IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000575

Gülcan Neşem Baskan, Neşe Çelebisoy

{"title":"Central Positional Nystagmus Can Be the Sole Presentation of Cerebellar Nodulus Infarction.","authors":"Gülcan Neşem Baskan, Neşe Çelebisoy","doi":"10.1097/NRL.0000000000000575","DOIUrl":"10.1097/NRL.0000000000000575","url":null,"abstract":"Objectives: To draw attention to acute positional vertigo and central positional nystagmus (CPN) developing as the sole features of cerebellar nodulus infarction.Background: The cerebellar nodulus is vascularized by the medial branch of the posterior inferior cerebellar artery, which also supplies the uvula, tonsil, tuber, and pyramid of the vermis, and the inferior part of the cerebellar hemisphere, making isolated cerebellar nodulus infarction extremely rare. CPN occurs after a change in head position with respect to gravity and is caused by pathologies involving the vestibulo-cerebellar pathways. CPN is rarely seen in isolation. Additional neurological signs and ocular motor abnormalities are generally present.Methods: A 62-year-old man was admitted to the emergency department with acute-onset positional vertigo and CPN as the sole finding on examination. Cranial magnetic resonance imaging revealed an acute infarction involving the nodulus. Results: Infarcts restricted to nodulus can cause positional vertigo and CPN without any associated neurological signs or ocul ar motor abnormalities.Conclusion: Though very rare, cerebellar nodulus stroke must be searched in patients with positional vertigo of acute onset and isolated CPN on examination.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Low Dose Aspirin Initiation 18 Hours After Thrombolytic Therapy in Acute Ischemic Stroke. 急性缺血性脑卒中患者在接受溶栓治疗 18 小时后开始服用小剂量阿司匹林。

IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000566

Aubrey Murphy, Leslie A Hamilton, Kalene Farley, Shaun A Rowe, Thomas Christianson, Brittny Medenwald

{"title":"Low Dose Aspirin Initiation 18 Hours After Thrombolytic Therapy in Acute Ischemic Stroke.","authors":"Aubrey Murphy, Leslie A Hamilton, Kalene Farley, Shaun A Rowe, Thomas Christianson, Brittny Medenwald","doi":"10.1097/NRL.0000000000000566","DOIUrl":"10.1097/NRL.0000000000000566","url":null,"abstract":"Objectives: To investigate the safety of administering low-dose aspirin (81 mg) 18 hours after intravenous thrombolytic therapy.Methods: This is a retrospective cohort investigation. Individuals received either alteplase or tenecteplase for acute ischemic stroke followed by aspirin 81 mg (after follow-up imaging). An institutional change moved follow-up post-thrombolytic CT scans to 18 hours, and qualifying patients were grouped based on whether they received aspirin ≤24 hours or >24 hours. Chart reviews were conducted to assess the primary outcome of new or worsening intracranial hemorrhage, as well as secondary outcomes of change in stroke scale scores at discharge and 3 months, lengths of stay, favorable outcomes at 3 months, hospital readmission, and mortality.Results: Out of 350 patients screened, 130 qualified for inclusion-50 of whom received aspirin ≤24 hours (mean 21.1 hours, SD±6.2), and 80 who received aspirin >24 hours (mean 34 hours, SD±8.2). Only 1 new intracranial bleed occurred following aspirin administration in the >24-hour group. No statistically significant differences were observed in any of the secondary outcomes, although there was higher mortality (3/50 vs. 2/80, P =0.372) and shorter hospital length of stay (median difference -1.0 day, P =0.0336) in the <24 hours group.Conclusions: Low-dose aspirin administration sooner than 24 hours following thrombolytic therapy did not increase bleeding events. Sooner aspirin administration after ischemic stroke can potentially enhance the prevention of secondary embolization and did not demonstrate worse clinical outcomes; however, further randomized controlled trials are needed.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Education and Age in Return to Work After Ischemic Stroke: A Danish Nationwide Registry-based Cohort Study. 缺血性脑卒中后重返工作岗位的教育程度和年龄：丹麦全国登记队列研究》。

IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000563

Eva Rosendahl, Nicholas Carlson, Kristian Kragholm, Jawad H Butt, Emil L Fosbøl, Gunnar Gislason, Christian Torp-Pedersen, Christine Benn Christiansen

{"title":"Education and Age in Return to Work After Ischemic Stroke: A Danish Nationwide Registry-based Cohort Study.","authors":"Eva Rosendahl, Nicholas Carlson, Kristian Kragholm, Jawad H Butt, Emil L Fosbøl, Gunnar Gislason, Christian Torp-Pedersen, Christine Benn Christiansen","doi":"10.1097/NRL.0000000000000563","DOIUrl":"10.1097/NRL.0000000000000563","url":null,"abstract":"Objectives: To investigate return to work and workforce detachment in ischemic stroke, including the association with age and level of education.Methods: Patients in the workforce aged 18 to 60 with first-time ischemic stroke between 1997 and 2017 were identified in Danish registers and followed for 5 years. The cumulative incidence of return to work and subsequent workforce detachment was computed overall and stratified according to age group and education level. Cox regression analysis was used for multivariate analysis.Results: A total of 28,325 patients were included (median age 52.3 (interquartile range (IQR) 46.1 to 56.6) and 64.3% male). After 1 year, 62.0% were in the workforce, highest in age group 18 to 30 (80.0%) and lowest in patients aged 51 to 60 (58.5%). One-year cumulative incidence of return to work overall was 73.4% (20,475), highest in the young age group (87.0%, 76.7%, 74.5%, and 71.3% for age group 18 to 30, 31 to 40, 41 to 50, and 51 to 60, respectively) and high education (80.3%, 72.1%, and 71.3% for long higher, basic or vocational education, respectively). One-year cumulative incidence of subsequent workforce detachment was 25.6% (5248), lowest in young age (22.4%, 23.1%, 24.1%, and 27.2% for age groups 18 to 30, 31 to 40, 41 to 50, and 51 to 60, respectively) and high level of education (13.0%, 28.4%, and 27.2% for long higher, basic, and vocational education, respectively). During the full follow-up, 10,855 (53.0%) left the workforce again.Conclusions: A high proportion of patients returned to work within 1 year, but more than half left the workforce again. Young age and long education were associated with a higher incidence of return to work and lower subsequent workforce detachment.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Framingham Stroke Risk Profile Score and White Matter Disease Progression. 弗雷明汉卒中风险档案评分与白质疾病进展。

IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000567

Hossam Youssef, Mutlu Demirer, Erik H Middlebrooks, Bhrugun Anisetti, James F Meschia, Michelle P Lin

{"title":"Framingham Stroke Risk Profile Score and White Matter Disease Progression.","authors":"Hossam Youssef, Mutlu Demirer, Erik H Middlebrooks, Bhrugun Anisetti, James F Meschia, Michelle P Lin","doi":"10.1097/NRL.0000000000000567","DOIUrl":"10.1097/NRL.0000000000000567","url":null,"abstract":"Objectives: To evaluate the relationship between Framingham Stroke Risk Profile (FSRP) score and rate of white matter hyperintensity (WMH) progression and cognition.Methods: Consecutive patients enrolled in the Mayo Clinic Florida Familial Cerebrovascular Diseases Registry (2011-2020) with 2 brain-MRI scans at least 1 year apart were included. The primary outcome was annual change in WMH volume (cm 3 /year) stratified as fast versus slow (above vs. below median). Cognition was assessed using a Mini-Mental State Exam (MMSE, 0-30). FSRP score (0 to 8) was calculated by summing the presence of age 65 years or older, smoking, systolic blood pressure greater than 130 mmHg, diabetes, coronary disease, atrial fibrillation, left ventricular hypertrophy, and antihypertensive medication use. Linear and logistic regression analyses were performed to examine the association between FSRP and WMH progression, and cognition.Results: In all, 207 patients were included, with a mean age of 60±16 y and 54.6% female. FSRP scores risk distribution was: 31.9% scored 0 to 1, 36.7% scored 2 to 3, and 31.4% scored ≥4. The baseline WMH volume was 9.6 cm 3 (IQR: 3.3-28.4 cm 3 ), and the annual rate of WMH progression was 0.9 cm3/year (IQR: 0.1 to 3.1 cm 3 /year). A higher FSRP score was associated with fast WMH progression (odds ratio, 1.45; 95% CI: 1.22-1.72; P<0.001) and a lower MMSE score (23.6 vs. 27.1; P<0.001). There was a dose-dependent relationship between higher FSRP score and fast WMH progression (odds ratios, 2.20, 4.64, 7.86, 8.03 for FSRP scores 1, 2, 3, and ≥4, respectively; trend P <0.001).Conclusions: This study demonstrated an association between higher FSRP scores and accelerated WMH progression, as well as lower cognition.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Analysis of Clinical Characteristics and Influencing Factors of Early Neurological Deterioration in Patients With Mild Stroke by Intravenous Alteplase Therapy. 静脉注射阿替普酶治疗轻度脑卒中患者的临床特征及早期神经功能恶化的影响因素分析

IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000553

Xin-Lei Mao, Si-Si He, Cai-Dan Lin, Xiang-Dong Huang, Jun Sun

{"title":"Analysis of Clinical Characteristics and Influencing Factors of Early Neurological Deterioration in Patients With Mild Stroke by Intravenous Alteplase Therapy.","authors":"Xin-Lei Mao, Si-Si He, Cai-Dan Lin, Xiang-Dong Huang, Jun Sun","doi":"10.1097/NRL.0000000000000553","DOIUrl":"10.1097/NRL.0000000000000553","url":null,"abstract":"Objectives: Thrombolysis treatment for patients with mild stroke is controversial. The aim of our study was to investigate the clinical characteristics and influencing factors of early neurological deterioration (END) in this group of patients.Methods: A retrospective analysis was performed on ischemic stroke patients with intravenous thrombolysis (IVT) in Wenzhou Central Hospital. Subgroup analyses were performed for the mild stroke group and nonmild stroke group, END group, and non-early neurological deterioration group in mild stroke patients, respectively.Results: A total of 498 patients were included in this study. Compared with the control group, the mild stroke group was younger age, less atrial fibrillation, previous history of stroke and less use of antithrombotic drugs, more dyslipidemia, smoking, and drinking. Small artery occlusion type was more common in mild stroke, cardioembolism and stroke of undetermined etiology type were less. In the mild stroke group, the symptomatic intracerebral hemorrhage (sICH) rate was 2.54%, and the END rate was 16.1%. Predictors of END included systolic blood pressure, blood glucose, cardioembolism subtype, sICH, and large vessel occlusion. In END patients, the sICH rate was 10.53%, and 84.21% of cases started to worsen within 12 hours after IVT. There was no statistically significant difference in the time to exacerbation among different subtypes.Conclusions: The occurrence of mild stroke in young patients was largely related to unhealthy lifestyles. The incidence of END in mild stroke IVT patients was low, with most occurring within 12 hours of IVT. There were many risk factors for END: large vessel occlusion and hyperglycemia were independent risk factors for END after IVT. sICH was an important but rare risk factor for END.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stop Ischemic Event to the Brain: Screening Risk Factors of Cerebrovascular Stenosis in Coronary Artery Disease Patients. 阻止脑缺血事件：筛查冠心病患者脑血管狭窄的风险因素。

IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000568

Shi-Chang Yang, Xing-Wen Zhang, Xi-Ting Nie, Ying-Lu Liu, Hui Su, Yan Wang, Ya Cao, Hui-Juan Yuan, Zhe Yu, Shan-Shan Kong, Sheng-Yuan Yu

{"title":"Stop Ischemic Event to the Brain: Screening Risk Factors of Cerebrovascular Stenosis in Coronary Artery Disease Patients.","authors":"Shi-Chang Yang, Xing-Wen Zhang, Xi-Ting Nie, Ying-Lu Liu, Hui Su, Yan Wang, Ya Cao, Hui-Juan Yuan, Zhe Yu, Shan-Shan Kong, Sheng-Yuan Yu","doi":"10.1097/NRL.0000000000000568","DOIUrl":"10.1097/NRL.0000000000000568","url":null,"abstract":"Objectives: In this study, we investigated the difference in risk factors between the 2 diseases, aiming to further clarify who needs to do ischemic cerebrovascular disease (ICVD)-related screening among coronary artery disease (CAD) patients.Methods: Clinical data of 326 patients with first-episode CAD from June 1, 2017, to July 31, 2020, in the Chinese PLA General Hospital were retrospectively reviewed. Outcomes, including clinical features and laboratory examination, were taken. Features related to ICVD including the extension of intracranial arterial (internal carotid artery intracranial segment, middle cerebral artery M1 segment, anterior cerebral A1 segment, vertebrobasilar artery intracranial segment, posterior cerebral artery P1 segment) and carotid arterial (internal carotid artery extracranial segment, common carotid artery, subclavian artery) stenosis were detected. Risk factors for the occurrence of ICVD in patients with CAD were analyzed.Results: Among patients with the onset of CAD, in comparison of the nonstenosis and stenosis of intracranial artery subgroups, there were statistical differences in the onset age, hypertension, and duration of hypertension as well as the biochemical indicators, including high-density lipoprotein and glycosylated hemoglobin. In addition, statistical differences were detected in the onset age as well as the biochemical indicators, including glycosylated hemoglobin and blood glucose serum protein, along with the difference in the degree of cardiovascular stenosis.Conclusions: The onset age of CAD was shown to serve as a vital risk factor for ICVD. The primary prevention of ICVD in patients with CAD should lay more emphasis on the management of hypertension and diabetes.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship of Day-by-Day Blood Pressure Variability and Admission Stroke Severity in Acute Ischemic Stroke. 急性缺血性脑卒中患者逐日血压变化与入院时脑卒中严重程度的关系

IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000556

Yuan Zhu, Minghua Wu, Yawei Zheng, Xintong Wang, Jingyi Xiayang, Tianrui Zhang, Shana Wang, Zhuyuan Fang

{"title":"Relationship of Day-by-Day Blood Pressure Variability and Admission Stroke Severity in Acute Ischemic Stroke.","authors":"Yuan Zhu, Minghua Wu, Yawei Zheng, Xintong Wang, Jingyi Xiayang, Tianrui Zhang, Shana Wang, Zhuyuan Fang","doi":"10.1097/NRL.0000000000000556","DOIUrl":"10.1097/NRL.0000000000000556","url":null,"abstract":"Objectives: Research on the association between stroke severity and day-by-day blood pressure variability (BPV) in acute ischemic stroke (AIS) is rare as the majority focus on the blood pressure (BP) or the short-term BPV. Our study aims to explore the exact roles of daily BPV through the 7-day commencement on stroke severity in AIS.Methods: The study included 633 patients with AIS, defining AIS as the time from the beginning of symptom up to 7 days with recording BP twice a day as well as calculating the daily BPV, and then matching them to the stroke severity. The logistic regression models were used to evaluate associations between stroke severity and day-by-day BPV. We used the smooth curve fitting to identify whether there was a nonlinear association. In addition, the subgroup analyses were performed using the logistic regression.Results: According to the modified National Institutes of Health Stroke Scale score, 301 (47.5%) patients were allocated to the mild stroke group and 332 (52.5%) to the moderate-to-severe stroke group. In terms of stroke categories, we found no significant difference between BP at admission or mean BP. However, the moderate-to-severe stroke group exhibited higher daily BPV. The multiple logistic regression analysis indicated that day-by-day BPV was positively correlated to stroke severity [odds ratio (OR)=1.05, 95% CI:1.01-1.1, P =0.03 for SBP-SD; OR=1.08, 95% CI:1.01-1.15, P =0.03 for SBP-CV; OR=1.04, 95% CI:1.01-1.07, P =0.015 for SBP-SV).Conclusions: High day-by-day BPV in AIS was associated with more severe stroke independent of BP levels.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Symptomatic Unilateral Carotid Artery Disease: An Uncommon but Reversible Cause of Corticobasal Syndrome. 症状性单侧颈动脉疾病：皮质基底综合征：一种不常见但可逆的病因

IF 1.1 4区医学

Neurologist Pub Date : 2024-09-01 DOI: 10.1097/NRL.0000000000000573

Konstantinos Melanis, Athanasia Athanasaki, Eleni Bakola, Maria Chondrogianni, Andreas Lazaris, Alexandra Akrivaki, Alexandros Stavros Triantafyllou, Vasiliki Kotsali-Peteinelli, Anastasios Bonakis, George P Paraskevas, Georgios Tsivgoulis

{"title":"Symptomatic Unilateral Carotid Artery Disease: An Uncommon but Reversible Cause of Corticobasal Syndrome.","authors":"Konstantinos Melanis, Athanasia Athanasaki, Eleni Bakola, Maria Chondrogianni, Andreas Lazaris, Alexandra Akrivaki, Alexandros Stavros Triantafyllou, Vasiliki Kotsali-Peteinelli, Anastasios Bonakis, George P Paraskevas, Georgios Tsivgoulis","doi":"10.1097/NRL.0000000000000573","DOIUrl":"10.1097/NRL.0000000000000573","url":null,"abstract":"Introduction: Symptomatic carotid artery disease (CAD) represents an uncommon but treatable cause of corticobasal syndrome.Case report: We present the clinical details and successful management of a previously healthy 77-year-old patient who presented with 1-year cognitive dysfunction, alien limb syndrome, limb kinetic apraxia, and ipsilateral cortical sensory deficit, fulfilling the criteria of the diagnosis of probable corticobasal syndrome. Imaging modalities, including magnetic resonance imaging and time-of-flight magnetic resonance angiography, revealed acute external borderzone infarcts of the right hemisphere due to symptomatic CAD causing near occlusion of the vessel. The patient underwent a right carotid endarterectomy, leading to a marked improvement in mobility and neuropsychological evaluation.Conclusion: This case highlights the importance of swift diagnosis of symptomatic CAD in patients with corticobasal syndrome. Moreover, it emphasizes the efficacy of carotid endarterectomy in achieving symptom improvement in such cases.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Gender and Marital Status on Door-To-Treatment (DTT) Time and Acute Stroke Outcome. 性别和婚姻状况对治疗前（DTT）时间和急性中风预后的影响

IF 1.1 4区医学

Neurologist Pub Date : 2024-07-24 DOI: 10.1097/NRL.0000000000000580

Nurose Karim, Dmitry Tumin, Sehrish Karim

{"title":"Impact of Gender and Marital Status on Door-To-Treatment (DTT) Time and Acute Stroke Outcome.","authors":"Nurose Karim, Dmitry Tumin, Sehrish Karim","doi":"10.1097/NRL.0000000000000580","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000580","url":null,"abstract":"Objectives: Delays in acute stroke treatment lead to poor outcomes. Women can present with atypical stroke symptoms, are older at the time of stroke, and tend to be living alone, causing delays in pre-hospital diagnosis and seeking care. It is unclear if gender disparities in ED arrival and stroke assessment are compounded by gender differences after ED arrival. Therefore, we sought to identify if gender and marital status were associated with faster door-to-treatment (DTT) time.Methods: Our single-center stroke database was queried for adults presenting to ED with acute stroke between January 1, 2018 and January 30, 2023 treated with IV thrombolytics (IVT)+/- endovascular thrombectomy (EVT) and a known DTT time. The primary outcome was DTT (door-to-needle+door-to-puncture) time. Data collected includes the National Institutes of Health Stroke Scale (NIHSS) at presentation and discharge, gender, marital status, age, and intervention (IVT alone or IVT+/- EVT).Results: Among 674 patients identified, 35 patients were excluded due to missing data. Of 639 patients (median age 66 y), 25%/18% of patients were married men/women, respectively, and 22%/35% were single men/women. Median DTN time, DTP time, and discharge NIHSS score were 36, 79, and 4 mins, respectively. On multivariable analysis, neither DTT time nor NIHSS score at discharge improved among married men relative to any other combination of gender and marital status.Conclusions: Gender differences in the knowledge of stroke warning signs and gender disparities in ED assessment did not translate into faster DTT time. More work is needed to find ways to accelerate stroke care after ED arrival.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Single-Centre Experience with Endovascular Therapy in Acute Occlusion of ICAS: Preferred Stent Thrombectomy Versus Preferred Angioplasty. ICAS 急性闭塞的血管内治疗单中心经验：首选支架血栓切除术与首选血管成形术。

IF 1.1 4区医学

Neurologist Pub Date : 2024-07-24 DOI: 10.1097/NRL.0000000000000578

Kechun Chen, Yin Zhou, Gang Guo, Qiuyi Wu

{"title":"Single-Centre Experience with Endovascular Therapy in Acute Occlusion of ICAS: Preferred Stent Thrombectomy Versus Preferred Angioplasty.","authors":"Kechun Chen, Yin Zhou, Gang Guo, Qiuyi Wu","doi":"10.1097/NRL.0000000000000578","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000578","url":null,"abstract":"Objectives: The preferred endovascular therapy (EVT) for large-vessel occlusion in intracranial atherosclerosis (ICAS) is unknown. We compared the efficacy of preferred stent thrombectomy and preferred angioplasty in patients with acute large-vessel occlusion in ICAS.Methods: Data from consecutive EVT patients (May 2020 to September 2023) with acute middle cerebral artery occlusion in ICAS were retrospectively analyzed. Preferred angioplasty was performed if there was a preoperative \"microcatheter first-pass effect;\" otherwise, preferred stent thrombectomy was performed. Analyses were grouped according to the two EVT treatments. Clinical data of all patients, including the time from puncture to recanalization, rate of successful reperfusion, early neurological improvement, intracranial hemorrhage, and modified Rankin Scale score at 90 days, were recorded and analyzed.Results: Six-two patients were enrolled in this study (mean age was 60.66±13.21 y, 22.6% female). The preferred angioplasty group had a higher first-pass recanalization rate than the preferred stent thrombectomy group (61.3% vs. 21.9%, P<0.001) and a higher proportion of patients who were functionally independent (defined as a modified Rankin Scale score of 0 to 3) at 90 days [odds ratio,3.681; 95% confidence interval (CI):1.009 to 13.428; P=0.048]. There was no significant difference between the groups in the time from puncture to recanalization, the frequency of successful reperfusion, and early neurological improvement, or intracranial hemorrhage (P>0.05).Conclusions: This study suggests that for acute middle cerebral artery occlusion in ICAS, preferred angioplasty may be a safe and effective procedure.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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