Background and Purpose— The authors present an overview of the current evidence management recommendations for evaluation treatment adults with acute ischemic stroke. intended audiences are prehospital care providers, physicians, allied health professionals, hospital administrators responsible stroke patients within first 48 hours from onset. These guidelines supersede prior 2007 2009 updates. Methods— Members writing committee were appointed by American Stroke Association Council’s...

<b><i>Background:</i></b> Hyperglycemia during acute ischemic stroke may augment brain injury, predispose to intracerebral hemorrhage (ICH), or both. <b><i>Method: </i></b> To analyze the relationship between admission glucose level and clinical outcomes from stroke, authors performed multivariate regression analysis with National Institute of Neurological Disorders Stroke recombinant tissue plasminogen activator (rt-PA) Trial data. Neurologic improvement was defined as on NIH Scale by 4...

<b><i><i>Background:</i></i></b> Hyperglycemia at the time of acute ischemic stroke has been linked to worse outcome in both human and animal studies. <b><i><i>Objective:</i></i></b> To describe prevalence severity hyperglycemia on hospital admission among patients, examine independent relationship all-cause mortality, document inpatient management hyperglycemia. <b><i><i>Methods:</i></i></b> Patients hospitalized with one from July 1993 June 1998 (n = 656) were identified. Demographic data,...

To study the relation between acute blood glucose level and outcome from ischemic stroke.Hyperglycemia may augment brain injury increase risk of hemorrhagic transformation infarct.The authors analyzed admission (within 24 hours stroke onset) clinical in 1,259 patients enrolled Trial ORG 10172 Acute Stroke Treatment (TOAST)-a placebo-controlled, randomized, double-blind trial to test efficacy a low-molecular weight heparinoid stroke. Very favorable was defined as Glasgow Outcome Scale score 1...

Hyperglycemia during acute ischemic stroke is common and associated with worse outcomes. The efficacy of intensive treatment hyperglycemia in this setting remains unknown.To determine the stroke.The Stroke Insulin Network Effort (SHINE) randomized clinical trial included adult patients (glucose concentration >110 mg/dL if had diabetes or ≥150 did not have diabetes) who were enrolled within 12 hours from onset at 63 US sites between April 2012 August 2018; follow-up ended November 2018. 1151...

The simplified modified Rankin Scale questionnaire (smRSq) enables a reliable and rapid determination of the score after stroke. We test reliability validity slightly revised smRSq.Fifty consecutive outpatients 4.83 ± 3.00 months stroke were scored with smRSq by 3 raters selected consecutively from list 10: 4 faculty, neurology residents, 2 medial students, 1 research coordinator. Two ratings in person within 20 minutes each other was telephone to days later. rating also included quality...

New treatments for acute stroke will likely have to be given soon after onset. Little is known about patients' general knowledge stroke, their interpretation of symptoms, and how these factors influence the timing decision seek medical attention.We interviewed consecutive patients within 72 hours onset define influencing time arrival emergency department. Data recorded included demographic information, method transportation, type patient's previous warning signs. Stroke severity was measured...

Background and Purpose— Hyperglycemia may worsen brain injury during acute cerebral infarction. We tested the feasibility tolerability of aggressive hyperglycemia correction with intravenous insulin compared usual care Methods— conducted a randomized, multicenter, blinded pilot trial for patients infarction within 12 hours after onset, baseline glucose value ≥8.3 mmol/L (≥150 mg/dL), National Institutes Health Stroke Scale score 3 to 22. Patients were randomized 2:1 treatment continuous or...

Background and Purpose— The modified Rankin Scale (mRS) is a popular primary stroke outcome measure, but its usefulness limited by suboptimal reliability (inter-rater agreement). Methods— We developed tested the of simplified mRS questionnaire (smRSq) in 50 patients after seen outpatient clinics. Randomly chosen paired raters administered smRSq within 20 minutes each other ratings were blinded until end this study. Results— Agreement among was 78%, κ statistic 0.72 (95% CI, 0.58–0.86),...

We present the results of a 12-year retrospective analysis 11 patients, eight women and three men, aged 16-76 years, with pathologically documented atrial myxomas. Nine patients were found to have left myxoma; right myxomas identified in two. Five (45%) had abnormalities on neurologic examination, five computed tomographic evidence nonhemorrhagic cerebral infarction. Neurologic symptoms initial presentation four patients. Six reported history cardiac disease; auscultation. Echocardiography...

Recombinant tissue plasminogen activator (rTPA) is an established treatment for acute ischemic stroke. The rate and type of protocol violations in rTPA use their effect on patient outcomes this setting are not well understood.The objective study was to examine associations between community-based use.We reviewed medical records stroke patients treated with 10 acute-care hospitals Indianapolis from July 1996 February 1998 assessed complications outcome. Retrospective National Institute Health...

Rationale Patients with acute ischemic stroke and hyperglycemia have worse outcomes than those without hyperglycemia. Intensive glucose control during is feasible can be accomplished safely but has not been fully assessed for efficacy. Aims The Stroke Hyperglycemia Insulin Network Effort trial aims to determine the safety efficacy of standard vs. intensive insulin in hyperglycemic patients. Design This a randomized, blinded, multicenter, phase III approximately 1400 patients who receive...

Several sympathomimetic agents have been associated with ischemic and hemorrhagic stroke. Ephedrine, a drug that has high potential for abuse can be readily obtained without prescription in unrestricted quantities, rarely We report ephedrine-related stroke three patients. One patient developed thalamic infarct after ingesting known quantities of ephedrine as street-purchased "speed" weight loss. Two patients had fatal intracranial hemorrhages unknown ephedrine; one them history abuse, lacked...

Objective: To determine whether asymptomatic retinal cholesterol embolism is a risk factor for vascular events. Design: Cohort study with retrospectively selected controls. Setting: A Veterans Affairs medical center. Patients: 70 consecutive patients emboli on dilated ocular examination in an eye clinic and controls without emboli. Controls were matched to sex; age; prevalence of hypertension, diabetes mellitus, ischemic heart disease; serum level; smoking history. Measurements: Stroke,...

A relationship between seasonal climate changes and the occurrence of stroke has been postulated. We reviewed in 2,960 patients seen at University Iowa from 1978 through 1985. Stroke was classified as cerebral infarction (CI; n = 1,357, 46%), transient ischemic attacks (TIAs; 913, 31 %), subarachnoid hemorrhage (SAH; 476, 16%) intracerebral (ICH; 214, 7%). Local climatological data were obtained National Oceanic Atmospheric Administration. Poisson regression used to analyze data. The TIA SAH...

Moyamoya disease was diagnosed as the cause of cerebral infarction in eight young adults (seven women, one man), aged 17-40 (mean 33) years. All had angiographic abnormalities characteristic moyamoya disease. Single-photon emission tomography showed bilateral carotid circulation hypoperfusion and posterior hyperemia all seven patients with regional blood flow studies. women used oral contraceptives before infarction. Four were treated medically; died a second 9 months after diagnosis....

Acute brain ischemia is a dynamic process susceptible to multiple modulating factors, such as blood glucose level. During acute ischemic injury, hyperglycemia exacerbates deleterious derangements. Timely and sufficient correction of during may limit the injury improve clinical outcomes. The efficacy intervention remains be proven. Although results from animal observational studies suggest that exacerbate there no evidence randomized treatment trials rapid improves Given excess effort, cost,...

Moyamoya usually presents with cerebral ischemia in children and intracranial hemorrhage adults. Treatment remains controversial.We reviewed our experience from June 1995 to August 1999 of 20 adult pediatric angiographically diagnosed patients moyamoya report their clinical presentation, radiological findings, management, outcomes.The mean age at symptom onset was 17 years (range, 2-54 years). Patients were divided into 2 groups (group 1, <18 years; group 2, > or =18 There 13 1 7 2. Ischemic...

Between October 1983 and November 1986, 20 patients suspected of having a paradoxical cerebral or retinal embolism were identified. Cerebral infarction was the most common presentation. Six had patent foramen ovale demonstrated by cardiac catheterization surgery. Three newly discovered atrial septal defect, one an defect that previously been treated surgically. Results physical examination, chest roentgenography, electrocardiography unremarkable in 12 patients. Eighteen right-to-left shunt...