Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cereb...Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus C hristi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regre ssion, variables independently associated with three separate outcomes were soug ht: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation varia bles. Percentage use of recombinant tissue plasminogen activator (rt-PA) was c alculated. Results: A total of 941 Mexican Americans (MAs) and 855 non-Hispani c whites (NHWs) were seen for ischemic stroke (66% ) or TIA (34% ). Only 8% of patients received an inperson neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology cons ultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.8 1]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA. Conclusions: Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED ), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.展开更多
Context: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy.Risk factors for this condition have not been clearly defined.Objective: To determine maternal and infant characteristic...Context: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy.Risk factors for this condition have not been clearly defined.Objective: To determine maternal and infant characteristics associated with PAS.Design, Setting, and Patients: Case-control study nested within the cohort of all 199176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California.Case patients were confirmed by review of brain imaging and medical records (n = 40).Three controls per case were randomly selected from the study population.Main Outcome Measure: Association of maternal and infant complications with risk of PAS.Results: The population prevalence of PAS was 20 per 100000 live births.The majority (85%) of infants with PAS were delivered at term.The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73%vs 44%, P=.002), fetal heart rate abnormality (46%vs 14%, P<.001), emergency cesarean delivery (35%vs 13%, P=.002), chorioamnionitis (27%vs 11%, P=.03), prolonged rupture of membranes (26%vs 7%, P=.002), prolonged second stage of labor (25%vs 4%, P<.001), vacuum extraction (24%vs 11%, P=.04) , cord abnormality (22%vs 6%, P=.01), preeclampsia (19%vs 5%, P=.01), and oligohydramnios (14%vs 3%, P=.01).Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95%confidence interval [CI], 1.3-45.0)-, preeclampsia (OR, 5.3; 95%CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95%CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95%CI, 1.1-10.5).The rate of PAS increased dramatically when multiple risk factors were present.Conclusions: Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors.How these complications, along with their potential effects on the placenta and fetus, may play a role in causing perinatal stroke 展开更多
Background/Aim:The neurological effects of internal carotid artery(ICA)occlusion vary between patients.The authors investigated whether the severity of symptoms in a large group of patients with ipsilateral or/and con...Background/Aim:The neurological effects of internal carotid artery(ICA)occlusion vary between patients.The authors investigated whether the severity of symptoms in a large group of patients with ipsilateral or/and contralateral ICA occlusion at presentation with ocular or cerebral ischaemic symptoms could be explained by patency of other extra or intracranial arteries to act as collateral pathways.Methods:The authors prospectively identified all patients(n=2881)with stroke,cerebral transient ischaemic attack(TIA),retinal artery occlusion(RAO),and amaurosis fugax(AFx)presenting to our hospital over five years,obtained detailed history and examination,and examined the intra and extracranial arteries with carotid and colour-power transcranial Doppler ultrasound.For this analysis,all those with intracranial haemorrhage on brain imaging and cerebral events without brain imaging were excluded.Results:Among 2228/2397 patients with brain imaging(1713 ischaemic strokes,401 cerebral TIAs,193 AFx,and 90 RAO)who underwent carotid Doppler,195(9%)had ICA occlusion.Among those patients with cortical events,disease in potential collateral arteries(contralateral ICA,external carotid,ipsilateral or contralateral vertebral or intracranial arteries)was equally distributed among patients with severe and mild ischaemic presenting symptoms.Conclusion:The authors found no evidence that the clinical presentation associated with an ICA occlusion was related to patency of other extra or intracranial arteries to act as collateral pathways.Further work is required to investigate what determines the clinical effects of ICA occlusion.展开更多
文摘Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus C hristi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regre ssion, variables independently associated with three separate outcomes were soug ht: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation varia bles. Percentage use of recombinant tissue plasminogen activator (rt-PA) was c alculated. Results: A total of 941 Mexican Americans (MAs) and 855 non-Hispani c whites (NHWs) were seen for ischemic stroke (66% ) or TIA (34% ). Only 8% of patients received an inperson neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology cons ultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.8 1]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA. Conclusions: Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED ), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.
文摘Context: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy.Risk factors for this condition have not been clearly defined.Objective: To determine maternal and infant characteristics associated with PAS.Design, Setting, and Patients: Case-control study nested within the cohort of all 199176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California.Case patients were confirmed by review of brain imaging and medical records (n = 40).Three controls per case were randomly selected from the study population.Main Outcome Measure: Association of maternal and infant complications with risk of PAS.Results: The population prevalence of PAS was 20 per 100000 live births.The majority (85%) of infants with PAS were delivered at term.The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73%vs 44%, P=.002), fetal heart rate abnormality (46%vs 14%, P<.001), emergency cesarean delivery (35%vs 13%, P=.002), chorioamnionitis (27%vs 11%, P=.03), prolonged rupture of membranes (26%vs 7%, P=.002), prolonged second stage of labor (25%vs 4%, P<.001), vacuum extraction (24%vs 11%, P=.04) , cord abnormality (22%vs 6%, P=.01), preeclampsia (19%vs 5%, P=.01), and oligohydramnios (14%vs 3%, P=.01).Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95%confidence interval [CI], 1.3-45.0)-, preeclampsia (OR, 5.3; 95%CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95%CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95%CI, 1.1-10.5).The rate of PAS increased dramatically when multiple risk factors were present.Conclusions: Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors.How these complications, along with their potential effects on the placenta and fetus, may play a role in causing perinatal stroke
文摘Background/Aim:The neurological effects of internal carotid artery(ICA)occlusion vary between patients.The authors investigated whether the severity of symptoms in a large group of patients with ipsilateral or/and contralateral ICA occlusion at presentation with ocular or cerebral ischaemic symptoms could be explained by patency of other extra or intracranial arteries to act as collateral pathways.Methods:The authors prospectively identified all patients(n=2881)with stroke,cerebral transient ischaemic attack(TIA),retinal artery occlusion(RAO),and amaurosis fugax(AFx)presenting to our hospital over five years,obtained detailed history and examination,and examined the intra and extracranial arteries with carotid and colour-power transcranial Doppler ultrasound.For this analysis,all those with intracranial haemorrhage on brain imaging and cerebral events without brain imaging were excluded.Results:Among 2228/2397 patients with brain imaging(1713 ischaemic strokes,401 cerebral TIAs,193 AFx,and 90 RAO)who underwent carotid Doppler,195(9%)had ICA occlusion.Among those patients with cortical events,disease in potential collateral arteries(contralateral ICA,external carotid,ipsilateral or contralateral vertebral or intracranial arteries)was equally distributed among patients with severe and mild ischaemic presenting symptoms.Conclusion:The authors found no evidence that the clinical presentation associated with an ICA occlusion was related to patency of other extra or intracranial arteries to act as collateral pathways.Further work is required to investigate what determines the clinical effects of ICA occlusion.
