Hinn , Stroke.
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Abstract Download PDF Background and Purpose —With the advent of time-dependent thrombolytic therapy for ischemic stroke, it has become increasingly important for stroke patients to arrive at the hospital quickly. This study investigates the association between the use of emergency medical services EMS and delay time among individuals with stroke symptoms and examines the predictors of EMS use. Results —EMS use was associated with decreased prehospital and in-hospital delay. Those who used EMS had a median prehospital delay time of 2. Patients were more likely to use EMS if someone other than the patient first identified that there was a problem OR 2.
Conclusions —Interventions aimed at increasing EMS use among stroke patients need to stress the urgency of stroke symptoms and the importance of calling and need to be broad-based, encompassing not only those at high risk for stroke but also their friends and family. A Multivariable Analysis Vincent N. Thijs , , Maarten G. Lansberg , , Christian Beaulieu , , Michael P. Marks , , Michael E. Moseley , , and Gregory W.
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Albers , Stroke. We investigated whether the volume of early ischemic brain lesions assessed with diffusion-weighted imaging DWI was an independent predictor of functional outcome. Methods —We retrospectively selected patients with nonlacunar ischemic stroke in the anterior circulation from 4 prospective Stanford Stroke Center studies evaluating early MRI. A logistic regression model was performed with factors that were significantly different between the 2 groups in univariate analysis.
Results —Sixty-three patients fulfilled the entry criteria. Conclusions —DWI lesion volume measured within 48 hours of symptom onset is an independent risk factor for functional independence. This finding could have implications for the design of acute stroke trials.
Bosworth , , Ronnie D. Horner , , Lloyd J.
Edwards , , David B. Abstract Download PDF Background and Purpose —This prospective study examined the determinants of the utility value placed on health status among a sample of patients with acute ischemic and intracerebral hemorrhagic stroke. Data were obtained by telephone interviews at 1, 6, and 12 months and by medical record review. In adjusted analyses, living alone, being institutionalized, decreased physical function, and depression were independently associated with lower levels of patient health status utility over time.
Conclusions —Stroke patient health status utilities are relatively stable during the initial year after stroke. In addition to physical function, psychological health and social environment are important determinants of patient health status utility. These factors need to be considered when conducting stroke decision analyses if more accurate conclusions are to be drawn regarding preferred patterns of care.
Limburg , , and G. Abstract Download PDF Background and Purpose —Handicap or health-related quality of life HRQL measures are seldom used in stroke trials, although the importance of these measures has been stressed frequently. Methods —We included patients who had had a stroke 6 months earlier. To interpret the continuous SA-SIP30 and SIP scores, we used receiver operating characteristic curve analysis with the aforementioned measures as external criteria. Results —The psychosocial dimension scores of both SIP versions remained largely unexplained.
Abstract Download PDF Background and Purpose —We estimated the incidence of first-ever cerebral infarction in regard to its subtypes and analyzed their risk factors separately in a community-based prospective cohort study in Japan. During this period, cerebral infarctions occurred and were divided into lacunar, 62 atherothrombotic, 56 cardioembolic, and 13 undetermined subtypes of infarction on the basis of clinical information including brain imaging and autopsy findings.go here
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Results —The age-adjusted incidence of lacunar infarction 3. Additionally, ST depression on ECG, glucose intolerance, and smoking in men and left ventricular hypertrophy on ECG and body mass index in women remained significant risk factors for lacunar infarction. ST depression was also significantly related to events of atherothrombotic infarction in women. The risk of atrial fibrillation for cardioembolic infarction was outstandingly high in both sexes, and left ventricular hypertrophy and lower total cholesterol were additional risk factors for cardioembolic infarction in women.
Conclusions —In this Japanese population, lacunar infarction was the most common subtype of cerebral infarction and had a greater variety of risk factors, including not only hypertension but also ECG abnormalities, diabetes, obesity, and smoking, than did atherothrombotic infarction or cardioembolic infarction. Di Tullio , , Ralph L. Sciacca , , and Shunichi Homma , Stroke. Abstract Download PDF Background and Purpose —Atherosclerotic plaque of the proximal portion of the aorta is associated with an increased risk of ischemic stroke in the elderly. Different cutoffs of plaque thickness have been used in the literature for risk stratification and have been applied to both men and women.
However, the assumption that the relationship between plaque thickness and stroke risk is the same in the 2 genders has not been proven. The aim of this study was to evaluate whether the prevalence of different degrees of aortic plaque thickness differed in men and women with ischemic stroke. However, plaques 3 to 3.
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Conclusions —Smaller aortic plaques are significantly associated with ischemic stroke in women but not in men. If the increased prevalence of smaller plaques in women is confirmed to be associated with increased risk for embolic stroke, different cutoff points may have to be adopted in men and women for risk stratification and for decisions regarding medical intervention. Petty , , Bijoy K.
Khandheria , , Jack P. Whisnant , , JoRean D. Sicks , , W. Wiebers , Stroke. Abstract Download PDF Background and Purpose —There is little population-based information on cerebrovascular events and survival among valvular heart disease patients. We used the Kaplan-Meier product-limit method and the Cox proportional hazards model to determine rates and predictors of cerebrovascular events and death among valve disease patients. Results —During person-years of follow-up, 98 patients developed cerebrovascular events and died.
Compared with expected numbers, these observations are significantly elevated, with standardized morbidity ratio of 3. Independent predictors of cerebrovascular events were age, atrial fibrillation, and severe aortic stenosis. The risk ratio of severe aortic stenosis was 3. Valve disease type and severity were not independent determinants of death.
Conclusions —The risk of cerebrovascular events and death among patients with valve disease remains high. Age, atrial fibrillation, and severe aortic stenosis are independent predictors of cerebrovascular events, and age, sex, cerebrovascular events, congestive heart failure, and ischemic heart disease are independent predictors of death in these patients.
Henderson , , David A. Steinman , , Michael Eliasziw , , Henry J. A potential source of error in using ultrasound peak systolic velocity PSV measurements is that the redistribution of blood flow due to severe stenosis in a contralateral carotid artery may lead to artificially elevated values.
The mean change in PSV in the unoperated artery was assessed across all degrees of angiographically defined stenosis. A simple theoretical resistance model of the cerebral circulation was also derived. Results —Complete bilateral ultrasound examinations were performed within 90 days of the initial scan in patients. The patterns of observed results were congruent with those from the theoretical model. Since the effect was greatest when bilaterally severe stenoses were present, caution must be exercised when assessing the degree of ICA stenosis on the basis of ultrasonography PSV measurements alone.
Abstract Download PDF Background and Purpose —Intracranial large-artery occlusive disease is the predominant vascular lesion found in stroke patients of Asian, African, and Hispanic ancestry, making it numerically perhaps the most common vascular cause of stroke in the world.
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