scholarly journals Expert opinion paper on cardiac imaging after ischemic stroke

2021 ◽  
Author(s):  
Renate B. Schnabel ◽  
Stephan Camen ◽  
Fabian Knebel ◽  
Andreas Hagendorff ◽  
Udo Bavendiek ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Expert Opinion ◽  
Cardiac Imaging ◽  
Controlled Trial ◽  
Case Series ◽  
Stroke Care ◽  
Imaging Method ◽  
Cardiac Evaluation ◽  
Magnetic Resonance Imaging Mri ◽  
Ischemic Attack

AbstractThis expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

scholarly journals Effectiveness of home rehabilitation for ischemic stroke

2009 ◽  
Vol 1 (1) ◽  
pp. 36 ◽  
Author(s):  
Pakaratee Chaiyawat ◽  
Kongkiat Kulkantrakorn ◽  
Paskorn Sritipsukho
Keyword(s):  
Ischemic Stroke ◽  
Controlled Trial ◽  
Intervention Group ◽  
Stroke Care ◽  
Rehabilitation Program ◽  
Outcome Data ◽  
Depression Score ◽  
Control Group ◽  
Acute Stroke Care ◽  
Middle Cerebral Artery Infarction

The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke. This was a randomized controlled trial in 60 patients with recent middle cerebral artery infarction. After hospital discharge for acute stroke care, they were randomly assigned to receive either a home rehabilitation program for three months (intervention group) or usual care (control group). We collected outcome data over three months after their discharge from the hospital. The Barthel Index (BI), the Modified Rankin Scale (MRS), the health-related quality-of-life index (EQ-5D), the Hospital Anxiety and Depression score (HADs), and the Thai Mental State Examination (TMSE) were used to analyze the outcomes. In the intervention group, all outcomes were significantly better (p

scholarly journals Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Ali M. Al Khathaami ◽  
Haya Aloraini ◽  
S. Almudlej ◽  
Haifa Al Issa ◽  
Nourhan Elshammaa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Controlled Trial ◽  
Negative Attitude ◽  
Stroke Care ◽  
Emergency Physicians ◽  
Web Based ◽  
Inadequate Knowledge ◽  
Proven Efficacy ◽  
Knowledge And Attitude

Background and Objectives. Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care. Here we aimed to assess the knowledge and attitude of Saudi emergency physicians toward t-PA use within 4.5 hours of onset in acute ischemic stroke. Methods. A web-based, self-administered, locally designed questionnaire was sent to all emergency physicians practicing in the city of Riyadh from January to September 2017. Results. Out of 450 emergency physicians, 122 from ten hospitals in Riyadh participated in the survey, with a 27% response rate. The majority of participants were men (78%), and their mean age was 40 ± 8 years. Half of the participants were board certified, and 36% were consultants. Half of the participants consider the evidence for t-PA use in stroke within 4.5 hours of stroke onset to be controversial, and 41% recommend against its use due to lack of proven efficacy (37%), the risk of hemorrhagic complications (35%), lack of stroke expertise (21%), and medicolegal liability (9%). Nearly half were willing to administer IV t-PA for ischemic stroke in collaboration with remote stroke neurology consultation if telestroke is implemented. Conclusion. Our study detected inadequate knowledge and a negative attitude among Saudi emergency physicians toward t-PA use in acute stroke. This might negatively impact patient outcome. Therefore, we recommend developing urgent strategies to improve emergency physicians’ knowledge, attitudes, and beliefs in the management of acute stroke.

scholarly journals Cardiac imaging in ischemic stroke or transient ischemic attack of undetermined cause: Systematic review & meta-analysis

2021 ◽  
Author(s):  
Gerlinde van der Maten ◽  
Saskia Dijkstra ◽  
Matthijs F.L. Meijs ◽  
Clemens von Birgelen ◽  
Job van der Palen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Cardiac Imaging ◽  
Transient Ischemic Attack ◽  
Meta Analysis ◽  
Ischemic Attack

scholarly journals Detection of Major Cardioembolic Sources in Real-World Patients with Ischemic Stroke or Transient Ischemic Attack of Undetermined Cause

2021 ◽  
pp. 22-28
Author(s):  
Gerlinde van der Maten ◽  
Jorieke M.B. Reimer ◽  
Matthijs F.L. Meijs ◽  
Clemens von Birgelen ◽  
Marjolein G.J. Brusse-Keizer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Real World ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Medical Center ◽  
Standard Work ◽  
Cardiac Symptoms ◽  
Cardiac Evaluation ◽  
Ischemic Attack ◽  
Rhythm Monitoring

<b><i>Background/Aim:</i></b> Current guidelines recommend transthoracic echocardiography (TTE) and ambulatory rhythm monitoring following ischemic stroke or transient ischemic attack (TIA) of undetermined cause for identifying cardioembolic sources (CES). Due to ongoing controversies about this routine strategy, we evaluated its yield in a real-world setting. <b><i>Methods:</i></b> In a tertiary medical center, we retrospectively evaluated consecutive patients with ischemic stroke or TIA of undetermined cause, who (after standard work-up) underwent TTE, ambulatory rhythm monitoring, or both. CES were classified as major if probably related to ischemic events and warranting a change of therapy. <b><i>Results:</i></b> Between January 2014 and December 2017, 674 patients had ischemic stroke or TIA of undetermined cause. Of all 484 patients (71.8%) who underwent TTE, 9 (1.9%) had a major CES. However, 7 of them had already been identified for cardiac evaluation due to new major electrocardiographic abnormalities or cardiac symptoms. Thus, only 2 patients (0.4%) truly benefitted from unselected TTE screening. Ambulatory rhythm monitoring was performed in 411 patients (61.0%) and revealed AF in 10 patients (2.4%). <b><i>Conclusion:</i></b> Detecting a major CES is essential because appropriate treatment lowers the risk of recurrent stroke. Nonetheless, in this real-world study that aimed at routine use of TTE and ambulatory rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause, the prevalence of major CES was low. Most patients with major CES on TTE already had an indication for referral to a cardiologist, suggesting that major CES might also have been identified with a much more selective use of TTE.

Abstract 147: Cannabis, Ischemic Stroke and Transient Ischemic Attack: A Case Control Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
P A Barber ◽  
Heidi Pridmore ◽  
Venkatesh Krishnamurthy ◽  
Sally Roberts ◽  
David A Spriggs ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Case Series ◽  
Population Based ◽  
Cannabis Use ◽  
Urine Samples ◽  
Controlled Study ◽  
Increased Risk ◽  
Urine Drug ◽  
Hospital Patients ◽  
Ischemic Attack

Background: Cannabis is the most widely used illicit drug of abuse. A temporal relationship between cannabis use and stroke has been reported in case series and population based studies. To date this relationship has not been confirmed. We performed a case-controlled study on the recent use of cannabis in younger stroke patients. Methods: Consecutive ischemic stroke/TIA patients aged 18-55 years had urine screens for cannabis. A control cohort of age, sex and ethnicity matched hospital patients were screened for cannabis using anonymized urine samples obtained for other indications and which would otherwise be discarded. The study was performed with the approval of the regional Ethics Committee. Results: One hundred and sixty of 218 (73%) ischemic stroke/TIA patients had urine drug screens [100 men, 60 women; mean (SD) age 44.8 (8.7) years], of whom 150 (94%) had ischemic stroke and 10 (6%) had TIA. Fifty-eight patients did not have drug screens, mainly because they were admitted outside office hours or had been discharged early (primarily TIA patients). All of the patients approached to provide a urine sample agreed to do so. Twenty-five (15.6%) patients had positive cannabis drug screens, and these patients were more likely to be male (84% versus 59%, χ 2 p=0.016) and tobacco smokers (88% versus 28%, χ 2 p<0.001). There were no differences in age, stroke mechanism or most vascular risk factors between those with and without positive cannabis tests. Control urine samples were obtained from 160 patients matched for age (t-test, p=0.979), sex (χ 2 p=0.492) and ethnicity (χ 2 p=0.910). Thirteen (8.1%) control participants tested positive for cannabis. In a logistic regression analysis adjusted for age, sex and ethnicity, cannabis use was associated with increased risk of ischemic stroke and TIA (odds ratio 2.30, 95% confidence intervals 1.07-4.95). Conclusions: This study provides the strongest evidence to date of an association between cannabis and stroke, with ischemic stroke and TIA patients twice as to have recently used cannabis likely as control participants. Cannabis is generally perceived as having few serious adverse effects. This study suggests that this may not be the case and that the association between cannabis and stroke warrants further investigation.

scholarly journals Clinical, Laboratory, and Imaging Characteristics of Transient Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and Intracranial Arteries

2015 ◽  
Vol 5 (3) ◽  
pp. 115-123 ◽  
Author(s):  
Toshiyuki Uehara ◽  
Tomoyuki Ohara ◽  
Kazunori Toyoda ◽  
Kazuyuki Nagatsuka ◽  
Kazuo Minematsu
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Clinical Laboratory ◽  
Stroke Care ◽  
Large Artery ◽  
Intracranial Artery ◽  
Imaging Characteristics ◽  
Artery Disease ◽  
Ischemic Attack

Background/Aims: The aims of this study were to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 h of TIA onset between April 2008 and December 2013, 85 patients (63 men, mean age 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared with those in the extracranial group. Eleven patients in the extracranial group and none in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2 vs. 0%, p = 0.044) and the 90-day risk (17.1 vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Among our patients with TIA caused by large artery disease, patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

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