Diagnosis of Acute Ischemic Stoke

Published on Nov 1, 2016in Emergency Medicine Clinics of North America2.264
· DOI :10.1016/J.EMC.2016.06.008
Lauren M. Nentwich5
Estimated H-index: 5
(BU: Boston University)
Sources
Abstract
: Acute ischemic stroke is a challenging and time-sensitive diagnosis. Diagnosis begins with rapid detection of acute stroke symptoms by the patient, their family or caregivers, or bystanders. If acute stroke is suspected, EMS providers should be called for rapid assessment. EMS providers will utilize prehospital stroke tools to diagnose and determine potential stroke severity. Once at the hospital, the stroke team works rapidly to solidify the patient history, perform a focused neurologic examination and obtain necessary laboratory tests and brain imaging to accurately diagnose acute ischemic stroke and properly treat the patient.
References77
Newest
#1William J. PowersH-Index: 70
#2Colin P. DerdeynH-Index: 77
Last. Dileep R. YavagalH-Index: 37
view all 13 authors...
Purpose—The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines. Methods—This focused update analyzes results from 8 randomized, clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publicat...
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#1Jeffrey L. Saver (UCLA: University of California, Los Angeles)H-Index: 124
BACKGROUND Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. METHODS We randomly assigned eligible patients with stroke who were receiving or had received intravenous...
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#1Ángel ChamorroH-Index: 8
#2Erik CoboH-Index: 27
Last. Antonio DávalosH-Index: 54
view all 22 authors...
Methods During a 2-year period at four centers in Catalonia, Spain, we randomly assigned 206 patients who could be treated within 8 hours after the onset of symptoms of acute ischemic stroke to receive either medical therapy (including intravenous alteplase when eligible) and endovascular therapy with the Solitaire stent retriever (thrombectomy group) or medical therapy alone (control group). All patients had confirmed proximal anterior circulation occlusion and the absence of a large infarct on...
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#1James C. Grotta (University Hospital Heidelberg)H-Index: 119
#2Werner HackeH-Index: 138
Before December 2014, the only proven effective treatment for acute ischemic stroke was recombinant tissue-type plasminogen activator (r-tPA). This has now changed with the publication of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE), Extending the Time for Thrombolysis in E...
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#1Brian S. Katz (University of Cincinnati Academic Health Center)H-Index: 1
#2Jason T. McMullanH-Index: 22
Last. Joseph P. BroderickH-Index: 144
view all 5 authors...
Background and Purpose—We derived and validated the Cincinnati Prehospital Stroke Severity Scale (CPSSS) to identify patients with severe strokes and large vessel occlusion (LVO). Methods—CPSSS was developed with regression tree analysis, objectivity, anticipated ease in administration by emergency medical services personnel and the presence of cortical signs. We derived and validated the tool using the 2 National Institute of Neurological Disorders and Stroke (NINDS) tissue-type plasminogen act...
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#1Mayank GoyalH-Index: 74
#2Muneer Eesa (U of C: University of Calgary)H-Index: 24
Last. Abstr Act (U of C: University of Calgary)H-Index: 1
view all 16 authors...
Among patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation. Methods We randomly assigned participants to receive standard care ...
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#1Bruce C.V. Campbell (Royal Melbourne Hospital)H-Index: 61
#2Leonid Churilov (University of Melbourne)H-Index: 49
Last. Abstr Act (RNSH: Royal North Shore Hospital)H-Index: 1
view all 18 authors...
Background Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whether more advanced imaging selection, recently developed devices, and earlier intervention improve outcomes. Methods We randomly assigned patients with ischemic stroke who were receiving 0.9 mg of alteplase per kilogram of body weight less than 4.5 hours after the onset of ischemic stroke either to undergo endovascular thrombectomy with the Solitaire FR (Flow Restorati...
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#1Lisa Mellon (RCSI: Royal College of Surgeons in Ireland)H-Index: 12
#2Frank Doyle (RCSI: Royal College of Surgeons in Ireland)H-Index: 28
Last. Anne Hickey (RCSI: Royal College of Surgeons in Ireland)H-Index: 31
view all 5 authors...
Background Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms.
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Author(s): Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Judd, Suzanne E; Kissela, Brett M; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Pal...
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#1Debbie Beumer (UM: Maastricht University)H-Index: 19
#2Julie Staals (UM: Maastricht University)H-Index: 29
Last. Abstr Act (LEI: Leiden University)H-Index: 1
view all 10 authors...
Methods We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The...
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Cited By3
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This comprehensive review provides an insight into the pathophysiology, epidemiology, evaluation, and treatment of sickle cell anemia (SCA)-related stroke in developed and developing countries. Vascular injury, hypercoagulability and vaso-occlusion play a role in the pathophysiology of stroke in SCA. Transcranial Doppler ultrasound (TCD) has lowered the incidence of ischemic stroke from 11% to 1% as TCD identifies children who are at risk for stroke, providing opportunities for interventions to ...
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#1Matthew S. Siket (UVM: University of Vermont)
#2Rhonda Cadena (UNC: University of North Carolina at Chapel Hill)H-Index: 4
The treatment of acute ischemic stroke is one of the most rapidly evolving areas in medicine. Like all ischemic vascular emergencies, the priority is reperfusion before irreversible infarction. The central nervous system is sensitive to brief periods of hypoperfusion, making stroke a golden hour diagnosis. Although the phrase "time is brain" is relevant today, emerging treatment strategies use more specific markers for consideration of reperfusion than time alone. Innovations in early stroke det...
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#1Alfredo E. Urdaneta (Stanford University)H-Index: 1
#2Paulomi Kadakia Bhalla (Stanford University)H-Index: 2
: Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process impr...
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