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| 2. |
- Johansson, Elias, 1984-, et al.
(författare)
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Vaskulärt ultraljud vid stroke
- 2013
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 110
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Tidskriftsartikel (refereegranskat)abstract
- Den senaste tidens framsteg inom strokesjukvården ställer höga krav på snabb och säker diagnostik och monitorering av patienter som drabbats av stroke. Patienter med symtomgivande karotisstenos ska opereras kort tid efter att symtomen debuterat, och där kan ultraljudsteknik vara till hjälp i diagnostiken. Huruvida personer med asymtomatisk karotisstenos ska opereras är ett debatterat ämne, men ultraljudsteknik kan vara en framkomlig väg för att selektera vilka personer med asymtomatisk karotisstenos som ska opereras. Denna artikel är en översikt över vad vi i dag känner till om ultraljudets användbarhet och begränsning inom strokesjukvården, med fokus på patienter med karotisstenos.
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| 3. |
- Kremer, Christine, et al.
(författare)
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Dissociation of severity of stroke and aphasia recovery early after intravenous recombinant tissue plasminogen activator thrombolysis.
- 2014
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Ingår i: Journal of Clinical Neuroscience. - : Elsevier BV. - 1532-2653 .- 0967-5868. ; 21:10, s. 1828-1830
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Tidskriftsartikel (refereegranskat)abstract
- Clinical observation suggested to us that aphasia recovers relatively better than other deficits early after intravenous recombinant tissue plasminogen activator (IV-rtPA) treatment in stroke patients with minor deficits, while the reverse seemed the case in those with severe deficits. Retrospective analysis of acute ischemic stroke patients with aphasia admitted within 3hours from symptom onset and treated with IV-rtPA was carried out. Stroke severity, aphasia and global neurological impairment were assessed at admission and 24hours after thrombolysis. Improvement of aphasia (gain of ⩾1 point on the National Institutes of Health Stroke Scale [NIHSS] aphasia score) and global neurological improvement (gain of ⩾4 points on the NIHSS) were compared in minor strokes (NIHSS ⩽7), moderate strokes (NIHSS 8-15), and major strokes (NIH ⩾16). Sixty-nine of 243 stroke patients suffered from aphasia. Improvement of aphasia occurred in 7/16 minor strokes, 11/25 moderate strokes, and 7/28 severe strokes. Improvement of ⩾4 points on the NIHSS occurred in 3/16 minor strokes, 17/25 moderate strokes and 15/28 severe strokes. There is a significant (X(2)=4.073, p<0.05) dissociation of recovery of aphasia and that of other neurological deficits between minor versus severe strokes. This confirms the clinically suspected dissociation between a good early recovery from aphasia in minor strokes relative to recovery of other neurological deficits, as opposed to a better recovery from other neurological deficits than from aphasia in patients with severe strokes.
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| 4. |
- Kremer, Christine, et al.
(författare)
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Prognosis of aphasia in stroke patients early after iv thrombolysis.
- 2013
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Ingår i: Clinical Neurology and Neurosurgery. - : Elsevier BV. - 1872-6968 .- 0303-8467. ; 115:3, s. 289-292
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Stroke patients with aphasia have a high long-term morbidity. Intravenous rt-PA (iv) thrombolysis is given more deliberately to these patients. Early outcome data is lacking. Aim of this study was to determine early benefit from rt-PA in patients with aphasia. METHODS: Data of stroke patients treated by iv thrombolysis was scrutinized for the presence of aphasia defined as ≥1 point for aphasia on the National Institute of Health Stroke Scale (NIHSS). Improvement was defined as a gain of ≥1 point within 24h. Cranial computed tomography (CT) scans were evaluated regarding early ischemic changes (EICs), infarct volume and localization. RESULTS: Fifty patients with aphasia were included. 16 (32%) of patients improved (4 (36%) minor, 7 (41%) moderate, 5 (23%) major stroke patients), while 44 (62%) remained unchanged. Of 28 patients with EICs, 10 (36%) improved compared to 7 out of 22 (32%) patients without (p=0.773). Aphasia outcome was significantly associated with infarct volume at admission and at 24h (Kruskal-Wallis, p=0.033, p≤0.001, respectively). CONCLUSION: EICs are not predictive of aphasia outcome and patients with improvement showed smaller infarct volumes. One third improved within 24h, while two thirds remained unchanged. This might justify a closer follow-up of aphasia in stroke patients at the acute stage.
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| 5. |
- Kremer, Christine, et al.
(författare)
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Reduction of flow velocities in patients with ischemic events in the middle cerebral artery--long-term follow-up with ultrasound.
- 2011
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Ingår i: Acta Neurologica Belgica. - 2240-2993. ; 111:2, s. 111-115
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Tidskriftsartikel (refereegranskat)abstract
- Data concerning the persistent reduction of flow velocities measured by transcranial color-coded sonography (TCCS) in relation to the clinical and radiological outcome among patients with ischemic events in middle cerebral artery (MCA) territory is scarce. Patients with > or = 50% reduction of peak systolic velocities (PSV-MCA) as compared to the contralateral MCA were prospectively included in follow-up by TCCS (mean 404 days). Out of 849 patients with stroke admitted to our stroke unit, 25 patients showed reduced PSV-MCA and included in the analyses of this study. Ten (40%) survivors showed persistent reduction of PSV-MCA. None of the patients with normalized PSV-MCA suffered an ischemic event compared with three patients with persistent reduction of PSV-MCA (all had ipsilateral occlusion of the internal carotid artery caused by dissection). Patients with persistently reduced PSV-MCA exhibited significantly (Mann-Whitney test, p = 0.02) larger infarct volumes on CT (mean +/- SD 38 +/-50 cm3) compared to those with normalized PSV-MCA (6 +/- 7 cm3). The functional outcome were, however, similar in patients with normalized and those with persistently reduced PSV-MCA. We found that a relatively high percentage (40%) of patients suffered ischemic event in the MCA territory with initial reduction of flow velocity on TCCS showed persistent reduction on long term follow-up.
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| 6. |
- Stiehm, Markus, et al.
(författare)
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Management of the Treatment Delay in Symptomatic Carotid Artery Stenosis.
- 2013
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Ingår i: European Neurology. - : S. Karger AG. - 1421-9913 .- 0014-3022. ; 70:3-4, s. 179-184
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Tidskriftsartikel (refereegranskat)abstract
- Saving time to intervention is crucial in patients with symptomatic carotid artery stenosis (SCAS). We introduced a fast-track protocol (FTP). Time frames from the onset of symptoms to intervention before and after the introduction of an FTP were analyzed. SCAS patients (403 patients/405 procedures) were evaluated according to whether surgery was performed before (group 1) or after (group 2) the introduction of the FTP. Time frames to surgery, causes of delay and frequency of recurrent events are reported. The median time delay decreased from 17 to 12 days (p < 0.001), but time to ultrasound examination remained unchanged. Surgery was within 2 weeks in 41% in group 1 and in 57% in group 2 (p = 0.001). Of 181 (30%) patients treated according to the FTP, 54 were operated within 7 days (median), and 80% had the intervention within 2 weeks. Time to surgery decreased significantly after the introduction of the FTP. © 2013 S. Karger AG, Basel.
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