Athletic participation after acute ischemic childhood stroke: a survey of pediatric stroke experts

Minimal evidence exists about the risk of recurrent childhood acute ischemic stroke in patients subjected to a subsequent head or neck injury. Recurrent or multiple dissections have been demonstrated in select cases. Minor head trauma has also been associated with acute ischemic stroke. The objective of this study was to survey pediatric stroke experts about participation of patients following acute ischemic stroke in high impact, medium impact, and low impact exercise. International Pediatric Stroke Study members were surveyed about athletic participation after stroke. Participants were asked about 2 scenarios: acute ischemic stroke with dissection, and acute ischemic stroke with a negative coagulation work-up and a negative angiogram. In these scenarios, most experts would eventually allow moderate impact sports, with some restrictions. Many experts would not allow high impact sports after a dissection, but disagree about recommendations after idiopathic acute ischemic stroke.     

On the production of neurologists in the United States: an update

Based primarily on a survey of all neurology residency training programs in the United States conducted in 1985-1986, the average annual production (incidence) of general neurologists for 1980-1986 was 363.6 and of child neurologists for 1982-1986, 53.8. About 1/4 of these general neurologists and 1/3 of child neurologists are women; about 1/4 of either are foreign medical graduates, predominantly foreign-born. Data routinely published by the AMA well match the questionnaire information. First postgraduate year of training was in internal medicine for 2/3 of general neurologists. Board certification have recently averaged 290.9 (general) and 37.1 (child) per annum. From life-table calculations, prevalence of general neurologists in 1990 is estimated at 7,500 fully-trained and 5,500 board-certified, and of child neurologists near 1,100 trained and over 600 certified. The number of neurologists is predicted to plateau near the year 2020 at some 13,700 trained, including 1,700 child neurologists, and 9,800 certified (1,100 child). The maximal prevalence rate for all neurologists will be 4.75 per 100,000 population in 2010, declining then to 4.42 by 2050; those rates provide shortfalls of 30% and 35%, respectively, compared with previously calculated needs for neurologists.     

On national needs for neurologists in the United States

Estimates of the number of neurologists needed in the United States have been widely divergent. For direct patient care needs alone in a US population of 243.5 million, the Joint Commission on Neurology (ANA-AAN) estimate was 14,000 neurologist, the Delphi Panel median (Battelle/GMENAC) 11,200, and the Advisory Panel (Battelle/GMENAC) 6,200; our review suggests a need for 12,600. Total needs for clinical neurologists including faculty were 8,400 (Advisory Panel), 14,500 (Delphi Panel), and 16,500 (ours) for respective rates of 3.44, 5.96, and 6.76 neurologists per 100,000 population.     

AAN Epilepsy Quality Measures in clinical practice: a survey of neurologists

Epilepsy Quality Measures (EQM) were developed by the American Academy of Neurology (AAN) to convey standardization and eliminate gaps and variations in the delivery of epilepsy care (Fountain et al., 2011 [1]). The aim of this study was to identify adherence to these measures and other emerging practice standards in epilepsy care. A 15-item survey was mailed to neurologists in Michigan, USA, inquiring about their practice patterns in relation to EQM. One hundred thirteen of the 792 surveyed Michigan Neurologists responded (14%). The majority (83% to 94%) addressed seizure type and frequency, reviewed EEG and MRI, and provided pregnancy counseling to women of childbearing potential. Our survey identified gaps in practice patterns such as counseling about antiepileptic drug (AED) side effects and knowledge about referral for surgical therapy of intractable epilepsy. Statistical significance in the responses on the AAN EQM was noted in relation to number of years in practice, number of epilepsy patients seen, and additional fellowship training in epilepsy. Practice patterns assessment in relation to other comorbidities revealed that although bone health and sudden unexplained death in epilepsy are addressed mainly in patients at risk, depression is infrequently discussed. The findings in this study indicate that additional educational efforts are needed to increase awareness and to improve quality of epilepsy care at various points of health care delivery.     

Desmoteplase in the treatment of acute ischemic stroke

Desmoteplase, developed by Paion, Forest and Lundbeck, is a novel plasminogen activator that selectively activates fibrin-bound plasminogen and is currently being investigated for the treatment of acute ischemic stroke within the time window of 3-9 h after symptom onset. Desmoteplase is believed to offer pharmacologic advantages over currently approved treatment options. To date, two published Phase II perfusion imaging-based clinical trials have reported the safety and potential efficacy of desmoteplase in ischemic stroke. Results from a recently completed Phase III trial in Europe, Asia and the USA are awaited. This article reviews the available data on desmoteplase, including discussion of its favorable features and potential benefit beyond the 3-h time window in the treatment of ischemic stroke.     

Views on the use of tissue plasminogen activator in acute ischemic stroke: A state-wide survey among neurologists and emergency medicine physicians in Indiana.

Indiana emergency medicine physicians and neurologists were presented with 6 brief cases of patients presenting with acute ischemic stroke and asked whether they would administer tissue plasminogen activator (t-PA) in each case; 25% responded in concordance with published American Heart Association guidelines in all cases. Only 19% gave the appropriate exclusion in the 4 cases with definite exclusion criteria. Administering t-PA to a patient with elevated blood pressure was the most common deviation from the guidelines. More neurologists reported that they would have given t-PA in the exclusion-free scenario (85% v 49%; P<.001). Physicians likely to treat acute stroke patients do not consistently follow published guidelines on the use of intravenous t-PA in acute ischemic stroke. Neurologists were more likely to report that they would use t-PA in an exclusion-free scenario. Continued physician education about thrombolytic use in acute ischemic stroke is needed.     

Advances in treatment of acute ischemic stroke

Stroke carries a severe toll in terms of loss of life and disability for patients and their families. Until 10 years ago, physicians, and in particular neurologists, had a conservative, non-aggressive approach to this devastating disease. The advent of thrombolytic therapy not only proved that acute ischemic stroke is treatable, but also that early reperfusion can dramatically change the outcome of acute stroke patients. As a result of these trials, intravenous (IV) tissue plasminogen activator (t-PA) has been approved for treatment of acute ischemic stroke within 3 hours after symptom onset in the United States, Canada, Australia, and the European Union. The near future is extremely promising. Imaging modalities, such as diffusion- and perfusion-weighted images, as well as CT perfusion and CT angiography, to better select patients for treatment are now routinely performed in most academic medical centers. Novel IV and intra-arterial (IA) agents have been developed and tested. Emerging therapies will soon be available to increase the therapeutic windows for thrombolysis both by better screening patients using MRI or CT and by new IV and IA treatments. Several multicenter controlled trials in both imaging-guided decisions and therapeutic agents are either completed or being performed. We review data on advancement in imaging and treatment of acute ischemic stroke, in particular focusing on pharmacologic and mechanical IA thrombolysis.     

Advances in treatment of acute ischemic stroke

Stroke carries a severe toll in terms of loss of life and disability for patients and their families. Until 10 years ago, physicians, and in particular neurologists, had a conservative, nonaggresive approach to this devastating disease. The advent of thrombolytic therapy not only proved that acute ischemic stroke is treatable, but also that early reperfusion can dramatically change the outcome of acute stroke patients. As a result of these trials, intravenous (IV) tissue plasminogen activator (t-PA) has been approved for treatment of acute ischemic stroke within 3 hours after symptom onset in the United States, Canada, Australia, and the European Union. The near future is extremely promising. Imaging modalities, such as diffusion- and perfusion-weighted images, as well as CT perfusion and CT angiography, to better select patients for treatment are now routinely performed in most academic medical centers. Novel IV and intra-arterial (IA) agents have been developed and tested. Emerging therapies will soon be available to increase the therapeutic windows for thrombolysis both by better screening patients using MRI or CT and by new IV and IA treatments. Several multicenter controlled trials in both imaging-guided decisions and therapeutic agents are either completed or being performed. We review data on advancement in imaging and treatment of acute ischemic stroke, in particular focusing on pharmacologic and mechanical IA thrombolysis.     

急性缺血性卒中血管内治疗新技术探讨

卒中包括脑梗死和脑出血,其现已成为中国城市人群死亡原因的第二位,农村人群死亡原因的第一位.据报道,全国约有600万～700万卒中幸存者,每年新发卒中人数约250万～300万,死亡人数约150万.卒中幸存者中有3/4的存在不同程度的神经功能丧失,重残者超过40％.缺血性脑梗死即缺血性卒中,包括动脉血栓形成性脑梗死、脑栓塞、腔隙性梗死和分水岭梗死等.血栓形成、栓子脱落、血管壁斑块形成及血管狭窄等是导致急性缺血性卒中的常见病因.由于缺血性卒中发病原因复杂,导致了血管内治疗技术的多样性和高难度.     

急性缺血性脑卒中的神经保护治疗

脑卒中是影响人类健康的主要疾病之一,为我国城市人口死亡的首位原因。约三分之一的脑卒中幸存者残留不同程度的神经功能障碍。急性缺血性脑卒中治疗的最重要途径为改善脑血流(溶栓)和阻断神经元缺血性病理生化级联反应,即神经保护治疗。一、神经保护治疗的合理性脑梗死的发生取决于两个基本条件,即脑血流量(cerebralbloodflow,CBF)下降的严重程度和缺血持续的时间。脑缺血后,若脑循环在一段时间内恢复,脑功能可获完全恢复,该时间为“再灌注时间窗”。由于脑缺血后引起的病理生理变化持续存在,即使重新建立起足够的脑循环,仍可能产生延迟…