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1.
Victoria A. Chang Dawn M. Meyer Brett C. Meyer 《Journal of stroke and cerebrovascular diseases》2019,28(1):163-166
Background
Acute stroke codes may be activated for anisocoria, but how often these codes lead to a final stroke diagnosis or alteplase treatment is unknown. The purpose of this study was to assess the frequency of anisocoria in stroke codes that ultimately resulted in alteplase administration.Methods
We retrospectively assessed consecutive alteplase-treated patients from a prospectively-collected stroke registry between February 2015 and July 2018. Based on the stroke code exam, patients were categorized as having isolated anisocoria [A+(only)], anisocoria with other findings [A+(other)], or no anisocoria [A?]. Baseline demographics, stroke severity, alteplase time metrics, and outcomes were also collected.Results
Ninety-six patients received alteplase during the study period. Of the 94 who met inclusion criteria, there were 0 cases of A+(only). There were 9 cases of A+(other) (9.6%). A+(other) exhibited higher baseline National Institutes of Health (NIH) Stroke Scale scores compared to A? (17 versus 7; P?=?.0003), and no additional differences in demographics or alteplase time metrics. Final stroke diagnosis and other outcome measures were no different between A+(other) and A?. Of the A+ patients without pre-existing anisocoria, 5 of 6 (83%) had posterior circulation events or diffuse subarachnoid hemorrhage.Conclusions
In this exploratory analysis, zero patients with isolated anisocoria received alteplase treatment. Anisocoria as a part of the neurologic presentation occurred in 10% of alteplase patients, and was strongly associated with a posterior circulation event. Therefore, we conclude that anisocoria has a higher likelihood of leading to alteplase treatment when identified in the presence of other neurologic deficits. 相似文献2.
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目的:探讨急性缺血性卒中接受重组组织型纤溶酶原激活剂( Recombinant Tissue Plasminogen Activa-tor,rt-PA)静脉溶栓治疗后大脑中动脉再通患者的临床预后情况。方法回顾性分析2013年9月至2014年9月,于天津市环湖医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者资料552例。入选患者按照0.9 mg/kg剂量标准,给予rt-PA静脉溶栓治疗。所有患者于溶栓前及溶栓后24 h进行头部MRA检查,采用TICI血管再通分级标准判断大脑中动脉的再通情况。其中根据溶栓后24 h MRA检查结果分为血管再通组(188例),血管未通组(364例)。溶栓前及溶栓后24 h的神经功能缺损评分及疗效判定,采用美国国立卫生研究院卒中量表( National Institute of Health Stroke Scale,NIHSS)。神经功能的预后评价,采用改良Rankin评分( modified Rankin Scale,mRS)。对2组患者溶栓后颅内出血( intracranial hemorrhage,ICH)、症状性颅内出血( symptomatic intracranial hemorrhage,SICH)的发生率、死亡率、神经功能缺损恢复及预后情况进行统计对比分析。结果血管再通组患者的恢复良好率和预后良好率均高于血管未通组,差异有统计学意义( P <0.05)。血管再通组患者未出现症状性颅内出血,有6例患者出现了非症状性颅内出血。血管再通组及血管未通组的颅内出血发生率、其他部位出血率和住院期间死亡率差异均无统计学意义(P>0.05)。结论研究结果表明,急性缺血性卒中患者在接受静脉溶栓治疗后,大脑中动脉再通的患者较未通患者神经功能缺损症状改善明显。静脉溶栓后,血管再通的患者临床预后获益更大。 相似文献
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目的:比较急性缺血性卒中患者卒中后认知障碍的发生与软脑膜侧支循环的代偿程度及是否接受静脉溶栓治疗的相关性。方法:前瞻性收集2019年1月至2021年3月在石河子市人民医院住院的急性前循环脑梗死患者161例,获取患者入院时人口学资料,包括是否溶栓、性别、合并症等;通过蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分、简易精神状态检查量表(mini mental state examination,MMSE)评分评估患者认知功能;入院时美国国立卫生院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分获取患者神经功能缺损症状;通过Blessed行为量表(Blessed behavior scale,BBS)评分评估患者的日常生活能力;通过区域软脑膜评分(regional leptomeningeal collateral score,rLMC)获取患者软脑膜侧支循环;根据卒中后6个月是否合并认知障碍分为认知障碍组和非认知障碍组,采用logistic多因素回归方法进行统计比较,分析2组患... 相似文献
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目的:探讨低剂量(0.6mg/kg)与标准剂量(0.9mg/kg)阿替普酶静脉溶栓治疗高龄(年龄80岁)急性脑梗死患者的疗效与安全性。方法:将40例发病3h内的高龄脑卒中患者分为阿替普酶低剂量组(n=21)和标准剂量组(n=19),比较两组患者的一般情况、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、出血事件、发病90d改良Rankin量表(mRS)评分和90d死亡率。结果:低剂量组与标准剂量组患者一般临床资料、基线NIHSS评分、溶栓24h及溶栓7dNIHSS差异无统计学意义。低剂量组与标准剂量组患者出血性脑梗死发生率、发病90d死亡率以及90d的mRS评分0~2分患者比例差异均无统计学意义。结论:高龄急性缺血性脑卒中患者早期低剂量与标准剂量阿替普酶静脉溶栓的疗效及安全类似。 相似文献
7.
David Hunt 《Internal medicine journal》1998,28(4):514-517
The GUSTO trial and an Australian consensus meeting in 1993 led to the recommendation that recombinant tissue plasminogen activator (r-TPA) was the preferred thrombolytic in patients with acute myocardial infarction (AMI) and ST segment elevation under the age of 75, whose infarction was anterior, who could be treated within four hours of the onset of symptoms and who did not have a contraindication to thrombolysis. Available data suggest that streptokinase (SK) should not be administered in a patient who has received this drug three days or more previously.
New data on the risks of stroke confirm that the use of r-TPA is associated with a higher risk of intracranial haemorrhage than SK, and those with a high risk profile for intracranial haemorrhage (hypertension and advanced age) should receive SK rather than r-TPA.
It may be justified to give r-TPA to any patient with a large infarct regardless of location, within four hours of the onset of infarction in an attempt to achieve TIMI flow grade 3 (complete) reperfusion, reduce mortality and improve left ventricular function and clinical outcomes. The focus for the future will be on how to treat more patients earlier with thrombolytic agents, rather than the choice of agent. 相似文献
New data on the risks of stroke confirm that the use of r-TPA is associated with a higher risk of intracranial haemorrhage than SK, and those with a high risk profile for intracranial haemorrhage (hypertension and advanced age) should receive SK rather than r-TPA.
It may be justified to give r-TPA to any patient with a large infarct regardless of location, within four hours of the onset of infarction in an attempt to achieve TIMI flow grade 3 (complete) reperfusion, reduce mortality and improve left ventricular function and clinical outcomes. The focus for the future will be on how to treat more patients earlier with thrombolytic agents, rather than the choice of agent. 相似文献
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10.
目的??探究依达拉奉联合阿替普酶治疗急性脑梗死的疗效及其对出血性转化(HT) 、 五聚素 3(PTX3)
与血浆脂蛋白相关磷脂酶 A2(Lp-PLA2)的影响。方法??选取 2014 年 1 月—2017 年 1 月承德医学院附属医院收治的 116 例急性脑梗死患者。根据随机数字表法分为观察组和对照组,每组 58 例。对照组给予阿替普酶治疗,观察组在对照组基础上给予依达拉奉治疗。 比较两组患者的临床疗效、 HT的发生率及治疗前后NIHSS评分、 ADL评分,同时监测治疗前后血清 PTX-3、Lp-PLA2 水平及治疗过程中不良反应发生率。结果??治疗后两组 NIHHS 评分均较治疗前降低( P <0.05) ,且观察组低于对照组( P <0.05) ; 对照组、观察组总有效率分别为 50.00% 和74.14%,观察组高于对照组( P <0.05) ; 对照组、观察组出血性转化发生率分别为 24.14% 和 10.34%,观察组低于对照组( P <0.05) ; 治疗后两组 PTX-3、 Lp-PLA2 均较治疗前下降( P <0.05) , 且观察组低于对照组( P <0.05) ; 观察组和对照组不良反应总发生率为 10.34% 和 12.07%, 差异无统计学意义( P >0.05) 。结论??依达拉奉联合阿替普酶治疗急性脑梗死, 可以有效改善神经功能缺损, 提高临床疗效, 预防出血性转化, 降低血清 Lp-PLA2、 PTX3 水平, 减轻炎症反应, 且安全性较好。 相似文献