Small strokes affecting central vestibular projections can present with isolated AVS. The HINTS "plus" hearing battery identifies these patients with greater accuracy than early MRI-DWI, which is falsely negative in half, up to 48 hours after onset. We found nonlacunar mechanisms in half, suggesting greater risk than might otherwise be assumed for patients with such small infarctions.

Malignant middle cerebral artery (MCA) infarction occurs in about 10% of all patients with supratentorial ischemic strokes. The infarction involves the entire MCA territory. Due to the consequences of severe brain edema, brain herniation, elevated intracranial pressure (ICP), and midline shift, these events carry a mortality rate of up to 80%. No clinical trials have been conducted to study the efficacy of the osmotic agents such as mannitol or hypertonic saline. Furthermore, aggressive use of such treatments may be detrimental. Surgical decompression has previously been proposed as a way to relieve the vicious cycle of malignant cerebral edema and reduced cerebral perfusion. Its use in relieving ICP is also controversial. Recently, a pooled analysis of three independent European trials has shown that decompressive hemicraniectomy is clearly beneficial in reducing mortality from large hemispheric infarctions. Although controversies still exist on its indications, surgical decompression can effectively reduce ICP, reduce mortality, and improve neurologic outcomes in selected patients with a malignant MCA stroke syndrome.

IntroductionIt is well known that the efficacy of intravenous (IV) tissue plasminogen activator (tPA) is time-dependent when used to treat patients with acute ischemic strokes.AimOur study examines the safety issue of giving IV tPA without complete blood count (CBC) resulted.Materials and MethodsThis is a retrospective observational study by examining the database from Huashan Hospital in China and OSF/INI Comprehensive Stroke Center in United States. Patient data collected included demographics, occurrence of symptomatic intracranial hemorrhage, door to needle intervals, National Institute of Health Stroke Scale scores on admission, CBC results on admission and follow-up modified Rankin Scale scores. Linear regression and multivariable logistic regression analysis were used to identify factors that would have an impact on door-to-needle intervals.ResultsOur study included120 patients from Huashan Hospital and 123 patients from INI. Among them, 36 in Huashan Hospital and 51in INI received IV tPA prior to their CBC resulted. Normal platelet count was found in 98.8% patients after tPA was given. One patient had thrombocytopenia but no hemorrhagic event. A significantly shorter door to needle interval (DTN) was found in the group without CBC resulted. There was also a difference in treatment interval between the two hospitals. Door to needle intervals had a strong correlation to onset to treatment intervals and NIHSS scores on admission.ConclusionIn patients presented with acute ischemic stroke, the risk of developing hemorrhagic event is low if IV tPA is given before CBC has resulted. The door to needle intervals can be significantly reduced.

To determine the recurrence rate of central serous chorioretinopathy and risk factors responsible for recurrence. Methods: The study was designed as a hospital-based retrospective study. Medical records of all patients with CSCR, seen at the retina clinic from January 1999 to December 2008, were retrospectively analyzed. Univariate and multivariate analysis were done using statistical package for social sciences (SPSS). Results: The recurrence rate of CSCR in 752 patients was 19.41%. The mean attack rate was 1.29. Using the Wilcoxon signed ranks test, it was found that in patients with and without recurrence, there was a significant improvement in visual acuity after treatment. Univariate analysis done, to study the association between risk factors and recurrence of CSCR, showed that patients aged less than 40 and the male sex were significantly associated with recurrence of CSCR. Multivariate logistic regression analysis showed the same two factors to be significantly associated with recurrence of CSCR. 8.37% patients had bilateral CSCR. Conclusion: The recurrence rate of CSCR in 752 patients, with an average follow-up of 12.11 months was 19.41%. Patients aged less than 40 years had a 1.59 times increased risk of recurrence. Patients of the male sex had a 1.96 times increased risk of recurrence.

Intravenous (IV) tissue-type plasminogen activator (tPA) is the only approved noninvasive therapy for acute ischemic stroke (AIS). However, after tPA treatment, the outcome of patients with different subtypes of stroke according to their vascular risk factors remains to be elucidated. We aim to explore the relationship between the outcome and different risk factors in patients with different subtype of acute strokes treated with IV tPA. Records of patients in this cohort were reviewed. Data collected and analysed included the demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) scores, 90-day modified Rankin Scores (mRS), and subtypes of stroke. By using the 90-day mRS, patients were dichotomized into favorable versus unfavorable outcome in each subtype of stroke. We identified the vascular risk factors that are likely associated with the poor outcome in each subtype. Among 570 AIS patients received IV tPA, 217 were in the large artery atherosclerosis (LAA) group, 146 in the small vessel occlusion(SVO) group, and 140 in the cardioaortic embolism(CE) group. Lower NIHSS score on admission was related to favorable outcome in patients in all subtypes. Patients with history of dyslipidemia were likely on statin treatment before their admission and hence less likely to have elevated cholesterol level on admission. Therefore, there was a possible paradoxical effect on the outcome in patients with LAA and SVO subtypes of strokes. SVO patients with history of diabetes had higher risk of unfavorable outcome. SVO patients had favorable outcome if their time from onset to treatment was short. In conclusion, the outcome of patients treated with IV tPA may be related to different vascular risk factors associated with different subtypes of stroke.

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