for the OSF Stroke TeamBackground and Purpose-Since the FDA approved tissue plasminogen activator (tPA) in 1996 for acute ischemic stroke, few data have been obtained during the postmarketing phase, and applicability in rural hospitals does not exist. We attempt to examine the safety and outcome of intravenous tPA for acute ischemic stroke in the OSF Stroke Network. Methods-Fifty-seven consecutive patients treated with tPA were examined from June 1996 through December 1998.Admission and discharge National Institute of Health Stroke Scales (NIHSS), modified Rankin Scales (MRS), and discharge disposition, as well as intracerebral hemorrhage and mortality rates, were compared. Results-Of 20 network hospitals, 12 had the experience of administering tPA. No statistically significant differences in the variables recorded were observed for patients treated at the community hospitals versus those who received tPA at the tertiary medical center. In 35% of patients, tPA was initiated by an emergency room or primary care physician in consultation with an OSF neurologist. At discharge, 47% of the patients had minimal or no disability (MRS, 0 to 1), 44% had an NIHSS score of 0 or 1, 54% went home, 25% were transferred to in-patient rehabilitation, 12% went to a nursing or skilled-care facility, and 9% died. Intracerebral hemorrhage rate was 9%; 5% were symptomatic. Conclusions-tPA can be administered safely with good outcome at community and rural hospitals. The OSF StrokeNetwork can serve as a model to assist small community hospitals to set up stroke programs and deliver up-to-date, acute stroke therapies. (Stroke. 2000;31:77-81.)
Magnetic resonance imaging (MRI) has improved the diagnosis of several pathological entities of the brain. MRI especially has been credited with distinguishing demyelinating diseases of the central nervous system from other diseases. The presence of a mass effect in a demyelinating disorder, however, makes difficult the distinction between tumor and a demyelinating disease. We report a case of a demyelinating disorder simulating an infiltrating glioma of the corpus callosum on MRI scan, resulting in surgical intervention. To our knowledge, this is the first case to be reported with MRI and documented pathological findings.
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