This databank-based, multicenter study compared all stroke patients with IV tissue plasminogen activator aged > or = 80 years (n = 38) and those < 80 years old (n = 287). Three-month mortality was higher in older patients. Favorable outcome (modified Rankin scale < or = 1) and intracranial hemorrhage (asymptomatic/symptomatic/fatal) were similarly frequent in both groups. Logistic regression showed that stroke severity, time to thrombolysis, glucose level, and history of coronary heart disease independently predicted outcome, whereas age did not.

Background and Purpose-Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Whether this is also true for cervical artery dissection (CAD) is addressed in this study. Methods-We used the Swiss IVT databank to compare outcome and complications of IVT-treated patients with CAD with IVT-treated patients with other etiologies (non-CAD patients). Main outcome and complication measures were favorable 3-month outcome, intracranial cerebral hemorrhage, and recurrent ischemic stroke. Modified Rankin Scale score Յ1 at 3 months was considered favorable. Results-Fifty-five (5.2%) of 1062 IVT-treated patients had CAD. Patients with CAD were younger (median age 50 versus 70 years) but had similar median National Institutes of Health Stroke Scale scores (14 versus 13) and time to treatment (152.5 versus 156 minutes) as non-CAD patients. In the CAD group, 36% (20 of 55) had a favorable 3-month outcome compared with 44% (447 of 1007) non-CAD patients (OR, 0.72; 95% CI, 0.41 to 1.26), which was less favorable after adjustment for age, gender, and National Institutes of Health Stroke Scale score (OR, 0.50; 95% CI, 0.27 to 0.95; Pϭ0.03). Intracranial cerebral hemorrhages (asymptomatic, symptomatic, fatal) were equally frequent in CAD (14% [7%, 7%, 2%]) and non-CAD patients (14% [9%, 5%, 2%]; Pϭ0.99). Recurrent ischemic stroke occurred in 1.8% of patients with CAD and in 3.7% of non-CAD-patients (Pϭ0.71). Conclusion-IVT-treated patients with CAD do not recover as well as IVT-treated non-CAD patients. However, intracranial bleedings and recurrent ischemic strokes were equally frequent in both groups. Key Words: carotid artery Ⅲ cervical artery dissection Ⅲ complications Ⅲ dissection Ⅲ outcome Ⅲ thrombolysis I ntravenous thrombolysis (IVT) for acute ischemic stroke using recombinant tissue plasminogen activator has been shown to be safe and efficacious. 1,2 Treatment response seems to be independent of the underlying stroke mechanism. 3 However, whether this observation includes patients with strokes attributable to cervical artery dissection (CAD) has not been studied. CAD is characterized by intramural accumulation of blood. Theoretically, IVT might promote and increase the intramural bleeding in CAD and cause progressive hemodynamic worsening and infarct growth. In patients with stroke with aortic dissection extending to the cervical arteries, IVT might be dangerous as it is in patients with IVT for myocardial infarction. 4 -6 According to recent pilot data, the outcome of 7 IVT-treated patients with CAD tended to be worse than that of 7 patients with CAD not treated with IVT. 7 In turn, patients with CAD have not been excluded from randomized, placebo-controlled trials 1,8,9 of IVT in stroke. Treatment guidelines 10 do not advise against IVT in such patients, but randomized, placebo-controlled trial-based data about IVT versus placebo in patients with CAD are not available. Only information of case series without control groups and small sample sizes (ie, 30, 11 11, 12 6, 13 a...

SummaryThe rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presumptive 'toxic' factors, and improvement of the rheological quality of the blood. We evaluated the records of 61 patients treated with ET to describe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of 61 patients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exchange transfusion is applied according to the clinician's subjective impression rather than strict guidelines. Logistic regression analysis adjusting for the differences in clinical parameters between patients treated with or without ET did not identify treatment as a prognostic indicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4-4.9). Exchange transfusion did not significantly improve the unfavourable prognosis in cases of severe falciparum malaria. However, failure to reach statistical significance may be due to the retrospective design of the study and therefore non-systematic approach.keywords malaria, Plasmodium falciparum, treatment, exchange blood transfusion correspondence Dr Gerd-Dieter Burchard, Bernhard

Intravenous thrombolysis in patients with stroke attributable to small artery occlusion Funding SourcesThis study was unfunded Conflicts of interest/DisclosuresAll co-authors agree to the content of the manuscript and disclose any financial interest.Copyright agreement forms as well as details about the contributions of each author will be provided upon acceptance of the paper. AbstractBackground: IV thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Recent observations raised concern, that IVT might cause harm in patients with strokes attributable to small artery occlusion (SAO). The safety of IVT in SAO-patients is addressed in this study. Methods:We used the Swiss IVT databank to compare outcome and complications of IVTtreated SAO-patients with IVT treated patients with other etiologies (non-SAO-patients). Main outcome and complication measures were functional independence after 3 months (modified Rankin scale 2) at 3 months, intracranial cerebral hemorrhage (ICH), and recurrent ischemic stroke.Results: Sixty-five (6.2%) of 1048 IVT-treated patients had SAO. Among SAO-patients, 1.5%(1/65) patients died within 3 months, compared to 11.2% (110/983) in the non-SAO-group (p=0.14). SAO-patients reached functional independence more often than non-SAO-patients (58.9% versus 75.4%; OR 2.14 (95%CI 1.20-3.81; p=0.0.01). This association became insignificant after adjustment for age, gender, and stroke severity (OR 1.41 95%CI 0.713-2.788; p=0.323). Glucose level and stroke severity but not age predicted 3-month-independence in IVTtreated SAO-patients. ICHs (all/symptomatic) were equally frequent in SAO-(12.3%/4.6%) and non-SAO-patients (13.4%/5.3%;p>0.8). Fatal ICH occurred in 3.3% of the non-SAO-patients but were absent among SAO-patients. Recurrent ischemic stroke occurred in 1.5% of SAO-patients and in 2.3% of non-SAO-patients (p=0.68). Conclusion:IVT treated SAO-patients reached functional independence more often than IVT treated non-SAO-patients do. However, the variable "SAO" was a dependent rather than an independent outcome predictor. The absence of an excess in ICH indicates that IVT seems not to be harmful in SAO-patients.

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