Background Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. Objective The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. Methods This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. Results A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33% vs 11/52, 21%; P=.16), diastolic BP<85 mm Hg (44/54, 81% vs 37/52, 71%; P=.21), HbA1c level<7% (36/55, 65% vs 30/40, 75%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P<.001). Conclusions The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. Trial Registration ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330
We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG. The patient was obtunded and remained unresponsive after MRI, with minimal response and a deteriorating clinical condition. The patient was given hyperosmolar therapy with a mannitol bolus. She recovered well with near resolution of imaging findings.
BACKGROUND Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. OBJECTIVE The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. METHODS This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. RESULTS A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic B<i>P</i><125 mm Hg (18/54, 33% vs 11/52, 21%; <i>P</i>=.16), diastolic B<i>P</i><85 mm Hg (44/54, 81% vs 37/52, 71%; <i>P</i>=.21), HbA<sub>1c</sub> level<7% (36/55, 65% vs 30/40, 75%; <i>P</i>=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; <i>P</i>=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (<i>P</i><.001). CONCLUSIONS The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. CLINICALTRIAL ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330
Introduction: Telestroke has expanded access to tPA and thrombectomy for acute ischemic stroke and improved neurologic outcomes. A key step in the evaluation of acute stroke is non-contrast head CT (HCT) and head and neck CT angiogram (CTA). These imaging studies can either be bundled at presentation, or a delayed CTA may be performed after a tPA decision based on HCT alone. Bundled imaging may facilitate faster transfer and treatment times, while delaying tPA. We investigated the effect of bundled imaging on thrombectomy transfer and treatment times in our telestroke network. Methods: We reviewed patients in our telestroke network from 2019-2021. We included patients who had received HCT and CTA at a partner hospital prior to transfer to our comprehensive stroke center (CSC) for thrombectomy. We collected baseline clinical variables, and timing of imaging, transfer and treatment relative to time of initial HCT. Patients were divided into a bundled imaging group (simultaneous HCT and CTA) or a delayed CTA group. Wilcoxon Rank sum test was used to compare between the two groups for HCT to tPA needle time, HCT to CSC arrival time, and HCT to Groin Puncture Time Results: 273 patients were assessed via telestroke in the study period. Of these 93 were included. 43 patients received bundled CTA, and 50 patients received a delayed CTA. 20 patients received tPA in the bundled group vs 25 in the delayed CTA group. Median CSC transfer time was lower with a bundled imaging strategy (110 min vs 160 min; p<0.001), as was median time to groin puncture (174 min vs 242 min; p<0.001). Further, there was no difference in tPA needle time (38 min vs 37 min; p=0.86). Conclusions: Bundled HCT and CTA at telestroke sites was associated with significantly faster transfer and groin puncture times for patients with large vessel occlusion. Further, obtaining the CTA prior to a tPA decision did not significantly prolong HCT-to-needle times.
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