Avoiding Misdiagnosis in Patients With Posterior Circulation Ischemia: A Narrative Review

Gurley, Kiersten; Edlow, Jonathan A.

doi:10.1111/acem.13830

Cited by 32 publications

(35 citation statements)

References 84 publications

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“…Another interesting finding is the significant decrease in patients managed for posterior circulation stroke during the pandemic period. Outside the pandemic period, posterior circulation strokes are more likely misdiagnosed in part because of nonspecific clinical presentation [13]. This phenomenon may have been exacerbated during the COVID-19 period.…”

Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

et al. 2020

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Background The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133-2238] vs 1023 [960-1410]; p < 0.01). Conclusions Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intrahospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.

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Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Another interesting nding is the signi cant decrease in patients managed for posterior circulation stroke during the pandemic period. Outside the pandemic period, posterior circulation strokes are more likely misdiagnosed in part because of nonspeci c clinical presentation [13]. This phenomenon may have been exacerbated during the COVID-19 period.…”

Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

Plumereau

Cho

Buisson

et al. 2020

Preprint

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period.MethodsWe conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods.ResultsA total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period (55 (54.5%) vs 74 (69.2%); p=0.03) and was mainly due to time delay among patients treated with MT. The volume of MT remains stable over the two periods (72 (71.3%) vs 65 (60.8%); p=0.14) but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260]; p<0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133-2238] vs 1023 [960-1410]; p<0.01).ConclusionsOur study showed a decrease of the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.

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“…Diagnosing symptoms such as abnormal eye movements often requires a trained physician. A trained physician would look into deficits of interest such as nystagmus, abnormal visual fixation, and skew deviation 6,7 . Here the physician performs specific examination procedures that involve fixation and smooth-pursuit of visual stimuli.…”

Section: Introductionmentioning

confidence: 99%

“…Here the physician performs specific examination procedures that involve fixation and smooth-pursuit of visual stimuli. Abnormal eye position and movements due to a PCS can be subtle and difficult to detect by the untrained observer 6,8 . While clinical maneuvers such as the HINTS exam 9 are a viable solution in the ED, they are not well adapted for use by non-experts in the pre-hospital setting such as first-responders.…”

Section: Introductionmentioning

confidence: 99%

Investigating the Need for Calibration to Track Eye Movements: A Feasibility Study

Ameen¹,

Aldridge²,

Zhuang³

et al. 2021

Preprint

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Automated eye tracking technology could enhance diagnosis and treatment for many neurological diseases, including posterior circulation stroke. Much of the current literature focuses on gaze estimation through a form of calibration. Unlike other fields, medicine has a clear need to better track eye symmetry during movement for better detection of abnormal conjugacy, ductions, and vestibulo-ocular function in a variety of neurological diseases. However, patients with neuro-ocular deficits may have a difficult time completing a calibration procedure due to inattention and other associated neurologic deficits. Here, we investigate the need for calibration to measure the symmetry of eye movements in healthy individuals including testing fixations, smooth pursuits, and saccades. The results of this feasibility study suggest that calibration may not be necessary to measure and track binocular eye movements in tandem. The structure or shape which the eyes draw during visual tracking remain intact even without a calibration procedure. The preliminary study suggests that this technology can be deployed without a calibration procedure within this clinical context. Further research is needed to validate these findings in populations with neuro-ophthalmologic disease, including posterior circulation stroke.

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Avoiding Misdiagnosis in Patients With Posterior Circulation Ischemia: A Narrative Review

Cited by 32 publications

References 84 publications

Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

Investigating the Need for Calibration to Track Eye Movements: A Feasibility Study

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