Prehospital pathways of occipital stroke patients with mainly visual symptoms

Räty, Silja; Silvennoinen, Katri; Tatlısumak, Turgut

doi:10.1111/ane.12807

Cited by 14 publications

(18 citation statements)

References 35 publications

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“…With perimetry, the frequency of detected VFD in our study was higher at admittance, 79%. Our numbers are in accordance with a large prospective multicenter trial where VFD was found in 52% of a general stroke population, while 86% VFD was reported among occipital stroke patients with mainly visual symptoms admitted to an emergency department at a university hospital in Finland …”

Section: Discussionsupporting

confidence: 91%

“…The mean age of the patients was about 70 years, two thirds were men, and hypertension (52%) and smoking (40%) were the most frequent risk factors. The demographics were similar to those presented in the recent study of occipital stroke in Finland, yet the frequency of hypertension, hyperlipidemia, and diabetes was lower in our population . However, the rate of smoking in our patients was substantially higher than the 18% found in the general stroke population in Norway…”

Section: Discussionsupporting

confidence: 86%

“…Many of these patients display visual symptoms, such as VFD. However, both patients and healthcare professionals may have difficulties in recognizing visual problems as related to acute stroke, and the thrombolysis rate in patients with occipital infarction has been reported as low as 6.5% . This was not the case in our study, where the thrombolysis rate was 20%.…”

Section: Discussioncontrasting

confidence: 75%

“…Treatment with thrombolysis after acute infarction is associated with improved recovery from visual impairment . However, occipital stroke patients often contact healthcare late, their visual disturbances might be inadequately recognized, and they are often ineligible for intravenous thrombolysis because they do not arrive within the therapeutic window for acute intervention . This might result in a missed opportunity for prevention of permanent visual impairment.…”

Section: Introductionmentioning

confidence: 99%

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Vision‐related quality of life in patients with occipital stroke

et al. 2020

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Objectives The aim of this study was to detect visual field defects (VFDs) after occipital infarction, investigate the rate of recovery and the impact of VFD upon vision‐related quality of life (QoL). Materials and methods Multicenter, prospective study including patients with MRI verified acute occipital infarction (NOR‐OCCIP project). Ophthalmological examination including perimetry was performed within 2 weeks and after 6 months. Vision‐related QoL was assessed by the National Eye Institute Visual Function Questionnaire 25 (VFQ‐25) at one and 6 months post‐stroke. Results We included 76 patients, reliable perimetry results were obtained in 66 patients (87%) at a median of 8 days after admittance and VFD were found in 52 cases (79%). Evaluation of VFD after 6 months revealed improvement in 52%. Patients with VFD had significantly lower composite score in VFQ‐25 at both test points (77 vs 96, P = .001 and 87 vs 97, P = .009), in nine out of eleven subscales of VFQ‐25 at 1 month and seven subscales after 6 months, including mental health, dependency, near and distance activities. Milder VFD had better results on VFQ‐25 modified composite score (95 vs 74, P = .002).VFD improvement was related to improved VFQ‐25 modified composite score (9.6 vs 0.8, P = .018). About 10% of patients with VFD reported driving 1 month post‐stroke and 38% after 6 months. Conclusion VFD substantially reduces multiple aspects of vision‐related QoL. Severity of VFD is related to QoL and VFD improvement results in better QoL. Neglecting visual impairment after stroke may result in deterioration of rehabilitation efforts. Driving post‐stroke deserves particular attention.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Vision‐related quality of life in patients with occipital stroke

et al. 2020

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“…This period should preferably be less than three hours (14)(15)(16). However, according to the results of a study by Raty et al, only 5.6% of the patients were referred to the clinics at the desired time (17). In Iran, according to study by Ghiasian et al, the mean delay time was 7.4 hours (18).…”

Section: Introductionmentioning

confidence: 99%

Effect of Public Education Regarding Stroke Warning Signs on Pre-Hospital Delay and Frequency of Tissue Plasminogen Activator Therapy in Stroke Patients: A Quasi-Experimental Study

Vakilian

Sadeghi

Seyed-Bagheri

et al. 2020

Jundishapur J Chronic Dis Care

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Background: Treatment with tissue plasminogen activator (tPA) is one of the effective therapeutic strategies for treating stroke. Its effectiveness is associated with the period between the onset of symptoms and initiation of the treatment. An earlier intervention can result in better results and prognosis. Objectives: The aim of this study was to determine the effect of public education regarding stroke warning signs on pre-hospital delay and frequency of tPA therapy in stroke patients referring to the emergency department. Methods: In this quasi-experimental study, the research population included all stroke patients referring to an emergency department in an urban area of Iran in 2016-2018. Educational intervention included the distribution of educational pamphlets through the city, the installation of banners, radio training programs, etc. began in November 2017 and lasted one year. Patients' information was collected one year before and one year after the intervention. Data were analyzed with independent t-test and chi-square test using SPSS version 18 software. Results: According to the results, in the post-intervention phase, the frequency of referrals in all three intervals (less than 3 hours, 3-6 hours, and more than 6 hours) were increased compared with the pre-intervention phase. There was no significant difference regarding the frequency of treatment with tPA between two intervals. Conclusions: Based on the results, public education can raise awareness regarding the symptoms of stroke and prevent serious neurological defects after ischemic stroke, based on which the used intervention is highly recommended.

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Homonymous visual field defect and retinal thinning after occipital stroke

Rashid

Yang

et al. 2021

Brain and Behavior

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Introduction: Stroke is the most common cause of homonymous visual field defects (VFD). About half of the stroke patients recover from VFD. However, relationship between VFD and retinal changes remains elusive. Purpose:To investigate the association between occurrence of VFD, changes of macular ganglion cell and inner plexiform layer (GCIPL) and its axon retinal nerve fiber layer (RNFL) detected with optical coherence tomography (OCT). Patients and methods:The study consists of retrospective review of medical records and follow-up examinations. Patients with acute occipital stroke were registered. VFD was identified with confrontation and/or perimetry tests at the onset. At follow-up, the patients were examined with visual field tests and OCT measurements.Results: Thirty-six patients met the inclusion criteria. At onset, 26 patients (72%) had VFD. At follow-up >1 year after stroke, 13 patients (36%) had remaining VFD: 5 had homonymous hemianopia, 5 had homonymous quadrantanopia, and 3 had homonymous scotomas. Average thickness of GCIPL and RNFL were significantly reduced in each eye in patients with VFD compared to non-VFD (NVFD) (p < .01 for all comparisons). Thickness of superior and inferior RNFL quadrants was significantly reduced in VFD compared to NVFD (p < .01 for both). Among these 13 patients, 4 had characteristic homonymous quadrant-GCIPL thinning, 2 had characteristic homonymous hemi-GCIPL thinning, and 7 had diffuse GCIPL thinning. Conclusion:GCIPL and RNFL thinning were observed in the patients with VFD. GCIPL thinning appears in two forms: atypical diffuse thinning, or homonymous hemi-GCIPL thinning. Examining GCIPL and RNFL provides easy and reliable objective measures and is therefore proposed to be of predictive value on visual function.

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Prehospital pathways of occipital stroke patients with mainly visual symptoms

Cited by 14 publications

References 35 publications

Vision‐related quality of life in patients with occipital stroke

Vision‐related quality of life in patients with occipital stroke

Effect of Public Education Regarding Stroke Warning Signs on Pre-Hospital Delay and Frequency of Tissue Plasminogen Activator Therapy in Stroke Patients: A Quasi-Experimental Study

Homonymous visual field defect and retinal thinning after occipital stroke

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