Rapidly Improving Stroke Symptoms: A Pilot, Prospective Study

Balucani, Clotilde; Bianchi, R. M.; Ramkishun, Charles; Weedon, Jeremy; Law, Susan; Szarek, Michael; Rojas-Soto, Diana; Tariq, Sara; Levine, Steven R.

doi:10.1016/j.jstrokecerebrovasdis.2015.01.017

Cited by 2 publications

(9 citation statements)

References 16 publications

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“…3 The other studies did not report time of initial examination, but enrolled patients up to 4.5 hours and 6 hours after LKW so likely had even later first evaluations. 1,2 The current study, by analyzing assessments performed in the field, was able to capture an earlier part of stroke symptom course, when deficits are less stable and more subject to change. 17 The current study of U-RNI complements a prior investigation in the FAST-MAG population of the frequency and outcomes of ultra-early neurologic deterioration in the prehospital and ED course.…”

Section: Discussionmentioning

confidence: 99%

“…These studies found a lower frequency of RNI than the present investigation, ranging from 5% to 24%. 1-3…”

Section: Discussionmentioning

confidence: 99%

“…Between 5% and 24% of patients have been reported to show RNI in the first hours after arrival to the hospital. 1,2 Despite in-hospital RNI has been associated with generally more favorable course, a considerable proportion of these patients have disabled outcome at 3 months. [1][2][3] To date, studies evaluating the causes, frequency, and outcomes of RNI have generally focused on RNI occurring after hospital arrival.…”

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confidence: 99%

“…1,2 Despite in-hospital RNI has been associated with generally more favorable course, a considerable proportion of these patients have disabled outcome at 3 months. 1-3…”

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confidence: 99%

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Neurologic Improvement in Acute Cerebral Ischemia

et al. 2023

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BACKGROUNDAND PURPOSE: Investigations of rapid neurological improvement (RNI) in patients with acute cerebral ischemia (ACI) have focused upon RNI occurring after hospital arrival. However, with stroke routing decisions and interventions increasingly migrating to the prehospital setting, there is a need to delineate the frequency, magnitude, predictors, and clinical outcomes of ACI patients with ultra-early RNI (U-RNI) in the prehospital and early post-arrival period.METHODS:We analyzed prospectively collected data of the prehospital Field Administration of Stroke Therapy-Magnesium (FAST-MAG) randomized clinical trial.AnyU-RNI was defined as improvement by 2 or more points on the Los Angeles Motor Scale (LAMS) score between the prehospital and early post-Emergency Department (ED) arrival exams and classified asmoderate(2-3 point) ordramatic(4-5 point) improvement. Outcomes measures included excellent recovery [modified Rankin Scale (mRS) score 0-1] and death by 90 days.RESULTS:Among the 1,245 ACI patients, mean age was 70.9 years (standard deviation 13.2); 45% were women; median prehospital-LAMS was 4 [interquartile range (IQR) 3-5]; median last known well to ED-LAMS time was 59 minutes (IQR 46-80) and median prehospital-LAMS to ED-LAMS time was 33 minutes (IQR 28-39). Overall,anyU-RNI occurred in 31%,moderateU-RNI in 23%, anddramaticU-RNI in 8%.AnyU-RNI was associated with improved outcomes, including excellent recovery (mRS 0-1) at 90 days 65.1% (246/378) vs 35.4% (302/852), p<0.0001; decreased mortality by 90 days 3.7% (14/378) vs 16.4% (140/852), p<0.0001; decreased symptomatic intracranial hemorrhage 1.6% (6/384) vs 4.6% (40/861), p=0.0112 ; increased likelihood of being discharged home 56.8% (218/384) vs. 30.2% (260/861), p <0.0001.DISCUSSION:U-RNI occurs in nearly 1 in 3 ambulance-transported patients with ACI and is associated with excellent recovery and decreased mortality at 90 days. Accounting for U-RNI may be useful for routing decisions and future prehospital interventions.

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Section: Discussionmentioning

confidence: 99%

“…These studies found a lower frequency of RNI than the present investigation, ranging from 5% to 24%. 1-3…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…1,2 Despite in-hospital RNI has been associated with generally more favorable course, a considerable proportion of these patients have disabled outcome at 3 months. 1-3…”

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confidence: 99%

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Neurologic Improvement in Acute Cerebral Ischemia

et al. 2023

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“…Consecutive medical records of adults (≥ 18 years) admitted to a hyperacute stroke unit within a metropolitan quaternary hospital in Queensland, Australia, between January 2015 and December 2017 for acute ischaemic stroke treated with ECR and/or thrombolysis were included. To be eligible for thrombolysis, patients had to present within 6 h of symptom onset, and have nil history of intracranial haemorrhage or acute trauma on admission (Balucani et al., 2015; Sørensen et al., 2016). To be eligible for ECR, patients had to present within 24 h of symptom onset, have large vessel occlusion confirmed via computed tomography (CT) or magnetic resonance imaging (MRI) (e.g., basilar artery, middle cerebral artery), generally independent premorbid function, and nil intracerebral haemorrhage (ICH) (Sim et al., 2018; Sørensen et al., 2016).…”

Section: Methodsmentioning

confidence: 99%

The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review

Minchell

Rumbach

Finch

2021

Intl J Lang & Comm Disor

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Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post‐stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post‐ECR and/or thrombolysis. Purpose To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech‐language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence‐base for SLPs and the wider medical team and to inform clinical practice guidelines. What this paper adds What is already known on the subjectStroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper addsDespite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications ...

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Rapidly Improving Stroke Symptoms: A Pilot, Prospective Study

Cited by 2 publications

References 16 publications

Neurologic Improvement in Acute Cerebral Ischemia

Neurologic Improvement in Acute Cerebral Ischemia

The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review

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