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  • 1
    Online Resource
    Online Resource
    Acetaminophen for Altering Body Temperature in Acute Stroke : A Randomized Clinical Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2002
    In:  Stroke Vol. 33, No. 1 ( 2002-01), p. 130-135
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 1 ( 2002-01), p. 130-135
    Abstract: Background and Purpose — Mild alterations in temperature have prominent effects on ischemic cell injury and stroke outcome. Elevated core body temperature (CBT), even if mild, may exacerbate neuronal injury and worsen outcome, whereas hypothermia is potentially neuroprotective. The antipyretic effects of acetaminophen were hypothesized to reduce CBT. Methods — This was a randomized, controlled clinical trial at 2 university hospitals. Patients were included if they had stroke within 24 hours of onset of symptoms, National Institutes of Health Stroke Scale (NIHSS) score ≥5, initial CBT 〈 38.5°C, and white blood cell count 〈 12 600 cells/mm 3 ; they were excluded if they had signs of infection, severe medical illness, or contraindication to acetaminophen. CBT was measured every 30 minutes. Patients were randomized to receive acetaminophen 650 mg or placebo every 4 hours for 24 hours. The primary outcome measure was mean CBT during the 24-hour study period; the secondary outcome measure was the change in NIHSS. Results — Thirty-nine patients were randomized. Baseline CBT was the same: 36.96°C for acetaminophen versus 36.95°C for placebo ( P =0.96). During the study period, CBT tended to be lower in the acetaminophen group (37.13°C versus 37.35°C), a difference of 0.22°C (95% CI, −0.08°C to 0.51°C; P =0.14). Patients given acetaminophen tended to be more often hypothermic 〈 36.5°C (OR, 3.4; 95% CI, 0.83 to 14.2; P =0.09) and less often hyperthermic 〉 37.5°C (OR, 0.52; 95% CI, 0.19 to 1.44; P =0.22). The change in NIHSS scores from baseline to 48 hours did not differ between the groups ( P =0.93). Conclusions — Early administration of acetaminophen (3900 mg/d) to afebrile patients with acute stroke may result in a small reduction in CBT. Acetaminophen may also modestly promote hypothermia 〈 36.5°C or prevent hyperthermia 〉 37.5°C. These effects are unlikely to have robust clinical impact, and alternative or additional methods are needed to achieve effective thermoregulation in stroke patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/hs0102.101477
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2002
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  • 2
    Online Resource
    Online Resource
    Pilot Dose-Escalation Study of Caffeine Plus Ethanol (Caffeinol) in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 5 ( 2003-05), p. 1242-1245
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 5 ( 2003-05), p. 1242-1245
    Abstract: Background and Purpose— In animal models, the combination of caffeine and ethanol (caffeinol) provides robust neuroprotection at blood levels that should be easily and safely achieved in humans. This study was designed to determine the safety and tolerability of ascending doses of this combination in stroke patients. Methods— This Food and Drug Administration–approved open-label, single-arm, dose-escalation study had 3 original dose groups: group 1, caffeine 6 mg/kg plus ethanol 0.2 g/kg; groups 2 and 3, incremental increases of caffeine and ethanol by 2 mg/kg and 0.2 g/kg, respectively. Intravenous thrombolysis was encouraged if patients qualified. Drug was started within 6 hours of stroke onset, and blood levels of caffeine and ethanol were drawn at baseline and end of infusion. The target blood caffeine and ethanol ranges were 8 to 10 μg/mL and 30 to 50 mg/dL, respectively. Clinical outcome measurements included the National Institutes of Health Stroke Scale at the end of infusion, at 24 hours, and at discharge. Potential complications from caffeine and ethanol were recorded. Cases were reviewed by an independent stroke neurologist for safety. Results— A total of 23 patients were recruited. Target blood caffeine and ethanol levels were reached in 0 of the 4 patients in the first group. The second dose group (caffeine 8 mg/kg plus ethanol 0.4 g/kg) included 8 patients. The median end-of-infusion caffeine and ethanol levels were within the desired target ranges. Two days after infusion, 1 patient in this group with preexisting cardiac disease and end-of-infusion caffeine and ethanol levels of 10.7 μg/mL and 69 mg/dL developed reversible congestive heart failure and required transfer to an intensive care unit. The original third dose group was canceled given achievement of target blood caffeine and ethanol levels in group 2. However, 3 new dose groups were created in an attempt to minimize the dose of ethanol. Although blood levels were proportional to dose, none of these new dose groups provided optimal blood levels. Congestive heart failure occurred in 1 other patient with previously asymptomatic cardiomyopathy. No other side effects were noted. Concomitant thrombolytic therapy was given in 8 patients, 1 of whom died of intracerebral hemorrhage. Conclusions— Caffeinol alone or combined with intravenous tissue plasminogen activator can be administered safely. Caffeine 8 mg/kg plus ethanol 0.4 g/kg produces target caffeine and ethanol levels of 8 to 10 μg/mL and 30 to 50 mg/dL, respectively. A randomized, placebo-controlled trial is needed to determine the neuroprotective effect of this combination.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000067706.23777.04
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
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  • 3
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    Online Resource
    Abstract 3471: Emergent Carotid Artery Stenting: Outcomes on a National Level
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: Emergent carotid artery stenting (CAS) is sometimes performed in the setting of acute cerebral ischemia. In this study, we assess outcomes associated with CAS when performed emergently. Methods: A cohort of patients with CAS was identified from the National Inpatient Sample database using the procedure codes (00.63) for the years 2004 through 2007. The type of admission (elective or emergent) for each patient was clarified in the database. Patients with missing admission type were eliminated. We further ascertained the emergent hospitalization by including only patients who were admitted through the Emergency Department. Primary outcomes include stroke (ischemic or hemorrhagic), myocardial infarction or death occurring during the same hospitalization. Multivariate logistic regression analyses were used to assess covariates associated with the primary outcome and hospital mortality. Results: In this analysis, 9001 patients were admitted and treated with CAS; 822 patients (9.13%) had the procedure performed emergently and the rest had elective CAS. The mean age (69.0 ± 13.2 vs. 70.6 ± 10.2) and gender (females 40.4% vs. 39.8%) were similar in both groups. Risk factors included higher rates of congestive failure and chronic lung disease in the emergent group. In addition, emergent CAS had more severe Charlson comorbidity index (4.0% vs. 1.76%; p 〈 0.0001). Unadjusted analysis showed higher rate of any stroke, myocardial infarction or death in the emergent group (12.3% vs. 3.37%; OR 4.0; 95% CI 3.15, 5.10). Adjusted analysis for the basic demographic, risk factors and the comorbidity index revealed a higher risk of any stroke, myocardial infarction and death when CAS performed emergently (OR 3.27; (95% CI, 2.54, 4.21). Secondary outcomes of hospital mortality (5.11% vs. 0.67%), myocardial infarction (5.47% vs. 1.11%) and intracerebral hemorrhage (2.07% vs. 0.35%) were higher in the emergent CAS group (P 〈 0.0001). Post-operative stroke rates were similar (1.92% vs. 1.82%; P= 0.85). Intracerebral hemorrhage was the strongest predictor of mortality (OR 64.0; 95% CI 32.1, 127.7). Other predictors of mortality include congestive heart failure, myocardial infarction and the use of thrombolytic. Conclusion: CAS is associated with higher risk of stroke, myocardial infarction and death when performed emergently. Despite the low rate of intracerebral hemorrhage when CAS performed emergently, intracerebral hemorrhage remains the strongest predictor of mortality.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A3471
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 4
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    Online Resource
    Abstract 3548: Neuroimaging Modalities Predict Robust Collaterals For Optimal Intraarterial Acute Stroke Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: BACKGROUND: Collaterals during intra-arterial (IA) therapy have been shown to impact outcome. We sought to identify pre-treatment predictors of robust collaterals to improve patient selection for this therapy. METHODS: With institutional review board approval, we retrospectively reviewed patients from a single center receiving IA therapy for internal carotid artery (ICA) and middle cerebral artery (MCA) M1 segment occlusions from January 2009 to June 2011. We collected the following clinical data: age, gender, stroke score, and risk factors. Radiologic parameters included the pre-treatment Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast CT (NCCT) and CT Perfusion (CTP) cerebral blood volume maps and site of occlusion. All patients had complete diagnostic angiography prior to IA therapy. Collateral circulation of the symptomatic MCA territory was based on a previously published protocol in which any collateral filling of the MCA M1 segment was scored 1, any filling up to the M2 segments was scored 2, any filling up to the M3 segments was scored 3, any filling up to the M4 segments was scored 4. Absent collaterals were scored 5. The endpoint was robust collaterals defined as a score 〈 4. Associations between demographic, clinical, and radiologic parameters and robust collaterals were determined using chi-squared analysis. Receiver-operating characteristic (ROC) curves determined sensitivities and specificities for significant predictors. RESULTS: Fifty-three patients were identified (mean age of 66 %/- 11 years, median stroke score of 16.5). Occlusions occurred in the MCA M1 segment (37), ICA origin (2), intracranial ICA (9), and tandem ICA origin with intracranial ICA or M1 MCA (5). Robust collaterals were identified in 42 patients and predicted by 2 correlates on multivariate analysis: NCCT ASPECTS 〉 8 (p = .011), where 89.2% of patients with NCCT ASPECTS 〉 8 had robust collaterals, compared to 56.3% of patients with NCCT ASPCECTS ≤ 8; and CTP ASPECTS 〉 7 (p 〈 0.001), where 100% of patients with CTP ASPECTS 〉 7 had robust collaterals, compared to 45.5% of patients with CTP ASPCECTS ≤ 7. NCCT ASPECTS 〉 8 had a sensitivity of 79% and a specificity of 64% in predicting robust collateral circulation. CTP ASPECTS 〉 7 had a sensitivity of 83% and a specificity of 100%. CONCLUSIONS: Higher ASPECT scores on baseline CT and CTP reflects presence of robust collaterals and can aid in patient selection for IA therapy. In addition, a protocol using CTP may further increase the selection accuracy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A3548
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 5
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    An Unusual Presentation of Concomitant Cervical Spinal Cord and Cerebellar Acute Ischemic Stroke in a Patient on Weight Loss Medications (5364)
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Neurology Vol. 94, No. 15_supplement ( 2020-04-14)
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 15_supplement ( 2020-04-14)
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.94.15_supplement.5364
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    Trends and Predictors of In-hospital Mortality for Status Epilepticus: National Inpatient Sample Study 2005–2014 (4922)
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Neurology Vol. 94, No. 15_supplement ( 2020-04-14)
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 15_supplement ( 2020-04-14)
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.94.15_supplement.4922
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 7
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    Online Resource
    Benedict hand as presentation of acute ischemic stroke (2133)
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology Vol. 96, No. 15_supplement ( 2021-04-13)
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 15_supplement ( 2021-04-13)
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.96.15_supplement.2133
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 8
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    Online Resource
    Vomiting and Hiccup as the First Presentation of Thyrotoxicosis
    Elsevier BV ; 2015
    In:  The American Journal of Medicine Vol. 128, No. 5 ( 2015-05), p. e5-e6
    Details
    In: The American Journal of Medicine, Elsevier BV, Vol. 128, No. 5 ( 2015-05), p. e5-e6
    Type of Medium: Online Resource
    ISSN: 0002-9343
    URL: Article
    DOI: 10.1016/j.amjmed.2014.11.032
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2003338-2
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  • 9
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    Abstract WP132: National Trends In Utilization And Outcomes Of Acute Ischemic Stroke And Intracerebral Hemorrhage Patients Undergoing Gastrostomy Tube Placement
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background and Purpose: Persistent dysphagia requiring gastrostomy tube placement continues to be a major issue for stroke patients. We performed analysis to evaluate trends in utilization of gastrostomy tube placement and associated rates of death among acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients over a 10-year period. Methods: We obtained data for patients admitted to hospitals in United States from 2009 to 2018 with a primary diagnosis of IS or ICH using a large national database. We determined rate and pattern of utilization and associated in-hospital outcomes of gastrostomy tube placement among IS and ICH patients. Results: A total of 50551 (7.05%) and 136922 (2.45%) patients underwent gastrostomy tube placement among the 716777and 5567538patients admitted with ICH and IS, respectively. There was a 3.2-fold decrease in patients who gastrostomy tube placement among patients with IS (2.3% in 2009 vs 0.7% in 2018; P 〈 0.001), and by a 1.5-fold decrease for those with ICH (7.8% in 2009 vs 5.3% in 2018; P 〈 0.001). The rates of in-hospital mortality among patients undergoing gastrostomy tube placement remained unchanged throughout the 10 years for patients with IS (5.2% in 2009 vs 4.9% in 2018; p = 0.54) but decreased by fold for those with ICH (7.58% in 2009 vs 2.7% in 2010; p = 0.01). The length of hospitalization remained significantly higher in patients undergoing gastrostomy tube placement compared with those who did not for both patients with IS (16.2 ±15.7versus 3.6±4.3, p 〈 .0001) and those with ICH (24.4±22.1 versus 6.0±7.5, p 〈 .0001). The cost of hospitalization remained significantly higher in patients undergoing gastrostomy tube placement compared with those who did not for both patients with IS ($140563± 172413 versus $ 37950.2± 45101.6, p 〈 .0001) and those with ICH ($254519± 251973 versus $ 62133.3± 90833.9, p 〈 .0001). Conclusions: Between 2009 and 2018, there has been a significant reduction in the proportion of IS and ICH patients who underwent gastrostomy tube placement. However, the length and cost of hospitalization remained significantly higher among patients who underwent gastrostomy tube placement.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.WP132
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 10
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    Abstract WP363: Outcomes for Intracerebral Hemorrhage Patients with Renal Failure as Comorbidity in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Background: Clinical characteristics and outcomes for patients with intracerebral hemorrhage and underlying chronic kidney disease (CKD) are not well determined. We hypothesized rate adverse events and in-hospital mortality is higher in patients with intracerebral hemorrhage and underlying renal disease. Objective: To determine the Outcomes for intracerebral hemorrhage stroke patients with renal failure as comorbidity in the United States Methods: We analyzed the data from Nationwide Inpatient Sample (2009-2011) for all intracerebral hemorrhage stroke patients with or without renal failure as comorbidity. Patients were identified using the International Classification of Disease, Ninth Revision. Baseline characteristics, in-hospital complications including myocardial infarction), sepsis, pneumonia, deep venous thrombosis, urinary tract infections, and discharge outcomes (mortality, minimal disability, and moderate-to-severe disability) were compared between the two groups. All in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Results: Of the 33521 patients with intracerebral hemorrhage stroke, 3899 (11.6%) had renal failure as comorbidity. Patients with underlying renal disease were higher rates for in hospital complications like myocardial infarction (3.64% versus 2.03%, P≤.0001) , sepsis (5.82% versus 3.14%, P≤.0001) , pneumonia (6.92% versus 5.18%, P≤.0001) , deep venous thrombosis (1.67 % versus 1.17%, P≤ .0.0078) , urinary tract infections (16.41% versus 15.08%, P≤ 0.0293) and hypernatremia (8.62% versus 4.98%, P≤ 〈 .0001). In multivariate analysis adjusted for baseline cormorbitdities and in hospital complications, intracerebral hemorrhage patients with underlying renal disease had higher in hospital mortality (OR 1.146 (95% confidence interval (CI) 1.058- 1.240p-value=0.0008) , while there is no statistically significant difference for minimal/moderate disability between two groups ( OR = 0.980 (95% CI 0.896- 1.072 p-value=0.6571). Conclusions: Intracerebral hemorrhage patients with underlying renal disease have higher rate of in hospital complications and mortality. Future prospective studies are indicated to study this finding.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wp363
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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