ABSTRACT
Objectives: Although thrombolytic therapy has been shown to be benefi cial to stroke patients, its safety and effectiveness in stroke patients with cardiac tumor is unknown. This study assessed the safety and effi cacy of intravenous thrombolysis with recombinant-tissue plasminogen activator (rtPa) in stroke patients with cardiac myxoma. Methods: We systematically searched databases for all publications on thrombolysis in patients with cardiac tumor-related strokes. The literature on thrombolysis in ischemic stroke patients with myxoma was systematically analyzed; information on the hemorrhagic transformation and response rates in patients over and under 70 years of age was extracted and compared. Statistical tests were performed to evaluate the odds ratios for these factors. Results: Twelve case reports were identifi ed. Four patients were 70 years of age or older, two (50%) of whom had demonstrated hemorrhagic transformation, which was not found in patients under 60 years of age. The rate of response to treatment was 60% (3/5) in patients under 60 and 25% (1/4) in those ≥70 years of age. The rate of hemorrhagic transformation in the patients ≥70 years of age was higher than that in patients <70 years of age (odds ratio 7). Conclusion: Intravenous thrombolysis in ischemic stroke patients with myxoma who were over 70 years of age was associated with a lower response rate and a higher risk of hemorrhagic transformation.
ABSTRACT
Objectives: To assess the relationship of variation of blood pressure and neurological deterioration (ND) in ischemic stroke patients. Methods: We recruited patients with the fi rst-ever ischemic stroke at a teaching hospital. The National Institutes of Health Stoke Score (NIHSS) of each patient was monitored for 2 months. ND was defi ned as an increase of ≥ 2 points in NIHSS during the fi rst 7 days after stroke. Blood pressure was measured every 6 hours for fi rst 7 days. We analyzed blood pressure data in the fi rst 36 hours to study the relationship between variation of blood pressure and ND. Successive variation of systolic (svSBP) and diastolic (svDBP) blood pressure was calculated as svSBP= |SBPn+1 – SBPn | and svDBP= |DBPn+1 – DBPn | respectively. The largest svSBP in the fi rst 36 hours of hospitalization or before ND was defi ned as maximum variation of systolic blood pressure (maxvSBP). Then, the mean variation of systolic (mvSBP) and diastolic (mvDBP) blood pressure was calculated as mvSBP= svSBP/N and mvDBP= svDBP/N respectively. Results: A total of 121 patients were included in this study, and 38 of them had ND. The mvSBP was higher in the ND Group (17.9±8.4 mmHg vs. 13.7±4.4 mmHg, p=0.006) but the difference in mvDBP did not reach statistical signifi cance (9.8±3.5mmHg vs. 8.6±3.0 mmHg p=0.06). The ND Group had a larger maxvSBP (35.2±17.2 vs. 27.6±11.6 mmHg, p =0.01), which was more frequently over 30mmHg than that in the stable group (P=0.02). Conclusions: A large svSBP is associated with an increased risk for ND. The study highlights the importance of close monitoring of blood pressure in ischemic stroke patients.