Bias in request for medical care and impact on outcome during office and non-office hours in stroke patients.

BACKGROUND AND PURPOSE: We compared characteristics and treatment success of ischaemic stroke patients admitted during daytime on working days (office hours) with patients admitted on weekend or nighttime (non-office hours) to test if differences in presentation or restraints of medical care during non-office hours determine outcome in stroke patients. METHODS: We analyzed a prospective stroke registry and grouped patients according to admission on office hours and non-office hours. Clinical state on admission, risk factors, sociodemographic items, complications, place of discharge, and clinical state on discharge were recorded. RESULTS: A total of 37,396 stroke patients were evaluated. Onset-admission time on Monday was significantly elevated and on weekend significantly reduced. Number of patients with treatment success did not differ between patient groups whilst mortality within 7 days, proportion of embolic stroke, overall mortality and rate of complications where higher in patients admitted during non-office hours, rate of thrombolytic treatment was significantly higher during non-office hours. After adjustment for clinical state and admission latency, risk for severe outcome or death was independent from time of admission. CONCLUSION: Considering the fact that stroke patients admitted during non-office hours were in more severe clinical condition we found no differences in outcome. Fear of impaired access to sophisticated treatment options during non-office hours could be dispelled by the fact, that rate of thrombolytic treatment was even higher during night and weekend. Therefore, our data do not confirm a weekend effect or night effect on stroke treatment. Delay in request of medical care of mildly affected patients that suffer from stroke on weekends confirms need for educational efforts.

LPS-induced endotoxic shock does not cause early brain edema formation - an MRI study in rats.

OBJECTIVE AND DESIGN: Early microcirculatory failure is assumed as a key factor in the development of a septic encephalopathy. However, brain edema is also a common finding in sepsis syndromes possibly interfering with the vasoregulative mechanisms of the brain. We assessed the occurrence of brain edema in a rat model of endotoxic shock. MATERIAL AND SUBJECTS: Eleven mechanically ventilated male CD-rats. TREATMENT: Intravenous application of 5 mg/kg LPS (n = 8) or vehicle (n = 3). METHODS: Apparent diffusion coefficient (ADC) and T2-relaxation time (T2RT) were quantified on cerebral MRI at baseline and repeatedly for up to 3.5 h after LPS-injection. Change in blood pressure was compensated with norepinephrine. Brain water content was quantified using the wet/dry method. RESULTS: All LPS-treated rats developed endotoxic shock. No significant difference in T2RT or ADC was detectable before and after LPS-injection (T2RT: baseline 60.33 +/- 1.21; after 3.5 h 60.15 +/- 0.59; ADC: baseline 6.86 +/- 0.51; after 3.5 h 6.75 +/- 0.33). Post-mortem analysis did not indicate a difference in brain water content between septic and non-septic animals. CONCLUSIONS: Reports of early microcirculatory failure seem not to be related to the occurrence of early (< or =3.5 h) brain edema.

Diagnostic and prognostic value of contrast-enhanced ultrasound in acute stroke.

In the last decade transcranial color-coded sonography (TCCS) was established as a routine in neurovascular departments for the evaluation of brain-supplying vessels in cerebrovascular diseases. TCCS has demonstrated feasibility and validity for the evaluation of the basal cerebral arteries, especially for the middle cerebral artery (MCA). In some patients an insufficient bone window may limit the diagnostic power. The application of microbubble agents can overcome this limitation in most patients. Beside the demonstration of vessel pathology such as stenosis and occlusion, TCCS also provides prognostic information. In the case of proximal MCA occlusion shown by TCCS within 6 hours of stroke, nearly 90 % of the patients suffered an unfavorable outcome. Furthermore TCCS is suitable for monitoring thrombolysis in acute stroke to detect whether there is recanalization of the affected vessel. The possibility for bedside examination, the non-invasiveness and the cost-effectiveness are features which make TCCS an optimal tool for the evaluation of cerebral vessels in acute ischemic stroke.