ABSTRACT
BACKGROUND: Official guidelines on stroke promote the use of telemedicine via bidirectional videoconferencing equipment, which provides a valid and reliable means of facilitating thrombolysis delivery to patients in distant or rural hospitals. METHODS: The present prospective cohort study describes the characteristics and 3-month outcome of the thrombolysis patients treated in 5 community hospitals served by the Helsinki University Central Hospital (HUCH) in a telestroke network during 2007 to 2009. The characteristics and outcome of telestroke thrombolysis patients are compared with consecutive thrombolysis patients (n = 985) treated at HUCH. RESULTS: A total of 106 consecutive telestroke consultations in 2 years led to IV thrombolysis in 61 patients (57.5%). The median NIH Stroke Scale score was 10 (range 3-26), onset to treatment time 120 minutes (interquartile range [IQR] 49), length of consultation 25 minutes (IQR 18) if the consultation led to thrombolysis and 15 minutes (IQR 10) if not (p = 0.032). The rate of symptomatic intracranial bleedings was 6.7% (4/60) according to the National Institute of Neurological Disorders and Stroke definition. Half (28/57) of the thrombolysis patients with complete follow-up data had a favorable outcome (modified Rankin Scale [mRS] 0-2) and a third (17/57) had an excellent recovery (mRS 0-1). Thus the patients treated with thrombolysis based on teleconsultation had similar outcome with those treated at HUCH (mRS 0-2: 49.1% vs 58.1%, p = 0.214 and mRS 0-1: 17/57 [29.4%] vs 352/957 [36.8%], p = 0.289). CONCLUSIONS: A special feature of the Finnish pilot is the high percentage of consultations leading to thrombolytic treatment with features and results very similar to on-site thrombolysis at the neurologic emergency room of HUCH.
Subject(s)
Fibrinolytic Agents/therapeutic use , Guidelines as Topic , Hospitals, Rural , Stroke/drug therapy , Telemedicine/methods , Thrombolytic Therapy/methods , Videoconferencing , Adult , Aged , Aged, 80 and over , Cohort Studies , Emergency Service, Hospital , Female , Finland , Hospitals, Community , Humans , Male , Middle Aged , Prospective Studies , Stroke/physiopathology , Time Factors , Treatment OutcomeABSTRACT
Three patients with lymphocytic meningoradiculitis were admitted in 1983-84 to the Department of Neurology, University Central Hospital of Helsinki. Two patients had classical Bannwarth's meningoradiculitis with facial diplegia, and a third patient showed a migrating arthralgia and cardiac involvement compatible with a diagnosis of Lyme disease. Cerebrospinal fluid (CSF) showed initially in all patients a lymphocytic pleocytosis and increased protein with signs of intrathecal IgG synthesis.
