Predictors of noticing stroke educational campaign.

BACKGROUND: Long-term campaigns to improve stroke awareness, such as the campaign conducted in the Czech Republic since 2006, have not been effective. However, the small subpopulation that noticed the campaign had better stroke awareness than the population that did not. To better understand this awareness campaign responsiveness and to design more successful future campaigns, predictors of noticing campaigns were identified. MATERIALS AND METHODS: This study is a secondary analysis of cross-sectional nationwide survey data of the Czech population older than 40 years, collected in 2009. The survey used a 3-stage random sampling method (area, household, and household member) and personal semistructured interview questionnaires concerning participants' stroke knowledge, demographic characteristics, medical history, and stroke information sources. To identify the association between these variables and whether the campaign was noticed (the primary outcome of the study), multivariate binary logistic regression analysis was used. RESULTS: A total of 601 participants were surveyed (90% response rate), 19% of them stated that they noticed the stroke awareness campaign. Primary independent predictors of campaign efficiency were heart disease (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.2), obesity (OR, 2.4; 95% CI, 1.3-4.7), and current smoking (OR, .4; 95% CI, .3-.7). CONCLUSIONS: Tobacco smokers in particular should be targeted by stroke awareness campaigns, for example, through health warning labels on cigarette packs. People with some stroke risk factors, such as heart disease and obesity, are responsive to information about stroke. Therefore, educational campaigns should target the groups with increased risk of stroke.

Impairment of brain vessels may contribute to mortality in patients with Parkinson's disease.

BACKGROUND: The effect of brain-vessel pathology on mortality in 57 consecutive PD patients was studied. METHODS: Baseline clinical, neuropsychological, ultrasonographic (US), and MR data obtained from patients who died (n = 18) during a 4-year follow-up period were compared with the data of patients who survived. RESULTS: US/MRI data displayed a more-severe vascular impairment in deceased patients. Differences were significant between both groups with respect to age, clinical and cognitive status, intima-media thickness, and resistance index (indicators of large and small vessel impairment). The sum score of white-matter hyperintensities was significantly higher among decedents. A cluster analysis displayed two clusters that differed in the two parameters (i.e. in age and in sum score). CONCLUSIONS: This study provides evidence that comorbid atherosclerosis and otherwise subclinical impairment of brain vessels may contribute to mortality in PD. The vascular pathology may act in association with other comorbidities on the terrain of progressive neurodegenerative pathology.

Reperfusion therapies for acute ischemic stroke.

OPINION STATEMENT: Ischemic stroke is most often caused by an acute extracranial or intracranial thromboembolic lesion obstructing an artery. It has been demonstrated that recanalization is the most important modifiable predictor of a good clinical outcome. Reperfusion strategies focus on early reopening of the vessel to reestablish antegrade flow within the penumbra.Current standard therapy within 4.5 h is intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA, 0.9 mg/kg body weight, maximum dose 90 mg). Thrombolytic therapy appears to be safe and effective across various types of hospitals, if the treatment is conducted by a physician with stroke expertise.New imaging methods (MR diffusion/perfusion, CT perfusion) are being investigated in order to better select patients who are most likely to benefit from recanalization therapy based on current clinical evidence. Neither perfusion imaging with CT or MR nor the mismatch concept are recommended for routine treatment decisions within or beyond the 4.5 h available for IVT.If major vessel occlusion is proven but IVT is contraindicated, intra-arterial thrombolysis (IAT) with tPA or mechanical thrombectomy with the Merci Retriever or Penumbra System may be a treatment option. The availability of IAT generally should not preclude the intravenous administration of tPA in otherwise eligible patients. Intra-arterial treatment can be performed within 8 h after stroke onset. Combining intravenous tPA pretreatment with subsequent IAT or mechanical thrombectomy may improve the recanalization rate and may be used as a rescue therapy in cases of persistent major vessel occlusion after unsuccessful IVT.Despite testing, no thrombolytic agent other than tPA (e.g., IIb/IIIa antagonists, heparin, etc.) has yet been approved for routine practice for either intravenous or intra-arterial application, alone or in combination with tPA.Continuous transcranial Doppler (TCD) monitoring of an occluded vessel may increase the rate of early recanalization after tPA; this effect may be facilitated by the administration of microbubbles. This method is still considered experimental.

Outcome of patients with negative CT angiography results for arterial occlusion treated with intravenous thrombolysis.

BACKGROUND AND PURPOSE: Stroke patients without evidence of arterial occlusion may not be suitable candidates for thrombolytic therapy. In our study, we investigated the outcomes of patients with negative CT angiography results for arterial occlusion. METHODS: The study included patients treated within 3 hours after symptom onset with intravenous thrombolysis for significant neurological deficit between August 2003 and June 2007. All of the patients were documented with negative CT angiography results for arterial occlusion by independent reviews. Outcome measurements included modified Rankin score at 3 months, incidence of intracranial hemorrhage, and infarction volume on control CT. The predictors of unfavorable outcome (modified Rankin score, 2-6) were identified by multivariate logistic regression. RESULTS: Altogether, 173 patients received intravenous thrombolysis; of those, 138 underwent CT angiography. The CT angiography results were negative for arterial occlusion in 39 (28%) of the patients: mean age, 71+/-10 years; 16 (41%) female; median baseline NIHSS, 11. At 3 months, modified Rankin score of 0 to 1 was achieved in 18 (46%) of the patients; 6 (15%) died; and 3 (8%) had symptomatic parenchymal hemorrhage. The median infarct volume was 1.5 cm(3). The independent predictors of unfavorable clinical outcome were higher age (OR, 1.1; 95% CI, 1.01-1.27), and baseline NIHSS >12 (OR, 18.8; 95% CI, 1.4 to 261). One patient had encephalitis diagnosed. CONCLUSIONS: Negative baseline CT angiography is not uncommon. The risk of intracerebral hemorrhage after thrombolytic therapy for patients without evidence of arterial occlusion is similar to the risk carried in an unselected patient population. Given the prognosis, thrombolytic therapy seems justified; however, etiology other than stroke should be considered.

Vascular pathology in patients with idiopathic Parkinson's disease.

To study the impact of brain vessel pathology on the clinical status of Parkinson's disease (PD), in 57 consecutive patients the clinical and neuropsychological data were compared with clinical MRI signs of vascular impairment and with the ultrasound brain vessel investigations. There was a significant correlation between clinical and cognitive status and intimomedial thickness, which is an indicator of large vessel impairment. Cognitive status was significantly related to the pulsatility index (an indicator of small vessel impairment). This study provides evidence that subclinical vascular pathology could influence the clinical status by contributing to motor and cognitive dysfunction in PD.