Are there differences between rural and urban populations in long-term outcome after systemic cerebral thrombolysis in a hospital located in an agricultural region?

INTRODUCTION: It is generally considered that rural hospitals have a much lower capacity to adequately care for patients with acute ischemic stroke (AIS). Analysis of the demographic and logistic factors affecting the outcome of intravenous (IV) thrombolysis in patients with AIS in a rural hospital are presented. METHODS: The observational study included 300 patients with AIS who were consecutively treated with IV thrombolysis. Long-term outcome and hemorrhagic complication rate in patients from rural and urban populations were compared. RESULTS: A total of 60.7% of patients were transported from rural areas. In the rural patients thrombolytic therapy at night was performed less frequently compared to that for urban patients (p=0.01). There were no differences in frequency of treatment between rural and urban patients treated with IV thrombolysis on weekends and on working days (p=0.47). In rural patients mortality was higher (p=0.04). The presence of hemorrhagic transformation (HT) (p=0.87) and of symptomatic intra-cerebral hemorrhage (SICH) (p=0.61) were similar in both groups. A multivariate analysis showed no impact of place of onset on favorable outcome after 3 months (p=0.9), on the presence of (SICH) (p=0.43) or on mortality rate (p=0.69). CONCLUSIONS: Patients from rural areas are less likely to be treated with IV thrombolysis during the night. Rural and urban patients treated in the hospital located in the agricultural region had a similar efficacy and safety profile of thrombolytic treatment.

[Intravenous thrombolysis patients with acute ischemic stroke: the analysis of the 100 cases. Part I. Characteristic of the patients and effectiveness of treatment]. / Dozylne leczenie trombolityczne chorych z ostrym udarem niedokrwiennym mózgu--analiza 100 przypadków. Czesc I. Charakterystyka chorych oraz wyniki leczenia.

BACKGROUND: Intravenous thrombolytic therapy with recombinant tissue activator (rt-PA) in treating acute ischemic stroke is effective and safe in the time window 4.5 hours after symptom onset. MATERIAL AND METHODS: In the study group of patients demographic and logistic data and vascular risk factors were analysed. We also analysed status of the patients at the moment of admission, after 24 hours, one month and 3 months after symptom onset according to National Institutes of Health Stroke Scale (NIHSS) and results of treatment after 3 months according to modified Rankin Score (mRS). We compared the selective variables with data from the register SITS. RESULTS: Between September 2006 and April 2009 in the stroke unit in Sandomierz 807 patients with ischemic stroke were treated, including 100 patients (aged 42-88, mean 69.74 +/- 9.85; 55% of men) treated with rt-PA (12.39%). In 22% of patients treated rt-PA large and medium vessel disease, in 47%--cardiogenic embolism, in 4%--small vessel disease, in 3%-- other unusual causes and in 24%--infarct multiple etiology were diagnosed. The average time from the onset of the disease to the beginning of the treatment was 148.25 +/- 38.77 min. (in SITS centers--145 min.). At the moment of admission the average neurological conditions in NIHSS 12.03 +/- 4.94 (SITS--12); after 24 hours--8.51 +/- 6.09; after 7 days--6.51 +/- 6.38; after one month--4.27 +/- 5.15 and after 3 months--2.95 +/- 3.36 were evaluated. The results according to mRS were respectively: after 7 days--2.80 +/- 1.77; after 1 month--2.37 +/- 2.00 and after 3 months 2.16 +/- 2.16(SITS--2.5). After 3 months 53% of patients were functionally independent (SITS--53%), 29%--had moderate or severe disability (-32%) and 18%--died (-15%). CONCLUSIONS: In analysed time in stroke unit in Sandomierz the percentage of patients with acute ischemic stroke treated with rt-PA was high. The presentation of results of intravenous thrombolysis in patients with acute ischemic stroke performed in different centers makes the important aspect of evaluation of the effectiveness and safety of this therapy.

[Intravenous thrombolysis patients with acute ischemic stroke--the analysis of the 100 cases. Part II. Neuroimaging, the analysis of hemorrhagic complications and deaths]. / Dozylne leczenie trombolityczne chorych z ostrym udarem niedokrwiennym mózgu--analiza 100 przypadków. Czesc II. Badania obrazowe, analiza powiklan krwotocznych i zgonów.

INTRODUCTION: Computed tomography (CT) remains the basic diagnostic examination in patients with ischaemic stroke. The main purpose of CT examination is distinguishing between hemorrhagic and ischemic stroke, exclusion of other diseases and revealing early ischemic radiological changes. MATERIAL AND METHODS: The results of baseline CT scans and CT performed on 2nd and 7th days after symptom onset, in terms of patients' long-term outcome, presence of serious adverse events and deaths within 3 months were analyzed. RESULTS: The analysis included 100 patients treated with rt-PA in stroke unit from September 2006 to April 2009. More than one third of patients had normal baseline CT, in one third--old ischemic changes and in one third--early ischemic changes were revealed. After 3 months the patients who had early changes in baseline CT, and those who had extensive ischemic changes in the area of MCA (middle cerebral artery) or ICA (internal carotid artery) had the worst clinical status. In this group deaths appeared most often (in a subgroup with ischemic signs in the whole territory of MCA, p < 0.01 and in a group of patients with stroke in the ICA territory, p < 0.001), similarly to a group of patients with old changes in baseline CT (34.3% died; p < 0.001) and a group with cerebral edema in control CT (32.4%; p < 0.01). Hemorrhagic transformation appeared in 18% of patients. In this group of patients we found higher risk of death within 3 months after stroke onset(p < 0.001). CONCLUSIONS: The imaging examinations are very important in process of qualification of patients for thrombolytic treatment. Safety of intravenous thrombolysis in patients with ischemic stroke depends on the detailed analyses of the CT scans.

[Favourable course of herpes simplex encephalitis in the 37-year-old woman in 26th weeks of pregnancy]. / Opryszczkowe zapalenie mózgu u 37-letniej kobiety w 26 tygodniu clay o pomyslnym przebiegu.

Herpes simplex (HSV) encephalitis is a disease with a high mortality. HSV infections affect relatively young people. Characteristic neurological signs, MRI findings, PCR of cerebrospinal fluid (CSF) are useful tools in early recognition of HSV encephalitis. We present a case of HSV encephalitis with favourable course in 37-year-old woman in 26 week of pregnancy.

[The spinal epidural abscess effective conservative treatment]. / Ropnie zewnatrzoponowe kanalu kregowego skutecznie leczone metoda zachowawcza.

We present a case of 61-years-old man admitted to our department because of a strong pain in lumbar area and lower extremities. There was no neurological deficit in physical examination. MRI showed multiple extradural abscesses in thoracic and lumbar spine. Patient was treated with intravenous antibiotics and intraspinal immunoglobulin infusions. We observed gradual improvement of patient's condition, with resolution of fever and pain.