Magnetic resonance brain imaging in patients with acute stroke: feasibility and patient related difficulties.

OBJECTIVES: To assess organisational and patient specific limitations and safety of magnetic resonance imaging (MRI) as the first line investigation for hospital admitted stroke patients. METHODS: Consecutive patients admitted with acute stroke were assessed and an attempt was made to perform MRI in all patients. Oxygen saturation and interventions required during scanning were recorded. RESULTS: Among 136 patients recruited over 34 weeks, 85 (62%) underwent MRI. The patients' medical instability (15 of the 53 not scanned), contraindications to MRI (six of the 53 not scanned), and rapid symptom resolution (10 of the 53 not scanned) were the main reasons for not performing MRI. Of the 85 patients who underwent MRI, 26 required physical intervention, 17 did not complete scanning, and 11 of the 61 who had successful oxygen saturation monitoring were hypoxic during MRI. Organisational limitations accounted for only 13% of failures to scan. CONCLUSIONS: Up to 85% of hospital admitted acute stroke patients could have MRI as first line imaging investigation, but medical instability is the major limitation. Hypoxia is frequent in MRI. Patients should be monitored carefully, possibly by an experienced clinician, during scanning.

The influence of food ingestion on blood pressure in stroke patients.

We aimed to investigate whether and how often changes in blood pressure (BP) were occurring in relation to eating in a large sample of acute stroke patients. BP was measured non-invasively at 5-min intervals from 10 min before the meal, throughout the meal and for 10 min after completion of the meal while the patient was seated. Stroke patients (n = 93) had a higher BP at baseline than both elderly (n = 49) and young controls (n = 20), which was statistically significant. There were no significant differences in the magnitude of change of BP during the meal between the three groups. Compared with the average baseline BP recordings, stroke and elderly control patients, but not young healthy control subjects, had a significant fall in average BP recordings by 3-4 mm Hg. Falls of >/=10 mm Hg in systolic BP immediately after finishing the meal were observed in a similar frequency of stroke (26%) and elderly patients (22%) and in a small number of young controls (10%). These data suggest that acute stroke and elderly patients have similar changes in BP during and immediately after eating. Although reassuring, these results may have greater implications in patients with acute ischaemic stroke, although it is unclear whether changes in BP of this magnitude and duration might influence the fate of the penumbral brain tissue and thus the clinical outcome after stroke.

Patient positioning influences oxygen saturation in the acute phase of stroke.

We evaluated arterial oxygen saturation (SaO(2)) and heart rate in acute stroke patients to determine whether routine positioning affected these physiological parameters. Measurements were recorded at the bedside non-invasively in five different positions assigned in random order each maintained for 10 min. One hundred and twenty-nine patients examined within a median of 72 h, lying on the left side resulted in slightly lower SaO(2) than lying on the right side, which was statistically significant in the patients with a right (n = 66), but not left, hemiparesis. Patients able to sit in a chair (n = 65), who mostly had less severe strokes, had a significantly higher mean SaO(2) and heart rate when sitting in the chair than when placed in any other position. About 10% of patients, especially those with a severe stroke, with right hemiparesis and concomitant chest disease, experienced falls in SaO(2) to 90% or less for >/=2 min in certain positions; the hypoxia was more likely when they were lying on their left side. These results may have implications for current practice and for future patient positioning strategies to improve outcome after stroke.

What do nurses and therapists think about the positioning of stroke patients?

BACKGROUND: At present, there are a number of different positioning strategies for stroke patients, but these are mainly based on clinical experience rather than research. Prior to developing a study to evaluate the effect of positioning on outcome after stroke, it was important to establish if nurses in our hospital had given much thought to the positioning of stroke patients. AIM OF THE STUDY: This study aimed to explore whether nurses working on the stroke unit at a Scottish teaching hospital held different views on the positioning of conscious and unconscious stroke patients to nurses working on other wards with stroke patients and therapists. METHODS: Questionnaires on various aspects of patient positioning were sent to 150 nurses and 25 therapists working in five specialities where stroke patients are cared for in a large teaching hospital. FINDINGS: Overall, the majority of nurses and therapists (74%) believed that the best position for conscious stroke patients was sitting in a chair. Also, 80% of them believed that the best position for unconscious stroke patients was lying on the nonparetic side. There was less of a consensus between nurses and therapists working in the five specialities as to whether it was appropriate for conscious or unconscious stroke patients to lie on their paretic side, lie supine or sit propped-up in bed in either a 30 or 70 degrees angle. CONCLUSIONS: The lack of consensus between nurses working in the five specialities is probably because at present there is little research to guide nursing practices for the positioning of stroke patients. Therefore, research to confirm which positions improves or hinders outcome after stroke is essential. Indeed, positioning is a simple inexpensive strategy, which could have a substantial public health impact, as stroke is so common.

Does feeding alter arterial oxygen saturation in patients with acute stroke?

BACKGROUND AND PURPOSE: We measured arterial oxygen saturation (SaO(2)) during eating in acute stroke patients to establish the frequency of any meal-related hypoxemia, which could further damage already vulnerable brain tissue. METHODS: Stroke patients (