Transcranial Doppler monitoring of middle cerebral artery during verbal stimulation in aphasic patients.

Hemodynamic changes can be noninvasively real-time monitored in stroke patients by means of transcranial Doppler sonography (TCD). The aim of this pilot study was to assess hemodynamic changes in both middle cerebral arteries (MCA) in aphasic stroke patients by means of TCD during verbal stimulation. Eight aphasic patients with stroke in the territory of the left MCA were tested by modified Boston Diagnostic Aphasia Examination (BDAE) within 3 days of stroke onset. Both MCA were monitored simultaneously by means of TCD with 2 MHz probes. Basic MCA mean blood flow velocity (MBFV) values were assessed and monitored during verbal stimulation. Verbal stimulation was performed with 30 photos of objects for daily usage, arranged by function. The same test was performed in 16 right-handed healthy controls. In stroke patients, the mean MBFV were 56 cm/s in the left MCA and 56 cm/s in the right MCA. A mean 30% increase was observed in the left MCA and 22% in the right MCA. In healthy controls, a mean 21.7% increase was observed in the left MCA and 18% in the right MCA. A trend toward higher percentage of MBFV increase was observed in the left MCA during verbal stimulations in aphasic patients as compared to control subjects.

Management of patients with transient ischemic attack (TIA) at Sestre milosrdnice University Hospital Center.

Improved outcomes were observed in transient ischemic attack (TIA) patients after implementation of recommendations for stroke management and after multiple interventions such as public campaigns focused on raising awareness of stroke and reorganization of health services. The aim of this study was to describe reorganization of in-hospital services to improve the management of patients suspected of having TIA or stroke, and to validate these measures with patient outcomes. Data on 5219 patients examined between January 1 and December 31, 2008 at emergency neurology outpatient department were analyzed. Patients were referred by general practitioners, emergency physicians, or were brought by relatives without being previously seen by health services staff. The emergency services department is intended to improve care for TIA patients, providing a short standardized clinical assessment followed by initiation of a comprehensive stroke prevention program. Demographic data, risk factors, stroke type, previous TIA history, ABCD2 scores and admission rates were analyzed. A total of 1057 patients suspected of having stroke or TIA were examined. There were 447 patients with ischemic stroke (mean age 73 +/- 11 years, 196 males) and 99 patients with TIA (mean age 67 +/- 14 years, 55 males). Parenchymal hemorrhage was diagnosed in 56 and subarachnoid hemorrhage in 49 patients, while 406 patients had nonspecific symptoms or other systemic or neurologic diseases. TIA preceded stroke in 29 (6.5%) patients and 197 (44%) patients were examined for worsening of stroke symptoms (133 within 24 hours, 47 within 48 hours, and 17 within 7 days). The mean ABCD2 score was 2.95. In all examined patients, a comprehensive stroke prevention program was started; 427/447 (95%) strokes and 31/99 (31%) TIAs were hospitalized at neurology department. Four (4%) TIA patients developed stroke and were hospitalized, three of them after 2 days (ABCD2 score 3.4 and 5) and one after 7 days (ABCD2 score 5). Preventive measures resulted in a low number of strokes after TIA (< 7%), but a relatively high percentage (44%) of stroke patients ignored initial symptoms and sought medical attention after persistence or worsening of the symptoms.