Abstract P311: Outpatient Evaluation of Transient Ischemic Attack and Minor, Non-Disabling Stroke During the COVID-19 Pandemic

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Paul Wechsler ◽  
Babak B Navi ◽  
Alan Z Segal ◽  
Neal S Parikh ◽  
Halina White
Keyword(s):  
Ischemic Stroke ◽  
Emergency Room ◽  
Median Time ◽  
Symptom Onset ◽  
Transient Global Amnesia ◽  
Patient Characteristics ◽  
Quality Data ◽  
Minor Stroke ◽  
Laboratory Diagnostics ◽  
Global Amnesia

Introduction: Reductions in hospital visits for stroke have been seen during the COVID-19 pandemic, partly reflecting perceived risks of in-hospital care. We recently implemented an evidence-based protocol for outpatient rapid evaluation of transient and minor, non-disabling stroke symptoms for patients seeking care 24 hours after symptom onset. We present our early experience through the pandemic. Methods: We conducted a retrospective review of patients evaluated in the RESCUE-TIA ( R apid E valuation of minor S troke and C erebrovasc U lar E vents including TIA ) clinic from December 2019-August 2020. The clinic sees patients with TIA symptoms or with fixed, non-disabling deficits seeking care > 24 hours after symptom onset. We introduced telemedicine in March 2020. Magnetic resonance brain and vascular imaging is available within 24 hours of visit. We summarized patient characteristics and quality data with standard descriptive statistics. Results: A total of 21 patients were seen in the RESCUE-TIA clinic, including 15 patients during the height of the pandemic in NY; 67% were seen by telemedicine. The median age was 75 years (interquartile range [IQR], 61-82), and 71% were women. The median NIH Stroke Score for patients with minor stroke was 0 (IQR, 0-1), and the median ABCD 2 score for TIA patients was 3 (IQR, 2-3). Median time from symptom onset to evaluation was 3 days (IQR, 2.5-17.5). Median time from evaluation to laboratory diagnostics was 8 hours (IQR, 2-21), and to completion of imaging was 1 day (IQR, 0-5). Outpatient telemetry commenced in a median of 5 days (IQR, 1-9), and echocardiography was completed in a median of 8 days (IQR, 0-10). One patient was referred to the emergency room for a carotid occlusion. Final diagnoses were TIA (n=12), ischemic stroke (n=5), transient global amnesia (n=2), migraine (n=1), and non-aneurysmal, distal subarachnoid hemorrhage (n=1). Secondary prevention was initiated or optimized in 94% of TIA and stroke patients. Recurrent TIA occurred in 1 patient after 67 days, and ischemic stroke occurred in 1 patient 55 days after TIA. Conclusion: Timely outpatient evaluation of patients with recent TIA and minor, non-disabling stroke is feasible and may be useful during the pandemic, especially during emergency room crowding.

Abstract 159: Trends in Dual Antiplatelet Therapy Prescription Patterns for Secondary Prevention in Patients With Noncardioembolic Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Peter Shrader ◽  
Eric Smith ◽  
Gregg C Fonarow ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Patient Characteristics ◽  
Minor Stroke ◽  
Secondary Stroke Prevention ◽  
Class Iii ◽  
Prescription Patterns ◽  
Class Iib ◽  
Over Time

Background: The recommendations for dual antiplatelet (DAPT aspirin + clopidogrel) for secondary stroke prevention has evolved over time. Following the publication of CHANCE trial (07/2013), the AHA/ASA updated the DAPT recommendations from Class III harm (10/2010) for patient with noncardioembolic ischemic stroke, to Class IIb benefit ≥ risk (02/2014), and Class IIa benefit >> risk (03/2018) for a subgroup of patients with minor stroke (NIHSS≤3). Subsequent to the last guideline update, the POINT trial (05/2018) provided further support for the effectiveness of DAPT. Methods: We evaluated antiplatelet prescription patterns of 1,024,074 noncardioembolic ischemic stroke survivors (median age 65 years and 46% women) eligible for antiplatelet therapy (no contraindications) and discharged from the Get With The Guidelines-Stroke Hospitals between Q1 2011 and Q1 2019. Results: Baseline patient characteristics were similar within the four periods: pre-CHANCE (01/2011-07/2013), pre-2014 guideline update (08/2013-02/2014), pre-POINT/2018 guideline update (03/2014-05/2018), and post-POINT (06/2018-03/2019). Use of DAPT gradually increased from 16.7% in the pre-CHANCE period, to 19.4% pre-2014 guideline update, 23.3% pre-POINT/2018 guideline update, and 29.8% post-POINT period (p<0.001, Figure). Yet increase in DAPT use was observed over time for individuals with NIHSS≤3 (17.1%, 19.9%, 24.1%, and 31.4%, p<0.001) and those with NIHSS>3 (18.7%, 22.8%, 28.3%, and 28.3%, p<0.001). Conclusions: A sustained increase in DAPT use for secondary stroke prevention was observed after publication of pivotal trials and AHA guideline updates. While recommended for minor strokes or TIA only, such increase was also observed in ischemic stroke patients with NIHSS>3, where the risk-benefit ratio of DAPT remains to be established.

scholarly journals Transient global amnesia: a study with Tc-99m ECD SPECT shortly after symptom onset and after recovery

2016 ◽  
Vol 22 (5) ◽  
pp. 476-480 ◽  
Author(s):  
Bom Sahn Kim ◽  
Sang Soo Cho ◽  
Joon Young Choi ◽  
Young Hwan Kim
Keyword(s):  
Symptom Onset ◽  
Transient Global Amnesia ◽  
Global Amnesia

TRANSIENT GLOBAL AMNESIA IN THE PRACTICE OF A NEUROLOGIST IN EMERGENCY ROOM OF STROKE CENTER

2015 ◽  
Vol 19 (3) ◽  
pp. 13
Author(s):  
V. N. Grigoryeva ◽  
V. N. Nesterova ◽  
T. A. Sorokina
Keyword(s):  
Emergency Room ◽  
Transient Global Amnesia ◽  
Global Amnesia ◽  
Stroke Center

scholarly journals Transient Global Amnesia and the Risk of Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (2) ◽  
pp. 389-393 ◽  
Author(s):  
Atul Mangla ◽  
Babak B. Navi ◽  
Kelly Layton ◽  
Hooman Kamel
Keyword(s):  
Ischemic Stroke ◽  
Transient Global Amnesia ◽  
Global Amnesia

Transient global amnesia does not increase the risk of subsequent ischemic stroke: a propensity score-matched analysis

2021 ◽  
Author(s):  
Aayushi Garg ◽  
Kaustubh Limaye ◽  
Amir Shaban ◽  
Harold P. Adams ◽  
Enrique C. Leira
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Transient Global Amnesia ◽  
Global Amnesia

scholarly journals Optimization of magnetic resonance imaging protocol for the diagnosis of transient global amnesia

2019 ◽  
Vol 52 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Luiz de Abreu Junior ◽  
Laiz Laura de Godoy ◽  
Luciana Pinheiro dos Santos Vaz ◽  
André Evangelista Torres ◽  
Angela Maria Borri Wolosker ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Symptom Onset ◽  
Transient Global Amnesia ◽  
B Value ◽  
Slice Thickness ◽  
Resonance Imaging ◽  
Imaging Protocol ◽  
Global Amnesia ◽  
The Ideal

Abstract Objective: To emphasize the most appropriate magnetic resonance imaging (MRI) diffusion protocol for the detection of lesions that cause transient global amnesia, in order to perform an accurate examination, as well as to determine the ideal time point after the onset of symptoms to perform the examination. Materials and Methods: We evaluated five patients with a diagnosis of transient global amnesia treated between 2012 and 2015. We analyzed demographic characteristics, clinical data, symptom onset, diffusion techniques, and radiological findings. Examination techniques included a standard diffusion sequence (b value = 1000 s/mm2; slice thickness = 5 mm) and a optimized diffusion sequence (b value = 2000 s/mm2; slice thickness = 3 mm). Results: Brain MRI was performed at 24 h or 36 h after symptom onset, except in one patient, in whom it was performed at 12 h after (at which point no changes were seen) and repeated at 36 h after symptom onset (at which point it showed alterations in the right hippocampus). The standard and optimized diffusion sequences were both able to demonstrate focal changes in the hippocampi in all of the patients but one, in whom the changes were demonstrated only in the optimized sequence. Conclusion: MRI can confirm a clinical hypothesis of transient global amnesia. Knowledge of the optimal diffusion parameters and the ideal timing of diffusion-weighted imaging (> 24 h after symptom onset) are essential to improving diagnostic efficiency.

Abstract 2185: The Historical Stroke Severity Score Predicts Stroke Progression in TIA and Minor Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Shelagh B Coutts ◽  
Andrew M Demchuk ◽  
Alexandre Y Poppe ◽  
Philip A Barber ◽  
Nan Shobha ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Symptom Onset ◽  
Severity Score ◽  
Minor Stroke ◽  
Stroke Severity ◽  
Motor Power ◽  
Motor Weakness ◽  
Symptom Progression ◽  
Severe Weakness

TIA and minor stroke have a high risk of early neurological deterioration. Many of these early deteriorations are from progression of the presenting event. It has previously been shown that patients with large early neurological improvement are at high risk of subsequent deterioration. In this study we prospectively generated a scoring system for assessing the most severe historical deficit. Methods: Consecutive patients presenting with TIA or minor stroke (NIHSS<4) were prospectively enrolled in the prospective CATCH imaging study, if a stroke neurologist assessed them and they had a CT/CTA (Aortic arch to vertex) completed within 24 hours of symptom onset. The Historical Stroke Severity Score (HSSS) was developed in advance of the study to allow measurement of the severity of a patients’ worst deficits. The HSSS was scored based upon the clinical history and ranged from 0-11 points and included assessment of: a. Level of consciousness (alert (0), drowsy (1), Unconscious (2)); b. Speech disturbance (normal (0), dysarthria only (1), mild aphasia (2), severe aphasia or mute (3)); c. Arm motor power (normal (0), mild weakness or heaviness (1), moderate weakness (2), severe weakness (3)); d. Leg motor power (normal (0), mild weakness or heaviness (1), moderate weakness (2), severe weakness (3)); e. Sensory symptoms (normal (0), mild sensory (1), severe sensory (2)). The individual components of the score and the total score were assessed for their ability to predict symptom progression. Symptom progression was defined as a worsening of the presenting symptoms related to the initial event and not as a distinct second event. Results: 510 patients were enrolled and 90-day follow up was available in 499 (98%). These patients were assessed early with a median time from symptom onset to CTA was 5.5 hours (IQR: 6.4 hours). The HSSS was rated immediately after patients were enrolled in the study - ie immediately after the CT/CTA. 19 (3.7% 95% CI 2.3-5.8) patients had symptom progression with a median time to event of one day. The progression rates for low (0-3), intermediate (4-7) and high (8-11) total scores were 2.7%, 6% and 14%. The total HSSS was associated with symptom progression (ROC 0.68 (0.56-0.79). Only the motor severity components of the HSSS were predictive of symptom progression (arm motor weakness (p=0.015) and leg motor weakness (p=0.006). Therefore the score could be simplified to include only motor historical severity of the arm and leg (ROC 0.68 (0.57-0.8) with a total score range of 0-6. Conclusions: The taking of a detailed history is highly relevant. A score based on the historical description of how severe the worst deficits were is able to predict symptom progression in a TIA and minor stroke population assessed early in the emergency department. Severity of motor symptoms appears to best predict symptom progression in TIA and minor stroke patients.

scholarly journals First experience with intravenous thrombolysis in ischemic stroke in Serbia

2007 ◽  
Vol 135 (11-12) ◽  
pp. 621-628 ◽  
Author(s):  
Dejana Jovanovic ◽  
Ljiljana Beslac-Bumbasirevic ◽  
Vladimir Kostic
Keyword(s):  
Ischemic Stroke ◽  
Median Time ◽  
Symptom Onset ◽  
Intravenous Thrombolysis ◽  
Favourable Outcome ◽  
Nihss Score ◽  
Number Of Patients ◽  
Systemic Thrombolytic Therapy ◽  
Neurological Exam

Introduction Systemic thrombolytic therapy in the first three hours of acute ischemic stroke (IS) significantly improves its outcome. This therapy was approved for treatment in USA in 1997, and in most European countries in 2002. First intravenous thrombolysis of IS in Serbia was carried out in February 2006. Objective We present our preliminary experience with intravenous thrombolysis in treating patients with acute IS and compare it with the results of other clinical studies. Method All patients with IS treated with intravenous thrombolysis in our department were included in the study. The time of stroke onset, first neurological exam, time of CT exam and beginning of therapy were recorded. The early CT signs of ischemia were graded by the ASPECTS score. Neurological deficit was assessed with NIHSS score and functional outcome with modified Rankin Scale (mRS). Results During the eight-month period intravenous thrombolysis was given to 12 patients with acute IS, aged 18 to 66 years, of whom 75% were younger than 55 years. Median time from symptom onset to hospital door was 57.5 minutes, median time door-to-CT was 32.5 minutes, and the time from symptom onset to treatment was 155 minutes. Early CT signs of ischemia were present in 10 patients with median ASPECTS score 9. Median initial NIHSS score was 16.5 with its decline during the first 24 hours for at least 5 points in 58% of patients. Symptomatic intracerebral haemorrhage was present in one patient. After 30 days of follow-up 42% of patients had favourable outcome (mRS?1). In only 2 patients the outcome was poor (mRS 4-5). One patient died with signs of cardiac failure. Conclusion Despite a small number of patients with short time of follow up, these results with thrombolysis in acute IS were found to be consistent with other authors? reports. Uniqueness of our series of patients who received thrombolysis as compared to other studies was their very young age.

scholarly journals Transient global amnesia caused by cryptogenic ischemic stroke

2021 ◽  
Vol 23 ◽  
pp. 100911
Author(s):  
Mi-Kyoung Kang ◽  
Sang Yeon Kim ◽  
Hyun Goo Kang ◽  
Byoung-Soo Shin ◽  
Chan-Hyuk Lee
Keyword(s):  
Ischemic Stroke ◽  
Transient Global Amnesia ◽  
Global Amnesia
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