Intravenous Thrombolysis in Ischemic Stroke Patients With Active Cancer

Introduction: It has been difficult to state specific guidelines for IV-tPA use in cancer patients. Many of the randomized tPA-trials included too few patients with cancer or excluded patients with cancer entirely. In this report, we aimed to study the use of IV-tPA in patients with active cancer and acute ischemic stroke. We also investigated if the cancer patients who received IV-tPA experienced adverse events.Methods: All patients with ischemic stroke admitted to the Stroke Unit at Haukeland University Hospital were prospectively registered in the NORSTROKE database and every patient's medical record was searched for cancer diagnoses.Results: Of 1,646 patients admitted with ischemic stroke, 82 (5.0%) patients had active cancer. The total number of patients treated with IV-tPA was 16.2%. Five patients with stroke and active cancer were treated with IV-tPA (6.1%) and none suffered adverse events. Of the patients with no history of cancer, 261 (16.7%) were treated with IV-tPA and 3.8% experienced tPA-related adverse events.Conclusions: Few patients with active cancer receive thrombolysis for acute ischemic stroke. We report five cancer patients (three known and two occult) treated with IV-tPA for ischemic stroke without tPA-related adverse events

Stroke in the Young 2012

Non peer reviewe

Stroke in the Young 2012

Non peer reviewe

Early ischemic CT changes before thrombolysis: The influence of age and diabetes mellitus

Lars Thomassen, Ulrike Waje-Andreassen, Halvor NaessDepartment of Neurology, Haukeland University Hospital, Bergen, NorwayObjectives: The significance of early ischemic changes (EIC) on computed tomography (CT) within 3 hours after stroke onset remains controversial. The semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) is found to have prognostic value in early stroke. This study assesses factors associated with the presence of EIC and the relation between EIC and clinical outcome.Materials and methods: CT scans from 61 consecutive patients receiving thrombolytic therapy were reviewed by 3 experienced stroke neurologists, assessing EIC (ASPECTS) and vascular signs (hyperdense middle cerebral artery stem and/or branches). Short-term outcome was assessed with the National Institute of Health Stroke Scale at 24 hours and long-term outcome with the modified Rankin Scale score after 3 months.Results: The prevalence of EIC was 54% and the agreement between assessors was good (kappa 0.52–0.67). EIC was independently associated with younger age and absence of diabetes mellitus. Neither EIC nor vascular signs were associated with 3-months outcome.Conclusions: ASPECTS is as simple, systematic approach to assessing EIC, and the interobserver agreement is good. Patient age and diabetes mellitus influence the presence of EIC.Keywords: acute stroke, computed tomography, ischemia, thrombolysi

Occipital lobe infarctions are different

Halvor Naess, Ulrikke Waje-Andreassen, Lars ThomassenDepartment of Neurology, Haukeland University Hospital, University of Bergen, N-5021 Bergen, NorwayObjectives: We hypothesized that occipital lobe infarctions differ from infarctions in other locations as to etiology, risk factors and prognosis among young adults.Methods: Location, etiology, risk factors and long-term outcome were evaluated among all young adults 15–49 years suffering from cerebral infarction in Hordaland County, Norway between 1988 and 1997.Results: The following variables were more frequent among patients with occipital lobe infarction compared with patients with infarctions located elsewhere: younger age (P < 0.001), female sex (P = 0.016), prothrombotic state (P = 0.005) and lack of hypertension (P = 0.001). There was no difference as to long-term mortality or recurrence of cerebral infarction. Conclusion: Occipital lobe infarctions differ from infarctions in other locations among young adults. This may have important etiologic and therapeutical implications that need further studies.Keywords: cerebral infarction, occipital lobe, young adult

Comparison between Ischemic Stroke Patients <50 Years and ≥50 Years Admitted to a Single Centre: The Bergen Stroke Study

Introduction. Young adults are likely to differ from old patients concerning cerebral infarction. Methods. We compared characteristics of patients aged under and above 50 years, admitted to the Department of Neurology with cerebral infarction between 2006 and 2009, based on prospective registration. Investigation followed one common protocol for both groups. Results and Discussion. One hundred patients (8.2%) were <50 years old, and the proportion of males was higher in this group (72% versus 55.8%, P = .002). Young stroke patients are more often current smokers (44.1% versus 23.6%, P < .001). Common causes for stroke in the young were cervical artery dissection (18% versus 0.6%, P < .001) and cardiac embolism due to disorders other than atrial arrhythmias (18% versus 5.5%, P < .001). Among the old, atrial fibrillation and flutter dominated (29.1% versus 5%, P < .001). Stroke severity and location did not differ. Old patients more often suffered from pneumonia (10.6% versus 2%, P < .003) and urinary tract infection (14.6% versus 2%, P = .001). Conclusions. Males dominate, and current smoking is more common in the young. Cervical artery dissection and nonarrhythmic heart disorders are frequent causes among young patients, while traditional risk factors dominate the old. Stroke severity is similar, but old patients seem more exposed for infectious complications

Low body temperature associated with severe ischemic stroke within 6 hours of onset: The Bergen NORSTROKE Study

Christopher E Kvistad, Lars Thomassen, Ulrike Waje-Andreassen, Halvor NaessDepartment of Neurology, Haukeland University Hospital, University of Bergen, Bergen, NorwayBackground: Hypothermia is considered neuroprotective and a potential treatment in cerebral ischemia. Some studies suggest that hyperthermia may promote clot lysis. We hypothesized that low body temperature would prolong time to spontaneous clot lysis resulting in an association between low body temperature and severe neurological deficits in the early phase of ischemic stroke.Methods: In this prospective study, patients (n = 516) exhibiting ischemic stroke with symptom onset within 6 hours were included. Body temperature and National Institute of Health Stroke Scale (NIHSS) score were registered on admission. Because low body temperature on admission may be secondary to immobilization due to large stroke, separate analyses were performed on patients with cerebral hemorrhage admitted within 6 hours (n = 85).Results: Linear regression showed that low body temperature on admission was independently associated with a high NIHSS score within 6 hours of stroke onset in patients with ischemic stroke (P &amp;lt; 0.001). The association persisted when NIHSS was measured at 24 hours after admission. No such associations were found in patients with cerebral hemorrhage admitted within 6 hours of stroke onset.Conclusion: Our study suggests that low body temperature within 6 hours of symptom onset is associated with severe ischemic stroke. This is in support of our hypothesis, although other contributing mechanisms cannot be excluded.Keywords: body temperature, cerebral infarction, cerebral hemorrhage, clot lysi

Admission C – reactive protein after acute ischemic stroke is associated with stroke severity and mortality: The 'Bergen stroke study'

<p>Abstract</p> <p>Background</p> <p>There is growing evidence that inflammation plays an important role in atherogenesis. Previous studies show that C-reactive protein (CRP), an inflammatory marker, is associated with stroke outcomes and future vascular events. It is not clear whether this is due a direct dose-response effect or rather an epiphenomenon. We studied the effect of CRP measured within 24 hours after stroke onset on functional outcome, mortality and future vascular events.</p> <p>Methods</p> <p>We prospectively studied 498 patients with ischemic stroke who were admitted within 24 hours after the onset of symptoms. CRP and NIH stroke scale (NIHSS) were measured at the time of admission. Short-term functional outcome was measured by modified Rankin scale (mRS) and Barthel ADL index (BI) 7 days after admission. Patients were followed for up to 2.5 years for long-term mortality and future vascular events data.</p> <p>Results</p> <p>The median CRP at admission was 3 mg/L. High CRP was associated with high NIHSS (p = 0.01) and high long-term mortality (p < 0.0001). After adjusting for confounding variables, high CRP remained to be associated with high NIHSS (p = 0.02) and high long-term mortality (p = 0.002). High CRP was associated with poor short-term functional outcomes (mRS > 3; BI < 95) (p = 0.01; p = 0.03). However, the association was not significant after adjusting for confounding variables including stroke severity (p = 0.98; p = 0.88). High CRP was not associated with future vascular events (p = 0.98).</p> <p>Conclusion</p> <p>Admission CRP is associated with stroke severity and long-term mortality when measured at least 24 hours after onset. There is a crude association between high CRP and short-term functional outcome which is likely secondary to stroke severity. CRP is an independent predictor of long-term mortality after ischemic stroke.</p