Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes

Wallace, Emma; Liberman, Ava L

doi:10.2147/ndt.s275750

Cited by 9 publications

(13 citation statements)

References 107 publications

(172 reference statements)

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“…The symptoms reach their peak within minutes or hours of onset. As earlier alluded to, the nature of symptoms as well as their severity depends on the artery involved [ 19 ]. Failure to provide quick interventions can endanger the patient's life [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Mannitol Combined with 6-Aminocaproic Acid in the Treatment of Patients with Cerebral Hemorrhage and Its Impact on Immune Function

Tian

Zhang

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To determine the efficacy of Mannitol combined with 6-aminocaproic acid in the treatment of patients with cerebral hemorrhage, as well as its impact on the immune system. Methods. The study subjects consisted of 122 patients with early intracerebral hemorrhage treated in our hospital from April 2019 to April 2022. Based on the different admission times, the participants were randomly divided into the control group and the study group in a ratio of 1:1. 6-Aminocaproic acid was used to treat patients in the control group, while Mannitol along with 6-aminocaproic acid was used to treat patients in the study group. Short form-36 health survey (SF-36) scores, hematoma volume changes, National Institutes of Health Stroke Scale (NIHSS), and Mini-Mental State Examination (MMSE) scores, clinical efficacy, and changes in the immune function in patients from the two groups were analyzed and compared. Results. The total efficacy of treatment in the study group was significantly higher than that in the control group (x2 = 9,375, P < 0.001 ). Patients in the study group had significantly higher scores in social function, mental health, physical function, and physiological function compared to those in the control group ( P < 0.05 ). After treatment, there was a significant reduction in NIHSS scores in patients from both groups, but a greater reduction was seen in patients from the study group ( P < 0.05 ). After 2 weeks of treatment, the volume of cerebral edema was significantly smaller in patients from the study group than in those from the control group ( P < 0.05 ). Before treatment, there was no significant difference in the number of CD4+ and CD8+ T lymphocytes between patients in the two groups. However, after treatment, patients in the study group had higher numbers of CD4+ T lymphocytes and lower numbers of CD8+ T lymphocytes compared to those in the control group ( P < 0.05 ). Conclusions. The combination of Mannitol and 6-aminocaproic acid appears to be very efficacious in the treatment of cerebral hemorrhage. It improves immune function, reduces neurological damage, and minimizes the volume of cerebral edema.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Mannitol Combined with 6-Aminocaproic Acid in the Treatment of Patients with Cerebral Hemorrhage and Its Impact on Immune Function

Tian

Zhang

2022

Evidence-Based Complementary and Alternative Medicine

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“…Indeed, symptoms such as vertigo, dysphagia, gait disturbance, nystagmus, cranial nerve palsies, and ataxia are not adequately assessed by the NIHSS score [13]. On the other hand, such symptoms associated with posterior circulation stroke may lead to an under-recognition of this pathology by clinicians, as well as other less common symptoms, such as nausea and vomiting, imbalance, ill-defined dizziness, and isolated vertigo [14,15]. Physicians must consider that patients presenting at the emergency department with a low NIHSS score may have a posterior circulation stroke.…”

Section: Discussionmentioning

confidence: 99%

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre

Valente

Consoli

et al. 2021

Life

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Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion (“functional” BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0–0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0–0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33–16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16–3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.

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“…This is reflected in a study comparing 156 consecutive stroke patients misdiagnosed in an emergency department in Sydney, Australia, which found that patients who experienced stroke misdiagnosis were commonly FAST-negative and displayed non-specific or atypical symptoms ( 70 ). The problem of stroke misdiagnosis has seen calls for a broadening of the symptoms being considered during the initial stroke diagnosis period and improvements to the diagnosis process itself ( 69 , 71 ). Studies into the adoption of utilizing BE-FAST (Balance, Eyes, Face, Arms, Speech, and Time) as a wider screening technique in acute intervention found that this helped reduce the amount of missed strokes ( 72 , 73 ).…”

Section: Discussionmentioning

confidence: 99%

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

Hall

Kroll

Wijck

et al. 2022

Front. Rehabilit. Sci.

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BackgroundStroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals.MethodsThis study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions.FindingsSix online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support.ConclusionStroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.

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Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes

Cited by 9 publications

References 107 publications

The Efficacy of Mannitol Combined with 6-Aminocaproic Acid in the Treatment of Patients with Cerebral Hemorrhage and Its Impact on Immune Function

The Efficacy of Mannitol Combined with 6-Aminocaproic Acid in the Treatment of Patients with Cerebral Hemorrhage and Its Impact on Immune Function

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

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