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  • ISSN: 2334-2307
    Early Online
    Volume 5, Issue 3
    Research Article
    Hiroyuki Kawano, Andrew Bivard, Mark W. Parsons, Christine L. Paul, Martin Krause, Catherine A. D'Este, Christopher F. Bladin, Richard I. Lindley, John R. Attia, Frans Henskens, Mark Longworth1, Sandy Middleton1, Annika Ryan, Erin Kerr, Robert W. Sanson-Fisher, Christopher R. Levi* and the Thrombolysis ImPlementation in Stroke (TIPS) Study Group
    Background: Rapid alteplase delivery for ischemic stroke patients has been shown to increase the likelihood of disability-free life. Identification of barriers to rapid alteplase delivery and streamlining processes around imaging assessments are important. Our aim was to examine the relationships between hospital arrival time and post- imaging processes in stroke thrombolysis.
    Methods: De-identified data of patients who underwent intravenous alteplase therapy at 20 hospitals in Australia were entered into the Thrombolysis ImPlementation in Stroke (TIPS) audit tool. During the pre-intervention phase, 601 patients who received alteplase = 270 minutes of stroke onset were analysed. Onset-to-door (OTD), door-to-needle (DTN), door-to-imaging (DTI), and imaging-to-needle (ITN) times were assessed using univariable and multivariable linear regression analyses.
    Results: The age was 71.3 13.4years, and the median NIHSS score was 11. The median OTD, DTN, DTI, ITN times were 73, 85, 32, and 46 minutes, respectively. Every minute earlier of OTD resulted in 0.24 minutes slower DTN (p<0.01), 0.06 minutes slower DTI (p=0.02), and 0.17 minutes slower ITN times (p<0.01). Every point decrease of baseline NIHSS score resulted in 0.66 minutes slower DTN (p =0.01) and 0.47 minutes slower DTI (p =0.01), however ITN had no significant association with baseline NIHSS score.
    Conclusions: Early arrival time was a greater contributor to delayed treatment, in particular post-imaging processes compared with pre-imaging processes, in patients with alteplase therapy for ischemic stroke. Improved processes to reduce post-imaging delays are needed for rapid alteplase treatment.
    Vahid Abbasi, Firouz Amani, Roghayeh Aslanian*, Ali Hoseinkhani, Anahita Zakeri, and Rahim Masoumi
    Introduction: Stroke is one of the neurologic diseases and the third common causes of death in USA after cancer and heart disease. Two-thirds of strokes occur in developing countries and people up 65 years old. Based on WHO report, the country Iran with 97.4 deaths per 100000 is in the 90th ranking between world countries. The aim of this study was epidemiological study on stroke in Ardabil city at 2015.
    Methods: A cross sectional study was conducted on 207 hospitalized stroke patients in Ardabil city hospital. The necessary data collected from patients hospital records and analyzed by statistical methods in SPSS.16.
    Results: 52% of patients were male and rest of them was female. 98% of patients were married and 67% were from urban. The mean age of patients was 70 13 years. 71% of patients have hypertension and 47% history of stroke. Of all patients, 25.6% had the diabetes and Hypertension at the same time that the rate of mortality in these patients was 22.6%.
    Conclusion: This study showed that the epidemiology of stroke in the Ardabil city is similar to other places and doing more studies in future is essential.
    Hiroshi Tenjin*
    Objective: Subarachnoid hemorrhage in young and middle-aged adults influences the life of patients and their family. Our goal was to identify factors associated with higher incidence of aneurysms that would justify screening; we also compared the treatment results between unruptured cerebral aneurysms (UA) and ruptured cerebral aneurysms (RA) in young and middle-aged adults as a retrospective cohort study.
    Patients: One hundred and eighteen aneurysms in one hundred and twelve patients, between 20 and 59 years old, were included this study. There were 67 UA in 61 patients and 51 RA in 51 patients. In the UA-group the size of aneurysms was 5.6 2.9 mm (2.2 17), and in the RA-group, the size of the aneurysms was 6.5 3.3 mm (3-18).
    Results: 1: UA was detected by screening 55/67 (82%). Thirty of 51 (59%) patients in whom UA was detected by screening had either long lasting or repeated headache, subarachnoid hemorrhage in second-degree relatives, hypertension, hyperlipidemia, cardiovascular disease, or were cigarette smokers. Thirty-one of 51 (61%) patients with RA had either of the above. 2: The treatment outcome: The number of patients who returned to their lifestyle before treatment with UA treated by our selection criteria was 58/59. On the other hand, that of RA was 28/51 (P<0.05).
    Conclusion: Young and middle-aged people, who have any of the following risk factors including long lasting or repeated headache, subarachnoid hemorrhage in second-degree relatives, hypertension, hyperlipidemia, cardiovascular disease, or history of cigarette smoking, are recommended to be screened for UA. The outcome was significantly better in UA compared to RA in young and middle-aged patients.
    Mini Review
    Sophia Delicou*
    Neuroferritinopathy is a recently recognized, dominantly inherited movement disorder caused by a mutation of the ferritin light chain gene.It presents in mid-adult life and is the only autosomal dominant disease in a group of conditions termed neurodegeneration with brain iron accumulation (NBIA). The most frequent presentation is with chorea (50%), followed by dystonia (42.5 %) and parkinsonism (7.5%).Brain magnetic resonance imaging demonstrates iron deposition in the basal ganglia and cavitation. Neuropathological studies have shown neuronal loss in the cerebral cortex, cerebellum and basal ganglia. Ferritin inclusion bodies were demonstrated within neurons and glia.
    Review Article
    Ramiro Palazon-Garcia*
    Spasticity is a common complication after spinal cord injury (SCI) within the upper motor neuron syndrome. The prevalence of spasticity is about 65% of people with SCI.
    This article (part 1) addresses the characteristics of spasticity in SCI patient, its pathophysiology, differences between spasticity of cerebral or spinal origin, exacerbating factors for spasticity, advantages and disadvantages caused by spasticity, and assessment of spasticity and its consequences. The treatment will be described in part 2.
    Ramiro Palazon-Garcia and Ana Maria Benavente-Valdepenas
    Spasticity is a common complication after spinal cord injury (SCI) within the upper motor neuron syndrome. We describe it in 2 parts: in the first one (Part 1) the pathophysiology, clinical features and assessment are shown, and in this part (Part 2) its treatment will be considered.
    Once it has been decided to treat spasticity, the treatment is based on starting with simpler and less problematic activities, and increasing in complexity the procedures against spasticity. The possibilities of therapy with its characteristics are described: control of triggering factors, positioning, physical modalities (stretching, muscle strengthening, cold, splinting/ orthoses, electrical stimulation, robotic devices), oral medication (baclofen, diazepam, clonazepam, tizanidine, clonidine, and cannabinoids), intrathecal baclofen, local injections (phenol, botulinum toxin) or surgical interventions.
    In order to assess the effectiveness of the different applied treatments we must measure outcomes. A management protocol is proposed for the spasticity of the SCI patient.
    Editorial
    Hiroshi Kanno*
    Spinal surgeries are based on anatomical structures around spinal bone.
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