Yasuyuki Iguchi

Background and Purpose: Our aim was to confirm the clinical relationship between the Kurashiki Prehospital Stroke Scale (KPSS) scored by paramedics and favorable outcomes in patients with modified Rankin scale (mRS) scores of 0–1 assessed 3 months after symptom onset. Methods: We enrolled patients with acute stroke and transient ischemic attack showing symptoms on admission. Paramedics transferred patients to our hospital after estimating stroke severity using the KPSS. After categorizing patients into either the mRS 0–1 group (favorable outcome) or the mRS 2–6 group (no favorable outcome), we compared the background data between the two groups. We assessed KPSS scores predictive of a favorable outcome. Multivariate regression modeling was conducted to identify factors independently associated with a favorable outcome. Results: The study cohort comprised 147 patients with a premorbid status of mRS 0–1: 69 patients (47%) of them were in the mRS 0–1 group and 78 (53%) in the mRS 2–6 group at the follow-up 3 months after symptom onset. The median KPSS score was lower in the mRS 0–1 group than in the mRS 2–6 group (1 vs. 4, p < 0.001). After classifying the 147 patients into KPSS tertiles with thresholds of 2 and 4, the frequency of mRS 0–1 gradually decreased with increasing KPSS score (lower KPSS, 67.2%; middle KPSS, 47.6%, and higher KPSS, 21.3%; p < 0.001). KPSS score Conclusion: KPSS score <3 apparently presents a reasonable cutoff for predicting a favorable outcome in patients with acute cerebral ischemia.

Backgrounds: Our aim was to confirm the utility of paramedics using the Kurashiki Prehospital Stroke Scale (KPSS), with a maximum score of 13, for patients who may be eligible for administration of intravenous tissue plasminogen activator (IV t-PA). Methods: The subjects comprised acute stroke and transient ischemic attack (TIA) patients transferred to our hospital by paramedics. We analyzed correlations between KPSS and the National Institutes of Health Stroke Scale (NIHSS). Patients admitted within 3 h of onset were categorized into 2 groups: KPSS ≧4 and KPSS <4. We compared the proportion of patients receiving IV t-PA between the groups. Results: Among 430 consecutive patients (mean age = 73 years; 266 men), paramedics recorded KPSS for 256 patients (59.5%). Excellent correlation was observed between KPSS and NIHSS in all 256 patients (R = 0.766; p < 0.001) and in 94 patients (ischemic stroke and TIA with symptoms on admission) admitted within 3 h of onset (R = 0.706; p < 0.001). Among these 94 patients, IV t-PA was more frequently given in the KPSS ≧4 group (30 of 58 patients, 51.7%) than in the KPSS <4 group (5 of 36 patients, 13.9%; p < 0.001). Arterial occlusion was more frequently observed in the KPSS ≧4 group (57.9 vs. 31.4%, p = 0.018). KPSS ≧4 was independently associated with administration of IV t-PA (odds ratio = 4.7; 95% confidence interval = 1.5–14.6, p = 0.008). Conclusion: Reliable concordance between KPSS and NIHSS was found in acute stroke and TIA patients. KPSS ≧4 represents a good score to indicate prospective t-PA patients among those admitted within 3 h of stroke onset.

BACKGROUND AND PURPOSE: The aim of this study was to investigate whether physiological factors, including body mass index (BMI), are associated with detection of right‐to‐left shunt (RLS) by contrast transcranial Doppler ultrasonography (c‐TCD). METHODS: After prospective c‐TCD for stroke patients, we compared clinical backgrounds between patients with positive and negative results for RLS. After counting microembolic signals (MES), RLS were functionally graded as follows (grade 0 = 0 MES, grade I = 1‐10 MES, grade II = 11‐30 MES, grade III = 31‐100 MES if countable, grade IV = over 100 MES or uncountable like a shower. RESULTS: Subjects comprised 584 patients (203 men, 381 women) with a mean age of 67.9 ± 11.1 years. RLS was detected in 134 of 584 patients (23%). In univariate analysis, mean BMI was 22.1 in patients with RLS and 23.3 in those without RLS (P= .004). Mean BMI in concordance with RLS grade gradually decreased (grade 0; 22.7, grade I; 20.8, grade II; 20.1, grade III; 19.6, P= .001). After performing the Valsalva maneuver, mean BMI in concordance with RLS grade linearly increased (grade I; 20.6, grade II; 23.2, grade III; 24.8, grade IV; 25.8, P < .001). CONCLUSION: Although smaller body size may be associated with detection of RLS, a patient with significant RLS (grade III or IV) had larger body.

Backgrounds and propose Intravenous thrombolysis using tissue plasminogen activator (tPA) can improve patient outcomes in acute stroke if administered within 3 hours of onset. However, patients with aortic dissection should avoid tPA therapy due to the possibility of tPA administration inducing rupture of the aortic dissection. We studied the frequency and clinical characteristics of stroke patients presenting with aortic dissection within 3 hours of onset. Methods Among stroke patients admitted to our hospital within 3 hours of onset, we examined the frequency of patients presenting with aortic dissection. Next, we examined the clinical characteristics of such patients, including cases published on PubMed. Results Among 208 stroke patients presenting within 3 hours of onset, 2 patients (1%) displayed aortic dissection. Carotid duplex ultrasonography could exclude them from tPA therapy. For 19 patients, including 17 published cases from PubMed, median age was 61.0 years, 47% were women, right pulse weakness was seen in 70%, chest pain in 22%, and lone left hemiparesis in 72%. In 6 patients, carotid ultrasonography showed arterial dissection due to aortic dissection. Conclusion Aortic dissection may not be a rare complication in acute stroke within 3 hours of onset. Right pulse weakness and left hemiparesis are often present. Carotid ultrasonography may be useful in diagnosing aortic dissection before tPA infusion.