Glossopharyngeal Neuralgia Associated With Bradycardia and syncope-a Case Report.

We describe a case of 76-year-old woman with glossopharyngeal neuralgia who developed bradycardia and syncope after decreased carbamazepine dosing due to worsening renal function. Telemetry and EKG showed bradycardia and sinus pauses associated with paroxysms of typical glossopharyngeal neuralgia pain. With the addition of gabapentin to carbamazepine, her glossopharyngeal neuralgia pain as well as bradycardia resolved.

Tissue-Based Stroke Definition Impacts Stroke Incidence but not Ethnic Differences.

Objectives: We explored how the new, tissue-based stroke definition impacted incidence estimates, including an ethnic comparison, in a population-based study.

Methods: Stroke patients, May, 2014-May, 2016 in Nueces County, Texas were ascertained and validated using source documentation. Overall, ethnic-specific and age-specific Poisson regression models were used to compare first-ever ischemic stroke and intracerebral hemorrhage (ICH) incidence between old and new stroke definitions, adjusting for age, ethnicity, sex, and National Institutes of Health Stroke Scale score.

Assessment of the End Point Adjudication Process on the Results of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial: A Secondary Analysis.

Importance: Debate continues about the value of event adjudication in clinical trials and whether independent centralized assessments improve reliability and validity of study results in masked randomized trials compared with local, investigator-assessed end points.

Objective: To assess the results of the adjudicated end point process in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial by comparing end points assessed by local site investigators with centrally adjudicated end points.

Design, Setting, And Participants: This is an ad hoc secondary analysis of a randomized, double-blind clinical trial comparing safety and effectiveness of clopidogrel bisulphate plus aspirin vs placebo plus aspirin.

The effect of concussion on batting performance of major league baseball players.

Purpose: Previous investigations into concussions' effects on Major League Baseball (MLB) players suggested that concussion negatively impacts traditional measures of batting performance. This study examined whether post-concussion batting performance, as measured by traditional, plate discipline, and batted ball statistics, in MLB players was worse than other post-injury performance.

Subjects And Methods: MLB players with concussion from 2008 to 2014 were identified.

The stroke navigator: meaningful use of the electronic health record to efficiently report inpatient stroke care quality.

To facilitate high-quality inpatient care for stroke patients, we built a system within our electronic health record (EHR) to identify stroke patients while they are in the hospital; capture necessary data in the EHR to minimize the burden of manual abstraction for stroke performance measures, decreasing daily time requirement from 2 hours to 15 minutes; generate reports using an automated process; and electronically transmit data to third parties. Provider champions and support from the EHR development team ensured that we balanced the needs of the hospital with those of frontline providers. This work summarizes the development and implementation of our stroke quality system.

Morphometric Evaluation of the Frontal Migraine Trigger Site.

Background: Migraine headache has been attributed to specific craniofacial peripheral nerve trigger sites. Some have postulated that hypertrophy of the corrugator muscles causes compression of the supraorbital and supratrochlear nerves, resulting in migraine headache. This study uses morphometric evaluation to determine whether corrugator anatomy differs between patients with migraine headache and control subjects.

Stroke Quality Measures in Mexican Americans and Non-Hispanic Whites.

Mexican Americans (MAs) have been shown to have worse outcomes after stroke than non-Hispanic Whites (NHWs), but it is unknown if ethnic differences in stroke quality of care may contribute to these worse outcomes. We investigated ethnic differences in the quality of inpatient stroke care between MAs and NHWs within the population-based prospective Brain Attack Surveillance in Corpus Christi (BASIC) Project (February 2009- June 2012). Quality measures for inpatient stroke care, based on the 2008 Joint Commission Primary Stroke Center definitions were assessed from the medical record by a trained abstractor.

Stroke Performance Measures Do Not Predict Functional Outcome.

Background And Purpose: Poststroke functional outcome is critical to stroke survivors. We sought to determine whether adherence to current stroke performance measures is associated with better functional outcome 90 days after an ischemic stroke.

Methods: Utilizing the Brain Attack Surveillance in Corpus Christi cohort, we examined adherence to 7 ischemic stroke performance measures from February 2009 to June 2012.

Sex Disparity in Stroke Quality of Care in a Community-Based Study.

Background: Studies have suggested that women may receive lower stroke quality of care (QOC) than men, although population-based studies at nonacademic centers are limited. We investigated sex disparities in stroke QOC in the Brain Attack Surveillance in Corpus Christi Project.

Methods: All ischemic stroke patients admitted to 1 of 6 Nueces County nonacademic hospitals between February 2009 and June 2012 were prospectively identified.

Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study.

Objective: To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.

Methods: Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset.

Protocol Deviations before and after Treatment with Intravenous Tissue Plasminogen Activator in Community Hospitals.

Background: Protocol deviations before and after tissue plasminogen activator (tPA) treatment for ischemic stroke are common. It is unclear if patient or hospital factors predict protocol deviations. We examined predictors of protocol deviations and the effects of protocol violations on symptomatic intracerebral hemorrhage (sICH).

Marked Regional Variation in Acute Stroke Treatment Among Medicare Beneficiaries.

Background And Purpose: Little is known about how regions vary in their use of thrombolysis (intravenous tissue-type plasminogen activator and intra-arterial treatment) for acute stroke. We sought to determine regional variation in thrombolysis treatment and investigate the extent to which regional variation is accounted for by patient demographics, regional factors, and elements of stroke systems of care.

Methods: Retrospective cross-sectional study of all fee-for-service Medicare patients with ischemic stroke admitted via the Emergency Department from 2007 to 2010 who were assigned to 1 of 3436 hospital service areas.

The Women Independently Living Alone with a Medical Alert Device (WILMA) trial.

Women are more likely to live alone compared with men, and therefore have more difficulty activating emergency medical systems for stroke. The goal of this study was to examine the benefit of wearing medical alert devices to activate emergency medical systems for elderly women living alone. This was a randomized, controlled pilot trial.

Influence of training institution on academic affiliation and productivity among plastic surgery faculty in the United States.

Background: Educational processes that encourage a career in academic plastic surgery remain unclear. The authors' study aim was to examine the impact of training institution on the pursuit of a career in academic plastic surgery.

Methods: Academic plastic surgery faculty (n = 838) were identified through an Internet-based search of all 94 Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs.

Loss of the Mexican American survival advantage after ischemic stroke.

Background And Purpose: Mexican Americans (MAs) were previously found to have lower mortality after ischemic stroke than non-Hispanic whites. We studied mortality trends in a population-based design.

Methods: Active and passive surveillance were used to find all ischemic stroke cases from January 2000 to December 2011 in Nueces County, TX.

Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.

Background And Purpose: Poststroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among patients with stroke.

Influence of hospital-level practices on readmission after ischemic stroke.

Objective: To inform stroke quality improvement initiatives by determining the relationship between hospital-level stroke practices and readmission after accounting for patient-level factors.

Methods: Retrospective cohort study of adult patients hospitalized for ischemic stroke (principal ICD-9-CM codes 433.x1, 434.

Intracerebral hemorrhage mortality is not changing despite declining incidence.

Objective: To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study.

Methods: We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases.

The accuracy of surrogate decision makers: informed consent in hypothetical acute stroke scenarios.

Background: Over one third of stroke patients have cognitive or language deficits such that they require surrogate consent for acute stroke treatment or enrollment into acute stroke trials. Little is known about the agreement of stroke patients and surrogates in this time-sensitive decision-making process. We sought to determine patient and surrogate agreement in 4 hypothetical acute stroke scenarios.

Stroke awareness among inpatient nursing staff at an academic medical center.

Background And Purpose: Because 10% of strokes occur in hospitalized patients, we sought to evaluate stroke knowledge and predictors of stroke knowledge among inpatient and emergency department nursing staff.

Methods: Nursing staff completed an online stroke survey. The survey queried outcome expectations (the importance of rapid stroke identification), self-efficacy in recognizing stroke, and stroke knowledge (to name 3 stroke warning signs or symptoms).

Persistent ischemic stroke disparities despite declining incidence in Mexican Americans.

Objective: To determine trends in ischemic stroke incidence among Mexican Americans and non-Hispanic whites.

Methods: We performed population-based stroke surveillance from January 1, 2000 to December 31, 2010 in Corpus Christi, Texas. Ischemic stroke patients 45 years and older were ascertained from potential sources, and charts were abstracted.