Sex Differences in Care and Long-Term Mortality After Stroke: Australian Stroke Clinical Registry.

There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry. Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations.

LC3 Immunostaining in the Inferior Olivary Nuclei of Cats With Niemann-Pick Disease Type C1 Is Associated With Patterned Purkinje Cell Loss.

The feline model of Niemann-Pick disease, type C1 (NPC1) recapitulates the clinical, neuropathological, and biochemical abnormalities present in children with NPC1. The hallmarks of disease are the lysosomal storage of unesterified cholesterol and multiple sphingolipids in neurons, and the spatial and temporal distribution of Purkinje cell death. In feline NPC1 brain, microtubule-associated protein 1 light chain 3 (LC3) accumulations, indicating autophagosomes, were found within axons and presynaptic terminals.

Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry.

Background: Given the potential differences in etiology and impact, the treatment and outcome of younger patients (aged 18-64 years) require examination separately to older adults (aged ≥65 years) who experience acute stroke.

Methods: Data from the Australian Stroke Clinical Registry (2010-2015) including demographic and clinical characteristics, provision of evidence-based therapies and health-related quality of life (HRQoL) post-stroke was used. Descriptive statistics and multilevel regression models were used for group comparisons.

Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme.

Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017.

Strategic framework improves access to stroke reperfusion across the state of Victoria Australia.

Background: In 2010, rapid access to stroke thrombolysis centres was limited in some regional areas in the Australian state of Victoria. These results, and planning for endovascular clot retrieval (ECR), have led to the implementation of strategies by the Victorian Stroke Clinical Network, the Victorian Stroke Telemedicine Program and local health services to improve state-wide access.

Aims: To examine whether access to stroke reperfusion services (thrombolysis and ECR) in regional Victoria have subsequently improved.

Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion: Real-World Data in the Thrombectomy Era.

Background And Purpose: Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials.

Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR).

Objectives: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate.

Design: Cohort design linking Australian Stroke Clinical Registry data with national death registrations.

Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective.

We undertook a qualitative analysis to identify the broader benefits of a state-wide acute stroke telemedicine service beyond the patient-clinician consultation. Since 2010, the Victorian Stroke Telemedicine (VST) programme has provided a clinical service for regional hospitals in Victoria, Australia. The benefits of the Victorian Stroke Telemedicine programme were identified through document analysis of governance activities, including communications logs and reports from hospital co-ordinators of the programme.

Intravenous thrombolysis for acute ischaemic stroke in the setting of rivaroxaban use.

The risk of thrombolysis in patients taking novel anticoagulants remains unclear. We describe a patient with a large acute ischaemic stroke, who had a low calibrated anti-factor Xa level, who safely received thrombolysis 15-17 hours after standard dose rivaroxaban without subsequent intracerebral haemorrhage.

Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months.

Objective: To test the transferability of the Helsinki stroke thrombolysis model that achieved a median 20-minute door-to-needle time (DNT) to an Australian health care setting.

Methods: The existing "code stroke" model at the Royal Melbourne Hospital was evaluated and restructured to include key components of the Helsinki model: 1) ambulance prenotification with patient details alerting the stroke team to meet the patient on arrival; 2) patients transferred directly from triage onto the CT table on the ambulance stretcher; and 3) tissue plasminogen activator (tPA) delivered in CT immediately after imaging. We analyzed our prospective, consecutive tPA registry for effects of these protocol changes on our DNT after implementation during business hours (8 am to 5 pm Monday-Friday) from May 2012.

Do patients who take part in stroke research differ from non-participants? Implications for generalizability of results.

Background: Stroke is one of the most disabling neurological conditions. Clinical research is vital for expanding knowledge of treatment effectiveness among stroke patients. However, evidence begins to accumulate that stroke patients who take part in research represent only a small proportion of all stroke patients.

CT perfusion improves diagnostic accuracy and confidence in acute ischaemic stroke.

Background And Objective: CT perfusion (CTP) is rapid and accessible for emergency ischaemic stroke diagnosis. The feasibility of introducing CTP and diagnostic accuracy versus non-contrast CT (NCCT) in a tertiary hospital were assessed.

Methods: All patients presenting <9 h from stroke onset or with wake-up stroke were eligible for CTP (Siemens 16-slice scanner, 2×24 mm slabs) unless they had estimated glomerular filtration rate (eGFR)<50 ml/min or diabetes with unknown eGFR.

Differing associations of white matter lesions and lacunar infarction with retinal microvascular signs.

Background: White matter lesions (WML) and lacunar infarcts (LI) are believed to have microvascular etiologies but the exact microvascular changes occurring in each is unclear.

Aim: Using the retina as a proxy, we assessed retinal microvascular changes in WML and LI.

Methods: We prospectively recruited 1211 acute stroke patients.

Transient ischemic attack and acute ischemic stroke: associations with retinal microvascular signs.

Background And Purpose: Small vessel disease plays a role in cerebral events. We aimed to investigate the prevalence and patterns of retinal microvascular signs (surrogates for cerebral small vessel disease) among patients with transient ischemic attack (TIA) or acute stroke and population control subjects.

Methods: Patients with TIA or acute stroke aged ≥49 years admitted to hospitals in Melbourne and Sydney, Australia, were recruited to the Multi-Centre Retina and Stroke Study (n=693, 2005 to 2007).

Retinopathy and lobar intracerebral hemorrhage: insights into pathogenesis.

Background: The vascular pathogenesis underlying lobar intracerebral hemorrhage (ICH) is unclear.

Objective: To determine whether certain retinal microvascular signs are associated with lobar ICH to improve understanding of its underlying cerebral vasculopathy.

Design: Prospective cohort study.

Differential associations of cortical and subcortical cerebral atrophy with retinal vascular signs in patients with acute stroke.

Background And Purpose: The relationship of cortical and subcortical cerebral atrophy to cerebral microvascular disease is unclear. We aimed to assess the associations of retinal vascular signs with cortical and subcortical atrophy in patients with acute stroke.

Methods: In the Multi-Centre Retinal Stroke Study, 1360 patients with acute stroke admitted to 2 Australian and 1 Singaporean tertiary hospital during 2005 to 2007 underwent neuroimaging and retinal photography.

Brain imaging in transient ischemic attack--redefining TIA.

Transient ischemic attack (TIA) has recently been redefined to incorporate the latest clinical and neuroimaging information that has shed new light on TIA pathophysiology. Patients suffering from TIA are at a substantial risk of subsequent stroke, but quantifying this risk is difficult as TIA patients are a heterogeneous population and there are multiple TIA mimics. Clinical scores for prediction of stroke risk are principally based on patient history and potentially understate actual risk.

Retinal fractals and acute lacunar stroke.

This study aimed to determine whether retinal fractal dimension, a quantitative measure of microvascular branching complexity and density, is associated with lacunar stroke. A total of 392 patients presenting with acute ischemic stroke had retinal fractal dimension measured from digital photographs, and lacunar infarct ascertained from brain imaging. After adjusting for age, gender, and vascular risk factors, higher retinal fractal dimension (highest vs lowest quartile and per standard deviation increase) was independently and positively associated with lacunar stroke (odds ratio [OR], 4.

Retinal microvascular signs may provide clues to the underlying vasculopathy in patients with deep intracerebral hemorrhage.

Background And Purpose: Deep intracerebral hemorrhage (ICH) and lacunar infarcts are the result of small vessel disease, whereas nonlacunar infarcts are often caused by large artery atherosclerosis or cardiac embolism. We hypothesized that patients with deep ICH and lacunar infarcts have similar retinal microvascular signs and that these differ from those seen in patients with nonlacunar infarcts.

Methods: We studied patients with acute stroke and classified their stroke as deep ICH, lacunar infarction, or nonlacunar infarction.

Acute hyperglycaemia and mortality in patients with transient ischaemic attack.

Acute hyperglycaemia is associated with poorer outcome in stroke, however limited evidence is available regarding its association with transient ischaemic attack (TIA). This study aimed to determine the association between acute hyperglycaemia and mortality in 194 patients with TIA. Mortality data were obtained from a state-wide death registry.

Retinal vascular caliber and extracranial carotid disease in patients with acute ischemic stroke: the Multi-Centre Retinal Stroke (MCRS) study.

Background And Purpose: Previous studies show that both retinal vascular caliber and carotid disease predict incident stroke in the general population, but the exact relationship between these 2 microvascular and macrovascular structural risk factors is unclear. We studied the relationship between retinal vascular caliber and carotid disease in patients presenting with acute ischemic stroke.

Methods: We conducted a cross-sectional study of patients with acute ischemic stroke recruited from 3 centers (Melbourne, Sydney, Singapore).