Characteristics and predictors of stroke mimics in young patients in the norwegian tenecteplase stroke trial (NOR-TEST).

Background: Several studies have shown that stroke mimics occur more often among young patients. Our aims were to identify the common mimics in young patients under the age of 60 years who received thrombolysis, to analyze the risk of hemorrhage after treatment with thrombolysis, and to identify risk factors and clinical parameters that might identify mimics in this group.

Methods: Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs.

Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial.

Background: Tenecteplase is a modified tissue plasminogen activator with pharmacological and practical advantages over alteplase-which is currently the only approved thrombolytic drug for ischaemic stroke. The NOR-TEST trial showed that 0·4 mg/kg tenecteplase had an efficacy and safety profile similar to that of a standard dose (0·9 mg/kg) of alteplase, albeit in a patient population with a high prevalence of minor stroke. The aim of NOR-TEST 2 was to establish the non-inferiority of tenecteplase 0·4 mg/kg to alteplase 0·9 mg/kg for patients with moderate or severe ischaemic stroke.

Atrial fibrillation in cryptogenic stroke and transient ischaemic attack - The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design.

Purpose: Paroxysmal atrial fibrillation is often suspected as a probable cause of cryptogenic stroke. Continuous long-term ECG monitoring using insertable cardiac monitors is a clinically effective technique to screen for atrial fibrillation and superior to conventional follow-up in cryptogenic stroke. However, more studies are needed to identify factors which can help selecting patients with the highest possibility of detecting atrial fibrillation with prolonged rhythm monitoring.

Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial.

Background: Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis.

Early Thrombectomy of a Proximal Middle Cerebral Artery Occlusion Leading to Complete Recovery with No Infarct.

Many recent trials show the benefit of mechanical thrombectomy in acute ischemic stroke caused by thrombi lodged in large arteries. We report the case of a 55-year-old patient who developed sudden-onset right-sided hemiplegia and aphasia. Computed tomography angiography showed a thrombus in the M1 segment of the left middle cerebral artery.

A pragmatic approach to sonothrombolysis in acute ischaemic stroke: the Norwegian randomised controlled sonothrombolysis in acute stroke study (NOR-SASS).

Background: Ultrasound accelerates thrombolysis with tPA (sonothrombolysis). Ultrasound in the absence of tPA also accelerates clot break-up (sonolysis). Adding intravenous gaseous microbubbles may potentiate the effect of ultrasound in both sonothrombolysis and sonolysis.

The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke.

Background: Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking.

C-reactive protein and homocysteine predict long-term mortality in young ischemic stroke patients.

Background: We investigated the relationship between C-reactive protein (CRP) and homocysteine on follow-up and subsequent mortality in young ischemic stroke patients in a population-based study.

Methods: Young ischemic stroke patients were followed-up on average 6 years after the index stroke. CRP and homocysteine levels were measured and risk factors were recorded, including myocardial infarction, diabetes mellitus, hypertension, smoking, alcoholism, and cancer.

Serum uri acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study.

Background: A possible synergic role of serum uric acid (SUA) with thrombolytic therapies is controversial and needs further investigations. We therefore evaluated association of admission SUA with clinical improvement and clinical outcome in patients receiving rt-PA, early admitted patients not receiving rt-PA, and patients admitted after time window for rt-PA.

Methods: SUA levels were obtained at admission and categorized as low, middle and high, based on 33° and 66° percentile values.

Microemboli-monitoring during the acute phase of ischemic stroke: is it worth the time?

Background: The prevalence of microembolic signals (MES) during the acute phase of ischemic stroke and its influence on outcome is not well studied. The aim of our study was to determine the prevalence of MES, the different factors that are associated with the presence of MES and the association between MES and outcomes in stroke patients investigated within 6 hours after the onset of ischemic stroke.

Methods: We included unselected ischemic stroke patients who underwent microemboli-monitoring within six hours after stroke onset.

High proportion of lacunar strokes at night: the Bergen stroke study.

The main objective of this study was to investigate the circadian distribution of subtypes of ischemic stroke. The time of onset of stroke in consecutive stroke patients was registered and categorized into the following time intervals: midnight-6 am, 6 am-noon, noon-6 pm, and 6 pm-midnight. Patients with unknown onset of stroke were categorized as woke up with stroke, found with stroke by others, and miscellaneous.

Clinical presentation and diffusion weighted MRI of acute cerebral infarction. The Bergen Stroke Study.

Background: No large study has compared the yield of diffusion-weighted imaging (DWI) with clinical examination in order to differentiate lacunar stroke from other stroke subtypes. This differentiation is important for guiding further investigations and treatment.

Methods: Consecutive patients admitted with cerebral infarction were classified according to the Oxfordshire Community Stroke Project scale.

Case report of a patient who underwent thrombolysis of a "silent" thrombus in the middle cerebral artery.

Introduction: Some stroke patients present with mild or absent measurable neurologic deficits in spite of a significant thromboembolic event. A thrombus in the distal region of the middle cerebral artery may have such a presentation. CT angiography in the acute phase helps to identify the culprit thrombus.

Serum albumin in ischemic stroke patients: the higher the better. The Bergen Stroke Study.

Background: Animal studies show a neuroprotective effect of serum albumin in ischemic stroke. The neuroprotective effect of albumin in ischemic stroke in humans is not well studied. This study was aimed to determine the association of serum albumin with outcome and mortality after ischemic stroke.

Preadmission use of warfarin improves short-term outcome in patients with acute cerebral infarction. The Bergen Stroke Study.

Background: We hypothesized that patients with cerebral infarction on preadmission warfarin have less severe neurological deficits on admittance, less severe neurological deficits 1 week after the onset of cerebral infarction and a larger improvement as to neurological deficits within 1 week of acute cerebral infarction.

Methods: All patients with cerebral infarction who did not receive thrombolytic treatment were included. Preadmission use of warfarin was registered.

Admission C-reactive protein after acute ischemic stroke is associated with stroke severity and mortality: the 'Bergen stroke study'.

Background: There is growing evidence that inflammation plays an important role in atherogenesis. Previous studies show that C-reactive protein (CRP), an inflammatory marker, is associated with stroke outcomes and future vascular events. It is not clear whether this is due a direct dose-response effect or rather an epiphenomenon.

The effect of physiologic derangement in patients with stroke treated with thrombolysis.

Background: Body temperature, blood glucose, and blood pressure (BP) may interfere with outcome in patients with acute ischemic stroke treated with thrombolysis.

Methods: We prospectively studied 127 patients who received thrombolysis with tissue plasminogen activator for acute stroke in Bergen, Norway. Body temperature, blood glucose, and BP were measured before thrombolysis.

Neurological complications and aspects of basilar artery occlusive disease.

A recent case of basilar artery occlusion (BAO) in a 62-year-old woman is presented, along with a review of the literature on the clinical aspects of the disorder and treatment options. Therapeutic modalities such as intravenous and intra-arterial thrombolysis may significantly improve outcomes for patients with this disease.