Front Psychiatry
December 2024
Department of Neurology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Background: Wernicke-Korsakoff encephalopathy is a metabolic disease caused by vitamin B1 deficiency that predominantly affects alcoholic patients. Its clinical picture is characterized mainly by altered mental status with memory deficits, ophthalmoparesis, and ataxia, although other clinical manifestations may also be present. The current case presents certain clinical difficulties regarding the diagnosis when confronting an atypical presentation of a classical disease in an acute setting when a decision to administer an intravenous thrombolytic agent needs to be made.
View Article and Find Full Text PDFNeurologist
January 2025
Department of Neurology, Lehigh Valley Health Network, Allentown, PA.
Objectives: The utility of thrombolysis and/or thrombectomy in patients with mild stroke and large vessel occlusion (LVO) remains inconclusive. This retrospective study compared short-term and long-term outcomes in patients treated with best medical therapy (BMT group) versus with intravenous thrombolytics and/or endovascular thrombectomy (intervention group).
Methods: Patients with acute ischemic stroke (AIS), LVO, and National Institutes of Health Stroke Score (NIHSS) ≤5 were included.
BMC Med
January 2025
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Background: The benefits of intravenous thrombolysis in patients with acute minor stroke remain controversial. For the aim of providing a better therapeutic strategy, high-quality trials are required to validate the efficacy of thrombolytic medicine other than intravenous recombinant tissue plasminogen and tenecteplase. In the trial, we evaluate the efficacy and safety of urokinase (UK) in acute minor stroke.
View Article and Find Full Text PDFJ Invest Surg
December 2025
Department of Neurology, Baotou Central Hospital, Baotou, China.
Background: To evaluate the prognostic effect of endovascular treatment (EVT) in patients with acute base artery occlusion (ABAO) within 24 h of onset, and analyze the factors related to prognosis.
Methods: A retrospective analysis was conducted on all ABAO patients who received EVT within 24 h of onset in the neurology department of Baotou Central Hospital in Inner Mongolia from May 2016 to October 2022. Good prognosis was defined as a Modified Rankin Scale (mRS) score of 0-3 and poor prognosis mRS score of 4-6 at 90 day follow-up, and factors related to prognosis were analyzed.
South Med J
January 2025
From the University of Kentucky College of Medicine, Lexington.
Objective: Pulmonary embolism (PE) is the third leading cause of cardiovascular death. The objective of this study was to examine the current management of pulmonary embolism at a single academic institution.
Methods: With institutional review board approval, we conducted a retrospective chart review of 805 encounters among 775 patients presenting with acute PE from January 1, 2016 to June 30, 2019.
J Neurol
January 2025
Neurology, Cantonal Hospital of Baden, Baden, Switzerland.
Background: Correct identification of those patients presenting with an acute vestibular syndrome (AVS) or an acute imbalance syndrome (AIS) that have underlying posterior-circulation stroke (PCS) and thus may benefit from revascularization (intravenous thrombolysis (IVT), endovascular therapy (EVT)) is important. Treatment guidelines for AVS/AIS patients are lacking. We reviewed the evidence on acute treatment strategies in AVS/AIS focusing on predictors for IVT/EVT and outcome.
View Article and Find Full Text PDFAnn Acad Med Singap
December 2024
Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore.
Introduction: Pleural infections are a significant cause of mortality. Intrapleural fibrinolytic therapy (IPFT) utilising alteplase and dornase is a treatment option for patients unsuitable for surgery. The optimal dose of alteplase is unknown, and factors affecting treatment success in an Asian population are unclear.
View Article and Find Full Text PDFSci Rep
January 2025
Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Sci Rep
January 2025
Department of Orthopedics and Traumatology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
Patients at high risk of deep vein thrombosis are recommended to undergo lower-extremity ultrasonography to screen for pulmonary embolism (PE); however, there are few reports on whether this can effectively reduce the occurrence of fatal pulmonary embolism (FPE). This study aimed to assess the risk factors associated with PE and to investigate whether perioperative ultrasound screening of lower extremity veins in orthopedic patients can effectively reduce the incidence of FPE. We enrolled 137 patients with PE who underwent orthopedic surgery between 2013 and 2020.
View Article and Find Full Text PDFBiochimie
December 2024
Department of Animal Morphology and Physiology, Rural Federal University of Pernambuco (UFRPE), Dom Manoel de Medeiros Avenue, Recife, PE 52171-900, Brazil.
Fibrinolytic enzymes are promising in treating cardiovascular diseases due to their capacity to dissolve blood clots. The fibrinolytic enzyme from Arthrospira platensis (FEAP) was purified by ion exchange chromatography to investigate its ability to activate plasminogen, as well as its thrombolytic and fibrinogenolytic potential. Subsequently, two different cytotoxic assays (MTT and NR) and hemolysis test were performed to evaluate FEAP's safety.
View Article and Find Full Text PDFStroke
January 2025
Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China (X.C., L.H., Y.L., Yiran Zhang, X.L., S.L., L.Y., Q.D.).
Background: Whether it is effective and safe to extend the time window of intravenous thrombolysis up to 24 hours after the last known well is unknown. We aimed to determine the efficacy and safety of tenecteplase in Chinese patients with acute ischemic stroke due to large/medium vessel occlusion within an extended time window.
Methods: Patients with ischemic stroke presenting 4.
Cureus
December 2024
Cardiology, Faculty of Medicine, Necmettin Erbakan University, Konya, TUR.
Background: Acute pulmonary embolism (APE) is a serious cardiovascular condition characterized by high rates of morbidity and mortality, with inflammation playing a significant role in the severity of the disease and patient outcomes. This study aimed to evaluate the effects of thrombolytic therapy on inflammatory markers in patients diagnosed with APE.
Study Design And Methods: The study was conducted retrospectively on 138 individuals, 69 with pulmonary embolism and 69 without pulmonary embolism (control), who were admitted to Necmettin Erbakan University between January 2019 and April 2023.
BMC Neurol
December 2024
Department of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Sanxiang Road, Suzhou, Jiangsu Province, 1055, China.
Objective: We aimed to determine the predictive value of renal function status [estimating glomerular filtration rate (eGFR)] in conjunction with inflammatory biomarkers [white blood cell(WBC) and C-reactive protein (CRP)] for in-hospital outcomes in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT).
Methods: We retrospectively screened a total of 409 AIS patients treated with IVT. The study participants were classified into two groups according to post-stroke pneumonia or functional outcome.
Trials
December 2024
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Background: Intermediate-high risk pulmonary embolism (PE) carries a significant risk of hemodynamic deterioration or death. Treatment should balance efficacy in reducing clot burden with the risk of complications, particularly bleeding. Previous studies on high-dose, short-term thrombolysis with alteplase (rtPA) showed a reduced risk of hemodynamic deterioration but no change in mortality and increased bleeding complications.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
December 2024
Division of Cardiovascular Medicine, New York University, New York, New York, USA.
Background: The recently published PEERLESS trial compared catheter-directed thrombolysis (CDT) and catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE). However, it included a low proportion of patients with contraindications to thrombolytic therapy (4.4%), leaving uncertainty about how CDT would perform relative to CBT in a real-world cohort with higher bleeding risk.
View Article and Find Full Text PDFEgypt Heart J
December 2024
Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania.
Background: Concurrent ST-elevation myocardial infarction (STEMI) and acute ischemic stroke (AIS) are extremely rare, and their management remains perplexing due to the absence of high-quality evidence and limited resources. For the first time, we report a rare, preventable, and suboptimally managed case of concurrent AIS and STEMI in a patient with non-Hodgkin lymphoma (NHL) who received cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy.
Case Presentation: A 59-year-old postmenopausal woman of African origin with a background history of type 2 diabetes mellitus presented to the Jakaya Kikwete Cardiac Institute with sudden onset of left-sided weakness and typical ischemic chest pain for 3 days.
Comput Methods Programs Biomed
December 2024
College of Mechanical and Electrical Engineering, Wenzhou University, Wenzhou, 325035, China.
Background And Objective: Deep vein thrombosis (DVT) of the lower limbs is a critical global vascular disease. Accurately assessing and predicting the efficacy of DVT treatment remains a significant challenge due to a lack of understanding of the mechanisms by which the level of patient-specific embolization and the rate of drug injection affect thrombolytic therapy.
Methods: In this study, we used the computed tomographic venography (CTV) clinical method to obtain patient-specific parameters, and the flow-solid interaction (FSI) method combined with biochemical response modeling of thrombolysis to analyze patient-specific hemodynamic and biomechanical characteristics and to quantitatively assess the effects of three vessel embolism levels (VEL) versus two drug injection rates (DIR) on bifurcated femoral venous thrombolytic therapy.
Catheter Cardiovasc Interv
December 2024
Department of Fetal, Neonatal and Cardiovascular Sciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Kawasaki Disease (KD) is a systemic vasculitis that can lead to coronary artery aneurysms (CAA) in up to 10% of treated cases, significantly increasing the risk of thrombosis and acute myocardial infarction (AMI). While thrombolytic therapy is commonly used in adult coronary syndromes, its application in pediatric KD remains poorly studied. We report a 9-month-old infant with KD and giant CAA complicated by a subocclusive thrombus in the left anterior descending artery (LAD).
View Article and Find Full Text PDFFront Endocrinol (Lausanne)
December 2024
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Background: The effect of renal impairment in patients who receive intravenous thrombolysis for acute ischemic stroke (AIS) is unclear. We aimed to determine the associations of renal impairment and clinical outcomes and any modification of the effect of intensive versus guideline-recommended blood pressure (BP) control in the BP arm of the International Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).
Methods: We conducted a analysis of the ENCHANTED BP arm, which involved 2,196 thrombolyzed AIS patients.
Ned Tijdschr Geneeskd
December 2024
Leids Universitair Medisch Centrum, Leiden. Afd. Trombose & Hemostase.
Treatment options for patients with severe pulmonary embolism (PE) have increased substantially over the past decade. Although systemic thrombolysis is still the reperfusion therapy of choice for hemodynamically unstable PE patients, several new catheter guided reperfusion therapies have emerged as possibly safer alternatives. These therapies are increasingly implemented in clinical practice even though their efficacy and safety are yet to be proven by clinical outcome studies.
View Article and Find Full Text PDFAm J Cardiol
December 2024
Jinan Hospital, Jinan City, China.
Individual cerebral small vessel disease (SVD) markers independently predict poor prognosis after stroke. However, the impact of a single SVD, especially cumulative SVD burden, on outcomes in acute ischemic stroke (AIS) after intravenous thrombolysis remains unclear. This study evaluated the occurrence of SVD in patients with AIS who were treated with intravenous thrombolytic therapy using multimodal magnetic resonance imaging.
View Article and Find Full Text PDFJ Neurol
December 2024
Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Intravenous thrombolysis and mechanical thrombectomy reduce morbidity and improve functional outcome in ischemic stroke. However, acute recanalization therapies may increase the risk of symptomatic intracranial hemorrhage due to its effects on the brain tissue. An increasing proportion of patients with ischemic stroke are using direct oral anticoagulants (DOACs).
View Article and Find Full Text PDFNeurology
January 2025
From the Center for Stroke Research Berlin (I.G., J.B.F.), Charité-Universitätsmedizin Berlin, Germany; Service de Biostatistique (F.B., P.R.), Hospices Civils de Lyon, France; Department of Neurology (B.C., C.G., G.T.), University Medical Center Hamburg-Eppendorf, France; Department of Stroke Medicine (T.-H.C.), Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France; Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin; Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Center for Stroke Research Berlin (M. Endres); German Center for Neurodegenerative Diseases (DZNE), partner site Berlin (M. Endres); German Centre for Cardiovascular Research (DZHK), partner site Berlin (M. Endres); German Center for Mental Health (DZPG), partner site Berlin (M. Endres), Germany; Department of Neurology (C.E.), Medical University of Graz, Austria; Department of Diagnostic and Interventional Neuroradiology (J.F.), Universitätsklinikum Hamburg-Eppendorf, Germany; Robertson Centre for Biostatistics (I.F.), University of Glasgow, Scotland; mediri GmbH (J.G.); Fraunhofer Institute for Digital Medicine MEVIS (M.G.), Bremen, Germany; Department of Neurosciences (R.L., A.W.), Experimental Neurology, KU Leuven-University of Leuven, Belgium; School of Psychology & Neuroscience (K.W.M.), University of Glasgow, Scotland; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, and Hospices Civils de Lyon, France; Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark; Florey Institute of Neuroscience and Mental Health (V.N.T.), Heidelberg, Australia; and Institut d'Investigació Biomèdica de Girona (S.P.), Hospital Universitari Doctor Josep Trueta, Girona, Spain.
Background And Objectives: Data from randomized trials on the treatment effect of pure thrombolysis in patients with vessel occlusion are lacking. We examined data from a corresponding subsample of patients from the multicenter, randomized, placebo-controlled WAKE-UP trial to determine whether MRI-guided IV thrombolysis with alteplase in unknown-onset ischemic stroke benefits patients presenting with vessel occlusion.
Methods: Patients with an acute ischemic lesion visible on MRI diffusion-weighted imaging but no marked parenchymal hyperintensity on fluid-attenuated inversion recovery images were randomized to treatment with IV alteplase or placebo.
Int J Nurs Sci
November 2024
Department of Emergency Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, China.
Objective: Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes. This study investigated whether optimizing intravenous thrombolytic (IVT) therapy strategies for stroke could reduce treatment delays.
Methods: To reduce delays in IVT therapy for ischemic stroke, a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou, Zhejiang Province, from June 2021 to August 2023, which included developing a timeline process management system, forming a nurse-led stroke process management team, providing homogeneous training, standardizing the IVT therapy process for ischemic stroke, and introducing an incentive policy.
BMJ Case Rep
December 2024
Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA.
Acute aortic dissection is considered a contraindication to the use of intravenous thrombolysis in patients presenting with acute ischaemic stroke, but less has been described about previously repaired dissections. We present a case of a woman in her 50s presenting with acute left hemiparesis with a known history of aortic dissection within the thrombolysis window. After multidisciplinary discussion with cardiothoracic surgery and discussion with the patient, she was treated with intravenous thrombolysis without complication.
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