Stupid, stupid, stupid.
http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2012.00952.x/abstract;jsessionid=6A50E26F8ECC6B1A26277017DEAEAC1C.d02t02?
Background
Lack
of recognition of early symptoms of acute posterior circulation
ischaemic stroke might delay timely diagnosis and treatment with tissue
plasminogen activator.
Aims and hypothesis
We
hypothesized that patients with posterior circulation stroke receive
delayed thrombolytic treatment in comparison to anterior circulation
stroke. We investigated the differences in times to evaluation or
treatment between patients with anterior circulation ischaemic stroke
and posterior circulation stroke in our aim to understand the barriers
that might have caused these delays.
Methods
A
cross-sectional study was conducted using consecutive patients
presenting to our tertiary academic centre with acute ischaemic stroke
who were treated with intravenous tissue plasminogen activator within
4·5 h from symptom onset. We compared demographics, stroke severity,
symptoms and signs, and time intervals among onset, emergency department
arrival, emergency department physician evaluation, neurologist
evaluation, brain imaging, and tissue plasminogen activator treatment in
patients with anterior circulation stroke and posterior circulation
stroke.
Results
Among
252 patients treated with intravenous tissue plasminogen activator, 12%
had posterior circulation stroke. Patients with posterior circulation
stroke had significantly lower median baseline the National Institutes
of Health and Stroke Scale (NIHSS) score (P = 0·01), higher frequency of nausea (P < 0·01), vomiting (P < 0·01), dizziness (P < 0·01), and lower frequency of aphasia (P = 0·002) or neglect (P
= 0·048). The emergency department physician evaluation-to-neurologist
evaluation and door-to-needle intervals were significantly longer for
posterior circulation stroke patients compared with anterior circulation
stroke patients. The neurologist-to-needle time, however, was similar
in the two groups. The presence of nausea and vomiting was associated
with a longer time from emergency department evaluation to neurology
evaluation and had a significant association with delayed treatment.
Conclusions
Posterior
circulation stroke patients had a delay in neurology evaluation after
initial emergency department evaluation and a delay in intravenous
tissue plasminogen activator administration compared with anterior
circulation stroke patients. There may be difficulties in rapidly
recognizing the symptoms of posterior circulation stroke, in contrast to
anterior circulation stroke, in the emergency department.
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