Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, October 22, 2013

Admission Insular Infarction >25% Is the Strongest Predictor of Large Mismatch Loss in Proximal Middle Cerebral Artery Stroke

I hate these people that don't do actual research into how to prevent neuronal loss. Their department head should be ashamed and be talked to by a survivor.
http://stroke.ahajournals.org/content/44/11/3084.abstract.html?etoc
  1. Michael H. Lev, MD, FAHA, FACR
+ Author Affiliations
  1. From the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
  1. Correspondence to Michael H. Lev, MD, FAHA, FACR, Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Gray B241H, 55 Fruit St, Boston, MA 02114. E-mail mlev@partners.org
  1. * Drs Kamalian and Kemmling contributed equally.

Abstract

Background and Purpose—Previous univariate analyses have suggested that proximal middle cerebral artery infarcts with insular involvement have greater severity and are more likely to progress into surrounding penumbral tissue at risk. We hypothesized that a practical, simple scoring method to assess percent insular ribbon infarction (PIRI score) would improve prediction of penumbral loss over other common imaging biomarkers.
Methods—Of consecutive acute stroke patients from 2003 to 2008, 45 with proximal middle cerebral artery–only occlusion met inclusion criteria, including available penumbral imaging. Infarct (diffusion-weighted imaging), tissue at risk (magnetic resonance mean transit time), and final infarct volume (magnetic resonance/computed tomography) were manually segmented. Diffusion-weighted imaging images were rated according to the 5-point PIRI score (0, normal; 1, <25%; 2, 25%–49%; 3, 50%–74%; 4, ≥75% insula involvement). Percent mismatch loss was calculated as an outcome measure of infarct progression. Receiver operating characteristic curve and multivariate analyses were performed.
Results—Mean admission diffusion-weighted imaging infarct volume was 30.9 (±38.8) mL and median (interquartile range) PIRI score was 3 (0.75–4). PIRI score was significantly correlated with percent mismatch loss (P<0.0001). When percent mismatch loss was dichotomized based on its median value (30.0%), receiver operating characteristic curve area under curve was 0.89 (P=0.0001) with a 25% insula infarction optimal threshold. After adjusting for time to imaging and treatment, binary logistic regression, including dichotomized PIRI (25% threshold), age, National Institutes of Health Stroke Scale score, diffusion-weighted imaging infarct volume, and computed tomography angiography collateral score as covariates, revealed that only dichotomized insula score (P=0.03) and age (P=0.02) were independent predictors of large (68.2%) versus small (8.1%) mismatch loss. There was excellent interobserver agreement for dichotomized PIRI scoring (κ=0.91).
Conclusions—Admission insular infarction >25% is the strongest predictor of large mismatch loss in this cohort of proximal middle cerebral artery occlusive stroke. This outcome marker may help to identify treatment-eligible patients who are in greatest need of rapid reperfusion therapy.

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