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ABSTRACT: A survey of graduating neurology residents conducted in 2000 showed that many residents had limited experience and comfort treating with tissue-type plasminogen activator (tPA). We examined changes in residents' experience during the past decade.
A 12-item survey was sent to US neurology residents in their final year of training. Items examined residents' experience and confidence with assessment of the acute stroke patient and use of tPA for treatment. Questions were worded identically in the 2000 and 2010 surveys, and responses were compared between the two.
Of 491 residents, 286 (58%) responded. There was a significant increase from 2000 to 2010 in the percentage of residents who felt comfortable independently treating with tPA (73% versus 94%, P<0.001), who had observed administration of tPA (88% versus 99%, P<0.001), who had personally treated with tPA (80% versus 95%, P<0.001), and who had been involved in post-tPA care (89% versus 98%, P<0.001). There was a substantial increase in residents with formal training in using the National Institutes of Health Stroke Scale (65% versus 92%, P<0.001) and who had dedicated stroke teams at their institution (84% versus 93%, P=0.001).
Neurology residents' experience and comfort treating acute ischemic stroke with tPA increased significantly between 2000 and 2010, as did resident exposure to stroke teams and formal training in the National Institutes of Health Stroke Scale.
Stroke 08/2011; 42(10):2963-5. · 5.73 Impact Factor
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ABSTRACT: Introduction. Stroke patients often meet respiratory guidelines for extubation, but uncertainty exists if patients will protect their airway due to impaired mental status. Patients with middle cerebral artery (MCA) acute ischemic stroke (AIS) might have specific predictors of successful extubation. Methods. Retrospective cohort of MCA AIS patients requiring intubation. Results. Thirty-seven MCA AIS patients were extubated successfully and ten failed extubation. Those who successfully extubated had higher extubation composite and eye response Glasgow Coma Scale (GCS) scores compared to those who failed (median 10T (IQR 9T-11T) versus 9.5T (8T-10T), P = 0.047, and 4 (3-4) versus 2.5 (1-3), P < 0.01). When adjusted for age, admission National Institutes of Health Stroke Scale score and laterality, patients with a GCS score ≥8T trended toward extubating successfully (OR 23.30 (CI 0.94-580.27), P = 0.055). Conclusions. The GCS score might be important in predicting successful extubation in MCA AIS patients. Further prospective study is warranted to better assess factors predictive of extubation outcome in stroke and other brain-injured patients.
Stroke research and treatment. 01/2011; 2011:248789.
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ABSTRACT: Ornithine transcarbamylase deficiency (OTCD) is the most common of the urea cycle disorders and results in an accumulation of ammonia and its metabolites. Excess ammonia in the brain is metabolized to glutamine, which increases intracellular osmolarity and contributes to cytotoxic edema.
We report a case of a woman heterozygous for OTCD who developed acute hyperammonemic encephalopathy and increased intracranial pressure (ICP).
Despite hemodialysis, protein restriction, and administration of pharmacologic nitrogen scavengers, she developed progressive cerebral edema and increased ICP that was refractory to maximal medical management. She underwent a bifrontal decompressive craniectomy resulting in resolution of her intracranial hypertension.
Aggressive multimodality management of the patient coupled with bifrontal decompressive hemicraniectomy was a life-saving measure, offering the patient a reasonable outcome. At 6 month follow-up she had moderate disability on the Glasgow Outcome Score associated with cognitive difficulties.
Neurocritical Care 08/2010; 13(1):113-7. · 2.47 Impact Factor
