Magnetic resonance imaging (MRI) may be an alternative to computed tomography
(CT) to distinguish hemorrhage from ischemia in patients with acute stroke
symptoms; however, the accuracy of MRI vs CT for this purpose is not clear.
Kidwell and colleagues report results of their study of patients with early
stroke symptoms who underwent MRI followed by CT to assess for hemorrhage.
The authors found that MRI was equivalent to CT for the diagnosis of acute
hemorrhage and superior to CT in detecting chronic intracerebral hemorrhage.
Three articles in this issue of JAMAaddress
patient outcomes after thrombolytic therapy for stroke. First, Heuschmann
and colleagues Article reviewed data on patients receiving
tissue plasminogen activator (tPA) to identify predictors of in-hospital death.
Patient characteristics predictive of mortality were older age and decreased
level of consciousness. In-hospital mortality risk was inversely associated
with hospital experience administering tPA. In the second article, Saposnik
and colleagues Article report an analysis of data from
a prospective study of patients who received alteplase therapy to identify
factors predictive of lack of improvement at 24 hours. They found that an
elevated baseline glucose level, cortical involvement, and increasing time
to thrombolytic therapy were associated with a lack of improvement at 24 hours,
which was an independent predictor of poor outcome and death at 3 months.
In the third article, Lindsberg and colleagues Articledescribe
outcomes for 50 patients with basilar artery occlusion who received intravenous
thrombolytic therapy. They found these patients had comparable survival, recanalization,
and functional outcomes as previously reported for patients treated with an
endovascular approach. In an editorial, Caplan Article discusses
how existing guidelines for stroke diagnosis and treatment require updating
to ensure timely and effective care.
Carotid stenosis is only 1 factor contributing to stroke risk. Spagnoli
and colleagues Articlereport results of histologic examination
of carotid endarterectomy specimens from patients with similar degrees of
carotid stenosis and ipsilateral stroke, transient ischemia, or no symptoms
to assess the role of plaque rupture and thrombosis in stroke. The authors
found that thrombosis with plaque rupture and high inflammatory cell infiltrate
were associated with major ischemic stroke events. In an editorial, Toole
and colleagues Article discuss current strategies for
Luft and colleagues report preliminary findings from a small randomized
trial of patients with residual upper-extremity hemiparesis following ischemic
stroke. Patients who received bilateral arm training with rhythmic cueing
had increased contralesional motor cortex activation on functional magnetic
resonance imaging studies, changes not seen in patients who received standard
“It was a terrible thing . . . to live long
enough to see your child die.” From “The Secret.”
Problems in Nigeria have impeded an initiative to eradicate polio by
the end of next year, but an international partnership is stepping up surveillance
and immunization campaigns to get the effort back on track.
The role of antiplatelet therapy in preventing vascular events.
See Pages Article and Article
Fauci discusses public health and biomedical responses to present and
emerging infectious diseases.
Call for PapersAuthors are invited to submit
manuscripts for a JAMA theme issue on tuberculosis.
For your patients: Information about hemorrhagic stroke.
This Week in JAMA . JAMA. 2004;292(15):1789. doi:10.1001/jama.292.15.1789