Sarraj Amrou, Medrek Sarah, Albright Karen, Martin-Schild Sheryl, Bibars Wafi, Vahidy Farhaan, Grotta James C, Savitz Sean I
Department of Neurology, University of Texas Medical School-Houston, UT Health, Houston, TX, USA.
Department of Neurology, University of Texas-Houston, Houston, TX, USA.
Int J Stroke. 2015 Jul;10(5):672-8. doi: 10.1111/j.1747-4949.2012.00952.x. Epub 2013 Mar 22.
Lack of recognition of early symptoms of acute posterior circulation ischaemic stroke might delay timely diagnosis and treatment with tissue plasminogen activator.
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.
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.
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.
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.
对急性后循环缺血性卒中早期症状认识不足可能会延误组织型纤溶酶原激活剂的及时诊断和治疗。
我们假设与前循环卒中相比，后循环卒中患者接受溶栓治疗的时间会延迟。我们调查了前循环缺血性卒中和后循环卒中患者在评估或治疗时间上的差异，旨在了解可能导致这些延迟的障碍。
采用横断面研究，纳入连续就诊于我们三级学术中心的急性缺血性卒中患者，这些患者在症状发作后4.5小时内接受了静脉注射组织型纤溶酶原激活剂治疗。我们比较了前循环卒中和后循环卒中患者的人口统计学特征、卒中严重程度、症状和体征，以及症状发作、急诊科就诊、急诊科医生评估、神经科医生评估、脑部成像和组织型纤溶酶原激活剂治疗之间的时间间隔。
在252例接受静脉注射组织型纤溶酶原激活剂治疗的患者中，12%患有后循环卒中。后循环卒中患者的美国国立卫生研究院卒中量表（NIHSS）基线中位数得分显著较低（P = 0.01），恶心（P < 0.01）、呕吐（P < 0.01）、头晕（P < 0.01）的发生率较高，失语（P = 0.002）或忽视（P = 0.048）的发生率较低。与前循环卒中患者相比，后循环卒中患者从急诊科医生评估到神经科医生评估以及从就诊到用药的时间间隔显著更长。然而，两组的神经科医生到用药的时间相似。恶心和呕吐的存在与从急诊科评估到神经科评估的时间延长相关，并且与延迟治疗有显著关联。
与前循环卒中患者相比，后循环卒中患者在急诊科初步评估后神经科评估延迟，静脉注射组织型纤溶酶原激活剂给药延迟。与前循环卒中相比，在急诊科快速识别后循环卒中的症状可能存在困难。
