Stroke : Highlights of Selected Articles

Abstract

HomeStrokeVol. 46, No. 2Stroke: Highlights of Selected Articles Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBStroke: Highlights of Selected Articles Originally published1 Feb 2015https://doi.org/10.1161/STROKEAHA.114.008576Stroke. 2015;46:321Reliability and Limitations of Automated Arrhythmia Detection in Telemetric Monitoring After StrokeAll patients with acute ischemic stroke should have continuous ECG monitoring during admission to the hospital because of the increased risk of serious cardiac arrhythmia and for the detection of possible atrial fibrillation. Data on the use of continuous cardiac monitoring for patients with stroke are lacking. The current study by Kurka et al aimed to determine the validity of cardiac monitoring in a stroke unit after acute stroke. A total of 151 patients were included in the study, and >4800 hours of monitoring were evaluated. In total, 22 509 alarms were detected. Approximately 73% of all nonlife threatening alarms were correct. In contrast, only 8.6% of the 140 alarms deemed life-threatening arrhythmias were correct. Of these, asystole had the highest false-positive rate, as only 2% of these alarms were true asystole. In summary, continuous cardiac monitoring in acute stroke seems sensitive but not specific. The high false positivity can lead to noise disturbances and alarm fatigue. Further improvement in specificity of continuous cardiac monitoring is needed. See p 560.Bright Vessel Appearance on Arterial Spin Labeling MRI for Localizing Arterial Occlusion in Acute Ischemic StrokeArterial spin labeling (ASL) is a perfusion-weighted MRI sequence. The current study by Yoo et al reviewed the MRIs of 117 patients with acute ischemic stroke. All MRIs were analyzed for the presence or absence of bright vessel signal on ASL, susceptibility vessel sign, fluid-attenuated inversion recovery vascular hyperintensity, and arterial occlusion on MR angiography (MRA). The purpose of the study was to determine whether bright vessel signal on ASL could help localize arterial occlusion on MRI in patients with acute stroke. ASL bright vessel appearance was more common in patients with arterial occlusion seen on MRA than those without occlusion. The bright appearance on ASL was seen both proximal and distal to the site of occlusion. The sensitivity of ASL bright vessel appearance in detecting arterial occlusion was far more sensitive than susceptibility vessel sign when using MRA as a standard reference (94%, 33/35 versus 66%, 23/35; P=0.002). Among the 82 cases of negative MRA, ASL bright vessel appearance detected more peripheral occlusions than susceptibility vessel sign (21%, 17/82 versus 10%, 8/82; P=0.012). Importantly, this study showed that bright vessel signal on ASL may be helpful in identifying arterial occlusions not seen on MRA. Although further confirmatory studies are needed, the use of ASL in acute stroke MRI protocol may be helpful in diagnosing embolic lesions. See p 564.Safety and Effect of Metoclopramide to Prevent Pneumonia in Patients With Stroke Fed via Nasogastric Tubes TrialPneumonia is a major cause of morbidity and mortality after stroke. Dysphagia and aspiration are important causes of pneumonia after stroke. Patients receiving tube feeds via nasogastric tubes are at high risk of pneumonia. Metoclopramide, a dopamine antagonist, is both an antiemetic and gastric prokinetic. The authors hypothesized that the reduction in vomiting and reflux in patients on metoclopramide would lead to a reduction in the risk of aspiration and pneumonia. Metoclopramide to Prevent Pneumonia in Patients With Stroke Fed Via Nasogastric Tubes (MAPS) trial is a randomized, double blind, placebo-controlled trial of prophylactic metoclopramide versus placebo in patients with stroke fed via nasogastric tubes. Sixty patients were enrolled in this study in the 1:1 ratio. Pneumonia was significantly more common in the placebo group compared with the metoclopramide group (rate ratio, 5.24; P<0.001). There were also significantly more episodes of aspiration and days on antibiotics in the placebo group. There was no significant difference in mortality between both treatment groups. Extrapyramidal reactions, such as dystonic reactions and tardive dyskinesia, were not seen in the metoclopramide group. The results of the MAPS study show that the prophylactic use of metoclopramide in patients with stroke with nasogastric tubes is safe and reduces the incidence of pneumonia. Although these results are certainly promising, this study is limited by its size, and thus, larger studies will be needed before best determine the effect of metoclopramide in this stroke population. See p 454. Previous Back to top Next FiguresReferencesRelatedDetails February 2015Vol 46, Issue 2 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.114.008576 Originally publishedFebruary 1, 2015 PDF download Advertisement