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Find video protocols related to scientific articles indexed in Pubmed.
A dark side of subcortical diffusion-weighted lesions? Characteristics, cause, and outcome in large subcortical infarction: the bergen norwegian stroke cooperation study.
Stroke
PUBLISHED: 07-10-2014
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Diffusion-weighted imaging (DWI) is highly accurate in identifying and locating ischemic stroke injury. Few studies using DWI have investigated large subcortical infarctions (LSIs). We aimed to study clinical characteristics, cause, and outcome in patients with ischemic stroke with LSI diagnosed on DWI and compare these with those who had lacunar DWI lesions or DWI lesions located elsewhere.
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Prognostic value of blood interleukin-6 in the prediction of functional outcome after stroke: a systematic review and meta-analysis.
J. Neuroimmunol.
PUBLISHED: 06-10-2014
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We aimed to quantify the association of blood interleukin-6 (IL-6) concentrations with poor outcome after stroke and its added predictive value over clinical information. Meta-analysis of 24 studies confirmed this association with a weighted mean difference of 3.443 (1.592-5.294) pg/mL, despite high heterogeneity and publication bias. Individual participant data including 4112 stroke patients showed standardized IL-6 levels in the 4th quartile were independently associated with poor outcome (OR=2.346 (1.814-3.033), p<0.0001). However, the additional predictive value of IL-6 was moderate (IDI=1.5%, NRI=5.35%). Overall these results indicate an unlikely translation of IL-6 into clinical practice for this purpose.
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Diffusion-weighted lesions in stroke patients with transient symptoms - where are they located?
Cerebrovasc. Dis.
PUBLISHED: 04-09-2014
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MR diffusion-weighted imaging (DWI) has revolutionized neuroimaging and contributed to a tissue-based redefinition of transient ischemic attack (TIA). Stroke patients with DWI lesions may have neurological symptoms that resolve completely within 24 h, suggesting successful vessel recanalization. Prior studies of stroke patients with transient symptoms have not found any predilection for DWI lesions in any specific territory. Other studies have, however, reported an association between higher brain dysfunction and presence of DWI lesions in patients with transient ischemic symptoms, suggesting a high rate of cortical affection in these patients. We sought to see whether DWI location in stroke patients with transient symptoms <24 h differed from those with persistent symptoms ?24 h. We hypothesized an association between transient symptoms <24 h and cortical DWI lesion localization due to a possible higher rate of vessel recanalization in patients with transient symptoms causing distal cortical infarctions.
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Prevalence of intracranial stenosis in a Norwegian ischemic stroke population.
J Stroke Cerebrovasc Dis
PUBLISHED: 03-26-2014
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There is no data about prevalence of intracranial stenosis (IS) in Northern Europe. This study aimed to investigate the prevalence of symptomatic and asymptomatic IS in a Norwegian, community-based ischemic stroke population.
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The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke.
BMC Neurol
PUBLISHED: 03-19-2014
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Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase.
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Risk factors and their impact on carotid intima-media thickness in young and middle-aged ischemic stroke patients and controls: the Norwegian Stroke in the Young Study.
BMC Res Notes
PUBLISHED: 03-07-2014
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Vascular morbidity and mortality due to cardiovascular disease (CVD) are high after ischemic stroke at a young age. Data on carotid intima-media thickness (cIMT) as marker of atherosclerosis are scarce for young stroke populations. In this prospective case-control study, we examined cIMT, the burden of vascular risk factors (RF) and their associations among young and middle-aged ischemic stroke patients and controls. We aimed to detect clinical and sub-clinical arterial disease.
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Effect of microbubble contrast on intracranial blood flow velocity assessed by transcranial Doppler.
J Ultrasound
PUBLISHED: 03-01-2014
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Ultrasound contrast agents (UCA) salvage a considerable number of transcranial Doppler (TCD) exams which would have failed because of poor bone window. UCA bolus injection causes an undesirable increase in measured blood flow velocity (BFV). The effect of UCA continuous infusion on measured BFV has not been investigated, and some in vitro experiments suggest that gain reduction during UCA administration may also influence measured BFV. This study aimed to investigate the effect of UCA continuous infusion on BFV measured by TCD and the influence of gain reduction on these measurements in a clinical setting.
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Early Vascular Aging in Young and Middle-Aged Ischemic Stroke Patients: The Norwegian Stroke in the Young Study.
PLoS ONE
PUBLISHED: 01-01-2014
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Ischemic stroke survivors have high risk of cardiovascular morbidity and mortality even at young age, suggesting that early arterial aging is common among such patients.
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Is higher body temperature beneficial in ischemic stroke patients with normal admission CT angiography of the cerebral arteries?
Vasc Health Risk Manag
PUBLISHED: 01-01-2014
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Low body temperature is considered beneficial in ischemic stroke due to neuroprotective mechanisms, yet some studies suggest that higher temperatures may improve clot lysis and outcomes in stroke patients treated with tissue plasminogen activator (tPA). The effect of increased body temperature in stroke patients treated with tPA and with normal computed tomography angiography (CTA) on admission is unknown. We hypothesized a beneficial effect of higher body temperature in the absence of visible clots on CTA, possibly due to enhanced lysis of small, peripheral clots.
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Does a history of migraine affect the rate of thrombolysis in young stroke patients?
Stroke Res Treat
PUBLISHED: 09-12-2013
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Background. Migraine is prevalent in young patients and a frequent stroke mimic. To distinguish stroke mimics from true stroke can be difficult, and there is a possibility of misdiagnosing a stroke as a migrainous attack in patients with migraine. We aimed to investigate if a history of migraine affects the rate of thrombolytic therapy in young stroke patients. Methods. All patients below 50 years of age admitted in the period 2006-2013 to the Bergen Stroke Centre with acute ischaemic stroke were included. The rate of thrombolytic therapy in patients with migraine was compared to patients with no history of migraine. A multivariate analysis was performed to adjust confounding factors. Results. A total of 170 young stroke patients were enrolled, 49 with migraine and 121 with no migraine. In total, 10.2% of young patients with migraine received thrombolytic therapy, compared with 26.5% of young patients with nomigraine (P = 0.02). Migraine was associated with a low rate of thrombolytic therapy when adjusting for possible confounding factors (OR 0.19 CI: 0.05-0.72, P = 0.02). Conclusion. Migraine is associated with a low rate of thrombolytic therapy in young patients admitted with acute ischaemic stroke. Migraine patients admitted with acute ischaemic stroke are at risk of maltreatment.
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Elevated Admission Blood Pressure and Stroke Severity in Acute Ischemic Stroke: The Bergen NORSTROKE Study.
Cerebrovasc. Dis.
PUBLISHED: 08-06-2013
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Background: Transient elevated blood pressure (BP) is frequent in patients presenting with acute ischemic stroke. The pathophysiology of this response is not clear and its effect on clinical outcome has shown contradictory results. Some studies have suggested that BP elevation may represent a protective response to enhance perfusion in ischemic brain tissue. In this study, we aimed to explore the association between elevated admission BP and stroke severity in the acute phase of ischemic stroke. If it is true that elevated BP represents a protective response in acute ischemia, we expected an inverse association between elevated BP and admission stroke severity, and a positive association between elevated BP and complete neurological recovery within 24 h and/or favorable short-term outcome. Methods: Patients with ischemic stroke with hospital admission <6 h after symptom onset were prospectively included in a stroke registry (Bergen NORSTROKE Registry). BP was measured immediately after admission in all patients. Elevated BP was defined as systolic BP ?140 mm Hg or diastolic BP ?90 mm Hg. The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity upon admission. Mild stroke was defined as NIHSS score <8, moderate stroke as NIHSS score 8-14, and severe stroke as NIHSS score ?15. Complete neurological recovery (CNR) was defined as no persistent ischemic stroke symptoms at 24 h after admission. Favorable short-term outcome was defined as a modified Rankin Scale score of 0 or 1 at day 7. Results: A total of 749 patients with ischemic stroke were included, of which 621 patients (82.9%) presented with elevated BP. Elevated BP was independently associated with mild stroke (odds ratio, OR: 2.12; 95% CI: 1.39-3.24; p < 0.001), whereas lack of elevated BP was independently associated with severe stroke (OR: 0.41; 95% CI: 0.25-0.68; p < 0.001). There was a nonsignificant association between elevated BP and CNR (OR: 2.11; 95% CI: 0.96-4.68; p = 0.063), yet no association between elevated BP and favorable short-term outcome (OR: 0.97; 95% CI: 0.59-1.59; p = 0.906) when adjusted for confounders. Conclusion: Our study showed an inverse association between elevated BP and stroke severity on admission, where elevated BP was associated with mild stroke and lack of elevated BP was associated with severe stroke. This could be explained by a protective effect of elevated BP in the acute phase of ischemic stroke, although the absence of association between elevated BP and favorable outcome argues against this hypothesis. © 2013 S. Karger AG, Basel.
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C-reactive Protein and Homocysteine Predict Long-term Mortality in Young Ischemic Stroke Patients.
J Stroke Cerebrovasc Dis
PUBLISHED: 02-26-2013
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We investigated the relationship between C-reactive protein (CRP) and homocysteine on follow-up and subsequent mortality in young ischemic stroke patients in a population-based study.
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Carotid intima-media thickness - a potential predictor for rupture risk of intracranial aneurysms.
Int J Stroke
PUBLISHED: 02-25-2013
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Individual assessment of rupture risk of cerebral aneurysms is challenging, and increased knowledge of predictors for aneurysm rupture is needed. Smoking and hypertension are shared risk factors for atherosclerotic disease and cerebral aneurysms, and patients with atherosclerosis have an increased prevalence of intracranial aneurysms. Carotid ultrasound with evaluation of intima-media thickness (IMT) is a non-invasive, safe, rapid, well-validated and reproducible technique for quantification of subclinical atherosclerosis and assessment of cardio- and cerebrovascular risk. Increased IMT is associated with elevated risk for ischemic stroke and myocardial infarction, but sparse data exist on carotid ultrasound findings in patients with intracranial aneurysms.
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The Norwegian Stroke in the Young Study (NOR-SYS): rationale and design.
BMC Neurol
PUBLISHED: 02-13-2013
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Ischemic stroke in young adults is a major health problem being associated with a higher vascular morbidity and mortality compared to controls, and a stroke recurrence rate of 25% during the first decade. The assumed cause of infarction and the detected risk factors determine the early- and long-term treatment. However, for many patients the cause of stroke remains unknown. Risk factor profile and etiology differ in young and elderly ischemic stroke patients, and atherosclerosis is the determined underlying condition in 10 to 15%. However, subclinical atherosclerosis is probably more prevalent and may go unrecognized.Ultrasound imaging is a sensitive method for the detection of arterial disease and for measurement of adipose tissue. The relationship between intima-media thickness (IMT), plaques, cardiovascular risk factors including visceral adipose tissue (VAT) and ischemic events has repeatedly been shown.We have established The Norwegian Stroke in the Young Study (NOR-SYS) as a three-generation research program with the goal to increase our knowledge on heredity and the development of arterial disease and ischemic stroke. Extended standardized ultrasound examinations are done in order to find subclinical vessel disease for early and better prophylaxis.Methods/design: NOR-SYS is a prospective long-term research program. Standardized methods are used for anamnestic, clinical, laboratory, imaging, and ultrasound data collection in ischemic stroke patients aged <=60 years, their partners and joint adult offspring. The ultrasound protocol includes the assessment of intracranial, carotid and femoral arteries, abdominal aorta, and the estimation of VAT. To date, the study is a single centre study with approximately 400 patients, 250 partners and 350 adult offspring expected to be recruited at our site.
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Persistent middle cerebral artery occlusion associated with lower body temperature on admission.
Vasc Health Risk Manag
PUBLISHED: 01-01-2013
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Low body temperature is considered neuroprotective in ischemic stroke, yet some studies suggest that low body temperature may also inhibit clot lysis and recanalization. We hypothesized that low body temperature was associated with persistent proximal middle cerebral artery (MCA) occlusion in patients with acute ischemic stroke presenting with symptoms of proximal MCA occlusion, suggesting a possible detrimental effect of low body temperature on recanalization.
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[a woman with recurrence of venous and arterial thrombosis].
Tidsskr. Nor. Laegeforen.
PUBLISHED: 07-05-2011
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Hypercoagulability leading to arterial or venous thrombosis and embolism in patients with cancer is a known phenomenon.
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[Treatment of cerebrovascular disease in a comprehensive stroke unit].
Tidsskr. Nor. Laegeforen.
PUBLISHED: 05-11-2011
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Development of stroke units during the last decade has changed management of patients with stroke. The aim of this study is to assess unselected patients admitted to an acute stroke unit with respect to daily functioning (neurological deficits), treatment and 7-day outcome.
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[Patients with acute cerebral infarction admitted to stroke unit].
Tidsskr. Nor. Laegeforen.
PUBLISHED: 05-11-2011
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Treatment of acute cerebral infarction has greatly improved over the last 15 years. The purpose of this article is to describe patients with acute cerebral infarction admitted to a stroke unit from a geographically well defined population between 2007 and 2009.
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Serum uri acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study.
BMC Neurol
PUBLISHED: 02-21-2011
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A possible synergic role of serum uric acid (SUA) with thrombolytic therapies is controversial and needs further investigations. We therefore evaluated association of admission SUA with clinical improvement and clinical outcome in patients receiving rt-PA, early admitted patients not receiving rt-PA, and patients admitted after time window for rt-PA.
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Fatigue among stroke patients on long-term follow-up. The Bergen Stroke Study.
J. Neurol. Sci.
PUBLISHED: 02-17-2011
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To evaluate characteristics and mortality related to post-stroke fatigue (PSF).
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Decline of arterial cerebral infarction among young women: the Bergen Stroke Study.
Vasc Health Risk Manag
PUBLISHED: 02-15-2011
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To assess the frequency of females and males aged ? 30 years with cerebral infarction in two different time periods.
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Comparison between Ischemic Stroke Patients <50 Years and ?50 Years Admitted to a Single Centre: The Bergen Stroke Study.
Stroke Res Treat
PUBLISHED: 01-20-2011
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Introduction. Young adults are likely to differ from old patients concerning cerebral infarction. Methods. We compared characteristics of patients aged under and above 50 years, admitted to the Department of Neurology with cerebral infarction between 2006 and 2009, based on prospective registration. Investigation followed one common protocol for both groups. Results and Discussion. One hundred patients (8.2%) were <50 years old, and the proportion of males was higher in this group (72% versus 55.8%, P = .002). Young stroke patients are more often current smokers (44.1% versus 23.6%, P < .001). Common causes for stroke in the young were cervical artery dissection (18% versus 0.6%, P < .001) and cardiac embolism due to disorders other than atrial arrhythmias (18% versus 5.5%, P < .001). Among the old, atrial fibrillation and flutter dominated (29.1% versus 5%, P < .001). Stroke severity and location did not differ. Old patients more often suffered from pneumonia (10.6% versus 2%, P < .003) and urinary tract infection (14.6% versus 2%, P = .001). Conclusions. Males dominate, and current smoking is more common in the young. Cervical artery dissection and nonarrhythmic heart disorders are frequent causes among young patients, while traditional risk factors dominate the old. Stroke severity is similar, but old patients seem more exposed for infectious complications.
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Post-stroke pain on long-term follow-up: the Bergen stroke study.
J. Neurol.
PUBLISHED: 01-21-2010
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The objective of this study is to evaluate characteristics and mortality related to long-term post-stroke pain (PSP). All surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, between February 2006 and July 2009 received a postal questionnaire including the fatigue severity scale (FSS), the hospital anxiety and depression scale (HADSD), the Barthel index (BI), and questions regarding location of pain and pain severity at least 6 months after onset of stroke. Survival among patients returning the questionnaire was determined by November 2009. Stroke severity was defined by the modified Rankin score (mRS), 7 days after stroke onset. About 30% of the 408 patients had moderate to severe PSP. On logistic regression, PSP was associated with females (odds ratio (OR) = 2.1, p = 0.002), lower age (OR = 0.98, p = 0.04), fatigue (OR = 3.1, p < 0.001), sleep disturbances (OR = 3.3, p < 0.001), and mRS 3-5 (OR = 1.9, p = 0.03). Among patients with pareses (persistent or transient), there was no difference between paretic and non-paretic side as to frequency of limb pain on follow-up (p = 0.91). By November 2009, 26 patients had died. Cox regression analysis showed that mortality was associated with PSP (hazard ratio (HR) = 2.4, p = 0.040), high age (HR = 1.07, p = 0.001), males (HR = 2.5, p = 0.04), and low BI (HR = 0.97, p < 0.001). In conclusion, our study indicates a multifactorial basis for post-stroke pain. The main new findings were that the frequencies of pain were similar in paretic and non-paretic limbs and that long-term mortality was associated with post-stroke pain.
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High proportion of lacunar strokes at night: the Bergen stroke study.
J Stroke Cerebrovasc Dis
PUBLISHED: 01-06-2010
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The main objective of this study was to investigate the circadian distribution of subtypes of ischemic stroke. The time of onset of stroke in consecutive stroke patients was registered and categorized into the following time intervals: midnight-6 am, 6 am-noon, noon-6 pm, and 6 pm-midnight. Patients with unknown onset of stroke were categorized as woke up with stroke, found with stroke by others, and miscellaneous. Patients who woke up with stroke, were included in the midnight-6 am interval. Stroke subtypes were categorized according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria and as lacunar or embolic stroke based on diffusion-weighted magnetic resonance imaging (DWI). The study group comprised 1101 patients who sustained ischemic stroke between February 2006 and March 2008. The proportion of lacunar stroke, defined according to both the TOAST criteria and DWI findings, was significantly higher in the midnight-6 am interval compared with the other time intervals. In our study group, the prevalence of lacunar strokes was highest at night.
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[Thrombolysis in arterial cerebral infarction in children].
Tidsskr. Nor. Laegeforen.
PUBLISHED: 11-10-2009
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After the neonatal period, the incidence of arterial cerebral infarction is 1-2/100 000 children/year. Thrombolysis in cerebral stroke is recommended for adults, but is still controversial for children. The aim of this paper was to provide an overview of documentation on treatment with thrombolysis after arterial cerebral infarction in children.
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[Thrombolytic therapy in cerebral infarction].
Tidsskr. Nor. Laegeforen.
PUBLISHED: 11-10-2009
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Intravenous thrombolysis has gained widespread acceptance during the last 10 years, and is the only specific treatment approved for cerebral infarction. Haukeland University hospital introduced thrombolysis in 1998. The aim of this paper is to summarize our experience with the first 100 patients who had stroke caused by middle cerebral artery (MCA) occlusion and were treated with thrombolysis.
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Admission C-reactive protein after acute ischemic stroke is associated with stroke severity and mortality: the Bergen stroke study.
BMC Neurol
PUBLISHED: 04-28-2009
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There is growing evidence that inflammation plays an important role in atherogenesis. Previous studies show that C-reactive protein (CRP), an inflammatory marker, is associated with stroke outcomes and future vascular events. It is not clear whether this is due a direct dose-response effect or rather an epiphenomenon. We studied the effect of CRP measured within 24 hours after stroke onset on functional outcome, mortality and future vascular events.
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Clinical presentation and diffusion weighted MRI of acute cerebral infarction. The Bergen Stroke Study.
BMC Neurol
PUBLISHED: 02-28-2009
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No large study has compared the yield of diffusion-weighted imaging (DWI) with clinical examination in order to differentiate lacunar stroke from other stroke subtypes. This differentiation is important for guiding further investigations and treatment.
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Preadmission use of warfarin improves short-term outcome in patients with acute cerebral infarction. The Bergen Stroke Study.
Cerebrovasc. Dis.
PUBLISHED: 02-02-2009
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We hypothesized that patients with cerebral infarction on preadmission warfarin have less severe neurological deficits on admittance, less severe neurological deficits 1 week after the onset of cerebral infarction and a larger improvement as to neurological deficits within 1 week of acute cerebral infarction.
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Serum albumin in ischemic stroke patients: the higher the better. The Bergen Stroke Study.
Cerebrovasc. Dis.
PUBLISHED: 01-09-2009
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Animal studies show a neuroprotective effect of serum albumin in ischemic stroke. The neuroprotective effect of albumin in ischemic stroke in humans is not well studied. This study was aimed to determine the association of serum albumin with outcome and mortality after ischemic stroke.
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Persistent atrial fibrillation is associated with worse prognosis than paroxysmal atrial fibrillation in acute cerebral infarction.
ISRN Cardiol
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Background and Purpose. We hypothesized that patients with persistent atrial fibrillation (AF) suffer from more severe cerebral infarction than patients with paroxysmal AF due to differences in clot structure and volume. Methods. This study includes consecutive patients with acute cerebral infarction and persistent or paroxysmal AF documented by ECG any time prior to stroke onset. The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity on admission. Short-term outcome was determined by the modified Rankin scale (mRS) score, Barthel index, and NIHSS score 7 days after stroke onset. Risk factors were registered on admission. Eligible patients were treated with thrombolysis. Results. In total, 141 (52%) patients had paroxysmal AF, and 129 (48%) patients had persistent AF. NIHSS score on admission, mRS score at day 7, and mortality were significantly higher among patients with persistent AF. Thrombolysis was less effective in patients with persistent AF. Conclusions. Our study shows that patients with persistent AF and acute cerebral infarction have poorer short-term outcome than patients with paroxysmal AF. Differences in clot structure or clot volume may explain this.
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Low body temperature associated with severe ischemic stroke within 6 hours of onset: The Bergen NORSTROKE Study.
Vasc Health Risk Manag
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Hypothermia is considered neuroprotective and a potential treatment in cerebral ischemia. Some studies suggest that hyperthermia may promote clot lysis. We hypothesized that low body temperature would prolong time to spontaneous clot lysis resulting in an association between low body temperature and severe neurological deficits in the early phase of ischemic stroke.
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