Acute Ischemic Stroke

Background and Purpose—Pooled analysis of major placebo-controlled trials suggests that the earlier thrombolysis is
given after ischemic stroke, the better the outcome. We report a single-center assessment of the effect of ultraearly
thrombolysis on the outcome of our patients.
Methods—Between January 2003, and December 2008, a total of 878 patients with ischemic stroke received thrombolysis
within 4.5 hours from the symptom onset at the Helsinki University Central Hospital. Using univariate methods and
multivariable logistic regression, we assessed the association between onset-to-treatment time (OTT) and favorable
3-month outcome (modified Rankin Scale 0 to 2).
Results—Median age was 70.5 years, median OTT 115 minutes, and median National Institutes of Health Stroke Scale
(NIHSS) on admission 9. After adjustment for baseline stroke severity, more patients with OTT
70 minutes had a
favorable outcome than those with OTT
70 minutes. Specifically, OR of 5.15 (1.50 to 27.5) was for the patients with
NIHSS 7 to 12, and 2.74 (1.26 to 5.90) for those with NIHSS
13. Of the patients with OTT90 minutes, those with NIHSS
7 to 12 had an OR of 1.72 (1.00 to 2.96) for a favorable outcome, and those with NIHSS
13 had lower mortality than the
ones with OTT 90 minutes (16.4% versus 29.5%; P0.01). Multivariable model showed an association of better outcome
with lower baseline glucose level, younger age, lower baseline NIHSS, and OTT
70 minutes.
Conclusions—Ultraearly thrombolysis was associated with better outcome of our patients with stroke with moderate or
severe symptoms. The earlier the treatment was given, the higher the likelihood of favorable outcome. (Stroke. 2010;
41:712-716.)

Background. Transient ischemic attack (TIA) is characterized by stroke-like neurologic signs and symptoms in the absence of demonstrable structural neuropathology. There is no test for TIA, with classification often reliant on subjective, retrospective report. Functional brain measures such as the electroencephalogram (EEG) may be helpful in objectively detecting and describing the pathophysiology of TIA, but this has not been adequately examined.

Methods. EEG was obtained from a single electrode over the left frontal lobe during 3-minute resting-state and auditory oddball conditions administered to consecutive patients within 72 hours of admission to the acute stroke ward of a tertiary hospital. Separately, patients were classified by their treating team
as having suffered either an ischemic stroke (n = 10) or a TIA (n = 10). Relative power of delta, theta, alpha, and beta EEG frequency bands were extracted for comparison between the 2 clinical groups and an existing normative sample of 10 healthy, age-, gender-, and education-matched older adults.

Results. Analysis of variance with post hoc testing identified pronounced delta activity in stroke patients, while alpha and beta power were elevated in TIA patients. Both patient groups exhibited attenuated theta activity compared with healthy controls. Receiver operating characteristic curve analysis identified thresholds for each EEG frequency capable of distinguishing the 3 participant groups.

Conclusions. TIA, ischemic stroke, and healthy aging are each associated with distinct electrophysiological profiles. These preliminary findings suggest that acute EEG may be helpful in elucidating the pathophysiology and reversibility of TIA symptoms, and further exploration of the value of this unique functional brain data is encouraged.