Research and development in stroke services.
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Biomedical Research↗
Biomedical subjects
Damian Jenkinson
Publications and source records attributed to Damian Jenkinson.
Assessing dynamic cerebral autoregulation after stroke using a novel technique of combining transcranial Doppler ultrasonography and rhythmic handgrip.
OBJECTIVES: Dynamic cerebral autoregulation (CA) is impaired after stroke. Methods employed to assess this phenomenon usually involve deliberate alterations in blood pressure (BP) by physical means. We performed a pilot study to assess dynamic CA in acute stroke patients using a novel technique of combining transcranial Doppler (TCD) ultrasonography with rhythmic handgrip. METHODS: Ten patients with ischaemic stroke in the middle cerebral artery (MCA) territory were studied. We performed continuous recordings of bilateral MCA velocities and used rhythmic handgrip to induce BP oscillations. Changes in autoregulation were indicated by changes in phase shift and gain of MCA velocity in relation to BP. Patients were examined at <7 days, 6 weeks, and 3 months after stroke. RESULTS: There were no significant differences in phase shift or gain between the affected and unaffected cerebral hemispheres. Combining the results from both hemispheres, there was a trend of increasing phase shift (P=0.04) and decreasing gain (P=0.24) over the first three months after stroke, indicating improving CA. Rhythmic handgrip produced an average percentage change in BP (peak-to-trough) of 10% around the mean, and the frequency of the induced BP oscillations was very similar to that of the rhythmic handgrip. CONCLUSIONS: Combining TCD with rhythmic handgrip appeared to be a useful technique for assessing dynamic CA and it deserves further studies. In this pilot study, there was some evidence that CA might improve up to 3 months after ischaemic stroke.
Aged↗
Thrombolytic therapy for acute ischaemic stroke.
Recombinant tissue plasminogen activator (rt-PA, also known as alteplase; Actilyse) is the first and only licensed thrombolytic approved for use in acute ischaemic stroke in the UK. This article reviews the evidence for the role of rt-PA in acute stroke management and how it may improve long-term clinical outcome for selected patients as part of a comprehensive stroke service.
Acute Disease↗
Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test.
BACKGROUND AND PURPOSE: Timely referral of appropriate patients to acute stroke units is necessary for effective provision of skilled care. We compared the characteristics of referrals with suspected stroke to an academic acute stroke unit via 3 primary referral routes: ambulance paramedics using a rapid ambulance protocol and stroke recognition instrument, the Face Arm Speech Test; primary care doctors (PCDs); and emergency room (ER) referrals. METHODS: Patient characteristics, final diagnosis, and admission delay were recorded in all suspected acute stroke referrals in a 6-month period. RESULTS: Four hundred eighty-seven patients (356 strokes/transient ischemic attacks) were admitted by the 3 routes: 178 by ambulance, 216 by PCDs, and 93 through the ER. The proportion of nonstrokes admitted by each route was similar (23%, 29%, and 29%, respectively). Ambulance paramedics' stroke diagnosis was correct in 144 of 183 (79%) stroke patients who initially presented to them. Thirty-nine of 66 strokes/transient ischemic attacks referred via ER were taken there following initial ambulance assessment. Compared with PCDs, paramedics referred more total anterior circulation (39% versus 14%, P<0.0001) and fewer lacunar strokes (14% versus 31%, P<0.001) and admitted more patients (46% versus 12%, P<0.01) within 3 hours of symptom onset. The most common nonstroke conditions were seizures, infections and confusion, cardiovascular collapse, and cerebral tumors. Paramedics admitted more patients with seizures. CONCLUSIONS: Misdiagnosis of stroke is common in the ER and by PCDs. Paramedics using the Face Arm Speech Test achieved high levels of detection and diagnostic accuracy of stroke.
Adult↗