BACKGROUND: Stroke is an emergency. In order to provide proper acute stroke treatment, there must be prompt activation of a stroke response system designed to deliver timely and optimum care. In our institution, the Brain Attack Team (BAT) was initiated upon the inception of the neurology residency training program.

OBJECTIVES:to ascertain the number and nature of BAT referral cases; to determine the time frames of the acute stroke response system observed in our institution. The time frames were compared to target times recommended by the National Institute of Neurological Disorders and Stroke (NINDS).

METHOD: We reviewed records of 399 BAT referral cases - both emergency room (ER) and floor referrals -over a ten-month period from January to October 2007. Frequency and percentage distributions were computed for the number of BAT referrals. Median time intervals in minutes were computed.

RESULTS: January had the most number of BAT calls at 17% (68 of 399). Fifty-five percent (220 of 399) of BAT calls were made during the night duty shift. Ischemic strokes had the highest incidence at 49.6% (198 of 399). Fifty-three percent (211 of 399) of patients were able to arrive at the ER within 3 hours; 47% (99 of 211) of these patients were ischemic stroke cases, and therefore eligible for possible thrombolysis. Of the 99 eligible patients, 8 passed our hospital criteria for thrombolysis. Intravenous recombinant tissue-plasminogen activator (rTPA) was administered in 6 out of 8 patients. Median time values were as follows: Ictus-to-Door time was 180 minutes, Door/Ictus at the floors-to-BAT referral was 30 minutes, BAT referral-to-BAT response was 5 minutes, Door/Order-to CT scan was 43 minutes. Door/Ictus at the floors-to-Drug median time among thrombolysed patients was 102.5 minutes.

CONCLUSION: Median time of BAT referral-to-BAT response was immediate. This was true even during night shift. Among those cases of patients who were given thrombolytic therapy, Door/Order-to-CT scan was within the NINDS target.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Stroke ; Brain ; Neurology ; Neurosciences

INTRODUCTION: Stroke research in western countries has recently begun to focus on gender differences. There is evidence that the burden of stroke seems to be greater among women. They were found to have different stroke risk factor profiles from men; and found to be managed differently from men. To date, there are no local studies documenting gender disparities in stroke.

OBJECTIVES: To determine whether there are differences in stroke risk profiles -hypertension, diabetes mellitus, congestive heart failure, atrial fibrillation, previous strokes or transient ischemic attacks, smoking, BMI, low-density lipoprotein (LPL) levels, medication intake; stroke types; and initial stroke assessment  - NHSS scores and blood pressure levels on admission - among male and female stroke patients in our institution.

METHOD: Chart review of 181 stroke patients (98 males, 83 females) admitted in our institution over an eight-month period.

CONCLUSION: Our findings suggest that gender disparities among Filipino stroke patients may exist and should not be overlooked. Defining these disparities would then pave the way to optimal stroke risk management in our setting.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Gender Identity ; Stroke ; Risk Factors ; Male ; Female ; Philippines ; Patients

INTRODUCTION: Intravenous administration of Recombinant Tissue Plasminogen Activator (IV-rTPA) has been an essential component of reperfusion treatment strategies in the aftermath of the 1995 National Institute of Neurological Disorders and Stroke (NINDS) TPA Stroke Study. However, it remains to be under-utilized both nationally and worldwide. Local data on thrombolytic use are very limited.

OBJECTIVES: This study aims to document our institution's experience with the use of intravenous thrombolysis in acute ischemic stroke cases by describing the demographic, clinical, radiographic, and management profiles of all our patients who were given IV - rTPA and their functional outcomes upon discharge and after three months.

METHOD: This is a descriptive study utilizing a clinical series design. Chart review of eighteen (18) patients who were admitted in our institution--a tertiary private hospital--due to acute ischemic stroke from January 2007 to August 2009 and who has given IV- rTPA was done. The patients' functional outcomes measured by the Modified Rankin Scale (MRS) upon discharge and at three months after stroke onset were documented by reviewing the patients' inpatient and outpatient records and by telephone interview conducted with the patients and/or their relatives.

RESULTS: The mean age of patients thrombolysed in our institution was 57.11 + 13.5 years (range: 31 to 80 years). All cases, except for one vertebrobasilar stroke, were anterior circulation strokes. Mean ictus-to-needle time frame for all thrombolysed patients was 174.3 + 56.6 minutes. The mean rTPA dose given to our patients was 0.87 + 0.08 mg/kg. A total 77.8% patients (14 of 18) received the standard rTPA dose of 0/9 mg/kg. Fourteen patients had follow-up imaging post-rTPA. Among these, 21.4% (3 of 14) developed non-symptomatic intracerebral hemorrhage (NSICH); 7.1% (1 of 14) developed a fatal symptomatic intracerebral hemorrhage (SICH). The mean baseline National Institutes of Health Stroke Scale (NIHSS) score of all patients was 14.9 + 5.9 (range: 4 to 24). Mean NIHSS score within the first 24 hours post-rTPA was 8.8 ± 6.1 (range: 0 to 19)--a 41% improvement from baseline. Eleven patients (11 of 18) or 61.1% were noted to have early improvement or an improvement of NIHSS score within the first 24 hours by ≥ 4. The mean follow-up NIHSS score beyond the first 24 hours post-rTPA was 5.5 ± 5.3 (range: 0 to 18), obtained at an average of 4.8 ± 2.4 days post-thrombolysis--a 63% improvement from the baseline mean NIHSS score. The mean MRS score of all patients upon hospital discharge was 3.17 ± 1.69. Two patients (2 of 18) or 11.1% expired 4 and 5 days post-thrombolysis; two (2 of 18) were lost to follow-up. For those who survived to discharge and not lost to follow-up (n=14), the mean MRS score at three months was noted to be 1.50 ± 1.09--a 53% improvement from mean MRS upon discharge. Seven of 18 patients (39%) had a favorable outcome defined as MRS ≤ 1 at three months post thrombolysis. Protocol deviations in our hospital were reported in 16.7% (3 of 18).

CONCLUSION: Our study showed trends to early improvement and favorable outcomes among stroke patients given IV-rTPA within 3 to 4.5 hours from ictus in our institution--with NIHSS scores improving by 40 to 60% during the course of their hospital stay, and 39% of patients having minimal or no disability at 3 months using the MRS. Our institution has more experience the standard rTPA dose of 0.9 mg/kg. A hospital brain rack team (BAT) that is on-call 24 hours' aids in the facilitation of thrombolytic treatment in acute ischemic strokes.

Human ; Aged 80 And Over ; Tissue Plasminogen Activator ; National Institute Of Neurological Disorders And Stroke (u.s.) ; Stroke ; Length Of Stay ; Brain Ischemia ; Inpatients ; Outpatients ; Follow-up Studies ; Lost To Follow-up ; Fibrinolytic Agents ; Cerebral Hemorrhage ; Reperfusion ; Administration, Intravenous ; Brain ; Hospitals, Private ; Demography ; Telephone

BACKGROUND: The Mini-Mental Status Examination (MMSE) is widely used as a screening tool for dementia. However, it has limitations as it lacks assessment of other cognitive domains. The Montreal Cognitive Assessment (MoCA), a 30-point test which can be administered in 10 minutes and which was made freely available by its developer, has been recently introduced and has been found to be a more sensitive screening tool fur early cognitive impairment and dementia compared to the MMSE. OBJECTIVES: To modify the MoCA so it can be adapted into the Filipino setting (Filipino adaptation of the MoCA or FA-MoCA); To assess the applicability of the FA-MoCA in our local setting; Using pre-determined cut-off points, to compare the number of respondents scoring normally and below cut-offi in both FA-MoCA and the MMSE-Filipino (MMSE-F). METHOD: One hundred (100) respondents which comprised of nursing and nursing aide staff from two tertiary hospitals, were administered both MMSE-F and FA-MoCAin random order with a minimum of one hour and a maximum of three days from each other. Global individual and mean scores for both tests and item mean scores for the FA-MoCA were computed. Proportion of subjects scoring below and within/above cutoff points were determined for both tests. Using one-sample t-test, FA-MoCA mean scores of the respondents were compared to the MoCA normative data derived from an earlier validity study for the latter. RESULTS: Mean age of the respondents was 28.27 ± 7.70 years. All the respondents had 14 years of schooling. The mean MMSE-F score was 28.75 ± 1.21; mean FA-MoCA score for all respondents was 24.83 ± 1.97. Ninety-seven (97%) of the respondents had normal MMSE-F scores, 3% had MMSE-F scores below cut-off point; whereas, 39% had normal FA-MoCA scores and 61 % had FA-MoCA scores below cut-off. Among those with normal MMSE-F scores, 59 (60.8%) had abnormal FA-MoCA scores and 38 (39.2%) had normal FA-MoCA scores. Compared to the MoCA normative data, the respondents' global mean FA-MoCA score was significantly lower than that of the normal controls (p=0.00, t-test, CI: -2.93 to -2.15). With regards to the item mean FA-MoCA scores, the following were noted to be significantly lower than the MoCA item scores of normal controls in the MoCA normative data: cube (p=0.00, t-test), clock (p=0.00, t-test), naming (p=0.00, t-test), memory (p=0.004, t-test), sentence repetition (p=0.00, t-test), and abstraction (p=0.00, t-test). On the other hand, the FA-MoCA respondents' score in the digit span item was significantly higher (p=0.00, t-test) then the MoCA normative data. CONCLUSION: The FA-MoCA may be easily administered as an initial screening tool for cognition with recommended minimal modifications for its administration. It dearly provides more information than the MMSE-F as it allows assessment of more cognitive domains.

Human ; Male ; Female ; Diagnosis ; Diagnostic Techniques And Procedures ; Dementia ; Nervous System Diseases ; Central Nervous System Diseases ; Brain Diseases