Megan Donohue

Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis

Objective: To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance. Methods: We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014–November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges. Results: Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7, p = 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls, p < 0.0001), median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes controls, p < 0.0001), median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes controls, p = 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes controls, p = 0.0485). Sixteen patients evaluated on MSTU received thrombolysis, 25% of whom received it within 60 minutes of symptom onset. Conclusion: Compared with the traditional ambulance model, telemedicine-enabled ambulance-based thrombolysis resulted in significantly decreased time to imaging and treatment.

Significant Period Between Presentation and Diagnosis in Basilar Artery Occlusion: Five Cases and the Lessons Learned

Basilar artery occlusion remains a challenging pathological process. Time delay between presentation and diagnosis and treatment can be associated with poor outcome, but the low frequency and variable presentation in BAO makes rapid diagnosis difficult. Clinicians should maintain an index of suspicion for basilar artery occlusion in patients of any age who present with focal neurological symptoms that could be referable to the basilar artery. Timely vessel imaging is critical for the diagnosis and initiation of treatment in these patients.

Pathological Evidence of Cardiac Papillary Fibroelastoma in a Retrieved Intracranial Embolus

Approximately one-quarter of all cardiac tumors present with systemic embolization. Cardiac papillary fibroelastomas (CPF) represent a potential embolic source, accounting for 8% of all primary cardiac tumors, second in frequency after cardiac myxomas. Most case reports describe papillary fibroelastoma as a potential source for stroke, but histopathological evidence of actual tumor fragment causing a stroke is lacking. We describe a case of histologically confirmed CPF mechanically retrieved from a cerebral artery during an emergent cerebral endovascular procedure with subsequent discovery of the CPF in the heart, providing in vivo demonstration of intracranial embolization of this cardiac tumor.