Posterior circulation stroke is associated with prolonged door-to-needle time

Area of Science:

• Neurology
• Emergency Medicine
• Vascular Neurology

Background:

• Acute posterior circulation ischaemic stroke diagnosis can be delayed due to unrecognized early symptoms.
• Timely treatment with tissue plasminogen activator is critical for improving outcomes in acute ischaemic stroke.

Purpose of the Study:

• To test the hypothesis that posterior circulation stroke patients receive delayed thrombolytic treatment compared to anterior circulation stroke patients.
• To identify barriers causing delays in evaluation and treatment for posterior circulation stroke.

Main Methods:

• A cross-sectional study of 252 patients treated with intravenous tissue plasminogen activator within 4.5 hours of symptom onset.
• Comparison of demographics, stroke severity, symptoms, and time intervals between anterior and posterior circulation stroke patients.

Main Results:

• Posterior circulation stroke patients (12%) had lower NIHSS scores, more nausea, vomiting, and dizziness, and less aphasia or neglect.
• Longer intervals were observed for emergency department physician-to-neurologist evaluation and door-to-needle times in posterior circulation stroke.
• Nausea and vomiting were associated with delayed neurology evaluation and overall treatment.

Conclusions:

• Posterior circulation stroke patients faced delays in neurology evaluation and tissue plasminogen activator administration.
• Difficulties in rapidly recognizing posterior circulation stroke symptoms in the emergency department may contribute to these delays.