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Blood is circulated throughout the human body through a network of blood vessels called the circulatory system. This system includes arteries that transport blood from the heart to various body parts. These arterial pathways divide into smaller vessels until they reach the arterioles, which further split into capillaries. It is within these minuscule capillaries that the exchange of nutrients and waste products takes place. After this exchange, the blood is collected by venules, which fuse to...
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The vascular system, an integral part of the circulatory system, comprises various blood vessels that play crucial roles in maintaining the body's homeostasis. These blood vessels form a complex and efficient circulatory network. The three primary categories of blood vessels are the arteries, veins, and capillaries.
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Large Vessel Occlusion in Acute Stroke.

Lena-Alexandra Beume1,2,3, Maren Hieber1,2,3, Christoph P Kaller1,2,3

  • 1From the Department of Neurology and Neuroscience (L.-A.B., M.H., C.P.K., K.N., J.B., C.W., M.R.), Medical Center, University of Freiburg, Germany.

Stroke
|October 26, 2018
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Summary

Cortical symptoms like aphasia are reliable prehospital indicators for large vessel occlusion (LVO) stroke and mechanical thrombectomy (MT). This finding supports prompt transport to specialized stroke centers.

Keywords:
aphasiaintracranial hemorrhageneglectstrokethrombectomy

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Stroke Research

Background:

  • No established prehospital clinical score reliably identifies large vessel occlusion (LVO) stroke requiring mechanical thrombectomy (MT).
  • Current prehospital stroke assessment often prioritizes motor deficits, potentially overlooking critical indicators.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of cortical symptoms versus motor deficits as prehospital markers for LVO and MT.
  • To propose a more sensitive prehospital assessment strategy for acute ischemic stroke.

Main Methods:

  • Retrospective analysis of 543 acute stroke patients, including diverse stroke types and mimics.
  • Comparison of sensitivity and specificity for LVO and MT between cortical symptoms (aphasia, neglect) and motor deficits.

Main Results:

  • Cortical symptoms demonstrated high sensitivity (0.91 for LVO, 0.90 for MT) and moderate specificity (0.70 for LVO, 0.60 for MT).
  • Motor deficits showed lower specificity for LVO (0.53) and MT (0.48) compared to cortical symptoms.
  • Cortical symptoms proved more reliable indicators for LVO and MT than motor deficits in the prehospital setting.

Conclusions:

  • The presence of cortical symptoms is a reliable prehospital indicator for LVO requiring mechanical thrombectomy.
  • Identifying cortical symptoms justifies immediate transport of acute stroke patients to an MT-capable center for timely intervention.