ORIGINAL ARTICLE Questionnaire-based study of cerebrovascular complications during pregnancy in Aichi Prefecture, Japan
|
|
- Alban Wilkinson
- 5 years ago
- Views:
Transcription
1 Hypertension Research Eclampsia and stroke In Pregnancy during pregnancy 40 ORIGINAL ARTICLE Questionnaire-based study of cerebrovascular complications during pregnancy in Aichi Prefecture, Japan Yasumasa Ohno 1, Kaoru Ishikawa 2, Shigeaki Kaseki 3, Fumitaka Kikkawa 4 Reprint request to: Yasumasa Ohno, M.D., Ph.D., Ohno Ladies Clinic, 10 Takahata, Inari-cho, Iwakuracity, Aichi, , Japan. yasumasa@ohno-clinic.jp Key words: eclampsia, etiological research, pregnancy, pregnancy induced hypertension, stroke Received: December 7, 2012 Revised: December 29, 2012 Accepted: January 13, Ohno Ladies Clinic, 2 Department of Regeneration of Medicine in Kuwana District, Suzuka University of Medical Science, 3 Kaseki Hospital, 4 Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine Aim: Our aim was to establish a therapeutic strategy for eclampsia and stroke during pregnancy. Methods: We performed a questionnaire-based study of eclampsia and stroke during pregnancy from 2005 to 2009 that targeted all obstetric institutions in Aichi Prefecture. The survey inquired about characteristics of eclampsia and stroke during pregnancy, management of hypertension during labor, and the current situation surrounding the maternal transport system as well as that for collaboration with neurosurgeons. Results: Our survey revealed that 66% of deliveries, 40% of eclampsia episodes, and 31% of stroke incidents occurred at primary medical institutions. With the exception of strokes, most cases were diagnosed by brain magnetic resonance imaging (MRI) and/or computed tomography (CT) at intensive medical institutions. Most medical institutions measured blood pressure during labor. However, other management strategies, including those involving the use of hypotensors, varied by institution. Conclusions: The present study is the first long-term etiological research project to address eclampsia and pregnancyassociated stroke in Japan. From our survey data, we were able to obtain detailed information and assess several issues regarding the maternal transport system, blood pressure management during labor, and collaboration with neurosurgeons. Introduction Eclampsia and stroke during pregnancy are major causes of maternal and neonatal death in many countries. 1 3) Despite the ubiquity of these conditions and their public health impacts, neither their etiologies nor therapeutic strategies for their treatment have been established. The lack of etiological information about eclampsia and stroke makes it difficult to propose appropriate management strategies for them. Close collaboration with neurosurgeons is necessary to prevent stroke; however, some medical institutions fail to establish good relationships with neurosurgeons, which can affect the prognoses for pregnant women who suffer strokes. In addition, some pregnant women develop hypertension after labor onset; unfortunately, hypertension is difficult to diagnose during early labor, and often overlooked, sometimes resulting in eclampsia and/or stroke. We performed a questionnaire-based study of eclampsia and stroke during pregnancy involving all obstetric institutions in Aichi Prefecture. Survey data were thereby named AICHI DATA. Aichi Prefecture accounts for 7% of the Japanese population as well as 7% of annual births in Japan. Therefore, AICHI DATA could provide useful etiological information regarding eclampsia and stroke during pregnancy in Japanese mothers. Our study results may also contribute to the development of therapeutic strategies for eclampsia and stroke during pregnancy. Materials and methods We performed a questionnaire-based study of eclampsia 40 Hypertens Res Pregnancy 2013; 1: The Authors Hypertension Research in Pregnancy 2013 Japan Society for the Study of Hypertension in Pregnancy
2 Y. Ohno et al. and stroke during pregnancy that targeted all obstetric institutions in Aichi Prefecture from at 2007 (166 institutions) and 2010 (155 institutions). From the time we began the survey to the end, the number of medical institutions decreased from 166 to 155. All institutions responded to our questionnaire, which was designed to obtain detailed information about cases of eclampsia and stroke during pregnancy. Financial support was provided by the Perinatal Care Association of the Aichi Prefectural Government. Results Characteristics of eclampsia and stroke Between 2005 and 2009 in Aichi Prefecture, 322,599 deliveries occurred. Of these, 126 cases of eclampsia (0.04%) and 26 cases of stroke (0.008%) were reported. Forty percent of the eclampsia cases and 31% of strokes occurred at primary medical institutions, while 19% of strokes occurred at home. Most eclampsia cases (92.8%) and all strokes were managed at intensive medical Table 1. Eclampsia and stroke during pregnancy in Aichi Prefecture from 2005 to 2009 Total Intensive institutions Primary institutions Home Institutions* Delivery 322,599 (100%) 110,997 ( 34.4%) 211,602 (65.6%) Eclampsia (onset) 126 (100%) 75 ( 59.6%) 50 (39.7%) 1 ( 0.7%) Eclampsia (managed) 126 (100%) 117 ( 92.8%) 9 ( 7.2%) Stroke (onset) 26 (100%) 13 ( 50.0%) 8 (30.8%) 5 (19.2%) Stroke (managed) 26 (100%) 26 (100.0%) 0 * The number of all institutions were decreasing from 166 in 2007 to 155 in 2010, intensive from 52 to 50, primary from 114 to 105. Table 2. Characteristics of annual eclampsia in Aichi Prefecture Total Delivery 322,599 63,512 67,311 62,431 65,007 64,338 Eclampsia Onset antepartum 21 (16.7%) during labor 50 (39.7%) postpartum 55 (43.6%) Neuroimaging CT MRI CT + MRI no imaging Therapy anticonvulsants* MgSO 4 * hydralazine* Ca blockers* glycerine* PGE 1 * Prognosis further episodes ( ) further episodes ( + ) death * data obtained between 2007 and 2009 Hypertens Res Pregnancy 2013; 1:
3 Eclampsia and stroke during pregnancy institutions. Forty percent of pregnant women who suffered strokes at home died (Table 1). The majority of eclampsia episodes occurred during labor (39.7%) or postpartum (43.6%). In 87% of eclampsia cases, brain computed tomography (CT) and/ or magnetic resonance imaging (MRI) was performed for Table 3. Characteristics of annual stroke during pregnancy Total No. of deliveries 322,599 63,512 67,311 62,431 65,007 64,338 Stroke Onset antepartum 9 (34.6%) during labor 3 (11.5%) postpartum 14 (53.9%) CH SAH MD CI CVT PRES others Prognosis further episodes ( ) further episodes ( + ) death CH: cerebral hemorrhaging, SAH: subarachnoid hemorrhaging, MD: moyamoya disease, CI: cerebral infarction, CVT: cerebral venous thrombosis, PRES: posterior reversible encephalopathy syndrome Table 4. Classification with stroke during pregnancy Total CH SAH MD CI CVT PRES Other Onset institution intensive primary home Onset antepartum during labor postpartum Therapy conservative surgery Prognosis further episodes ( ) further episodes ( + ) death CH: cerebral hemorrhaging, SAH: subarachnoid hemorrhaging, MD: moyamoya disease, CI: cerebral infarction, CVT: cerebral venous thrombosis, PRES: posterior reversible encephalopathy syndrome 42 Hypertens Res Pregnancy 2013; 1: 40 45
4 Y. Ohno et al. diagnosis. Thus, neuroimaging techniques can reveal the pathophysiology of patients with abnormal neurological symptoms and can also detect and localize cerebral edema, hemorrhaging, and infarction. All patients with eclampsia showed good prognoses except for one patient who suffered a second episode of eclampsia (Table 2). The majority of strokes occurred either antepartum (34.6%) or postpartum (53.9%). Surgery was performed in 4 of 26 cases. Six of the stroke patients died (2 cerebral hemorrhages, 3 subarachnoid hemorrhages, and 1 cerebral venous thrombosis), while 6 patients suffered further strokes (Tables 3 and 4). Management of eclampsia and stroke With regard to blood pressure (BP) measurement during labor, 46.5% of institutions measured BP for all patients, 31.6% only measured BP for patients who presented with BP values greater than 140/90 mmhg on admission, and 14.2% allowed supporting medical staff to decide when to take BP measurements. Regarding the criteria for reporting BP data to doctors, 9.7% of institutions reported all data, 45.2% only reported BP values greater than 140/90 mmhg, and 22.6% left reporting decisions to the supporting medical staff. These findings revealed that the BP measurement strategies during labor were left in the hands of the supporting medical staff in roughly 20% of Table 5. Blood pressure measurement during labor Total Intensive Primary institutions institutions Measurement all cases 72 (46.5%) 30 (60.0%) 42 (40.0%) BP > 140/90 mmhg at admission 49 (31.6%) 8 (16.0%) 41 (39.0%) decided by supporting medical staff 22 (14.2%) 8 (16.0%) 14 (13.3%) none 4 ( 2.6%) 1 ( 2.0%) 3 (2.9%) Report to doctor all cases 15 ( 9.7%) 0 15 (14.3%) BP > 140/ 90 mmhg 70 (45.2%) 21 (42.0%) 49 (46.7%) BP > 150/100 mmhg 21 (13.5%) 6 (12.0%) 15 (14.3%) BP > 160/110 mmhg 4 ( 2.6%) 2 ( 4.0%) 2 (1.9%) decided by supporting medical staff 35 (22.6%) 15 (30.0%) 20 (19.0%) Table 6. Therapy for hypertension during labor Total Intensive Primary institutions institutions Cut-off point for hypertensive therapy 140/ 90 mmhg 9 (5.8%) 1 ( 2.0%) 8 ( 7.6%) 150/100 mmhg 25 (16.1%) 5 (10.0%) 20 (19.0%) 160/110 mmhg 58 (37.4%) 21 (42.0%) 37 (35.2%) 180/ mmhg 47 (30.3%) 18 (36.0%) 29 (27.6%) Antihypertensive agent methyldopa hydralazine nifedipine nicardipine MgSO 4 usage cases without convulsions 29 (18.7%) 15 (30.0%) 14 (13.3%) cases with convulsions 25 (16.1%) 12 (24.0%) 13 (12.4%) none 92 (59.4%) 21 (42.0%) 71 (67.6%) Hypertens Res Pregnancy 2013; 1:
5 Eclampsia and stroke during pregnancy Table 7. Action (transport or collaboration with neurosurgeons) in response to convulsions during labor Total Intensive Primary institutions institutions Immediately 76 (49.0%) 16 (32.0%) 60 (57.1%) When repeated convulsions or neurological abnormalities occurred 77 (49.7%) 35 (70.0%) 42 (40.0%) Continue managing patient 2 ( 1.3%) 1 ( 2.0%) 1 ( 1.0%) institutions (Table 5). In antihypertensive therapy for hypertension during labor, 37.4% of institutions started using hypotensors when patient BP reached 160/110 mmhg, and 30.3% started using them when it reached 180 mmhg of systolic BP. Nicardipine and hydralazine were the most frequently used hypotensors. In addition, 18.7% of institutions used MgSO 4 in hypertensive patients without convulsions, 16.1% used it after convulsions occurred, and 59.4% did not use it at all (Table 6). Present state of the transport system for pregnant women with eclampsia and stroke Our survey revealed that 32.0% of intensive medical institutions initiated a collaborative management strategy with a neurosurgeon at the first convulsion, while 70.0% of them started only after repeated convulsions. In addition, 57.1% of primary medical institutions transported eclamptic patients at the first convulsion, while 40.0% of them transported the patient only after repeated convulsions (Table 7). Discussion The present study has been named AICHI DATA, as it collected detailed information pertaining to 322,599 deliveries in Aichi Prefecture. Of these, 126 cases of eclampsia (0.04%) and 26 cases of stroke (0.008%) were reported, corresponding to similar rates reported in other countries. 1 4) The lack of sufficient etiological data and the absence of a consensus regarding optimal treatment for eclampsia and stroke make it difficult to establish therapeutic strategies for these conditions. AICHI DATA is the first long-term etiological study of eclampsia and pregnancy-associated stroke in Japan. We obtained useful information from these data, which pertained to patients treated at both primary and intensive medical institutions. Forty percent of eclampsia cases and 31% of strokes occurred at primary medical institutions, which highlights the importance of not only appropriate diagnoses at primary medical institutions, but the establishment of efficient inter-institution transport systems as well. The majority of eclampsia episodes occurred during labor or postpartum, and the majority of strokes occurred antepartum or postpartum. This indicates that the possibility of eclampsia and/or stroke is relevant during all stages of pregnancy. Management of BP levels during labor was left up to the supporting medical staff at roughly 20% of the institutions, even though hypertension during labor can result in eclampsia or stroke. If a patient shows signs of hypertension, it is critical for the supporting medical staff to report the patient s BP to a doctor immediately, so that the necessary medical interventions can be discussed. Thirty-seven percent of institutions started using hypotensors when patient BP reached 160/110 mmhg, and 30% started using them when BP reached 180 mmhg of systolic BP. Nicardipine and hydralazine were the most frequently used hypotensors. If patient BP is greater than 160/110 mmhg, MgSO 4 can be used to decrease the risk of convulsions and reduce their BP to mmhg/ mmhg. The Joint National Committee in America and European Society of Hypertension proposed to reduce BP in patients with BP greater than 180/120 mmhg. 5 8) Methyldopa, hydralazine, nifedipine, labetalol, and nicardipine can be used as antihypertensive drugs during labor. Among them, nicardipine is likely the most common. Hydralazine is not suitable for patients with active cerebral hemorrhaging. Brain CT is an optimal method for stroke detection. When a stroke is detected, collaborative treatment with a neurosurgeon should be started as soon as possible. In the present study, 41% of primary medical institutions only transported eclamptic patients after repeated convulsions. If a stroke is suspected at a primary medical institution, rapid maternal transport to an intensive medical institution is necessary. Discrimination between eclampsia and stroke is difficult, but strokes are often characterized by the presence of facial or arm muscle 9, 10) weakness, or a speech deficit. This study provided detailed information and highlighted several issues, including the poor current state of maternal transport between primary and intensive 44 Hypertens Res Pregnancy 2013; 1: 40 45
6 Y. Ohno et al. medical institutions, the necessity of educating the staff of primary medical institutions about stroke, the lack of established criteria for BP reporting during labor, and the importance of collaborating with neurosurgeons. AICHI DATA provides important Japanese etiological data and might be used to revise the associated guidelines. Acknowledgements This work was supported in part by the Perinatal Care Association of the Aichi Prefectural Government. Conflict of interest The authors have no conflicts of interest to report. References 1. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ. 1994; 309: Kullberg G, Lindeberg S, Hanson U. Eclampsia in Sweden. Hypertens Pregnancy. 2002; 21: Sidorov EV, Feng W, Caplan LR. Stroke in pregnant and postpartum women. Expert Rev Cardiovasc Ther. 2011; 9: Knight M. Eclamlpsia in the United Kingdom BJOG. 2007; 114: Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003; 42: European Society of Hypertension-European Society of Cardiology Guidelines Committee European Society of Hypertension- European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003; 21: Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000; 356: The Joint National Committee. The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC V). Arch Intern Med. 1993; 153: Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati prehospital stroke scale: reproducibility and validity. Ann Emerg Med. 1999; 33: Hurwitz AS, Brice JH, Overby BA, Evenson KR. Directed use of the Cincinnati prehospital stroke scale by laypersons. Prehosp Emerg Care. 2005; 9: Hypertens Res Pregnancy 2013; 1:
Hypertensives Emergency and Urgency
Hypertensives Emergency and Urgency Budi Yuli Setianto Cardiology Divisision Department of Internal Medicine Faculty of Medicine UGM Sardjito Hospital Yogyakarta Background USA: Hypertension is 30% of
More informationBased on 2014 SOGC Guidelines
Based on 2014 SOGC Guidelines 22nd Edition 2015 1 ICH + gestational hypertension by far the biggest cause of direct maternal deaths New stats coming in 2013 OCR 22nd Edition 2015 2 Diastolic 90 mmhg is
More informationCMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan
CMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth New! Improving Health Care Response to Preeclampsia:
More informationComparison of Efficacy and Safety of Intravenous Labetalol Versus Hydralazine for Management of Severe Hypertension in Pregnancy
https://doi.org/10.1007/s13224-017-1053-9 ORIGINAL ARTICLE Comparison of Efficacy and Safety of Intravenous Labetalol Versus Hydralazine for Management of Severe Hypertension in Pregnancy Purvi Patel 1
More informationAWHONN Oregon Section 2014
AWHONN Oregon Section 2014 Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth Hypertensive in Pregnancy Carol J Harvey, MS, RNC-OB, C-EFM Clinical Specialist Northside
More informationCHAPTER 12 HYPERTENSION IN SPECIAL GROUPS HYPERTENSION IN PREGNANCY
CHAPTER 12 HYPERTENSION IN SPECIAL GROUPS HYPERTENSION IN PREGNANCY v Mild preeclampsia is managed by close observation of the mother and fetus preferably in hospital. If the diastolic blood pressure remains
More informationAgenda. Management of Accelerated Hypertension (Updated in 2017) Salwa Roshdy Prof. of Cardiology Assiut University CardioEgypt 23/2/2017 2/27/2017
Management of Accelerated Hypertension (Updated in 2017) By Salwa Roshdy Prof. of Cardiology Assiut University CardioEgypt 23/2/2017 Agenda Definition of Accelerated HTN Pathophysiology & Etiology Prognosis
More information, Correlation between Neuroimaging and Clinical Presentation in Eclampsia
Correlation between Neuroimaging and Clinical Presentation in Eclampsia Krishna Dahiya, Mahesh Rathod, Seema Rohilla, Pushpa Dahiya Department of Obstetrics and Gynecology, Pt.BDS, PGIMS, Rohtak Email:
More informationGUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE
2018 UPDATE QUICK SHEET 2018 American Heart Association GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE A Summary for Healthcare Professionals from the American Heart Association/American
More information"Women's Health" is also available at
"Women's Health" is also available at www.squarepharma.com.bd Vol-5 No-4 Oct-Dec 2012 Editorial Board Editorial Note: Dr. Omar Akramur Rab MBBS, FCGP, FIAGP Dear Doctor, Mohammad Hanif M. Pharm, MBA A.H.M.
More informationMagnesium Sulfate Prophylaxis in Preeclampsia: Evidence From Randomized Trials
CLINICAL OBSTETRICS AND GYNECOLOGY Volume 48, Number 2, 478 488 Ó 2005, Lippincott Williams & Wilkins Magnesium Sulfate Prophylaxis in Preeclampsia: Evidence From Randomized Trials BAHA M. SIBAI, MD Department
More informationMercy San Juan Medical Center. Preeclampsia and Other Hypertensive Disorders of Pregnancy
SUBJECT: Preeclampsia and Other Hypertensive Disorders of Pregnancy DEPARTMENTS: FBC, Emergency Department PURPOSE: To outline the nursing management of inpatients who have preeclampsia or other hypertensive
More informationMagnesium sulfate has an antihypertensive effect on severe pregnancy induced hypertension
Hypertension Research In Pregnancy 11 S. Takenaka et al. ORIGINAL ARTICLE Magnesium sulfate has an antihypertensive effect on severe pregnancy induced hypertension Shin Takenaka 1, Ryu Matsuoka 2, Daisuke
More informationClinical features. Abnormal vasculogenesis and angiogenesis and releasing of antiangiogenic
Clinical features Abnormal vasculogenesis and angiogenesis and releasing of antiangiogenic factors results in Vasospasm Endothelial dysfunction Etiology of various clinical signs and symptoms So, Preeclampsia
More informationPolicy REVISED: 6/30/2016 3:30 PM. Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016
Title: Antihypertensive Treatment for Severe Hypertension During Pregnancy Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016 Policy POLICY STATEMENT: Pregnant or postpartum patients
More informationPostpartum hypertension, preeclampsia and eclampsia. Arun Jeyabalan, MD MS University of Pittsburgh
Postpartum hypertension, preeclampsia and eclampsia Arun Jeyabalan, MD MS University of Pittsburgh Confusing concept Preeclampsia only occurs in pregnancy placenta is required Delivery cures preeclampsia
More informationCounseling and Long-term Follow up After Gestational Disorders
Counseling and Long-term Follow up After Gestational Disorders Tanya Melnik, MD Assistant Professor, University of Minnesota Sarina Martini, MD Ob/Gyn Resident, PGY4 University of Minnesota Counseling
More informationPatient characteristics. Intervention Comparison Length of followup. Outcome measures. Number of patients. Evidence level.
5.0 Rapid recognition of symptoms and diagnosis 5.1. Pre-hospital health professional checklists for the prompt recognition of symptoms of TIA and stroke Evidence Tables ASM1: What is the accuracy of a
More informationHypertensive Crises. Controlling high blood pressure prevents disease. Recognition and Management of Acute Hypertensive Emergencies
Controlling high blood pressure prevents disease Recognition and Management of Acute Hypertensive Emergencies David idweiner, M.D. Co-holder, C. Craig and Audrae Tisher Chair in Nephrology Functional Genomics
More informationDeclaration of conflict of interest
Declaration of conflict of interest Claudio Borghi Lectures fees: Menarini International, Servier International, Recordati International, Ely-Lilly USA, BMS, Boheringer Ingelheim, Novartis Pharma Research
More informationStroke in Pregnancy. Stroke in Pregnancy 6/23/13
G5#$#Preven*ng#Maternal#Morbidity#and#Mortality#Via# Expanded#Scope#of#Nursing#Prac*ce#As#First#Responder# in#hypertensive#crisis#of#preeclampsia# The$presenter$reports$no$relevant,$influencing$financial$rela5onships.$
More informationYou admitted a previously healthy nullipara at 36 weeks gestation who presented with new-onset periorbital edema and is found to have blood pressure
Preeclampsia Case report You admitted a previously healthy nullipara at 36 weeks gestation who presented with new-onset periorbital edema and is found to have blood pressure readings of 150/100 to 155/105
More informationhttps://www.lucidoc.com/cgi/doc-gw.pl?ref=overlake_p:53602
Page 1 of 6 Protocol : Severe Hypertension in Obstetrics: Emergent Treatment DocID: 53602 Revision: 7 Status: Official Department: Women's and Infants' Admin Manual(s): Labor and Delivery Mother Baby Unit
More informationPreeclampsia: What s old is new again. Gene Chang, MD Maternal Fetal Medicine
Preeclampsia: What s old is new again Gene Chang, MD Maternal Fetal Medicine Objectives Define Preeclampsia Review current guidelines Role of proteinuria Timing of delivery Seizure prevention Severe Hypertension
More informationShould infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants?
Should infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants? Shoshana Revel-Vilk, MD MSc Pediatric Hematology Center, Pediatric Hematology/Oncology Department,
More informationBlood pressure and total cholesterol level are critical risks especially for hemorrhagic stroke in Akita, Japan.
Blood pressure and total cholesterol level are critical risks especially for hemorrhagic stroke in Akita, Japan. Manabu Izumi, Kazuo Suzuki, Tetsuya Sakamoto and Masato Hayashi Jichi Medical University
More informationMANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM
MANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM Are Particular Anti-hypertensives More Effective or Harmful Than Others in Hypertension in Pregnancy? Existing data is inadequate Methyldopa and
More informationBlood Pressure Management in Acute Ischemic Stroke
Blood Pressure Management in Acute Ischemic Stroke Kimberly Clark, PharmD, BCCCP Clinical Pharmacy Specialist Critical Care, Greenville Health System Adjunct Assistant Professor, South Carolina College
More informationTony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight
Treatment of a Stroke patient: A look at how to care for the Stroke patient in the aeromedical setting Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight Objectives 1. Discuss the assessment
More informationLEARNING OBJECTIVES 2/20/2017
HYPERTENSION IN PREGNANCY: PREVENTING SEVERE MATERNAL MORBIDITY & MORTALITY THROUGH THE IMPLEMENTATION OF EVIDENCED BASED PROTOCOLS Laura Senn, RN, PhD, CNS Sutter Medical Center, Sacramento LEARNING OBJECTIVES
More informationCONTROL OF BLOOD PRESSURE IN PREGNANCY: HOW HIGH IS TOO HIGH? EVELYNE REY, CHU Ste-Justine, Montreal
CONTROL OF BLOOD PRESSURE IN PREGNANCY: HOW HIGH IS TOO HIGH? EVELYNE REY, CHU Ste-Justine, Montreal CONFLICTS OF INTEREST $: None Others: Canadian guidelines, CHIPS CSIM2015 2 LEARNING OBJECTIVES New
More informationHypertension. Risk of cardiovascular disease beginning at 115/75 mmhg doubles with every 20/10mm Hg increase. (Grade B)
Practice Guidelines and Principles: Guidelines and principles are intended to be flexible. They serve as reference points or recommendations, not rigid criteria. Guidelines and principles should be followed
More informationHypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute
Hypertension Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension 2017 Classification BP Category Systolic Diastolic Normal 120 and 80 Elevated
More informationIncidental Findings; Management of patients presenting with high BP. Phil Swales
Incidental Findings; Management of patients presenting with high BP Phil Swales Consultant Physician Acute & General Medicine University Hospitals of Leicester NHS Trust Objectives The approach to an incidental
More informationShould hypertensive disorders of pregnancy be considered as a prehypertension state?
February 2018 Should hypertensive disorders of pregnancy be considered as a prehypertension state? Pr. Jacques Blacher Paris-Descartes University ; AP-HP ; Unité HTA, prévention et thérapeutique cardio-vasculaires,
More informationHypertensive Urgencies And Emergencies
Hypertensive Urgencies And Emergencies 1 / 6 2 / 6 3 / 6 Hypertensive Urgencies And Emergencies INTRODUCTION. This topic discusses the initial management of hypertensive emergencies and urgencies in children.
More informationINTRAVENOUS HYDRALAZINE POLICY
PURPOSE INTRAVENOUS HYDRALAZINE POLICY The purpose of this policy is to: provide safe and effective care for women establish a local approach to care that is evidence based and consistent inform good decision
More informationPreeclampsia. &Eclampsia. Hypertensive Disorders of Pregnancy. What we need to know about. Hypertensive Disorders of Pregnancy.
Preeclampsia &Eclampsia Hypertensive Disorders of Pregnancy Barbara Koop MS, RNC-OB What we need to know about Hypertensive Disorders of Pregnancy Define clinical criteria for: Gestational hypertension,
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 3/ Issue 22/June 02, 2014 Page 6058
A RETROSPECTIVE ANALYSIS OF CONVULSIONS IN PREGNANCY IN A TERTIARY REFERRAL MEDICAL COLLEGE HOSPITAL Anoop Sreevalsan 1, Srinija P 2, Surya P 3, Vasantha N. Subbiah 4 HOW TO CITE THIS ARTICLE: Anoop Sreevalsan,
More informationRadiology. General radiology department. X-ray
The radiology directorate provides a diagnostic, interventional and therapeutic service for its local population, and a tertiary service for the region. It also provides support to some national work such
More informationPregnancy and Neurological Disorders
Pregnancy and Neurological Disorders Myles Connor NHS Borders and University of Edinburgh, United Kingdom Outline Why is it important? Specific conditions Eclampsia Cerebrovascular disease Epilepsy Idiopathic
More informationCOMPARATIVE STUDY OF LOW DOSE MAGNESIUM SULPHATE & PRITCHARD REGIME FOR ECLAMPSIA & IMMINENT ECLAMPSIA
COMPARATIVE STUDY OF LOW DOSE MAGNESIUM SULPHATE & PRITCHARD REGIME FOR ECLAMPSIA & IMMINENT ECLAMPSIA N. S. Kshirsagar, Manisha Laddad, Amit Bafana 1. Professor. Department of Obstetrics & Gynecology,
More informationNIH Public Access Author Manuscript JAMA Intern Med. Author manuscript; available in PMC 2015 August 01.
NIH Public Access Author Manuscript Published in final edited form as: JAMA Intern Med. 2014 August ; 174(8): 1397 1400. doi:10.1001/jamainternmed.2014.2492. Prevalence and Characteristics of Systolic
More informationInt. J. Pharm. Sci. Rev. Res., 36(1), January February 2016; Article No. 06, Pages: JNC 8 versus JNC 7 Understanding the Evidences
Research Article JNC 8 versus JNC 7 Understanding the Evidences Anns Clara Joseph, Karthik MS, Sivasakthi R, Venkatanarayanan R, Sam Johnson Udaya Chander J* RVS College of Pharmaceutical Sciences, Coimbatore,
More informationMethamphetamine Abuse During Pregnancy
Methamphetamine Abuse During Pregnancy Robert Davis, MD / r.w.davismd@gmail.com ❶ Statistics ❷ Pregnancy Concerns ❸ Postpartum Concerns ❹ Basic Science ❺ Best Practice Guidelines ❻ Withdrawal ❼ Recovery
More informationClinical Features and Subtypes of Ischemic Stroke Associated with Peripheral Arterial Disease
Cronicon OPEN ACCESS EC NEUROLOGY Research Article Clinical Features and Subtypes of Ischemic Stroke Associated with Peripheral Arterial Disease Jin Ok Kim, Hyung-IL Kim, Jae Guk Kim, Hanna Choi, Sung-Yeon
More informationTodd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between
More informationNew Frontiers in Intracerebral Hemorrhage
New Frontiers in Intracerebral Hemorrhage Ryan Hakimi, DO, MS Director, Neuro ICU Director, Inpatient Neurology Services Greenville Health System Clinical Associate Professor Department of Medicine (Neurology)
More informationWHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE
WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE Subarachnoid Hemorrhage is a serious, life-threatening type of hemorrhagic stroke caused by bleeding into the space surrounding the brain,
More informationReversible Posterior Encephalopathy Syndrome as the Presentation of Late Postpartum Eclampsia: A Case Report
Case Reports 158 Reversible Posterior Encephalopathy Syndrome as the Presentation of Late Postpartum Eclampsia: A Case Report Yih-Hwa Chiou and Ping-Hong Chen Abstract- We presented a case of previous
More informationStudy of the role of low dose magnesium Sulphate in Hypertensive Disorders of Pregnancy 1 2
ORIGINAL ARTICLE J Pub Health Med Res 2015;3(2):31-37 Study of the role of low dose magnesium Sulphate in Hypertensive Disorders of Pregnancy 1 2 Shubha C.R. Vailaya, Naveena Kumari M. 1 Chief Consultant
More informationProtocol for IV rtpa Treatment of Acute Ischemic Stroke
Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and
More informationAngst og depresjon under graviditet og postpartum: et epidemiologisk perspektiv
Angst og depresjon under graviditet og postpartum: et epidemiologisk perspektiv Malin Eberhard-Gran, professor MD, PhD Norwegian Institute of Public Health og Akershus University Hospital Mood and anxiety
More informationPrevalence of Hypertension in Semi-Urban area of Nepal
ORIGINAL ARTICLE Prevalence of Hypertension in Semi-Urban area of Nepal Koju R*, Manandhar K*, Gurung R*, Pant P*, Bedi TRS* *Department of Internal Medicine, Dhulikhel Hospital KUH ABSTRACT Hypertension
More informationESM 1. Survey questionnaire sent to French GPs. Correct answers are in bold. Part 2: Clinical cases: (Good answer are in bold) Clinical Case 1:
ESM 1. Survey questionnaire sent to French GPs. Correct answers are in bold. Part 2: Clinical cases: (Good answer are in bold) Clinical Case 1: to your office at 2 pm for a feeling of weakness and numbness
More informationATTENDING PHYSICIAN'S STATEMENT STROKE / BRAIN ANEURYSM SURGERY OR CEREBRAL SHUNT INSERTION / CAROTID ARTERY SURGERY
ATTENDING PHYSICIAN'S STATEMENT STROKE / BRAIN ANEURYSM SURGERY OR CEREBRAL SHUNT INSERTION / CAROTID ARTERY SURGERY A) Patient s Particulars Name of Patient Gender NRIC/FIN or Passport No. Date of Birth
More informationUpdated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข
Updated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข Emergency start at community level: Prehospital care Acute stroke
More informationManagement of Acute Ischemic Stroke. Learning Objec=ves. What is a Stroke? Jen Simpson Neurohospitalist
Management of Acute Ischemic Stroke Jen Simpson Neurohospitalist Learning Objec=ves Iden=fy signs/symptoms of stroke Recognize pa=ents who may be eligible for treatment of acute stroke What is a Stroke?
More informationNeurosurgical Management of Stroke
Overview Hemorrhagic Stroke Ischemic Stroke Aneurysmal Subarachnoid hemorrhage Neurosurgical Management of Stroke Jesse Liu, MD Instructor, Neurological Surgery Initial management In hospital management
More informationDefinition พ.ญ.ส ธ ดา เย นจ นทร. Epidemiology. Definition 5/25/2016. Seizures after stroke Can we predict? Poststroke seizure
Seizures after stroke Can we predict? พ.ญ.ส ธ ดา เย นจ นทร PMK Epilepsy Annual Meeting 2016 Definition Poststroke seizure : single or multiple convulsive episode(s) after stroke and thought to be related
More informationStudy of role of MRI brain in evaluation of hypoxic ischemic encephalopathy
Original article: Study of role of MRI brain in evaluation of hypoxic ischemic encephalopathy *Dr Harshad Bhagat, ** Dr Ravindra Kawade, ***Dr Y.P.Sachdev *Junior Resident, Department Of Radiodiagnosis,
More informationNeuroimaging in Pregnancy
Neuroimaging in Pregnancy January 18, 2014 Sarasota, FL Joshua P. Klein, M.D., Ph.D. Departments of Neurology and Radiology Brigham and Women s Hospital and Harvard Medical School American Society of Neuroimaging
More informationOutline. Calgary Pediatric Stroke Program. Parent Information and Networking Session
Calgary Pediatric Stroke Program Parent Information and Networking Session Perinatal Stroke Adam Kirton MD MSc FRCPC Pediatric Neurologist Alberta Children s Hospital Sonia Rothenmund RN, BN, CNN(C) Pediatric
More informationSWISS SOCIETY OF NEONATOLOGY. Neonatal cerebral infarction
SWISS SOCIETY OF NEONATOLOGY Neonatal cerebral infarction May 2002 2 Mann C, Neonatal and Pediatric Intensive Care Unit, Landeskrankenhaus und Akademisches Lehrkrankenhaus Feldkirch, Austria Swiss Society
More informationSupplementary Online Content
Supplementary Online Content Hooshmand B, Magialasche F, Kalpouzos G, et al. Association of vitamin B, folate, and sulfur amino acids with brain magnetic resonance imaging measures in older adults: a longitudinal
More informationPost-op Carotid Complications A Nursing Perspective of What to Watch Out for
Post-op Carotid Complications A Nursing Perspective of What to Watch Out for By Kariss Peterson, ARNP Swedish Medical Center Inpatient Neurology Team 1 Post-op Carotid Management Objectives Review the
More informationCardiac Pathophysiology
Cardiac Pathophysiology Evaluation Components Medical history Physical examination Routine laboratory tests Optional tests Medical History Duration and classification of hypertension. Patient history of
More information2017 High Blood Pressure Clinical Practice Guideline
2017 High Blood Pressure Clinical Practice Guideline Applying the Latest Hypertension Guideline to Your Practice Carmine D Amico, D.O., F.A.C.C. 2017 ACC / AHA / AAPA / ABC / ACPM / AGS / APhA / ASH /
More informationVomiting Should Be a Prompt Predictor of Stroke Outcome
Vomiting Should Be a Prompt Predictor of Stroke Outcome Kazuo Shigematsu, Osamu Shimamura, Hiromi Nakano, Yoshiyuki Watanabe, Tatsuyuki Sekimoto, Kouichiro Shimizu, Akihiko Nishizawa, Masahiro Makino Emerg
More informationSinus and Cerebral Vein Thrombosis
Sinus and Cerebral Vein Thrombosis A Summary Sinus and cerebral vein clots are uncommon. They can lead to severe headaches, confusion, and stroke-like symptoms. They may lead to bleeding into the surrounding
More informationSupplemental Digital Content: Definitions Based on the International Classification of Diseases, Ninth Revision, Clinical Modification
Supplemental Digital Content: Definitions Based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Diagnose and Procedures Codes 1. ICD-9-CM definition of
More informationOBSERVATION. Postpartum Angiopathy With Reversible Posterior Leukoencephalopathy
Postpartum Angiopathy With Reversible Posterior Leukoencephalopathy Aneesh B. Singhal, MD OBSERVATION Background: Postpartum angiopathy (PPA) is a cerebral vasoconstriction syndrome of uncertain cause
More informationANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION*
Progress in Clinical Medicine 1 ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION* Keishi ABE** Asian Med. J. 44(2): 83 90, 2001 Abstract: J-MUBA was a large-scale clinical
More informationOsama Sanad (MD) Prof. of Cardiology Benha University 2016
Osama Sanad (MD) Prof. of Cardiology Benha University 2016 Back in time. 1912 Back in time. 1912 No body knows that hypertension is a lethal disease Hypertension in 1940s Among anti-hypertensives mentioned
More informationManaging Hypertension in the Perioperative Arena
Managing Hypertension in the Perioperative Arena Optimizing Perioperative Management Strategies for Hypertension in the Cardiac Surgical Patient Objectives: Treatment of hypertensive emergencies. ALBERT
More informationCOMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA)
COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA) Prof. Hayfaa Wahabi, King Saud University, Riyadh Saudi Arabia Hayfaa
More informationIncidence of Strokes and Its Prognosis in Patients on Maintenance Hemodialysis
Incidence of Strokes and Its Prognosis in Patients on Maintenance Hemodialysis Kaoru ONOYAMA, M.D., Harumitsu KUMAGAI, M.D., Tiaki MIISHIMA, M.D., Hiroshi TSURUDA, M.D., Suguru TOMOOKA, M.D., Kenichi MOTOMURA,
More informationESC Guidelines on the Management of Cardiovascular Diseases during Pregnancy
ESC Guidelines on the Management of Cardiovascular Diseases during Pregnancy Task force on the management of CVD during pregnancy of the ESC Chair: Vera Regitz-Zagrosek, Charite, Berlin None DECLARATION
More informationSex Differences in Stroke Risk and Quality of Life after Stroke
Sex Differences in Stroke Risk and Quality of Life after Stroke Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, WFB Stroke Center Disclosures Research funding from: World Federation
More informationA Study on Clinical and Etiological Factors of New-Onset Seizures in Adults
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X A Study on Clinical and Etiological Factors of New-Onset Seizures in Adults P. S. V. Ramana Murthy Associate Professor, Department of General
More informationUpdate on Hypertensive Diseases in Pregnancy
Objectives Update on Hypertensive Diseases in Pregnancy ANNA MCCORMICK, DO MFM FELLOW, MEDICAL COLLEGE OF WISCONSIN At the conclusion of this session, attendees will be able to: Describe the classification
More informationAntithrombotic therapy in patients with transient ischemic attack / stroke (acute phase <48h)
Antithrombotic therapy in patients with transient ischemic attack / stroke (acute phase
More informationPathophysiology of stroke
A practical approach to acute stro ke Dr. Sanjith Aaron, M.D., D.M., Professor, Department of Neurosciences, CMC Vellore Stroke is characterized by an abrupt onset of neurological deficit lasting more
More informationClinical Features of Patients Who Come to Hospital at the Super Acute Phase of Stroke
Research Article imedpub Journals http://www.imedpub.com Clinical Features of Patients Who Come to Hospital at the Super Acute Phase of Stroke Abstract Background: The number of patients who are adopted
More informationAyman Mahmoud Alboudi MD, MSc Rashid Hospital, Dubai, UAE
Systemic Varicella Zoster Infection Causing Cerebral Venous Thrombosis and Revealing Prothrombotic State Ayman Mahmoud Alboudi MD, MSc Rashid Hospital, Dubai, UAE CVT is a rare disorder with incidence
More informationCardiac disease as a cause of maternal mortality in Europe
Cardiac Problems in Pregnancy, Las Vegas, 2016 Risk prediction and maternal mortality Cardiac disease as a cause of maternal mortality in Europe (Els) Petronella G Pieper University Medical Centre Groningen
More informationHypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to
Hypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to 90 mmhg. These pressures are called Normal blood pressure
More informationSupplementary material 1. Definitions of study endpoints (extracted from the Endpoint Validation Committee Charter) 1.
Rationale, design, and baseline characteristics of the SIGNIFY trial: a randomized, double-blind, placebo-controlled trial of ivabradine in patients with stable coronary artery disease without clinical
More informationOptimizing Postpartum Maternal Health to Prevent Chronic Diseases
Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research
More informationwith susceptibility-weighted imaging and computed tomography perfusion abnormalities in diagnosis of classic migraine
Emerg Radiol (2012) 19:565 569 DOI 10.1007/s10140-012-1051-2 CASE REPORT Susceptibility-weighted imaging and computed tomography perfusion abnormalities in diagnosis of classic migraine Christopher Miller
More informationIMET 2000 PAL International Medical Education Trust Palestine What the GP Should Know about Hypertension
What the GP Should Know about Hypertension Raed Abu Sham a, M.D Internist and Cardiologist Cardiac Pacing and Electrophysiologist Impact of Age on Blood Pressure Prevalence of HTN according to Age Fast
More informationNeurosurgical decision making in structural lesions causing stroke. Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery)
Neurosurgical decision making in structural lesions causing stroke Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery) Subarachnoid Hemorrhage Every year, an estimated 30,000 people in the United States experience
More informationAlan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination P 80/min reg, BP 160/95, normal
More informationSystemic Hypertension Dr ahmed almutairi Assistant professor Internal medicine dept
Systemic Hypertension Dr ahmed almutairi Assistant professor Internal medicine dept Continents 1- introduction 2- classification/definition 3- classification/etiology 4-etiology in both categories 5- complications
More information2018 Early Management of Acute Ischemic Stroke Guidelines Update
2018 Early Management of Acute Ischemic Stroke Guidelines Update Brandi Bowman, PhC, Pharm.D. April 17, 2018 Pharmacist Objectives Describe the recommendations for emergency medical services and hospital
More informationHow Low Should You Go? Management of Blood Pressure in Intracranial Hemorrhage
How Low Should You Go? Management of Blood Pressure in Intracranial Hemorrhage Rachael Scott, Pharm.D. PGY2 Critical Care Pharmacy Resident Pharmacy Grand Rounds August 21, 2018 2018 MFMER slide-1 Patient
More informationInfluence of Dysphagia on Short-Term Outcome in Patients with Acute Stroke
Authors: Shinichiro Maeshima, MD, PhD Aiko Osawa, MD Yasuhiro Miyazaki, MA Yasuko Seki, BA Chiaki Miura, BA Yuu Tazawa, BA Norio Tanahashi, MD Affiliations: From the Department of Rehabilitation Medicine
More informationRole of Computed Tomography in Evaluation of Cerebrovascular Accidents.
DOI: 10.21276/aimdr.2017.3.2.RD10 Original Article ISSN (O):2395-2822; ISSN (P):2395-2814 Role of Computed Tomography in Evaluation of Cerebrovascular Accidents. Rishikant Sinha 1, Ahmad Rizwan Karim 2
More informationMalignant isolated cortical vein thrombosis with type II protein S deficiency: a case report
Arai et al. BMC Neurology (2016) 16:69 DOI 10.1186/s12883-016-0597-0 CASE REPORT Open Access Malignant isolated cortical vein thrombosis with type II protein S deficiency: a case report Nobuhiko Arai *,
More information