Prehospital pathways of occipital stroke patients with mainly visual symptoms

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Räty , S , Silvennoinen , K & Tatlisumak , T 2018 , ' Prehospital pathways of occipital stroke patients with mainly visual symptoms ' , Acta Neurologica Scandinavica , vol. 137 , no. 1 , pp. 51-58 . https://doi.org/10.1111/ane.12807

Title: Prehospital pathways of occipital stroke patients with mainly visual symptoms
Author: Räty, S.; Silvennoinen, K.; Tatlisumak, T.
Contributor: University of Helsinki, Department of Neurosciences
University of Helsinki, Neurologian yksikkö
Date: 2018-01
Language: eng
Number of pages: 8
Belongs to series: Acta Neurologica Scandinavica
ISSN: 0001-6314
URI: http://hdl.handle.net/10138/303646
Abstract: ObjectivesOccipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition. Materials & methodsThis observational, retrospective, registry-based study comprises occipital stroke patients with isolated visual symptoms treated at the neurological emergency department of Helsinki University Central Hospital in 2010-2015. We analyzed their prehospital pathways, including time from symptom onset to admission at the neurological emergency department (ODT), the number of points of care, the percentage of patients with ODT4.5hours, and factors associated with delay. ResultsAmong 245 patients, only 20.8% arrived within 4.5hours and 6.5% received IV thrombolysis. Delayed arrival was most often due to patients' late contact to health care. Of the patients, 27.3% arrived through at least two points of care, and differential diagnostics to ophthalmologic disorders proved particularly challenging. ODT4.5hours was associated with EMS utilization, direct arrival, and atrial fibrillation; a visit at an ophthalmologist and initial misdiagnosis were associated with ODT>4.5hours. After multivariable analysis, only direct arrival predicted ODT4.5hours. ConclusionsOccipital stroke patients with visual symptoms contact health care late, are inadequately recognized, and present with complex prehospital pathways. Consequently, they are often ineligible for IV thrombolysis. This presents a missed opportunity for preventing permanent visual field defects.
Subject: 3112 Neurosciences
3124 Neurology and psychiatry
cerebrovascular diseases
emergency care
strokes
thrombolysis
visual field defect
POSTERIOR CIRCULATION STROKE
ISOLATED HOMONYMOUS HEMIANOPIA
TRANSIENT ISCHEMIC ATTACK
IN-HOSPITAL DELAY
INTRAVENOUS THROMBOLYSIS
EMERGENCY-DEPARTMENT
TIME
ADMISSION
CARE
MULTICENTER
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