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JAMA. 2004;292:1789.

STROKE

Detection of Acute Intracerebral Hemorrhage
Magnetic resonance imaging (MRI) may be an alternative to computed tomography (CT) to distinguish hemorrhage from ischemia in patients with acute stroke symptoms; however, the accuracy of MRI vs CT for this purpose is not clear. Kidwell and colleagues report results of their study of patients with early stroke symptoms who underwent MRI followed by CT to assess for hemorrhage. The authors found that MRI was equivalent to CT for the diagnosis of acute hemorrhage and superior to CT in detecting chronic intracerebral hemorrhage.

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Outcomes Following Thrombolysis for Stroke
Three articles in this issue of JAMAaddress patient outcomes after thrombolytic therapy for stroke. First, Heuschmann and colleagues (SEE ARTICLE) reviewed data on patients receiving tissue plasminogen activator (tPA) to identify predictors of in-hospital death. Patient characteristics predictive of mortality were older age and decreased level of consciousness. In-hospital mortality risk was inversely associated with hospital experience administering tPA. In the second article, Saposnik and colleagues (SEE ARTICLE) report an analysis of data from a prospective study of patients who received alteplase therapy to identify factors predictive of lack of improvement at 24 hours. They found that an elevated baseline glucose level, cortical involvement, and increasing time to thrombolytic therapy were associated with a lack of improvement at 24 hours, which was an independent predictor of poor outcome and death at 3 months. In the third article, Lindsberg and colleagues (SEE ARTICLE)describe outcomes for 50 patients with basilar artery occlusion who received intravenous thrombolytic therapy. They found these patients had comparable survival, recanalization, and functional outcomes as previously reported for patients treated with an endovascular approach. In an editorial, Caplan (SEE ARTICLE) discusses how existing guidelines for stroke diagnosis and treatment require updating to ensure timely and effective care.

Thrombotically Active Carotid Plaque and Stroke Risk
Carotid stenosis is only 1 factor contributing to stroke risk. Spagnoli and colleagues (SEE ARTICLE)report results of histologic examination of carotid endarterectomy specimens from patients with similar degrees of carotid stenosis and ipsilateral stroke, transient ischemia, or no symptoms to assess the role of plaque rupture and thrombosis in stroke. The authors found that thrombosis with plaque rupture and high inflammatory cell infiltrate were associated with major ischemic stroke events. In an editorial, Toole and colleagues (SEE ARTICLE) discuss current strategies for stroke prevention.

Improving Motor Function in Chronic Stroke Survivors
Luft and colleagues report preliminary findings from a small randomized trial of patients with residual upper-extremity hemiparesis following ischemic stroke. Patients who received bilateral arm training with rhythmic cueing had increased contralesional motor cortex activation on functional magnetic resonance imaging studies, changes not seen in patients who received standard therapeutic exercises.

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A Piece of My Mind
"It was a terrible thing . . . to live long enough to see your child die." From "The Secret."

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Medical News & Perspectives
Problems in Nigeria have impeded an initiative to eradicate polio by the end of next year, but an international partnership is stepping up surveillance and immunization campaigns to get the effort back on track.

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CLINICIAN’S CORNER
Antiplatelet Therapy
The role of antiplatelet therapy in preventing vascular events.

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Emerging Infectious Diseases
Fauci discusses public health and biomedical responses to present and emerging infectious diseases.

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Tuberculosis
Call for Papers
Authors are invited to submit manuscripts for a JAMA theme issue on tuberculosis.

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JAMA Patient Page
For your patients: Information about hemorrhagic stroke.

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