Recrudescence of Old Stroke Deficits Among Transient Neurological Attacks

No clue, my doctor never warned me of this, but then he knew absolutely nothing about stroke, managed to tell me I had a CVA(had to ask what that was), nothing on recovery, he did warn me about fainting taking warfarin.  My OT was the only person that seemed to know anything. With a 10% occurrence rate your doctor is responsible for a protocol to prevent that problem. Which will never happen.

Recrudescence of Old Stroke Deficits Among Transient Neurological Attacks 

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Adalia H. Jun-O’connell, MD, Nils Henninger, MD, PhD, Majaz Moonis, MD, ...

First Published February 21, 2019 Research Article

https://doi.org/10.1177/1941874419829288

Article information

Abstract

Background:

Recrudescence of old stroke deficits (ROSD) is a reported cause of transient neurological symptoms, but it is not well characterized.

Objective:

We sought to determine the prevalence, potential triggers, and clinical outcome of ROSD in a cohort of patients presenting with acute transient neurological attack (TNA) and absent acute pathology on brain imaging.

Methods:

We retrospectively analyzed 340 consecutive patients who presented with TNA and no acute pathology on brain imaging that were included in an institutional stroke registry between February 2013 and April 2015. The presumed TNA cause was categorized as transient ischemic attack (TIA), ROSD, and other cause. Baseline characteristics, triggers, cardiovascular complications within 90 days, and death were recorded.

Results:

The prevalence of ROSD in the studied cohort was 10% (34/340). Infectious stressors and acute metabolite derangements were more common in ROSD compared to TIA (P < .05, each). Compared to TIA and the other TNA, ROSD was more likely to have more than 1 acute stressor (P < .001). Patients with ROSD had similar vascular risk factors compared to TIA (P >> .05), including hypertension, diabetes mellitus, peripheral vascular disease, hyperlipidemia, and similarly used HMG-CoA reductase inhibitor, antihypertensive, and antiplatelet medications. Among the patients with an available 90-day follow-up (n = 233), cardiovascular events were more frequent in the TIA group as compared to other TNA (P < .05).

Conclusion:

ROSD is common and distinct from TIA and is associated with a triggering physiologic reaction leading to transient reemergence of prior neurologic deficits. Further study of the mechanism of this phenomenon is needed to help better identify these patients.

Keywords transient neurological symptoms, locus minoris resistantiae, poststroke recrudescence, exacerbation of focal neurological deficits, reactivation of prior deficits, diagnosis, stroke

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The Effects of Integrating a Physiatrist into an Acute Stroke Team

Well my physiatrist knew nothing and did nothing. But then I'm stroke-addled so I probably missed all the work he did. He didn't even tell me I had a stroke, I was supposed to interpret what a CVA was. No discussions on how or what recovery might occur. Nothing on my chances of full recovery - 10%. No explanation as to why tPA failed to put me back to normal. In general he should have never been paid for anything he didn't do for me.
http://www.newswise.com/articles/new-research-presented-at-the-effects-of-integrating-a-physiatrist-into-an-acute-stroke-team
A research team at Emory University presents new research at the 2015 AAP Annual Meeting in San Antonio that suggests that early rehabilitation as well as discharges to acute rehabilitation facilities post stroke can improve neurologic outcomes. The purpose of the study was to investigate the impact of introducing a physiatrist into an acute stroke team.
"What we do as physiatrists is independent from early mobilization by therapists. It is our ability to anticipate, prevent, identity and treat barriers to rehabilitation that changes patient outcomes," said author Lisa Foster. (REALLY?)
There is evidence that suggests that a physiatrist on staff may facilitate a more favorable discharge destination and decrease risk of mortality. (I bet this is cherry-picking research subjects)
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The Association of Academic Physiatrists (AAP) is the only academic association dedicated to the specialty of physical medicine and rehabilitation (PM&R) in the world. AAP is an organization of leading physicians, researchers, in-training physiatrists, and others involved or interested in leadership, mentorship, and discovery in PM&R. AAP is based in Baltimore, MD. To learn more about the Association and the field of physiatry, visit our site at www.physiatry.org. Follow us on Twitter at https://twitter.com/AAPhysiatrists.
The 2015 AAP Annual Meeting will take place in San Antonio, March 10-14, 2015. The AAP Annual Meeting brings together physiatrists and academicians, in-training physiatrists, researchers, and academic PM&R professionals to share the latest information, innovative techniques, best practices, and new technologies. AAP 2015 covers a broad spectrum of cutting edge topics in academic physiatry. The meeting is packed with educational activities including educational sessions, cutting-edge keynote speakers, hands-on workshops, and scientific paper presentations along with over 400 poster board presentations showcasing the finest scientific innovations and research. To learn more about the Annual Meeting visit www.physiatry.org/AAP2015.