Abstract W P295: Admission Is Delayed in Patients with Predominantly Visual Symptoms of Ischemic Occipital Stroke
Introduction: Stroke patients with predominantly visual symptoms due to posterior circulation ischemia rarely receive thrombolytic treatment despite the often debilitating nature of their homonymous visual field deficits. In addition to stroke physicians’ judgment of risks and benefits, perhaps influenced also by low scores on the National Institutes of Health Stroke Scale, lack of thrombolytic treatment may be caused by delayed admission to a stroke center.
Hypothesis: We hypothesized that patients with occipital infarcts presenting with predominantly visual field symptoms would show less direct routes and longer onset-to-admission delays to a stroke center compared to the general stroke population, of which approximately half are admitted within 4h of symptom onset.
Methods: All patients with visual field deficits as their primary symptom of occipital infarction treated at the Helsinki University Central Hospital between 2010 and 2013 were retrospectively identified from all cases of ischemic stroke by careful review of medical records and radiological data. All patients with acute stroke within the Greater Helsinki area (catchment area of 1.5 million) are brought to our emergency room (ER). Data were gathered on admission route and length of delay from symptom onset to admission.
Results: Of the 179 occipital ischemic stroke patients with hemianopia as their main symptom or sign, 32 (18%) were admitted within 4h of symptom onset and a further 64 (36%) within 4-24h. Only 17 patients (9.5%) arrived as pre-notified thrombolysis candidates. 10 patients (5.6%) received thrombolysis, but half of them were only recognized as thrombolysis candidates after ER admission. Of all patients, 35 (20%) arrived directly at our ER, whereas 45 (25%) had visited two or more points of care or had been initially discharged, with a significant proportion of all patients, 30%, having visited an ophthalmologist prior to admission.
Conclusions: Recognizing ischemic stroke presenting with visual field symptoms is challenging. Complexity of patient routes and long admission delays likely contribute to the low rates of thrombolytic therapy in this patient group.
Author Disclosures: K. Silvennoinen: Research Grant; Significant; ERA-NET NEURON EU Grant. H. Silvennoinen: None. C. Gall: Research Grant; Significant; ERA-NET NEURON EU Grant. P.M. Rossini: Research Grant; Significant; ERA-NET NEURON EU Grant. W.J. Waleszczyk: Research Grant; Significant; ERA-NET NEURON EU Grant. B.A. Sabel: Research Grant; Significant; ERA-NET NEURON EU Grant. T. Tatlisumak: Research Grant; Significant; ERA-NET NEURON EU Grant.
- © 2015 by American Heart Association, Inc.