This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Minutes matter in acute brain ischemia. Actions taken in the critical first moments after hospital presentation shape the course of patients' lives for the remainder of their years. Once the infarct is completed, reperfusion therapy is futile. Therapy long delayed is therapy denied. However, conditions that mimic acute cerebral ischemia are not uncommon, and thrombolytic therapy carries potential risk. The stroke physician must balance the clinical principles of primum non tardare and primum non nocere, 1 the need for speed and the need for accuracy.
Despite advances in multimodal CT and MRI, noncontrast CT alone continues as the only available acute imaging modality in many hospitals, and even hospitals with advanced emergency imaging capabilities encounter patients with renal failure, pacemakers, and other conditions that limit imaging studies. Although noncontrast CT rules out brain hemorrhage effectively, it rules in ischemic stroke (by identifying hyperdense artery signs and early infarct signs) in a modest proportion of cases.2 Often, physicians confront a tradeoff between treating early based on initial clinical presentation and absence of hemorrhage on CT or delaying therapy to acquire more diagnostic information, by locating and speaking to additional witnesses, observing the initial postarrival clinical course, or obtaining more sophisticated imaging. Inevitably, some patients treated early will not show a cerebral infarct on outcome imaging.
Broadly, these patients fall into 2 classes, one for whom thrombolytic treatment is eminently desirable and one for whom treatment is optimally avoided. The first group consists …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
