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Sample records for aged stroke patients

  1. Risk factors for ischemic stroke and transient ischemic attack in patients under age 50

    NARCIS (Netherlands)

    Janssen, A.W.M.; Leeuw, F.E. de; Janssen, M.C.H.

    2011-01-01

    To analyze risk factors for ischemic stroke and transient ischemic attack (TIA) in young adults under the age of 50. To make recommendations for additional research and practical consequences. From 97 patients with ischemic stroke or TIA under the age of 50, classical cardiovascular risk factors, co

  2. Outcome and Risk Factors Presented in Old Patients Above 80 Years of Age Versus Younger Patients After Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, Line; Christensen, Louisa; Christensen, Anders

    2014-01-01

    . METHODS: The analysis was based on consecutive patients admitted within 6 hours after stroke onset and discharged with ischemic stroke, surviving at least 3 months after ictus. To prevent bias, the analysis was based on a registry from before implementation of tissue plasminogen activator treatment; all...... of age or older presented with significantly more severe strokes than younger patients, median Scandinavian Stroke Scale score 39 vs 42 (P = .003). Median mRS score before stroke was significantly higher in patients aged 80 years or older (P ictus (P...

  3. Comparison of the Risk Factor Profile, Stroke Subtypes, and Outcomes Between Stroke Patients Aged 65 Years or Younger and Elderly Stroke Patients: A Hospital-based Study

    Directory of Open Access Journals (Sweden)

    Yi-Min Chen

    2013-12-01

    Conclusion: We conclude that, apart from risk factors and stroke subtypes, the functional outcomes observed in the two groups differed. Early identification of these differences with good management may help to improve the clinical outcomes in younger stroke patients.

  4. [Stroke and aging].

    Science.gov (United States)

    Ly, J; Maquet, P

    2014-01-01

    Stroke risk increases with aging and one third of ischemic strokes occurs in very elderly (> or = 80 years). These are responsible of two thirds of the overall stroke-related morbi-mortality. Stroke in very elderly differs from younger individuals by sex ratio (more women), risk factors (more atrial fibrillation and hypertension) and usually a worse functional outcome. Very elderly are likely to benefit from stroke unit care and early revascularisation treatments although they have historically been excluded from this urgent management. These issues are likely to worsen in the future with the increasing impact of stroke on our aging societies.

  5. Impact of acute ischemic stroke treatment in patients over age 80: the SPOTRIAS consortium experience

    Science.gov (United States)

    Willey, Joshua Z; Ortega-Gutierrez, Santiago; Petersen, Nils; Khatri, Pooja; Ford, Andria L; Rost, Natalia S; Ali, Latisha K; Gonzales, Nichole R; Merino, Jose G; Meyer, Brett C; Marshall, Randolph S

    2012-01-01

    Background and Purpose Few studies have addressed outcomes among patients ≥80 years treated with acute stroke therapy. In this study, we outline in-hospital outcomes in (1) patients ≥80 years compared to their younger counterparts, and (2) those over age 80 receiving intra-arterial therapy (IAT) compared to those treated with intravenous recombinant tissue plasminogen activator (IVrtPA). Methods Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IVrtPA or IAT from 1/1/2005 to 12/31/2010. IAT was defined as receiving any endovascular therapy; IAT was further divided into bridging therapy (BT) when the patient received both IAT and IVrtPA, and endovascular therapy alone (ETA). In-hospital mortality was compared in (1) all patients age ≥80 versus younger counter-parts, and (2) IAT, BT, and ETA versus IVrtPA only among those age ≥80 using multivariable logistic regression. An age-stratified analysis was also performed. Results A total of 3768 patients were included in the study; 3378 were treated with IVrtPA alone, 808 with IAT (383 with ETA and 425 with BT). Patients ≥80 (n=1182) had a higher risk of in-hospital mortality compared to younger counterparts regardless of treatment modality (OR 2.13, 95%CI 1.60–2.84). When limited to those age ≥80, IAT (OR 0.95, 95%CI 0.60–1.49), BT (OR 0.82, 95%CI 0.47–1.45), or ETA (OR 1.15, 95%CI 0.64–2.08) versus IVrtPA were not associated with increased in-hospital mortality Conclusions IAT does not appear to increase the risk of in-hospital mortality among those over age 80 compared to intravenous thrombolysis alone. PMID:22798327

  6. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  7. Age- and Gender-Specific Prevalence of Risk Factors in Patients with First-Ever Ischemic Stroke in China

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    Xiao-ying Yao

    2012-01-01

    Full Text Available Background. Evidences are accumulating that age and gender have great impact on the distribution of stroke risk factors. Such data are lacking in Chinese population. Methods. 1027 patients with first-ever ischemic stroke (IS were recruited and divided into young adult (80 years groups according to stroke onset ages. Vascular risk factors were collected and compared among groups. Results. Female patients were globally older than male patients at stroke onset and having higher prevalence of diabetes mellitus (DM, heart diseases, and atrial fibrillation (AF. However, females were less likely to drink heavily or smoke than males. Young patients had a much higher proportion of smoking and drinking than middle-aged and very old patients and the highest family history of hypertension, while very old patients had the highest prevalence of heart diseases and AF but lowest proportion of positive family history of vascular diseases. Hypertension and DM were equally frequent among three groups. Conclusion. Our study showed that vascular risk factors had a specific age and gender distribution pattern in Chinese IS patients. Secondary prevention strategy should emphasize on the control of different risk factors based on patient’s age and gender.

  8. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart

    2009-01-01

    on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...

  9. Assessing the temporal aspects of attention and its correlates in aging and chronic stroke patients.

    Science.gov (United States)

    Shalev, Nir; Humphreys, Glyn; Demeyere, Nele

    2016-11-01

    Temporal dynamics of attention have been in the spotlight of research since the earliest days of cognitive psychology. Typically, researchers describe two different aspects of the temporal fluctuations of attention: one is in intervals of milliseconds (phasic alertness), and the other over minutes or even hours (tonic alertness or sustained attention). In order to evaluate individual capacities for sustained attention and phasic alertness, most studies rely on variations of the Continuous Performance Task (CPT). Indices of sustained attention and phasic alertness are typically based on reaction times to targets; phasic alertness is related to the change in reaction times following a cue, and sustained attention is related to variability of reaction times during the task. In the following study, we attempted to establish a new approach for studying sustained attention and phasic alertness, not reliant solely on reaction time measures. We developed a new variation of the CPT with conjunctive feature targets and forward and backward masking to induce a higher variability in accuracy. This allowed us to assess an individual's ability to maintain the same level of sensitivity to targets (d-prime) across a ten minute period on the task as an index for sustained attention. We also assessed reaction times as a function of previous trial type, and suggest previous trial RT benefit might be a marker for an individual's phasic alertness. We demonstrated the use of this task with healthy aging controls and stroke survivors. As a demonstration of external validity of the novel paradigm, we present a correlation between how individual performance drops over time and individual reports of distractibility in everyday life on the Cognitive Failures Questionnaire. In addition, we found significant differences between the patient and control groups in our proposed marker of phasic alertness. We discuss the implications of our study for current assessment tools, as well as general

  10. Poor Long-Term Functional Outcome After Stroke Among Adults Aged 18 to 50 Years: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) Study

    NARCIS (Netherlands)

    Synhaeve, N.E.; Arntz, R.M.; Maaijwee, N.A.M.M.; Rutten-Jacobs, L.C.A.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Kort, P.L.M. de; Dijk, E.J. van; Leeuw, F.E. de

    2014-01-01

    BACKGROUND AND PURPOSE: Stroke in young adults has a dramatic effect on life; therefore, we investigated the long-term functional outcome after transient ischemic attack, ischemic stroke, or intracerebral hemorrhage in adults aged 18 to 50 years. METHODS: We studied 722 young patients with first-eve

  11. Dysphagia in the elderly stroke patient.

    Science.gov (United States)

    Lugger, K E

    1994-04-01

    Of all strokes 75% occur in people over age 65, and the incidence of stroke rises with age. Because swallowing problems often result, the elderly stroke patient is at risk for dysphagia and its complications. Acute and chronic swallowing problems are associated with many complications including dehydration, malnutrition, aspiration, pneumonitis, depression and even death. These complications make swallowing problems in the aged stroke patient an important focus for nursing attention. Nurses must be aware of the complexity of normal swallowing mechanisms, knowledgeable about the aged stroke patient's risk for dysphagia, aware of the importance of early detection and treatment of dysphagia and confident about their role in dysphagia assessment and treatment regimen. This information can be used in the assessment, treatment and rehabilitation of the elderly dysphagic stroke patient.

  12. Risk of Stroke in Migraineurs Using Triptans. Associations with Age, Sex, Stroke Severity and Subtype

    DEFF Research Database (Denmark)

    Albieri, Vanna; Olsen, Tom Skyhøj; Andersen, Klaus Kaae

    2016-01-01

    BACKGROUND: Identifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population. METHODS: A cohort study including all citizens 25-80years of age in Denmark 2003-2011 was conducted. All persons prescribed triptans, and all those hospitalized...... for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients. FINDINGS: Of the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income...... for severe strokes was lower among migraineurs (RR 0.77; CI 0.65-0.91). Risk was age-related; highest among women 25-45years (RR≈1.7). Risk was unrelated to numbers of dispensations. INTERPRETATION: Migraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor...

  13. Risk factors for stroke and thromboembolism in relation to age among patients with atrial fibrillation: the loire valley atrial fibrillation project

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Fauchier, Laurent; Lane, Deirdre A;

    2012-01-01

    According to the latest European guidelines on the management of nonvalvular atrial fibrillation (NVAF), all patients aged ≥ 65 years should be treated with oral anticoagulation (if not contraindicated). Therefore, stroke risk factors should be investigated exclusively in patients with NVAF aged...

  14. Sensorimotor control of tracking movements at various speeds for stroke patients as well as age-matched and young healthy subjects.

    Directory of Open Access Journals (Sweden)

    Di Ao

    Full Text Available There are aging- and stroke-induced changes on sensorimotor control in daily activities, but their mechanisms have not been well investigated. This study explored speed-, aging-, and stroke-induced changes on sensorimotor control. Eleven stroke patients (affected sides and unaffected sides and 20 control subjects (10 young and 10 age-matched individuals were enrolled to perform elbow tracking tasks using sinusoidal trajectories, which included 6 target speeds (15.7, 31.4, 47.1, 62.8, 78.5, and 94.2 deg/s. The actual elbow angle was recorded and displayed on a screen as visual feedback, and three indicators, the root mean square error (RMSE, normalized integrated jerk (NIJ and integral of the power spectrum density of normalized speed (IPNS, were used to investigate the strategy of sensorimotor control. Both NIJ and IPNS had significant differences among the four groups (P<0.01, and the values were ranked in the following order: young controls < age-matched controls stroke patients stroke patients, which could be explained by the stroke- and aging-induced increase in reliance on feedback control. The RMSE increased with the increase in the target speed and the NIJ and IPNS initially declined and then remained steady for all four groups, which indicated a shift from feedback to feedforward control as the target speed increased. The feedback-feedforward trade-off induced by stroke, aging and speed might be explained by a change in the transmission delay and neuromotor noise. The findings in this study improve our understanding of the mechanism underlying the sensorimotor control and neurological changes caused by stroke and aging.

  15. Protocol and methodology of the Stroke in Young Fabry Patients (sifap1) study: a prospective multicenter European study of 5,024 young stroke patients aged 18-55 years.

    LENUS (Irish Health Repository)

    Rolfs, Arndt

    2011-01-01

    Stroke in the young has not been thoroughly investigated with most previous studies based on a small number of patients from single centers. Furthermore, recent reports indicate that Fabry disease may be a significant cause for young stroke. The primary aim of our study was to determine the prevalence of Fabry disease in young stroke patients, while the secondary aim was to describe patterns of stroke in young patients.

  16. Stroke Care in Young Patients

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    L. Tancredi

    2013-01-01

    Full Text Available The aims of this study were (i to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed ( and , resp.. Undetermined causes decreased over 5-year period of study (. The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8% was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases.

  17. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2017-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  18. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Jørgensen, H S; Reith, J

    2004-01-01

    BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age as an ind...... and rehabilitation after stroke.......BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age...... as an independent predictor of short- and long-term outcome. METHODS: In the community-based Copenhagen Stroke Study we recorded admission clinical characteristics in 1197 consecutive stroke patients. Patients were stratified according to age groups on admission. Follow-up was performed at a mean of 7 years after...

  19. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N

    2014-01-01

    BACKGROUND AND PURPOSE: There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting......, and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA2DS2-VASc......) scores. RESULTS: One thousand five hundred nine patients were followed for 4.3±0.8 years (6529 patient-years). Rates of stroke were 5.6 versus 21.8 per 1000 patient-years pre- and post-AVR; 429 (28%) underwent AVR and 139 (9%) died. Atrial fibrillation (hazard ratio [HR], 2.7; 95% confidence interval [CI...

  20. Age trajectories of stroke case fatality

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae

    2011-01-01

    Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages.......Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages....

  1. The Female Stroke Survival Advantage: Relation to Age

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Dehlendorff, Christian; Andersen, Klaus Kaae

    2009-01-01

    logistic regression. Results: The probability of death within 1 week adjusted for stroke severity, stroke type and risk factors was highly age-dependent in both men and women. Up to the age of 50 years, the 1-week female/male mortality rates paralleled being slightly (15%) but insignificantly better......Background: Age-related hormonal factors are thought to be related to the gender gap in longevity. Testing the hypothesis that survival is best in young premenopausal women we studied the effect of age on 1-week mortality in stroke patients. Methods: A registry was started in 2001 with the aim...

  2. Adaptation to stroke using a model of successful aging.

    Science.gov (United States)

    Donnellan, C; Hevey, D; Hickey, A; O'Neill, D

    2012-01-01

    The process of adaptation to the physical and psychosocial consequences after stroke is a major challenge for many individuals affected. The aim of this study was to examine if stroke patients within 1 month of admission (n = 153) and followed up at 1 year (n = 107) engage in selection, optimization, and compensation (SOC) adaptive strategies and the relationship of these strategies with functional ability, health-related quality of life (HRQOL) and depression 1 year later. Adaptive strategies were measured using a 15-item SOC questionnaire. Internal and external resources were assessed including recovery locus of control, stroke severity, and socio-demographics. Outcome measures were the Stroke Specific Quality of Life Questionnaire (SS-QoL), the Nottingham Extended Activities of Daily Living Scale and the Depression Subscale of the Hospital Anxiety and Depression Scale. Findings indicated that stroke patients engaged in the use of SOC strategies but the use of these strategies were not predictive of HRQOL, functional ability or depression 1 year after stroke. The use of SOC strategies were not age specific and were consistent over time, with the exception of the compensation subscale. Results indicate that SOC strategies may potentially be used in response to loss regulation after stroke and that an individual's initial HRQOL functional ability, levels of depression and socio-economic status that are important factors in determining outcome 1 year after stroke. A stroke-specific measure of SOC may be warranted in order to detect significant differences in determining outcomes for a stroke population.

  3. Epidemiology Investigation of stroke among Mongolian and Han population aged over 45 in Inner Mongolia.

    Science.gov (United States)

    Zhang, Chunyu; Lan, Tian; Zhe, Yan; Hu, Baolige; Zhang, Guohua; He, Juan; Wang, Zhiguang; Jiang, Mingfang; Hu, Riletemuer

    2017-04-04

    To discuss the status of epidemiology of stroke in the Mongolian and Han population aged over 45 years and to understand the treatment and prevention of stroke. Data collected on stroke populations aged over 45 years in the six areas in Inner Mongolia were analyzed by using stratified multi-stage cluster sampling. The prevalence rate of stroke in patients aged over 45 years in Inner Mongolia was 4.62%. The stroke prevalence rate increased with age in both males and females, the Han and Mongolian populations, and was higher in males than in females in Inner Mongolia. The prevalence rate of stroke in the Mongolian population was higher than in the Han population. The incidence rate of stroke in patients aged over 45 years in Inner Mongolia was 0.28%, of which the rate of relapsed ischemic stroke was 23.29%. The proportion of ischemic stroke in the stroke patients was higher than hemorrhagic stroke. The prevalence and incidence rates of stroke in patients aged over 45 years in Inner Mongolia were high. The prevalence rate of stroke in both the Han population and the Mongolian population increased with age. Ischemic stroke was the major form of stroke.

  4. Motor Imagery Impairment in Postacute Stroke Patients

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    Niclas Braun

    2017-01-01

    Full Text Available Not much is known about how well stroke patients are able to perform motor imagery (MI and which MI abilities are preserved after stroke. We therefore applied three different MI tasks (one mental chronometry task, one mental rotation task, and one EEG-based neurofeedback task to a sample of postacute stroke patients (n=20 and age-matched healthy controls (n=20 for addressing the following questions: First, which of the MI tasks indicate impairment in stroke patients and are impairments restricted to the paretic side? Second, is there a relationship between MI impairment and sensory loss or paresis severity? And third, do the results of the different MI tasks converge? Significant differences between the stroke and control groups were found in all three MI tasks. However, only the mental chronometry task and EEG analysis revealed paresis side-specific effects. Moreover, sensitivity loss contributed to a performance drop in the mental rotation task. The findings indicate that although MI abilities may be impaired after stroke, most patients retain their ability for MI EEG-based neurofeedback. Interestingly, performance in the different MI measures did not strongly correlate, neither in stroke patients nor in healthy controls. We conclude that one MI measure is not sufficient to fully assess an individual’s MI abilities.

  5. Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus

    DEFF Research Database (Denmark)

    Mishra, N K; Ahmed, N; Davalos, A;

    2011-01-01

    in Stroke-International Stroke Thrombolysis Register) compared to nonthrombolyzed controls (C; data from Virtual International Stroke Trials Archive). METHODS: We selected ischemic stroke patients on whom we held data on age, baseline NIH Stroke Scale score (NIHSS), and 90-day modified Rankin Scale score (m......BACKGROUND: Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. We examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy (T; data from Safe Implementation of Thrombolysis......RS). We compared the distribution of mRS between T and C by Cochran-Mantel-Haenszel (CMH) test and proportional odds logistic regression, after adjustment for age and baseline NIHSS, in patients with and without DM, PS, or the combination. We report odds ratios (OR) for improved distribution of m...

  6. Rehabilitative Games for Stroke Patients

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    A. Pyae

    2015-07-01

    Full Text Available Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement.

  7. Neuroimaging in stroke and non-stroke pusher patients

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    Taiza Elaine Grespan Santos-Pontelli

    2011-12-01

    Full Text Available Pusher behavior (PB is a disorder of postural control affecting patients with encephalic lesions. This study has aimed to identify the brain substrates that are critical for the occurrence of PB, to analyze the influence of the midline shift (MS and hemorrhagic stroke volume (HSV on the severity and prognosis of the PB. We identified 31 pusher patients of a neurological unit, mean age 67.4±11.89, 61.3% male. Additional neurological and functional examinations were assessed. Neuroimaging workup included measurement of the MS, the HSV in patients with hemorrhagic stroke, the analysis of the vascular territory, etiology and side of the lesion. Lesions in the parietal region (p=0.041 and thalamus (p=0.001 were significantly more frequent in PB patients. Neither the MS nor the HSV were correlated with the PB severity or recovery time.

  8. Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

    Science.gov (United States)

    Atalay, Ayce; Turhan, Nur

    2009-01-01

    The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

  9. Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

    Science.gov (United States)

    Atalay, Ayce; Turhan, Nur

    2009-01-01

    The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

  10. Age-specific transcriptional response to stroke.

    Science.gov (United States)

    Sieber, Matthias W; Guenther, Madlen; Jaenisch, Nadine; Albrecht-Eckardt, Daniela; Kohl, Matthias; Witte, Otto W; Frahm, Christiane

    2014-07-01

    Increased age is a major risk factor for stroke incidence and post-ischemic mortality. To develop age-adjusted therapeutic interventions, a clear understanding of the complexity of age-related post-ischemic mechanisms is essential. Transient occlusion of the middle cerebral artery--a model that closely resembles human stroke--was used to induce cerebral infarction in mice of 4 different ages (2, 9, 15, 24 months). By using Illumina cDNA microarrays and quantitative PCR we detected a distinct age-dependent response to stroke involving 350 differentially expressed genes. Our analyses also identified 327 differentially expressed genes that responded to stroke in an age-independent manner. These genes are involved in different aspects of the inflammatory and immune response, oxidative stress, cell cycle activation and/or DNA repair, apoptosis, cytoskeleton reorganization and/or astrogliosis, synaptic plasticity and/or neurotransmission, and depressive disorders and/or dopamine-, serotonin-, GABA-signaling. In agreement with our earlier work, aged brains displayed an attenuated inflammatory and immune response (Sieber et al., 2011) and a reduced impairment of post-stroke synaptic plasticity. Our data also revealed a distinct age-related susceptibility for post-ischemic depression, the most common neuropsychiatric consequence of stroke, which has a major influence on functional outcome.

  11. Atrial Fibrillation and Stroke in Elderly Patients

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    Geetanjali Dang

    2016-11-01

    Full Text Available The increasing prevalence of stroke, with an estimated annual cost of $71.5 billion, has made it a major health problem that increases disability and death, particularly in patients with atrial fibrillation. Although advanced age and atrial fibrillation are recognized as strong risk factors for stroke, the basis for this susceptibility are not well defined. Aging or associated diseases are accompanied by changes in rheostatic, humoral, metabolic and hemodynamic factors that may contribute more to stroke predisposition than rhythm abnormality alone. Several thromboembolism-predisposing clinical characteristics and serum biomarkers with prognostic significance have been identified in patients with atrial fibrillation. Although anticoagulation decreases the risk of thromboembolism, management in the elderly remains complex due to major concerns about bleeding. New anticoagulants and nonpharmacologic strategies are helpful to reduce the risk of bleeding, particularly in older-elderly patients. Herein, we review the pathogenesis and management of select issues of thromboembolism in the elderly with atrial fibrillation.

  12. Protein consumptions in stroke patients

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    Zahra Maghsoudi

    2013-01-01

    Full Text Available Background : Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women and 60 controls (30 men and 30 women was collected with a food frequency questionnaire (FFQ. The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women. Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex.

  13. The follow-up of patients of sixty-five years of age and younger with acute ischemic stroke and transient ischemic attacks, and elevated D-dimer levels in plasma

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    Magnus Vrethem

    2009-09-01

    Full Text Available D-dimer levels in plasma, a degradation product of fibrin, have been shown to correlate with the severity of ischemic stroke. In order to investigate the outcome of patients with elevated D-dimer we have carried out a follow-up study of patients of 65 years of age and younger with acute ischemic stroke or transient ischemic attacks (TIA admitted to our stroke unit from 1991 to 1992. Twenty-two of the 57 patients had elevated D-dimer levels in the plasma. High levels were associated with cardioembolic stroke. On follow-up after a mean of 12 years, 15 patients had died and six patients had suffered another stroke or TIA (three of whom were dead. Ten patients had suffered other cardiovascular events and seven of them were dead. We concluded that high levels of D-dimer in acute ischemic stroke patients on admission were associated with cardioembolic stroke and might have prognostic value for the development of further cardio- or cerebrovascular events. Advanced age was found to be an independent risk factor.

  14. Accidente cerebrovascular isquémico en mayores de 80 años Acute ischemic stroke in patients aged 80 or older

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    Juan I Rojas

    2007-12-01

    Full Text Available En los pacientes de edad avanzada, el perfil de factores de riesgo vascular y el subtipo de accidente cerebrovascular (ACV es diferente en comparación con pacientes más jóvenes. El objetivo del presente trabajo fue describir el perfil de factores de riesgo y subtipo de ACV isquémico en nuestra población de pacientes ancianos. Incluimos a pacientes mayores de 80 años con diagnóstico de ACV isquémico y ataque isquémico transitorio (AIT entre junio de 2003 y junio de 2006. De 535 pacientes con eventos cerebrovasculares isquémicos, en 366 casos el diagnóstico fue de ACV y 169 de AIT. El 33.5% (179 pacientes fueron mayores de 80 años. La edad media fue de 84.4 ± 4.4 años. Los factores de riesgo más frecuentes fueron: hipertensión arterial 82.7%, dislipemia 40.2% y fibrilación auricular 24.6%. El subtipo de ACV que se presentó con mayor frecuencia fue la enfermedad de pequeñas arterias en un 41.7%, seguido por el evento cardioembólico en el 19.7%, enfermedad de gran arteria 6%, otras causas en el 0.8%. De los factores de riesgo vasculares tradicionales, los más significativos fueron hipertensión e hipercolesterolemia. Estos datos son coincidentes con estudios epidemiológicos previos y explican la mayor incidencia de infartos lacunares.Young and old age stroke groups have different vascular risk profiles for cerebral ischemic events. The objective of the study was to describe the risk factor profile and stroke subtype in this population of very elderly people. We included patients over 80 years old with diagnosis of ischemic stroke and transient ischemic attack registered between June 2003 and June 2006. We described the demographic data and subtype of ischemic stroke. Of 535 patients with cerebrovascular ischemic events, the final diagnosis was stroke in 366 cases and transient ischemic attack in 169. Of these patients 33.5% were over 80 years old (179. The mean age was 84.4 ± 4.4 years. The most frequent risk factors were

  15. Increased Risk of Stroke in Patients With Fibromyalgia

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    Tseng, Chun-Hung; Chen, Jiunn-Horng; Wang, Yu-Chiao; Lin, Ming-Chia; Kao, Chia-Hung

    2016-01-01

    Abstract Neuropsychiatric diseases might enhance stroke development, possibly through inflammation and atherosclerosis. Approximately 25% to 40% of patients with stroke, largely younger patients, are not associated with any conventional stroke risk factors. In this research, we explored whether fibromyalgia (FM), a neuropsychosomatic disorder, increases stroke risk. From a claims dataset with one million enrollees sourced of the Taiwan National Health Insurance database, we selected 47,279 patients with FM and randomly selected 189,112 age- and sex-matched controls within a 3-year period from January 1, 2000 to December 31, 2002. Stroke risk was assessed using Cox proportional hazards regression. Comorbidities associated with increased stroke risk, such as hypertension, diabetes, hyperlipidemia, coronary heart disease, irritable bowel syndrome, and interstitial cystitis, were more prevalent in patients with FM and high stroke risk than in the controls. The overall stroke risk was 1.25-fold (95% confidence interval [CI]: 1.21–1.30) higher in the FM group than in the non-FM group. Even without comorbidities, stroke risk was higher in patients with FM than in the controls (adjusted hazard ratio [aHR] = 1.44, 95% CI: 1.35–1.53, P < 0.001). The relative risk of stroke was 2.26-fold between FM and non-FM groups in younger patients (age <35 years, 95% CI: 1.86–2.75). This is the first investigation associating FM with an increased risk of stroke development. The outcomes imply that FM is a significant risk factor for stroke and that patients with FM, particularly younger patients, require close attention and rigorous measures for preventing stroke. PMID:26937918

  16. Fatigue after Stroke: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Victoria Louise Barbour

    2012-01-01

    Full Text Available Background. Fatigue after stroke is common and distressing to patients. Aims. Our aims were to explore patients' perceptions of post-stroke fatigue, including the causes of fatigue and the factors that alleviate fatigue, in a mixed methods study. Results. We interviewed 15 patients who had had a stroke and were inpatients on stroke rehabilitation wards. A substantial proportion of patients reported that their fatigue started at the time of their stroke. Various different factors were reported to improve fatigue, including exercise, good sleep, rehabilitation and rest. Fatigue influences patients' sense of “control” after their stroke. Conclusion. Our results are consistent with the possibility that poststroke fatigue might be triggered by factors that occur at the time of the stroke (e.g., the stroke lesion itself, or admission to hospital and then exacerbated by poor sleep and boredom. These factors should be considered when developing complex interventions to improve post-stroke fatigue.

  17. [Nutritional support in stroke patients].

    Science.gov (United States)

    Burgos Peláez, Rosa; Segurola Gurrutxaga, Hegoi; Bretón Lesmes, Irene

    2014-01-01

    Stroke is a public health problem of the first order. In developed countries is one of the leading causes of death, along with cardiovascular disease and cancer. In addition, stroke is the leading cause of permanent disability in adulthood. Many of the patients who survive do so with significant sequelae that limit them in their activities of daily living. Most strokes (80-85%) are due to ischemia, while the rest are hemorrhagic. We have identified many modifiable risk factors, some with an important relationship with dietary factors or comorbidities in wich the diet has a significant impact. The incidence of malnutrition in stroke patients is not well known, but most likely impacts on patient prognosis. Furthermore, the nutritional status of patients admitted for stroke often deteriorates during hospitalization. It is necessary to perform a nutritional assessment of the patient in the early hours of admission, to determine both the nutritional status and the presence of dysphagia. Dysphagia, through alteration of the safety and efficacy of swallowing, is a complication that has an implication for nutritional support, and must be treated to prevent aspiration pneumonia, which is the leading cause of mortality in the stroke patient. Nutritional support should begin in the early hours. In patients with no or mild dysphagia that can be controlled by modifying the texture of the diet, they will start oral diet and oral nutritional supplementation will be used if the patient does not meet their nutritional requirements. There is no evidence to support the use of nutritional supplements routinely. Patients with severe dysphagia, or decreased level of consciousness will require enteral nutrition. Current evidence indicates that early nutrition should be initiated through a nasogastric tube, with any advantages of early feeding gastrostomy. Gastrostomy will be planned when the enteral nutrition support will be expected for long-term (4 weeks). Much evidence points to the

  18. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke.

    Science.gov (United States)

    Yu, Yi-Jing; Weng, Wei-Chieh; Su, Feng-Chieh; Peng, Tsung-I; Chien, Yu-Yi; Wu, Chia-Lun; Lee, Kuang-Yung; Wei, Yi-Chia; Lin, Shun-Wen; Zhu, Jun-Xiao; Huang, Wen-Yi

    2016-11-01

    The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (Ppneumonia in acute stroke stage is a significant predictor of 3-year mortality (hazard ratio=6.39, 95% confidence interval=4.03-10.11, Ppneumonia during the acute stroke stage is associated with increased risk of 3-year mortality. Interventions to prevent pneumonia in acute stroke stage might improve ischemic stroke outcome.

  19. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography

    Science.gov (United States)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of patent foramen ovale are both significantly associated with cryptogenic stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are associated with a higher risk of stroke. (Stroke. 1993;24:1865-1873.) KEY WORDS aneurysm echocardiography foramen ovale, patent mitral valve prolapse o young adults

  20. Integrated analysis of ischemic stroke datasets revealed sex and age difference in anti-stroke targets.

    Science.gov (United States)

    Li, Wen-Xing; Dai, Shao-Xing; Wang, Qian; Guo, Yi-Cheng; Hong, Yi; Zheng, Jun-Juan; Liu, Jia-Qian; Liu, Dahai; Li, Gong-Hua; Huang, Jing-Fei

    2016-01-01

    Ischemic stroke is a common neurological disorder and the burden in the world is growing. This study aims to explore the effect of sex and age difference on ischemic stroke using integrated microarray datasets. The results showed a dramatic difference in whole gene expression profiles and influenced pathways between males and females, and also in the old and young individuals. Furthermore, compared with old males, old female patients showed more serious biological function damage. However, females showed less affected pathways than males in young subjects. Functional interaction networks showed these differential expression genes were mostly related to immune and inflammation-related functions. In addition, we found ARG1 and MMP9 were up-regulated in total and all subgroups. Importantly, IL1A, ILAB, IL6 and TNF and other anti-stroke target genes were up-regulated in males. However, these anti-stroke target genes showed low expression in females. This study found huge sex and age differences in ischemic stroke especially the opposite expression of anti-stroke target genes. Future studies are needed to uncover these pathological mechanisms, and to take appropriate pre-prevention, treatment and rehabilitation measures.

  1. Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation Study

    NARCIS (Netherlands)

    Arntz, R.M.; Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.; Dijk, E.J. van; Leeuw, F.E. de

    2015-01-01

    BACKGROUND AND PURPOSE: Poststroke epilepsy is a common complication after a young stroke. We investigated the association between poststroke epilepsy and mortality. METHODS: We performed a prospective cohort study among 631 patients with a first-ever transient ischemic attack or ischemic stroke, ag

  2. Communication in conversation in stroke patients.

    Science.gov (United States)

    Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

    2010-07-01

    In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe

  3. Cognitive impairment and stroke in elderly patients

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    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  4. [Nutritional intervention in patients with cerebrovascular stroke].

    Science.gov (United States)

    Kozáková, S; Charvát, J; Hrdlicka, L; Soucek, M; Kvapil, M

    2003-08-01

    The patients with acute cerebral stroke suffer from stress situation which may induce the catabolic state. The aim of our study was to evaluate the influence of the nutrition intervention and follow-up of the nutrition parameters in the patients with acute ischemic cerebral stroke. We have examined 30 patients with acute ischemic cerebral stroke, the average age 71.4 +/- 8.6 years. In all the patients we have measured some antropometric, biochemic and immunologic parameters of the nutrition status on admission. At the same time we have evaluated the size of the neurological deficit with NIH stroke scale and Barthel index. Every day we have monitored in all the patients the nutrition intake. In case the food intake has not reached 30 kcal/kg/day we have started the nutrition intervention by giving polymer enteral nutrition: either like sipping or if necessary through nasogastric tube. The nutrition intervention has been necessary in 18 patients (60%). The measurement of antropometric, biochemical and immunologic parameters have been repeated after 14 days. The evaluation of nutrition parameters have shown no significant changes since admission. The changes of the nutrition parameters in this group of the patients we have compared with the earlier reported group of the patients where no nutrition monitoring and intervention were applied and the nutrition parameters have deteriorated significantly in 2 weeks. By comparing we have confirmed that the careful monitoring of nutrition intake and in the majority of patients also nutrition intervention are necessary, especially because the improvement of the neurological deficit have been noticed more in the group of the monitored and intervened patients. The nutrition intervention can stabilize the followed nutrition parameters which may play the significant role in the speed and efficacy of the rehabilitation.

  5. STROKE PREVENTION IN HYPERTENSIVE PATIENTS

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    S. Y. Martsevich

    2006-01-01

    Full Text Available Importance of the stroke as one of the main reason of population mortality and invalidity is considered. Stroke risk factors including arterial hypertension are described. The main pharmacotherapy ways of primary and secondary stroke prevention are discussed.

  6. Gerstmann'S syndrome in acute stroke patients.

    Science.gov (United States)

    Zukic, Sanela; Mrkonjic, Zamir; Sinanovic, Osman; Vidovic, Mirjana; Kojic, Biljana

    2012-12-01

    Gerstmann in 1924. observed in a few patients a concomitant impairment in discriminating their own fingers, writing by hand, distinguishing left from right and performing calculations. He claimed that this tetrad of symptoms constituted a syndromal entity, assigned it to a lesion of the dominant parietal lobe. Since than, Gerstmann`s syndrome (GS) was enigma for neuropsychologists. The aim of this study was to analyze frequency and clinical features of GS among acute stroke patients. We prospectively analyzed 194 acute stroke patients (average age 65±11.06 years, male 113 (58.2%), female 81 (41.8%) hospitalized at department of Neurology, University Clinical Center tuzla, during the six mounths in 2010. For clinical assessment of agraphia, alexia and acalculia we used Minessota test for differential diagnosis of aphasia's. Among these acute stroke patients, 59 (30.40%) had alexia, agraphia and acalculia or different combinations of these disorders. two patients (3.4%) had agraphia and acalculia associated with other part of tetrad of GS: fi nger agnosia and left-right disorientation. they both where men, right handed, and cranial computed tomography scan showed ischemic lesion in the left parietal and left temporoparietal lobe. Gerstmann`s syndrome is rare clinical entity, and has the high value in localization and the lesion is mainly localized to angular gyrus of the dominant hemisphere.

  7. Post-stroke seizures in consecutive elderly stroke patients

    Institute of Scientific and Technical Information of China (English)

    Yue Chen; Lufang Chen; Yiqing Tao; Maomao Han; Chunlan Cui; Shichao Liu

    2011-01-01

    This prospective study sought to investigate the clinical, radiological and electroencephalographic (EEG) characteristics of seizures in elderly stroke patients, and their outcomes. Over a 2-year study period, 158 consecutive eldedy patients with stroke were examined and followed up. Of these patients, 32 (20%) developed seizures, primarily related to stroke, within a follow up period between 5 months and 2 years. Of these 32 cases, 20 experienced infarctions, and 12 experienced hemorrhages. Involvement of cortical regions was detected in most of the patients exhibiting seizures. In these patients, 44% of the lesions involved cortical areas exclusively or in addition to subcortical areas observed on computed tomography (CT) images. Twenty-five patients (78%)developed early seizures (within 2 weeks after stroke), and half exhibited immediate post-stroke seizures. None of the patients exhibiting early onset seizures developed recurrent seizures or epilepsy, while 57% of late onset seizures (four cases) developed epilepsy. No specific EEG patterns were apparent in those who later developed epilepsy. Overall, early onset seizures after stroke were found to be relatively common, and did not affect outcome. Late onset seizures were less common, but were associated with chronic epilepsy.

  8. Stroke in a Patient With HIV Infection

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    Buse Rahime Hasırcı

    2015-08-01

    Full Text Available Stroke which is a common complication in Human immumodeficiency virus type 1 positive patients is seen between 1% and 5% in clinical series. Vasculopathy and atherogenesis in HIV are the main pathologic mechanisms of stroke. We report a 63 year old man with sudden onset of a right hemiplegia and who was diagnosed as HIV-related stroke.

  9. Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities

    DEFF Research Database (Denmark)

    Mérie, Charlotte; Køber, Lars; Olsen, Peter Skov;

    2012-01-01

    The risk of stroke after coronary artery bypass grafting (CABG) is known to increase dramatically with age. During recent years, the age of patients operated on has increased and concomitant therapy has changed. Therefore, we have re-evaluated the risk of stroke after CABG....

  10. Polysomnographic indicators of mortality in stroke patients

    DEFF Research Database (Denmark)

    Ponsaing, Laura B; Iversen, Helle K; Jennum, Poul

    2017-01-01

    PURPOSE: The purpose of the study was to assess polysomnographic indicators of increased mortality risk in patients with stroke or a transient ischemic attack (TIA). METHODS: We performed polysomnographies in 63 acute stroke/TIA patients. Mortality data were collected from a national database after...... a 19-37-month follow-up period. RESULTS: Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher.......92; 95 % CI 2.00-49.23; p = 0.005), and there was a trend toward a higher mortality risk with atrial fibrillation/flutter (HR 3.63; 95 % CI 0.97-13.51; p = 0.055). CONCLUSIONS: In stroke patients, the AHI and nocturnal wake time are indicators of increased mortality risk. SRBDs in stroke patients should...

  11. Changes of resting cerebral activities in subacute ischemic stroke patients

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    Ping Wu

    2015-01-01

    Full Text Available This study aimed to detect the difference in resting cerebral activities between ischemic stroke patients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunction and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks and 15 age-matched healthy participants. A resting-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely potential targets for the neural regeneration of subacute ischemic stroke patients.

  12. Changes of resting cerebral activities in subacute ischemic stroke patients

    Institute of Scientific and Technical Information of China (English)

    Ping Wu; Fang Zeng; Yong-xin Li; Bai-li Yu; Li-hua Qiu; Wei Qin; Ji Li; Yu-mei Zhou; Fan-rong Liang

    2015-01-01

    This study aimed to detect the difference in resting cerebral activities between ischemic stroke pa-tients and healthy participants, deifne the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efifcacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunc-tion and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks) and 15 age-matched healthy participants. A rest-ing-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental ifndings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely po-tential targets for the neural regeneration of subacute ischemic stroke patients.

  13. Health, function and disability in stroke patients in the community

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    Bárbara P. B. Carvalho-Pinto

    2016-01-01

    Full Text Available ABSTRACT Background Stroke patients commonly have impairments associated with reduction in functionality. Among these impairments, the motor impairments are the most prevalent. The functional profile of these patients living in the community who are users of the primary health-care services in Brazil has not yet been established Objective To describe the functional profile of stroke patients who are users of the primary health-care services in Brazil, looking at one health-care unit in the city of Belo Horizonte, Brazil. Method From medical records and home visits, data were collected regarding health status, assistance received following the stroke, personal and environmental contextual factors, function and disability, organized according to the conceptual framework of the International Classification of Functioning, Disability and Health (ICF. Test and instruments commonly applied in the assessment of stroke patients were used. Results Demographic data from all stroke patients who were users of the health-care unit (n=44, age: 69.23±13.12 years and 67±66.52 months since the stroke participated of this study. Most subjects presented with disabilities, as changes in emotional function, muscle strength, and mobility, risks of falling during functional activities, negative self-perception of quality of life, and perception of the environment factors were perceived as obstacles. The majority of the patients used the health-care unit to renew drug prescriptions, and did not receive any information on stroke from health professionals, even though patients believed it was important for patients to receive information and to provide clarifications. Conclusion Stroke patients who used primary health-care services in Brazil have chronic disabilities and health needs that require continuous health attention from rehabilitation professionals. All of these health needs should be considered by health professionals to provide better management as part of

  14. [Neuroprotective treatment with citicoline (ceraxon) in patients with ischemic stroke].

    Science.gov (United States)

    Martynov, M Iu; Boĭko, A N; Kamchatnov, P R; Kabanov, A A; Iasamanova, A N; Shchukin, I A; Kolesnikova, T I; Chubykin, V I; Glukhareva, A P; Gusev, E I

    2012-01-01

    The dynamics of neurological symptoms assessed with the Scandinavian stroke scale, the Barthel index and the modified Rankin scale was studied in 89 patients with moderate ischemic stroke who received citicoline (ceraxone) intravenously and orally. The results were compared to a group of 52 age-, sex- and stroke-matched patients who did not receive citicoline. To the date of discharge from the hospital (days 21-24), the full restoration (pciticoline was significantly (p<0.05) higher in patients younger than 70 years and when the drug was used in the first hours of disease.

  15. Reasons for exclusion from intravenous thrombolysis in stroke patients admitted to the Stroke Unit.

    Science.gov (United States)

    Cappellari, Manuel; Bosco, Mariachiara; Forlivesi, Stefano; Tomelleri, Giampaolo; Micheletti, Nicola; Carletti, Monica; Bovi, Paolo

    2016-11-01

    Intravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU 4.5 h (p = 0.001) and unknown time of onset (or stroke present on awakening) (p = 0.004) were reasons listed in the current SPC of Actilyse reasons for exclusion even they occurred singly, whereas mild deficit (or rapidly improving symptoms) (p exclusion even when it occurred singly, whereas early CT hypodensity (p exclusion, early CT hypodensity was associated with decision not offer IV thrombolysis in patients with mild deficit (p 80 years (p 4.5 h (p = 0.005), and unknown time of onset (p = 0.037), while severe pre-stroke disability (p = 0.025) and admission under non-stroke specialist neurologist assessment (p = 0.018) in patients with age >80 years. There are often unjustified reasons for exclusion from IV thrombolysis in SU.

  16. Cilostazol may prevent cardioembolic stroke in patients undergoing antiplatelet therapy.

    Science.gov (United States)

    Horie, Nobutaka; Kaminogo, Makio; Izumo, Tsuyoshi; Hayashi, Kentaro; Tsujino, Akira; Nagata, Izumi

    2015-07-01

    Randomised trials have shown the efficacy of antiplatelet therapy with cilostazol to prevent secondary ischaemic stroke. Recently, cilostazol has been reported to prevent the development and/or recurrence of atrial fibrillation (AF), which can potentially prevent cardioembolic stroke in patients undergoing antiplatelet therapy. Herein, we examined the impact of prior antiplatelet therapy with cilostazol on the incidence of cardioembolic stroke, which had not been fully investigated. Using the multicenter retrospective study of stroke risk in antithrombotic therapy (RESTATE) database, we analysed consecutive patients with primary or secondary stroke under single antiplatelet therapy. We evaluated the characteristics of ischaemic stroke based on the type of antiplatelet agent used: aspirin, ticlopidine/clopidogrel or cilostazol. Of 1069 consecutive patients with primary or secondary stroke during antithrombotic therapy from January to December 2012, 615 patients received single antiplatelet therapy (293 and 322 cases of primary and secondary strokes, respectively). Interestingly, the percentage of cardioembolic infarction was significantly lower in patients taking cilostazol compared with other agents. Multivariate regression analysis found that age (OR: 1.03, 95% CI: 1.01-1.06, P = 0.0029), serum creatinine (OR: 1.17, 95% CI: 1.03-1.34, P = 0.0198), aspirin (OR: 1.75, 95% CI: 1.00-3.22, P = 0.0486), cilostazol (OR: 0.19, 95% CI: 0.03-0.73, P = 0.0125), and smoking (OR: 1.86, 95% CI: 1.16-2.94, P = 0.0102) were independently associated with cardioembolic stroke. Cilostazol may prevent cardioembolic stroke in patients undergoing antiplatelet therapy. This could be a novel strategy for cardioembolic stroke prevention potentially by affecting cardiac remodelling, in contrast to secondary anticoagulant therapy.

  17. Predictors of Outcome in Patients Presenting with Acute Ischemic Stroke and Mild Stroke Scale Scores.

    Science.gov (United States)

    Kenmuir, Cynthia L; Hammer, Maxim; Jovin, Tudor; Reddy, Vivek; Wechsler, Lawrence; Jadhav, Ashutosh

    2015-07-01

    Although National Institutes of Health Stroke Scale (NIHSS) is a known predictor of outcome in acute ischemic stroke, there are other factors like age, ambulatory status, and ability to swallow that may be predictors of outcome but are not assessed by the traditional NIHSS. The aim of this retrospective review was to identify predictors of outcome in mild ischemic stroke. Discharge outcomes from patients who presented to our large academic stroke center with acute ischemic stroke from 2005 to 2013 were retrospectively reviewed. Of 7189 patients reviewed, 2597 had initial NIHSS less than 5. Outcome measures were modified Rankin Scale (MRS) score 0-1 and discharge to home. In all, 65% of patients with NIHSS 0-4 were discharged directly home independent of treatment. Of those patients discharged to home, 74% were able to ambulate independently and 98% passed their dysphagia screen. Of patients not discharged directly home, 66% were unable to ambulate independently and 21% did not pass their dysphagia screen. Multivariate logistic regression analysis revealed a significant effect of dysphagia screen (P = .001), ability to ambulate independently (P = .002), age (P = .016), and NIHSS (P = .005) on discharge to home but not MRS of 0-1 (P = .564). In patients with mild stroke scale scores defined as NIHSS 0-4, several factors including age, NIHSS, ambulatory status, and ability to swallow may be independent predictors of functional outcome and discharge home. These data support the development of a modified grading system for assessing functional outcome in mild stroke that considers these factors. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Stroke patients' experiences of return to work.

    Science.gov (United States)

    Medin, Jennie; Barajas, Josefin; Ekberg, Kerstin

    2006-09-15

    Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.Method. Six patients who had their first ever stroke in 2001, were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or "will" and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

  19. Women Sex Importance in Stroke Patients with Atrial Fibrillation

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    Cemile Handan Mısırlı

    2014-08-01

    Full Text Available OBJECTIVE: It was shown the differences in age, risk factors and treatment between women and men in stroke patients with atrial fibrillation METHODS: The stroke patients with atrial fibrillation who were hospitalized in our department at the last 2 years were seperated into 2 groups of aged above 75 and below 75, investigated with CHADS2 and CHA2DS2VASc scores and looked at the sex differences of women and men. RESULTS: Stroke ratio according to sex was statistically meaningful especially in women above the age of 75. Risc factors also were founded in elderly women and CHA2DS2VASc scores were higher in women than men so more anticoagulan treatment were begun. No differences were shown between sexes at lone atrial fibrillation and no treatment were begun. CONCLUSION: Women with atrial fibrillation had more risk factors, higher stroke rate and higher anticoagulation treatment.

  20. Functional recovery in aging mice after experimental stroke.

    Science.gov (United States)

    Manwani, Bharti; Liu, Fudong; Xu, Yan; Persky, Rebecca; Li, Jun; McCullough, Louise D

    2011-11-01

    Aging is a non-modifiable risk factor for stroke. Since not all strokes can be prevented, a major emerging area of research is the development of effective strategies to enhance functional recovery after stroke. However, in the vast majority of pre-clinical stroke studies, the behavioral tests used to assess functional recovery have only been validated for use in young animals, or are designed for rats. Mice are increasingly utilized in stroke models but well validated behavioral tests designed for rats are not necessarily reproducible in mice. We examined a battery of behavioral tests to evaluate functional recovery in an aging murine model of stroke. We found that the vertical pole, hanging wire and open field can accurately assess acute behavioral impairments after stroke in both young and aging male mice, but animals recover rapidly on these tasks. The corner test can accurately and repeatedly differentiate stroke from sham animals up to 30 days post stroke and can be performed reliably in aging mice. Aging male mice had significantly worse behavioral impairment compared to young male mice in the first two weeks after stroke but eventually recovered to the same degree as young mice. In contrast, chronic infarct size, as measured by ipsilateral cerebral atrophy, was significantly lower in aging male mice compared to young male mice. Reactive gliosis, formation of glial scar, and an enhanced innate immune response was seen in the aging brain and may contribute to the delayed behavioral recovery seen in the aging animals.

  1. Relationship between Postural Sway and Dynamic Balance in Stroke Patients

    OpenAIRE

    2014-01-01

    [Purpose] The purpose of the current study was to investigate the relationship between postural sway and dynamic balance in post stroke patients. [Subjects] Thirty-one stroke patients (20 men and 11 women; age 64.25 years; stroke duration 12.70 months; MMSE-K score 26.35) participated in this study. [Methods] This study applied a cross-sectional design. A Good Balance system was used for measurement of the postural sway velocity (anteroposterior and mediolateral) and velocity moment of subjec...

  2. Sex Differences in Stroke Subtypes, Severity, Risk Factors, and Outcomes Among Elderly Patients with Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Changshen eYu

    2015-09-01

    Full Text Available Background: Although the age-specific incidence and mortality of stroke is higher among men, stroke has a greater clinical effect on women. However, the sex differences in stroke among elderly patients are unknown. Therefore, we aimed to assess the sex differences in stroke among elderly stroke patients.Methods: Between 2005 and 2013, we recruited 1,484 consecutive acute ischemic stroke patients (≥75 years old from a specialized neurology hospital in Tianjin, China. Information regarding their stroke subtypes, severity, risk factors, and outcomes at 3 and 12 months after stroke were recorded.Results: Comparing with men, women had a significantly higher prevalence of severe stroke (17.20% vs. 12.54%, hypertension (76.42% vs. 66.39%, dyslipidemias (30.35% vs. 22.76%, and obesity (18.40% vs. 9.32%, P < 0.05. Comparing with women, men had a significantly higher prevalence of intracranial artery stenosis (23.11% vs. 17.45%, current smoking (29.60% vs. 13.05%, and alcohol consumption (12.15% vs. 0.47%, P < 0.05. Moreover, dependency was more common among women at 3 and 12 months after stroke, although the sex difference disappeared after adjusting for stroke subtypes, severity, and risk factors. Conclusions: Elderly women with acute ischemic stroke had more severe stroke status and worse outcomes at 3 and 12 months after stroke. Thus, elderly female post-acute ischemic stroke patients are a crucial population that should be assisted with controlling their risk factors for stroke and changing their lifestyle.

  3. Post-stroke bacteriuria among stroke patients attending a physiotherapy clinic in Ghana: a cross-sectional study

    Science.gov (United States)

    Donkor, Eric S; Akumwena, Amos; Amoo, Philip K; Owolabi, Mayowa O; Aspelund, Thor; Gudnason, Vilmundur

    2016-01-01

    Background Infections are known to be a major complication of stroke patients. In this study, we evaluated the risk of community-acquired bacteriuria among stroke patients, the associated factors, and the causative organisms. Methods This was a cross-sectional study involving 70 stroke patients and 83 age- and sex-matched, apparently healthy controls. Urine specimens were collected from all the study subjects and were analyzed by standard microbiological methods. Demographic and clinical information was also collected from the study subjects. For stroke patients, the information collected also included stroke parameters, such as stroke duration, frequency, and subtype. Results Bacteriuria was significantly higher among stroke patients (24.3%, n=17) than among the control group (7.2%, n=6), with a relative risk of 3.36 (confidence interval [CI], 1.40–8.01, P=0.006). Among the control group, all six bacteriuria cases were asymptomatic, whereas the 17 stroke bacteriuria cases comprised 15 cases of asymptomatic bacteriuria and two cases of symptomatic bacteriuria. Female sex (OR, 3.40; CI, 1.12–10.30; P=0.03) and presence of stroke (OR, 0.24; CI, 0.08–0.70; P=0.009) were significantly associated with bacteriuria. The etiology of bacteriuria was similar in both study groups, and coagulase-negative Staphylococcus spp. were the most predominant organisms isolated from both stroke patients (12.9%) and the control group (2.4%). Conclusion Stroke patients in the study region have a significantly higher risk of community-acquired bacteriuria, which in most cases is asymptomatic. Community-acquired bacteriuria in stroke patients appears to have little or no relationship with clinical parameters of stroke such as stroke subtype, duration and frequency. PMID:27051289

  4. Racial Difference in Cerebral Microbleed Burden among Ischemic Stroke Patients.

    Science.gov (United States)

    Shahjouei, Shima; Tsivgoulis, Georgios; Singh, Mantinderpreet; McCormack, Michael; Noorbakhsh-Sabet, Nariman; Goyal, Nitin; Alexandrov, Anne W; Alexandrov, Andrei V; Zand, Ramin

    2017-08-21

    Data on the epidemiology of cerebral microbleeds (CMBs) among patients with ischemic stroke are limited. This study compared the number, associated factors, and topography of CMBs between African American and Caucasian ischemic stroke patients in the Mid-South United States. We evaluated consecutive ischemic stroke patients admitted to our tertiary stroke center, University of Tennessee Health Science Center, Memphis, Tennessee, in a two-year period. We analyzed T2*-weighted magnetic resonance images for the number, location, and topography of CMBs, as well as patients' demographic and clinical information. Among 760 ischemic stroke patients who were included (mean age was 62.1 ± 13.9 years, 51.4% men), 450 (59.2%) were African American. In comparison with Caucasians, African Americans were about five years younger (P = .000) and had a higher rate of hypertension (80.9% vs. 74.5%, P = .036). Similarly, African Americans had a higher prevalence of diabetes mellitus (P = .001). There was no significant difference between African-Americans and Caucasians in terms of CMBs presence and location. African Americans had a higher number of CMBs in comparison with Caucasians, but the difference was not significant. African Americans were more likely to have CMBs ≥5 (P = .047). Although African American stroke patients had a higher rate of large confluent white matter lesions, there was no significant racial difference regarding the rate and severity of deep white matter lesions. We did not observe any differences between African American and Caucasian patients with ischemic stroke patients regarding the presence, number, and location of CMBs. However, our results suggested that the prevalence of multiple CMBs (CMBs ≥5) might be higher among African American stroke patients. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Pattern of hospitalized-stroke patients in ASEAN countries an ASNA stroke epidemiological study

    Directory of Open Access Journals (Sweden)

    Jusuf Misbach

    2001-03-01

    Full Text Available To better understanding the demographic characteristics, admission time, clinical pattern, risk factors, stroke type, length of stay, and discharge outcome of hospitalized acute stroke patients in ASEAN member countries, ASEAN   Neurological Association (ASNA formed a Standing Commiltee for Stroke in 1996 and this is the first ASNA Stroke Epidemiological Study using the same stroke protocol. This prospective hospital based study was conducted in seven ASEAN countries (Brunei, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam by participating neurologists from October 1996 to March 1997. Of the 3723 consecutive hospitalized stroke patients (2030 males and 1660 females from 44 participating hospitals in this study ie Brunei (n=53, Indonesia (n=2065, Malaysia (n=300,Philippines (n=545,Singapore (n=232, Thailand (n=244 and Vietnam (n=284, the mean age was 59.0 ± 13,8 years 16% of patients were younger than 45 years and 37% of patients were older than 65 years. There were no significant differences in age at onset among stroke subjects except in Vietnam (younger and Singapore (older. The sex distribution showed a slight higher prevalence of women in Singapore and in the age group > 64 years. The mean adrnission time was 41.5 ± 87.0 hours, 19% of patients were admitted within 3 hours, 29% within 6 hours and 66% more than 6 hours (delayed admission especially in Malaysia and Singapore (80% and 77% respectively. Motor disability was the most prevalent clinical feature in all countries and carotid bruit was the rarest (1%. Hypertension was the most common risk factor (68% in all countries, followed by TIA (35%, smoking, diabetes mellitus, ischnemic heart disease and hypercholesterolemia. CT scan was performed on 76% of subjects. The diagnostic classification was non lacunar anterior circulation (32%, lacunar infarction (14%, hemorrhagic stroke (26%, SAH (4%. Mean length of stay was 11.4 ± 11.8 days. Most of the patients

  6. Stroke prevention awareness and treatment knowledge among patients' relatives

    Institute of Scientific and Technical Information of China (English)

    Kai Li; Dongcai Yuan

    2008-01-01

    BACKGROUND: Recent research indicates that if a stroke can be effectively treated within three hours, prognosis is improved. Therefore, it is necessary to properly educate stroke patients' relatives about prevention and treatment. OBJECTIVE: To survey and analyze the present awareness of stroke prevention and treatment knowledge among patients' relatives. DESIGN: Cross-sectional study. SETTING: Beijing Hospital and Medical College of Shandong University and Harrison International Peace Hospital, the Affiliated Hospital of Hebei Medical University.PARTICIPANTS: From May 2005 to November 2006, a "stroke awareness" questionnaire survey was performed in four hospitals, including Harrison International Peace Hospital in Hengshui City (third class, first grade), Fucheng County People's Hospital (second class, first grade), Zaoqiang County Jiahui Countryside Hospital (first class, first grade) and Hengshui City Electricity Industry Bureau Infirmary. The participants provided confirmed consent.METHODS: The "stroke awareness" questionnaire included 10 questions: 1–8 were related to the understanding of stroke, 9 and 10 were related to behavior and attitude towards medical treatment. Demographic information was also collected on each participant, including age, education level, and occupation. Each positive answer accounted for one point. A score of 8 or higher was categorized as "good stroke awareness".MAIN OUTCOME MEASURES: Scores of stroke awareness. RESULTS: A total of 4 000 "stroke awareness" questionnaires were printed and distributed. 3 597 copies were completed and 3 468 were included in the study. ① Relative factors of stroke awareness: The survey demonstrated that the participant's age, educational level, occupation, grade of hospital, and the relationship with the patient had a significant effect on their stroke awareness (P < 0.05–0.01). ② Stroke knowledge: With regard to stroke awareness, 72% subjects did not know the signs indicating the onset of

  7. Atrial fibrillation in patients with ischemic stroke

    DEFF Research Database (Denmark)

    Thygesen, Sandra Kruchov; Frost, Lars; Eagle, Kim A;

    2009-01-01

    BACKGROUND: Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care...... and outcomes in a cohort of first-time ischemic stroke patients with and without atrial fibrillation. METHODS: Based on linkage of public medical databases, we did a population-based follow-up study among 3,849 stroke patients from the County of Aarhus, Denmark admitted in the period of 2003......-2007 and prospectively registered in the Danish National Indicator Project. RESULTS: Atrial fibrillation was associated with an adverse prognostic profile but not with an overall poorer quality of in-hospital care. Patients with atrial fibrillation had a longer total length of stay (median: 15 vs 9 days), and were...

  8. Methylenetetrahydrofolate reductase gene polymorphism in Indian stroke patients

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    Kalita J

    2006-01-01

    Full Text Available Background and Aims: In view of the prevailing controversy about the role of Methylenetetrahydrofolate reductase (MTHFR C677T mutation in stroke and paucity of studies from India, this study has been undertaken to evaluate MTHFR C677T gene polymorphism in consecutive ischemic stroke patients and correlate these with folic acid, homocysteine (Hcy and conventional risk factors. Settings and Design: Ischemic stroke patients prospectively evaluated in a tertiary care teaching hospital. Materials and Methods: Computerized tomography proven ischemic stroke patients were prospectively evaluated including clinical, family history of stroke, dietary habits and addictions. Their fasting and postprandial blood sugar, lipid profile, vitamin B12, folic acid and MTHFR gene analysis were done. Statistical Analysis: MTHFR gene polymorphism was correlated with serum folic acid, Vitamin B12 and Hcy levels; family history of stroke in first-degree relatives; and dietary habits; employing Chi-square test. Results: There were 58 patients with ischemic stroke, whose mean age was 50 (4-79 years; among them, 10 were females. MTHFR gene polymorphism was present in 19 (32.8% patients, 3 were homozygous and 16 were heterozygous. Both serum folate and B12 levels were low in 29 (50% patients and Hcy in 48 (83%. Hypertension was present in 28 (48% patients, diabetes in 12 (21%, hyperlipidemia in 52 (90%, smoking in 17 (29%, obesity in 1 (1.7% and family history of stroke in first-degree relatives in 13 (22.4%. There was no significant relationship of MTHFR gene polymorphism with folic acid, B12, Hcy levels, dietary habits and number of risk factors. Vitamin B12 level was low in vegetarians ( P Conclusion: MTHFR gene polymorphism was found in one-third of patients with ischemic stroke and was insignificantly associated with higher frequency of elevated Hcy.

  9. [Nutrition for elderly acute stroke patients].

    Science.gov (United States)

    Ha, Lisa; Iversen, Per Ole; Hauge, Truls

    2008-09-11

    Elderly people have an increased risk of malnutrition due to biological and physiological changes and underlying disease. Almost 90% of the stroke patients are older than 65 years, and the consequences of acute stroke may lead to additional nutritional problems. This paper reviews nutritional therapy for stroke patients. PubMed was searched (non-systematically) for prospective cohort studies of occurrence, diagnostics and consequences of undernutrition in stroke patients. Randomized trials were examined to identify clinical effects of oral protein and energy supplements or tube feeding on nutritional status and intake, functional status, infections, length of stay, quality of life and mortality. 8-35% of stroke patients are undernourished. Body weight is one of the most important parameters for assessment of nutritional status. Dysphagia occurs in up to 80% of patients with acute stroke and increases the risk of undernutrition, which again leads to prolonged length of stay, reduced functional status and poorer survival. Early nasogastric tube feeding does not increase the risk of pneumonia and may improve survival after six months. Oral supplements lead to a significantly improved nutritional intake in undernourished stroke patients, as well as improved nutritional status and survival in undernourished elderly. Nutritional treatment can improve the clinical outcome after an acute stroke, provided that there are good procedures for follow-up and monitoring of the treatment.

  10. Age- and Gender-Specific Prevalence of Cardiovascular Risk Factors in 40 102 Patients With First-Ever Ischemic Stroke A Nationwide Danish Study

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Andersen, Z. J.; Olsen, T. S.

    2010-01-01

    underwent evaluation including stroke severity (Scandinavian Stroke Scale), CT, and cardiovascular risk factors: hypertension, atrial fibrillation, diabetes mellitus, intermittent arterial claudication, previous myocardial infarction, body mass index, smoking, and alcohol consumption. We estimated...... the independent effect of gender and age on prevalence of cardiovascular risk factors and calculated age and gender-specific prevalence rates for each risk factor. Results—The register contained 47.9% women and 52.1% men. Men had more often diabetes mellitus, previous myocardial infarction, intermittent arterial...... claudication, and over the limit alcohol consumption. Women had more often hypertension and obesity. Atrial fibrillation and smoking were equally frequent in both genders. Age stratification revealed that the lifestyle cardiovascular risk factors smoking, alcohol, and obesity were more common in the younger...

  11. Interactions between Age, Sex, and Hormones in Experimental Ischemic Stroke

    Science.gov (United States)

    Liu, Fudong; McCullough, Louise D.

    2012-01-01

    Age, sex, and gonadal hormones have profound effects on ischemic stroke outcomes, although how these factors impact basic stroke pathophysiology remains unclear. There is a plethora of inconsistent data reported throughout the literature, primarily due to differences in the species examined, the timing and methods used to evaluate injury, the models used, and confusion regarding differences in stroke incidence as seen in clinical populations versus effects on acute neuroprotection or neurorepair in experimental stroke models. Sex and gonadal hormone exposure have considerable independent impact on stroke outcome, but these factors also interact with each other, and the contribution of each differs throughout the lifespan. The contribution of sex and hormones to experimental stroke will be the focus of this review. Recent advances and our current understanding of age, sex, and hormone interactions in ischemic stroke with a focus on inflammation will be discussed. PMID:23068990

  12. Protective factors in patients aged over 65 with stroke treated by physiotherapy, showing cognitive impairment, in the Valencia Community. Protection Study in Older People (EPACV

    Directory of Open Access Journals (Sweden)

    Gil-Guillen Vicente

    2012-10-01

    Full Text Available Abstract Background Family function may have an influence on the mental health deterioration of the caregivers of dependent family members and it could have a varying importance on the care of dependents. Little attention has been paid to the preparation of minor stroke survivors for the recovery trajectory or the spouse for the caregiving role. Therefore, this study protocol intends to analyze the influence of family function on the protection of patients with stroke sequels needing physiotherapy in the family environment. Methods/Design This is an analytical observational design, prospective cohort study and using a qualitative methodology by means of data collected in the “interviews of life”. The study will be carried out by the Rehabilitation Service at Hospital of Elda in the Valencia Community. All patients that have been diagnosed with stroke and need physiotherapy treatment, having a dependency grade assigned and consent to participate in the study, will undergo a monitoring of one year in order to assess the predictive factors depending on the dependence of the people affected. Discussion Our research aims to analyze the perception of caregivers, their difficulties to work, and the influence of family function. Moreover, it aims to register the perception of the patients with stroke sequel over the care received and whether they feel protected in their family environment.

  13. The emerging age of endovascular treatment of acute ischaemic stroke and the role of CT angiography in patient work-up: a guide for the radiologist.

    Science.gov (United States)

    Loughborough, W; Mahady, K; Bradley, M D; Renowden, S A; Mortimer, A M

    2016-01-01

    Recent trial evidence suggests that for patients suffering large-vessel occlusive stroke, endovascular therapy based on the stent-retriever technique is associated with superior clinical outcomes when compared to intravenous thrombolysis alone. The challenge now is how this service is to be delivered. This may involve both centralisation of services around large cities and development of robust networks to receive patients from district general hospitals situated further afield. Both diagnostic and interventional neuroradiology will need to expand. Furthermore, we suggest that it would be advantageous for radiology departments in those hospitals receiving hyperacute stroke patients to perform computed tomography (CT) angiography in addition to non-contrast CT, which also has implications for service delivery in these units. This could swiftly aid identification of patients who might benefit from thrombectomy and improve decision-making through demonstration of occlusive thrombus and of collateral status.

  14. Preclinical models of stroke in aged animals with or without comorbidities: role of neuroinflammation.

    Science.gov (United States)

    Buga, A-M; Di Napoli, Mario; Popa-Wagner, A

    2013-12-01

    Age is the principal nonmodifiable risk factor for stroke. Over the past 10 years, suitable models for stroke in aged rats have been established. At genetic and cellular level there are significant differences in behavioral, cytological and genomics responses to injury in old animals as compared with the young ones. Behaviorally, the aged rats have the capacity to recover after cortical infarcts albeit to a lower extent than the younger counterparts. Similarly, the increased vulnerability of the aged brain to stroke, together with a decreased interhemisphere synchrony after stroke, assessed by different experimental methods (MRI, fMRI, in vivo microscopy, EEG) leads to unfavorable recovery of physical and cognitive functions in aged people and may have a prognostic value for the recovery of stroke patients. Furthermore, in elderly, comorbidities like diabetes or arterial hypertension are associated with higher risk of stroke, increased mortality and disability, and poorer functional status and quality of life. Aging brain reacts strongly to ischemia-reperfusion injury with an early inflammatory response. The process of cellular senescence can be an important additional contributor to chronic post-stroke by creating a "primed" inflammatory environment in the brain. Overall, these pro-inflammatory reactions promote early scar formation associated with tissue fibrosis and reduce functional recovery. A better understanding of molecular factors and signaling pathways underlying the contribution of comorbidities to stroke-induced pathological sequelae, may be translated into successful treatment or prevention therapies for age-associated diseases which would improve lifespan and quality of life.

  15. Optimising stroke prevention in elderly patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Lip, Gregory Y H

    2016-01-01

    Atrial fibrillation (AF) is more prevalent in the elderly, and is associated with an increasing risk of stroke and thromboembolism. Despite the perception that elderly patients do badly on oral anticoagulation (OAC), the evidence clearly shows how with increasing age, OAC is increasingly more...... protective, with no difference between OAC and aspirin in terms of serious bleeding or intracranial bleeding. This is consistent with various studies showing a beneficial effect of OAC with one or more stroke risk factors, with a positive net clinical benefit (NCB) balancing ischaemic stroke reduction...

  16. Hearing Characteristics of Stroke Patients: Prevalence and Characteristics of Hearing Impairment and Auditory Processing Disorders in Stroke Patients.

    Science.gov (United States)

    Koohi, Nehzat; Vickers, Deborah A; Lakshmanan, Rahul; Chandrashekar, Hoskote; Werring, David J; Warren, Jason D; Bamiou, Doris-Eva

    2017-06-01

    Stroke survivors may suffer from a range of hearing impairments that may restrict their participation in postacute rehabilitation programs. Hearing impairment may have a significant impact on listening, linguistic skills, and overall communication of the affected stroke patient. However, no studies sought to systematically characterize auditory function of stroke patients in detail, to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful in understanding and addressing the hearing needs of stroke survivors. The present study aimed to characterize and classify the hearing impairments, using a detailed audiological assessment test battery, in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. A case-control study. Forty-two recruited stroke patients who were discharged from a stroke unit and 40 control participants matched for age. All participants underwent pure-tone audiometry and immittance measurements including acoustic reflex threshold, transient-evoked otoacoustic emissions, auditory-evoked brainstem response, and a central auditory processing assessment battery, performed in a single session. Hearing impairments were classified as peripheral hearing loss (cochlear and neural type), central auditory processing disorder (CAPD), and as a combination of CAPD and peripheral hearing loss. Overall mean hearing thresholds were not significantly different between the control and stroke groups. The most common type of hearing impairment in stroke patients was the combination type, "peripheral and CAPD," in the 61- to 80-yr-old subgroup (in 55%), and auditory processing deficits in 18- to 60-yr-olds (in 40%), which were both significantly higher than in controls. This is the first study to examine hearing function in detail in stroke patients. Given the importance of hearing for the efficiency of communication, it is essential to identify

  17. One-year outcomes and secondary prevention in patients after acute minor stroke: results from the China National Stroke Registry.

    Science.gov (United States)

    Tan, Ying; Pan, Yuesong; Liu, Liping; Wang, Yilong; Zhao, Xingquan; Wang, Yongjun

    2017-06-01

    Limited data are available on secondary preventive therapy use and patient outcomes after acute minor ischemic stroke in China. This study investigated secondary prevention strategies and outcomes up to 1 year after minor ischemic stroke. Patients from the China National Stroke Registry experienced a minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤5) and admitted to hospital within 24 hours of symptom onset were included. One-year rates of recurrent stroke, stroke-related disability, and all-cause death were evaluated. Risk factors associated with 1-year stroke recurrence were examined in a multivariate model. The secondary prevention strategies in the acute phase were evaluated as combination of secondary prevention medication classes and the medications used in 1 year follow-up were examined. The study included 1913 patients who had experienced acute minor ischemic stroke (mean age: 65.1 years; 67.3% men; mean NIHSS score: 2.5). Rates of recurrent stroke, disability, and death were 13.2, 17.0, and 6.3% at 1 year, respectively. History of hypertension, ischemic stroke, transient ischemic attack, and atrial fibrillation were independent predictors of one-year stroke recurrence. Rate of 1 year all-cause death in patients with triple combined therapy in acute phase was 4.1%, whereas in patients with none was 14.5%. At 1 year, only half patients continued the secondary prevention medications. Outcomes in individuals in China who had experienced acute minor stroke were unfavorable, underscoring the importance of early, sustained preventive therapy in this patient population. Combination of secondary prevention medication classes was associated with a lower risk of death.

  18. Inflammatory markers and elderly patients with stroke

    Institute of Scientific and Technical Information of China (English)

    Antonello Silvestri; Cristiana Vitale; Pasquale Galetta; Daniela Onorati; Massimo Fini; Giuseppe MC Rosano

    2004-01-01

    Objective C-reactive protein (CRP) is associated with tnfavorable outcome in patients with acute ischemic syndromes and in patients with chronic stable angina. Elevated CRP levels suggestive of heightened inflammatory state in vascular conditions are often associated with elevated interleulin-6 (IL-6) levels. The aim of our study was to show the predictive importance of CRP and IL-6 levels in patients with ischemic stroke that has not been fully elucidated. Design We studied 647 consecutive elderly patients ( > 65 years) with stroke who were documented with ischemic stroke, presence of significant carotid atherosclerosis and absence of atrial fibrillation. The study population included 150 patients (74 men, 76 women, mean age 74 ± 2). Patients underwent evaluation of high sensitive CRP and IL-6 levels at baseline, during hospitalization and at discharge. Results In-hospital mortality was 6%, 1 year mortality was 15% and a second cerebrovascular event occurred in 12% of patients. Those with inhospital events had significantly higher baseline CRP and IL-6 levels than patients without events (3.8 ± 1.1 vs 1.9±0.9 mg/L,P<0.01 and 13.8±3.4 vs6.3±2.1 pg/ml, P<0.01, respectively). Also CRP and IL-6 levels were significantly higher in those patients with an event within 3 months of discharge compared to patientswithout an event (3.6±1.3 vs 1.1±0.7 ing/L, P<0.01 and 14.2±3.7 vs5.4±1.6 pg/ml, P<0.01,respectively). Both base line CRP levels and IL-6 were predictive of events both in-hospital and after 3 months while CRP and IL-6 levels at baseline were not associated with a poor 1 year prognosis. Elevated ClRP levels were associated with an unfavorable outcome only when IL-6 levels were also elevated. In a stepwise multivariate analysis IL-6 level was a stronger predictor of outcome than CRP. Conclusions In conclnsion, elevated CRP and IL-6 levels may identify elderly patients at increased medium term risk, but do not predict one year events in this subset

  19. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation...... in patients with acute ischemic stroke and atrial fibrillation....... are at increased risk of stroke progression and recurrence. We sought to assess whether D-dimer and other markers of hemostatic activation could predict these adverse events in such patients. Method -  Blood samples were obtained from patients included in the Heparin in Acute Embolic Stroke Trial. Stroke...

  20. The Use of Major Risk Factors for Computer-Based Distinction of Diabetic Patients with Ischemic Stroke and Without Stroke

    Science.gov (United States)

    2007-11-02

    Features include age, gender, duration of diabetes , cholesterol, higher density lipoprotein (HDL), triglicerit levels, neuropathy, nephropathy ...THE USE of MAJOR RISK FACTORS for COMPUTER-BASED DISTINCTION of DIABETIC PATIENTS with ISCHEMIC STROKE and WITHOUT STROKE Sibel Oge Merey1...boun.edu.tr Abstract- This study proposes a computer-based decision support system to investigate the distinctive factors of diabetes mellitus (DM

  1. Rehabilitation of a patient with stroke

    Directory of Open Access Journals (Sweden)

    Apurba Barman

    2013-01-01

    Full Text Available Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community and improve the self-esteem of patient. A comprehensive stroke rehabilitation service should provide early assessment of impairments and disabilities, management and prevention of complications and well-organized rehabilitation program in both in-patient and out-patient settings. A multidisciplinary or interdisciplinary team approach is necessary to reduce the post-stroke disabilities. It has many members, including physicians, physical therapists, occupational therapists, speech and language pathologists, orthotist, psychotherapists, social workers, vocational rehabilitation therapists, rehabilitation nurse, patients, families and other caregivers. Physicians caring for patients with stroke during rehabilitation must be aware of potential medical complications, as well as a number of special problems that may complicate recovery, including cognitive deficits, aphasia, dysphagia, urinary incontinence, shoulder pain, spasticity, falls and depression. Involvement of patient and caregivers in the rehabilitation process is essential. This article outlines the salient features of the early comprehensive rehabilitation after stroke.

  2. Physical Activity in Hospitalised Stroke Patients

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    Tanya West

    2012-01-01

    Full Text Available The aim of this paper was to examine the amount and type of physical activity engaged in by people hospitalised after stroke. Method. We systematically reviewed the literature for observational studies describing the physical activity of stroke patients. Results. Behavioural mapping, video recording and therapist report are used to monitor activity levels in hospitalised stroke patients in the 24 included studies. Most of the patient day is spent inactive (median 48.1%, IQR 39.6%–69.3%, alone (median 53.7%, IQR 44.2%–60.6% and in their bedroom (median 56.5%, IQR 45.2%–72.5%. Approximately one hour per day is spent in physiotherapy (median 63.2 minutes, IQR 36.0–79.5 and occupational therapy (median 57.0 minutes, IQR 25.1–58.5. Even in formal therapy sessions limited time is spent in moderate to high level physical activity. Low levels of physical activity appear more common in patients within 14 days post-stroke and those admitted to conventional care. Conclusions. Physical activity levels are low in hospitalised stroke patients. Improving the description and classification of post stroke physical activity would enhance our ability to pool data across observational studies. The importance of increasing activity levels and the effectiveness of interventions to increase physical activity after stroke need to be tested further.

  3. Functional recovery of post stroke patients with hemiparesis after stroke of different aetiology

    Directory of Open Access Journals (Sweden)

    Mandić Milan

    2012-01-01

    Full Text Available Introduction. Medical rehabilitation focuses on improvement of functional recovery in post stroke patients. The aim of the work was to analyze functional recovery in a cohort of post stroke patients with hemiparesis three months after stroke. Material and Methods. A prospective, cohort study included 30 patients from the city of Niš aged 40 to 69. The study was conducted at the Department of Physical Medicine and Rehabilitation in Niš from March 1 to June 30, 2009. The aetiology of stroke was determined by the nuclear magnetic resonance. The average values, standard deviation, and t-test were calculated. Results. Of the total sample of 30 patients, 23 (77%, 16 men and 7 women had left hemiparesis and 7 (23%, 4 men and 3 women had right hemiparesis. The average age of the patients was 58.93± 6.86. Fourteen (47% patients were not able to move, 10 (33% patients could move when they were assisted by someone and only 6 (20% patients could move independently. Twenty-six (88% patients were not able to take care of themselves without assistance and 4 (13% patients could take care of themselves. The average Barthel Index score on admission to the Department of Physical Medicine and Rehabilitation was 57 and 3 months after discharge it was 79; the determined difference was statistically significant (p<0.01. At the end of the study, 57% of all the patients could walk without assistance. Conclusion. These results suggest that disabled post stroke patients may attain significant functional improvements in response to early rehabilitation as well as to prolonged rehabilitation therapy.

  4. Gender differences in patients with acute ischemic stroke.

    Science.gov (United States)

    Caso, Valeria; Paciaroni, Maurizio; Agnelli, Giancarlo; Corea, Francesco; Ageno, Walter; Alberti, Andrea; Lanari, Alessia; Micheli, Sara; Bertolani, Luca; Venti, Michele; Palmerini, Francesco; Billeci, Antonia M R; Comi, Giancarlo; Previdi, Paolo; Silvestrelli, Giorgio

    2010-01-01

    Stroke has a greater effect on women than men owing to the fact that women have more stroke events and are less likely to recover. Age-specific stroke rates are higher in men; however, because of women's longer life expectancy and the much higher incidence of stroke at older ages, women have more stroke events than men overall. The aims of this prospective study in consecutive patients were to assess whether there are gender differences in stroke risk factors, treatment or outcome. Consecutive patients with ischemic stroke were included in this prospective study at four study centers. Disability was assessed using a modified Rankin Scale score (>or=3 indicating disabling stroke) in both genders at 90 days. Outcomes and risk factors in both genders were compared using the chi(2) test. Multiple logistic regression analysis was used to identify any independent predictors of outcome. A total of 1136 patients were included in this study; of these, 494 (46%) were female. Women were statistically older compared with men: 76.02 (+/- 12.93) and 72.68 (+/- 13.27) median years of age, respectively. At admission, females had higher NIH Stroke Scale scores compared with males (9.4 [+/- 6.94] vs 7.6 [+/- 6.28] for men; p = 0.0018). Furthermore, females tended to have more cardioembolic strokes (153 [30%] vs 147 [23%] for men; p = 0.004). Males had lacunar and atherosclerotic strokes more often (146 [29%] vs 249 [39%] for men; p = 0.002, and 68 [13%] vs 123 [19%] for men; p = 0.01, respectively). The mean modified Rankin Scale score at 3 months was also significantly different between genders, at 2.5 (+/- 2.05) for women and 2.1 (+/- 2.02) for men (p = 0.003). However, at multivariate analysis, female gender was not an indicator for negative outcome. It was concluded that female gender was not an independent factor for negative outcome. In addition, both genders demonstrated different stroke pathophysiologies. These findings should be taken into account when diagnostic workup and

  5. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    钱方媛

    2014-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke andpost-stroke depression(PSD)initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory(BDI,21-item)and DSM-Ⅳcriteria was used to diagnose post-stroke depression(PSD)at 2 weeks after stroke.

  6. Increased Risk of Ischemic Stroke in Young Nasopharyngeal Carcinoma Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ching-Chih [Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (China); Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Su, Yu-Chieh [Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Ho, Hsu-Chueh [Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Hung, Shih-Kai; Lee, Moon-Sing [Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Chiou, Wen-Yen [Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Chou, Pesus [Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (China); Huang, Yung-Sung, E-mail: enttcd@hotmail.com [Division of Neurology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China)

    2011-12-01

    Purpose: Radiation/chemoradiotherapy-induced carotid stenosis and cerebrovascular events in patients with nasopharyngeal carcinoma (NPC) can cause severe disability and even death. This study aimed to estimate the risk of ischemic stroke in this patient population over more than 10 years of follow-up. Methods and Materials: The study cohorts consisted of all patients hospitalized with a principal diagnosis of NPC (n = 1094), whereas patients hospitalized for an appendectomy during 1997 and 1998 (n = 4376) acted as the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the stroke-free survival rate between the two cohorts after adjusting for possible confounding and risk factors. Results: Of the 292 patients with ischemic strokes, 62 (5.7%) were from the NPC cohort and 230 (5.3%) were from the control group. NPC patients ages 35-54 had a 1.66 times (95% CI, 1.16-2.86; p = 0.009) higher risk of ischemic stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. There was no statistical difference in ischemic stroke risk between the NPC patients and appendectomy patients ages 55-64 years (hazard ratio = 0.87; 95% CI, 0.56-1.33; p = 0.524) after adjusting for other factors. Conclusions: Young NPC patients carry a higher risk for ischemic stroke than the general population. Besides regular examinations of carotid duplex, different irradiation strategies or using new technique of radiotherapy, such as intensity modulated radiation therapy or volumetric modulated arc therapy, should be considered in young NPC patients.

  7. Mortality and use of psychotropic medication in patients with stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Baandrup, Lone; Iversen, Helle K

    2016-01-01

    OBJECTIVES: The study sought to describe whether psychotropic medication may have long-term side effects in patients with stroke compared with controls. SETTING: Use of national register data from healthcare services were identified from the Danish National Patient Registry in Denmark. Information...... about psychotropic medication use was obtained from the Danish Register of Medicinal Product Statistics. OBJECTIVES: We aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in patients with stroke and matched controls. PARTICIPANTS: Patients...... with a diagnosis of stroke and either no drug use or preindex use of psychotropic medication (n=49,968) and compared with control subjects (n=86,100) matched on age, gender, marital status and community location. PRIMARY OUTCOME MEASURE: All-cause mortality. RESULTS: All-cause mortality was higher in patients...

  8. Mortality and use of psychotropic medication in patients with stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Baandrup, Lone; Iversen, Helle K;

    2016-01-01

    with a diagnosis of stroke and either no drug use or preindex use of psychotropic medication (n=49 968) and compared with control subjects (n=86 100) matched on age, gender, marital status and community location. PRIMARY OUTCOME MEASURE: All-cause mortality. RESULTS: All-cause mortality was higher in patients......OBJECTIVES: The study sought to describe whether psychotropic medication may have long-term side effects in patients with stroke compared with controls. SETTING: Use of national register data from healthcare services were identified from the Danish National Patient Registry in Denmark. Information...... about psychotropic medication use was obtained from the Danish Register of Medicinal Product Statistics. OBJECTIVES: We aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in patients with stroke and matched controls. PARTICIPANTS: Patients...

  9. Dabigatran in Secondary Stroke Prevention: Clinical Experience with 106 Patients

    Directory of Open Access Journals (Sweden)

    Alicia DeFelipe-Mimbrera

    2014-01-01

    Full Text Available Introduction. Our aim was to analyze our clinical experience with dabigatran etexilate in secondary stroke prevention. Methods. We retrospectively included patients starting dabigatran etexilate for secondary stroke prevention from March 2010 to December 2012. Efficacy and safety variables were registered. Results. 106 patients were included, median follow-up of 12 months (range 1–31. Fifty-six females (52.8%, mean age 76.4 (range 50–95, SD 9.8, median CHADS2 4 (range 2–6, CHA2DS2-VASc 5 (range 2–9, and HAS-BLED 2 (range 1–5. Indication for dabigatran etexilate was ischemic stroke in 101 patients and acute cerebral hemorrhage (CH due to warfarin in 5 (4.7%. Dabigatran etexilate 110 mg bid was prescribed in 71 cases (67% and 150 mg bid was prescribed in the remaining. Seventeen patients (16% suffered 20 complications during follow-up. Ischemic complications (10 were 6 transient ischemic attacks (TIA, 3 ischemic strokes, and 1 acute coronary syndrome. Hemorrhagic complications (10 were CH (1, gastrointestinal bleeding (6, mild hematuria (2, and mild metrorrhagia (1, leading to dabigatran etexilate discontinuation in 3 patients. Patients with previous CH remained uneventful. Three patients died (pneumonia, congestive heart failure, and acute cholecystitis and 9 were lost during follow-up. Conclusions. Dabigatran etexilate was safe and effective in secondary stroke prevention in clinical practice, including a small number of patients with previous history of CH.

  10. Characterizing the Mechanisms of Central and Peripheral Forms of Neurostimulation in Chronic Dysphagic Stroke Patients

    OpenAIRE

    2014-01-01

    Background Swallowing problems following stroke may result in increased risk of aspiration pneumonia, malnutrition, and dehydration. Objective/hypothesis Our hypothesis was that three neurostimulation techniques would produce beneficial effects on chronic dysphagia following stroke through a common brain mechanism that would predict behavioral response. Methods In 18 dysphagic stroke patients (mean age: 66 ± 3 years, 3 female, time-post-stroke: 63 ± 15 weeks [±SD]), pharyngeal electromyograph...

  11. Clinical characteristics of advance-aged posterior ci rculation ischemic stroke patients%高龄后循环脑梗死患者的临床特点分析

    Institute of Scientific and Technical Information of China (English)

    刘猛; 吴坚; 盛世英; 练学淦; 唐晓春; 姜晴晴; 陈利民

    2014-01-01

    目的:探讨高龄后循环脑梗死患者的发病危险因素、临床表现、影像学特点和预后。方法选择522例老年急性后循环脑梗死患者,依据年龄分为高龄组152例(≥80岁)和老年组370例(60~79岁)。比较2组患者的临床症状、影像学资料和发病危险因素,并在病后30d进行改良Rankin量表评估分析预后。结果与老年组比较,高龄组头晕和双侧肢体乏力、心房颤动比例明显升高(42.11%vs29.73%、7.89%vs3.24%、17.11%vs10.00%,P<0.05,P<0.01)。高龄组最常累积后循环血管的中段和远段。与老年组比较,高龄组枕叶单发梗死和多发梗死明显升高;预后不良比例明显升高(28.29%vs17.57%,P<0.01)。结论高龄后循环脑梗死患者在发病危险因素、临床表现以及影像学特点均与老年后循环脑梗死患者存在差异,高龄后循环脑梗死患者预后相对较差。%Objective To study the risk factors ,clinical manifestations ,radiological features and outcome of advance-aged posterior circulation ischemic stroke patients .Methods Five hundred and twenty-two posterior circulation ischemic stroke patients with their age ≥60 years were di-vided into ≥80 years old group (n=152) and 60 -79 years old group (n=370) .Their risk fac-tors ,clinical manifestations ,radiological data and outcome were compared according to the modi-fied Rankin Scale (mRS) on day 30 after onset of posterior circulation ischemic stroke .Results The incidence of dizziness ,bilateral limb weakness and atrial fibrillation was significantly higher in ≥80 years old group than in 60-79 years old group (42 .11% vs 29 .73% ,7 .89% vs 3 .24% , 17 .11% vs 10 .00% ,P<0 .05 ,P<0 .01) .The most commonly involved were the middle and distal segments of posterior circulation vessels in advance-aged posterior circulation ischemic stroke pa-tients .Occipital lobe infarction was more common and the

  12. Prevalence of cerebral microbleeds in Thai patients with ischemic stroke

    Directory of Open Access Journals (Sweden)

    Artit Potigumjon

    2017-01-01

    Full Text Available Background: With the widespread use of magnetic resonance imaging (MRI, cerebral microbleeds (CMBs are commonly detected. Ethnicity seems to play a role in the prevalence of CMB, with higher prevalence in participants from Asian origin. The purpose of the study is to look for the prevalence of CMBs and associated factors in Thai patients with ischemic stroke. Methods: Patients with acute ischemic stroke who had MRI and magnetic resonance angiography during January–August 2014 were included in the study. T2*-weighted gradient-recalled echo was used to define CMBs. Baseline characteristics, stroke subtypes, and severity of white matter lesions were compared between patients with and without CMBs. Results: Two hundred patients were included in the study. Mean age of the patients was 61-year-old. Mean National Institutes of Health Stroke Scale was 8. The prevalence of CMBs was 20% (39/200 patients. Hypertension (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.07–8.68, P = 0.037, and moderate-to-severe white matter lesions (Fazekas 2–3, OR 7.61, 95% CI 3.06–18.95, P < 0.001 were related to the presence of CMBs. Conclusions: CMBs were found in 20% of patients with ischemic stroke, which was lower than those reported from Japanese studies but comparable to a Chinese study. CMBs were associated with hypertension and severity of the white matter lesions.

  13. Prevalence of Cerebral Microbleeds in Thai Patients with Ischemic Stroke.

    Science.gov (United States)

    Potigumjon, Artit; Watcharakorn, Arvemas; Dharmasaroja, Pornpatr A

    2017-01-01

    With the widespread use of magnetic resonance imaging (MRI), cerebral microbleeds (CMBs) are commonly detected. Ethnicity seems to play a role in the prevalence of CMB, with higher prevalence in participants from Asian origin. The purpose of the study is to look for the prevalence of CMBs and associated factors in Thai patients with ischemic stroke. Patients with acute ischemic stroke who had MRI and magnetic resonance angiography during January-August 2014 were included in the study. T2*-weighted gradient-recalled echo was used to define CMBs. Baseline characteristics, stroke subtypes, and severity of white matter lesions were compared between patients with and without CMBs. Two hundred patients were included in the study. Mean age of the patients was 61-year-old. Mean National Institutes of Health Stroke Scale was 8. The prevalence of CMBs was 20% (39/200 patients). Hypertension (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.07-8.68, P = 0.037), and moderate-to-severe white matter lesions (Fazekas 2-3, OR 7.61, 95% CI 3.06-18.95, P CMBs. CMBs were found in 20% of patients with ischemic stroke, which was lower than those reported from Japanese studies but comparable to a Chinese study. CMBs were associated with hypertension and severity of the white matter lesions.

  14. Management of a post-stroke patient

    Directory of Open Access Journals (Sweden)

    Vladimir Anatolyevich Parfenov

    2013-01-01

    Full Text Available The management of a post-stroke patient represents is a challenge to modern neurology. Complete recovery of all functions requires only recurrent stroke prevention. If the patient continues to have motor, speech, and/or other disorders that are promising to recover function, there is a need for rehabilitation. Patient care and prevention of recurrent stroke and akinesia-associated complications are required if there are no promises for functional recovery. The paper describes the current methods for the prevention of recurrent stroke, which include lifestyle modification, blood pressure normalization, and the use of surgical procedures (in some patients, antithrombotic agents, and statins (after ischemic stroke. It analyzes the possibilities and methods of treatment in lost motor and speech functions, neuropsychic (cognitive and depressive disorders, and urination disorders. It is noted that the application of current treatment options makes it possible to substantially reduce the risk of recurrent stroke and to improve recovery of lost functions and quality of life in the patient.

  15. Hypercapnic evaluation of vascular reactivity in healthy aging and acute stroke via functional MRI

    Directory of Open Access Journals (Sweden)

    Ryan V. Raut

    2016-01-01

    Full Text Available Functional MRI (fMRI is well-established for the study of brain function in healthy populations, although its clinical application has proven more challenging. Specifically, cerebrovascular reactivity (CVR, which allows the assessment of the vascular response that serves as the basis for fMRI, has been shown to be reduced in healthy aging as well as in a range of diseases, including chronic stroke. However, the timing of when this occurs relative to the stroke event is unclear. We used a breath-hold fMRI task to evaluate CVR across gray matter in a group of acute stroke patients (<10 days from stroke; N = 22 to address this question. These estimates were compared with those from both age-matched (N = 22 and younger (N = 22 healthy controls. As expected, young controls had the greatest mean CVR, as indicated by magnitude and extent of fMRI activation; however, stroke patients did not differ from age-matched controls. Moreover, the ipsilesional and contralesional hemispheres of stroke patients did not differ with respect to any of these measures. These findings suggest that fMRI remains a valid tool within the first few days of a stroke, particularly for group fMRI studies in which findings are compared with healthy subjects of similar age. However, given the relatively high variability in CVR observed in our stroke sample, caution is warranted when interpreting fMRI data from individual patients or a small cohort. We conclude that a breath-hold task can be a useful addition to functional imaging protocols for stroke patients.

  16. Highly sensitive troponin T in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, J K; Ueland, T; Aukrust, P;

    2012-01-01

    in decedents than in survivors. After adjustment for stroke severity, C-reactive protein, age, NT-proBNP and prior heart and/or renal failure, hsTnT levels were not a significant predictor of long-term all-cause or cardiovascular mortality. Conclusion: Elevated levels of hsTnT are frequently present......Background: Newly developed troponin assays have superior diagnostic and prognostic performance in acute coronary syndrome (ACS), when compared to conventional troponin assays; however, highly sensitive troponin has not been evaluated in patients with acute ischemic stroke. Methods: Highly...... sensitive troponin T (hsTnT) was measured daily during the first 4 days in 193 consecutive patients with acute ischemic stroke without overt ACS or atrial fibrillation. The patients were previously tested normal with a fourth-generation TnT assay. The patients were followed for 47 months, with all...

  17. Etiologic Subtypes, Risk Factors, and Outcomes of Acute Ischemic Stroke in Young Patients

    Directory of Open Access Journals (Sweden)

    İnci Şule Özer

    2015-04-01

    Full Text Available Objective: Stroke in people aged less than 45 years is less frequent than in older patients, but has major impacts on both the individual and society. The aim of this study was to determine the etiologic subtypes of acute ischemic stroke in the young. Materials and Methods: We reviewed the hospital records of 619 patients who were admitted with acute ischemic stroke between January 2011 and November 2014. Acute ischemic stroke in the young was defined as patients aged 45 years and under. Demographic data, the National Institutes of Health Stroke Scale (NIHSS scores at admission and detailed investigations aimed at determining etiologic cause were recorded. Etiologic stroke subtypes were determined using the automated Causative Classification System. Modified Rankin Scale (mRS scores were recorded in the follow-up. Results: There were 32 (5.2% young patients with acute ischemic stroke. The rates of hypertension, diabetes mellitus, atrial fibrillation, and coronary artery disease were significantly lower in young patients compared with patients aged more than 45 years (p<0.05. The mean NIHSS score at admission and hospital mortality was significantly lower in patients aged 45 years and under compared with those older than 45 years (p=0.006, p=0.043. Cardioaortic embolism was the most common etiologic stroke subtype in both groups. Other causes were significantly more frequent in the young acute ischemic stroke group compared with the older patients. The median follow-up mRS was significantly lower in patients aged 45 years and under compared with those older than 45 years (p<0.001. Conclusion: Young patients with ischemic stroke have different risk factors, stroke etiology, stroke severity and prognosis compared with patients older than 45 years with the same condition

  18. Clinical Outcomes of Intravenous rt-PA Thrombolysis Therapy for Advance-Aged Patients with Acute Ischemic Stroke: A Multi-Center Clinical Study

    Directory of Open Access Journals (Sweden)

    Ling-feng LAI

    2015-09-01

    Full Text Available Background: Intravenous recombinant tissue plasminogen activator (rt-PA thrombolysis therapy has been regarded as a promising therapeutic measure for acute ischemic stroke (AIS. But its effectiveness and safety are unclear because of the lack of large, long-term, prospective and multi-center clinical studies in China. Objective: This study was to explore the efficacy of the therapy, and hypothesize some baseline clinical variables that might affect clinical outcomes.Methods: All patients with AIS were treated by intravenous rt-PA thrombolysis within 4.5 h from stroke onset. The clinical records and laboratory data of pre- and post-treatment were statistically analyzed to testify the efficacy and safety of this treatment and to find out the independent prognostic factors.Results: A total of 1 067 patients were selected in this study and divided into group A (<80 years old, n=769 and group B (≥80 years old, n=298. A favorable outcome was observed in 261 patients in group A and 81 patients in group B, respectively. A total of 6 factors were identified as independent prognostic factors for intravenous rt-PA thrombolysis therapy.Conclusion: rt-PA thrombolysis therapy is effective in treating AIS patients, but there are multiple risk factors that affect prognosis.

  19. MEMORY SONGS DECREASE DEPRESSION FOR STROKE PATIENTS

    Directory of Open Access Journals (Sweden)

    Harmayetty Harmayetty

    2017-07-01

    Full Text Available Introduction: Biological, physical and phsycosocial changes in stroke patient could be a stressor that induced a depression state. There would be an emotional disturbance in stroke patient and stroke attack would be recurrent, if it was not treated. One of the alternative techniques to reduce depression is musical therapy especially memory songs. Method: This study was used a quasy experimental pre-post test purposive sampling design. The population was stroke patients who treated in Neurological Ward A and Stroke Unit Dr Soetomo Hospital Surabaya. There were 12 respondents divided into 6 respondents for treatment group and 6 respondents for control group. The independent variable was music (memory song and dependent variable was depression. Data were collected by using questionnaire which adapted from Hamilton Depression Rating Scale and Geriatric Depression Rating Scale, then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that there was a difference between pre test and post test in depression (p=0.0196 and there was a difference in the depression between treatment group and control group (p=0.002. Discussion: It can be concluded that music (memory songs has an effect to the depression of stroke patient. Further studies are needed to concerning other factors that may affect the relaxation technique especially in listening music.

  20. Malnutrition in Patients with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Stella D. Bouziana

    2011-01-01

    Full Text Available Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding.

  1. Malnutrition in Patients with Acute Stroke

    Science.gov (United States)

    Bouziana, Stella D.; Tziomalos, Konstantinos

    2011-01-01

    Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding. PMID:22254136

  2. Comparison of the reaction time of wrist flexion and extension between patients with stroke and age-matched healthy subjects and correlation with clinical measures

    Institute of Scientific and Technical Information of China (English)

    BI Sheng; WAN Chun-xiao

    2013-01-01

    Background Brain injury had an effect on reaction time (RT) and brain-injured patients were normally significantly slower than normal controls.The RT of the paretic upper limb (UL) in patients with stroke was slower than in a control group.The present study was designed to compare the RTs of the unaffected and affected sides in stroke survivors and those of normal subjects.This study also explores the relationships among wrist flexion and extension RTs in the affected side and the motor deficits of the UL as measured by clinical Composite Spasticity Index (CSI),Associated Reaction Rating Score (ARRS),and Wolf Motor Function Test (WMFT) scores.Methods Ninety-eight hemiparetic stroke survivors and 20 normal subjects participated in the study.Abnormal muscle tone was measured by CSI.Associated reaction was measured by ARRS.Motor function was measured by WMFT.The subject was asked to flex or extend the affected and non-affected wrists as fast as possible,following an auditory "go"signal.An electrogoniometer attached to the wrist measured wrist flexion and extension angle.RT was defined as the time from the "go" signal to a change in wrist angle denoting movement onset.Clinical assessments and RT were conducted within one day.Differences in the variables between normal subjects and the unaffected sides of the stroke patients were analyzed using analysis of variance.Correlations were assessed by computing Spearman's correlation coefficient.The significance level was set at 5%.Results RTs of wrist flexion and extension in the stroke survivors' affected hands were significantly longer than those in normal subjects and their unaffected hands (P <0.01 for both).The wrist flexion RT moderately correlated with CSI (ρ=0.412,P <0.001) and ARRS (ρ=0.341,P <0.001) and with WMFT functional ability (negatively; ρ=-0.531,P <0.001)and time score (p=0.504,P <0.001).Similarly,the wrist extension RT moderately correlated with CSI (ρ=0.429,P <0.001),ARRS (ρ=0.374,P <0

  3. Long-term outcome in children of patients after stroke

    NARCIS (Netherlands)

    van de Port, Ingrid G. L.; Visser-Meily, Anne M. A.; Post, Marcel W. M.; Lindeman, Eline

    2007-01-01

    Objective: To investigate the long-term effects on children of parental stroke, with respect to care-giving tasks, children's behavioural problems and stress, and to study the relationship between stress and child, patient and partner characteristics. Subjects: A total of 44 children (age range 10-2

  4. Long-term outcome in children of patients after stroke

    NARCIS (Netherlands)

    van de Port, Ingrid G. L.; Visser-Meily, Anne M. A.; Post, Marcel W. M.; Lindeman, Eline

    2007-01-01

    Objective: To investigate the long-term effects on children of parental stroke, with respect to care-giving tasks, children's behavioural problems and stress, and to study the relationship between stress and child, patient and partner characteristics. Subjects: A total of 44 children (age range 10-2

  5. Obstructive sleep apnea in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aliye Tosun

    2008-01-01

    Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.

  6. Decreased contribution from afferent feedback to the soleus muscle during walking in patients with spastic stroke

    DEFF Research Database (Denmark)

    Mazzaro, Nazarena; Nielsen, Jørgen Feldbæk; Grey, Michael James

    2007-01-01

    We investigated the contribution of afferent feedback to the soleus (SOL) muscle activity during the stance phase of walking in patients with spastic stroke. A total of 24 patients with hemiparetic spastic stroke and age-matched healthy volunteers participated in the study. A robotic actuator...... by the Ashworth score. These results indicate that although the stretch reflex response is facilitated during spastic gait, the contribution of afferent feedback to the ongoing locomotor SOL activity is depressed in patients with spastic stroke....

  7. Telerehabilitation for stroke patients: an overview of reviews

    DEFF Research Database (Denmark)

    Turolla, Andrea; Larsen, Torben

    2012-01-01

    Home Care (IHC) we performed an overview of reviews on the telefacilites for the homecare in stroke patients, in order to plan a clinical trial. A broad literature research was conducted in PUBMED, Web of Science® and The Cochrane Library databases. We included and graded all the reviews matching...... the following criteria: published in English in peer-reviewed journals, targeting stroke as adult patients (age>18yr.) and considering a homecare setting in the intervention. 6 full-text reviews were included: 1 systematic review with meta-analysis and 5 non-systematic reviews. Despite the absence of adverse...

  8. Functional disability of ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Theodore Kapadohos

    2010-04-01

    Full Text Available Stroke is the third leading cause of death and the first cause of disability, in the developed countries and it is frequently described by the literature as a major global health problem. It is estimated that stroke is responsible for approximately 4.5 million deaths per year and over 9 million stroke survivors, globally. Aim: The aim of the present study was to review the literature about the consequences of functional disability that stroke imposes on the survivors’ life and to shortly describe functional instruments used in evaluation of stroke patients.The method οf this study included bibliography research from both the review and the research literature, mainly in the pub med data base which referred to the functional disability of stroke patients, as well as to the scales used for the evaluation of functional state. Results: Despite the accurate diagnosis and the recent therapeutic advances, stroke can still cause long-term disability in the majority of patients which induces significant changes between the patient and his environment. The results of recent studies indicate that the loss of independence that experience stroke survivals has significant consequences on their quality of life and it is likely to lead to family-crisis and social isolation. It is also widely accepted that the economic impact of stroke is considerable, worldwide. Recovery of functional disability after stroke is influenced by many variables, of which the main are the initial severity of stroke, the level of deficit and the level of social and family support. Ιn clinical practise many measurement instruments are applied and capable of providing assessments of functional ability and other related concepts since it is well documented that evaluation of functional state is a matter of great importance for the assessment of patients’ outcome. Conclusions: As it is supported by published evidence, rehabilitation of neurological deficit in conjunction with

  9. Current perspectives on cardioembolic ischemic stroke in very old patients

    Directory of Open Access Journals (Sweden)

    Arboix A

    2014-12-01

    Full Text Available Adrià Arboix,1 Joan Massons,1 Josefina Alió2 1Division of Cerebrovascular Diseases, Department of Neurology, Hospital Universitari del Sagrat Cor, University of Barcelona, 2Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain Abstract: The oldest old population (>85 years of age represents the faster growing segment of the elderly in developed countries. Cardioembolic infarction (CI accounts for 14%–30% of all cerebral infarcts and is the most severe ischemic stroke subtype with the highest in-hospital mortality. Also, CI is associated with a low frequency of symptom-free patients at hospital discharge and presents a non-negligible risk of early embolic recurrence. Moreover, cardioembolic stroke is the acute cerebrovascular event most commonly found in very old subjects. However, some clinical aspects of the natural course of the disease in very old patients are still poorly defined. The present report presents an updated review of relevant aspects of CI related to clinical manifestations, biological characteristics, prognostic implications, and treatment strategies, which may contribute to improving the quality of care and outcome of acute cardioembolic stroke in very old patients. The most relevant aspects of CI are discussed based on the data published in the literature and the authors' experience in the management of stroke patients, collected from the hospital-based "Sagrat Cor Hospital of Barcelona Stroke Registry". The following aspects are commented on: epidemiologic data and risk factors, clinical characteristics, cardiac workup studies, special cardioembolic clinical features, outcome, thrombolytic therapy, antithrombotic treatment, and indications for future research lines. Cardioembolic stroke is an important topic in the frontier between cardiology and vascular neurology. The impact of CI on the patients' health and quality of life, health care systems, and society

  10. Patient management in the recovery period of stroke

    Directory of Open Access Journals (Sweden)

    O. V. Kosivtsova

    2014-01-01

    Full Text Available Stroke heads the list of all causes of disability in middle-aged and elderly people. In recent years, there have been about 30% of morbid events among able-bodied persons (less than 65 years of age. The major post-stroke incapacitating disorders are motor and speech defects, cognitive and psychoemotional disorders, and pelvic organ dysfunctions. The patients’ quality of life largely depends on the degree of recovery of lost functions. In turn, the degree of their recovery depends on the start, proportioning, and continuity of initiated rehabilitation measures and on whether the patient has cognitive, speech, and psychoemotional problems and pelvic organ dysfunctions. Unfortunately, after discharge from a specialized unit, only a small number of post-stroke patients are admitted to specialized rehabilitation centers. The responsibility of caring forthese patients rests with their relatives and outpatient physicians.The main tasks in the early and late recovery periods following stroke are, in addition to the prevention of recurrent stroke, the implementation of rehabilitation programs to correct motor and speech disorders and cognitive impairments, the stabilization of emotions, and the provision of proper and qualitative general care for patients with severe motor defects and pelvic organ dysfunctions. The paper considers the main principles of patient management in the early and late post-stroke recovery periods. The authors give rehabilitation recommendations and main errors in routine practice (their relatives and junior medical staff have no speech contact with patients having speech disorders; psychoemotional disorders are underestimated and uncorrected; proper general care for patients with pelvic organ dysfunctions is absent.

  11. Five-Year Outcome in Stroke Patients Submitted to Thrombolysis.

    Science.gov (United States)

    Machado, Célia; Pinho, João; Alves, José Nuno; Santos, Ana Filipa; Ferreira, Maria do Céu; Abreu, Maria João; Oliveira, Liliana; Mota, João; Fontes, João Ramalho; Ferreira, Carla

    2015-08-01

    Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT). Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1. Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5-43.3) and mortality was 43.9% (95%CI=36.1-51.7). Increasing age (odds ratio =0.93, 95% CI =0.90-0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74-0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03-1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12-0.66) were independently associated with mortality during follow-up. One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome. © 2015 American Heart Association, Inc.

  12. School-Aged Outcomes After Neonatal Arterial Ischemic Stroke

    OpenAIRE

    Theresa Czech; Pardo, Andrea C.

    2016-01-01

    Investigators from the Accident Vasculaire Cérébral de nouveau-né (AVCnn) Study Group, a multicenter registry in France, examined outcomes at 7 years of age in children previously identified with neonatal arterial ischemic stroke (NAIS).

  13. School-Aged Outcomes After Neonatal Arterial Ischemic Stroke.

    Science.gov (United States)

    Czech, Theresa; Pardo, Andrea C

    2016-02-01

    Investigators from the Accident Vasculaire Cérébral de nouveau-né (AVCnn) Study Group, a multicenter registry in France, examined outcomes at 7 years of age in children previously identified with neonatal arterial ischemic stroke (NAIS).

  14. Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.

    Directory of Open Access Journals (Sweden)

    Kui-Kai Lau

    Full Text Available BACKGROUND AND PURPOSE: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. METHODS: This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. RESULTS: Amongst 1,105 patients, 58 patients (5.2% had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year, substantially more than those without cancer (21%, 4.65%/year (p<0.01. In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR of 2.42 (95% confidence interval (CI: 1.54-3.80, 1.01 (1.00-1.03 and 1.35 (1.01-1.82 respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08. In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02, age (HR: 1.04, 95% CI 1.02-1.06, heart failure (HR: 3.06, 95% CI 1.72-5.47 and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36 were independent predictors for cardiovascular mortality. CONCLUSIONS: Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.

  15. Characteristics of Balance Impairment in Aged Stroke Patients%老年脑卒中患者平衡功能障碍特征分析

    Institute of Scientific and Technical Information of China (English)

    宋桂芸; 张璞; 杨明

    2011-01-01

    Objective To analyze the characteristics of balance impairment in stroke patients over 60 years old. Methods This was a retrospective case-control study. Subjects were divided into two groups, normal control group and stroke group. Tetrax Interactive Balance System was used to examine stability index (ST), weight distribution percentages, weight distribution index (WDI), fall index (FI), synchronizations and spectrum analysis of postural sway under the condition of standing still with eyes open respectively in both groups. Results Frequencies of spectrum analysis of postural sway in the stroke group were significantly higher than that in normal control group (P<0.05) except the low frequencies. The weight distribution percentages of unaffected foot and WDI of the stroke group were significantly higher than the normal control group (P<0.05). ST and synchronizations in the stroke group were worse than the normal control group (P<0.05). In the stroke group, correlations were found between FI and ST, FI and spectrun analysis of postural sway (except the low frequencies), as well as between FI and synchronizations (P<0.05). Conclusion Stability index, weight distribution percentages, weight distribution index, synchronizations and spectrum analysis of postural sway are significantly abnormal in the elderly stroke patients with balance impairment. And their fall index was found to be correlated to a variety of factors.%目的 分析老年脑卒中患者平衡功能损害的特征.方法 回顾性对照研究.分为患者组和正常对照组.采用Tetrax平衡仪分别检测两组睁眼站立状态下的一般稳定性、体重分布及体重分布指数、跌倒风险指数、同步性及姿势摆动频谱分析.结果 患者组除低频段外,其余频段姿势摆动强度均高于对照组(P<0.05);患者组健侧足跟和足趾部位的体重百分比及体重分布指数均高于对照组(P<0.05);患者组稳定性、"四点"同步

  16. Acupuncture therapy for stroke patients.

    Science.gov (United States)

    Li, Xin; Wang, Qiang

    2013-01-01

    Acupuncture is one of the most important parts of Traditional Chinese Medicine, has been used for more than 3000 years as prevention and treatment for various diseases in China as well as in adjacent regions, and is widely accepted in western countries in recent years. More and more clinical trials revealed that acupuncture shows positive effect in stroke, not only as a complementary and alternative medicine for poststroke rehabilitation but also as a preventive strategy which could induce cerebral ischemic tolerance, especially when combined with modern electrotherapy. Acupuncture has some unique characteristics, which include acupoint specificity and parameter-dependent effect. It also involves complicated mechanism to exert the beneficial effect on stroke. Series of clinical trials have shown that acupuncture primarily regulates the release of neurochemicals, hemorheology, cerebral microcirculation, metabolism, neuronal activity, and the function of specific brain region. Animal studies showed that the effects of acupuncture therapy on stroke were possibly via inhibition of postischemic inflammatory reaction, stimulation of neurogenesis and angiogenesis, and influence on neural plasticity. Mechanisms for its preconditioning effect include activity enhancement of antioxidant, regulation of the endocannabinoid system, and inhibition of apoptosis. Although being controversial, acupuncture is a promising preventive and treatment strategy for stroke, but further high-quality clinical trials would be needed to provide more confirmative evidence.

  17. Community stroke rehabilitation helps patients return to work.

    Science.gov (United States)

    Pearn, John; O'Connor, Rory J

    2013-09-01

    Around 150,000 people experience a stroke every year in the UK. Nearly one million people in England are living with the effects of a stroke; one third of whom are moderately to severely disabled. A quarter of stroke survivors are under the age of 65 meaning that many are in work and/or have responsibility for caring for children or elderly parents. With a comprehensive rehabilitation team, patients with more complex or severe disability can be rehabilitated in the community providing that the home environment can be suitably adapted. All patients will require regular review by their own doctor and some of these reviews will focus on standardised assessments of risk factors for stroke and implementation of appropriate secondary prevention. The GP has a role in identifying the emotional impact of stroke on the patient and the impact that the stroke has on relatives and carers. The core components of the community-based programme can be broadly defined as improving emotional wellbeing, communication, cognitive function and physical independence and supporting return to work. Antidepressants are effective in reducing emotional lability. Cognitive functions such as memory, attention, perception and planning are often affected by stroke. Assessment and treatment by the occupational therapy team and clinical psychologist can reduce the impact of these impairments. Speech and language therapy is instrumental in facilitating recovery as is training carers in supportive communication and providing aphasia-friendly information. NICE recommends that patients receive 45 minutes of each relevant therapy five times a week. Each therapy needs to be provided at an intensity that will produce a functional change. Most patients will be able to drive again if there is no significant visual field loss or uncontrolled epilepsy. Graded return to work programmes are more successful as people are gradually accustomed to the workplace.

  18. A Research on Factors Influencing the Clinical Prognosis of Acute Stroke Patie.patients

    Institute of Scientific and Technical Information of China (English)

    Luo Zuming; Li Manli

    2000-01-01

    Object: To search for the factors significantly influencing the clinical prognosis of acute stroke patients. Background: There are lack of prospective multivariate analysis research m acute stroke in the world. Method: We chose 17 factors possibly influencing the prognosis of acute patients, took Barthel′s Index at the end of 2 months after stroke onset and decreased percentage of neurological deficit scores (MESSS) between 72h after hospitalization and 2 months after onset as gold standard, to have a prospective, multivariate analysis research combined with univariate analysis. Results: Multivariate analysis of 106 acute stroke patients combined with univariate analysis showed the factors significantly influencing the clinical prognosis of acute stroke patients were: initial MESSS score、 age、 complication、 mass effect、 stroke location、 time of delay before emergency arrival (BDT). Time of delay after emergency arrival was not found to be a significant prognostic factor. Discussion: Barthel Index at the end of 1 month after stroke onset was strongly related to that at the end of 2 month after onset, as was the same with MESSS score. It showed there was no significant difference between 1 month and 2 months after stroke onset when we choose time interval in evaluating prognosis of acute stroke patients.Conclusion: BDT、 initial MESSS score、 age、 stroke location、 mass effect、 complication were important factors of acute stroke patients. Avoid the delay before emergency arrival after onset, prevent and treat complications after stroke, more carefully treat acute stroke patients with advanced age, advanced age, high initial MESSS scores and those with mass effect reported by CT, we can improve the outcome of stroke patients.

  19. ANALYSIS OF RISK FACTORS IN 3901 PATIENTS WITH STROKE

    Institute of Scientific and Technical Information of China (English)

    Xin-Feng Liu; Guy van Melle; Julien Bogousslavsky

    2005-01-01

    Objective To estimate the frequency of various risk factors for overall stroke and to identify risk factors for cerebral infarction (CI) versus intracerebral hemorrhage (ICH) in a large hospital-based stroke registry.Methods Data from a total of 3901 patients, consisting of 3525 patients with CI and 376 patients with ICH were prospectively coded and entered into a computerized data bank.Results Hypertension and smoking were the most prominent factors affecting overall stroke followed by mild internal carotid artery stenosis (< 50%), hypercholesterolemia, transient ischemic attacks (TIAs), diabetes mellitus, and cardiac ischemia. Univariate analysis showed that factors in male significantly associated with CI versus ICH were old age, a family history of stroke, and intermittent claudication; whereas in female the factors were oral contraception and migraine. By multivariate analysis, in all patients, the factors significantly associated with CI as opposed to ICH were smoking, hypercholesterolemia, migraine, TIAs, atrial fibrillation, structural heart disease, and arterial disease. Hypertension was the only significant factor related with ICH versus CI.Conclusions The factors for ischemic and hemorrhagic stroke are not exactly the same. Cardiac and arterial disease are the most powerful factors associated with CI rather than ICH.

  20. Age and gender as predictors of allied health quality stroke care

    Directory of Open Access Journals (Sweden)

    Luker JA

    2011-07-01

    Full Text Available Julie A Luker1, Julie Bernhardt2, Karen A Grimmer-Somers11International Centre for Allied Health Evidence, University of South Australia Adelaide, South Australia, Australia; 2School of Physiotherapy, La Trobe University Melbourne, Victoria, Australia and Stroke Division, Florey Neurosciences Institutes Heidelberg Heights, Melbourne, Victoria, AustraliaBackground: Improvement in acute stroke care requires the identification of variables which may influence care quality. The nature and impact of demographic and stroke-related variables on care quality provided by allied health (AH professionals is unknown.Aims: Our research explores the association of age and gender on an index of acute stroke care quality provided by AH professionals.Methods: A retrospective clinical audit of 300 acute stroke patients extracted data on AH care, patients' age and gender. AH care quality was determined by the summed compliance with 20 predetermined process indicators. Our analysis explored relationships between this index of quality, age, and gender. Age was considered in different ways (as a continuous variable, and in different categories. It was correlated with care quality, using gender-specific linear and logistic regression models. Gender was then considered as a confounder in an overall model.Results: No significant association was found for any treatment of age and the index of AH care quality. There were no differences in gender-specific models, and gender did not significantly adjust the age association with care quality.Conclusion: Age and gender were not predictors of the quality of care provided to acute stroke patients by AH professionals.Keywords: acute stroke, allied health, quality of care, age, gender

  1. Comparison of Provision of Stroke Care in Younger and Older Patients: Findings from the South London Stroke Register

    Science.gov (United States)

    Crichton, Siobhan L.; Wolfe, Charles D. A.; Rudd, Anthony G.; McKevitt, Christopher

    2012-01-01

    Background. Evidence-based stroke care should be available to all patients. However, evidence exists of inequalities according to age. This study compared access to care for younger adults to that for over 65s. Methods. Using population-based data from 4229 patients with first-ever stroke between 1995 and 2010, associations between age and 21 care indicators were investigated using multivariable logistic regression. Results. Age was not associated with stroke unit admission for ischaemic stroke (P = 0.666). Younger PICH patients were least likely to be admitted to stroke units (P = 0.001), instead treated on neurosurgical or ICU wards. Younger age was also associated with admission to neurosurgery or ICU after SAH (P = 0.006), increased occupational or physiotherapy at 1 year (P = 0.043), and contact with a GP 3 months after stroke (P < 0.001). Conclusion. Younger patients have equal or greater access to evidence-based care. However, there is a need to ensure that services meet the needs of this group. PMID:22593833

  2. Comparison of Provision of Stroke Care in Younger and Older Patients: Findings from the South London Stroke Register

    Directory of Open Access Journals (Sweden)

    Siobhan L. Crichton

    2012-01-01

    Full Text Available Background. Evidence-based stroke care should be available to all patients. However, evidence exists of inequalities according to age. This study compared access to care for younger adults to that for over 65s. Methods. Using population-based data from 4229 patients with first-ever stroke between 1995 and 2010, associations between age and 21 care indicators were investigated using multivariable logistic regression. Results. Age was not associated with stroke unit admission for ischaemic stroke (P=0.666. Younger PICH patients were least likely to be admitted to stroke units (P=0.001, instead treated on neurosurgical or ICU wards. Younger age was also associated with admission to neurosurgery or ICU after SAH (P=0.006, increased occupational or physiotherapy at 1 year (P=0.043, and contact with a GP 3 months after stroke (P<0.001. Conclusion. Younger patients have equal or greater access to evidence-based care. However, there is a need to ensure that services meet the needs of this group.

  3. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Jørgensen, H S; Reith, J;

    2004-01-01

    old had hypertension (25% versus 34%, P = 0.02) and diabetes (14% versus 22%, P = 0.01). In adjusted multiple regression models, very old age predicted short-term mortality (OR 2.5; 95% CI 1.5-4.2), and discharge to nursing home or in-hospital mortality (OR 2.7; 95% CI 1.7-4.4). Five years after...... stroke onset. By way of multiple logistic regression and survival analyses very old age was independently related to short- and long-term mortality and nursing home placement independent of other clinical characteristics. RESULTS: 16% of patients were 85 years or older at the time of stroke onset. More...... stroke very old age predicted mortality or nursing home placement (OR 3.9; 95% CI 2.1-7.3), and long-term mortality (HR 2.0; 95% CI 1.6-2.5). However, other factors such as onset stroke severity, pre-existing disability and atrial fibrillation were also significant independent predictors of prognosis...

  4. The impact evaluation of physical therapy on the quality of life of cerebrovascular stroke patients.

    Science.gov (United States)

    Paula Caleffi Segura, Ana; Veloso Fontes, Sissy; Maiumi Fukujima, Marcia; de Andrade Matas, Sandro Luiz

    2006-09-01

    This study aimed to evaluate the impact of physical therapy on the quality of life of patients presenting with a motor deficit caused by ischemic stroke at the median cerebral artery. Physical therapeutic intervention consisted of three sessions per week of conventional kinesiotherapy; 50 min each, for three consecutive months. The sample comprised 18 patients aged between 18 and 72 years old, evaluated according to the Stroke Impact Scale. There was a significant difference for the following domains: strength (P stroke.

  5. Clues to occult cancer in patients with ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Suk Jae Kim

    Full Text Available BACKGROUND: We hypothesized that hidden malignancy could be detected in patients with cryptogenic stroke without active cancer when they showed the distinctive characteristics of cancer-related stroke. METHODS AND FINDINGS: Among 2,562 consecutive patients with acute ischemic stroke, patients with cryptogenic stroke were analyzed and categorized into two groups according to the presence of active cancer: cryptogenic stroke with active cancer (cancer-related stroke, CA-stroke group and without active cancer (CR-stroke group. Patients with active lung cancer without stroke were also recruited for comparison purposes (CA-control. Clinical factors, lesion patterns on diffusion-weighted MRI (DWI, and laboratory findings were analyzed among groups. A total of 348 patients with cryptogenic stroke were enrolled in this study. Among them, 71 (20.4% patients had active cancer at the time of stroke. The D-dimer levels were significantly higher in patients with CA-stroke than those with CR-stroke or CA-control (both p<0.001. Regarding lesion patterns, patients with CA-stroke mostly had multiple lesions in multiple vascular territories, while more than 80% of patients with CR-stroke had single/multiple lesions in a single vascular territory (P<0.001. D-dimer levels (OR 1.11 per 1 µg/mL increase; 95% CI 1.06-1.15; P<0.001 and DWI lesion patterns (OR 7.13; 95% CI 3.42-14.87; P<0.001 were independently associated with CA-stroke. Workup for hidden malignancy was performed during hospitalization in 10 patients who showed elevated D-dimer levels and multiple infarcts involving multiple vascular territories but had no known cancer, and it revealed hidden malignancies in all the patients. CONCLUSION: Patients with CA-stroke have distinctive D-dimer levels and lesion patterns. These characteristics can serve as clues to occult cancer in patients with cryptogenic stroke.

  6. Age, subjective stress, and depression after ischemic stroke.

    Science.gov (United States)

    McCarthy, Michael J; Sucharew, Heidi J; Alwell, Kathleen; Moomaw, Charles J; Woo, Daniel; Flaherty, Matthew L; Khatri, Pooja; Ferioli, Simona; Adeoye, Opeolu; Kleindorfer, Dawn O; Kissela, Brett M

    2016-02-01

    The incidence of stroke among younger adults in the United States is increasing. Few studies have investigated the prevalence of depressive symptoms after stroke among different age groups or the extent to which subjective stress at the time of stroke interacts with age to contribute to post-stroke depression. The present study examined whether there exists an age gradient in survivors' level of depressive symptoms and explored the extent to which financial, family, and health-related stress may also impact on depression. Bivariate analyses (N = 322) indicated significant differences in depression and stress by age group, as well as differences in age and stress by 3-month depression status. Linear regression analyses indicated that survivors between the ages of 25-54 and 55-64 years old had, on average, significantly higher depressive symptom scores. Those with financial, family, and health-related stress at the time of stroke, irrespective of age, also had significantly higher scores.

  7. Aortic atheromas in acute ischemic stroke patients in northern Israel.

    Science.gov (United States)

    Telman, Gregory; Kouperberg, Efim; Sprecher, Elliot; Agmon, Yoram

    2012-01-01

    There are currently no data on ethnic differences in aortic atherosclerosis in Arab and Jewish patients from northern Israel with acute ischemic stroke. Data on demographic and risk factors alongside transesophageal echocardiography (TEE) data and treatment details for 509 patients with acute ischemic stroke were included in the study. The patients with aortic atheromas were older and had significantly more frequent vascular risk factors (hypertension, hyperlipidemia, and smoking), as well as vascular disease (ischemic heart disease, peripheral vascular disease, and carotid plaques). They were also treated with statins more often than those without aortic atheroma. Logistic regression analysis showed that age, smoking, ethnicity, and the presence of carotid plaques were independent predictors for aortic atheromas. Aortic plaques were found more frequently in Jewish patients than Arab patients (160 (41.9%) vs. 35 (27.3%); p= 0.003). This finding did not change after adjustment for age, sex, all vascular risk factors, and type of antithrombotic treatment. We did not find any difference between Arab and Jewish patients in the distribution of plaques by location or complexity before and after adjustment for age, sex, all vascular risk factors, or type of antithrombotic or lipid-lowering treatment. Our findings emphasize the influence of ethnicity on the prevalence of aortic atheromas in acute ischemic stroke patients in northern Israel. The search for genetic, cultural, socioeconomic, and other factors explaining these ethnic differences should be the topic of future studies.

  8. Is Barthel index a relevant measure for measuring prevalence of urinary incontinence in stroke patients?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Dehlendorff, Christian

    2012-01-01

    To compare the prevalence of urinary incontinence (UI) measured by Barthel Index and the Danish Prostate Symptom Score (DAN‐PSS‐1) questionnaire in stroke patients. A cross‐sectional, hospital based survey was initiated whereby 407 stroke patients, average age 67 (SD 12) years with a mean interval...

  9. Trends in in-hospital mortality among patients with stroke in China.

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    Qian He

    Full Text Available BACKGROUND: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. METHODS: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. RESULTS: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001. The percentage of severe patients increased while odds of mortality (2010 versus 2007 decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987, intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708, and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649. In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. CONCLUSIONS: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

  10. Attenuated inflammatory response in aged mice brains following stroke.

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    Matthias W Sieber

    Full Text Available BACKGROUND: Increased age is a major risk factor for stroke incidence, post-ischemic mortality, and severe and long-term disability. Stroke outcome is considerably influenced by post-ischemic mechanisms. We hypothesized that the inflammatory response following an ischemic injury is altered in aged organisms. METHODS AND RESULTS: To that end, we analyzed the expression pattern of pro-inflammatory cytokines (TNF, IL-1α, IL-1β, IL-6, anti-inflammatory cytokines (IL-10, TGFβ1, and chemokines (Mip-1α, MCP-1, RANTES of adult (2 months and aged (24 months mice brains at different reperfusion times (6 h, 12 h, 24 h, 2 d, 7 d following transient occlusion of the middle cerebral artery. The infarct size was assessed to monitor possible consequences of an altered inflammatory response in aged mice. Our data revealed an increased neuro-inflammation with age. Above all, we found profound age-related alterations in the reaction to stroke. The response of pro-inflammatory cytokines (TNF, and IL-1β and the level of chemokines (Mip-1α, and MCP-1 were strongly diminished in the aged post-ischemic brain tissue. IL-6 showed the strongest age-dependent decrease in its post-ischemic expression profile. Anti-inflammatory cytokines (TGFβ1, and IL-10 revealed no significant age dependency after ischemia. Aged mice brains tend to develop smaller infarcts. CONCLUSION: The attenuated inflammatory response to stroke in aged animals may contribute to their smaller infarcts. The results presented here highlight the importance of using aged animals to investigate age-associated diseases like stroke, and should be considered as a major prerequisite in the development of age-adjusted therapeutic interventions.

  11. Kinesthetic taping improves walking function in patients with stroke

    DEFF Research Database (Denmark)

    Boeskov, Birgitte; Carver, Line Tornehøj; von Essen-Leise, Anders

    2014-01-01

    walking speed and clinical indices of spasticity in patients with stroke. METHODS: Thirty-two patients (9 women) receiving rehabilitation after stroke (average, 50 days since stroke) who had impaired walking ability were recruited. Primary outcome was maximal walking speed measured by the 10-meter walk...... be a valuable adjunct in physical therapy and rehabilitation of patients with stroke.......BACKGROUND: Stroke is an important cause of severe disability and impaired motor function. Treatment modalities that improve motor function in patients with stroke are needed. The objective of this study was to investigate the effect of kinesthetic taping of the anterior thigh and knee on maximal...

  12. Brain magnetic resonance imaging findings in cryptogenic stroke patients under 60 years with patent foramen ovale

    Energy Technology Data Exchange (ETDEWEB)

    Boutet, Claire, E-mail: claire.boutet@chu-st-etienne.fr [Department of Radiology, University Hospital of Saint-Etienne (France); Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Rouffiange-Leclair, Laure, E-mail: laurerouffiange@hotmail.com [Department of Radiology, University Hospital of Saint-Etienne (France); Garnier, Pierre, E-mail: pierre.garnier@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Quenet, Sara, E-mail: sara.quenet@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Delsart, Daphné, E-mail: daphne.delsart@hotmail.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne (France); Inserm, CIE3, F-42055 Saint-Etienne (France); Varvat, Jérôme, E-mail: jvarvat@9online.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Epinat, Magali, E-mail: magali.epinat@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Schneider, Fabien, E-mail: fabien.schneider@univ-st-etienne.fr [Department of Radiology, University Hospital of Saint-Etienne (France); Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Antoine, Jean-Christophe, E-mail: j.christophe.antoine@chu-st-etienne.fr [Department of Neurology, University Hospital of Saint-Etienne (France); Lyon Neuroscience Research Center, INSERM U1028 – CNRS UMR5292 (France); EA 4338, Jean Monnet University, Saint-Etienne (France); and others

    2014-05-15

    Purpose: To compare magnetic resonance imaging (MRI) brain feature in cryptogenic stroke patients with patent foramen ovale (PFO), cryptogenic stroke patients without PFO and patients with cardioembolic stroke. Materials and methods: The ethics committee required neither institutional review board approval nor informed patient consent for retrospective analyses of the patients’ medical records and imaging data. The patients’ medical files were retrospectively reviewed in accordance with human subject research protocols. Ninety-two patients under 60 years of age were included: 15 with cardioembolic stroke, 32 with cryptogenic stroke with PFO and 45 with cryptogenic stroke without PFO. Diffusion-weighted imaging of brain MRI was performed by a radiologist blinded to clinical data. Univariate, Fischer's exact test for qualitative data and non-parametric Wilcoxon test for quantitative data were used. Results: There was no statistically significant difference found between MRI features of patients with PFO and those with cardioembolic stroke (p < .05). Patients without PFO present more corticosubcortical single lesions (p < .05) than patients with PFO. Patients with PFO have more often subcortical single lesions larger than 15 mm, involvement of posterior cerebral arterial territory and intracranial occlusion (p < .05) than patients with cryptogenic stroke without PFO. Conclusion: Our study suggests a cardioembolic mechanism in ischemic stroke with PFO.

  13. In-hospital medical complications associated with patient dependency after acute ischemic stroke: data from the China National Stroke Registry

    Institute of Scientific and Technical Information of China (English)

    WANG Peng-lian; ZHAO Xing-quan; DU Wan-liang; WANG An-xin; JI Rui-jun; YANG Zhong-hua; WANG Chun-xue

    2013-01-01

    Background The mortality of stroke patients is strongly affected by medical complications.However,there are limited data investigating the effect of in-hospital medical complications on the dependency of stroke patients worldwide.We prospectively and systematically investigated the effect of medical complications on dependency of patients at 3,6 and 12 months after stroke using the China National Stroke Registry (CNSR).Methods This prospective cohort study collected data of patients age >18 years with acute ischemic stroke in 132 clinical centers distributed across 32 provinces and four municipalities (including Hong Kong region) of China,from September 2007 to August 2008.Data on medical complications,dependency and other information were obtained from paper-based registry forms.Medical complications associated with stroke outcomes were assessed using multivariable Logistic regression.Results Of 11 560 patients with acute ischemic stroke,1826 (15.80%) presented with in-hospital medical complications.In-hospital medical complications were independent risk factors for dependency of patients at 3 months (adjusted odds ratio (OR) 2.367,95% confidence interval (CI) 2.021-2.771),6 months (adjusted OR 2.257,95% CI 1.922-2.650),and 12 months (adjusted OR 1.820,95% CI 1.538-2.154) after acute ischemic stroke.Conclusion The results demonstrated that the short-term and long-term dependency of acute ischemic stroke patients is significantly associated with in-hospital medical complications in China.

  14. Acute Stroke Management in Patients Taking Dabigatran

    NARCIS (Netherlands)

    Brouns, Raf; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; De Raedt, Sylvie; Uyttenboogaart, Maarten; Luijckx, Gert-Jan; Jochmans, Kristin; De Keyser, Jacques

    Dabigatran etexilate is emerging as an alternative for vitamin K antagonists, but evidence-based guidelines for management of intracerebral hemorrhage and acute ischemic stroke in patients taking this drug are nonexistent. This review summarizes current knowledge on key pharmacological features and

  15. Age-Related Macular Degeneration and Incident Stroke: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Fernandez, Antonio B.; Panza, Gregory A.; Cramer, Benjamin; Chatterjee, Saurav; Jayaraman, Ramya; Wu, Wen-Chih

    2015-01-01

    Background Age-related macular degeneration (AMD) is the leading cause of vision loss and blindness in people over 65 years old in the United States and has been associated with cardiovascular risk and decreased survival. There is conflicting data, however, regarding the contribution of AMD to the prediction of stroke. Aim To determine whether AMD is a risk indicator for incident stroke in a meta-analysis of available prospective and retrospective cohort studies published in the English literature. Methods We performed a systematic literature search of all studies published in English with Pub Med and other databases from 1966 to August 2014, reporting stroke incidence in patients with macular degeneration. Two investigators independently extracted the data. A random effects model was used to report Odds ratios (OR), with corresponding 95% confidence intervals (CI). Meta-regression using a mixed linear model was used to understand potential heterogeneity amongst studies. Results We identified 9 studies that reported stroke incidence in patients with and without early AMD (N = 1,420,978). No significant association was found between early AMD with incident stroke. Combined, these 9 studies demonstrated random effects (OR, 1.12; CI, 0.86–1.47; I2 = 96%). Meta-regression on baseline covariates of age, sex, and year of publication did not significantly relate to heterogeneity. Conclusions We found no significant relationship between AMD and incident stroke. Further studies are needed to clarify other causes of decreased survival in patients with AMD. PMID:26580396

  16. Validating Age-Related Functional Imaging Changes in Verbal Working Memory with Acute Stroke

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    Timothy B. Meier

    2011-01-01

    Full Text Available Functional imaging studies consistently find that older adults recruit bilateral brain regions in cognitive tasks that are strongly lateralized in younger adults, a characterization known as the Hemispheric Asymmetry Reduction in Older Adults model. While functional imaging displays what brain areas are active during tasks, it cannot demonstrate what brain regions are necessary for task performance. We used behavioral data from acute stroke patients to test the hypothesis that older adults need both hemispheres for a verbal working memory task that is predominantly left-lateralized in younger adults. Right-handed younger (age ≥ 50, n = 7 and older adults (age > 50, n = 21 with acute unilateral stroke, as well as younger (n = 6 and older (n = 13 transient ischemic attack (TIA patients, performed a self-paced verbal item-recognition task. Older patients with stroke to either hemisphere had a higher frequency of deficits in the verbal working memory task compared to older TIA patients. Additionally, the deficits in older stroke patients were mainly in retrieval time while the deficits in younger stroke patients were mainly in accuracy. These data suggest that bihemispheric activity is necessary for older adults to successfully perform a verbal working memory task.

  17. Reduced Numbers and Impaired Function of Regulatory T Cells in Peripheral Blood of Ischemic Stroke Patients

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    Johanna Ruhnau

    2016-01-01

    Full Text Available Background and Purpose. Regulatory T cells (Tregs have been suggested to modulate stroke-induced immune responses. However, analyses of Tregs in patients and in experimental stroke have yielded contradictory findings. We performed the current study to assess the regulation and function of Tregs in peripheral blood of stroke patients. Age dependent expression of CD39 on Tregs was quantified in mice and men. Methods. Total FoxP3+ Tregs and CD39+FoxP3+ Tregs were quantified by flow cytometry in controls and stroke patients on admission and on days 1, 3, 5, and 7 thereafter. Treg function was assessed by quantifying the inhibition of activation-induced expression of CD69 and CD154 on T effector cells (Teffs. Results. Total Tregs accounted for 5.0% of CD4+ T cells in controls and <2.8% in stroke patients on admission. They remained below control values until day 7. CD39+ Tregs were most strongly reduced in stroke patients. On day 3 the Treg-mediated inhibition of CD154 upregulation on CD4+ Teff was impaired in stroke patients. CD39 expression on Treg increased with age in peripheral blood of mice and men. Conclusion. We demonstrate a loss of active FoxP3+CD39+ Tregs from stroke patient’s peripheral blood. The suppressive Treg function of remaining Tregs is impaired after stroke.

  18. Cardioembolic Sources in Stroke Patients in South of Brazil

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    Luiz Carlos Porcello Marrone

    2014-01-01

    Full Text Available Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5% and coronary artery disease (16%. Hypertension (61.7% and dyslipidemia (43.7% were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation were the main cause of cardioembolism.

  19. Cardioembolic Sources in Stroke Patients in South of Brazil

    Science.gov (United States)

    Porcello Marrone, Luiz Carlos; Farina Brunelli, João Pedro; Lutzky Saute, Ricardo; Henrique Tomasi, Gustavo; Cecchele Madeira, Bianca; Alves Martins, William; Dupont Rohr, Robson; Heck, Ana Paula; Botton, Luiz Ricardo; Martins de Castro, Marilia; Bodanese, Rodrigo; Bodanese, Luiz Carlos; Huf Marrone, Antônio Carlos; Costa da Costa, Jaderson

    2014-01-01

    Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism. PMID:25349734

  20. Recovery of Motor Imagery Ability in Stroke Patients

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    Sjoerd de Vries

    2011-01-01

    Full Text Available Objective. To investigate whether motor imagery ability recovers in stroke patients and to see what the relationship is between different types of imagery and motor functioning after stroke. Methods. 12 unilateral stroke patients were measured at 3 and 6 weeks poststroke on 3 mental imagery tasks. Arm-hand function was evaluated using the Utrecht Arm-Hand task and the Brunnström Fugl-Meyer Scale. Age-matched healthy individuals (N=10 were included as controls. Results. Implicit motor imagery ability and visual motor imagery ability improved significantly at 6 weeks compared to 3 weeks poststroke. Conclusion. Our study shows that motor imagery can recover in the first weeks after stroke. This indicates that a group of patients who might not be initially selected for mental practice can, still later in the rehabilitation process, participate in mental practice programs. Moreover, our study shows that mental imagery modalities can be differently affected in individual patients and over time.

  1. Resistant hypertension, patient characteristics, and risk of stroke.

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    Chen-Ying Hung

    Full Text Available Little is known about the prognosis of resistant hypertension (RH in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes.Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6% patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years. Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events] in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years. There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09-1.26; p<0.001. Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08-1.27; p<0.001, especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20-1.48; p<0.001, but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95-1.19; p = 0.312 or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99-1.39; p = 0.070 were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients.Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and elderly patients than in male or young

  2. Predictors of extubation success in acute ischemic stroke patients.

    Science.gov (United States)

    Lioutas, Vasileios-Arsenios; Hanafy, Khalid A; Kumar, Sandeep

    2016-09-15

    Acute ischemic stroke (AIS) patients often undergo intubation and mechanical ventilation (MV). Prolonged intubation and MV have disadvantages and complications. Conventional extubation criteria based only on respiratory parameters are insufficient to guide extubation practices in stroke patients where capacity for airway protection is a major concern. To identify clinical and neuroanatomical markers of successful extubation in AIS patients requiring MV. Retrospective review of tertiary care hospital patient database from May 2009-November 2012 to identify consecutive patients with AIS intubated during hospitalization. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness, facial weakness, dysarthria, neglect, infarct location, dysphagia, respiratory parameters and history of pneumonia on successful extubation by hospital discharge using multivariate logistic regression analysis. 112 subjects met study criteria and were included in the analysis. Age and NIHSS scores (mean±standard deviation) were 74.5±16.1years and 19±9.8, respectively; 56% were women. In multivariate analysis, NIHSS score≤15 (Odds Ratio 4.6, 95% Confidence Interval 1.9-11.3, pstroke and absence of dysarthria prior to intubation were independently associated with extubation success. Our findings could help inform extubation practices in patients with AIS though prospective validation is necessary. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Mortality, Recurrence, and Dependency Rates Are Higher after Acute Ischemic Stroke in Elderly Patients with Diabetes Compared to Younger Patients.

    Science.gov (United States)

    Long, Xue; Lou, Yongzhong; Gu, Hongfei; Guo, Xiaofei; Wang, Tao; Zhu, Yanxia; Zhao, Wenjuan; Ning, Xianjia; Li, Bin; Wang, Jinghua; An, Zhongping

    2016-01-01

    Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age alcohol consumers. Mortality, dependency, and recurrence rates at 12 months after stroke were 19.0, 48.5, and 20.9% in the elderly group and 7.4, 30.9, and 15.4% in the younger group, respectively (all P dependency, and recurrence rates at 12 and 36 months after stroke were significantly higher in the elderly group than in the younger group after adjusting for stroke subtypes, stroke severity, and risk factors. Odds ratios (95% confidence interval) at 12 and 36 months after stroke were 2.18 (1.64-2.89) and 3.10 (2.35-4.08), respectively, for mortality, all P dependency, all P dependency after stroke.

  4. CHARACTERISTICS OF PATIENTS WITH CEREBRAL STROKE OR TRANSIENT ISCHEMIC ATTACK, INCLUDED INTO THE LIS-2 REGISTER (LYUBERTSY STUDY OF MORTALITY IN PATIENTS AFTER STROKE

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2015-01-01

    Full Text Available Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. All patients (n=960 admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%, atrial fibrillation in 252 (26.8% patients, 199 (20.7% patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years. Low frequency of the antihypertensive therapy (34.5%, lipid-lowering therapy (0.7%, antiplatelet agents (5.7%, anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

  5. Epidemiology, pathophysiology, and treatment of hypertension in ischaemic stroke patients.

    Science.gov (United States)

    Hisham, Nur Fatirul; Bayraktutan, Ulvi

    2013-10-01

    Stroke continues to be one of the leading causes of mortality and morbidity worldwide. There are 2 main types of stroke: ischaemic strokes, which are caused by obstruction of the blood vessels leading to or within the brain, and haemorrhagic strokes, which are induced by the disruption of blood vessels. Stroke is a disease of multifactorial aetiology that may develop as an end state in patients with serious vascular conditions--most notably, uncontrolled arterial hypertension--thereby necessitating the effective control of this risk factor to prevent stroke or its recurrence. This paper focuses specifically on the epidemiology and pathogenesis of ischaemic stroke mainly in chronically hypertensive patients and pays particular attention to the efficacy of a select group of routinely used major antihypertensive drugs (i.e., angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor blockers, and calcium channel blockers) in the treatment of strokes. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Pneumonia in acute stroke patients fed by nasogastric tube

    OpenAIRE

    Dziewas, R. (Rainer); Ritter, M.; Schilling, M; Konrad, C.; Oelenberg, S; Nabavi, D; Stogbauer, F; Ringelstein, E; Ludemann, P

    2004-01-01

    Background: Aspiration pneumonia is the most important acute complication of stroke related dysphagia. Tube feeding is usually recommended as an effective and safe way to supply nutrition in dysphagic stroke patients.

  7. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  8. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

    Institute of Scientific and Technical Information of China (English)

    Chao-jin-zi Li; Tong Zhang; Xiao-xia Du; Kun Yang; Lu-ping Song; Peng-kun Li; Qiang Wang; Rong Sun; Xiao-ling Lin; Hong-yu Lu

    2016-01-01

    Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyper-homocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modiifed Rankin Scale scores were increased at discharge. Six months atfer discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved signiifcantly in young stroke patients atfer professional rehabilitation, but the number of patients who returned to society within 6 months atfer stroke was still small.

  9. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

    Directory of Open Access Journals (Sweden)

    Chao-jin-zi Li

    2016-01-01

    Full Text Available Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6% was the primary stroke type found in the young group, while ischemic stroke (60.0% was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

  10. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients.

    Science.gov (United States)

    Li, Chao-Jin-Zi; Du, Xiao-Xia; Yang, Kun; Song, Lu-Ping; Li, Peng-Kun; Wang, Qiang; Sun, Rong; Lin, Xiao-Ling; Lu, Hong-Yu; Zhang, Tong

    2016-11-01

    Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

  11. Clinical characteristics affecting motor recovery and ambulation in stroke patients

    Science.gov (United States)

    Yetisgin, Alparslan

    2017-01-01

    [Purpose] To describe the clinical characteristics affecting motor recovery and ambulation in stroke patients. [Subjects and Methods] Demographic and clinical characteristics of 53 stroke patients (31 M, 22 F), such as age, gender, etiology, hemiplegic side, Brunnstrom stage, functional ambulation scale scores, history of rehabilitation, and presence of shoulder pain and complex regional pain syndrome were evaluated. [Results] The etiology was ischemic in 79.2% of patients and hemorrhagic in 20.8%. Brunnstrom hand and upper extremity values in females were lower than in males. Complex regional pain syndrome was observed at a level of 18.9% in all patients (more common in females). Brunnstrom hand stage was lower in complex regional pain syndrome patients than in those without the syndrome. Shoulder pain was present in 44.4% of patients. Brunnstrom lower extremity values and functional ambulation scale scores were higher in rehabilitated than in non-rehabilitated cases. [Conclusion] Brunnstrom stages of hand and upper extremity were lower and complex regional pain syndrome was more common in female stroke patients. Shoulder pain and lower Brunnstrom hand stages were related to the presence of complex regional pain syndrome. PMID:28265142

  12. Utilization of Emergent Neuroimaging for Thrombolysis-Eligible Stroke Patients.

    Science.gov (United States)

    Sanossian, Nerses; Fu, Katherine A; Liebeskind, David S; Starkman, Sidney; Hamilton, Scott; Villablanca, J Pablo; Burgos, Adrian M; Conwit, Robin; Saver, Jeffrey L

    2017-01-01

    Advances in diagnostic imaging of stroke include multimodal techniques such as noninvasive angiography and perfusion imaging. We aimed to characterize trends in neuroimaging utilization among acute stroke patients. Utilization of multimodal imaging for acute stroke in the community has remained largely uncharacterized despite its increased adoption at academic medical centers. We quantified neuroimaging utilization in the emergency department (ED) for 1,700 hyperacute stroke patients presenting Neuroimaging.

  13. Telerehabilitation for stroke patients: an overview of reviews

    DEFF Research Database (Denmark)

    Turolla, Andrea; Larsen, Torben

    2012-01-01

    the following criteria: published in English in peer-reviewed journals, targeting stroke as adult patients (age>18yr.) and considering a homecare setting in the intervention. 6 full-text reviews were included: 1 systematic review with meta-analysis and 5 non-systematic reviews. Despite the absence of adverse......”, “adherence” and “patient acceptability” should be included as secondary outcomes, for a complete evaluation of the tele-intervention. This indications should be considered as relevant in planning a telerehabilitation trial, in order to observe the expected effectiveness from a multidimensional point of view...... Home Care (IHC) we performed an overview of reviews on the telefacilites for the homecare in stroke patients, in order to plan a clinical trial. A broad literature research was conducted in PUBMED, Web of Science® and The Cochrane Library databases. We included and graded all the reviews matching...

  14. Brain CT-scan in acute stroke patients: silent infarcts and relation to outcome.

    Science.gov (United States)

    Corea, Francesco; Tambasco, Nicola; Luccioli, Roberto; Ciorba, Ettore; Parnetti, Lucilla; Gallai, Virgilio

    2002-01-01

    Silent infarcts (SIs) are common findings in stroke patients, but their clinical significance remains controversial. Aim of this study was to evaluate the prevalence of SI in consecutive stroke patients, characteristics, associated factors, and influence on in-hospital mortality. The population consisted of 191 patients, consecutively admitted for an acute stroke. Of 191 patients, 74 had SI on CT-scan. Silent infarcts were often multiple, right sided, lacunar. We found SI more frequently in older patients, smokers, with an ischemic stroke having small vessel disease as presumed cause. In our study SI were associated with ageing, smoke habit and lacunar stroke. Silent infarcts size influenced the rate of in-hospital mortality.

  15. Relationship between Postural Sway and Dynamic Balance in Stroke Patients.

    Science.gov (United States)

    Cho, Kihun; Lee, Kyoungsuk; Lee, Byungjoon; Lee, Hwangjae; Lee, Wanhee

    2014-12-01

    [Purpose] The purpose of the current study was to investigate the relationship between postural sway and dynamic balance in post stroke patients. [Subjects] Thirty-one stroke patients (20 men and 11 women; age 64.25 years; stroke duration 12.70 months; MMSE-K score 26.35) participated in this study. [Methods] This study applied a cross-sectional design. A Good Balance system was used for measurement of the postural sway velocity (anteroposterior and mediolateral) and velocity moment of subjects under the eyes open and eyes closed conditions in a standing posture. The postural sway of subjects was measured under two surface conditions (stable and unstable surfaces). [Results] On the unstable surface (foam), no significant correlation was observed between postural sway and dynamic balance except for the berg balance scale (BBS) score and anteroposterior postural sway velocity under the eyes open condition, anteroposterior postural sway velocity under the eyes closed condition, and postural sway velocity moment. In addition, in the stable condition, no significant correlation was observed between postural sway and dynamic balance. [Conclusion] Our results indicate that a decrease in postural sway does not necessarily reflect improvement of dynamic balance ability. We believe that this finding may be useful in balance rehabilitation for prevention of falls after a stroke.

  16. Left atrial appendage morphology in patients with suspected cardiogenic stroke without known atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Miika Korhonen

    Full Text Available The left atrial appendage (LAA is the typical origin for intracardiac thrombus formation. Whether LAA morphology is associated with increased stroke/TIA risk is controversial and, if it does, which morphological type most predisposes to thrombus formation. We assessed LAA morphology in stroke patients with cryptogenic or suspected cardiogenic etiology and in age- and gender-matched healthy controls. LAA morphology and volume were analyzed by cardiac computed tomography in 111 patients (74 males; mean age 60 ± 11 years with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology other than known atrial fibrillation (AF. A subgroup of 40 patients was compared to an age- and gender-matched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years. LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, CauliFlower modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%, ChickenWing (23.4%, 37.5%, 10.0%, WindSock (47.7%, 35.0%, 67.5%, and CauliFlower (19.8%, 22.5%, 2.5%. The distribution of morphology types differed significantly (P<0.001 between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001 in the matched stroke subgroup (55% than the control group (6%. LAA volumes were significantly larger (P<0.001 in both stroke study groups compared to controls patients. To conclude, LAA morphology differed significantly between stroke patients and controls, and single-lobed LAAs were overrepresented and LAA volume was larger in patients with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology.

  17. Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data.

    Science.gov (United States)

    Fernández-Menéndez, S; García-Santiago, R; Vega-Primo, A; González Nafría, N; Lara-Lezama, L B; Redondo-Robles, L; Montes-Montes, M; Riveira-Rodríguez, M C; Tejada-García, J

    2016-06-01

    Cardiac arrhythmias are frequent in acute stroke. Stroke units are widely equipped with cardiac monitoring systems. Pre-existing heart diseases and heart-brain interactions may be implicated in causing cardiac arrhythmias in acute stroke. This article analyses cardiac arrhythmias detected in patients hospitalised in a stroke unit. Prospective observational study of consecutive patients admitted to a stroke unit with cardiac monitoring. We collected clinical data from patients and the characteristics of their cardiac arrhythmias over a 1-year period (2013). Time of arrhythmia onset, associated predisposing factors, and the therapeutic decisions made after detection of arrhythmia were examined. All patients underwent continuous cardiac monitoring during no less than 48hours. Of a total of 332 patients admitted, significant cardiac arrhythmias occurred in 98 patients (29.5%) during their stay in the stroke unit. Tachyarrhythmia (ventricular tachyarrhythmias, supraventricular tachyarrhythmias, complex ventricular ectopy) was present in 90 patients (27.1%); bradyarrhythmia was present in 13 patients (3.91%). Arrhythmias were independently associated with larger size of brain lesion and older age. In 10% of the patient total, therapeutic actions were taken after detection of significant cardiac arrhythmias. Most events occurred within the first 48hours after stroke unit admission. Systematic cardiac monitoring in patients with acute stroke is useful for detecting clinically relevant cardiac arrhythmias. Incidence of arrhythmia is higher in the first 48hours after stroke unit admission. Age and lesion size were predicted appearance of arrhythmias. Detection of cardiac arrhythmias in a stroke unit has important implications for treatment. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Pediatric Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... communicate with your child’s doctor. Symptoms of a Stroke Stroke is an injury to part of the ...

  19. Prognostic Significance of Uric Acid Levels in Ischemic Stroke Patients.

    Science.gov (United States)

    Zhang, Xia; Huang, Zhi-Chao; Lu, Tao-Sheng; You, Shou-Jiang; Cao, Yong-Jun; Liu, Chun-Feng

    2016-01-01

    The importance and function of serum uric acid (UA) levels in patients with cardiovascular disease or stroke are unclear. We sought to evaluate the appropriate UA levels for stroke patients and the association between endogenous UA levels and clinical outcomes in acute ischemic stroke (AIS) patients, particularly regarding the possible interaction between gender and UA levels with respect to AIS prognosis. We examined 303 patients who had an onset of ischemic stroke within 48 h. Of those, 101 patients received thrombolytic treatment. Serum UA (μmol/L) levels were measured the second morning after admission. Patient prognosis was evaluated 90 days after clinical onset by modified Rankin Scale. Patients were divided into four groups according to serum UA quartiles. A binary multivariate logistic regression model was used to assess clinical relevance in regard to functional outcome and endogenous UA levels. Analysis of subgroups by gender and normal glomerular filtration rate were also been done. Poor functional outcome was associated with older age, history of atrial fibrillation, or higher baseline National Institutes of Health Stroke Scale scores. After adjustment for potential confounders, patients with higher UA levels (>380 μmol/L) or lower UA levels (≤250 μmol/L) were 2-3 times more likely to have a poor outcome (OR 2.95, 95% CI 1.14-7.61; OR 2.78, 95% CI 1.02-7.58, respectively) compared to the baseline group (UA level 316-380 μmol/L). The same results were observed in thrombolyzed patients. Patients with high and low UA levels were 9-18 times more likely to having poor outcomes compared to the baseline group (UA level: 316-380 μmol/L; OR 18.50, 95% CI: 2.041-167.67; OR 9.66, 95% CI 1.42-65.88, respectively). In men, patients with high UA levels were 6 times more likely to have poor outcomes compared to the baseline group (UA level: 279-334 μmol/L; OR 6.10, 95% CI 1.62-22.93). However, female patients with UA level 271-337 μmol/L were seven times more

  20. Aging aggravates ischemic stroke-induced brain damage in mice with chronic peripheral infection.

    Science.gov (United States)

    Dhungana, Hiramani; Malm, Tarja; Denes, Adam; Valonen, Piia; Wojciechowski, Sara; Magga, Johanna; Savchenko, Ekaterina; Humphreys, Neil; Grencis, Richard; Rothwell, Nancy; Koistinaho, Jari

    2013-10-01

    Ischemic stroke is confounded by conditions such as atherosclerosis, diabetes, and infection, all of which alter peripheral inflammatory processes with concomitant impact on stroke outcome. The majority of the stroke patients are elderly, but the impact of interactions between aging and inflammation on stroke remains unknown. We thus investigated the influence of age on the outcome of stroke in animals predisposed to systemic chronic infection. Th1-polarized chronic systemic infection was induced in 18-22 month and 4-month-old C57BL/6j mice by administration of Trichuris muris (gut parasite). One month after infection, mice underwent permanent middle cerebral artery occlusion and infarct size, brain gliosis, and brain and plasma cytokine profiles were analyzed. Chronic infection increased the infarct size in aged but not in young mice at 24 h. Aged, ischemic mice showed altered plasma and brain cytokine responses, while the lesion size correlated with plasma prestroke levels of RANTES. Moreover, the old, infected mice exhibited significantly increased neutrophil recruitment and upregulation of both plasma interleukin-17α and tumor necrosis factor-α levels. Neither age nor infection status alone or in combination altered the ischemia-induced brain microgliosis. Our results show that chronic peripheral infection in aged animals renders the brain more vulnerable to ischemic insults, possibly by increasing the invasion of neutrophils and altering the inflammation status in the blood and brain. Understanding the interactions between age and infections is crucial for developing a better therapeutic regimen for ischemic stroke and when modeling it as a disease of the elderly.

  1. Which risk factors are more associated with ischemic stroke than intracerebral hemorrhage in patients with atrial fibrillation?

    Science.gov (United States)

    McGrath, Emer R; Kapral, Moira K; Fang, Jiming; Eikelboom, John W; ó Conghaile, Aengus; Canavan, Michelle; O'Donnell, Martin J

    2012-08-01

    The decision to prescribe oral anticoagulant therapy in patients with atrial fibrillation is based on an assessment of the competing risks of ischemic stroke and major bleeding, of which intracerebral hemorrhage (ICH) is the most important type. We sought to determine the comparative importance of risk factors for ischemic stroke and ICH in patients with acute stroke and atrial fibrillation with particular emphasis on risk factors common to both stroke types. Consecutive patients with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network constituted the cohort. Multivariable logistic regression analysis was used to determine the association between baseline risk factors and presentation with ICH versus ischemic stroke. Risk factors included: (1) those previously reported to be risk factors for both ischemic stroke and major bleeding (particularly ICH) ("shared" risk factors, including age, alcohol, hypertension, diabetes mellitus, renal impairment, prior stroke/transient ischemic attack and preadmission dementia); and (2) other risk factors associated with either stroke subtype alone. A total of 3197 patients presented with atrial fibrillation and acute stroke, of which 12.2% presented with ICH. Of the "shared" risk factors, age (OR, 1.19; 95% CI, 1.06-1.34 per decade) and prior stroke/transient ischemic attack (OR, 1.45; 95% CI, 1.12-1.87) were more associated with ischemic stroke than ICH, whereas a history of hypertension (OR, 0.89; 95% CI, 0.68-1.17), diabetes mellitus (OR 1.23; 95% CI, 0.92-1.64), renal impairment (OR, 1.28; 95% CI, 0.95-1.71), and alcohol intake were not more strongly associated with either stroke subtype. Of the risk factors known to be associated with both ischemic stroke and ICH in patients with atrial fibrillation, we found that none had a stronger association with ICH. Older age was more strongly associated with ischemic stroke than ICH.

  2. Risk factors and prognosis of ischemic stroke in young patients in Uzbekistan

    Directory of Open Access Journals (Sweden)

    Khurshidakhon Rasulova

    2011-03-01

    Full Text Available Between 2004 and 2008, we studied reasons and risk factors of ischemic stroke in 150 young patients (aged between 17-44 years, compared with those in elderly patients (n=70. According to our data, heredity, arterial hypertension, cerebral vasculitis, thyroid diseases, chronic alcoholism, smoking and long-term use of oral contraceptives are main risk factors of ischemic stroke in the young in Uzbekistan. However, relative risk of stroke in this group of patients is less than in elder patients. In 16% cases, usage of standard diagnostic measures does not lead to identification of the disease cause.

  3. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

    Directory of Open Access Journals (Sweden)

    Tanya West

    2013-01-01

    Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

  4. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, Peter Krogh; Husted, Steen; Damsgaard, Else Marie Skjøde

    2007-01-01

    INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...... focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery......, length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...

  5. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, P K; Damsgaard, Else Marie; Husted, Steen

    2007-01-01

    , length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...... was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months. CONCLUSION: 35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables showed......INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...

  6. Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.

    Science.gov (United States)

    Skolarus, Lesli E; Burke, James F; Morgenstern, Lewis B; Meurer, William J; Adelman, Eric E; Kerber, Kevin A; Callaghan, Brian C; Lisabeth, Lynda D

    2014-08-01

    Poststroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among patients with stroke. Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample. Medicaid coverage of IRFs (yes versus no) was ascertained. Primary outcome was discharge to IRF (versus other discharge destinations). We fit a logistic regression model that included patient demographics, Medicaid coverage, comorbidities, length of stay, tissue-type plasminogen activator use, state Medicaid IRF coverage, and the interaction between patient Medicaid status and state Medicaid IRF coverage while accounting for hospital clustering. Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) of 42 states. The impact of State Medicaid IRF coverage was limited to Medicaid stroke patients (P for interaction stroke patients in states with Medicaid IRF coverage, Medicaid stroke patients hospitalized in states without Medicaid IRF coverage were less likely to be discharged to an IRF of 11.6% (95% confidence interval, 8.5%-14.7%) versus 19.5% (95% confidence interval, 18.3%-20.8%), Pstroke patients with Medicaid. Given the increasing stroke incidence among the working age and Medicaid expansion under the Affordable Care Act, careful attention to state Medicaid policy for poststroke rehabilitation and analysis of its effects on stroke outcome disparities are warranted. © 2014 American Heart Association, Inc.

  7. How is nursing care for stroke patients organised? Nurses' views on best praactices

    DEFF Research Database (Denmark)

    Lind, Jette; Struwe, Jytte Holm; Baernholdt, Marianne

    2013-01-01

    In the developed world, stroke is the third leading cause of death (DSFA 2009) In Denmark there are 12400 new patients every year and 30000 - 40000 people living with long-term after stroke. This group consists mainly of people aged 80 years and older. When these patients have a stroke their biol...... their biological age and co-morbidities complicate their in-hospital stay and rehabilitation. Nevertheless with the right treatment and quality care these strok victims can experience good outcomes and regain their quality of life (Gosselin et al. 2008, Saposnik et al. 2009)...

  8. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  9. Effectiveness of Conventional Rehabilitation Therapy on Postural Stability and Clinic in Stroke Patients with Hemiplegia

    OpenAIRE

    İnanır, Ahmet; Okan, Sevil; Filiz, Behçet; Kuyucu, Emre

    2013-01-01

    Objective: The aim of the present study was to determine the effectiviness of conventional rehabilitation in patients with stroke on static and dynamic balance as well as clinical assessment Methods: Twelve patients with stroke, 7 (58.33%) of them being male and 5 (41.66%) female, ranging from 51 to 75 in age who were treated in Physical Medicine and Rehabilitation clinic were involved in this study. The patients were treated with conventional rehabilitation. All individuals were evaluat...

  10. Laryngeal Elevation Velocity and Aspiration in Acute Ischemic Stroke Patients

    Science.gov (United States)

    Zhang, Jing; Zhou, Yun; Wei, Na; Yang, Bo; Wang, Anxin; Zhou, Hai; Zhao, Xingquan; Wang, Yongjun; Liu, Liping; Ouyoung, Melody; Villegas, Brenda; Groher, Michael

    2016-01-01

    secondary to reduced laryngeal elevation velocity after adjusting for the effects of other indices. Intrarater and interrater reliability were calculated using Pearson’s correlation coefficients. Results Data from 89 patients were analyzed. This cohort included 71 males and 18 females with a mean age of 59.31±11.46 years. The mean time from stroke onset to the VFS study was 3 days (1–7). Twenty one (23%) patients aspirated while swallowing 5 ml of diluted barium (40%, w/v). Aspiration was associated with age, the velocity (%/s) of laryngeal elevation and duration, delayed pharyngeal phase, pharyngeal transit time, abnormal epiglottic tilt, and invalid laryngeal elevation before true swallowing, and duration of upper esophageal sphincter (UES) opening. After adjusting for the effects of the indices mentioned above, logistic regression analysis revealed that a reduced of laryngeal elevation velocity before vestibule closure was predictive of aspiration independently (OR, 0.993; 95% CI, 0.987–1.000). Discussions Reduced laryngeal elevation velocity for laryngeal elevated to position where laryngeal vestibule is fully closed was an independent predictor of aspiration in patients with acute ischemic stroke. This may be related to a decreased contraction velocity of the muscles involved in hyolaryngeal elevation. Therapeutic methods aimed at improving laryngeal elevation velocity may decrease aspiration events and pneumonias after stroke. PMID:27583413

  11. Ischemic stroke subtype is associated with outcome in thrombolyzed patients

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Ziegler; Svendsen, M L

    2017-01-01

    OBJECTIVES: The impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator (IV-tPA) is sparsely examined. We studied the association between stroke subtype and clinical outcome in magnetic resonance imaging (MRI)-evaluated patients...... treated with IV-tPA. MATERIAL AND METHODS: We conducted a single-center retrospective analysis of MRI-selected stroke patients treated with IV-tPA between 2004 and 2010. The Trial of ORG 10172 in Acute Stroke Treatment criteria were used to establish the stroke subtype by 3 months. The outcomes...... of interest were a 3-month modified Rankin Scale score of 0-1 (favorable outcome), and early neurological improvement defined as complete remission of neurological deficit or improvement of ≥4 on the National Institute of Health Stroke Scale at 24 h. The outcomes among stroke subtypes were compared...

  12. Proteinuria is an independent risk factor for ischemic stroke among diabetic patients.

    Science.gov (United States)

    Mondol, G; Rahman, K M; Uddin, M J; Bhattacharjee, M; Dey, S K; Israil, A; Miah, A H; Sarkar, U K; Islam, S S; Rahman, M M; Hossain, F; Bhuiya, M M; Bhowmik, R; Chowdhury, A H; Kabir, M S; Uddin, M S

    2012-07-01

    This study was done to assess the relationship between proteinuria and ischemic stroke in subjects with diabetes mellitus, and to determine whether proteinuria is an independent risk factor for stroke. This comparative study was conducted in Mymensingh Medical College Hospital from January 2009 to June 2010. It was done to establish the relationship between proteinuria (Microalbuminuria) and ischemic stroke among diabetic patients. Other risk factors were also assessed. Patients were divided in Group A - diabetic patients with ischemic stroke (n=50) and Group B diabetic patients without stroke (n=50). Mean age of the Group A & B were 60.16±8.33 and 57.19±7.73 years (p=0.068). Mean Blood sugar (2 hours after Break Fast) was 14.68±4.32mmol/L in Group A and 14.75±4.02mmol/L in Group B (p>0.05). Albumin Creatinine ratio was abnormal in 84.0% in Group A and 22.0% in Group A (p=0.001) [Odds ratio (95%CI) = 18.61 (6.78-51.09)]. Logistic regression analysis has also shown that microalbuminuria (ACR) is an independent risk factor for ischemic stroke (p=0.001), [Odds ratio (95%CI) = 19.811(5.915-66.348)]. In diabetic patients increased urinary protein is a risk factor for stroke. Estimation of urinary protein (Microalbuminuria) may be used as a predictor for ischemic stroke in patients with diabetes.

  13. Improving stroke patients' care: a patient held record is not enough

    Directory of Open Access Journals (Sweden)

    Lampe Fiona

    2001-03-01

    Full Text Available Abstract Background Stroke patients' care in hospital tends to be poorly organised, with poor communication and a lack of information being frequent sources of complaint. The purpose of this study was to evaluate whether a patient-held record (PHR would result in greater patient satisfaction and better care planning for stroke patients. Methods A time series control (6 months - intervention (8 months - control (6 months was used among London teaching hospital general medical and geriatric medicine inpatient wards. All stroke patients admitted to the wards during the intervention phase received a PHR and were instructed in its use. Demographic, stroke severity, social factors and outcomes were collected from all stroke patients during all phases of the study. Results Of 252 stroke patients aged 46 to 98 years entered into the study, by six months after admission 118 (46.8% had died. PHR and control group patients were well matched in terms of socio-demographic characteristics and pre-stroke ability. At six months after admission, 119 (97% patients responded to the questionnaire. Just over half (56%, 13 of intervention group patients recalled receiving a PHR. Of those patients, 59% reported reading the PHR, 27% had lost their PHR, and two-thirds said they had difficulties encouraging staff to write in the PHR. Half felt that possession of the PHR was more trouble than it was worth. PHR group patients were more satisfied with the recovery they had made (79% vs. 59%, p=0.04, but felt less able to talk to staff about their problems (61% vs. 82%, p=0.02. PHR group patients reported receiving fewer explanations about their condition (18% vs. 33%, p=0.12 and treatment (26% vs. 45%, p=0.07, and were more afraid of asking doctors questions (21% vs. 4%, p=0.01 than controls. PHR group patients were no better prepared for hospital discharge than control group patients, and both groups were ill-informed about services and benefits that might have helped

  14. Improving stroke care: Quality of care and health education in patients with a stroke or transient ischemic attack

    NARCIS (Netherlands)

    E. Maasland (Lisette)

    2011-01-01

    textabstractThis thesis focuses on the applicability of results of clinical trials of stroke and TIA patients in everyday practice and on measurement of quality of stroke care. A third aim is to further expand an underexposed aspect of stroke care, namely health education in stroke patients. Chapter

  15. Improving stroke care: Quality of care and health education in patients with a stroke or transient ischemic attack

    NARCIS (Netherlands)

    E. Maasland (Lisette)

    2011-01-01

    textabstractThis thesis focuses on the applicability of results of clinical trials of stroke and TIA patients in everyday practice and on measurement of quality of stroke care. A third aim is to further expand an underexposed aspect of stroke care, namely health education in stroke patients. Chapter

  16. Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients

    Directory of Open Access Journals (Sweden)

    Hattori Yoshiyuki

    2011-10-01

    Full Text Available Abstract Background We analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD and cerebrovascular accident (CVA according to glycemic control. Methods and Results We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study of type 2 diabetes patients (n = 4014 for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70 and hemoglobin A1C levels (≤ 7.0 and > 7.0%. Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026 and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028. CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C 7.0%. Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018 and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02. CVA was associated with short duration of diabetes in both female groups. Conclusions IHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin

  17. Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients

    Science.gov (United States)

    2011-01-01

    Background We analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD) and cerebrovascular accident (CVA) according to glycemic control. Methods and Results We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) of type 2 diabetes patients (n = 4014) for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70) and hemoglobin A1C levels (≤ 7.0 and > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026) and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028). CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018) and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02). CVA was associated with short duration of diabetes in both female groups. Conclusions IHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin use has a potential

  18. Ethnic Comparison of Clinical Characteristics and Ischemic Stroke Subtypes Among Young Adult Patients With Stroke in Hawaii.

    Science.gov (United States)

    Nakagawa, Kazuma; Ito, Cherisse S; King, Sage L

    2017-01-01

    Native Hawaiians and other Pacific Islanders (NHOPI) with ischemic stroke have younger age of stroke onset compared with whites. However, ethnic differences in stroke subtypes in this population have been inadequately studied. Consecutive young adult patients (aged ≤55 years) who were hospitalized for ischemic stroke between 2006 and 2012 at a tertiary center in Honolulu were studied. Clinical characteristics and stroke subtypes based on pathophysiological TOAST classification (Trial of Org 10172) of NHOPI and Asians were compared with whites. A total of 427 consecutive young adult (mean age, 46.7±7.8 years) patients (NHOPI 45%, Asians 38%, and whites 17%) were studied. NHOPI had a higher prevalence of hypertension, diabetes mellitus, prosthetic valve, higher body mass index, hemoglobin A1c, and lower high-density lipoprotein than whites (all P<0.05). Stroke subtype distribution was not different between the ethnic groups. Specifically, the prevalence of small-vessel disease was similar between NHOPI (26.6%), whites (28.4%), and Asians (24.8%). In the univariate analyses, the use of intravenous tissue-type plasminogen activator was lower among NHOPI (4.7%; P=0.01) and Asians (3.1%; P=0.002) than among whites (12.5%). In the multivariable model, NHOPI (odds ratio, 0.35; 95% confidence interval, 0.12-0.98) and Asians (odds ratio, 0.23; 95% confidence interval, 0.07-0.74) were less likely to be treated with intravenous tissue-type plasminogen activator than whites. NHOPI have greater cardiovascular risk factors than whites, but there were no differences in stroke subtypes between the ethnic groups. Furthermore, NHOPI and Asians may be less likely to be treated with intravenous tissue-type plasminogen activator than whites. © 2016 American Heart Association, Inc.

  19. Dabigatran and other oral antithrombotic agents for the prevention of stroke in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Testai F

    2011-06-01

    Full Text Available Fernando D Testai, Venkatesh AiyagariSection of Neurological Critical Care and Stroke, Department of Neurology and Rehabilitation, Center for Stroke Research, University of Illinois College of Medicine, Chicago, IL, USAAbstract: Atrial fibrillation (AF is considered to be one of the most prevalent abnormal heart rhythm disorders and a leading cause of cerebral ischemia. The risk of stroke in AF is associated with vascular risk factors including advancing age, hypertension, congestive heart disease, diabetes mellitus, vascular disease, and prior history of stroke or transient ischemic attack. The classic management of patients with AF at risk of suffering stroke includes the use of warfarin. The use of this medication in clinical practice is, however, limited owing to its narrow therapeutic window, multiple drug and food interactions, prolonged half-life, and the need for periodic anticoagulation monitoring. Recently, newer oral anticoagulants with better pharmacokinetic and pharmacodynamic profiles have been developed and compared to warfarin in phase III trials for the prevention of stroke and systemic embolism in patients with AF. Dabigatran stands out from these studies as a safe and efficacious alternative to warfarin for treating patients with AF at risk of stroke. In this article we review classic and novel approaches for stroke prevention in AF with special emphasis on dabigatran.Keywords: oral anticoagulants, vitamin K antagonists, antiplatelet agents, stroke prevention, atrial fibrillation

  20. European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke.

    Science.gov (United States)

    Ntaios, George; Dziedzic, Tomasz; Michel, Patrik; Papavasileiou, Vasileios; Petersson, Jesper; Staykov, Dimitre; Thomas, Brenda; Steiner, Thorsten

    2015-08-01

    Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. We found low-quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low-quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better-informed recommendations in the future. © 2015 World Stroke Organization.

  1. Predicting Recovery Potential for Individual Stroke Patients Increases Rehabilitation Efficiency.

    Science.gov (United States)

    Stinear, Cathy M; Byblow, Winston D; Ackerley, Suzanne J; Barber, P Alan; Smith, Marie-Claire

    2017-04-01

    Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm. Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82). Predictions guided rehabilitation therapy focus for patients in the implementation group. The effects of predictive information on clinical practice (length of stay, therapist confidence, therapy content, and dose) were evaluated. Clinical outcomes (upper limb function, impairment and use, independence, and quality of life) were measured 3 and 6 months poststroke. The primary clinical practice outcome was inpatient length of stay. The primary clinical outcome was Action Research Arm Test score 3 months poststroke. Length of stay was 1 week shorter for the implementation group (11 days; 95% confidence interval, 9-13 days) than the comparison group (17 days; 95% confidence interval, 14-21 days; P=0.001), controlling for upper limb impairment, age, sex, and comorbidities. Therapists were more confident (P=0.004) and modified therapy content according to predictions for the implementation group (Prehabilitation efficiency after stroke without compromising clinical outcome. URL: http://anzctr.org.au. Unique identifier: ACTRN12611000755932. © 2017 American Heart Association, Inc.

  2. [The Determinants of Dysphagia in Patients With Stroke During Hospitalized Rehabilitation].

    Science.gov (United States)

    Szu, Li-Yun; Hsieh, Suh-Ing; Tseng, Su-Mei; Huang, Tzu-Hsin

    2017-06-01

    Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively. To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia. This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression. The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression. Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients' clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.

  3. Association of cerebral microbleeds with mortality in stroke patients having atrial fibrillation.

    Science.gov (United States)

    Song, Tae-Jin; Kim, Jinkwon; Song, Dongbeom; Nam, Hyo Suk; Kim, Young Dae; Lee, Hye Sun; Heo, Ji Hoe

    2014-10-07

    We investigated the association of cerebral microbleeds (CMBs) with long-term mortality in patients with nonvalvular atrial fibrillation (NVAF) according to burden and distribution of CMBs. This was a retrospective, hospital-based, observational study. In total, 504 consecutive ischemic stroke patients with NVAF who underwent brain T2-weighted, gradient-recalled echo MRI were included. Data for the date and causes of death were based on the death certificates from the Korean National Statistical Office. We determined the association of the presence, burden, and distribution of CMBs with mortality from all-cause, ischemic heart disease, ischemic stroke, and hemorrhagic stroke. CMBs were found in 30.7% of patients (155/504). During a median follow-up of 2.5 years, 176 patients (34.9%) died (ischemic stroke, 81; hemorrhagic stroke, 12; ischemic heart disease, 32). Patients with CMBs died more frequently than those without (41.9% vs 31.8%, p = 0.028). After adjusting for age, sex, and other significant variables, the presence of multiple (≥5) CMBs was as an independent predictor for all-cause (hazard ratio [HR]: 1.99) and ischemic stroke (HR: 3.39) mortality. Patients with strictly lobar CMBs had an increased risk of hemorrhagic stroke mortality (HR: 5.91). The presence and burden of CMBs were associated with increased mortality in stroke patients with NVAF. Patients with lobar CMBs were at increased risk of death due to hemorrhagic stroke. The diagnosis of CMBs is of value in predicting long-term prognosis in stroke patients with NVAF. © 2014 American Academy of Neurology.

  4. Effect of Chinese herbal medicine on stroke patients with type 2 diabetes.

    Science.gov (United States)

    Tsai, Fuu-Jen; Ho, Tsung-Jung; Cheng, Chi-Fung; Liu, Xiang; Tsang, Hsinyi; Lin, Ting-Hsu; Liao, Chiu-Chu; Huang, Shao-Mei; Li, Ju-Pi; Lin, Cheng-Wen; Lin, Jaung-Geng; Lin, Jung-Chun; Lin, Chih-Chien; Liang, Wen-Miin; Lin, Ying-Ju

    2017-03-22

    Complications of type 2 diabetes (T2D) include stroke, which is a cerebrovascular disturbance characterized by reduced blood flow in the brain, leading to death or physical disability. Chinese herbal medicine (CHM) has been widely used in ancient China for the treatment of diabetes and stroke by supplementing Qi and activating blood circulation. This study aimed to investigate the frequencies and patterns of CHM treatment for stroke patients with T2D and the outcomes of long-term use in Taiwan. We identified 3079 stroke patients (ICD-9-CM: 430-438) with T2D. We allocated 618 stroke patients, matched for age, gender, and T2D-to-stroke duration, to both CHM and non-CHM groups. Chi-square test, conditional multivariable logistic regression, Kaplan-Meier method, and the log-rank test were used in this study. The CHM group was characterized by more cases of chronic obstructive pulmonary disease, ulcer disease, hyperlipidemia, tobacco use, and higher income. The cumulative survival probability was higher in the CHM group (Pherbs, respectively. The use of CHM as adjunctive therapy may improve the overall survival (OS) of stroke patients with T2D. The list of the comprehensive herbal medicines that they used might be useful in future large-scale, randomized clinical investigations of agent effectiveness, safety, and potential interactions with conventional treatments in stroke patients with T2D. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  5. Changes in serum growth factors in stroke rehabilitation patients and their relation to hemiparesis improvement.

    Science.gov (United States)

    Okazaki, Hideto; Beppu, Hidehiko; Mizutani, Kenmei; Okamoto, Sayaka; Sonoda, Shigeru

    2014-07-01

    Predicting recovery from hemiparesis after stroke is important for rehabilitation. A few recent studies reported that the levels of some growth factors shortly after stroke were positively correlated with the clinical outcomes during the chronic phase. The aim of this study was to examine the relationships between the serum levels of growth factors (vascular endothelial growth factor [VEGF], insulin-like growth factor-I [IGF-I], and hepatocyte growth factor [HGF]) and improvement in hemiparesis in stroke patients who received rehabilitation in a postacute rehabilitation hospital. Subjects were 32 stroke patients (cerebral infarction: 21 and intracerebral hemorrhage [ICH]: 11). We measured serum levels of VEGF, IGF-I, and HGF and 5 items of the Stroke Impairment Assessment Set (SIAS) for hemiparesis on admission and at discharge. Age-matched healthy subjects (n=15) served as controls. Serum levels of VEGF and HGF in cerebral infarct patients on admission were higher than those in control subjects, and the serum levels of IGF-I in stroke patients were lower than those in controls. The level of HGF in ICH patients on admission was negatively correlated with gains in SIAS, and higher outliers in HGF concentration were correlated with lower gains in SIAS. Focusing on the extremely high levels of these factors may be a predictor of the low recovery from hemiparesis after stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Risk of sudden sensorineural hearing loss in stroke patients

    Science.gov (United States)

    Kuo, Chin-Lung; Shiao, An-Suey; Wang, Shuu-Jiun; Chang, Wei-Pin; Lin, Yung-Yang

    2016-01-01

    Abstract Poststroke sudden sensorineural hearing loss (SSNHL) can hinder communication between patients and healthcare professionals, thereby restricting participation in rehabilitation programs and limiting improvements in physical performance. However, the relationship between stroke and SSNHL remains unclear. This study employed a nationwide population-based dataset to investigate the relationship between stroke and SSNHL. The Taiwan Longitudinal Health Insurance Database was used to compile data from 11,115 stroke patients and a comparison cohort of 33,345 matched nonstroke enrollees. Each patient was followed for 5 years to identify new-onset SSNHL. Stratified Cox proportional-hazard regression analysis was used to examine the association of stroke with subsequent SSNHL. Among the 44,460 patients, 66 patients (55,378 person-years) from the stroke cohort and 105 patients (166,586 person-years) from the comparison cohort were diagnosed with SSNHL. The incidence of SSNHL was approximately twice as high among stroke patients than among nonstroke patients (1.19 and 0.63/1000 person-years, respectively). Stroke patients had a 71% increased risk of SSNHL, compared with nonstroke patients (adjusted hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.24–2.36). We also observed a remarkable increase in risk of SSNHL in stroke patients within 1-year of follow-up (adjusted HR 5.65, 95% CI 3.07–10.41) or under steroid therapy during hospitalization (adjusted HR 5.14, 95% CI 2.08–12.75). Patients with stroke had a higher risk of subsequent SSNHL compared with patients without stroke. In particular, stroke patients within 1-year follow-up and those undergoing steroid therapy during hospitalization should be treated with the utmost caution, considering that the risk of SSNHL increases by more than 5-fold. PMID:27603402

  7. Psychological problems affecting the prognosis of stroke patients

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND:It is believed that mental disorder influences the morbility and prognosis of cardio-cerebrovascular disease by biological factors.OBJECTIVE:To observe the characteristics of stroke patients complicated by psychological problems and the prognosis of such patients.DESIGN:Observational study.SETTING:Department of Neurology,Beijing Longfu Hospital.PARTICIPANTS:Totally 160 inpatients (46 males and 114 females) with stroke admitted to Department of Neurology,Beijing Longfu Hospital between June 2005 and June 2006 were recruited in this study.The involved patients all corresponded to the diagnosis criteria of cerebrovascular disease formulated in the 1995 National Conference of Cerebrovascular Disease and confirmed by skull CT or MRI examination.The age range was between 43 and 74 years.They all signed the informed consent for the detection and therapeutic regimen,and the application of this technique also gave the approval of the Ethics Committee of the hospital.METHODS:On admission,the patients were investigated on psychological problems using Hopkin symptom checklist.After admission,all the patients received oral administration of aspirin anti-platelet drugs and intravenous infusion of Fufang Danshen.Motor relearning program was used in the rehabilitation treatment for disability rehabilitation.Mental intervention was carried out in the end of observation period.On day 30 after admission,the recovery of two groups of patients was compared using activities of daily living scale,Scandinanvian Stroke Scale (SSS) and disability level.MAIN OUTCOME MEASURES:The activities of daily living were assessed with Barthel index.Higher scores of patients suggested better activities of daily living.For SSS,the higher points,the severer defect degree.The reduction of scores of neurologic impairment suggested that neurological function improved.Disability level was graded according to the method formulated in the Second National Cerebrovascular Conference.RESULTS:All the 160

  8. Evaluation of neurogenic dysphagia in Iraqi patients with acute stroke.

    Science.gov (United States)

    Hasan, Zeki N; Al-Shimmery, Ehsan K; Taha, Mufeed A

    2010-04-01

    To clinically assess neurogenic dysphagia, and to correlate its presence with demographic features, different stroke risk factors, anatomical arterial territorial stroke types, and pathological stroke types. Seventy-two stroke inpatients were studied between July 2007 and February 2008, at the Departments of Medicine and Neurology at Al-Yarmouk Teaching Hospital, Baghdad, and Rizgary Teaching Hospital, Erbil, Iraq. All patients were assessed using the Mann Assessment of Swallowing Ability score (MASA), Modified Rankin Scale, and the Stroke Risk Scorecard. All patients were reassessed after one month. There were 40 males and 32 females. Sixty-eight patients had ischemic stroke, and 4 had primary intracerebral hemorrhage (ICH). According to the MASA score, 55% of anterior circulation stroke (ACS) cases were associated with dysphasia, and 91% of lateral medullary syndrome cases were associated with dysphagia. Fifty-six percent of ACS dysphagic cases improved within the first month. Forty percent of dysphagic patients died in the one month follow up period, and in most, death was caused by aspiration pneumonia. We observed no significant differences regarding demographic features of dysphagia. Dysphagia can be an indicator of the severity of stroke causing higher mortality and morbidity in affected patients. It was not related to the stroke risk factors and the type of stroke. It is essential from a prognostic point of view to assess swallowing, and to treat its complications early.

  9. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial

    Science.gov (United States)

    Sit, Janet WH; Chair, Sek Ying; Choi, Kai Chow; Chan, Carmen WH; Lee, Diana TF; Chan, Aileen WK; Cheung, Jo LK; Tang, Siu Wai; Chan, Po Shan; Taylor-Piliae, Ruth E

    2016-01-01

    Background Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management. Purpose To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery. Methods This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P0.05). Those in IG had significantly better functional recovery (Barthel, all Pstroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long

  10. Characteristics of inpatient care and rehabilitation for acute first-ever stroke patients.

    Science.gov (United States)

    Chang, Won Hyuk; Shin, Yong-Il; Lee, Sam-Gyu; Oh, Gyung-Jae; Lim, Young Shil; Kim, Yun-Hee

    2015-01-01

    The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients. This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records. Both ischemic and hemorrhagic strokes were included. Survey items included demographic data, risk factors, stroke type, state of rehabilitation treatment, discharge destination, and functional status at discharge. A total of 2159 patients were reviewed. The mean age was 61.5±14.4 years and the ratio of males to females was 1.23:1. Proportion of ischemic stroke comprised 54.9% and hemorrhagic stroke 45.1%. Early hospital mortality rate was 8.1%. Among these patients, 27.9% received rehabilitation consultation and 22.9% underwent inpatient rehabilitation treatment. The mean period from admission to rehabilitation consultation was 14.5 days. Only 12.9% of patients were transferred to a rehabilitation department and the mean period from onset to transfer was 23.4 days. Improvements in functional status were observed in the patients who had received inpatient rehabilitation treatment after acute stroke management. Our analysis revealed that a relatively small portion of patients who suffered from an acute first-ever stroke received rehabilitation consultation and inpatient rehabilitation treatment. Thus, applying standardized clinical practice guidelines for post-acute rehabilitation care is needed to provide more effective and efficient rehabilitation services to patients with stroke.

  11. Posturo-respiratory synchronization: effects of aging and stroke.

    Science.gov (United States)

    Manor, Brad D; Hu, Kun; Peng, Chung-Kang; Lipsitz, Lewis A; Novak, Vera

    2012-06-01

    Spontaneous respiration influences the body's center-of-mass when standing. We contend that the healthy postural control system actively adapts to respiration, thereby minimizing its effect on postural sway. We therefore examined the interaction between respiration and postural sway, as measured by center-of-pressure (COP) oscillations, and quantified the extent to which this interaction resulted in "posturo-respiratory synchronization." We hypothesized that synchronization would be stronger in elderly subjects and those with stroke, and when standing with eyes closed as compared to open, due to alterations in the physiologic mechanisms that normally regulate postural sway. Twenty-five subjects with chronic hemispheric infarction and 38 controls (50-80 years) stood on a force platform for 3 min with eyes-open and 3 min with eyes-closed. Respiratory flow and COP dynamics were simultaneously recorded. The dominant oscillatory mode of respiration and the corresponding oscillatory modes of anterioposterior and mediolateral COP dynamics were extracted using ensemble empirical mode decomposition. The strength of posturo-respiratory synchronization was quantified from the regularity of instantaneous phase shifts between extracted respiratory and COP oscillations. Significant posturo-respiratory synchronization was only present in the anterioposterior direction. The strength of synchronization increased with age (pstroke patients (p=0.01). These observations suggest that a control system actively regulates the effects of respiration on sagittal-plane postural sway, particularly during eyes-open standing. As evidenced by increased posturo-respiratory synchronization with advanced age and central lesion, this novel metric may be used as a clinical marker of altered postural control.

  12. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial.

    Science.gov (United States)

    Sit, Janet Wh; Chair, Sek Ying; Choi, Kai Chow; Chan, Carmen Wh; Lee, Diana Tf; Chan, Aileen Wk; Cheung, Jo Lk; Tang, Siu Wai; Chan, Po Shan; Taylor-Piliae, Ruth E

    2016-01-01

    Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Patient empowerment intervention (HEISS) may influence self-efficacy in illness management

  13. The prevalence and risk factors of stroke in patients with chronic schizophrenia

    Directory of Open Access Journals (Sweden)

    Liang Y

    2016-05-01

    Full Text Available Ying Liang,1 Jian Huang,1 Jingbin Tian,2 Yuanyuan Cao,2 Guoling Zhang,2 Chungang Wang,2 Ying Cao,2 Jianrong Li2 1National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health, Peking University, 2Changping Traditional Chinese Medicine Hospital, Beijing, People’s Republic of China Objective: To investigate the stroke risk and risk factors in patients with chronic schizophrenia.Patients and methods: This study was a large-sample, cross-sectional survey. A total of 363 patients with chronic schizophrenia were selected from the Changping Traditional Chinese Medicine Hospital, Beijing, in August 2014. The patients were divided into either stroke group or control group based on the presence of stroke. Clinical evaluation included positive and negative syndrome scale assessment and a detailed questionnaire to collect the general information and disease-related conditions.Results: The prevalence of stroke was 16.5% (60 cases. Stroke and control groups showed a significant difference in age, sex, smoking, combined medication, doses, negative factor score in positive and negative syndrome scale, body mass index, waist circumference, and systolic blood pressure. Multivariate analysis showed that a number of factors are significantly related to stroke, including age, sex, smoking, combined medication, doses, body mass index, and systolic blood pressure.Conclusion: The prevalence of stroke is relatively higher in Chinese patients with chronic schizophrenia. Chronic schizophrenia patients are more likely to suffer from stroke; meanwhile, a number of risk factors were identified, including old age, female sex, smoking history, combined medication with a variety of drugs, high doses, obesity, and high blood pressure. Keywords: schizophrenia, stroke, risk, risk factors

  14. A Rare Case of Stroke Secondary to Iron Deficiency Anemia in a Young Female Patient

    Science.gov (United States)

    Gopalratnam, Kavitha; Sena, Kanaga; Gupta, Manisha

    2017-01-01

    Ischemic strokes occur when there is a sudden obstruction of an artery supplying blood flow to an area of the brain, leading to a focal neurological deficit. Strokes can be thrombotic or embolic in etiology and are associated with underlying conditions such as hypertension and atherosclerosis. Possible etiologies of strokes include cardioembolic disease, hematologic disorders, connective tissue disorders, and substance abuse or can be cryptogenic. Most stroke cases are seen in patients over 65 years of age. However, about one-fourth of strokes occur in young adults. Iron deficiency anemia (IDA) has been described as a known cause for strokes in children, but very few case reports describe this association in adults. We describe a 20-year-old female who presented with sudden onset left side weakness. Magnetic Resonance Imaging (MRI) of the brain demonstrated ischemic infarctions. Patient was also found to be severely anemic. Patient had a thorough work-up including Magnetic Resonance Angiography (MRA) of the brain, echocardiogram, and an extensive screen for thrombophilia disorders. This, however, did not demonstrate a clear etiology. As it has been suggested that IDA is a potential cause for stroke, it is possible the stroke in this young patient was attributable to severe IDA. PMID:28348599

  15. Combination of Low Body Mass Index and Low Serum Albumin Level Leads to Poor Functional Recovery in Stroke Patients.

    Science.gov (United States)

    Kimura, Yosuke; Yamada, Minoru; Kakehi, Tomohiro; Itagaki, Atsunori; Tanaka, Naoki; Muroh, Yasushi

    2017-02-01

    Nutritional status is associated with the functional recovery of stroke patients. This study aimed to examine the influence of the combination of body mass index (BMI) and serum albumin level on functional recovery in subacute stroke patients. This retrospective cohort study included 259 subacute stroke patients (mean age 68.9 ± 12.3 years). Patients were categorized into 4 groups according to their BMI and serum albumin level: group 1, low BMI (stroke patients than either factor alone. The combination of BMI and serum albumin level should be taken into account when predicting functional recovery in subacute stroke patients. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Detection of previously undiagnosed atrial fibrillation in patients with stroke risk factors and usefulness of continuous monitoring in primary stroke prevention.

    Science.gov (United States)

    Ziegler, Paul D; Glotzer, Taya V; Daoud, Emile G; Singer, Daniel E; Ezekowitz, Michael D; Hoyt, Robert H; Koehler, Jodi L; Coles, James; Wyse, D George

    2012-11-01

    The detection of undiagnosed atrial tachycardia/atrial fibrillation (AT/AF) among patients with stroke risk factors could be useful for primary stroke prevention. We analyzed newly detected AT/AF (NDAF) using continuous monitoring in patients with stroke risk factors but without previous stroke or evidence of AT/AF. NDAF (AT/AF >5 minutes on any day) was determined in patients with implantable cardiac rhythm devices and ≥1 stroke risk factors (congestive heart failure, hypertension, age ≥75 years, or diabetes). All devices were capable of continuously monitoring the daily cumulative time in AT/AF. Of 1,368 eligible patients, NDAF was identified in 416 (30%) during a follow-up of 1.1 ± 0.7 years and was unrelated to the CHADS(2) score (congestive heart failure, hypertension [blood pressure consistently >140/90 mm Hg or hypertension treated with medication], age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack). The presence of AT/AF >6 hours on ≥1 day increased significantly with increased CHADS(2) scores and was present in 158 (54%) of 294 patients with NDAF and a CHADS(2) score of ≥2. NDAF was sporadic, and 78% of patients with a CHADS(2) score of ≥2 with NDAF experienced AT/AF on risk patients was 72 days (interquartile range 13 to 177). In conclusion, continuous monitoring identified NDAF in 30% of patients with stroke risk factors. In patients with NDAF, AT/AF occurred sporadically, highlighting the difficulty in detecting paroxysmal AT/AF using traditional monitoring methods. However, AT/AF also persisted for >6 hours on ≥1 days in most patients with NDAF and multiple stroke risk factors. Whether patients with CHADS(2) risk factors but without a history of AF might benefit from implantable monitors for the selection and administration of anticoagulation for primary stroke prevention merits additional investigation.

  17. An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings

    OpenAIRE

    Irisawa, Taro; Iwami, Taku; Kitamura, Tetsuhisa; Nishiyama, Chika; Sakai, Tomohiko; Tanigawa-Sugihara, Kayo; Hayashida, Sumito; Nishiuchi, Tatsuya; Shiozaki, Tadahiko; Tasaki, Osamu; Kawamura, Takashi; Hiraide, Atsushi; Shimazu, Takeshi

    2013-01-01

    Background: Stroke is difficult to diagnose when consciousness is disturbed. However few reports have discussed the clinical predictors of stroke in out-of-hospital emergency settings. This study aims to evaluate the association between initial systolic blood pressure (SBP) value measured by emergency medical service (EMS) and diagnosis of stroke among impaired consciousness patients. Methods: We included all patients aged 18 years or older who were treated and transported by EMS, and had imp...

  18. Elevated factor VIII level and stroke in patients without traditional risk factors associated with cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Lasek-Bal A

    2013-06-01

    Full Text Available Anetta Lasek-Bal, Przemyslaw Puz, Zofia KazibutowskaStroke Unit, Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, PolandIntroduction: Hemostasis is affected by interactions between physiological processes, including those connected with the coagulation system, whose essence is converting fibrinogen into fibrin. The role of factor VIII (FVIII consists in activating factor X, which directly participates in the generation of thrombin, which is able to produce stable fibrin, which in turn forms blood clots. There are divergent opinions regarding the significance of high levels of FVIII in stroke pathogenesis.Aim: The aim of our study was to evaluate FVIII activity in individuals with cryptogenic stroke in order to determine a potential relationship between it and cerebral ischemia.Material and methods: Nine patients suffering with stroke were used in this study: six women and three men aged 49–63 years. In all of the patients, the presence of known and potential risk factors for stroke had been excluded during previous diagnostic procedures. These patients accounted for 1.2% of the 719 people who suffered a stroke and were hospitalized in 2011 at the Stroke Unit. FVIII activity was examined in each of the nine qualified subjects within 1–2 months of the occurrence of stroke (the first test and repeated (the second test in five patients with abnormal results obtained from the first examination.Results: Increased activity of FVIII was found in 5 out of 9 patients. In patients with abnormal results, elevated FVIII was found in follow-up examinations in the 8th–10th month following stroke. Hemodynamic abnormalities in carotid or cerebral artery (presence of thrombus were found in 3 of the 5 patients with increased FVIII levels. In the first 24 hours following stroke the neurological state of patients with abnormal FVIII was worse than individuals with normal FVIII activity. The

  19. PATIENT DEMOGRAPHIC, RISK FACTORS AND SEASONAL VARIATION IN ONSET OF STROKE

    Directory of Open Access Journals (Sweden)

    M. K. M. Kathyayani

    2016-10-01

    Full Text Available BACKGROUND Existence of particular chronobiological pattern in onset of acute cerebrovascular diseases characterised by circannual rhythms has been detected. India is a subtropical country with clear seasonal variations in weather conditions. Stroke causes death and disability worldwide. Seasons may influence stroke occurrence. The mechanisms underlying these seasonal variations of stroke are not fully understood, but a possible reason may include seasonal variation of biological factors such as arterial blood pressure, serum lipid levels and other blood components. Better understanding and controlling of risk factors associated with onset of stroke will improve the disease prevention. The objective of the present study is to examine the role of possible precipitating or triggering factors. This study reviews records of patients with stroke attending the Department of Medicine, KGH, Visakhapatnam. MATERIALS AND METHODS Patients with diagnosis of stroke attending the Department of Medicine, KGH, Visakhapatnam, were selected. Computed tomographic types of stroke, both ischaemic and haemorrhagic and risk factors associated were considered with tropical seasonal variation. RESULTS A total of 150 stroke patients were included in the study of which 93 (62% were males, 57 (38% were females and 46% in 50-65 years age group, 4% in 20-35 years, 28% in 35-50 years, 22% in 65-80 years and above age groups. Of the total, 93.33% presented with 1st attack and only 6.66% presented with recurrent stroke. The prevalence of types of stroke was: ischaemic stroke 54.66%, haemorrhagic stroke 45.33%. The prevalence of risk factors associated with stroke was - male gender 62%, smoking 56.66%, hypertension 56%, age >50 years 46%, alcohol consumption 43%, hyperlipidaemia 16.66%, consumption of alcohol and smoking together 13.33%, valvular heart diseases 6.66%. A high seasonal prevalence was observed in winter season (50.66%. CONCLUSION This study revealed that male

  20. Upper-limb motor control in patients after stroke: Attentional demands and the potential beneficial effects of arm support

    NARCIS (Netherlands)

    Houwink, A.; Steenbergen, B.; Prange, G.B.; Buurke, J.H.; Geurts, A.C.H.

    2013-01-01

    The goal of this study was to investigate the attentional load of using the upper limb in moderately and mildly affected patients after stroke, with and without arm support. Ten patients with stroke (4 mild and 6 moderate paresis) and ten healthy, gender- and age-matched control subjects performed a

  1. Upper-limb motor control in patients after stroke: Attentional demands and the potential beneficial effects of arm support.

    NARCIS (Netherlands)

    Houwink, A.; Steenbergen, B.; Prange, G.B.; Buurke, J.H.; Geurts, A.C.H.

    2013-01-01

    The goal of this study was to investigate the attentional load of using the upper limb in moderately and mildly affected patients after stroke, with and without arm support. Ten patients with stroke (4 mild and 6 moderate paresis) and ten healthy, gender- and age-matched control subjects performed a

  2. White matter changes in stroke patients. Relationship with stroke subtype and outcome

    DEFF Research Database (Denmark)

    Leys, D; Englund, E; Del Ser, T;

    1999-01-01

    or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... with vascular dementia. WMC are more frequent in patients with lacunar infarcts, deep intracerebral hemorrhages, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and cerebral amyloid angiopathy. After an acute ischemic stroke, WMC are associated with a higher risk...

  3. An associative Brain-Computer-Interface for acute stroke patients

    DEFF Research Database (Denmark)

    Mrachacz-Kersting, Natalie; Stevenson, Andrew James Thomas; Aliakbaryhosseinabadi, Susan

    2016-01-01

    An efficient innovative Brain-Computer-Interface system that empowers chronic stroke patients to control an artificial activation of their lower limb muscle through task specific motor intent has been tested in the past. In the current study it was applied to acute stroke patients. The system...

  4. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    OpenAIRE

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulati...

  5. Prevalence of brain MRI markers of haemorrhagic risk in patients with stroke and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Christopher Karayiannis

    2016-09-01

    Full Text Available Background and Purpose: Cerebral microbleeds, cortical superficial siderosis, white matter lesions and cerebral atrophy may signify greater bleeding risk particularly in patients in whom anticoagulation is to be considered. We investigated their prevalence and associations with stroke type in patients with stroke and atrial fibrillation. Material and Methods: Cross-sectional sample, Monash Medical Centre (Melbourne, Australia between 2010 and 2013, with brain MRI. MRI abnormalities were rated using standardized methods. Logistic regression was used to study associations adjusting for age and sex.Results: There were 170 patients, mean age 78 years (SD 9.8, 154 (90.6% with ischemic stroke. Prevalence of MRI markers were: any microbleed 49%, multiple (≥2 microbleeds 30%, confluent white matter lesions 18.8%, siderosis 8.9%, severe cerebral atrophy 37.7%. Combinations of the severe manifestations of these markers were much less prevalent (2.9% to 12.4%. Compared with ischemic stroke, those with hemorrhagic stroke were more likely to have ≥10 microbleeds (OR 5.50 95% CI 1.46-20.77, p=0.012 and siderosis (OR 6.24, 95% CI 1.74-22.40, p=0.005. Siderosis was associated with multiple microbleeds (OR 8.14, 95% CI 2.38 - 27.86, p = 0.001. Patients admitted with hemorrhagic stroke and multiple microbleeds were more frequently anticoagulated prior to stroke (6/7, 85.7% than in those with single (1/2, 50% or no microbleeds (4/7, 57%. Conclusion: Multiple CMBs, severe WML, and severe cerebral atrophy were common individually in hospitalized patients with stroke and AF, but less so in combination. A higher burden of CMBs may be associated with ICH in stroke patients with AF.

  6. Is air transport of stroke patients faster than ground transport?

    DEFF Research Database (Denmark)

    Hesselfeldt, Rasmus; Gyllenborg, Jesper; Steinmetz, Jacob;

    2014-01-01

    BACKGROUND: Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. METHODS: In this prospective controlled...... observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre...

  7. Effect of atorvastatin in elderly patients with a recent stroke or transient ischemic attack

    DEFF Research Database (Denmark)

    Chaturvedi, S; Zivin, J; Breazna, A;

    2009-01-01

    BACKGROUND: It is unclear whether patients age 65 years and over with a recent stroke or TIA benefit from statin treatment to a similar degree as younger patients. METHODS: The 4,731 patient cohort in the SPARCL study was divided into an elderly group (65 and over) and a younger group. The primar...

  8. Dyslipidemia and Outcome in Patients with Acute Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    XU Tian; ZHANG Jin Tao; YANG Mei; ZHANG Huan; LIU Wen Qing; KONG Yan; XU Tan; ZHANG Yong Hong

    2014-01-01

    ObjectiveTo study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. MethodsData about 1 568 patients with acute ischemic stroke werecollected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale (NIHSS) >10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. ResultsThe serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 (1.259, 7.214)/2.655 (1.298, 5.43), 3.157(1.306, 7.631)/3.405(1.621, 7.154), and 0.482 (0.245, 0.946)/0.51 (0.282, 0.921), respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke (chi-square=8.235, P=0.411). ConclusionSerum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.

  9. The Importance Of Patient Involvement In Stroke Rehabilitation

    DEFF Research Database (Denmark)

    Kristensen, Hanne Kaae; Tistad, Malin; Von Koch, Lena;

    2016-01-01

    Objective: To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. Method: Data...... was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess....... Conclusions: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs....

  10. The Importance of Patient Involvement in Stroke Rehabilitation

    DEFF Research Database (Denmark)

    Kristensen, Hanne Kaae; Tistad, Malin; Koch, Lena von

    2016-01-01

    OBJECTIVE: To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD: Data...... was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess....... CONCLUSIONS: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs....

  11. Long-term impact of stroke on patients' health-related quality of life.

    Science.gov (United States)

    De Wit, Liesbet; Theuns, Peter; Dejaeger, Eddy; Devos, Stefanie; Gantenbein, Andreas R; Kerckhofs, Eric; Schuback, Birgit; Schupp, Wilfried; Putman, Koen

    2017-07-01

    This international study aims to examine the size and determinants of the impact of stroke on five-year survivors' health-related quality of life (HRQoL) in four different European countries. Patients were recruited consecutively in four European rehabilitation centers. Five years after stroke, the EuroQol-visual analog scale (EQ-VAS) was administered in 226 first-ever stroke patients. Impact of stroke was determined by calculating EQ-VAS z-norm scores (= deviation - expressed in SD - of patients' EQ-VAS level relative to their age-and gender-matched national population norms). Determinants of EQ-VAS z-norm scores were identified using multivariate linear regression analysis. Five years post-stroke, patients' mean EQ-VAS was 63.74 (SD = 19.33). Mean EQ-VAS z-norm score was -0.57 [95%CI: (-0.70)-(-0.42)]. Forty percent of the patients had an EQ-VAS z-norm score +0.75 SD. Higher patients' levels of depression, anxiety and disability were associated with increasingly negative EQ-VAS z-norm scores (adjusted R(2)( )=( )0.392). Five years after stroke, mean HRQoL of stroke survivors showed large variability and was more than ½ SD below population norm. Forty percent had a HRQoL level below, 52% on, and 8% above population norm. The variability could only partially be explained by the variables considered in this study. Longitudinal studies are needed to increase our understanding of the size and determinants of the impact of stroke on the HRQoL of long-term stroke survivors. Implications for rehabilitation The current European concept of stroke rehabilitation is focused on the acute and sub-acute rehabilitation phase, i.e., in the first months after stroke. The results of this study show that at five years after stroke, the mean level of HRQoL of stroke survivors remains below the healthy population level. This finding shows the need for continuation of rehabilitation in the chronic phase. At five years after stroke, higher patients' levels of depression

  12. Differing Patterns of Altered Slow-5 Oscillations in Healthy Aging and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Christian eLa

    2016-04-01

    Full Text Available The ‘default-mode’ network (DMN has been investigated in the presence of various disorders, such as Alzheimer’s disease and Autism spectrum disorders. More recently, this investigation has expanded to include patients with ischemic injury. Here, we characterized the effects of ischemic injury in terms of its spectral distribution of resting-state low-frequency oscillations and further investigated whether those specific disruptions were unique to the DMN, or rather more general, affecting the global cortical system. With 43 young healthy adults, 42 older healthy adults, 14 stroke patients in their early stage (< 7 days after stroke onset, and 16 stroke patients in their later stage (between 1-6 months after stroke onset, this study showed that patterns of cortical system disruption may differ between healthy aging and following the event of an ischemic stroke. The stroke group in the later stage demonstrated a global reduction in the amplitude of the slow-5 oscillations (0.01-0.027 Hz in the DMN as well as in the primary visual and sensorimotor networks, two ‘task-positive’ networks. In comparison to the young healthy group, the older healthy subjects presented a decrease in the amplitude of the slow-5 oscillations specific to the components of the DMN, while exhibiting an increase in oscillation power in the task-positive networks. These two processes of a decrease DMN and an increase in ‘task-positive’ slow-5 oscillations may potentially be related, with a deficit in DMN inhibition, leading to an elevation of oscillations in non-DMN systems. These findings also suggest that disruptions of the slow-5 oscillations in healthy aging may be more specific to the DMN while the disruptions of those oscillations following a stroke through remote (diaschisis effects may be more widespread, highlighting a non-specificity of disruption on the DMN in stroke population. The mechanisms underlying those differing modes of network disruption need

  13. Differing Patterns of Altered Slow-5 Oscillations in Healthy Aging and Ischemic Stroke.

    Science.gov (United States)

    La, Christian; Mossahebi, Pouria; Nair, Veena A; Young, Brittany M; Stamm, Julie; Birn, Rasmus; Meyerand, Mary E; Prabhakaran, Vivek

    2016-01-01

    The 'default-mode' network (DMN) has been investigated in the presence of various disorders, such as Alzheimer's disease and Autism spectrum disorders. More recently, this investigation has expanded to include patients with ischemic injury. Here, we characterized the effects of ischemic injury in terms of its spectral distribution of resting-state low-frequency oscillations and further investigated whether those specific disruptions were unique to the DMN, or rather more general, affecting the global cortical system. With 43 young healthy adults, 42 older healthy adults, 14 stroke patients in their early stage (stroke onset), and 16 stroke patients in their later stage (between 1 to 6 months after stroke onset), this study showed that patterns of cortical system disruption may differ between healthy aging and following the event of an ischemic stroke. The stroke group in the later stage demonstrated a global reduction in the amplitude of the slow-5 oscillations (0.01-0.027 Hz) in the DMN as well as in the primary visual and sensorimotor networks, two 'task-positive' networks. In comparison to the young healthy group, the older healthy subjects presented a decrease in the amplitude of the slow-5 oscillations specific to the components of the DMN, while exhibiting an increase in oscillation power in the task-positive networks. These two processes of a decrease DMN and an increase in 'task-positive' slow-5 oscillations may potentially be related, with a deficit in DMN inhibition, leading to an elevation of oscillations in non-DMN systems. These findings also suggest that disruptions of the slow-5 oscillations in healthy aging may be more specific to the DMN while the disruptions of those oscillations following a stroke through remote (diaschisis) effects may be more widespread, highlighting a non-specificity of disruption on the DMN in stroke population. The mechanisms underlying those differing modes of network disruption need to be further explored to better inform

  14. Evaluation of the relative risk of stroke in patients with hypertension using cerebrovascular hemodynamic accumulative score

    Institute of Scientific and Technical Information of China (English)

    HUANG Jiuyi; WANG Guiqing; GUO Jiping; CAO Yifeng; WANG Yan; YANG Yongju; YU Xuehai

    2007-01-01

    The relative risk(RR)of stroke in patients with hypertension was evaluated by using synthetic index of cerebrovascular hemodynamics.A total of 7,371 patients with hypertension with ages≥40 years were selected from a population-based cohort study of the risk factors for stroke.The data on the baseline investigation of risk factors,the determination of cerebrovascular hemodynamic parameters (CVHP),and stroke follow-up were analyzed.The RR of stroke in patients with hypertension was evaluated by CVHP scores.Univariate analysis indicated that hypertension,complicated by other risk factors,had significant statistical association with the onset of stroke.RRS for stroke when hypertension complicated with decrease of hemodynamic scores,heart disease,cigarette smoking and alcohol consumption were 4.93(95%CI,3.26-7.45),1.90(95%CI,1.36-2.66),1.99(95%CI,1.42-2.79)and 1.73(95%CI,1.19-2.53)respectively.In multivariate analysis,hemodynamic score,age,sex,cigarette smoking,family history of stroke and systolic blood pressure were selected by the Cox regression for inclusion in the final analysis.Among them,the RR of hemodynamic score was highest.The analysis of doseresponse relationships indicated that when the hemodynamic scores in patients with hypertension were lower than 75 points,the RR of stroke at 75,60,45,30 and 15 points were 2.85,4.43,4.54,5.40 and 9.88,respectively.The risk of stroke in patients with hypertension is closely associated with hemodynamic impairment and the hemodynamic score may be used for quantitative evaluation of relative risks of stroke.

  15. Neurofunctional assessment in a stroke patient with musical hallucinations.

    Science.gov (United States)

    Calabrò, Rocco Salvatore; Baglieri, Annalisa; Ferlazzo, Edoardo; Passari, Smeralda; Marino, Silvia; Bramanti, Placido

    2012-01-01

    We reported a case of an elderly female patient affected by musical hallucinations (MHs) as the unique symptom of a right temporal ischemic stroke. A functional magnetic resonance imaging examination was performed in the patient and in five age- and sex-matched normal controls (NC) to detect the complex neural substrate subserving MHs in such a context. Although an activation pattern involving the primary auditory cortex and the temporal associative areas bilaterally was found in the patient and NC, a significant increased activation mostly located in right temporal cortex (in the ischemic area), was observed in the patient. Further functional neuroimaging studies should be performed to detect the complex neural pathways underlying MHs and to find out differences between these hallucinations and real music perception.

  16. Effect of statin use on clinical outcomes in ischemic stroke patients with atrial fibrillation

    Science.gov (United States)

    Wu, Yi-Ling; Saver, Jeffrey L.; Chen, Pei-Chun; Lee, Jiann-Der; Wang, Hui-Hsuan; Rao, Neal M.; Lee, Meng; Ovbiagele, Bruce

    2017-01-01

    Abstract It remains unclear whether statin therapy should be applied to ischemic stroke patients with atrial fibrillation. The objective of this study was to clarify whether statin therapy can influence the prognosis in recent ischemic stroke patients with atrial fibrillation. We identified ischemic stroke patients with atrial fibrillation between 2001 and 2011 from Taiwan National Health Insurance Database. Patients not treated with statins during the first 90 days after the index stroke were matched to patients treated with statins in the first 90 days in a 2:1 ratio on the basis of age, sex, hypertension, diabetes mellitus, ischemic heart disease, heart failure, estimated National Institutes of Health Stroke Scale, use of anticoagulant, and year of their entry into the cohort. The primary outcome was the first event of recurrent stroke, and the secondary outcome was in-hospital death. A total of 1546 atrial fibrillation patients with statin therapy in the first 90 days poststroke and 3092 matched atrial fibrillation nonstatin controls were enrolled for this analysis. During the median 2.4-year follow-up, the risk of recurrent stroke was not different between subjects receiving versus not receiving statin therapy (hazard ratios = 1.01, 95% confidence interval 0.88 to 1.15). However, patients with atrial fibrillation receiving statin therapy had a reduced risk for death during any hospitalization throughout the long-term follow-up period (hazard ratios = 0.74, 95% confidence interval 0.61 to 0.89). Among ischemic stroke patients with atrial fibrillation, statin therapy initiated during the acute to subacute poststroke stage did not alter the rate of stroke recurrence but was associated with a decreased rate of in-hospital death. PMID:28151869

  17. Characterization of stroke- and aging-related changes in the complexity of EMG signals during tracking tasks.

    Science.gov (United States)

    Ao, Di; Sun, Rui; Tong, Kai-Yu; Song, Rong

    2015-04-01

    To explore the stroke- and aging-induced neurological changes in paretic muscles from an entropy point of view, fuzzy approximate entropy (fApEn) was utilized to represent the complexity of EMG signals in elbow-tracking tasks. In the experiment, 11 patients after stroke and 20 healthy control subjects (10 young and 10 age-matched adults) were recruited and asked to perform elbow sinusoidal trajectory tracking tasks. During the tests, the elbow angle and electromyographic (EMG) signals of the biceps brachii and triceps brachii were recorded simultaneously. The results showed significant differences in fApEn values of both biceps and triceps EMG among four groups at six velocities (p stroke patients stroke patients age-matched controls aged-matched controls and in the aged individuals in comparison with young controls might be the reduction in the number and firing rate of active motor units. This method and index provide evidence of neurological changes after stroke and aging by complexity analysis of the surface EMG signals. Further studies are needed to validate and facilitate the application in clinic.

  18. Depression and coping styles of stress in patients with stroke

    OpenAIRE

    Barreda S., Dennys; Facultad de Psicología, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    The stroke is defined as the sudden interruption of blood flow in vessels in any area of the brain. The presence of depression is given with great regularity in those affected. Also, people with more stress are potential candidates for developing stroke. For this reason, this research describe the relationship between depression and stress coping styles, in a sample of 50 stroke patients treated at the outpatient service of neurology at Daniel Alcides Carrion Hospital . For this purpose used ...

  19. Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study

    Science.gov (United States)

    2014-01-01

    Background Stroke complications can occur not only in the acute ward but also during the subsequent rehabilitation period. However, existing studies have not adequately addressed the incidence of various complications among stroke in patients undergoing rehabilitation using a longitudinal method. We aimed to investigate the longitudinal impact of age on complication rates in patients undergoing inpatient stroke rehabilitation at different disease stages. Methods Five hundred and sixty-eight first-time stroke patients transferred to the rehabilitation ward between July 2002 and June 2012 were included in the study. Patients were stratified into age groups for comparison: rehabilitation ward, and incidence was >10% in all three age groups. The frequency of incidence of upper gastrointestinal bleeding (UGIB) was higher in the younger old (17.9%) and older old (20.6%) groups than in the young group (4.1%) during initial stay in the rehabilitation ward (p rehabilitation ward (p = 0.011). The incidence of symptomatic UTI was higher in the younger old (21.0%) and older old (20.0%) groups than in the young group (11.5%) during initial stay in the rehabilitation ward (p = 0.019). The incidence of symptomatic UTI was higher in the older old group (29.17%) than in the younger old (9.21%) and young (3.14%) groups during subsequent stay in the rehabilitation ward (p stroke patients aged ≥65 years during their stay in the rehabilitation ward. PMID:24684939

  20. Risk factors for swallowing dysfunction in stroke patients

    Directory of Open Access Journals (Sweden)

    Anna Flávia Ferraz Barros Baroni

    2012-06-01

    Full Text Available CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

  1. Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients.

    LENUS (Irish Health Repository)

    von Sarnowski, Bettina

    2013-03-06

    OBJECTIVE: Atherosclerosis is believed to be a minor cause of TIA and stroke in younger and middle-aged patients. However, data from large cohorts are limited. This study investigates the prevalence of extracranial and intracranial atherosclerosis in stroke and TIA patients aged 18-55 years in the multinational sifap1 study. METHODS: From the sifap1 cohort (n = 5,023), we analyzed a subset of patients with complete data from carotid ultrasound studies. Patients with arterial dissections, vasculitis, and mobile thrombi were excluded. Among the remaining 2,187 patients (men: n = 1,319; 18-44 years: n = 744), intracranial arteries were additionally examined with ultrasonography in 1,612 patients (73.7%). Patients were stratified by sex and age groups (younger: 18-44 years; middle-aged: 45-55 years). RESULTS: In patients with ischemic stroke, the overall prevalence of carotid artery stenoses and occlusions was 8.9% (younger: 4.9%; middle-aged: 11.0%), of which 81% were symptomatic. Nonstenotic carotid plaques were more common in men than in women (15.8% vs 7.7%; p < 0.001), and in middle-aged than in younger patients (17.0% vs 4.9%; p < 0.001). Supratentorial intracranial artery stenoses and occlusions amounted to 11.8%. Supratentorial stenoses occurred more frequently in middle-aged patients (13.0% vs 7.8%; p < 0.001), whereas occlusions were equally common (both 3.2%; not significant). CONCLUSIONS: We observed a substantial proportion of atherosclerotic carotid artery stenoses and occlusions in younger stroke patients. Intracranial stenoses and occlusions were even more prevalent than extracranial carotid artery disease. Together with nonstenotic plaques, one-fifth of patients (21.2%) had symptomatic or asymptomatic large-artery atherosclerosis, which should encourage future stroke prevention campaigns to target risk factor modification in young people.

  2. Characteristics and outcome of stroke patients with cerebrovascular accident at the intensive care unit of a tertiary hospital in Nigeria.

    Science.gov (United States)

    Tobi, Ku; Okojie, Nq

    2013-01-01

    Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial. Aim & Objectives: To determine the characteristics and outcome of patients with cerebrovascular accident managed at the Intensive Care Unit of University of Benin Teaching Hospital. Demographic characteristics, clinical features and course, treatment options and outcome of all stroke patients admitted in ICU from January 2002 to January 2012 were retrieved from the hospital records and analyzed. A patient before and after each stroke patient were selected as controls for the study. Primary outcome variable was ICU mortality, type of stroke whether ischemic or haemorrhagic, duration of stay, whether patients were transferred from the medical/stroke ward or from the accident and emergency department of the hospital. A total of thirty six (36) stroke patients were admitted into the ICU within the study period accounting for 5.6% of the total ICU admissions. The male: female ratio is 2:1 and patients aged >60 years accounted for 55.6%. Stroke patients admitted into ICU had a mortality rate of 77.8%. Patients with severe stroke admitted into the ICU were 4 times more likely to die compared to non-stroke patients in the ICU (p=0.002, OR=4.472). However, severe stroke had no significant impact on duration of ICU stay (p=0.454, OR=1.464). Stroke patients have a high mortality in the intensive care unit that is independent on the type and route of admission. Provision of the support equipment and instruments required for high dependency service in the intensive care unit and early admission should improve the outcome.

  3. Utility of Ward-Based Retinal Photography in Stroke Patients.

    Science.gov (United States)

    Frost, Shaun; Brown, Michael; Stirling, Verity; Vignarajan, Janardhan; Prentice, David; Kanagasingam, Yogesan

    2017-03-01

    Improvements in acute care of stroke patients have decreased mortality, but survivors are still at increased risk of future vascular events and mitigation of this risk requires thorough assessment of the underlying factors leading to the stroke. The brain and eye share a common embryological origin and numerous similarities exist between the small vessels of the retina and brain. Recent population-based studies have demonstrated a close link between retinal vascular changes and stroke, suggesting that retinal photography could have utility in assessing underlying stroke risk factors and prognosis after stroke. Modern imaging equipment can facilitate precise measurement and monitoring of vascular features. However, use of this equipment is a challenge in the stroke ward setting as patients are frequently unable to maintain the required seated position, and pupil dilatation is often not feasible as it could potentially obscure important neurological signs of stroke progression. This small study investigated the utility of a novel handheld, nonmydriatic retinal camera in the stroke ward and explored associations between retinal vascular features and stroke risk factors. This camera circumvented the practical limitations of conducting retinal photography in the stroke ward setting. A positive correlation was found between carotid disease and both mean width of arterioles (r = .40, P = .00571) and venules (r = .30, P = .0381). The results provide further evidence that retinal vascular features are clinically informative about underlying stroke risk factors and demonstrate the utility of handheld retinal photography in the stroke ward. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. ANNUAL FORECAST IN PATIENTS WITH ACUTE ISCHEMIC STROKE: ROLE OF PATHOLOGICAL ANKLE-BRACHIAL INDEX

    Directory of Open Access Journals (Sweden)

    A. N. Sumin

    2016-01-01

    Full Text Available Aim. To study the factors associated with a poor annual prognosis in patients with acute stroke and prognostic role of pathological ankle-brachial index (ABI.Material and methods. The study included 345 patients (age 63.6±7.8 years, 181 males and 164 females with ischemic stroke that were observed for 1 year. All patients were divided into 2 groups: Group 1 included patients with favorable annual outcome of stroke; Group 2 included patients that during a year had any clinical events including death. All patients underwent a standard neurological and instrumental examination including assessment of peripheral arteries status by sphygmomanometry.Results. Both groups did not differ by age and sex. The frequency of unfavorable outcomes (death, re-stroke, cardiovascular events 1 year after ischemic stroke was 29.5%. Chronic heart failure, atrial fibrillation, previous cardiovascular events, presence of peripheral atherosclerosis, overweight were identified most commonly in Group 2. Patients of Group 2 initially had a rough neurological deficit. The pathological ABI was detected in 70.7% of patients in Group 2 vs 33.8% of patients in Group 1 (p=0.000001. A strong relationship of pathological ABI with a poor outcome of stroke was found by regression analysis.Conclusions. Detection of pathological ABI in patients with ischemic stroke makes it possible to reveal peripheral atherosclerosis and to carry out the targeted preventive measures in these patients. Risk stratification can contribute to more individual and effective secondary prevention in patients with cerebrovascular disease. 

  5. Reasons for diagnostic delay in patient with out-of-hospital acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Tongge Wang; Qi Ma

    2006-01-01

    BACKGROUND:Time window is a common problem in various therapies of acute ischemic stroke,and diagnostic duration plays an important role in prognosis.OBJECTIVE:To analyze the main reasons for out-of-hospital diagnostic delay of patients with acute ischemic stroke.DESIGN:Survey and analysis.SETTING:Department of Neurology,the First Affiliated Hospital of Jinan University.PARTICIPANTS: A total of 116 patients with acute ischemic stroke were selected from the Department of Neurology,the First Affiliated Hospital of Jinan University from December 2002 to December 2005,including 79 males and 37 females aged fnom 35 to 90 years with the mean age of(65+10)years.All patients met the diagnostic criteda of "mainly diagnostic points of various cerebrovascular diseases"established by the 4th National Cerebrovascular Diseases Meeting in 1995.Patients having acute ischemic stroke in hospital were excluded.Moreover,32 nurses received questionnaires of partial items.All patients and nurses provided informed consent.METHODS:①Information,such as social Position,educational level and incomes,was added up based on questionnaires.②Out-of-hospital diagnostic delay was surveyed based on the recorded time of patients treated in emergency department and out-patient clinic or during hospitalization. ③Ability of patients and nurses to identify symptoms of stroke dudng an early period was evaluated:meanwhile,understanding concept of stroke and using emergent system of social medicine by patients were surveyed,Especially.whether Patients understood the emergent number"120" or not and how they used it practically were investigated further.④Attitude and behavior of patients to stroke were surveyed.⑤Whether patients were able to identify the symptoms of stroke or not was investigated;furthermore,identification of stroke by patients and nurses was dealt with semi-quantitative analysis.The scores ranged from-10 to 10.The higher the scores were,the better the identification was

  6. Low back pain prevalence and characteristics in caregivers of stroke patients: a pilot study.

    Science.gov (United States)

    Yalcinkaya, Ebru Yilmaz; Ones, Kadriye; Ayna, Ata Bora; Turkyilmaz, Aysegul Kucukali; Erden, Nuran

    2010-01-01

    The aim of this study was to determine the frequency and features of low back pain (LBP) among stroke caregivers. Participants included 64 caregivers of stroke survivors in our inpatient clinic. Age, gender, body weight, FIMTM, and Brunnstrom Scale of patients and low back pain history, Short Form-36 (SF-36), Beck Depression Measure (BDM), and Oswestry Disability Scale (ODS) of caregivers were reported. Descriptive statistics, Spearman correlation, and Mann-Whitney U test were used. Fifty-three (82.8 %) of caregivers had LBP. Stroke survivors of caregivers with LBP (group 1) had significantly lower FIMTM scores when compared with stroke survivors of caregivers without LBP (group 2) (P Caregivers had a higher frequency of LBP in this study. However it was a study with a small number of participants. There are many studies about stroke caregivers' depression and life quality. LBP should also be investigated.

  7. Vision-related quality of life in first stroke patients with homonymous visual field defects

    Directory of Open Access Journals (Sweden)

    Sabel Bernhard A

    2010-03-01

    Full Text Available Abstract Background To evaluate vision-related and health-related quality of life (VRQoL, HRQoL in first stroke patients with homonymous visual field defects (VFD with respect to the extent of the lesion. Since VFD occur in approximately 10% of stroke patients the main purpose of the study was to investigate the additional impact of VFD in stroke patients hypothesizing that VFD causes diminished VRQoL. Methods In 177 first stroke patients with persisting VFD 2.5 years after posterior-parietal lesions VRQoL was assessed by the National-Eye-Institute-Visual-Functioning-Questionnaire (NEI-VFQ and HRQoL by the Medical-Outcome-Study Short-Form-36 Health-Survey (SF-36. Questionnaire results of VFD-patients were compared with age- and sex-matched healthy controls and with general non-selected stroke samples as published elsewhere. VFD-type and visual acuity were partially correlated with questionnaire results. Results Compared to healthy controls VFD-patients had lower NEI-VFQ scores except ocular pain (Z-range -11.34 to -3.35 and lower SF-36 scores except emotional role limitations (Z-range -7.21 to -3.34. VFD-patients were less impaired in SF-36 scores than general stroke patients one month post lesion (6/8 subscales but had lower SF-36 scores compared to stroke patients six months post lesion (5/8 subscales. Visual acuity significantly correlated with NEI-VFQ scores (r-range 0.27 to 0.48 and VFD-type with SF-36 mental subscales (r-range -0.26 to -0.36. Conclusions VFD-patients showed substantial reductions of VRQoL and HRQoL compared to healthy normals, but better HRQoL compared to stroke patients one month post lesion. VFD-patients (although their lesion age was four times higher had significantly lower HRQoL than a general stroke population at six months post-stroke. This indicates that the stroke-related subjective level of HRQoL impairment is significantly exacerbated by VFD. While VRQoL was primarily influenced by visual acuity, mental

  8. Vision-related quality of life in first stroke patients with homonymous visual field defects

    Science.gov (United States)

    2010-01-01

    Background To evaluate vision-related and health-related quality of life (VRQoL, HRQoL) in first stroke patients with homonymous visual field defects (VFD) with respect to the extent of the lesion. Since VFD occur in approximately 10% of stroke patients the main purpose of the study was to investigate the additional impact of VFD in stroke patients hypothesizing that VFD causes diminished VRQoL. Methods In 177 first stroke patients with persisting VFD 2.5 years after posterior-parietal lesions VRQoL was assessed by the National-Eye-Institute-Visual-Functioning-Questionnaire (NEI-VFQ) and HRQoL by the Medical-Outcome-Study Short-Form-36 Health-Survey (SF-36). Questionnaire results of VFD-patients were compared with age- and sex-matched healthy controls and with general non-selected stroke samples as published elsewhere. VFD-type and visual acuity were partially correlated with questionnaire results. Results Compared to healthy controls VFD-patients had lower NEI-VFQ scores except ocular pain (Z-range -11.34 to -3.35) and lower SF-36 scores except emotional role limitations (Z-range -7.21 to -3.34). VFD-patients were less impaired in SF-36 scores than general stroke patients one month post lesion (6/8 subscales) but had lower SF-36 scores compared to stroke patients six months post lesion (5/8 subscales). Visual acuity significantly correlated with NEI-VFQ scores (r-range 0.27 to 0.48) and VFD-type with SF-36 mental subscales (r-range -0.26 to -0.36). Conclusions VFD-patients showed substantial reductions of VRQoL and HRQoL compared to healthy normals, but better HRQoL compared to stroke patients one month post lesion. VFD-patients (although their lesion age was four times higher) had significantly lower HRQoL than a general stroke population at six months post-stroke. This indicates that the stroke-related subjective level of HRQoL impairment is significantly exacerbated by VFD. While VRQoL was primarily influenced by visual acuity, mental components of HRQoL were

  9. A cerebrovascular stroke following endoscopy for an elderly patient ...

    African Journals Online (AJOL)

    Ahmed Gado

    2015-02-02

    Feb 2, 2015 ... for an elderly patient with acute upper gastrointestinal bleeding. ... Peer review under responsibility of Alexandria University Faculty of. Medicine. ... endoscopy, the patient suffered an ischemic-cerebrovascular stroke leaving ...

  10. Correlation between the Quality of Attention and Cognitive Competence with Motor Action in Stroke Patients

    Directory of Open Access Journals (Sweden)

    S. Arsic

    2015-01-01

    Full Text Available It is considered that cognitive function and attention could affect walking, motion control, and proper conduct during the walk. To determine whether there is a difference in the quality of attention and cognitive ability in stroke patients and patients without neurological damage of similar age and education and to determine whether the connection of attention and cognition affects motor skills, the sample consisted of 50 stroke patients tested with hemiparesis, involved in the process of rehabilitation, and 50 persons, randomly chosen, without neurological damage. The survey used the following tests: Trail Making (TMT A B test for assessing the flexibility of attention; Mini-Mental State Examination (MMSE for cognitive status; Functional Ambulation Category (FAC test to assess the functional status and parameters of walk: speed, frequency, and length of stride; STEP test for assessing the precision of movement and balance. With stroke patients, relationship between age and performance on the MMSE test was marginally significant. The ratio of performance to TMT A B test and years does not indicate statistical significance, while statistical significance between the MMSE test performance and education exists. In stroke patients, performance on MMSE test is correlated with the frequency and length of stride walk. The quality of cognitive function and attention is associated with motor skills but differs in stroke patients and people without neurological damage of similar age. The significance of this correlation can supplement research in neurorehabilitation, improve the quality of medical rehabilitation, and contribute to efficient recovery of these patients.

  11. Prevalence and Risk Factors for Delirium in Acute Stroke Patients. A Retrospective 5-Years Clinical Series.

    Science.gov (United States)

    Alvarez-Perez, Francisco José; Paiva, Fatima

    2017-03-01

    Delirium is characterized by disturbances of attention and cognition that cause functional decline and complications. The predisposing factors of delirium are age, male gender, systemic or metabolic disorders, dementia, and stroke. This study aims to evaluate the prevalence of delirium and to identify risk factors. This is a retrospective study that includes patients admitted over 5 years with acute stroke. Patients with transient ischemic attack or venous thrombosis were excluded. Delirium was defined according the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographical characteristics, clinical-radiological profile, dependence on discharge (modified Rankin Scale score of ≥3 and Barthel Index delirium. A total of 1161 patients were admitted (910 ischemic and 162 hemorrhagic). During hospitalization, 118 patients presented with delirium (10.2%) and 93 died (8%). On discharge, 517 patients were dependent (44.5%). Delirium was significantly associated with age, male gender, cortical infarcts in anterior circulation, higher leukocyte count, cholesterol and fibrinogen levels, lower albumin, atrial fibrillation, previous diagnosis of Alzheimer's disease, and hemorrhagic stroke. Logistic regression results showed that only previous Alzheimer's disease was related to delirium (odds ratio 21.68 [95% confidence interval 1.190-395.026, P = .038]). Dependence on discharge was associated with delirium. Ten percent of the patients presented with delirium associated with older age, Alzheimer's disease, and cortical anterior stroke. Patients with delirium had a higher risk of functional dependence on discharge. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Variables That Best Differentiate In-Patient Acute Stroke from Stroke-Mimics with Acute Neurological Deficits

    Directory of Open Access Journals (Sweden)

    P. Natteru

    2016-01-01

    Full Text Available Introduction. Strokes and stroke-mimics have been extensively studied in the emergency department setting. Although in-hospital strokes are less studied in comparison to strokes in the emergency department, they are a source of significant direct and indirect costs. Differentiating in-hospital strokes from stroke-mimics is important. Thus, our study aimed to identify variables that can differentiate in-hospital strokes from stroke-mimics. Methods. We present here a retrospective analysis of 93 patients over a one-year period (2009 to 2010, who were evaluated for a concern of in-hospital strokes. Results. About two-thirds (57 of these patients were determined to have a stroke, and the remaining (36 were stroke-mimics. Patients with in-hospital strokes were more likely to be obese (p=0.03, have been admitted to the cardiology service (p=0.01, have atrial fibrillation (p=0.03, have a weak hand or hemiparesis (p=0.03, and have a prior history of stroke (p=0.05, whereas, when the consults were called for “altered mental status” but no other deficits (p<0.0001, it is likely a stroke-mimic. Conclusion. This study demonstrates that in-hospital strokes are a common occurrence, and knowing the variables can aid in their timely diagnosis and treatment.

  13. A STUDY ON THE CLINICAL CORRELATION OF THE GLYCAEMIC STATUS AND STROKE EVENTS AMONG STROKE PATIENTS ADMITTED IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    K. Ghanachandra Singh

    2016-09-01

    Full Text Available BACKGROUND AND OBJECTIVES Stroke is a common cause of chronic debilitating disease as a result of the vascular related effect of certain part of the brain. Also the mortality due to the nature of stroke either Intracerebral Haemorrhage (ICH or Cerebral Infarction (Ischaemic stroke vary, the earlier causing more fatality. The risk factors of the ICH or the Ischaemic stroke vary to certain degree. Glycaemic state of stroke patients affects the outcome of them. It is of importance to establish clinical correlation of the glycaemic status of the stroke patients with the type and extent of the lesion documented by Computerised Tomography (CT scan of brain for development of preventive measures and clinical management of such patients for better outcome. Hence, this study was conducted among stroke patients who were admitted in Medicine wards, Jawaharlal Nehru Institute of Medical Sciences (JNIMS, Porompat, Manipur. DATA AND METHODS A study of stroke cases was undertaken in patients who were admitted to Medicine wards, Jawaharlal Nehru Institute of Medical Sciences (JNIMS, Porompat, Manipur from January 2011 till December 2014. All the patients were investigated with CT scan brain, Blood sugar along with Glycosylated Haemoglobin (HbA1C besides other routine tests and recorded. RESULT Out of the 200 stroke patients registered in 48 months, 120 patients were having hyperglycaemia. All the patients with stress hyperglycaemia were haemorrhagic. 85.71% of the cases among known diabetes were also haemorrhagic. CONCLUSION Glycaemic state of patients presented in stroke gives a picture of clinical difference. The size of the lesion measured by CT scan of brain also varies among different types of hyperglycaemia and the prognosis of the patients and showed that those patients with higher glucose level had haemorrhagic lesions with bigger size and had higher mortality rate. The deteriorating glucose tolerance with age also contributes to the increased incidence

  14. Stroke Among Patients With Dizziness, Vertigo, and Imbalance in the Emergency Department: A Population-Based Study

    Science.gov (United States)

    Kerber, Kevin A.; Brown, Devin L.; Lisabeth, Lynda D.; Smith, Melinda A.; Morgenstern, Lewis B.

    2006-01-01

    Background and Purpose Dizziness, vertigo, and imbalance are common presenting symptoms in the emergency department. Stroke is a leading concern even when these symptoms occur in isolation. The objective of the present study was to determine the “real-world” proportion of stroke among patients presenting to the emergency department with these dizziness symptoms (DS). Methods From a population-based study, patients >44 years of age presenting with DS to the emergency department, or directly admitted to the hospital, were identified. Demographics, the frequency of new cerebrovascular events, and the frequency of isolated DS (ie DS with no other stroke screening term or accompanying neurologic signs or symptoms) were assessed. Multivariable logistic regression was used to evaluate the association of age, gender, ethnicity, and isolated DS with stroke/transient ischemic attack (TIA). The association of the presenting symptoms with stroke/TIA was also assessed. Results Stroke/TIA was diagnosed in 3.2% (53 of 1666) of all patients with DS. Only 0.7% (9 of 1297) of those with isolated DS had a stroke/TIA. Patients with stroke/TIA were slightly older than those without stroke/TIA (69.3±11.7 vs 65.3±12.9, P=0.02). Male gender was associated with stroke/TIA, whereas isolated DS was negatively associated with stroke/TIA. Patients with imbalance (dizziness as referent) were more likely to have stroke/TIA. Conclusions The proportion of cerebrovascular events in patients presenting with dizziness, vertigo, or imbalance is very low. Isolated dizziness, vertigo, or imbalance strongly predicts a noncerebrovascular cause. The symptom of imbalance is a predictor of stroke/TIA. PMID:16946161

  15. Association between Atrial Fibrillation and Three-Year Mortality in Nondiabetic Patients with Acute First-Ever Ischemic Stroke.

    Science.gov (United States)

    Chu, Chun-Hsueh; Weng, Wei-Chieh; Su, Feng-Chieh; Peng, Tsung-I; Chien, Yu-Yi; Wu, Chia-Lun; Lee, Kuang-Yung; Wei, Yi-Chia; Lin, Shun-Wen; Yu, Yi-Jing; Huang, Wen-Yi

    2016-11-01

    Diabetes mellitus (DM) is a risk factor for atrial fibrillation (AF) and is known to be an important risk factor for death from stroke. The influence of AF on long-term outcomes in patients with ischemic stroke remains controversial. To clarify the exact influence of AF on stroke outcome and exclude the effect from DM, we investigated the influence of AF on the 3-year outcomes of nondiabetic patients with acute first-ever ischemic stroke. Five-hundred seventy-four nondiabetic patients with acute first-ever ischemic stroke were enrolled and had been followed for 3 years. Patients were divided into 2 groups according to whether AF was diagnosed or not. Clinical presentations, risk factors for stroke, laboratory data, comorbidities, and outcomes were recorded. A total of 107 patients (18.6%) had AF. The age was significantly older in patients with AF. Total anterior circulation syndrome occurred more frequently among patients with AF (P acute ward was significantly higher in patients with AF (P acute first-ever ischemic stroke. Careful cardiac evaluation and treatment are essential in patients with AF and stroke. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Age- and stroke-related skeletal muscle changes: a review for the geriatric clinician.

    Science.gov (United States)

    Sions, Jaclyn Megan; Tyrell, Christine M; Knarr, Brian A; Jancosko, Angela; Binder-Macleod, Stuart A

    2012-01-01

    Independently, aging and stroke each have a significant negative impact on skeletal muscle, but the potential cumulative effects of aging and stroke have not been explored. Optimal interventions for individuals post stroke may include those that specifically target skeletal muscle. Addressing changes in muscles may minimize activity limitations and enhance participation post stroke. This article reviews the impact of aging and stroke on muscle morphology and composition, including fiber atrophy, reductions in muscle cross-sectional area, changes in muscle fiber distributions, and increases in intramuscular fat. Relationships between changes in muscle structure, muscle function, and physical mobility are reviewed. Clinical recommendations that preserve and enhance skeletal muscle in the aging adult and individuals post stroke are discussed. Future research directions that include systematic comparison of the differences in skeletal muscle between younger and older adults who have sustained a stroke are suggested.

  17. Cognitive Deficits in Chronic Stroke Patients: Neuropsychological Assessment, Depression, and Self-Reports

    Directory of Open Access Journals (Sweden)

    Arne E. Nakling

    2017-08-01

    Full Text Available Background: Following stroke, clinicians are challenged to detect and untangle symptoms of cognitive dysfunction and mood disorders. Additionally, they need to evaluate the informative value of self-reports to identify patients in need of further attendance. Aims: To examine the association between neuropsychological measures, symptoms of depression, and self-reported cognitive function. Methods: One-hundred and five chronic stroke patients underwent assessment covering 6 cognitive domains and answered the Hospital Anxiety and Depression Scale and the Memory and Thinking Scale from the Stroke Impact Scale 1 year after stroke. Age and gender difference in cognitive impairment were examined; linear regression was used to predict depression scores. Sensitivity and specificity analyses were used to validate self-reported functioning against performance on cognitive tests. Results: Cognitive impairment was observed in 60% of the patients in at least 1 cognitive domain. Cognitive performance was associated with symptoms of depression as well as with self-reported cognitive function. The final analyses revealed low sensitivity and specificity for the Memory and Thinking subscale from the Stroke Impact Scale. Conclusion: Cognitive impairment occurs frequently even in patients in a chronic phase after stroke and predicts symptoms of depression. Using the Stroke Impact Scale, clinicians should be aware of low sensitivity of self-reported cognitive function.

  18. Evaluation of Factors Influencing Sensory Disability in Cerebral Stroke Patients

    Directory of Open Access Journals (Sweden)

    K Ghandehari

    2010-06-01

    Full Text Available Introduction: Clinical findings affecting disability in stroke patients are important as presence of these factors determines the prognosis and future course of these patients. Methods: Consecutive stroke patients admitted at Ghaem hospital, Mashhad were enrolled in this prospective study in 2008. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was evaluated in these patients. Disability score was based on the Modified Ranking Disability Score (MRDS, 72 hours post stroke. Mean of MRDS was analyzed by T test and Fisher tests and p<0.05 was considered as significant. Results: A total of 329 stroke patients were investigated. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was found in 37.4%, 13.8%, 7.9% and 7.3% of the patients, respectively. MRDS was significantly higher in patients with hemianesthesia as compared to other stroke patients, (p<0.001. MRDS of patients with hemihypoestheisa, hemineglect and homonyous hemianopsia was not significantly different than patients without these abnormalities (p=0.44, p=023 and p=0.83. Patients with triad of hemianesthesia, hemineglect and homonymous hemianopsia had significantly higher MRDS than others (p<0.001. Conclusion: Hemianesthesia is a clinical factor affecting sensory disability in cerebral stroke patients. Presence of the above triad could increase MRDS in these patients.

  19. Effects of percutaneous endoscopic gastrostomy on survival of patients in a persistent vegetative state after stroke.

    Science.gov (United States)

    Wu, Kunpeng; Chen, Ying; Yan, Caihong; Huang, Zhijia; Wang, Deming; Gui, Peigen; Bao, Juan

    2017-10-01

    To assess the effect of percutaneous endoscopic gastrostomy on short- and long-term survival of patients in a persistent vegetative state after stroke and determine the relevant prognostic factors. Stroke may lead to a persistent vegetative state, and the effect of percutaneous endoscopic gastrostomy on survival of stroke patients in a persistent vegetative state remains unclear. Prospective study. A total of 97 stroke patients in a persistent vegetative state hospitalised from January 2009 to December 2011 at the Second Hospital, University of South China, were assessed in this study. Percutaneous endoscopic gastrostomy was performed in 55 patients, and mean follow-up time was 18 months. Survival rate and risk factors were analysed. Median survival in the 55 percutaneous endoscopic gastrostomy-treated patients was 17·6 months, higher compared with 8·2 months obtained for the remaining 42 patients without percutaneous endoscopic gastrostomy treatment. Univariate analyses revealed that age, hospitalisation time, percutaneous endoscopic gastrostomy treatment status, family financial situation, family care, pulmonary infection and nutrition were significantly associated with survival. Multivariate analysis indicated that older age, no gastrostomy, poor family care, pulmonary infection and poor nutritional status were independent risk factors affecting survival. Indeed, percutaneous endoscopic gastrostomy significantly improved the nutritional status and decreased pulmonary infection rate in patients with persistent vegetative state after stroke. Interestingly, median survival time was 20·3 months in patients with no or one independent risk factors of poor prognosis (n = 38), longer compared with 8·7 months found for patients with two or more independent risk factors (n = 59). Percutaneous endoscopic gastrostomy significantly improves long-term survival of stroke patients in a persistent vegetative state and is associated with improved nutritional status

  20. Effects of Music Therapy on Mood in Stroke Patients

    OpenAIRE

    Kim, Dong Soo; Park, Yoon Ghil; Choi, Jung Hwa; Im, Sang-Hee; Jung, Kang Jae; Cha, Young A; Jung, Chul Oh; Yoon, Yeo Hoon

    2011-01-01

    Purpose To investigate the effects of music therapy on depressive mood and anxiety in post-stroke patients and evaluate satisfaction levels of patients and caregivers. Materials and Methods Eighteen post-stroke patients, within six months of onset and mini mental status examination score of over 20, participated in this study. Patients were divided into music and control groups. The experimental group participated in the music therapy program for four weeks. Psychological status was evaluated...

  1. The Association of Lesion Location and Sleep Related Breathing Disorder in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Teuber, Anja; Wersching, Heike; Young, Peter; Dittrich, Ralf; Ritter, Martin; Dziewas, Rainer; Minnerup, Jens

    2017-01-01

    Background and aims Sleep related breathing disorders (SRBD) are common in patients with ischemic stroke and are associated with poor outcome. SRBD after stroke were assumed to be a direct consequence of injury of specific central nervous system structures. However, whether specific locations of ischemic infarcts cause SRBD is yet unknown. We therefore investigated the association of ischemic lesion location with SRBD. Methods Patients with acute ischemic stroke treated on our stroke unit were included in a prospective observational study. All patients underwent magnetic resonance imaging (MRI) and polygraphy in the acute phase after stroke. SRBD was defined by an apnea—hypopnea index (AHI) ≥10. MRI were evaluated using standardized maps to depict voxel-wise probability distribution of infarction for patients with and without SRBD. Groups were compared using logistic regression analysis. Results Of 142 patients included, 86 (59%) had a SRBD. Age, body mass index and prevalence of arterial hypertension were significantly higher in patients with SRBD. There was no statistically significant association between any lesion location and SRBD. Conclusion We found no association of lesion location and SRBD in stroke patients, whereas established risk factors for SRBD, known from general population, were significantly associated with SRBD. Given the high prevalence of SRBD in stroke patients, these findings suggest that cerebral ischemia facilitates the occurrence of SRBD in patients with pre-existing risk factors rather than causing it by damaging specific central nervous system structures. Our findings can be used to identify stroke patients who might benefit from polygraphy screening. PMID:28135315

  2. Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring.

    Science.gov (United States)

    Thakkar, Sandeep; Bagarhatta, Rajeev

    2014-01-01

    Paroxysmal atrial fibrillation and flutter are strong risk factors for stroke. Due to high recurrence rate of ischemic events and given the benefit of oral anticoagulation over antiplatelet drugs, it is important to identify this arrhythmia. Unfortunately, paroxysmal AF or flutter is asymptomatic in majority and therefore, difficult to detect. Consecutive patients presenting with symptoms of acute ischemic stroke or transient ischemic attack were included. All patients free of AF or flutter on presentation underwent 24 h Holter monitoring within 7 days of admission. Overall, fifty two (52) patients (mean age 59.51 ± 13.45 years) with acute stroke (80.8%) and TIA (19.8%) underwent 24 h Holter monitoring. Paroxysmal AF was detected in 3 cases (5.8%), all 3 patients had acute stroke and were older than age 60 years. Type of stroke was the only factor which was associated with greater risk of having paroxysmal AF or flutter, AF accounted for 50% cases (2 out of 4) of clinically suspected cardio embolic stroke. Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 17 patients. Older age and type of stroke are strongly associated with increased risk. By carefully selecting the patients, the detection rates could be further increased. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  3. Delayed gait recovery in a stroke patient

    Institute of Scientific and Technical Information of China (English)

    Jeong Pyo Seo; Mi Young Lee; Yong Hyun Kwon; Sung Ho Jang

    2013-01-01

    We report on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage. This 32-year-old female patient underwent craniotomy and drainage for right intracerebral hemorrhage due to rupture of an arteriovenous malformation. Brain MR images revealed a large leukomalactic lesion in the right fronto-parietal cortex. Diffusion tensor tractography at 8 months after onset revealed that the right corticospinal tract was severely injured. At this time, the patient could not stand or walk despite undergoing rehabilitation from 2 months after onset. It was believed that severe spasticity of the left leg and right ankle was largely responsible, and thus, antispastic drugs, antispastic procedures (alcohol neurolysis of the motor branch of the tibial nerve and an intramuscular alcohol wash of both tibialis posterior muscles) and physical therapy were tried to control the spasticity. These measures relieved the severe spasticity, with the result that the patient was able to stand at 3 months. In addition, the improvements in sensorimotor function, visuospatial function, and cognition also seemed to contribute to gait recovery. As a result, she gained the ability to walk independently on even floor with a left ankle foot orthosis at 11 months after onset. This case illustrates that clinicians should attempt to find the months after onset.

  4. Impact of Polypharmacy on the Rehabilitation Outcome of Japanese Stroke Patients in the Convalescent Rehabilitation Ward

    Directory of Open Access Journals (Sweden)

    Eiji Kose

    2016-01-01

    Full Text Available Background. A risk factor associated with stroke onset is chronic kidney disease (CKD. To prevent stroke reoccurrence, it is necessary to strictly manage blood pressure, lipids, and plasma glucose. Therefore, some cases are forced to polypharmacy, elderly patients in particular. Polypharmacy often leads to adverse drug reactions and has the potential to negatively affect the rehabilitation of stroke patients. The aim of the present study was to investigate the effects of polypharmacy using a functional independence measure (FIM. Methods. A total of 144 stroke patients with CKD were included in the present analysis. We divided stroke patients into those taking six or more drugs (polypharmacy group and those taking less than six drugs (nonpolypharmacy group upon admission. Patient background features, laboratory data, and FIM scores were compared. Results. FIM-Motor (FIM-M efficiency, age, and diabetes mellitus were positively associated with polypharmacy. FIM-M efficiency in the polypharmacy group was significantly lower than in the nonpolypharmacy group. Conclusion. Polypharmacy interferes with the effect of rehabilitation in stroke patients with CKD. Pharmacists and doctors should make efforts to optimize medications to be able to respond to the outcome of each patient.

  5. Improved nutritional status in elderly patients 6 months after stroke.

    Science.gov (United States)

    Brynningsen, P K; Damsgaard, E M S; Husted, S E

    2007-01-01

    Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery, length of stay in hospital and infectious complications. 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months and 6 months. Nutritional status was evaluated by body weight, body mass index (BMI), mid upper arm circumference (MAC), triceps skinfold thickness (TSF) and serum concentrations of albumin and transferrin. Malnutrition was defined if the patients had 2 or more abnormal nutritional variables. We found a significant increase in albumin from 1 week to 6 months (P nutritional variables was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months. 35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables showed improvement for serum proteins, and 22 % of the patients were malnourished 6 months after stroke.

  6. Factors associated with strain in informal caregivers of stroke patients.

    Science.gov (United States)

    Hung, Jen-Wen; Huang, Yu-Ching; Chen, Jin-Hua; Liao, Li-Na; Lin, Chun-Ju; Chuo, Chia-Ying; Chang, Ku-Chou

    2012-01-01

    Stroke is one of the most prevalent causes of adult disability and handicap. Informal caregivers play an important role in poststroke care. However, informal caregivers may experience strain, which threatens the recovery of stroke subjects. This study aimed to describe changes in strain experienced by informal caregivers from 3 to 6 months after the stroke, and identify the predicting factors. We recruited pairs of inpatients with ischemic stroke and informal caregivers from a tertiary referral hospital and interviewed them at 3 and 6 months after the stroke. Caregiver strain was evaluated using the Caregiver Strain Index (CSI), with a CSI ≥ 7 indicating considerable caregiver strain. Various factors associated with caregiver strain were analyzed using generalized estimating equations. Eighty-nine stroke patients and caregivers completed the study. Considerable strain was reported in 46% and 43% of the caregivers at the 3rd and 6th month, respectively. Patient factors such as severe disabilities (Barthel Index ≤ 60), poor cognition (Mini-Mental State Examination ≤ 23), depression (Beck Depression Inventory [BDI] ≥ 10), and recurrent stroke were predictors for caregiver strain. Caregiver factors, such as changed employment status, help from formal caregivers, and depression (BDI ≥ 10) were also associated with considerable caregiver strain. Nearly 50% of caregivers experienced considerable strain. Interventions aimed at reducing the caregivers' strain should focus on enhancing the functional and emotional status of stroke subjects, prevention of recurrent stroke, and efficient management of depression symptoms in caregivers.

  7. Frequency of Hyperthermia in Acute Ischemic Stroke Patients Visiting a Tertiary Care Hospital.

    Science.gov (United States)

    Maheshwari, Amrat Kumar; Kumar, Pawan; Alam, Muhammad Tanveer; Aurangzeb, Muhammad; Parkash, Jai; Imran, Khalid; Masroor, Muhammad

    2016-06-01

    To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country. Cross-sectional, observational study. Medical Wards of Civil Hospital, Karachi, from January to June 2013. Patients aged ≥18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA). Atotal of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 ±9.5 years. Among these, 61 (57.5%) were males and 45 (42.5%) females. Among all patients, 51.9% presented with loss of consciousness, 30.2% with slurred speech, 77.4% with limb weakness, and 9.4% with decrease vision. Atotal of 17 (16%) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of ischemic stroke was 16% and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia.

  8. Mechanical thrombectomy with snare in patients with acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Alejandro; Mayol, Antonio [Hospital Universitario Virgen del Rocio, Interventional Neuroradiology, Department of Radiology, Seville (Spain); Martinez, Eva; Gonzalez-Marcos, Jose R.; Gil-Peralta, Alberto [Hospital Universitario Virgen del Rocio, Department of Neurology, Seville (Spain)

    2007-04-15

    We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS). This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2-4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively. Nine patients (mean age 55 years, range 17-69 years) were included. Their basal mean NIHSS score was 16 (range 12-24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50-75 min). At 3 months, the mRSS score was 0 in two patients and 3-4 in three patients (two patients died). According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS. (orig.)

  9. Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Ali, Farwa; Young, Jimmy; Rabinstein, Alejandro A; Flemming, Kelly D; Fugate, Jennifer E

    2016-05-01

    Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients. We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men. Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease. Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Risk of Recurrent Neurologic Stroke or Transient Ischemic Attack in Patients with Cryptogenic Stroke and Intrapulmonary Shunt.

    Science.gov (United States)

    Sinha, Rahul S; Hussain, Zeeshan; Bhatia, Nirmanmoh; Stoddard, Marcus F

    2016-02-01

    Cardio-embolic phenomenon is believed to underlie a significant proportion of cryptogenic strokes. We recently showed that intrapulmonary shunt (IPS) was associated with cryptogenic stroke and transient ischemic attack (TIA). We hypothesized that patients with prior cryptogenic stroke or TIA that had an IPS were at a higher risk for recurrent ischemic events. The population included subjects with cryptogenic cerebrovascular accident (CVA) or TIA. Inclusion criteria were age ≥18 years, sinus rhythm, and clinically indicated transesophageal echocardiography (TEE). Exclusion criteria were hemorrhagic CVA, septal defect, and patent foramen. Patients were followed from index TEE. Of 71 patients, 8 were lost to follow-up. A total of 23 patients had and 40 were without IPS. Average follow-up duration was 38.3 ± 19.2 months. Groups were similar at baseline. There was no significant difference in the recurrence of ischemic CVA or TIA in the IPS versus non-IPS groups (0% vs. 7.5%; P = NS). There was no difference between the incidence of hemorrhagic CVA in the IPS and non-IPS groups (4.3% vs. 5.0%; P = NS). The proportion of patients on warfarin in the IPS group was significantly higher compared to the non-IPS group (17.4% vs. 0%; P stroke or TIA did not have a higher recurrence of ischemic cerebral events. Warfarin was significantly higher at follow-up in the IPS compared to the non-IPS group, which may explain these findings. A study randomizing patients with IPS and cryptogenic stroke or TIA to warfarin or no warfarin would be of great interest. © 2015, Wiley Periodicals, Inc.

  11. Income and education as predictors of return to working life among younger stroke patients

    Directory of Open Access Journals (Sweden)

    Kåreholt Ingemar

    2011-09-01

    Full Text Available Abstract Background Socioeconomic conditions are not only related to poor health outcomes, they also contribute to the chances of recovery from stroke. This study examines whether income and education were predictors of return to work after a first stroke among persons aged 40-59. Methods All first-stroke survivors aged 40-59 who were discharged from a hospital in 1996-2000 and who had received income from work during the year prior to the stroke were sampled from the Swedish national register of in-patient care (n = 7,081. Income and education variables were included in hazard regressions, modelling the probability of returning to work from one to four years after discharge. Adjustments for age, sex, stroke subtype, and length of in-patient care were included in the models. Results Both higher income and higher education were associated with higher probability of returning to work. While the association between education and return to work was attenuated by income, individuals with university education were 13 percent more likely to return than those who had completed only compulsory education, and individuals in the highest income quartile were about twice as likely to return as those in the lowest. The association between socioeconomic position and return to work was similar for different stroke subtypes. Income differences between men and women also accounted for women's lower probability of returning to work. Conclusions The study demonstrates that education and income were independent predictors of returning to work among stroke patients during the first post-stroke years. Taking the relative risk of return to work among those in the higher socioeconomic positions as the benchmark, there may be considerable room for improvement among patients in lower socioeconomic strata.

  12. Stroke

    Science.gov (United States)

    ... rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke. NIH: National Institute of Neurological Disorders and Stroke

  13. The FAST-ED App: A Smartphone Platform for the Field Triage of Patients With Stroke.

    Science.gov (United States)

    Nogueira, Raul G; Silva, Gisele S; Lima, Fabricio O; Yeh, Yu-Chih; Fleming, Carol; Branco, Daniel; Yancey, Arthur H; Ratcliff, Jonathan J; Wages, Robert Keith; Doss, Earnest; Bouslama, Mehdi; Grossberg, Jonathan A; Haussen, Diogo C; Sakano, Teppei; Frankel, Michael R

    2017-05-01

    The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved. The FAST-ED (Field Assessment Stroke Triage for Emergency Destination) application is based on a built-in automated decision-making algorithm that relies on (1) a brief series of questions assessing patient's age, anticoagulant usage, time last known normal, motor weakness, gaze deviation, aphasia, and hemineglect; (2) a database of all regional stroke centers according to their capability to provide endovascular treatment; and (3) Global Positioning System technology with real-time traffic information to compute the patient's eligibility for intravenous tissue-type plasminogen activator or endovascular treatment as well as the distances/transportation times to the different neighboring stroke centers in order to assist Emergency Medical Services professionals with the decision about the most suitable destination for any given patient with acute ischemic stroke. The FAST-ED smartphone application has great potential to improve the triage of patients with acute ischemic stroke, as it seems capable to optimize resources, reduce hospital arrivals times, and maximize the use of both intravenous tissue-type plasminogen activator and endovascular treatment ultimately leading to better clinical outcomes. Future field studies are needed to properly evaluate the impact of this tool in stroke outcomes and resource utilization. © 2017 American Heart Association, Inc.

  14. Stroke occurring in patients with cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Solène Moulin

    Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

  15. Bexarotene targets autophagy and is protective against thromboembolic stroke in aged mice with tauopathy

    Science.gov (United States)

    Huuskonen, Mikko T.; Loppi, Sanna; Dhungana, Hiramani; Keksa-Goldsteine, Velta; Lemarchant, Sighild; Korhonen, Paula; Wojciechowski, Sara; Pollari, Eveliina; Valonen, Piia; Koponen, Juho; Takashima, Akihiko; Landreth, Gary; Goldsteins, Gundars; Malm, Tarja; Koistinaho, Jari; Kanninen, Katja M.

    2016-01-01

    Stroke is a highly debilitating, often fatal disorder for which current therapies are suitable for only a minor fraction of patients. Discovery of novel, effective therapies is hampered by the fact that advanced age, primary age-related tauopathy or comorbidities typical to several types of dementing diseases are usually not taken into account in preclinical studies, which predominantly use young, healthy rodents. Here we investigated for the first time the neuroprotective potential of bexarotene, an FDA-approved agent, in a co-morbidity model of stroke that combines high age and tauopathy with thromboembolic cerebral ischemia. Following thromboembolic stroke bexarotene enhanced autophagy in the ischemic brain concomitantly with a reduction in lesion volume and amelioration of behavioral deficits in aged transgenic mice expressing the human P301L-Tau mutation. In in vitro studies bexarotene increased the expression of autophagy markers and reduced autophagic flux in neuronal cells expressing P301L-Tau. Bexarotene also restored mitochondrial respiration deficits in P301L-Tau neurons. These newly described actions of bexarotene add to the growing amount of compelling data showing that bexarotene is a potent neuroprotective agent, and identify a novel autophagy-modulating effect of bexarotene. PMID:27624652

  16. Improving pain assessment and managment in stroke patients.

    Science.gov (United States)

    Nesbitt, Julian; Moxham, Sian; Ramadurai, Gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.

  17. Inpatient rehabilitation outcomes of patients with apraxia after stroke.

    Science.gov (United States)

    Wu, Andy J; Burgard, Emily; Radel, Jeff

    2014-01-01

    Stroke-induced paresis commands much attention during rehabilitation; other stroke-related consequences receive less consideration. Apraxia is a stroke disorder that may have important implications for rehabilitation and recovery. To investigate association of apraxia with stroke rehabilitation outcomes during inpatient rehabilitation. This cohort study compared patients with and without apraxia after a first left hemispheric stroke. All study patients received standard of care. Clinical measures were the Functional Independence Measure (FIM) and the upper extremity section of the Fugl-Meyer Assessment (FMA) administered upon admission and at discharge. Length of stay was also documented. Florida Apraxia Battery subtests were used to classify patients with apraxia. Fifteen patients were included in this study, 10 of whom had apraxia. Data analysis revealed that patients with apraxia exhibited improvement from admission to discharge in clinical measures; however, admission FIM score was significantly lower compared to patients without apraxia. There was no statistically significant difference between groups on FMA score, length of stay, or amount of change on clinical measures. This study of acute patients found those with apraxia to be significantly less independent upon admission to inpatient rehabilitation compared to patients without apraxia. Although both groups improved a similar amount during rehabilitation, patients with apraxia discharged at a level of independence comparable to patients without apraxia upon admission. Such disparity in independence is of concern, and apraxia as a factor in stroke rehabilitation and recovery deserves further attention.

  18. Results of the seven-year prospective study of stroke patients.

    Science.gov (United States)

    Scmidt, E V; Smirnov, V E; Ryabova, V S

    1988-08-01

    Using the registry method, 1,538 stroke patients were detected in one district of Moscow between January 1, 1972, and December 31, 1974. Of the 965 patients who survived the acute stage of stroke (the first 3 weeks after onset), 941 (505 women and 436 men) were followed for the next 7 years. We analyzed incidence and types of recurrent strokes. During this 7-year follow-up, we recorded 32.1% of the patients as having recurrent strokes, most of which developed in the first 3 years and especially during the first year after the index stroke. The majority of recurrent strokes were of the same type as the index stroke and were localized in the same area of the brain. The cumulative mortality rates for the initial 1,538 patients were 37.3% dead by 3 weeks, 63.6% dead by 3 years, 72.1% dead by 5 years, and 76.5% dead by 7 years. In the first 3 months (excluding the first 3 weeks), most patients who died died of pulmonary thromboembolism. The mortality rate from recurrent strokes and pneumonia was higher than that from cardiovascular mortality. Transient ischemic attacks occurred in 49.5% of all patients and myocardial infarction in 16.4%. Functional prognosis was determined mainly by age, motor function, and concomitant diseases. After 1 year, 68.2% of the surviving patients were fully independent, while 81% of those surviving 7 years had reached this level. A significant number of patients were capable of returning to their previous work.

  19. Dyslipidaemia among diabetic patients with ischemic stroke in a Chinese hospital

    Institute of Scientific and Technical Information of China (English)

    WANG Shao-hua; SUN Zi-lin; RUAN Xiong-zhong; GUO Yi-jing; WANG Yao; JIN Hui; YUAN Yang; WEI Qiong

    2009-01-01

    Background Dyslipidaemia is a potential independent risk factor for cerebrovascular disease in patients with diabetes.The aim of this study was to investigate dyslipidaemia,treatment and control of dyslipidaemia among diabetic patients with ischemic stroke in a Chinese hospital.Methods A total of 1046 type 2 diabetic patients were assigned to diabetes with(n=522)and diabetes without stroke groups.The two groups were matched by gender,age and diabetes duration.Lipid and lipoprotein profile were measured.Serum level and control of lipids were assessed and classified according to Amedcan Diabetes Association(ADA)guidelines and an intensified low density lipoprotein-cholesterol(LDL-C)target recommended in Chinese dyslipidaemia control criteria.Results Diabetic patients suffering stroke displayed not only poorly-controlled lipid and lipoprotein profiles,including the significantly lower proportion of patients achieving intensified LDL-C target of<2.07 mmol/L(80 mg/dl),and high density lipoprotein-cholesterol(HDL-C)target(14.4% vs 21.0%,P=0.005;45.8% vs 51.9%,P=0.048 respectively),but also less adherence to therapy prescribed for dyslipidaemia(30.8% vs 41.0%,P=0.001),when compared with diabetic patients without stroke.For the diabetic women with stroke,situation of dyslipidaemia was worse,with significantly lower serum level of HDL-C and apoA1,higher LDL-C level and higher ratio of apoB/apoA1 when compared with diabetic counterparts without stroke.Conclusions Many diabetic patients with ischernic stroke remain uncontrolled for dyslipidaemia.Intensified LDL-C and overall lipid lowering clinical goals are potential precautions taken against ischemic stroke among diabetic patients in China.

  20. Early depression screening is feasible in hospitalized stroke patients.

    Directory of Open Access Journals (Sweden)

    Rahul R Karamchandani

    Full Text Available Post-stroke depression (PSD is common but is not routinely assessed for in hospitalized patients. As a Comprehensive Stroke Center, we screen all stroke inpatients for depression, though the feasibility of early screening has not been established. We assessed the hypothesis that early depression screening in stroke patients is feasible. We also explored patient level factors associated with being screened for PSD and the presence of early PSD.The medical records of all patients admitted with ischemic stroke (IS or intracerebral hemorrhage (ICH between 01/02/13 and 15/04/13 were reviewed. A depression screen, modified from the Patient Health Questionnaire-9, was administered (maximum score 27, higher scores indicating worse depression. Patients were eligible if they did not have a medical condition precluding screening. Feasibility was defined as screening 75% of all eligible patients.Of 303 IS and ICH inpatients, 70% (211 were eligible for screening, and 75% (158 of all eligible patients were screened. More than one-third of all patients screened positive for depression (score > 4. Women (OR 2.06, 95% CI 1.06-4.01 and younger patients (OR 0.97, 95% CI 0.96-0.99 were more likely to screen positive. Screening positive was not associated with poor discharge/day 7 outcome (mRS > 3; OR 1.45, 95% CI 0.74-2.83.Screening stroke inpatients for depression is feasible and early depression after stroke is common. Women and younger patients are more likely to experience early PSD. Our results provide preliminary evidence supporting continued screening for depression in hospitalized stroke patients.

  1. High-quality Health Information Provision for Stroke Patients

    Institute of Scientific and Technical Information of China (English)

    Hong-Sheng Du; Jing-Jian Ma; Mu Li

    2016-01-01

    Objective:High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making,better manage the stroke,and make a good recovery.In this study,we reviewed information needs of stroke patients,methods for providing information to patients,and considerations needed by the information providers.Data Sources:The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015.Study Selection:We included all the relevant articles on information provision for stroke patients in English,with no limitation of study design.Results:Stroke is a major public health concern worldwide.High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare,and empowering them to effectively self-manage their long-standing chronic conditions.Different methods for providing information to patients have their relative merits and suitability,and as a result,the effective strategies taken by health professionals may include providing high-quality information,meeting patients' individual needs,using suitable methods in providing information,and maintaining active involvement of patients.Conclusions:It is suggested that to enable stroke patients to access high-quality health information,greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs.Health professionals should use suitable information delivery methods,and actively involve stroke patients in information provision.

  2. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    BACKGROUND: Uncertainty remains about whether stroke affects men and women similarly. We studied differences between men and women with regard to stroke severity and survival. METHODS AND RESULTS: We used the Danish Stroke Registry, with information on all hospital admissions for stroke in Denmark...... between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death...... reported on death certificates as due to stroke was related to the index stroke if death occurred within the first week or month after stroke. Multivariate Cox regression analysis and multiple imputation were applied. Stroke was the cause of death for 4373 and 5512 of the 79 617 patients within 1 week (5...

  3. Intracranial Pressure Elevation 24 Hours after Ischemic Stroke in Aged Rats is Prevented by Early, Short Hypothermia Treatment

    Directory of Open Access Journals (Sweden)

    Lucy Anne Murtha

    2016-05-01

    Full Text Available Stroke is predominantly a senescent disease, yet most preclinical studies investigate treatment in young animals. We recently demonstrated that short-duration hypothermia-treatment completely prevented the dramatic intracranial pressure (ICP rise seen post-stroke in young rats. Here, our aim was to investigate whether a similar ICP rise occurs in aged rats and to determine whether short-duration hypothermia is an effective treatment in aged animals. Experimental Middle Cerebral Artery occlusion (MCAo - 3 hour occlusion was performed on male Wistar rats aged 19-20 months. At one hour after stroke-onset, rats were randomized to 2.5 hours hypothermia-treatment (32.5 °C or normothermia (37 °C. ICP was monitored at baseline, for 3.5 hours post-occlusion, and at 24 hours post-stroke. Infarct and edema volumes were calculated from histology. Baseline pre-stroke ICP was 11.2 ± 3.3 mmHg across all animals. Twenty-four hours post-stroke, ICP was significantly higher in normothermic animals compared to hypothermia-treated animals (27.4 ± 18.2 mmHg vs. 8.0 ± 5.0 mmHg, p = 0.03. Infarct and edema volumes were not significantly different between groups. These data demonstrate ICP may also increase 24 hours post-stroke in aged rats, and that short-duration hypothermia treatment has a profound and sustained preventative effect. These findings may have important implications for the use of hypothermia in clinical trials of aged stroke patients.

  4. Thrombolytic treatment in the oldest-old patient with acute ischemic stroke: an update on current evidence

    Directory of Open Access Journals (Sweden)

    Fabiola Maioli

    2013-09-01

    Full Text Available The incidence of ischemic stroke rises exponentially with age, with a steep increase in the age interval between 75 and 85 years. Thrombolytic therapy restores cerebral blood flow in patients with acute ischemic stroke of any etiology by using drugs that dissolve blood clots. Infusion for 1 h of alteplase at the dose of 0.9 mg/kg within 3 h of the start of the symptoms is associated to a 30% increase in the likelihood of gaining a favorable outcome with respect to placebo. There is strong evidence that selected patients with ischemic stroke may benefit from intravenous thrombolysis when treated within 3 h. The aim of the study was to evaluate available evidence for the efficacy and safety of thrombolytic therapy in patients with ischemic stroke aged 80 years and over. Compared to younger stroke patients treated with thrombolytic therapy, those aged 80 years and over have higher acute mortality due to symptomatic intracranial hemorrhage. However, functional outcome at six months is significantly better for over-80-year-olds than younger patients. There is a need for screening tools that take into account pre-stroke functional and cognitive status that are able to identify those over-80-year-old patients with ischemic stroke who can most benefit from thrombolytic treatment. Available evidence supports further recruitment of oldest-old patients into ongoing trials of thrombolysis.

  5. Management of Acute Hypertensive Response in Patients With Ischemic Stroke

    Science.gov (United States)

    Qureshi, Adnan I.

    2016-01-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction. PMID:27366297

  6. Management of Acute Hypertensive Response in Patients With Ischemic Stroke.

    Science.gov (United States)

    AlSibai, Ahmad; Qureshi, Adnan I

    2016-07-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction.

  7. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene;

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during...... a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.MethodsWe performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch...... of the ambulance to arrival at the scene, on-scene time and transport time to the hospital¿in total, alarm-to-door time. In addition, we noted baseline characteristics.ResultsWe reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33¿52), of which 18 (12...

  8. Dietary habits in patients with ischemic stroke: a case-control study.

    Directory of Open Access Journals (Sweden)

    Ana Rodríguez-Campello

    Full Text Available Diet appears to have some role in stroke development. The objective of our study was to describe the dietary habits in patients admitted with acute ischemic stroke and compare selected dietary components with healthy controls. Adherence to healthy diet behaviors was also assessed.A case-control study of consecutive patients with acute ischemic stroke admitted to the Neurology Department of Hospital del Mar from 2007 to 2010. Patients were matched by age and sex with control subjects. A previously validated nutritional survey was administered to patients and controls. Demographic data, vascular risk factors, caloric intake and dietary nutrients were evaluated. Intention to follow a healthy diet was also assessed in both groups.A total of 300 acute ischemic stroke patients and 300 controls with evaluation of dietary habits. No differences were observed in vascular risk factors, except smoking habit, diabetes and ischemic heart disease. Stroke patients reported a higher caloric intake: 2444.8(1736.8-3244.5 vs 2208.7(1753.1-2860.7 Kcal, p = 0.001. After adjusting for energy intake, patients had higher intake of proteins (p<0.001; OR 1.02, total cholesterol (p = 0.001; OR 1.04, and breaded foods (p = 0.001; OR 1.94 and lower consumption of probiotic yogurt (p = 0.002; OR 0.88. Compared to patients, control participants indicated greater intention to eat vegetables (p = 0.002; OR 1.5 and whole foods (p = 0.000; OR 2.4 and reduce their intake of salt (p = 0.002; OR 1.7, fat (p = 0.000; OR 3.7 and sweets (p = 0.004; OR 1.7 than patients.We observed different dietary patterns between stroke patients and controls. Stroke patients have a higher caloric intake and are less concerned about maintaining healthy nutritional habits.

  9. Abnormal organization of white matter network in patients with no dementia after ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Lin Shi

    Full Text Available Structural changes after ischemic stroke could affect information communication extensively in the brain network. It is likely that the defects in the white matter (WM network play a key role in information interchange. In this study, we used graph theoretical analysis to examine potential organization alteration in the WM network architecture derived from diffusion tensor images from subjects with no dementia and experienced stroke in the past 5.4-14.8 months (N = 47, Mini-Mental Screening Examination, MMSE range 18-30, compared with a normal control group with 44 age and gender-matched healthy volunteers (MMSE range 26-30. Region-wise connectivity was derived from fiber connection density of 90 different cortical and subcortical parcellations across the whole brain. Both normal controls and patients with chronic stroke exhibited efficient small-world properties in their WM structural networks. Compared with normal controls, topological efficiency was basically unaltered in the patients with chronic stroke, as reflected by unchanged local and global clustering coefficient, characteristic path length, and regional efficiency. No significant difference in hub distribution was found between normal control and patient groups. Patients with chronic stroke, however, were found to have reduced betweenness centrality and predominantly located in the orbitofrontal cortex, whereas increased betweenness centrality and vulnerability were observed in parietal-occipital cortex. The National Institutes of Health Stroke Scale (NIHSS score of patient is correlated with the betweenness centrality of right pallidum and local clustering coefficient of left superior occipital gyrus. Our findings suggest that patients with chronic stroke still exhibit efficient small-world organization and unaltered topological efficiency, with altered topology at orbitofrontal cortex and parietal-occipital cortex in the overall structural network. Findings from this study could

  10. Stroke rehabilitation and patients with multimorbidity: a scoping review protocol

    Directory of Open Access Journals (Sweden)

    Michelle L.A. Nelson

    2015-02-01

    Full Text Available Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing “best practice” stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy’s Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.

  11. Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis.

    Science.gov (United States)

    Shimoyama, Takashi; Iguchi, Yasuyuki; Kimura, Kazumi; Mitsumura, Hidetaka; Sengoku, Renpei; Kono, Yu; Morita, Masayo; Mochio, Soichiro

    2012-10-01

    Cerebral microbleeds (CMBs) are recognized as a manifestation of arteriolosclerosis in cerebral small vessels. However, little is known regarding whether stroke patients with CMBs often have systemic atherosclerosis. The aim of the present study was to elucidate this issue using the cardio-ankle vascular index (CAVI), a new index of systemic atherosclerosis, in acute ischemic stroke patients. We prospectively studied 105 patients (71 males, median age=70.0 years) with acute ischemic stroke. All of the patients were examined using T2*-weighted gradient echo magnetic resonance imaging (MRI) to look for and assess the CMBs and using fluid-attenuated inversion recovery to evaluate white matter hyperintensity (WMH). We assigned the patients into CMB and non-CMB groups and compared the clinical characteristics of these groups. The factors associated with CMBs were investigated using multivariate logistic regression analysis. T2*-weighted gradient echo MRI revealed CMBs in 47 patients (44.8%) and no CMBs in 58 patients (55.2%). The CAVI was significantly higher in the CMBs group (10.5 vs. 8.6, PCMBs. A high CAVI was independently associated with CMBs in patients with acute ischemic stroke. Our results indicated that ischemic stroke patients with CMBs may have cerebral arteriolosclerosis as well as systemic atherosclerosis.

  12. Obesity and Abdominal Fat Markers in Patients with a History of Stroke and Transient Ischemic Attacks.

    Science.gov (United States)

    Winter, Yaroslav; Pieper, Lars; Klotsche, Jens; Riedel, Oliver; Wittchen, Hans-Ulrich

    2016-05-01

    Abdominal obesity is a well-recognized cardiovascular risk factor. Conflicting data concerning its significance with respect to stroke have been discussed in recent years. The objective of this study was to analyze the association between anthropometric parameters and the risk of stroke and transient ischemic attacks (TIAs) in German primary care. Patient recruitment in this large-scale epidemiological study was performed in 3188 representative primary care offices in Germany. Among 6980 study participants, 1745 patients with a history of stroke or TIA were identified and matched for age and gender with 5235 regional controls. Associations between standard anthropometric measures such as body mass index (BMI), waist-to-hip ratio, waist circumference, waist-to-height ratio, and cerebrovascular risk were investigated using logistic regression analysis with adjustment for age, gender, and vascular risk factors. BMI showed no significant associations with the risk of stroke or TIA in any of the applied mathematical models. Markers of abdominal obesity were associated with an increased risk of stroke or TIA in the unadjusted model (waist circumference: odds ratio [OR] 1.15; 95% confidence interval [CI], 1.00-1.32; waist-to-hip ratio: OR 1.21; 95% CI, 1.05-1.38; waist-to-height ratio: OR 1.25; 95% CI, 1.09-1.44, comparisons between top and bottom tertiles). After adjustment for vascular risk factors, all associations were insignificant. Abdominal obesity is a stronger predictor of risk of stroke or TIA than BMI. However, the association between abdominal obesity and the risk of stroke or TIA is not independent of other vascular risk factors. Stroke-related weight changes should be considered in longitudinal studies examining the role of obesity in cerebrovascular disease. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Screening for apraxia: a short assessment for stroke patients.

    Science.gov (United States)

    Almeida, Quincy J; Black, Sandra E; Roy, Eric A

    2002-01-01

    Apraxia is a disorder that involves impaired ability to execute previously learned movements that cannot be attributed to basic sensory or motor disturbances. A thorough assessment of apraxia typically entails both pantomiming and imitation of transitive (tool-related), intransitive (communication-related), and meaningless gestures, presented in an array of different, process-dependent sensory conditions. Precise and detailed assessment tools are often time-consuming and a shorter screening tool may be desirable for efficient surveillance of this disorder in stroke patients. In the present study, stroke patients (N = 37) were compared to healthy controls (N = 30) in their production of commonly used transitive and intransitive gestures. Five gestures (knife, flipper, tweezers, okay sign, cab hailing) were consistently performed with poorer accuracy in stroke patients when compared to healthy controls. The combination of gestures that best captured apraxic performance was statistically determined based on Z-score data. Results provide a shortened and sensitive method of detecting apraxia in stroke patients.

  14. Early Sitting in Ischemic Stroke Patients (SEVEL: A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Fanny Herisson

    Full Text Available Extended immobility has been associated with medical complications during hospitalization. However no clear recommendations are available for mobilization of ischemic stroke patients.As early mobilization has been shown to be feasible and safe, we tested the hypothesis that early sitting could be beneficial to stroke patient outcome.This prospective multicenter study tested two sitting procedures at the acute phase of ischemic stroke, in a randomized controlled fashion (clinicaltrials.org registration number NCT01573299. Patients were eligible if they were above 18 years of age and showed no sign of massive infarction or any contra-indication for sitting. In the early-sitting group, patients were seated out of bed at the earliest possible time but no later than one calendar day after stroke onset, whereas the progressively-sitting group was first seated out of bed on the third calendar day after stroke onset. Primary outcome measure was the proportion of patients with a modified Rankin score [0-2] at 3 months post stroke. Secondary outcome measures were a. prevalence of medical complications, b. length of hospital stay, and c. tolerance to the procedure.One hundred sixty seven patients were included in the study, of which 29 were excluded after randomization. Data from 138 patients, 63 in the early-sitting group and 75 in the progressively-sitting group were analyzed. There was no difference regarding outcome of people with stroke, with a proportion of Rankin [0-2] score at 3 months of 76.2% and 77.3% of patients in the early- and progressive-sitting groups, respectively (p = 0.52. There was also no difference between groups for secondary outcome measures, and the procedure was well tolerated in both arms.Due to a slow enrollment, fewer patients than anticipated were available for analysis. As a result, we can only detect beneficial/detrimental effects of +/- 15% of the early sitting procedure on stroke outcome with a realized 37% power. However

  15. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    N.J.A. van Exel (Job); M.A. Koopmanschap (Marc); J.D.H. van Wijngaarden (Jeroen); W.J.M. Scholte op Reimer (Wilma)

    2003-01-01

    textabstractBackground. Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses

  16. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)

    2003-01-01

    textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. Th

  17. Responsiveness of the Berg Balance Scale in patients early after stroke.

    Science.gov (United States)

    Saso, Adam; Moe-Nilssen, Rolf; Gunnes, Mari; Askim, Torunn

    2016-05-01

    The Berg Balance Scale (BBS) has previously shown good measurement properties. However, its ability to detect important change in patients early after stroke is still unknown. The purpose of the present study was to determine the minimal important change (MIC) and its relation to the minimal detectable change (MDC) for BBS in patients early after stroke. This prospective follow-up study included patients within the first 2 weeks after onset of stroke. The BBS, Barthel Index, and Scandinavian Stroke Scale were obtained at inclusion and 1 month later. At the follow-up assessment, the Patient Global Impression of Change was obtained. A receiver operating characteristic (ROC) curve was used to calculate the cut-off value for the MIC. Fifty-two patients (mean age of 78.7, SD 8.5 years) were included. All measures showed a significant improvement from baseline to follow-up. The ROC analysis identified a MIC of ≥6 BBS points, while the MDC was 5.97 BBS points at the 80% confidence level. This study shows that a change of 6 BBS point or more can be considered an important change for patients in the sub-acute phase after stroke, which also represents an 80% probability of exceeding the measurement error. A total of 80% of unchanged patients would display random fluctuations within the bounds of MDC80, while 20% of unchanged patients would exceed MDC80.

  18. Program to Diagnose Probability of Aspiration Pneumonia in Patients with Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Pinto, Gisele

    2014-05-01

    Full Text Available Introduction Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective To evaluate the use of software to infer the probability of pneumonia in patients with ischemic stroke. Methods Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2% women. Of the 52 patients, only 3 (5.7% had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7% had pneumonia probability between 0 and 19%, 5 (9.5% between 20 and 49%, 3 (5.8% between 50 and 79%, and 12 (23.0% between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke.

  19. Sexual function in post-stroke patients: considerations for rehabilitation.

    Science.gov (United States)

    Rosenbaum, Talli; Vadas, Dor; Kalichman, Leonid

    2014-01-01

    While the rehabilitation goals of post-stroke patients include improving quality of life and returning to functional activities, the extent to which sexual activity is addressed as part of the standard rehabilitation process is unknown. Moreover, the specific sexual concerns of stroke patients, including the effect of stroke on intimate relationships and sexuality of the partner, the ability to physically engage in sex, and the effect of psychological components such as role identity, depression, and anxiety on sexuality, all warrant examination by rehabilitation professionals. The aim of this study is to examine the existing literature on sexuality and stroke patients in order to better understand how the sexual lives of stroke patients and their partners are affected and to provide recommendations to rehabilitation professionals for addressing sexuality as part of treatment. Narrative review, PubMed, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2012) were searched for the key words "stroke," "sexual dysfunction," "sexuality," "quality of life," and their combination. All relevant articles in English and secondary references were reviewed. We report the results of the literature review. Sexual dysfunction and decreased sexual satisfaction are common in the post-stroke population and are related to physical, psychosocial, and relational factors. However, they are not adequately addressed in post-stroke rehabilitation. As sexual function is an important component to quality of life and activities of daily living, physicians and rehabilitation specialists, including physical, occupational, and speech therapists, should receive training in addressing sexuality in the treatment of post-stroke patients. Sexologists and sex therapists should be an integral part of the rehabilitation team. © 2013 International Society for Sexual Medicine.

  20. Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom.

    Science.gov (United States)

    Senoo, Keitaro; An, Yoshimori; Ogawa, Hisashi; Lane, Deirdre A; Wolff, Andreas; Shantsila, Eduard; Akao, Masaharu; Lip, Gregory Y H

    2016-12-01

    Data on stroke, mortality and associated comorbidities in elderly patients with atrial fibrillation (AF) in Japan may differ from Western countries. There have been few systematic comparisons between stroke risk profiles and outcomes among community-based elderly (aged ≥75 years) patients with AF in Japan and the UK. We compared clinical characteristics, stroke risk and outcomes among elderly patients with AF from the Fushimi AF Registry (Japan; N=1791) and the Darlington AF Registry (UK; N=1338). The Fushimi cohort had a mean age 81.8 (standard deviation (SD) 5.3) years and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (double), diabetes mellitus, previous thromboembolism (double), vascular disease, age 65-74 years and female gender) score 4.3 (1.4), whereas the Darlington cohort had a mean age 83.6 (5.7) years and CHA2DS2-VASc score 4.4 (1.4). Over a 12-month follow-up period, observed stroke and mortality rates in Fushimi were 3.4% (n=61) and 11.5% (n=206), while corresponding event rates in the Darlington cohort were 4.4% (n=59) and 14.1% (n=188), respectively. Appropriate use of oral anticoagulation (OAC, essentially a vitamin K antagonist) was <60% in both registries.On multivariable analysis, ethnicity (Japan vs UK) was neither associated with the risk of stroke (OR 0.92, 95% CI 0.63 to 1.36; p=0.69) nor death (OR 0.92, 95% CI 0.80 to 1.27; p=0.92). In a subgroup analysis of elderly patients not receiving OAC (n=1489), a history of stroke was associated with the risk of stroke (OR 2.42, 95% CI 1.39 to 4.12; p=0.002), but not ethnicity (OR 0.86, 95% CI 0.50 to 1.47; p=0.58). Elderly (age ≥75 years) patients with AF in both Japan and the UK are at similarly high risk of stroke and death, with OAC still underused in both populations. Ethnicity was not independently associated with the risk of stroke, regardless of OAC use or non-use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  1. A STUDY OF MEAN PLATELET VOLUME LEVELS IN PATIENTS WITH ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Kandan Muralidharan

    2016-09-01

    Full Text Available CONTEXT Stroke is the most common cause of death after cardiac disease and cancer. This study attempts to identify the significance of mean platelet volume as a risk factor as well as prognostic factor for ischemic stroke patients1 . This may help in early identification of high risk individuals who can be targeted for aggressive acute management and improved secondary prevention measures. AIM OF THE STUDY To assess whether mean platelet volume levels are elevated in ischemic stroke and to assess MPV as independent risk factor and to assess whether the severity and outcome of ischemic stroke correlates with elevated mean platelet volume. SETTINGS AND DESIGN Analytical Case Control Study. MATERIALS AND METHODS This study is conducted among 50 ischemic stroke patients who were admitted at Government Rajaji Hospital, Madurai from December 2014 to June 2015. After taking detailed history and physical examination and investigations, MPV was determined for Ischemic stroke patients and Modified Rankin scale (MRS at the time of admission was calculated. After 8 weeks of onset of stroke, all the patients were again followed up. Functional outcomes were determined by use of Modified Rankin Scale (MRS2,3. All patients were stratified using MRS2,3 Scale [0-2, 3-4 and 5-6] into three groups. MPV level was correlated with MRS score at the time of admission and again at 8 weeks. Patients with MRS score of 5 and 6 were declared as very poor outcome & MRS of 3 and 4 as poor outcome. Patients with MRS 0, and 1 were considered as good outcome. STATISTICAL ANALYSIS One way ANOVA, Pearson correlation and Chi square test. RESULTS There is no statistically significant difference among the case and control groups with regard to the age or sex composition or smoking or alcoholism. MPV did not vary with diabetes or hypertension. There was a linear relation with MPV and severity of ischemic stroke i.e. as the MPV increases the severity (MRS 2,3of stroke increases

  2. Prevalence of risk factors for ischaemic stroke and their treatment among a cohort of stroke patients in Dublin.

    LENUS (Irish Health Repository)

    McDonnell, R

    2000-10-01

    The majority of strokes are due to ischaemia. Risk factors include atrial fibrillation, hypertension and smoking. The incidence can be reduced by addressing these risk factors. This study examines the prevalence of risk factors and their treatment in a cohort of patients with ischaemic stroke registered on a Dublin stroke database.

  3. Effects of a Web-Based Stroke Education Program on Recurrence Prevention Behaviors among Stroke Patients: A Pilot Study

    Science.gov (United States)

    Kim, Jae-Il; Lee, Sook; Kim, Jung-Hee

    2013-01-01

    The effectiveness of methods to prevent stroke recurrence and of education focusing on learners' needs has not been fully explored. The aims of this study were to assess the effects of such interventions among stroke patients and their primary caregivers and to evaluate the feasibility of a web-based stroke education program. The participants were…

  4. A COMPAR A TIVE STUDY OF SELECTIVE INDICATOR PROFILES IN PATIENTS WITH ISCHEMIC STROKE AND HEMORRHAGIC STROKE

    OpenAIRE

    Narayanaswamy; Ravi; Nagarjun

    2015-01-01

    BACKGROUND: In Urban India, stroke accounts for 1% mortality in all hospital admissions. The pathogenic role of increased plasma fibrinogen level in causing stroke has been recently reinforced. It was therefore of interest to measure plasma fibrinogen level in patients with ischemic and hemorrhagic stroke and to compare it with lipid profile....

  5. Effects of a Web-Based Stroke Education Program on Recurrence Prevention Behaviors among Stroke Patients: A Pilot Study

    Science.gov (United States)

    Kim, Jae-Il; Lee, Sook; Kim, Jung-Hee

    2013-01-01

    The effectiveness of methods to prevent stroke recurrence and of education focusing on learners' needs has not been fully explored. The aims of this study were to assess the effects of such interventions among stroke patients and their primary caregivers and to evaluate the feasibility of a web-based stroke education program. The participants were…

  6. Neuronal and Glia-Related Biomarkers in Cerebrospinal Fluid of Patients with Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Clara Hjalmarsson

    2014-01-01

    Full Text Available Background Cerebral ischemia promotes morphological reactions of the neurons, astrocytes, oligodendrocytes, and microglia in experimental studies. Our aim was to examine the profile of CSF (cerebrospinal fluid biomarkers and their relation to stroke severity and degree of white matter lesions (WML. Methods A total of 20 patients (mean age 76 years were included within 5–10 days after acute ischemic stroke (AIS onset. Stroke severity was assessed using NIHSS (National Institute of Health stroke scale. The age-related white matter changes (ARWMC scale was used to evaluate the extent of WML on CT-scans. The concentrations of specific CSF biomarkers were analyzed. Results Patients with AIS had significantly higher levels of NFL (neurofilament, light, T-tau, myelin basic protein (MBP, YKL-40, and glial fibrillary acidic protein (GFAP compared with controls; T-Tau, MBP, GFAP, and YKL-40 correlated with clinical stroke severity, whereas NFL correlated with severity of WML (tested by Mann–Whitney test. Conclusions Several CSF biomarkers increase in AIS, and they correlate to clinical stroke severity. However, only NFL was found to be a marker of degree of WML.

  7. Feasibility of the cognitive assessment scale for stroke patients (CASP) vs. MMSE and MoCA in aphasic left hemispheric stroke patients.

    Science.gov (United States)

    Barnay, J-L; Wauquiez, G; Bonnin-Koang, H Y; Anquetil, C; Pérennou, D; Piscicelli, C; Lucas-Pineau, B; Muja, L; le Stunff, E; de Boissezon, X; Terracol, C; Rousseaux, M; Bejot, Y; Binquet, C; Antoine, D; Devilliers, H; Benaim, C

    2014-01-01

    Post-stroke aphasia makes it difficult to assess cognitive deficiencies. We thus developed the CASP, which can be administered without using language. Our objective was to compare the feasibility of the CASP, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in aphasic stroke patients. All aphasic patients consecutively admitted to seven French rehabilitation units during a 4-month period after a recent first left hemispheric stroke were assessed with CASP, MMSE and MoCA. We determined the proportion of patients in whom it was impossible to administer at least one item from these 3 scales, and compared their administration times. Forty-four patients were included (age 64±15, 26 males). The CASP was impossible to administer in eight of them (18%), compared with 16 for the MMSE (36%, P=0.05) and 13 for the MoCA (30%, P=0.21, NS). It was possible to administer the CASP in all of the patients with expressive aphasia, whereas the MMSE and the MoCA could not be administered. Administration times were longer for the CASP (13±4min) than for the MMSE (8±3min, P<10(-6)) and the MoCA (11±5min, P=0.23, NS). The CASP is more feasible than the MMSE and the MoCA in aphasic stroke patients. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  8. Patients' and carers' experiences of gaining access to acute stroke care: A qualitative study

    OpenAIRE

    Harrison, M; Ryan, T.; Gardiner, C.; Jones, A

    2012-01-01

    Background: Rapid access to acute stroke care is essential to improve stroke patient outcomes. Policy recommendations for the emergency management of stroke have resulted in signi ficant changes to stroke services, including the introduction of hyper-acute care. Objective: To explore patients' and carers' experiences of gaining access to acute stroke care and identify the factors that enabled or prevented stroke from being treated as a medical emergency. Methods: Qualitative semi-structured i...

  9. Evaluation methods on the nutritional status of stroke patients.

    Science.gov (United States)

    Wang, J; Luo, B; Xie, Y; Hu, H-Y; Feng, L; Li, Z-N

    2014-01-01

    This study was designed to assess the effect of particular tools on the nutritional status of patients with stroke risk factors; to analyze these risk factors; to construct an assessment table; and to enable nurses to conduct fast and accurate assessment of the nutritional status of patients with stroke. Various nutritional assessment tools were employed to assess the nutritional status of stroke patients [(Nutritional Risk Screening 2002, NRS2002); (mini nutritional assessment, MNA), (subjective global assessment SGA), (malnutrition universal screening, MUST); (body composition, BCA)]. The leading disease-related factors of cerebral apoplexy were observed in patients with malnutrition. And a statistical analysis was conducted. The significant risk factors of cerebral apoplexy in malnourished patients older than 70 years were swallowing dysfunctions, disturbance of consciousness and reliance or half-reliance on feeding practices. The significant risk factors of malnutrition in patients with cerebral apoplexy were the decline in upper limb muscle strength, decline in the performance of various activities, loss of appetite and gastrointestinal symptoms. Disorders that affect the nutritional status of stroke patients can be used as evaluation tools, as described in the evaluation table. The clinical relevance of this study includes the following: to enable the clinical nursing staff to easily assess the patient's nutritional status in a timely manner; to improve compliance with nutritional evaluation; to provide clinical nutrition support to patients with stroke; and to provide a scientific basis for the improvement of the clinical outcomes of patients with cerebral apoplexy.

  10. Predicting the performance of motor imagery in stroke patients: multivariate pattern analysis of functional MRI data.

    Science.gov (United States)

    Park, Chang-hyun; Chang, Won Hyuk; Lee, Minji; Kwon, Gyu Hyun; Kim, Laehyun; Kim, Sung Tae; Kim, Yun-Hee

    2015-01-01

    In a brain-computer interface for stroke rehabilitation, motor imagery is a preferred means for providing a gateway to an effector action or behavior. However, stroke patients often exhibit failure to comply with motor imagery, and therefore their motor imagery performance is highly variable. We sought to identify motor cortical areas responsible for motor imagery performance in stroke patients, specifically by using a multivariate pattern analysis of functional magnetic resonance imaging data. We adopted an imaginary finger tapping task in which motor imagery performance could be monitored for 12 chronic stroke patients with subcortical infarcts and 12 age- and sex-matched healthy controls. We identified the typical activation pattern elicited for motor imagery in healthy controls, as computed over the voxels within each searchlight in the motor cortex. Then we measured the similarity of each individual's activation pattern to the typical activation pattern. In terms of activation levels, the stroke patients showed no activation in the ipsilesional primary motor cortex (M1); in terms of activation patterns, they showed lower similarity to the typical activation pattern in the area than the healthy controls. Furthermore, the stroke patients were better able to perform motor imagery if their activation patterns in the bilateral supplementary motor areas and ipsilesional M1 were close to the typical activation pattern. These findings suggest functional roles of the motor cortical areas for compliance with motor imagery in stroke, which can be applied to the implementation of motor imagery-based brain-computer interface for stroke rehabilitation. © The Author(s) 2014.

  11. Atopic Diseases and Subsequent Ischemic Stroke Among Patients With Schizophrenia: A Nationwide Longitudinal Study.

    Science.gov (United States)

    Chen, Mu-Hong; Li, Cheng-Ta; Hsu, Ju-Wei; Huang, Kai-Lin; Lin, Wei-Chen; Chang, Wen-Han; Chen, Tzeng-Ji; Pan, Tai-Long; Su, Tung-Ping; Bai, Ya-Mei

    2015-01-01

    Chronic inflammation plays an important role in schizophrenia and atopic diseases, and studies have suggested that chronic inflammation is associated with an increased risk of stroke. The role of atopic diseases in the development of stroke among patients with schizophrenia is still unknown. A total of 63,913 patients with schizophrenia without a stroke history between 2002 and 2008 and 63,913 age- and sex-matched controls were included and followed up to the end of 2011. Patients with schizophrenia and the reference group were divided into subgroups based on the presence or absence of atopic diseases. Individuals who developed stroke during follow-up were identified. Patients with schizophrenia had an increased risk of developing ischemic stroke (no atopic disease: hazard ratio [HR] = 2.18, 95% confidence interval [CI] = 1.88-2.53; with atopic disease: HR = 3.11, 95% CI = 2.63-3.69) compared with the reference group without atopic diseases. Among patients with schizophrenia, the presence of atopic diseases increased the risk of developing ischemic stroke (HR = 1.44, 95% CI = 1.24-1.66), with a cumulative relationship between greater numbers of atopic comorbidities and a greater risk of ischemic stroke (one atopic disease: HR = 1.39, 95% CI = 1.19-1.63; two atopic comorbidities: HR = 1.48, 95% CI = 1.10-2.00; at least 3 atopic comorbidities: HR = 2.81, 95% CI = 1.55-5.12). The combined presence of schizophrenia and atopic diseases is associated with an increased risk of ischemic stroke in later life compared with individuals without these conditions.

  12. Subclinical Carpal Tunnel Syndrome in Patients with Acute Stroke

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    Soroosh Dabiri

    2012-07-01

    Full Text Available Background: Stroke is the first cause of morbidity all around the world. Entrapment neuropathies are a known complication of stroke. The objective of this study is to assess the frequency of subclinical carpal tunnel syndrome in the healthy and paretic hands of stroke patients.Methods: The authors performed nerve conduction study in the first three days after admission in 39 stroke patients without subclinical carpal tunnel syndrome and 30 days after admission. Electrophysiological studies were done in both paretic and non-paretic hands. Both ulnar and median nerves were studied.Results: After one month we found subclinical carpal tunnel syndrome in 16 paretic hands and 13 healthy hands. We did not find any difference in the frequency of carpal tunnel syndrome in two sides.Conclusion: The authors suggest that simultaneous different mechanisms may act in inducing carpal tunnel syndrome in both hands of hemiparetic patients.

  13. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    Science.gov (United States)

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into “a training package”, based on the patient’s functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients. PMID:25133141

  14. Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Smith, Eric E; Saposnik, Gustavo; Biessels, Geert Jan; Doubal, Fergus N; Fornage, Myriam; Gorelick, Philip B; Greenberg, Steven M; Higashida, Randall T; Kasner, Scott E; Seshadri, Sudha

    2017-02-01

    Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. © 2016 American Heart Association, Inc.

  15. Prevalence of stroke-related sarcopenia and its association with poor oral status in post-acute stroke patients: Implications for oral sarcopenia.

    Science.gov (United States)

    Shiraishi, Ai; Yoshimura, Yoshihiro; Wakabayashi, Hidetaka; Tsuji, Yuri

    2016-12-10

    The aim of the study was to investigate the prevalence of stroke-related sarcopenia and its association with poor oral status in post-acute stroke patients. This cross-sectional study included 202 consecutive stroke patients who were admitted to convalescent rehabilitation wards in Japan. The Revised Oral Assessment Guide (ROAG) was used to assess oral status. Sarcopenia was defined as a loss of skeletal muscle mass index (SMI) with bioelectrical impedance and decreased muscle strength as measured by handgrip strength; cut-off values were adopted from the Asian Working Group for Sarcopenia. Univariate and multivariate analyses were applied to examine the associations between oral status, SMI, and HG. Study participants included 107 males and 95 females with a mean age of 72 ± 12 years. According to the ROAG, 82.2% of participants had slight to severe oral problems (median score: 11 [9-14]). The prevalence of stroke-related sarcopenia was 53.5%. Both SMI (mean: 6.1 ± 1.3) and handgrip strength (median: 15 [7-25]) were significantly lower in the group with oral problems (SMI = 5.8 ± 1.2, handgrip strength = 12 [6-20]) compared to individuals without oral problems (SMI = 7.4 ± .8, handgrip strength = 27 [23-34]) (p stroke severity, activities of daily living, cognitive level, nutritional status, comorbidities, and time from stroke onset. Poor oral status was associated with sarcopenia, reduced muscle mass and strength in post-acute stroke patients. Poor oral status and stroke-related sarcopenia were very common among the patients in this study, suggesting that healthcare providers should monitor for oral sarcopenia in post-acute stroke patients. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  16. The taxonomy statistic uncovers novel clinical patterns in a population of ischemic stroke patients.

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    Andrzej Tukiendorf

    Full Text Available In this paper, we describe a simple taxonomic approach for clinical data mining elaborated by Marczewski and Steinhaus (M-S, whose performance equals the advanced statistical methodology known as the expectation-maximization (E-M algorithm. We tested these two methods on a cohort of ischemic stroke patients. The comparison of both methods revealed strong agreement. Direct agreement between M-S and E-M classifications reached 83%, while Cohen's coefficient of agreement was κ = 0.766(P < 0.0001. The statistical analysis conducted and the outcomes obtained in this paper revealed novel clinical patterns in ischemic stroke patients. The aim of the study was to evaluate the clinical usefulness of Marczewski-Steinhaus' taxonomic approach as a tool for the detection of novel patterns of data in ischemic stroke patients and the prediction of disease outcome. In terms of the identification of fairly frequent types of stroke patients using their age, National Institutes of Health Stroke Scale (NIHSS, and diabetes mellitus (DM status, when dealing with rough characteristics of patients, four particular types of patients are recognized, which cannot be identified by means of routine clinical methods. Following the obtained taxonomical outcomes, the strong correlation between the health status at moment of admission to emergency department (ED and the subsequent recovery of patients is established. Moreover, popularization and simplification of the ideas of advanced mathematicians may provide an unconventional explorative platform for clinical problems.

  17. Estimating the lifetime economic burden of stroke according to the age of onset in South Korea: a cost of illness study

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    Suh Hae Sun

    2011-08-01

    Full Text Available Abstract Background The recently-observed trend towards younger stroke patients in Korea raises economic concerns, including erosion of the workforce. We compared per-person lifetime costs of stroke according to the age of stroke onset from the Korean societal perspective. Methods A state-transition Markov model consisted of three health states ('post primary stroke event', 'alive post stroke', and 'dead' was developed to simulate the natural history of stroke. The transition probabilities for fatal and non-fatal recurrent stroke by age and gender and for non-stroke causes of death were derived from the national epidemiologic data of the Korean Health Insurance Review and Assessment Services and data from the Danish Monitoring Trends in Cardiovascular Disease study. We used an incidence-based approach to estimate the long-term costs of stroke. The model captured stroke-related costs including costs within the health sector, patients' out-of-pocket costs outside the health sector, and costs resulting from loss of productivity due to morbidity and premature death using a human capital approach. Average insurance-covered costs occurring within the health sector were estimated from the National Health Insurance claims database. Other costs were estimated based on the national epidemiologic data and literature. All costs are presented in 2008 Korean currency values (Korean won = KRW. Results The lifetime costs of stroke were estimated to be: 200.7, 81.9, and 16.4 million Korean won (1,200 KRW is approximately equal to one US dollar for men who suffered a first stroke at age 45, 55 and 65 years, respectively, and 75.7, 39.2, and 19.3 million KRW for women at the same age. While stroke occurring among Koreans aged 45 to 64 years accounted for only 30% of the total disease incidence, this age group incurred 75% of the total national lifetime costs of stroke. Conclusions A higher lifetime burden and increasing incidence of stroke among younger Koreans

  18. Effects of Comprehensive Stroke Care Capabilities on In-Hospital Mortality of Patients with Ischemic and Hemorrhagic Stroke: J-ASPECT Study

    Science.gov (United States)

    Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

    2014-01-01

    Background The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Methods and Results Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. Conclusions CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type. PMID:24828409

  19. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study.

    Directory of Open Access Journals (Sweden)

    Koji Iihara

    Full Text Available BACKGROUND: The effectiveness of comprehensive stroke center (CSC capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. METHODS AND RESULTS: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH, and 28.1% for patients with subarachnoid hemorrhage (SAH. Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CONCLUSIONS: CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.

  20. Beyond stroke : Description and evaluation of an effective intervention to support family caregivers of stroke patients

    NARCIS (Netherlands)

    Schure, Lidwien M.; van den Heuvel, Elisabeth T. P.; Stewart, Roy E.; Sanderman, Robbert; de Witte, Luc P.; Meyboom-de Jong, Betty

    2006-01-01

    Objective: The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients. It also examined the best fit between intervention variant and family caregiver and patient characteristics. van den He

  1. Beyond stroke : Description and evaluation of an effective intervention to support family caregivers of stroke patients

    NARCIS (Netherlands)

    Schure, Lidwien M.; van den Heuvel, Elisabeth T. P.; Stewart, Roy E.; Sanderman, Robbert; de Witte, Luc P.; Meyboom-de Jong, Betty

    Objective: The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients. It also examined the best fit between intervention variant and family caregiver and patient characteristics. van den

  2. Rehabilitation assessments for patients with stroke in Australian hospitals do not always reflect the patients' rehabilitation requirements.

    Science.gov (United States)

    Lynch, Elizabeth A; Luker, Julie A; Cadilhac, Dominique A; Hillier, Susan L

    2015-05-01

    To examine the frequency and factors associated with patients with stroke in Australian hospitals receiving documented rehabilitation assessments; to examine the criteria used when rehabilitation was not recommended; and to examine whether being assessed for rehabilitation affected access to rehabilitation. Retrospective medical record audit of patients with a diagnosis of stroke who were discharged consecutively between 2013 and 2014. Acute care public hospitals. Adults with stroke (N=333) receiving care in participating hospitals. Not applicable. Documented assessment regarding patient suitability for rehabilitation during acute hospitalization. Data from 292 patients were included for analysis (60% men; mean age, 72y). Of the patients, 42% were assessed for rehabilitation by a health professional providing care in the hospital, 43% were assessed for rehabilitation by a representative from a rehabilitation service, and 37% did not receive any documented rehabilitation assessment. In multivariable analysis, patients were significantly more likely to be assessed for rehabilitation if they lived in the community before their stroke, had moderate severity strokes, or received occupational therapy during hospital admission. Rehabilitation was not recommended in 9% of assessments despite the presence of stroke-related symptoms. Patients not assessed for rehabilitation were significantly less likely to access rehabilitation than patients who were assessed. More than one third of patients were not assessed for rehabilitation. When assessed, rehabilitation was not consistently recommended for patients with stroke-related symptoms. This study highlights factors that increase the likelihood of being assessed for rehabilitation. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Effects of statins on the liver: clinical analysis of patients with ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li-san; LIU Zheng-xia; L(U) Wen; HU Xing-yue

    2011-01-01

    Background Statins are one of the most common agents prescribed for ischemic stroke patients, but their side effects on the liver are worrisome to both physicians and patients. This study aimed to analyze the features and related factors of the hepatic side effects of, statins in patients with ischemic troke.Methods Four hundred and eighty-one patients with ischemic stroke who had been treated with statins at our department from July 1, 2008 to June 30, 2009 were investigated retrospectively. Liver function, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), within 6 months after they began to use statins and related factors were analyzed.Results The incidence of mild ALT and AST elevation, less than three times the upper limit of normal, and the incidence of moderate elevation, ALT and AST levels 3-10 times the upper limit of normal, in ischemic stroke patients who had been treated with statins were 2.3% and 2.1%, respectively. These incidences were higher than in patients with common hyperlipidemia or coronary heart disease. The relatively high incidence was associated with older age (>65 years) and chronic liver diseases, and was not related to the type of stroke, gender, and reduction of low-density lipoprotein. The levels of ALT and AST normalized after withdrawal of statins or lowering the dosage. None of the patients developed hepatic failure.Conclusions Asymptomatic elevation of ALT and AST after administration of statins is more likely to occur in ischemic stroke patients than in others, and the elevation is related to age and chronic liver diseases. However, statins are still safe for ischemic stroke patients.

  4. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Sit JW

    2016-10-01

    Full Text Available Janet WH Sit,1 Sek Ying Chair,1 Kai Chow Choi,1 Carmen WH Chan,1 Diana TF Lee,1 Aileen WK Chan,1 Jo LK Cheung,1 Siu Wai Tang,2 Po Shan Chan,2 Ruth E Taylor-Piliae3 1The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, 2Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong Hospital Authority, Causeway Bay, Hong Kong, People’s Republic of China; 3College of Nursing, The University of Arizona, Tucson, AZ, USA Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS] was developed to enhance patients’ ability to participate in self-management.Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery.Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]. Outcome data were collected at baseline (T0, 1 week (T1, 3 months (T2, and 6 months (T3 postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring, and functional recovery (Barthel and Lawton indices across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention between the two groups.Results: A total of 210 (CG =105, IG =105 Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic

  5. Study on the Prevalence and Corelation of Carotid Atherosclerosis in Stroke Patients

    Institute of Scientific and Technical Information of China (English)

    Wei Hua; Wang Yongjun; Yah Zhenying

    2000-01-01

    Objective To assess the prevalence and severity of carotid atherosclerosis in stroke patients and the risk factors of carotid atherosclerosis. Methods Two hundred fifty-one ischemic stroke patients,46 ccrcbral hemorrhagc patients and 96 control subjects were entercd into this study. Sonographic assessment of the extracranial carotid arteries was performed in all patients. Diametcr. IMT, plaques and percentage ratio of lumen stenosis were observcd. Results (1)The prevalence of carotid plaqucs was prominent in stroke patients than the control subjects(63.0%vs 36.5%). (2)The prevalencc of lumen stenosis>50% in ischemic stroke patients was higher than the cerebral hemorrhage patients and control subjects (15.6% vs 4.3%. 2.1%).(3) The prevalence of severe carotid artery stcnosis(>75%) was promincnt in aged 61~70 years old patients.(4)Our data revealed 30% of the cortical infarction subgroup, 17.5%of the subcortical infarction subgroup, 17% of the lacunar infarction subgroup,8% of the vcrtibral-basilar artery infarction subgroup.2.8% of thc CT normal subgroup possessed carotid stcnosis >50%. (5)Age, diabetes mellitus and ApoAl(inversely) were independent predictors of the extracranial carotid atherosclcrosis. Discusssion (Ⅰ)There is close relation between extracraniai carotid atherosclerosis and ischemic cerebrovascular disease.(2)The extent of serious carotid artery stcnosis in aged patients was lower.(3)Thc severity of extracranial carotid artery atherosclerosis was prominent in patients with conical infarction. Conclusion There is a high prevalence of extracranial carotid atherosclerosis in Chinese stroke patients.

  6. Usage of Traditional and Complementary Medicine (T & CM): Prevalence, Practice and Perception among Post Stroke Patients Attending Conventional Stroke Rehabilitation in A Teaching Hospital in Malaysia.

    Science.gov (United States)

    Ali, M F; Abdul Aziz, A F; Rashid, M R; Che Man, Z; Amir, A A; Lim, Y S; Ramli, N S; Zainal Abidin, N A

    2015-02-01

    The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital. A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data. Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%). Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.

  7. Ischemic stroke induces gut permeability and enhances bacterial translocation leading to sepsis in aged mice

    Science.gov (United States)

    Verma, Rajkumar; Venna, Venugopal R.; Liu, Fudong; Chauhan, Anjali; Koellhoffer, Edward; Patel, Anita; Ricker, Austin; Maas, Kendra; Graf, Joerg; McCullough, Louise D.

    2016-01-01

    Aging is an important risk factor for post-stroke infection, which accounts for a large proportion of stroke-associated mortality. Despite this, studies evaluating post-stroke infection rates in aged animal models are limited. In addition, few studies have assessed gut microbes as a potential source of infection following stroke. Therefore we investigated the effects of age and the role of bacterial translocation from the gut in post-stroke infection in young (8-12 weeks) and aged (18-20 months) C57Bl/6 male mice following transient middle cerebral artery occlusion (MCAO) or sham surgery. Gut permeability was examined and peripheral organs were assessed for the presence of gut-derived bacteria following stroke. Furthermore, sickness parameters and components of innate and adaptive immunity were examined. We found that while stroke induced gut permeability and bacterial translocation in both young and aged mice, only young mice were able to resolve infection. Bacterial species seeding peripheral organs also differed between young (Escherichia) and aged (Enterobacter) mice. Consequently, aged mice developed a septic response marked by persistent and exacerbated hypothermia, weight loss, and immune dysfunction compared to young mice following stroke. PMID:27115295

  8. Potential role of group clinics to boost outcomes among elderly Spanish-only speaking stroke patients.

    Science.gov (United States)

    Ovbiagele, Bruce

    2010-06-01

    Ethnic minorities are generally at higher risk for experiencing a stroke and dying from a stroke than non-Hispanic Whites, but are less likely to have optimal stroke risk factor control. Part of this ethnic disparity in stroke outcomes can be attributed to sociocultural factors. As such, there is a need to use culturally sensitive qualitative analysis to explore various strategies for enhancing vascular risk reduction in minority stroke patients encountered in under-resourced health systems. One potential strategy could be the use of nurse-led group clinics. Group clinics might be a relatively straightforward way of supplementing physician-centered efforts to improve outcomes in under-resourced settings by improving efficiency and encouraging patient self-management. However, research is limited on the implementation of group clinics among low-income, ethnic minority populations. This study aimed to obtain information about the feasibility of successfully implementing group clinics to boost treatment adherence among elderly Spanish-speaking only stroke patients within an under-resourced urban health system. A total of 13 Spanish-only speaking participants aged >or=60 years discharged from a local government hospital in Los Angeles within 18 months of an index ischemic stroke, and 6 caregivers, engaged in focus groups and interviews. Structured interviews were conducted with 11 care providers and 9 administrators at the hospital. Framework analysis examined the data and elicited themes necessary for successful execution of nurse-led group clinics for promoting vascular risk reduction treatment adherence among Elderly Spanish-only speaking stroke patients encountered within an urban health care system.

  9. Gut dysbiosis is associated with metabolism and systemic inflammation in patients with ischemic stroke

    Science.gov (United States)

    Yamashiro, Kazuo; Tanaka, Ryota; Urabe, Takao; Ueno, Yuji; Yamashiro, Yuichiro; Nomoto, Koji; Takahashi, Takuya; Tsuji, Hirokazu; Asahara, Takashi; Hattori, Nobutaka

    2017-01-01

    The role of metabolic diseases in ischemic stroke has become a primary concern in both research and clinical practice. Increasing evidence suggests that dysbiosis is associated with metabolic diseases. The aim of this study was to investigate whether the gut microbiota, as well as concentrations of organic acids, the major products of dietary fiber fermentation by the gut microbiota, are altered in patients with ischemic stroke, and to examine the association between these changes and host metabolism and inflammation. We analyzed the composition of the fecal gut microbiota and the concentrations of fecal organic acids in 41 ischemic stroke patients and 40 control subjects via 16S and 23S rRNA-targeted quantitative reverse transcription (qRT)-PCR and high-performance liquid chromatography analyses, respectively. Multivariable linear regression analysis was subsequently performed to evaluate the relationships between ischemic stroke and bacterial counts and organic acid concentrations. Correlations between bioclinical markers and bacterial counts and organic acids concentrations were also evaluated. Although only the bacterial counts of Lactobacillus ruminis were significantly higher in stroke patients compared to controls, multivariable analysis showed that ischemic stroke was independently associated with increased bacterial counts of Atopobium cluster and Lactobacillus ruminis, and decreased numbers of Lactobacillus sakei subgroup, independent of age, hypertension, and type 2 diabetes. Changes in the prevalence of Lactobacillus ruminis were positively correlated with serum interleukin-6 levels. In addition, ischemic stroke was associated with decreased and increased concentrations of acetic acid and valeric acid, respectively. Meanwhile, changes in acetic acid concentrations were negatively correlated with the levels of glycated hemoglobin and low-density lipoprotein cholesterol, whereas changes in valeric acid concentrations were positively correlated with the

  10. Anosognosia in patients with acute hemispheric ischemic stroke

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    V. N. Grigoryeva

    2016-01-01

    Full Text Available Objective: to investigate the frequency of anosognosia (a deficit of self-awareness, its anatomic correlates associated with other neuropsychological and neurological disorders in acute hemispheric ischemic stroke (IS.Patients and methods 150 patients (83 men and 67 women; mean age, 63.0±9.3 years with acute hemispheric IS were examined. All the patients underwent neurological, neuroimaging, and neuropsychological (by the procedure described by A.R. Luria examinations. neuropsychological investigations. Anosognosia was diagnosed using the Dysexecutive Questionnaire (DEX and the authors' procedure involving a scale to measure impaired self-rating of motor abilities and a scale to measure impaired self-rating of cognitive abilities in everyday life.Results and discussion. In the acute period of hemispheric IS, reduced self-awareness of motor and cognitive abilities was noted in 14% of the patients and unawareness of only cognitive abilities was recorded in 15%. Patients with anosognosia and cognitive dysfunction (ACD and those with anosognosia and motor dysfunction (AMD had right-sided hemispheric IS more frequently (76% while this was not found in patients with isolated ACD. The development of anosognosia for paralysis and paresis was favored by the large sizes of an ischemic focus that involved a few lobes in the posterior regions of the brain although no lesions were found in the anosognosia-specific anatomical regions. ACD and AMD proved to be associated with unilateral spatial and tactile neglect and obvious regulatory dysfunction. 

  11. Difference in motor fatigue between patients with stroke and patients with multiple sclerosis: a pilot study

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    Aida eSehle

    2014-12-01

    Full Text Available Fatigue is often reported in stroke patients. However, it is still unclear if fatigue in stroke patients is more prominent, more frequent or more typical than in patients with multiple sclerosis (MS and if the pathophysiology differs between these two populations. The purpose of this study was to compare motor fatigue and fatigue induced changes in kinematic gait parameters between stroke patients, MS patients and healthy persons. Gait parameters at the beginning and end of a treadmill walking test were assessed in 10 stroke patients, 40 MS patients and 20 healthy subjects. The recently developed Fatigue index Kliniken Schmieder (FKS based on change of the movement’s attractor and its variability was used to measure motor fatigue. Six stroke patients had a pathological FKS. The FKS (indicating the level of motor fatigue in stroke patients was similar compared to MS patients. Stroke patients had smaller step length, step height and greater step width, circumduction with the right and left leg as well as greater sway compared to the other groups at the beginning and at the end of test. A severe walking impairment in stroke patients does not necessarily cause a pathological FKS indicating motor fatigue. Moreover, the FKS can be used as a measure of motor fatigue in stroke and MS and may also be applicable to other diseases.

  12. Dynamic attentional modulation of vision across space and time after right hemisphere stroke and in ageing

    Science.gov (United States)

    Russell, Charlotte; Malhotra, Paresh; Deidda, Cristiana; Husain, Masud

    2013-01-01

    Introduction Attention modulates the availability of sensory information to conscious perception. In particular, there is evidence of pathological, spatial constriction of the effective field of vision in patients with right hemisphere damage when a central task exhausts available attentional capacity. In the current study we first examined whether this constriction might be modulated across both space and time in right hemisphere stroke patients without neglect. Then we tested healthy elderly people to determine whether non-pathological ageing also leads to spatiotemporal impairments of vision under conditions of high attention load. Methods Right hemisphere stroke patients completed a task at fixation while attempting to discriminate letters appearing in the periphery. Attentional load of the central task was modulated by increasing task difficulty. Peripheral letters appeared simultaneously with the central task or at different times (stimulus onset asynchronies, SOAs) after it. In a second study healthy elderly volunteers were tested with a modified version of this paradigm. Results Under conditions of high attention load right hemisphere stroke patients have a reduced effective visual field, over a significantly extended ‘attentional blink’, worse for items presented to their left. In the second study, older participants were unable to discriminate otherwise salient items across the visual field (left or right) when their attention capacity was loaded on the central task. This deficit extended temporally, with peripheral discrimination ability not returning to normal for up to 450 msec. Conclusions Dynamically tying up attention resources on a task at fixation can have profound effects in patient populations and in normal ageing. These results demonstrate that items can escape conscious detection across space and time, and can thereby impact significantly on visual perception in these groups. PMID:23245427

  13. Pyramidal neurons of the prefrontal cortex in post-stroke, vascular and other ageing-related dementias.

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    Foster, Vincent; Oakley, Arthur E; Slade, Janet Y; Hall, Roslyn; Polvikoski, Tuomo M; Burke, Matthew; Thomas, Alan J; Khundakar, Ahmad; Allan, Louise M; Kalaria, Raj N

    2014-09-01

    Dementia associated with cerebrovascular disease is common. It has been reported that ∼30% of elderly patients who survive stroke develop delayed dementia (post-stroke dementia), with most cases being diagnosed as vascular dementia. The pathological substrates associated with post-stroke or vascular dementia are poorly understood, particularly those associated with executive dysfunction. Three separate yet interconnecting circuits control executive function within the frontal lobe involving the dorsolateral prefrontal cortex, anterior cingulate cortex and the orbitofrontal cortex. We used stereological methods, along with immunohistological and related cell morphometric analysis, to examine densities and volumes of pyramidal neurons of the dorsolateral prefrontal cortex, anterior cingulate cortex and orbitofrontal cortex in the frontal lobe from a total of 90 elderly subjects (age range 71-98 years). Post-mortem brain tissues from post-stroke dementia and post-stroke patients with no dementia were derived from our prospective Cognitive Function After Stroke study. We also examined, in parallel, samples from ageing controls and similar age subjects pathologically diagnosed with Alzheimer's disease, mixed Alzheimer's disease and vascular dementia, and vascular dementia. We found pyramidal cell volumes in layers III and V in the dorsolateral prefrontal cortex of post-stroke and vascular dementia and, of mixed and Alzheimer's disease subjects to be reduced by 30-40% compared to post-stroke patients with no dementia and controls. There were no significant changes in neuronal volumes in either the anterior cingulate or orbitofrontal cortices. Remarkably, pyramidal neurons within the orbitofrontal cortex were also found to be smaller in size when compared to those in the other two neocortical regions. To relate the cell changes to cognitive function, we noted significant correlations between neuronal volumes and total CAMCOG, orientation and memory scores and clinical

  14. Prediction of Independent Walking Ability for Severely Hemiplegic Stroke Patients at Discharge from a Rehabilitation Hospital.

    Science.gov (United States)

    Hirano, Yoshitake; Hayashi, Takeshi; Nitta, Osamu; Takahashi, Hidetoshi; Nishio, Daisuke; Minakawa, Tomoya; Kigawa, Hiroshi

    2016-08-01

    It is important to predict walking ability for stroke patients, because rehabilitation programs are planned on such predictions. We therefore examined predictive factors that are available before discharge from a rehabilitation hospital. Seventy-two consecutive patients with a first attack of stroke with severe hemiplegia were included in this study. We retrospectively evaluated background factors (age, gender, time from stroke onset, paresis side, and stroke type). Other neurological and physical parameters were collected by means of the modified National Institutes of Health Stroke Scale, the Mini-Mental State Examination, the Trunk Control Test (TCT), and the knee extension strength/body weight ratio on the unaffected side (KES/BW-US) at the time of admission. We divided the patients into 2 groups, the independent group (n = 49) and the dependent group (n = 23), on the basis of the Barthel Index of mobility at the time of discharge. We then compared the 2 groups with respect to the aforementioned parameters. We also performed stepwise discriminant analyses to ascertain which parameters are the best predictors of walking ability at the time of discharge. Age, TCT score, and the KES/BW-US ratio were significantly different between the groups. Discriminant analysis revealed that younger age and a higher KES/BW-US ratio were significantly associated with walking ability at discharge, which could be precisely predicted using the following formula: Y = .093 × (age) - 4.316 × (KES/BW-US) - 4.984. At the time of admission, age and the KES/BW-US ratio permit the prediction of independent walking ability at the time of discharge. Our formula predicts walking ability with an accuracy of more than 91%. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Left atrial size in patients with cryptogenic stroke as a predictor of occurrence of atrial fibrillation

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    Antonio Cruz Culebras

    2017-04-01

    Full Text Available Objective: To determine whether the left atrial size can predict the development of atrial fibrillation (AF in patients with embolic stroke of undetermined source (ESUS. Methods: Patients with ischemic stroke were included prospectively (January 2015-July 2015 when ESUS was suspected. Clinical and cardiac imaging data were recorded. Patients with cardiac failure were excluded. Results: a total of 55 patients were included. Medium age was 71 years. The proportion of patients who developed AF during the follow-up (1 year was 23, 63%. 10 % of patients did not have any vascular risk factor. Basal ECG was normal in 98% of cases. The left atrial size volume was 36, 08 ml in patients who developed AF and 27, 14 ml in patients who did not. Conclusions: In patients with ESUS, left atrial size dimensions do not predict the occurrence of AF.

  16. Upper extremity proprioception in healthy aging and stroke populations, and the effects of therapist- and robot-based rehabilitation therapies on proprioceptive function

    Directory of Open Access Journals (Sweden)

    Charmayne Mary Lee Hughes

    2015-03-01

    Full Text Available The world’s population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover, the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist- and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research.

  17. Upper extremity proprioception in healthy aging and stroke populations, and the effects of therapist- and robot-based rehabilitation therapies on proprioceptive function.

    Science.gov (United States)

    Hughes, Charmayne Mary Lee; Tommasino, Paolo; Budhota, Aamani; Campolo, Domenico

    2015-01-01

    The world's population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover, the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review, we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist- and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research.

  18. Upper Extremity Proprioception in Healthy Aging and Stroke Populations, and the Effects of Therapist- and Robot-Based Rehabilitation Therapies on Proprioceptive Function

    Science.gov (United States)

    Hughes, Charmayne Mary Lee; Tommasino, Paolo; Budhota, Aamani; Campolo, Domenico

    2015-01-01

    The world’s population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover, the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review, we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist- and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research. PMID:25784872

  19. Do nasogastric tubes worsen dysphagia in patients with acute stroke?

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    Ringelstein Erich B

    2008-07-01

    Full Text Available Abstract Background Early feeding via a nasogastric tube (NGT is recommended as safe way of supplying nutrition in patients with acute dysphagic stroke. However, preliminary evidence suggests that NGTs themselves may interfere with swallowing physiology. In the present study we therefore investigated the impact of NGTs on swallowing function in acute stroke patients. Methods In the first part of the study the incidence and consequences of pharyngeal misplacement of NGTs were examined in 100 stroke patients by fiberoptic endoscopic evaluation of swallowing (FEES. In the second part, the effect of correctly placed NGTs on swallowing function was evaluated by serially examining 25 individual patients with and without a NGT in place. Results A correctly placed NGT did not cause a worsening of stroke-related dysphagia. Except for two cases, in which swallowing material got stuck to the NGT and penetrated into the laryngeal vestibule after the swallow, no changes of the amount of penetration and aspiration were noted with the NGT in place as compared to the no-tube condition. Pharyngeal misplacement of the NGT was identified in 5 of 100 patients. All these patients showed worsening of dysphagia caused by the malpositioned NGT with an increase of pre-, intra-, and postdeglutitive penetration. Conclusion Based on these findings, there are no principle obstacles to start limited and supervised oral feeding in stroke patients with a NGT in place.

  20. Stem cell therapies in age-related neurodegenerative diseases and stroke.

    Science.gov (United States)

    Wang, Yuan; Ji, Xunming; Leak, Rehana K; Chen, Fenghua; Cao, Guodong

    2017-03-01

    Aging, a complex process associated with various structural, functional and metabolic changes in the brain, is an important risk factor for neurodegenerative diseases and stroke. These diseases share similar neuropathological changes, such as the formation of misfolded proteins, oxidative stress, loss of neurons and synapses, dysfunction of the neurovascular unit (NVU), reduction of self-repair capacity, and motor and/or cognitive deficiencies. In addition to gray matter dysfunction, the plasticity and repair capacity of white matter also decrease with aging and contribute to neurodegenerative diseases. Aging not only renders patients more susceptible to these disorders, but also attenuates their self-repair capabilities. In addition, low drug responsiveness and intolerable side effects are major challenges in the prevention and treatment of senile diseases. Thus, stem cell therapies-characterized by cellular plasticity and the ability to self-renew-may be a promising strategy for aging-related brain disorders. Here, we review the common pathophysiological changes, treatments, and the promises and limitations of stem cell therapies in age-related neurodegenerative diseases and stroke. Published by Elsevier B.V.

  1. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

    Science.gov (United States)

    Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L.; Mack, William J.; Sanossian, Nerses

    2015-01-01

    Introduction Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Methods Each county’s local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Results Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. Conclusion California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources. PMID:26587100

  2. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

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    Nikolay Dimitrov

    2015-10-01

    Full Text Available Introduction: Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Methods: Each county’s local emergency medical services agency (LEMSA was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Results: Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45% had stroke routing protocols, covering 23 counties (40% and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile. In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. Conclusion: California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

  3. Review of nutrition support and evaluation in stroke patients

    OpenAIRE

    Zhuo-li WU; Shao-shi WANG

    2015-01-01

    Malnutrition is common after stroke, usually caused by cognitive disorder, dysphagia, paralysis, sensorimotor disability and visual field defect. Many researches indicate that the initiation of early enteral nutrition in stroke patients would own enormous clinical benefits, including a decrease in the risk of death and infectious diseases, shorter hospital stay and lower health expenditure. However, irregular nutrition management could increase the incidence of hypostatic pneumonia and ...

  4. Characteristic adverse events and their incidence among patients participating in acute ischemic stroke trials.

    Science.gov (United States)

    Hesse, Kerrick; Fulton, Rachael L; Abdul-Rahim, Azmil H; Lees, Kennedy R

    2014-09-01

    Adverse events (AE) in trial populations present a major burden to researchers and patients, yet most events are unrelated to investigational treatment. We aimed to develop a coherent list of expected AEs, whose incidence can be predicted by patient characteristics that will inform future trials and perhaps general poststroke care. We analyzed raw AE data from patients participating in acute ischemic stroke trials. We identified events that occurred with a lower 99% confidence bound greater than nil. Among these, we applied receiver operating characteristic principles to select the fewest types of events that together represented the greatest number of reports. Using ordinal logistic regression, we modeled the incidence of these events as a function of patient age, sex, baseline National Institutes of Health Stroke Scale, and multimorbidity status, defining Pstroke. Right hemisphere (odds ratio [OR], 1.67), increasing baseline National Institutes of Health Stroke Scale (OR, 1.11), multimorbidity status (OR, 1.09 per disease), patient age (OR, 1.01 per year), height (OR, 1.01 per centimeter), diastolic blood pressure (OR, 0.99 per mm Hg), and smoking (OR, 0.82) were independently associated with developing more AEs but together explained only 13% of the variation. A list of 132 expected AEs after acute ischemic stroke may be used to simplify interpretation and reporting of complications. AEs can be modestly predicted by patient characteristics, facilitating stratification of patients by risk for poststroke complications. © 2014 American Heart Association, Inc.

  5. [Stroke in HIV-infected patients].

    Science.gov (United States)

    Lino, Ireneia; Sousa, António; Correia, José

    2007-01-01

    The spectrum of human immunodeficiency virus infection (HIV) is changing. New drug treatments have reduced morbidity and mortality of this disease, therefore it is necessary to start treating the HIV infection as a chronical disease. The association of the stroke with the HIV infection was inicially thought to be a result of other opportunistic infeccions and tumors. However, the vascular disease associated with HIV infection has been a subject of research and debate. New evidence shows that the vascular diseases could be a threat for the pacients doing highly active antirretroviral therapy (HAART). In this paper, we review the association between the HIV infection and stroke. Furthermore, we have done an analysis of the risk for the stroke on pacients with HIV infection considering the changes of the infection spectrum by the introduction of HAART.

  6. The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study.

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    Hung-Chi Wu

    Full Text Available OBJECTIVE: This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder. METHODS: This study identified a study population from the National Health Insurance Research Database (NHIRD between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430-438 and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors. RESULTS: A total of 472 (2.81% patients with bipolar disorder and 1,443 (2.14% controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12-1.38; p<0.0001 after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8% patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06-1.55; p = 0.012 after adjusting for patient, physician and hospital variables. CONCLUSIONS: The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period.

  7. Safety Outcomes After Thrombolysis for Acute Ischemic Stroke in Patients With Recent Stroke.

    Science.gov (United States)

    Merkler, Alexander E; Salehi Omran, Setareh; Gialdini, Gino; Lerario, Michael P; Yaghi, Shadi; Elkind, Mitchell S V; Navi, Babak B

    2017-08-01

    It is uncertain whether previous ischemic stroke within 3 months of receiving intravenous thrombolysis (tPA [tissue-type plasminogen activator]) for acute ischemic stroke (AIS) is associated with an increased risk of adverse outcomes. Using administrative claims data, we identified adults with AIS who received intravenous tPA at California, New York, and Florida hospitals from 2005 to 2013. Our primary outcome was intracerebral hemorrhage, and our secondary outcomes were unfavorable discharge disposition and inpatient mortality. We used logistic regression to compare rates of outcomes in patients with and without previous ischemic stroke within 3 months of intravenous tPA for AIS. We identified 36 599 AIS patients treated with intravenous tPA, of whom 568 (1.6%) had a previous ischemic stroke in the past 3 months. Of all patients who received intravenous tPA, the rate of intracerebral hemorrhage was 4.9% (95% confidence interval [CI], 4.7%-5.1%), and death occurred in 10.7% (95% CI, 10.4%-11.0%). After adjusting for demographics, vascular risk factors, and the Elixhauser Comorbidity Index, previous ischemic stroke within 3 months of thrombolysis for AIS was not associated with an increased risk of intracerebral hemorrhage (odds ratio, 0.9; 95% CI, 0.6-1.4; P=0.62), but was associated with an increased risk of death (odds ratio, 1.5; 95% CI, 1.2-1.9; P=0.001) and unfavorable discharge disposition (odds ratio, 1.3; 95% CI, 1.0-1.7; P=0.04). Among patients who receive intravenous tPA for AIS, recent ischemic stroke is not associated with an increased risk of intracerebral hemorrhage but is associated with a higher risk of death and unfavorable discharge disposition. © 2017 American Heart Association, Inc.

  8. [Sequential enteral nutrition support for patients with severe cerebral stroke].

    Science.gov (United States)

    Chen, Jiefang; He, Xudong; Zhang, Lisan; Hu, Xingyue

    2013-11-01

    To evaluate the efficacy of sequential enteral nutrition support in patients with severe cerebral stroke. Forty-nine patients with severe cerebral stroke met the inclusion criteria were randomly divided into sequential enteral nutrition group (Group A, n=24) and conventional enteral nutrition group (Group B, n=25). Patients in Group A received short-peptide-based enteral nutrition support first, then gradually transferred to intact protein enteral nutrition. Meanwhile, patients in Group B constantly received intact protein enteral nutrition support. The nutritional indexes and the rate of complications were compared between two groups. The nutritional indexes were decreased in both groups within 4 weeks after admission, but the decreasing levels of hemoglobin and albumin in Group A were significantly lower than those in Group B (P0.05). Sequential enteral nutritional support can improve the nutritional status and decrease the incidence of complications in critical patients with cerebral stroke.

  9. Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke.

    Science.gov (United States)

    Senda, Joe; Ito, Keiichi; Kotake, Tomomitsu; Kanamori, Masahiko; Kishimoto, Hideo; Kadono, Izumi; Suzuki, Yoshiro; Katsuno, Masahisa; Nishida, Yoshihiro; Ishiguro, Naoki; Sobue, Gen

    2016-01-01

    We investigated the factors influencing inpatient convalescent rehabilitation outcomes in patients with ischemic stroke, particularly severity of leukoaraiosis on magnetic resonance imaging. Participants included 520 patients with ischemic stroke (317 men and 203 women; mean age, 72.8±8.4 years) who were transferred from acute care hospitals for inpatient convalescent rehabilitation. Ischemic stroke subtypes included lacunar infarction (n=41), atherothrombosis (n=223), artery-to-artery embolism (n=67), cardiogenic embolism (n=97), undetermined embolism (n=76), and uncategorized ischemic stroke (n=16). Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on magnetic resonance imaging. Functional Independence Measure scores were assessed on admission and at discharge. Multiple regression analysis revealed that rehabilitation outcomes, measured as total Functional Independence Measure scores, were significantly associated with leukoaraiosis estimated by PVH grade. This association was observed after adjustment for factors such as severity, age, and poststroke history. In all patients, PVH grades were associated with Functional Independence Measure motor scores (PFunctional Independence Measure cognitive scores (Pstroke. Furthermore, the PVH grade was associated with motor function outcome, whereas the deep white matter hyperintensity grade correlated with cognitive function outcome, likely because the progression patterns and anatomic backgrounds of PVH and deep white matter hyperintensity differ according to ischemic stroke subtype. © 2015 American Heart Association, Inc.

  10. Edema of the paretic hand in elderly post-stroke nursing patients.

    Science.gov (United States)

    Leibovitz, Arthur; Baumoehl, Yehuda; Roginsky, Yelena; Glick, Zahava; Habot, Beni; Segal, Refael

    2007-01-01

    Post-stroke edema of the paretic hand constitutes an additional, functional, and esthetic nuisance for the patient. Although often encountered in daily practice, it is not even mentioned in the stroke chapters of the various textbooks. The phenomenon is far from being elucidated and various aspects are still obscure. In this study we tried to estimate the extent of post-stroke hand edema (PSHE) in a sample of elderly patients. The study group consisted of 188 elderly post-stroke nursing patients with hemi or only hand paresis. Seventy, age matched, non-paretic patients were examined as controls. The basis of comparison was the difference in circumference between the two arms at three sites: mid-finger, hand, and wrist as measured in the control group. Values above two standard deviations (S.D.) of the mean difference in circumference of the controls, at two or three sites, were considered as edema. Edema of the paretic hand was detected in 37% of post-stroke patients. Most (about three-quarters), could be classified as simple PSHE, while the rest may have had reflex sympathetic dystrophy (RSD).

  11. Embolic stroke after ligation of the pulmonary artery in patients with functional single ventricle.

    Science.gov (United States)

    Oski, J A; Canter, C E; Spray, T L; Kan, J S; Cameron, D E; Murphy, A M

    1996-10-01

    In the setting of functional single ventricle with pulmonary overcirculation, pulmonary artery banding is frequently used to alleviate symptoms and to prepare for staged repair. At subsequent cavopulmonary anastomosis or Fontan procedure, the pulmonary artery may be ligated at the site of the pulmonary band. This article describes the association of embolic stroke and thrombus in a ligated or divided pulmonary artery stump in three patients with functional single ventricle. These events occurred from 1990 through 1992 among the 1700 inpatient pediatric cardiology admissions at two institutions. The patients, ranging in age from 15 months to 9 years, had cerebral infarctions documented by computed axial tomography scan or magnetic resonance imaging associated with the echocardiographic finding of thrombus in the proximal pulmonary artery stump after the embolic strokes. The strokes occurred 5 days to 5 years after surgery. Two patients had a second infarction within 2 to 5 weeks of the initial stroke. It is concluded that the presence of the ligated pulmonary artery stump may place patients at risk for embolic stroke. Surgical approaches to reduce the risk of thrombus formation should be considered prospectively in this patient group.

  12. Motor recovery of stroke patients after rehabilitation: one-year follow-up study.

    Science.gov (United States)

    Kuptniratsaikul, Vilai; Kovindha, Apichana; Suethanapornkul, Sumalee; Massakulpan, Pornpimon; Permsirivanich, Wutichai; Kuptniratsaikul, Patcharawimol Srisa-An

    2017-01-01

    Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.

  13. 中青年及老年缺血性脑卒中患者的临床特点对比与分析%A comparative analysis of clinical characteristics of the young-middle-aged and old-aged patients with ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    刘慧; 谢明

    2013-01-01

    Objective: To compare and analyze the clinical characteristics of the young-middle-aged and old-aged patients with ischemic stroke in order to guide the prevention and treatment. Methods: Clinical data of 102 young-middle-aged patients with ischemic stroke were retrospectively analyzed and compared with those of 132 cases of the elderly patients. Results: Compared with the elderly patients, young and middle aged patients were male-dominated and the incidence of ischemic stroke increased with age. The proportion of smoking and alcohol abuse were significantly more than those of elderly patients (P < 0. 05 ). There were significant difference in the clinical symptoms and signs in regard to slurred speech, headache, nausea, vomiting, dyskinesia, and bulbar paralysis (P<0. 05) , which might be related to the localization and range of the lesion. The cure rate in young-middle aged group was significantly higher than that of the elderly group ( P < 0.05). Conclusion: We should fully aware of these clinical characteristics, enforce the prevention as well as treatment to improve patients'outcome and quality of life.%目的:比较中青年与老年缺血性脑卒中的临床特点,以指导中青年患者的预防与治疗.方法:回顾性分析我院收治的102例中青年缺血性脑卒中患者病例资料,并与132例老年患者的相应资料对比分析.结果:与老年患者相比,中青年患者以男性为主,发病率随年龄增加而增加;吸烟、酗酒等所占比例与老年患者有显著差异(P<0.05);言语不清、头痛、恶心、呕吐、运动障碍及球麻痹等临床症状和体征与老年患者相比有显著差异(P<0.05),这可能与病变部位及范围有关;中青年组基本治愈率要明显高于老年患者(P<0.05).结论:临床工作中应充分了解中青年脑卒中患者的临床特点,加强预防,及时治疗,以改善患者的预后和生活质量.

  14. A STUDY ON RISK FACTORS AND LIPID PROFILE PATTERN IN PATIENTS OF STROKE

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    Jawgam Umbon

    2016-07-01

    Full Text Available BACKGROUND Stroke is usually end result of predisposing conditions that originated years before the ictus. Creating awareness and treatment of its modifiable risk factors will reduce the incidence of stroke. OBJECTIVE To study the risk factors and lipid profile pattern in stroke patients. METHODS Patients with diagnosis of stroke comprising 50 consecutive patients each of ischaemic and haemorrhagic strokes who were admitted in Jorhat Medical College & Hospital, Assam over a period of 1 year (May 2015 - April 2016 included in the study, while patients on lipid lowering therapy were excluded from the study. History of risk factors like hypertension, diabetes mellitus, smoking and alcoholism were taken. To determine the subtype of stroke, clinical examination followed by CT scan/MRI of brain were done. A serum sample after 8 hours of overnight fasting was taken on the next day of admission for both groups of patients. Total serum cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol and HDL-cholesterol was determined, using enzymatic colorimetric method. RESULTS A total of 100 patients were studied, of whom 66 were males and 34 were females. The mean age for the ischaemic group was 62±12 years and for the haemorrhagic group were 55±14 years. In this study, dyslipidaemia was present in 58 (58% patients. Patients with high total cholesterol - 33 (18 ischaemic, 15 haemorrhagic, high LDL-cholesterol was found in 38 (22 ischaemic, 16 haemorrhagic, high triglycerides in 31 (14 ischaemic, 17 haemorrhagic and low HDL-cholesterol in 47 (29 ischaemic, 18 haemorrhagic. Among 100 patients, 66 had hypertension, 20 had diabetes mellitus, 18 had both diabetes and hypertension, 43 were smokers, 36 consumed alcohol and >2 risk factor were found in 44. CONCLUSION Dyslipidaemia was found in 58% of patients and most striating features were low HDL-cholesterol and elevated triglycerides level, indicating they are independent risk factors for stroke. No

  15. Availability of informal caregivers in surviving stroke patients in Belgium.

    Science.gov (United States)

    Francois, Silke; Borgermans, Liesbeth; Van Casteren, Viviane; Vanthomme, Katrien; Devroey, Dirk

    2014-12-01

    To quantify the availability of informal caregivers in surviving stroke patients residing at home in Belgium. National estimates on the availability of informal caregivers were made using data from a nationwide observational registration of family physicians working in sentinel practices and a nationwide administrative database for reimbursement of hospitals in Belgium. A total of 189 Belgian family physicians (FPs) from 141 practices participated in the study and recorded 326 patients (144 men and 182 women) with stroke. These FPs reach 1.5% of the Belgian population. After 1 month, 71% of the male and 75% of the female stroke survivors received support from family caregivers (p = 0.547). After 6 months, the percentage of male patients who received support from family caregivers decreased to 60% compared with 75% in female (p = 0.038). Of all patients with stroke admitted to Belgian hospitals during the reference year 2009 (n = 16.437), 8.997 returned home. Based on the findings from the sentinel practices, it is estimated that a mean of 73% (n = 6.568) and 67.5% (n = 6.073) of surviving patients with stroke can rely on informal caregivers in their home setting after one and 6 months, respectively. A vast majority of surviving stroke patients in Belgium can rely on informal caregivers in their home setting, but their availability rapidly decreases 6 months after the event. These findings underline the importance of proactive health policy making in stroke care taking into account the potentially decreasing number of available informal caregivers in the decades to come. © 2013 Nordic College of Caring Science.

  16. Intracranial arterial calcification is highly prevalent in hemodialysis patients but does not associate with acute ischemic stroke.

    Science.gov (United States)

    Power, Albert; Chan, Kakit; Haydar, Ali; Hamady, Mohamed; Cairns, Tom; Taube, David; Duncan, Neill

    2011-04-01

    Intracranial arterial calcification (IAC) is associated with ischemic stroke in the general population but this relationship has not been examined in hemodialysis patients. We examined the factors associated with IAC and its relationship with acute ischemic stroke in this population. We retrospectively studied 490 head computed tomographic scans from 2225 hemodialysis patients presenting with neurological symptoms at our center (October 2005-May 2009). Intracranial arterial calcification was graded using a validated scoring system. Multivariate regression was used to examine the factors associated with the presence of IAC, its severity, and its ability to predict acute ischemic stroke. Weibull's survival models analyzed the relationship between IAC severity and survival. Ninety-five percent of patients with ischemic stroke had IAC vs. 83% in the nonstroke group (P=0.02). Intracranial arterial calcification severity increased with age (Pacute ischemic stroke (P=0.05) on logistic regression analysis. High-grade and not low-grade IAC was associated with worse survival (P=0.008). Intracranial arterial calcification is highly prevalent in hemodialysis patients, especially in those with acute ischemic stroke. Its severity is prognostically significant and associated with risk factors for vascular calcification and may confer a greater risk of acute ischemic stroke. The mechanisms underlying the high incidence of ischemic stroke in this patient group require further comprehensive study. © 2011 The Authors. Hemodialysis International © 2011 International Society for Hemodialysis.

  17. Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia

    Science.gov (United States)

    Kepplinger, Jessica; Barlinn, Kristian; Albright, Karen C.; Schrempf, Wiebke; Boehme, Amelia K.; Pallesen, Lars-Peder; Schwanebeck, Uta; Graehlert, Xina; Storch, Alexander; Reichmann, Heinz; Alexandrov, Andrei V.; Bodechtel, Ulf

    2017-01-01

    Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 % of studied patients. We enrolled 61 patients (84 % AIS, 16 % TIA): mean age 66 ± 8 years, 44 % men, median NIHSS 1 (0–15), median ESS 5 (0–13). Analyzability was given in 56/61 (91.8 %; one-sided 95 % CI, lower-bound 86.0 %) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 % in TIA, 91 % minor stroke, 83 % major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea–hypopnea index ≥5/h (median: 20/h [0–79]); 32 % (18/ 56) mild, 30 % (17/56) moderate, and 29 % (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 %, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 %, p = 0.69) of SA. After 12 months, 27/38 (71 %) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 %) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients. PMID:23263538

  18. Motor imagery ability in stroke patients: The relationship between implicit and explicit motor imagery measures.

    Directory of Open Access Journals (Sweden)

    Sjoerd eDe Vries

    2013-11-01

    Full Text Available There is little consensus on how motor imagery ability should be measured in stroke patients. In particular it is unclear how two methods tapping different aspects of the motor imagery process relate to each other. The aim of this study was to investigate the relationship between implicit and explicit motor imagery ability by comparing performance of stroke patients and controls on a motor imagery questionnaire and a hand laterality judgment task (HLJT. Sixteen ischemic stroke patients (36±13 weeks post-stroke and 16 controls, matched by age (51±10 years, gender (7 females and handedness (3 left-handed, performed a HLJT and completed a motor imagery questionnaire. Our study shows that neither in the healthy controls nor in patients, a correlation is found between the HLJT and the motor imagery questionnaire. Although the patient group scored significantly lower than the control group on the visual motor imagery component (U= 60; p = 0.010 and the kinesthetic motor imagery component (U = 63.5; p = 0.015 of the questionnaire, there were no significant differences between patients and controls on accuracy scores of the HLJT. Analyses of the reaction time profiles of patients and controls showed that patient were still able to use an implicit motor imagery strategy in the HLJT task. Our results show that after stroke performance on tests that measure two different aspects of motor imagery ability, e.g. implicit and explicit motor imagery, can be differently affected. These results articulate the complex relation phenomenological experience and the different components of motor imagery have and caution the use of one tool as an instrument for use in screening, selecting and monitoring stroke patients in rehabilitation settings.

  19. Evaluation of activity and effectiveness of occupational therapy in stroke patients at the early stage of rehabilitation.

    Science.gov (United States)

    Petruseviciene, Daiva; Krisciūnas, Aleksandras

    2008-01-01

    In Lithuania, the stroke is not only medical, but social issue as well, since only 20% of patients suffering from stroke remain active at work. Yearly stroke incidence in Lithuania is 7000-8000 cases. The most common outcome of stroke is unilateral paralysis (hemiplegia) followed by disorders of coordination, balance, and movements. Due to dysfunctions of movements, self-care, cognition, behavior, and communication, some part of stroke patients remains disabled. They need assistance and care provided by other people. Occupational therapy, which is part of rehabilitation of patients after stroke, is directed to independence training. There are scarce data related to effectiveness of occupational therapy depending on motor, cognitive, and psychosocial dysfunctions. Goals of study were to estimate effectiveness of occupational therapy at the early stage of rehabilitation depending on type of stroke, localization of brain injury, grade of lesion, age, and gender, to identify factors influencing effectiveness of occupational therapy, and to estimate their positive predictive value. The study included 106 patients at the early stage of rehabilitation, who were admitted to Department of Neurorehabilitation after stabilization of clinical condition from Departments of Neurology and Neurosurgery (mean duration of 14+/-2 days after stroke). The program of occupational therapy was not fulfilled by 6 patients: 2 patients were transferred to Nursing Hospital due to severe condition, and 4 patients were discharged prematurely and continued rehabilitation in outpatient setting. Hence, study population consisted of 100 subjects (47 men and 53 women) who were diagnosed with stroke (ischemic or hemorrhagic). Patient's functional status and disorders of activities were evaluated using Barthel Index and Functional Independence Measure. Complexes of occupational therapy were adjusted according to examination of patient's disorders of activities, age, grade of lesion, other diseases

  20. Effect of sex and age interactions on functional outcome after stroke.

    Science.gov (United States)

    Kim, Tae-Hee; Vemuganti, Raghu

    2015-04-01

    Stroke is one of the leading causes of death and disability worldwide. Experimental and clinical studies showed that sex and age play an important role in deciding the outcome after stroke. At younger ages, males were shown to have a higher risk for stroke than females. However, this trend reverses in older ages particularly when females reach menopause. Many preclinical studies indicate that steroid hormones modulate the age-dependent differential stroke outcome. In addition, patterns of cell death pathways activated following cerebral ischemia are distinct between males and females, but independent of steroid hormones. Recent studies also indicate that microRNAs play important roles in mediating sex-specific stroke outcome by regulating stroke-related genes. This review discusses the contribution of sex and age to outcome after stroke with particular emphasis on the experimental studies that examined the effects of steroid hormones, differential cell death pathways, and involvement of sex-specific microRNAs following cerebral ischemia. Current understanding of the role of thrombolytic agents in stroke therapy is also discussed.

  1. Pharmacologic approaches to cerebral aging and neuroplasticity: insights from the stroke model.

    Science.gov (United States)

    Chollet, François

    2013-03-01

    Brain plasticity is an intrinsic characteristic of the nervous system that allows continuous remodeling of brain functions in pathophysiological conditions. Although normal aging is associated with morphological modifications and decline of cerebral functions, brain plasticity is at least partially preserved in elderly individuals. A growing body of evidence supports the notion that cognitive enrichment and aerobic training induce a dynamic reorganization of higher cerebral functions, thereby helping to maintain operational skills in the elderly and reducing the incidence of dementia. The stroke model clearly shows that spontaneous brain plasticity exists after a lesion, even in old patients, and that it can be modulated through external factors like rehabilitation and drugs. Whether drugs can be used with the aim of modulating the effects of physical training or cognitive stimulation in healthy aged people has not been addressed until now. The risk:benefit ratio will be the key question with regard to the ethical aspect of this challenge. We review in this article the main aspects of human brain plasticity as shown in patients with stroke, the drug modulation of brain plasticity and its consequences on recovery, and finally we address the question of the influence of aging on brain plasticity.

  2. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    Directory of Open Access Journals (Sweden)

    Madsen, Tracy E.

    2014-12-01

    Full Text Available Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV tissue plasminogen activator (tPA. Emergency department (ED triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI levels and use of ED critical care beds. Methods: This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ≥18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results: There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001, and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001. Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77; 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53. After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81] and 3

  3. Information provision for stroke patients and their caregivers.

    Science.gov (United States)

    Forster, Anne; Brown, Lesley; Smith, Jane; House, Allan; Knapp, Peter; Wright, John J; Young, John

    2012-11-14

    Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. To assess the effectiveness of information provision strategies in improving the outcome for stroke patients or their identified caregivers, or both. For this update we searched the Cochrane Stroke Group Trials Register (June 2012), the Cochrane Central Register of Controlled trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the NHS Economic Evaluation Database (EED), and the Health Technology Assessment (HTA) Database (The Cochrane Library June, 2012), MEDLINE (1966 to June 2012), EMBASE (1980 to June 2012), CINAHL (1982 to June 2012) and PsycINFO (1974 to June 2012). We also searched ongoing trials registers, scanned bibliographies of relevant articles and books and contacted researchers. Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone. Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood. We have added four new trials to this update. This review now includes 21 trials involving 2289 patient and 1290 carer participants. Nine trials evaluated a passive and 12 trials an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient knowledge (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.12 to 0.46, P 0.05) on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post

  4. Clinical and imaging features associated with intracranial internal carotid artery calcifications in patients with ischemic stroke

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    Yilmaz, Arda [Mersin University, Department of Neurology, Faculty of Medicine, Mersin (Turkey); Akpinar, Erhan [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey); Topcuoglu, Mehmet Akif; Arsava, Ethem Murat [Hacettepe University, Department of Neurology, Faculty of Medicine, Ankara (Turkey)

    2015-05-01

    Intracranial internal carotid artery calcifications (ICAC), a frequent finding on imaging studies, are predictive of future stroke risk in population-based studies. The clinical significance of this observation among ischemic stroke patients is however less clear. In this study, we analyzed ICAC burden in relation to vascular risk factor profile, stroke etiology, and extent of craniocervical vascular calcifications in a consecutive series of ischemic stroke patients. The burden of ICAC was determined both on non-contrast CT and CT-angiography source images by semiquantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype, and calcification burden in other craniocervical arteries was assessed among patients with no ICAC, mild-moderate ICAC, and severe ICAC. Of 319 patients included into the study, 28 % had no ICAC, 35 % had mild-moderate ICAC, and 37 % had severe ICAC on CT angiography. Independent factors associated with ICAC burden in multivariate analysis included age (p < 0.001), diabetes mellitus (p = 0.006), and coronary artery disease (p < 0.001). Furthermore, a stroke etiology of large artery atherosclerosis or cardioaortic embolism was significantly related to higher ICAC burden (p = 0.006). Patients with severe ICAC were more likely to harbor calcifications in other vascular beds (p < 0.001). All of these findings persisted when analyses were repeated with CT-based ICAC burden assessments. ICAC burden reflects a continuum of atherosclerotic disease involving carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with stroke of large vessel or cardioembolic origin. This information might help the clinician in prioritizing etiologic work-up in the acute period. (orig.)

  5. Noninvasive Ventilatory Correction in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Tsivgoulis, Georgios; Alexandrov, Andrei V; Katsanos, Aristeidis H; Barlinn, Kristian; Mikulik, Robert; Lambadiari, Vaia; Bonakis, Anastasios; Alexandrov, Anne W

    2017-08-01

    Even though current guidelines suggest that noninvasive ventilatory correction (NIVC) could be considered for acute ischemic stroke patients with obstructive sleep apnea, available evidence is conflicting, with no adequately powered randomized clinical trial being available to date. We conducted a systematic review and meta-analysis of all available literature data evaluating the effect of NIVC on neurological improvement (based on decrease in National Institutes of Health Stroke Scale score), vascular events (recurrent stroke, transient ischemic attack, myocardial infarction and unstable angina), and mortality during the follow-up period. We identified 4 randomized clinical trials and 1 prospectively matched observational cohort, comprising a total of 389 patients (59.8% males, mean age: 64.4 years). The risk of both performance and detection bias was considered high in most of the included randomized clinical trials because of the lack of blinding in participants, personnel and/or outcome assessors. The mean decrease in National Institutes of Health Stroke Scale scores during the first (≤30) days of acute ischemic stroke was found to be greater in NIVC-treated patients in comparison to controls (standardized mean difference, 0.38; 95% confidence interval, 0.11-0.66; P=0.007). However, no significant differences were detected between NIVC-treated acute ischemic stroke patients and controls on both the risk of vascular events (risk ratio, 0.53; 95% confidence interval, 0.25-1.14; P=0.11) and mortality (risk ratio, 0.71; 95% confidence interval, 0.37-1.36; P=0.30). No evidence of heterogeneity (I(2)=0%; P for Cochran Q>0.50) or publication bias were detected in all analyses. NIVC seems to be associated with greater short-term neurological improvement in acute ischemic stroke patients with obstructive sleep apnea. This finding deserves further investigation within the settings of an adequately powered, sham-control, randomized clinical trial. © 2017 American Heart

  6. Elevated C-reactive protein levels predict worsening prognosis in Chinese patients with first-onset stroke

    Institute of Scientific and Technical Information of China (English)

    Jiangtao YAN; Rutai HUI; Daowen WANG

    2009-01-01

    The role of high sensitivity C-reactive protein (hsCRP) in predicting prognosis after stroke in the Asian population has not been investigated. We hypothesized that elevated levels of hsCRP were associated with worsening prognosis after stroke in Chinese patients. Two hundred and ninety consecutive patients with first-onset stroke and 290 age- and gender-matched control subjects without any cerebrovascular disease were enrolled for study. Plasma hsCRP level was detected and subsequent vascular events and death were recorded in both groups over a 5-year period. Compared to control group, patients presenting with stroke had higher plasma hsCRP level (3.3±3.8 vs 1.3±2.2 mg/L, P < 0.01). Furthermore, in the group of patients with stroke, the mean plasma hsCRP level was higher in patients who developed subsequent vascular diseases or died as compared with the patients without further complications (4.4±4.3 vs 2.7±3.3 mg/L, P< 0.01). Compared to the lowest tertile of hsCRP level, the relative risk for vascular events or death in stroke patients was 2.91 in the highest tertile ofhsCRP (95% CI, 1.54-5.50, P = 0.001). This increase in relative risk for vascular events or death in stroke patients continued after adjustment for age, sex and other cardiovascular risk factors such as hypertension and diabetes (OR: 2.771, 95% CI: 1.367-5.617, P = 0.005). These findings indicate that increased hsCRP level is associated with worsening prognosis after stroke in Chinese patients and suggests that inflammation is correlated with stroke outcome.

  7. Stable stroke occurrence despite incidence reduction in an aging population

    DEFF Research Database (Denmark)

    Thorvaldsen, P; Davidsen, M; Brønnum-Hansen, Henrik

    1999-01-01

    A stroke register was established at the Glostrup Population Studies in 1982 with the objective to monitor stroke occurrence in the population continuously during a 10-year period and contribute data to the WHO Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Project...

  8. The Importance Of Patient Involvement In Stroke Rehabilitation

    DEFF Research Database (Denmark)

    Kristensen, Hanne Kaae; Tistad, Malin; Von Koch, Lena;

    2016-01-01

    the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke...... stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading....... Conclusions: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs....

  9. The standardization therapeutics of ischemic stroke the clinical analysis of 312 patients with stoke

    Institute of Scientific and Technical Information of China (English)

    Dong Qiang; Fang Xin; Hun Xiang

    2000-01-01

    Objective: To study the outcome after the standardization therapeutics of ischemic stroke and the relatively factors which can influence the outcome of patients with stroke. Methods: Using data collected from 312 patients enrolled in the clinical standardization therapeutics trial, and neurological impairment at the hospitalization and the discharge was quantified using the China Stroke Scale (CSS), the outcome at the discharge using the percentage of CSS decreasing. The outcome was rated as cure if the percentage of CSS decreasing was over 89% and dead. Analyses were adjusted for age, history of previous disorders, and the form of onset, blood pressure at onset, complication. Results: The percentage of cure after the thrombolysis was 12.5%, after anticoagulant was 8.23%, after decreasing fibrinogen was 8.57% and after the convention treatment was only 5.66%. And at the same time, the percentage of dead after the thrombolysis was 12.5%, after anticoagulant was 8.23%, after decreasing fibrinogen was 8.57% and after the convention treatment was 10.1%. The other factors had no differently between the variability treatments. The complication could influence the outcome of stroke patients, especially the infect of respiratory, disturbance of kidney and electrolyte. Conclusions: The standardization therapeutics should be contributing the outcome of patients with ischemic stroke.

  10. Telemedicine System for Game-Based Rehabilitation of Stroke Patients in the FP7-“StrokeBack” Project

    OpenAIRE

    Vogiatzaki, Emmanouela; Gravezas, Yannis; Dalezios, Nikos; Biswas, Dwaipayan; Cranny, Andy; Ortmann, Steffen; Peter, Langendörfer; LAMPRINOS, Ilias; Giannakopoulou, Gioula; Achner, Josy; Klemke, Jasmin; Jost, Holger

    2014-01-01

    Stroke is a disease with very high socio-economic impact. In average, the healthcare expenditure cost for Strokes across different countries in Europe and USA exceeds 3% of their entire healthcare expenditure, including inpatient treatments, outpatient hospital visits and long-term rehabilitation and care. Therefore, there is an urgent need for devising an effective long-term care and rehabilitation strategy for stroke patients, which would actively involve patients in the rehabilitation proc...

  11. The outcome of patients with mild stroke improves after treatment with systemic thrombolysis.

    Directory of Open Access Journals (Sweden)

    Xabier Urra

    Full Text Available INTRODUCTION: In up to one third of patients with mild stroke suitable to receive systemic thrombolysis the treatment is not administered because the treating physicians estimate a good spontaneous recovery. However, it is not settled whether the fate of these patients is equivalent to those who are thrombolysed. METHODS: We analyzed 203 consecutive patients (134 men and 69 women, mean age 69±14 years without premorbid disability and a NIHSS score ≤5 at admission [median 3 (IQR 2-4]. Intravenous thrombolysis was administered within 4.5 hours from stroke onset (n = 119, or it was withheld (n = 84 whenever the treating physician predicted a spontaneous recovery. The baseline risk factors, clinical course, infarction volume, bleeding complications, and functional outcome at 3 months were analyzed and declared to a Web-based registry which was accessible to the local Health Authorities. RESULTS: Expectedly, not thrombolysed patients had the mildest strokes at admission [median 2 (IQR 1-3.75]. At day 2 to 5, the infarct volume on DWI-MRI was similar in both groups. There were no symptomatic cerebral bleedings in the study. An ordinal regression model adjusted for baseline stroke severity showed that thrombolysis was associated with a greater proportion of patients who shifted down on the modified Rankin Scale score at 3 months (OR 2.66; 95% CI 1.49-4.74, p = 0.001. CONCLUSIONS: Intravenous thrombolysis seems to be safe in patients with mild stroke and may be associated with improved outcome compared with untreated patients. These results support the evaluation of the efficacy of intravenous thrombolysis in mild stroke patients in randomized clinical trials.

  12. Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study.

    Science.gov (United States)

    Fukuda, Hiroyuki; Morishita, Takashi; Ogata, Toshiyasu; Saita, Kazuya; Hyakutake, Koichi; Watanabe, Junko; Shiota, Etsuji; Inoue, Tooru

    2016-01-01

    This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors' knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.

  13. Hyponatremia And Disability, Prevalence And Prognosis In Babol Stroke Patients.

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    Alijan Ahmadi Ahangar

    2017-02-01

    Full Text Available Background: Stroke is the leading cause of serious long-term disability. In recent studies hyponatremia as a risk factor for stroke. Methods: This cross-sectional descriptive study was to evaluate serum zinc level in serum sodium over the first 24 hours after the onset of stroke. Different intensities were determined on Stroke Scale NIH (National Institute of Health (mild 4-1 and (average moderate 15-5 and (moderate to severe 20-16 and (extreme severe 42- 21. Determination intensity of stroke after admission and discharge with Modified Rankin Scale and Barthel index. Blood serum concentrations of sodium 0.5 mL of venous blood were taken and sodium serum level was performed with Latex particle agglutination test in Ayatollah Rouhani Hospital. That normal range was defined 136-146 meq / L Findings: 125 patients were entered into this study; the prevalence of hyponatremia in female was 70% vs 60% in male. Of stroke patients included in this study 66% of them had hyponatremia and the frequency of hyponatremia in ischemic and hemorrhagic was 82% and 63%, respectively. Increase in hyponatremia with disability period of admission had statistically significant (10(12 mild vs 40(32 moderate, 32(25.6 severe, p=0.01 also with disability before discharge (24(19.2 mild, 26(20.8 moderate, 32(25.6 severe, p=0.03. Conclusions: Hyponatremia can effect on severity of the stroke and can be considered as a predictor of increased stroke severity and disability at admission and discharge.

  14. Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER scale in Chinese patients in Hong Kong.

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    Hui-lin Jiang

    Full Text Available BACKGROUND AND PURPOSE: The objective of this study was to determine the performance of the Recognition Of Stroke In the Emergency Room (ROSIER scale in risk-stratifying Chinese patients with suspected stroke in Hong Kong. METHODS: This was a prospective cohort study in an urban academic emergency department (ED over a 7-month period. Patients over 18 years of age with suspected stroke were recruited between June 2011 and December 2011. ROSIER scale assessment was performed in the ED triage area. Logistic regression analysis was used to estimate the impacts of diagnostic variables, including ROSIER scale, past history and ED characteristics. FINDINGS: 715 suspected stroke patients were recruited for assessment, of whom 371 (52% had acute cerebrovascular disease (302 ischaemic strokes, 24 transient ischaemic attacks (TIA, 45 intracerebral haemorrhages, and 344 (48% had other illnesses i.e. stroke mimics. Common stroke mimics were spinal neuropathy, dementia, labyrinthitis and sepsis. The suggested cut-off score of>0 for the ROSIER scale for stroke diagnosis gave a sensitivity of 87% (95%CI 83-90, a specificity of 41% (95%CI 36-47, a positive predictive value of 62% (95%CI 57-66, and a negative predictive value of 75% (95%CI 68-81, and the AUC was 0.723. The overall accuracy at cut off>0 was 65% i.e. (323+141/715. INTERPRETATION: The ROSIER scale was not as effective at differentiating acute stroke from stroke mimics in Chinese patients in Hong Kong as it was in the original studies, primarily due to a much lower specificity. If the ROSIER scale is to be clinically useful in Chinese suspected stroke patients, it requires further refinement.

  15. The comparison of two physiotherapeutic approaches for gait improvement in sub-acute stroke patients.

    Science.gov (United States)

    Krawczyk, Maciej; Szczerbik, Ewa; Syczewska, Małgorzata

    2014-01-01

    The functional gait problems encountered by stroke patients include impaired balance, abnormal gait pattern with marked asymmetry, pathological trunk and spinal motion. Many different methods of physiotherapy are used to improve functional ability (especially gait) in stroke patients, but their efficacy and outcome are often not objectively assessed. The goal of this paper is to compare two therapeutic programs: one that is traditionally used in our rehabilitation facilities (exercises in lying position, "open chain" exercises, isolated movements of extremities with trunk stabilization) and the new one (exercises in vertical position, sitting or standing, "closed chain" exercises involving whole paretic side of the body). Fifty one stroke patients, aged 34 to 79 years, participated in the study. Patients were randomly allocated to one of the two groups. Patients underwent clinical assessment (Fugl-Meyer, Rivermead Motor Assessment, Berg Balance Scale) and instrumented gait analysis (using six-camera VICON 460 system) simultaneously three times: prior to the beginning of the rehabilitation program, after 6 weeks of the program, and after another 6 weeks of physiotherapy, at the end of rehabilitation program. Results demonstrated that both rehabilitation programs improved the gait function and clinical status in patients suffering from stroke. Despite the differences between the two programs the progress achieved by the patients in locomotor function is similar. Two equivalent physiotherapy programs could be applied during rehabilitation process depending on the patient's individual preferences and needs, as the amount of functional improvement provided by them is comparable.

  16. Tai Chi Chuan for the Primary Prevention of Stroke in Middle-Aged and Elderly Adults: A Systematic Review

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    Guohua Zheng

    2015-01-01

    Full Text Available Background. Stroke is a major healthcare problem with serious long-term disability and is one of the leading causes of death in the world. Prevention of stroke is considered an important strategy. Methods. Seven electronic databases were searched. Results. 36 eligible studies with a total of 2393 participants were identified. Primary outcome measures, TCC exercise combined with other intervention had a significant effect on decreasing the incidence of nonfatal stroke (n=185, RR = 0.11, 95% CI 0.01 to 0.85, P=0.03 and CCD (n=125, RR = 0.33, 95% CI 0.11 to 0.96, P=0.04. For the risk factors of stroke, pooled analysis demonstrated that TCC exercise was associated with lower body weight, BMI, FBG level, and decreasing SBP, DBP, plasma TC, and LDL-C level regardless of the intervention period less than half a year or more than one year and significantly raised HDL-C level in comparison to nonintervention. Compared with other treatments, TCC intervention on the basis of the same other treatments in patients with chronic disease also showed the beneficial effect on lowering blood pressure. Conclusion. The present systematic review indicates that TCC exercise is beneficially associated with the primary prevention of stroke in middle-aged and elderly adults by inversing the high risk factors of stroke.

  17. An emergency clinical pathway for stroke patients – results of a cluster randomised trial (isrctn41456865

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    Ferri Marica

    2009-01-01

    Full Text Available Abstract Background Emergency Clinical Pathways (ECP for stroke have never been tested in randomized controlled trials (RCTs. Objective To evaluate the effectiveness of an ECP for stroke patients in Latium (Italy emergency system. Methods cluster-RCT designed to compare stroke patient referrals by Emergency Medical Service (EMS and Emergency Room (ER health professionals trained in the ECP, with those of non-trained EMS and ER controls. Primary outcome measure was the proportion of eligible (aged ≤ 80 and symptom onset ≤ 6 hours stroke patients referred to a stroke unit (SU. Intention to treat (ITT and per-protocol (PP analyses were performed, and risk ratios (RR adjusted by age, gender and area, were calculated. Results 2656 patients in the intervention arm and 2239 in the control arm required assistance; 78.3% of the former and 80.6% of the latter were admitted to hospitals, and respectively 74.8% and 78.3% were confirmed strokes. Of the eligible confirmed strokes, 106/434 (24.4% in the intervention arm and 43/328 (13.1% in the control arm were referred to the SU in the ITT analysis (RR = 2.01; 95% CI: 0.79–4.00, and respectively 105/243 (43.2% and 43/311 (13.8% in the PP analysis (RR = 3.21; 95%CI: 1.62–4.98. Of patients suitable for i.v. thrombolysis, 15/175 (8.6% in the intervention arm and 2/115 (1.7% in the control arm received thrombolysis (p = 0.02 in the ITT analysis, and respectively 15/99 (15.1% and 2/107 (1.9%(p = 0.001 in the PP analysis. Conclusion Our data suggest potenti efficiency and feasibility of an ECP. The integration of EMS and ERs with SU networks for organised acute stroke care is feasible and may ameliorate the quality of care for stroke patients. Trial registration Current Controlled Trials (ISRCTN41456865.

  18. Stroke outcomes in Thai elderly patients treated with and without intravenous thrombolysis

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    Pornpatr A. Dharmasaroja

    2013-08-01

    Full Text Available Higher mortality was found in very old patients with acute ischemic stroke treated with intravenous recombinant tissue-plasminogen activator (rtPA as compared to younger patients. The benefit of thrombolytic treatment in this particular subgroup is still a subject of debate. The purpose of this study was to compare stroke outcomes in Thai patients aged over 70 years treated with and without intravenous rtPA. This was a retrospective review of sequential cases and was not a randomized controlled study. One-hundred and five patients with acute ischemic stroke aged over 70 years who were treated with intravenous rtPA and 105 patients without rtPA treatment (control group were included in the study. Patients’ base-line characteristics and study outcomes of interest were compared. There were significant differences in the base-line characteristics of the two groups. However, for the subgroup of patients aged over 80 years, these characteristics were similar. Those who were treated with intravenous rtPA had a higher rate of favorable outcomes (40% vs 16%; P=0.137 and a lower rate of mortality (22% vs 44%; P=0.128 than patients who did not receive rtPA treatment. In well-matched subgroups of patients aged over 80 years, our retrospective review revealed there was a trend of a higher rate of favorable outcome and lower mortality in patients receiving rtPA treatment. More study is needed to further confirm the suggested benefit of thrombolysis in Asian octogenarian acute stroke patients.

  19. Baltes' SOC model of successful ageing as a potential framework for stroke rehabilitation.

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    Donnellan, C; O'Neill, D

    2014-01-01

    The aim of this paper is to explore approaches used to address some stroke rehabilitation interventions and to examine the potential use of one of the life-span theories called the Baltes' model of selective optimisation with compensation (SOC) as a potential framework. Some of the key considerations for a stroke rehabilitation intervention framework are highlighted including accommodating for the life management changes post stroke, alterations in self-regulation, acknowledge losses and focusing on a person-centred approach for transition from acute rehabilitation to the home or community setting. The Baltes' SOC model is then described in terms of these considerations for a stroke rehabilitation intervention framework. The Baltes' SOC model may offer further insights, including ageing considerations, for stroke rehabilitation approaches and interventions. It has potential to facilitate some of the necessary complexities of adjustment required in stroke rehabilitation. However, further development in terms of empirical support is required for using the model as a framework to structure stroke rehabilitation intervention. Implications for Rehabilitation There is a scarcity of theoretical frameworks that can facilitate and be inclusive for all the necessary complexities of adjustment, required in stroke rehabilitation. In addition to motor recovery post stroke, rehabilitation intervention frameworks should be goal orientated; address self-regulatory processes; be person-centred and use a common language for goal planning, setting and attainment. The Baltes' SOC model is one such framework that may address some of the considerations for stroke rehabilitation, including motor recovery and other life management aspects.

  20. Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients.

    Science.gov (United States)

    Cho, Ki Hun; Kim, Min Kyu; Lee, Hwang-Jae; Lee, Wan Hee

    2015-01-01

    Virtual reality training is considered as an effective intervention method of stroke patients, and the virtual reality system for therapeutic rehabilitation has emphasized the cognitive factors to improve walking function. The purpose of current study was to investigate the effect of virtual reality training with cognitive load (VRTCL) on walking function of chronic stroke. Chronic stroke patients were randomly assigned to the VRTCL group (11 patients, including 5 men; mean age, 60.0 years; post-stroke duration, 273.9 days) or control group (11 patients, including 2 men; mean age, 58.6 years; post-stroke duration, 263.9 days). All subjects participated in the standard rehabilitation program that consisted of physical and occupational therapies. In addition, VRTCL group participated in the VRTCL for 4 weeks (30 min per day and five times a week), while those in the control group participated in virtual reality treadmill training. Walking function under single (walking alone) and dual task (walking with cognitive tasks) conditions was assessed using an electrical walkway system. After the 4-week intervention, under both single and dual task conditions, significant improvement on walking function was observed in VRTCL and control groups (P < 0.05). In addition, in the dual task condition, greater improvement on walking function was observed in the VRTCL group, compared with the control group (P < 0.05). These findings demonstrated the efficacy of VRTCL on the walking function under the dual task condition. Therefore, we suggest that VRTCL may be an effective method for the achievement of independent walking in chronic stroke patients.

  1. Detection of metals and metalloproteins in the plasma of stroke patients by mass spectrometry methods.

    Science.gov (United States)

    Kodali, Phanichand; Chitta, Karnakar R; Landero Figueroa, Julio A; Caruso, Joseph A; Adeoye, Opeolu

    2012-10-01

    Stroke is the leading cause of adult disability, worldwide. Metalloproteins and metals play key roles in epigenetic events in living organisms, including hypertension, the most important modifiable risk factor for stroke. Thus, metalloproteins may be important target biomarkers for disease diagnosis. The primary goal of this study was to assess metal containing proteins in blood plasma, detected by ICP-MS, followed by ESIMS for peptide/protein identification. We then compared the relative concentration differences between samples from patients with ischemic stroke, hemorrhagic stroke and stroke mimics. In 29 plasma samples (10 stroke mimics, 10 ischemic stroke and 9 hemorrhagic stroke patients) previously collected from patients who presented to the University of Cincinnati Emergency Department within 12 hours of symptom onset for a plasma banking project. For the metal associated protein study, Mg, Mn, Cu, Se concentrations were statistically different when compared between stroke mimics vs. ischemic stroke patients and ischemic stroke patients vs. hemorrhagic stroke patients. Pb concentrations were statistically different when compared between stroke mimics vs. ischemic stroke patients and Mo levels were statistically the same among the three groups. In addition, we also report concentration levels and preliminary correlation studies for total elemental analysis among the three sets of patients. This pilot study demonstrates that mass spectrometry methods may be highly valuable in detecting novel stroke biomarkers in blood plasma. Expanded studies are warranted to confirm these findings.

  2. Prevalence of lower urinary tract symptoms (LUTS) in stroke patients

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Klarskov, Peter

    2008-01-01

    AIMS: The aims of this study were primarily to investigate the prevalence, severity and impact on daily life of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and secondly to identify factors associated with LUTS. MATERIALS AND METHODS: This was a cross-sectional, hos......AIMS: The aims of this study were primarily to investigate the prevalence, severity and impact on daily life of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and secondly to identify factors associated with LUTS. MATERIALS AND METHODS: This was a cross......-sectional, hospital based survey whereby stroke patients were invited by letter to complete The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire at least 1 month following their stroke. Subjects were asked to report the frequency and severity of their symptoms (symptom score) and the impact of each symptom...... on their daily life (bother score) over the previous fortnight. Of 519 stroke patients invited, 482 subjects were eligible. RESULTS: The response rate was 84%. The period prevalence of at least one symptom was 94%; the most frequent symptom was nocturia (76%) followed by urgency (70%) and daytime frequency (59...

  3. Ultrasonographic Findings in Hemiplegic Knees of Stroke Patients

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    Chao-Pin Yang

    2005-02-01

    Full Text Available Clinical and radiologic asymmetric arthritic differences between paralyzed and nonparalyzed limbs of stroke patients have been reported. Arthritic pathology aggravates motor dysfunction and compromises rehabilitation. Musculoskeletal ultrasonography plays an important role in showing soft tissue and the articular cartilage of the knee. Fifty-nine patients with either ischemic or hemorrhagic stroke-induced right or left hemiplegia were recruited to evaluate soft-tissue and intra-articular cartilage changes in hemiplegic knees of stroke patients using ultrasonography. An additional 15 subjects (30 knees without knee disease or a history of knee trauma or surgery were used as controls. There were significant differences in suprapatellar effusion and patellar tendinitis between hemiplegic and nonhemiplegic knees. Suprapatellar effusion and pes anserinus tendinitis were correlated with Brunnstrom stage. The length of time since stroke onset was not significantly correlated with positive ultrasonographic findings in hemiplegic knees. In conclusion, ultrasonography is useful for detecting periarticular soft-tissue changes and intra-articular lesions in hemiplegic knees of stroke patients.

  4. Variability in the use of neuroimaging techniques for diagnosis and follow-up of stroke patients.

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    Valcárcel-Nazco, C; Alonso-Modino, D; Montón-Álvarez, F; Sabatel-Hernández, R; Pastor-Santoveña, M S; Mesa-Blanco, P; López-Fernández, J C; Serrano-Aguilar, P

    2017-04-18

    Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data. We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI. Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. A rare presentation of stroke in young age ( moyamoya disease

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    Amal F Radwan

    2013-01-01

    Full Text Available A 37-year-old hypertensive housewife presented with a sudden onset of left-sided hemiplegia, hemianaesthesia, dysarthria and urinary incontinence. The condition was preceded by recurrent attacks of motor neurological deficits over a 3-year duration. She reported a history of a fall from a height at the age of 10, which was followed by a hearing deficit and a history of two caesarean sections after eclampsia. The blood pressure was 170/100 mmHg. Laboratory investigations revealed hyperglycaemia (fasting glucose 306 mg/dl and normal kidney function tests. The computed tomography scans revealed old multiple bilateral cerebral infarcts with recent intracranial haemorrhage in the right parietal region. The inflammatory markers (ESR and CRP and immune profile (ANA, anti-ds DNA and ANCA were found to be normal. Cerebral angiography revealed a complete occlusion of the intracranial parts of both internal carotid arteries at their supraclinoid segments along with the proximal parts of the anterior cerebral artery and middle cerebral artery, with collaterals from the posterior circulation. Consequently, the diagnosis of moyamoya disease with the collaterals was confirmed. Antihypertensive medications and insulin were administered. Cerebral dehydration measures were undertaken with partial improvement. A superficial temporal artery-middle cerebral artery bypass operation was performed with some postoperative improvement. One month later, she suffered a new stroke with severe impairment of the level of consciousness; the computed tomography scans revealed a large recent cerebral infarct, her condition deteriorated rapidly and she died shortly thereafter.

  6. A System for Monitoring Stroke Patients in a Home Environment

    NARCIS (Netherlands)

    Klaassen, Bart; Beijnum, van Bert-Jan; Weusthof, Marcel; Hofs, Dennis; Meulen, van Fokke; Luinge, Henk; Lorussi, Frederico; Hermens, Hermie; Veltink, Peter

    2014-01-01

    Currently, the changes of functional capacity and performance of stroke patients after returning home from a rehabilitation hospital is unknown for a physician, having no objective information about the intensity and quality of a patient's daily-life activities. Therefore, there is a need to develop

  7. Single-item and associative working memory in stroke patients

    NARCIS (Netherlands)

    Geldorp, B. van; Kessels, R.P.C.; Hendriks, M.P.

    2013-01-01

    In this study, we examined working memory performance of stroke patients. A previous study assessing amnesia patients found deficits on an associative working memory task, although standard neuropsychological working memory tests did not detect any deficits. We now examine whether this may be the ca

  8. Identifying dysfunctional cortex: Dissociable effects of stroke and aging on resting state dynamics in MEG and fMRI

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    Aneta eKielar

    2016-03-01

    Full Text Available Spontaneous signals in neuroimaging data may provide information on cortical health in disease and aging, but the relative sensitivity of different approaches is unknown. In the present study, we compared different but complementary indicators of neural dynamics in resting-state MEG and BOLD fMRI, and their relationship with blood flow. Participants included patients with post-stroke aphasia, age-matched controls, and young adults. The complexity of brain activity at rest was quantified in MEG using spectral analysis and multiscale entropy (MSE measures, whereas BOLD variability was quantified as the standard deviation (SDBOLD, mean squared successive difference (MSSD and sample entropy of the BOLD time series. We sought to assess the utility of signal variability and complexity measures as markers of age-related changes in healthy adults and perilesional dysfunction in chronic stroke. The results indicate that reduced BOLD variability is a robust finding in aging, whereas MEG measures are more sensitive to the cortical abnormalities associated with stroke. Furthermore, reduced complexity of MEG signals in perilesional tissue were correlated with hypoperfusion as assessed with arterial spin labeling, while no such relationship was apparent with BOLD variability. These findings suggest that MEG signal complexity offers a sensitive index of neural dysfunction in perilesional tissue in chronic stroke, and that these effects are clearly distinguishable from those associated with healthy aging.

  9. Identifying Dysfunctional Cortex: Dissociable Effects of Stroke and Aging on Resting State Dynamics in MEG and fMRI.

    Science.gov (United States)

    Kielar, Aneta; Deschamps, Tiffany; Chu, Ron K O; Jokel, Regina; Khatamian, Yasha B; Chen, Jean J; Meltzer, Jed A

    2016-01-01

    Spontaneous signals in neuroimaging data may provide information on cortical health in disease and aging, but the relative sensitivity of different approaches is unknown. In the present study, we compared different but complementary indicators of neural dynamics in resting-state MEG and BOLD fMRI, and their relationship with blood flow. Participants included patients with post-stroke aphasia, age-matched controls, and young adults. The complexity of brain activity at rest was quantified in MEG using spectral analysis and multiscale entropy (MSE) measures, whereas BOLD variability was quantified as the standard deviation (SDBOLD), mean squared successive difference (MSSD), and sample entropy of the BOLD time series. We sought to assess the utility of signal variability and complexity measures as markers of age-related changes in healthy adults and perilesional dysfunction in chronic stroke. The results indicate that reduced BOLD variability is a robust finding in aging, whereas MEG measures are more sensitive to the cortical abnormalities associated with stroke. Furthermore, reduced complexity of MEG signals in perilesional tissue were correlated with hypoperfusion as assessed with arterial spin labeling (ASL), while no such relationship was apparent with BOLD variability. These findings suggest that MEG signal complexity offers a sensitive index of neural dysfunction in perilesional tissue in chronic stroke, and that these effects are clearly distinguishable from those associated with healthy aging.

  10. Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery

    DEFF Research Database (Denmark)

    Christiansen, Mia N.; Andersson, Charlotte; Gislason, Gunnar H.

    2017-01-01

    BACKGROUND: The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown. METHODS: All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day...... mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14...... days), propensity-score matching was performed. RESULTS: Of 146,694 nonvascular surgeries (composing 98% of all emergency surgeries), 5.3% had previous stroke (mean age, 75 yr [SD = 13]; 53% women, 50% major orthopedic surgery). Antithrombotic treatment and atrial fibrillation were more frequent...

  11. [Loss of quality of life in family caregivers of stroke patients: an entity to be considered].

    Science.gov (United States)

    Marco, E; Duarte, E; Santos, J-F; Aguirrezabal, A; Morales, A; Belmonte, R; Muniesa, J M; Tejero, M; Escalada, F

    2010-01-01

    Among stroke consequences highlights the negative impact on the informal carers' health related quality of life (HRQoL). To identify HRQoL dimensions most greatly affected in stroke caregivers and establish relations with dependent variables of survivors and caregivers. Transversal study of 215 informal caregivers of stroke survivors (1:3 man/woman, mean age 63.6 (±11.03) years). Main outcome measure was health perception assessed with the Short Fom 36 (SF-36). Clinical and demographic data of stroke patients were also registered. Statistical tests used were Chi-square, t-Student test and Spearman correlation coefficient. Vitality and general health were the most affected dimensions perceived by caregivers. In comparison with the Spanish general population, female caregivers aged 45-54 years presented a significant reduction in the SF-36 subscales of vitality (p=0.003), social function (p=0.01), emotional role (p=0.038) and mental health (p=0.002). Female caregivers aged 55-64 years also showed a significant reduction in social function (p=0.027) and emotional role (p=0.024). Male caregivers did not present significant lower HRQoL. Caregiving experience has a negative impact on HRQoL, specially middle-aged female caregivers. Some carer physical and psychological characteristics (depression, musculoskeletal pain, time spent on caring) and survivor disability shown to influence carers outcomes. Caregivers play an important role in the recovery of stroke patients, so that the identification of strategies which help them to cope with the stroke might avoid that the role of caring results in a loss of quality of life. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

  12. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

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    Josie Merchant

    2016-01-01

    Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

  13. Soluble glycoprotein VI is raised in the plasma of patients with acute ischemic stroke.

    Science.gov (United States)

    Al-Tamimi, Mohammad; Gardiner, Elizabeth E; Thom, Jim Y; Shen, Yang; Cooper, Matthew N; Hankey, Graeme J; Berndt, Michael C; Baker, Ross I; Andrews, Robert K

    2011-02-01

    Ischemic stroke induced by thrombosis may be triggered by atherosclerotic plaque rupture and collagen-induced platelet activation. Collagen induces glycoprotein VI shedding. We measured plasma-soluble glycoprotein VI (sGPVI) by enzyme-linked immunosorbent assay in 159 patients with acute (ischemic stroke and age/sex-matched community-based control subjects. sGPVI was elevated in stroke compared with controls (P=0.0168). ORs were higher in Quartile 4 for stroke cases (P=0.0121), and sGPVI was significantly elevated in stroke associated with large artery disease across Quartiles 2 to 4 and small artery disease in Quartile 4. sGPVI decreased 3 to 6 months after antiplatelet treatment, consistent with elevated sGPVI due to platelet activation during the thrombotic event. sGPVI correlated with P-selectin (P=0.0007) and was higher in individuals with the GPVIa haplotype (P=0.024). Glycoprotein VI shedding is implicated in the pathology of acute ischemic stroke.

  14. White matter structure and clinical characteristics of stroke patients: A diffusion tensor MRI study.

    Science.gov (United States)

    Ueda, Ryo; Yamada, Naoki; Kakuda, Wataru; Abo, Masahiro; Senoo, Atsushi

    2016-03-15

    Fractional anisotropy has been used in many studies that examined post-stroke changes in white matter. This study was performed to clarify cerebral white matter changes after stroke using generalized fractional anisotropy (GFA). White matter structure was visualized using diffusion tensor imaging in 72 patients with post-stroke arm paralysis. Exercise-related brain regions were examined in cerebral white matter using GFA. The relationship between GFA and clinical characteristics was examined. Overall, the mean GFA of the lesioned hemisphere was significantly lower than that of the non-lesioned hemisphere (PBrodmann area 5 of the non-lesioned hemisphere. Age correlated negatively with GFA in Brodmann areas 5 and 7 of the lesioned hemisphere. Though these results may be due to a decrease in the frequency of use of the paralyzed limb over time, GFA overall was significantly and negatively affected by the subject's age. The GFA values of patients with paralysis of the dominant hand were significantly different from those of patients with paralysis of the nondominant hand in Brodmann areas 4 and 6 of the non-lesioned hemisphere and Brodmann area 4 of the lesioned hemisphere (P<0.05). The stroke size and location were not associated with GFA differences. Differences between the GFA of the lesioned and non-lesioned hemispheres varied depending on the affected brain region, age at onset of paralysis, and paralysis of the dominant or non-dominant hand. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. The importance of dynamometry during medical rehabilitation of stroke patients

    Directory of Open Access Journals (Sweden)

    Tomašević Snežana

    2003-01-01

    Full Text Available Introduction Rehabilitation centers pay great attention to recovery of motor functions. Dynamometry is used for monitoring and objective overall assessment of damage and recovery of motor functions. Material and methods The aim of this investigation was estimation of upper limb muscle strength, with stroke patients during medical rehabilitation. It included 80 right-handed examinees of certain age and sex distribution. The clinical part of examination estimated motor recovery, applying Signe-Brunnström staging, as well as estimation of upper limb muscle strength, using dynamometry during inpatient rehabilitation. Results Average values of muscle strength of the affected hand with patients who had right-sided hemiparesis increased by 22.01%, whereas with patients who had left-sided hemiparesis by 36.38%, compared with values from the beginning of treatment. Examination results showed that muscle strength values in both hands after rehabilitation were statistically, considerably improved (p<0.05, compared with the results from the beginning of treatment. However, they did not reach values of the control group. Discussion and Conclusion Muscle strength improvement at the end of treatment is affected by complex changes of the neural system, leading to lesion regression, as well as by positive effects of rehabilitation treatment. Result of examination help decision making regarding treatment duration and speak in favor of early rehabilitation applying facilitation techniques for fast and significant recovery.

  16. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    Directory of Open Access Journals (Sweden)

    Ersin Kasım Ulusoy

    2015-08-01

    Full Text Available Emery-Dreifuss muscular dystrophy (EDMD is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t have regular cardiac follow-up was reported and the importance of the treatment of cardiac diseases which could play a role in ischemic stroke etiology and the implantation of pace-maker was mentioned.

  17. Prevention of recurrent stroke in patients with patent foramen ovale.

    Science.gov (United States)

    Wessler, Benjamin S; Kent, David M

    2015-05-01

    Patent foramen ovale (PFO) is common and only rarely related to stroke. The high PFO prevalence in healthy individuals makes for difficult decision making when a PFO is found in the setting of a cryptogenic stroke, because the PFO may be an incidental finding. Recent clinical trials of device-based PFO closure have had negative overall summary results; these trials have been limited by low recurrence rates. The optimal antithrombotic strategy for these patients is also unknown. Recent work has identified a risk score that estimates PFO-attributable fractions based on individual patient characteristics, although whether this score can help direct therapy is unclear.

  18. Multiparametric Approach Enhances Detection of Patients with Cerebral TIAs at Risk of Stroke: A Prospective Pilot Case Series

    Science.gov (United States)

    Abd-Allah, Foad; Tawfik, Tarek Zoheir; Shamloul, Reham Mohammed; Hegazy, Montasser M; Hashad, Assem; Kamel, Ayman Ismail; Farees, Dina; Shalaby, Nevin M

    2016-01-01

    Background Patients with transient ischemic attack (TIA) are generally clinically unstable, with fear of developing a handicapping stroke. Identification of those at highest and lowest risk of stroke in the first days and weeks after a TIA would allow appropriate use of worthy secondary prevention strategies. Objective Incorporation of a clinical scoring system, neurovascular imaging, and magnetic resonance-diffusion-weighted imaging (MR-DWI) to help predicting risk of developing an ischemic stroke following a TIA. Subjects and methods A prospective observational study was conducted on 25 patients with TIAs, 64% were females, and 26% were males, with a mean age of 57±10.36. Patients were assessed clinically and an ABCD2 score was applied. Patients have undergone diffusion-weighted imaging (DWI), within 24 h from the event, and intra- and extracranial duplex study. Patients were followed up at intervals of one week, three months, six months, and one year. Results Six patients (24%) developed stroke on their follow-up, most of them (83.3%) had their strokes within the first three months and had an initial ABCD2 score of ≥4. The development of stroke was associated with the presence of significant extra and/or intracranial vessel disease (P=0.006) and the presence of acute lesions on their DWI (P=0.035). Conclusion Incorporation of brain MR-DWIs and neurovascular imaging together with the ABCD2 score improves prediction of ischemic stroke following TIA. PMID:27403225

  19. Phenotypic ASCO Characterisation of Young Patients with Ischemic Stroke in the Prospective Multicentre Observational sifap1 Study.

    Science.gov (United States)

    Wolf, Marc E; Grittner, Ulrike; Böttcher, Tobias; Norrving, Bo; Rolfs, Arndt; Hennerici, Michael G

    2015-01-01

    The prospective, multinational European 'Stroke in Young Fabry Patients' (sifap1) study collected 4,467 patients with acute ischemic cerebrovascular events aged 18-55 years. Initially, aetiologic subtyping was performed using the TOAST classification; however, recently the phenotypic ASCO classification was presented and might be more useful to identify stroke aetiologies in young patients with a wide set of different causes. ASCO is a classification system divided in four etiologic categories (Atherosclerosis, Small vessel disease (SVD), Cardiac embolism, Other cause) with different grades of severity (1-3) and aims to characterise patients in a more comprehensive way. We determined the ASCO score for each patient, according to prospectively collected data using the study protocol. The distribution of aetiologies was analysed with regard to concomitant causes, cryptogenic stroke and different age groups. A potentially causal aetiology (grade 1) was detected in 29.3% of 4,467 patients. Merging grades 1 and 2, a suspected aetiology was found in 54.1%. In 8.6% of patients concomitant aetiologies were identified. Most common causes were cervical arterial dissection and persistent foramen ovale, but there was also a high prevalence of large artery atherosclerosis and SVD especially in older patients of this collective. About 50% of patients had more than one finding with a lower grade of evidence (grade 3). In 14% final classification of strictly cryptogenic stroke was made. This is the largest study to date, using the ASCO characterisation of ischemic stroke aetiologies. ASCO classification provides first evidence that many young patients presenting with acute stroke have concomitant stroke aetiologies associated with a substantial atherosclerosis risk profile. ASCO could be integrated in clinical routine and registry data banks, as well as large clinical trials to improve stroke documentation. © 2015 S. Karger AG, Basel.

  20. Clinical implication of hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator.

    Science.gov (United States)

    Ho, Bo-Lin; Chen, Chien-Fu; Lin, Ruey-Tay; Liu, Ching-Kuan; Chao, A-Ching

    2016-11-01

    To determine the clinical implications of hemorrhagic transformation (HT) after thrombolysis, 241 eligible patients receiving alteplase for acute ischemic stroke were studied. HT was classified, according to the European Cooperative Acute Stroke Study criteria, as hemorrhagic infarction (HI) or parenchymal hemorrhage (PH). Symptomatic intracranial hemorrhage (SICH) was defined according to the National Institute of Neurological Disorders and Stroke study. A novel classification, clinically significant intracranial hemorrhage (CSICH) was defined as HTs associated with an unfavorable clinical outcome (modified Rankin Scale 5-6) at 3 months. For all subtypes of HT, we found that patients receiving alteplase were more often in the standard-dose group (0.90 ± 0.02 mg/kg) than in the lower dose group (0.72 ± 0.07 mg/kg). PH and SICH were related to an unfavorable clinical outcome, while HI was not. There was a positive trend between age and CSICH in patients receiving the standard dose (P = 0.0101), and between alteplase dose and CSICH in patients ≥70 years old (P = 0.0228). All PHs (including asymptomatic PHs) and symptomatic HIs have been found to be associated with unfavorable outcome, and for this reason defined as CSICH. Independent predictors of CSICH were age ≥70 years and the standard dose of alteplase. Further studies of thrombolysis for ischemic stroke with different doses of alteplase are warranted.

  1. Timing Matters? Learning of Complex Spatiotemporal Sequences in Left-hemisphere Stroke Patients.

    Science.gov (United States)

    Dovern, Anna; Fink, Gereon R; Timpert, David C; Saliger, Jochen; Karbe, Hans; Weiss, Peter H; Koch, Iring

    2016-02-01

    During rehabilitation after stroke motor sequence learning is of particular importance because considerable effort is devoted to (re)acquiring lost motor skills. Previous studies suggest that implicit motor sequence learning is preserved in stroke patients but were restricted to the spatial dimension, although the timing of single action components is as important as their spatial order. As the left parietal cortex is known to play a critical role in implicit timing and spatiotemporal integration, in this study we applied an adapted version of the SRT task designed to assess both spatial (different stimulus locations) and temporal (different response-stimulus intervals) aspects of motor learning to 24 right-handed patients with a single left-hemisphere (LH) stroke and 24 age-matched healthy controls. Implicit retrieval of sequence knowledge was tested both at Day 1 and after 24 hr (Day 2). Additionally, voxel-based lesion symptom mapping was used to investigate the neurobiological substrates of the behavioral effects. Although LH stroke patients showed a combined spatiotemporal learning effect that was comparable to that observed in controls, LH stroke patients did not show learning effects for the learning probes in which only one type of sequence information was maintained whereas the other one was randomized. Particularly on Day 2, patients showed significantly smaller learning scores for these two learning probes than controls. Voxel-based lesion symptom mapping analyses revealed for all learning probes that diminished learning scores on Day 2 were associated with lesions of the striatum. This might be attributed to its role in motor chunking and offline consolidation as group differences occurred on Day 2 only. The current results suggest that LH stroke patients rely on multimodal information (here: temporal and spatial information) when retrieving motor sequence knowledge and are very sensitive to any disruption of the learnt sequence information as they seem

  2. Therapeutic hypothermia after recanalization in patients with acute ischemic stroke.

    Science.gov (United States)

    Hong, Ji Man; Lee, Jin Soo; Song, Hee-Jung; Jeong, Hye Seon; Jung, Hae-Sun; Choi, Huimahn Alex; Lee, Kiwon

    2014-01-01

    Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. We investigated the clinical and radiological effects of therapeutic hypothermia in acute ischemic stroke patients after recanalization. A prospective cohort study at 2 stroke centers was performed. We enrolled patients with acute ischemic stroke in the anterior circulation with an initial National Institutes of Health Stroke Scale≥10 who had successful recanalization (≥thrombolysis in cerebral ischemia, 2b). Patients at center A underwent a mild hypothermia (34.5°C) protocol, which included mechanical ventilation, and 48-hour hypothermia and 48-hour rewarming. Patients at center B were treated according to the guidelines without hypothermia. Cerebral edema, hemorrhagic transformation, good outcome (3-month modified Rankin Scale, ≤2), mortality, and safety profiles were compared. Potential variables at baseline and during the therapy were analyzed to evaluate for independent predictors of good outcome. The hypothermia group (n=39) had less cerebral edema (P=0.001), hemorrhagic transformation (P=0.016), and better outcome (P=0.017) compared with the normothermia group (n=36). Mortality, hemicraniectomy rate, and medical complications were not statistically different. After adjustment for potential confounders, therapeutic hypothermia (odds ratio, 3.0; 95% confidence interval, 1.0-8.9; P=0.047) and distal occlusion (odds ratio, 7.3; 95% confidence interval; 1.3-40.3; P=0.022) were the independent predictors for good outcome. Absence of cerebral edema (odds ratio, 5.4; 95% confidence interval, 1.6-18.2; P=0.006) and no medical complications (odds ratio, 9.3; 95% confidence interval, 2.2-39.9; P=0.003) were also independent predictors for good outcome during the therapy. In patients with ischemic stroke, after successful recanalization, therapeutic hypothermia may reduce risk of cerebral edema and hemorrhagic transformation, and lead to improved

  3. Robotics in the rehabilitation treatment of patients with stroke.

    Science.gov (United States)

    Volpe, Bruce T; Ferraro, Mark; Krebs, Hermano I; Hogan, Neville

    2002-07-01

    Stroke is the leading cause of permanent disability despite continued advances in prevention and novel interventional treatments. Post-stroke neuro-rehabilitation programs teach compensatory strategies that alter the degree of permanent disability. Robotic devices are new tools for therapists to deliver enhanced sensorimotor training and concentrate on impairment reduction. Results from several groups have registered success in reducing impairment and increasing motor power with task-specific exercise delivered by the robotic devices. Enhancing the rehabilitation experience with task-specific repetitive exercise marks a different approach to the patient with stroke. The clinical challenge will be to streamline, adapt, and expand the robot protocols to accommodate healthcare economies, to determine which patients sustain the greatest benefit, and to explore the relationship between impairment reduction and disability level. With these new tools, therapists will measure aspects of outcome objectively and contribute to the emerging scientific basis of neuro-rehabilitation.

  4. Perilesional reorganization of motor function in stroke patients

    Institute of Scientific and Technical Information of China (English)

    Sung Ho Jang

    2010-01-01

    Perilesional reorganization is an important recovery mechanism for stroke patients because it yields good motor outcomes. However, perilesional reorganization remains poorly understood. The scientific basis for stroke rehabilitation can be established when detailed mechanisms of recovery are clarified. In addition, studies at the subcortical level remain in the early stages. Therefore, the present study suggested that additional investigations should focus on perilesional reorganization at the subcortical level, identifying the critical period for this mechanism and determining treatment strategies and modalities to facilitate development. The present study reviews literature focused on perilesional reorganization in stroke patients with regard to demonstration, clinical characteristics,and rehabilitative aspects, as well as previous studies of perilesional reorganization at cortical and subcortical levels.

  5. A study of stroke patients with respect to their clinical and demographic profile and outcome

    Directory of Open Access Journals (Sweden)

    Debasis Sarkar

    2016-09-01

    Conclusions: Stroke can occur at any age, but the elderly persons are more commonly affected with a slight predilection to male. The hemorrhagic stroke outnumbers the ischemic stroke mainly because of uncontrolled hypertension. The GCS at presentation can predict the stroke outcome. Risk factors of stroke include Hypertension, smoking, high cholesterol and Diabetes, obesity, lack of exercise, and genetic factors. [Int J Res Med Sci 2016; 4(9.000: 4061-4066

  6. Geriatric rehabilitation of stroke patients in nursing homes : a study protocol

    NARCIS (Netherlands)

    Spruit-van Eijk, M.; Buijck, B.I.; Zuidema, S.U.; Voncken, F.L.M.; Geurts, A.C.H.; Koopmans, R.T.C.M.

    2010-01-01

    BACKGROUND: Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few

  7. Language-specific dysgraphia in Korean stroke patients.

    Science.gov (United States)

    Yoon, Ji Hye; Suh, Mee Kyung; Kim, HyangHee

    2010-12-01

    We investigated how changes in the writing of 14 Korean stroke patients reflect the unique features of the Korean writing system. The Korean writing system, Han-geul, has both linguistic and visuospatial/constructive characteristics. In the visuospatial construction of a syllable, the component consonant(s) and vowel(s) must be arranged from top-to-bottom and/or left-to-right within the form of a square. This syllabic organization, unique to Korean writing, may distinguish dysgraphia in Korean patients from the disorder in other languages, and reveal the effects of stroke on visuospatial/constructive abilities. We compared 2 groups of patients affected by stroke, 1 group with left hemisphere (LH) lesions and the other with right hemisphere (RH) lesions. We instructed them to write from a dictation of 90 monosyllabic stimuli, each presented with a real word cue. Patients had to repeat a target syllable and a word cue, and then to write the target syllable only. Patients with LH and RH lesions produced qualitatively different error patterns. While the LH lesion group produced primarily linguistic errors, visuospatial/constructive errors predominated in the group with RH lesions. With regard to language-specific features, these Korean patients with RH lesions produced diverse visuospatial/constructive errors not commonly observed in dysgraphia of the English language. Language-specific writing errors by Korean stroke patients reflect the unique characteristics of Korean writing, which include the arrangement of strokes and graphemes within a square syllabic form by dimensional and spatial rules. These findings support the notion that the Korean writing system possesses a language-specific nature with both linguistic and visuospatial/constructive processes. Distinctive patterns of dysgraphia in the Korean language also suggest interactivity between linguistic and visuospatial/constructive levels of processing. This study is noteworthy for its systematic description of

  8. Left ventricular geometry and white matter lesions in ischemic stroke patients.

    Science.gov (United States)

    Butenaerts, Demian; Chrzanowska-Wasko, Joanna; Slowik, Agnieszka; Dziedzic, Tomasz

    2016-06-01

    Abnormal left ventricular (LV) geometry is associated with extracardiac organ damage in patients with hypertension. The aim of this study was to determine the relationship between LV geometry and white matter lesions (WMLs) in ischemic stroke patients. We retrospectively analyzed data from 155 patients (median age 62; 49.8% male) with mild ischemic stroke (median National Institutes of Health Stroke Scale score 4) who underwent brain magnetic resonance imaging and echocardiography. Patients were categorized into four groups: normal LV geometry, concentric remodeling, eccentric left ventricular hypertrophy (LVH) and concentric LVH. WMLs were graded using the Fazekas scale on fluid-attenuated inversion recovery images. Extensive WMLs were defined as a Fazekas score > 2. Extensive WMLs were more prevalent in patients with concentric LVH, eccentric LVH and concentric remodeling than in those with normal LV geometry. After adjusting for hypertension, age, diabetes mellitus, hypercholesterolemia, glomerular filtration rate and ischemic heart disease, patients with concentric remodeling [odds ratio (OR) 3.94, 95% confidence interval (CI) 1.26-12.31, p = 0.02] and those with concentric LVH (OR 3.69, 95% CI 1.24-10.95, p = 0.02), but not patients with eccentric LVH (OR 2.44, 95% CI 0.72-8.29, p = 0.15), had higher risk of extensive WMLs than patients with normal LV geometry.

  9. Early Home Supported Discharge of Stroke Patients:

    DEFF Research Database (Denmark)

    Larsen, Torben; Olsen, T. Skyhøj; Sørensen, Jan

    2006-01-01

    OBJECTIVES: A comprehensive and systematic assessment (HTA) of early home-supported discharge by a multidisciplinary team that plans, coordinates, and delivers care at home (EHSD) was undertaken and the results were compared with that of conventional rehabilitation at stroke units. METHODS......: A systematic literature search for randomized trials (RCTs) on "early supported discharge" was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline...

  10. Clinical implications of eye deviation on admission CT examination of acute ischaemic stroke patients.

    Science.gov (United States)

    Payabvash, S; Qureshi, I; Qureshi, A I

    2016-12-01

    To determine the frequency and prognostic value of eye deviation detected on the admission computed tomography (CT) of acute ischaemic stroke patients. The clinical and imaging data from the Albumin in Acute Stroke (ALIAS) Trials 1 and 2 were analysed. Two reviewers evaluated all admission CT images for the presence of eye deviation, and Alberta Stroke Program Early CT Score (ASPECTS). The admission National Institutes of Health Stroke Scale (NIHSS) scores and 3-month modified Rankin scale (mRs) scores were ascertained. Disability or death was defined as mRS score >2, at 3-month follow-up. Of 1,223 patients included in the present series, 352 (28.8%) had rightward and 331 (27.1%) had leftward eye deviation on admission CT. Patients with eye deviation on CT had higher admission NIHSS score and larger middle cerebral artery (MCA) territory infarct volume (based on ASPECTS). The presence of eye deviation on CT was associated with higher rates of haemorrhagic transformation at 24 hours (19.8% versus 13.5%, p=0.004), and higher rates of disability or death at 3-month follow-up (53.1% versus 35.7%, peye deviation relation with higher rate of disability or death is predominantly due to its association with higher admission NIHSS scores, lower ASPECTS, and to a lesser extent patients' older age. The presence of eye deviation on CT examination of acute ischaemic stroke patients is associated with larger anterior circulation stroke volumes, higher risk of 24-hour haemorrhagic transformation, and 3-month disability or death. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Differential effects of aging and sex on stroke induced inflammation across the lifespan.

    Science.gov (United States)

    Manwani, Bharti; Liu, Fudong; Scranton, Victoria; Hammond, Matthew D; Sansing, Lauren H; McCullough, Louise D

    2013-11-01

    Aging and biological sex are critical determinants of stroke outcome. Post-ischemic inflammatory response strongly contributes to the extent of ischemic brain injury, but how this response changes with age and sex is unknown. We subjected young (5-6 months), middle aged (14-15 months) and aged (20-22 months), C57BL/6 male and female mice to transient middle cerebral artery occlusion (MCAO) and found that a significant age by sex interaction influenced histological stroke outcomes. Acute functional outcomes were worse with aging. Neutrophils, inflammatory macrophages, macrophages, dendritic cells (DCs) and microglia significantly increased in the brain post MCAO. Cycling females had higher Gr1(-) non-inflammatory macrophages and lower T cells in the brain after stroke and these correlated with serum estradiol levels. Estrogen loss in acyclic aged female mice exacerbated stroke induced splenic contraction. Advanced age increased T cells, DCs and microglia at the site of injury, which may be responsible for the exacerbated behavioral deficits in the aged. We conclude that aging and sex have differential effects on the post stroke inflammatory milieu. Putative immunomodulatory therapies need to account for this heterogeneity.

  12. Zinc Serum Level Can Be a Risk Factor In Babol Stroke Patients?

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    Alijan AhmadiAhangar

    2017-02-01

    Full Text Available Background and Purpose: Stroke is the second leading cause of death worldwide. The role of zinc as a contributing factor in the pathogenesis of stroke was considered. Results: This cross-sectional study on 100 stroke patients in Ayatollah Rouhani Hospital and 100 control group from cohort master plan "Ageing and health projects Amirkola was conducted. Zinc levels Serum simultaneously with other blood tests in the early hours of hospitalization. Zinc serum level was defined 70 to 120 micrograms per deciliter. Findings: The difference in mean of zinc level in patients and control group was not significant (102.6±47.7 in control group vs 100.9±35.8 in patient, p=0.7. Difference in zinc Serum level had statically significant with IHD (under70 0 cases (0, 70 to120 8 cases (24, 120 and upper24 cases (75, p=0.003 and with type of stroke (under70 (3(3.3 hemorrhagic vs 0(0 ischemic, 70 to 120(19(21 vs6 (60, 120 and upper68 (75.6 vs4 (40, p=0.025 and also with patient and control group (under70 (3(3 in patient's vs 20(20 control group, 70 to 120(25(25 vs54 (54, 120 and upper72 (72 vs26 (26, p<0001. In patients group 72(73.5 of cases had zinc serum level above 120. HLP difference was significant in patient and control group (50(50 in control group vs 35(35 in patients, p=0.04. Regression logistic show that IHD (p<0001, OR=30, CI=6-152, HLP (p<0001, OR=4, CI=9.09-1.85, zinc serum level (p<0001, OR=15.5, CI=4-59.8 had significant role. Conclusions: Zinc serum levels, Ischemic Heart Disease, Hyperlipidemia were most risk factor that play role in Babol stroke patients.

  13. Use of a Diagnostic Score to Prioritize Computed Tomographic (CT) Imaging for Patients Suspected of Ischemic Stroke Who May Benefit from Thrombolytic Therapy

    Science.gov (United States)

    Bots, Michiel L.; Selvarajah, Sharmini; Kappelle, L. Jaap; Abdul Aziz, Zariah; Sidek, Norsima Nazifah; Vaartjes, Ilonca

    2016-01-01

    Background A shortage of computed tomographic (CT) machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging. Methods From the Malaysian National Neurology Registry, we selected patients aged 18 years and over with clinical features suggesting of a stroke, who arrived in the hospital 4.5 hours or less from ictus. The prioritization of receiving CT imaging was left to the discretion of the treating physician. We applied the Siriraj Stroke Score to all patients, refitted the score and defined a cut-off value to best distinguish an ischemic stroke from a hemorrhagic stroke. Results Of the 2176 patients included, 73% had an ischemic stroke. Only 33% of the ischemic stroke patients had CT imaging within 4.5 hours. The median door-to-scan time for these patients was 4 hours (IQR: 1;16). With the recalibrated score, it would have been possible to prioritize 95% (95% CI: 94%–96%) of patients with an ischemic stroke for urgent CT imaging. Conclusions In settings where CT imaging capacity is limited, we propose the use of the Siriraj Stroke Score to prioritize patients with a probable ischemic stroke for urgent CT imaging. PMID:27768752

  14. Characteristics and dynamics of cognitive impairment in patients with primary and recurrent cerebral ischemic hemispheric stroke

    Directory of Open Access Journals (Sweden)

    A. A. Kozyolkin

    2014-08-01

    Full Text Available Acute cerebrovascular disease is a global medical and social problem of the modern angioneurology, occupying leading positions in the structure of morbidity and mortality among adult population of the world. Ischemic stroke – is one of the most common pathology. Today this disease took out the world pandemic. More than 16 million new cases of cerebral infarction recorded in the world each year and it “kills” about 7 million of people. About 111,953 cases of cerebral stroke were registered in 2013 in Ukraine. Cognitive impairment, t hat significantly disrupt daily activities and life of the patient, is one of the most significant post-stroke complications that have social, medical and biological significance. Aim. The purpose of this investigation was to study features and dynamics of cognitive impairments in patients with primary and recurrent cerebral hemispheric ischemic stroke (CHIS in the acute stage of the disease. Materials and methods. To achieve the aim, and the decision of tasks in the clinic of nervous diseases Zaporozhye State Medical University (supervisor - Doctor of Medicine, Professor Kozelkin A. based on the department of acute cerebrovascular disease were performed comparative, prospective cohort study, which included comprehensive clinical and paraclinical examinations of 41 patients (26 men and 15 women aged 45 to 85 years (mean age 66,4 ± 1,4 years with acute left-hemispheric (2 patients and right - hemispheric (39 patients CHIS . First up was a group of 28 patients (19 men and 9 women, mean age 65,6 ± 1,6 years, who suffered from primary CHIS. The second group consisted of 13 patients (7 men and 6 women, mean age 68,1 ± 2,5 years with recurrent CHIS. The groups were matched by age, sex, localization of the lesion and the initial level of neurological deficit. All patients underwent physical examination, neurological examination. Dynamic clinical neurological examination assessing the severity of stroke was conducted

  15. Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia.

    Science.gov (United States)

    Kim, Tackeun; Oh, Chang Wan; Kwon, O-Ki; Hwang, Gyojun; Kim, Jeong Eun; Kang, Hyun-Seung; Cho, Won-Sang; Bang, Jae Seung

    2016-06-01

    OBJECT Moyamoya disease (MMD) is a progressive disease that can cause recurrent stroke. The authors undertook this retrospective case-control study with a large sample size in an attempt to assess the efficacy of direct or combined revascularization surgery for ischemia in adults with MMD. METHODS The authors investigated cases involving patients with moyamoya disease presenting with ischemia who visited Seoul National University Bundang Hospital and Seoul National University Hospital between 2000 and 2014. Among 441 eligible patients, 301 underwent revascularization surgery and 140 were treated conservatively. Variables evaluated included age at diagnosis, sex, surgical record, Suzuki stage, and occurrence of stroke. Patients were stratified into 2 groups based on whether or not they had undergone revascularization surgery. Actuarial 1-, 5-, and 10-year stroke rates were calculated using the life table method. Risk factor analysis for 5-year stroke occurrence was conducted with multivariate regression. RESULTS Of the 441 patients, 301 had been surgically treated (revascularization group) and 140 had not (control group). The mean follow-up durations were 45 and 77 months, respectively. The actuarial 10-year cumulative incidence rate for any kind of stroke was significantly lower in the revascularization group (9.4%) than in the control group (19.6%) (p = 0.041); the relative risk reduction (RRR) was also superior (52.0%) in the revascularization group, and the number needed to treat was 10. The 10-year rate of ischemic stroke was greater (13.3%) in the control group than in the revascularization group (3.9%) (p = 0.019). The RRR for ischemic stroke in the revascularization group was 70.7%, and the number needed to treat was 11. However, the actuarial 1- and 5-year rates of ischemic stroke did not significantly differently between the groups. Overall, revascularization surgery was shown to be an independent protective factor, as revealed by multivariate analysis

  16. FUNCTIONAL SHORT TERM RECOVERY FACTORS IN PATIENTS WITH STROKE A RETROSPECTIVE OBSERVATIONAL COHORT STUDY

    Directory of Open Access Journals (Sweden)

    Bruno Corrado

    2015-12-01

    Full Text Available Background: The potential for early functional recovery in stroke patients is the basis for treatment choices and drives the rehabilitation. In this study we aimed to determine the predictive factors for short-term functional recovery in stroke patients admitted in a rehabilitation clinic. Methods: We conducted an analytical, observational, retrospective cohort study on 108 stroke patients at Campolongo Hospital for Rehabilitation. The short-term functional recovery of stroke patients has been studied by the Motricity Index (MI and the Trunk Control Test (TCT in respect of motor recovery, and the Functional Independence Measure (FIM scale about disability. The influence of predictors on short-term functional recovery has been studied by Chi square test. Results: All patients showed a good functional recovery at discharge. Statistically significant correlations have been found between patient’s age and the lack of trunk control at discharge (p = 0.0305, between patient’s age and the value of the Motricity Index at discharge (p = 0.0093, between the presence of aphasia and the severity of motor deficit at discharge (p = 0.0397, between the presence of neglect and the severity of motor deficit at both entry and discharge (p = 0.0051 and p = 0.0031. Conclusion: Our experience suggests that a predictive model of the short-term functional prognosis in early stroke patients allows for the optimization of the treatment and the rehabilitation taking charge. The final result will be an improvement of the patient’s satisfaction and a rationalization in the use of available resources.

  17. RANGE OF MOTION EXERCISE OF ARMS INCREASES THE MUCLE STRENGTH FOR POST STROKE PATIENTS

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    Judi Nurbaeni

    2017-04-01

    Full Text Available Introduction: Someone attached by stroke can’t do their activity fluently because stroke can cause the weakness of motor and sensor function. This condition cause physical defect and give effect in social and economic too, because someone who suffered stroke usually still in productive age. The objective of this study was to examine the effect of arm range of motion in the muscle strength of post stroke patient. Method: Pre experimental pre–post test design was used in this study. Population of this study was post stroke patient in Wijayakusuma ward dr. Soedono Hospital and total samples were 11 respondents. Independent variable was arm range of motion exercise, dependent variable was strength of arm muscle. Data were collected by observation with manual muscle testing of Lovelt, Naniel and Worthinghom and then analyzed using wilcoxon signed rank test with signi fi cant level of α ≤ 0.05. Result: The result showed that 11 respondents had increased their strength of muscle (p = 0.04. Discussion: It can be concluded that the strength of muscle increased after get arm range of motion exercise. When range of motion had been done Ca+ will be activated by cell so that happen integrity of muscle protein. If Ca+ and troponin had been activated, actin and myosin would have been defensed, so that can moved the skeletal and followed by muscle contraction, expand, outgrow and had a tonus. This condition can showed the strength of muscle.

  18. How a Stroke Is Diagnosed

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... Diagnosis » How a Stroke is Diagnosed How a Stroke is Diagnosed How a Stroke is Diagnosed Lab ...

  19. Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study.

    Science.gov (United States)

    O'Brien, Emily C; Greiner, Melissa A; Xian, Ying; Fonarow, Gregg C; Olson, DaiWai M; Schwamm, Lee H; Bhatt, Deepak L; Smith, Eric E; Maisch, Lesley; Hannah, Deidre; Lindholm, Brianna; Peterson, Eric D; Pencina, Michael J; Hernandez, Adrian F

    2015-10-13

    In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making. Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines-Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94), 28 more home-time days after discharge (PStatin therapy at discharge was not associated with increased risk of hemorrhagic stroke (hazard ratio, 0.94; 95% confidence interval, 0.72-1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had outcomes similar to those of recipients of moderate-intensity statin. In older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of major adverse cardiovascular events and nearly 1 month more home time during the 2-year period after hospitalization. © 2015 American Heart Association

  20. [Surface electromyographic activities of submental muscles among stroke patients with dysphagia].

    Science.gov (United States)

    Xiao, Ling-jun; Xue, Jing-jing; Yan, Tie-bin; Wu, Shao-ling

    2013-06-18

    To explore the swallowing functions of stroke patients with dysphagia. A total of 41 subjects were recruited.There were 15 stroke patients with dysphagia, 12 stroke patients without swallowing disorders and 14 age-and gender-matched healthy controls.Surface electromyography (sEMG) was employed over the suprahyoid muscle group.Single swallow was applied twice with 5 and 10 ml of thin liquid barium as well as 5 and 10 ml of paste barium.The duration, average amplitude of sEMG and peak amplitude of submental muscle contraction were compared among three groups.Three-way analysis of variance (ANOVA) was performed. No significant differences existed in the general data among three groups (P > 0.05).However, all volumes, consistencies and durations [ (1.38 ± 0.21), (1.66 ± 0.30), (1.46 ± 0.24), (1.78 ± 0.28) s] were significantly longer for the group of dysphagia patients than for those without dysphagia and healthy subjects (P 0.05). As a simple and useful tool, sEMG is feasible for evaluating swallowing function and quantifying the strength of swallowing muscles in post-stroke patients with dysphagia.

  1. Altered resting-state network connectivity in stroke patients with and without apraxia of speech

    Directory of Open Access Journals (Sweden)

    Anneliese B. New

    2015-01-01

    Full Text Available Motor speech disorders, including apraxia of speech (AOS, account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS, inferior frontal gyrus (IFG, and ventral premotor cortex (PM in a group of 32 left hemisphere stroke patients and 18 healthy, age-matched controls. Two expert clinicians rated severity of AOS, dysarthria and nonverbal oral apraxia of the patients. Fifteen individuals were categorized as AOS and 17 were AOS-absent. Comparison of connectivity in patients with and without AOS demonstrated that AOS patients had reduced connectivity between bilateral PM, and this reduction correlated with the severity of AOS impairment. In addition, AOS patients had negative connectivity between the left PM and right aINS and this effect decreased with increasing severity of non-verbal oral apraxia. These results highlight left PM involvement in AOS, begin to differentiate its neural mechanisms from those of other motor impairments following stroke, and help inform us of the neural mechanisms driving differences in speech motor planning and programming impairment following stroke.

  2. Altered resting-state network connectivity in stroke patients with and without apraxia of speech.

    Science.gov (United States)

    New, Anneliese B; Robin, Donald A; Parkinson, Amy L; Duffy, Joseph R; McNeil, Malcom R; Piguet, Olivier; Hornberger, Michael; Price, Cathy J; Eickhoff, Simon B; Ballard, Kirrie J

    2015-01-01

    Motor speech disorders, including apraxia of speech (AOS), account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS), inferior frontal gyrus (IFG), and ventral premotor cortex (PM)) in a group of 32 left hemisphere stroke patients and 18 healthy, age-matched controls. Two expert clinicians rated severity of AOS, dysarthria and nonverbal oral apraxia of the patients. Fifteen individuals were categorized as AOS and 17 were AOS-absent. Comparison of connectivity in patients with and without AOS demonstrated that AOS patients had reduced connectivity between bilateral PM, and this reduction correlated with the severity of AOS impairment. In addition, AOS patients had negative connectivity between the left PM and right aINS and this effect decreased with increasing severity of non-verbal oral apraxia. These results highlight left PM involvement in AOS, begin to differentiate its neural mechanisms from those of other motor impairments following stroke, and help inform us of the neural mechanisms driving differences in speech motor planning and programming impairment following stroke.

  3. Emerging Risk Factors for Recurrent Vascular Events in Patients With Embolic Stroke of Undetermined Source.

    Science.gov (United States)

    Ueno, Yuji; Yamashiro, Kazuo; Tanaka, Ryota; Kuroki, Takuma; Hira, Kenichiro; Kurita, Naohide; Urabe, Takao; Hattori, Nobutaka

    2016-11-01

    Underlying embolic causes diagnosed by transesophageal echocardiography could be implicated in mechanisms of embolic stroke of undetermined source. We aimed to explore factors, including underlying embolic causes, related to recurrent vascular events in embolic stroke of undetermined source. Patients who fulfilled the diagnostic criteria for embolic stroke of undetermined source and whose potential embolic sources were examined by transesophageal echocardiography were included. Recurrent vascular events, including ischemic stroke, cardiovascular and peripheral artery diseases, and vascular death, were retrospectively analyzed. Cox proportional hazards regression analysis was used to explore factors, including clinical characteristics, embolic causes on transesophageal echocardiography, and the Calcification in the Aortic Arch, Age, Multiple Infarction score (CAM), based on the degree of aortic arch calcification on chest radiograph (0-3 points), age (≥70 years; 1 point), and multiple infarctions on magnetic resonance imaging (multiple infarcts in 1, 2, or ≥3 territories of large intracranial arteries, 1, 2, or 3 points) associated with recurrent vascular events. A total of 177 patients (age, 64.1±14.2 years; 127 men) were enrolled. Thirty-one patients had recurrent vascular events (follow-up, 3.5±2.7 years; annualized rate, 5.0% per person-year). Among embolic causes on transesophageal echocardiography, incidence of recurrent vascular events was high in patients with large aortic arch plaques (7.5% per person-year). Diabetes mellitus (hazard ratio, 2.56; 95% confidence interval, 1.23-5.32; P=0.012) and CAM score grade (hazard ratio, 2.29; 95% confidence interval, 1.11-4.72; P=0.026) predicted recurrent vascular events. History of diabetes mellitus and the CAM score could be novel risk factors for recurrent vascular events in embolic stroke of undetermined source. © 2016 American Heart Association, Inc.

  4. Discharge home after acute stroke : Differences between older and younger patients

    NARCIS (Netherlands)

    Dutrieux, Roy D.; Van Eijk, Monica; Van Mierlo, Marloes L.; Van Heugten, Caroline M.; Visser-Meily, Johanna M A; Achterberg, Wilco P.

    2016-01-01

    Objective: To identify determinants for discharge destination of older (≥ 70 years) and younger (<70 years) acute stroke patients. Design: Multicentre prospective cohort. Patients: A total of 395 patients, within 7 days of clinically evaluated stroke, were included from 6 hospital stroke units. Meth

  5. Recovery of slow-5 oscillations in a longitudinal study of ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    C. La

    2016-01-01

    Full Text Available Functional networks in resting-state fMRI are identified by characteristics of their intrinsic low-frequency oscillations, more specifically in terms of their synchronicity. With advanced aging and in clinical populations, this synchronicity among functionally linked regions is known to decrease and become disrupted, which may be associated with observed cognitive and behavioral changes. Previous work from our group has revealed that oscillations within the slow-5 frequency range (0.01–0.027 Hz are particularly susceptible to disruptions in aging and following a stroke. In this study, we characterized longitudinally the changes in the slow-5 oscillations in stroke patients across two different time-points. We followed a group of ischemic stroke patients (n = 20 and another group of healthy older adults (n = 14 over two visits separated by a minimum of three months (average of 9 months. For the stroke patients, one visit occurred in their subacute window (10 days to 6 months after stroke onset, the other took place in their chronic window (>6 months after stroke. Using a mid-order group ICA method on 10-minutes eyes-closed resting-state fMRI data, we assessed the frequency distributions of a component's representative time-courses for differences in regards to slow-5 spectral power. First, our stroke patients, in their subacute stage, exhibited lower amplitude slow-5 oscillations in comparison to their healthy counterparts. Second, over time in their chronic stage, those same patients showed a recovery of those oscillations, reaching near equivalence to the healthy older adult group. Our results indicate the possibility of an eventual recovery of those initially disrupted network oscillations to a near-normal level, providing potentially a biomarker for stroke recovery of the cortical system. This finding opens new avenues in infra-slow oscillation research and could serve as a useful biomarker in future treatments aimed at recovery.

  6. Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

    DEFF Research Database (Denmark)

    Brunner-Frandsen, Nicole; Dammann Andersen, Andreas; Ashournia, Hamoun;

    2015-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study wa...

  7. Towards evidence-based physiotherapy for patients with stroke

    NARCIS (Netherlands)

    van Peppen, R.P.S.

    2008-01-01

    The first aim of the thesis was to collect and review systematically, and to appraise critically the available evidence stemming from physiotherapy and physiotherapy-related studies in patients with stroke. It can be concluded that the application of physiotherapy improves performance to execute reg

  8. Review of nutrition support and evaluation in stroke patients

    Directory of Open Access Journals (Sweden)

    Zhuo-li WU

    2015-04-01

    Full Text Available Malnutrition is common after stroke, usually caused by cognitive disorder, dysphagia, paralysis, sensorimotor disability and visual field defect. Many researches indicate that the initiation of early enteral nutrition in stroke patients would own enormous clinical benefits, including a decrease in the risk of death and infectious diseases, shorter hospital stay and lower health expenditure. However, irregular nutrition management could increase the incidence of hypostatic pneumonia and urinary tract infection. Therefore, both European Society for Parenteral and Enteral Nutrition (ESPEN and American Society for Parenteral and Enteral Nutrition (ASPEN recommended that nutrition screening and assessment and nutrition support be initiated as soon as possible, preferably within 24 h of hospital admission, to improve clinical outcomes. Chinese neurologists and patients have accepted this concept and have done many worthful studies in the past few years. This paper summarized the common methods of nutrition assessment and measurement of interstinal barrier function, in order to monitor the nutritional status of stroke patients, and push the establishment and improvement of nutrition support system for stroke patients in China. DOI: 10.3969/j.issn.1672-6731.2015.04.004

  9. Diagnostic dilemmas in a patient with multivascular embolic stroke

    NARCIS (Netherlands)

    Delsing, C.P.A.; Duijnhoven, M. van; Arnoldussen, C.; Noble, J.

    2015-01-01

    We describe a patient admitted to the intensive care unit with aphasia, which was due to an embolic ischaemic cerebral stroke associated with a previously unknown patent foramen ovale. Eventually, this finding during echocardiography led us to the diagnosis of pancreatic cancer. The thrombotic compl

  10. Improving Balance in Subacute Stroke Patients: A Randomized Controlled Study

    Science.gov (United States)

    Goljar, Nika; Burger, Helena; Rudolf, Marko; Stanonik, Irena

    2010-01-01

    The aim of the study was to compare the efficacy of balance training in a balance trainer, a newly developed mechanical device for training balance, with conventional balance training in subacute stroke patients. This was a randomized controlled study. Fifty participants met the inclusion criteria and 39 finished the study. The participants were…

  11. Long-term use of antiplatelet drugs by stroke patients

    DEFF Research Database (Denmark)

    Ostergaard, Kamilla; Hallas, Jesper; Bak, Søren

    2012-01-01

    in a cohort of stroke patients discharged from a Danish neurology department. The antiplatelet drugs comprised acetylsalicylic acid (ASA), clopidogrel and dipyridamole (if combined with ASA use). Non-persistence was defined as failure to present a prescription for antiplatelet drugs within 180 days after...

  12. [Intravenous thrombolysis for ischemic stroke: Experience in 54 patients].

    Science.gov (United States)

    Guevara O, Carlos; Bulatova, Kateryna; Aravena, Felipe; Caba, Sheila; Monsalve, Juan; Lara, Hugo; Nieto, Elena; Navarrete, Isabel; Morales, Marcelo

    2016-04-01

    Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) reduces disability in patients with ischemic stroke. However, its implementation in Chilean public general hospitals has been slow and faces some difficulties. To analyze the results of an intravenous thrombolysis protocol implementation in a public general hospital. During a lapse of 28 months a standardized protocol for intravenous thrombolysis implemented in the emergency room of a public hospital, was prospectively evaluated. Fifty four patients with ischemic stroke were treated and assessed three months later as outpatients. At three months of follow-up, 66.4% of patients subjected to thrombolysis had a favorable evolution, defined as having 0 to 1 points in the modified Rankin scale. Intracerebral hemorrhage rate was 11.1%, including 5.5% of symptomatic intracerebral hemorrhage. Four percent of patients had systemic bleeding complications after thrombolysis. The mortality rate was 14.8%. The success rates, mortality, and complications rate were comparable to the results obtained in international studies, despite of the absence of a stroke unit to manage stroke and its complications.

  13. [The education influence on effects of rehabilitation in patients after stroke].

    Science.gov (United States)

    Dudka, Sabina; Winczewski, Piotr; Janczewska, Katarzyna; Kubsik, Anna; Woldańska-Okońska, Marta

    2016-11-25

    Patients after stroke face a new situation where some educational and pedagogical actions should be reinitiated. Stroke often causes a break away from the previous lifestyle. It the acute phase it excludes the possibility of employment or performance of household duties that were carried out before or indulging in previously preferred ways of spending free time. Patients often abandon the habits that they developed before stroke, inclusive of hygienic habits. Therefore, it is an important objective of rehabilitation to reinstate in stroke patients behaviours characteristic of their peers, which would mark the beginning of their own care for health. The pedagogic and educational activities should lead to a transformation in the patient. This could be one of the factors in facilitating the patient's return to previous forms of activity. The aim of this study was to analyze progress in patient's rehabilitation and satisfaction, to assess impact of health education on higher satisfaction and better knowledge in stroke patients as well as on their recovery. Another aim was to assess the factors that maximize the patients' chances of returning to the labor market. The study involved 30 patients after stroke, 8 women and 22 men, over 40 years of age, who underwent either early or late rehabilitation, the type of which affected the time of treatment. The minimal duration of the patient's stay was 21 days, in which time an individually tailored way of education, rehabilitation, treatment and care was implemented. The study used a questionnaire and the Bartel and the Rankin scales. The subject of the analysis consisted of 22 questions that were based on hypotheses. They assessed the facts, the sources of information, knowledge and subjective feelings of the patients concerning the education carried out by the rehabilitation team and its impact on the patients' rehabilitation. A highly significant (prehabilitation. During the rehabilitation patients gained a significant

  14. Solar term peak of onset and death in 1597 patients with acute ischemic stroke Circular statistical analysis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Previously, time data were analyzed by using constituent ratio or relative ratio; however,circular statistical analysis could exactly provide average peak phase of diseases.OBJECTIVE: To investigate the correlation of solar term peak with onset and death of acute ischemic stroke.DESIGN: Retrospective case analysis.SETTINGS: Emergency Department of Foshan Municipal Hospital of Traditional Chinese Medicine;Department of Science and Education, the Second People's Hospital of Foshan.PARTICIPANTS: A total of 1597 patients with acute ischemic stroke were selected from Emergency Room,Department of Neurology, Foshan Municipal Hospital of Traditional Chinese Medicine from 1994 to 2002.There were 875 males and 722 females, and their ages ranged from 33 to 97 years. All cases met the diagnostic criteria of acute cerebral infarction modified by the Second National Cerebrovascular Disease Academic Meeting; meanwhile, they were diagnosed with CT/MRI test. Patients and their relatives provided the confirmed consent.METHODS: Solar term of onset was retrospectively analyzed in 1 597 patients with acute ischemic stroke;among them, solar term of death in 90 cases were analyzed by using circular statistical analysis to calculate peak phase of onset and death of acute ischemic stroke and investigate the correlation of solar term with onset and death of acute ischemic stroke.MAIN OUTCOME MEASURES: Onset and death time of patients with acute ischemic stroke. RESULTS: Solar term of onset in 1 597 patients, especially solar term of death in 90 patients, was not concentrated (P > 0.05), and specific peak phase was not found out. Acute ischemic stroke low attacked from vernal equinox to summer begins, but death caused by acute ischemic stroke high attacked from grain buds to autumn begins.CONCLUSION: Patients with acute ischemic stroke do not have specific solar term peak of onset and death.

  15. How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?

    Science.gov (United States)

    Doijiri, Ryosuke; Uno, Hisakazu; Miyashita, Kotaro; Ihara, Masafumi; Nagatsuka, Kazuyuki

    2016-10-01

    The sudden development of vertigo or dizziness without focal neurological symptoms is generally attributable to vestibular diseases such as benign paroxysmal positional vertigo. Isolated vertigo or dizziness attack needs more attention than vestibular diseases. This retrospective study was performed to elucidate the frequency of strokes in patients with isolated vertigo or dizziness attack. We enrolled 221 patients (men, 119; women, 102; mean age, 68.4 ± 10.3 years) who were admitted to our hospital over the last 10 years because of sudden isolated vertigo or dizziness attack without other neurological symptoms except for nystagmus, deafness, or tinnitus. We investigated the clinical features, final diagnosis, neuroimaging findings, and short- or long-term outcome of these patients. One hundred eighteen patients had vertigo whereas the other 103 had dizziness. Brain computed tomography or magnetic resonance imaging revealed recent stroke lesions in 25 patients (11.3%) (ischemic, 21; hemorrhagic, 4).The lesions were generally small and localized in the cerebellum (n = 21), pons (n = 1), medulla oblongata (n = 1), or corona radiata (n = 1). Of the 25 patients, 19 (76%) had dizzy-type spells; none had neurological dysfunction at the time of discharge. In the remaining 196 patients, no stroke was detected on computed tomography or magnetic resonance imaging. Stroke was found in 11% of patients with isolated vertigo or dizziness attack. The posterior inferior cerebellar artery area was the most frequently implicated for isolated vertigo or dizziness. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Efficacy and safety of Cerebrolysin in patients with hemorrhagic stroke

    OpenAIRE

    Bajenaru, O; Tiu, C; Moessler, H; Antochi, F; Muresanu, D; Popescu, BO; Novak, P.

    2010-01-01

    The purpose of the study was to investigate the efficacy and safety of Cerebrolysin in patients with hemorrhagic stroke. The primary objective of this trial was to assess the clinical efficacy and safety of a 10–days course of therapy with a daily administration of Cerebrolysin (50 mL Ⅳ per day). The trial had to demonstrate that Cerebrolysin treatment is safe in hemorrhagic stroke. Methods: The study was performed as a prospective, randomized, double blind, placebo–controlled, parallel group...

  17. Impaired glucose regulation predicted 1-year mortality of Chinese patients with ischemic stroke: data from abnormal glucose regulation in patients with acute stroke across China.

    Science.gov (United States)

    Jia, Qian; Liu, Gaifen; Zheng, Huaguang; Zhao, Xingquan; Wang, Chunxue; Wang, Yilong; Liu, Liping; Wang, Yongjun

    2014-05-01

    It remains uncertain if impaired glucose regulation (IGR) as a predictor for stroke outcomes. This study aimed at observing the effect of IGR on the 1-year outcomes in Chinese patients with ischemic stroke. Patients with acute ischemic stroke were recruited consecutively in multihospitals across China. Oral glucose tolerance test was performed to identify IGR. Cox proportion hazard model was performed to investigate the effect of IGR on 1-year mortality or stroke recurrence in patients with ischemic stroke. The study recruited 2639 patients with ischemic stroke. IGR was shown as an independent risk factor for the mortality of patients with ischemic stroke (hazard ratio [95% confidence interval], 3.088 [1.386-6.884]; P=0.006). However, IGR showed no significant effects on the dependency or stroke recurrence of patients (P=0.540 and 0.618, respectively). IGR was an independent predictor for the mortality of patients with ischemic stroke. IGR should be highlighted and intervened actively in the patients with ischemic stroke.

  18. Examining interference of different cognitive tasks on voluntary balance control in aging and stroke.

    Science.gov (United States)

    Bhatt, Tanvi; Subramaniam, Savitha; Varghese, Rini

    2016-09-01

    This study compared the effect of semantic and working memory tasks when each was concurrently performed with a voluntary balance task to evaluate the differences in the resulting cognitive-motor interference (CMI) between healthy aging and aging with stroke. Older stroke survivors (n = 10), older healthy (n = 10) and young adults (n = 10) performed the limits of stability, balance test under single task (ST) and dual task (DT) with two different cognitive tasks, word list generation (WLG) and counting backwards (CB). Cognitive ability was evaluated by recording the number of words and digits counted while sitting (ST) and during balance tasks (DT). The balance and cognitive costs were computed using [(ST-DT)/ST] × 100 for all the variables. Across groups, the balance cost was significantly higher for the older stroke survivors group in the CB condition than older healthy (p stroke survivors than in older healthy (p stroke survivors. Young adults showed the least CMI, with a similar performance on the two memory tasks. On the other hand, healthy aging and stroke impact both semantic and working memory. Stroke-related cognitive deficits may further significantly decrease working memory function.

  19. Lost life years attributable to stroke among patients with nonvalvular atrial fibrillation: a nationwide population-based follow-up study

    DEFF Research Database (Denmark)

    Frost, Lars; Andersen, Ljubica; Johnsen, Søren Paaske;

    2007-01-01

    Registry of Patients from calendar year 1980 to 2002, and no previous or concomitant diagnosis of stroke or heart valve disease. All patients were followed in the Danish National Registry of Patients for occurrence of an incident diagnosis of stroke of any type (ischemic and/or hemorrhagic......AIM: We assessed the number of lost life years attributable to stroke among patients with a hospital diagnosis of nonvalvular atrial fibrillation. METHODS: We identified all patients, aged 40-89 years, with an incident hospital diagnosis of atrial fibrillation or flutter in the Danish National...... lost life years by sex, age, and time to incident stroke after diagnosis of atrial fibrillation, adjusted for conditions of comorbidity and calendar year of diagnosis of atrial fibrillation. RESULTS: The mean loss of life years attributable to incident stroke within 20 years after a first diagnosis...

  20. Left Atrial Function Is Impaired in Some Patients With Stroke of Undetermined Etiology: Potential Implications for Evaluation and Therapy.

    Science.gov (United States)

    Sanchis, Laura; Montserrat, Silvia; Obach, Víctor; Cervera, Álvaro; Chamorro, Ángel; Vidal, Bàrbara; Mas-Stachurska, Aleksandra; Bijnens, Bart; Sitges, Marta

    2016-07-01

    Stroke etiology remains undetermined in up to 30% of cases. Paroxysmal atrial fibrillation is found in 20% to 28% of patients with stroke initially classified as being of undetermined etiology. The aim of our study was to analyze left atrial function in ischemic stroke patients to identify patterns associated with cardioembolic etiology and to determine whether the patterns identified can be found in individuals initially classified as having a stroke of undetermined etiology. We studied a cohort of in-hospital ischemic stroke patients referred for transthoracic echocardiography. Treating neurologists determined stroke etiology based on the TOAST classification. Left atrial contractile function was assessed using 2-dimensional echocardiography to determine their ejection fraction and speckle tracking to measure left atrial strain rate: a-wave. Left atrial function was compared between stroke etiology subgroups and healthy controls. Ninety-seven patients (aged 67±15 years) with ischemic stroke (16.5% large-artery atherosclerosis, 15.5% small-vessel occlusion, 11.3% cardioembolic, 5.1% other determined etiology, 51.1% undetermined etiology) and 10 healthy volunteers (aged 63±7 years) were included. Left atrial ejection fraction was significantly decreased only in patients with stroke of cardioembolic and undetermined etiology compared with the control group (31.5±17.2%, 40.2±17.1%, and 59.1±8.4%, respectively; P=.004). The left atrial strain rate was significantly lower in patients with stroke caused by cardioembolic or undetermined etiology, or large-artery atherosclerosis compared with controls (-0.86±0.49, -1.31±0.56, -1.5±0.47, -2.37±1.18, respectively; Pundetermined etiology with left atrial function (ejection fraction and strain) similar to that of cardioembolic stroke patients may be misclassified and could potentially benefit from prolonged electrocardiography monitoring. Left atrial function analysis (ejection fraction and strain) might help to

  1. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  2. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    2013-10-01

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  3. Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients.

    Science.gov (United States)

    Hojs Fabjan, Tanja; Penko, Meta; Hojs, Radovan

    2014-02-01

    Renal dysfunction is associated with mortality in patients after ischemic stroke. Cystatin C is a potentially superior marker of renal function compared to creatinine and estimated glomerular filtration rate (GFR). In our observational cohort study, 390 Caucasian patients suffered from acute ischemic stroke (mean age 70.9 years; 183 women and 207 men) were included and prospectively followed up to maximal 56 months. Serum creatinine and cystatin C were measured at admission to the hospital; GFR was estimated according to CKD-EPI creatinine and CKD-EPI creatinine/cystatin equations. According to values of serum creatinine, estimated GFR and serum cystatin C patients were divided into quintiles. In the follow-up period, 191 (49%) patients died. For serum cystatin C and estimated GFR based on creatinine and cystatin C, the mortality and the hazard ratios for long-term mortality increased from the first to the fifth quintile nearly linearly. The associations of serum creatinine and estimated GFR categories based on creatinine with long-term mortality were J-shaped. As compared with lowest quintile of serum cystatin C, the fifth quintile was associated with long-term mortality significantly also after multivariate adjustment (age, gender, initial stroke severity, known risk factors for stroke mortality). In contrast, in adjusted analysis serum creatinine and estimated GFR (CKD-EPI creatinine and CKD-EPI creatinine/cystatin) were not associated with long-term mortality. In summary, serum cystatin C was independently and better associated with the risk of long-term mortality in patients suffering from ischemic stroke than were creatinine and estimated GFR using both CKD-EPI equations.

  4. Relationship between Barthel Index scores during the acute phase of rehabilitation and subsequent ADL in stroke patients

    National Research Council Canada - National Science Library

    Nakao, Shigetaka; Takata, Shinjiro; Uemura, Hirokazu; Kashihara, Michiharu; Osawa, Toshifumi; Komatsu, Koji; Masuda, Yuki; Okahisa, Tetsuya; Nishikawa, Koji; Kondo, Shin; Yamada, Megumi; Takahara, Risa; Ogata, Yoshimi; Nakamura, Yuka; Nagahiro, Shinji; Kaji, Ryuji; Yasui, Natsuo

    2010-01-01

    The Barthel Index (BI) cannot be used to measure initial stroke severity or by extension, to stratify patients by severity in acute stroke trials because most patients are bedbound in the first few hours after str