Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke.

Science.gov (United States)

Sen, Souvik; Giamberardino, Lauren D; Moss, Kevin; Morelli, Thiago; Rosamond, Wayne D; Gottesman, Rebecca F; Beck, James; Offenbacher, Steven

2018-02-01

Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk. In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs). In the ARIC study 10 362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (χ 2 trend P periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95% confidence interval, 1.2-5.6) and thrombotic (hazard ratio, 2.2; 95% confidence interval, 1.3-3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95% confidence interval, 0.63-0.94). We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke. © 2018 American Heart Association, Inc.

Determinants of social inequalities in stroke incidence across Europe

DEFF Research Database (Denmark)

Ferrario, Marco M.; Veronesi, Giovanni; Kee, Frank

2017-01-01

Background: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across...

Multivitamin use and risk of stroke incidence and mortality amongst women.

Science.gov (United States)

Adebamowo, S N; Feskanich, D; Stampfer, M; Rexrode, K; Willett, W C

2017-10-01

Few studies have examined the association between multivitamin use and the risk of stroke incidence and mortality, and the results remain inconclusive as to whether multivitamins are beneficial. The associations between multivitamin use and the risk of incident stroke and stroke mortality were prospectively examined in 86 142 women in the Nurses' Health Study, aged 34-59 years and free of diagnosed cardiovascular disease at baseline. Multivitamin use and covariates were updated every 2 years and strokes were documented by review of medical records. Hazard ratios of total, ischaemic and hemorrhagic strokes were calculated across categories of multivitamin use (non-user, past, current user) and duration (years), using Cox proportional hazards models. During 32 years of follow-up from 1980 to 2012, 3615 incident strokes were documented, including 758 deaths from stroke. In multivariate analyses, women who were current multivitamin users did not have a lower risk of incident total stroke compared to non-users [relative risk (RR) 1.02, 95% confidence interval (CI) 0.93-1.11], even those with longer durations of 15 or more years of use (RR 1.08, 95% CI 0.97-1.20) or those with a lower quality diet (RR 0.96, 95% CI 0.80-1.15). There was also no indication of benefit from multivitamin use for incident ischaemic or hemorrhagic strokes or for total stroke mortality. Long-term multivitamin use was not associated with reduced risk of stroke incidence or mortality amongst women in the study population, even amongst those with a lower diet quality. An effect in a less well-nourished population cannot be ruled out. © 2017 EAN.

Study of Stroke Incidence in the Aseer Region, Southwestern Saudi Arabia.

Science.gov (United States)

Alhazzani, Adel A; Mahfouz, Ahmed A; Abolyazid, Ahmed Y; Awadalla, Nabil J; Aftab, Razia; Faraheen, Aesha; Khalil, Shamsun Nahar

2018-01-26

Recent data regarding first-stroke incidence in Saudi Arabia in general and in the Aseer region in particular are scarce and even lacking. The aim of this work was to study the first-time stroke incidence in the Aseer region, southwestern Saudi Arabia. All first-stroke patients admitted to all hospitals in the Aseer region over a one-year period (January through December 2016) were included. Stroke patients outside the Aseer region were excluded from the study. The incidence per 100,000 patients and the concomitant 95% CI (Confidence Intervals) were computed. The present study included 1249 first-time stroke patients and calculated an overall minimal incidence rate of hospitalized first-time stroke of 57.64 per 100,000 persons per year (95% CI: 57.57-57.70). A steady increase was noticed depending on the patients' age, reaching a figure of 851.81 (95% CI: 849.2-854.5) for those patients aged 70 years and more. Overall, the incidence rate for females (48.14; 95% CI: 48.04-48.24) was lower compared to males (65.52; 95% CI: 65.1-66.0). Taking into consideration the expected rise of the elderly because of the prominent medical services provided by the Saudi government, leading to a subsequent change in the horizontal and vertical age distribution structure of the population, an increase in the number of stroke patients is expected. It is suggested to establish a nationwide stroke surveillance system in the Kingdom, with the objective to report, analyze, and maintain an updated overview of the stroke status in Saudi Arabia.

Gross domestic product and health expenditure associated with incidence, 30-day fatality, and age at stroke onset: a systematic review.

Science.gov (United States)

Sposato, Luciano A; Saposnik, Gustavo

2012-01-01

Differences in definitions of socioeconomic status and between study designs hinder their comparability across countries. We aimed to analyze the correlation between 3 widely used macrosocioeconomic status indicators and clinical outcomes. We selected population-based studies reporting incident stroke risk and/or 30-day case-fatality according to prespecified criteria. We used 3 macrosocioeconomic status indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity, total health expenditures per capita at purchasing power parity, and unemployment rate. We examined the correlation of each macrosocioeconomic status indicator with incident risk of stroke, 30-day case-fatality, proportion of hemorrhagic strokes, and age at stroke onset. Twenty-three articles comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using the standardized World Health Organization World population was associated to lower per capita gross domestic product adjusted for purchasing power parity (ρ=-0.661, P=0.027, R(2)=0.32) and total health expenditures per capita at purchasing power parity (ρ=-0.623, P=0.040, R(2)=0.26). Thirty-day case-fatality rates and proportion of hemorrhagic strokes were also related to lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. Moreover, stroke occurred at a younger age in populations with low per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. There was no correlation between unemployment rates and outcome measures. Lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity were associated with higher incident risk of stroke, higher case-fatality, a greater

Incidence of hemorrhagic stroke in the general population

DEFF Research Database (Denmark)

Gaist, David; Wallander, Mari-Ann; González-Pérez, Antonio

2013-01-01

and assessed the incidence of these events. METHODS: Patients aged 20-89 years were identified and followed until (i) ICH or SAH was detected, (ii) the patient reached 90 years old (iii) death, or (iv) the end of the study. Computerized patient profiles were reviewed manually; those not discarded became...... stroke in THIN followed by manual review of clinical profiles is a valid method. The incidence of hemorrhagic stroke increases sharply with age. Copyright © 2012 John Wiley & Sons, Ltd....

Trends in stroke incidence. The Copenhagen City Heart Study

DEFF Research Database (Denmark)

Truelsen, T; Prescott, E; Grønbaek, M

1997-01-01

at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis. RESULTS......: For subjects aged 45 to 64 years, no significant trends were observed, with an annual incidence rate ratio of 1.00 (95% confidence interval [CI], 0.97 to 1.03) and 1.04 (95% CI, 0.99 to 1.08) for men and women, respectively. In subjects aged 65 to 84 years a significant decrease in stroke incidence was found...... in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women. CONCLUSIONS: During the period from 1976 to 1993...

Incidence of stroke and stroke subtypes in Malmö, Sweden, 1990-2000: marked differences between groups defined by birth country.

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Khan, Farhad Ali; Zia, Elisabet; Janzon, Lars; Engstrom, Gunnar

2004-09-01

The proportion of immigrants has increased in Sweden markedly during the last decades, as in many other Western countries. Incidence of stroke has increased during this period. However, it is primarily unknown whether incidence of stroke and stroke subtypes in Sweden is related to country of birth. Incidence of first-ever stroke was followed during 10 years in a cohort consisting of all 40- to 89-year-old inhabitants in the city of Malmö, Sweden (n=118,134). Immigrants from 12 different countries were compared with native-born Swedes. Adjusted for age, sex, marital status, and socioeconomic indicators, the incidence of stroke (all subtypes) was significantly higher among immigrants from former Yugoslavia (relative risk [RR], 1.31; 95% CI, 1.1 to 1.6) and Hungary (RR, 1.33; CI, 1.02 to 1.7). A significantly increased incidence of intracerebral hemorrhage was observed in immigrants from Peoples Republic of China or Vietnam (RR, 4.2; CI, 1.7 to 10.4) and the former Soviet Union (RR, 2.7; CI, 1.01 to 7.3). Immigrants from Finland had a significantly higher incidence of subarachnoid hemorrhage (RR, 2.8; CI, 1.1 to 6.8). A significantly lower incidence of stroke was observed in the group from Romania (RR, 0.14; CI, 0.04 to 0.6). Immigrants from Denmark, Norway, Germany, Chile, Czechoslovakia, and Poland had approximately the same risk as citizens born in Sweden. In this urban population from Sweden, there are substantial differences in stroke incidence and stroke subtypes between immigrants from different countries. To what extent this could be accounted for by exposure to biological risk factors remains to be explored.

Acute cerebrovascular incident in a young woman: Venous or arterial stroke? – Comparative analysis based on two case reports

International Nuclear Information System (INIS)

Sleiman, Katarzyna; Zimny, Anna; Kowalczyk, Edyta; Sąsiadek, Marek

2013-01-01

Cerebrovascular diseases are the most common neurological disorders. Most of them are arterial strokes, mainly ischemic, less often of hemorrhagic origin. Changes in the course of cerebral venous thrombosis are less common causes of acute cerebrovascular events. Clinical and radiological presentation of arterial and venous strokes (especially in emergency head CT) may pose a diagnostic problem because of great resemblance. However, the distinction between arterial and venous stroke is important from a clinical point of view, as it carries implications for the treatment and determinates patient’s prognosis. In this article, we present cases of two young women (one with an acute venous infarction, the second with an arterial stroke) who presented with similar both clinical and radiological signs of acute vascular incident in the cerebral cortex. We present main similarities and differences between arterial and venous strokes regarding the etiology, clinical symptoms and radiological appearance in various imaging techniques. We emphasize that thorough analysis of CT (including cerebral vessels), knowledge of symptoms and additional clinical information (e.g. risk factors) may facilitate correct diagnosis and allow planning further diagnostic imaging studies. We also emphasize the importance of MRI, especially among young people, in the differential diagnosis of venous and arterial infarcts

Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010.

Science.gov (United States)

Rosengren, Annika; Giang, Kok Wai; Lappas, Georgios; Jern, Christina; Torén, Kjell; Björck, Lena

2013-09-01

The incidence of stroke in Sweden increased between 1989 and 2000 among people aged ≤65 years, but more recent data on those aged >65 years are lacking. Through the Swedish Hospital Discharge and Cause of Death registries, we identified all cases of nonfatal and fatal ischemic stroke (IS) among people aged 18 to 84 years during 1987-2010 in Sweden. Of the 391 081 stroke cases identified, 1.6% were 18 to 44 years, 16.7% were 45 to 64 years, and 81.7% were 65 to 84 years. Among people aged 18 to 44 years, there was a continuous increase in the incidence of stroke of 1.3% (95% confidence interval, 0.8%-1.8%) per year for men and 1.6% (1.0%-2.3%) per year for women. Among men and women aged 45 to 64 years, slightly declining rates were observed from the late 1990s, with a mean annual decrease of 0.4% (0.1%-0.7%) among men and 0.6% (0.2%-1.0%) among women. Among men aged 65 to 84 years, a decrease of 3.7% in IS (3.4%-4.0%) per year was observed from the late 1990s. This was more marked in women, where an initial decrease of 2.5% (2.1%-2.9%) per year was followed by an accelerated decrease of 5.1% (4.4%-5.8%) after 2005. Mortality from IS decreased markedly in all age groups. The incidence of IS in elderly people in Sweden is now decreasing, whereas the decline in IS incidence in the middle-aged people is much less steep. The increasing incidence of stroke in the young, particularly if carried forward to an older age, is concerning.

Hemoglobin Concentration and Risk of Incident Stroke in Community-Living Adults.

Science.gov (United States)

Panwar, Bhupesh; Judd, Suzanne E; Warnock, David G; McClellan, William M; Booth, John N; Muntner, Paul; Gutiérrez, Orlando M

2016-08-01

In previous observational studies, hemoglobin concentrations have been associated with an increased risk of stroke. However, these studies were limited by a relatively low number of stroke events, making it difficult to determine whether the association of hemoglobin and stroke differed by demographic or clinical factors. Using Cox proportional hazards analysis and Kaplan-Meier plots, we examined the association of baseline hemoglobin concentrations with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults aged ≥45 years. A total of 518 participants developed stroke over a mean 7±2 years of follow-up. There was a statistically significant interaction between hemoglobin and sex (P=0.05) on the risk of incident stroke. In Cox regression models adjusted for demographic and clinical variables, there was no association of baseline hemoglobin concentration with incident stroke in men, whereas in women, the lowest (14.0 g/dL) quartiles of hemoglobin were associated with higher risk of stroke when compared with the second quartile (12.4-13.2 g/dL; quartile 1: hazard ratio, 1.59; 95% confidence interval, 1.09-2.31; quartile 2: referent; quartile 3: hazard ratio, 0.91; 95% confidence interval, 0.59-1.38; quartile 4: hazard ratio, 1.59; 95% confidence interval, 1.08-2.35). Similar results were observed in models stratified by hemoglobin and sex and when hemoglobin was modeled as a continuous variable using restricted quadratic spline regression. Lower and higher hemoglobin concentrations were associated with a higher risk of incident stroke in women. No such associations were found in men. © 2016 American Heart Association, Inc.

Social network, social support, and risk of incident stroke: Atherosclerosis Risk in Communities study.

Science.gov (United States)

Nagayoshi, Mako; Everson-Rose, Susan A; Iso, Hiroyasu; Mosley, Thomas H; Rose, Kathryn M; Lutsey, Pamela L

2014-10-01

Having a small social network and lack of social support have been associated with incident coronary heart disease; however, epidemiological evidence for incident stroke is limited. We assessed the longitudinal association of a small social network and lack of social support with risk of incident stroke and evaluated whether the association was partly mediated by vital exhaustion and inflammation. The Atherosclerosis Risk in Communities study measured social network and social support in 13 686 men and women (mean, 57 years; 56% women; 24% black; 76% white) without a history of stroke. Social network was assessed by the 10-item Lubben Social Network Scale and social support by a 16-item Interpersonal Support Evaluation List-Short Form. During a median follow-up of 18.6 years, 905 incident strokes occurred. Relative to participants with a large social network, those with a small social network had a higher risk of stroke (hazard ratio [95% confidence interval], 1.44 [1.02-2.04]) after adjustment for demographics, socioeconomic variables, marital status, behavioral risk factors, and major stroke risk factors. Vital exhaustion, but not inflammation, partly mediated the association between a small social network and incident stroke. Social support was unrelated to incident stroke. In this sample of US community-dwelling men and women, having a small social network was associated with excess risk of incident stroke. As with other cardiovascular conditions, having a small social network may be associated with a modestly increased risk of incident stroke. © 2014 American Heart Association, Inc.

Influenza vaccination and risk of stroke: Self-controlled case-series study.

Science.gov (United States)

Asghar, Zahid; Coupland, Carol; Siriwardena, Niroshan

2015-10-05

Stroke may be triggered by respiratory infections, including influenza. Influenza vaccination could therefore reduce risk of stroke. Previous studies of this association have shown conflicting results. We aimed to investigate whether influenza vaccination was associated with reduced risk of stroke. We used a self-controlled case series design. The General Practice Research Database (GPRD) was used to extract records of patients aged 18 years or over recorded with stroke (fatal or non-fatal) from September 2001 to May 2009. Statistical modelling with conditional Poisson regression was employed to compute incidence rate ratios (IRR). The incidence rate of stroke in fixed time periods after influenza vaccination was compared with the incidence rate during a baseline period. There were 17,853 eligible individuals who received one or more influenza vaccinations and experienced a stroke during the observation period. The incidence of stroke was significantly reduced in the first 59 days following influenza vaccination compared with the baseline period. We found reductions of 55% (IRR 0.45; 95% CI 0.36-0.57) in the first 1-3 days after vaccination, 36% (0.64; 0.53-0.76) at 4-7 days, 30% (0.70; 0.61-0.79) at 8-14 days, 24% (0.76; 0.70-0.84) at 15-28 days and 17% (0.83; 0.77-0.89) at 29-59 days after vaccination. Early vaccination between 1 September and 15 November showed a greater reduction in IRR compared to later vaccination given after mid-November. Influenza vaccination is associated with a reduction in incidence of stroke. This study supports previous studies which have shown a beneficial association of influenza vaccination for stroke prevention. Copyright © 2015 Elsevier Ltd. All rights reserved.

Incidence of Stroke in North West Frontier Province of Pakistan

Directory of Open Access Journals (Sweden)

Qamruz Zaman

2011-06-01

Full Text Available The main purpose of the study is to find factors which are directly and indirectly related with the incidence of stroke. For this purpose the data of 300 stroke patients was analyzed. The average age was found to be 57.3(+/-15.76 SD years. The average male age is 59.11 (+/- 17.64 SD years as compared to 55.66 (+/-13.65 SD years in females. The investigation showed significant difference between the average age for males and females. The study provides evidence of association between incidence of stroke and DM or/ and HTN. Study also revealed that stroke is highly associated with age. [J Contemp Med 2011; 1(2.000: 35-41

Stroke incidence rates among black residents of Harare - a ...

African Journals Online (AJOL)

and a first-week mortaJrty rate of 35%, stroke must now be considered an ... which accelerated in the late 196Os,oHi accurate information about stroke incidence and ... impression of physicians, based on hospital discharge records, is that ...

Incidence of Stroke and Transient Ischemic Attack in Croatia: A Population Based Study.

Science.gov (United States)

Kadojić, Dragutin; Demarin, Vida; Dikanović, Marinko; Lusić, Ivo; Tuskan-Mohar, Lidija; Trkanjec, Zlatko; Mihaljević, Ivan; Kadojić, Mira; Bitunjac, Milan; Vranjes, Zeljko

2015-09-01

The aim of this population based neuroepidemiological study was to establish the real incidence rates of acute cerebrovascular disease (CVD): stroke and transient ischemic attack (TIA) in the Republic of Croatia. Multicentric study included 89 501 persons of all ages in four regional centres in Croatia: Zagreb, Osijek + Slavonski Brod, Rijeka and Split. The following incidence rates of stroke, expressed at population of 100 000, have been established: Zagreb 290.52, Osijek + Slavonski Brod 302.14, Rijeka 219.65, Split 195.82. Incidence rate of stroke for the Republic of Croatia is 251.39. The following incidence rates of TIA, expressed at population of 100,000, have been established: Zagreb 87.15, Osijek + Slavonski Brod 156.53, Rijeka 90.11, Split 59.10. Incidence rate of TIA for the Republic of Croatia is 100.55. In the continental part of Croatia (Zagreb, Osijek + Slavonski Brod) incidence rate of stroke is higher by 45%, while incidence rate of TIA is higher by 82% than in the coastal part of Croatia, probably due to different lifestyle and environmental factors. The study has shown relatively high incidence rates of acute CVD (stroke and TIA) in the Republic of Croatia, which proves that CVD are a great public health problem.

Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands

DEFF Research Database (Denmark)

Agyemang, Charles; van Oeffelen, Aloysia A M; Nørredam, Marie Louise

2014-01-01

BACKGROUND AND PURPOSE: Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands. METHODS: A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010....... We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch). RESULTS: Compared.......16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence...

Ischemic stroke in paediatrics - narrative review of the literature and two cases.

Science.gov (United States)

Klucka, Jozef; Stourac, Petr; Stoudek, Roman; Toukalkova, Michaela; Harazim, Hana; Kosinova, Martina; Stouracova, Alena; Mrlian, Andrej; Suk, Petr; Malaska, Jan

2017-03-01

Stroke is a rare condition in childhood with an estimated incidence of between 1.3-13/100.000 patients. Clinical manifestation and risk factors for paediatric stroke are different from those of adults. The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors. Neuroimaging (DWI MR) is the golden standard for diagnosis of paediatric stroke and other investigations can be considered according to the clinical condition. Despite advances in paediatric stroke research and clinical care, questions remain unanswered regarding acute treatment, secondary prevention and rehabilitation. The treatment recommendations are mainly extrapolated from studies on adult populations. In the review authors summarized the clinical characteristics and diagnostic steps for stroke in children/adolescents based on the most recent international guidelines and practical directions for recognising and managing the child/adolescent with stroke in paediatric emergency. In the two case reports, we describe the clinical course in both stroke patients.

Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands

NARCIS (Netherlands)

Agyemang, Charles; van Oeffelen, Aloysia A. M.; Norredam, Marie; Kappelle, L. Jaap; Klijn, Catharina J. M.; Bots, Michiel L.; Stronks, Karien; Vaartjes, Ilonca

2014-01-01

Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands. A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke

Can Survival Bias Explain the Age Attenuation of Racial Inequalities in Stroke Incidence?: A Simulation Study.

Science.gov (United States)

Mayeda, Elizabeth Rose; Banack, Hailey R; Bibbins-Domingo, Kirsten; Zeki Al Hazzouri, Adina; Marden, Jessica R; Whitmer, Rachel A; Glymour, M Maria

2018-07-01

In middle age, stroke incidence is higher among black than white Americans. For unknown reasons, this inequality decreases and reverses with age. We conducted simulations to evaluate whether selective survival could account for observed age patterning of black-white stroke inequalities. We simulated birth cohorts of 20,000 blacks and 20,000 whites with survival distributions based on US life tables for the 1919-1921 birth cohort. We generated stroke incidence rates for ages 45-94 years using Reasons for Geographic and Racial Disparities in Stroke (REGARDS) study rates for whites and setting the effect of black race on stroke to incidence rate difference (IRD) = 20/10,000 person-years at all ages, the inequality observed at younger ages in REGARDS. We compared observed age-specific stroke incidence across scenarios, varying effects of U, representing unobserved factors influencing mortality and stroke risk. Despite a constant adverse effect of black race on stroke risk, the observed black-white inequality in stroke incidence attenuated at older age. When the hazard ratio for U on stroke was 1.5 for both blacks and whites, but U only directly influenced mortality for blacks (hazard ratio for U on mortality =1.5 for blacks; 1.0 for whites), stroke incidence rates in late life were lower among blacks (average observed IRD = -43/10,000 person-years at ages 85-94 years versus causal IRD = 20/10,000 person-years) and mirrored patterns observed in REGARDS. A relatively moderate unmeasured common cause of stroke and survival could fully account for observed age attenuation of racial inequalities in stroke.

Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in Black Americans

Science.gov (United States)

Judd, Suzanne E; Gutiérrez, Orlando M.; Newby, PK; Howard, George; Howard, Virginia J; Locher, Julie L; Kissela, Brett M; Shikany, James M

2014-01-01

Background and Purpose Black Americans and residents of the Southeastern United States, are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. Methods Between 2003–2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30,239 black and white Americans aged 45 years or older. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox proportional hazards models were used to examine risk of stroke. Results Over 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the Plant-based pattern was associated with lower stroke risk (HR=0.71; 95% CI=0.56–0.91; ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (HR=1.39; 95% CI=1.05, 1.84), with a significant (p = 0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. Conclusions These data suggest that adherence to a Southern style diet may increase the risk of stroke while adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary impact on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke. PMID:24159061

Open Heart Surgery Does Not Increase the Incidence of Ipsilateral Ischemic Stroke in Patients with Asymptomatic Severe Carotid Stenosis.

Science.gov (United States)

Castaldo, John E; Yacoub, Hussam A; Li, Yuebing; Kincaid, Hope; Jenny, Donna

2017-10-01

We evaluated the incidence of perioperative stroke following the institution's 2007 practice change of discontinuing combined carotid endarterectomy and open heart surgery (OHS) for patients with severe carotid stenosis. In this retrospective cohort study, we compared 113 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both from 2007 to 2011 with data collected from 2001 to 2006 from a similar group of patients. Our aim was to assess whether the practice change led to a greater incidence of stroke. A total of 7350 consecutive patients undergoing OHS during the specified time period were screened. Of these, 3030 had OHS between 2007 and 2011 but none were combined with carotid artery surgery (new cohort). The remaining 4320 had OHS before 2007 and 44 had combined procedures (old cohort). Of patients undergoing OHS during the 10-year period of observation, 230 had severe (>80%) carotid stenosis. In the old cohort (before 2007), carotid stenosis was associated with perioperative stroke in 2.5% of cases. None of the 113 patients having cardiac procedures after 2007 received combined carotid artery surgery; only 1 of these patients harboring severe carotid stenosis had an ischemic stroke (.9%) during the perioperative period. The difference in stroke incidence between the 2 cohorts was statistically significant (P = .002). The incidence of stroke in patients with severe carotid artery stenosis undergoing OHS was lower after combined surgery was discontinued. Combined carotid and OHS itself seems to be an important risk factor for stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Rehabilitation outcome in hemorrhagic transformation of ischemic stroke: a case presentation

Directory of Open Access Journals (Sweden)

Ioana Stanescu

2018-06-01

Full Text Available Hemorrhagic transformation (HT may occur as a part of the natural history of acute ischemic stroke, with incidence between 13-43% in computer-tomography (CT studies. Detection of HT in a patient with ischemic stroke is important in establishing treatment in the acute phase in assessing prognosis and in taking therapeutical decisions for secondary stroke prevention. There were controversies regarding optimal treatment in acute ischemic stroke with HT, especially if the patient needs further anticoagulant or antiplatelet treatment. Rehabilitation treatment needs to be continued for post-stroke patients who developed HT, because HT does not decrease rehabilitation outcome. We present rehabilitation treatment and prognosis in a case of hemorrhagic transformation after an embolic ischemic stroke treated with anticoagulants, which required reinitiation of anticoagulant treatment.

Poststroke epilepsy in the Copenhagen stroke study: incidence and predictors

DEFF Research Database (Denmark)

Kammersgaard, Lars Peter; Olsen, Tom Skyhøj

2005-01-01

Poststroke epilepsy (PSE) is a feared complication after stroke and is reported in 3% to 5% of stroke survivors. In this study we sought to identify incidence and predictors of PSE in an unselected stroke population with a follow-up period of 7 years. The study was community-based and comprises...... a cohort of 1197 consecutively and prospectively admitted patients with stroke. Patients were followed up for 7 years. We defined PSE as recurrent epileptic seizures with onset after stroke and requiring antiepileptic prophylaxis. PSE was related to clinical factors (age, sex, onset stroke severity, lesion...... size on computed tomography scans, stroke subtype, localization, stroke risk factor profile, and early seizures) in univariate analyses. Independent predictors of PSE were identified through multiple logistic regression analyses. Overall, 38 patients (3.2%) developed PSE. Univariately, PSE...

Stroke Incidence by Major Pathological Type and Ischemic Subtypes in the Auckland Regional Community Stroke Studies: Changes Between 2002 and 2011.

Science.gov (United States)

Krishnamurthi, Rita V; Barker-Collo, Suzanne; Parag, Varsha; Parmar, Priyakumari; Witt, Emma; Jones, Amy; Mahon, Susan; Anderson, Craig S; Barber, P Alan; Feigin, Valery L

2018-01-01

Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calculated for differences in age-standardized rates between the 2 studies. In ARCOS-IV, there were 1329 (81%) ISs, 211 (13%) ICHs, 79 (5%) subarachnoid hemorrhages, and 24 (1%) undetermined type strokes. The proportional distribution of IS subtypes was 29% cardioembolism, 21% small-vessel occlusion, 15% large-artery atherosclerosis, 5% other determined etiology, and 31% undetermined type. Between 2002 and 2011, age-standardized incidence decreased for subarachnoid hemorrhage (rate ratios, 0.73; 95% confidence intervals, 0.54-0.99) and undetermined type (rate ratios, 0.14; 95% confidence intervals, 0.09-0.22). Rates were stable for IS and ICH. Among IS subtypes, large-artery atherosclerosis and small-vessel occlusion rates increased significantly. The frequency of all risk factors increased in IS. Ethnic differences were observed for both stroke subtype rates and their risk factor frequencies. A lack of change in IS and ICH incidence may reflect a trend toward increased incidence of younger

Incidence of stroke in women in Auckland, New Zealand. Ethnic trends over two decades: 1981-2003.

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Dyall, Lorna; Carter, Kristie; Bonita, Ruth; Anderson, Craig; Feigin, Valery; Kerse, Ngaire; Brown, Paul

2006-11-17

Although women have a greater lifetime risk of stroke than men, along with other gender differences in stroke, there is lack of reliable data on long-term trends in stroke in women. This paper presents the results of three population-based registers in Auckland (1981-1982, 1991-1992, and 2002-2003) which aimed to determine the trends in the incidence of stroke in New Zealand. This paper reports on the burden of stroke in women across different ethnic groups over the study period from 1981 to 2003. Three studies using similar methodology and overlapping case finding methods have been conducted in New Zealand to estimate trends in the incidence and outcome of stroke. The studies are recognised as meeting the 'ideal' criteria for stroke incidence and identify all first-ever and recurrent strokes in residents (aged greater than and equal to 15 years) the population of Auckland, New Zealand in the 12-month periods from 1981-1982, 1991-1992, and 2002-2003. There were totals of 307,578 strokes among women in 1981, 372,642 in 1991, and 470,727 in 2001, according to each Census representing over 50% of the population at each period (51%-54%). The WHO standard world population was used for direct age standardisation of annual rates (per 100,000 population), reported with 95% confidence intervals (CI). The proportion of women who have experienced a stroke did not change markedly over the study period but there were ethnic differences emerging which were related to population changes within the New Zealand population. Standardised stroke incidence in women was relatively stable across the three study periods (1981-1982), 133 [95% CI 118-151]; (1991-1992), 143 [95% CI 116-241]; and (2002-2003), 124 [95% CI 115-134]). However, a significant decline of 14% (95% CI 2%-29%) in rates of first-ever stroke was found between 1991-1992 and 2002-2003 in women. In contrast to the significant declines in event rates in European women over two decades (Rate ratio 0.84, 95% CI 0

Acupuncture Therapy and Incidence of Depression After Stroke.

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Lu, Chung-Yen; Huang, Hsin-Chia; Chang, Hen-Hong; Yang, Tsung-Hsien; Chang, Chee-Jen; Chang, Su-Wei; Chen, Pei-Chun

2017-06-01

We investigated whether use of acupuncture within a 3-month poststroke period after hospital discharge is associated with reduced risk of depression. This cohort study included 16 046 patients aged ≥18 years with an initial hospitalization for stroke during 2000 and 2012 in the claims database of a universal health insurance program. Patients who had received acupuncture therapies within 3 months of discharge were defined as acupuncture users (n=1714). All patients were followed up for incidence of depression until the end of 2013. We assessed the association between use of acupuncture and incidence of depression using Cox proportional hazards models in all subjects and in propensity score-matched samples consisting of 1714 pairs of users and nonusers. During the follow-up period, the incidence of depression per 1000 person-years was 11.1 and 9.7 in users and nonusers, respectively. Neither multivariable-adjusted Cox models (hazard ratio, 1.04; 95% confidence interval, 0.84-1.29) nor the propensity score-matching model (hazard ratio, 1.06; 95% confidence interval, 0.79-1.42) revealed an association between use of acupuncture and incidence of depression. In patients admitted to hospital for stroke, acupuncture therapy within 3 months after discharge was not associated with subsequent incidence of depression. © 2017 American Heart Association, Inc.

Death caused by heat stroke: Case report

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Savić Slobodan

2014-01-01

Full Text Available Introduction. Heat stroke is the most dangerous among numerous disorders caused by elevated environmental temperature. It is characterized by an increased body temperature of over 40°C, the dysfunction of the central nervous system and the development of multiple organ failure. The aim of this paper was to highlight problems in the clinical and post-mortal diagnosis of fatal heat stroke. Case Outline. A 20-year-old male was found unconscious on the street; on admission at the Emergency Center, Clinical Center of Serbia, Belgrade, he was in a coma. The body temperature of 40°C was maintained despite the applied therapy, meningeal signs were negative, tachycardia with gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of skin bruises. Laboratory findings: highly elevated LDH and creatine kinase, elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6 hours after admission, and the case remained clinically unsolved. Autopsy showed signs of hemorrhagic diathesis, brain and pulmonary edema, and microscopic examination revealed general congestion, internal bleeding in various organs, cerebral edema, massive blood aspiration and pulmonary edema. Toxicological and bacteriological examinations were negative. Based on these findings and subsequently obtained data on the conditions at the workplace where the young man had a part-time job, it was concluded that the violent death was caused by heat stroke. Conclusion. Since heat stroke is associated with a high mortality rate and high incidence of serious and permanent organ damage in survivors, it is important to make the diagnosis of heat stroke as quickly as possible and apply appropriate treatment. Misdiagnosis of heat stroke, and consequently inadequate treatment, with a potential fatal outcome for the patient, can be the reason for blaming doctors for the legal offense of medical malpractice in failing to administer first aid.

Changes in the Employment Status and Risk of Stroke and Stroke Types.

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Eshak, Ehab S; Honjo, Kaori; Iso, Hiroyasu; Ikeda, Ai; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro

2017-05-01

Because of limited evidence, we investigated a long-term impact of changes in employment status on risk of stroke. This was a prospective study of 21 902 Japanese men and 19 826 women aged 40 to 59 years from 9 public health centers across Japan. Participants were followed up from 1990 to 1993 to the end of 2009 to 2014. Cox proportional hazard ratio of stroke (incidence and mortality) and its types (hemorrhagic and ischemic) was calculated according to changes in the employment status within 5 years interval between 1990 to 1993 and 1995 to 1998 (continuously employed, job loss, reemployed, and continuously unemployed). During the follow-up period, 973 incident cases and 275 deaths from stroke in men and 460 cases and 131 deaths in women were documented. Experiencing 1 spell of unemployment was associated with higher risks of morbidity and mortality from total, hemorrhagic, and ischemic stroke in both men and women, even after propensity score matching. Compared with continuously employed subjects, the multivariable hazard ratio (95% confidence interval) for total stroke incidence in job lost men was 1.58 (1.18-2.13) and in job lost women was 1.51 (1.08-2.29), and those for total stroke mortality were 2.22 (1.34-3.68) in men and 2.48 (1.26-4.77) in women. The respective hazard ratio (95% confidence interval) in reemployed men was 2.96 (1.89-4.62) for total stroke incidence and 4.21 (1.97-8.97) for mortality, whereas those in reemployed women were 1.30 (0.98-1.69) for incidence and 1.28 (0.76-2.17) for mortality. Job lost men and women and reemployed men had increased risks for both hemorrhagic and ischemic stroke incidence and mortality. © 2017 American Heart Association, Inc.

Strokes Associated With Pregnancy and Puerperium: A Nationwide Study by the Japan Stroke Society.

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Yoshida, Kazumichi; Takahashi, Jun C; Takenobu, Yohei; Suzuki, Norihiro; Ogawa, Akira; Miyamoto, Susumu

2017-02-01

The incidence and cause of strokes associated with pregnancy and the puerperium are still not fully understood. The aim of this study was to characterize pregnancy-related strokes in Japan using a large-scale survey with current imaging techniques. A retrospective analysis was conducted based on clinical chart reviews in 736 stroke teaching hospitals certified by the Japan Stroke Society between 2012 and 2013, using a web-based questionnaire requesting the detailed clinical course without any personally identifying information. The collection rate of this questionnaire was 70.5%, with 151 pregnancy-associated strokes extracted. Hemorrhagic strokes were observed in 111 cases (73.5%), ischemic strokes in 37 (24.5%), and mixed type in 3 cases (2.0%). The estimated incidence of pregnancy-associated stroke was 10.2 per 100 000 deliveries. Major causes of hemorrhage were aneurysm (19.8%), arteriovenous malformation (17.1%), pregnancy-induced hypertension (11.7%), and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) (8.1%). Preexisting cerebrovascular diseases responsible for hemorrhage were detected in 59 cases (53.1%). Among the ischemic strokes, 28 (75.7%) were arterial and 9 (24.3%) were venous infarctions. The most frequent cause of arterial infarctions was reversible cerebral vasoconstriction syndrome. Hemorrhagic stroke showed much poorer prognosis than ischemic stroke. The incidence of pregnancy-associated stroke in Japan did not seem higher than that in other Asian and Western countries. The proportion of hemorrhagic stroke among Japanese women was much higher than that in white women. Preexisting cerebrovascular diseases and reversible cerebral vasoconstriction syndrome play a key role in hemorrhagic and ischemic stroke, respectively. © 2016 American Heart Association, Inc.

Functional Stroke Mimics: Incidence and Characteristics at a Primary Stroke Center in the Middle East

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Wilkins, Stacy Schantz; Bourke, Paula; Salam, Abdul; Akhtar, Naveed; D'Souza, Atlantic; Kamran, Saadat; Bhutta, Zain; Shuaib, Ashfaq

2018-01-01

ABSTRACT Objective Approximately 30% of individuals who initially present with stroke are found to be stroke mimics (SM), with functional/psychological SM (FSM) accounting for up to 6.4% of all stroke presentations. Middle Eastern countries may have higher rates of somatization of emotional distress. The aim of this study was to evaluate the incidence and characteristics of FSM at a large general hospital in the Middle East. Methods All patients presenting with an initial diagnosis of stroke from June 2015 to September 2016 were eligible for this study. Clinical and sociodemographic data were obtained from the hospital's stroke database. All SM and strokes were diagnosed by Joint Commission International–certified stroke program neurologists. SM was defined as any discharge diagnosis (other than acute stroke) for symptoms that prompted initial admission for suspected stroke. FSM were compared with medical stroke mimics (MSM) and strokes (ischemic, hemorrhagic, and transient ischemic attacks). Results A total of 1961 patients were identified; 161 FSM (8.2%), 390 MSM (19.9%), and 1410 strokes (71.9%) (985 ischemic strokes, 196 transient ischemic attacks, 229 intracerebral hemorrhages). Admission with FSM was related to patients' nationality, with the highest frequency in Arabic (15.6%) and African (16.8%) patients. FSM patients were younger, more often female, and had fewer cardiovascular risk factors except for smoking compared with the strokes. FSM patients presented with more left-sided weakness and had more magnetic resonance imagings than the stroke and MSM groups. A total of 9.9% of FSM patients received thrombolysis versus only 0.5% of the MSM and 16.4% of ischemic strokes. Conclusions FSM frequencies varied by nationality, with Arab and African nationals being twice as prevalent. Stress, vulnerable status as expats, sociopolitical instability, and exposure to trauma are proposed as potential factors contributing to FSM. PMID:29394187

Incidence and predictors of new-onset constipation during acute hospitalisation after stroke.

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Lim, S-F; Ong, S Y; Tan, Y L; Ng, Y S; Chan, Y H; Childs, C

2015-04-01

We investigated new-onset constipation in patients with stroke compared with orthopaedic conditions and explored the predictors associated with constipation during acute hospitalisation. This was a prospective matched cohort study of 110 patients comparing stroke patients (n = 55) with orthopaedic patients (n = 55) admitted to a large tertiary acute hospital. Both cohorts were matched by age and sex. The incidence of new-onset constipation which occurred during a patient's acute hospitalisation was determined. Demographics, comorbidity, clinical factors, laboratory parameters and medications were evaluated as possible predictors of constipation. The incidence of new-onset constipation was high for both stroke (33%) and orthopaedic patients (27%; p = 0.66). Seven stroke patients (39%) and four orthopaedic patients (27%) developed their first onset of constipation on day 2 of admission. Mobility gains (RR 0.741, p constipation. Bedpan use (RR 2.058, p constipation. New-onset constipation is common among patients admitted for stroke and orthopaedic conditions during acute hospitalisation. The early occurrence, on day 2 of admission, calls for prompt preventive intervention for constipation. © 2015 John Wiley & Sons Ltd.

Small brain lesions and incident stroke and mortality: A cohort study

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Windham, B Gwen; Deere, Bradley; Griswold, Michael E.; Wang, Wanmei; Bezerra, Daniel C; Shibata, Dean; Butler, Kenneth; Knopman, David; Gottesman, Rebecca F; Heiss, Gerardo; Mosley, Thomas H

2015-01-01

Background Although cerebral lesions ≥3mm on imaging are associated with incident stroke, lesions stroke risks associated with subclinical brain lesions by size (stroke; average 14.5 years follow-up. Measurements MRI lesions: none (n=1611), stroke (n=157), overall mortality (n=576), stroke mortality (n=50). Hazard Ratios (HR) estimated with proportional hazards models. Results Compared to no lesions, stroke risk was tripled with lesions Stroke risk doubled with WMH ≥3 (HR=2.14, 95% CI:1.45-3.16). Stroke mortality risk tripled with lesions stroke events (n=147), especially hemorrhagic (n=15); limited numbers of participants with only lesions ≤3mm (n=50) or with both lesions ≤3mm and 3–20mm (n=35). Conclusions Very small cerebrovascular lesions may be associated with increased risks of stroke and mortality; having both < 3 mm and ≥3 mm lesions may represent a particularly striking risk increase. Larger studies are needed to confirm findings and provide more precise estimates. PMID:26148278

Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

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Sattler, Margriet G.A., E-mail: g.a.sattler@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Vroomen, Patrick C. [Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Sluiter, Wim J. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Schers, Henk J. [Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (Netherlands); Berg, Gerrit van den [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Wolffenbuttel, Bruce H.R. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Bergh, Alphons C.M. van den [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Beek, André P. van [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

2013-09-01

Purpose: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. Methods and Materials: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log–rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population. Results: Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariate RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049). Conclusions: In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk

Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

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Sattler, Margriet G.A.; Vroomen, Patrick C.; Sluiter, Wim J.; Schers, Henk J.; Berg, Gerrit van den; Langendijk, Johannes A.; Wolffenbuttel, Bruce H.R.; Bergh, Alphons C.M. van den; Beek, André P. van

2013-01-01

Purpose: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. Methods and Materials: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log–rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population. Results: Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariate RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049). Conclusions: In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk

Stroke in Commercial Flights.

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Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli

2016-04-01

Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

Report of a Pediatric Case of Hemorrhagic Stroke

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N Tabkhi

2009-01-01

Full Text Available Stroke, though rare in children is among the top 10 causes of death in childhood. Incidence of ischemic and hemorrhagic stroke is the same in children .We report a case of hemorrhagic stroke in a two year old girl who presented with a limp, inability to stand on the left leg and left hemiparesia. Her complaint began 10 days ago after a bout of left clonic seizure. She had been admitted to the hospital for a week due to delayed hemorrhage of the umbilical stump at the age of 18 days. Brain CT scan showed a round, hyper dense area with mass effect in the right supraparietal region. Craniotomy revealed a hemorrhage and report of pathology was hematoma. Considering the delayed umbilical cord bleeding and normality of usual tests for hemostasis and partial deficiency of factor XIII in both parents, the problem was diagnosed as homozygote severe deficiency of factor XIII.

Increase of Stroke Incidence in Young Adults in a Middle-Income Country: A 10-Year Population-Based Study.

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Cabral, Norberto Luiz; Freire, Aracélli Tavares; Conforto, Adriana Bastos; Dos Santos, Nayara; Reis, Felipe Ibiapina; Nagel, Vivian; Guesser, Vanessa V; Safanelli, Juliana; Longo, Alexandre L

2017-11-01

The incidence of stroke is on the rise in young adults in high-income countries. However, there is a gap of knowledge about trends in stroke incidence in young adults from low- and middle-income countries. We aimed to measure trends in incidence of ischemic stroke (IS) and intracerebral hemorrhage (IH) in young people from 2005 to 2015 in Joinville, Brazil. We retrospectively ascertained all first-ever IS subtypes and IH that occurred in Joinville in the periods of 2005 to 2006, 2010 to 2011, and 2014 to 2015. Poisson regression was used to calculate incidence rate ratios of all strokes, IS, and IH. We also compared the prevalence of risk factors and extension of diagnostic work-up across the 3 periods. For 10 years, we registered 2483 patients (7.5% aged incidence significantly increased by 62% (incidence rate ratios, 1.62; 95% confidence interval, 1.10-2.40) in subjects incidence rate ratios, 1.29; 95% confidence interval, 1.04-1.60). Incidence of IS increased by 66% (incidence rate ratios, 1.66; 95% confidence interval, 1.09-2.54), but there was no significant change in incidence of IH in subjects incidence is rising in young adults in Joinville, Brazil, because of increase in rates of ischemic but not hemorrhagic strokes. We urgently need better policies of cardiovascular prevention in the young. © 2017 American Heart Association, Inc.

Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England

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Benjamin D Bray, MD

2018-04-01

Full Text Available Summary: Background: We aimed to estimate socioeconomic disparities in the incidence of hospitalisation for first-ever stroke, quality of care, and post-stroke survival for the adult population of England. Methods: In this cohort study, we obtained data collected by a nationwide register on patients aged 18 years or older hospitalised for first-ever acute ischaemic stroke or primary intracerebral haemorrhage in England from July 1, 2013, to March 31, 2016. We classified socioeconomic status at the level of Lower Super Output Areas using the Index of Multiple Deprivation, a neighbourhood measure of deprivation. Multivariable models were fitted to estimate the incidence of hospitalisation for first stroke (negative binomial, quality of care using 12 quality metrics (multilevel logistic, and all-cause 1 year case fatality (Cox proportional hazards. Findings: Of the 43·8 million adults in England, 145 324 were admitted to hospital with their first-ever stroke: 126 640 (87% with ischaemic stroke, 17 233 (12% with intracerebral haemorrhage, and 1451 (1% with undetermined stroke type. We observed a socioeconomic gradient in the incidence of hospitalisation for ischaemic stroke (adjusted incidence rate ratio 2·0, 95% CI 1·7–2·3 for the most vs least deprived deciles and intracerebral haemorrhage (1·6, 1·3–1·9. Patients from the lowest socioeconomic groups had first stroke a median of 7 years earlier than those from the highest (p<0·0001, and had a higher prevalence of pre-stroke disability and diabetes. Patients from lower socioeconomic groups were less likely to receive five of 12 care processes but were more likely to receive early supported discharge (adjusted odds ratio 1·14, 95% CI 1·07–1·22. Low socioeconomic status was associated with a 26% higher adjusted risk of 1-year mortality (adjusted hazard ratio 1·26, 95% CI 1·20–1·33, for highest vs lowest deprivation decile, but this gradient was largely attenuated after

Fish Consumption and Ischemic stroke in Southern Sweden

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Wennberg Maria

2011-10-01

Full Text Available Abstract Background The relationship between fish intake and stroke incidence has been inconsistent in previous Swedish studies. Here, we report the risk of stroke and fish intake in a cohort from southern Sweden. Findings Data were obtained from an already available population based case-control study where the cases were defined as incident first-time ischemic stroke patients. Complete data on all relevant variables were obtained for 2722 controls and 2469 cases. The data were analyzed with logistic regression analysis. Stroke risk decreased with fat fish intake ([greater than or equal to] 1/week versus Conclusions The results suggest fat fish intake to decrease ischemic stroke risk and lean fish intake to increase women's stroke risk. The inconsistent relationship between fish intake and stroke risk reported in previous studies is further stressed by the results of this study.

Cerebral Microbleeds and the Risk of Incident Ischemic Stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy).

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Puy, Laurent; De Guio, François; Godin, Ophélia; Duering, Marco; Dichgans, Martin; Chabriat, Hugues; Jouvent, Eric

2017-10-01

Cerebral microbleeds are associated with an increased risk of intracerebral hemorrhage. Recent data suggest that microbleeds may also predict the risk of incident ischemic stroke. However, these results were observed in elderly individuals undertaking various medications and for whom causes of microbleeds and ischemic stroke may differ. We aimed to test the relationship between the presence of microbleeds and incident stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy)-a severe monogenic small vessel disease known to be responsible for both highly prevalent microbleeds and a high incidence of ischemic stroke in young patients. We assessed microbleeds on baseline MRI in all 378 patients from the Paris-Munich cohort study. Incident ischemic strokes were recorded during 54 months. Survival analyses were used to test the relationship between microbleeds and incident ischemic stroke. Three hundred sixty-nine patients (mean age, 51.4±11.4 years) were followed-up during a median time of 39 months (interquartile range, 19 months). The risk of incident ischemic stroke was higher in patients with microbleeds than in patients without (35.8% versus 19.6%, hazard ratio, 1.87; 95% confidence interval, 1.16-3.01; P =0.009). These results persisted after adjustment for history of ischemic stroke, age, sex, vascular risk factors, and antiplatelet agents use (hazard ratio, 1.89; 95% confidence interval, 1.10-3.26; P =0.02). The presence of microbleeds is an independent risk marker of incident ischemic stroke in CADASIL, emphasizing the need to carefully interpret MRI data. © 2017 American Heart Association, Inc.

Air Pollution and Ischemic Stroke Among Young Adults.

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Yitshak Sade, Maayan; Novack, Victor; Ifergane, Gal; Horev, Anat; Kloog, Itai

2015-12-01

Studies have demonstrated consistent associations between cardiovascular illness and particulate matter (PM) stroke received less attention. We hypothesized that air pollution, an inflammation progenitor, can be associated with stroke incidence in young patients in whom the usual risk factors for stroke are less prevalent. We aimed to evaluate the association between stroke incidence and exposure to PM stroke between 2005 and 2012. Exposure assessment was based on a hybrid model incorporating daily satellite remote sensing data at 1-km spatial resolution. We performed case-crossover analysis, stratified by personal characteristics and distance from main roads. We identified 4837 stroke cases (89.4% ischemic stroke). Interquartile range of PM ischemic stroke and increases of interquartile range average concentrations of particulate matter ischemic stroke associated with PM among young adults. This finding can be explained by the inflammatory mechanism, linking air pollution and stroke. © 2015 American Heart Association, Inc.

Incidence of upper limb oedema in patients with acute hemiparetic stroke.

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Gebruers, Nick; Truijen, Steven; Engelborghs, Sebastiaan; De Deyn, Peter Paul

2011-01-01

 Assessment of the incidence of upper limb oedema in an acute care setting by means of clinical and volumetric evaluation.  Patients with acute hemiparetic stroke were recruited from 2006 until 2009 (n = 125). Baseline measurements consisted of the National Institute of Health Stroke Scale, Fugl-Meyer Assessment Arm Section and demographic characteristics. Oedema assessment was performed at 7 days after inclusion and at 1 month and 3 months follow-up. A standardised water displacement method (objective measurement) was used to define oedema and was compared to data from visual inspection and palpation (subjective measurement).  In literature, the incidence of upper limb oedema ranges from 16-83%, defined by a variety of definitions. Oedema incidence in this study was defined by strict criteria using water displacement and ranged from 9-13.9%, while the incidence of oedema defined by visual inspection and palpation ranged from 6-18.5% during the different stages of follow-up. The agreement (Kappa) between both measurements ranged from 0.23-0.38, which is not more than 'moderate' but comparable to the agreement of 0.34 found in literature.  An objective and subjective assessment of oedema was used; the agreement between both methods was only moderate. The incidence of oedema found in this study is lower than the incidences found in literature.

Associations between serum uric acid levels and the incidence of nonfatal stroke: a nationwide community-based cohort study.

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Kamei, Keita; Konta, Tsuneo; Hirayama, Atsushi; Ichikawa, Kazunobu; Kubota, Isao; Fujimoto, Shouichi; Iseki, Kunitoshi; Moriyama, Toshiki; Yamagata, Kunihiro; Tsuruya, Kazuhiko; Narita, Ichiei; Kondo, Masahide; Shibagaki, Yugo; Kasahara, Masato; Asahi, Koichi; Watanabe, Tsuyoshi

2017-06-01

Hyperuricemia is an established risk factor for cardiovascular events and mortality. This study investigated the association between serum uric acid and the incidence of nonfatal stroke in a Japanese community-based population. We used a nationwide database of 155,322 subjects (aged 40-73, male 39 %) who participated in the annual "Specific Health Check and Guidance in Japan" checkup from 2008 to 2010. We examined the relationship between the quintiles of serum uric acid levels at baseline and the incidence of nonfatal stroke during a 2-year study period using self-reported data. The crude incidence of nonfatal stroke was significantly associated with serum uric acid levels at baseline, showing the lowest values in subjects with the 3rd quintile (Q3: men, 5.0-5.6; women, 3.8-4.3) of uric acid levels (mg/dL) and the highest values in subjects with the highest quintile (Q5: men ≥7.1, women ≥5.5) both in men and women (P uric acid levels for incident stroke was high, irrespective of characteristics such as age, sex, and renal function. This study has shown that serum uric acid is independently associated with the incidence of nonfatal stroke in the general Japanese population.

Brain strokes related to aortic aneurysma – the analysis of three cases

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Pastuszak Żanna

2017-04-01

Full Text Available Brain stroke connected with aortic blood flow disturbances is a rare disease and its incidence is difficult to assume. Nevertheless, 10-50% of patients with aortic dissection may not experience any pain. In case of 18-30% patients with aortic dissection neurological signs are first disease presentation and among them ischemic stroke is the most common. The most popular aortic dissection classification is with use of Stanford system. Type A involves the ascending aorta and type B is occurring distal to the subclavian artery. Aortic dissection risk factors include hypertension, cystic medionecrosis, bicuspid aortic valve and Marfan’s or Ehlers-Danlos syndrome.

Incidence of stroke and coronary heart disease in the adult health study sample, 1958 - 78

International Nuclear Information System (INIS)

Kodama, Kazunori; Shimizu, Yukiko; Sawada, Hisao; Kato, Hiroo.

1986-04-01

Approximately 16,000 study subjects in the Adult Health Study sample who had received examination at least once during the 20 years (1958 - 78) in Hiroshima or Nagasaki and were found to have neither stroke nor coronary heart disease (CHD) at the initial examination were studied for the incidence of stroke and CHD and the relationship of these to atomic bomb radiation exposure. Their secular trends were also studied. Findings suggestive of a relationship between stroke and radiation exposure among Hiroshima females were first discovered for the years 1969 - 73, that is, 24 - 28 years after A-bomb exposure. In general, this association is supported by the present analysis. Stroke incidence continued to decrease during the present report's period of observation. Analysis by type showed that cerebral infarction and cerebral hemorrhage both decreased, but the decrease of the latter is especially remarkable. The trend to decrease is observed in both sexes and in both cities. A relationship between CHD and radiation exposure was, as noted for stroke, first observed only in Hiroshima females for the years 1969 - 73, but from this analysis it appears that the trend began earlier and the association is getting stronger with the passage of time. Analysis by type showed myocardial infarction (MI), but not angina pectoris, to be related to radiation exposure. The incidence rate for CHD, especially for MI, was almost constant during the observation period, it being 1.2/1,000 person-years on the average. Comparing by sex, the incidence rate was constant in males. In females, the pattern varied with time. There appear to be no between-city differences in secular trends - essentially constant. (author)

Long-term incidence of depression and predictors of depressive symptoms in older stroke survivors.

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Allan, Louise M; Rowan, Elise N; Thomas, Alan J; Polvikoski, Tuomo M; O'Brien, John T; Kalaria, Raj N

2013-12-01

Depression is common and an important consequence of stroke but there is limited information on the longer-term relationship between these conditions. To identify the prevalence, incidence and predictors of depression in a secondary-care-based cohort of stroke survivors aged over 75 years, from 3 months to up to 10 years post-stroke. Depression was assessed annually by three methods: major depression by DSM-IV criteria, the self-rated Geriatric Depression Scale (GDS) and the observer-rated Cornell scale. We found the highest rates, 31.7% baseline prevalence, of depressive symptoms with the GDS compared with 9.7% using the Cornell scale and 1.2% using DSM-IV criteria. Incidence rates were 36.9, 5.90 and 4.18 episodes per 100 person years respectively. Baseline GDS score was the most consistent predictor of depressive symptoms at all time points in both univariate and multivariate analyses. Other predictors included cognitive impairment, impaired activities of daily living and in the early period, vascular risk factor burden and dementia. Our results emphasise the importance of psychiatric follow-up for those with early-onset post-stroke depression and long-term monitoring of mood in people who have had a stroke and remain at high risk of depression.

Red cell distribution width in relation to incidence of stroke and carotid atherosclerosis: a population-based cohort study.

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Martin Söderholm

Full Text Available Increased red cell distribution width (RDW has been related to poor prognosis in patients with cardiovascular disease, and is a predictor of cardiovascular mortality in the general population. The purpose of the present study was to investigate if RDW is associated with increased incidence of stroke and its subtypes in individuals from the general population.Red cell distribution width was measured in 26,879 participants (16,561 women and 10,318 men aged 45-73 years without history of coronary events or stroke, from the population-based Malmö Diet and Cancer Study. Incidences of total stroke and stroke subtypes over a mean follow-up of 15.2 years were calculated in relation to sex-specific quartiles of RDW. The presence of carotid plaque and intima-media thickness, as assessed by ultrasound, was studied in relation to RDW in a randomly selected subcohort (n = 5,309.Incidences of total stroke (n = 1,869 and cerebral infarction (n = 1,544 were both increased in individuals with high RDW. Hazard ratios (HRs in the highest compared to the lowest quartile were 1.31 for total stroke (95% confidence interval [CI]: 1.11-1.54, p for trend = 0.004 and 1.32 for cerebral infarction (95% CI: 1.10-1.58, p for trend = 0.004 after adjustment for stroke risk factors and hematological parameters. The adjusted HR for intracerebral hemorrhage (n = 230 was 1.44 (95% CI: 0.90-2.30 and the HR for subarachnoid hemorrhage (n = 75 was 0.94 (95% CI: 0.43-2.07, in the highest compared to the lowest quartile of RDW. Red cell distribution width was positively associated with intima-media thickness of the common carotid artery (p for trend = 0.011.Red cell distribution width in the highest quartile was associated with increased incidence of total stroke and cerebral infarction. There was no significant association between RDW and incidence of intracerebral or subarachnoid hemorrhage.

Sudden unexpected death caused by stroke

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Ågesen, Frederik Nybye; Risgaard, Bjarke; Zachariasardóttir, Sára

2017-01-01

Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered....... There was a male predominance (56%) and the median age was 33 years. The incidence of sudden death by stroke in individuals aged 1-49 years was 0.19 deaths per 100,000 person-years. Stroke was hemorrhagic in 94% of cases, whereof subarachnoid hemorrhage was the cause of death in 63% of cases. Seventeen (33%) cases...... contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke...

Complications following incident stroke resulting in readmissions: an analysis of data from three Scottish health surveys.

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Ponomarev, Dmitry; Miller, Claire; Govan, Lindsay; Haig, Caroline; Wu, Olivia; Langhorne, Peter

2015-08-01

Stroke is widely recognized as the major contributor to morbidity and mortality in the United Kingdom. We analyzed the data obtained from the three consecutive Scottish Health Surveys and the Scottish Morbidity records, with the aim of identifying risk factors for, and timing of, common poststroke complications. There were 19434 individuals sampled during three Scottish Health Surveys in 1995, 1998, and 2001. For these individuals their morbidity and mortality outcomes were obtained in 2007. Incident stroke prevalence, risk factors for a range of poststroke complications, and average times until such complications in the sample were established. Of the total of 168 incident stroke admissions (0·86% of the survey), 16·1% people died during incident stroke hospitalization. Of the remaining 141 stroke survivors, 75·2% were rehospitalized at least once. The most frequent reason for readmission after stroke was a cardiovascular complication (28·6%), median time until event 1412 days, followed by infection (17·3%, median 1591 days). The risk of cardiovascular readmission was higher in those with 'poor' self-assessed health (odds ratio 7·70; 95% confidence interval 1·64-43·27), smokers (odds ratio 4·24; 95% confidence interval 1·11-21·59), and doubled with every five years increase in age (odds ratio 1·97; 95% confidence interval 1·46-2·65). 'Poor' self-assessed health increased chance of readmission for infection (odds ratio 14·11; 95% confidence interval 2·27-276·56). Cardiovascular events and infections are the most frequent poststroke complications resulting in readmissions. The time period until event provides a possibility to focus monitoring on those people at risk of readmission and introduce preventative measures, thereby reducing readmission-associated costs. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Risk of Stroke after Herpes Zoster - Evidence from a German Self-Controlled Case-Series Study.

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Schink, Tania; Behr, Sigrid; Thöne, Kathrin; Bricout, Hélène; Garbe, Edeltraut

2016-01-01

Herpes zoster (HZ) is caused by reactivation of the latent varicella-zoster virus (VZV). A severe complication of HZ is VZV vasculopathy which can result in ischemic or hemorrhagic stroke. The aims of our study were to assess the risk of stroke after the onset of HZ and to investigate the roles of stroke subtype, HZ location and the time interval between HZ onset and stroke. A self-controlled case-series study was performed on a cohort of patients with incident stroke recorded in the German Pharmacoepidemiological Research Database (GePaRD), which covers about 20 million persons throughout Germany. We estimated adjusted incidence rate ratios (IRR) by comparing the rate of stroke in risk periods (i.e., periods following HZ) with the rate of stroke in control periods (i.e., periods without HZ) in the same individuals, controlling for both time-invariant and major potentially time-variant confounders. The cohort included 124,462 stroke patients, of whom 6,035 (5%) had at least one HZ diagnosis identified in GePaRD either as main hospital discharge diagnosis or as HZ treated with antivirals. The risk of stroke was about 1.3 times higher in the risk periods 3 months after HZ onset, than in the control periods (IRR: 1.29; 95% confidence interval: 1.16-1.44). An elevated risk of similar magnitude was observed for ischemic and unspecified stroke, but a 1.5-fold higher risk was observed for hemorrhagic stroke. A slightly stronger effect on the risk of stroke was also observed during the 3 months after HZ ophthalmicus (HZO) onset (1.59; 1.10-2.32). The risk was highest 3 and 4 weeks after HZ onset and decreased thereafter. Our study corroborates an increased risk of stroke after HZ, which is highest 3 to 4 weeks after HZ onset. The results suggest that the risk is more pronounced after HZO and is numerically higher for hemorrhagic than for ischemic stroke.

 Ischemic Stroke Secondary to Aortic Dissection Following Rifle Butt Recoil Chest Injury: A Case Report

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John Valiath

2011-11-01

Full Text Available  Ischemic stroke secondary to aortic dissection is not uncommon. We present a patient with left hemiplegia secondary to Stanford type A aortic dissection extending to the supra-aortic vessels, which was precipitated by rifle butt recoil chest injury. The diagnosis of aortic dissection was delayed due to various factors. Finally, the patient underwent successful Bentall procedure with complete resolution of symptoms. This case emphasizes the need for caution in the use of firearms for recreation and to take precautions in preventing such incidents. In addition, this case illustrates the need for prompt cardiovascular physical examination in patients presenting with stroke.

A One Year Prospective Study of Neurogenic Stuttering Following Stroke: Incidence and Co-Occurring Disorders

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Theys, C.; van Wieringen, A.; Sunaert, S.; Thijs, V.; De Nil, L. F.

2011-01-01

In this prospective study, data on incidence, stuttering characteristics, co-occurring speech disorders, and recovery of neurogenic stuttering in a large sample of stroke participants were assessed. Following stroke onset, 17 of 319 participants (5.3%; 95% CI, 3.2-8.3) met the criteria for neurogenic stuttering. Stuttering persisted in at least…

Young Ischemic Stroke as Presentation of Thrombotic Thrombocytopenic Purpura: A Case Report

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Ahmad Najib Azmi

2017-12-01

Full Text Available Thrombotic thrombocytopenic purpura (TTP is a rare disorder with an estimated incidence of 3 - 7/1,000,000. It is an autoimmune disorder characterized by fever, neurological signs, microangiopathic hemolytic anemia, thrombocytopenia and renal failure. This case report will describe a young lady who presented with acute middle cerebral artery infarct and was subsequently diagnosed to have TTP. Therapeutic plasma exchange (TPE did not improve the neurological deficit. This case highlights the importance of recognizing TTP as a possible differential diagnosis in young onset stroke.

Clinical Characteristics, Risk Factors, and Outcomes Associated With Neonatal Hemorrhagic Stroke: A Population-Based Case-Control Study.

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Cole, Lauran; Dewey, Deborah; Letourneau, Nicole; Kaplan, Bonnie J; Chaput, Kathleen; Gallagher, Clare; Hodge, Jacquie; Floer, Amalia; Kirton, Adam

2017-03-01

Hemorrhage into the brain of term newborns often results in major injury and lifelong disability. The clinical epidemiology of neonatal hemorrhagic stroke (NHS) remains undefined, hindering the development of strategies to improve outcomes. To characterize the incidence, types, presentations, associated factors, and outcomes of neonatal hemorrhagic stroke. Population-based, nested case-control study. The Alberta Perinatal Stroke Project, a provincial registry, ascertained NHS cases using exhaustive diagnostic code searching (1992-2010, >2500 medical record reviews). Prospective cases were captured through the Calgary Pediatric Stroke Program (2007-2014). Participants included term neonates with magnetic resonance imaging-confirmed NHS including primary and secondary intracerebral hemorrhage, hemorrhagic transformation of ischemic injury, and presumed perinatal hemorrhagic stroke. Control infants with common data were recruited from a population-based study (4 to 1 ratio). Infants with NHS underwent structured medical record review using data-capture forms and blinded scoring of neuroimaging. Clinical risk factor common data elements were explored using logistic regression. Provincial live births were obtained from Statistics Canada. Outcomes were extrapolated to the Pediatric Stroke Outcome Measure. We identified 86 cases: 51 infants (59%) with NHS, of which 32 (67%) were idiopathic, 30 (35%) were hemorrhagic transformation of primary ischemic injuries (14 with neonatal cerebral sinovenous thrombosis, 11 with hypoxic ischemic encephalopathy, and 5 with neonatal arterial ischemic stroke), and 5 were presumed perinatal hemorrhagic stroke. Sixty-two percent were male. Incidence of pure NHS was 1 in 9500 live births and 1 in 6300 for all forms. Most presented in the first week of life with seizures and encephalopathy. Acute neurosurgical intervention was rare (3 of 86 total cases; 3.5%). Temporal lobe was the most common NHS location (16 of 51 pure NHS cases; 31%). A

A cross-sectional study of quality of life in incident stroke survivors in rural northern Tanzania.

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Howitt, Suzanne C; Jones, Matthew P; Jusabani, Ahmed; Gray, William K; Aris, Eric; Mugusi, Ferdinand; Swai, Mark; Walker, Richard W

2011-08-01

The aim of this study was to evaluate changes to, and predictors of, quality of life (QOL) in a community-based cohort of stroke survivors from an earlier stroke incidence study in rural northern Tanzania. Patients were assessed 1-5 years after their incident stroke. The study cohort was compared with an age- and sex-matched control group from the same rural district within a cross-sectional design. Patients and controls were asked a series of questions relating to their QOL [World Health Organization quality of life, abbreviated version (WHOQOL-BREF)], levels of anxiety and depression [hospital anxiety and depression (HAD) scale], cognitive function [community screening instrument for dementia (CSI-D) screening tool], socioeconomic status and demographic characteristics (e.g. age, sex, education and abode). Patients were further assessed for functional outcome and disability (Barthel index, modified Rankin scale), post-stroke care and psychosocial functioning. Patients (n = 58) were found to have significantly lower QOL than controls (n = 58) in all six domains of the WHOQOL-BREF. Gender, socioeconomic status, cognitive function and time elapsed since stroke were not associated with QOL. Older patients and those with more impaired motor function and disability (Barthel index, modified Rankin score) had significantly poorer physical health-related QOL. Greater anxiety and depression, reduced muscle power and less involvement in social events were significantly correlated with lower physical and psychological health-related QOL. To our knowledge, this is the first long-term study of QOL in survivors of incident stroke in Sub-Saharan Africa (SSA). Poorer QOL was associated with greater levels of physical disability, anxiety and depression and reduced social interaction. Demographic factors appear to be much less significant. Modifying these QOL predictors could be important in planning effective post-stroke care within a stretched healthcare system.

Maternal cerebrovascular accidents in pregnancy: incidence and outcomes.

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Walsh, Jennifer; Murphy, Cliona; Murray, Aoife; O'Laoide, Risteard; McAuliffe, Fionnuala M

2010-12-01

Stroke occurring during pregnancy and the postnatal period is a rare but potentially catastrophic event. The aim of this study was to examine the incidence and outcomes of pregnancies complicated by maternal stroke in a single centre. This is a prospective study of over 35,000 consecutive pregnancies over a four-year period at the National Maternity Hospital in Dublin from 2004 to 2008; in addition we also retrospectively examined all cases of maternal mortality at our institution over a 50-year period from 1959 to 2009. We prospectively identified eight cases of strokes complicating pregnancy and the postnatal period giving an overall incidence of 22.34 per 100,000 pregnancies or 24.74 per 100,000 deliveries. There were no stroke-related mortalities during that time. Retrospective analysis of maternal mortality revealed 102 maternal deaths over a 50-year period, 19 (18.6%) of which were due to cerebrovascular accidents. In conclusion, strokes complicating pregnancy and the puerperium remain a rare event and though there appears to be evidence that the incidence is increasing, the associated maternal mortality appears to be falling.

Cannabis and stroke: systematic appraisal of case reports.

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Hackam, Daniel G

2015-03-01

An increasing number of case reports link cannabis consumption to cerebrovascular events. Yet these case reports have not been scrutinized using criteria for causal inference. All case reports on cannabis and cerebrovascular events were retrieved. Four causality criteria were addressed: temporality, adequacy of stroke work-up, effects of rechallenge, and concomitant risk factors that could account for the cerebrovascular event. There were 34 case reports on 64 patients. Most cases (81%) exhibited a temporal relationship between cannabis exposure and the index event. In 70%, the evaluation was sufficiently comprehensive to exclude other sources for stroke. About a quarter (22%) of patients had another stroke after subsequent re-exposure to cannabis. Finally, half of patients (50%) had concomitant stroke risk factors, most commonly tobacco (34%) and alcohol (11%) consumption. Many case reports support a causal link between cannabis and cerebrovascular events. This accords well with epidemiological and mechanistic research on the cerebrovascular effects of cannabis. © 2015 American Heart Association, Inc.

Population-based study of ischemic stroke risk after trauma in children and young adults.

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Fox, Christine K; Hills, Nancy K; Vinson, David R; Numis, Adam L; Dicker, Rochelle A; Sidney, Stephen; Fullerton, Heather J

2017-12-05

To quantify the incidence, timing, and risk of ischemic stroke after trauma in a population-based young cohort. We electronically identified trauma patients (trauma and 3 controls per case. A physician panel reviewed medical records, confirmed cases, and adjudicated whether the stroke was related to trauma. We calculated the 4-week stroke incidence and estimated stroke odds ratios (OR) by injury location using logistic regression. From 1,308,009 trauma encounters, we confirmed 52 trauma-related ischemic strokes. The 4-week stroke incidence was 4.0 per 100,000 encounters (95% confidence interval [CI] 3.0-5.2). Trauma was multisystem in 26 (50%). In 19 (37%), the stroke occurred on the day of trauma, and all occurred within 15 days. In 7/28 cases with cerebrovascular angiography at the time of trauma, no abnormalities were detected. In unadjusted analyses, head, neck, chest, back, and abdominal injuries increased stroke risk. Only head (OR 4.1, CI 1.1-14.9) and neck (OR 5.6, CI 1.03-30.9) injuries remained associated with stroke after adjusting for demographics and trauma severity markers (multisystem trauma, motor vehicle collision, arrival by ambulance, intubation). Stroke risk is elevated for 2 weeks after trauma. Onset is frequently delayed, providing an opportunity for stroke prevention during this period. However, in one-quarter of stroke cases with cerebrovascular angiography at the time of trauma, no vascular abnormality was detected. © 2017 American Academy of Neurology.

Prevalence, Incidence, Prognosis, Early Stroke Risk, and Stroke-Related Prognostic Factors of Definite or Probable Transient Ischemic Attacks in China, 2013

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Bin Jiang

2017-06-01

Full Text Available The epidemiological characteristics of transient ischemic attacks (TIAs in China are unclear. In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TIA in China using a complex, multistage, probability sampling design. Results showed that the weighted prevalence of TIA in China was 103.3 [95% confidence interval (CI: 83.9–127.2] per 100,000 in the population, 92.4 (75.0–113.8 per 100,000 among men, and 114.7 (87.2–151.0 per 100,000 among women. The weighted incidence of TIA was 23.9 (17.8–32.0 per 100,000 in the population, 21.3 (14.3–31.5 per 100,000 among men, and 26.6 (17.0–41.7 per 100,000 among women. No difference in average prognosis was found between TIA and stroke in the population. Weighted risk of stroke among TIA patients was 9.7% (6.5–14.3%, 11.1% (7.5–16.1%, and 12.3% (8.4–17.7% at 2, 30, and 90 days, respectively. The risk of stroke was higher among male patients with a history of TIA than among female patients with a history of TIA (OR: 2.469; 95% CI: 1.172–5.201; P = 0.018, and higher among TIA patients with hypertension than among TIA patients without hypertension (OR: 2.671; 1.547–4.613; P < 0.001. It can be concluded that there are an estimated 1.35 million TIA patients nationwide, with 0.31 million new cases of TIA annually in China. TIA patients were not better managed prior to a stroke event. Early risk of stroke among TIA patients is high. Sex and hypertension may be stroke-associated prognostic factors among TIA patients. TIA clinics and surveillance should be integrated into the national health-care system.

Incidence of stroke in young adults in the Reggio Emilia area, northern Italy.

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Guidetti, D; Baratti, M; Zucco, R G; Greco, G; Terenziani, S; Vescovini, E; Sabadini, R; Bondavalli, M; Masini, L; Salvarani, C

1993-01-01

A retrospective epidemiological study on the first episode of stroke in young adults aged 15-44 years was carried out in the territory of the Local Health Unit No. 9 in Reggio Emilia (46,491 km2), Italy, from 1987 to 1989. 29 patients were identified: 17 were affected with cerebral infarction and 12 with hemorrhage. All young patients were discharged with diagnostic codes 430-438 according to the International Classification of Disease, i.e. the criteria of the World Health Organisation for stroke definition. All patients had computed tomography or necropsy. The average annual incidence rate per 100,000 population aged 15-44 for all strokes was 13.6 and the 95% confidence interval (CI 95%) was 9.1-19.6. The general population of the same age on January 1, 1987, was 69,845 and 71,920 on December 31, 1989; the incidence rate of stroke was 14.0 for males (CI 95% 7.9-2.3) and 13.2 (CI 95% 7.1-22.2) for females. The average annual incidence rates were 8.0 (CI 95% 4.7-12.2) for cerebral infarction (8.4, CI 95% 3.9-16 for males, 7.6, CI 95% 3.3-14.9 for females), 5.6 (CI 95% 2.9-9.9) for cerebral hemorrhage and 2.8 (CI 95% 1.0-6.1) for both subarachnoid (SAH) and intracerebral hemorrhage (ICH). Based on angiography or necropsy findings, aneurysms or arteriovenous malformations were present in 83% of the patients with SAH and in 66% of the patients with ICH. The 1-month fatality ratio was 0 for cerebral infarction, 50% for SAH and 33% for ICH.(ABSTRACT TRUNCATED AT 250 WORDS)

Omega-3 Fatty Acids and Incident Ischemic Stroke and Its Atherothrombotic and Cardioembolic Subtypes in 3 US Cohorts.

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Saber, Hamidreza; Yakoob, Mohammad Yawar; Shi, Peilin; Longstreth, W T; Lemaitre, Rozenn N; Siscovick, David; Rexrode, Kathryn M; Willett, Walter C; Mozaffarian, Dariush

2017-10-01

The associations of individual long-chain n-3 polyunsaturated fatty acids with incident ischemic stroke and its main subtypes are not well established. We aimed to investigate prospectively the relationship of circulating eicosapentaenoic acid, docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with risk of total ischemic, atherothrombotic, and cardioembolic stroke. We measured circulating phospholipid fatty acids at baseline in 3 separate US cohorts: CHS (Cardiovascular Health Study), NHS (Nurses' Health Study), and HPFS (Health Professionals Follow-Up Study). Ischemic strokes were prospectively adjudicated and classified into atherothrombotic (large- and small-vessel infarctions) or cardioembolic by imaging studies and medical records. Risk according to fatty acid levels was assessed using Cox proportional hazards (CHS) or conditional logistic regression (NHS, HPFS) according to study design. Cohort findings were pooled using fixed-effects meta-analysis. A total of 953 incident ischemic strokes were identified (408 atherothrombotic, 256 cardioembolic, and 289 undetermined subtypes) during median follow-up of 11.2 years (CHS) and 8.3 years (pooled, NHS and HPFS). After multivariable adjustment, lower risk of total ischemic stroke was seen with higher DPA (highest versus lowest quartiles; pooled hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.58-0.92) and DHA (HR, 0.80; 95% CI, 0.64-1.00) but not eicosapentaenoic acid (HR, 0.94; 95% CI, 0.77-1.19). DHA was associated with lower risk of atherothrombotic stroke (HR, 0.53; 95% CI, 0.34-0.83) and DPA with lower risk of cardioembolic stroke (HR, 0.58; 95% CI, 0.37-0.92). Findings in each individual cohort were consistent with pooled results. In 3 large US cohorts, higher circulating levels of DHA were inversely associated with incident atherothrombotic stroke and DPA with cardioembolic stroke. These novel findings suggest differential pathways of benefit for DHA, DPA, and eicosapentaenoic acid. © 2017

Risk of Carotid Stroke after Chiropractic Care

DEFF Research Database (Denmark)

Cassidy, J. David; Boyle, Eleanor; Côté, Pierre

2017-01-01

Background Chiropractic manipulation is a popular treatment for neck pain and headache, but may increase the risk of cervical artery dissection and stroke. Patients with carotid artery dissection can present with neck pain and/or headache before experiencing a stroke. These are common symptoms seen...... by both chiropractors and primary care physicians (PCPs). We aimed to assess the risk of carotid artery stroke after chiropractic care by comparing association between chiropractic and PCP visits and subsequent stroke. Methods A population-based, case-crossover study was undertaken in Ontario, Canada. All...... incident cases of carotid artery stroke admitted to hospitals over a 9-year period were identified. Cases served as their own controls. Exposures to chiropractic and PCP services were determined from health billing records. Results We compared 15,523 cases to 62,092 control periods using exposure windows...

Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort.

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Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H; Bach, Flemming W; Larsen, Torben Bjerregaard

2015-09-01

The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. 42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores. In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application. © 2015 American Heart Association, Inc.

Mortality and Incidence of Hospital Admissions for Stroke among Brazilians Aged 15 to 49 Years between 2008 and 2012.

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Fernando Adami

Full Text Available The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012.Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60-I64. Crude and standardized mortality (WHO reference and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0.There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15-49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54 in 2008 to 6.32 (95% CI 6.31; 6.32 in 2012 (β = -0.27, p = 0.013, r2 = 0.90. During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67 in 2008 and 25.11 (95% CI 25.10; 25.11 in 2012 (β = 0.09, p = 0.692, r2 = 0.05. There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group.We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults.

Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

DEFF Research Database (Denmark)

Larsen, Bjørn Strøier; Kumarathurai, Preman; Falkenberg, Julie

2015-01-01

.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of ≥2 was 2...

STROKE IN YOUNG ADULTS: A RETROSPECTIVE STUDY OF 68 CASES

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M. H. Harirchian

2006-06-01

Full Text Available Numerous etiologies are responsible for cases of stroke in young adults. This study reviews the causes of two types of stroke (ischemic and intracerebral hemorrhage in young adults aged 15 to 40years, admitted to our center (a tertiary care center from 1997 to 2002. The purpose of this study is to determine the relative frequency of causes of stroke in young adults and compare this with published data in the literature. Using the codes 46.0 to 46.8 of the International Classification of Diseases- 10th Edition (ICD-10, cases were identified from the records of the stroke patients admitted in Imam Khomeini Hospital and the data were collected from their files using a comprehensive questionnaire. Forty-two cases of ischemic stroke (62% and 26 cases of intracerebral hemorrhage (38% were identified. The leading cause of ischemic stroke was cardioembolism (38.1%, followed by atherosclerosis in 5 cases (11.9%. Among cardiac causes infarction was attributable to consequences of rheumatic heart disease in 8 cases. In 3 cases a cessation or decrease in dose of warfarin was followed directly by an ischemic stroke. The most leading cause of intracerebral hemorrhage was hypertension (30.8%. Other causes were anticoagulant therapy, intratumoral hemorrhage, aplastic anemia, leukemia, arteriovenous malformations, and chronic active hepatitis. In conclusion, cardioembolism and hypertension were the most leading causes of ischemic and hemorrhagic stroke in young adults admitted in our hospital.

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

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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 Ppatients, reporting 21 217 AEs. Among 756 types of AEs, 132 accounted for 82.7%, of which 80% began within 10 days after stroke. 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.

The Christchurch earthquake stroke incidence study.

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Wu, Teddy Y; Cheung, Jeanette; Cole, David; Fink, John N

2014-03-01

We examined the impact of major earthquakes on acute stroke admissions by a retrospective review of stroke admissions in the 6 weeks following the 4 September 2010 and 22 February 2011 earthquakes. The control period was the corresponding 6 weeks in the previous year. In the 6 weeks following the September 2010 earthquake there were 97 acute stroke admissions, with 79 (81.4%) ischaemic infarctions. This was similar to the 2009 control period which had 104 acute stroke admissions, of whom 80 (76.9%) had ischaemic infarction. In the 6 weeks following the February 2011 earthquake, there were 71 stroke admissions, and 61 (79.2%) were ischaemic infarction. This was less than the 96 strokes (72 [75%] ischaemic infarction) in the corresponding control period. None of the comparisons were statistically significant. There was also no difference in the rate of cardioembolic infarction from atrial fibrillation between the study periods. Patients admitted during the February 2011 earthquake period were less likely to be discharged directly home when compared to the control period (31.2% versus 46.9%, p=0.036). There was no observable trend in the number of weekly stroke admissions between the 2 weeks leading to and 6 weeks following the earthquakes. Our results suggest that severe psychological stress from earthquakes did not influence the subsequent short term risk of acute stroke, but the severity of the earthquake in February 2011 and associated civil structural damages may have influenced the pattern of discharge for stroke patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

Self-Reported Exercise Prevalence and Determinants in the Long Term After Stroke: The North East Melbourne Stroke Incidence Study.

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Simpson, Dawn; Callisaya, Michele L; English, Coralie; Thrift, Amanda G; Gall, Seana L

2017-12-01

Exercise has established benefits following stroke. We aimed to describe self-reported exercise 5 and 10 years after stroke, change in exercise over time, and to identify factors associated with long-term exercise. Data on exercise (defined as 20 minutes' duration, causing sweating and increased heart rate) were obtained by questionnaire from a population-based stroke incidence study with 10-year follow-up. For change in exercise between 5 and 10 years (n = 276), we created 4 categories of exercise (no exercise, ceased exercising, commenced exercising, continued exercising). Multinomial regression determined associations between exercise categories and exercising before stroke, receiving exercise advice and functional ability and demographic factors. The prevalence of exercise at 5 years (n = 520) was 18.5% (n = 96) (mean age 74.7 [standard deviation {SD} 14] years, 50.6% male) and 24% (n = 78) at 10 years. In those with data at both 5 and 10 years (mean age 69 [standard deviation 14] years, 52.9% male), 15% (n = 42) continued exercising, 10% (n = 27) commenced exercising, 14% (n = 38) ceased exercising, and 61% (n = 169) reported no exercise. Continued exercise was associated with younger age (relative risk [RR] .47 95% confidence interval [CI] .25-0.89), greater Barthel score (RR 2.97 95% CI 1.00-8.86), independent walking (RR 2.32 95% CI 1.16-4.68), better quality of life (RR 10.9 95% CI 2.26-52.8), exercising before stroke (RR 16.0 95%CI 4.98-51.5), and receiving advice to exercise (RR 2.99 95% CI 1.73-5.16). Few people exercise after stroke and fewer commence exercise long term. Innovative interventions to promote and maintain exercise are required after stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Delayed-Onset Post-Stroke Delusional Disorder: A Case Report

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Raíssa B. Barboza

2013-01-01

Full Text Available Although the prevalence of neuropsychiatric disorders among patients with cerebrovascular illness is relatively high, there are only few case reports describing post-stroke psychotic symptoms. In general, post-stroke psychoses have been reported to emerge few days after the vascular event and to vanish soon afterwards. In this report, we describe delayed-onset post-stroke delusional disorder, persecutory type. A middle-aged female patient developed a persistent delusional disorder with homicidal behavior about one year after a cerebrovascular accident affecting the right fronto-temporo-parietal region and a long period of chronic post-stroke mixed anxiety and depressive symptoms. Our case suggests that there might be long intervals between stroke and the appearance of psychotic symptoms.

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....

Hyponatremia in stroke

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Sheikh Saleem

2014-01-01

Full Text Available Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH or cerebral salt wasting syndrome (CSWS. We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l. The data was analysed using Chi-square test using SPSS (Statistical package for social science software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67% had SIADH and 115 (33% had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate.

Migraine and risk of hemorrhagic stroke

DEFF Research Database (Denmark)

Gaist, David; González-Pérez, Antonio; Ashina, Messoud

2014-01-01

to select 10,000 controls free from hemorrhagic stroke. Using unconditional logistic regression models, we calculated the risk of hemorrhagic stroke associated with migraine, adjusting for age, sex, calendar year, alcohol, body mass index, hypertension, previous cerebrovascular disease, oral contraceptive......BACKGROUND: We investigated the association between hemorrhagic stroke and migraine using data from The Health Improvement Network database. FINDINGS: We ascertained 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH). Density-based sampling was used...

Stroke trends in an aging population. The Technology Assessment Methods Project Team.

Science.gov (United States)

Niessen, L W; Barendregt, J J; Bonneux, L; Koudstaal, P J

1993-07-01

Trends in stroke incidence and survival determine changes in stroke morbidity and mortality. This study examines the extent of the incidence decline and survival improvement in the Netherlands from 1979 to 1989. In addition, it projects future changes in stroke morbidity during the period 1985 to 2005, when the country's population will be aging. A state-event transition model is used, which combines Dutch population projections and existing data on stroke epidemiology. Based on the clinical course of stroke, the model describes historical national age- and sex-specific hospital admission and mortality rates for stroke. It extrapolates observed trends and projects future changes in stroke morbidity rates. There is evidence of a continuing incidence decline. The most plausible rate of change is an annual decline of -1.9% (range, -1.7% to -2.1%) for men and -2.4% (range, -2.3% to -2.8%) for women. Projecting a constant mortality decline, the model shows a 35% decrease of the stroke incidence rate for a period of 20 years. Prevalence rates for major stroke will decline among the younger age groups but increase among the oldest because of increased survival in the latter. In absolute numbers this results in an 18% decrease of acute stroke episodes and an 11% increase of major stroke cases. The increase in survival cannot fully explain the observed mortality decline and, therefore, a concomitant incidence decline has to be assumed. Aging of the population partially outweighs the effect of an incidence decline on the total burden of stroke. Increase in cardiovascular survival leads to a further increase in major stroke prevalence among the oldest age groups.

Increased Incidence of Interatrial Block in Younger Adults with Cryptogenic Stroke and Patent Foramen Ovale

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P.E. Cotter

2011-04-01

Full Text Available Background: Stroke is often unexplained in younger adults, although it is often associated with a patent foramen ovale (PFO. The reason for the association is not fully explained, and mechanisms other than paradoxical embolism may be involved. Young stroke patients with PFO have more atrial vulnerability than those without PFO. It is plausible that stretching of the interatrial septum may disrupt the interatrial conduction pathways causing interatrial block (IAB. IAB is associated with atrial fibrillation, dysfunctional left atria and stroke. Methods: Electrocardiogram (ECG characteristics of prospectively recruited young patients (≤55 years of age with unexplained stroke (TOAST and A-S-C-O were compared with control data. All stroke cases underwent bubble contrast transthoracic and transoesophageal echography. IAB was defined as a P-wave duration of ≧110 ms. ECG data were converted to electronic format and analysed in a blind manner. Results: Fifty-five patients and 23 datasets were analysed. Patients with unexplained stroke had longer P-wave duration (p = 0.013 and a greater prevalence of IAB (p = 0.02 than healthy controls. Case status was an independent predictor of P-wave duration in a significant multivariate model. There was a significant increase in the proportion of cases with a PFO with IAB compared with cases without PFO and with controls (p = 0.005. Conclusions: Young patients with unexplained stroke, particularly those with PFO, exhibit abnormal atrial electrical characteristics suggesting atrial arrhythmia or atrial dysfunction as a possible mechanism of stroke.

Socioeconomic status and stroke incidence in the US elderly: the role of risk factors in the EPESE study.

NARCIS (Netherlands)

Avendano, Mauricio; Kawachi, Ichiro; Lenthe, Frank J van; Boshuizen, Hendriek C; Mackenbach, Johan P; Bos, G A M van den; Fay, Martha E; Berkman, Lisa F

2006-01-01

BACKGROUND AND PURPOSE: This study assesses the effect of socioeconomic status on stroke incidence in the elderly, and the contribution of risk factors to stroke disparities. METHODS: Data comprised a sample of 2812 men and women aged 65 years and over from the New Haven cohort of the Established

Sex differences in stroke: a socioeconomic perspective

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Delbari A

2016-09-01

Full Text Available Ahmad Delbari,1 Farzane Keyghobadi,2 Yadollah Abolfathi Momtaz,1,3 Fariba Keyghobadi,2 Reza Akbari,2 Houman Kamranian,2 Mohammad Shouride Yazdi,2 Sayed Shahaboddin Tabatabaei,1 Seyed-Mohammad Fereshtehnejad4 1Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 2Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Khorasan, Iran; 3Malaysian Research Institute on Ageing (MyAgeing™, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 4Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society (NVS, Karolinska Institutet, Stockholm, Sweden Background: A number of studies have explored the issue of sex differences in stroke from biomedical perspective; however, there are still large gaps in the existing knowledge. The purpose of this study was to assess whether the differences in socioeconomic status and living conditions between men and women may explain the part of the sex differences in incidence and outcomes of stroke. Methods: All stroke participants aged ≥60 years admitted in Vaseie Hospital in Sabzevar, Iran, from March 21, 2013, until March 20, 2014, were included in this study. Computerized tomography and magnetic resonance imaging were used to confirm stroke. A series of χ2 tests were performed and Statistical Program for Social Sciences, Version 21.0, was used to investigate the potential differences between older men and women in stroke incidence and outcomes. Results: A total of 159 incident stroke cases were documented during 1 year. The annual rate of stroke was statistically significantly higher in elderly women than in elderly men (401 vs 357 per 100,000; P<0.001. Female elderly participants had significantly lower socioeconomic status, poorer living conditions, and higher lifetime history of depression, hypertension, and diabetes mellitus than their male counterparts. Conclusion: The findings from this study

Thrombotic CV Stroke in a Young Male with Hyperhomocysteinemia and Protein S Deficiency: A Case Report

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Nilima Shah

2014-12-01

Full Text Available Stroke in young poses a major health problem. Thrombophilic factors have been implicated in 4-8% of the young strokes worldwide. Hyperhomocysteinemia is an independent risk factor for atherosclerosis but there are few data regarding its role in acute arterial thrombosis without any previous lesion. Overall estimated incidence of deep vein thrombosis is 1 per 1000 persons with Protein S deficiency but very few studies suggest association between arterial thrombosis with Protein S deficiency. We present a case of 18 year old boy who presented to us with acute onset right sided hemiplegia and aphasia whose laboratory findings were suggestive of hyperhomocyseinemia and Protein S deficiency.

Suicide after a stroke: a population study

DEFF Research Database (Denmark)

Teasdale, T W; Engberg, A W

2001-01-01

STUDY OBJECTIVE: To establish whether there are increased rates of suicide after a stroke and the degree to which any increase is related to gender, age at stroke, diagnosis, duration of hospitalisation, and time since stroke. DESIGN: Cross linkage of national registers for hospitalisations...... cases of suicide were identified. MAIN RESULTS: Annual incidence rates, both observed and expected, together with standardised mortality ratios (SMR) were computed based on annual population and suicide statistics, stratified by age and gender. The overall annual incidence rate of suicide in the cohort.......76) for patients under 50 years of age group and were least for patients 80 years or older (1.3; 0.95, 1.79). There was no clear relation to stroke diagnosis. Suicides were negatively related to duration of hospitalisation, being lowest for those hospitalised for more than three months (0.88; 0.65, 1...

A Stroke Mimic: A Case Report

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Annia Martínez Rivas

2016-03-01

Full Text Available Diseases mimicking a stroke are a major health problem for a large number of hospitals. This paper aims at presenting a disease that has a stroke-like presentation. The case of a 46-year-old man admitted to the stroke unit with a clinical and radiological diagnosis of cerebral infarction is presented. The patient developed fever and a serious deterioration of consciousness. Changes on computed tomography consistent with a brain abscess were observed. Broad-spectrum antibiotics were administered and a follow-up tomography was performed. Once the treatment was completed, the clinical and radiological suspicion of a brain abscess was confirmed.

Common variants of ROCKs and the risk of hypertension, and stroke: Two case-control studies and a follow-up study in Chinese Han population.

Science.gov (United States)

Yang, Song; Zhao, Yanping; Tian, Yuanrui; Chen, Yanchun; Zhao, Xianghai; Li, Ying; Zhao, Hailong; Chen, Xiaotian; Zhu, Lijun; Fang, Zhengmei; Yao, YingShui; Hu, Zhibing; Shen, Chong

2018-03-01

The Rho kinases (ROCKs) are recognized as a critical regulator of vascular functions in cardiovascular disorders. It is crucial to illustrate the association of ROCKs genetic variation and hypertension and/or stroke events. Herein we aimed at investigating the association of ROCK1 and ROCK2 with hypertension and stroke in Chinese Han population. Seven tagSNPs at ROCK1 and ROCK2 were genotyped in a community-based case-control study consisting of 2012 hypertension cases and 2210 normotensive controls and 4128 subjects were further followed up. In stroke case-control study, 1471 ischemic stroke (IS) inpatients and 607 hemorrhagic stroke (HS) inpatients were collected, and 2443 age-matched controls were selected from the follow-up population. Risks were estimated as odds ratio (OR) and hazard ratio (HR) by logistic and Cox regression. The community-based case-control study didn't identify any significant tagSNPs associated with hypertension even after adjustment for covariates. The follow-up analysis showed that rs1481280 of ROCK1 significantly associated with incident hypertension (HR=1.130, P=0.048) after adjusting for covariates. rs7589629 and rs978906 of ROCK2 were significantly associated with incident IS (HR=1.373, P=0.004; HR=1.284, P=0.026) respectively. In stroke case-control study, rs288980, rs1481280 and rs7237677 were significantly associated with IS and the adjusted ORs (P values) of additive model were 0.879 (0.010), 0.895 (0.036) and 0.857 (0.002) respectively. Furthermore, rs288980, rs7237677 and rs978906 were significantly associated with HS and the adjusted ORs (P values) of additive model were 0.857 (0.025), 0.848 (0.018) and 0.856 (0.027) respectively. Our findings suggest that ROCK1 and ROCK2 contribute to the genetic susceptibility of hypertension and stroke. Copyright © 2017 Elsevier B.V. All rights reserved.

Drug abuse, a rare cause of stroke: Case report

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Zeynep Özözen Ayas

2017-04-01

Full Text Available At the present time the incidence of illicit drug use increases worldwide among young adults. Abuse of these substances is a rare cause of stroke in young adults. Cocaine, heroin, cannabis, and amphetamines use increase the risk of stroke. Cannabis sativa induce main effects by delta-9-hydrocannabinol. The main mechanism of marijuana-related stroke in young patients is vasospazm. The other possible mechanisms are systemic hypotension, impaired cerebral autoregulation, alteration of cerebral blood flow, cardioembolism due to atrial fibrillation. In this article a 25-year-old young male patient with paresia and paresthesia of right side who had chronic abuse of marijuana is reported. Clinicians must be alert about marijuana can be seriously harmful to cerebrovascular system in chronic use.

[Moyamoya disease as a rare cause of ischaemic stroke--case report].

Science.gov (United States)

Kułakowska, Alina; Kapica-Topczewska, Katarzyna; Borowik, Helena; Drozdowski, Wiesław

2009-10-01

Moyamoya disease is a rare, progressive disease of the vessels diagnosed according to characteristic abnormalities of brain arteries in the angiography. The incidence of moyamoya disease in Europe is lower than in Asia and its clinical course in European population is probably different from Asiatic (older age of onset and rare incidence of hemorrhagic strokes). Two young patients were diagnosed as moyamoya disease on the basis of clinical symptoms (ischaemic stroke) and results of brain vessels' angiography, which documented an occlusion of both internal carotid arteries above branching-off the ocular arteries in the first patient and stenosis of distal internal carotid arteries and proximal medial and anterior cerebral arteries in the second one. Both patients are under control of the Neurological Outpatient Department and their neurological state is stable. Despite that moyamoya disease is a rare cause of ischaemic stroke, it should be always considered as one of etiologic factors, especially in young patients.

Noonan Syndrome and Stroke: A Case Report

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Ebru Nur Mıhçı

2012-03-01

Full Text Available Noonan syndrome is an autosomal dominant genetic disease characterized by short stature, webbed neck, typical facial appearance and congenital heart disease. Here we report a 24 year old woman patient with the diagnosis of Noonan syndrome who admitted to our clinic with ischemic stroke caused by atrial fibrillation secondary to hypertrophic cardiomyopathy. Noonan syndrome patients with stroke due to vascular malformations have been reported, but non-obstructive hypertrophic cardiomyopathy is a rare cause for stroke in patients with Noonan syndrome. Our aim of presenting the case emphasize that Noonan syndrome should be thought as a differential diagnosis in patients with stroke at a young age and dysmorphic facial appearance

Noonan Syndrome and Stroke: A Case Report

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Ebru Nur Mıhçı

2012-03-01

Full Text Available Noonan syndrome is an autosomal dominant genetic disease characterized by short stature, webbed neck, typical facial appearance and congenital heart disease. Here we report a 24 year old woman patient with the diagnosis of Noonan syndrome who admitted to our clinic with ischemic stroke caused by atrial fibrillation secondary to hypertrophic cardiomyopathy. Noonan syndrome patients with stroke due to vascular malformations have been reported, but non-obstructive hypertrophic cardiomyopathy is a rare cause for stroke in patients with Noonan syndrome. Our aim of presenting the case emphasize that Noonan syndrome should be thought as a differential diagnosis in patients with stroke at a young age and dysmorphic facial appearance.

Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort

DEFF Research Database (Denmark)

Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H

2015-01-01

, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. Methods—We conducted a registry-based study in patients with incident ischemic stroke...

Growth hormone treatment for childhood short stature and risk of stroke in early adulthood.

Science.gov (United States)

Poidvin, Amélie; Touzé, Emmanuel; Ecosse, Emmanuel; Landier, Fabienne; Béjot, Yannick; Giroud, Maurice; Rothwell, Peter M; Carel, Jean-Claude; Coste, Joël

2014-08-26

We investigated the incidence of stroke and stroke subtypes in a population-based cohort of patients in France treated with growth hormone (GH) for short stature in childhood. Adult morbidity data were obtained in 2008-2010 for 6,874 children with idiopathic isolated GH deficiency or short stature who started GH treatment between 1985 and 1996. Cerebrovascular events were validated using medical reports and imaging data and classified according to standard definitions of subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke. Case ascertainment completeness was estimated with capture-recapture methods. The incidence of stroke and of stroke subtypes was calculated and compared with population values extracted from registries in Dijon and Oxford, between 2000 and 2012. Using both Dijon and Oxford population-based registries as references, there was a significantly higher risk of stroke among patients treated with GH in childhood. The excess risk of stroke was mainly attributable to a very substantially and significantly higher risk of hemorrhagic stroke (standardized incidence ratio from 3.5 to 7.0 according to the registry rates considered, and accounting or not accounting for missed cases), and particularly subarachnoid hemorrhage (standardized incidence ratio from 5.7 to 9.3). We report a strong relationship between hemorrhagic stroke and GH treatment in childhood for isolated growth hormone deficiency or childhood short stature. Patients treated with GH worldwide should be advised about this association and further studies should evaluate the potentially causal role of GH treatment in these findings. © 2014 American Academy of Neurology.

Incidence, causative mechanisms, and anatomic localization of stroke in pituitary adenoma patients treated with postoperative radiation therapy versus surgery alone

NARCIS (Netherlands)

Sattler, Margriet; Vroomen, Patrick; Sluiter, Wim J.; Schers, Henk J.; van den Berg, Gerrit; Langendijk, Johannes A.; Wolffenbuttel, Bruce H. R.; van den Bergh, Alphons C. M.; van Beek, Andre P.

2013-01-01

PURPOSE: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. METHODS AND MATERIALS: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical

Analysis of clinical and imaging characters and prognosis in patients with epilepsy after stroke

International Nuclear Information System (INIS)

Huang Yongguang; Zeng Huiliang

2003-01-01

Objective: To evaluate the relationship between clinical, imaging characters and prognosis in patients with epilepsy after stroke. Methods: In total 78 cases of post-stroke epilepsy were studied retrospectively out of 840 cases. Results: The incidence of post-stroke epilepsy was 9.29%. The early-stage epilepsy (less than 2 weeks) accounted for 61.54%. The major type of seizure were partial seizure and general tonic-clonic seizure. The incidence was higher in patients with cerebral hemorrhage or with lesions involving the cortex. Symptomatolytic medication was effective. Compared with non-epilepsy group, the mortality of epilepsy was higher. Conclusion: Post-stroke epilepsy is usually accompanied with cortical focus, which is more often seen in patients with cerebral hemorrhage than in patients with cerebral infarction. Post-stroke epilepsy responses well to the medication but indicates a poor prognosis

Conversion Disorder in Stroke: A Case Report

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Hsien-Yeh Chou

2006-11-01

Full Text Available Conversion disorder is caused by previous severe stress, emotional conflict, or an associated psychiatric disorder, and usually presents with one or more neurologic symptoms. Clinically, it is challenging to diagnose diseases such as transient ischemia attack, stroke, brain tumor, spinal cord injury, and neuropathy. In this case report, we present a male stroke patient who had a typical conversion disorder.

The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study.

Science.gov (United States)

Maselko, Joanna; Bates, Lisa M; Avendaño, Mauricio; Glymour, M Maria

2009-12-01

To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke. Longitudinal cohort. U.S. national sample, community based. U.S. adults aged 50 and older and their spouses. Health and Retirement Study (HRS) participants born between 1900 and 1947 (N=22,818), aged 50 and older, and stroke-free at baseline were followed an average of 9.4 years for self- or proxy-reported stroke (2,372 events). Financial resources, behavioral risk factors, and cardiovascular conditions were used to predict incident stroke in Cox proportional hazard models stratified according to sex and marital status (married, widowed, divorced or separated, or never married). Women were less likely to be married than men. The distribution of risk factors differed according to sex and marital status. Men had higher incident stroke rates than women, even after full risk factor adjustment (hazard ratio (HR)=1.22, 95% confidence interval (CI)=1.11-1.34). For both sexes, being never married or widowed predicted greater risk, associations that were attenuated after adjustment for financial resources. Widowed men had the highest risk (HR=1.40, 95% CI=1.12-1.74 vs married women). Lower income and wealth were associated with similarly high risk across subgroups, although this risk factor especially affected unmarried women, with this group reporting the lowest income and wealth levels. Most other risk factors had similar HRs across subgroups, although moderate alcohol use did not predict lower stroke risk in unmarried women. Stroke incidence and risk factors vary substantially according to sex and marital status. It is likely that gendered social experiences, such as marriage and socioeconomic disadvantage, mediate pathways linking sex and stroke.

Incidence of Depression After Stroke, and Associated Risk Factors and Mortality Outcomes, in a Large Cohort of Danish Patients

DEFF Research Database (Denmark)

Jørgensen, Terese S. H.; Wium-Andersen, Ida K.; Wium-Andersen, Marie K.

2016-01-01

the incidence of and risk factors for depression differ between patients with stroke and a reference population without stroke and to assess how depression influences mortality. Design, Setting, and Participants: Register-based cohort study in Denmark. Participants were all individuals 15 years or older......Importance: More than 30 million people live with a stroke diagnosis worldwide. Depression after stroke is frequent, and greater knowledge of associated risk factors and outcomes is needed to understand the etiology and implications of this disabling complication. Objectives: To examine whether...... ratio for stroke vs the reference population, 1.93; 95% CI, 1.85-2.08). Significant risk factors for depression for patients with stroke and the reference population included older age, female sex, single cohabitation status, basic educational attainment, diabetes, high level of somatic comorbidity...

Adipose tissue fatty acids present in dairy fat and risk of stroke: the Danish Diet, Cancer and Health cohort

DEFF Research Database (Denmark)

Laursen, Anne Sofie Dam; Dahm, Christina Catherine; Johnsen, Søren Paaske

2018-01-01

of adipose tissue biopsies was determined by gas chromatography and specific fatty acids were expressed as percentage of total fatty acids. Stroke cases were identified in the Danish National Patient Registry and the diagnoses were individually verified. We recorded 2108 stroke cases of which 1745 were......The role of dairy fat for the risk of stroke is not yet clear. Adipose tissue reflects long-term fatty acid intake and metabolism. We, therefore, investigated associations for percentages of adipose tissue fatty acids, for which dairy products are a major source (12:0, 14:0, 14:1 cis-9, 15:0, 17......:0, 18:1 trans-11 and 18:2 cis-9, trans-11), with incident total stroke and stroke subtypes. We conducted a case-cohort study within the Danish Diet, Cancer and Health cohort, including all incident stroke cases (n = 2108) and a random sample of the total cohort (n = 3186). The fatty acid composition...

Clinical Characteristics of Fatal Methamphetamine-related Stroke: A National Study.

Science.gov (United States)

Darke, Shane; Lappin, Julia; Kaye, Sharlene; Duflou, Johan

2018-05-01

The study aimed to determine the clinical characteristics of fatal methamphetamine-related stroke in Australia, 2009-2015. There were 38 cases, 60.5% male, with a mean age of 40.3 years. In no case was there evidence that this was the first time methamphetamine had been used by the decedent, and 52.6% had known histories of injecting drug use. The stroke was hemorrhagic in 37 of 38 cases. In 21.1% of cases, the stroke was purely parenchymal and, in 18.4%, involved purely the subarachnoid space. A ruptured berry aneurysm was present in 31.6% and in 68.8% of initial subarachnoid hemorrhages. There was evidence of systemic hypertension in 8 of 25 cases in which full autopsy findings were available. With increased use of methamphetamine, there is a high probability of increased hemorrhagic stroke incidence among young people. In cases of fatal hemorrhagic stroke among young cases presenting to autopsy, the possibility of methamphetamine use should be borne in mind. © 2017 American Academy of Forensic Sciences.

30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012: A Multi-Ethnic Population-Based Series of Studies.

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Valery L Feigin

Full Text Available Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ over 30-years.Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard annual incidence and mortality with corresponding 95% confidence intervals (CI were calculated per 100,000 people, assuming a Poisson distribution.5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31% and 62% (95% CI 36%-86%, respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively compared with NZ/Europeans (mean age 75 years. There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17% across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in

30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies.

Science.gov (United States)

Feigin, Valery L; Krishnamurthi, Rita V; Barker-Collo, Suzanne; McPherson, Kathryn M; Barber, P Alan; Parag, Varsha; Arroll, Bruce; Bennett, Derrick A; Tobias, Martin; Jones, Amy; Witt, Emma; Brown, Paul; Abbott, Max; Bhattacharjee, Rohit; Rush, Elaine; Suh, Flora Minsun; Theadom, Alice; Rathnasabapathy, Yogini; Te Ao, Braden; Parmar, Priya G; Anderson, Craig; Bonita, Ruth

2015-01-01

Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency

Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years: Results from the Global Burden of Disease Study 2013

NARCIS (Netherlands)

Barker-Collo, S.; Bennett, D.; Krishnamurthi, R.V.; Parmar, P.; Feigin, V.L.; Naghavi, M.R.; Forouzanfar, M.H.; Johnson, C.; Nguyen, G.; Mensah, G.A.; Vos, T.; Murray, C.J.; Roth, G.A.; Geleijnse, J.M.

2015-01-01

Background: Accurate information on stroke burden in men and women are important for evidence-based healthcare planning and resource allocation. Previously, limited research suggested that the absolute number of deaths from stroke in women was greater than in men, but the incidence and mortality

Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA.

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Hirsch, J A; Yoo, A J; Nogueira, R G; Verduzco, L A; Schwamm, L H; Pryor, J C; Rabinov, J D; González, R G

2009-07-01

Ischemic stroke is a major cause of disability and death in the USA. Intravenous tissue plasminogen activator (t-PA) remains underutilized. With the development of newer intra-arterial reperfusion therapies, there is increased opportunity to address the more devastating large-vessel occlusions. We seek to identify the numbers of patients with stroke treated with intravenous and intra-arterial therapies, as well as to estimate the potential number of intra-arterial cases in the foreseeable future. We performed a literature search to determine case volumes of intravenous t-PA use. We extrapolated the current case volume of intra-arterial stroke therapies from the numbers of cases in which the Merci retrieval device was used. In order to estimate the potential numbers of intra-arterial stroke cases, we characterized the percentage of patients with stroke who received intra-arterial therapy at two leading stroke centers. We applied these percentages to the numbers of patients with stroke seen at the top 100, 200 and 500 stroke centers by volume. The rate of intravenous t-PA use is 2.4-3.6%, resulting in 15 000-22 000 cases/year in the USA. The estimated case volume of intra-arterial therapies is 3500-7200 in 2006. Based on data from St. Luke's Brain and Stroke Institute and Massachusetts General Hospital, approximately 5-20% of patients with ischemic stroke can be treated with intra-arterial therapies. Extrapolating this to the top 500 stroke centers by volume, the potential number of intra-arterial cases in the USA is 10 400-41 500/year. Based on the current numbers of intra-arterial cases, our theoretical model identifies a potential for significant growth of this stroke therapy.

Executive function, but not memory, associates with incident coronary heart disease and stroke

DEFF Research Database (Denmark)

Rostamian, Somayeh; van Buchem, Mark A; Westendorp, Rudi G J

2015-01-01

OBJECTIVE: To evaluate the association of performance in cognitive domains executive function and memory with incident coronary heart disease and stroke in older participants without dementia. METHODS: We included 3,926 participants (mean age 75 years, 44% male) at risk for cardiovascular diseases...... from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) with Mini-Mental State Examination score ≥24 points. Scores on the Stroop Color-Word Test (selective attention) and the Letter Digit Substitution Test (processing speed) were converted to Z scores and averaged into a composite...... executive function score. Likewise, scores of the Picture Learning Test (immediate and delayed memory) were transformed into a composite memory score. Associations of executive function and memory were longitudinally assessed with risk of coronary heart disease and stroke using multivariable Cox regression...

Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

OpenAIRE

Grace Vincent-Onabajo; Taritei Moses

2016-01-01

Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...

ABCD2 score and BNP level in patients with TIA and cerebral stroke.

Science.gov (United States)

Mortezabeigi, H R; Taghizadeh, A; Talebi, M; Amini, K; Goldust, M

2013-11-01

Scoring systems have been designed to help physicians in early prediction of cerebral stroke following Transitional Ischemic Attack (TIA). ABCD2 system is one of these scoring systems. Considering increase of brain natriuretic peptide following cerebral ischemic stroke, BNP level may be associated with incidence of ischemic stroke following TIA. The present study evaluates ABCD2 score, BNP level in patients with TIA and incidence of cerebral stroke. This cross sectional-analytical study evaluated 78 patients with TIA. ABCD2 score was calculated for all patients based on some criteria including age, blood pressure, clinical manifestations (speech/motor disorder), symptoms duration and diabetes. BNP level was measured at the reference laboratory when the patient referred to the treatment center. The patients were followed up for 6 months considering incidence of cerebral stroke and TIA. Mean age of the patients was 66.53 +/- 13.08 years and the sample was consisted of 62.8% male and 37.2% female patients. Mean BNP level and mean ABCD2 score was 611.31 +/- 125.61 and 4.61 +/- 10.99 in all patients, respectively. During follow-up period, TIA recurrence and cerebral stroke were, respectively seen in 11.5 and 3.8% of cases. Mortality was reported in 5.1% of the patients. BNP was significantly higher in cases with recursive TIA (p = 0.03). But, there was not any difference considering ABCD2 score (p = 0.38). BNP is capable of predicting TIA recurrence following first TIA and it can be used in this case.

Adherence to a Healthy Nordic Diet and Risk of Stroke: A Danish Cohort Study.

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Hansen, Camilla Plambeck; Overvad, Kim; Kyrø, Cecilie; Olsen, Anja; Tjønneland, Anne; Johnsen, Søren Paaske; Jakobsen, Marianne Uhre; Dahm, Christina Catherine

2017-02-01

Specific dietary patterns, including the Mediterranean diet, have been associated with stroke prevention. Our aim was to investigate whether adherence to a healthy Nordic diet, including fish, apples and pears, cabbages, root vegetables, rye bread, and oatmeal, was associated with risk of stroke. Incident cases of stroke among 55 338 men and women from the Danish Diet, Cancer and Health cohort were identified from the Danish National Patient Register and verified by review of records. Cases of ischemic stroke were further subclassified based on etiology according to the TOAST classification system (Trial of Org 10172 in Acute Stroke Treatment). Information on diet was collected at baseline (1993-1997) using a semiquantitative food-frequency questionnaire. Cox proportional hazards models were used to estimate hazards ratios of total stroke and subtypes of ischemic and hemorrhagic stroke. During a median follow-up of 13.5 years, 2283 cases of incident stroke were verified, including 1879 ischemic strokes. Adherence to a healthy Nordic diet, as reflected by a higher Healthy Nordic Food Index score, was associated with a lower risk of stroke. The hazards ratio comparing an index score of 4 to 6 (high adherence) with an index score of 0 to 1 (low adherence) was 0.86 (95% confidence interval 0.76-0.98) for total stroke. Inverse associations were observed for ischemic stroke, including large-artery atherosclerosis. No trend was observed for hemorrhagic stroke; however, a statistically insignificant trend was observed for intracerebral hemorrhage. Our findings suggest that a healthy Nordic diet may be recommended for the prevention of stroke. © 2017 American Heart Association, Inc.

A clinical study on cognitive impairment in post-ischemic stroke patients with metabolic syndrome

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LI Chen

2012-02-01

Full Text Available Objective To explore the relation between metabolic syndrome (MetS and cognitive impairment after ischemic stroke. Methods Ninety-four cases of first ischemic stroke patients were divided into stroke without MetS group (n = 54 and stroke with MetS group (n = 40 according to the diagnostic criteria for MetS defined by Metabolic Syndrome Researching Group of Chinese Diabetes Society. All patients underwent Mini-Mental State Examination (MMSE, Clock Drawing Test (CDT, animal Verbal Fluency Test (aVFT, Trial Making Test-A (TMT-A at 2 weeks and 3 months after stroke to evaluate mental state such as verbal learning memory, and executive, attentional and visuospatial abilities. The incidence and development of cognitive impairment were also assessed. Results At 2 weeks and 3 months after stroke, the incidence of cognitive impairment were 24.47% (23/94 and 22.34% (21/94, respectively, and in the cognitive impairment patients the incidence of non-dementia were 21.28% (20/94 and 19.15% (18/94, while the incidence of dementia were 3.19% (3/94 and 3.19% (3/94, respectively. The incidence of cognitive impairment was higher in the stroke patients with MetS than the stroke patients without MetS, 37.50% (15/40 vs 14.81% (8/54 (Z = 2.500, P = 0.012 at 2 weeks after stroke and 35.00% (14/40 vs 12.96% (7/54 (Z = 2.513, P = 0.012 at 3 months after stroke. In the scores of MMSE, delay recall and CDT of the stroke patients with MetS were all lower than those without MetS at 2 weeks after stroke and at 3 months after stroke (P < 0.05, for all. The stroke patients with MetS had more cognition deterioration than the stroke patients without MetS at 3 months after stroke, the difference was significant (Z = 2.134, P = 0.033. Conclusion MetS can increase the incidence of cognitive impairment, especially non-dementia cognitive impairment in post ischemic stroke. Executive dysfunction and hypomnesis are often seen. The development of cognitive impairment in stroke patients

Relationship between weather conditions and admissions for ischemic stroke and subarachnoid hemorrhage.

Science.gov (United States)

Tarnoki, Adam D; Turker, Acar; Tarnoki, David L; Iyisoy, Mehmet S; Szilagyi, Blanka K; Duong, Hoang; Miskolczi, Laszlo

2017-02-28

To assess impacts of different weather conditions on hospitalizations of patients with ischemic strokes and subarachnoid hemorrhages (SAH) in South Florida. Diagnostic data of patients with spontaneous SAH and strokes were recorded between June 2010 and July 2013. Daily synchronous forecast charts were collected from the National Weather Service and the whole data were matched prospectively. The incidence rate ratio (IRR) was calculated. Increased incidence rate of ischemic stroke was consistent with the daily lowest and highest air pressure (IRR 1.03, P=0.128 and IRR 0.98, P=0.380, respectively), highest air temperature (IRR 0.99, P=0.375), and presence of hurricanes or storms (IRR 0.65, P=0.054). Increased incidence of SAH cases was consistent with daily lowest and highest air pressure (IRR 0.87, P<0.001 and IRR 1.08, P=0.019, respectively) and highest air temperature (IRR 0.98, P<0.001). Presence of hurricanes and/or tropical storms did not influence the frequency of SAH. We found no relationship between the presence of fronts and the admissions for ischemic stroke or SAH. Higher number of ischemic stroke and SAH cases can be expected with the daily lowest and highest air pressure, highest air temperature. Presence of hurricanes or tropical storms increased the risk of ischemic stroke but not the SAH. These findings can help to develop preventive health plans for cerebrovascular diseases.

Antipsychotic medications and stroke in schizophrenia: A case-crossover study.

Directory of Open Access Journals (Sweden)

Wen-Yin Chen

Full Text Available The association between antipsychotic use and the risk of stroke in schizophrenic patients is controversial. We sought to study the association in a nationwide cohort with schizophrenia.Using a retrospective cohort of patients with schizophrenia (N = 31,976 derived from the Taiwan National Health Insurance Research Database, 802 new-onset cases of stroke were identified within 10 years of follow-up (from 2000 through 2010. We designed a case-crossover study using 14-day windows to explore the risk factors of stroke and the association between antipsychotic drugs and the risk of stroke. We analyzed the risks of individual antipsychotics on various subgroups of stroke including ischemic, hemorrhagic, and other strokes, and the risks based on the antipsychotic receptor-binding profile of each drug.Use of any second-generation antipsychotic was associated with an increased risk of stroke (adjusted risk ratio = 1.45, P = .009 within 14 days while the use of any first-generation antipsychotic was not. Intriguingly, the use of any second-generation antipsychotic was associated with ischemic stroke but not hemorrhagic stroke. The antipsychotic receptor-binding profile analysis showed that the antihistamine 1 receptor was significantly associated with ischemic stroke (adjusted risk ratio = 1.72, P = .037, and the sensitivity analysis based on the 7-day window of exposure validated the association (adjusted risk ratio = 1.87, P = .015.Use of second-generation antipsychotic drugs appeared to be associated with an increased risk of ischemic stroke in the patients studied, possibly mediated by high affinity for histamine-1 receptor blockade. Further research regarding the underlying biological mechanism and drug safety is suggested.

Predictors of early neurological deterioration after ischaemic stroke: a case-control study.

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Barber, Mark; Wright, Fiona; Stott, David J; Langhorne, Peter

2004-01-01

Early neurological deterioration after ischaemic stroke (stroke in progression) is reported to be common and associated with poor outcome or death. The causes of progressing stroke are, however, uncertain. To determine whether prior drug treatment (with anticoagulant or antiplatelet agents) or early adverse physiological features (pyrexia, hypoxia, dehydration or hyperglycaemia) are associated with progressing ischaemic stroke. The study used a case-control design. From a database of 873 consecutive acute stroke admissions, 196 cases of progressing ischaemic stroke (defined by point deterioration in components of the Scandinavian Stroke Scale or death over the first 72 h after hospital admission) were matched to 196 controls on the basis of age and stroke type. Univariate and conditional logistic regression techniques were used to explore predictors of progressing stroke. Cases and controls were well matched for baseline stroke severity. Warfarin use prior to admission was associated with a reduced risk of progressing stroke [odds ratio (OR) 0.10, p = 0.005]. Prior antiplatelet use was not related. A previous history of diabetes (OR 2.11, p = 0.039) and elevated systolic blood pressure on admission (OR 1.01 for each 1 mm Hg rise, p = 0.017) predicted progressing stroke. Although there were no differences in time to presentation or to brain imaging, a visible causative lesion on CT scanning was more common in the progressing stroke group (OR 2.30, p = 0.022). We found no evidence that adverse physiological features were associated with progressing stroke. Outcomes were worse in the progressing stroke group with 70% being dead or dependent by 30 days compared to 55% in the control group (p = 0.002). Prior warfarin use may be protective against progressing ischaemic stroke. A previous history of diabetes along with elevated admission systolic blood pressure predict deterioration. We found no evidence for an association between adverse physiological features and

Subtypes and case-fatality rates of stroke: a hospital-based stroke registry in Taiwan (SCAN-IV).

Science.gov (United States)

Jeng, J S; Lee, T K; Chang, Y C; Huang, Z S; Ng, S K; Chen, R C; Yip, P K

1998-04-01

Stroke data bank can afford important information regarding risk factors, pathogenesis, prognosis, etc. By means of hospital-based stroke registry, we investigated the risk factors and case-fatality rates in different types of stroke and transient ischemic attack (TIA) patients at the National Taiwan University Hospital in 1995. After excluding ineligible patients, 995 patients aged 1-98 years (575 men and 420 women) were recruited. Men predominated in all age groups for stroke and TIA in general except for cerebral hemorrhage (CH) in patients aged or = 45 years. Of these, 676 (67.9%), 41 (4.1%), 228 (22.9%) and 50 (5%) patients were classified in the categories of cerebral infarction (CI), TIA, CH and SAH, respectively. The CI/CH ratio was 2.96. Hypertension remained one of the most important risk factors for CI, CH and TIA patients. Severe extracranial carotid artery stenosis (> or = 50%) was found in 12% of the CI patients and 27% of the TIA patients, but not found in the CH and SAH patients. Of these patients, the 30-day case-fatality rate was 10.9%, highest in SAH (30%), followed by CH (24.1%) and CI (5.6%). There were 41 in-hospital stroke patients who had significantly higher case-fatality rates than the other stroke patients (PTaiwan, there is a secular trend of increasing CI/CH ratios. These findings in Taiwan were compared with those in other populations, including other Asian, Caucasian and black populations. The CI/CH ratios in Asian populations, including Chinese, Japanese and Korean, were much lower than those in Caucasian and black populations. Dietary, environmental and genetic factors probably play important roles in these differences.

30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies

Science.gov (United States)

Feigin, Valery L.; Krishnamurthi, Rita V.; Barker-Collo, Suzanne; McPherson, Kathryn M.; Barber, P. Alan; Parag, Varsha; Arroll, Bruce; Bennett, Derrick A.; Tobias, Martin; Jones, Amy; Witt, Emma; Brown, Paul; Abbott, Max; Bhattacharjee, Rohit; Rush, Elaine; Suh, Flora Minsun; Theadom, Alice; Rathnasabapathy, Yogini; Te Ao, Braden; Parmar, Priya G.; Anderson, Craig; Bonita, Ruth

2015-01-01

Background Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. Methods Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981–1982, 1991–1992, 2002–2003 and 2011–2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. Results 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes

脑卒中后抑郁状态的相关因素分析%Relative factors analysis of depression after stroke

Institute of Scientific and Technical Information of China (English)

钟剑萍

2002-01-01

Objective To study the relative factors of concomitant depression after stroke.Methods Using Geriatric depression Scale(GDS) and SSS,we scored 121 storke cases who were treated from January 2001 to December 2001, in which 54 cases were concomitant with depression, assessed defect and promotion degree of nervous function, and observed relationship between number of lesion and onset of depression.Result Incidence of depression of cerebral hemarrhage patients was apparently higher than that of cerebral infarction patients (P0.05), incidence of concomitant depression of stroke patients with multiple lesions was apparently higher than that of stroke patients with single lesion.Conclusion Concomitant depression of stroke patients is related to location, number of lesions and severity of stroke.

Identification of stroke mimics among clinically diagnosed acute strokes.

Science.gov (United States)

Tuntiyatorn, Lojana; Saksornchai, Pichaya; Tunlayadechanont, Supoch

2013-09-01

Stroke is a clinically syndrome of a sudden onset of neurological deficit in a vascular cause. Stroke mimics is the non-vascular disorders with stroke-like clinical symptoms. It is important to distinguish true stroke from mimics since treatment plan may differ To determine the incidence of the stroke mimics and identify their etiologies. All non-contrast head CT of the patients with clinically diagnosed stroke who immediately received imaging upon arrival at the emergency department of the university hospital were retrospectively reviewed in 12-month period between January 1 and December 31, 2008. Medical records, laboratory results, MRI, and 6-month clinical follow-up records were reviewed for final diagnosis. Seven hundred four patients were included in this study, including 363 (51.5%) men and 341 (48.5%) women with range in age from 24 to 108 years. Amongst those, 417 (59.2%) were ischemic stroke, 80 (11.40%) were hemorrhagic stroke, 186 (26.4%) were stroke-mimics, and 21 (3%) were inconclusive. The etiologies among stroke-mimics were metabolic/intoxication (35, 18.8%), sepsis (28, 15.0%), seizure (21, 11.3%), syncope (20, 10.8%), subdural hemorrhage (14, 7.5%), vertigo (11, 6.0%), brain tumor (10, 5.30%), central nervous system infection (5, 2.7%), others (26, 14.0%), and unspecified (16, 8.6%). Incidence rates and etiologies of the stroke mimics were similar to the western reports. However the frequency of each mimic was not.

Common genetic variation in six lipid-related and statin-related genes, statin use and risk of incident nonfatal myocardial infarction and stroke.

Science.gov (United States)

Hindorff, Lucia A; Lemaitre, Rozenn N; Smith, Nicholas L; Bis, Joshua C; Marciante, Kristin D; Rice, Kenneth M; Lumley, Thomas; Enquobahrie, Daniel A; Li, Guo; Heckbert, Susan R; Psaty, Bruce M

2008-08-01

Genetic polymorphisms are associated with lipid-lowering response to statins, but generalizeability to disease endpoints is unclear. The association between 82 common single nucleotide polymorphisms (SNPs) in six lipid-related or statin-related genes (ABCB1, CETP, HMGCR, LDLR, LIPC, NOS3) and incident nonfatal myocardial infarction (MI) and ischemic stroke was analyzed according to current statin use and overall in a population-based case-control study (856 MI, 368 stroke, 2686 controls). Common SNPs were chosen from resequencing data using pairwise linkage disequilibrium. Gene-level analyses (testing global association within a gene) and SNP-level analyses (comparing the number of observed vs. expected associations across all genes) were performed using logistic regression, setting nominal statistical significance at P value of less than 0.05. No gene-level interactions with statin use on MI or stroke were identified. Across all genes, two SNP-statin interactions on MI were observed (one ABCB1, one LIPC) and five interactions on stroke (one CETP, four LIPC). The strongest SNP-statin interaction was for synonymous CETP SNP rs5883 on stroke (P=0.008). Gene-level associations were present for LIPC and MI (P=0.026), but not other genes or outcomes. SNP-level associations included three SNPs with MI (one LDLR, two LIPC) and two SNPs with stroke (one CETP, one LDLR). The number of observed SNP associations was no greater than expected by chance. Several potential novel associations or interactions of SNPs in ABCB1, CETP, LDLR, and LIPC with MI and stroke were identified; however, our results should be regarded as hypothesis generating until corroborated by other studies.

Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN: a case-control study

Directory of Open Access Journals (Sweden)

Mayowa O Owolabi, ProfDrMed

2018-04-01

Full Text Available Summary: Background: Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub-Saharan Africa. Methods: The Stroke Investigative Research and Educational Network (SIREN study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs and population-attributable risks (PARs with 95% CIs. Findings: Between Aug 28, 2014, and June 15, 2017, we enrolled 2118 case-control pairs (1192 [56%] men with mean ages of 59·0 years (SD 13·8 for cases and 57·8 years (13·7 for controls. 1430 (68% had ischaemic stoke, 682 (32% had haemorrhagic stroke, and six (<1% had discrete ischaemic and haemorrhagic lesions. 98·2% (95% CI 97·2–99·0 of adjusted PAR of stroke was associated with 11 potentially modifiable risk factors with ORs and PARs in descending order of PAR of 19·36 (95% CI 12·11–30·93 and 90·8% (95% CI 87·9–93·7 for hypertension, 1·85 (1·44–2·38 and 35·8% (25·3–46·2 for dyslipidaemia, 1·59 (1·19–2·13 and 31·1% (13·3–48·9 for regular meat consumption, 1·48 (1·13–1·94 and 26·5% (12·9–40·2 for elevated waist-to-hip ratio, 2·58 (1·98–3·37 and 22·1% (17·8–26·4 for diabetes, 2·43 (1·81–3·26 and 18·2% (14·1–22·3 for low green leafy vegetable consumption, 1·89 (1·40–2·54 and 11·6% (6·6–16·7

Increase of Meningitis Risk in Stroke Patients in Taiwan

Directory of Open Access Journals (Sweden)

Chie-Hong Wang

2018-03-01

Full Text Available Background and purposeThe blood–brain barrier (BBB not only provides a physical obstruction but also recruits and activates neutrophils in cases of infection. Hemorrhagic or ischemic stroke reportedly induces the disruption of the BBB. However, few studies have reported a correlation between the incidence of meningitis in patients with a history of stroke. This study tested the hypothesis that patients with a history of stroke may be more vulnerable to meningitis.MethodsStroke and age-matched comparison (n = 29,436 and 87,951, respectively cohorts were recruited from the Taiwan National Health Insurance database (2000–2011. Correlations between the two cohorts were evaluated by Cox proportional hazard regression model, Kaplan–Meier curve, and log-rank tests.ResultsThe incidence of meningitis was higher in the stroke cohort compared to that in the comparison cohort [hazard ratio (HR, 2.89; 95% confidence interval (CI, 2.23–3.74, p < 0.001]. After adjusting for age, sex, and comorbidities, the estimated HR in the stroke cohort was 2.55-fold higher than that in the comparison cohort (CI, 1.94–3.37; p < 0.001. Notably, patients who had experienced hemorrhagic stroke had a higher incidence rate of meningitis than those with a history of ischemic stroke, except for patients older than 75 years (incidence rates in hemorrhagic/ischemic stroke patients, 3.14/1.48 in patients younger than 45 years, 1.52/0.41 in 45- to 64-year group, 1.15/0.90 in 65- to 74-year group, 0.74/0.93 in patients older than 75 years. Moreover, stroke patients who had undergone head surgery had the highest meningitis risk (adjusted HR, 8.66; 95% CI, 5.55–13.5; p < 0.001 followed by stroke patients who had not undergone head surgery (adjusted HR, 2.11; 95% CI, 1.57–2.82; p < 0.001.ConclusionOur results indicated that stroke patients have higher risks of meningitis. Compromised BBB integrity in stroke patients may lead to increased

Basic characteristics of hospital stroke services in Eastern Hungary

International Nuclear Information System (INIS)

Mihalka, Laszlo; Fekete, Istvan; Csepany, Tuende; Csiba, Laszlo; Bereczki, Daniel

1999-01-01

Stroke mortality is extremely high in Central-Eastern European countries. We report basic characteristics of a stroke unit in Eastern Hungary, including age and sex distribution; the proportion of transient ischemic attacks (TIA), ischemic and hemorrhagic strokes; case fatality; application of diagnostic methods; and length of stay for all patients treated with acute cerebrovascular disease over a 12-month period. Records of all patients with acute cerebrovascular disease (n = 522) discharged in 1995 from a stroke unit with a well defined catchment area of 220,000 inhabitants in Eastern Hungary were retrospectively analyzed. Case fatality was 18.6% for all patients and 21.1% after excluding cases with TIA. Computer tomography, duplex carotid ultrasound, cerebrospinal fluid examination and electroencephalography were performed in 79%, 77%, 7% and 2% of the patients, respectively. The database of the university hospital with the same catchment area was electronically searched for patients who were discharged with the diagnosis of stroke from the three departments of internal medicine. Stroke mortality data of the catchment area based on death certificates was obtained from the Central Statistical Bureau. Two hundred twenty-eight stroke deaths were reported in the catchment area in 1995. In the same period 97 stroke deaths occurred at the stroke unit and 76 at the departments of internal medicine. If we aim to treat all patients with acute stroke at the stroke unit, with the present stroke incidence and duration of hospital stay the current capacity of the stroke unit (1 bed per 10.000 inhabitants) should be doubled

Rationale and design of INTERSTROKE: a global case-control study of risk factors for stroke

DEFF Research Database (Denmark)

O'Donnell, M; Serpault, Damien Xavier; Diener, C

2010-01-01

with a first stroke within 72 h of hospital presentation in whom CT or MRI is performed. Proxy respondents are used for cases unable to communicate. Etiological and topographical stroke subtype is documented for all cases. Controls are hospital- and community-based, matched for gender, ethnicity and age (+/-5...... years). A questionnaire (cases and controls) is used to acquire information on known and proposed risk factors for stroke. Cardiovascular (e.g. blood pressure) and anthropometric (e.g. waist-to-hip ratio) measurements are obtained at the time of interview. Nonfasting blood samples and random urine......-income countries is inadequate, where a very large burden of stroke occurs. Accordingly, a similar epidemiological study is required for stroke, to inform effective population-based strategies to reduce the risk of stroke. Methods: INTERSTROKE is an international, multicenter case-control study. Cases are patients...

Traffic-related air pollution exposure and incidence of stroke in four cohorts from Stockholm.

Science.gov (United States)

Korek, Michal J; Bellander, Tom D; Lind, Tomas; Bottai, Matteo; Eneroth, Kristina M; Caracciolo, Barbara; de Faire, Ulf H; Fratiglioni, Laura; Hilding, Agneta; Leander, Karin; Magnusson, Patrik K E; Pedersen, Nancy L; Östenson, Claes-Göran; Pershagen, Göran; Penell, Johanna C

2015-01-01

We investigated the risk of stroke related to long-term ambient air pollution exposure, in particular the role of various exposure time windows, using four cohorts from Stockholm County, Sweden. In total, 22,587 individuals were recruited from 1992 to 2004 and followed until 2011. Yearly air pollution levels resulting from local road traffic emissions were assessed at participant residences using dispersion models for particulate matter (PM10) and nitrogen oxides (NOX). Cohort-specific hazard ratios were estimated for time-weighted air pollution exposure during different time windows and the incidence of stroke, adjusted for common risk factors, and then meta-analysed. Overall, 868 subjects suffered a non-fatal or fatal stroke during 238,731 person-years of follow-up. An increment of 20 μg/m(3) in estimated annual mean of road-traffic related NOX exposure at recruitment was associated with a hazard ratio of 1.16 (95% CI 0.83-1.61), with evidence of heterogeneity between the cohorts. For PM10, an increment of 10 μg/m(3) corresponded to a hazard ratio of 1.14 (95% CI 0.68-1.90). Time-window analyses did not reveal any clear induction-latency pattern. In conclusion, we found suggestive evidence of an association between long-term exposure to NOX and PM10 from local traffic and stroke at comparatively low levels of air pollution.

Interventions for preventing falls in people after stroke.

NARCIS (Netherlands)

Verheyden, G.S.; Weerdesteijn, V.G.M.; Pickering, R.M.; Kunkel, D.; Lennon, S.; Geurts, A.C.H.; Ashburn, A.

2013-01-01

BACKGROUND: Falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. OBJECTIVES: To evaluate

Fatigue after stroke: the development and evaluation of a case definition.

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Lynch, Joanna; Mead, Gillian; Greig, Carolyn; Young, Archie; Lewis, Susan; Sharpe, Michael

2007-11-01

While fatigue after stroke is a common problem, it has no generally accepted definition. Our aim was to develop a case definition for post-stroke fatigue and to test its psychometric properties. A case definition with face validity and an associated structured interview was constructed. After initial piloting, the feasibility, reliability (test-retest and inter-rater) and concurrent validity (in relation to four fatigue severity scales) were determined in 55 patients with stroke. All participating patients provided satisfactory answers to all the case definition probe questions demonstrating its feasibility For test-retest reliability, kappa was 0.78 (95% CI, 0.57-0.94, Pdefinition also had substantially higher fatigue scores on four fatigue severity scales (Pvalidity. The proposed case definition is feasible to administer and reliable in practice, and there is evidence of concurrent validity. It requires further evaluation in different settings.

Pre-Stroke Weight Loss is Associated with Post-Stroke Mortality among Men in the Honolulu-Asia Aging Study

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Bell, Christina L.; Rantanen, Taina; Chen, Randi; Davis, James; Petrovitch, Helen; Ross, G. Webster; Masaki, Kamal

2013-01-01

Objective To examine baseline pre-stroke weight loss and post-stroke mortality among men. Design Longitudinal study of late-life pre-stroke body mass index (BMI), weight loss and BMI change (midlife to late-life), with up to 8-year incident stroke and mortality follow-up. Setting Honolulu Heart Program/Honolulu-Asia Aging Study. Participants 3,581 Japanese-American men aged 71–93 years and stroke-free at baseline. Main Outcome Measure Post-stroke Mortality: 30-day post-stroke, analyzed with stepwise multivariable logistic regression and long-term post-stroke (up to 8-year), analyzed with stepwise multivariable Cox regression. Results Weight loss (10-pound decrements) was associated with increased 30-day post-stroke mortality (aOR=1.48, 95%CI 1.14–1.92), long-term mortality after incident stroke (all types n=225, aHR=1.25, 95%CI=1.09–1.44) and long-term mortality after incident thromboembolic stroke (n=153, aHR 1.19, 95%CI-1.01–1.40). Men with overweight/obese late-life BMI (≥25kg/m2, compared to normal/underweight BMI) had increased long-term mortality after incident hemorrhagic stroke (n=54, aHR=2.27, 95%CI=1.07–4.82). Neither desirable nor excessive BMI reductions (vs. no change/increased BMI) were associated with post-stroke mortality. In the overall sample (n=3,581), nutrition factors associated with increased long-term mortality included 1) weight loss (10-pound decrements, aHR=1.15, 1.09–1.21); 2) underweight BMI (vs. normal BMI, aHR=1.76, 1.40–2.20); and 3) both desirable and excessive BMI reductions (vs. no change or gain, separate model from weight loss and BMI, aHRs=1.36–1.97, pstroke incidence, pre-stroke weight loss was associated with increased post-stroke (all types and thromboembolic) mortality. Overweight/obese late-life BMI was associated with increased post-hemorrhagic stroke mortality. Desirable and excessive BMI reductions were not associated with post-stroke mortality. Weight loss, underweight late-life BMI and any BMI

Dancing to death: A case of heat stroke.

Science.gov (United States)

Nadesan, K; Kumari, Chandra; Afiq, Mohd

2017-08-01

Heat stroke is a medical emergency which may lead to mortality unless diagnosed early and treated effectively. Heat stroke may manifest rapidly, hence making it difficult to differentiate it from other clinical causes in a collapsed victim. 1 We are presenting a case report of twelve patients who were admitted to our emergency department from a music festival held on 13-15th of March 2014. They developed complications arising from a combination of severe adverse weather condition, prolonged outdoor physical exertion due to long hours of dancing and drug-use, resulting in heat stroke. Three of them died while the remaining patients survived. Their condition was initially misdiagnosed as a classical illicit drug overdose. This was based on the history of drug ingestion by some of the patients who attended the music festival on that day. The information in this case report aims, to create awareness amongst members of the medical team on duty in outdoor events, pre hospital responders and ED physicians when treating and managing similar cases in the future. In addition it is intended to warn the organizers of such events to take adequate precautions to avoid such tragedies in the future. Copyright © 2017. Published by Elsevier Ltd.

Low Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients - Insight From the Fushimi AF Registry.

Science.gov (United States)

Hamatani, Yasuhiro; Ogawa, Hisashi; Uozumi, Ryuji; Iguchi, Moritake; Yamashita, Yugo; Esato, Masahiro; Chun, Yeong-Hwa; Tsuji, Hikari; Wada, Hiromichi; Hasegawa, Koji; Abe, Mitsuru; Morita, Satoshi; Akao, Masaharu

2015-01-01

Japanese patients with atrial fibrillation (AF) are generally small and lean, but knowledge of the clinical characteristics of those with low body weight (LBW: ≤50 kg) is limited. The Fushimi AF Registry is a community-based prospective survey of AF patients who visited the participating medical institutions in Fushmi-ku, Japan. The BW and follow-up data were available for 2,945 patients. We compared the background and the incidence of clinical events during a median follow-up of 746 days between a LBW and non-LBW group. Patients in the LBW group accounted for 26.8% (788 patients) of the total. The LBW group was more often female, older, and had higher CHADS2score. The incidence of stroke/systemic embolism (SE) during follow-up was higher in the LBW group (hazard ratio (HR): 2.19, 95% confidence interval (CI): 1.57-3.04; Pincidence of stroke/SE, but the incidence of major bleeding was not particularly high.

mStroke: "Mobile Stroke"-Improving Acute Stroke Care with Smartphone Technology.

Science.gov (United States)

Andrew, Benjamin Y; Stack, Colleen M; Yang, Julian P; Dodds, Jodi A

2017-07-01

This study aimed to evaluate the effect of method and time of system activation on clinical metrics in cases utilizing the Stop Stroke (Pulsara, Inc.) mobile acute stroke care coordination application. A retrospective cohort analysis of stroke codes at 12 medical centers using Stop Stroke from March 2013 to May 2016 was performed. Comparison of metrics (door-to-needle time [DTN] and door-to-CT time [DTC], and rate of DTN ≤ 60 minutes [goal DTN]) was performed between subgroups based on method (emergency medical service [EMS] versus emergency department [ED]) and time of activation. Effects were adjusted for confounders (age, sex, National Institutes of Health Stroke Scale [NIHSS] score) using multiple linear and logistic regression. The final dataset included 2589 cases. Cases activated by EMS were more severe (median NIHSS score 8 versus 4, P technology provides unique insight into acute stroke codes. Activation of mobile electronic stroke coordination in the field appears to promote a more expedited and successful care process. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Lifestyle Factors and Gender-Specific Risk of Stroke in Adults with Diabetes Mellitus: A Case-Control Study.

Science.gov (United States)

Guo, Jian; Guan, Tianjia; Shen, Ying; Chao, Baohua; Li, Mei; Wang, Longde; Liu, Yuanli

2018-07-01

The lifestyle interventions are effective preventive measures for stroke in general population, and the stroke risk with lifestyle factors may be modified by gender, health conditions, etc. Therefore, we conducted a case-control study to investigate the gender-specific association between stroke risk and lifestyle factors in adults with diabetes based on the China National Stroke Screening Survey. Structured questionnaires were used to collect demographic data and information regarding lifestyle factors, history of chronic medical conditions, and family history of stroke and the status of treatment. The case group comprised individuals diagnosed with first-ever stroke in 2013-2014 screening period. Their corresponding controls (frequency-matched for age group and urban/rural ratio) were randomly selected from individuals with diabetes without stroke. There were 170 total stroke cases (500 controls) and 152 ischemic stroke cases (456 controls) among men with diabetes, and 183 total stroke cases (549 controls) and 168 ischemic stroke cases (504 controls) among women with diabetes. We found that physical inactivity was significantly associated with increased risk of total stroke (odds ratio [OR] = 1.50, 95% confidence interval [CI] 1.02-2.21) and of ischemic stroke (OR = 1.57, 95% CI 1.04-2.36) in women with diabetes. We found no significant association of smoking, overweight/obesity, or physical inactivity with risk of total or ischemic stroke in men with diabetes. Among the lifestyle factors of smoking, overweight/obesity, and physical inactivity, physical inactivity might increase the risk of total and ischemic stroke in women with diabetes. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Is age-related macular degeneration associated with stroke among elderly americans?

Science.gov (United States)

Liao, Duanping; Mo, Jingping; Duan, Yinkang; Klein, Ronald; Scott, Ingrid U; Huang, Kui A; Zhou, Haibo

2008-03-08

To investigate whether age-related macular degeneration (AMD) is associated with the development of ischemic and hemorrhagic stroke among elderly Americans. Population-based cohort study. The five percent random sample of 2000-2003 Medicare enrollees was obtained. The cohort (n=1,519,086) consisted of enrollees who were aged 65 or older at the first two-year (January 1, 2000 to December 31, 2001). Baseline demographic variables and chronic conditions (AMD and type, history of myocardial infarction (MI), stroke, hypertension, and diabetes) were defined based on the occurrence of relevant ICD-9 codes in relevant diagnosis fields of the baseline Medicare Data. We excluded 215,900 persons who had a diagnosis of MI or stroke during baseline period to form a cohort of 1,303,186 individuals who were free of major cardio-cerebral vascular disease (CVD) at baseline. In two years of follow-up (January 1, 2002 to December 31, 2003), a total of 89,501 incident stroke cases were identified, including 80,018 ischemic, 7048 hemorrhagic, and 2,435 stroke cases of both types. Baseline mean age was 75 years (Standard Divination=7.7), with 60% women and 88% whites. The prevalence of AMD was 10.6%, with 19.7% being neovascular AMD and 80.3% being non-neovascular AMD. Baseline age, gender, race, hypertension, and diabetes adjusted 2-year incident odds ratios and 95% confidence internal of stroke associated with AMD were 1.31 (1.26, 1.36) for neovascular AMD, 1.18 (1.15, 1.21) for non-neovascular AMD, and 1.21 (1.18, 1.23) for either neovascular or non-neovascular AMD. The findings are suggestive of an association between AMD, especially neovascular AMD, and incident stroke, independent of demographic factors and co-morbidity. These findings, if confirmed by other studies that control for smoking and other lifestyle covariables not measured in this study, suggest the possibility of shared common antecedents between stroke and AMD.

Thromboxane biosynthesis in stroke and post-stroke dementia

NARCIS (Netherlands)

F. van Kooten (Fop)

2002-01-01

textabstractWith 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic

Stroke and methamphetamine use in young adults: a review.

Science.gov (United States)

Lappin, Julia M; Darke, Shane; Farrell, Michael

2017-12-01

Methamphetamine use and stroke are significant public health problems. Strokes among people aged below 45 years are much less common than in older age groups but have significant mortality and morbidity. Methamphetamine is a putative cause of strokes among younger people. A review of methamphetamine-related strokes was conducted. Bibliographic databases were searched until February 2017 for articles related to methamphetamine and stroke. Both haemorrhagic and ischaemic strokes were considered. Of 370 articles screened, 77 were selected for inclusion. There were 81 haemorrhagic and 17 ischaemic strokes reported in case reports and series. Both types were approximately twice as common in males. Route of administration associated with haemorrhagic stroke was typically oral or injecting, but for ischaemic stroke inhalation was most common. Haemorrhagic stroke was associated with vascular abnormalities in a third of cases. One quarter of individuals completely recovered, and a third died following haemorrhagic stroke. One-fifth completely recovered, and one-fifth died following ischaemic stroke. There is a preponderance of haemorrhagic strokes associated with methamphetamine use in young people, and methamphetamine-related stroke is associated with poor clinical outcomes. Mechanisms of methamphetamine-associated stroke include hypertension, vasculitis, direct vascular toxicity and vasospasm. In a period of rising worldwide methamphetamine use, the incidence of methamphetamine-related stroke will increase, with a consequent increase in the burden of disease contributed by such events. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The analysis of hyper-homocysteine incidence rate and multi-risk factors in 200 patients with cerebral stroke

International Nuclear Information System (INIS)

Ding Xiudong; Yang Jianghui; Huo Aimei; Wang Yan; Chu Yanchuang; Dong Mei

2009-01-01

To investigate the hyperhomocysteine incidence rate and clinical significance in 200 patients with cerebral stroke, the serum homocysteine, fibrinogen, C-reaction protein, cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol levels in 200 patients with cerebral stroke and 100 normal healthy controls were detected. The results showed that both serum homocysteine and plasma FIB levels in patients with cerebral infarction and intracerebral hemorrhage were significantly higher than those in controls (P 0.05). The hyper-homocysteinemia is an independent risk factor for cerebral stoke, and hyperhomocysteine may lead to the increase of Fibrinogen level, which is one of the important reasons for the high blood viscosity in the cerebral infarction patients. (authors)

Stroke Risk and Mortality in Patients With Ventricular Assist Devices.

Science.gov (United States)

Parikh, Neal S; Cool, Joséphine; Karas, Maria G; Boehme, Amelia K; Kamel, Hooman

2016-11-01

Ventricular assist devices (VADs) have advanced the management of end-stage heart failure. However, these devices are associated with hemorrhagic and thrombotic complications, including stroke. We assessed the incidence, risk factors, and outcomes of ischemic and hemorrhagic stroke after VAD placement. Using administrative claims data from acute care hospitals in California, Florida, and New York from 2005 to 2013, we identified patients who underwent VAD placement, defined by the International Classification of Diseases, Ninth Revision, Clinical Modification code 37.66. Ischemic and hemorrhagic strokes were identified by previously validated coding algorithms. We used survival statistics to determine the incidence rates and Cox proportional hazard analyses to examine the associations. Among 1813 patients, we identified 201 ischemic strokes and 116 hemorrhagic strokes during 3.4 (±2.0) years of follow-up after implantation of a VAD. The incidence of stroke was 8.7% per year (95% confidence interval [CI], 7.7-9.7). The annual incidence of ischemic stroke (5.5%; 95% CI, 4.8-6.4) was nearly double that of hemorrhagic stroke (3.1%; 95% CI, 2.6-3.8). Women faced a higher hazard of stroke than men (hazard ratio, 1.6; 95% CI, 1.2-2.1), particularly hemorrhagic stroke (hazard ratio, 2.2; 95% CI, 1.4-3.4). Stroke was strongly associated with subsequent in-hospital mortality (hazard ratio, 6.1; 95% CI, 4.6-7.9). The incidence of stroke after VAD implantation was 8.7% per year, and incident stroke was strongly associated with subsequent in-hospital mortality. Notably, ischemic stroke occurred at nearly twice the rate of hemorrhagic stroke. Women seemed to face a higher risk for hemorrhagic stroke than men. © 2016 American Heart Association, Inc.

The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study

Directory of Open Access Journals (Sweden)

Fattore Giovanni

2012-11-01

costs while functional outcomes (Barthel Index and Modified Ranking Scale scores were significantly associated with both healthcare and societal costs at one year. Conclusions The significant role of informal care in stroke management and different distribution of costs over time suggest that appropriate planning should look at both incident and prevalent stroke cases to forecast health infrastructure needs and more importantly, to assure that stroke patients have adequate “social” support.

Paraneoplastic Ischemic Stroke: Case Report and Review

Directory of Open Access Journals (Sweden)

Murat Sumer

2008-10-01

Full Text Available OBJECTIVE: Paraneoplastic etiology is not frequent among cerebrovascular disorders. This rare disorder is interesting with different mechanisms, clinical manifestations and treatment options. Diagnosis may be overlooked for its rarity. We present a paraneoplastic ischemic stroke patient with its clinical and imaging characteristics for recalling this rare disease. CASE: A sixty years old woman with a history of ovarian and colon cancer and liver metastasis admitted with acute left sided hemiplegia. Brain magnetic resonance imaging showed multiple ischemic lesions at the same age. Laboratory findings were compatible with chronic disseminated intravascular coagulopathy. She was anticoagulated but the clinical findings were not changed. She died one month after her discharge from the hospital. CONCLUSIONS: Paraneoplastic ischemic stroke is rare and it should be recognized by the clinician to differentiate from other ischemic strokes by its different mechanisms, imaging characteristics and treatment modalities. Prognosis depends on the characteristics of the primary tumor

Variability in Clinical Presentation of Neonatal Stroke: Report of Four Cases

OpenAIRE

Joseph, Sonia; Angelis, Dimitrios; Bennett, Robert; Kola, Bhargavi; Hughes, Amanda

2017-01-01

Neonatal stroke can be a cause of long term neurodevelopmental disability, seizures, and impaired cognitive function. We present four cases of neonatal stroke, associated with different risk factors and clinical presentations. Two of these newborns were born to mothers with no prenatal care.

Zone specific fractal dimension of retinal images as predictor of stroke incidence.

Science.gov (United States)

Aliahmad, Behzad; Kumar, Dinesh Kant; Hao, Hao; Unnikrishnan, Premith; Che Azemin, Mohd Zulfaezal; Kawasaki, Ryo; Mitchell, Paul

2014-01-01

Fractal dimensions (FDs) are frequently used for summarizing the complexity of retinal vascular. However, previous techniques on this topic were not zone specific. A new methodology to measure FD of a specific zone in retinal images has been developed and tested as a marker for stroke prediction. Higuchi's fractal dimension was measured in circumferential direction (FDC) with respect to optic disk (OD), in three concentric regions between OD boundary and 1.5 OD diameter from its margin. The significance of its association with future episode of stroke event was tested using the Blue Mountain Eye Study (BMES) database and compared against spectrum fractal dimension (SFD) and box-counting (BC) dimension. Kruskal-Wallis analysis revealed FDC as a better predictor of stroke (H = 5.80, P = 0.016, α = 0.05) compared with SFD (H = 0.51, P = 0.475, α = 0.05) and BC (H = 0.41, P = 0.520, α = 0.05) with overall lower median value for the cases compared to the control group. This work has shown that there is a significant association between zone specific FDC of eye fundus images with future episode of stroke while this difference is not significant when other FD methods are employed.

Genetic predisposition to coronary heart disease and stroke using an additive genetic risk score: A population-based study in Greece

Science.gov (United States)

Yiannakouris, N.; Katsoulis, M.; Dilis, V.; Parnell, L.D.; Trichopoulos, D.; Ordovas, J.M.; Trichopoulou, A.

2012-01-01

Objective To determine the extent to which the risk for incident coronary heart disease (CHD) increases in relation to a genetic risk score (GRS) that additively integrates the influence of high-risk alleles in nine documented single nucleotide polymorphisms (SNPs) for CHD, and to examine whether this GRS also predicts incident stroke. Methods Genotypes at nine CHD-relevant SNPs were determined in 494 cases of incident CHD, 320 cases of incident stroke and 1345 unaffected controls drawn from the population-based Greek component of the European Prospective Investigation into Cancer and nutrition (EPIC) cohort. An additive GRS was calculated for each study participant by adding one unit for the presence of each high-risk allele multiplied by the estimated effect size of that allele in the discovery samples. Statistical analysis was performed using logistic regression. Results The GRS was significantly associated with the incidence of CHD where the odds of CHD incidence in the highest quintile of the GRS were 1.74 times higher (95% confidence interval [CI] = 1.25–2.43, p for trend = 0.0004), compared to the lowest quintile. With respect to stroke, a weaker and non-significant positive association with GRS was apparent as the odds of stroke incidence in the highest quintile of the GRS were 1.36 times higher (95% CI = 0.90–2.06, p for trend = 0.188), compared to the lowest quintile. Conclusion A GRS relying on nine documented “CHD-specific” SNPs is significantly predictive of CHD but it was not found to be statistically significantly associated with incident stroke. PMID:22429504

Percutaneous atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

DEFF Research Database (Denmark)

Munkholm-Larsen, Stine; Cao, Christopher; Yan, Tristan D

2012-01-01

databases. Fourteen studies were identified for evaluation. Overall, implantation was successful in 93% of all cases. Periprocedural mortality and stroke rates were 1.1% and 0.6%, respectively. The incidences of pericardial effusion/cardiac tamponade and device embolisation were 4% and 0.7%, respectively....... At the time of the latest follow-up (up to 40 months), the overall incidence of stroke among all studies was 1.4% per annum. Existing evidence suggests that PLAAO is a relatively safe treatment for patients with AF. However, there is a need for further evaluation of its efficacy in the form of large and well...

Stroke in young adults: about 128 cases | Chraa | Pan African ...

African Journals Online (AJOL)

Ischemic stroke is rare in young adults, but it is genuinely a serious situation giving the fact that it touch a very active part of our society. We report a series of 128 cases. The purpose is to analyze the risk factors, etiologies and outcomes of ischemic stroke in young adults in Marrakesh. Retrospective study performed at the ...

Is Age-Related Macular Degeneration Associated with Stroke Among Elderly Americans?§

Science.gov (United States)

Liao, Duanping; Mo, Jingping; Duan, Yinkang; Klein, Ronald; Scott, Ingrid U; Huang, Kui A; Zhou, Haibo

2008-01-01

Objective: To investigate whether age-related macular degeneration (AMD) is associated with the development of ischemic and hemorrhagic stroke among elderly Americans. Design: Population-based cohort study. Participants: The five percent random sample of 2000-2003 Medicare enrollees was obtained. The cohort (n=1,519,086) consisted of enrollees who were aged 65 or older at the first two-year (January 1, 2000 to December 31, 2001). Methods: Baseline demographic variables and chronic conditions (AMD and type, history of myocardial infarction (MI), stroke, hypertension, and diabetes) were defined based on the occurrence of relevant ICD-9 codes in relevant diagnosis fields of the baseline Medicare Data. We excluded 215,900 persons who had a diagnosis of MI or stroke during baseline period to form a cohort of 1,303,186 individuals who were free of major cardio-cerebral vascular disease (CVD) at baseline. Main Outcome Measures: In two years of follow-up (January 1, 2002 to December 31, 2003), a total of 89,501 incident stroke cases were identified, including 80,018 ischemic, 7048 hemorrhagic, and 2,435 stroke cases of both types. Results: Baseline mean age was 75 years (Standard Divination=7.7), with 60% women and 88% whites. The prevalence of AMD was 10.6%, with 19.7% being neovascular AMD and 80.3% being non-neovascular AMD. Baseline age, gender, race, hypertension, and diabetes adjusted 2-year incident odds ratios and 95% confidence internal of stroke associated with AMD were 1.31 (1.26, 1.36) for neovascular AMD, 1.18 (1.15, 1.21) for non-neovascular AMD, and 1.21 (1.18, 1.23) for either neovascular or non-neovascular AMD. Conclusion: The findings are suggestive of an association between AMD, especially neovascular AMD, and incident stroke, independent of demographic factors and co-morbidity. These findings, if confirmed by other studies that control for smoking and other lifestyle covariables not measured in this study, suggest the possibility of shared common

Ischemic Stroke Following Multiple Traumas in a Child: A Case Report

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Pei-Jung Lin

2006-04-01

Full Text Available Stroke is an uncommon disorder in children but an increasingly recognized cause of disability. Acute stroke may be attributable to trauma, but this topic is seldom discussed. In limited reports, most ischemic strokes following trauma were detected after a considerable delay. Early recognition of stroke following trauma might reduce secondary neurologic complications. We report a case of posterior cerebral artery area infarct following multiple traumas in a child. A comprehensive etiologic survey was undertaken and discussed. Although the definite pathogenesis is still unclear, adequate, individualized, and uncomplicated management can significantly affect the outcome.

Stroke in Patients With Acute Coronary Syndromes: Incidence and Outcomes in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial

NARCIS (Netherlands)

K.W. Mahaffey (Kenneth); C.M. MacAulay; R.A. Harrington (Robert Alex); M.L. Simoons (Maarten); C.B. Granger (Christopher); R.M. Califf (Robert); C. Graffagnino (Carmen); M.J. Alberts; D.T. Laskowitz; E.J. Topol (Eric); J.M. Miller; M.A. Sloan (Michael); L.G. Berdan (Lisa); A.M. Lincoff (Michael); J.W. Deckers (Jaap)

1999-01-01

textabstractBACKGROUND: The incidence of stroke in patients with acute coronary syndromes has not been clearly defined because few trials in this patient population have been large enough to provide stable estimates of stroke rates. METHODS AND RESULTS: We studied the 10 948

[Stroke in young adults: incidence and clinical picture in 280 patients according to their aetiological subtype].

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Arboix, Adrià; Massons, Joan; García-Eroles, Luís; Oliveres, Montserrat

2016-03-04

To assess the clinical features and incidence rate of stroke in young adults (less than 55 years of age). Hospital-based descriptive study of 280 young inpatients consecutively admitted for stroke over a period of 24 years. We conducted a comparison with the remaining 4,312 patients admitted for stroke. Stroke in young adults represented 6.1% of all strokes, 5.7% of transient ischaemic attacks, 5.8% of cerebral infarctions and 8.4% of brain haemorrhages. However, reported minimal frequency of cardioembolic (2.1%) and atherothrombotic (3.4%) infarctions, accounted for 5.9% of lacunar and for 10.7% of essential infarctions and showed a maximum frequency in those infarctions of unusual aetiology (36%). Factors independently associated with stroke in young adults were cigarette smoking (OR 4.23; 95% CI 3.02-5.93; P=.000), unusual aetiology (OR 4.97; 95% CI 3.15-7.84; P=.000), headache (OR 4.57; 95% CI 2.59-8.07; P=.000), alcohol abuse (OR 3.93; 95% CI 2.46-6.29; P=.000), oral contraceptives (OR 14.07; 95% CI 2.37-83.40; P=.004), atrial fibrillation (OR 0.15; 95% CI 0.08-0.28; P=.000), arterial hypertension (OR 0.43; 95% CI 0.33-0.57; P=.000), COPD (OR 0.20; 95% CI 0.09-0.44; P=.000), atherothrombotic infarction (OR 0.51; 95% CI 0.34-0.77; P=.001), female sex (OR 0.71; 95% CI 0.52-0.97; P=.029), diabetes mellitus (OR 0.66; 95% CI 0.46-0.98; P=.030), ischaemic heart disease (OR 0.56; 95% CI 0.33-0.95; P=.032) and intermittent claudication (OR 0.48; 95% CI 0.24-0.94; P=.033). Stroke in young adults is infrequent (6.1% of the total), but represents the highest frequency of cerebral infarcts of unusual aetiology (36%). We conclude that stroke in younger patients presents its own and differentiated clinical profile. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

'This stroke was sent…': Stroke-related illness concepts and ...

African Journals Online (AJOL)

Though there is evidence that stroke incidence is increasing even in low and middle income countries, there is no study of stroke-related illness concepts and HSB in Nigerians. Data from 960 educated Nigerians were analysed. Eight hundred and fifty four respondents (431 aged 20-40 years and 423 aged 41 years or ...

Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records

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Piscitelli P

2012-12-01

Full Text Available Prisco Piscitelli,1,2 Giovanni Iolascon,3 Alberto Argentiero,2 Giovanna Chitano,2 Cosimo Neglia,2 Gemma Marcucci,1 Manuela Pulimeno,2 Marco Benvenuto,2 Santa Mundi,2 Valentina Marzo,2 Daniela Donato,4 Angelo Baggiani,4 Alberto Migliore,5 Mauro Granata,6 Francesca Gimigliano,3 Raffaele Di Blasio,7 Alessandra Gimigliano,3 Lorenzo Renzulli,7 Maria Luisa Brandi,1 Alessandro Distante,2,4 Raffaele Gimigliano3,71University of Florence, Florence Italy; 2ISBEM Research Centre, Brindisi, Italy; 3Second University of Naples, Naples, Italy; 4University of Pisa, Pisa, Italy; 5Fatebenefratelli St Peter’s Hospital, Rome, Italy; 6St Filippo Neri Hospital, Rome, Italy; 7Casa di Cura Santa Maria del Pozzo, Somma Vesuviana, ItalyObjectives: As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI] occurring in the whole adult population.Methods: We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820–821, AMI (code 410, hemorrhagic (codes 430, 431, 432 and ischemic strokes (codes 433–434, and TIA (code 435 between 2001–2005. Cost analyses were based on diagnosis-related groups.Results: The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005, as well as that of AMI (+20.2% and strokes (hemorrhagic: +9.6%; ischemic: +14.7 occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and

Plasma Magnesium and the Risk of Ischemic Stroke among Women

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Akarolo-Anthony, Sally N.; Jiménez, Monik C.; Chiuve, Stephanie E.; Spiegelman, Donna; Willett, Walter C.; Rexrode, Kathryn M.

2014-01-01

Background and Purpose Lower plasma magnesium levels may be associated with higher blood pressure and endothelial dysfunction, but sparse prospective data are available for stroke. Methods Among 32,826 participants in the Nurses’ Health Study who provided blood samples in 1989–1990, incident ischemic strokes were identified and confirmed by medical records through 2006. We conducted a nested case-control analysis of 459 cases, matched 1:1 to controls on age, race/ethnicity, smoking status, date of blood draw, fasting status, menopausal status and hormone use. We used conditional logistic regression models to estimate the multivariable adjusted association of plasma magnesium and the risk of ischemic stroke and ischemic stroke subtypes. Results Median magnesium levels did not differ between ischemic stroke cases and controls (median=0.86 mmol/l for both; p-value=0.14). Conditional on matching factors, women in the lowest magnesium quintile had a relative risk (RR) of 1.34 (95% confidence interval [CI]: 0.86–2.10, p trend=0.13) for total ischemic stroke, compared to women in the highest quintile. Additional adjustment for risk factors and confounders did not substantially alter the risk estimates for total ischemic stroke. Women with magnesium levels magnesium levels ≥0.82 mmol/l. No significant effect modification was observed by age, body mass index, hypertension or diabetes. Conclusions Lower plasma magnesium levels may contribute to higher risk of ischemic stroke among women. PMID:25116874

Cardiovascular Risks Associated with Incident and Prevalent Periodontal Disease

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Yu, Yau-Hua; Chasman, Daniel I; Buring, Julie E; Rose, Lynda; Ridker, Paul M

2014-01-01

Aim While prevalent periodontal disease associates with cardiovascular risk, little is known about how incident periodontal disease influences future vascular risk. We compared effects of incident versus prevalent periodontal disease in developing major cardiovascular diseases (CVD), myocardial infarction (MI), ischemic stroke and total CVD. Material and Methods In a prospective cohort of 39863 predominantly white women, age ≥ 45 years and free of cardiovascular disease at baseline were followed for an average of 15.7 years. Cox proportional hazard models with time-varying periodontal status (prevalent [18%], incident [7.3%] vs. never [74.7%]) were used to assess future cardiovascular risks. Results Incidence rates of all CVD outcomes were higher in women with prevalent or incident periodontal disease. For women with incident periodontal disease, risk factor adjusted hazard ratios (HRs) were 1.42 (95% CI, 1.14–1.77) for major CVD, 1.72 (1.25–2.38) for MI, 1.41(1.02–1.95) for ischemic stroke, and 1.27(1.06–1.52) for total CVD. For women with prevalent periodontal disease, adjusted HRs were 1.14 (1.00–1.31) for major CVD, 1.27 (1.04–1.56) for MI, 1.12(0.91–1.37) for ischemic stroke, and 1.15(1.03–1.28) for total CVD. Conclusion New cases of periodontal disease, not just those that are pre-existing, place women at significantly elevated risks for future cardiovascular events. PMID:25385537

Atypical Strokes in a Young African American Male: A Case of Mitochondrial Encephalopathy Lactic Acidosis and Stroke-Like Episodes (MELAS) Syndrome

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Sanchez, Jully M.; Tan, Judy Ann; Farmakiotis, Dimitrios; Aggarwal, Vikas

2011-01-01

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare but important cause of stroke-like symptoms which can often be missed Thambisetty and Newman 2004. We describe a case of a young male presenting with stroke-like episodes, later diagnosed with MELAS in an attempt to improve the understanding about diagnosing MELAS in the appropriate clinical context. PMID:21789268

Stroke in Asia: a global disaster.

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Kim, Jong S

2014-10-01

Although stroke is a world-wide problem, the burden of stroke is particularly serious in Asia; its mortality is higher than in Europe or North America. The situation in Asia is dichotomized. Stroke mortality and case fatality has been declining in northern-eastern countries such as Korea, Japan, Taiwan, and urbanized areas of China. This is attributed to both the risk factor control and stroke care improvement. However, declining stroke incidence is rarely observed, which is in part due to rapidly aging population. As a result, there is an increase in the number of stroke survivors who require long-term, costly care. The extremely low birth rate and relatively insecure social health system markedly increases the caregiver burden. The problem in southern Asian countries, such as India, Pakistan, Bangladesh, and Indonesia is more fundamental. With the improving control of infectious diseases, life expectancy is prolonged. However, risk factors such as hypertension, diabetes, obesity and cigarette smoking become prevalent, and are poorly controlled. Stroke neurologists, organized stroke centers, and diagnostic tools are insufficient, which has resulted in high stroke fatality and mortality. Throughout Asia, the most urgent priority should be the primary stroke prevention through promoting a healthy lifestyle, e.g. low salt intake, regular physical exercise, stopping smoking, government sectors should take a stronger initiative to accomplish this. The rapidly aging populations and stroke burden will shrink the economy and destabilize the society, not only in Asia but also globally unless appropriate efforts are promptly initiated, this may result in a global disaster. © 2014 World Stroke Organization.

[Ischemic stroke in the young adult].

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Calvet, D

2016-01-01

Ischemic stroke is not rare in young adults since one in ten stroke patients are less than 50 years old. This incidence increased over the past last years, mainly due to the rise in the prevalence of traditional vascular risk factors in this sub-group of age but also of illegal drug use. Even though both survival and functional outcome of young stroke patients are better than those observed in older patients, socio-economic and quality of life consequences make this disease a main objective in terms of primary and secondary prevention. Identifying the cause of ischemic stroke in young adults is of major importance to prevent stroke recurrence. However, given the wide variety of potential underlying causes, the etiologic work-up of stroke in young adults requires a different approach from that in the elderly. In this context, a sequential diagnostic work-up is needed in order to optimize the yield of diagnostic tests, to reduce their cost and risks for the patient. Arterial dissection is the most frequent cause of stroke in young adults but other less frequent causes are numerous. Despite a comprehensive work-up, about one third of cases remains unexplained leading to the diagnosis of cryptogenic ischemic stroke. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Self-Reported Stroke Risk Stratification: Reasons for Geographic and Racial Differences in Stroke Study.

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Howard, George; McClure, Leslie A; Moy, Claudia S; Howard, Virginia J; Judd, Suzanne E; Yuan, Ya; Long, D Leann; Muntner, Paul; Safford, Monika M; Kleindorfer, Dawn O

2017-07-01

The standard for stroke risk stratification is the Framingham Stroke Risk Function (FSRF), an equation requiring an examination for blood pressure assessment, venipuncture for glucose assessment, and ECG to determine atrial fibrillation and heart disease. We assess a self-reported stroke risk function (SRSRF) to stratify stroke risk in comparison to the FSRF. Participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) were evaluated at baseline and followed for incident stroke. The FSRF was calculated using directly assessed stroke risk factors. The SRSRF was calculated from 13 self-reported questions to exclude those with prevalent stroke and assess stroke risk. Proportional hazards analysis was used to assess incident stroke risk using the FSRF and SRSRF. Over an average 8.2-year follow-up, 939 of 23 983 participants had a stroke. The FSRF and SRSRF produced highly correlated risk scores ( r Spearman =0.852; 95% confidence interval, 0.849-0.856); however, the SRSRF had higher discrimination of stroke risk than the FSRF (c SRSRF =0.7266; 95% confidence interval, 0.7076-0.7457; c FSRF =0.7075; 95% confidence interval, 0.6877-0.7273; P =0.0038). The 10-year stroke risk in the highest decile of predicted risk was 11.1% for the FSRF and 13.4% for the SRSRF. A simple self-reported questionnaire can be used to identify those at high risk for stroke better than the gold standard FSRF. This instrument can be used clinically to easily identify individuals at high risk for stroke and also scientifically to identify a subpopulation enriched for stroke risk. © 2017 American Heart Association, Inc.

Five-year outcome of a stroke cohort in Martinique, French West Indies: Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents vasculaires cérebraux, Part 2.

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Chausson, Nicolas; Olindo, Stéphane; Cabre, Philippe; Saint-Vil, Martine; Smadja, Didier

2010-04-01

Limited information exists on stroke among black populations outside the United States and United Kingdom. Part 1 of the Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents vasculaires cérebraux (ERMANCIA) provided strong epidemiologic data on the incidence of first-ever stroke in a black Caribbean population and showed a 40% greater incidence of stroke in Martinique than in continental France. In ERMANCIA part 2, we evaluated the long-term outcomes of our cohort. Survivors of a first stroke from this prospective, community-based, stroke incidence study were reassessed at 5 years according to standardized procedures and criteria, including the modified Rankin scale, Barthel Index, Montgomery-Asberg Depression-Rating Scale, Mini-Mental State Examination, treatment compliance, and blood pressure control. Of the 293 survivors of the original 580 (50.5%) patients who were still alive 5 years after stroke, 262 (89.4%) were assessed. Among these survivors, 66.4% were functionally independent and 43% were completely autonomous for activities of daily living, but 25.8% were depressed and 58.9% were cognitively impaired. Only 50 of 170 (29.4%) of the hypertensive patients achieved their target blood pressure. These results highlight the very poor blood pressure control and the very high rate of cognitive impairment in Martinican patients after stroke. As a consequence, a poststroke prevention network was established in Martinique.

Annual incidence and standardized incidence ratio of cerebrovascular accidents in patients with systemic lupus erythematosus.

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Mok, C C; Ho, L Y; To, C H

2009-01-01

To study the annual incidence and standardized incidence ratio (SIR) of cerebrovascular accident (CVA) in patients with systemic lupus erythematosus (SLE). The annual incidence of CVA from 1999 to 2007 in a longitudinal cohort of SLE patients was calculated each year and compared with that of the regional population within the same study period. Age-specific SIRs and outcome of CVA in SLE patients were also studied. In 2007, there were 490 SLE patients in our cohort. The mean annual incidence of CVA between 1999 and 2007 was 6.45/1000 patients and no obvious trend over time was observed. Of the 20 CVAs in patients with SLE, 18 (90%) were ischaemic stroke whereas two (10%) were haemorrhagic stroke. The mean SIR of all types of CVA in SLE patients was 2.02 [95% confidence interval (CI) 1.30-3.81; p = 0.002]. The SIR of ischaemic stroke decreased with age and the stroke incidence was no longer significantly higher than that of the population in patients aged >or= 60 years. Haemorrhagic stroke occurred mainly in younger SLE patients. The duration of hospitalization and the mortality rate for CVA was non-significantly higher in SLE than in non-SLE patients. The incidence of CVA in SLE remained constant over the 8 years between 1999 and 2007. Younger SLE patients are at substantially increased risk of CVA compared to age-matched population. The duration of hospitalization and the mortality rate for CVA are similar in SLE and non-SLE patients.

[Broad ischemic stroke revealing infective endocarditis in a young patient: about a case].

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Ravelosaona, Fanomezantsoa Noella; Razafimahefa, Julien; Randrianasolo, Rahamefy Odilon; Rakotoarimanana, Solofonirina; Tehindrazanarivelo, Djacoba Alain

2016-01-01

Broad ischemic stroke is mainly due to a cardiac embolus or to an atheromatous plaque. In young subjects, one of the main causes of ischemic stroke (broad ischemic stroke in particolar) is embolic heart disease including infective endocarditis. Infective endocarditis is a contraindication against the anticoagulant therapy (which is indicated for the treatment of embolic heart disease complicated by ischemic stroke). One neurologic complications of infective endocarditis is ischemic stroke which often occurs in multiple sites. We here report the case of a 44-year old man with afebrile acute onset of severe left hemiplegia associated with a sistolic mitral murmur, who had fever in hospital on day 5 with no other obvious source of infection present. Brain CT scan showed full broad ischaemic stroke of the right middle cerebral artery territory and doppler ultrasound, performed after stroke onset, showed infective endocarditis affecting the small mitral valve. He was treated with 4 weeks of antibiotic therapy without anticoagulant therapy ; evolution was marked by the disappearance of mitral valve vegetations and by movement sequelae involving the left side of the body. In practical terms, our problem was the onset of the fever which didn't accompany or pre-exist patient's deficit, leading us to the misdiagnosis of ischemic stroke of cardioembolic origin. This case study underlines the importance of doppler ultrasound, in the diagnosis of all broad ischemic strokes, especially superficial, before starting anticoagulant therapy.

Meta-analysis of factor V Leiden and ischemic stroke in young adults: the importance of case ascertainment.

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Hamedani, Ali G; Cole, John W; Mitchell, Braxton D; Kittner, Steven J

2010-08-01

The factor V Leiden mutation is associated with ischemic stroke in children but not in adults. Whether it is associated with ischemic stroke in young adults, however, is uncertain. To address this issue, we performed a meta-analysis of 18 case-control studies of ischemic stroke in adults 50 years of age and younger published before June 2009. Across all studies, factor V Leiden was detected in 154 of 2045 cases (7.5%) and 217 of 5307 controls (4.1%), yielding a fixed-effect odds ratio of 2.00 (95% CI, 1.59-2.51). However, further analyses revealed substantial heterogeneity among these studies (P=0.005 for Q-test of heterogeneity). Hypothesizing that this heterogeneity could be related to differences among studies in case selection criteria, we stratified the meta-analysis into studies for which case samples were enriched or not enriched to include cases having an increased likelihood of prothrombotic genetic involvement ("selected" ischemic stroke studies, n=9) and those that recruited cases from consecutive neurology referrals or hospitalizations ("unselected" ischemic stroke studies, n=8). Among the 9 "selected" ischemic stroke studies, factor V Leiden was more strongly associated with stroke (OR, 2.73; 95% CI, 1.98-3.75), whereas among the 8 "unselected" ischemic stroke studies, the association between factor V Leiden and stroke was substantially weaker (OR, 1.40; 95% CI, 0.998-1.95). This difference was found to be statistically significant (P=0.003 for Woolf test for heterogeneity). We conclude that factor V Leiden is associated with ischemic stroke in young adults, particularly in patient populations in which there is an increased clinical suspicion of prothrombotic state.

Self-perceived psychological stress and ischemic stroke: a case-control study

Directory of Open Access Journals (Sweden)

Blomstrand Christian

2009-10-01

Full Text Available Abstract Background A growing body of evidence suggests that psychological stress contributes to coronary artery disease. However, associations between stress and stroke are less clear. In this study, we investigated the possible association between ischemic stroke and self-perceived psychological stress, as measured by a single-item questionnaire, previously reported to be associated with myocardial infarction. Methods In the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS, 600 consecutive patients with acute ischemic stroke (aged 18 to 69 years and 600 age-matched and sex-matched population controls were recruited. Ischemic stroke subtype was determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST criteria. Self-perceived psychological stress preceding stroke was assessed retrospectively using a single-item questionnaire. Results Permanent self-perceived psychological stress during the last year or longer was independently associated with overall ischemic stroke (multivariate adjusted odds ratio (OR 3.49, 95% confidence interval (CI 2.06 to 5.93. Analyses by stroke subtype showed that this association was present for large vessel disease (OR 3.91, 95% CI 1.58 to 9.67, small vessel disease (OR 3.20, 95% CI 1.64 to 6.24, and cryptogenic stroke (OR 4.03, 95% CI 2.34 to 6.95, but not for cardioembolic stroke (OR 1.48, 95% CI 0.64 to 3.39. Conclusion In this case-control study, we found an independent association between self-perceived psychological stress and ischemic stroke. A novel finding was that this association differed by ischemic stroke subtype. Our results emphasize the need for further prospective studies addressing the potential role for psychological stress as a risk factor for ischemic stroke. In such studies ischemic stroke subtypes should be taken into consideration.

Paediatric Stroke: A Rare Presentation of Iron Deficiency Anemia in a Four Year Old Child.

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Subedi, K; Koirala, S; Basnet, R; Poudel, A

Paediatric stroke is an uncommon syndrome with even lesser annual incidence rates of arterial ischemic stroke in infants and children. In children the diagnosis of stroke is frequently delayed or missed. This is due to subtle and nonspecific clinical presentations, a complicated differential diagnosis and a lack of awareness by physicians and also delay in the seeking of medical attention as in our case. We report you a rare case of a four year old child from remote Nepal who presented to our Out Patient Department after a long gap of around four months after the sudden onset of loss of consciousness and decreased movement of right limbs who after detailed history examination and lab investigations and imaging revealed ischemic stroke due to iron deficiency anemia.

Trends in incidence and early outcomes in a Black Afro-Caribbean population from 1999 to 2012: Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents Vasculaires Cérébraux II Study.

Science.gov (United States)

Olindo, Stephane; Chausson, Nicolas; Mejdoubi, Mehdi; Jeannin, Severine; Rosillette, Karine; Saint-Vil, Martine; Signate, Aissatou; Edimonana-Kaptue, Mireille; Larraillet, Veronique; Cabre, Philippe; Smadja, Didier; Joux, Julien

2014-11-01

Seldom studies are available on trends in stroke incidence in blacks. We aimed to evaluate whether stroke risk prevention policies modified first-ever stroke incidence and outcomes in the black Afro-Caribbean population of Martinique. Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents Vasculaires Cérébraux (ERMANCIA) I and II are 2 sequential prospective population-based epidemiological studies. There have assessed temporal trends in first-ever stroke incidence, risk factors, pathological types, and early outcomes in the black Afro-Caribbean population of Martinique comparing two 12-month periods (1998-1999 and 2011-2012). Crude and age-standardized incidence and 30-day outcomes for stroke in the 2 study periods were compared using Poisson regression. We identified 580 and 544 first-ever strokes in the 2 studies. World age-standardized incidence rates decreased by 30.6% in overall (111 [95% confidence interval, 102-120] versus 77 [95% confidence interval, 70-84]). Rate decline was greater in women than in men (34% versus 26%) particularly in women aged 65 to 74 years (-69%) and 75 to 84 years (-43%). Frequencies of hypertension and diabetes mellitus were unchanged, whereas dyslipidemia, smoking, and atrial fibrillation significantly increased. Only ischemic stroke types showed significant rate reduction in overall and in women, incidence rate ratio (95% confidence intervals) of 0.69 (0.50-0.97) and 0.61 (0.42-0.88), respectively. The overall 30-day case-fatality ratio remained stable (19.3%/17.6%), whereas a better 30-day outcome was found (modified Rankin Score, ≤2 in 47%/37.6%; P=0.03). Over 13 years, there has been a significant decrease (30.6%) in the age-specific first-ever stroke incidence in our Afro-Carribean population. Although prevention policies seem effective, we need to focus on new risk factors limitation and on male population adherence to prevention program. © 2014 American Heart Association, Inc.

Serious hemorrhages after ischemic stroke or TIA - Incidence, mortality, and predictors.

Science.gov (United States)

Ögren, Joachim; Irewall, Anna-Lotta; Söderström, Lars; Mooe, Thomas

2018-01-01

Data are lacking on the risk and impact of a serious hemorrhage on the prognosis after ischemic stroke (IS) or transient ischemic attack (TIA). We aimed to estimate the incidence of serious hemorrhage, analyze the impact on mortality, and identify predictors of hemorrhage after discharge from IS or TIA. All patients admitted to Östersund Hospital for an IS or TIA in 2010-2013 were included (n = 1528, mean age: 75.1 years). Serious hemorrhages were identified until 31st December 2015. Incidence rates were calculated. The impact on mortality (stratified by functional level) was determined with Kaplan-Meier analysis. Non-parametric estimation under the assumption of competing risk was performed to assess the cumulative incidence and predictors of serious hemorrhages. The incidence rates of serious (n = 113) and intracranial hemorrhages (n = 45) after discharge from IS and TIA were 2.48% and 0.96% per year at risk, respectively. Patients with modified Rankin Scale (mRS) scores of 3-5 exhibited 58.9% mortality during follow-up and those with mRS scores of 0-2 exhibited 18.4% mortality. A serious hemorrhage did not affect mortality in patients with impaired functional status, but it increased the risk of death in patients with mRS scores of 0-2. Hypertension was associated with increased risk of serious hemorrhage. We found that, after discharge from an IS or TIA, serious hemorrhages were fairly common. Impairments in function were associated with high mortality, but serious hemorrhages only increased the risk of mortality in patients with no or slight disability. Improved hypertension treatment may decrease the risk of serious hemorrhage, but in patients with low functional status, poor survival makes secondary prevention challenging.

Strokes in young adults: epidemiology and prevention

Directory of Open Access Journals (Sweden)

Smajlović D

2015-02-01

Full Text Available Dževdet Smajlović Department of Neurology, University Clinical Centre Tuzla, School of Medicine, University of Tuzla, Bosnia and Herzegovina Abstract: Strokes in young adults are reported as being uncommon, comprising 10%–15% of all stroke patients. However, compared with stroke in older adults, stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. Recent publications report an increased incidence of stroke in young adults. This is important given the fact that younger stroke patients have a clearly increased risk of death compared with the general population. The prevalence of standard modifiable vascular risk factors in young stroke patients is different from that in older patients. Modifiable risk factors for stroke, such as dyslipidemia, smoking, and hypertension, are highly prevalent in the young stroke population, with no significant difference in geographic, climatic, nutritional, lifestyle, or genetic diversity. The list of potential stroke etiologies among young adults is extensive. Strokes of undetermined and of other determined etiology are the most common types among young patients according to TOAST (Trial of Org 10172 in Acute Stroke Treatment criteria. Prevention is the primary treatment strategy aimed at reducing morbidity and mortality related to stroke. Therefore, primary prevention is very important with regard to stroke in young adults, and aggressive treatment of risk factors for stroke, such as hypertension, smoking, and dyslipidemia, is essential. The best form of secondary stroke prevention is directed toward stroke etiology as well as treatment of additional risk factors. However, there is a lack of specific recommendations and guidelines for stroke management in young adults. In conclusion, strokes in young adults are a major public health problem and further research, with standardized methodology, is needed in order to give us more

Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013

DEFF Research Database (Denmark)

Feigin, Valery L; Krishnamurthi, Rita V; Parmar, Priya

2015-01-01

(DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. METHODOLOGY: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence......BACKGROUND: Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke......, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. OBJECTIVES: This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years...

Higher Incidence of Stroke on the Last Day of the Month in Hungary-a Role for Psychosocial Factors and Financial Insecurity?

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Folyovich, András; Biczó, Dávid; Bajnok, Anna; Bessenyei, Dávid; Kis, Ibolya; Gimesi-Országh, Judit; Béres-Molnár, Anna K; Toldi, Gergely

2016-05-01

The seasonal cumulation of acute ischemic stroke events is a well-known phenomenon. Critical days are determined by both biological and psychosocial factors. We hypothesized that the financial stability of those with a monthly income living in an economically unpredictable environment rises upon the arrival of their salary and decreases in the preceding days, leading to anxiety and existential insecurity, which may increase the incidence of acute ischemic stroke. We assessed the daily average number of thrombolytic treatments due to acute ischemic stroke in Hungary between December 1, 2005, and November 30, 2013, calculating the ratio of thrombolytic treatments on the last day of the month (irrespectively whether it was the 28th-31st days) to thrombolytic treatments on the other days, and determined 95% confidence intervals. In this period, 7880 thrombolytic treatments were performed nationwide (2.70/day), out of which 1867 occurred on the last day of the month (19.45/day). If the 28th, 29th, or 30th was not the last day of the month, 15.8, 20.6, and 22 times less thrombolytic treatments, respectively, were performed than on the last day of that month. We propose that financial insecurity on the days prior to the receipt of a salary might play a role in the elevation of stroke incidence observed on the last day of the month in Hungary. Further analysis of this phenomenon and its psychosocial effects is needed to adequately allocate healthcare resources and to take preventive measures in the high-risk population. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Analysis of preventability of stroke-related maternal death from the nationwide registration system of maternal deaths in Japan.

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Katsuragi, Shinji; Tanaka, Hiroaki; Hasegawa, Junichi; Nakamura, Masamitsu; Kanayama, Naohiro; Nakata, Masahiko; Murakoshi, Takeshi; Yoshimatsu, Jun; Osato, Kazuhiro; Tanaka, Kayo; Sekizawa, Akihiko; Ishiwata, Isamu; Ikeda, Tomoaki

2018-08-01

The number of stroke-related maternal deaths is increasing in Japan. We investigated methods to reduce maternal death from stroke. We analyzed stroke-related maternal deaths in Japan reported to the Committee of the Ministry of Health, Labor, and Welfare from 2010 to 2014 inclusive. A total of 35 cases were identified. The median maternal age was 35 years (range 22-45) and the incidence of stoke in women ≥40 was seven-fold higher than in death from stroke.

A CLINICAL STUDY OF STROKE IN YOUNG

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Kumbha Thulasi Ram

2015-02-01

Full Text Available NTRIDUCTION : Stroke is one of the important causes of morbidity and mortality all over the world. Incidence of stroke steadily increases with age. Experts are concerned of the emerging stroke epidemic in India. Stroke affecting the young has potentially devastating consequence son the individual and his family. Certain risk factors are unique to the young. I t needs more studies for identification and modification of risk factors. The study aims to evaluate clinical features, risk factors, etiology and mortality of stroke in young patients. METHODS : 74 young patients satisfying the inclusion criteria were included in this study. A detailed history was taken from young stroke patients, systemic examination and required investigations were done. Data was collected in standardized proforma and analysed. RESULTS: Stroke in young accounts for 7.95% of stroke cases of all age groups. The mean age of the patients was 34.66 ± 7.48 years. Among 74 patients, 47(63.51% were male and 27(36.49% were female. Seizures, decreased consciousness, speech involvement and motor deficit were observed in 33.78%, 44.59%, 22.97% and 100% of cases respectively. 82.43% patients had ischemic and 17.57% patients had hemorrhagic stroke. Among ischemic stroke, large artery atherosclerosis was 16.21%, tuberculous meningoencephalitis with vasculitis was 16.21%, lacunar stroke was 10.81%, CVT was 10.81% and cardio embolic stroke was 6.76%. Smoking (59.45%, alcoholism (58.10%, hypertension (43.24%, coronary artery disease (8.10%, diabetes mellitus (10.81%, elevated total cholesterol (25.67%, elevated low density lipo proteins (22.97%, elevated triglycerides (27.02% and low HDL (22.97% were important risk factors. Carotid doppler was abnormal in 9.45% of patients. 6.76% patients had mitral stenosis in echocardiogram. Low protein C and protein S were found in 1.35% of patients. Eight (10.81% patients died during the hospital stay. INTERPRETATION AND CONCLUSIONS: The major risk

Serum Taurine and Stroke Risk in Women: A Prospective, Nested Case-Control Study

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Wu, Fen; Koenig, Karen L.; Zeleniuch-Jacquotte, Anne; Jonas, Saran; Afanasyeva, Yelena; Wójcik, Oktawia P.; Costa, Max; Chen, Yu

2016-01-01

Background Taurine (2-aminoethanesulfonic acid), a conditionally essential sulfur-containing amino acid, is mainly obtained from diet in humans. Experimental studies have shown that taurine’s main biological actions include bile salt conjugation, blood pressure regulation, anti-oxidation, and anti-inflammation. Methods We conducted a prospective case-control study nested in the New York University Women’s Health Study, a cohort study involving 14,274 women enrolled since 1985. Taurine was measured in pre-diagnostic serum samples of 241 stroke cases and 479 matched controls. Results There was no statistically significant association between serum taurine and stroke risk in the overall study population. The adjusted ORs for stroke were 1.0 (reference), 0.87 (95% CI, 0.59–1.28), and 1.03 (95% CI, 0.69–1.54) in increasing tertiles of taurine (64.3–126.6, 126.7–152.9, and 153.0–308.5 nmol/mL, respectively). A significant inverse association between serum taurine and stroke risk was observed among never smokers, with an adjusted OR of 0.66 (95% CI, 0.37–1.18) and 0.50 (95% CI, 0.26–0.94) for the second and third tertile, respectively (p for trend = 0.01), but not among past or current smokers (p for interaction taurine and stroke risk, although a protective effect was observed in never smokers, which requires further investigation. Taurine, Stroke, Epidemiology, Prospective, Case-control study, NYUWHS. PMID:26866594

Atlas of the Global Burden of Stroke (1990-2013)

DEFF Research Database (Denmark)

Feigin, Valery L; Mensah, George A; Norrving, Bo

2015-01-01

for ischemic stroke and hemorrhagic stroke in the world for 1990-2013. METHODOLOGY: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality......BACKGROUND: World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. OBJECTIVES: To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends...... estimates of global population. All estimates have been computed with 95% uncertainty intervals. RESULTS: Age-standardized incidence, mortality, prevalence and DALYs/YLDs declined over the period from 1990 to 2013. However, the absolute number of people affected by stroke has substantially increased across...

Is migraine a risk factor for pediatric stroke?

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Gelfand, Amy A; Fullerton, Heather J; Jacobson, Alice; Sidney, Stephen; Goadsby, Peter J; Kurth, Tobias; Pressman, Alice

2015-12-01

Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). Children ages 2-17 years who were members of KPNC for ≥6 months between 1997 and 2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. Main outcome measures included stroke incidence rates and incidence rate ratios (IR). Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (three (38%) hemorrhagic; five (63%) ischemic). Eighty strokes occurred in children without headache (53 (66%) hemorrhagic; 27 (34%) ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8-5.2). A post-hoc analysis of adolescents (12-17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4 (95% CI 1.2-9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2-2.0). There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible risk factor for ischemic stroke among adolescent

Case report. Neurosyphilis Masquerading as Stroke in an 84-year-old

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Bologa Cristina

2017-04-01

Full Text Available The case of an 84 years old woman with uncharacteristic neurologic and cognitive symptoms, suspected of ischemic stroke is presented. Following an extensive assessment in the departments of neurology and internal medicine, the unusual aetiology of stroke was identified as meningovascular neurosyphilis. The patient fully recovered after antibiotic therapy. To our knowledge, this the eldest patient with tertiary neurosyphilis reported in the literature.

Juvenile ischemic stroke secondary to cardiogenic embolism: A rare case report

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Hassan Soleimanpour

2014-01-01

Full Text Available Myxomas, the most common primary cardiac tumors, are known as a source of cardiogenic emboli. The possibility of their early detection has made them of great importance for emergency medicines. Detection of the disease is probable at early stages using echocardiography and associate complications such as syncope, cerebral embolic ischemic strokes, and sudden death. We report experience of a rare case of juvenile acute stroke in a patient with cardiac myxoma affecting all cardiac chambers presenting to the emergency department. In young stroke patients with signs and symptoms compatible with cardiovascular involvement, cardiogenic emboli should be taken into consideration; early echocardiographic studies are highly recommended. Prompt myxoma resection is required in both asymptomatic and stroke patients in whom intravenous thrombolysis course has not been implemented due to any limitations.

Corticospinal tract integrity and motor function following neonatal stroke: a case study

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Gordon Anne L

2012-07-01

Full Text Available Abstract Background New MRI techniques enable visualisation of corticospinal tracts and cortical motor activity. The objective of this case study was to describe the magnetic resonance evidence of corticospinal pathway reorganisation following neonatal stroke. Case presentation An 11 year old boy with a neonatal right middle cerebral artery territory ischaemic stroke was studied. Functional MRI was undertaken with a whole hand squeezing task, comparing areas of cortical activation between hands. White matter tracts, seeded from the area of peak activation in the cortex, were visualised using a diffusion weighted imaging probabilistic tractography method. Standardised evaluations of unilateral and bilateral motor function were undertaken. Clinically, the child presented with a left hemiparesis. Functional MRI demonstrated that movement of the hemiparetic hand resulted in activation in the ipsi-lesional (right hemisphere only. Diffusion tractography revealed pathways in the right (lesioned hemisphere tracked perilesionally to the cortical area identified by functional MRI. Conclusion Our case demonstrates that neonatal stroke is associated with maintenance of organization of corticospinal pathways sufficient to maintain some degree of hand function in the affected hemisphere. Functional MRI and diffusion weighted imaging tractography may inform our understanding of recovery, organisation and reorganisation and have the potential to monitor responses to intervention following neonatal stroke.

Pregnancy and puerperium-related strokes in Asian women.

Science.gov (United States)

Khan, Maria; Wasay, Mohammad; Menon, Bindu; Saadatnia, Mohammad; Venketasubramanian, Narayanaswamy; Gunaratne, Padma; Mehndiratta, M M; Dai, Alper; Kaul, Subhash

2013-11-01

Despite an increased risk of stroke in pregnancy and puerperium, the overall incidence of the condition in this population is low. Therefore, there is limited data pertaining to these patients particularly from Asian countries. Our objective was to describe the risk factors and outcomes of 110 pregnancy-related ischemic strokes from 5 Asian countries. Data were collected by retrospective chart review in most cases and prospectively in the rest. Inclusion criteria for this subanalysis were women, pregnant or within 1-month postpartum, presenting to the study center with acute ischemic stroke (arterial or venous) confirmed by neuroimaging. Intracranial hemorrhages other than the ones associated with cerebral venous thrombosis or hemorrhagic infarct were excluded. Risk factors were diagnosed based on already published criteria. Outcomes were measured using modified Rankin score. Statistical analysis was done using Statistical Package for Social Sciences version 19.0. In all, 110 women with mean age of 27.94 years presented with pregnancy-related ischemic strokes; 58.2% of the strokes occurred postpartum and 49.1% were secondary to cerebral venous thrombosis. Venous strokes were significantly more likely to occur postpartum compared with arterial strokes (P=.01), to have abnormal "hypercoagulable panel result on admission" (PAsian women. Both traditional and pregnancy-specific risk factors should be addressed to control ischemic stroke risk in these women. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Stroke with neuropsychiatric sequelae after cannabis use in a man: a case report

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Giroud Maurice

2011-06-01

Full Text Available Abstract Introduction The outcome of cerebral ischemic stroke associated with cannabis use is usually favorable. Here we report the first case of cannabis-related stroke followed by neuropsychiatric sequelae. Case presentation A 24-year-old Caucasian man was discovered in a deeply comatose non-reactive state after cannabis use. A magnetic resonance imaging scan of his brain showed bilateral multiple ischemic infarcts. The patient remained deeply comatose for four days, after which time he developed other behavioral impairments and recurrent seizures. Conclusion Stroke related to cannabis use can be followed by severe neuropsychiatric sequelae. Concomitant alcohol intoxication is essential neither to the occurrence of this neurologic event nor to its severity.

Does national expenditure on research and development influence stroke outcomes?

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Kim, Young Dae; Jung, Yo Han; Norrving, Bo; Ovbiagele, Bruce; Saposnik, Gustavo

2017-10-01

Background Expenditure on research and development is a macroeconomic indicator representative of national investment. International organizations use this indicator to compare international research and development activities. Aim We investigated whether differences in expenditures on research and development at the country level may influence the incidence of stroke and stroke mortality. Methods We compared stroke metrics with absolute amount of gross domestic expenditure on R&D (GERD) per-capita adjusted for purchasing power parity (aGERD) and relative amount of GERD as percent of gross domestic product (rGERD). Sources included official data from the UNESCO, the World Health Organization, the World Bank, and population-based studies. We used correlation analysis and multivariable linear regression modeling. Results Overall, data on stroke mortality rate and GERD were available from 66 countries for two periods (2002 and 2008). Age-standardized stroke mortality rate was associated with aGERD (r = -0.708 in 2002 and r = -0.730 in 2008) or rGERD (r = -0.545 in 2002 and r = -0.657 in 2008) (all p < 0.001). Multivariable analysis showed a lower aGERD and rGERD were independently and inversely associated with higher stroke mortality (all p < 0.05). The estimated prevalence of hypertension, diabetes, or obesity was higher in countries with lower aGERD. The analysis of 27 population-based studies showed consistent inverse associations between aGERD or rGERD and incident risk of stroke and 30-day case fatality. Conclusions There is higher stroke mortality among countries with lower expenditures in research and development. While this study does not prove causality, it suggests a potential area to focus efforts to improve global stroke outcomes.

Falls and Fear of Falling After Stroke: A Case-Control Study.

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Goh, Hui-Ting; Nadarajah, Mohanasuntharaam; Hamzah, Norhamizan Binti; Varadan, Parimalaganthi; Tan, Maw Pin

2016-12-01

Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population. To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors. Case-control observational study. Primary teaching hospital. Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested. Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ 2 test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling. Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments. Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P falling than did nonstroke control participants (P falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group

Process review of a departmental change from conventional coronary artery bypass grafting to totally arterial coronary artery bypass and its effects on the incidence and severity of postoperative stroke.

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Albert, Alexander; Sergeant, Paul; Florath, Ines; Ismael, Mohammed; Rosendahl, Ulrich; Ennker, Jürgen

2011-04-01

We evaluated the process of changing from conventional coronary artery bypass grafting (CABG) to totally arterial off-pump coronary artery bypass (TOPCAB) at a single heart center in Germany. We (1) used multivariate statistical methods to assess real-time monitoring of OPCAB effects, (2) conducted a case review to assess preventable deaths and identify areas of improvement, (3) conducted a team survey, and (4) evaluated benchmarking results. All surgeons and assistants (n = 18) at this center were involved and were guided by the department head and one of the consultants, who was trained in this procedure in 2004 at the Leuven OPCAB school. The frequency of OPCAB operations increased abruptly in 2005 from 5% to 43% and then increased gradually to 67% (n = 546) by 2008 (total, 1781 OPCAB cases and 1563 on-pump cases). The in-hospital and 30-day mortality rates for OPCAB surgeries (n = 10 [0.6%] and 21 [1.2%], respectively) were lower than for on-pump surgeries (n = 27 [1.7%] and 26 [1.7%], respectively). Stroke rates were also lower for OPCAB surgeries (7 cases [0.4%] versus 15 cases [1%]). The lower risk of stroke in the OPCAB group was significant (P popularity, and a top national rank). The change from conventional CABG to TOPCAB was effective in decreasing the incidence and severity of stroke, in developing a team routine and a positive team attitude, and in producing excellent benchmarking results. The presence of a training and communication deficiency at the beginning of the study suggested an area for further improvement. After 6 years TOPCAB had largely replaced conventional CABG.

Hypercholesterolemia in patients of ischemic stroke

International Nuclear Information System (INIS)

Saeed, E.; Ali, R.; Din, M.J.U.; Saeed, A.; Jadoon, R.J.

2015-01-01

Background: Stroke is a common neurological disease that results in significant mortality and morbidity globally. Several risk factors have been identified for stroke among which hyperlipidaemia is one of the modifiable risk factors. Recent clinical trials have shown a reduction in ischemic stroke for patients taking lipid lowering medications. Therefore, the aim of this study was to find out the frequency of hypercholesterolemia in patients of ischemic stroke in Hazara region. Method: This cross sectional study was carried out in the Medical Department of Ayub Teaching Hospital, Abbottabad. Ninety patients of stroke confirmed as ischemic by CT scan brain were enrolled in the study after informed consent. The frequency of hypercholesterolemia in patients was recorded. Results: There were 55 (61.1 percentage) males. The mean age of patients was 64.4±11.5 years. The mean serum cholesterol in all patients was 4.16±1.1 mmol/l. The mean serum cholesterol of male patients was 4.3±1.2 mmol/l and 4.0±10.9 mmol/l in the case of females. Conclusions: Hypercholesterolemia could not be established as a major risk factor for stroke in our setup through this study that allude to the fact that other risk factors might be contributing more to the incidence of cerebrovascular accident in our population. (author)

Primary prevention of stroke by a healthy lifestyle in a high-risk group.

Science.gov (United States)

Larsson, Susanna C; Åkesson, Agneta; Wolk, Alicja

2015-06-02

To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke because of other cardiovascular diseases or conditions. Our study population comprised 11,450 men in the Cohort of Swedish Men who had a history of hypertension, high cholesterol levels, diabetes, heart failure, or atrial fibrillation. Participants had completed a questionnaire about diet and lifestyle and were free from stroke and ischemic heart disease at baseline (January 1, 1998). We defined a healthy lifestyle as a low-risk diet (≥5 servings/d of fruits and vegetables and 0 to ≤30 g/d). Ascertainment of stroke cases was accomplished through linkage with the National Inpatient Register and the Swedish Cause of Death Register. During a mean follow-up of 9.8 years, we ascertained 1,062 incident stroke cases. The risk of total stroke and stroke types decreased with increasing number of healthy lifestyle factors. The multivariable relative risk of total stroke for men who achieved all 5 healthy lifestyle factors compared with men who achieved 0 or 1 factor was 0.28 (95% confidence interval 0.14-0.55). The corresponding relative risks (95% confidence interval) were 0.31 (0.15-0.66) for ischemic stroke and 0.32 (0.04-2.51) for hemorrhagic stroke. A healthy lifestyle is associated with a substantially reduced risk of stroke in men at higher risk of stroke. © 2015 American Academy of Neurology.

The cardiovascular status of the black stroke patient

International Nuclear Information System (INIS)

Joubert, J.; Van Gelder, A.L.; Pilloy, W.J.; Darazs, B.

1989-01-01

The cardiac status of 102 consecutive black stroke patients entered to the Medunsa Stroke Databank was determined. Cardiological examination, echocardiography and a gated blood pool scan revealed structural and/or functional cardiac abnormalities in 73,6% of patients. Rheumatic heart disease was diagnosed in 15,6%, mitral valve prolapse in 5,8% and mitral annulus calcification in 4,9% of cases. 'Possible' cardiac sources of cerebral embolism were detected in 22,5% and 'definite' sources in 23,5% of patients. Hypertensive heart disease was diagnosed in 35,2% and cardiomyopathy in 13,7% of the study population. Ischaemic heart disease was present in 6,86%. Ultrasonography revealed ventricular bands in 29,4% of patients. The high incidence of structural cardiac abnormalities detected by non-invasive means is in keeping with recent studies in white stroke patients. 32 refs., 11 tabs., 2 figs

Burden of stroke in Bangladesh.

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Islam, Md Nazmul; Moniruzzaman, Mohammed; Khalil, Md Ibrahim; Basri, Rehana; Alam, Mohammad Khursheed; Loo, Keat Wei; Gan, Siew Hua

2013-04-01

Stroke is the third leading cause of death in Bangladesh. The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world. The reported prevalence of stroke in Bangladesh is 0.3%, although no data on stroke incidence have been recorded. Hospital-based studies conducted in past decades have indicated that hypertension is the main cause of ischaemic and haemorrhagic stroke in Bangladesh. The high number of disability-adjusted life-years lost due to stroke (485 per 10,000 people) show that stroke severely impacts Bangladesh's economy. Although two non-governmental organizations, BRAC and the Centre for the Rehabilitation of the Paralysed, are actively involved in primary stroke prevention strategies, the Bangladeshi government needs to emphasize healthcare development to cope with the increasing population density and to reduce stroke occurrence. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Imaging of Hemorrhagic Stroke.

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Hakimi, Ryan; Garg, Ankur

2016-10-01

Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. The most common initial neuroimaging study is a noncontrast head CT, which allows for the identification of hemorrhage. Once an intracranial hemorrhage has been identified, the pattern of blood and the patient's medical history, neurologic examination, and laboratory studies lead the practitioner to pursue further neuroimaging studies to guide the medical, surgical, and interventional management. Given that hemorrhagic stroke constitutes a heterogeneous collection of diagnoses, the subsequent neuroimaging pathway necessary to better evaluate and care for these patients is variable based on the etiology.With an increasing incidence and prevalence of atrial fibrillation associated with the aging population and the introduction of three new direct factor Xa inhibitors and one direct thrombin inhibitor to complement vitamin K antagonists, oral anticoagulant use continues to increase. Patients on oral anticoagulants have a sevenfold to tenfold increased risk for intracerebral hemorrhage (ICH). Furthermore, patients who have an ICH associated with oral anticoagulant use have a higher mortality rate than those with primary ICH. Despite the reduced incidence of hypertension-related ICH over the past decade, it is expected that the incidence of ICH will continue to increase. Neuroimaging studies are integral to the identification of hemorrhagic stroke, determination of the underlying etiology, prevention of hematoma expansion, treatment of acute complications, and treatment of the underlying etiology, if indicated. Neuroimaging is essential for prognostication and thus directly impacts patient care.

Longitudinal Change of Perceived Salt Intake and Stroke Risk in a Chinese Population.

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Li, Yun; Huang, Zhe; Jin, Cheng; Xing, Aijun; Liu, Yesong; Huangfu, Chunmei; Lichtenstein, Alice H; Tucker, Katherine L; Wu, Shouling; Gao, Xiang

2018-06-01

Data for a relationship between salt intake and stroke have been inconsistent. This inconstancy could be because of the majority of studies evaluated salt intake at a single time point, which may be insufficient to accurately characterize salt intake throughout the observation period. Included were 77 605 participants from the Kailuan study. We assessed perceived salt intake via questionnaire in 2006, 2008, and 2010. Salt intake trajectories from 2006 to 2010 were identified using latent mixture models. Incident stroke cases were identified from 2010 to 2015 and confirmed by review of medical records. Cox proportional hazards model was used to examine the association between salt intake trajectories and stroke risk after adjusting for possible confounders, including age, sex, lifestyle, social economic status, body mass index, use of medicines, blood pressure, and lipoprotein profiles. Identified were 5 distinct salt intake trajectories: moderate-stable (n=59 241), moderate-decreasing (n=9268), moderate-increasing (n=2975), low-increasing (n=2879), and high-decreasing (n=3242). During the 5-year follow-up period, there were 1564 incident strokes cases. Compared with individuals with the moderate-stable salt intake trajectory, individuals with moderate-decreasing salt intake trajectory had significantly lower cerebral infarction stroke risk (adjusted hazard ratio, 0.76; 95% confidence interval, 0.63-0.92) but not intracerebral hemorrhage risk (adjusted hazard ratio, 0.84; 95% confidence interval, 0.55-1.29). Further adjustment for 2006 or 2010 perceived salt intakes generated similar results. When baseline perceived salt intake only was used as the exposure, a significant dose-response relationship between higher perceived salt intake and higher stroke risk was observed ( P trend=0.006). Change in salt intake was associated with the stroke risk. These data support the dietary recommendation to the reduction of salt intake. © 2018 American Heart Association, Inc.

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.

ISCHAEMIC STROKE IN A 38-YEAR-YOUNG AS A PRESENTING FEATURE OF POLYCYTHAEMIA VERA: A CASE REPORT

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Masaraf Hussain

2016-06-01

Full Text Available Ischemic stroke is rare as a presenting feature of polycythaemia. Here, we report a case of polycythaemia whose presenting feature was ischaemic stroke. Recurrence of stroke may occur if polycythaemia is not treated in these patients. Therefore, identifying this cause of stroke timely may prevent recurrence.

Stroke: advances in medical therapy and acute stroke intervention.

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Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

2015-10-01

Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

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Emine Rabia Koç

2014-09-01

Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking

Stroke in SSA: Review of current literature concerning the incidence ...

African Journals Online (AJOL)

2013-11-04

Nov 4, 2013 ... C, Pancioli A, Jauch E, Shukla R, Broderick J. Stroke in a Biracial ... and Obstetrics. 1998. 61(1). 1-8. SASPI. Secondary prevention of stroke- results from. 20. ... Durand M, Sheehy O, Jean-Guy B, LeLorier J, Tremblay. 29.

Sexual dimorphism in ischemic stroke: lessons from the laboratory

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Manwani, Bharti; McCullough, Louise D

2011-01-01

Ischemic stroke is emerging as a major health problem for elderly women. Women have lower stroke incidence than men until an advanced age, when the epidemiology of ischemic stroke shifts and incidence rises dramatically in women. Experimental models of rodent stroke have replicated this clinical epidemiology, with exacerbated injury in older compared with young female rodents Many of the detrimental effects of aging on ischemic stroke outcome in females can be replicated by ovariectomy, suggesting that hormones such as estrogen play a neuroprotective role. However, emerging data suggest that the molecular mechanisms leading to ischemic cell death differ in the two sexes, and these effects may be independent of circulating hormone levels. This article highlights recent clinical and experimental literature on sex differences in stroke outcomes and mechanisms. PMID:21612353

Neighborhood disadvantage and ischemic stroke: the Cardiovascular Health Study (CHS).

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Brown, Arleen F; Liang, Li-Jung; Vassar, Stefanie D; Stein-Merkin, Sharon; Longstreth, W T; Ovbiagele, Bruce; Yan, Tingjian; Escarce, José J

2011-12-01

Neighborhood characteristics may influence the risk of stroke and contribute to socioeconomic disparities in stroke incidence. The objectives of this study were to examine the relationship between neighborhood socioeconomic status and incident ischemic stroke and examine potential mediators of these associations. We analyzed data from 3834 whites and 785 blacks enrolled in the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ages≥65 years from 4 US counties. The primary outcome was adjudicated incident ischemic stroke. Neighborhood socioeconomic status was measured using a composite of 6 census tract variables. Race-stratified multilevel Cox proportional hazard models were constructed adjusted for sociodemographic, behavioral, and biological risk factors. Among whites, in models adjusted for sociodemographic characteristics, stroke hazard was significantly higher among residents of neighborhoods in the lowest compared with the highest neighborhood socioeconomic status quartile (hazard ratio, 1.32; 95% CI, 1.01-1.72) with greater attenuation of the hazard ratio after adjustment for biological risk factors (hazard ratio, 1.16; 0.88-1.52) than for behavioral risk factors (hazard ratio, 1.30; 0.99-1.70). Among blacks, we found no significant associations between neighborhood socioeconomic status and ischemic stroke. Higher risk of incident ischemic stroke was observed in the most disadvantaged neighborhoods among whites, but not among blacks. The relationship between neighborhood socioeconomic status and stroke among whites appears to be mediated more strongly by biological than behavioral risk factors.

Circle of Willis variation in a complex stroke presentation: a case report

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Young Carolyn A

2006-03-01

Full Text Available Abstract Background The impact of circle of Willis anatomical variation upon the presentation of stroke is probably underrecognised. Case presentation A 63-year-old right-handed woman developed a left hemiparesis and right leg weakness sequentially following a road traffic accident (RTA. Despite initial concern about the possibility of cervical spinal cord injury, the final diagnosis was bilateral artery-to-artery embolic cerebral infarction with dominant right internal carotid artery. Conclusion The case illustrates the complex presentation of stroke as a pseudo-cervical cord lesion and the impact of circle of Willis anatomical variation upon the expression of large vessel cerebrovascular disease.

Combined effects of socioeconomic position, smoking, and hypertension on risk of ischemic and hemorrhagic stroke

DEFF Research Database (Denmark)

Nordahl, Helene; Osler, Merete; Frederiksen, Birgitte Lidegaard

2014-01-01

BACKGROUND AND PURPOSE: Combined effects of socioeconomic position and well-established risk factors on stroke incidence have not been formally investigated. METHODS: In a pooled cohort study of 68 643 men and women aged 30 to 70 years in Denmark, we examined the combined effect and interaction...... between socioeconomic position (ie, education), smoking, and hypertension on ischemic and hemorrhagic stroke incidence by the use of the additive hazards model. RESULTS: During 14 years of follow-up, 3613 ischemic strokes and 776 hemorrhagic strokes were observed. Current smoking and hypertension were...... more prevalent among those with low education. Low versus high education was associated with greater ischemic, but not hemorrhagic, stroke incidence. The combined effect of low education and current smoking was more than expected by the sum of their separate effects on ischemic stroke incidence...

Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

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Broeg-Morvay, Anne; Meisterernst, Julia; Schlager, Markus; Mono, Marie-Luise; El-Koussy, Marwan; Kägi, Georg; Jung, Simon; Sarikaya, Hakan

2016-01-01

Background Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. Methods We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia. Results Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, pdysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; pdysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality. Conclusion Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization. PMID:26863627

Lipid management in the prevention of stroke: a meta-analysis of fibrates for stroke prevention

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Zhou Yu-Hao

2013-01-01

Full Text Available Abstract Background Fibrates has been extensively used to improve plasma lipid levels and prevent adverse cardiovascular outcomes. However, the effect of fibrates on stroke is unclear at the present time. We therefore carried out a comprehensive systematic review and meta-analysis to evaluate the effects of fibrates on stroke. Methods We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings to identify studies for our analysis. We included randomized placebo controlled trials which reported the effects of fibrates on stroke. Relative risk (RR was used to measure the effect of fibrates on the risk of stroke under random effect model. The analysis was further stratified by factors that could affect the treatment effects. Results Overall, fibrate therapy was not associated with a significant reduction on the risk of stroke (RR, 1.02, 95% CI, 0.90 to 1.16, P = 0.78. In the subgroup analyses, we observed that gemfibrozil therapy showed a beneficial effect on stroke (RR, 0.72, 95% CI, 0.53 to 0.98, P = 0.04. Similarly, fibrate therapy comparing to placebo had no effect on the incidence of fatal stroke. Subgroup analysis suggested that fibrate therapy showed an effect on fatal stroke when the Jadad score more than 3 (RR, 0.41, 95% CI, 0.17 to 1.00, P = 0.049. Furthermore, a sensitivity analysis indicated that fibrate therapy may play a role in fatal stroke (RR, 0.49, 95% CI, 0.26 to 0.93, P = 0.03 for patients with previous diabetes, cardiovascular disease or stroke. Conclusions Our study indicated that fibrate therapy might play an important role in reducing the risk of fatal stroke in patients with previous diabetes, cardiovascular disease or stroke. However, it did not have an effect on the incidence of stroke.

Accuracy of Electronic Health Record Data for Identifying Stroke Cases in Large-Scale Epidemiological Studies: A Systematic Review from the UK Biobank Stroke Outcomes Group.

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Rebecca Woodfield

Full Text Available Long-term follow-up of population-based prospective studies is often achieved through linkages to coded regional or national health care data. Our knowledge of the accuracy of such data is incomplete. To inform methods for identifying stroke cases in UK Biobank (a prospective study of 503,000 UK adults recruited in middle-age, we systematically evaluated the accuracy of these data for stroke and its main pathological types (ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, determining the optimum codes for case identification.We sought studies published from 1990-November 2013, which compared coded data from death certificates, hospital admissions or primary care with a reference standard for stroke or its pathological types. We extracted information on a range of study characteristics and assessed study quality with the Quality Assessment of Diagnostic Studies tool (QUADAS-2. To assess accuracy, we extracted data on positive predictive values (PPV and-where available-on sensitivity, specificity, and negative predictive values (NPV.37 of 39 eligible studies assessed accuracy of International Classification of Diseases (ICD-coded hospital or death certificate data. They varied widely in their settings, methods, reporting, quality, and in the choice and accuracy of codes. Although PPVs for stroke and its pathological types ranged from 6-97%, appropriately selected, stroke-specific codes (rather than broad cerebrovascular codes consistently produced PPVs >70%, and in several studies >90%. The few studies with data on sensitivity, specificity and NPV showed higher sensitivity of hospital versus death certificate data for stroke, with specificity and NPV consistently >96%. Few studies assessed either primary care data or combinations of data sources.Particular stroke-specific codes can yield high PPVs (>90% for stroke/stroke types. Inclusion of primary care data and combining data sources should improve accuracy in large

Chuanxiong preparations for preventing stroke.

Science.gov (United States)

Yang, Xunzhe; Zeng, Xiaoxi; Wu, Taixiang

2010-01-20

Stroke is a major healthcare problem and is one of the leading causes of death and serious long-term disability. Prevention of stroke is considered an important strategy. Chuanxiong is traditionally used in China in the treatment and prevention of stroke. In recent years, Chinese researchers have developed new patented Chuanxiong preparations. To assess the effects and safety of Chuanxiong preparations in preventing stroke in high-risk adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2008, Issue 1), MEDLINE (1950 to March 2008), EMBASE (1980 to March 2008), AMED (1985 to March 2008), Chinese Biomedical Database (CBM) (1975 to March 2008), China National Knowledge Infrastructure (CNKI) (1994 to March 2008), and the VIP Database (1989 to March 2008). Trials registers were searched for ongoing studies. No language restrictions were applied. Randomised controlled trials (RCTs) studying the effects of Chuanxiong preparations in preventing stroke were included. Three reviewers independently selected studies for inclusion and two reviewers independently extracted data. Authors of identified RCTs were telephoned to confirm the randomisation procedure. Outcomes assessed included: stroke, composite cardiovascular outcomes, changes in cardiovascular and cerebrovascular haemodynamic indices and adverse events. Peto odds ratio (OR) with 95% confidence intervals (CI) were calculated for dichotomous variables and mean differences for continuous outcomes. Three RCTs (5042 participants) were included. One higher quality study (4415 participants) compared Nao-an capsule with aspirin for primary prevention in high-risk stroke populations. Nao-an capsule appeared to reduce the incidence of stroke compared with aspirin (OR 0.56 95% CI 0.33 to 0.96). One study of low methodological quality indicated that a self-prepared Xifenwan tablet reduced the incidence of stroke in people with transient ischaemia attack (TIA) (OR 0.18, 95% CI 0.04 to 0.78). The

European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy

DEFF Research Database (Denmark)

Holtkamp, Martin; Beghi, Ettore; Benninger, Felix

2017-01-01

-based guidelines on the management of post-stroke seizures and epilepsy. Method A writing committee of six clinicians and researchers from five European countries and Israel identified seven questions relating to prevention of (further) post-stroke seizures and epilepsy and to amelioration of functional outcome......Background Following stroke, acute symptomatic seizures (manifestation within seven days) and epilepsy, i.e. occurrence of at least one unprovoked seizure (manifestation after more than seven days), are reported in 3–6% and up to 12% of patients, respectively. Incidence of acute symptomatic...... seizures is higher in intracranial haemorrhage (10–16%) than in ischaemic stroke (2–4%). Acute symptomatic seizures and unprovoked seizure may be associated with unfavourable functional outcome and increased mortality. In view of the clinical relevance, the European Stroke Organisation has issued evidence...

Serious adverse events and the risk of stroke in patients with rheumatoid arthritis: results from the German RABBIT cohort.

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Meissner, Y; Richter, A; Manger, B; Tony, H P; Wilden, E; Listing, J; Zink, A; Strangfeld, A

2017-09-01

In the general population, the incidence of stroke is increased following other serious events and hospitalisation. We investigated the impact of serious adverse events on the risk of stroke in patients with rheumatoid arthritis (RA), taking risk factors and treatment into account. Using data of the German biologics register RABBIT (Rheumatoid Arthritis: Observation of Biologic Therapy) with 12354 patients with RA, incidence rates (IRs) and risk factors for stroke were investigated using multi-state and Cox proportional hazard models. In addition, in a nested case-control study, all patients with stroke were matched 1:2 to patients with identical baseline risk profile and analysed using a shared frailty model. During follow-up, 166 strokes were reported. The overall IR was 3.2/1000 patient-years (PY) (95% CI 2.7 to 3.7). It was higher after a serious adverse event (IR: 9.0 (7.3 to 11.0)), particularly within 30 days after the event (IR: 94.9 (72.6 to 121.9)). The adjusted Cox model showed increased risks of age per 5 years (HR: 1.4 (1.3 to 1.5)), hyperlipoproteinaemia (HR: 1.6 (1.0 to 2.5)) and smoking (HR: 1.9 (1.3 to 2.6)). The risk decreased with better physical function (HR: 0.9 (0.8 to 0.96)). In the case-control study, 163 patients were matched to 326 controls. Major risk factors for stroke were untreated cardiovascular disease (HR: 3.3 (1.5 to 7.2)) and serious infections (HR:4.4 (1.6 to 12.5)) or other serious adverse events (HR: 2.6 (1.4 to 4.8)). Incident adverse events, in particular serious infections, and insufficient treatment of cardiovascular diseases are independent drivers of the risk of stroke. Physicians should be aware that patients who experience a serious event are at increased risk of subsequent stroke. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Risk factors for falls of hospitalized stroke patients

NARCIS (Netherlands)

Tutuarima, J. A.; van der Meulen, J. H.; de Haan, R. J.; van Straten, A.; Limburg, M.

1997-01-01

Patients with stroke are at a high risk for falling. We assessed the fall incidence and risk factors for patients hospitalized as the result of an acute stroke. We studied a cohort of 720 stroke patients from 23 hospitals in The Netherlands. The data were abstracted from the medical and nursing

Clinical Epidemiology Of Stroke

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Nagaraja D

2005-01-01

Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

Stroke in thrombotic thrombocytopenic purpura induced by thyrotoxicosis: a case report.

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Bellante, Flavio; Redondo Saez, Patricia; Springael, Cecile; Dethy, Sophie

2014-07-01

Thrombotic thrombocytopenic purpura (TTP) is a hematologic disease involving the platelet aggregation and resulting in hemolytic anemia, thrombocytopenia, and microvascular occlusion. Although frequent neurologic features are headache and confusion, focal deficit is described in 30% of the cases. There are a lot of causes inducing thrombotic thrombocytopenic, but reports are lacking when associated with Grave disease. We describe the case of a 51-year-old Caucasian woman presenting a 24-hour story of sudden onset of dysarthria and left superior limb palsy. Four months before, she developed severe hyperthyroidism associated with petechiae, hemolytic anemia, thrombocytopenia, and schistocytes at blood film examination. Relapse of TTP in association with Grave disease was diagnosed. There are few reports describing association between Grave disease and TTP with only mild neurologic involvement. We described, to our knowledge, the first case of acute ischemic stroke secondary to thrombotic thrombocytopenic induced by thyrotoxicosis. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Estimating the cost-effectiveness of stroke units in France compared with conventional care.

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Launois, R; Giroud, M; Mégnigbêto, A C; Le Lay, K; Présenté, G; Mahagne, M H; Durand, I; Gaudin, A F

2004-03-01

The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year. This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 for conventional care and 34 638 in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 per year of life gained without disability was estimated. The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 ) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

High dietary fiber intake prevents stroke at a population level.

Science.gov (United States)

Casiglia, Edoardo; Tikhonoff, Valérie; Caffi, Sandro; Boschetti, Giovanni; Grasselli, Carla; Saugo, Mario; Giordano, Nunzia; Rapisarda, Valentina; Spinella, Paolo; Palatini, Paolo

2013-10-01

This research was aimed at clarifying whether high dietary fiber intake has an impact on incidence and risk of stroke at a population level. In 1647 unselected subjects, dietary fiber intake (DFI) was detected in a 12-year population-based study, using other dietary variables, anagraphics, biometrics, blood pressure, heart rate, blood lipids, glucose, insulin, uricaemia, fibrinogenaemia, erytrosedimentation rate, diabetes, insulin resistance, smoking, pulmonary disease and left ventricular hypertrophy as covariables. In adjusted Cox models, high DFI reduced the risk of stroke. In analysis based on quintiles of fiber intake adjusted for confounders, HR for incidence of stroke was lower when the daily intake of soluble fiber was >25 g or that of insoluble fiber was >47 g. In multivariate analyses, using these values as cut-off of DFI, the risk of stroke was lower in those intaking more that the cut-off of soluble (HR 0.31, 0.17-0.55) or insoluble (HR 0.35, 0.19-0.63) fiber. Incidence of stroke was also lower (-50%, p < 0.003 and -46%, p < 0.01, respectively). Higher dietary DFI is inversely and independently associated to incidence and risk of stroke in general population. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Female- and Male-Specific Risk Factors for Stroke : A Systematic Review and Meta-analysis

NARCIS (Netherlands)

Poorthuis, Michiel H F; Algra, Annemijn M; Algra, Ale; Kappelle, L Jaap; Klijn, Catharina J M

2017-01-01

Importance: The incidence of stroke is higher in men than in women. The influence of sex-specific risk factors on stroke incidence and mortality is largely unknown. Objective: To conduct a systematic review and meta-analysis of female- and male-specific risk factors for stroke. Data Sources: PubMed,

Female- and Male-Specific Risk Factors for Stroke: A Systematic Review and Meta-analysis

NARCIS (Netherlands)

Poorthuis, M.H.; Algra, A.M.; Kappelle, L.J.; Klijn, C.J.M.

2017-01-01

Importance: The incidence of stroke is higher in men than in women. The influence of sex-specific risk factors on stroke incidence and mortality is largely unknown. Objective: To conduct a systematic review and meta-analysis of female- and male-specific risk factors for stroke. Data Sources: PubMed,

The association of atopy with incidence of ischemic heart disease, stroke, and diabetes

DEFF Research Database (Denmark)

Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Thuesen, Betina Heinsbæk

2015-01-01

analyzed by Cox regression analyses with age as underlying time axis and adjusted for study cohort, gender, education, body mass index, alcohol intake, smoking habits, physical activity during leisure time, serum lipids, and blood pressure. The prevalence of atopy was 26.9 % (n = 3,994). There were 1......Allergy is a systemic inflammatory disease that could theoretically affect the risk of cardiovascular disease (CVD) and diabetes through inflammatory pathways or mast cell-induced coronary spasm. Whether allergy is associated with an increased risk of CVD and diabetes is largely unknown. We......-specific IgE positivity to inhalant allergens. The Danish National Diabetes Register enabled identification of incident diabetes. Likewise, the Danish Registry of Causes of Death and the Danish National Patient Register provided information on fatal and non-fatal ischemic heart disease and stroke. Data were...

Radiology in cases of cerebral stroke

International Nuclear Information System (INIS)

Forsting, M.; Reith, W.; Kummer, R. von; Sartor, K.

1993-01-01

Today radiologic methods play an important role in the diagnosis of cerebral stroke. The aim of the radiologist, however, should not only be to classify the stroke into the four main categories (ischemic stroke, intracerebral bleeding, subarachnoid hemorrhage, sinovenous thrombis), but also to interprete the findings with regard to the etiology of the disease. The pattern of lesions gives information about the etiology of ischemic stroke; the correct interpretation of these lesion patterns allows one to optimize therapeutic decisions. This paper additionally focusses on the differential diagnosis of intracerebral hemorrhage and the CT and MR signs of sinovenous thrombosis. New developed concepts in the field of stroke therapy and prophylaxis call for authority and continuous education of the radiolgist on this topic. Pure descriptions of radiologic findings without an understanding of the pathogenesis of the disease will be ignored by the clinician. On the other hand, the radiologist can turn the therapeutic decisions in the right direction by combining morphological descriptions with pathogenetic orientated interpretations. In this way, the radiolgist can contribute to the reduction of costs in the public health system. (orig.) [de

Late-onset radiation-induced vasculopathy and stroke in a child with medulloblastoma.

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Bansal, Lalit R; Belair, Jeffrey; Cummings, Dana; Zuccoli, Giulio

2015-05-01

We report a case of a 15-year-old boy who presented to our institution with left-sided weakness and slurred speech. He had a history of medulloblastoma diagnosed at 3 years of age, status postsurgical resection and craniospinal radiation. Magnetic resonance imaging (MRI) of brain revealed a right paramedian pontine infarction, suspected secondary to late-onset radiation-induced vasculopathy of the vertebrobasilar system. Radiation to the brain is associated with increased incidence of ischemic stroke. Clinicians should have a high index of suspicion for stroke when these patients present with new neurologic symptoms. © The Author(s) 2014.

Stroke Risk among Patients with Type 2 Diabetes Mellitus in Zhejiang: A Population-Based Prospective Study in China

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Lihua Guo

2016-01-01

Full Text Available Objective. This study aimed to explore the incidence of stroke and stroke subtypes among patients with type 2 diabetes mellitus (T2DM based on the long-term surveillance data in Zhejiang, China, during 2007 to 2013. Materials and Methods. During January 1, 2007, and December 31, 2013, a total of 327,268 T2DM and 307,984 stroke patients were registered on Diabetes and Stroke Surveillance System, respectively. Stroke subtypes were classified according to standard definitions of subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke. The incidence of stroke and stroke subtypes was calculated by standardized incidence ratio (SIRs with 95% confidence intervals (CIs compared with general population. Results. The incidence of stroke and stroke subtypes among patients with T2DM was significantly higher than in general population. Stroke risk was found significantly increased with an SIR of 3.87 (95% CI 3.76–3.99 and 3.38 (95% CI 3.27–3.48 in females and males, respectively. The excess risk of stroke was mainly attributable to the significantly higher risk of cerebral infarctions with the risk for T2DM being four times that for general population. Conclusions. The relationship between stroke and T2DM was strong, especially in female. The incidence of stroke and stroke subtypes among patients with T2DM was up to 3-fold higher than in general population in Zhejiang province, especially the subtype of cerebral infarctions.

SURVIVAL RATE PENYANDANG HIPERTENSI DENGAN KONSUMSI NATRIUM RENDAH TERHADAP KEJADIAN STROKE

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Ekowati Rahajeng

2017-01-01

Full Text Available Stroke is the leading cause of death and disability in the world. Several studies have shown that stroke can be prevented through modifiable risk factors. The adequate treatment of hypertension may reduce the risk of stroke. Lifestyle modification such as reducing salt intake in hypertension management have demonstrated lowering blood pressure, enhancing the effectiveness of antihypertension drugs and also reducing stroke risk. This study aims to verify the survival rate of hypertension with lower sodium intake (<2000 mg per day on the incidence of stroke. The study was conducted through a prospective cohort study (4 years of follow-up in 1082 people with confirmed hypertension. Stroke were confirmed by neurologist. The consumption of sodium, sugar and fat were collected through 24-hour dietary recall. Hypertension survival rate was calculated using Life Table Survival analysis. This study has demonstrated evidence of the higher survival rate of hypertension with low sodium intake on the incidence of stroke, with the difference 2-year survival rate is 3 percent higher and 4-year survival rate is 5 percent higher. Sodium consumption of <2000 mg per day in people with hypertension has prevented a 78 percent incidence of stroke. Therefore, the intervention programs to reduce of the consumption of salt or sodium in Indonesia should be prioritized.

Risk Factors of Nicardipine-Related Phlebitis in Acute Stroke Patients.

Science.gov (United States)

Kawada, Kei; Ohta, Tsuyoshi; Tanaka, Koudai; Kadoguchi, Naoto; Yamamoto, Souichi; Morimoto, Masanori

2016-10-01

Intravenous nicardipine is generally used to treat hypertension in acute stroke patients but is associated with frequent phlebitis. We aimed to identify the incidence and risk factors of phlebitis in such patients. The incidence and risk factors of phlebitis were investigated in 358 acute stroke patients from July 2014 to June 2015. In total, 138 patients received intravenous nicardipine. Of 45 (12.6%) phlebitis patients in 358 acute stroke patients, 42 (93.3%) were administered nicardipine, which was significantly associated with phlebitis occurrence (P phlebitis of acute stroke patients in univariate analysis were intracerebral hemorrhage (P phlebitis is frequently observed in acute stroke patients and is significantly associated with administration of a maximum concentration of nicardipine greater than 130 µg/mL. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Estrogen-IGF-1 interactions in neuroprotection: Ischemic Stroke as a case study

Science.gov (United States)

Sohrabji, Farida

2014-01-01

The steroid hormone 17b-estradiol and the peptide hormone insulin-like growth factor (IGF)-1 independently exert neuroprotective actions in neurologic diseases such as stroke. Only a few studies have directly addressed the interaction between the two hormone systems, however, there is a large literature that indicates potentially greater interactions between the 17b-estradiol and IGF-1 systems. The present review focuses on key issues related to this interaction including IGF-1 and sex differences and common activation of second messenger systems. Using ischemic stroke as a case study, this review also focuses on independent and cooperative actions of estrogen and IGF-1 on neuroprotection, blood brain barrier integrity, angiogenesis, inflammation and post-stroke epilepsy. Finally, the review also focuses on the astrocyte, a key mediator of post stroke repair, as a local source of 17b-estradiol and IGF-1. This review thus highlights areas where significant new research is needed to clarify the interactions between these two neuroprotectants. PMID:24882635

Potential serum biomarkers and metabonomic profiling of serum in ischemic stroke patients using UPLC/Q-TOF MS/MS.

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Hongxue Sun

Full Text Available Stroke still has a high incidence with a tremendous public health burden and it is a leading cause of mortality and disability. However, biomarkers for early diagnosis are absent and the metabolic alterations associated with ischemic stroke are not clearly understood. The objectives of this case-control study are to identify serum biomarkers and explore the metabolic alterations of ischemic stroke.Metabonomic analysis was performed using ultra-performance liquid chromatography quadrupole time-of-flight tandem mass spectrometry and multivariate statistical analysis was employed to study 60 patients with or without ischemic stroke (30 cases and 30 controls.Serum metabolic profiling identified a series of 12 metabolites with significant alterations, and the related metabolic pathways involved glycerophospholipid, sphingolipid, phospholipid, fat acid, acylcarnitine, heme, and purine metabolism. Subsequently, multiple logistic regression analyses of these metabolites showed uric acid, sphinganine and adrenoyl ethanolamide were potential biomarkers of ischemic stroke with an area under the receiver operating characteristic curve of 0.941.These findings provide insights into the early diagnosis and potential pathophysiology of ischemic stroke.

Increased risk of stroke in contact dermatitis patients

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Chang, Wei-Lun; Hsu, Min-Hsien; Lin, Cheng-Li; Chan, Po-Chi; Chang, Ko-Shih; Lee, Ching-Hsiao; Hsu, Chung-Yi; Tsai, Min-Tein; Yeh, Chung-Hsin; Sung, Fung-Chang

2017-01-01

Abstract Dermatologic diseases are not traditional risk factors of stroke, but recent studies show atopic dermatitis, psoriasis, and bullous skin disease may increase the risk of stroke and other cardiovascular diseases. No previous studies have focused on the association between contact dermatitis and stroke. We established a cohort comprised of 48,169 contact dermatitis patients newly diagnosed in 2000–2003 and 96,338 randomly selected subjects without the disorder, frequency matched by sex, age, and diagnosis year, as the comparison cohort. None of them had a history of stroke. Stroke incidence was assessed by the end of 2011 for both cohorts. The incidence stroke was 1.1-fold higher in the contact dermatitis cohort than in the comparison cohort (5.93 vs 5.37 per 1000 person-years, P contact dermatitis cohort increased with age, from 1.14 (95% CI, 1.03–1.27) for 65 to 74 years; to 1.27 (95% CI, 1.15–1.42) for 75 years and older. The aHR of stroke were 1.16 (95% CI, 1.07–1.27) and 1.09 (95% CI, 1.00–1.18) for men and women, respectively. This study suggests that patients with contact dermatitis were at a modestly increased risk of stroke, significant for ischemic stroke but not for hemorrhagic stroke. Comorbidity, particularly hypertension, increased the hazard of stroke further. PMID:28272195

Successful Intra-Arterial Thrombolysis for Acute Ischemic Stroke in the Immediate Postpartum Period: Case Report

International Nuclear Information System (INIS)

Mendez, Jose C.; Masjuan, J.; Garcia, N.; Lecinana, M. de

2008-01-01

Stroke in pregnancy and the puerperium is a rare but potentially devastating event. We present the case of a previously healthy woman who underwent a cesarean delivery and experienced a middle cerebral artery thrombosis in the immediate postpartum period that was subsequently lysed with intra-arterial urokinase. The patient made a complete neurologic recovery. To the best of our knowledge, this is the first reported case of successful intra-arterial thrombolysis for ischemic stroke in the postpartum period

Stroke in sickle cell anemia: New concepts in diagnosis and ...

African Journals Online (AJOL)

Stroke is a devastating and potentially fatal complication of sickle cell disease. The highest incidence of cerebrovascular disease is in the first 10 years and especially between 2 to 5 years. Two types of stroke occur in these patients – infarctive and hemorrhagic strokes. While infarctive strokes occur frequently in children, ...

The organisational context of nursing care in stroke units: a case study approach.

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Burton, Christopher R; Fisher, Andrea; Green, Theresa L

2009-01-01

Internationally the stroke unit is recognised as the evidence-based model for patient management, although clarity about the effective components of stroke units is lacking. Whilst skilled nursing care has been proposed as one component, the theoretical and empirical basis for stroke nursing is limited. We attempted to explore the organisational context of stroke unit nursing, to determine those features that staff perceived to be important in facilitating high quality care. A case study approach was used, that included interviews with nurses and members of the multidisciplinary teams in two Canadian acute stroke units. A total of 20 interviews were completed, transcribed and analysed thematically using the Framework Approach. Trustworthiness was established through the review of themes and their interpretation by members of the stroke units. Nine themes that comprised an organisational context that supported the delivery of high quality nursing care in acute stroke units were identified, and provide a framework for organisational development. The study highlighted the importance of an overarching service model to guide the organisation of care and the development of specialist and advanced nursing roles. Whilst multidisciplinary working appears to be a key component of stroke unit nursing, various organisational challenges to its successful implementation were highlighted. In particular the consequence of differences in the therapeutic approach of nurses and therapy staff needs to be explored in greater depth. Successful teamwork appears to depend on opportunities for the development of relationships between team members as much as the use of formal communication systems and structures. A co-ordinated approach to education and training, clinical leadership, a commitment to research, and opportunities for role and practice development also appear to be key organisational features of stroke unit nursing. Recommendations for the development of stroke nursing

Acute ischemic stroke in a 6 year old boy, treated with mechanical thrombectomy: A case report

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Kim, Gi Hong; Lee, Mu Sook; Yang, Tae Ki [Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of)

2016-11-15

Pediatric acute ischemic stroke (AIS) is a relatively rare disease with an annual estimated incidence of 2.4-13 per 100000 children. However, pediatric AIS can lead to significant morbidity and mortality. Stroke in children differs from that in adults with respect to etiology, clinical presentation, or management. Therapeutic options for adult AIS are intravenous tissue plasminogen activator, intra-arterial pharmacological thrombolysis, and mechanical thrombectomy. However, management strategies for pediatric AIS, extrapolated largely from those of adult AIS, remain controversial. In this article, we present our experience in a boy with AIS, who was successfully treated with mechanical thrombectomy, by utilizing the Solitaire FR revascularization device.

Characterizing stroke lesions using digital templates and lesion quantification tools in a web-based imaging informatics system for a large-scale stroke rehabilitation clinical trial

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Wang, Ximing; Edwardson, Matthew; Dromerick, Alexander; Winstein, Carolee; Wang, Jing; Liu, Brent

2015-03-01

Previously, we presented an Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) imaging informatics system that supports a large-scale phase III stroke rehabilitation trial. The ePR system is capable of displaying anonymized patient imaging studies and reports, and the system is accessible to multiple clinical trial sites and users across the United States via the web. However, the prior multicenter stroke rehabilitation trials lack any significant neuroimaging analysis infrastructure. In stroke related clinical trials, identification of the stroke lesion characteristics can be meaningful as recent research shows that lesion characteristics are related to stroke scale and functional recovery after stroke. To facilitate the stroke clinical trials, we hope to gain insight into specific lesion characteristics, such as vascular territory, for patients enrolled into large stroke rehabilitation trials. To enhance the system's capability for data analysis and data reporting, we have integrated new features with the system: a digital brain template display, a lesion quantification tool and a digital case report form. The digital brain templates are compiled from published vascular territory templates at each of 5 angles of incidence. These templates were updated to include territories in the brainstem using a vascular territory atlas and the Medical Image Processing, Analysis and Visualization (MIPAV) tool. The digital templates are displayed for side-by-side comparisons and transparent template overlay onto patients' images in the image viewer. The lesion quantification tool quantifies planimetric lesion area from user-defined contour. The digital case report form stores user input into a database, then displays contents in the interface to allow for reviewing, editing, and new inputs. In sum, the newly integrated system features provide the user with readily-accessible web-based tools to identify the vascular territory involved, estimate lesion area

Cardiac disease, depressive symptoms, and incident stroke in an elderly population.

NARCIS (Netherlands)

Wouts, L.; Oude Voshaar, R.C.; Bremmer, M.A.; Buitelaar, J.K.; Penninx, B.W.J.H.; Beekman, A.T.

2008-01-01

CONTEXT: Previous research suggests that depression is a risk factor for stroke. However, the reliability of much research is limited by the lack of documentation on the presence of preexistent cardiovascular disease and by the use of limited measures of depression or stroke. OBJECTIVES: To test the

Gingivitis and periodontitis as a risk factor for stroke: A case-control study in the Iranian population.

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Hashemipour, Maryam Alsadat; Afshar, Afsaneh Jahanshahi; Borna, Roya; Seddighi, Behnas; Motamedi, Amin

2013-09-01

Periodontitis and gingivitis are one of the most infectious diseases in human. Several studies have been carried out on dependence of periodontitis and stroke. The aim of this study was to investigate the gingivitis and periodontitis as a risk factor for stroke in Iranian population. A case-control study was conducted on 100 patients suffering from stroke as case group, and 100 hospitalized patients as control group. The case group included 42 males and 58 females, and in control group there were 44 males and 56 females. Using a University of North Carolina-15 manual probe, the clinical attachment level, the distance between the cemento-enamel junction and the probed base of the periodontal pocket, were recorded by gingival and periodontal indexes. The data were analyzed by multiple logistic regressions, Chi-square test, Fisher's test, t-test, Man Whitney, and SPSS11.5 software program. P > 0.05 was considered as significant. The case group included 42 males and 58 females, and in control group 44 males and 56 females were included. In this investigation, the average of gingival index in men and women of case group was 1.22 ± 0.55 and 1.31 ± 0.55, respectively. This study showed that the average of gingival index in case group was more than control group. Periodontal index in both groups in men was more than women. The moderate and severe periodontitis in case group were more than that of control group (P = 0.003, P = 0.001). The result of this study shows that there is a significant relation between stroke and periodontal index; however, there isn't any significant relation between stroke and gingival index.

Stroke and Long-Term Exposure to Outdoor Air Pollution From Nitrogen Dioxide A Cohort Study

DEFF Research Database (Denmark)

Andersen, Zorana Jovanovic; Kristiansen, Luise Cederkvist; Andersen, Klaus K.

2012-01-01

Background and Purpose-Years of exposure to tobacco smoke substantially increase the risk for stroke. Whether long-term exposure to outdoor air pollution can lead to stroke is not yet established. We examined the association between long-term exposure to traffic-related air pollution and incident...... and fatal stroke in a prospective cohort study.Methods-We followed 57 053 participants of the Danish Diet, Cancer and Health cohort in the Hospital Discharge Register for the first-ever hospital admission for stroke (incident stroke) between baseline (1993-1997) and 2006 and defined fatal strokes as death...

Incidence of DWI-positive stroke in patients with vertigo of unclear etiology, preliminary results.

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Leker, Ronen R; Hur, Tamir Ben; Gomori, John M; Paniri, R; Eichel, Roni; Cohen, Jose E

2013-03-01

Acute vertigo may be secondary to stroke or to non-ischemic causes. Accurate identification of vertigo secondary to ischemia may lead to appropriate timely intervention that can minimize stroke-related damage and can help in tailoring the most appropriate individual therapy for affected patients. Diffusion weighted MRI (DWI) is very accurate for diagnosing stroke and we therefore aimed to test whether it can aid in making a correct diagnosis of vertigo secondary to stroke. All patients presenting with vertigo in which the diagnosis of stroke was considered underwent DWI only MRI. Data regarding the symptoms and neurological deficits, vascular risk factors, imaging findings, and outcomes was accrued. Patients with stroke on DWI were compared with those without ischemia. Between June 2010 and August 2011, 28 patients fulfilling the entry criteria were identified with a mean age of 62·2±12·8 (60% male). The final diagnosis was stroke in 11 patients (39%). Patients with stroke did not differ from those without stroke in their risk factor profile. However, patients with stroke more often tended to present with vertigo accompanied by other neurological symptoms (73% versus 12% respectively, P = 0·001). After adjusting for age and the presence of diabetes, the presence of multiple symptoms remained the only variable that was associated with a positive DWI scan (odds ratio: 30: 95% confidence interval: 2·6-349). Most patients with stroke had very mild strokes with a median admission NIHSS score of 3 and DWI lesion volumes >2 cm were found in only three patients. Most stroke patients made a good recovery (modified Rankin score ≤2 in seven of nine patients with 90 day data). The most common diagnosis in patients without stroke was of vertigo of peripheral origin (14/17). DWI only MRI can be used to rapidly screen patients presenting with vertigo and suspected vertebrobasilar stroke. The occurrence of vertigo in combination with other focal neurological symptoms may

Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis.

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Lekoubou, Alain; Philippeau, Frédéric; Derex, Laurent; Olaru, Angel; Gouttard, Michel; Vieillart, Anne; Kengne, Andre Pascal

2014-07-01

Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment. We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients. Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA. Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32‰). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17‰; 95% confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100% of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47% cases, ipsilateral in 14%, and bilateral in 39%; and resolved within 24 hours with treatment in 90%. No related death was recorded. About 17‰ acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.

The impact of stroke unit care on outcome in a Scottish stroke population, taking into account case mix and selection bias.

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Turner, Melanie; Barber, Mark; Dodds, Hazel; Dennis, Martin; Langhorne, Peter; Macleod, Mary Joan

2015-03-01

Randomised trials indicate that stroke unit care reduces morbidity and mortality after stroke. Similar results have been seen in observational studies but many have not corrected for selection bias or independent predictors of outcome. We evaluated the effect of stroke unit compared with general ward care on outcomes after stroke in Scotland, adjusting for case mix by incorporating the six simple variables (SSV) model, also taking into account selection bias and stroke subtype. We used routine data from National Scottish datasets for acute stroke patients admitted between 2005 and 2011. Patients who died within 3 days of admission were excluded from analysis. The main outcome measures were survival and discharge home. Multivariable logistic regression was used to estimate the OR for survival, and adjustment was made for the effect of the SSV model and for early mortality. Cox proportional hazards model was used to estimate the hazard of death within 365 days. There were 41 692 index stroke events; 79% were admitted to a stroke unit at some point during their hospital stay and 21% were cared for in a general ward. Using the SSV model, we obtained a receiver operated curve of 0.82 (SE 0.002) for mortality at 6 months. The adjusted OR for survival at 7 days was 3.11 (95% CI 2.71 to 3.56) and at 1 year 1.43 (95% CI 1.34 to 1.54) while the adjusted OR for being discharged home was 1.19 (95% CI 1.11 to 1.28) for stroke unit care. In routine practice, stroke unit admission is associated with a greater likelihood of discharge home and with lower mortality up to 1 year, after correcting for known independent predictors of outcome, and excluding early non-modifiable mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Diagnostic accuracy of guys Hospital stroke score (allen score) in acute supratentorial thrombotic/haemorrhagic stroke

International Nuclear Information System (INIS)

Zulfiqar, A.; Toori, K. U.; Khan, S. S.; Hamza, M. I. M.; Zaman, S. U.

2006-01-01

A consecutive series of 103 patients, 58% male with mean age of 62 year (range 40-75 years), admitted with supratentorial stroke in our teaching hospital were studied. All patients had Computer Tomography scan brain done after clinical evaluation and application of Allen stroke score. Computer Tomography Scan confirmed thrombotic stroke in 55 (53%) patients and haemorrhagic stroke in 48 (47%) patients. Out of the 55 patients with definitive thrombotic stroke on Computer Tomography Scan, Allen stroke score suggested infarction in 67%, haemorrhage in 6% and remained inconclusive in 27% of cases. In 48 patients with definitive haemorrhagic stroke on Computer Tomography Scan, Allen stroke score suggested haemorrhage in 60%, infarction in 11% and remained inconclusive in 29% of cases. The overall accuracy of Allen stroke score was 66%. (author)

Prospective multicentre cohort study of heparin-induced thrombocytopenia in acute ischaemic stroke patients

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Kawano, Hiroyuki; Yamamoto, Haruko; Miyata, Shigeki; Izumi, Manabu; Hirano, Teruyuki; Toratani, Naomi; Kakutani, Isami; Sheppard, Jo-Ann I; Warkentin, Theodore E; Kada, Akiko; Sato, Shoichiro; Okamoto, Sadahisa; Nagatsuka, Kazuyuki; Naritomi, Hiroaki; Toyoda, Kazunori; Uchino, Makoto; Minematsu, Kazuo

2011-01-01

Acute ischaemic stroke patients sometimes receive heparin for treatment and/or prophylaxis of thromboembolic complications. This study was designed to elucidate the incidence and clinical features of heparin-induced thrombocytopenia (HIT) in acute stroke patients treated with heparin. We conducted a prospective multicentre cohort study of 267 patients who were admitted to three stroke centres within 7 d after stroke onset. We examined clinical data until discharge and collected blood samples on days 1 and 14 of hospitalization to test anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs) using an enzyme-linked immunosorbent assay (ELISA); platelet-activating antibodies were identified by serotonin-release assay (SRA). Patients with a 4Ts score ≥4 points, positive-ELISA, and positive-SRA were diagnosed as definite HIT. Heparin was administered to 172 patients (64·4%: heparin group). Anti-PF4/H Abs were detected by ELISA in 22 cases (12·8%) in the heparin group. Seven patients had 4Ts ≥ 4 points. Among them, three patients (1·7% overall) were also positive by both ELISA and SRA. National Institutes of Health Stroke Scale score on admission was high (range, 16–23) and in-hospital mortality was very high (66·7%) in definite HIT patients. In this study, the incidence of definite HIT in acute ischaemic stroke patients treated with heparin was 1·7% (95% confidence interval: 0·4–5·0). The clinical severity and outcome of definite HIT were unfavourable. PMID:21671895

Epidemiology of non-fatal cerebrovascular stroke and transient ischemic attacks in Al Quseir, Egypt

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El-Tallawy HN

2013-11-01

Full Text Available Hamdy N El-Tallawy,1 Wafaa MA Farghaly,1 Ghaydaa A Shehata,1 Nabil M Abdel-Hakeem,2 Tarek A Rageh,1 Reda Badry,1 Mahmoud R Kandil1 1Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, 2Department of Neurology, Faculty of Medicine, Al-Azhar University, Assiut branch, Assuit, Egypt Background and purpose: Stroke is a medical emergency that can cause permanent neurological damage, complications, and disability. We aim to determine the epidemiology of non-fatal cerebrovascular stroke (CVS and transient ischemic attacks (TIAs in Al Quseir City, Red Sea, Egypt. Methods: The total population (n=33,285 was screened through a door to door study by three specialists of neurology and 15 female social workers (for demographic data collection. All suspected stroke patients were subjected to a full clinical examination, computerized tomography (CT and/or magnetic resonance imaging (MRI of their brain, blood sugar, lipogram, serum uric acid, complete blood cells, blood urea, and serum creatinine, as well as evaluated by Barthel Index and Scandinavian Stroke Scale. Carotid doppler, echocardiography, and thyroid functions were done for selected cases. Results: CVS was recorded among 130 patients out of 19,848 subjects aged 20 years and more, yielding a total prevalence of 6.55/1,000 population. From June 1, 2010 to May 31, 2011, 36 patients were recorded to have stroke within 1-year, yielding an incidence rate of 1.81/1,000. Prevalence and incidence rates were higher among males than females, and both indices increased steadily with advancing age to reach the highest prevalence (37.02/1,000 and incidence rate (9.5/1,000 among aged persons 60 years and more. Conclusion: The prevalence of non-fatal stroke in Al Quseir city (6.55/1,000 was at the lower range of that recorded in developing countries (5–10/1,000 and slightly higher than that recorded in industrialized countries (5/1,000 population. Ischemic stroke is the most

Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort.

Directory of Open Access Journals (Sweden)

Mi Kyoung Son

Full Text Available Atrial fibrillation (AF is a major risk factor for ischemic stroke and associated with a 5-fold higher risk of stroke. In this retrospective cohort study, the incidence of and risk factors for ischemic stroke in patients with AF were identified. All patients (≥30 years old without previous stroke who were diagnosed with AF in 2007-2013 were selected from the National Health Insurance Service-National Sample Cohort. To identify factors that influenced ischemic stroke risk, Cox proportional hazard regression analysis was conducted. During a mean follow-up duration of 3.2 years, 1022 (9.6% patients were diagnosed with ischemic stroke. The overall incidence rate of ischemic stroke was 30.8/1000 person-years. Of all the ischemic stroke that occurred during the follow-up period, 61.0% occurred within 1-year after AF diagnosis. Of the patients with CHA2DS2-VASc score of ≥2, only 13.6% were receiving warfarin therapy within 30 days after AF diagnosis. Relative to no antithrombotic therapy, warfarin treatment for >90 days before the index event (ischemic stroke in stroke patients and death/study end in non-stroke patients associated with decreased ischemic stroke risk (Hazard Ratio = 0.41, 95%confidence intervals = 0.32-0.53. Heart failure, hypertension, and diabetes mellitus associated with greater ischemic stroke risk. AF patients in Korea had a higher ischemic stroke incidence rate than patients in other countries and ischemic stroke commonly occurred at early phase after AF diagnosis. Long-term (>90 days continuous warfarin treatment may be beneficial for AF patients. However, warfarin treatment rates were very low. To prevent stroke, programs that actively detect AF and provide anticoagulation therapy are needed.

Post-stroke epilepsy in young adults: a long-term follow-up study

NARCIS (Netherlands)

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

2013-01-01

BACKGROUND: Little is known about the incidence and risk of seizures after stroke in young adults. Especially in the young seizures might dramatically influence prognosis and quality of life. We therefore investigated the long-term incidence and risk of post-stroke epilepsy in young adults with a

Antibiotic therapy for preventing infections in people with acute stroke

NARCIS (Netherlands)

Vermeij, Jan-Dirk; Westendorp, Willeke F.; Dippel, Diederik Wj; van de Beek, Diederik; Nederkoorn, Paul J.

2018-01-01

Stroke is the main cause of disability in high-income countries and ranks second as a cause of death worldwide. Infections occur frequently after stroke and may adversely affect outcome. Preventive antibiotic therapy in the acute phase of stroke may reduce the incidence of infections and improve

Factor V leiden and ischemic stroke risk: the Genetics of Early Onset Stroke (GEOS) study.

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Hamedani, Ali G; Cole, John W; Cheng, Yuching; Sparks, Mary J; O'Connell, Jeffrey R; Stine, Oscar C; Wozniak, Marcella A; Stern, Barney J; Mitchell, Braxton D; Kittner, Steven J

2013-05-01

Factor V Leiden (FVL) has been associated with ischemic stroke in children but not in adults. Although the FVL mutation is associated with increased risk for venous thrombosis, its association with ischemic stroke in young adults remains uncertain. Therefore, we examined the association between FVL and ischemic stroke in participants of the Genetics of Early Onset Stroke (GEOS) study. A population-based case control study identified 354 women and 476 men 15 to 49 years of age with first-ever ischemic stroke and 907 controls. Participant-specific data included vascular risk factors, FVL genotype and, for cases, the ischemic stroke subtype by modified Trial of ORG 10172 in Acute Stroke criteria. Logistic regression was used to calculate odds ratios for the entire population and for subgroups stratified by risk factors and ischemic stroke subtype. The frequency of the FVL mutation was similar between ischemic stroke patients (3.6%; 95% confidence interval [CI] 2.5%-5.1%) and nonstroke controls (3.8%; 95% CI 2.7%-5.2%). This frequency did not change significantly when cases were restricted to patients with stroke of undetermined etiology (4.1%; 95% CI 2.6%-6.4%). Among young adults, we found no evidence for an association between FVL and either all ischemic stroke or the subgroup with stroke of undetermined etiology. Published by Elsevier Inc.

Paediatric stroke

African Journals Online (AJOL)

2011-04-02

Apr 2, 2011 ... Organization definition of stroke is 'a clinical syndrome of rapidly developing focal or global ..... In the case of sickle cell disease primary and secondary prevention is by ... stroke and must involve caregivers. Prognosis7,10,17.

Unusual case of stroke related to Kocuria Kristinae endocarditis treated with surgical procedure.

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Aleksic, D; Miletic-Drakulic, S; Boskovic-Matic, T; Simovic, S; Toncev, G

2016-01-01

We report the case of a 35-year-old man with stroke related to infective endocarditis (IE) caused by Kocuria kristinae . The patient with chronic hepatitis C virus infection and a former intravenous drug user developed a stroke suddenly, after three months duration of fever and malaise. Duplex ultrasonography of the carotid arteries (zero level diastolic flow, diastolic reversed flow) focused attention to cardiac valve pathology and endocarditis (definite confirmation was made by transesophageal echocardiography). Kocuria kristinae was grown from the blood culture and antibiotic therapy administered, according to the antibiogram, did not cure the infection and the patient underwent an aortic valve replacement with a mechanical prosthesis and debridement of the mitral valve. One year after the surgery, the patient had no subjective problems and neurological findings were normal.  Conclusion: To our knowledge, this is the first case of IE caused by Kocuria kristinae , which was diagnosed after the development of stroke, where IE was suspected based on Duplex ultrasonography of the carotid arteries.  This is the second case of infection by this bacterium which could not be cured by antibiotics only and had to be submitted to surgical intervention. Hippokratia 2016, 20(3): 231-234.

Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups.

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Gezmu, Tefera; Schneider, Dona; Demissie, Kitaw; Lin, Yong; Giordano, Christine; Gizzi, Martin S

2014-01-01

Evidence implicates lipid abnormalities as important but modifiable risk factors for stroke. This study assesses whether hypercholesterolemia can be used to predict the risk for etiologic subtypes of ischemic stroke between sexes within racial/ethnic groups. Data elements related to stroke risk, diagnosis, and outcomes were abstracted from the medical records of 3,290 acute stroke admissions between 2006 and 2010 at a regional stroke center. Sex comparison within racial/ethnic groups revealed that South Asian and Hispanic men had a higher proportion of ischemic stroke than women, while the inverse was true for Whites and African Americans (P=0.0014). All women, except South Asian women, had higher mean plasma total cholesterol and higher blood circulating low-density lipoprotein levels (≥100 mg/dL) than men at the time of their admissions. The incidence of large-artery atherosclerosis (LAA) was more common among women than men, except among Hispanics, where men tended to have higher incidences. A regression analysis that considered patients diagnosed with either LAA or small-artery occlusion etiologic subtype as the outcomes and high-density lipoproteins and triglycerides as predictors showed inconsistent associations between lipid profiles and the incidence of these subtypes between the sexes within racial/ethnic groups. In conclusion, our investigation suggests that women stroke patients may be at increased risk for stroke etiologic subtype LAA than men. Although the higher prevalence of stroke risk factors examined in this study predicts the increase in the incidence of the disease, lack of knowledge/awareness and lack of affordable treatments for stroke risk factors among women and immigrants/non-US-born subpopulations may explain the observed associations.

Serum Insulin-Like Growth Factor 1 and the Risk of Ischemic Stroke: The Framingham Study.

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Saber, Hamidreza; Himali, Jayandra J; Beiser, Alexa S; Shoamanesh, Ashkan; Pikula, Aleksandra; Roubenoff, Ronenn; Romero, Jose R; Kase, Carlos S; Vasan, Ramachandran S; Seshadri, Sudha

2017-07-01

Low insulin-like growth factor 1 (IGF-1) has been associated with increased risk of atherosclerosis and atrial fibrillation in cross-sectional studies. Yet, prospective data linking IGF-1 levels to the development of ischemic stroke remain inconclusive. We examined prospectively the association between serum IGF-1 levels and incident ischemic stroke. We measured serum IGF-1 levels in 757 elderly individuals (mean age 79±5, 62% women), free of prevalent stroke, from the Framingham original cohort participants at the 22nd examination cycle (1990-1994) and were followed up for the development of ischemic stroke. Cox models were used to relate IGF-1 levels to the risk for incident ischemic stroke, adjusted for potential confounders. During a mean follow-up of 10.2 years, 99 individuals developed ischemic stroke. After adjustment for age, sex, and potential confounders, higher IGF-1 levels were associated with a lower risk of incident ischemic stroke, with subjects in the lowest quintile of IGF-1 levels having a 2.3-fold higher risk of incident ischemic stroke (95% confidence interval, 1.09-5.06; P =0.03) as compared with those in the top quintile. We observed an effect modification by diabetes mellitus and waist-hip ratio for the association between IGF-1 and ischemic stroke ( P <0.1). In subgroup analyses, the effects were restricted to subjects with diabetics and those in top waist-hip ratio quartile, in whom each standard deviation increase in IGF-1 was associated with a 61% (hazard ratio, 0.39; 95% confidence interval, 0.20-0.78; P =0.007) and 41% (hazard ratio, 0.59; 95% confidence interval, 0.37-0.95; P =0.031) lower risk of incident ischemic stroke, respectively. IGF-1 levels were inversely associated with ischemic stroke, especially among persons with insulin resistance. © 2017 American Heart Association, Inc.

Stroke Outreach in an Inner City Market: A Platform for Identifying African American Males for Stroke Prevention Interventions.

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Sharrief, Anjail Zarinah; Johnson, Brenda; Urrutia, Victor Cruz

2015-01-01

There are significant racial disparities in stroke incidence and mortality. Health fairs and outreach programs can be used to increase stroke literacy, but they often fail to reach those at highest risk, including African American males. We conducted a stroke outreach and screening program at an inner city market in order to attract a high-risk group for a stroke education intervention. A modified Framingham risk tool was used to estimate stroke risk and a 10-item quiz was developed to assess stroke literacy among 80 participants. We report results of the demographic and stroke risk analyses and stroke knowledge assessment. The program attracted a majority male (70%) and African American (95%) group of participants. Self-reported hypertension (57.5%), tobacco use (40%), and diabetes (23.8%) were prevalent. Knowledge of stroke warning signs, risk factors, and appropriate action to take for stroke symptoms was not poor when compared to the literature. Stroke outreach and screening in an inner city public market may be an effective way to target a high-risk population for stroke prevention interventions. Stroke risk among participants was high despite adequate stroke knowledge.

Fluent Aphasia in Telugu: A Case Comparison Study of Semantic Dementia and Stroke Aphasia

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Alladi, Suvarna; Mridula, Rukmini; Mekala, Shailaja; Rupela, Vani; Kaul, Subhash

2010-01-01

This study presents two cases with fluent aphasia in Telugu with semantic dementia and post-stroke fluent aphasia. Comparable scores were obtained on the conventional neuropsychological and language tests that were administered on the two cases. Both cases demonstrated fluent, grammatical and well-articulated speech with little content, impaired…

Ethnic differences in ischemic stroke subtypes in young-onset stroke: the Stroke Prevention in Young Adults Study.

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Trivedi, Megh M; Ryan, Kathleen A; Cole, John W

2015-10-29

Prior studies indicate that young African-Americans (AA) have a greater frequency of ischemic stroke than similarly aged European-Americans (EA). We hypothesized that differences in stroke subtype frequency mediated through sex and differing risk factor profiles may play a role in ethnicity-specific stroke. Utilizing our biracial young-onset stroke population, we explored these relationships. Fifty nine hospitals in the Baltimore-Washington area participated in a population-based study of young-onset stroke in men (218-AA, 291-EA) and women (219-AA, 222-EA) aged 16-49. Data on age, sex, ethnicity and stroke risk factors (hypertension (HTN) and smoking) were gathered through standardized interview. A pair of vascular neurologists adjudicated each case to determine TOAST subtype. Logistic regression analyses evaluating for differences in stroke risk factors by TOAST subtype were performed. Analyses controlling for age and sex demonstrated that AA were more likely to have a lacunar stroke than EA (OR = 1.61; 95% CI = 1.12-2.32; p = 0.011) when utilizing the other TOAST subtypes as the reference group. This effect was mediated by HTN, which increases the risk of lacunar stroke (OR = 2.03; 95% CI = 1.38-2.98; p = 0.0003) and large artery stroke (OR = 1.70; 95% CI = 1.01-2.88; p = 0.048) when controlling for sex, ethnicity, and age. Cases below age 40 were more likely to have a cardioembolic stroke than those above age 40 (OR = 1.62; 95% CI = 1.15-2.27; p = 0.006), controlling for sex and ethnicity. Lastly, current smokers were more likely to have a large artery stroke than non-smokers (OR = 1.79; 95% CI = 1.08-2.98; p = 0.024). Our population-based data demonstrate ethnic differences in ischemic stroke subtypes. These findings may help clarify mechanisms of stroke in young adults which may in part be driven by ethnic-specific differences in early-onset traditional risk factors, thereby indicating differing emphasis on workup and prevention.

Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

Science.gov (United States)

Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

2011-08-01

Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

Polymorphisms of the lipoprotein lipase gene as genetic markers for stroke in colombian population: a case control study.

Science.gov (United States)

Velásquez Pereira, Leydi Carolina; Vargas Castellanos, Clara Inés; Silva Sieger, Federico Arturo

2016-12-30

To analyze if there is an association between the presence of polymorphisms in the LPL gene (rs320, rs285 and rs328) with development of acute ischemic stroke in Colombian population. In a case control design, 133 acute ischemic stroke patients (clinical diagnosis and x-ray CT) and 269 subjects without stroke as controls were studied. PCR -RFLP technique was used to detect rs320, rs285 and rs328 polymorphisms in the LPL gene. In the present research was not found any association between any of the LPL gene polymorphism and acute ischemic stroke in the population studied; the allele and genotypic frequencies of the studied polymorphisms were similar in cases and controls and followed the Hardy-Weinberg equilibrium. The study was approved by the IRB and each subject signed the informed consent. LPL gene polymorphisms are not genetic markers for the development of stroke in the Colombian sample used.

Analysis of speed, stroke rate, and stroke distance for world-class breaststroke swimming.

Science.gov (United States)

Garland Fritzdorf, Stephen; Hibbs, Angela; Kleshnev, Valery

2009-02-15

Speed in aquatic locomotion is determined by stroke distance and stroke rate, but it does not always follow that an increase in stroke rate will lead to an increase in speed. Kleshnev (2006) developed a method to evaluate the relationship between speed and stroke rate during rowing - the effective work per stroke. In this case study, the effective work per stroke was determined for a male world-class 100-m breaststroke swimmer for seven races in major championships and compared between: each of the seven races; each quarter within each race; and the best swims of this case study and seven other world-class swimmers. The effective work per stroke was related to race performance, with the fastest race having the highest effective work per stroke and lowest stroke rate, with slower races having low effectiveness and high stroke rate (R(2) = 0.85). The effective work per stroke was reduced in a race as the swimmer fatigued. The within-race standard deviation of effectiveness was lower in fast swims (R(2) = 0.84). This analysis has identified some characteristics of fast swimming: high effectiveness, optimal stroke rate, and a flat effectiveness profile. Training and racing strategies can now be devised to improve performance by increasing the sensitivity of assessment of strengths and weaknesses in individuals.

Multiple Silent Lacunes Are Associated with Recurrent Ischemic Stroke

DEFF Research Database (Denmark)

Andersen, Søren Due; Skjøth, Flemming; Yavarian, Yousef

2016-01-01

ackground: Silent lacunes are a common finding on brain imaging in ischemic stroke patients, but the prognostic significance of these lesions is uncertain. We aimed at investigating the association of silent lacunes and the risk of ischemic stroke recurrence, death, and cardiovascular events...... in a cohort of patients with incident ischemic stroke and no atrial fibrillation (AF). Methods: We included 786 patients (mean age 59.5 (SD 14.0); 42.9% females) in a registry-based, observational cohort study on patients with first-ever ischemic stroke. On brain MRI we assessed the number of silent lacunes...... as none, single, or multiple and we calculated stratified incidence rates of the outcomes. Cox proportional hazard ratios (HRs) adjusted for age, gender, congestive heart failure, hypertension, diabetes, and vascular disease were calculated with no silent lacunes as reference. In additional analyses, we...

Impact of occupational stress on stroke across occupational classes and genders.

Science.gov (United States)

Tsutsumi, Akizumi; Kayaba, Kazunori; Ishikawa, Shizukiyo

2011-05-01

The aims of the present study were to analyze the association between incident stroke, occupational class and stress and to examine whether the association is found in both men and women in a prospective study of Japanese male and female workers. A total of 3190 male and 3363 female Japanese community-dwelling workers aged 65 or under with no history of cardiovascular disease were followed. Occupational stress was evaluated using a demand-control questionnaire. The impact on stroke was examined in stratified analyses of occupational classes. We identified 147 incident strokes (91 in men and 56 in women) during the 11-year follow-up period. Men with high strain jobs (combination of high job demand and low job control) were nearly three times more likely to suffer from a stroke than men with low strain jobs (combination of low job demand and high job control). Among male workers in low occupational classes (blue-collar and non-managerial work), job strain was associated with a higher risk of stroke. In contrast, there was no association between job strain and incident stroke among male workers in high occupational classes (white-collar and managerial work). No statistically significant differences were found for stroke incidence among the job characteristic categories in all the female participants. However, significant, over five-fold excess risks were found among white-collar and managerial female workers exposed to high job strain, compared with their counterparts with low strain jobs. Our study of Japanese workers provided supportive evidence for vulnerability to occupational stress among lower occupational class workers in males but not in females. Copyright © 2011 Elsevier Ltd. All rights reserved.

Combined effects of road traffic noise and ambient air pollution in relation to risk for stroke?

Science.gov (United States)

Sørensen, Mette; Lühdorf, Pernille; Ketzel, Matthias; Andersen, Zorana J; Tjønneland, Anne; Overvad, Kim; Raaschou-Nielsen, Ole

2014-08-01

Exposure to road traffic noise and air pollution have both been associated with risk for stroke. The few studies including both exposures show inconsistent results. We aimed to investigate potential mutual confounding and combined effects between road traffic noise and air pollution in association with risk for stroke. In a population-based cohort of 57,053 people aged 50-64 years at enrollment, we identified 1999 incident stroke cases in national registries, followed by validation through medical records. Mean follow-up time was 11.2 years. Present and historical residential addresses from 1987 to 2009 were identified in national registers and road traffic noise and air pollution were modeled for all addresses. Analyses were done using Cox regression. A higher mean annual exposure at time of diagnosis of 10 µg/m(3) nitrogen dioxide (NO2) and 10 dB road traffic noise at the residential address was associated with ischemic stroke with incidence rate ratios (IRR) of 1.11 (95% CI: 1.03, 1.20) and 1.16 (95% CI: 1.07, 1.24), respectively, in single exposure models. In two-exposure models road traffic noise (IRR: 1.15) and not NO2 (IRR: 1.02) was associated with ischemic stroke. The strongest association was found for combination of high noise and high NO2 (IRR=1.28; 95% CI=1.09-1.52). Fatal stroke was positively associated with air pollution and not with traffic noise. In conclusion, in mutually adjusted models road traffic noise and not air pollution was associated ischemic stroke, while only air pollution affected risk for fatal strokes. There were indications of combined effects. Copyright © 2014 Elsevier Inc. All rights reserved.

Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort.

Science.gov (United States)

Goulart, Alessandra C; Fernandes, Tiotrefis G; Santos, Itamar S; Alencar, Airlane P; Bensenor, Isabela M; Lotufo, Paulo A

2013-05-24

Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis. We prospectively ascertained 665 consecutive first-ever ischemic and hemorrhagic stroke cases from "The Study of Stroke Mortality and Morbidity" (The EMMA Study) in a community hospital in São Paulo, Brazil. We evaluated cardiovascular risk factors and sociodemographic characteristics (age, gender, race and educational level). We found a lower survival rate among hemorrhagic cases compared to ischemic stroke cases at the end of 4 years of follow-up (52% vs. 44%, p = 0.04). The risk of death was two times higher among people with ischemic stroke without formal education. Also, we found consistently higher risk of death for diabetics with ischemic stroke (HR = 1.45; 95% CI = 1.07-1.97) compared to no diabetics. As expected, age equally influenced on the high risk of poor survival, regardless of stroke subtype. For ischemic stroke, the lack of formal education and diabetes were significant independent predictors of poor long-term survival.

Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke.

Science.gov (United States)

Li, Linxin; Rothwell, Peter M

2016-05-16

 To determine the accuracy of coding of admissions for stroke on weekdays versus weekends and any impact on apparent outcome.  Prospective population based stroke incidence study and a scoping review of previous studies of weekend effects in stroke.  Primary and secondary care of all individuals registered with nine general practices in Oxfordshire, United Kingdom (OXVASC, the Oxford Vascular Study).  All patients with clinically confirmed acute stroke in OXVASC identified with multiple overlapping methods of ascertainment in 2002-14 versus all acute stroke admissions identified by hospital diagnostic and mortality coding alone during the same period.  Accuracy of administrative coding data for all patients with confirmed stroke admitted to hospital in OXVASC. Difference between rates of "false positive" or "false negative" coding for weekday and weekend admissions. Impact of inaccurate coding on apparent case fatality at 30 days in weekday versus weekend admissions. Weekend effects on outcomes in patients with confirmed stroke admitted to hospital in OXVASC and impacts of other potential biases compared with those in the scoping review.  Among 92 728 study population, 2373 episodes of acute stroke were ascertained in OXVASC, of which 826 (34.8%) mainly minor events were managed without hospital admission, 60 (2.5%) occurred out of the area or abroad, and 195 (8.2%) occurred in hospital during an admission for a different reason. Of 1292 local hospital admissions for acute stroke, 973 (75.3%) were correctly identified by administrative coding. There was no bias in distribution of weekend versus weekday admission of the 319 strokes missed by coding. Of 1693 admissions for stroke identified by coding, 1055 (62.3%) were confirmed to be acute strokes after case adjudication. Among the 638 false positive coded cases, patients were more likely to be admitted on weekdays than at weekends (536 (41.0%) v 102 (26.5%); Pcoded acute stroke admissions and false positive

Burden of Stroke in Qatar.

Science.gov (United States)

Ibrahim, Faisal; Deleu, Dirk; Akhtar, Naveed; Al-Yazeedi, Wafa; Mesraoua, Boulenouar; Kamran, Sadaat; Shuaib, Ashfaq

2015-12-01

Qatar is located on the northeastern coast of the Arabian Peninsula. The total population is over 2.1 million with around 15% being Qatari citizens. Hamad General Hospital (HGH) is the only tertiary referral governmental hospital in Qatar which admits acute (thrombolysis-eligible) stroke patients. To provide an overview of the burden of stroke in Qatar. Data from literature databases, online sources and our stroke registry were collated to identify information on the burden of stroke in Qatar. Overall, over 80% of all stroke patients in Qatar are admitted in HGH. In 2010, the age-standardized incidence for first-ever ischemic stroke was 51.88/100,000 person-years. To date our stroke registry reveals that 79% of all stroke patients are male and almost 50% of stroke patients are 50 years or less. Hypertension, diabetes and dyslipidemia are the main predisposing factors for stroke, with ischemic stroke being more common (87%) than hemorrhagic stroke (13%). Despite the lack of a stroke unit, 9% of ischemic stroke patients are being thrombolyzed. However the presence of a stroke ward allows swift turnover of patients with a length of stay of less than 5 days before discharge or, if required, transfer to the fully-equipped hospital-based rehabilitation service. Several community awareness programs are ongoing, in addition to several research programs funded by the Qatar National Research Fund and Hamad Medical Corporation. In a country where over 15% of the population suffers from diabetes there is continuous need for national community-based awareness campaigns, prevention and educational programs particularly targeting patients and health care workers. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Secondary stroke prevention: challenges and solutions.

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Esenwa, Charles; Gutierrez, Jose

2015-01-01

Stroke is the leading cause of disability in the USA and a major cause of mortality worldwide. One out of four strokes is recurrent. Secondary stroke prevention starts with deciphering the most likely stroke mechanism. In general, one of the main goals in stroke reduction is to control vascular risk factors such as hypertension, diabetes, dyslipidemia, and smoking cessation. Changes in lifestyle like a healthy diet and aerobic exercise are also recommended strategies. In the case of cardioembolism due to atrial fibrillation, mechanical valves, or cardiac thrombus, anticoagulation is the mainstay of therapy. The role of anticoagulation is less evident in the case of bioprosthetic valves, patent foramen ovale, and dilated cardiomyopathy with low ejection fraction. Strokes due to larger artery atherosclerosis account for approximately a third of all strokes. In the case of symptomatic extracranial carotid stenosis, surgical intervention as close as possible in time to the index event seems highly beneficial. In the case of intracranial large artery atherosclerosis, the best medical therapy consists of antiplatelets, high-dose statins, aggressive controls of vascular risk factors, and lifestyle modifications, with no role for intracranial arterial stenting or angioplasty. For patients with small artery occlusion (ie, lacunar stroke), the therapy is similar to that used in patients with intracranial large artery atherosclerosis. Despite the constant new evidence on how to best treat patients who have suffered a stroke, the risk of stroke recurrence remains unacceptably high, thus evidencing the need for novel therapies.

Secondary stroke prevention: challenges and solutions

Directory of Open Access Journals (Sweden)

Esenwa C

2015-08-01

Full Text Available Charles Esenwa, Jose GutierrezDepartment of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USAAbstract: Stroke is the leading cause of disability in the USA and a major cause of mortality worldwide. One out of four strokes is recurrent. Secondary stroke prevention starts with deciphering the most likely stroke mechanism. In general, one of the main goals in stroke reduction is to control vascular risk factors such as hypertension, diabetes, dyslipidemia, and smoking cessation. Changes in lifestyle like a healthy diet and aerobic exercise are also recommended strategies. In the case of cardioembolism due to atrial fibrillation, mechanical valves, or cardiac thrombus, anticoagulation is the mainstay of therapy. The role of anticoagulation is less evident in the case of bioprosthetic valves, patent foramen ovale, and dilated cardiomyopathy with low ejection fraction. Strokes due to larger artery atherosclerosis account for approximately a third of all strokes. In the case of symptomatic extracranial carotid stenosis, surgical intervention as close as possible in time to the index event seems highly beneficial. In the case of intracranial large artery atherosclerosis, the best medical therapy consists of antiplatelets, high-dose statins, aggressive controls of vascular risk factors, and lifestyle modifications, with no role for intracranial arterial stenting or angioplasty. For patients with small artery occlusion (ie, lacunar stroke, the therapy is similar to that used in patients with intracranial large artery atherosclerosis. Despite the constant new evidence on how to best treat patients who have suffered a stroke, the risk of stroke recurrence remains unacceptably high, thus evidencing the need for novel therapies.Keywords: stroke mechanisms, stroke risk, hypertension, diabetes, dyslipidemia

Timing of Incident Stroke Risk After Cervical Artery Dissection Presenting Without Ischemia.

Science.gov (United States)

Morris, Nicholas A; Merkler, Alexander E; Gialdini, Gino; Kamel, Hooman

2017-03-01

Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection presenting without ischemia remains uncertain. We performed a crossover cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005 to 2011 in CA, 2006 to 2013 in NY, and 2005 to 2013 in FL. Using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified patients with a cervical artery dissection and no previous or concurrent stroke or transient ischemic attack diagnosis. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risk increases were calculated using McNemar test for matched data. In a sensitivity analysis, we limited our population to patients presenting with typical symptoms of cervical artery dissection. We identified 2791 patients with dissection without ischemia. The absolute increase in stroke risk was 1.25% (95% confidence interval, 0.84-1.67%) in the first 2 weeks after dissection compared with the same time period 1 year later. The absolute risk increase was 0.18% (95% confidence interval, 0.02-0.34%) during weeks 3 to 4 and was no longer significant during the remainder of the 12-week postdissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection. The risk of stroke after cervical artery dissection unaccompanied by ischemia at time of diagnosis seems to be limited to the first 2 weeks. © 2017 American Heart Association, Inc.

A stepwise approach to stroke surveillance in Brazil: the EMMA (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral) study.

Science.gov (United States)

Goulart, Alessandra C; Bustos, Iara R; Abe, Ivana M; Pereira, Alexandre C; Fedeli, Ligia M; Benseñor, Isabela M; Lotufo, Paulo A

2010-08-01

Stroke mortality rates in Brazil are the highest in the Americas. Deaths from cerebrovascular disease surpass coronary heart disease. To verify stroke mortality rates and morbidity in an area of São Paulo, Brazil, using the World Health Organization Stepwise Approach to Stroke Surveillance. We used the World Health Organization Stepwise Approach to Stroke Surveillance structure of stroke surveillance. The hospital-based data comprised fatal and nonfatal stroke (Step 1). We gathered stroke-related mortality data in the community using World Health Organization questionnaires (Step 2). The questionnaire determining stroke prevalence was activated door to door in a family-health-programme neighbourhood (Step 3). A total of 682 patients 18 years and above, including 472 incident cases, presented with cerebrovascular disease and were enrolled in Step 1 during April-May 2009. Cerebral infarction (84.3%) and first-ever stroke (85.2%) were the most frequent. In Step 2, 256 deaths from stroke were identified during 2006-2007. Forty-four per cent of deaths were classified as unspecified stroke, 1/3 as ischaemic stroke, and 1/4 due to haemorrhagic subtype. In Step 3, 577 subjects over 35 years old were evaluated at home, and 244 cases of stroke survival were diagnosed via a questionnaire, validated by a board-certified neurologist. The population demographic characteristics were similar in the three steps, except in terms of age and gender. By including data from all settings, World Health Organization stroke surveillance can provide data to help plan future resources that meet the needs of the public-health system.

Stroke secondary to multiple spontaneous cholesterol emboli.

Science.gov (United States)

Pascual, M; Baumgartner, J M; Bounameaux, H

1991-01-01

We describe one male, 49-year-old diabetic patient in whom regressive stroke with aphasia and right-sided hemiparesia was related to multiple small emboli in the left paraventricular cortex. Simultaneous presence of several cholesterol emboli in the left eye ground and detection of an atheromatous plaque at the homolateral carotid bifurcation let assume that the cerebral emboli originated from that plaque and also consisted of cholesterol crystals. The patient was discharged on low-dose aspirin (100 mg/day) after neurologic improvement. Follow-up at one year revealed clinical stability, recurrence of the cholesterol emboli at the eye ground examination and no change of the carotid plaque. Cholesterol embolization with renal failure, hypertension and peripheral arterial occlusions causing skin ulcerations is classical in case of atheromatous aortic disease but stroke has rarely been reported in this syndrome. However, more frequent use of invasive procedures (arteriography, transluminal angioplasty, vascular surgery) or thrombolytic treatment might increase its incidence in the near future.

Risk of First and Recurrent Stroke in Childhood Cancer Survivors Treated With Cranial and Cervical Radiation Therapy

International Nuclear Information System (INIS)

Mueller, Sabine; Sear, Katherine; Hills, Nancy K.; Chettout, Nassim; Afghani, Shervin; Gastelum, Erica; Haas-Kogan, Daphne; Fullerton, Heather J.

2013-01-01

Purpose: To assess, in a retrospective cohort study, rates and predictors of first and recurrent stroke in patients treated with cranial irradiation (CRT) and/or cervical irradiation at ≤18 years of age. Methods and Materials: We performed chart abstraction (n=383) and phone interviews (n=104) to measure first and recurrent stroke in 383 patients who received CRT and/or cervical radiation at a single institution between 1980 and 2009. Stroke was defined as a physician diagnosis and symptoms consistent with stroke. Incidence of first stroke was number of first strokes per person-years of observation after radiation. We used survival analysis techniques to determine cumulative incidence of first and recurrent stroke. Results: Among 325 subjects with sufficient follow-up data, we identified 19 first strokes (13 ischemic, 4 hemorrhagic, 2 unknown subtype) occurring at a median age of 24 years (interquartile range 17-33 years) in patients treated with CRT. Imaging was reviewed when available (n=13), and the stroke was confirmed in 12. Overall rate of first stroke was 625 (95% confidence interval [CI] 378-977) per 100,000 person-years. The cumulative incidence of first stroke was 2% (95% CI 0.01%-5.3%) at 5 years and 4% (95% CI 2.0%-8.4%) at 10 years after irradiation. With each 100-cGy increase in the radiation dose, the stroke hazard increased by 5% (hazard ratio 1.05; 95% CI 1.01-1.09; P=.02). We identified 6 recurrent strokes; 5 had available imaging that confirmed the stroke. Median time to recurrence was 15 months (interquartile range 6 months-3.2 years) after first stroke. The cumulative incidence of recurrent stroke was 38% (95% CI 17%-69%) at 5 years and 59% (95% CI 27%-92%) at 10 years after first stroke. Conclusion: Cranial irradiation puts childhood cancer survivors at high risk of both first and recurrent stroke. Stroke prevention strategies for these survivors are needed

[Verbal patient information through nurses--a case of stroke patients].

Science.gov (United States)

Christmann, Elli; Holle, Regina; Schüssler, Dörte; Beier, Jutta; Dassen, Theo

2004-06-01

The article represents results of a theoretical work in the field of nursing education, with the topic: Verbal Patient Information through Nurses--A Case of Stroke Patients. The literature review and analysis show that there is a shortage in (stroke) patient information generally and a lack of successful concepts and strategies for the verbal (stroke) patient information through nurses in hospitals. The authors have developed a theoretical basis for health information as a nursing intervention and this represents a model of health information as a "communicational teach-and-learn process", which is of general application to all patients. The health information takes place as a separate nursing intervention within a non-public, face-to-face communication situation and in the steps-model of the nursing process. Health information is seen as a learning process for patients and nurses too. We consider learning as information production (constructivism) and information processing (cognitivism). Both processes are influenced by different factors and the illness-situation of patients, personality information content and the environment. For a successful health information output, it is necessary to take care of these aspects and this can be realized through a constructivational understanding of didactics. There is a need for an evaluation study to prove our concept of health information.

Neurorehabilitation in stroke produced by vertebral artery dissection: case presentation

Directory of Open Access Journals (Sweden)

Stanescu Ioana

2018-02-01

Full Text Available Arterial dissections are a common cause of stroke in the young (mean age 44 to 46 years. Primary lesion is a tear of the arterial intima, which promotes platelet aggregation, thrombus formation, which further produced vessel stenosis / occlusion, distal embolism or vessel wall rupture. Vertebral artery (VA dissection appear most commonly in extracranial segments V2 and V3, and could be spontaneous (with underlying predispositions or triggered by various traumatisms. Clinicaly, VA dissection produces an ischemic stroke or transient ischemic attack , preceded by local symptoms such as neck pain or headache. The diagnosis is confirmed by neurovascular imaging. Treatment of symptomatic VA dissections respect indications of treatment in ischemic strokes. Prognosis is mostly favorable in extracranial dissections. We present the case of a left VA dissection in V2 segment, produced by physical effort (swimming, which causes 2 ischemic lesions, one in the territory of the left posterior cerebral artery and the other in the territory of the left posterolateral chorroidal artery. Patient’s treatment included antiplatelet agents, statines, and an adapted physical rehabilitation program. At three months he showed significant clinical improvement with regain of autonomy and partial recanalisation at angio-MRI of the V2 segment of the dissected artery.

Hypercholesterolemia, Stroke And Statins

Directory of Open Access Journals (Sweden)

Prabhakar S

2005-01-01

Full Text Available The link between serum cholesterol levels and the incidence of stroke still remain to be established. There are conflicting reports from a series of observational cohort studies. However, clinical trials with HMG CoA reductase inhibitors (also called statins have shown that cholesterol lowering therapy used in the primary and secondary prevention of myocardial infarction significantly reduced cardiovascular events including strokes. Meta analysis of trials with statins have shown a relative risk reduction in stroke of 12 to 48% in patients with coronary heart disease after MI. It has been postulated that the clinical action of statins is the result of pleiotropic / antiatherogenic effects rather than simply a reduction in cholesterol. The putative beneficial effect of statins in stroke involve blocking of macrophage and platelet activation, improvement of endothelial cell vasomotor function, enhancement of endothelial fibrinolytic function, immunosuppressive and anti-inflammatory action, inhibition of smooth muscle cell proliferation and particularly enhancement of endothelial nitric oxide synthase (eNOS.

Idarucizumab in Three Patients Needing Urgent Surgical Intervention and One Case of Intravenous Thrombolysis in Ischaemic Stroke

Directory of Open Access Journals (Sweden)

Fredrik Andreas von Wowern

2017-05-01

Full Text Available Objective: To describe the benefits of reversal of the anticoagulation effects of dabigatran etexilate in patients requiring urgent surgery or thrombolysis for ischaemic stroke. Materials and methods: Four patients, treated with dabigatran etexilate and presenting with cholecystitis, tibial fracture, lower limb ischaemia and ischaemic stroke, respectively. Results: Administration of idarucizumab normalized bleeding parameters and provided safe conditions for surgery and, in one case, successful thrombolysis of an ischaemic stroke. Conclusion: The introduction of an effective reversal agent for dabigatran etexilate allows physicians perform surgery under conditions of normal coagulation and permits thrombolysis in patients with ischaemic stroke despite being treated with dabigatran etexilate.

Biases in detection of apparent “weekend effect” on outcome with administrative coding data: population based study of stroke

Science.gov (United States)

Li, Linxin

2016-01-01

Objectives To determine the accuracy of coding of admissions for stroke on weekdays versus weekends and any impact on apparent outcome. Design Prospective population based stroke incidence study and a scoping review of previous studies of weekend effects in stroke. Setting Primary and secondary care of all individuals registered with nine general practices in Oxfordshire, United Kingdom (OXVASC, the Oxford Vascular Study). Participants All patients with clinically confirmed acute stroke in OXVASC identified with multiple overlapping methods of ascertainment in 2002-14 versus all acute stroke admissions identified by hospital diagnostic and mortality coding alone during the same period. Main outcomes measures Accuracy of administrative coding data for all patients with confirmed stroke admitted to hospital in OXVASC. Difference between rates of “false positive” or “false negative” coding for weekday and weekend admissions. Impact of inaccurate coding on apparent case fatality at 30 days in weekday versus weekend admissions. Weekend effects on outcomes in patients with confirmed stroke admitted to hospital in OXVASC and impacts of other potential biases compared with those in the scoping review. Results Among 92 728 study population, 2373 episodes of acute stroke were ascertained in OXVASC, of which 826 (34.8%) mainly minor events were managed without hospital admission, 60 (2.5%) occurred out of the area or abroad, and 195 (8.2%) occurred in hospital during an admission for a different reason. Of 1292 local hospital admissions for acute stroke, 973 (75.3%) were correctly identified by administrative coding. There was no bias in distribution of weekend versus weekday admission of the 319 strokes missed by coding. Of 1693 admissions for stroke identified by coding, 1055 (62.3%) were confirmed to be acute strokes after case adjudication. Among the 638 false positive coded cases, patients were more likely to be admitted on weekdays than at weekends (536

Internet-based control recruitment for a case-control study of major risk factors for stroke in Korea: lessons from the experience.

Science.gov (United States)

Park, Jong-Moo; Cho, Yong-Jin; Lee, Kyung Bok; Park, Tai Hwan; Lee, Soo Joo; Han, Moon-Ku; Ko, Youngchai; Lee, Jun; Cha, Jae-Kwan; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee-Joon

2014-01-01

This study aimed to estimate the population-attributable risks (PARs) of 9 major risk factors for stroke in Korea through a case-control study and to test the feasibility and validity of internet-based control recruitment. From April 2008 to September 2009, controls were enrolled via internet after providing consent for participation through a web-based survey. The cases included patients who were admitted to the participating centers due to acute stroke or transient ischemic attack within 7 days of onset during the study period. Each control was age- and sex-matched with 2 cases. Adjusted odd ratios, age-standardized prevalence, and PARs were estimated for the 9 major risk factors using the prevalence of risk factors in the control group and the age and sex characteristics from Korea's national census data. In total, 1041 controls were matched to 2082 stroke cases. Because of a shortage of elderly controls in the internet-based recruitment, 248 controls were recruited off-line. The PARs were 23.44%, 10.95%, 51.32%, and 6.35% for hypertension, diabetes, smoking, and stroke history, respectively. Hypercholesterolemia, atrial fibrillation, obesity, coronary heart disease, and a family history of stroke were not associated with stroke. Comparison with education and religion of the control group with that mentioned in the national census data showed a notable difference. The study results imply that internet-based control recruitment for a case-control study requires careful selection of risk factors with high self-awareness and effective strategies to facilitate the recruitment of elderly participants. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Heat Stroke

DEFF Research Database (Denmark)

Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

2017-01-01

not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat......Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity...... and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...

[Neuro-rehabilitation after stroke].

Science.gov (United States)

Murie-Fernández, M; Irimia, P; Martínez-Vila, E; John Meyer, M; Teasell, R

2010-04-01

the high incidence of stroke results in significant mortality and disability leading to immense health care costs. These costs lead to socioeconomic, budgetary, and staffing repercussions in developing countries. Improvements in stroke management focus mainly on acute neurological treatment, admission to stroke units, fibrinolytic treatment for ischaemic strokes and rehabilitation processes. Among these, rehabilitation has the longest therapeutic window, can be applied in both ischaemic and haemorrhagic strokes, and can improve functional outcomes months after stroke. Neurologists, because of their knowledge in neuroanatomy, physiopathology, neuro-pharmacology, and brain plasticity, are in an ideal position to actively participate in the neurorehabilitation process. Several processes have been shown to play a role in determining the efficacy of rehabilitation; time from stroke onset to rehabilitation admission and the duration and intensity of treatment. neurorehabilitation is a sub-speciality in which neurologists should be incorporated into multidisciplinary neurorehabilitation teams. Early time to rehabilitation admission and greater intensity and duration of treatment are associated with better functional outcomes, lower mortality/institutionalisation, and shorter length of stay. In order to be efficient, a concerted effort must be made to ensure patients receive neurorehabilitation treatment in a timely manner with appropriate intensity to maximize patient outcomes during both inpatient and outpatient rehabilitation. Published by Elservier España, S.L. All rights reserved.

Gorlin-Goltz syndrome and stroke: a case report.

Science.gov (United States)

Budinčević, Hrvoje; Starčević, Katarina; Bielen, Ivan; Demarin, Vida

2014-01-01

We report on the case of a 32-years old male patient who was previously diagnosed with Gorlin-Goltz syndrome. The patient presented with sudden-onset right-sided hemiparesis, supranuclear facioparesis, and motor aphasia. He was treated with thrombolytic therapy, which successfully alleviated the symptoms. Subsequent radiologic work-up revealed anomalies in the vertebral arteries, a bifid rib, an ischemic lesion in the supply area of the left middle cerebral artery, and falx calcifications. Laboratory tests showed a 4G/4G polymorphism of the plasminogen activator inhibitor 1 (PAI-1) gene whose correlation with stroke is discussed in the article.

Sleep duration, daytime napping, markers of obstructive sleep apnea and stroke in a population of southern China

Science.gov (United States)

Wen, Ye; Pi, Fu-Hua; Guo, Pi; Dong, Wen-Ya; Xie, Yu-Qing; Wang, Xiang-Yu; Xia, Fang-Fang; Pang, Shao-Jie; Wu, Yan-Chun; Wang, Yuan-Yuan; Zhang, Qing-Ying

2016-01-01

Sleep habits are associated with stroke in western populations, but this relation has been rarely investigated in China. Moreover, the differences among stroke subtypes remain unclear. This study aimed to explore the associations of total stroke, including ischemic and hemorrhagic type, with sleep habits of a population in southern China. We performed a case-control study in patients admitted to the hospital with first stroke and community control subjects. A total of 333 patients (n = 223, 67.0%, with ischemic stroke; n = 110, 23.0%, with hemorrhagic stroke) and 547 controls were enrolled in the study. Participants completed a structured questionnaire to identify sleep habits and other stroke risk factors. Least absolute shrinkage and selection operator (Lasso) and multiple logistic regression were performed to identify risk factors of disease. Incidence of stroke, and its subtypes, was significantly associated with snorting/gasping, snoring, sleep duration, and daytime napping. Snorting/gasping was identified as an important risk factor in the Lasso logistic regression model (Lasso’ β = 0.84), and the result was proven to be robust. This study showed the association between stroke and sleep habits in the southern Chinese population and might help in better detecting important sleep-related factors for stroke risk. PMID:27698374

Strokes attributable to underuse of warfarin and antiplatelets

DEFF Research Database (Denmark)

Olsen, Tom Skyhøj; Rasmussen, Berit Hammershaimb; Kammersgaard, Lars Peter

2007-01-01

Despite their proven efficacy in stroke prevention, warfarin and antiplatelets remain underused. We determined the frequency of ischemic strokes attributable to underuse of warfarin and antiplatelets for stroke prevention in a Danish community. We included all patients with ischemic stroke...... in a Copenhagen community with 302,000 inhabitants admitted to the hospital between September 1999 and May 2000 (n = 426). Patients who did not receive warfarin or antiplatelet medication even though they were at known risk for cardiovascular disease before the incident stroke were identified; they had known...... not received warfarin or antiplatelets on admission, 27 had not received warfarin but had received antiplatelets, and 11 had received warfarin. Assuming that warfarin and antiplatelets reduces the risk of stroke by 66% and 25%, respectively, it was calculated that between 6 and 12 of these strokes with atrial...

Atorvastatin in stroke: a review of SPARCL and subgroup analysis

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Branko N Huisa

2010-03-01

Full Text Available Branko N Huisa, Andrew B Stemer, Justin A ZivinDepartment of Neuroscience University of California, San Diego, CA, USAAbstract: Statin therapy in patients with cardiovascular disease is associated with reduced incidence of stroke. The Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL trial showed daily treatment with 80 mg of atorvastatin in patients with a recent stroke or transient ischemic attack (TIA reduced the incidence of fatal or nonfatal stroke by 16%. Several post hoc analyses of different subgroups followed the SPARCL study. They have not revealed any significant differences when patients were sorted by age, sex, presence of carotid disease or type of stroke, with the exception of intracranial hemorrhage as the entry event. Lower low-density lipoprotein cholesterol levels in addition to possible neuroprotective mechanisms due to atorvastatin treatment correlate with improved risk reduction. Although not predefined subgroups and subject to an insufficient power, these post hoc studies have generated new clinical questions. However, clinicians should avoid denying therapy based on such subgroup analysis. At this point, the best evidence powerfully demonstrates stroke and TIA patients should be prescribed high dose statin therapy for secondary stroke prevention.Keywords: statins, intracranial hemorrhage, neuroprotection, outcome, prevention, carotid stenosis, transient ischemic attack

Meta-analysis in more than 17,900 cases of ischemic stroke reveals a novel association at 12q24.12

OpenAIRE

Kilarski, L. L.; Achterberg, S.; Devan, W. J.; Traylor, M.; Malik, R.; Lindgren, A.; Pare, G.; Sharma, P.; Slowik, A.; Thijs, V.; Walters, M.; Worrall, B. B.; Sale, M. M.; Algra, A.; Kappelle, L. J.

2014-01-01

textabstractResults: In an overall analysis of 17,970 cases of ischemic stroke and 70,764 controls, we identified a novel association on chromosome 12q24 (rs10744777, odds ratio [OR] 1.10 [1.07-1.13], p 5 7.12 3 10-11) with ischemic stroke. The association was with all ischemic stroke rather than an individual stroke subtype, with similar effect sizes seen in different stroke subtypes. There was no association with intracerebral hemorrhage (OR 1.03 [0.90-1.17], p 5 0.695).Conclusion: Our resu...

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...

Ischemic stroke risk, smoking, and the genetics of inflammation in a biracial population: the stroke prevention in young women study

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Sorkin John D

2008-08-01

Full Text Available Abstract Background Although cigarette smoking is a well-established risk factor for vascular disease, the genetic mechanisms that link cigarette smoking to an increased incidence of stroke are not well understood. Genetic variations within the genes of the inflammatory pathways are thought to partially mediate this risk. Here we evaluate the association of several inflammatory gene single nucleotide polymorphisms (SNPs with ischemic stroke risk among young women, further stratified by current cigarette smoking status. Methods A population-based case-control study of stroke among women aged 15–49 identified 224 cases of first ischemic stroke (47.3% African-American and 211 age-comparable control subjects (43.1% African-American. Several inflammatory candidate gene SNPs chosen through literature review were genotyped in the study population and assessed for association with stroke and interaction with smoking status. Results Of the 8 SNPs (across 6 genes analyzed, only IL6 SNP rs2069832 (allele C, African-American frequency = 92%, Caucasian frequency = 55% was found to be significantly associated with stroke using an additive model, and this was only among African-Americans (age-adjusted: OR = 2.2, 95% CI = 1.0–5.0, p = 0.049; risk factor adjusted: OR = 2.5, 95% CI = 1.0–6.5, p = 0.05. When stratified by smoking status, two SNPs demonstrated statistically significant gene-environment interactions. First, the T allele (frequency = 5% of IL6 SNP rs2069830 was found to be protective among non-smokers (OR = 0.30, 95% CI = 0.11–.082, p = 0.02, but not among smokers (OR = 1.63, 95% CI = 0.48–5.58, p = 0.43; genotype by smoking interaction (p = 0.036. Second, the C allele (frequency = 39% of CD14 SNP rs2569190 was found to increase risk among smokers (OR = 2.05, 95% CI = 1.09–3.86, p = 0.03, but not among non-smokers (OR = 0.93, 95% CI = 0.62–1.39, p = 0.72; genotype by smoking interaction (p = 0.039. Conclusion This study demonstrates

Mortality after hemorrhagic stroke

DEFF Research Database (Denmark)

González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

2013-01-01

OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated......, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients...

Job strain and the risk of stroke

DEFF Research Database (Denmark)

Fransson, Eleonor I; Nyberg, Solja T; Heikkilä, Katriina

2015-01-01

BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain. METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort...... studies to investigate the association between job strain, a measure of work-related stress, and incident stroke. RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job....... CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies....

Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study.

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Feigin, Valery L; Krishnamurthi, Rita V; Parmar, Priya; Norrving, Bo; Mensah, George A; Bennett, Derrick A; Barker-Collo, Suzanne; Moran, Andrew E; Sacco, Ralph L; Truelsen, Thomas; Davis, Stephen; Pandian, Jeyaraj Durai; Naghavi, Mohsen; Forouzanfar, Mohammad H; Nguyen, Grant; Johnson, Catherine O; Vos, Theo; Meretoja, Atte; Murray, Christopher J L; Roth, Gregory A

2015-01-01

Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs). In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing

Genetic determinants and stroke in children with sickle cell disease

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Daniela O.W. Rodrigues

2016-11-01

Conclusion: There is a high incidence of stroke in male children and in children with SCA. Coexistence with α‐thal and haplotypes of the beta globin chain cluster did not show any significant association with stroke. The heterogeneity between previously evaluated populations, the non‐reproducibility between studies, and the need to identify factors associated with stroke in patients with SCA indicate the necessity of conducting further research to demonstrate the relevance of genetic factors in stroke related to SCD.

Dementia wander garden aids post cerebrovascular stroke restorative therapy: a case study.

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Detweiler, Mark B; Warf, Carlena

2005-01-01

An increasing amount of literature suggests the positive effects of nature in healthcare. The extended life expectancy in the US and the consequent need for long-term care indicates a future need for restorative therapy innovations to reduce the expense associated with long-term care. Moving carefully selected stroke patients' sessions to the peaceful setting of a dementia wander garden, with its designed paths and natural stimuli, may be beneficial. Natural settings have been shown to improve attention and reduce stress--both important therapy objectives in many post-stroke rehabilitation programs. In this case study, using the dementia wander garden for restorative therapy of a non-dementia patient was a novel idea for the restorative therapy group, which does not have a horticultural therapy program. The dementia wander garden stage of the post-stroke rehabilitation helped the patient through a period of treatment resistance. The garden provided both an introduction to the patient's goal of outdoor rehabilitation and a less threatening environment than the long-term care facility hallways. In part because the patient was less self-conscious about manifesting his post-stroke neurological deficits, falling, and being viewed as handicapped when in the dementia wander garden setting, he was able to resume his treatment plan and finish his restorative therapy. In many physical and mental rehabilitation plans, finding a treatment modality that will motivate an individual to participate is a principal goal. Use of a dementia wander garden may help some patients achieve this goal in post-stroke restorative therapy.

Basics of acute stroke treatment

International Nuclear Information System (INIS)

Haass, A.

2005-01-01

Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O 2 delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.) [de

[Genetics of ischemic stroke].

Science.gov (United States)

Gschwendtner, A; Dichgans, M

2013-02-01

Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.

External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

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Ping Yu

Full Text Available A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke.The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient.The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82, and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84. Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008.The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

Whole Grain Consumption and Risk of Ischemic Stroke: Results From 2 Prospective Cohort Studies.

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Juan, Juan; Liu, Gang; Willett, Walter C; Hu, Frank B; Rexrode, Kathryn M; Sun, Qi

2017-12-01

Higher intake of whole grains may exert cardiometabolic benefits, although findings on stroke risk are inconclusive. The potentially differential effects of individual whole grain foods on ischemic stroke have not been examined. We analyzed whole grain consumption in relation to ischemic stroke among 71 750 women from the Nurses' Health Study and 42 823 men from the Health Professionals Follow-up Study who were free of cardiovascular disease, diabetes mellitus, and cancer at baseline (1984 and 1986, respectively) through 2010 using a Cox proportional hazards model. Validated semiquantitative food frequency questionnaires were used to assess consumption of whole grain intake, including whole grain cold breakfast cereal, dark bread, oatmeal, brown rice, popcorn, bran, and germ. Self-reported incident cases of ischemic stroke were confirmed through medical record review. During 2 820 128 person-years of follow-up in the 2 cohorts, 2458 cases of ischemic stroke were identified and confirmed. Intake of total whole grains was not associated with risk of ischemic stroke after adjustment for covariates: the pooled hazard ratio (95% confidence interval) comparing extreme intake levels was 1.04 (0.91-1.19). However, intake of whole grain cold breakfast cereal and total bran was inversely associated with ischemic stroke after multivariate adjustment: the pooled hazard ratios (95% confidence intervals) were 0.88 (0.80-0.96; P trend =0.008) and 0.89 (0.79-1.00; P trend =0.004), respectively. Other whole grain foods were not associated with a lower risk of ischemic stroke. Although overall consumption of whole grains was not associated with lower risk of ischemic stroke, greater consumption of whole grain cold breakfast cereal and bran was significantly associated with a lower risk of ischemic stroke. More studies are needed to replicate these associations between individual whole grain foods and risk of ischemic stroke among other populations. © 2017 American Heart

Case report: a 70-year-old man with undiagnosed factor VII deficiency presented with acute ischemic stroke.

Science.gov (United States)

Ip, Hing-Lung; Chan, Anne Yin-Yan; Ng, Kit-Chung; Soo, Yannie Oi-Yan; Wong, Lawrence Ka-Sing

2013-11-01

Factor VII deficiency is an uncommon coagulation disorder that patient usually presents with bleeding diathesis, but thrombotic event has been reported. We report a case of unusual clinical presentation in a patient with undiagnosed factor VII deficiency who presented with acute ischemic stroke. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Patent Foramen Ovale in Patients with Sickle Cell Disease and Stroke: Case Presentations and Review of the Literature

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Sheila Razdan

2013-01-01

Full Text Available Although individuals with sickle cell disease (SCD are at increased risk for stroke, the underlying pathophysiology is incompletely understood. Intracardiac shunting via a patent foramen ovale (PFO is associated with cryptogenic stroke in individuals without SCD. Recent evidence suggests that PFOs are associated with stroke in children with SCD, although the role of PFOs in adults with stroke and SCD is unknown. Here, we report 2 young adults with SCD, stroke, and PFOs. The first patient had hemoglobin SC and presented with a transient ischemic attack and a subsequent ischemic stroke. There was no evidence of cerebral vascular disease on imaging studies and the PFO was closed. The second patient had hemoglobin SS and two acute ischemic strokes. She had cerebral vascular disease with moyamoya in addition to a peripheral deep venous thrombosis (DVT. Chronic transfusion therapy was recommended, and the DVT was managed with warfarin. The PFO was not closed, and the patients' neurologic symptoms were stabilized. We review the literature on PFOs and stroke in SCD. Our cases and the literature review illustrate the dire need for further research to evaluate PFO as a potential risk factor for stroke in adults with SCD.

Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups

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Gezmu T

2014-05-01

Full Text Available Tefera Gezmu,1 Dona Schneider,1 Kitaw Demissie,2 Yong Lin,2 Christine Giordano,3 Martin S Gizzi4 1Edward J. Bloustein School of Planning and Public Policy, Rutgers, the State University of New Jersey, New Brunswick, NJ, 2Rutgers School of Public Health, Department of Epidemiology, Piscataway, NJ, 3Rutgers New Jersey Medical School, Newark, NJ, 4New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, NJ, USA Abstract: Evidence implicates lipid abnormalities as important but modifiable risk factors for stroke. This study assesses whether hypercholesterolemia can be used to predict the risk for etiologic subtypes of ischemic stroke between sexes within racial/ethnic groups. Data elements related to stroke risk, diagnosis, and outcomes were abstracted from the medical records of 3,290 acute stroke admissions between 2006 and 2010 at a regional stroke center. Sex comparison within racial/ethnic groups revealed that South Asian and Hispanic men had a higher proportion of ischemic stroke than women, while the inverse was true for Whites and African Americans (P=0.0014. All women, except South Asian women, had higher mean plasma total cholesterol and higher blood circulating low-density lipoprotein levels (≥100 mg/dL than men at the time of their admissions. The incidence of large-artery atherosclerosis (LAA was more common among women than men, except among Hispanics, where men tended to have higher incidences. A regression analysis that considered patients diagnosed with either LAA or small-artery occlusion etiologic subtype as the outcomes and high-density lipoproteins and triglycerides as predictors showed inconsistent associations between lipid profiles and the incidence of these subtypes between the sexes within racial/ethnic groups. In conclusion, our investigation suggests that women stroke patients may be at increased risk for stroke etiologic subtype LAA than men. Although the higher prevalence of stroke

Rehabilitation following hemorrhagic stroke: building the case for stroke-subtype specific recovery therapies [version 1; referees: 2 approved

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Tomoko Kitago

2017-11-01

Full Text Available Intracerebral hemorrhage (ICH, a form of brain bleeding and minor subtype of stroke, leads to significant mortality and long-term disability. There are currently no validated approaches to promote functional recovery after ICH. Research in stroke recovery and rehabilitation has largely focused on ischemic stroke, but given the stark differences in the pathophysiology between ischemic and hemorrhagic stroke, it is possible that strategies to rehabilitate the brain in distinct stroke subtypes will be different. Here, we review our current understanding of recovery after primary intracerebral hemorrhage with the intent to provide a framework to promote novel, stroke-subtype specific approaches.

Effect of pre-stroke use of ACE inhibitors on ischemic stroke severity

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Caplan Louis

2005-06-01

Full Text Available Abstract Background Recent trials suggest that angiotensin-converting enzyme inhibitors (ACEI are effective in prevention of ischemic stroke, as measured by reduced stroke incidence. We aimed to compare stroke severity between stroke patients who were taking ACEI before their stroke onset and those who were not, to examine the effects of pretreatment with ACEI on ischemic stroke severity. Methods We retrospectively studied 126 consecutive patients presenting within 24 hours of ischemic stroke onset, as confirmed by diffusion-weighted magnetic resonance imaging (DWI. We calculated the NIHSS score at presentation, as the primary measure of clinical stroke severity, and categorized stroke severity as mild (NIHSS [less than or equal to] 7, moderate (NIHSS 8–13 or severe (NIHSS [greater than or equal to] 14. We analyzed demographic data, risk-factor profile, blood pressure (BP and medications on admissions, and determined stroke mechanism according to TOAST criteria. We also measured the volumes of admission diffusion- and perfusion-weighted (DWI /PWI magnetic resonance imaging lesions, as a secondary measure of ischemic tissue volume. We compared these variables among patients on ACEI and those who were not. Results Thirty- three patients (26% were on ACE-inhibitors. The overall median baseline NIHSS score was 5.5 (range 2–21 among ACEI-treated patients vs. 9 (range 1–36 in non-ACEI patients (p = 0.036. Patients on ACEI prior to their stroke had more mild and less severe strokes, and smaller DWI and PWI lesion volumes compared to non-ACEI treated patients. However, none of these differences were significant. Predictably, a higher percentage of patients on ACEI had a history of heart failure (p = 0.03. Age, time-to-imaging or neurological evaluation, risk-factor profile, concomitant therapy with lipid lowering, other antihypertensives or antithrombotic agents, or admission BP were comparable between the two groups. Conclusion Our results

Exertional heat stroke management strategies in United States high school football.

Science.gov (United States)

Kerr, Zachary Y; Marshall, Stephen W; Comstock, R Dawn; Casa, Douglas J

2014-01-01

The 5-year period of 2005-2009 saw more exertional heat stroke-related deaths in organized sports than any other 5-year period in the past 35 years. The risk of exertional heat stroke appears highest in football, particularly during the preseason. To estimate the incidence of exertional heat stroke events and assess the utilization of exertional heat stroke management strategies during the 2011 preseason in United States high school football programs. Cross-sectional study; Level of evidence, 3. A self-administered online questionnaire addressing the incidence of exertional heat stroke events and utilization of exertional heat stroke management strategies (eg, removing athlete's football equipment, calling Emergency Medical Services [EMS]) was completed in May to June 2012 by 1142 (18.0%) athletic trainers providing care to high school football athletes during the 2011 preseason. Among all respondents, 20.3% reported treating at least 1 exertional heat stroke event. An average of 0.50 ± 1.37 preseason exertional heat stroke events were treated per program. Athletic trainers responding to exertional heat stroke reported using an average of 6.6 ± 1.8 management strategies. The most common management strategies were low-level therapeutic interventions such as removing the athlete's football equipment (98.2%) and clothing (77.8%) and moving the athlete to a shaded area (91.6%). Few athletic trainers reported active management strategies such as calling EMS (29.3%) or using a rectal thermometer to check core body temperature (0.9%). Athletic trainers in states with mandated preseason heat acclimatization guidelines reported a higher utilization of management strategies such as cooling the athlete through air conditioning (90.1% vs 65.0%, respectively; P football programs. The standard of care is (and should be) to treat proactively; therefore, treatment is not a perfect proxy for incidence. Nevertheless, there is an urgent need for improved education and awareness of

Airplane stroke syndrome.

Science.gov (United States)

Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

2016-07-01

Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

Subarachnoid haemorrhage in Sweden 1987-2002 : regional incidence and case fatality rates

NARCIS (Netherlands)

Koffijberg, H.; Buskens, E.; Granath, F.; Adami, J.; Ekbom, A.; Rinkel, G. J. E.; Blomqvist, P.

Background: Incidence estimates of subarachnoid haemorrhage (SAH) in Sweden vary, which may be caused by regional variations. Reliable estimates of age-specific case fatality rates are lacking. We analysed regional incidence rates and case fatality rates of SAH in Sweden. Methods: The Swedish

Impact of Scotland's comprehensive, smoke-free legislation on stroke.

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Daniel F Mackay

Full Text Available Previous studies have reported a reduction in acute coronary events following smoke-free legislation. Evidence is lacking on whether stroke is also reduced. The aim was to determine whether the incidence of stroke, overall and by sub-type, fell following introduction of smoke-free legislation across Scotland on 26 March 2006.A negative binomial regression model was used to determine whether the introduction of smoke-free legislation resulted in a step and/or slope change in stroke incidence. The model was adjusted for age-group, sex, socioeconomic deprivation quintile, urban/rural residence and month. Interaction tests were also performed. Routine hospital administrative data and death certificates were used to identify all hospital admissions and pre-hospital deaths due to stroke (ICD10 codes I61, I63 and I64 in Scotland between 2000 and 2010 inclusive. Prior to the legislation, rates of all stroke, intracerebral haemorrhage and unspecified stroke were decreasing, whilst cerebral infarction was increasing at 0.97% per annum. Following the legislation, there was a dramatic fall in cerebral infarctions that persisted for around 20 months. No visible effect was observed for other types of stroke. The model confirmed an 8.90% (95% CI 4.85, 12.77, p<0.001 stepwise reduction in cerebral infarction at the time the legislation was implemented, after adjustment for potential confounders.Following introduction of national, comprehensive smoke-free legislation there was a selective reduction in cerebral infarction that was not apparent in other types of stroke.

Association Between Carotid Bulb Diaphragm and Ischemic Stroke in Young Afro-Caribbean Patients: A Population-Based Case-Control Study.

Science.gov (United States)

Joux, Julien; Boulanger, Marion; Jeannin, Severine; Chausson, Nicolas; Hennequin, Jean-Luc; Molinié, Vincent; Smadja, Didier; Touzé, Emmanuel; Olindo, Stephane

2016-10-01

Carotid bulb diaphragm (CBD) has been described in young carotid ischemic stroke (CIS) patients, especially in blacks. However, the prevalence of CBD in CIS patients is unknown, and whether CBD is a risk factor for CIS remains unclear. We assessed the association between CBD and incident CIS in a population-based study. We selected all young (young (stroke-free patients admitted for a road crash who routinely had computed tomographic angiography. Odds ratio (ORs) were calculated by conditional logistic regression adjusted for hypertension, dyslipidemia, diabetes and smoking. CIS associated with ipsilateral CBD incidence was 3.8 per 100 000 person-years (95% confidence interval, 1.4-6.1). Prevalence of ipsilateral CBD was 23% in all CIS and 37% in undetermined CIS patients. When restricted to undetermined CIS, CBD prevalence was 24 times higher than that in controls (adjusted OR, 24.1; 95% confidence interval, 1.8-325.6). CBD is associated with an increased risk of ipsilateral CIS in young Afro-Caribbean population. © 2016 American Heart Association, Inc.

Heritability of young- and old-onset ischaemic stroke.

Science.gov (United States)

Bluher, A; Devan, W J; Holliday, E G; Nalls, M; Parolo, S; Bione, S; Giese, A K; Boncoraglio, G B; Maguire, J M; Müller-Nurasyid, M; Gieger, C; Meschia, J F; Rosand, J; Rolfs, A; Kittner, S J; Mitchell, B D; O'Connell, J R; Cheng, Y C

2015-11-01

Although the genetic contribution to stroke risk is well known, it remains unclear if young-onset stroke has a stronger genetic contribution than old-onset stroke. This study aims to compare the heritability of ischaemic stroke risk between young and old, using common genetic variants from whole-genome array data in population-based samples. This analysis included 4050 ischaemic stroke cases and 5765 controls from six study populations of European ancestry; 47% of cases were young-onset stroke (age stroke risk in these unrelated individuals, the pairwise genetic relatedness was estimated between individuals based on their whole-genome array data using a mixed linear model. Heritability was estimated separately for young-onset stroke and old-onset stroke (age ≥ 55 years). Heritabilities for young-onset stroke and old-onset stroke were estimated at 42% (±8%, P genetic contribution to the risk of stroke may be higher in young-onset ischaemic stroke, although the difference was not statistically significant. © 2015 EAN.

Management Of Post Stroke Seizures

Directory of Open Access Journals (Sweden)

Kavian Ghandehari

2017-02-01

Full Text Available The incidence of seizures in relation to stroke is 8.9%, with a frequency of 10.6 and 8.6% in haemorrhagic and ischaemic stroke, respectively. In subarachnoid haemorrhage the incidence is 8.5%. Due to the fact that infarcts are significantly more frequent than haemorrhages, seizures are mainly related to occlusive vascular disease of the brain. The general view is to consider stroke-related seizures as harmless complications in the course of a prolonged vascular disease involving the heart and brain. Seizures can be classified as those of early and those of late onset in a paradigm comparable to post-traumatic epilepsy, with an arbitrary dividing point of two weeks after the event. Most early-onset seizures occur during the first day after the stroke. Late-onset seizures occur three times more often than early-onset ones. A first late-onset epileptic event is most likely to take place between six months and two years after the stroke. However, up to 28% of patients develop their first seizure several years later. Simple partial seizures, with or without secondary generalisation, account for about 50% of total seizures, while complex partial spells, with or without secondary generalisation, and primary generalised tonic–clonic insults account for approximately 25% each. Status epilepticus occurs in 12% of stroke patients, but the recurrence rate after an initial status epilepticus is not higher than after a single seizure. Inhibitory seizures, mimicking transient ischaemic attacks, are observed in 7.1% of cases. The only clinical predictor of late-onset seizures is the initial presentation of partial anterior circulation syndrome due to a territorial infarct. Patients with total anterior circulation syndrome have less chance of developing epileptic spells, not only due to their shorter life expectancy but also due to the fact that the large infarcts are sharply demarcated in these patients. The optimal timing and type of antiepileptic drug

Association of influenza vaccination and reduced risk of stroke hospitalization among the elderly: a population-based case-control study.

Science.gov (United States)

Lin, Hui-Chen; Chiu, Hui-Fen; Ho, Shu-Chen; Yang, Chun-Yuh

2014-04-02

The aim of this study was to investigate the effect of influenza vaccination (and annual revaccination) on the risk of stroke admissions. We conducted a population-based case-control study in Taiwan. Cases consisted of patients >65 years of age who had a first-time diagnosis of stroke during the influenza seasons from 2006 to 2009. Controls were selected by matching age, sex, and index date to cases. Multiple logistic regression analysis was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Ever vaccinated individuals in the current vaccination season were associated with a reduced risk of ischemic stroke admissions (OR = 0.76, 95% CI = 0.60-0.97). Compared with individuals never vaccinated against influenza during the past 5 years, the adjusted ORs were 0.92 (95% CI = 0.68-1.23) for the group with 1 or 2 vaccinations, 0.73 (95% CI = 0.54-1.00) for the group with 3 or 4 vaccinations, and 0.56 (95% CI = 0.38-0.83) for the group with 5 vaccinations. There was a significant trend of decreasing risk of ischemic stroke admissions with an increasing number of vaccinations. This study provides evidence that vaccination against influenza may reduce the risk of hospitalization for ischemic stroke and that annual revaccination provides greater protection.

Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project.

Science.gov (United States)

Wiborg, Andreas; Widder, Bernhard

2003-12-01

Assessing both stroke patients and their CT scans by using a conventional videoconference system offers an interesting opportunity to improve stroke care in rural areas. However, until now there have been no studies to suggest whether this method is feasible in routine stroke management. Seven rural hospitals in the southern part of Germany in Swabia were connected to the stroke unit of Günzburg with the use of a videoconference link (Telemedicine in Stroke in Swabia [TESS] Project). The local physicians are free to present every admitted stroke patient to the Günzburg stroke expert, who can assess the clinical status and CT images, thereafter giving therapeutic recommendations. All teleconsultations are rated concerning transmission quality and relevance of telemedicine for stroke management. A total of 153 stroke patients were examined by teleconsultation. Mean age was 67.5 years. Eighty-seven patients had suffered an ischemic stroke, 9 had an intracerebral hemorrhage, and 17 suffered a transient ischemic attack. Forty patients were revealed to have a diagnosis other than stroke. Duration of teleconsultation was 15 minutes on average. User satisfaction was good concerning imaging and audio quality, and patient satisfaction was very good or good in all cases. Relevant contributions could be made in >75% of the cases concerning diagnostic workup, CT assessment, and therapeutic recommendations. Teleconsultation using a videoconference system seems to be a feasible and promising method to improve stroke care in rural areas where management in a stroke unit is hindered by long transportation distances.

Spreading depolarizations occur in human ischemic stroke with high incidence

DEFF Research Database (Denmark)

Dohmen, C.; Sakowitz, O.W.; Fabricius, M.

2008-01-01

Objective: Cortical spreading depression (CSD) and periinfarct depolarization (PID) have been shown in various experimental models of stroke to cause secondary neuronal damage and infarct expansion. For decades it has been questioned whether CSD or PID occur in human ischemic stroke. Here, we...... potential change spreading between adjacent channels was accompanied by transient depression of ECoG activity. In PID, a slow potential change spread between neighboring channels despite already established suppression of ECoG activity. Most CSDs and PIDs appeared repetitively in clusters. CSD or PID...... was observed in all but two patients. In these two patients, the electrode strip had been placed over infarcted tissue, and accordingly, no local ECoG or recurrent transient depolarization activity occurred throughout the observation period. Interpretation: CSD and PID occurred spontaneously with high...

Stroke treatment outcomes in hospitals with and without Stroke Units.

Science.gov (United States)

Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

2017-10-23

Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Late night activity regarding stroke codes: LuNAR strokes.

Science.gov (United States)

Tafreshi, Gilda; Raman, Rema; Ernstrom, Karin; Rapp, Karen; Meyer, Brett C

2012-08-01

There is diurnal variation for cardiac arrest and sudden cardiac death. Stroke may show a similar pattern. We assessed whether strokes presenting during a particular time of day or night are more likely of vascular etiology. To compare emergency department stroke codes arriving between 22:00 and 8:00 hours (LuNAR strokes) vs. others (n-LuNAR strokes). The purpose was to determine if late night strokes are more likely to be true strokes or warrant acute tissue plasminogen activator evaluations. We reviewed prospectively collected cases in the University of California, San Diego Stroke Team database gathered over a four-year period. Stroke codes at six emergency departments were classified based on arrival time. Those arriving between 22:00 and 8:00 hours were classified as LuNAR stroke codes, the remainder were classified as 'n-LuNAR'. Patients were further classified as intracerebral hemorrhage, acute ischemic stroke not receiving tissue plasminogen activator, acute ischemic stroke receiving tissue plasminogen activator, transient ischemic attack, and nonstroke. Categorical outcomes were compared using Fisher's Exact test. Continuous outcomes were compared using Wilcoxon's Rank-sum test. A total of 1607 patients were included in our study, of which, 299 (19%) were LuNAR code strokes. The overall median NIHSS was five, higher in the LuNAR group (n-LuNAR 5, LuNAR 7; P=0·022). There was no overall differences in patient diagnoses between LuNAR and n-LuNAR strokes (P=0·169) or diagnosis of acute ischemic stroke receiving tissue plasminogen activator (n-LuNAR 191 (14·6%), LuNAR 42 (14·0%); P=0·86). Mean arrival to computed tomography scan time was longer during LuNAR hours (n-LuNAR 54·9±76·3 min, LuNAR 62·5±87·7 min; P=0·027). There was no significant difference in 90-day mortality (n-LuNAR 15·0%, LuNAR 13·2%; P=0·45). Our stroke center experience showed no difference in diagnosis of acute ischemic stroke between day and night stroke codes. This

Socioeconomic position and incidence of ischemic stroke in denmark 2003-2012. A nationwide hospital-based study

DEFF Research Database (Denmark)

Andersen, Klaus Kaae; Steding-Jessen, Marianne; Dalton, Susanne Oksbjerg

2014-01-01

BACKGROUND: A greater burden of stroke risk factors in general is associated with a higher risk for stroke among people of lower than those of higher socioeconomic position. The relative impact of individual stroke risk factors is still unclear. METHODS AND RESULTS: We studied the relations between...... socioeconomic position, measured as household income and length of education, and all hospital admissions for a first ischemic stroke among 54 048 people over the age of 40 years in Denmark in 2003-2012 in comparison with the general Danish population (23.5 million person-years). We also studied...... the cardiovascular risk factor profile associated with socioeconomic position in stroke patients. Relative risks for stroke were estimated in log-linear Poisson regression models. The risk for hospitalization for a first ischemic stroke was almost doubled for people in the lowest income group, and the risk of those...

Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases.

Science.gov (United States)

Suárez-García, Inés; Jarrín, Inmaculada; Iribarren, José Antonio; López-Cortés, Luis Fernando; Lacruz-Rodrigo, José; Masiá, Mar; Gómez-Sirvent, Juan Luis; Hernández-Quero, José; Vidal, Francesc; Alejos-Ferreras, Belén; Moreno, Santiago; Del Amo, Julia

2013-05-01

The aim of this study was to investigate the incidence and risk factors for the development of AIDS-defining cancers (ADCs); and to investigate the effect of making different assumptions on the definition of incident cases. A multicentre cohort study was designed. Poisson regression was used to assess incidence and risk factors. To account for misclassification, incident cases were defined using lag-times of 0, 14 and 30 days after enrolment. A total of 6393 HIV-positive subjects were included in the study. The incidences of ADCs changed as the lag periods were varied from 0 to 30 days. Different risk factors emerged as the definition of incident cases was changed. For a lag time of 0, the risk of Kaposi sarcoma [KS] and non-Hodgkin lymphoma [NHL] increased at CD4 counts sex with men had a higher risk of KS. KS and NHL were not associated with viral load, gender, or hepatitis B or C. The results were similar for a lag-time of 14 and 30 days; however, hepatitis C was significantly associated with NHL. This analysis shows the importance of the definition of incident cases in cohort studies. Alternative definitions gave different incidence estimates, and may have implications for the analysis of risk factors. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Stroke outcomes in Northern Scotland: does rurality really matter?

Science.gov (United States)

O'Neill, N P; Godden, D J

2003-01-01

, 303 patients with a suspected first-ever stroke were notified to the study. The resulting crude incidence of reported stroke was 1.1 per 1000. From the notifications, 239 patients were sent a consent form, of whom 118 agreed to participate in the study. The final dataset, after exclusions for incorrect diagnosis, deaths and other reasons, was derived from 85 patients. Among these, patients from remote rural and very remote settlements were over-represented, when compared to all patients notified. The majority of patients returned home from acute hospitals during the study period and the likelihood of returning home was not related to settlement category. However, a greater proportion of patients in remote rural settlements were admitted to community hospitals and remained there at 6 months. Approximately two-thirds had some degree of disability (or limitation in activities) after their stroke. One-third of patients classed themselves as independent across all time points. Overall, the Barthel Index score increased over time (ie, patients experienced a reduction in disability) with the average score at 1 month post-stroke being 82.5 (range 0-100), at 3 months 85 (range 5-100), and at 6 months 90 (range 5-100). Uptake of services was similar across all settlement categories, with low levels of use at 6-months post-stroke. In particular, few patients used social-support and stroke-specific services, for example Chest, Heart and Stroke Scotland, and Stroke Nurse services. The proportion of patients using any service at 1, 3 and 6 months did not differ between settlement categories. Rural patients did not therefore appear disadvantaged in service provision. The low incidence of reported stroke may have been due to a number of reasons including: death prior to notification; diagnostic uncertainty; stroke severity--failure to notify very mild or very severe stroke cases; and inadequate reporting of patients managed at home. The greater proportion of patients in remote rural

Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes.

Science.gov (United States)

Rebello, L C; Bouslama, M; Haussen, D C; Grossberg, J A; Dehkharghani, S; Anderson, A; Belagaje, S R; Bianchi, N A; Grigoryan, M; Frankel, M R; Nogueira, R G

2017-06-01

Chronic hypoperfusion from athero-stenotic lesions is thought to lead to better collateral recruitment compared to cardioembolic strokes. It was sought to compare collateral flow in stroke patients with atrial fibrillation (AF) versus stroke patients with cervical atherosclerotic steno-occlusive disease (CASOD). This was a retrospective review of a prospectively collected endovascular database. Patients with (i) anterior circulation large vessel occlusion stroke, (ii) pre-treatment computed tomography angiography (CTA) and (iii) intracranial embolism from AF or CASOD were included. CTA collateral patterns were evaluated and categorized into two groups: absent/poor collaterals (CTA collateral score 0-1) versus moderate/good collaterals (CTA collateral score 2-4). CT perfusion was also utilized for baseline core volume and evaluation of infarct growth. A total of 122 patients fitted the inclusion criteria, of whom 88 (72%) had AF and 34 (27%) CASOD. Patients with AF were older (P Collateral scores were lower in the AF group (P = 0.01) with patients having poor collaterals in 28% of cases versus 9% in the CASOD group (P = 0.03). Mortality rates (20% vs. 0%; P = 0.02) were higher in the AF patients whilst rates of any parenchymal hemorrhage (6% vs. 26%; P collaterals (odds ratio 4.70; 95% confidence interval 1.17-18.79; P = 0.03). Atheroembolic strokes seem to be associated with better collateral flow compared to cardioembolic strokes. This may in part explain the worse outcomes of AF-related stroke. © 2017 EAN.

Stroke in Patients With Aortic Stenosis

DEFF Research Database (Denmark)

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

2014-01-01

, 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......], 1.1-6.6), CHA2DS2-VASc score (HR 1.4 per unit; 95% CI, 1.1-1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI, 1.1-1.8), and AVR with concomitant coronary artery bypass grafting (HR, 3.2; 95% CI, 1.4-7.2, all P≤0.026) were independently associated with stroke. Incident stroke predicted...

Stroke in HIV-infected individuals with and without HCV coinfection in Spain in the combination antiretroviral therapy era

Science.gov (United States)

Alvaro-Meca, Alejandro; Díaz, Asunción; Micheloud, Dariela; Aldámiz-Echevarría, Teresa; Fanciulli, Chiara

2017-01-01

The incidence of stroke in human immunodeficiency virus (HIV)–infected individuals has been well analyzed in recent epidemiological studies. However, little is known about the specific contribution of hepatitis C virus (HCV) infection to stroke among HIV-infected individuals. The aims of this study were to analyze trends in the incidence rates of stroke in HIV-infected individuals during the combination antiretroviral (cART) era in Spain and to categorize them by the presence or absence of HCV coinfection. We analyzed hospital discharges with a diagnosis of stroke in Spain according to ICD-9-CM during 1997–2013. The study period was divided into four calendar periods (1997–1999, 2000–2003, 2004–2007, and 2008–2013). Patients were classified according to HCV serology. The number of HIV-infected patients was estimated based on data from the National Centre of Epidemiology. We calculated incidence rates (events per 10,000 patient-years) and in-hospital case fatality rates (CFR). The incidence of hemorrhagic stroke (HS) decreased in HIV-monoinfected patients (15.8 [1997–1999] to 6.5 [2008–2013]; P<0.001) and increased in HIV/HCV-coinfected patients (1.3 [1997–1999] to 5.5 [2008–2013]; P<0.001). The incidence of ischemic stroke (IS) decreased in HIV-monoinfected patients (27.4 [1997–1999] to 21.7 [2008–2013]; P = 0.005) and increased in HIV/HCV-coinfected patients (1.8 [1997–1999] to 11.9 [2008–2013]; P<0.001). The CFR was 3.3 times higher for HS than for IS for the whole study period. The CFR of HS in HIV-monoinfected patients decreased significantly (47.4% [1997–1999] to 30.6% [2008–2013]; P = 0.010) but did not change significantly among HIV/HCV-coinfected patients (41.4% [1997–1999] to 44.7% [2008–2013]; P = 0.784). The CFR of IS in the whole HIV-infected population decreased significantly (14.6% [1997–1999] to 10.9% [2008–2013]; P = 0.034), although no significant differences were found when each group was analyzed separately

Acute kidney injury and edaravone in acute ischemic stroke: the Fukuoka Stroke Registry.

Science.gov (United States)

Kamouchi, Masahiro; Sakai, Hironori; Kiyohara, Yutaka; Minematsu, Kazuo; Hayashi, Kunihiko; Kitazono, Takanari

2013-11-01

A free radical scavenger, edaravone, which has been used for the treatment of ischemic stroke, was reported to cause acute kidney injury (AKI) as a fatal adverse event. The aim of the present study was to clarify whether edaravone is associated with AKI in patients with acute ischemic stroke. From the Fukuoka Stroke Registry database, 5689 consecutive patients with acute ischemic stroke who were hospitalized within 24 hours of the onset of symptoms were included in this study. A logistic regression analysis for the Fukuoka Stroke Registry cohort was done to identify the predictors for AKI. A propensity score-matched nested case-control study was also performed to elucidate any association between AKI and edaravone. Acute kidney injury occurred in 128 of 5689 patients (2.2%) with acute ischemic stroke. A multivariate analysis revealed that the stroke subtype, the basal serum creatinine level, and the presence of infectious complications on admission were each predictors of developing AKI. In contrast, a free radical scavenger, edaravone, reduced the risk of developing AKI (multivariate-adjusted odds ratio [OR] .45, 95% confidence interval [CI] .30-.67). Propensity score-matched case-control study confirmed that edaravone use was negatively associated with AKI (propensity score-adjusted OR .46, 95% CI .29-.74). Although AKI has a significant impact on the clinical outcome of hospital inpatients, edaravone has a protective effect against the development of AKI in patients with acute ischemic stroke. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Coated-platelets predict stroke at 30 days following TIA.

Science.gov (United States)

Kirkpatrick, Angelia C; Vincent, Andrea S; Dale, George L; Prodan, Calin I

2017-07-11

To examine the potential for coated-platelets, a subset of highly procoagulant platelets observed on dual agonist stimulation with collagen and thrombin, for predicting stroke at 30 days in patients with TIA. Consecutive patients with TIA were enrolled and followed up prospectively. ABCD2 scores were obtained for each patient. Coated-platelet levels, reported as percent of cells converted to coated-platelets, were determined at baseline. The primary endpoint was the occurrence of stroke at 30 days. Receiver operator characteristic (ROC) analysis was used to calculate area under the curve (AUC) values for a model including coated-platelets to predict incident stroke at 30 days. A total of 171 patients with TIA were enrolled, and 10 strokes were observed at 30 days. A cutoff of 51.1% for coated-platelet levels yielded a sensitivity of 0.80 (95% confidence interval [CI] 0.55-1.0), specificity of 0.73 (95% CI 0.66-0.80), positive predictive value of 0.16 (95% CI 0.06-0.26), and negative predictive value of 0.98 (95% CI 0.96-1.0). The adjusted hazard ratio of incident stroke in patients with coated-platelet levels ≥51.1% was 10.72 compared to those with levels TIA. © 2017 American Academy of Neurology.

Association of Neovascular Glaucoma with Risk of Stroke: A Population-Based Cohort Study

Directory of Open Access Journals (Sweden)

Cheng-Wen Su

2017-01-01

Full Text Available Neovascular glaucoma (NVG, caused by ocular ischemia, is a serious ocular disease complicated by intractably increased intraocular pressure. Cerebrovascular accidents are classified into ischemic and hemorrhagic stroke. Based on the similar pathogenic mechanisms of NVG and ischemic stroke, we investigated the relationship between NVG and stroke by using a nationally representative sample. This study included 416 NVG patients and 4160 controls. Medical comorbidities were also evaluated. The cumulative incidence of ischemic stroke was 15.6% higher in the NVG cohort than in the control cohort (p<0.001; the incidence density rates of stroke were 3.80 and 1.19 per 10,000 person-years in the NVG and control cohorts, respectively. According to the multivariable Cox regression results, the estimated adjusted hazard ratio (aHR of stroke was 2.07 (95% confidence interval (CI = 1.41–3.02 for the NVG cohort. Furthermore, the NVG cohort was 2.24-fold more likely to develop ischemic stroke (95% CI = 1.51–3.32. The risk of ischemic stroke was higher in patients with hypertension (aHR = 2.09, 95% CI = 1.55–2.82 and in patients with diabetic retinopathy (aHR = 1.69, 95% CI = 1.05–2.72. Notably, patients with NVG have a higher risk of ischemic stroke, but not hemorrhagic stroke.

Epidemiology of stroke : the role of blood pressure, alcohol and diet

NARCIS (Netherlands)

Keli, S.O.

1995-01-01

This thesis evaluates the recent trends in stroke mortality in the Netherlands Antilles, and the role of long-term blood pressure, alcohol and diet as risk factors for stroke incidence. The official mortality statistics and population data from the Netherlands Antilles over the period

Number of nursing staff and falls: a case-control study on falls by stroke patients in acute-care settings

NARCIS (Netherlands)

Tutuarima, J. A.; de Haan, R. J.; Limburg, M.

1993-01-01

Falls occur frequently in patients with a stroke and have serious consequences: discharge delays and hip fractures can result. In order to evaluate the impact of nursing workload on stroke-patient falls, we assessed the patients per nurse ratio in a detailed case-control study carried out in nine

Ischemic stroke risk, smoking, and the genetics of inflammation in a biracial population: the stroke prevention in young women study

OpenAIRE

Cole, John W; Brown, David W; Giles, Wayne H; Stine, Oscar C; O'Connell, Jeffrey R; Mitchell, Braxton D; Sorkin, John D; Wozniak, Marcella A; Stern, Barney J; Sparks, Mary J; Dobbins, Mark T; Shoffner, Latasha T; Zappala, Nancy K; Reinhart, Laurie J; Kittner, Steven J

2008-01-01

Abstract Background Although cigarette smoking is a well-established risk factor for vascular disease, the genetic mechanisms that link cigarette smoking to an increased incidence of stroke are not well understood. Genetic variations within the genes of the inflammatory pathways are thought to partially mediate this risk. Here we evaluate the association of several inflammatory gene single nucleotide polymorphisms (SNPs) with ischemic stroke risk among young women, further stratified by curre...

Stroke and Episodic Memory Disorders

Science.gov (United States)

Lim, Chun; Alexander, Michael P.

2009-01-01

Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…

Protein consumptions in stroke patients

Directory of Open Access Journals (Sweden)

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.

Stroke and cannabis use in patients with no cardiovascular risk factors: a systematic review of case reports.

Science.gov (United States)

Gómez Ochoa, S A

2017-12-22

Cannabis and its synthetic analogues are currently the most widely consumed illicit substances worldwide. Multiple alterations have been linked to its use, including cerebrovascular disease (CVD) or stroke, whose association with the substance has been based mainly on the hypothesis of transient vasoconstriction, which explains a large proportion of the cases reported. However, epidemiological studies have not performed an individual analysis of patients without other cardiovascular risk factors, which may limit the estimation of the risk of stroke associated with cannabis use alone. A systematic literature review was conducted through Medline, EBSCOhost, EMBASE, Lilacs, and Scielo to gather case reports published before 13 May 2016 presenting patients with a diagnosis of CVD or transient ischaemic attack, a history of cannabinoid use, and no other cardiovascular risk factors. Key words such as stroke, cerebrovascular disease, cannabis, and marijuana, among others, were used. A total of 18 case reports were selected from the 566 references found. There is a wide variety of reports of stroke associated with cannabis use in patients with no other risk factors. Noteworthy findings were presentation at young age and a strong temporal association, which place cannabis use as a potential risk factor for this population in line with the epidemiological and pathophysiological studies in this area. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Patent foramen ovale and the risk of ischemic stroke in a multiethnic population.

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Di Tullio, Marco R; Sacco, Ralph L; Sciacca, Robert R; Jin, Zhezhen; Homma, Shunichi

2007-02-20

We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 +/- 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 +/- 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30). Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.

Association Between Markers of Inflammation and Total Stroke by Hypertensive Status Among Women

Science.gov (United States)

Rexrode, Kathryn M.; Kotler, Gregory; Everett, Brendan M.; Glynn, Robert J.; Lee, I-Min; Buring, Julie E.; Ridker, Paul M.; Sesso, Howard D.

2016-01-01

BACKGROUND Markers of systemic inflammation (high-sensitivity C-reactive protein [hsCRP], soluble intercellular adhesion molecule 1 [sICAM-1], and fibrinogen) have been associated with a greater risk of total and ischemic stroke, in addition to elevated blood pressure. However, the role of these inflammatory markers on stroke pathophysiology by hypertension status is uncertain. METHODS Blood samples were collected and assayed for hsCRP, sICAM-1, and fibrinogen among 27,330 initially healthy women from the Women’s Health Study, and women were followed up from 1992 to 2013. Prior to randomization, the baseline questionnaire collected self-reported hypertension status, cardiovascular risk factors, and lifestyle factors. New cases of total, ischemic, and hemorrhagic stroke were updated annually through questionnaires and confirmed by medical records according to the National Survey of Stroke criteria. Multivariable Cox models estimated overall associations between each inflammatory marker and stroke and separately stratified by hypertension status. RESULTS We observed 629 incident total strokes over 477,278 person-years. In adjusted analyses, extreme quartiles of hsCRP and sICAM-1 were each associated with a significantly greater risk of total stroke (hsCRP: hazard ratios [HR] = 1.77, 95% confidence interval [CI]: 1.39–2.26; sICAM-1: HR = 1.28, 95% CI: 1.00–1.63). Fibrinogen was not associated with a significantly greater stroke risk. In analyses stratified by hypertension status, elevated hsCRP was associated with a nonstatistically significant greater risk of total stroke among prehypertensive and hypertensive women. CONCLUSIONS These data indicate that hsCRP and sICAM-1 are associated with hypertension status and stroke risk among women. Further work should examine the role of inflammatory markers on ischemic stroke subtypes and clarify mechanisms. PMID:27235695

5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore.

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Sun, Yan; Lee, Sze Haur; Heng, Bee Hoon; Chin, Vivien S

2013-10-03

Stroke is the 4th leading cause of death and 1st leading cause of disability in Singapore. However the information on long-term post stroke outcomes for Singaporean patients was limited. This study aimed to investigate the post stroke outcomes of 5-year survival and rehospitalization due to stroke recurrence for hemorrhagic and ischemic stroke patients in Singapore. The outcomes were stratified by age, ethnic group, gender and stroke types. The causes of death and stroke recurrence were also explored in the study. A multi-site retrospective cohort study. Patients admitted for stroke at any of the three hospitals in the National Healthcare Group of Singapore were included in the study. All study patients were followed up to 5 years. Kaplan-Meier was applied to study the time to first event, death or rehospitalization due to stroke recurrence. Cox proportional hazard model was applied to study the time to death with adjustment for stroke type, age, sex, ethnic group, and admission year. Cumulative incidence model with competing risk was applied for comparing the risks of rehospitalization due to stroke recurrence with death as the competing risk. Totally 12,559 stroke patients were included in the study. Among them, 59.3% survived for 5 years; 18.4% were rehospitalized due to stroke recurrence in 5 years. The risk of stroke recurrence and mortality increased with age in all stroke types. Gender, ethnic group and admitting year were not significantly associated with the risk of mortality or stroke recurrence in hemorrhagic stroke. Male or Malay patient had higher risk of stroke recurrence and mortality in ischemic stroke. Hemorrhagic stroke had higher early mortality while ischemic stroke had higher recurrence and late mortality. The top cause of death among died stroke patients was cerebrovascular diseases, followed by pneumonia and ischemic heart diseases. The recurrent stroke was most likely to be the same type as the initial stroke among rehospitalized stroke

Genetic determinants and stroke in children with sickle cell disease,

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Daniela O.W. Rodrigues

Full Text Available Abstract Objective: To verify genetic determinants associated with stroke in children with sickle cell disease (SCD. Methods: Prospective cohort with 110 children submitted to neonatal screening by the Neonatal Screening Program, between 1998 and 2007, with SCD diagnosis, followed at a regional reference public service for hemoglobinopathies. The analyzed variables were type of hemoglobinopathy, gender, coexistence with alpha thalassemia (α-thal, haplotypes of the beta globin chain cluster, and stroke. The final analysis was conducted with 66 children with sickle cell anemia (SCA, using the chi-squared test in the program SPSS® version 14.0. Results: Among children with SCD, 60% had SCA. The prevalence of coexistence with α-thal was 30.3% and the Bantu haplotype (CAR was identified in 89.2%. The incidence of stroke was significantly higher in those with SCA (27.3% vs. 2.3%; p = 0.001 and males (24.1% vs. 9.6%; p = 0.044. The presence of α-thal (p = 0.196, the CAR haplotype (p = 0.543, and socioeconomic factors were not statistically significant in association with the occurrence of stroke. Conclusion: There is a high incidence of stroke in male children and in children with SCA. Coexistence with α-thal and haplotypes of the beta globin chain cluster did not show any significant association with stroke. The heterogeneity between previously evaluated populations, the non-reproducibility between studies, and the need to identify factors associated with stroke in patients with SCA indicate the necessity of conducting further research to demonstrate the relevance of genetic factors in stroke related to SCD.

External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

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Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

2016-01-01

A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient. The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84). Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, pcase-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

Association between self-perceived psychological stress and transitory ischaemic attack and minor stroke: A case-control study.

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Ramírez-Moreno, J M; Muñoz Vega, P; Espada, S; Bartolomé Alberca, S; Aguirre, J; Peral, D

2017-12-22

Stroke has a complex aetiopathogenesis influenced by numerous risk factors. There is growing interest in the study of the pathophysiological changes associated with stress and their potential relationship with cerebrovascular disease. The purpose of this paper is to assess the strength of association between exposure to stress and stroke. We conducted a case-control study (1:1) to compare exposure to stress in a group of patients with a history of a first transient ischaemic attack (TIA) or minor stroke and in a control group. Participants were asked a subjective question about their perception of stress in the previous months and completed the standardised Effort-Reward Imbalance (ERI) questionnaire. Logistic regression models were used for data analysis. The study included data on 50 cases and 50 controls. There were no significant differences in demographic variables and economic, social, and employment status between cases and controls. Fifty percent of the cases reported moderate to severe stress, compared to 30% of controls (OR: 2.33; 95% CI: 1.02-5.30; P=.041). ERI questionnaire results found that greater effort at work (OR: 1.48; 95% CI: 1.19-1.83) and greater commitment is associated with stroke (OR: 1.34; 95% CI: 1.17-1.54), while higher reward constitutes a protective factor against the disease (OR: 0.71; 95% CI: 0.61-0.82). There is a strong association between self-perceived psychological stress and TIA. The imbalance between effort and reward at work is also clearly related to TIA. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Clinicoanatomical correlation in stroke related aphasia

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Vikram Bohra

2015-01-01

Full Text Available Context: With advances in neuroimaging, traditional views regarding the clinicoanatomic correlation in stroke patients with aphasia are being challenged and it has been observed that lesions at a given cortical or subcortical site may manifest with different aphasia profiles. Aims: To study as to whether there is a strict clinicoanatomical correlation between the type of aphasia and lesion site in patients with first ever stroke. Settings and Design: Observational study, based in a tertiary care center. Materials and Methods: Stroke patient′s ≥18 years of age were screened and those with first ever stroke and aphasia were subjected to a detailed stroke workup and language assessment using the Hindi version of Western Aphasia Battery (WAB. Statistical analysis was done with χ2 test with Yates correction and Kruskal-Wallis test. The level of significance was set at P < 0.05. Results: Overall aphasia was detected in 27.9% of the 260 screened cases with stroke. Amongst 60 cases with first ever stroke and aphasia, the aphasia type was: Global (33.33%, Broca′s (28.3%, transcortical motor (13.33%, transcortical sensory (10%, Wernicke′s (8.33%, anomic (5%, and conduction (1.67% aphasia. A definite correlation between the lesion site and the type of aphasia as per the traditional classification was observed in 35% cases only. Conclusions: No absolute correlation exists between the lesion site and the type of clinical aphasia syndrome in majority of the patients with cortical and subcortical stroke.

Up-date on Specificities of Stroke in Women

DEFF Research Database (Denmark)

Christensen, Hanne Krarup; Bentsen, Line; Christensen, Louisa

2016-01-01

depending both on cultural factors and the overall access to care; in especially lower income countries though data is very scarce the impression is that women's access to care is restricted in comparison to men. Specific female risk factors including pregnancy or sex hormone therapy are rare causes......Abstract The majority of strokes occur in women who in crude numbers have poorer outcome including higher mortality from stroke than men. This may, however, to a large degree be explained by the preponderance of women in the older age groups. Nevertheless, incidence of stroke is higher in men than...... in women. Overall rates of stroke decline, but more in men than in women; consequently the excess number of strokes in women will be on the rise in the years to come. Risk factors differ between men and women: e.g. rates of atrial fibrillation and hypertension are higher in women with stroke, while rates...

Neurological outcomes in patients with ischemic stroke receiving enoxaparin or heparin for venous thromboembolism prophylaxis: subanalysis of the Prevention of VTE after Acute Ischemic Stroke with LMWH (PREVAIL) study.

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Kase, Carlos S; Albers, Gregory W; Bladin, Christopher; Fieschi, Cesare; Gabbai, Alberto A; O'Riordan, William; Pineo, Graham F

2009-11-01

The Prevention of VTE after Acute Ischemic Stroke with LMWH (PREVAIL) study demonstrated that enoxaparin was superior to unfractionated heparin (UFH) in preventing venous thromboembolism in patients with ischemic stroke and was associated with a small but statistically significant increase in extracranial hemorrhage rates. In this PREVAIL subanalysis, we evaluate the long-term neurological outcomes associated with the use of enoxaparin compared with UFH. We also determine predictors of stroke progression. Acute ischemic stroke patients aged >or=18 years, who could not walk unassisted, were randomized to receive enoxaparin (40 mg once daily) or UFH (5000 U every 12 hours) for 10 days. Patients were stratified according to baseline stroke severity using the National Institutes of Health Stroke Scale score. End points for this analysis included stroke progression (>or=4-point increase in National Institutes of Health Stroke Scale score), neurological outcomes up to 3 months postrandomization (assessed using National Institutes of Health Stroke Scale score and modified Rankin Scale score), and incidence of intracranial hemorrhage. Stroke progression occurred in 45 of 877 (5.1%) patients in the enoxaparin group and 42 of 872 (4.8%) of those receiving UFH. Similar improvements in National Institutes of Health Stroke Scale and modified Rankin Scale scores were observed in both groups over the 90-day follow-up period. Incidence of intracranial hemorrhage was comparable between groups (20 of 877 [2.3%] and 22 of 872 [2.5%] in enoxaparin and UFH groups, respectively). Baseline National Institutes of Health Stroke Scale score, hyperlipidemia, and Hispanic ethnicity were independent predictors of stroke progression. The clinical benefits associated with use of enoxaparin for venous thromboembolism prophylaxis in patients with acute ischemic stroke are not associated with poorer long-term neurological outcomes or increased rates of symptomatic intracranial hemorrhage compared

Neurology Concepts: Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department.

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Chang, Bernard P; Wira, Charles; Miller, Joseph; Akhter, Murtaza; Barth, Bradley E; Willey, Joshua; Nentwich, Lauren; Madsen, Tracy

2018-01-01

Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting. A panel of six board-certified emergency physicians, one with fellowship training in stroke and one with training in sex- and sex-based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors. Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals. Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment

Case studies of hydrogen sulphide occupational exposure incidents in the UK.

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Jones, Kate

2014-12-15

The UK Health and Safety Executive has investigated several incidents of workplace accidents involving hydrogen sulphide exposure in recent years. Biological monitoring has been used in some incidents to determine the cause of unconsciousness resulting from these incidents and as a supporting evidence in regulatory enforcement. This paper reports on three case incidents and discusses the use of biological monitoring in such cases. Biological monitoring has a role in identifying hydrogen sulphide exposure in incidents, whether these are occupational or in the wider environment. Sample type, time of collection and sample storage are important factors in the applicability of this technique. For non-fatal incidents, multiple urine samples are recommended at two or more time points between the incident and 15 h post-exposure. For routine occupational monitoring, post-shift samples should be adequate. Due to endogenous levels of urinary thiosulphate, it is likely that exposures in excess of 12 ppm for 30 min (or 360 ppm/min equivalent) would be detectable using biological monitoring. This is within the Acute Exposure Guideline Level 2 (the level of the chemical in air at or above which there may be irreversible or other serious long-lasting effects or impaired ability to escape) for hydrogen sulphide. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

The incidence of vasculitis is increased in female stroke-prone ...

African Journals Online (AJOL)

Background: Vascular changes in hypertension share common characteristics with inflammatory wall injury. Since it is known that chronic inflammatory diseases are frequently more prevalent in females, this study tested the hypothesis that vasculitis would be more evident in female stroke-prone spontaneously hypertensive ...

The Assessment of Early Stage Computed Tomography Findings in Acute Ischemic Stroke

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Nebahat Taşdemir

2008-01-01

Full Text Available The imaging techniques have become important tools during diagnostic stage of acute ischemic stroke during the last 30 years. The improvement in these techniques further increased the clinical areas that these tools could be used. As computerized brain tomography (CT is a rapid, cheap, non-invasive and highly available imaging tool in most hospitals, it remains to be the primary scanning method for all acute patients.The aim of this study was to evaluate the early stage CT findings in the ischemic stroke patients which have been scanned in the first 8 to 12 hours after the incidence. Sixty four cases (26 male, 38 female who had clinical symptoms of ischemic stroke have been included in this study. CT scan was performed twice to these patients; first in the first 8 to 12 hours, and second in between 24 hours and 48 hours after the stroke. The middle cerebral artery perfused area was the most common arterial area affected among cases who had CT findings in early scans. Hypodense lesions were most common lesions encountered in CT findings. Hyperdense middle cerebral artery sign in early CT findings could be an indicator of ischemia due to arterial occlusion. We determined that the CT images obtained at the beginning of developing stroke appeared to show the lesions smaller than what they really were. There were significant differences between the emergency room evaluation and detailed clinical evaluation of CT scans. More findings have been observed in late CT scans performed between 24 hours and 48 hours than the ones performed in the first 8 hours and 12 hours. There was no correlation between the presence of CT findings in early scans and severity of clinical features of ischemia. CT appears to be an important tool in diagnosing ischemic strokes even at early stages. Developments in diagnostic precision of CT tools will further increase our understanding of ischemic strokes and their clinical progress.

[Ischemic stroke in young women

NARCIS (Netherlands)

Ekker, M.S.; Wermer, M.J.; Riksen, N.P.; Klijn, C.J.; Leeuw, F.E. de

2016-01-01

- In virtually all age groups, the incidence of ischemic stroke is higher in men. However, in women aged between 25-49 years the prevalence is higher than in men. Female-specific risk factors and disorders may explain this peak.- Pregnancy and the post-partum period are associated with physiological

Combining Mental Training and Physical Training With Goal-Oriented Protocols in Stroke Rehabilitation: A Feasibility Case Study

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Xin Zhang

2018-04-01

Full Text Available Stroke is one of the leading causes of permanent disability in adults. The literature suggests that rehabilitation is key to early motor recovery. However, conventional therapy is labor and cost intensive. Robotic and functional electrical stimulation (FES devices can provide a high dose of repetitions and as such may provide an alternative, or an adjunct, to conventional rehabilitation therapy. Brain-computer interfaces (BCI could augment neuroplasticity by introducing mental training. However, mental training alone is not enough; but combining mental with physical training could boost outcomes. In the current case study, a portable rehabilitative platform and goal-oriented supporting training protocols were introduced and tested with a chronic stroke participant. A novel training method was introduced with the proposed rehabilitative platform. A 37-year old individual with chronic stroke participated in 6-weeks of training (18 sessions in total, 3 sessions a week, and 1 h per session. In this case study, we show that an individual with chronic stroke can tolerate a 6-week training bout with our system and protocol. The participant was actively engaged throughout the training. Changes in the Wolf Motor Function Test (WMFT suggest that the training positively affected arm motor function (12% improvement in WMFT score.

Neuroserpin polymorphisms and stroke risk in a biracial population: the stroke prevention in young women study

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Stern Barney J

2007-10-01

Full Text Available Abstract Background Neuroserpin, primarily localized to CNS neurons, inhibits the adverse effects of tissue-type plasminogen activator (tPA on the neurovascular unit and has neuroprotective effects in animal models of ischemic stroke. We sought to evaluate the association of neuroserpin polymorphisms with risk for ischemic stroke among young women. Methods A population-based case-control study of stroke among women aged 15–49 identified 224 cases of first ischemic stroke (47.3% African-American and 211 age-matched control subjects (43.1% African-American. Neuroserpin single nucleotide polymorphisms (SNPs chosen through HapMap were genotyped in the study population and assessed for association with stroke. Results Of the five SNPs analyzed, the A allele (frequency; Caucasian = 0.56, African-American = 0.42 of SNP rs6797312 located in intron 1 was associated with stroke in an age-adjusted dominant model (AA and AT vs. TT among Caucasians (OR = 2.05, p = 0.023 but not African-Americans (OR = 0.71, p = 0.387. Models adjusting for other risk factors strengthened the association. Race-specific haplotype analyses, inclusive of SNP rs6797312, again demonstrated significant associations with stroke among Caucasians only. Conclusion This study provides the first evidence that neuroserpin is associated with early-onset ischemic stroke among Caucasian women.

Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients.

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Tsai, M-S; Chuang, P-Y; Huang, C-H; Shih, S-R; Chang, W-T; Chen, N-C; Yu, P-H; Cheng, H-J; Tang, C-H; Chen, W-J

2015-12-01

An increased risk for ischaemic stroke has been reported in young hyperthyroidism patients independent of atrial fibrillation (AF). However, whether the use of antithyroid drugs in hyperthyroidism patients can reduce the occurrence of ischaemic stroke remains unclear. A total of 36,510 newly diagnosed hyperthyroidism patients during 2003-2006 were identified from the Taiwan National Health Insurance Research database. Each patient was individually tracked for 5 years from their index date (beginning the antithyroid drugs) to identify those who suffered from new episode of ischaemic stroke. Medication possession ratio (MPR) was used to represent the antithyroid drug compliance. The association between the MPR and the risk of stroke was examined. The stroke incidence rates for hyperthyroidism patients with age hyperthyroidism patients without AF, good antithyroid drugs compliance also reduced the incidence of stroke significantly (adjusted HR, range: 1.52-1.61; p = 0.02); but not in hyperthyroidism with AF. Hyperthyroidism patients with good antithyroid drug compliance had a lower risk of ischaemic stroke than patients with poor compliance. © 2015 John Wiley & Sons Ltd.

Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

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Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

2013-11-01

U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

Theophylline as an add-on to thrombolytic therapy in acute ischaemic stroke (TEA-Stroke)

DEFF Research Database (Denmark)

Modrau, Boris; Hjort, Niels; Østergaard, Leif

2016-01-01

the collateral supply in acute ischaemic brain tissue and thus facilitate reperfusion despite proximal vessel occlusion. The primary study objective is to evaluate whether theophylline is safe and efficient in acute ischaemic stroke patients as an add-on to thrombolytic therapy.MethodsThe TEA-Stroke Trial...... models, clinical case series and randomized clinical trials are controversial. A Cochrane analysis from 2004 concluded that there was not enough evidence to assess whether theophylline is safe and improves outcomes in patients with acute ischaemic stroke. The TEA-Stroke Trial will clarify whether...

Effect of vitamin C supplementation on stroke recovery: a case-control study.

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Rabadi, Meheroz H; Kristal, Bruce S

2007-01-01

Epidemiological studies have associated increased dietary intake of antioxidants (vitamin C, E, and beta-carotene) in preventing and decreasing the extent of ischemic brain injury. The effect of vitamin C supplementation on functional recovery after stroke has not been studied. In this retrospective, case-control study of 23 patients with ischemic stroke taking vitamin C were identified and matched for age, sex, onset to admission, and admission total functional independence measure (TFIM) with 23 patients with ischemic stroke not taking Vitamin C supplementation. Vitamin C 1000 mg daily was prescribed on admission to our unit mainly to patients who were undernourished (defined as significant weight loss and/or 90% or less ideal body weight for age and sex) and those with pressure sores. The outcome measures were: change in the TFIM, FIM-Cognition (FIM-Cog), and FIM-Motor sub-scores, discharge disposition, and length of stay (LOS). The change in TFIM (20 +/- 13 standard deviation [SD] vs. 26 +/- 6, p = 0.20), FIM-Cog (3 +/- 3 SD vs. 4 +/- 5, p = 0.41), FIM-Motor (15 +/- 11 SD vs. 20 +/- 13, p = 0.21) sub-scores were less in the vitamin C treated group, but these differences did not reach statistical significance. Similarly, no significant differences were found in LOS (21 +/- 9 SD vs. 23 +/- 9, p = 0.59), and discharge disposition (home/institution) (9/10 vs. 13/9, p = 0.60) between the vitamin C and the control groups. This study suggests vitamin C supplementation did not enhance functional recovery in undernourished ischemic stroke patients.

Dietary Sodium to Potassium Ratio and Risk of Stroke in a Multiethnic Urban Population: The Northern Manhattan Study.

Science.gov (United States)

Willey, Joshua; Gardener, Hannah; Cespedes, Sandino; Cheung, Ying K; Sacco, Ralph L; Elkind, Mitchell S V

2017-11-01

There is growing evidence that increased dietary sodium (Na) intake increases the risk of vascular diseases, including stroke, at least in part via an increase in blood pressure. Higher dietary potassium (K), seen with increased intake of fruits and vegetables, is associated with lower blood pressure. The goal of this study was to determine the association of a dietary Na:K with risk of stroke in a multiethnic urban population. Stroke-free participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were followed-up for incident stroke. Baseline food frequency questionnaires were analyzed for Na and K intake. We estimated the hazard ratios and 95% confidence intervals for the association of Na:K with incident total stroke using multivariable Cox proportional hazards models. Among 2570 participants with dietary data (mean age, 69±10 years; 64% women; 21% white; 55% Hispanic; 24% black), the mean Na:K ratio was 1.22±0.43. Over a mean follow-up of 12 years, there were 274 strokes. In adjusted models, a higher Na:K ratio was associated with increased risk for stroke (hazard ratio, 1.6; 95% confidence interval, 1.2-2.1) and specifically ischemic stroke (hazard ratio, 1.6; 95% confidence interval, 1.2-2.1). Na:K intake is an independent predictor of stroke risk. Further studies are required to understand the joint effect of Na and K intake on risk of cardiovascular disease. © 2017 American Heart Association, Inc.

Patent Foramen Ovale and Cryptogenic Strokes in the Stroke in Young Fabry Patients Study.

Science.gov (United States)

Huber, Roman; Grittner, Ulrike; Weidemann, Frank; Thijs, Vincent; Tanislav, Christian; Enzinger, Christian; Fazekas, Franz; Wolf, Markus; Hennerici, Michael G; McCabe, Dominick J H; Putaala, Jukaa; Tatlisumak, Turgut; Kessler, Christoph; von Sarnowski, Bettina; Martus, Peter; Kolodny, Edwin; Norrving, Bo; Rolfs, Arndt

2017-01-01

A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; Pstrokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (Pstroke patients demonstrate a heterogeneous PFO prevalence. Even in case of less conclusive diseases like nonstenotic arteriosclerosis, patients should preferentially be considered to have a non-PFO-mediated stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2016 American Heart Association, Inc.