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Sample records for stroke related hemiplegia

  1. Constraint-induced movement therapy promotes brain functional reorganization in stroke patients with hemiplegia.

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    Wang, Wenqing; Wang, Aihui; Yu, Limin; Han, Xuesong; Jiang, Guiyun; Weng, Changshui; Zhang, Hongwei; Zhou, Zhiqiang

    2012-11-15

    Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia.

  2. Constraint-induced movement therapy promotes brain functional reorganization in stroke patients with hemiplegia

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    Wang, Wenqing; Wang, Aihui; Yu, Limin; Han, Xuesong; Jiang, Guiyun; Weng, Changshui; Zhang, Hongwei; Zhou, Zhiqiang

    2012-01-01

    Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia. PMID:25337108

  3. The Timed 180° Turn Test for Assessing People with Hemiplegia from Chronic Stroke

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    Regan L. Robinson

    2018-01-01

    Full Text Available Background. Turning is ubiquitous in activities of daily living. For people with hemiplegia, persistent impairments in strength, balance, and coordination will affect their ability to turn safely. Consequently, turning retraining should be addressed in rehabilitation programs. To measure turning for these individuals, a reliable clinical tool is required. Objective. To investigate (i the intrarater, interrater, and test-retest reliability of the timed 180° turn test; (ii the correlation of the timed 180° turn test with other measures of stroke-specific impairments; and (iii the cut-off time that best discriminates individuals with hemiplegia from chronic stroke and healthy older adults. Methods. 33 individuals with hemiplegia due to chronic stroke and 32 healthy elderly individuals participated in this cross-sectional study. The timed 180° turn test was administered along with other measures of stroke-specific impairment. Results. The timed 180° turn test demonstrated excellent intrarater, interrater, and test-retest reliability in individuals with hemiplegia from chronic stroke. The timed 180° turn test (times significantly correlated with the Fugl-Meyer Assessment of the Lower Extremities (FMA-LE, affected ankle plantar flexion strength, the 5-Times-Sit-To-Stand test, the Berg Balance Scale (BBS, and the Timed Up and Go (TUG test. Conclusion. The timed 180° turn test is a reliable clinical tool to assess the turning ability of subjects with hemiplegia from chronic stroke.

  4. Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study.

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    Takashima, Risa; Murata, Waka; Saeki, Kazuko

    2016-08-01

    Meanings of movement for stroke survivors could give therapists significant insights, especially during maintenance phase. The purpose of this study was to examine how post-stroke users of a long-term elderly care facility had experienced changes in movement resulting from hemiplegia. The participants of this study were 18 stroke survivors using a long-term elderly care facility. Based on phenomenology, between two and three interviews were conducted with each participant about their experiences with hemiplegia. Data analysis consisted of the following phases: 'data immersion', 'data transformation' and 'thematic analysis'. This study was approved by the ethics committee of the authors' institution. Participants experienced seven themes resulting from hemiplegia, perceiving themselves differently from the way they did before the stroke. The themes were as follows: 'inescapable dependence', 'sense of incompetence', 'lack of autonomy', 'symbol of deviation from normal', 'licence for amae', 'security of self-worth' and 'proof of effort'. The first four themes attempt to express participants' pain and difficulty in living with their present body; the last three attempt to express methods for coping with the present body in the company of others. Results will assist therapists to understand the significant needs of their clients in the maintenance phase. Implications for Rehabilitation Hemiplegia is paralysis of half of the body; it represents one kind of physical disability caused by stroke. Re-interpretation of how patients had experienced the changes of their movements after they had hemiplegia is helpful for the therapists to understand the significant needs for their clients. It may be especially relevant for therapists working with stroke survivors in the maintenance phase, whose functional recovery of physical movements is not expected to occur to a greater extent.

  5. Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad.

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    Siddiqui, Tahir Saeed; Rehman, Anis ur; Ahmed, Basharat

    2006-01-01

    Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005. All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad.

  6. [Spasmodic hemiplegia after stroke treated with scalp acupuncture, music therapy and rehabilitation: a randomized controlled trial].

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    Jia, Chengjie; Zhang, Hongru; Ni, Guangxia; Zhang, Yinan; Su, Bin; Xu, Xinlei

    2017-12-12

    To evaluate the differences in the clinical therapeutic effects on spasmodic hemiplegia after stroke among the alliance therapy of scalp acupuncture, music therapy combined with rehabilitation, the simple rehabilitation therapy and the combination of music therapy and rehabilitation. A total of 76 patients of post-stroke spasmodic hemiplegia were randomized into a rehabilitation group (25 cases), a combination group with music therapy and rehabilitation (25 cases) and an alliance therapy group with scalp acupuncture, music therapy and rehabilitation (26 cases). In the rehabilitation group, the routine rehabilitation therapy was applied, including the removal of various incentives that cause spasm, the correction of body position and the physical therapy. In the combination group, the music therapy was added on the basis of the treatment as the rehabilitation group. The music physician used the rhythmic auditory stimulation, the patterned sensory enhancement and the therapeutic instrumental music playing to set up the task in the treatment. In the alliance therapy group, scalp acupuncture was added on the basis of the treatment as the combination group. The anterior oblique line of vertex-tempora (MS 6) and the posterior oblique line of vertex-tempora (MS 7) on the contralateral side were selected and stimulated with penetrating needling technique. The needles were retained. During the needling retaining, the needles were rotated once every 10 min, for 2 min each time. The treatment was given one session a day, totally for 5 sessions a week, continuously for 4 weeks. The Fugl-Meyer assessment (FMA), Barthel index (BI) and the modified Ashworth scale (MAS) of the affected elbow and the passive knee movement at static condition were observed in the patients before and after treatment. The results of FMA, BI and MAS were not different before treatment in the patients among the three groups (all P >0.05), indicating the comparability among groups. After treatment, FMA

  7. Radiological Projection for Diagnosis of Shoulder Subluxation in Patients with Post-Stroke Hemiplegia

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    Cho, Kwang Ho; Kang, Yeong Han

    2009-01-01

    The purpose of this study was to find out useful radiological projection of shoulder subluxation in patients with post-stroke hemiplegia. A total of 33 patients with post-stroke hemiplegia were included(20 men and 13 women, mean age 62.3 years) and having the subluxed shoulder over one finger breath. The shoulder subluxation was determined as the ratio of the radiographic vertical and horizontal distance. The vertical distance was determined by measuring the distance between the most inferolateral point of the acromion and the central point of the humeral head. The horizontal distance was determined by measuring the distance between the central point of the glenoid fossa and the central point of the humeral head. To measure of the shoulder subluxation, the shoulder AP, axial and transthoracic lateral projections were taken on both affected and unaffected shoulders. We analyzed the difference of subluxation distance by t-test. When patients was in sitting position, the average time of being shoulder subluxation was 123 second. There was significant difference between supine(49.90±13.6 mm) and sitting position(60.72±16.3 mm) in the vertical distance of shoulder anterior-posterior projection. Also, there was significant difference on transthoracic lateral projections, Affected 35.92±6.2 mm, Unaffected 28.76±5.4 mm. But in case of shoulder axial projection(supine position), there was no significant difference (Unaffected and affected was 23.01±9.0 mm, 22.45±8.2 mm each). Radiological projection of shoulder subluxation has diagnostic value when it goes after check out the process of subluxation through finger breadth test. For this, patients must be in sitting and shoulder neutral position about 2 minutes. In addition, Shoulder anterior-posterior and transthoracic projection were significant to diagnose subluxation. But in axial projection, there wasn't meaningful differences.

  8. Radiological Projection for Diagnosis of Shoulder Subluxation in Patients with Post-Stroke Hemiplegia

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    Cho, Kwang Ho [Dept. of Radiological Science, Catholic University of Daegu, Daegu (Korea, Republic of); Kang, Yeong Han [Dept. of Radiology, Daegu Catholic University Hospital, Daegu (Korea, Republic of)

    2009-09-15

    The purpose of this study was to find out useful radiological projection of shoulder subluxation in patients with post-stroke hemiplegia. A total of 33 patients with post-stroke hemiplegia were included(20 men and 13 women, mean age 62.3 years) and having the subluxed shoulder over one finger breath. The shoulder subluxation was determined as the ratio of the radiographic vertical and horizontal distance. The vertical distance was determined by measuring the distance between the most inferolateral point of the acromion and the central point of the humeral head. The horizontal distance was determined by measuring the distance between the central point of the glenoid fossa and the central point of the humeral head. To measure of the shoulder subluxation, the shoulder AP, axial and transthoracic lateral projections were taken on both affected and unaffected shoulders. We analyzed the difference of subluxation distance by t-test. When patients was in sitting position, the average time of being shoulder subluxation was 123 second. There was significant difference between supine(49.90{+-}13.6 mm) and sitting position(60.72{+-}16.3 mm) in the vertical distance of shoulder anterior-posterior projection. Also, there was significant difference on transthoracic lateral projections, Affected 35.92{+-}6.2 mm, Unaffected 28.76{+-}5.4 mm. But in case of shoulder axial projection(supine position), there was no significant difference (Unaffected and affected was 23.01{+-}9.0 mm, 22.45{+-}8.2 mm each). Radiological projection of shoulder subluxation has diagnostic value when it goes after check out the process of subluxation through finger breadth test. For this, patients must be in sitting and shoulder neutral position about 2 minutes. In addition, Shoulder anterior-posterior and transthoracic projection were significant to diagnose subluxation. But in axial projection, there wasn't meaningful differences.

  9. Effect of motor relearning programme on motor function recovery of acute stroke patients with hemiplegia

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    Min GUAN

    2017-03-01

    Full Text Available Objective To explore the effect of motor relearning programme (MRP on motor function recovery of patients with hemiplegia after acute stroke.  Methods A total of 64 hemiplegic patients with acute stroke (duration ≤ 14 d were randomly divided into 2 groups: control group (N = 32 and observation group (N = 32. Control group received routine drug therapy and conventional rehabilitation training, and observation group was treated by routine therapy and MRP training. Fugl-Meyer Assessment Scale - Balance (FMA - Balance, Modified Rivermead Mobility Index (MRMI and modified Barthel Index (mBI were used to assess the motor function of patients in both groups before and after treatment.  Results All patients successfully completed the rehabilitation training without severe adverse events. A few patients felt fatigue occasionally after training and recovered after rest. Compared to before treatment, the FMA-Balance score (P = 0.000, MRMI score (P = 0.000 and mBI score (P = 0.000 after treatment in both groups were significantly increased. Compared to control group, the FMA-Balance score (P = 0.031, MRMI score (P = 0.013 and mBI score (P = 0.049 after treatment in observation group were significantly increased.  Conclusions MRP training in the early stage of stroke is beneficial to the recovery of motor function of patients. DOI: 10.3969/j.issn.1672-6731.2017.03.007

  10. Relationship between functional connectivity and motor function assessment in stroke patients with hemiplegia: a resting-state functional MRI study

    International Nuclear Information System (INIS)

    Zhang, Ye; Wang, Li; Zhang, Jingna; Sang, Linqiong; Li, Pengyue; Qiu, Mingguo; Liu, Hongliang; Yan, Rubing; Yang, Jun; Wang, Jian

    2016-01-01

    Resting-state functional magnetic resonance imaging (fMRI) has been used to examine the brain mechanisms of stroke patients with hemiplegia, but the relationship between functional connectivity (FC) and treatment-induced motor function recovery has not yet been fully investigated. This study aimed to identify the brain FC changes in stroke patients and study the relationship between FC and motor function assessment using the resting-state fMRI. Seventeen stroke patients with hemiplegia and fifteen healthy control subjects (HCSs) were recruited in this study. We compared the FC between the ipsilesional primary motor cortex (M1) and the whole brain of the patients with the FC of the HCSs and studied the FC changes in the patients before and after conventional rehabilitation and motor imagery therapy. Additionally, correlations between the FC change and motor function of the patients were studied. Compared to the HCSs, the FC in the patient group was significantly increased between the ipsilesional M1 and the ipsilesional inferior parietal cortex, frontal gyrus, supplementary motor area (SMA), and contralesional angular and decreased between the ipsilesional M1 and bilateral M1. After the treatment, the FC between the ipsilesional M1 and contralesional M1 increased while the FC between the ipsilesional M1 and ipsilesional SMA and paracentral lobule decreased. A statistically significant correlation was found between the FC change in the bilateral M1 and the Fugl-Meyer assessment (FMA) score change. Our results revealed an abnormal motor network after stroke and suggested that the FC could serve as a biomarker of motor function recovery in stroke patients with hemiplegia. (orig.)

  11. Muscle activity adapts to anti-gravity posture during pedalling in persons with post-stroke hemiplegia.

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    Brown, D A; Kautz, S A; Dairaghi, C A

    1997-05-01

    With hemiplegia following stroke, a person's movement response to anti-gravity posture often appears rigid and inflexible, exacerbating the motor dysfunction. A major determinant of pathological movement in anti-gravity postures is the failure to adapt muscle-activity patterns automatically to changes in posture. The aim of the present study was to determine whether the impaired motor performance observed when persons with hemiplegia pedal in a horizontal position is exacerbated at more vertical anti-gravity body orientations. Twelve healthy elderly subjects and 17 subjects with chronic (> 6 months) post-stroke hemiplegia participated in the study. Subjects pedalled a modified ergometer at different body orientations (from horizontal to vertical), maintaining the same workload, cadence, and hip and knee kinematics. Pedal reaction forces, and crank and pedal kinematics, were measured and then used to calculate the work done by each leg and their net positive and negative components. The EMG was recorded from four leg muscles (tibialis anterior, medial gastrocnemius, rectus femoris and biceps femoris). The main result from this study was that impaired plegic leg performance, as measured by net negative work done by the plegic leg and abnormal early rectus femoris activity, was exacerbated at the most vertical body orientations. However, contrary to the belief that muscle activity cannot adapt to anti-gravity postures, net positive work increased appropriately and EMG activity in all muscles showed modulated levels of activity similar to those in elderly control subjects. These results support the hypothesis that increased verticality exacerbates the already impaired movement performance. Yet, much of the motor response to verticality was flexible and appropriate, given the mechanics of the task.

  12. [Clinical study of post-stroke upper limb spasmodic hemiplegia treated with jingou diaoyu needling technique and Bobath therapy].

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    Sun, Runjie; Tian, Liang; Fang, Xiaoli; Du, Xiaozheng; Zhu, Bowen; Song, Zhongyang; Xu, Xuan; Qin, Xiaoguang

    2017-04-12

    To compare the difference in the clinical efficacy on post-stroke upper limb spasmodic hemiplegia between the combined therapy of jingou diaoyu needling technique and Bobath technology and simple Bobath technology. Sixty patients were randomized into an observation group and a control group, 30 cases in each one. The usual medication of neurological internal medicine was used in the two groups. In the control group, Bobath facilitation technology was applied to the rehabilitation training. In the observation group, on the basis of the treatment as the control group, jingou diaoyu needling technique was used to stimulate Zhongfu (LU 1), Tianfu (LU 3), Chize (LU 5), Quchi (LI 11), Jianshi (PC 5) and Daling (PC 7). The treatment was given once a day; 5 treatments made one session and totally 4-week treatment was required in the two groups. The modified Ashworth scale, the modified Fugle-Meyer assessment (FMA) and the Barthel index (BI) were adopted to evaluate the muscular tension, the upper limb motor function and the activities of daily living (ADL) before and after treatment in the two groups. The clinical efficacy was compared between the two groups. Compared with those before treatment, the modified Ashworth scale, Fugl-Meyer score and BI score were all improved after treatment in the two groups (all P Bobath therapy achieve the superior efficacy on post-stroke upper limb spasmodic hemiplegia as compared with the simple application Bobath therapy. This combined treatment effectively relieve spasmodic state and improve the upper limb motor function and the activities of daily living.

  13. Sliding and pressure evaluation on conventional and V-shaped seats of reclining wheelchairs for stroke patients with flaccid hemiplegia: a crossover trial

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    Chen Chi-Myn

    2011-07-01

    Full Text Available Abstract Background Reclining wheelchairs are commonly used to transport elderly stroke patients in Taiwan. However, there is concern that the patient's body in the wheelchair often slides forward when they return to a seated position, increasing the sitting pressure. Therefore, a novel reclining wheelchair with an ergonomic "V-Seat" was designed to prevent forward sliding and pressure sores. The use of these reclining chairs by stroke patients has not yet been studied. Thus, we investigated the effects of V-shaped and conventional seats in reclining wheelchairs on the extent of forward sliding and on the sitting pressure of stroke patients with flaccid hemiplegia and of able-bodied elders. Methods We recruited 13 able-bodied elders and 11 stroke patients with flaccid hemiplegia and performed 5 reclining cycles in both types of wheelchair. The amount of sliding along the backrest (BS plane and the seat (SS plane, the mean sitting pressure (MP, and the sacral peak pressure (SPP of the subjects were recorded. We used the Wilcoxon signed-rank test to compare the BS, SS, MP, and SPP in wheelchairs with conventional and V-shaped seats, and we used the Wilcoxon rank sum test to compare the differences in BS and SS between stroke patients and able-bodied elders in both types of reclining wheelchair. Results The BS, SS, and SPP of stroke patients were significantly lower in the wheelchairs with V-shaped seats than in conventional wheelchairs in most comparisons; however, the BS of able-bodied elders was higher in V-shaped seats than in conventional seats. The SS and SPP of stroke patients were significantly higher than those of able-bodied elders in both types of reclining wheelchair, and the BS of stroke patients was significantly higher than that of able-bodied elders only in conventional reclining wheelchairs. Conclusions The use of V-shaped seats in reclining wheelchairs can help reduce the forward sliding and sacral peak pressure of stroke patients

  14. Effect of ankle-foot orthoses on the sagittal plane displacement of the center of mass in patients with stroke hemiplegia: a pilot study.

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    Kobayashi, Toshiki; Leung, Aaron K L; Akazawa, Yasushi; Hutchins, Stephen W

    2012-01-01

    Ankle-foot orthoses (AFOs) have been reported to have positive effects on the temporal-spatial parameters and kinematics and kinetics of gait in patients with stroke. The center of mass (COM) may be used to represent whole body movement and energy cost in gait, and therefore COM movement would also be positively influenced with use of an appropriate AFO. To investigate the effect of AFOs on the sagittal plane displacement of the COM in patients with stroke hemiplegia. Five male subjects with stroke hemiplegia participated in this pilot study. The trajectory of the COM in the sagittal plane, gait speed, bilateral step length, step width, and bilateral stance time were analyzed while participants ambulated under 2 test conditions: with an AFO or with footwear only. The height of the 2 peaks of the vertical displacement of the COM in a gait cycle was subsequently measured and normalized to body height. Statistical analyses were conducted using a nonparametric Friedman test. Gait speed, bilateral step length, and the normalized peak height of the vertical COM trajectory during stance phase on the affected leg all revealed statistically significant increases (P < .05), and step width showed significant decreases (P < .05) under the AFO condition when compared to the footwear-only condition. An AFO may influence the vertical displacement of the COM in patients with stroke hemiplegia. The results of this pilot study therefore suggested that vertical movement of COM could potentially serve as a useful parameter to evaluate the effect of an AFO.

  15. Immediate effects of scalp acupuncture with twirling reinforcing manipulation on hemiplegia following acute ischemic stroke: a hidden association study

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    Xiao-zheng Du

    2016-01-01

    Full Text Available Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui (GV20 and Taiyang (EX-HN5. We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave (H max /M max , muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of "Deficiency and Excess". The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and H max /M max immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate H max /M max change. Additionally, when the difference value of muscle tension for the upper and lower limbs was > 0 or < 0, the difference value of H max /M max was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients

  16. Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke.

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    Lennon, S

    2001-03-01

    This case report describes the use of gait re-education based on the Bobath concept to measure the changes that occurred in the gait of 2 patients with hemiplegia who were undergoing outpatient physical therapy. One patient ("NM"), a 65-year-old woman, was referred for physical therapy 6 weeks following a right cerebrovascular accident. She attended 30 therapy sessions over a 15-week period. The other patient ("SA"), a 71-year-old woman, was referred for physical therapy 7 weeks following a left cerebrovascular accident. She attended 28 therapy sessions over a 19-week period. Clinical indexes of impairment and disability and 3-dimensional gait data were obtained at the start of treatment and at discharge. Therapy was based on the Bobath concept. At discharge, NM demonstrated improvements in her hip and knee movements, reduced tone, and improved mobility. At discharge, SA demonstrated improved mobility. During gait, both patients demonstrated more normal movement patterns at the level of the pelvis, the knee, and the ankle in the sagittal plane. SA also demonstrated an improvement in hip extension. These cases demonstrate that recovery of more normal movement patterns and functional ability can be achieved following a cardiovascular accident and provide insight into the clinical decision making of experienced practitioners using Bobath's concept.

  17. [Clinical research on post-stroke hemiplegia treated with the optimized rehabilitation program of integrated Chinese and western medicine].

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    Zhang, Xiao-Li; Qi, Rui; Yan, Jun-Tao

    2013-12-01

    To explore the optimized rehabilitation program in the treatment of post-stroke hemiplegia at the recovery stage. Based on the randomized controlled principle, 60 patients were randomized into an rehabilita tion + massage group (group A) and an rehabilitation + acupuncture group (group B), 30 cases in each one. Bobath sport therapy and functional training were adopted in the two groups. In the group A, the massage therapy was added. The rolling method and palm-rubbing method were used on the affected side, the pressing, kneading and plucking methods were applied to Jianliao (LI 15), Jianzhen (SI 9), Quchi (LI 11), Huantiao (GB 30), Weizhong (BL 40), Chengshan (BL 57), Zusanli (ST 36) and the other acu points; and the nipping method was adopted at the twelve Jing-well points. In the group B, acupuncture was applied to Baihui (BL 20), Jianliao (LI 15), Quchi (LI 11), Shousanli (LI 10), Huantiao (GB 30), Yanglingquan (GB 34), Jiexi (ST 41) and the other acupoints. The treatment was given once a day, 5 treatments a week in the two groups. The efficacy was evaluated in 3 weeks. Fugl-Meyer scale, Barthel index (BI) score, modified Rankin scale and stroke-specific quality of life (SS-QOL) were used to assess the limb motor function, the activity of daily life (ADL), independent activity of life and the quality of life of the patients in the two groups before and after treatment. Based on the total cost and benefit, the health economics evaluation was conducted in the patients of the two groups. The treatments all improved the limb motor function (group A: 26.00 (22) vs 37.00 (33); group B: 30.50 (21) vs 39.50 (36)), the independent activity of life, ADL (group A: 43.50 +/- 22.25 vs 57.50 +/- 22.25; group B: 52.83 +/- 16.59 vs 66.67 +/- 12.82) and the quality of life (group A: 122.23 +/- 30.00 vs 145.50 +/- 28.14; group B: 132.43 +/- 23.87 vs 151.47 +/- 22.37) in the patients of the two groups. The differences in all the indices were significant statistically before and

  18. Internal fixation versus conservative treatment for elderly patients with a trochanteric hip fracture in conjunction with post-stroke hemiplegia.

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    Li, Kainan; Zheng, Yingjie

    2016-10-01

    To retrospectively evaluated Gamma nail internal fixation in the treatment of elderly patients with post-stroke hemiplegia experiencing trochanteric hip fracture. The patients were obtained consecutively from January 2005 to December 2010 with inclusion criteria. The total number was 138 and allocated to two groups: treated with the Gamma nail (n=72,group A) and continuous skin traction (n=66,group B). Preoperative variables including patient age, gender, duration of cerebrovascular accident, duration of hypertension, ASA risk score, Harris hip score and fracture type were recorded and compared. After treatment, time of patients activity on the bed, ambulation time, Harris hip score, mortality, complications were recorded and used to compare the outcomes. (1) Follow-up was undertaken from 3 to 10 years, with an average of 5.8 years. (2) No statistical difference in preoperative variables was found between the 2 groups. (3) two groups had statistical significance (P=0.000) in the time of patients activity on the bed and ambulation time and group A can activities on the bed and ambulates earlier. (4) There were significant differences between 2 groups in Harris hip score at 1 and 3 years and group A was significantly higher than group B. (5) there were statistically significant differences in mortality of 3 years, 5 years and 10 years and the group B was significantly higher than the group A. (6) There was a statistical significance in complications between 2 groups and group B was higher than group A. Major complications in group A were pain, lag screw cut out, implant infection and distal femoral fractures caused by fall after the surgery. On elderly patients with trochanteric hip fracture on the hemiplegic lower side, Gamma nail internal fixation treatment can achieve better effect, patients can be early activity, fewer complications, and less mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

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    Ahmet Inanir

    2013-06-01

    Full Text Available Objective: The aim of the present study was to determine the effectiviness of conventional rehabilitation in patients with stroke on static and dynamic balance as well as clinical assessment Methods: Twelve patients with stroke, 7 (58.33% of them being male and 5 (41.66% female, ranging from 51 to 75 in age who were treated in Physical Medicine and Rehabilitation clinic were involved in this study. The patients were treated with conventional rehabilitation. All individuals were evaluated using balance tests before (Group 1 and after (Group 2 the treatment. Balance level and postural control has been assessed through Berg Balance Scale (BBS, Trunk Control Test (TCT and Biodex Stability System (BSS, motor level through BMIE, ambulation state through Functional Ambulatory Scale (FAS and functional state in daily activities through Functional Independence Measure (FIM. The same tests were repeated while the patients were being discharged. Results: The mean age of the study population was 65,83±4,38 years, the average Body Mas Index (BMI was 30,55±6,94. In the evaluations according to FIM, FAS, TCT and BBS differences between the mean of patients before and after the rehabilitation were significantly higher for the post-treatment (p=0.001, p=0.001, p=0.001 and p=0.001, respectively. In the evaluations according to Overall Stability Index (OSI, Antero-Posterior Stability Index (APSI and Medio-Lateral Stability Index (MLSI differences between the mean of patients before and after the rehabilitation were significantly higher for the pre-treatment (p=0.001, p=0.001 and p=0.001, respectively. Conclusion: It can be stated that this approach is effective and useful in restoring static and dynamic balance as well as in obtaining an effective improvement in the treatment of patients with stroke through conventional treatment. [Cukurova Med J 2013; 38(3.000: 446-455

  20. Synergistic effect of moxibustion and rehabilitation training in functional recovery of post-stroke spastic hemiplegia.

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    Wei, Yan-Xia; Zhao, Xia; Zhang, Bao-Chao

    2016-06-01

    To evaluate the therapeutic benefit of combining moxibustion and rehabilitation training for functional recovery in post-stroke spastic hemiplegic patients. We randomly divided 84 cases subjecting to inclusion criteria into moxibustion plus rehabilitation training group (MRT group, n=44) and rehabilitation training group (RT group, n=40). Evaluation of therapeutic effect was observed before treatment, 2 weeks during treatment and 6 months after treatment. Spasticity was evaluated using modified Ashworth scale (MAS) and Clinical Spasticity Index (CSI), recovery of motor function was assessed by Brunnstrom recovery stages and Simplified Fugl-Meyer Motor Scale, and performance of activities of daily living (ADL) was measured, and the quality of life was assessed by Patient Reported Outcomes (PRO). Evaluation of upper limbs, hands and lower limbs based on CSI and MAS revealed significant improvements in patients treated with MRT, compared to RT alone, both during and after therapy. CSI and MAS also showed significant improvement in patients at each time point in the MRT group, compared to RT group. Marked improvement in Fugl-Meyer Motor Scale was also observed in MRT group at each time point. Based on Brunnstrom grades of upper limbs, hands and lower limbs, significant differences between the two groups were recorded at all time points during and after therapy. Barthel index (BI) and PRO also confirmed the dramatic differences between the two therapy groups. Our results demonstrate that combination therapy with moxibustion and rehabilitation training offers greater clinical benefits in relieving spasticity, promoting function recovery of motion, improving the performance of ADL, and increasing quality of life in post-stroke spastic hemiplegic patients, compared to RT alone. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  2. Reflex sympathetic dystrophy in hemiplegia.

    Science.gov (United States)

    Gokkaya, Nilufer Kutay Ordu; Aras, Meltem; Yesiltepe, Elcin; Koseoglu, Fusun

    2006-12-01

    There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (Preflex sympathetic dystrophy. Glenohumeral subluxation was present in 37 patients (38.9%) in our study group and the presence of this complication was related to the occurrence of reflex sympathetic dystrophy. The presence of glenohumeral subluxation was significantly higher in patients with reflex sympathetic dystrophy (21/29, 72.4%) when compared to the patients without reflex sympathetic dystrophy (16/66, 24.2%) (Preflex sympathetic dystrophy. These results suggest that lower recovery stages, reduced tonus and glenohumeral subluxation significantly contribute to the occurrence of reflex sympathetic dystrophy in the hemiplegic patient. We believe that preventive and treatment measures should consider these factors as they seem to have in common a higher risk of traumatizing the paralyzed upper limb and causing reflex sympathetic dystrophy.

  3. Muscle Strength and Poststroke Hemiplegia

    DEFF Research Database (Denmark)

    Kristensen, Otto H; Stenager, Egon; Dalgas, Ulrik

    2017-01-01

    OBJECTIVES: To systematically review (1) psychometric properties of criterion isokinetic dynamometry testing of muscle strength in persons with poststroke hemiplegia (PPSH); and (2) literature that compares muscle strength in patients poststroke with that in healthy controls assessed by criterion...... test in persons with stroke, generally showing marked reductions in muscle strength of paretic and, to a lesser degree, nonparetic muscles when compared with healthy controls, independent of muscle group, contraction mode, and contraction velocity....

  4. Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial.

    Science.gov (United States)

    Kim, Chang-Yong; Lee, Jung-Sun; Kim, Hyeong-Dong; Kim, In-Seob

    2015-08-01

    No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia. Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15  minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1  second (FEV1). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity. Our results showed that changes between the pre- and post-test values of FVC (F = 12.50, P = 0.02) and FEV1 (F = 12.81, P = 0.01) (P activation of the diaphragm (F = 13.75, P = 0.003) and external intercostal (F = 14.33, P = 0.002) (P muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P < 0.05) greater than those in patients of the RMTG and the CG at post-test. Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.

  5. Axillary nerve conduction changes in hemiplegia

    Directory of Open Access Journals (Sweden)

    Ring Haim

    2008-12-01

    Full Text Available Abstract Aim To prove the possibility of axillary nerve conduction changes following shoulder subluxation due to hemiplegia, in order to investigate the usefulness of screening nerve conduction studies in patients with hemiplegia for finding peripheral neuropathy. Methods Forty-four shoulders of twenty-two patients with a first-time stroke having flaccid hemiplegia were tested, 43 ± 12 days after stroke onset. Wasting and weakness of the deltoid were present in the involved side. Motor nerve conduction latency and compound muscle action potential (CMAP amplitude were measured along the axillary nerve, comparing the paralyzed to the sound shoulder. The stimulation was done at the Erb's point whilst the recording needle electrode was inserted into the deltoid muscle 4 cm directly beneath the lateral border of the acromion. Wilcoxon signed rank test was used to compare the motor conduction between the sound and the paralytic shoulder. Mann-Whitney test was used to compare between plegic and sound shoulder in each side. Results Mean motor nerve conduction latency time to the deltoid muscle was 8.49, SD 4.36 ms in the paralyzed shoulder and 5.17, SD 1.35 ms in the sound shoulder (p Mean compound muscle action potential (CMAP amplitude was 2.83, SD 2.50 mV in the paralyzed shoulder and was 7.44, SD 5.47 mV in the sound shoulder (p p p = 0.003, 1-sided for amplitude, and patients with left paralyzed shoulder compared to patients with left sound shoulder (p = 0.011, 1-sided for latency, p = 0.001, 1-sided for amplitude, support the same outcomes. The electro-physiological changes in the axillary nerve may appear during the first six weeks after stroke breakout. Conclusion Continuous traction of the axillary nerve, as in hypotonic shoulder, may affect the electro-physiological properties of the nerve. It most probably results from subluxation of the head of the humerus, causing demyelinization and even axonopathy. Slowing of the conduction velocities of

  6. Weight transfer analysis in adults with hemiplegia using ankle foot orthosis.

    Science.gov (United States)

    Nolan, Karen J; Yarossi, Mathew

    2011-03-01

    Identifying and understanding the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia. The purpose of this investigation was to use a novel analysis technique to objectively measure weight transfer during double support (DS) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis. Prospective, Repeated measures, case-controlled trial. Participants included 25 adults with stroke-related hemiplegia >6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls. Main outcome measures included the weight transfer point timing (WTP, %DS), maximum total force timing (MTF, %DS), timing difference between WTP and MTF (MTF-WTP, %DS) and the linearity of loading (LOL, R(2)) during the DS phase of the gait cycle. The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals, p ≤ 0.01. The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group, p ≤ 0.0001 and p = 0.03, respectively. MTF, MTF-WTP and LOL were significantly different between individuals with stroke (during affected limb loading) and healthy controls (during right limb loading). This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait. This novel method can be used to elucidate biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation. This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic

  7. Children's Hemiplegia and Stroke Association

    Science.gov (United States)

    ... education. This is our 15th year of awarding college and vocational scholarships! The total award for 2016 is $16,800. A very talented ... You're not alone You’re not alone. CHASA parents tell us ...

  8. Axillary nerve conduction changes in hemiplegia.

    Science.gov (United States)

    Tsur, Atzmon; Ring, Haim

    2008-12-17

    To prove the possibility of axillary nerve conduction changes following shoulder subluxation due to hemiplegia, in order to investigate the usefulness of screening nerve conduction studies in patients with hemiplegia for finding peripheral neuropathy. Forty-four shoulders of twenty-two patients with a first-time stroke having flaccid hemiplegia were tested, 43 +/- 12 days after stroke onset. Wasting and weakness of the deltoid were present in the involved side. Motor nerve conduction latency and compound muscle action potential (CMAP) amplitude were measured along the axillary nerve, comparing the paralyzed to the sound shoulder. The stimulation was done at the Erb's point whilst the recording needle electrode was inserted into the deltoid muscle 4 cm directly beneath the lateral border of the acromion. Wilcoxon signed rank test was used to compare the motor conduction between the sound and the paralytic shoulder. Mann-Whitney test was used to compare between plegic and sound shoulder in each side. Mean motor nerve conduction latency time to the deltoid muscle was 8.49, SD 4.36 ms in the paralyzed shoulder and 5.17, SD 1.35 ms in the sound shoulder (p atrophy in the same limb. The usefulness of routine screening nerve conduction studies in the shoulder of hemiplegic patients seems to be advocated.

  9. '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 ...

  10. Acute hemiplegia in childhood

    International Nuclear Information System (INIS)

    Okuno, Takehiko; Takao, Tatsuo; Itoh, Masatoshi; Konishi, Yukuo; Nakano, Shozo

    1983-01-01

    The results of CT in 100 patients with acute hemiplegia in childhood are reported here. The etiology was various: 2 patients had infratentorial brain tumors, 56 had cerebral vascular diseases, 3 had head injuries, 16 had intracranial infectious diseases, one had postinfectious encephalomyelitis, one had multiple sclerosis, 2 had epilepsy, and the diagnosis of 19 were unknown. Eleven patients had a normal CT and a good prognosis. As for the type of onset, there were patients of type 1 with fever and 42 with convulsions and unconsciousness; those of type 2 with convulsions and unconsciousness were 12, and those of type 3 without fever and convulsions were 46. This classification is assumed to be useful, as the type of onset is characteristic of the etiology. Six patients were diagnosed correctly by repeated examinations, although the first CT did not reveal any remarkable findings. Capsular infarction, occlusion of the posterior cerebral artery in acute hemiplegia in childhood, abnormal findings of the internal capsule, thalamus, and midbrain in a patient with postinfectious encephalomyelitis, and a diffuse low density in the CT of the unilateral hemisphere in the patients with acute encephalopathy and acute hemiplegia of an obscure origin have been found after the introduction of computerized tomography. (author)

  11. [Evaluation on efficacy of Jin's "Sanzhen" therapy combined with rehabilitation training for hemiplegia of stroke patients by Fugl-Meyer scale].

    Science.gov (United States)

    Han, De-Xiong; Zhuang, Li-Xing; Zhang, Ying

    2011-06-01

    To assess the therapeutic effect of Jin's "Sanzhen" therapy combined with rehabilitation training on limb-motor function of stroke patients by using Fugl-Meyer scale. A total of 254 hemiplegic stroke outpatients and inpatients from 7 hospitals were randomly divided into Jin's "Sanzhen" (JSZ) group (n = 83), rehabilitation group (n = 84) and combination group (n = 87). Acupuncture was applied to acupoints of Jin's "Sanzhen" including Quchi (LI 11), Waiguan (SJ 5) and Hegu (LI 4); Futu (ST 32). Zusanli (ST 36) and Sanyinjiao (SP 6); etc. The acupuncture needles were retained for 30 min after "Deqi". Rehabilitation training included passive joint movement, standing-sitting training, tapping-pressing stimulation, walking training, etc. The treatment was conducted once daily, 5 sessions a week and for 4 weeks. Fugl-Meyer scale composed of 100-point motor domain of the upper- and lower-extremity sections was used to assess the patients' motor function. On day 28 after the treatment, of the 83.84 and 87 hemiplegic stroke patients in the JSZ, rehabilitation and combination groups, 48 (57.8%), 31 (36.9%) and 50 (57.5%) experienced marked improvement in their clinical symptoms and signs, 26 (31.3%), 44 (52.4%) and 31(35.6%) had an improvement, and 9 (10.8%), 9 (10.7%) and 6 (6.9%) failed in the treatment, with the total effective rates being 89.2%, 89.3% and 93.1%, respectively. The neurological deficit score (NDS) of the combination group was significantly lower than that of the rehabilitation group (P Fugl-Meyer assessment score (FMAS) for extremity motor function of the combination group was apparently higher than those of the JSZ and rehabilitation groups (P 0.05). Jin's "Sanzhen" therapy combined with rehabilitation training can significantly improve the limb motor function of hemiplegic stroke patients, and has a good synergistic effect.

  12. Stroke Rehabilitation

    Science.gov (United States)

    ... unique for each person. Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process. Effects of a Stroke Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole ...

  13. Hemisferectomia na hemiplegia infantil

    Directory of Open Access Journals (Sweden)

    Rolando A. Tenuto

    1956-03-01

    Full Text Available Os autores relatam o caso de um paciente com 18 anos de idade, portador de paralisia cerebral instalada aos 4 anos de idade após moléstia febril prolongada (hemiplegia esquerda, crises convulsivas generalizadas, freqüentes e rebeldes à medicação, deficiência mental e alterações de conduta. O eletrencefalograma e o pneumencefalograma revelaram alterações graves do hemisfério direito; tendo o primeiro destes exames demonstrado a existência de perturbações propagadas ao outro hemisfério. Foi praticada a hemisferectomia direita. Durante o ato cirúrgico, por exigência técnica foram extirpados, além do hemisfério cerebral, os dois terços rostrais do núcleo caudado e o núcleo amigdalóide. No pós-operatório foi intercorrência de osteomielite e meningite, medicadas com antibióticos e seqüestrectomia. Apesar da complicação pós-operatória, instalou-se progressiva melhora em relação à conduta social; diminuiu também a espasticidade no membro inferior esquerdo e não mais se repetiram as crises convulsivas. Não foram observadas modificações quanto ao rendimento intelectual e quanto aos distúrbios sensitivos que existiam antes da intervenção cirúrgica. O exame neurocular mostrou hemianopsia homônima esquerda. Êstes resultados são concordantes com os assinalados na literatura sobre o assunto.

  14. A new clinical sign probably associated to left hemiplegia with left hemineglect syndrome: the crossed legs.

    Science.gov (United States)

    Bazan, Rodrigo; Fernandes, Thiago; Braga, Gabriel; Luvizutto, Gustavo; Resende, Luiz

    2014-06-01

    To describe a new clinical sign associated with left unilateral neglect syndrome (UNS) in patients with ischemic stroke. Head computed tomography (CT) and National Institute of Health Stroke Scale were obtained in 150 patients with ischemic stroke. Those with right cerebral vascular lesions, left hemiplegia and right leg persistently crossed over the left were submitted to specific tests for UNS. The tests were also applied to 30 patients with right cerebral vascular lesions, left hemiplegia but without crossed legs. From 9 patients with persistent tendency to cross the right leg over the left, UNS was detected in 8. One patient died before the clinical tests were applied. Of the 30 patients without the crossed legs, 20 had normal clinical tests for UNS and 10 had minimal alterations, not sufficient for the diagnosis of UNS. The right leg crossed over the left may represent a new neurological semiotic sign associated with left hemiplegia and left UNS.

  15. The influence of the level of physical activity and human development in the quality of life in survivors of stroke

    OpenAIRE

    Aidar, Felipe J; de Oliveira, Ricardo J; Silva, Ant?nio J; de Matos, Dihogo G; Carneiro, Andr? L; Garrido, Nuno; Hickner, Robert C; Reis, Victor M

    2011-01-01

    Abstract Background The association between physical activity and quality of life in stroke survivors has not been analyzed within a framework related to the human development index. This study aimed to identify differences in physical activity level and in the quality of life of stroke survivors in two cities differing in economic aspects of the human development index. Methods Two groups of subjects who had suffered a stroke at least a year prior to testing and showed hemiplegia or hemipare...

  16. Short Communication - Alternating Hemiplegia in a Child ...

    African Journals Online (AJOL)

    Background: Alternating hemiplegia of children is a rare neurological disorder that in its characteristic form has few differential diagnosis. The diagnosis of intractable seizures is difficult to avoid for physicians not aware of the disease. Objective: To describe the clinical characteristics of Alternating Hemiplegia of Childhood ...

  17. Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome

    Science.gov (United States)

    2012-01-01

    Background Pyrexia after stroke (temperature ≥37.5°C) is associated with poor prognosis, but information on timing of body temperature changes and relationship to stroke severity and subtypes varies. Methods We recruited patients with acute ischemic stroke, measured stroke severity, stroke subtype and recorded four-hourly tympanic (body) temperature readings from admission to 120 hours after stroke. We sought causes of pyrexia and measured functional outcome at 90 days. We systematically summarised all relevant previous studies. Results Amongst 44 patients (21 males, mean age 72 years SD 11) with median National Institute of Health Stroke Score (NIHSS) 7 (range 0–28), 14 had total anterior circulation strokes (TACS). On admission all patients, both TACS and non-TACS, were normothermic (median 36.3°C vs 36.5°C, p=0.382 respectively) at median 4 hours (interquartile range, IQR, 2–8) after stroke; admission temperature and NIHSS were not associated (r2=0.0, p=0.353). Peak temperature, occurring at 35.5 (IQR 19.0 to 53.8) hours after stroke, was higher in TACS (37.7°C) than non-TACS (37.1°C, ptemperatures. Sixteen (36%) patients became pyrexial, in seven (44%) of whom we found no cause other than the stroke. Conclusions Normothermia is usual within the first 4 hours of stroke. Peak temperature occurs at 1.5 to 2 days after stroke, and is related to stroke severity/subtype and more closely associated with poor outcome than admission temperature. Temperature-outcome associations after stroke are complex, but normothermia on admission should not preclude randomisation of patients into trials of therapeutic hypothermia. PMID:23075282

  18. A Critical Review of Constraint-Induced Movement Therapy and Forced Use in Children With Hemiplegia

    Directory of Open Access Journals (Sweden)

    Jeanne Charles

    2005-01-01

    Full Text Available Hemiplegia is a physical impairment that can occur in childhood following head trauma, cerebral vascular accident or transient ischemic attack (stroke, brain tumor, or congenital or perinatal injury. One of the most disabling symptoms of hemiplegia is unilaterally impaired hand and arm function. Sensory and motor impairments in children with hemiplegia compromise movement efficiency. Such children often tend not to use the affected extremity, which may further exacerbate the impairments, resulting in a developmentally learned non-use of the involved upper extremity, termed ‘developmental disuse’. Recent studies suggest that children with hemiplegia benefit from intensive practice. Forced use and Constraint-lnduced Movement Therapy (CI therapy are recent therapeutic interventions involving the restraint of the non-involved upper extremity and intensive practice with the involved upper extremity. These approaches were designed for adults with hemiplegia, and increasing evidence suggests that they are efficacious in this population. Recently, forced use and constraint-induced therapy have been applied to children with hemiplegia. In this review, we provide a brief description of forced use and CI therapy and their historical basis, provide a summary of studies of these interventions in children, and discuss a number of important theoretical considerations, as well as implications for postural control. We will show that whereas the studies to date suggest that both forced use and CI therapy appear to be promising for improving hand function in children with hemiplegia, the data are limited. Substantially more work must be performed before this approach can be advocated for general clinical use.

  19. The Migraine-Ischemic Stroke Relation in Young Adults

    OpenAIRE

    Pezzini, Alessandro; Del Zotto, Elisabetta; Giossi, Alessia; Volonghi, Irene; Costa, Paolo; Dalla Volta, Giorgio; Padovani, Alessandro

    2010-01-01

    In spite of the strong epidemiologic evidence linking migraine and ischemic stroke in young adults, the mechanisms explaining this association remain poorly understood. The observation that stroke occurs more frequently during the interictal phase of migraine prompts to speculation that an indirect relation between the two diseases might exist. In this regard, four major issues might be considered which may be summarized as follows: (1) the migraine-ischemic stroke relation is influenced by s...

  20. Perceived confidence relates to driving habits post-stroke.

    Science.gov (United States)

    McNamara, Annabel; Walker, Ruth; Ratcliffe, Julie; George, Stacey

    2015-01-01

    Returning to driving post-stroke is a step towards independence. On return to driving following stroke, confidence is related to performance in on-road assessment and self-regulation of driving behaviours occurs. The aim of this study was to examine the relationship between driver's confidence and driving habits post-stroke. Structured telephone surveys were completed with 40 stroke survivors (62% men), of mean age 65 years SD 12.17 who returned to driving post-stroke within the previous 3 years. The survey included: (1) socio-demographics, (2) Adelaide Driving Self Efficacy Scale (ADSES) and (3) Driving Habits Questionnaire (DHQ). Male stroke survivors were more likely to return to driving, drive further and more often. Stroke survivors under 65 years were likely to drive further. Driving confidence was significantly associated with kilometres driven (p = 0.006), distance driven (p = 0.027) and self-limiting driving (p = 0.00). Findings indicate a relationship between confidence and driving behaviours post-stroke. Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life. Implications for Rehabilitation Findings indicate a relationship between confidence and driving behaviours post-stroke. Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life.

  1. Novo sinal clínico provavelmente associado a hemiplegia esquerda com heminegligência espacial esquerda: as pernas cruzadas

    OpenAIRE

    Bazan, Rodrigo; Fernandes, Thiago; Braga, Gabriel; Luvizutto, Gustavo; Resende, Luiz

    2014-01-01

    Objective : To describe a new clinical sign associated with left unilateral neglect syndrome (UNS) in patients with ischemic stroke. Method : Head computed tomography (CT) and National Institute of Health Stroke Scale were obtained in 150 patients with ischemic stroke. Those with right cerebral vascular lesions, left hemiplegia and right leg persistently crossed over the left were submitted to specific tests for UNS. The tests were also applied to 30 patients with right cerebral vascular le...

  2. 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.

  3. Clinicoanatomical correlation in stroke related aphasia

    Directory of Open Access Journals (Sweden)

    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.

  4. The Migraine-Ischemic Stroke Relation in Young Adults

    Directory of Open Access Journals (Sweden)

    Alessandro Pezzini

    2011-01-01

    Full Text Available In spite of the strong epidemiologic evidence linking migraine and ischemic stroke in young adults, the mechanisms explaining this association remain poorly understood. The observation that stroke occurs more frequently during the interictal phase of migraine prompts to speculation that an indirect relation between the two diseases might exist. In this regard, four major issues might be considered which may be summarized as follows: (1 the migraine-ischemic stroke relation is influenced by specific risk factors such as patent foramen ovale or endothelial dysfunction and more frequent in particular conditions like spontaneous cervical artery dissection; (2 migraine is associated with an increased prevalence of cardiovascular risk factors; (3 the link is caused by migraine-specific drugs; (4 migraine and ischemic vascular events are linked via a genetic component. In the present paper, we will review epidemiological studies, discuss potential mechanisms of migraine-induced stroke and comorbid ischemic stroke, and pose new research questions.

  5. Stroke-related stigma among West Africans: Patterns and predictors.

    Science.gov (United States)

    Sarfo, Fred Stephen; Nichols, Michelle; Qanungo, Suparna; Teklehaimanot, Abeba; Singh, Arti; Mensah, Nathaniel; Saulson, Raelle; Gebregziabher, Mulugeta; Ezinne, Uvere; Owolabi, Mayowa; Jenkins, Carolyn; Ovbiagele, Bruce

    2017-04-15

    Disability-adjusted life-years lost after stroke in Low & Middle-Income Countries (LMICs) is almost seven times those lost in High-income countries. Although individuals living with chronic neurological and mental disorders are prone to stigma, there is a striking paucity of literature on stroke-related stigma particularly from LMICs. To assess the prevalence, severity, determinants and psycho-social consequences of stigma among LMIC stroke survivors. Between November 2015 and February 2016, we conducted a cross-sectional survey of 200 consecutive stroke survivors attending a neurology clinic in a tertiary medical center in Ghana. The validated 8-Item Stigma Scale for Chronic Illness (SSCI-8) questionnaire was administered to study participants to assess internalized and enacted domains of stigma at the personal dimension with further adaptation to capture family and community stigma experienced by stroke participants. Responses on the SSCI-8 were scored from 1 to 5 for each item, where 1=never, 2=rarely, 3=sometimes, 4=often and 5=always with a score range of 8-40. Demographic and clinical data on stroke type and severity as well as depression and Health-Related Quality of Life indicators were also collected. Predictors of stroke-related stigma were assessed using Linear Models (GLM) via Proc GENMOD in SAS 9.4. 105 (52.5%) subjects recruited were males and the mean±SD age of stroke survivors in this survey was 62.0±14.4years. Mean SSCI-8 score was highest for personal stigma (13.7±5.7), which was significantly higher than family stigma (11.9±4.6; p=0.0005) and social/community stigma (11.4±4.4; pstigma. A graded increase in scores on the Geriatric Depression Scale and Centre for Epidemiological Studies-Depression scale was observed across the three categories. Living in an urban setting was associated with higher SSCI-8 scores. Moreover, stroke subjects with more severe post-stroke residual symptom deficits reported a significantly higher frequency of stigma

  6. The Female Stroke Survival Advantage: Relation to Age

    DEFF Research Database (Denmark)

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

    2009-01-01

    Background: Age-related hormonal factors are thought to be related to the gender gap in longevity. Testing the hypothesis that survival is best in young premenopausal women we studied the effect of age on 1-week mortality in stroke patients. Methods: A registry was started in 2001 with the aim...... logistic regression. Results: The probability of death within 1 week adjusted for stroke severity, stroke type and risk factors was highly age-dependent in both men and women. Up to the age of 50 years, the 1-week female/male mortality rates paralleled being slightly (15%) but insignificantly better...... in women. While mortality increased almost linearly in women over the entire age range, it increased steeply in men from the age of 50 and at the age of 80 years survival was 80% better in women. Conclusion: The female stroke survival advantage applies to all ages. It increases with age due to a steeply...

  7. Effects of ankle plantar flexors stretching with closed kinetic chain on pelvic movements and gait speed in hemiplegia patients: a case study.

    Science.gov (United States)

    Moon, Sang-Hyun; Boo, Jung-A; Park, Si-Eun

    2016-01-01

    [Purpose] The purpose of this study was to identify the effects of ankle plantar flexors stretching with closed kinetic chain (CKC) in hemiplegia patients. [Methods] This study used a reversal design (A-B-A') for a stroke with hemiplagia. The intervention program consisted of 30 min sessions, once a day, for 15 days. The subjects were trained for 15 sessions in total. Pelvic movements (anterior ·posterior tilting, elevation, depression, forward·backward rotation) during walking and gait speed were measured in hemiplegia patients. [Results] Overall, the angle of pelvic movements was increased in Treatment and, Baseline II compared with Baseline I. The gait speed was maximally increased in Baseline II, followed by Treatment and Baseline I. [Conclusion] These results suggest that ankle plantar flexors stretching with closed kinetic chain had a positive effect on pelvic movements and gait speed in hemiplegia patients. Also, after treatment, its effect on gait of hemiplegia patients was maintained.

  8. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes.

    Science.gov (United States)

    Al-Khaled, Mohamed; Matthis, Christine; Binder, Andreas; Mudter, Jonas; Schattschneider, Joern; Pulkowski, Ulrich; Strohmaier, Tim; Niehoff, Torsten; Zybur, Roland; Eggers, Juergen; Valdueza, Jose M; Royl, Georg

    2016-01-01

    Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. © 2016 S. Karger AG, Basel.

  9. Acute Infantile Hemiplegia Associated with Ipsilateral Retinal ...

    African Journals Online (AJOL)

    An 18-month-old patient with acute infantile hemiplegia, aphasia and ipsilateral retinal vascular occlusion, is described. The opthalmic findings suggest that the lesion was due to emboli originating from both internal carotid arteries, probably as a result of upper respiratory tract infection and otitis media. This report ...

  10. Topiramate in Alternating Hemiplegia of Childhood

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-01-01

    Full Text Available A 12-year-old girl with a family history of migraine and attacks of hemiplegia was treated successfully with topiramate (TPM, in a report from the University Hospital of Messina, Italy; and Leiden University Medical Centre, The Netherlands.

  11. Are we overestimating the stroke risk related to contraceptive pills?

    Science.gov (United States)

    Gompel, Anne; Plu-Bureau, Genevieve

    2014-02-01

    Hormonal contraceptives are used by million of women worldwide. Ischemic stroke is one of the major harmful effects of hormonal contraceptives, but remains a very uncommon disease before menopause. The increased risk of stroke under third and fourth-generation contraceptive pills and nonoral contraceptives has been recently highlighted. Given the benefits associated with combined hormonal contraceptives (COCs), it is important to properly evaluate their risks in order to provide a better benefit/risk balance to young women. Scarce studies addressing the rates of stroke in young women suggest that the fraction attributable to the contraceptive pill remains low. In contrast, there is abundant literature on the relative risks of stroke under COCs. The risk of arterial disease seems to be similar among users of second and third-generation pills, drospirenone-containing pills and nonoral hormonal contraceptives. Progestin-only contraceptives do not appear to be associated with an increased risk of stroke. New formulations of hormonal contraceptives are not safer than second-generation COCs. Even if the absolute numbers of strokes attributable to hormonal contraceptives is very low, stringent selection of patients should help to reduce the events still more, and progestin-only contraceptives/nonhormonal methods should be preferred in cases of associated risk factors.

  12. Visual Attention in Posterior Stroke and Relations to Alexia

    DEFF Research Database (Denmark)

    Petersen, Anders; Vangkilde, Signe; Fabricius, Charlotte

    2016-01-01

    that reduced visual speed and span may explain pure alexia. Eight patients with unilateral PCA strokes (four left hemisphere, four right hemisphere) were selected on the basis of lesion location, rather than the presence of any visual symptoms. Visual attention was characterized by a whole report paradigm......Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere, while attentional effects of more posterior lesions are less clear. Commonly, such deficits are investigated in relation to specific syndromes like visual...... agnosia or pure alexia. The aim of this study was to characterize visual processing speed and apprehension span following posterior cerebral artery (PCA) stroke. In addition, the relationship between these attentional parameters and single word reading is investigated, as previous studies have suggested...

  13. Hemiplegias velo-faringo-laríngicas

    Directory of Open Access Journals (Sweden)

    Nicanor Letti

    1967-12-01

    Full Text Available São relatados três casos de hemiplegias velo-faringo-laríngicas por lesão do núcleo ambíguo. A localização da lesão, os aspectos da paralisia velar e seu diagnóstico pela radiografia durante a fonação de consoantes orais e nasais são discutidos.

  14. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    NARCIS (Netherlands)

    Horsch, Alexander D; Dankbaar, Jan Willem; van der Graaf, Yolanda; Niesten, Joris M; van Seeters, Tom; van der Schaaf, Irene C; Kappelle, L Jaap; Velthuis, Birgitta K

    2015-01-01

    INTRODUCTION: Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT

  15. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    NARCIS (Netherlands)

    Horsch, Alexander D.; Dankbaar, Jan Willem; van der Graaf, Yolanda; Niesten, Joris M.; van Seeters, Tom; van der Schaaf, Irene C.; Kappelle, L. Jaap; Velthuis, Birgitta K.; Majoie, C. B.; Roos, Y. B.; Duijm, L. E.; Keizer, K.; van der Lugt, A.; Dippel, D. W.; Droogh-deGreve, K. E.; van Walderveen, M. A.; Wermer, M. J.; Lycklama à Nijeholt, G. J.; Boiten, J.; Duyndam, D.; Kwa, V. I.; Meijer, F. J.; van Dijk, E. J.; Kesselring, F. O.; Hofmeijer, J.; Vos, J. A.; Schonewille, W. J.; van Rooij, W. J.; de Kort, P. L.; Pleiter, C. C.; Bakker, S. L.; Bot, J.; Visser, M. C.; Velthuis, B. K.; van der Schaaf, I. C.; Dankbaar, J. W.; Mali, W. P.; van Seeters, T.; Horsch, A. D.; Niesten, J. M.; Biessels, G. J.; Kappelle, L. J.; Luitse, M. J.; van der Graaf, Y.

    2015-01-01

    Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary

  16. Community reintegration and related factors in a Nigerian stroke ...

    African Journals Online (AJOL)

    Background: The goal of stroke rehabilitation has shifted from mere survival of a victim to how well a survivor can be effectively reintegrated back into the community. Objectives: The present study determined the level of satisfaction with community reintegration (CR) and related factors among Nigerian community-dwelling ...

  17. Alternating hemiplegia of childhood in Denmark

    DEFF Research Database (Denmark)

    Høi-Hansen, Christina; Dali, Christine I.; Lyngbye, Troels Johan Brünnich

    2014-01-01

    Alternating hemiplegia of childhood (AHC) is a rare neurodevelopmental disorder characterized by early-onset recurrent distinctive hemiplegic episodes commonly accompanied by other paroxysmal features and developmental impairment. De novo mutations in ATP1A3 were recently identified as a genetic...... at position 801 is a mutation hotspot. Three girls aged 5-13 years did not reveal any ATP1A3 mutations. They were rather mildly clinically affected and displayed a normal or near-normal psychomotor development. This is the first study of AHC in the Danish paediatric population. The patients harboured a wide...

  18. Stroke

    Science.gov (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  19. Automatic segmentation of equine larynx for diagnosis of laryngeal hemiplegia

    Science.gov (United States)

    Salehin, Md. Musfequs; Zheng, Lihong; Gao, Junbin

    2013-10-01

    This paper presents an automatic segmentation method for delineation of the clinically significant contours of the equine larynx from an endoscopic image. These contours are used to diagnose the most common disease of horse larynx laryngeal hemiplegia. In this study, hierarchal structured contour map is obtained by the state-of-the-art segmentation algorithm, gPb-OWT-UCM. The conic-shaped outer boundary of equine larynx is extracted based on Pascal's theorem. Lastly, Hough Transformation method is applied to detect lines related to the edges of vocal folds. The experimental results show that the proposed approach has better performance in extracting the targeted contours of equine larynx than the results of using only the gPb-OWT-UCM method.

  20. Temporal evolution of event-related desynchronization in acute stroke: A pilot study

    NARCIS (Netherlands)

    Tangwiriyasakul, Chayanin; Verhagen, Rens; Rutten, Wim; van Putten, Michel Johannes Antonius Maria

    2014-01-01

    Objective Assessment of event-related desynchronization (ERD) may assist in predicting recovery from stroke and rehabilitation, for instance in BCI applications. Here, we explore the temporal evolution of ERD during stroke recovery. Methods Ten stroke patients and eleven healthy controls were

  1. Disability pensions in relation to stroke: a population study

    DEFF Research Database (Denmark)

    Teasdale, T W; Engberg, A W

    2002-01-01

    PRIMARY OBJECTIVE: This study aimed to establish prevalence levels of disability pensions among stroke patients within a national population. RESEARCH DESIGN: From a Danish National register of hospitalizations, 72 673 patients were identified who had a discharge diagnosis of stroke between the y...... of stroke units and post-acute rehabilitation programmes may justify greater optimism.......PRIMARY OBJECTIVE: This study aimed to establish prevalence levels of disability pensions among stroke patients within a national population. RESEARCH DESIGN: From a Danish National register of hospitalizations, 72 673 patients were identified who had a discharge diagnosis of stroke between...... OUTCOMES AND RESULTS: Being in possession of a disability pension prior to stroke (n = 8565, 12%), rarely at the highest level, was not associated with elevated risk for stroke, or with elevated stroke mortality. It was, however, associated with a greater mortality subsequent to stroke. Disability pensions...

  2. Electromyogram-controlled assistive exercise for the motor recovery of shoulder in chronic hemiplegia: A pilot study.

    Science.gov (United States)

    Park, Byung Kyu; Kim, Ji-Won; Kwon, Yuri; Heo, Jae-Hoon; Yoon, Joo-Seok; Eom, Gwang-Moon

    2015-01-01

    Correct-active-repetitive exercise is important for the motor recovery in hemiplegics. The present study hypothesizes that the electromyogram (EMG)-controlled assistance of motion would be an effective implementation of the concept for the rehabilitation of the hemiplegic shoulder, even in chronic patients. This study aims to investigate the feasibility of the suggested method. The motor intention is derived from the EMG of the shoulder muscles and the shoulder movement (flexion and abduction) is assisted by an electro-mechanical system only when the motor intention (EMG amplitude) exceeded the threshold. Twelve patients in the chronic stage of stroke participated in this pilot study. The EMG-controlled assistive exercise lasts for two weeks, 20 min per day and 5 days a week. The active range of motion in both abduction and flexion increases significantly after the intervention (p shoulder-related items (p shoulder-unrelated items of the upper extremity (p = 0.13) nor in the lower extremity items (p = 0.19). This pilot study demonstrates that EMG-controlled assistive exercise can improve shoulder motor functions related to selected muscles and the suggested method is promising for the motor recovery of the shoulder in chronic hemiplegia.

  3. Arsenic Exposure in Relation to Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study.

    Science.gov (United States)

    Tsinovoi, Cari L; Xun, Pengcheng; McClure, Leslie A; Carioni, Vivian M O; Brockman, John D; Cai, Jianwen; Guallar, Eliseo; Cushman, Mary; Unverzagt, Frederick W; Howard, Virginia J; He, Ka

    2018-01-01

    The purpose of this case-cohort study was to examine urinary arsenic levels in relation to incident ischemic stroke in the United States. We performed a case-cohort study nested within the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort. A subcohort (n=2486) of controls was randomly sampled within region-race-sex strata while all incident ischemic stroke cases from the full REGARDS cohort (n=671) were included. Baseline urinary arsenic was measured by inductively coupled plasma-mass spectrometry. Arsenic species, including urinary inorganic arsenic and its metabolites monomethylarsonic acid and dimethylarsinic acid, were measured in a random subset (n=199). Weighted Cox's proportional hazards models were used to calculate hazard ratios and 95% confidence intervals of ischemic stroke by arsenic and its species. The average follow-up was 6.7 years. Although incident ischemic stroke showed no association with total arsenic or total inorganic arsenic, for each unit higher level of urinary monomethylarsonic acid on a log-scale, after adjustment for potential confounders, ischemic stroke risk increased ≈2-fold (hazard ratio=1.98; 95% confidence interval: 1.12-3.50). Effect modification by age, race, sex, or geographic region was not evident. A metabolite of arsenic was positively associated with incident ischemic stroke in this case-cohort study of the US general population, a low-to-moderate exposure area. Overall, these findings suggest a potential role for arsenic methylation in the pathogenesis of stroke, having important implications for future cerebrovascular research. © 2017 American Heart Association, Inc.

  4. The site of embolization related to infarct size, oedema and clinical outcome in a rat stroke model - further translational stroke research

    DEFF Research Database (Denmark)

    Overgaard, Karsten; Rasmussen, Rune S; Johansen, Flemming F

    2010-01-01

    Reliable models are essential for translational stroke research to study the pathophysiology of ischaemic stroke in an effort to find therapies that may ultimately reduce oedema, infarction and mortality in the clinic. The purpose of this study was to investigate the relation between the site...... of arterial embolization and the subsequent oedema, infarction and clinical outcome in a rat embolic stroke model....

  5. Stroke-related mortality in a tertiary care hospital in Andalusia: Analysis and reflections.

    Science.gov (United States)

    Maestre-Moreno, J F; Fernández-Pérez, M D; Triguero-Cueva, L; Gutiérrez-Zúñiga, R; Herrera-García, J D; Espigares-Molero, A; Mínguez-Castellanos, A

    Stroke is a very common cause of death, especially in southern Spain. The present study analyses in-hospital mortality associated with stroke in an Andalusian tertiary care hospital. We gathered the files of all patients who had died at Hospital Universitario Virgen de las Nieves in Granada in 2013 and whose death certificates indicated stroke as the cause of death. We also gathered stroke patients discharge data and compared them to that of patients with acute coronary syndrome (ACS). A total of 825 patients had a diagnosis of stroke (96 deaths, 11.6%); of these, 562 had ischaemic stroke (44 deaths, 7.8%) and 263 haemorrhagic stroke (52 deaths, 19.7%). Patients with haemorrhagic stroke therefore showed greater mortality rate (OR=2.9). Patients in this group died after a shorter time in hospital (median, 4 vs 7 days; mean, 6 days). However, patients with ischaemic stroke were older and presented with more comorbidities. On the other hand, 617 patients had a diagnosis of ACS (36 deaths, 5.8%). The mortality odds ratio (MOR) was 2.1 (stroke/SCA). Around 23% of the patients who died from stroke were taking anticoagulants. 60% of the deceased patients with ischaemic stroke and 20% of those with haemorrhagic stroke had atrial fibrillation (AF); 35% of the patients with ischaemic stroke and AF were taking anticoagulants. Stroke is associated with higher admission and in-hospital mortality rates than SCA. Likewise, patients with haemorrhagic stroke showed higher mortality rates than those with ischaemic stroke. Patients with fatal stroke usually had a history of long-term treatment with anticoagulants; 2 thirds of the patients with fatal ischaemic stroke and atrial fibrillation were not receiving anticoagulants. According to our results, optimising prevention in patients with AF may have a positive impact on stroke-related in-hospital mortality. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Preventing stroke

    Science.gov (United States)

    ... A.M. Editorial team. Related MedlinePlus Health Topics Hemorrhagic Stroke Ischemic Stroke Stroke Browse the Encyclopedia A.D. ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

  7. Effects of ideomotor apraxia on functional outcomes in patients with right hemiplegia.

    Science.gov (United States)

    Unsal-Delialioglu, Sibel; Kurt, Murat; Kaya, Kurtulus; Culha, Canan; Ozel, Sumru

    2008-06-01

    The aim of this study was to investigate the effect of ideomotor apraxia on activities of daily living and to determine if the presence of apraxia interferes with rehabilitation. This study was conducted on 47 patients with right hemiplegia. All the patients were assessed at their admission and discharge, respectively, for apraxia by Ideomotor Apraxia Test, for daily living activities by Functional Independence Measure (FIM, Santa Clara Valley Medical Center, San Jose, California, USA), for cognitive functions by Mini Mental State Examination (MMSE), and for language components by Gulhane Aphasia Test (GAT). The effects of apraxia presence and time course on FIM, MMSE, and GAT scores were investigated. Presence of apraxia was found to have significant effect on all test scores (Papraxia and time course on the test scores was not significant either. In other words, apraxic and nonapraxic patients seemed to gain benefits from the neurological rehabilitation. However, mean FIM scores of apraxic patients during discharge have failed to reach the mean FIM scores of nonapraxic patients during admission. Apraxia is considered as an important determinant in the dependence of patients with stroke in their activities of daily living. For this reason, during the initial assessment of patients with right hemiplegia, apraxia should be tested, and the presence of apraxia as well as its severity should be determined.

  8. New Rehabilitation Approaches for Upper Limb Function of Children With Hemiplegia

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Sadegh Hosseini

    2017-10-01

    Conclusion Based on the positive results of all these studies, constraint-induced therapy, forced use and hand-arm bimanual intensive therapy seemed to show effectiveness as interventions to improve involved hand and arm function in children with hemiplegia. Nevertheless, we needed to conduct researches with level 1 of evidence for each of the above treatment methods, particularly hand-arm bimanual intensive therapy for use in medical centers. Forced use was started with animal studies and then was continued on human studies of stroke patients and eventually expanded to children with hemiplegic cerebral palsy. Further research based on principles of motor learning and neuroplasticity promoted the use of forced use and developed constraint-induced movement therapy. Finally, the hand-arm bimanual intensive therapy was developed to remove constraints and difficulties of intervention in constraint induced movement therapy. Each of these interventions may be useful for hemiplegia. Comparative studies between these interventions are suggested to study their effects on the target behaviors.

  9. EFFECT OF TASK SPECIFIC MIRROR THERAPY WITH FUNCTIONAL ELECTRICAL STIMULATION ON UPPER LIMB FUNCTION FOR SUBACUTE HEMIPLEGIA

    Directory of Open Access Journals (Sweden)

    Sumana Nagapattinam

    2015-10-01

    Full Text Available Background: The principal target of any stroke rehabilitation is the motor impairments. Many studies have been advocated on the effect of Functional electrical stimulation and Task specific mirror therapy. Hence, the purpose of the study is to find the combined effect of task specific Mirror therapy with Functional Electrical Stimulation on upper limb function for subjects with sub-acute hemiplegia. Methods: An experimental study design, 60 subjects with sub-acute Hemiplegia randomised into 3 groups, functional electrical stimulation group (n=20, task specific mirror therapy group (n=20, and combined group (n=20. Each group received the corresponding regimen of treatment for 30 minutes with rest period for total 12 sessions over 2 weeks along with conventional physiotherapy. The outcome measure such as action research arm test was measured before and after two weeks of intervention. Result: When means of action research arm test were analyzed within the groups, there was a significant difference within all the three groups. When means were compared between three groups there is no statistically significant difference in pre- intervention and post intervention means. Conclusion: It is concluded that a combination therapy of task specific mirror therapy with functional electrical stimulation for two weeks duration, is shown to be effective for recovery of upper limb function in subjects with sub-acute hemiplegia. However, the combination of task specific mirror therapy and functional electrical stimulation is shown to have similar improvements as only task specific mirror therapy and functional electrical stimulation.

  10. The incidence of pregnancy-related stroke: A systematic review and meta-analysis.

    Science.gov (United States)

    Swartz, Richard H; Cayley, Megan L; Foley, Norine; Ladhani, Noor Niyar N; Leffert, Lisa; Bushnell, Cheryl; McClure, J A; Lindsay, M Patrice

    2017-10-01

    Background Stroke risk is increased during pregnancy, but estimates of pregnancy-related stroke incidence vary widely. Aims A systematic review and meta-analysis was conducted to assess the incidence of stroke during pregnancy and the puerperium. Ovid Medline, EMBASE, and ISI Web of Science were searched for studies published between 1990 and January 2017 reporting stroke incidence during pregnancy and postpartum, from defined pregnancy populations. Pooled analyses were conducted using a random effects approach and expressed as an incidence rate per 100,000 pregnancies, with 95% confidence intervals. Subgroup analyses of stroke type and timing were conducted. Summary of review Eleven studies met inclusion criteria. Variation in estimated rates was noted based on geography and study methodology. The pooled crude rate of pregnancy-related stroke was 30.0 per 100,000 pregnancies (95% confidence interval 18.8-47.9). The pooled crude rates from nonhemorrhagic stroke (arterial and cerebral venous sinus thrombosis) were 19.9 (95% confidence interval 10.7-36.9) and from hemorrhage 12.2 (95% confidence interval 6.4-23.2) per 100,000 pregnancies. For studies separately reporting cerebral venous sinus thrombosis, the rates were roughly equal between ischemic stroke (12.2, 95% confidence interval 6.7-22.2), cerebral venous sinus thrombosis (9.1, 95% confidence interval 4.3-18.9), and hemorrhage (12.2, 95% confidence interval 6.4-23.2). The crude stroke rate for antenatal/perinatal stroke was 18.3 (95% confidence interval 11.9-28.2), and for postpartum stroke was 14.7 (95% confidence interval 8.3-26.1). Conclusions Stroke affects 30.0 per 100,000 pregnancies, with ischemia, cerebral venous sinus thrombosis, and hemorrhage causing roughly equal numbers and with highest risk peripartum and postpartum. Organized approaches to the management of this high-risk population, informed by existing evidence from stroke and obstetrical care are needed.

  11. Relation between shoulder proprioception, kinematics and pain after stroke

    NARCIS (Netherlands)

    Niessen, M. H M; Veeger, H. E J; Meskers, C.G.; Koppe, P.A.; Konijnenbelt, M.H.; Janssen, T. W J

    2010-01-01

    Purpose: To identify a possible relationship between chronic Post-Stroke Shoulder Pain (PSSP), scapular resting pose and shoulder proprioception. Methods: A total of 21 inpatients with stroke and 10 healthy control subjects were included and kinematics and proprioception of both shoulders were

  12. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    International Nuclear Information System (INIS)

    Horsch, Alexander D.; Dankbaar, Jan Willem; Niesten, Joris M.; Seeters, Tom van; Schaaf, Irene C. van der; Velthuis, Birgitta K.; Graaf, Yolanda van der; Kappelle, L.J.

    2015-01-01

    Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT. From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment. Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %). Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status. (orig.)

  13. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Horsch, Alexander D. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Dankbaar, Jan Willem; Niesten, Joris M.; Seeters, Tom van; Schaaf, Irene C. van der; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Graaf, Yolanda van der [Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Kappelle, L.J. [University Medical Center, Department of Neurology, Utrecht Stroke Center, Utrecht (Netherlands); Collaboration: DUST investigators

    2015-12-15

    Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT. From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment. Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %). Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status. (orig.)

  14. Serum cardiac troponin I in acute stroke is related to serum cortisol and TNF-alpha

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Johannesen, Helle Hjorth; Christensen, Anders Fogh

    2004-01-01

    Serum cardiac troponin I (cTnI) is a specific marker of myocardial injury related to in-patient fatality and cardiac injury in acute stroke. We investigated whether cTnI in acute stroke is related to serum cortisol, acute inflammatory response, and insular damage. We also investigated whether c...

  15. Determinants in Adolescence of Stroke-Related Hospital Stay Duration in Men: A National Cohort Study.

    Science.gov (United States)

    Bergh, Cecilia; Udumyan, Ruzan; Appelros, Peter; Fall, Katja; Montgomery, Scott

    2016-09-01

    Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke. Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first. Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45). Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors. © 2016 American Heart Association, Inc.

  16. Identification of risk factors related to perceived unmet demands in patients with chronic stroke

    NARCIS (Netherlands)

    van de Port, I. G. L.; van den Bos, G. A. M.; Voorendt, M.; Kwakkel, G.; Lindeman, E.

    2007-01-01

    PURPOSE: To investigate the prevalence of unmet demands concerning autonomy and participation and to identify risk factors related to these unmet demands in patients with chronic stroke. METHOD: A cross-sectional study of 147 patients three years after stroke. We assessed perceived unmet care

  17. On the relative contribution of the paretic leg to the control of posture after stroke

    NARCIS (Netherlands)

    Roerdink, Melvyn; Geurts, Alexander C. H.; de Haart, Mirjam; Beek, Peter J.

    2009-01-01

    Reduced postural steadiness and asymmetry of weight bearing are characteristic for posture after stroke. To examine the relative contribution of each leg to postural control in a cohort of 33 stroke patients at 5 stages during 3 months of inpatient rehabilitation, while taking clinical scores of

  18. On the relative contribution of the paretic leg to the control of posture after stroke

    NARCIS (Netherlands)

    Roerdink, M.; Geurts, A.C.; de Haart, M.; Beek, P.J.

    2009-01-01

    Background: Reduced postural steadiness and asymmetry of weight bearing are characteristic for posture after stroke. Objective: To examine the relative contribution of each leg to postural control in a cohort of 33 stroke patients at 5 stages during 3 months of inpatient rehabilitation, while taking

  19. On the relative contribution of the paretic leg to the control of posture after stroke.

    NARCIS (Netherlands)

    Roerdink, M.; Geurts, A.C.H.; Haart, M. de; Beek, P.J.

    2009-01-01

    BACKGROUND: Reduced postural steadiness and asymmetry of weight bearing are characteristic for posture after stroke. OBJECTIVE: To examine the relative contribution of each leg to postural control in a cohort of 33 stroke patients at 5 stages during 3 months of inpatient rehabilitation, while taking

  20. Cause-Specific Mortality after Stroke: Relation to Age, Sex, Stroke Severity, and Risk Factors in a 10-Year Follow-Up Study

    DEFF Research Database (Denmark)

    Mogensen, UB; Olsen, TS; Andersen, KK

    2013-01-01

    We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n = 988) were...... registered on admission. Evaluation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate information was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were...... after 10 years (18%). Stroke was the dominant cause of death during first year, with an absolute risk of 20.2% versus 5.2% for heart/arterial disease and 6.5% for nonvascular disease. The subsequent absolute risk of death per year was 2.8% for stroke, 4.5% for heart/arterial disease, and 5...

  1. Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study.

    Science.gov (United States)

    Hayden, Derek T; Hannon, Niamh; Callaly, Elizabeth; Ní Chróinín, Danielle; Horgan, Gillian; Kyne, Lorraine; Duggan, Joseph; Dolan, Eamon; O'Rourke, Killian; Williams, David; Murphy, Sean; Kelly, Peter J

    2015-12-01

    Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors. We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan-Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke. Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5-46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA2DS2-VASc) score (hazard ratio [HR], 1.34; PStroke Scale (HR, 1.09; Pstroke onset (HR, 3.29; P=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40; P=0.001) and statin use after index stroke (HR, 0.52; P=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5-31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09; P=0.07) and CHA2DS2-VASc score (HR, 1.34; P=0.07). Nursing home care was needed for 25.9% of patients. AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed. © 2015 American Heart Association, Inc.

  2. Age-related rehabilitation outcome in stroke patients.

    Science.gov (United States)

    Manimmanakorn, Nuttaset; Arrayawichanon, Preeda; Wattanapun, Pattra; Nuntharuksa, Chompilai; Kuptniratsaikul, Vilai

    2008-03-01

    Patients who survive a stroke usually have residual neurological deficits. Consequently, a rehabilitation program is valuable for improving their quality of life (QOL). However, age is a known factor that needs qualification vis-à-vis rehabilitation outcomes among Thai patients. To study the functional and psychological outcomes and the QOL before and after rehabilitation program among three age groups of Thai stroke patients ( or = 65 years of age). Prospective, analytical study. Three hundred and twenty seven stroke patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO QOL BREF questionnaire before and after undergoing an in-patient rehabilitation program. Data were collected from nine sites around Thailand. Functional and psychological outcomes and the quality of life score improved after the rehabilitation program. The youngest group of stroke victims showed the greatest improvement in functional outcome and QOL score in both the physical and social domains. No significant difference was found regarding anxiety and depression among the three groups. An in-patient rehabilitation program was of benefit to Thai stroke patients but age significantly determined rehabilitation outcomes.

  3. Dual extradural cortical stimulation in chronic stroke patients with large infarcts: technical case report.

    Science.gov (United States)

    Shin, Yong-Il; Kim, Hyoungihl; Moon, Seong-Keun; Kim, Hyojoon; Yun, Yong-Soon; Chung, Gyung-Ho

    2010-06-01

    Recent works on extradural cortical stimulation have been successful in improving neurological recovery in chronic stroke patients. On the other hand, single perirolandic stimulations are often associated with disappointing results. We report two cases of chronic stroke in which the magnitude of infarct was too large to be improved with single perirolandic stimulation. Patient 1 had severe hemiplegia associated with large cortical infarct in the right frontoparietal area. The patient could neither stand independently or walk. Patient 2 had hemiplegia and aphasia due to cortical infarct in the left middle cerebral artery territory. Both patients had intensive rehabilitative training for more than 6 months with no beneficial results. Two paddle electrodes covering frontal and parietal area were implanted, followed by dual cortical stimulation with concurrent rehabilitative training in patient 1. After 6 months of stimulation, the patient could walk with a good posture. Two paddle electrodes were implanted to cover pre-motor and motor cortex in patient 2. After similar treatment, the motor function was markedly improved. Dual cortex stimulation, which acts on more diffuse areas or functionally related areas, is beneficial to promote the motor recovery in chronic stroke patients with large infarcts.

  4. Serum C-reactive protein concentration and genotype in relation to ischemic stroke subtype.

    Science.gov (United States)

    Ladenvall, Claes; Jood, Katarina; Blomstrand, Christian; Nilsson, Staffan; Jern, Christina; Ladenvall, Per

    2006-08-01

    C-reactive protein (CRP) has evolved as an inflammatory risk marker of cardiovascular disease. Several single-nucleotide polymorphisms at the CRP locus have been found to be associated with CRP levels. The aim of the present study was to investigate CRP levels and genetic variants in etiological subtypes of ischemic stroke. The Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) comprises 600 consecutive ischemic stroke cases (18 to 69 years) and 600 matched controls from western Sweden. Stroke subtypes were defined by the TOAST classification. Serum CRP levels were determined by a high-sensitivity immunometric assay. CRP levels were significantly higher for all ischemic stroke subtypes compared with controls, both in the acute phase and at the 3-month follow-up. After adjustment for traditional risk factors, CRP at follow-up was related to higher odds ratios (ORs) of overall ischemic stroke (OR, 1.25; 95% CI, 1.09 to 1.43) and large-vessel disease (OR, 1.48; 95% CI, 1.09 to 2.00). The CRP -286C>T>A, 1059G>C, and 1444C>T single-nucleotide polymorphisms showed significant associations with CRP levels. However, neither CRP genotypes nor haplotypes showed an association to overall ischemic stroke. This is the first large study on CRP in different TOAST subtypes in a young ischemic stroke population. CRP levels differed between etiological subtypes of ischemic stroke both in the acute phase and at the 3-month follow-up. CRP at follow-up was associated with overall ischemic stroke and the large-vessel disease subtype. Genetic variants at the CRP locus were associated with CRP levels, but no association was detected for overall ischemic stroke.

  5. Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda.

    Science.gov (United States)

    Rowat, Anne; Pollock, Alex; St George, Bridget; Cowey, Eileen; Booth, Joanne; Lawrence, Maggie

    2016-11-01

    To determine the top 10 research priorities specific to stroke nursing. It is important that stroke nurses build their research capability and capacity. This project built on a previous James Lind Alliance prioritization project, which established the shared stroke research priorities of stroke survivors, carers and health professionals. Research priority setting project using James Lind Alliance methods; a survey for interim prioritization and a consensus meeting for final priority setting. Between September - November 2014, stroke nurses were invited to select their top 10 priorities from a previously established list of 226 unique unanswered questions. These data were used to generate a list of shared research priorities (interim priority setting stage). A purposefully selected group of stroke nurses attended a final consensus meeting (April 2015) to determine the top 10 research priorities. During the interim prioritization stage, 97 stroke nurses identified 28 shared priority treatment uncertainties. At the final consensus meeting, 27 stroke nurses reached agreement on the top 10 stroke nursing research priorities. Five of the top 10 questions relate to stroke-specific impairments and five relate to rehabilitation and long-term consequences of stroke. The research agenda for stroke nursing has now been clearly defined, facilitating nurses to undertake research, which is of importance to stroke survivors and carers and central to supporting optimal recovery and quality of life after stroke. © 2016 John Wiley & Sons Ltd.

  6. Anticipatory postural adjustments in children with hemiplegia and diplegia.

    Science.gov (United States)

    Girolami, Gay L; Shiratori, Takako; Aruin, Alexander S

    2011-12-01

    Anticipatory postural adjustments (APAs) play an important role in the performance of many activities requiring the maintenance of standing posture. However, little is known about if and how children with cerebral palsy (CP) generate APAs. Two groups of children with CP (hemiplegia and diplegia) and a group of children with typical motor development performed arm flexion and extension movements while standing on a force platform. Electromyographic activity of six trunk and leg muscles and displacement of center of pressure (COP) were recorded. Children with CP were able to generate anticipatory postural adjustments and produce directionally specific APAs and COP displacements similar to those described in adults and typically developing children. However, children with diplegia were unable to generate APAs of the same magnitude as children with typical development and hemiplegia and had higher baseline muscle activity prior to movement. In children with diplegia, COP was posteriorly displaced and peak acceleration was smaller during bilateral extension compared to children with hemiplegia. The outcomes of the study highlight the role of APAs in the control of posture of children with CP and point out the similarities and differences in anticipatory control in children with diplegia and hemiplegia. These differences may foster ideas for treatment strategies to enhance APAs in children with CP. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Fisse, Anna Lena; Kemmling, André; Teuber, Anja; Wersching, Heike; Young, Peter; Dittrich, Ralf; Ritter, Martin; Dziewas, Rainer; Minnerup, Jens

    2017-01-01

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

  8. Cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL)

    NARCIS (Netherlands)

    Bugiani, Marianna; Kevelam, Sietske H.; Bakels, Hannah S.; Waisfisz, Quinten; Ceuterick-de Groote, Chantal; Niessen, Hans W. M.; Abbink, Truus E. M.; Lesnik Oberstein, Saskia A. M. J.; van der Knaap, Marjo S.

    2016-01-01

    To characterize the clinical and MRI features of 2 families with adult-onset dominant leukoencephalopathy and strokes and identify the underlying genetic cause. We applied MRI pattern recognition, whole-exome sequencing, and neuropathology. Based on brain imaging, 13 family members of 40 years or

  9. Profile of stroke-related late onset epilepsy among Nigerians ...

    African Journals Online (AJOL)

    in which a total of 302 consecutive patients were recruited. in three tertiary centres from northern and southern Nigeria, those with neuroimaging finding in keeping with stroke were selected to to determine their clinical , neuroimaging and electroencephalographic profile as well as response to anticonvulsants. Result: Sixty ...

  10. Profile and health-related quality of life of Ghanaian stroke survivors

    Directory of Open Access Journals (Sweden)

    Donkor ES

    2014-10-01

    Full Text Available Eric S Donkor,1,2 Mayowa O Owolabi,3 Patrick O Bampoh,4 Philip K Amoo,5 Thor Aspelund,2,6 Vilmundur Gudnason2,61College of Health Sciences, University of Ghana, Accra, Ghana; 2Centre for Public Health Sciences, University of Iceland, Reykjavík, Iceland; 3Department of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria; 4Tamale Central Hospital, Tamale, Ghana; 5Public Health Unit, Korle-Bu Teaching Hospital, Accra, Ghana; 6Icelandic Heart Association Research Institute, Kopavogur, IcelandBackground: Stroke is a leading cause of mortality with a major effect on health-related quality of life (HRQoL. There are no previous studies exploring HRQoL among stroke survivors in Ghana, despite the increasing public health significance of the disease in this country. Here we describe the profile of and factors associated with HRQoL among stroke survivors in Ghana.Methods: This was a cross-sectional study involving 156 stroke survivors and 156 ­age- and sex-matched, apparently healthy controls. A robust HRQoL questionnaire involving seven domains was used to collect data from the study participants. Clinical epidemiology data were also collected from stroke survivors on parameters such as stroke severity and risk factors. Statistical analyses were performed on the interrelationships among the study variables. Results: The mean ages of the stroke survivors and healthy controls were 58.0 (standard deviation, 11.4 and 57.6 (standard deviation, 12.0 years, respectively. Fifty-three percent (86 of the stroke survivors had mild stroke and 35.3% (55 had moderate stroke, whereas 12.2% (19 had severe stroke. Ischemic infarction was the prevalent stroke subtype (78.1%. ­Hypertension was the most common risk factor (89% among the stroke survivors, followed by diabetes (29%. HRQoL scores ranged from 57.7% (cognitive domain to 80.0% (spirit domain for stroke survivors, whereas HRQoL scores of the control group ranged from 65.6% (cognitive

  11. [Impacts of eye acupuncture on neurological deficit and Barthel index in patients of infarction hemiplegia].

    Science.gov (United States)

    Jiao, Junjie; Guo, Hongliang; He, Youdi; Dong, Qian; Yuan, Junliang; Li, Shujuan; Hu, Wenli

    2016-06-12

    To observe the impacts of eye acupuncture on neurological deficit and Barthel index in the patients of infarction hemiplegia and explore its function mechanism. Ninety-six patients of infarction hemiplegia were randomized into an observation group and a control group, 48 cases in each one. In the control group, the routine western medicines such as thrombolysis and antiplatelet aggregation were used. In the observation group, on the basis of the treatment as the control group, eye acupuncture was added at Shangjiao and Xiajiao areas bilaterally, once a day, 5 times a week. Separately, before treatment and after 2 weeks' treatment the score changes of the modified Edinburgh Scandinavia stroke scale (MESSS) and the activity of daily life scale (ADL, Barthel index, BI) were observed and the efficacy was compared between the two groups. The plasma endothelin was determined and compared before and after treatment in the two groups. After treatment, the effective rate was 93.8% (45/48) in the observation group and was 79.2% (38/48) in the control group. The effective rate in the observation group was higher apparently than that in the control group ( P Barthel index were (82.33±1.56) and (63.34±2.14) in the observation group and control group respectively, which all higher apparently than (38.53±1.54) and (38.14±2.56) before treatment (both P <0.05), and the difference was significant between the two groups after treatment ( P <0.05). The levels of plasma endothelin were (54.55±11.48)ng/L and (62.44±9.88)ng/L in the observation group and the control group after treatment respectively, which were all lower apparently than (78.24±9.25)ng/L and (78.14±10.78)ng/L before treatment (both P <0.05). Additionally, the difference was significant between the two groups after treatment ( P <0.05). Eye acupuncture effectively improves the neurological deficit and Brathel index in the patients of infarction hemiplegia and comprehensively improves the efficacy. The effect

  12. The relation between serum Vitamin D levels and body antioxidant status in ischemic stroke patients: A case?control study

    OpenAIRE

    Afshari, Laleh; Amani, Reza; Soltani, Farhad; Haghighizadeh, Mohammad Hossein; Afsharmanesh, Mohammad Reza

    2015-01-01

    Background: Stroke is the second cause of death among elderly people. Oxidative stress plays an important role in brain damage after stroke. Currently, Vitamin D has been shown as an antioxidant. The aim of this study was to evaluate the status of Vitamin D, antioxidant enzymes, and the relation between them in ischemic stroke patients. Materials and Methods: This case?control study was carried out on 36 patients with ischemic stroke patients and 36 matched subjects as controls. Intake of fru...

  13. THE RELATIONS BETWEEN ANTHROPOLOGICAL DIMENSIONS AND SWIMMING THE BREAST STROKE

    Directory of Open Access Journals (Sweden)

    Milomir Trivun

    2011-09-01

    Full Text Available at the Faculty of the Physical Education and Sport in East Sarajevo during 2009/10. Students were 22 years ± 6 months old. There was done the comparison in the following parameters: 11 variables of the anthropological status and one variable of the swimming the breast stroke at 50m. Predictable variables of the anthropological dimensions were: height, weight, shoulders’ breadth, hips’ breadth, skins’ folds of the back, skins’ folds of the upper arm, skins’ folds of the abdomen, the measurement of the upper arm, the measurement of the thigh, the measurement of the shank and the diameter of the knee’s joint. The criterion’s variable referred to the results’ success in swimming the breast stroke at 50m. The descriptive statistics was used in the research. The measures of central tendencies mean, minimum, maximum, standard deviation are expressed by descriptive statistics. For the correlation of the results of the anthropological status with the results at swimming the breast stroke at 50m the regressive analysis was used. The results of the group of 23 tested male students in 2009/10, which were shown in the measures of central tendencies, descriptive statistics and regressive analysis of the set of 11 predictable variables of anthropological students’ dimensions were compared with the results of the criterion’s variable shown by swimming the butterfly. During the regressive analysis, the list of the data which contains the information about the regression parameters and statistic values relevant for described testing procedures of the marked parameters were got. In this case the parameters were 11 variables of anthropological dimensions and the variables of the results‘ success in swimming the breast stroke at 50m.

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

    Directory of Open Access Journals (Sweden)

    Sabel Bernhard A

    2010-03-01

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

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

    Science.gov (United States)

    Gall, Carolin; Franke, Gabriele H; Sabel, Bernhard A

    2010-03-26

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

  16. The Evaluation Acute Traumatic Stress Level in Close Relatives of Stroke Patients.

    Science.gov (United States)

    Ünal, Yasemin; Ünal, Yes Im; Öztürk, Dilek A; Emir, Gülser K; Yılmaz, Mustafa; Kutlu, Gulnihal

    2017-09-01

    Stroke is the second most common cause of death and the leading cause of adult disability. Both stroke patients and their family can therefore experience increased traumatic stress level. The participants are close relatives of patients (n=65) who had a first time stroke (CRPWS) hospitalized. A control group (CG) (n=61), who had no history of chronic illness in their family and had at least one traumatic life event experience. The National Institutes of Health Stroke Scale, Modified Rankin Scale, Personal Information Form, Life Events Checklist, Traumatic Stress Symptom Scale, and Multidimensional Scale of Perceived Social Support, were used in the study. We found no significant association between NIHSS and MRS of patients and traumatic stress level of the family member. The traumatic stress level was significantly higher in the CRPWS group than in the CG group. Traumatic stress level was higher in women than men and was not associated with perceived social support in the CRPWS group. The traumatic stress level of the relatives was not associated with the clinical features of the stroke patients. In the early phase, after the diagnosis of stroke, psychological support may be important to prevent CRPWS from PTSD.

  17. Social Determinants of Stroke as Related to Stress at Work among Working Women: A Literature Review

    Directory of Open Access Journals (Sweden)

    Susanna Toivanen

    2012-01-01

    Full Text Available In adult life, many of the social determinants of health are connected to working life. Yet, our knowledge of the role of work-related factors for the risk of stroke is fairly limited. In contemporary occupational health research, the Demand-Control Model (DCM is frequently used to measure work stress. Previous literature reviews of the association of work stress and cardiovascular disease (CVD do not include stroke as a specific outcome. Results regarding work stress and the risk of CVD are less evident in working women. With the focus on working women, the purpose of the present paper was to review the current research into the DCM in relation to stroke and to scrutinize potential gender differences. A literature search was performed and eight studies from three countries were identified. Based on the reviewed studies, there is some evidence that high psychological demands, low job control, and job strain are associated with increased stroke risk in women as well as in men. Any major reduction in deaths and disability from stroke is likely to come from decreasing social inequalities in health, and reducing work stress has a potential to contribute to a reduced risk of stroke in working populations.

  18. Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

    OpenAIRE

    Idowu, Bukunmi Michael; Ayoola, Oluwagbemiga Oluwole; Adetiloye, Victor Adebayo; Komolafe, Morenikeji Adeyoyin

    2017-01-01

    BACKGROUND: Stroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices. MATERIAL AND METHODS: Forty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-sub...

  19. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    NARCIS (Netherlands)

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after

  20. Reactive Balance in Individuals With Chronic Stroke: Biomechanical Factors Related to Perturbation-Induced Backward Falling.

    Science.gov (United States)

    Salot, Pooja; Patel, Prakruti; Bhatt, Tanvi

    2016-03-01

    An effective compensatory stepping response is the first line of defense for preventing a fall during sudden large external perturbations. The biomechanical factors that contribute to heightened fall risk in survivors of stroke, however, are not clearly understood. It is known that impending sensorimotor and balance deficits poststroke predispose these individuals to a risk of fall during sudden external perturbations. The purpose of this study was to examine the mechanism of fall risk in survivors of chronic stroke when exposed to sudden, slip-like forward perturbations in stance. This was a cross-sectional study. Fourteen individuals with stroke, 14 age-matched controls (AC group), and 14 young controls (YC group) were exposed to large-magnitude forward stance perturbations. Postural stability was computed as center of mass (COM) position (XCOM/BOS) and velocity (ẊCOM/BOS) relative to the base of support (BOS) at first step lift-off (LO) and touch-down (TD) and at second step TD. Limb support was quantified as vertical hip descent (Zhip) from baseline after perturbation onset. All participants showed a backward balance loss, with 71% of the stroke group experiencing a fall compared with no falls in the control groups (AC and YC groups). At first step LO, no between-group differences in XCOM/BOS and ẊCOM/BOS were noted. At first step TD, however, the stroke group had a significantly posterior XCOM/BOS and backward ẊCOM/BOS compared with the control groups. At second step TD, individuals with stroke were still more unstable (more posterior XCOM/BOS and backward ẊCOM/BOS) compared with the AC group. Individuals with stroke also showed greater peak Zhip compared with the control groups. Furthermore, the stroke group took a larger number of steps with shorter step length and delayed step initiation compared with the control groups. Although the study highlights the reactive balance deficits increasing fall risk in survivors of stroke compared with healthy

  1. Stroke - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100218.htm Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  2. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life

    NARCIS (Netherlands)

    Renzenbrink, Gerbert J.; IJzerman, Maarten Joost

    2004-01-01

    Objective: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Design: Prospective, open label design. Setting: The outpatient services of a large teaching

  3. Postural alignment is altered in people with chronic stroke and related to motor and functional performance.

    Science.gov (United States)

    Verheyden, Geert; Ruesen, Carolien; Gorissen, Monique; Brumby, Victoria; Moran, Rachel; Burnett, Malcolm; Ashburn, Ann

    2014-10-01

    Trunk control is impaired after stroke but little is known about how changes in posture relate to other deficits. We examined spinal postural alignment in people with chronic stroke and explored the relationship between postural alignment and clinical measures. Twenty-one subjects with stroke and 22 age-matched healthy comparison subjects participated in this observational, cross-sectional study. Data collection included measurements of thoracic, lumbar, sacral, and overall postural alignment in the sagittal plane in both sitting and standing. Measurements were made in different postures, including: upright, flexed forward, and extended backward. Clinical outcome measures included the Trunk Impairment Scale and its subscales, Fugl-Meyer Scale, Berg Balance Scale, Barthel Index, and Stroke Impact Scale. Significant deviations in postural alignment for participants with stroke compared with comparison subjects were apparent in sacral alignment (P Scale (r = -0.61) and Berg Balance Scale (r = -0.64). Participants with greater anterior pelvic tilt when flexed forward and more overall inclination when flexed forward and extended backward scored better on the Trunk Impairment Scale, its subscales, and Berg Balance Scale (r = -0.6-0.7). People with chronic stroke have altered postural alignment in standing compared with subjects without neurological deficits. Investigating interventions focusing on increasing anterior and posterior pelvic tilt seem warranted.Video Abstract available. See video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A76) for more insights from the authors.

  4. Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke

    DEFF Research Database (Denmark)

    Muus, Ingrid; Petzold, Max; Ringsberg, Karin C

    2010-01-01

    This paper aimed to describe health related quality of life three and 12 months after mild stroke or transient ischemic attack, TIA, to describe the perceived changes from pre to post stroke status and to examine sociodemographic determinants for health related quality of life.......This paper aimed to describe health related quality of life three and 12 months after mild stroke or transient ischemic attack, TIA, to describe the perceived changes from pre to post stroke status and to examine sociodemographic determinants for health related quality of life....

  5. INFLAMMATORY MARKERS IN ACUTE ISCHAEMIC STROKE IN RELATION TO CLINICAL SEVERITY AND EARLY OUTCOME

    Directory of Open Access Journals (Sweden)

    S. Gopi

    2018-01-01

    Full Text Available BACKGROUND Biochemical markers of inflammation could be useful to predict severity of stroke in acute phase. Stroke is the third cause of mortality and the first cause of disability. Recent literature have demonstrated that inflammation contributes to all phases of atherosclerosis. The results of researchers suggest that atherosclerosis is an inflammatory disease. The aim of the study is to assess the1. Level of peripheral inflammatory markers in acute ischaemic stroke and their relation to severity of acute stroke. 2. Value of inflammatory markers in predicting the short-term outcome and disability at the end of six months. MATERIALS AND METHODS This is a prospective case control study for 6 months done from September 2014 to August 2016 in 100 patients of acute ischaemic stroke within first 5 days of symptom onset in comparison >18 years of age with 50 age and sex matched controls. Blood samples for all cases and controls were sent for erythrocyte sedimentation rate, Neutrophil-to-Lymphocyte Ratio (NLR, hs-C-reactive protein, mean platelet volume, serum ferritin, serum albumin and S. gamma-glutamyl transferase at admission. RESULTS The mean values of ESR, NLR, hs-CRP in all the cases are higher when compared to the controls and are statistically significant, whereas the mean values of MPV, S. ferritin, S. albumin and GGT in cases are lower when compared to controls, but are within normal range and difference is statistically significant except ferritin. ESR, hs-CRP has significant correlation with severity of acute ischaemic stroke. The mean values of these markers increased with increase in severity. Serum albumin has significant correlation with severity of acute ischaemic stroke with mean values of these markers decreasing with increase in severity of stroke. There is no significant correlation of the inflammatory markers in present study with the short-term outcome. CONCLUSION Inflammation plays an important role in the pathogenesis of non

  6. The impact of stroke-related dysarthria on social participation and implications for rehabilitation.

    Science.gov (United States)

    Brady, Marian C; Clark, Alexander M; Dickson, Sylvia; Paton, Gillian; Barbour, Rosaline S

    2011-01-01

    Each year an estimated 30,000-45,000 UK individuals experience stroke-related dysarthria (impairment of movements required to produce speech). Many will experience persistent dysarthria long after discharge from stroke services. Although we have some insight into the impact of other communication impairments, we have very limited information on the impact of dysarthria on social participation. To explore the impact of dysarthria on social participation following stroke. We report data from in-depth semi-structured interviews with 24 individuals with stroke-related dysarthria. Our findings suggest a complex association between the severity of an individual's dysarthria and the impact on their social participation. Participants' descriptions highlighted their experiences of social participation and isolation. We further suggest that, in some cases, the coping strategies adopted by the participants could be seen to further exacerbate this isolation. These results have important implications for the prioritisation, planning and delivery of therapeutic interventions for people with dysarthria. The impact of stroke-related dysarthria transcends the physiological impairment to impact upon individuals' social participation, which is key to the process of rehabilitation. The development and evaluation of the effectiveness of an intervention that addresses these impacts is the next challenge for therapists and researchers working in this area.

  7. The effects of neuromuscular facilitation techniques on osteoporosis of hemiplegia limbs and serum leptin level in patients or rats with cerebral infarction.

    Science.gov (United States)

    Si, Zhihua; Hu, Ke; Wang, Congcong; Jia, Likun; Zhang, Xiuqing; Wang, Aihua

    2016-01-01

    This study was to investigate the effect of proprioceptive neuromuscular facilitation techniques (NFT) on osteoporosis and serum leptin level in cerebral infarction patients or rats. Forty cerebral infarction rats were randomly grouped into control, sham operation, conventional treatment (CT) group and CT+NFT group. Fifty-two stroke patients with hemiplegia were included in this study. The bone mineral densities (BMD) of proximal hemiplegia limbs and serum ALP, BALP, BGP, IL-6 and leptin levels were detected using commercial kits. In cerebral infarction rats, the BMD, BGP, BALP, ALP and leptin concentrations in the CT+NFT group was higher compared with the control and CT group, while serum IL-6 level was more reduced by CT+NFT than control and CT. In cerebral infarction patients, both CT and CT+NFT increased the BMD, ALP, BGP and leptin levels. In addition, compared with CT, the BMD, ALP, BGP and leptin levels were markedly increased by CT+NFT. C Conclusion: NFC elevated the BMD of hemiplegia limbs, serum ALP, BGP, IL-6 and leptin levels and, thus, alleviated osteoporosis in rats and patients with cerebral infarction.

  8. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

    NARCIS (Netherlands)

    M. Geurts (Marjolein); Scheijmans, F.E.V. (Féline E.V.); T. van Seeters (Tom); G.J. Biessels; L.J. Kappelle (Jaap); B.K. Velthuis (Birgitta K.); H.B. van der Worp (Bart); C.B. Majoie (Charles); Y.B.W.E.M. Roos (Yvo); L.E.M. Duijm (Lucien); K. Keizer (Koos); A. van der Lugt (Aad); D.W.J. Dippel (Diederik); Greve, D. (Droogh-de); H.P. Bienfait (Henri); M.A.A. van Walderveen (Marianne); M.J.H. Wermer (Marieke); G.J. Lycklama à Nijeholt (Geert); J. Boiten (Jelis); A. Duyndam (Anita); V.I.H. Kwa; F.J. Meijer (F.); E.J. van Dijk (Ewoud); A.M. Kesselring (Anouk); J. Hofmeijer; J.A. Vos (Jan Albert); W.J. Schonewille (Wouter); W.J. van Rooij (W.); P.L.M. de Kort (Paul); C.C. Pleiter (C.); S.L.M. Bakker (Stef); Bot, J.; M.C. Visser (Marieke); B.K. Velthuis (Birgitta); I.C. van der Schaaf (Irene); J.W. Dankbaar (Jan); W.P. Mali (Willem); van Seeters, T.; A.D. Horsch (Alexander D.); J.M. Niesten (Joris); G.J. Biessels (Geert Jan); L.J. Kappelle (Jaap); J.S.K. Luitse; Y. van der Graaf (Yolanda)

    2016-01-01

    textabstractBackground: High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute

  9. Challenges in integrating international evidence relating to stroke rehabilitation: experiences from a Cochrane systematic review.

    Science.gov (United States)

    Pollock, Alex; Campbell, Pauline; Baer, Gillian; Choo, Pei Ling; Forster, Anne; Morris, Jacqui; Pomeroy, Valerie M; Langhorne, Peter

    2014-12-01

    There are many randomized controlled trials relating to stroke rehabilitation being carried out in China, which are often published in Chinese-language journals. A recent update to our Cochrane systematic review of physical rehabilitation to improve function and mobility after stroke included 96 trials; over half (51) were conducted in China; 37 of these included studies were published in Chinese. Analyses within this Cochrane review support the conclusion that physical rehabilitation, using a mix of components from different approaches, is effective for the recovery of function and mobility after stroke. The inclusion of the Chinese studies had a substantial impact on the volume of evidence and, consequently, the conclusions. In this paper, we explore whether it is appropriate to draw implications for clinical practice throughout the world from evidence relating to a complex rehabilitation intervention delivered within one particular geographical healthcare setting. We explore the unique challenges associated with incorporating the body of evidence from China, particularly the Chinese-language publications, and identify the ongoing debate about the quality of Chinese research publications. We conclude that the growing body of evidence from China has important implications for future systematic reviews and evidence-based stroke care, but analysis and interpretation raise challenges, and improved reporting is critical. © 2014 World Stroke Organization.

  10. Determinants of disease-specific health-related quality of life in Turkish stroke survivors.

    Science.gov (United States)

    Safaz, İsmail; Kesikburun, Serdar; Adigüzel, Emre; Yilmaz, Bilge

    2016-06-01

    Stroke is a worldwide cause of morbidity and mortality that affects health-related quality of life. In this study, our objective was to identify determinants of disease-specific health-related quality of life in Turkish stroke survivors. A total of 114 consecutive patients who experienced a stroke at least 6 months earlier were studied. Health-related quality of life was measured using Stroke-specific Quality of Life (SS-QoL) consisting of 12 domains. Demographic and clinical data were collected, including age, sex, marital status, years of education, time since stroke, whether the patient received rehabilitation before enrollment, stroke etiology, whether the dominant hand was affected or not, presence of vision defect, neglect, aphasia, and dysarthria. The patients were assessed by the functional independence measure (FIM) and the Mini-Mental State Examination. A multiple linear regression analysis was carried out using a stepwise method to determine the predictors of 12 domains and the total score of the SS-QoL. The domains of work, social roles, mobility, and self-care had the lowest SS-QoL scores, whereas the highest scores were for the domains of personality, thinking, language, and vision. The total SS-QoL score was explained by the total FIM and Mini-Mental State Examination. Among the 12 domains, the mobility domain was explained the best (R=0.50) by motor FIM, previously received rehabilitation, and age, followed by the language domain (R=0.37) explained by the presence of aphasia and dysarthria, and previously received rehabilitation. The domains of mood (R=0.13) and upper extremity (R=0.19) were explained the worst. The results indicated that functional independence, age, cognitive status, and receiving a rehabilitation program were the primary determinants of the SS-QoL.

  11. Motor Imagery Ability in Children with Congenital Hemiplegia: Effect of Lesion Side and Functional Level

    Science.gov (United States)

    Williams, Jacqueline; Reid, Susan M.; Reddihough, Dinah S.; Anderson, Vicki

    2011-01-01

    In addition to motor execution problems, children with hemiplegia have motor planning deficits, which may stem from poor motor imagery ability. This study aimed to provide a greater understanding of motor imagery ability in children with hemiplegia using the hand rotation task. Three groups of children, aged 8-12 years, participated: right…

  12. [Heat stroke related to the use of topiramate. The importance of prevention].

    Science.gov (United States)

    Rosich Del Cacho, M; Pareja Grande, J; Martínez Jiménez, M D; Latorre Latorre, J F; Bejarano Ramírez, N; López-Menchero Oliva, C

    2014-09-01

    Heat stroke is the most severe pathology related to heat. It is defined as an increase in core body temperature accompanied by signs of neurological dysfunction. In the absence of an early treatment, it has a very high mortality rate. Topiramate is a well known drug widely used in epilepsy treatment and migraine prevention. Oligohydrosis has been described amongst topiramate side effects, favouring the risk of hyperthermia and heatstroke. We present the case of a patient who developed heat stroke due to physical exercise while under topiramate treatment. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  13. Stroke education using an animated cartoon and a manga for junior high school students.

    Science.gov (United States)

    Shigehatake, Yuya; Yokota, Chiaki; Amano, Tatsuo; Tomii, Yasuhiro; Inoue, Yasuteru; Hagihara, Takaaki; Toyoda, Kazunori; Minematsu, Kazuo

    2014-07-01

    We investigated whether junior high school students could be educated regarding stroke with an animated cartoon and a Manga that we produced for the purpose of dissemination of this knowledge. We produced a 10-minute animated cartoon and a Manga that provided information regarding stroke risk factors, stroke signs and symptoms, and awareness to immediately contact emergent medical service (EMS) on identification of stroke signs and symptoms. From December 2011 to March 2012, 493 students in 15 classes of the first grade (age 12-13 years) of 3 junior high schools were enrolled in the study. Each subject watched the animated cartoon and read the Manga; this was referred to as "training." Lessons about stroke were not given. Questionnaires on stroke knowledge were evaluated at baseline, immediately after the training, and 3 months after the training. The proportion of correct answers given immediately after the training was higher for all questions, except those related to arrhythmia, compared with baseline. Percentage of correct answers given at 3 months was higher than that at baseline in questions related to facial palsy (75% versus 33%), speech disturbance (91% versus 60%), hemiplegia (79% versus 52%), numbness of 1 side (58% versus 51%), calling for EMS (90% versus 85%), alcohol intake (96% versus 72%), and smoking (69% versus 54%). At 3 months after the training, 56% of students answered the FAST (facial droop, arm weakness, speech disturbance, time to call for EMS) mnemonic correctly. Stroke education using these teaching aids of the animated cartoon and the Manga improved stroke knowledge in junior high school students. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke

    NARCIS (Netherlands)

    Gerrits, K.H.L.; Beltman, M.J.; Koppe, P.A.; Konijnenbelt, H.; Elich, P.D.; de Haan, A.; Janssen, T.W.J.

    2009-01-01

    Gerrits KH, Beltman MJ, Koppe PA, Konijnenbelt H, Elich PD, de Haan A, Janssen TW. Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke. Objective: (1) To examine the isometric strength, speed, and fatigue resistance of the knee extensors

  15. Stroke-Related Knowledge, Lifestyle Behaviours and Health Beliefs in Singaporean Chinese: Implications for Health Education

    Science.gov (United States)

    Wong, Wai Pong; Yeung, Meredith; Loh, Susan; Lee, Mina; Ghazali, F.; Chan, C. J.; Feng, S.; Liew, Y. V.; Seah, P. F.; Wee, J.; Wang, J.; Huang, X.; Dean, Elizabeth

    2013-01-01

    Objective: The objective of the present study was to describe stroke-related knowledge (risk factors, warning signs and emergency response), lifestyle behaviours and health beliefs among Singaporean Chinese, and to identify any factors associated with such knowledge, behaviours and beliefs. Design: This was a cross-sectional study design employing…

  16. Co-55-PET in stroke : relation to bloodflow, oxygen metabolism and gadolinium-MRI

    NARCIS (Netherlands)

    Stevens, H; Jansen, HML; DeReuck, J; Lemmerling, M; Strijckmans, K; Goethals, P; Lemahieu, [No Value; DeJong, BM; Willemsen, ATM; Korf, J

    BACKGROUND: Several studies have shown the feasibility of Co-isotopes (Co-55 and Co-57) in imaging of neuronal damage in stroke, multiple sclerosis, cerebral tumors and trauma. These studies indicate that Co-isotopes allow visualization of brain pathology related to inflammatory processes, reactive

  17. Biomarkers related to carotid intima-media thickness and plaques in long-term survivors of ischemic stroke

    OpenAIRE

    Waje-Andreassen, Ulrike; Næss, Halvor; Thomassen, Lars; Marøy, Tove Helene; Mazengia, Kibret Yimer; Eide, Geir Egil; Vedeler, Christian A.

    2015-01-01

    Lifestyle risk factors, inflammation and genetics play a role in the development of atherosclerosis. We therefore studied Fc gamma receptor (FcγR) polymorphisms, interleukin (IL)-10 polymorphisms and other biomarkers related to carotid intima-media thickness (cIMT) in patients with ischemic stroke at a young age. Patients were evaluated 12 years after stroke occurrence. Patients (n = 232) 49 years of age or younger with an index stroke between 1988 and 1997 were retrospectively selected. Bloo...

  18. Aphasia and right hemiplegia after cervical myelography with metrizamide

    International Nuclear Information System (INIS)

    Angiari, P.; Merli, G.A.; Crisi, G.

    1984-01-01

    We report a case of aphasia and right hemiplegia, developing after myelography with metrizamide and lasting for an unusually long time. The neurological disorders, manifested 1 h after the examination was completed, were due to accidental passage of contrast medium into the basal cisterns. In the light of analogous case reports in the literature, as well as experimental data concerning the biochemical activity of metrizamide, possible aetiopathogenetic mechanisms responsible for such disturbances are indicated. The authors underline the lack of effective therapeutic measures after the onset of the disorders, and thus the importance of preventing such complications that behave functionally as true ictuses although with no anatomic substratum. (orig.)

  19. Pontine tegmentum hematoma: report of a case with pure hemiplegia

    Directory of Open Access Journals (Sweden)

    MILAGRES ANTONIO CARLOS DE PÁDUA

    1998-01-01

    Full Text Available The authors report the case of a 50 year-old hypertensive male patient with a pontine hematoma. The clinical presentation was characterized by pure pyramidal deficit signs (no other signs or symptoms were present. A pure hemiplegia syndrome, although common in supratentorial lesions, is considered to be a rare event in pontine vascular lesions. The pathophysiologic mechanisms of these neurological findings are unclear. The exclusive involvement of the pyramidal tract in this case is likely due to a variation in the vascular anatomy of the pons but, in some cases, a vascular malformation may be the cause.

  20. An overview of communication, movement and perception difficulties after stroke.

    Science.gov (United States)

    Dark, Joanna; Sander, Ruth

    2014-06-01

    For many people who have had a stroke, weakness or paralysis on one side - hemiparesis or hemiplegia - is the most obvious symptom. However, brain damage, including stroke, can cause a range of impairments that may be less obvious but equally devastating for people and their families. This article provides an overview of communication, movement and perception difficulties, and the strategies nurses can use to help people cope with any changes to their lives.

  1. [Visual dependence after recent stroke].

    Science.gov (United States)

    Bonan, I; Derighetti, F; Gellez-Leman, M-C; Bradaï, N; Yelnik, A

    2006-05-01

    After chronic stroke, inability to use pertinent somatosensory or vestibular information have been described. The aim of the study was to determine whether visual dependence occurred early after stroke before rehabilitation. Thirty patients with recent hemiplegia (16 right and 14 left hemispheric stroke) performed the rod and frame test (RFT). Patients were asked to adjust the rod to the vertical position under 3 conditions: basically, with a frame tilted 18 degrees to the right and then with the frame tilted to the left. Bias in each condition (mean, SD) was recorded and compared to adjustments of the rod by 23 controls. Motor control, sensibility, functional level (functional independence measure), age, neglect, and then balance by the postural assessment scale for stroke were assessed. Fifty-six per cent (17/30) of patients but only 26% of controls were influenced by the tilt of the frame on the 2 sides (visual dependence). No correlation was found between visual dependence and the characteristics of the patients. Many patients with recent hemiplegia seem to rely on visual input. The mechanisms of such visual dependence are discussed. Rehabilitation programs should take into account the possible impairment of sensory organisation and should include exercises to be performed under visual disturbances.

  2. The relation between knowledge about hypertension and education in hospitalized patients with stroke in Vienna.

    Science.gov (United States)

    Samal, Doris; Greisenegger, Stefan; Auff, Eduard; Lang, Wilfried; Lalouschek, Wolfgang

    2007-04-01

    Knowledge about hypertension and its control influences blood pressure control in patients with hypertension. We assessed these parameters in a large cohort of patients with ischemic stroke or transient ischemic attack and analyzed their association with educational attainment. Five hundred ninety-one consecutive patients with stroke with a medical history of hypertension were interviewed about knowledge concerning hypertension within a multicenter hospital-based stroke registry. We analyzed answers in relation to educational level with multivariate logistic regression adjusted for age and sex. Seventy-seven percent of the patients stated to have known about hypertension being a risk factor for stroke, but only 30% felt at increased risk of stroke. Less than half (47%) could identify 140 mm Hg or less as the maximum tolerated systolic blood pressure, and 53% had their blood pressure only controlled monthly or less often. Knowledge of possible consequences of myocardial infarction, nephropathy, peripheral vascular disease, and retinopathy was 64%, 20%, 11%, and 16%, respectively. Approximately half of patients were acquainted with the nonpharmacologic treatment options of physical activity (49%), reduction of salt intake (54%), and reduction of caloric intake (48%), whereas relaxation techniques were only known to 17%. Adherence to those treatment options ranged from 42% to 67%. Educational level was significantly associated with knowledge of increased risk, possible consequences of hypertension, and knowledge about nonmedication treatment options. Knowledge in our population was insufficient and partly associated with educational level, leaving much room for improvement by educational campaigns. Furthermore, we found a gap between knowledge of the increased risk for stroke in patients with hypertension and awareness of their own risk.

  3. 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.

  4. Relation between intracranial artery calcifications and aortic atherosclerosis in ischemic stroke patients.

    Science.gov (United States)

    Bugnicourt, Jean-Marc; Chillon, Jean-Marc; Tribouilloy, Christophe; Canaple, Sandrine; Lamy, Chantal; Massy, Ziad A; Godefroy, Olivier

    2010-08-01

    We previously demonstrated a strong relation between carotid atherosclerosis (defined as carotid artery stenosis > or =50%) and intracranial artery calcification (IAC) in ischemic stroke patients. The purpose of this study was to evaluate the relation between aortic atherosclerosis and IAC. Four hundred fifty-four patients with ischemic stroke were included. Complex aortic plaques (CAP) were assessed by transesophageal echocardiography (TEE) and defined as plaques > or =4 mm thick or with mobile components in the proximal aorta. IAC were assessed in the seven major cerebral arteries and a semiquantitative score system was applied, ranging from 0 (no calcification) to 7. Forty-two patients (9.3%) had CAP. Patients with CAP were older compared with patients without CAP (73.6 vs. 63.6 years, p vs. 1.8; p stroke or TIA (OR 3.3; 95%CI 1.5-7.0; p = 0.002), carotid artery stenosis > or =50% (OR 3.7; 95%CI 1.7-8.0; p = 0.001), chronic kidney disease (OR 3.8; 95%CI 1.9-7.8; p stroke patients, the absence of IAC strongly points to the lack of CAP. However, these results warrant confirmation in prospective studies before concluding the non-utility of the use of TEE to exclude CAP as a potential source of cerebral embolism in patients without IAC.

  5. Sleep deprivation before stroke is neuroprotective: a pre-ischemic conditioning related to sleep rebound.

    Science.gov (United States)

    Cam, E; Gao, B; Imbach, L; Hodor, A; Bassetti, C L

    2013-09-01

    We have previously shown in a rat model of focal cerebral ischemia that sleep deprivation after stroke onset aggravates brain damage. Others reported that sleep deprivation prior to stroke is neuroprotective. The main aim of this study was to test the hypothesis that the neuroprotection may be related to an increase in sleep (sleep rebound) during the acute phase of stroke. Male Sprague Dawley rats (n=36) were subjected to continuous polygraphic recordings for baseline, total sleep deprivation (TSD), and 24h after ischemia. TSD for 6h was performed by gentle handling and immediately followed by ischemia. Focal cerebral ischemia was induced by permanent occlusion of distal branches of the middle cerebral artery. Control experiments included ischemia without SD (nSD) and sham surgery with TSD (n=6/group). Shortly after stroke, the amount of slow wave sleep (SWS) and paradoxical sleep (PS) increased significantly (psleep time by 30% compared to baseline, or by 20% compared with the nSD/ischemia group. The infarct volume decreased significantly by 50% in the TSD/ischemia compared to nSD group (psleep rebound by allowing TSD-rats sleep for 24h before ischemia eliminated the reduction in the infarct size. Sleep deprivation results in sleep rebound and reduces brain damage. Sleep rebound may be causally related to the neuroprotection. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Somatosensory system hyperexcitability in alternating hemiplegia of childhood.

    Science.gov (United States)

    Vollono, C; Rinalduzzi, S; Miliucci, R; Vigevano, F; Valeriani, M

    2014-12-01

    Alternating hemiplegia of childhood (AHC) is a rare neurological disease characterized by recurrent paroxysmal attacks of hemiplegia. The aim of the study was to assess the recovery cycle of the somatosensory evoked potentials (SEPs) in a group of AHC patients. Seven AHC patients and 10 control age-matched subjects (CS) were recruited. Right and left median nerve SEPs were recorded. The somatosensory system excitability was assessed by calculating the SEP changes after paired electrical stimuli. All patients were studied during the interictal phase, whilst four patients were studied also during the ictal phase. In AHC patients during the interictal phase, the amplitudes of the cervical N13 and of the cortical N20, P24 and N30 responses showed a faster recovery than in CS. In AHC patients during the ictal phase, the cortical N20 recovery cycle was prolonged compared with the interictal phase. A shortened SEP recovery cycle in AHC during the interictal phase suggests multilevel somatosensory system hyperexcitability in AHC. A partial recovery of this phenomenon during the ictal phase possibly reflects a functional reset of the somatosensory system. Overall, there is a disinhibition of the somatosensory system in AHC, a functional change of brain function associated with a possible involvement of the Na(+) /K(+) channels. This abnormality and its partial recovery during the attacks might be linked to the pathophysiological and genetic mechanisms of the disease. © 2014 EAN.

  7. Motor function domains in alternating hemiplegia of childhood.

    Science.gov (United States)

    Masoud, Melanie; Gordon, Kelly; Hall, Amanda; Jasien, Joan; Lardinois, Kara; Uchitel, Julie; Mclean, Melissa; Prange, Lyndsey; Wuchich, Jeffrey; Mikati, Mohamad A

    2017-08-01

    To characterize motor function profiles in alternating hemiplegia of childhood, and to investigate interrelationships between these domains and with age. We studied a cohort of 23 patients (9 males, 14 females; mean age 9y 4mo, range 4mo-43y) who underwent standardized tests to assess gross motor, upper extremity motor control, motor speech, and dysphagia functions. Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure-88 (GMFM-88), Manual Ability Classification System (MACS), and Revised Melbourne Assessment (MA2) scales manifested predominantly mild impairments; motor speech, moderate to severe; Modified Dysphagia Outcome and Severity Scale (M-DOSS), mild-to moderate deficits. GMFCS correlated with GMFM-88 scores (Pearson's correlation, p=0.002), MACS (p=0.038), and MA2 fluency (p=0.005) and accuracy (p=0.038) scores. GMFCS did not correlate with motor speech (p=0.399), MA2 dexterity (p=0.247), range of motion (p=0.063), or M-DOSS (p=0.856). Motor speech was more severely impaired than the GMFCS (pprofile of motor function in alternating hemiplegia of childhood, argue against the presence of worse motor function in older patients, identify tools helpful in evaluating this population, and identify oropharyngeal function as the more severely affected domain, suggesting that brain areas controlling this function are more affected than others. © 2017 Mac Keith Press.

  8. Cross-sectional analysis of cognitive impairment and relative factors after acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    ZHOU Yu-ying

    2013-04-01

    Full Text Available Background Acute ischemic stroke may decline cognitive function and induce vascular dementia (VaD. In early identification of vascular cognitive impairment (VCI, active searching for relevant factors, effective and timely treatment can reduce or even prevent further decline of cognitive function. The purpose of this study is to investigate the cognitive impairment after acute ischemic stroke and its associated factors. Methods A total of 314 cases of acute ischemic stroke patients were recruited in this study. The Montreal Cognitive Assessment (MoCA was used to evaluate the degree of cognitive impairment. The American National Institutes of Health Stroke Scale (NIHSS was used to evaluate the extent of neurological deficit. The Barthel Index (BI was used to evaluate activities of daily living. Hamilton Depression Rating Scale (HAMD was used to evaluate the patients' mental or emotional state. Results Based on the examination results, post-stroke cognitive impairment (PSCI group were less educated ( P = 0.000 with lower BI score ( P = 0.008, higher HAMD score and higher NIHSS score ( P = 0.000, for all, and elevated serum high-sensitivity C-reactive protein (hs-CRP, P = 0.002 and glycosylated hemoglobin A1c (HbA1c levels (P = 0.005 than those in post-stroke no cognitive impairment (PSNCI group. In PSCI group, the concentration of serum hs-CRP and HbA1c, NIHSS and HAMD scores were negatively correlated with the MoCA rating (P < 0.05, for all; whereas, BI score was positively correlated with the MoCA rating (P < 0.05. The subjects in PSCI group had more cortical ischemic vascular disease (CIVD and left hemisphere ischemic vascular disease (LHIVD than subjects in PSNCI group ( P < 0.05. Logistic regression analysis indicated that lower education, history of diabetes, higher HAMD score, higher serum hs-CRP and HbA1c levels were independent risk factors for PSCI. Conclusion Cognitive impairment after acute ischemic stroke may be closely related to

  9. 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

  10. 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.

  11. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    OpenAIRE

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after stroke (17 men) were compared with 10 healthy age-matched control subjects. Using an electromagnetic tracking device, the kinematics of both the contralateral and ipsilateral (i.e. paretic and non-paret...

  12. Polyphenols and Oxidative Stress in Atherosclerosis-Related Ischemic Heart Disease and Stroke

    OpenAIRE

    Cheng, Yu-Chen; Sheen, Jer-Ming; Hu, Wen Long; Hung, Yu-Chiang

    2017-01-01

    Good nutrition could maintain health and life. Polyphenols are common nutrient mainly derived from fruits, vegetables, tea, coffee, cocoa, mushrooms, beverages, and traditional medicinal herbs. They are potential substances against oxidative-related diseases, for example, cardiovascular disease, specifically, atherosclerosis-related ischemic heart disease and stroke, which are health and economic problems recognized worldwide. In this study, we reviewed the risk factors for atherosclerosis, i...

  13. Trajectories of health-related quality of life after stroke : results from a one-year prospective cohort study

    NARCIS (Netherlands)

    van Mierlo, Maria; van Heugten, Caroline; Post, Marcel W M; Hoekstra, Trynke; Visser-Meily, Anne

    2018-01-01

    PURPOSE: To identify trajectories of physical and psychosocial health-related quality of life (HRQoL) from two months to one-year post stroke and to determine the factors that are associated with trajectory membership. METHOD: Multicenter prospective cohort study in which 351 stroke patients were

  14. [Efficacy of interventions with video games consoles in stroke patients: a systematic review].

    Science.gov (United States)

    Ortiz-Huerta, J H; Perez-de-Heredia-Torres, M; Guijo-Blanco, V; Santamaria-Vazquez, M

    2018-01-16

    In recent years video games and games consoles have been developed that are potentially useful in rehabilitation, which has led to studies conducted to evaluate the degree of efficacy of these treatments for people following a stroke. To analyse the literature available related to the effectiveness of applying video games consoles in the functional recovery of the upper extremities in subjects who have survived a stroke. A review of the literature was conducted in the CINHAL, Medline, PEDro, PsycArticles, PsycInfo, Science Direct, Scopus and Web of Science databases, using the query terms 'video game', 'stroke', 'hemiplegia', 'upper extremity' and 'hemiparesis'. After applying the eligibility criteria (clinical trials published between 2007 and 2017, whose participants were adults who had suffered a stroke with involvement of the upper extremity and who used video games), the scientific quality of the selected studies was rated by means of the PEDro scale. Eleven valid clinical trials were obtained for the systematic review. The studies that were selected, all of which were quantitative, presented different data and the inferential results indicated different levels of significance between control and experimental groups (82%) or between the different types of treatment (18%). The use of video games consoles is a useful complement for the conventional rehabilitation of the upper extremities of persons who have survived a stroke, since it increases rehabilitation time and enhances the recovery of motor functioning. Nevertheless, homogeneous intervention protocols need to be implemented in order to standardise the intervention.

  15. Balance training using an interactive game to enhance the use of the affected side after stroke.

    Science.gov (United States)

    Ciou, Shih-Hsiang; Hwang, Yuh-Shyan; Chen, Chih-Chen; Chen, Shih-Ching; Chou, Shih-Wei; Chen, Yu-Luen

    2015-12-01

    [Purpose] Stroke and other cerebrovascular diseases are major causes of adult mobility problems. Because stroke immobilizes the affected body part, balance training uses the healthy body part to complete the target movement. The muscle utilization rate on the stroke affected side is often reduced which further hinders affected side functional recovery in rehabilitation. [Subjects and Methods] This study tested a newly-developed interactive device with two force plates to measuring right and left side centers of pressure, to establish its efficacy in the improvement of the static standing ability of patients with hemiplegia. An interactive virtual reality game with different side reaction ratios was used to improve patient balance. The feasibility of the proposed approach was experimentally demonstrated. [Results] Although the non-affected-side is usually used to support the body weight in the standing position, under certain circumstances the patients could switch to using the affected side. A dramatic improvement in static standing balance control was achieved in the eyes open condition. [Conclusion] The proposed dual force plate technique used in this study separately measured the affected and non-affected-side centers of pressure. Based on this approach, different side ratio integration was achieved using an interactive game that helped stroke patients improve balance on the affected side. Only the patient who had suffered stroke relatively recently benefited significantly. The proposed technique is of little benefit for patients whose mobility has stagnated to a certain level.

  16. Event related desynchronization-modulated functional electrical stimulation system for stroke rehabilitation: A feasibility study

    Directory of Open Access Journals (Sweden)

    Takahashi Mitsuru

    2012-08-01

    Full Text Available Abstract Background We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD reflecting motor intent was continuously detected from the primary cortical motor area. Methods We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation. The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation. Results After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone. Conclusions The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients.

  17. Impact of light rail transit on traffic-related pollution and stroke mortality.

    Science.gov (United States)

    Park, Eun Sug; Sener, Ipek Nese

    2017-09-01

    This paper evaluates the changes in vehicle exhaust and stroke mortality for the general public residing in the surrounding area of the light rail transit (LRT) in Houston, Texas, after its opening. The number of daily deaths due to stroke for 2002-2005 from the surrounding area of the original LRT line (exposure group) and the control groups was analyzed using an interrupted time-series analysis. Ambient concentrations of acetylene before and after the opening of LRT were also compared. A statistically significant reduction in the average concentration of acetylene was observed for the exposure sites whereas the reduction was negligible at the control site. Poisson regression models applied to the stroke mortality data indicated a significant reduction in daily stroke mortality after the opening of LRT for the exposure group, while there was either an increase or a considerably smaller reduction for the control groups. The findings support the idea that LRT systems provide health benefits for the general public and that the reduction in motor-vehicle-related air pollution may have contributed to these health benefits.

  18. High-sensitivity C-reactive protein, lipoprotein-related phospholipase A2, and acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Kara H

    2014-08-01

    Full Text Available Hasan Kara,1 Murat Akinci,1 Selim Degirmenci,1 Aysegul Bayir,1 Ahmet Ak,1 Alaaddin Nayman,2 Ali Unlu,3 Fikret Akyurek,3 Mesut Sivri2 1Department of Emergency Medicine, 2Department of Radiology, 3Department of Biochemistry, Faculty of Medicine, Selçuk University, Konya, Turkey Background: Serum biomarkers may be useful for early diagnosis of acute ischemic stroke, exclusion of other diseases that may mimic stroke, and prediction of infarct volume. We evaluated serum high-sensitivity C-reactive protein (hs-CRP and lipoprotein-related phospholipase A2 (Lp-PLA2 in patients who had acute ischemic stroke.Methods: In 200 patients who presented to an emergency service (acute ischemic stroke, 102 patients; control with no stroke, 98 patients, stroke patients were evaluated with the Canadian neurological scale and diffusion-weighted magnetic resonance imaging, and all patients were evaluated with the Glasgow coma scale and their serum hs-CRP level and Lp-PLA2 activity were assessed. The volume of stroke lesions was calculated from magnetic resonance images.Results: Patients who had stroke had higher mean serum hs-CRP level (stroke, 7±6 mg/dL; ­control, mean ± standard deviation 1±1 mg/dL; P≤0.001 and Lp-PLA2 activity (stroke, mean ± standard deviation 113±86 nmol/min/mL; control, mean ± standard deviation 103±50 nmol/min/mL; P≤0.001 than control patients who did not have stroke. The mean hs-CRP level and Lp-PLA2 activity were higher in patients who had greater stroke severity (lower Canadian neurological scale score and were higher in patients who had larger volume strokes. Conclusion: Higher hs-CRP level and Lp-PLA2 activity are significantly associated with more severe neurologic impairment and larger infarct size in patients who have acute ischemic stroke. These biomarkers may be useful for rapid diagnosis and prediction of ischemic tissue volume in the early stage of ischemic stroke. These findings may be important for health

  19. Influence of Sociodemographic and Stroke-related Factors on Availability of Social Support among Nigerian Stroke Survivors.

    Science.gov (United States)

    Vincent-Onabajo, G O; Muhammad, M M; Ali, M Usman; Masta, M Ali

    2015-01-01

    Availability of social support has been identified as an important prerequisite for positive outcomes after stroke. There is however, little information on variables that influence the availability of social support after stroke. This study explored the influence of selected sociodemographic and clinical variables on social support of stroke survivors in Nigeria. One hundred stroke survivors undergoing rehabilitation at two tertiary-care hospitals in Northern Nigeria participated in the study. Data on age, gender, living arrangement, marital, education and prestroke employment status, and time after stroke were obtained through interview, while poststroke disability was evaluated with the modified Rankin Scale. Social support was assessed with the multidimensional scale of perceived social support (MSPSS). Univariate and multiple linear regression analyses were conducted. A P value of less than 0.05 is considered as significant. Univariate analysis showed that gender, education, and prestroke employment status were significantly associated with the availability of social support. In a regression model that accounted for 11 % of the variance in social support, prestroke employment was the only variable that independently influenced availability of social support (β = -0.33, P social network and was also found to influence significantly, the availability of poststroke social support in this study. Further studies are required to identify factors that more substantially influence the availability of social support after stroke.

  20. Alternating hemiplegia of childhood and a pathogenic variant of ATP1A3

    DEFF Research Database (Denmark)

    Pavlidis, Elena; Uldall, Peter; Gøbel Madsen, Camilla

    2017-01-01

    We describe a case of a child suffering from alternating hemiplegia with a heterozygous p. E815K pathogenic variant of ATP1A3. The patient started to present abnormal eye movements in the first days of life, followed by the appearance at 2 months of dystonic episodes, and later on, by recurrent...... prominently affected by the pathogenetic abnormalities underlying alternating hemiplegia of childhood, rendering it more prone to early ischaemic lesions and recurrent unilateral status epilepticus. We speculate whether alternating hemiplegia of childhood shares some common pathophysiological mechanisms...

  1. Preliminary evaluations related to the ranges of hematological and biochemical variables in hospitalized patients with stroke

    Directory of Open Access Journals (Sweden)

    Ahmad Chitsaz

    2013-01-01

    Conclusions: Any considerable alter in patients′ biochemical and hematological figures (BS, Hgb, Plt and Lymph may necessitate further attention related to inter- and intra-individual variability in clinical supervision and drug′s assortment. Therefore, success in treatment could be achieved by the close management of clinical, biochemical, hematological, and pharmacological manifestation. To reduce disability, mortality, and morbidity in Iranian stroke population further clinical studies are needed to correlate drugs and laboratory markers to associated clinical events in order.

  2. Temporal profile of body temperature in acute ischemic stroke: relation to infarct size and outcome.

    Science.gov (United States)

    Geurts, Marjolein; Scheijmans, Féline E V; van Seeters, Tom; Biessels, Geert J; Kappelle, L Jaap; Velthuis, Birgitta K; van der Worp, H Bart

    2016-11-21

    High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute ischemic stroke. In 419 patients with acute ischemic stroke we assessed the relation between body temperature on admission and during the first 3 days with both infarct size and functional outcome. Infarct size was measured in milliliters on CT or MRI after 3 days. Poor functional outcome was defined as a modified Rankin Scale score ≥3 at 3 months. Body temperature on admission was not associated with infarct size or poor outcome in adjusted analyses. By contrast, each additional 1.0 °C in body temperature on day 1 was associated with 0.31 ml larger infarct size (95% confidence interval (CI) 0.04-0.59), on day 2 with 1.13 ml larger infarct size(95% CI, 0.83-1.43), and on day 3 with 0.80 ml larger infarct size (95% CI, 0.48-1.12), in adjusted linear regression analyses. Higher peak body temperatures on days two and three were also associated with poor outcome (adjusted relative risks per additional 1.0 °C in body temperature, 1.52 (95% CI, 1.17-1.99) and 1.47 (95% CI, 1.22-1.77), respectively). Higher peak body temperatures during the first days after ischemic stroke, rather than on admission, are associated with larger infarct size and poor functional outcome. This suggests that prevention of high temperatures may improve outcome if continued for at least 3 days.

  3. Relative effects of statin therapy on stroke and cardiovascular events in men and women: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Study

    DEFF Research Database (Denmark)

    Goldstein, L.B.; Amarenco, P.; Lamonte, M.

    2008-01-01

    similarly benefited from randomization to statin treatment. METHODS: The effect of sex on treatment-related reductions in stroke and other cardiovascular outcomes were analyzed with Cox regression modeling testing for sex by treatment interactions. RESULTS: Women (n=1908) constituted 40% of the SPARCL study...

  4. Evaluation of ideomotor apraxia in patients with stroke: a study of reliability and validity.

    Science.gov (United States)

    Kaya, Kurtulus; Unsal-Delialioglu, Sibel; Kurt, Murat; Altinok, Nermin; Ozel, Sumru

    2006-03-01

    This aim of this study was to determine the reliability and validity of an established ideomotor apraxia test when applied to a Turkish stroke patient population and to healthy controls. The study group comprised 50 patients with right hemiplegia and 36 with left hemiplegia, who had developed the condition as a result of a cerebrovascular accident, and 33 age-matched healthy subjects. The subjects were evaluated for apraxia using an established ideomotor apraxia test. The cut-off value of the test and the reliability coefficient between observers were determined. Apraxia was found in 54% patients with right hemiplegia (most being severe) and in 25% of left hemiplegic patients (most being mild). The apraxia scores for patients with right hemiplegia were found to be significantly lower than for those with left hemiplegia and for healthy subjects. There was no statistically significant difference between patients with left hemiplegia and healthy subjects. It was shown that the ideomotor apraxia test could distinguish apraxic from non-apraxic subjects. The reliability coefficient among observers in the study was high and a reliability study of the ideomotor apraxia test was therefore performed.

  5. Calculation of prevalence estimates through differential equations: application to stroke-related disability.

    Science.gov (United States)

    Mar, Javier; Sainz-Ezkerra, María; Moler-Cuiral, Jose Antonio

    2008-01-01

    Neurological diseases now make up 6.3% of the global burden of disease mainly because they cause disability. To assess disability, prevalence estimates are needed. The objective of this study is to apply a method based on differential equations to calculate the prevalence of stroke-related disability. On the basis of a flow diagram, a set of differential equations for each age group was constructed. The linear system was solved analytically and numerically. The parameters of the system were obtained from the literature. The model was validated and calibrated by comparison with previous results. The stroke prevalence rate per 100,000 men was 828, and the rate for stroke-related disability was 331. The rates steadily rose with age, but the group between the ages of 65 and 74 years had the highest total number of individuals. Differential equations are useful to represent the natural history of neurological diseases and to make possible the calculation of the prevalence for the various states of disability. In our experience, when compared with the results obtained by Markov models, the benefit of the continuous use of time outweighs the mathematical requirements of our model. (c) 2008 S. Karger AG, Basel.

  6. No Relation between Body Temperature and Arterial Recanalization at Three Days in Patients with Acute Ischaemic Stroke

    NARCIS (Netherlands)

    Geurts, Marjolein; van der Worp, HB; Horsch, Alexander D.; Kappelle, L. Jaap; Biessels, Geert J.; Velthuis, BK

    2015-01-01

    Background Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods We included 278 patients with acute ischaemic stroke within nine hours after

  7. No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

    NARCIS (Netherlands)

    M. Geurts (Marjolein); H.B. Van Der Worp (H. Bart); A.D. Horsch (Alexander D.); L.J. Kappelle (Jaap); G.J. Biessels (Geert Jan); B.K. Velthuis (Birgitta); C.B. Majoie (Charles); Y.B.W.E.M. Roos; L.E.M. Duijm (Lucien); K. Keizer (Koos); A. van der Lugt (Aad); D.W.J. Dippel (Diederik); K.E. Droogh-De Greve; H.P. Bienfait (Henri); M.A.A. van Walderveen (Marianne); M.J.H. Wermer (Marieke); G.J. Lycklama à Nijeholt (Geert); J. Boiten (Jelis); A. Duyndam (Anita); V.I.H. Kwa; F.J. Meijer (F.); E.J. van Dijk (Ewoud); A.M. Kesselring (Anouk); J. Hofmeijer; J.A. Vos (Jan Albert); W.J. Schonewille (Wouter); W.J. van Rooij (W.); P.L.M. de Kort (Paul); C.C. Pleiter (C.); S.L.M. Bakker (Stef); J. Bot (Joseph); M.C. Visser (Marieke); I.C. van der Schaaf (Irene); J.W. Dankbaar (Jan); W.P. Mali (Willem); T. van Seeters (Tom); A.D. Horsch (Alexander D.); J.M. Niesten (Joris); G.J. Biessels; L.J. Kappelle; J.S.K. Luitse; Y. van der Graaf (Yolanda)

    2015-01-01

    textabstractBackground: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine

  8. Stroke in relation to use of raloxifene and other drugs against osteoporosis

    DEFF Research Database (Denmark)

    Vestergaard, P; Schwartz, K; Pinholt, E M

    2011-01-01

    Prior studies have associated fatal stroke with raloxifene. In a cohort study, we found no excess risk of stroke with raloxifene; whereas, an excess risk of stroke and fatal stroke was seen with alendronate and etidronate. However, the excess risks were small....

  9. Which is better in the rehabilitation of stroke patients, core stability exercises or conventional exercises?

    Science.gov (United States)

    Sun, Xibo; Gao, Qian; Dou, Honglei; Tang, Shujie

    2016-04-01

    [Purpose] The aim of this study was to determine which is better in the rehabilitation of stroke patients, core stability exercises or conventional exercises. [Subjects and Methods] Forty participants with hemiplegia were recruited in the Department of Neurology of Yidu Central Hospital of Weifang between January 2014 and February 2015 and randomly divided into either an experimental or control group. The patients in the control group performed conventional exercises for six weeks, and those in the experiment group performed core stability exercises for six weeks. The outcomes were evaluated using Modified Barthel Index and Berg Balance Scale. [Results] After treatment, the Modified Barthel Index and Berg Balance Scale were significantly increased in both groups when compared with the baseline. The Modified Barthel Index was significantly lower in the control group compared with the experimental group. The Berg Balance Scale scores in the control group were relatively lower than those in the experimental group, but there was no significant difference between the two groups. [Conclusion] Core stability exercises have a better effect on patients with hemiplegia than conventional exercises.

  10. Relative contribution of different altered motor unit control to muscle weakness in stroke: a simulation study

    Science.gov (United States)

    Shin, Henry; Suresh, Nina L.; Zev Rymer, William; Hu, Xiaogang

    2018-02-01

    Objective. Chronic muscle weakness impacts the majority of individuals after a stroke. The origins of this hemiparesis is multifaceted, and an altered spinal control of the motor unit (MU) pool can lead to muscle weakness. However, the relative contribution of different MU recruitment and discharge organization is not well understood. In this study, we sought to examine these different effects by utilizing a MU simulation with variations set to mimic the changes of MU control in stroke. Approach. Using a well-established model of the MU pool, this study quantified the changes in force output caused by changes in MU recruitment range and recruitment order, as well as MU firing rate organization at the population level. We additionally expanded the original model to include a fatigue component, which variably decreased the output force with increasing length of contraction. Differences in the force output at both the peak and fatigued time points across different excitation levels were quantified and compared across different sets of MU parameters. Main results. Across the different simulation parameters, we found that the main driving factor of the reduced force output was due to the compressed range of MU recruitment. Recruitment compression caused a decrease in total force across all excitation levels. Additionally, a compression of the range of MU firing rates also demonstrated a decrease in the force output mainly at the higher excitation levels. Lastly, changes to the recruitment order of MUs appeared to minimally impact the force output. Significance. We found that altered control of MUs alone, as simulated in this study, can lead to a substantial reduction in muscle force generation in stroke survivors. These findings may provide valuable insight for both clinicians and researchers in prescribing and developing different types of therapies for the rehabilitation and restoration of lost strength after stroke.

  11. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement

    DEFF Research Database (Denmark)

    Aadal, Lena; Angel, Sanne; Langhorn, Leanne

    2017-01-01

    and the relatives and support the interaction between the patient and the relatives. Four themes occurred: the changed lives of relatives; shared life after stroke; noncooperating relatives; time for the relatives. CONCLUSION: Nurses experience their roles and functions addressing relatives after stroke as crucial...... to the patient. Caregivers require nurse assistance, support and to be seen as an essential partner in the care giving process. However, the nurses do not perceive that teaching of relatives is a task they should routinely undertake. This might indicate an ambiguity between the relatives' expectations...... and the actual contribution from nurses. AIM: This study describes nurses' experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation. METHODOLOGICAL DESIGN: A phenomenological hermeneutic approach influenced by Paul Ricoeur. In a secondary analysis focus...

  12. Sex-related time-dependent variations in post-stroke survival-evidence of a female stroke survival advantage

    DEFF Research Database (Denmark)

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

    2007-01-01

    of stroke and remained so during the first month suggesting a female survival advantage. Throughout the second month the rate reversed in favour of men suggesting that women in that period are paying a 'toll' for their initial survival advantage. Hereafter, the rate steadily decreased, and after 4 months...

  13. Neuromuscular Electrical Stimulation for Motor Restoration in Hemiplegia

    Science.gov (United States)

    Knutson, Jayme S.; Fu, Michael J.; Sheffler, Lynne R.; Chae, John

    2015-01-01

    Synopsis This article reviews the most common therapeutic and neuroprosthetic applications of neuromuscular electrical stimulation (NMES) for upper and lower extremity stroke rehabilitation. Fundamental NMES principles and purposes in stroke rehabilitation are explained. NMES modalities used for upper and lower limb rehabilitation are described and efficacy studies are summarized. The evidence for peripheral and central mechanisms of action is also summarized. PMID:26522909

  14. Spatiotemporal and Kinematic Parameters Relating to Oriented Gait and Turn Performance in Patients with Chronic Stroke.

    Directory of Open Access Journals (Sweden)

    Céline Bonnyaud

    Full Text Available The timed up and go test (TUG is a functional test which is increasingly used to evaluate patients with stroke. The outcome measured is usually global TUG performance-time. Assessment of spatiotemporal and kinematic parameters during the Oriented gait and Turn sub-tasks of the TUG would provide a better understanding of the mechanisms underlying patients' performance and therefore may help to guide rehabilitation. The aim of this study was thus to determine the spatiotemporal and kinematic parameters which were most related to the walking and turning sub-tasks of TUG performance in stroke patients.29 stroke patients carried out the TUG test which was recorded using an optoelectronic system in two conditions: spontaneous and standardized condition (standardized foot position and instructed to turn towards the paretic side. They also underwent a clinical assessment. Stepwise regression was used to determine the parameters most related to Oriented gait and Turn sub-tasks. Relationships between explanatory parameters of Oriented gait and Turn performance and clinical scales were evaluated using Spearman correlations.Step length and cadence explained 82% to 95% of the variance for the walking sub-tasks in both conditions. Percentage single support phase and contralateral swing phase (depending on the condition respectively explained 27% and 56% of the variance during the turning sub-task in the spontaneous and standardized conditions.Step length, cadence, percentage of paretic single support phase and non-paretic swing phase, as well as dynamic stability were the main parameters related to TUG performance and they should be targeted in rehabilitation.

  15. Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Emilie M.M. [Erasmus MC - University Medical Center Rotterdam, Department of Radiology, P.O. Box 2040, Rotterdam (Netherlands); Department of Radiology, AMC, Amsterdam (Netherlands); Yoo, Albert J. [Texas Stroke Institute, Plano, TX (United States); Beenen, Ludo F.; Majoie, Charles B. [Department of Radiology, AMC, Amsterdam (Netherlands); Berkhemer, Olvert A. [Department of Radiology, AMC, Amsterdam (Netherlands); Department of Neurology, Erasmus MC, Rotterdam (Netherlands); Blanken, Mark D. den; Wismans, Carrie [AMC, Department of Biomedical Engineering and Physics, Amsterdam (Netherlands); Niessen, Wiro J. [Erasmus MC - University Medical Center Rotterdam, Department of Radiology, P.O. Box 2040, Rotterdam (Netherlands); Delft University of Technology, Faculty of Applied Sciences, Delft (Netherlands); Marquering, Henk A. [Department of Radiology, AMC, Amsterdam (Netherlands); AMC, Department of Biomedical Engineering and Physics, Amsterdam (Netherlands); Collaboration: on behalf of the MR CLEAN investigators

    2016-02-15

    Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland-Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs. (orig.)

  16. Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

    International Nuclear Information System (INIS)

    Santos, Emilie M.M.; Yoo, Albert J.; Beenen, Ludo F.; Majoie, Charles B.; Berkhemer, Olvert A.; Blanken, Mark D. den; Wismans, Carrie; Niessen, Wiro J.; Marquering, Henk A.

    2016-01-01

    Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland-Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs. (orig.)

  17. EVALUATION OF RISK FACTORS IN ACUTE STROKE

    Directory of Open Access Journals (Sweden)

    Putta

    2015-03-01

    Full Text Available Introduction: Cerebrovascular disease is the third most common cause of death in the developed world after cancer and ischemic heart disease. In India, community surveys have shown a crude prevalence rate of 200 per 100000 population for hemiplegia. Aims and objectives: Identification of risk factors for c erebrovascular disease. Materials and Methods: Inclusion Criteria: Cases of acute stroke admitted in S.V.R.R.G.G.H, Tirupati were taken for the study. Exclusion Criteria: Head injury cases, neoplasm cases producing cerebrovascular disease were excluded. Re sults: Stroke was more common in male, 54% patients were male 46% were female. It was more common in 6 th and 7 th decade. More common risk factors were hypertension followed by smoking, diabetes mellitus. More common pathology was infarction. Conclusion: Com mon risk factors for acute stroke are hypertension, smoking, diabetes mellitus, alcoholism, obesity, cardiac disease. Stroke was confirmed by CT scan of brain.

  18. Hemiplegia espástica pura de origem piramidal

    Directory of Open Access Journals (Sweden)

    Ricardo de Oliveira Souza

    1988-03-01

    Full Text Available Três pacientes acometidos de hemiplegia espástica pura apresentaram, à tomografia computadorizada, imagens hipodensas envolvendo regiões dos hemisférios cerebrais hoje identificadas como locais de passagem dos feixes córtico-nuclear e piramidal. Em nenhum deles se registraram alterações de forma, latência e amplitude dos potenciais evocados sômato-sensitivos. Com base nestes casos e em outros idênticos, recolhidos da literatura, reafirmamos a validade anátomo-clínica da síndrome piramidal, constituída de paresia, hiper-reflexia, espasticidade e sinal de Babinski. O reconhecimento da existência de síndromes piramidais deficitárias, levou-nos a postular a heterogeneidade anatômica e funcional do feixe piramidal, através do conceito de «controle funcional diferencial». Aparentemente, estas conclusões se aplicam integralmente apenas ao ser humano.

  19. Is there a relation between neuropsychologic variables and quality of life after stroke?

    NARCIS (Netherlands)

    Hochstenbach, J. B.; Anderson, PG; Mulder, TT

    2001-01-01

    Objectives: To describe the quality of life (QOL) of stroke patients and to distill neuropsychologic predictors for poor QOL. Design: A cohort study in which patients were neuropsychologically assessed at a mean of 72.2 days after stroke, with follow-up at a mean of 9.8 months after stroke. Setting:

  20. Absolute and relative temporal order memory for performed activities following stroke.

    Science.gov (United States)

    Schoo, Linda A; van Zandvoort, Martine J E; Reijmer, Yael D; Biessels, Geert Jan; Kappelle, L Jaap; Postma, Albert

    2014-01-01

    Reconstructing the temporal order of events is a crucial part of episodic memory. The temporal dimension, however, is often discarded in clinical settings, and measurements of true temporal aspects of episodic memory are scarce. The present study assessed temporal memory in stroke patients and in age- and education-matched healthy controls. Both groups underwent a standardized neuropsychological examination. We asked participants afterwards to reconstruct the order of tests they had performed, measured in absolute temporal order (event placed on correct moment in sequence) and relative temporal order (event placed correctly relative to directly preceding and following events). The aim of the study was to examine how serial-position curve effects (measuring absolute temporal order anchored in exact time) and how relative temporal order memory (anchored to other events) may differ in a group of cerebral stroke patients. Another aim was to link temporal order memory deficits with established neuropsychological measures of cognitive functioning. Although item identification was comparable in both groups, absolute temporal order memory was impaired in patients: A total of 43% of the patients lacked the expected primacy and recency effects (serial position effect). In addition, relative temporal order memory was affected in this group as well, F(1, 70) = 4.08, p < .05; 25% of the patients were impaired in reconstructing the relative temporal order (p = .019, Fisher's Exact Test). Both absolute and relative temporal order memory performance related to the domains of executive functioning and memory. Our results suggest that it is important to test both absolute and relative temporal order memory, especially because these types of memory depend on different anchors, either on time or on adjacent events.

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

    Science.gov (United States)

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

    2017-03-01

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

  2. The associations between insomnia and health-related quality of life in rehabilitation units at 1month after stroke.

    Science.gov (United States)

    Kim, Won-Hyoung; Jung, Han-Young; Choi, Ha-Yoon; Park, Chan-Hyuk; Kim, Eun-Suk; Lee, Sook-Joung; Ko, Sung-Hwa; Kim, Soo-Yeon; Joa, Kyung-Lim

    2017-05-01

    The principal objective of this study was to investigate the relationship between insomnia and health-related quality of life (HRQoL) during the early stage of stroke rehabilitation. The subjects were 214 first-time stroke patients admitted to a rehabilitation unit at one of three Korean hospitals. Within 7days after stroke, functions were evaluated using; the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, the Frontal Assessment Battery, Screening Tests for Aphasia and Neurologic-Communication Disorders, and the National Institute of Health Stroke Scale. Insomnia, depression, anxiety, and HRQoL were investigated at one month after stroke. Insomnia was defined as presence of at least one of the four following; difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and non-restorative sleep. HRQoL was assessed using the Short Form Health survey SF-8. Depression and anxiety were measured using the Hospital Anxiety Depression Scale. Multivariate linear regression analysis was conducted to examine the association between insomnia and HRQoL. The prevalence of insomnia at one month after stroke was 59.5%. Patients with insomnia were more likely to be older and female and to have depression and anxiety. Patients with insomnia had poorer physical and mental HRQoL. By multivariate analyses, physical HRQoL was significantly associated with type of stroke, hypnotic usage, balancing function, and insomnia. Mental HRQoL was significantly associated with balancing function, depression, and insomnia. Insomnia was found to be negatively associated with physical and mental HRQoL in stroke patients during the early stage of rehabilitation. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Predictors of Poststroke Health-Related Quality of Life in Nigerian Stroke Survivors: A 1-Year Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Ashiru Mohammad Hamza

    2014-01-01

    Full Text Available This study aims to identify the predictors in the different aspects of the health-related quality of life (HRQoL and to measure the changes of functional status over time in a cohort of Nigerian stroke survivors. A prospective observational study was conducted in three hospitals of Kano state of Nigeria where stroke survivors receive rehabilitation. The linguistic-validated Hausa versions of the stroke impact scale 3.0, modified Rankin scale, Barthel index and Beck depression inventory scales were used. Paired samples t-test was used to calculate the amount of changes that occur over time and the forward stepwise linear regression model was used to identify the predictors. A total of 233 stroke survivors were surveyed at 6 months, and 93% (217/233 were followed at 1 year after stroke. Functional disabilities were significantly reduced during the recovery phase. Motor impairment, disability, and level of depression were independent predictors of HRQoL in the multivariate regression analysis. The involvement of family members as caregivers is the key factor for those survivors with improved functional status. Thus, to enhance the quality of poststroke life, it is proposed that a holistic stroke rehabilitation service and an active involvement of family members are established at every possible level.

  4. Relations between Recent Past Leisure Activities with Risks of Dementia and Cognitive Functions after Stroke.

    Science.gov (United States)

    Wong, Adrian; Lau, Alexander Y L; Lo, Eugene; Tang, Michael; Wang, Zhaolu; Liu, Wenyan; Tanner, Nicole; Chau, Natalie; Law, Lorraine; Shi, Lin; Chu, Winnie C W; Yang, Jie; Xiong, Yun-Yun; Lam, Bonnie Y K; Au, Lisa; Chan, Anne Y Y; Soo, Yannie; Leung, Thomas W H; Wong, Lawrence K S; Lam, Linda C W; Mok, Vincent C T

    2016-01-01

    Leisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke. Hospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3-6 months after stroke. Regular participation (≥3 times per week) in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3-6 months after stroke. Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63) and stretching & toning physical exercise (0.37, 0.21-0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, pleisure activities was associated with better poststroke cognitive performance. Findings of this retrospective cohort study call for studies of activity intervention for prevention of cognitive decline in individuals at elevated risk of stroke.

  5. 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.

  6. Recovery-related indicators of motor network plasticity according to impairment severity after stroke.

    Science.gov (United States)

    Lee, J; Park, E; Lee, A; Chang, W H; Kim, D-S; Kim, Y-H

    2017-10-01

    Brain connectivity analysis has been widely used to investigate brain plasticity and recovery-related indicators of patients with stroke. However, results remain controversial because of interindividual variability of initial impairment and subsequent recovery of function. In this study, we aimed to investigate the differences in network plasticity and motor recovery-related indicators according to initial severity. We divided participants (16 males and 14 females, aged 54.2 ± 12.0 years) into groups of different severity by Fugl-Mayer Assessment score, i.e. moderate (50-84), severe (20-49) and extremely severe (impairment groups. Longitudinal resting-state functional magnetic resonance imaging data were acquired at 2 weeks and 3 months after onset. The differences in network plasticity and recovery-related indicators between groups were investigated using network distance and graph measurements. As the level of impairment increased, the network balance was more disrupted. Network balance, interhemispheric connectivity and network efficiency were recovered at 3 months only in the moderate impairment group. However, this was not the case in the extremely severe impairment group. A single connection strength between the ipsilesional primary motor cortex and ventral premotor cortex was implicated in the recovery of motor function for the extremely severe impairment group. The connections of the ipsilesional primary motor cortex-ventral premotor cortex were positively associated with motor recovery as the patients were more severely impaired. Differences in plasticity and recovery-related indicators of motor networks were noted according to impairment severity. Our results may suggest meaningful implications for recovery prediction and treatment strategies in future stroke research. © 2017 EAN.

  7. The aerobic demand of backstroke swimming, and its relation to body size, stroke technique, and performance.

    Science.gov (United States)

    Smith, H K; Montpetit, R R; Perrault, H

    1988-01-01

    Few studies have examined the aerobic demand of backstroke swimming, and its relation to body morphology, technique, or performance. The aims of this study were thus to: i) describe the aerobic demand of backstroke swimming in proficient swimmers at high velocities; ii) assess the effects of body size and stroke technique on submaximal and maximal O2 costs, and; iii) test for a relationship between submaximal O2 costs and maximal performance. Sixteen male competitive swimmers were tested during backstroke swimming at velocities from 1.0 to 1.4 m.s-1. Results showed that VO2 increased linearly with velocity (m.s-1) following the equation VO2 = 6.28v - 3.81 (r = 0.77, SEE/Y = 14.9%). VO2 was also related to the subjects' body mass, height, and armspan. Longer distances per stroke were associated with lower O2 costs, and better maximal performances. A significant relation was found between VO2 at 1.1 m.s-1, adjusted for body mass, and 400 m performance (r = -0.78). Submaximal VO2 was also related to reported times for 100 m and 200 m races. Multiple correlation analyses indicated that VO2 at 1.1 m.s-1 and VO2max accounted for up to 78% of the variance in maximal performances. These results suggest that the assessment of submaximal and maximal VO2 during backstroke swimming may be of value in the training and testing programs of competitive swimmers.

  8. Lack of SLC2A1 (glucose transporter 1) mutations in 30 Italian patients with alternating hemiplegia of childhood.

    Science.gov (United States)

    De Grandis, Elisa; Stagnaro, Michela; Biancheri, Roberta; Giannotta, Melania; Gobbi, Giuseppe; Traverso, Monica; Veneselli, Edvige; Zara, Federico

    2013-07-01

    Alternating hemiplegia of childhood is a rare, predominantly sporadic disorder. Diagnosis is clinical, and little is known about genetics. Glucose transporter 1 deficiency syndrome shares with alternating hemiplegia of childhood paroxysmal and nonparoxysmal symptoms. The aim of the study was to investigate glucose transporter 1 mutations in 30 Italian patients. Genetic material was analyzed by DNA amplification and glucose transporter 1 region sequencing. Mutational analysis findings of the SLC2A1 gene were negative in all patients. The pattern of movement disorders was reviewed. Interictal dystonia and multiple paroxysmal events were typical of alternating hemiplegia of childhood. In conclusion, alternating hemiplegia of childhood is a heterogeneous clinical condition, and although glucose transporter 1 deficiency can represent an undiagnosed cause of this disorder, mutational analysis is not routinely recommended. Alternatively, a careful clinical analysis and the 3-O-methyl-D-glucose uptake test can allow prompt identification of a subgroup of patients with alternating hemiplegia of childhood treatable with a ketogenic diet.

  9. Health-related quality of life in stroke patients questionnaire, short version (HRQOLISP-40): validation for its use in Colombia.

    Science.gov (United States)

    Guzmán Sabogal, Yahira Rossini; Pla Vidal, Jorge; Sánchez Pedraza, Ricardo; Ortuño Sánchez-Pedreño, Felipe; Gómez Guevara, María Catalina

    2016-11-28

    The health-related quality of life in stroke patients (HRQOLISP-40, short version) survey was developed in Nigeria and constitutes a 40-item, multidimensional, self-administrated questionnaire. We assessed the validity and reliability of the HRQOLISP-40 Spanish version for stroke patients in Colombia. The analysis included factor analysis, confirmatory factor analysis, Rasch analysis, convergent validity, internal consistency (261 stroke patients), test-retest reliability (73 patients assessed at two different times) and sensitivity to change (46 patients assessed before and after a rehabilitation intervention). We found an 8-domain structure. None of the items had a significant impact on the global alpha value in order to be removed. Lin's concordance correlation coefficient indicated test-retest reliability (Rho IC: 0.76 to 0.95), suggesting an adequate stability of the instrument. Regarding sensitivity to change differences, they were only significant in the psychological and eco-social domains (p <0.05). When comparing SF-36 with HRQOLISP-40, all the correlation coefficients values were significantly different from zero, except those related to vitality. The highest scores were found in the physical and physical functioning domains, with a value of 0.722. The HRQOLISP-40 scale is valid and reliable for assessing patients' quality of life after a stroke. Validating quality of life assessment instruments is necessary in order to improve the effectiveness of rehabilitation programs for Colombian stroke patients.

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

    Science.gov (United States)

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

    2014-09-01

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

  11. Noisy visual feedback training impairs detection of self-generated movement error: implications for anosognosia for hemiplegia

    Directory of Open Access Journals (Sweden)

    Catherine ePreston

    2014-06-01

    Full Text Available Anosognosia for hemiplegia (AHP is characterised as a disorder in which patients are unaware of their contralateral motor deficit. Many current theories for unawareness in AHP are based on comparator model accounts of the normal experience of agency. According to such models, while small mismatches between predicted and actual feedback allow unconscious fine-tuning of normal actions, mismatches that surpass an inherent threshold reach conscious awareness and inform judgements of agency (whether a given movement is produced by the self or another agent. This theory depends on a threshold for consciousness that is greater than the intrinsic noise in the system to reduce the occurrence of incorrect rejections of self-generated movements and maintain a fluid experience of agency. Pathological increases to this threshold could account for reduced motor awareness following brain injury, including AHP. The current experiment tested this hypothesis in healthy controls by exposing them to training in which noise was applied the visual feedback of their normal reaches. Subsequent self/other attribution tasks without noise revealed a decrease in the ability to detect manipulated (other feedback compared to training without noise. This suggests a slackening of awareness thresholds in the comparator model that may help to explain clinical observations of decreased action awareness following stroke.

  12. Obstructive Sleep Apnea is Related to Impaired Cognitive and Functional Status after Stroke.

    Science.gov (United States)

    Aaronson, Justine A; van Bennekom, Coen A M; Hofman, Winni F; van Bezeij, Tijs; van den Aardweg, Joost G; Groet, Erny; Kylstra, Wytske A; Schmand, Ben

    2015-09-01

    Obstructive sleep apnea (OSA) is a common sleep disorder in stroke patients and is associated with prolonged hospitalization, decreased functional outcome, and recurrent stroke. Research on the effect of OSA on cognitive functioning following stroke is scarce. The primary objective of this study was to compare stroke patients with and without OSA on cognitive and functional status upon admission to inpatient rehabilitation. Case-control study. 147 stroke patients admitted to a neurorehabilitation unit. N/A. All patients underwent sleep examination for diagnosis of OSA. We assessed cognitive status by neuropsychological examination and functional status by two neurological scales and a measure of functional independence. We included 80 stroke patients with OSA and 67 stroke patients without OSA. OSA patients were older and had a higher body mass index than patients without OSA. OSA patients performed worse on tests of attention, executive functioning, visuoperception, psychomotor ability, and intelligence than those without OSA. No differences were found for vigilance, memory, and language. OSA patients had a worse neurological status, lower functional independence scores, and a longer period of hospitalization in the neurorehabilitation unit than the patients without OSA. OSA status was not associated with stroke type or classification. Obstructive sleep apnea (OSA) is associated with a lower cognitive and functional status in patients admitted for stroke rehabilitation. This underlines the importance of OSA as a probable prognostic factor, and calls for well-designed randomized controlled trials to study its treatability. © 2015 Associated Professional Sleep Societies, LLC.

  13. A predictive model for diagnosing stroke-related apraxia of speech.

    Science.gov (United States)

    Ballard, Kirrie J; Azizi, Lamiae; Duffy, Joseph R; McNeil, Malcolm R; Halaki, Mark; O'Dwyer, Nicholas; Layfield, Claire; Scholl, Dominique I; Vogel, Adam P; Robin, Donald A

    2016-01-29

    Diagnosis of the speech motor planning/programming disorder, apraxia of speech (AOS), has proven challenging, largely due to its common co-occurrence with the language-based impairment of aphasia. Currently, diagnosis is based on perceptually identifying and rating the severity of several speech features. It is not known whether all, or a subset of the features, are required for a positive diagnosis. The purpose of this study was to assess predictor variables for the presence of AOS after left-hemisphere stroke, with the goal of increasing diagnostic objectivity and efficiency. This population-based case-control study involved a sample of 72 cases, using the outcome measure of expert judgment on presence of AOS and including a large number of independently collected candidate predictors representing behavioral measures of linguistic, cognitive, nonspeech oral motor, and speech motor ability. We constructed a predictive model using multiple imputation to deal with missing data; the Least Absolute Shrinkage and Selection Operator (Lasso) technique for variable selection to define the most relevant predictors, and bootstrapping to check the model stability and quantify the optimism of the developed model. Two measures were sufficient to distinguish between participants with AOS plus aphasia and those with aphasia alone, (1) a measure of speech errors with words of increasing length and (2) a measure of relative vowel duration in three-syllable words with weak-strong stress pattern (e.g., banana, potato). The model has high discriminative ability to distinguish between cases with and without AOS (c-index=0.93) and good agreement between observed and predicted probabilities (calibration slope=0.94). Some caution is warranted, given the relatively small sample specific to left-hemisphere stroke, and the limitations of imputing missing data. These two speech measures are straightforward to collect and analyse, facilitating use in research and clinical settings. Copyright

  14. Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density.

    Science.gov (United States)

    Pang, M Y C; Eng, J J

    2008-07-01

    Chronic stroke survivors with low hip bone density are particularly prone to fractures. This study shows that fear of falling is independently associated with falls in this population. Thus, fear of falling should not be overlooked in the prevention of fragility fractures in these patients. Chronic stroke survivors with low bone mineral density (BMD) are particularly prone to fragility fractures. The purpose of this study was to identify the determinants of balance, mobility and falls in this sub-group of stroke patients. Thirty-nine chronic stroke survivors with low hip BMD (T-score fall-related self-efficacy. Any falls in the past 12 months were also recorded. Multiple regression analysis was used to identify the determinants of balance and mobility performance, whereas logistic regression was used to identify the determinants of falls. Multiple regression analysis revealed that after adjusting for basic demographics, fall-related self-efficacy remained independently associated with balance/mobility performance (R2 = 0.494, P fall-related self-efficacy, but not balance and mobility performance, was a significant determinant of falls (odds ratio: 0.18, P = 0.04). Fall-related self-efficacy, but not mobility and balance performance, was the most important determinant of accidental falls. This psychological factor should not be overlooked in the prevention of fragility fractures among chronic stroke survivors with low hip BMD.

  15. Association between clinical condition and F-waves changes in the acute phase of stroke

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    Gustavo José Luvizutto

    Full Text Available ABSTRACT Objective To relate F-waves with clinical and laboratory exams in the acute phase of stroke. Methods Inclusion criteria for this cross-sectional study were: hemiplegia, absence of previous cranial trauma, myopathy, diabetes, alcoholism or other known causes of peripheral neuropathy, and normal sensory and motor conduction. The National Institutes of Health Stroke Scale (NIHSS score, glycemia, glucosilate hemoglobin, and CPK were obtained at admission by routine blood exams. After hospital admission, the F-wave latencies and persistence were obtained from the deep peroneal nerve using symmetrical techniques. Results Evaluation of 20 individuals – mean age 66 years, 50% male and 85% Caucasian – showed association of F-wave persistence with glycemia (r = 0.71; p < 0.001 and NIHSS categorized (NIHSS 1-7 = 65.0 x NIHSS 9-23 = 100; p = 0.004. Multivariate analysis found only association of F-wave persistence with glycemia β = 0.59 (0.44–0.74; p < 0.001. Conclusion The increase in the persistence of F-waves are associated with hyperglycemia in the acute phase of stroke.

  16. The Influence of Laterality of Pharyngeal Bolus Passage on Dysphagia in Hemiplegic Stroke Patients

    Science.gov (United States)

    Kim, Min Seok; Lee, Seong Jae; Seo, Dong Hyuk; Hyun, Jung Keun; Kim, Jae Il

    2012-01-01

    Objective To investigate swallowing laterality in hemiplegic patients with stroke and recovery of dysphagia according to the laterality. Method The sample was comprised of 46 dysphagic patients with hemiplegia after their first stroke. The sample's videofluoroscopic swallowing study (VFSS) was reviewed. Swallowing laterality was determined by the anterior-posterior view of VFSS. We measured width difference of barium sulfate liquid flow in the pharyngoesophageal segment. If there was double or more the width of that from the opposite width in the pharyngoesophageal segment more than twice on three trials of swallowing, then it was judged as having laterality. Subjects were assigned to no laterality (NL), laterality that is ipsilateral to hemiplegic side (LI), and laterality that is contralateral to hemiplegic side (LC) groups. We measured the following: prevalence of aspiration, the 8-point penetration-aspiration scale, and the functional dysphagia scale of the subjects at baseline and follow up. Results Laterality was observed in 45.7% of all patients. Among them, 52.4% were in the hemiplegic direction. There was no significant difference between groups at baseline in all measurements. When we compared the changes in all measurements on follow-up study, there were no significant differences between groups. Conclusion Through this study, we found that there was no significant relation between swallowing laterality and the severity or prognosis of swallowing difficulty. More studies for swallowing laterality on stroke patients will be needed. PMID:23185735

  17. Mirror therapy for upper limb rehabilitation in chronic patients after stroke

    Directory of Open Access Journals (Sweden)

    Dreyzialle Vila Nova Mota

    Full Text Available Abstract Introduction: Individuals with stroke sequelae present changes in the postural alignment and muscle strength associated with hemiplegia or hemiparesis. Mirror therapy is a technique that aims to improve the motor function of the paretic limb. Objective: The aim of this study was to evaluate the effect of mirror therapy, associated with conventional physiotherapy, for range of motion (ROM, degree of spasticity of the affected upper limb, and the level of independence in the activities of daily living (ADL of chronic patients after stroke. Methods: This was a quasi-experimental (before and after study. The study included ten stroke survivors undertaking physiotherapy and presenting with upper limb paresis. The following gauges were used for the present study: goniometry, the Modified Ashworth Scale, Fugl-Meyer and Barthel Index. Fifteen sessions were performed, each lasting 30 minutes, consisting of stretching of the flexor and extensor muscles of the wrist and elbow, pronators and supinators, followed by mirror therapy with gradual functional exercises. Results: Improvement was observed in all aspects studied, however with significant differences for ROM wrist extension (p = 0.04 and forearm supination (p = 0.03 Conclusion: It can be concluded that mirror therapy contributed to the participants' good performance in the aspects studied, mainly in relation to ROM of the affected upper limb.

  18. Gait outcome following outpatient physiotherapy based on the Bobath concept in people post stroke.

    Science.gov (United States)

    Lennon, Sheila; Ashburn, Ann; Baxter, David

    The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept. Nine patients, at least 6 weeks post stroke and recently discharged from a stroke unit, were measured before and after a period of outpatient physiotherapy (mean duration = 17.4 weeks). Therapy was documented using a treatment checklist for each patient. The primary outcome measures were a number of gait variables related to the therapists' treatment hypothesis, recorded during the gait cycle using the CODA motion analysis system. Other secondary outcome measures were the Motor Assessment Scale, Modified Ashworth Scale, subtests of the Sodring Motor Evaluation Scale, the Step test, a 10-m walk test, the Barthel Index and the London Handicap Score. Recovery of more normal gait patterns in the gait cycle (using motion analysis) did not occur. Significant changes in temporal parameters (loading response, single support time) for both legs, in one kinematic (dorsiflexion during stance) and one kinetic variable on the unaffected side (hip flexor moment), and most of the clinical measures of impairment, activity and participation (with the exception of the Modified Ashworth Scale and the 10-m walk) were noted. Study findings did not support the hypothesis that the Bobath approach restored more normal movement patterns to the gait cycle. Further research is required to investigate the treatment techniques that are effective at improving walking ability in people after stroke.

  19. Stroke Treatments

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  20. Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus.

    Science.gov (United States)

    Turner, Grace M; Backman, Ruth; McMullan, Christel; Mathers, Jonathan; Marshall, Tom; Calvert, Melanie

    2018-01-01

    What is the problem and why is this important? Mini-strokes are similar to full strokes, but symptoms last less than 24 h. Many people (up to 70%) have long-term problems after a mini-stroke, such as anxiety; depression; problems with brain functioning (like memory loss); and fatigue (feeling tired). However, the current healthcare pathway only focuses on preventing another stroke and care for other long-term problems is not routinely given. Without proper treatment, people with long-term problems after a mini-stroke could have worse quality of life and may find it difficult to return to work and their social activities. What is the aim of the research? We wanted to understand the research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of mini-stroke. How did we address the problem? We invited patients, clinicians, researchers and other stakeholders to attend a meeting. At the meeting people discussed the issues relating to the long-term impact of mini-stroke and came to an agreement on their research priorities. There were three stages: (1) people wrote down their individual research suggestions; (2) in smaller groups people came to an agreement on what their top research questions were; and (3) the whole group agreed final research priorities. What did we find? Eleven people attended who were representatives for patients, GPs, stroke consultants, stroke nurses, psychologists, the Stroke Association (charity) and stroke researchers, The group agreed on eleven research questions which they felt were the most important to improve health and well-being for people who have had a mini-stroke.The eleven research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how

  1. A Comparison of the Relation of Depression, and Cognitive, Motor and Functional Deficits in Chronic Stroke Patients: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Amin Ghaffari

    2017-10-01

    Full Text Available Aim and background: One of the most important psychological disorders after stroke is depression, which leads to reduced quality of life, optimal rehabilitation failure, loss of cognitive tasks and decrease in the recovery process. In this research, relation between patterns of depression and cognitive, motor and function deficits in people with chronic stroke was studied. Methods and materials: In a pilot cross-sectional study, 40 patients with chronic stroke (more than 6 months were enrolled. Depression (Beck Depression Inventory, cognition (attention test TMT-A & B and Wechsler memory, motor (Motorcity index, basic activities of daily living (Barthel scale and instrumental activities of daily living (Lawton scale were evaluated. Results: The results of the study revealed a significant positive correlation between post stroke depression and verbal memory (r=0.440،P<.05, attention (r=0.615،P<.05, motor function(r-0.368،P<.05, independence in basic activities of daily living (r=0.781،P<.05 and instrumental activities of daily living (r=0.741, P<.05. Conclusion: According to the findings, further studies of factors affecting post stroke depression (PSD clinical and practical aspects are necessary. Cognitive rehabilitation programs with motor rehabilitation can decrease depression and gain independence in activities of daily living and more participation in society activities.

  2. Effects of combined special education treatment and occupational therapy on upper extremities motor skills in adult patients with hemiplegia

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    Savković Nada

    2017-01-01

    Full Text Available Background/Aim. Stroke is the most common single cause of severe and multiple physical disabilities, and rehabilitation that reduces functional deficits is the most effective treatment. The aim of this study was to determine the effect of special education treatment as a supplement to occupational therapy on upper extremities motor skills in adult patients with post stroke hemiplegia. Methods. Standard education tests for motor function evaluation of the upper extremities: O`Connor, Ring and Hand grip test, were applied on a sample of 64 patients who were in the process of rehabilitation in the Clinic for Rehabilitation “Dr. Miroslav Zotović” in Belgrade. After the evaluation, all the participants were included in occupational therapy and divided in two intervention groups per 32 subjects each. The patients from the first experimental group received individually dosed special education treatment which was performed for at least 12 weeks as a supplement together with occupational therapy, while patients from the second experimental group were only in the process of occupational therapy without special education treatment. At the end of the study the same tests were used to re-evaluate the level of motor abilities of the patients in both groups. Results.The patients from the first experimental group with individually dosed special education treatment as a supplement showed significantly better scores after applying the treatment in all tested variables – explosive, static and dynamic muscular strength grip fist, as well as oculomotor skills at the level of the elbow and shoulder for both healthy and paretic hand. Conclusion. On the basis of the obtained results, it can be concluded that special education treatment added to occupational therapy lead to better performing of upper extremities motor skills and that it can be a good supplement to conventional occupational therapy methods and techniques.

  3. The effect of ankle-foot orthoses on self-reported balance confidence in persons with chronic poststroke hemiplegia.

    Science.gov (United States)

    Zissimopoulos, Angelika; Fatone, Stefania; Gard, Steven

    2014-04-01

    One intervention often used to address physical impairments post stroke is an ankle-foot orthosis. Ankle-foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one's ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle-foot orthosis use. Repeated measures study design. Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle-foot orthosis. Activities-specific Balance Confidence Scale scores were significantly higher (p ≤ 0.01) for the ankle-foot orthosis condition compared to no ankle-foot orthosis. One mechanism by which ankle-foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle-foot orthosis use.

  4. Paraneoplastic Ischemic Stroke: Case Report and Review

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    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

  5. Community ambulation in patients with chronic stroke : How is it related to gait speed?

    NARCIS (Netherlands)

    van de Port, Ingrid G.; Kwakkel, Gert; Lindeman, Eline

    Objective: To explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables. Design: Cross-sectional study conducted 3 years after stroke. Subjects: A total of 102 patients after first-ever stroke

  6. Community ambulation in patients with chronic stroke: how is it related to gait speed?

    NARCIS (Netherlands)

    van de Port, I.; Kwakkel, G.; Lindeman, E.

    2008-01-01

    Objective: To explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables. Design: Cross-sectional study conducted 3 years after stroke. Subjects: A total of 102 patients after first-ever stroke

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

    Science.gov (United States)

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

    2014-07-01

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

  8. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement.

    Science.gov (United States)

    Aadal, Lena; Angel, Sanne; Langhorn, Leanne; Pedersen, Birgitte Blicher; Dreyer, Pia

    2017-09-04

    In the last decades, length of stay of in-hospital rehabilitation of patients with stroke has been significantly reduced. Health authorities expect relatives to be at disposal to convey the knowledge of everyday life and to provide emotional as well as practical support in relation to the patient. Caregivers require nurse assistance, support and to be seen as an essential partner in the care giving process. However, the nurses do not perceive that teaching of relatives is a task they should routinely undertake. This might indicate an ambiguity between the relatives' expectations and the actual contribution from nurses. This study describes nurses' experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation. A phenomenological hermeneutic approach influenced by Paul Ricoeur. In a secondary analysis focus group, interviews of 19 randomly selected nurses from three different hospital settings were interpreted in three levels. The study was conducted in accordance with the ethical guidelines for nursing research in the Nordic countries. The nurses expressed that they address the patient and the relatives and support the interaction between the patient and the relatives. Four themes occurred: the changed lives of relatives; shared life after stroke; noncooperating relatives; time for the relatives. Nurses experience their roles and functions addressing relatives after stroke as crucial, challenging and multifaceted. They acknowledged care needs of the relatives in their own right by addressing the relatives' vulnerability during in-hospital rehabilitation characterised by an existential threat to the physical as well as the shared life. The focus on the needs of relatives considering their expected future role was experienced as conflicting with restricting time frames and a healthcare system focusing on the individual patient. © 2017 Nordic College of Caring Science.

  9. Serum Calcium is Related to the Degree of Artery Stenosis in Acute Ischemic Stroke

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    Jiayan Wu

    2018-04-01

    Full Text Available Background/Aims: Acute ischemic stroke is caused by stenosis of artery supplying to brain. We aimed to detect some metabolites in the serum that would be related to the degree of artery stenosis and to analyze potential mechanisms. Methods: Patients diagnosed with acute ischemic stroke were divided into two groups according to their degree of artery stenosis (which was determined by computed tomographic angiography: a mild group (stenosis ≤ 30% and a severe group (stenosis > 30%. Serum from these patients was collected, and we focused on the differences in the concentrations of calcium, uric acid, low density lipoprotein and homocysteine. The dataset GSE11583 from the Gene Expression Omnibus database was analyzed to find the potential mechanism using bioinformatics methods. Results: Among the four metabolites, the only difference that reached significance between the two groups was in the concentration of calcium in serum (2.27±0.08 mmol/L vs 2.21±0.08 mmol/L. By comparing the gene expression levels between normal endothelial cells and adaptive remodeling endothelial cells in GSE11583, we identified 51 upregulated and 40 downregulated genes in adaptive remodeling endothelial cells. The gene set enrichment analysis revealed that upregulated genes were enriched in a phosphatidylinositol signaling system, which is closely involved in the calcium signaling pathway. Conclusion: Our results suggest that the concentration of serum calcium is higher in patients with more severe artery stenosis lesions and that the phosphatidylinositol signaling system is a key biological pathway involved in this process.

  10. Serum Calcium is Related to the Degree of Artery Stenosis in Acute Ischemic Stroke.

    Science.gov (United States)

    Wu, Jiayan; Xie, Junchao; Zhao, Yanxin; Gong, Li; Liu, Xueyuan; Liu, Wangmi

    2018-01-01

    Acute ischemic stroke is caused by stenosis of artery supplying to brain. We aimed to detect some metabolites in the serum that would be related to the degree of artery stenosis and to analyze potential mechanisms. Patients diagnosed with acute ischemic stroke were divided into two groups according to their degree of artery stenosis (which was determined by computed tomographic angiography): a mild group (stenosis ≤ 30%) and a severe group (stenosis > 30%). Serum from these patients was collected, and we focused on the differences in the concentrations of calcium, uric acid, low density lipoprotein and homocysteine. The dataset GSE11583 from the Gene Expression Omnibus database was analyzed to find the potential mechanism using bioinformatics methods. Among the four metabolites, the only difference that reached significance between the two groups was in the concentration of calcium in serum (2.27±0.08 mmol/L vs 2.21±0.08 mmol/L). By comparing the gene expression levels between normal endothelial cells and adaptive remodeling endothelial cells in GSE11583, we identified 51 upregulated and 40 downregulated genes in adaptive remodeling endothelial cells. The gene set enrichment analysis revealed that upregulated genes were enriched in a phosphatidylinositol signaling system, which is closely involved in the calcium signaling pathway. Our results suggest that the concentration of serum calcium is higher in patients with more severe artery stenosis lesions and that the phosphatidylinositol signaling system is a key biological pathway involved in this process. © 2018 The Author(s). Published by S. Karger AG, Basel.

  11. Social and economic costs and health-related quality of life in stroke survivors in the Canary Islands, Spain

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    Lopez-Bastida Julio

    2012-09-01

    Full Text Available Abstract Background Cost-of-illness analysis is the main method of providing an overall vision of the economic impact of a disease. Such studies have been used to set priorities for healthcare policies and inform resource allocation. The aim of this study was to determine the economic burden and health-related quality of life (HRQOL in the first, second and third years after surviving a stroke in the Canary Islands, Spain. Methods Cross-sectional, retrospective study of 448 patients with stroke based on ICD 9 discharge codes, who received outpatient care at five hospitals. The study was approved by the Research Ethics Committee of Nuestra Señora de la Candelaria University Hospital. Data on demographic characteristics, health resource utilization, informal care, labor productivity losses and HRQOL were collected from the hospital admissions databases and questionnaires completed by stroke patients or their caregivers. Labor productivity losses were calculated from physical units and converted into monetary units with a human capital-based method. HRQOL was measured with the EuroQol EQ-5D questionnaire. Healthcare costs, productivity losses and informal care costs were analyzed with log-normal, probit and ordered probit multivariate models. Results The average cost for each stroke survivor was €17 618 in the first, €14 453 in the second and €12 924 in the third year after the stroke; the reference year for unit prices was 2004. The largest expenditures in the first year were informal care and hospitalizations; in the second and third years the main costs were for informal care, productivity losses and medication. Mean EQ-5D index scores for stroke survivors were 0.50 for the first, 0.47 for the second and 0.46 for the third year, and mean EQ-5D visual analog scale scores were 56, 52 and 55, respectively. Conclusions The main strengths of this study lie in our bottom-up-approach to costing, and in the evaluation of stroke survivors from a

  12. Social support, coping strategies and health-related quality of life among primary caregivers of stroke survivors in China.

    Science.gov (United States)

    Yu, Yunhong; Hu, Jie; Efird, Jimmy T; McCoy, Thomas P

    2013-08-01

    To examine the relationships of social support and coping strategies to health-related quality of life among primary caregivers of stroke survivors in China. Caring for a stroke survivor is highly stressful, which can negatively affect a caregiver's physical and psychological well-being. Stroke caregivers generally report more somatic symptoms, depressive symptoms, sleep disorders and social isolation. They generally have poorer quality of life than the general population. A cross-sectional, descriptive, correlational study. A quasi-random, point of reference sample of 121 survivor-caregiver dyads was recruited from three community health centres and six health service stations in a city in central China. Data were collected in face-to-face interviews at participants' homes using structured questionnaires. Higher educational levels, planning and active coping were positively associated with health-related quality of life. The number of chronic conditions, hours of care per day and functional dependence of the survivor were negatively related to quality of life. Active coping strategies predicted better health-related quality of life. Findings suggest that intervention programmes should be developed to enhance caregivers of stroke survivors' coping skills and improve social support for these caregivers in China. Community healthcare providers may need to help caregivers strengthen strategies that are effective (planning, active coping, seeking instrumental and emotional support) and change those that are not helpful (venting, denial and self-blame). © 2013 John Wiley & Sons Ltd.

  13. Memory Loss, Dementia, and Stroke: Implications for Rehabilitation of Older Adults with Age-Related Macular Degeneration

    Science.gov (United States)

    Warren, Mary

    2008-01-01

    Older adults with age-related macular degeneration (AMD) are not immune to the other diseases of aging. Although AMD is the leading cause of low vision in older Americans, stroke is the leading cause of disability, and dementias affect another 2.5 million older Americans. Each condition alone can significantly impair a person's ability to…

  14. The relation between electrocardiographic ST-T changes and NT-proBNP in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper K; Korsholm, Lars; Høilund-Carlsen, Poul Flemming

    2007-01-01

    BACKGROUND: ST-segment depression and T-wave inversion (ST-T changes) in the electrocardiogram (ECG) and raised levels of natriuretic peptide have been observed in acute ischemic stroke patients. It is unknown whether any relation between ST-T changes and raised levels of natriuretic peptides...

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Participation in leisure activities after stroke: A survey of community-residing stroke survivors in Nigeria.

    Science.gov (United States)

    Vincent-Onabajo, Grace; Blasu, Cephas

    2016-01-01

    Leisure provides pleasure and relaxation, and has health benefits even after a stressful and life-changing event such as a stroke. This study examined leisure participation among a sample of community-residing stroke survivors in Nigeria. Fifty-five stroke survivors undergoing rehabilitation were consecutively recruited from two government hospitals in Northern Nigeria. Data on pre- and post-stroke participation, and socio-demographic (age, sex, marital, employment, and educational status) and clinical (level of disability, post-stroke duration, stroke type and side of hemiplegia/hemiparesis) attributes of the stroke survivors were obtained. Leisure participation was assessed in four domains of recreational, social, cognitive, and productive/creative activities. Associations between leisure participation and the socio-demographic and clinical variables were examined using bivariate analysis. Mean (SD) age of the stroke survivors was 53.55 (14.39) years. Prevalence of leisure participation was 89.1%. Participation in specific leisure domains however varied thus: social (83.6%), cognitive (60%), recreational (41.8%), productive/creative activities (30.9%). Significant associations were observed between participation in cognitive, productive/creative, and recreational leisure activities, and specific socio-demographic and clinical attributes. Leisure participation was high in a general sense but marginal in recreational and productive/creative activities. The observed socio-demographic and clinical associations with post-stroke leisure participation may assist in providing effective leisure rehabilitation strategies.

  18. De novo mutations in ATP1A3 cause alternating hemiplegia of childhood

    DEFF Research Database (Denmark)

    Heinzen, Erin L; Swoboda, Kathryn J; Hitomi, Yuki

    2012-01-01

    Alternating hemiplegia of childhood (AHC) is a rare, severe neurodevelopmental syndrome characterized by recurrent hemiplegic episodes and distinct neurological manifestations. AHC is usually a sporadic disorder and has unknown etiology. We used exome sequencing of seven patients with AHC and the...

  19. Motor imagery for walking: A comparison between cerebral palsy adolescents with hemiplegia and diplegia

    NARCIS (Netherlands)

    Molina, M.; Kudlinski, C.; Guilbert, J.; Spruijt, S.; Steenbergen, B.; Jouen, F.

    2015-01-01

    The goal of the study was to investigate whether motor imagery (MI) could be observed in cerebral palsy (CP) participants presenting a bilateral affected body side (diplegia) as it has been previously revealed in participants presenting a unilateral body affected sided (hemiplegia). MI capacity for

  20. Motor imagery for walking: a comparison between cerebral palsy adolescents with hemiplegia and diplegia

    NARCIS (Netherlands)

    Molina, M.; Kudlinski, C.; Guilbert, J.; Spruijt, S.; Steenbergen, B.; Jouen, F.

    2015-01-01

    The goal of the study was to investigate whether motor imagery (MI) could be observed in cerebral palsy (CP) participants presenting a bilateral affected body side (diplegia) as it has been previously revealed in participants presenting a unilateral body affected sided (hemiplegia). MI capacity for

  1. Motor imagery for walking: A comparison between cerebral palsy adolescents with hemiplegia and diplegia

    NARCIS (Netherlands)

    Molina, M.; Kudlinski, C.; Guilbert, J.; Spruijt, S.; Steenbergen, B.; Jouen, F.

    2014-01-01

    The goal of the study was to investigate whether motor imagery (MI) could be observed in cerebral palsy (CP) participants presenting a bilateral affected body side (diplegia) as it has been previously revealed in participants presenting a unilateral body affected sided (hemiplegia). MI capacity for

  2. Relative filling time delay based on CT perfusion source imaging: a simple method to predict outcome in acute ischemic stroke.

    Science.gov (United States)

    Cao, W; Campbell, B C V; Dong, Q; Davis, S M; Yan, B

    2014-09-01

    Collateral vessel status is strongly associated with clinical outcome in ischemic stroke but can be challenging to assess. The aim of this study was to develop a tomography perfusion source imaging-based assessment of collateral vessel status. Consecutive patients with ischemic stroke who received intravenous thrombolysis or intra-arterial reperfusion therapy after CTP were retrospectively analyzed. In those with middle cerebral artery or internal carotid artery occlusion, CT perfusion source imaging was used to identify the relative filling time delay between the normal MCA Sylvian branches and those in the affected hemisphere. Receiver operating characteristic analysis and logistic regression were used to assess the association of the relative filling time delay with the 24-hour Alberta Stroke Program Early CT Score based on noncontrast CT and the 90-day modified Rankin Scale score. There were 217 patients treated in 2009-2011 who had CTP data, of whom 60 had MCA or ICA occlusion and 55 had 90-day mRS data. The intraclass correlation coefficient for relative filling time delay was 0.95. Relative filling time delay was correlated with 24-hour ASPECTS (Spearman ρ=-0.674; Prelative filling time delay was associated with poor radiologic outcome (ASPECTS, 0-7) (area under the curve=0.79, Prelative filling time delay with poor outcome remained significant, independent of age, sex, and baseline National Institutes of Health Stroke Scale score. Relative filling time delay is a useful independent predictor of clinical outcome after ischemic stroke. © 2014 by American Journal of Neuroradiology.

  3. Polyphenols and Oxidative Stress in Atherosclerosis-Related Ischemic Heart Disease and Stroke.

    Science.gov (United States)

    Cheng, Yu-Chen; Sheen, Jer-Ming; Hu, Wen Long; Hung, Yu-Chiang

    2017-01-01

    Good nutrition could maintain health and life. Polyphenols are common nutrient mainly derived from fruits, vegetables, tea, coffee, cocoa, mushrooms, beverages, and traditional medicinal herbs. They are potential substances against oxidative-related diseases, for example, cardiovascular disease, specifically, atherosclerosis-related ischemic heart disease and stroke, which are health and economic problems recognized worldwide. In this study, we reviewed the risk factors for atherosclerosis, including hypertension, diabetes mellitus, hyperlipidemia, obesity, and cigarette smoking as well as the antioxidative activity of polyphenols, which could prevent the pathology of atherosclerosis, including endothelial dysfunction, low-density lipoprotein oxidation, vascular smooth muscle cell proliferation, inflammatory process by monocytes, macrophages or T lymphocytes, and platelet aggregation. The strong radical-scavenging properties of polyphenols would exhibit antioxidative and anti-inflammation effects. Polyphenols reduce ROS production by inhibiting oxidases, reducing the production of superoxide, inhibiting OxLDL formation, suppressing VSMC proliferation and migration, reducing platelet aggregation, and improving mitochondrial oxidative stress. Polyphenol consumption also inhibits the development of hypertension, diabetes mellitus, hyperlipidemia, and obesity. Despite the numerous in vivo and in vitro studies, more advanced clinical trials are necessary to confirm the efficacy of polyphenols in the treatment of atherosclerosis-related vascular diseases.

  4. Polyphenols and Oxidative Stress in Atherosclerosis-Related Ischemic Heart Disease and Stroke

    Directory of Open Access Journals (Sweden)

    Yu-Chen Cheng

    2017-01-01

    Full Text Available Good nutrition could maintain health and life. Polyphenols are common nutrient mainly derived from fruits, vegetables, tea, coffee, cocoa, mushrooms, beverages, and traditional medicinal herbs. They are potential substances against oxidative-related diseases, for example, cardiovascular disease, specifically, atherosclerosis-related ischemic heart disease and stroke, which are health and economic problems recognized worldwide. In this study, we reviewed the risk factors for atherosclerosis, including hypertension, diabetes mellitus, hyperlipidemia, obesity, and cigarette smoking as well as the antioxidative activity of polyphenols, which could prevent the pathology of atherosclerosis, including endothelial dysfunction, low-density lipoprotein oxidation, vascular smooth muscle cell proliferation, inflammatory process by monocytes, macrophages or T lymphocytes, and platelet aggregation. The strong radical-scavenging properties of polyphenols would exhibit antioxidative and anti-inflammation effects. Polyphenols reduce ROS production by inhibiting oxidases, reducing the production of superoxide, inhibiting OxLDL formation, suppressing VSMC proliferation and migration, reducing platelet aggregation, and improving mitochondrial oxidative stress. Polyphenol consumption also inhibits the development of hypertension, diabetes mellitus, hyperlipidemia, and obesity. Despite the numerous in vivo and in vitro studies, more advanced clinical trials are necessary to confirm the efficacy of polyphenols in the treatment of atherosclerosis-related vascular diseases.

  5. Spasticity and its association with functioning and health-related quality of life 18 months after stroke.

    Science.gov (United States)

    Welmer, Anna-Karin; von Arbin, Magnus; Widén Holmqvist, Lotta; Sommerfeld, Disa K

    2006-01-01

    There is no consensus concerning the presence of spasticity or the relationship between spasticity and functioning and spasticity and health-related quality of life (HRQL) in the stable phase after stroke. The aim of the present study was to describe, 18 months after stroke, the frequency of spasticity and its association with functioning and HRQL. In a cohort of 66 consecutive patients with first-ever stroke, studied prospectively, the following parameters were assessed 18 months after stroke: spasticity, by the Modified Ashworth Scale (0-4 points with 1+ as the modification), muscle stiffness, by self-report, abnormal tendon reflexes, by physical examination, motor performance, by the Lindmark Motor Assessment Scale, mobility, by the Rivermead Mobility Index, activities of daily living, by the Barthel Index, and HRQL, by the Swedish Short Form 36 Health Survey Questionnaire (SF-36). Of 66 patients studied, 38 were hemiparetic; of these, 13 displayed spasticity, 12 had increased tendon reflexes, and 7 reported muscle stiffness 18 months after stroke. Weak (r < 0.5) to moderate (r = 0.5-0.75) correlations were seen between spasticity and functioning scores. Correlations between spasticity and HRQL were generally weak (r < 0.5). Hemiparetic patients without spasticity had significantly better functioning scores and significantly better HRQL on 1 of the 8 SF-36 health scales (physical functioning) than patients with spasticity. Few patients displayed spasticity 18 months after stroke. Spasticity might contribute to impairment of movement function and to limitation of activity, but seems to have a less pronounced effect on HRQL.

  6. Psychometric comparisons of four disease-specific health-related quality of life measures for stroke survivors.

    Science.gov (United States)

    Chou, Chia-Yeh; Ou, Yu-Chih; Chiang, Tsuey-Ru

    2015-08-01

    To examine psychometric properties of four stroke-specific health-related quality of life (HRQoL) measures, including original Stroke-Specific Quality of Life Scale (12-domain SSQoL), modified 8-domain SSQoL, Stroke Impact Scale (SIS 3.0), and modified SIS-16 focused on physical domains. Prospective repeated measures study conducted in rehabilitation and wards in hospitals. Study cohort was recruited with 263 patients in the first administration and 121 in the second administration, an average of two weeks later. To investigate discriminant validity, the same number of patients (i.e., 52) was grouped for each of 3 levels of stroke severity. Outcome measures, including National Institutes of Health Stroke Scale, Mini-Mental State Examination, and Barthel Index. Patients completed HRQoL self-reports. Domains of four measures showed (1) good reliability, except 12-domainSSQoL family roles (Cronbach's α = 0.68) and personality domains (Cronbach's α = 0.65) and SIS 3.0 social participation (ICC=0.67) domain; (2) acceptable precision, except 12-domain SSQoL family role domain and SIS 3.0 social participation domain; (3) good convergent validity, except 12-domain SSQoL/8-domain SSQoL vision domain (r = 0.19), (4) good discriminant validity, except 12-domain SSQoL and 8-domain SSQoL thinking domains (P = 0.365); and (5) acceptable floor effects and strong ceiling effects. The 12-domain SSQoL and 8-domain SSQoL met scaling assumptions better than SIS 3.0 and SIS-16. Four measures showed acceptable psychometric properties with some domains slightly less satisfactory. Overall, use of 8-domain SSQoL and SIS 3.0 are feasible for clinical practice to monitor HRQoL of stroke survivors. © The Author(s) 2014.

  7. Balance Confidence Is Related to Features of Balance and Gait in Individuals with Chronic Stroke.

    Science.gov (United States)

    Schinkel-Ivy, Alison; Wong, Jennifer S; Mansfield, Avril

    2017-02-01

    Reduced balance confidence is associated with impairments in features of balance and gait in individuals with subacute stroke. However, an understanding of these relationships in individuals at the chronic stage of stroke recovery is lacking. This study aimed to quantify the relationships between balance confidence and specific features of balance and gait in individuals with chronic stroke. Participants completed a balance confidence questionnaire and clinical balance assessment (quiet standing, walking, and reactive stepping) at 6 months postdischarge from inpatient stroke rehabilitation. Regression analyses were performed using balance confidence as a predictor variable, and quiet standing, walking, and reactive stepping outcome measures as the dependent variables. Walking velocity was positively correlated with balance confidence, whereas mediolateral center of pressure excursion (quiet standing) and double support time, step width variability, and step time variability (walking) were negatively correlated with balance confidence. This study provides insight into the relationships between balance confidence and balance and gait measures in individuals with chronic stroke, suggesting that individuals with low balance confidence exhibited impaired control of quiet standing as well as walking characteristics associated with cautious gait strategies. Future work should identify the direction of these relationships to inform community-based stroke rehabilitation programs for individuals with chronic stroke, and determine the potential utility of incorporating interventions to improve balance confidence into these programs. Copyright © 2017. Published by Elsevier Inc.

  8. Balance confidence is related to features of balance and gait in individuals with chronic stroke

    Science.gov (United States)

    Schinkel-Ivy, Alison; Wong, Jennifer S.; Mansfield, Avril

    2016-01-01

    Reduced balance confidence is associated with impairments in features of balance and gait in individuals with sub-acute stroke. However, an understanding of these relationships in individuals at the chronic stage of stroke recovery is lacking. This study aimed to quantify relationships between balance confidence and specific features of balance and gait in individuals with chronic stroke. Participants completed a balance confidence questionnaire and clinical balance assessment (quiet standing, walking, and reactive stepping) at 6 months post-discharge from inpatient stroke rehabilitation. Regression analyses were performed using balance confidence as a predictor variable and quiet standing, walking, and reactive stepping outcome measures as the dependent variables. Walking velocity was positively correlated with balance confidence, while medio-lateral centre of pressure excursion (quiet standing) and double support time, step width variability, and step time variability (walking) were negatively correlated with balance confidence. This study provides insight into the relationships between balance confidence and balance and gait measures in individuals with chronic stroke, suggesting that individuals with low balance confidence exhibited impaired control of quiet standing as well as walking characteristics associated with cautious gait strategies. Future work should identify the direction of these relationships to inform community-based stroke rehabilitation programs for individuals with chronic stroke, and determine the potential utility of incorporating interventions to improve balance confidence into these programs. PMID:27955809

  9. The Effect of rTMS with Rehabilitation on Hand Function and Corticomotor Excitability in Sub-Acute Stroke

    Directory of Open Access Journals (Sweden)

    Heidar Saadati

    2015-12-01

    Full Text Available Objectives: Stroke is the leading cause of long-term disability. Hand motor impairment resulting from chronic stroke may have extensive physical, psychological, financial, and social implications despite available rehabilitative treatments. The best time to start treatment for stroke, is in sub-acute period. Repetitive transcranial magnetic stimulation (rTMS is a method of stimulating and augmenting the neurophysiology of the motor cortex in order to promote the neuroplastic changes that are associated with motor recovery. The purpose of this study was to compare the effects of repetitive transcranial magnetic stimulation protocols plus routine rehabilitation on hand motor functions and hand corticomotor excitability in stroke patients with hemiplegia with pure routine rehabilitation programs. Methods: This study was a randomized clinical trial which was performed on 24 patients with hemiplegia who were randomly divided in to three groups. One group (n=7, received high frequency repetitive transcranial magnetic stimulation (Hf rTMS on lesioned M1 with routine rehabilitation program, and the other group (n=7, received rehabilitation program with low frequency repetitive transcranial magnetic stimulation stimulation (Lf rTMS on nonlesined M1, and a control group (n=10, who were given only routine rehabilitation programs. The treatment was performed for 10 sessions, three times peri-test, Post and follow-up about neurophysiological contralesional hemisphere evaluations using record of MEP wave indices by single pulse TMS, and assessing functional wolf test and hand grip power of disabled hand by dynamometer. Results: The results demonstrated that the rest MEP threshold reduction in experimental group which received high frequency magnetic stimulation was statistically significant (P<0.05. There was similar finding for active MEP threshold in the both high and low frequency but not in control group (P<0.05. Also there were more significant

  10. Persistence of locomotor-related interlimb reflex networks during walking after stroke.

    Science.gov (United States)

    Zehr, E Paul; Loadman, Pamela M

    2012-04-01

    Cutaneous nerve stimulation evokes coordinated and phase-modulated reflex output widely distributed to muscles of all four limbs during walking. Accessibility to this distributed network after stroke offers insight into the pathological changes and suggests utility for therapeutic applications. Here we examined muscles in both the more (MA) and less affected (LA) legs evoked by stimulation at the ankle and wrist during walking in chronic (>6 months post CVA) stroke. Stroke and control participants walked on a treadmill with a harness support system. Reflexes were evoked with trains of electrical stimuli delivered separately to the cutaneous superficial peroneal (SP; at the ankle) and superficial radial (SR; at the wrist) nerves. Background locomotor and reflex EMG were phase-averaged across the gait cycle and analyzed off line. Locomotor background muscle activation patterns were altered bilaterally in stroke, as compared with control. Phase-dependent modulation of interlimb cutaneous reflexes was found in both stroke and control subjects with stimulation of each nerve, but responses were blunted in stroke. Reflex reversal in tibialis anterior (TA) at heel strike with SP nerve stimulation was present in both groups. Notably, SR nerve stimulation produced facilitation during the swing-to-stance transition in the TA and suppression of MG in the MA leg during stance. Interlimb cutaneous inputs may access coordinated reflex pathways in the MA limb during walking after stroke. Importantly activation in these pathways could provoke responses to counter foot drop during swing phase of walking. Additionally, our data support the perspective that there is no "unaffected" side after stroke and that caution should be used when interpreting the LA side as "control" after stroke. The presence of functionally-relevant interlimb cutaneous reflexes in the MA leg presents a substrate that may be strengthened by rehabilitation. Copyright © 2011 International Federation of Clinical

  11. Relations between Recent Past Leisure Activities with Risks of Dementia and Cognitive Functions after Stroke.

    Directory of Open Access Journals (Sweden)

    Adrian Wong

    Full Text Available Leisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke.Hospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD 3-6 months after stroke. Regular participation (≥3 times per week in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3-6 months after stroke.Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63 and stretching & toning physical exercise (0.37, 0.21-0.64 was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, p<0.01 and in intellectual (r = 0.40, p<0.01, recreational (r = 0.24, p<0.01, strenuous aerobic (r = 0.23, p<0.01 and mind-body (r = 0.10, p<0.01 activities was associated with higher poststroke Mini-mental State Examination scores in models adjusted for prestroke cognitive decline.Regular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in patients with and without recurrent strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance. Findings of this

  12. Longitudinal Brain Functional Connectivity Changes of the Cortical Motor-Related Network in Subcortical Stroke Patients with Acupuncture Treatment

    Directory of Open Access Journals (Sweden)

    Yongxin Li

    2017-01-01

    Full Text Available In clinical practice, the effectiveness of the rehabilitation therapy such as acupuncture combining conventional Western medicine (AG on stroke people’s motor-related brain network and their behaviors has not been systematically studied. In the present study, seventeen adult ischemic patients were collected and divided into two groups: the conventional Western medicine treatment group (CG and the AG. The neurological deficit scores (NDS and resting-state functional MRI data were collected before and after treatment. Compared with the CG patients, AG patients exhibited a significant enhancement of the percent changes of NDS from pre- to posttreatment intervention. All patients showed significant changes of functional connectivity (FC between the pair of cortical motor-related regions. After treatment, both patient groups showed a recovery of brain connectivity to the nearly normal level compared with the controls in these pairs. Moreover, a significant correlation between the percent changes of NDS and the pretreatment FC values of bilateral primary motor cortex (M1 in all patients was found. In conclusion, our results showed that AG therapy can be an effective means for ischemic stroke patients to recover their motor function ability. The FC strengths between bilateral M1 of stroke patients can predict stroke patients’ treatment outcome after rehabilitation therapy.

  13. Dietary fiber and fiber-rich food intake in relation to risk of stroke in male smokers.

    Science.gov (United States)

    Larsson, S C; Männistö, S; Virtanen, M J; Kontto, J; Albanes, D; Virtamo, J

    2009-08-01

    There is convincing evidence that a high dietary fiber intake may lower the risk of coronary heart disease. However, the role of fiber in the prevention of stroke is unclear. We examined the associations of dietary fiber and fiber-rich food intake with risk of stroke within the Alpha-tocopherol, Beta-carotene Cancer Prevention Study. Between 1985 and 1988, 26,556 Finnish male smokers aged 50-69 years, who had no history of stroke, completed a dietary questionnaire. During a mean follow-up of 13.6 years, 2702 cerebral infarctions, 383 intracerebral hemorrhages and 196 subarachnoid hemorrhages were ascertained. After adjustment for cardiovascular risk factors and folate and magnesium intakes, there was no significant association between intake of total fiber, water-soluble fiber, water-insoluble fiber, or fiber derived from fruit or cereal sources and risk of any stroke subtype. Vegetable fiber intake, as well as the consumption of fruit, vegetables and cereals, was inversely associated with the risk of cerebral infarction; the multivariate relative risks for the highest quintile of intake as compared with the lowest were 0.86 (95% confidence interval (CI): 0.76-0.99) for vegetable fiber, 0.82 (95% CI: 0.73-0.93) for fruit, 0.75 (95% CI: 0.66-0.85) for vegetables and 0.87 (95% CI: 0.74-1.03) for cereals. Vegetable consumption was inversely associated with risk of subarachnoid hemorrhage (relative risk for highest versus lowest quintile: 0.62; 95% CI: 0.40-0.98), and cereal consumption was inversely associated with risk of intracerebral hemorrhage (relative risk: 0.64; 95% CI: 0.41-1.01). These findings suggest a beneficial effect of the consumption of fruits, vegetables and cereals on stroke risk.

  14. Adherence to a DASH-Style Diet in Relation to Stroke: A Case-Control Study.

    Science.gov (United States)

    Niknam, Mahdieh; Saadatnia, Mohammad; Shakeri, Forough; Keshteli, Ammar Hassanzadeh; Saneei, Parvane; Esmaillzadeh, Ahmad

    2015-01-01

    Despite the growing body of evidence from Western societies on the association between dietary patterns and stroke, limited data are available in this regard from developing countries. This study was conducted to examine the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of stroke among the Iranian population. This hospital-based case-control study included 194 stroke patients and 194 controls and was conducted at the Alzahra University Hospital, Isfahan, Iran. The cases were stroke patients who were hospitalized in the neurology ward of the Alzahra University Hospital. Controls were randomly selected from among hospitalized patients in the orthopedic or surgical wards of this center. A validated food frequency questionnaire (FFQ) was used to assess the patients' usual dietary intake. We constructed the DASH diet score based on food and nutrients emphasized or minimized in the DASH diet. The prevalence of stroke among those in the top quartile of the DASH diet score was 40%, which was 15% lower than among those in the bottom quartile; this difference was marginally significant (p = 0.10). After controlling for age, sex, and total energy intake, adherence to the DASH diet was inversely associated with the risk of stroke (OR: 0.52; 95% CI: 0.28; 0.98). These associations remained significant even after additionally controlling for physical activity, smoking, hypertension, and diabetes, such that individuals in the highest quartile of the DASH diet score had a 58% lower risk of stroke than those in the lowest category (OR: 0.48; 95% CI: 0.24, 0.96). However, after further adjustment for body mass index (BMI), the association disappeared (OR: 0.62; 95% CI: 0.29, 1.31), indicating an obesity-dependent association. We found an inverse relationship between the DASH-style diet and prevalence of stroke. Prospective studies are needed to confirm this association.

  15. 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.

  16. Relationship between somatosensory event-related potential N140 aberrations and hemispatial agnosia in patients with stroke: a preliminary study.

    Science.gov (United States)

    Ueno, Tomoyuki; Hada, Yasushi; Shimizu, Yukiyo; Yamada, Thoru

    2018-06-01

    The somatosensory event-related potential N140 is thought to be related to selective attention. This study aimed to compare the somatosensory event-related potential N140 in healthy subjects to that in patients with stroke to determine whether N140 and attentiveness are associated in patients with stroke with or without hemispatial agnosia. Normal somatosensory event-related potential N140 values were determined using data from ten healthy subjects. Fifteen patients with stroke were divided into two groups based on the presence of hemispatial neglect. Somatosensory event-related potential N140 components were compared between the two groups. Stimulation of the affected limb in the hemispatial agnosia group resulted in significantly longer N140 latency at the contralateral vs. the ipsilateral electrode. This was the inverse of the relationship observed in normal subjects, with stimulation of the intact side in patients with hemispatial agnosia, and with stimulation of both the intact and affected sides in patients without agnosia. In the hemispatial agnosia group, the peak latency of N140 following stimulation of the affected side was significantly longer than it was following stimulation of the intact side and when compared to that in patients without agnosia. In addition, abnormal N140 peak latencies were observed at the Cz and ipsilateral electrodes in patients with hemispatial agnosia following stimulation of the intact side. These findings suggest that somatosensory event-related potential N140 is independently generated in each hemisphere and may reflect cognitive attention.

  17. Manual Aspiration Thrombectomy in Patients with Acute Stroke-Related Calcified Cerebral Emboli.

    Science.gov (United States)

    Koh, Esther; Kwak, Hyo Sung; Chung, Gyung-Ho

    2017-10-01

    The aim of this study was to evaluate the effectiveness of mechanical aspiration thrombectomy (MAT) in patients with acute ischemic stroke from calcified cerebral emboli. Procedural results were reviewed for acute stroke patients with clinically neurological deficits who underwent recanalization from October 2012 through September 2015. Initial imaging studies and cerebral angiography were analyzed. Of the total number of patients with acute stroke, 5 patients were confirmed to have acute ischemic stroke by calcified cerebral emboli. On initial brain computed tomographic imaging, all patients showed small, dense single calcifications in the middle cerebral artery with no definitive ischemic low-density lesions (M1: 3, M2: 2, mean size: 4.8 mm). All patients had angiographic findings of filling defects from calcified emboli. Four patients had good collateral flow and two had continuous distal flow. All patients underwent MAT using a Penumbra catheter (Penumbra Inc., Alameda, CA). MAT did not remove calcified emboli in all patients. Two patients with good collateral flow had favorable functional outcomes (modified Rankin Scale score ≤2). Four patients had diffuse calcification in the aortic arch, carotid artery, and aortic valve. Cerebral angiography supports a diagnosis of stroke when calcified cerebral emboli have contrast-filling defects and a degree of vascular occlusion. However, in this study, MAT was not an effective treatment for patients with calcified cerebral emboli because of hardness of the calcified plaque and packing into the arterial lumen. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Health-related quality of life in children and adolescents with stroke, self-reports, and parent/proxies reports: cross-sectional investigation.

    Science.gov (United States)

    Neuner, Bruno; von Mackensen, Sylvia; Krümpel, Anne; Manner, Daniela; Friefeld, Sharon; Nixdorf, Sarah; Frühwald, Michael; deVeber, Gabrielle; Nowak-Göttl, Ulrike

    2011-07-01

    Limited data are available on health-related quality of life (HR-QoL) in pediatric stroke survivors. The aim of the present study was to assess HR-QoL by self-assessment and parent/proxy-assessment in children and adolescents who survived a first stroke episode. We investigated HR-QoL in pediatric stroke survivors (71 preschool children [G1] and 62 school children/adolescents [G2]) and in 169 healthy controls. HR-QoL was assessed in patients and parents/proxies with the generic KINDL-R questionnaire exploring overall well-being and 6 well-being subdimensions (physical, psychological, self-esteem, family-related, friend-related, and school-related). In pediatric stroke survivors the neurological long-term outcome was measured with the standardized Pediatric Stroke Outcome Measure. Of stroke survivors, 65% exhibited at least 1 neurologic disability. Pediatric stroke survivors reported lower overall well-being compared with healthy controls. In G2 stroke patients, friend-related well-being respectively emotional well-being was significantly reduced compared with healthy controls (73.0 vs 85.0 points; p proxies of both stroke survivors rated the overall well-being and all subdimensions (except family-related and school-related well-being in G1 and G2 stroke survivors and physical functioning in G2 stroke survivors) lower compared with parents/proxies of healthy children/adolescents. Overall well-being was significantly reduced in children with moderate/severe neurological deficits compared with normal/mildly affected patients (75.5 vs 83.3 points, p = 0.01). Neonatal stroke survivors reported a significantly better neurological long-term outcome compared to childhood stroke survivors (82.0 vs 75.0 points; p = 0.005). Pediatric stroke survivors compared with healthy controls are strongly affected regarding their overall well-being and older children/adolescents regarding their well-being with peers. Copyright © 2011 American Neurological Association.

  19. Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease.

    Science.gov (United States)

    Selwaness, Mariana; Bos, Daniel; van den Bouwhuijsen, Quirijn; Portegies, Marileen L P; Ikram, M Arfan; Hofman, Albert; Franco, Oscar H; van der Lugt, Aad; Wentzel, Jolanda J; Vernooij, Meike W

    2016-06-01

    Because atherosclerosis is a systemic disease, presence and composition on 1 location may relate to ischemic events in distant locations. We examined whether carotid atherosclerotic wall thickness, stenosis, and plaque composition are related to history of ischemic stroke and coronary heart disease (CHD). From the population-based Rotterdam Study, 1731 asymptomatic participants (mean age, 72.4±9.1 years; 55% males) underwent magnetic resonance imaging of both carotid arteries. We assessed carotid wall thickness, stenosis and plaque composition, that is presence of intraplaque hemorrhage, lipid, and calcification. History of ischemic stroke and CHD was assessed until date of magnetic resonance imaging. The study was approved by the institutional review board, and all participants gave informed consent. Logistic regression analyses adjusted for age and traditional cardiovascular risk factors were used to study sex-specific associations between plaque characteristics and clinical events. We found that both carotid stenosis and intraplaque hemorrhage were associated with ischemic stroke in men but not in women (men: odds ratio [OR] for stenosis [per 10% increase]: 1.17 [95% CI, 1.06-1.30] and for intraplaque hemorrhage 2.39 [95% CI, 1.32-4.35]). In both men and women, carotid stenosis was associated with CHD (men: OR per 10% increase 1.12 [95% CI, 1.04-1.21] and women: OR, 1.17 [95% CI, 1.03-1.34]) and carotid wall thickness was associated with CHD (men: OR, 1.20 [95% CI, 1.03-1.39] and women: OR, 1.21 [95% CI, 0.88-1.65]). None of the plaque components was associated with CHD. Whereas carotid plaque thickness and stenosis are associated with the history of ischemic stroke and CHD, carotid intraplaque hemorrhage is associated with ischemic stroke, but not with CHD, providing novel insights into the pathogenesis of cardiovascular events. © 2016 American Heart Association, Inc.

  20. Childhood intelligence in relation to adult coronary heart disease and stroke risk: evidence from a Danish birth cohort study

    DEFF Research Database (Denmark)

    Batty, G. David; Mortensen, Erik Lykke; Andersen, Anne-Marie Nybo

    2005-01-01

    While recent studies have reported an inverse relation between childhood intelligence test scores and all-cause mortality in later life, the link with disease-specific outcomes has been rarely examined. Furthermore, the potential confounding effect of birthweight and childhood social circumstances...... is unknown. We investigated the relation of childhood intelligence with coronary heart disease (CHD) and stroke risk in a cohort of 6910 men born in 1953 in the Copenhagen area of Denmark. Events were ascertained from 1978 to 2000 using a cause-of-death register and hospital discharge records. There were 150...... CHD (19 fatal; 131 non-fatal) and 93 stroke (4 fatal; 89 non-fatal) events during follow-up into mid-life. Childhood intelligence was inversely related to CHD with the highest rate apparent in adults with low childhood test scores (HR(lowest vs. highest quartile), 2.70; 95% confidence interval: 1...

  1. Prevalence and impact of disability and sexual dysfunction on Health-Related Quality of Life of Nigerian stroke survivors.

    Science.gov (United States)

    Oyewole, Olufemi O; Ogunlana, Michael O; Gbiri, Caleb A O; Oritogun, Kolawole S

    2017-10-01

    To investigate the impact of disability and sexual dysfunction on Health-Related Quality of Life (HRQoL) among Nigerian stroke survivors (SSv) and to determine their association using sexual functioning (SF), Global Disability Measure and Function (GDMF), and demographic profiles. This study involved 121 consecutive SSv attending healthcare services in two tertiary health facilities in Nigeria. Demographic details were obtained through interview while HRQoL, SF, and Global Disability (GD) were assessed using Stroke-Specific Quality of Life (SS-QoL-12), Changes in Sexual Functioning Questionnaire (CSFQ-14), and World Health Organization Disability Assessment Schedule (WHODAS-2.0), respectively. Determinants of HRQoL were explored using the Poisson regression analysis. Most of the SSv had moderate/severe GD (95%) and low SF (86.8%). Their HRQoL decreased with increase in their age (p = 0.005) and with increase in GD (p = 0.001). This association remained unchanged even when adjusted for SF (p = 0.001). Those with low SF but with mild GD had relatively better HRQoL than those with moderate/severe GD even when they had higher SF. Their HRQoL was negatively impacted by their GD but not by their SF despite direct correlation between SF and HRQoL. With a unit increase in level of GD, there was 8% decrease in HRQoL scores in psychosocial and 17% decrease in physical domains. Although sexual dysfunction and global disability are prevalent among Nigerian SSv, their low HRQoL is determined by their disability and not by SF. Hence, effort at reducing global disability should be the focus of rehabilitation after stroke. Implication for Rehabilitation Global functional and sexual deficiencies abound in stroke survivors and they impact negatively on their overall quality of life. Sexual dysfunction correlates negatively on physical and psychosocial wellbeing of stroke survivors. Rehabilitation goal(s) should focus disability reduction and improvement of sexual

  2. Hemiplegia cruzada associada a impressão basilar, malformação de Arnold-Chiari e siringomielia: relato de caso Cruciate hemiplegia associated with basilar impression, Arnold-Chiari malformation and syringomyelia: case report

    Directory of Open Access Journals (Sweden)

    José Alberto Gonçalves da Silva

    1996-12-01

    Full Text Available Os autores apresentam um caso de hemiplegia cruzada associada a impressão basilar, malformação de Arnold-Chiari e siringomielia. Discutem as propostas anatômicas e a fiopatogenia desta síndrome de ocorrência bastante rara.The authors report a case of cruciate hemiplegia associated with basilar impression, Chiari malformation and syringomyelia. The neuroanatomical controversy, the surgical treatment and the good outcome of the patient are discussed.

  3. Correlation of resting elbow angle with spasticity in chronic stroke survivors

    OpenAIRE

    Minal Y Bhadane; Minal Y Bhadane; Fan eGao; Gerard E Francisco; Gerard E Francisco; Ping eZhou; Ping eZhou; Ping eZhou; Sheng eLi; Sheng eLi

    2015-01-01

    Objective: To evaluate whether resting joint angle is indicative of severity of spasticity of the elbow flexors in chronic stroke survivors. Methods: Seventeen hemiparetic stroke subjects (male: n=13; female: n=4; age: 37-89 years; 11 right and 6 left hemiplegia; averaged 54.8 months after stroke, ranging 12-107 months) participated in the study. The number of subjects with modified Ashworth scale score (MAS) = 0, 1, 1+, 2, 3 was 3, 3, 5, 3, 3, respectively. In a single experimental session, ...

  4. Correlation of Resting Elbow Angle with Spasticity in Chronic Stroke Survivors

    OpenAIRE

    Bhadane, Minal Y.; Gao, Fan; Francisco, Gerard E.; Zhou, Ping; Li, Sheng

    2015-01-01

    Objective To evaluate whether resting joint angle is indicative of severity of spasticity of the elbow flexors in chronic stroke survivors. Methods Seventeen hemiparetic stroke subjects (male: n = 13; female: n = 4; age: 37–89 years; 11 right and 6 left hemiplegia; averaged 54.8 months after stroke, ranging 12–107 months) participated in the study. The number of subjects with modified Ashworth scale score (MAS) = 0, 1, 1+, 2, and 3 was 3, 3, 5, 3, and 3, respectively. In a single e...

  5. Ischemic stroke as a rare manifestation of aluminum phosphide poisoning: a case report.

    Science.gov (United States)

    Abedini, Mahmoud; Fatehi, Farzad; Tabrizi, Nasim

    2014-01-01

    Aluminum phosphide (AlP) is a solid fumigant which is widely used for a suicide attempt in Iran. Although neurologic symptoms are commonly reported, cerebrovascular stenosis is rare in AlP poisoning. We described ischemic stroke as a delayed complication of AlP intoxication. A 30-year-old man was admitted because of sudden onset left side hemiplegia, 11 days after intentional ingestion of three rice tablets. Investigations revealed in situ thrombosis in right middle cerebral artery (MCA) while other causes of stroke in young adults were excluded. Ischemic stroke should be considered as a delayed complication of AlP intoxication even after the acute phase of intoxication.

  6. Age-specific trends of atrial fibrillation-related ischaemic stroke and transient ischaemic attack, anticoagulant use and risk factor profile in Chinese population: a 15-year study.

    Science.gov (United States)

    Soo, Yannie; Chan, Nathan; Leung, Kam Tat; Chen, Xiang-Yan; Mok, Vincent; Wong, Lawrence; Leung, Thomas

    2017-09-01

    Prevalence of atrial fibrillation (AF) is increasing globally, and the fivefold increase in stroke risk constitutes significant healthcare burden. We aim to evaluate the trends of AF-related stroke and transient ischaemic attack (AF-stroke/TIA), prior anticoagulant use and their risk factors in different age groups in Chinese population. Data were retrieved from the stroke registry at Prince of Wales Hospital. We compared the data at 5-year intervals over a 15-year period (years 1999, 2004, 2009 and 2014). A total of 3894 patients were included, 712 patients had AF-stroke/TIA. Over the 15 years, the total number of ischaemic stroke/TIA fluctuated slightly during the period from year 1999 to 2009, and increased by 21.5% in the year 2014. While AF-stroke/TIA increased continuously with time by 282.1%. Increasing trend of AF-stroke/TIA was observed in all age groups. Absolute growth was highest in patients aged ≥80 years; relative growth was most pronounced in those between 65 and 72 years (>3.5 fold increase). Throughout the 15 years, >70% of AF-stroke/TIA occurred in non-anticoagulated patients, and this proportion increased with age. Increasing trends in both hypertension and ischaemic heart disease were also observed in patients with AF aged ≥73 years. AF-stroke/TIA has increased continuously by >2.5 fold in Chinese population over a 15-year period, with the majority of AF-stroke/TIA occurring in non-anticoagulated patients. Strategic planning is needed to optimise anticoagulant use, particularly non-vitamin K antagonist oral anticoagulants in elderly patients, low-income group and those with ischaemic heart disease requiring concomitant antiplatelet therapy. © 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.

  7. Systematic review of published studies on aquatic exercise for balance in patients with multiple sclerosis, Parkinson's disease, and hemiplegia

    Directory of Open Access Journals (Sweden)

    Pichanan Methajarunon, MSc, PT

    2016-12-01

    Conclusion: Aquatic exercises may be effective at improving balance impairment in patients with hemiplegia and multiple sclerosis. There is a need for further research investigating its effect on Parkinson's disease before encouraging the use of aquatic exercises.

  8. Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life: Randomized Controlled Trial.

    Science.gov (United States)

    Visser, Marieke M; Heijenbrok-Kal, Majanka H; Van't Spijker, Adriaan; Lannoo, Engelien; Busschbach, Jan J V; Ribbers, Gerard M

    2016-01-01

    This study investigated whether problem-solving therapy (PST) is an effective group intervention for improving coping strategy and health-related quality of life (HRQoL) in patients with stroke. In this multicenter randomized controlled trial, the intervention group received PST as add-on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear-mixed models. Primary outcomes were task-oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke-Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ-5D-5L utility score, emotion-oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem-solving skills as measured by the Social Problem Solving Inventory-Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale. Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19), 53% men, median time poststroke 7.29 months (interquartile range, 4.90-10.61 months). Six months post intervention, the PST group showed significant improvement when compared with the control group in task-oriented coping (P=0.008), but not stroke-specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months. PST seems to improve task-oriented coping but not disease-specific psychosocial HRQoL after stroke >6-month follow-up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509. © 2015 American Heart Association, Inc.

  9. Can robot-assisted movement training (Lokomat) improve functional recovery and psychological well-being in chronic stroke? Promising findings from a case study.

    Science.gov (United States)

    Calabrò, Rocco Salvatore; Reitano, Simone; Leo, Antonio; De Luca, Rosaria; Melegari, Corrado; Bramanti, Placido

    2014-01-01

    The Lokomat is a robotic device that has been widely used for gait rehabilitation in several neurological disorders, with a positive effect also in the chronic phase. We describe the case of a 54-yearold female with post-stroke moderate-to-severe chronic hemiplegia, whose force, gait and balance significantly improved after intensive training with Lokomat Pro. We also noted a positive impact of Lokomat on mood and coping styles. This may be partly related to the task-oriented exercises with computerized visual feedback, which in turn can be considered an important tool for increasing patients' motor output, involvement and motivation during gait training. Augmented feedback during robot-assisted gait appears to be a promising way of facilitating gait and physical function, but also of improving psychological and cognitive status.

  10. Prediction of prognosis of upper-extremity function following stroke-related paralysis using brain imaging.

    Science.gov (United States)

    Nakashima, Akira; Moriuchi, Takefumi; Mitsunaga, Wataru; Yonezawa, Takehito; Kataoka, Hideki; Nakashima, Ryusei; Koizumi, Tetsuji; Shimizu, Tadashi; Ryu, Nobutoshi; Higashi, Toshio

    2017-08-01

    [Purpose] Diffusion tensor imaging (DTI) has attracted attention as a method for determining prognosis following paralysis after stroke. However, DTI can assess the degree of damage to the corticospinal tract but cannot evaluate other brain regions. In this study, we examined in detail the prognosis of upper-limb function of the paralyzed side following stroke, using DTI and voxel-based morphometry (VBM). [Subjects and Methods] We studied 17 consecutive patients diagnosed with stroke, including hemorrhagic and ischemic types, who exhibited hemiparesis and were treated in our hospital. DTI and VBM were performed 14 days after admission. Outcome measurements that assessed upper limb function were Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), which were applied after 3 months. [Results] The fractional anisotropy ratio of the bilateral cerebral peduncles (rFA) was significantly correlated with FMA, amount of use, and quality of movement 3 months after stroke. The precentral gyrus significantly degenerated as compared with the control group for a case with notable motor paralysis, for which rFA was high. [Conclusion] We suggest it may be possible to predict recovery of upper limb function following stroke by combining DTI and VBM visualization methods.

  11. Gender-related risk factors for perioperative stroke after carotid endarterectomy in symptomatic patients.

    Science.gov (United States)

    Stelągowski, Mirosław; Kasielska-Trojan, Anna; Bogusiak, Katarzyna; Timler, Dariusz; Łysakowski, Marek; Kaźmierski, Piotr; Pająk, Michał; Szostek, Małgorzata

    2017-11-01

    Carotid endarterectomy (CEA) is a surgical procedure used in ischemic brain stroke prevention in patients with symptomatic and asymptomatic severe carotid artery stenosis. This study compares perioperative stroke or death rate after carotid endarterectomy (CEA) in male and female patients, and determines risk factors for perioperative incidents in women and men. The outcome of surgical treatment of 269 consecutive symptomatic patients (181 men and 88 women) treated from January 2004 to August 2008 in the Department of Vascular, General and Oncologic Surgery was analyzed. Perioperative stroke-death rate (within 30 days after the surgery) in women was 6.8% (6/88) and 3.3% (6/181) in men (p > 0.05). In the female group, none of the analyzed risk factors were associated with a higher risk of periprocedural incident, while in men, only hypercholesterolemia was a significant predictor of perioperative stroke (TC > 240 vs 240 vs 200-240: OR = 6.59; 95% CI: 1.12-38.97; p = 0.0375). In men, hypercholesterolemia significantly increased the risk of perioperative stroke or death, while in females, none of the analyzed factors were determined as the predictors of the incident. The fact that plaque type VI by AHA was significantly more frequent in women and men more frequently were suffering from ischemic heart disease and peripheral artery occlusive disease appeared not to influence the outcome of CEA.

  12. Ischemic stroke related to intracranial branch atheromatous disease and comparison with large and small artery diseases.

    Science.gov (United States)

    Kwan, May Wai-Mei; Mak, Windsor; Cheung, Raymond Tak-Fai; Ho, Shu-Leong

    2011-04-15

    The mechanism of ischemic stroke in intracranial branch atheromatous disease (BAD) is different from large artery atherothrombotic disease (LAD) or lacunar infarction (LACI). The concept of BAD is underused in clinical practice and research. Patients admitted over 24-months with ischemic stroke caused by atherosclerotic disease were reviewed retrospectively and classified according to radiological±clinical criteria into LAD, BAD and LACI. The BAD cases were further divided into 5 BAD syndromes. Clinical characteristics, vascular risk factors, results of vascular workup and outcome among these subgroups were compared. 123 cases of LAD (17% of all stroke patients or 33% of all studied patients), 147 BAD (20% or 40%) and 102 LACI (14% or 27%) presented during the study period. Compared to LAD, BAD patients had milder neurological deficits, were less often diabetic and carotid stenosis was less common, while stenosis of the intracranial arteries was more frequent in BAD as compared with LACI patients. Outcome in BAD patients was intermediate between LAD and LACI. Comparisons among the BAD syndromes indicated they were homogenous conditions. BAD is the most prevalent ischemic stroke subtype in our cohort. The homogeneity among the BAD syndromes suggests they might represent a distinctive stroke entity. Copyright © 2011 Elsevier B.V. All rights reserved.

  13. Pathophysiology of brain ischemia as it relates to the therapy of acute ischemic stroke

    DEFF Research Database (Denmark)

    Lassen, N A

    1990-01-01

    Current knowledge of the pathophysiology of cerebral ischemia, summarized in the present study, predicts that neurological deficits caused by moderate ischemia (flows in the penumbral range between 23 and 10 ml/100 g/min) are reversible provided flow is restored within 3-4 h of onset. It also...... predicts that areas of dense ischemia cannot be salvaged and that reperfusion of such areas is risky, because massive edema or even hemorrhage may develop following reperfusion. On this basis, it is argued that selection of stroke cases for thrombolysis or surgical revascularization must be based not only...... on computed tomographic (CT) scanning to exclude hemorrhagic stroke, but also on cerebral blood flow (CBF) tomography to exclude lacunar infarcts, early reperfusion, and dense ischemia. The methods available for routing CBF tomography in acute stroke cases are discussed, and it is concluded that single photon...

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

    DEFF Research Database (Denmark)

    Sørensen, Mette; Lühdorf, Pernille; Ketzel, Matthias

    2014-01-01

    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...... 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 10µg/m(3) nitrogen dioxide (NO2) and 10dB road traffic noise at the residential address...... 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...

  15. Modulation of task-related cortical connectivity in the acute and subacute phase after stroke

    DEFF Research Database (Denmark)

    Larsen, Lisbeth Hoejkjaer; Zibrandtsen, Ivan Chrilles; Wienecke, Troels

    2018-01-01

    The functional relevance of cortical reorganisation post-stroke is still not well understood. In this study we investigated task-specific modulation of cortical connectivity between neural oscillations in key motor regions during the early phase after stroke. EEG and EMG recordings were examined...... from 15 patients and 18 controls during a precision grip task using the affected hand. Each patient attended two sessions in the acute and subacute phase (median of 3 & 34 days) post-stroke. Dynamic causal modeling (DCM) for induced responses was used to investigate task-specific modulations......). Bayesian model selection favoured a fully connected model. A reduced coupling from SMA and intact M1 in the γ-band (31-48 Hz) to lesioned M1 in the β-band (15-30 Hz) was observed in patients in the acute phase compared to controls. Behavioral performance improved significantly in the subacute phase while...

  16. Hemiplejía con dos signos de Babinski Hemiplegia with two Babinski´s sign

    Directory of Open Access Journals (Sweden)

    Fidias E. Leon-Sarmiento

    2007-08-01

    Full Text Available La evaluación semiológica apropiada es uno de los aspectos más importantes para realizar un adecuado diagnóstico neurológico. Presentamos una paciente colombiana de 60 años de edad, quien padeció un infarto de la arteria cerebral media izquierda, originándole hemiplejía derecha, afasia motora, parálisis facial "central" derecha y atrofia del músculo platisma derecho. Este último hallazgo, originalmente descrito por Joseph Babinski, el cual es el verdadero signo de Babinski, no fue identificado sino hasta dos años y siete meses después de haberse presentado el ictus, aunque había sido evaluada, previamente, por diferentes especialistas en ciencias neurológicas. La no identificación de signos como el mencionado aquí lleva, en ocasiones, a realizar diagnósticos erróneos o incompletos afectando no sólo la localización apropiada de las lesiones sino, también, las eventuales medidas que se deben tomar en la neurorrehabilitación de estos pacientes.Neurological signs and symptoms are very important to establish a correct neurological diagnosis. We present here a Colombian female patient, 60 yearsold, who had ischaemic stroke in the left cerebral media artery. It produced right hemiplegia, motor aphasia, "central" facial palsy and atrophy of right platysma muscle. This latter finding, described originally by Joseph Babinski as "The Babinski Sign" was observed only two years and seven months after the ictus even when she had, previously, been evaluated by several neurologists. The underdiagnosis of clinical signs like the one described here may lead to erroneous diagnosis that will, ultimately, affect neurorehabilitation measures.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm.

    Science.gov (United States)

    Rodda, J; Graham, H K

    2001-11-01

    Classifications of gait and postural patterns in spastic hemiplegia and spastic diplegiía are presented, based on the work of previous authors. The classifications are used as a biomechanical basis, linking spasticity, musculoskeletal pathology in the lower limbs, and the appropriate intervention strategies. The choice of target muscles for spasticity management, the muscle contractures requiring lengthening and the choice of orthotics are then linked to the underlying gait pattern.

  19. Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach?

    Science.gov (United States)

    Morreale, Manuela; Marchione, Pasquale; Pili, Antonio; Lauta, Antonella; Castiglia, Stefano F; Spallone, Aldo; Pierelli, Francesco; Giacomini, Patrizia

    2016-02-01

    Early/intensive mobilization may improve functional recovery after stroke but it is not clear which kind of "mobilization" is more effective. Proprioceptive neuromuscular facilitation (PNF) and cognitive therapeutic exercise (CTE) are widespread applied in post-stroke rehabilitation but their efficacy and safety have not been systematically investigated. To compare PNF and CTE methods in a two different time setting (early versus standard approach) in order to evaluate different role of time and techniques in functional recovery after acute ischemic stroke. We designed a prospectical multicenter blinded interventional study of early versus standard approach with two different methods by means of both PNF and CTE. A discrete stroke-dedicated area for out-of-thrombolysis patients, connected with two different comprehensive stroke centres in two different catchment areas. Three hundred and forty consecutive stroke patient with first ever sub-cortical ischemic stroke in the mean cerebral artery (MCA) territory and contralateral hemiplegia admitted within 6 and 24 hours from symptoms onset. All patients were randomly assigned by means of a computer generated randomization sequence in blocks of 4 to one to the 4 interventional groups: early versus delayed rehabilitation programs with Kabat's schemes or Perfetti's technique. Patients in both delayed group underwent to a standard protocol in the acute phase. disability at 3-12 months. Disability measures: modified Rankin Score and Barthel Index. Safety outcome: immobility-related adverse events. Six-Minute Walking Test, Motricity Index, Mini-Mental State Examination, Beck Depression Inventory. Disability was not different between groups at 3 months but Barthel Index significantly changed between early versus delayed groups at 12 months (P=0.01). Six-Minute Walking Test (P=0.01) and Motricity Index in both upper (P=0.01) and lower limbs (P=0.001) increased in early versus delayed groups regardless rehabilitation schedule. A

  20. Effect of Child Friendly Constraint Induced Movement Therapy on Unimanual and Bimanual Function in Hemiplegia

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Sadegh Hosseini

    2010-10-01

    Full Text Available Objectives: Hemiplegia is a non-progressive damage in premature growing brain which causes movement disorders in one side of the body. The objective of present research is to study the method of modified constraints induced movement therapy (CIMT which can be appropriate on unimanual and bimanual functions of children with Hemiplegia. Methods: This single-blinded, randomized, control trial study performed on twenty-eight participants who were selected based on specific inclusion criteria and divided into two groups of CIMT and conventional therapy. Intervention at CIMT was done six hours every day, for 10 days, whereas another group received conventional occupational therapy. Results: To analyze the data, independent-sample t-test and paired-sample t-test were used. Results showed that significant differences in variables of unimanual function, Jebson Taylor test and dexterity of involved hand in CIMT group, but, these variables did not show any difference in conventional group. Also bimanual functions in CIMT demonstrated significant difference in variables of bimanual function, bilateral coordination, and caregivers’ perception (how much and (how well, whereas this variables did not show any difference in pre-test and post-test of conventional therapy. Discussion: Child friendly CIMT has fairly good effects on unimanual function and some variables of bimanual function of children with hemiplegia.

  1. Rehabilitation for hemiplegia using an upper limb training system based on a force direction.

    Science.gov (United States)

    Ogata, Kunihiro; Hirabayashi, Yuto; Kubota, Keisuke; Hasegawa, Yuri; Tsuji, Toshiaki

    2017-07-01

    Hemiplegia patients have complete paralysis of half their body, and encounter many challenges in living an independent life. Rehabilitation of the lower body is more important than that of the upper body for independent living; thus, recovering upper body functions of their paralyzed side is not enough. Rehabilitation robots may be used to assist training without therapists. In this study, a small portable rehabilitation robot was developed for use at home, and a new training method was proposed. This robot consists on an omni wheel mechanism and a force sensor, and is capable of deciding the motion based on the force value. Voluntary movement of a hemiplegia patient is recovered by the rehabilitation robot and proposed training method. Thus, verification experiments were performed using participants with hemiplegia. The CCI (Co-Contraction Index) from after training were smaller than ones of before training, thus the movement skills of the participants improved with respect to controlling force direction and magnitude. Moreover, manual function test (MFT) scores increased as reflected by improvements in the motor function of the upper limb using the proposed training method.

  2. Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study

    Science.gov (United States)

    Fischer, Urs; Cooney, Marie Therese; Bull, Linda M; Silver, Louise E; Chalmers, John; Anderson, Craig S; Mehta, Ziyah; Rothwell, Peter M

    2014-01-01

    Summary Background It is often assumed that blood pressure increases acutely after major stroke, resulting in so-called post-stroke hypertension. In view of evidence that the risks and benefits of blood pressure-lowering treatment in acute stroke might differ between patients with major ischaemic stroke and those with primary intracerebral haemorrhage, we compared acute-phase and premorbid blood pressure levels in these two disorders. Methods In a population-based study in Oxfordshire, UK, we recruited all patients presenting with stroke between April 1, 2002, and March 31, 2012. We compared all acute-phase post-event blood pressure readings with premorbid readings from 10-year primary care records in all patients with acute major ischaemic stroke (National Institutes of Health Stroke Scale >3) versus those with acute intracerebral haemorrhage. Findings Of 653 consecutive eligible patients, premorbid and acute-phase blood pressure readings were available for 636 (97%) individuals. Premorbid blood pressure (total readings 13 244) had been measured on a median of 17 separate occasions per patient (IQR 8–31). In patients with ischaemic stroke, the first acute-phase systolic blood pressure was much lower than after intracerebral haemorrhage (158·5 mm Hg [SD 30·1] vs 189·8 mm Hg [38·5], pblood pressure after intracerebral haemorrhage was substantially higher than premorbid levels (mean increase of 40·7 mm Hg, pblood pressure also increased steeply in the days and weeks before intracerebral haemorrhage (regression pblood pressure reading after primary intracerebral haemorrhage was more likely than after ischaemic stroke to be the highest ever recorded (OR 3·4, 95% CI 2·3–5·2, pblood pressure within 3 h of onset was 50 mm Hg higher, on average, than the maximum premorbid level whereas that after ischaemic stroke was 5·2 mm Hg lower (pblood pressure is substantially raised compared with usual premorbid levels after intracerebral haemorrhage, whereas acute

  3. A review on assessment and treatment of the trunk in stroke: A need or luxury.

    Science.gov (United States)

    Karthikbabu, Suruliraj; Chakrapani, Mahabala; Ganeshan, Sailakshmi; Rakshith, Kedambadi C; Nafeez, Syed; Prem, Venkatesan

    2012-09-05

    Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke. The primary contribution of the trunk muscles is to allow the body to remain upright, adjust weight shifts, and control movements against constant pull of gravity and is considered central key point of the body. Proximal stability of the trunk is a pre-requisite for distal limb mobility, balance, gait and functional activities and its positive correlation in hemiplegia has been demonstrated in a cross-sectional study. Both isokinetic and handheld dynamometer muscle strength testing demonstrated the weakness of bilateral trunk flexors, extensors and rotator muscles in both acute and chronic hemiplegic patients. This was confirmed by electromyography analysis which identified poor bilateral trunk muscles activity in patients with stroke. Trunk impairment scale is sensitive to evaluate the selective muscle control of upper and lower trunk, and it has been reported that lateral flexion of the trunk is easier than rotation of the trunk and the clinical observation concurs to the difficulty in lower trunk rotation of stroke patients. However, trunk exercises given early after stroke could produce enhanced balance performance post- stroke. This review attempts to report the evidence supporting the involvement of the trunk and its influence on balance and functional performance in post-stroke hemiplegia.

  4. Psychological health of caregivers and association with functional status of stroke patients.

    Science.gov (United States)

    Em, Serda; Bozkurt, Mehtap; Caglayan, Mehmet; Ceylan Cevik, Figen; Kaya, Cemal; Oktayoglu, Pelin; Nas, Kemal

    2017-07-01

    Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients. This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey. The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores. Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.

  5. Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

    NARCIS (Netherlands)

    Santos, Emilie M. M.; Yoo, Albert J.; Beenen, Ludo F.; Berkhemer, Olvert A.; den Blanken, Mark D.; Wismans, Carrie; Niessen, Wiro J.; Majoie, Charles B.; Marquering, Henk A.; Fransen, Puck S. S.; Beumer, Debbie; van den Berg, Lucie A.; Lingsma, Hester F.; Schonewille, Wouter J.; Vos, Jan Albert; Nederkoorn, Paul J.; Wermer, Marieke J. H.; van Walderveen, Marianne A. A.; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A.; Lycklama à Nijeholt, Geert J.; Boiten, Jelis; Brouwer, Patrick A.; Emmer, Bart J.; de Bruijn, Sebastiaan F.; van Dijk, Lukas C.; Kappelle, L. Jaap; Lo, Rob H.; van Dijk, Ewoud J.; de Vries, Joost; de Kort, Paul L. M.; van den Berg, Jan S. P.; A A M van Hasselt, Boudewijn; Aerden, Leo A. M.; Dallinga, René J.; Visser, Marieke C.; Bot, Joseph C. J.; Vroomen, Patrick C.; Eshghi, Omid; Schreuder, Tobien H. C. M. L.; Heijboer, Roel J. J.; Keizer, Koos; Tielbeek, Alexander V.; Hertog, Heleen M. Den; Gerrits, Dick G.; van den Berg-Vos, Renske M.; Karas, Giorgos B.; Steyerberg, Ewout W.; Flach, H. Zwenneke; Sprengers, Marieke E. S.; Jenniskens, Sjoerd F. M.; van den Berg, René; Koudstaal, Peter J.; van Zwam, Wim H.; Roos, Yvo B. W. E. M.; van der Lugt, Aad; van Oostenbrugge, Robert J.; Dippel, Diederik W. J.

    2016-01-01

    Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert

  6. Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

    NARCIS (Netherlands)

    E.M.M. Santos (Emilie M.); A.J. Yoo (Albert J.); L.F.M. Beenen (Ludo); O.A. Berkhemer (Olvert); M.D. Den Blanken (Mark D.); C. Wismans (Carrie); W.J. Niessen (Wiro); C.B. Majoie (Charles); H. Marquering (Henk)

    2016-01-01

    textabstractIntroduction: Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by

  7. Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

    NARCIS (Netherlands)

    Santos, E.M.; Yoo, A.J.; Beenen, L.F.; Berkhemer, O.A.; Blanken, M.D. den; Wismans, C.; Niessen, W.J.; Majoie, C.B.; Marquering, H.A.; Dijk, E.J. van; et al.,

    2016-01-01

    INTRODUCTION: Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and

  8. Absolute and relative temporal order memory for performed activities following stroke

    NARCIS (Netherlands)

    Schoo, Linda A.|info:eu-repo/dai/nl/304833215; Van Zandvoort, Martine J E|info:eu-repo/dai/nl/229475094; Reijmer, Yael D.; Biessels, Geert Jan; Kappelle, L. Jaap; Postma, Albert|info:eu-repo/dai/nl/08621182X

    2014-01-01

    Reconstructing the temporal order of events is a crucial part of episodic memory. The temporal dimension, however, is often discarded in clinical settings, and measurements of true temporal aspects of episodic memory are scarce. The present study assessed temporal memory in stroke patients and in

  9. Health-related quality of life after stroke: reliability of proxy responses

    DEFF Research Database (Denmark)

    Muus, Ingrid; Petzold, Max; Ringsberg, Karin C

    2009-01-01

    A Danish version of the Stroke-Specific Quality of Life Scale (SSQOL-DK) has been developed for self-reporting; it contains 12 physical and psychosocial domains. The purpose of this study was (a) to assess the reliability of the proxy version of the SSQOL-DK and (b) to evaluate the influence...

  10. ESPRIT (European/Australasian Stroke Prevention in Reversible Ischaemia Trial) and related studies

    NARCIS (Netherlands)

    Halkes, P.H.A.

    2008-01-01

    1. We compared 120 patients who had had a large subcortical infarct with 324 who had had a small deep infarct and with 211 who had had a cortical infarct from the same cohort. We found no differences in risk factor profiles between the three groups, nor a difference in stroke recurrence rate. 2. We

  11. High Homocysteine and Blood Pressure Related to Poor Outcome of Acute Ischemia Stroke in Chinese Population

    Science.gov (United States)

    Liu, Changjiang; Zhao, Liang; Zhou, Mo; Sun, Wenjie; Xu, Tan; Tong, Weijun

    2014-01-01

    Objectives To assess the association between plasma homocysteine (Hcy), blood pressure (BP) and poor outcome at hospital discharge among acute ischemic stroke patients, and if high Hcy increases the risk of poor outcome based on high BP status in a northern Chinese population. Methods Between June 1, 2009 and May 31, 2013, a total of 3695 acute ischemic stroke patients were recruited from three hospitals in northern Chinese cities. Demographic characteristics, lifestyle risk factors, medical history, and other clinical characteristics were recorded for all subjects. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score ≥3 or death. The association between homocysteine concentration, admission blood pressure, and risk of poor outcome following acute ischemic stroke was analyzed by using multivariate non-conditional logistic regression models. Results Compared with those in the lowest quartile of Hcy concentration in a multivariate-adjusted model, those in the highest quartile of Hcy concentration had increased risk of poor outcome after acute ischemic stroke, (OR = 1.33, P<0.05). The dose-response relationship between Hcy concentration and risk of poor outcome was statistically significant (p-value for trend  = 0.027). High BP was significantly associated with poor outcome following acute ischemic stroke (adjusted OR = 1.44, 95%CI, 1.19–1.74). Compared with non-high BP with nhHcy, in a multivariate-adjusted model, the ORs (95% CI) of non-high BP with hHcy, high BP with nhHcy, and high BP with hHcy to poor outcome were 1.14 (0.85–1.53), 1.37 (1.03–1.84) and 1.70 (1.29–2.34), respectively. Conclusion The present study suggested that high plasma Hcy and blood pressure were independent risk factors for prognosis of acute ischemic stroke, and hHcy may further increase the risk of poor outcome among patients with high blood pressure. Additionally, the results indicate that high Hcy with high BP may cause increased susceptibility

  12. Mirror therapy for upper limb rehabilitation in chronic patients after stroke

    OpenAIRE

    Mota,Dreyzialle Vila Nova; Meireles,André Luís Ferreira de; Viana,Marcelo Tavares; Almeida,Rita de Cássia de Albuquerque

    2016-01-01

    Abstract Introduction: Individuals with stroke sequelae present changes in the postural alignment and muscle strength associated with hemiplegia or hemiparesis. Mirror therapy is a technique that aims to improve the motor function of the paretic limb. Objective: The aim of this study was to evaluate the effect of mirror therapy, associated with conventional physiotherapy, for range of motion (ROM), degree of spasticity of the affected upper limb, and the level of independence in the activ...

  13. Which is better in the rehabilitation of stroke patients, core stability exercises or conventional exercises?

    OpenAIRE

    Sun, Xibo; Gao, Qian; Dou, Honglei; Tang, Shujie

    2016-01-01

    [Purpose] The aim of this study was to determine which is better in the rehabilitation of stroke patients, core stability exercises or conventional exercises. [Subjects and Methods] Forty participants with hemiplegia were recruited in the Department of Neurology of Yidu Central Hospital of Weifang between January 2014 and February 2015 and randomly divided into either an experimental or control group. The patients in the control group performed conventional exercises for six weeks, and those ...

  14. Ischemic stroke as a rare manifestation of aluminum phosphide poisoning: a case report.

    OpenAIRE

    Mahmoud Abedini; Farzad Fatehi; Nasim Tabrizi

    2014-01-01

    Aluminum phosphide (AlP) is a solid fumigant which is widely used for a suicide attempt in Iran. Although neurologic symptoms are commonly reported, cerebrovascular stenosis is rare in AlP poisoning. We described ischemic stroke as a delayed complication of AlP intoxication. A 30-year-old man was admitted because of sudden onset left side hemiplegia, 11 days after intentional ingestion of three rice tablets. Investigations revealed in situ thrombosis in right middle cerebral artery (MCA) whil...

  15. Effects of repeated vibratory stimulation of wrist and elbow flexors on hand dexterity, strength, and sensory function in patients with chronic stroke: a pilot study.

    Science.gov (United States)

    Choi, Won-Ho

    2017-04-01

    [Purpose] The aim of this study was to investigate the effects of repeated vibratory stimulation to muscles related to hand functions on dexterity, strength, and sensory function in patients with chronic stroke. [Subjects and Methods] A total of 10 stroke patients with hemiplegia participated in this study. They were divided into two groups: a) Experimental and b) Control, with five randomly selected subjects for each group. The experimental group received vibratory stimulation, while the control group received the traditional physical therapy. Both interventions were performed for 30 minutes each session, three times a week for four weeks. [Results] There was a significant within-group improvement in the box and block test results in both groups for dexterity. Grip strength improved in both groups but the improvement was not statistically significant. [Conclusion] The vibratory stimulation activated the biceps brachii and flexor carpi radialis, which increased dexterity to grasp and lift the box and block from the surface. Therefore, repeated vibratory stimulation to muscles related to hand functions improved hand dexterity equality to the traditional physical therapy in patients with chronic stroke.

  16. Daily physical activity and its contribution to the health-related quality of life of ambulatory individuals with chronic stroke

    Directory of Open Access Journals (Sweden)

    Rand Debbie

    2010-08-01

    Full Text Available Abstract Background Participation in daily physical activity (PA post-stroke has not previously been investigated as a possible explanatory variable of health-related quality of life (HRQL. The aims were 1 to determine the contribution of daily PA to the HRQL of individuals with chronic stroke and 2 to assess the relationship between the functional ability of these individuals to the amount of daily PA. Methods The amount of daily PA of forty adults with chronic stroke (mean age 66.5 ± 9.6 years was monitored using two measures. Accelerometers (Actical were worn on the hip for three consecutive days in conjunction with a self-report questionnaire [the PA Scale for Individuals with Physical Disabilities (PASIPD]. The daily physical activity was measured as the mean total accelerometer activity counts/day and the PASIPD scores as the metabolic equivalent (MET hr/day. HRQL was assessed by the Physical and Mental composite scores of the Medical Outcomes Study Short-Form 36 (SF-36 in addition to the functional ability of the participants. Correlation and regression analyses were performed. Results After controlling for the severity of the motor impairment, the amount of daily PA, as assessed by the PASIPD and accelerometers, was found to independently contribute to 10-12% of the variance of the Physical Composite Score of the SF-36. No significant relationship was found between PA and the Mental Composite Score of the SF-36.The functional ability of the participants was found to be correlated to the amount of daily PA (r = 0.33 - 0.67, p Conclusion The results suggest that daily PA is associated with better HRQL (as assessed by the Physical composite score of the SF-36 for people living with stroke. Daily PA should be encouraged to potentially increase HRQL. Accelerometers in conjunction with a self-report questionnaire may provide important measures of PA which can be monitored and modified, and potentially influence HRQL.

  17. Combination of 24-Hour and 7-Day Relative Neurological Improvement Strongly Predicts 90-Day Functional Outcome of Endovascular Stroke Therapy.

    Science.gov (United States)

    Pu, Jie; Wang, Huaiming; Tu, Mingyi; Zi, Wenjie; Hao, Yonggang; Yang, Dong; Liu, Wenhua; Wan, Yue; Geng, Yu; Lin, Min; Jin, Ping; Xiong, Yunyun; Xu, Gelin; Yin, Qin; Liu, Xinfeng

    2018-01-03

    Early judgment of long-term prognosis is the key to making medical decisions in acute anterior circulation large-vessel occlusion stroke (LVOS) after endovascular treatment (EVT). We aimed to investigate the relationship between the combination of 24-hour and 7-day relative neurological improvement (RNI) and 90-day functional outcome. We selected the target population from a multicenter ischemic stroke registry. The National Institutes of Health Stroke Scale (NIHSS) scores at baseline, 24 hours, and 7 days were collected. RNI was calculated by the following equation: (baseline NIHSS - 24-hour/7-day NIHSS)/baseline NIHSS × 100%. A modified Rankin Scale score of 0-2 at 90 days was defined as a favorable outcome. Multivariable logistic regression analysis was used to evaluate the relationship between RNI and 90-day outcome. Receiver operator characteristic curve analysis was performed to identify the predictive power and cutoff point of RNI for functional outcome. A total of 568 patients were enrolled. Both 24-hour and 7-day RNI were independent predictors of 90-day outcome. The best cutoff points of 24-hour and 7-day RNI were 28% and 42%, respectively. Compared with those with 24-hour RNI of less than 28% and 7-day RNI of less than 42%, patients with 24-hour RNI of 28% or greater and 7-day RNI of 42% or greater had a 39.595-fold (95% confidence interval 22.388-70.026) increased probability of achieving 90-day favorable outcome. The combination of 24-hour and 7-day RNI very strongly predicts 90-day functional outcome in patients with acute anterior circulation LVOS who received EVT, and it can be used as an early accurate surrogate of long-term outcome. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Family History in Young Patients With Stroke.

    Science.gov (United States)

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

    2015-07-01

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

  19. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav

    2014-03-01

    Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP

  20. EEG Event-Related Desynchronization of patients with stroke during motor imagery of hand movement

    Science.gov (United States)

    Tabernig, Carolina B.; Carrere, Lucía C.; Lopez, Camila A.; Ballario, Carlos

    2016-04-01

    Brain Computer Interfaces (BCI) can be used for therapeutic purposes to improve voluntary motor control that has been affected post stroke. For this purpose, desynchronization of sensorimotor rhythms of the electroencephalographic signal (EEG) can be used. But it is necessary to study what happens in the affected motor cortex of this people. In this article, we analyse EEG recordings of hemiplegic stroke patients to determine if it is possible to detect desynchronization in the affected motor cortex during the imagination of movements of the affected hand. Six patients were included in the study; four evidenced desynchronization in the affected hemisphere, one of them showed no results and the EEG recordings of the last patient presented high noise level. These results suggest that we could use the desynchronization of sensorimotor rhythms of the EEG signal as a BCI paradigm in a rehabilitation programme.

  1. Childhood Stature and Growth in Relation to First Ischemic Stroke or Intracerebral Hemorrhage

    DEFF Research Database (Denmark)

    Gjærde, Line Klingen; Truelsen, Thomas Clement; Baker, Jennifer Lyn

    2018-01-01

    BACKGROUND AND PURPOSE: Attained height, an indicator of genetic potential and childhood growth environment, is inversely associated with stroke, but the mechanisms are poorly understood. We investigated whether childhood height and growth are associated with ischemic stroke (IS) and intracerebral...... hemorrhage (ICH). METHODS: In a cohort of Danish schoolchildren born 1930 to 1989, with measured height from 7 to 13 years, we investigated associations of childhood stature and growth with risks of adult IS and ICH. Cox proportional hazards regressions were performed to estimate hazard ratios (HRs) with CIs.......90 [95% CI: 0.88-0.92]) and with ICH in men (HR=0.89 [95% CI: 0.84-0.94]) but not in women (HR=0.97 [95% CI: 0.91-1.04]). Associations were similar at older childhood ages and were stable throughout the study period. No statistically significant associations for growth from 7 to 13 years were observed...

  2. Childhood Stature and Growth in Relation to First Ischemic Stroke or Intracerebral Hemorrhage.

    Science.gov (United States)

    Gjærde, Line Klingen; Truelsen, Thomas Clement; Baker, Jennifer Lyn

    2018-03-01

    Attained height, an indicator of genetic potential and childhood growth environment, is inversely associated with stroke, but the mechanisms are poorly understood. We investigated whether childhood height and growth are associated with ischemic stroke (IS) and intracerebral hemorrhage (ICH). In a cohort of Danish schoolchildren born 1930 to 1989, with measured height from 7 to 13 years, we investigated associations of childhood stature and growth with risks of adult IS and ICH. Cox proportional hazards regressions were performed to estimate hazard ratios (HRs) with CIs separately for women and men. Among 311 009 individuals, 10 412 were diagnosed with IS and 2546 with ICH. Height at 7 years was inversely and significantly associated with IS in both sexes (per z score, equivalent to ≈5.2 cm in women and 5.1 cm in men; women: HR=0.89 [95% CI: 0.87-0.92]; men: HR=0.90 [95% CI: 0.88-0.92]) and with ICH in men (HR=0.89 [95% CI: 0.84-0.94]) but not in women (HR=0.97 [95% CI: 0.91-1.04]). Associations were similar at older childhood ages and were stable throughout the study period. No statistically significant associations for growth from 7 to 13 years were observed for IS or ICH. Short stature at 7 to 13 years is significantly associated with increased risks of IS in both sexes and with ICH in men. Growth during this period of childhood is not significantly associated with either of these stroke subtypes, suggesting that underlying mechanisms linking height with risks of stroke may exert their influence already by early childhood. © 2018 American Heart Association, Inc.

  3. A síndrome ombro-mão nas hemiplegias vasculares Shoulder-hand syndrome in cerebrovascular hemiplegia

    Directory of Open Access Journals (Sweden)

    Sebastião E. Melo Souza

    1968-09-01

    Full Text Available São expostos os dados obtidos em 18 casos de síndrome ombro-mão, encontrados mediante revisão de 175 pacientes acometidos de afecção cerebro-vascular aguda. Em todos os casos a síndrome se instalou no lado paralisado, evidenciando a importância da imobilização. O início se deu, na maioria das vezes, por edema de mão, aparecendo dentro de duas a três semanas após o icto. Os resultados eletromiográficos obtidos em 7 casos, são comentados. O tratamento de maior êxito se deve à cinesiterapia, podendo-se associar a griseofulvina, útil no alívio da dor.From 175 cases of cerebrovascular disease, 18 patients with shoulder-hand syndrome are studied. In all patients the syndrome involved the paralysed limb, a fact that points to immobility as a enhancing factor. Hand edema occurring two to three weeks after the stroke was the first sign of the syndrome. Eletromyographic data were evaluated in 7 patients. Griseofulvine (for pain and kinesiotherapy are the best available tratment.

  4. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    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.

  5. Does cultural and linguistic diversity affect health-related outcomes for people with stroke at discharge from hospital?

    Science.gov (United States)

    Davies, Sarah E; Dodd, Karen J; Hill, Keith D

    2017-04-01

    Primary purpose to determine if cultural and linguistic diversity affects health-related outcomes in people with stroke at discharge from hospital and secondary purpose to explore whether interpreter use alters these outcomes. Systematic search of: Cochrane, PEDro, CINAHL, Medline, Pubmed, Embase, PsycINFO and Ageline databases. Publications were classified into whether they examined the impact of diversity in culture, or language or culture and language combined. Quality of evidence available was summarized using Best Evidence Synthesis. Eleven studies met inclusion criteria and were reviewed. Best Evidence Synthesis indicated conflicting evidence about the impact of culture alone and language barriers alone on health-related outcomes. There was strong evidence that hospital length of stay does not differ between groups when the combined impact of culture and language was investigated. Conflicting evidence was found for other outcomes including admission, discharge and change in FIM scores, and post-hospital discharge living arrangements. It is unknown if interpreter use alters health-related outcomes, because this was infrequently reported. The current limited research suggests that cultural and linguistic diversity does not appear to impact on health-related outcomes at discharge from hospital for people who have had a stroke, however further research is needed to address identified gaps. Implications for Rehabilitation The different language, culture and beliefs about health demonstrated by patients with stroke from minority groups in North America do not appear to significantly impact on their health-related outcomes during their admission to hospital. It is not known whether interpreter use influences outcomes in stroke rehabilitation because there is insufficient high quality research in this area. Clinicians in countries with different health systems and different cultural and linguistic groups within their communities need to view the results with caution

  6. Fish oil diet associated with acute reperfusion related hemorrhage, and with reduced stroke-related sickness behaviors and motor impairment.

    Science.gov (United States)

    Pascoe, Michaela C; Howells, David W; Crewther, David P; Constantinou, Nicki; Carey, Leeanne M; Rewell, Sarah S; Turchini, Giovanni M; Kaur, Gunveen; Crewther, Sheila G

    2014-01-01

    Ischemic stroke is associated with motor impairment and increased incidence of affective disorders such as anxiety/clinical depression. In non-stroke populations, successful management of such disorders and symptoms has been reported following diet supplementation with long chain omega-3-polyunsaturated-fatty-acids (PUFAs). However, the potential protective effects of PUFA supplementation on affective behaviors after experimentally induced stroke and sham surgery have not been examined previously. This study investigated the behavioral effects of PUFA supplementation over a 6-week period following either middle cerebral artery occlusion or sham surgery in the hooded-Wistar rat. The PUFA diet supplied during the acclimation period prior to surgery was found to be associated with an increased risk of acute hemorrhage following the reperfusion component of the surgery. In surviving animals, PUFA supplementation did not influence infarct size as determined 6 weeks after surgery, but did decrease omega-6-fatty-acid levels, moderate sickness behaviors, acute motor impairment, and longer-term locomotor hyperactivity and depression/anxiety-like behavior.

  7. Biomarkers Related to Carotid Intima-Media Thickness and Plaques in Long-Term Survivors of Ischemic Stroke.

    Science.gov (United States)

    Waje-Andreassen, Ulrike; Naess, Halvor; Thomassen, Lars; Maroy, Tove Helene; Mazengia, Kibret Yimer; Eide, Geir Egil; Vedeler, Christian Alexander

    2015-08-01

    Lifestyle risk factors, inflammation and genetics play a role in the development of atherosclerosis. We therefore studied Fc gamma receptor (FcγR) polymorphisms, interleukin (IL)-10 polymorphisms and other biomarkers related to carotid intima-media thickness (cIMT) in patients with ischemic stroke at a young age. Patients were evaluated 12 years after stroke occurrence. Patients (n = 232) 49 years of age or younger with an index stroke between 1988 and 1997 were retrospectively selected. Blood samples were taken at a first follow-up 6 years after the stroke. At a second follow-up, additional arterial events were registered for 140 patients, new blood samples were taken, and measurements of cIMT and blood pressure (BP) were performed. Unadjusted logistic regression analysis showed that cIMT ≥1 mm was associated with age, male gender, additional arterial events, BP, cholesterol, sedimentation rate, haemoglobin, triglycerides, creatinine, glycolysed haemoglobin (HbA1c) and FcγRIIIB-NaII/NaII. Adjusted backward stepwise logistic regression showed significance for age (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.04 to1.23, p = 0.003), male gender (OR 4.07, 95% CI 1.15 to 14.5, p = 0.030), HbA1c (OR 6.65, 95% CI 1.21 to 36.5, p = 0.029) and FcγRIIIB-NaII/NaII (OR 3.94, 95% CI 1.08 to 14.3, p = 0.037). In this long-term follow-up study of patients with ischemic stroke at a young age, FcγRIIIB-NaII/NaII was identified as a possible contributing factor for cIMT ≥1 mm together with known risk factors, such as age, male gender, systolic BP, additional arterial events and HbA1c.

  8. Stroke Rehabilitation

    Science.gov (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

  9. Effects of ankle-foot orthoses for children with hemiplegia on weight-bearing and functional ability.

    Science.gov (United States)

    O'Reilly, Tara; Hunt, Adrienne; Thomas, Bronwyn; Harris, Lynne; Burns, Joshua

    2009-01-01

    To compare the effects of a leaf spring ankle-foot orthosis (LAFO) and a hinged AFO with plantar flexion stop with that of shoe only on weight-bearing and function in children with hemiplegia. The study used an experimental single-subject alternating treatment design with replication. Outcomes measured were weight-bearing symmetry, weight-bearing on the hemiplegic rear foot compared with that of the forefoot, functional ability, and child and parent preference. Both AFOs increased relative contact area of the hemiplegic foot. The LAFO increased relative force through the hemiplegic foot. There was increased pressure through the rear foot, time spent on the rear foot, and force through the forefoot. Rear foot contact area increased in the LAFO. Neither AFO affected function. Patient preference for AFO condition was inconsistent. Both AFOs increased weight-bearing through the hemiplegic foot and rear foot, indicative of potential benefit to growth. Neither the LAFO nor the hinged AFO with plantar flexion stop improved function of the children.

  10. Gasoline-related organics in Lake Tahoe before and after prohibition of carbureted two-stroke engines

    Science.gov (United States)

    Lico, M.S.

    2004-01-01

    On June 1, 1999, carbureted two-stroke engines were banned on waters within the Lake Tahoe Basin of California and Nevada. The main gasoline components MTBE (methyl tert-butyl ether) and BTEX (benzene, toluene, ethylbenzene, and xylenes) were present at detectable concentrations in all samples taken from Lake Tahoe during 1997-98 prior to the ban. Samples taken from 1999 through 2001 after the ban contained between 10 and 60 percent of the pre-ban concentrations of these compounds, with MTBE exhibiting the most dramatic change (a 90 percent decrease). MTBE and BTEX concentrations in water samples from Lake Tahoe and Lower Echo Lake were related to the amount of boat use at the sampling sites. Polycyclic aromatic hydrocarbon (PAH) compounds are produced by high-temperature pyrolytic reactions. They were sampled using semipermeable membrane sampling devices in Lake Tahoe and nearby Donner Lake, where carbureted two-stroke engines are legal. PAHs were detected in all samples taken from Lake Tahoe and Donner Lake. The number of PAH compounds and their concentrations are related to boat use. The highest concentrations of PAH were detected in samples from two heavily used boating areas, Tahoe Keys Marina and Donner Lake boat ramp. Other sources of PAH, such as atmospheric deposition, wood smoke, tributary streams, and automobile exhaust do not contribute large amounts of PAH to Lake Tahoe. Similar numbers of PAH compounds and concentrations were found in Lake Tahoe before and after the ban of carbureted two-stroke engines. ?? by the North American Lake Management Society 2004.

  11. Relative and cumulative effects of lipid and blood pressure control in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial

    DEFF Research Database (Denmark)

    Amarenco, Pierre; Goldstein, Larry B; Messig, Michael

    2009-01-01

    randomized 4731 patients with recent stroke or transient ischemic attack and no known coronary heart disease to atorvastatin 80 mg per day or placebo. RESULTS: After 4.9 years, at each level of LDL-C reduction, subjects with HDL-C value above the median or systolic BP below the median had greater reductions......BACKGROUND AND PURPOSE: The relative contributions of on-treatment low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides, and blood pressure (BP) control on the risk of recurrent stroke or major cardiovascular events in patients with stroke is not well defined. METHODS: We...... in stroke and major cardiovascular events and those with a reduction in triglycerides above the median or diastolic BP below the median showed similar trends. There were no statistical interactions between on-treatment LDL-C, HDL-C, triglycerides, and BP values. In a further exploratory analysis, optimal...

  12. Left Ventricular Geometry Determines Prognosis and Reverse J-Shaped Relation Between Blood Pressure and Mortality in Ischemic Stroke Patients.

    Science.gov (United States)

    Park, Chan Soon; Park, Jun-Bean; Kim, Yerim; Yoon, Yeonyee E; Lee, Seung-Pyo; Kim, Hyung-Kwan; Kim, Yong-Jin; Cho, Goo-Yeong; Sohn, Dae-Won; Lee, Seung-Hoon

    2018-03-01

    This study sought to investigate the prognostic significance of left ventricular (LV) mass and geometry in ischemic stroke survivors, as well as the LV geometry-specific differences in the blood pressure-mortality relationship. LV mass and geometry are well-known prognostic factors in various populations; however, there are no data on their role in ischemic stroke patients. We prospectively recruited 2,328 consecutive patients admitted with acute ischemic stroke to our institute between 2002 and 2010. Of these, 2,069 patients were analyzed in whom echocardiographic data were available to assess LV mass and geometry. All-cause mortality was significantly greater in patients with concentric hypertrophy (adjusted hazard ratio [HR]: 1.417; 95% confidence interval [CI]: 1.045 to 1.920) and concentric remodeling (HR: 1.540; 95% CI: 1.115 to 2.127) but nonsignificantly in those with eccentric hypertrophy (HR: 1.388; 95% CI: 0.996 to 1.935) compared with normal geometry in multivariate analyses. Relative wall thickness was a significant predictor of all-cause mortality (HR: 1.149 per 0.1-U increase in relative wall thickness; 95% CI: 1.021 to 1.307), whereas LV mass index was not (HR: 1.003 per 1 g/m 2 increase in LV mass index; 95% CI: 0.999 to 1.007). Similar results were observed with cardiovascular mortality. In multivariable fractional polynomials, patients with altered LV geometry showed reverse J-curve relationships between acute-phase systolic blood pressure and all-cause or cardiovascular mortality, with the highest risks in the lower extremes, whereas those with normal geometry did not. Echocardiographic assessment of LV geometry provided independent and additive prognostic information in ischemic stroke patients. A reverse J-shaped relation of mortality with blood pressure was found in patients with abnormal LV geometry. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Inadvertent Central Arterial Catheterization: An Unusual Cause of Ischemic Stroke

    Science.gov (United States)

    Katyal, Nakul; Korzep, Amanda; Newey, Christopher

    2018-01-01

    Central venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed. He was found to have a right frontal ischemic stroke on computed tomography (CT). CT angiography noted that the catheter was arterial and had a thrombosis around it. He was started on a low-dose heparin infusion. A combination of cardiothoracic surgery and interventional cardiology was required to safely remove the catheter. Central arterial catheterization is an unusual cause for acute ischemic stroke and presents management challenges. PMID:29456363

  14. The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke.

    Science.gov (United States)

    Alibiglou, Laila; Rymer, William Z; Harvey, Richard L; Mirbagheri, Mehdi M

    2008-07-15

    Spasticity is a common impairment that follows stroke, and it results typically in functional loss. For this reason, accurate quantification of spasticity has both diagnostic and therapeutic significance. The most widely used clinical assessment of spasticity is the modified Ashworth scale (MAS), an ordinal scale, but its validity, reliability and sensitivity have often been challenged. The present study addresses this deficit by examining whether quantitative measures of neural and muscular components of spasticity are valid, and whether they are strongly correlated with the MAS. We applied abrupt small amplitude joint stretches and Pseudorandom Binary Sequence (PRBS) perturbations to both paretic and non-paretic elbow and ankle joints of stroke survivors. Using advanced system identification techniques, we quantified the dynamic stiffness of these joints, and separated its muscular (intrinsic) and reflex components. The correlations between these quantitative measures and the MAS were investigated. We showed that our system identification technique is valid in characterizing the intrinsic and reflex stiffness and predicting the overall net torque. Conversely, our results reveal that there is no significant correlation between muscular and reflex torque/stiffness and the MAS magnitude. We also demonstrate that the slope and intercept of reflex and intrinsic stiffnesses plotted against the joint angle are not correlated with the MAS. Lack of significant correlation between our quantitative measures of stroke effects on spastic joints and the clinical assessment of muscle tone, as reflected in the MAS suggests that the MAS does not provide reliable information about the origins of the torque change associated with spasticity, or about its contributing components.

  15. Using T3, an improved decision tree classifier, for mining stroke-related medical data.

    Science.gov (United States)

    Tjortjis, C; Saraee, M; Theodoulidis, B; Keane, J A

    2007-01-01

    Medical data are a valuable resource from which novel and potentially useful knowledge can be discovered by using data mining. Data mining can assist and support medical decision making and enhance clinical management and investigative research. The objective of this work is to propose a method for building accurate descriptive and predictive models based on classification of past medical data. We also aim to compare this method with other well established data mining methods and identify strengths and weaknesses. We propose T3, a decision tree classifier which builds predictive models based on known classes, by allowing for a certain amount of misclassification error in training in order to achieve better descriptive and predictive accuracy. We then experiment with a real medical data set on stroke, and various subsets, in order to identify strengths and weaknesses. We also compare performance with a very successful and well established decision tree classifier. T3 demonstrated impressive performance when predicting unseen cases of stroke resulting in as little as 0.4% classification error while the state of the art decision tree classifier resulted in 33.6% classification error respectively. This paper presents and evaluates T3, a classification algorithm that builds decision trees of depth at most three, and results in high accuracy whilst keeping the tree size reasonably small. T3 demonstrates strong descriptive and predictive power without compromising simplicity and clarity. We evaluate T3 based on real stroke register data and compare it with C4.5, a well-known classification algorithm, showing that T3 produces significantly more accurate and readable classifiers.

  16. Predictive value of vertebral artery extracranial color-coded duplex sonography for ischemic stroke-related vertigo

    Directory of Open Access Journals (Sweden)

    Li-Min Liou

    2013-12-01

    Full Text Available Vertigo can be a major presentation of posterior circulation stroke and can be easily misdiagnosed because of its complicated presentation. We thus prospectively assessed the predictive value of vertebral artery extracranial color-coded duplex sonography (ECCS for the prediction of ischemic stroke-related vertigo. The inclusion criteria were: (1 a sensation of whirling (vertigo; (2 intractable vertigo for more than 1 hour despite appropriate treatment; and (3 those who could complete cranial magnetic resonance imaging (MRI and vertebral artery (V2 segment ECCS studies. Eventually, 76 consecutive participants with vertigo were enrolled from Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan between August 2010 and August 2011. Demographic data, neurological symptoms, neurologic examinations, and V2 ECCS were assessed. We chose the parameters of peak systolic velocity (PSV, end diastolic velocity (EDV, PSV/EDV, mean velocity (MV, resistance index (RI, and pulsatility index (PI to represent the hemodynamics. Values from both sides of V2 segments were averaged. We then calculated the average RI (aRI, average PI (aPI, average PSV (aPSV/EDV, and average (aMV. Axial and coronal diffusion-weighted MRI findings determined the existence of acute ischemic stroke. We grouped and analyzed participants in two ways (way I and way II analyses based on the diffusion-weighted MRI findings (to determine whether there was acute stroke and neurological examinations. Using way I analysis, the “MRI (+” group had significantly higher impedance (aRI, aPI, and aPSV/EDV ratio and lower velocity (aPSV, aEDV, and aMV(PSV + EDV/2, compared to the “MRI (–” group. The cutoff value/sensitivity/specificity of aPSV, aEDV, aMV, aPI, aRI, and aPSV/EDV between the MRI (+ and MRI (– groups were 41.15/61.5/66.0 (p = 0.0101, 14.55/69.2/72.0 (p = 0.0003, 29.10/92.1/38.0 (p = 0.0013, 1.07/76.9/64.0 (p = 0.0066, 0.62/76.9/64.0 (p = 0.0076, and 2

  17. Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients

    Directory of Open Access Journals (Sweden)

    Tomoko Ohura

    2017-08-01

    Full Text Available Abstract Background The Barthel Index (BI is a measure of independence in activities of daily living (ADL. In the modified Barthel Index (MBI, a five-point system replaced the original two or three or four point rating system. Based on this modified measure, the performance evaluation tool MBI (PET-MBI was developed in Japan. Although the reliability and validity of PET-MBI have been verified for older people, the use of this tool in stroke patients has not been evaluated. This study investigated the validity and reliability of PET-MBI for stroke patients. Methods Ten raters independently determined the BI and PET-MBI scores of stroke patients by direct observation. These patients’ ADL were videotaped, and 10 other raters then evaluated the videos privately and assigned PET-MBI scores twice, one month apart. The criterion-related validity of the PET-MBI against the BI was evaluated using the correlation coefficients for their total scores. Furthermore, to assess inter- and intra-rater reliabilities from the results of the first and second sessions, Fleiss’ intraclass correlation coefficients (ICCs were calculated for the total scores, with the lower limits of the 95% confidence interval (95%CI, along with weighted kappa (κw coefficients for agreement in individual tasks of this evaluation tool. ICC and κw coefficients of 0.81–1.00 were considered to be “almost perfect” agreement. Results The mean age of the 30 patients (23 men, 7 women was 71.9 (standard deviation 10.5 years. One patient had diplegia, 14 had right hemiplegia, and 15 had left hemiplegia. For the total scores obtained by direct evaluation, Pearson’s and Spearman’s correlation coefficients of the BI versus the PET-MBI were both 0.95 (lower limit of the 95%CI, 0.90. The ICC representing inter-rater reliability for the first session was 0.99 (lower limit of the 95%CI, 0.98]. For intra-rater reliability, the mean value of the ICCs was 0.99 (range, 0.99–1.00. For

  18. Spotlight on botulinum toxin and its potential in the treatment of stroke-related spasticity

    Science.gov (United States)

    Kaku, Michelle; Simpson, David M

    2016-01-01

    Poststroke spasticity affects up to one-half of stroke patients and has debilitating effects, contributing to diminished activities of daily living, quality of life, pain, and functional impairments. Botulinum toxin (BoNT) is proven to be safe and effective in the treatment of focal poststroke spasticity. The aim of this review is to highlight BoNT and its potential in the treatment of upper and lower limb poststroke spasticity. We review evidence for the efficacy of BoNT type A and B formulations and address considerations of optimal injection technique, patient and caregiver satisfaction, and potential adverse effects of BoNT. PMID:27022247

  19. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome

    DEFF Research Database (Denmark)

    Sandset, Else C; Murray, Gordon D; Bath, Philip M W

    2012-01-01

    The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome....

  20. Cardiac myxoma causing acute ischemic stroke in a pediatric patient and a review of literature.

    Science.gov (United States)

    Fuchs, Jennifer; Leszczyszyn, David; Mathew, Don

    2014-05-01

    Ischemic stroke in the pediatric population is a rare occurrence, and its possible causes span a wide differential that includes atrial myxomas. Myxomas are friable cardiac tumors that produce "showers" of emboli resulting in transient neurological deficits, cutaneous eruptions, and ophthalmologic deficits. We present an 11-year-old boy with a months-long history of an intermittent spotted "rash" who presented with acute ischemic stroke caused by a left atrial myxoma. We also review clinical features in all 16 other cases of cardiac myxoma causing pediatric stroke reported in the literature. Our case, along with the review of the literature, highlights the fact that myxomas often initially present as stroke with acute hemiplegia and transient cutaneous eruptions due to fragmentation of the tumor. Cardiac myxoma should be considered in any child presenting with ischemic stroke, and transient skin findings may provide an important diagnostic clue prior to onset of neurological symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Concurrence of Crossed Cerebellar Diaschisis and Parakinesia Brachialis Oscitans in a Patient with Hemorrhagic Stroke

    Directory of Open Access Journals (Sweden)

    Yung-Tsan Wu

    2013-01-01

    Full Text Available Crossed cerebellar diaschisis (CCD is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to the supratentorial focal lesion. The phenomenon termed parakinesia brachialis oscitans (PBO in which stroke patients experience involuntary stretching of the hemiplegic arm during yawning is rarely reported. The concurrence of CCD and PBO has never been described. A 52-year-old man had putaminal hemorrhage and demonstrated no significant recovery in his left hemiplegia after intensive rehabilitation, but his gait improved gradually. Two months after the stroke, the single photon emission computed tomography (SPECT showed CCD. Four months after the stroke, the patient noticed PBO. The follow-up SPECT showed persistent CCD and the patient’s arm was still plegic. The frequency and intensity of PBO have increased with time since the stroke. We speculate that the two phenomena CCD and PBO might share similar neuroanatomical pathways and be valuable for predicting clinical recovery after stroke.

  2. Type 2 Diabetic Patients with Ischemic Stroke: Decreased Insulin Sensitivity and Decreases in Antioxidant Enzyme Activity Are Related to Different Stroke Subtypes

    Directory of Open Access Journals (Sweden)

    Aleksandra Jotic

    2013-01-01

    C (1.14±0.58, 1.00±0.26 versus 3.14±0.62 min−1/mU/l × 104, P<0.001 and in nondiabetics in D and E versus F (3.38±0.77, 3.03±0.72 versus 6.03±1.69 min−1/mU/l × 104, P<0.001. Also, GSH-Px and GR activities were lower in A and B versus C (GSH-Px: 21.96±3.56,  22.51±1.23 versus 25.12±1.67; GR: 44.37±3.58,  43.50±2.39 versus 48.58±3.67 U/gHb; P<0.001 and in D and E versus F (GSH-Px: 24.75±3.02,  25.57±1.92 versus 28.56±3.91; GR: 48.27±6.81,  49.17±6.24 versus 53.67±3.96 U/gHb; P<0.001. Decreases in Si and GR were significantly related to both ATI and LI in T2D. Our results showed that decreased IS and impaired antioxidant enzymes activity influence ischemic stroke subtypes in T2D. The influence of insulin resistance might be exerted on the level of glutathione-dependent antioxidant enzymes.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Relative Influence of Capillary Index Score, Revascularization and Time on Stroke Outcomes from the IMS III Trial

    Science.gov (United States)

    Al-Ali, Firas; Elias, John J.; Tomsick, Thomas A.; Liebeskind, David S; Broderick, Joseph P.

    2015-01-01

    Background and Purpose Until recently, acute ischemic stroke (AIS) trials have failed to show a benefit of endovascular therapy (EVT) compared to standard therapy, leading some authors to recommend decreasing the time from ictus to revascularization (TIR) to improve outcomes. We hypothesize that improving patient selection using the capillary index score (CIS) may also be a useful strategy. Methods CIS was calculated, blinded to outcome, from pre-treatment diagnostic cerebral angiograms for 78 subjects in the Interventional Management of Stroke (IMS) III database with internal carotid artery (ICA) and middle cerebral artery trunk (M1) occlusion. The CIS was dichotomized into favorable (fCIS = 2 or 3) and poor (pCIS = 0 or 1). Outcomes were categorized based on the modified Rankin Scale (mRS) score at 90-days (0 to 2 considered a good outcome). Modified thrombolysis in cerebral infarction (mTICI) score 2b or 3 was considered good revascularization. Multivariable logistic regression was performed to relate CIS, TIR, mTICI score, and NIH Stroke Scale score to good outcomes. Results Only CIS and mTICI score were correlated with good outcomes (p < 0.01). Patients with fCIS and good revascularization achieved 71% mRS ≤ 2, compared to 13% for patients with pCIS and good revascularization. Conclusions In this subset of patients from the IMS III Trial, CIS and mTICI were strong predictors of outcome after endovascular reperfusion. Using the CIS to improve patient selection could be a powerful strategy to improve rate of good outcomes in EVT. A randomized trial is needed. Clinical Trial Registration: www.clinicaltrials.gov. Unique identifier: NCT00359424 PMID:25953374

  5. A preliminary study into the criterion validity of the Modified Modified Ashworth Scale using the new measure of the alpha motoneuron excitability in spastic hemiplegia.

    Science.gov (United States)

    Naghdi, S; Ebrahimi, I; Asgari, A; Olyaei, G R; Kazemnejad, A; Mansouri, K; Ansari, N N

    2007-01-01

    The Modified Ashworth Scale (MAS) is the most widely used clinical test for the measurement of muscle spasticity. This scale that suffers from limitations and lack of reliability and validity has recently been remodified. The aim of the present study is to investigate the criterion validity of the new Modified MAS(MMAS) in the upper limb in post-stroke hemiplegia, using the Hslope/Mslope (Hslp/Mslp) as a novel index of alpha motor neuron excitability. Prior to the validity study, the reliability of the MMAS was evaluated in 30 hemiplegic patients. The raters agreed on 23 patients (0. 76%). The MMAS had good inter-rater reliability (K= 0.63, SE = 0.11, p 0.05). There was also no relationship between the clinical scale of MMAS and either the traditional [Hmax / Mmax ratio (r = -0.06)] or the new index [Hslp / Mslp (r = 0.24)] of spinal excitability. This preliminary study recruited a small number of patients, and failed to confirm a linear correlation between these variables. A study with a large number of patients is suggested to clarify the outcome.

  6. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz

    2017-02-01

    induce ischemic or hemorrhagic strokes. Crack cocaine: medical complication of crack cocaine is stroke. Parenteral cocaine users are at risk of stroke related to infectious endocarditis and also experience stroke caused directly by the drug itself.

  7. The impact of health-related quality of life on the incidence of ischaemic heart disease and stroke; a cohort study in an Iranian population.

    Science.gov (United States)

    Dadjou, Yahya; Kermani-Alghoraishi, Mohammad; Sadeghi, Masoumeh; Talaei, Mohammad; Yousefy, Alireza; Oveisgharan, Shahram; Roohafza, Hamidreza; Rabiei, Katayoun; Sarrafzadegan, Nizal

    2016-04-01

    The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire. We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded. More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subjects with stroke had a significantly higher score in all QoL domains in comparison with individuals without stroke (P 0.050). This study indicates that there is no association between QoL and IHD incidence although there was a significant relationship between higher QoL and incidence of stroke.

  8. Correlation between risk factors, functional recovery, and the health-related quality of life of stroke survivors

    Directory of Open Access Journals (Sweden)

    Mandić Milan

    2017-01-01

    Full Text Available Introduction/Objective It has been estimated that 50% of strokes are preventable through the control of modifiable risk factors. The objective of the paper was to determine the correlation between the risk factors, functional status, and the health-related quality of life (HRQOL of stroke survivors. Method The prospective cohort study was used. The study included 136 patients 30–79 years old. Functional recovery was assessed using the Barthel index (BI and the Modified Rankin Scale (mRS. The HRQOL was evaluated by the generic Short Form 36 (SF-36 questionnaire. BI and mRS were determined at admission at the rehabilitation, one, three and six months after the stroke. The SF-36 was filled out at the same time. The analysis of the repeated measure variance (Repeated Measures ANOVA was applied, as well as the correlation analysis and Spearman’s coefficient of rank correlation. Results A total number of 136 patients [66 (48.5% male and 70 (51.5% female] completed the questionnaire. The average age of stroke survivors was 63.72 ± 8.73. At admission, mRS was 4.75 ± 0.55, and six months after the stroke onset it decreased to 2.60 ± 1.08. The average value of BI at admission was 25 ± 24.66, and within six months it increased to 83.75 ± 18.59 (p = 0.001. The ANOVA showed that the values of mRS significantly decreased (p < 0.001 and the values of BI significantly increased (ANOVA: p < 0.001. All domains of the SF-36 questionnaire, except for the pain domain, significantly increased (p < 0.001. The physical function (r = 0.238; p < 0. 01, physical role (r = 0.199; p < 0.05, and emotional role (r = 0.237; p < 0.01 were significantly lower among alcohol addicts (r = 0.199; p < 0.05. Mental health (r = 0.244; p < 0.01 and social relationships domains were significantly lower among smokers (r = 0.272; p < 0.01. The general health (r = -0.290; p < 001 and health condition change domains were significantly lower among smokers (r = 0.225; p < 0

  9. The need for emergency surgical treatment in carotid-related stroke in evolution and crescendo transient ischemic attack.

    Science.gov (United States)

    Capoccia, Laura; Sbarigia, Enrico; Speziale, Francesco; Toni, Danilo; Biello, Antonella; Montelione, Nunzio; Fiorani, Paolo

    2012-06-01

    The purpose of this study was to examine the safety of emergency carotid endarterectomy (CEA) in patients with carotid stenosis and unstable neurological symptoms. This prospective, single-center study involved patients with stroke in evolution (SIE) or fluctuating stroke or crescendo transient ischemic attack (cTIA) related to a carotid stenosis ≥ 50% who underwent emergency surgery. Preoperative workup included National Institute of Health Stroke Scale (NIHSS) neurological assessment on admission, immediately before surgery and at discharge, carotid duplex scan, brain contrast-enhanced head computed tomography (CT) or magnetic resonance imaging (MRI). End points were perioperative (30-day) neurological mortality, NIHSS score variation, and hemorrhagic or ischemic stroke recurrence. Patients were evaluated according to clinical presentation (SIE or cTIA), timing of surgery, and presence of brain infarction on neuroimaging. Between January 2005 and December 2009, 48 patients were submitted to emergency surgery. CEAs were performed from 1 to 24 hours from onset of symptoms (mean, 10.16 ± 7.75). Twenty-six patients presented an SIE with a worsening NIHSS score between admission and surgery, and 22 presented ≥ 3 cTIAs with a normal NIHSS score (= 0) immediately before surgery. An ischemic brain lesion was detected in four patients with SIE and eight patients with cTIA. All patients with cTIA presented a persistent NIHSS normal score before and after surgery. Twenty-five patients with SIE presented an NIHSS score improvement after surgery. Mean NIHSS score was 5.30 ± 2.81 before surgery and 0.54 ± 0.77 at discharge in the SIE group (P hemorrhagic transformation of an undetected brain ischemic lesion after surgery, with progressive neurological deterioration and death (2%). Due to the absence of randomized controlled trials of CEA for neurologically unstable patients, data currently available do not support a policy of emergency CEA in those patients. Our results

  10. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

    Apr 2, 2011 ... Ischemic Stroke Registry yielded an incidence of 3.3 cases per 100 000 children per year, of ... Neonatal stroke. The newborn period confers the highest risk period for childhood ischaemic stroke. Focal patterns of ischaemic brain injury to the perinatal brain are .... family history of young stroke/ thrombosis.

  11. Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study.

    Science.gov (United States)

    Lee, Stephanie Hyeyoung; Lee, Ji-Yeong; Kim, Mi-Young; Jeon, Yu-Jin; Kim, Suyoung; Shin, Joon-Ho

    2018-03-02

    To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke. A pilot, randomized, single-blind, controlled trial. Stroke rehabilitation inpatient unit. Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3. FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity-based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period. Primary outcome measures were changes in Fugl-Meyer Assessment-Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance. Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment-distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test-gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale-activities of daily living/instrumental activities of daily living score. FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Abnormal haemorheology, endothelial function and thrombogenesis in relation to hypertension in acute (ictus < 12 h) stroke patients: the West Birmingham Stroke Project.

    Science.gov (United States)

    Lip, G Y; Blann, A D; Farooqi, I S; Zarifis, J; Sagar, G; Beevers, D G

    2001-06-01

    While the blood vessels are exposed to high pressures in hypertension, the main complications of hypertension (stroke and myocardial infarction) are paradoxically thrombotic rather than haemorrhagic. To investigate abnormalities of haemorheology (plasma viscosity, fibrinogen), endothelial dysfunction (von Willebrand factor), platelet activation (soluble P-selectin) and thrombogenesis (plasminogen activator inhibitor and fibrin D-dimer) in stroke and the effects of concurrent hypertension, we studied 86 consecutive patients (58 male, 28 female) aged ictus 160 mmHg and/or diastolic > 90 mmHg) on admission and those without hypertension. Mean plasma viscosity (one-way analysis of variance, P = 0.026) and fibrinogen levels (P = 0.016) were significantly higher in stroke patients and hospital controls, when compared with healthy controls. The von Willebrand factor, plasminogen activator inhibitor soluble P-selectin and fibrin D-dimer levels were highest in the acute stroke patients, intermediate in hospital controls and lowest in healthy controls (all P 160 mmHg or diastolic blood pressures > 90 mmHg using clinical (manual) readings or mean daytime or night-time ambulatory blood pressure monitoring recordings. There were no statistically significant differences between the measured parameters on admission and at 3 months follow-up in 26 patients (all P = not significant). Plasma viscosity was significantly correlated with mean daytime systolic blood pressure (r = 0.314, P = 0.021) and mean night-time systolic blood pressure (r = 0.309, P = 0.025). This study of hypertension and haemostasis in acute stroke has demonstrated clear abnormalities of haemorheology, endothelial dysfunction, platelet activation and thrombogenesis, which do not appear to be affected by the height of the blood pressure or the presence of hypertension. This is despite the known hypercoagulable state found in hypertension and the relationship of haemostatic abnormalities to vascular complications.

  13. Ischemic Stroke and Cancer: Stroke Severely Impacts Cancer Patients, While Cancer Increases the Number of Strokes

    OpenAIRE

    Bang, Oh Young; Seok, Jin Myoung; Kim, Seon Gyeong; Hong, Ji Man; Kim, Hahn Young; Lee, Jun; Chung, Pil-Wook; Park, Kwang-Yeol; Kim, Gyeong-Moon; Chung, Chin-Sang; Lee, Kwang Ho

    2011-01-01

    Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This revi...

  14. A Comparison of the Long-term Health Related Quality of Life and Handicap of Stroke Patients in Mainland China and Hong Kong

    Directory of Open Access Journals (Sweden)

    T Kwok

    2010-01-01

    Full Text Available Purpose To compare health related quality of life (HRQOL and handicap of stroke survivors in Hong Kong (HK and Chengdu (CD in Mainland China. Method Fifty-four pairs of first ever stroke patients in CD and in HK matched by age, sex and Modified Barthel Index (MBI were interviewed using a structured questionnaire at 16–36 months after stroke. HRQOL and handicap outcomes were evaluated by the Chinese version of the Short-Form Health Survey (SF-36 and London Handicap Scale (LHS respectively. Results Compared to stroke patients in CD, HK subjects reported significantly greater handicap, especially in the occupation domain. HK subjects also had significantly lower HRQOL Z scores in domains of role limitations due to emotional or physical problems, and bodily pain. CD subjects had more social support, but had more difficulties in meeting medical costs, and were less likely to have regular medical follow-up and dysphagia symptom. After adjusting for social and health related factors, the site differences in handicap and the role limitation (physical domain of SF36 became insignificant. Conclusions CD stroke survivors had better scores in HRQOL and fewer handicaps than their counterparts in HK, because of social and health related factors.

  15. Motor imagery for walking: a comparison between cerebral palsy adolescents with hemiplegia and diplegia.

    Science.gov (United States)

    Molina, Michèle; Kudlinski, Cyril; Guilbert, Jessica; Spruijt, Steffie; Steenbergen, Bert; Jouen, François

    2015-02-01

    The goal of the study was to investigate whether motor imagery (MI) could be observed in cerebral palsy (CP) participants presenting a bilateral affected body side (diplegia) as it has been previously revealed in participants presenting a unilateral body affected sided (hemiplegia). MI capacity for walking was investigated in CP adolescents diagnosed with hemiplegia (n=10) or diplegia (n=10) and in adolescents with typical motor development (n=10). Participants were explicitly asked to imagine walking before and after actually walking toward a target located at 4 m and 8 m. Movement durations for executed and imagined trials were recorded. ANOVA and Pearson's correlation analyses revealed the existence of time invariance between executed and imagined movement durations for the control group and both groups of CP participants. However, results revealed that MI capacity in CP participants was observed for the short distance (4 m) but not for the long distance (8 m). Moreover, even for short distance, CP participants performed worse than typical adolescents. These results are discussed inline of recent researches suggesting that MI in CP participants may not depend on the side of the lesion. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. MRI-based radiologic scoring system for extent of brain injury in children with hemiplegia.

    Science.gov (United States)

    Shiran, S I; Weinstein, M; Sirota-Cohen, C; Myers, V; Ben Bashat, D; Fattal-Valevski, A; Green, D; Schertz, M

    2014-12-01

    Brain MR imaging is recommended in children with cerebral palsy. Descriptions of MR imaging findings lack uniformity, due to the absence of a validated quantitative approach. We developed a quantitative scoring method for brain injury based on anatomic MR imaging and examined the reliability and validity in correlation to motor function in children with hemiplegia. Twenty-seven children with hemiplegia underwent MR imaging (T1, T2-weighted sequences, DTI) and motor assessment (Manual Ability Classification System, Gross Motor Functional Classification System, Assisting Hand Assessment, Jebsen Taylor Test of Hand Function, and Children's Hand Experience Questionnaire). A scoring system devised in our center was applied to all scans. Radiologic score covered 4 domains: number of affected lobes, volume and type of white matter injury, extent of gray matter damage, and major white matter tract injury. Inter- and intrarater reliability was evaluated and the relationship between radiologic score and motor assessments determined. Mean total radiologic score was 11.3 ± 4.5 (range 4-18). Good inter- (ρ = 0.909, P classification systems (ρ = 0.708, P high inter- and intrarater reliability and significant associations with manual ability classification systems and motor evaluations. This score provides a standardized radiologic assessment of brain injury extent in hemiplegic patients with predominantly unilateral injury, allowing comparison between groups, and providing an additional tool for counseling families. © 2014 by American Journal of Neuroradiology.

  17. [Alternating hemiplegia of childhood: ATP1A3 gene analysis in 16 patients].

    Science.gov (United States)

    Ulate-Campos, Adriana; Fons, Carmen; Campistol, Jaume; Martorell, Loreto; Cancho-Candela, Ramón; Eiris, Jesús; López-Laso, Eduardo; Pineda, Mercedes; Sans, Anna; Velázquez, Ramón

    2014-07-07

    Alternating hemiplegia in childhood (AHC) is a disease characterized by recurrent episodes of hemiplegia, tonic or dystonic crisis and abnormal ocular movements. Recently, mutations in the ATP1A3 gene have been identified as the causal mechanism of AHC. The objective is to describe a series of 16 patients with clinical and genetic diagnosis of AHC. It is a descriptive, retrospective, multicenter study of 16 patients with clinical diagnosis of AHC in whom mutations in ATP1A3 were identified. Six heterozygous, de novo mutations were found in the ATP1A3 gene. The most frequent mutation was G2401A in 8 patients (50%) followed by G2443A in 3 patients (18.75%), G2893A in 2 patients (12.50%) and C2781G, G2893C and C2411T in one patient, respectively (6.25% each). In the studied population with AHC, de novo mutations were detected in 100% of patients. The most frequent mutations were D801N y la E815K, as reported in other series. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J

    2001-01-01

    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome....... In addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

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

    Directory of Open Access Journals (Sweden)

    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.

  20. 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…

  1. Lack of association between a functional variant of the BRCA-1 related associated protein (BRAP) gene and ischemic stroke

    OpenAIRE

    Liao, Yi-Chu; Lin, Hsiu-Fen; Guo, Yuh-Cherng; Chen, Chung-Hung; Huang, Zhi-Zhang; Juo, Suh-Hang Hank; Lin, Ruey-Tay

    2013-01-01

    Abstract Background Atherosclerosis shares common pathogenic features with myocardial infarction (MI) and ischemic stroke. BRCA-1 associated protein (BRAP), a newly identified risk gene for MI, aggravates the inflammatory response in atherosclerosis. The aim of this study was to test the association between the BRAP gene and stroke in a Taiwanese population. Methods A total of 1,074 stroke patients and 1,936 controls were genotyped for the functional SNP rs11066001. In our previous studies, t...

  2. Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2).

    Science.gov (United States)

    Schönenberger, Silvia; Niesen, Wolf-Dirk; Fuhrer, Hannah; Bauza, Colleen; Klose, Christina; Kieser, Meinhard; Suarez, José I; Seder, David B; Bösel, Julian

    2016-04-01

    Tracheostomy is a common procedure in long-term ventilated critical care patients and frequently necessary in those with severe stroke. The optimal timing for tracheostomy is still unknown, and it is controversial whether early tracheostomy impacts upon functional outcome. The Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2 (SETPOINT2) is a multicentre, prospective, randomized, open-blinded endpoint (PROBE-design) trial. Patients with acute ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage who are so severely affected that two weeks of ventilation are presumed necessary based on a prediction score are eligible. It is intended to enroll 190 patients per group (n = 380). Patients are randomized to either percutaneous tracheostomy within the first five days after intubation or to ongoing orotracheal intubation with consecutive weaning and extubation and, if the latter failed, to percutaneous tracheostomy from day 10 after intubation. The primary endpoint is functional outcome defined by the modified Rankin Scale (mRS, 0-4 (favorable) vs. 5 + 6 (unfavorable)) after six months; secondary endpoints are mortality and cause of mortality during intensive care unit-stay and within six months from admission, intensive care unit-length of stay, duration of sedation, duration of ventilation and weaning, timing and reasons for withdrawal of life support measures, relevant intracranial pressure rises before and after tracheostomy. The necessity and optimal timing of tracheostomy in ventilated stroke patients need to be identified. SETPOINT2 should clarify whether benefits in functional outcome can be achieved by early tracheostomy in these patients. © 2016 World Stroke Organization.

  3. An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial.

    Science.gov (United States)

    Sackley, Catherine M; Walker, Marion F; Burton, Christopher R; Watkins, Caroline L; Mant, Jonathan; Roalfe, Andrea K; Wheatley, Keith; Sheehan, Bart; Sharp, Leslie; Stant, Katie E; Fletcher-Smith, Joanna; Steel, Kerry; Wilde, Kate; Irvine, Lisa; Peryer, Guy

    2015-02-05

    the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval -0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies.Trial registration Current Controlled Trials ISRCTN00757750. © Sackley et al 2015.

  4. Alternating Hemiplegia

    Science.gov (United States)

    ... body, multiple limbs, or a single limb. The paralysis may affect different parts of the body at different times and may be brief or last for several days. Oftentimes these episodes will resolve after sleep. Affected children may also have abnormal movements involving ...

  5. Stroke of a cardiac myxoma origin.

    Science.gov (United States)

    Yuan, Shi-Min; Humuruola, Gulimila

    2015-01-01

    The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition. Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014. Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery), multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery) and areas (the basal ganglion, cerebellum and parietal and temporal regions) corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%. Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct.

  6. Stroke of a cardiac myxoma origin

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2015-04-01

    Full Text Available AbstractObjective:The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition.Methods:Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014.Results:Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery, multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery and areas (the basal ganglion, cerebellum and parietal and temporal regions corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%.Conclusion:Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct.

  7. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  8. Relative risks for stroke by age, sex, and population based on follow-up of 18 European populations in the MORGAM Project

    DEFF Research Database (Denmark)

    Asplund, Kjell; Karvanen, Juha; Giampaoli, Simona

    2009-01-01

    .92). The impact of the individual risk factors differed somewhat between countries/regions with high blood pressure being particularly important in central Europe (Poland and Lithuania). CONCLUSIONS: Age, sex, and region-specific estimates of relative risks for stroke conferred by classical risk factors...

  9. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  10. Mental Practice Combined with Motor Rehabilitation to Treat Upper Limb Hemiparesis of Post-Stroke Patients: Clinical and Experimental Evidence

    Science.gov (United States)

    Machado, Sergio; Lattari, Eduardo; Paes, Flávia; Rocha, Nuno B.F.; Nardi, Antonio E.; Arias-Carrión, Oscar; Mura, Gioia; Yuan, Ti-Fei; Carta, Mauro G.; Campos, Carlos

    2016-01-01

    Stroke is one of the major causes of disability in the world. Due to the extended lifetime of the world's population, the number of people affected by stroke has increased substantially over the last years. Stroke may lead to sensorimotor deficits, usually causing hemiplegia or hemiparesia. In order to reduce motor deficits and accelerate functional recovery, MP combined with motor rehabilitation was introduced to the rehabilitation process of post-stroke patients. Evidence has shown that MP combining with motor rehabilitation based on activities of daily living was more effective than conventional motor rehabilitation used per se. This combination proved very useful and effective, with significant results in improvement of motor deficits in post-stroke patients. However, further studies must be conducted to determine specific parameters, such as type of imagery, frequency or duration. PMID:27346996

  11. Lack of association between a functional variant of the BRCA-1 related associated protein (BRAP) gene and ischemic stroke.

    Science.gov (United States)

    Liao, Yi-Chu; Lin, Hsiu-Fen; Guo, Yuh-Cherng; Chen, Chung-Hung; Huang, Zhi-Zhang; Juo, Suh-Hang Hank; Lin, Ruey-Tay

    2013-01-28

    Atherosclerosis shares common pathogenic features with myocardial infarction (MI) and ischemic stroke. BRCA-1 associated protein (BRAP), a newly identified risk gene for MI, aggravates the inflammatory response in atherosclerosis. The aim of this study was to test the association between the BRAP gene and stroke in a Taiwanese population. A total of 1,074 stroke patients and 1,936 controls were genotyped for the functional SNP rs11066001. In our previous studies, the rare allele of this SNP has been repeatedly shown to exert a recessive effect. Therefore, in the current study, we tested for the same recessive model. First, the genotype distributions between all the controls and all the stroke cases were compared. Then to reduce heterogeneity, we explored several population subsets by selecting young stroke subjects (using 45 years of age as the cutoff point), age- and sex-comparable controls, plaque-free controls, and stroke subtypes. We did not find any significant association for the entire data set (OR = 0.94, p = 0.74) or for the subset analyses using age- and sex-comparable controls (p = 0.70) and plaque-free controls (p = 0.91). Analyses of the four stroke subtypes also failed to show any significant associations (p = 0.42 - 0.98). For both young and old subjects, the GG genotype of rs11066001 was similar in the stroke cases and unmatched controls (8.1% vs. 9.4% in young subjects and 8.0% vs. 7.8% in old subjects). Comparing stroke cases with plaque-free controls also failed to find any significant association. The BRAP polymorphism may not play an important role in ischemic stroke in the studied population.

  12. Lack of association between a functional variant of the BRCA-1 related associated protein (BRAP gene and ischemic stroke

    Directory of Open Access Journals (Sweden)

    Liao Yi-Chu

    2013-01-01

    Full Text Available Abstract Background Atherosclerosis shares common pathogenic features with myocardial infarction (MI and ischemic stroke. BRCA-1 associated protein (BRAP, a newly identified risk gene for MI, aggravates the inflammatory response in atherosclerosis. The aim of this study was to test the association between the BRAP gene and stroke in a Taiwanese population. Methods A total of 1,074 stroke patients and 1,936 controls were genotyped for the functional SNP rs11066001. In our previous studies, the rare allele of this SNP has been repeatedly shown to exert a recessive effect. Therefore, in the current study, we tested for the same recessive model. First, the genotype distributions between all the controls and all the stroke cases were compared. Then to reduce heterogeneity, we explored several population subsets by selecting young stroke subjects (using 45 years of age as the cutoff point, age- and sex-comparable controls, plaque-free controls, and stroke subtypes. Results We did not find any significant association for the entire data set (OR = 0.94, p = 0.74 or for the subset analyses using age- and sex-comparable controls (p = 0.70 and plaque-free controls (p = 0.91. Analyses of the four stroke subtypes also failed to show any significant associations (p = 0.42 – 0.98. For both young and old subjects, the GG genotype of rs11066001 was similar in the stroke cases and unmatched controls (8.1% vs. 9.4% in young subjects and 8.0% vs. 7.8% in old subjects. Comparing stroke cases with plaque-free controls also failed to find any significant association. Conclusions The BRAP polymorphism may not play an important role in ischemic stroke in the studied population.

  13. Effect of a rigid ankle-foot orthosis on hamstring length in children with hemiplegia.

    Science.gov (United States)

    Thompson, N S; Taylor, T C; McCarthy, K R; Cosgrove, A P; Baker, R J

    2002-01-01

    Eighteen children with hemiplegia, mean age 8 years 5 months, underwent gait analysis and musculoskeletal modelling using specially designed software. The maximum lengths of the hamstrings were determined for each child walking in and out of an ankle-foot orthosis (AFO). The muscles were deemed to be short if shorter than the normal average -1SD. In bare feet 8 participants had short medial hamstrings with a higher proportion of these in the less involved individuals. All participants showed an increase in maximum hamstring length when wearing an AFO. In all but one child this was sufficient to restore hamstring length to within normal limits. These finding suggest that hamstring pathology in hemiplegic gait is usually secondary to more distal lower limb pathology.

  14. Kinematic features of rear-foot motion using anterior and posterior ankle-foot orthoses in stroke patients with hemiplegic gait.

    Science.gov (United States)

    Chen, Chih-Chi; Hong, Wei-Hsien; Wang, Chin-Man; Chen, Chih-Kuang; Wu, Katie Pei-Hsuan; Kang, Chao-Fu; Tang, Simon F

    2010-12-01

    To evaluate the kinematic features of rear-foot motion during gait in hemiplegic stroke patients, using anterior ankle-foot orthoses (AFOs), posterior AFOs, and no orthotic assistance. Crossover design with randomization for the interventions. A rehabilitation center for adults with neurologic disorders. Patients with hemiplegia due to stroke (n=14) and able-bodied subjects (n=11). Subjects with hemiplegia were measured walking under 3 conditions with randomized sequences: (1) with an anterior AFO, (2) with a posterior AFO, and (3) without an AFO. Control subjects were measured walking without an AFO to provide a normative reference. Rear-foot kinematic change in the sagittal, coronal, and transverse planes. In the sagittal plane, compared with walking with an anterior AFO or without an AFO, the posterior AFO significantly decreased plantar flexion to neutral at initial heel contact (P=.001) and the swing phase (PRehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Mastery motivation in children with congenital hemiplegia: individual and environmental associations.

    Science.gov (United States)

    Miller, Laura; Ziviani, Jenny; Ware, Robert S; Boyd, Roslyn N

    2014-03-01

    The aim of this study was to examine the relationship between mastery motivation and individual and environmental characteristics in school-aged children with congenital hemiplegia. Forty-eight child-caregiver dyads (children's mean age 7y 11mo, SD 2y 4mo; 33 males, 15 females; Manual Ability Classification System [MACS] level I, n=25, and level II, n=23; predominant motor type spastic hemiplegia, n=47) were recruited to this cross-sectional study. Children were assessed using the Melbourne Assessment of Unilateral Upper Limb Function (MUUL) and the Assisting Hand Assessment. Caregivers completed the Dimensions of Mastery Questionnaire, the Parenting Scale, and a demographic questionnaire. Consistent and positive parental disciplinary practices were associated with higher total motivation (p=0.006) and instrumental aspect scores (p=0.009). Children with siblings and from single-parent families experienced greater negative reactions to failure (p=0.006). Children from two-parent families (p=0.018) and with better bimanual performance (p=0.015) demonstrated greater object-oriented persistence. Age, sex, limitations in manual ability (MACS), and movement and body function of the impaired limb (MUUL) did not contribute significantly to mastery motivation. Inconsistent, excessively lax, and verbose parenting practices may discourage children from persevering with challenging tasks. Functional parenting styles, positive discipline practices, and autonomy-supportive strategies for task engagement should be encouraged when intervening with children with cerebral palsy. Parents should be supported to engage in these practices in all aspects of daily activities. © 2013 Mac Keith Press.

  16. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  17. Altered Coupling between Motion-Related Activation and Resting-State Brain Activity in the Ipsilesional Sensorimotor Cortex after Cerebral Stroke

    Directory of Open Access Journals (Sweden)

    Jianping Hu

    2017-07-01

    Full Text Available Functional connectivity maps using resting-state functional magnetic resonance imaging (rs-fMRI can closely resemble task fMRI activation patterns, suggesting that resting-state brain activity may predict task-evoked activation or behavioral performance. However, this conclusion was mostly drawn upon a healthy population. It remains unclear whether the predictive ability of resting-state brain activity for task-evoked activation would change under different pathological conditions. This study investigated dynamic changes of coupling between patterns of resting-state functional connectivity (RSFC and motion-related activation in different stages of cerebral stroke. Twenty stroke patients with hand motor function impairment were involved. rs-fMRI and hand motion-related fMRI data were acquired in the acute, subacute, and early chronic stages of cerebral stroke on a 3-T magnetic resonance (MR scanner. Sixteen healthy participants were enrolled as controls. For each subject, an activation map of the affected hand was first created using general linear model analysis on task fMRI data, and then an RSFC map was determined by seeding at the peak region of hand motion activation during the intact hand task. We then measured the extent of coupling between the RSFC maps and motion-related activation maps. Dynamic changes of the coupling between the two fMRI maps were estimated using one-way repeated measures analysis of variance across the three stages. Moreover, imaging parameters were correlated with motor performances. Data analysis showed that there were different coupling patterns between motion-related activation and RSFC maps associating with the affected motor regions during the acute, subacute, and early chronic stages of stroke. Coupling strengths increased as the recovery from stroke progressed. Coupling strengths were correlated with hand motion performance in the acute stage, while coupling recovery was negatively correlated with the recovery

  18. Stroke rehabilitation: recent advances and future therapies.

    LENUS (Irish Health Repository)

    Brewer, L

    2012-09-27

    Despite advances in the acute management of stroke, a large proportion of stroke patients are left with significant impairments. Over the coming decades the prevalence of stroke-related disability is expected to increase worldwide and this will impact greatly on families, healthcare systems and economies. Effective neuro-rehabilitation is a key factor in reducing disability after stroke. In this review, we discuss the effects of stroke, principles of stroke rehabilitative care and predictors of recovery. We also discuss novel therapies in stroke rehabilitation, including non-invasive brain stimulation, robotics and pharmacological augmentation. Many trials are currently underway, which, in time, may impact on future rehabilitative practice.

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

    Science.gov (United States)

    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.

  20. Chronic Pain After Stroke: A Hospital-Based Study of Its Profile and Correlation with Health-Related Quality of Life

    Directory of Open Access Journals (Sweden)

    Olawale

    2016-12-01

    Full Text Available Background Chronic pain is one of the most troublesome sequelae of stroke. The correlation between post-stroke pain and patients’ quality of life has not been extensively studied. Objectives The purpose of this study was to investigate certain profiles of post-stroke chronic pain and evaluate its correlation with health-related quality of life. Methods The study involved 118 participants with stroke comprising 72 (61.0% males and 46 (39.0% females. A convenience sampling technique was used to recruit the subjects for the study. Socio-demographic data of the participants were taken. Data on chronic pain and health-related quality of life (HRQoL were collected using the brief pain inventory (BPI and short form health survey (SF-36, respectively. Independent t-test was used to compare HRQoL between participants with and without chronic pain. The correlation of chronic pain with HRQoL was investigated using Spearman’s correlation coefficient. The level of significance was P ≤ 0.05. Results Chronic pain was reported by 88 (72% out of the 118 participants. Musculoskeletal pain was the most common type of pain. The upper limb was the most reported site of pain (63.6%. Participants with chronic pain had poorer HRQoL than those without chronic pain (P = 0.001. There were significant correlations between chronic pain and all domains of HRQoL (P < 0.05 with r values ranging from 0.181 to 0.309. Conclusions The study showed that the majority of patients with stroke had chronic pain. The pain had a significant impact on all domains of health-related quality of life among the patients.

  1. Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies.

    Science.gov (United States)

    Paci, Matteo

    2003-01-01

    The Bobath concept, also known as neurodevelopmental treatment, is a widely used approach in the rehabilitation of hemiparetic subjects in many countries. Despite 50 years of clinical use its effectiveness is questionable. This paper aims to examine whether there is evidence to accept neurodevelopmental treatment as an effective approach. A systematic literature search was undertaken. Fifteen trials have been selected and classified according to a 5-level hierarchic scale of evidence for clinical interventions. Results show no evidence proving the effectiveness of neurodevelopmental treatment or supporting neurodevelopmental treatment as the optimal type of treatment, but neither do methodological limitations allow for conclusions of non-efficacy. Methodological aspects of selected studies are discussed and requirements for further research are suggested.

  2. Clinical neurogenetics: stroke.

    Science.gov (United States)

    Rost, Natalia S

    2013-11-01

    Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Stair locomotion in children with spastic hemiplegia: the impact of three different ankle foot orthosis (AFOs) configurations.

    Science.gov (United States)

    Sienko Thomas, Susan; Buckon, Cathleen E; Jakobson-Huston, Sabrina; Sussman, Michael D; Aiona, Michael D

    2002-10-01

    The purpose of this study was to investigate the impact of three different ankle foot orthoses (AFO) configurations on the function and kinematics of stair locomotion in children with spastic hemiplegia. Nineteen children were evaluated barefoot and with a hinged, posterior leaf spring (PLS) and solid AFO during stair ascent and descent. Stair specific items from the Pediatric Evaluation of Disability Inventory (PEDI) were used to evaluate function, while a motion measurement system was used to evaluate kinematics. The PEDI revealed no significant differences between AFOs and barefoot, although a greater percentage of children were able to keep up with their peers while wearing a hinged AFO. At the ankle, the hinged AFO provided the greatest amount of dorsiflexion during stance. All AFOs reduced plantarflexion in comparison to barefoot. The results of this study indicate that for children with spastic hemiplegia the use of an AFO did not impair stair ambulation.

  4. Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke (RECOST Study). 50 patients prospective study

    International Nuclear Information System (INIS)

    Costalat, V.; Lobotesis, K.; Machi, P.; Mourand, I.; Maldonado, I.; Heroum, C.; Vendrell, J.F.; Milhaud, D.; Riquelme, C.; Bonafé, A.; Arquizan, C.

    2012-01-01

    Background and aims: New thrombectomy devices allow successful and rapid recanalization in acute ischemic stroke. Nevertheless prognostics factors need to be systematically analyzed in the context of these new therapeutic strategies. The aim of this study was to analyze prognostic factors related to clinical outcome following Solitaire FR thrombectomy in ischemic stroke. Methods: Fifty consecutive ischemic stroke patients with large vessel occlusion were included. Three treatment strategies were applied; rescue therapy, combined therapy, and standalone thrombectomy. DWI ASPECT score < 5 was the main exclusion criterion after initial MRI (T2, T2*, TOF, FLAIR, DWI). Sexes, age, time to recanalization were prospectively collected. Clinical outcome was assessed post treatment, day one and discharge by means of a NIHSS. Three months mRS evaluation was performed by an independent neurologist. The probability of good outcome at 3 months was assessed by forward stepwise logistic regression using baseline NIHSS score, Glasgow score at entrance, hyperglycemia, dyslipidemia, blood–brain barrier disruption on post-operative CT, embolic and hemorrhagic post procedural complication, ischemic brain lesion extension on 24 h imaging, NIHSS at discharge, ASPECT score, and time to recanalization. All variables significantly associated with the outcome in the univariate analysis were entered in the model. The significance of adding or removing a variable from the logistic model was determined by the maximum likelihood ratio test. Odds-ratio (OR) and their 95% confidence intervals were calculated. Results: At 3 months 54% of patients had a mRS 0–2, 70% in MCA, 44% in ICA, and 43% in BA with an overall mortality rate of 12%. Baseline NIHSS score (p = 0.001), abnormal Glasgow score at entrance (p = 0.053) hyperglycemia (p = 0.023), dyslipidemia (p = 0.031), blood–brain barrier disruption (p = 0.022), embolic and hemorrhagic post procedural complication, ischemic brain lesion

  5. Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke (RECOST Study). 50 patients prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Costalat, V., E-mail: vincentcost@hotmail.com [CHU Montpellier, Neuroradiology, Montpellier (France); Lobotesis, K., E-mail: kyriakos@lobotesis.co.uk [CHU Montpellier, Neuroradiology, Montpellier (France); Machi, P., E-mail: paolo.machi@gmail.com [CHU Montpellier, Neuroradiology, Montpellier (France); Mourand, I., E-mail: i-mourand@chu-montpellier.fr [CHU Montpellier, Neurology, Montpellier (France); Maldonado, I., E-mail: imaldonado@terra.com.br [CHU Montpellier, Neuroradiology, Montpellier (France); Heroum, C., E-mail: c-heroum@chu-montpellier.fr [CHU Montpellier, Neurology, Montpellier (France); Vendrell, J.F., E-mail: jf-vendrell@chu-montpellier.fr [CHU Montpellier, Neuroradiology, Montpellier (France); Milhaud, D., E-mail: d-milhaud@chu-montpellier.fr [CHU Montpellier, Neurology, Montpellier (France); Riquelme, C., E-mail: c-riquelme@chu-montpellier.fr [CHU Montpellier, Neuroradiology, Montpellier (France); Bonafé, A., E-mail: a-bonafe@chu-montpellier.fr [CHU Montpellier, Neuroradiology, Montpellier (France); Arquizan, C., E-mail: c-arquizan@chu-montpellier.fr [CHU Montpellier, Neurology, Montpellier (France)

    2012-12-15

    Background and aims: New thrombectomy devices allow successful and rapid recanalization in acute ischemic stroke. Nevertheless prognostics factors need to be systematically analyzed in the context of these new therapeutic strategies. The aim of this study was to analyze prognostic factors related to clinical outcome following Solitaire FR thrombectomy in ischemic stroke. Methods: Fifty consecutive ischemic stroke patients with large vessel occlusion were included. Three treatment strategies were applied; rescue therapy, combined therapy, and standalone thrombectomy. DWI ASPECT score < 5 was the main exclusion criterion after initial MRI (T2, T2*, TOF, FLAIR, DWI). Sexes, age, time to recanalization were prospectively collected. Clinical outcome was assessed post treatment, day one and discharge by means of a NIHSS. Three months mRS evaluation was performed by an independent neurologist. The probability of good outcome at 3 months was assessed by forward stepwise logistic regression using baseline NIHSS score, Glasgow score at entrance, hyperglycemia, dyslipidemia, blood–brain barrier disruption on post-operative CT, embolic and hemorrhagic post procedural complication, ischemic brain lesion extension on 24 h imaging, NIHSS at discharge, ASPECT score, and time to recanalization. All variables significantly associated with the outcome in the univariate analysis were entered in the model. The significance of adding or removing a variable from the logistic model was determined by the maximum likelihood ratio test. Odds-ratio (OR) and their 95% confidence intervals were calculated. Results: At 3 months 54% of patients had a mRS 0–2, 70% in MCA, 44% in ICA, and 43% in BA with an overall mortality rate of 12%. Baseline NIHSS score (p = 0.001), abnormal Glasgow score at entrance (p = 0.053) hyperglycemia (p = 0.023), dyslipidemia (p = 0.031), blood–brain barrier disruption (p = 0.022), embolic and hemorrhagic post procedural complication, ischemic brain lesion

  6. Distribution of symptoms of post-stroke depression in relation to ...

    African Journals Online (AJOL)

    PSD) in relation to some predisposing factors in an African population. ... Conclusion: Age could be a risk factor for PSD, which was more prevalent in the elderly than young/middle-age adults, female gender, left cerebral lesion, complications, ...

  7. Projected Temperature-Related Years of Life Lost From Stroke Due To Global Warming in a Temperate Climate City, Asia: Disease Burden Caused by Future Climate Change.

    Science.gov (United States)

    Li, Guoxing; Guo, Qun; Liu, Yang; Li, Yixue; Pan, Xiaochuan

    2018-04-01

    Global warming has attracted worldwide attention. Numerous studies have indicated that stroke is associated with temperature; however, few studies are available on the projections of the burden of stroke attributable to future climate change. We aimed to investigate the future trends of stroke years of life lost (YLL) associated with global warming. We collected death records to examine YLL in Tianjin, China, from 2006 to 2011. We fitted a standard time-series Poisson regression model after controlling for trends, day of the week, relative humidity, and air pollution. We estimated temperature-YLL associations with a distributed lag nonlinear model. These models were then applied to the local climate projections to estimate temperature-related YLL in the 2050s and 2070s. We projected temperature-related YLL from stroke in Tianjin under 19 global-scale climate models and 3 different greenhouse gas emission scenarios. The results showed a slight decrease in YLL with percent decreases of 0.85%, 0.97%, and 1.02% in the 2050s and 0.94%, 1.02%, and 0.91% in the 2070s for the 3 scenarios, respectively. The increases in heat-related annual YLL and the decreases in cold-related YLL under the high emission scenario were the strongest. The monthly analysis showed that the most significant increase occurred in the summer months, particularly in August, with percent changes >150% in the 2050s and up to 300% in the 2070s. Future changes in climate are likely to lead to an increase in heat-related YLL, and this increase will not be offset by adaptation under both medium emission and high emission scenarios. Health protections from hot weather will become increasingly necessary, and measures to reduce cold effects will also remain important. © 2018 American Heart Association, Inc.

  8. Ultrasonographic Findings in Hemiplegic Knees of Stroke Patients

    Directory of Open Access Journals (Sweden)

    Chao-Pin Yang

    2005-02-01

    Full Text Available Clinical and radiologic asymmetric arthritic differences between paralyzed and nonparalyzed limbs of stroke patients have been reported. Arthritic pathology aggravates motor dysfunction and compromises rehabilitation. Musculoskeletal ultrasonography plays an important role in showing soft tissue and the articular cartilage of the knee. Fifty-nine patients with either ischemic or hemorrhagic stroke-induced right or left hemiplegia were recruited to evaluate soft-tissue and intra-articular cartilage changes in hemiplegic knees of stroke patients using ultrasonography. An additional 15 subjects (30 knees without knee disease or a history of knee trauma or surgery were used as controls. There were significant differences in suprapatellar effusion and patellar tendinitis between hemiplegic and nonhemiplegic knees. Suprapatellar effusion and pes anserinus tendinitis were correlated with Brunnstrom stage. The length of time since stroke onset was not significantly correlated with positive ultrasonographic findings in hemiplegic knees. In conclusion, ultrasonography is useful for detecting periarticular soft-tissue changes and intra-articular lesions in hemiplegic knees of stroke patients.

  9. Validity and reliability of critical speed, critical stroke rate, and anaerobic capacity in relation to front crawl swimming performances.

    Science.gov (United States)

    Dekerle, J; Sidney, M; Hespel, J M; Pelayo, P

    2002-02-01

    The purpose of this investigation was to determine whether the concepts of critical swimming speed, critical stroke rate and anaerobic swimming capacity could be used by coaches as a reliable index in order to monitor endurance performances in competitive swimmers. The results of this study conducted with well-trained swimmers showed that the 30-min test velocity (V30) is not different from the critical swimming speed determined from 200- and 400-m tests but is overestimated by 3.2 %. Furthermore, a regression analysis of the number of stroke cycles on time calculated for each swimmer showed a linear relationship (r(2) greater than 0.99 and p less than 0.01). The 30-min stroke rate test (SR30) was not different from the critical stroke rate determined from 200- and 400-m tests after a correction of minus 3.9 %. These data suggest that the slope of this regression line represents the critical stroke rate defined as the maximal stroke rate value, which can theoretically be maintained continuously without exhaustion. Coaches could easily use critical swimming speed combined with critical stroke rate in order not only to set aerobic training loads but also to control the swimming technique during training. Besides, anaerobic swimming capacity (ASC) values defined as the y-intercept of the regression line between distance and time were not correlated (p > 0.05) with the determined distance over which a significant drop in the maximal speed could be noticed on a 25-m test. Thus, ASC does not provide a reliable estimation of the anaerobic capacity.

  10. Impairment of language is related to left parieto-temporal glucose metabolism in aphasic stroke patients.

    Science.gov (United States)

    Karbe, H; Szelies, B; Herholz, K; Heiss, W D

    1990-02-01

    Twenty-six aphasic patients who had an ischaemic infarct in the territory of the left middle cerebral artery (MCA) were investigated. Cranial computed tomography (CT) showed various lesion sites: infarcts restricted to cortical structures in 12 patients, combined cortical and subcortical infarcts in 7 and isolated subcortical infarcts sparing the left cortex in another 7 cases. 18F-2-fluoro-2-deoxyglucose positron emission tomography revealed remote hypometabolism of the left convexity cortex and of the left basal ganglia, which was extended further than the morphological infarct zone in all cases. Types and degrees of aphasia were classified using the Aachener Aphasie Test (AAT): 10 patients had global aphasia, 2 Broca's, 5 Wernicke's, and 5 amnesic aphasia. Four patients suffered from minimal or residual aphasic symptoms. The AAT results were compared with the regional cerebral metabolic rates of glucose of the left hemisphere. Irrespective of the infarct location all five AAT subtests (Token test, repetition, written language, confrontation naming, auditory and reading comprehension) were closely correlated among each other and with left parieto-temporal metabolic rates, whereas left frontal and left basal ganglia metabolism showed no significant correlation. The close relation between left temporo-parietal functional activity and all five AAT subtests suggests that the different aspects of aphasia tested by AAT can be related to a common disorder of language processing in those areas.

  11. Recovering after stroke

    Science.gov (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave ...

  12. 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

  13. Ischemic stroke as a rare manifestation of aluminum phosphide poisoning: a case report.

    Directory of Open Access Journals (Sweden)

    Mahmoud Abedini

    2014-12-01

    Full Text Available Aluminum phosphide (AlP is a solid fumigant which is widely used for a suicide attempt in Iran. Although neurologic symptoms are commonly reported, cerebrovascular stenosis is rare in AlP poisoning. We described ischemic stroke as a delayed complication of AlP intoxication. A 30-year-old man was admitted because of sudden onset left side hemiplegia, 11 days after intentional ingestion of three rice tablets. Investigations revealed in situ thrombosis in right middle cerebral artery (MCA while other causes of stroke in young adults were excluded. Ischemic stroke should be considered as a delayed complication of AlP intoxication even after the acute phase of intoxication.

  14. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO

    2016-11-01

    Full Text Available Mohammad Obadah Nakawah, Eugene C Lai Stanely H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA Abstract: Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months. Keywords: vascular dyskinesia, stroke, movement disorders

  15. Pediatric Stroke

    Science.gov (United States)

    ... of 3 and 10. In those with SCD, ischemic strokes most often occur in children under the age of 15 and adults over the age of 30, while hemorrhagic strokes most often occur in young adults between the ages of 20 and 30. ...

  16. Increasing Dose of Autologous Bone Marrow Mononuclear Cells Transplantation Is Related to Stroke Outcome: Results from a Pooled Analysis of Two Clinical Trials

    Directory of Open Access Journals (Sweden)

    Francisco Moniche

    2016-01-01

    Full Text Available Background and Purpose. BM-MNC transplantation improves recovery in experimental models of ischemic stroke. Clinical trials are ongoing to test efficacy in stroke patients. However, whether cell dose is related to outcomes is not known. Methods. We performed a pooling data analysis of two pilot clinical trials with autologous BM-MNCs transplantation in ischemic stroke patients. Cell dose and route were analyzed to evaluate their relation to good outcome (m-Rankin scale [mRS] score 0–2 at 6 months. Results. Twenty-two patients were included. A median of 153 × 106 (±121 × 106 BM-MNCs was injected. Intra-arterial route was used in 77.3% of cases. A higher number of cells injected were associated with better outcomes at 180 days (390 × 106 [320–422] BM-MNCs injected in those patients with mRS of 0–2 at 6 months versus 130 × 106 [89–210] in those patients with mRS 3–6, p=0.015. In the intra-arterially treated patients, a strong correlation between dose of cells and disability was found (r=-0.63, p=0.006. A cut point of 310 × 106 injected cells predicted good outcome with 80% sensitivity and 88.2% specificity. Conclusions. Similar to preclinical studies, a higher dose of autologous BM-MNC was related to better outcome in stroke patients, especially when more than 310 × 106 cells are injected. Further interventional studies are warranted to confirm these data.

  17. The influence of anaemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide

    DEFF Research Database (Denmark)

    Nybo, M; Kristensen, S R; Mickley, H

    2007-01-01

    the prevalence of renal affection, smoking and heart failure was lower. At 6 months follow-up, 23 patients were dead, and anaemia had an odds ratio of 4.7 when adjusted for age, Scandinavian Stroke Scale and a combined variable of heart and/or renal failure and/or elevation of troponin T using logistic...... regression. The median NT-proBNP level in the anaemic group was significantly higher than in the non-anaemic group, and in a multivariate linear regression model, anaemia remained an independent predictor of NT-proBNP. Conclusively, anaemia was found to be a negative prognostic factor for ischemic stroke...

  18. Comparison of three ankle-foot orthosis configurations for children with spastic hemiplegia.

    Science.gov (United States)

    Buckon, C E; Thomas, S S; Jakobson-Huston, S; Sussman, M; Aiona, M

    2001-06-01

    The purpose of this study was to examine the effectiveness of the hinged ankle-foot orthosis (HAFO), posterior leaf spring (PLS), and solid ankle-foot orthosis (SAFO), in preventing contracture, improving efficiency of gait, and enhancing performance of functional motor skills in 30 children (21 male, 9 female; mean age 9 years 4 months; age range 4 to 18 years,) with spastic hemiplegia. Following a 3-month baseline period of no ankle-foot orthosis (AFO) use, each AFO was worn for 3 months after which ankle range of motion, gait analysis, energy consumption, and functional motor skills were assessed. The HAFO and PLS increased passive ankle dorsiflexion and normalization of ankle rocker function during gait. Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuration. The HAFO was the most effective in controlling knee hyperextension in stance, while PLS was the most effective in promoting knee extension in children with >10 degree knee flexion in stance. Energy efficiency was improved in 21 of the children, with 13 of these children demonstrating the greatest improvement in HAFO and PLS. Improvements in functional mobility were greatest in the HAFO and PLS.

  19. Phenomenology and neural correlates of implicit and emergent motor awareness in patients with anosognosia for hemiplegia.

    Science.gov (United States)

    Moro, Valentina; Pernigo, Simone; Zapparoli, Paola; Cordioli, Zeno; Aglioti, Salvatore M

    2011-11-20

    Anosognosia for hemiplegia (AH) is characterized by a lack of awareness of motor disorders and appears associated with fronto-temporal-parietal damage. Neuropsychological evidence indicates that behavioral indices of residual forms of motor awareness may co-exist with explicit denial of impairment. Here we explore whether the attempt by AH patients to perform an action may disclose residual forms of motor awareness and whether such forms are underpinned by different neural structures. Twelve hemiplegic patients affected by AH were tested in tasks assessing: (i) implicit awareness (IA), indexed by discrepancies between verbal reports and actual motor behavior; (ii) emergent awareness (EA), indexed by increased verbal awareness induced by the attempt to perform actions. IA and EA were found in five and three patients, respectively. Lesion analysis indicates that while the lack of IA is associated with damage to subcortical white matter anterior to the basal ganglia, lack of EA is linked to damage to cortical regions including insulo-frontal, temporal and parietal structures. Our results indicate that deficits in explicit and implicit awareness are associated with lesions involving different cortico-subcortical structures. Moreover, the results show that the attempt to perform an action may ameliorate body awareness deficits and have implications for rehabilitation. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. De novo mutations in ATP1A3 cause alternating hemiplegia of childhood

    Science.gov (United States)

    Heinzen, Erin L.; Swoboda, Kathryn J.; Hitomi, Yuki; Gurrieri, Fiorella; Nicole, Sophie; de Vries, Boukje; Tiziano, F. Danilo; Fontaine, Bertrand; Walley, Nicole M.; Heavin, Sinéad; Panagiotakaki, Eleni; Fiori, Stefania; Abiusi, Emanuela; Di Pietro, Lorena; Sweney, Matthew T.; Newcomb, Tara M.; Viollet, Louis; Huff, Chad; Jorde, Lynn B.; Reyna, Sandra P.; Murphy, Kelley J.; Shianna, Kevin V.; Gumbs, Curtis E.; Little, Latasha; Silver, Kenneth; Ptác̆ek, Louis J.; Haan, Joost; Ferrari, Michel D.; Bye, Ann M.; Herkes, Geoffrey K.; Whitelaw, Charlotte M.; Webb, David; Lynch, Bryan J.; Uldall, Peter; King, Mary D.; Scheffer, Ingrid E.; Neri, Giovanni; Arzimanoglou, Alexis; van den Maagdenberg, Arn M.J.M.; Sisodiya, Sanjay M.; Mikati, Mohamad A.; Goldstein, David B.; Nicole, Sophie; Gurrieri, Fiorella; Neri, Giovanni; de Vries, Boukje; Koelewijn, Stephany; Kamphorst, Jessica; Geilenkirchen, Marije; Pelzer, Nadine; Laan, Laura; Haan, Joost; Ferrari, Michel; van den Maagdenberg, Arn; Zucca, Claudio; Bassi, Maria Teresa; Franchini, Filippo; Vavassori, Rosaria; Giannotta, Melania; Gobbi, Giuseppe; Granata, Tiziana; Nardocci, Nardo; De Grandis, Elisa; Veneselli, Edvige; Stagnaro, Michela; Gurrieri, Fiorella; Neri, Giovanni; Vigevano, Federico; Panagiotakaki, Eleni; Oechsler, Claudia; Arzimanoglou, Alexis; Nicole, Sophie; Giannotta, Melania; Gobbi, Giuseppe; Ninan, Miriam; Neville, Brian; Ebinger, Friedrich; Fons, Carmen; Campistol, Jaume; Kemlink, David; Nevsimalova, Sona; Laan, Laura; Peeters-Scholte, Cacha; van den Maagdenberg, Arn; Casaer, Paul; Casari, Giorgio; Sange, Guenter; Spiel, Georg; Boneschi, Filippo Martinelli; Zucca, Claudio; Bassi, Maria Teresa; Schyns, Tsveta; Crawley, Francis; Poncelin, Dominique; Vavassori, Rosaria

    2012-01-01

    Alternating hemiplegia of childhood (AHC) is a rare, severe neurodevelopmental syndrome characterized by recurrent hemiplegic episodes and distinct neurologic manifestations. AHC is usually a sporadic disorder with unknown etiology. Using exome sequencing of seven patients with AHC, and their unaffected parents, we identified de novo nonsynonymous mutations in ATP1A3 in all seven AHC patients. Subsequent sequence analysis of ATP1A3 in 98 additional patients revealed that 78% of AHC cases have a likely causal ATP1A3 mutation, including one inherited mutation in a familial case of AHC. Remarkably, six ATP1A3 mutations explain the majority of patients, including one observed in 36 patients. Unlike ATP1A3 mutations that cause rapid-onset-dystonia-parkinsonism, AHC-causing mutations revealed consistent reductions in ATPase activity without effects on protein expression. This work identifies de novo ATP1A3 mutations as the primary cause of AHC, and offers insight into disease pathophysiology by expanding the spectrum of phenotypes associated with mutations in this gene. PMID:22842232

  1. Post-stroke urinary incontinence.

    Science.gov (United States)

    Mehdi, Z; Birns, J; Bhalla, A

    2013-11-01

    To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals. © 2013 John Wiley & Sons Ltd.

  2. Stroke and Cerebrovascular Diseases Registry

    Science.gov (United States)

    2017-09-11

    Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial

  3. Nurses' and nurse assistants' beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit-A qualitative study

    DEFF Research Database (Denmark)

    Loft, Mia I; Poulsen, Ingrid; Esbensen, Bente A

    2017-01-01

    AIMS AND OBJECTIVES: To explore nurses' and nurse assistants' beliefs, attitudes and actions related to their function in an inpatient stroke rehabilitation unit. BACKGROUND: Several attempts have been made to describe nurses' roles and functions in inpatient neurorehabilitation. However, current...... stroke rehabilitation. We obtained insights into nursing staff's beliefs and attitudes about rehabilitation-as well as their own role and function-and furthermore how the latter affects their actions in daily practice. RELEVANCE TO CLINICAL PRACTICE: The nursing role and function are still not clearly...... defined. Further education is needed to strengthen the contribution of nursing staff to patients' rehabilitation. Furthermore, focus on developing a professional language and a framework that supports continuity within daily care and rehabilitation is needed....

  4. Stroke research questions: a nursing perspective.

    Science.gov (United States)

    Rowat, Anne; Lawrence, Maggie; Horsburgh, Dorothy; Legg, Lynn; Smith, Lorraine N

    stroke is a national research priority. However, in the literature there is still minimal systematic investigation of stroke nursing - especially practice. The aim of this study was to explore stroke nurses' research priorities through a series of focus groups. the study was qualitative and involved focus groups (n = 7) with registered nurses working in stroke care settings and who were members of the Scottish Stroke Nurses Forum. Data were analysed to identify conceptual categories, which were found to relate to the categories defined by Kirkevold (1997) and Booth (2001). five priority areas for stroke nursing were described: preventive/conserving; supporting/consoling; restorative; integrative; and service structure/systems. by consulting stroke nurses it can be ensured that future research truly reflects the nature of nursing care and is of particular relevance to stroke nursing practice. The development of research evidence-base in stroke nursing will lead to increased knowledge, a better quality of care and ultimately better outcomes for patients.

  5. Experimental thromboembolic stroke in cynomolgus monkey.

    Science.gov (United States)

    Kito, G; Nishimura, A; Susumu, T; Nagata, R; Kuge, Y; Yokota, C; Minematsu, K

    2001-01-30

    To develop an experimental model of thromboembolic stroke without intracranial surgery, an autologous blood clot was delivered to the middle cerebral artery (MCA) via the internal carotid artery in cynomolgus monkeys. Male cynomolgus monkeys, in which a chronic catheter had been earlier implanted in the left internal carotid artery, were used. The clot was flushed into the internal carotid artery under sevofluorane anesthesia. A neurologic deficit score was assigned after MCA embolization. After 24 h, cerebral infarct size and location were determined by the TTC staining method. Cerebral blood flow (CBF) was measured prior to and after MCA embolization, using positron emission tomography (PET). After embolization, long-lasting and profound extensor hypotonia of the contralateral upper and lower limbs, and mild to severe incoordination were observed. Contralateral hemiplegia was observed over the following 24 h. In gross morphologic observation of the brain, the lesions involved mostly the caudate nucleus, putamen, globus pallidus and insular cortex. CBF was maximally reduced in the left MCA territory, but not in the right MCA territory. This model is relevant to thromboembolic stroke in human in neurologic dysfunction and histopathologic brain damage.

  6. Tetrahydrocannabinol Induces Brain Mitochondrial Respiratory Chain Dysfunction and Increases Oxidative Stress: A Potential Mechanism Involved in Cannabis-Related Stroke

    Directory of Open Access Journals (Sweden)

    Valérie Wolff

    2015-01-01

    Full Text Available Cannabis has potential therapeutic use but tetrahydrocannabinol (THC, its main psychoactive component, appears as a risk factor for ischemic stroke in young adults. We therefore evaluate the effects of THC on brain mitochondrial function and oxidative stress, key factors involved in stroke. Maximal oxidative capacities Vmax (complexes I, III, and IV activities, Vsucc (complexes II, III, and IV activities, Vtmpd (complex IV activity, together with mitochondrial coupling (Vmax/V0, were determined in control conditions and after exposure to THC in isolated mitochondria extracted from rat brain, using differential centrifugations. Oxidative stress was also assessed through hydrogen peroxide (H2O2 production, measured with Amplex Red. THC significantly decreased Vmax (−71%; P<0.0001, Vsucc (−65%; P<0.0001, and Vtmpd (−3.5%; P<0.001. Mitochondrial coupling (Vmax/V0 was also significantly decreased after THC exposure (1.8±0.2 versus 6.3±0.7; P<0.001. Furthermore, THC significantly enhanced H2O2 production by cerebral mitochondria (+171%; P<0.05 and mitochondrial free radical leak was increased from 0.01±0.01 to 0.10±0.01% (P<0.001. Thus, THC increases oxidative stress and induces cerebral mitochondrial dysfunction. This mechanism may be involved in young cannabis users who develop ischemic stroke since THC might increase patient’s vulnerability to stroke.

  7. Stroke frequency, but not swimming speed, is related to body size in free-ranging seabirds, pinnipeds and cetaceans

    Science.gov (United States)

    Sato, Katsufumi; Watanuki, Yutaka; Takahashi, Akinori; Miller, Patrick J.O; Tanaka, Hideji; Kawabe, Ryo; Ponganis, Paul J; Handrich, Yves; Akamatsu, Tomonari; Watanabe, Yuuki; Mitani, Yoko; Costa, Daniel P; Bost, Charles-André; Aoki, Kagari; Amano, Masao; Trathan, Phil; Shapiro, Ari; Naito, Yasuhiko

    2006-01-01

    It is obvious, at least qualitatively, that small animals move their locomotory apparatus faster than large animals: small insects move their wings invisibly fast, while large birds flap their wings slowly. However, quantitative observations have been difficult to obtain from free-ranging swimming animals. We surveyed the swimming behaviour of animals ranging from 0.5 kg seabirds to 30 000 kg sperm whales using animal-borne accelerometers. Dominant stroke cycle frequencies of swimming specialist seabirds and marine mammals were proportional to mass−0.29 (R2=0.99, n=17 groups), while propulsive swimming speeds of 1–2 m s−1 were independent of body size. This scaling relationship, obtained from breath-hold divers expected to swim optimally to conserve oxygen, does not agree with recent theoretical predictions for optimal swimming. Seabirds that use their wings for both swimming and flying stroked at a lower frequency than other swimming specialists of the same size, suggesting a morphological trade-off with wing size and stroke frequency representing a compromise. In contrast, foot-propelled diving birds such as shags had similar stroke frequencies as other swimming specialists. These results suggest that muscle characteristics may constrain swimming during cruising travel, with convergence among diving specialists in the proportions and contraction rates of propulsive muscles. PMID:17476766

  8. Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates

    NARCIS (Netherlands)

    Amiri, M.; Kunst, A. E.; Janssen, F.; Mackenbach, J. P.

    2006-01-01

    Objectives: To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries. Study Design and Setting: Data on ischemic heart disease (IHD) and stroke

  9. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.

    2011-01-01

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

  10. Communicative strategies used by spouses of individuals with communication disorders related to stroke-induced aphasia and Parkinson's disease.

    Science.gov (United States)

    Carlsson, Emilia; Hartelius, Lena; Saldert, Charlotta

    2014-11-01

    A communicative disability interferes with the affected person's ability to take active part in social interaction, but non-disabled communication partners may use different strategies to support communication. However, it is not known whether similar strategies can be used to compensate for different types of communicative disabilities, nor what factors contribute to the development of a particular approach by communication partners. To develop a set of categories to describe the strategies used by communication partners of adults who have problems expressing themselves due to neurogenic communicative disabilities. The reliability of assessment was a particular focus. The material explored consisted of 21 video-recorded everyday conversations involving seven couples where one spouse had a communicative disability. Three of the dyads included a person with dysarthria and anomia related to later stages of Parkinson's disease, while four of them included a person with stroke-induced aphasia involving anomia. First a qualitative interaction analysis was performed to explore the strategies used by the communication partners when their spouses had problems expressing themselves. The strategies were then categorized, the reliability of the categorizations was explored and the relative frequency of the various strategies was examined. The analysis of the conversational interactions resulted in a set of nine different strategies used by the communication partners without a communicative disability. Each of these categories belonged to one of three overall themes: No participation in repair; Request for clarification or modification; and Providing candidate solutions. The reliability of the categorization was satisfactory. There were no statistically significant differences between diagnoses in the frequency of use of strategies, but the spouses of the persons with Parkinson's disease tended to use open-class initiations of repair more often than the spouses of the persons

  11. Stroke injury, cognitive impairment and vascular dementia☆

    Science.gov (United States)

    Kalaria, Raj N.; Akinyemi, Rufus; Ihara, Masafumi

    2016-01-01

    The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. PMID:26806700

  12. Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke.

    Science.gov (United States)

    Hafsteinsdóttir, Thóra B; Kappelle, Jaap; Grypdonck, Maria H F; Algra, Ale

    2007-10-01

    To measure the effects of Bobath-based (BB) therapy on depression, shoulder pain and health-related quality of life (HRQoL) of patients during one year after stroke. In a prospective, non-randomized design, the use of BB therapy was compared with a more task-oriented therapy and no BB therapy. A total of 324 patients in 12 hospitals. Patients in the intervention group received BB therapy, whereas patients in the control group received no BB therapy and a more task-oriented therapy. HRQoL was measured using the SF-36; depression was measured with the Center of Epidemiological Studies Depression Scale and shoulder pain was measured with the Visual Analogue Scale at discharge, 6 and 12 months. Linear and logistic regression analyses were performed. No effects of BB therapy on HRQoL or shoulder pain were found. After one year fewer patients were depressed in the BB group (30%) than in the non-BB group (43%); the adjusted odds ratio was 0.6 (95% confidence interval 0.3-1.0). BB therapy did not have any effect on HRQoL or shoulder pain in stroke patients. Healthcare professionals should reconsider the use of BB therapy in the care of stroke patients.

  13. Beneficial effects of footbaths in controlling spasticity after stroke

    Science.gov (United States)

    Matsumoto, Shuji; Shimodozono, Megumi; Etoh, Seiji; Shimozono, Yurika; Tanaka, Nobuyuki; Kawahira, Kazumi

    2010-07-01

    Footbaths are considered to provide beneficial thermal therapy for post-stroke patients with spasticity, but their anti-spastic effects have not been investigated comprehensively. The present study aimed to evaluate alterations in motor-neuron excitability using F-wave parameters in post-stroke patients with spastic hemiplegia. Subjects’ legs below the knee joint were immersed in water at 41°C and F-wave recordings were made over the abductor hallucis muscle before, immediately after, and 30 min after thermal treatment. Antidromic stimulation was performed on the tibial nerve at the ankle. Measurements included F-wave amplitude, F-wave/M-response ratio, changes in modified Ashworth scale (MAS), body temperature and surface-skin temperature. The mean values of both F-wave parameters were higher on the affected side before footbath treatment. In post-stroke patients, the mean values of F-wave parameters were significantly reduced after footbath treatment ( P spastic effects of footbath treatment were indicated by decreased F-wave parameters, in parallel with decreases in MAS. Body temperature was significantly increased both immediately after, and 30 min following footbath treatment in both groups, which appeared to play an important role in decreased spasticity. Surface-skin temperature increased immediately after footbath treatment in both groups and returned to baseline 30 min later. These findings demonstrate that the use of footbaths is an effective nonpharmacological anti-spastic treatment that might facilitate stroke rehabilitation.

  14. Direct evidence of impaired neuronal Na/K-ATPase pump function in alternating hemiplegia of childhood.

    Science.gov (United States)

    Simmons, Christine Q; Thompson, Christopher H; Cawthon, Bryan E; Westlake, Grant; Swoboda, Kathryn J; Kiskinis, Evangelos; Ess, Kevin C; George, Alfred L

    2018-03-19

    Mutations in ATP1A3 encoding the catalytic subunit of the Na/K-ATPase expressed in mammalian neurons cause alternating hemiplegia of childhood (AHC) as well as an expanding spectrum of other neurodevelopmental syndromes and neurological phenotypes. Most AHC cases are explained by de novo heterozygous ATP1A3 mutations, but the fundamental molecular and cellular consequences of these mutations in human neurons are not known. In this study, we investigated the electrophysiological properties of neurons generated from AHC patient-specific induced pluripotent stem cells (iPSCs) to ascertain functional disturbances underlying this neurological disease. Fibroblasts derived from two subjects with AHC, a male and a female, both heterozygous for the common ATP1A3 mutation G947R, were reprogrammed to iPSCs. Neuronal differentiation of iPSCs was initiated by neurogenin-2 (NGN2) induction followed by co-culture with mouse glial cells to promote maturation of cortical excitatory neurons. Whole-cell current clamp recording demonstrated that, compared with control iPSC-derived neurons, neurons differentiated from AHC iPSCs exhibited a significantly lower level of ouabain-sensitive outward current ('pump current'). This finding correlated with significantly depolarized potassium equilibrium potential and depolarized resting membrane potential in AHC neurons compared with control neurons. In this cellular model, we also observed a lower evoked action potential firing frequency when neurons were held at their resting potential. However, evoked action potential firing frequencies were not different between AHC and control neurons when the membrane potential was clamped to -80 mV. Impaired neuronal excitability could be explained by lower voltage-gated sodium channel availability at the depolarized membrane potential observed in AHC neurons. Our findings provide direct evidence of impaired neuronal Na/K-ATPase ion transport activity in human AHC neurons and demonstrate the potential

  15. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  16. Problematising risk in stroke rehabilitation.

    Science.gov (United States)

    Egan, Mary Y; Kessler, Dorothy; Ceci, Christine; Laliberté-Rudman, Debbie; McGrath, Colleen; Sikora, Lindsey; Gardner, Paula

    2016-11-01

    more severe stroke. Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.

  17. Relation of glycated hemoglobin with carotid atherosclerosis in ischemic stroke patients: An observational study in Indian population

    Directory of Open Access Journals (Sweden)

    Amit Shankar Singh

    2013-01-01

    Full Text Available Context: Glycated hemoglobin A 1 c (HbA 1 c indicates long-term uncontrolled hyperglycemia in the body, which in diabetic patients leads to various vascular complications as a part of generalized atherosclerosis culminating ultimately into ischemic stroke. Aims: Study aims to show the association between marker of uncontrolled long-term hyperglycemia HbA 1 c and marker of atherosclerosis (Carotid intima media thickness [CIMT] and carotid plaque in ischemic stroke patients. Subjects and Methods: Carotid sonography using high resolution 7.5 MHz sonography technique was done in each patient to find the occurrence of increased CIMT and presence of plaque according to Mannheim CIMT Consensus (2004-2006. Levels of HbA 1 c measured in blood in both diabetic and non-diabetic patients and a comparison made between them. Finally an association sought between HbA 1 c levels with CIMT and plaque. Results: The average value of HbA 1 c of this cohort was 7.51 ± 1.75% with higher values in diabetic patients (9.29 ± 1.73%. The patients with high CIMT (>0.8 mm had higher values of HbA 1 c then that of normal CIMT patients and this was nearly significantly (P = 0.06. However, HbA 1 c levels of blood were significantly associated with stroke patients with presence of carotid arteries plaque (P = 0.008. Conclusions: Prediction of future risk and prevention strategies for ischemic stroke could be formulated by utilizing HbA 1 c levels in both diabetic and non-diabetic population.

  18. Burden of stroke in Cambodia.

    Science.gov (United States)

    Loo, Keat Wei; Gan, Siew Hua

    2013-08-01

    In Cambodia, stroke is not ranked among the top 10 leading causes of death, but infectious disease are among the top three leading causes of death. This finding could be attributed to a lack of awareness among Cambodians of the signs and symptoms of stroke or to poor reporting, incomplete data, lack of neurologists and neurosurgeons, or low accessibility to the hospitals. The only study of stroke in Cambodia is the Prevalence of Non-Communicable Disease Risk Factors in Cambodia survey, which identified several stroke-related risk factors in the population. Tobacco chewing or smoking is the main risk factor for stroke in Cambodia. Traditional therapies, such as oyt pleung (moxibustion) and jup (cupping), are widely practiced for stroke rehabilitation. In Cambodia, there are few neurologists and few important equipment, such as magnetic resonance imaging machines and computed tomography scanners. The Cambodian government should cooperate with the World Health Organization and the United Nations Children's Fund to attract foreign expertise and technologies to treat stroke patients. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  19. Comparison of the effectiveness of one- and two-suture prosthesis used to correct left laryngeal hemiplegia in the equine: followed by Nd:YAG laser ventricle ablation

    Science.gov (United States)

    Burnett, Cindy; Tate, Lloyd P.; Correa, Maria T.

    1992-06-01

    The effectiveness of one or two suture prothesis in performing laryngoplasty was compared. Forty-six horses treated for left laryngeal hemiplegia at North Carolina State University, College of Veterinary Medicine (NCSU-CVM) between January 1987 and April 1991 were included in the study. Thirty-seven of the horses were treated with two sutures, while nine were treated with one suture. All horses, after recovering from general anesthesia, were sedated the following day and were subjected to a transendoscopic neodymium: yttrium aluminum garnet (Nd:YAG) laser ablation of the left laryngeal ventricle. Ability to perform after treatment relative to before treatment, reduction or elimination of respiratory noise, owner or trainer satisfaction, were compared for the two suture prosthetic procedures using chi-squared test or Fisher's exact test. No statistical significant differences were found for performance, reduction of noise, and owner or trainer satisfaction. The use of one or two sutures seemed to have no effect on the effectiveness of prosthetic laryngoplasty procedure followed by Nd:YAG ventricular ablation.

  20. Clinical Characteristics of Stroke Occurring while Bathing.

    Science.gov (United States)

    Inamasu, Joji; Nakatsukasa, Masashi; Oshima, Takeo; Tomiyasu, Kazuhiro; Mayanagi, Keita; Imai, Akira

    2017-07-01

    Stroke can occur during any human activity. Although cardiac arrests or drowning accidents while bathing have been studied extensively, there are few studies focusing on stroke occurring while bathing. The objectives of this study were to evaluate the clinical characteristics of stroke occurring while bathing and the association between stroke and drowning accidents. Clinical data prospectively acquired between January 2011 and December 2015 on 1939 patients with stroke (1224 cerebral infarctions [CIs], 505 intracerebral hemorrhages [ICHs], and 210 subarachnoid hemorrhages [SAHs]) were reviewed to identify patients who sustained a stroke while bathing. The ratio of bathing-related strokes to strokes occurring during other activities was evaluated. Moreover, the demographics of these 2 groups were compared in each stroke type. Among the 1939 patients, 78 (CI, 32; ICH, 28; and SAH, 18) sustained a stroke while bathing. The ratio of bathing to other activities in the SAH group was the highest (8.6%), followed by the ICH group (5.5%), whereas that in the CI group was the lowest (2.6%). Regardless of stroke type, only a minority of patients were found to have collapsed inside the bathtub. The higher ratio of bathing in hemorrhagic strokes may indicate that there is a small risk of hemorrhagic stroke while bathing in vulnerable subjects. This retrospective study did not establish a causal relationship between bathing and stroke nor identify risk factors, which means that future prospective studies are warranted. The finding that the great majority of bathing-related stroke patients were found to have collapsed outside the bathtub suggests that the involvement of stroke in drowning accidents in the bathtub may be small. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Prothrombin G20210A mutation, hypogonadotropic hypogonadism, and generalized vitiligo-related ischemic stroke in a young adult.

    Science.gov (United States)

    Varoglu, Asuman Orhan; Kocatürk, Idris; Tatar, Abdulgani

    2010-06-01

    Cerebral infarction is a rare neurological situation in young adults, usually caused by genetic factors. We report here a case of multiple cerebral infarctions with prothrombin G20210A mutation, hypogonadotropic hypogonadism, and generalized vitiligo as a first case report. A 17-year-old female adolescent was admitted to our clinic due to a change in mental status. The patient's neurological examination revealed loss of consciousness and the presence of tetraparesia. Generalized vitiligo was also detected. Magnetic resonance imaging (MRI) and diffusion-weighted investigations (DWIs) showed acute ischemic stroke in the bilateral cerebellum, pons and left occipital regions. Heterozygote prothrombin G20210A mutation was found upon genetic examination. She had never had a menstrual cycle. Laboratory data revealed that the level of luteinizing hormone (LH) was 0.5 mIU/mL (1.1-11.6) and follicle-stimulating hormone (FSH) was 1.7 mIU/mL (2.8-11.3). Therefore, she was diagnosed with hypogonadotropic hypogonadism. The causes of ischemic stroke are heterozygote prothrombin G20210A mutation, generalized vitiligo, and hypogonadotropic hypogonadism. After treatment, the patient's neurological deficit partially improved and she was discharged. In order to identify the etiology of ischemic stroke, we suggest physicians take into account heterozygote prothrombin G20210A mutation and endocrine abnormalities, especially hypogonadotropic hypogonadism and generalized vitiligo.

  2. A crucial role for the cortico-striato-cortical loop in the pathogenesis of stroke-related neurogenic stuttering.

    Science.gov (United States)

    Theys, Catherine; De Nil, Luc; Thijs, Vincent; van Wieringen, Astrid; Sunaert, Stefan

    2013-09-01

    Neurogenic stuttering is an acquired speech disorder characterized by the occurrence of stuttering-like dysfluencies following brain damage. Because the onset of stuttering in these patients is associated with brain lesions, this condition provides a unique opportunity to study the neural processes underlying speech dysfluencies. Lesion localizations of 20 stroke subjects with neurogenic stuttering and 17 control subjects were compared using voxel-based lesion symptom mapping. The results showed nine left-hemisphere areas associated with the presence of neurogenic stuttering. These areas were largely overlapping with the cortico-basal ganglia-cortical network comprising the inferior frontal cortex, superior temporal cortex, intraparietal cortex, basal ganglia, and their white matter interconnections through the superior longitudinal fasciculus and internal capsule. These results indicated that stroke-induced neurogenic stuttering is not associated with neural dysfunction in one specific brain area but can occur following one or more lesion throughout the cortico-basal ganglia-cortical network. It is suggested that the onset of neurogenic stuttering in stroke subjects results from a disintegration of neural functions necessary for fluent speech. Copyright © 2012 Wiley Periodicals, Inc., a Wiley company.

  3. Changes in daily occupations and the meaning of work for three women caring for relatives post-stroke.

    Science.gov (United States)

    Van Dongen, Isabella; Josephsson, Staffan; Ekstam, Lisa

    2014-09-01

    This qualitative study explored how some working Austrians experienced and coped with changes in their daily occupations after becoming informal carers of persons who had had a stroke. The study provides insights into the working carers' occupational experiences and strategies during a period of pronounced life changes. Three participants, who were employed in full- or part-time work, as well as being informal carers of persons who had had a stroke, were interviewed on two occasions. The data from these interviews were analysed using Interpretative Phenomenological Analyses. Carers found themselves in an ongoing process, ranging from the disruption of daily occupations to their eventual restructure. First, the stroke led to involuntary changes in the carers' daily life, which resulted in challenges in their own, and in shared, occupations. Second, carers actively changed their values and performance of occupations, which appeared to be a strategy to shape their well-being. Paid work was found to be a stabilizing and balancing occupation, which contributed to coping and the well-being of carers. The authors' findings demonstrate the benefits of paid work and engagement in meaningful occupation for the carers' well-being. These results should encourage occupational therapists to be sensitive to the complexity of the lives of working informal carers.

  4. INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia

    Directory of Open Access Journals (Sweden)

    Gilmore Rose

    2010-01-01

    Full Text Available Abstract Background Congenital hemiplegia is the most common form of cerebral palsy (CP accounting for 1 in 1300 live births. These children have limitations in capacity to use the impaired upper limb and bimanual coordination deficits which impact on daily activities and participation in home, school and community life. There are currently two diverse intensive therapy approaches. Traditional therapy has adopted a bimanual approach (BIM training and recently, constraint induced movement therapy (CIMT has emerged as a promising unimanual approach. Uncertainty remains about the efficacy of these interventions and characteristics of best responders. This study aims to compare the efficacy of CIMT to BIM training to improve outcomes across the ICF for school children with congenital hemiplegia. Methods/Design A matched pairs randomised comparison design will be used with children matched by age, gender, side of hemiplegia and level of upper limb function. Based on power calculations a sample size of 52 children (26 matched pairs will be recruited. Children will be randomised within pairs to receive either CIMT or BIM training. Both interventions will use an intensive activity based day camp model, with groups receiving the same dosage of intervention delivered in the same environment (total 60 hours over 10 days. A novel circus theme will be used to enhance motivation. Groups will be compared at baseline, then at 3, 26 and 52 weeks following intervention. Severity of congenital hemiplegia will be classified according to brain structure (MRI and white matter fibre tracking, cortical excitability using Transcranial Magnetic Stimulation (TMS, functional use of the hand in everyday tasks (Manual Ability Classification System and Gross Motor Function Classification System (GMFCS. Outcomes will address neurovascular changes (functional MRI, functional connectivity, and brain (reorganisation (TMS, body structure and function (range of motion, spasticity

  5. The Reticulospinal Pathway Does Not Increase Its Contribution to the Strength of Contralesional Muscles in Stroke Survivors as Compared to Ipsilesional Side or Healthy Controls

    Directory of Open Access Journals (Sweden)

    Sheng Li

    2017-11-01

    Full Text Available ObjectiveStartling acoustic stimulation (SAS, via activation of reticulospinal (RS pathways, has shown to increase muscle strength in healthy subjects. We hypothesized that, given RS hyperexcitability in stroke survivors, SAS could increase muscle strength in stroke survivors. The objective was to quantify the effect of SAS on maximal and sub-maximal voluntary elbow flexion on the contralesional (impaired side in stroke survivors as compared to ipsilesional (non-impaired side and healthy controls.DesignThirteen hemiparetic stroke survivors and 12 healthy subjects volunteered for this investigation. Acoustic stimulation was given at rest, during ballistic maximal and sustained sub-maximal isometric elbow contractions using low (80 dB and high intensity sound (105 dB. The effect of acoustic stimuli was evaluated from EMG and force recordings.ResultsPrevalence of acoustic startle reflex with shorter latency in the impaired biceps was greater as compared to the response in the non-impaired side of stroke subjects and in healthy subjects. Delivery of SAS resulted in earlier initiation of elbow flexion and greater peak torque in healthy subjects and in stroke subjects with spastic hemiplegia during maximal voluntary elbow flexion tasks. During sub-maximal elbow flexion tasks, SAS-induced force responses were slightly greater on the impaired side than the non-impaired side. However, no statistically significant difference was found in SAS-induced responses between impaired and non-impaired sides at maximal and sub-maximal elbow flexion tasks.ConclusionThe findings suggest RS hyperexcitability in stroke survivors with spastic hemiplegia. The results of similar SAS-induced responses between healthy and stroke subjects indicate that RS projections via acoustic stimulation are not likely to contribute to muscle strength for stroke survivors to a significant extent.

  6. Investigation of the effects of mirror therapy on the upper extremity functions of stroke patients using the manual function test.

    Science.gov (United States)

    Kim, Hwanhee; Shim, Jemyung

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of mirror therapy on the upper extremity functions of stroke patients. [Subjects] The subjects of this study were 14 hemiplegia patients (8 males, 6 females; 9 infarction, 5 hemorrhage; 8 right hemiplegia, 6 left hemiplegia) who voluntarily consented to participate in the study. [Methods] The Korean version of the manual function test (MFT) was used in this study. The test was performed in the following order: arm movement (4 items), grasp and pinch (2 items), and manipulation (2 items). The experiment was conducted with the subjects sitting in a chair. The mirror was vertically placed in the sagittal plane on the desk. The paretic hand was placed behind the mirror, and the non-paretic hand was placed in front of the mirror so that it was reflected in the mirror. In this position, the subjects completed activities repetitively according to the mirror therapy program over the course of four weeks. [Results] There were significant increases in the grasp-and-pinch score and manipulation score. [Conclusion] In conclusion, the grasp-and-pinch and manipulation functions were improved through mirror therapy.

  7. Neurosurgical management of L-asparaginase induced haemorrhagic stroke.

    LENUS (Irish Health Repository)

    Ogbodo, Elisha

    2012-01-01

    The authors describe a case of L-asparaginase induced intracranial thrombosis and subsequent haemorrhage in a newly diagnosed 30-year-old man with acute lymphoblastic leukaemia who was successfully managed by surgical intervention. At presentation, he had a Glasgow Coma Score of 7\\/15, was aphasic and had dense right hemiplegia. Neuroimaging revealed an acute anterior left middle cerebral artery infarct with parenchymal haemorrhagic conversion, mass effect and subfalcine herniation. He subsequently underwent left frontal craniotomy and evacuation of large frontal haematoma and decompressive craniectomy for cerebral oedema. Six months postoperatively he underwent titanium cranioplasty. He had made good clinical recovery and is currently mobilising independently with mild occasional episodes of expressive dysphasia, difficulty with fine motor movement on the right side, and has remained seizure free. This is the first documented case of L-asparaginase induced haemorrhagic stroke managed by neurosurgical intervention. The authors emphasise the possible role of surgery in managing chemotherapy induced intracranial complications.

  8. Effects of a school-based stroke education program on stroke-related knowledge and behaviour modification-school class based intervention study for elementary school students and parental guardians in a Japanese rural area.

    Science.gov (United States)

    Kato, Suzuka; Okamura, Tomonori; Kuwabara, Kazuyo; Takekawa, Hidehiro; Nagao, Masanori; Umesawa, Mitsumasa; Sugiyama, Daisuke; Miyamatsu, Naomi; Hino, Tenyu; Wada, Shinichi; Arimizu, Takuro; Takebayashi, Toru; Kobashi, Gen; Hirata, Koichi; Yokota, Chiaki; Minematsu, Kazuo

    2017-12-21

    This study aimed to determine the effect of a stroke education programme on elementary school students and their parental guardians in a rural area in Japan that has high stroke mortality. School class based intervention study. Eleven public elementary schools in Tochigi Prefecture, Japan. 268 students aged 11-12 years and 267 parental guardians. Students received lessons about stroke featuring animated cartoons and were instructed to communicate their knowledge about stroke to their parental guardians using material (comic books) distributed in the lessons. Stroke knowledge (symptoms, risk factors and attitude towards stroke) and behavioural change for risk factors were assessed at baseline, immediately after the programme and at 3 months. We also evaluated behavioural change for risk factors among parental guardians. The percentage of students with all correct answers for stroke symptoms, risk factors and the recommended response to stroke was significantly increased at 3 months P<0.001). We observed a significant increase in the percentage of guardians who chose all correct symptoms (P<0.001: 61.0% vs 85.4%) and risk factors (P<0.001: 41.2% vs 59.9%) at 3 months compared with baseline. The percentage of parental guardians with a high behavioural response to improving risk factors was significantly increased at 3 months compared with baseline (P<0.001). In a rural population with high stroke mortality, stroke education can improve knowledge about stroke in elementary school students and their parental guardians. We conducted the intervention as a part of compulsory education; this study was not a clinical trial. This study was approved by the Ethics Committee of the National Cerebral and Cardiovascular Center (M27-026). © 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.

  9. Driving After a Stroke

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... a wheelchair accessible or modified van, truck or car can provide the assurance you need to feel ...

  10. Determination of endogenous inflammation-related lipid mediators in ischemic stroke rats using background subtracting calibration curves by liquid chromatography-tandem mass spectrometry.

    Science.gov (United States)

    Yang, Yang; Zhong, Qisheng; Mo, Canlong; Zhang, Hao; Zhou, Ting; Tan, Wen

    2017-11-01

    Accurate and reliable quantification of endogenous lipid mediators in complex biological samples is a daunting challenge. In this study, a robust and direct endogenous quantitative method using background subtracting calibration curves by liquid chromatography-tandem mass spectrometry was first developed for the determination of endogenous lipid mediators in ischemic stroke rats. Absolute quantification without surrogate matrix could be achieved by using background subtracting calibration curves, which were corrected and verified from standard curves constructed on original matrix. The recoveries of this method were in the range of 50.3-98.3%, the precision with the relative standard deviation was less than 13.8%, and the accuracy with the relative error was within ± 15.0%. In addition, background subtracting calibration curves were further verified by validation factors ranging from 90.3 to 110.9%. This validated method has been successfully applied to the analysis of seven endogenous inflammation-related lipid mediators in the brain tissues of ischemic stroke rats. The results indicated that prostaglandins as inflammatory factors and some lipid mediators with neuroprotective effects increased apparently (p endogenous compounds in the complex biological samples. Graphical abstract The analysis procedure of determining endogenous inflammation-related lipid mediators using BSCC by LC-MS/MS.

  11. Do Women With Atrial Fibrillation Experience More Severe Strokes? Results From the Austrian Stroke Unit Registry.

    Science.gov (United States)

    Lang, Clemens; Seyfang, Leonhard; Ferrari, Julia; Gattringer, Thomas; Greisenegger, Stefan; Willeit, Karin; Toell, Thomas; Krebs, Stefan; Brainin, Michael; Kiechl, Stefan; Willeit, Johann; Lang, Wilfried; Knoflach, Michael

    2017-03-01

    Ischemic strokes associated with atrial fibrillation (AF) are more severe than those of other cause. We aim to study potential sex effects in this context. In this cross-sectional study, 74 425 adults with acute ischemic stroke from the Austrian Stroke Unit Registry were included between March 2003 and January 2016. In 63 563 patients, data on the National Institutes of Health Stroke Scale on admission to the stroke unit, presence of AF, vascular risk factors, and comorbidities were complete. Analysis was done by a multivariate regression model. Stroke severity in general increased with age. AF-related strokes were more severe than strokes of other causes. Sex-related differences in stroke severity were only seen in stroke patients with AF. Median (Q 25 , 75 ) National Institutes of Health Stroke Scale score points were 9 (4,17) in women and 6 (3,13) in men ( P stroke severity was independent of age, previous functional status, vascular risk factors, and vascular comorbidities and remained significant in various subgroups. Women with AF do not only have an increased risk of stroke when compared with men but also experience more severe strokes. © 2017 American Heart Association, Inc.

  12. Effects of a dynamic progressive orthotic intervention for chronic hemiplegia: a case series.

    Science.gov (United States)

    Doucet, Barbara M; Mettler, Joni A

    2013-01-01

    Case series design on a single subgroup of participants. Management of hypertonicity and resistance to passive movement (RTPM) in the upper extremity is an intractable problem for persons with stroke and the therapists who provide their care. Therapists have limited options for assessment and treatment of this condition which can profoundly limit functional performance and quality of life. To evaluate the effect of a 12-week dynamic progressive orthotic intervention in persons with chronic stroke exhibiting wrist flexion contracture who are residents of a long-term skilled nursing facility. A custom-fitted dynamic progressive wrist extension orthotic was applied to 6 residents with chronic stroke. The orthotic was worn for 4 h daily, 4×/week for 12 weeks. Wrist passive range of motion (PROM) and RTPM were measured weekly and after discontinuation of the orthotics using the Modified Ashworth Scale and the Tardieu Scale of Spasticity. Signal analysis of electromyographical (EMG) flexor response to extensor stretching was also measured before and after orthotic intervention using maximal root mean square (RMS) values and EMG burst onset time. A moderate effect was found for changes in PROM with the orthotic intervention. Progress made diminished following discontinuation. Moderate effects were also seen in EMG measures which indicated increases in amount of resistive-free movement following intervention. A dynamic progressive orthotic intervention can be an effective option for increasing wrist PROM and reducing RTPM in persons with chronic stroke. 4. Copyright © 2013 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  13. Upper-Limb Recovery After Stroke: A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation.

    Science.gov (United States)

    Wilson, Richard D; Page, Stephen J; Delahanty, Michael; Knutson, Jayme S; Gunzler, Douglas D; Sheffler, Lynne R; Chae, John

    2016-11-01

    This study compared the effect of cyclic neuromuscular electrical stimulation (NMES), electromyographically (EMG)-triggered NMES, and sensory stimulation on motor impairment and activity limitations in patients with upper-limb hemiplegia. This was a multicenter, single-blind, multiarm parallel-group study of nonhospitalized hemiplegic stroke survivors within 6 months of stroke. A total of 122 individuals were randomized to receive either cyclic NMES, EMG-triggered NMES, or sensory stimulation twice every weekday in 40-minute sessions, over an 8 week-period. Patients were followed for 6 months after treatment concluded. There were significant increases in the Fugl-Meyer Assessment [F(1, 111) = 92.6, P stimulation therapy applied within 6 months of stroke. Improvements were likely a result of spontaneous recovery. There was no difference based on the type of electrical stimulation that was administered. © The Author(s) 2016.

  14. Effects of Task-oriented Approach on Affected Arm Function in Children with Spastic Hemiplegia Due to Cerebral Palsy.

    Science.gov (United States)

    Song, Chiang-Soon

    2014-06-01

    [Purpose] The purpose of the present study was to examine the effects of task-oriented approach on motor function of the affected arm in children with spastic hemiplegia due to cerebral palsy. [Subjects] Twelve children were recruited by convenience sampling from 2 local rehabilitation centers. The present study utilized a one-group pretest-posttest design. All of children received task-oriented training for 6 weeks (40 min/day, 5 days/week) and also underwent regular occupational therapy. Three clinical tests, Box and Block Test (BBT), Manual Ability Measure (MAM-16), and Wee Functional Independence Measure (WeeFIM) were performed 1 day before and after training to evaluate the effects of the training. [Results] Compared with the pretest scores, there was a significant increase in the BBT, MAM-16, and WeeFIM scores of the children after the 6-week practice period. [Conclusion] The results of this study suggest that a task-oriented approach to treatment of the affected arm improves functional activities, such as manual dexterity and fine motor performance, as well as basic daily activities of patients with spastic hemiplegia due to cerebral palsy.

  15. Muscle releases to improve passive motion and relieve pain in patients with spastic hemiplegia and elbow flexion contractures.

    Science.gov (United States)

    Namdari, Surena; Horneff, J Gabe; Baldwin, Keith; Keenan, Mary Ann

    2012-10-01

    Patients with spastic hemiplegia after upper motor neuron (UMN) injury can develop elbow contractures. This study evaluated outcomes of elbow releases in treating spastic elbow flexion contractures in hemiplegic patients. Adults with spastic hemiplegia due to UMN injury who underwent elbow releases (brachialis, brachioradialis, and biceps muscles) were included. Nonoperative treatment was unsuccessful in all patients. Patients complained of difficulty with passive functions. Passive range of motion (ROM), pain relief, Modified Ashworth spasticity score, and complications were evaluated preoperatively and postoperatively. There were 8 men and 21 women with an average age of 52.4 years (range, 24.1-81.4 years). Seventeen patients had pain preoperatively. Postoperative follow-up was a mean of 1.7 years (range, 1-4.5 years). Preoperatively, patients lacked a mean of 78° of passive elbow extension compared with 17° postoperatively (P .05). Releases of the brachialis, brachioradialis, and biceps muscles can be an effective means of pain relief, improved passive ROM, and decreased spasticity in patients with elbow flexion deformity after UMN injury. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  16. Feasibility of Using an Arm Weight-Supported Training System to Improve Hand Function Skills in Children With Hemiplegia.

    Science.gov (United States)

    Krishnaswamy, Swetha; Coletti, Daniel J; Berlin, Hilary; Friel, Kathleen

    This investigation was a pilot feasibility trial evaluating the use of an arm-weight-supported training device to improve upper-extremity function in children with hemiplegia. A single-group within-subject design was used. Participants were 6 children ages 7-17 yr with upper-extremity weakness secondary to hemiplegia. The intervention consisted of 15-18 treatment sessions using an arm-weight-supported training device with the affected upper extremity. Fine motor function was assessed using the Jebsen-Taylor Hand Function Test, the Box and Block Test, and the Assisting Hand Assessment. We examined participants' interactions with the device and assessment scores pre- and postintervention. Five of the 6 children exhibited some changes after the therapy. The system required significant modifications to ensure appropriate positioning. The arm-weight-supported system may be viable for therapeutic use. Future studies should use randomized controlled designs and compare effectiveness of weight-supported training with that of other rehabilitation strategies. Copyright © 2016 by the American Occupational Therapy Association, Inc.

  17. Evaluation of Hand Stereognosis Level in 3-6 years Old Children with Spastic Hemiplegia and Diplegia

    Directory of Open Access Journals (Sweden)

    Minou Kalantari

    2013-07-01

    Full Text Available Objective: One of the most prevalent sensory problems in cerebral palsy is Astereognosis which has special importance in daily manual functions. The purpose of this study was to determine the level of hand stereognosis using common objects and geometric shapes in children with spastic hemiplegia and diplegia. Materials & Methods: In this cross sectional study, 20 children with cerebral palsy between 3-6 years old (9 males, 11 females with mean age (hemiplegya: 55months, diplegya: 57months were selected through nonrandomized convinience sampling referd to Occupational Therapy centers of Shahid Beheshti University of Medical Sciences. Stereognosis was evaluated using geometric shapes (square, circle, rectangular, triangle and common objects (pencil, key, coin, nail, teaspoon and screw and test special board. The data were analyzed by Mixed Analysis of Variance and Regression statistical tests. Results: There was no significant regression between common objects stereognosis score and age in hemiplegic childrenbut this regression was significant for stereognosis score of geometric shapes (P=0.027. There was no significant regression between stereognosis score of common objects and geometric shapes in diplegic children. The Main effects of gender was not significant in stereognosis of children with spastic hemiplegia and diplegia, also main effects of hand were not significant in two groups. Conclusion: There was no significant difference between stereognosis of affected and unaffected hand in hemiplegic childrenand between right and left hands in diplegic children. Also There was no significant regression between age and stereognosis score of geometric shapes in diplegic children .

  18. The influence of the level of physical activity and human development in the quality of life in survivors of stroke

    Directory of Open Access Journals (Sweden)

    Hickner Robert C

    2011-10-01

    Full Text Available Abstract Background The association between physical activity and quality of life in stroke survivors has not been analyzed within a framework related to the human development index. This study aimed to identify differences in physical activity level and in the quality of life of stroke survivors in two cities differing in economic aspects of the human development index. Methods Two groups of subjects who had suffered a stroke at least a year prior to testing and showed hemiplegia or hemiparesis were studied: a group from Belo Horizonte (BH with 48 people (51.5 ± 8.7 years and one from Montes Claros (MC with 29 subjects (55.4 ± 8.1 years. Subsequently, regardless of location, the groups were divided into Active and Insufficiently Active so their difference in terms of quality of life could be analyzed. Results There were no significant differences between BH and MCG when it came to four dimensions of physical health that were evaluated (physical functioning, physical aspect, pain and health status or in the following four dimensions of mental health status (vitality, social aspect, emotional aspect and mental health. However, significantly higher mean values were found in Active when compared with Insufficiently Active individuals in various measures of physical health (physical functioning 56.2 ± 4.4 vs. 47.4 ± 6.9; physical aspect 66.5 ± 6.5 vs. 59.1 ± 6.7; pain 55.9 ± 6.2 vs. 47.7 ± 6.0; health status 67.2 ± 4.2 vs. 56.6 ± 7.8 (arbitrary units, and mental health (vitality 60.9 ± 6.8 vs. 54.1 ± 7.2; social aspect 60.4 ± 7.1 vs. 54.2 ± 7.4; emotional aspect 64.0 ± 5.5 vs. 58.1 ± 6.9; mental health status 66.2 ± 5.5 vs. 58.4 ± 7.5 (arbitrary units. Conclusions Despite the difference between the cities concerning HDI values, no significant differences in quality of life were found between BH and MCG. However, the Active group showed significantly better results, confirming the importance of active lifestyle to enhance quality of

  19. The influence of the level of physical activity and human development in the quality of life in survivors of stroke.

    Science.gov (United States)

    Aidar, Felipe J; de Oliveira, Ricardo J; Silva, António J; de Matos, Dihogo G; Carneiro, André L; Garrido, Nuno; Hickner, Robert C; Reis, Victor M

    2011-10-13

    The association between physical activity and quality of life in stroke survivors has not been analyzed within a framework related to the human development index. This study aimed to identify differences in physical activity level and in the quality of life of stroke survivors in two cities differing in economic aspects of the human development index. Two groups of subjects who had suffered a stroke at least a year prior to testing and showed hemiplegia or hemiparesis were studied: a group from Belo Horizonte (BH) with 48 people (51.5 ± 8.7 years) and one from Montes Claros (MC) with 29 subjects (55.4 ± 8.1 years). Subsequently, regardless of location, the groups were divided into Active and Insufficiently Active so their difference in terms of quality of life could be analyzed. There were no significant differences between BH and MCG when it came to four dimensions of physical health that were evaluated (physical functioning, physical aspect, pain and health status) or in the following four dimensions of mental health status (vitality, social aspect, emotional aspect and mental health). However, significantly higher mean values were found in Active when compared with Insufficiently Active individuals in various measures of physical health (physical functioning 56.2 ± 4.4 vs. 47.4 ± 6.9; physical aspect 66.5 ± 6.5 vs. 59.1 ± 6.7; pain 55.9 ± 6.2 vs. 47.7 ± 6.0; health status 67.2 ± 4.2 vs. 56.6 ± 7.8) (arbitrary units), and mental health (vitality 60.9 ± 6.8 vs. 54.1 ± 7.2; social aspect 60.4 ± 7.1 vs. 54.2 ± 7.4; emotional aspect 64.0 ± 5.5 vs. 58.1 ± 6.9; mental health status 66.2 ± 5.5 vs. 58.4 ± 7.5) (arbitrary units). Despite the difference between the cities concerning HDI values, no significant differences in quality of life were found between BH and MCG. However, the Active group showed significantly better results, confirming the importance of active lifestyle to enhance quality of life in stroke survivors.

  20. Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders.

    Science.gov (United States)

    Idowu, Bukunmi Michael; Ayoola, Oluwagbemiga Oluwole; Adetiloye, Victor Adebayo; Komolafe, Morenikeji Adeyoyin

    2017-01-01

    Stroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices. Forty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-subdeltoid bursitis or effusion and adhesive capsulitis. Hemiplegic shoulders exhibited significantly higher number of pathologies compared to the unaffected shoulders and shoulders of controls ( p =0.000). One or more structural abnormalities were found in all 45 (100%) hemiplegic shoulders, 25 (55.6%) unaffected shoulders of the stroke subjects, and 39 (43.3%) control shoulders. The most frequent pathologies in the hemiplegic shoulders were the following: tendinosis of the long head of bicep tendon (48.9%), inferior shoulder subluxation (44.4%), co-existing subacromial-subdeltoid bursa/long head of bicep tendon sheath effusion (44.4%), and long head of bicep tendon sheath effusion only (40%). Tendinosis of the long head of bicep tendon was commoner in hemiplegic shoulders with poor motor status than those with good motor status. Hemiplegic shoulders have significantly higher number of structural abnormalities than unaffected shoulders and the shoulders of controls. Hemiplegic stroke patients should undergo ultrasonography of the hemiplegic shoulder to define the nature and extent of soft tissue injuries prior to physical therapy.

  1. The imaging of ischaemic stroke

    International Nuclear Information System (INIS)

    Hoggard, Nigel; Wilkinson, Iain D.; Griffiths, Paul D.

    2001-01-01

    Stroke is a clinical syndrome of a rapidly developing focal neurological deficit that may be classified for practical purposes into ischaemic and haemorrhagic. The role of imaging is to exclude mimics of ischaemic stroke or intracranial haemorrhage and confirm the presence of an ischaemic stroke. Computed tomography (CT) remains the investigation of choice to exclude acute intracranial haemorrhage but diffusion weighted magnetic resonance (MR) has proved to be a sensitive method of detecting early ischaemic infarction. Perfusion weighted MR allows further assessment at the same examination that could help guide the clinician in the risk/benefit analysis of treatment with thrombolytics or neuroprotective agents under evaluation. This can also be achieved with CT. This review article discusses the imaging of ischaemic stroke, relating the pathophysiology of stroke to it. It deals separately in more detail with these newer MR techniques. Hoggard, N. et al. (2001)

  2. Heat Stroke

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...... 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...

  3. Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?

    Directory of Open Access Journals (Sweden)

    Gupta Anupam

    2009-01-01

    Full Text Available Objective: Assessment of bladder by urodynamic study (UDS in patients with urinary incontinence following stroke, and correlation with site of lesion. Study Design and Setting: Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute. Materials and Methods: Forty patients (22 males with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion. Results: The mean age was 46.80 ± 16.65 years (range: 18-80 years. Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 ± 10.27 days (range: 8-53 days after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90% having overactive detrusor (OD and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5% had OD without detrusor-sphincter dyssynergy (DSD and 11 (27.5% had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation ( P > 0.05 was found between type of bladder and age or side and site of lesion. Conclusions: UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion.

  4. Pulsatility Index of Blood Echogenicity of the Human Radial and Common Carotid Arteries: Relation with Age and Stroke

    International Nuclear Information System (INIS)

    Bok, Tae Hoon; Kong, Qi; Nam, Kweon Ho; Choi, Jay Chol; Paeng, Dong Guk

    2012-01-01

    In the present paper, the ultrasound blood images were measured at both the human radial artery(RA) and common carotid artery(CCA), depending on the age, and the pulsatility index of blood echogenicity(PIBE) was analyzed. In addition, the ultrasound blood images were measured at both RA and CCA of both the stroke patients and the control group, and PIBE was compared. PIBE of RA for the young group was similar with that for the old group (0.13±0.21 and 0.16±0.03). PIBE of CCA for the young group, however, was larger than that for the old group (0.70±0.21 and 0.32±0.01), and was more variable depending on the subject. Similarly, the fibrinogen concentrations of the patients (336±61 and 340±126 mg/dl) were more than that of the control group (264±38 and 43 mg/dl), for both RA and CCA. The results indicate the possibility of the ultrasonic test on the correlation between erythrocyte aggregation and stroke, and it is expected that the in-vivo EA measurement would be clinically useful.

  5. Calcifications of Vertebrobasilar Arteries on CT: Detailed Distribution and Relation to Risk Factors in 245 Ischemic Stroke Patients

    Directory of Open Access Journals (Sweden)

    Slaven Pikija

    2013-01-01

    Full Text Available Introduction. Intracranial atherosclerosis is responsible for a substantial proportion of strokes worldwide but its detailed morphology in the vertebrobasilar arteries (VBA is unknown. Subject and Methods. Cases with ischemic strokes were retrospectively sought from the hospital database. Native CT scans were assessed for vessel area and intracranial artery calcifications (ICACs in VBA. The calcifications were classified as focal (FCs, crescent, and circular. Results. 245 patients (mean age: years, 57.6% females had visible ICACs. Calcifications were found in 75.9%, 63.3%, and 17.1% in the left vertebral artery (LVA, the right vertebral artery (RVA, and the basilar artery (BA, respectively. FCs were present in 91.0%, 90.3%, and 100.0%; crescents in 30.3%, 29.0%, and 7.1%, and circulars in 6.4%, 4.8%, and 0.0% of the RVA, LVA, and BA, respectively. FCs in dorsolateral quadrant were least prevalent in both vertebral arteries (VAs: 46 (29.8% and 46 (27.4% for RVA and LVA, respectively. Risk factors associated with vertical dispersion of ICACs were male gender (OR : 2.69, 1.38–5.28 and diabetes (OR : 2.28, 1.04–4.99. Conclusions. FCs in VAs are least prevalent in dorsolateral quadrants. The vertical dispersion of ICACs seems to be associated with the male gender and diabetes.

  6. Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: A randomized, controlled study.

    Science.gov (United States)

    Shin, Joon-Ho; Bog Park, Si; Ho Jang, Seong

    2015-08-01

    In the present study, we aimed to determine whether game-based virtual reality (VR) rehabilitation, combined with occupational therapy (OT), could improve health-related quality of life, depression, and upper extremity function. We recruited 35 patients with chronic hemiparetic stroke, and these participants were randomized into groups that underwent VR rehabilitation plus conventional OT, or the same amount of conventional OT alone, for 20 sessions over 4 weeks. Compared to baseline, the VR rehabilitation plus OT group exhibited significantly improved role limitation due to emotional problems (p=0.047). Compared to baseline, both groups also exhibited significantly improved depression (p=0.017) and upper extremity function (p=0.001), although the inter-group differences were not significant. However, a significant inter-group difference was observed for role limitation due to physical problems (p=0.031). Our results indicate that game-based VR rehabilitation has specific effects on health-related quality of life, depression, and upper extremity function among patients with chronic hemiparetic stroke. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Effects of kinesio tape to reduce hand edema in acute stroke.

    Science.gov (United States)

    Bell, Alison; Muller, Melissa

    2013-01-01

    The purpose of the study was to evaluate the effi cacy of Kinesio Tape (Kinesio USA, Albequerque, NM) for reducing hand edema in individuals with hemiplegia post stroke. Seventeen individuals who experienced acute stroke were screened for visual signs of edema and were randomly assigned to experimental and control groups. The experimental group received Kinesio Tape that was applied to hand and forearm for 6 days in combination with standard therapy; the control group received standard therapy. Blinded raters assessed edema reduction via circumferential measurements. Application of Kinesio Tape did not result in statistically signifi cant reduction in edema. Large and medium effect sizes were seen for edema reduction at the metacarpophalangeal and wrist joints, respectively, with Kinesio Tape. Further research is warranted to investigate the utility of Kinesio Tape in edema reduction.

  8. Feasibility of a Day-Camp Model of Modified Constraint-Induced Movement Therapy with and without Botulinum Toxin A Injection for Children with Hemiplegia

    Science.gov (United States)

    Eliasson, Ann-Christin; Shaw, Karin; Ponten, Eva; Boyd, Roslyn; Krumlinde-Sundholm, Lena

    2009-01-01

    The objective of the study was to investigate the feasibility of modified constraint-induced (CI) therapy provided in a 2-week day-camp model with and without intramuscular botulinum toxin type A (BoNT-A) injections for children with congenital cerebral palsy. Sixteen children with congenital hemiplegia, Manual Ability Classification System (MACS)…

  9. Kinematic aiming task: measuring functional changes in hand and arm movements after botulinum toxin-A injections in children with spastic hemiplegia.

    NARCIS (Netherlands)

    Rameckers, E.A.A.; Speth, L.A.; Duysens, J.E.J.; Vles, J.S.; Smits-Engelsman, B.C.M.

    2007-01-01

    OBJECTIVE: To describe different aspects of a kinematic aiming task (KAT) as a quantitative way to assess changes in arm movements within 2 wks after botulinum toxin-A (BTX-A) injections in children with spastic hemiplegia. DESIGN: Intervention study randomized clinical trial; follow-up within 4 wks

  10. Nutrition and its relation to mealtime preparation, eating, fatigue and mood among stroke survivors after discharge from hospital - a pilot study.

    Science.gov (United States)

    Westergren, Albert

    2008-01-01

    Eating difficulties and nutritional deficits are common among persons with acute stroke and during rehabilitation. Little is known about such problems after discharge from hospital. In addition the relationship between fatigue and nutritional status among stroke survivors living in the community remains to be explored. The aim of this pilot study was to describe mealtime preparation, eating, fatigue, mood and nutritional status among persons with stroke six months after discharge from hospital and to explore associations between these factors. Patients were interviewed six months poststroke. Standardised questions and methods were used. The mean age of the 89 respondents was 77.2 (SD 6.6) years, 44 were women and 45 men. Difficulties with swallowing, ingestion and energy to eat occurred among 27%, 20% and 7% respectively. Difficulties with cooking and buying food occurred among 57% and 56% respectively and 41% were at nutritional risk. Feeling full of energy less than some of the time was experienced by 61% while 15% had felt gloomy and sad at least some of the time during the previous four weeks. Considering activities of daily living (ADL), having a less favourable nutritional status was significantly predicted by difficulties with buying food, difficulties with ingestion and being a woman. Considering psychological state (mood and energy), having a less favourable nutritional status was significantly predicted by a lack of energy and high age. This study supports the occurrence of a nutritionally related fatigue by means of "lack of energy". The associations between poor nutritional status and fatigue can work in both directions. Thus persons with fatigue are more prone to have poor nutritional status and those with poor nutritional status are at greater risk of fatigue. Besides fatigue also difficulties with buying food and ingestion are associated with nutritional risk. As nutritional deficits occur a long time after stroke onset it is important to assess

  11. Impairments in precision grip correlate with functional measures in adult hemiplegia.

    Science.gov (United States)

    McDonnell, Michelle N; Hillier, Susan L; Ridding, Michael C; Miles, Timothy S

    2006-07-01

    Analysis of a precision grip-lift task provides measures to assess functional disability of the hand, but the correlation between these measures and accepted tests of motor function in stroke patients has not been established. Seventeen subacute stroke patients were studied to compare parameters of a precision grip-lift task between the affected and unaffected side, and to correlate them with function. Functional impairment was assessed with the Action Research Arm Test and the Fugl-Meyer assessment, as well as grip strength and maximal finger-tapping speed. The grip force (GF) and load force (LF) were recorded as patients lifted a custom-built manipulandum. All measures were recorded on two separate occasions, at least 1 week apart. There was good reproducibility between testing sessions for the grip-lift and functional measures. The affected hand gripped the manipulandum for longer prior to lift-off than the unaffected hand, and the normal close temporal coupling between the rate of change of GF and LF during the lift was disrupted. These two measures correlated more highly with the ARAT than the FMA and, when combined with measures of grip strength and tapping speed, explained 71% of the variance of the ARAT. The grip-lift task is a sensitive measure of impaired dexterity following stroke and provides measures which correlate well with a commonly applied functional assessment scale. This task may be used clinically to detect changes in the hemiplegic upper limb during rehabilitation and recovery.

  12. The relation between Ashworth scale scores and the excitability of the alpha motor neurones in patients with post-stroke muscle spasticity.

    Science.gov (United States)

    Bakheit, A M O; Maynard, V A; Curnow, J; Hudson, N; Kodapala, S

    2003-05-01

    The modified Ashworth scale (MAS) is the most widely used method for assessing muscle spasticity in clinical practice and research. However, the validity of this scale has been challenged. To compare the MAS with objective neurophysiological tests of spasticity. The MAS was recorded in patients with post-stroke lower limb muscle spasticity and correlated with the excitability of the alpha motor neurones. The latter was evaluated by measuring the latency of the Hoffmann reflex (H reflex) and the ratio of the amplitude of the maximum H reflex (H(max)) to that of the compound action motor potential of the soleus muscle (M(max)). Data on 24 randomly recruited patients were analysed. Patients were divided into two groups according to their MAS score: 14 had a MAS score of 1 (group A) and 10 scored 2 (group B). The two groups were comparable with respect to age and sex, but in group A there was a longer period since the stroke. The H reflex latency was reduced and the H(max):M(max) ratio was increased in both groups. The H(max):M(max) ratio values were higher for group B but the differences were not statistically significant. There is a relation between the MAS scores and alpha motor neurone excitability, although it is not linear. This suggests that the MAS measures muscle hypertonia rather than spasticity.

  13. Rehabilitative Games for Stroke Patients

    Directory of Open Access Journals (Sweden)

    A. Pyae

    2015-07-01

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

  14. The role of nitric oxide in stroke

    Directory of Open Access Journals (Sweden)

    Zhou-qing Chen

    2017-01-01

    Full Text Available Stroke is considered to be an acute cerebrovascular disease, including ischemic stroke and hemorrhagic stroke. The high incidence and poor prognosis of stroke suggest that it is a highly disabling and highly lethal disease which can pose a serious threat to human health. Nitric oxide (NO, a common gas in nature, which is often thought as a toxic gas, because of its intimate relationship with the pathological processes of many diseases, especially in the regulation of blood flow and cell inflammation. However, recent years have witnessed an increased interest that NO plays a significant and positive role in stroke as an essential gas signal molecule. In view of the fact that the neuroprotective effect of NO is closely related to its concentration, cell type and time, only in the appropriate circumstances can NO play a protective effect. The purpose of this review is to summarize the roles of NO in ischemic stroke and hemorrhagic stroke.

  15. Risk Factors and Neurologic Outcomes in Childhood Arterial Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Taner Sezer

    2017-09-01

    Full Text Available Objective: The aim of this study is to describe clinical characteristics, treatment modalities and outcomes of children with arterial ischemic stroke (AIS. Material and Methods: We retrospectively reviewed the charts of 102 children (62 girls and 40 boys with AIS admitted at our hospital between 2009 and 2015. Age at stroke, sex, medical history, family history, clinical findings upon admission, history of seizure, and radiological findings were recorded. Cardiac assessment, hematological and immunological tests, metabolic screening were all performed in the patients. Results: In 25 children stroke occured as a complication of cardiac disease, 12 had transient cerebral arteriopathy, 11 had Down’s syndrome, 9 had thalassemia, 7 had moyamoya disease, 6 had MTHFR mutation, 4 had homozygote for factor V Leiden, 3 had protein C deficiency, 1 had sickle cell disease, and in 24 children no underlying cause could be found. Multiple risk factors were found in 16 children and recurrent stroke was observed in 4 patients. Hemiplegia was the commonest initial clinical presentation (88.2% followed by seizure (66.6% and decreased level of consciousness (54.9%. The avarage length of follow-up was 32.1±5.4 months. The outcome in all 102 stroke patients was as follows: asymptomatic 57.8%; persistent neurologic deficit or epilepsy 40.2%; and death 2%. Conclusion: Our study showed an underlying cause for AIS in 76.5% of the patients; 42.2% of the patients either died or had motor and/or cognitive sequelae and recurrence occured despite prophylactic aspirin treatment in 4 patients. [J Contemp Med 2017; 7(3.000: 278-283

  16. Plasma cytokines in acute stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Boysen, Gudrun; Christensen, Erik

    2011-01-01

    GOALS: The aim of this study was to test the relations between plasma cytokines and the clinical characteristics, course, and risk factors in acute stroke. PATIENTS AND METHODS: The analysis was based on 179 patients with acute stroke included within 24 hours of stroke onset. On inclusion and 3...... months later plasma levels of interleukin 1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), interleukin-1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), interleukin 10 (IL-10), soluble tumor necrosis factor receptor 1 (sTNF-R1), and soluble tumor necrosis factor receptor 2 (sTNF-R2) were...

  17. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  18. Effect of an evidence-based mobility intervention on the level of function in acute intracerebral and subarachnoid hemorrhagic stroke patients on a neurointensive care unit.

    Science.gov (United States)

    Rand, Maxine L; Darbinian, Jeanne A

    2015-07-01

    To explore the effect of an evidence-based mobility intervention on the level of function (LOF) achieved by patients with intracerebral hemorrhage (ICH) stroke and subarachnoid hemorrhage (SAH) stroke and to identify clinical characteristics and measures associated with walking distances >15.24m. Retrospective pre- and postintervention study. Regional neurointensive care unit. Adult patients with ICH and SAH (N=361). Daily mobility intervention based on patient's current LOF. Walking >15.24m (LOF 5) by neurointensive care unit discharge. Electronic health records for 361 patients (52.6% women; mean age, 62.1y; ICH stroke, 63.2%; aphasia, 35%; hemiplegia, 33%) were included. There was a 2.3-fold increase in patients with hemorrhagic stroke achieving a LOF of 5 by neurointensive care unit discharge after introduction of a mobility intervention. In the multivariable logistic regression model including neurointensive care unit length of stay (LOS) as a covariate, the intervention, LOF of 5 at admission, SAH stroke type, third (vs lowest) quartile of neurointensive care unit LOS, and absence of aphasia and/or hemiplegia were associated with higher likelihood of achieving a LOF of 5 (odds ratio [OR]=5.28; 95% confidence interval [CI], 2.52-11.06; OR=6.02; 95% CI, 1.45-24.96; OR=3.78; 95% CI, 1.83-7.80; OR=2.94; 95% CI, 1.16-7.47; OR=17.77; 95% CI, 6.59-47.92, respectively). A mobility intervention was strongly associated with increased distance walked by neurointensive care unit patients with acute hemorrhage at discharge and can be applied in any intensive care unit setting to promote stroke recovery. Future studies directed at building predictive models for walking achievement in patients with acute hemorrhagic stroke may provide insight into individualized treatment goal setting and discharge planning. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  19. Assessing the reliability of the Modified Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia.

    Science.gov (United States)

    Ansari, Noureddin Nakhostin; Naghdi, Soofia; Hasson, Scott; Fakhari, Zahra; Mashayekhi, Masoud; Herasi, Mona

    2009-01-01

    The Modified Modified Ashworth Scale (MMAS) is a simple clinical outcome measure to assess muscle spasticity in people with brain injury. The objective of this cross-sectional study was to assess the interrater reliability of the MMAS in the upper limb of adult patients with hemiplegia. Participants were fifteen patients with a mean age of 57.3 +/- 14.4 years. They had brain injury on average 33.3 +/- 26.2 months earlier. Two common spastic muscle groups (elbow flexor and wrist flexor) on the hemiparetic side of the patients were rated by two physiotherapists according to a standardized protocol. The order of raters' assessment and the sequence of muscle testing was randomized. The weighted Kappa (kappaw) values were calculated for reliability. The kappaw was 0.61 for elbow flexor and 0.78 for wrist flexor. Results support the good interrater reliability of the MMAS for persons with upper limb spasticity.

  20. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Shoulder tenotomies to improve passive motion and relieve pain in patients with spastic hemiplegia after upper motor neuron injury.

    Science.gov (United States)

    Namdari, Surena; Alosh, Hassan; Baldwin, Keith; Mehta, Samir; Keenan, Mary Ann

    2011-07-01

    Shoulder adduction and internal rotation contractures commonly develop in patients with spastic hemiplegia after upper motor neuron (UMN) injury. Contractures are often painful, macerate skin, and impair axillary hygiene. We hypothesize that shoulder tenotomies are an effective means of pain relief and passive motion restoration in patients without active upper extremity motor function. A consecutive series of 36 adults (10 men, 26 women) with spastic hemiplegia from UMN injury, shoulder adduction, and internal rotation contractures, and no active movement, who underwent shoulder tenotomies of the pectoralis major, latissimus dorsi, teres major, and subscapularis were evaluated. Patients were an average age of 52.2 years. Pain, passive motion, and satisfaction were considered preoperatively and postoperatively. Average follow-up was 14.3 months. Preoperatively, all patients had limited passive motion that interfered with passive functions. Nineteen patients had pain. After surgery, passive extension, flexion, abduction, and external rotation improved from 50%, 27%, 27%, and 1% to 85%, 70%, 66%, and 56%, respectively, compared with the normal contralateral side (P pain had improved pain relief at follow-up, with 18 (95%) being pain-free. Thirty-five (97%) were satisfied with the outcome of surgery, and all patients reported improved axillary hygiene and skin care. Age, gender, etiology, and chronicity of UMN injury were not associated with improvement in motion. We observed improvements in passive ROM and high patient satisfaction with surgery at early follow-up. Patients who had pain with passive motion preoperatively had significant improvements in pain after shoulder tenotomy. Shoulder tenotomy to relieve spastic contractures resulting from UMN injury can be an effective means of pain relief and improved passive range of motion in patients without active motor function. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby

  2. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  3. Absolute and Relative Reliability of the Timed 'Up & Go' Test and '30second Chair-Stand' Test in Hospitalised Patients with Stroke.

    Science.gov (United States)

    Lyders Johansen, Katrine; Derby Stistrup, Rikke; Skibdal Schjøtt, Camilla; Madsen, Jacqueline; Vinther, Anders

    2016-01-01

    The timed 'Up & Go' test and '30second Chair-Stand' test are simple clinical outcome measures widely used to assess functional performance. The reliability of both tests in hospitalised stroke patients is unknown. The purpose was to investigate the relative and absolute reliability of both tests in patients admitted to an acute stroke unit. Sixty-two patients (men, n = 41) attended two test sessions separated by a one hours rest. Intraclass correlation coefficients (ICC2,1) were calculated to assess relative reliability. Absolute reliability was expressed as Standard Error of Measurement (with 95% certainty-SEM95) and Smallest Real Difference (SRD) and as percentage of their respective means if heteroscedasticity was observed in Bland Altman plots (SEM95% and SRD%). ICC values for interrater reliability were 0.97 and 0.99 for the timed 'Up & Go' test and 0.88 and 0.94 for '30second Chair-Stand' test, respectively. ICC values for intrarater reliability were 0.95 and 0.96 for the timed 'Up & Go' test and 0.87 and 0.91 for '30second Chair-Stand' test, respectively. Heteroscedasticity was observed in the timed 'Up & Go' test. Interrater SEM95% ranged from 9.8% to 14.2% with corresponding SRD% of 13.9-20.1%. Intrarater SEM95% ranged from 15.8% to 18.7% with corresponding SRD% of 22.3-26.5%. For '30second Chair-Stand' test interrater SEM95 ranged between 1.5 and 1.9 repetitions with corresponding SRD of 2 and 3 and intrarater SEM95 ranged between 1.8 and 2.0 repetitions with corresponding SRD values of 3. Excellent reliability was observed for the timed 'Up & Go' test and the '30second Chair-Stand' test in hospitalised stroke patients. The thresholds to detect a real change in performance were 18.7% for the timed 'Up & Go' test and 2.0 repetitions for the '30second Chair-Stand' in groups of patients and 26.5% and 3 repetitions in individual patients, respectively.

  4. Effective mechanical thrombectomy in a patient with hyperacute ischemic stroke associated with cardiac myxoma.

    Science.gov (United States)

    Baek, Seol-Hee; Park, Soonchan; Lee, Nam Joon; Kang, Youngjin; Cho, Kyung-Hee

    2014-10-01

    Ischemic stroke is the most common neurologic manifestation of cardiac myxoma. However, there has been no current guideline on the treatment of hyperacute ischemic stroke due to cardiac myxoma. We describe a patient with hyperacute stroke caused by cardiac myxoma who had a good outcome with rapid recanalization through mechanical thrombectomy. A 46-year-old man was admitted with acute symptoms of right side hemiplegia and global aphasia. Brain computed tomography (CT) angiography showed a T occlusion of the left internal carotid artery. Intravenous recombinant tissue plasminogen activator was administered. However, his clinical symptoms did not improve. Thus, we performed endovascular treatment and had a successful outcome. A pathologic examination of the retrieved clot revealed a tumor emboli from a cardiac myxoma. Transthoracic echocardiogram revealed a left atrial myxoma in which a large mass was attached to the posterior wall of the aorta. The patient's neurologic deficits recovered with the exception of left eye blindness. Reperfusion therapy with mechanical thrombectomy might be safe and effective for the rapid revascularization of large vessel occlusions in hyperacute ischemic stroke, from which the tumor thrombi can be retrieved. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Oral health-related quality of life in patients with stroke: a randomized clinical trial of oral hygiene care during outpatient rehabilitation.

    Science.gov (United States)

    Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

    2017-08-09

    This study was to evaluate the effectiveness of oral hygiene care in improving oral health- and health-related quality of life (OHRQoL and HRQoL) among patients receiving outpatient stroke rehabilitation. Subjects were randomized to: (1) a conventional oral hygiene care programme (COHCP) comprising a manual toothbrush, and oral hygiene instruction, or (2) an advanced oral hygiene care programme (AOHCP) comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, and oral hygiene instruction. The interventional period lasted for 3 months, followed by a 3-month observational period. HRQoL was assessed by SF-12, and OHRQoL was assessed by Oral Health Impact Profile-14 (OHIP-14), General Oral Health Assessment Index (GOHAI), and Oral Health Transitional Scale (OHTS). Participants in AOHCP group had significantly better OHRQoL at the end of clinical trial as assessed by OHTS (p improving subjective health.

  6. Preventing Stroke Deaths

    Science.gov (United States)

    ... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...

  7. Two Kinds of Stroke

    Science.gov (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  8. Healthy Living after Stroke

    Science.gov (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  9. Three-dimensional echocardiographic ventricular mass/end-diastolic volume ratio in native hypertensive patients: relation between stroke volume and geometry.

    Science.gov (United States)

    Lembo, Maria; Esposito, Roberta; Santoro, Ciro; Lo Iudice, Francesco; Schiano-Lomoriello, Vincenzo; Fazio, Valeria; Grimaldi, Maria Gabriella; Trimarco, Bruno; de Simone, Giovanni; Galderisi, Maurizio

    2018-03-22

    Elevated left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been associated with higher evidence of myocardial fibrosis and dysfunction in hypertensive patients by cardiac magnetic resonance, a technique with limited availability. We investigated the ability of three-dimensional (3D) echocardiography in identifying a phenotype of LV concentric geometry according to LVM/EDV ratio, possibly detecting early myocardial damage in native-hypertensive patients. One hundred and twenty-eight native-hypertensive patients underwent 2D and 3D-echocardiography. The population was divided into two groups, according to cut-off point values of 3D-LVM/EDV ratio corresponding to its upper 95% confidence interval in a population of 90 healthy normotensive individuals: LVM/EDV ratio cut-off was 1.22 in men and 1.23 in women. An increased 3D-LVM/EDV ratio identified a higher rate of LV concentric geometry in comparison with 2D-derived relative wall thickness (37 versus 24%, P = 0.03). Patients with LVM/EDV ratio of 1.22 or more in men and 1.23 or more in women were significantly older, had smaller 3D-LV end-diastolic and end-systolic volumes and higher LV mass index, without difference in ejection fraction. 3D-stroke volume (P geometry than 2D-relative wall thickness. Stroke volume is independently and negatively associated with LVM/EDV ratio and its reduction represents an early marker of myocardial dysfunction in hypertensives with LV concentric geometry.

  10. Understanding Life After Stroke

    OpenAIRE

    Hjelmblink, Finn

    2008-01-01

    Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered. This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews...

  11. 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.

  12. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Simple Techniques Can Help Memory after a Stroke Self-Esteem after Stroke Cognitive Challenges After Stroke Depression Trumps ... spasticity), fatigue and more. Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, recovery, ...

  13. Imaging of Hemorrhagic Stroke.

    Science.gov (United States)

    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.

  14. Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2016-09-01

    Full Text Available The new clinical construct of embolic stroke of undetermined source (ESUS suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42 were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembolic strokes (3.5% and significantly higher than in cryptogenic non-ESUS (1.2% (P<0.0001. This is the first description of a cohort of ESUS patients in an Italian stroke unit. Patients with ESUS have a significantly higher risk of recurrence than in those with non-ESUS cryptogenic strokes, and slightly higher than in those with cardioembolic strokes. Results support the hypothesis of a more extensive diagnostic evaluation in cryptogenic strokes and the feasibility of such approach.

  15. Job strain and the risk of stroke

    DEFF Research Database (Denmark)

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

    2015-01-01

    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....

  16. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj

    2009-01-01

    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... of infarcts. For a number of years, tight glycemic control has been regarded as beneficial in critically illness, but recent research has been unable to support this notion. The only completed randomized study on glucose-lowering therapy in stroke has failed to demonstrate effect, and concerns relating...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  17. Comparison of spatial filters and features for the detection and classification of movement-related cortical potentials in healthy individuals and stroke patients

    Science.gov (United States)

    Jochumsen, Mads; Niazi, Imran Khan; Mrachacz-Kersting, Natalie; Jiang, Ning; Farina, Dario; Dremstrup, Kim

    2015-10-01

    Objective. The possibility of detecting movement-related cortical potentials (MRCPs) at the single trial level has been explored for closing the motor control loop with brain-computer interfaces (BCIs) for neurorehabilitation. A distinct feature of MRCPs is that the movement kinetic information is encoded in the brain potential prior to the onset of the movement, which makes it possible to timely drive external devices to provide sensory feedback according to the efferent activity from the brain. The aim of this study was to compare methods for the detection (different spatial filters) and classification (features extracted from various domains) of MRCPs from continuous electroencephalography recordings from executed and imagined movements from healthy subjects (n = 24) and attempted movements from stroke patients (n = 6) to optimize the performance of MRCP-based BCIs for neurorehabilitation. Approach. The MRCPs from four cue-based tasks were detected with a template matching approach and a set of spatial filters, and classified with a linear support vector machine using the combination of temporal, spectral, time-scale, or entropy-based features. Main results. The best spatial filter (large Laplacian spatial filter (LLSF)) resulted in a true positive rate of 82 ± 9%, 78 ± 12% and 72 ± 9% (with detections occurring ˜200 ms before the onset of the movement) for executed, imagined and attempted movements (stroke patients). The best feature combination (temporal and spectral) led to pairwise classification of 73 ± 9%, 64 ± 10% and 80 ± 12%. When the detection was combined with classification, 60 ± 10%, 49 ± 10% and 58 ± 10% of the movements were both correctly detected and classified for executed, imagined and attempted movements. A similar performance for detection and classification was obtained with optimized spatial filtering. Significance. A simple setup with an LLSF is useful for detecting cued movements while the combination of features from the time

  18. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial.

    Science.gov (United States)

    Chollet, François; Tardy, Jean; Albucher, Jean-François; Thalamas, Claire; Berard, Emilie; Lamy, Catherine; Bejot, Yannick; Deltour, Sandrine; Jaillard, Assia; Niclot, Philippe; Guillon, Benoit; Moulin, Thierry; Marque, Philippe; Pariente, Jérémie; Arnaud, Catherine; Loubinoux, Isabelle

    2011-02-01

    Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that fluoxetine enhances motor recovery but its clinical efficacy is unknown. We therefore aimed to investigate whether fluoxetine would enhance motor recovery if given soon after an ischaemic stroke to patients who have motor deficits. In this double-blind, placebo-controlled trial, patients from nine stroke centres in France who had ischaemic stroke and hemiplegia or hemiparesis, had Fugl-Meyer motor scale (FMMS) scores of 55 or less, and were aged between 18 years and 85 years were eligible for inclusion. Patients were randomly assigned, using a computer random-number generator, in a 1:1 ratio to fluoxetine (20 mg once per day, orally) or placebo for 3 months starting 5-10 days after the onset of stroke. All patients had physiotherapy. The primary outcome measure was the change on the FMMS between day 0 and day 90 after the start of the study drug. Participants, carers, and physicians assessing the outcome were masked to group assignment. Analysis was of all patients for whom data were available (full analysis set). This trial is registered with ClinicalTrials.gov, number NCT00657163. 118 patients were randomly assigned to fluoxetine (n=59) or placebo (n=59), and 113 were included in the analysis (57 in the fluoxetine group and 56 in the placebo group). Two patients died before day 90 and three withdrew from the study. FMMS improvement at day 90 was significantly greater in the fluoxetine group (adjusted mean 34·0 points [95% CI 29·7-38·4]) than in the placebo group (24·3 points [19·9-28·7]; p=0·003). The main adverse events in the fluoxetine and placebo groups were hyponatraemia (two [4%] vs two [4%]), transient digestive disorders including nausea, diarrhoea, and abdominal pain (14 [25%] vs six [11%]), hepatic enzyme disorders (five [9%] vs ten [18%]), psychiatric disorders (three [5%] vs four [7%]), insomnia (19 [33%] vs 20 [36%]), and partial

  19. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  20. Could Stroke Trigger Be Prevented by Healthy Family Relationships?

    Science.gov (United States)

    Rochette, Annie; Gaulin, Philippe; Tellier, Myriam

    2009-01-01

    Although major stroke risk factors are well documented, little is known about which life circumstances are perceived to be related to the actual triggering of a first stroke. The purpose was to explore self-perceived spontaneously related life circumstances surrounding the trigger of a first stroke. A qualitative design with a phenomenological…

  1. Stroke Knowledge in Spanish-speaking populations

    Science.gov (United States)

    Hawkes, Maximiliano A; Ameriso, Sebastián F; Willey, Joshua Z

    2015-01-01

    Background Spanish is the second most spoken language in the world. Spanish-speaking populations (SSP) have heterogeneous cultural backgrounds, racial and ethnical origins, economic status, and access to health care systems. There are no published reviews about stroke knowledge in SSP. We reviewed the existing literature addressing stroke knowledge among SSP and propose future directions for research. Summary We identified 18 suitable studies by searching PubMed, Lilacs, Scopus, Embase, Cochrane and Scielo databases, and looking at reference lists of eligible articles. We also included 2 conference abstracts. Data related to stroke knowledge from studies of Spanish-speakers was analyzed. Key messages Little is known about stroke knowledge in SSP, especially in Latin America. Information is poor even among subjects at risk, stroke patients, stroke survivors, and health care providers. “Ictus”, the word used for stroke in Spanish, is largely unrecognized among subjects at risk. Furthermore, access to medical care and presence of neurologists are suboptimal in many regions. There are several potential issues to solve regarding stroke knowledge and stroke care in SSP. Programs to educate the general population and non-neurologists medical providers in stroke and telemedicine may be suitable options to improve the present situation. PMID:25871697

  2. Robot-aided therapy for upper limbs in patients with stroke-related lesions. Brief report of a clinical experience

    Directory of Open Access Journals (Sweden)

    Dall'Armi Valentina

    2011-04-01

    Full Text Available Abstract This study was aimed at verifying the improvement on the motor impairment and functionality in 19 patients with chronic hemiparesis after stroke treated with a robot-aided rehabilitation protocol using the ReoGo™ system (Motorika Medical Ltd, Israel, and at evaluating the persistence of the effects after 1 month. The study also focused on the actual possibility of administering the robot-aided therapy with the ReoGo™ for the upper limbs and on the patients' degree of acceptance and compliance with the treatment. Subjects underwent an assessment prior to the start of the rehabilitation project (T-1, one at the start (T0, one at the end of the treatment (T1 and one after one month from the end of the treatment (T2. The following tests were administered: (i Fugl-Meyer (FM upper limb; Ashworth scale (AS; Functional Independence Measure (FIM™ (T-1 - T2; (ii strength evaluation; Visual Analogue Scale (VAS for pain; Frenchay Arm test (FAT; Box and Block test (BBT; Timed Up and Go (TUG test (T0 - T2. Additionally, the Euro-QoL questionnaire and a VAS for the treatment satisfaction were administered to the subjects. Non-statistical difference of scores at T-1 and T0 on almost the entire battery of tasks suggested a stable patients' performance prior to the start of the rehabilitation. With the exception of the Medical Research Council (MRC and the AS sub-scales measuring -as appropriate- strength and spasticity of the shoulder, triceps and wrist, all scores showed a significant increase between T0 and T1. The improvement on the pain could not be proved significant (p = 0.10. A significant increase between T0 and T2 was found for all assessment scores, with the exception of the MRC for external shoulder rotators (p = 0.05 and of the AS for shoulder (p = 0.32 and wrist (p = 0.08. Substantial stability was observed between T1 and T2. Patients were capable of completing the treatment and showed good participant satisfaction. This pilot study

  3. Virtual reality in stroke rehabilitation: still more virtual than real.

    Science.gov (United States)

    Crosbie, J H; Lennon, S; Basford, J R; McDonough, S M

    2007-07-30

    To assess the utility of virtual reality (VR) in stroke rehabilitation. The Medline, Proquest, AMED, CINAHL, EMBASE and PsychInfo databases were electronically searched from inception/1980 to February 2005, using the keywords: Virtual reality, rehabilitation, stroke, physiotherapy/physical therapy and hemiplegia. Articles that met the study's inclusion criteria were required to: (i) be published in an English language peer reviewed journal, (ii) involve the use of VR in a stroke rehabilitation setting; and (iii) report impairment and/or activity oriented outcome measures. Two assessors independently assessed each study's quality using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) grading system. Eleven papers met the inclusion criteria: Five addressed upper limb rehabilitation, three gait and balance, two cognitive interventions, and one both upper and lower limb rehabilitation. Three were judged to be AACPDM Level I/Weak, two Level III/Weak, three Level IV/Weak and three Level V quality of evidence. All articles involved before and after interventions; three randomized controlled trials obtained statistical significance, the remaining eight studies found VR-based therapy to be beneficial. None of the studies reported any significant adverse effects. VR is a potentially exciting and safe tool for stroke rehabilitation but its evidence base is too limited by design and power issues to permit a definitive assessment of its value. Thus, while the findings of this review are generally positive, the level of evidence is still weak to moderate, in terms of research quality. Further study in the form of rigorous controlled studies is warranted.

  4. Identification of stroke during the emergency call: a descriptive study of callers' presentation of stroke.

    Science.gov (United States)

    Berglund, Annika; von Euler, Mia; Schenck-Gustafsson, Karin; Castrén, Maaret; Bohm, Katarina

    2015-04-28

    To evaluate symptoms presented by the caller during emergency calls regarding stroke, and to assess if symptoms in the Face-Arm-Speech-Time Test (FAST) are related to identification of stroke. Emergency calls to the Emergency Medical Communication Center (EMCC) concerning patients discharged with stroke diagnosis in a large teaching hospital in Stockholm, Sweden, in January-June 2011. The emergency calls of 179 patients who arrived at hospital by ambulance, and who were discharged with a stroke diagnosis and consented to participate were included in the study. Frequencies of stroke symptoms presented and a comparison of symptoms presented in calls with dispatch code stroke or other dispatch code. Of the 179 emergency calls analysed, 64% were dispatched as 'Stroke'. FAST symptoms, that is, facial or arm weakness or speech disturbances, were presented in 64% of the calls and were spontaneously revealed in 90%. Speech disturbance was the most common problem (54%) in all calls, followed by fall/lying position (38%) and altered mental status (27%). For patients with dispatch codes other than stroke, the dominating problem presented was a fall or being in a lying position (66%), followed by speech disturbance (31%) and altered mental status (25%). Stroke-specific symptoms were more common in patients dispatched as stroke. FAST symptoms were reported in 80% of patients dispatched as stroke compared with 35% in those dispatched as something else. This study implicates that fall/lying position and altered mental status could be considered as possible symptoms of stroke during an emergency call. Checking for FAST symptoms in these patients might uncover stroke symptoms. Future studies are needed to evaluate if actively asking for FAST symptoms in emergency calls presenting falls or a lying position can improve the identification of stroke. Stroke2010/703-31/2. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  5. Handicap 5 years after stroke in the North East Melbourne Stroke Incidence Study.

    Science.gov (United States)

    Gall, Seana L; Dewey, Helen M; Sturm, Jonathan W; Macdonell, Richard A L; Thrift, Amanda G

    2009-01-01

    Handicap is rarely comprehensively examined after stroke. We examined handicap among 5-year stroke survivors from an 'ideal' stroke incidence study. Survivors were assessed with the London Handicap Scale [LHS, score range: 0 (greatest handicap) to 100 (least handicap)]. Multivariable regression was used to examine demographic, risk and stroke-related factors associated with handicap. 351 of 441 (80%) survivors were assessed. Those assessed were more often Australian born than those not assessed (p handicap was present for physical independence and occupation/leisure items. Handicap was associated with older age, manual occupations, smoking, initial stroke severity, recurrent stroke and mood disorders. Reducing recurrent stroke, through better risk factor management, is likely to reduce handicap. The association between handicap and mood disorders, which are potentially modifiable, warrants further investigation. Copyright (c) 2008 S. Karger AG, Basel.

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

    DEFF Research Database (Denmark)

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

    1999-01-01

    or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However......White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC...

  7. Impact of Libido at 2 Weeks after Stroke on Risk of Stroke Recurrence at 1-Year in a Chinese Stroke Cohort Study

    OpenAIRE

    Jing-Jing Li; Huai-Wu Yuan; Chun-Xue Wang; Ben-Yan Luo; Jie Ruan; Ning Zhang; Yu-Zhi Shi; Yong Zhou; Yi-Long Wang; Tong Zhang; Juan Zhou; Xing-Quan Zhao; Yong-Jun Wang

    2015-01-01

    Background: There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year. Methods: It is a multi-centered, prospective cohort study. The 14 th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of ...

  8. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  9. Stroke: First Aid

    Science.gov (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  10. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

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

    Directory of Open Access Journals (Sweden)

    Suk Jae Kim

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

  12. Survival after stroke. Risk factors and determinants in the Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter

    2010-01-01

    -based surveys is emphasized. For factors such as sex, and most cardiovascular risk factors further studies are necessary to clarify the relation to survival because studies disagree. Conclusions from studies of the relation between survival and alcohol intake are still debatable, mostly because of diverging...... definitions of the intensity of exposure. Smoking is uniformly associated with a poorer survival after stroke. Stroke unit treatment improves both short- and longterm survival regardless of stroke type, severity, age, and cardiovascular risk factor profile....

  13. Correlation of Resting Elbow Angle with Spasticity in Chronic Stroke Survivors.

    Science.gov (United States)

    Bhadane, Minal Y; Gao, Fan; Francisco, Gerard E; Zhou, Ping; Li, Sheng

    2015-01-01

    To evaluate whether resting joint angle is indicative of severity of spasticity of the elbow flexors in chronic stroke survivors. Seventeen hemiparetic stroke subjects (male: n = 13; female: n = 4; age: 37-89 years; 11 right and 6 left hemiplegia; averaged 54.8 months after stroke, ranging 12-107 months) participated in the study. The number of subjects with modified Ashworth scale score (MAS) = 0, 1, 1+, 2, and 3 was 3, 3, 5, 3, and 3, respectively. In a single experimental session, resting elbow joint angle, MAS, and Tardieu scale score (Tardieu R1) were measured. A customized motorized stretching device was used to stretch elbow flexors at 5, 50, and 100°/s, respectively. Biomechanical responses (peak reflex torque and reflex stiffness) of elbow flexors were quantified. Correlation analyses between clinical and biomechanical assessments were performed. Resting elbow joint angle showed a strong positive correlation with Tardieu R1 (r = 0.77, p spasticity in chronic stroke. Resting angle observation for spasticity assessment can and will be an easy, yet a valid way of spasticity estimation in clinical settings, particularly for small muscles or muscles which are not easily measurable by common clinical methods.

  14. The Effects of Shoulder Slings on Balance in Patients With Hemiplegic Stroke

    Science.gov (United States)

    Sohn, Min Kyun; Jee, Sung Ju; Hwang, Pyoungsik; Jeon, Yumi

    2015-01-01

    Objective To investigate the effects of a shoulder sling on balance in patients with hemiplegia. Methods Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. Results The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (pBobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. Conclusion The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position. PMID:26798614

  15. Effects of constraint-induced movement therapy in children with hemiplegia: a single case experimental study Efeitos da terapia de restrição por movimento induzido em crianças com hemiplegia: desenho experimental de caso único

    Directory of Open Access Journals (Sweden)

    Marina B. Brandão

    2009-12-01

    Full Text Available OBJECTIVE: To investigate the profile of changes in the use of the upper extremity in three children with hemiplegia submitted to an adapted protocol of constraint-induced movement therapy (CIMT. METHODS: A single-subject design (ABA was replicated in three children aged 8 to 11 years old. Baseline phases (A1 and (A2 and the intervention phase (B lasted 2 weeks each. During the intervention period, children wore a splint on the non-affected extremity for 10 hours a day and were submitted to 3 hours of therapy a day during 10 days. Training consisted of activities with the affected upper extremity, with gradually increasing complexity and verbal feedback. Hand function was classified according to the Manual Ability Classification System (MACS. Children were assessed four times every week with the Toddler Arm Use Test (TAUT and three adapted tasks from the Jebsen-Taylor Hand Function test (JTHF, and once a week with the Pediatric Motor Activity Log (PMAL and self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI. Celeration Line, Two-Standard Deviation Band and visual analysis methods were used for data analyses. RESULTS: Significant improvements in the amount and quality of upper extremity use (PMAL, TAUT quality of use for children 2 and 3, and participation for child 1, as well as decreased time to complete JTHF tasks for children 2 and 3 were observed. No changes were observed in the PEDI self-care scales. CONCLUSION: CIMT effects were associated with improvements in manual dexterity, amount and quality of use of the affected upper extremity in children with hemiplegia.OBJETIVO: Investigar mudanças longitudinais no uso da extremidade superior em três crianças com hemiplegia submetidas a um protocolo adaptado de terapia de movimento induzido por restrição (CIMT. MÉTODOS: Um desenho experimental de caso único (ABA foi replicado em três crianças entre 8 e 11 anos de idade. Fases de baseline (A1 e (A2 e fase de

  16. Trends in the prevalence and management of pre-stroke atrial fibrillation, the South London Stroke Register, 1995-2014.

    Directory of Open Access Journals (Sweden)

    Vageesh Jain

    Full Text Available Previous studies have found low use of anticoagulation prior to stroke, in people with atrial fibrillation (AF. This study examined data on patients with AF-related stroke from a population-based stroke register, and sought to examine changes in management of AF prior to stroke, and reasons for suboptimal treatment, in those who were known to be at a high risk of stroke.The South London Stroke Register (SLSR is an ongoing population-based register recording first-in-a-lifetime stroke. Trends in the prevalence of AF, and antithrombotic medication prescribed before the stroke, were investigated from 1995 to 2014. Multivariable logistic regression analyses were conducted to assess the factors associated with appropriate management.Of the 5041 patients on the register, 816 (16.2% were diagnosed with AF before their stroke. AF related stroke increased substantially among Black Carribean and Black African patients, comprising 5% of the overall cohort in 1995-1998, increasing to 25% by 2011-2014 (p = 2] increased from 9% (1995-1998 to 30% (2011-2014 (p65 were significantly less likely to be prescribed an anticoagulant, with ethnicity, gender and deprivation showing no association with anticoagulation.Most AF-related strokes occurred in people who could have been predicted to be at high risk before their stroke, yet were not prescribed optimal preventative treatment. The elderly,despite being at highest stroke risk, were rarely prescribed anticoagulants.

  17. Atrophy of muscles surrounding the shoulder in hemiplegia. Analysis with MRI

    International Nuclear Information System (INIS)

    Fukuda, Fumio; Kobayashi, Tsunesaburo; Matsumoto, Shinichi

    1996-01-01

    Decrease of range of motion and subluxation of shoulders are common secondary dysfunctions after the stroke. The purpose of this study is to evaluate the atrophy of muscles surrounding shoulders in hemiplegic patients and to delineate the correlations between those atrophies and shoulder functions. MRI studies were done on bilateral shoulders in 13 hemiplegic patients with shoulder pain. The cross sectional areas of muscles surrounding shoulder, i.e., subscapularis, supraspinatus, infraspinatus, teres minor and deltoid muscle were measured on those images obtained. The degree of atrophies were evaluated by dividing cross-sectional area of the muscle on affected shoulder by that of non-affected shoulder, that is muscle atrophy ratio [MAR], for each muscle in every case. Also, the range of movements [ROM], the degree of subluxation and muscle strength of shoulder flexion were evaluated. All muscle cross-sectional areas on the affected side were significantly smaller than those of muscles on the unaffected side (p<0.01). The means of MARs were 0.68, 0.69, 0.86, 0.72 and 0.69 for subscapularis, supraspinatus, infraspinatus, teres minor and deltoid muscle. The pattern of muscle atrophies, however, varies from case to case. Both correlations of ROM versus supraspinatus MAR and degree of shoulder subluxation versus deltoid MAR were statistically significant (p<0.05). These results indicate the contribution of muscle atrophy to the shoulder dysfunction in hemiplegic patients. (author)

  18. Atrophy of muscles surrounding the shoulder in hemiplegia. Analysis with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Fukuda, Fumio; Kobayashi, Tsunesaburo; Matsumoto, Shinichi [Fukushima Rosai Hospital, Iwaki (Japan)

    1996-01-01

    Decrease of range of motion and subluxation of shoulders are common secondary dysfunctions after the stroke. The purpose of this study is to evaluate the atrophy of muscles surrounding shoulders in hemiplegic patients and to delineate the correlations between those atrophies and shoulder functions. MRI studies were done on bilateral shoulders in 13 hemiplegic patients with shoulder pain. The cross sectional areas of muscles surrounding shoulder, i.e., subscapularis, supraspinatus, infraspinatus, teres minor and deltoid muscle were measured on those images obtained. The degree of atrophies were evaluated by dividing cross-sectional area of the muscle on affected shoulder by that of non-affected shoulder, that is muscle atrophy ratio [MAR], for each muscle in every case. Also, the range of movements [ROM], the degree of subluxation and muscle strength of shoulder flexion were evaluated. All muscle cross-sectional areas on the affected side were significantly smaller than those of muscles on the unaffected side (p<0.01). The means of MARs were 0.68, 0.69, 0.86, 0.72 and 0.69 for subscapularis, supraspinatus, infraspinatus, teres minor and deltoid muscle. The pattern of muscle atrophies, however, varies from case to case. Both correlations of ROM versus supraspinatus MAR and degree of shoulder subluxation versus deltoid MAR were statistically significant (p<0.05). These results indicate the contribution of muscle atrophy to the shoulder dysfunction in hemiplegic patients. (author).

  19. Stroke prevention in atrial fibrillation: findings from Tuscan FADOI Stroke Registry

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2014-06-01

    Full Text Available Despite vitamin K antagonists (VKAs are considered the first choice treatment for stroke prevention in atrial fibrillation (AF, literature shows their underuse in this context. Since data about VKAs use prior and after acute stroke lack, the aim of this study was to focus on management of anticoagulation with VKAs in this context. Data were retrieved from Tuscan FADOI Stroke Registry, an online data bank aimed to report on characteristics of stroke patients consecutively admitted in Internal Medicine wards in 2010 and 2011. In this period 819 patients with mean age 76.5±12.3 years were enrolled. Data on etiology were available for 715 of them (88.1%, 87% being ischemic and 13% hemorrhagic strokes. AF was present in 238 patients (33%, 165 (69.3% having a known AF before hospitalization, whereas 73 patients (31.7% received a new diagnosis of AF. A percentage of 89% of strokes in patients with known AF were ischemic and 11% hemorrhagic. A percentage of 86.7% of patients with known AF had a CHADS2 ≥2, but only 28.3% were on VKAs before hospitalization. A percentage of 78.8% of patients treated with VKAs before stroke had an international normalized ratio (INR ≤2.0; 68.7% of patients with VKAs-related hemorrhagic strokes had INR ≤3.0. Combined endpoint mortality or severe disability in patients with ischemic stroke associated with AF was present in 47%, while it was present in 19.30% and 19.20% of atherothrombotic and lacunar strokes, respectively. At hospital discharge, VKAs were prescribed in 25.9% of AF related ischemic stroke patients. AF related strokes are burdened by severe outcome but VKAs are dramatically underused in patients with AF, even in higher risk patients. Efforts to improve anticoagulation in this stroke subtype are warranted.

  20. Parkinson's disease is related to an increased risk of ischemic stroke-a population-based propensity score-matched follow-up study.

    Directory of Open Access Journals (Sweden)

    Ya-Ping Huang

    Full Text Available OBJECTIVE: The risk of stroke in patients with Parkinson's disease (PD remains controversial. The purpose of this population-based propensity score-matched longitudinal follow-up study was to determine whether there is an increased risk of ischemic stroke after PD. METHODS: We used a logistic regression model that includes age, sex, pre-existing comorbidities and socioeconomic status as covariates to compute the propensity score. A total of 2204 patients with at least two ambulatory visits with the principal diagnosis of PD in 2001 was enrolled in the PD group. The non- PD group consisted of 2204, propensity score-matched subjects without PD. The ischemic stroke-free survival rates of the two groups were estimated using the Kaplan-Meier method. Stratified Cox proportional hazard regression with patients matched on propensity score was used to estimate the effect of PD on the occurrence of ischemic stroke. RESULTS: During the three-year follow-up period, 328 subjects in the PD group and 156 subjects in the non-PD group developed ischemic stroke. The ischemic stroke-free survival rate of the PD group was significantly lower than that of the non-PD group (P<0.0001. The hazard ratio (HR of stroke for the PD group was 2.37 (95% confidence interval [CI], 1.92 to 2.93, P<0.0001 compared to the non- PD group. CONCLUSIONS: This study shows a significantly increased risk of ischemic stroke in PD patients. Further studies are required to investigate the underlying mechanism.

  1. Psychological factors determine depressive symptomatology after stroke

    NARCIS (Netherlands)

    Van Mierlo, Maria L.; Van Heugten, Caroline M.; Post, Marcel W.; De Kort, Paul L.; Visser-Meily, Anne

    2015-01-01

    Objective To identify psychological factors related to poststroke depressive symptoms. Design Cross-sectional study, with patients assessed at 2 months poststroke. Setting Patients with stroke from 6 general hospitals. Participants Stroke patients (N=344; mean age ± SD, 66.9±12.3y). Interventions

  2. Psychological Factors Determine Depressive Symptomatology After Stroke

    NARCIS (Netherlands)

    van Mierlo, Maria L.; van Heugten, Caroline M.; Post, Marcel W.; de Kort, Paul L.; Visser-Meily, Johanna M.

    Objective: To identify psychological factors related to poststroke depressive symptoms. Design: Cross-sectional study, with patients assessed at 2 months poststroke. Setting: Patients with stroke from 6 general hospitals. Participants: Stroke patients (N=344; mean age +/- SD, 66.9 +/- 12.3y).

  3. Invariant properties between stroke features in handwriting

    NARCIS (Netherlands)

    Teulings, H L; Schomaker, L R

    A handwriting pattern is considered as a sequence of ballistic strokes. Replications of a pattern may be generated from a single, higher-level memory representation, acting as a motor program. Therefore, those stroke features which show the most invariant pattern are probably related to the

  4. Stroke in Asia: a global disaster.

    Science.gov (United States)

    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.

  5. Does Diagnosis of Hypertension Prevent Stroke? A Preliminary ...

    African Journals Online (AJOL)

    Introduction: The present study was designed to determine the relative frequency of previously diagnosed and undiagnosed hypertension in first stroke in order to evaluate if previous diagnosis of hypertension can prevent stroke. Patients and Methods: One hundred and twenty nine first stroke patients presenting at the ...

  6. Impact of stroke type on survival and functional health

    NARCIS (Netherlands)

    van Straten, A.; Reitsma, J. B.; Limburg, M.; van den Bos, G. A.; de Haan, R. J.

    2001-01-01

    In a cohort 760 consecutive stroke patients (23 hospitals in the Netherlands), we studied prognosis in relation to stroke type and focused on (a) short-term and long-term mortality, and (b) long-term functional health. Based on clinical and CT data, we distinguished infratentorial strokes from

  7. Extracorporeal Shock Wave Therapy reduces upper limb spasticity and improves motricity in patients with chronic hemiplegia: a case series.

    Science.gov (United States)

    Troncati, Franco; Paci, Matteo; Myftari, Tefta; Lombardi, Bruna

    2013-01-01

    Extracorporeal Shock Wave Therapy (ESWT) has been proposed for treatment of abnormal muscle tone only in the last years. The effects on motor impairment are unknown. To assess the long-term effects of ESWT on muscle tone and motricity in upper limb in patients with chronic hemiplegia. Twelve patients were selected and treated with two sessions of ESWT. Participants were assessed at baseline, after the treatment, and at 3 and 6 months. Muscle tone of shoulder adductors, elbow, wrist and finger flexors was evaluated at all assessment points using the Modified Ashworth Scale (MAS), while motricity, passive range of motion (PROM) and pain sub-scores of upper extremity part of the Fugl-Meyer scale were used to assess motor recovery. The degree of perceived benefit from treatment was assessed on a visual analogue scale. MAS showed a significant reduction of spasticity and Fugl-Meyer scores improved immediately after treatment. Persistent effects were observed at 3 and 6 months for MAS, and for motricity and PROM subscores of the Fugl-Meyer scale. Clinical improvement was not correlated to the patients' perceived benefit. Two sessions of ESWT seem to have long-term effects in reducing muscle tone and enhancing motor impairment.

  8. Absolute and Relative Reliability of the Timed 'Up & Go' Test and '30second Chair-Stand' Test in Hospitalised Patients with Stroke

    DEFF Research Database (Denmark)

    Lyders Johansen, Katrine; Derby Stistrup, Rikke; Skibdal Schjøtt, Camilla

    2016-01-01

    OBJECTIVE: The timed 'Up & Go' test and '30second Chair-Stand' test are simple clinical outcome measures widely used to assess functional performance. The reliability of both tests in hospitalised stroke patients is unknown. The purpose was to investigate the relative and absolute reliability.......94 for '30second Chair-Stand' test, respectively. ICC values for intrarater reliability were 0.95 and 0.96 for the timed 'Up & Go' test and 0.87 and 0.91 for '30second Chair-Stand' test, respectively. Heteroscedasticity was observed in the timed 'Up & Go' test. Interrater SEM95% ranged from 9.8% to 14.......2% with corresponding SRD% of 13.9-20.1%. Intrarater SEM95% ranged from 15.8% to 18.7% with corresponding SRD% of 22.3-26.5%. For '30second Chair-Stand' test interrater SEM95 ranged between 1.5 and 1.9 repetitions with corresponding SRD of 2 and 3 and intrarater SEM95 ranged between 1.8 and 2.0 repetitions...

  9. Genetic determinants and stroke in children with sickle cell disease

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. Angiotensinogen gene promoter haplotype and microangiopathy-related cerebral damage: results of the Austrian Stroke Prevention Study

    NARCIS (Netherlands)

    H. Schmidt (Helena); F. Fazekas (Franz); G.M. Kostner; R. Schmidt (Reinhold); C.M. van Duijn (Cornelia)

    2001-01-01

    textabstractBACKGROUND AND PURPOSE: Microangiopathy-related cerebral damage (MARCD) is a common finding in the elderly. It may lead to cognitive impairment and gait disturbances. Arterial hypertension and age are the most important risk factors. We assessed the association between MARCD and sequence

  12. Drip, ship, and grip, then slice and dice: Comprehensive stroke center management of cervical and intracranial emboli.

    Directory of Open Access Journals (Sweden)

    Jason D Hinman

    2013-07-01

    Full Text Available BACKGROUND AND PURPOSE: Tandem acute thrombotic emboli in the cervical and intracranial arteries are an unusual case of stroke presenting unique management challenges. In regional systems of acute stroke care anchored by Comprehensive Stroke Centers, combined fibrinolytic, endovascular, and open surgical intervention is a new therapeutic option. SUMMARY OF CASE: A 28 year old male underwent retinal surgery, including post-operative neck compression and the next day presented to a primary stroke center with aphasia and right hemiplegia. Intravenous tissue plasminogen activator therapy was initiated and the patient was transferred to a comprehensive stroke center (CSC for higher level of care (drip and ship. Imaging at the CSC demonstrated tandem thrombi: a near occlusive lesion at the origin of the left cervical internal carotid artery and a total occlusion of the M1 segment of the left middle cerebral artery. Endovascular thrombectomy with the Solitaire stent retriever resulted in intracranial recanalization (grip. Immediately after the endovascular procedure, open carotid thrombectomy was performed to achieve cervical carotid revascularization without systemic heparinization (slice. Both cervical carotid and intracranial thrombi were processed for proteomic analysis via mass spectrometry (dice. CONCLUSION: Combined fibrinolytic, endovascular, and open surgical intervention can yield revascularization and good clinical outcome in cases of tandem lesions.

  13. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...

  14. Stroke: Working toward a Prioritized World Agenda

    Science.gov (United States)

    Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Jr., Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko

    2010-01-01

    Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build

  15. Stroke: working toward a prioritized world agenda.

    Science.gov (United States)

    Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko

    2010-08-01

    The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and

  16. Cost of stroke in France.

    Science.gov (United States)

    Chevreul, K; Durand-Zaleski, I; Gouépo, A; Fery-Lemonnier, E; Hommel, M; Woimant, F

    2013-07-01

    A cost of illness study was undertaken on behalf of the French Ministry of Health to estimate the annual cost of stroke in France with the goal of better understanding the current economic burden so that improved strategies for care may be developed. Using primary data from exhaustive national databases and both top-down and bottom-up approaches, the stroke-related costs for healthcare, nursing care and lost productivity were estimated. The total healthcare cost of stroke patients in France in 2007 was €5.3 billion, 92% of which was borne by statutory health insurance. The average cost of incident cases was €16 686 per patient in the first year, while the annual cost of prevalent cases was a little less than half that amount (€8099). Nursing care costs were estimated at €2.4 billion. Lost productivity reached €255.9 million and that income loss for stroke patients was partially compensated by €63.3 million in social benefit payments. With healthcare costs representing 3% of total health expenditure in France, stroke constitutes an ongoing burden for the health system and overall economy. Nursing care added nearly half again the amount spent on healthcare, while productivity losses were more limited because nearly 80% of acute incident strokes were in patients over age 65. The high cost of illness underscores the need for improved prevention and interventions to limit the disabling effects of stroke. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

  17. Role of prediabetes in stroke

    Directory of Open Access Journals (Sweden)

    Mijajlović MD

    2017-02-01

    Full Text Available Milija D Mijajlović,1,* Vuk M Aleksić,2,* Nadežda M Šternić,1 Mihailo M Mirković,3 Natan M Bornstein4,5 1Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, 2Department of Neurosurgery, Clinical Hospital Center Zemun, Belgrade, 3Department of Neurology, General Hospital Valjevo, Valjevo, Serbia; 4Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, 5Shaare Zedek Medical Center, Jerusalem, Israel *These authors contributed equally to this work Abstract: Stroke is one of the leading causes of death and probably the greatest cause of adult disability worldwide. Diabetes mellitus (DM is a state of accelerated aging of blood vessels. Patients with diabetes have increased risk of stroke. Hyperglycemia represents a risk factor for poor outcome following stroke, and probably is just a marker of poor outcome rather than a cause. Lowering of blood glucose levels has not been shown to improve prognosis. Also, prevention of stroke risk among patients with DM is not improved with therapy for reduction of glucose levels. On the other hand, prediabetes, a metabolic state between normal glucose metabolism and diabetes, is a risk factor for the development of DM type 2 and subsequently for stroke. Several methods are known to identify prediabetes patients, including fasting plasma glucose levels, 2-hour post load glucose levels, and glycosylated hemoglobin levels. In this text, we tried to summarize known data about diagnosis, epidemiology, risk factors, pathophysiology, and prevention of prediabetes in relation to DM and stroke. Keywords: diabetes mellitus, insulin, metabolic syndrome, prediabetes, risk factors, stroke

  18. Stroke in Southern Europe: A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Angelo V. Vasiliadis

    2013-01-01

    Full Text Available Background: Stroke is a leading cause of death and acquired disability worldwide. In Europe, strokes account for almost 1.1 million death per year. In particular, countries in Southern Europe constitute populations with a different lifestyle and dietary habits from those in Northern Europe and that may influence stroke incidence, type and risk factors.Aim: The objective of this study was to review and summarise the trends of the incidence of stroke in Southern Europe, as well as,to mention stroke subtypes and recognise the risk factors for stroke.Methods: A systematic review in PubMed was conducted.Results: Therefore, twenty-three articles, representing seven countries, related to incidence, type and risk factors of stroke in this specific geographical area of Europe were identified. The annual stroke incidence varied from approximately 1.41 to 3.73 per 1000 population per year. Currently, in all the countries studied, ischemic stroke was the commonest stroke type in all series. Hypertension remains the main risk factor for both ischemic andhemorrhagic strokes, followed by diabetes mellitus, hyperlipidemia and other factors.Conclusions: A wide range of stroke incidence may be due to the different lifestyle and behavioural factors among countries. Further research that uses the best possible methods to study the incidence, type and risk factors of stroke are urgently needed in Balkan Peninsula.

  19. Large Animal Stroke Models vs. Rodent Stroke Models, Pros and Cons, and Combination?

    Science.gov (United States)

    Cai, Bin; Wang, Ning

    2016-01-01

    Stroke is a leading cause of serious long-term disability worldwide and the second leading cause of death in many countries. Long-time attempts to salvage dying neurons via various neuroprotective agents have failed in stroke translational research, owing in part to the huge gap between animal stroke models and stroke patients, which also suggests that rodent models have limited predictive value and that alternate large animal models are likely to become important in future translational research. The genetic background, physiological characteristics, behavioral characteristics, and brain structure of large animals, especially nonhuman primates, are analogous to humans, and resemble humans in stroke. Moreover, relatively new regional imaging techniques, measurements of regional cerebral blood flow, and sophisticated physiological monitoring can be more easily performed on the same animal at multiple time points. As a result, we can use large animal stroke models to decrease the gap and promote translation of basic science stroke research. At the same time, we should not neglect the disadvantages of the large animal stroke model such as the significant expense and ethical considerations, which can be overcome by rodent models. Rodents should be selected as stroke models for initial testing and primates or cats are desirable as a second species, which was recommended by the Stroke Therapy Academic Industry Roundtable (STAIR) group in 2009.

  20. 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...

  1. Pilot study of antibodies against varicella zoster virus and human immunodeficiency virus in relation to the risk of developing stroke, nested within a rural cohort in Uganda.

    Science.gov (United States)

    Asiki, Gershim; Stockdale, Lisa; Kasamba, Ivan; Vudriko, Tobias; Tumwekwase, Grace; Johnston, Tom; Kaleebu, Pontiano; Kamali, Anatoli; Seeley, Janet; Newton, Robert

    2015-10-01

    The risk of stroke rises after episodes of herpes zoster and chickenpox, which are caused by varicella zoster virus (VZV). We conducted a pilot case-control study of stroke, nested within a long-standing cohort in Uganda (the General Population Cohort), to examine antibodies against VZV prior to diagnosis. We used stored sera to examine the evolution of IgG and IgM antibodies against VZV among 31 clinically confirmed cases of stroke and 132 matched controls. For each participant, three samples of sera were identified: one each, taken at or near the time of (pseudo)diagnosis, between 5 and 10 years prior to diagnosis and at 15 years prior to diagnosis. All participants had detectable antibodies against VZV, but there were no significant differences between cases and controls in the 15 years prior to diagnosis. As a secondary finding, 16% (5/31) of cases and 6% (8/132) of controls had HIV (OR 3.0; 95% CI 0.8-10.1; P = 0.06). This is the first prospective study to examine a biological measure of exposure to VZV prior to diagnosis of stroke and although we identified no significant association, in this small pilot, with limited characterisation of cases, we cannot exclude the possibility that the virus is causal for a subset. The impact of HIV on risk of stroke has not been well characterised and warrants further study. © 2015 John Wiley & Sons Ltd.

  2. Epidemiology and clinical presentation of stroke in Upper Egypt (desert area

    Directory of Open Access Journals (Sweden)

    El Tallawy HN

    2015-08-01

    Full Text Available Hamdy N El Tallawy,1 Wafaa M Farghaly,1 Reda Badry,1 Nermin A Hamdy,2 Ghaydaa A Shehata,1 Tarek A Rageh,1 Nabil A Metwally,3 Enas M Hassan,2 Sayed S Elsayed,2 Mohamed A Yehia,2 Wael T Soliman2 1Department of Neurology and Psychiatry, Assiut University, Assiut, 2Department of Neurology, El Minia University, El-Minia City, 3Department of Neurology, Al-Azhar University (Assuit Branch, Assiut, Egypt Background: Stroke is a common cause of morbidity and mortality worldwide. Four out of five strokes occur in the low- and middle-income countries. This study aims to find lifetime prevalence of stroke in Upper Egypt and to identify clinical presentations and possible risk factors of stroke in this population.Methods: This is a door-to-door (every door study conducted on all inhabitants in Al Kharga district (representative of western desert and Al Quseir city (representative of eastern desert. The study was conducted in two stages, and every stage consisted of three phases (screening, diagnostic, and investigatory.Results: The total lifetime prevalence of stroke was 8.5/1,000 in the population aged 20 years and more. It increased with advancing age and was higher among males than females among all age groups except in the childbearing period (20 years to <40 years of age. Lifetime prevalence of ischemic stroke (7.2/1,000 was higher than hemorrhagic stroke (1.1/1,000. Hemiparesis and hemiplegia were the commonest presentation of stroke. Headache, vomiting, and vertigo were found to be significantly more common accompaniments of hemorrhagic stroke. The most common risk factor was hypertension, followed by hyperlipidemia and diabetes mellitus.Conclusion: The total lifetime prevalence of stroke in the population aged 20 years and more in Upper Egypt (desert area lies within the range that is recorded in developing countries. Clinical presentation and risk factors are similar to those recorded from developing and developed countries. Keywords: stroke

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

    DEFF Research Database (Denmark)

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

    2004-01-01

    stroke onset. By way of multiple logistic regression and survival analyses very old age was independently related to short- and long-term mortality and nursing home placement independent of other clinical characteristics. RESULTS: 16% of patients were 85 years or older at the time of stroke onset. More...... stroke very old age predicted mortality or nursing home placement (OR 3.9; 95% CI 2.1-7.3), and long-term mortality (HR 2.0; 95% CI 1.6-2.5). However, other factors such as onset stroke severity, pre-existing disability and atrial fibrillation were also significant independent predictors of prognosis......BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age...

  4. Test Your Stroke Knowledge

    Science.gov (United States)

    ... 9-1-1. Which of the following are risk factors for stroke? High blood pressure Heart disease Smoking High cholesterol Diabetes Show Answer All of these are risk factors for stroke. If you smoke - quit. If you have high ...

  5. Heart and Stroke Encyclopedia

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a brief ... of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. A ...

  6. Stroke Connection Magazine

    Science.gov (United States)

    ... Resources Submit A Story Edit Module Show Tags Stroke Rehabilitation Two-Part Series Making the Best Decisions at ... first part of a two-part series on stroke rehab, we offer guidance for the decision-making process ...

  7. Stroke (For Kids)

    Science.gov (United States)

    ... your friend. Being around friends can help with healing. Preventing Strokes Some strokes can be prevented in ... Why Does Hair Turn Gray? What Are Wrinkles? Alzheimer Disease Your Brain & Nervous System Why Exercise Is ...

  8. Stroke Trials Registry

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  9. Time course and risk factors of post-stroke fatigue: a prospective cohort study

    NARCIS (Netherlands)

    Snaphaan, L.; van der Werf, S.; de Leeuw, F.-E.

    2011-01-01

    Background: Post-stroke fatigue (PSF) often occurs after stroke and has a negative impact on the rehabilitation process. Several studies focused either on short- or on long-term PSF and their relations with stroke characteristics. However, possible pre-stroke risk factors such as history of

  10. Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital

    Science.gov (United States)

    Zaky, Hend Elham Mohamed; EL-Lateef Mohammad, Zienab Abd; EL-Labban, Abdou Saad Taha; Ahmed, Gahen

    2015-01-01

    Background: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of…

  11. Combined Electrical Stimulation and Exercise for Swallow Rehabilitation Post-Stroke: A Pilot Randomized Control Trial

    Science.gov (United States)

    Sproson, Lise; Pownall, Sue; Enderby, Pam; Freeman, Jenny

    2018-01-01

    Background: Dysphagia is common after stroke, affecting up to 50% of patients initially. It can lead to post-stroke pneumonia, which causes 30% of stroke-related deaths, a longer hospital stay and poorer health outcomes. Dysphagia care post-stroke generally focuses on the management of symptoms, via modified oral intake textures and adapted…

  12. Visual attention in posterior stroke

    DEFF Research Database (Denmark)

    Fabricius, Charlotte; Petersen, Anders; Iversen, Helle K

    Objective: Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere. However, attentional effects of more posterior lesions are less clear. The aim of this study was to characterize visual processing speed...... and apprehension span following posterior cerebral artery (PCA) stroke. We also relate these attentional parameters to visual word recognition, as previous studies have suggested that reduced visual speed and span may explain pure alexia. Methods: Nine patients with MR-verified focal lesions in the PCA......-territory (four left PCA; four right PCA; one bilateral, all >1 year post stroke) were compared to 25 controls using single case statistics. Visual attention was characterized by a whole report paradigm allowing for hemifield-specific speed and span measurements. We also characterized visual field defects...

  13. [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.

  14. Hemorrhagic Stroke in Children

    OpenAIRE

    Jordan M.D., Lori C.; Hillis M.D., Argye E.

    2007-01-01

    Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research ...

  15. Road traffic noise and stroke

    DEFF Research Database (Denmark)

    Sørensen, Mette; Hvidberg, Martin; Andersen, Zorana J

    2011-01-01

    Epidemiological studies suggest that long-term exposure to road traffic noise increases the risk of cardiovascular disorders. The aim of this study was to investigate the relation between exposure to road traffic noise and risk for stroke, which has not been studied before....

  16. THE RHEOLOGICAL PROPERTIES OF BLOOD IN THE MOST ACUTE STAGE OF ISCHEMIC STROKE AND THEIR RELATION TO THE SEVERITY OF NEUROLOGICAL IMPAIRMENT

    Directory of Open Access Journals (Sweden)

    M. N. Azhermacheva

    2013-01-01

    Full Text Available The study evaluated the rheological parameters of blood: blood viscosity, plasma viscosity, hematocrit, red blood cell aggregation and deformability. The severity of the patients was assessed by clinical scales:Glasgowcoma scale, the scale NIHSS, Barthel index. The study found that in the acute phase of ischemic stroke increased blood viscosity by increasing red blood cell aggregation and reduced erythrocyte deformability. The increase in the viscosity of the blood in acute ischemic stroke is accompanied by increased severity of neurological disorders.

  17. Impact of metabolic disorders on the relation between overweight/obesity and incident myocardial infarction and ischaemic stroke in fertile women

    DEFF Research Database (Denmark)

    Andersen, S S; Andersson, C; Berger, S M

    2015-01-01

    AIMS: Whether overweight is a risk factor for cardiovascular disease in the absence of metabolic disorders remains under debate and is largely unexamined in young women. We evaluated the risk of myocardial infarction and ischaemic stroke in fertile women conditional on time-dependent presence of ...... be beneficial to reduce cardiovascular disease in overweight/obese young women.......AIMS: Whether overweight is a risk factor for cardiovascular disease in the absence of metabolic disorders remains under debate and is largely unexamined in young women. We evaluated the risk of myocardial infarction and ischaemic stroke in fertile women conditional on time-dependent presence...

  18. A randomized trial of upper limb botulimun toxin versus placebo injection, combined with physiotherapy, in children with hemiplegia.

    Science.gov (United States)

    Ferrari, Adriano; Maoret, Anna Rosa; Muzzini, Simonetta; Alboresi, Silvia; Lombardi, Francesco; Sgandurra, Giuseppina; Paolicelli, Paola Bruna; Sicola, Elisa; Cioni, Giovanni

    2014-10-01

    The main goal of this study was to investigate the efficacy of Botulinum Toxin A (BoNT-A), combined with an individualized intensive physiotherapy/orthoses treatment, in improving upper limb activity and competence in daily activity in children with hemiplegia, and to compare its effectiveness with that of non-pharmacological instruments. It was a Randomized Clinical Trial of 27 children with spastic hemiplegic cerebral palsy, outpatients of two high speciality Centres for child rehabilitation. Each child was assigned by simple randomization to experimental group (BoNT-A) or control group (placebo). Assisting Hand Assessment (AHA) was chosen as primary outcome measure; other measures were selected according to ICF dimensions. Participants were assessed at baseline (T0), at T1, T2, T3 (1-3-6 months after injection, respectively). Every patient was given a specific physiotherapeutic treatment, consisting of individualized goal directed exercises, task oriented activities, daily stretching manoeuvres, functional and/or static orthoses. BoNT-A group showed a significant increase of AHA raw scores at T2, compared to control group (T2-T0: p=.025) and functional goals achievement (GAS) was also slightly better in the same group (p=.033). Other measures indicated some improvement in both groups, without significant intergroup differences. Children with intermediate severity of hand function at House scale for upper limb impairment seem to have a better benefit from BoNT-A protocol. BoNT-A was effective in improving manipulation in the activity domain, in association with individualized goal-directed physiotherapy and orthoses; the combined treatment is recommended. The study brings more evidence for the efficacy of a combined treatment botulinum toxin injection-physiotherapy-orthoses, and it gives some suggestions for candidate selection and individualized treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Alternating Hemiplegia of Childhood: Retrospective Genetic Study and Genotype-Phenotype Correlations in 187 Subjects from the US AHCF Registry.

    Directory of Open Access Journals (Sweden)

    Louis Viollet

    Full Text Available Mutations in ATP1A3 cause Alternating Hemiplegia of Childhood (AHC by disrupting function of the neuronal Na+/K+ ATPase. Published studies to date indicate 2 recurrent mutations, D801N and E815K, and a more severe phenotype in the E815K cohort. We performed mutation analysis and retrospective genotype-phenotype correlations in all eligible patients with AHC enrolled in the US AHC Foundation registry from 1997-2012. Clinical data were abstracted from standardized caregivers' questionnaires and medical records and confirmed by expert clinicians. We identified ATP1A3 mutations by Sanger and whole genome sequencing, and compared phenotypes within and between 4 groups of subjects, those with D801N, E815K, other ATP1A3 or no ATP1A3 mutations. We identified heterozygous ATP1A3 mutations in 154 of 187 (82% AHC patients. Of 34 unique mutations, 31 (91% are missense, and 16 (47% had not been previously reported. Concordant with prior studies, more than 2/3 of all mutations are clusteredin exons 17 and 18. Of 143 simplex occurrences, 58 had D801N (40%, 38 had E815K(26% and 11 had G947R (8% mutations [corrected].Patients with an E815K mutation demonstrate an earlier age of onset, more severe motor impairment and a higher prevalence of status epilepticus. This study further expands the number and spectrum of ATP1A3 mutations associated with AHC and confirms a more deleterious effect of the E815K mutation on selected neurologic outcomes. However, the complexity of the disorder and the extensive phenotypic variability among subgroups merits caution and emphasizes the need for further studies.

  20. Atrial fibrillation and risk of stroke

    DEFF Research Database (Denmark)

    Christiansen, Christine Benn; Gerds, Thomas A.; Olesen, Jonas Bjerring

    2016-01-01

    AIM: Although the relation between stroke risk factors and stroke in patients with atrial fibrillation (AF) has been extensively examined, only few studies have explored the association of AF and the risk of ischaemic stroke/systemic thromboembolism/transient ischaemic attack (stroke....../TE/TIA) in the presence of concomitant stroke risk factors. METHODS AND RESULTS: From nationwide registries, all persons who turned 50, 60, 70, or 80 from 1997 to 2011 were identified. Persons receiving warfarin were excluded. The absolute risk of stroke/TE/TIA was reported for a 5-year period, as was the absolute risk...... ratios for AF vs. no AF according to prior stroke and the number of additional risk factors. The study cohort comprised of 3 076 355 persons without AF and 48 189 with AF. For men aged 50 years, with no risk factors, the 5-year risk of stroke was 1.1% (95% confidence interval 1.1-1.1); with AF alone 2...

  1. Stroke Prevention: Managing Modifiable Risk Factors

    Directory of Open Access Journals (Sweden)

    Silvia Di Legge

    2012-01-01

    Full Text Available Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEIs and angiotensin II receptor blockers (ARBs are indicated in stroke prevention because they also promote vascular health. Effective secondary-prevention strategies for selected patients include carotid revascularization for high-grade carotid stenosis and vitamin K antagonist treatment for atrial fibrillation. The results of recent clinical trials investigating new anticoagulants (factor Xa inhibitors and direct thrombin inhibitors clearly indicate alternative strategies in stroke prevention for patients with atrial fibrillation. This paper describes the current landscape and developments in stroke prevention with special reference to medical treatment in secondary prevention of ischemic stroke.

  2. The role of hydrogen sulfide in stroke

    Directory of Open Access Journals (Sweden)

    Yang Dou

    2016-01-01

    Full Text Available Stroke is a kind of acute cerebrovascular disease characterized by the focal lack of neurological function, including ischemic stroke and hemorrhagic stroke. As society ages rapidly, stroke has become the second leading cause of disability and death, and also become the main threat to human health and life. In recent years, findings from increasing animal and clinical trials have supplied scientific evidences for the treatment of stroke. Hydrogen sulfide (H 2 S, which has always been seen as a toxic gas, now has been thought to be the third gaseous signaling molecule following nitric oxide and carbon monoxide. Accumulating evidences indicate that H 2 S plays an important role in stroke. Given that its neuroprotective effect is dose-dependent, only when its concentration is relatively low, H 2 S can yield the neuroprotection, while high dose may lead to neurotoxicity. All these study results suggest that H 2 S may offer a new promising application for the therapy of stroke. Here, our review will present the role of H 2 S in stroke from its mechanism to animal and clinical studies.

  3. National data on stroke outcomes in Thailand.

    Science.gov (United States)

    Kongbunkiat, Kannikar; Kasemsap, Narongrit; Thepsuthammarat, Kaewjai; Tiamkao, Somsak; Sawanyawisuth, Kittisak

    2015-03-01

    Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼$USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. The European Stroke Organisation Guidelines: a standard operating procedure.

    Science.gov (United States)

    Ntaios, George; Bornstein, Natan M; Caso, Valeria; Christensen, Hanne; De Keyser, Jacques; Diener, Hans-Christoph; Diez-Tejedor, Exuperio; Ferro, Jose M; Ford, Gary A; Grau, Armin; Keller, Emanuella; Leys, Didier; Russell, David; Toni, Danilo; Turc, Guillaume; Van der Worp, Bart; Wahlgren, Nils; Steiner, Thorsten

    2015-10-01

    In 2008, the recently founded European Stroke Organisation published its guidelines for the management of ischemic stroke and transient ischemic attack. This highly cited document was translated in several languages and was updated in 2009. Since then, the European Stroke Organisation has published guidelines for the management of intracranial aneurysms and subarachnoidal hemorrhage, for the establishment of stroke units and stroke centers, and recently for the management of intracerebral hemorrhage. In recent years, the methodology for the development of guidelines has evolved significantly. To keep pace with this progress and driven by the strong determination of the European Stroke Organisation to further promote stroke management, education, and research, the European Stroke Organisation decided to delineate a detailed standard operating procedure for its guidelines. There are two important cornerstones in this standard operating procedure: The first is the implementation of the Grading of Recommendations Assessment, Development, and Evaluation methodology for the development of its Guideline Documents. The second one is the decision of the European Stroke Organisation to move from the classical model of a single Guideline Document about a major topic (e.g. management of ischemic stroke) to focused modules (i.e. subdivisions of a major topic). This will enable the European Stroke Organisation to react faster when new developments in a specific stroke field occur and update its recommendations on the related module rather swiftly; with the previous approach of a single large Guideline Document, its entire revision had to be completed before an updated publication, delaying the production of up-to-date guidelines. After discussion within the European Stroke Organisation Guidelines Committee and significant input from European Stroke Organisation members as well as methodologists and analysts, this document presents the official standard operating procedure for

  5. Racial Differences by Ischemic Stroke Subtype: A Comprehensive Diagnostic Approach

    Directory of Open Access Journals (Sweden)

    Sarah Song

    2012-01-01

    Full Text Available Background. Previous studies have suggested that black populations have more small-vessel and fewer cardioembolic strokes. We sought to analyze racial differences in ischemic stroke subtype employing a comprehensive diagnostic workup with magnetic resonance-imaging-(MRI- based evaluation including diffusion-weighted imaging (DWI. Methods. 350 acute ischemic stroke patients admitted to an urban hospital with standardized comprehensive diagnostic evaluations were retrospectively analyzed. Ischemic stroke subtype was determined by three Trial of Org 10172 in Acute Stroke Treatment (TOAST classification systems. Results. We found similar proportions of cardioembolic and lacunar strokes in the black and white cohort. The only subtype category with a significant difference by race was “stroke of other etiology,” more common in whites. Black stroke patients were more likely to have an incomplete evaluation, but this did not reach significance. Conclusions. We found similar proportions by race of cardioembolic and lacunar strokes when employing a full diagnostic evaluation including DWI MRI. The relatively high rate of cardioembolism may have been underappreciated in black stroke patients when employing a CT approach to stroke subtype diagnosis. Further research is required to better understand the racial differences in frequency of “stroke of other etiology” and explore disparities in the extent of diagnostic evaluations.

  6. Stroke after coronary artery bypass grafting. Is there place for a stroke-risk stratification model?

    NARCIS (Netherlands)

    Noyez, L.; Swieten, H.A. van

    2009-01-01

    AIM: Preoperative carotid screening is common in the prevention of perioperative stroke. The authors describe our experience with selective screening of patients with a recent (<1 year) neurological event. Because many variables are related with the development of perioperative stroke we

  7. Recovery of Gait After Stroke: What Changes?

    NARCIS (Netherlands)

    Buurke, Jaap; Nene, A.V.; Kwakkel, Gert; Erren-Wolters, Victorien; IJzerman, Maarten Joost; Hermens, Hermanus J.

    2008-01-01

    Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles

  8. Recovery of gait after stroke: what changes?

    NARCIS (Netherlands)

    Buurke, J.H.; Nene, A.V.; Kwakkel, G.; Erren-Wolters, V.; IJzerman, M.J.; Hermens, H.J.

    2008-01-01

    Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective. The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles

  9. Recovery of gait after stroke: what changes?

    NARCIS (Netherlands)

    Buurke, Jaap; Nene, A.V.; Kwakkel, G.; Erren-Wolters, V.; IJzerman, Maarten Joost; Hermens, Hermanus J.

    2008-01-01

    Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles

  10. Beneficial falls in stroke patients: evaluation using a mixed method design.

    Science.gov (United States)

    Watabe, Takayuki; Suzuki, Hisayoshi; Konuki, Yusuke; Aoki, Keiichiro; Nagashima, Jun; Sako, Rikitaro

    2018-03-01

    Purpose To use a mixed method design to evaluate how clinicians judge falls in stroke patients as a beneficial event, and to identify patient-specific characteristics associated with beneficial falls. Methods The definition of beneficial falls was based on interviews with six experienced clinicians in stroke rehabilitation. Interview data were analyzed using the grounded theory approach, with outcomes used to develop a checklist to judge falls as beneficial. We subsequently used the checklist to identify falls sustained by patients in our rehabilitation unit as beneficial events. The characteristics of beneficial fallers were investigated in this retrospective study. Results According to experienced clinicians, beneficial falls result from patient-specific factors and level of independence. Beneficial falls are not associated with after-effects or a diagnosis of cognitive impairment, do not result in physical injury and post-fall syndrome, and do not alter the course of rehabilitation. These falls are considered to enhance patients' self-awareness of their physical status and abilities. Among the 123 stroke patients who experienced a fall in our study group, 23 patients (18.7%) were identified as beneficial fallers according to