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Sample records for stroke treatment toast

  1. Relationship between serum high-sensitivity C-reactive protein and modified TOAST classification as well as OCSP subtypes in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Hua-jun CHANG

    2014-10-01

    Full Text Available This paper aims to investigate the relationship between serum high-sensitivity C-reactive protein (hs-CRP level and modified TOAST classification as well as OCSP subtypes in patients with acute ischemic stroke. Serum hs-CRP was measured in 240 patients with acute ischemic stroke and 120 normal controls. All patients were classified according to modified TOAST classification and OCSP criteria. Serum hs-CRP levels in acute ischemic stroke group were significantly higher than those in normal control group [(13.68 ± 6.92 mg/L vs (3.98 ± 0.76 mg/L; t = 6.922, P = 0.002]. Among modified TOAST subtypes, the highest serum hs-CRP level was in cardioembolism (CE group [(16.82 ± 6.16 mg/L], followed by arterothrombosis (AT group [(15.17 ± 5.68 mg/L], stroke of undetermined etiology (SUD group [(10.06 ± 3.89 mg/L] and small artery disease (SAD group [(9.86 ± 3.75 mg/L, P = 0.027]. Among OCSP subtypes, the highest serum hs-CRP level was in total anterior circulation infarct (TACI group [(17.02 ± 6.98 mg/L], followed by posterior circulation infarct (POCI group [(15.91 ± 7.12 mg/L], partial anterior circulation infarct (PACI group [(12.83 ± 4.95 mg/L] and lacunar infarct (LACI group [(10.61 ± 5.73 mg/L, P = 0.005]. Serum hs-CRP levels are various in different modified TOAST and OCSP subtypes, which may reflect etiological and pathophysiological diversity of acute ischemic stroke, guide clinical treatment and help to predict prognosis. doi: 10.3969/j.issn.1672-6731.2014.10.013

  2. 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 ...

  3. Effect of Dry Heat Pre-Treatment (Toasting) on the Cooking Time of ...

    African Journals Online (AJOL)

    The cooking time for IAR48 and IT89KD-288 cowpea varieties increased from 104.67 to 106.00 and 88.00 to 88.67 min, respectively. The results indicate that the cooking time of cowpea seeds can be reduced significantly on toasting, while maintaining their potential as functional agents in the food industry for nutrition and ...

  4. Effects of toasting procedures on the levels of polycyclic aromatic hydrocarbons in toasted bread.

    Science.gov (United States)

    Rey-Salgueiro, Ledicia; García-Falcón, Mercedes Sonia; Martínez-Carballo, Elena; Simal-Gándara, Jesús

    2008-05-15

    Some polycyclic aromatic hydrocarbons (PAHs), particularly those with a high molecular weight, have been classified as probably carcinogens to humans by the International Agency for Research on Cancer (IARC). The significance of the determination of PAHs is reflected by the special attention of the European Union, which is paying to regulate the maximum allowed levels of PAHs in foodstuffs such as smoked foods. Like other thermally processed foodstuffs, toasted bread can contain these carcinogenic chemicals, not only due to a contamination at source but also during toasting. In order to check PAHs generated from toasting in sandwich bread, several treatment conditions were evaluated: direct toasting (flame-toasting, coal-grilling or gas oven-toasting) or indirect toasting (electric oven-toasting). PAHs were extracted by solid-liquid extraction (SLE) and determined by liquid chromatography with fluorescence detection (LC-FD). Based on the results, the used toasted technique would strongly affect in PAH levels in the final product. No samples obtained by electric oven and toaster were polluted; otherwise the samples toasted by charcoal and flame grilling presented very important levels. Up to 350μg/kg of total PAHs were detected in toasted samples by wood flame. Differences between different ways of toasting could be ascribed to deposition of PAHs from smoke. Finally, several commercial toasted samples of bread were tested to determine PAHs. Overall, the PAH levels were very low. Benzo[a]pyrene ranged from no detectable to 0.23μg/kg. Copyright © 2007 Elsevier Ltd. All rights reserved.

  5. Association between Interleukin-1 Gene Single Nucleotide Polymorphisms and Ischemic Stroke Classified by TOAST Criteria in the Han Population of Northern China

    Directory of Open Access Journals (Sweden)

    Zheng Zhang

    2013-01-01

    Full Text Available Increasing evidence suggests that IL-1β (C-511T and IL-1α (C-889T genes polymorphisms are associated with the susceptibility to cardiocerebral vascular disease. In this paper, we investigated the relationships between these polymorphisms and the risk of ischemic stroke (IS classified by TOAST criteria in the north Chinese Han population. 440 cases of IS and 486 age- and gender-matched controls of Chinese Han population were enrolled. Association study showed that the TT genotype and T allele of IL-1α-889 C/T were significantly associated with IS of a large artery atherosclerosis (LAA (TT: OR = 2.01, 95% CI = 1.34–3.0, and P<0.001; T: OR = 1.44, 95% CI = 1.18–1.78, and P=0.001. However, there was no significant difference in the distribution of IL-1α-889 C/T genotypes and allele frequencies between the two subgroups (small-artery occlusion (SVD and cardioembolism (CE of IS and control groups. No significant association was also found between the IL-1β-511 TT genotype and T allele (TT: OR = 0.79, 95% CI = 0.56–1.11, and P=0.175; T: OR = 0.83, 95% CI = 0.68–1.01, and P=0.066 and IS as well as subgroups of CE and SVD. Our results implicated that IL-1α-889 C/T gene polymorphism might be associated with the susceptibility to IS, especially to IS with LAA, in a north Chinese Han population.

  6. Pathological Sub-Types, Risk Factors And Outcome Of Stroke At The ...

    African Journals Online (AJOL)

    Seventy five patients (93.8%) were discharged and four (5%) died in hospital. All patients who died had anterior circulation ischaemic stroke as per Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Conclusion: Ischaemic stroke is the most common pathological sub-type observed in this study.

  7. Basics of acute stroke treatment

    International Nuclear Information System (INIS)

    Haass, A.

    2005-01-01

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

  8. The PRE-hospital Stroke Treatment Organization.

    Science.gov (United States)

    Audebert, Heinrich; Fassbender, Klaus; Hussain, M Shazam; Ebinger, Martin; Turc, Guillaume; Uchino, Ken; Davis, Stephen; Alexandrov, Anne; Grotta, James

    2017-12-01

    Background The PRE-hospital Stroke Treatment Organization was formed in 2016 as an international consortium of medical practitioners involved in pre-hospital treatment of patients with acute stroke. Aims PRE-hospital Stroke Treatment Organization's mission is to improve stroke outcomes by supporting research and advocacy for pre-hospital stroke treatment in Mobile Stroke Units. PRE-hospital Stroke Treatment Organization will provide a platform to enhance collaborative research across the spectrum of acute stroke management in the pre-hospital setting. PRE-hospital Stroke Treatment Organization will also facilitate the appropriate proliferation and distribution of Mobile Stroke Units by providing a forum for professional communication, resource for public education, and stimulus for government, industry, and philanthropic support. Summary of review In this "white paper", we describe the evidence supporting pre-hospital stroke treatment, progress to date, practical issues such as application in various environments and staffing, planned research initiatives, and organizational structure. Conclusions PRE-hospital Stroke Treatment Organization is not-for-profit, with membership open to anyone involved (or hoping to become involved) in pre-hospital stroke care. PRE-hospital Stroke Treatment Organization has a Steering Committee comprised of members from Europe, U.S., Canada, Australia, and other regions having a Mobile Stroke Unit in operation. PRE-hospital Stroke Treatment Organization convenes satellite meetings for membership at the International Stroke Conference and European Stroke Congress each year to address the PRE-hospital Stroke Treatment Organization mission. The first research collaborations agreed upon are to: (1) develop a list of common data elements to be collected by all Mobile Stroke Unit programs and entered into a common research database, and (2) develop a protocol for investigating the natural history of hyper-acute Intracerebral Hemorrhage.

  9. Effect of Varying Toasting Time of Soybean Meal on Organ and ...

    African Journals Online (AJOL)

    Ninety Anak broiler chicks were used at four weeks of age in a 28 day feeding trial to assess the effect of toasting time of soybean on organ and carcass characteristics of finisher broiler birds. The birds were assigned to five dietary treatments containing raw soybean as control and full fat soybean toasted for 5, 10, 15 and 20 ...

  10. Effect of toasting field beans and of grass-clover

    DEFF Research Database (Denmark)

    Mogensen, Lisbeth; Vestergaard, Jannie Steensig; Fretté, Xavier

    2010-01-01

    The effect of toasting field beans and of grass-clover: maize silage ratio on milk production, milk composition and the sensory quality of the milk was investigated in a 2   2 factorial experiment. Toasting of field beans resulted in lower milk contents of both fat (44.2 versus 46.1 g/kg, P = 0......-β-carotene (P = 0.04) and β-carotene (P = 0.05). Toasting of field beans compared with untreated field beans did not affect the milk content of carotenoids and had only small effects on fatty acid composition. Regarding the sensory quality, the four treatments resulted in milk being characterized...... by a distinctly fatty mouthfeel and creamy flavour and a pronounced sugar-sweet taste and creamy odour. The higher proportions of maize in the feed resulted, in general, in milk characterized by a significantly more intense maize odour (P 

  11. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

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

    2017-10-23

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

  12. TOASTing Your Images With Montage

    Science.gov (United States)

    Berriman, G. Bruce; Good, John

    2017-01-01

    The Montage image mosaic engine is a scalable toolkit for creating science-grade mosaics of FITS files, according to the user's specifications of coordinates, projection, sampling, and image rotation. It is written in ANSI-C and runs on all common *nix-based platforms. The code is freely available and is released with a BSD 3-clause license. Version 5 is a major upgrade to Montage, and provides support for creating images that can be consumed by the World Wide Telescope (WWT). Montage treats the TOAST sky tessellation scheme, used by the WWT, as a spherical projection like those in the WCStools library. Thus images in any projection can be converted to the TOAST projection by Montage’s reprojection services. These reprojections can be performed at scale on high-performance platforms and on desktops. WWT consumes PNG or JPEG files, organized according to WWT’s tiling and naming scheme. Montage therefore provides a set of dedicated modules to create the required files from FITS images that contain the TOAST projection. There are two other major features of Version 5. It supports processing of HEALPix files to any projection in the WCS tools library. And it can be built as a library that can be called from other languages, primarily Python. http://montage.ipac.caltech.edu.GitHub download page: https://github.com/Caltech-IPAC/Montage.ASCL record: ascl:1010.036. DOI: dx.doi.org/10.5281/zenodo.49418 Montage is funded by the National Science Foundation under Grant Number ACI-1440620,

  13. Endovascular stroke treatment in a small-volume stroke center.

    Science.gov (United States)

    Behzadi, Gry N; Fjetland, Lars; Advani, Rajiv; Kurz, Martin W; Kurz, Kathinka D

    2017-04-01

    Our purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers. A total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH). Mean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT. The use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.

  14. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins

    2012-11-01

    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.

  15. Feeding toasted field beans to dairy cows

    OpenAIRE

    Jørgensen, K.F.; Kjeldsen, A.M.; Askegaard, M.

    2013-01-01

    Toasting field beans can improve the protein quality of field beans markedly. In the feed demonstrations carried out in Project EcoProtein testing a new method of toasting with a drum dryer, showed, however, only reduced effect on the protein quality due to a lower than optimal temperature. The toasted field beans were fed in two organic dairy herds, replacing a part of the concentrates in the ration in a cross-over design. Preliminary results showed no milk yield difference in herd 1, but a ...

  16. Feasibility of progesterone treatment for ischaemic stroke.

    Science.gov (United States)

    Gibson, Claire L; Bath, Philip M

    2016-03-01

    Two multi-centre phase III clinical trials examining the protective potential of progesterone following traumatic brain injury have recently failed to demonstrate any improvement in outcome. Thus, it is timely to consider how this impacts on the translational potential of progesterone treatment for ischaemic stroke. A wealth of experimental evidence supports the neuroprotective properties of progesterone, and associated metabolites, following various types of central nervous system injury. In particular, for ischaemic stroke, studies have also begun to reveal possible mechanisms of such neuroprotection. However, the results in traumatic brain injury now question whether further clinical development of progesterone for ischaemic stroke is relevant. © The Author(s) 2015.

  17. Hypothermia for treatment of stroke

    Directory of Open Access Journals (Sweden)

    Jong Youl Kim

    2015-01-01

    Full Text Available Stroke is a major cause of neurological disability and death in industrialized nations. Therapeutic hypothermia has been shown to protect the brain from ischemia, stroke, and other acute neurological insults at the laboratory level. It has been shown to improve neurological outcome in certain clinical settings including anoxic brain injury due to cardiac arrest and hypoxic-ischemic neonatal encephalopathy. Hypothermia seems to affect multiple aspects of brain physiology and it is likely that multiple mechanisms underlie its protective effect. Understanding the events that occur in the ischemic brain during hypothermia might help lead to an understanding of how to protect the brain against acute injuries.

  18. Spasticity after stroke: Physiology, assessment and treatment

    OpenAIRE

    Thibaut, Aurore; Chatelle, Camille; Ziegler, Erik; Bruno, Marie-Aurelie; Laureys, Steven; Gosseries, Olivia

    2013-01-01

    Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. This review aims to define spasticity, describe hypotheses explaining its development after a stroke, give an overview of related neuroimaging studies as well as a description of the most common scales used to quantify the degree of spasticity and finally explore which treatments are currently being used to treat this disorder. The lack of consensus is high...

  19. [Acute surgical treatment of malignant stroke].

    Science.gov (United States)

    Lilja-Cyron, Alexander; Eskesen, Vagn; Hansen, Klaus; Kondziella, Daniel; Kelsen, Jesper

    2016-10-24

    Malignant stroke is an intracranial herniation syndrome caused by cerebral oedema after a large hemispheric or cerebellar stroke. Malignant middle cerebral artery infarction is a devastating disease with a mortality around 80% despite intensive medical treatment. Decompressive craniectomy reduces mortality and improves functional outcome - especially in younger patients (age ≤ 60 years). Decompression of the posterior fossa is a life-saving procedure in patients with malignant cerebellar infarctions and often leads to good neurological outcome.

  20. Intensive Treatment of Dysarthria Secondary to Stroke

    Science.gov (United States)

    Mahler, Leslie A.; Ramig, Lorraine O.

    2012-01-01

    This study investigated the impact of a well-defined behavioral dysarthria treatment on acoustic and perceptual measures of speech in four adults with dysarthria secondary to stroke. A single-subject A-B-A experimental design was used to measure the effects of the Lee Silverman Voice Treatment (LSVT[R]LOUD) on the speech of individual…

  1. 21 CFR 573.310 - Crambe meal, heat toasted.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Crambe meal, heat toasted. 573.310 Section 573.310... Additive Listing § 573.310 Crambe meal, heat toasted. (a) The additive is the seed meal of Crambe... solvent extraction or by solvent extraction alone. The resulting seed meal is heat toasted. (b) The...

  2. Toast: The power system operators assistant

    Energy Technology Data Exchange (ETDEWEB)

    Talukdar, S.N.; Cardozo, E.; Leao, L.

    1986-07-01

    The environments in which power system operators work are becoming more complex. New constraints are appearing, old constraints are tightening, and the number of decision variables is increasing. To cope with these trends, operators need intelligent assistants to help manage information and lighten their decision-making burdens. Such assistants can be divided into two types: Phase-1 assistants for off-line uses and Phase-2 assistants for on-line uses and Phase-2 assistants for on-line, real-time uses. Toast is an evolving Phase-1 assistant. Of the nine possible functions of an assistant, Toast has immediate potential in two-diagnosis and criticism. Its diagnostic knowledge, though hardly complete, is extensive enough to be useful to human operators. In contrast, its abilities to critique proposed courses of action are much less developed and, as yet, consist only of facilities to simulate some of the these courses of action. Toast has been written in Cops, a programming environment that allows for distributed processing and has a readily extensible library of both symbolic and numerical programs. These features should make the task of expanding Toast relatively painless. Of the many directions in which expansions could occur, we plan on adding diagnostic capabilities in the area of power system security. This area was identified in a study as the most worthy of development.

  3. Neurodevelopmental treatment after stroke : a comparative study

    NARCIS (Netherlands)

    Dr. T.B. Hafsteinsdóttir; A Algra; M.H.F. Grypdonck; L.J. Kappelle

    2005-01-01

    Background: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. Objective: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients

  4. 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

  5. Antioxidant activity of polyphenols from green and toasted mate tea.

    Science.gov (United States)

    Coentrão, Patricia de Abreu Marques; Teixeira, Valéria Laneuville; Netto, Annibal Duarte Pereira

    2011-05-01

    The production and distribution of toasted mate tea in Brazil has increased, which has resulted in its greater consumption. Mate tea is obtained by roasting non-fermented erva-mate in order to produce toasted erva-mate or toasted mate tea. However, although the product is much appreciated, studies of its chemical composition and the concentration of polyphenols, particularly flavonols present in toasted mate tea, are few and often controversial. This paper elucidates some misunderstandings involving the nomenclature of erva-mate and toasted mate, and mainly provides an overview of the composition of polyphenols and antioxidant capacity of toasted mate tea and its raw material, erva-mate, in comparison with other teas, the compositions of which were found in the literature.

  6. Thrombolytic treatment for stroke in the Scandinavian countries

    DEFF Research Database (Denmark)

    Slot, K.B.; Murray, V.; Boysen, G.

    2009-01-01

    Objective - We wanted to describe the use of thrombolytic treatment for stroke in Scandinavia, to assess stroke doctors' opinions on this treatment, to identify barriers against treatment, and to suggest improvements to overcome these barriers. Methods - We sent questionnaires to 493 Scandinavian...... treatment for stroke as beneficial, yet its implementation in clinical practice has so far been poor. Our survey identified important barriers and potential measures that could increase its future use Udgivelsesdato: 2009/10...

  7. 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 ...

  8. Who benefits from treatment and rehabilitation in a stroke Unit?

    DEFF Research Database (Denmark)

    Jorgensen, H S; Kammersgaard, L P; Houth, J

    2000-01-01

    The beneficial effects of treatment and rehabilitation of patients with acute stroke in a dedicated stroke unit (SU) are well established. We wanted to examine if these effects are limited to certain groups of patients or if they apply to all patients independent of age, sex, comorbidity......, and initial stroke severity....

  9. Effect of extrusion, espansion and toasting on the nutritional value of peas, faba beans and lupins

    Directory of Open Access Journals (Sweden)

    Filippo Rossi

    2010-01-01

    Full Text Available An assessment was made of the effect that different treatments (toasting, expansion, extrusion have on the nutritionalvalue of protein plants (pea, faba bean, lupin. In a randomized block design, feeds were screened for enzymaticdigestibility of starch and protein, N solubility and in vitro protein degradability. Expansion and extrusion cause increasedstarch enzymatic degradability while toasting produced virtually no effects. In peas this value increased from 11.80% inmeal to 39.70% in the extruded product; 85.37% is the percentage for the expanded product, while 10.90% is the starchdigestibility value for toasted peas. In faba beans the extrusion process increased starch digestibility from 11.39% to85.05%, while in extruded lupins a complete starch hydrolysis was obtained, while in the meal the polysaccharide digestionwas 54.48%.The expansion and extrusion processes significantly decreased rumen degradability during the first 8 hours of incubation.Toasted peas had lower degradability if compared with controls but not with the other treatments. The onlypotentially alternative source to soybean is the extruded faba bean. In spite of its lower protein content, this feed ischaracterized by a considerably lower in vitro protein degradability than soybean. This implies that the digestible foodprotein content is comparable (124.90 g/kg DM to that of soybean (109.78 g/kg DM and definitely higher than thatof all other protein plants.

  10. Challenges in the diagnosis and treatment of pediatric stroke

    Science.gov (United States)

    Jordan, L. C.; Hillis, A. E.

    2012-01-01

    The onset of stroke in children rarely owes to traditional stroke risk factors such as hypertension or diabetes. Rather, stroke in this patient group typically results from the simultaneous occurrence of multiple stroke risk factors, the presence of which necessitates a thorough evaluation. Several challenges exist in the care of children with stroke. Of note, recognition of pediatric stroke onset by parents and caregivers is often delayed, highlighting the need for increased awareness of and education regarding this condition. In terms of diagnostic challenges, various neurological conditions resemble stroke in pediatric patients and definite diagnosis of stroke will require MRI; adding to the challenge, young children may need to be sedated to undergo acute MRI. Perhaps the most significant challenge is the need for clinical research studies focusing on pediatric stroke treatment, so as to allow evidence-based treatment decision-making. A final challenge is standardizing outcome assessment after stroke across a wide range of ages and developmental levels. In this Review, we examine recent findings and diagnostic issues pertaining to both arterial ischemic stroke and hemorrhagic stroke in children. PMID:21386815

  11. Proximate analysis of Sweet Potato Toasted Granules | Meludu ...

    African Journals Online (AJOL)

    Sweet potato is an important root crop in the food system of many African countries. The yield, nutrition and economic potential of sweet potato have been identified as very high. In this study, sweet potato was processed and toasted into granules. The proximate analysis performed on the toasted granules showed protein, ...

  12. Substitution Value of toasted Pigeon pea ( Cajanus cajan ) seed ...

    African Journals Online (AJOL)

    One hundred and eighty 7-day old broilers were used in a 28-day feeding trial to determine the substitution value of toasted pigeon pea seeds meal (TPSM) for soybean meal and maize in boiler starter diet. The brown coat coloured pigeon pea seeds were toasted at 100oC for 15minutes and milled. The inclusion levels of ...

  13. Potential of Toasted Lima bean ( Phaseolus lunatus L) as a ...

    African Journals Online (AJOL)

    Potential of Toasted Lima bean ( Phaseolus lunatus L) as a substitute for full fat soyabean meal in the diets for (Oreochromis niloticus) fingerlings. ... decreased with increase in inclusion level of toasted lima bean except the high specific growth rate (SGR) value observed in the group fed test diet D (40% inclusion level).

  14. Argatroban versus aspirin plus clopidogrel in the treatment of acute ischemic stroke: a pilot, randomised, open-label study

    Directory of Open Access Journals (Sweden)

    Meng-chan LIU

    2015-07-01

    Full Text Available Objective To evaluate the efficacy and safety of argatroban versus aspirin plus clopidogrel in the treatment of acute ischemic stroke. Methods Seventy five patients with acute ischemic stroke within 48h of symptom onset were randomly divided into two groups: argatroban group (argatroban was used for 7 days according to the instructions, followed by aspirin 100mg per day plus clopidogrel 75mg per day until discharge, n=35, and combination antiplatelet group (300mg of clopidogrel for the first day, then 75mg daily plus aspirin 100mg daily until discharge, n=40. Oxfordshire Community Stroke Project (OCSP classification was assessed in patients before treatment. National Institutes of Health Stroke Scale (NIHSS was used for rating neurological deficit score of patients, and Barthel index for rating activities of daily life (ADL, and modified Rankin scale for handicap score. NIHSS was assessed one week after enrollment, while ADL and mRS assessment were recorded 3 months after onset. Brain imaging, liver and kidney function, blood routine tests and blood coagulation capacity of the patients were measured before and one week after enrollment to observe changes in hemorrhage and biochemical indicators. Drugs-related adverse events were recorded during treatment. All patients received TOAST analysis before leaving hospital. Results 1. In both groups, NIHSS was reduced after oneweek treatment, compared with that before treatment, while ADL was improved at three-month follow-up, compared with those at admission. The results showed statistically significant difference (P0.05 was found between two groups. The transient ischemic attacks (TIA disappeared in both groups. Brain imaging showed that in three patients the lesion advanced to infarction in argatroban group (total 6 patients, and two patients in the combined antiplatelet group (total 5 patients suffered from the same change. 2. The brain imaging and measuring of relevant laboratory indicators

  15. Relevance of prehospital stroke code activation for acute treatment measures in stroke care: a review.

    Science.gov (United States)

    Baldereschi, Marzia; Piccardi, Benedetta; Di Carlo, Antonio; Lucente, Giuseppe; Guidetti, Donata; Consoli, Domenico; Provinciali, Leandro; Toni, Danilo; Sacchetti, Maria Luisa; Polizzi, Bianca Maria; Inzitari, Domenico

    2012-01-01

    The use of emergency services with prehospital stroke assessment and early notification to the treatment hospital (stroke code) is a crucial determinant of delay time for acute stroke treatment. We reviewed and summarized the literature on prehospital stroke code system implementation. Two databases were explored (last update June 20, 2011) with 3 key words (stroke code, stroke prehospital management and stroke prehospital services). Inclusion criteria were: randomized and quasirandomized controlled trials, cohort and case-control studies, and hospital- and emergency-based registers, with no year or language restrictions. We examined the reference lists of all included articles. All potentially relevant reports and abstracts were transcribed into a specifically designed data abstraction form. Only 19 of the 680 studies which were initially retrieved, published from 1999 to 2011, fulfilled our inclusion criteria. One clinical trial was identified. Large differences in stroke code procedures and study designs within and across countries prohibited the pooling of the data. Most studies were carried out in urban areas. Assuming the rate of tissue-plasminogen activator treatment as the performance measure, most studies report a significant increase in the rate of treatment (increase between 3.2 and 16%) with only 1 study not reporting any increase. Despite its limitations, this review suggests that the use of prehospital stroke code is an important intervention to improve the accessibility of the benefits of thrombolysis, especially when implemented together with educational campaigns to optimize the awareness and behavior of patients and bystanders. Copyright © 2012 S. Karger AG, Basel.

  16. Mechanical recanalization in acute stroke treatment

    International Nuclear Information System (INIS)

    Berkefeld, J.; Rochemont, R. du Mesnil de; Zanella, F.E.; Sitzer, M.

    2005-01-01

    The development of endovascular techniques for the treatment of acute stroke began with the introduction of local intra-arterial fibrinolysis. In parallel to designing new systemic therapy approaches, catheter systems for loosening, disintegrating, or removing cerebral thrombi have undergone assessment in recent years to serve as alternatives or supplements to fibrinolytic treatment. Mechanical alteration of intracranial thrombi with balloon catheters, manipulations with the guide wire, or ultrasound waves transmitted into the vascular system as well as techniques for thrombus aspiration, snare extraction, or more complex hydrodynamic or laser-guided thrombectomy systems have been tested in feasibility studies, which evidenced basic functionality and relative safety. Broad clinical applications outside of the clinical trial setting cannot yet be recommended since the new catheter systems are still in early phase clinical testing. (orig.) [de

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-09-01

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

  18. Ischemic stroke classification and risk of embolism in patients with Chagas disease.

    Science.gov (United States)

    Montanaro, Vinícius Viana Abreu; da Silva, Creuza Maria; de Viana Santos, Carla Verônica; Lima, Maria Inacia Ruas; Negrão, Edson Marcio; de Freitas, Gabriel R

    2016-12-01

    Ischemic stroke (IS) and Chagas disease are strongly related. Nevertheless, little attention has been paid to this association and its natural history. The current guidelines concerning the management and secondary prevention of IS are largely based on the incomplete information or extrapolation of knowledge from other stroke etiologies. We performed a retrospective study which compared stroke etiologies among a cohort of hospitalized patients with IS and Chagas disease. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC/FIOCRUZ) embolic score was also used to identify and evaluate the risk of embolism in this population. A total of 86 patients were included in the analysis. The mean age of the study population was 58 years, and 60 % were men. According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification, 45 % of the strokes were of undetermined etiology and 45 % of cardioembolic origin, while the Stop Stroke Study/Causative Classification System (SSS/CCS) TOAST indicated that 34 % were undetermined and 50 % cardioembolic (p Chagas disease. The IPEC/FIOCRUZ score did not correlate with the number of patients who were determined to have cardioembolic stroke etiologies. The current guidelines for stroke prevention should be reviewed in this population.

  19. Ischemic Stroke Treatment Trials: Neuroimaging Advancements and Implications.

    Science.gov (United States)

    Patel, Vivek P; Heit, Jeremy J

    2017-06-01

    There have been significant advancements in the treatment of acute ischemic stroke in the last 2 decades. Recent trials have placed a significant emphasis on minimizing the time from symptom onset to stroke treatment by reperfusion therapies, which decreases the cerebral infarct volume and improves clinical outcomes. These clinical advances have paralleled and been aided by advances in neuroimaging. However, controversy remains regarding how much time should be spent on neuroimaging evaluation versus expediting patient treatment. In this review article, we examine the key endovascular stroke trials published in the past 25 years, and we briefly highlight the failures and successes of endovascular stroke trials performed in the past 4 years. We also discuss the advantages and disadvantages of using time from symptom onset versus neuroimaging in determining endovascular stroke therapy candidacy.

  20. Who benefits from treatment and rehabilitation in a stroke Unit?

    DEFF Research Database (Denmark)

    Jorgensen, H S; Kammersgaard, L P; Houth, J

    2000-01-01

    The beneficial effects of treatment and rehabilitation of patients with acute stroke in a dedicated stroke unit (SU) are well established. We wanted to examine if these effects are limited to certain groups of patients or if they apply to all patients independent of age, sex, comorbidity, and ini...

  1. Sleep apnea in stroke: Diagnosis, consequences & treatment

    NARCIS (Netherlands)

    Aaronson, J.A.

    2016-01-01

    Obstructive sleep apnea (OSA) is the most common sleep disorder in stroke, but is often left unrecognized and untreated. When left untreated, OSA is thought to contribute to decreased recovery from stroke. The main objectives of this thesis were 1) to improve early recognition of sleep apnea in

  2. Stroke care in Galicia: telemedicine in the early, multidisciplinary treatment of all acute stroke cases.

    Science.gov (United States)

    Rodríguez-Castro, Emilio; Vázquez-Lima, Manuel José; Rodríguez-Yáñez, Manuel; Verde, Luis; Castillo, José

    2018-02-01

    Stroke is the main cause of morbidity and mortality in Spain and in Galicia in particular. Tissue viability after stroke depends on the time taken to restore circulation. The widely dispersed and aging population of this region challenges efforts to provide equal care for patients with time-sensitive emergencies such as stroke. Two regional hospitals (Hospital do Salnés and Hospital do Barbanza) and the reference Hospital Clínico de Santiago launched a telestroke pilot program in 2011 in which patients whose treatment was guided at a distance were discharged with lower levels of stroke severity and mortality. That outcome was probably attributable to more rapid diagnosis. Given those preliminary results and the characteristics of the population, the centrally coordinated Galician Stroke Care Plan was launched in 2016 to provide a telemedicine service that connects all hospitals in the health system of Galicia. This paper summarizes the experience of developing and implementing the program.

  3. 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.

  4. Update on acute endovascular and surgical stroke treatment

    DEFF Research Database (Denmark)

    Kondziella, D; Cortsen, M; Eskesen, V

    2013-01-01

    Emergency stroke care has become a natural part of the emerging discipline of neurocritical care and demands close cooperation between the neurologist and neurointerventionists, neurosurgeons, and anesthesiologists. Endovascular treatment (EVT), including intra-arterial thrombolysis, mechanical...

  5. Balneotherapy in treatment of spastic upper limb after stroke.

    Science.gov (United States)

    Erceg-Rukavina, Tatjana; Stefanovski, Mihajlo

    2015-02-01

    After stroke, spasticity is often the main problem that prevents functional recovery. Pain occurs in up to 70% of patients during the first year post-stroke. A total of 70 patients (30 female and 45 male) mean age (65.67) participated in prospective, controlled study. ischaemic stroke, developed spasticity of upper limb, post-stroke interval cryotherapy. The outcome was evaluated using Modified Ashworth scale for spasticity and VAS scale for pain. The significance value was sat at pspasticity and pain in affected upper limb. Reduction in tone of affected upper limb muscles was significant in Ex group (pspasticity and pain significantly and can help in treatment of post-stroke patients.

  6. CITICOLIN IN THE TREATMENT OF STROKE AND VASCULAR COGNITIVE DISORDERS

    Directory of Open Access Journals (Sweden)

    Vladimir Anatol'evich Parfenov

    2009-01-01

    Full Text Available Citicolin (ceraxon is used as a neuroprotector in the treatment of acute stroke and vascular cognitive disorders. Experimental animal studies have demonstrated that citicolin reduces the extent of cerebral infarct and increases the degree of functional recovery. A few clinical trials have provided evidence for the efficacy of intravenous or oral citicolin used within the first 24 hours of ischemic stroke or cerebral hemorrhage in recovery of neurological functions. Citicolin is effective in memory and behavioral disorders in elderly patients with chronic cerebrovascular diseases. The use of citicolin has been found to be safe in stroke and vascular cognitive disorders

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

    LENUS (Irish Health Repository)

    McDonnell, R

    2000-10-01

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

  8. Gender, Social Networks, and Stroke Preparedness in the Stroke Warning Information and Faster Treatment Study.

    Science.gov (United States)

    Madsen, Tracy E; Roberts, Eric T; Kuczynski, Heather; Goldmann, Emily; Parikh, Nina S; Boden-Albala, Bernadette

    2017-12-01

    The study aimed to investigate the effect of gender on the association between social networks and stroke preparedness as measured by emergency department (ED) arrival within 3 hours of symptom onset. As part of the Stroke Warning Information and Faster Treatment study, baseline data on demographics, social networks, and time to ED arrival were collected from 1193 prospectively enrolled stroke/transient ischemic attack (TIA) patients at Columbia University Medical Center. Logistic regression was conducted with arrival to the ED ≤3 hours as the outcome, social network characteristics as explanatory variables, and gender as a potential effect modifier. Men who lived alone or were divorced were significantly less likely to arrive ≤3 hours than men who lived with a spouse (adjusted odds ratio [aOR]: .31, 95% confidence interval [CI]: .15-0.64) or were married (aOR: .45, 95% CI: .23-0.86). Among women, those who lived alone or were divorced had similar odds of arriving ≤3 hours compared with those who lived with a spouse (aOR: 1.25, 95% CI: .63-2.49) or were married (aOR: .73, 95% CI: .4-1.35). In patients with stroke/TIA, living with someone or being married improved time to arrival in men only. Behavioral interventions to improve stroke preparedness should incorporate gender differences in how social networks affect arrival times. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Stroke treatment in Stroke Unit: from scientific evidences to clinical practice

    Directory of Open Access Journals (Sweden)

    Michele Stornello

    2013-04-01

    Full Text Available Background: In themanagement of stroke disease, evidences fromthe literature demonstrate that the introduction of stroke units, hospital wards with dedicated beds providing intensive care within 48 hours of symptoms’ onset, produced a real improvement in the outcome, reducing in-hospital fatality cases and increasing the proportion of patients independently living in long term follow-up. Discussion: The article focuses on stroke disease-management, suggesting a stroke integrated approach for the admission of patients on dedicated beds, in order to extend the ‘‘stroke care’’ approach outcomes to as many hospitals as possible in Italy. This approach implies the set up of a stroke network for an effective patients’ stratification according to the severity of the illness at debut; the set up of an integrated team of specialists in hospital management of the acute phase (first 48 hours and a timely rehabilitation treatment. Ultimately the hospital should be organized according to department’s semi-intensive areas in order to assure to the patients, in the early stage of the disease, a timely high intensity care aimed to improve the long term outcome.

  10. Guidelines for the treatment of acute ischaemic stroke.

    Science.gov (United States)

    Alonso de Leciñana, M; Egido, J A; Casado, I; Ribó, M; Dávalos, A; Masjuan, J; Caniego, J L; Martínez Vila, E; Díez Tejedor, E; Fuentes, B; Álvarez-Sabin, J; Arenillas, J; Calleja, S; Castellanos, M; Castillo, J; Díaz-Otero, F; López-Fernández, J C; Freijo, M; Gállego, J; García-Pastor, A; Gil-Núñez, A; Gilo, F; Irimia, P; Lago, A; Maestre, J; Martí-Fábregas, J; Martínez-Sánchez, P; Molina, C; Morales, A; Nombela, F; Purroy, F; Rodríguez-Yañez, M; Roquer, J; Rubio, F; Segura, T; Serena, J; Simal, P; Tejada, J; Vivancos, J

    2014-03-01

    Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  11. Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

    DEFF Research Database (Denmark)

    Brunner-Frandsen, Nicole; Dammann Andersen, Andreas; Ashournia, Hamoun

    2015-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study...... was observed. An explanation could be an increase in the prevalence of AF in the general population, leaving the proportion of patients admitted with ischemic stroke unchanged. Other risk factors have been sought reduced as well with the implementation of national guidelines regarding hypertension...... was set up to clarify whether this effort has resulted in a decreased proportion of patients with known AF experiencing an ischemic stroke. METHODS: Patients admitted to the Department of Neurology, Vejle Hospital, Denmark, with ischemic stroke from January 1997 to December 2012 were included in the study...

  12. Hemorrhagic transformation in ischemic stroke and its treatment during thrombolysis

    Directory of Open Access Journals (Sweden)

    Maurizio Paciaroni

    2011-08-01

    Full Text Available Haemorrhagic transformation (HT of brain infarction or hemorrhagic infarction is a complication of acute ischemic stroke, especially in cardioembolic stroke, and represents the most feared complication of thrombolysis. HT is a multifocal secondary bleeding into brain infarcts with innumerable foci of capillary and venular extravasation either remaining as discrete petechiae or emerging to form confluent purpura. HT is evidenced as a parenchymal area of increased density within an area of low attenuation in a typical vascular distribution on non-contrasted CT scans and is subdivided into two major categories on the basis of standardised definition: haemorrhagic infarct (HI and parenchymal haematoma (PH. PH has been associated to poor outcome in ischemic stroke patients. Thus, its prevention, early detection and adequate treatment represent key points in the management of acute stroke.

  13. Arterial stiffness and functional outcome in acute ischemic stroke.

    Science.gov (United States)

    Lee, Yeong-Bae; Park, Joo-Hwan; Kim, Eunja; Kang, Chang-Ki; Park, Hyeon-Mi

    2014-03-01

    Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. ONE HUNDRED PATIENTS WERE ENROLLED WITH A DIAGNOSIS OF ACUTE ISCHEMIC STROKE AND CATEGORIZED INTO TWO GROUPS: large-artery atherosclerosis (LAAS) or small vessel disease (SVD) subtype of Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Each group was divided into two sub-groups based on the functional outcome of acute ischemic stroke, indicated by modified Rankin Scale (mRS) at discharge. Poor functional outcome group was defined as a mRS ≥ 3 at discharge. Student's t-test or Mann-Whitney U-test were used to compare maximal brachial-ankle PWV (baPWV) values. Twenty-four patients whose state was inadequate to assess baPWV or mRS were excluded. There were 38 patients with good functional outcome (mRS vs. 1,789.80 ± 421.91, p = 0.022), while there was no significant difference of baPWV among patients with LAAS subtype (2,071.76 ± 618.42 vs. 1,878.00 ± 365.35, p = 0.579). Arterial stiffness indicated by baPWV is associated with the functional outcome of acute ischemic stroke. This finding suggests that measurement of baPWV predicts functional outcome in patients with stroke especially those whose TOAST classification was confirmed as SVD subtype.

  14. Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke

    DEFF Research Database (Denmark)

    Bath, Philip M W; Scutt, Polly; Love, Jo

    2016-01-01

    BACKGROUND AND PURPOSE: Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. METHODS:...

  15. The Development and Validation of the Test Of Astronomy STandards (TOAST)

    Science.gov (United States)

    Slater, Stephanie J.

    2014-01-01

    The Test Of Astronomy STandards (TOAST) is a comprehensive assessment instrument designed to measure students' general astronomy content knowledge. Built upon the research embedded within a generation of astronomy assessments designed to measure single concepts, the TOAST is appropriate to measure across an entire astronomy course. The TOAST's…

  16. Statin treatment and stroke outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Goldstein, L.B.; Amarenco, P.; Zivin, J.

    2009-01-01

    BACKGROUND AND PURPOSE: Laboratory experiments suggest statins reduce stroke severity and improve outcomes. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial was a placebo-controlled, randomized trial designed to determine whether treatment with atorvastatin reduces...... strokes in subjects with recent stroke or transient ischemic attack (n=4731). We analyzed SPARCL trial data to determine whether treatment favorably shifts the distribution of severities of ischemic cerebrovascular outcomes. METHODS: Severity was assessed with the National Institutes of Health Stroke...... Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. RESULTS: Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5...

  17. Basics of acute stroke treatment; Grundzuege der akuten Schlaganfalltherapie

    Energy Technology Data Exchange (ETDEWEB)

    Haass, A. [Neurologische Universitaetsklinik Homburg/Saar (Germany)

    2005-05-01

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

  18. Vanadium extraction by combined process of lixiviation and toasting

    International Nuclear Information System (INIS)

    Coral, Aldo

    1992-01-01

    Combinated toasting and leaching processes were applied at laboratory level to vanadiferous ore from Puyango deposit in order to evaluate different rates. Before leaching, a pretreatment consisting in toasting at open atmosphere was given to the ore. Both raw and toasted ore were later washed in organic solvents. In reason of mineralogical and petrographic characteristics of the ore, only alcaline leaching was tested under different pressure temperature and pH conditions of leaching solution (pH=9.8) in order to optimize time and efficiency of each individual process. Four different unitary alcaline leaching processes were studied: MECHANICAL STIRRING, PNEUMATIC STIRRING, LEACHING IN AUTOCLAVE AND LEACHING IN COLUMNS. For these four processes were obtained recovery rates (in percentage) of 18.63 and 87.82; 17.03 and 82.57; 60.42 and 99.55; 2.5 and 30.10; respectively from raw and pre-toasted ore. After filtration, vanadium was extracted from enriched solutions by using liquid resin ALAMINE 336, selective for vanadium at pH=2.8. Vanadium was later discharged with a Sodium Carbonate solution (10 per cent) and finally precipitated as the commercial compound Ammonium Vanadate, NH4VO3. Nuclear techniques as X-ray fluorescence and Atomic Absorption spectroscopy were used for analysis all over the investigation

  19. Influence of graded levels or toasted Bambara groundnut meal on ...

    African Journals Online (AJOL)

    The effect of feeding graded levels of toasted bambara ground nut meal on rabbit weaners was investigated. A total of fifty white rabbit weaners of 6 - 8 weeks with an average weight of 366.7g were fed the graded level of Bambara nut meal at 0, 5, 15, 25 or 35% inclusion level in a complete randomized design experiment ...

  20. Shelf Life Extension of Toasted Groundnuts through the Application ...

    African Journals Online (AJOL)

    The use of cassava starch and soy protein concentrate edible coatings containing 20% glycerol in extending the shelf life of toasted groundnut during ambient (27 ± 1oC) storage for 14 days was studied. Chemical indices of oxidative rancidity and sensory parameters were evaluated using standard procedures. Moisture ...

  1. Effects of anti-inflammatory treatments on stroke outcome in animal models

    NARCIS (Netherlands)

    Tiebosch, I.A.C.W.

    2012-01-01

    Background: Stroke is a devastating disease with over 5.5 million yearly casualties worldwide. Acute treatment strategies are limited. The acute inflammatory response following stroke has been demonstrated to be detrimental on stroke outcome, for both ischemic and hemorrhagic stroke subtypes.

  2. Effects of alteplase in the treatment of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Yayan J

    2012-09-01

    Full Text Available Josef YayanDepartment of Internal Medicine, Vinzentius Hospital, Landau, GermanyBackground: For the last 15 years, alteplase (recombinant tissue plasminogen activator has been used widely throughout the world for the treatment of acute ischemic stroke. Although considered to be safe and effective, like all drugs, alteplase has side effects.Methods: This retrospective cohort study was conducted in the intensive care unit of the department of internal medicine in a mid-size peripheral acute hospital in Germany. Patients with acute ischemic stroke who underwent alteplase-induced thrombolysis were investigated.Results: Among the 1017 patients admitted for stroke investigation, 23 (2.26% received thrombolytic therapy consisting of intravenous alteplase. Of these, six patients (26.09% experienced complications, ie, four (17.39% had intracerebral hemorrhage, one (4.35% developed orolingual angioedema, and one (4.35% had a hematoma on the right arm. After treatment with alteplase, two (33.33% patients in the study group (n = 6 died because of intracerebral hemorrhage and one (16.67% died because of aspiration pneumonia. One (5.88% patient in the control group (n = 17 died of cerebral edema.Conclusion: The incidence of stroke and number of patients treated with alteplase in the examined hospital subunit has not increased in recent years. Also, in this study, no statistically significant difference was found in the incidence of various complications occurring during treatment for acute ischemic stroke with alteplase, but intracerebral hemorrhage was the most common complication.Keywords: alteplase, complications, acute ischemic stroke, safety, efficacy

  3. Treatment and partial recovery of ischemic stroke hemiplegy through acupuncture

    Directory of Open Access Journals (Sweden)

    David Gonçalves Nordon

    2011-06-01

    Full Text Available ABSTRACT We present the case of a patient with hemiplegy and dysphonia due to an ischemic stroke in the pons who was treated through classical systemic and scalpean acupuncture and electroacupuncture, presenting considerable improvement in speaking, walking and moving her right arm after three months of treatment.

  4. Is it important to classify ischaemic stroke?

    LENUS (Irish Health Repository)

    Iqbal, M

    2012-02-01

    Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total\\/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.

  5. Treatment of acute ischemic stroke: Awareness among general practitioners

    OpenAIRE

    Aaron S; Alexander M; Maya T; Mathew V; Goyal M

    2010-01-01

    For promptly referral of a patient with acute ischemic stroke (AIS) for possible thrombolysis, general practitioners (GPs) need to equipped with the advanced knowledge of AIS treatment. We assessed the knowledge regarding treatment of AIS among GPs practicing in and around a quaternary care teaching hospital in south India. A total of 109 GPs who attend to medical emergencies were interviewed using a standard questionnaire. Of the 109 GPs interviewed, 54% felt that tissue plasminogen a...

  6. Thrombolytic and anticoagulation treatment in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, K; Meden, P

    2003-01-01

    OBJECTIVES: The effects of pentasaccharide (PENTA), given alone or combined with thrombolysis using recombinant tissue plasminogen activator (rt-PA), on infarct size and clinical outcome were evaluated in a rat embolic stroke model. MATERIALS AND METHODS: Ninety-two rats were embolized unilaterally...... group, 4% (P treatment. Compared with rt-PA treatment alone, 0.5 mg/kg PENTA...... alone or combined with rt-PA did not significantly increase mortality or tendency for hemorrhage....

  7. Pericyte: Potential Target for Hemorrhagic Stroke Prevention and Treatment.

    Science.gov (United States)

    Li, Qiang; Liu, Xin; Ruan, Huaizhen; Chen, Yujie; Feng, Hua

    2017-09-06

    Despite long-standing and worldwide efforts, hemorrhagic stroke remains a critical clinical syndrome that exerts a heavy toll on affected individuals and their families due to the lack of preventive and therapeutic targets. To clarify the pathogenesis of hemorrhagic stroke and to identify novel therapeutic targets. Targeting pericytes, the typical mural cells of microvessels, could serve as a way to modulate microvascular permeability, development, and maturation by regulating endothelial cell functions and modulating tissue fibrosis and inflammatory responses. Pericytes in hemorrhagic stroke may exert the following functions: before bleeding, the morphological aberration and dysfunction of pericytes may lead to aneurysm formation, angiopsathyrosis, and hemodynamic disturbances, ultimately causing vasculature rupture. In the acute phase after hemorrhage, pericytes are faced with a complicated bleeding environment, which results in the death of pericytes, blood-brain barrier damage, pericyte-mediated inflammatory cascades, white matter impairment, and ultimately aggravated neural injury. In the recovery period post-hemorrhage, in situ pericytes are activated and differentiate into neurons, glia and endothelial cells to repair the neural vascular network. Moreover, many pericytes are recruited to the lesion and contribute to blood-brain barrier remodeling, thus facilitating neurovascular functional recovery after stroke. Due to the multiple functions of pericytes in the development of vascular rupture and hemorrhagic stroke pathophysiology, additional drugs and trials targeting pericytes and evaluations of their effectiveness are required in future investigations to develop new strategies for the prevention and treatment of hemorrhagic stroke. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  8. [Endovascular treatment in acute ischaemic stroke. A stroke care plan for the region of Madrid].

    Science.gov (United States)

    Alonso de Leciñana, M; Díaz-Guzmán, J; Egido, J A; García Pastor, A; Martínez-Sánchez, P; Vivancos, J; Díez-Tejedor, E

    2013-09-01

    Endovascular therapies (intra-arterial thrombolysis and mechanical thrombectomy) after acute ischaemic stroke are being implemented in the clinical setting even as they are still being researched. Since we lack sufficient data to establish accurate evidence-based recommendations for use of these treatments, we must develop clinical protocols based on current knowledge and carefully monitor all procedures. After review of the literature and holding work sessions to reach a consensus among experts, we developed a clinical protocol including indications and contraindications for endovascular therapies use in acute ischaemic stroke. The protocol includes methodology recommendations for diagnosing and selecting patients, performing revascularisation procedures, and for subsequent patient management. Its objective is to increase the likelihood of efficacy and treatment benefit and minimise risk of complications and ineffective recanalisation. Based on an analysis of healthcare needs and available resources, a cooperative inter-hospital care system has been developed. This helps to ensure availability of endovascular therapies to all patients, a fast response time, and a good cost-to-efficacy ratio. It includes also a prospective register which serves to monitor procedures in order to identify any opportunities for improvement. Implementation of endovascular techniques for treating acute ischaemic stroke requires the elaboration of evidence-based clinical protocols and the establishment of appropriate cooperative healthcare networks guaranteeing both the availability and the quality of these actions. Such procedures must be monitored in order to improve methodology. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

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

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during...

  10. Neural function, injury, and stroke subtype predict treatment gains after stroke.

    Science.gov (United States)

    Burke Quinlan, Erin; Dodakian, Lucy; See, Jill; McKenzie, Alison; Le, Vu; Wojnowicz, Mike; Shahbaba, Babak; Cramer, Steven C

    2015-01-01

    This study was undertaken to better understand the high variability in response seen when treating human subjects with restorative therapies poststroke. Preclinical studies suggest that neural function, neural injury, and clinical status each influence treatment gains; therefore, the current study hypothesized that a multivariate approach incorporating these 3 measures would have the greatest predictive value. Patients 3 to 6 months poststroke underwent a battery of assessments before receiving 3 weeks of standardized upper extremity robotic therapy. Candidate predictors included measures of brain injury (including to gray and white matter), neural function (cortical function and cortical connectivity), and clinical status (demographics/medical history, cognitive/mood, and impairment). Among all 29 patients, predictors of treatment gains identified measures of brain injury (smaller corticospinal tract [CST] injury), cortical function (greater ipsilesional motor cortex [M1] activation), and cortical connectivity (greater interhemispheric M1-M1 connectivity). Multivariate modeling found that best prediction was achieved using both CST injury and M1-M1 connectivity (r(2) = 0.44, p = 0.002), a result confirmed using Lasso regression. A threshold was defined whereby no subject with >63% CST injury achieved clinically significant gains. Results differed according to stroke subtype; gains in patients with lacunar stroke were best predicted by a measure of intrahemispheric connectivity. Response to a restorative therapy after stroke is best predicted by a model that includes measures of both neural injury and function. Neuroimaging measures were the best predictors and may have an ascendant role in clinical decision making for poststroke rehabilitation, which remains largely reliant on behavioral assessments. Results differed across stroke subtypes, suggesting the utility of lesion-specific strategies. © 2014 American Neurological Association.

  11. Diffusion and Perfusion MR Imaging in Acute Stroke: Clinical Utility and Potential Limitations for Treatment Selection

    DEFF Research Database (Denmark)

    Bateman, Mathew; Slater, Lee-Anne; Leslie-Mazwi, Thabele M

    2017-01-01

    Magnetic resonance (MR) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) offer unique insight into acute ischemic stroke pathophysiology. These techniques may offer the ability to apply pathophysiology to accurately individualize acute stroke reperfusion treatment, including ...

  12. Germinated, toasted and cooked chickpea as ingredients for breadmaking

    OpenAIRE

    Ouazib, Meriem; Garzón, Raquel; Farid Zaidi, Farid; Rosell, Cristina M.

    2016-01-01

    The effect of processing (germination, toasting and cooking) of chickpea beans was investigated on the resulting flours characteristics and their potential for obtaining gluten free breads. Rheological properties of dough were recorded using Mixolab�� and breads were analyzed for their instrumental quality, nutritional and sensory properties. Chickpea based doughs showed low consistency and their rheological behavior was defined by the starch gelatinization and gelification. The bread made wi...

  13. Facial nerve stimulation as a future treatment for ischemic stroke

    Directory of Open Access Journals (Sweden)

    Mark K Borsody

    2016-01-01

    Full Text Available Stimulation of the autonomic parasympathetic fibers of the facial nerve system (hereafter simply "facial nerve" rapidly dilates the cerebral arteries and increases cerebral blood flow whether that stimulation is delivered at the facial nerve trunk or at distal points such as the sphenopalatine ganglion. Facial nerve stimulation thus could be used as an emergency treatment of conditions of brain ischemia such as ischemic stroke. A rich history of scientific research has examined this property of the facial nerve, and various means of activating the facial nerve can be employed including noninvasive means. Herein, we review the anatomical and physiological research behind facial nerve stimulation and the facial nerve stimulation devices that are in development for the treatment of ischemic stroke.

  14. Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke

    Science.gov (United States)

    Scutt, Polly; Love, Jo; Clavé, Pere; Cohen, David; Dziewas, Rainer; Iversen, Helle K.; Ledl, Christian; Ragab, Suzanne; Soda, Hassan; Warusevitane, Anushka; Woisard, Virginie; Hamdy, Shaheen

    2016-01-01

    Background and Purpose— Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. Methods— We randomly assigned 162 patients with a recent ischemic or hemorrhagic stroke and dysphagia, defined as a penetration aspiration score (PAS) of ≥3 on video fluoroscopy, to PES or sham treatment given on 3 consecutive days. The primary outcome was swallowing safety, assessed using the PAS, at 2 weeks. Secondary outcomes included dysphagia severity, function, quality of life, and serious adverse events at 6 and 12 weeks. Results— In randomized patients, the mean age was 74 years, male 58%, ischemic stroke 89%, and PAS 4.8. The mean treatment current was 14.8 (7.9) mA and duration 9.9 (1.2) minutes per session. On the basis of previous data, 45 patients (58.4%) randomized to PES seemed to receive suboptimal stimulation. The PAS at 2 weeks, adjusted for baseline, did not differ between the randomized groups: PES 3.7 (2.0) versus sham 3.6 (1.9), P=0.60. Similarly, the secondary outcomes did not differ, including clinical swallowing and functional outcome. No serious adverse device-related events occurred. Conclusions— In patients with subacute stroke and dysphagia, PES was safe but did not improve dysphagia. Undertreatment of patients receiving PES may have contributed to the neutral result. Clinical Trial Registration— URL: http://www.controlled-trials.com. Unique identifier: ISRCTN25681641. PMID:27165955

  15. The prognosis of acute symptomatic seizures after ischaemic stroke.

    Science.gov (United States)

    Leung, Thomas; Leung, Howan; Soo, Yannie O Y; Mok, Vincent C T; Wong, K S

    2017-01-01

    Acute symptomatic seizure (AS) after ischaemic stroke is defined as a seizure occurring ≤7 days of the stroke. There remains a lack of information on the prognosis of AS after ischaemic stroke and how it should be treated. We prospectively recruited patients after their incidents of ischaemic stroke from a population-based stroke registry. Stroke aetiology was defined according to Trial-of-ORG-10172 in acute-stroke treatment (TOAST). Patients were examined for any transient complete-occlusion with recanalisation (TCOR) and haemorrhagic transformation. The seizure outcomes were (1) acute clustering of seizures ≤7 days, (2) seizure recurrence associated with stroke recurrence beyond the 7-day period and (3) unprovoked seizure (US) >7 days. 104 patients (mean age 65 years/55% female) with AS after ischaemic stroke were identified (mean follow-up 6.17 years). Comparison of the group of patients with AS and those without seizures showed that patients with AS had significantly less large-vessel and small-vessel disease but more cardioembolisms (pstroke beyond 7 days was 13.5% at 2 years, 16.4% at 4 years and 18% at 8 years. Presence of >2 cardiovascular risk factors (pischaemic stroke may appear as acute clustering. Afterwards, seizures may occur as often with a recurrent stroke as without one within 4.2 years. We recommend the use of antiepileptic agents for up to 4 years if the underlying stroke aetiology cannot be fully treated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Drug treatments in the secondary prevention of ischaemic stroke.

    Science.gov (United States)

    Schulz, Ursula G

    2013-11-01

    Stroke is an important cause of death and disability. However, about two thirds of cerebrovascular events are initially minor. They carry a high risk of potentially severe recurrent events, but they also offer an opportunity for secondary prevention to avoid such recurrences. As most recurrent events occur within a short time after the initial presentation, secondary prevention has to be started as soon as possible. Dramatic risk reduction can be achieved with well-established drugs if used in a timely manner. A standard secondary preventive regimen will address multiple vascular risk factors and will usually consist of an antiplatelet agent, a lipid lowering drug, and an antihypertensive agent. Depending on the risk factor profile of each patient, this will have to be adjusted individually, for example, taking into account the presence of cardioembolism or of stenotic disease of the brain-supplying arteries. In recent years, the approach to treating these risk factors has evolved. In addition to absolute blood pressure, blood pressure variability has emerged as an important contributing factor to stroke risk, which is affected differently by different antihypertensive agents. New oral anticoagulants reduce the risk of cerebral haemorrhage and the need for regular blood checks. The best antiplatelet regimen for stroke prevention is still uncertain, and treatment of dyslipidaemia may change if trials with cholesteryl ester transfer protein (CETP) inhibitors, which increase levels of HDL-cholesterol, are successful. This article reviews the current evidence for drug treatments in the secondary prevention of ischaemic stroke. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Case Study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis

    OpenAIRE

    Formánková, Dita

    2012-01-01

    Title: Case study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis. Objectives: The aim of the thesis is to obtain academic findings about stroke concerning anatomy, pathology, therapetuic approaches and methods which can be utilised in cases of stroke. The specific part focuses on the therapeutic care of a patient after hemorragic stroke which was taken during a month practice at Rehabilitation clinic Malvazinky, Medditera s.r.o. Summary: The theory of the ...

  18. Case study of physioterapy treatment of patient after hemoragic stroke with left hemiparesis

    OpenAIRE

    Waldmann, Tadeáš

    2014-01-01

    Title: Case study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis. Objectives: The aim of the thesis is to obtain academic findings about stroke concerning anatomy, pathology, therapetuic approaches and methods which can be utilised in cases of stroke. The specific part focuses on the therapeutic care of a patient after hemorragic stroke which was taken during a month practice at Regional hospital Kladno Spa Summary: The theory of the thesis discusses anato...

  19. Intravenous Thrombolysis in Unknown-Onset Stroke: Results From the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry.

    Science.gov (United States)

    Dorado, Laura; Ahmed, Niaz; Thomalla, Götz; Lozano, Manuel; Malojcic, Branko; Wani, Mushtaq; Millán, Mònica; Tomek, Ales; Dávalos, Antoni

    2017-03-01

    Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014. Two groups were defined: (1) patients with UKO (n=502) and (2) patients treated within 4.5 hours of stroke onset (n=44 875). Outcome measures were symptomatic intracerebral hemorrhage per Safe Implementation of Treatment in Stroke on the 22 to 36 hours post-treatment neuroimaging and mortality and functional outcome assessed by the modified Rankin Scale at 3 months. Patients in UKO group were significantly older, had more severe stroke at baseline, and longer door-to-needle times than patients in the ≤4.5 hours group. Logistic regression showed similar risk of symptomatic intracerebral hemorrhage (adjusted odds ratio, 1.09; 95% confidence interval, 0.44-2.67) and no significant differences in functional independency (modified Rankin Scale score of 0-2; adjusted odds ratio, 0.79; 95% confidence interval, 0.56-1.10), but higher mortality (adjusted odds ratio, 1.58; 95% confidence interval, 1.04-2.41) in the UKO group compared with the ≤4.5 hours group. Patients treated within 4.5 hours showed reduced disability over the entire range of modified Rankin Scale compared with the UKO group (common adjusted odds ratio, 1.29; 95% confidence interval, 1.01-1.65). Our data suggest no excess risk of symptomatic intracerebral hemorrhage but increased mortality and reduced favorable outcome in patients with UKO stroke compared with patients treated within the approved time window. © 2017 American Heart Association, Inc.

  20. Balneotherapy in Treatment of Spastic Upper Limb after Stroke

    OpenAIRE

    Erceg-Rukavina, Tatjana; Stefanovski, Mihajlo

    2015-01-01

    Introduction: After stroke, spasticity is often the main problem that prevents functional recovery. Pain occurs in up to 70% of patients during the first year post-stroke. Materials and methods: A total of 70 patients (30 female and 45 male) mean age (65.67) participated in prospective, controlled study. Inclusion criteria: ischaemic stroke, developed spasticity of upper limb, post-stroke interval

  1. DAWN of a New Era for Stroke Treatment: Implications of the DAWN Study for Acute Stroke Care and Stroke Systems of Care.

    Science.gov (United States)

    Alberts, Mark J; Ollenschleger, Martin D; Nouh, Amre

    2018-01-18

    Until recently, the selection of patients with large artery occlusion and ischemic stroke for reperfusion therapy was based on time criteria (typically within 6 hours) and basic imaging protocols (head CT, CT angiogram, ASPECTS score). The recently published DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) study has changed this paradigm by using a tissue-based selection criteria and a greatly expanded treatment time window (up to 24 hours). 1 This is a transformational change in acute stroke therapy and has implications for many healthcare providers and EMS systems.

  2. Modelling the Effect of Toasting Time on the Functional Properties of ...

    African Journals Online (AJOL)

    The effect of toasting time on the functional properties of Brachystegia eurycoma flour was investigated. The water absorption capacity, swelling power and solubility index of the flour, increased with increase in toasting time, while the oil absorption capacity and amylose content of the flour decreased with increase in ...

  3. 21 CFR 73.140 - Toasted partially defatted cooked cottonseed flour.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Toasted partially defatted cooked cottonseed flour... defatted cooked cottonseed flour. (a) Identity. (1) The color additive toasted partially defatted cooked cottonseed flour is a product prepared as follows: Food quality cottonseed is delinted and decorticated; the...

  4. The feed value of toasted Mucuna sloanei meal on the performance ...

    African Journals Online (AJOL)

    An experiment was conducted to determine the feed value of toasted Mucuna sloanei meal (TMSM) on the performance, haematology and blood biochemistry of broiler finisher birds. Mucuna sloanei seeds were processed into toasted Mucuna sloanei meal (TMSM) and analyzed for proximate and phytochemical ...

  5. The iron content and ferritin contribution in fresh, dried, and toasted nori, Pyropia yezoensis.

    Science.gov (United States)

    Masuda, Taro; Yamamoto, Ami; Toyohara, Haruhiko

    2015-01-01

    Iron is one of the essential trace elements for humans. In this study, the iron contents in fresh, dried, and toasted nori (Pyropia yezoensis) were analyzed. The mean iron content of fresh, dried, and toasted nori were 19.0, 22.6, and 26.2 mg/100 g (dry weight), respectively. These values were superior to other food of plant origin. Furthermore, most of the iron in nori was maintained during processing, such as washing, drying, and toasting. Then, the form of iron in fresh, dried, and toasted nori was analyzed. As a result, an iron storage protein ferritin contributed to iron storage in raw and dried nori, although the precise rate of its contribution is yet to be determined, while ferritin protein cage was degraded in the toasted nori. It is the first report that verified the ferritin contribution to iron storage in such edible macroalgae with commercial importance.

  6. Advances in rapid cooling treatment for heat stroke

    Directory of Open Access Journals (Sweden)

    Jia-jia ZHAO

    2014-10-01

    Full Text Available Heat stroke is a life-threatening disease characterized clinically by central nervous system dysfunction and severe hyperthermia (core temperature rises to higher than 40℃. The unchecked rise of body core temperature overwhelms intrinsic or extrinsic heat generation mechanism, thus overwhelms homoeostatic thermoregulation. Hyperthermia causes cellular and organ dysfunction with progressive exacerbation resulting in multi-organ failure and death. Rapid cooling to reduce core temperature as quickly as possible is the primary and most effective treatment, as it has been shown that the major determinant of outcome in heatstroke is the degree and duration of hyperthermia. If suppression of body temperature is delayed, the fatality rate will be elevated. Several cooling methods are available, including physical cooling by conduction, convection and evaporation with ice/cold water immersion, internal cooling by invasive methods such as hemofiltration, intravascular cooling, cold water gastric and rectal lavage, and cooling with drugs. It is crucial to formulate a scientific and reasonable strategy for the subsequent treatment in accordance with the patient's physical condition, the condition of cooling equipment, and the manipulator's proficiency in cooling methods and equipment usage. This article reviews the domestic and international advances in study of rapid and efficient cooling measures for heat stroke. DOI: 10.11855/j.issn.0577-7402.2014.10.17

  7. Young ischaemic stroke in South Auckland: a hospital-based study.

    Science.gov (United States)

    Wu, Teddy Y; Kumar, Ajay; Wong, Edward H

    2012-10-26

    To analyse the risk factors, trends in incidence and aetiology of stroke in young adults in a hospital-based population in South Auckland, New Zealand. A retrospective review of patients aged 15 years to 45 years with a discharge diagnosis of ischaemic stroke (ICD 10 Codes I63 - I65, G46, I672, I675-I679, I694- I694) from June 1 2004 to December 31, 2009. Vascular risk factors, demographic factors, stroke severity, stroke subtype, results of investigations and stroke outcome were determined from review of the hospital record (paper copy and electronic record). A total of 131 patients were identified, representing 4.6% of all stroke discharges. Over one-half of the patients were of "underdetermined cause" (Trial of Org 10172 in Acute Stroke Treatment [TOAST] criteria), (1) mainly due to incomplete investigation. Cardioembolism (16%) was the second most common cause of stroke, followed by small vessel disease and stroke of other determined aetiology (both 12.2%). Confirmed large vessel atherosclerosis (6.1%) was the least common cause of stroke in this study population. The most common risk factors were hyperlipidaemia (45.8%), hypertension (42.7%), current tobacco smoking (42.7%) and obesity (36.6%). The indigenous Maori and Pacific Island people had a higher rate of stroke, at least double of other ethnicities. The in-hospital fatality rate was 3.1%. All surviving patients were discharged home. Eighty-six percent of the survivors were independent. Our study demonstrates strokes of undetermined aetiology and cardioembolism were the most common cause of stroke in young people in South Auckland, and that Māori and Pacific Island people have a higher rate of stroke.

  8. Association of Diabetes and Prognosis of Minor Stroke and Its Subtypes: A Prospective Observational Study

    Science.gov (United States)

    Pan, Yuesong; Wang, Yongjun; Li, Hao; Gaisano, Herbert Y.; Wang, Yilong; He, Yan

    2016-01-01

    Background The association between diabetes mellitus (DM) and prognosis of minor stroke is unclear. The aim of this study is to investigate whether DM contributes to the prognosis of minor stroke or its specific subtype. Methods All minor ischemic stroke patients were derived from the China National Stroke Registry and classified into 5 subtypes according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. DM was defined as either self-reported physician diagnosis of diabetes or use of hypoglycemic medications during hospitalization or at discharge. Patients were followed up for 1 year for clinical outcomes of recurrent stroke, death and functional outcome. Poor functional outcomes were defined as a score of 2–6 for modified Rankin Score. Associations between DM and prognosis of minor stroke and its subtypes were analyzed by univariable and multivariable logistic regression. Results Of 4,548 patients with minor stroke, 1,230(27.0%) patients had DM, 1,038(22.8%) had poor outcomes and 570(13.0%) of 4,401 patients had recurrent stroke at 1 year. In multivariable analyses, DM were significantly associated with 1-year stroke recurrence (Odds Ratio [OR], 1.31; 95% confidence interval [CI]: 1.08–1.59) and poor outcome (OR, 1.51; 95%CI: 1.28–1.77). Among the subtypes of minor stroke, DM was only significantly associated with 1-year stroke recurrence (OR, 1.63; 95%CI: 1.07–2.50) and poor outcome (OR, 1.73; 95%CI: 1.22–2.45) in the small-artery occlusion subtype. Conclusions DM significantly increased the risk of stroke recurrence and poor outcome in the small-artery occlusion subtype, but not in other subtypes of minor stroke. PMID:27070309

  9. Stroke care challenges in rural India: Awareness of causes, preventive measures and treatment options of stroke among the rural communities

    Directory of Open Access Journals (Sweden)

    Kanaga Lakshmi

    2014-12-01

    Full Text Available Introduction: Management of stroke in the remote rural areas in India faces major challenges because of lack of awareness. Stroke care services can be optimally implemented only if the communities have an understanding of the disease. Method: A population based, cross sectional survey of an adult general population sample between the ages of 31-60 years in a rural block in Tamil Nadu, India was carried out to study their knowledge, attitude, beliefs about cause, signs and symptoms, preventive measures and treatment options of stroke. Results: Of the 174 subjects studied only 69% were aware of the term stroke and 63% were able to list the symptoms. Only a little more than half the participants (58% were aware that diabetes, smoking and hypertension are risk factors for stroke. None of the participants were aware of the endovascular thrombolysis injection for better recovery from stroke. About quarter (23% of the participants did not think that the stroke is an emergency condition and they need to take the patient urgently to the hospital. Only 56% of the participants had checked their blood pressure and 49% for diabetes. A history of having either hypertension or diabetes and stroke in the family was the only factor that was significantly associated with better awareness (p=<0.001 independent of other potential facilitating factors including age, occupation, education and gender. Conclusion: There is a need to educate the rural communities about the risk factors, how to recognize the onset, the preventive measures and optimum care of stroke to reduce the burden.

  10. Physical and chemical changes of rapeseed meal proteins during toasting and their effects onin vitrodigestibility.

    Science.gov (United States)

    Salazar-Villanea, Sergio; Bruininx, Erik M A M; Gruppen, Harry; Hendriks, Wouter H; Carré, Patrick; Quinsac, Alain; van der Poel, Antonius F B

    2016-01-01

    Toasting during the production of rapeseed meal (RSM) decreases ileal crude protein (CP) and amino acid (AA) digestibility. The mechanisms that determine the decrease in digestibility have not been fully elucidated. A high protein quality, low-denatured, RSM was produced and toasted up to 120 min, with samples taken every 20 min. The aim of this study was to characterize secondary structure and chemical changes of proteins and glucosinolates occurring during toasting of RSM and the effects on its in vitro CP digestibility. The decrease in protein solubility and the increase of intermolecular β-sheets with increasing toasting time were indications of protein aggregation. The contents of NDF and ADIN increased with increasing toasting time. Contents of arginine, lysine and O -methylisourea reactive lysine (OMIU-RL) linearly decreased with increasing toasting time, with a larger decrease of OMIU-RL than lysine. First-order reactions calculated from the measured parameters show that glucosinolates were degraded faster than lysine, OMIU-RL and arginine and that physical changes to proteins seem to occur before chemical changes during toasting. Despite the drastic physical and chemical changes noticed on the proteins, the coefficient of in vitro CP digestibility ranged from 0.776 to 0.750 and there were no effects on the extent of protein hydrolysis after 120 min. In contrast, the rate of protein hydrolysis linearly decreased with increasing toasting time, which was largely correlated to the decrease in protein solubility, lysine and OMIU-RL observed. Rate of protein hydrolysis was more than 2-fold higher for the untoasted RSM compared to the 120 min toasted material. Increasing the toasting time for the production of RSM causes physical and chemical changes to the proteins that decrease the rate of protein hydrolysis. The observed decrease in the rate of protein hydrolysis could impact protein digestion and utilization.

  11. Statin treatment and stroke outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Goldstein, L.B.; Amarenco, P.; Zivin, J.

    2009-01-01

    Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. RESULTS: Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5...... or no event), there was only a trend toward lesser severity with treatment based on the modified Rankin Scale score (P=0.0647) with no difference based on the National Institutes of Health Stroke Scale or Barthel Index. CONCLUSIONS: The present exploratory analysis suggests that the outcome of recurrent...... or 4), moderate (modified Rankin Scale score 3 or 2), and mild (modified Rankin Scale score 1 or 0) outcome ischemic strokes and transient ischemic attacks and an increase in the proportion of event-free subjects randomized to atorvastatin (P

  12. Improvement of Endovascular Stroke Treatment: A 24-Hour Neuroradiological On-Site Service Is Not Enough

    OpenAIRE

    Nikoubashman, Omid; Schürmann, Kolja; Othman, Ahmed E.; Bach, Jan-Philipp; Wiesmann, Martin; Reich, Arno

    2018-01-01

    Background and Purpose. With the advent of endovascular stroke treatment (EST) with mechanical thrombectomy, stroke treatment has also become more challenging. Purpose of this study was to investigate whether a fulltime neuroradiological on-site service and workflow optimization with a structured documentation of the interdisciplinary stroke workflow resulted in improved procedural times. Material and Methods. Procedural times of 322 consecutive patients, who received EST (1) before (n=96) an...

  13. Intracranial atherosclerosis: Causes of ischemic stroke, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    V.A Sorokoumov

    2014-01-01

    Full Text Available The paper reviews the literature on the identification of the causes of ischemic stroke and transient ischemic attacks in intracranial atherosclerosis. Symptomatic intracranial atherosclerosis is the cause of an ischemic focus in not only the cortical and subcortical structures due to hypoperfusion or arterio-arterial embolism, but also in the deep structures of the cerebral hemispheres and brainstem. Major artery dolichoectasia may make an accurate diagnosis and treatment choice difficult.Progress in the treatment of patients with symptomatic intracranial atherosclerosis depends on the availability of current brain and vessel imaging techniques and cranial artery angioplasty and stenting methods. The efficiency of aggressive medical prevention, primarily blood pressure reduction and different combinations of antiplatelet drugs, is being intensively investigated.

  14. 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 ...

  15. Patients With Undetermined Stroke Have Increased Atrial Fibrosis: A Cardiac Magnetic Resonance Imaging Study.

    Science.gov (United States)

    Fonseca, Ana Catarina; Alves, Pedro; Inácio, Nuno; Marto, João Pedro; Viana-Baptista, Miguel; Pinho-E-Melo, Teresa; Ferro, José M; Almeida, Ana G

    2018-03-01

    Some patients with ischemic strokes that are currently classified as having an undetermined cause may have structural or functional changes of the left atrium (LA) and left atrial appendage, which increase their risk of thromboembolism. We compared the LA and left atrial appendage of patients with different ischemic stroke causes using cardiac magnetic resonance imaging. We prospectively included a consecutive sample of ischemic stroke patients. Patients with structural changes on echocardiography currently considered as causal for stroke in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3-T cardiac magnetic resonance imaging was performed. One hundred and eleven patients were evaluated. Patients with an undetermined cause had a higher percentage of LA fibrosis ( P =0.03) than patients with other stroke causes and lower, although not statistically significant, values of LA ejection fraction. Patients with atrial fibrillation and undetermined stroke cause showed a similar value of atrial fibrosis. The LA phenotype that was found in patients with undetermined cause supports the hypothesis that an atrial disease may be associated with stroke. © 2018 American Heart Association, Inc.

  16. Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Aldo Bonaventura

    2016-11-01

    Full Text Available After an acute ischemic stroke (AIS, inflammatory processes are able to concomitantly induce both beneficial and detrimental effects. In this narrative review, we updated evidence on the inflammatory pathways and mediators that are investigated as promising therapeutic targets. We searched for papers on PubMed and MEDLINE up to August 2016. The terms searched alone or in combination were: ischemic stroke, inflammation, oxidative stress, ischemia reperfusion, innate immunity, adaptive immunity, autoimmunity. Inflammation in AIS is characterized by a storm of cytokines, chemokines, and Damage-Associated Molecular Patterns (DAMPs released by several cells contributing to exacerbate the tissue injury both in the acute and reparative phases. Interestingly, many biomarkers have been studied, but none of these reflected the complexity of systemic immune response. Reperfusion therapies showed a good efficacy in the recovery after an AIS. New therapies appear promising both in pre-clinical and clinical studies, but still need more detailed studies to be translated in the ordinary clinical practice. In spite of clinical progresses, no beneficial long-term interventions targeting inflammation are currently available. Our knowledge about cells, biomarkers, and inflammatory markers is growing and is hoped to better evaluate the impact of new treatments, such as monoclonal antibodies and cell-based therapies.

  17. Technologies for diagnosis and treatment of acute stroke

    Energy Technology Data Exchange (ETDEWEB)

    Fitch, J.P.

    1998-02-09

    From October 1994 to June 1997, a multidisciplinary team of scientists and engineers at Lawrence Livermore National Laboratory were funded through LDRD to develop and integrate technologies for diagnosis and treatment of acute stroke. The project was summarized in a Science and Technology Review article `Brain Attack` that appeared in June 1997 and again in the Center for Healthcare Technologies Report (UCRL-LR-124761). This article is the best overview of the project, epidemiology of stroke and technical progress. Most of the technical progress has been documented in conference papers and presentations and refereed journal articles. Additional technical publication can be expected as our remaining patent applications progress through the US Patent and Trademark Office. The purpose of this report is to provide an appropriate introduction and organization to the numerous publications so that interested readers can quickly find information. Because there is no documentation for the history of this project, this report provides a summary. It also provides the final status report for the LDRD funding.

  18. Comparing withdrawal and not withdrawal of life-sustaining treatment among patients who died from stroke

    Directory of Open Access Journals (Sweden)

    Helvig E

    2015-09-01

    Full Text Available Eirik Helvig,1 Lars Thomassen,2 Ulrike Waje-Andreassen,2 Halvor Naess3 1Department of Neurology, Haukeland University Hospital, Jonas Liesgt, Bergen, 2Institute of Clinical Medicine, University of Bergen, Bergen, 3Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, NorwayBackground: In severe stroke, a decision to withdraw life-sustaining treatment is sometimes made in cooperation with the family. The aim of this study was to study the time from withdrawing life-sustaining treatment to death in patients with severe ischemic or hemorrhagic stroke.Methods: In total, 2,506 patients with stroke admitted to Haukeland University Hospital between 2006 and 2011 were prospectively registered in the Bergen NORSTROKE database. Risk factors, stroke severity, etiology, and blood analyses were registered. Retrospectively, the patients' records were examined to determine the number of days from withdrawing all life-sustaining treatment to death in patients who died from severe stroke during the hospital stay.Results: Life-sustaining treatment was withheld in 50 patients with severe stroke. Median time to death after withdrawing life-sustaining treatment was 4 days, and a quarter lived at least 1 week (range =1–11 days. Cox regression analyses showed that short time from withdrawing life-sustaining treatment to death was associated with high age (Hazard ratio [HR] =1.05, P=0.07, male sex (HR =2.9, P=0.01, high C-reactive protein on admission (HR =1.01, P=0.001, and hemorrhagic stroke (versus ischemic stroke, HR =1.5, P=0.03.Conclusion: One week after withdrawing life-sustaining treatment, a quarter of our patients with severe stroke remained alive. Short time to death was associated with high age, male sex, hemorrhagic stroke, and high C-reactive protein on admittance. Keywords: stroke, withdrawal of life-sustaining treatment, prognosis

  19. A Community-Engaged Assessment of Barriers and Facilitators to Rapid Stroke Treatment

    Science.gov (United States)

    Nemeth, Lynne S.; Jenkins, Carolyn; Jauch, Edward C.; Conway, Sharon; Pearlman, Adam; Spruill, Ida J.; Brown, Lynette J.; Linnen, Joyce; Linnen, Florene; Andrews, Jeannette O.

    2016-01-01

    Treatment for acute ischemic stroke must be initiated within hours of stroke symptom onset, and the sooner it is administered, the better. In South Carolina, 76% of the population can access expert stroke care, and rural hospitals may provide specialized treatment using telemedicine, but many stroke sufferers seek care too late to achieve full benefit. Using a community-engaged approach in a southern rural community, we explored barriers and facilitators to early stroke care and implications for improvement. The Community-Engaged Assessment to facilitate Stroke Elimination (CEASE) study was guided by a community advisory group to ensure community centeredness and local relevance. In a qualitative descriptive study, eight focus groups were conducted including 52 individuals: recent stroke survivors, family members, emergency medical personnel, hospital emergency department staff, primary care providers, and community leaders. From analysis of focus group transcripts came six themes: lack of trust in healthcare system and providers; weak relationships fueled by poor communication; low health literacy; financial limitations related to health care; community-based education; and faith as a message of hope. A hierarchy model for improving early community-based stroke care was developed through consensus dialogue by community representatives and the research team. This model can be used to inform a community-partnered, stake-holder-informed intervention to improve stroke care in a rural southern community with the goal of improving stroke education, care, and outcome. PMID:27545591

  20. Rehabilitation Treatment In Aphasia Caused By Stroke(Review

    Directory of Open Access Journals (Sweden)

    Parvane Rahimifar

    2017-02-01

    Full Text Available Aphasia is a relatively common language disorder, occurring in about 25% of all stroke patients. The ultimate aim of aphasia treatment is to improve patients oral and written language abilities and to facilitate their participation in everyday communication. Over the last decades, a range of approaches in aphasia therapy have been introduced, based on cognitive neuropsychological models, psycholinguistic theories, and socio-pragmatic approaches. In view of the range of different approaches and findings of therapy studies, the challenge for therapists is to decide which approach is the most appropriate one for an aphasic individual at a specific stage of recovery. The Findings showed that, therapy plan for aphasic individuals involves selecting the therapeutic approach most appropriate for dealing with a particular type of disorder, degree of severity, stage of recovery and the extent of the patient's participation in social life. A framework of aphasia treatment is outlined which considers the rehabilitation process at the various stages of recovery, and Different approaches are combined into a comprehensive treatment regimen which differentiates three stages of recovery: the acute, post-acute, and chronic stage. Also ,The intensive therapy in the treatment of language disorders have a great effect, and Brain imaging studies have shown that the linguistic reorganization of a damaged brain is aided by intensive speech therapy even in the chronic phase.

  1. Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study

    OpenAIRE

    Weng, Shu-Wen; Liao, Chien-Chang; Yeh, Chun-Chieh; Chen, Ta-Liang; Lane, Hsin-Long; Lin, Jaung-Geng; Shih, Chun-Chuan

    2016-01-01

    Objective To investigate the risk of epilepsy in stroke patients receiving and not receiving acupuncture treatment. Design Retrospective cohort study. Setting This study was based on Taiwan's National Health Insurance Research Database that included information on stroke patients hospitalised between 1 January 2000 and 31 December 2004. Participants We identified 42?040 patients hospitalised with newly diagnosed stroke who were aged 20?years and above. Primary and secondary outcome measures W...

  2. Preadmission oral anticoagulant treatment and clinical outcome among patients hospitalized with acute stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Svendsen, Marie Louise; Hansen, Morten Lock

    2014-01-01

    Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide...... historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further....

  3. Distribution territories and causative mechanisms of ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, A.; Grive, E.; Alvarez-Sabin, J. [Unidad de Resonancia Magnetica, Hospital Vall d' Hebron, Barcelona (Spain)

    2005-03-01

    Ischemic stroke prognosis, risk of recurrence, clinical assessment, and treatment decisions are influenced by stroke subtype (anatomic distribution and causative mechanism of infarction). Stroke subtype diagnosis is better achieved in the early phase of acute ischemia with the use of multimodal MR imaging. The pattern of brain lesions as shown by brain MR imaging can be classified according to a modified Oxfordshire method, based on the anatomic distribution of the infarcts into six groups: (1) total anterior circulation infarcts, (2) partial anterior circulation infarcts, (3) posterior circulation infarcts, (4) watershed infarcts, (5) centrum ovale infarcts, and (6) lacunar infarcts. The subtype of stroke according to its causative mechanism is based on the TOAST method, which classifies stroke into five major etiologic groups: (1) large-vessel atherosclerotic disease, (2) small-vessel atherosclerotic disease, (3) cardioembolic source, (4) other determined etiologies, and (5) undetermined or multiple possible etiologies. The different MR imaging patterns of acute ischemic brain lesions visualized using diffusion-weighted imaging and the pattern of vessel involvement demonstrated with MR angiography are essential factors that can suggest the most likely causative mechanism of infarction. This information may have an impact on decisions regarding therapy and the performance of additional diagnostic tests. (orig.)

  4. Increased stroke risk in Bell's palsy patients without steroid treatment.

    Science.gov (United States)

    Lee, C-C; Su, Y-C; Chien, S-H; Ho, H-C; Hung, S-K; Lee, M-S; Chou, P; Chiu, B C-H; Huang, Y-S

    2013-04-01

    To investigate the risk of stroke development following a diagnosis of Bell's palsy in a nationwide follow-up study. Information on Bell's palsy and other factors relevant for stroke was obtained for 433218 eligible subjects without previous stroke who had ambulatory visit in 2004. Of those, 897 patients with Bell's palsy were identified. Over a median 2.9 years of follow-up, 4581 incident strokes were identified. We estimated hazard ratios (HR) and 95% confidence intervals [CI] with Cox proportional hazard models adjusting for age, sex, co-morbidities, and important risk factors. Standardized incidence ratio of stroke amongst patients with Bell's palsy was analyzed. Compared with non-Bell's palsy patients, patients with Bell's palsy had a 2.02-times (95% CI, 1.42-2.86) higher risk of stroke. The adjusted HR of developing stroke for patients with Bell's palsy treated with and without systemic steroid were 1.67 (95% CI, 0.69-4) and 2.10 (95%, 1.40-3.07), respectively. Patients with Bell's palsy carry a higher risk of stroke than the general population. Our data suggest that these patients might benefit from a more intensive stroke prevention therapy and regular follow-up after initial diagnosis. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  5. Increased risk of treatment with antidepressants in stroke compared with other chronic illness

    DEFF Research Database (Denmark)

    Dam, Henrik; Harhoff, Mette; Andersen, Per Kragh

    2007-01-01

    The prevalence of depression and anxiety is higher in patients with stroke than in the general population but it is unclear whether patients with stroke are at an increased risk of being treated for depression and anxiety compared with patients with other chronic illness. The objective...... of the present study was to investigate whether the rate of treatment with antidepressants is increased in patients with stroke compared with patients with other chronic illness and compared with the general population. By linkage of nationwide case registers, all patients who received a main diagnosis of stroke...

  6. Music and Stroke Rehabilitation: A Narrative Synthesis of the Music-Based Treatments used to Rehabilitate Disorders of Speech and Language following Left-Hemispheric Stroke

    OpenAIRE

    Kevin Draper

    2016-01-01

    Stroke is a leading cause of long-term disability. A stroke can damage areas of the brain associated with communication, resulting in speech and language disorders. Such disorders are frequently acquired impairments from left-hemispheric stroke. Music-based treatments have been implemented, and researched in practice, for the past thirty years; however, the number of published reports reviewing these treatments is limited. This paper uses the four elements of the narrative synthesis framework...

  7. Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study

    DEFF Research Database (Denmark)

    Jørgensen, H S; Kammersgaard, L P; Nakayama, H

    1999-01-01

    We have previously reported a marked reduction in mortality up to 1 year after treatment and rehabilitation on a stroke unit versus on general neurological and medical wards in unselected stroke patients. In the present study we wanted to test the hypothesis that this mortality-reducing effect...

  8. An augmented cognitive behavioural therapy for treating post-stroke depression: description of a treatment protocol

    NARCIS (Netherlands)

    Kootker, J.A.; Rasquin, S.M.C.; Smits, P.; Geurts, A.C.H.; Heugten, C.M. van; Fasotti, L.

    2015-01-01

    Aim Currently, no evidence-based treatment is available for mood problems after stroke. We present a new psychological intervention designed to reduce depressive complaints after stroke. Method of protocol development This intervention was based on cognitive behavioural therapy principles and was

  9. An augmented cognitive behavioural therapy for treating post-stroke depression: description of a treatment protocol

    NARCIS (Netherlands)

    Kootker, J.A.; Rasquin, S.M.; Smits, P; Geurts, A.C.H.; Heugten, C.M. van; Fasotti, L.

    2015-01-01

    AIM: Currently, no evidence-based treatment is available for mood problems after stroke. We present a new psychological intervention designed to reduce depressive complaints after stroke. METHOD OF PROTOCOL DEVELOPMENT: This intervention was based on cognitive behavioural therapy principles and was

  10. Bringing the hospital to the patient: first treatment of stroke patients at the emergency site.

    Directory of Open Access Journals (Sweden)

    Silke Walter

    2010-10-01

    Full Text Available Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.We developed a "Mobile Stroke Unit", consisting of an ambulance equipped with computed tomography, a point-of-care laboratory system for complete stroke laboratory work-up, and telemedicine capabilities for contact with hospital experts, to achieve delivery of etiology-specific and guideline-adherent stroke treatment at the site of the emergency, well before arrival at the hospital. In a departure from current practice, stroke patients could be differentially treated according to their ischemic or hemorrhagic etiology even in the prehospital phase of stroke management. Immediate diagnosis of cerebral ischemia and exclusion of thrombolysis contraindications enabled us to perform prehospital rt-PA thrombolysis as bridging to later intra-arterial recanalization in one patient. In a complementary patient with cerebral hemorrhage, prehospital diagnosis allowed immediate initiation of hemorrhage-specific blood pressure management and telemedicine consultation regarding surgery. Call-to-therapy-decision times were 35 minutes.This preliminary study proves the feasibility of guideline-adherent, etiology-specific and causal treatment of acute stroke directly at the emergency site.

  11. NESDIS Total Ozone from Analysis of Stratospheric and Tropospheric components (TOAST)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — TOAST combines UV and IR ozone retrievals from an algorithm using the Solar Backscatter Ultraviolet Version 2 (SBUV/2) and the Cross-track Infrared Sounder (CrIS)...

  12. Cell Treatment for Stroke in Type Two Diabetic Rats Improves Vascular Permeability Measured by MRI.

    Directory of Open Access Journals (Sweden)

    Guangliang Ding

    Full Text Available Treatment of stroke with bone marrow stromal cells (BMSC significantly enhances brain remodeling and improves neurological function in non-diabetic stroke rats. Diabetes is a major risk factor for stroke and induces neurovascular changes which may impact stroke therapy. Thus, it is necessary to test our hypothesis that the treatment of stroke with BMSC has therapeutic efficacy in the most common form of diabetes, type 2 diabetes mellitus (T2DM. T2DM was induced in adult male Wistar rats by administration of a high fat diet in combination with a single intraperitoneal injection (35mg/kg of streptozotocin. These rats were then subjected to 2h of middle cerebral artery occlusion (MCAo. T2DM rats received BMSC (5x106, n = 8 or an equal volume of phosphate-buffered saline (PBS (n = 8 via tail-vein injection at 3 days after MCAo. MRI was performed one day and then weekly for 5 weeks post MCAo for all rats. Compared with vehicle treated control T2DM rats, BMSC treatment of stroke in T2DM rats significantly (p<0.05 decreased blood-brain barrier disruption starting at 1 week post stroke measured using contrast enhanced T1-weighted imaging with gadopentetate, and reduced cerebral hemorrhagic spots starting at 3 weeks post stroke measured using susceptibility weighted imaging, although BMSC treatment did not reduce the ischemic lesion volumes as demarcated by T2 maps. These MRI measurements were consistent with histological data. Thus, BMSC treatment of stroke in T2DM rats initiated at 3 days after stroke significantly reduced ischemic vascular damage, although BMSC treatment did not change infarction volume in T2DM rats, measured by MRI.

  13. Time to treatment with intravenous alteplase and outcome in stroke

    DEFF Research Database (Denmark)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger

    2010-01-01

    BACKGROUND: Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to trea...

  14. Frequency and predictors of stroke after acute myocardial infarction: specific aspects of in-hospital and postdischarge events.

    Science.gov (United States)

    Hachet, Olivier; Guenancia, Charles; Stamboul, Karim; Daubail, Benoit; Richard, Carole; Béjot, Yannick; Yameogo, Valentin; Gudjoncik, Aurélie; Cottin, Yves; Giroud, Maurice; Lorgis, Luc

    2014-12-01

    Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced in-hospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis

  15. Research progress of endovascular treatment of acute ischemic stroke: Chinese scholars' reports published abroad

    Directory of Open Access Journals (Sweden)

    Ji LIU

    2017-11-01

    Full Text Available Stroke has become the leading common cause of disability and the second most common cause of death in China. Endovascular treatment emerged in recent years as a promising treatment method with a higher recanalization rate and better functional outcome in patients with acute ischemic stroke caused by large vessel occlusion. This paper selected 4 high-quality retrospective studies by Chinese scholars regarding endovascular treatment in patients with acute ischemic stroke, which were published in foreign journals during past 3 years, and focused on study methods and results. DOI: 10.3969/j.issn.1672-6731.2017.11.003

  16. Toasting of cereal grains: effects on in vitro rumen gas production and VFA yield

    Directory of Open Access Journals (Sweden)

    Seerp Tamminga

    2010-01-01

    Full Text Available The fermentation properties of the following feeds: pelleted barley (PB, toasted and pelleted barley (TPB, pelleted maize (PM and toasted and pelleted maize (TPM were studied using an in vitro gas production (GP technique. Each feed sample (0.5g was incubated (3 replications, with rumen fluid collected from 3 grazing lactating dairy cows. The kinetics of GP were automatically recorded for 72h. The amounts of DM disappeared (DMd and the volatile fatty acid yields (VFA were measured. On barley, compared to simple pelleting, toasting significantly (P<0.05 reduced DMd (87.5 vs. 86.2%, the asymptotic GP (A, 388 vs. 367ml/g DMd and slightly increased the time of maximum GP rate (TRmax, 2.89 vs. 3.15h. On maize toasting did not affect DMd and A, but significantly reduced T1/2 (9.71 vs. 8.57; P<0.05 and TRmax (5.04 vs. 4.49, P<0.05. Toasting significantly reduced the VFA yields both of barley and maize. These results, in agreement with previous in sacco and in vivo observations, suggest that toasting might reduce the amount of potential fermentable substrate of barley, whereas it might increase the rate of fermentation of maize.

  17. The effect of yogurt on acetaminophen absorption by activated charcoal and burnt toast.

    Science.gov (United States)

    Dasgupta, Amitava; Wells, Alice

    2007-01-01

    Although acetaminophen overdose can be treated with N-acetylcysteine, activated charcoal is useful in preventing absorption of acetaminophen from the gut. Mixing activated charcoal with yogurt may make the dose more palatable. We investigated effects of yogurt on absorption of acetaminophen by burnt toast or activated charcoal in intestinal fluid using an in vitro model. The aliquots of phosphate buffer saline (PBS) were supplemented with high concentrations of acetaminophen after adjusting the pH to 7.2 (to mimic intestinal fluid). Then specimens were treated with various dosages (15 mg/mL, 25 mg/mL, or 50 mg/mL) of activated charcoal or burnt toast. A small amount of fluid was withdrawn at 0, 5, 10, 20, and 30 min and acetaminophen concentrations were measured by the fluorescence polarization immunoassay (FPIA). We also treated other aliquots of PBS buffer containing acetaminophen with activated charcoal and yogurt or burnt toast and yogurt. Then small aliquots were withdrawn at specific time intervals to determine concentrations of acetaminophen. Activated charcoal was very effective in removing acetaminophen from intestinal fluids and the presence of yogurt insignificantly affected such absorptions. In contrast, burnt toast had a modest effect on removing acetaminophen from fluids but yogurt significantly increased the capability of burnt toast to absorb acetaminophen. However, the activated charcoal/yogurt combination is more effective than the burnt toast/yogurt combination for absorbing acetaminophen.

  18. Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service

    International Nuclear Information System (INIS)

    McCusker, M.W.; Robinson, S.; Looby, S.; Power, S.; Ti, J.P.; Grech, R.; Galvin, L.; O'Hare, A.; Brennan, P.; O'Kelly, P.; O'Brien, P.; Collins, R.; Dolan, E.; Williams, D.J.; Thornton, J.

    2015-01-01

    Aim: To report the experience of a regional stroke referral service with endovascular treatment for patients with acute ischaemic stroke (AIS) and large vessel occlusion. Materials and methods: A prospective review was undertaken of 93 consecutive cases receiving endovascular treatment for AIS over a 42-month period (January 2010 to June 2013). The National Institutes of Health Stroke Scale (NIHSS), location of large vessel occlusion, details of endovascular procedure, and degree of reperfusion achieved (Thrombolysis In Cerebral Infarction [TICI] score) were recorded. Mortality and functional outcome (modified Rankin Scale [mRS]) were measured at 90 days. Results: The mean patient age was 62 years (range 26–87 years). The mean NIHSS at presentation was 16 (range 6–29). All patients had confirmed proximal large-artery occlusion on computed tomography (CT) angiography: 87 in the anterior circulation, six in the posterior circulation. Of the 93 patients treated, 64 (69%) received intravenous thrombolysis. Successful reperfusion (TICI grade 2a to 3) was achieved in 80 (86%) cases. There were 13 (14%) cases of failed vessel recanalisation (TICI grade 0). Good functional outcome (mRS ≤2) was achieved in 51 (55%) cases. The 90-day mortality was 20 (22%) cases. Fifty-seven (61%) cases were transferred from outside centres. There was no significant increase in morbidity or mortality for transferred patients. Conclusion: Successful endovascular recanalisation can result in good functional outcomes for patients with AIS and large vessel occlusion. Our interventional neuroradiology service provides endovascular treatment as part of a regional stroke service without increase in morbidity or mortality for patients transferred from outside institutions. - Highlights: • Acute stoke patients may benefit from transfer to a specialist centre for endovascular treatment. • The authors offer endovascular treatment for suitable patients as part of a regional stroke service.

  19. Physical and chemical changes of rapeseed meal proteins during toasting and their effects on in vitro digestibility

    OpenAIRE

    Salazar-Villanea, Sergio; Bruininx, Erik M. A. M.; Gruppen, Harry; Hendriks, Wouter H.; Carr?, Patrick; Quinsac, Alain; van der Poel, Antonius F. B.

    2016-01-01

    BackgroundToasting during the production of rapeseed meal (RSM) decreases ileal crude protein (CP) and amino acid (AA) digestibility. The mechanisms that determine the decrease in digestibility have not been fully elucidated. A high protein quality, low-denatured, RSM was produced and toasted up to 120 min, with samples taken every 20 min. The aim of this study was to characterize secondary structure and chemical changes of proteins and glucosinolates occurring during toasting of RSM and the ...

  20. Develop of a Sweet Cookie with toasted sesame and ground

    Directory of Open Access Journals (Sweden)

    Dr.C. Aldo Hernández-Monzón

    2015-11-01

    Full Text Available The sweet cookies nutritionally are rich source of energy and they have great acceptance to world level and the sesame (Sésamum indicum it is of the family of the oleaginous ones that possesses a high quantity of protein and fat where 80% belongs to the fatty polinsaturadas fundamentally linoleic acid, it has high content of calcium and the presence iron, magnesium and zinc, what makes it a functional food. This work had as objective to develop a sweet cookie with addition of toastedsesame and ground with good characteristic sensorial and nutritional. The addition of the toasted sesame and ground it was carried out in dose of 10, 15 and 20% to the formulation of a sweet cookie. The sweet cookies were evaluated by seven trained judges to determine the most appropriate dose according to the general impression of obtained quality. The accepted formulation it was determined humidity, proteins, fat, ashy, calcium, iron, and zinc and texture analysis. The best formulation wasthat of 15% sesame for the obtaining of a product with an acceptability of excellent, a percentage of humidity and typical fat of sweet cookies and high content of proteins and calcium as well as appreciable iron content and zinc. The obtained sweet cookie was characterized sensorial to possess a scent and flavor defined to sesame, good crujencia and harmony among its components, very pleasant hardness and the weight and thickness similar to that of other sweet cookies.

  1. Intra-Arterial Treatment in a Child with Embolic Stroke Due to Atrial Myxoma

    Science.gov (United States)

    van den Wijngaard, Ido; Wermer, Marieke; van Walderveen, Marianne; Wiendels, Natalie; Peeters-Scholte, Cacha; Lycklama à Nijeholt, Geert

    2014-01-01

    Summary Arterial ischaemic stroke is an important cause of morbidity in children. Timely diagnosis is necessary for acute stroke treatment but can be challenging in clinical practice. Due to a paucity of data there are no specific recommendations regarding the use of mechanical thrombectomy devices in current paediatric stroke guidelines. A 14-year-old boy presented with a severe acute left hemisphere stroke due to a proximal middle cerebral artery occlusion caused by emboli from an atrial myxoma. No clinical improvement was seen after administration of intravenous thrombolysis. Subsequent mechanical thrombectomy with a second-generation stent-based thrombectomy device resulted in successful recanalization and clinical improvement. To our knowledge, this is the first report of mechanical thrombectomy in a child with acute embolic stroke caused by atrial myxoma. PMID:24976098

  2. Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Fazekas, Franz; McCabe, Dominick J H; Giese, Anne-Katrin; Kessler, Christof; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Schmidt, Reinhold; Tanislav, Christian; Putaala, Jukka; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt; Enzinger, Christian

    2017-09-01

    We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients. We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, P =0.065; 29.1% versus 16.5% for old lesions, P ischemic attack and ischemic stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2017 American Heart Association, Inc.

  3. Stroke subtypes and comorbidity among ischemic stroke patients in Brasilia and Cuenca: a Brazilian-Spanish cross-cultural study.

    Science.gov (United States)

    Carod-Artal, Francisco Javier; Casanova Lanchipa, Jardiel Omar; Cruz Ramírez, Luis Miguel; Pérez, Noelia Sánchez; Siacara Aguayo, Fátima M; Moreno, Isabel Gómez; Romero, Lourdes Gómez; Coral, Luciene Ferreira; Trizotto, Daniele Stieven; Moreira, Clarissa Menezes

    2014-01-01

    With the increase in life expectancy worldwide, changes in stroke subtypes and burden of stroke population are expected in both developing and developed countries. Prevalence of stroke subtypes and comorbidity in ischemic stroke patients was assessed in Brasilia, Brazil, and Cuenca, Spain. This was an international (Brazilian-Spanish) cross-sectional study. Stroke subtypes were assessed by means of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Modified Rankin scale was used to measure functional recovery and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to assess comorbidity. A total of 500 patients (mean age 66.2 ± 16.4 years; 48% female; 48.2% Spanish) were included in the study. Spanish patients were significantly older than Brazilian ones (76.4 ± 11.2 versus 56.7 ± 14.6 years; P < .0001). Prevalence of ischemic cardiopathy (20.3% versus 6.2%) and atrial fibrillation (25.7% versus 6.6%) was significantly higher in Spanish stroke patients, whereas they less frequently used tobacco (28.3% versus 52.9%); P less than .0001. Prevalence of stroke subtypes in Spanish and Brazilian stroke patients was: stroke of undetermined etiology (58.1% versus 32.4%), cardioembolism (24.5% versus 11.6%), lacunar infarct (11.6% versus 25.5%), atherothrombotic (3.7% versus 19.7%), and other causes (2.1% versus 10.8%); P less than .0001. The Spanish sample had a significantly higher frequency of comorbidities. The CIRS-G total score and CIRS-G mean number of affected organs significantly increased with age, and correlated with the level of functional dependence as measured by Rankin scale (rS = 0.50; P = .0005). Spanish stroke people had a higher frequency of comorbid conditions, atrial fibrillation, and cardioembolism and these facts were associated with age. Atherothrombotic and lacunar strokes were more common in the younger Brazilian stroke population. Copyright © 2014 National Stroke Association. Published by Elsevier

  4. The effect of medical treatments on stroke risk in asymptomatic carotid stenosis.

    Science.gov (United States)

    King, Alice; Shipley, Martin; Markus, Hugh

    2013-02-01

    Recent evidence suggests current best medical treatment may be sufficient to prevent stroke in patients with asymptomatic carotid stenosis. If this is the case, then it is important to determine risk reduction provided by treatments. Using Asymptomatic Carotid Emboli Study (ACES) prospective data, the effect of current treatment and risk factors on future stroke and transient ischemic attack risk were determined. Four-hundred seventy-seven patients with asymptomatic carotid stenosis were followed-up every 6 months for 2 years. Changes in risk factors and stroke prevention therapies were reviewed at each visit. Using time-dependent Cox regression, the relationship between current treatment over time was determined and presented as hazard ratios and 95% confidence intervals for risk of stroke, transient ischemic attack, and cardiovascular death end points. On multivariate analysis, antiplatelets (P=0.001) and lower mean blood pressure (P=0.002) were independent predictors of reduced risk of ipsilateral stroke and transient ischemic attack. Antiplatelets (Pstroke or cardiovascular death. Antiplatelet therapy and blood pressure control are the most important factors in reducing short-term stroke and cardiovascular risk in patients with asymptomatic carotid stenosis. More prospective data are required for medical treatments in asymptomatic carotid stenosis in particular for current statin usage.

  5. Regional Pediatric Acute Stroke Protocol: Initial Experience During 3 Years and 13 Recanalization Treatments in Children.

    Science.gov (United States)

    Tabone, Laurence; Mediamolle, Nicolas; Bellesme, Celine; Lesage, Fabrice; Grevent, David; Ozanne, Augustin; Naggara, Olivier; Husson, Beatrice; Desguerre, Isabelle; Lamy, Catherine; Denier, Christian; Kossorotoff, Manoelle

    2017-08-01

    To evaluate hyperacute management of pediatric arterial ischemic stroke, setting up dedicated management pathways is the first recommended step to prove the feasibility and safety of such treatments. A regional pediatric stroke alert protocol including 2 centers in the Paris-Ile-de-France area, France, was established. Consecutive pediatric patients (28 days-18 years) with confirmed arterial ischemic stroke who had acute recanalization treatment (intravenous r-tPA [recombinant tissue-type plasminogen activator], endovascular procedure, or both) according to the regional pediatric stroke alert were retrospectively reviewed during a 40-month period. Thirteen children, aged 3.7 to 16.6 years, had recanalization treatment. Median time from onset to magnetic resonance imaging was 165 minutes (150-300); 9 out of 13 had large-vessel occlusion. Intravenous r-tPA was used in 11 out of 13 patients, with median time from onset to treatment of 240 minutes (178-270). Endovascular procedure was performed in patients time-out for intravenous r-tPA (n=2) or after intravenous r-tPA inefficiency (n=2). No intracranial or peripheral bleeding was reported. One patient died of malignant stroke; outcome was favorable in 11 out of 12 survivors (modified Rankin Scale score 0-2). Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged. © 2017 American Heart Association, Inc.

  6. Challenges of antithrombotic treatment after embolic stroke- case presentation

    Directory of Open Access Journals (Sweden)

    Ioana Stanescu

    2017-05-01

    Full Text Available Atrial fibrillation (AF represents one of the most common preventable causes of stroke, conferring a fivefold increased risk of stroke. The risk of stroke caused by AF is underestimated, many AF episodes being asymptomatic. Embolic strokes caused by AF can be prevented using anticoagulant therapy. The ESC (European Society of Cardiology guidelines for patients with AF recommend anticoagulant therapy if the risk for embolic stroke / systemic embolism, evaluated with the CHA2DS2-VASc score, is high. Bleeding is the major complication of anticoagulant therapy. For every patient taking anticoagulant medication, HAS-BLED score assessing the risk of bleeding needs to be performed. The priorities in treating patients with atrial fibrillation are protection against embolic events and minimal risk of hemorrhagic events. Vitamin K antagonists, despite their accessibility and long term use, have important limitations. New/direct oral anticoagulants are better options, with alt least identical efficacy and higher safety profile. In real life, the choice of the appropriate anticoagulant agent could be challenging.

  7. Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study.

    Science.gov (United States)

    Weng, Shu-Wen; Liao, Chien-Chang; Yeh, Chun-Chieh; Chen, Ta-Liang; Lane, Hsin-Long; Lin, Jaung-Geng; Shih, Chun-Chuan

    2016-07-13

    To investigate the risk of epilepsy in stroke patients receiving and not receiving acupuncture treatment. Retrospective cohort study. This study was based on Taiwan's National Health Insurance Research Database that included information on stroke patients hospitalised between 1 January 2000 and 31 December 2004. We identified 42 040 patients hospitalised with newly diagnosed stroke who were aged 20 years and above. We compared incident epilepsy during the follow-up period until the end of 2009 in stroke patients who were and were not receiving acupuncture. The adjusted HRs and 95% CIs of epilepsy associated with acupuncture were calculated using multivariate Cox proportional hazard regression. Stroke patients who received acupuncture treatment (9.8 per 1000 person-years) experienced a reduced incidence of epilepsy compared to those who did not receive acupuncture treatment (11.5 per 1000 person-years), with an HR of 0.74 (95% CI 0.68 to 0.80) after adjustment for sociodemographic factors and coexisting medical conditions. Acupuncture treatment was associated with a decreased risk of epilepsy, particularly among stroke patients aged 20-69 years. The log-rank test probability curve indicated that stroke patients receiving acupuncture treatment had a reduced probability of epilepsy compared with individuals who did not receive acupuncture treatment during the follow-up period (pacupuncture treatment had a reduced risk of epilepsy compared with those not receiving acupuncture treatment. However, the protective effects associated with acupuncture treatment require further validation in prospective cohort studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

    Science.gov (United States)

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

    2014-08-26

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

  9. Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke.

    Science.gov (United States)

    Hao, Yonggang; Yang, Dong; Wang, Huaiming; Zi, Wenjie; Zhang, Meng; Geng, Yu; Zhou, Zhiming; Wang, Wei; Xu, Haowen; Tian, Xiguang; Lv, Penghua; Liu, Yuxiu; Xiong, Yunyun; Liu, Xinfeng; Xu, Gelin

    2017-05-01

    Symptomatic intracranial hemorrhage (SICH) pose a major safety concern for endovascular treatment of acute ischemic stroke. This study aimed to evaluate the risk and related factors of SICH after endovascular treatment in a real-world practice. Patients with stroke treated with stent-like retrievers for recanalizing a blocked artery in anterior circulation were enrolled from 21 stroke centers in China. Intracranial hemorrhage was classified as symptomatic and asymptomatic ones according to Heidelberg Bleeding Classification. Logistic regression was used to identify predictors for SICH. Of the 632 enrolled patients, 101 (16.0%) were diagnosed with SICH within 72 hours after endovascular treatment. Ninety-day mortality was higher in patients with SICH than in patients without SICH (65.3% versus 18.8%; P 0.83 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.24-3.46), pretreatment Alberta Stroke Program Early Computed Tomography Score of stroke of cardioembolism type (OR, 1.91; 95% CI, 1.13-3.25), poor collateral circulation (OR, 1.97; 95% CI, 1.16-3.36), delay from symptoms onset to groin puncture >270 minutes (OR, 1.70; 95% CI, 1.03-2.80), >3 passes with retriever (OR, 2.55; 95% CI, 1.40-4.65) were associated with SICH after endovascular treatment. Incidence of SICH after thrombectomy is higher in Asian patients with acute ischemic stroke. Cardioembolic stroke, poor collateral circulation, delayed endovascular treatment, multiple passes with stent retriever device, lower pretreatment Alberta Stroke Program Early Computed Tomography Score, higher baseline neutrophil ratio may increase the risk of SICH. © 2017 American Heart Association, Inc.

  10. Substitution of Linoleic Acid for Other Macronutrients and the Risk of Ischemic Stroke.

    Science.gov (United States)

    Venø, Stine K; Schmidt, Erik B; Jakobsen, Marianne U; Lundbye-Christensen, Søren; Bach, Flemming W; Overvad, Kim

    2017-12-01

    Ischemic stroke is a major health problem worldwide, but the influence of dietary factors on stroke risk is not well known. This study aimed to investigate the risk of ischemic stroke and its subtypes with a higher intake from linoleic acid and a concomitant lower intake from saturated fatty acids, monounsaturated fatty acids, or glycemic carbohydrates. In the Danish prospective Diet, Cancer, and Health Study of 57 053 participants aged 50 to 64 years at baseline, information on diet was collected using a validated semiquantitative food frequency questionnaire. Information on ischemic stroke was obtained from the Danish National Patient Register, and cases were all validated and subclassified according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. Substitution of linoleic acid for saturated fatty acid, monounsaturated fatty acid, or glycemic carbohydrates was investigated in relation to the risk of ischemic stroke and subtypes. Cox proportional hazards regression was used to estimate the associations with ischemic stroke adjusting for appropriate confounders. During 13.5 years of follow-up 1879 participants developed ischemic stroke. A slightly lower risk of ischemic stroke was found with a 5% higher intake of linoleic acid and a concomitant lower intake of saturated fatty acid (hazard ratio, 0.98; 95% confidence interval, 0.83-1.16), monounsaturated fatty acid (hazard ratio, 0.80; 95% confidence interval, 0.63-1.02), and glycemic carbohydrates (hazard ratio, 0.92; 95% confidence interval, 0.78-1.09), although not statistically significant. Similar patterns of association were found for large-artery atherosclerosis and small-vessel occlusions. This study suggests that replacing saturated fatty acid, glycemic carbohydrate, or monounsaturated fatty acid with linoleic acid may be associated with a lower risk of ischemic stroke. © 2017 American Heart Association, Inc.

  11. [The rehabilitation treatment of patients with motor and cognitive disorders after stroke].

    Science.gov (United States)

    Sakharov, V Iu; Isanova, V A

    2014-01-01

    Objective. To study the possibility of using the rehabilitative pneumatic suit "Atlant" in stroke outpatients. Material and methods. We studied 11 stroke patients who wore the pneumatic suit in the early rehabilitation period. A comparison group included 13 patients. The high effectiveness of complex treatment with using the suit "Atlant" was shown. The motor activity was improved in 71.4% of patients, the recovery of speech was found in 33.3% patients. Conclusion. Continuity of rehabilitation in outpatients with stroke promotes the recovery of functional activity, motor, cognitive and speech functions and positively impacts on the emotional state of the patient.

  12. Minocycline treatment in acute stroke: an open-label, evaluator-blinded study.

    Science.gov (United States)

    Lampl, Y; Boaz, M; Gilad, R; Lorberboym, M; Dabby, R; Rapoport, A; Anca-Hershkowitz, M; Sadeh, M

    2007-10-02

    Ischemic animal model studies have shown a neuroprotective effect of minocycline. To analyze the effect of minocycline treatment in human acute ischemic stroke. We performed an open-label, evaluator-blinded study. Minocycline at a dosage of 200 mg was administered orally for 5 days. The therapeutic window of time was 6 to 24 hours after onset of stroke. Data from NIH Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI) were evaluated. The primary objective was to compare changes from baseline to day 90 in NIHSS in the minocycline group vs placebo. One hundred fifty-two patients were included in the study. Seventy-four patients received minocycline treatment, and 77 received placebo. NIHSS and mRS were significantly lower and BI scores were significantly higher in minocycline-treated patients. This pattern was already apparent on day 7 and day 30 of follow-up. Deaths, myocardial infarctions, recurrent strokes, and hemorrhagic transformations during follow-up did not differ by treatment group. Patients with acute stroke had significantly better outcome with minocycline treatment compared with placebo. The findings suggest a potential benefit of minocycline in acute ischemic stroke.

  13. Mobile Interventional Stroke Teams Lead to Faster Treatment Times for Thrombectomy in Large Vessel Occlusion.

    Science.gov (United States)

    Wei, Daniel; Oxley, Thomas J; Nistal, Dominic A; Mascitelli, Justin R; Wilson, Natalie; Stein, Laura; Liang, John; Turkheimer, Lena M; Morey, Jacob R; Schwegel, Claire; Awad, Ahmed J; Shoirah, Hazem; Kellner, Christopher P; De Leacy, Reade A; Mayer, Stephan A; Tuhrim, Stanley; Paramasivam, Srinivasan; Mocco, J; Fifi, Johanna T

    2017-12-01

    Endovascular recanalization treatment for acute ischemic stroke is a complex, time-sensitive intervention. Trip-and-treat is an interhospital service delivery model that has not previously been evaluated in the literature and consists of a shared mobile interventional stroke team that travels to primary stroke centers to provide on-site interventional capability. We compared treatment times between the trip-and-treat model and the traditional drip-and-ship model. We performed a retrospective analysis on 86 consecutive eligible patients with acute ischemic stroke secondary to large vessel occlusion who received endovascular treatment at 4 hospitals in Manhattan. Patients were divided into 2 cohorts: trip-and-treat (n=39) and drip-and-ship (n=47). The primary outcome was initial door-to-puncture time, defined as the time between arrival at any hospital and arterial puncture. We also recorded and analyzed the times of last known well, IV-tPA (intravenous tissue-type plasminogen activator) administration, transfer, and reperfusion. Mean initial door-to-puncture time was 143 minutes for trip-and-treat and 222 minutes for drip-and-ship ( P Stroke Scale for trip-and-treat compared with drip-and-ship ( P =0.0704). Compared with drip-and-ship, the trip-and-treat model demonstrated shorter treatment times for endovascular therapy in our series. The trip-and-treat model offers a valid alternative to current interhospital stroke transfers in urban environments. © 2017 American Heart Association, Inc.

  14. 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, ...

  15. Cerebrovascular recovery after stroke with individual and combined losartan and captopril treatment of SHRsp.

    Science.gov (United States)

    Smeda, John S; Daneshtalab, Noriko

    2017-09-01

    We assessed whether the superior restoration of cerebrovascular function after hemorrhagic stroke by losartan versus captopril treatment was due to better BP, uremia, uricaemia, or aldosterone control in Kyoto Wistar stroke-prone-hypertensive rats and evaluated whether elevated angiotensin II (A2) levels enhanced the effectiveness of losartan treatment. Constriction was studied in the middle cerebral arteries (MCAs) using a pressure myograph. Post-stroke survival increased from 21 to 310 and 189days respectively with losartan and captopril treatment. Neither treatment reduced BP, both reversed uremia and hyperaldosteronism equally after 7days. Plasma uric acid remained low. At stroke, MCA constriction to pressure (PDC), protein kinase C (PKC) activation, depolarization, and sarcoplasmic Ca 2+ were attenuated. Endothelial-dependent-vasodilation by bradykinin and endogenous NO release were lost. Both treatments recovered these functions within 7days. These functions deteriorated after 116days of captopril but not losartan treatment. Inhibiting A2 formation during losartan treatment didn't alter BP or vascular recovery. The superior recovery of PDC by losartan over captopril was not produced by better BP, uremia or aldosterone control or elevated A2. PDC recovery was associated with improved PKC function and enhanced basal NO release. The re-establishment of PDC could reduce cerebrovascular over-perfusion and hematoma expansion after stroke. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Development of the Test Of Astronomy STandards (TOAST) Assessment Instrument

    Science.gov (United States)

    Slater, Timothy F.; Slater, S. J.

    2008-05-01

    Considerable effort in the astronomy education research (AER) community over the past several years has focused on developing assessment tools in the form of multiple-choice conceptual diagnostics and content knowledge surveys. This has been critically important in advancing the AER discipline so that researchers could establish the initial knowledge state of students as well as to attempt measure some of the impacts of innovative instructional interventions. Unfortunately, few of the existing instruments were constructed upon a solid list of clearly articulated and widely agreed upon learning objectives. This was not done in oversight, but rather as a result of the relative youth of AER as a discipline. Now that several important science education reform documents exist and are generally accepted by the AER community, we are in a position to develop, validate, and disseminate a new assessment instrument which is tightly aligned to the consensus learning goals stated by the American Astronomical Society - Chair's Conference on ASTRO 101, the American Association of the Advancement of Science's Project 2061 Benchmarks, and the National Research Council's National Science Education Standards. In response, researchers from the Cognition in Astronomy, Physics and Earth sciences Research (CAPER) Team at the University of Wyoming's Science & Math Teaching Center (UWYO SMTC) have designed a criterion-referenced assessment tool, called the Test Of Astronomy STandards (TOAST). Through iterative development, this instrument has a high degree of reliability and validity for instructors and researchers needing information on students’ initial knowledge state at the beginning of a course and can be used, in aggregate, to help measure the impact of course-length duration instructional strategies for courses with learning goals tightly aligned to the consensus goals of our community.

  17. Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

    Directory of Open Access Journals (Sweden)

    Herlitz Johan

    2010-09-01

    Full Text Available Abstract Background The two major complications of atherosclerosis are acute myocardial infarction (AMI and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase. Method A literature search was performed on the PubMed, Embase (Ovid SP and Cochrane Library databases. Results In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women. With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke. Conclusion Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between

  18. Glibenclamide for the treatment of ischemic and hemorrhagic stroke.

    Science.gov (United States)

    Caffes, Nicholas; Kurland, David B; Gerzanich, Volodymyr; Simard, J Marc

    2015-03-04

    Ischemic and hemorrhagic strokes are associated with severe functional disability and high mortality. Except for recombinant tissue plasminogen activator, therapies targeting the underlying pathophysiology of central nervous system (CNS) ischemia and hemorrhage are strikingly lacking. Sur1-regulated channels play essential roles in necrotic cell death and cerebral edema following ischemic insults, and in neuroinflammation after hemorrhagic injuries. Inhibiting endothelial, neuronal, astrocytic and oligodendroglial sulfonylurea receptor 1-transient receptor potential melastatin 4 (Sur1-Trpm4) channels and, in some cases, microglial KATP (Sur1-Kir6.2) channels, with glibenclamide is protective in a variety of contexts. Robust preclinical studies have shown that glibenclamide and other sulfonylurea agents reduce infarct volumes, edema and hemorrhagic conversion, and improve outcomes in rodent models of ischemic stroke. Retrospective studies suggest that diabetic patients on sulfonylurea drugs at stroke presentation fare better if they continue on drug. Additional laboratory investigations have implicated Sur1 in the pathophysiology of hemorrhagic CNS insults. In clinically relevant models of subarachnoid hemorrhage, glibenclamide reduces adverse neuroinflammatory and behavioral outcomes. Here, we provide an overview of the preclinical studies of glibenclamide therapy for CNS ischemia and hemorrhage, discuss the available data from clinical investigations, and conclude with promising preclinical results that suggest glibenclamide may be an effective therapeutic option for ischemic and hemorrhagic stroke.

  19. Glibenclamide for the Treatment of Ischemic and Hemorrhagic Stroke

    Directory of Open Access Journals (Sweden)

    Nicholas Caffes

    2015-03-01

    Full Text Available Ischemic and hemorrhagic strokes are associated with severe functional disability and high mortality. Except for recombinant tissue plasminogen activator, therapies targeting the underlying pathophysiology of central nervous system (CNS ischemia and hemorrhage are strikingly lacking. Sur1-regulated channels play essential roles in necrotic cell death and cerebral edema following ischemic insults, and in neuroinflammation after hemorrhagic injuries. Inhibiting endothelial, neuronal, astrocytic and oligodendroglial sulfonylurea receptor 1–transient receptor potential melastatin 4 (Sur1–Trpm4 channels and, in some cases, microglial KATP (Sur1–Kir6.2 channels, with glibenclamide is protective in a variety of contexts. Robust preclinical studies have shown that glibenclamide and other sulfonylurea agents reduce infarct volumes, edema and hemorrhagic conversion, and improve outcomes in rodent models of ischemic stroke. Retrospective studies suggest that diabetic patients on sulfonylurea drugs at stroke presentation fare better if they continue on drug. Additional laboratory investigations have implicated Sur1 in the pathophysiology of hemorrhagic CNS insults. In clinically relevant models of subarachnoid hemorrhage, glibenclamide reduces adverse neuroinflammatory and behavioral outcomes. Here, we provide an overview of the preclinical studies of glibenclamide therapy for CNS ischemia and hemorrhage, discuss the available data from clinical investigations, and conclude with promising preclinical results that suggest glibenclamide may be an effective therapeutic option for ischemic and hemorrhagic stroke.

  20. Spasticity after stroke: an overview of prevalence, test instruments, and treatments.

    Science.gov (United States)

    Sommerfeld, Disa K; Gripenstedt, Ullabritt; Welmer, Anna-Karin

    2012-09-01

    The objective of this study was to present an overview of the prevalence of spasticity after stroke as well as of test instruments and treatments. Recent studies show that spasticity occurs in 20%-30% of all stroke victims and in less than half of those with pareses. Although spasticity may occur in paretic patients after stroke, muscle weakness is more likely to be the reason for the pareses. Spasticity after stroke is more common in the upper than the lower limbs, and it seems to be more common among younger than older people. To determine the nature of passive stretch, electromyographic equipment is needed. However, the Modified Ashworth Scale, which measures the sum of the biomechanical and neural components in passive stretch, is the most common instrument used to grade spasticity after stroke. Treatment of spasticity with physiotherapy is recommended, although its beneficial effect is uncertain. The treatment of spasticity with botulinum toxin in combination with physiotherapy is suggested to improve functioning in patients with severe spasticity. A task-specific approach rather than a neurodevelopmental approach in assessing and treating a patient with spasticity after stroke seems to be preferred.

  1. Decision-tree model of treatment-seeking behaviors after detecting symptoms by Korean stroke patients.

    Science.gov (United States)

    Oh, Hyo-Sook; Park, Hyeoun-Ae

    2006-06-01

    This study was performed to develop and test a decision-tree model of treatment-seeking behaviors about when Korean patients visit a doctor after experiencing stroke symptoms. The study used methodological triangulation. The model was developed based on qualitative data collected from in-depth interviews with 18 stroke patients. The model was tested using quantitative data collected from interviews and a structured questionnaire involving 150 stroke patients. The predictability of the decision-tree model was quantified as the proportion of participants who followed the pathway predicted by the model. Decision outcomes of the model were categorized into immediate and delayed treatment-seeking behavior. The model was influenced by lowered consciousness, social-group influences, perceived seriousness of symptoms, past history of hypertension or stroke, and barriers to hospital visits. The predictability of the model was found to be 90.7%. The results from this study can help healthcare personnel understand the education needs of stroke patients regarding treatment-seeking behaviors, and hence aid in the development of educational strategies for stroke patients.

  2. Role of Transporters in Central Nervous System Drug Delivery and Blood-Brain Barrier Protection: Relevance to Treatment of Stroke

    Directory of Open Access Journals (Sweden)

    Hrvoje Brzica

    2017-03-01

    Full Text Available Ischemic stroke is a leading cause of morbidity and mortality in the United States. The only approved pharmacologic treatment for ischemic stroke is thrombolysis via recombinant tissue plasminogen activator (r-tPA. A short therapeutic window and serious adverse events (ie, hemorrhage, excitotoxicity greatly limit r-tPA therapy, which indicates an essential need to develop novel stroke treatment paradigms. Transporters expressed at the blood-brain barrier (BBB provide a significant opportunity to advance stroke therapy via central nervous system delivery of drugs that have neuroprotective properties. Examples of such transporters include organic anion–transporting polypeptides (Oatps and organic cation transporters (Octs. In addition, multidrug resistance proteins (Mrps are transporter targets in brain microvascular endothelial cells that can be exploited to preserve BBB integrity in the setting of stroke. Here, we review current knowledge on stroke pharmacotherapy and demonstrate how endogenous BBB transporters can be targeted for improvement of ischemic stroke treatment.

  3. Robotic upper limb rehabilitation after acute stroke by NeReBot: evaluation of treatment costs.

    Science.gov (United States)

    Stefano, Masiero; Patrizia, Poli; Mario, Armani; Ferlini, Gregorio; Rizzello, Roberto; Rosati, Giulio

    2014-01-01

    Stroke is the first cause of disability. Several robotic devices have been developed for stroke rehabilitation. Robot therapy by NeReBot is demonstrated to be an effective tool for the treatment of poststroke paretic upper limbs, able to improve the activities of daily living of stroke survivors when used both as additional treatment and in partial substitution of conventional rehabilitation therapy in the acute and subacute phases poststroke. This study presents the evaluation of the costs related to delivering such therapy, in comparison with conventional rehabilitation treatment. By comparing several NeReBot treatment protocols, made of different combinations of robotic and nonrobotic exercises, we show that robotic technology can be a valuable and economically sustainable aid in the management of poststroke patient rehabilitation.

  4. Opening a New Time Window for Treatment of Stroke by Targeting HDAC2.

    Science.gov (United States)

    Lin, Yu-Hui; Dong, Jian; Tang, Ying; Ni, Huan-Yu; Zhang, Yu; Su, Ping; Liang, Hai-Ying; Yao, Meng-Cheng; Yuan, Hong-Jin; Wang, Dong-Liang; Chang, Lei; Wu, Hai-Yin; Luo, Chun-Xia; Zhu, Dong-Ya

    2017-07-12

    Narrow therapeutic window limits treatments with thrombolysis and neuroprotection for most stroke patients. Widening therapeutic window remains a critical challenge. Understanding the key mechanisms underlying the pathophysiological events in the peri-infarct area where secondary injury coexists with neuroplasticity over days to weeks may offer an opportunity for expanding the therapeutic window. Here we show that ischemia-induced histone deacetylase 2 (HDAC2) upregulation from 5 to 7 d after stroke plays a crucial role. In this window phase, suppressing HDAC2 in the peri-infarct cortex of rodents by HDAC inhibitors, knockdown or knock-out of Hdac2 promoted recovery of motor function from stroke via epigenetically enhancing cells survival and neuroplasticity of surviving neurons as well as reducing neuroinflammation, whereas overexpressing HDAC2 worsened stroke-induced functional impairment of both WT and Hdac2 conditional knock-out mice. More importantly, inhibiting other isoforms of HDACs had no effect. Thus, the intervention by precisely targeting HDAC2 in this window phase is a novel strategy for the functional recovery of stroke survivors. SIGNIFICANCE STATEMENT Narrow time window phase impedes current therapies for stroke patients. Understanding the key mechanisms underlying secondary injury may open a new window for pharmacological interventions to promote recovery from stroke. Our study indicates that ischemia-induced histone deacetylase 2 upregulation from 5 to 7 d after stroke mediates the secondary functional loss by reducing survival and neuroplasticity of peri-infarct neurons as well as augmenting neuroinflammation. Thus, precisely targeting histone deacetylase 2 in the window phase provides a novel therapeutic strategy for stroke recovery. Copyright © 2017 the authors 0270-6474/17/376712-17$15.00/0.

  5. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST)

    DEFF Research Database (Denmark)

    Sandset, Else Charlotte; Bath, Philip M W; Boysen, Gudrun

    2011-01-01

    within 30 h of symptom onset. Patients were randomly allocated to candesartan or placebo (1:1) for 7 days, with doses increasing from 4 mg on day 1 to 16 mg on days 3 to 7. Randomisation was stratified by centre, with blocks of six packs of candesartan or placebo. Patients and investigators were masked...... to treatment allocation. There were two co-primary effect variables: the composite endpoint of vascular death, myocardial infarction, or stroke during the first 6 months; and functional outcome at 6 months, as measured by the modified Rankin Scale. Analyses were by intention to treat. The study is registered...... significant at p≤0·025 level]). The observed effects were similar for all prespecified secondary endpoints (including death from any cause, vascular death, ischaemic stroke, haemorrhagic stroke, myocardial infarction, stroke progression, symptomatic hypotension, and renal failure) and outcomes (Scandinavian...

  6. Mechanism of Action and Clinical Potential of Fingolimod for the Treatment of Stroke

    Directory of Open Access Journals (Sweden)

    Wentao Li

    2016-08-01

    Full Text Available Fingolimod (FTY720 is an orally bio-available immunomodulatory drug currently approved by the FDA for the treatment of multiple sclerosis. Currently, there is a significant interest in the potential benefits of FTY720 on stroke outcomes. FTY720 and the sphingolipid signaling pathway it modulates has a ubiquitous presence in the central nervous system and both rodent models and pilot clinical trials seem to indicate that the drug may improve overall functional recovery in different stroke subtypes. Although the precise mechanisms behind these beneficial effects are yet unclear, there is evidence that FTY720 has a role in regulating cerebrovascular responses, blood brain barrier permeability, and cell survival in the event of cerebrovascular insult. In this article, we critically review the data obtained from the latest laboratory findings and clinical trials involving both ischemic and hemorrhagic stroke, and attempt to form a cohesive picture of FTY720’s mechanisms of action in stroke

  7. Improvement of Endovascular Stroke Treatment: A 24-Hour Neuroradiological On-Site Service Is Not Enough

    Directory of Open Access Journals (Sweden)

    Omid Nikoubashman

    2018-01-01

    Full Text Available Background and Purpose. With the advent of endovascular stroke treatment (EST with mechanical thrombectomy, stroke treatment has also become more challenging. Purpose of this study was to investigate whether a fulltime neuroradiological on-site service and workflow optimization with a structured documentation of the interdisciplinary stroke workflow resulted in improved procedural times. Material and Methods. Procedural times of 322 consecutive patients, who received EST (1 before (n=96 and (2 after (n=126 establishing a 24-hour neuroradiological on-site service as well as (3 after implementation of a structured interdisciplinary workflow documentation (“Stroke Check” (n=100, were analysed. Results. A fulltime neuroradiological on-site service resulted in a nonsignificant improvement of procedural times during out-of-hours admissions (p≥0.204. Working hours and out-of-hours procedural times improved significantly, if additional workflow optimization was realized (p≤0.026. Conclusions. A 24-hour interventional on-site service is a major prerequisite to adequately provide modern reperfusion therapies in patients with acute ischemic stroke. However, simple measures like standardized and focused documentation that affect the entire interdisciplinary pre- and intrahospital stroke rescue chain seem to be important.

  8. Improvement of Endovascular Stroke Treatment: A 24-Hour Neuroradiological On-Site Service Is Not Enough.

    Science.gov (United States)

    Nikoubashman, Omid; Schürmann, Kolja; Othman, Ahmed E; Bach, Jan-Philipp; Wiesmann, Martin; Reich, Arno

    2018-01-01

    With the advent of endovascular stroke treatment (EST) with mechanical thrombectomy, stroke treatment has also become more challenging. Purpose of this study was to investigate whether a fulltime neuroradiological on-site service and workflow optimization with a structured documentation of the interdisciplinary stroke workflow resulted in improved procedural times. Procedural times of 322 consecutive patients, who received EST (1) before ( n = 96) and (2) after ( n = 126) establishing a 24-hour neuroradiological on-site service as well as (3) after implementation of a structured interdisciplinary workflow documentation ("Stroke Check") ( n = 100), were analysed. A fulltime neuroradiological on-site service resulted in a nonsignificant improvement of procedural times during out-of-hours admissions ( p ≥ 0.204). Working hours and out-of-hours procedural times improved significantly, if additional workflow optimization was realized ( p ≤ 0.026). A 24-hour interventional on-site service is a major prerequisite to adequately provide modern reperfusion therapies in patients with acute ischemic stroke. However, simple measures like standardized and focused documentation that affect the entire interdisciplinary pre- and intrahospital stroke rescue chain seem to be important.

  9. In-treatment stroke volume predicts cardiovascular risk in hypertension

    DEFF Research Database (Denmark)

    Lønnebakken, Mai T; Gerdts, Eva; Boman, Kurt

    2011-01-01

    substudy. Results: During follow-up, a total of 91 primary endpoints occurred. At baseline, lower left ventricular stroke volume was associated with smaller body size, female sex, lower left ventricular mass and stress-corrected midwall shortening, higher relative wall thickness and total peripheral...... with higher risk of cardiovascular events {hazard ratio 1.69 per 1 SD (6 ml/m2.04) lower stroke volume [95% confidence interval (CI) 1.35–2.11], P mass and concentric geometry and in a secondary model also independent of stress-corrected midwall shortening...... resistance, more concentric left ventricular geometry and impaired diastolic relaxation (all P indexed for height2.04 was associated...

  10. Efficacy of Surgical Treatment on the Recurrent Stroke Prevention for Adult Patients With Hemorrhagic Moyamoya Disease.

    Science.gov (United States)

    Wang, Guoqing; Zhang, Xiaoyang; Feng, Mengzhao; Liu, Xianzhi; Guo, Fuyou

    2017-11-01

    It remains controversial about the optimal treatment of adult hemorrhagic moyamoya disease (MMD). In this study, the authors performed a meta-analysis to determine whether surgical treatment of adult hemorrhagic MMD is superior to conservative treatment. A systematic search of the PubMed, EMBASE, and Cochrane Central databases was performed for articles published until May 2017. Randomized-controlled trials and cohort studies about the efficacy of surgical treatment and conservative treatment in patients with hemorrhagic MMD at 16 years of age or older were selected. Recurrent stroke incidence including hemorrhagic and ischemic events at the end of the follow-up period was calculated between the 2 groups with a 95% confidence interval (CI). A total of 3 articles (including 146 patients) were included in the meta-analysis. There were significant differences between the 2 groups when the authors compared the overall recurrent stroke rate at the end of the follow-up period. Surgical treatment significantly reduced the risk of stroke (risk ratio, 0.43; 95% CI, 0.24-0.76; P = 0.004). The current meta-analysis suggests that surgical treatment is better for conservative treatment in adult hemorrhagic MMD with recurrent stroke rate. Future studies are required to confirm this conclusion.

  11. Analysis of the morbidity and associated factors of early onset post-stroke depression

    Directory of Open Access Journals (Sweden)

    Yu ZHANG

    2015-03-01

    Full Text Available Objective To investigate the morbidity and associated factors of early onset depression after acute ischemic stroke, in order to improve its diagnostic rate and cure rate.  Methods The depression symptoms of 150 patients with acute ischemic stroke were evaluated by using Hamilton Depression Rating Scale-17 (HAMD-17 2 weeks after onset. According to Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-Ⅳ criteria, patients with HAMD-17 score ≥ 7 were diagnosed as post-stroke depression (PSD. Clinical data of those patients, including gender, age, education, laboratory indexes, predisposing factors, National Institute of Health Stroke Scale (NIHSS score, Trial of Org10172 in Acute Stroke Treatment (TOAST type, Oxfordshire Community Stroke Project (OCSP classification, and concurrent carotid artery stenosis were recorded. Univariate and multivariate Logistic regression analysis was used to investigate the related factors of PSD.  Results The morbidity of PSD in patients 2 weeks after stroke onset was 18% (27/150. Univariate and multivariate Logistic regression analysis showed triglyceride level (P = 0.042, neural function deficiency (P = 0.001 and concurrent carotid artery stenosis (P = 0.003 were independent risk factors for early onset PSD. Further subgroup analysis indicated concurrent carotid artery stenosis was the independent risk factor for PSD in non-minor stroke patients (P = 0.014. Conclusions Stroke patients with severe neurological deficits and carotid artery stenosis are susceptible to early onset PSD. DOI: 10.3969/j.issn.1672-6731.2015.03.007

  12. [Androgenic deficit and its treatment in stroke male patients with diabetes mellitus type II].

    Science.gov (United States)

    Morgunov, L Iu; Denisova, I A; Rozhkova, T I; Stakhovskaia, L V; Skvortsova, V I

    2011-01-01

    We have studied 154 men (mean age 61,4+/-4,1 years) with the first hemispheric ischemic stroke. Clinical and laboratory studies have revealed the androgenic deficit in 66,3%, with its frequency higher in patients with diabetes mellitus type II (50 and 26,3%, respectively). Forty-two men with diabetes mellitus type II and acquired androgenic deficit received replacing treatment with testosterone undecanoate in dose 1000 mg intramuscular. The treatment was started one week after the development of stroke, the next injections were given after 6 weeks and then every 12 weeks during 2 years. The control group included 30 males who did not receive androgens. After 2 years from the beginning of treatment, there were the decrease in clinical severity of androgenic deficit, the increase of total and free testosterone levels, and muscle power in the main group compared to the controls. Body mass index, glicated hemoglobin, cholesterol, triglycerides, low density lipoproteins have decreased as well. Secondary stroke has developed in 3 (7,1%) patients of the main group and in 5 (16,6%) controls; 12 (28,6%) patients returned to work in the main group compared to 2 (6,6%) in the control group. The treatment with androgens has a positive effect on risk factors of secondary ischemic stroke. It is an effective method for improvement of social adaptation of men survived after the stroke.

  13. Relevance of Post-Stroke Circulating BDNF Levels as a Prognostic Biomarker of Stroke Outcome. Impact of rt-PA Treatment.

    Science.gov (United States)

    Rodier, Marion; Quirié, Aurore; Prigent-Tessier, Anne; Béjot, Yannick; Jacquin, Agnès; Mossiat, Claude; Marie, Christine; Garnier, Philippe

    2015-01-01

    The recombinant form of tissue plasminogen activator (rt-PA) is the only curative treatment for ischemic stroke. Recently, t-PA has been linked to the metabolism of brain-derived neurotrophic factor (BDNF), a major neurotrophin involved in post-stroke neuroplasticity. Thus, the objective of our study was to investigate the impact of rt-PA treatment on post-stroke circulating BDNF levels in humans and in animals. Serum BDNF levels and t-PA/plasmin activity were measured at hospital admission and at up to 90 days in stroke patients receiving (n = 24) or not (n = 14) rt-PA perfusion. We investigated the relationships between serum BDNF with concurrent t-PA/plasmin activity, neurological outcomes and cardiovascular scores at admission. In parallel, serum BDNF levels and t-PA/plasmin activity were assessed before and after (1, 4 and 24h) the induction of ischemic stroke in rats. Our study revealed higher serum BDNF levels and better neurological outcome in rt-PA-treated than non-treated patients. However, serum BDNF levels did not predict stroke outcome when the whole cohort of stroke patients was analyzed. By contrast, serum BDNF levels when measured at admission and at day 90 correlated with cardiovascular scores, and those at day 1 correlated with serum t-PA/plasmin activity in the whole cohort of patients whereas no association could be found in the rt-PA-treated group. In rats devoid of cardiovascular risk, no difference in post-stroke serum BDNF levels was detected between rt-PA- and vehicle-treated animals and no correlation was found between serum BDNF levels and t-PA/plasmin activity. Overall, the data suggest that serum BDNF levels may not be useful as a prognostic biomarker of stroke outcome and that endothelial dysfunction could be a confounding factor when serum BDNF levels after stroke are used to reflect of brain BDNF levels.

  14. Acute ischemic stroke treatment, part 2: TreatmentRoles of Capillary Index Score, Revascularization and Time

    Directory of Open Access Journals (Sweden)

    Firas eAL-ALI

    2015-06-01

    Full Text Available Due to recent results from clinical intra-arterial treatment for acute ischemic stroke (IAT-AIS trials such as the Interventional Management of Stroke (IMS III, IAT-AIS and the merit of revascularization have been contested. Even though intra-arterial treatment (IAT has been shown to improve revascularization rates, a corresponding increase in good outcomes has only recently been noted. Even though a significant percentage of patients achieve good revascularization in a timely manner, results do not translate into good clinical outcomes (GCOs. Based on a review of the literature, the authors suspect limited good clinical outcomes following timely and successful revascularization are due to poor patient selection that led to futile and possibly even harmful revascularization. The Capillary Index Score (CIS is a simple angiography-based scale that can potentially be used to improve patient selection to prevent revascularization being performed on patients who are unlikely to benefit from treatment. The CIS characterizes presence of capillary blush related to collateral flow as a marker of residual viable tissue, with absence of blush indicating the tissue is no longer viable due to ischemia. By only selecting patients with a favorable CIS for IAT, the rate of GCOs should consistently approach 80-90%. Current methods of patient selection are primarily dependent on time from ischemia. Time from cerebral ischemia to irreversible tissue damage seems to vary from patient to patient, however, so focusing on viable tissue based on the CIS rather than relying on an artificial time window seems to be a more appropriate approach to patient selection.

  15. A novel classification method for aid decision of traditional Chinese patent medicines for stroke treatment.

    Science.gov (United States)

    Zhao, Yufeng; Liu, Bo; He, Liyun; Bai, Wenjing; Yu, Xueyun; Cao, Xinyu; Luo, Lin; Rong, Peijing; Zhao, Yuxue; Li, Guozheng; Liu, Baoyan

    2017-09-01

    Traditional Chinese patent medicines are widely used to treat stroke because it has good efficacy in the clinical environment. However, because of the lack of knowledge on traditional Chinese patent medicines, many Western physicians, who are accountable for the majority of clinical prescriptions for such medicine, are confused with the use of traditional Chinese patent medicines. Therefore, the aid-decision method is critical and necessary to help Western physicians rationally use traditional Chinese patent medicines. In this paper, Manifold Ranking is employed to develop the aid-decision model of traditional Chinese patent medicines for stroke treatment. First, 115 stroke patients from three hospitals are recruited in the cross-sectional survey. Simultaneously, traditional Chinese physicians determine the traditional Chinese patent medicines appropriate for each patient. Second, particular indicators are explored to characterize the population feature of traditional Chinese patent medicines for stroke treatment. Moreover, these particular indicators can be easily obtained byWestern physicians and are feasible for widespread clinical application in the future. Third, the aid-decision model of traditional Chinese patent medicines for stroke treatment is constructed based on Manifold Ranking. Experimental results reveal that traditional Chinese patent medicines can be differentiated. Moreover, the proposed model can obtain high accuracy of aid decision.

  16. Safety and efficacy of alteplase in the treatment of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Giuseppe Micieli

    2009-05-01

    Full Text Available Giuseppe Micieli, Simona Marcheselli, Piera Angela TosiNeurology and Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano (MI, italyAbstract: After publication of the results of the National Institute of Neurological Disorders and Stroke study, the application of intravenous thrombolysis for ischemic stroke was launched and has now been in use for more than 10 years. The approval of this drug represented only the first step of the therapeutic approach to this pathology. Despite proven efficacy, concerns remain regarding the safety of recombinant tissue-type plasminogen activator for acute ischemic stroke used in routine clinical practice. As a result, a small proportion of patients are currently treated with thrombolytic drugs. Several factors explain this situation: a limited therapeutic window, insufficient public knowledge of the warning signs for stroke, the small number of centers able to administer thrombolysis on a 24-hour basis and an excessive fear of hemorrhagic complications. The aim of this review is to explore the clinical efficacy of treatment with alteplase and consider the hemorrhagic risks.Keywords: rt-PA, acute ischemic stroke, intracranial hemorrhage

  17. Reduced risk of poststroke pneumonia in thrombolyzed stroke patients with continued statin treatment.

    Science.gov (United States)

    Scheitz, Jan F; Endres, Matthias; Heuschmann, Peter U; Audebert, Heinrich J; Nolte, Christian H

    2015-01-01

    Pneumonia is a frequent complication after stroke with strong impact on clinical outcome. Statins have pleiotropic immunmodulatory properties and were recently shown to exert beneficial effects on the development and clinical course of pneumonia. We aimed to investigate whether statin use is associated with a reduced risk of poststroke pneumonia in acute ischemic stroke patients treated with tissue plasminogen activator within 4·5hours. Data was extracted from a local register including all consecutive stroke patients who received thrombolysis at our institution. Prior statin use was identified retrospectively from clinical records and had to be continued after hospital admission. Poststroke pneumonia was diagnosed according to standardized criteria of US Centers for Disease Control and Prevention. Mortality and functional outcome at three-months were further assessed. Overall, 481 ischemic stroke patients were analyzed. Continued statin use was documented in 17% of the patients. Frequency of pneumonia was 11%. Patients with statin use were less likely to develop poststroke pneumonia (5% vs. 13%, P = 0·04). After multivariable adjustment for known risk factors for poststroke pneumonia (age, stroke severity, dysphagia, male sex and diabetes), statin treatment was negatively associated with pneumonia (OR 0·31; 95% CI 0·10-0·94). Occurrence of pneumonia independently predicted three-month mortality and functional outcome. Use of statins in acute ischemic stroke patients who receive thrombolysis might reduce the risk of poststroke pneumonia. Further studies are warranted to validate this finding. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  18. Does treatment with t-PA increase the risk of developing epilepsy after stroke?

    Science.gov (United States)

    Keller, Lena; Hobohm, Carsten; Zeynalova, Samira; Classen, Joseph; Baum, Petra

    2015-10-01

    Patients suffering from ischemic stroke carry an enhanced risk of developing secondary epilepsy. We sought to clarify whether thrombolytic treatment with recombinant tissue plasminogen activator (t-PA) is independently associated with post-stroke epilepsy (PSE). In this observational study, data from 302 stroke patients treated at a single academic neurological department were analyzed retrospectively. Median follow-up was 42 months (maximum 80). Variables included presence of comorbidity, stroke severity, neurological presentation, complications, infarct characteristics, and treatment with t-PA. After univariate analyses, a multivariate analysis was performed to create a model of factors that were significantly associated with PSE, including treatment with t-PA. 13.9 % of patients developed PSE during follow-up. Multivariate analysis identified 5 independent factors for PSE: low Barthel Index at discharge; hemianopia; infection acquired during the hospital stay; involvement of the temporal lobe; involvement of the perirolandic cortex. While the incidence of PSE was higher in patients treated with t-PA (20.6 vs. 10.7 %, univariate analysis; p = 0.020), the effect was lost after adjusting for several factors associated with t-PA treatment [odds ratio for PSE after treatment with t-PA 1.3 (95 % CI 0.6-2.9), p = 0.489]. This study failed to identify treatment with t-PA as an independent risk factor for PSE.

  19. Effect of structure in the sensory characterization of the crispness of toasted rusk roll

    NARCIS (Netherlands)

    Primo-Martin, C.; Castro-Prada, E.M.; Meinders, M.B.J.; Vereijken, P.F.G.; Vliet, van T.

    2008-01-01

    Crispness is a salient textural attribute of toasted foods strongly related to their preference. Crispness is affected by water content, mechanical properties and morphology of the food. Sound emission and force characteristics during food crushing play a key role in crispness. The aim was to assess

  20. Effects of Toasting Time on Digestive Hydrolysis of Soluble and Insoluble 00-Rapeseed Meal Proteins

    NARCIS (Netherlands)

    Salazar-Villanea, Sergio; Bruininx, Erik M.A.M.; Gruppen, Harry; Carré, Patrick; Quinsac, Alain; Poel, van der Thomas

    2017-01-01

    Thermal damage to proteins can reduce their nutritional value. The effects of toasting time on the kinetics of hydrolysis, the resulting molecular weight distribution of 00-rapeseed meal (RSM) and the soluble and insoluble protein fractions separated from the RSM were studied. Hydrolysis was

  1. Chemical, physical and nutritional changes in soybean meal as a result of toasting and extrusion cooking

    NARCIS (Netherlands)

    Marsman, G.J.P.

    1998-01-01

    The effect of soybean meal extrusion and the development of shear forces during single-screw extrusion was compared with the toasting process of soybean meal. Attention was focused on chemical, physical and nutritional changes during these thermo-mechanical

  2. Antioxidant capacities of extracts in relation to toasting oak and acacia wood

    Czech Academy of Sciences Publication Activity Database

    Híc, P.; Soural, I.; Balík, J.; Kulichová, J.; Vrchotová, Naděžda; Tříska, Jan

    2017-01-01

    Roč. 56, č. 2 (2017), s. 129-137 ISSN 1336-8672 Institutional support: RVO:67179843 Keywords : oak * acacia * toasting wood * barrique extract * antioxidant capacity * weight loss Subject RIV: EH - Ecology, Behaviour OBOR OECD: Environmental sciences (social aspects to be 5.7) Impact factor: 1.950, year: 2016

  3. Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers

    International Nuclear Information System (INIS)

    Nikoubashman, Omid; Reich, Arno; Jungbluth, Michael; Pjontek, Rastislav; Wiesmann, Martin

    2014-01-01

    The purpose of this paper is to investigate the clinical significance of postinterventional subarachnoid hyperdensities (PSH) after endovascular mechanical thrombectomy in acute ischemic stroke. We analysed clinical and radiological data of 113 consecutive patients who received postinterventional CT scans within 4.5 h after mechanical thrombectomy. PSH was present in 27 of 113 patients (24 %). Extravasation of contrast agent was observed during intervention in only 6 of 27 cases (22 %). There was consecutive haemorrhagic transformation in four patients with PSH (p = 0.209, Fisher's exact test). Preinterventional predictors for the occurrence of PSH in our series were a long interval between clinical onset and recanalization (p = 0.028), a long procedure time (p = 0.010), and a high number of recanalization attempts (p = 0.001). PSH had no significant impact on clinical outcome (modified Rankin Scale) at discharge (p = 0.419) or at 3 months (p = 0.396). There were no significant correlations between PSH and thrombectomy devices (Solitaire: p = 0.433, Trevo Pro: p = 0.124). PSH after endovascular mechanical thrombectomy in acute ischemic stroke are likely to occur in complicated cases in which more than one revascularisation attempt is performed. PSH per se do not appear to be associated with an impaired clinical outcome or an elevated risk for consecutive haemorrhage. (orig.)

  4. Blood pressure-lowering treatment with candesartan in patients with acute hemorrhagic stroke.

    Science.gov (United States)

    Jusufovic, Mirza; Sandset, Else C; Bath, Philip M W; Berge, Eivind

    2014-11-01

    Early and intensive blood pressure-lowering treatment seems to be beneficial in patients with acute hemorrhagic stroke and high blood pressure. We wanted to see if similar benefits can be shown from a later and more gradual blood pressure lowering, using data from the Scandinavian Candesartan Acute Stroke Trial (SCAST). SCAST was a randomized- and placebo-controlled, double-masked trial of candesartan given for 7 days, in 2029 patients with acute stroke and systolic blood pressure ≥140 mm Hg. We assessed the effects of candesartan in the 274 patients with hemorrhagic stroke, using the trial's 2 coprimary effect variables: the composite vascular end point of vascular death, stroke or myocardial infarction, and functional outcome at 6 months, according to the modified Rankin Scale. We used Cox proportional hazards models and ordinal regression for analysis and adjusted for key, predefined prognostic variables. There was no association between treatment with candesartan and risk of vascular events (17 of 144 [11.8%] versus 13 of 130 [10.0%]; hazard ratio, 1.36; 95% confidence interval, 0.65-2.83; P=0.41). For functional outcome we found evidence of a negative effect of candesartan (common odds ratio, 1.61; 95% confidence interval, 1.03-2.50; P=0.036). There was no evidence that blood pressure-lowering treatment with candesartan is beneficial during the first week of hemorrhagic stroke. Instead, there were signs that such treatment may be harmful, but this needs to be verified in larger studies. http://www.clinicaltrials.gov. Unique identifier: NCT00120003. © 2014 American Heart Association, Inc.

  5. A pilot study of rivastigmine in the treatment of delirium after stroke: A safe alternative

    Directory of Open Access Journals (Sweden)

    Jansen Ben PW

    2008-09-01

    Full Text Available Abstract Background Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine. Methods This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS. Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge. Results No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean DRS declined from 14.8 on day one to 8.5 after therapy and 5.6 after tapering. The mean duration of delirium was 6.7 days (range; 2–17. Conclusion Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke. Trial registration Nederlands Trial Register NTR1395

  6. Thrombolytic treatment for acute ischemic cerebral stroke: intraarterial urokinase infusion vs. intravenous heparin and urokinase infusion

    International Nuclear Information System (INIS)

    Ko, Gi Young; Suh, Dae Chul; Lee, Jae Hong; Kim, Jun Hyoung; Choi, Choong Gon; Lee, Ho Kyu; Lee, Myoung Chong

    1996-01-01

    To evaluate the efficacy and limitation of intra-arterial urokinase (IAUK) infusion for treatment of acute cerebral stroke. Twenty-seven acute cerebral stroke patients treated with IAUK infusion within six hours of stroke onset were reviewed. All patients showed normal initial brain findings on CT. In 21 patients, urokinase(5-15 x 10 5 IU) was administered through a microcatheter placed into or proximal to occluded segment. Mechanical disruption of thrombus by guidewire was performed in 17 patients. Angiographic and clinical responses and complications after IAUK infusion, were evaluated and the results were compared with those of intravenous heparin(N=19) and urokinase infusion(N=19). Complete or partial angiographic recanalization of occluded segment was found in 18 patients (67%), and neurologic improvement was followed in 14 patients(52%). The degree of improvement on the stroke scale score after IAUK infusion was statistically more significant(p<0.05) than that shown after intravenous heparin and urokinase infusion. Complications after IAUK infusion were large(15%) and small amount intracerebral hemorrhage(15%), contrast leakage into brain parenchyma(11%), and gastrointestinal bleeding(4%). Between the IAVK and the intravenous urokinase infusion group, differences in extent and types of complications were statistically insignificant, but were significantly higher in those two groups than in the intravenous heparin infusion group. IAUK infusion may be effective for the treatment of acute cerebral stroke

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

    Science.gov (United States)

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

    2015-10-29

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

  8. Distribution of Major Chlorogenic Acids and Related Compounds in Brazilian Green and Toasted Ilex paraguariensis (Maté) Leaves.

    Science.gov (United States)

    Lima, Juliana de Paula; Farah, Adriana; King, Benjamin; de Paulis, Tomas; Martin, Peter R

    2016-03-23

    Ilex paraguariensis (maté) is one of the best sources of chlorogenic acids (CGA) in nature. When leaves are toasted, some isomers are partly transformed into 1,5-γ-quinolactones (CGL). Both CGA and CGL are important contributors to the brew's flavor and are thought to contribute to human health. In this study, we quantified 9 CGA, 2 CGL, and caffeic acid in 20 samples of dried green and toasted maté that are commercially available in Brazil. Total CGA content in green maté varied from 8.7 to 13.2 g/100 g, dry weight (dw). Caffeic acid content varied from 10.8 to 13.5 mg/100 g dw, respectively. Content in toasted maté varied from 1.5 to 4.6 g/100 g and from 1.5 to 7.2 mg/100 g dw, respectively. Overall, caffeoylquinic acid isomers (CQA) were the most abundant CGA in both green and toasted maté, followed by dicaffeoylquinic acids (diCQA) and feruloylquinic acids (FQA). These classes accounted for 58.5%, 40.0%, and 1.5% of CGA, respectively, in green maté and 76.3%, 20.7%, and 3.0%, respectively, in toasted maté. Average contents of 3-caffeoylquinolactone (3-CQL) and 4-caffeoylquinolactone (4-CQL) in commercial toasted samples were 101.5 mg/100 g and 61.8 mg/100 g dw, respectively. These results show that, despite overall losses during the toasting process, CGA concentrations are still substantial in toasted leaves, compared to other food sources of CGA and phenolic compounds in general. In addition to evaluating commercial samples, investigation of changes in CGA profile and formation of 1,5-γ-quinolactones was performed in experimental maté toasting.

  9. The Effect of Electromagnetic Field Treatment on Recovery from Ischemic Stroke in a Rat Stroke Model: Clinical, Imaging, and Pathological Findings

    Directory of Open Access Journals (Sweden)

    Y. Segal

    2016-01-01

    Full Text Available Stroke is a leading cause of death and disability. Effects of stroke include significant deficits in sensory-motor skills and cognitive abilities. At present, there are limited effective interventions for postacute stroke patients. In this preliminary research we studied a new noninvasive, very low intensity, low frequency, electromagnetic field treatment (VLIFE, targeting a neural network, on an in vivo stroke rat model. Eighteen rats were divided into three groups: sham (M1 and two treatment groups which were exposed to VLIFE treatment for 4 weeks, one using theta waves (M2 and another using beta waves (M3; all groups were followed up for an additional month. Results indicate that the M2 and M3 treated groups showed recovery of sensorimotor functional deficits, as demonstrated by Modified Neurological Severity Score and forelimb placement tests. Brain MRI imaging results show a decrease in perilesional edema and lateral ventricle widening in the treated groups. Fiber tracts’ imaging, following VLIFE treatment, showed a higher white matter integrity compared to control. Histological findings support neural regeneration processes. Our data suggest that VLIFE treatment, targeting a specific functional neural network by frequency rather than location, promotes neuronal plasticity after stroke and, as a result, improves clinical recovery. Further studies will investigate the full potential of the treatment.

  10. Systems pharmacology dissection of multi-scale mechanisms of action for herbal medicines in stroke treatment and prevention.

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    Jingxiao Zhang

    Full Text Available Annually, tens of millions of first-ever strokes occur in the world; however, currently there is lack of effective and widely applicable pharmacological treatments for stroke patients. Herbal medicines, characterized as multi-constituent, multi-target and multi-effect, have been acknowledged with conspicuous effects in treating stroke, and attract extensive interest of researchers although the mechanism of action is yet unclear. In this work, we introduce an innovative systems-pharmacology method that combines pharmacokinetic prescreening, target fishing and network analysis to decipher the mechanisms of action of 10 herbal medicines like Salvia miltiorrhizae, Ginkgo biloba and Ephedrae herba which are efficient in stroke treatment and prevention. Our systematic analysis results display that, in these anti-stroke herbal medicines, 168 out of 1285 constituents with the favorable pharmacokinetic profiles might be implicated in stroke therapy, and the systematic use of these compounds probably acts through multiple mechanisms to synergistically benefit patients with stroke, which can roughly be classified as preventing ischemic inflammatory response, scavenging free radicals and inhibiting neuronal apoptosis against ischemic cerebral damage, as well as exhibiting lipid-lowering, anti-diabetic, anti-thrombotic and antiplatelet effects to decrease recurrent strokes. Relying on systems biology-based analysis, we speculate that herbal medicines, being characterized as the classical combination therapies, might be not only engaged in multiple mechanisms of action to synergistically improve the stroke outcomes, but also might be participated in reducing the risk factors for recurrent strokes.

  11. NURR1 involvement in recombinant tissue-type plasminogen activator treatment complications after ischemic stroke.

    Science.gov (United States)

    Merino-Zamorano, Cristina; Hernández-Guillamon, Mar; Jullienne, Amandine; Le Béhot, Audrey; Bardou, Isabelle; Parés, Mireia; Fernández-Cadenas, Israel; Giralt, Dolors; Carrera, Caty; Ribó, Marc; Vivien, Denis; Ali, Carine; Rosell, Anna; Montaner, Joan

    2015-02-01

    Despite the effectiveness of recombinant tissue-type plasminogen activator (r-tPA) during the acute phase of ischemic stroke, the therapy remains limited by a narrow time window and the occurrence of occasional vascular side effects, particularly symptomatic hemorrhages. Our aim was to investigate the mechanisms underlying the endothelial damage resulting from r-tPA treatment in ischemic-like conditions. Microarray analyses were performed on cerebral endothelial cells submitted to r-tPA treatment during oxygen and glucose deprivation to identify novel biomarker candidates. Validation was then performed in vivo in a mouse model of thromboembolic stroke and culminated in an analysis in a clinical cohort of patients with ischemic stroke treated with thrombolysis. The transcription factor NURR1 (NR4A2) was identified as a downstream target induced by r-tPA during oxygen and glucose deprivation. Silencing NURR1 expression reversed the endothelial-toxicity induced by the combined stimuli, a protective effect attributable to reduced levels of proinflammatory mediators, such as nuclear factor-kappa-beta 2 (NF-κ-B2), interleukin 1 alpha (IL1α), intercellular adhesion molecule 1 (ICAM1), SMAD family member 3 (SMAD3), colony stimulating factor 2 (granulocyte-macrophage; CSF2). The detrimental effect of delayed thrombolysis, in conditions in which NURR1 gene expression was enhanced, was confirmed in the preclinical stroke model. Finally, we determined that patients with stroke who had a symptomatic hemorrhagic transformation after r-tPA treatment exhibited higher baseline serum NURR1 levels than did patients with an asymptomatic or absence of cerebral bleedings. Our results suggest that NURR1 upregulation by r-tPA during ischemic stroke is associated with endothelial dysfunction and inflammation and the enhancement of hemorrhagic complications associated to thrombolysis. © 2014 American Heart Association, Inc.

  12. Clinical research of the five needles combined with rehabilitation training treatment dysphagia after stroke.

    Science.gov (United States)

    Li, Yanjie; Ren, Kun; Xing, Ruoxing; Peng, Junfeng; Zhang, Zhixin; Zhao, Jing

    2016-09-01

    To compare therapeutic effects of Five Needles of the Nape and routine acupuncture on treatment of pseudo bulbar paralysis dysphagia after Brain stroke. 60 patients were randomly divided into five key groups and routine acupuncture, and 30 cases in each group. The group of Five Needles of the Nape set points to take dumb door, Tianzhu, cure choke point with acupuncture treatment which cooperate with swallowing training . The group of routine acupuncture set points to take Lian Quan, Tong Li, Zhao Hai points with acupuncture treatment. Both groups were acupunctured once a day, 6 times a week and 2 weeks is a period of treatment, evaluating curative effect after two courses of treatment. The total effective rate of Five Needles of the Nape group was 93.3%, when the total effective rate of routine acupuncture group was 80.0%.as a consequence Five Needles of the Nape group is superior to routine acupuncture group (Pdysphagia after Brain stroke.

  13. [Early treatment and nursing role in the case of a haemorrhagic stroke].

    Science.gov (United States)

    Héraud-Carré, Séverine; Le Roy, Bruno; Prével, Gladys

    Paediatric stroke constitute a medical and/or surgical emergency. The speed and timeliness of the treatment have a significant impact on the prognosis. The nursing role, from carrying out continuous observation to specific procedures, is essential in the assessment, the care pathway and the short-, medium- and long-term outcome for the child. Copyright © 2017. Published by Elsevier Masson SAS.

  14. Art Therapy Outcomes in the Rehabilitation Treatment of a Stroke Patient: A Case Report

    Science.gov (United States)

    Kim, Sun-Hyun; Kim, Min-Young; Lee, Jae-Hyuk; Chun, Sae-il

    2008-01-01

    This case report discusses the potential for art therapy to aid in the recovery of early-chronic stroke patients. The patient was diagnosed with having a subarachnoid hemorrhage from a cerebral aneurysm rupture 1 year prior to hospitalization. Therapies used as part of the patient's treatment included 10 weeks of art therapy conducted twice a…

  15. CT perfusion assessment of treatment response and complications in acute ischemic stroke

    NARCIS (Netherlands)

    Horsch, AD

    2016-01-01

    An acute ischemic stroke is caused by the sudden occlusion of a large blood vessel to a part of the brain. Current treatment options are to dissolve the clot with the injection of a solvent into a vein or to physically remove the clot with an interventional radiology procedure. A major complication

  16. Pitfalls in effectiveness research: a comparative analysis of treatment goals and outcome measures in stroke rehabilitation

    NARCIS (Netherlands)

    Lettinga, A.T.; Reynders, K.; Mulder, Th.; Mol, A.M.

    Problem: There is a great diversity of movement therapies in stroke rehabilitation, each of which is treated as a more or less independent system. Objective: To articulate pitfalls in effectiveness research that has been employed to reduce the number of different forms of treatment. Methods: The

  17. Pitfalls in effectiveness research : a comparative analysis of treatment goals and outcome measures in stroke rehabilitation

    NARCIS (Netherlands)

    Lettinga, Ant; Reynders, K; Mulder, T; Mol, A

    Problem: There is a great diversity of movement therapies in stroke rehabilitation, each of which is treated as a more or less independent system. Objective: To articulate pitfalls in effectiveness research that has been employed to reduce the number of different forms of treatment. Methods: The

  18. Modulation of Cardiac Autonomic Dysfunction in Ischemic Stroke following Ayurveda (Indian System of Medicine Treatment

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    Sriranjini Sitaram Jaideep

    2014-01-01

    Full Text Available Objectives. Cardiac autonomic dysfunction in stroke has implications on morbidity and mortality. Ayurveda (Indian system of medicine describes stroke as pakshaghata. We intended to study the effect of Ayurveda therapies on the cardiac autonomic dysfunction. Methods. Fifty patients of ischemic stroke (middle cerebral artery territory (mean age 39.26 ± 9.88 years; male 43, female 7 were recruited within one month of ictus. All patients received standard allopathic medications as advised by neurologist. In addition, patients were randomized to receive physiotherapy (Group I or Ayurveda treatment (Group II for 14 days. Continuous electrocardiogram and finger arterial pressure were recorded for 15 min before and after treatments and analyzed offline to obtain heart rate and blood pressure variability and baroreflex sensitivity (BRS. Results were analysed by RMANOVA. Results. Patients in Group II showed statistically significant improvement in cardiac autonomic parameters. The standard deviation of normal to normal intervals,and total and low frequency powers were significantly enhanced (F=8.16, P=0.007, F=9.73, P=0.004, F=13.51, and P=0.001, resp.. The BRS too increased following the treatment period (F=10.129, P=0.004. Conclusions. The current study is the first to report a positive modulation of cardiac autonomic activity after adjuvant Ayurveda treatment in ischemic stroke. Further long term studies are warranted.

  19. Stroke in systemic lupus erythematosus and antiphospholipid syndrome: risk factors, clinical manifestations, neuroimaging, and treatment.

    Science.gov (United States)

    de Amorim, L C D; Maia, F M; Rodrigues, C E M

    2017-04-01

    Neurologic disorders are among the most common and important clinical manifestations associated with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), mainly those that affect the central nervous system (CNS). Risk of cerebrovascular events in both conditions is increased, and stroke represents one of the most severe complications, with an incidence rate between 3% and 20%, especially in the first five years of diagnosis. This article updates the data regarding the risk factors, clinical manifestations, neuroimaging, and treatment of stroke in SLE and APS.

  20. Late Thrombolytic Treatment In A Patient With Ischemic Stroke Caused By Biatrial Thrombus

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    Halit CINARKA

    2015-07-01

    Full Text Available Venous thromboembolism is a preventable disease when necessary precautions are taken and it occurs along with deep vein thrombosis and pulmonary embolism. Mortality related to venous thromboembolism may be high in the acute phase of the disease and it may become chronic. Intracardiac thrombus may be detected in some venous thromboemboli cases. Cardiac embolism is responsible for most of the ischemic strokes which can be very mortal or may cause serious morbidity when they are not treated in time. In this report, we aimed to present the results of late antithrombolytic treatment in a 77-year old patient who developed deep vein thrombosis, biatrial thrombosis and ischemic stroke following hydrocephalus shunt operation.   Key words: Venous thromboembolism; ischemic stroke; thrombolytic therapy

  1. Generalized Safety and Efficacy of Simplified Intravenous Thrombolysis Treatment (SMART) Criteria in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Sørensen, Sigrid B; Barazangi, Nobl; Chen, Charlene

    2016-01-01

    BACKGROUND: Common intravenous recombinant tissue plasminogen activator (IV rt-PA) exclusion criteria may substantially limit the use of thrombolysis. Preliminary data have shown that the SMART (Simplified Management of Acute stroke using Revised Treatment) criteria greatly expand patient...... within a regional stroke network was performed. Patients were divided into those receiving thrombolysis locally versus at an outside hospital. The primary outcome was modified Rankin Scale score (≤1) at discharge and the main safety outcome was symptomatic intracranial hemorrhage (sICH) rate. RESULTS...... eligibility by reducing thrombolysis exclusions, but they have not been assessed on a large scale. We evaluated the safety and efficacy of general adoption of SMART thrombolysis criteria to a large regional stroke network. METHODS: Retrospective analysis of consecutive patients who received IV thrombolysis...

  2. Stroke in Switzerland: social determinants of treatment access and cost of illness.

    Science.gov (United States)

    Snozzi, Philippe; Blank, Patricia R; Szucs, Thomas D

    2014-01-01

    Few useful empirical data on stroke are available for Switzerland. The aim of this study was to collect data on the use of medical resources and associated costs among stroke patients. Special attention was paid to possible correlations between epidemiologic indicators, sociodemographic variables, resource use, and costs. We carried out a representative population survey of 19,123 households in the German- and French-speaking parts of Switzerland with computer-assisted telephone interviews in 2005. Detailed sociodemographic data and information on the use of resources were collected from 509 individuals aged 15-75 years who had cared for a stroke patient in the past 1-2 years. In the last 1-2 years, a total of 7.8% of households were affected by stroke in the German-speaking part of Switzerland, whereas only 4.3% of households were affected in the French-speaking part of Switzerland (odds ratio [OR] = 1.89, P Switzerland. Patients with supplementary insurance were treated more frequently as inpatients than patients with statutory insurance (OR: 2.14, P = .014), and patients with a low household income were referred less frequently to an inpatient rehabilitation facility than those with medium or high household income (OR = .58, P Switzerland. Patients without supplementary insurance or with low household income were less likely to receive inpatient treatment. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Proximal to distal approach in the treatment of tandem occlusions causing an acute stroke.

    Science.gov (United States)

    Spiotta, Alejandro M; Lena, Jonathan; Vargas, Jan; Hawk, Harris; Turner, Raymond D; Chaudry, M Imran; Turk, Aquilla S

    2015-03-01

    A tandem occlusion is a rare presentation of acute stroke that involves an occlusion of the internal carotid artery at the bifurcation with an intracranial middle cerebral artery occlusion. This study describes the experience at our institution in treating tandem occlusions with a proximal to distal approach in the acute stroke setting. A retrospective review of acute strokes caused by tandem occlusions requiring thrombectomy were performed. 16 cases were identified with a mean National Institutes of Health Stroke Scale score at presentation of 13.1 ± 3.9. The proximal occlusion was crossed initially with a microwire in all cases. All carotid occlusions were treated with stenting, and intracranial vessel thrombectomy was performed with a variety of devices. Procedure related complications occurred in two (12.5%) patients. Eight patients (50%) achieved a good outcome (modified Rankin Scale score of 0-2). A tandem occlusion of the carotid artery at the bifurcation with a concomitant intracranial occlusion is a relatively rare and complex presentation of acute stroke. We have found that addressing the proximal lesion first and covering it with a stent prior to performing distal thrombectomy appears to be a safe and effective option in the treatment algorithm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Venous thromboses and thromboembolism in acute stroke: risk factors, diagnosis, treatment, and prevention

    Directory of Open Access Journals (Sweden)

    Andrei Viktorovich Fonyakin

    2013-01-01

    Full Text Available Stroke patients among all patients with somatic diseases are at one of the highest risks for venous thromboembolism (VTE. The proven risk factors for venous thrombosis in stroke are prolonged immobilization, elderly age, obesity, diabetes mellitus, and inherited coagulopathies. If no drug prevention is done, the course of stroke is complicated by deep vein thrombosis (DVT in 75% of the immobilized patients and pulmonary thromboembolism develops in 20%. At present there are mechanical, pharmacological, and combined DVT prevention strategies that may considerably lower the rate of pulmonary embolism. In stroke patients, the use of low-molecular-weight heparins (LMWH reduces therisk of DVT, without increasing the risk of hemorrhagic complications. Novel oral anticoagulants used to treat venous thrombosis and VTE in stroke patients are an equivalent alternative to LMWH therapy. Treatment with novel oral anticoagulants to prevent recurrent VTE is effective and safe and may be continued up to 1–2 years.

  5. Modeling the Cost Effectiveness of Neuroimaging-Based Treatment of Acute Wake-Up Stroke.

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    Ankur Pandya

    Full Text Available Thrombolytic treatment (tissue-type plasminogen activator [tPA] is only recommended for acute ischemic stroke patients with stroke onset time 4.5 hours, 46.3% experienced a good stroke outcome. Lifetime discounted QALYs and costs were 5.312 and $88,247 for the no treatment strategy and 5.342 and $90,869 for the MRI-based strategy, resulting in an ICER of $88,000/QALY. Results were sensitive to variations in patient- and provider-specific factors such as sleep duration, hospital travel and door-to-needle times, as well as onset probability distribution, MRI specificity, and mRS utility values.Our model-based findings suggest that an MRI-based treatment strategy for this population could be cost-effective and quantifies the impact that patient- and provider-specific factors, such as sleep duration, hospital travel and door-to-needle times, could have on the optimal decision for wake-up stroke patients.

  6. Systematic review of long-term Xingnao Kaiqiao needling effcacy in ischemic stroke treatment

    Directory of Open Access Journals (Sweden)

    Zhi-xin Yang

    2015-01-01

    CONCLUSION: The Xingnao Kaiqiao needling method has a better effect than control treatment in reducing disability rate. The long-term effect of Xingnao Kaiqiao needling against ischemic stroke is better than that of control treatment. However, the limitations of this study limit the strength of the conclusions. Randomized controlled trials with a strict, reasonable design, and multi-center, large-scale samples and follow-up are necessary to draw conclusions about Xingnao Kaiqiao needling.

  7. 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....

  8. An augmented cognitive behavioural therapy for treating post-stroke depression: description of a treatment protocol.

    Science.gov (United States)

    Kootker, Joyce A; Rasquin, Sascha M C; Smits, Peter; Geurts, Alexander C; van Heugten, Caroline M; Fasotti, Luciano

    2015-09-01

    Currently, no evidence-based treatment is available for mood problems after stroke. We present a new psychological intervention designed to reduce depressive complaints after stroke. This intervention was based on cognitive behavioural therapy principles and was shown feasible in a pilot study. In order to meet the specific needs of stroke patients (concerning both sensori-motor, cognitive, and behavioural problems), we incorporated motivational interviewing, grief resolution, and psycho-education. We emphasised for each session to take into account the cognitive deficits of the patients (i.e. be concrete, accessible, structured, specific, and repeat information). Moreover, we augmented the psychologist-administered therapy with the contribution of an occupational or movement therapist aimed at facilitating patients' goal-setting and attainment. The intervention consisted of 12 one-hour sessions with a psychologist and three or four one-hour sessions with an occupational or movement therapist. Currently, the effectiveness of the intervention is evaluated in a randomised controlled trial. The proposed psychological treatment protocol is innovative, as it applies cognitive behavioural therapy in a stroke-specific manner; moreover, it supports goal attainment by incorporating occupational or movement therapy sessions. © The Author(s) 2014.

  9. Stent-assisted mechanical recanalization for the treatment of acute ischemic stroke

    International Nuclear Information System (INIS)

    Xu Haowen; Song Bo; Guo Xinbin; Guan Sheng

    2011-01-01

    Objective: to evaluate the safety and efficacy of stent-assisted mechanical recanalization technique in treating acute ischemic stroke. Methods: Stent-assisted mechanical recanalization procedure was carried out in 12 patients with acute ischemic stroke. The lesions were located at the anterior circulation in 10 cases and at posterior circulation in 2 cases. The clinical data were retrospectively analyzed. The technical success rate, the vascular recanalization, the occurrence of symptomatic intracranial hemorrhage, the clinical improvement and mortality were observed and evaluated. Results: The stent was successfully deployed in 11 patients (92%). After the treatment, different degrees of vascular recanalization were obtained in all patients. The complete (TIMI 3), partial (TIMI 2) and minor (TIMI 1) recanalization rate was 58.3% (7/12), 25% (3/12) and 8.3% (1/12), respectively. Postoperative symptomatic intracranial hemorrhage occurred in one patient (8.3%). Stroke-related death occurred in one patient (8.3%) and eight patients had their modified Rankin Score ≤ 2. Conclusion: For the treatment of acute ischemic stroke, stent-assisted mechanical recanalization technique is clinically feasible and safe with high vascular recanalization rate although further studies with larger sample to clarify its clinical usefulness are still needed. (authors)

  10. Rehabilitation of stroke patients using traditional Thai massage, herbal treatments and physical therapies.

    Science.gov (United States)

    Sibbritt, David; van der Riet, Pamela; Dedkhard, Saowapa; Srithong, Kannapatch

    2012-07-01

    To determine quantitatively if a unique rehabilitation program using traditional Thai massage, herbal treatments and physical therapies could improve activities of daily living, mood and sleep patterns, and pain intensity of stroke patients over time. This was a prospective cohort study, conducted over a three-month period. Patients were recruited from a 42-bed rehabilitation centre in Northern Thailand, which admits mainly stroke, head injury and spinal patients for rehabilitation. There were 62 patients enrolled in the study, with 55% being male. The average age of patients was 59 years and 63% were married. The average time since the initial stroke was 15 months. At baseline, the average Barthel Index score was 50.7, and the average emotion, pain and sleep scores were 2.6, 3.1, and 3.2, respectively. After adjusting for age, gender and time since initial stroke in the longitudinal model, the Barthel Index significantly improved by 6.1 points after one month (P<0.01) and by 14.2 points after three months (P<0.01); emotion significantly improved by 0.7 points after one month (P<0.01) and by 0.9 points after three months (P<0.01); pain significantly improved by 0.5 points after one month (P<0.01) and by 0.5 points after three months (P<0.01); sleep significantly improved by 0.5 points after one month (P<0.01) and by 0.6 points after three months (P<0.01). This unique stroke rehabilitation program has produced significant improvements in activities of daily living, mood, pain and sleep patterns of stroke patients. These findings warrant the need for further research to compare patients undergoing this program of rehabilitation with patients undergoing more conventional rehabilitation programs.

  11. Process improvement to enhance existing stroke team activity toward more timely thrombolytic treatment.

    Science.gov (United States)

    Cho, Han-Jin; Lee, Kyung Yul; Nam, Hyo Suk; Kim, Young Dae; Song, Tae-Jin; Jung, Yo Han; Choi, Hye-Yeon; Heo, Ji Hoe

    2014-10-01

    Process improvement (PI) is an approach for enhancing the existing quality improvement process by making changes while keeping the existing process. We have shown that implementation of a stroke code program using a computerized physician order entry system is effective in reducing the in-hospital time delay to thrombolysis in acute stroke patients. We investigated whether implementation of this PI could further reduce the time delays by continuous improvement of the existing process. After determining a key indicator [time interval from emergency department (ED) arrival to intravenous (IV) thrombolysis] and conducting data analysis, the target time from ED arrival to IV thrombolysis in acute stroke patients was set at 40 min. The key indicator was monitored continuously at a weekly stroke conference. The possible reasons for the delay were determined in cases for which IV thrombolysis was not administered within the target time and, where possible, the problems were corrected. The time intervals from ED arrival to the various evaluation steps and treatment before and after implementation of the PI were compared. The median time interval from ED arrival to IV thrombolysis in acute stroke patients was significantly reduced after implementation of the PI (from 63.5 to 45 min, p=0.001). The variation in the time interval was also reduced. A reduction in the evaluation time intervals was achieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from 35 to 29 min for complete blood counts (p=0.006)]. PI is effective for continuous improvement of the existing process by reducing the time delays between ED arrival and IV thrombolysis in acute stroke patients.

  12. Mirror neurons: action observation treatment as a tool in stroke rehabilitation.

    Science.gov (United States)

    Franceschini, M; Agosti, M; Cantagallo, A; Sale, P; Mancuso, M; Buccino, G

    2010-12-01

    The observation of actions performed by others activate in an observer the same neural structures (including mirror neurons) as when he/she actually performs the same actions. The aim of the present study was to assess whether action observation treatment may improve upper limb motor impairment in chronic stroke patients. This was an observational study. Patients were recruited by three Italian Centres for Neurorehabilitation between 2006 and 2008. Twenty-eight chronic stroke patients with upper limb impairment have undergone for four weeks, five days a week, a rehabilitation treatment based on observation of video-clips presenting hand daily actions, followed by the imitation of those same actions with the affected limb. Functional evaluation by means of Modified Barthel Index (MBI), Frenchay Arm Test (FAT) and Fugl Meyer (FM) was carried out twice before treatment (BT1 and BT2), at an interval of 15 days, then after treatment (AT1) and finally at a two-month follow-up (AT2). Wilcoxon Signed Rank test was applied to test differences between scores obtained from functional scales before and after treatment (BT1 vs. BT2; BT2 vs. AT1; AT1 vs. AT2). In all scales, scores did not differ when comparing BT1 with BT2. Scores improved significantly in all scales at AT1 as compared to BT2 (MBI, P=0.026; FAT, P=0.005; FM, P=0.001). This improvement was still present at the two-month follow-up as testified by no score difference between AT1 and AT2. Action Observation Treatment may become a useful strategy in the rehabilitation of stroke patients. The present preliminary study suggests that stimulation of neural structures (including mirror neurons), activated when the patients actually perform the same actions as those observed could constitute a good alternative rehabilitative approach in chronic stroke patients.

  13. Pronase hydrolysis as a pretreatment for quantifying Maillard intermediates during toasting of cornflakes

    Directory of Open Access Journals (Sweden)

    Mario A. Cueto

    2016-04-01

    Full Text Available Some of the products generated by the Maillard reaction are desired and very important for defining consumer acceptance of breakfast cereals. However, in recent years there has been an increased concern about compounds that are potentially harmful such as furfurals. The aim of this work was to analyze the effectiveness of protein hydrolysis with pronase as a pretreament for the evaluation of furfurals generated by the Maillard reaction during toasting of cornflakes and the parallel development of brown and fluorescent compounds. Furfurals were more accurately quantified with the pronase hydrolysis pretreatment because the protein matrix binds furfurals and fluorescent compounds. For control of the early reaction steps in the toasting process, the most sensitive parameter was fluorescence.

  14. The impact of anger in adherence to treatment and beliefs about disease 1 year after stroke.

    Science.gov (United States)

    Santos, A Catarina; Ferro, José M

    2017-09-01

    Anger is a frequent neuropsychiatric symptom after stroke, which can disrupt treatment and recovery, in particular by affecting adherence behaviour to treatment and health care education. This study aimed to follow-up a cohort of stroke patients 12 months after their stroke to describe the presence of anger, compare levels and profile of acute and post-acute anger and analyse its impact on the adherence to treatment and beliefs about stroke. We followed (13.3 months mean follow-up) 91 stroke patients with a standardized protocol, using State-Trait Anger Expression Inventory-2 (STAXI-2) to assess the frequency and profile of anger and its components and one questionnaire to measure adherence to treatment and health education (meaning on the treatment) (Adh-T). We used as explanatory variables socio-demographic, clinical, stroke type and location information collected during the acute phase. Anger-state was detected in 15 (17%) patients, while anger-trait was present in 7 (8%) patients. The best regression model revealed that trait-anger, stroke location (posterior infarcts), and impact of stroke sequels were independent predictive factors for anger (R 2  = 43%). Patients with higher levels of anger expression had lower adherence rates, independently of the adherence dimension. In the chronic phase after stroke anger was related with posterior lesions, the impact of stroke consequences and anger as a personality trait. The detection and monitoring of anger could eventually prevent the negative impact of anger in care, especially in adherence to rehabilitation and secondary prevention.

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

    Science.gov (United States)

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

    2018-01-01

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

  16. Endovascular Acute Stroke Treatment Performed by Vascular Interventional Radiologists: Is It Safe and Efficacious?

    International Nuclear Information System (INIS)

    Fjetland, Lars; Roy, Sumit; Kurz, Kathinka D.; Larsen, Jan Petter; Kurz, Martin W.

    2012-01-01

    Purpose: To evaluate the safety and efficacy of neurointerventional procedures in acute stroke patients performed by a team of vascular interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists and to compare the results with those of previous reports from centres with specialised interventional neuroradiologists. Material and Methods: A total of 39 patients with acute ischemic stroke due to large-vessel occlusion not responding to or not eligible for intravenous thrombolysis were treated with either intra-arterial thrombolysis or mechanical thrombectomy (Penumbra System or solitaire FR thrombectomy system, respectively) and included in our prospective study. Outcomes were measured using the modified Rankin scale after 90 days, and recanalization was assessed by thrombolysis using the myocardial infarction score. Results: Mean patient age was 68.3 ± 14.2 years; the average National Institutes of Health Stroke Scale score at hospital admission was 17.2 (SD = 6.2 [n = 38]). Successful recanalization was achieved in 74.4 % of patients. Median time from clinical onset to recanalization was 5 h 11 min. Procedure-related complications occurred in 5 % of patients, and 7.5 % had a symptomatic intracerebral hemorrhage. Of the patients, 22.5 % died within the first 90 postprocedural days, 5 % of these from cerebral causes. Patients who were successfully recanalized had a clinical better outcome at follow-up than those in whom treatment failed. Of the patients, 35.9 % had an mRS score ≤2 after 90 days. Conclusion: Our results are in line with those in the published literature and show that a treatment strategy with general interventional radiologists performing neurointerventional procedures in acute stroke patients with large vessel occlusions can be achieved to the benefit of patients.

  17. Treatment of stroke with early imaging and revascularization: when to be aggressive?

    Science.gov (United States)

    Toni, Danilo; Pieroni, Alessio

    2017-01-01

    Neuroimaging has a key role in the assessment and treatment of acute stroke. Cerebral computer tomography is the first step to differentiate hemorragic from ischemic stroke and to detect, in the latter, early signs representative of the lesion severity and predicting a possible hemorrhagic infarction after thrombolytic treatment.Advanced neuroimaging techniques are relevant in the assessment of the ischemic and/or hypo-perfused area, being an essential tool in uncertain situations or when the time of symptoms onset is unavailable, increasing the efficacy and safety of endovenous thrombolysis by enlarging its therapeutic window and leading to more accurate selection of patients to be treated.Moreover, advanced neuroimaging may be of help in choosing the patients to be submitted to endovascular treatment when occlusion of an intracranial artery is documented, either after intravenous thrombolysis or as a primary approach.Here we describe the impact of neuroimaging in the decisional process in acute ischemic stroke, presenting the literature evidence on the topic, especially regarding the recent trials on endovascular treatment.

  18. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial.

    Science.gov (United States)

    van Vliet, P M; Lincoln, N B; Foxall, A

    2005-04-01

    Bobath based (BB) and movement science based (MSB) physiotherapy interventions are widely used for patients after stroke. There is little evidence to suggest which is most effective. This single-blind randomised controlled trial evaluated the effect of these treatments on movement abilities and functional independence. A total of 120 patients admitted to a stroke rehabilitation ward were randomised into two treatment groups to receive either BB or MSB treatment. Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale. Secondary measures assessed functional independence, walking speed, arm function, muscle tone, and sensation. Measures were performed by a blinded assessor at baseline, and then at 1, 3, and 6 months after baseline. Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve (AUC) and inserting AUC values into Mann-Whitney U tests. Comparison between groups showed no significant difference for any outcome measures. Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87. There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention. Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients.

  19. The Effect of Mannitol Treatment on Renal Functions in Acute Stroke

    Directory of Open Access Journals (Sweden)

    Neslihan Eşkut

    2010-06-01

    Full Text Available OBJECTIVE: Mannitol is an osmotic diuretic agent and reduces intracranial pressure. The most serious side effect of mannitol is kidney dysfunction. In this study, renal functions in acute stroke patients treated with mannitol were evaluated. METHODS: One hundred and twenty-two patients followed in the neurology intensive care unit with the diagnosis of stroke and treated with fractionated mannitol for 5 days were evaluated retrospectively. Ninety-six patients had ischemic and 26 had hemorrhagic stroke. Mean age was 69.9 ± 11.8 (18-91 years. Serum urea, creatinine and electrolyte levels measured before and on the second, third, fourth, fifth and tenth days of treatment were compared statistically with paired sample t test. RESULTS: The average urea and creatinine levels on the second, third, fourth and fifth days of treatment were significantly higher than the baseline (p< 0.05. On the other hand, mannitol treatment did not change average sodium, potassium and chlorine levels. The creatinine levels had returned to the normal range on the tenth day of treatment, but the urea levels, although decreased, did not fall to the normal range. CONCLUSION: Our results support the view that close monitoring of renal function is necessary in patients treated with mannitol

  20. Patient-Identified Factors That Influence Spasticity in People with Stroke and Multiple Sclerosis Receiving Botulinum Toxin Injection Treatments

    Science.gov (United States)

    Cheung, Janice; Rancourt, Amanda; Di Poce, Stephanie; Levine, Amy; Hoang, Jessica; Ismail, Farooq; Boulias, Chris

    2015-01-01

    ABSTRACT Purpose: To describe the nature, extent, and impact of spasticity; determine factors that are perceived to influence its severity; and examine the relationship between time since diagnosis and impact of spasticity on daily activities in people with stroke and multiple sclerosis (MS) who are receiving botulinum toxin injection treatments. Methods: After a cross-sectional telephone survey, descriptive statistics and correlations were analyzed separately for the stroke and MS groups. Results: A total of 29 people with stroke and 10 with MS were surveyed. Both groups perceived increased spasticity with outdoor cold (69% stroke, 60% MS), muscle fatigue (59% stroke, 80% MS), and mental stress (59% stroke, 90% MS). No statistically significant correlations were found between time since diagnosis and perceived impact of spasticity on function in the stroke (r=0.07, p=0.37) or MS (r=0.16, p=0.33) groups. The MS group experienced bilateral and more severe perception of spasticity in the legs than the stroke group and identified more factors as worsening their spasticity (pspasticity was significantly correlated with severity of impact of the following factors in the MS group only: lying on the back (r=0.70, pspasticity differently depending on individual factors, severity, location (arm vs. leg), and distribution of spasticity (unilateral vs. bilateral). Clinicians can use the findings to better understand, educate, and treat people with stroke and MS. PMID:25931667

  1. Intravascular Cooling in the Treatment of Stroke (ICTuS): early clinical experience.

    Science.gov (United States)

    Lyden, Patrick D; Allgren, Robin L; Ng, Ken; Akins, Paul; Meyer, Brett; Al-Sanani, Fahmi; Lutsep, Helmi; Dobak, John; Matsubara, Bradley S; Zivin, Justin

    2005-01-01

    We sought to evaluate the safety and feasibility of mild therapeutic hypothermia using an endovascular temperature management system in awake acute ischemic stroke patients. The Intravascular Cooling in the Treatment of Stroke (ICTuS) study was an uncontrolled, multicenter development and feasibility study of conscious patients (n = 18) presenting within 12 hours of onset of an acute ischemic stroke at 5 clinical sites in the United States. Enrolled patients were to undergo core temperature management using an endovascular cooling system to induce and maintain mild, therapeutic hypothermia (target temperature of 33.0 degrees C) for a period of either 12 or 24 hours, followed by controlled rewarming to 36.5 degrees C over the subsequent 12-hour period. Nine patients underwent 12 hours of cooling followed by 12 hours of controlled rewarming, and 6 patients underwent 24 hours of cooling followed by 12 hours of controlled rewarming. Three patients underwent <1.5 hours of hypothermia due to clinical or technical issues. We also developed an antishivering regimen using buspirone and meperidine administered prophylactically to suppress shivering. The endovascular cooling catheter was well tolerated, with acceptable adverse event rates. Increasing the duration of hypothermia administration from 12 hours to 24 hours did not appear to increase the incidence or severity of adverse effects. Endovascular cooling with a proactive antishivering regimen can be accomplished in awake stroke patients. Further studies are needed to establish the safety and efficacy of this approach.

  2. Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA.

    Science.gov (United States)

    Villwock, Mark R; Padalino, David J; Deshaies, Eric M

    2016-05-01

    Mechanical thrombectomy (MT) for the treatment of acute ischemic stroke has been growing in popularity while the therapeutic benefit of MT has been increasingly debated. Our objective was to examine national trends in mortality following MT. We analyzed the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2008-2011) for patients with a primary diagnosis of acute ischemic stroke that received MT. Temporal trends in mortality were examined using Spearman's rank correlation. To account for confounding factors, mortality was further analyzed in binary logistic regression. Hospitals performing MT comprised 8% of all hospitals treating ischemic stroke. The percentage of stroke cases treated with MT increased from 0.6% of cases in 2008 to 1.1% in 2012, totaling 16 307 MT cases in a 5 year period. Inhospital mortality decreased over the study period from 25.4% in 2008 to 16.1% in 2012 (r=-0.081, ptrend is increasing. Mortality following MT has been showing a steady decline over the past 5 years. This may be a result of a learning curve, improved patient selection, and/or device improvements. Randomized trials remain essential to evaluate the potential benefit of endovascular devices and identify the most appropriate patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L): final results.

    Science.gov (United States)

    Hemmen, Thomas M; Raman, Rema; Guluma, Kama Z; Meyer, Brett C; Gomes, Joao A; Cruz-Flores, Salvador; Wijman, Christine A; Rapp, Karen S; Grotta, James C; Lyden, Patrick D

    2010-10-01

    Induced hypothermia is a promising neuroprotective therapy. We studied the feasibility and safety of hypothermia and thrombolysis after acute ischemic stroke. Intravenous Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke (ICTuS-L) was a randomized, multicenter trial of hypothermia and intravenous tissue plasminogen activator in patients treated within 6 hours after ischemic stroke. Enrollment was stratified to the treatment time windows 0 to 3 and 3 to 6 hours. Patients presenting within 3 hours of symptom onset received standard dose intravenous alteplase and were randomized to undergo 24 hours of endovascular cooling to 33°C followed by 12 hours of controlled rewarming or normothermia treatment. Patients presenting between 3 and 6 hours were randomized twice: to receive tissue plasminogen activator or not and to receive hypothermia or not. Results- In total, 59 patients were enrolled. One patient was enrolled but not treated when pneumonia was discovered just before treatment. All 44 patients enrolled within 3 hours and 4 of 14 patients enrolled between 3 to 6 hours received tissue plasminogen activator. Overall, 28 patients randomized to receive hypothermia (HY) and 30 to normothermia (NT). Baseline demographics and risk factors were similar between groups. Mean age was 65.5±12.1 years and baseline National Institutes of Health Stroke Scale score was 14.0±5.0; 32 (55%) were male. Cooling was achieved in all patients except 2 in whom there were technical difficulties. The median time to target temperature after catheter placement was 67 minutes (Quartile 1 57.3 to Quartile 3 99.4). At 3 months, 18% of patients treated with hypothermia had a modified Rankin Scale score of 0 or 1 versus 24% in the normothermia groups (nonsignificant). Symptomatic intracranial hemorrhage occurred in 4 patients (68); all were treated with tissue plasminogen activator <3 hours (1 received hypothermia). Six patients in the hypothermia and 5 in the normothermia

  4. Ischaemic stroke in HIV-infected patients: a case-control study.

    Science.gov (United States)

    Silva-Pinto, A; Costa, A; Serrão, R; Sarmento, A; Abreu, P

    2017-03-01

    The aim of the study was to provide insights into the contributions of HIV infection stage, antiretroviral therapy (ART) and vascular risk factors to the occurrence of ischaemic stroke in HIV-infected patients. We performed a case-control study of HIV-infected patients followed in our clinic. We compared patients hospitalized between January 2006 and June 2014 with an ischaemic stroke or transient ischaemic attack to age- and gender-matched controls without stroke. Of 2146 patients followed in our clinic, we included 23 cases (20 men and three women; mean age 51.3 years) and 23 controls. Eighty-three per cent of cases had had a stroke and 17% a transient ischaemic attack. According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, small-vessel occlusion was the most frequent aetiology, followed by large-artery atherosclerosis and cardioembolism. Compared with controls, stroke was statistically significantly associated with diabetes, smoking and low concentrations of high-density lipoprotein (HDL) cholesterol. Illegal drug use, a low CD4 count and a high viral load were also associated with ischaemic cerebral events. There were no statistically significant differences between cases and controls in Centers for Disease Control and Prevention (CDC) HIV stage, CD4 count nadir and HIV infection time-to-event. No statistically significant differences were found concerning ART or treatment compliance. In our single centre study, we found associations of illegal drug use, HIV replication and some traditional vascular risk factors with the occurrence of ischaemic cerebral events. The paradigm of the care of HIV-infected patients is changing. Concomitant diseases in the ageing patient with HIV infection, including cerebrovascular disease, must also be addressed in view of their impacts on morbidity and mortality. Apart from controlling the HIV infection and immunosuppression with ART, vascular risk factors must also be addressed. © 2016 British HIV

  5. Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke: A Randomized Controlled Trial.

    Science.gov (United States)

    Bath, Philip M; Scutt, Polly; Love, Jo; Clavé, Pere; Cohen, David; Dziewas, Rainer; Iversen, Helle K; Ledl, Christian; Ragab, Suzanne; Soda, Hassan; Warusevitane, Anushka; Woisard, Virginie; Hamdy, Shaheen

    2016-06-01

    Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. We randomly assigned 162 patients with a recent ischemic or hemorrhagic stroke and dysphagia, defined as a penetration aspiration score (PAS) of ≥3 on video fluoroscopy, to PES or sham treatment given on 3 consecutive days. The primary outcome was swallowing safety, assessed using the PAS, at 2 weeks. Secondary outcomes included dysphagia severity, function, quality of life, and serious adverse events at 6 and 12 weeks. In randomized patients, the mean age was 74 years, male 58%, ischemic stroke 89%, and PAS 4.8. The mean treatment current was 14.8 (7.9) mA and duration 9.9 (1.2) minutes per session. On the basis of previous data, 45 patients (58.4%) randomized to PES seemed to receive suboptimal stimulation. The PAS at 2 weeks, adjusted for baseline, did not differ between the randomized groups: PES 3.7 (2.0) versus sham 3.6 (1.9), P=0.60. Similarly, the secondary outcomes did not differ, including clinical swallowing and functional outcome. No serious adverse device-related events occurred. In patients with subacute stroke and dysphagia, PES was safe but did not improve dysphagia. Undertreatment of patients receiving PES may have contributed to the neutral result. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN25681641. © 2016 The Authors.

  6. Hemorrhagic risk of emergent endovascular treatment plus stenting in patients with acute ischemic stroke.

    Science.gov (United States)

    Dorado, Laura; Castaño, Carlos; Millán, Mònica; Aleu, Aitziber; de la Ossa, Natàlia Pérez; Gomis, Meritxell; López-Cancio, Elena; Vivas, Elio; Rodriguez-Campello, Ana; Castellanos, Mar; Dávalos, Antoni

    2013-11-01

    Several endovascular revascularization strategies have been described for the treatment of acute ischemic stroke (AIS). One of them is stenting when a very narrow stenosis with high reocclusion risk remains after recanalization. This study describes the risk of symptomatic intracerebral hemorrhage (SICH) after emergent stenting in patients with AIS treated with endovascular therapies. Consecutive patients who underwent endovascular treatment over a 37-month period were retrospectively analyzed. Patients were classified in 2 groups: (1) patients in whom a stent was deployed; and (2) patients without stenting. Double antiplatelet treatment with aspirin and clopidogrel was administered at the time of stenting. SICH was defined as any hemorrhagic transformation with National Institutes of Health Stroke Scale (NIHSS) score worsening 4 points or more (European-Australasian Acute Stroke Study II criteria). A total of 143 patients were included (mean age: 66.1±11.7 years, median NIHSS score: 18). Acute phase stenting was performed in 24 subjects (16.8%): 4 intracranial (3 in basilar artery, 1 in middle cerebral artery) and 20 extracranial (internal carotid artery). SICH occurred in 11 patients, 5 of 24 (20.8%) in patients with stenting and in 3 of 119 (2.5%) without (P=.008). No differences were found with respect to baseline NIHSS score or intravenous tissue plasminogen activator administration. Acute phase stenting emerged as an independent predictor of SICH after adjustment for potential confounders and procedure duration: odds ratio 7.3 (confidence interval 1.4-36.8, P=.016). Our findings suggest that emergent stenting in endovascular treatment of AIS is associated with SICH. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil

    Directory of Open Access Journals (Sweden)

    Elza Dias Tosta

    2014-05-01

    Full Text Available Purpose: This paper presents the initial experience with thrombolysis for acute ischaemic stroke at Hospital de Base do Distrito Federal (HBDF, Brazil, and the difficulties associated with the implementation of this treatment. Method: A retrospective study was performed using the medical records of all patients with acute stroke who were treated with intravenous alteplase in our department, between May 2011 and April 2012. Results: The thrombolytic therapy was administered to 32 patients. The mean time between the ictus and the start of stroke therapy start was 195 (60-270 minutes. Sixteen patients demonstrated a significant clinical improvement (decrease in National Institute Health Stroke Scale [NIHSS] score≥4 points in 24 hours; 6 patients were discharged with an NIHSS score of 0 and 2 demonstrated haemorrhagic transformation. Conclusions: The results of our study are similar to those reported in the literature, although we have been dealing with difficulties, such as the lack of a stroke unit.

  8. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Yaghi, Shadi; Willey, Joshua Z; Cucchiara, Brett; Goldstein, Joshua N; Gonzales, Nicole R; Khatri, Pooja; Kim, Louis J; Mayer, Stephan A; Sheth, Kevin N; Schwamm, Lee H

    2017-12-01

    Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The document sections were divided among writing group members who performed the literature review, summarized the literature, and provided suggestions on the diagnosis and treatment of patients with sICH caused by systemic thrombolysis with alteplase. Several drafts were circulated among writing group members until a consensus was achieved. sICH is an uncommon but severe complication of systemic thrombolysis in acute ischemic stroke. Prompt diagnosis and early correction of the coagulopathy after alteplase have remained the mainstay of treatment. Further research is required to establish treatments aimed at maintaining integrity of the blood-brain barrier in acute ischemic stroke based on inhibition of the underlying biochemical processes. © 2017 American Heart Association, Inc.

  9. Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke.

    Science.gov (United States)

    Blanc, Raphaël; Redjem, Hocine; Ciccio, Gabriele; Smajda, Stanislas; Desilles, Jean-Philippe; Orng, Eliane; Taylor, Guillaume; Drumez, Elodie; Fahed, Robert; Labreuche, Julien; Mazighi, Mikael; Lapergue, Bertrand; Piotin, Michel

    2017-06-01

    A direct aspiration first pass technique (ADAPT) has been reported to be fast, safe, and effective for the treatment of acute ischemic stroke. The aim of this study is to determine the preoperative factors that affect success of the aspiration component of the technique in ischemic stroke patients with large vessel occlusion in the anterior circulation. We enrolled all 347 consecutive patients with anterior circulation acute ischemic stroke admitted for mechanical thrombectomy at our institution from August 2013 to October 2015 and treated by ADAPT for the endovascular treatment of stroke. Baseline and procedural characteristics, modified thrombolysis in cerebral infarction scores, and 3-month modified Rankin Scale were captured and analyzed. Among the 347 patients (occlusion sites: middle cerebral artery=200, 58%; internal carotid artery Siphon=89, 25%; Tandem=58, 17%), aspiration component led to successful reperfusion (modified thrombolysis in cerebral infarction 2b/3 scores) in 55.6% (193/347 patients), stent retrievers were required in 40%, and a total successful final reperfusion rate of 83% (288/347) was achieved. Overall, procedural complications occurred in 13.3% of patients (48/347). Modified Rankin Scale score of 0 to 2 at 90 days was reported in 45% (144/323). Only 2 factors positively influenced the success of the aspiration component: an isolated middle cerebral artery occlusion ( P stroke onset to clot contact ( P =0.018). In this large retrospective study, ADAPT was shown to be safe and effective for anterior circulation acute ischemic stroke with a final successful reperfusion achieved in 83%. The site of arterial occlusion and delay of the procedure were predictors for reperfusion. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02523261, NCT02678169, and NCT02466893. © 2017 American Heart Association, Inc.

  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. [HE Xingwei's exploration and experience in the pathogenesis and treatment of motor impairment of the trunk after stroke].

    Science.gov (United States)

    Zhang, Peng; Hu, Songfeng; He, Fan; Fang, Jinying; Wang, Qiang; He, Xingwei

    2017-02-12

    In the paper, it is introduced professor HE Xingwei 's recognition on the pathogenesis and professor HE 's experience in the treatment of the motor impairment of the trunk after stroke. Professor He believes that the motor impairment of the trunk after stroke is the essential factor affecting the rehabilitation in stroke. The motor impairment of the trunk after stroke results from brain marrow damage and spiritual impairment. Hence, regaining the consciousness and promoting the circulation of the governor vessel are the basic principles of the treatment, named regulating the mind and controlling qi , benefiting qi and warming yang , tonifying the kidney and filling up the essence, and promoting the circulation of the governor vessel. Those four therapeutic methods are equally important. Acupuncture, moxibusiton and herbal medicine are applied in combination in the treatment. Additionally, the psychotherapy and rehabilitation are the accessory therapies.

  12. Type of Preadmission Antidiabetic Treatment and Outcome among Patients with Ischemic Stroke: A Nationwide Follow-up Study

    DEFF Research Database (Denmark)

    Horsdal, Henriette Thisted; Mehnert, Frank; Rungby, Jørgen

    2012-01-01

    computed mortality rates and rates of readmission recurrent ischemic stroke or myocardial infarction according to type of treatment and used the Cox proportional hazards regression analysis to compute hazard ratios (HRs). RESULTS: We identified 4817 stroke patients with type 2 diabetes mellitus. We found...... hospitalized with ischemic stroke between 2003 and 2006 and who were registered in the Danish National Indicator Project. We obtained data on diabetes and type of antidiabetic treatment, patient characteristics, in-hospital quality of care, and mortality and readmissions by linking medical databases. We......, it did not reach statistical significance for all treatment groups. CONCLUSIONS: Preadmission use of sulfonylureas appeared not to be associated with an overall improved clinical outcome among type 2 diabetic patients admitted with ischemic stroke....

  13. Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Layton, Kennith F.; Cloft, Harry J.; Kallmes, David F. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); White, J. Bradley [Mayo Clinic, Department of Neurosurgery, Rochester, MN, (United States); Manno, Edward M. [Mayo Clinic, Department of Neurology, Rochester, MN, (United States)

    2006-06-15

    Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. (orig.)

  14. A Successful Endovascular Treatment of an Ischemic Stroke following Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Maher A. Al-Khawaldeh

    2015-11-01

    Full Text Available Ischemic stroke following cardiac surgery is one of the devastating complications that surgeons may encounter, and may lead to serious disabilities for the patient. The clinical course of such a complication may be prolonged if it is not treated properly. Making a quick decision when choosing a revascularization method is very helpful in this matter. Effective treatment options are usually limited. Neurointerventional maneuvers have recently emerged as a possible therapeutic modality in this field. We present the case of a 52-year-old woman who had open heart surgery in Queen Alia Heart Institute, Jordan, to replace a severely stenotic rheumatic mitral valve and repair a leaking tricuspid valve. Her surgery went smoothly with no major event. However, she developed a massive ischemic stroke during her recovery period despite being on adequate anticoagulation therapy. Urgent radiological work-up confirmed the diagnosis of ischemic stroke in the territory of the right middle cerebral artery. We chose a neuro-interventional method for her treatment, and mechanical thrombectomy was performed with a successful outcome and no apparent complications.

  15. Role of steaming and toasting on the odor, protein characteristics of chickpea (Cicer arietinum L.) flour, and product quality.

    Science.gov (United States)

    Ravi, R; Ajila, C M; Rao, U J S Prasada

    2011-03-01

    Proteins play an important role in imparting functional attributes like texture and shape, which determine the sensory quality of the foods. Boondi, a deep fried product from chickpea (Cicer arietinum L.) flour dispersion, is a popular snack food in India. Chickpea dhal (splits) or flour was subjected to various processing conditions like steaming and toasting, to determine their effect on the chickpea flour protein characteristics and on the product quality. Dhal and flour subjected to different heat treatments showed differences in their odor profiles. The SDS-PAGE of sodium phosphate buffer extracts of steamed dhal or flour showed that the high molecular weight (HMW) proteins of 66 to 100 kDa that were present in the untreated dhal were found to be absent in steamed dhal extracts. However, SDS buffer extracts on SDS-PAGE of these steamed samples did not show any difference between untreated and thermally treated dhal samples. Phosphate buffer extracts of the thermally treated flours were subjected to gel filtration chromatography and the results indicated that the HMW protein fraction content decreased significantly in the treated dhal or flour samples compared to control. Boondi prepared from the thermally treated dhal samples resulted in the loss of spherical shape of boondi. Thus, the results indicate that thermal treatment of chickpea dhal and flour influence changes in protein characteristics, the sensory profile and quality of boondi.

  16. Comparison of the efficacy and safety of intensive-dose and standard-dose statin treatment for stroke prevention

    Science.gov (United States)

    Wang, Juan; Chen, Dan; Li, Da-Bing; Yu, Xin; Shi, Guo-Bing

    2016-01-01

    Abstract Background: Previous study indicated that high-dose statin treatment might increase the risk of hemorrhagic stroke and adverse reactions. We aim to compare the efficacy and safety of intensive-dose and standard-dose statin treatment for preventing stroke in high-risk patients. Methods: A thorough search was performed of multiple databases for publications from 1990 to June 2015. We selected the randomized clinical trials comparing standard-dose statin with placebo and intensive-dose statin with standard-dose statin or placebo for the prevention of stroke events in patients. Duplicate independent data extraction and bias assessments were performed. Data were pooled using a fixed-effects model or a random-effects model if significant heterogeneity was present. Results: For the all stroke incidences, intensive-dose statin treatment compared with placebo treatment and standard-dose statin treatment compared with placebo treatment showed a significant 21% reduction in relative risk (RR) (RR 0.79, 95% confidence interval (CI) [0.71, 0.87], P statin treatment compared with standard dose or placebo was effective reducing fatal stroke (RR 0.61, 95% CI [0.39, 0.96], P = 0.03) and the RR was 1.01 (95% CI [0.85, 1.20], P = 0.90) in standard-dose statin treatment compared with placebo. Conclusion: The results of this meta-analysis suggest that intensive-dose statin treatment might be more favorable for reducing the incidences of all strokes than standard-dose statin treatment, especially for patients older than 65 years in reducing the incidences of all stroke incidences. PMID:27684837

  17. Bone marrow mesenchymal stem cell therapy in ischemic stroke: mechanisms of action and treatment optimization strategies

    Directory of Open Access Journals (Sweden)

    Guihong Li

    2016-01-01

    Full Text Available Animal and clinical studies have confirmed the therapeutic effect of bone marrow mesenchymal stem cells on cerebral ischemia, but their mechanisms of action remain poorly understood. Here, we summarize the transplantation approaches, directional migration, differentiation, replacement, neural circuit reconstruction, angiogenesis, neurotrophic factor secretion, apoptosis, immunomodulation, multiple mechanisms of action, and optimization strategies for bone marrow mesenchymal stem cells in the treatment of ischemic stroke. We also explore the safety of bone marrow mesenchymal stem cell transplantation and conclude that bone marrow mesenchymal stem cell transplantation is an important direction for future treatment of cerebral ischemia. Determining the optimal timing and dose for the transplantation are important directions for future research.

  18. Treatment Modality and Quality Benchmarks of Aneurysmal Subarachnoid Hemorrhage at a Comprehensive Stroke Center

    Directory of Open Access Journals (Sweden)

    Wengui Yu

    2018-03-01

    Full Text Available BackgroundAneurysmal subarachnoid hemorrhage (aSAH is the most severe type of stroke. In 2012, the Joint Commission, in collaboration with the American Heart Association/American Stroke Association (AHA/ASA, launched the Advanced Certification for Comprehensive Stroke Centers (CSCs. This new level of certification was designed to promote higher standard of care for patients with complex stroke.ObjectiveThe goal of this study was to examine the treatment modality and quality benchmarks of aSAH at one of the first five certified CSCs in the United States.MethodsConsecutive patients with aSAH at Cedars-Sinai Medical Center between April 1, 2012 and May 30, 2014 were included for this retrospective study. The ruptured aneurysm was treated with coiling or clipping within 24 h. All patients were managed per AHA guidelines. Discharge outcomes were assessed using modified Rankin Scale (mRS. The rate of aneurysm treatment, door-to-treatment time, rate of posttreatment rebleed, hospital length of stay (LOS, discharge outcome, and mortality rates were evaluated as quality indicators.ResultsThe median age (interquartile range of the 118 patients with aSAH was 55 (19. Among them, 84 (71.2% were females, 94 (79.7% were transfers from outside hospitals, and 74 (62.7% had Hunt and Hess grades 1–3. Sixty patients (50.8% were treated with coiling, 52 (44.1% with clipping, and 6 (5.1% untreated due to ictal cardiac arrest or severe comorbidities. The rate of aneurysm treatment was 95% (112/118 with median door-to-treatment time at 12.5 (8.5 h and 0.9% (1/112 posttreatment rebleed. The median ICU and hospital LOS were 12.5 (7 and 17.0 (14.5 days, respectively. Coiling was associated with significantly shorter LOS than clipping. There were 59 patients (50% with favorable outcome and 19 deaths (16.1% at hospital discharge. There was no significant difference in discharge outcome between coiling and clipping.ConclusionCare of aSAH at one of the early CSCs in the

  19. 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

  20. Results of the ICTuS 2 Trial (Intravascular Cooling in the Treatment of Stroke 2).

    Science.gov (United States)

    Lyden, Patrick; Hemmen, Thomas; Grotta, James; Rapp, Karen; Ernstrom, Karin; Rzesiewicz, Teresa; Parker, Stephanie; Concha, Mauricio; Hussain, Syed; Agarwal, Sachin; Meyer, Brett; Jurf, Julie; Altafullah, Irfan; Raman, Rema

    2016-12-01

    Therapeutic hypothermia is a potent neuroprotectant approved for cerebral protection after neonatal hypoxia-ischemia and cardiac arrest. Therapeutic hypothermia for acute ischemic stroke is safe and feasible in pilot trials. We designed a study protocol to provide safer, faster therapeutic hypothermia in stroke patients. Safety procedures and 4°C saline infusions for faster cooling were added to the ICTuS trial (Intravascular Cooling in the Treatment of Stroke) protocol. A femoral venous intravascular cooling catheter after intravenous recombinant tissue-type plasminogen activator in eligible patients provided 24 hours cooling followed by a 12-hour rewarm. Serial safety assessments and imaging were performed. The primary end point was 3-month modified Rankin score 0,1. Of the intended 1600 subjects, 120 were enrolled before the study was stopped. Randomly, 63 were to receive hypothermia plus antishivering treatment and 57 normothermia. Compared with previous studies, cooling rates were improved with a cold saline bolus, without fluid overload. The intention-to-treat primary outcome of 90-day modified Rankin Score 0,1 occurred in 33% hypothermia and 38% normothermia subjects, odds ratio (95% confidence interval) of 0.81 (0.36-1.85). Serious adverse events occurred equally. Mortality was 15.9% hypothermia and 8.8% normothermia subjects, odds ratio (95% confidence interval) of 1.95 (0.56-7.79). Pneumonia occurred in 19% hypothermia versus 10.5% in normothermia subjects, odds ratio (95% confidence interval) of 1.99 (0.63-6.98). Intravascular therapeutic hypothermia was confirmed to be safe and feasible in recombinant tissue-type plasminogen activator-treated acute ischemic stroke patients. Protocol changes designed to reduce pneumonia risk appeared to fail, although the sample is small. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01123161. © 2016 American Heart Association, Inc.

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

    Directory of Open Access Journals (Sweden)

    Lucy Anne Murtha

    2016-05-01

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

  2. Quantitative replacement of soybean meal with toasted African yam ...

    African Journals Online (AJOL)

    From the result, one can conclude that 25% AYB (treatment II) compared favourably with the control diets 0% AYB in starter broiler diets and is hereby recommended as optimal for quantitative replacement of soybean in broiler starter diet. Key words: Broiler Starter diet, African Yam Bean, Soyabean replacement ...

  3. Therapeutic Strategies to Attenuate Hemorrhagic Transformation After Tissue Plasminogen Activator Treatment for Acute Ischemic Stroke.

    Science.gov (United States)

    Kanazawa, Masato; Takahashi, Tetsuya; Nishizawa, Masatoyo; Shimohata, Takayoshi

    2017-03-01

    This review focuses on the mechanisms and emerging concepts of stroke and therapeutic strategies for attenuating hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) treatment for acute ischemic stroke (AIS). The therapeutic time window for tPA treatment has been extended. However, the patients who are eligible for tPA treatment are still <5% of all patients with AIS. The risk of serious or fatal symptomatic hemorrhage increases with delayed initiation of treatment. HT is thought to be caused by 1) ischemia/reperfusion injury; 2) the toxicity of tPA itself; 3) inflammation; and/or 4) remodeling factor-mediated effects. Modulation of these pathophysiologies is the basis of direct therapeutic strategies to attenuate HT after tPA treatment. Several studies have revealed that matrix metalloproteinases and free radicals are potential therapeutic targets. In addition, we have demonstrated that the inhibition of the vascular endothelial growth factor-signaling pathway and supplemental treatment with a recombinant angiopoietin-1 protein might be a promising therapeutic strategy for attenuating HT after tPA treatment through vascular protection. Moreover, single-target therapies could be insufficient for attenuating HT after tPA treatment and improving the therapeutic outcome of patients with AIS. We recently identified progranulin, which is a growth factor and a novel target molecule with multiple therapeutic effects. Progranulin might be a therapeutic target that protects the brain through suppression of vascular remodeling (vascular protection), neuroinflammation, and/or neuronal death (neuroprotection). Clinical trials which evaluate the effects of anti-VEGF drugs or PGRN-based treatment with tPA will be might worthwhile.

  4. Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the United States.

    Science.gov (United States)

    Tekle, Wondwossen G; Chaudhry, Saqib A; Hassan, Ameer E; Rodriguez, Gustavo J; Suri, M Fareed K; Qureshi, Adnan I

    2012-07-01

    To provide a national assessment of thrombolytic administration using drip-and-ship treatment paradigm. Patients treated with the drip-and-ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment were identified within the Nationwide Inpatient Sample. Thrombolytic utilization, patterns of referral, comparative in-hospital outcomes, and hospitalization charges related to drip-and-ship paradigm were determined. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Of the 22 243 ischemic stroke patients who received thrombolytic treatment, 4474 patients (17%) were treated using drip-and-ship paradigm. Of these 4474 patients, 81% were referred to urban teaching hospitals for additional care, and 7% of them received follow-up endovascular treatment. States with a higher proportion of patients treated using the drip-and-ship paradigm had higher rates of overall thrombolytic utilization (5.4% versus 3.3%; Pcare was significantly higher in patients treated with drip-and-ship paradigm compared with those who received thrombolytics through primary emergency department arrival in the multivariate analysis (OR, 1.198; 95% CI, 1.019-1.409; P=0.0286). One of every 6 thrombolytic-treated patients in United States is treated using drip-and-ship paradigm. States with the highest proportion of drip-and-ship cases were also the states with the highest thrombolytic utilization.

  5. Acupuncture treatment for ischaemic stroke in young adults: protocol for a randomised, sham-controlled clinical trial.

    Science.gov (United States)

    Chen, Lifang; Fang, Jianqiao; Jin, Xiaoming; Keeler, Crystal Lynn; Gao, Hong; Fang, Zhen; Chen, Qin

    2016-01-06

    Stroke in young adults is not uncommon. Although the overall incidence of stroke has been recently declining, the incidence of stroke in young adults is increasing. Traditional vascular risk factors are the main cause of young ischaemic stroke. Acupuncture has been shown to benefit stroke rehabilitation and ameliorate the risk factors for stroke. The aims of this study were to determine whether acupuncture treatment will be effective in improving the activities of daily living (ADL), motor function and quality of life (QOL) in patients of young ischaemic stroke, and in preventing stroke recurrence by controlling blood pressure, lipids and body weight. In this randomised, sham-controlled, participant-blinded and assessor-blinded clinical trial, 120 patients between 18 and 45 years of age with a recent (within 1 month) ischaemic stroke will be randomised for an 8-week acupuncture or sham acupuncture treatment. The primary outcome will be the Barthel Index for ADL. The secondary outcomes will include the Fugl-Meyer Assessment for motor function; the World Health Organization Quality of Life BREF (WHOQOL-BREF) for QOL; and risk factors that are measured by ambulatory blood pressure, the fasting serum lipid, body mass index and waist circumference. Incidence of adverse events and long-term mortality and recurrence rate during a 10-year and 30-year follow-up will also be investigated. Ethics approval was obtained from the Ethics Committee of The Third Affiliated Hospital of Zhejiang Chinese Medical University. Protocol V.3 was approved in June 2013. The results will be disseminated in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients by telephone during follow-up calls enquiring on the patient's post-study health status. ChiCTR-TRC- 13003317; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

    Directory of Open Access Journals (Sweden)

    Fabiola Maioli

    2013-09-01

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

  7. Mediterranean Diet in patients with acute ischemic stroke: Relationships between Mediterranean Diet score, diagnostic subtype, and stroke severity index.

    Science.gov (United States)

    Tuttolomondo, Antonino; Casuccio, Alessandra; Buttà, Carmelo; Pecoraro, Rosaria; Di Raimondo, Domenico; Della Corte, Vittoriano; Arnao, Valentina; Clemente, Giuseppe; Maida, Carlo; Simonetta, Irene; Miceli, Giuseppe; Lucifora, Benedetto; Cirrincione, Anna; Di Bona, Danilo; Corpora, Francesca; Maugeri, Rosario; Iacopino, Domenico Gerardo; Pinto, Antonio

    2015-11-01

    Adherence to a Mediterranean Diet appears to reduce the risk of cardiovascular disease, cancer, Alzheimer's disease, and Parkinson's disease, as well as the risk of death due to cardiovascular disease. No study has addressed the association between diagnostic subtype of stroke and its severity and adherence to a Mediterranean Diet in subjects with acute ischemic stroke. To evaluate the association between Mediterranean Diet adherence, TOAST subtype, and stroke severity by means of a retrospective study. The type of acute ischemic stroke was classified according to the TOAST criteria. All patients admitted to our ward with acute ischemic stroke completed a 137-item validated food-frequency questionnaire adapted to the Sicilian population. A scale indicating the degree of adherence to the traditional Mediterranean Diet was used (Me-Di score: range 0-9). 198 subjects with acute ischemic stroke and 100 control subjects without stroke. Stroke subjects had a lower mean Mediterranean Diet score compared to 100 controls without stroke. We observed a significant positive correlation between Me-Di score and SSS score, whereas we observed a negative relationship between Me-Di score and NIHSS and Rankin scores. Subjects with atherosclerotic (LAAS) stroke subtype had a lower mean Me-Di score compared to subjects with other subtypes. Multinomial logistic regression analysis in a simple model showed a negative relationship between MeDi score and LAAS subtype vs. lacunar subtype (and LAAS vs. cardio-embolic subtype). Patients with lower adherence to a Mediterranean Diet are more likely to have an atherosclerotic (LAAS) stroke, a worse clinical presentation of ischemic stroke at admission and a higher Rankin score at discharge. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. 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 ...

  9. Dynamics of the recovery of autonomic nervous system in patients after surgical treatment of hemorrhagic stroke.

    Directory of Open Access Journals (Sweden)

    Kuftan Mohammed Nazmi Kuftan

    2012-04-01

    Full Text Available We talking about the impact of tools and techniques of physical rehabilitation on the performance of the autonomic nervous system (parasympathetic activity and sympathetic tone and heart rate of patients after surgical treatment of hemorrhagic stroke. The experiment had involved 53 patients aged from 37 to 72 years. The survey was conducted on patients' clinical stage of rehabilitation in the second, third and sixth week after surgery. The analysis is based on the measurement of heart rate variability. A positive effect of the use of tools and techniques of physical rehabilitation program on the state of autonomic regulation.

  10. Current perspectives on the use of intravenous recombinant tissue plasminogen activator (tPA for treatment of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Chapman SN

    2014-02-01

    Full Text Available Sherita N Chapman,1 Prachi Mehndiratta,1 Michelle C Johansen,1 Timothy L McMurry,2 Karen C Johnston,1,2 Andrew M Southerland1,2 1Department of Neurology, University of Virginia, Charlottesville, VA, USA; 2Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA Abstract: In 1995, the NINDS (National Institute of Neurological Disorders and Stroke tPA (tissue plasminogen activator Stroke Study Group published the results of a large multicenter clinical trial demonstrating efficacy of intravenous tPA by revealing a 30% relative risk reduction (absolute risk reduction 11%–15% compared with placebo at 90 days in the likelihood of having minimal or no disability. Since approval in 1996, tPA remains the only drug treatment for acute ischemic stroke approved by the US Food and Drug Administration. Over the years, an abundance of research and clinical data has supported the safe and efficacious use of intravenous tPA in all eligible patients. Despite such supporting data, it remains substantially underutilized. Challenges to the utilization of tPA include narrow eligibility and treatment windows, risk of symptomatic intracerebral hemorrhage, perceived lack of efficacy in certain high-risk subgroups, and a limited pool of neurological and stroke expertise in the community. With recent US census data suggesting annual stroke incidence will more than double by 2050, better education and consensus among both the medical and lay public are necessary to optimize the use of tPA for all eligible stroke patients. Ongoing and future research should continue to improve upon the efficacy of tPA through more rapid stroke diagnosis and treatment, refinement of advanced neuroimaging and stroke biomarkers, and successful demonstration of alternative means of reperfusion. Keywords: IV tPA, rtPA, t-PA, rt-PA, cerebrovascular disease, cerebrovascular accident

  11. Combination of Thrombolysis and Statins in Acute Stroke Is Safe: Results of the STARS Randomized Trial (Stroke Treatment With Acute Reperfusion and Simvastatin).

    Science.gov (United States)

    Montaner, Joan; Bustamante, Alejandro; García-Matas, Silvia; Martínez-Zabaleta, Maite; Jiménez, Carmen; de la Torre, Javier; Rubio, Francisco R; Segura, Tomás; Masjuán, Jaime; Cánovas, David; Freijo, Mar; Delgado-Mederos, Raquel; Tejada, Javier; Lago, Aida; Bravo, Yolanda; Corbeto, Natália; Giralt, Dolors; Vives-Pastor, Bárbara; de Arce, Anna; Moniche, Francisco; Delgado, Pilar; Ribó, Marc

    2016-11-01

    The STARS trial (Stroke Treatment With Acute Reperfusion and Simvastatin) was conducted to demonstrate the efficacy and safety of simvastatin treatment in acute stroke. STARS07 was a multicentre, phase IV, prospective, randomized, double-blind, placebo-controlled trial. Patients with Acute ischemic stroke recruited within 12 hours from symptom onset were randomized to oral simvastatin 40 mg or placebo, once daily for 90 days. Primary outcome was proportion of independent patients (modified Rankin Scale score of ≤2) at 90 days. Safety end points were hemorrhagic transformation, hemorrhagic events, death, infections, and serious adverse events. From April 2009 to March 2014, 104 patients were included. Fifty-five patients received intravenous tissue-type plasminogen activator. No differences were found between treatment arms regarding the primary outcome (adjusted odds ratio, 0.99 [0.35-2.78]; P=0.98). Concerning safety, no significant differences were found in the rate of hemorrhagic transformation of any type, nor symptomatic hemorrhagic transformation. There were no differences in other predefined safety outcomes. In post hoc analyses, for patients receiving tissue-type plasminogen activator, a favorable effect for simvastatin treatment was noted with higher proportion of patients experiencing major neurological recovery (adjusted odds ratio, 4.14 [1.18-14.4]; P=0.02). Simvastatin plus tissue-type plasminogen activator combination seems safe in acute stroke, with low rates of bleeding complications. Because of the low recruitment, the STARS trial was underpowered to detect differences in simvastatin efficacy. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01073007. © 2016 American Heart Association, Inc.

  12. [Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial].

    Science.gov (United States)

    Fu, Qin-hui; Pei, Jian; Jia, Qi; Song, Yi; Gu, Yue-hua; You, Xiao-xin

    2012-05-01

    Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community. A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months. The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support

  13. Effect of different combinations of physiotherapy treatment approaches on functional outcomes in stroke patients: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Bryan Ping Ho Chung, MSc in Health Care

    2014-06-01

    Full Text Available This retrospective study compared the functional outcomes among stroke patients who had received rehabilitation based on different physiotherapy treatment approaches. The participants were divided into three groups according to the physiotherapist in charge of their treatment. The primary treatment approaches applied in Group A, Group B, and Group C were the functional approach, the Bobath approach, and the motor learning approach, respectively. For each participant, the Berg's Balance Scale score, the Modified Barthel Index, and the Modified Rivermead Mobility Index were compared among these three groups prior to and after the stroke rehabilitation programme. Within-group analysis showed that Group A, Group B, and Group C participants had a statistically significant improvement in their Modified Barthel Index (p  0.05. In summary, this study showed that different combinations of treatment approaches may induce similar improvement in functional outcomes after stroke rehabilitation.

  14. Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis.

    Science.gov (United States)

    Rodrigues, Filipe Brogueira; Neves, Joana Briosa; Caldeira, Daniel; Ferro, José M; Ferreira, Joaquim J; Costa, João

    2016-04-18

    To evaluate the efficacy and safety of endovascular treatment, particularly adjunctive intra-arterial mechanical thrombectomy, in patients with ischaemic stroke. Systematic review and meta-analysis. Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SciELO, LILACS, and clinical trial registries from inception to December 2015. Reference lists were crosschecked. Randomised controlled trials in adults aged 18 or more with ischaemic stroke comparing endovascular treatment, including thrombectomy, with medical care alone, including intravenous recombinant tissue plasminogen activator (rt-PA). Trial endpoints were functional outcome (modified Rankin scale scores of ≤2) and mortality at 90 days after onset of symptoms. No language or time restrictions applied. 10 randomised controlled trials (n=2925) were included. In pooled analysis endovascular treatment, including thrombectomy, was associated with a higher proportion of patients experiencing good (modified Rankin scale scores ≤2) and excellent (scores ≤1) outcomes 90 days after stroke, without differences in mortality or rates for symptomatic intracranial haemorrhage, compared with patients randomised to medical care alone, including intravenous rt-PA. Heterogeneity was high among studies. The more recent studies (seven randomised controlled trials, published or presented in 2015) proved better suited to evaluate the effect of adjunctive intra-arterial mechanical thrombectomy on its index disease owing to more accurate patient selection, intravenous rt-PA being administered at a higher rate and earlier, and the use of more efficient thrombectomy devices. In most of these studies, more than 86% of the patients were treated with stent retrievers, and rates of recanalisation were higher (>58%) than previously reported. Subgroup analysis of these seven studies yielded a risk ratio of 1.56 (95% confidence interval 1.38 to 1.75) for good functional outcomes and 0.86 (0.69 to 1.06) for

  15. Recognized homonymous hemianopsia and delirium during the admission examination leading to diagnosis and appropriate treatment of a new stroke

    Directory of Open Access Journals (Sweden)

    Tsymbalov KS

    2016-06-01

    Full Text Available Konstantin S Tsymbalov, Douglas R Fetkenhour Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA Abstract: This case report describes the detection of homonymous hemianopsia and delirium during the admission physical examination of a patient with esophageal adenocarcinoma, resulting in the new diagnosis of subacute hemorrhagic stroke. The poststroke visual field defect can result in significant disability and reduction in quality of life. Patients with visual field cut show a severely reduced quality of life and require additional neuropsychological and visual rehabilitation. Only thorough physical examination is able to challenge prior negative positron emission tomography scan, leading to the diagnosis of subacute stroke and, following appropriate treatment, secondary stroke prophylaxis and rehabilitation, instead of brain radiation and chemotherapy. Keywords: physical examination, homonymous hemianopsia, stroke, esophageal tumor 

  16. Dissipation kinetics of organophosphorus pesticides in milled toasted maize and wheat flour (gofio) during storage.

    Science.gov (United States)

    González-Curbelo, Miguel Ángel; Socas-Rodríguez, Bárbara; Herrero, Miguel; Herrera-Herrera, Antonio V; Hernández-Borges, Javier

    2017-08-15

    The dissipation/degradation of the pesticides dimethoate, terbufos, disulfoton, and pirimiphos-methyl were evaluated in milled toasted maize and wheat flour (gofio) during three months of storage. Their dissipation kinetics and residual levels were determined, as well as their possible decomposition into some of their main transformation products (disulfoton sulfoxide, terbufos sulfone and disulfoton sulfone). For this purpose, pesticide-free milled toasted maize and wheat samples were spiked with the pesticides, and they were then stored in the darkness at ambient temperature in a closed container to simulate current storage conditions of such packed food. A multiresidue analysis based on the QuEChERS (Quick, Easy, Cheap, Effective, Rugged and Safe) method was performed for the simultaneous determination of these pesticides and their metabolites. After three months of storage, the dissipation of residues ranged between 34% (pirimiphos-methyl) and 86% (disulfoton) for maize gofio and between 69% (terbufos) and 92% (disulfoton and pirimiphos-methyl) for wheat gofio. The results demonstrated that the degradation was slower in gofio than in wheat gofio and that none of the selected metabolites were detected in any of the samples. Dissipation curves of all studied pesticides fitted to a first-order decay curve in both types of cereals. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Opportunity to learn: Investigating possible predictors for pre-course Test Of Astronomy STandards TOAST scores

    Science.gov (United States)

    Berryhill, Katie J.

    As astronomy education researchers become more interested in experimentally testing innovative teaching strategies to enhance learning in introductory astronomy survey courses ("ASTRO 101"), scholars are placing increased attention toward better understanding factors impacting student gain scores on the widely used Test Of Astronomy STandards (TOAST). Usually used in a pre-test and post-test research design, one might naturally assume that the pre-course differences observed between high- and low-scoring college students might be due in large part to their pre-existing motivation, interest, experience in science, and attitudes about astronomy. To explore this notion, 11 non-science majoring undergraduates taking ASTRO 101 at west coast community colleges were interviewed in the first few weeks of the course to better understand students' pre-existing affect toward learning astronomy with an eye toward predicting student success. In answering this question, we hope to contribute to our understanding of the incoming knowledge of students taking undergraduate introductory astronomy classes, but also gain insight into how faculty can best meet those students' needs and assist them in achieving success. Perhaps surprisingly, there was only weak correlation between students' motivation toward learning astronomy and their pre-test scores. Instead, the most fruitful predictor of TOAST pre-test scores was the quantity of pre-existing, informal, self-directed astronomy learning experiences.

  18. Is It Working? Distractor Analysis Results from the Test Of Astronomy STandards (TOAST) Assessment Instrument

    Science.gov (United States)

    Slater, Stephanie

    2009-05-01

    The Test Of Astronomy STandards (TOAST) assessment instrument is a multiple-choice survey tightly aligned to the consensus learning goals stated by the American Astronomical Society - Chair's Conference on ASTRO 101, the American Association of the Advancement of Science's Project 2061 Benchmarks, and the National Research Council's National Science Education Standards. Researchers from the Cognition in Astronomy, Physics and Earth sciences Research (CAPER) Team at the University of Wyoming's Science and Math Teaching Center (UWYO SMTC) have been conducting a question-by-question distractor analysis procedure to determine the sensitivity and effectiveness of each item. In brief, the frequency each possible answer choice, known as a foil or distractor on a multiple-choice test, is determined and compared to the existing literature on the teaching and learning of astronomy. In addition to having statistical difficulty and discrimination values, a well functioning assessment item will show students selecting distractors in the relative proportions to how we expect them to respond based on known misconceptions and reasoning difficulties. In all cases, our distractor analysis suggests that all items are functioning as expected. These results add weight to the validity of the Test Of Astronomy STandards (TOAST) assessment instrument, which is designed to help instructors and researchers measure the impact of course-length duration instructional strategies for undergraduate science survey courses with learning goals tightly aligned to the consensus goals of the astronomy education community.

  19. The chain of care enabling tPA treatment in acute ischemic stroke : a comprehensive review of organisational models

    NARCIS (Netherlands)

    Lahr, Maarten M. H.; Luijckx, Gert-Jan; Vroomen, Patrick; van der Zee, D.J.; Buskens, Erik

    Protracted and partial implementation of treatment with intravenous tissue plasminogen activator (tPA) within 4.5 h after acute stroke onset results in potentially eligible patients not receiving optimal treatment. The goal of this study was to review the performance of various organisational models

  20. Combining statins with tissue plasminogen activator treatment after experimental and human stroke: a safety study on hemorrhagic transformation.

    Science.gov (United States)

    Campos, Mireia; García-Bonilla, Lidia; Hernández-Guillamon, Mar; Barceló, Verónica; Morancho, Anna; Quintana, Manolo; Rubiera, Marta; Rosell, Anna; Montaner, Joan

    2013-11-01

    Statins may afford neuroprotection against ischemic injury, but it remains controversial whether combined treatment with tissue plasminogen activator (tPA) after stroke increases the risk of hemorrhagic transformation (HT), the major tPA-related complication. We evaluated the safety of combining statin with tPA administration during the acute phase of both experimental and human stroke. The occurrence and severity of HT, infarct volume, and neurological outcome were evaluated in spontaneous hypertensive rats (SHR) subjected to embolic middle cerebral arterial occlusion (MCAO), which received vehicle or simvastatin (20 mg/kg), 15 min after ischemia and tPA (9 mg/kg) 3 h after ischemia. Additionally, HT rate was evaluated in stroke patients who were treated with tPA (0.9 mg/kg) within 3 h after symptom onset, considering whether or not were under statins treatment when the stroke occurred. In the experimental study, no differences in HT rates and severity were found between treatment groups, neither regarding mortality, neurological deficit, infarct volume, or metalloproteinases (MMPs) brain content. In the clinical study, HT rates and hemorrhage type were similar in stroke patients who were or not under statins treatment. This study consistently confirms that the use of statins does not increase HT rates and severity when is combined with tPA administration. © 2013 John Wiley & Sons Ltd.

  1. The design of a focused ultrasound transducer array for the treatment of stroke: a simulation study

    International Nuclear Information System (INIS)

    Pajek, Daniel; Hynynen, Kullervo

    2012-01-01

    High intensity focused ultrasound (HIFU) is capable of mechanically disintegrating blood clots at high pressures. Safe thrombolysis may require frequencies higher than those currently utilized by transcranial HIFU. Since the attenuation and focal distortion of ultrasound in bone increases at higher frequencies, resulting focal pressures are diminished. This study investigated the feasibility of using transcranial HIFU for the non-invasive treatment of ischemic stroke. The use of large aperture, 1.1–1.5 MHz phased arrays in targeting four clinically relevant vessel locations was simulated. Resulting focal sizes decreased with frequency, producing a maximum –3 dB depth of field and lateral width of 2.0 and 1.2 mm, respectively. Mean focal gains above an order of magnitude were observed in three of four targets and transducer intensities required to achieve thrombolysis were determined. Required transducer element counts are about an order of magnitude higher than what currently exists and so, although technically feasible, new arrays would need to be developed to realize this as a treatment modality for stroke. (paper)

  2. Improving treatment times for patients with in-hospital stroke using a standardized protocol.

    Science.gov (United States)

    Koge, Junpei; Matsumoto, Shoji; Nakahara, Ichiro; Ishii, Akira; Hatano, Taketo; Sadamasa, Nobutake; Kai, Yasutoshi; Ando, Mitsushige; Saka, Makoto; Chihara, Hideo; Takita, Wataru; Tokunaga, Keisuke; Kamata, Takahiko; Nishi, Hidehisa; Hashimoto, Tetsuya; Tsujimoto, Atsushi; Kira, Jun-Ichi; Nagata, Izumi

    2017-10-15

    Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008-March 2014) and after implementation (April 2014-December 2016). Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5min, pvs. 26.5min, pvs. 16min, p=0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53min, p=0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity.

    Science.gov (United States)

    Demetrios, Marina; Khan, Fary; Turner-Stokes, Lynne; Brand, Caroline; McSweeney, Shane

    2013-06-05

    Spasticity may affect stroke survivors by contributing to activity limitations, caregiver burden, pain and reduced quality of life (QoL). Spasticity management guidelines recommend multidisciplinary (MD) rehabilitation programmes following botulinum toxin (BoNT) treatment for post-stroke spasticity. However, the evidence base for the effectiveness of MD rehabilitation is unclear. To assess the effectiveness of MD rehabilitation, following BoNT and other focal intramuscular treatments such as phenol, in improving activity limitations and other outcomes in adults and children with post-stroke spasticity. To explore what settings, types and intensities of rehabilitation programmes are effective. We searched the Cochrane Stroke Group Trials Register (February 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 12), MEDLINE (1948 to December 2011), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), AMED (1985 to January 2012), LILACS (1982 to September 2012), PEDro, REHABDATA and OpenGrey (September 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registries and reference lists, handsearched journals and contacted authors. We included randomised controlled trials (RCTs) that compared MD rehabilitation (delivered by two or more disciplines in conjunction with medical input) following BoNT and other focal intramuscular treatments for post-stroke spasticity with placebo, routinely available local services, or lower levels of intervention; or studies that compared MD rehabilitation in different settings, of different types, or at different levels of intensity. We excluded RCTs that assessed the effectiveness of unidisciplinary therapy (for example physiotherapy only) or a single modality (for example stretching, casting, electrical stimulation or splinting only). The primary outcomes were validated measures of activity level (active and passive function

  4. Neurointerventional Treatment in Acute Stroke. Whom to Treat? (Endovascular Treatment for Acute Stroke: Utility of THRIVE Score and HIAT Score for Patient Selection)

    International Nuclear Information System (INIS)

    Fjetland, Lars; Roy, Sumit; Kurz, Kathinka D.; Solbakken, Tore; Larsen, Jan Petter; Kurz, Martin W.

    2013-01-01

    Purpose: Intra-arterial therapy (IAT) is used increasingly as a treatment option for acute stroke caused by central large vessel occlusions. Despite high rates of recanalization, the clinical outcome is highly variable. The authors evaluated the Houston IAT (HIAT) and the totaled health risks in vascular events (THRIVE) score, two predicting scores designed to identify patients likely to benefit from IAT. Methods: Fifty-two patients treated at the Stavanger University Hospital with IAT from May 2009 to June 2012 were included in this study. We combined the scores in an additional analysis. We also performed an additional analysis according to high age and evaluated the scores in respect of technical efficacy. Results: Fifty-two patients were evaluated by the THRIVE score and 51 by the HIAT score. We found a strong correlation between the level of predicted risk and the actual clinical outcome (THRIVE p = 0.002, HIAT p = 0.003). The correlations were limited to patients successfully recanalized and to patients <80 years. By combining the scores additional 14.3 % of the patients could be identified as poor candidates for IAT. Both scores were insufficient to identify patients with a good clinical outcome. Conclusions: Both scores showed a strong correlation to poor clinical outcome in patients <80 years. The specificity of the scores could be enhanced by combining them. Both scores were insufficient to identify patients with a good clinical outcome and showed no association to clinical outcome in patients aged ≥80 years

  5. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II).

    Science.gov (United States)

    Adams, Harold P; Effron, Mark B; Torner, James; Dávalos, Antoni; Frayne, Judith; Teal, Philip; Leclerc, Jacques; Oemar, Barry; Padgett, Lakshmi; Barnathan, Elliot S; Hacke, Werner

    2008-01-01

    A previous randomized, placebo-controlled, double-blind study suggested that abciximab may be safe and effective in treatment of acute ischemic stroke. The current phase 3 study was planned to test the relative efficacy and safety of abciximab in patients with acute ischemic stroke with planned treatment within 5 hours since symptoms onset. An international, randomized, placebo-controlled, double-blind phase 3 trial tested intravenous administration of abciximab in 2 study cohorts using stratification variables of time since onset and stroke severity. The planned enrollment was 1800 patients. The primary cohort enrolled those patients who could be treated within 5 hours of onset of stroke. A companion cohort enrolled patients that were treated 5 to 6 hours after stroke as well as a smaller cohort of patients who could be treated within 3 hours of stroke present on awakening. The primary efficacy measure was the dichotomous modified Rankin Scale score at 3 months as adjusted to the baseline severity of stroke among subjects in the primary cohort. The primary safety outcome was the rate of symptomatic or fatal intracranial hemorrhage that occurred within 5 days of stroke. The trial was terminated prematurely after 808 patients in all cohorts were enrolled by recommendation of an independent safety and efficacy monitoring board due to an unfavorable benefit-risk profile. At 3 months, approximately 33% of patients assigned placebo (72/218) and 32% of patients assigned abciximab (71/221; P=0.944) in the primary cohort were judged to have a favorable response to treatment. The distributions of outcomes on the modified Rankin Scale were similar between the treated and control groups. Within 5 days of enrollment, approximately 5.5% of abciximab-treated and 0.5% of placebo-treated patients in the primary cohort had symptomatic or fatal intracranial hemorrhage (P=0.002). The trial also did not demonstrate an improvement in outcomes with abciximab among patients in the

  6. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke

  7. National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke.

    Science.gov (United States)

    Romero Kräuchi, O; Valencia, L; Iturri, F; Mariscal Ortega, A; López Gómez, A; Valero, R

    2018-01-01

    To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. 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 ...

  9. Management of stenosis lesions during the period of endovascular treatment for acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Hong-xing HAN

    2017-11-01

    Full Text Available Objective To investigate the management of stenosis lesions during endovascular treatment for acute ischemic stroke. Methods A total of 36 acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis were treated with endovascular treatment or bridging treatment. Time from aggravation on admission or in hospital stay to femoral artery puncture, from femoral arterypuncture to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI was usedto assess the recanalization immediately after operation. Modified Rankin Scale (mRS was used to evaluate prognosis at 90 d after operation. Occurrence rate of symptomatic intracranial hemorrhage and mortality were recorded. Results Among 36 patients, 13 patients (36.11% underwent intravenous thrombolysis and then endovascular thrombectomy. In all patients, there were 21 (58.33% with intracranial stenosis and 15 (41.67% with extracranial stenosis, 16 (44.44% with anterior circulation stenosis and 20 (55.56% with posterior circulation stenosis. Stent thrombectomy was used in 25 patients (69.44% , while balloon dilatation and/or stent implantation was used in 11 patients (30.56% . For 21 patients with intracranial arterial stenosis, 4 were treated with balloon dilatation only, 9 with Wingspan self-expandable stents and 8 with Apollo balloon-expandable stents. Fifteen patients with extracranial arterial stenosis were treated with balloon dilatation and stent implantation. A total of 33 patients (91.67% achieved recanalization (mTICI 2b-3 grade, 21 patients (58.33% had good outcomes (mRS ≤ 2 score, while symptomatic intracranial hemorrhage occurred in 2 patients (5.56% and 5 (13.89% died. There were no statistically significant differences in the rate of good prognosis, symptomatic intracranial hemorrhage and mortality between intracranial and extracranial arterial stenosis, anterior and posterior circulation stenosis (Fisher exact probability: P > 0.05, for

  10. Physical and chemical changes of rapeseed meal proteins during toasting and their effects on in vitro digestibility

    NARCIS (Netherlands)

    Salazar Villanea, S.; Bruininx, E.M.A.M.; Gruppen, H.; Hendriks, W.H.; Carré, P.; Quinsac, A.; Poel, van der A.F.B.

    2016-01-01


    Background

    Toasting during the production of rapeseed meal (RSM) decreases ileal crude protein (CP) and amino acid (AA) digestibility. The mechanisms that determine the decrease in digestibility have not been fully elucidated. A high protein quality, low-denatured, RSM was produced and

  11. Mobile platform for treatment of stroke: A case study of tele-assistance

    Science.gov (United States)

    Torres Zenteno, Arturo Henry; Fernández, Francisco; Palomino-García, Alfredo; Moniche, Francisco; Escudero, Irene; Jiménez-Hernández, M Dolores; Caballero, Auxiliadora; Escobar-Rodriguez, Germán; Parra, Carlos

    2015-01-01

    This article presents the technological solution of a tele-assistance process for stroke patients in acute phase in the Seville metropolitan area. The main objective of this process is to reduce time from symptom onset to treatment of acute phase stroke patients by means of telemedicine, regarding mobility between an intensive care unit ambulance and an expert center and activating the pre-hospital care phase. The technological platform covering the process has been defined following an interoperability model based on standards and with a focus on service-oriented architecture focus. Messaging definition has been designed according to the reference model of the CEN/ISO 13606, messages content follows the structure of archetypes. An XDS-b (Cross-Enterprise Document Sharing-b) transaction messaging has been designed according to Integrating the Healthcare Enterprise profile for archetype notifications and update enquiries.This research has been performed by a multidisciplinary group. The Virgen del Rocío University Hospital acts as Reference Hospital and the Public Company for Healthcare as mobility surroundings. PMID:25975806

  12. Wearable textile platform for assessing stroke patient treatment in daily life conditions

    Directory of Open Access Journals (Sweden)

    Federico eLorussi

    2016-03-01

    Full Text Available Monitoring physical activities during post-stroke rehabilitation in daily life may help physicians to optimize and tailor the training program for patients. The European research project INTERACTION (FP7-ICT-2011-7-287351 evaluated motor capabilities in stroke patients during the recovery treatment period. We developed wearable sensing platform based on the sensor fusion among inertial, knitted piezoresistive sensors and textile EMG electrodes . The device was conceived in modular form and consists of a separate shirt, trousers, glove and shoe. Thanks to the novel fusion approach it has been possible to develop a model for the shoulder taking into account the scapulo-thoracic joint of the scapular girdle, considerably improving the estimation of the hand position in reaching activities. In order to minimize the sensor set used to monitor gait, a single inertial sensor fused with a textile goniometer proved to reconstruct the orientation of all the body segments of the leg. Finally, the sensing glove, endowed with three textile goniometers and three force sensors showed good capabilities in the reconstruction of grasping activities and evaluating the interaction of the hand with the environment, according to the project specifications. This paper reports on the design and the technical evaluation of the performance of the sensing platform, tested on healthy subjects.

  13. Factors associated with rapid neurological improvement 24 h following intra-arterial thrombolytic treatment for acute ischemic stroke.

    Science.gov (United States)

    Christoforidis, Gregorgy; Mohammad, Yousef M; Khadir, Mohammed; Yang, Ming; Slivka, Andrew P

    2013-01-01

    Significant 24 h improvement is the strongest indicator of functional recovery following thrombolytic treatment for acute ischemic stroke. This study sought to analyze factors contributing to rapid neurological improvement (RNI) following intra-arterial thrombolytic treatment (IATT). Angiograms and clinical information derived from consecutive patients receiving treatment initiated within 6 h of stroke onset were retrospectively reviewed. RNI was defined as at least 50% 24 h improvement on the National Institutes of Health Stroke Scale score. Logistic regression analysis identified factors associated with RNI. Variables tested included: age, gender, serum glucose, platelet count, pial collateral formation, presenting National Institutes of Health Stroke Scale score, time to treatment, extent of reperfusion, site and location of occlusion, treatment agent and systolic blood pressure. Greater than 50% reperfusion of the involved territory, time to treatment within 270 min and good pial collateral formation (large penumbra zone) significantly predicted RNI. RNI occurred in 31% of the 112 patients studied. RNI occurred in 21/26 (80.8%) patients exhibiting all three favorable variables whereas patients with only one favorable variable had a 6.5% chance of RNI. 94% of patients displaying RNI had a modified Rankin Scale score of 2 or less at 3 months compared with 28.6% without RNI. RNI following IATT for stroke is more likely when at least two of the following are present: good reperfusion, good pial collateral formation and treatment within 4.5 h of symptom onset, and is strongly predictive of 3 month outcomes. Important to clinical management, IATT may need to be reconsidered in patients with poor pial collateral formation if time to treatment exceeds 4.5 h.

  14. Effects of toasting blue lupins, soybeans or barley as supplement for high-yielding organic dairy cows fed grass-clover silage ad libitum

    DEFF Research Database (Denmark)

    Mogensen, Lisbeth; Lund, Peter; Kristensen, Troels

    2008-01-01

    The effect of toasted supplement on milk production was examined in three experiments on an organic study farm during the winter 2004/2005. Three types of iso-energetic supplement feed, toasted or untreated, were examined in each experiment, with an untreated cereal mixture as control. The supple......The effect of toasted supplement on milk production was examined in three experiments on an organic study farm during the winter 2004/2005. Three types of iso-energetic supplement feed, toasted or untreated, were examined in each experiment, with an untreated cereal mixture as control....... The supplement under investigation was: lupins in experiment 1, barley in experiment 2 and soybeans in experiment 3. The same forage mixture of grass-clover silage (84% of DM), grass pellets (11% of DM) and straw (5% of DM) was fed ad libitum in all the experiments. Toasting decreased effective rumen protein...... of soybeans did not affect milk protein content. ECM yield was significantly higher (P = 0.002) for cows fed toasted soybeans than for cows fed untreated soybeans (28.1 versus 26.4 kg ECM) whereas there was no significant effect on ECM yield from toasting lupins or barley. It can be concluded...

  15. Surgical treatment for central pain after stroke based on the neural mechanism

    International Nuclear Information System (INIS)

    Hirato, Masafumi; Takahashi, Akio; Watanabe, Katsushige; Kazama, Ken; Yoshimoto, Yuhei

    2008-01-01

    Previous neurophysiological and neuroimaging studies have suggested that functional changes might occur in the sensory thalamus, associated with reorganization of the thalamocortical system, in cases with central pain after stroke (thalamic pain). It might cause the misconduction of the sensory signal or a hyperactive response to peripheral natural stimulation on the thalamus, resulting in it playing an important roles in the genesis of central pain. Hyperactivity in the cerebral cortex adjacent to the central sulcus on the side ipsilateral to a cerebrovascular disease (CVD) lesion also might relate to central pain. We performed various kinds of surgical treatments in 29 cases with central pain after stroke based on the neural mechanism deserbed above. Epidural spinal cord stimulation was effective in 4 out of 7 cases with localized pain on the distal part of the leg and arm. We achieved pain control in these cases showing definite somatosensory evoked potential (SEP) originating in the sensory cortex before surgery. Stereotactic (Vim-Vcpc) thalamotomy with the aid of depth microrecording was effective in 4 out of 7 cases with diffuse pain. In good responders, we could find responses to natural peripheral stimulation and seldom encountered irregular burst discharges in the sensory thalamus during the operation. Preoperative positron emission tomography (PET) studies also revealed an increase of regional cerebral blood flow (rCBF) in the sensory cortex ipsilateral to the thalamic CVD lesion during contralateral thumb brushing. Gamma knife treatment was effective in 5 out of 7 cases after stereotactic thalamotomy. It became stable in 3 out of these 5 cases. Each case was treated with a maximum dose of 120-150 Gy using a 4 mm collimator. Precentral electrical cortical stimulation was performed in 8 cases. Sufficient pain relief was achieved in 3 out of 6 cases in which we could implant an importable pulse generator (IPG). In one of these cases, we found definite

  16. Post-stroke treatment with 17β-estradiol exerts neuroprotective effects in both normotensive and hypertensive rats.

    Science.gov (United States)

    Stoop, Wendy; De Geyter, Deborah; Verachtert, Sofie; Brouwers, Sofie; Verdood, Peggy; De Keyser, Jacques; Kooijman, Ron

    2017-04-21

    Although ischemic stroke is a major cause of death worldwide and the predominant cause of acquired disability, the only effective drug therapy that has been developed thus far is reperfusion by tissue plasminogen activator. Since most patients do not qualify for this treatment, new methods have to be developed. It is well known that estradiol (E 2 ) exerts neuroprotective effects in different models of cerebral ischemia, but post-stroke treatment after an acute stroke has hardly been investigated. As many patients with an acute ischemic stroke have arterial hypertension, it is also of interest to evaluate the influence of this co-morbidity on the treatment efficacy of E 2 . The effects of E 2 administered 30min after a transient middle cerebral artery occlusion (tMCAO) induced by an intracerebral injection of endothelin-1 were assessed in male normotensive Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs). Treatment with E 2 reduced infarct size in both WKY and SHRs and decreased the number of degenerating neurons, indicating that acute treatment with E 2 is indeed neuroprotective. To address the role of glia in neuroprotection, the effects of E 2 on the activation of microglia and astrocytes was determined. It appeared that E 2 had no effect on microglial activation, but reduced the activation of astrocytes in SHRs but not in the normotensive controls. We conclude that post-stroke E 2 treatment in both normotensive and hypertensive rats is neuroprotective. Although the presence of hypertension changed the astrocytic response to E 2 , it did not affect treatment efficacy. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

  17. Comparison of atria and CHA2DS2-vasc risk stratification schemes for the prediction of stroke in the individual patient with atrial fibrillation and the impact on treatment decisions

    NARCIS (Netherlands)

    Van Den Ham, Hendrika A.; Klungel, Olaf H.; Singer, Daniel E.; Leufkens, Hubert G.M.; Van Staa, Tjeerd P.

    2014-01-01

    Background: Atrial fibrillation (AF) increases the risk of ischaemic stroke and treatment with anticoagulants should be prescribed according to stroke risk. Objectives: To compare the predictive ability of the currently recommended CHA2DS2-VASc ischaemic stroke risk score with the new ATRIA stroke

  18. The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review.

    Science.gov (United States)

    Tao, Wu; Fu, Yu; Hai-Xin, Song; Yan, Dong; Jian-Hua, Li

    2015-09-01

    [Purpose] This review article is designed to expose the application of sonography in shoulder pain after stroke. [Methods] A range of databases was searched to identify articles that address sonography examination, with or without ultrasound guided corticosteroid injection for hemiplegic shoulder pain (HSP). The electronic databases of PubMed, CENTRAL, CINAHL, Cochrane Library, Medline were searched. [Results] According to the articles identified in our databases research, sonographic technique has potential to provide objective measurements in patients with HSP. The main sonography finding of HSP included subacromial subdeltoid (SASD) bursal effusion, tendinosis of the supraspinatus and subscapularis tendon, long head of biceps tendon sheath effusion, and shoulder subluxation. Our analysis also revealed significantly decreased pain score (VAS) and increased passive external rotation degree in the steroid injection group than control group. [Conclusion] The sonography examination is useful for HSP assessment and ultrasound guided technique is recommended for HSP injection treatment.

  19. Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Rob A. van de Graaf

    2018-04-01

    Full Text Available BackgroundMore than one-third of the patients with ischemic stroke caused by an intracranial large vessel occlusion do not recover to functional independence despite fast and successful recanalization by acute mechanical thrombectomy (MT. This may partially be explained by incomplete microvascular reperfusion. Some antithrombotics, e.g., antiplatelet agents and heparin, may be able to restore microvascular reperfusion. However, antithrombotics may also increase the risk of symptomatic intracranial hemorrhage (sICH. The aim of this review was to assess the potential safety and functional outcome of periprocedural antiplatelet or heparin use during acute MT for ischemic stroke.MethodsWe systematically searched PubMed, Embase, Medline, Web of Science, and Cochrane for studies investigating the safety and functional outcome of periprocedural antiplatelet or heparin treatment during acute MT for ischemic stroke. The primary outcome was the risk for sICH. Secondary outcomes were functional independence after 3–6 months (modified Rankin Scale 0–2 and mortality within 6 months.Results837 studies were identified through the search, of which 19 studies were included. The sICH risks of the periprocedural use of antiplatelets ranged from 6 to 17%, and for heparin from 5 to 12%. Two of four studies reporting relative effects of the use of antithrombotics are pointing toward an increased risk of sICH. Among patients treated with antiplatelet agents, functional independence varied from 23 to 60% and mortality from 18 to 33%. For heparin, this was, respectively, 19–54% and 19–33%. The three studies presenting relative effects of antiplatelets on functional independence showed neutral effects. Both studies reporting relative effects of heparin on functional independence found it to increase this chance.ConclusionRandomized controlled trials investigating the effect of periprocedural antithrombotic treatment in MT are lacking. Some observational

  20. Stroke Avoidance for Children in REpública Dominicana (SACRED): Protocol for a Prospective Study of Stroke Risk and Hydroxyurea Treatment in Sickle Cell Anemia.

    Science.gov (United States)

    Jeste, Neelum D; Sánchez, Luisanna M; Urcuyo, Gabriela S; Bergés, Melissa E; Luden, Judy P; Stuber, Susan E; Latham, Teresa S; Mena, Rafael; Nieves, Rosa M; Ware, Russell E

    2017-06-02

    In the Dominican Republic, where the burden of sickle cell anemia (SCA) is high, many children lack access to routine screening and preventative care. Children with SCA are at risk for stroke, an event that leads to significant morbidity and mortality. In the United States, screening via transcranial Doppler (TCD) identifies children with SCA at highest stroke risk, allowing early intervention with blood transfusions. The need for indefinite transfusions for primary stroke prevention limits their practicality in limited-resource countries. Hydroxyurea has been shown to lower TCD velocities and to prevent conversion from conditional (170 to 199 cm/sec) to abnormal (greater than or equal to 200 cm/sec) velocities. In resource-limited settings, implementation of a TCD screening program, coupled with hydroxyurea therapy, could reduce the burden of SCA and stroke. The aims of the Stroke Avoidance for Children in REpública Dominicana (SACRED) trial are (1) to screen children with SCA for stroke risk using TCD and to determine the prevalence of elevated velocities in a cross-sectional sample; (2) to identify clinical and laboratory correlates of elevated velocities; and (3) to obtain longitudinal data on the natural history of TCD velocities and to measure therapeutic effects of hydroxyurea. This prospective trial, designed and conducted by Cincinnati Children's Hospital Medical Center (CCHMC) and Hospital Infantil Robert Reid Cabral (HIRRC) with Centro de Obstetricia y Ginecología, includes a baseline cross-sectional epidemiological survey of the distribution of TCD velocities across a large cohort of children with SCA in the Dominican Republic. Children with conditional velocities are eligible to begin protocol-directed hydroxyurea if laboratory criteria are met. The treatment schedule begins with a fixed-dose of approximately 20 mg/kg/day for 6 months, after which it escalates to maximum tolerated dose (MTD). All participants undergo longitudinal annual TCD

  1. Acute Ischemic Stroke Treatment Using Mechanical Thrombectomy: A Study of 137 Patients.

    Science.gov (United States)

    Singh, Rakeshsingh K; Chafale, Vishal Annaji; Lalla, Rakesh Shyam; Panchal, Keyurkumar Chandrakantbhai; Karapurkar, Anil Pandurang; Khadilkar, Satish Vasant; Ojha, Pawan K; Godge, Yogesh; Singh, Rakesh K; Benny, Rajesh

    2017-01-01

    Mechanical thrombectomy (MT) is the most effective treatment in large vessel occlusion (LVO). We have analyzed our initial experience of MT of 137 patients in anterior circulation (AC) and posterior circulation (PC) LVO using Solitaire stent retriever device. Retrospective cohort analysis of 112 AC and 25 PC acute ischemic strokes was done considering various baseline characteristics, risk factors, National Institute of Health Stroke Scale (NIHSS) change, revascularization rate, complications, and functional outcome at 3 months using modified Rankin score. Out of 137 patients, occlusion was found in M1 segment (44.5%), carotid T occlusion (37.2%), and basilar artery (18.2%). Atrial fibrillation was important risk factor for Carotid T occlusion. 50.4% patients received intravenous thrombolysis. Baseline mean NIHSS in AC was 15.5 (±4.32), and PC was 19 (±5.5). Tandem lesions were noted in 14.6%. There was significant difference in mean door-to-needle time for AC and PC (220 ± 80.6 and 326 ± 191.8 min, respectively). Mean time to revascularization for AC (39.5 ± 14.1) and PC (42.2 ± 19.4) was similar. Procedural success (modified thrombolysis in cerebral infarction ≥2b) observed in AC and PC was 92.9% and 84%, respectively ( P = 0.154). NIHSS at admission between 5 and 15 and immediate postprocedure NIHSS improvement >4 was associated with significant better clinical outcome at 3 months. Overall complication rate was about 15.3% including symptomatic intracranial hemorrhage in 8.1% and 6.6% deaths. MT is safe treatment and equally effective for both AC and PC LVO. With careful patient selection, clinical outcome in PC was comparable to AC despite delayed presentation and higher baseline NIHSS.

  2. Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment

    NARCIS (Netherlands)

    Borst, Jordi; Berkhemer, Olvert A.; Roos, Yvo B. W. E. M.; van Bavel, Ed; van Zwam, Wim H.; van Oostenbrugge, Robert J.; van Walderveen, Marianne A. A.; Lingsma, Hester F.; van der Lugt, Aad; Dippel, Diederik W. J.; Yoo, Albert J.; Marquering, Henk A.; Majoie, Charles B. L. M.; Fransen, Puck S. S.; Beumer, Debbie; van den Berg, Lucie A.; Schonewille, Wouter J.; Vos, Jan Albert; Nederkoorn, Paul J.; Wermer, Marieke J. H.; 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.; van Hasselt, Boudewijn A. A. M.; 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.; den Hertog, Heleen M.; 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.; Beenen, Ludo F. M.; van den Berg, René; Koudstaal, Peter J.; Brown, Martin M.; Liebig, Thomas; Stijnen, Theo; Andersson, Tommy; Mattle, Heinrich; Wahlgren, Nils; van der Heijden, Esther; Ghannouti, Naziha; Fleitour, Nadine; Hooijenga, Imke; Puppels, Corina; Pellikaan, Wilma; Geerling, Annet; Lindl-Velema, Annemieke; van Vemde, Gina; de Ridder, Ans; Greebe, Paut; de Bont-Stikkelbroeck, José; de Meris, Joke; Janssen, Kirsten; Struijk, Willy; Simons, Tiny; Messchendorp, Gert; van der Minne, Friedus; Bongenaar, Hester; Licher, Silvan; Boodt, Nikki; Ros, Adriaan; Venema, Esmee; Slokkers, Ilse; Ganpat, Raymie-Jayce; Mulder, Maxim; Saiedie, Nawid; Heshmatollah, Alis; Schipperen, Stefanie; Vinken, Stefan; van Boxtel, Tiemen; Koets, Jeroen; Boers, Merel; Santos, Emilie; Jansen, Ivo; Kappelhof, Manon; Lucas, Marit; Geuskens, Ralph; Barros, Renan Sales; Dobbe, Roeland; Csizmadia, Marloes

    2015-01-01

    The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between

  3. 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.

  4. Thrombolysis: Improving door-to-needle times for ischemic stroke treatment - A narrative review.

    Science.gov (United States)

    Kamal, Noreen; Smith, Eric E; Jeerakathil, Thomas; Hill, Michael D

    2017-01-01

    Background The effectiveness of thrombolysis is highly time dependent. For this reason, short target times have been set to reduce time to treatment from hospital arrival, which is called door-to-needle time. Summary of review There has been considerable work done at single centers and across multiple hospitals to improve door-to-needle time. There have been reductions of 8 to 47 min when applying one or more improvement strategies at single centers, and there have been many multi-hospital initiatives. The delays to treatment have been attributed to both patient and hospital factors, and strategies to address these delays have been proven to reduce door-to-needle time. The most effective strategies include pre-notification of arrival by Emergency Medical Services (EMS), single-call activation of stroke team, rapid registration process, moving the patient to computed tomography on EMS stretcher, and administration of alteplase in the scanner. There are many exciting areas of future direction including reduction of door-to-needle time in developing countries, improving pre-hospital response times, and improving the efficiency of endovascular treatment. Conclusions There is now a broad understanding of the causes of delays to fast treatment and the strategies that can be employed to improve door-to-needle time such that most centers could achieve median door-to-needle time of 30 min.

  5. Guidelines for the preventive treatment of ischaemic stroke and TIA (I). Update on risk factors and life style.

    Science.gov (United States)

    Fuentes, B; Gállego, J; Gil-Nuñez, A; Morales, A; Purroy, F; Roquer, J; Segura, T; Tejada, J; Lago, A; Díez-Tejedor, E; Alonso de Leciñana, M; Alvarez-Sabin, J; Arenillas, J; Calleja, S; Casado, I; Castellanos, M; Castillo, J; Dávalos, A; Díaz-Otero, F; Egido, J A; López-Fernández, J C; Freijo, M; García Pastor, A; Gilo, F; Irimia, P; Maestre, J; Masjuan, J; Martí-Fábregas, J; Martínez-Sánchez, P; Martínez-Vila, E; Molina, C; Nombela, F; Ribó, M; Rodríguez-Yañez, M; Rubio, F; Serena, J; Simal, P; Vivancos, J

    2012-01-01

    To update the ad hoc Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischaemic stroke (IS) and transient ischaemic attack (TIA). We reviewed available evidence on risk factors and means of modifying them to prevent ischaemic stroke and TIA. Levels of evidence and recommendation grades are based on the classification of the Centre for Evidence-Based Medicine. This first section summarises the recommendations for action on the following factors: blood pressure, diabetes, lipids, tobacco and alcohol consumption, diet and physical activity, cardio-embolic diseases, asymptomatic carotid stenosis, hormone replacement therapy and contraceptives, hyperhomocysteinemia, prothrombotic states and sleep apnea syndrome. Changes in lifestyle and pharmacological treatment for hypertension, diabetes mellitus and dyslipidemia, according to criteria of primary and secondary prevention, are recommended for preventing ischemic stroke. © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  6. Stem cell-based treatments against stroke: observations from human proof-of-concept studies and considerations regarding clinical applicability

    Directory of Open Access Journals (Sweden)

    Thorsten Roland Doeppner

    2014-10-01

    Full Text Available Ischemic stroke remains a heavy burden for industrialized countries. The only causal therapy is the recanalization of occluded vessels via thrombolysis, which due to a narrow time window still can be offered only to a minority of patients. Since the majority of patients continues to exhibit neurological deficits even following successful thrombolysis, restorative therapies are urgently needed that promote brain remodeling and repair once stroke injury has occurred. Due to their unique properties of action, stem cell-based strategies gained increasing interest during recent years. Using various stroke models in both rodents and primates, the transplantation of stem cells, namely of bone marrow derived mesenchymal stem cells (MSCs or neural progenitor cells (NPCs, has been shown to promote neurological recovery most likely via indirect bystander actions. In view of promising observations, clinical proof-of-concept studies are currently under way, in which effects of stem and precursor cells are evaluated in human stroke patients. In this review we summarize already published studies, which due to the broad experience in other medical contexts mostly employed bone marrow-derived MSCs by means of intravenous transplantation. With the overall number of clinical trials limited in number, only a fraction of these studies used non-treated control groups, and only single studies were adequately blinded. Despite these limitations, first promising results justify the need for more elaborate clinical trials in order to make stem cell transplantation a success for stroke treatment in the future.

  7. The effects of poststroke captopril and losartan treatment on cerebral blood flow autoregulation in SHRsp with hemorrhagic stroke

    Science.gov (United States)

    Smeda, John S; Daneshtalab, Noriko

    2011-01-01

    The ability of captopril and losartan treatment to restore cerebral blood flow (CBF) autoregulation after intracerebral hemorrhagic stroke (HS) was assessed in Kyoto–Wistar stroke-prone hypertensive rats (SHRsp). Laser Doppler techniques assessed CBF autoregulation in the middle cerebral artery (MCA) perfusion domain and a pressure myograph was used to measure pressure-dependent constriction (PDC) in isolated MCAs before and after stroke and after 13, 33, and 63 days of poststroke captopril or losartan treatment. The treatments did not lower blood pressure (BP) and equally suppressed plasma aldosterone after HS. The HS development was associated with the loss of CBF autoregulation, high CBF, increased CBF conductance to elevations in BP, and the loss of PDC in the MCAs. Both treatments restored these functions to prestroke levels within 13 days. The PDC and CBF autoregulation subsequently deteriorated after 63 days of captopril treatment while being maintained at prestroke levels over all durations of losartan treatment. The SHRsp subjected to 35 days of poststroke losartan treatment exhibited less blood–brain barrier (BBB) disruption and brain herniation than captopril-treated SHRsp. The superior ability of losartan to restore CBF autoregulation and myogenic function may have contributed to the more effective attenuation of cerebral damage after HS. PMID:20648036

  8. Possibilities оf use of testosterone undecanoate in treatment in stroke male patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    L. Yu. Morgunov

    2014-11-01

    Full Text Available We have studied 154 men with the first hemispheric ischemic stroke. Clinical and laboratory studies have revealed the androgen deficiency in 66.3 %, with its frequency higher in patients with diabetes mellitus type 2 (50 % and 26.3 %, respectively. Forty-two men with diabetes mellitus type 2 and acquired androgenic deficit received replacing treatment with testosterone undecanoate. After 2 years from the beginning of treatment, there were the decrease in clinical severity of androgenic deficit, the increase of total and free testosterone levels, and muscle power in the main group compared to the controls. Body mass index, glycated hemoglobin, cholesterol, triglycerides, low density lipoproteins have decreased as well. Secondary stroke has developed in 3 (7.1 % patients of the main group and in 5 (16.6 % controls. The treatment with androgens has a positive effect on risk factors of secondary ischemic stroke. It is an effective method for improvement of social adaptation of men survived after the stroke..

  9. Qualitative systematic reviews of treatment burden in stroke, heart failure and diabetes - Methodological challenges and solutions

    Science.gov (United States)

    2013-01-01

    Background Treatment burden can be defined as the self-care practices that patients with chronic illness must perform to respond to the requirements of their healthcare providers, as well as the impact that these practices have on patient functioning and well being. Increasing levels of treatment burden may lead to suboptimal adherence and negative outcomes. Systematic review of the qualitative literature is a useful method for exploring the patient experience of care, in this case the experience of treatment burden. There is no consensus on methods for qualitative systematic review. This paper describes the methodology used for qualitative systematic reviews of the treatment burdens identified in three different common chronic conditions, using stroke as our exemplar. Methods Qualitative studies in peer reviewed journals seeking to understand the patient experience of stroke management were sought. Limitations of English language and year of publication 2000 onwards were set. An exhaustive search strategy was employed, consisting of a scoping search, database searches (Scopus, CINAHL, Embase, Medline & PsycINFO) and reference, footnote and citation searching. Papers were screened, data extracted, quality appraised and analysed by two individuals, with a third party for disagreements. Data analysis was carried out using a coding framework underpinned by Normalization Process Theory (NPT). Results A total of 4364 papers were identified, 54 were included in the review. Of these, 51 (94%) were retrieved from our database search. Methodological issues included: creating an appropriate search strategy; investigating a topic not previously conceptualised; sorting through irrelevant data within papers; the quality appraisal of qualitative research; and the use of NPT as a novel method of data analysis, shown to be a useful method for the purposes of this review. Conclusion The creation of our search strategy may be of particular interest to other researchers carrying out

  10. Hyperacute thrombolysis with recombinant tissue plasminogen activator of acute ischemic stroke: Feasibility and effectivity from an Indian perspective

    Directory of Open Access Journals (Sweden)

    Sharma S

    2008-01-01

    Full Text Available Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS is under evaluation in developing countries like India, especially in areas such as western Utter Pradesh, where it is overly crowded and there is poor affordability. Aim: This study was done to evaluate recombinant tissue plasminogen activator r-tpa in acute ischemic stroke in hyper acute phase, in selected patients of western Utter Pradesh, in terms of feasibility and effectivity. Design: Open, non randomized study. Materials and Methods: Thirty two patients were classified using Trial of ORG 10172 in Acute Stroke treatment (TOAST criteria (large artery atherosclerotic = 8; cardio embolic = 6; small vessel occlusion = 14; other determined etiology = 2; undetermined etiology = 2. The mean time to reach the hospital was 2 h (1.15-3.0, the mean door to CT scan 20 min (10-40 and door to r-tpa injection was 30 min (24-68. The National Institute of Health Stroke Scale (NIHSS scores ranged from 11-22 (mean 15.5 +2.7. The dose of r-tpa administered was 0.9 mg/kg. Results: Twenty one patients (65.6% showed significant improvement on the NIHSS score, at 48 h (4 points. (Mean change = 10; range = 4-17. At one month, 25 (78% recorded improvement on the Barthel index (mean change = 45%. One developed frontal lobe hemorrhage and another developed recurrent stroke; one died of aspiration; and four showed no improvement. Modified Rankin score (m RS was administered at the end of three months to 28 patients (90%; however, the rest could not be directly observed. The average modified Rankin Score was 1.2 (0-2. Conclusions: Hyperacute thrombolysis was found feasible and effective in selected patients with AIS from western Utter Pradesh and who had poor affordability.

  11. General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization

    Energy Technology Data Exchange (ETDEWEB)

    Janssen, H., E-mail: hendrik.janssen@med.uni-muenchen.de [Ludwig-Maximilians-University Hospital, Department of Neuroradiology (Germany); Buchholz, G. [Ludwig-Maximilians-University Hospital, Department of Neurology (Germany); Killer, M. [Paracelsus Medical University, Neurology/Research Institute of Neurointervention (Austria); Ertl, L.; Brückmann, H. [Ludwig-Maximilians-University Hospital, Department of Neuroradiology (Germany); Lutz, J. [Ingolstadt Hospital, Department of Neuroradiology (Germany)

    2016-09-15

    PurposeWhile today mechanical thrombectomy is an established treatment option for main branch occlusions in anterior circulation stroke, there is still an ongoing debate on the kind of anesthesia to be preferred. Introducing a simple method for head stabilization, we analyzed safety and duration of endovascular recanalization procedures under general anesthesia (GA) and conscious sedation (CS).MethodsWe retrospectively identified 84 consecutive patients who underwent mechanical thrombectomy owing to acute anterior circulation stroke. Fifty-three were treated under GA and 31 under CS equipped with a standard cervical collar to reduce head movement. We evaluated recanalization results, in-house time to start recanalization, procedure times, technical and clinical complication rates, and conversion rates from CS to GA.ResultsRecanalization of mTICI ≥2b was achieved in 80 % under CS and in 81 % under GA. Median in-house time to start recanalization for CS was 60 min (IQR 28; 44–72) and 77 min (IQR 23; 68–91) for GA (P = 0.001). Median procedure time under CS was 35 min (IQR 43; 69–25) and 41 min (IQR 43; 66–23) for GA (P = 0.9). No major complications such as ICH occurred in either group, and no conversions from CS to GA were necessary.ConclusionMechanical thrombectomy can be performed faster and safely under CS in combination with simple head immobilization using a standard cervical collar.

  12. General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization

    International Nuclear Information System (INIS)

    Janssen, H.; Buchholz, G.; Killer, M.; Ertl, L.; Brückmann, H.; Lutz, J.

    2016-01-01

    PurposeWhile today mechanical thrombectomy is an established treatment option for main branch occlusions in anterior circulation stroke, there is still an ongoing debate on the kind of anesthesia to be preferred. Introducing a simple method for head stabilization, we analyzed safety and duration of endovascular recanalization procedures under general anesthesia (GA) and conscious sedation (CS).MethodsWe retrospectively identified 84 consecutive patients who underwent mechanical thrombectomy owing to acute anterior circulation stroke. Fifty-three were treated under GA and 31 under CS equipped with a standard cervical collar to reduce head movement. We evaluated recanalization results, in-house time to start recanalization, procedure times, technical and clinical complication rates, and conversion rates from CS to GA.ResultsRecanalization of mTICI ≥2b was achieved in 80 % under CS and in 81 % under GA. Median in-house time to start recanalization for CS was 60 min (IQR 28; 44–72) and 77 min (IQR 23; 68–91) for GA (P = 0.001). Median procedure time under CS was 35 min (IQR 43; 69–25) and 41 min (IQR 43; 66–23) for GA (P = 0.9). No major complications such as ICH occurred in either group, and no conversions from CS to GA were necessary.ConclusionMechanical thrombectomy can be performed faster and safely under CS in combination with simple head immobilization using a standard cervical collar.

  13. Neuroprotective Functions Through Inhibition of ER Stress by Taurine or Taurine Combination Treatments in a Rat Stroke Model.

    Science.gov (United States)

    Prentice, Howard; Gharibani, Payam M; Ma, Zhiyuan; Alexandrescu, Anamaria; Genova, Rafaella; Chen, Po-Chih; Modi, Jigar; Menzie, Janet; Pan, Chunliu; Tao, Rui; Wu, Jang-Yen

    2017-01-01

    Taurine, as a free amino acid, is found at high levels in many tissues including brain, heart and skeletal muscle and is known to demonstrate neuroprotective effects in a range of disease conditions including stroke and neurodegenerative disease. Using in vitro culture systems we have demonstrated that taurine can elicit protection against endoplasmic reticulum stress (ER stress) from glutamate excitotoxicity or from excessive reactive oxygen species in PC12 cells or rat neuronal cultures. In our current investigation we hypothesized that taurine treatment after stroke in the rat middle cerebral artery occlusion (MCAO) model would render protection against ER stress processes as reflected in decreased levels of expression of ER stress pathway components. We demonstrated that taurine elicited high level protection and inhibited both ATF-6 and IRE-1 ER stress pathway components. As ischemic stroke has a complex pathology it is likely that certain combination treatment approaches targeting multiple disease mechanisms may have excellent potential for efficacy. We have previously employed the partial NMDA antagonist DETC-MeSO to render protection against in vivo ischemic stroke using a rat cerebral ischemia model. Here we tested administration of subcutaneous administration of 0.56 mg/kg DETC-MeSO or 40 mg/kg of taurine separately or as combined treatment after a 120 min cerebral ischemia in the rat MCAO model. Neither drug alone demonstrated protection at the low doses employed. Remarkably however the combination of low dose DETC-MeSO plus low dose taurine conferred a diminished infarct size and an enhanced Neuroscore (reflecting decreased neurological deficit). Analysis of ER stress markers pPERK, peIF-2-alpha and cleaved ATF-6 all showed decreased expression demonstrating that all 3 ER stress pathways were inhibited concurrent with a synergistic protective effect by the post-stroke administration of this DETC-MeSO-taurine combination treatment.

  14. A new treatment in the rehabilitation of the paretic upper limb after stroke: the ARAMIS prototype and treatment protocol.

    Science.gov (United States)

    Pignolo, Loris; Lucca, Lucia F; Basta, Giuseppina; Serra, Sebastiano; Pugliese, Maria E; Sannita, Walter G; Dolce, Giuliano

    2016-01-01

    In recent years, as part of the rehabilitation of post stroke patients, the use of robotic technologies to improve recovery of upper limb has become more widespread. The Automatic Recovery Arm Motility Integrated System (ARAMIS) is a concept robot and prototype designed to promote the functional interaction of the arms in the neurorehabilitation of the paretic upper limb. Two computer-controlled, symmetric and interacting exoskeletons compensate for the inadequate strength and accuracy of the paretic arm and the effect of gravity during rehabilitation. Rehabilitation is possible in 3 different modalities; asynchronous, synchronous and active-assisted. To compare the effectiveness of robotic rehabilitation by an exoskeleton prototype system with traditional rehabilitation in motor and functional recovery of the upper limb after stroke. Case-control study, 52 patients enrolled in the study, 28 cases (women: 8, age: 65 ± 10 yrs) treated with ARAMIS and 24 controls (women: 11, age: 69 ± 7 yrs) with conventional rehabilitation. Motor impairment assessed before and after treatment with Fugl-Meyer scale and Motricity Index, level of disability assessed with the Functional Independence Measure. A questionnaire was also administered to assess the patient's tolerance to robotic therapy. After 28 ± 4 sessions over a 54 ± 3.6-day period, the patients treated by ARAMIS had an improvement on the Fugl-Meyer scale (global score from 43 ± 18 to 73 ± 29; p scale (p Fugl-Meyer global score of the control group improved from 41 ± 13 to 58 ± 16 (p < 0.006) and the motor function item from 9.4 ± 4.1 to 14.9 ± 5.8 (p < 0.023). Motor improvement was greater at the wrist and hand than at shoulder and elbow level in patients treated by ARAMIS and controls, but it was significantly greater in ARAMIS-treated patients than in controls. The results indicate a greater efficacy of ARAMIS compared to conventional rehabilitation.

  15. Sex-based differences in the effect of intra-arterial treatment of stroke: analysis of the PROACT-2 study.

    Science.gov (United States)

    Hill, Michael D; Kent, David M; Hinchey, Judith; Rowley, Howard; Buchan, Alastair M; Wechsler, Lawrence R; Higashida, Randall T; Fischbein, Nancy J; Dillon, William P; Gent, Michael; Firszt, Carolyn M; Schulz, Gregory A; Furlan, Anthony J

    2006-09-01

    Sex influences outcome after intravenous thrombolysis. In a combined analysis of the tissue plasminogen activator clinical trials, a sex-by-treatment interaction was observed. We sought to confirm that observation in an independent data set. Data were from the Pro-Urokinase for Acute Cerebral Thromboembolism-2 (PROACT-2) trial. Baseline factors were compared by sex. The primary outcome was an assessment of a sex-by-treatment interaction term within a logistic regression model, using a modified Rankin Scale score treatment. In the PROACT-2 study of intra-arterial stroke thrombolysis, in both women and men, prourokinase resulted in better outcomes than control. A sex by prourokinase treatment interaction was observed, with women showing a larger treatment effect (20% absolute benefit) compared with men (10% absolute benefit). The reason for this interaction is that thrombolytic treatment nullifies the worse outcome for untreated women compared with men. The reasons for effect modification do not include improved recanalization at 2 hours among women. Women with middle cerebral artery ischemic stroke benefit more from intra-arterial therapy. Further study of how sex affects stroke outcome is needed.

  16. Apixaban for treatment of embolic stroke of undetermined source (ATTICUS randomized trial): Rationale and study design.

    Science.gov (United States)

    Geisler, Tobias; Poli, Sven; Meisner, Christoph; Schreieck, Juergen; Zuern, Christine S; Nägele, Thomas; Brachmann, Johannes; Jung, Werner; Gahn, Georg; Schmid, Elisabeth; Bäezner, Hansjörg; Keller, Timea; Petzold, Gabor C; Schrickel, Jan-Wilko; Liman, Jan; Wachter, Rolf; Schön, Frauke; Schabet, Martin; Lindner, Alfred; Ludolph, Albert C; Kimmig, Hubert; Jander, Sebastian; Schlegel, Uwe; Gawaz, Meinrad; Ziemann, Ulf

    2017-12-01

    Rationale Optimal secondary prevention of embolic stroke of undetermined source is not established. The current standard in these patients is acetylsalicylic acid, despite high prevalence of yet undetected paroxysmal atrial fibrillation. Aim The ATTICUS randomized trial is designed to determine whether the factor Xa inhibitor apixaban administered within 7 days after embolic stroke of undetermined source, is superior to acetylsalicylic acid for prevention of new ischemic lesions documented by brain magnetic resonance imaging within 12 months after index stroke. Design Prospective, randomized, blinded, parallel-group, open-label, German multicenter phase III trial in approximately 500 patients with embolic stroke of undetermined source. A key inclusion criterion is the presence or the planned implantation of an insertable cardiac monitor. Patients are 1:1 randomized to apixaban or acetylsalicylic acid and treated for a 12-month period. It is an event-driven trial aiming for core-lab adjudicated primary outcome events. Study outcomes The primary outcome is the occurrence of at least one new ischemic lesion identified by axial T2-weighted FLAIR magnetic resonance imaging and/or axial DWI magnetic resonance imaging at 12 months when compared with the baseline magnetic resonance imaging. Key secondary outcomes are the combination of recurrent ischemic strokes, hemorrhagic strokes, systemic embolism; combination of MACE including recurrent stroke, myocardial infarction, and cardiovascular death and combination of major and clinically relevant non-major bleeding defined according to ISTH, and change of cognitive function and quality of life (EQ-5D, Stroke Impact Scale). Discussion Embolic stroke of undetermined source is caused by embolic disease and associated with a high risk of recurrent ischemic strokes and clinically silent cerebral ischemic lesions. ATTICUS will investigate the impact of atrial fibrillation detected by insertable cardiac monitor and the effects of

  17. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials

    DEFF Research Database (Denmark)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger

    2010-01-01

    Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to treatment with i...

  18. 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...

  19. Four evolving strategies in the emergent treatment of acute ischemic stroke.

    Science.gov (United States)

    Thurman, R Jason; Jauch, Edward C; Panagos, Peter D; Reynolds, Matthew R; Mocco, J

    2012-07-01

    Stroke is the leading cause of long-term disability in the United States and is the fourth leading cause of death, affecting nearly 800,000 patients each year. The physical, emotional, and financial toll stroke inflicts on patients and their families cannot be overstated. At the forefront of acute stroke care, emergency clinicians are positioned to have a major impact on the quality of care that stroke patients receive. This issue outlines and reviews the literature on 4 evolving strategies reflecting developing advancements in the care of acute ischemic stroke and their potential to impact patients in the emergency department setting: (1) the expanding window for intravenous rt-PA, (2) the use of multimodal computed tomographic scanning in emergent diagnostic imaging, (3) endovascular therapies for stroke, and (4) stroke systems of care. Whether practicing in a tertiary care environment or in a remote emergency department, emergency clinicians will benefit from familiarizing themselves with these advancements and should consider how these new approaches might influence their management of patients with acute ischemic stroke.

  20. Statin Use and Functional Outcome after Tissue Plasminogen Activator Treatment in Acute Ischaemic Stroke

    NARCIS (Netherlands)

    Miedema, I; Uyttenboogaart, M; Koopman, K; De Keyser, J; Luijckx, G J

    Background: Preliminary findings suggest that statins may have a neuroprotective effect in patients with acute ischaemic stroke. This study investigated whether patients prior on statin therapy and treated with tissue plasminogen activator (tPA) for acute ischaemic stroke have a better functional

  1. Body Temperature and Inflammation in Acute Stroke: implications for prognosis and treatment

    NARCIS (Netherlands)

    H.M. den Hertog (Heleen)

    2009-01-01

    textabstractSafe, cheap, and broadly applicable therapies for acute stroke are urgently needed. Stroke ranks second as a cause of death worldwide and is the main cause of disability in high-income countries. In the Netherlands alone, more than 37.000 patients are admitted to hospital for acute

  2. Statin treatment and the occurrence of hemorrhagic stroke in patients with a history of cerebrovascular disease

    NARCIS (Netherlands)

    Vergouwen, Mervyn D. I.; de Haan, Rob J.; Vermeulen, Marinus; Roos, Yvo B. W. E. M.

    2008-01-01

    Background and Purpose-The recently published Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed that statins exert a marginally beneficial effect on stroke prevention in patients with a history of cerebrovascular disease. Interestingly, the magnitude of the

  3. Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death

    DEFF Research Database (Denmark)

    Ostergaard, Kamilla; Pottegård, Anton; Hallas, Jesper

    2014-01-01

    BACKGROUND: We wished to examine the impact of antiplatelet drug discontinuation on recurrent stroke and all-cause mortality. METHODS: We identified a cohort of incident ischaemic stroke patients in a Danish stroke registry, 2007-2011. Using population-based registries we assessed subjects' drug...... experienced a second stroke and 600 died. Compared with current antiplatelet drug use, both recent use (1.3 (0.8-2.0)), and non-use (1.3 (0.8-1.9)) were associated with increased recurrent stroke risk. The corresponding HRs of death were 1.9 (1.4-2.5) for recent and 1.8 (1.4-2.3) for non-use of antiplatelet......-pharmacological biases, such as 'sick stopper', may threaten the validity of this risk estimate. © 2014 S. Karger AG, Basel....

  4. Outcomes Associated With Resuming Warfarin Treatment After Hemorrhagic Stroke or Traumatic Intracranial Hemorrhage in Patients With Atrial Fibrillation.

    Science.gov (United States)

    Nielsen, Peter Brønnum; Larsen, Torben Bjerregaard; Skjøth, Flemming; Lip, Gregory Y H

    2017-04-01

    The increase in the risk for bleeding associated with antithrombotic therapy causes a dilemma in patients with atrial fibrillation (AF) who sustain an intracranial hemorrhage (ICH). A thrombotic risk is present; however, a risk for serious harm associated with resumption of anticoagulation therapy also exists. To investigate the prognosis associated with resuming warfarin treatment stratified by the type of ICH (hemorrhagic stroke or traumatic ICH). This nationwide observational cohort study included patients with AF who sustained an incident ICH event during warfarin treatment from January 1, 1998, through February 28, 2016. Follow-up was completed April 30, 2016. Resumption of warfarin treatment was evaluated after hospital discharge. No oral anticoagulant treatment or resumption of warfarin treatment, included as a time-dependent exposure. One-year observed event rates per 100 person-years were calculated, and treatment strategies were compared using time-dependent Cox proportional hazards regression models with adjustment for age, sex, length of hospital stay, comorbidities, and concomitant medication use. A total of 2415 patients with AF in this cohort (1481 men [61.3%] and 934 women [38.7%]; mean [SD] age, 77.1 years [9.1 years]) sustained an ICH event. Of these events, 1325 were attributable to hemorrhagic stroke and 1090 were secondary to trauma. During the first year, 305 patients with a hemorrhagic stroke (23.0%) died, whereas 210 in the traumatic ICH group (19.3%) died. Among patients with hemorrhagic stroke, resuming warfarin therapy was associated with a lower rate of ischemic stroke or systemic embolism (SE) (adjusted hazard ratio [AHR], 0.49; 95% CI, 0.24-1.02) and an increased rate of recurrent ICH (AHR, 1.31; 95% CI, 0.68-2.50) compared with not resuming warfarin therapy, but these differences did not reach statistical significance. For patients with traumatic ICH, resuming warfarin therapy also was associated with a lower rate of ischemic stroke

  5. Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?

    Science.gov (United States)

    Visvanathan, Akila; Dennis, Martin; Mead, Gillian; Whiteley, William N; Lawton, Julia; Doubal, Fergus Neil

    2017-12-01

    People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i.e. values). Patients' values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision making is unclear. Presumably, a "shared decision-making tool" that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalized may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke. The evaluation of this tool in its success to achieve outcomes consistent with patients' values may require more than one clinical trial.

  6. Acute Ischemic Stroke Treatment, Part 1: Patient Selection “The 50% Barrier and the Capillary Index Score”

    Science.gov (United States)

    Al-Ali, Firas; Elias, John J.; Filipkowski, Danielle E.; Faber, James E.

    2015-01-01

    The current strategy for intra-arterial treatment (IAT) of acute ischemic stroke focuses on minimizing time from ictus to revascularization and maximizing revascularization. Employing this strategy has yet to lead to improved rates of successful outcomes. However, the collateral blood supply likely plays a significant role in maintaining viable brain tissue during ischemia. Based on our prior work, we believe that only approximately 50% of patients are genetically predisposed to have sufficient collaterals for a good outcome following treatment, a concept we call the 50% barrier. The Capillary Index Score (CIS) has been developed as a tool to identify patients with a sufficient collateral blood supply to maintain tissue viability prior to treatment. Patients with a favorable CIS (f CIS) may be able to achieve a good outcome with IAT beyond an arbitrary time window. The CIS is incorporated into a proposed patient treatment algorithm. For patients suffering from a large stroke without aphasia, a non-enhanced head CT should be followed by CT angiography (CTA). For patients without signs of stroke mimics or visible signs of structural changes due to large irreversible ischemia, CTA can help confirm the vascular occlusion and location. The CIS can be obtained from a diagnostic cerebral angiogram, with IAT offered to patients categorized as f CIS. PMID:25954243

  7. Treatment with intravenous thrombolysis in acute ischemic stroke is associated with reduced bed day use

    DEFF Research Database (Denmark)

    Terkelsen, Thorkild; Schmitz, Marie Louise; Simonsen, Claus Z.

    2015-01-01

    Introduction: Several studies have demonstrated the beneficial effects of intravenous tissue-type plasminogen activator (IV-tPA) on neurological outcome in acute ischemic stroke. It is uncertain whether the improved neurological outcome also translates into less morbidity and lower need for hospi......Introduction: Several studies have demonstrated the beneficial effects of intravenous tissue-type plasminogen activator (IV-tPA) on neurological outcome in acute ischemic stroke. It is uncertain whether the improved neurological outcome also translates into less morbidity and lower need...... for hospital admissions during follow-up. Methods: We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). IV-tPA-treated patients were propensity-score matched with IV-tPA eligible but non-treated ischemic stroke patients from...... stroke centers not offering tPA. The adjusted Hazard ratio (HR) for first readmission was estimated by multivariable Cox regression among patients who survived the initial stroke admission. Total all-cause bed day use in the first year after stroke admission was determined for patients with a potential...

  8. 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.

  9. Hospital treatment costs and length of stay associated with hypertension and multimorbidity after hemorrhagic stroke.

    Science.gov (United States)

    Specogna, Adrian V; Turin, Tanvir C; Patten, Scott B; Hill, Michael D

    2017-08-10

    Previous studies have identified various treatment and patient characteristics that may be associated with higher hospital cost after spontaneous intracerebral hemorrhage (ICH); a devastating type of stroke. Patient morbidity is perhaps the least understood of these cost-driving factors. We describe how hypertension and other patient morbidities affect length of stay, and hospital treatment costs after ICH using primary and simulated data. We also describe the relationship between cost and length of stay within these patients. We used a cohort design; evaluating 987 consecutive ICH patients across one decade in a Canadian center. Economic, treatment, and patient data were obtained from clinical and administrative sources. Multimorbidity was defined as the presence of one or more diagnoses at hospital admission in addition to a primary diagnosis of ICH. Hypertension was the most frequent (67%) morbidity within these patients, as well as the strongest predictor of longer stay (adjusted RR for >7 days: 1.31, 95% CI: 1.07-1.60), and was significantly associated with higher cost per visit when accounting for other morbidities (adjusted cost increase for hypertension $8123.51, 95% CI: $4088.47 to $12,856.72 USD). A Monte Carlo simulation drawing one million samples of patients estimated for a generation (100 years) assuming 0.94% population growth per year, and a hospitalization rate of 12 per 100,000 inhabitants, supported these findings (p = 0.516 for the difference in unadjusted cost: simulated vs primary). Using a restricted cubic spline, we observed that the rate of change in overall cost for all patients was greatest for the first 3 weeks (p < 0.001) compared to subsequent weeks. Patient multimorbidity, specifically hypertension, is a strong predictor of longer stay and cost after ICH. The non-linear relationship between cost and time should also be considered when forecasting healthcare spending in these patients.

  10. [The peculiarities of the application of transcranial magnetic therapy and electrical stimulation for the treatment of the patients presenting with various types of stroke].

    Science.gov (United States)

    Melnikova, E A

    2015-01-01

    In this article, the results of the authors' research, including analysis of the clinical and instrumental data concerning 203 patients with, stroke are presented. It is shown that the clinical effectiveness of the transcranial methods incorporated in the combined rehabilitation programs depends on the type of stroke and localization of the lesions. Specifically, the patients presenting with ischemic stroke of hemispheric localization experienced a neurophysiologically confirmed significant clinical improvement that became apparent after the consistent application of transcranial magnetic therapy and micropolarization. In the patients with ischemic stroke of stem localization, the positive influence on psychomotor recovery was achieved with the application of transcranial magnetic therapy, but transcranial micropolarization did not have an appreciable effect on the recovery of such patients. The patients presenting with hemorrhagic stroke did not experience any significant improvement of psychomotor parameters from transcranial magnetic therapy and transcranial micropolarization. The likely mechanism underlying the recovery of psychomotor processes under effect of transcranial magnetic therapy in the patients with ischemic stroke is the normalization of the frequency of interaction between brain structures. In addition, in the patients with ischemic stroke of hemispheric localization and in the patients with hemorrhagic stroke electrical myostimulation has a marked impact on the psychomotor recovery only in case of functional treatment. In the patients suffering from ischemic stroke of stem localization non-functional electromyostimulation significantly improves motor functions and cognitive motor control.

  11. Ischemic Stroke in Young Adults: Profile of SARAH Hospital Brasília From 2008 to 2012.

    Science.gov (United States)

    Montanaro, Vinícius V A; Freitas, Denise D S; Ruiz, Miguel C M; Cavalcanti, Eduardo B U; Marinho, Patricia B C; Freitas, Maria C D N B; Oliveira, Eleonora M J D

    2017-03-01

    The societal and economic impact of ischemic stroke in young adults is considerable. The etiological investigation of ischemic stroke in this population is also challenging. To describe the characteristics of young patients with ischemic stroke admitted to a neurological rehabilitation program in Brazil. This transversal retrospective study analyzed data from the electronic health records of 134 patients aged 18 to 45 years with ischemic stroke admitted from 2008 to 2012. The average patient age at the time of ictus was 33 years; 56% of the subjects were female, and 29.3% had undetermined etiologies of stroke, on the basis of both TOAST and SSS TOAST criteria. Further, 48.7% of the subjects had a known vascular risk factor, which was arterial hypertension in most cases. The results of thrombophilia testing were positive in 13.7% of patients, but in only 3.7% of patients, thrombophilia was determined to be the causal mechanism of the stroke. There was a significant association between thrombophilia and patent foramen ovale, but no significant association was found between thrombophilia and arterial dissection. Among the patients with artery dissections, 46% had a history of trauma, which was statistically significant. Etiological diagnosis of stroke in the young is challenging for clinicians. Hence, a more effective classification scheme, better investigative mechanisms, and correct determination of causal associations in ischemic stroke are needed. Thrombophilia screening should be performed in the presence of relevant clinical signs and/or family history.

  12. [Edoxaban for stroke prevention in atrial fibrillation and treatment of venous thromboembolism: an expert position paper].

    Science.gov (United States)

    Weiss, Thomas W; Rohla, Miklos; Dieplinger, Benjamin; Domanovits, Hans; Fries, Dietmar; Vosko, Milan R; Gary, Thomas; Ay, Cihan

    2018-04-01

    Edoxaban is the most recent available representative of the Non-Vitamin K antagonist oral anticoagulants (NOAC). The approval was based on the largest phase III trials of NOACs for stroke prevention in patients with non-valvular atrial fibrillation (AF, ENGAGE-AF), and for the treatment of venous thromboembolism (VTE, HOKUSAI-VTE). In both trials, edoxaban was associated with similar efficacy and a significant reduction in bleeding events with respect to the pre-defined primary safety endpoints, as compared to warfarin.Additionally, the once daily dosing of edoxaban, the clinically investigated strategy for dose-reduction based on clearly defined criteria and the favorable pharmacokinetic profile might further support the clinical applicability of the substance.In the light of recent data, this expert consensus document aims to summarize the latest clinical trial results while providing a concise overview of current guideline recommendations on the management of patients with non-valvular AF and VTE.

  13. Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review

    Directory of Open Access Journals (Sweden)

    Monica Lavoie

    2015-04-01

    Procedures and analyses: The PRISMA statement(1 for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions was used as a guideline to conduct the present review. A systematic search of publications on PubMed and PsycInfo was conducted. Experimental studies designed to assess the effectiveness of an intervention delivered by a technology, namely computer, smart tablet or teletreatment, to specifically improve anomia in post-stroke participants were selected, without limitations as to the dates of publication. The main outcomes studied were improvement in naming skills and generalization to untreated items and daily communication. The Downs and Black checklist for randomised and non-randomised studies of health care interventions(2 was used by two reviewers (ML and JM to conduct the methodological quality assessment. Results: A total of 20 studies were included in this review. Up to now, computer is by far the most popular technology, whereas only a few studies aimed at exploring the effectiveness of smart tablet or teletreatment. In some studies, technology was used as a therapy tool in a clinical setting, in the presence of the clinician, while in others, therapy with technology was self-administered at home, without the clinician. All studies confirmed the effectiveness of therapy provided by technology to improve naming of trained items. However, generalization to untrained items is unclear and assessment of generalization to daily communication is scarce. Conclusions: The results of this systematic review confirm that technology is a promising avenue in the management of post-stroke anomia. Self-administered therapies are particularly interesting since they allow increasing significantly the intensity and frequency of therapeutic activities, a factor that has been explicitly recognized as a positive determinant of the efficacy of language treatment(3. In future studies, ecological tasks aiming to evaluate therapy

  14. Use of acupuncture therapy as a supplement to conventional medical treatments for acute ischaemic stroke patients in an academic medical centre in Korea.

    Science.gov (United States)

    Chang, Hyejung; Kwon, Young Dae; Yoon, Sung Sang

    2011-10-01

    Acupuncture has served as a major complementary and alternative therapy that supplements conventional medicine and is the subject of growing public interest. This study was conducted to estimate the usage rate of acupuncture as a supplemental treatment in acute ischaemic stroke patients and to identify factors associated with the choice to use this therapy. Using the registry of stroke patients admitted to an academic medical centre in Korea, the use of acupuncture therapy was recorded and analysed, along with the patients' socio-demographic characteristics, hospital access variables, risk factors for ischaemic stroke and clinical characteristics. The data were analysed using descriptive statistics, chi-square tests and multiple logistic regression analyses. Of 2167 patients, 18% received acupuncture therapy. The choice of acupuncture therapy was significantly associated with stroke severity as well as gender, age, geographical residence and previous history of stroke. After controlling for other significant factors, there was an approximately 3.4-fold greater usage in patients with moderately severe strokes (95% confidence interval (CI)=2.5-4.6) and 4.1-fold greater usage in patients with severe strokes (95% CI=2.7-6.4). The findings provide a better understanding of patients' utilization of acupuncture therapy as a supplement to conventional medical treatments and of factors associated with the utilization of acupuncture in patients with acute ischemic stroke. Strategic implications of acupuncture therapy are suggested for both health-care providers and policy makers. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia.

    Science.gov (United States)

    Meinzer, Marcus; Darkow, Robert; Lindenberg, Robert; Flöel, Agnes

    2016-04-01

    = 0.71). Treatment effects for trained items were significantly better maintained in the anodal-transcranial direct current stimulation group 6 months later (d = 1.19). Transfer to untrained items was significantly larger in the anodal-transcranial direct current stimulation group after the training (d = 1.49) and during the 6 month follow-up assessment (d = 3.12). Transfer effects were only maintained in the anodal-transcranial direct current stimulation group. Functional communication was significantly more improved in the anodal-transcranial direct current stimulation group at both time points compared to patients treated with sham-transcranial direct current stimulation (d = 0.75-0.99). Our results provide the first evidence from a randomized, controlled trial that transcranial direct current stimulation can improve both function and activity-related outcomes in chronic aphasia, with medium to large effect sizes, and that these effects are maintained over extended periods of time. These effects were achieved with an easy-to-implement and thus clinically feasible motor-cortex montage that may represent a promising 'backdoor' approach to improve language recovery after stroke. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Choice of ANesthesia for EndoVAScular Treatment of Acute Ischemic Stroke: Protocol for a randomized controlled (CANVAS) trial.

    Science.gov (United States)

    Peng, Yuming; Li, Yan; Jian, Minyu; Liu, Xiaoyuan; Sun, Jian; Jia, Bo; Dong, Jia; Zeng, Min; Lin, Nan; Zhang, Li; Gelb, Adrian W; Chan, Matthew Tv; Han, Ruquan

    2017-12-01

    Background Observational studies indicate that the type of anesthesia, local or general, may be associated with the post-procedural neurological function in patients with acute ischemic stroke undergoing endovascular treatment. However, these results need further confirmation, and the causal relationship has not yet been established. Methods This is a randomized controlled equivalence trial. Permuted block randomization stratified by culprit vessels will be used. Six hundred and forty patients with acute ischemic stroke undergoing endovascular recanalization will be randomized one to one to receive either general anesthesia or local anesthesia. The primary endpoint is the modified Rankin scale at 90 days after endovascular treatment. The secondary endpoints are the peri-procedural mortality and morbidity. Discussion The study aims to determine the effects of anesthetic choice on neurological outcomes in patients with acute ischemic stroke undergoing intra-arterial recanalization. If the results are positive, the study will indicate that the type of anesthesia does not affect neurological outcome after endovascular treatment. ClinicalTrial.gov identifier: NCT02677415.

  17. The Nasal Route as a Potential Pathway for Delivery of Erythropoietin in the Treatment of Acute Ischemic Stroke in Humans

    Directory of Open Access Journals (Sweden)

    Julio Cesar García-Rodríguez

    2009-01-01

    Full Text Available Intranasal delivery provides a practical, noninvasive method of bypassing the blood-brain barrier (BBB in order to deliver therapeutic agents to the brain. This method allows drugs that do not cross the BBB to be delivered to the central nervous system in a few minutes. With this technology, it will be possible to eliminate systemic administration and its potential side effects. Using the intranasal delivery system, researchers have demonstrated neuroprotective effects in different animal models of stroke using erythropoietin (EPO as a neuroprotector or other different types of EPO without erythropoiesis-stimulating activity. These new molecules retain their ability to protect neural tissue against injury and they include Asialoerythropoietin (asialoEPO carbamylated EPO (CEPO, and rHu-EPO with low sialic acid content (Neuro-EPO. Contrary to the other EPO variants, Neuro-EPO is not chemically modified, making it biologically similar to endogenous EPO, with the advantage of less adverse reactions when this molecule is applied chronically. This constitutes a potential benefit of Neuro-EPO over other variants of EPO for the chronic treatment of neurodegenerative illnesses. Nasal administration of EPO is a potential, novel, neurotherapeutic approach. However, it will be necessary to initiate clinical trials in stroke patients using intranasal delivery in order to obtain the clinical evidence of its neuroprotectant capacity in the treatment of patients with acute stroke and other neurodegenerative disorders. This new therapeutic approach could revolutionize the treatment of neurodegenerative disorders in the 21st century.

  18. What Are Some Common Outcomes of Stroke and Some Common Treatments for These Outcomes?

    Science.gov (United States)

    ... Research Information Find a Study Resources and Publications Pediatric Injury Condition Information NICHD Research Information Find a ... functions damaged by the stroke. These therapies include: Physical therapy A physical therapist uses training and exercises to ...

  19. What Are Some Common Outcomes of Stroke and Some Common Treatments for These Outcomes?

    Science.gov (United States)

    ... Research Information Find a Study Resources and Publications Pelvic Floor Disorders Condition Information NICHD Research Information Find a ... functions damaged by the stroke. These therapies include: Physical therapy A physical therapist uses training and exercises to ...

  20. Methylene blue treatment in experimental ischemic stroke: A mini-review

    Directory of Open Access Journals (Sweden)

    Zhao Jiang

    2016-01-01

    Full Text Available Stroke is among the leading causes of death and long-term disability. Methylene blue (MB, a drug grandfathered by the Food and Drug Administration with a long history of safe usage in humans for treating methemoglobinemia and cyanide poisoning, has recently been shown to be neuroprotective in neurodegenerative diseases and brain injuries. The goal of this paper is to review studies on MB in experimental stroke models.

  1. OPTIMIZING OVERALL FUNCTION OF THE UPPER LIMB IS EFFECTIVE TREATMENT FOR SHOULDER PAIN IN INDIVIDUALS WITH STROKE: A RANDOMIZED CONTROLLED TRIAL

    OpenAIRE

    Mohamed E Khallaf, PhD PT

    2014-01-01

    Background: Shoulder pain is frequent after stroke and interferes with the rehabilitative process and functional outcomes. Treatments used for post-stroke shoulder pain are limited and largely ineffective. Objectives: This randomized controlled study was conducted to study the effect of optimizing overall function of upper limb on the basis of pathomechanics and motor relearning as a treatment of hemiparetic shoulder pain. Subjects and methods: Thirty patients with first ever stro...

  2. [Clinical Trials for Treatment of Stroke Patients with Dysphagia by Vitalstim Electroacupuncture Combined with Swallowing Rehabilitation Training].

    Science.gov (United States)

    Zhang, Sheng-Yu; Liu, Shao-Bing; Wu, Wei; Chen, Yi-Min; Liao, Kang-Lin; Xiang, Yong; Pan, Dun

    2017-04-25

    To observe the clinical effect of vitalstim electroacupuncture (EA) combined with swallowing rehabilitation training in the treatment of stroke patients with dysphagia. A total of 80 stroke patients with dysphagia were randomized into treatment and control groups ( n =40 in each group). Patients of the control group were treated by regular medication for anti-platelet aggregation and anti-coagulation, lipid-lowering, neuroprotection, blood glucose control and blood pressure control, etc. and swallowing function rehabilitation training, and those of the treatment group treated by EA stimulation of Fengchi (GB 20), Jinjin (EX-HN 12) and Yuye (EX-HN 13) with a Vitalstim Electrostimulator and manual acupuncture stimulation of Lianquan (CV 23), Tiantu (CV 22) in combination with regular medication plus swallowing function training as those mentioned in the control group. The EA and manual acupuncture stimulation treatment was conducted once daily, 6 times a week and 4 weeks altogether. The therapeutic effect was assessed by using Kubota swallowing ability test (6 levels), dysphagia subscale (0-6 scores) of the neurological deficit degrees, videofluorography (VFG) assessment (markedly effective, effective and invalid, for evaluating the function and symmetry state of the swallowing movements), and the MOS Item Short Form Health Survey (SF-36, 8 minor items of two major aspects in physiological function, mental health, emotional function, social function and overall health) for assessing the patients' daily-life quality. After the treatment, the dysphagia score of the treatment group was signi-ficantly lower than that of the control group ( P dysphagia (showed by dysphagia score and VFG outcomes) and life quality. EA treatment combined with swallowing function rehabilitation training is effective in improving swallowing ability and daily-life quality in stroke patients with dysphagia.

  3. Penumbra Stroke System as an ''add-on'' for the treatment of large vessel occlusive disease following thrombolysis: first results

    International Nuclear Information System (INIS)

    Struffert, Tobias; Engelhorn, Tobias; Richter, Gregor; Doerfler, Arnd; Koehrmann, Martin; Nowe, Tim; Schellinger, Peter D.; Schwab, Stefan

    2009-01-01

    The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS ≤ 2) was 42%. One patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5 in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome. (orig.)

  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. Role of the MMP9 gene in hemorrhagic transformations after tissue-type plasminogen activator treatment in stroke patients.

    Science.gov (United States)

    Fernández-Cadenas, Israel; Del Río-Espínola, Alberto; Carrera, Caty; Domingues-Montanari, Sophie; Mendióroz, Maite; Delgado, Pilar; Rosell, Anna; Ribó, Marc; Giralt, Dolors; Quintana, Manolo; Castellanos, Mar; Obach, Victor; Martínez, Sergi; Freijo, Mari Mar; Jiménez-Conde, Jordi; Roquer, Jaume; Martí-Fábregas, Joan; Molina, Carlos A; Alvarez-Sabín, José; Montaner, Joan

    2012-05-01

    Despite the benefits of tissue-type plasminogen activator treatment, some stroke patients experience adverse hemorrhagic transformations (HT). Plasma protein levels of MMP9 have been associated with HT occurrence. We aimed to analyze the association of the MMP9 gene with HT occurrence. We analyzed the MMP9 gene in blood samples from 885 stroke patients treated with tissue-type plasminogen activator by tag-SNP, imputed SNP, direct sequencing, and RNA expression. We did not observe any significant association between MMP9 genetic variations or MMP9 expression and HT occurrence. Moreover, no association was found between MMP9 expression and MMP9 polymorphisms. Genetic variations in the MMP9 gene are not associated with HT occurrence in tissue-type plasminogen activator-treated patients.

  6. Effect of Treatment Delay, Stroke Type, and Thrombolysis on the Effect of Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome after Acute Stroke: A Systematic Review and Meta-Analysis of Individual Patient from Randomised Trials

    Directory of Open Access Journals (Sweden)

    Philip M. Bath

    2016-01-01

    Full Text Available Background. Nitric oxide (NO donors are a candidate treatment for acute stroke and two trials have suggested that they might improve outcome if administered within 4–6 hours of stroke onset. We assessed the safety and efficacy of NO donors using individual patient data (IPD from completed trials. Methods. Randomised controlled trials of NO donors in patients with acute or subacute stroke were identified and IPD sought from the trialists. The effect of NO donor versus control on functional outcome was assessed using the modified Rankin scale (mRS and death, by time to randomisation. Secondary outcomes included measures of disability, mood, and quality of life. Results. Five trials (4,197 participants were identified, all involving glyceryl trinitrate (GTN. Compared with control, GTN lowered blood pressure by 7.4/3.3 mmHg. At day 90, GTN did not alter any clinical measures. However, in 312 patients randomised within 6 hours of stroke onset, GTN was associated with beneficial shifts in the mRS (odds ratio (OR 0.52, 95% confidence interval (CI 0.34–0.78 and reduced death (OR 0.32, 95% CI 0.14–0.78. Conclusions. NO donors do not alter outcome in patients with recent stroke. However, when administered within 6 hours, NO donors might improve outcomes in both ischaemic and haemorrhagic stroke.

  7. Results of the Intravascular Cooling in the Treatment of Acute Stroke 2 Trial (ICTuS-2)

    Science.gov (United States)

    Lyden, Patrick; Hemmen, Thomas; Grotta, James; Rapp, Karen; Ernstrom, Karin; Rzesiewicz, Teresa; Parker, Stephanie; Concha, Mauricio; Syed, Hussain; Agarwal, Sachin; Meyer, Brett; Jurf, Julie; Altafullah, Irfan; Raman, Rema

    2016-01-01

    Background and Purpose Therapeutic hypothermia (TH) is a potent neuroprotectant approved for cerebral protection after neonatal hypoxia-ischemia and cardiac arrest. TH for acute ischemic stroke is safe and feasible in pilot trials. We designed a study protocol to provide safer, faster TH in stroke patients. Methods Safety procedures and 4°C saline infusions for faster cooling were added to the Intravascular Cooling Treatment in Acute Stroke (ICTuS) trial protocol. A femoral venous intravascular cooling catheter following intravenous rt-PA in eligible patients provided 24 hours cooling followed by a 12 hour re-warm. Serial safety assessments and imaging were performed. The primary endpoint was 3-month modified Rankin score 0,1. Results Of the intended 1600 subjects, 120 were enrolled before the study was stopped. Randomly, 63 were to receive hypothermia (HY) plus anti-shivering treatment and 57 normothermia (NT). Compared to prior studies, cooling rates were improved with a cold saline bolus, without fluid overload. The intention-to-treat primary outcome of 90-day mRS 0,1 occurred in 33% HY and 38% NT subjects, OR (95% CL) of 0.81 (0.36, 1.85). Serious adverse events occurred equally. Mortality was 15.9% HY and 8.8% NT subjects, OR (95% CL) of 1.95 (0.56, 7.79). Pneumonia occurred in 19% HY vs. 10.5% in NT subjects, OR (95% CL) of 1.99 (0.63, 6.98). Conclusion Intravascular TH was confirmed to be safe and feasible in rt-PA treated acute ischemic stroke patients. Protocol changes designed to reduce pneumonia risk appeared to fail, although the sample is small. Clinical trial registration clinicaltrials.gov NCT 01123161. PMID:27834742

  8. An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke.

    Science.gov (United States)

    Turk, Aquilla S; Campbell, John M; Spiotta, Alejandro; Vargas, Jan; Turner, Raymond D; Chaudry, M Imran; Battenhouse, Holly; Holmstedt, Christine A; Jauch, Edward

    2014-01-01

    The use of mechanical thrombectomy for the treatment of acute ischemic stroke has significantly advanced over the past 5 years, with few available data. The aim of this study was to analyze the cost and benefit of mechanical thrombectomy devices utilized during endovascular therapy of ischemic stroke patients. A retrospective chart review of patients that underwent intra-arterial stroke interventions was conducted. Clinical, angiographic, all devices used, procedural and postprocedural event and outcome data were collected. Thrombectomy devices were categorized as Penumbra aspiration system thrombectomy (group P) or stent retriever (group S). Statistical analysis of outcomes and costs for each group was performed. 171 patients underwent mechanical thrombectomy. The Penumbra aspiration system was able to primarily achieve recanalization in 41.7% and the stent retriever in 70.4% of the time (p=0.006). The average cost was $11 159 and $16 022 (p=0.0002) in groups P and S, respectively. Average time to recanalization for group P was 85.1 min and for group S, 51.6 min (p<0.0001). Procedural complications were more frequent with the stent retriever (11.1% vs 9.0%; p=0.72) as were periprocedural significant complications (14.8 v 3%; p=0.04). Successful recanalization rates (Thrombolysis in Cerebral Infarction score 2b-3) were the same in groups P and S (78.5 vs. 77.8%). Similar rates of good neurologic outcomes were seen in group P (36.4%) and group S (50.0%) (p=0.19). For the treatment of acute stroke patients, the use of aspiration appears to be the most cost effective method to achieve acceptable recanalization rates and low complication rates. Stent retriever with local aspiration, despite higher costs and complication rates, yielded better overall outcome.

  9. Neuronox versus BOTOX in the Treatment of Post-Stroke Upper Limb Spasticity: A Multicenter Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Han Gil Seo

    Full Text Available Botulinum toxin type A is widely used for treating spasticity. Neuronox (Neu-BoNT/A, a newly manufactured botulinum toxin a, has not yet been investigated for its efficacy and safety in the treatment of post-stroke upper limb spasticity.We evaluated the efficacy and safety of Neuronox (Neu-BoNT/A compared with BOTOX (onabotulinum toxin A for treating post-stroke upper limb spasticity.In total, 196 stroke patients with moderate to severe upper limb spasticity were randomly assigned to either Neuronox or BOTOX intervention. The wrist flexors were mandatory and elbow, finger, and thumb flexors were optional muscles to be injected. Assessments were performed at baseline and 4, 8, and 12 weeks after the intervention. The primary outcome measure was the change from baseline of the Modified Ashworth Scale (MAS at the wrist flexors at week 4. Secondary outcome measures included the change of MAS at each visit, response rate, Disability Assessment Scale (DAS, Carer Burden Scale, and Global Assessment of treatment benefit.Primary outcome measures were -1.39±0.79 and -1.56±0.81 in the Neuronox and BOTOX groups, respectively. The difference was within the noninferiority margin of 0.45 (95% upper limit=0.40. There were no significant differences between the groups in the secondary outcome and safety measures, except the change of the MAS at the elbow flexors at week 12 (-0.88±0.75 in the Neuronox group, -0.65±0.74 in the BOTOX group; P=0.0429. Both groups showed significant improvements in the MAS, DAS, and Carer Burden Scale at weeks 4, 8, and 12.Neuronox showed equivalent efficacy and safety compared with BOTOX for treating post-stroke upper limb spasticity.ClinicalTrials.gov NCT01313767.

  10. What You Need to Know about Stroke

    Science.gov (United States)

    ... the brain. The other kind of stroke, called hemorrhagic stroke, is caused by a blood vessel that breaks ... are very common among African Americans. The best treatment for stroke is prevention. You can reduce your ...

  11. Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

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    Octávio Marques Pontes-Neto

    Full Text Available ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.

  12. New Contemporary Criterion-Referenced Assessment Instruments for Astronomy & Geology: TOAST & EGGS

    Science.gov (United States)

    Guffey, Sarah Katie; Slater, Stephanie J.; Slater, Timothy F.

    2015-08-01

    Considerable effort in the astronomy and Earth sciences education research over the past decade has focused on developing assessment tools in the form of multiple-choice conceptual diagnostics and content knowledge surveys. This has been critically important in advancing discipline-based education research allowing scholar to establish the initial, incoming knowledge state of students as well as to attempt to measure some of the impacts of innovative instructional interventions. Before now, few of the existing instruments were constructed upon a solid list of clearly articulated and widely agreed upon learning objectives. Whereas first-generation assessment tools, such as the Astronomy Diagnostics Test ADT2) were based primarily upon further identifying documented astronomy misconceptions, scholars from the CAPER Center for Astronomy & Physics Education Research team are creating contemporary instruments based instead by developing items using modern test construction techniques and tightly aligned to the consensus learning goals identified by the American Association of the Advancement of Science’s Project 2061 Benchmarks, and the National Research Council’s National Science Education Standards, and the National Research Council’s Frameworks for A Framework for K-12 Science Education: Practices, Crosscutting Concepts, and Core Ideas. These consensus learning goals are further enhanced guiding documents from the American Astronomical Society - Chair’s Conference on ASTRO 101 and the NSF-funded Earth Science Literacy Initiative. Two of the resulting criterion-referenced assessment tools widely used by researchers are the Test Of Astronomy STandards (TOAST) and the Exam of GeoloGy StandardS (EGGS). These easy-to-use and easy-to-score multiple-choice instruments have a high degree of reliability and validity for instructors and researchers needing information on students’ initial knowledge state at the beginning of a course and can be used, in aggregate, to

  13. First Results from the Test Of Astronomy STandards (TOAST) Assessment Instrument

    Science.gov (United States)

    Slater, Stephanie

    2009-01-01

    Considerable effort in the astronomy education research over the past several years has focused on developing assessment tools in the form of multiple-choice conceptual diagnostics and content knowledge surveys. This has been critically important in advancing astronomy as a sub-discipline of physics education research, allowing researchers to establish the initial knowledge state of students as well as to attempt to measure some of the impacts of innovative instructional interventions. Before now, few of the existing instruments were constructed upon a solid list of clearly articulated and widely agreed upon learning objectives. Moving beyond the 10-year old Astronomy Diagnostics Test, we have developed and validated a new assessment instrument that is tightly aligned to the consensus learning goals stated by the American Astronomical Society - Chair's Conference on ASTRO 101, the American Association of the Advancement of Science's Project 2061 Benchmarks, and the National Research Council's National Science Education Standards. Researchers from the Cognition in Astronomy, Physics and Earth sciences Research (CAPER) Team at the University of Wyoming's Science and Math Teaching Center (UWYO SMTC) designed a criterion-referenced assessment tool, called the Test Of Astronomy STandards (TOAST). Through iterative development, this multiple-choice instrument has a high degree of reliability and validity for instructors and researchers needing information on students’ initial knowledge state at the beginning of a course and can be used, in aggregate, to help measure the impact of course-length duration instructional strategies for undergraduate science survey courses with learning goals tightly aligned to the consensus goals of the astronomy education community.

  14. Intravenous thrombolytic treatment experiences in patients with acute ischemic stroke at the University of Kocatepe, Neurology Clinics

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    Serdar Oruç

    2015-12-01

    Full Text Available INTRODUCTION: This study aimed to discuss the results of the intravenous thrombolytic treatment (IV-tPA to acute ischemic stroke patients, in the light of the literature. METHODS: We performed our study with forty acute ischemic stroke patients who were receiving the IV-tPA in the intensive care unit of our neurology clinic between 2011 and 2015.. The demographic, clinical and radiological data were collected retrospectively. The intracranial hemorrhage detected within 3 months after discharge and neurological status at the end of the 3rd month were evaluated by using modified Rankin scale (MRS and National Institutes of Health Stroke Scale (NIHSS scores. The symptom-to-needle time, Alberta stroke programe early computed tomography score (ASPECT and initial and follow-up scores of NIHSS were analyzed. RESULTS: Fifteen patients were female, twenty-five were male, and the mean age was 66.45±10.56. The initial mean NIHSS score was 13±4.33, whereas it was 4,10±3,37at 3rd month. The initial mean ASPECT score was 8.23±1.20. Symptomatic intracranial hemorrhage was detected in 1 patient and asymptomatic intracranial hemorrhage was detected in 6. The mean symptom-to-needle time was 139,0±48,1 minutes. The neurological disability of 13 patients ( %32.5 were fully recovered at the end of the 3rd month, while 7 patients were died. (% 17,5 The initial NIHSS and ASPECT scores were significantly different between group of patients with a MRS score between 0-2 and between 3-6 (p=0.03 and p=0.006; respectively, while the symptom-to-needle time was not different (p=0.79. DISCUSSION AND CONCLUSION: The results of the current study are in accordance with previous studies in the literature. These results have shown that the IV-tPA treatment is efficient and safe treatment modality in acute ischemic stroke, and reduces disability at the end of the 3rd month.

  15. 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

  16. Laser Therapy of Painful Shoulder and Shoulder-Hand Syndrome in Treatment of Patients after the Stroke

    Directory of Open Access Journals (Sweden)

    Azra Karabegović

    2009-02-01

    Full Text Available The common complication after stroke is pain and dysfunction of shoulder of paralyzed arm, as well as the swelling of the hand. The aim of this study was to determine the effects of LASER therapy and to correlate with electrotherapy (TENS, stabile galvanization in subjects after stroke. We analyzed 70 subjects after stroke with pain in shoulder and oedema of paralyzed hand. The examinees were divided in two groups of 35, and they were treated in the Clinic for Physical Medicine and Rehabilitation in Tuzla during 2006 and 2007. Experimental group (EG had a treatment with LASER, while the control group (CG was treated with electrotherapy. Both groups had kinesis therapy and ice massage. All patients were examined on the admission and discharge by using the VAS, DASH, Barthel index and FIM. The pain intensity in shoulder was significantly reduced in EG (p<0,0001, swelling is lowered in EG (p=0,01. Barthel index in both groups was significant higher (p<0,01. DASH was significantly improved after LASER therapy in EG (p<0,01. EG had higher level of independency (p<0,01. LASER therapy used on EG shows significantly better results in reducing pain, swelling, disability and improvement of independency

  17. 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

  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. Individualized model predicts brain current flow during transcranial direct-current stimulation treatment in responsive stroke patient.

    Science.gov (United States)

    Datta, Abhishek; Baker, Julie M; Bikson, Marom; Fridriksson, Julius

    2011-07-01

    Although numerous published reports have demonstrated the beneficial effects of transcranial direct-current stimulation (tDCS) on task performance, fundamental questions remain regarding the optimal electrode configuration on the scalp. Moreover, it is expected that lesioned brain tissue will influence current flow and should therefore be considered (and perhaps leveraged) in the design of individualized tDCS therapies for stroke. The current report demonstrates how different electrode configurations influence the flow of electrical current through brain tissue in a patient who responded positively to a tDCS treatment targeting aphasia. The patient, a 60-year-old man, sustained a left hemisphere ischemic stroke (lesion size = 87.42 mL) 64 months before his participation. In this study, we present results from the first high-resolution (1 mm(3)) model of tDCS in a brain with considerable stroke-related damage; the model was individualized for the patient who received anodal tDCS to his left frontal cortex with the reference cathode electrode placed on his right shoulder. We modeled the resulting brain current flow and also considered three additional reference electrode positions: right mastoid, right orbitofrontal cortex, and a "mirror" configuration with the anode over the undamaged right cortex. Our results demonstrate the profound effect of lesioned tissue on resulting current flow and the ability to modulate current pattern through the brain, including perilesional regions, through electrode montage design. The complexity of brain current flow modulation by detailed normal and pathologic anatomy suggest: (1) That computational models are critical for the rational interpretation and design of individualized tDCS stroke-therapy; and (2) These models must accurately reproduce head anatomy as shown here. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials

    DEFF Research Database (Denmark)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger

    2010-01-01

    Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to treatment with i...... with intravenous rt-PA (alteplase) on therapeutic benefit and clinical risk by adding recent trial data to the analysis....

  1. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.

    Science.gov (United States)

    Emberson, Jonathan; Lees, Kennedy R; Lyden, Patrick; Blackwell, Lisa; Albers, Gregory; Bluhmki, Erich; Brott, Thomas; Cohen, Geoff; Davis, Stephen; Donnan, Geoffrey; Grotta, James; Howard, George; Kaste, Markku; Koga, Masatoshi; von Kummer, Ruediger; Lansberg, Maarten; Lindley, Richard I; Murray, Gordon; Olivot, Jean Marc; Parsons, Mark; Tilley, Barbara; Toni, Danilo; Toyoda, Kazunori; Wahlgren, Nils; Wardlaw, Joanna; Whiteley, William; del Zoppo, Gregory J; Baigent, Colin; Sandercock, Peter; Hacke, Werner

    2014-11-29

    Alteplase is effective for treatment of acute ischaemic stroke but debate continues about its use after longer times since stroke onset, in older patients, and among patients who have had the least or most severe strokes. We assessed the role of these factors in affecting good stroke outcome in patients given alteplase. We did a pre-specified meta-analysis of individual patient data from 6756 patients in nine randomised trials comparing alteplase with placebo or open control. We included all completed randomised phase 3 trials of intravenous alteplase for treatment of acute ischaemic stroke for which data were available. Retrospective checks confirmed that no eligible trials had been omitted. We defined a good stroke outcome as no significant disability at 3-6 months, defined by a modified Rankin Score of 0 or 1. Additional outcomes included symptomatic intracranial haemorrhage (defined by type 2 parenchymal haemorrhage within 7 days and, separately, by the SITS-MOST definition of parenchymal type 2 haemorrhage within 36 h), fatal intracranial haemorrhage within 7 days, and 90-day mortality. Alteplase increased the odds of a good stroke outcome, with earlier treatment associated with bigger proportional benefit. Treatment within 3·0 h resulted in a good outcome for 259 (32·9%) of 787 patients who received alteplase versus 176 (23·1%) of 762 who received control (OR 1·75, 95% CI 1·35-2·27); delay of greater than 3·0 h, up to 4·5 h, resulted in good outcome for 485 (35·3%) of 1375 versus 432 (30·1%) of 1437 (OR 1·26, 95% CI 1·05-1·51); and delay of more than 4·5 h resulted in good outcome for 401 (32·6%) of 1229 versus 357 (30·6%) of 1166 (OR 1·15, 95% CI 0·95-1·40). Proportional treatment benefits were similar irrespective of age or stroke severity. Alteplase significantly increased the odds of symptomatic intracranial haemorrhage (type 2 parenchymal haemorrhage definition 231 [6·8%] of 3391 vs 44 [1·3%] of 3365, OR 5·55, 95% CI 4·01-7·70

  2. Pain in stroke patients: characteristics and impact on the rehabilitation treatment. A multicenter cross-sectional study.

    Science.gov (United States)

    Aprile, I; Briani, C; Pazzaglia, C; Cecchi, F; Negrini, S; Padua, L

    2015-12-01

    Post-stroke pain (PSP) is a common and disabling complication, difficult to treat, that often decreases patients' quality of life (QoL). The hypothesis is that PSP may negatively affect rehabilitation treatment. The aim of this paper was to quantify and characterize pain in a sample of post-stroke patients undergoing rehabilitation and to investigate the impact of pain in slowing down or discontinuing the rehabilitation program. Multicenter cross-sectional study. Inpatients and outpatients of rehabilitation department. One hundred and six subacute and chronic stroke patients. Pain intensity was measured with the NRS or the PAINAD (if cognitive/language impairment was present); pain characteristics were assessed with the DN4, and NPSI questionnaire. Qol was measured with the SF-36. A clinical assessment and a semi-structured questionnaire on pain occurrence, impact, and management was administered by the physiotherapist in charge of the patients and by the physician. Nearly 1/3 of the patients (32.9%) with normal cognitive functions and language reported pain occurrence after stroke; 81.8% of them had NRS≥3 and 31.8% DN4≥4 (meaning neuropathic origin of pain). In about 20% of the patients the PAINAD was used to measure pain; 17.4% of them presented a score ≥3. In 24.5% of our sample, pain influenced rehabilitation treatment. In 16% of the whole sample, pain influenced patients' attention during rehabilitation session. Patients with hypoesthesia presented significantly higher neuropathic pain scores than patients with normal sensory function. Regarding QoL, we found that patients with higher neuropathic pain showed more severe deterioration of mental aspects of QoL, where patients with higher nociceptive pain presented more severe deterioration of physical aspects of QoL. The results from this multicenter study showed that in about ¼ of the patients, pain negatively influenced the rehabilitation program delaying the recovery and likely increasing the cost of

  3. Etiology and treatment of perinatal stroke; a role for prothrombotic coagulation factors?

    NARCIS (Netherlands)

    Cnossen, M. H.; van Ommen, C. H.; Appel, I. M.

    2009-01-01

    The detection rate of perinatal stroke is rising due to improved neuroradiological imaging techniques, increased survival of neonates with severe underlying diseases and an increased awareness of the diagnosis by pediatricians. Its pathogenesis is multifactorial and includes a large variety of

  4. Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis.

    Science.gov (United States)

    Bayés de Luna, Antoni; Martínez-Sellés, Manuel; Bayés-Genís, Antoni; Elosua, Roberto; Baranchuk, Adrian

    2017-07-31

    Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors - as aging, diabetes, hypertension - induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG. IAB is classified as partial when the P wave duration is ≥120 ms, and advanced if the P wave also presents a biphasic pattern in II, III and aVF. IAB is very frequent in the elderly and, particularly in the case of the advanced type, is associated with AF, AF recurrences, stroke, and dementia. The anticoagulation in elderly patients at high risk of AF without documented arrhythmias is an open issue but recent data suggest that it might have a role, particularly in elderly patients with structural heart disease, high CHA 2 DS 2 VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled] - Vascular disease, Age 65-74, and Sex category [female]), and advanced IAB. In this debate, we discuss the association of surface ECG IAB, a marker of atrial fibrosis, with AF and stroke. We also present the rationale that justifies further studies regarding anticoagulation in some of these patients.

  5. Acute but not delayed amphetamine treatment improves behavioral outcome in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, Karsten; Kristiansen, Uffe

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the effects of d-amphetamine (amph) upon recovery after embolic stroke in rats. METHODS: Ninety-three rats were embolized in the right middle cerebral artery and assigned to: (1) controls; (2) combination (acute amph and later amph-facilitate...

  6. Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

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    Davide Strambo

    2017-01-01

    Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

  7. Potential of the Angiotensin Receptor Blockers (ARBs) Telmisartan, Irbesartan, and Candesartan for Inhibiting the HMGB1/RAGE Axis in Prevention and Acute Treatment of Stroke

    Science.gov (United States)

    Kikuchi, Kiyoshi; Tancharoen, Salunya; Ito, Takashi; Morimoto-Yamashita, Yoko; Miura, Naoki; Kawahara, Ko-ichi; Maruyama, Ikuro; Murai, Yoshinaka; Tanaka, Eiichiro

    2013-01-01

    Stroke is a major cause of mortality and disability worldwide. The main cause of stroke is atherosclerosis, and the most common risk factor for atherosclerosis is hypertension. Therefore, antihypertensive treatments are recommended for the prevention of stroke. Three angiotensin receptor blockers (ARBs), telmisartan, irbesartan and candesartan, inhibit the expression of the receptor for advanced glycation end-products (RAGE), which is one of the pleiotropic effects of these drugs. High mobility group box 1 (HMGB1) is the ligand of RAGE, and has been recently identified as a lethal mediator of severe sepsis. HMGB1 is an intracellular protein, which acts as an inflammatory cytokine when released into the extracellular milieu. Extracellular HMGB1 causes multiple organ failure and contributes to the pathogenesis of hypertension, hyperlipidemia, diabetes mellitus, atherosclerosis, thrombosis, and stroke. This is the first review of the literature evaluating the potential of three ARBs for the HMGB1-RAGE axis on stroke therapy, including prevention and acute treatment. This review covers clinical and experimental studies conducted between 1976 and 2013. We propose that ARBs, which inhibit the HMGB1/RAGE axis, may offer a novel option for prevention and acute treatment of stroke. However, additional clinical studies are necessary to verify the efficacy of ARBs. PMID:24065095

  8. Treatment Effects of Ischemic Stroke by Berberine, Baicalin, and Jasminoidin from Huang-Lian-Jie-Du-Decoction (HLJDD Explored by an Integrated Metabolomics Approach

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    Qian Zhang

    2017-01-01

    Full Text Available Berberine, baicalin, and jasminoidin were major active ingredients of Huang-Lian-Jie-Du-Decoction (HLJDD, a famous prescription of traditional Chinese medicine (TCM, which has been used for the treatment of ischemic stroke. The aim of the present study was to classify their roles in the treatment effects of ischemic stroke. A rat model of middle cerebral artery occlusion (MCAO was constructed to mimic ischemic stroke and treatment effects of berberine, baicalin, and jasminoidin, and HLJDD was assessed by neurologic deficit scoring, infarct volume, histopathology, immunohistochemistry, biochemistry, quantitative real-time polymerase chain reaction (qRT-PCR, and Western blotting. In addition, the 1H NMR metabolomics approach was used to assess the metabolic profiles, which combined with correlation network analysis successfully revealed metabolic disorders in ischemic stroke concerning the treatment of the three principal compounds from HLJDD for the first time. The combined results suggested that berberine, baicalin, and jasminoidin are responsible for the effectiveness of HLJDD on the treatment of ischemic stroke by amelioration of abnormal metabolism and regulation of oxidative stress, neuron autophagy, and inflammatory response. This integrated metabolomics approach showed its potential in understanding the function of complex formulae and clarifying the role of its components in the overall treatment effects.

  9. The gender effect in stroke thrombolysis: of CASES, controls, and treatment-effect modification.

    Science.gov (United States)

    Kent, David M; Buchan, Alastair M; Hill, Michael D

    2008-09-30

    Large studies of patients with acute stroke not receiving thrombolytic therapy have repeatedly demonstrated poorer outcomes for women compared to men. An analysis of five pooled randomized controlled trials testing IV recombinant tissue plasminogen activator (rtPA) demonstrated that rtPA benefits women more than men; the usual gender difference, apparent among controls, was totally nullified in the rtPA group. This nullification of the usual gender effect among rtPA-treated patients has not been confirmed. We analyzed baseline characteristics and functional outcomes in men vs women in the Canadian Alteplase for Stroke Effectiveness Study (CASES), a multicenter study that collected outcomes data for patients treated with rtPA in Canada to assess the safety and effectiveness of alteplase for stroke in the context of routine care. Among 1,110 patients, including 615 men and 505 women, a normal or near normal outcome at 90 days was found in 37.1% of men vs 36.0% of women (p = 0.71). This was essentially unchanged after adjusting for differences in baseline characteristics, including age >70, glucose, hypertension, atrial fibrillation, hypercholesterolemia, baseline National Institute of Health Stroke Severity, and baseline Alberta Stroke Program Early CT score (35.2% in men vs 38.2% in women, p = 0.332). Ninety-day mortality was similar between the sexes in both the adjusted and unadjusted analysis. There was no difference in 90-day outcomes in recombinant tissue plasminogen activator (rtPA)-treated men and rtPA-treated women. This is consistent with the pooled analysis of randomized controlled trials, showing greater benefit for thrombolysis in women and nullification of the usual gender difference in outcome.

  10. Clinical Epidemiology Of Stroke

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    Nagaraja D

    2005-01-01

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

  11. Prophylactic neuroprotection against stroke: low-dose, prolonged treatment with deferoxamine or deferasirox establishes prolonged neuroprotection independent of HIF-1 function

    Science.gov (United States)

    Zhao, Yanxin; Rempe, David A

    2011-01-01

    Prophylactic neuroprotection against stroke could reduce stroke burden in thousands of patients at high risk of stroke, including those with recent transient ischemic attacks (TIAs). Prolyl hydroxylase inhibitors (PHIs), such as deferoxamine (DFO), reduce stroke volume when administered at high doses in the peristroke period, which is largely mediated by the hypoxia-inducible transcription factor (HIF-1). Yet, in vitro experiments suggest that PHIs may also induce neuroprotection independent of HIF-1. In this study, we examine chronic, prophylactic, low-dose treatment with DFO, or another iron chelator deferasirox (DFR), to determine whether they are neuroprotective with this paradigm and mediate their effects through a HIF-1-dependent mechanism. In fact, prophylactic administration of low-dose DFO or DFR significantly reduces stroke volume. Surprisingly, DFO remained neuroprotective in mice haploinsufficient for HIF-1 (HIF-1+/−) and transgenic mice with conditional loss of HIF-1 function in neurons and astrocytes. Similarly, DFR was neuroprotective in HIF-1+/− mice. Neither DFO nor DFR induced expression of HIF-1 targets. Thus, low-dose chronic administration of DFO or DFR induced a prolonged neuroprotective state independent of HIF-1 function. As DFR is an orally administered and well-tolerated medication in clinical use, it has promise for prophylaxis against stroke in patients at high risk of stroke. PMID:21245873

  12. Cardioembolic but Not Other Stroke Subtypes Predict Mortality Independent of Stroke Severity at Presentation

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    Latha Ganti Stead

    2011-01-01

    Results. The study population consisted of 500 patients who resided in the local county or the surrounding nine-county area. No patients were lost to followup. Two hundred and sixty one (52.2% were male, and the mean age at presentation was 73.7 years (standard deviation, SD = 14.3. Subtypes were as follows: large artery atherosclerosis 97 (19.4%, cardioembolic 144 (28.8%, small vessel disease 75 (15%, other causes 19 (3.8%, and unknown 165 (33%. One hundred and sixty patients died: 69 within the first 30 days, 27 within 31–90 days, 29 within 91–365 days, and 35 after 1 year. Low 90-, 180-, and 360-day survival was seen in cardioembolic strokes (67.1%, 65.5%, and 58.2%, resp., followed for cryptogenic strokes (78.0%, 75.3%, and 71.1%. Interestingly, when looking into the cryptogenic category, those with insufficient information to assign a stroke subtype had the lowest survival estimate (57.7% at 90 days, 56.1% at 180 days, and 51.2% at 1 year. Conclusion. Cardioembolic ischemic stroke subtype determined by TOAST criteria predicts long-term mortality, even after adjusting for age and stroke severity.

  13. Embolic strokes of undetermined source in young adults: baseline characteristics and long-term outcome.

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    Martinez-Majander, N; Aarnio, K; Pirinen, J; Lumikari, T; Nieminen, T; Lehto, M; Sinisalo, J; Kaste, M; Tatlisumak, T; Putaala, J

    2018-03-01

    Embolic strokes of undetermined source (ESUS) are a recent entity, not yet thoroughly investigated in young stroke patients. The clinical characteristics and long-term risks of vascular events and all-cause mortality between young-onset ESUS and other aetiological subgroups were compared. Patients with ESUS were identified amongst the 1008 patients aged 15-49 years with first-ever ischaemic stroke in Helsinki Young Stroke Registry, and primary end-points were defined as recurrent stroke, composite vascular events and all-cause mortality. Cumulative 15-year risks for each end-point were analysed with life tables and adjusted risks were based on Cox proportional hazard analyses. Of the 971 eligible patients, 203 (20.9%) were classified as ESUS. They were younger (median age 40 years, interquartile range 32-46 vs. 45 years, 39-47), more often female (43.3% vs. 35.7%) and had fewer cardiovascular risk factors than other modified TOAST groups. With a median follow-up time of 10.1 years, ESUS patients had the second lowest cumulative risk of recurrent stroke and composite vascular events and lowest mortality compared to other TOAST groups. Large-artery atherosclerosis and small vessel disease carried significantly higher risk for recurrent stroke than did ESUS, whilst no difference appeared between cardioembolism from high-risk sources and ESUS. In our cohort, ESUS patients were younger and had milder cardiovascular risk factor burden and generally better long-term outcome compared to other causes of young-onset stroke. The comparable risk of recurrent stroke between ESUS and high-risk sources of cardioembolism might suggest similarities in their pathophysiology. © 2017 EAN.

  14. VALOR BIOLÓGICO DO GRÃO DE AMARANTO EXTRUSADO, CRU E TORRADO PROTEIN BIOLOGICAL VALUE OF EXTRUDED, RAW AND TOASTED AMARANTH GRAIN

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    Tânia Aparecida Pinto de Castro Ferreira

    2007-09-01

    dicotyledonous class and Amaranthacea family. An increase in the production and consumption of amaranth, particularly in tropical regions of the World, should be considered due to its excellent nutritional value. It has the additional advantage that it can be planted as an intermediate crop between successive soybean crops. Extrusion is considered one of the best methods to maximize the nutritive value of amaranth. The objective of this study was to evaluate the protein quality of raw, toasted and extruded amaranth. Defatted amaranth flour was extruded at 150ºC and at four different moisture levels (11%, 13%, 15% and 24%. The samples were extruded through a screw of 3.55:1 compression ratio, 20:1 L/D ratio at the speed of 200 rpm in a laboratory extrusion machine. Individually housed, male Wistar rats 21 to 23 days old maintained under controlled conditions of light and temperature, were used for the protein bioassays. The protein bioassay experiments used a total of eighty rats and were done according to published AOAC methods (1995. The extruded amaranth diet at 24% moisture reached higher corrected protein efficiency ratio (corrected-PER than all the other treatments. Each of the extruded amaranth diet reached greater net protein ratio (NPR values than casein control and raw and toasted amaranth diets. On the other hand, the true digestibility (TD was similar to the raw and all processed grains, extruded and toasted diet, and lesser than casein control diet. The differences between extruded and raw amaranth samples were probably due to destruction of toxic factors present in the raw grain, in combination with increasing palatability, improvement of the carbohydrate use and it was not due to the increasing protein digestibility. The results indicate that extruded amaranth contains very high quality protein.

    KEY-WORDS: Extrusion; toasting; amaranth; nutritional value.

  15. Uric Acid Therapy Prevents Early Ischemic Stroke Progression: A Tertiary Analysis of the URICO-ICTUS Trial (Efficacy Study of Combined Treatment With Uric Acid and r-tPA in Acute Ischemic Stroke).

    Science.gov (United States)

    Amaro, Sergio; Laredo, Carlos; Renú, Arturo; Llull, Laura; Rudilosso, Salvatore; Obach, Víctor; Urra, Xabier; Planas, Anna M; Chamorro, Ángel

    2016-11-01

    Identification of neuroprotective therapies in acute ischemic stroke is imperative. We report a predefined analysis of the URICO-ICTUS trial (Efficacy Study of Combined Treatment With Uric Acid and r-tPA in Acute Ischemic Stroke) assessing the efficacy of uric acid (UA) compared with placebo to prevent early ischemic worsening (EIW) and the relevance of collateral circulation. URICO-ICTUS was a double-blind, placebo-controlled, phase 2b trial where a total of 411 patients treated with alteplase within 4.5 hours of stroke onset were randomized (1:1) to receive UA 1000 mg (n=211) or placebo (n=200) before the end of alteplase infusion. EIW defined an increment ≥4 points in the National Institutes of Health Stroke Scale score within 72 hours of treatment in the absence of hemorrhage or recurrent stroke. Logistic regression models assessed the interaction between therapy and the collateral circulation in 112 patients who had a pretreatment computed tomographic angiography. EIW occurred in 2 of 149 (1%) patients with good outcome and 23 of 262 (9%) patients with poor outcome (χ 2 ; P=0.002). EIW occurred in 7 of 204 (3%) patients treated with UA and in 18 of 200 (9%) patients treated with placebo (χ 2 ; P=0.01). There was a significant interaction between the efficacy of UA to prevent EIW and collaterals (P=0.029), with lower incidence in patients with good collaterals treated with UA compared with placebo (2% versus 15%, respectively; P=0.048). UA therapy may prevent EIW after acute stroke in thrombolysed patients. Optimal access of UA to its molecular targets through appropriate collaterals may modify the magnitude of the neuroprotective effect. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00860366. © 2016 American Heart Association, Inc.

  16. A Health Economic Evaluation of Stroke Prevention in Atrial Fibrillation: Guideline Adherence Versus the Observed Treatment Strategy Prior to 2012 in Denmark.

    Science.gov (United States)

    Vestergaard, Anne Sig; Ehlers, Lars Holger

    2015-09-01

    In 2012 the European Society of Cardiology (ESC) published new guidelines on pharmacological stroke prophylaxis in non-valvular atrial fibrillation (AF). The health economics of adhering to these guidelines in clinical practice remains to be elucidated. This paper offers a health economic evaluation of two stroke-prophylactic treatment strategies: complete national adherence to the ESC guidelines on stroke prophylaxis in AF versus stroke-prophylactic treatment prior to 2012 in Denmark. A cost-utility analysis was performed to compare two treatment strategies. The first strategy reflected national guideline adherence with the use of non-vitamin K antagonist oral anticoagulants (i.e. dabigatran etexilate), warfarin, and no treatment. The second strategy reflected observed stroke prophylaxis prior to 2012 with the utilization of warfarin, acetylsalicylic acid, and no treatment. A Danish health sector perspective was adopted. A Markov model was designed and populated with information on input parameters from the literature and local cost data reflecting 2014 values. A modeled patient cohort was constructed with a risk profile intended to reflect that of the Danish patient population with AF. The applied outcome was quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio amounted to 3557 per QALY for the guideline-adherent treatment strategy (GTS) compared with the pre-2012 treatment strategy. This ratio is below a threshold of 25,000 (£20,000) per QALY. Sensitivity analyses revealed that the result was largely robust to changes in input parameters. All analyses found the GTS to be cost effective. Guideline adherence is a cost-effective treatment strategy compared with the strategy employed prior to 2012 for pharmacological stroke prophylaxis in AF.

  17. Intravenous Thrombolysis plus Hypothermia for Acute Treatment of Ischemic Stroke (ICTuS-L) – Final results

    Science.gov (United States)

    Hemmen, Thomas M; Raman, Rema; Guluma, Kama Z; Meyer, Brett C; Gomes, Joao A; Cruz-Flores, Salvador; Wijman, Christine A; Rapp, Karen S; Grotta, James C; Lyden, Patrick D

    2010-01-01

    Background Induced hypothermia is a promising neuroprotective therapy. We studied the feasibility and safety of hypothermia and thrombolysis after acute ischemic stroke. Methods ICTuS-L was a randomized, multi-center trial of hypothermia and intravenous t-PA in patients treated within 6 hours after ischemic stroke. Enrollment was stratified to the treatment time windows 0–3 and 3–6 hours. Patients presenting within 3 hours of symptom onset received standard dose intravenous alteplase (IV tPA) and were randomized to undergo 24 hours of endovascular cooling to 33°C followed by 12 hours of controlled re-warming or normothermia treatment. Patients presenting between 3 and 6 hours were randomized twice: to receive t-PA or not and to receive hypothermia or not. Results In total, 59 patients were enrolled. One patient was enrolled but not treated when pneumonia was discovered just prior to treatment. All 44 patients enrolled within 3 hours and 4 of 14 patients enrolled between 3–6 hours received t-PA. Overall, 28 patients randomized to receive hypothermia (HY) and 30 to normothermia (NT). Baseline demographics and risk factors were similar between groups. Mean age was 65.5±12.1 years and baseline NIHSS was 14.0±5.0; 32 (55%) were male. Cooling was achieved in all patients except 2 in whom there were technical difficulties. The median time to target temperature after catheter placement was 67min (Q1 57.3 –Q3 99.4). At 3 months, 18% of patients treated with HY had a modified Rankin Scale (mRS) of 0 or 1, versus 24% in the NT groups (NS). Symptomatic intracranial hemorrhage occurred in 4 patients (68), all were treated with tPA less than 3 hours (1 received HY). Six patients in the HY and 5 in the NT groups died within 90 days (NS). Pneumonia occurred in 14 patients in the HY and in 3 of the NT groups (p=0.001). The pneumonia rate did not significantly adversely affect 3 month mRS (p=0.32). Conclusion This study demonstrates the feasibility and preliminary safety

  18. Constraint-Induced Aphasia Therapy for Treatment of Chronic Post-Stroke Aphasia: A Randomized, Blinded, Controlled Pilot Trial.

    Science.gov (United States)

    Szaflarski, Jerzy P; Ball, Angel L; Vannest, Jennifer; Dietz, Aimee R; Allendorfer, Jane B; Martin, Amber N; Hart, Kimberly; Lindsell, Christopher J

    2015-09-24

    To provide a preliminary estimate of efficacy of constraint-induced aphasia therapy (CIAT) when compared to no-intervention in patients with chronic (>1 year) post-stroke aphasia in order to plan an appropriately powered randomized controlled trial (RCT). We conducted a pilot single-blinded RCT. 24 patients were randomized: 14 to CIAT and 10 to no-intervention. CIAT groups received up to 4 hours/day of intervention for 10 consecutive business days (40 hours or therapy). Outcomes were assessed within 1 week of intervention and at 1 and 12 weeks after intervention and included several linguistic measures and a measure of overall subjective communication abilities (mini-Communicative Abilities Log (mini-CAL)). Clinicians treating patients (CIAT group) did not communicate with other team members to maintain blinding and the testing team members were blinded to treatment group assignment. Overall, the results of this pilot RCT support the results of previous observational studies that CIAT may lead to improvements in linguistic abilities. At 12 weeks, the treatment group reported better subjective communication abilities (mini-CAL) than the no-intervention group (p=0.019). Other measures trended towards better performance in the CIAT group. In this pilot RCT intensive language therapy led to an improvement in subjective language abilities. The effects demonstrated allow the design of a definitive trial of CIAT in patients with a variety of post-stroke aphasia types. In addition, our experiences have identified important considerations for designing subsequent trial(s) of CIAT or other interventions for post-stroke aphasia.

  19. Intracranial angioplasty and stenting for cerebral atherosclerosis: new treatments for stroke are needed

    International Nuclear Information System (INIS)

    Higashida, Randall T.; Meyers, Philip M.

    2006-01-01

    Intracranial atherosclerosis is a common cause of stroke. Recent technological developments offer improved methods for endovascular revascularization of symptomatic and asymptomatic cerebral artery stenosis. Identification of appropriate patients remains a diagnostic challenge, and our knowledge about the natural history of the disease remains limited. At this time, patients with significant intracranial stenosis should receive counseling on the benefits and risks of revascularization therapy. Ultimately, determination of which patients should undergo revascularization procedures will require carefully planned, randomized clinical trials. (orig.)

  20. The cerebral collateral circulation: Relevance to pathophysiology and treatment of stroke.

    Science.gov (United States)

    Ginsberg, Myron D

    2017-08-09

    The brain's collateral circulation consists of arterial anastomotic channels capable of providing nutrient perfusion to brain regions whose normal sources of flow have become compromised, as occurs in acute ischemic stroke. Modern CT-based neuroimaging is capable of providing detailed information as to collateral extent and sufficiency and is complemented by magnetic resonance-based methods. In the present era of standard-of-care IV thrombolysis for acute ischemic stroke, and following the recent therapeutic successes of randomized clinical trials of acute endovascular intervention, the sufficiency of the collateral circulation has been convincingly established as a key factor influencing the likelihood of successful reperfusion and favorable clinical outcome. This article reviews the features of the brain's collateral circulation; methods for its evaluation in the acute clinical setting; the relevance of collateral circulation to prognosis in acute ischemic stroke; the specific insights into the collateral circulation learned from recent trials of endovascular intervention; and the major influence of genetic factors. Finally, we emphasize the need to develop therapeutic approaches to augment collateral perfusion as an adjunctive strategy to be employed along with, or prior to, thrombolysis and endovascular interventions, and we highlight the possible potential of inhaled nitric oxide, albumin, and other approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. 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 ...

  2. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial).

    Science.gov (United States)

    Dávalos, Antoni; Alvarez-Sabín, José; Castillo, José; Díez-Tejedor, Exuperio; Ferro, Jose; Martínez-Vila, Eduardo; Serena, Joaquín; Segura, Tomás; Cruz, Vitor T; Masjuan, Jaime; Cobo, Erik; Secades, Julio J

    2012-07-28

    Citicoline is approved in some countries for the treatment of acute ischaemic stroke. The drug has shown some evidence of efficacy in a pooled analysis. We sought to confirm the efficacy of citicoline in a larger trial. We undertook a randomised, placebo-controlled, sequential trial in patients with moderate-to-severe acute ischaemic stroke admitted at university hospitals in Germany, Portugal, and Spain. Using a centralised minimisation process, patients were randomly assigned in a 1:1 ratio to receive citicoline or placebo within 24 h after the onset of symptoms (1000 mg every 12 h intravenously during the first 3 days and orally thereafter for a total of 6 weeks [2×500 mg oral tablets given every 12 h]). All study participants were masked. The primary outcome was recovery at 90 days measured by a global test combining three measures of success: National Institutes of Health Stroke Scale ≤1, modified Rankin score ≤1, and Barthel Index ≥95. Safety endpoints included symptomatic intracranial haemorrhage in patients treated with recombinant tissue plasminogen activator, neurological deterioration, and mortality. This trial is registered, NCT00331890. 2298 patients were enrolled into the study from Nov 26, 2006, to Oct 27, 2011. 37 centres in Spain, 11 in Portugal, and 11 in Germany recruited patients. Of the 2298 patients who gave informed consent and underwent randomisation, 1148 were assigned to citicoline and 1150 to placebo. The trial was stopped for futility at the third interim analysis on the basis of complete data from 2078 patients. The final randomised analysis was based on data for 2298 patients: 1148 in citicoline group and 1150 in placebo group. Global recovery was similar in both groups (odds ratio 1·03, 95% CI 0·86-1·25; p=0·364). No significant differences were reported in the safety variables nor in the rate of adverse events. Under the circumstances of the ICTUS trial, citicoline is not efficacious in the treatment of moderate

  3. Multicenter Study of Adverse Events After Intravenous Tissue-Type Plasminogen Activator Treatment of Acute Ischemic Stroke.

    Science.gov (United States)

    Fernandez-Gotico, Hannah; Lightfoot, Tiffany; Meighan, Melissa

    2017-02-01

    The approved treatment by the Food and Drug Administration for acute ischemic stroke is intravenous tissue-type plasminogen activator (IV tPA). After IV tPA administration, patients are monitored for adverse events using an American Heart Association/American Stroke Association guideline instituted in 1996. There is limited evidence describing the safest and most efficient method to monitor patients during the first 24 hours after tPA administration. Although the overall rates of adverse events have been reported, the time when patients may be at most risk for an event has not been studied. The purpose of this study was to identify the time of adverse event occurrences in the first 24 hours after IV tPA administration. This was a descriptive, retrospective chart review study of patients admitted to an integrated health system and treated with IV tPA for acute stroke between July 2010 and July 2012. Charts were reviewed for adverse events using the Institute for Healthcare Improvement's Global Trigger Tool for Measuring Adverse Events. Possible chart indicators of adverse events or "triggers" included neurological decline, vital signs elevated above specified parameters, and emergent imaging. Adverse events included episodes of neurological decline, angioedema, allergic reactions, bleeding, and intracerebral hemorrhage (ICH). The timing of each detected event was determined, and descriptive statistics were used for data analysis. Fourteen adverse events (2.8%) were detected in a population of 498 patients. Reactions consisted of allergic reaction (n = 1), angioedema (n = 1), neurological decline without ICH (n = 1), gastrointestinal bleeding (n = 1), bleeding gums (n = 1), and high-risk ICH (n = 9). Thirteen of the 14 adverse events (92.9%) occurred within the first 12 hours after IV tPA administration. Close monitoring during the first 12 hours after IV tPA treatment may be essential. However, close monitoring after 12 hours may not contribute significantly to

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Caplan Louis

    2005-06-01

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

  6. Association of ischaemic stroke subtype with long-term cardiovascular events.

    Science.gov (United States)

    Ntaios, G; Papavasileiou, V; Makaritsis, K; Milionis, H; Michel, P; Vemmos, K

    2014-08-01

    There is no strong evidence that all ischaemic stroke types are associated with high cardiovascular risk. Our aim was to investigate whether all ischaemic stroke types are associated with high cardiovascular risk. All consecutive patients with ischaemic stroke registered in the Athens Stroke Registry between 1 January 1993 and 31 December 2010 were categorized according to the TOAST classification and were followed up for up to 10 years. Outcomes assessed were cardiovascular and all-cause mortality, myocardial infarction, stroke recurrence, and a composite cardiovascular outcome consisting of myocardial infarction, angina pectoris, acute heart failure, sudden cardiac death, stroke recurrence and aortic aneurysm rupture. The Kaplan-Meier product limit method was used to estimate the probability of each end-point in each patient group. Cox proportional hazards models were used to determine the independent covariates of each end-point. Two thousand seven hundred and thirty patients were followed up for 48.1 ± 41.9 months. The cumulative probabilities of 10-year cardiovascular mortality in patients with cardioembolic stroke [46.6%, 95% confidence interval (CI) 40.6-52.8], lacunar stroke (22.1%, 95% CI 16.2-28.0) or undetermined stroke (35.2%, 95% CI 27.8-42.6) were either similar to or higher than those of patients with large-artery atherosclerotic stroke (LAA) (28.7%, 95% CI 22.4-35.0). Compared with LAA, all other TOAST types had a higher probability of 10-year stroke recurrence. In Cox proportional hazards analysis, compared with patients with LAA, patients with any other stroke type were associated with similar or higher risk for the outcomes of overall mortality, cardiovascular mortality, stroke recurrence and composite cardiovascular outcome. Large-artery atherosclerotic stroke and cardioembolic stroke are associated with the highest risk for future cardiovascular events, with the latter carrying at least as high a risk as LAA stroke. © 2014 The Author

  7. Supporting Treatment decision making to Optimise the Prevention of STROKE in Atrial Fibrillation: The STOP STROKE in AF study. Protocol for a cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Gattellari Melina

    2012-07-01

    Full Text Available Abstract Background Suboptimal uptake of anticoagulation for stroke prevention in atrial fibrillation has persisted for over 20 years, despite high-level evidence demonstrating its effectiveness in reducing the risk of fatal and disabling stroke. Methods The STOP STROKE in AF study is a national, cluster randomised controlled trial designed to improve the uptake of anticoagulation in primary care. General practitioners from around Australia enrolling in this ‘distance education’ program are mailed written educational materials, followed by an academic detailing session delivered via telephone by a medical peer, during which participants discuss patient de-identified cases. General practitioners are then randomised to receive written specialist feedback about the patient de-identified cases either before or after completing a three-month posttest audit. Specialist feedback is designed to provide participants with support and confidence to prescribe anticoagulation. The primary outcome is the proportion of patients with atrial fibrillation receiving oral anticoagulation at the time of the posttest audit. Discussion The STOP STROKE in AF study aims to evaluate a feasible intervention via distance education to prevent avoidable stroke due to atrial fibrillation. It provides a systematic test of augmenting academic detailing with expert feedback about patient management. Trial registration Australian Clinical Trials Registry Registration Number: ACTRN12611000076976.

  8. Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data

    Directory of Open Access Journals (Sweden)

    Egen-Lappe V

    2013-03-01

    Full Text Available Veronika Egen-Lappe, Ingrid Köster, Ingrid SchubertPMV Research Group, Department of Child and Adolescence Psychiatry and Psychotherapy, University of Cologne, Cologne, GermanyBackground: Spasticity after stroke has been internationally recognized as an important health problem causing impairment of mobility, deformity, and pain. The aim of this study was to assess the frequency of first-ever and recurrent stroke and of subsequent spastic and flaccid paresis. Factors influencing the development of spasticity were analyzed. A further major aim was to provide a "real-life" assessment of the treatment of spasticity in Germany and to discuss this in view of the treatment recommended by German and international clinical guidelines.Methods: The database used in this study comprised a cohort of 242,090 insurants from a large statutory health insurance fund in the federal state of Hesse, Germany. A first hospital discharge diagnosis in 2009 with any of the International Classification of Diseases, Tenth Revision (ICD-10 codes I60–I64 was used to identify patients with acute stroke (hemorrhage and ischemic. These patients were followed up six months after stroke to monitor whether they developed spastic or flaccid paresis (hospital or ambulatory care diagnoses ICD-10 code G81–G83 [excluding G82.6/G83.4/G83.8]. For patients with spastic paresis after stroke the spasticity treatment was analyzed for a six-month period (physiotherapy, oral muscle relaxants, intrathecal baclofen, and botulinum toxin.Results: Standardized to the population of Germany, 3.7 per 1000 persons suffered a stroke in 2009 (raw 5.2/1000. Of all surviving patients, 10.2% developed spasticity within 6 months. Cox regression revealed no significant influence of patient age, gender, morbidity (diabetes, hypertensive diseases, ischemic heart diseases or type of stroke on development of spasticity. 97% of surviving patients with spasticity received physiotherapy (inpatient care 89

  9. Influence of the botanical origin and toasting level on the ellagitannin content of wines aged in new and used oak barrels.

    Science.gov (United States)

    Navarro, María; Kontoudakis, Nikolaos; Gómez-Alonso, Sergio; García-Romero, Esteban; Canals, Joan Miquel; Hermosín-Gutíerrez, Isidro; Zamora, Fernando

    2016-09-01

    The influence of the botanical origin (French oak: Quercus petraea and American oak: Quercus alba) and different toasting levels (light, medium and heavy) on the ellagitannin content of wines aged in oak barrels has been studied. This took place in two consecutive vintages in order to study what happens after the barrels have been already used for one year with another wine. This study was carried out with two red wines (Cabernet Sauvignon) and with two decolored white wines (Macabeo) from vintages 2012 and 2013 in order to work with a simpler matrix which facilitates chemical analysis. The results show that the botanical origin, toasting level and the number of times that the barrels have been used exert a major influence on the final ellagitannin concentration. In general, the behavior of all the individual ellagitannins was very similar to that described for the total ellagitannins. Briefly, the levels of total ellagitannins concentration in the decolored white wine aged for 12months in new French barrels ranged between 31.2mg/L in the lightly toasted and 4.7mg/L in the heavy toasted. In contrast, these levels were quite lower in American new barrels ranging between 3.6mg/L and 0.9mg/L. Finally, the total ellagitannin concentration decreased an average of 63% in the wines aged in the one year used barrels. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Assessment of stroke and concomitant cerebrovascular disease with heart disease requires invasive treatment: analysis of 249 consecutive patients with heart disease.

    Science.gov (United States)

    Kim, Myeong Jin; Song, Hyun; Oh, Se-Yang; Choi, Jai Ho; Kim, Bum-Soo; Kang, Joonkyu; Shin, Yong Sam

    2014-06-01

    The aim of this study was to analyze the relationships of cerebrovascular disease (CVD), heart problems, and stroke in patients who required an invasive cardiac procedure. We enrolled 249 consecutive patients who required to or underwent invasive cardiac treatment and divided into a non-CVD group (n = 116) and a CVD group (n = 133). The latter group was divided into a coronary artery disease (CAD) group (n = 118) and a non-CAD group such as cardiac structural lesions (n = 15). No significant relationship with significant cerebrovascular stenosis was observed in either the CADs or non-CADs. The incidence of past stroke was significantly higher in the CVD group than that in the non-CVD group (12.8 vs. 3.4%; p = 0.017). Previous stroke event had increased odds of having significant cerebrovascular stenosis (odds ratio, 3.919, p = 0.006). In patients with both cardiac disease and the CVD, perioperative stroke was only one case (0.9%). The main source of stroke was cardiogenic in the immediate results and cerebrovascular lesions in the delayed results (1-12 months). The risk of perioperative stroke was very low in combined cardiac disease and the CVD. However, for preventing ischemic stroke due to the predetected cerebrovascular lesions, precautionary efforts could be needed for patients undergoing an invasive cardiac procedure, and concomitant cerebrovascular lesions should be considered as main source of delayed ischemic stroke. Georg Thieme Verlag KG Stuttgart · New York.

  11. Anti-inflammatory treatment and risk for depression after first-time stroke in a cohort of 147 487 Danish patients

    DEFF Research Database (Denmark)

    Wium-Andersen, Ida Kim; Wium-Andersen, Marie Kim; Jørgensen, Martin Balslev

    2017-01-01

    BACKGROUND: Depression is a common complication after stroke, and inflammation may be a pathophysiological mechanism. This study examines whether anti-inflammatory treatment with acetylsalicylic acid (ASA), nonsteroid anti-inflammatory drugs (NSAIDs) or statins influence the risk of depression...... with a tendency toward a decreased risk. LIMITATIONS: The study used prescription of antidepressant medication as a proxy measure for depression and did not include anti-inflammatory drugs bought over the counter. CONCLUSION: Anti-inflammatory treatment is associated with a lower risk for depression shortly after...... after stroke. METHODS: A register-based cohort including all patients admitted to hospital with a first-time stroke from Jan. 1, 2001, through Dec. 31, 2011, and a nonstroke population with a similar age and sex distribution was followed for depression until Dec. 31, 2014. Depression was defined...

  12. Can multivariable risk-benefit profiling be used to select treatment-favorable patients for thrombolysis in stroke in the 3- to 6-hour time window?

    Science.gov (United States)

    Kent, David M; Selker, Harry P; Ruthazer, Robin; Bluhmki, Erich; Hacke, Werner

    2006-12-01

    The Stroke-Thrombolytic Predictive Instrument (Stroke-TPI) uses multivariate equations to predict outcomes with and without thrombolysis. We sought to examine whether such a multivariate predictive instrument might be useful in selecting patients with a favorable risk-benefit treatment profile for therapy after 3 hours. We explored outcomes in patients from 5 major randomized clinical trials testing intravenous recombinant tissue plasminogen activator (rt-PA) classified by the Stroke-TPI as "treatment-favorable" or "treatment-unfavorable." We used iterative bootstrap re-sampling to estimate how such a model would perform on independent test data. Among patients treated within the 3- to 6-hour window, 67% of patients were classified by Stroke-TPI predicted outcomes as "treatment-favorable" and 33% were classified as "treatment-unfavorable." Outcomes in the treatment-favorable group demonstrated benefit for thrombolysis (modified Rankin Scale score < or =1: 44.0% with rt-PA versus 34.2 with placebo, P=0.005), whereas harm was demonstrated in the treatment-unfavorable group (modified Rankin Scale score < or =1: 31.3% with rt-PA versus 38.3% with placebo; P=0.004). Bootstrap resampling with complete cross-validation showed that the absolute margin of benefit in the treatment-favorable group diminished on average by 36% between derivation and independent validation sets, but still represented a significant tripling of improvement in benefit compared with conventional inclusion criteria (5.2% [interquartile range, 1.7% to 8.6%] versus 1.8% [interquartile range, -0.5 to 4.1], P<0.0001). Such multivariable risk-benefit profiling may be useful in the selection of acute stroke patients for rt-PA therapy even more than 3 hours after symptom onset. Prospective testing is indicated.

  13. A treatment schedule of conventional physical therapy provided to enhance upper limb sensorimotor recovery after stroke: expert criterion validity and intra-rater reliability.

    Science.gov (United States)

    Donaldson, Catherine; Tallis, Raymond C; Pomeroy, Valerie M

    2009-06-01

    Inadequate description of treatment hampers progress in stroke rehabilitation. To develop a valid, reliable, standardised treatment schedule of conventional physical therapy provided for the paretic upper limb after stroke. Eleven neurophysiotherapists participated in the established methodology: semi-structured interviews, focus groups and piloting a draft treatment schedule in clinical practice. Different physiotherapists (n=13) used the treatment schedule to record treatment given to stroke patients with mild, moderate and severe upper limb paresis. Rating of adequacy of the treatment schedule was made using a visual analogue scale (0 to 100mm). Mean (95% confidence interval) visual analogue scores were calculated (expert criterion validity). For intra-rater reliability, each physiotherapist observed a video tape of their treatment and immediately completed a treatment schedule recording form on two separate occasions, 4 to 6 weeks apart. The Kappa statistic was calculated for intra-rater reliability. The treatment schedule consists of a one-page A4 recording form and a user booklet, detailing 50 treatment activities. Expert criterion validity was 79 (95% confidence interval 74 to 84). Intra-rater Kappa was 0.81 (Pwork is needed to investigate generalisability beyond this geographical area.

  14. Safety and Efficacy of the Sofia (6F) PLUS Distal Access Reperfusion Catheter in the Endovascular Treatment of Acute Ischemic Stroke.

    Science.gov (United States)

    Shallwani, Hussain; Shakir, Hakeem J; Rangel-Castilla, Leonardo; Davies, Jason M; Sonig, Ashish; Sattur, Mithun G; Bendok, Bernard R; Snyder, Kenneth V; Siddiqui, Adnan H; Levy, Elad I

    2018-03-01

    Neuroendovascular intervention has become a key treatment option for acute ischemic stroke. The Sofia (6F) PLUS catheter was designed for neurovascular access for diagnostic or therapeutic interventions. To report the first series describing use of the Sofia PLUS intermediate/distal access reperfusion catheter in the treatment of acute ischemic stroke. In this retrospective study, 41 stroke cases were identified in which the catheter was utilized for thrombolysis/thrombectomy. Mean preprocedure National Institutes of Health Stroke Scale score was 16.5 ± 5.2 (range 4-29). Occluded vessels included the M1 segment, M2 segment, internal carotid artery terminus, cervical internal carotid artery, and basilar artery. Successful positioning of the Sofia PLUS catheter near the occlusion site was achieved in 38 (92.7%) of 41 cases in which thrombectomy or thrombolysis was attempted using intraarterial tissue plasminogen activator, a direct aspiration first-pass technique, and/or stent retrieval. A postprocedure thrombolysis in cerebral infarction (TICI) score of 2b/3 was achieved in 37 of 41 cases. Of 15 cases where the Sofia PLUS was used for a direct aspiration first-pass technique, TICI 2b/3 was achieved in 11 (73.3%). In one case where intra-arterial tissue plasminogen activator was used as the only treatment modality, TICI 2a was achieved. No device-related or catheter-related complications were observed. The mean 7-d-postprocedure National Institutes of Health Stroke Scale score among the 39 survivors was 8.5 ± 7.3 (range 0-23). Initial results with use of the Sofia (6F) PLUS for endovascular treatment of acute ischemic stroke have been encouraging. Experience with a larger series is warranted to further evaluate the safety and efficacy of this device and compare it with other reperfusion catheters. Copyright © 2017 by the Congress of Neurological Surgeons

  15. 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.

  16. Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation-a cohort study in primary care.

    Science.gov (United States)

    Wändell, Per; Carlsson, Axel C; Holzmann, Martin; Ärnlöv, Johan; Johansson, Sven-Erik; Sundquist, Jan; Sundquist, Kristina

    2017-02-01

    The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care. Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid cardiovascular conditions. During a mean of 5.8 years (SD 2.4) of follow-up, 162 patients (1.3 %; 67 women and 95 men) with HS were recorded. The adjusted risk associated with persistent warfarin treatment compared to no antithrombotic treatment consistently showed no increased HS risk, HR for women 0.53 (95 % CI 0.23-1.27) and for men 0.55 (95 % CI 0.29-1.04); corresponding HRs for ASA were, for women, 0.45 (95 % CI 0.14-1.44) and, for men, 0.56 (95 % CI 0.24-1.29). In this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.

  17. Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study.

    Science.gov (United States)

    Nacu, A; Fromm, A; Sand, K M; Waje-Andreassen, U; Thomassen, L; Naess, H

    2016-03-01

    Age dependency of acute ischaemic stroke aetiology and vascular risk factors have not been adequately evaluated in stroke patients in Norway. Aims of this study were to evaluate how stroke subtypes and vascular risk factors vary with age in a western Norway stroke population. Patients aged 15-100 years consecutively admitted to our neurovascular centre with acute ischaemic stroke between 2006 and 2012 were included. The study population was categorized as young (15-49 years), middle-aged (50-74 years) or elderly (≥ 75 years). Stroke aetiology was defined by TOAST criteria. Risk factors and history of cardiovascular disease were recorded. In total, 2484 patients with acute cerebral infarction were included: 1418 were males (57.3%). Mean age was 70.8 years (SD ± 14.9), 228 patients were young, 1126 middle-aged, and 1130 were elderly. The proportion of large-artery atherosclerosis and of small-vessel occlusion was highest among middle-aged patients. The proportion of cardioembolism was high at all ages, especially among the elderly. The proportion of stroke of other determined cause was highest among young patients. Some risk factors (diabetes mellitus, active smoking, angina pectoris, prior stroke and peripheral artery disease) decreased among the elderly. The proportions of several potential causes increased with age. The proportion of stroke subtypes and vascular risk factors are age dependent. Age 50-74 years constitutes the period in life where cardiovascular risk factors become manifest and stroke subtypes change. © 2015 The Authors. Acta Neurologica Scandinavica Published by John Wiley & Sons Ltd.

  18. Intravenous Treatment with a Long-Chain Omega-3 Lipid Emulsion Provides Neuroprotection in a Murine Model of Ischemic Stroke - A Pilot Study.

    Directory of Open Access Journals (Sweden)

    Dirk Berressem

    Full Text Available Single long-chain omega-3 fatty acids (e.g. docosahexaenoic acid (DHA or eicosapentaenoic acid (EPA are known for their neuroprotective properties associated with ischemic stroke. This pilot study aimed to test the effectiveness of an acute treatment with a long-chain omega-3 lipid emulsion (Omegaven 10%®, OGV that contains fish oil (DHA 18 mg/ml; EPA 21 mg/ml and α-tocopherol (0.2 mg/ml in a transient middle cerebral artery occlusion (MCAO model of ischemic stroke in mice. For this purpose, female CD-1 mice were anesthetized and subjected to 90 minutes of MCAO. To reflect a clinically relevant situation for an acute treatment, either after induction of stroke or after reperfusion, a single dose of OGV was injected intravenously into the tail vein (5 ml/kg b.w.. A neurological severity score was used to assess motor function and neurological outcome. Stroke-related parameters were determined 24 hours after MCAO. Microdialysis was used to collect samples from extracellular space of the striatum. Mitochondrial function was determined in isolated mitochondria or dissociated brain cells. Inflammation markers were measured in brain homogenate. According to control experiments, neuroprotective effects could be attributed to the long-chain omega-3 content of the emulsion. Intravenous injection of OGV reduced size and severity of stroke, restored mitochondrial function, and prevented excitotoxic glutamate release. Increases of pro-inflammatory markers (COX-2 and IL-6 were attenuated. Neurological severity scoring and neurochemical data demonstrated that acute OGV treatment shortly after induction of stroke was most efficient and able to improve short-term neurological outcome, reflecting the importance of an acute treatment to improve the outcome. Summarising, acute treatment of stroke with a single intravenous dose of OGV provided strong neuroprotective effects and was most effective when given immediately after onset of ischemia. As OGV is an

  19. The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests.

    Science.gov (United States)

    Chalmers, Peter N; Cvetanovich, Gregory L; Kupfer, Noam; Wimmer, Markus A; Verma, Nikhil N; Cole, Brian J; Romeo, Anthony A; Nicholson, Gregory P

    2016-02-01

    While Jobe's test is widely used, it does not isolate supraspinatus activity. Our purpose was to examine the electromyographic (EMG) activity within the supraspinatus and deltoid with resisted abduction to determine the shoulder position that best isolates the activity of the supraspinatus. We performed EMG analysis of the supraspinatus, anterior head of the deltoid, and middle head of the deltoid in 10 normal volunteers. We measured EMG activity during resisted shoulder abduction in the scapular plane to both manual resistance and a standardized load in varying degrees of abduction and rotation. To determine which position best isolates supraspinatus activity, the ratio of supraspinatus to deltoid activity (S:D) was calculated for each position. Results were analyzed with a repeated-measures analysis of variance with Bonferroni correction. The posterior deltoid was excluded as it serves mostly to extend and externally rotate. Our study confirmed Jobe's findings of maximal supraspinatus activity at 90° of abduction. However, decreasing abduction significantly increased S:D for both resisted manual testing and testing against a standardized load (P = .002 and .001, respectively). The greatest S:D ratio (4.6 ± 3.4 for standardized load testing) was seen at the "champagne toast" position, i.e., 30° of abduction, mild external rotation, 30° of flexion, and 90° of elbow flexion. The smallest ratio (0.8 ± 0.6) was seen at Jobe's position. Testing of abduction strength in the champagne toast position, i.e., 30° of abduction, mild external rotation, and 30° of flexion, better isolates the activity of the supraspinatus from the deltoid than Jobe's "empty can" position. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

    Science.gov (United States)

    Emberson, Jonathan; Lees, Kennedy R; Lyden, Patrick; Blackwell, Lisa; Albers, Gregory; Bluhmki, Erich; Brott, Thomas; Cohen, Geoff; Davis, Stephen; Donnan, Geoffrey; Grotta, James; Howard, George; Kaste, Markku; Koga, Masatoshi; von Kummer, Ruediger; Lansberg, Maarten; Lindley, Richard I; Murray, Gordon; Olivot, Jean Marc; Parsons, Mark; Tilley, Barbara; Toni, Danilo; Toyoda, Kazunori; Wahlgren, Nils; Wardlaw, Joanna; Whiteley, William; del Zoppo, Gregory J; Baigent, Colin; Sandercock, Peter; Hacke, Werner

    2014-01-01

    Summary Background Alteplase is effective for treatment of acute ischaemic stroke but debate continues about its use after longer times since stroke onset, in older patients, and among patients who have had the least or most severe strokes. We assessed the role of these factors in affecting good stroke outcome in patients given alteplase. Methods We did a pre-specified meta-analysis of individual patient data from 6756 patients in nine randomised trials comparing alteplase with placebo or open control. We included all completed randomised phase 3 trials of intravenous alteplase for treatment of acute ischaemic stroke for which data were available. Retrospective checks confirmed that no eligible trials had been omitted. We defined a good stroke outcome as no significant disability at 3–6 months, defined by a modified Rankin Score of 0 or 1. Additional outcomes included symptomatic intracranial haemorrhage (defined by type 2 parenchymal haemorrhage within 7 days and, separately, by the SITS-MOST definition of parenchymal type 2 haemorrhage within 36 h), fatal intracranial haemorrhage within 7 days, and 90-day mortality. Findings Alteplase increased the odds of a good stroke outcome, with earlier treatment associated with bigger proportional benefit. Treatment within 3·0 h resulted in a good outcome for 259 (32·9%) of 787 patients who received alteplase versus 176 (23·1%) of 762 who received control (OR 1·75, 95% CI 1·35–2·27); delay of greater than 3·0 h, up to 4·5 h, resulted in good outcome for 485 (35·3%) of 1375 versus 432 (30·1%) of 1437 (OR 1·26, 95% CI 1·05–1·51); and delay of more than 4·5 h resulted in good outcome for 401 (32·6%) of 1229 versus 357 (30·6%) of 1166 (OR 1·15, 95% CI 0·95–1·40). Proportional treatment benefits were similar irrespective of age or stroke severity. Alteplase significantly increased the odds of symptomatic intracranial haemorrhage (type 2 parenchymal haemorrhage definition 231 [6·8%] of 3391 vs 44 [1·3

  1. Acute ischemic stroke update.

    Science.gov (United States)

    Baldwin, Kathleen; Orr, Sean; Briand, Mary; Piazza, Carolyn; Veydt, Annita; McCoy, Stacey

    2010-05-01

    Stroke is the third most common cause of death in the United States and is the number one cause of long-term disability. Legislative mandates, largely the result of the American Heart Association, American Stroke Association, and Brain Attack Coalition working cooperatively, have resulted in nationwide standardization of care for patients who experience a stroke. Transport to a skilled facility that can provide optimal care, including immediate treatment to halt or reverse the damage caused by stroke, must occur swiftly. Admission to a certified stroke center is recommended for improving outcomes. Most strokes are ischemic in nature. Acute ischemic stroke is a heterogeneous group of vascular diseases, which makes targeted treatment challenging. To provide a thorough review of the literature since the 2007 acute ischemic stroke guidelines were developed, we performed a search of the MEDLINE database (January 1, 2004-July 1, 2009) for relevant English-language studies. Results (through July 1, 2009) from clinical trials included in the Internet Stroke Center registry were also accessed. Results from several pivotal studies have contributed to our knowledge of stroke. Additional data support the efficacy and safety of intravenous alteplase, the standard of care for acute ischemic stroke since 1995. Due to these study results, the American Stroke Association changed its recommendation to extend the time window for administration of intravenous alteplase from within 3 hours to 4.5 hours of symptom onset; this recommendation enables many more patients to receive the drug. Other findings included clinically useful biomarkers, the role of inflammation and infection, an expanded role for placement of intracranial stents, a reduced role for urgent carotid endarterectomy, alternative treatments for large-vessel disease, identification of nontraditional risk factors, including risk factors for women, and newly published pediatric stroke guidelines. In addition, new devices for

  2. Evidence to Maintain the Systolic Blood Pressure Treatment Threshold at 140 mm Hg for Stroke Prevention: The Northern Manhattan Study.

    Science.gov (United States)

    Dong, Chuanhui; Della-Morte, David; Rundek, Tatjana; Wright, Clinton B; Elkind, Mitchell S V; Sacco, Ralph L

    2016-03-01

    In 2014, the Eighth Joint National Committee revised the target maximum systolic blood pressure (SBP) from 140 to 150 mm Hg in patients aged ≥60 years without diabetes mellitus or chronic kidney disease. The evidence from cohort studies supporting this change was sparse, particularly among US minority populations. In the Northern Manhattan Study, 1750 participants aged ≥60 years and free of stroke, diabetes mellitus, and chronic kidney disease had SBP measured at baseline and were annually followed up for incident stroke. Mean age at baseline was 72±8 years, 63% were women, 48% Hispanic, 25% non-Hispanic white, and 25% non-Hispanic black. Among all participants, 40% were on antihypertensive medications; 43% had SBP Hg, 20% had 140 to 149 mm Hg, and 37% had ≥150 mm Hg. Over a median follow-up of 13 years, 182 participants developed stroke. The crude stroke incidence was greater among individuals with SBP≥150 mm Hg (10.8 per 1000 person-years) and SBP 140 to 149 (12.3) than among those with SBPHg had an increased risk of stroke (hazard ratio, 1.7; 95% confidence interval, 1.2-2.6) compared with those with SBP Hg. The increased stroke risk was most notable among Hispanics and non-Hispanic blacks. Raising the SBP threshold from 140 to 150 mm Hg as a new target for hypertension treatment in older individuals without diabetes mellitus or chronic kidney disease could have a detrimental effect on stroke risk reduction, especially among minority US populations. © 2016 American Heart Association, Inc.

  3. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  4. Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

    Science.gov (United States)

    Shams, Tanzila; Auchus, Alexander P; Oparil, Suzanne; Wright, Clinton B; Wright, Jackson; Furlan, Anthony J; Sila, Cathy A; Davis, Barry R; Pressel, Sara; Yamal, Jose-Miguel; Einhorn, Paula T; Lerner, Alan J

    2017-11-01

    The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups ( P ≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542. © 2017 American Heart Association, Inc.

  5. Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS)

    DEFF Research Database (Denmark)

    Bath, Philip M W; Woodhouse, Lisa; Scutt, Polly

    2015-01-01

    BACKGROUND: High blood pressure is associated with poor outcome after stroke. Whether blood pressure should be lowered early after stroke, and whether to continue or temporarily withdraw existing antihypertensive drugs, is not known. We assessed outcomes after stroke in patients given drugs......·91-1·13; p=0·83), and with continue versus stop antihypertensive drugs OR was 1·05 (0·90-1·22; p=0·55). INTERPRETATION: In patients with acute stroke and high blood pressure, transdermal glyceryl trinitrate lowered blood pressure and had acceptable safety but did not improve functional outcome. We show...

  6. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2011-01-01

    Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program: before the program, 3 parents of 75 (3.9%) were able to identify the five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995

  7. 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.

  8. Child-Mediated Stroke Communication: findings from Hip Hop Stroke.

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2012-01-01

    Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

  9. Loci associated with ischaemic stroke and its subtypes (SiGN): a genome-wide association study.

    Science.gov (United States)

    2016-02-01

    The discovery of disease-associated loci through genome-wide association studies (GWAS) is the leading genetic approach to the identification of novel biological pathways underlying diseases in humans. Until recently, GWAS in ischaemic stroke have been limited by small sample sizes and have yielded few loci associated with ischaemic stroke. We did a large-scale GWAS to identify additional susceptibility genes for stroke and its subtypes. To identify genetic loci associated with ischaemic stroke, we did a two-stage GWAS. In the first stage, we included 16 851 cases with state-of-the-art phenotyping data and 32 473 stroke-free controls. Cases were aged 16 to 104 years, recruited between 1989 and 2012, and subtypes of ischaemic stroke were recorded by centrally trained and certified investigators who used the web-based protocol, Causative Classification of Stroke (CCS). We constructed case-control strata by identifying samples that were genotyped on nearly identical arrays and were of similar genetic ancestral background. We cleaned and imputed data by use of dense imputation reference panels generated from whole-genome sequence data. We did genome-wide testing to identify stroke-associated loci within each stratum for each available phenotype, and we combined summary-level results using inverse variance-weighted fixed-effects meta-analysis. In the second stage, we did in-silico lookups of 1372 single nucleotide polymorphisms identified from the first stage GWAS in 20 941 cases and 364 736 unique stroke-free controls. The ischaemic stroke subtypes of these cases had previously been established with the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification system, in accordance with local standards. Results from the two stages were then jointly analysed in a final meta-analysis. We identified a novel locus (G allele at rs12122341) at 1p13.2 near TSPAN2 that was associated with large artery atherosclerosis-related stroke (first stage odds ratio

  10. 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 ...

  11. 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 ...

  12. [Treatment choice for patients with hemorrhagic cerebral stroke expected to be in a disabled condition--An analysis of questionnaire responses of patients' families].

    Science.gov (United States)

    Torigoe, Takahiro; Fukuhara, Toru

    2015-01-01

    Many patients with cerebral stroke are successively treated with the latest advances in medical therapies. Surgical hematoma evacuation is a treatment option for patients with hemorrhagic cerebral stroke, however; it may result in a prolonged vegetative state. The difficult choice of whether or not such surgery should be performed is mostly made by the family, frequently in an urgent manner, and nurses need to understand the factors affecting this decision-making. We performed statistical analyses on the responses of 30 patients' families who answered our questionnaire, presuming disabilities after the surgery were expected. Multiple answers were obtained according to the severity of the expected disabilities after the surgery. The refusal of surgery increased as the expected disabilities worsened, and the statistically significant factor affecting the decision-making process was "what they would wish if they suffered a stroke themselves." The 18 nurses working in the neurological ward who responded to the same questionnaire wished surgery more in the case of the patient's cognition being preserved. Since it is rare for patients with stroke to have an advance directive, patients' families have to decide the treatment choice in most cases. In the clinical setting, such decisions frequently need to be made rapidly, however; the decision should be made by speculating on the patients' own will, and it is desirable for medical staff to explain the expected outcomes of the surgery in detail as far as possible.

  13. Stroke is not a treatment dilemma for early valve surgery in active infective endocarditis.

    Science.gov (United States)

    Wan, Su; Sung, Kiick; Park, Pyo Won; Kim, Wook Sung; Lee, Young Tak; Jun, Tae-Gook; Yang, Ji-Hyuk; Jeong, Dong Seop; Cho, Yang Hyun

    2014-09-01

    While early valve surgery for active infective endocarditis (AIE) is recommended, surgeons have hesitated to operate on patients complicated by cerebral septic embolism resulting in cerebral bleeding when cardiopulmonary bypass is required intraoperatively. The study aim was to review the outcomes of operations for AIE, and to determine the risks of neurologic complications resulting from cerebral septic embolism. Between 1994 and June 2011, among 278 patients who underwent heart valve surgery for AIE at the authors' institution, 39 (14%) had cerebral septic embolisms. Cerebral lesions were verified by imaging, and were predominantly multiple embolic infarctions (34 patients; 87.2%). Five patients had brain abscess, and 10 had hemorrhage with or without infarction. The mean interval between the recent onset of a stroke and surgery was 10.1 ± 10.1 days (range: 0-43 days). One patient died postoperatively of septic shock. New neurologic complications occurred in five patients, including secondary hemorrhagic transformation in the previous lesions (n = 2), newly developed subdural and subarachnoid hemorrhage (n = 2), and an increased degree of subarachnoid hemorrhage (n = 1). One patient needed a craniotomy, and the others were treated medically. There were five late deaths, including one cardiac death, and one redo valve surgery due to repaired valve failure during the follow up period of 46.3 ± 40.4 months (range: 1.9-127.4 months). The overall and event-free survival rates at five and 10 years were 84.3 ± 6.5% and 75.9 ± 9.9%, and 81.7 ± 6.8% and 73.6 ± 9.9%, respectively. Surgery for AIE with cerebral septic embolisms can be performed safely, with good early and mid-term follow-up results. When urgent or emergent surgery for AIE is needed, neurologic complications should not be a reason for delay.

  14. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases.

    Science.gov (United States)

    Sánchez-Larsen, Á; García-García, J; Ayo-Martín, O; Hernández-Fernández, F; Díaz-Maroto, I; Fernández-Díaz, E; Monteagudo, M; Segura, T

    2016-09-16

    We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide. Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    P.E. Cotter

    2011-04-01

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

  16. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2015-01-01

    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  17. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B

    2015-01-01

    STUDY QUESTION: What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? METHODS: This Danish cohort study (1996......-2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge...... gastrointestinal bleeding. 27.1% (n=924) of patients did not resume antithrombotic treatment. Compared with non-resumption of treatment, a reduced risk of all cause mortality was found in association with restart of oral anticoagulation (hazard ratio 0.39, 95% confidence interval 0.34 to 0.46), an antiplatelet...

  18. Intra-arterial thrombolysis vs. standard treatment or intravenous thrombolysis in adults with acute ischemic stroke: a systematic review and meta-analysis.

    Science.gov (United States)

    Nam, Julian; Jing, He; O'Reilly, Daria

    2015-01-01

    Recent evidence has suggested that intra-arterial thrombolysis may provide benefit beyond intravenous thrombolysis in ischemic stroke patients. Previous meta-analyses have only compared intra-arterial thrombolysis with standard treatment without thrombolysis. The objective was to review the benefits and harms of intra-arterial thrombolysis in ischemic stroke patients. We undertook a meta-analysis of randomized controlled trials comparing the efficacy and safety of intra-arterial thrombolysis with either standard treatment or intravenous thrombolysis following acute ischemic stroke. Primary outcomes included poor functional outcomes (modified Rankin Scale 3-6), mortality, and symptomatic intracranial hemorrhage. Study quality was assessed, and outcomes were stratified by comparison treatment received. Four trials (n = 351) comparing intra-arterial thrombolysis with standard treatment were identified. Intra-arterial thrombolysis reduced the risk of poor functional outcomes (modified Rankin Scale 3-6) [relative risk (RR) = 0·80; 95% confidence interval = 0·67-0·95; P = 0·01]. Mortality was not increased (RR = 0·82; 95% confidence interval = 0·56-1·21; P = 0·32); however, risk of symptomatic intracranial hemorrhage was nearly four times more likely (RR = 3·90; 95% confidence interval = 1·41-10·76; P = 0·006). Two trials (n = 81) comparing intra-arterial thrombolysis with intravenous thrombolysis were identified. Intra-arterial thrombolysis was not found to reduce poor functional outcomes (modified Rankin Scale 3-6) (RR = 0·68; 95% confidence interval = 0·46-1·00; P = 0·05). Mortality was not increased (RR = 1·12; 95% confidence interval = 0·47-2·68; P = 0·79); neither was symptomatic intracranial hemorrhage (RR = 1·13; 95% confidence interval = 0·32-3·99; P = 0·85). Differences in time from symptom onset-to-treatment and type of thrombolytic administered were found

  19. Functional Improvement after Photothrombotic Stroke in Rats Is Associated with Different Patterns of Dendritic Plasticity after G-CSF Treatment and G-CSF Treatment Combined with Concomitant or Sequential Constraint-Induced Movement Therapy.

    Directory of Open Access Journals (Sweden)

    Katrin Frauenknecht

    Full Text Available We have previously shown that granulocyte-colony stimulating factor (G-CSF treatment alone, or in combination with constraint movement therapy (CIMT either sequentially or concomitantly, results in significantly improved sensorimotor recovery after photothrombotic stroke in rats in comparison to untreated control animals. CIMT alone did not result in any significant differences compared to the control group (Diederich et al., Stroke, 2012;43:185-192. Using a subset of rat brains from this former experiment the present study was designed to evaluate whether dendritic plasticity would parallel improved functional outcomes. Five treatment groups were analyzed (n = 6 each (i ischemic control (saline; (ii CIMT (CIMT between post-stroke days 2 and 11; (iii G-CSF (10 μg/kg G-CSF daily between post-stroke days 2 and 11; (iv combined concurrent group (CIMT plus G-CSF and (v combined sequential group (CIMT between post-stroke days 2 and 11; 10 μg/kg G-CSF daily between post-stroke days 12 and 21, respectively. After impregnation of rat brains with a modified Golgi-Cox protocol layer V pyramidal neurons in the peri-infarct cortex as well as the corresponding contralateral cortex were analyzed. Surprisingly, animals with a similar degree of behavioral recovery exhibited quite different patterns of dendritic plasticity in both peri-lesional and contralesional areas. The cause for these patterns is not easily to explain but puts the simple assumption that increased dendritic complexity after stroke necessarily results in increased functional outcome into perspective.

  20. 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.

  1. Combination treatment of low-frequency rTMS and occupational therapy with levodopa administration: an intensive neurorehabilitative approach for upper limb hemiparesis after stroke.

    Science.gov (United States)

    Kakuda, Wataru; Abo, Masahiro; Kobayashi, Kazushige; Momosaki, Ryo; Yokoi, Aki; Fukuda, Akiko; Ito, Hiroshi; Tominaga, Ayumi

    2011-07-01

    The combination treatment of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy was applied with concomitant oral administration of levodopa in five post-stroke patients with upper limb hemiparesis (age at treatment: 56-66 years; interval between onset of stroke and treatment: 18-143 months) as a 15-day inpatient protocol. Daily levodopa administration of 100 mg was initiated 1 week before admission and continued until 4 weeks after discharge. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere for 40 min daily (two 20-min sessions) combined with intensive occupational therapy consisting of 60-min one-on-one training and 60-min self-exercise. Motor function of the affected upper limb was serially evaluated with the Fugl-Meyer Assessment and the Wolf Motor Function Test. At the end of the treatment, all patients showed improved motor function in the affected upper limbs. In some patients, the improvement was maintained until 4 weeks after discharge. No patient showed any adverse effect from the intervention. Our proposed protocol featuring levodopa administration, low-frequency rTMS, and intensive occupational therapy could provide a safe and feasible intervention for upper limb hemiparesis after stroke.

  2. The relationship between interventionists' experience and clinical and radiological outcome in intra-arterial treatment for acute ischemic stroke. A MR CLEAN pretrial survey.

    Science.gov (United States)

    Beumer, Debbie; van Boxtel, Tiemen H; Schipperen, Stefanie; van Zwam, Wim H; Lycklama À Nijeholt, Geert J; Brouwer, Patrick A; Jenniskens, Sjoerd F M; Schonewille, Wouter J; Vos, Jan Albert; van der Lugt, Aad; Roos, Yvo B; Majoie, Charles B; van Oostenbrugge, Robert J; Dippel, Diederik W J

    2017-06-15

    Intra-arterial treatment in acute ischemic stroke is safe and effective as recently shown in several randomized clinical trials. The level of experience of the interventionist performing the IAT procedure has not been studied. The present study investigates effects of interventionists' experience on technical aspects of the procedure and clinical outcome of the patient. In this study of 313 patients with a proximal intracranial arterial anterior circulation occlusion, treated in the Netherlands from 2002 until participation in the Multicenter Randomized Clinical trial of Endovascular treatment for acute ischemic stroke (MR CLEAN), data were collected retrospectively. The association of the senior interventionists' experience with duration of the procedure, adverse events, recanalization, neurological outcome, and functional outcome at discharge was analyzed. Multiple regression models adjusted for age, sex, stroke severity, carotid terminus occlusion, use of a retrievable stent and onset to door time were used. No association between interventionists' experience and recanalization, neurological outcome, or functional outcome was observed in a strict selection of patients. This strict selection include a start of intra-arterial treatment within 6h, no coagulation disturbances, systolic blood pressureexperience and either serious neurologic adverse events or poor outcomes was observed in this study of treatments by interventionists with experience of experience with procedure times, results and patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    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.

  4. Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making

    Science.gov (United States)

    Luby, Marie; Warach, Steven J; Albers, Gregory W; Baron, Jean-Claude; Cognard, Christophe; Dávalos, Antoni; Donnan, Geoffrey A; Fiebach, Jochen B; Fiehler, Jens; Hacke, Werner; Lansberg, Maarten G; Liebeskind, David S; Mattle, Heinrich P; Oppenheim, Catherine; Schellinger, Peter D; Wardlaw, Joanna M; Wintermark, Max

    2016-01-01

    Background and Purpose The purpose of this study was to collect precise information on the typical imaging decisions given specific clinical acute stroke scenarios. Stroke centers worldwide were surveyed regarding typical imaging used to work up representative acute stroke patients, make treatment decisions, and willingness to enroll in clinical trials. Methods STroke Imaging Research and Virtual International Stroke Trials Archive-Imaging circulated an online survey of clinical case vignettes through its website, the websites of national professional societies from multiple countries as well as through email distribution lists from STroke Imaging Research and participating societies. Survey responders were asked to select the typical imaging work-up for each clinical vignette presented. Actual images were not presented to the survey responders. Instead, the survey then displayed several types of imaging findings offered by the imaging strategy, and the responders selected the appropriate therapy and whether to enroll into a clinical trial considering time from onset, clinical presentation, and imaging findings. A follow-up survey focusing on 6 h from onset was conducted after the release of the positive endovascular trials. Results We received 548 responses from 35 countries including 282 individual centers; 78% of the centers originating from Australia, Brazil, France, Germany, Spain, United Kingdom, and United States. The specific onset windows presented influenced the type of imaging work-up selected more than the clinical scenario. Magnetic Resonance Imaging usage (27–28%) was substantial, in particular for wake-up stroke. Following the release of the positive trials, selection of perfusion imaging significantly increased for imaging strategy. Conclusions Usage of vascular or perfusion imaging by Computed Tomography or Magnetic Resonance Imaging beyond just parenchymal imaging was the primary work-up (62–87%) across all clinical vignettes and time windows

  5. Systemic thrombolysis increases hemorrhagic stroke risk without survival benefit compared with catheter-directed intervention for the treatment of acute pulmonary embolism.

    Science.gov (United States)

    Liang, Nathan L; Avgerinos, Efthymios D; Singh, Michael J; Makaroun, Michel S; Chaer, Rabih A

    2017-03-01

    Systemic thrombolysis (ST) and catheter-directed intervention (CDI) are both used in the treatment of acute pulmonary embolism (PE), but the comparative outcomes of these two therapies remain unclear. The objective of this study was to compare short-term mortality and safety outcomes between the two treatments using a large national database. Patients presenting with acute PE were identified in the National Inpatient Sample (NIS) from 2009 to 2012. Comorbidities, clinical characteristics, and invasive procedures were identified using International Classification of Diseases, Ninth Revision (ICD) codes and the Elixhauser comorbidity index. To adjust for anticipated baseline differences between the two treatment groups, propensity score matching was used to create a matched ST cohort with clinical and comorbid characteristics similar to those of the CDI cohort. Subgroups of patients with and without hemodynamic shock were analyzed separately. Primary outcomes were in-hospital mortality, overall bleeding risk, and hemorrhagic stroke risk. Of 263,955 subjects with acute PE, 1.63% (n = 4272) received ST and 0.55% (n = 1455) received CDI. ST subjects were older, had more chronic comorbidities, and had higher rates of respiratory failure (ST, 27.9% [n = 1192]; CDI, 21.2% [n = 308]; P hemorrhagic stroke rates (ST, 2.2% [n = 96]; CDI, 1.4% [n = 20]; P = .041). After propensity matching, 1430 patients remained in each cohort; baseline characteristics of the matched cohorts did not differ significantly using standardized difference comparisons. Analysis of the matched cohorts did not demonstrate a significant effect of CDI on in-hospital mortality or overall bleeding risk but did show a significant protective effect against hemorrhagic stroke compared with ST (odds ratio, 0.47; 95% confidence interval, 0.27-0.82; P = .01). Subgroup analysis showed decreased odds of hemorrhagic stroke for CDI in the nonshock subgroup and increased procedural bleeding for CDI but no

  6. Stroke treatment with alteplase given 3.0-4.5 h after onset of acute ischaemic stroke (ECASS III): additional outcomes and subgroup analysis of a randomised controlled trial.

    Science.gov (United States)

    Bluhmki, Erich; Chamorro, Angel; Dávalos, Antoni; Machnig, Thomas; Sauce, Christophe; Wahlgren, Nils; Wardlaw, Joanna; Hacke, Werner

    2009-12-01

    In the European Cooperative Acute Stroke Study III (ECASS III), alteplase administered 3.0-4.5 h after the onset of stroke symptoms resulted in a significant benefit in the primary endpoint (modified Rankin scale [mRS] score 0-1) versus placebo, with no difference in mortality between the treatment groups. Compared with the 0-3 h window, there was no excess risk of symptomatic intracranial haemorrhage. We assessed the usefulness of additional endpoints and did subgroup and sensitivity analyses to further investigate the benefit of alteplase. In a double-blind, multicentre study in Europe, patients with acute ischaemic stroke were randomly assigned to intravenous alteplase (0.9 mg/kg bodyweight) or placebo. Additional outcome analyses included functional endpoints at day 90 or day 30 (mRS 0-1 [day 30], mRS 0-2, Barthel index > or =85, and global outcome statistic [day 30]) and treatment response (8-point improvement from baseline or 0-1 score on the National Institutes of Health stroke scale [NIHSS], and a stratified responder analysis by baseline NIHSS score). The subgroup analyses were based on the mRS 0-1 at day 90, symptomatic intracranial haemorrhage, and death. Analyses were by intention to treat and per protocol. This study is registered with ClinicalTrials.gov, number NCT00153036. 418 patients were assigned to alteplase and 403 to placebo. Although not significant in every case, all additional endpoints showed at least a clear trend in favour of alteplase. Alteplase was effective in various subgroups, including older patients ( or =65 years: 1.15, 0.80-1.64; p=0.230), and the effectiveness was independent of the severity of stroke at baseline (NIHSS 0-9: 1.28, 0.84-1.96; NIHSS 10-19: 1.16, 0.73-1.84; NIHSS > or =20: 2.32, 0.61-8.90; p=0.631). The incidence of symptomatic intracranial haemorrhage seemed to be independent of previous antiplatelet drug use (no: 2.41, 1.09-5.33; yes: 2.33, 0.79-6.90; p=0.962) and time from onset of symptoms to treatment (181

  7. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B

    2015-01-01

    with better outcomes for all cause mortality and thromboembolism compared with patients who did not resume treatment. This was despite an increased longitudinal associated risk of bleeding. FUNDING, COMPETING INTERESTS, DATA SHARING: This study was supported by a grant from Boehringer-Ingelheim. Competing...

  8. Risk factors of outcomes in elderly patients with acute ischemic stroke in China.

    Science.gov (United States)

    Wu, Qi; Zou, Chunying; Wu, Chengji; Zhang, Shuping; Huang, Zuoyi

    2016-08-01

    Stroke results in poor outcomes among elderly patients. However, the factors associated with outcome over different follow-up periods in this population are unknown. To evaluate the outcomes and risk factors of outcomes in elderly patients after stroke. Outcomes, including mortality, dependency (defined as a mRS >2), and recurrence rates, and associated risk factors were assessed at 3 and 12 months after stroke in patients aged ≥80 years. There were 419 acute ischemic stroke patients aged ≥80 years at 3 months, and 309 patients at 12 months; outcomes and relevant risk factors were assessed in these patients. Hypertension was more prevalent in women than in men. At 3 months, the mortality, dependency, and recurrence rates were 13.8, 54.2, and 18.1 %, respectively; the corresponding rates at 12 months were 26.9, 58.0, and 32.6 %, respectively. In the multivariate analysis, after adjusting by confounding factors, TOAST classification and stroke severity were associated with mortality and recurrence, while stroke severity was associated with dependency at 3 months. The mortality and dependency rates at 12 months were significantly associated with moderate and severe stroke, but severe stroke was an independent factor associated with recurrence. Stroke subtype and severity were associated with stroke outcomes among elderly patients in northern China. These findings suggest that it is crucial to highlight the affected factors of stroke outcome among elderly patients for reduce the burden of stroke in China.

  9. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial.

    Science.gov (United States)

    McCabe, Jessica; Monkiewicz, Michelle; Holcomb, John; Pundik, Svetlana; Daly, Janis J

    2015-06-01

    To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors. Single-blind, randomized trial. Medical center. Enrolled subjects (N=39) were >1 year postsingle stroke (attrition rate=10%; 35 completed the study). All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training). Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM). There was no significant difference found in treatment response across groups (AMAT: P≥.584; FM coordination: P≥.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P≤.009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects. Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Feeding dairy cows with full fat extruded or toasted soybean seeds as replacement of soybean meal and effects on milk yield, fatty acid profile and CLA content

    Directory of Open Access Journals (Sweden)

    Giovanni Bittante

    2010-01-01

    Full Text Available The aim of this study was to evaluate the effects of the replacement of about 70% of soybean meal (SBM with extruded(ES or toasted (TS full-fat soybean seeds in diets for lactating cows on milk quality, fatty acid profile, and conjugatedlinoleic acid (CLA content. Eighteen lactating cows were assigned to 3 groups which received a basal diet, supplementedwith 1.8, 2.1 and 2.1 kg/head, respectively, of SBM, ES and TS. There was no significant effect on milk yield,calculated as the difference between daily yield during the experimental period and the mean of the last 5 days of adaptation(-1.65, -1.29 and -0.20 kg/d, respectively, for SBM, ES and TS; P>0.10 and milk quality parameters (fat, protein,urea and cheese making parameters among treatments. In the ES group there was a decrease in the short chainFA content (from C4 to C13 in milk fat (9.2 vs 11.0 and 10.8 g/100 g lipids, respectively, for ES, SBM and TS; PMedium chain FA (from C14 to C17 content in milk fat was lower for ES and TS groups compared with SBM (46.8 and48.0 vs 54.8 g/100 g lipids respectively; PSBM group compared to the others (34.3 vs 44.2 and 41.2 g/100 g lipids, respectively, for SBM, ES and TS; PThe replacement of SBM with ES enhanced oleic and linoleic acid and, particularly, CLA content. Intermediate values wereobserved for the TS group. CLA content (0.91, 0.62 and 0.56 g/100 g lipids, respectively, for ES, TS and SBM; Pincreased throughout the trial in all groups. ES also reduced the proportion of SFA with respect to SBM (65.2, 68.2 and70.9 g/100 g lipids, respectively, for ES, TS and SBM; Pin the same order; Pimproving the health-quality of milk. The various soybean products did not affect either metabolic profile (protein, urea,glucose, cholesterol, NEFA, triglycerides, liver parameters and mineral serum content or rumen parameters (pH, ammoniaand VFAs. The replacement of SBM with ES and TS permitted an improvement in the nutritional properties of milkwithout negatively

  11. Therapeutic synergism in the treatment of post-stroke arm paresis utilizing botulinum toxin, robotic therapy, and constraint-induced movement therapy.

    Science.gov (United States)

    Takebayashi, Takashi; Amano, Satoru; Hanada, Keisuke; Umeji, Atsushi; Takahashi, Kayoko; Koyama, Tetsuo; Domen, Kazuhisa

    2014-11-01

    Botulinum toxin type A (BtxA) injection, constraint-induced movement therapy (CIMT), and robotic therapy (RT) each represent promising approaches to enhance arm motor recovery after stroke. To provide more effective treatment for a 50-year-old man with severe left spastic hemiparesis, we attempted to facilitate CIMT with adaptive approaches to extend the wrist and fingers using RT for 10 consecutive weeks after BtxA injection. This combined treatment resulted in substantial improvements in arm function and the amount of arm use in activities of daily living, and may be effective for stroke patients with severe arm paresis. However, we were unable to sufficiently prove the efficacy of combined treatment based only on a single case. To fully elucidate the efficacy of the combined approach for patients with severe hemiparesis after stroke, future studies of a larger number of patients are needed. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  12. Treatment with B vitamins and incidence of cancer in patients with previous stroke or transient ischemic attack: results of a randomized placebo-controlled trial.

    Science.gov (United States)

    Hankey, Graeme J; Eikelboom, John W; Yi, Qilong; Lees, Kennedy R; Chen, Christopher; Xavier, Denis; Navarro, Jose C; Ranawaka, Udaya K; Uddin, Wasim; Ricci, Stefano; Gommans, John; Schmidt, Reinhold

    2012-06-01

    To determine the effect of B vitamin treatment on the incidence of cancer among patients with stroke or transient ischemic attack. A total of 8164 patients with recent stroke or transient ischemic attack were randomly allocated to double-blind treatment with 1 tablet daily of placebo or B vitamins (2 mg folic acid, 25 mg vitamin B(6), 500 μg vitamin B(12)) and followed for a median of 3.4 years for any cancer as an adverse event. There was no significant difference in the incidence of any cancer among participants assigned B vitamins compared with placebo (4.04% versus 4.59%; risk ratio, 0.86; 95% CI, 0.70-1.07) and no difference in cancer mortality (2.35% versus 2.09%; risk ratio, 1.09; 0.81-1.46). Among 1899 patients with diabetes, the incidence of cancer was higher among participants assigned B vitamins compared with placebo (5.35% versus 3.28%; adjusted risk ratio, 2.21; 1.31-3.73), whereas among 6168 patients without diabetes, the incidence of cancer was lower among participants assigned B vitamins compared with placebo (3.66% versus 5.03%; adjusted risk ratio, 0.67; 0.51-0.87; P for interaction=0.0001). Daily administration of folic acid, vitamin B(6), and vitamin B(12) to 8164 patients with recent stroke or transient ischemic attack for a median of 3.4 years had no significant effect, compared with placebo, on cancer incidence or mortality. However, a post hoc subgroup analysis raises the hypothesis that folic acid treatment may increase the incidence of cancer among diabetics and reduce the incidence of cancer among nondiabetics with a history of stroke or transient ischemic attack.

  13. Secular trends in ischemic stroke subtypes and stroke risk factors.

    Science.gov (United States)

    Bogiatzi, Chrysi; Hackam, Daniel G; McLeod, A Ian; Spence, J David

    2014-11-01

    Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012. There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (Prisk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted. © 2014 American Heart Association, Inc.

  14. Sex differences in stroke.

    NARCIS (Netherlands)

    Haast, R.A.M.; Gustafson, D.R.; Kiliaan, A.J.

    2012-01-01

    Sex differences in stroke are observed across epidemiologic studies, pathophysiology, treatments, and outcomes. These sex differences have profound implications for effective prevention and treatment and are the focus of this review. Epidemiologic studies reveal a clear age-by-sex interaction in

  15. The effects of early insulin treatment combined with thrombolysis in rat embolic stroke

    DEFF Research Database (Denmark)

    Meden, Per; Andersen, Martin; Overgaard, Karsten

    2002-01-01

    The therapeutic effect of insulin alone or insulin combined with 30 min delayed thrombolytic therapy was investigated in rats embolized in the right hemisphere with a fibrin clot made from autologous blood. Animals were killed seven days after embolization and the infarct volumes were measured...... in % of the affected hemisphere. Mortality was calculated as the number of animals dying spontaneously before the scheduled euthanasia. The median infarct volume in control animals (n = 12) was 24%. Insulin (3 IU kg(-1)) was given subcutaneously 15 min, 3 h, and 24 h after embolization (n = 12) and reduced median......% (n = 14). The infarct volumes in the treatment groups were not significantly different from controls (p = 0.62, Kruskal Wallis test). Mortality rates increased from 0% among controls to 47% (p = 0.01) in the insulin alone and 38% (p = 0.02) in the combination therapy group. In conclusion, insulin...

  16. Stroke in hereditary hemorrhagic telangiectasia patients. New evidence for repeated screening and early treatment of pulmonary vascular malformations: two case reports

    Directory of Open Access Journals (Sweden)

    Viader Fausto

    2011-07-01

    Full Text Available Abstract Background Paradoxical embolism due to pulmonary arteriovenous malformations is the main mechanism of brain infarction in patients with hereditary hemorrhagic telangiectasia. International Guidelines have recently been published to clarify the performance of screening tests and the effectiveness of treatment for pulmonary arteriovenous malformations. Case Presentation We present two cases of hereditary hemorrhagic telangiectasia patients of our hospital who experienced an acute stroke secondary to paradoxical embolism. Conclusions These two cases show that the guidelines must be followed to prevent the occurrence of ischemic stroke in patients with hereditary hemorrhagic telangiectasia, and that although they may be adequate in most cases, there are some patients who need a more personalized approach.

  17. Progesterone attenuates hemorrhagic transformation after delayed tPA treatment in an experimental model of stroke in rats: involvement of the VEGF-MMP pathway.

    Science.gov (United States)

    Won, Soonmi; Lee, Jin Hwan; Wali, Bushra; Stein, Donald G; Sayeed, Iqbal

    2014-01-01

    Tissue plasminogen activator (tPA) is the only FDA-approved treatment for acute stroke, but its use remains limited. Progesterone (PROG) has shown neuroprotection in ischemia, but before clinical testing, we must determine how it affects hemorrhagic transformation in tPA-treated ischemic rats. Male Sprague-Dawley rats underwent middle cerebral artery occlusion with reperfusion at 4.5 hours and tPA treatment at 4.5 hours, or PROG treatment intraperitoneally at 2 hours followed by subcutaneous injection at 6 hours post occlusion. Rats were killed at 24 hours and brains evaluated for cerebral hemorrhage, swelling, blood-brain barrier (BBB) permeability, and levels of matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor level (VEGF), and tight junction (TJ) proteins. We also evaluated PROG's efficacy in preventing tPA-induced impairment of transendothelial electrical resistance (TEER) and TJ proteins under hypoxia/reoxygenation in the endothelial cells. Delayed tPA treatment induced significant hemorrhagic conversion and brain swelling. Treatment with PROG plus tPA ameliorated hemorrhage, hemispheric swelling, BBB permeability, MMP-9 induction, and VEGF levels compared with controls. Progesterone treatment significantly prevented tPA-induced decrease in TEER and expression of occludin and claudin-5, and attenuated VEGF levels in culture media subjected to hypoxia. The study concluded that PROG may extend the time window for tPA administration in ischemic stroke and reduce hemorrhagic conversion.

  18. 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 ...

  19. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials.

    Science.gov (United States)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger; Brott, Thomas G; Toni, Danilo; Grotta, James C; Albers, Gregory W; Kaste, Markku; Marler, John R; Hamilton, Scott A; Tilley, Barbara C; Davis, Stephen M; Donnan, Geoffrey A; Hacke, Werner; Allen, Kathryn; Mau, Jochen; Meier, Dieter; del Zoppo, Gregory; De Silva, D A; Butcher, K S; Parsons, M W; Barber, P A; Levi, C; Bladin, C; Byrnes, G

    2010-05-15

    Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to treatment with intravenous rt-PA (alteplase) on therapeutic benefit and clinical risk by adding recent trial data to the analysis. We added data from ECASS III (821 patients) and EPITHET (100 patients) to a pool of common data elements from six other trials of alteplase for acute stroke (2775 patients). We used multivariate logistic regression to assess the relation of stroke onset to start of treatment (OTT) with treatment on favourable 3-month outcome (defined as modified Rankin score 0-1), mortality, and occurrence and outcome of clinically relevant parenchymal haemorrhage. The presence of an arterial occlusion was inferred from the patient's symptoms and absence of haemorrhage or other causes of ischaemic stroke. Vascular imaging was not a requirement in the trials. All patients with confirmed OTT within 360 min were included in the analysis. Treatment was started within 360 min of stroke onset in 3670 patients randomly allocated to alteplase (n=1850) or to placebo (n=1820). Odds of a favourable 3-month outcome increased as OTT decreased (p=0.0269) and no benefit of alteplase treatment was seen after around 270 min. Adjusted odds of a favourable 3-month outcome were 2.55 (95% CI 1.44-4.52) for 0-90 min, 1.64 (1.12-2.40) for 91-180 min, 1.34 (1.06-1.68) for 181-270 min, and 1.22 (0.92-1.61) for 271-360 min in favour of the alteplase group. Large parenchymal haemorrhage was seen in 96 (5.2%) of 1850 patients assigned to alteplase and 18 (1.0%) of 1820 controls, with no clear relation to OTT (p=0.4140). Adjusted odds of mortality increased with OTT (p=0.0444) and were 0.78 (0.41-1.48) for 0-90 min, 1.13 (0.70-1.82) for 91-180 min, 1.22 (0.87-1.71) for 181-270 min, and 1.49 (1.00-2.21) for

  20. Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial.

    Science.gov (United States)

    Goyal, Mayank; Jadhav, Ashutosh P; Bonafe, Alain; Diener, Hans; Mendes Pereira, Vitor; Levy, Elad; Baxter, Blaise; Jovin, Tudor; Jahan, Reza; Menon, Bijoy K; Saver, Jeffrey L

    2016-06-01

    Purpose To study the relationship between functional independence and time to reperfusion in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial in patients with disabling acute ischemic stroke who underwent endovascular therapy plus intravenous tissue plasminogen activator (tPA) administration versus tPA administration alone and to investigate variables that affect time spent during discrete steps. Materials and Methods Data were analyzed from the SWIFT PRIME trial, a global, multicenter, prospective study in which outcomes were compared in patients treated with intravenous tPA alone or in combination with the Solitaire device (Covidien, Irvine, Calif). Between December 2012 and November 2014, 196 patients were enrolled. The relation between time from (a) symptom onset to reperfusion and (b) imaging to reperfusion and clinical outcome was analyzed, along with patient and health system characteristics that affect discrete steps in patient workflow. Multivariable logistic regression was used to assess relationships between time and outcome; negative binomial regression was used to evaluate effects on workflow. The institutional review board at each site approved the trial. Patients provided written informed consent, or, at select sites, there was an exception from having to acquire explicit informed consent in emergency circumstances. Results In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay. Time from arrival at the emergency department to arterial access was 90 minutes (interquartile range, 69-120 minutes), and time to reperfusion was 129 minutes (interquartile range, 108-169 minutes). Patients who initially arrived at a referring facility had longer symptom onset to groin puncture times compared with

  1. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature i...

  2. 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

  3. WARFARIN IN PATIENTS WITH CARDIOEMBOLIC STROKE

    Directory of Open Access Journals (Sweden)

    E. N. Dankovtseva

    2012-01-01

    Full Text Available Analysis of the current literature data on the use of warfarin in patients with cardioembolic stroke is presented. Cardioembolic stroke pathology and particularities of this condition therapywith antithrombotic medications are shown in details. Possibility to apply thrombolysis during warfarin treatment and the use of anticoagulants after cardioembolic stroke is discussed.

  4. 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 ...

  5. 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. ...

  6. Comparison study of the curative effect between interventional ultrasound and microwave in the treatment of post-stroke shoulder-hand syndrome

    Directory of Open Access Journals (Sweden)

    Shuang LI

    2017-07-01

    Full Text Available Objective To investigate the efficacy and safety of interventional ultrasound and microwave in the treatment of post-stroke shoulder-hand syndrome (SHS.  Methods A total of 42 cases of post-stroke SHS (stage Ⅰ were randomized to receive microwave combined with routine rehabilitation training (control group, N = 19 and interventional ultrasound combined with routine rehabilitation training (treatment group, N = 23, respectively. Before and 3 d, 10 d after treatment, Visual Analogue Scale (VAS was used to evaluate shoulder joint pain, and measure the swelling degree of dorsum of hand and metacarpophalangeal joints. Before and 10 d after treatment, Fugl - Meyer Assessment Scale for Upper Extremity (FMA-UE and Barthel Index (BI were used to assess upper limb motor function and activities of daily living (ADL.  Results There was statistically significant difference between 2 groups at different time points on VAS score (P = 0.000 and swelling degree of dorsum of hand and metacarpophalangeal joints (P = 0.000. VAS score (control group: P = 0.000, 0.000; treatment group: P = 0.000, 0.000 and swelling degree of dorsum of hand and metacarpophalangeal joints (control group: P = 0.042, 0.000; treatment group: P = 0.000, 0.000 at 3 and 10 d after treatment were significantly lower than before treatment. VAS score (P = 0.000, 0.000 and swelling degree of dorsum of hand and metacarpophalangeal joints (P = 0.000, 0.000 10 d after treatment were significantly lower than 3 d after treatment. Compared with before treatment, both VAS score (P = 0.031 and swelling degree of dorsum of hand and metacarpophalangeal joints (P = 0.000 in 2 groups were significantly lower, while FMA-UE (P = 0.000 and BI (P = 0.000 scores were significantly higher after treatment.  Conclusions Both interventional ultrasound and microwave combined with routine rehabilitation training can improve shoulder joint pain, swelling degree of dorsum of hand and metacarpophalangeal joints

  7. Stroke Risk Factors, Genetics, and Prevention.

    Science.gov (United States)

    Boehme, Amelia K; Esenwa, Charles; Elkind, Mitchell S V

    2017-02-03

    Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention. © 2017 American Heart Association, Inc.

  8. 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

  9. Long-term safety of repeated high doses of incobotulinumtoxinA injections for the treatment of upper and lower limb spasticity after stroke.

    Science.gov (United States)

    Santamato, Andrea; Panza, Francesco; Intiso, Domenico; Baricich, Alessio; Picelli, Alessandro; Smania, Nicola; Fortunato, Francesca; Seripa, Davide; Fiore, Pietro; Ranieri, Maurizio

    2017-07-15

    Current guidelines suggested a dosage up to 600units (U) of botulinum toxin type A (BoNT-A) (onabotulinumtoxinA or incobotulinumtoxinA) in reducing spastic hypertonia with low prevalence of complications, although a growing body of evidence showed efficacy with the use of high doses (>800U). The available evidence mainly referred to a single set of injections evaluating the efficacy and safety of the neurotoxin 30days after the treatment. In a prospective, non-randomized, open-label study, we studied the safety of repeated higher doses of incobotulinumtoxinA in post-stroke upper and lower limb spasticity. Two years after the first set of injections, we evaluated in 20 stroke survivors with upper and lower limb spasticity the long-term safety of repeated high doses of incobotulinumtoxinA (up to 840U) for a total of eight sets of injections. Patients reported an improvement of their clinical picture concerning a reduction of spasticity measured with the Asworth Scale (AS) for elbow, wrist, fingers and ankle flexor muscles and disability measured with the Disability Assessment Scale (DAS) 30days after the last set of injections (eighth set) compared to the baseline (pspasticity after stroke without general adverse effects. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. MRI versus CT-based thrombolysis treatment within and beyond the 3 h time window after stroke onset: a cohort study.

    Science.gov (United States)

    Köhrmann, Martin; Jüttler, Eric; Fiebach, Jochen B; Huttner, Hagen B; Siebert, Stefan; Schwark, Christian; Ringleb, Peter A; Schellinger, Peter D; Hacke, Werner

    2006-08-01

    Thrombolytic treatment with recombinant tissue plasminogen activator (rtPA) is approved for use within 3 h after stroke onset. Thus only a small percentage of patients can benefit. Meta-analyses and more recent studies suggest a benefit for a subset of patients beyond 3 h. We assessed the safety and efficacy of an MRI-based selection protocol for stroke treatment within and beyond 3 h compared with standard CT-based treatment. We assessed clinical outcome and incidence of symptomatic intracerebral haemorrhage (ICH) in 400 consecutive patients treated with intravenous rtPA. Patients eligible for thrombolysis within 3 h were selected by CT or MRI and beyond 3 h only by MRI. 18 patients were excluded from analysis because of violation of that algorithm. The remaining 382 patients were divided into three groups: CT-based treatment within 3 h (n=209); MRI-based treatment within 3 h (n=103); and MRI-based treatment beyond 3 h (n=70). Patients in group 3 (MRI > 3 h) had a similar 90 day outcome to those in the other two groups (48% were independent in the CT < or = 3 h group, 51% in the MRI < or = 3 h group, and 56% in group 3), but without an increased risk for symptomatic ICH (9%, 1%, 6%) or mortality (21%, 13%, 11%). MRI-selected patients overall had a significantly lower risk than CT-selected patients for symptomatic ICH (3% vs 9%; p=0.013) and mortality (12% vs 21%; p=0.021). Time to treatment did not affect outcomes in univariate and multivariate analyses. Our data suggest that beyond 3 h and maybe even within 3 h, patient selection is more important than time to treatment for a good outcome. Furthermore, MRI-based thrombolysis, irrespective of the time window, shows an improved safety profile while being at least as effective as standard CT-based treatment within 3 h.

  11. Suprascapular nerve block for the treatment of hemiplegic shoulder pain in patients with long-term chronic stroke: a pilot study.

    Science.gov (United States)

    Picelli, Alessandro; Bonazza, Sara; Lobba, Davide; Parolini, Massimo; Martini, Alvise; Chemello, Elena; Gandolfi, Marialuisa; Polati, Enrico; Smania, Nicola; Schweiger, Vittorio

    2017-09-01

    Hemiplegic shoulder pain is the most common pain condition after stroke. Suprascapular nerve block is an effective treatment for shoulder pain. The aim of this pilot study was to evaluate the effects of suprascapular nerve block on pain intensity, spasticity, shoulder passive range of motion, and quality of life in long-term chronic stroke patients with hemiplegic shoulder pain. Ten chronic stroke patients (over 2 years from onset) with hemiplegic shoulder pain graded ≥30 mm on the Visual Analogue Scale underwent suprascapular nerve block injection with 1 mL of 40 mg/mL methylprednisolone and 10 mL 0.5% bupivacaine hydrochloride. Main outcome was the Visual Analogue Scale evaluated before and after nerve block at 1 h, 1 week, and 1 month. Secondary outcomes were the modified Ashworth scale and the shoulder elevation, abduction, and external rotation passive range of motion evaluated before the nerve block and after 1 h as well as the American Chronic Pain Association Quality of Life Scale evaluated before and after nerve block at 1 month. The Visual Analogue Scale significantly improved after nerve block at 1 h (P = 0.005) and 1 week (P = 0.011). Significant improvements were found at 1 h after nerve block in the modified Ashworth scale (P = 0.014) and the passive range of motion of shoulder abduction (P = 0.026), flexion (P = 0.007), and external rotation (P = 0.017). The American Chronic Pain Association Quality of Life Scale significantly improved at 1 month after nerve block (P = 0.046). Our findings support the use of suprascapular nerve block for treating hemiplegic shoulder pain in long-term chronic stroke patients.

  12. 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

  13. Short-term effect of local muscle vibration treatment versus sham therapy on upper limb in chronic post-stroke patients: a randomized controlled trial.

    Science.gov (United States)

    Costantino, Cosimo; Galuppo, Laura; Romiti, Davide

    2017-02-01

    In recent years, local muscle vibration received considerable attention as a useful method for muscle stimulation in clinical therapy. Some studies described specific vibration training protocol, and few of them were conducted on post-stroke patients. Therefore there is a general uncertainty regarding the vibrations protocol. The aim of this study was to evaluate the effects of local muscle high frequency mechano-acoustic vibratory treatment on grip muscle strength, muscle tonus, disability and pain in post-stroke individuals with upper limb spasticity. Single-blind randomized controlled trial. Outpatient rehabilitation center. Thirty-two chronic poststroke patients with upper-limb spasticity: 21 males, 11 females, mean age 61.59 years ±15.50, time passed from stroke 37.78±17.72 months. The protocol treatment consisted of the application of local muscle vibration, set to a frequency of 300 Hz, for 30 minutes 3 times per week, for 12 sessions, applied to the skin covering the venter of triceps brachii and extensor carpi radialis longus and brevis muscles during voluntary isometric contraction. All participants were randomized in two groups: group A treated with vibration protocol; group B with sham therapy. All participants were evaluated before and after 4-week treatment with Hand Grip Strength Test, Modified Ashworth Scale, QuickDASH score, FIM scale, Fugl-Meyer Assessment, Jebsen-Taylor Hand Function Test and Verbal Numerical Rating Scale of pain. Outcomes between groups was compared using a repeated-measures ANOVA. Over 4 weeks, the values recorded in group A when compared to group B demonstrated statistically significant improvement in grip muscle strength, pain and quality of life and decrease of spasticity; P-values were <0.05 in all tested parameters. Rehabilitation treatment with local muscle high frequency (300 Hz) vibration for 30 minutes, 3 times a week for 4 weeks, could significantly improve muscle strength and decrease muscle tonus, disability and

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

    Science.gov (United States)

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

    2017-01-01

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

  15. Assessment and Treatment of Short-Term and Working Memory Impairments in Stroke Aphasia: A Practical Tutorial

    Science.gov (United States)

    Salis, Christos; Kelly, Helen; Code, Chris

    2015-01-01

    Background: Aphasia following stroke refers to impairments that affect the comprehension and expression of spoken and/or written language, and co-occurring cognitive deficits are common. In this paper we focus on short-term and working memory impairments that impact on the ability to retain and manipulate auditory-verbal information. Evidence from…

  16. Factors influencing outcome in acute ischaemic stroke : outcome scales, the role of blood glucose and rtPA treatment

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten

    2008-01-01

    This thesis describes several aspects that influence outcome in acute ischaemic strok. In the first part, two frequently used outcome scales - the Barthel index and modified Rankin scale - are studied and for both scales, optimal endpoints for stroke trials are proposed. In the second part, the

  17. Dehydration, Heat Stroke, or Hyponatremia? The Recognition, Treatment, and Prevention of Hyponatremia Caused by High Exercise Outdoor Activities.

    Science.gov (United States)

    Cochran, Brent

    Hyponatremia (severe sodium depletion) has symptoms similar to heat exhaustion and heat stroke and can easily be misdiagnosed. The number of wilderness users and extreme adventure activities has increased in recent years, and more cases are being diagnosed. Given that a 1993 study found that 1 in 10 cases of heat-related illnesses were…

  18. Stroke as a late treatment effect of Hodgkin's disease : A report from the Childhood Cancer Survivor Study

    NARCIS (Netherlands)

    Bowers, DC; McNeil, DE; Liu, Y; Yasui, Y; Stovall, M; Gurney, JG; Hudson, MM; Donaldson, SS; Packer, RJ; Mitby, PA; Kasper, CE; Robison, LL; Oeffinger, KC

    2005-01-01

    Purpose The objectives of this report are to examine the incidence of and risk factors for stroke among childhood Hodgkin's disease (HD) survivors. Patients and Methods The Childhood Cancer Survivor Study is a multi-institutional cohort study of more than 5-year cancer survivors diagnosed between

  19. The current status of prevention and treatment of exertional heat stroke at home and abroad: from the scene to the hospital

    Directory of Open Access Journals (Sweden)

    De-qiang LUO

    2017-10-01

    Full Text Available Exertional heat stroke (EHS is an emergency with a high mortality rate, characterized by acute onset and identification difficulties. EHS prevention focuses on evaluating the environment by professionals, making preventive measures in advance, identifying internal and external risk factors for the onset of disease, carrying out prior heat adaptation and endurance training, monitoring the status of high risk persons in real time. After occurrence of EHS, the key to success treatment is on-site accurate identification and diagnosis and rapid implementation of effective cooling measures, thus winning time of EHS patients transferred to the hospital for the treatment. This article reviews the current status of EHS prevention and treatment in domestic and foreign from the scene to the hospital. Summarizing the recognition, diagnosis, cooling measures, treatment concepts and principles of EHS, we hope to provide a reference for the rescue of EHS in hospital and outside. DOI: 10.11855/j.issn.0577-7402.2017.08.15

  20. The association between high on-treatment platelet reactivity and early recurrence of ischemic events after minor stroke or TIA.

    Science.gov (United States)

    Rao, Zilong; Zheng, Huaguang; Wang, Fei; Wang, Anxin; Liu, Liping; Dong, Kehui; Zhao, Xingquan; Wang, Yilong; Cao, Yibin

    2017-08-01

    To evaluate the role of HTPR in predicting early recurrence of ischemic events in patients with minor ischemic stroke or high-risk TIA. From January 2014 to September 2014, a single center continuously enrolled patients with minor ischemic stroke or high-risk TIA and gave them antiplatelet therapy consisting of aspirin with clopidogrel. HTPR was assessed by TEG after 7 days of antiplatelet therapy and detected CYP2C19 genotype. The incidence of recurrent ischemic events was assessed 3 months after onset. The incidence of recurrent ischemic events was compared between the HTPR and NTPR groups with the Kaplan-Meier method, and multivariate Cox proportional hazards models were used to determine the risk factors associated with recurrent ischemic events. We enrolled 278 eligible patients with minor ischemic stroke or high-risk TIA. Through TEG testing, patients with HTPR were 22.7%, and carriers were not associated with HTPR to ADP by TEG-ADP(%) (p = 0.193). A total of 265 patients completed 3 months of follow-up, and Kaplan-Meier analysis showed that patients with HTPR had a higher percentage of recurrent ischemic events compared with patients with NTPR (p = 0.002). In multivariate Cox proportional hazards models, history of ischemic stroke or TIA (HR 4.45, 95% CI 1.77-11.16, p = 0.001) and HTPR (HR 3.34, 95% CI 1.41-7.91, p = 0.006) was independently associated with recurrent ischemic events. In patients with minor stroke or TIA, the prevalence of HTPR was 22.7%, and HTPR was independently associated with recurrent ischemic events.

  1. Differentiating intraparenchymal hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients undergoing endovascular treatment

    International Nuclear Information System (INIS)

    Payabvash, Seyedmehdi; Qureshi, Mushtaq H.; Khan, Shayaan M.; Khan, Mahnoor; Majidi, Shahram; Pawar, Swaroop; Qureshi, Adnan I.

    2014-01-01

    This study aimed to identify the imaging characteristics that can help differentiate intraparenchymal hemorrhage from benign contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients after endovascular treatment. We reviewed the clinical and imaging records of all acute ischemic stroke patients who underwent endovascular treatment in two hospitals over a 3.5-year period. The immediate post-procedural CT scan was evaluated for the presence of hyperdense lesion(s). The average attenuation of the lesion(s) was measured. Intraparenchymal hemorrhage was defined as a persistent hyperdensity visualized on follow-up CT scan, 24 h or greater after the procedure. Of the 135 patients studied, 74 (55 %) patients had hyperdense lesion(s) on immediate post-procedural CT scan. Follow-up scans confirmed the diagnosis of intraparenchymal hemorrhage in 20 of these 74 patients. A receiver operating characteristic analysis showed that the average attenuation of the most hyperdense lesion can differentiate intraparenchymal hemorrhage from contrast extravasation with an area under the curve of 0.78 (p = 0.001). An average attenuation of <50 Hounsfield units (HU) in the most visually hyperattenuating hyperdense lesion had 100 % specificity and 56 % sensitivity for identification of contrast extravasations. Petechial hyperdensity was seen in 46/54 (85 %) patients with contrast extravasation versus 9/20 (45 %) patients with intraparenchymal hemorrhage on the immediate post-procedural CT scan (p < 0.001). An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment. (orig.)

  2. Differentiating intraparenchymal hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients undergoing endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Payabvash, Seyedmehdi [Zeenat Qureshi Stroke Institute, Minneapolis, MN (United States); University of Minnesota, Department of Radiology, Minneapolis, MN (United States); Qureshi, Mushtaq H.; Khan, Shayaan M.; Khan, Mahnoor; Majidi, Shahram; Pawar, Swaroop; Qureshi, Adnan I. [Zeenat Qureshi Stroke Institute, Minneapolis, MN (United States)

    2014-09-15

    This study aimed to identify the imaging characteristics that can help differentiate intraparenchymal hemorrhage from benign contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients after endovascular treatment. We reviewed the clinical and imaging records of all acute ischemic stroke patients who underwent endovascular treatment in two hospitals over a 3.5-year period. The immediate post-procedural CT scan was evaluated for the presence of hyperdense lesion(s). The average attenuation of the lesion(s) was measured. Intraparenchymal hemorrhage was defined as a persistent hyperdensity visualized on follow-up CT scan, 24 h or greater after the procedure. Of the 135 patients studied, 74 (55 %) patients had hyperdense lesion(s) on immediate post-procedural CT scan. Follow-up scans confirmed the diagnosis of intraparenchymal hemorrhage in 20 of these 74 patients. A receiver operating characteristic analysis showed that the average attenuation of the most hyperdense lesion can differentiate intraparenchymal hemorrhage from contrast extravasation with an area under the curve of 0.78 (p = 0.001). An average attenuation of <50 Hounsfield units (HU) in the most visually hyperattenuating hyperdense lesion had 100 % specificity and 56 % sensitivity for identification of contrast extravasations. Petechial hyperdensity was seen in 46/54 (85 %) patients with contrast extravasation versus 9/20 (45 %) patients with intraparenchymal hemorrhage on the immediate post-procedural CT scan (p < 0.001). An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment. (orig.)

  3. Pathophysiology and Biomarkers in Acute Ischemic Stroke – A Review

    African Journals Online (AJOL)

    Stroke is one of the major causes of death and disability, including ischemic stroke, which accounts for 85 - 87 % of cases. Currently, there are few treatment options available for minimizing tissue death following a stroke. Emerging data suggest that biomarkers may help improve current clinical outcome of stroke. As such ...

  4. Understanding clinicians' decisions to offer intravenous thrombolytic treatment to patients with acute ischaemic stroke: a protocol for a discrete choice experiment.

    Science.gov (United States)

    De Brún, Aoife; Flynn, Darren; Joyce, Kerry; Ternent, Laura; Price, Christopher; Rodgers, Helen; Ford, Gary A; Lancsar, Emily; Rudd, Matthew; Thomson, Richard G

    2014-07-09

    Intravenous thrombolysis is an effective emergency treatment for acute ischaemic stroke for patients meeting specific criteria. Approximately 12% of eligible patients in England, Wales and Northern Ireland received thrombolysis in the first quarter of 2013, yet as many as 15% are eligible to receive treatment. Suboptimal use of thrombolysis may have been largely attributable to structural factors; however, with the widespread implementation of 24/7 hyper acute stroke services, continuing variation is likely to reflect differences in clinical decision-making, in particular the influence of ambiguous areas within the guidelines, licensing criteria and research evidence. Clinicians' perceptions about thrombolysis may now exert a greater influence on treatment rates than structural/service factors. This research seeks to elucidate factors influencing thrombolysis decision-making by using patient vignettes to identify (1) patient-related and clinician-related factors that may help to explain variation in treatment and (2) associated trade-offs in decision-making based on the interplay of critical factors. A discrete choice experiment (DCE) will be conducted to better understand how clinicians make decisions about whether or not to offer thrombolysis to patients with acute ischaemic stroke. To inform the design, exploratory work will be undertaken to ensure that (1) all potentially influential factors are considered for inclusion; and (2) to gain insights into the 'grey areas' of patient factors. A fractional factorial design will be used to combine levels of patient factors in vignettes, which will be presented to clinicians to allow estimation of the variable effects on decisions to offer thrombolysis. Ethical approval for this study was obtained from the Newcastle University Research Ethics Committee. The results will be disseminated in peer review publications and at national conferences. Findings will be translated into continuing professional development activities

  5. The ThRombolysis in UnconTrolled Hypertension (TRUTH) protocol: an observational study on treatment strategy of elevated blood pressure in stroke patients eligible for IVT.

    Science.gov (United States)

    Zonneveld, T P; Algra, A; Dippel, D W J; Kappelle, L J; van Oostenbrugge, R J; Roos, Y B W E M; Wermer, M J; van der Worp, H B; Nederkoorn, P J; Kruyt, N D

    2015-11-23

    Intravenous thrombolysis (IVT) with (recombinant) tissue plasminogen activator is an effective treatment in acute ischemic stroke. However, IVT is contraindicated when blood pressure is above 185/110 mmHg, because of an increased risk on symptomatic intracranial hemorrhage. In current Dutch clinical practice, two distinct strategies are used in this situation. The active strategy comprises lowering blood pressure with antihypertensive agents below these thresholds to allow start of IVT. In the conservative strategy, IVT is administered only when blood pressure drops spontaneously below protocolled thresholds. A retrospective analysis in two recent stroke trials showed a non-significant signal towards better functional outcome in the active group; robust evidence for either strategy, however, is lacking. We hypothesize that (I) the active strategy leads to a better functional outcome three months after acute ischemic stroke. Secondary hypotheses are that this effect occurs despite (II) increasing the number of symptomatic intracranial hemorrhages, and could be attributable to (III) a higher rate of IVT treatments and (IV) a shorter door-to-needle time. The TRUTH is a prospective, observational, cluster-based, parallel group follow-up study; in which participating centers continue their current local treatment guidelines. Outcomes of patients admitted to centers with an active will be compared to those admitted to centers with a conservative strategy. The primary outcome is functional outcome on the modified Rankin Scale at three months. Secondary outcomes are symptomatic intracranial hemorrhage, IVT treatment and door-to-needle time. We based our sample size estimate on an ordinal analysis of the mRS with the "proportional odds" model. With the aforementioned signal observed in a recent retrospective study in these patients as an estimate of the effect size and with alpha 0 · 05, this analysis would have an 80 % power with a total number of 600 patients

  6. Know Stroke: Know the Signs, Act in Time Video

    Medline Plus

    Full Text Available ... much better chance for a complete recovery. Effective treatment is available for strokes caused by a blood ... And the blood starts flowing again." Announcer: New treatments can limit the disability caused by a stroke, ...

  7. REDUCTION DEGREE OF LOW-DENSITY LIPOPROTEINS CHOLESTEROL LEVELS ACCORDING TO DIFFERENT DOSES OF STATINS; ITS EFFECT ON THE RISK OF ISCHEMIC HEART DISEASE ACUTE EPISODES DEPENDING ON TREATMENT DURATION; AND RISK OF ISCHEMIC AND THROMBOEMBOLIC STROKE. COMMENT ON THE PAPER OF LAW M.R., WALD N.J., RUDNICKA A.R. QUANTIFYING EFFECT OF STATINS ON LOW DENSITY LIPOPROTEIN CHOLESTEROL, ISCHAEMIC HEART DISEASE, AND STROKE: SYSTEMATIC REVIEW AND META-ANALYSIS. BMJ 2003; 326:1423-1427

    Directory of Open Access Journals (Sweden)

    N. V. Perova

    2011-01-01

    Full Text Available Comparative dose-dependent ability of different statins to lower serum low-density lipoproteins (LDL cholesterol was determined in three large meta-analysis. Besides, it was found that standardized decrease in LDL cholesterol levels on 1.0 or 1.8 mmol/l leads to rate reduction in ischemic heart disease acute episodes as well as stroke depending on treatment duration. Effect of LDL cholesterol reduction on stroke occurrence was more significant in studies, which included a major share of patients with vascular disease, because these patients have a higher risk of thromboembolic stroke (rather than haemorrhagic stroke in comparison with the general population.

  8. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta

    2014-01-01

    Full Text Available Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  9. Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke).

    Science.gov (United States)

    Froehler, Michael T; Saver, Jeffrey L; Zaidat, Osama O; Jahan, Reza; Aziz-Sultan, Mohammad Ali; Klucznik, Richard P; Haussen, Diogo C; Hellinger, Frank R; Yavagal, Dileep R; Yao, Tom L; Liebeskind, David S; Jadhav, Ashutosh P; Gupta, Rishi; Hassan, Ameer E; Martin, Coleman O; Bozorgchami, Hormozd; Kaushal, Ritesh; Nogueira, Raul G; Gandhi, Ravi H; Peterson, Eric C; Dashti, Shervin R; Given, Curtis A; Mehta, Brijesh P; Deshmukh, Vivek; Starkman, Sidney; Linfante, Italo; McPherson, Scott H; Kvamme, Peter; Grobelny, Thomas J; Hussain, Muhammad S; Thacker, Ike; Vora, Nirav; Chen, Peng Roc; Monteith, Stephen J; Ecker, Robert D; Schirmer, Clemens M; Sauvageau, Eric; Abou-Chebl, Alex; Derdeyn, Colin P; Maidan, Lucian; Badruddin, Aamir; Siddiqui, Adnan H; Dumont, Travis M; Alhajeri, Abdulnasser; Taqi, M Asif; Asi, Khaled; Carpenter, Jeffrey; Boulos, Alan; Jindal, Gaurav; Puri, Ajit S; Chitale, Rohan; Deshaies, Eric M; Robinson, David H; Kallmes, David F; Baxter, Blaise W; Jumaa, Mouhammad A; Sunenshine, Peter; Majjhoo, Aniel; English, Joey D; Suzuki, Shuichi; Fessler, Richard D; Delgado Almandoz, Josser E; Martin, Jerry C; Mueller-Kronast, Nils H

    2017-12-12

    Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation. STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours. Patients underwent MT with or without intravenous tissue plasminogen activator and were admitted to endovascular-capable centers via either interhospital transfer or direct presentation. The primary clinical outcome was functional independence (modified Rankin Score 0-2) at 90 days. We assessed (1) real-world time metrics of stroke care delivery, (2) outcome differences between direct and transfer patients undergoing MT, and (3) the potential impact of local hospital bypass. A total of 984 patients were analyzed. Median onset-to-revascularization time was 202.0 minutes for direct versus 311.5 minutes for transfer patients ( P <0.001). Clinical outcomes were better in the direct group, with 60.0% (299/498) achieving functional independence compared with 52.2% (213/408) in the transfer group (odds ratio, 1.38; 95% confidence interval, 1.06-1.79; P =0.02). Likewise, excellent outcome (modified Rankin Score 0-1) was achieved in 47.4% (236/498) of direct patients versus 38.0% (155/408) of transfer patients (odds ratio, 1.47; 95% confidence interval, 1.13-1.92; P =0.005). Mortality did not differ between the 2 groups (15.1% for direct, 13.7% for transfer; P =0.55). Intravenous tissue plasminogen activator did not impact outcomes. Hypothetical bypass

  10. Depressive symptoms following stroke and transient ischemic attack: is it time for a more intensive treatment approach? results from the TABASCO cohort study.

    Science.gov (United States)

    Tene, Oren; Shenhar-Tsarfaty, Shani; Korczyn, Amos D; Kliper, Efrat; Hallevi, Hen; Shopin, Ludmila; Auriel, Eitan; Mike, Anat; Bornstein, Natan M; Assayag, Einor Ben

    2016-05-01

    To examine whether depressive symptoms after a stroke or a transient ischemic attack (TIA) increase the risk of cognitive impairment and functional deterioration at 2-year follow-up. Participants were survivors of first-ever, mild-to-moderate ischemic stroke or TIA from the TABASCO prospective cohort study who underwent 3T magnetic resonance imaging and were examined by a multiprofessional team 6, 12, and 24 months after the event using direct interviews, depression scales, and neurologic, neuropsychological, and functional evaluations. The main outcome was the development of cognitive impairment, either mild cognitive impairment (MCI) or dementia. MCI was diagnosed by a decline on at least 1 cognitive domain (≥ 1.5 SD) of the Montreal Cognitive Assessment score and/or on the computerized neuropsychological battery, as compared with age- and education-matched published norms. Dementia was diagnosed by a consensus forum that included senior neurologists specializing in memory disorders and a neuropsychologist. Data were obtained from 306 consecutive eligible patients (mean age: 67.1 ± 10.0 years) who were admitted to the department of emergency medicine at the Tel Aviv Medical Center from April 1, 2008, to December 1, 2011, within 72 hours from onset of symptoms of TIA or stroke. Of these patients, 51 (16.7%) developed cognitive impairment during a 2-year follow-up. Multivariate regression analysis showed that a Geriatric Depression Scale (GDS) score ≥ 6 at admission and at 6 months after the event was a significant independent marker of cognitive impairment 2 years after the stroke/TIA (OR = 3.62, 95% CI, 1.01-13.00; OR = 3.68, 95% CI, 1.03-13.21, respectively). A higher GDS score at 6 months was also related to a worse functional outcome (P depression screening among stroke and TIA survivors as a tool to identify patients who are prone to have a worse cognitive and functional outcome. These patients may benefit from closer medical surveillance and a more

  11. Selection of Patients and Anesthetic Types for Endovascular Treatment in Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Fubing Ouyang

    Full Text Available and Purpose Recent randomized controlled trials have demonstrated consistent effectiveness of endovascular treatment (EVT for acute ischemic stroke, leading to update on stroke management guidelines. We conducted this meta-analysis to assess the efficacy and safety of EVT overall and in subgroups stratified by age, baseline stroke severity, brain imaging feature, and anesthetic type.Published randomized controlled trials comparing EVT and standard medical care alone were evaluated. The measured outcomes were 90-day functional independence (modified Rankin Scale ≤2, all-cause mortality, and symptomatic intracranial hemorrhage.Nine trials enrolling 2476 patients were included (1338 EVT, 1138 standard medical care alone. For patients with large vessel occlusions confirmed by noninvasive vessel imaging, EVT yielded improved functional outcome (pooled odds ratio [OR], 2.02; 95% confidence interval [CI], 1.64-2.50, lower mortality (OR, 0.75; 95% CI, 0.58-0.97, and similar symptomatic intracranial hemorrhage rate (OR, 1.12; 95% CI, 0.72-1.76 compared with standard medical care. A higher proportion of functional independence was seen in patients with terminus intracranial artery occlusion (±M1 (OR, 3.16; 95% CI, 1.64-6.06, baseline Alberta Stroke Program Early CT score of 8-10 (OR, 2.11; 95% CI, 1.25-3.57 and age ≤70 years (OR, 3.01; 95% CI, 1.73-5.24. EVT performed under conscious sedation had better functional outcomes (OR, 2.08; 95% CI, 1.47-2.96 without increased risk of symptomatic intracranial hemorrhage or short-term mortality compared with general anesthesia.Vessel-imaging proven large vessel occlusion, a favorable scan, and younger age are useful predictors to identify anterior circulation stroke patients who may benefit from EVT. Conscious sedation is feasible and safe in EVT based on available data. However, firm conclusion on the choice of anesthetic types should be drawn from more appropriate randomized controlled trials.

  12. Investigation into the formation of PAHs in foods prepared in the home to determine the effects of frying, grilling, barbecuing, toasting and roasting.

    Science.gov (United States)

    Rose, Martin; Holland, Joe; Dowding, Alan; Petch, Steve R G; White, Shaun; Fernandes, Alwyn; Mortimer, David

    2015-04-01

    The effects of frying, grilling, barbecuing, toasting and roasting on the formation of 27 different PAHs in foods were investigated. A total of 256 samples from in-house cooking experiments were produced. There was little evidence of PAH formation during the grilling, frying, roasting and toasting experiments. Comparison with the raw materials used in the experiments showed little or no increase in PAH concentrations for all of the sample types, regardless of distances from the heat source, cooking mediums and intensity of cooking conditions. Barbecuing with charcoal plus wood chips however resulted in the formation of benzo[a]pyrene in most foods; for beef burgers only, barbecuing over charcoal (without the use of wood chips) gave the highest levels. In general PAH levels increased when the food was barbequed closer to the heat source. For sausages cooked over briquettes, and for beef burgers, beef and salmon cooked over charcoal, the concentration of PAHs was lower when the food was closer to the heat source. Cooking time may result in a moderate increase of PAHs in some foods, although concentrations in beef burgers appeared to fall when cooking time was extended by 50-100%. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  13. EuroHYP-1: European multicenter, randomized, phase III clinical trial of therapeutic hypothermia plus best medical treatment vs. best medical treatment alone for acute ischemic stroke.

    Science.gov (United States)

    van der Worp, H Bart; Macleod, Malcolm R; Bath, Philip M W; Demotes, Jacques; Durand-Zaleski, Isabelle; Gebhardt, Bernd; Gluud, Christian; Kollmar, Rainer; Krieger, Derk W; Lees, Kennedy R; Molina, Carlos; Montaner, Joan; Roine, Risto O; Petersson, Jesper; Staykov, Dimitre; Szabo, Istvan; Wardlaw, Joanna M; Schwab, Stefan

    2014-07-01

    Cooling reduced infarct size and improved neurological outcomes in animal studies modeling ischemic stroke, and also improved outcome in randomized clinical trials in patients with hypoxic-ischemic brain injury after cardiac arrest. Cooling awake patients with ischemic stroke has been shown feasible in phase II clinical trials. To determine whether systemic cooling to a target body temperature between 34·0 and 35·0°C, started within six-hours of symptom onset and maintained for 24 h, improves functional outcome at three-months in patients with acute ischemic stroke. International, multicenter, phase III, randomized, open-label clinical trial with blinded outcome assessment in 1500 patients aged 18 years or older with acute ischemic stroke and a National Institutes of Health Stroke Scale score of 6 up to and including 18. In patients randomized to hypothermia, cooling to a target body temperature of 34-35°C will be started within six-hours after symptom onset with rapid intravenous infusion of refrigerated normal saline or a surface cooling technique and maintained for 24 h with a surface or endovascular technique. Patients randomized to hypothermia will receive pethidine and buspirone to prevent shivering and discomfort. Score on the modified Rankin Scale at 91 days, as analyzed with ordinal logistic regression and expressed as a common odds ratio. With 750 patients per intervention group, this trial has 90% power to detect 7% absolute improvement at the 5% significance level. The full trial protocol is available at http://www.eurohyp1.eu. ClinicalTrials.gov Identifier: NCT01833312. © 2014 World Stroke Organization.

  14. 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

  15. [Impact on the gait time cycle of ischemic stroke in the treatment with yin-yang respiratory reinforcing and reducing needling technique].

    Science.gov (United States)

    Li, Qi; Tian, Fu-Ling; Liu, Guo-Rong; Zheng, De-Song; Chen, Jin-Ming; Ma, Shu-Riang; Cui, Jian-Mei; Wang, Hong-Bin; Li, Xue-Qing

    2014-03-01

    To compare the difference in the efficacy on gait time cycle of ischemic stroke between yin-yang respiratory reinforcing and reducing needling technique (yin-yang needling) and the conventional acupuncture. Sixty cases of ischemic stroke were randomized into a conventional acupuncture group and a yin-yang needling group, 30 cases in each one. The basic treatment (the control of blood pressure, blood sugar and blood lipid, the intravenous drops of ginkgo leaf extract and dipyridamole injection and vinpocetine injection) were applied in the two groups. Additionally, in the conventional acupuncture group, the acupoints of the Stomach Meridian of Foot-Yangming [Biguan (ST 31), Liangqiu (ST 34), Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), etc.] were selected and stimulated with the even needling technique. In the yin-yang needling group, the acupoints of yin meridians such as Zuwuli (LR 10), Xuehai (SP 10), Yinlingquan (SP 9) and Sanyinjiao (SP 6), etc. and the acupoints of yang meridians such as Biguan (ST 31), Liangqiu (ST 34) and Yanglingquan (GB 34), etc. were selected. The reducing manipulation of respiratory reinforcing and reducing technique was applied to the acupoints of yin meridians and the reinforcing manipulation was applied to the acupoints of yang meridians. The kinematics time parameters were determined and compared before and 4 weeks after treatment. After treatment, the differences in the gait cycle, the phase time of standing (%), the phase time of single support (%), the phase time of unilateral sway (%) on the affected (healthy) foot and phase time of double support (%) were significant as compared with those before treatment in the patients of the two groups (all P yin-yang needling group were improved much obviously after treatment as compared with those in the conventional acupuncture group. The differences in support phase time (%), single support phase time (%) and sway phase time (%) were significant between the affected limb and

  16. Identification of stroke mimics among clinically diagnosed acute strokes.

    Science.gov (United States)

    Tuntiyatorn, Lojana; Saksornchai, Pichaya; Tunlayadechanont, Supoch

    2013-09-01

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

  17. The URICO-ICTUS study, a phase 3 study of combined treatment with uric acid and rtPA administered intravenously in acute ischaemic stroke patients within the first 4.5 h of onset of symptoms.

    Science.gov (United States)

    Amaro, Sergio; Cánovas, David; Castellanos, Mar; Gállego, Jaime; Martí-Fèbregas, Joan; Segura, Tomás; Chamorro, Angel

    2010-08-01

    Oxidative stress is a major contributor to brain damage in patients with ischaemic stroke. Uric acid (UA) is a potent endogenous antioxidant molecule. In experimental ischaemia in rats, the exogenous administration of uric acid is neuroprotective and enhances the effect of rtPA. Moreover, in acute stroke patients receiving rtPA within 3 h of stroke onset, the intravenous administration of uric acid is safe, prevents an early decline in uric acid levels and reduces an early increase in oxidative stress markers and in active matrix metalloproteinase nine levels. To determine whether the combined treatment with uric acid and rtPA is superior to rtPA alone in terms of clinical efficacy in acute ischaemic stroke patients treated within the first 4.5 h of onset of symptoms. Multicentre, interventional, randomised, double-blind and vehicle-controlled efficacy study with parallel assignment (1 : 1). Estimated enrolment: 420 patients over 3 years, starting in January 2010. Treatment arms included patients will receive a single intravenous infusion of 1 g of UA dissolved in a vehicle (500 ml of 0.1% lithium carbonate and 5% mannitol) (n=210) or vehicle alone (n=210). the study will include patients older than 18 years, treated with rtPA within the first 4.5 h of clinical onset and with a baseline National Institute of Health Stroke Scale score >6 and or =4 points of increase in the National Institute of Health Stroke Scale score).

  18. Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms.

    Science.gov (United States)

    Hall, Shelby L; Munich, Stephan A; Cress, Marshall C; Rangel-Castilla, Leonardo; Levy, Elad I; Snyder, Kenneth V; Siddiqui, Adnan H

    2016-02-04

    Combining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24-48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period. We aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014. We identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed. Four patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs -0.09, respectively; p=0.0008). This study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Studying post-stroke functional impairment after treatment with neural progenitor cells – an analysis of behavioral tests

    Directory of Open Access Journals (Sweden)

    Thorsten R. Doeppner

    2014-10-01

    Full Text Available Systemic transplantation of neural progenitor cells (NPCs in rodents reduces functional impairment after cerebral ischemia. In light of upcoming stroke trials regarding safety and feasibility of NPC transplantation, experimental studies have to successfully analyze the extent of NPC-induced neurorestoration on the functional level. However, appropriate behavioral tests for analysis of post-stroke motor coordination deficits and cognitive impairment after NPC grafting are not fully established. We therefore exposed male C57BL6 mice to either 45 min (mild or 90 min (severe of cerebral ischemia, using the thread occlusion model followed by intravenous injection of PBS or NPCs 6 h post-stroke with an observation period of three months. Post-stroke motor coordination was assessed by means of the rota rod, tight rope, corner turn, inclined plane, grip strength, foot fault, adhesive removal, pole test and balance beam test, whereas cognitive impairment was analyzed using the water maze, the open field and the passive avoidance test. Significant motor coordination differences after both mild and severe cerebral ischemia in favor of NPC-treated mice were observed for each motor coordination test except for the inclined plane and the grip strength test, which only showed significant differences after severe cerebral ischemia. Cognitive impairment after mild cerebral ischemia was successfully assessed using the water maze test, the open field and the passive avoidance test. On the contrary, the water maze test was not suitable in the severe cerebral ischemia paradigm, as it too much depends on motor coordination capabilities of test mice. In terms of both reliability and cost-effectiveness considerations, we thus recommend the corner turn, foot fault, balance beam, and open field test, which do not depend on durations of cerebral ischemia.

  20. Hip Hop Stroke: Study Protocol for a Randomized Controlled Trial to Address Stroke Literacy.

    Science.gov (United States)

    Williams, Olajide; Leighton-Herrmann, Ellyn; DeSorbo, Alexandra; Hecht, Mindy; Hedmann, Monique; Huq, Saima; Gerin, William; Chinchilli, Vernon; Ogedegbe, Gbenga; Noble, James

    2015-10-01

    Stroke is the fifth leading cause of death and the leading cause of serious long-term adult disability in the US. Acute stroke treatments with intravenous thrombolysis and endovascular therapy are proven to reduce disability, however a critical limitation on their effectiveness is the narrow time window for administration, which is 4.5 hours and 6 hours respectively from the onset of symptoms. Our overarching goal is to reduce pre-hospital delays to acute stroke treatments in economically disadvantaged minority communities where the greatest delays exist, using Hip Hop Stroke. Hip Hop Stroke (HHS) is a school-based, child-mediated, culturally-tailored stroke communication multimedia intervention developed using validated models of behavior change and designed to improve stroke literacy (knowledge of stroke symptoms, the urgent need to call 911, and prevention measures) of 4 th , 5 th and 6 th grade students and their parents residing in poor urban communities. Children in the intervention arm will receive the HHS intervention, while those in the attentional control arm will receive standardized nutrition education based on the USDA's MyPyramid program. Children will be trained and motivated to share stroke information with their parents or other adult caregiver. Both children and parents will complete a stroke knowledge assessment at baseline, immediately following the program, and at 3-months post-program. The primary outcome is the effect of the child mediation on parental stroke literacy. Stroke literate children, a captive audience in school systems, may represent a viable channel for spreading stroke information into households of poor urban communities where mass media stroke campaigns have shown the lowest penetration. These children may also call 911 when witnessing a stroke in their homes or communities. The HHS program may highlight the potential role of children in the chain of stroke recovery as a strategy for reducing prehospital delays to acute stroke

  1. Results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial by stroke subtypes

    DEFF Research Database (Denmark)

    Amarenco, Pierre; Benavente, Oscar; Goldstein, Larry B

    2009-01-01

    BACKGROUND AND PURPOSE: The SPARCL trial showed that atorvastatin 80 mg/d reduces the risk of stroke and other cardiovascular events in patients with recent stroke or transient ischemic attack (TIA). We tested the hypothesis that the benefit of treatment varies according to index event stroke sub...

  2. Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN)

    NARCIS (Netherlands)

    Yoo, Albert J.; Berkhemer, Olvert A.; Fransen, Puck S. S.; van den Berg, Lucie A.; Beumer, Debbie; Lingsma, Hester F.; Schonewille, Wouter J.; Sprengers, Marieke E. S.; van den Berg, René; van Walderveen, Marianne A. A.; Beenen, Ludo F. M.; Wermer, Marieke J. H.; Nijeholt, Geert J. Lycklama À; Boiten, Jelis; Jenniskens, Sjoerd F. M.; Bot, Joseph C. J.; Boers, Anna M. M.; Marquering, Henk A.; Roos, Yvo B. W. E. M.; van Oostenbrugge, Robert J.; Dippel, Diederik W. J.; van der Lugt, Aad; van Zwam, Wim H.; Majoie, Charles B. L. M.

    2016-01-01

    Whether infarct size modifies intra-arterial treatment effect is not certain, particularly in patients with large infarcts. We examined the effect of the baseline Alberta Stroke Program Early CT Score (ASPECTS) on the safety and efficacy of intra-arterial treatment in a subgroup analysis of the

  3. Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN)

    NARCIS (Netherlands)

    Yoo, A.J.; Berkhemer, O.A.; Fransen, P.S.; Berg, L.A. van den; Beumer, D.; Lingsma, H.F.; Schonewille, W.J.; Sprengers, M.E.; Berg, R. van den; Walderveen, M.A. van; Beenen, L.F.; Wermer, M.J.; Nijeholt, G.J.; Boiten, J.; Jenniskens, S.F.M.; Bot, J.C.; Boers, A.M.; Marquering, H.A.; Roos, Y.B.; Oostenbrugge, R.J. van; Dippel, D.W.; Lugt, A. van der; Zwam, W.H. van; Majoie, C.B.; et al.,

    2016-01-01

    BACKGROUND: Whether infarct size modifies intra-arterial treatment effect is not certain, particularly in patients with large infarcts. We examined the effect of the baseline Alberta Stroke Program Early CT Score (ASPECTS) on the safety and efficacy of intra-arterial treatment in a subgroup analysis

  4. Stroke prevention: an update.

    Science.gov (United States)

    Bousser, Marie-Germaine

    2012-03-01

    Stroke is a personal, familial, and social disaster. It is the third cause of death worldwide, the first cause of acquired disability, the second cause of dementia, and its cost is astronomic. The burden of stroke is likely to increase given the aging of the population and the growing incidence of many vascular risk factors. Prevention of stroke includes--as for all other diseases--a "mass approach" aiming at decreasing the risk at the society level and an individual approach, aiming at reducing the risk in a given subject. The mass approach is primarily based on the identification and treatment of vascular risk factors and, if possible, in the implementation of protective factors. These measures are the basis of primary prevention but most of them have now been shown to be also effective in secondary prevention. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli. There is a growing awareness of the huge evidence-to-practice gap that exists in stroke prevention largely due to socio-economic factors. Recent approaches include low cost intervention packages to reduce blood pressure and cheap "polypills" combining in a single tablet aspirin and several drugs to lower blood pressure and cholesterol. Polypill intake should however not lead to abandon the healthy life-style measures which remain the mainstay of stroke prevention.

  5. Acute Stroke Imaging Research Roadmap

    Science.gov (United States)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Köhrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Wu, Ona; Warach, Steven

    2009-01-01

    The recent “Advanced Neuroimaging for Acute Stroke Treatment” meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), industry representatives, and members of the US Food and Drug Administration (FDA) to discuss the role of advanced neuroimaging in acute stroke treatment. The goals of the meeting were to assess state-of-the-art practice in terms of acute stroke imaging research and to propose specific recommendations regarding: (1) the standardization of perfusion and penumbral imaging techniques, (2) the validation of the accuracy and clinical utility of imaging markers of the ischemic penumbra, (3) the validation of imaging biomarkers relevant to clinical outcomes, and (4) the creation of a central repository to achieve these goals. The present article summarizes these recommendations and examines practical steps to achieve them. PMID:18477656

  6. Auditory Hallucinations in Acute Stroke

    Directory of Open Access Journals (Sweden)

    Yair Lampl

    2005-01-01

    Full Text Available Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

  7. 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)

  8. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial.

    Science.gov (United States)

    Middleton, Sandy; McElduff, Patrick; Ward, Jeanette; Grimshaw, Jeremy M; Dale, Simeon; D'Este, Catherine; Drury, Peta; Griffiths, Rhonda; Cheung, N Wah; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique; Levi, Christopher

    2011-11-12

    We assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence-based management of fever, hyperglycaemia, and swallowing dysfunction in acute stroke units (ASUs). In the Quality in Acute Stroke Care (QASC) study, a single-blind cluster randomised controlled trial, we randomised ASUs (clusters) in New South Wales, Australia, with immediate access to CT and on-site high dependency units, to intervention or control group. Patients were eligible if they spoke English, were aged 18 years or older, had had an ischaemic stroke or intracerebral haemorrhage, and presented within 48 h of onset of symptoms. Intervention ASUs received treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction with multidisciplinary team building workshops to address implementation barriers. Control ASUs received only an abridged version of existing guidelines. We recruited pre-intervention and post-intervention patient cohorts to compare 90-day death or dependency (modified Rankin scale [mRS] ≥2), functional dependency (Barthel index), and SF-36 physical and mental component summary scores. Research assistants, the statistician, and patients were masked to trial groups. All analyses were done by intention to treat. This trial is registered at the Australia New Zealand Clinical Trial Registry (ANZCTR), number ACTRN12608000563369. 19 ASUs were randomly assigned to intervention (n=10) or control (n=9). Of 6564 assessed for eligibility, 1696 patients' data were obtained (687 pre-intervention; 1009 post-intervention). Results showed that, irrespective of stroke severity, intervention ASU patients were significantly less likely to be dead or dependent (mRS ≥2) at 90 days than control ASU patients (236 [42%] of 558 patients in the intervention group vs 259 [58%] of 449 in the control group, p=0·002; number needed to treat 6·4; adjusted absolute difference 15·7% [95% CI 5·8-25·4]). They also had a

  9. Stroke characterization in Sun Saharan Africa: Congolese population.

    Science.gov (United States)

    Limbole, Emmanuel Bakilo; Magne, Julien; Lacroix, Philippe

    2017-08-01

    Stroke is the second cause of death worldwide and over than 80% of deaths occurs in developing countries. However, its characteristics in the Democratic Republic of Congo (DRC) are poorly defined. This study aimed to describe the key features of stroke in a hospital population of Kinshasa in DRC and to assess the frequency of cardiovascular risk factors and their impact on target organs. A descriptive study was carried out from three hospitals in Kinshasa between January and April 2013. Cardiovascular risk factors, clinical and biological data were collected during the study period. The study involved 166 patients aged 18years and over. The mean age of patients was 59.6±12.3years, the sex ratio for male of 1.9. Stroke was ischemic in 66% of cases. Hypertension was the most frequent cardiovascular risk factor (84.3%), followed by high blood cholesterol (45.2%).The etiologies of ischemic stroke (TOAST classification) were dominated by lacunas (38.5%) and embolic heart diseases (12.8%). The origin was unknown in 45.9% of cases. Coma was observed in 37% of patients on admission and was the main independent prognostic factor of mortality, which was 19.3%. Left ventricular hypertrophy and renal failure were found respectively in 64.7% and 34% of patients. This study found a growing increase of ischemic stroke in a society where hemorrhagic type used to be the most common, a high rate of hypertension, hypercholesterolemia and diabetes, indicative of a fast epidemiological transition. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Diagnosis in stroke - an uptake

    International Nuclear Information System (INIS)

    Aichner, F.T.

    2003-01-01

    In practical day-to-day terms, most patients have one of the common causes of stroke: ischemic stroke caused by the complications of atherothrombosis, intracranial small vessel disease, embolism from the heart, primary intracerebral hemorrhage caused by hypertension, or subarachnoid hemorrhage as a result of a ruptured saccular aneurysm. There are three issues to be considered in assessing the reliability of the clinical diagnosis of stroke: the diagnosis of stroke itself: is it a stroke or not; whether the stroke is caused by an infarct or a hemorrhage and particular in ischemic stroke the site and size of the lesion (anterior vs. posterior circulation, lacunar vs. cortical, etc.). No clinical scoring method can differentiate with absolute reliability ischemic stroke from primary intracerebral hemorrhage. To do this brain computed tomography or magnetic resonance imaging is required. For vascular diagnosis ultrasound and magnetic resonance angiography are ideal and complementary non-invasive techniques. Both have no risks and are reasonably sensitive. Catheterangiography is only reserved for patients with subarachnoid hemorrhage with a view to surgical or endovascular treatment or in exceptional cases to establish a more firm prognosis. The diagnosis of ischemic stroke caused by embolism from the heart can only be considered at all if there is an identifiable cardioembolic source which is the case in about 30 % of ischemic stroke, a higher proportion in recent studies using transoesophageal echocardiography. It is not clear that transoesophageal echocardiography provides much more information for clinical decision-making than transthoracic echocardiography, although it certainly provides more anatomical information in selected patients. This article summarizes the diagnostic armamentarium which is used for the diagnosis of stroke and gives an overview of clinically reliable and relevant measures. Refs. 23 (author)

  11. 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 ...

  12. Serum YKL-40, a prognostic marker in patients with large-artery atherosclerotic stroke.

    Science.gov (United States)

    Chen, X-L; Li, Q; Huang, W-S; Lin, Y-S; Xue, J; Wang, B; Jin, K-L; Shao, B

    2017-08-01

    Inflammation comprises important aspects of large-artery atherosclerosis (LAA) stroke pathophysiology. YKL-40 is a new and emerging biomarker that is associated with both acute and chronic inflammations. Elevated serum concentrations of YKL-40 have been reported in patients with atherosclerosis and other cardiovascular diseases. This study investigates whether serum YKL-40 concentrations on admission can predict 3-month clinical outcomes after LAA stroke. We recruited control patients (n=85) and those with LAA stroke (n=141) according to the TOAST classification system. The modified Rankin scale at 3 months after stroke was used to evaluate the prognosis. The prognostic accuracy was assessed by the receiver operating characteristic curve. Serum YKL-40 level was significantly higher for LAA patients than for controls (P40 concentrations on admission (P=.01). High YKL-40 levels predicted poor functional outcome (OR=6.47, P=.02). Moreover, the combination of YKL-40 level and the NIHSS score could improve the prognostic accuracy of the NIHSS in predicting functional outcome (combined areas under the curve, 0.87; 95% CI, 0.80-0.94; P40 is a significant and independent biomarker to predict the clinical outcome of LAA stroke. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Effect of Prior Atorvastatin Treatment on the Frequency of Hospital Acquired Pneumonia and Evolution of Biomarkers in Patients with Acute Ischemic Stroke: A Multicenter Prospective Study

    Directory of Open Access Journals (Sweden)

    Yuetian Yu

    2017-01-01

    Full Text Available Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP. Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n=268, PG and no prior treatment group (n=224, NG. All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC, procalcitonin (PCT, tumor necrosis factor-alpha (TNF-α, and interleukin-6 (IL-6] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p>0.05 and 28-day mortality (50.72% versus 58.18%, p>0.05. However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP (36.54% versus 58.14%, p=0.041 and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p=0.038. Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p<0.01. Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry.

  14. Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands).

    Science.gov (United States)

    Mulder, Maxim J H L; Ergezen, Saliha; Lingsma, Hester F; Berkhemer, Olvert A; Fransen, Puck S S; Beumer, Debbie; van den Berg, Lucie A; Lycklama À Nijeholt, Geert; Emmer, Bart J; van der Worp, H Bart; Nederkoorn, Paul J; Roos, Yvo B W E M; van Oostenbrugge, Robert J; van Zwam, Wim H; Majoie, Charles B L M; van der Lugt, Aad; Dippel, Diederik W J

    2017-07-01

    High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT. This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms. Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09-1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP. BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP. URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758. © 2017 American Heart Association, Inc.

  15. A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers.

    Science.gov (United States)

    Flynn, Darren; Ford, Gary A; Stobbart, Lynne; Rodgers, Helen; Murtagh, Madeleine J; Thomson, Richard G

    2013-06-18

    Tools to support clinical or patient decision-making in the treatment/management of a health condition are used in a range of clinical settings for numerous preference-sensitive healthcare decisions. Their impact in clinical practice is largely dependent on their quality across a range of domains. We critically analysed currently available tools to support decision making or patient understanding in the treatment of acute ischaemic stroke with intravenous thrombolysis, as an exemplar to provide clinicians/researchers with practical guidance on development, evaluation and implementation of such tools for other preference-sensitive treatment options/decisions in different clinical contexts. Tools were identified from bibliographic databases, Internet searches and a survey of UK and North American stroke networks. Two reviewers critically analysed tools to establish: information on benefits/risks of thrombolysis included in tools, and the methods used to convey probabilistic information (verbal descriptors, numerical and graphical); adherence to guidance on presenting outcome probabilities (IPDASi probabilities items) and information content (Picker Institute Checklist); readability (Fog Index); and the extent that tools had comprehensive development processes. Nine tools of 26 identified included information on a full range of benefits/risks of thrombolysis. Verbal descriptors, frequencies and percentages were used to convey probabilistic information in 20, 19 and 18 tools respectively, whilst nine used graphical methods. Shortcomings in presentation of outcome probabilities (e.g. omitting outcomes without treatment) were identified. Patient information tools had an aggregate median Fog index score of 10. None of the tools had comprehensive development processes. Tools to support decision making or patient understanding in the treatment of acute stroke with thrombolysis have been sub-optimally developed. Development of tools should utilise mixed methods and

  16. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia.

    Science.gov (United States)

    Sun, Shu-Fen; Hsu, Chien-Wei; Lin, Huey-Shyan; Sun, Hsien-Pin; Chang, Ping-Hsin; Hsieh, Wan-Ling; Wang, Jue-Long

    2013-12-01

    Dysphagia is common after stroke. Neuromuscular electrical stimulation (NMES) and fiberoptic endoscopic evaluation of swallowing (FEES) for the treatment of dysphagia have gained in popularity, but the combined application of these promising modalities has rarely been studied. We aimed to evaluate whether combined NMES, FEES, and traditional swallowing rehabilitation can improve swallowing functions in stroke patients with moderate to severe dysphagia. Thirty-two patients with moderate to severe dysphagia poststroke (≥3 weeks) were recruited. Patients received 12 sessions of NMES for 1 h/day, 5 days/week within a period of 2-3 weeks. FEES was done before and after NMES for evaluation and to guide dysphagic therapy. All patients subsequently received 12 sessions of traditional swallowing rehabilitation (50 min/day, 3 days/week) for 4 weeks. Primary outcome measure was the Functional Oral Intake Scale (FOIS). Secondary outcome measures included clinical degree of dysphagia, the patient's self-perception of swallowing ability, and the patient's global satisfaction with therapy. Patients were assessed at baseline, after NMES, at 6-month follow-up, and at 2-year follow-up. Twenty-nine patients completed the study. FOIS, degree of dysphagia, and patient's self-perception of swallowing improved significantly after NMES, at the 6-month follow-up, and at the 2-year follow-up (p rehabilitation showed promise for improving swallowing functions in stroke patients with moderate-to-severe dysphagia. The benefits were maintained for up to 2 years. The results are promising enough to justify further studies.

  17. High-density lipoprotein-based therapy reduces the hemorrhagic complications associated with tissue plasminogen activator treatment in experimental stroke.

    Science.gov (United States)

    Lapergue, Bertrand; Dang, Bao Quoc; Desilles, Jean-Philippe; Ortiz-Munoz, Guadalupe; Delbosc, Sandrine; Loyau, Stéphane; Louedec, Liliane; Couraud, Pierre-Olivier; Mazighi, Mikael; Michel, Jean-Baptiste; Meilhac, Olivier; Amarenco, Pierre

    2013-03-01

    We have previously reported that intravenous injection of high-density lipoproteins (HDLs) was neuroprotective in an embolic stroke model. We hypothesized that HDL vasculoprotective actions on the blood-brain barrier (BBB) may decrease hemorrhagic transformation-associated with tissue plasminogen activator (tPA) administration in acute stroke. We used tPA alone or in combination with HDLs in vivo in 2 models of focal middle cerebral artery occlusion (MCAO) (embolic and 4-hour monofilament MCAO) and in vitro in a model of BBB. Sprague-Dawley rats were submitted to MCAO, n=12 per group. The rats were then randomly injected with tPA (10 mg/kg) or saline with or without human plasma purified-HDL (10 mg/kg). The therapeutic effects of HDL and BBB integrity were assessed blindly 24 hours later. The integrity of the BBB was also tested using an in vitro model of human cerebral endothelial cells under oxygen-glucose deprivation. tPA-treated groups had significantly higher mortality and rate of hemorrhagic transformation at 24 hours in both MCAO models. Cotreatment with HDL significantly reduced stroke-induced mortality versus tPA alone (by 42% in filament MCAO, P=0.009; by 73% in embolic MCAO, P=0.05) and tPA-induced intracerebral parenchymal hematoma (by 92% in filament MCAO, by 100% in embolic MCAO; Phemorrhagic transformation in rat models of MCAO. Both in vivo and in vitro results support the vasculoprotective action of HDLs on BBB under ischemic conditions.

  18. Relevance of blood-brain barrier disruption after endovascular treatment of ischemic stroke: dual-energy computed tomographic study.

    Science.gov (United States)

    Renú, Arturo; Amaro, Sergio; Laredo, Carlos; Román, Luis San; Llull, Laura; Lopez, Antonio; Urra, Xabier; Blasco, Jordi; Oleaga, Laura; Chamorro, Ángel

    2015-03-01

    Computed tomographic (CT) high attenuation (HA) areas after endovascular therapy for acute ischemic stroke are a common finding indicative of blood-brain barrier disruption. Dual-energy CT allows an accurate differentiation between HA areas related to contrast staining (CS) or to brain hemorrhage (BH). We sought to evaluate the prognostic significance of the presence of CS and BH after endovascular therapy. A prospective cohort of 132 patients treated with endovascular therapy was analyzed. According to dual-energy CT findings, patients were classified into 3 groups: no HA areas (n=53), CS (n=32), and BH (n=47). The rate of new hemorrhagic transformations was recorded at follow-up neuroimaging. Clinical outcome was evaluated at 90 days with the modified Rankin Scale (poor outcome, 3-6). Poor outcome was associated with the presence of CS (odds ratio [OR], 11.3; 95% confidence interval, 3.34-38.95) and BH (OR, 10.4; 95% confidence interval, 3.42-31.68). The rate of poor outcome despite complete recanalization was also significantly higher in CS (OR, 9.7; 95% confidence interval, 2.55-37.18) and BH (OR, 15.1; 95% confidence interval, 3.85-59.35) groups, compared with the no-HA group. Patients with CS disclosed a higher incidence of delayed hemorrhagic transformation at follow-up (OR, 4.5; 95% confidence interval, 1.22-16.37) compared with no-HA patients. Blood-brain barrier disruption, defined as CS and BH on dual-energy CT, was associated with poor clinical outcomes in patients with stroke treated with endovascular therapies. Moreover, isolated CS was associated with delayed hemorrhagic transformation. These results support the clinical relevance of blood-brain barrier disruption in acute stroke. © 2015 American Heart Association, Inc.

  19. 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

  20. The effect of obstructive sleep apnea and treatment with continuous positive airway pressure on stroke rehabilitation: rationale, design and methods of the TOROS study

    NARCIS (Netherlands)

    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 A.

    2014-01-01

    Obstructive sleep apnea is a common sleep disorder in stroke patients. Obstructive sleep apnea is associated with stroke severity and poor functional outcome. Continuous positive airway pressure seems to improve functional recovery in stroke rehabilitation. To date, the effect of continuous positive

  1. The effect of obstructive sleep apnea and treatment with continuous positive airway pressure on stroke rehabilitation: rationale, design and methods of the TOROS study

    NARCIS (Netherlands)

    Aaronson, J.A.; van Bennekom, C.A.M.; Hofman, W.F.; van Bezeij, T.; van den Aardweg, J.G.; Groet, E.; Kylstra, W.A.; Schmand, B.A.

    2014-01-01

    BACKGROUND: Obstructive sleep apnea is a common sleep disorder in stroke patients. Obstructive sleep apnea is associated with stroke severity and poor functional outcome. Continuous positive airway pressure seems to improve functional recovery in stroke rehabilitation. To date, the effect of

  2. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry.

    Directory of Open Access Journals (Sweden)

    Ajay K Kakkar

    Full Text Available Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated.The Global Anticoagulant Registry in the FIELD (GARFIELD is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5 took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults (≥18 years diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with ≥1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes, and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD age of the population was 70.2 (11.2 years; 43.2% were women. Mean±SD CHADS2 score was 1.9±1.2, and 57.2% had a score ≥2. Mean CHA2DS2-VASc score was 3.2±1.6, and 8,957 (84.4% had a score ≥2. Overall, 38.0% of patients with a CHADS2 score ≥2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (score 0 received anticoagulant therapy.These contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke.ClinicalTrials.gov TRI08888.

  3. Risk Profiles and Antithrombotic Treatment of Patients Newly Diagnosed with Atrial Fibrillation at Risk of Stroke: Perspectives from the International, Observational, Prospective GARFIELD Registry

    Science.gov (United States)

    Kakkar, Ajay K.; Mueller, Iris; Bassand, Jean-Pierre; Fitzmaurice, David A.; Goldhaber, Samuel Z.; Goto, Shinya; Haas, Sylvia; Hacke, Werner; Lip, Gregory Y. H.; Mantovani, Lorenzo G.; Turpie, Alexander G. G.; van Eickels, Martin; Misselwitz, Frank; Rushton-Smith, Sophie; Kayani, Gloria; Wilkinson, Peter; Verheugt, Freek W. A.

    2013-01-01

    Background Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated. Methods and Findings The Global Anticoagulant Registry in the FIELD (GARFIELD) is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5) took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults (≥18 years) diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with ≥1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes), and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD) age of the population was 70.2 (11.2) years; 43.2% were women. Mean±SD CHADS2 score was 1.9±1.2, and 57.2% had a score ≥2. Mean CHA2DS2-VASc score was 3.2±1.6, and 8,957 (84.4%) had a score ≥2. Overall, 38.0% of patients with a CHADS2 score ≥2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (score 0) received anticoagulant therapy. Conclusions These contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke

  4. Wen Dan Decoction for hemorrhagic stroke and ischemic stroke.

    Science.gov (United States)

    Xu, Jia-Hua; Huang, Yan-Mei; Ling, Wei; Li, Yang; Wang, Min; Chen, Xiang-Yan; Sui, Yi; Zhao, Hai-Lu

    2015-04-01

    The use of traditional Chinese medicine (TCM) in stroke is increasing worldwide. Here we report the existing clinical evidence of the Pinellia Ternata containing formula Wen Dan Decoction (WDD) for the treatment of ischemic stroke and hemorrhagic stroke. PubMed, CNKI, Wan Fang database, Cochrane Library and online Clinical Trial Registry were searched up to 26 February 2013 for randomized, controlled clinical trials (RCTs) using WDD as intervention versus Western conventional medicine as control to treat stroke. Clinical outcomes were improvement of the