Sample records for stroke volume decreased

  1. Serum Soluble Corin is Decreased in Stroke. (United States)

    Peng, Hao; Zhu, Fangfang; Shi, Jijun; Han, Xiujie; Zhou, Dan; Liu, Yan; Zhi, Zhongwen; Zhang, Fuding; Shen, Yun; Ma, Juanjuan; Song, Yulin; Hu, Weidong


    Soluble corin was decreased in coronary heart disease. Given the connections between cardiac dysfunction and stroke, circulating corin might be a candidate marker of stroke risk. However, the association between circulating corin and stroke has not yet been studied in humans. Here, we aimed to examine the association in patients wtith stroke and community-based healthy controls. Four hundred eighty-one patients with ischemic stroke, 116 patients with hemorrhagic stroke, and 2498 healthy controls were studied. Serum soluble corin and some conventional risk factors of stroke were examined. Because circulating corin was reported to be varied between men and women, the association between serum soluble corin and stroke was evaluated in men and women, respectively. Patients with ischemic and hemorrhagic stroke had a significantly lower level of serum soluble corin than healthy controls in men and women (all P values, stroke than men in the highest quartile. Women in the lowest quartile of serum soluble corin were also more likely to have ischemic (OR, 3.10; 95% confidence interval, 1.76-5.44) and hemorrhagic (OR, 8.54; 95% confidence interval, 2.35-31.02) stroke than women in the highest quartile. ORs of ischemic and hemorrhagic stroke were significantly increased with the decreasing levels of serum soluble corin in men and women (all P values for trend, stroke compared with healthy controls. Our findings raise the possibility that serum soluble corin may have a pathogenic role in stroke. © 2015 American Heart Association, Inc.


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    Harmayetty Harmayetty


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

  3. Volume of Plasma Expansion and Functional Outcomes in Stroke. (United States)

    Miller, Joseph B; Lewandowski, Christopher; Wira, Charles R; Taylor, Andrew; Burmeister, Charlotte; Welch, Robert


    Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke. This was a secondary analysis of data from the Albumin in Acute Stroke Part 2 trial investigating the relationship between the magnitude of overall intravenous volume infusion (crystalloid and colloid) to clinical outcome. The data were inclusive of 841 patients with a mean age of 64 years and a median National Institutes of Health Stroke Scale (NIHSS) of 11. In a multivariable-adjusted logistic regression model, this analysis tested the volume of plasma expansion over the first 48 h of hospitalization as a predictor of favorable outcome, defined as either a modified Rankin Scale score of 0 or 1 or a NIHSS score of 0 or 1 at 90 days. This model included all study patients, irrespective of albumin or isotonic saline treatment. Patients that received higher volumes of plasma expansion more frequently had large vessel ischemic stroke and higher NIHSS scores. The multivariable-adjusted model revealed that there was decreased odds of a favorable outcome for every 250 ml additional volume plasma expansion over the first 48 h (OR 0.91, 95 % CI, 0.88-0.94). The present study demonstrates an association between greater volume of plasma expansion and worse neurological recovery.

  4. Clinically significant change in stroke volume in pulmonary hypertension

    NARCIS (Netherlands)

    van Wolferen, S.A.; van de Veerdonk, M.C.; Mauritz, G.J.; Jacobs, W.; Marcus, J.T.; Marques, K.M.J.; Bronzwaer, J.G.F.; Heijmans, M.W.; Boonstra, A.; Postmus, P.E.; Westerhof, N.; Noordegraaf, A.V.


    Background: Stroke volume is probably the best hemodynamic parameter because it reflects therapeutic changes and contains prognostic information in pulmonary hypertension (PH). Stroke volume directly reflects right ventricular function in response to its load, without the correction of compensatory

  5. Dynamics of myelin content decrease in the rat stroke model (United States)

    Kisel, A.; Khodanovich, M.; Atochin, D.; Mustafina, L.; Yarnykh, V.


    The majority of studies were usually focused on neuronal death after brain ischemia; however, stroke affects all cell types including oligodendrocytes that form myelin sheath in the CNS. Our study is focused on the changes of myelin content in the ischemic core and neighbor structures in early terms (1, 3 and 10 days) after stroke. Stroke was modeled with middle cerebral artery occlusion (MCAo) in 15 male rats that were divided into three groups by time points after operation. Brain sections were histologically stained with Luxol Fast Blue (LFB) for myelin quantification. The significant demyelination was found in the ischemic core, corpus callosum, anterior commissure, whereas myelin content was increased in caudoputamen, internal capsule and piriform cortex compared with the contralateral hemisphere. The motor cortex showed a significant increase of myelin content on the 1st day and a significant decrease on the 3rd and 10th days after MCAo. These results suggest that stroke influences myelination not only in the ischemic core but also in distant structures.

  6. Clinically significant change in stroke volume in pulmonary hypertension. (United States)

    van Wolferen, Serge A; van de Veerdonk, Marielle C; Mauritz, Gert-Jan; Jacobs, Wouter; Marcus, J Tim; Marques, Koen M J; Bronzwaer, Jean G F; Heymans, Martijn W; Boonstra, Anco; Postmus, Pieter E; Westerhof, Nico; Vonk Noordegraaf, Anton


    Stroke volume is probably the best hemodynamic parameter because it reflects therapeutic changes and contains prognostic information in pulmonary hypertension (PH). Stroke volume directly reflects right ventricular function in response to its load, without the correction of compensatory increased heart rate as is the case for cardiac output. For this reason, stroke volume, which can be measured noninvasively, is an important hemodynamic parameter to monitor during treatment. However, the extent of change in stroke volume that constitutes a clinically significant change is unknown. The aim of this study was to determine the minimal important difference (MID) in stroke volume in PH. One hundred eleven patients were evaluated at baseline and after 1 year of follow-up with a 6-min walk test (6MWT) and cardiac MRI. Using the anchor-based method with 6MWT as the anchor, and the distribution-based method, the MID of stroke volume change could be determined. After 1 year of treatment, there was, on average, a significant increase in stroke volume and 6MWT. The change in stroke volume was related to the change in 6MWT. Using the anchor-based method, an MID of 10 mL in stroke volume was calculated. The distribution-based method resulted in an MID of 8 to 12 mL. Both methods showed that a 10-mL change in stroke volume during follow-up should be considered as clinically relevant. This value can be used to interpret changes in stroke volume during clinical follow-up in PH.


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    Prasantha Kumar Thankappan


    Full Text Available BACKGROUND Stroke is a major cause of long term morbidity and mortality. Several factors are known to increase the liability to stroke. Platelets play a crucial role in the pathogenesis of atherosclerotic complications, contributing to thrombus formation. Platelet size (mean platelet volume, MPV is a marker and possible determinant of platelet function, large platelets being potentially more reactive. Hence an attempt has-been made to study the association if any between mean platelet volume and thrombotic stroke. The aim of this study was to determine whether an association exists between Mean Platelet Volume (MPV and thrombotic stroke. MATERIALS AND METHODS The study is a case control study and data was collected at Government Medical College Hospital, Kottayam, Kerala a tertiary care referral centre. The study was carried out among fifty patients diagnosed with thrombotic stroke and presenting to the hospital within forty eight hours of onset of symptoms. Fifty age group and sex matched controls were also recruited. Mean platelet volume was obtained using a SYSMEX automated analyser. RESULTS This study has shown a statistically significant relation between mean platelet volume and risk of thrombotic stroke but no statistically significant correlation between clinical severity of stroke and mean platelet volume. CONCLUSION This study has shown an elevation of MPV in acute phase of thrombotic stroke. Platelet mass was found to be more or less a constant. This study did not find a statistically significant correlation between clinical severity of stroke and mean platelet volume.

  8. Endovascular stroke treatment in a small-volume stroke center. (United States)

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


    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.

  9. Decreased cerebral metabolism in stroke-prone spontaneously hypertensive rats (SHRSP) with stroke and its possible improvement by Solcoseryl. (United States)

    Yamasaki, Y; Yamamoto, Y; Senga, Y; Isogai, M; Shimizu, H; Yamori, Y


    Local cerebral glucose utilization (LCGU) was decreased in SHRSP with stroke compared with normotensive Wistar rats. The decrement of LCGU was less in Solcoseryl-treated SHRSP with stroke than that in saline-treated SHRSP with stroke and these brain areas where LCGU was less damaged, in Solcoseryl-treated SHRSP were consistent with the important functioning sites of emotion, motor movement and memory. The result suggests that Solcoseryl may be useful for metabolic improvement of the brain damage after stroke.

  10. Optimising stroke volume and oxygen delivery in abdominal aortic surgery

    DEFF Research Database (Denmark)

    Bisgaard, J; Gilsaa, T; Rønholm, E


    , intraoperatively and post-operatively. Patients were followed up for 30 days. RESULTS: Stroke volume index and oxygen delivery index were both higher in the post-operative period in the intervention group. In this group, 27 of 32 achieved the post-operative oxygen delivery index target vs. 18 of 32 in the control...... group, stroke volume was optimised by 250 ml colloid boluses intraoperatively and for the first 6 h post-operatively. The optimisation aimed at an oxygen delivery of 600 ml/min/m(2) in the post-operative period. Haemodynamic data were collected at pre-defined time points, including baseline...... group (P = 0.01). However, the number of complications per patient or length of stay in the intensive care unit or hospital did not differ between the groups. CONCLUSION: Perioperative individualised goal-directed therapy targeting stroke volume and oxygen delivery did not affect post...

  11. Decreased mean platelet volume in panic disorder

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    Göğçegöz Gül I


    Full Text Available Işil Göğçegöz Gül, Gül Eryilmaz, Eylem Özten, Gökben Hizli Sayar Neuropsychiatry Health, Practice, and Research Center, Uskudar University, Istanbul, Turkey Aim: The relationship between psychological stress and platelet activation has been widely studied. It is well known that platelets may reflect certain biochemical changes that occur in the brain when different mental conditions occur. Platelet 5-hydroxytryptamine (5-HT is also extensively studied in psychiatry. The mean platelet volume (MPV, the accurate measure of platelet size, has been considered a marker and determinant of platelet function. The aim of the present study was to search for any probable difference in the MPV of subjects with panic disorder (PD.Methods: A total of 37 drug-free subjects, aged 18 to 65 years, diagnosed with PD, with or without agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV criteria and 45 healthy control subjects were included in the study. Platelet count and MPV were measured and recorded for each subject.Results: There were no statistically significant differences between groups in terms of female/male ratio, age, or body mass index between the PD group and control group (P=0.91, P=0.82, and P=0.93, respectively. The MPV was found to be significantly lower in the PD group compared with the control group (8.8±0.9 fL vs 9.2±0.8 fL; P=0.02. All the participants had MPV values in the standard range of 6.9–10.8 fL.Conclusion: We concluded that abnormalities of the 5-HT1A receptor function in the central nervous system of subjects with a diagnosis of PD are also mirrored in as an alteration in platelet activity. Measurements of platelet activity may be used as a tool for neuropsychiatric and psychopharmacological research and for studying how certain mental diseases and medications affect the central nervous system. Keywords: 5-HT, thrombocyte, anxiety 

  12. Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

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    Lee Su-Ho


    Full Text Available Abstract Background Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results Among the 500 patients (median 67 years, 62% men, the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313. Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381, knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633 and use of ambulance (OR 1.961, 95% CI 1.176-3.270 were significantly associated with early arrival. Conclusions In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.

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

    DEFF Research Database (Denmark)

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


    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...

  14. Association of mean platelet volume and platelet count with the development and prognosis of ischemic and hemorrhagic stroke. (United States)

    Du, J; Wang, Q; He, B; Liu, P; Chen, J-Y; Quan, H; Ma, X


    Mean platelet volume (MPV) and platelet (PLT) count are the two major parameters that reflect the functions and activities of PLTs. The associations of MPV and PLT count with the occurrence and prognosis of stroke have not been fully clarified. This study aimed to investigate the association of MPV and PLT count with the development and prognosis of first-ever ischemic and hemorrhagic stroke in order to provide evidence for early diagnosis and treatment of both strokes. This study included 281 first-ever ischemic stroke and 164 first-ever hemorrhagic stroke patients between 2010 and 2012. All participants received routine blood tests within 2 h after admission and were categorized into good or poor prognosis group based on the Modified Rankin Scale (mRS) score. MPV and PLT counts were transformed into categorical variables and their association with the occurrence and prognosis of both strokes was evaluated by multivariate logistic regression. The risk of ischemic and hemorrhagic stroke in MPV group (>13 fL) was 22.17 and 5.21 times higher compared with normal MPV group. The PLT count was positively correlated with the risk of ischemic stroke, but negatively correlated with the risk of hemorrhagic stroke. MPV and PLT count was not correlated with the prognosis of either stroke. Increased MPV is an independent risk factor for both strokes. Elevated PLT count increases the risk for ischemic stroke, but decreases the risk for hemorrhagic stroke. However, neither MPV nor PLT count has significant association with the prognosis of either stroke. © 2016 John Wiley & Sons Ltd.

  15. The association of insular stroke with lesion volume

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    Nishanth Kodumuri


    Full Text Available The insula has been implicated in many sequelae of stroke. It is the area most commonly infarcted in people with post-stroke arrhythmias, loss of thermal sensation, hospital acquired pneumonia, and apraxia of speech. We hypothesized that some of these results reflect the fact that: (1 ischemic strokes that involve the insula are larger than strokes that exclude the insula (and therefore are associated with more common and persistent deficits; and (2 insular involvement is a marker of middle cerebral artery (MCA occlusion. We analyzed MRI scans of 861 patients with acute ischemic hemispheric strokes unselected for functional deficits, and compared infarcts involving the insula to infarcts not involving the insula using t-tests for continuous variables and chi square tests for dichotomous variables. Mean infarct volume was larger for infarcts including the insula (n = 232 versus excluding the insula (n = 629: 65.8 ± 78.8 versus 10.2 ± 15.9 cm3 (p < 0.00001. Even when we removed lacunar infarcts, mean volume of non-lacunar infarcts that included insula (n = 775 were larger than non-lacunar infarcts (n = 227 that excluded insula: 67.0 cm3 ± 79.2 versus 11.5 cm3 ± 16.7 (p < 0.00001. Of infarcts in the 90th percentile for volume, 87% included the insula (χ2 = 181.8; p < 0.00001. Furthermore, 79.0% infarcts due to MCA occlusion included the insula; 78.5% of infarcts without MCA occlusion excluded the insula (χ2 = 93.1; p < 0.0001. The association between insular damage and acute or chronic sequelae likely often reflects the fact that insular infarct is a marker of large infarcts caused by occlusion of the MCA more than a specific role of the insula in a range of functions. Particularly in acute stroke, some deficits may also be due to ischemia of the MCA or ICA territory caused by large vessel occlusion.

  16. Moderate intensity supine exercise causes decreased cardiac volumes and increased outer volume variations: a cardiovascular magnetic resonance study. (United States)

    Steding-Ehrenborg, Katarina; Jablonowski, Robert; Arvidsson, Per M; Carlsson, Marcus; Saltin, Bengt; Arheden, Håkan


    The effects on left and right ventricular (LV, RV) volumes during physical exercise remains controversial. Furthermore, no previous study has investigated the effects of exercise on longitudinal contribution to stroke volume (SV) and the outer volume variation of the heart. The aim of this study was to determine if LV, RV and total heart volumes (THV) as well as cardiac pumping mechanisms change during physical exercise compared to rest using cardiovascular magnetic resonance (CMR). 26 healthy volunteers (6 women) underwent CMR at rest and exercise. Exercise was performed using a custom built ergometer for one-legged exercise in the supine position during breath hold imaging. Cardiac volumes and atrio-ventricular plane displacement were determined. Heart rate (HR) was obtained from ECG. HR increased during exercise from 60±2 to 94±2 bpm, (pexercise although not statistically significant (p=0.18). Longitudinal contribution to RVSV decreased during exercise by -6±15% (pexercise by -4±1%, (pexercise from 5.9±0.5% to 9.7±0.6% (pexercise. THV becomes significantly smaller due to decreases in RVEDV whilst LVEDV remains unchanged. THVV and consequently radial pumping increases during exercise which may improve diastolic suction during the rapid filling phase.

  17. Charting cognitive and volumetric trajectories after stroke: protocol for the Cognition And Neocortical Volume After Stroke (CANVAS) study. (United States)

    Brodtmann, Amy; Werden, Emilio; Pardoe, Heath; Li, Qi; Jackson, Graeme; Donnan, Geoffrey; Cowie, Tiffany; Bradshaw, Jennifer; Darby, David; Cumming, Toby


    Globally, stroke and dementia are leading causes of disability and mortality. More than one third of stroke patients will develop dementia, but mechanisms are unclear. The study aims to establish whether brain volume change is associated with poststroke dementia, and to elucidate potential causal mechanisms, including genetic markers, amyloid deposition and vascular risk factors. An understanding of whether - and in whom - stroke is neurodegenerative is critical for the strategic use of potential disease-modifying therapies. That stroke patients will exhibit greater brain volume loss than comparable cohorts of stroke-free controls; and that those who develop dementia will exhibit greater brain volume loss than those who do not. Advanced brain imaging techniques are used to longitudinally measure brain volume and cortical thickness in 135 stroke patients. Concurrent neuropsychological testing will correlate clinical profile with these measures. Primary imaging end-point is brain volume change between three-months and three-years poststroke; primary clinical outcome is the presence of dementia at three-years. We will examine the correlations with the following variables: dementia subtype; physical activity levels; behavioral dysfunction as measured by patient and caregiver-reported scales; structural and functional brain connectivity disruption; apolipoprotein E; and specific neuropsychological test scores. Magnetic resonance imaging markers of structural brain aging and performance on neuropsychological tests are powerful predictors of dementia. We need to understand the trajectory of regional brain volume change and cognitive decline in patients after stroke. This will allow future risk stratification for prognostic counseling, service planning, and early therapeutic intervention. © 2014 World Stroke Organization.

  18. Characterization of regulatory volume decrease in freshly isolated mouse cholangiocytes. (United States)

    Cho, Won Kyoo


    Cell volume regulation plays a vital role in many cell functions. Recent study indicates that both K(+) and Cl(-) channels are important for the regulatory volume decrease (RVD) of cholangiocarcinoma cells, but its physiological significance is unclear due to the tumorous nature of the cells used. This present study reports the RVD of normal mouse cholangiocytes by using freshly isolated bile duct cell clusters (BDCC). A relatively simple and practical method of measuring the cross-sectional area of BDCCs by quantitative videomicroscopy was used to indirectly measure their volumes. Mouse cholangiocytes exhibited RVD, which was inhibited by 5-nitro-2'-(3-phenylpropylamino)-benzoate, DIDS, and glibenclamide, suggesting its dependence on certain chloride channels, such as volume-activated chloride channels. It is also inhibited by barium chloride but not by tetraethylammonium chloride, indicating its dependence on certain potassium channels. However, cAMP agonists had no significant effect on the RVD of BDCCs. This indirect method described can be used to study the RVD of cholangiocytes from normal as well as genetically altered mouse livers.

  19. Changes in superior mesenteric artery Doppler waveform during reduction of cardiac stroke volume and hypotension

    DEFF Research Database (Denmark)

    Perko, M J; Perko, Grazyna; Just, S


    the hypovolemia. Alterations in pV and pulsatility indices were closely related to changes in stroke volume, and a negative correlation was found between diastolic velocities and stroke volume. regression analysis showed no significant relation between variations in velocity parameters and blood pressure. Results...

  20. Acute effects of volume-oriented incentive spirometry on chest wall volumes in patients after a stroke. (United States)

    Lima, Illia Ndf; Fregonezi, Guilherme Af; Melo, Rodrigo; Cabral, Elis Ea; Aliverti, Andrea; Campos, Tânia F; Ferreira, Gardênia Mh


    The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls. Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry. Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P = .001) and under 3 conditions (P spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to VT was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P = .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P = .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P = .14). Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation. Copyright © 2014 by Daedalus Enterprises.

  1. Splenectomy reduces infarct volume and neuroinflammation in male but not female mice in experimental stroke (United States)

    Dotson, Abby L.; Wang, Jianming; Saugstad, Julie; Murphy, Stephanie J.; Offner, Halina


    The peripheral immune response contributes to neurodegeneration after stroke yet little is known about how this process differs between males and females. The current study demonstrates that splenectomy prior to experimental stroke eliminates sex differences in infarct volume and activated brain monocytes/microglia. In the periphery of both sexes, activated T cells correlate directly with stroke outcome while monocytes are reduced by splenectomy only in males. This study provides new information about the sex specific mechanisms of the peripheral immune response in neurodegeneration after stroke and demonstrates the need for representation of both sexes in basic and clinical stroke research. PMID:25434281

  2. Stroke rates and diving air volumes of emperor penguins: implications for dive performance. (United States)

    Sato, Katsufumi; Shiomi, Kozue; Marshall, Greg; Kooyman, Gerald L; Ponganis, Paul J


    Emperor penguins (Aptenodytes forsteri), both at sea and at an experimental dive hole, often have minimal surface periods even after performance of dives far beyond their measured 5.6 min aerobic dive limit (ADL: dive duration associated with the onset of post-dive blood lactate accumulation). Accelerometer-based data loggers were attached to emperor penguins diving in these two different situations to further evaluate the capacity of these birds to perform such dives without any apparent prolonged recovery periods. Minimum surface intervals for dives as long as 10 min were less than 1 min at both sites. Stroke rates for dives at sea were significantly greater than those for dives at the isolated dive hole. Calculated diving air volumes at sea were variable, increased with maximum depth of dive to a depth of 250 m, and decreased for deeper dives. It is hypothesized that lower air volumes for the deepest dives are the result of exhalation of air underwater. Mean maximal air volumes for deep dives at sea were approximately 83% greater than those during shallow (emperor penguins, (b) stroke rate at sea is greater than at the isolated dive hole and, therefore, a reduction in muscle stroke rate does not extend the duration of aerobic metabolism during dives at sea, and (c) a larger diving air volume facilitates performance of deep dives by increasing the total body O(2) store to 68 ml O(2) kg(-1). Although increased O(2) storage and cardiovascular adjustments presumably optimize aerobic metabolism during dives, enhanced anaerobic capacity and hypoxemic tolerance are also essential for longer dives. This was exemplified by a 27.6 min dive, after which the bird required 6 min before it stood up from a prone position, another 20 min before it began to walk, and 8.4 h before it dived again.

  3. Decreased diaphragm excursion in stroke patients with dysphagia as assessed by M-mode sonography. (United States)

    Park, Geun-Young; Kim, Seong-Rim; Kim, Young Woo; Jo, Kwang Wook; Lee, Eu Jeen; Kim, Young Moon; Im, Sun


    To record diaphragm excursion via M-mode ultrasonography in stroke patients with dysphagia and determine whether they present reduced diaphragm excursion during voluntary cough compared with stroke patients without dysphagia and healthy subjects. Prospective cross-sectional study. University rehabilitation hospital. Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia (n=24), and healthy control participants (n=27) (N=74). Not applicable. Diaphragm motions during quiet breathing, deep breathing, and voluntary coughing were recorded via ultrasonography using M-mode tracing (mm). Maximum inspiratory and expiratory pressures (cmH2O) and peak cough flow (L/min) during voluntary coughing were measured. The mean diaphragm movement (mm) of the hemiplegic side for all groups during quiet breathing, deep breathing, and voluntary coughing was 14.8±4.3, 17.6±4.8, and 20.9±3.7 (Pdysphagia explained up to 60% (Pdysphagia have decreased diaphragm excursion and compromised respiratory function during voluntary coughing. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Cell Volume Regulation and Apoptotic Volume Decrease in Rat Distal Colon Superficial Enterocytes

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    Stefania Antico


    Full Text Available Background: The colon epithelium is physiologically exposed to osmotic stress, and the activation of cell volume regulation mechanisms is essential in colonocyte physiology. Moreover, colon is characterized by a high apoptotic rate of mature cells balancing the high division rate of stem cells. Aim: The aim of the present work was to investigate the main cell volume regulation mechanisms in rat colon surface colonocytes and their role in apoptosis. Methods: Cell volume changes were measured by light microscopy and video imaging on colon explants; apoptosis sign appearance was monitored by confocal microscopy on annexin V/propidium iodide labeled explants. Results: Superficial colonocytes showed a dynamic regulation of their cell volume during anisosmotic conditions with a Regulatory Volume Increase (RVI response following hypertonic shrinkage and Regulatory Volume Decrease (RVD response following hypotonic swelling. RVI was completely inhibited by bumetanide, while RVD was completely abolished by high K+ or iberiotoxin treatment and by extracellular Ca2+ removal. DIDS incubation was also able to affect the RVD response. When colon explants were exposed to H2O2 as apoptotic inducer, colonocytes underwent an isotonic volume decrease ascribable to Apoptotic Volume Decrease (AVD within about four hours of exposure. AVD was shown to precede annexin V positivity. It was also inhibited by high K+ or iberiotoxin treatment. Interestingly, treatment with iberiotoxin significantly inhibited apoptosis progression. Conclusions: In rat superficial colonocytes K+ efflux through high conductance Ca2+-activated K+ channels (BK channels was demonstrated to be the main mechanism of RVD and to plays also a crucial role in the AVD process and in the progression of apoptosis.

  5. The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients

    Directory of Open Access Journals (Sweden)

    Thanakiatpinyo T


    Full Text Available Thanitta Thanakiatpinyo,1 Supakij Suwannatrai,2 Ueamphon Suwannatrai,2 Phanitanong Khumkaew,2 Dokmai Wiwattamongkol,2 Manmas Vannabhum,2 Somluck Pianmanakit,1 Vilai Kuptniratsaikul1 1Department of Rehabilitation Medicine, 2Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Purpose: To study the efficacy of traditional Thai massage (TTM versus conventional physical therapy (PT programs in treating muscle spasticity, functional ability, anxiety, depression, and quality of life (QoL in Thai stroke patients.Methods: This randomized controlled trial with a blinded assessor was carried out at the Department of Rehabilitation Medicine, Siriraj Hospital (Bangkok, Thailand. The study included 50 stroke (onset ≥3 months outpatients experiencing spasticity at the elbow or knee muscles at a grade of ≥1+ on the modified Ashworth Scale who were ≥50 years old and able to communicate. The subjects were randomly allocated to the treatment group receiving TTM (24 subjects or the control group receiving the PT program (26 subjects. Both groups received treatment (either TTM or PT twice a week for 6 weeks. Spasticity grade, functional ability, anxiety, depression, and QoL were measured at Week 0 and Week 6.Results: At Week 6, the percentage of patients whose modified Ashworth Scale score had decreased by at least one grade was not statistically significant between the two groups. Both TTM and PT groups experienced a significant increase in functional ability and QoL, but no difference was found between the groups. Anxiety and depression scores showed a decreasing trend in the TTM group.Conclusion: This preliminary report showed no evidence that TTM differed from the PT program in decreasing spasticity. However, both interventions may relieve spasticity, increase functional ability, and improve QoL after 6 weeks. Only TTM can decrease anxiety and depression scores. Further studies with

  6. Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humans

    DEFF Research Database (Denmark)

    van Lieshout, J J; Harms, M P M; Pott, F


    The stroke volume (SV) of the heart depends on the diastolic volume but, for the intact organism, central pressures are applied widely to express the filling of the heart.......The stroke volume (SV) of the heart depends on the diastolic volume but, for the intact organism, central pressures are applied widely to express the filling of the heart....

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

    Directory of Open Access Journals (Sweden)

    Aleksandra Jotic


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

  8. Prediction of final infarct volume on subacute MRI by quantifying cerebral edema in ischemic stroke. (United States)

    Tipirneni-Sajja, Aaryani; Christensen, Soren; Straka, Matus; Inoue, Manabu; Lansberg, Maarten G; Mlynash, Michael; Bammer, Roland; Parsons, Mark W; Donnan, Geoffrey A; Davis, Stephen M; Albers, Gregory W


    Final infarct volume in stroke trials is assessed on images obtained between 30 and 90 days after stroke onset. Imaging at such delayed timepoints is problematic because patients may be lost to follow-up or die before the scan. Obtaining an early assessment of infarct volume on subacute scans avoids these limitations; however, it overestimates true infarct volume because of edema. The aim of this study was to develop a novel approach to quantify edema so that final infarct volumes can be approximated on subacute scans. We analyzed data from 20 stroke patients (median age, 75 years) who had baseline, subacute (fu5d) and late (fu90d) MRI scans. Edema displaces CSF from sulci and ventricles; therefore, edema volume was estimated as change in CSF volume between baseline and spatially coregistered fu5d ADC maps. The median (interquartile range, IQR) estimated edema volume was 13.3 (7.5-37.7) mL. The fu5d lesion volumes correlated well with fu90d infarct volumes with slope: 1.24. With edema correction, fu5d infarct volumes are in close agreement, slope: 0.97 and strongly correlated with actual fu90d volumes. The median (IQR) difference between actual and predicted infarct volumes was 0.1 (-3.0-5.7) mL. In summary, this novel technique for estimation of edema allows final infarct volume to be predicted from subacute MRI.

  9. Neurogenesis upregulation on the healthy hemisphere after stroke enhances compensation for age-dependent decrease of basal neurogenesis. (United States)

    Adamczak, Joanna; Aswendt, Markus; Kreutzer, Christina; Rotheneichner, Peter; Riou, Adrien; Selt, Marion; Beyrau, Andreas; Uhlenküken, Ulla; Diedenhofen, Michael; Nelles, Melanie; Aigner, Ludwig; Couillard-Despres, Sebastien; Hoehn, Mathias


    Stroke is a leading cause of death and disability worldwide with no treatment for the chronic phase available. Interestingly, an endogenous repair program comprising inflammation and neurogenesis is known to modulate stroke outcome. Several studies have shown that neurogenesis decreases with age but the therapeutic importance of endogenous neurogenesis for recovery from cerebral diseases has been indicated as its ablation leads to stroke aggravation and worsened outcome. A detailed characterization of the neurogenic response after stroke related to ageing would help to develop novel and targeted therapies. In an innovative approach, we used the DCX-Luc mouse, a transgenic model expressing luciferase in doublecortin-positive neuroblasts, to monitor the neurogenic response following middle cerebral artery occlusion over three weeks in three age groups (2, 6, 12months) by optical imaging while the stroke lesion was monitored by quantitative MRI. The individual longitudinal and noninvasive time profiles provided exclusive insight into age-dependent decrease in basal neurogenesis and neurogenic upregulation in response to stroke which are not accessible by conventional BrdU-based measures of cell proliferation. For cortico-striatal strokes the maximal upregulation occurred at 4days post stroke followed by a continuous decrease to basal levels by three weeks post stroke. Older animals effectively compensated for reduced basal neurogenesis by an enhanced sensitivity to the cerebral lesion, resulting in upregulated neurogenesis levels approaching those measured in young mice. In middle aged and older mice, but not in the youngest ones, additional upregulation of neurogenesis was observed in the contralateral healthy hemisphere. This further substantiates the increased propensity of older brains to respond to lesion situation. Our results clearly support the therapeutic relevance of endogenous neurogenesis for stroke recovery and particularly in older brains. Copyright

  10. The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients (United States)

    Thanakiatpinyo, Thanitta; Suwannatrai, Supakij; Suwannatrai, Ueamphon; Khumkaew, Phanitanong; Wiwattamongkol, Dokmai; Vannabhum, Manmas; Pianmanakit, Somluck; Kuptniratsaikul, Vilai


    Purpose To study the efficacy of traditional Thai massage (TTM) versus conventional physical therapy (PT) programs in treating muscle spasticity, functional ability, anxiety, depression, and quality of life (QoL) in Thai stroke patients. Methods This randomized controlled trial with a blinded assessor was carried out at the Department of Rehabilitation Medicine, Siriraj Hospital (Bangkok, Thailand). The study included 50 stroke (onset ≥3 months) outpatients experiencing spasticity at the elbow or knee muscles at a grade of ≥1+ on the modified Ashworth Scale who were ≥50 years old and able to communicate. The subjects were randomly allocated to the treatment group receiving TTM (24 subjects) or the control group receiving the PT program (26 subjects). Both groups received treatment (either TTM or PT) twice a week for 6 weeks. Spasticity grade, functional ability, anxiety, depression, and QoL were measured at Week 0 and Week 6. Results At Week 6, the percentage of patients whose modified Ashworth Scale score had decreased by at least one grade was not statistically significant between the two groups. Both TTM and PT groups experienced a significant increase in functional ability and QoL, but no difference was found between the groups. Anxiety and depression scores showed a decreasing trend in the TTM group. Conclusion This preliminary report showed no evidence that TTM differed from the PT program in decreasing spasticity. However, both interventions may relieve spasticity, increase functional ability, and improve QoL after 6 weeks. Only TTM can decrease anxiety and depression scores. Further studies with adequate sample size are necessary. PMID:25143717

  11. The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients. (United States)

    Thanakiatpinyo, Thanitta; Suwannatrai, Supakij; Suwannatrai, Ueamphon; Khumkaew, Phanitanong; Wiwattamongkol, Dokmai; Vannabhum, Manmas; Pianmanakit, Somluck; Kuptniratsaikul, Vilai


    To study the efficacy of traditional Thai massage (TTM) versus conventional physical therapy (PT) programs in treating muscle spasticity, functional ability, anxiety, depression, and quality of life (QoL) in Thai stroke patients. This randomized controlled trial with a blinded assessor was carried out at the Department of Rehabilitation Medicine, Siriraj Hospital (Bangkok, Thailand). The study included 50 stroke (onset ≥ 3 months) outpatients experiencing spasticity at the elbow or knee muscles at a grade of ≥ 1+ on the modified Ashworth Scale who were ≥ 50 years old and able to communicate. The subjects were randomly allocated to the treatment group receiving TTM (24 subjects) or the control group receiving the PT program (26 subjects). Both groups received treatment (either TTM or PT) twice a week for 6 weeks. Spasticity grade, functional ability, anxiety, depression, and QoL were measured at Week 0 and Week 6. At Week 6, the percentage of patients whose modified Ashworth Scale score had decreased by at least one grade was not statistically significant between the two groups. Both TTM and PT groups experienced a significant increase in functional ability and QoL, but no difference was found between the groups. Anxiety and depression scores showed a decreasing trend in the TTM group. This preliminary report showed no evidence that TTM differed from the PT program in decreasing spasticity. However, both interventions may relieve spasticity, increase functional ability, and improve QoL after 6 weeks. Only TTM can decrease anxiety and depression scores. Further studies with adequate sample size are necessary.

  12. Very low cerebral blood volume predicts parenchymal hematoma in acute ischemic stroke

    DEFF Research Database (Denmark)

    Hermitte, Laure; Cho, Tae-Hee; Ozenne, Brice


    Cooperative Acute Stroke Study II criteria. Recanalization and reperfusion were assessed on 3-hour follow-up MRI. RESULTS: Of the 110 patients, hemorrhagic transformation occurred in 59 patients, including 7 PH. In univariate analysis, the acute National Institutes of Health Stroke Scale score (P=0...... hemorrhagic transformation or PH. CONCLUSION: Very low CBV was the only independent predictor of PH in patients with acute stroke.......BACKGROUND AND PURPOSE: Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective...

  13. Decreased nighttime heart rate variability is associated with increased stroke risk

    DEFF Research Database (Denmark)

    Binici, Zeynep; Mouridsen, Mette Rauhe; Køber, Lars


    Prediction of stroke in healthy individuals is challenging and there is a diurnal variation of stroke onset. We hypothesized that heart rate variability with a focus on nighttime heart rate variability will predict the risk of stroke in apparently healthy middle-age and elderly subjects....

  14. Use of Oxygen Pulse in Predicting Doppler-Derived Maximal Stroke Volume in Adolescents. (United States)

    Unnithan, Vishwanath; Rowland, Thomas W


    Clinical exercise physiologists and physicians administering stress tests in the young have used oxygen pulse as a surrogate measure of stroke volume. It is important to recognize 1) the accuracy of O₂ pulse in predicting maximal stroke volume during exercise, and 2) the normal pattern of O₂ pulse during a progressive exercise test. This study examined both of these issues in a cohort of 44 healthy adolescent males and females (ages 14-16 years) who performed routine progressive cycle exercise to exhaustion. Gas exchange variables were measured by standard open circuit techniques. Stroke volume at rest and during exercise was assessed by the Doppler ultrasound method. At peak exercise O₂ pulse correlated closely with stroke volume (r = .73) with a SEE of 12.6 ml·beat⁻¹. Values of maximal O₂ pulse in nonathletic boys and girls were 13.3 ± 2.5 and 11.0 ± 1.7 ml·beat⁻¹, respectively. After the initial workload, a steady rise was observed in O₂ pulse, entirely reflecting an increasing arterial venous oxygen difference, with a slope of approximately 4 ml/beat per 100 watts work load. The findings support the use of O₂ pulse as a valid predictor of stroke volume during exercise in youth with a moderately high level of accuracy.

  15. Decreased integration and information capacity in stroke measured by whole brain models of resting state activity. (United States)

    Adhikari, Mohit H; Hacker, Carl D; Siegel, Josh S; Griffa, Alessandra; Hagmann, Patric; Deco, Gustavo; Corbetta, Maurizio


    While several studies have shown that focal lesions affect the communication between structurally normal regions of the brain, and that these changes may correlate with behavioural deficits, their impact on brain's information processing capacity is currently unknown. Here we test the hypothesis that focal lesions decrease the brain's information processing capacity, of which changes in functional connectivity may be a measurable correlate. To measure processing capacity, we turned to whole brain computational modelling to estimate the integration and segregation of information in brain networks. First, we measured functional connectivity between different brain areas with resting state functional magnetic resonance imaging in healthy subjects (n = 26), and subjects who had suffered a cortical stroke (n = 36). We then used a whole-brain network model that coupled average excitatory activities of local regions via anatomical connectivity. Model parameters were optimized in each healthy or stroke participant to maximize correlation between model and empirical functional connectivity, so that the model's effective connectivity was a veridical representation of healthy or lesioned brain networks. Subsequently, we calculated two model-based measures: 'integration', a graph theoretical measure obtained from functional connectivity, which measures the connectedness of brain networks, and 'information capacity', an information theoretical measure that cannot be obtained empirically, representative of the segregative ability of brain networks to encode distinct stimuli. We found that both measures were decreased in stroke patients, as compared to healthy controls, particularly at the level of resting-state networks. Furthermore, we found that these measures, especially information capacity, correlate with measures of behavioural impairment and the segregation of resting-state networks empirically measured. This study shows that focal lesions affect the brain's ability to

  16. A new electric method for non-invasive continuous monitoring of stroke volume and ventricular volume-time curves

    Directory of Open Access Journals (Sweden)

    Konings Maurits K


    Full Text Available Abstract Background In this paper a new non-invasive, operator-free, continuous ventricular stroke volume monitoring device (Hemodynamic Cardiac Profiler, HCP is presented, that measures the average stroke volume (SV for each period of 20 seconds, as well as ventricular volume-time curves for each cardiac cycle, using a new electric method (Ventricular Field Recognition with six independent electrode pairs distributed over the frontal thoracic skin. In contrast to existing non-invasive electric methods, our method does not use the algorithms of impedance or bioreactance cardiography. Instead, our method is based on specific 2D spatial patterns on the thoracic skin, representing the distribution, over the thorax, of changes in the applied current field caused by cardiac volume changes during the cardiac cycle. Since total heart volume variation during the cardiac cycle is a poor indicator for ventricular stroke volume, our HCP separates atrial filling effects from ventricular filling effects, and retrieves the volume changes of only the ventricles. Methods ex-vivo experiments on a post-mortem human heart have been performed to measure the effects of increasing the blood volume inside the ventricles in isolation, leaving the atrial volume invariant (which can not be done in-vivo. These effects have been measured as a specific 2D pattern of voltage changes on the thoracic skin. Furthermore, a working prototype of the HCP has been developed that uses these ex-vivo results in an algorithm to decompose voltage changes, that were measured in-vivo by the HCP on the thoracic skin of a human volunteer, into an atrial component and a ventricular component, in almost real-time (with a delay of maximally 39 seconds. The HCP prototype has been tested in-vivo on 7 human volunteers, using G-suit inflation and deflation to provoke stroke volume changes, and LVot Doppler as a reference technique. Results The ex-vivo measurements showed that ventricular filling

  17. Effect of fluid loading with normal saline and 6% hydroxyethyl starch on stroke volume variability and left ventricular volume

    Directory of Open Access Journals (Sweden)

    Kanda H


    Full Text Available Hirotsugu Kanda,1 Yuji Hirasaki,2 Takafumi Iida,1 Megumi Kanao,1 Yuki Toyama,1 Takayuki Kunisawa,1 Hiroshi Iwasaki,11Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, 2Department of Anatomy, The Jikei University Graduate School of Medicine, Tokyo, JapanPurpose: The aim of this clinical trial was to investigate changes in stroke volume variability (SVV and left ventricular end-diastolic volume (LVEDV after a fluid bolus of crystalloid or colloid using real-time three-dimensional transesophageal echocardiography (3D-TEE and the Vigileo-FloTrac™ system.Materials and methods: After obtaining Institutional Review Board approval, and informed consent from the research participants, 22 patients undergoing scheduled peripheral vascular bypass surgery were enrolled in the study. The patients were randomly assigned to receive 500 mL of hydroxyethyl starch (HES; HES group, n=11 or normal saline (Saline group, n=11 for fluid replacement therapy. SVV was measured using the Vigileo-FloTrac system. LVEDV, stroke volume, and cardiac output were measured by 3D-TEE. The measurements were performed over 30 minutes before and after the fluid bolus in both groups.Results: SVV significantly decreased after fluid bolus in both groups (HES group, 14.7%±2.6% to 6.9%±2.7%, P<0.001; Saline group, 14.3%±3.9% to 8.8%±3.1%, P<0.001. LVEDV significantly increased after fluid loading in the HES group (87.1±24.0 mL to 99.9±27.2 mL, P<0.001, whereas no significant change was detected in the Saline group (88.8±17.3 mL to 91.4±17.6 mL, P>0.05. Stroke volume significantly increased after infusion in the HES group (50.6±12.5 mL to 61.6±19.1 mL, P<0.01 but not in the Saline group (51.6±13.4 mL to 54.1±12.8 mL, P>0.05. Cardiac output measured by 3D-TEE significantly increased in the HES group (3.5±1.1 L/min to 3.9±1.3 L/min, P<0.05, whereas no significant change was seen in the Saline group (3.4±1.1 L/min to 3.3±1.0 L

  18. GABA Levels Are Decreased After Stroke and GABA Changes During Rehabilitation Correlate With Motor Improvement (United States)

    Blicher, Jakob Udby; Near, Jamie; Næss-Schmidt, Erhard; Stagg, Charlotte J.; Johansen-Berg, Heidi; Nielsen, Jørgen Feldbæk; Østergaard, Leif; Ho, Yi-Ching Lynn


    Background and Objective γ-Aminobutyric acid (GABA) is the dominant inhibitory neurotransmitter in the brain and is important in motor learning. We aimed to measure GABA content in primary motor cortex poststroke (using GABA-edited magnetic resonance spectroscopy [MRS]) and in relation to motor recovery during 2 weeks of constraint-induced movement therapy (CIMT). Methods Twenty-one patients (3-12 months poststroke) and 20 healthy subjects were recruited. Magnetic resonance imaging structural T1 and GABA-edited MRS were performed at baseline and after CIMT, and once in healthy subjects. GABA:creatine (GABA:Cr) ratio was measured by GABA-edited MRS. Motor function was measured using Wolf Motor Function Test (WMFT). Results Baseline comparison between stroke patients (n = 19) and healthy subjects showed a significantly lower GABA:Cr ratio in stroke patients (P < .001) even after correcting for gray matter content in the voxel (P < .01) and when expressing GABA relative to N-acetylaspartic acid (NAA; P = .03). After 2 weeks of CIMT patients improved significantly on WMFT, but no consistent change across the group was observed for the GABA:Cr ratio (n = 17). However, the extent of improvement on WMFT correlated significantly with the magnitude of GABA:Cr changes (P < .01), with decreases in GABA:Cr ratio being associated with better improvements in motor function. Conclusions In patients 3 to 12 months poststroke, GABA levels are lower in the primary motor cortex than in healthy subjects. The observed association between GABA and recovery warrants further studies on the potential use of GABA MRS as a biomarker in poststroke recovery. PMID:25055837

  19. Rowing increases stroke volume and cardiac output to a greater extent than cycling

    Czech Academy of Sciences Publication Activity Database

    Horn, P.; Ošťádal, P.; Ošťádal, Bohuslav


    Roč. 64, č. 2 (2015), s. 203-207 ISSN 0862-8408 Institutional support: RVO:67985823 Keywords : cardiac output * cycling * heart rate * stroke volume Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 1.643, year: 2015

  20. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index

    DEFF Research Database (Denmark)

    Fuglsang, S; Bendtsen, F; Christensen, E


    Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40%...... predictors of SV/PP (P abnormalities in the arterial compliance of these patients....

  1. Improved cardiac filling facilitates the postprandial elevation of stroke volume in Python regius. (United States)

    Enok, Sanne; Leite, Gabriella S P C; Leite, Cléo A C; Gesser, Hans; Hedrick, Michael S; Wang, Tobias


    To accommodate the pronounced metabolic response to digestion, pythons increase heart rate and elevate stroke volume, where the latter has been ascribed to a massive and fast cardiac hypertrophy. However, numerous recent studies show that heart mass rarely increases, even upon ingestion of large meals, and we therefore explored the possibility that a rise in mean circulatory filling pressure (MCFP) serves to elevate venous pressure and cardiac filling during digestion. To this end, we measured blood flows and pressures in anaesthetized Python regius The anaesthetized snakes exhibited the archetypal tachycardia as well as a rise in both venous pressure and MCFP that fully account for the approximate doubling of stroke volume. There was no rise in blood volume and the elevated MCFP must therefore stem from increased vascular tone, possibly by means of increased sympathetic tone on the veins. Furthermore, although both venous pressure and MCFP increased during volume loading, there was no evidence that postprandial hearts were endowed with an additional capacity to elevate stroke volume. In vitro measurements of force development of paced ventricular strips also failed to reveal signs of increased contractility, but the postprandial hearts had higher activities of cytochrome oxidase and pyruvate kinase, which probably serves to sustain the rise in cardiac work during digestion. © 2016. Published by The Company of Biologists Ltd.

  2. Limitations and pitfalls in measurements of right ventricular stroke volume in an animal model of right heart failure

    International Nuclear Information System (INIS)

    Vildbrad, Mads Dam; Andersen, Asger; Andersen, Thomas Krarup; Axelgaard, Sofie; Holmboe, Sarah; Andersen, Stine; Nielsen-Kudsk, Jens Erik; Ringgaard, Steffen


    Right heart failure occurs in various heart and pulmonary vascular diseases and may be fatal. We aimed to identify limitations in non-invasive measurements of right ventricular stroke volume in an animal model of right ventricular failure. Data from previous studies randomising rats to pulmonary trunk banding (PTB, n = 33) causing pressure-overload right ventricular failure or sham operation (n = 16) was evaluated retrospectively. We measured right ventricular stroke volume by high frequency echocardiography and magnetic resonance imaging (MRI). We found correlation between right ventricular stroke volume measured by echocardiography and MRI in the sham animals (r = 0.677, p = 0.004) but not in the PTB group. Echocardiography overestimated the stroke volume compared to MRI in both groups. Intra- and inter-observer variation did not explain the difference. Technical, physiological and anatomical issues in the pulmonary artery might explain why echocardiography over-estimates stroke volume. Flow acceleration close to the pulmonary artery banding can cause uncertainties in the PTB model and might explain the lack of correlation. In conclusion, we found a correlation in right ventricular stroke volume measured by echocardiography versus MRI in the sham group but not the PTB group. Echocardiography overestimated right ventricular stroke volume compared to MRI. (paper)

  3. Evaluation of stroke volume variation obtained by arterial pulse contour analysis to predict fluid responsiveness intraoperatively. (United States)

    Lahner, D; Kabon, B; Marschalek, C; Chiari, A; Pestel, G; Kaider, A; Fleischmann, E; Hetz, H


    Fluid management guided by oesophageal Doppler monitor has been reported to improve perioperative outcome. Stroke volume variation (SVV) is considered a reliable clinical predictor of fluid responsiveness. Consequently, the aim of the present trial was to evaluate the accuracy of SVV determined by arterial pulse contour (APCO) analysis, using the FloTrac/Vigileo system, to predict fluid responsiveness as measured by the oesophageal Doppler. Patients undergoing major abdominal surgery received intraoperative fluid management guided by oesophageal Doppler monitoring. Fluid boluses of 250 ml each were administered in case of a decrease in corrected flow time (FTc) to 10%. The ability of SVV to predict fluid responsiveness was assessed by calculation of the area under the receiver operating characteristic (ROC) curve. Twenty patients received 67 fluid boluses. Fifty-two of the 67 fluid boluses administered resulted in fluid responsiveness. SVV achieved an area under the ROC curve of 0.512 [confidence interval (CI) 0.32-0.70]. A cut-off point for fluid responsiveness was found for SVV > or =8.5% (sensitivity: 77%; specificity: 43%; positive predictive value: 84%; and negative predictive value: 33%). This prospective, interventional observer-blinded study demonstrates that SVV obtained by APCO, using the FloTrac/Vigileo system, is not a reliable predictor of fluid responsiveness in the setting of major abdominal surgery.

  4. Effects of radiation dose reduction in Volume Perfusion CT imaging of acute ischemic stroke

    International Nuclear Information System (INIS)

    Othman, Ahmed E.; Brockmann, Carolin; Afat, Saif; Pjontek, Rastislav; Nikobashman, Omid; Brockmann, Marc A.; Wiesmann, Martin; Yang, Zepa; Kim, Changwon; Kim, Jong Hyo


    To examine the influence of radiation dose reduction on image quality and sensitivity of Volume Perfusion CT (VPCT) maps regarding the detection of ischemic brain lesions. VPCT data of 20 patients with suspected ischemic stroke acquired at 80 kV and 180 mAs were included. Using realistic reduced-dose simulation, low-dose VPCT datasets with 144 mAs, 108 mAs, 72 mAs and 36 mAs (80 %, 60 %, 40 % and 20 % of the original levels) were generated, resulting in a total of 100 datasets. Perfusion maps were created and signal-to-noise-ratio (SNR) measurements were performed. Qualitative analyses were conducted by two blinded readers, who also assessed the presence/absence of ischemic lesions and scored CBV and CBF maps using a modified ASPECTS-score. SNR of all low-dose datasets were significantly lower than those of the original datasets (p <.05). All datasets down to 72 mAs (40 %) yielded sufficient image quality and high sensitivity with excellent inter-observer-agreements, whereas 36 mAs datasets (20 %) yielded poor image quality in 15 % of the cases with lower sensitivity and inter-observer-agreements. Low-dose VPCT using decreased tube currents down to 72 mAs (40 % of original radiation dose) produces sufficient perfusion maps for the detection of ischemic brain lesions. (orig.)

  5. Effects of radiation dose reduction in Volume Perfusion CT imaging of acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Othman, Ahmed E. [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, Aachen (Germany); Eberhard Karls University Tuebingen, University Hospital Tuebingen, Department for Diagnostic and Interventional Radiology, Tuebingen (Germany); Brockmann, Carolin; Afat, Saif; Pjontek, Rastislav; Nikobashman, Omid; Brockmann, Marc A.; Wiesmann, Martin [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, Aachen (Germany); Yang, Zepa; Kim, Changwon [Seoul National University, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Suwon (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Kim, Jong Hyo [Seoul National University, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Suwon (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Center for Medical-IT Convergence Technology Research, Advanced Institute of Convergence Technology, Suwon (Korea, Republic of)


    To examine the influence of radiation dose reduction on image quality and sensitivity of Volume Perfusion CT (VPCT) maps regarding the detection of ischemic brain lesions. VPCT data of 20 patients with suspected ischemic stroke acquired at 80 kV and 180 mAs were included. Using realistic reduced-dose simulation, low-dose VPCT datasets with 144 mAs, 108 mAs, 72 mAs and 36 mAs (80 %, 60 %, 40 % and 20 % of the original levels) were generated, resulting in a total of 100 datasets. Perfusion maps were created and signal-to-noise-ratio (SNR) measurements were performed. Qualitative analyses were conducted by two blinded readers, who also assessed the presence/absence of ischemic lesions and scored CBV and CBF maps using a modified ASPECTS-score. SNR of all low-dose datasets were significantly lower than those of the original datasets (p <.05). All datasets down to 72 mAs (40 %) yielded sufficient image quality and high sensitivity with excellent inter-observer-agreements, whereas 36 mAs datasets (20 %) yielded poor image quality in 15 % of the cases with lower sensitivity and inter-observer-agreements. Low-dose VPCT using decreased tube currents down to 72 mAs (40 % of original radiation dose) produces sufficient perfusion maps for the detection of ischemic brain lesions. (orig.)

  6. Infarct volume predicts critical care needs in stroke patients treated with intravenous thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Faigle, Roland; Marsh, Elisabeth B.; Llinas, Rafael H.; Urrutia, Victor C. [Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD (United States); Wozniak, Amy W. [Johns Hopkins University, Department of Biostatistics, Bloomberg School of Public Health, Baltimore, MD (United States)


    Patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (IVT) for ischemic stroke are monitored in an intensive care unit (ICU) or a comparable unit capable of ICU interventions due to the high frequency of standardized neurological exams and vital sign checks. The present study evaluates quantitative infarct volume on early post-IVT MRI as a predictor of critical care needs and aims to identify patients who may not require resource intense monitoring. We identified 46 patients who underwent MRI within 6 h of IVT. Infarct volume was measured using semiautomated software. Logistic regression and receiver operating characteristics (ROC) analysis were used to determine factors associated with ICU needs. Infarct volume was an independent predictor of ICU need after adjusting for age, sex, race, systolic blood pressure, NIH Stroke Scale (NIHSS), and coronary artery disease (odds ratio 1.031 per cm{sup 3} increase in volume, 95 % confidence interval [CI] 1.004-1.058, p = 0.024). The ROC curve with infarct volume alone achieved an area under the curve (AUC) of 0.766 (95 % CI 0.605-0.927), while the AUC was 0.906 (95 % CI 0.814-0.998) after adjusting for race, systolic blood pressure, and NIHSS. Maximum Youden index calculations identified an optimal infarct volume cut point of 6.8 cm{sup 3} (sensitivity 75.0 %, specificity 76.7 %). Infarct volume greater than 3 cm{sup 3} predicted need for critical care interventions with 81.3 % sensitivity and 66.7 % specificity. Infarct volume may predict needs for ICU monitoring and interventions in stroke patients treated with IVT. (orig.)

  7. Gray matter volume changes in chronic subcortical stroke: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Qingqing Diao


    Full Text Available This study aimed to investigate the effects of lesion side and degree of motor recovery on gray matter volume (GMV difference relative to healthy controls in right-handed subcortical stroke. Structural MRI data were collected in 97 patients with chronic subcortical ischemic stroke and 79 healthy controls. Voxel-wise GMV analysis was used to investigate the effects of lesion side and degree of motor recovery on GMV difference in right-handed chronic subcortical stroke patients. Compared with healthy controls, right-lesion patients demonstrated GMV increase (P < 0.05, voxel-wise false discovery rate correction in the bilateral paracentral lobule (PCL and supplementary motor area (SMA and the right middle occipital gyrus (MOG; while left-lesion patients did not exhibit GMV difference under the same threshold. Patients with complete and partial motor recovery showed similar degree of GMV increase in right-lesion patients. However, the motor recovery was correlated with the GMV increase in the bilateral SMA in right-lesion patients. These findings suggest that there exists a lesion-side effect on GMV difference relative to healthy controls in right-handed patients with chronic subcortical stroke. The GMV increase in the SMA may facilitate motor recovery in subcortical stroke patients.

  8. Ischemic lesion volume correlates with long-term functional outcome and quality of life of middle cerebral artery stroke survivors

    NARCIS (Netherlands)

    Schiemanck, S. K.; Post, M. W. M.; Kwakkel, G.; Witkamp, Th D.; Kappelle, L. J.; Prevo, A. J. H.


    PURPOSE: Previous studies investigating relationships between stroke lesion volume and outcome were restricted to short follow-up periods (3-6 months) and outcome measures of stroke severity and activities only, whereas functional improvement has been found to extend far beyond six months.

  9. Role of BK channels in the apoptotic volume decrease in native eel intestinal cells

    DEFF Research Database (Denmark)

    Lionetto, Maria Giulia; Giordano, Maria Elena; Calisi, Antonio


    of these channels in the Apoptotic Volume Decrease (AVD) of isolated eel enterocytes, and the possible interaction between BK channels and the progression of apoptosis. The detection of apoptosis was performed by confocal microscopy and annexin V and propidium iodide labelling; cell volume changes were monitored...

  10. White Matter Hyperintensity Volume and Outcome of Mechanical Thrombectomy With Stentriever in Acute Ischemic Stroke. (United States)

    Atchaneeyasakul, Kunakorn; Leslie-Mazwi, Thabele; Donahue, Kathleen; Giese, Anne-Katrin; Rost, Natalia S


    Finding of white matter hyperintensity (WMH) has been associated with an increased risk of parenchymal hematoma and poor clinical outcomes after mechanical thrombectomy using old-generation endovascular devices. Currently, no data exist with regard to the risk of mechanical thrombectomy using stentriever devices in patients with significant WMH. We hypothesized that WMH volume will not affect the hemorrhagic and clinical outcome in patients with acute ischemic stroke undergoing thrombectomy using new-generation devices. A retrospective cohort of consecutive acute ischemic stroke patients >18-year-old receiving mechanical thrombectomy with stentriever devices at a single academic center was examined. WMH volume was assessed by a semiautomated volumetric analysis on T2 fluid attenuated inversion recovery-magnetic resonance imaging. Outcomes included the rate of any intracerebral hemorrhage, 90-day modified Rankin Score (mRS), the rate of good outcome (discharge mRS ≤2), and the rate of successful reperfusion (thrombolysis in cerebral ischemia score 2b or 3). Between June 2012 and December 2015, 56 patients with acute ischemic stroke met the study criteria. Median WMH volume was 6.76 cm 3 (4.84-16.09 cm 3 ). Increasing WMH volume did not significantly affect the odds of good outcome (odds ratio [OR], 0.811; 95% confidence interval [CI], 0.456-1.442), intracerebral hemorrhage (OR, 1.055; 95% CI, 0.595-1.871), parenchymal hematoma (OR, 0.353; 95% CI, 0.061-2.057), successful recanalization (OR, 1.295; 95% CI, 0.704-2.383), or death (OR, 1.583; 95% CI, 0.84-2.98). Mechanical thrombectomy using stentrievers seems to be safe in selected patients with acute ischemic stroke with large vessel occlusion, nonwithstanding the severity of WMH burden in this population. Larger prospective studies are warranted to validate these findings. © 2017 American Heart Association, Inc.

  11. Know your tools - concordance of different methods for measuring brain volume change after ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Yassi, Nawaf; Campbell, Bruce C.V.; Davis, Stephen M.; Bivard, Andrew [The University of Melbourne, Departments of Medicine and Neurology, Melbourne Brain Centre rate at The Royal Melbourne Hospital, Parkville, Victoria (Australia); Moffat, Bradford A.; Steward, Christopher; Desmond, Patricia M. [The University of Melbourne, Department of Radiology, The Royal Melbourne Hospital, Parkville (Australia); Churilov, Leonid [The University of Melbourne, The Florey Institute of Neurosciences and Mental Health, Parkville (Australia); Parsons, Mark W. [University of Newcastle and Hunter Medical Research Institute, Priority Research Centre for Translational Neuroscience and Mental Health, Newcastle (Australia)


    Longitudinal brain volume changes have been investigated in a number of cerebral disorders as a surrogate marker of clinical outcome. In stroke, unique methodological challenges are posed by dynamic structural changes occurring after onset, particularly those relating to the infarct lesion. We aimed to evaluate agreement between different analysis methods for the measurement of post-stroke brain volume change, and to explore technical challenges inherent to these methods. Fifteen patients with anterior circulation stroke underwent magnetic resonance imaging within 1 week of onset and at 1 and 3 months. Whole-brain as well as grey- and white-matter volume were estimated separately using both an intensity-based and a surface watershed-based algorithm. In the case of the intensity-based algorithm, the analysis was also performed with and without exclusion of the infarct lesion. Due to the effects of peri-infarct edema at the baseline scan, longitudinal volume change was measured as percentage change between the 1 and 3-month scans. Intra-class and concordance correlation coefficients were used to assess agreement between the different analysis methods. Reduced major axis regression was used to inspect the nature of bias between measurements. Overall agreement between methods was modest with strong disagreement between some techniques. Measurements were variably impacted by procedures performed to account for infarct lesions. Improvements in volumetric methods and consensus between methodologies employed in different studies are necessary in order to increase the validity of conclusions derived from post-stroke cerebral volumetric studies. Readers should be aware of the potential impact of different methods on study conclusions. (orig.)

  12. Stroke (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 ...

  13. Decreasing Irradiated Rat Lung Volume Changes Dose-Limiting Toxicity From Early to Late Effects

    International Nuclear Information System (INIS)

    Veen, Sonja J. van der; Faber, Hette; Ghobadi, Ghazaleh; Brandenburg, Sytze; Langendijk, Johannes A.; Coppes, Robert P.; Luijk, Peter van


    Purpose: Technological developments in radiation therapy result in smaller irradiated volumes of normal tissue. Because the risk of radiation therapy-induced toxicity generally depends on irradiated volume, changing volume could change the dose-limiting toxicity of a treatment. Recently, in our rat model, we found that early radiation-induced lung dysfunction (RILD) was closely related to irradiated volume dependent vascular remodeling besides inflammation. The exact relationship between early and late RILD is still unknown. Therefore, in this preclinical study we investigated the dose-volume relationship of late RILD, assessed its dependence on early and late pathologies and studied if decreasing irradiated volume changed the dose-limiting toxicity. Methods and Materials: A volume of 25%, 32%, 50%, 63%, 88%, or 100% of the rat lung was irradiated using protons. Until 26 weeks after irradiation, respiratory rates were measured. Macrovascular remodeling, pulmonary inflammation, and fibrosis were assessed at 26 weeks after irradiation. For all endpoints dose-volume response curves were made. These results were compared to our previously published early lung effects. Results: Early vascular remodeling and inflammation correlated significantly with early RILD. Late RILD correlated with inflammation and fibrosis, but not with vascular remodeling. In contrast to the early effects, late vascular remodeling, inflammation and fibrosis showed a primarily dose but not volume dependence. Comparison of respiratory rate increases early and late after irradiation for the different dose-distributions indicated that with decreasing irradiated volumes, the dose-limiting toxicity changed from early to late RILD. Conclusions: In our rat model, different pathologies underlie early and late RILD with different dose-volume dependencies. Consequently, the dose-limiting toxicity changed from early to late dysfunction when the irradiated volume was reduced. In patients, early and late

  14. Comparison of quantitative estimation of intracerebral hemorrhage and infarct volumes after thromboembolism in an embolic stroke model

    DEFF Research Database (Denmark)

    Eriksen, Nina; Rasmussen, Rune Skovgaard; Overgaard, Karsten


    BACKGROUND: Strokes have both ischemic and hemorrhagic components, but most studies of experimental stroke only address the ischemic component. This is likely because investigations of hemorrhagic transformation are hindered by the lack of methods based on unbiased principles for volume estimation....... AIMS: We evaluated different methods for estimating the volume of infarcts, hemorrhages, after embolic middle cerebral artery occlusion with or without thrombolysis. METHODS: An experimental thromboembolytic rat model was used in this study. The rats underwent surgery and were placed in two groups...... of measuring both the ischemic and the hemorrhagic components of stroke, two parameters that may be differentially regulated when therapeutic regimens are tested....

  15. Decreased right heart blood volume determined by magnetic resonance imaging: evidence of central underfilling in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Søndergaard, L; Møgelvang, J


    mL, NS), and left atrial volume (70 vs. 57 mL, P = .08) were normal or slightly increased. The right ejection fraction (68% vs. 53%, P fraction was slightly reduced (61% vs. 69%, NS). The central and arterial blood volume (CBV), assessed......Whether the central blood volume is reduced or expanded in cirrhosis is still under debate. Accordingly, the current study was undertaken to assess the volume of the heart cavities. Ten cirrhotic patients and matched controls had their right and left ventricular end-diastolic volumes (RVDV and LVDV...... as the cardiac output (CO) multiplied by the central circulation time, was significantly decreased (1.47 vs. 1.81 L, P blood volume (4.43 vs. 3.64 L, P

  16. Reduced Maximum Pitch Elevation Predicts Silent Aspiration of Small Liquid Volumes in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Akila Theyyar Rajappa


    Full Text Available Background and purposePreliminary evidence has shown that reduced ability to maximally raise vocal pitch correlates with the occurrence of aspiration (i.e., airway invasion by food or liquid. However, it is unclear if this simple task can be used as a reliable predictor of aspiration in stroke patients. Our aim was to examine whether maximum vocal pitch elevation predicted airway invasion and dysphagia in stroke.MethodsForty-five consecutive stroke patients (<1 month poststroke at a rehabilitation setting participated in a videofluoroscopic swallow study and two maximum vocal pitch elevation tasks. Maximum pitch was evaluated acoustically [maximum fundamental frequency (max F0] and perceptually. Swallowing safety was rated using the Penetration/Aspiration Scale and swallowing performance was assessed using components of the Modified Barium Swallow Impairment Profile (MBSImPTM©. Data were analyzed using simple regression and receiver operating characteristics curves to test the sensitivity and specificity of max F0 in predicting aspiration. Correlations between max F0 and MBSImP variables were also examined.ResultsMax F0 predicted silent aspiration of small liquid volumes with 80% sensitivity and 65% specificity (p = 0.023; area under the curve: 0.815; cutoff value of 359.03 Hz. Max F0 did not predict non-silent aspiration or penetration in this sample and did not significantly correlate with MBSImP variables. Furthermore, all participants who aspirated silently on small liquid volumes (11% of sample had suffered cortical or subcortical lesions.ConclusionIn stroke patients (<1 month poststroke, reduced maximum pitch elevation predicts silent aspiration of small liquid volumes with high sensitivity and moderate specificity. Future large-scale studies focusing on further validating this finding and exploring the value of this simple and non-invasive tool as part of a dysphagia screening are warranted.

  17. Effects of radiation dose reduction in Volume Perfusion CT imaging of acute ischemic stroke. (United States)

    Othman, Ahmed E; Brockmann, Carolin; Yang, Zepa; Kim, Changwon; Afat, Saif; Pjontek, Rastislav; Nikobashman, Omid; Brockmann, Marc A; Kim, Jong Hyo; Wiesmann, Martin


    To examine the influence of radiation dose reduction on image quality and sensitivity of Volume Perfusion CT (VPCT) maps regarding the detection of ischemic brain lesions. VPCT data of 20 patients with suspected ischemic stroke acquired at 80 kV and 180 mAs were included. Using realistic reduced-dose simulation, low-dose VPCT datasets with 144 mAs, 108 mAs, 72 mAs and 36 mAs (80 %, 60 %, 40 % and 20 % of the original levels) were generated, resulting in a total of 100 datasets. Perfusion maps were created and signal-to-noise-ratio (SNR) measurements were performed. Qualitative analyses were conducted by two blinded readers, who also assessed the presence/absence of ischemic lesions and scored CBV and CBF maps using a modified ASPECTS-score. SNR of all low-dose datasets were significantly lower than those of the original datasets (p < .05). All datasets down to 72 mAs (40 %) yielded sufficient image quality and high sensitivity with excellent inter-observer-agreements, whereas 36 mAs datasets (20 %) yielded poor image quality in 15 % of the cases with lower sensitivity and inter-observer-agreements. Low-dose VPCT using decreased tube currents down to 72 mAs (40 % of original radiation dose) produces sufficient perfusion maps for the detection of ischemic brain lesions. • Perfusion CT is highly accurate for the detection of ischemic brain lesions • Perfusion CT results in high radiation exposure, therefore low-dose protocols are required • Reduction of tube current down to 72 mAs produces sufficient perfusion maps.

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

    DEFF Research Database (Denmark)

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


    attached to the foot and leg was used to apply 3 types of ankle perturbations during treadmill walking. First, fast dorsiflexion perturbations were applied to elicit stretch reflexes in the SOL muscle. The SOL short-latency stretch reflex was facilitated in the patients (1.4 +/- 0.3) compared...... by the Ashworth score. These results indicate that although the stretch reflex response is facilitated during spastic gait, the contribution of afferent feedback to the ongoing locomotor SOL activity is depressed in patients with spastic stroke....

  19. Neutrophil to lymphocyte ratio and the hematoma volume and stroke severity in acute intracerebral hemorrhage patients. (United States)

    Sun, Yaming; You, Shoujiang; Zhong, Chongke; Huang, Zhichao; Hu, Lifang; Zhang, Xia; Shi, Jijun; Cao, Yongjun; Liu, Chun-Feng


    Neutrophil to lymphocyte ratio (NLR) serves as a powerful inflammatory marker for predicting cardiovascular events. Here, we investigate whether admission NLR is associated with hematoma volume, stroke severity, and 3-month outcomes in patients with acute intracerebral hemorrhage (ICH). 352 patients with acute ICH were prospectively identified in this study. Demographic characteristics, lifestyle risk factors, NIHSS score, hematoma volumes, and other clinical features were recorded for all participants. Patients was divided into quartiles based on the admission NLR levels (Q1: hematoma volume, admission severity, or the outcomes after ICH. Median NIHSS scores for each quartile (Q1 to Q4) were 6.0, 6.0, 6.0, and 11.0 (P=.001), and median hematoma volumes were 9.5, 9.3, 9.1, and 15.0ml (P=.005), respectively. After adjusting the age, sex, and other potential risk factors, the patients in Q4 had higher NIHSS scores (P=.042) and larger hematoma volume (P=.014). After 3-month follow-up, 148 poor outcomes (mRS, 3-6) and 47 all-cause deaths were documented. There were more patients with poor outcomes in Q4 than Q1. However, compared with the patients in Q1, those in Q4 were not associated with poor outcomes (P-trend=0.379), and all-cause mortality (P-trend=0.843) after adjust for other risk factors. Higher admission NLR are associated with larger hematoma volume and more serious stroke, but not 3-month outcomes in patients with acute ICH. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. PD-L1 enhances CNS inflammation and infarct volume following experimental stroke in mice in opposition to PD-1. (United States)

    Bodhankar, Sheetal; Chen, Yingxin; Vandenbark, Arthur A; Murphy, Stephanie J; Offner, Halina


    Stroke severity is worsened by recruitment of inflammatory immune cells into the brain. This process depends in part on T cell activation, in which the B7 family of co-stimulatory molecules plays a pivotal role. Previous studies demonstrated more severe infarcts in mice lacking programmed death-1 (PD-1), a member of the B7 family, thus implicating PD-1 as a key factor in limiting stroke severity. The purpose of this study was to determine if this protective effect of PD-1 involves either of its ligands, PD-L1 or PD-L2. Central nervous system (CNS) inflammation and infarct volume were evaluated in male PD-L1 and PD-L2 knockout (-/-) mice undergoing 60 minutes of middle cerebral artery occlusion (MCAO) followed by 96 hours of reperfusion and compared to wild-type (WT) C57BL/6J mice. PD-L1-/- and PD-L2-/- mice had smaller total infarct volumes compared to WT mice. The PD-L1-/- and to a lesser extent PD-L2-/- mice had reduced levels of proinflammatory activated microglia and/or infiltrating monocytes and CD4+ T cells in the ischemic hemispheres. There was a reduction in ischemia-related splenic atrophy accompanied by lower activation status of splenic T cells and monocytes in the absence of PD-L1, suggesting a pathogenic rather than a regulatory role for both PD-1 ligands (PD-Ls). Suppressor T cells (IL-10-producing CD8+CD122+ T cells) trafficked to the brain in PD-L1-/- mice and there was decreased expression of CD80 on splenic antigen-presenting cells (APCs) as compared to the WT and PD-L2-/- mice. Our novel observations are the first to implicate PD-L1 involvement in worsening outcome of experimental stroke. The presence of suppressor T cells in the right MCAO-inflicted hemisphere in mice lacking PD-L1 implicates these cells as possible key contributors for controlling adverse effects of ischemia. Increased expression of CD80 on APCs in WT and PD-L2-/- mice suggests an overriding interaction leading to T cell activation. Conversely, low CD80 expression by APCs

  1. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

    Energy Technology Data Exchange (ETDEWEB)

    Seeters, Tom van; Schaaf, Irene C. van der; Dankbaar, Jan Willem; Horsch, Alexander D.; Niesten, Joris M.; Luitse, Merel J.A.; Mali, Willem P.T.M.; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Majoie, Charles B.L.M. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Vos, Jan Albert [St. Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Schonewille, Wouter J. [St. Antonius Hospital, Department of Neurology, Nieuwegein (Netherlands); Walderveen, Marianne A.A. van [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Wermer, Marieke J.H. [Leiden University Medical Center, Department of Neurology, Leiden (Netherlands); Duijm, Lucien E.M. [Catharina Hospital, Department of Radiology, Eindhoven (Netherlands); Keizer, Koos [Catharina Hospital, Department of Neurology, Eindhoven (Netherlands); Bot, Joseph C.J. [VU University Medical Center, Department of Radiology, Amsterdam (Netherlands); Visser, Marieke C. [VU University Medical Center, Department of Neurology, Amsterdam (Netherlands); Lugt, Aad van der [Erasmus MC University Medical Center, Department of Radiology, Rotterdam (Netherlands); Dippel, Diederik W.J. [Erasmus MC University Medical Center, Department of Neurology, Rotterdam (Netherlands); Kesselring, F.O.H.W. [Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Hofmeijer, Jeannette [Rijnstate Hospital, Department of Neurology, Arnhem (Netherlands); Lycklama a Nijeholt, Geert J. [Medical Center Haaglanden, Department of Radiology, The Hague (Netherlands); Boiten, Jelis [Medical Center Haaglanden, Department of Neurology, The Hague (Netherlands); Rooij, Willem Jan van [St. Elisabeth Hospital, Department of Radiology, Tilburg (Netherlands); Kort, Paul L.M. de [St. Elisabeth Hospital, Department of Neurology, Tilburg (Netherlands); Roos, Yvo B.W.E.M. [Academic Medical Center, Department of Neurology, Amsterdam (Netherlands); Meijer, Frederick J.A. [Radboud University Medical Center, Department of Radiology, Nijmegen (Netherlands); Pleiter, C.C. [St. Franciscus Hospital, Department of Radiology, Rotterdam (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: Dutch acute stroke study (DUST) investigators


    We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R{sup 2} was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R{sup 2} = 0.58) was superior to patient characteristics and non-contrast CT alone (R{sup 2} = 0.44) and to addition of CTA alone (R{sup 2} = 0.55) or CTP alone (R{sup 2} = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. (orig.)

  2. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index

    DEFF Research Database (Denmark)

    Fuglsang, S; Bendtsen, F; Christensen, E


    Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40....../PP on one side and age, sex, body weight, portal pressure, systemic hemodynamics, biochemical variables, and severity of disease on the other. In the multiple-regression analysis, sex, age, mean arterial blood pressure, systemic vascular resistance, and biochemical variables were significant independent...

  3. Decreased Left Putamen and Thalamus Volume Correlates with Delusions in First-Episode Schizophrenia Patients

    Directory of Open Access Journals (Sweden)

    Xiaojun Huang


    Full Text Available BackgroundDelusional thinking is one of the hallmark symptoms of schizophrenia. However, the underlying neural substrate for delusions in schizophrenia remains unknown. In an attempt to further our understanding of the neural basis of delusions, we explored gray matter deficits and their clinical associations in first-episode schizophrenia patients with and without delusions.MethodsTwenty-four first-episode schizophrenia patients with delusions and 18 without delusions as well as 26 healthy controls (HC underwent clinical assessment and whole-brain structural imaging which were acquired a 3.0 T scanner. Voxel-based morphometry was used to explore inter-group differences in gray matter volume using analysis of covariance, and Spearman correlation coefficients (rho between the Scale for the Assessment of Positive Symptoms (SAPS-delusion scores and mean regional brain volumes was obtained.ResultsPatients with delusions showed decreased brain gray matter volumes in the left putamen, thalamus, and caudate regions compared with HC. Patients with delusions also showed decreased regional volume in the left putamen and thalamus compared with patients without delusions. SAPS-delusion scores were negatively correlated with the gray matter volumes of the left putamen and thalamus.DiscussionLeft putamen and thalamus volume loss may be biological correlates of delusions in schizophrenia.

  4. Insomnia severity is associated with a decreased volume of the CA3/Dentate Gyrus Hippocampal Subfield (United States)

    Neylan, Thomas C.; Mueller, Susanne G.; Wang, Zhen; Metzler, Thomas J.; Lenoci, Maryann; Truran, Diana; Marmar, Charles R.; Weiner, Michael W.; Schuff, Norbert


    Background Prolonged disruption of sleep in animal studies is associated with decreased neurogenesis in the dentate gyrus. Our objective was to determine if insomnia severity in a sample of PTSD and controls was associated with decreased volume in the CA3/dentate hippocampal subfield. Methods Volumes of hippocampal subfields in seventeen veteran males positive for PTSD (41 ±12 years) and nineteen age-matched male veterans negative for PTSD were measured using 4 Tesla MRI. Subjective sleep quality was measured by the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Results Higher scores on the ISI, indicating worse insomnia, were associated with smaller volumes of the CA3/dentate subfields (r= −.48, p < 0.01) in the combined sample. Adding the ISI score as a predictor for CA3/dentate volume to a hierarchical linear regression model after first controlling for age and PTSD symptoms accounted for a 13 % increase in incremental variance (t= −2.47, p= 0.02). Conclusions The findings indicate for the first time in humans that insomnia severity is associated with volume loss of the CA3/dentate subfields. This is consistent with animal studies showing that chronic sleep disruption is associated with decreased neurogenesis and dendritic branching in these structures. PMID:20598672

  5. Mean platelet volume as a risk stratification tool in the Emergency Department for evaluating patients with ischaemic stroke and TIA

    International Nuclear Information System (INIS)

    Dogan, N.O.; Karakurt, K.


    Objective: To investigate the variations of mean platelet volume in patients with ischaemic cerebrovascular complaints, and to find out its diagnostic utility in an acute setting to help risk stratification in patients with ischaemic stroke and transient ischaemic attacks. Methods: The prospective cross-sectional study was conducted at the Gazi University Hospital, Ankara, Turkey, from November 2009 to June 2010. It comprised 143 consecutive patients of acute ischaemic stroke, 39 patients of transient ischaemic attacks and 60 healthy volunteers. SPSS 13 was used for statistical analysis, and so were t-test, one-way analysis of variance test and correlation analysis. Statistical significance was accepted at p <0.05. Results: Mean platelet volume results were significantly higher in patients with cortical infarction and transient ischaemic attack compared to the control group (p <0.001 and p <0.002). A statistically significant increase was also noted in hospitalised patients when compared with discharged patients from the emergency department (p <0.036). A weak positive correlation was identified between the National Institute of Health Stroke Scores and mean platelet volume levels (r=0.207; p <0.001). A significant relationship was identified between mean platelet volume levels and previous stroke (p <0.005). Conclusion: The measurement of mean platelet volume levels may provide useful diagnostic and prognostic information to emergency physicians caring for patients with transient ischaemic attack and ischaemic stroke. In patients with suspected neurological ischaemic symptoms, high levels may be considered as an atherosclerotic risk factor. (author)

  6. Atrial natriuretic peptide decreases blood volume in intact and anephric rats

    International Nuclear Information System (INIS)

    Trippodo, N.C.; Chien, Y.W.; Pegram, B.L.; Cole, F.E.; MacPhee, A.A.; Kardon, M.B.


    Atrial natriuretic peptide (ANP) reportedly lowers atrial pressure and increases hematocrit, suggesting venodilation and/or decreased blood volume (BV). To examine these possibilities, rat ANP (99-126) was administered to Inactinanesthetized rats (313 +/- 9 g, +/- SE) at 0.5 μg/kg/min for 30 minutes. Urine flow increased by 0.05 ml/min (p 51 Cr-RBC) decreased by 3.4 ml/kg (p < 0.001). Mean circulatory filling pressure, measured by inflating an intracardiac balloon to briefly stop the circulation, did not change. Distribution of BV between the thoracic and spanchnic organs (whole-animal freezing in liquid nitrogen) was not measurably altered. The results suggest that the decrease in CVP was related more to decreased BV than to venodilation. To investigate possible mechanisms for the decreased BV, the same dose of ANP was administered to anephric rats. MAP decreased by 8 mmHg (p < 0.001); hematocrit increased by 2.4 units (p < 0.001) and BV decreased by 1.7 ml/kg (p < 0.05). The results indicate that short-term administration of ANP decreases blood volume by causing intravascular fluid to shift into the interstitium as well as by inducing diuresis

  7. Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke


    Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In


    Abstract We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox ...

  8. Automatic extraction of forward stroke volume using dynamic PET/CT

    DEFF Research Database (Denmark)

    Harms, Hans; Tolbod, Lars Poulsen; Hansson, Nils Henrik

    Background: Dynamic PET can be used to extract forward stroke volume (FSV) by the indicator dilution principle. The technique employed can be automated and is in theory independent on the tracer used and may therefore be added to any dynamic cardiac PET protocol. The aim of this study was to vali......Background: Dynamic PET can be used to extract forward stroke volume (FSV) by the indicator dilution principle. The technique employed can be automated and is in theory independent on the tracer used and may therefore be added to any dynamic cardiac PET protocol. The aim of this study...... was to validate automated methods for extracting FSV directly from dynamic PET studies for two different tracers and to examine potential scanner hardware bias. Methods: 21 subjects underwent a dynamic 27 min 11C-acetate PET scan on a Siemens Biograph TruePoint 64 PET/CT scanner (scanner I). In addition, 8...... subjects underwent a dynamic 6 min 15O-water PET scan followed by a 27 min 11C-acetate PET scan on a GE Discovery ST PET/CT scanner (scanner II). The LV-aortic time-activity curve (TAC) was extracted automatically from dynamic PET data using cluster analysis. The first-pass peak was isolated by automatic...

  9. Simulation method for cardiac stroke volume estimation by intracardiac electrical impedance measurement. (United States)

    Barak, C; Leviatan, Y; Inbar, G F; Hoekstein, K N


    Using the electrical impedance measurement technique to investigate stroke volume estimation, three models of the ventricle were simulated. A four-electrode impedance catheter was used; two electrodes to set up an electric field in the model and the other two to measure the potential difference. A new approach, itself an application of the quasi-static case of a method used to solve electromagnetic field problems, was used to solve the electric field in the model. The behaviour of the estimation is examined with respect to the electrode configuration on the catheter and to catheter location with respect to the ventricle walls. Cardiac stroke volume estimation was found to be robust to catheter location generating a 10 per cent error for an offset of 40 per cent of the catheter from the chamber axis and rotation of 20 degrees with respect to the axis. The electrode configuration has a dominant effect on the sensitivity and accuracy of the estimation. Certain configurations gave high accuracy, whereas in others high sensitivity was found with lower accuracy. This led to the conclusion that the electrode configuration should be carefully chosen according to the desired criteria.

  10. Experimental studies for the development of a new method for stroke volume measuring using X-ray videodensitometry

    International Nuclear Information System (INIS)

    Odenthal, H.J.


    Quantitative videodensitometry was studied with a view to its possible application as a new, non-invasive method of measuring cardiac stroke volume. To begin with, the accuracy of roentgen volumetric measurements was determined. After this, blood volume variations were measured by densitometry in five animal experiments. The findings were compared with the volumes measured by a flowmeter in the pulmonary artery. The total stroke volume was found to be proportional to the difference between the maximum and mean densitometric volume. A comparison between videodensitometry and other non-invasive methods showed that, in a stable circulatory system, the results of videodensitometry are equally reliable as, or even more reliable than, those of the conventional methods. (orig./MG) [de

  11. Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry. (United States)

    Cocho, D; Sagales, M; Cobo, M; Homs, I; Serra, J; Pou, M; Perez, G; Pujol, G; Tantinya, S; Bao, P; Aloy, A; Sabater, R; Gendre, J; Otermin, P

    During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Permissive role of calcium on regulatory volume decrease in freshly isolated mouse cholangiocytes. (United States)

    Park, Jae-Seung; Choi, Yong Jin; Siegrist, Vicki J; Ko, Yoo-Seung; Cho, Won Kyoo


    Calcium (Ca2+) pathways are important in cell volume regulation in many cells, but its role in volume regulatory processes in cholangiocytes is unclear. Thus, we have investigated the role of Ca2+ in regulatory volume decrease (RVD) in cholangiocytes using freshly isolated bile duct cell clusters (BDCCs) from normal mouse. No significant increase in [Ca2+]i was observed during RVD, while ionomycin and ATP showed significant increases. Confocal imaging also showed no significant changes in the levels or distributions of intracellular Ca2+ during RVD. Cell volume study by quantitative videomicroscopy indicated that removal and chelation of extracellular Ca2+ by ethylene glycol-bis (beta-aminoethyl ether)-N,N,N-tetraacetic acid (EGTA) or administration of nifedipine did not affect RVD but verapamil significantly inhibited the RVD. Moreover, Ca2+ agonists or inhibitors of Ca2+ release from intracellular stores had no significant effect on RVD. However, 1,2-bis (2-aminophenoxy) ethane-N,N,N'N'-tetraacetic acid-AM (BAPTA-AM) showed significant decreases in [Ca2+]i and significantly inhibited RVD, which was reversed with coadministration of valinomycin, suggesting that BAPTA-AM-induced inhibition is due to potassium conductance or other cellular processes requiring permissive [Ca2+](i. These findings indicate that an increase in [Ca2+]i or extracellular Ca2+ is not required for RVD but Ca2+ has a permissive role in RVD of mouse cholangiocytes.

  13. Decreased left temporal lobe volume of panic patients measured by magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    R.R. Uchida


    Full Text Available Reported neuroimaging studies have shown functional and morphological changes of temporal lobe structures in panic patients, but only one used a volumetric method. The aim of the present study was to determine the volume of temporal lobe structures in patients with panic disorder, measured by magnetic resonance imaging. Eleven panic patients and eleven controls matched for age, sex, handedness, socioeconomic status and years of education participated in the study. The mean volume of the left temporal lobe of panic patients was 9% smaller than that of controls (t21 = 2.37, P = 0.028. In addition, there was a trend (P values between 0.05 and 0.10 to smaller volumes of the right temporal lobe (7%, t21 = 1.99, P = 0.06, right amygdala (8%, t21 = 1.83, P = 0.08, left amygdala (5%, t21 = 1.78, P = 0.09 and left hippocampus (9%, t21 = 1.93, P = 0.07 in panic patients compared to controls. There was a positive correlation between left hippocampal volume and duration of panic disorder (r = 0.67, P = 0.025, with recent cases showing more reduction than older cases. The present results show that panic patients have a decreased volume of the left temporal lobe and indicate the presence of volumetric abnormalities of temporal lobe structures.

  14. Decreased left temporal lobe volume of panic patients measured by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Uchida, R.R.; Del-Ben, C.M.; Araujo, D.; Crippa, J.A.; Graeff, F.G. [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Dept. de Neurologia e Psicologia Medica]. E-mail:; Santos, A.C. [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Dept. de Clinica Medica; Guimaraes, F.S. [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Dept. de Farmacologia


    Reported neuroimaging studies have shown functional and morphological changes of temporal lobe structures in panic patients, but only one used a volumetric method. The aim of the present study was to determine the volume of temporal lobe structures in patients with panic disorder, measured by magnetic resonance imaging. Eleven panic patients and eleven controls matched for age, sex, handedness, socioeconomic status and years of education participated in the study. The mean volume of the left temporal lobe of panic patients was 9% smaller than that of controls (t{sub 21} = 2.37, P = 0.028). In addition, there was a trend (P values between 0.05 and 0.10) to smaller volumes of the right temporal lobe (7%, t{sub 21} = 1.99, P = 0.06), right amygdala (8%, t{sub 21} = 1.83, P = 0.08), left amygdala (5%, t{sub 21} = 1.78, P 0.09) and left hippocampus (9%, t{sub 21} = 1.93, P = 0.07) in panic patients compared to controls. There was a positive correlation between left hippocampal volume and duration of panic disorder (r = 0.67, P = 0.025), with recent cases showing more reduction than older cases. The present results show that panic patients have a decreased volume of the left temporal lobe and indicate the presence of volumetric abnormalities of temporal lobe structures. (author)

  15. Decreased left temporal lobe volume of panic patients measured by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Uchida, R.R.; Del-Ben, C.M.; Araujo, D.; Crippa, J.A.; Graeff, F.G.; Santos, A.C.; Guimaraes, F.S.


    Reported neuroimaging studies have shown functional and morphological changes of temporal lobe structures in panic patients, but only one used a volumetric method. The aim of the present study was to determine the volume of temporal lobe structures in patients with panic disorder, measured by magnetic resonance imaging. Eleven panic patients and eleven controls matched for age, sex, handedness, socioeconomic status and years of education participated in the study. The mean volume of the left temporal lobe of panic patients was 9% smaller than that of controls (t 21 = 2.37, P = 0.028). In addition, there was a trend (P values between 0.05 and 0.10) to smaller volumes of the right temporal lobe (7%, t 21 = 1.99, P = 0.06), right amygdala (8%, t 21 = 1.83, P = 0.08), left amygdala (5%, t 21 = 1.78, P 0.09) and left hippocampus (9%, t 21 = 1.93, P = 0.07) in panic patients compared to controls. There was a positive correlation between left hippocampal volume and duration of panic disorder (r = 0.67, P = 0.025), with recent cases showing more reduction than older cases. The present results show that panic patients have a decreased volume of the left temporal lobe and indicate the presence of volumetric abnormalities of temporal lobe structures. (author)

  16. Metformin Therapy Decreases Hyperandrogenism and Ovarian Volume in Women with Polycystic Ovary Syndrome

    Directory of Open Access Journals (Sweden)

    Marzieh Farimani Sanoee


    Full Text Available Background: It is well known that there is a close relationship between elevated androgen plasma levels and the ultrasound findings of stromal hypertrophy in polycystic ovary syndrome (PCOS. The objective of this study was to investigate the effects metformin on the hyperandrogenism and ovarian volume in PCOS. Methods: The study is an unrandomized clinical trial with before–after design. Twenty eight patients with infertility (male or female factor meeting the Rotterdam ESHRE/ASRM criteria for PCOS were studied during the 2008-2009. The anthropometric characteristics of the patients, mean bilateral ovarian volume, and morphology by trans vaginal sonography as well as the plasma levels of leutinizing hormone, follicle stimulating hormone, estradiol, testosterone, 17-α-hydroxyprogesterone, and dehydroepianderosterone sulfate were obtained before and after treatment with metformin (500 mg three times a day for three months. Paired t, Pearson's Correlation Coefficient, or Partial Correlation test was used to analyze the findings. Results: The patients had a mean age of 25.67 years. A significant reduction in mean ovarian volume (11.70±4.31 ml vs 8.27±3.71 ml P=0.001, body mass index (BMI, 28.11±4.55 kg/m2 vs 26.84±4.55 kg/m2 P=0.000 and serum androgen levels was seen after three months of treatment with metformin. There was positive correlations between the ovarian volume and serum testosterone level (r=0.589, P=0.001 or BMI (r=0.663, P=0.000. Conclusion: Metformin therapy may lead to a reduction in ovarian volume. It is likely that the reduction of ovarian volume reflect a decrease in the mass of androgen producing tissues

  17. Stroke Volume During Concomitant Apnea and Exercise: Influence of Gravity and Venous Return (United States)

    Hoffmann, Uwe; Drager, Tobias; Steegmanns, Ansgar; Koesterer, Thomas; Linnarsson, Dag


    The responses of the cardiovascular system to intensive exercise (hiP) and combined stimuli by hiP and breath-hold (hiP-BH) for 20 s were examined during changing gravity (parabolic flight) and constant gravity (1g). The basic response to microgravity (μg) during low-intensity exercise was an increase in cardiac output (CO) and stroke volume (SV) as a result of augmented venous return. When onset of hiP was superimposed, the initial augmentation of CO and SV were increased further. In contrast, when BH was added, the increases of CO and SV were slowed. We propose that this was due to a transient increase of the pulmonary blood volume with the combination of μg and BH at large lung volume, creating a temporary imbalance between right ventricular input and left ventricular output. In addition, the BH- induced relative bradycardia may have contributed to a prolongation of the right-to- left indirect ventricular interdependence.

  18. Stroke volume estimation in heart failure patients using bioimpedance: a realistic simulation of the forward problem

    International Nuclear Information System (INIS)

    Sokolovsky, R E; Zlochiver, S; Abboud, S


    Bioimpedance techniques may be appropriate for cardiac stroke volume (SV) monitoring since thoracic anatomical changes during the heart contraction reflect on the conductivity distribution. In some bioimpedance techniques, the electrical potential is calculated from the impedance distribution using Poisson's equation. That is called the forward problem and in many applications it is used inherently in the solution of the inverse problem—finding the impedance distribution from the electrical potentials. In this work, the forward problem was simulated using a realistic 3D hybrid phantom of the human thorax. The cardiac cycle of normal patients and patients suffering from cardiogenic pulmonary edema was simulated, including the effect of pulmonary blood perfusion during heart contraction. The forward problem was found to be most sensitive to SV when current was injected from the right breast toward the left scapula (−0.021 µV ml −1 ). Our simulations show that both the heart volume and lung conductivity affect the developing voltage; therefore in SV estimation, the lung conductivity and heart volume should be jointly estimated

  19. Automatic extraction of forward stroke volume using dynamic PET/CT

    DEFF Research Database (Denmark)

    Harms, Hans; Tolbod, Lars Poulsen; Hansson, Nils Henrik Stubkjær


    Background The aim of this study was to develop and validate an automated method for extracting forward stroke volume (FSV) using indicator dilution theory directly from dynamic positron emission tomography (PET) studies for two different tracers and scanners. Methods 35 subjects underwent...... a dynamic 11 C-acetate PET scan on a Siemens Biograph TruePoint-64 PET/CT (scanner I). In addition, 10 subjects underwent both dynamic 15 O-water PET and 11 C-acetate PET scans on a GE Discovery-ST PET/CT (scanner II). The left ventricular (LV)-aortic time-activity curve (TAC) was extracted automatically...... from PET data using cluster analysis. The first-pass peak was isolated by automatic extrapolation of the downslope of the TAC. FSV was calculated as the injected dose divided by the product of heart rate and the area under the curve of the first-pass peak. Gold standard FSV was measured using phase...

  20. Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation

    DEFF Research Database (Denmark)

    Perner, A; Faber, T


    Stroke volume variation (SVV)--as measured by the pulse contour cardiac output (PiCCO) system--predicts the cardiac output response to a fluid challenge in patients on controlled ventilation. Whether this applies to patients on pressure support ventilation is unknown....

  1. KCNQ channels are involved in the regulatory volume decrease response in primary neonatal rat cardiomyocytes

    DEFF Research Database (Denmark)

    Calloe, Kirstine; Nielsen, Morten Schak; Grunnet, Morten


    Cardiomyocytes may experience significant cell swelling during ischemia and reperfusion. Such changes in cardiomyocyte volume have been shown to affect the electrical properties of the heart, possibly leading to cardiac arrhythmia. In the present study the regulatory volume decrease (RVD) response...... of neonatal rat cardiomyocytes was studied in intact single cells attached to coverslips, i.e. with an intact cytoskeleton. The potential contribution of KCNQ (Kv7) channels to the RVD response and the possible involvement of the F-actin cytoskeleton were investigated. The rate of RVD was significantly...... inhibited in the presence of the KCNQ channel blocker XE-991 (10 and 100 microM). Electrophysiological experiments confirmed the presence of an XE-991 sensitive current and Western blotting analysis revealed that KCNQ1 channel protein was present in the neonatal rat cardiomyocytes. Hypoosmotic cell swelling...

  2. Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging. (United States)

    Bargalló, Núria; Olondo, Lourdes; Garcia, Ana I; Capurro, Sebastian; Caral, Luis; Rumia, Jordi


    Endoscopic third ventriculostomy (ETV) is increasingly used as alternative treatment for obstructive hydrocephalus. The aim of this study was to determine the utility of quantitative and qualitative examinations with cine phase-contrast MR imaging to determine the efficacy of ventriculostomy across time and whether CSF pulsation is restored after ETV. Thirty-eight patients treated with ETV were evaluated with cine phase-contrast MR within 1 month after surgery. Follow-up studies were performed after 1 year in 25 patients and after 2 years in 12. We evaluated flow void changes in the floor of the third ventricle and quantified the stroke volume at the site of the ventriculostomy. We also recorded changes in ventricular size and clinical outcome. To determine the restoration of CSF pulsation, we compared the CSF waveform at the ventriculostomy with the CSF waveform at the aqueduct in a healthy control group. After ventriculostomy, restoration of pulsate motion characteristics of CSF circulation was observed. The stroke volume registered at ventriculostomy was maintained with time. There was a statistically significant relationship between clinical outcome and stroke volume. Overall flow magnitude was the most effective variable to determine which patients would improve after surgery. Values >75 mm3 showed a sensitivity of 76.7% and a specificity of 87.5% There was no relationship between ventricular size changes and clinical outcome. Patients with primary aqueduct stenosis had the best response to surgery, whereas patients with Arnold Chiari malformation or communicating hydrocephalus had the worst response. Quantitative analysis with phase-contrast MR imaging indicates that ETV is an efficient technique for restoring CSF pulsation, with efficacy being maintained during the follow-up controls. Quantification of stroke volume at ventriculostomy is a good indicator of the functional status of ETV, and a high stroke volume in the ventriculostomy appears to be a positive

  3. Decreased blood platelet volume and count in patients with liver disease

    DEFF Research Database (Denmark)

    Jørgensen, B; Fischer, E; Ingeberg, S


    Mean platelet volume (MPV) and count (PLT) were assessed in patients with moderately affected liver function. PLT was significantly decreased in patients with liver disease (197 X 10(9)l-1 +/- 87 (SD), no. = 79) compared with that of controls (273 X 10(9)l-1 +/- 53 (SD), no. = 37, P less than 0...... (r = -0.2, 0.05 less than P less than 0.1). It is concluded that the low MPV and PLT are compatible with an intravascular activation (loss of granules) and increased consumption of platelets, which may take place in the diseased liver even in patients with a relatively well preserved liver function....

  4. Mathematical simulation of water distillation column for decreasing volume of tritiated water

    International Nuclear Information System (INIS)

    Kinoshita, Masahiro; Naruse, Yuji


    Water distillation is an attractive method for decreasing volume of the tritiated water produced by operation of tritium facilities. The tritiated water is continuously fed to a column and it is separated into two streams. The top stream is discarded to the environment after addition of sufficient amount of uncontaminated water. The bottom stream is further treated for solidification and capsulation. The tridiagonal matrix method proved to provide surprisingly rapid convergences of the calculations. The concentration of deuterium naturally contained in the tritiated water is higher than the tritium concentration, but it was verified that presence of HDO can be ignored in the calculation. (author)

  5. Sleep apnea termination decreases cerebral blood volume: a near-infrared spectroscopy case study (United States)

    Virtanen, Jaakko; Noponen, Tommi; Salmi, Tapani; Toppila, Jussi; Meriläinen, Pekka


    Medical near-infrared spectroscopy (NIRS) can be used to estimate cerebral haemodynamic changes non-invasively. Sleep apnea is a common sleep disorder where repetitive pauses in breathing decrease the quality of sleep and exposes the individual to various health problems. We have measured oxygenated and deoxygenated haemoglobin concentration changes during apneic events in sleep from the forehead of one subject using NIRS and used principal component analysis to extract extracerebral and cortical haemodynamic changes from NIRS signals. Comparison of NIRS signals with EEG, bioimpedance, and pulse oximetry data suggests that termination of apnea leads to decreases in cerebral blood volume and flow that may be related to neurological arousal via neurovascular coupling.

  6. Carbondioxide-Aided Angiography Decreases Contrast Volume and Preserves Kidney Function in Peripheral Vascular Interventions. (United States)

    Stegemann, Emilia; Tegtmeier, Catharina; Bimpong-Buta, Nana Yaw; Sansone, Roberto; Uhlenbruch, Mark; Richter, Andreas; Stegemann, Berthold; Roden, Michael; Westenfeld, Ralf; Kelm, Malte; Heiss, Christian


    Chronic kidney disease is a common comorbidity in patients with peripheral artery disease. We investigated the safety and efficacy of carbon dioxide (CO2) as supplemental contrast agent to decrease contrast volume during fluoroscopy-guided peripheral vascular procedures in routine angiological practice. We analyzed 191 consecutive interventions of the lower extremity in claudicants and critical limb ischemia (CLI) that were performed with iodinated contrast media (ICM) alone (n = 154) or with the aided or exclusive use of CO2 (n = 37). The technical success rate, total irradiation, and intervention time were not significantly different between ICM and CO2 No severe procedure-related complications occurred. The contrast volume was lower in CO2 than in ICM. Although kidney function, creatinine, and estimated glomerular filtration rate was lower in CO2 at baseline, the incidence of contrast-induced nephropathy was lower in CO2 compared to ICM. These data support CO2 as an alternative supplemental contrast agent that can be applied safely and efficiently to lower contrast volume during peripheral vascular interventions preventing kidney dysfunction even in patients with disease of the popliteal artery and below the knee and CLI. © The Author(s) 2015.

  7. Cadmium affects osmotic phase and regulatory volume decrease in cultured human embryonic kidney cells

    Directory of Open Access Journals (Sweden)

    Rossana Morabito


    Full Text Available The present investigation aims to verify whether cadmium (Cd2+, a metal possibly accumulated in body tissues from air and food, affects cell volume regulation capability in cultured human embryonic kidney (HEK 293 Phoenix cells. The osmotic phase (OP, which is the expected cell swelling due to aquaporins involvement after hyposmotic challenge, and regulatory volume decrease (RVD, bringing cell volume back to control values through Ca2+-dependent ion efflux (K+ and Cl–, have been monitored in HEK 293 cells treated with Cd2+ (1-10-100 μM for different time intervals (30 min, 3 h, overnight and then submitted to 15 % hyposmotic shock. The results show that both 1 and 10 μM Cd2+ significantly reduced OP, whereas 100 μM impaired Cd2+ RVD mechanisms. The use of glutathione (GSH, 200 μM confirmed that Cd2+ elicited its effect via oxidative damage, being RVD inhibition after Cd2+ treatment prevented by this antioxidant compound. Our findings show that: i HEK 293 cells are a suitable model to assay the effect of xenobiotics on cell homeostasis; ii Cd2+, depending on its concentration, affects cell homeostasis at different levels, i.e. water and ion permeability, responsible for, respectively, OP and RVD mechanism, adding thus more information to the knowledge of Cd2+ toxicology.

  8. Increased CSF-BACE1 activity associated with decreased hippocampus volume in Alzheimer's disease.

    LENUS (Irish Health Repository)

    Ewers, Michael


    The enzyme beta-secretase (BACE1) is essentially involved in the production of cerebral amyloidogenic pathology in Alzheimer\\'s disease (AD). The measurement of BACE1 activity in cerebrospinal fluid (CSF) has been reported, which may render CSF measurement of BACE1 a potential biomarker candidate of AD. In order to investigate whether BACE1 protein activity is correlated with regional brain atrophy in AD, we investigated the association between CSF levels of BACE1 and MRI-assessed hippocampus volume in patients with AD (n = 30). An increase in CSF-BACE1 activity was associated with decreased left and right hippocampus volume corrected for global head volume in the AD patients. Boot-strapped regression analysis showed that increased CSF levels of BACE1 activity were associated with increased CSF concentration of total tau but not amyloid-beta1-42 in AD. White matter hyperintensities did not influence the results. BACE1 activity and protein levels were significantly increased in AD compared to 19 elderly healthy controls. Thus, the CSF biomarker candidate of BACE1 activity was associated with hippocampus atrophy in AD in a robust manner and may reflect neurotoxic amyloid-beta-related processes.

  9. Anorexia Nervosa during Adolescence Is Associated with Decreased Gray Matter Volume in the Inferior Frontal Gyrus.

    Directory of Open Access Journals (Sweden)

    Takashi X Fujisawa

    Full Text Available Anorexia nervosa (AN is an eating disorder characterized by the relentless pursuit to lose weight, mostly through self-starvation, and a distorted body image. AN tends to begin during adolescence among women. However, the underlying neural mechanisms related to AN remain unclear. Using voxel-based morphometry based on magnetic resonance imaging scans, we investigated whether the presence of AN was associated with discernible changes in brain morphology. Participants were 20 un-medicated, right-handed patients with early-onset AN and 14 healthy control subjects. Group differences in gray matter volume (GMV were assessed using high-resolution, T1-weighted, volumetric magnetic resonance imaging datasets (3T Trio scanner; Siemens AG and analyzed after controlling for age and total GMV, which was decreased in the bilateral inferior frontal gyrus (IFG (left IFG: FWE corrected, p < 0.05; right IFG: uncorrected, p < 0.05 of patients with AN. The GMV in the bilateral IFG correlated significantly with current age (left IFG: r = -.481, p < .05; right IFG: r = -.601, p < .01 and was limited to the AN group. We speculate that decreased IFG volume might lead to deficits in executive functioning or inhibitory control within neural reward systems. Precocious or unbalanced neurological trimming within this particular region might be an important factor for the pathogenesis of AN onset.

  10. Stroke (United States)

    ... or reading Dizziness or abnormal feeling of movement (vertigo) Eyesight problems, such as decreased vision, double vision, ... control risk factors, such as high blood pressure, diabetes, and high cholesterol Special procedures or surgery to ...

  11. Colloid volume loading does not mitigate decreases in central blood volume during simulated hemorrhage while heat stressed

    DEFF Research Database (Denmark)

    Crandall, Craig G; Wilson, Thad E; Marving, Jens


    ±5%, all P0.05 relative to heat stress alone). These data suggest that blood volume loading during passive heat stress (via 11 ml/kg of a colloid solution) normalizes regional blood volumes in the torso, but does not mitigate the reduction in central blood volume during a simulated hemorrhagic challenge...

  12. Impedance cardiography: Pulsatile blood flow and the biophysical and electrodynamic basis for the stroke volume equations

    Directory of Open Access Journals (Sweden)

    Donald P Bernstein


    Full Text Available Impedance cardiography (ICG is a branch of bioimpedance pimarily concerned with the determination of left ventricular stroke volume (SV. As implemented, using the transthoracic approach, the technique involves applying a current field longitudinally across a segment of thorax by means of a constant magnitude, high frequency, low amplitude alternating current (AC. By Ohm's Law, the voltage difference measured within the current field is proportional to the electrical impedance Z (Ω. Without ventilatory or cardiac activity, Z is known as the transthoracic, static base impedance Z0. Upon ventricular ejection, a characteristic time dependent cardiac-synchronous pulsatile impedance change is obtained, ΔZ(t, which, when placed electrically in parallel with Z0, constitutes the time-variable total transthoracic impedance Z(t. ΔZ(t represents a dual-element composite waveform, which comprises both the radially-oriented volumetric expansion of and axially-directed forward blood flow within both great thoracic arteries. In its majority, however, ΔZ(t is known to primarily emanate from the ascending aorta. Conceptually, commonly implemented methods assume a volumetric origin for the peak systolic upslope of ΔZ(t, (i.e. dZ/dtmax, with the presumed units of Ω·s-1. A recently introduced method assumes the rapid ejection of forward flowing blood in earliest systole causes significant changes in the velocity-induced blood resistivity variation (Δρb(t, Ωcm·s-1, and it is the peak rate of change of the blood resistivity variation dρb(t/dtmax (Ωcm·s-2 that is the origin of dZ/dtmax. As a consequence of dZ/dtmax peaking in the time domain of peak aortic blood acceleration, dv/dtmax (cm·s-2, it is suggested that dZ/dtmax is an ohmic mean acceleration analog (Ω·s-2 and not a mean flow or velocity surrogate as generally assumed. As conceptualized, the normalized value, dZ/dtmax/Z0, is a dimensionless ohmic mean acceleration equivalent (s-2

  13. Regulatory volume decrease in isolated nematocytes is affected by crude venom from the jellyfish Pelagia noctiluca

    Directory of Open Access Journals (Sweden)

    Rossana Morabito


    Full Text Available Crude venom from nematocysts of the Scyphozoan Pelagia noctiluca possesses hemolytic and cytotoxic power on cultured cells and elicits local and systemic inflammation reactions in vivo. The ability of regulating their volume after exposure to an anisosmotic solution is a fundamental feature common to cells from vertebrates and invertebrates, including Cnidarians. The aim of the present work i s to assay whether crude venom from Pelagia noctiluca may affect the regulatory volume decrease (RVD of nematocytes isolated from the Anthozoan Aiptasia mutabilis, here employed as a cell model. For this purpose, nematocytes were isolated by 605 mM NaSCN plus 0.01 mM Ca2+ application on acontia of Aiptasia mutabilis, while crude venom was obtained by sonication of a population of, respectively, 10, 25 and 50 nematocysts/µL (n/µL. Isolated nematocytes were pre-treated for 30 min with crude venom, submitted to hypotonic stress and their osmotic response and RVD were measured optically. Our results show that, after exposure to crude venom, nematocytes were morphologically intact, as shown by the Trypan blue exclusion test, but did not exhibit RVD. This effect was dose-dependent and reversed by the ionopho re gramicidin. The last observation suggests an inhibitory effect of venom on cell membrane ion transport mechanisms involved in RVD. Further studies are needed to verify this hypothesis and ascertain if a similar effect could be observed in human cells.

  14. Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume

    NARCIS (Netherlands)

    van den Wijngaard, I. R.; Holswilder, G.; Wermer, M. J. H.; Boiten, J.; Algra, A.; Dippel, D. W. J.; Dankbaar, J. W.; Velthuis, B. K.; Boers, A. M. M.; Majoie, C. B. L. M.; van Walderveen, M. A. A.


    Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up. We selected patients with acute ischemic stroke due to

  15. Respiratory-gated electrical impedance tomography: a potential technique for quantifying stroke volume (United States)

    Arshad, Saaid H.; Murphy, Ethan K.; Halter, Ryan J.


    Telemonitoring is becoming increasingly important as the proportion of the population living with cardiovascular disease (CVD) increases. Currently used health parameters in the suite of telemonitoring tools lack the sensitivity and specificity to accurately predict heart failure events, forcing physicians to play a reactive versus proactive role in patient care. A novel cardiac output (CO) monitoring device is proposed that leverages a custom smart phone application and a wearable electrical impedance tomography (EIT) system. The purpose of this work is to explore the potential of using respiratory-gated EIT to quantify stroke volume (SV) and assess its feasibility using real data. Simulations were carried out using the 4D XCAT model to create anatomically realistic meshes and electrical conductivity profiles representing the human thorax and the intrathoracic tissue. A single 5-second period respiration cycle with chest/lung expansion was modeled with end-diastole (ED) and end-systole (ES) heart volumes to evaluate how effective EIT-based conductivity changes represent clinically significant differences in SV. After establishing a correlation between conductivity changes and SV, the applicability of the respiratory-gated EIT was refined using data from the PhysioNet database to estimate the number of useful end-diastole (ED) and end-systole (ES) heart events attained over a 3.3 minute period. The area associated with conductivity changes was found to correlate to SV with a correlation coefficient of 0.92. A window of 12.5% around peak exhalation was found to be the optimal phase of the respiratory cycle from which to record EIT data. Within this window, ~47 useable ED and ES were found with a standard deviation of 28 using 3.3 minutes of data for 20 patients.

  16. Relationship between Stroke Volume Variation and Blood Transfusion during Liver Transplantation. (United States)

    Choi, Jae Moon; Lee, Yoon Kyung; Yoo, Hwanhee; Lee, Sukyung; Kim, Hee Yeong; Kim, Young-Kug


    Intraoperative blood transfusion increases the risk for perioperative mortality and morbidity in liver transplant recipients. A high stroke volume variation (SVV) method has been proposed to reduce blood loss during living donor hepatectomy. Herein, we investigated whether maintaining high SVV could reduce the need for blood transfusion and also evaluated the effect of the high SVV method on postoperative outcomes in liver transplant recipients. We retrospectively analyzed 332 patients who underwent liver transplantation, divided into control (maintaining blood transfusion requirement and hemodynamic parameters, including SVV, as well as postoperative outcomes, such as incidences of acute kidney injury, durations of postoperative intensive care unit and hospital stay, and rates of 1-year mortality. Mean SVV values were 7.0% ± 1.3% in the control group (n = 288) and 11.2% ± 1.8% in the high SVV group (n = 44). The median numbers of transfused packed red blood cells and fresh frozen plasmas in the high SVV group were significantly lower than those in control group (0 vs. 2 units, P = 0.003; and 0 vs. 3 units, P = 0.033, respectively). No significant between-group differences were observed for postoperative outcomes. Maintaining high SVV can reduce the blood transfusion requirement during liver transplantation without worsening postoperative outcomes. These findings provide insights into improving perioperative management in liver transplant recipients.

  17. Real-time stroke volume measurements for the optimization of cardiac resynchronization therapy parameters. (United States)

    Dizon, José M; Quinn, T Alexander; Cabreriza, Santos E; Wang, Daniel; Spotnitz, Henry M; Hickey, Kathleen; Garan, Hasan


    We investigated the utility of real-time stroke volume (SV) monitoring via the arterial pulse power technique to optimize cardiac resynchronization therapy (CRT) parameters at implant and prospectively evaluated the clinical and echocardiographic results. Fifteen patients with ischaemic or non-ischaemic dilated cardiomyopathy, sinus rhythm, Class III congestive heart failure, and QRS >150 ms underwent baseline 2D echocardiogram (echo), 6 min walk distance, and quality of life (QOL) questionnaire within 1 week of implant. Following implant, 0.3 mmol lithium chloride was injected to calibrate SV via dilution curve. Atrioventricular (AV) delay (90, 120, 200 ms, baseline: atrial pacing only) and V-V delay (-80 to 80 ms in 20 ms increments) were varied every 60 s. The radial artery pulse power autocorrelation method (PulseCO algorithm, LiDCO, Ltd.) was used to monitor SV on a beat-to-beat basis (LiDCO, Ltd.). Optimal parameters were programmed and echo, 6 min walk, and QOL were repeated at 6-8 weeks post-implant. Nine patients had >5% increase in SV after optimization (Group A). Six patients had Real-time SV measurements can be used to optimize CRT at the time of implant. Improvement in SV correlates with improvement in LVEF, LVEDD, and 6 min walk, and improvement in echocardiographic dyssynchrony.

  18. Automatic extraction of forward stroke volume using dynamic PET/CT

    DEFF Research Database (Denmark)

    Harms, Hans; Tolbod, Lars Poulsen; Hansson, Nils Henrik

    subjects underwent a dynamic 6 min 15O-water PET scan followed by a 27 min 11C-acetate PET scan on a GE Discovery ST PET/CT scanner (scanner II). The LV-aortic time-activity curve (TAC) was extracted automatically from dynamic PET data using cluster analysis. The first-pass peak was isolated by automatic......Background: Dynamic PET can be used to extract forward stroke volume (FSV) by the indicator dilution principle. The technique employed can be automated and is in theory independent on the tracer used and may therefore be added to any dynamic cardiac PET protocol. The aim of this study...... was to validate automated methods for extracting FSV directly from dynamic PET studies for two different tracers and to examine potential scanner hardware bias. Methods: 21 subjects underwent a dynamic 27 min 11C-acetate PET scan on a Siemens Biograph TruePoint 64 PET/CT scanner (scanner I). In addition, 8...

  19. Moderate Recovery Unnecessary to Sustain High Stroke Volume during Interval Training. A Brief Report

    Directory of Open Access Journals (Sweden)

    Jamie Stanley


    Full Text Available It has been suggested that the time spent at a high stroke volume (SV is important for improving maximal cardiac function. The aim of this study was to examine the effect of recovery intensity on cardiovascular parameters during a typical high-intensity interval training (HIIT session in fourteen well-trained cyclists. Oxygen consumption (VO2, heart rate (HR, SV, cardiac output (Qc, and oxygenation of vastus lateralis (TSI were measured during a HIIT (3×3-min work period, 2 min of recovery session on two occasions. VO2, HR and Qc were largely higher during moderate-intensity (60% compared with low-intensity (30% (VO2, effect size; ES = +2.6; HR, ES = +2.8; Qc, ES = +2.2 and passive (HR, ES = +2.2; Qc, ES = +1.7 recovery. By contrast, there was no clear difference in SV between the three recovery conditions, with the SV during the two active recovery periods not being substantially different than during exercise (60%, ES = −0.1; 30%, ES = −0.2. To conclude, moderate-intensity recovery may not be required to maintain a high SV during HIIT.

  20. Mean platelet volume is decreased in adults with active lupus disease

    Directory of Open Access Journals (Sweden)

    Guillermo Delgado-García

    Full Text Available ABSTRACT Background: Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE. Mean platelet volume (MPV has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. Objective: We investigated the association between MPV and disease activity in adult patients with SLE. Methods: In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group. Subjects were age- and gender-matched. Results: MPV was significantly decreased with respect to those of inactive patients (7.16 ± 1.39 vs. 8.16 ± 1.50, p = 0.005. At a cutoff level of 8.32 fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r = 0.407, p = 0.001, which in turn is inversely associated with disease activity. Conclusions: In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

  1. Stroke volume variation compared with pulse pressure variation and cardiac index changes for prediction of fluid responsiveness in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Randa Aly Soliman


    Conclusions: Baseline stroke volume variation ⩾8.15% predicted fluid responsiveness in mechanically ventilated patients with acute circulatory failure. The study also confirmed the ability of pulse pressure variation to predict fluid responsiveness.

  2. Extravascular Lung Water Does Not Increase in Hypovolemic Patients after a Fluid-Loading Protocol Guided by the Stroke Volume Variation

    Directory of Open Access Journals (Sweden)

    Carlos Ferrando


    Full Text Available Introduction. Circulatory failure secondary to hypovolemia is a common situation in critical care patients. Volume replacement is the first option for the treatment of hypovolemia. A possible complication of volume loading is pulmonary edema, quantified at the bedside by the measurement of extravascular lung water index (ELWI. ELWI predicts progression to acute lung injury (ALI in patients with risk factors for developing it. The aim of this study was to assess whether fluid loading guided by the stroke volume variation (SVV, in patients presumed to be hypovolemic, increased ELWI or not. Methods. Prospective study of 17 consecutive postoperative, fully mechanically ventilated patients diagnosed with circulatory failure secondary to presumed hypovolemia were included. Cardiac index (CI, ELWI, SVV, and global end-diastolic volume index (GEDI were determined using the transpulmonary thermodilution technique during the first 12 hours after fluid loading. Volume replacement was done with a strict hemodynamic protocol. Results. Fluid loading produced a significant increase in CI and a decrease in SVV. ELWI did not increase. No correlation was found between the amount of fluids administered and the change in ELWI. Conclusion. Fluid loading guided by SVV in hypovolemic and fully mechanically ventilated patients in sinus rhythm does not increase ELWI.

  3. Research to improve the accuracy of determining the stroke volume of an artificial ventricle using the wavelet transform (United States)

    Grad, Leszek; Murawski, Krzysztof; Sulej, Wojciech


    In the article we presented results obtained during research, which are the continuation of work on the use of artificial neural networks to determine the relationship between the view of the membrane and the stroke volume of the blood chamber of the mechanical prosthetic heart. The purpose of the research was to increase the accuracy of determining the blood chamber volume. Therefore, the study was focused on the technique of the features that the image extraction gives. During research we used the wavelet transform. The achieved results were compared to the results obtained by other previous methods. Tests were conducted on the same mechanical prosthetic heart model used in previous experiments.

  4. Reduction of infarct volume by thrombolysis with rt-PA in an embolic rat stroke model

    DEFF Research Database (Denmark)

    Overgaard, K.; Sereghy, T.; Boysen, G.


    Rat, thrombolytic therapy, recombinant tissue plasminogen activator, acute ischaemic stroke, cerebral infarction and embolism, experimental thromboembolism, in vitro thrombotic clotting, cerebral ......Rat, thrombolytic therapy, recombinant tissue plasminogen activator, acute ischaemic stroke, cerebral infarction and embolism, experimental thromboembolism, in vitro thrombotic clotting, cerebral ...

  5. The mean platelet volume is decreased in patients with mild head trauma and brain injury. (United States)

    Lippi, Giuseppe; Carbucicchio, Andrea; Benatti, Mario; Cervellin, Gianfranco


    We planned a prospective study to assess platelet number and size in patients with or without brain injury after mild head trauma (MHT). Platelet count and mean platelet volume (MPV) were assessed in consecutive patients admitted to the emergency department with isolate MHT, as well as in healthy blood donors who served as controls. The study population consisted in 54 patients with MHT, 13 of whom (24%) with intracranial lesions suggestive for brain injury, and 339 healthy blood donors. The value of platelet count was significantly lower in patients with MHT and positive computerized tomography than in healthy controls (P = 0.014). The vales of MPV progressively decreased from healthy controls (11.1 fl) to patients with MHT and negative computerized tomography (9.8 fl; P < 0.001), and further to patients with MHT and positive computerized tomography (8.6 fl; P < 0.001). The MPV was significantly lower in patients with MHT and positive computerized tomography than in those with negative computerized tomography (P = 0.002). As compared with healthy controls, the frequency of decreased MPV values was 10-fold and 17-fold higher in MTH patients with negative and positive computerized tomography, respectively. The MPV exhibited an area under the curve of 0.74 (95% CI, 0.58 to 0.89; P < 0.001) for differentiating MHT patients with positive computerized tomography from those with negative computerized tomography. MHT patients display a larger prevalence of small and hyporeactive platelets. This observation provides a reliable basis for planning further studies to establish whether MPV may be useful for diagnostic evaluation of MHT in the emergency department.

  6. Regulatory volume decrease in Leishmania mexicana: effect of anti-microtubule drugs

    Directory of Open Access Journals (Sweden)

    Francehuli Dagger


    Full Text Available The trypanosomatid cytoskeleton is responsible for the parasite's shape and it is modulated throughout the different stages of the parasite's life cycle. When parasites are exposed to media with reduced osmolarity, they initially swell, but subsequently undergo compensatory shrinking referred to as regulatory volume decrease (RVD. We studied the effects of anti-microtubule (Mt drugs on the proliferation of Leishmania mexicana promastigotes and their capacity to undergo RVD. All of the drugs tested exerted antiproliferative effects of varying magnitudes [ansamitocin P3 (AP3> trifluoperazine > taxol > rhizoxin > chlorpromazine]. No direct relationship was found between antiproliferative drug treatment and RVD. Similarly, Mt stability was not affected by drug treatment. Ansamitocin P3, which is effective at nanomolar concentrations, blocked amastigote-promastigote differentiation and was the only drug that impeded RVD, as measured by light dispersion. AP3 induced 2 kinetoplasts (Kt 1 nucleus cells that had numerous flagella-associated Kts throughout the cell. These results suggest that the dramatic morphological changes induced by AP3 alter the spatial organisation and directionality of the Mts that are necessary for the parasite's hypotonic stress-induced shape change, as well as its recovery.

  7. Analysis of decrease in lung perfusion blood volume with occlusive and non-occlusive pulmonary embolisms

    International Nuclear Information System (INIS)

    Ikeda, Yohei; Yoshimura, Norihiko; Hori, Yoshiro; Horii, Yosuke; Ishikawa, Hiroyuki; Yamazaki, Motohiko; Noto, Yoshiyuki; Aoyama, Hidefumi


    Highlights: • The proportion of preserved PE lesions in the non-occlusive group was 76.7% (33/43). • HUs of the iodine map were significantly higher in the non-occlusive group than in the occlusive group. • There was no significant difference in HUs between the non-occlusive and corresponding normal group. - Abstract: Purpose: The aim of this study was to determine if lung perfusion blood volume (lung PBV) with non-occlusive pulmonary embolism (PE) differs quantitatively and visually from that with occlusive PE and to investigate if lung PBV with non-occlusive PE remains the same as that without PE. Materials and methods: Totally, 108 patients suspected of having acute PE underwent pulmonary dual-energy computed tomography angiography (DECTA) between April 2011 and January 2012. Presence of PE on DECTA was evaluated by one radiologist. Two radiologists visually evaluated the PE distribution (segmental or subsegmental) and its nature (occlusive or non-occlusive) on DECTA and classified perfusion in lung PBV as “decreased,” “slightly decreased,” and “preserved”. Two radiologists used a lung PBV application to set a region of interest (ROI) in the center of the lesion and measured HU values of an iodine map. In the same slice as the ROI of the lesion and close to the lesion, another ROI was set in the normal perfusion area without PE, and HUs were measured. The proportion of lesions was compared between the occlusive and non-occlusive groups. HUs were compared among the occlusive, non-occlusive, and corresponding normal groups. Results: Twenty-five patients had 80 segmental or subsegmental lesions. There were 37 and 43 lesions in the occlusive and non-occlusive groups, respectively. The proportion of decreased lesions was 73.0% (27/37) in the occlusive group, while that of preserved lesions in the non-occlusive group was 76.7% (33/43). There was a significant difference in the proportion of lesions (P < 0.001) between the two groups. HUs of the

  8. Peak plasma interleukin-6 and other peripheral markers of inflammation in the first week of ischaemic stroke correlate with brain infarct volume, stroke severity and long-term outcome

    Directory of Open Access Journals (Sweden)

    del Zoppo Gregory J


    Full Text Available Abstract Background Cerebral ischaemia initiates an inflammatory response in the brain and periphery. We assessed the relationship between peak values of plasma interleukin-6 (IL-6 in the first week after ischaemic stroke, with measures of stroke severity and outcome. Methods Thirty-seven patients with ischaemic stroke were prospectively recruited. Plasma IL-6, and other markers of peripheral inflammation, were measured at pre-determined timepoints in the first week after stroke onset. Primary analyses were the association between peak plasma IL-6 concentration with both modified Rankin score (mRS at 3 months and computed tomography (CT brain infarct volume. Results Peak plasma IL-6 concentration correlated significantly (p Conclusions These data provide evidence that the magnitude of the peripheral inflammatory response is related to the severity of acute ischaemic stroke, and clinical outcome.

  9. Increased range of motion and decreased muscle activity during maximal reach with gravity compensation in stroke patients

    NARCIS (Netherlands)

    Prange, Grada Berendina; Stienen, Arno; Jannink, M.J.A.; van der Kooij, Herman; IJzerman, Maarten Joost; Hermens, Hermanus J.; G.J. Gelderblom Bart Driessen, Just L. Herder


    To stimulate restoration of arm function after stroke, active movement is important, which can be facilitated by supporting the weight of the hemiparetic arm, either in conventional treatment or in other approaches such as robot-aided therapy. During arm support, the active range of motion during

  10. The thick left ventricular wall of the giraffe heart normalises wall tension, but limits stroke volume and cardiac output. (United States)

    Smerup, Morten; Damkjær, Mads; Brøndum, Emil; Baandrup, Ulrik T; Kristiansen, Steen Buus; Nygaard, Hans; Funder, Jonas; Aalkjær, Christian; Sauer, Cathrine; Buchanan, Rasmus; Bertelsen, Mads Frost; Østergaard, Kristine; Grøndahl, Carsten; Candy, Geoffrey; Hasenkam, J Michael; Secher, Niels H; Bie, Peter; Wang, Tobias


    Giraffes--the tallest extant animals on Earth--are renowned for their high central arterial blood pressure, which is necessary to secure brain perfusion. Arterial pressure may exceed 300 mmHg and has historically been attributed to an exceptionally large heart. Recently, this has been refuted by several studies demonstrating that the mass of giraffe heart is similar to that of other mammals when expressed relative to body mass. It thus remains unexplained how the normal-sized giraffe heart generates such massive arterial pressures. We hypothesized that giraffe hearts have a small intraventricular cavity and a relatively thick ventricular wall, allowing for generation of high arterial pressures at normal left ventricular wall tension. In nine anaesthetized giraffes (495±38 kg), we determined in vivo ventricular dimensions using echocardiography along with intraventricular and aortic pressures to calculate left ventricular wall stress. Cardiac output was also determined by inert gas rebreathing to provide an additional and independent estimate of stroke volume. Echocardiography and inert gas-rebreathing yielded similar cardiac outputs of 16.1±2.5 and 16.4±1.4 l min(-1), respectively. End-diastolic and end-systolic volumes were 521±61 ml and 228±42 ml, respectively, yielding an ejection fraction of 56±4% and a stroke volume of 0.59 ml kg(-1). Left ventricular circumferential wall stress was 7.83±1.76 kPa. We conclude that, relative to body mass, a small left ventricular cavity and a low stroke volume characterizes the giraffe heart. The adaptations result in typical mammalian left ventricular wall tensions, but produce a lowered cardiac output. © 2016. Published by The Company of Biologists Ltd.

  11. Ventromedial Prefrontal Cortex Damage Is Associated with Decreased Ventral Striatum Volume and Response to Reward. (United States)

    Pujara, Maia S; Philippi, Carissa L; Motzkin, Julian C; Baskaya, Mustafa K; Koenigs, Michael


    The ventral striatum and ventromedial prefrontal cortex (vmPFC) are two central nodes of the "reward circuit" of the brain. Human neuroimaging studies have demonstrated coincident activation and functional connectivity between these brain regions, and animal studies have demonstrated that the vmPFC modulates ventral striatum activity. However, there have been no comparable data in humans to address whether the vmPFC may be critical for the reward-related response properties of the ventral striatum. In this study, we used fMRI in five neurosurgical patients with focal vmPFC lesions to test the hypothesis that the vmPFC is necessary for enhancing ventral striatum responses to the anticipation of reward. In support of this hypothesis, we found that, compared with age- and gender-matched neurologically healthy subjects, the vmPFC-lesioned patients had reduced ventral striatal activity during the anticipation of reward. Furthermore, we observed that the vmPFC-lesioned patients had decreased volumes of the accumbens subregion of the ventral striatum. Together, these functional and structural neuroimaging data provide novel evidence for a critical role for the vmPFC in contributing to reward-related activity of the ventral striatum. These results offer new insight into the functional and structural interactions between key components of the brain circuitry underlying human affective function and decision-making. Maladaptive decision-making is a common problem across multiple mental health disorders. Developing new pathophysiologically based strategies for diagnosis and treatment thus requires a better understanding of the brain circuits responsible for adaptive decision-making and related psychological subprocesses (e.g., reward valuation, anticipation, and motivation). Animal studies provide evidence that these functions are mediated through direct interactions between two key nodes of a posited "reward circuit," the ventral striatum and the ventromedial prefrontal

  12. High tidal volume decreases adult respiratory distress syndrome, atelectasis, and ventilator days compared with low tidal volume in pediatric burned patients with inhalation injury. (United States)

    Sousse, Linda E; Herndon, David N; Andersen, Clark R; Ali, Arham; Benjamin, Nicole C; Granchi, Thomas; Suman, Oscar E; Mlcak, Ronald P


    Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of this study was to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia, and ARDS in pediatric burned patients with inhalation injury within 1 year post burn injury. From 1986 to 2014, inhalation injury was diagnosed by bronchoscopy in pediatric burned patients (n = 932). Patients were divided into 3 groups: unventilated (n = 241), high tidal volume (HTV, 15 ± 3 mL/kg, n = 190), and low tidal volume (LTV, 9 ± 3 mL/kg, n = 501). High tidal volume was associated with significantly decreased ventilator days (p tidal volume significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared with low tidal volume in pediatric burned patients with inhalation injury. Therefore, the use of HTV may interrupt sequences leading to lung injury in our patient population. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Hemoglobin and mean platelet volume predicts diffuse T1-MRI white matter volume decrease in sickle cell disease patients

    Directory of Open Access Journals (Sweden)

    Soyoung Choi


    Our findings suggest that there are diffuse white matter abnormalities in SCD patients, especially in the frontal, parietal and temporal lobes, that are associated with low hemoglobin levels and mean platelet volume. The pattern of brain loss suggests chronic microvascular insufficiency and tissue hypoxia as the causal mechanism. However, longitudinal studies of global and regional brain morphometry can help us give further insights on the pathophysiology of SCD in the brain.

  14. Stroke promotes survival of nearby transplanted neural stem cells by decreasing their activation of caspase 3 while not affecting their differentiation. (United States)

    Kosi, Nina; Alić, Ivan; Salamon, Iva; Mitrečić, Dinko


    Although transplantation of stem cells improves recovery of the nervous tissue, little is known about the influence of different brain regions on transplanted cells. After we confirmed that cells with uniform differentiation potential can be generated in independent experiments, one million of neural stem cells isolated from B6.Cg-Tg(Thy1-YFP)16Jrs/J mouse embryos were transplanted into the brain 24 h after induction of stroke. The lateral ventricles, the corpus callosum and the striatum were tested. Two and four weeks after the transplantation, the cells transplanted in all three regions have been attracted to the ischemic core. The largest number of attracted cells has been observed after transplantation into the striatum. Their differentiation pattern and expression of neuroligin 1, SynCAM 1, postsynaptic density protein 95 and synapsin 1 followed the same pattern observed during in vitro cultivation and it did not differ among the tested regions. Differentiation pattern of the cells transplanted in the stroke-affected and healthy animals was the same. On the other hand, neural stem cells transplanted in the striatum of the animals affected by stroke exhibited significantly increased survival rates reaching 260 ± 19%, when compared to cells transplanted in their wild type controls. Surprisingly, improved survival two and four weeks after transplantation was not due to increased proliferation of the grafted cells and it was accompanied by decreased levels of activity of Casp3 (19.56 ± 3.1% in the stroke-affected vs. 30.14 ± 2.4% in healthy animals after four weeks). We assume that the decreased levels of Casp3 in cells transplanted near the ischemic region was linked to increased vasculogenesis, synaptogenesis, astrocytosis and axonogenesis detected in the host tissue affected by ischemia. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Spider phobia is associated with decreased left amygdala volume: a cross-sectional study (United States)


    Background Evidence from animal and human studies imply the amygdala as the most critical structure involved in processing of fear-relevant stimuli. In phobias, the amygdala seems to play a crucial role in the pathogenesis and maintenance of the disorder. However, the neuropathology of specific phobias remains poorly understood. In the present study, we investigated whether patients with spider phobia show altered amygdala volumes as compared to healthy control subjects. Methods Twenty female patients with spider phobia and twenty age-matched healthy female controls underwent magnetic resonance imaging to investigate amygdala volumes. The amygdalae were segmented using an automatic, model-based segmentation tool (FSL FIRST). Differences in amygdala volume were investigated by multivariate analysis of covariance with group as between-subject factor and left and right amygdala as dependent factors. The relation between amygdala volume and clinical features such as symptom severity, disgust sensitivity, trait anxiety and duration of illness was investigated by Spearman correlation analysis. Results Spider phobic patients showed significantly smaller left amygdala volume than healthy controls. No significant difference in right amygdala volume was detected. Furthermore, the diminished amygdala size in patients was related to higher symptom severity, but not to higher disgust sensitivity or trait anxiety and was independent of age. Conclusions In summary, the results reveal a relation between higher symptom severity and smaller left amygdala volume in patients with spider phobia. This relation was independent of other potential confounders such as the disgust sensitivity or trait anxiety. The findings suggest that greater spider phobic fear is associated with smaller left amygdala. However, the smaller left amygdala volume may either stand for a higher vulnerability to develop a phobic disorder or emerge as a consequence of the disorder. PMID:23442196

  16. Increased perceived stress is related to decreased prefrontal cortex volumes among older adults. (United States)

    Moreno, Georgina L; Bruss, Joel; Denburg, Natalie L


    Several of the brain regions vulnerable to increased levels of stress (i.e., hippocampus and prefrontal cortex) are also known to undergo disproportionate decline during normal aging. To date, surprisingly little research has examined the effects of stress on the brain among healthy human populations, much less in the elderly. The aim of the current study was to investigate the relationship between chronic stress and brain morphometry in regions known for their involvement in the stress response, namely the prefrontal cortex, hippocampus, and amygdala, in a sample of healthy older adults. The Perceived Stress Scale and structural magnetic resonance imaging (MRI) were collected in 28 older adult individuals aged 65 to 90 years. Gray and white matter volumes in various regions of interest in the prefrontal cortex and medial temporal lobes were calculated using semiautomated segmentation tools. Perceived stress was negatively correlated with overall prefrontal cortex (PFC) volume, specifically in overall white matter volume of the PFC. Additionally, perceived stress was negatively correlated with gray and white matter volumes in lateral regions of the PFC, specifically, in the ventrolateral and dorsolateral PFC. Perceived stress was not significantly related to medial temporal lobe volumes. These findings suggest that among healthy older adults, there is a salient relationship between prefrontal cortex volumes and levels of perceived stress. This research fills a critical gap in the current literature and provides initial groundwork for future studies investigating the relationship between perceived stress and the prefrontal cortex in the context of healthy aging.

  17. Three-dimensional echocardiographic ventricular mass/end-diastolic volume ratio in native hypertensive patients: relation between stroke volume and geometry. (United States)

    Lembo, Maria; Esposito, Roberta; Santoro, Ciro; Lo Iudice, Francesco; Schiano-Lomoriello, Vincenzo; Fazio, Valeria; Grimaldi, Maria Gabriella; Trimarco, Bruno; de Simone, Giovanni; Galderisi, Maurizio


    Elevated left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been associated with higher evidence of myocardial fibrosis and dysfunction in hypertensive patients by cardiac magnetic resonance, a technique with limited availability. We investigated the ability of three-dimensional (3D) echocardiography in identifying a phenotype of LV concentric geometry according to LVM/EDV ratio, possibly detecting early myocardial damage in native-hypertensive patients. One hundred and twenty-eight native-hypertensive patients underwent 2D and 3D-echocardiography. The population was divided into two groups, according to cut-off point values of 3D-LVM/EDV ratio corresponding to its upper 95% confidence interval in a population of 90 healthy normotensive individuals: LVM/EDV ratio cut-off was 1.22 in men and 1.23 in women. An increased 3D-LVM/EDV ratio identified a higher rate of LV concentric geometry in comparison with 2D-derived relative wall thickness (37 versus 24%, P = 0.03). Patients with LVM/EDV ratio of 1.22 or more in men and 1.23 or more in women were significantly older, had smaller 3D-LV end-diastolic and end-systolic volumes and higher LV mass index, without difference in ejection fraction. 3D-stroke volume (P geometry than 2D-relative wall thickness. Stroke volume is independently and negatively associated with LVM/EDV ratio and its reduction represents an early marker of myocardial dysfunction in hypertensives with LV concentric geometry.

  18. Cerebral oxygen transport failure?: decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality: STroke: RelevAnt Impact of hemoGlobin, Hematocrit and Transfusion (STRAIGHT)--an observational study. (United States)

    Kellert, Lars; Martin, Evgenia; Sykora, Marek; Bauer, Harald; Gussmann, Philipp; Diedler, Jennifer; Herweh, Christian; Ringleb, Peter A; Hacke, Werner; Steiner, Thorsten; Bösel, Julian


    Although conceivably relevant for penumbra oxygenation, the optimal levels of hemoglobin (Hb) and hematocrit (Hct) in patients with acute ischemic stroke are unknown. We identified patients from our prospective local stroke database who received intravenous thrombolysis based on multimodal magnet resonance imaging during the years 1998 to 2009. A favorable outcome at 3 months was defined as a modified Rankin Scale score≤2 and a poor outcome as a modified Rankin Scale score≥3. The dynamics of Hemoglobin (Hb), Hematocrit (Hct), and other relevant laboratory parameters as well as cardiovascular risk factors were retrospectively assessed and analyzed between these 2 groups. Of 217 patients, 114 had a favorable and 103 a poor outcome. In a multivariable regression model, anemia until day 5 after admission (odds ratio [OR]=2.61; 95% CI, 1.33 to 5.11; P=0.005), Hb nadir (OR=0.81; 95% CI, 0.67 to 0.99; P=0.038), and Hct nadir (OR=0.93; 95% CI, 0.87 to 0.99; P=0.038) remained independent predictors for poor outcome at 3 months. Mortality after 3 months was independently associated with Hb nadir (OR=0.80; 95% CI, 0.65 to 0.98; P=0.028) and Hb decrease (OR=1.34; 95% CI, 1.01 to 1.76; P=0.04) as well as Hct decrease (OR=1.12; 95% CI, 1.01 to 1.23; P=0.027). Poor outcome and mortality after ischemic stroke are strongly associated with low and further decreasing Hb and Hct levels. This decrease of Hb and Hct levels after admission might be more relevant and accessible to treatment than are baseline levels.

  19. Deregulation of apoptotic volume decrease and ionic movements in multidrug-resistant tumor cells: role of chloride channels

    DEFF Research Database (Denmark)

    Poulsen, Kristian Arild; Andersen, E C; Hansen, C F


    Changes in cell volume and ion gradients across the plasma membrane play a pivotal role in the initiation of apoptosis. Here we explore the kinetics of apoptotic volume decrease (AVD) and ion content dynamics in wild-type (WT) and multidrug-resistant (MDR) Ehrlich ascites tumor cells (EATC). In WT...... EATC, induction of apoptosis with cisplatin (5 muM) leads to three distinctive AVD stages: an early AVD(1) (4-12 h), associated with a 30% cell water loss; a transition stage AVD(T) ( approximately 12 to 32 h), where cell volume is partly recovered; and a secondary AVD(2) (past 32 h), where cell volume...... was further reduced. AVD(1) and AVD(2) were coupled to net loss of Cl(-), K(+), Na(+), and amino acids (ninhydrin-positive substances), whereas during AVD(T), Na(+) and Cl(-) were accumulated. MDR EATC was resistant to cisplatin, showing increased viability and less caspase 3 activation. Compared with WT EATC...

  20. The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: can co-morbidity with other forms of dementia be excluded?

    International Nuclear Information System (INIS)

    Bateman, Grant A.; Levi, Christopher R.; Wang, Yang; Lovett, Elizabeth C.; Schofield, Peter


    Variable results are obtained from the treatment of normal pressure hydrocephalus (NPH) by shunt insertion. There is a high correlation between NPH and the pathology of Alzheimer's disease (AD) on brain biopsy. There is an overlap between AD and vascular dementia (VaD), suggesting that a correlation exists between NPH and other forms of dementia. This study seeks to (1) understand the physiological factors behind, and (2) define the ability of, the aqueduct stroke volume to exclude dementia co-morbidity. Twenty-four patients from a dementia clinic were classified as having either early AD or VaD on the basis of clinical features, Hachinski score and neuropsychological testing. They were compared with 16 subjects with classical clinical findings of NPH and 12 aged-matched non-cognitively impaired subjects. MRI flow quantification was used to measure aqueduct stroke volume and arterial pulse volume. An arterio-cerebral compliance ratio was calculated from the two volumes in each patient. The aqueduct stroke volume was elevated in all three forms of dementia, with no significant difference noted between the groups. The arterial pulse volume was elevated by 24% in VaD and reduced by 35% in NPH, compared to normal (P=0.05 and P=0.002, respectively), and was normal in AD. There was a spectrum of relative compliance with normal compliance in VaD and reduced compliance in AD and NPH. The aqueduct stroke volume depends on the arterial pulse volume and the relative compliance between the arterial tree and brain. The aqueduct stroke volume cannot exclude significant co-morbidity in NPH. (orig.)

  1. The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: can co-morbidity with other forms of dementia be excluded?

    Energy Technology Data Exchange (ETDEWEB)

    Bateman, Grant A. [John Hunter Hospital, Department of Medical Imaging, Newcastle (Australia); Levi, Christopher R.; Wang, Yang; Lovett, Elizabeth C. [Hunter Medical Research Institute, Clinical Neurosciences Program, Newcastle (Australia); Schofield, Peter [James Fletcher Hospital, Neuropsychiatry Unit, Newcastle (Australia)


    Variable results are obtained from the treatment of normal pressure hydrocephalus (NPH) by shunt insertion. There is a high correlation between NPH and the pathology of Alzheimer's disease (AD) on brain biopsy. There is an overlap between AD and vascular dementia (VaD), suggesting that a correlation exists between NPH and other forms of dementia. This study seeks to (1) understand the physiological factors behind, and (2) define the ability of, the aqueduct stroke volume to exclude dementia co-morbidity. Twenty-four patients from a dementia clinic were classified as having either early AD or VaD on the basis of clinical features, Hachinski score and neuropsychological testing. They were compared with 16 subjects with classical clinical findings of NPH and 12 aged-matched non-cognitively impaired subjects. MRI flow quantification was used to measure aqueduct stroke volume and arterial pulse volume. An arterio-cerebral compliance ratio was calculated from the two volumes in each patient. The aqueduct stroke volume was elevated in all three forms of dementia, with no significant difference noted between the groups. The arterial pulse volume was elevated by 24% in VaD and reduced by 35% in NPH, compared to normal (P=0.05 and P=0.002, respectively), and was normal in AD. There was a spectrum of relative compliance with normal compliance in VaD and reduced compliance in AD and NPH. The aqueduct stroke volume depends on the arterial pulse volume and the relative compliance between the arterial tree and brain. The aqueduct stroke volume cannot exclude significant co-morbidity in NPH. (orig.)

  2. What causes the hippocampal volume decrease in depression? : Are neurogenesis, glial changes and apoptosis implicated?

    NARCIS (Netherlands)

    Czeh, B.; Lucassen, P.J.


    Even though in vivo imaging studies document significant reductions of hippocampal volume in depressed patients, the exact underlying cellular mechanisms are unclear. Since stressful life events are associated with an increased risk of developing depression, preclinical studies in which animals are

  3. Prediction of infarction and reperfusion in stroke by flow- and volume-weighted collateral signal in MR angiography. (United States)

    Ernst, M; Forkert, N D; Brehmer, L; Thomalla, G; Siemonsen, S; Fiehler, J; Kemmling, A


    In proximal anterior circulation occlusive strokes, collateral flow is essential for good outcome. Collateralized vessel intensity in TOF- and contrast-enhanced MRA is variable due to different acquisition methods. Our purpose was to quantify collateral supply by using flow-weighted signal in TOF-MRA and blood volume-weighted signal in contrast-enhanced MRA to determine each predictive contribution to tissue infarction and reperfusion. Consecutively (2009-2013), 44 stroke patients with acute proximal anterior circulation occlusion met the inclusion criteria with TOF- and contrast-enhanced MRA and penumbral imaging. Collateralized vessels in the ischemic hemisphere were assessed by TOF- and contrast-enhanced MRA using 2 methods: 1) visual 3-point collateral scoring, and 2) collateral signal quantification by an arterial atlas-based collateral index. Collateral measures were tested by receiver operating characteristic curve and logistic regression against 2 imaging end points of tissue-outcome: final infarct volume and percentage of penumbra saved. Visual collateral scores on contrast-enhanced MRA but not TOF were significantly higher in patients with good outcome. Visual collateral scoring on contrast-enhanced MRA was the best rater-based discriminator for final infarct volume 50% (area under the curve, 0.67; P = .04). Atlas-based collateral index of contrast-enhanced MRA was the overall best independent discriminator for final infarct volume of collateral index combining the signal of TOF- and contrast-enhanced MRA was the overall best discriminator for effective reperfusion (percentage of penumbra saved >50%; area under the curve, 0.89; P collateral assessment, TOF- and contrast-enhanced MRA both contain predictive signal information for penumbral reperfusion. This could improve risk stratification in further studies. © 2015 by American Journal of Neuroradiology.

  4. Modelflow Estimates of Stroke Volume Do Not Correlate With Doppler Ultrasound Estimates During Upright Posture (United States)

    Ferguson, Connor R.; Lee, Stuart M. C.; Stenger, Michael B.; Platts, Steven H.; Laurie, Steven S.


    Orthostatic intolerance affects 60-80% of astronauts returning from long-duration missions, representing a significant risk to completing mission-critical tasks. While likely multifactorial, a reduction in stroke volume (SV) represents one factor contributing to orthostatic intolerance during stand and head up tilt (HUT) tests. Current measures of SV during stand or HUT tests use Doppler ultrasound and require a trained operator and specialized equipment, restricting its use in the field. BeatScope (Finapres Medical Systems BV, The Netherlands) uses a modelflow algorithm to estimate SV from continuous blood pressure waveforms in supine subjects; however, evidence supporting the use of Modelflow to estimate SV in subjects completing stand or HUT tests remain scarce. Furthermore, because the blood pressure device is held extended at heart level during HUT tests, but allowed to rest at the side during stand tests, changes in the finger arterial pressure waveform resulting from arm positioning could alter modelflow estimated SV. The purpose of this project was to compare Doppler ultrasound and BeatScope estimations of SV to determine if BeatScope can be used during stand or HUT tests. Finger photoplethysmography was used to acquire arterial pressure waveforms corrected for hydrostatic finger-to-heart height using the Finometer (FM) and Portapres (PP) arterial pressure devices in 10 subjects (5 men and 5 women) during a stand test while simultaneous estimates of SV were collected using Doppler ultrasound. Measures were made after 5 minutes of supine rest and while subjects stood for 5 minutes. Next, SV estimates were reacquired while each arm was independently raised to heart level, a position similar to tilt testing. Supine SV estimates were not significantly different between all three devices (FM: 68+/-20, PP: 71+/-21, US: 73+/-21 ml/beat). Upon standing, the change in SV estimated by FM (-18+/-8 ml) was not different from PP (-21+/-12), but both were significantly

  5. The decrease of cardiac chamber volumes and output during positive-pressure ventilation

    DEFF Research Database (Denmark)

    Kristensen, Kasper Kyhl; Ahtarovski, Kiril Aleksov; Iversen, Kasper


    ) ml (P heart rate increased by 7 (±2) beats/min; and CO decreased by 1.0 (±0.4) l/min (P right and left ventricular peak filling rates decreased......Positive-pressure ventilation (PPV) is widely used for treatment of acute cardiorespiratory failure, occasionally at the expense of compromised cardiac function and arterial blood pressure. The explanation why has largely rested on interpretation of intracardiac pressure changes. We evaluated...

  6. High Tidal Volume Decreases ARDS, Atelectasis, and Ventilator Days Compared to Low Tidal Volume in Pediatric Burned Patients with Inhalation Injury (United States)

    Sousse, Linda E; Herndon, David N; Andersen, Clark R; Ali, Arham; Benjamin, Nicole C; Granchi, Thomas; Suman, Oscar E; Mlcak, Ronald P


    Background Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of the present study is to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia and ARDS in pediatric burned patients with inhalation injury within one year post burn injury. Methods From 1986–2014, inhalation injury was diagnosed by bronchoscopy in pediatric burned patients (n=932). Patients were divided into three groups: (1) unventilated (n=241), (2) high tidal volume (HTV, 15 ± 3 ml/kg, n=190), and (3) low tidal volume (LTV, 9 ± 3 ml/kg, n = 501). Results HTV was associated with significantly decreased ventilator days (p<0.005) and maximum positive end expiratory pressure (p<0.0001) and significantly increased maximum peak inspiratory pressure (p<0.02) and plateau pressure (p<0.02) compared to patients with LTV. The incidence of atelectasis (p<0.0001) and ARDS (p<0.02) was significantly decreased with HTV compared to LTV. However, the incidence of pneumothorax was significantly increased in the HTV group compared with LTV (p<0.03). Conclusions HTV significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared to low tidal volume in pediatric burned patients with inhalation injury. Thus, the use of HTV may interrupt sequences leading to lung injury in our patient population. PMID:25724604

  7. Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Svendsen, Jesper Hastrup; Aldershvile, J


    The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution...... or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements......, r = 0.93 (p less than 0.001). LVEF determined by multigated radionuclide cardiography was, however, significantly lower than when measured by cardioangiography, the mean difference being 6 per cent (p less than 0.001). These findings suggest that radionuclide determinations of SV and LVEF...

  8. Decreasing NOx of a Low-Speed Two-Stroke Marine Diesel Engine by Using In-Cylinder Emission Control Measures

    Directory of Open Access Journals (Sweden)

    Liyan Feng


    Full Text Available The authors applied one-dimensional (1-D simulation and 3-D Computational Fluid Dynamics (CFD simulation to evaluate the potential of in-cylinder control methods on a low-speed 2-stroke marine engine to reach the International Maritime Organization (IMO Tier 3 NOx emissions standards. Reducing the combustion temperature is an important in-cylinder measure to decrease NOx emissions of marine diesel engines. Miller-cycle and Exhaust Gas Recirculation (EGR are effective methods to reduce the maximum combustion temperature and accordingly decrease NOx emissions. The authors’ calculation results indicate that with a combination of 2-stage turbocharging, a mild Miller-cycle and 10% EGR rate, the NOx emissions can be decreased by 48% without the increased Specific Fuel Oil Consumption (SFOC penalties; with a medium Miller-cycle and 10% EGR, NOx can be decreased by 56% with a slight increase of SFOC; with a medium Miller-cycle and 20% EGR, NOx can be decreased by 77% and meet IMO Tier 3 standards, but with the high price of a considerable increase of SFOC. The first two schemes are promising to meet IMO Tier 3 standards with good fuel economy if other techniques are combined.

  9. The magnitude and course of exercise-induced stroke volume changes determine the exercise tolerance in heart transplant recipients with heart failure and normal ejection fraction

    Czech Academy of Sciences Publication Activity Database

    Meluzín, J.; Hude, P.; Leinveber, P.; Jurák, Pavel; Soukup, L.; Viščor, Ivo; Špinarová, L.; Štěpánová, R.; Podroužková, H.; Vondra, Vlastimil; Langer, P.; Němec, P.


    Roč. 20, č. 1 (2014), s. 674-687 ISSN 1205-6626 R&D Projects: GA MŠk(CZ) LO1212 Keywords : heart failure * stroke volume index * exercise tolerance * bioimpedance Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 0.758, year: 2013

  10. Assessment of collateral status by dynamic ct angiography in acute mca stroke : Timing of acquisition and relationship with final infarct volume

    NARCIS (Netherlands)

    Van Den Wijngaard, I. R.; Holswilder, G.; Wermer, M. J H; Boiten, J.; Algra, A.; Dippel, D. W J; Dankbaar, J. W.; Velthuis, B. K.; Boers, A. M M; Majoie, C. B L M; Van Walderveen, M. A A


    BACKGROUND AND PURPOSE: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up. MATERIALS AND METHODS: We selected

  11. Assessment of collateral status by dynamic ct angiography in acute mca stroke: Timing of acquisition and relationship with final infarct volume

    NARCIS (Netherlands)

    I.R. Van Den Wijngaard (Ido R.); G. Holswilder (Ghislaine); M.J.H. Wermer (Marieke); J. Boiten (Jelis); A. Algra (Ale); D.W.J. Dippel (Diederik); J.W. Dankbaar (Jan); B.K. Velthuis (Birgitta); A.M.M. Boers (Anna); C.B. Majoie (Charles); M.A.A. van Walderveen (Marianne)


    textabstractBACKGROUND AND PURPOSE: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up. MATERIALS AND METHODS: We

  12. Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke: 24-Hour Versus 1-Week Imaging. (United States)

    Bucker, Amber; Boers, Anna M; Bot, Joseph C J; Berkhemer, Olvert A; Lingsma, Hester F; Yoo, Albert J; van Zwam, Wim H; van Oostenbrugge, Robert J; van der Lugt, Aad; Dippel, Diederik W J; Roos, Yvo B W E M; Majoie, Charles B L M; Marquering, Henk A


    Ischemic lesion volume (ILV) on noncontrast computed tomography at 1 week can be used as a secondary outcome measure in patients with acute ischemic stroke. Twenty-four-hour ILV on noncontrast computed tomography has greater availability and potentially allows earlier estimation of functional outcome. We aimed to assess lesion growth 24 hours after stroke onset and compare the associations of 24-hour and 1-week ILV with functional outcome. We included 228 patients from MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), who received noncontrast computed tomography at 24-hour and 1-week follow-up on which ILV was measured. Relative and absolute lesion growth was determined. Logistic regression models were constructed either including the 24-hour or including the 1-week ILV. Ordinal and dichotomous (0-2 and 3-6) modified Rankin scale scores were, respectively, used as primary and secondary outcome measures. Median ILV was 42 mL (interquartile range, 21-95 mL) and 64 mL (interquartile range: 30-120 mL) at 24 hours and 1 week, respectively. Relative lesion growth exceeding 30% occurred in 121 patients (53%) and absolute lesion growth exceeding 20 mL occurred in 83 patients (36%). Both the 24-hour and 1-week ILVs were similarly significantly associated with functional outcome (both P <0.001). In the logistic analyses, the areas under the curve of the receiver-operator characteristic curves were similar: 0.85 (95% confidence interval, 0.80-0.90) and 0.87 (95% confidence interval, 0.82-0.91) for including the 24-hour and 1-week ILV, respectively. Growth of ILV is common 24-hour poststroke onset. Nevertheless, the 24-hour ILV proved to be a valuable secondary outcome measure as it is equally strongly associated with functional outcome as the 1-week ILV. URL: Unique identifier: ISRCTN10888758. © 2017 American Heart Association, Inc.

  13. Increased tidal volume variability in children is a better marker of opioid-induced respiratory depression than decreased respiratory rate. (United States)

    Barbour, Sean J; Vandebeek, Christine A; Ansermino, J Mark


    During opioid administration, decreasing respiratory rate is typically used as a predictor of respiratory depression. Prior to opioid-induced apnea, progressively irregular breathing patterns have been noticed. We hypothesize that opioid administration to children will increase tidal volume variability (TV(var)) and that this will be a better predictor of respiratory depression than a decrease in respiratory rate. We recruited 32 children aged 2-8 years scheduled to undergo surgery. During spontaneous ventilation, flow rates and respiratory rates were continuously recorded, while remifentanil was infused at stepwise increasing doses each lasting 10 min. The infusion was continued until the patient showed signs of respiratory depression. Flow data from each dose was used to calculate tidal volumes, from which TV(var) was calculated. The respiratory rate and TV(var) during the last (D(last)), second to last (D-2), and third to last (D-3), administered doses were compared to those during baseline (fourth to last dose). We chose a threshold of TV(var) increase and compared it to a decrease in respiratory rate below 10 breaths per min as predictors of respiratory depression. Compared to baseline, the TV(var) increased by 336% and 668% during D(-2) and D(last), respectively, whereas respiratory rate decreased by 14.3%, 31.7%, and 55.5% during D(-3), D(-2), and D(last), respectively. A threshold increase in TV(var) of 150% over baseline correctly predicted respiratory depression in 41% of patients, compared to a drop in respiratory rate correctly predicting 22% of patients. TV(var) increases as children approach opioid-induced respiratory depression. This is a more useful predictor of respiratory depression than a fall in respiratory rate because the TV(var) increase is 10 times the drop in respiratory rate. A TV(var) increase also correctly predicts respiratory depression twice as often as decreased respiratory rate and is independent of age-related alterations in

  14. Maternal hydration and L-arginine supplementation improves liquor volume in patients with decreased liquor and prolongs pregnancy

    Directory of Open Access Journals (Sweden)

    Shripad Hebbar


    Full Text Available Background: Oligohydramnios (reduced amniotic fluid may be responsible for the problems of malpresentations, umbilical cord compression, meconium staining of amniotic fluid in the liquor, and difficult or failed external cephalic version. Simple intervention maternal hydration has been reported as a way of increasing amniotic fluid volume in order to reduce some of these problems. Objective: To assess the influence of maternal hydration and l-arginine supplementation in improving liquor volume in patients with decreased liquor. Study Design: Prospective nonrandomized interventional study. Materials and Methods: 50 patients remote from term, with decreased liquor [amniotic fluid index (AFI < 8] were enrolled in the study. Before the proposed intervention, the antenatal risk factors were studied. Patients with hypertensive disorders of pregnancy were administered l-arginine (one sachet 3 g, two times daily and others received both arginine and intravenous hydration (500 ml of fructodex which contains 5% dextrose and 5% fructose, and lactated Ringer′s solution daily. The treatment was continued till the liquor improved significantly. However, patients were considered for delivery if the liquor remained less than 5. Mean increase in liquor, intervention delivery interval, and neonatal outcome were studied. Results: The mean gestational age at the time of recruitment was 33.4 ΁ 1.9 weeks. The mean AFI at the time of enrolment was 6.9 (SD 0.8. These patients were delivered at 36.3 ΁ 1.3 weeks, and thus, pregnancy could be prolonged by 2.9 weeks. The mean AFI at the end of therapeutic intervention was 9.3 (SD 1.7, and thus, an AFI increase of 2.4 could be obtained. There was no significant neonatal morbidity in these patients. Significant improvement in liquor volume was obtained in these patients after intervention with either or both l-arginine and fructodex infusion (P < 0.0001. The pregnancy could be prolonged from 33.4 weeks to 36.3 weeks

  15. Placed in a steady magnetic field, the flux density inside a permalloy-shielded volume decreases over hours and days (United States)

    Feinberg, Benedict; Gould, Harvey


    Following the application of an external magnetic field to a thin-walled demagnetized Permalloy cylinder, the magnetic flux density at the center of the shielded volume decreases by roughly 20% over periods of hours to days. We measured this effect for applied magnetic fields from 0.48 A/m to 16 A/m, the latter being comparable to the Earths magnetic field at its weakest point. Delayed changes in magnetic flux density are also observed following alternating current demagnetization. We attribute these effects to delayed changes in magnetization, which have previously been observed in thin Permalloy films and small bulk samples of ferromagnetic materials. Phenomenological models of thermal activation are discussed. Some possible effects on experiments that rely on static shielding are noted.

  16. Goal-directed fluid therapy: stroke volume optimisation and cardiac dimensions in supine healthy humans

    DEFF Research Database (Denmark)

    Jans, O.; Tollund, C.; Bundgaard-Nielsen, M.


    patient and whether the heart becomes distended. To answer these questions, this study related SV to the diastolic filling of the heart while varying central blood volume (CBV) between hypo- and hyper-volaemia, simulating bleeding, and fluid loading, respectively, when exposing healthy human subjects...... to head-up (HUT) and head-down tilt (HDT). METHODS: Twelve healthy volunteers underwent graded tilt from 20 degrees HDT to 30 degrees HUT. The end-diastolic dimensions of the heart were assessed by transthoracic echocardiography with independent evaluation of SV by Modelflow. The CBV was monitored...... by thoracic electrical admittance, central venous oxygenation and pressure, and arterial plasma atrial natriuretic peptide. Also, muscle and brain oxygenation were assessed by near infrared spectroscopy (n=7). RESULTS: The HUT reduced the mentioned indices of CBV, the end-diastolic dimensions of the heart...

  17. Two-dimensional color Doppler echocardiography for left ventricular stroke volume assessment: a comparison study with three-dimensional echocardiography. (United States)

    Silva, Cristina Da; Pedro, Fátima; Deister, Lizandra; Sahlén, Anders; Manouras, Aristomenis; Shahgaldi, Kambiz


    Whether measurement of left ventricular outflow tract diameter (LVOTd) using color Doppler (CD) in order to more accurately define LVOTd is more accurate for determination of stroke volume (SV) than gray scale and compare it with direct measurement of LVOT area (a) using three-dimensional echocardiography (3DE) for SV determination. Twenty-one volunteers were examined. LVOTa was calculated by two-dimensional echocardiography (2DE) using the following formula: π× (d/2)(2) , d = LVOT diameter by gray scale and CD, respectively. Planimetry of LVOTa was performed in parasternal long axis using 3DE. Eccentricity Index was calculated using the lateral and anterior-posterior LVOTd. SV was obtained by four different methods: (1) 2D gray scale, (2) 2D color, (3) LVOTa × LVOT velocity time integral, and (4) SV by Simpson's biplane method. Gray scale LVOTd was significantly smaller compared to LVOTd obtained with CD (P vs 3.67 ± 0.70 cm(2) , P vs 3.61 ± 0.89 cm(2) , P = 0.011). Half of the subjects had at least 17% difference between the lateral and anterior-posterior LVOTd. There were significant differences between SV by 2D gray scale and 2D CD (82.8 ± 17.1 mL vs 92.4 ± 16.8 mL, P vs 90.7 ± 19.8 mL, P = 0.025). Our study demonstrates LVOT being frequently elliptical. SV and LVOTa were found to be similar when comparing 2DE CD and 3DE planimetry and showed higher values in comparison to 2DE gray scale, which suggests 2DE CD to be an alternative approach for SV assessment. © 2012, Wiley Periodicals, Inc.

  18. Deteriorating ischaemic stroke. cytokines, soluble cytokine receptors, ferritin, systemic blood pressure, body temperature, blood glucose, diabetes, stroke severity, and CT infarction-volume as predictors of deteriorating ischaemic stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne; Boysen, Gudrun; Johannesen, Helle Hjorth


    Although the causes of neurological deterioration in acute cerebral infarction have not yet been identified, many variables have been associated with deterioration. The aim of this study was to investigate deteriorating ischaemic stroke....

  19. Left Ventricular Stroke Volume Quantification by Contrast Echocardiography – Comparison of Linear and Flow-Based Methods to Cardiac Magnetic Resonance (United States)

    Dele-Michael, Abiola O.; Fujikura, Kana; Devereux, Richard B; Islam, Fahmida; Hriljac, Ingrid; Wilson, Sean R.; Lin, Fay; Weinsaft, Jonathan W.


    Background Echocardiography (echo) quantified LV stroke volume (SV) is widely used to assess systolic performance after acute myocardial infarction (AMI). This study compared two common echo approaches – predicated on flow (Doppler) and linear chamber dimensions (Teichholz) – to volumetric SV and global infarct parameters quantified by cardiac magnetic resonance (CMR). Methods Multimodality imaging was performed as part of a post-AMI registry. For echo, SV was measured by Doppler and Teichholz methods. Cine-CMR was used for volumetric SV and LVEF quantification, and delayed-enhancement CMR for infarct size. Results 142 patients underwent same-day echo and CMR. On echo, mean SV by Teichholz (78±17ml) was slightly higher than Doppler (75±16ml; Δ=3±13ml, p=0.02). Compared to SV on CMR (78±18ml), mean difference by Teichholz (Δ=−0.2±14; p=0.89) was slightly smaller than Doppler (Δ−3±14; p=0.02) but limits of agreement were similar between CMR and echo methods (Teichholz: −28, 27 ml, Doppler: −31, 24ml). For Teichholz, differences with CMR SV were greatest among patients with anteroseptal or lateral wall hypokinesis (p<0.05). For Doppler, differences were associated with aortic valve abnormalities or root dilation (p=0.01). SV by both echo methods decreased stepwise in relation to global LV injury as assessed by CMR-quantified LVEF and infarct size (p<0.01). Conclusions Teichholz and Doppler calculated SV yield similar magnitude of agreement with CMR. Teichholz differences with CMR increase with septal or lateral wall contractile dysfunction, whereas Doppler yields increased offsets in patients with aortic remodeling. PMID:23488864

  20. Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study. (United States)

    de Souza, Vanessa; Zeitoun, Sandra Salloum; Lopes, Camila Takao; de Oliveira, Ana Paula Dias; Lopes, Juliana de Lima; de Barros, Alba Lucia Bottura Leite


    To assess the clinical usefulness of the operational definitions for the defining characteristics of the NANDA International nursing diagnoses, activity intolerance, decreased cardiac output and excess fluid volume, and the concomitant presence of those diagnoses in patients with decompensated heart failure. Content validity of the operational definitions for the defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output have been previously validated by experts. Their clinical usefulness requires clinical validation. This was a descriptive exploratory study. Two expert nurses independently assessed 25 patients with decompensated heart failure for the presence or absence of 29 defining characteristics. Interrater reliability was analysed using the Kappa coefficient as a measure of clinical usefulness. The Fisher's exact test was used to test the association of the defining characteristics of activity intolerance and excess fluid volume in the presence of decreased cardiac output, and the correlation between the three diagnoses. Assessments regarding the presence of all defining characteristics reached 100% agreement, except with anxiety. Five defining characteristics of excess fluid volume were significantly associated with the presence of decreased cardiac output. Concomitant presence of the three diagnoses occurred in 80% of the patients. However, there was no significant correlation between the three diagnoses. The operational definitions for the diagnoses had strong interrater reliability, therefore they were considered clinically useful. Only five defining characteristics were representative of the association between excess fluid volume and decreased cardiac output. Therefore, excess fluid volume is related to decreased cardiac output, although these diagnoses are not necessarily associated with activity intolerance. The operational definitions may favour early recognition of the sequence of responses to decompensation

  1. Stroke Treatments (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 ...

  2. Potassium-chloride cotransporter 3 interacts with Vav2 to synchronize the cell volume decrease response with cell protrusion dynamics.

    Directory of Open Access Journals (Sweden)

    Adèle Salin-Cantegrel

    Full Text Available Loss-of-function of the potassium-chloride cotransporter 3 (KCC3 causes hereditary motor and sensory neuropathy with agenesis of the corpus callosum (HMSN/ACC, a severe neurodegenerative disease associated with defective midline crossing of commissural axons in the brain. Conversely, KCC3 over-expression in breast, ovarian and cervical cancer is associated with enhanced tumor cell malignancy and invasiveness. We identified a highly conserved proline-rich sequence within the C-terminus of the cotransporter which when mutated leads to loss of the KCC3-dependent regulatory volume decrease (RVD response in Xenopus Laevis oocytes. Using SH3 domain arrays, we found that this poly-proline motif is a binding site for SH3-domain containing proteins in vitro. This approach identified the guanine nucleotide exchange factor (GEF Vav2 as a candidate partner for KCC3. KCC3/Vav2 physical interaction was confirmed using GST-pull down assays and immuno-based experiments. In cultured cervical cancer cells, KCC3 co-localized with the active form of Vav2 in swelling-induced actin-rich protruding sites and within lamellipodia of spreading and migrating cells. These data provide evidence of a molecular and functional link between the potassium-chloride co-transporters and the Rho GTPase-dependent actin remodeling machinery in RVD, cell spreading and cell protrusion dynamics, thus providing new insights into KCC3's involvement in cancer cell malignancy and in corpus callosum agenesis in HMSN/ACC.

  3. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

    Directory of Open Access Journals (Sweden)

    Jian Zhang


    Full Text Available OBJECTIVES: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting in thoracic surgery patients requiring one-lung ventilation.

  4. Constraint-induced movement therapy and rehabilitation exercises lessen motor deficits and volume of brain injury after striatal hemorrhagic stroke in rats. (United States)

    DeBow, Suzanne B; Davies, Melissa L A; Clarke, Heather L; Colbourne, Frederick


    Constraint-induced movement therapy (CIMT) promotes motor recovery after occlusive stroke in humans, but its efficacy after intracerebral hemorrhage (ICH) has not been investigated clinically or in the laboratory. In this study we tested whether CIMT and a rehabilitation exercise program would lessen motor deficits after ICH in rats. Rats were subjected to striatal ICH (via infusion of collagenase) or sham stroke. Seven days later, treatment began with CIMT (8 h/d of ipsilateral forelimb restraint), rehabilitation exercises (eg, reaching, walking; 1 h/d), or both for 7 days. Some rats were not treated. Motor deficits were assessed up to the 60-day survival time, after which the volume of tissue lost was determined. Untreated ICH rats made more limb slips traversing a horizontal ladder and showed an asymmetry toward less use of the contralateral paw in the cylinder test of limb use asymmetry (day 28). These rats were also significantly less successful in the Montoya staircase test (days 55 to 59) of skilled reaching. Neither therapy alone provided much benefit. However, the combination of daily exercises and CIMT substantially and persistently improved recovery. Unexpectedly, this group had a statistically smaller volume of tissue lost than untreated ICH rats. The combination of focused rehabilitation exercises and CIMT effectively promotes functional recovery after ICH, while either therapy alone is less effective. This therapy may work in part by reducing the volume of tissue lost, likely through reducing atrophy while promoting remodeling.

  5. Heart rate variability and stroke volume variability to detect central hypovolemia during spontaneous breathing and supported ventilation in young, healthy volunteers

    International Nuclear Information System (INIS)

    Elstad, Maja; Walløe, Lars


    Cardiovascular oscillations exist in many different variables and may give important diagnostic and prognostic information in patients. Variability in cardiac stroke volume (SVV) is used in clinical practice for diagnosis of hypovolemia, but currently is limited to patients on mechanical ventilation. We investigated if SVV and heart rate variability (HRV) could detect central hypovolemia in spontaneously breathing humans: We also compared cardiovascular variability during spontaneous breathing with supported mechanical ventilation.Ten subjects underwent simulated central hypovolemia by lower body negative pressure (LBNP) with >10% reduction of cardiac stroke volume. The subjects breathed spontaneously and with supported mechanical ventilation. Heart rate, respiratory frequency and mean arterial blood pressure were measured. Stroke volume (SV) was estimated by ModelFlow (Finometer). Respiratory SVV was calculated by: 1) SVV% = (SVmax − SVmin)/SVmean during one respiratory cycle, 2) SVIntegral from the power spectra (Fourier transform) at 0.15–0.4 Hz and 3) SVV-norm = (√SVIntegral)/SVmean. HRV was calculated by the same methods.During spontaneous breathing two measures of SVV and all three measures of HRV were reduced during hypovolemia compared to baseline. During spontaneous breathing SVIntegral and HRV% were best to detect hypovolemia (area under receiver operating curve 0.81). HRV% ≤ 11% and SVIntegral ≤ 12 ml 2 differentiated between hypovolemia and baseline during spontaneous breathing.During supported mechanical ventilation, none of the three measures of SVV changed and two of the HRV measures were reduced during hypovolemia. Neither measures of SVV nor HRV were classified as a good detector of hypovolemia.We conclude that HRV% and SVIntegral detect hypovolemia during spontaneous breathing and both are candidates for further clinical testing. (paper)

  6. Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction. (United States)

    VAN Iterson, Erik H; Olson, Thomas P; Borlaug, Barry A; Johnson, Bruce D; Snyder, Eric M


    Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the "gold" standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=V˙O2/HR). Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R = 0.30, 0.36, 0.67), but not controls (R = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R = 0.70, 0.53, 0.70) and controls (R = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.

  7. Two Years of Cinacalcet Hydrochloride Treatment Decreased Parathyroid Gland Volume and Serum Parathyroid Hormone Level in Hemodialysis Patients With Advanced Secondary Hyperparathyroidism. (United States)

    Yamada, Shunsuke; Tokumoto, Masanori; Taniguchi, Masatomo; Toyonaga, Jiro; Suehiro, Takaichi; Eriguchi, Rieko; Fujimi, Satoru; Ooboshi, Hiroaki; Kitazono, Takanari; Tsuruya, Kazuhiko


    The long-term effect of cinacalcet hydrochloride treatment on parathyroid gland (PTG) volume has been scarcely investigated in patients with moderate to advanced secondary hyperparathyroidism (SHPT). The present study was a prospective observational study to determine the effect of cinacalcet treatment on PTG volume and serum biochemical parameters in 60 patients with renal SHPT, already treated with intravenous vitamin D receptor activator (VDRA). Measurement of biochemical parameters and PTG volumes were performed periodically, which were analyzed by stratification into tertiles across the baseline parathyroid hormone (PTH) level or PTG volume. We also determined the factors that can estimate the changes in PTG volume and the achievement of the target PTH range by multivariable analyses. Two years of cinacalcet treatment significantly decreased the serum levels of PTH, calcium, and phosphate, followed by the improvement of achieving the target ranges for these parameters recommended by the Japanese Society for Dialysis Therapy. Cinacalcet decreased the maximal and total PTG volume by about 30%, and also decreased the serum PTH level independent of the baseline serum PTH level and PTG volume. Ten out of 60 patients showed 30% increase in maximal PTG after 2 years. Multivariable analysis showed that patients with nodular PTG at baseline and patients with higher serum calcium and PTH levels at 1 year were likely to exceed the target range of PTH at two years. In conclusion, cinacalcet treatment with intravenous VDRA therapy decreased both PTG volume and serum intact PTH level, irrespective of the pretreatment PTG status and past treatment history. © 2015 The Authors. Therapeutic Apheresis and Dialysis © 2015 International Society for Apheresis.

  8. Gastroduodenal resistance and neural mechanisms involved in saline flow decrease elicited by acute blood volume expansion in anesthetized rats

    Directory of Open Access Journals (Sweden)

    Graça J.R.V.


    Full Text Available We have previously demonstrated that blood volume (BV expansion decreases saline flow through the gastroduodenal (GD segment in anesthetized rats (Xavier-Neto J, dos Santos AA & Rola FH (1990 Gut, 31: 1006-1010. The present study attempts to identify the site(s of resistance and neural mechanisms involved in this phenomenon. Male Wistar rats (N = 97, 200-300 g were surgically manipulated to create four gut circuits: GD, gastric, pyloric and duodenal. These circuits were perfused under barostatically controlled pressure (4 cmH2O. Steady-state changes in flow were taken to reflect modifications in circuit resistances during three periods of time: normovolemic control (20 min, expansion (10-15 min, and expanded (30 min. Perfusion flow rates did not change in normovolemic control animals over a period of 60 min. BV expansion (Ringer bicarbonate, 1 ml/min up to 5% body weight significantly (P<0.05 reduced perfusion flow in the GD (10.3 ± 0.5 to 7.6 ± 0.6 ml/min, pyloric (9.0 ± 0.6 to 5.6 ± 1.2 ml/min and duodenal (10.8 ± 0.4 to 9.0 ± 0.6 ml/min circuits, but not in the gastric circuit (11.9 ± 0.4 to 10.4 ± 0.6 ml/min. Prazosin (1 mg/kg and yohimbine (3 mg/kg prevented the expansion effect on the duodenal but not on the pyloric circuit. Bilateral cervical vagotomy prevented the expansion effect on the pylorus during the expansion but not during the expanded period and had no effect on the duodenum. Atropine (0.5 mg/kg, hexamethonium (10 mg/kg and propranolol (2 mg/kg were ineffective on both circuits. These results indicate that 1 BV expansion increases the GD resistance to liquid flow, 2 pylorus and duodenum are important sites of resistance, and 3 yohimbine and prazosin prevented the increase in duodenal resistance and vagotomy prevented it partially in the pylorus

  9. A quality initiative to decrease pathology specimen-labeling errors using radiofrequency identification in a high-volume endoscopy center. (United States)

    Francis, Dawn L; Prabhakar, Shalini; Sanderson, Schuyler O


    Our institution has had problems with mislabeling of tissue specimens in our gastrointestinal and colorectal surgery endoscopy units. Most labeling errors have been due to either the wrong patient label or no label being affixed to a specimen bottle. As a result, an initiative was created to reduce the number of specimen-labeling errors. This initiative involved the application of radiofrequency identification (RFID) technology to specimen bottles, moving to a paperless pathology requisition system and confirmation of the correct site and correct patient by both the endoscopy nursing staff and the endoscopist for each specimen bottle. We reviewed the number of specimen-labeling errors from our endoscopy unit for the first 3 months of 2007, before the implementation of the initiative, and for the first 3 months of 2008, 6 months after the initiation of RFID specimen labeling with paperless requisition and two-provider confirmation of correct site, correct patient specimen labeling. The RFID system we used was an off-the-shelf 3M (St. Paul, MN) Library Sciences RFID system modified and installed for our purposes. Specimen-labeling errors were categorized as Class 1 (only typographical with no potential clinical consequences), Class 2 (minor error, unlikely to have clinical consequences) or Class 3 (significant error that has the potential to detrimentally impact patient care). The Fischer's exact test was used to compare the rate of specimen-bottle labeling errors before and after the initiation of this new system. In the first 3 months of 2007, our endoscopy unit sent 8,231 specimen bottles to our pathology laboratory for evaluation; 8,539 bottles were sent in the first 3 months of 2008. There were 646 (7.85%) Class 1 errors in the first quarter of 2007 and 35 (0.41%) in the first quarter of 2008 (PRFID technology, a paperless requisition process, and confirmation of the correct site and correct patient by two health-care providers significantly decreased specimen

  10. The volume of Purkinje cells decreases in the cerebellum of acrylamide-intoxicated rats, but no cells are lost

    DEFF Research Database (Denmark)

    Larsen, Jytte Overgaard; Tandrup, T; Braendgaard, H


    The effects of acrylamide intoxication on the numbers of granule and Purkinje cells and the volume of Purkinje cell perikarya have been evaluated with stereological methods. The analysis was carried out in the cerebella of rats that had received a dose of 33.3 mg/kg acrylamide, twice a week, for 7.......5 weeks. The total numbers of cerebellar granule and Purkinje cells were estimated using the optical fractionator and the mean volume of the Purkinje cell perikarya was estimated with the vertical rotator technique. The volumes of the molecular layer, the granular cell layer and the white matter were...... estimated using the Cavalieri principle. The mean weight of the cerebellum of the intoxicated rats was 7% lower than that of the control rats (2P = 0.001). The numbers of the Purkinje cells and granule cells were the same in both groups, but the mean volume of the perikarya of the Purkinje cells...

  11. Decrease in temporal gyrus gray matter volume in first-episode, early onset schizophrenia: an MRI study.

    Directory of Open Access Journals (Sweden)

    Jinsong Tang

    Full Text Available BACKGROUND: Loss of gray matter has been previously found in early-onset schizophrenic patients. However, there are no consistent findings between studies due to different methods used to measure grey matter volume/density and influences of confounding factors. METHODS: The volume of gray matter (GM was measured in 29 first episode early-onset schizophrenia (EOS and 34 well-matched healthy controls by using voxel-based morphometry (VBM. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS. The correlations between the GM volume and PANSS scores, age of psychosis onset, duration of psychosis, and chlorpromazine (CPZ equivalent value were investigated. RESULTS: Relative to healthy subjects, the patients with first episode EOS showed significantly lower GM volume in the left middle and superior temporal gyrus. The loss of GM volume negatively correlated with PANSS-positive symptoms (p = 0.002, but not with PANSS-negative symptoms, PANSS-general psychopathology, and PANSS-total score. No significant correlation was found between GM volume and age of psychosis onset, duration of psychosis, and CPZ equivalent value. CONCLUSION: Patients with first episode EOS have evidence of reduced GM in the left middle and superior temporal gyrus. Structural abnormalities in the left middle and superior temporal gyrus may contribute to the pathophysiology of schizophrenia.

  12. Ischemic Stroke Treatment Trials: Neuroimaging Advancements and Implications. (United States)

    Patel, Vivek P; Heit, Jeremy J


    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.

  13. Acute MRI changes in progressive ischemic stroke

    DEFF Research Database (Denmark)

    Kalowska, E.; Rostrup, E.; Rosenbaum, S.


    the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...... as a permanent decrease of >or=3 Scandinavian Stroke Scale (SSS) points for speech or >or=2 SSS points for consciousness or >or=2 SSS points for limb strength, when assessed at baseline compared to the day after admission and daily during the following week. Patients were followed up on day 90 and assessed using...

  14. Effects of repetitive transcranial magnetic stimulation on arm function and decreasing unilateral spatial neglect in subacute stroke: a randomized controlled trial. (United States)

    Cha, Hyun Gyu; Kim, Myoung Kwon


    The objective of this study is to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the functional recovery of stroke patients with unilateral neglect. Randomized controlled experimental study. Outpatient rehabilitation hospital. Thirty patients with stroke were randomly assigned to two groups: an rTMS group (experimental) and a control group. Stroke patients in the experimental group underwent comprehensive rehabilitation therapy and rTMS. Stroke patients in the control group underwent sham therapy and comprehensive rehabilitation therapy. Participants in both groups received therapy 5 days per week for 4 weeks. Line bisection, Albert, Box and block and Grip strength tests were assessed before and after the four-week therapy period. A significant difference in the post-training gains in Line bisection (16.53 SD 9.78 vs. 3.60 SD 5.02), Albert (14.13 SD 4.92 vs. 3.26 SD 2.01), Box and block (15.06 SD 9.68 vs. 6.93 SD 7.52), and Grip strength tests (3.60 SD 2.66 vs 0.80 SD 1.26) was observed between the experimental group and the control group (P<0.05). In addition, the effect size for gains in the experimental and control groups was very strong in AT, BBT (effect size=2.15, 0.77 respectively). We conclude that rTMS might be effective in improvement in reduction of the unilateral neglect and motor function. © The Author(s) 2015.

  15. The volume of Purkinje cells decreases in the cerebellum of acrylamide-intoxicated rats, but no cells are lost

    DEFF Research Database (Denmark)

    Larsen, Jytte Overgaard; Tandrup, T; Braendgaard, H


    The effects of acrylamide intoxication on the numbers of granule and Purkinje cells and the volume of Purkinje cell perikarya have been evaluated with stereological methods. The analysis was carried out in the cerebella of rats that had received a dose of 33.3 mg/kg acrylamide, twice a week, for 7...

  16. Correlation of perfusion- and diffusion-weighted MRI with Japan stroke scale in acute stroke

    International Nuclear Information System (INIS)

    Kawaguchi, Naoki; Murakami, Masato; Mikami, Taishi; Kamoshita, Hiroshi


    Diffusion-weighted imaging (DWI) and perfusion-imaging (PI) MRI are powerful new techniques for the assessment of early ischemic changes in acute stroke patients. We aimed to determine whether the results of these acute phase DWI and PI MRI are useful to predict their neurological outcomes. DWI, PI and fluid-attenuated inversion recovery imaging (FLAIR) MRI lesion volumes were compared with neurological deficit as determined by Japan Stroke Scale (JSS) and Barthel index in 12 patients with acute stroke at two time points. Patients were scanned and their clinical severity was measured first at their admission and two weeks after the initial scan. We could perform MRI within 5 days (mean: 2.6 days), and detect the latest ischemic lesions with initial DWI in all cases. Most patients showed decreased DWI lesion volumes, increased FLAIR volumes and decreased JSS scores reflecting their neurological improvements. Initial DWI volumes correlated with follow-up FLAIR volumes (p=0.0047, r 2 =0.976). The results seem to indicate that lesion volumes determined by DWI in the acute phase may be predictive of irreversible ischemic lesion, although the initial MRI study did not correlate with JSS, BI and patients' age. (author)

  17. Cerebral Blood Volume ASPECTS Is the Best Predictor of Clinical Outcome in Acute Ischemic Stroke: A Retrospective, Combined Semi-Quantitative and Quantitative Assessment.

    Directory of Open Access Journals (Sweden)

    Marina Padroni

    Full Text Available The capability of CT perfusion (CTP Alberta Stroke Program Early CT Score (ASPECTS to predict outcome and identify ischemia severity in acute ischemic stroke (AIS patients is still questioned.62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF, cerebral blood volume (CBV and mean transit time (MTT maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT, recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS at 3 months after onset were recorded.Semi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001. CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS ≤ 2 and inversely associated with final infarct volume and mRS (p values: from p<0.05 to p<0.00001. CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values: from p<0.05 to p<0.02 only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome.Our findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size.

  18. SDN-MPOA volume in male rats is decreased by prenatal stress, but is not related to ejaculatory behavior. (United States)

    Kerchner, M; Ward, I L


    A computer-assisted image analysis technique was used to measure the adult volume of the sexually dimorphic nucleus of the medial preoptic area (SDN-MPOA) in prenatally stressed male rats and in groups of non-stressed males and females. The SDN-MPOA of male offspring from dams stressed daily (i.e. three 45-min exposures to physical restraint and bright light) during the last week of pregnancy was significantly smaller than in males not exposed to stress, but was larger than in females. Maternal stress has been shown to attenuate the surge in fetal plasma testosterone (T) which normally occurs on days 18 and 19 of gestation in male rats. The present results suggest that suppression of T during prenatal development leads to an incomplete masculinization of the SDN-MPOA in male rats. There was no difference in SDN-MPOA volume between males that exhibited the ejaculatory pattern when tested with estrous females and males that failed to ejaculate in either the control or prenatal stress group. SDN-MPOA volume does not appear to be predictive of masculine ejaculatory performance.

  19. Low-volume continuous hemodiafiltration with nafamostat mesilate increases trypsin clearance without decreasing plasma trypsin concentration in severe acute pancreatitis. (United States)

    Okita, Yoshio; Okahisa, Toshiya; Sogabe, Masahiro; Suzuki, Masaharu; Ohnishi, Yoshiaki; Ito, Susumu


    Continuous hemodiafiltration (CHDF) has recently been used for treatment of severe acute pancreatitis. CHDF is capable of eliminating small molecules from blood, but whether trypsin can be eliminated by CHDF is not clear. In this study, elimination of trypsin-like enzyme activity (TLE) and cationic trypsin-like immunoreactivity (TLI) using low-volume CHDF was examined at the first CHDF session in eight patients with severe acute pancreatitis. CHDF was performed with a polysulfone hemofilter (membrane area, 0.7 m2) and nafamostat mesilate, a protease inhibitor and anticoagulant, at a blood flow rate of 100 ml/min and a filtration and dialysis flow rate of 10 ml/min each. Before beginning CHDF, plasma TLE was 3.41 +/- 2.86 nmol/(ml.min), and TLI was 5,900 +/- 9,008 ng/ml. The average plasma clearances of TLE and TLI achieved by the circuit during the 12-hour therapy were 56.7 +/- 4.9 ml/min and 8.0 +/- 7.2 ml/min, respectively. The average plasma clearance of TLI into the waste fluid was 2.4 +/- 1.6 ml/min whereas TLE was below the measurable sensitivity. The plasma concentration of TLE and TLI remained unchanged. These results indicate that low-volume CHDF using nafamostat mesilate as an anticoagulant can increase trypsin plasma clearance. However, low-volume CHDF is not effective to eliminate the plasma trypsin concentration.

  20. Impact of Libido at 2 Weeks after Stroke on Risk of Stroke Recurrence at 1-Year in a Chinese Stroke Cohort Study

    Directory of Open Access Journals (Sweden)

    Jing-Jing Li


    Conclusions: One out of three stroke patients in mainland China has decreased libido at 2 weeks after stroke. Decreased libido is a protective factor for stroke recurrence at 1-year, which is more prominent among older male patients.

  1. Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke: A Population-Based Nationwide Cohort Study From 2002 to 2013. (United States)

    Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In


    We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox proportional hazard models to test our hypothesis. A total of 798 subjects were included in our study. After adjusting for hospital volume of cerebrovascular surgical procedures as well as all for other potential confounders, the hazard ratio (HR) of 30-day mortality in low healthcare technology hospitals as compared to high healthcare technology hospitals was 2.583 (P technology hospitals with high volume as compared to high healthcare technology hospitals with high volume was the highest (10.014, P technology hospitals had the highest 30-day mortality rate, irrespective of hospital volume. Although results of our study provide scientific evidence for a hospital volume/30-day mortality rate relationship in ischemic stroke patients who underwent cerebrovascular surgical procedures, our results also suggest that the level of hospital-based healthcare technology is associated with mortality rates independent of hospital volume. Given these results, further research into what components of hospital-based healthcare technology significantly impact mortality is warranted.

  2. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D


    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.

  3. Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin Population Stroke Study.

    LENUS (Irish Health Repository)


    Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study.

  4. Rho family GTP binding proteins are involved in the regulatory volume decrease process in NIH3T3 mouse fibroblasts

    DEFF Research Database (Denmark)

    Pedersen, Stine F; Beisner, Kristine H; Willumsen, Berthe M


    kinase inhibitor Y-27632 and the phosphatidyl-inositol 3 kinase (PI3K) inhibitor wortmannin. The maximal rates of swelling-activated K+ (86 Rb+ as tracer) and taurine ([3H]taurine as tracer) efflux after a 30 % reduction in extracellular osmolarity were increased about twofold in cells with maximal Rho......AV14 expression compared to wild-type cells, but were unaffected by Y-27632. The volume set points for activation of release of both osmolytes appeared to be reduced by RhoAV14 expression. The maximal taurine efflux rate constant was potentiated by the tyrosine phosphatase inhibitor Na(3)VO(4......), and inhibited by the tyrosine kinase inhibitor genistein. The magnitude of the swelling-activated Cl- current (I(Cl,swell) ) was higher in RhoAV14 than in wild-type cells after a 7.5 % reduction in extracellular osmolarity, but, in contrast to 86Rb+ and [3H]taurine efflux, similar in both strains after a 30...

  5. A promoter polymorphism (rs17222919, -1316T/G of ALOX5AP gene is associated with decreased risk of ischemic stroke in two independent Chinese populations.

    Directory of Open Access Journals (Sweden)

    Yujia Fan

    Full Text Available No coding sequence variants of the gene encoding 5-lipoxygenase-activating protein (ALOX5AP leading to amino acid substitutions have been identified. Therefore, variants in the ALOX5AP promoter region have received attention recently. The purpose of this study was to explore whether the promoter polymorphism rs17222919 is involved in the etiology of ischemic stroke (IS in the Chinese Han population. We investigated the rs17222919 polymorphism by TaqMan genotyping in two independent Chinese Han samples: the first comprised 910 IS patients and 925 healthy inhabitants from the northern Henan Province, while the second included 1003 IS patients and 889 healthy controls from the southern Henan Province. Functional characterization of rs17222919 was performed by an in vitro luciferase assay. After adjusting for conventional risk factors, the G allele frequencies in the IS groups were significantly lower than that in the control groups of the two independent Chinese cohorts (19.0% vs. 22.9%, P = 0.004, odds ratio (OR = 0.792, 95% confidence interval (CI = 0.675-0.929; 18.8% vs. 22.9%, P = 0.002, OR = 0.782, 95% CI = 0.668-0.915, respectively. This was also observed in the large-artery atherosclerosis (LAA and stroke of other undetermined etiology (SUE subtypes (P = 0.019, OR = 0.815, 95% CI = 0.687-0.967; P = 0.021, OR = 0.815, 95% CI = 0.685-0.970, respectively. Additionally, the TG genotype and G allele frequencies were significantly lower in the IS compared with the control group in two female cohorts (P<0.05. Finally, the in vitro luciferase assay demonstrated that the G allele has a significantly lower transcription activity than the T allele (P = 0.031. Our study provides evidence that the promoter single nucleotide polymorphism (SNP rs17222919 is a potential genetic protective factor for IS in the Chinese Han population.

  6. Excessively High Hydration Volume May Not Be Associated With Decreased Risk of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention in Patients With Renal Insufficiency. (United States)

    Liu, Yong; Li, Hualong; Chen, Shiqun; Chen, Jiyan; Tan, Ning; Zhou, Yingling; Liu, Yuanhui; Ye, Piao; Ran, Peng; Duan, Chongyang; Chen, Pingyan


    No well-defined protocols currently exist regarding the optimal rate and duration of normal saline administration to prevent contrast-induced acute kidney injury (CI-AKI) in patients with renal insufficiency. Hydration volume ratios (hydration volume/weight; HV/W) were calculated in 1406 patients with renal insufficiency (estimated glomerular filtration rate [eGFR], chronic heart failure, diuretics, contrast volume, lesions, smoking status, and number of stents, multivariate analysis showed that a higher HV/W ratio was not associated with a decreased CI-AKI risk (Q2 vs Q1: adjusted odds ratio [OR], 1.13; Q3 vs Q1: adjusted OR, 1.51; Q4 vs Q1: adjusted OR, 1.87; all P>0.05) and even increased CI-AKI risk (HV/W >25 mL/kg: adjusted OR, 2.11; 95% CI, 1.24-3.59; P=0.006). Additionally, higher HV/W was significantly associated with an increased risk of death (Q4 vs Q1: adjusted hazard ratio, 3.44; 95% CI, 1.20-9.88; P=0.022). Excessively high hydration volume at routine speed might be associated with increased risk of CI-AKI and death post-PCI in patients with renal insufficiency. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  7. Decreased left middle temporal gyrus volume in antipsychotic drug-naive, first-episode schizophrenia patients and their healthy unaffected siblings. (United States)

    Hu, Maorong; Li, Jun; Eyler, Lisa; Guo, Xiaofeng; Wei, Qingling; Tang, Jingsong; Liu, Feng; He, Zhong; Li, Lihua; Jin, Hua; Liu, Zhening; Wang, Juan; Liu, Fang; Chen, Huafu; Zhao, Jingping


    The shared neuropathological characteristics of patients with schizophrenia and their siblings might represent intermediate phenotypes that could be used to investigate genetic susceptibility to the illness. We sought to discover gray matter volume differences in patients with schizophrenia and their unaffected siblings with voxel-based morphometry (VBM). We recruited antipsychotic drug-naive, first-episode schizophrenia (FES) patients, their unaffected siblings and age-, sex- and handedness-matched healthy controls. We used VBM to investigate differences in gray matter volume among the 3 groups. There were significant gray matter volumetric differences among the 3 groups in bilateral hippocampal and parahippocampal gyri, bilateral middle temporal gyri, and superior temporal gyri (FDR ptemporal gyrus, and volume of this region was not different between siblings and patients. Our findings confirm and extend previous VBM analyses in schizophrenia and it indicate that schizophrenia may be characterized by an abnormal development of cerebral lateralization. Furthermore, these data argue that patients and their unaffected siblings might share decreases in the gray matter volume of the left middle temporal gyrus, and this regional reduction might be a potential endophenotype for schizophrenia. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. Preventing stroke (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 ...

  9. Stroke Rehabilitation (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 ...

  10. Content validation of the operational definitions of the nursing diagnoses of activity intolerance, excess fluid volume, and decreased cardiac output in patients with heart failure. (United States)

    de Souza, Vanessa; Zeitoun, Sandra Salloum; Lopes, Camila Takao; de Oliveira, Ana Paula Dias; Lopes, Juliana de Lima; de Barros, Alba Lucia Botura Leite


    To consensually validate the operational definitions of the nursing diagnoses activity intolerance, excessive fluid volume, and decreased cardiac output in patients with decompensated heart failure. Consensual validation was performed in two stages: analogy by similarity of defining characteristics, and development of operational definitions and validation with experts. A total of 38 defining characteristics were found. Operational definitions were developed and content-validated. One hundred percent of agreement was achieved among the seven experts after five rounds. "Ascites" was added in the nursing diagnosis excessive fluid volume. The consensual validation improves interpretation of human response, grounding the selection of nursing interventions and contributing to improved nursing outcomes. Support the assessment of patients with decompensated heart failure. © 2013 NANDA International.

  11. Impaired regulatory volume decrease in freshly isolated cholangiocytes from cystic fibrosis mice: implications for cystic fibrosis transmembrane conductance regulator effect on potassium conductance. (United States)

    Cho, Won Kyoo; Siegrist, Vicki J; Zinzow, Wendy


    Various K(+) and Cl(-) channels are important in cell volume regulation and biliary secretion, but the specific role of cystic fibrosis transmembrane conductance regulator in cholangiocyte cell volume regulation is not known. The goal of this research was to study regulatory volume decrease (RVD) in bile duct cell clusters (BDCCs) from normal and cystic fibrosis (CF) mouse livers. Mouse BDCCs without an enclosed lumen were prepared as described (Cho, W. K. (2002) Am. J. Physiol. 283, G1320-G1327). The isotonic solution consisted of HEPES buffer with 40% of the NaCl replaced with isomolar amounts of sucrose, whereas hypotonic solution was the same as isotonic solution without sucrose. The cell volume changes were indirectly assessed by measuring cross-sectional area (CSA) changes of the BDCCs using quantitative videomicroscopy. Exposure to hypotonic solutions increased relative CSAs of normal BDCCs to 1.20 +/- 0.01 (mean +/- S.E., n = 50) in 10 min, followed by RVD to 1.07 +/- 0.01 by 40 min. Hypotonic challenge in CF mouse BDCCs also increased relative CSA to 1.20 +/- 0.01 (n = 53) in 10 min but without significant recovery. Coadministration of the K(+)-selective ionophore valinomycin restored RVD in CF mouse BDCCs, suggesting that the impaired RVD was likely from a defect in K(+) conductance. Moreover, this valinomycin-induced RVD in CF mice was inhibited by 5-nitro-2'-(3-phenylpropylamino)-benzoate, indicating that it is not from nonspecific effects. Neither cAMP nor calcium agonists could reverse the impaired RVD seen in CF cholangiocytes. Our conclusion is that CF mouse cholangiocytes have defective RVD from an impaired K(+) efflux pathway, which could not be reversed by cAMP nor calcium agonists.

  12. Paediatric stroke

    African Journals Online (AJOL)


    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.

  13. Mechanical ventilation with high tidal volumes attenuates myocardial dysfunction by decreasing cardiac edema in a rat model of LPS-induced peritonitis

    Directory of Open Access Journals (Sweden)

    Smeding Lonneke


    Full Text Available Abstract Background Injurious mechanical ventilation (MV may augment organ injury remote from the lungs. During sepsis, myocardial dysfunction is common and increased endothelial activation and permeability can cause myocardial edema, which may, among other factors, hamper myocardial function. We investigated the effects of MV with injuriously high tidal volumes on the myocardium in an animal model of sepsis. Methods Normal rats and intraperitoneal (i.p. lipopolysaccharide (LPS-treated rats were ventilated with low (6 ml/kg and high (19 ml/kg tidal volumes (Vt under general anesthesia. Non-ventilated animals served as controls. Mean arterial pressure (MAP, central venous pressure (CVP, cardiac output (CO and pulmonary plateau pressure (Pplat were measured. Ex vivo myocardial function was measured in isolated Langendorff-perfused hearts. Cardiac expression of endothelial vascular cell adhesion molecule (VCAM-1 and edema were measured to evaluate endothelial inflammation and leakage. Results MAP decreased after LPS-treatment and Vt-dependently, both independent of each other and with interaction. MV Vt-dependently increased CVP and Pplat and decreased CO. LPS-induced peritonitis decreased myocardial function ex vivo but MV attenuated systolic dysfunction Vt-dependently. Cardiac endothelial VCAM-1 expression was increased by LPS treatment independent of MV. Cardiac edema was lowered Vt-dependently by MV, particularly after LPS, and correlated inversely with systolic myocardial function parameters ex vivo. Conclusion MV attenuated LPS-induced systolic myocardial dysfunction in a Vt-dependent manner. This was associated with a reduction in cardiac edema following a lower transmural coronary venous outflow pressure during LPS-induced coronary inflammation.

  14. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener


    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.

  15. Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS

    International Nuclear Information System (INIS)

    Dhainaut, J.F.; Devaux, J.Y.; Monsallier, J.F.; Brunet, F.; Villemant, D.; Huyghebaert, M.F.


    Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H 2 O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H 2 O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance

  16. Comparison of stroke volume and cardiac output as measured by a single observer using four different ultrasound techniques in six clinically healthy cats. (United States)

    Biermann, K; Hungerbühler, S; Kästner, S B R


    The aim of this study was to assess agreement and repeatability of four ultrasound methods for measuring stroke volume (SV) and cardiac output (CO) in cats. Measurement of SV and CO was performed by the Teichholz method, the Simpson's method (SM), the area length method (ALM) and a volumetric flow method across the aorta (Trace method). For each method, the coefficient of variation (CV) was calculated and agreement was determined by Bland-Altman analysis. The CV was acceptable (parameters, except for SV and CO obtained by SM (28.8% and 22.4%, respectively) and ALM (21.6% and 22.6%, respectively). Narrow limits of agreement were observed between both planimetric methods (SM and ALM). The Trace method was the most repeatable, followed by the Teichholz method. Despite excellent inter-method agreement, neither of the planimetric methods produced results with adequate repeatability. As the Teichholz and Trace methods were acceptably repeatable, and probably gave the most representative values, they appear to be the most useful methods for the measurement of SV and CO in cats. Further investigations are needed to compare the echocardiographic methods described here with a standard technique such as thermodilution. Copyright © 2012. Published by Elsevier Ltd.

  17. Fetal cardiac stroke volume determination by four-dimensional ultrasound with spatio-temporal image correlation compared with two-dimensional and Doppler ultrasonography. (United States)

    Rizzo, Giuseppe; Capponi, Alessandra; Cavicchioni, Ottavia; Vendola, Marianne; Arduini, Domenico


    To assess the agreement of stroke volume (SV) measured with two-dimensional (2D) ultrasonography with Doppler capability (vs) four-dimensional (4D) with spatiotemporal image correlation (STIC) in normal and growth restricted fetuses. 2D Doppler and 4D STIC were used to measure SV of 40 normal fetuses at 20 to 22 and 28 to 32 weeks, and 16 growth-restricted fetuses at 26 to 34 weeks of gestation. Intraclass correlation was used to evaluate the agreement between left and right SV obtained by the two techniques, and proportionate Bland-Altman plots constructed. The time necessary to obtain SV was analyzed. The intraclass correlation coefficient between 2D Doppler and 4D STIC measurements for the left ventricle were 0.977 and 0.980 for the right ventricle. The proportionate limits of agreement between the two methods were 18.7 to 23.9% for the left ventricle and - 20.9 to 21.7% for the right ventricle. The time necessary to measure SV was significantly shorter with 4D STIC (3.1 (vs) 7.9 min p < 0.0001) than with 2D Doppler. There is a good agreement between SV measured either by 2D Doppler or by 4D STIC. The 4D STIC represents a simple and rapid technique to estimate fetal SV and promises to become the method of choice. Copyright (c) 2007 John Wiley & Sons, Ltd.

  18. Simvastatin pretreatment protects cerebrum from neuronal injury by decreasing the expressions of phosphor-CaMK II and AQP4 in ischemic stroke rats. (United States)

    Zhu, Min-xia; Lu, Chao; Xia, Chun-mei; Qiao, Zhong-wei; Zhu, Da-nian


    Excitotoxicity and cytotoxic edema are the two major factors resulting in neuronal injury during brain ischemia and reperfusion. Ca2+/calmodulin-dependent protein kinase II (CaMK II), the downstream signal molecular of N-methyl-D-aspartate receptors (NMDARs), is a mediator in the excitotoxicity. Aquaporin 4 (AQP4), expressed mainly in the brain, is an important aquaporin to control the flux of water. In a previous study, we had reported that pretreatment of simvastatin protected the cerebrum from ischemia and reperfusion injury by decreasing neurological deficit score and infarct area (Zhu et al. PLoS One 7:e51552, 2012). The present study used a middle cerebral artery occlusion (MCAO) model to further explore the pleiotropic effect of simvastatin via CaMK II and AQP4. The results showed that simvastatin reduced degenerated cells and brain edema while decreasing the protein expressions of phosphor-CaMK II and AQP4, and increasing the ratios of Bcl-2/Bax, which was independent of cholesterol-lowering effect. Immunocomplexes formed between the subunit of NMDARs-NR3A and AQP4 were detected for the first time. It was concluded that simvastatin could protect the cerebrum from neuronal excitotoxicity and cytotoxic edema by downregulating the expressions of phosphor-CaMK II and AQP4, and that the interaction between NR3A and AQP4 might provide the base for AQP4 involving in the signaling pathways mediated by NMDARs.

  19. 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.

  20. Effect of sodium dodecyl sulfate (SDS) on stress response in the Mediterranean mussel (Mytilus Galloprovincialis): regulatory volume decrease (Rvd) and modulation of biochemical markers related to oxidative stress. (United States)

    Messina, Concetta Maria; Faggio, Caterina; Laudicella, Vincenzo Alessandro; Sanfilippo, Marilena; Trischitta, Francesca; Santulli, Andrea


    In this study the effects of an anionic surfactant, sodium dodecyl sulfate (SDS), are assessed on the Mediterranean mussel (Mytilus galloprovincialis), exposed for 18 days at a concentration ranging from 0.1 mg/l to 1 mg/l. The effects are monitored using biomarkers related to stress response, such as regulatory volume decrease (RVD), and to oxidative stress, such as reactive oxygen species (ROS), endogenous antioxidant systems and Hsp70 levels. The results demonstrate that cells from the digestive gland of M. galloprovincialis, exposed to SDS were not able to perform the RVD owing to osmotic stress. Further, SDS causes oxidative stress in treated organisms, as demonstrated by the increased ROS production, in comparison to the controls (pSDS, under the tested concentrations, exerts a toxic effect in mussels in which the disruption of the osmotic balance follows the induction of oxidative stress. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Pre-existing hypertension dominates γδT cell reduction in human ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Mateusz G Adamski

    Full Text Available T lymphocytes may play an important role in the evolution of ischemic stroke. Depletion of γδT cells has been found to abrogate ischemia reperfusion injury in murine stroke. However, the role of γδT cells in human ischemic stroke is unknown. We aimed to determine γδT cell counts and γδT cell interleukin 17A (IL-17A production in the clinical setting of ischemic stroke. We also aimed to determine the associations of γδT cell counts with ischemic lesion volume, measures of clinical severity and with major stroke risk factors. Peripheral blood samples from 43 acute ischemic stroke patients and 26 control subjects matched on race and gender were used for flow cytometry and complete blood count analyses. Subsequently, cytokine levels and gene expression were measured in γδT cells. The number of circulating γδT cells was decreased by almost 50% (p = 0.005 in the stroke patients. γδT cell counts did not correlate with lesion volume on magnetic resonance diffusion-weighted imaging or with clinical severity in the stroke patients, but γδT cells showed elevated levels of IL-17A (p = 0.048. Decreased γδT cell counts were also associated with older age (p = 0.004, pre-existing hypertension (p = 0.0005 and prevalent coronary artery disease (p = 0.03, with pre-existing hypertension being the most significant predictor of γδT cell counts in a multivariable analysis. γδT cells in human ischemic stroke are reduced in number and show elevated levels of IL-17A. A major reduction in γδT lymphocytes also occurs in hypertension and may contribute to the development of hypertension-mediated stroke and vascular disease.

  2. Ischemic Stroke (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 ...

  3. Stroke - slideshow (United States)

    ... this page: // 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 ...

  4. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia


    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.

  5. Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure. (United States)

    Wenzel, V; Idris, A H; Banner, M J; Kubilis, P S; Band, R; Williams, J L; Lindner, K H


    The purpose of the present study was to evaluate respiratory system compliance after cardiopulmonary resuscitation (CPR) and subsequent stomach inflation. Further, we calculated peak airway pressure according to the different tidal volume recommendations of the European Resuscitation Council (7.5 ml/kg) and the American Heart Association (15 ml/kg) for ventilation of an unintubated cardiac arrest victim. After 4 min of ventricular fibrillation, and 6 min of CPR, return of spontaneous circulation (ROSC) after defibrillation occurred in seven pigs. Respiratory system compliance was measured at prearrest, after ROSC, and after 2 and 4 l of stomach inflation in the postresuscitation phase; peak airway pressure was subsequently calculated. Before cardiac arrest the mean (+/- S.D.) respiratory system compliance was 30 +/- 3 ml/cm H2O, and decreased significantly (P CPR and subsequent induction of stomach inflation in an animal model with a wide open airway. This may have a significant impact on peak airway pressure and distribution of gas during ventilation of an unintubated patient with cardiac arrest.

  6. Non-demented Parkinson's disease patients with apathy show decreased grey matter volume in key executive and reward-related nodes. (United States)

    Martinez-Horta, Saul; Sampedro, Frederic; Pagonabarraga, Javier; Fernandez-Bobadilla, Ramón; Marin-Lahoz, Juan; Riba, Jordi; Kulisevsky, Jaime


    Apathy is a common but poorly understood neuropsychiatric disturbance in Parkinson's disease (PD). In a recent study using event-related brain potentials we demonstrated impaired reward processing and compromised mesocortico-limbic pathways in PD patients with clinical symptoms of apathy. Here we aimed to further investigate the involvement of reward circuits in apathetic PD patients by assessing potential differences in brain structure. Using structural magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) we quantified grey matter volume (GMV) in a sample of 18 non-demented and non-depressed PD patients with apathy, and 18 matched non-apathetic patients. Both groups were equivalent in terms of sociodemographic characteristics, disease stage, cognitive performance and L-Dopa equivalent daily dose. Apathetic patients showed significant GMV loss in cortical and subcortical brain structures. Various clusters of cortical GMV decrease were found in the parietal, lateral prefrontal cortex, and orbitofrontal cortex (OFC). The second largest cluster of GMV loss was located in the left nucleus accumbens (NAcc), a subcortical structure that is a key node of the human reward circuit. Isolated apathy in our sample is explained by the combined GMV loss in regions involved in executive functions, and cortical and subcortical structures of the mesolimbic reward pathway. The correlations observed between apathy and cognition suggests apathy as a marker of more widespread brain degeneration even in a sample of non-demented PD patients.

  7. Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates. (United States)

    Blohm, Martin Ernst; Hartwich, Jana; Obrecht, Denise; Kersten, Jan Felix; Singer, Dominique


    This prospective single-center observational study compared impedance cardiography [electrical velocimetry (EV)] with transthoracic echocardiography (TTE, based on trans-aortic flow) and analyzed the influence of physiological shunts, such as patent ductus arteriosus (PDA) or patent foramen ovale (PFO), on measurement accuracy. Two hundred and ninety-one triplicate simultaneous paired left ventricular stroke volume (LVSV) measurements by EV (LVSV EV ) and TTE (LVSV TTE ) in 99 spontaneously breathing neonates (mean weight 3270 g; range 1227-4600 g) were included. For the whole cohort, the mean absolute LVSV EV was 5.5 mL, mean LVSV TTE was 4.9 mL, resulting in an absolute Bland-Altman bias of -0.7 mL (limits of agreement LOA -3.0 to 1.7 mL), relative bias -12.8 %; mean percentage error MPE 44.9 %; true precision TP EV 33.4 % (n = 99 aggregated data points). In neonates without shunts (n = 32): mean LVSV EV 5.0 mL, mean LVSV TTE 4.6 mL, Bland-Altman bias -0.4 mL (LOA -2.8 to 2.0 mL), relative bias -8.2 %; MPE 50.7 %; TP EV 40.9 %. In neonates with shunts (PDA and/or PFO; n = 67): mean LVSV EV 5.8 mL, mean LVSV TTE 5.0 mL, bias -0.8 mL (LOA -3.1 to 1.5 mL), relative bias -14.8 %, MPE 41.9 %, TP EV 29.3 %. Accuracy was affected by PDA and/or PFO, with a significant increase in the relative difference in LVSV EV versus LVSV TTE : Subjects without shunts -2.9 % (n = 91), PFO alone -9.6 % (n = 125), PDA alone -14.0 % (n = 12), and PDA and PFO -18.5 % (n = 63). Physiological shunts (PDA and/or PFO) in neonates affect measurement accuracy and cause overestimation of LVSV EV compared with LVSV TTE .

  8. Overexpression of synapsin Ia in the rat calyx of Held accelerates short-term plasticity and decreases synaptic vesicle volume and active zone area (United States)

    Vasileva, Mariya; Renden, Robert; Horstmann, Heinz; Gitler, Daniel; Kuner, Thomas


    Synapsins are synaptic vesicle (SV) proteins organizing a component of the reserve pool of vesicles at most central nervous system synapses. Alternative splicing of the three mammalian genes results in multiple isoforms that may differentially contribute to the organization and maintenance of the SV pools. To address this, we first characterized the expression pattern of synapsin isoforms in the rat calyx of Held. At postnatal day 16, synapsins Ia, Ib, IIb and IIIa were present, while IIa—known to sustain repetitive transmission in glutamatergic terminals—was not detectable. To test if the synapsin I isoforms could mediate IIa-like effect, and if this depends on the presence of the E-domain, we overexpressed either synapsin Ia or synapsin Ib in the rat calyx of Held via recombinant adeno-associated virus-mediated gene transfer. Although the size and overall structure of the perturbed calyces remained unchanged, short-term depression and recovery from depression were accelerated upon overexpression of synapsin I isoforms. Using electron microscopic three-dimensional reconstructions we found a redistribution of SV clusters proximal to the active zones (AZ) alongside with a decrease of both AZ area and SV volume. The number of SVs at individual AZs was strongly reduced. Hence, our data indicate that the amount of synapsin Ia expressed in the calyx regulates the rate and extent of short-term synaptic plasticity by affecting vesicle recruitment to the AZ. Finally, our study reveals a novel contribution of synapsin Ia to define the surface area of AZs. PMID:24391547

  9. Recovering after stroke (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 ...

  10. Stroke Rehabilitation (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 ...

  11. Pediatric Stroke (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. ...

  12. Neurorestorative Therapy of Stroke in Type two Diabetes Rats Treated with Human Umbilical Cord Blood Cells (United States)

    Yan, Tao; Venkat, Poornima; Chopp, Michael; Zacharek, Alex; Ning, Ruizhuo; Cui, Yisheng; Roberts, Cynthia; Kuzmin-Nichols, Nicole; Sanberg, Cyndy Davis; Chen, Jieli


    Background and Purpose Diabetes mellitus is a high risk factor for ischemic stroke. Diabetic stroke patients suffer worse outcomes, poor long term recovery, risk of recurrent strokes and extensive vascular damage. We investigated the neurorestorative effects and the underlying mechanisms of stroke treatment with human umbilical cord blood cells (HUCBCs) in Type two diabetes mellitus (T2DM) rats. Methods Adult male T2DM rats were subjected to 2 h of middle cerebral artery occlusion (MCAo). Three days after MCAo, rats were treated via tail-vein injection with: 1) phosphate-buffered-saline (PBS); 2) HUCBCs (5×106); n=10/group. Results HUCBC stroke treatment initiated 3 days after MCAo in T2DM rats did not significantly decrease blood-brain-barrier (BBB) leakage (p=0.1) and lesion volume (p=0.078), but significantly improved long term functional outcome and decreased brain hemorrhage (ptreatment significantly promoted white matter (WM) remodeling as indicated by increased expression of Bielschowsky silver (axons marker), Luxol fast blue (myelin marker), SMI-31 (neurofilament) and Synaptophysin in the ischemic border zone (IBZ). HUCBC promoted vascular remodeling, and significantly increased arterial and vascular density. HUCBC treatment of stroke in T2DM rats significantly increased M2 macrophage polarization (increased M2 macrophage CD163, CD 206; decreased M1 macrophage ED1 and iNOS expression) in the ischemic brain compared to PBS-treated T2DM-MCAo controls (ptreatment initiated 3 days after stroke significantly increased WM and vascular remodeling in the ischemic brain as well as decreased neuroinflammatory factor expression in the ischemic brain in T2DM rats and promoted M2 macrophage polarization. HUCBC reduction of neuroinflammation and increased vascular and WM-axonal remodeling may contribute to the HUCBC induced beneficial effects in T2DM stroke rats. PMID:26243222

  13. Effect of volume loading on the Frank-Starling relation during reductions in central blood volume in heat-stressed humans

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, Morten; Wilson, T E; Seifert, Thomas


    During reductions in central blood volume while heat stressed, a greater decrease in stroke volume (SV) for a similar decrease in ventricular filling pressure, compared to normothermia, suggests that the heart is operating on a steeper portion of a Frank-Starling curve. If so, volume loading...... of heat-stressed individuals would shift the operating point to a flatter portion of the heat stress Frank-Starling curve thereby attenuating the reduction in SV during subsequent decreases in central blood volume. To investigate this hypothesis, right heart catheterization was performed in eight males.......06). However, subsequent volume loading increased SV to 143 +/- 29 ml (P = 0.003). LBNP provoked a larger decrease in SV relative to the decrease in PCWP during heating (8.6 +/- 1.9 ml mmHg(1)) compared to normothermia (4.5 +/- 3.0 ml mmHg(1), P = 0.02). After volume loading while heat stressed, the reduction...

  14. Lower Ipsilateral Hippocampal Integrity after Ischemic Stroke in Young Adults: A Long-Term Follow-Up Study

    NARCIS (Netherlands)

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


    Background and purpose Memory impairment after stroke is poorly understood as stroke rarely occurs in the hippocampus. Previous studies have observed smaller ipsilateral hippocampal volumes after stroke compared with controls. Possibly, these findings on macroscopic level are not the first

  15. Lower Ipsilateral Hippocampal Integrity after Ischemic Stroke in Young Adults: A Long-Term Follow-Up Study

    NARCIS (Netherlands)

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


    BACKGROUND AND PURPOSE: Memory impairment after stroke is poorly understood as stroke rarely occurs in the hippocampus. Previous studies have observed smaller ipsilateral hippocampal volumes after stroke compared with controls. Possibly, these findings on macroscopic level are not the first

  16. Ipsilateral hippocampal atrophy is associated with long-term memory dysfunction after ischemic stroke in young adults

    NARCIS (Netherlands)

    Schaapsmeerders, P.; Uden, I.W.M. van; Tuladhar, A.M.; Maaijwee, N.A.M.M.; Dijk, E.J. van; Rutten-Jacobs, L.C.A.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Leeuw, H.F. de; Kessels, R.P.C.


    Memory impairment after stroke in young adults is poorly understood. In elderly stroke survivors memory impairments and the concomitant loss of hippocampal volume are usually explained by coexisting neurodegenerative disease (e.g., amyloid pathology) in interaction with stroke. However,

  17. Stroke and Cerebrovascular Diseases Registry (United States)


    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

  18. Decreased Libido (United States)

    ... causes decreased libido? Decreased libido often accompanies other sexual disorders. Although most men with erectile dysfunction do not complain of decreased libido, after time, persistent failure with erections and sexual performance can lead to reduced sex drive in ...

  19. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014. (United States)

    Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie


    Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

  20. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.


    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

  1. Intra-tumour 18F-FDG uptake heterogeneity decreases the reliability on target volume definition with positron emission tomography/computed tomography imaging. (United States)

    Dong, Xinzhe; Wu, Peipei; Sun, Xiaorong; Li, Wenwu; Wan, Honglin; Yu, Jinming; Xing, Ligang


    This study aims to explore whether the intra-tumour (18) F-fluorodeoxyglucose (FDG) uptake heterogeneity affects the reliability of target volume definition with FDG positron emission tomography/computed tomography (PET/CT) imaging for nonsmall cell lung cancer (NSCLC) and squamous cell oesophageal cancer (SCEC). Patients with NSCLC (n = 50) or SCEC (n = 50) who received (18)F-FDG PET/CT scanning before treatments were included in this retrospective study. Intra-tumour FDG uptake heterogeneity was assessed by visual scoring, the coefficient of variation (COV) of the standardised uptake value (SUV) and the image texture feature (entropy). Tumour volumes (gross tumour volume (GTV)) were delineated on the CT images (GTV(CT)), the fused PET/CT images (GTV(PET-CT)) and the PET images, using a threshold at 40% SUV(max) (GTV(PET40%)) or the SUV cut-off value of 2.5 (GTV(PET2.5)). The correlation between the FDG uptake heterogeneity parameters and the differences in tumour volumes among GTV(CT), GTV(PET-CT), GTV(PET40%) and GTV(PET2.5) was analysed. For both NSCLC and SCEC, obvious correlations were found between uptake heterogeneity, SUV or tumour volumes. Three types of heterogeneity parameters were consistent and closely related to each other. Substantial differences between the four methods of GTV definition were found. The differences between the GTV correlated significantly with PET heterogeneity defined with the visual score, the COV or the textural feature-entropy for NSCLC and SCEC. In tumours with a high FDG uptake heterogeneity, a larger GTV delineation difference was found. Advance image segmentation algorithms dealing with tracer uptake heterogeneity should be incorporated into the treatment planning system. © 2015 The Royal Australian and New Zealand College of Radiologists.

  2. Velocity, stroke rate, and distance per stroke during elite swimming competition. (United States)

    Craig, A B; Skehan, P L; Pawelczyk, J A; Boomer, W L


    The mean velocity of 9 out of 10 women's events during the U.S. Olympic Swimming Trials was greater in 1984 as compared to 1976. Three of the 10 men's events showed improvement. In 9 out of these 12 events, the increased velocity was accounted for by increased distance per stroke (range, -3 to -13%). In the women's 100-m butterfly and 100-m backstroke, increased velocity was due solely to faster stroke rates. The finalists in each event were compared to those whose velocities were 3-7% slower. In almost all events and stroke styles, the finalists achieved greater distances per stroke than did the slower group. In the men's events increased distance per stroke was associated with decreased stroke rate, except in the backstroke, in which both were increased for the finalists. Although the faster women swimmers generally had greater distances per stroke, they were more dependent than men on faster stroke rates to achieve superiority. The profile of velocity for races of 200 m and longer indicated that as fatigue developed the distance per stroke decreased. The faster swimmers compensated for this change by maintaining or increasing stroke rate more than did their slower competitors. This study indicates that improvements and superiority in stroke mechanics are reflected in the stroke rate and distance per stroke used to swim a race.

  3. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.


    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

  4. Time configuration of combined neuromodulation and motor training after stroke: A proof-of-concept study. (United States)

    Powell, Elizabeth S; Carrico, Cheryl; Westgate, Philip M; Chelette, Kenneth C; Nichols, Laurie; Reddy, Lakshmi; Salyers, Emily; Ward, Andrea; Sawaki, Lumy


    Intensive motor training is a therapeutic intervention that supports recovery of movement function after stroke by capitalizing on the brain's capacity for neuroplastic change. Peripheral nerve stimulation and transcranial direct current stimulation are neuromodulation techniques that can upregulate neuroplasticity and, in turn, enhance outcomes of motor training after stroke. Few studies have investigated possible adjuvant effects between peripheral nerve stimulation, transcranial direct current stimulation, and intensive motor training. This proof-of-concept study investigated whether timing variations in neuromodulation paired with robot-assisted motor training effect differential outcomes for subjects with chronic, moderate-to-severe upper extremity impairment after stroke. Ten subjects in the chronic phase (>12 months after stroke) of recovery completed the study. Subjects received 10 daily sessions of transcranial direct current stimulation either at the start (n = 4) or at the end (n = 6) of peripheral nerve stimulation preceding intensive motor training. Pre-post changes in motor function (Fugl-Meyer Assessment; Stroke Impact Scale) and neuroplasticity (transcranial magnetic stimulation) were assessed by condition. Significant improvement in Stroke Impact Scale (p = 0.02) and no change in Fugl-Meyer Assessment were associated with the start condition. No changes in Stroke Impact Scale and Fugl-Meyer Assessment were associated with the end condition. Only 1 subject in the start group had measurable neuroplastic responses and demonstrated an increase in ipsilesional cortical map volume. Only 1 subject in the end group had measurable neuroplastic responses and demonstrated a decrease in ipsilesional cortical map volume. Opposite shifts in ipsilesional cortical centers of gravity occurred relative to condition. In cases of moderate-to-severe impairment after stroke, transcranial direct current stimulation at the start, rather than the end, of

  5. Driving After a Stroke (United States)

    ... Stroke Professionals for Stroke Shop for Stroke Support for Stroke Association. ... a wheelchair accessible or modified van, truck or car can provide the assurance you need to feel ...

  6. Acute MRI changes in progressive ischemic stroke

    DEFF Research Database (Denmark)

    Kalowska, E.; Rostrup, E.; Rosenbaum, S.


    aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). METHODS: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...

  7. Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes. (United States)

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


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

  8. Stroke prevention: an update. (United States)

    Bousser, Marie-Germaine


    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.

  9. Polychlorinated biphenyls (PCBs) decrease the placental syncytiotrophoblast volume and increase Placental Growth Factor (PlGF) in the placenta of normal pregnancy. (United States)

    Tsuji, M; Aiko, Y; Kawamoto, T; T Hachisuga; Kooriyama, C; Myoga, M; Tomonaga, C; Matsumura, F; Anan, A; Tanaka, M; Yu, H S; Fujisawa, Y; Suga, R; Shibata, E


    Polychlorinated biphenyls (PCBs) are a class of biologically active, highly stable compounds. Exposure risks include consumption of fatty fish, meat, dairy products and human breast milk, as well as environmental and occupational settings. Numerous reports have described PCB-dependent adverse effects on human fetal growth, including increased risk for IUGR, changes in endocrine function and hormone metabolism, and immunosuppressive and neurological deficits. Here we test the prediction that in utero PCB exposure adversely effects placental morphology, potentially leading to placental insufficiency en route to fetal growth restriction. PCB homologs (10) were measured in the maternal and fetal blood of a small cohort of normotensive pregnancies (22) by gas chromatography-mass spectrometry. PCB levels were compared with angiogenesis associated proteins Placental Growth Factor (PlGF) and sFlt-1, determined by ELISA, and the total estimated syncytiotrophoblast (ST) volume. Significant associations between PCB exposure and both PlGF and ST volume were identified. PCB effects on placenta morphology and predicted function are discussed. These results demonstrate that the human placenta, including ST, is a target of PCB toxicity, and that current environmental PCB exposure levels are a risk to reproductive health. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Stroke from systemic vascular disorders in Saudi children: The devastating role of hypernatremic dehydration

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Zahraa, Jihad N.; Alorainy, Ibrahim A.; Hassan, Hamdy H.


    Systemic vascular disorders, leading to childhood stroke, include volume depletion or systemic hypotension and hypernatremic dehydration. We describe 3 cases of stroke following systemic vascular disorders. These were diagnosed during a prospective and retrospective study on childhood stroke, which included 104 patients. Post-gastroenteritis hypernatremic dehydration is an important, potentially preventable, cause of stroke in Saudi children. (author)

  11. Left ventricular volume measurement in mice by conductance catheter: evaluation and optimization of calibration

    DEFF Research Database (Denmark)

    Nielsen, Jan Møller; Kristiansen, Steen B; Ringgaard, Steffen


    of the hypertonic saline bolus was inferior to injection into the pulmonary artery as a calibration method. Calibration with an independent measurement of stroke volume decreased the agreement with V(MRI). Correction for an increase in blood conductivity during the in vivo experiments improved estimation of EDV...

  12. Neonatal handling enduringly decreases anxiety and stress responses and reduces hippocampus and amygdala volume in a genetic model of differential anxiety: Behavioral-volumetric associations in the Roman rat strains. (United States)

    Río-Álamos, Cristóbal; Oliveras, Ignasi; Piludu, Maria Antonietta; Gerbolés, Cristina; Cañete, Toni; Blázquez, Gloria; Lope-Piedrafita, Silvia; Martínez-Membrives, Esther; Torrubia, Rafael; Tobeña, Adolf; Fernández-Teruel, Alberto


    The hippocampus and amygdala have been proposed as key neural structures related to anxiety. A more active hippocampus/amygdala system has been related to greater anxious responses in situations involving conflict/novelty. The Roman Low- (RLA) and High-avoidance (RHA) rat lines/strains constitute a genetic model of differential anxiety. Relative to RHA rats, RLA rats exhibit enhanced anxiety/fearfulness, augmented hippocampal/amygdala c-Fos expression following exposure to novelty/conflict, increased hippocampal neuronal density and higher endocrine responses to stress. Neonatal handling (NH) is an environmental treatment with long-lasting anxiety/stress-reducing effects in rodents. Since hippocampus and amygdala volume are supposed to be related to anxiety/fear, we hypothesized a greater volume of both areas in RLA than in RHA rats, as well as that NH treatment would reduce anxiety and the volume of both structures, in particular in the RLA strain. Adult untreated and NH-treated RHA and RLA rats were tested for anxiety, sensorimotor gating (PPI), stress-induced corticosterone and prolactin responses, two-way active avoidance acquisition and in vivo 7 T 1H-Magnetic resonance image. As expected, untreated RLA rats showed higher anxiety and post-stress hormone responses, as well as greater hippocampus and amygdala volumes than untreated RHA rats. NH decreased anxiety/stress responses, especially in RLA rats, and significantly reduced hippocampus and amygdala volumes in this strain. Dorsal striatum volume was not different between the strains nor it was affected by NH. Finally, there were positive associations (as shown by correlations, factor analysis and multiple regression) between anxiety and PPI and hippocampus/amygdala volumes. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

  13. Heat Stroke

    DEFF Research Database (Denmark)

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


    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...

  14. Prinsip Umum Penatalaksanaan Cedera Olahraga Heat Stroke


    Ade Tobing, Saharun Iso


    Exercises that are conducted in an extreme heat environment can cause heat injury. Heatinjury is associated with disturbance to temperature regulation and cardiovascular systems. Heatstroke is the most severe type of heat injury. Heat stroke is associated with high morbidity andmortality numbers, particularly if therapy treatment is delayed. In general, heat stroke is caused bytwo things, namely increase in heat production and decrease in heat loss.Heat stroke signs include: (1) rectal temper...

  15. Stroke Location Is an Independent Predictor of Cognitive Outcome. (United States)

    Munsch, Fanny; Sagnier, Sharmila; Asselineau, Julien; Bigourdan, Antoine; Guttmann, Charles R; Debruxelles, Sabrina; Poli, Mathilde; Renou, Pauline; Perez, Paul; Dousset, Vincent; Sibon, Igor; Tourdias, Thomas


    On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes. Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample. In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample. Stroke location is an independent predictor of cognitive outcome (MoCA) at 3

  16. Prognostic value of single-photon emission tomography in acute ischaemic stroke

    International Nuclear Information System (INIS)

    Weir, C.J.; Bolster, A.A.; Tytler, S.; Murray, G.D.; Corrigall, R.S.; Adams, F.G.; Lees, K.R.


    Single-photon emission tomography (SPET) is widely used in the investigation of acute stroke. We investigated the relationship between SPET data and functional outcome in a large group of acute stroke patients. One hundred and eight patients underwent cerebral computed tomography (CT) and technetium-99m hexamethylpropylene amine oxime SPET after acute ischaemic stroke. We categorised the clinical presentation according to the Oxford classification of acute stroke. Outcome was measured 1 year after stroke using mortality and the Barthel Index for survivors. SPET scans were interpreted without reference to the clinical data using a semi-automatic technique. Three experienced observers determined the presence of luxury perfusion using suitably scaled SPET images in conjunction with the CT scan. Both SPET volume and severity of deficit were significantly negatively correlated with Barthel Index at 1 year (r s =-0.310, P s =-0.316, P s =-0.606, P s =-0.492, P 2 =0.073, df=1, P=0.79) with good functional outcome (Barthel score ≥60). Stepwise logistic regression identified Oxford classification, total deficit volume and patient's age as significant predictors of functional outcome. Overall predictive accuracy was 72%. Predictive accuracy was better in patients who received SPET within 16 h of stroke onset. SPET provides useful information about the functional outcome of acute stroke at 1 year. However, the accuracy of prediction decreases the longer SPET is delayed. Prognostication using SPET in combination with clinical assessment and other investigations may also be considered. (orig.). With 3 figs., 4 tabs

  17. Decreased Axon Caliber Underlies Loss of Fiber Tract Integrity, Disproportional Reductions in White Matter Volume, and Microcephaly in Angelman Syndrome Model Mice. (United States)

    Judson, Matthew C; Burette, Alain C; Thaxton, Courtney L; Pribisko, Alaine L; Shen, Mark D; Rumple, Ashley M; Del Cid, Wilmer A; Paniagua, Beatriz; Styner, Martin; Weinberg, Richard J; Philpot, Benjamin D


    Angelman syndrome (AS) is a debilitating neurodevelopmental disorder caused by loss of function of the maternally inherited UBE3A allele. It is currently unclear how the consequences of this genetic insult unfold to impair neurodevelopment. We reasoned that by elucidating the basis of microcephaly in AS, a highly penetrant syndromic feature with early postnatal onset, we would gain new insights into the mechanisms by which maternal UBE3A loss derails neurotypical brain growth and function. Detailed anatomical analysis of both male and female maternal Ube3a -null mice reveals that microcephaly in the AS mouse model is primarily driven by deficits in the growth of white matter tracts, which by adulthood are characterized by densely packed axons of disproportionately small caliber. Our results implicate impaired axon growth in the pathogenesis of AS and identify noninvasive structural neuroimaging as a potentially valuable tool for gauging therapeutic efficacy in the disorder. SIGNIFICANCE STATEMENT People who maternally inherit a deletion or nonfunctional copy of the UBE3A gene develop Angelman syndrome (AS), a severe neurodevelopmental disorder. To better understand how loss of maternal UBE3A function derails brain development, we analyzed brain structure in a maternal Ube3a knock-out mouse model of AS. We report that the volume of white matter (WM) is disproportionately reduced in AS mice, indicating that deficits in WM development are a major factor underlying impaired brain growth and microcephaly in the disorder. Notably, we find that axons within the WM pathways of AS model mice are abnormally small in caliber. This defect is associated with slowed nerve conduction, which could contribute to behavioral deficits in AS, including motor dysfunction. Copyright © 2017 the authors 0270-6474/17/377347-15$15.00/0.

  18. Effects of electroacupuncture on recent stroke inpatients with incomplete bladder emptying: a preliminary study

    Directory of Open Access Journals (Sweden)

    Yu KW


    , and seven of the stroke patients with IBE were treated with EA. Increased spontaneous voiding volume and decreased PVR urine volume were noted after ten sessions of EA.Conclusion: EA may have beneficial effects on stroke survivors with IBE, thereby making it a potential safe modality with which to improve urinary function.Keywords: acupuncture, electroacupuncture, incomplete bladder emptying, rehabilitation, stroke, urinary retention

  19. A study on regional cerebral circulation in stroke patients with aphasia

    International Nuclear Information System (INIS)

    Kudo, Ryozo


    To study the pathophysiology of aphasia due to cerebral stroke, regional cerebral blood flow (rCBF) was measured by the 133 Xe clearance method and the volume of low density area (LDA) was estimated on the basis of computerized tomography in 43 thrombotic (24 aphasia and 19 non-aphasia), 30 hemorrhagic (16 aphasia and 14 non-aphasia) and 6 non-stroke cases. 1) In the healthy hemisphere, rCBF showed no significant difference between aphasia and non-aphasia in both thrombotic and hemorrhagic cases. In the affected hemisphere, thrombotic cases showed significantly decreased rCBF in aphasic cases as compared to non-aphasic, however, hemorrhagic cases revealed no difference. 2) LDA volume showed no significant difference between aphasia and non-aphasia in cerebral thrombosis, however, LDA volume in non-aphasia was smaller than that in aphasia in cerebral hemorrage. 3) Significant differences in the pathophysiology of aphasia due to cerebral stroke were recognized between cerebral thrombosis and cerebral hemorrhage. Such differences should be taken into consideration in the management and treatment of aphasia caused by cerebral stroke. (author)

  20. Postoperative volume balance

    DEFF Research Database (Denmark)

    Frost, H; Mortensen, C.R.; Secher, Niels H.


    In healthy humans, stroke volume (SV) and cardiac output (CO) do not increase with expansion of the central blood volume by head-down tilt or administration of fluid. Here, we exposed 85 patients to Trendelenburg's position about one hour after surgery while cardiovascular variables were determin...

  1. Impact of Libido at 2 Weeks after Stroke on Risk of Stroke Recurrence at 1-Year in a Chinese Stroke Cohort Study


    Jing-Jing Li; Huai-Wu Yuan; Chun-Xue Wang; Ben-Yan Luo; Jie Ruan; Ning Zhang; Yu-Zhi Shi; Yong Zhou; Yi-Long Wang; Tong Zhang; Juan Zhou; Xing-Quan Zhao; Yong-Jun Wang


    Background: There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year. Methods: It is a multi-centered, prospective cohort study. The 14 th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of ...

  2. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (United States)

    Jauch, Edward C; Cucchiara, Brett; Adeoye, Opeolu; Meurer, William; Brice, Jane; Chan, Yvonne Yu-Feng; Gentile, Nina; Hazinski, Mary Fran


    Advances in stroke care will have the greatest effect on stroke outcome if care is delivered within a regional stroke system designed to improve both efficiency and effectiveness. The ultimate goal of stroke care is to minimize ongoing injury, emergently recanalize acute vascular occlusions, and begin secondary measures to maximize functional recovery. These efforts will provide stroke patients with the greatest opportunity for a return to previous quality of life and decrease the overall societal burden of stroke.

  3. Structural MRI markers of brain aging early after ischemic stroke. (United States)

    Werden, Emilio; Cumming, Toby; Li, Qi; Bird, Laura; Veldsman, Michele; Pardoe, Heath R; Jackson, Graeme; Donnan, Geoffrey A; Brodtmann, Amy


    To examine associations between ischemic stroke, vascular risk factors, and MRI markers of brain aging. Eighty-one patients (mean age 67.5 ± 13.1 years, 31 left-sided, 61 men) with confirmed first-ever (n = 66) or recurrent (n = 15) ischemic stroke underwent 3T MRI scanning within 6 weeks of symptom onset (mean 26 ± 9 days). Age-matched controls (n = 40) completed identical testing. Multivariate regression analyses examined associations between group membership and MRI markers of brain aging (cortical thickness, total brain volume, white matter hyperintensity [WMH] volume, hippocampal volume), normalized against intracranial volume, and the effects of vascular risk factors on these relationships. First-ever stroke was associated with smaller hippocampal volume ( p = 0.025) and greater WMH volume ( p = 0.004) relative to controls. Recurrent stroke was in turn associated with smaller hippocampal volume relative to both first-ever stroke ( p = 0.017) and controls ( p = 0.001). These associations remained significant after adjustment for age, sex, education, and, in stroke patients, infarct volume. Total brain volume was not significantly smaller in first-ever stroke patients than in controls ( p = 0.056), but the association became significant after further adjustment for atrial fibrillation ( p = 0.036). Cortical thickness and brain volumes did not differ as a function of stroke type, infarct volume, or etiology. Brain structure is likely to be compromised before ischemic stroke by vascular risk factors. Smaller hippocampal and total brain volumes and increased WMH load represent proxies for underlying vascular brain injury. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

  4. Difficulty of MRI based identification of lesion age by acute infra-tentorial ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Florian Grosse-Dresselhaus

    Full Text Available Systemic thrombolysis in acute ischemic stroke is restricted to the 4.5 h time window. Many patients are excluded from this treatment because symptom onset is unknown. Magnetic resonance imaging (MRI studies have shown that stroke patients presenting with acute supra-tentorial diffusion-weighted imaging (DWI lesions that do not have matching lesions on fluid attenuated inversion recovery (FLAIR are likely to be within a 4.5 hour time window. This study examines the DWI-FLAIR mismatch in infra-tentorial stroke.This was a retrospectively conducted substudy of the "1000+" study; a prospective, single-center observational study (; NCT00715533. Fifty-six patients with infra-tentorial stroke confirmed by MRI and known symptom onset who underwent the scan within 24 h after symptom onset were analysed. Two neurologists blinded to clinical information separately rated the DWI lesion visibility on FLAIR. Lesion volume, relative signal intensities of DWI and relative apparent diffusion coefficient values were determined.Regarding baseline characteristics our study population had a median age of 66 years, a median time from symptom onset to MRI of 616.5 minutes, a median NIHSS of 3 and a median DWI lesion volume of 0.26 ml. A negative FLAIR allocated patients to a time window under 4.5 h correctly with a sensitivity of 55% and a specificity of 61%, a positive predictive value of 44% and a negative predictive value of 71%. FLAIR positivity decreased with age (p = 0.018, and showed no significant correlation to lesion volume (p = 0.145.In our study the DWI-FLAIR-Mismatch does not help to reliably identify patients within 4.5 h of symptom onset in acute ischemic infra-tentorial stroke. Thus therapeutical decisions based on the DWI-FLAIR mismatch estimation of time from onset cannot be recommended in patients with infra-tentorial stroke.

  5. Sulfonylureas Improve Outcome in Patients With Type 2 Diabetes and Acute Ischemic Stroke (United States)

    Kunte, Hagen; Schmidt, Sein; Eliasziw, Michael; del Zoppo, Gregory J.; Simard, J. Marc; Masuhr, Florian; Weih, Markus; Dirnagl, Ulrich


    Background and Purpose The sulfonylurea receptor 1-regulated NCCa-ATP channel is upregulated in rodent models of stroke with block of the channel by the sulfonylurea, glibenclamide (glyburide), significantly reducing mortality, cerebral edema, and infarct volume. We hypothesized that patients with type 2 diabetes mellitus taking sulfonylurea agents both at the time of stroke and during hospitalization would have superior outcomes. Methods We reviewed medical records of patients with diabetes mellitus hospitalized within 24 hours of onset of acute ischemic stroke in the Neurology Clinic, Charité Hospital, Berlin, Germany, during 1994 to 2000. After exclusions, the cohort comprised 33 patients taking a sulfonylurea at admission through discharge (treatment group) and 28 patients not on a sulfonylurea (control group). The primary outcome was a decrease in National Institutes of Health Stroke Scale of 4 points or more from admission to discharge or a discharge National Institutes of Health Stroke Scale score of 0. The secondary outcome was a discharge modified Rankin Scale score ≤2. Results No significant differences, other than stroke subtype, were observed among baseline variables between control and treatment groups. The primary outcome was reached by 36.4% of patients in the treatment group and 7.1% in the control group (P=0.007). The secondary outcome was reached by 81.8% versus 57.1% (P=0.035). Subgroup analyses showed that improvements occurred only in patients with nonlacunar strokes and were independent of gender, previous transient ischemic attack, and blood glucose levels. Conclusion Sulfonylureas may be beneficial for patients with diabetes mellitus with acute ischemic stroke. Further investigation of similar cohorts and a prospective randomized trial are recommended to confirm the present observations. PMID:17673715

  6. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik


    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....

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

    NARCIS (Netherlands)

    Aaronson, J.A.


    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

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

    NARCIS (Netherlands)

    Feigin, V.L.; Krishnamurthi, R.V.; Parmar, P.; Norrving, B.; Mensah, G.A.; Bennett, D.; Barker-Collo, S.; Moran, A.E.; Sacco, R.L.; Truelsen, T.; Davis, S.C.; Pandian, J.D.; Naghavi, M.R.; Forouzanfar, M.H.; Nguyen, G.; Johnson, C.; Vos, T.; Meretoja, A.; Murray, C.J.; Roth, G.A.; Geleijnse, J.M.


    Background: Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are

  9. Lower Your Stroke Risk (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts


    Stroke is among the leading causes of death and disability worldwide. In the U.S., strokes are more common among women. In this podcast, Dr. Erika Odom discusses ways to decrease your chances of having a stroke.  Created: 11/5/2015 by MMWR.   Date Released: 11/5/2015.

  10. Stroke rehabilitation. (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert


    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.

  11. Bone marrow stromal cell therapy for ischemic stroke: A meta-analysis of randomized control animal trials. (United States)

    Wu, Qing; Wang, Yuexiang; Demaerschalk, Bart M; Ghimire, Saruna; Wellik, Kay E; Qu, Wenchun


    Background Results of animal studies assessing efficacy of bone marrow stromal cell therapy for ischemic stroke remain inconsistent. Aims The aims are to assess efficacy of bone marrow stromal cell therapy for ischemic stroke in animal studies. Methods Randomized controlled animal trials assessing efficacy of bone marrow stromal cell therapy were eligible. Stroke therapy academic industry round table was used to assess methodologic quality of included studies. Primary outcomes were total infarction volume and modified Neurological Severity Score. Multiple prespecified sensitivity analyses and subgroup analyses were conducted. Random effects models were used for meta-analysis. Results Thirty-three randomized animal trials were included with a total of 796 animals. The median quality score was 6 (interquartile range, 5-7). Bone marrow stromal cell therapy decreased total infarction volume (standardized mean difference, 0.897; 95% confidence interval, 0.553-1.241; P animals treated with bone marrow stromal cell and controls was 2.47 (95% confidence interval, 1.84-3.11; P animal studies. Conclusions Bone marrow stromal cell therapy significantly decreased total infarction volume and increased neural functional recovery in randomized controlled animal models of ischemic stroke.

  12. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha


    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  13. Evaluation of right ventricular volumes measured by magnetic resonance imaging

    DEFF Research Database (Denmark)

    Møgelvang, J; Stubgaard, M; Thomsen, C


    Right ventricular volumes were determined in 12 patients with different levels of right and left ventricular function by magnetic resonance imaging (MRI) using an ECG gated multisection technique in planes perpendicular to the diastolic position of the interventricular septum. Right ventricular...... stroke volume was calculated as the difference between end-diastolic and end-systolic volume and compared to left ventricular stroke volume and to stroke volume determined simultaneously by a classical indicator dilution technique. There was good agreement between right ventricular stroke volume...... determined by MRI and by the indicator dilution method and between right and left ventricular stroke volume determined by MRI. Thus, MRI gives reliable values not only for left ventricular volumes, but also for right ventricular volumes. By MRI it is possible to obtain volumes from both ventricles...

  14. A modified Glenn shunt reduces right ventricular stroke work during left ventricular assist device therapy. (United States)

    Schiller, Petter; Vikholm, Per; Hellgren, Laila


    Right ventricular (RV) failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) placement and remains hard to predict. We hypothesized that partial surgical exclusion of the RV with a modified Glenn shunt during LVAD treatment would reduce RV stroke work. An LVAD was implanted in eight pigs and a modified Glenn shunt was constructed. A conductance pressure-volume catheter was placed in the right ventricle through the apex. Haemodynamic data and pressure-volume loops were obtained at the following time periods: (i) baseline, (ii) open shunt, (iii) LVAD with closed shunt and (iii) LVAD and open shunt. During LVAD therapy, the right atrial (RA) pressure increased from 9 mmHg (9-9) to 15 mmHg (12-15), P = 0.01. RV stroke volume increased from 30 ml (29-40) to 51 ml (42-53), P < 0.01. Also, RV stroke work increased to 708 mmHg ml (654-1193) from 535 mmHg ml (424-717), P = 0.04, compared with baseline. During LVAD therapy in combination with a Glenn shunt, the RA pressure decreased from 15 mmHg (12-15) to 10 mmHg (7-11) when compared with LVAD therapy only, P = 0.01. A decrease in RV stroke work from 708 mmHg ml (654-1193) to 465 mmHg ml (366-711), P = 0.04, was seen when the LVAD was combined with a shunt, not significantly different from the baseline value (535 mmHg ml). The developed pressure in the right ventricle decreased from 29 mmHg (26-32) to 21 mmHg (20-24), P < 0.01. The pressure-volume loops of the RV show a significant reduction of RV stroke work during the use of the shunt with LVAD treatment. A modified Glenn shunt reduced RV volumes, RV stroke work and RA pressure during LVAD therapy in an experimental model of heart failure in pigs. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Preventing Stroke Deaths (United States)

    ... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...

  16. Two Kinds of Stroke (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  17. Healthy Living after Stroke (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  18. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study. (United States)

    Hoffmann, Sarah; Harms, Hendrik; Ulm, Lena; Nabavi, Darius G; Mackert, Bruno-Marcel; Schmehl, Ingo; Jungehulsing, Gerhard J; Montaner, Joan; Bustamante, Alejandro; Hermans, Marcella; Hamilton, Frank; Göhler, Jos; Malzahn, Uwe; Malsch, Carolin; Heuschmann, Peter U; Meisel, Christian; Meisel, Andreas


    Stroke-associated pneumonia is a frequent complication after stroke associated with poor outcome. Dysphagia is a known risk factor for stroke-associated pneumonia but accumulating evidence suggests that stroke induces an immunodepressive state increasing susceptibility for stroke-associated pneumonia. We aimed to confirm that stroke-induced immunodepression syndrome is associated with stroke-associated pneumonia independently from dysphagia by investigating the predictive properties of monocytic HLA-DR expression as a marker of immunodepression as well as biomarkers for inflammation (interleukin-6) and infection (lipopolysaccharide-binding protein). This was a prospective, multicenter study with 11 study sites in Germany and Spain, including 486 patients with acute ischemic stroke. Daily screening for stroke-associated pneumonia, dysphagia and biomarkers was performed. Frequency of stroke-associated pneumonia was 5.2%. Dysphagia and decreased monocytic HLA-DR were independent predictors for stroke-associated pneumonia in multivariable regression analysis. Proportion of pneumonia ranged between 0.9% in the higher monocytic HLA-DR quartile (≥21,876 mAb/cell) and 8.5% in the lower quartile (≤12,369 mAb/cell). In the presence of dysphagia, proportion of pneumonia increased to 5.9% and 18.8%, respectively. Patients without dysphagia and normal monocytic HLA-DR expression had no stroke-associated pneumonia risk. We demonstrate that dysphagia and stroke-induced immunodepression syndrome are independent risk factors for stroke-associated pneumonia. Screening for immunodepression and dysphagia might be useful for identifying patients at high risk for stroke-associated pneumonia.

  19. Understanding Life After Stroke


    Hjelmblink, Finn


    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...

  20. Difficulty Swallowing After Stroke (Dysphagia) (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, ...

  1. Impact of libido at 2 weeks after stroke on risk of stroke recurrence at 1-year in a chinese stroke cohort study. (United States)

    Li, Jing-Jing; Yuan, Huai-Wu; Wang, Chun-Xue; Luo, Ben-Yan; Ruan, Jie; Zhang, Ning; Shi, Yu-Zhi; Zhou, Yong; Wang, Yi-Long; Zhang, Tong; Zhou, Juan; Zhao, Xing-Quan; Wang, Yong-Jun


    There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year. It is a multi-centered, prospective cohort study. The 14 th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of former neurological functional deficit, new local or overall symptoms, or stroke diagnosed at re-admission. Among 2341 enrolled patients, 1757 patients had completed follow-up data, 533 (30.34%) patients had decreased libido at 2 weeks, and 166 (9.45%) patients had recurrent stroke at 1-year. Multivariate logistic regression analysis showed that, compared with patients with normal libido, the odds ratio (OR) of recurrent stroke in patients with decreased libido was reduced by 41% (OR = 0.59, 95% confidence interval [CI]: 0.40-0.87). The correlation was more prominent among male patients (OR = 0.52, 95% CI: 0.31-0.85) and patients of ≥60 years of age (OR = 0.57, 95% CI: 0.35-0.93). One out of three stroke patients in mainland China has decreased libido at 2 weeks after stroke. Decreased libido is a protective factor for stroke recurrence at 1-year, which is more prominent among older male patients.

  2. Pyramidal neurons of the prefrontal cortex in post-stroke, vascular and other ageing-related dementias. (United States)

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


    dementia ratings. Total estimated neuronal densities were not significantly changed between patients with post-stroke dementia and post-stroke patients with no dementia groups or ageing controls in any of the three frontal regions. In further morphometric analysis of the dorsolateral prefrontal cortex, we showed that neither diffuse cerebral atrophy nor neocortical thickness explained the selective neuronal volume effects. We also noted that neurofilament protein SMI31 immunoreactivity was increased in post-stroke and vascular dementia compared with post-stroke patients with no dementia and correlated with decreased neuronal volumes in subjects with post-stroke dementia and vascular dementia. Our findings suggest selective regional pyramidal cell atrophy in the dorsolateral prefrontal cortex-rather than neuronal density changes per se-are associated with dementia and executive dysfunction in post-stroke dementia and vascular dementia. The changes in dorsolateral prefrontal cortex pyramidal cells were not associated with neurofibrillary pathology suggesting there is a vascular basis for the observed highly selective neuronal atrophy. © The Author (2014). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email:

  3. The cost of pediatric stroke care and rehabilitation. (United States)

    Lo, Warren; Zamel, Khaled; Ponnappa, Kavita; Allen, Antoni; Chisolm, Deena; Tang, Monica; Kerlin, Bryce; Yeates, Keith O


    There is little data regarding the cost of pediatric stroke care or the elements that contribute to these costs. We examined costs for poststroke care during the first year after diagnosis and compared these costs with the volume of the cerebral infarct and the level of neurological and functional outcome. We identified 39 children who sustained nontraumatic ischemic or hemorrhagic strokes and confirmed the diagnoses by review of medical and radiology records. Medical costs were tabulated for the year after the diagnosis of stroke. Cerebral infarct volumes were measured from MRI or CT scans. Neurological outcome was assessed by telephone with a modification of the Pediatric Stroke Outcome Measure (PSOM), and functional outcomes were assessed with a standardized quality-of-life measure. The median cost for poststroke care during the year after diagnosis was $42,338 for the entire group. The cost for stroke care was higher for hemorrhagic stroke than for ischemic stroke. Cost had a significant positive correlation with neurological impairment. The modified PSOM score positively correlated with impairments of physical, emotional, social, and school function. The cost of stroke care may be one measure of stroke severity, with more extensive strokes resulting in greater medical costs. In addition, stroke appears to impair children's social ability along with their neurological function.

  4. Can a central blood volume deficit be detected by systolic pressure variation during spontaneous breathing?

    DEFF Research Database (Denmark)

    Dahl, Michael; Hayes, Chris; Steen Rasmussen, Bodil


    BACKGROUND: Whether during spontaneous breathing arterial pressure variations (APV) can detect a volume deficit is not established. We hypothesized that amplification of intra-thoracic pressure oscillations by breathing through resistors would enhance APV to allow identification of a reduced...... resistors. A brachial arterial catheter was used to measure blood pressure and thus systolic pressure variation (SPV), pulse pressure variation and stroke volume variation . Pulse contour analysis determined stroke volume (SV) and CO and we evaluated whether APV could detect a 10 % decrease in CO. RESULTS...... (from 21 (±15)% to 30 (±13)%). Yet during head-up tilt, a SPV ≥ 37 % predicted a decrease in CO ≥ 10 % with a sensitivity and specificity of 78 % and 100 %, respectively. CONCLUSION: In spontaneously breathing healthy volunteers combined inspiratory and expiratory resistors enhance SPV during head...

  5. The loss-of-function disease-mutation G301R in the Na+/K+-ATPase α2 isoform decreases lesion volume and improves functional outcome after acute spinal cord injury in mice. (United States)

    Ellman, Ditte Gry; Isaksen, Toke Jost; Lund, Minna Christiansen; Dursun, Safinaz; Wirenfeldt, Martin; Jørgensen, Louise Helskov; Lykke-Hartmann, Karin; Lambertsen, Kate Lykke


    The Na + /K + -ATPases are transmembrane ion pumps important for maintenance of ion gradients across the plasma membrane that serve to support multiple cellular functions, such as membrane potentials, regulation of cellular volume and pH, and co-transport of signaling transmitters in all animal cells. The α 2 Na + /K + -ATPase subunit isoform is predominantly expressed in astrocytes, which us the sharp Na + -gradient maintained by the sodium pump necessary for astroglial metabolism. Prolonged ischemia induces an elevation of [Na + ] i , decreased ATP levels and intracellular pH owing to anaerobic metabolism and lactate accumulation. During ischemia, Na + /K + -ATPase-related functions will naturally increase the energy demand of the Na + /K + -ATPase ion pump. However, the role of the α 2 Na + /K + -ATPase in contusion injury to the spinal cord remains unknown. We used mice heterozygous mice for the loss-of-function disease-mutation G301R in the Atp1a2 gene (α 2 +/G301R ) to study the effect of reduced α 2 Na + /K + -ATPase expression in a moderate contusion spinal cord injury (SCI) model. We found that α 2 +/G301R mice display significantly improved functional recovery and decreased lesion volume compared to littermate controls (α 2 +/+ ) 7 days after SCI. The protein level of the α 1 isoform was significantly increased, in contrast to the α 3 isoform that significantly decreased 3 days after SCI in both α 2 +/G301R and α 2 +/+ mice. The level of the α 2 isoform was significantly decreased in α 2 +/G301R mice both under naïve conditions and 3 days after SCI compared to α 2 +/+ mice. We found no differences in astroglial aquaporin 4 levels and no changes in the expression of chemokines (CCL2, CCL5 and CXCL1) and cytokines (TNF, IL-6, IL-1β, IL-10 and IL-5) between genotypes, just as no apparent differences were observed in location and activation of CD45 and F4/80 positive microglia and infiltrating leukocytes. Our proof of concept study

  6. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D


    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  7. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

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


    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  8. Stroke: First Aid (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. Ischemic Stroke Profile, Risk Factors, and Outcomes in India: The Indo-US Collaborative Stroke Project. (United States)

    Sylaja, P N; Pandian, Jeyaraj Durai; Kaul, Subhash; Srivastava, M V Padma; Khurana, Dheeraj; Schwamm, Lee H; Kesav, Praveen; Arora, Deepti; Pannu, Aman; Thankachan, Tijy K; Singhal, Aneesh B


    The Indo-US Collaborative Stroke Project was designed to characterize ischemic stroke across 5 high-volume academic tertiary hospitals in India. From January 2012 to August 2014, research coordinators and physician coinvestigators prospectively collected data on 2066 patients with ischemic stroke admitted Stroke Scale score was 10 (interquartile range, 5-15) and 24.5% had National Institutes of Health Stroke Scale ≥16. Hypertension (60.8%), diabetes mellitus (35.7%), and tobacco use (32.2%, including bidi/smokeless tobacco) were common risk factors. Only 4% had atrial fibrillation. All patients underwent computed tomography or magnetic resonance imaging; 81% had cerebrovascular imaging. Stroke etiologic subtypes were large artery (29.9%), cardiac (24.9%), small artery (14.2%), other definite (3.4%), and undetermined (27.6%, including 6.7% with incomplete evaluation). Intravenous or intra-arterial thrombolysis was administered in 13%. In-hospital mortality was 7.9%, and 48% achieved modified Rankin Scale score 0 to 2 at 90 days. On multivariate analysis, diabetes mellitus predicted poor 3-month outcome and younger age, lower admission National Institutes of Health Stroke Scale and small-artery etiology predicted excellent 3-month outcome. These comprehensive and novel clinical imaging data will prove useful in refining stroke guidelines and advancing stroke care in India. © 2017 American Heart Association, Inc.

  10. Adapting the Home After a Stroke (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  11. Large Animal Stroke Models vs. Rodent Stroke Models, Pros and Cons, and Combination? (United States)

    Cai, Bin; Wang, Ning


    Stroke is a leading cause of serious long-term disability worldwide and the second leading cause of death in many countries. Long-time attempts to salvage dying neurons via various neuroprotective agents have failed in stroke translational research, owing in part to the huge gap between animal stroke models and stroke patients, which also suggests that rodent models have limited predictive value and that alternate large animal models are likely to become important in future translational research. The genetic background, physiological characteristics, behavioral characteristics, and brain structure of large animals, especially nonhuman primates, are analogous to humans, and resemble humans in stroke. Moreover, relatively new regional imaging techniques, measurements of regional cerebral blood flow, and sophisticated physiological monitoring can be more easily performed on the same animal at multiple time points. As a result, we can use large animal stroke models to decrease the gap and promote translation of basic science stroke research. At the same time, we should not neglect the disadvantages of the large animal stroke model such as the significant expense and ethical considerations, which can be overcome by rodent models. Rodents should be selected as stroke models for initial testing and primates or cats are desirable as a second species, which was recommended by the Stroke Therapy Academic Industry Roundtable (STAIR) group in 2009.

  12. Exacerbation of Brain Injury by Post-Stroke Exercise Is Contingent Upon Exercise Initiation Timing

    Directory of Open Access Journals (Sweden)

    Fengwu Li


    Full Text Available Accumulating evidence has demonstrated that post-stroke physical rehabilitation may reduce morbidity. The effectiveness of post-stroke exercise, however, appears to be contingent upon exercise initiation. This study assessed the hypothesis that very early exercise exacerbates brain injury, induces reactive oxygen species (ROS generation, and promotes energy failure. A total of 230 adult male Sprague-Dawley rats were subjected to middle cerebral artery (MCA occlusion for 2 h, and randomized into eight groups, including two sham injury control groups, three non-exercise and three exercise groups. Exercise was initiated after 6 h, 24 h and 3 days of reperfusion. Twenty-four hours after completion of exercise (and at corresponding time points in non-exercise controls, infarct volumes and apoptotic cell death were examined. Early brain oxidative metabolism was quantified by examining ROS, ATP and NADH levels 0.5 h after completion of exercise. Furthermore, protein expressions of angiogenic growth factors were measured in order to determine whether post-stroke angiogenesis played a role in rehabilitation. As expected, ischemic stroke resulted in brain infarction, apoptotic cell death and ROS generation, and diminished NADH and ATP production. Infarct volumes and apoptotic cell death were enhanced (p < 0.05 by exercise that was initiated after 6 h of reperfusion, but decreased by late exercise (24 h, 3 days. This exacerbated brain injury at 6 h was associated with increased ROS levels (p < 0.05, and decreased (p < 0.05 NADH and ATP levels. In conclusion, very early exercise aggravated brain damage, and early exercise-induced energy failure with ROS generation may underlie the exacerbation of brain injury. These results shed light on the manner in which exercise initiation timing may affect post-stroke rehabilitation.

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

    Directory of Open Access Journals (Sweden)

    Caplan Louis


    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


    Directory of Open Access Journals (Sweden)

    Kumbha Thulasi Ram


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


    Directory of Open Access Journals (Sweden)

    S. Gopi


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

  16. Conditional ablation of myeloid TNF increases lesion volume after experimental stroke in mice, possibly via altered ERK1/2 signaling

    DEFF Research Database (Denmark)

    Clausen, Bettina Hjelm; Degn, Matilda; Sivasaravanaparan, Mithula


    Microglia are activated following cerebral ischemia and increase their production of the neuro- and immunomodulatory cytokine tumor necrosis factor (TNF). To address the function of TNF from this cellular source in focal cerebral ischemia we used TNF conditional knock out mice (LysMcreTNF(fl/fl))......Microglia are activated following cerebral ischemia and increase their production of the neuro- and immunomodulatory cytokine tumor necrosis factor (TNF). To address the function of TNF from this cellular source in focal cerebral ischemia we used TNF conditional knock out mice (Lys......McreTNF(fl/fl)) in which the TNF gene was deleted in cells of the myeloid lineage, including microglia. The deletion reduced secreted TNF levels in lipopolysaccharide-stimulated cultured primary microglia by ~93%. Furthermore, phosphorylated-ERK/ERK ratios were significantly decreased in naïve LysMcreTNF(fl/fl) mice...... compared to littermates (TNFfl/fl). In naïve LysMcreTNF(fl/fl) mice cytokine levels were low and comparable to littermates. At 6 hours, TNF producing microglia were reduced by 56% in the ischemic cortex in LysMcreTNF(fl/fl) mice compared to littermate mice, whereas no TNF(+) leukocytes were detected. At 24...

  17. Decreased endogenous progesterone and ratio of progesterone to ...

    African Journals Online (AJOL)

    Progesterone and estrogen are two steroid hormones whose exposure may decrease the risk and delay the onset of ischemic stroke. The main objective of this study was to determine the plasma level of progesterone, estrogen and ratio of progesterone/estrogen in ischemic stroke patients. The plasma levels of ...

  18. Airplane stroke syndrome. (United States)

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


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

  19. Association between arterial calcifications and nonlacunar and lacunar ischemic strokes. (United States)

    van Dijk, Anouk C; Fonville, Susanne; Zadi, Taihra; van Hattem, Antonius M G; Saiedie, Ghesrouw; Koudstaal, Peter J; van der Lugt, Aad


    Nonlacunar cerebral infarcts are presumed to be caused by thromboembolism from the heart or extracranial arteries, whereas lacunar infarcts are thought to be caused by small vessel disease. We investigated to what extent arterial calcifications differ between nonlacunar and lacunar ischemic strokes. We studied 820 consecutive patients with transient ischemic attack or ischemic stroke in the anterior circulation who underwent multidetector computed tomography angiography and had no rare cause of stroke. The presence of likely cardioembolic pathogenesis was determined according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The remaining 708 patients were categorized as nonlacunar or lacunar strokes, either transient ischemic attacks or strokes, based on clinical symptoms corrected by brain imaging results. We measured volume of calcifications in the aortic arch, symptomatic extracranial and intracranial carotid artery using multidetector computed tomography angiography. The difference in calcifications between nonlacunar and lacunar strokes was assessed with a multivariable logistic regression analysis. We adjusted for degree of symptomatic carotid artery stenosis and cardiovascular risk factors. We found an independent association between volume of aortic arch calcifications and nonlacunar ischemic strokes (adjusted odds ratio [95% confidence interval], 1.11 [1.02-1.21]). No independent associations between extracranial and intracranial carotid artery calcifications and nonlacunar strokes were present. The only difference we found between nonlacunar and lacunar strokes was a higher calcification volume in the aortic arch in nonlacunar strokes. Our findings only partially confirm the notion of distinct etiologies and suggest that the potential role of other plaque components, plaque morphology, and aortic arch calcifications in ischemic stroke subtypes awaits further evaluation.

  20. Cerebroprotective Effect of Moringa oleifera against Focal Ischemic Stroke Induced by Middle Cerebral Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Woranan Kirisattayakul


    Full Text Available The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg−1 was orally given to male Wistar rats (300–350 g once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration.

  1. Aspirin resistant patients with recent ischemic stroke. (United States)

    Castilla-Guerra, L; Navas-Alcántara, M S; Fernández-Moreno, M C


    Some patients with a recent ischemic stroke who are being treated with aspirin as an antiaggregant suffer a new ischemic stroke. These patients (15-25%) have been called unresponsive to aspirin or aspirin resistant. The aspirin-resistant patients have a four-time greater risk of suffering a stroke. Furthermore, these strokes are generally more severe, with increased infarct volume and greater risk of recurrence. There is currently no ideal laboratory test to detect the resistance to the antiaggregant effect of aspirin. The study of resistance to aspirin would only be indicated in selected cases. In these patients, one should first rule out any "pseudo-resistance" to aspirin (lack of compliance, concomitant treatments that interfere with the action of the aspirin). Copyright © 2013 Elsevier España, S.L. All rights reserved.

  2. Impact of the Swedish National Stroke Campaign on stroke awareness. (United States)

    Nordanstig, A; Asplund, K; Norrving, B; Wahlgren, N; Wester, P; Rosengren, L


    Time delay from stroke onset to arrival in hospital is an important obstacle to widespread reperfusion therapy. To increase knowledge about stroke, and potentially decrease this delay, a 27-month national public information campaign was carried out in Sweden. To assess the effects of a national stroke campaign in Sweden. The variables used to measure campaign effects were knowledge of the AKUT test [a Swedish equivalent of the FAST (Face-Arm-Speech-Time)] test and intent to call 112 (emergency telephone number) . Telephone interviews were carried out with 1500 randomly selected people in Sweden at eight points in time: before, three times during, immediately after, and nine, 13 and 21 months after the campaign. Before the campaign, 4% could recall the meaning of some or all keywords in the AKUT test, compared with 23% during and directly after the campaign, and 14% 21 months later. Corresponding figures were 15%, 51%, and 50% for those remembering the term AKUT and 65%, 76%, and 73% for intent to call 112 when observing or experiencing stroke symptoms. During the course of the campaign, improvement of stroke knowledge was similar among men and women, but the absolute level of knowledge for both items was higher for women at all time points. The nationwide campaign substantially increased knowledge about the AKUT test and intention to call 112 when experiencing or observing stroke symptoms, but knowledge declined post-intervention. Repeated public information therefore appears essential to sustain knowledge gains. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Risks for Heart Disease & Stroke (United States)

    ... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...

  4. Renal Function Predicts Outcomes in Patients with Ischaemic Stroke and Haemorrhagic Stroke. (United States)

    Snarska, Katarzyna; Kapica-Topczewska, Katarzyna; Bachórzewska-Gajewska, Hanna; Małyszko, Jolanta


    We evaluated renal function and the impact of renal function on in-hospital outcomes in patients with ischaemic and haemorrhagic stroke. We collected data from 766 patients with stroke; 637 (83.2 %) with ischaemic and 129 with haemorrhagic one. The mean serum creatinine on admission in patients with both types of stroke, who died, was significantly higher than in those who survived. Multivariate analysis showed that independent predictors of mortality in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital mortality among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke. © 2016 The Author(s) Published by S. Karger AG, Basel.

  5. Age and ethnic disparities in incidence of stroke over time: the South London Stroke Register. (United States)

    Wang, Yanzhong; Rudd, Anthony G; Wolfe, Charles D A


    Data on continuous monitoring of stroke risk among different age and ethnic groups are lacking. We aimed to investigate age and ethnic disparities in stroke incidence over time from an inner-city population-based stroke register. Trends in stroke incidence and before-stroke risk factors were investigated with the South London Stroke Register, a population-based register covering a multiethnic population of 357 308 inhabitants. Age-, ethnicity-, and sex-specific incidence rates with 95% confidence intervals were calculated, assuming a Poisson distribution and their trends over time tested by the Cochran-Armitage test. Four thousand two hundred forty-five patients with first-ever stroke were registered between 1995 and 2010. Total stroke incidence reduced by 39.5% during the 16-year period from 247 to 149.5 per 100 000 population (Pstroke incidence were observed in men, women, white groups, and those aged>45 years, but not in those aged 15 to 44 years (12.6-10.1; P=0.2034) and black groups (310.1-267.5; P=0.3633). The mean age at stroke decreased significantly from 71.7 to 69.6 years (P=0.0001). The reduction in prevalence of before-stroke risk factors was mostly seen in white patients aged>55 years, whereas an increase in diabetes mellitus was observed in younger black patients aged 15 to 54 years. Total stroke incidence decreased during the 16-year time period. However, this was not seen in younger age groups and black groups. The advances in risk factor reduction observed in white groups aged>55 years failed to be transferred to younger age groups and black groups.

  6. Neural Basis of Acquired Amusia and Its Recovery after Stroke. (United States)

    Sihvonen, Aleksi J; Ripollés, Pablo; Leo, Vera; Rodríguez-Fornells, Antoni; Soinila, Seppo; Särkämö, Teppo


    Although acquired amusia is a relatively common disorder after stroke, its precise neuroanatomical basis is still unknown. To evaluate which brain regions form the neural substrate for acquired amusia and its recovery, we performed a voxel-based lesion-symptom mapping (VLSM) and morphometry (VBM) study with 77 human stroke subjects. Structural MRIs were acquired at acute and 6 month poststroke stages. Amusia and aphasia were behaviorally assessed at acute and 3 month poststroke stages using the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA) and language tests. VLSM analyses indicated that amusia was associated with a lesion area comprising the superior temporal gyrus, Heschl's gyrus, insula, and striatum in the right hemisphere, clearly different from the lesion pattern associated with aphasia. Parametric analyses of MBEA Pitch and Rhythm scores showed extensive lesion overlap in the right striatum, as well as in the right Heschl's gyrus and superior temporal gyrus. Lesions associated with Rhythm scores extended more superiorly and posterolaterally. VBM analysis of volume changes from the acute to the 6 month stage showed a clear decrease in gray matter volume in the right superior and middle temporal gyri in nonrecovered amusic patients compared with nonamusic patients. This increased atrophy was more evident in anterior temporal areas in rhythm amusia and in posterior temporal and temporoparietal areas in pitch amusia. Overall, the results implicate right temporal and subcortical regions as the crucial neural substrate for acquired amusia and highlight the importance of different temporal lobe regions for the recovery of amusia after stroke. Lesion studies are essential in uncovering the brain regions causally linked to a given behavior or skill. For music perception ability, previous lesion studies of amusia have been methodologically limited in both spatial accuracy and time domain as well as by small sample sizes, providing

  7. The early predictive value of a decrease of metabolic tumor volume in repeated {sup 18}F-FDG PET/CT for recurrence of locally advanced non-small cell lung cancer with concurrent radiochemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Wei, E-mail: [Department of Radiation Oncology (Chest Section), Shandong' s Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan 250117 (China); Liu, Bo; Fan, Min [Department of Internal Medicine Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan (China); Zhou, Tao [Department of Radiation Oncology (Chest Section), Shandong' s Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan 250117 (China); Fu, Zheng [PET/CT center, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan (China); Zhang, Zicheng; Li, Hongsheng [Department of Radiation Oncology (Chest Section), Shandong' s Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan 250117 (China); Li, Baosheng, E-mail: [Department of Radiation Oncology (Chest Section), Shandong' s Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan 250117 (China)


    Highlights: •The patients underwent the second FDG PET during the early stage of concurrent chemoradiotherapy (CCRT). •To our knowledge, this could be the first study showing that the repeated FDG PET during the early stage of CCRT has added value by being a prognostic factor for recurrence of the locally advanced NSCLC patients. •This is a result of continuous research. •The decrease of MTV was the only significant risk factor for recurrence. -- Abstract: Purpose: The aim of this study is to investigate the value of [{sup 18}F] fluorodeoxyglucose positron emission tomography/computed tomography ({sup 18}F FDG PET/CT) to predict recurrence of patients with locally advanced non-small cell lung cancer (NSCLC) during the early stage of concurrent chemoradiotherapy (CCRT). Methods: A total of 53 stage III NSCLC patients without diabetics or undergoing surgery were enrolled in the prospective study. Those patients were evaluated by FDG PET before and following 40 Gy radiotherapy (RT) with a concurrent cisplatin-based heterogeneous chemotherapy regimen. Semiquantitative assessment was used to determine maximum and mean SUVs (SUVmax/SUVmean) and metabolic tumor volume (MTV) of the primary tumor. The prognostic significance of PET/CT parameters and other clinical variables was assessed using Cox regression analyses. The cutoffs of PET/CT parameters which have been determined by the previous study were used to separate the groups with Kaplan–Meier curves. Results: Recurrence rates at 1- and 2-years were 18.9% (10/53) and 50.9% (27/53) for all patients, respectively. Cox regression analysis showed that the only prognostic factor for recurrence was a decrease of MTV. Using the cutoff of 29.7%, a decrease of MTV can separate the patients into 2 groups with Kaplan–Meier curve successfully. Conclusion: The prospective study has reinforced the early predictive value of MTV in repeated {sup 18}F-FDG PET/CT for recurrence in a subgroup of locally advanced NSCLC who

  8. Fluid management guided by stroke volume variation failed to decrease the incidence of acute kidney injury, 30-day mortality, and 1-year survival in living donor liver transplant recipients

    Directory of Open Access Journals (Sweden)

    Shen-Chih Wang


    Conclusion: The outcomes of living donor liver transplant patients who had fluid therapy guided by an SVV less than 10% were similar to those of patients who were given fluids to reach a CVP of 10 mmHg. Our findings suggest that the two measures of vascular filling are similar in liver transplant recipients with demographic characteristics similar to those of our patients.

  9. Epidemiology and in-hospital outcome of stroke in South Ethiopia. (United States)

    Deresse, Birrie; Shaweno, Debebe


    Although the burden of stroke in Sub-Saharan Africa, including Ethiopia, is increasing, there are few available data on stroke in Ethiopia. To describe the magnitude of risk factors, sub-types and in-hospital outcome of stroke at Hawassa University Referral Hospital, Ethiopia. A prospective hospital-based study was conducted with all adult patients admitted to Hawassa University Referral Hospital with stroke diagnosis between May 2013 and April 2014. Computerized tomography scan was performed in all patients to confirm the type of stroke. Stroke severity at admission was assessed by the National Institute of Health Stroke Scale. Stroke outcome at discharge was measured using the modified Rankin stroke scale. A total of 163 stroke patients were recruited during the study period, of which 82 (50.3%) patients had ischemic stroke while 81 (49.7%) had hemorrhagic stroke. Stroke risk factors included hypertension (50.9%), cardiac diseases (16.6%), diabetes mellitus (7.4%), alcohol (10.4%), cigarette smoking (4.9%) and tuberculous meningitis (3.1%). In-hospital stroke mortality was 14.7%. The main predictors of in-hospital stroke mortality were stroke severity at admission, hemorrhagic stroke, decreased level of consciousness and seizure. The proportion of hemorrhagic stroke is higher than in Western countries. Hypertension is the most common risk factor for stroke. More than half of the patients were discharged with severe disability. We recommend establishing stroke units in resource limited countries like Ethiopia in order to reduce stroke mortality and post stroke disability. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. The role of neuroendocrine pathways in prognosis after stroke. (United States)

    El Husseini, Nada; Laskowitz, Daniel T


    A number of neuroendocrine changes have been described after stroke, which may serve adaptive or deleterious functions. The neuroendocrine changes include activation of the hypothalamo-pituitary-adrenal axis, sympathetic nervous system and alterations of several hormonal levels. Alterations of the HPA axis, increased catecholamines, natriuretic peptides and, decreased melatonin and IGF-1 levels are associated with poor post-stroke outcome, although there is no definitive proof of causality. Therefore, it remains to be established whether alteration of neuroendocrine responses could be used as a potential therapeutic target to improve stroke outcome. This article gives an overview of the major neuroendocrine pathways altered by stroke and highlights their potential for clinical use and further neurotherapeutic development by summarizing the evidence for their association with stroke outcome including functional outcome, post-stroke infection, delirium, depression and stroke-related myocardial injury.

  11. Test Your Stroke Knowledge (United States)

    ... 9-1-1. Which of the following are risk factors for stroke? High blood pressure Heart disease Smoking High cholesterol Diabetes Show Answer All of these are risk factors for stroke. If you smoke - quit. If you have high ...

  12. Heart and Stroke Encyclopedia (United States)

    ... Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a brief ... of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. A ...

  13. Stroke Connection Magazine (United States)

    ... Resources Submit A Story Edit Module Show Tags Stroke Rehabilitation Two-Part Series Making the Best Decisions at ... first part of a two-part series on stroke rehab, we offer guidance for the decision-making process ...

  14. Stroke (For Kids) (United States)

    ... your friend. Being around friends can help with healing. Preventing Strokes Some strokes can be prevented in ... Why Does Hair Turn Gray? What Are Wrinkles? Alzheimer Disease Your Brain & Nervous System Why Exercise Is ...

  15. Stroke Trials Registry (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  16. Nursing care for stroke patients: A survey of current practice in 11 European countries. (United States)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin; Jönsson, Ann-Cathrin


    To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies 2006 and to examine to what extent the European Stroke Strategies have been implemented in stroke care nursing in Europe. Stroke is a leading cause of death and disability globally. Optimal organisation of interdisciplinary stroke care is expected to ameliorate outcome after stroke. Consequently, universal access to stroke care based on evidence-based guidelines is a priority. This study is a descriptive cross-sectional survey. A questionnaire comprising 61 questions based on the European Stroke Strategies and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: organisation of stroke services, management of acute stroke and prevention including basic care and nursing, and secondary prevention. Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hr after stroke onset, 95% monitor patients regularly, 94% start mobilisation after 24 hr when patients are stable, and 89% assess patients' ability to swallow. Change of position for immobile patients is followed by 73%, and postvoid residual urine volume is measured by 85%. Some aspects needed improvement, for example, staff education (70%), education for patients/families/carers (55%) and individual care plans in secondary prevention (62%). The participating European countries comply well with the European Stroke Strategies guidelines, particularly in the acute stroke care, but not all stroke units have reached optimal development in all aspects of stroke care nursing. Our study may provide clinical administrators and nurses in stroke care with information that may contribute to improved compliance with the European Stroke Strategies and evidence

  17. [Genetics of ischemic stroke]. (United States)

    Gschwendtner, A; Dichgans, M


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

  18. Hemorrhagic Stroke in Children


    Jordan M.D., Lori C.; Hillis M.D., Argye E.


    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 ...

  19. Experiences of Sexuality Six Years After Stroke: A Qualitative Study. (United States)

    Nilsson, Marie I; Fugl-Meyer, Kerstin; von Koch, Lena; Ytterberg, Charlotte


    Little is known about the long-term consequences of stroke on sexuality, and studies on how individuals with stroke communicate with health care professionals about information and/or interventions on sexuality are even sparser. To explore experiences of sexuality 6 years after stroke, including communication with health care professionals concerning sexuality. This qualitative study was based on data collected by semistructured interviews with 12 informants 43 to 81 years old 6 years after stroke. Interviews were recorded and transcribed verbatim and thematic analysis was performed. The analysis resulted in the following three themes. Not exclusively negative experiences in sexuality after stroke: Most informants experienced some change in their sexual life from before their stroke. Decreased sexual interest and function were ascribed to decreased sensibility, post-stroke pain, or fatigue. Some informants reported positive changes in sexuality, which were attributed to feelings of increased intimacy. Individual differences and variability on how to handle sexuality after stroke: Different strategies were used to manage unwanted negative changes such as actively trying to adapt by planning time with the partner and decreasing pressure or stress. Open communication about sexuality with one's partner also was described as important. Strikingly, most informants with negative experiences of sexual life attributed these to age or a stage in life and not to the stroke or health issues. Furthermore, they compared themselves with others without stroke but with changes in sexuality, thus achieving a sense of normality. Communication and counseling concerning sexuality-many unmet needs: Experiences of communication with health care professionals varied. Very few informants had received any information or discussed sexuality with health care professionals during the 6 years since the stroke, although such needs were identified by most informants. When encountering individuals

  20. Ischemic stroke destabilizes circadian rhythms

    Directory of Open Access Journals (Sweden)

    Borjigin Jimo


    Full Text Available Abstract Background The central circadian pacemaker is a remarkably robust regulator of daily rhythmic variations of cardiovascular, endocrine, and neural physiology. Environmental lighting conditions are powerful modulators of circadian rhythms, but regulation of circadian rhythms by disease states is less clear. Here, we examine the effect of ischemic stroke on circadian rhythms in rats using high-resolution pineal microdialysis. Methods Rats were housed in LD 12:12 h conditions and monitored by pineal microdialysis to determine baseline melatonin timing profiles. After demonstration that the circadian expression of melatonin was at steady state, rats were subjected to experimental stroke using two-hour intralumenal filament occlusion of the middle cerebral artery. The animals were returned to their cages, and melatonin monitoring was resumed. The timing of onset, offset, and duration of melatonin secretion were calculated before and after stroke to determine changes in circadian rhythms of melatonin secretion. At the end of the monitoring period, brains were analyzed to determine infarct volume. Results Rats demonstrated immediate shifts in melatonin timing after stroke. We observed a broad range of perturbations in melatonin timing in subsequent days, with rats exhibiting onset/offset patterns which included: advance/advance, advance/delay, delay/advance, and delay/delay. Melatonin rhythms displayed prolonged instability several days after stroke, with a majority of rats showing a day-to-day alternation between advance and delay in melatonin onset and duration. Duration of melatonin secretion changed in response to stroke, and this change was strongly determined by the shift in melatonin onset time. There was no correlation between infarct size and the direction or amplitude of melatonin phase shifting. Conclusion This is the first demonstration that stroke induces immediate changes in the timing of pineal melatonin secretion, indicating


    Directory of Open Access Journals (Sweden)

    E. V. Konstantinova


    Full Text Available Myocardial infarction and ischemic stroke remain to be of the greatest medical and social importance because of their high prevalence, disability, and mortality rates. Intractable thrombotic occlusion of the respective artery leads to the formation of an ischemic lesion focus in the tissue of the heart or brain. Emergency reperfusion serves to decrease a necrotic focus, makes its formation reversible, and reduces patient death rates. The paper considers main reperfusion therapy lines: medical (with thrombolytic drugs and mechanical (with primary interventions one and their combination in treating patients with acute myocardial and cerebral ischemia. Each reperfusion procedure is discussed in view of its advantages, disadvantages, available guidelines, and possibilities of real clinical practice. Tenecteplase is assessed in terms of its efficacy, safety, and capacities for bolus administration, which allows its use at any hospital and at the pre-hospital stage. Prehospital thrombolysis permits reperfusion therapy to bring much closer to the patient and therefore aids in reducing time to reperfusion and in salvaging as much the myocardial volume as possible. The rapidest recovery of myocardial and cerebral perfusion results in a decreased necrotic area and both improved immediate and late prognosis. The results of randomized clinical trials studying the possibilities of the medical and mechanical methods to restore blood flow are analyzed in the context of evidence-based medicine. The reason why despite the available contraindications, limited efficiency, and the risk of hemorrhagic complications, thrombolytic therapy remains the method of choice for prehospital reperfusion, an alternative to primary percutaneous coronary intervention (PCI if it cannot be carried out in patients with myocardial infarction at the stated time, and the only treatment ischemic stroke treatment that has proven its efficiency and safety in clinical trials is under

  2. Sleep deprivation before stroke is neuroprotective: a pre-ischemic conditioning related to sleep rebound. (United States)

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


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

  3. Propensity of Withania somnifera to Attenuate Behavioural, Biochemical, and Histological Alterations in Experimental Model of Stroke. (United States)

    Sood, Abhilasha; Kumar, Aditya; Dhawan, Devinder K; Sandhir, Rajat


    The present study was designed to evaluate the beneficial effects of Withania somnifera (WS) pre-supplementation on middle cerebral artery occlusion (MCAO) model of ischemic stroke. Ischemic stroke was induced in the rats by inserting intraluminal suture for 90 min, followed by reperfusion injury for 24 h. The animals were assessed for locomotor functions (by neurological deficit scores, narrow beam walk and rotarod test), cognitive and anxiety-like behavioural functions (by morris water maze and elevated plus maze test). MCAO animals showed significant impairment in locomotor and cognitive functions. Neurobehavioural changes were accompanied by decreased acetylcholinesterase activity, increased oxidative stress in terms of enhanced lipid peroxidation and lowered thiol levels in the MCAO animals. In addition, MCAO animals had cerebral infarcts and the presence of pycnotic nuclei. Single-photon emission computerized tomography (SPECT) of MCAO animals revealed a cerebral infarct as a hypoactive area. On the other hand, pre-supplementation with WS (300 mg/kg body weight) for 30 days to MCAO animals was effective in restoring the acetylcholinesterase activity, lipid peroxidation, thiols and attenuated MCAO induced behavioural deficits. WS significantly reduced the cerebral infarct volume and ameliorated histopathological alterations. Improved blood flow was observed in the SPECT images from the brain regions of ischemic rats pre-treated with WS. The results of the study showed a protective effect of WS supplementation in ischemic stroke and are suggestive of its potential application in stroke management.

  4. A review of post-stroke urinary incontinence. (United States)

    Tuong, Nicole E; Klausner, Adam P; Hampton, Lance J


    Cerebrovascular accidents, or strokes, are a common cause of morbidity and mortality in the United States. Urinary incontinence is a prevalent morbidity experienced by post-stroke patients that is associated with long term disability and institutionalization effects on these patients. An extensive literature review was conducted using multiple academic search engines using the keywords: 'stroke,' 'CVA,' 'urinary incontinence,' 'urodynamics,' 'pharmacologic treatments,' and 'conservative treatments.' Articles were reviewed and summarized to explain incidence, assessment, and treatments of urinary incontinence in post-stroke individuals. Twenty-eight percent to seventy-nine percent of stroke survivors experience urinary incontinence with detrusor overactivity being the most common type of incontinence assessed by urodynamic studies. There continues to be insufficient data studying the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients. Similarly, urinary incontinence remains an indicator of increased morbidity, disability, and institutionalization rates in the post-stroke patient. Stroke is a debilitating disease which causes urinary incontinence in many patients. As a result, patients have increased rates of hospitalization and disability compared to post-stroke patients without urinary incontinence. The history and physical exam are key in diagnosing the type of urinary incontinence with urodynamic studies being an adjunctive study. Non-pharmacologic treatment, such as behavioral therapy, and pharmacologic agents including antimuscarinics and beta adrenergic medications, are not well studied in the post-stroke patient. Urinary incontinence in stroke patients needs to be further studied to help decrease morbidity and mortality rates within this population.

  5. [Post-stroke apathy]. (United States)

    López-Dóriga Bonnardeaux, Pedro; Andrino Díaz, Nuria


    Apathy is a motivational disturbance that can be defined as a quantitative reduction of goal-directed behaviour. Patients present with loss of motivation, concern, interest, and emotional response, resulting in a loss of initiative, decreased interaction with their environment, and a reduced interest in social life. Apathy not only appears to be common in stroke patients, but it has also been related to a wide range of negative consequences for the patients and their caregivers, including poor functional recovery, loss of social independence, and caregiver distress. Clear definition and consensus diagnostic criteria for apathy are needed to accomplish an accurate assessment and an individualised treatment plan. Although there have been reports of successful behavioural therapy treatment of apathetic states, there is a paucity of controlled clinical trials on the efficacy of apathetic behaviours using pharmacotherapy. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  6. Chromium supplementation improved post-stroke brain infarction and hyperglycemia. (United States)

    Chen, Wen-Ying; Mao, Frank Chiahung; Liu, Chia-Hsin; Kuan, Yu-Hsiang; Lai, Nai-Wei; Wu, Chih-Cheng; Chen, Chun-Jung


    Hyperglycemia is common after acute stroke and is associated with a worse outcome of stroke. Thus, a better understanding of stress hyperglycemia is helpful to the prevention and therapeutic treatment of stroke. Chromium is an essential nutrient required for optimal insulin activity and normal carbohydrate and lipid metabolism. Beyond its nutritional effects, dietary supplement of chromium causes beneficial outcomes against several diseases, in particular diabetes-associated complications. In this study, we investigated whether post-stroke hyperglycemia involved chromium dynamic mobilization in a rat model of permanent focal cerebral ischemia and whether dietary supplement of chromium improved post-stroke injury and alterations. Stroke rats developed brain infarction, hyperglycemia, hyperinsulinemia, glucose intolerance, and insulin resistance. Post-stroke hyperglycemia was accompanied by elevated secretion of counter-regulatory hormones including glucagon, corticosterone, and norepinephrine, decreased insulin signaling in skeletal muscles, and increased hepatic gluconeogenesis. Correlation studies revealed that counter-regulatory hormone secretion showed a positive correlation with chromium loss and blood glucose increased together with chromium loss. Daily chromium supplementation increased tissue chromium levels, attenuated brain infarction, improved hyperglycemia, and decreased plasma levels of glucagon and corticosterone in stroke rats. Our findings suggest that stroke rats show disturbance of tissue chromium homeostasis with a net loss through urinary excretion and chromium mobilization and loss might be an alternative mechanism responsible for post-stroke hyperglycemia.

  7. Ischemic stroke selectively inhibits REM sleep of rats


    Ahmed, Samreen; Meng, He; Liu, Tiecheng; Sutton, Blair; Opp, Mark R.; Borjigin, Jimo; Wang, Michael M.


    Sleep disorders are important risk factors for stroke; conversely, stroke patients suffer from sleep disturbances including disruptions of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep and a decrease in total sleep. This study was performed to characterize the effect of stroke on sleep architecture of rats using continuous electroencephalography (EEG) and activity monitoring. Rats were implanted with transmitters which enabled continuous real time recording of EEG, electrom...

  8. Preventing Strokes (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts


    Strokes are the fourth leading cause of death in the U.S., and they don’t just occur in older adults. Anyone can have a stroke at any age. In this podcast, Dr. Mary George discusses ways to decrease your chances of having a stroke.  Created: 6/5/2014 by MMWR.   Date Released: 6/5/2014.

  9. Polymorphonuclear leukocyte elastase in patients with stroke. (United States)

    Vila, N; Elena, M; Deulofeu, R; Chamorro, A


    Polymorphonuclear leukocytes (PMNL) are involved in the pathogenesis of acute cerebral ischemia and atherosclerosis. Elastase is one of the proteolytic enzymes released by activated PMNL. We evaluated whether plasma levels of elastase-inhibitor complexes (EIC) are related to acute cerebral damage or with extension of carotid atherosclerosis in patients with stroke. Plasma levels of EIC were determined in 44 patients during acute and chronic phases of stroke. We recorded in all patients vascular risk factors, clinical severity on admission, infarct volume, and extension of carotid atherosclerosis using B-mode ultrasound exam. EIC levels were not different between acute and chronic phases of stroke. Eleven patients (25%) had increased values of EIC. On multiple regression analysis diabetes, dislipemia, and coronary disease were predictors of abnormal EIC levels. EIC levels were not related to neurological severity on admission, infarct volume, or carotid atherosclerosis. EIC levels in stroke patients are associated to the presence of vascular risk factors and may reflect cellular inflammatory aspects of chronic vessel disease. However, whether elastase contributes to the development of carotid atherosclerosis in patients with stroke remains unknown.

  10. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

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


    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...

  11. The Ubiquitin E3 Ligase TRAF6 Exacerbates Ischemic Stroke by Ubiquitinating and Activating Rac1. (United States)

    Li, Tao; Qin, Juan-Juan; Yang, Xia; Ji, Yan-Xiao; Guo, Fangliang; Cheng, Wen-Lin; Wu, Xiaolin; Gong, Fu-Han; Hong, Ying; Zhu, Xue-Yong; Gong, Jun; Wang, Zhihua; Huang, Zan; She, Zhi-Gang; Li, Hongliang


    Stroke is one of the leading causes of morbidity and mortality worldwide. Inflammation, oxidative stress, apoptosis, and excitotoxicity contribute to neuronal death during ischemic stroke; however, the mechanisms underlying these complicated pathophysiological processes remain to be fully elucidated. Here, we found that the expression of tumor necrosis factor receptor-associated factor 6 (TRAF6) was markedly increased after cerebral ischemia/reperfusion (I/R) in mice. TRAF6 ablation in male mice decreased the infarct volume and neurological deficit scores and decreased proinflammatory signaling, oxidative stress, and neuronal death after cerebral I/R, whereas transgenic overexpression of TRAF6 in male mice exhibited the opposite effects. Mechanistically, we demonstrated that TRAF6 induced Rac1 activation and consequently promoted I/R injury by directly binding and ubiquitinating Rac1. Either functionally mutating the TRAF6 ubiquitination site on Rac1 or inactivating Rac1 with a specific inhibitor reversed the deleterious effects of TRAF6 overexpression during I/R injury. In conclusion, our study demonstrated that TRAF6 is a key promoter of ischemic signaling cascades and neuronal death after cerebral I/R injury. Therefore, the TRAF6/Rac1 pathway might be a promising target to attenuate cerebral I/R injury. SIGNIFICANCE STATEMENT Stroke is one of the most severe and devastating neurological diseases globally. The complicated pathophysiological processes restrict the translation of potential therapeutic targets into medicine. Further elucidating the molecular mechanisms underlying cerebral ischemia/reperfusion injury may open a new window for pharmacological interventions to promote recovery from stroke. Our study revealed that ischemia-induced tumor necrosis factor receptor-associated factor 6 (TRAF6) upregulation binds and ubiquitinates Rac1 directly, which promotes neuron death through neuroinflammation and neuro-oxidative signals. Therefore, precisely targeting

  12. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich


    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  13. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav


    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

  14. High serum levels of sclerostin and Dickkopf-1 are associated with acute ischaemic stroke. (United States)

    He, Xin-Wei; Wang, En; Bao, Yu-Yan; Wang, Feng; Zhu, Ming; Hu, Xiao-Fei; Jin, Xiao-Ping


    Sclerostin and Dickkopf-1 (Dkk-1) are potent antagonists of Wnt signalling and might therefore play important roles in cardiovascular disease. We investigated whether serum sclerostin and Dkk-1 levels are associated with acute ischaemic stroke and specific stroke subtypes. Serum levels of sclerostin and Dkk-1 were measured by ELISA on day 1 and on day 6 after stroke in 62 patients with large artery atherosclerotic (LAA) stroke, on day 1 after stroke in 62 age- and gender-matched patients with small-artery occlusion (SAO) stroke and on admission in 62 healthy controls. Stroke severity was determined based on the National Institutes of Health Stroke Scale (NIHSS) and by measuring stroke volume on diffusion-weighted imaging. Outcome was measured by the modified Rankin Scale (mRS) on day 90. Compared with controls, serum sclerostin and Dkk-1 levels were significantly higher in both patients with LAA stroke and with SAO stroke, and no difference was detected between the stroke subtypes. Sclerostin and Dkk-1 levels remained stable between the first and sixth day after stroke in the patients with LAA stroke. Receiver operating characteristic curve analysis was used to evaluate sclerostin and Dkk-1 as markers of a high risk of stroke and produced area under curve values of 0.773 and 0.776. Adjusted logistic regression showed that serum sclerostin and Dkk-1 levels remained as independent markers of stroke. No correlations were found between sclerostin or Dkk-1 levels and stroke severity or stroke outcome. High serum levels of sclerostin and Dkk-1 are associated with acute ischaemic stroke. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Respiratory Changes in Patients with Stroke

    Directory of Open Access Journals (Sweden)

    Rita Ocko


    Full Text Available This study aimed to review published literature concerning the major changes that occur in the respiratory system after stroke, and also the impact of respiratory muscle training in these patients. The literature search was conducted through electronic databases (PubMed, SciELO and Pedro in Portuguese and English languages on themes related to changes in the respiratory system and methods of assessment and rehabilitation of respiratory muscle strength in individuals affected by stroke. There is scientific evidence that individuals affected by stroke may show decreased inspiratory and expiratory muscle strength. Studies suggest that respiratory muscle training through threshold load can bring benefits by improving respiratory function and respiratory muscle strength. However, more studies should be conducted to deepen the knowledge about the benefits and long-term effects of pulmonary rehabilitation in patients with stroke.

  16. 25-Hydroxyvitamin D and symptomatic ischemic stroke

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Nordestgaard, Børge G; Schnohr, Peter


    OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen...... City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations...... were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D...

  17. Default Mode Network Connectivity in Stroke Patients. (United States)

    Tuladhar, Anil Man; Snaphaan, Liselore; Shumskaya, Elena; Rijpkema, Mark; Fernandez, Guillén; Norris, David G; de Leeuw, Frank-Erik


    The pathophysiology of episodic memory dysfunction after infarction is not completely understood. It has been suggested that infarctions located anywhere in the brain can induce widespread effects causing disruption of functional networks of the cortical regions. The default mode network, which includes the medial temporal lobe, is a functional network that is associated with episodic memory processing. We investigated whether the default mode network activity is reduced in stroke patients compared to healthy control subjects in the resting state condition. We assessed the whole brain network properties during resting state functional MRI in 21 control subjects and 20 'first-ever' stroke patients. Patients were scanned 9-12 weeks after stroke onset. Stroke lesions were located in various parts of the brain. Independent component analyses were conducted to identify the default mode network and to compare the group differences of the default mode network. Furthermore, region-of-interest based analysis was performed to explore the functional connectivity between the regions of the default mode network. Stroke patients performed significantly worse than control subjects on the delayed recall score on California verbal learning test. We found decreased functional connectivity in the left medial temporal lobe, posterior cingulate and medial prefrontal cortical areas within the default mode network and reduced functional connectivity between these regions in stroke patients compared with controls. There were no significant volumetric differences between the groups. These results demonstrate that connectivity within the default mode network is reduced in 'first-ever' stroke patients compared to control subjects. This phenomenon might explain the occurrence of post-stroke cognitive dysfunction in stroke patients.

  18. Regulation of central blood volume and cardiac filling in endurance athletes: the Frank-Starling mechanism as a determinant of orthostatic tolerance (United States)

    Levine, B. D.; Blomqvist, C. G. (Principal Investigator)


    Orthostatic intolerance may result from either an abnormally large postural decrease in central blood volume, cardiac filling pressures, and stroke volume, or inadequate neurohumoral responses to orthostasis. Endurance athletes have been reported as having a high incidence of orthostatic intolerance, which has been attributed primarily to abnormalities in baroreflex regulation of heart rate and peripheral resistance. In this review, we present evidence that athletes also have structural changes in the cardiovascular system that although beneficial during exercise, lead to an excessively large decrease in stroke volume during orthostasis and contribute to orthostatic intolerance. A unifying hypothesis based on cardiac mechanics that may explain the divergence of findings in conditions such as bed rest or spaceflight, and short- and long-term endurance training is presented.

  19. Stroke in Commercial Flights. (United States)

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


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

  20. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz


    Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

  1. Stopping Strokes (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts


    Stroke is a leading cause of disability in the U.S. Recognizing the symptoms and getting immediate treatment can decrease the chance of permanent disability and even death. In this podcast, Dr. Jennifer Foltz discusses the importance of getting immediate treatment for a stroke.  Created: 10/27/2016 by MMWR.   Date Released: 10/27/2016.

  2. Soleus H-reflex excitability during pedaling post-stroke

    DEFF Research Database (Denmark)

    Schindler-Ivens, Sheila; Brown, David A.; Lewis, Gwyn N.


    A major contributor to impaired locomotion post-stroke is abnormal phasing of paretic muscle activity, but the mechanisms remain unclear. Previous studies have shown that, in the paretic limb of people post-stroke, Group Ia reflexes are abnormally elevated and fail to decrease in amplitude during...

  3. Sequential strokes in a hyperacute stroke unit. (United States)

    Ganesalingam, Jeban; Buddha, Sandeep; Carlton-Jones, Anoma L; Nicholas, Richard


    Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.

  4. Dimensions of post-stroke fatigue: a two-year follow-up study

    DEFF Research Database (Denmark)

    Christensen, Doris; Johnsen, Soeren Paaske; Watt, Torquil


    , was reported by 59% (95% CI: 51-66%), 44% (95% CI: 36-51%), 38% (95% CI: 31-46%), and 40% (95% CI: 32-48%) of stroke patients 10 days, 3 months, 1 year, and 2 years following hospitalization for stroke, respectively. Post-stroke fatigue levels decreased after three months and remained stable throughout...

  5. Paradoxical centrally increased diffusivity in perinatal arterial ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Stence, Nicholas V.; Mirsky, David M.; Deoni, Sean C.L. [University of Colorado Anschutz School of Medicine, Department of Radiology, Aurora, CO (United States); Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); Armstrong-Wells, Jennifer [University of Colorado Anschutz School of Medicine, Department of Pediatrics (Neurology) and OB/GYN, Aurora, CO (United States); University of Colorado Hemophilia and Thrombosis Center, Aurora, CO (United States)


    Restricted diffusion on acute MRI is the diagnostic standard for perinatal arterial ischemic stroke. In a subset of children with perinatal arterial ischemic stroke, primarily those with large infarct volumes, we noted a core of centrally increased diffusivity with a periphery of restricted diffusion. Given the paradoxical diffusion-weighted imaging (DWI) appearance observed in some children with perinatal arterial ischemic stroke, we sought to determine its significance and hypothesized that: (1) centrally increased diffusivity is associated with larger infarcts in perinatal arterial ischemic stroke and (2) this tissue is irreversibly injured (infarcted). We reviewed all perinatal arterial ischemic stroke cases in a prospective cohort study from Aug. 1, 2000, to Jan. 1, 2012. Infarct volumes were measured by drawing regions of interest around the periphery of the area of restricted diffusion on DWI. The Mann-Whitney U test was used to compare means between groups. Of 25 eligible cases, centrally increased diffusivity was seen in 4 (16%). Cases with centrally increased diffusivity had larger average infarct volumes (mean 117,182 mm{sup 3} vs. 36,995 mm{sup 3}; P = 0.008), higher average apparent diffusion coefficient (ADC) values in the infarct core (1,679 x 10{sup -6} mm{sup 2}/s vs. 611 x 10{sup -6} mm{sup 2}/s, P < 0.0001), and higher ADC ratio (1.2 vs. 0.5, P < 0.0001). At last clinical follow-up, children with perinatal arterial ischemic stroke and centrally increased diffusivity were more often treated for ongoing seizures (75% vs. 0%; P < 0.001) than those without. Centrally increased diffusivity was associated with larger stroke volume and the involved tissue was confirmed to be infarcted on follow-up imaging. Radiologists should be aware of this unusual appearance of perinatal arterial ischemic stroke in order to avoid underestimating infarct volume or making an incorrect early diagnosis. (orig.)

  6. Development of smartphone application that aids stroke screening and identifying nearby acute stroke care hospitals. (United States)

    Nam, Hyo Suk; Heo, JoonNyung; Kim, Jinkwon; Kim, Young Dae; Song, Tae Jin; Park, Eunjeong; Heo, Ji Hoe


    The benefits of thrombolytic treatment are time-dependent. We developed a smartphone application that aids stroke patient self-screening and hospital selection, and may also decrease hospital arrival time. The application was developed for iPhone and Android smartphones. Map data for the application were adopted from the open map. For hospital registration, a web page ( was developed using PHP and MySQL. The Stroke 119 application includes a stroke screening tool and real-time information on nearby hospitals that provide thrombolytic treatment. It also provides information on stroke symptoms, thrombolytic treatment, and prescribed actions when stroke is suspected. The stroke screening tool was adopted from the Cincinnati Prehospital Stroke Scale and is displayed in a cartoon format. If the user taps a cartoon image that represents abnormal findings, a pop-up window shows that the user may be having a stroke, informs the user what to do, and directs the user to call emergency services. Information on nearby hospitals is provided in map and list views, incorporating proximity to the user's location using a Global Positioning System (a built-in function of smartphones). Users can search for a hospital according to specialty and treatment levels. We also developed a web page for hospitals to register in the system. Neurology training hospitals and hospitals that provide acute stroke care in Korea were invited to register. Seventy-seven hospitals had completed registration. This application may be useful for reducing hospital arrival times for thrombolytic candidates.

  7. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria


    Grace Vincent-Onabajo; Taritei Moses


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

  8. Novel Therapeutic Effects of Leonurine On Ischemic Stroke: New Mechanisms of BBB Integrity

    Directory of Open Access Journals (Sweden)

    Qiu-Yan Zhang


    Full Text Available Stroke is a leading cause of morbidity and mortality globally. Leonurine (also named SCM-198, a compound extracted from Herba leonuri, was effective on the prevention of various cardiovascular and brain diseases. The purpose of this study was to explore the possible therapeutic potential of SCM-198 against ischemia reperfusion injury and underlying mechanisms. In the in vivo transient middle cerebral artery occlusion (tMCAO rat model, we found that treatment with SCM-198 could decrease infarct volume and improve neurological deficit by protecting against blood-brain barrier (BBB breakdown. In the in vitro model of cell oxygen-glucose deprivation and reoxygenation (OGD/R, consistent results were obtained with decreased reactive oxygen species (ROS production and maintained the BBB integrity. Further study demonstrated that SCM-198 increased the expression of histone deacetylase- (HDAC- 4 which could inhibit NADPH oxidase- (NOX- 4 and matrix metalloproteinase- (MMP- 9 expression, resulting in the elevation of tight junction proteins, including claudin-5, occludin, and zonula occluden- (ZO- 1. These results indicated SCM-198 protected BBB integrity by regulating the HDAC4/NOX4/MMP-9 tight junction pathway. Our findings provided novel insights into the protective effects and mechanisms of SCM-198 on ischemic stroke, indicating SCM-198 as a new class of potential drug against acute onset of ischemic stroke.

  9. European Stroke Science Workshop (United States)

    Mattle, Heinrich P.; Brainin, Michael; Chamorro, Angel; Diener, Hans Christoph; Hacke, Werner; Leys, Didier; Norrving, Bo; Ward, Nick


    The European Stroke Organisation (ESO) held its first European Stroke Science Workshop in Garmisch-Partenkirchen, Germany (15-17 December 2011). Stroke experts based in Europe were invited to present and discuss their current research. The scope of the workshop was to review the most recent findings of selected topics in stroke, to exchange ideas, to stimulate new research and to enhance collaboration between European stroke research groups. Seven scientific sessions were held, each starting with a keynote lecture to review the state of the art of the given topic, followed by 4 or 5 short presentations by experts. They were asked to limit their presentations to 10 slides containing only recent information. The meeting was organized by the executive committee of the ESO (Heinrich Mattle, chairman, Michael Brainin, Angel Chamorro, Werner Hacke, Didier Leys) and supported by the European Stroke Conference (Michael Hennerici). In this article we summarize the main contents of this successful workshop. PMID:22836350

  10. 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

  11. Acute ischemic stroke--from symptom recognition to thrombolysis. (United States)

    Kurz, M W; Kurz, K D; Farbu, E


    The understanding of stroke has changed in the recent years from rehabilitation to an emergency approach. We review existing data from symptom recognition to thrombolysis and identify challenges in the different phases of patient treatment. Implementation of treatment in dedicated stroke units with a multidisciplinary team exclusively treating stroke patients has led to significant reduction of stroke morbidity and mortality. Yet, first the introduction of treatment with intravenous rtPA (IVT) has led to the 'time is brain' concept where stroke is conceived as an emergency. As neuronal death in stroke is time dependent, all effort should be laid on immediate symptom recognition, rapid transport to the nearest hospital with a stroke treatment facility and diagnosis and treatment as soon as possible. The main cause of prehospital delay is that patients do not recognize that they suffered a stroke or out of other reasons do not call the Emergency Medical Services immediately. Educational stroke awareness campaigns may have an impact in increasing the number of patients eligible for rtPA treatment and can decrease the prehospital times if they are directed both to the public and to the medical divisions treating stroke. Stroke transport times can be shortened by the use of helicopter and a stroke mobile--an ambulance equipped with a CT scanner--may be helpful to decrease time from onset to treatment start in the future. Yet, IVT has several limitations such as a narrow time window and a weak effect in ischemic strokes caused by large vessel occlusions. In these cases, interventional procedures and the concept of bridging therapy, a combined approach of IVT and intraarterial thrombolysis or mechanical thrombectomy, might improve recanalization rates and patient outcome. As neuronal death in stroke patients occurs in a time-dependent fashion, all effort should be made to decrease time from symptom onset to treatment start with rtPA: major challenges are stroke

  12. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj


    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied the ...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  13. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.


    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  14. Editor's Choice - High Annual Hospital Volume is Associated with Decreased in Hospital Mortality and Complication Rates Following Treatment of Abdominal Aortic Aneurysms: Secondary Data Analysis of the Nationwide German DRG Statistics from 2005 to 2013. (United States)

    Trenner, Matthias; Kuehnl, Andreas; Salvermoser, Michael; Reutersberg, Benedikt; Geisbuesch, Sarah; Schmid, Volker; Eckstein, Hans-Henning


    The aim of this study was to analyse the association between annual hospital procedural volume and post-operative outcomes following repair of abdominal aortic aneurysms (AAA) in Germany. Data were extracted from nationwide Diagnosis Related Group (DRG) statistics provided by the German Federal Statistical Office. Cases with a diagnosis of AAA (ICD-10 GM I71.3, I71.4) and procedure codes for endovascular aortic repair (EVAR; OPS 5-38a.1*) or open aortic repair (OAR; OPS 5-38.45, 5-38.47) treated between 2005 and 2013 were included. Hospitals were empirically grouped to quartiles depending on the overall annual volume of AAA procedures. A multilevel multivariable regression model was applied to adjust for sex, medical risk, type of procedure, and type of admission. Primary outcome was in hospital mortality. Secondary outcomes were complications, use of blood products, and length of stay (LOS). The association between AAA volume and in hospital mortality was also estimated as a function of continuous volume. A total of 96,426 cases, of which 11,795 (12.6%) presented as ruptured (r)AAA, were treated in >700 hospitals (annual median: 501). The crude in hospital mortality was 3.3% after intact (i)AAA repair (OAR 5.3%; EVAR 1.7%). Volume was inversely associated with mortality after OAR and EVAR. Complication rates, LOS, and use of blood products were lower in high volume hospitals. After rAAA repair, crude mortality was 40.4% (OAR 43.2%; EVAR 27.4%). An inverse association between mortality and volume was shown for rAAA repair; the same accounts for the use of blood products. When considering volume as a continuous variate, an annual caseload of 75-100 elective cases was associated with the lowest mortality risk. In hospital mortality and complication rates following AAA repair are inversely associated with annual hospital volume. The use of blood products and the LOS are lower in high volume hospitals. A minimum annual case threshold for AAA procedures might improve

  15. Association of CT perfusion parameters with hemorrhagic transformation in acute ischemic stroke. (United States)

    Jain, A R; Jain, M; Kanthala, A R; Damania, D; Stead, L G; Wang, H Z; Jahromi, B S


    Prediction of hemorrhagic transformation in acute ischemic stroke could help determine treatment and prognostication. With increasing numbers of patients with acute ischemic stroke undergoing multimodal CT imaging, we examined whether CT perfusion could predict hemorrhagic transformation in acute ischemic stroke. Patients with acute ischemic stroke who underwent CTP scanning within 12 hours of symptom onset were examined. Patients with and without hemorrhagic transformation were defined as cases and controls, respectively, and were matched as to IV rtPA administration and presentation NIHSS score (± 2). Relative mean transit time, relative CBF, and relative CBV values were calculated from CTP maps and normalized to the contralateral side. Receiver operating characteristic analysis curves were created, and threshold values for significant CTP parameters were obtained to predict hemorrhagic transformation. Of 83 patients with acute ischemic stroke, 16 developed hemorrhagic transformation (19.28%). By matching, 38 controls were found for only 14 patients with hemorrhagic transformation. Among the matched patients with hemorrhagic transformation, 13 developed hemorrhagic infarction (6 hemorrhagic infarction 1 and 7 hemorrhagic infarction 2) and 1 developed parenchymal hematoma 2. There was no significant difference between cases and controls with respect to age, sex, time to presentation from symptom onset, and comorbidities. Cases had significantly lower median rCBV (8% lower) compared with controls (11% higher) (P = .009; odds ratio, 1.14 for a 0.1-U decrease in rCBV). There was no difference in median total volume of ischemia, rMTT, and rCBF among cases and controls. The area under the receiver operating characteristic was computed to be 0.83 (standard error, 0.08), with a cutoff point for rCBV of 1.09. Of the examined CTP parameters, only lower rCBV was found to be significantly associated with a relatively higher chance of hemorrhagic transformation.

  16. [Etiologic mechanism and prevention of perioperative stroke]. (United States)

    Hayashi, Kentaro; Ujifuku, Kenta; Hiu, Takeshi; Kitagawa, Naoki; Suyama, Kazuhiko; Nagata, Izumi


    Despite advances in surgical techniques and improvements in perioperative care, the incidence of perioperative strokes has not decreased, reflecting the aging of the population and the increased number of patients with complication. We investigated the cases who were consulted due to perioperative stroke. From April, 2004 to March, 2007, a total of 102 patients were referred for neurological evaluation because of perioperative stroke. Types of planned or performed surgery, risk factors, types of stroke and timing of the events were analyzed. Sixty-seven cases were consulted preoperatively for history or risk factors of stroke. Forty-seven cases had ischemic risk factors and cerebral vascular recanalization was carried out in four patients who experienced severe cerebral hypoperfusion. The other patients with ischemic risk factors were treated to avoid dehydration or hypotension perioperatively. Nine cases with hemorrhagic risk factors, such as cerebral aneurysm, were treated to avoid significant hypertension during surgery. The types of planned surgery were cardiovascular surgery in 29 cases, abdominal surgery in 13, cervical surgery in 7, and thoracic surgery in 6. Except for one case, who suffered cerebral embolism due to cardiac surgery, those who were consulted preoperatively did not experience stroke. Neurological events had occurred in 35 patients and they were consulted postoperatively. The surgical procedures were cardiovascular surgery in 19 patients, thoracic surgery in 6, abdominal surgery in 6. The types of stroke were cerebral infarction in 20 cases, hypoxic brain in 8, and transient ischemic attack in 5. The cause of the cerebral infarction was considered as cerebral embolism in 19 cases. Those who were consulted preoperatively were treated to prevent intraoperative stroke and did not suffer neurological complication. Most stoke in patients undergoing surgery were not related to hypoperfusion but due to embolism.

  17. Trends in vascular risk factors, stroke performance measures, and outcomes in patients with first-ever ischemic stroke in Taiwan between 2000 and 2012. (United States)

    Hsieh, Cheng-Yang; Wu, Darren Philbert; Sung, Sheng-Feng


    With the aging of the population in Taiwan, the financial burden of stroke on the healthcare system is expected to rise. We aimed to investigate the trends in vascular risk factors, adherence to stroke performance measures, and stroke outcomes based on a nationwide representative sample. Adult patients hospitalized for first-ever ischemic stroke between 2000 and 2012 were identified from a nationwide administrative database. The study period was divided into 1-year intervals. The Cuzick test and the Cochran-Armitage test were used to determine the significance of changes over time. Trends in stroke outcomes as a function of year were assessed using logistic regression, controlling for age, sex, comorbidity, and stroke severity. A total of 11,462 patients (mean age 67.3years, female 40.9%) were hospitalized. Between 2000 and 2012, the prevalence of hypertension, diabetes mellitus, hyperlipidemia, and atrial fibrillation increased while the prevalence of coronary artery disease decreased. The proportion of patients taking antihypertensive or antidiabetic medication prior to stroke decreased, whereas the proportion of patients taking lipid lowering medication increased. Adherence to the five selected performance measures significantly improved. A significant decreasing trend in the proportion of recurrent stroke or all-cause death within one year was observed regardless of whether adjustment for age, sex, comorbidity, and stroke severity was made. Despite the rising prevalence of vascular risk factors, improved adherence to stroke performance measures was accompanied by better stroke outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Magnetic inductive phase shift: a new method to differentiate hemorrhagic stroke from ischemic stroke on rabbit. (United States)

    Yan, Qingguang; Jin, Gui; Ma, Ke; Qin, Mingxin; Zhuang, Wei; Sun, Jian


    The major therapy for ischemic stroke is thrombolytic treatment, but severe consequences occur when this method is used to treat hemorrhagic stroke. Currently, computed tomography and magnetic resonance imaging are used to differentiate between two types of stroke, but these two methods are ineffective for pre-hospital care. We developed a new brain diagnostic device for rabbits based on electromagnetic induction to non-invasively differentiate two types of stroke. The device includes two coils and a phase difference measurement system that detects the magnetic inductive phase shift (MIPS) value to reflect the tissue's condition. The hemorrhage model was established through the injection of autologous blood into the internal capsule of a rabbit's brain. Ischemia was induced in the brain of a rabbit by bilateral carotid artery occlusion. Two types of animal models were measured with our device. The MIPS value gradually decreased with increasing injected blood and increased with ischemia time. The MIPS changes induced by the two types of strokes were exact opposites, and the absolute values of MIPS variation in the hemorrhagic and the ischemic groups were significantly larger than those of the normal control group (P stroke from hemorrhagic stroke on rabbit brain in a non-invasive, continuous, and bulk monitoring manner by using a simple and inexpensive apparatus.

  19. Global and regional burden of stroke during 1990-2010

    DEFF Research Database (Denmark)

    Feigin, Valery L; Forouzanfar, Mohammad H; Krishnamurthi, Rita


    -years (DALYs) lost by age group (income level (high-income, and low-income and middle-income) for 1990, 2005, and 2010. FINDINGS: We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010......, the age-standardised incidence of stroke significantly decreased by 12% (95% CI 6-17)in high-income countries, and increased by 12% (-3 to 22) in low-income and middle-income countries, albeit nonsignificantly. Mortality rates decreased significantly in both high income (37%, 31-41) and low-income......, respectively), with most of the burden (68・6% incident strokes, 52・2% prevalent strokes, 70・9% stroke deaths, and 77・7% DALYs lost) in low-income and middle-income countries. In 2010, 5・2 million (31%) strokes were in children (aged aged adults(20-64 years), to which...

  20. A Four-Year Experience of Symptomatic Intracranial Hemorrhage Following Intravenous Tissue Plasminogen Activator at a Comprehensive Stroke Center. (United States)

    Orlando, Alessandro; Wagner, Jeffrey C; Fanale, Christopher V; Whaley, Michelle; McCarthy, Kathryn L; Bar-Or, David


    To describe the 4-year experience of symptomatic intracranial hemorrhage (sICH) rate at a high-volume comprehensive stroke center. All admitted adult (≥18 years) patients presenting with an ischemic stroke from 2010 to 2013 were included in this study. The primary outcome was sICH, defined as any hemorrhage with neurological deterioration (change in National Institutes of Health Stroke Scale score ≥4) within 36 hours of intravenous tissue plasminogen activator (IV-tPA) treatment, or any hemorrhage resulting in death. Secondary outcomes were in-hospital mortality and having a favorable modified Rankin Scale (mRS) score (≤2). A total of 1925 did not receive intravascular (IV) or intra-arterial (IA) therapy; only 451 received IV therapy; and 175 received both IV and IA therapies. In IV-only patients, the overall rate of sICH was 2.2%; in IV and IA patients, the rate was 5.7%; and in patients who received no therapy, the rate was .4%. The IV-only group had an sICH rate of .9% in 2013. There were no differences in the adjusted odds of dying in the hospital between the study groups. IV-only treatment offered significantly better odds of achieving a favorable functional outcome, compared to no therapy, among patients with moderate stroke severity, whereas IV and IA treatments offered significantly better odds among patients with severe strokes. The odds of achieving a favorable functional outcome by discharge were decreased by 97% if patients suffered an sICH (OR = .03, 95%CI = .004, .19). Despite an increased risk of sICH with IV-tPA, treatment with IV-tPA continues to be associated with increased odds of a favorable discharge mRS. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Mitochondrial Impairment in Cerebrovascular Endothelial Cells is Involved in the Correlation between Body Temperature and Stroke Severity (United States)

    Hu, Heng; Doll, Danielle N.; Sun, Jiahong; Lewis, Sara E.; Wimsatt, Jeffrey H.; Kessler, Matthew J.; Simpkins, James W.; Ren, Xuefang


    Stroke is the second leading cause of death worldwide. The prognostic influence of body temperature on acute stroke in patients has been recently reported; however, hypothermia has confounded experimental results in animal stroke models. This work aimed to investigate how body temperature could prognose stroke severity as well as reveal a possible mitochondrial mechanism in the association of body temperature and stroke severity. Lipopolysaccharide (LPS) compromises mitochondrial oxidative phosphorylation in cerebrovascular endothelial cells (CVECs) and worsens murine experimental stroke. In this study, we report that LPS (0.1 mg/kg) exacerbates stroke infarction and neurological deficits, in the mean time LPS causes temporary hypothermia in the hyperacute stage during 6 hours post-stroke. Lower body temperature is associated with worse infarction and higher neurological deficit score in the LPS-stroke study. However, warming of the LPS-stroke mice compromises animal survival. Furthermore, a high dose of LPS (2 mg/kg) worsens neurological deficits, but causes persistent severe hypothermia that conceals the LPS exacerbation of stroke infarction. Mitochondrial respiratory chain complex I inhibitor, rotenone, replicates the data profile of the LPS-stroke study. Moreover, we have confirmed that rotenone compromises mitochondrial oxidative phosphorylation in CVECs. Lastly, the pooled data analyses of a large sample size (n=353) demonstrate that stroke mice have lower body temperature compared to sham mice within 6 hours post-surgery; the body temperature is significantly correlated with stroke outcomes; linear regression shows that lower body temperature is significantly associated with higher neurological scores and larger infarct volume. We conclude that post-stroke body temperature predicts stroke severity and mitochondrial impairment in CVECs plays a pivotal role in this hypothermic response. These novel findings suggest that body temperature is prognostic for

  2. Neuroprotective efficacy of methylene blue in ischemic stroke: an MRI study.

    Directory of Open Access Journals (Sweden)

    Qiang Shen

    Full Text Available Methylene blue (MB has unique energy-enhancing and antioxidant properties and is FDA-approved drug to treat methemoglobinemia and cyanide poisoning. This study evaluated the efficacy of MB to treat ischemic stroke in rats using longitudinal MRI and behavioral measures. Rats were subjected to 60-minute middle-cerebral-artery occlusion. In a randomized double-blinded design, vehicle or MB was administered after reperfusion. The initial lesion volumes at 30 minutes post-ischemia were not significantly different between the two groups (P = 0.92. The final infarct volumes two days after stroke increased in the vehicle group but decreased in the MB group, yielding a 30% difference in infarct volume (P = 0.03. Tracking tissue fate on a pixel-by-pixel basis showed that MB salvaged more initial core pixels compared to controls (22±3% versus 11±3%, P = 0.03, and more mismatch pixels compared to controls (83±3% versus 61±8%, P = 0.02. This study demonstrates MB treatment minimizes ischemic brain injury and improves functional outcomes.

  3. Immune interventions in stroke (United States)

    Fu, Ying; Liu, Qiang; Anrather, Josef


    Inflammatory and immune responses in the brain can shape the clinical presentation and outcome of stroke. Approaches for effective management of acute stroke are sparse and many measures for brain protection fail, but our ability to modulate the immune system and modify the disease progression of multiple sclerosis is increasing. As a result, immune interventions are currently being explored as therapeutic interventions in acute stroke. In this Review, we compare the immunological features of acute stroke with those of multiple sclerosis, identify unique immunological features of stroke, and consider the evidence for immune interventions. In acute stroke, microglia activation and cell death products trigger an inflammatory cascade that damages vessels and the parenchyma within minutes to hours of the ischaemia or haemorrhage. Immune interventions that restrict brain inflammation, vascular permeability and tissue oedema must be administered rapidly to reduce acute immune-mediated destruction and to avoid subsequent immunosuppression. Preliminary results suggest that the use of drugs that modify disease in multiple sclerosis might accomplish these goals in ischaemic and haemorrhagic stroke. Further elucidation of the immune mechanisms involved in stroke is likely to lead to successful immune interventions. PMID:26303850

  4. Relational Processing Following Stroke (United States)

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


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

  5. National Stroke Association (United States)

    ... Event Join a Stroke Challenge Team Comeback Trail Tell Your Story Community Presentations Faces of Stroke Volunteer With Us ... in a video presentation. Watch Video ... to feel the right side of her body. Kathryn’s friends performed the FAST exam and soon ...

  6. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

    Jarenwattananon, A.; Khandji, A.; Brust, J.C.M.


    Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke

  7. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech


    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed...... in the golf stroke of a professional golfer....

  8. Acute ischemic stroke update. (United States)

    Baldwin, Kathleen; Orr, Sean; Briand, Mary; Piazza, Carolyn; Veydt, Annita; McCoy, Stacey


    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

  9. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager


    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  10. Stroke mimic diagnoses presenting to a hyperacute stroke unit. (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J


    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  11. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  12. Perception of stroke among patients with stroke | Ajayi | Nigerian ...

    African Journals Online (AJOL)

    The perception of patients to stroke is variable. The aim of this study was to determine the perception of stroke among stroke patients. The study was carried out between January 2004 - December 2004 on all the patients presenting with features of stroke at the Federal Medical Center Ido, Nigeria. Data were collected by ...

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

    Directory of Open Access Journals (Sweden)

    Qian He

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

  14. Interleukin-6 is increased in plasma and cerebrospinal fluid of community-dwelling domestic dogs with acute ischaemic stroke

    DEFF Research Database (Denmark)

    Gredal, Hanne; Thomsen, Barbara B; Boza-Serrano, Antonio


    and cerebrospinal fluid (CSF) in dogs with acute ischaemic stroke and to search for correlations between infarct volume and cytokine concentrations. Blood and CSF were collected from dogs less than 72 h after a spontaneous ischaemic stroke. Infarct volumes were estimated on MRIs. Interleukin (IL)-2, IL-6, IL-8, IL...

  15. Cerebrorenal interaction and stroke. (United States)

    Toyoda, Kazunori


    Beyond the original meaning of chronic kidney disease (CKD) as high-risk state for future dialysis, CKD is now known as an established risk factor for cardiovascular diseases. Stroke is a major player of cardiovascular disease and has deep two-way relationships with CKD. CKD is an evident risk factor for stroke. Meta-analyses of cohort studies and trials indicate that proteinuria/albuminuria increases the risk of stroke by 71-92%, and reduced glomerular filtration rate increases the risk by 43%. In addition, CKD has a strong relationship with subclinical brain damage including white matter changes, microbleeds, cognitive impairment, and carotid atherosclerosis. CKD is prevalent in acute stroke patients; patients with estimated glomerular filtration rate stroke patients and 39% of total intracerebral hemorrhage patients in our institute. Acute and chronic management of stroke are influenced by CKD. Therapeutic effects of several antithrombotic and thrombolytic agents, including recently-developed novel oral anticoagulants, are affected by renal function. Moreover, reduced glomerular filtration rate is independently associated with increased 1- and 10-year mortalities in the end. Stroke also has deep relationships with end-stage kidney disease. Stroke occurs much more commonly in dialysis patients than general population or CKD patients without need for dialysis. The triggers of ischemic and hemorrhagic stroke in patients with end-stage kidney disease include special characteristics unique to dialysis, such as drastic hemodynamic change, dialysate and anticoagulants, and vascular calcification. As cohorts of dialysis patients become older, more hypertensive, and more diabetic than before, stroke become more prevalent and more serious events in dialysis clinics. Now, clinicians should have much interest in the association between CKD and cerebrovascular diseases, so-called the cerebro-renal interaction. Copyright © 2013 S. Karger AG, Basel.

  16. Improving Upper Extremity Function and Quality of Life with a Tongue Driven Exoskeleton: A Pilot Study Quantifying Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Stephen N. Housley


    Full Text Available Stroke is a leading cause of long-term disability around the world. Many survivors experience upper extremity (UE impairment with few rehabilitation opportunities, secondary to a lack of voluntary muscle control. We developed a novel rehabilitation paradigm (TDS-HM that uses a Tongue Drive System (TDS to control a UE robotic device (Hand Mentor: HM while engaging with an interactive user interface. In this study, six stroke survivors with moderate to severe UE impairment completed 15 two-hour sessions of TDS-HM training over five weeks. Participants were instructed to move their paretic arm, with synchronized tongue commands to track a target waveform while using visual feedback to make accurate movements. Following TDS-HM training, significant improvements in tracking performance translated into improvements in the UE portion of the Fugl-Meyer Motor Assessment, range of motion, and all subscores for the Stroke Impact Scale. Regression modeling found daily training time to be a significant predictor of decreases in tracking error, indicating the presence of a potential dose-response relationship. The results of this pilot study indicate that the TDS-HM system can elicit significant improvements in moderate to severely impaired stroke survivors. This pilot study gives preliminary insight into the volume of treatment time required to improve outcomes.

  17. Association of MTHFR C677T Genotype With Ischemic Stroke Is Confined to Cerebral Small Vessel Disease Subtype (United States)

    Traylor, Matthew; Adib-Samii, Poneh; Thijs, Vincent; Sudlow, Cathie; Rothwell, Peter M.; Boncoraglio, Giorgio; Dichgans, Martin; Meschia, James; Maguire, Jane; Levi, Christopher; Rost, Natalia S.; Rosand, Jonathan; Hassan, Ahamad; Bevan, Steve; Markus, Hugh S.


    Background and Purpose— Elevated plasma homocysteine levels are associated with stroke. However, this might be a reflection of bias or confounding because trials have failed to demonstrate an effect from homocysteine lowering in stroke patients, although a possible benefit has been suggested in lacunar stroke. Genetic studies could potentially overcome these issues because genetic variants are inherited randomly and are fixed at conception. Therefore, we tested the homocysteine levels–associated genetic variant MTHFR C677T for association with magnetic resonance imaging–confirmed lacunar stroke and compared this with associations with large artery and cardioembolic stroke subtypes. Methods— We included 1359 magnetic resonance imaging–confirmed lacunar stroke cases, 1824 large artery stroke cases, 1970 cardioembolic stroke cases, and 14 448 controls, all of European ancestry. Furthermore, we studied 3670 ischemic stroke patients in whom white matter hyperintensities volume was measured. We tested MTHFR C677T for association with stroke subtypes and white matter hyperintensities volume. Because of the established association of homocysteine with hypertension, we additionally stratified for hypertension status. Results— MTHFR C677T was associated with lacunar stroke (P=0.0003) and white matter hyperintensity volume (P=0.04), but not with the other stroke subtypes. Stratifying the lacunar stroke cases for hypertension status confirmed this association in hypertensive individuals (P=0.0002), but not in normotensive individuals (P=0.30). Conclusions— MTHFR C677T was associated with magnetic resonance imaging–confirmed lacunar stroke, but not large artery or cardioembolic stroke. The association may act through increased susceptibility to, or interaction with, high blood pressure. This heterogeneity of association might explain the lack of effect of lowering homocysteine in secondary prevention trials which included all strokes. PMID:26839351

  18. Third European Stroke Science Workshop

    NARCIS (Netherlands)

    Dichgans, Martin; Planas, Anna M.; Biessels, Geert Jan|info:eu-repo/dai/nl/165576367; van der Worp, Bart|info:eu-repo/dai/nl/189855010; Sudlow, Cathie; Norrving, B.; Lees, Kennedy; Mattle, Heinrich P.


    Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science

  19. Reduced left ventricular filling following blood volume extraction does not result in compensatory augmentation of cardiac mechanics. (United States)

    Lord, Rachel; MacLeod, David; George, Keith; Oxborough, David; Shave, Rob; Stembridge, Mike


    What is the central question of this study? A reduction in left ventricular (LV) filling, and concomitant increase in heart rate, augments LV mechanics to maintain stroke volume (SV); however, the impact of reduced LV filling in isolation on SV and LV mechanics is currently unknown. What is the main finding and its importance? An isolated decrease in LV filling did not provoke a compensatory increase in mechanics to maintain SV; in contrast, LV mechanics and SV were reduced. These data indicate that when LV filling is reduced without changes in heart rate, LV mechanics do not compensate to maintain SV. An acute non-invasive reduction in preload has been shown to augment cardiac mechanics to maintain stroke volume and cardiac output. Such interventions induce concomitant changes in heart rate, whereas blood volume extraction reduces preload without changes in heart rate. Therefore, the purpose of this study was to determine whether a preload reduction in isolation resulted in augmented stroke volume achieved via enhanced cardiac mechanics. Nine healthy volunteers (four female, age 29 ± 11 years) underwent echocardiography for the assessment of left ventricular (LV) volumes and mechanics in a supine position at baseline and end extraction after the controlled removal of 25% of total blood volume (1062 ± 342 ml). Arterial blood pressure was monitored continuously by a pressure transducer attached to an indwelling radial artery catheter. Heart rate and total peripheral resistance were unchanged from baseline to end extraction, but systolic blood pressure was reduced (from 148 to 127 mmHg). From baseline to end extraction there were significant reductions in left ventricular end-diastolic volume (from 89 to 71 ml) and stroke volume (from 56 to 37 ml); however, there was no change in LV twist, basal or apical rotation. In contrast, LV longitudinal strain (from -20 to -17%) and basal circumferential strain (from -22 to -19%) were significantly reduced from

  20. Perfusion CT in acute stroke

    International Nuclear Information System (INIS)

    Eckert, Bernd; Roether, Joachim; Fiehler, Jens; Thomalla, Goetz


    Modern multislice CT scanners enable multimodal protocols including non-enhanced CT, CT angiography, and CT perfusion. A 64-slice CT scanner provides 4-cm coverage. To cover the whole brain, a 128 - 256-slice scanner is needed. The use of perfusion CT requires an optimized scan protocol in order to reduce exposure to radiation. As compared to non-enhanced CT and CT angiography, the use of CT perfusion increases detection rates of cerebral ischemia, especially small cortical ischemic lesions, while the detection of lacunar and infratentorial stroke lesions remains limited. Perfusion CT enables estimation of collateral flow in acute occlusion of large intra- or extracranial arteries. Currently, no established reliable thresholds are available for determining infarct core and penumbral tissue by CT perfusion. Moreover, perfusion parameters depend on the processing algorithms and the software used for calculation. However, a number of studies point towards a reduction of cerebral blood volume (CBV) below 2 ml/100 g as a critical threshold that identifies infarct core. Large CBV lesions are associated with poor outcome even in the context of recanalization. The extent of early ischemic signs on non-enhanced CT remains the main parameter from CT imaging to guide acute reperfusion treatment. Nevertheless, perfusion CT increases diagnostic and therapeutic certainty in the acute setting. Similar to stroke MRI, perfusion CT enables the identification of tissue at risk of infarction by the mismatch between infarct core and the larger area of critical hypoperfusion. Further insights into the validity of perfusion parameters are expected from ongoing trials of mechanical thrombectomy in stroke.

  1. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad


    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.

  2. The role of nitrous oxide in stroke

    Directory of Open Access Journals (Sweden)

    Zhu-wei Zhang


    Full Text Available Stroke that is caused by poor blood flow into the brain results in cell death, including ischemia stroke due to lack of blood into brain tissue, and hemorrhage due to bleeding. Both of them will give rise to the dysfunction of brain. In general, the signs and symptoms of stroke are the inability of feeling or moving on one side of body, sometimes loss of vision to one side. Above symptoms will appear soon after the stroke has happened. If the symptoms and signs happen in 1 or 2 hours, we often call them as transient ischemic attack. Moreover, hemorrhagic stroke often leads to severe headache. It is known that neuronal death can happen after stroke, and it depends upon the activation of N-methyl-D-aspartate (NMDA excitatory glutamate receptor which is the goal for a lot of neuroprotective agents. Nitrous oxide was discovered by Joseph Priestley in 1772, and then he and his friends, including the poet Coleridge and Robert Sauce, experimented with the gas. They found this gas could make patients loss the sense of pain and still maintain consciousness after inhalation. Shortly the gas was used as an anesthetic, especially in the field of dentists. Now, accroding to theme of Helene N. David and other scientists, both of nitrous oxide at 75 vol% and xenon at 50 vol% could reduce ischemic neuronal death in the cortex by 70% and decrease NMDA-induced Ca2+ influx by 30%. Therefore, more clinical and experimental studies are important to illuminate the mechanisms of how nitrous oxide protects brain tissue and to explore the best protocol of this gas in stroke treatment.

  3. Intraarterial administration of norcantharidin attenuates ischemic stroke damage in rodents when given at the time of reperfusion: novel uses of endovascular capabilities. (United States)

    Khan, Imad S; Odom, Mitchell; Ehtesham, Moneeb; Colvin, Daniel; Quarles, C Chad; McLaughlin, BethAnn; Singer, Robert J


    OBJECT Matrix metalloprotease-9 (MMP-9) plays a critical role in infarct progression, blood-brain barrier (BBB) disruption, and vasogenic edema. While systemic administration of MMP-9 inhibitors has shown neuroprotective promise in ischemic stroke, there has been little effort to incorporate these drugs into endovascular modalities. By modifying the rodent middle cerebral artery occlusion (MCAO) model to allow local intraarterial delivery of drugs, one has the ability to mimic endovascular delivery of therapeutics. Using this model, the authors sought to maximize the protective potential of MMP-9 inhibition by intraarterial administration of an MMP-9 inhibitor, norcantharidin (NCTD). METHODS Spontaneously hypertensive rats were subjected to 90-minute MCAO followed immediately by local intraarterial administration of NCTD. The rats' neurobehavioral performances were scored according to the ladder rung walking test results and the Garcia neurological test for as long as 7 days after stroke. MRI was also conducted 24 hours after the stroke to assess infarct volume and BBB disruption. At the end of the experimental protocol, rat brains were used for active MMP-9 immunohistochemical analysis to assess the degree of MMP-9 inhibition. RESULTS NCTD-treated rats showed significantly better neurobehavioral scores for all days tested. MR images also depicted significantly decreased infarct volumes and BBB disruption 24 hours after stroke. Inhibition of MMP-9 expression in the ischemic region was depicted on immunohistochemical analysis, wherein treated rats showed decreased active MMP-9 staining compared with controls. CONCLUSIONS Intraarterial NCTD significantly improved outcome when administered at the time of reperfusion in a spontaneously hypertensive rat stroke model. This study suggests that supplementing endovascular revascularization with local neuroprotective drug therapy may be a viable therapeutic strategy.

  4. Clinical neurogenetics: stroke. (United States)

    Rost, Natalia S


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

  5. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke


    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  6. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina


    Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior

  7. The Migraine?Stroke Connection


    Lee, Mi Ji; Lee, Chungbin; Chung, Chin-Sang


    Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like head...

  8. Stroke rehabilitation reaches a threshold.

    Directory of Open Access Journals (Sweden)

    Cheol E Han


    spontaneous use. Below this threshold, motor training is "in vain": there is little spontaneous arm use after training, the model exhibits learned nonuse, and compensatory movements with the less affected hand are reinforced. By exploring the nonlinear dynamics of stroke recovery using a biologically plausible neural model that accounts for reversal of the loss of motor cortex representation following rehabilitation or the lack thereof, respectively, we can explain previously hard to reconcile data on spontaneous arm use in stroke recovery. Further, our threshold prediction could be tested with an adaptive train-wait-train paradigm: if spontaneous arm use has increased in the "wait" period, then the threshold has been reached, and rehabilitation can be stopped. If spontaneous arm use is still low or has decreased, then another bout of rehabilitation is to be provided.

  9. Toxic acrolein production due to Ca(2+) influx by the NMDA receptor during stroke. (United States)

    Nakamura, Mizuho; Uemura, Takeshi; Saiki, Ryotaro; Sakamoto, Akihiko; Park, Hyerim; Nishimura, Kazuhiro; Terui, Yusuke; Toida, Toshihiko; Kashiwagi, Keiko; Igarashi, Kazuei


    N-Methyl-d-aspartate (NMDA) receptors have a high permeability to Ca(2+), contributing to neuronal cell death after stroke. We recently found that acrolein produced from polyamines is a major toxic compound during stroke. Thus, it was determined whether over-accumulation of Ca(2+) increases the production of acrolein from polyamines in a photochemically-induced thrombosis mouse model of stroke and in cell culture systems. A unilateral infarction was induced in mouse brain by photoinduction after injection of Rose Bengal. The volume of the infarction was analyzed using the public domain National Institutes of Health image program. Protein-conjugated acrolein levels at the locus of infarction and in cells were measured by Western blotting. Levels of polyamines were measured by high-performance liquid chromatography. When the size of brain infarction was decreased by N(1), N(4), N(8)-tribenzylspermidine, a channel blocker of the NMDA receptors, levels of Ca(2+) and protein-conjugated acrolein (PC-Acro) were reduced, while levels of polyamines were increased at the locus of infarction. When cell growth of mouse mammary carcinoma FM3A cells and neuroblastoma Neuro2a cells was inhibited by Ca(2+), the level of polyamines decreased, while that of PC-Acro increased. It was also shown that Ca(2+) toxicity was decreased in an acrolein toxicity decreasing FM3A mutant cells recently isolated. In addition, 20-40 μM Ca(2+) caused the release of polyamines from ribosomes. The results indicate that acrolein is produced from polyamines released from ribosomes through Ca(2+) increase. The results indicate that toxicity of Ca(2+) during brain infarction is correlated with the increase of acrolein. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh


    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices. PMID:27610118

  11. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions. (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh


    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices.

  12. Obstructive sleep apnea in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aliye Tosun


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

  13. Determinants of carotid atherosclerotic plaque burden in a stroke-free population

    NARCIS (Netherlands)

    Selwaness, Mariana; Hameeteman, Reinhard; Van 't Klooster, Ronald; Van den Bouwhuijsen, Quirijn; Hofman, Albert; Franco, Oscar H.; Niessen, W.J.; Klein, Stefan; Vernooij, Meike W.; Van Der Lugt, Aad; Wentzel, Jolanda J.


    Background and aims In a large stroke-free population, we sought to identify cardiovascular risk factors and carotid plaque components associated with carotid plaque burden, lumen volume and stenosis. Methods The carotid arteries of 1562 stroke-free participants from The Rotterdam Study were

  14. Sleep Duration and the Risk of Mortality From Stroke in Japan: The Takayama Cohort Study

    Directory of Open Access Journals (Sweden)

    Toshiaki Kawachi


    Full Text Available Background: Few studies have assessed the associations between sleep duration and stroke subtypes. We examined whether sleep duration is associated with mortality from total stroke, ischemic stroke, and hemorrhagic stroke in a population-based cohort of Japanese men and women. Methods: Subjects included 12 875 men and 15 021 women aged 35 years or older in 1992, who were followed until 2008. The outcome variable was stroke death (ischemic stroke, hemorrhagic stroke, and total stroke. Results: During follow-up, 611 stroke deaths (354 from ischemic stroke, 217 from hemorrhagic stroke, and 40 from undetermined stroke were identified. Compared with 7 h of sleep, ≥9 h of sleep was significantly associated with an increased risk of total stroke and ischemic stroke mortality after controlling for covariates. Hazard ratios (HRs and 95% confidence intervals (CIs were 1.51 (95% CI, 1.16–1.97 and 1.65 (95% CI, 1.16–2.35 for total stroke mortality and ischemic stroke mortality, respectively. Short sleep duration (≤6 h of sleep was associated with a decreased risk of mortality from total stroke (HR 0.77; 95% CI, 0.59–1.01, although this association was of borderline significance (P = 0.06. The trends for total stroke and ischemic stroke mortality were also significant (P < 0.0001 and P = 0.0002, respectively. There was a significant risk reduction of hemorrhagic stroke mortality for ≤6 h of sleep as compared with 7 h of sleep (HR 0.64; 95% CI, 0.42–0.98; P for trend = 0.08. The risk reduction was pronounced for men (HR 0.31; 95% CI, 0.16–0.64. Conclusions: Data suggest that longer sleep duration is associated with increased mortality from total and ischemic stroke. Short sleep duration may be associated with a decreased risk of mortality from hemorrhagic stroke in men.

  15. Stroke - risk factors (United States)

    ... Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of getting ... disease or condition. This article discusses the risk factors for stroke and things you can do to ...

  16. Post-Stroke Rehabilitation (United States)

    ... negotiate the provision of reasonable accommodations in the workplace. When can a stroke patient begin rehabilitation? Rehabilitation ... at home gives people the advantage of practicing skills and developing compensatory strategies in the context of ...

  17. A Stroke of Language (United States)

    Blaisdell, Bob


    The author reflects on foreign-language learning by his EFL students as well as his own foreign-language learning. He concludes by musing on the possible and fantastical devastation on language-ability wrought by strokes.

  18. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O


    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  19. The "Know Stroke" Campaign (United States)

    ... Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents For ... Javascript on. NINDS is conducting a public awareness campaign across the United States to educate people about ...

  20. Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients. (United States)

    Zhang, Yan; Wang, Wanhua; Cai, Sijie; Sheng, Qi; Pan, Shenggui; Shen, Fang; Tang, Qing; Liu, Yang


    Obstructive sleep apnea (OSA) is very common in stroke survivors. It potentially worsens the cognitive dysfunction and inhibits their functional recovery. However, whether OSA independently damages the cognitive function in stroke patients is unclear. A simple method for evaluating OSA-induced cognitive impairment is also missing. Forty-four stroke patients six weeks after onset and 24 non-stroke patients with snoring were recruited for the polysomnographic study of OSA and sleep architecture. Their cognitive status was evaluated with a validated Chinese version of Cambridge Prospective Memory Test. The relationship between memory deficits and respiratory, sleeping, and dementia-related clinical variables were analyzed with correlation and multiple linear regression tests. OSA significantly and independently damaged time- and event-based prospective memory in stroke patients, although it had less power than the stroke itself. The impairment of prospective memory was correlated with increased apnea-hypopnea index, decreased minimal and mean levels of peripheral oxygen saturation, and disrupted sleeping continuity (reduced sleep efficiency and increased microarousal index). The further regression analysis identified minimal levels of peripheral oxygen saturation and sleep efficiency to be the two most important predictors for the decreased time-based prospective memory in stroke patients. OSA independently contributes to the cognitive dysfunction in stroke patients, potentially through OSA-caused hypoxemia and sleeping discontinuity. The prospective memory test is a simple but sensitive method to detect OSA-induced cognitive impairment in stroke patients. Proper therapies of OSA might improve the cognitive function and increase the life quality of stroke patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Improving Outcomes Achieved by a New Stroke Program in Hungary

    Directory of Open Access Journals (Sweden)

    Csilla Égi


    Full Text Available Background: Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a ‘lysis alarm' program in September 2013 at our medical center. Methods: This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013 and after (October 2013-June 2014 the ‘lysis alarm' program was introduced at our medical center. Results: Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The ‘door-to-needle' time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program. In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the ‘lysis alarm' program, we have reached a 4% thrombolysis rate at our medical center. Conclusions: Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome.

  2. Telestroke in stroke survivors. (United States)

    Joubert, Jacques; Joubert, Lynette B; de Bustos, Elizabeth Medeiros; Ware, Dallas; Jackson, David; Harrison, Terrence; Cadilhac, Dominique


    Stroke is a high-frequency disorder placing a significant burden on the health care systems, being the foremost cause of complex chronic disability in adults. Devising systems that can enhance the prevention of stroke recurrence is an important priority and challenge in both the developed and the developing world. The potential for recurrent stroke can be substantially reduced by effective management of vascular risk factors. Telestroke is a tool with potential application to improve risk management of stroke survivors. Lack of acknowledgment of existing practices as well as lack of awareness of potential financial barriers to diffusion of telestroke can lead to limited implementation. Telestroke offers service providers the opportunity to access large numbers of stroke survivors targeting secondary prevention. The ideal 'telestroke model' provides service support, education for the patient and caregiver, as well as integration of specialist and primary care services. Effective use of technological advances, with adequate recognition of the importance of human interaction in the long-term management of a largely elderly population of stroke survivors is challenging but possible. Telestroke should be systems- and not technology-driven. Barriers in the implementation of telestroke have been identified as insufficient planning of IT infrastructure, lack of long-term vision for sustainability, a lack of contextual perspective as well as poor communication across domains. Future telestroke models should provide effective action in an integrated model of care recognizing and involving all existing players and practices. (c) 2009 S. Karger AG, Basel.

  3. Autopsy approach to stroke. (United States)

    Love, Seth


    Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology. © 2010 Blackwell Publishing Limited.

  4. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO


    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

  5. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin


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

  6. Improving public education about stroke. (United States)

    Alberts, Mark J


    Stroke is a common and serious disease. Most studies have shown that basic public knowledge about what a stroke is, symptoms of a stroke, and the proper reaction to a stroke is quite deficient. The fact that a stroke affects cognitive, communicative, and motor functions may partially explain the poor reaction to acute stroke symptoms. Several educational studies, using diverse formats and messaging paradigms, have been shown to positively affect public knowledge of stroke symptoms. Such efforts have often used mass media public education campaigns with an emphasis on recognizing symptoms of an acute stroke. Some have been able to demonstrate an increase in the chance of patients (or by-standers) calling 911 and seeking emergency care. However, many programs were of brief duration, and their long-term benefits are uncertain. Continual educational efforts will be needed to improve stroke knowledge and increase the percentage of patients who seek emergency care. © 2012 New York Academy of Sciences.

  7. Participation Changes in Sexual Functioning after Mild Stroke (United States)

    Seymour, Lisa M.; Wolf, Timothy J.


    The purpose of this study was to explore the extent to which persons with mild stroke experience changes in participation in sexual activity post-stroke. A cross-sectional study was completed with adults 6-18 months post-mild stroke (n = 13); a brief case study was also completed with one of the participants. Participants completed an assessment battery over the phone that included the modified Quality of Sexual Function Scale (QSF), the Stroke Impact Scale (SIS), and the Patient Health Questionnaire-9 (PHQ-9). The sample reported mild problems with sexual dysfunction (M = 10.77, SD = 4.09). Sexual dysfunction post-stroke was highly correlated (r2 = −.372 to −.875) with all the domains on the SIS. Several of the participants in this study reported that they would have liked more information about sexual functioning following stroke. These findings suggest that individuals with mild stroke are experiencing decreased participation in sexual activities post-stroke and that they would like more information from the health care community on the potential sexual changes. PMID:24652075


    Directory of Open Access Journals (Sweden)

    M. H. Harirchian


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

  9. Biomarkers of Acute Stroke Etiology (BASE) Study Methodology. (United States)

    Jauch, Edward C; Barreto, Andrew D; Broderick, Joseph P; Char, Doug M; Cucchiara, Brett L; Devlin, Thomas G; Haddock, Alison J; Hicks, William J; Hiestand, Brian C; Jickling, Glen C; June, Jeff; Liebeskind, David S; Lowenkopf, Ted J; Miller, Joseph B; O'Neill, John; Schoonover, Tim L; Sharp, Frank R; Peacock, W Frank


    Acute ischemic stroke affects over 800,000 US adults annually, with hundreds of thousands more experiencing a transient ischemic attack. Emergent evaluation, prompt acute treatment, and identification of stroke or TIA (transient ischemic attack) etiology for specific secondary prevention are critical for decreasing further morbidity and mortality of cerebrovascular disease. The Biomarkers of Acute Stroke Etiology (BASE) study is a multicenter observational study to identify serum markers defining the etiology of acute ischemic stroke. Observational trial of patients presenting to the hospital within 24 h of stroke onset. Blood samples are collected at arrival, 24, and 48 h later, and RNA gene expression is utilized to identify stroke etiology marker candidates. The BASE study began January 2014. At the time of writing, there are 22 recruiting sites. Enrollment is ongoing, expected to hit 1000 patients by March 2017. The BASE study could potentially aid in focusing the initial diagnostic evaluation to determine stroke etiology, with more rapidly initiated targeted evaluations and secondary prevention strategies.Clinical Trial Registration NCT02014896

  10. Possible Anandamide and Palmitoylethanolamide involvement in human stroke

    Directory of Open Access Journals (Sweden)

    Pizzolato Gilberto


    Full Text Available Abstract Background Endocannabinoids (eCBs are ubiquitous lipid mediators that act on specific (CB1, CB2 and non-specific (TRPV1, PPAR receptors. Despite many experimental animal studies proved eCB involvement in the pathogenesis of stroke, such evidence is still lacking in human patients. Our aim was to determine eCB peripheral levels in acute stroke patients and evaluate their relationship with clinical disability and stroke volume. Methods A cohort of ten patients with a first acute (within six hours since symptoms onset ischemic stroke and a group of eight age- and sex-matched normal subjects were included. Groups were also matched for metabolic profile. All subjects underwent a blood sample collection for anandamide (AEA, 2-arachidonoylglycerol (2-AG and palmitoylethanolamide (PEA measurement; blood sampling was repeated in patients on admission (T0, at 6 (T1 and 18 hours (T2 thereafter. Patients neurological impairment was assessed using NIHSS and Fugl-Meyer Scale arm subitem (FMSa; stroke volume was determined on 48 h follow-up brain CT scans. Blood samples were analyzed by liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry. Results 1T0 AEA levels were significantly higher in stroke patients compared to controls. 2A significant inverse correlation between T0 AEA levels and FMSa score was found. Moreover a positive correlation between T0 AEA levels and stroke volume were found in stroke patients. T0 PEA levels in stroke patients were not significantly different from the control group, but showed a significant correlation with the NIHSS scores. T0 2-AG levels were lower in stroke patients compared to controls, but such difference did not reach the significance threshold. Conclusions This is the first demonstration of elevated peripheral AEA levels in acute stroke patients. In agreement with previous murine studies, we found a significant relationship between AEA or PEA levels and neurological involvement, such

  11. Sleep deprivation attenuates experimental stroke severity in rats

    DEFF Research Database (Denmark)

    Moldovan, Mihai; Constantinescu, Alexandra Oana; Balseanu, Adrian


    Indirect epidemiological and experimental evidence suggest that the severity of injury during stroke is influenced by prior sleep history. The aim of our study was to test the effect of acute sleep deprivation on early outcome following experimental stroke. Young male Sprague-Dawley rats (n=20...... with a 2.5 fold smaller infarct volume and reduced morphological signs of neuronal injury at day 7 after MCAO. Our data suggest that brief TSD induces a neuroprotective response that limits the severity of a subsequent stroke, similar to rapid ischemic preconditioning....... after stroke was monitored using a battery of behavioral tests investigating the asymmetry of sensorimotor deficit (tape removal test and cylinder test), bilateral sensorimotor coordination (rotor-rod and Inclined plane) and memory (T-maze and radial maze). Following MCAO, control rats had impaired...

  12. Primary prevention of stroke by a healthy lifestyle in a high-risk group. (United States)

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


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

  13. Global Cognitive Dysfunction in First Ever Uschaemic Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D


    Full Text Available Cerebro-vascular disease in an important and a frequent cause of dementia. However, the prevalence and magnitude of global cognitive dysfunction in acute stroke has not been studied. Folstein′s mini mental state examination (MMSE is 2 sensitive and reliable test and may serve as a simple tool for screening dementia. Fifty consecutive patients with first ever completed stroke in life and no past history of cognitive disturbances were administered MMSE at least 10 days after the onset of stroke. Cranial CT scans were done in all after 48 hours of stroke. CT scans were blindly analysed and graded for number, location and volume of infarctions, white matter leukoaraiosis (WMLA and cortical and sub cortical atrophy. The radiological parameters of those with MMSE score of 23 or less on MMSE. Of all the conventional risk factors, only age of the patients was significantly higher in the "demented" group. Of the radiological parameters namely-number and volume of infarcts, WMLA, bi-frontal ratio (BFR, 3rd ventricular ratio (3 VR, cella media index (CMI and cortical index (CI, only cortical index was significantly more among patients with lower MMSE scores. Prevalence of global cerebral dysfunction first ever ischaemic stroke was 46% in this study. Advanced age and cortical atrophy appear to contribute to the low scores on MMSE. Though, volume and number of infarctions were higher among patients with low score, the differences were not statistically significant.

  14. Relearning the Basics: Rehabilitation after a Stroke (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Relearning the Basics: Rehabilitation After a Stroke Past ... to help them recover successfully. What is post-stroke rehabilitation? Rehab helps stroke survivors relearn skills lost to ...

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

    Directory of Open Access Journals (Sweden)

    Mi Kyoung Son

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

  16. Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter Aortic Valve Implantation. (United States)

    Muralidharan, Aditya; Thiagarajan, Karthy; Van Ham, Raymond; Gleason, Thomas G; Mulukutla, Suresh; Schindler, John T; Jeevanantham, Vinodh; Thirumala, Parthasarathy D


    Transcatheter aortic valve implantation (TAVI) is a rapidly evolving safe method with decreasing incidence of perioperative stroke. There is a void in literature concerning the impact of stroke after TAVI in predicting 30-day stroke-related mortality. The primary aim of this meta-analysis was to determine whether perioperative stroke increases risk of stroke-related mortality after TAVI. Online databases, using relevant keywords, and additional related records were searched to retrieve articles involving TAVI and stroke after TAVI. Data were extracted from the finalized studies and analyzed to generate a summary odds ratio (OR) of stroke-related mortality after TAVI. The stroke rate and stroke-related mortality rate in the total patient population were 3.07% (893 of 29,043) and 12.27% (252 of 2,053), respectively. The all-cause mortality rate was 7.07% (2,053 of 29,043). Summary OR of stroke-related mortality after TAVI was estimated to be 6.45 (95% confidence interval 3.90 to 10.66, p York Heart Association class III/IV status, previous stroke, valve type, and implantation route. All failed to exhibit any significant associations with the OR. In conclusion, perioperative strokes after TAVI are associated with >6 times greater risk of 30-day stroke-related mortality. Transapical TAVI is not associated with increased stroke-related mortality in patients who suffer from perioperative stroke. Preventative measures need to be taken to alleviate the elevated rates of stroke after TAVI and subsequent direct mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. CT perfusion in acute stroke calls: a pictorial review and differential diagnoses

    International Nuclear Information System (INIS)

    Chiu, Albert H; Phillips, Timothy J.; Phatouros, Constantine C.; Singh, Tejinder P.; McAuliffe, William; Hankey, Graeme; Blacker, David J.


    CT perfusion is increasingly utilised in hyperacute stroke to facilitate diagnosis and patient selection for reperfusion therapies. This review article demonstrates eight examples of how CT perfusion can be used to diagnose stroke mimics and small volume infarcts, which can be easily missed on non-contrast CT, and to suggest the presence of an ischaemic penumbra. Radiologists involved in stroke management must understand the importance of rapid imaging acquisition and be confident in the prospective interpretation of this powerful diagnostic tool as we move into a new era of hyperacute stroke care.

  18. Intravoxel incoherent motion diffusion-weighted imaging in stroke patients: initial clinical experience

    International Nuclear Information System (INIS)

    Yao, Y.; Zhang, S.; Tang, X.; Zhang, S.; Shi, J.; Zhu, W.; Zhu, W.


    Aim: To evaluate the feasibility of using intravoxel incoherent motion (IVIM) to measure diffusion and perfusion parameter variations in stroke. Materials and methods: Thirty-eight stroke patients were enrolled in the study. IVIM imaging was performed using 15 b-values from 0 to 1000 s/mm 2 . Arterial spin labelling (ASL) magnetic resonance perfusion was also undertaken. Relations between the IVIM parameters (including apparent diffusion coefficient [ADC], diffusion coefficient D slow [D], pseudo-diffusion coefficient D fast [D*], fractional perfusion-related volume [f]) and fD* (the multiplication of the first two parameters) and the ASL-derived parameter, cerebral blood flow (CBF), were analysed using paired t-tests. Comparisons of all the parameters between lesions and contralateral normal regions, as well as between acute and subacute groups were analysed using Student's t-test. Results: There were positive correlations between f and CBF as well as fD* and CBF (r=0.472 and 0.653). Quantitative analysis showed a significant decrease in ADC, D, D*, f, fD*, and CBF of the lesions compared with the contralateral side, in which the decrease of fD* (68.6%) was highest. The values of ADC, f, and fD* increased in the subacute period group compared with the acute period group. Conclusions: IVIM analysis allowed separation of perfusion contribution from true diffusion and thus provided an evaluation of the perfusion and diffusion variations during stroke, which might further elucidate the mechanisms of ischaemic stroke. - Highlights: • There exist positive correlations between fractional perfusion-related volume (f) and cerebral blood flow (CBF) as well as fD ∗ and CBF. • A significant decrease in ADC, diffusion coefficient D slow (D), pseudo-diffusion coefficient D fast (D ∗ ), f, fD ∗ and CBF of the lesions compared with the contralateral normal regions. • The values of ADC, f and fD ∗ increase significantly in the subacute period compared with the

  19. Collateral flow as causative of good outcomes in endovascular stroke therapy. (United States)

    Sheth, Sunil A; Sanossian, Nerses; Hao, Qing; Starkman, Sidney; Ali, Latisha K; Kim, Doojin; Gonzalez, Nestor R; Tateshima, Satoshi; Jahan, Reza; Duckwiler, Gary R; Saver, Jeffrey L; Vinuela, Fernando; Liebeskind, David S


    Endovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome. Demographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010. Higher collateral grade as assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading scheme on angiography at the time of presentation was associated with improved reperfusion rates after endovascular intervention, decreased post-procedural hemorrhage, smaller infarcts on presentation and discharge, as well as improved neurological function on arrival to the hospital, discharge, and 90 days later. Patients matched by vessel occlusion, age, and time of onset demonstrated smaller strokes on presentation and better functional and radiographic outcome if found to have superior collateral flow. In multivariate analysis, lower collateral grade independently predicted higher NIHSS on arrival. Improved collateral flow in patients with AIS undergoing endovascular therapy was associated with improved radiographic and clinical outcomes. Independent of age, vessel occlusion and time, in patients with comparable ischemic burdens, changes in collateral grade alone led to significant differences in initial stroke severity as well as ultimate clinical outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. Arctigenin attenuates ischemic stroke via SIRT1-dependent inhibition of NLRP3 inflammasome. (United States)

    Zhang, Shimeng; Jiang, Liangjun; Che, Fengyuan; Lu, Yucheng; Xie, Zhongxiang; Wang, Hao


    Arctigenin (ARC), a phenylpropanoid dibenzylbutyrolactone lignan derived from Arctium lappa L, has been reported to protect against cerebral ischemia injury in rats, but the underlying mechanism is unclear. In this study, we investigated whether ARC ameliorated ischemic stroke by inhibiting NLRP3 inflammasome-derived neuroinflammation and whether SIRT1 signaling was involved in this process. ARC (20 mg/kg) or vehicle were intraperitoneally injected to Sprague-Dawley rats for 3 days before middle cerebral artery occlusion (MCAO) surgery performed. The infarct volume, neurological score, brain water content, neuroinflammation, NLRP3 inflammasome activation and SIRT1 protein expression were assessed. Furthermore, we also investigated whether ARC protected against cerebral ischemia via SIRT1-dependent inhibition of NLRP3 inflammasome by administrating EX527, a specific SIRT1 inhibitor, under oxygen-glucose deprivation (OGD) condition. We found that ARC pretreatment decreased infarct volume, neurological score and brain water content. Moreover, ARC treatment effectively inhibited cerebral ischemia induced NLRP3 inflammasome activation and IL-1β, IL-18 secretion both in vivo and in vitro. Futhermore, ARC treatment activated Silent information regulator 1 (SIRT1) singnaling in the brain. Importantly, suppress of SIRT1 reversed the inhibitory effect of ARC on NLRP3 inflammasome activation. Taken together our results demonstrated that ARC may confer protection against ischemic stroke by inhibiting NLRP3 inflammasome activation. The activation of SIRT1 signaling pathway may contribute to the neuroprotection of ARC in MCAO. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Mini-Stroke vs. Regular Stroke: What's the Difference? (United States)

    ... How is a ministroke different from a regular stroke? Answers from Jerry W. Swanson, M.D. When ... brain, spinal cord or retina, which may cause stroke-like symptoms but does not damage brain cells ...

  2. Significance of left ventricular volume measurement after heart transplantation using radionuclide techniques

    International Nuclear Information System (INIS)

    Novitzky, D.; Cooper, D.; Boniaszczuk, J.


    Multigated equilibrium blood pool scanning using Technetium 99m labeled red blood cells was used to measure left ventricular volumes in three heterotopic and one orthotopic heart transplant recipient(s). Simultaneously, an endomyocardial biopsy was performed and the degree of acute rejection was assessed by a histological scoring system. The scores were correlated to changes in ejection fraction and heart rate. Technetium 99m scanning data were pooled according to the endomyocardial biopsy score: no rejection; mild rejection; moderate rejection, and severe rejection. In each group, the median of the left ventricular volume parameters was calculated and correlated with the endomyocardial biopsy score, using a non-parametric one-way analysis of variance. A decrease in stroke volume correlated best with the endomyocardial biopsy score during acute rejection. A decrease in end-diastolic left ventricular volumes did not correlate as well. Changes in the end-systolic left ventricular volumes were not statistically significant, but using a simple correlation between end-systolic left ventricular volumes and endomyocardial biopsy the correlation reached significance. Changes in left ventricular volumes measured by Technetium 99m scanning may be useful to confirm the presence or absence of acute rejection in patients with heart grafts

  3. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes. (United States)

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


    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.

  4. Stroke risk perception among participants of a stroke awareness campaign


    Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus


    Abstract Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. S...

  5. Child-Mediated Stroke Communication: findings from Hip Hop Stroke. (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William


    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.

  6. World Stroke Organization Global Stroke Services Guidelines and Action Plan


    Lindsay, Patrice; Furie, Karen L.; Davis, Stephen M.; Donnan, Geoffrey A.; Norrving, Bo


    Every two seconds, someone across the globe suffers a symptomatic stroke. 'Silent' cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence-based approaches to stroke prevention,...


    Feigin, Valery L.; Krishnamurthi, Rita; Parmar, Priya; Norrving, Bo; Mensah, George A.; Bennett, Derrick A.; Barker-Collo, Suzanne; Moran, Andrew; Sacco, Ralph L.; Truelsen, Thomas; Davis, Stephen; Pandian, Jeyaraj Durai; Naghavi, Mohsen; Forouzanfar, Mohammad H.; Nguyen, Grant; Johnson, Catherine O.; Vos, Theo; Meretoja, Atte; Murray, Christopher; Roth, Gregory A.; Thrift, Amanda; Banerjee, Amitava; Kengne, Andre Pascal; Misganaw, Awoke; Kissela, Brett M.; Wolfe, Charles; Yu, Chuanhua; Anderson, Craig; Kim, Daniel; Rojas-Rueda, David; Tanne, David; Tirschwell, David Lawrence; Nand, Devina; Kazi, Dhruv S.; Pourmalek, Farshad; Catalá-López, Ferrán; Abd-Allah, Foad; Gankpé, Fortuné; deVeber, Gabrielle; Donnan, Geoffrey; Hankey, Graeme J.; Christensen, Hanne K.; Campos-Nonato, Ismael; Shiue, Ivy; Fernandes, Jefferson G.; Jonas, Jost B.; Sheth, Kevin; Kim, Yunjin; Dokova, Klara; Stroumpoulis, Konstantinos; Sposato, Luciano A.; Bahit, Maria Cecilia; Geleijnse, Johanna M.; Mackay, Mark T.; Mehndiratta, Man Mohan; Endres, Matthias; Giroud, Maurice; Brainin, Michael; Kravchenko, Michael; Piradov, Michael; Soljak, Michael; Liu, Ming; Connor, Myles; Venketasubramanian, Narayanaswamy; Bornstein, Natan; Shamalov, Nikolay; Roy, Nobhojit; Cabral, Norberto; Beauchamp, Norman J.; Lavados, Pablo M.; Jeemon, Panniyammakal; Lotufo, Paulo A.; Chowdhury, Rajiv; Sahathevan, Ramesh; Hamadeh, Randah R.; Malekzadeh, Reza; Gillium, Richard; Westerman, Ronny; Akinyemi, Rufus Olusola; Salman, Rustam Al-Shahi; Dharmaratne, Samath D.; Basu, Sanjay; Abera, Semaw Ferede; Kosen, Soewarta; Sampson, Uchechukwu K. A.; Caso, Valeria; Vlassov, Vasiliy; Melaku, Yohannes Adama; Kokubo, Yoshiohiro; Shinohara, Yukito; Varakin, Yuri; Wang, Wenzhi


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

  8. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William


    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

  9. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.


    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring

  10. [Neuroimaging and Blood Biomarkers in Functional Prognosis after Stroke]. (United States)

    Branco, João Paulo; Costa, Joana Santos; Sargento-Freitas, João; Oliveira, Sandra; Mendes, Bruno; Laíns, Jorge; Pinheiro, João


    Stroke remains one of the leading causes of morbidity and mortality around the world and it is associated with an important long-term functional disability. Some neuroimaging resources and certain peripheral blood or cerebrospinal fluid proteins can give important information about etiology, therapeutic approach, follow-up and functional prognosis in acute ischemic stroke patients. However, among the scientific community, there is currently more interest in the stroke vital prognosis over the functional prognosis. Predicting the functional prognosis during acute phase would allow more objective rehabilitation programs and better management of the available resources. The aim of this work is to review the potential role of acute phase neuroimaging and blood biomarkers as functional recovery predictors after ischemic stroke. Review of the literature published between 2005 and 2015, in English, using the terms "ischemic stroke", "neuroimaging" e "blood biomarkers". We included nine studies, based on abstract reading. Computerized tomography, transcranial doppler ultrasound and diffuse magnetic resonance imaging show potential predictive value, based on the blood flow study and the evaluation of stroke's volume and localization, especially when combined with the National Institutes of Health Stroke Scale. Several biomarkers have been studied as diagnostic, risk stratification and prognostic tools, namely the S100 calcium binding protein B, C-reactive protein, matrix metalloproteinases and cerebral natriuretic peptide. Although some biomarkers and neuroimaging techniques have potential predictive value, none of the studies were able to support its use, alone or in association, as a clinically useful functionality predictor model. All the evaluated markers were considered insufficient to predict functional prognosis at three months, when applied in the first hours after stroke. Additional studies are necessary to identify reliable predictive markers for functional

  11. Ipsilateral hippocampal atrophy is associated with long-term memory dysfunction after ischemic stroke in young adults. (United States)

    Schaapsmeerders, Pauline; van Uden, Inge W M; Tuladhar, Anil M; Maaijwee, Noortje A M; van Dijk, Ewoud J; Rutten-Jacobs, Loes C A; Arntz, Renate M; Schoonderwaldt, Hennie C; Dorresteijn, Lucille D A; de Leeuw, Frank-Erik; Kessels, Roy P C


    Memory impairment after stroke in young adults is poorly understood. In elderly stroke survivors memory impairments and the concomitant loss of hippocampal volume are usually explained by coexisting neurodegenerative disease (e.g., amyloid pathology) in interaction with stroke. However, neurodegenerative disease, such as amyloid pathology, is generally absent at young age. Accumulating evidence suggests that infarction itself may cause secondary neurodegeneration in remote areas. Therefore, we investigated the relation between long-term memory performance and hippocampal volume in young patients with first-ever ischemic stroke. We studied all consecutive first-ever ischemic stroke patients, aged 18-50 years, admitted to our academic hospital center between 1980 and 2010. Episodic memory of 173 patients was assessed using the Rey Auditory Verbal Learning Test and the Rey Complex Figure and compared with 87 stroke-free controls. Hippocampal volume was determined using FSL-FIRST, with manual correction. On average 10 years after stroke, patients had smaller ipsilateral hippocampal volumes compared with controls after left-hemispheric stroke (5.4%) and right-hemispheric stroke (7.7%), with most apparent memory dysfunctioning after left-hemispheric stroke. A larger hemispheric stroke was associated with a smaller ipsilateral hippocampal volume (b=-0.003, Pstroke (b=-0.028 ml, P=0.002) and right-hemispheric stroke (b=-0.015 ml, P=0.03). Our results suggest that infarction is associated with remote injury to the hippocampus, which may lower or expedite the threshold for cognitive impairment or even dementia later in life. © 2015 Wiley Periodicals, Inc.

  12. Obstructive Sleep Apnea as an Independent Stroke Risk Factor: A Review of the Evidence, Stroke Prevention Guidelines, and Implications for Neuroscience Nursing Practice. (United States)

    King, Sharon; Cuellar, Norma


    Stroke is a leading cause of death and disability affecting nearly 800,000 people in the United States every year. Obstructive sleep apnea (OSA) is found in over 60% of patients with stroke/transient ischemic attack (TIA) and identified as an independent stroke risk factor in large epidemiology studies and Canadian Stroke Prevention Guidelines (SPG) but not in the United States. The 2014 Secondary SPG recommend OSA screening and treatment as a consideration only, not a requirement. The twofold purpose of this article is, first, to present the evidence supporting OSA as an independent stroke risk factor in national SPG with mandatory recommendations and, second, to engage neuroscience nurses to incorporate OSA assessment and interventions into the nursing process and thereby promote excellence in stroke/TIA patient care. A systematic literature search was conducted in Medline, CINAHL, and PubMed to identify research from 2003 through 2013 on the independent risk, mortality, and prevalence relationship between OSA and stroke/TIA including recurrence and recovery outcomes with continuous positive airway pressure (CPAP) therapy. Twenty-eight research articles were reviewed: 14 observational cohorts, five case-control studies, four cross-sectional studies, and four randomized control trials representing 12 countries and 10,671 subjects. OSA is highly prevalent in patients with stroke/TIA independently increasing stroke risk. CPAP studies revealed reduced stroke recurrence and improved recovery with feasible initiation in stroke units. Patients with stroke/TIA have less OSA-associated daytime sleepiness and obesity, making the usual screening tools insufficient and CPAP adherence challenging. Treating OSA decreases stroke prevalence and mortality. OSA initiatives empower neuroscience nurses to integrate this OSA evidence into clinical practice and improve stroke/TIA patient outcomes.

  13. Weakness of Eye Closure with Central Facial Paralysis after Unilateral Hemispheric Stroke Predicts a Worse Outcome. (United States)

    Lin, Jianwen; Chen, Yicong; Wen, Hongmei; Yang, Zhiyun; Zeng, Jinsheng


    Upper facial dysfunction is not generally considered a feature of central facial paralysis after unilateral hemispheric stroke; however, weakness of eye closure (WEC) has been observed in some cases. We aimed to investigate the frequency and characteristics of WEC in unilateral stroke and its association with stroke prognosis. Patients with unilateral stroke and central facial paralysis were prospectively recruited within 7 days of onset. Facial paralysis was evaluated via the fourth item in the National Institute of Health Stroke Scale (NIHSS-4) and the Japan Facial Score (JFS) on admission, and at days 7, 14, 21, and 30 after stroke. Eye closure strength was measured daily using an ergometer for 30 days after stroke. Primary outcome was assessed using the modified Rankin Scale (mRS) at 90 and 180 days. Univariate and multivariate analyses were performed to investigate risk factors of WEC. WEC was identified in 16 of 242 patients (6.6%). Baseline characteristics, stroke risk factors, and lesion volume were not significantly different between patients with and patients without WEC. Patients with WEC featured higher NIHSS-4 scores and lower JFS between admission and at 21 days after stroke. Severe central facial paralysis (odds ratio [OR] = 8.1, 95% confidence interval [CI] = 2.3-28.6, P = .001) and right hemispheric stroke (OR = 13.7, 95% CI = 3.7-51.2, P WEC. At 180 days after stroke, patients with WEC demonstrated a lower rate of functional independence (mRS = 0-2: 37.5% versus 72.1%, P WEC, which predicts a worse functional outcome at 180 days after unilateral stroke, demonstrates an association with severe central facial paralysis and right hemispheric stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Fibroblast Growth Factor Type 1 (FGF1)-Overexpressed Adipose-Derived Mesenchaymal Stem Cells (AD-MSCFGF1) Induce Neuroprotection and Functional Recovery in a Rat Stroke Model. (United States)

    Ghazavi, Hamed; Hoseini, Seyed Javad; Ebrahimzadeh-Bideskan, Alireza; Mashkani, Baratali; Mehri, Soghra; Ghorbani, Ahmad; Sadri, Kayvan; Mahdipour, Elahe; Ghasemi, Faezeh; Forouzanfar, Fatemeh; Hoseini, Azar; Pasdar, Ali Reza; Sadeghnia, Hamid Reza; Ghayour-Mobarhan, Majid


    Stroke, as the second most common cause of death, imposes a great financial burden on both the individual and society. Mesenchymal stem cells from rodents have demonstrated efficacy in experimental animal models of stroke due to enhanced neurological recovery. Since FGF1 (fibroblast growth factor 1) displays neuroprotective properties, for the first time, we investigated the effect of acute intravenous administration of FGF1 gene transfected adipose-derived mesenchymal stem cell (AD-MSC FGF1 ) on transient experimental ischemic stroke in rats. Stroke induction was made by transient middle cerebral artery occlusion (tMCAO). 2 × 10 6  AD-MSC FGF1 was administrated intravenously 30 min after carotid reperfusion. The ability of technetium 99m -hexamethyl propylene amine oxime ( 99m Tc-HMPAO)-labeled AD-MSC FGF1 to enter into ischemic brain was evaluated 2 h post injection. 24 h post operation, the neurological recovery (rotarod and Roger's tests), the infarct volume (2, 3, 5-triphenyltetrazolium chloride, TTC assay), apoptosis rate (TUNEL assay), and the expression of FGF1 protein (western blotting) in the ischemic hemisphere were assessed. The 99m Tc-HMPAO-labeled AD-MSC FGF1 could enter into the ischemic brain. Ischemic hemisphere activity was significantly higher than that observed in the contralateral hemisphere (p = 0.002). The administration of AD-MSC FGF1 resulted in significant improvement of neurological function tests and increased density of FGF1 protein in the peri-infarct area, while the infarct volume and the apoptotic index were significantly decreased, in comparison to the other treated groups. In conclusion, acute intravenous administration of AD-MSC FGF1 can be a novel and promising candidate approach for the treatment of ischemic stroke.

  15. Diabetes, Heart Disease, and Stroke (United States)

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  16. The obesity paradox in stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj


    . Data include age, gender, civil status, stroke severity, computed tomography, and cardiovascular risk factors. Patients were followed up to 9·8 years (median 2·6 years). We used Cox regression models to compare risk of death and readmission for recurrent stroke in the four body mass index groups......BACKGROUND: Although associated with excess mortality and morbidity, obesity is associated with lower mortality after stroke. The association between obesity and risk of recurrent stroke is unclear. AIMS: The study aims to investigate the association in stroke patients between body mass index...... and risk of death and readmission for recurrent stroke. METHODS: An administrative Danish quality-control registry designed to collect a predefined dataset on all hospitalized stroke patients in Denmark 2000–2010 includes 45 615 acute first-ever stroke patients with information on body mass index in 29 326...

  17. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press


    Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.

  18. Dynamic CT Perfusion Imaging for the Detection of Crossed Cerebellar Diaschisis in Acute Ischemic Stroke

    International Nuclear Information System (INIS)

    Jeon, Young Wook; Kim, Seo Hyun; Lee, Ji Young; Whang, Kum; Kim, Myung Soon; Kim, Young Ju; Lee, Myeong Sub; Brain Reserch Group


    Although the detection of crossed cerebellar diaschisis (CCD) by means of different imaging modalities is well described, little is known about its diagnosis by computed tomography perfusion (CTP) imaging. We investigated the detection rate of CCD by CTP imaging and the factors related to CCD on CTP images in patients with acute ischemic stroke. CT perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) obtained from 81 consecutive patients affected by an acute ischemic stroke were retrospectively reviewed. Whole-brain perfusion maps were obtained with a multichannel CT scanner using the toggling-table technique. The criteria for CCD was a unilateral supratentorial ischemic lesion and an accompanying decrease in perfusion of the contralateral cerebellar hemisphere on the basis of CTP maps by visual inspection without a set threshold. Maps were quantitatively analyzed in CCD positive cases. The criteria for CCD were fulfilled in 25 of the 81 cases (31%). Detection rates per CTP map were as follows: MTT (31%) > TTP (21%) > CBF (9%) > CBV (6%). Supratentorial ischemic volume, degree of perfusion reduction, and infratentorial asymmetry index correlated strongly (R, 0.555-0.870) and significantly (p < 0.05) with each other in CCD-positive cases. It is possible to detect CCD on all four of the CTP-based maps. Of these maps, MTT is most sensitive in detecting CCD. Our data indicate that CTP imaging is a valid tool for the diagnosis of CCD in patients affected by an acute hemispheric stroke.

  19. Depletion of Cultivatable Gut Microbiota by Broad-Spectrum Antibiotic Pretreatment Worsens Outcome After Murine Stroke (United States)

    Winek, Katarzyna; Engel, Odilo; Koduah, Priscilla; Heimesaat, Markus M.; Fischer, André; Bereswill, Stefan; Dames, Claudia; Kershaw, Olivia; Gruber, Achim D.; Curato, Caterina; Oyama, Naoki; Meisel, Christian; Meisel, Andreas


    Background and Purpose— Antibiotics disturbing microbiota are often used in treatment of poststroke infections. A bidirectional brain–gut microbiota axis was recently suggested as a modulator of nervous system diseases. We hypothesized that gut microbiota may be an important player in the course of stroke. Methods— We investigated the outcome of focal cerebral ischemia in C57BL/6J mice after an 8-week decontamination with quintuple broad-spectrum antibiotic cocktail. These microbiota-depleted animals were subjected to 60 minutes middle cerebral artery occlusion or sham operation. Infarct volume was measured using magnetic resonance imaging, and mice were monitored clinically throughout the whole experiment. At the end point, tissues were preserved for further analysis, comprising histology and immunologic investigations using flow cytometry. Results— We found significantly decreased survival in the middle cerebral artery occlusion microbiota-depleted mice when the antibiotic cocktail was stopped 3 days before surgery (compared with middle cerebral artery occlusion specific pathogen-free and sham-operated microbiota-depleted mice). Moreover, all microbiota-depleted animals in which antibiotic treatment was terminated developed severe acute colitis. This phenotype was rescued by continuous antibiotic treatment or colonization with specific pathogen-free microbiota before surgery. Further, infarct volumes on day one did not differ between any of the experimental groups. Conclusions— Conventional microbiota ensures intestinal protection in the mouse model of experimental stroke and prevents development of acute and severe colitis in microbiota-depleted mice not given antibiotic protection after cerebral ischemia. Our experiments raise the clinically important question as to whether microbial colonization or specific microbiota are crucial for stroke outcome. PMID:27056982

  20. Dynamic CT Perfusion Imaging for the Detection of Crossed Cerebellar Diaschisis in Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Young Wook; Kim, Seo Hyun; Lee, Ji Young; Whang, Kum; Kim, Myung Soon; Kim, Young Ju; Lee, Myeong Sub; Brain Reserch Group [Wonju Christian Hospital, Yonsei University Wonju University College of Medicine, Wonju (Korea, Republic of)


    Although the detection of crossed cerebellar diaschisis (CCD) by means of different imaging modalities is well described, little is known about its diagnosis by computed tomography perfusion (CTP) imaging. We investigated the detection rate of CCD by CTP imaging and the factors related to CCD on CTP images in patients with acute ischemic stroke. CT perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) obtained from 81 consecutive patients affected by an acute ischemic stroke were retrospectively reviewed. Whole-brain perfusion maps were obtained with a multichannel CT scanner using the toggling-table technique. The criteria for CCD was a unilateral supratentorial ischemic lesion and an accompanying decrease in perfusion of the contralateral cerebellar hemisphere on the basis of CTP maps by visual inspection without a set threshold. Maps were quantitatively analyzed in CCD positive cases. The criteria for CCD were fulfilled in 25 of the 81 cases (31%). Detection rates per CTP map were as follows: MTT (31%) > TTP (21%) > CBF (9%) > CBV (6%). Supratentorial ischemic volume, degree of perfusion reduction, and infratentorial asymmetry index correlated strongly (R, 0.555-0.870) and significantly (p < 0.05) with each other in CCD-positive cases. It is possible to detect CCD on all four of the CTP-based maps. Of these maps, MTT is most sensitive in detecting CCD. Our data indicate that CTP imaging is a valid tool for the diagnosis of CCD in patients affected by an acute hemispheric stroke.

  1. Does Stroke Contribute to Racial Differences in Cognitive Decline? (United States)

    Levine, Deborah A.; Kabeto, Mohammed; Langa, Kenneth M.; Lisabeth, Lynda D.; Rogers, Mary A.M.; Galecki, Andrzej T.


    Background and Purpose It is unknown whether blacks’ elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition. Methods Among 4908 black and white participants aged ≥65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998–2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time. Results We identified 34 of 453 (7.5%) blacks and 300 of 4455 (6.7%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black–white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; Pstroke on cognition did not statistically differ by race (P=0.52). Conclusions In this population-based cohort of older adults, incident stroke did not explain black–white differences in cognitive decline or impact cognition differently by race. PMID:25999389

  2. Mean platelet volume and mean platelet volume/platelet count ratio ...

    African Journals Online (AJOL)

    ... platelet volume (MPV) is a laboratory marker associated with platelet function and activity. Increased MPV in thromboembolic disease is reflected as an important risk factor. The aim of this study was to compare the MPV and mean platelet volume/platelet count (MPV/PC) ratio between ischemic cerebrovascular stroke and ...

  3. Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation. (United States)

    Isono, Naofumi; Imamura, Yuki; Ohmura, Keiko; Ueda, Norihide; Kawabata, Shinji; Furuse, Motomasa; Kuroiwa, Toshihiko


    For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. A minimal transthyretin concentration (stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.



    Sujatha; Ramalingam; Vinodkumar; Vasumathi; Valarmathi; Anu


    BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess fu...

  5. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara


    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR\\'s ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  6. Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study. (United States)

    Nacu, A; Fromm, A; Sand, K M; Waje-Andreassen, U; Thomassen, L; Naess, H


    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.

  7. Personal accounts of stroke experiences

    NARCIS (Netherlands)

    Wachters-Kaufmann, CSM


    As there appeared to be a need for personal accounts of stroke experiences, a book called "Speaking about Stroke" was written for stroke patients and their caregivers. For the past two years, a questionnaire was sent to the people who had ordered the book, to gain an insight into the characteristics

  8. Questions and Answers about Stroke (United States)

    ... stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition ... leading cause of serious, long-term adult disability. Four million Americans are living with the effects of stroke. The length of time to recover from a ...

  9. Stroke and Episodic Memory Disorders (United States)

    Lim, Chun; Alexander, Michael P.


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

  10. Intakes of Vegetables and Fruits are Negatively Correlated with Risk of Stroke in Iran. (United States)

    Hariri, Mitra; Darvishi, Leila; Maghsoudi, Zahra; Khorvash, Fariborz; Aghaei, Mahmud; Iraj, Bijan; Ghiasvand, Reza; Askari, Gholamreza


    Stroke is a leading cause of death. Current therapeutic strategies have been unsuccessful. Several studies have reported benefits on reducing stroke risk and improving the poststroke associated functional declines in patients who ate foods rich in fruits and vegetables. Their potential protective effects may be due to their antioxidants, calcium, potassium, riboflavine, peridoxin, riboflavin contents. Folic acid, peridoxin, and riboflavin are all cofactors in hyperhomocysteinemia as a stroke risk factor.Studies suggest that oxidative stress plays important roles in pathogenesis of ischemic cerebral injury and higher intake of antioxidants has been associated with a lower stroke risk. The aim of this study was to examine if the dietary intake of vegetables and fruits in patients with stroke were comparatively worse than those in patients without stroke. In this case control study, 93 stroke patients admitted to Alzahra hospital were matched for age and sex with 60 patients who were not affected with acute cerebrovascular diseases and did not have a history of stroke. Dietary intake was assessed with a validated food frequency questionnaire.Food intakes were compared between two groups and with recommended value. Mean daily intake of vegetable and fruits was more in male with stroke than male without stroke as well as calorie intake from vegetables and fruit was higher in male with stroke.Mean daily intake of vegetable and fruits were lower in women with stroke than women without stroke as well as calorie intake from vegetables and fruit was lower in women with stroke. Our findings suggest that increased vegetable and fruits intake may be associated with decreased risk of stroke.

  11. Epidemiology of stroke in the elderly in the Nordic countries. Incidence, survival, prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Torgeir Engstad


    Full Text Available Objective: To review what is known at present with respect to incidence, survival, risk factors and prevalence among the elderly stroke patients in the Nordic countries.Method: This article is based mainly on literature identified through search engines (Mc Master Plus, Cochrane Library, Medline and PubMed, restricted to first-ever stroke in Nordic population-based studies and having applied to the standard WHO definition, a prospective study design and no upper age limit.Results: Data from the Nordic countries show an incidence rate of 1250 to 1796/100 000 in the age group 75-84, and 1628 to 2234 in those above 85 years. The incidence rates are higher among men, but women are expected to contribute more to incident cases due to their higher life expectancy. If the age-specific incidence of stroke remains stable, the proportion of stroke patients aged 80 years and older may reach 50% in a few decades. The elderly stroke patients have a higher 30-days case fatality, and a higher risk of dependency. Better treatment of stroke patients has improved the survival over the last two decades. The prevalence is expected to increase due to the decrease in lethality, a slower fall in incidence and a higher proportion of elderly. Cardiovascular risk factors increase with age. Hypertension is a major risk factor for stroke mortality in the elderly. Cardioembolic stroke due to atrial fibrillation is the most common stroke subtype in the elderly. Lifestyle risk factors are less prevalent in the older stroke patients.Conclusion: The growing proportion of elderly stroke patients is a major challenge for future stroke care. The elderly stroke patients have a different risk factor profile compared to younger stroke patients. Treatment should focus on regaining independency. The age-specific epidemiology of stroke needs to be studied further in large studies in order to plan for future health care.

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


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


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

  13. Prevention, management, and rehabilitation of stroke in low- and middle-income countries

    Directory of Open Access Journals (Sweden)

    Lijing L. Yan


    Full Text Available Although stroke incidence in high-income countries (HICs decreased over the past four decades, it increased dramatically in low- and middle-income countries (LMICs. In this review, we describe the current status of primary prevention, treatment, and management of acute stroke and secondary prevention of and rehabilitation after stroke in LMICs. Although surveillance, screening, and accurate diagnosis are important for stroke prevention, LMICs face challenges in these areas due to lack of resources, awareness, and technical capacity. Maintaining a healthy lifestyle, such as no tobacco use, healthful diet, and physical activity are important strategies for both primary and secondary prevention of stroke. Controlling high blood pressure is also critically important in the general population and in the acute stage of hemorrhagic stroke. Additional primary prevention strategies include community-based education programs, polypill, prevention and management of atrial fibrillation, and digital health technology. For treatment of stroke during the acute stage, specific surgical procedures and medications are recommended, and inpatient stroke care units have been proven to provide high quality care. Patients with a chronic condition like stroke may require lifelong pharmaceutical treatment, lifestyle maintenance and self-management skills, and caregiver and family support, in order to achieve optimal health outcomes. Rehabilitation improves physical, speech, and cognitive functioning of disabled stroke patients. It is expected that home- or community-based services and tele-rehabilitation may hold special promise for stroke patients in LMICs.

  14. Left atrial volume and function in dogs with naturally occurring myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Höllmer, M.; Willesen, J. L.; Tolver, A.


    stroke volume increased, whereas LA reservoir and contractile function decreased with increasing disease severity. A maximal LA volume heart failure in dogs with chronic MMVD with a sensitivity of 96% and a specificity of 100......%. An active LA emptying fraction heart failure in dogs with chronic MMVD with a sensitivity of 77% and a specificity of 89% and a sensitivity of 82% and a specificity of 82%, respectively. CONCLUSION: Dogs with MMVD appear to have larger LA...... of cardiac compensation. Left atrial function in dogs with naturally occurring MMVD remains largely unexplored. The objective of this study was to evaluate LA volume and function in dogs with naturally occurring MMVD. ANIMALS: This prospective study included 205 client-owned dogs of different breeds, 114...

  15. Decreased endogenous progesterone and ratio of progesterone to ...

    African Journals Online (AJOL)



    Feb 1, 2010 ... Decreased endogenous progesterone and ratio of progesterone to estrogen in stroke ischemia. Nasrin Sheikh1, Heidar Tavilani1* and Aliakbar Rezaie2. 1Department of Biochemistry, School of Medicine Hamadan University of Medical Sciences, Hamadan, Iran. 2Department of Neurology, School of ...

  16. Sex and Intimacy after Stroke. (United States)

    Kautz, Donald D; Van Horn, Elizabeth R

    The sequelae of a stroke can negatively affect sex and intimacy for survivors and their partners. This clinical article offers practical evidence-based recommendations for nurses to use in advising couples who may be experiencing sexual problems due to decreased desire, erectile dysfunction, vaginal dryness, paraparesis, pain, spasticity, fatigue, aphasia, concrete thinking, emotional lability, shame, embarrassment, fear, depression, or neurogenic bladder. Recent research and clinical articles show that intimacy and sexual concerns are often ignored by the rehabilitation team, yet research shows that couples want information to assist them to maintain their sexual relationships. Using the PLISSIT model to address sexual concerns, nurses can facilitate discussions to aid couples toward improved sexual function and quality of life.

  17. Family History in Young Patients With Stroke. (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


    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: Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  18. Effects of aquatic physiotherapy on the improvement of balance and corporal symmetry in stroke survivors


    Montagna, Jéssica Cristine; Santos, Bárbara C; Battistuzzo, Camila R; Loureiro, Ana Paula C


    Introduction: One of the main problems associate with hemiparesis after stroke is the decrease in balance during static and dynamic postures which can highly affect daily life activities. Objective: To assess the effects of aquatic physiotherapy on the balance and quality of life (SS-QoL) of people with pos stroke. Methods: Chronic stroke participants received at total 18 individual sessions of aquatic physiotherapy using the principle of Halliwick (2x of 40 minutes per week). The outcomes me...

  19. The loss-of-function disease-mutation G301R in the Na+/K+-ATPase α2 isoform decreases lesion volume and improves functional outcome after spinal cord injury in mice

    DEFF Research Database (Denmark)

    Ellman, Ditte Gry; Isaksen, Toke Jost; Lund, Minna Christiansen


    to anaerobic metabolism and lactate accumulation. During ischemia, Na(+)/K(+)-ATPase-related functions will naturally increase the energy demand of the Na(+)/K(+)-ATPase ion pump. However, the role of the α2Na(+)/K(+)-ATPase in contusion injury to the spinal cord remains unknown. We used mice heterozygous mice...... for the loss-of-function disease-mutation G301R in the Atp1a2 gene (α 2(+/G301R) ) to study the effect of reduced α2Na(+)/K(+)-ATPase expression in a moderate contusion spinal cord injury (SCI) model. RESULTS: We found that α 2(+/G301R) mice display significantly improved functional recovery and decreased...... as no apparent differences were observed in location and activation of CD45 and F4/80 positive microglia and infiltrating leukocytes. CONCLUSION: Our proof of concept study demonstrates that reduced expression of the α2 isoform in the spinal cord is protective following SCI. Importantly, the BMS and lesion...

  20. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010 (United States)

    Feigin, Valery L; Forouzanfar, Mohammad H; Krishnamurthi, Rita; Mensah, George A; Connor, Myles; Bennett, Derrick A; Moran, Andrew E; Sacco, Ralph L; Anderson, Laurie; Truelsen, Thomas; O’Donnell, Martin; Venketasubramanian, Narayanaswamy; Barker-Collo, Suzanne; Lawes, Carlene M M; Wang, Wenzhi; Shinohara, Yukito; Witt, Emma; Ezzati, Majid; Naghavi, Mohsen; Murray, Christopher


    Summary Background Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990–2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specific, pre-specified associations between incidence, prevalence, and mortality, to calculate regional and country-specific estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (stroke significantly decreased by 12% (95% CI 6–17) in high-income countries, and increased by 12% (–3 to 22) in low-income and middle-income countries, albeit non-significantly. Mortality rates decreased significantly in both high income (37%, 31–41) and low-income and middle-income countries (20%, 15–30). In 2010, the absolute numbers of people with first stroke (16·9 million), stroke survivors (33 million), stroke-related deaths (5·9 million), and DALYs lost (102 million) were high and had significantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), with most of the burden (68·6% incident strokes, 52·2% prevalent strokes, 70·9% stroke deaths, and 77·7% DALYs lost) in low-income and middle-income countries. In 2010, 5·2 million (31%) strokes were in children (aged stroke burden between GBD regions and countries. More than 62% of new strokes, 69·8% of prevalent strokes, 45·5% of deaths from stroke, and 71·7% of DALYs lost because of stroke were in people younger than 75 years

  1. Decreasing relative risk premium

    DEFF Research Database (Denmark)

    Hansen, Frank


    such that the corresponding relative risk premium is a decreasing function of present wealth, and we determine the set of associated utility functions. We find a new characterization of risk vulnerability and determine a large set of utility functions, closed under summation and composition, which are both risk vulnerable...... and have decreasing relative risk premium. We finally introduce the notion of partial risk neutral preferences on binary lotteries and show that partial risk neutrality is equivalent to preferences with decreasing relative risk premium...

  2. Dabigatran Therapy in Acute Ischemic Stroke Patients Without Atrial Fibrillation. (United States)

    Kate, Mahesh; Gioia, Laura; Buck, Brian; Sivakumar, Leka; Jeerakathil, Thomas; Shuaib, Ashfaq; Butcher, Kenneth


    Acute ischemic stroke patients are at risk of early recurrence. We tested the feasibility and safety of initiating dabigatran in patients, within 24 hours of minor stroke in patients without atrial fibrillation. Minor stroke patients (National Institutes of Health Stroke Scale score ≤3) without atrial fibrillation and evidence of acute infarction on magnetic resonance imaging were treated with dabigatran. Treatment began within 24 hours of onset and was continued for 30 days. The primary end point was symptomatic hemorrhagic transformation. A total of 53 patients with median (interquartile range) age of 68 (57-77) years and National Institutes of Health Stroke Scale score of 1 (0-2) were enrolled. Baseline diffusion-weighted imaging volume was 0.8 (0.3-2.4) mL. No patients experienced symptomatic hemorrhagic transformation. Three patients had evidence of asymptomatic petechial hemorrhagic transformation on day 7, which remained stable at day 30, while continuing dabigatran. Dabigatran treatment within 24 hours of minor stroke is feasible. A larger randomized trial is required to confirm the safety and efficacy of this treatment approach. URL: Unique identifier: NCT 01769703. © 2015 American Heart Association, Inc.

  3. Functional significance of ipsilesional motor deficits after unilateral stroke. (United States)

    Chestnut, Caitilin; Haaland, Kathleen Y


    To determine whether ipsilesional motor skills, which have been related to independent functioning, are present chronically after unilateral stroke and are more common in people with apraxia than in those without apraxia. Observational cohort comparing the performance of an able-bodied control group, stroke patients with left- or right-hemisphere damage matched for lesion volume, and left-hemisphere stroke patients with and without ideomotor limb apraxia. Primary care Veterans Affairs and private medical center. Volunteer right-handed sample; stroke patients with left- or right-hemisphere damage about 4 years poststroke; a control group of demographically matched, able-bodied adults. Not applicable. Total time to perform the (1) Williams doors test and the (2) timed manual performance test (TMPT), which includes parts of the Jebsen-Taylor Hand Function Test. Ipsilesional motor deficits were present after left- or right-hemisphere stroke when using both measures, but deficits were consistently more common in patients with limb apraxia only for the TMPT. These findings add to a growing literature that suggests that ipsilesional motor deficits may have a functional impact in unilateral stroke patients, especially in patients with ideomotor limb apraxia.

  4. Ageism in stroke rehabilitation studies. (United States)

    Gaynor, Eva Joan; Geoghegan, Sheena Elizabeth; O'Neill, Desmond


    stroke is predominantly a disease of older people. While age bias has been demonstrated in studies of pharmacological therapeutic interventions in stroke, the extent of discrimination by age in stroke rehabilitation studies is unknown. The aim of this study was to systematically review the literature to assess the extent of ageism in stroke rehabilitation studies. all randomised control trials (RCT) on stroke rehabilitation entered in the Cochrane database which reported mean age were included. Patient gender and exclusion criteria were also recorded. of 241 RCT's identified, 182 were eligible for inclusion. The mean age of all patients was 64.3, almost a decade younger than those seen by stroke physicians in daily practice in global terms, and 11-12 years younger than encountered in hospital practice in the British Isles. Almost half (46%) of trials excluded patients with cognitive impairment, almost one-quarter (23%) patients with dysphasia and one-eighth (13%) excluded patients with multiple strokes. we have identified a clear difference in the mean age of those included in stroke rehabilitation studies compared with the international mean age of stroke. In addition, a quarter of trials excluded dysphasic patients which may indicate omission of more severe strokes. This means that the evidence base for stroke rehabilitation is deficient in terms of matching the characteristics of patients encountered in clinical practice, and a more representative sample of older people and those with significant disability must be included in future trials.

  5. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye


    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  6. Ischemic strokes and migraine

    International Nuclear Information System (INIS)

    Bousser, M.G.; Baron, J.C.; Chiras, J.


    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG)

  7. Stroke while jogging.


    Kelly, W. F.; Roussak, J.


    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging.

  8. Stroke while jogging. (United States)

    Kelly, W. F.; Roussak, J.


    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging. Images p229-a Fig. 1 PMID:7448490

  9. Sex differences in stroke.

    NARCIS (Netherlands)

    Haast, R.A.M.; Gustafson, D.R.; Kiliaan, A.J.


    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

  10. Use of Occupational Performance Coaching for stroke survivors (OPC-Stroke in late rehabilitation: A descriptive case study

    Directory of Open Access Journals (Sweden)

    Danika Belliveau


    Full Text Available Background: Stroke is a leading cause of disability in adults. Following stroke, 60% of people report needing help with everyday activities, and 80% report having very few meaningful activities. These restrictions often continue for years. This study explored the efficacy of Occupational Performance Coaching for stroke survivors (OPC-Stroke on the participation level of adults in the later stage of stroke rehabilitation. Method: A descriptive case study design was used. One participant in the later stages of rehabilitation was recruited. Outcome measures for participation, goal performance and satisfaction, and emotional well-being were administered pre and postintervention to observe for direction of change. A semi-structured interview was carried out postintervention to explore the participant’s experiences of the intervention. Results: The participant who took part in the study reported improvement with his goal performance and satisfaction. However, the level of participation did not improve and emotional well-being decreased. Qualitative data revealed an appreciation of the intervention and a recommendation of the intervention for others. Conclusion: OPC-Stroke was valued by the participant and shows promise for improving goal performance and satisfaction. Further research is necessary to determine the potential efficacy of OPC-Stroke in later stages of rehabilitation.

  11. Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke (United States)

    Xing, Shihui; Lacey, Elizabeth H.; Skipper-Kallal, Laura M.; Jiang, Xiong; Harris-Love, Michelle L.; Zeng, Jinsheng


    The neural mechanisms underlying recovery of language after left hemisphere stroke remain elusive. Although older evidence suggested that right hemisphere language homologues compensate for damage in left hemisphere language areas, the current prevailing theory suggests that right hemisphere engagement is ineffective or even maladaptive. Using a novel combination of support vector regression-based lesion-symptom mapping and voxel-based morphometry, we aimed to determine whether local grey matter volume in the right hemisphere independently contributes to aphasia outcomes after chronic left hemisphere stroke. Thirty-two left hemisphere stroke survivors with aphasia underwent language assessment with the Western Aphasia Battery-Revised and tests of other cognitive domains. High-resolution T1-weighted images were obtained in aphasia patients and 30 demographically matched healthy controls. Support vector regression-based multivariate lesion-symptom mapping was used to identify critical language areas in the left hemisphere and then to quantify each stroke survivor’s lesion burden in these areas. After controlling for these direct effects of the stroke on language, voxel-based morphometry was then used to determine whether local grey matter volumes in the right hemisphere explained additional variance in language outcomes. In brain areas in which grey matter volumes related to language outcomes, we then compared grey matter volumes in patients and healthy controls to assess post-stroke plasticity. Lesion–symptom mapping showed that specific left hemisphere regions related to different language abilities. After controlling for lesion burden in these areas, lesion size, and demographic factors, grey matter volumes in parts of the right temporoparietal cortex positively related to spontaneous speech, naming, and repetition scores. Examining whether domain general cognitive functions might explain these relationships, partial correlations demonstrated that grey matter

  12. Management Of Patients With Stroke In Critical Care Units, Considering Osmotic Therapy And Hypothermia

    Directory of Open Access Journals (Sweden)

    Ata Mahmoodpoor


    Full Text Available Cytotoxic brain edema is an early complication of stroke which increases the possibility of secondary ischemia. Hypertonic solutions, mannitol and recently hypertonic saline (HS has been considered for treatment of increased ICP. HS could decrease ICP especially in hypotensive patients with different mechanisms, direct effect on edema, decreasing inflammation which is mediated by attenuation of TNFa and IL-1b stimulation on Na-K-Cl cotransporter 1 and improvement of microcirculation. Improvement of microcirculation is so important for hypertonic solutions to be effective in ischemia especially focal ischemia. Based on the literature, hypertonic saline is more effective in decreasing cerebral edema than the equal volume of mannitol. The optimal dose and duration of therapy needs more trials. Caution should be performed with patients with moderate size hemispheric infarcts on presentation, race and genetic factors regarding osmotic therapy. Hypothermia has been rated as one of the most active modes of neuroprotection based on the results of different trials. Hypothermia in both ways, surface and intravascular, decreases cerebral metabolic rate of O2 and glucose and reduces brain oxygen consumption, inflammation and oxidative stress. Recent data continue to support consideration of therapeutic hypothermia for cerebral ischemia in larger clinical trials of acute ischemic stroke. By increasing the time window to therapy initiation and decreasing the treatment duration, selective intracarotid cold saline administration brings increased feasibility, potentially better outcomes and perhaps fewer complications compared with the whole body cooling. Hypothermia is now recommended as a targeted temperature management with defined protocol which should be started early; it may be performed pharmacologically in combination with other therapies. Applying hypothermia should be considered regarding its cost, using in awaked patients, re-warming protocol

  13. Thrombolysis in Postoperative Stroke. (United States)

    Voelkel, Nicolas; Hubert, Nikolai Dominik; Backhaus, Roland; Haberl, Roman Ludwig; Hubert, Gordian Jan


    Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery. Patients were included if surgery was performed within the last 90 days before stroke. The primary outcome was defined as surgical site hemorrhage. Subgroups with major/minor surgery and recent/nonrecent surgery (within 10 days before IVT) were analyzed separately. One hundred thirty-four patients underwent surgical intervention before IVT. Surgery had been performed recently (days 1-10) in 49 (37%) and nonrecently (days 11-90) in 85 patients (63%). In 86 patients (64%), surgery was classified as major, and in 48 (36%) as minor. Nine patients (7%) developed surgical site hemorrhage after IVT, of whom 4 (3%) were serious, but none was fatal. One fatal bleeding occurred remotely from surgical area. Rate of surgical site hemorrhage was significantly higher in recent than in nonrecent surgery (14.3% versus 2.4%, respectively, odds ratio adjusted 10.73; 95% confidence interval, 1.88-61.27). Difference between patients with major and minor surgeries was less distinct (8.1% and 4.2%, respectively; odds ratio adjusted 4.03; 95% confidence interval, 0.65-25.04). Overall in-hospital mortality was 8.2%. Intracranial hemorrhage occurred in 9.7% and was asymptomatic in all cases. IVT may be administered safely in postoperative patients as off-label use after appropriate risk-benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset. © 2017 American Heart Association, Inc.

  14. Imaging of Hemorrhagic Stroke. (United States)

    Hakimi, Ryan; Garg, Ankur


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

  15. Rehabilitating the Stroke Collection

    Directory of Open Access Journals (Sweden)

    Mary Grimmond


    Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.

  16. Trends in stroke incidence. The Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Truelsen, T; Prescott, E; Grønbaek, M


    in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women. CONCLUSIONS: During the period from 1976 to 1993......BACKGROUND AND PURPOSE: Stroke incidence has increased in some countries and decreased in others. After 20 years of intensive antihypertensive treatment the latter could be expected, and we have evaluated the sex-specific temporal trends in stroke incidence using 17 years of follow...... at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis. RESULTS...

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

    DEFF Research Database (Denmark)

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


    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...

  18. Stroke treatment outcomes in hospitals with and without Stroke Units. (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


    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.

  19. Secular trends in ischemic stroke subtypes and stroke risk factors. (United States)

    Bogiatzi, Chrysi; Hackam, Daniel G; McLeod, A Ian; Spence, J David


    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.

  20. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster


    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  1. Facilities available in European hospitals treating stroke patients. (United States)

    Leys, Didier; Ringelstein, E Bernd; Kaste, Markku; Hacke, Werner


    Stroke units decrease mortality and need for institutional care, but they are not widely available. The objective of the study was to determine, among European hospitals admitting acute stroke patients, how many are able to provide an appropriate level of care. Method- We randomly selected 886 hospitals in 25 countries. We used definitions derived from a European expert survey for comprehensive stroke centers (CSC), primary stroke centers (PSC), and minimum level required for any hospital ward (AHW) admitting stroke patients. We determined the proportion of hospitals meeting criteria for each category, and which facilities were not available. Participating hospitals treated approximately one-third of all strokes supposed to have occurred in these countries in 2005. Forty-three (4.9%) met criteria for CSC, 32 (3.6%) for PSC, 356 (40.2%) for AHW, and 455 (51.4%) provided a lower level of care. In 2005, hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 27 644 (8.3%), 17 365 (5.2%), 146 175 (44.1%), and 140 306 (42.3%) patients. There was no 24-hour availability for brain CT scan in 25% of hospitals not meeting criteria for AHW. Of 448 hospitals admitting at least 1 stroke per day, 51 (11.4%) met criteria for PSC or CSC, and 227 (50.7%) for AHW. Less than 10% of European hospitals admitting acute stroke patients have optimal facilities, and in 40% even the minimum level is not available. Because the availability of facilities does not grant their use, our study suggests that only few acute stroke patients are treated in appropriate centers in Europe.

  2. Sexual function in post-stroke patients: considerations for rehabilitation. (United States)

    Rosenbaum, Talli; Vadas, Dor; Kalichman, Leonid


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

  3. Stroke Lesions in a Large Upper Limb Rehabilitation Trial Cohort Rarely Match Lesions in Common Preclinical Models. (United States)

    Edwardson, Matthew A; Wang, Ximing; Liu, Brent; Ding, Li; Lane, Christianne J; Park, Caron; Nelsen, Monica A; Jones, Theresa A; Wolf, Steven L; Winstein, Carolee J; Dromerick, Alexander W


    Stroke patients with mild-moderate upper extremity motor impairments and minimal sensory and cognitive deficits provide a useful model to study recovery and improve rehabilitation. Laboratory-based investigators use lesioning techniques for similar goals. To determine whether stroke lesions in an upper extremity rehabilitation trial cohort match lesions from the preclinical stroke recovery models used to drive translational research. Clinical neuroimages from 297 participants enrolled in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study were reviewed. Images were characterized based on lesion type (ischemic or hemorrhagic), volume, vascular territory, depth (cortical gray matter, cortical white matter, subcortical), old strokes, and leukoaraiosis. Lesions were compared with those of preclinical stroke models commonly used to study upper limb recovery. Among the ischemic stroke participants, median infarct volume was 1.8 mL, with most lesions confined to subcortical structures (61%) including the anterior choroidal artery territory (30%) and the pons (23%). Of ICARE participants, stroke patients, but they represent a clinically and scientifically important subgroup. Compared with lesions in general stroke populations and widely studied animal models of recovery, ICARE participants had smaller, more subcortically based strokes. Improved preclinical-clinical translational efforts may require better alignment of lesions between preclinical and human stroke recovery models.

  4. Understanding Stroke - Know Stroke • Know the Signs • Act in Time (United States)

    ... Home Current Issue Past Issues Special Section Understanding Stroke Know Stroke • Know the Signs • Act in Time Past Issues / ... Julie Harris, and motivational speaker David Layton. Preventing Stroke "Until I had my stroke, I didn't ...

  5. Relationship between functional disability and costs one and two years post stroke.

    Directory of Open Access Journals (Sweden)

    Ingrid Lekander

    Full Text Available Stroke affects mortality, functional ability, quality of life and incurs costs. The primary objective of this study was to estimate the costs of stroke care in Sweden by level of disability and stroke type (ischemic (IS or hemorrhagic stroke (ICH.Resource use during first and second year following a stroke was estimated based on a research database containing linked data from several registries. Costs were estimated for the acute and post-acute management of stroke, including direct (health care consumption and municipal services and indirect (productivity losses costs. Resources and costs were estimated per stroke type and functional disability categorised by Modified Rankin Scale (mRS.The results indicated that the average costs per patient following a stroke were 350,000SEK/€37,000-480,000SEK/€50,000, dependent on stroke type and whether it was the first or second year post stroke. Large variations were identified between different subgroups of functional disability and stroke type, ranging from annual costs of 100,000SEK/€10,000-1,100,000SEK/€120,000 per patient, with higher costs for patients with ICH compared to IS and increasing costs with more severe functional disability.Functional outcome is a major determinant on costs of stroke care. The stroke type associated with worse outcome (ICH was also consistently associated to higher costs. Measures to improve function are not only important to individual patients and their family but may also decrease the societal burden of stroke.

  6. MIDAS (Modafinil in Debilitating Fatigue After Stroke) (United States)

    Lillicrap, Thomas; Krishnamurthy, Venkatesh; Holliday, Elizabeth; Attia, John; Pagram, Heather; Nilsson, Michael; Parsons, Mark; Levi, Christopher R.


    Background and Purpose— This study aimed to assess the efficacy of modafinil, a wakefulness-promoting agent in alleviating post-stroke fatigue ≥3 months after stroke. We hypothesized that 200 mg of modafinil daily for 6 weeks would result in reduced symptoms of fatigue compared with placebo. Methods— This single-center phase 2 trial used a randomized, double-blind, placebo-controlled, crossover design. The key inclusion criterion was a multidimensional fatigue inventory score of ≥60. Patients were randomized to either modafinil or placebo for 6 weeks of therapy, then after a 1 week washout period swapped treatment arms for a second 6 weeks of therapy. The primary outcome was the multidimensional fatigue inventory; secondary outcomes included the Montreal cognitive assessment, the Depression, Anxiety, and Stress Scale (DASS), and the Stroke-Specific Quality of Life (SSQoL) scale. The multidimensional fatigue inventory is a self-administered questionnaire with a range of 0 to 100. Treatment efficacy was assessed using linear regression by estimating within-person, baseline-adjusted differences in mean outcomes after therapy. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000350527). Results— A total of 232 stroke survivors were screened and 36 were randomized. Participants receiving modafinil reported a significant decrease in fatigue (multidimensional fatigue inventory, −7.38; 95% CI, −21.76 to −2.99; Pmodafinil therapy during the study period (P>0.05). Conclusions— Stroke survivors with nonresolving fatigue reported reduced fatigue and improved quality of life after taking 200 mg daily treatment with modafinil. Clinical Trial Registration— URL: Unique identifier: ACTRN12615000350527. PMID:28404841

  7. Communication in conversation in stroke patients. (United States)

    Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile


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

  8. Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes. (United States)

    Wu, Ona; Cloonan, Lisa; Mocking, Steven J T; Bouts, Mark J R J; Copen, William A; Cougo-Pinto, Pedro T; Fitzpatrick, Kaitlin; Kanakis, Allison; Schaefer, Pamela W; Rosand, Jonathan; Furie, Karen L; Rost, Natalia S


    Acute infarct volume, often proposed as a biomarker for evaluating novel interventions for acute ischemic stroke, correlates only moderately with traditional clinical end points, such as the modified Rankin Scale. We hypothesized that the topography of acute stroke lesions on diffusion-weighted magnetic resonance imaging may provide further information with regard to presenting stroke severity and long-term functional outcomes. Data from a prospective stroke repository were limited to acute ischemic stroke subjects with magnetic resonance imaging completed within 48 hours from last known well, admission NIH Stroke Scale (NIHSS), and 3-to-6 months modified Rankin Scale scores. Using voxel-based lesion symptom mapping techniques, including age, sex, and diffusion-weighted magnetic resonance imaging lesion volume as covariates, statistical maps were calculated to determine the significance of lesion location for clinical outcome and admission stroke severity. Four hundred ninety subjects were analyzed. Acute stroke lesions in the left hemisphere were associated with more severe NIHSS at admission and poor modified Rankin Scale at 3 to 6 months. Specifically, injury to white matter (corona radiata, internal and external capsules, superior longitudinal fasciculus, and uncinate fasciculus), postcentral gyrus, putamen, and operculum were implicated in poor modified Rankin Scale. More severe NIHSS involved these regions, as well as the amygdala, caudate, pallidum, inferior frontal gyrus, insula, and precentral gyrus. Acute lesion topography provides important insights into anatomic correlates of admission stroke severity and poststroke outcomes. Future models that account for infarct location in addition to diffusion-weighted magnetic resonance imaging volume may improve stroke outcome prediction and identify patients likely to benefit from aggressive acute intervention and personalized rehabilitation strategies. © 2015 American Heart Association, Inc.

  9. Decreasing Relative Risk Premium

    DEFF Research Database (Denmark)

    Hansen, Frank

    We consider the risk premium demanded by a decision maker with wealth x in order to be indifferent between obtaining a new level of wealth y1 with certainty, or to participate in a lottery which either results in unchanged present wealth or a level of wealth y2 > y1. We define the relative risk...... premium as the quotient between the risk premium and the increase in wealth y1–x which the decision maker puts on the line by choosing the lottery in place of receiving y1 with certainty. We study preferences such that the relative risk premium is a decreasing function of present wealth, and we determine...... relative risk premium in the small implies decreasing relative risk premium in the large, and decreasing relative risk premium everywhere implies risk aversion. We finally show that preferences with decreasing relative risk premium may be equivalently expressed in terms of certain preferences on risky...

  10. Challenging comparison of stroke scales

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari


    Full Text Available Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability. Despite advantages of modified National Institute of Health Stroke Scale and Scandinavian stroke scale comparing to the NIHSS, including their simplification and less inter-rater variability; most of the stroke neurologists around the world continue using the NIHSS. The modified Rankin scale (mRS and Barthel index (BI are widely used functional impairment and disability scales. Distinction between grades of mRS is poorly defined. The Asian stroke disability scale is a simplified functional impairment, handicap scale which is as valid as mRS and BI. At the present time, the NIHSS, mRS and BI are routine stroke scales because physicians have used to work with these scales for more than two decades, although it could not be an acceptable reason. On the other side, results of previous stroke trials, which are the basis of stroke management guidelines are driven using these scales.

  11. Post-stroke urinary incontinence. (United States)

    Mehdi, Z; Birns, J; Bhalla, A


    To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals. © 2013 John Wiley & Sons Ltd.

  12. Decreasing serial cost sharing

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter Raahave


    The increasing serial cost sharing rule of Moulin and Shenker (Econometrica 60:1009-1037, 1992) and the decreasing serial rule of de Frutos (J Econ Theory 79:245-275, 1998) are known by their intuitive appeal and striking incentive properties. An axiomatic characterization of the increasing serial...... rule was provided by Moulin and Shenker (J Econ Theory 64:178-201, 1994). This paper gives an axiomatic characterization of the decreasing serial rule....

  13. Decreasing Serial Cost Sharing

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter

    The increasing serial cost sharing rule of Moulin and Shenker [Econometrica 60 (1992) 1009] and the decreasing serial rule of de Frutos [Journal of Economic Theory 79 (1998) 245] have attracted attention due to their intuitive appeal and striking incentive properties. An axiomatic characterization...... of the increasing serial rule was provided by Moulin and Shenker [Journal of Economic Theory 64 (1994) 178]. This paper gives an axiomatic characterization of the decreasing serial rule...

  14. Effect of Ferrofluid on the Performance and Emission Patterns of a Four-Stroke Diesel Engine

    Directory of Open Access Journals (Sweden)

    M. B. Shafii


    Full Text Available Experimental tests were carried out to investigate the effects of adding water-based ferrofluid to diesel fuel in a diesel engine. These effects included the combustion performance and exhaust emission characteristics of the diesel engine. To this end, emulsified diesel fuels of 0, 0.4, and 0.8 ferrofluid/diesel ratios by volume were used in a four-stroke diesel engine, operating at 2200 rpm. The results indicate that adding ferrofluid to diesel fuel has a perceptible effect on engine performance, increasing the brake thermal efficiency relatively up to 12% and decreasing the brake-specific fuel consumption relatively up to 11% as compared to diesel fuel. Furthermore, from the analysis of gaseous species of engine exhaust, it was found that NOx emissions were lower than that of diesel fuel while the CO emissions increased. In addition, it was found that nanoparticles can be collected at the exhaust flow using a magnetic bar.

  15. Cardiac output and blood volume parameters using femoral arterial thermodilution. (United States)

    López-Herce, Jesús; Bustinza, Amaya; Sancho, Luis; Mencía, Santiago; Carrillo, Angel; Moral, Ramón; Bellón, Jose María


    The pulse-induced continuous cardiac output (PiCCO) system is a less invasive method than pulmonary thermodilution for the measurement of cardiac output and estimating blood volume parameters. The normal values in children have not been defined. The purpose of the present paper was therefore to evaluate cardiac output and parameters of blood volume using femoral arterial thermodilution in critically ill children. A prospective study was performed in 17 critically ill children aged between 2 months and 14 years. Two measurements were taken for each determination of cardiac output, global end diastolic volume (GEDVI), intrathoracic blood volume index (ITBI), extravascular lung water index (ELWI), systolic volume index (SVI), stroke volume variation (SVV), cardiac function index (CFI), left ventricular contractility (dp/dt max), and the systemic vascular resistance index (SVRI). One hundred and seventeen measurements were performed. The mean cardiac index (CI) was 3.5 +/- 1.3 L/min per m(2). The GEDVI (399.7 +/- 349.1 mL/m(2)), ITBI (574.5 +/- 212.2 mL/m(2)) and dp/dt max (804.6 +/- 372.1 mmHg/s) were lower than reported in adults, whereas ELWI (18.9 +/- 9.3 mL/m2) and CFI (8 +/- 2.5 L/min) where higher. The GEDVI, SVI, dp/dt max and CI increased with the weight of the patients whereas the ELWI values decreased. Femoral arterial thermodilution is a suitable technique for the measurement of cardiac output in critically ill children. The intrathoracic and intracardiac volumes are lower than in adults, whereas extrapulmonary water is higher; these values are related to the weight of the patient.

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

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins


    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 (

  17. For whom the desert bell tolls: heat stroke or stroke

    Directory of Open Access Journals (Sweden)

    Mustafa Bolatkale


    Full Text Available Heat stroke is the most complicated and dangerous amongst heat injuries that can lead to irreversible injury and even death with itself or with creating predisposibility to different diseases. The following case report depicts a patient who presented primarily with impairment of consciousness after walking 45 km in the summer heat to cross the Syria-Turkey border and later syncope. This case report aims to highlight the possibility of higher co-incidence with heat stroke and stroke.

  18. British Association of Stroke Physicians: benchmarking survey of stroke services. (United States)

    Rodgers, Helen; Dennis, Martin; Cohen, David; Rudd, Anthony


    the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. to describe the organisation and staffing of specialist hospital-based stroke services in the UK. a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

  19. Brain repair: cell therapy in stroke

    Directory of Open Access Journals (Sweden)

    Kalladka D


    Full Text Available Dheeraj Kalladka, Keith W Muir Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, United Kingdom Abstract: Stroke affects one in every six people worldwide, and is the leading cause of adult disability. Some spontaneous recovery is usual but of limited extent, and the mechanisms of late recovery are not completely understood. Endogenous neurogenesis in humans is thought to contribute to repair, but its extent is unknown. Exogenous cell therapy is promising as a means of augmenting brain repair, with evidence in animal stroke models of cell migration, survival, and differentiation, enhanced endogenous angiogenesis and neurogenesis, immunomodulation, and the secretion of trophic factors by stem cells from a variety of sources, but the potential mechanisms of action are incompletely understood. In the animal models of stroke, both mesenchymal stem cells (MSCs and neural stem cells (NSCs improve functional recovery, and MSCs reduce the infarct volume when administered acutely, but the heterogeneity in the choice of assessment scales, publication bias, and the possible confounding effects of immunosuppressants make the comparison of effects across cell types difficult. The use of adult-derived cells avoids the ethical issues around embryonic cells but may have more restricted differentiation potential. The use of autologous cells avoids rejection risk, but the sources are restricted, and culture expansion may be necessary, delaying treatment. Allogeneic cells offer controlled cell numbers and immediate availability, which may have advantages for acute treatment. Early clinical trials of both NSCs and MSCs are ongoing, and clinical safety data are emerging from limited numbers of selected patients. Ongoing research to identify prognostic imaging markers may help to improve patient selection, and the novel imaging techniques may identify biomarkers of recovery and the mechanism of action for cell

  20. Influence of statin therapy at time of stroke onset on functional outcome among patients with atrial fibrillation. (United States)

    Ko, Darae; Thigpen, Jonathan L; Otis, James A; Forster, Kristen; Henault, Lori; Quinn, Emily; Tripodis, Yorghos; Berger, Peter B; Limdi, Nita; Hylek, Elaine M


    Statin pretreatment has been associated with reduced infarct volume in nonlacunar strokes. The effect of statins on functional outcomes of strokes related to atrial fibrillation (AF) is unknown. We aimed to define the influence of prestroke statin use on functional outcome in AF. We assembled a cohort of consecutive ischemic stroke patients from 2006 to 2010. All patients underwent CT or MRI and were adjudicated by site investigators. AF was confirmed by electrocardiogram in 100% of patients. Site neurologists blinded to the study hypothesis affirmed the type of stroke and assessed the severity of disability at the time of hospital discharge. The frequency of death at 30-days was calculated. Ischemic stroke (n=1030) resulted in a severe neurological deficit or death (modified Rankin scale ≥4) at 30days in 711 patients (69%). Using multivariable logistic regression models adjusting for factors associated with statin treatment and factors associated with functional outcome, prestroke statin use was associated with a 32% reduction in frequency of severe stroke (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92; P=0.011). Other independent factors associated with severe stroke included older age, female sex, non-White race, diabetes mellitus, prior ischemic stroke, prior venous thromboembolism, and dementia. Ischemic strokes in AF are associated with high mortality and morbidity. Statin use at time of stroke onset among patients with AF was associated in this study with less severe stroke and warrant validation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Effect of Influenza Vaccination on Risk of Stroke: A Systematic Review and Meta-Analysis. (United States)

    Lee, Kyu Rae; Bae, Jeong Hun; Hwang, In Cheol; Kim, Kyoung Kon; Suh, Heuy Sun; Ko, Ki Dong


    Despite the presence of a strong association between influenza infection and stroke, whether influenza vaccination reduces the risk of stroke is yet a matter of controversy. We conducted a meta-analysis to determine whether influenza vaccination protects against stroke. We searched PubMed, EMBASE, and the Cochrane Library from database inception date to November 18, 2016, without language restrictions, to identify studies investigating the effect of influenza vaccination on subsequent risk of stroke. We conducted a meta-analysis to quantify the risk of stroke in overall and subgroup analyses and calculated a pooled OR for developing stroke with a 95% CI. Publication bias was assessed by Begg's rank correlation test. Eleven studies fulfilled our inclusion criteria. In a random-effects model, vaccinated individuals had a decreased risk of stroke compared with unvaccinated individuals (OR 0.82; 95% CI 0.75-0.91; p vaccination and stroke risk remained robust in subgroup analyses. The significant effect of influenza vaccination was associated with ascertainment of vaccination status and stage of prevention. Vaccination against influenza is associated with a lower risk of stroke. Well-designed prospective studies are needed to provide stronger evidence of the protective effect of influenza vaccination against stroke. © 2017 S. Karger AG, Basel.

  2. Hemichorea after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sadullah Saglam


    Full Text Available The deterioration of the balance between direct and indirect ways in the basal ganglia causes chorea. The lesions of contralateral basal ganglia, thalamus or the connection of them all together are responsible for this. Chorea can be observed during the course of metabolic and vascular diseases, neurodegenerative or hereditary diseases. Hyperkinetic movement disorders after acute ischemic stroke are reported as rare; however, hemichorea is the most frequent developing disorder of hyperkinetic movement as a result of cerebrovascular disease. In this case report, we presented two case who applied us with choreiform movements in his left half of the body after acute thalamic stroke. [Cukurova Med J 2016; 41(0.100: 29-32

  3. [Smoking and stroke]. (United States)

    Hashimoto, Yoichiro


    Cigarette smoking is a risk factor for the brain infarction (lacunar and atherothrombotic brain infarction) and subarachnoid hemorrhage. Not only active smoking but also passive smoking and smokeless tobacco products pose a risk. The risk after smoking cessation for 5-10 years is equal to that faced by a non-smoker. Many patients continue smoking even after an attack of stroke; therefore, support measures to enforce nonsmoking are required in this high-risk population. We offer nonsmoking support using the 5A approach, and assess the nonsmoking stage (precontemplation, contemplation, preparation, action, and maintenance). We also administer medical therapy for smoking cessation when the patients find it difficult to quit smoking on their own accord. Nicotine dependency needs a follow-up like that required for other risk factors in the primary and secondary prevention of the stroke because smoking is a chronic disease that tends to recur.

  4. Detrusor Hyperreflexia in Stroke


    AYBEK, Zafer


    In this study detrusor hyperreflexia was investigated by urodynamic study during the acute phase of stroke in patients who became incontinent after a cerebrovascular accident. Urodynamic studies reveal physiopathological findings of incontinence while the acute period of cerebrovascular accident do not cover neurogenic bladder features. In our study it was observed that most of the patients (60%) had normal bladder functions and detrusor hyperreflexia was a rare rindings. This res...

  5. Stroke Management: Nursing Roles


    Maryam Esmaeili


    Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms. Methods: This is a review paper that report up to date finding with review some...

  6. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. (United States)

    Sánchez-Larsen, Á; García-García, J; Ayo-Martín, O; Hernández-Fernández, F; Díaz-Maroto, I; Fernández-Díaz, E; Monteagudo, M; Segura, T


    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.

  7. Early rehabilitation after stroke. (United States)

    Bernhardt, Julie; Godecke, Erin; Johnson, Liam; Langhorne, Peter


    Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.

  8. Spreading depolarizations occur in human ischemic stroke with high incidence

    DEFF Research Database (Denmark)

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


    Objective: Cortical spreading depression (CSD) and periinfarct depolarization (PID) have been shown in various experimental models of stroke to cause secondary neuronal damage and infarct expansion. For decades it has been questioned whether CSD or PID occur in human ischemic stroke. Here, we...... for decompressive hernicraniectomy, an electrode strip was placed on the periinfarct region, from which four FCoG channels were acquired. Results: A total of 1,638 hours was recorded; mean monitoring time per patient was 109.2 hours. A total of 127 CSD and 42 PID events were observed. In CSD, a stereotyped slow...... frequency in this study of patients with malignant middle cerebral artery infarction. This suggests that the large volume of experimental studies of occlusive stroke that implicate spreading depolarizations in its pathophysiology can be translated, with appropriate caution, to patients and their treatment...

  9. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj


    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  10. Acute Stroke Imaging Research Roadmap


    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.


    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 n...

  11. Problematising risk in stroke rehabilitation. (United States)

    Egan, Mary Y; Kessler, Dorothy; Ceci, Christine; Laliberté-Rudman, Debbie; McGrath, Colleen; Sikora, Lindsey; Gardner, Paula


    Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or

  12. Acute-phase reactants and cytokines in ischemic stroke: do they have any relationship with short-term mortality? (United States)

    Sahan, M; Sebe, A; Acikalin, A; Akpinar, O; Koc, F; Ay, M O; Gulen, M; Topal, M; Satar, S


    Many unknown risk factors play a role in the etiopathogenesis of stroke. The appearance of inflammatory cells within the damaged tissue after cerebral ischemia suggests that an inflammatory response may play a role in stroke pathogenesis. In our study, we examined whether an association exists between the acute-phase reactants and the levels of cytokines, the volume and diameter of the stroke, and short-term mortality in patients who were diagnosed as acute ischemic a stroke after admission to the Emergency Department. A total of 50 consecutive patients who applied to the Emergency Service with acute ischemic stroke were enrolled in the study. Their stroke volume were calculated and serum samples were obtained as soon as they arrived into the Emergency Service. The patients were evaluated according to the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). There was no significant correlations between stroke volume and levels of cytokine and acute-phase reactants in dead patient group or in living patient group. A correlation and statistical significance was found between stroke volume and hospital stay time in living patient group. In addition, GCS and NIHSS scores were correlated with stroke volume and was found a significant statistically. Scales such as GKS and NIHHS, which evaluate the functional state of patients, are the best indicators for defining prognosis in our daily practices. In addition, we found a positive correlation between levels of CRP (C reactive protein) and prognosis. However, we did not observe a statistically significant correlation between prognosis and other acute-phase reactants such as TNF-alpha, IL-6, IL-8, IL-10, fibrinogen, and leukocytes.

  13. Guide to Choosing Stroke Rehabilitation Services (United States)

    National Stroke Association’s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you:  Re-learn basic skills such ...

  14. What You Need to Know about Stroke (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 ...

  15. Epidermoid Causing Ischemic Stroke in the Brainstem

    Directory of Open Access Journals (Sweden)

    Raghvendra Ramdasi


    Full Text Available Intracranial tumors may rarely cause stroke. We report an epidermoid cyst causing stroke in a pediatric patient. We have also reviewed the literature and pathogenesis of stroke caused by intracranial tumors.

  16. What Are the Warning Signs of Stroke? (United States)

    ... Cardiovascular Conditions What Are the Warning Signs of Stroke? Brain tissue affected by blockage Stroke is the fifth leading cause of death in ... over 55 years old have more chance of stroke, and the risk gets greater as you get ...

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

    Directory of Open Access Journals (Sweden)

    Kara H


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

  18. Relevance of the Updated Food and Drug Administration Alteplase Label for Acute Ischemic Stroke: The Estimated Impact and Current Guidelines. (United States)

    Shiue, Harn J; Albright, Karen C; Sands, Kara A


    In 2015, the Food and Drug Administration updated the contraindications for the use of alteplase in acute ischemic stroke (AIS), potentially creating a greater impact on treatment. A history of intracranial hemorrhage and recent stroke within 3 months were removed as contraindications, increasing the number of patients eligible for alteplase. The aim of this commentary is to call attention to the updates and discuss them relative to current American Heart Association/American Stroke Association guidelines. Additionally, we estimate the clinical impact of the updates by analyzing AIS admissions to a large-volume Comprehensive Stroke Center.

  19. Contralesional Cortical Structural Reorganization Contributes to Motor Recovery after Sub-Cortical Stroke: A Longitudinal Voxel-Based Morphometry Study. (United States)

    Cai, Jianxin; Ji, Qiling; Xin, Ruiqiang; Zhang, Dianping; Na, Xu; Peng, Ruchen; Li, Kuncheng


    Although changes in brain gray matter after stroke have been identified in some neuroimaging studies, lesion heterogeneity and individual variability make the detection of potential neuronal reorganization difficult. This study attempted to investigate the potential structural cortical reorganization after sub-cortical stroke using a longitudinal voxel-based gray matter volume (GMV) analysis. Eleven right-handed patients with first-onset, subcortical, ischemic infarctions involving the basal ganglia regions underwent structural magnetic resonance imaging in addition to National Institutes of Health Stroke Scale (NIHSS) and Motricity Index (MI) assessments in the acute (reorganization of the CL "cognitive" cortices might contribute to motor recovery after sub-cortical stroke.

  20. Burden of stroke in Cambodia. (United States)

    Loo, Keat Wei; Gan, Siew Hua


    In Cambodia, stroke is not ranked among the top 10 leading causes of death, but infectious disease are among the top three leading causes of death. This finding could be attributed to a lack of awareness among Cambodians of the signs and symptoms of stroke or to poor reporting, incomplete data, lack of neurologists and neurosurgeons, or low accessibility to the hospitals. The only study of stroke in Cambodia is the Prevalence of Non-Communicable Disease Risk Factors in Cambodia survey, which identified several stroke-related risk factors in the population. Tobacco chewing or smoking is the main risk factor for stroke in Cambodia. Traditional therapies, such as oyt pleung (moxibustion) and jup (cupping), are widely practiced for stroke rehabilitation. In Cambodia, there are few neurologists and few important equipment, such as magnetic resonance imaging machines and computed tomography scanners. The Cambodian government should cooperate with the World Health Organization and the United Nations Children's Fund to attract foreign expertise and technologies to treat stroke patients. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  1. Infections and Ischemic Stroke Outcome


    Grabska, Katarzyna; Gromadzka, Grażyna; Członkowska, Anna


    Background. Infections increase the risk of ischemic stroke (IS) and may worsen IS prognosis. Adverse effects of in-hospital infections on stroke outcome were also reported. We aimed to study the prevalence of pre- and poststroke infections and their impact on IS outcome. Methods. We analysed clinical data of 2066 IS patients to assess the effect of pre-stroke and post-stroke infections on IS severity, as well as short-term (up to 30 days) and long-term (90 days) outcome. The independent i...

  2. Stroke scale score and early prediction of outcome after stroke

    International Nuclear Information System (INIS)

    Ahmed, R.; Zuberi, F.Z.; Afsar, S.


    Objective: To evaluate the baseline National Institute of Health Stroke Scale (NIHSS) score as a predictor of functional outcome after ischemic stroke. Subjects and Methods: The study included 50 patients who presented to Civil Hospital, Karachi, during the study period with acute stroke and were evaluated with CT scan of brain. Only those patients were enrolled in the study that had acute ischemic stroke. The enrolled subjects were then evaluated for the neurological impairment using National Institute of Health Stroke Scale (NIHSS). The subjects were followed-up and their functional outcome was assessed using Barthel index (BI) on the 7th day of their admission. Results: Of the fifty patients enrolled in the study, 31 (62%) were males and 19 (38%) were females, with age ranging from 45 years to 95 years and a mean age of 59.9 years. Neurological impairment at presentation was assessed by NIHSS. The score ranged between 2 and 28. The functional outcome was evaluated on the 7th day using Barthel index (BI), which ranged from 0 to 80. NIHSS score was found to be a good predictor of functional outcome in patients with ischemic stroke (p<0.001). Other factors like gender, hypertension and heart disease did not affect the functional recovery in such patients. Various factors were found to be significant for early prediction of stroke recovery. The NIHSS score was the strongest predictor of outcome after ischemic stroke. Age at the time of the event was also found to be an important predictor for stroke recovery. Conclusion: The NIHSS score is a good predictor of patient's recovery after stroke. Assessing the patient's neurological impairment at first presentation of ischemic stroke can guide the physician regarding the prognosis and management plan. (author)

  3. Identification of stroke mimics among clinically diagnosed acute strokes. (United States)

    Tuntiyatorn, Lojana; Saksornchai, Pichaya; Tunlayadechanont, Supoch


    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.

  4. Combining Growth Factor and Bone Marrow Cell Therapy Induces Bleeding and Alters Immune Response After Stroke in Mice. (United States)

    Strecker, Jan-Kolja; Olk, Joanna; Hoppen, Maike; Gess, Burkhard; Diederich, Kai; Schmidt, Antje; Schäbitz, Wolf-Rüdiger; Schilling, Matthias; Minnerup, Jens


    Bone marrow cell (BMC)-based therapies, either the transplantation of exogenous cells or stimulation of endogenous cells by growth factors like the granulocyte colony-stimulating factor (G-CSF), are considered a promising means of treating stroke. In contrast to large preclinical evidence, however, a recent clinical stroke trial on G-CSF was neutral. We, therefore, aimed to investigate possible synergistic effects of co-administration of G-CSF and BMCs after experimental stroke in mice to enhance the efficacy compared with single treatments. We used an animal model for experimental stroke as paradigm to study possible synergistic effects of co-administration of G-CSF and BMCs on the functional outcome and the pathophysiological mechanism. G-CSF treatment alone led to an improved functional outcome, a reduced infarct volume, increased blood vessel stabilization, and decreased overall inflammation. Surprisingly, the combination of G-CSF and BMCs abrogated G-CSFs' beneficial effects and resulted in increased hemorrhagic infarct transformation, altered blood-brain barrier, excessive astrogliosis, and altered immune cell polarization. These increased rates of infarct bleeding were mainly mediated by elevated matrix metalloproteinase-9-mediated blood-brain barrier breakdown in G-CSF- and BMCs-treated animals combined with an increased number of dilated and thus likely more fragile vessels in the subacute phase after cerebral ischemia. Our results provide new insights into both BMC-based therapies and immune cell biology and help to understand potential adverse and unexpected side effects. © 2016 American Heart Association, Inc.

  5. Determinants and Time Trends for Ischaemic and Haemorrhagic Stroke in a Large Chinese Population (United States)

    Guo, Yutao; Wang, Hao; Tao, Tao; Tian, Yingchun; Wang, Yutang; Chen, Yundai; Lip, Gregory Y. H.


    Background The clinical epidemiology of stroke has been widely investigated in Caucasian populations, but the changes over time in the proportion of ischaemic to haemorrhagic strokes is less clear, especially in the Chinese population. Aims Our objective was to study the determinants and time trends for ischaemic and haemorrhagic stroke, in relation to age, in a large Chinese population cohort. Methods Using a medical insurance database in the southwest of China from 2001 to 2012, time trends in age-adjusted ischaemic and haemorrhagic stroke incidence and the contributing risk factors associated with age were investigated. Results Among 425,901 individuals without prior stroke (52.4% male, median age 54), the rate of ischaemic stroke (per 1000 patient-years) decreased between 2002–2007, then remained broadly similar between 2008–2012. The rate of haemorrhagic stroke showed a similar trend, being approximately 1.3–1.9 from 2008–2012. Compared to patients ageischaemic and haemorrhagic stroke incidences (rate, 95% confidential interval, CI) were higher in the elderly population (age ischaemic: 3.64, 3.33–4.00, vs 14.33, 14.01–14.60; haemorrhagic: 1.09, 1.00–1.10 vs 2.52,2.40–2.70, respectively, both pstroke rates between the elderly and the very elderly population. Ischaemic and haemorrhagic stroke shared similar risk factors (age, hypertension, coronary artery disease (CAD), vascular disease, and diabetes mellitus) (all pstroke (all pdisease (2.24, 1.49–3.37) was an additional major risk factor for haemorrhagic stroke, together with CAD and diabetes mellitus (all pischaemic stroke compared to haemorrhagic stroke with ageing. CAD, vascular disease, diabetes mellitus, and hypertension were major contributors to the development of hemorrhagic stroke in the very elderly Chinese population. PMID:27685332

  6. Microparticle Shedding from Neural Progenitor Cells and Vascular Compartment Cells Is Increased in Ischemic Stroke. (United States)

    Chiva-Blanch, Gemma; Suades, Rosa; Crespo, Javier; Peña, Esther; Padró, Teresa; Jiménez-Xarrié, Elena; Martí-Fàbregas, Joan; Badimon, Lina


    Ischemic stroke has shown to induce platelet and endothelial microparticle shedding, but whether stroke induces microparticle shedding from additional blood and vascular compartment cells is unclear. Neural precursor cells have been shown to replace dying neurons at sites of brain injury; however, if neural precursor cell activation is associated to microparticle shedding, and whether this activation is maintained at long term and associates to stroke type and severity remains unknown. We analyzed neural precursor cells and blood and vascular compartment cells microparticle shedding after an acute ischemic stroke. Forty-four patients were included in the study within the first 48h after the onset of stroke. The cerebral lesion size was evaluated at 3-7 days of the stroke. Circulating microparticles from neural precursor cells and blood and vascular compartment cells (platelets, endothelial cells, erythrocytes, leukocytes, lymphocytes, monocytes and smooth muscle cells) were analyzed by flow cytometry at the onset of stroke and at 7 and 90 days. Forty-four age-matched high cardiovascular risk subjects without documented vascular disease were used as controls. Compared to high cardiovascular risk controls, patients showed higher number of neural precursor cell- and all blood and vascular compartment cell-derived microparticles at the onset of stroke, and after 7 and 90 days. At 90 days, neural precursor cell-derived microparticles decreased and smooth muscle cell-derived microparticles increased compared to levels at the onset of stroke, but only in those patients with the highest stroke-induced cerebral lesions. Stroke increases blood and vascular compartment cell and neural precursor cell microparticle shedding, an effect that is chronically maintained up to 90 days after the ischemic event. These results show that stroke induces a generalized blood and vascular cell activation and the initiation of neuronal cell repair process after stroke. Larger cerebral lesions

  7. Decreasing asthma morbidity

    African Journals Online (AJOL)


    Dec 12, 1994 ... Apart from the optimal use of drugs, various supplementary methods have been tested to decrease asthma morbidity, usually in patients from reiatively affluent socio-economic backgrounds. A study of additional measures taken in a group of moderate to severe adult asthmatics from very poor socio- ...

  8. New possibilities in the prevention of stroke in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Vladimir Anatolyevich Parfenov


    Full Text Available The paper reviews the data available in the literature on the prevention of stroke in atrial fibrillati