Feasibility and safety of early lower limb robot-assisted training in sub-acute stroke patients: a pilot study.

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Gandolfi, Marialuisa; Geroin, Christian; Tomelleri, Christopher; Maddalena, Isacco; Kirilova Dimitrova, Eleonora; Picelli, Alessandro; Smania, Nicola; Waldner, Andreas

2017-12-01

So far, the development of robotic devices for the early lower limb mobilization in the sub-acute phase after stroke has received limited attention. To explore the feasibility of a newly robotic-stationary gait training in sub-acute stroke patients. To report the training effects on lower limb function and muscle activation. A pilot study. Rehabilitation ward. Two sub-acute stroke inpatients and ten age-matched healthy controls were enrolled. Healthy controls served as normative data. Patients underwent 10 robot-assisted training sessions (20 minutes, 5 days/week) in alternating stepping movements (500 repetitions/session) on a hospital bed in addition to conventional rehabilitation. Feasibility outcome measures were compliance, physiotherapist time, and responses to self-report questionnaires. Efficacy outcomes were bilateral lower limb muscle activation pattern as measured by surface electromyography (sEMG), Motricity Index (MI), Medical Research Council (MRC) grade, and Ashworth Scale (AS) scores before and after training. No adverse events occurred. No significant differences in sEMG activity between patients and healthy controls were observed. Post-training improvement in MI and MRC scores, but no significant changes in AS scores, were recorded. Post-treatment sEMG analysis of muscle activation patterns showed a significant delay in rectus femoris offset (P=0.02) and prolonged duration of biceps femoris (P=0.04) compared to pretreatment. The robot-assisted training with our device was feasible and safe. It induced physiological muscle activations pattern in both stroke patients and healthy controls. Full-scale studies are needed to explore its potential role in post-stroke recovery. This robotic device may enrich early rehabilitation in subacute stroke patients by inducing physiological muscle activation patterns. Future studies are warranted to evaluate its effects on promoting restorative mechanisms involved in lower limb recovery after stroke.

CT Angiography and Presentation NIH stroke Scale in Predicting TIA in Patients Presenting with Acute Stroke Symptoms.

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Karaman, Bedriye; Selph, James; Burdine, Joselyn; Graham, Cole Blease; Sen, Souvik

2013-11-08

Patient candidacy for acute stroke intervention, is currently assessed using brain computed tomography angiography (CTA) evidence of significant stenosis/occlusion (SSO) with a high National Institutes of Health Stroke Scale (NIHSS) (>6). This study examined the association between CTA without significant stenosis/occlusion (NSSO) and lower NIHSS (≤ 6) with transient ischemic attack (TIA) and other good clinical outcomes at discharge. Patients presenting TIA, modified Rankin Score [mRS] ≤ 1, and home as the discharge disposition. Eighty-five patients received both an NIHSS at presentation and a CTA at 4.2 ± 2.2 hours from stroke symptom onset. Patients with NSSO on CTA as well as those with NIHSS≤6 had better outcomes at discharge (pTIA (pTIA. Addition of NIHSS ≤ 6 to NSSO on CTA proved to be a stronger independent predictor of TIA (Adjusted OR 18.7 95% CI: 3.5-98.9, p=0.001).

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

DEFF Research Database (Denmark)

Bentsen, Line; Christensen, Louisa; Christensen, Anders

2014-01-01

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

Communication in conversation in stroke patients.

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Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

2010-07-01

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

Studies on the T sub 3 suppression test with reference to the thyrodial sup 123 I uptake in Graves' disease; Comparison of 24-hour and 3-hour uptake

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Yamaguchi, Takahiko; Kobayashi, Isao; Yamaguchi, Yoshiyuki; Iwashita, Akira; Inukai, Toshihiko; Ohshima, Kihachi; Shimomura, Yohnosuke; Kobayashi, Setsuo (Gunma Univ., Maebashi (Japan). School of Medicine)

1990-06-01

Eighty-three patients with Graves' disease had been treated with methylmercaptoimidazole (MMI). They were prescribed a maintenance dose of antithyroid drug (MMI, 5 mg/day) at the time of a T{sub 3} suppression test. The 3-hour and 24-hour thyroidal {sup 123}I uptake after T{sub 3} administration (75 {mu}g/day, 2 weeks) were measured (post T{sub 3} uptake). In 38 patients whose post T{sub 3} uptake was below 35% in post T{sub 3} 24-hour uptake, treatment was stopped. The T{sub 3} suppression test was then repeated 1 and 3 months later. During a one-year follow up, 26 remained well, while 12 relapsed within 6 to 12 months. We have observed a good correlation between 3-hour uptake and 24-hour uptake of {sup 123}I after T{sub 3} administration (r=0.847, p<0.001). In 38 patients who showed positive T{sub 3} suppression, most patients with MMI withdrawal produced a marked overshoot of post T{sub 3} 3-hour and 24-hour uptake at one month. Retrospective analysis indicated that there was no significant difference in circulating thyroid hormone levels between remission and relapse groups. The present study provides evidence that 3-hour uptake values are able to be substituted for 24-hour uptake values during a T{sub 3} suppression test. In addition, overshoot of thyroidal uptake after antithyroid drug withdrawal was observed in 3-hour values, similar to 24-hour values. (author).

Elevated body temperature in ischemic stroke associated with neurological improvement.

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Khanevski, A N; Naess, H; Thomassen, L; Waje-Andreassen, U; Nacu, A; Kvistad, C E

2017-11-01

Some studies suggest that high body temperature within the first few hours of ischemic stroke onset is associated with improved outcome. We hypothesized an association between high body temperature on admission and detectable improvement within 6-9 hours of stroke onset. Consecutive ischemic stroke patients with NIHSS scores obtained within 3 hours and in the interval 6-9 hours after stroke onset were included. Body temperature was measured on admission. A total of 315 patients with ischemic stroke were included. Median NIHSS score on admission was 6. Linear regression showed that NIHSS score 6-9 hours after stroke onset was inversely associated with body temperature on admission after adjusting for confounders including NIHSS score body temperature and neurological improvement within few hours after admission. This finding may be limited to patients with documented proximal middle cerebral artery occlusion on admission and suggests a beneficial effect of higher body temperature on clot lysis within the first three hours. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Reliability and validity of the de Morton Mobility Index in individuals with sub-acute stroke.

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Braun, Tobias; Marks, Detlef; Thiel, Christian; Grüneberg, Christian

2018-02-04

To establish the validity and reliability of the de Morton Mobility Index (DEMMI) in patients with sub-acute stroke. This cross-sectional study was performed in a neurological rehabilitation hospital. We assessed unidimensionality, construct validity, internal consistency reliability, inter-rater reliability, minimal detectable change and possible floor and ceiling effects of the DEMMI in adult patients with sub-acute stroke. The study included a total sample of 121 patients with sub-acute stroke. We analysed validity (n = 109) and reliability (n = 51) in two sub-samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 12.37, p = 0.577). All hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach's alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.95; 95% confidence interval: 0.92-0.97) were excellent. The minimal detectable change with 90% confidence was 13 points. No floor or ceiling effects were evident. These results indicate unidimensionality, sufficient internal consistency reliability, inter-rater reliability, and construct validity of the DEMMI in patients with a sub-acute stroke. Advantages of the DEMMI in clinical application are the short administration time, no need for special equipment and interval level data. The de Morton Mobility Index, therefore, may be a useful performance-based bedside test to measure mobility in individuals with a sub-acute stroke across the whole mobility spectrum. Implications for Rehabilitation The de Morton Mobility Index (DEMMI) is an unidimensional measurement instrument of mobility in individuals with sub-acute stroke. The DEMMI has excellent internal consistency and inter-rater reliability, and sufficient construct validity. The minimal detectable change of the DEMMI with 90% confidence in stroke rehabilitation is 13 points. The lack of any floor or ceiling effects on hospital admission indicates

Long working hours and stroke among employees in the general workforce of Denmark.

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Hannerz, Harald; Albertsen, Karen; Burr, Hermann; Nielsen, Martin Lindhardt; Garde, Anne Helene; Larsen, Ann Dyreborg; Pejtersen, Jan Hyld

2018-05-01

A systematic review and meta-analysis have found that long working hours were prospectively associated with an increased risk of overall stroke. The primary aim of the present study was to test if this finding could be reproduced in a sample that has been randomly selected from the general workforce of Denmark. A secondary aim was to estimate the association for haemorrhagic and ischaemic stroke separately. Individual participant data on 20- to 64-year-old employees were drawn from the Danish Labour Force Survey, 1999-2013, and linked to data on socio-economic status (SES), migrations, hospitalisations and deaths from national registers. The participants were followed from the time of the interview until the end of 2014. Poisson regression was used to estimate age-, sex- and SES-adjusted rate ratios for stroke as a function of weekly working hours. With 35-40 working hours per week as reference, the estimated rate ratios for overall stroke were 0.97 (95% confidence interval (CI) 0.83-1.13) for 41-48 working hours, 1.10 (95% CI 0.86-1.39) for 49-54 working hours and 0.89 (95% CI 0.69-1.16) for ≥55 working hours. The estimated rate ratios per one category increase in working hours were 0.99 (95% CI 0.93-1.06) for overall stroke, 0.96 (95% CI 0.88-1.05) for ischaemic stroke and 1.15 (95% CI 1.02-1.31) for haemorrhagic stroke. Our analysis does not support the hypothesis that long working hours are associated with increased rates of overall stroke. It suggests, however, that long working hours might be associated with increased rates of haemorrhagic stroke.

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

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Lucy Anne Murtha

2016-05-01

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

The impact of early specialist management on outcomes of patients with in-hospital stroke.

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Manawadu, Dulka; Choyi, Jithesh; Kalra, Lalit

2014-01-01

Delays in treatment of in-hospital stroke (IHS) adversely affect patient outcomes. We hypothesised that early referral and specialist management of IHS patients will improve outcomes at 90 days. Baseline characteristics, assessment delays, thrombolysis eligibility, 90-day functional outcomes and all-cause mortality were compared between IHS patients referred for specialist stroke management within 3 hours of symptom onset (early referrals) and later referrals. Patients were identified from a prospective stroke registry between January 2009 and December 2010. Inclusion criteria were primary admission with a non-stroke diagnosis, onset of new neurological deficits after admission and early ischaemic changes on CT or MR imaging. Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 year; 51% male, median NIHSS score 10). There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 (76%) of the 37/78 (47%) potentially eligible patients; 7 patients were excluded because specialist referral was delayed beyond 4.5 hours despite symptom recognition within 3 hours of onset. Early referral improved functional outcomes (modified Rankin Scale 0-2 at 90 days 40% v 7%, p = 0.001) and was an independent predictor of mRS 0-2 at 90 days after adjusting for age, pre-morbid function, primary cause for hospital admission and stroke severity [OR 1.13 (95% C.I.  = 1.10-1.27), p = 0.002]. Early referral and specialist management of IHS patients that includes thrombolysis is associated with better functional outcomes at 90 days.

[A comparison of stroke patients' characteristics between a sub-Saharan Africa population (Abidjan) and a French stroke unit (Amiens): An observational study].

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Bugnicourt, J-M; Tchouata-Ngandjouc, L; Beugre, K; Chillon, J-M; Godefroy, O

2013-03-01

Stroke characteristics in Sub-Saharan Africa (SSA) differ from developed countries. However, SSA subjects undergo epidemiological and demographic transition and it appears that the prevalence of vascular risk factors (RF) increases in this population. Here we aimed to compare stroke patients' characteristics between a SSA hospital (Cocody University Hospital, Abidjan, Côte d'Ivoire) and a French stroke unit (Amiens University Hospital, Amiens, France). This retrospective study included all consecutive stroke patients admitted between January and May 2008 (Cocody University Hospital, Abidjan, Côte d'Ivoire) and between October and December 2008 (Amiens University Hospital, Amiens, France). We assessed each patient's demographic details, RF, and CT confirmed pathological stroke type. The glomerular filtration rate (GFR) was estimated using the four-component Modification of Diet in Renal Disease (MDRD) equation and CKD was defined as a GFR less than 60ml/min/1.73 m(2). One hundred and ninety five patients were included (Amiens: 92; Abidjan: 103) with a mean age of 63±14 years. Patients in Amiens had more known vascular RF than African patients, whereas African patients had more RF discovered during hospitalisation. Furthermore, CKD was significantly more common in SSA patients (43% vs 24%, P=0.001). More African than European patients had cerebral hemorrhage (34% vs 8%, Pstroke mortality and treatments at hospital discharge were similar between the two hospitals. Finally, a high proportion of patients in Abidjan suffered from cervical atherosclerosis, although it was significantly lower than patients in Amiens (37% vs 67%, Pstroke patients. These findings could partly explain the high prevalence of cervical atherosclerosis found in this population. These results warrant confirmation in prospective studies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Nursing care for stroke patients

DEFF Research Database (Denmark)

Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

2018-01-01

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

Randomized controlled trial of a comprehensive stroke education program for patients and caregivers.

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Rodgers, H; Atkinson, C; Bond, S; Suddes, M; Dobson, R; Curless, R

1999-12-01

We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient- and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. Only 51 of 108 (47%) surviving patients randomized to the SEP completed the program, as did 20 of 93 (22%) informal carers of surviving patients. Perceived health status (Short Form 36 [SF-36] health survey) scores were similar for SEP patients and controls. Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group (P=0.04). Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls (patients, P=0.02; carers, P=0. 01). Patients in the SEP group were more satisfied with the information that they had received about stroke (P=0.004). There were no differences in emotional or functional outcomes between groups. Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services, this was not associated with an improvement in their perceived health status. Indeed, the social functioning of informal carers randomized to the SEP was less than in the control group.

Randomized Controlled Trial of Early Versus Delayed Statin Therapy in Patients With Acute Ischemic Stroke: ASSORT Trial (Administration of Statin on Acute Ischemic Stroke Patient).

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Yoshimura, Shinichi; Uchida, Kazutaka; Daimon, Takashi; Takashima, Ryuzo; Kimura, Kazuhiro; Morimoto, Takeshi

2017-11-01

Several studies suggested that statins during hospitalization were associated with better disability outcomes in patients with acute ischemic stroke, but only 1 small randomized trial is available. We conducted a multicenter, open-label, randomized controlled trial in patients with acute ischemic strokes in 11 hospitals in Japan. Patients with acute ischemic stroke and dyslipidemia randomly received statins within 24 hours after admission in the early group or on the seventh day in the delayed group, in a 1:1 ratio. Statins were administered for 12 weeks. The primary outcome was patient disability assessed by modified Rankin Scale at 90 days. A total of 257 patients were randomized and analyzed (early 131, delayed 126). At 90 days, modified Rankin Scale score distribution did not differ between groups ( P =0.68), and the adjusted common odds ratio of the early statin group was 0.84 (95% confidence interval, 0.53-1.3; P =0.46) compared with the delayed statin group. There were 3 deaths at 90 days (2 in the early group, 1 in the delayed group) because of malignancy. Ischemic stroke recurred in 9 patients (6.9%) in the early group and 5 patients (4.0%) in the delayed group. The safety profile was similar between groups. Our randomized trial involving patients with acute ischemic stroke and dyslipidemia did not show any superiority of early statin therapy within 24 hours of admission compared with delayed statin therapy 7 days after admission to alleviate the degree of disability at 90 days after onset. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02549846. © 2017 American Heart Association, Inc.

Association of serum 25-hydroxyvitamin D with symptoms of depression after 6 months in stroke patients.

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Yue, Wei; Xiang, Lei; Zhang, Ya-Jing; Ji, Yong; Li, Xin

2014-11-01

Our aim was to determine whether there was a relationship between 25-hydroxyvitamin D (25[OH] D) and post-stroke depression (PSD). Two hundred and forty-four ischemic stroke patients admitted to the hospital within the first 24 h after stroke onset were consecutively recruited and followed up for 6 months. Clinical information was collected. Serum 25[OH] D levels were measured at baseline. Based on the symptoms, diagnoses of depression were made in accordance with DSM-IV criteria for depression at 6-month after stroke. At 6-month, 91 patients (37.3 %) showed depression and in 60 patients (24.6 %) this depression was classified as major. There was a significant difference in median serum 25[OH] D levels between PSD patients and no depression cases [8.3 (IQR, 6.8-9.5) vs. 15.6 (IQR, 13.2-20.3) ng/ml, respectively; P < 0.001]. Serum 25[OH] D levels ≤ 11.2 ng/ml were independently associated with PSD [odds ratio 10.32, 95 % confidence interval 4.97-28.63; P < 0.001], after adjusting for possible confounders. Serum 25[OH] D levels reduced at admission was found to be associated with PSD. Additional research is needed on vitamin D supplementation to improve the outcome of patients with PSD.

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

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Philip M. Bath

2016-01-01

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

Treatment of hyperglycaemia in patients with acute stroke.

Science.gov (United States)

Castilla-Guerra, L; Fernández-Moreno, M C; Hewitt, J

2016-03-01

The proportion of diabetic patients who are hospitalised for stroke has been increasing in recent years, currently reaching almost a third of all cases of stroke. In addition, about half of patients with acute stroke present hyperglycaemia in the first hours of the stroke. Although hyperglycaemia in the acute phase of stroke is associated with a poor prognosis, its treatment is currently a topic of debate. There is no evidence that the adminstration of intravenous insulin to these patients offers benefits in terms of the evolution of the stroke. New studies in development, such as the SHINE study (Stroke Hyperglycemia Insulin Network Effort), may contribute to clarifying the role of intensive control of glycaemia during the acute phase of the stroke. Ultimately, patients who have presented with stroke should be screened for diabetes. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Risk Factors for Hemorrhagic and Ischemic Stroke in Sub-Saharan Africa

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Gertrude Namale

2018-01-01

Full Text Available Introduction. In sub-Saharan Africa (SSA, there is a significant burden of ischemic stroke (IS and hemorrhagic stroke (HS, although data on risk factors for each type are sparse. In this systematic review we attempt to characterize the risk factors. Methods. We systematically reviewed (PubMed, EMBASE, WHOLIS, Google Scholar, Wiley online, and the Cochrane Central Register of Controlled Trials (CENTRAL case-control studies and case series from 1980 to 2016 that reported risk factors for IS and/or HS in SSA. For each risk factor we calculated random-effects pooled odds ratios (ORs for case-control studies and pooled prevalence estimates for case series. Results. We identified 12 studies, including 4,387 stroke patients. Pooled analysis showed that patients who had diabetes (OR = 2.39; 95% CI: 1.14–5.03 and HIV (OR = 2.46 (95% CI: 1.59–3.81 were at a significantly greater risk of suffering from all stroke types. There were insufficient data to examine these factors by stroke type. Among case series, the pooled prevalence of hypertension was higher for HS than for IS (73.5% versus 62.8%, while diabetes mellitus (DM and atrial fibrillation (AF were more prevalent among IS compared to HS (15.9% versus 10.6% and 9.6% versus 2.3%, respectively. Conclusions. There remain too few data from SSA to reliably estimate the effect of various factors on the risk of IS and HS. Furthermore, the vast majority of cases were identified in hospital and so are unlikely to be representative of the totality of stroke cases in the community.

Family History in Young Patients With Stroke.

Science.gov (United States)

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

2015-07-01

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

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

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Pacheco, Felipe Torres; Littig, Ingrid Aguiar; Gagliardi, Rubens Jose; Rocha, Antônio Jose da

2015-01-01

Objective The potential of computed tomography angiography (CTA) was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours). Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2%) based on both clinical ...

Measurement of Cabbibo-suppressed {tau} lepton decays and the determination of vertical stroke V{sub us} vertical stroke

Energy Technology Data Exchange (ETDEWEB)

Schenk, Stefan

2008-07-07

This work presents simultaneous branching fraction measurements of the decay modes {tau}{sup -}{yields}K{sup -}n{pi}{sup 0}{nu}{sub {tau}} with n=0,1,2,3 and {tau}{sup -}{yields}{pi}{sup -}n{pi}{sup 0}{nu}{sub {tau}} with n=3,4. The analysis is based on a data sample of 427 x 10{sup 6}{tau}{sup +}{tau}{sup -} pairs recorded with the BABAR detector, which corresponds to an integrated luminosity of 464.4 fb{sup -1}. The measured values are B({tau}{sup -}{yields}K{sup -}{nu}{sub {tau}})=(6.57{+-}0.03{+-}0.11) x 10{sup -3}, B({tau}{sup -}{yields}K{sup -}{pi}{sup 0}{nu}{sub {tau}})=(4.61{+-}0.03{+-}0.11) x 10{sup -3}, B({tau}{sup -}{yields}K{sup -}{pi}{sup 0}{pi}{sup 0}{nu}{sub {tau}})=(5.05{+-}0.17{+-}0.44) x 10{sup -4}, B({tau}{sup -}{yields}K{sup -}{pi}{sup 0}{pi}{sup 0}{pi}{sup 0}{nu}{sub {tau}})=(1.31{+-}0.43{+-}0.40) x 10{sup -4}, B({tau}{sup -}{yields}{pi}{sup -}{pi}{sup 0}{pi}{sup 0}{pi}{sup 0}{nu}{sub {tau}})=(1.263{+-}0.008{+-}0.078) x 10{sup -2} and B({tau}{sup -}{yields}{pi}{sup -}{pi}{sup 0}{pi}{sup 0}{pi}{sup 0}{pi}{sup 0}{nu}{sub {tau}})=(9.6{+-}0.5{+-}1.2) x 10{sup -4}, where the uncertainties are statistical and systematic, respectively. All measurements are compatible with the current world averages whereas the uncertainties are significantly smaller by a factor of up to five. The determination of B({tau}{sup -}{yields}{pi}{sup -}{pi}{sup 0}{pi}{sup 0}{pi}{sup 0}{pi}{sup 0}{nu}{sub {tau}}) is the first measurement of this branching fraction. The measured branching fractions are combined with the current world averages. Using the new averages, an updated determination of vertical stroke V{sub us} vertical stroke from hadronic {tau} decays yields vertical stroke V{sub us} vertical stroke =0.2146{+-}0.0025, which improves previous measurements by 19%. Its uncertainty is comparable to the one of the current world average from semileptonic kaon decays. (orig.)

Relationship between Cardiac Troponin and Thrombo-Inflammatory Molecules in Prediction of Outcome after Acute Ischemic Stroke

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Csecsei, Peter; Pusch, Gabriella; Ezer, Erzsebet

2018-01-01

BACKGROUND: In patients with acute ischemic stroke (AIS) without cardiovascular complications, we investigated the association of serum concentration of cardiac troponin (high-sensitivity cardiac troponin T [hs-cTnT]) with thrombo-inflammatory markers. METHODS: Thirty-five patients with first......-ever AIS were prospectively examined. Serum hs-cTnT was measured 6 and 24 hours after stroke, whereas S100B, high-sensitivity C-reactive protein (hsCRP), soluble CD40 ligand, tissue plasminogen activator (tPA), monocyte chemoattractant protein-1 (MCP-1), and P-selectin were measured 6 and 72 hours after...... stroke. Severity of stroke was assessed by the National Institutes of Health Stroke Scale (NIHSS) on admission, 24 hours later, and at discharge. RESULTS: Concentration of MCP-1 at 6 hours was higher in the serum of patients with worsened NIHSS by 24 hours (P = .009). Concentration of hs-cTnT at both 6...

Improving the Prediction of Spontaneous and Post-thrombolytic Recanalization in Ischemic Stroke Patients.

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Vanacker, Peter; Lambrou, Dimitris; Eskandari, Ashraf; Ntaios, George; Cras, Patrick; Maeder, Philippe; Meuli, Reto; Michel, Patrik

2015-08-01

Endovascular treatment for acute ischemic stroke patients was recently shown to improve recanalization rates and clinical outcome in a well-defined study population. Intravenous thrombolysis (IVT) alone is insufficiently effective to recanalize in certain patients or of little value in others. Accordingly, we aimed at identifying predictors of recanalization in patients treated with or without IVT. In the observational Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, we selected those stroke patients (1) with an arterial occlusion on computed tomography angiography (CTA) imaging, (2) who had an arterial patency assessment at 24 hours (CTA/magnetic resonance angiography/transcranial Doppler), and (3) who were treated with IVT or had no revascularization treatment. Based on 2 separate logistic regression analyses, predictors of spontaneous and post-thrombolytic recanalization were generated. Partial or complete recanalization was achieved in 121 of 210 (58%) thrombolyzed patients. Recanalization was associated with atrial fibrillation (odds ratio , 1.6; 95% confidence interval, 1.2-3.0) and absence of early ischemic changes on CT (1.1, 1.1-1.2) and inversely correlated with the presence of a significant extracranial (EC) stenosis or occlusion (.6, .3-.9). In nonthrombolyzed patients, partial or complete recanalization was significantly less frequent (37%, P < .01). The recanalization was independently associated with a history of hypercholesterolemia (2.6, 1.2-5.6) and the proximal site of the intracranial occlusion (2.5, 1.2-5.4), and inversely correlated with a decreased level of consciousness (.3, .1-.8), and EC (.3, .1-.6) and basilar artery pathology (.1, .0-.6). Various clinical findings, cardiovascular risk factors, and arterial pathology on acute CTA-based imaging are moderately associated with spontaneous and post-thrombolytic arterial recanalization at 24 hours. If confirmed in other studies, this information may influence patient selection

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

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Madsen, Tracy E.

2014-12-01

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

Thrombolytic therapy for patients who wake-up with stroke.

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Barreto, Andrew D; Martin-Schild, Sheryl; Hallevi, Hen; Morales, Miriam M; Abraham, Anitha T; Gonzales, Nicole R; Illoh, Kachi; Grotta, James C; Savitz, Sean I

2009-03-01

Approximately 25% of ischemic stroke patients awaken with their deficits. The last-seen-normal time is defined as the time the patient went to sleep, which places these patients outside the window for thrombolysis. The purpose of this study was to describe our center's experience with off-label, compassionate thrombolysis for wake-up stroke (WUS) patients. A retrospective review of our database identified 3 groups of ischemic stroke patients: (1) WUS treated with thrombolysis; (2) nontreated WUS; and (3) 0- to 3-hour intravenous tissue plasminogen activator-treated patients. Safety and clinical outcome measures were symptomatic intracerebral hemorrhage, excellent outcome (discharge modified Rankin score, 0-1), favorable outcome (modified Rankin score, 0-2), and mortality. Outcome measures were controlled for baseline NIHSS using logistic regression. Forty-six thrombolysed and 34 nonthrombolysed WUS patients were identified. Sixty-one percent (28/46) of the treated WUS patients underwent intravenous thrombolysis alone whereas 30% (14/46) were given only intra-arterial thrombolysis. Four patients received both intravenous and intra-arterial thrombolysis (9%). Two symptomatic intracerebral hemorrhages occurred in treated WUS (4.3%). Controlling for NIHSS imbalance, treated WUS had higher rates of excellent (14% vs 6%; P=0.06) and favorable outcome (28% vs 13%; P=0.006), but higher mortality (15% vs 0%) compared to nontreated WUS. A second comparison controlling for baseline NIHSS between treated WUS and 174 intravenous tissue plasminogen activator patients treated within 3 hours of symptoms showed no significant differences in safety and clinical outcomes. Thrombolysis may be safe in WUS patients. Our center's experience supports considering a prospective, randomized trial to assess the safety and outcome of thrombolysis for this specific patient population.

The impact of patient's weight on post-stroke rehabilitation.

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Kalichman, Leonid; Alperovitch-Najenson, Deborah; Treger, Iuly

2016-08-01

Purpose To evaluate the influence of patient's weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission - FIM at discharge) were evaluated. The Kruskal-Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho = -0.20, p = 0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients' BMI. Implications for Rehabilitation In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients.

Pre-stroke apathy symptoms are associated with an increased risk of delirium in stroke patients.

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Klimiec, Elzbieta; Kowalska, Katarzyna; Pasinska, Paulina; Klimkowicz-Mrowiec, Aleksandra; Szyper, Aleksandra; Pera, Joanna; Slowik, Agnieszka; Dziedzic, Tomasz

2017-08-09

Neuropsychiatric symptoms can be interrelated to delirium. We aimed to investigate an association between pre-stroke neuropsychiatric symptoms and the risk of delirium in stroke patients. We included 606 patients (median age: 73, 53% female) with stroke or transient ischemic attack admitted within 48 hours from symptoms onset. We assessed delirium on a daily basis during the first 7 days of hospitalization. To make diagnosis of delirium we used DSM-5 criteria. We used Neuropsychiatric Inventory to assess neuropsychiatric symptoms occurring within 4 weeks prior to stroke. We diagnosed delirium in 28.2% of patients. On univariate analysis, higher score of pre-stroke depression (OR: 1.58, 95% CI: 1.04-2.40, P = 0.03), apathy (OR: 2.23, 95% CI: 1.44-3.45, P delirium. On multivariate analysis adjusted for age, atrial fibrillation, diabetes mellitus, stroke severity, right hemisphere lesion, pre-stroke cognitive decline, pre-stroke disability and infections, higher apathy score (OR: 2.03, 95% CI: 1.17-3.50, P = 0.01), but no other neuropsychiatric symptoms, remained independent predictor of delirium. We conclude that pre-stroke apathy symptoms are associated with increased risk of delirium in stroke patients.

Utilization of Emergency Medical Service Increases Chance of Thrombolytic Therapy in Patients with Acute Ischemic Stroke

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Hsieh, Ming-Ju; Tang, Sung-Chun; Chiang, Wen-Chu; Huang, Kuang-Yu; Chang, Anna Marie; Ko, Patrick Chow-In; Tsai, Li-Kai; Jeng, Jiann-Shing; Ma, Matthew Huei-Ming

2014-01-01

Objective To determine whether utilization of emergency medical service (EMS) can expedite and improve the rate of thrombolytic therapy administration in acute ischemic stroke patients. Methods This is a prospective observational study of consecutive patients presenting to the emergency department (ED) with an ischemic stroke within 72 hours of symptom onset. Variables associated with early ED arrival (within 3 hours of stroke onset), and administration of thrombolytic therapy were analyzed. We also evaluated the factors related to onset-to-needle time in patients receiving thrombolytic therapy. Results From January 1, 2010 to July 31, 2011, there were 1081 patients (62.3% men, age 69.6 ± 13 years) included in this study. Among them, 289 (26.7%) arrived in the ED within 3 hours, and 88 (8.1%) received intravenous thrombolytic therapy. Patients who arrived to the ED by EMS (n=279, 25.8 %) were independently associated with earlier ED arrival (adjusted odds ratio [OR] = 3.68, 95% confidence interval [CI] = 2.54 to 5.33), and higher chance of receiving thrombolytic therapy (adjusted OR = 3.89, 95% CI= 1.86 to 8.17). Furthermore, utilization of EMS decreased onset-to-needle time by 26 minutes in patients receiving thrombolytic therapy. Conclusion Utilization of EMS can help acute ischemic stroke patients in early presentation to ED, facilitate thrombolytic therapy, and reduce the onset to needle time. PMID:24296308

Stroke Burden in Rwanda: A Multicenter Study of Stroke Management and Outcome.

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Nkusi, Agabe Emmy; Muneza, Severien; Nshuti, Steven; Hakizimana, David; Munyemana, Paulin; Nkeshimana, Menelas; Rudakemwa, Emmanuel; Amendezo, Etienne

2017-10-01

Cerebrovascular accidents or stroke constitute the second leading cause of mortality worldwide. Low- and middle-income countries bear most of the stroke burden worldwide. The main objective of this study is to determine the burden of stroke in Rwanda. This was a prospective observational study in 2 parts: 6 months baseline data collection and outcome assessment sessions at 1 year. A total of 96 patients were enrolled in our series. Stroke constituted 2100 per 100,000 population. Of all patients, 55.2% were male and most (60%) were 55 years and older. Of all patients and/or caretakers, 22% were not aware of their previous health status and 53.5% of hypertensive patients were not on treatment by the time of the event. Median presentation delay was 72 hours for patients with ischemic stroke and 24 hours for patients with hemorrhagic stroke. Most patients had hemorrhagic stroke (65% vs. 35%), and more patients with hemorrhagic stroke presented with loss of consciousness (80% vs. 51%). Many patients (62% ischemic group and 44% hemorrhagic group) presented with severe stroke scores, and this was associated with worst outcome (P = 0.004). At 1 year follow-up, 24.7% had no or mild disability, 14.3% were significantly disabled, and 61% had died. Our results show that stroke is a significant public health concern in Rwanda. Risk factor awareness and control are still low and case fatality of stroke is significantly high. The significant delay in presentation to care and presentation with severe stroke are major contributors for the high mortality and severe disability rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Determination of the CKM matrix element vertical stroke V{sub cb} vertical stroke, the B {yields} X{sub s}{gamma} decay rate, and the b-quark mass

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Bernlochner, Florian Urs

2011-09-15

In this work, the preliminary measurements of two fundamental parameters of the Standard Model of particles physics are presented: the CKM matrix element vertical stroke V{sub cb} vertical stroke, and the b-quark mass. The measurement of the absolute value of the CKM matrix element V{sub cb} uses the full set of recorded data of 429.06 fb{sup -1} of B anti B mesons of the BABAR experiment. The CKM matrix element is obtained by measuring the branching fractions and non-perturbative shape parameters of the two transitions into the charmed 1S ground states, B {yields} Dl{nu}{sub l} and B {yields} D{sup *}l {nu}{sub l}, respectively. The kinematic of the produced lepton is measured and the kinematics of the short-lived charmed mesons is reconstructed from kaon and pion candidates. By combining the reconstructed three-momenta of both particles with the angular information of the decay, three independent variables can be obtained. The measured distributions in these variables are analyzed in a three-dimensional global fit, which simultaneously extracts the decay parameters and branching fractions of both charmed transitions. We find that B {yields} Dl {nu}{sub l}: vertical stroke V{sub cb} vertical stroke =(36.14{+-}0.57{sub stat.}{+-}1.30{sub sys.}{+-}0.80{sub theo.}) x 10{sup -3}, B {yields} D{sup *}l {nu}{sub l}: vertical stroke V{sub cb} vertical stroke =(39.71{+-}0.26{sub stat.}{+-}0.73{sub sys.}{+-}0.74{sub theo.}) x 10{sup -3}, where the uncertainties are statistical, systematic, and theoretical, respectively. In the Standard Model, both measured values of vertical stroke V{sub cb} vertical stroke can be averaged to further minimize the uncertainties. We find Combined: vertical stroke V{sub cb} vertical stroke =(38.29{+-}0.26{sub stat.}{+-}0.64{sub sys.}{+-}0.52{sub theo.}) x 10{sup -3}. Furthermore, several scenarios are explored how possible future unquenched lattice QCD points can be incorporated into the measurement, to further reduce the uncertainty on

Excessive Premature Atrial Complexes and the Risk of Recurrent Stroke or Death in an Ischemic Stroke Population.

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Vinther, Kristina H; Tveskov, Claus; Möller, Sören; Auscher, Soren; Osmanagic, Armin; Egstrup, Kenneth

2017-06-01

Our aim was to investigate the association of premature atrial complexes and the risk of recurrent stroke or death in patients with ischemic stroke in sinus rhythm. In a prospective cohort study, we used 24-hour Holter recordings to evaluate premature atrial complexes in patients consecutively admitted with ischemic strokes. Excessive premature atrial complexes were defined as >14 premature atrial complexes per hour and 3 or more runs of premature atrial complexes per 24 hours. During follow-up, 48-hour Holter recordings were performed after 6 and 12 months. Among patients in sinus rhythm, the association of excessive premature atrial complexes and the primary end point of recurrent stroke or death were estimated in both crude and adjusted Cox proportional hazards models. We further evaluated excessive premature atrial complexes contra atrial fibrillation in relation to the primary end point. Of the 256 patients included, 89 had atrial fibrillation. Of the patients in sinus rhythm (n = 167), 31 had excessive premature atrial complexes. During a median follow-up of 32 months, 50 patients (30% of patients in sinus rhythm) had recurrent strokes (n = 20) or died (n = 30). In both crude and adjusted models, excessive premature atrial complexes were associated with the primary end point, but not with newly diagnosed atrial fibrillation. Compared with patients in atrial fibrillation, those with excessive premature atrial complexes had similarly high risks of the primary end point. In patients with ischemic stroke and sinus rhythm, excessive premature atrial complexes were associated with a higher risk of recurrent stroke or death. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Zinc Serum Level Can Be a Risk Factor In Babol Stroke Patients?

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Alijan AhmadiAhangar

2017-02-01

Full Text Available Background and Purpose: Stroke is the second leading cause of death worldwide. The role of zinc as a contributing factor in the pathogenesis of stroke was considered. Results: This cross-sectional study on 100 stroke patients in Ayatollah Rouhani Hospital and 100 control group from cohort master plan "Ageing and health projects Amirkola was conducted. Zinc levels Serum simultaneously with other blood tests in the early hours of hospitalization. Zinc serum level was defined 70 to 120 micrograms per deciliter. Findings: The difference in mean of zinc level in patients and control group was not significant (102.6±47.7 in control group vs 100.9±35.8 in patient, p=0.7. Difference in zinc Serum level had statically significant with IHD (under70 0 cases (0, 70 to120 8 cases (24, 120 and upper24 cases (75, p=0.003 and with type of stroke (under70 (3(3.3 hemorrhagic vs 0(0 ischemic, 70 to 120(19(21 vs6 (60, 120 and upper68 (75.6 vs4 (40, p=0.025 and also with patient and control group (under70 (3(3 in patient's vs 20(20 control group, 70 to 120(25(25 vs54 (54, 120 and upper72 (72 vs26 (26, p<0001. In patients group 72(73.5 of cases had zinc serum level above 120. HLP difference was significant in patient and control group (50(50 in control group vs 35(35 in patients, p=0.04. Regression logistic show that IHD (p<0001, OR=30, CI=6-152, HLP (p<0001, OR=4, CI=9.09-1.85, zinc serum level (p<0001, OR=15.5, CI=4-59.8 had significant role. Conclusions: Zinc serum levels, Ischemic Heart Disease, Hyperlipidemia were most risk factor that play role in Babol stroke patients.

Non-stenotic intracranial arteries have atherosclerotic changes in acute ischemic stroke patients: a 3T MRI study

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Lee, Woo Jin; Choi, Hyun Seok; Jang, Jinhee; Sung, Jinkyeong; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Bum-soo [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, Seoul (Korea, Republic of); Kim, Tae-Won; Koo, Jaseong [The Catholic University of Korea, Department of Neurology, College of Medicine, Seoul (Korea, Republic of); Shin, Yong Sam [The Catholic University of Korea, Department of Neurosurgery, College of Medicine, Seoul (Korea, Republic of)

2015-10-15

The aim of this study is to evaluate the degree of atherosclerotic changes in intracranial arteries by assessing arterial wall thickness using T1-weighted 3D-turbo spin echo (3D-TSE) and time-of-flight MR angiography (TOF-MRA) in patients with acute ischemic stroke as compared with unaffected controls. Thirty-three patients with acute ischemic stroke and 36 control patients were analyzed. Acute ischemic stroke patients were divided according to TOAST classification. At both distal internal carotid arteries and basilar artery without stenosis, TOF-MRA was used to select non-stenotic portion of assessed arteries. 3D-TSE was used to measure the area including the lumen and wall (Area{sub Outer}) and luminal area (Area{sub Inner}). The area of the vessel wall (Area{sub VW}) of assessed intracranial arteries and the ratio index (RI) of each patient were determined. Area{sub Inner}, Area{sub Outer}, Area{sub VW}, and RI showed good inter-observer reliability and excellent intra-observer reliability. Area{sub Inner} did not significantly differ between stroke patients and controls (P = 0.619). However, Area{sub Outer}, Area{sub VW}, and RI were significantly larger in stroke patients (P < 0.001). The correlation coefficient between Area{sub Inner} and Area{sub Outer} was higher in the controls (r = 0.918) than in large vessel disease patients (r = 0.778). RI of large vessel disease patients was significantly higher than that of normal control, small vessel disease, and cardioembolic groups. In patients with acute ischemic stroke, wall thickening and positive remodeling are evident in non-stenotic intracranial arteries. This change is more definite in stroke subtype that is related to atherosclerosis than that in other subtypes which are not. (orig.)

Hyponatremia And Disability, Prevalence And Prognosis In Babol Stroke Patients.

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Alijan Ahmadi Ahangar

2017-02-01

Full Text Available Background: Stroke is the leading cause of serious long-term disability. In recent studies hyponatremia as a risk factor for stroke. Methods: This cross-sectional descriptive study was to evaluate serum zinc level in serum sodium over the first 24 hours after the onset of stroke. Different intensities were determined on Stroke Scale NIH (National Institute of Health (mild 4-1 and (average moderate 15-5 and (moderate to severe 20-16 and (extreme severe 42- 21. Determination intensity of stroke after admission and discharge with Modified Rankin Scale and Barthel index. Blood serum concentrations of sodium 0.5 mL of venous blood were taken and sodium serum level was performed with Latex particle agglutination test in Ayatollah Rouhani Hospital. That normal range was defined 136-146 meq / L Findings: 125 patients were entered into this study; the prevalence of hyponatremia in female was 70% vs 60% in male. Of stroke patients included in this study 66% of them had hyponatremia and the frequency of hyponatremia in ischemic and hemorrhagic was 82% and 63%, respectively. Increase in hyponatremia with disability period of admission had statistically significant (10(12 mild vs 40(32 moderate, 32(25.6 severe, p=0.01 also with disability before discharge (24(19.2 mild, 26(20.8 moderate, 32(25.6 severe, p=0.03. Conclusions: Hyponatremia can effect on severity of the stroke and can be considered as a predictor of increased stroke severity and disability at admission and discharge.

MRI based thrombolysis for FLAIR-negative stroke patients within 4.5-6h after symptom onset.

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Wei, Xiao-Er; Zhou, Jia; Li, Wen-Bin; Zhao, Yu-Wu; Li, Ming-Hua; Li, Yue-Hua

2017-01-15

To investigate the feasibility of DWI-FLAIR mismatch in identifying patients who might benefit from thrombolytic therapy within 4.5-6h, we analyzed the data of 105 ischemic stroke patients with known time of symptom onset who underwent MRI within 6h of stroke and thrombolysis between December 2006 and December 2013. They were divided into three groups: symptom onset within 4.5h (n=66); 4.5-6h and FLAIR images negative (n=9); and 4.5-6h and FLAIR images positive (n=30). Outcome of thrombolysis was assessed for each group by recanalization rate, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. The results showed that mismatch between positive DWI and negative FLAIR images identified patients within 4.5h of symptom onset with sensitivity, specificity, positive predictive value and negative predictive value of 40.9%, 76.9%, and 75% and 43.5%. Recanalization rate, NIHSS score and mRS score were all better in both the 0-4.5h and 4.5-6h FLAIR-negative groups than in the 4.5-6h FLAIR-positive group (psymptom onset, patients with negative FLAIR images may benefit from thrombolysis therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

Relationship between stroke and mortality in dialysis patients.

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Wetmore, James B; Phadnis, Milind A; Ellerbeck, Edward F; Shireman, Theresa I; Rigler, Sally K; Mahnken, Jonathan D

2015-01-07

Stroke is common in patients undergoing long-term dialysis, but the implications for mortality after stroke in these patients are not fully understood. A large cohort of dually-eligible (Medicare and Medicaid) patients initiating dialysis from 2000 to 2005 and surviving the first 90 days was constructed. Medicare claims were used to ascertain ischemic and hemorrhagic strokes occurring after 90-day survival. A semi-Markov model with additive hazard extension was generated to estimate the association between stroke and mortality, to calculate years of life lost after a stroke, and to determine whether race was associated with differential survival after stroke. The cohort consisted of 69,371 individuals representing >112,000 person-years of follow-up. Mean age±SD was 60.8±15.5 years. There were 21.1 (99% confidence interval [99% CI], 20.0 to 22.3) ischemic strokes and 4.7 (99% CI, 4.2 to 5.3) hemorrhagic strokes after cohort entry per 1000 patient-years. At 30 days, mortality was 17.9% for ischemic stroke and 53.4% for hemorrhagic stroke. The adjusted hazard ratio (AHR) depended on time since entry into the cohort; for patients who experienced a stroke at 1 year after cohort entry, for example, the AHR of hemorrhagic stroke for mortality was 25.4 (99% CI, 22.4 to 28.4) at 1 week, 9.9 (99% CI, 8.4 to 11.6) at 3 months, 5.9 (99% CI, 5.0 to 7.0) at 6 months, and 1.8 (99% CI, 1.5 to 2.1) at 24 months. The corresponding AHRs for ischemic stroke were 11.7 (99% CI, 10.2 to 13.1) at 1 week, 6.6 (99% CI, 6.4 to 6.7) at 3 months, and 4.7 (99% CI, 4.5 to 4.9) at 6 months, remaining significantly >1.0 even at 48 months. Median months of life lost were 40.7 for hemorrhagic stroke and 34.6 for ischemic stroke. For both stroke types, mortality did not differ by race. Dialysis recipients have high mortality after a stroke with corresponding decrements in remaining years of life. Poststroke mortality does not differ by race. Copyright © 2015 by the American Society of Nephrology.

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

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Chao-jin-zi Li

2016-01-01

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

Circadian Variation Of Stroke Onset

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Kamath vasantha

2003-01-01

Full Text Available Diurnal variations in various physiological and biochemical functions and certain pathological events like myocardial infarction and stroke have been documented. We studied prospectively one hundred and seven patients of acute onset stroke confirmed by computed tomography for the exact time of onset, risk factors and type of stroke. Patients who were unclear of time of onset and with a diagnosis of cerebral venous thrombosis or sub-arachnoid hemorrhage were excluded. Infarction was detected in 71 patients and hemorrhage in 33 patients. Men out numbered women (1:6:1. Hypertension was more frequent in hemorrhage in the morning time (5 AM-12 noon and more infarction between 12-6 pm. However there was no relation between the time of onset of stroke and various risk-factors of stroke.

Trends in C-Reactive Protein Levels Are Associated with Neurological Change Twenty-Four Hours after Thrombolysis for Acute Ischemic Stroke.

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Gill, Dipender; Sivakumaran, Prasanthi; Wilding, Peter; Love, Madeleine; Veltkamp, Roland; Kar, Arindam

2016-08-01

Elevated inflammatory markers such as C-reactive protein (CRP) are associated with worse outcomes in patients thrombolysed for acute ischemic stroke (AIS). To investigate whether changes in CRP levels are associated with neurological change after thrombolysis for AIS. Retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS from October 18, 2011, to June 15, 2015, inclusive. Multivariate regression analysis was used to investigate the relationship between change in CRP 12-24 hours after thrombolysis and change in NIHSS (National Institutes of Health Stroke Scale) score 24 hours after thrombolysis. The other potentially confounding predictor variables included in the model were CRP on admission and NIHSS score before thrombolysis. Complete data were available for 108 out of possible 435 eligible patients. Increases in CRP levels 12-24 hours after thrombolysis were negatively associated with reduction in NIHSS score 24 hours after thrombolysis (coefficient .08, 95% confidence interval .031-.129, P = .002). Thus, on average, for every 12.5 mg/L additional increase in CRP 12-24 hours after thrombolysis, NIHSS score at 24 hours improved by 1 point less. While it was previously known that elevated CRP levels are associated with worse outcomes in patients thrombolysed for AIS, the current work demonstrates that changes in CRP levels after thrombolysis also relate to neurological change, and thus may have scope for use as prognostic markers. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Selected acute phase CSF factors in ischemic stroke: findings and prognostic value

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Intskirveli Nino

2011-03-01

Full Text Available Abstract Background Study aimed at investigation of pathogenic role and prognostic value of several selected cerebrospinal fluid acute phase factors that can reflect the severity of ischemic brain damage. Methods Ninety five acute ischemic stroke patients were investigated. Ischemic region visualized at the twenty fourth hour by conventional Magnetic Resonance Imaging. Stroke severity evaluated by National Institute Health Stroke Scale. One month outcome of disease was assessed by Barthel Index. Cerebrospinal fluid was taken at the sixth hour of stroke onset. CSF pro- and anti-inflammatory cytokines were studied by Enzyme Linked Immunosorbent Assay. Nitric Oxide and Lipoperoxide radical were measured by Electron Paramagnetic Resonance. CSF Nitrate levels were detected using the Griess reagent. Statistics performed by SPSS-11.0. Results At the sixth hour of stroke onset, cerebrospinal fluid cytokine levels were elevated in patients against controls. Severe stroke patients had increased interleukin-6 content compared to less severe strokes (P Conclusion According to present study the cerebrospinal fluid contents of interleukin-6 and nitrates seem to be the most reliable prognostic factors in acute phase of ischemic stroke.

Reconstruction of B{sup -} {yields} D{sup *0}e{sup -} anti {nu}{sub e} decays and determination of vertical stroke V{sub cb} vertical stroke

Energy Technology Data Exchange (ETDEWEB)

Schubert, J.

2006-12-01

In this analysis the decay B{sup -} {yields} D{sup *0}e{sup -} anti {nu}{sub e} is measured. The underlying data sample consists of about 226 million B anti B-pairs accumulated on the {upsilon}(4S) resonance by the BABAR detector at the asymmetric e{sup +}e{sup -} collider PEP-II. The reconstruction of the decay uses the channels D{sup *0} {yields} D{sup 0}{pi}{sup 0}, D{sup 0} {yields} K{sup -}{pi}{sup +} and {pi}{sup 0} {yields} {gamma}{gamma}. The neutrino is not reconstructed. Since the rest frame of the B meson is unknown, the boost w of the D{sup *0} meson in the B meson rest frame is estimated by w. The w spectrum of the data is described in terms of the partial decay width d{gamma}/dw given by theory and the detector simulation translating each spectrum d{gamma}/dw into an expectation of the measured w spectrum. d{gamma}/dw depends on a form factor F(w) parameterizing the strong interaction in the decay process. To find the best descriptive d{gamma}/dw a fit to the data determines the following two parameters of d{gamma}/dw: (i) F(1) vertical stroke V{sub cb} vertical stroke, the product between F at zero D{sup *0}-recoil and the CKM matrix element vertical stroke V{sub cb} vertical stroke; (ii) {rho}{sup 2}{sub A1}, a parameter of the form factor F(w). The former parameter scales the height of d{gamma}/dw and {rho}{sup 2}{sub A1} varies the shape of it. The determined values of F(1) vertical stroke V{sub cb} vertical stroke, {rho}{sup 2}{sub A1} and B(B{sup -} {yields} D{sup *0}e{sup -} anti {nu}{sub e}) are F(1) vertical stroke V{sub cb} vertical stroke =(35.8{+-}0.5{+-}1.5) x 10{sup -3}, {rho}{sup 2}{sub A1}=(1.08{+-}0.05{+-}0.09) and B(B{sup -} {yields} D{sup *0}e{sup -} anti {nu}{sub e})=(5.60{+-}0.08{+-}0.42)%, where the uncertainties are statistical and systematic, respectively. The values of B(B{sup -} {yields} D{sup *0}e{sup -} anti {nu}{sub e}) has been determined by an integration of d{gamma}/dw over the allowed w range using the fitted values of

Red cell distribution width and neurological scoring systems in acute stroke patients

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Kara H

2015-03-01

Full Text Available Hasan Kara,1 Selim Degirmenci,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Ali Dogru,1 Fikret Akyurek,2 Seyit Ali Kayis3 1Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey; 2Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey; 3Department of Biostatistics, Faculty of Medicine, Karabuk University, Karabuk, Turkey Objectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW and the Glasgow Coma Scale (GCS, Canadian Neurological Scale (CNS, and National Institutes of Health Stroke Scale (NIHSS scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS. The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676–0.844. Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%. Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke

Plasma cytokines in acute stroke

DEFF Research Database (Denmark)

Christensen, Hanne Krarup; Boysen, Gudrun; Christensen, Erik

2011-01-01

GOALS: The aim of this study was to test the relations between plasma cytokines and the clinical characteristics, course, and risk factors in acute stroke. PATIENTS AND METHODS: The analysis was based on 179 patients with acute stroke included within 24 hours of stroke onset. On inclusion and 3...... months later plasma levels of interleukin 1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), interleukin-1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), interleukin 10 (IL-10), soluble tumor necrosis factor receptor 1 (sTNF-R1), and soluble tumor necrosis factor receptor 2 (sTNF-R2) were...

Eligibility and Predictors for Acute Revascularization Procedures in a Stroke Center.

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Vanacker, Peter; Lambrou, Dimitris; Eskandari, Ashraf; Mosimann, Pascal J; Maghraoui, Ali; Michel, Patrik

2016-07-01

Endovascular treatment (EVT) is a new standard of care for selected, large vessel occlusive strokes. We aimed to determine frequency of potentially eligible patients for intravenous thrombolysis (IVT) and EVT in comprehensive stroke centers. In addition, predictors of EVT eligibility were derived. Patients from a stroke center-based registry (2003-2014), admitted within 24 hours of last proof of usual health, were selected if they had all data to determine IVT and EVT eligibility according to American Heart Association/American Stroke Association (AHA/ASA) guidelines (class I-IIa recommendations). Moreover, less restrictive criteria adapted from randomized controlled trials and clinical practice were tested. Maximum onset-to-door time windows for IVT eligibility were 3.5 hours (allowing door-to-needle delay of ≤60 minutes) and 4.5 hours for EVT eligibility (door-to-groin delay ≤90 minutes). Demographic and clinical information were used in logistic regression analysis to derive variables associated with EVT eligibility. A total of 2704 patients with acute ischemic stroke were included, of which 26.8% were transfers. Of all patients with stroke arriving at our comprehensive stroke center, a total proportion of 12.4% patients was eligible for IVT. Frequency of EVT eligibility differed between AHA/ASA guidelines and less restrictive approach: 2.9% versus 4.9%, respectively, of all patients with acute ischemic stroke and 10.5% versus 17.7%, respectively, of all patients arriving within <6 hours. Predictors for AHA-EVT eligibility were younger, shorter onset-to-admission delays, higher National Institutes of Health Stroke Scale (NIHSS), decreased vigilance, hemineglect, absent cerebellar signs, atrial fibrillation, smoking, and decreasing glucose levels (area under the curve=0.86). Of patients arriving within 6 hours at a comprehensive stroke center, 10.5% are EVT eligible according to AHA/ASA criteria, 17.7% according to criteria resembling randomized controlled

Diffusion-weighted MRI in acute cerebral stroke

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Takayama, Hideichi; Kobayashi, Masahito; Suga, Sadao; Kawase, Takeshi; Nagasawa, Masakazu; Sadanaga, Humiko; Okamura, Miyuki; Kanai, Yoshihiro; Mihara, Ban [Mihara Memorial Hospital, Isezaki, Gunma (Japan)

1999-03-01

Diffusion-weighted MRI has been demonstrated to be valuable in the assessment of cerebral stroke. Recent advance in MR systems of hardware with larger maximum gradient amplitude and faster imaging strategies, such as EPI, has made it possible to acquire whole brain diffusion-weighted imaging (DWI) in less that one minute. The purposes of this study are to evaluate clinical usefulness of DWI and to clarify pitfalls in the diagnosis of acute cerebral stroke. Seventeen patients with 18 ischemic lesions were studied. DWI were taken with 1.5 Tesla MRI (Magnetom Vision, Siemens, Germany) using EPI sequence. Fifteen lesions out of them (3 in cerebral cortex, 9 in basal ganglia/deep white matter and 3 in cerebellum) were studied serially at various times up to 147 days. Acute cerebral infarction was seen clearly as an area of hyperintensity with DWI and as hypointensity in apparent diffusion coefficient (ADC) maps which are indicative of decreased diffusion. DWI detected areas of hyperintense acute infarcts, as early as 2.5 hours after onset, which were not visualized on T{sub 2}-weighted image (T2WI). The lesion of cerebral infarction became isointense in ADC maps at 14-28 days after onset, whereas with DWI it became isointense at about 2 months. Because ADC changed earlier than DWI, ADC maps were useful for differentiate acute from nonacute lesion in cases of recurrent stroke within a short period. In a patient with transient global amnesia for 7 hours, DWI did not show any lesion at 8 hours. In terms of cerebral hemorrhage, lesions were seen as area of hyperintensity in DWI at 3 days and were not distinguishable from that of infarct. Despite limitations in the diagnosis of transient ischemia and cerebral hemorrhage, DWI is a useful technique for early detection of cerebral infarction, especially within the first 6 hours after stroke onset. (author)

Late night activity regarding stroke codes: LuNAR strokes.

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

2012-08-01

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

Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study.

Science.gov (United States)

Palli, Christoph; Fandler, Simon; Doppelhofer, Kathrin; Niederkorn, Kurt; Enzinger, Christian; Vetta, Christian; Trampusch, Esther; Schmidt, Reinhold; Fazekas, Franz; Gattringer, Thomas

2017-09-01

Dysphagia is a common stroke symptom and leads to serious complications such as aspiration and pneumonia. Early dysphagia screening can reduce these complications. In many hospitals, dysphagia screening is performed by speech-language therapists who are often not available on weekends/holidays, which results in delayed dysphagia assessment. We trained the nurses of our neurological department to perform formal dysphagia screening in every acute stroke patient by using the Gugging Swallowing Screen. The impact of a 24/7 dysphagia screening (intervention) over swallowing assessment by speech-language therapists during regular working hours only was compared in two 5-month periods with time to dysphagia screening, pneumonia rate, and length of hospitalization as outcome variables. Overall, 384 patients (mean age, 72.3±13.7 years; median National Institutes of Health Stroke Scale score of 3) were included in the study. Both groups (pre-intervention, n=198 versus post-intervention, n=186) were comparable regarding age, sex, and stroke severity. Time to dysphagia screening was significantly reduced in the intervention group (median, 7 hours; range, 1-69 hours) compared with the control group (median, 20 hours; range, 1-183; P =0.001). Patients in the intervention group had a lower rate of pneumonia (3.8% versus 11.6%; P =0.004) and also a reduced length of hospital stay (median, 8 days; range, 2-40 versus median, 9 days; range, 1-61 days; P =0.033). 24/7 dysphagia screening can be effectively performed by nurses and leads to reduced pneumonia rates. Therefore, empowering nurses to do a formal bedside screening for swallowing dysfunction in stroke patients timely after admission is warranted whenever speech-language therapists are not available. © 2017 American Heart Association, Inc.

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

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

2016-02-01

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

Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis.

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Kellert, Lars; Hametner, Christian; Ahmed, Niaz; Rauch, Geraldine; MacLeod, Mary J; Perini, Francesco; Lees, Kennedy R; Ringleb, Peter A

2017-07-01

Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed. The primary measure of BP variability was successive variability. Data were preprocessed using coarsened exact matching. We assessed early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale [mRS] at 90 days) by binary and ordinal regression analyses. Attempts to explain successive variation for analysis of BPV with patients characteristics at admission found systolic BP (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from systolic BP, successive variation for analysis of BPV was associated with poor functional outcome mRS score of 0 to 2 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90-0.98), disadvantage across the shift of mRS (OR, 1.04; 95% CI, 1.01-1.08), mortality (OR, 1.10; 95% CI, 1.01-1.08), SICH SITS (OR, 1.14; 95% CI, 1.06-1.23), and SICH ECASS (OR, 1.24; 95% CI, 1.10-1.40; ECASS [European Cooperative Acute Stroke Study 2]). Analyzing successive variation for analysis of BPV as a function of pre-treatment, systolic BP significantly improved the prediction of functional outcome (mRS score of 0-1, mRS score of 0-2, neurological improvement, mRS-shift: all P interaction accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient. © 2017 American Heart Association, Inc.

Knowledge of stroke among stroke patients and their relatives in Northwest India.

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Pandian, Jeyaraj Durai; Kalra, Guneet; Jaison, Ashish; Deepak, Sukhbinder Singh; Shamsher, Shivali; Singh, Yashpal; Abraham, George

2006-06-01

The knowledge of warning symptoms and risk factors for stroke has not been studied among patients with stroke in developing countries. We aimed to assess the knowledge of stroke among patients with stroke and their relatives. Prospective tertiary referral hospital-based study in Northwest India. Trained nurses and medical interns interviewed patients with stroke and transient ischemic attack and their relatives about their knowledge of stroke symptoms and risk factors. Univariable and multivariable logistic regression were used. Of the 147 subjects interviewed, 102 (69%) were patients and 45 (31%) were relatives. There were 99 (67%) men and 48 (33%) women and the mean age was 59.7+/-14.1 years. Sixty-two percent of respondents recognized paralysis of one side as a warning symptom and 54% recognized hypertension as a risk factor for stroke. In the multivariable logistic regression analysis, higher education was associated with the knowledge of correct organ involvement in stroke (OR 2.6, CI 1.1- 6.1, P =0.02), whereas younger age (OR 2.7, CI 1.1-7.0, P =0.04) and higher education (OR 4.1, CI 1.5-10.9, P =0.005) correlated with a better knowledge regarding warning symptoms of stroke. In this study cohort, in general, there is lack of awareness of major warning symptoms, risk factors, organ involvement and self-recognition of stroke. However younger age and education status were associated with better knowledge. There is an urgent need for awareness programs about stroke in this study cohort.

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

OpenAIRE

Bath, Philip M.; Woodhouse, Lisa; Krishnan, Kailash; Anderson, Craig; Berge, Eivind; Ford, Gary A.; Robinson, Thompson G.; Saver, Jeffrey L.; Sprigg, Nikola; Wardlaw, Joanna M.; in Acute Stroke Collaboration (BASC), Blood pressure

2016-01-01

Background. Nitric oxide (NO) donors are a candidate treatment for acute stroke and two trials have suggested that they might improve outcome if administered within 4–6 hours of stroke onset. We assessed the safety and efficacy of NO donors using individual patient data (IPD) from completed trials. Methods. Randomised controlled trials of NO donors in patients with acute or subacute stroke were identified and IPD sought from the trialists. The effect of NO donor versus control on functional o...

Factors associated with delayed presentation in patients with TIA and minor stroke in China: analysis of data from the China National Stroke Registry (CNSR).

Science.gov (United States)

Wang, Linyu; Chao, Yangyun; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, David Z; Meng, Xia; Wang, Anxin; Wang, Yongjun; Xu, Yuming

2013-06-01

We aimed to evaluate the management of patients with transient ischemic attack (TIA) and minor stroke in China. Data from the China National Stroke Registry (CNSR) were used to identify patients who were admitted to 132 urban hospitals across China with TIA or minor stroke. Factors associated with delayed presentation to hospital were evaluated. Univariate and multivariate analyses were performed to analyze relationships between patient characteristics and time of presentation. Of the 7467 patients entered into the CNSR (1204 with TIA, 6263 with minor stroke), 780 patients (64·78%) with TIA and 3467 patients (55·36%) with minor stroke had delayed presentation to hospital (>24 hours). In both groups, factors associated with early presentation (≤24 hours) included transportation by ambulance and direct presentation to the emergency room. In patients with minor stroke, early presentation was associated with older age (65-80 years), motor and sensory symptoms, speech impairment, atrial fibrillation, previous TIA, and living in central or eastern China; and delayed presentation was associated with female sex, cognitive dysfunction, and diabetes. In patients with TIA, early presentation was associated with motor symptoms, and delayed presentation was associated with headache or vertigo. In China, many patients with TIA and minor stroke do not seek medical treatment immediately. Further education is needed to teach members of the public about the warning signs and symptoms of TIA and minor stroke, and encourage the use of ambulance transportation after TIA or stroke.

Thio-, selenido-, and telluridogermanates(III): K/sub 6/Ge/sub 2/S/sub 6/, K/sub 6/Ge/sub 2/Se/sub 6/, and Na/sub 6/Ge/sub 2/Te/sub 6/

Energy Technology Data Exchange (ETDEWEB)

Eisenmann, B; Kieselbach, E; Schaefer, H; Schrod, H [Technische Hochschule Darmstadt (Germany, F.R.). Fachbereich Anorganische Chemie und Kernchemie

1984-09-01

The new compounds K/sub 6/Ge/sub 2/S/sub 6/ and K/sub 6/Ge/sub 2/Se/sub 6/ crystallize in the monoclinic system, space group C2/m (No 12). The compounds are isotypic and form the K/sub 6/Si/sub 2/Te/sub 6/ structure. Na/sub 6/Ge/sub 2/Te/sub 6/ crystallizes in the K/sub 6/Sn/sub 2/Te/sub 6/ structure, monoclinic, space group P2/sub 1//c (No 14). The lattice constants are given.

Prevalence and predictors of 6-month fatigue in patients with ischemic stroke: a population-based stroke incidence study in Auckland, New Zealand, 2002-2003.

Science.gov (United States)

Feigin, Valery L; Barker-Collo, Suzanne; Parag, Varsha; Hackett, Maree L; Kerse, Ngaire; Barber, P Alan; Theadom, Alice; Krishnamurthi, Rita

2012-10-01

Although persistent and significant fatigue affects the daily life of stroke survivors, there are no population-based studies examining the prevalence of fatigue in 6-month survivors of ischemic stroke and few studies of predictors of poststroke fatigue. This article examined data from the Auckland Regional Community Stroke study conducted in Auckland, New Zealand, in 2002 to 2003. Presence of fatigue was evaluated at 6 months in 613 patients with ischemic stroke using a Short Form 36 Vitality Score (energy and fatigue) of ≤ 47. Multivariate logistic regression analysis was used to determine predictors of fatigue development 6 months poststroke. The prevalence of fatigue was 30% (28% in men and 33% in women). There was a clear association between increased prevalence of fatigue and advancing age. The only baseline variables independently associated with an increased risk of developing fatigue at 6 months poststroke were prestroke incontinence and being of New Zealand European ethnicity. Being independent and living alone at baseline were associated with significant reduction in the risk of being fatigued at 6 months poststroke. Severe depression at 6 months was significantly and independently associated with being fatigued. The prevalence of fatigue found in our study is at the lower level of range reported in other studies. The prevalence of fatigue increased with advancing age, as found in most previous studies. Because fatigue can have a negative impact on stroke recovery, particular attention needs to be paid to those who are older, incontinent before stroke, and those who report severe symptoms of depression at 6 months after stroke.

Atrial ectopic activity in cryptogenic ischemic stroke and TIA: a risk factor for recurrence.

Science.gov (United States)

Pinho, João; Braga, Carlos Galvão; Rocha, Sofia; Santos, Ana Filipa; Gomes, André; Cabreiro, Ana; Magalhães, Sónia; Ferreira, Carla

2015-02-01

To characterize atrial ectopic activity in patients with cryptogenic ischemic stroke (CIS) or transient ischemic attack (TIA) and determine its prognostic significance. Retrospective cohort study, in which 184 patients with CIS or TIA who had performed 24-hour Holter electrocardiogram were included. The median follow-up was 27.5 months. Baseline clinical and imagiologic characteristics, etiologic investigation results, and ischemic stroke and TIA recurrences information were collected. Number of atrial premature complexes (APCs) per hour was categorized as less than 10 APCs/hour, 10-30 APCs/hour, and more than 30 APCs/hour. Most of the patients had less than 10 APCs/hour (82.6%), 8.2% had 10-30 APCs/hour, and 9.2% had more than 30 APCs/hour. Patients with more than 30 APCs/hour had a greater median left atrium diameter than patients with 30 APCs/hour or less (42 mm vs. 38 mm; 95% confidence interval [CI], .50-7.00; P = .003). Annual recurrence rate of CIS or TIA was 2.9% in patients with less than 10 APCs/hour, 11.0% in 10-30 APCs/hour, and 22.6% in more than 30 APCs/hour (P = .001). More than 30 APCs/hour were independently associated with recurrence risk in multivariate survival analysis (hazard ratio, 3.40; 95% CI, 1.12-10.32; P = .030). In patients with CIS or TIA, frequent atrial ectopic activity (>30 APCs/h) was independently associated with increased risk of stroke or TIA recurrence. Further studies need to validate frequent atrial ectopic activity as a risk factor for recurrence in cryptogenic stroke and confirm its role as a predictor of occult atrial fibrillation. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Factors Delaying Hospital Arrival Aftr Acute Stroke Onset

Directory of Open Access Journals (Sweden)

Ghiasian M

2017-03-01

Full Text Available Introduction: Optimal time of referral aftr stroke and the use of new therapies, such as r-tPA and blood pressure control, could accelerate symptoms recovery aftr stroke. Th aim of this study was to investigate factors contributing to the delay in referral to hospitals aftr the occurrence of acute stroke. Methods: Ths analytic-descriptive study included 425 patients, who had referred to the Hamadan Farshchian hospital during years 2015 and 2016. Demographic data, time of referring to medical center, the time of occurrence of stroke, risk factors, clinical symptoms of stroke, way of referring, distance from medical center and type of stroke by using a questionnaire and checklist were recorded. Th SPSS (version 16 softare was used for all calculations. Results: Th mean age of patients in this study was 70.12 years old. Overall, 260 patients (61.2% were male and 85.6% had ischemic stroke. Mean time of referral to fist treatment center and Farshchian hospital was 2.06 and 4.77 hours, respectively. A total of 36.2% patients arrived to Farshchian hospital, within less than 2 hours. Factors that prolonged time to presentation were male gender, ischemic stroke, low education, being at a location far from the medical center, referral from other medical centers, being single, having no witness during stroke, and having a stroke at home, and during night. Th most common symptoms in patients who were referred within less than two hours were confusion and loss of consciousness with frequency of 29.2%. Th most common risk factor in 61.4% of patients, who were referred within less than 2 hours, was high blood pressure. Conclusion: Ths study showed mean time of referral for treatment aftr stroke was high. Inflential elements that could possibly delay hospital arrival include, being at a location far from the medical center, no adequate knowledge about stroke symptom, having stroke at night, not referring directly to the medical center, being single, and no

Ipsilateral hemiparesis in ischemic stroke patients.

Science.gov (United States)

Inatomi, Y; Nakajima, M; Yonehara, T; Ando, Y

2017-07-01

To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients. Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI. Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine. Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Help seeking behavior and onset-to-alarm time in patients with acute stroke: sub-study of the preventive antibiotics in stroke study

NARCIS (Netherlands)

Zock, E.; Kerkhoff, H.; Kleyweg, R. P.; van Bavel-Ta, T. B. V.; Scott, S.; Kruyt, N. D.; Nederkoorn, P. J.; van de Beek, D.

2016-01-01

Patients with acute stroke often do not seek immediate medical help, which is assumed to be driven by lack of knowledge of stroke symptoms. We explored the process of help seeking behavior in patients with acute stroke, evaluating knowledge about stroke symptoms, socio-demographic and clinical

Stroke management: Informal caregivers' burdens and strians of caring for stroke survivors.

Science.gov (United States)

Gbiri, Caleb Ademola; Olawale, Olajide Ayinla; Isaac, Sarah Oghenekewe

2015-04-01

Stroke survivors live with varied degrees of disabilities and cares are provided largely by the informal caregivers. This study investigated informal caregivers' burden and strains of caring for stroke patients. This study involved 157 (81 males and 76 females) informal caregivers of stroke survivors receiving care in all secondary and tertiary health institutions with physiotherapy services in Lagos State, Nigeria. Information was collected through self-administered questionnaire during clinic-hours. Data was analyzed using Spearman's Rank Correlation Coefficient. The patients' age ranged between 20 and 79 (mean=59.6 ± 14.6 years). Sixty-one had haemorrhagic stroke while 96 had ischaemic stroke. The informal caregivers' age was 39.2 ± 12.8 years (range: 17-36 years). More (60.8%) participants reported moderate objective while 79.2% had mild subjective burdens. The following factors significantly increased (Pfinancial well-beings of the informal caregivers. Caring for stroke survivors put social, emotional, health and financial burdens and strains on the informal caregivers. These burdens and strains increase with duration of stroke, intimacy, smaller number of caregivers and length of daily caregiving. Therefore, informal caregivers should be involved in the rehabilitation plan for stroke patients and their well-being should also be given adequate attention. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The L-arginine Pathway in Acute Ischemic Stroke and Severe Carotid Stenosis

DEFF Research Database (Denmark)

Molnar, Tihamer; Pusch, Gabriella; Papp, Viktoria

2014-01-01

BACKGROUND: Endothelial dysfunction is associated with increased levels of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) resulting in a decreased production of nitric oxide, which regulates the vascular tone. METHODS: Patients with acute ischemic stroke (AIS, n = 55......) and asymptomatic significant carotid stenosis (AsCS, n = 44) were prospectively investigated. L-arginine, ADMA, SDMA, S100 B, and high-sensitivity C-reactive protein (hsCRP) were serially measured within 6 hours after the onset of stroke, at 24 and 72 poststroke hours. All markers were compared with healthy...... subjects (n = 45). The severity of AIS was daily assessed by National Institute of Health Stroke Scale scoring. RESULTS: Even within 6 hours after the onset of stroke, L-arginine, ADMA, and SDMA were significantly higher in patients with AIS compared with both AsCS and healthy subjects. S100 B reflecting...

Diagnosis of acute ischemic stroke based on time-to-peak and diffusion-weighted magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Maruyama, Keisuke; Eguchi, Tsuneyoshi; Sora, Shigeo; Izumi, Masafumi; Hiyama, Hirofumi [Kameda General Hospital, Kamogawa, Chiba (Japan); Ueki, Keisuke [Tokyo Univ. (Japan). Hospital

2002-07-01

Rapid and accurate diagnosis of the hemodynamics of the brain is essential for the treatment of acute ischemic stroke. This study investigated whether time-to-peak and diffusion-weighted magnetic resonance (MR) imaging are useful for predicting the course of stroke. Fourteen patients with non-lacunar acute ischemic stroke underwent emergent MR imaging within 24 hours from the onset followed by cerebral angiography and xenon-enhanced computed tomography (CT). Serial CT was obtained to monitor changes in the size and nature of the infarct. Volumes of the abnormal lesions demonstrated on time-to-peak (V{sub T}) or diffusion-weighted (V{sub D}) images were measured, and the ratio of V{sub T} to V{sub D} was calculated. Based on this ratio, patients were classified into three groups: Group 1 (V{sub T}/V{sub D} 0.5-1.5, n=9), Group 2 (V{sub T}/V{sub D}>1.5, n=3), and Group 3 (V{sub T}/V{sub D}<0.5, n=2). The size of the infarct detected as a low-density area on serial CT scans did not change significantly throughout the course in Group 1 patients, but showed enlargement in all three patients in Group 2. Two patients in Group 3 had major trunk occlusion followed by spontaneous reperfusion, and both developed hemorrhagic transformation. Our study showed that classification of ischemic stroke based on the V{sub T}/V{sub D} ratio was predictive of the time course of the infarct, and may be useful in selecting the initial therapeutic procedure immediately after the onset of stroke. (author)

Frequency Of Hyperthermia In Acute Ischemic Stroke Patients Visiting A Tertiary Care Hospital

International Nuclear Information System (INIS)

Maheshwari, A. K.; Kumar, P.; Alam, M. T.; Aurangzeb, M.; Imran, K.; Masroor, M.; Parkash, J.

2016-01-01

Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country. Study Design: Cross-sectional, observational study. Place and Duration of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013. Methodology: Patients aged = 18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA). Result: A total of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 ±9.5 years. Among these, 61 (57.5 percentage) were males and 45 (42.5 percentage) females. Among all patients, 51.9 percentage presented with loss of consciousness, 30.2 percentage with slurred speech, 77.4 percentage with limb weakness, and 9.4 percentage with decrease vision. A total of 17 (16 percentage) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26 percentage developed hyperthermia compared to 7.1 percentage in patients of = 60 years of age (p=0.008). On gender stratification, among male patients, 14.8 percentage developed hyperthermia compared to 17.8 percentage in female patients (p=0.43). Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16 percentage and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia. (author)

On the fusion in SL(2)-WZNW models and 6j symbols of U{sub q}sl(2) x U{sub q'}osp(1 vertical stroke 2)

Energy Technology Data Exchange (ETDEWEB)

Koesling, Jens

2010-06-15

We introduce a novel method to determine 6j-symbols of quantum groups. This method is inspired by the methods used in the determination of fusing matrices of WZNW models. With this method we determine the 6j-symbols of the quantum group U{sub q}sl(2) and the super quantum group U{sub q}osp(1 vertical stroke 2). We present the 6j-symbols as a recurrence relation and its initial values. The 6j-symbols transform between the s-channel and the u-channel decomposition of the invariants of the four-fold tensor product of modules of a quantum group. These invariants fulfil certain difference equations. We set one of the representations in the invariant to the fundamental representation, and deduce a system of linear equations for the initial values of the recurrence relation determining the 6j-symbols. (orig.)

99mTc-HMPAO perfusion indices and brain-mapping in stroke patients

International Nuclear Information System (INIS)

Minchev, D.; Klisarova, A.

1997-01-01

It is the purpose of the study to establish correlations between 99mTc-HMPAO (hexamethylpropylenaminoxym) perfusion indices and changes in brain-mapping among patients with acute stroke. Forty-six patients with definitely proved stroke syndrome are investigated in the first 72 hours and 15 days after the onset of cerebrovascular accident using clinical, neuro-physiological and 99mTc-HMPAO SPECT methods. Regional and hemispheric perfusion asymmetry correlate with the brain-mapping cerebral disturbance (p < 0.001). In patients presenting focal hypoperfusion there is a significant correlation between perfusion indices and local EEG disturbance (r = 0.87). The dynamic study demonstrates a significant correlation between perfusion indices and electrical cerebral disturbance in the first 72 hours after the onset of the cerebrovascular accident. Fifteen days later no such correlation is documented. The obtained results demonstrate the essential practical bearing of 99mTc-HMPAO SPECT indices on the objective assessment of perfusion hemispheric and regional asymmetry in stroke patients, and the possibility of being used for indirect estimation of the regional cerebral blood flow in acute stroke patients against the background of visual and quantitative EEG changes (author)

Crystal structure, magnetic and magnetocaloric properties of aluminum-doped La{sub 0.6}Sr{sub 0.4}MnO{sub 3} perovskites

Energy Technology Data Exchange (ETDEWEB)

Elhamza, Amal; Dhahri, J. [Universite de Monastir, Laboratoire de la Matiere Condensee et des Nanosciences, Monastir (Tunisia); Rhouma, F.I.H. [Centre de Recherche des Sciences et Technologies de l' Energie, Laboratoire de Photovoltaique de Semi-Conducteurs et de Nanostructures, Hammam-Lif (Tunisia); Hlil, E.K. [CNRS-Universite Joseph Fourier, Institut Neel, Grenoble (France)

2017-05-15

In this paper, we report on the structural, magnetic and magnetocaloric properties of a series of nanocrystallines La{sub 0.6}Sr{sub 0.4}Mn{sub 1-x}Al{sub x}O{sub 3} (0 ≤ x ≤ 0.2) which were prepared by the sol-gel method. The X-ray powder diffraction showed that all our synthesized samples were of a single phase and have crystallized in the hexagonal symmetry with R anti 3c space group. Magnetic measurements showed that the sample exhibits a ferromagnetic-to-paramagnetic phase transition at a Curie temperature close to 206 K. The maximum value of the magnetic entropy change vertical stroke ΔS{sub M}{sup max} vertical stroke was found to be 1.09 J kg{sup -1} K{sup -1} for an applied magnetic field of 5T. At this value of magnetic field, the relative cooling power was 141 J kg{sup -1}. Our result on magnetocaloric properties suggests that La{sub 0.6}Sr{sub 0.4}Mn{sub 1-x}Al{sub x}O{sub 3} nanopowder with (0 ≤ x ≤ 0.2) is attractive as a potential refrigerant for high-temperature magnetic refrigeration. (orig.)

Mechanical thrombectomy with snare in patients with acute ischemic stroke

International Nuclear Information System (INIS)

Gonzalez, Alejandro; Mayol, Antonio; Martinez, Eva; Gonzalez-Marcos, Jose R.; Gil-Peralta, Alberto

2007-01-01

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

Frequency of cerebral infarction and haemorrhage in the patients of stroke

International Nuclear Information System (INIS)

Shah, A.N.; Ataullah, S.

2009-01-01

Stroke is rapidly developing phenomena of symptoms and signs of focal, and at times global, loss of cerebral function with no apparent cause other than that of vascular origin. The Objective was to know the frequency of cerebral infarction and haemorrhage in one hundred patients of stroke in a period of one year. Data was collected by consecutive sampling technique. Total one hundred patients of stroke were collected for the study. They were assessed through a detailed history of hypertension, diabetes mellitus, smoking, previous stroke, transient ischemic attack (TIA), previous myocardial infarction, angina, atrial fibrillation, alcohol intake, drugs used for hypertension/diabetes mellitus. Blood pressure was recorded at arrival and 24 hours after admission. There were 70% males and 30% females. Twenty percent of the patients were in the age range of 51-60 years, 26% of the patients were in the age range of 61-70 years and 18% were in the age range of 71-80 years. Cerebral infarction was present in 72% patients while cerebral haemorrhage was present in 28% patients. Hypertension was the most common risk factor among these stroke patients. Average blood pressure was 180/100 mmHg. Cerebral infarction is the commonest form of stroke. Hypertension is the leading risk factor in stroke patients. (author)

Risk factors of short-term stroke recurrence in patients with minor ischemic cerebrovascular events

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Kavian Ghandehari

2013-03-01

Full Text Available BACKGROUND: Assessing the risk of recurrent ischemic events in patients with transient ischemic attack (TIA and minor ischemic stroke (MIS is of a great importance in clinical practice. METHODS: Consecutive patients with TIA or MIS who were visited in Ghaem Hospital, (Mashhad, Iran were enrolled in a prospective cohort study during 2010 to 2011. Diagnosis of TIA or MIS was accomplished by a stroke neurologist. Only those who presented within 24 hours from the onset of symptoms were recruited. MIS was considered as an ischemic stroke with National Institutes of Health Stroke Scale (NIHSS < 4. The endpoint of the study was a new ischemic cerebrovascular event or vascular death in 90 days and additionally in 3 days. The decision to admit and type of treatment in each case was left to the discretion of the stroke neurologist. The association between 20 potential factors with recurrent ischemic events in 3 and 90 days was investigated using univariate and multivariate analysis (MVA. RESULTS: 393 TIA patients (238 males and 155 females and 118 MIS patients (77 males and 41 females were enrolled in the study. Stroke occurred in 117 (23.2% patients, TIA in 99 (19.6%, and there was 11 (2.2% vascular deaths within 3 months in the total 511 patients with minor ischemic events. Crescendo TIAs and multiple TIAs were associated with greater risk of stroke in 3 days in a univariate analysis (OR = 5.12, P < 0.001 and (OR = 3.98, P = 0.003, respectively. Patients with index stroke had 11.5% lower risk of recurrent stroke in 3 days than patients with index TIA in multivariate analysis (OR = 0.115, P = 0.039. Diabetes was independently associated with 3 months stroke recurrence in the patients with minor ischemic events (OR = 2.65, P = 0.039. CONCLUSION: Multiple and crescendo TIAs are the main predictors of stroke recurrence, derived from the univariate analysis of the patients with minor ischemic events.   Keywords: Transient Ischemic Attacks, Infarction, Brain

Finding atrial fibrillation in stroke patients: Randomized evaluation of enhanced and prolonged Holter monitoring--Find-AF(RANDOMISED) --rationale and design.

Science.gov (United States)

Weber-Krüger, Mark; Gelbrich, Götz; Stahrenberg, Raoul; Liman, Jan; Kermer, Pawel; Hamann, Gerhard F; Seegers, Joachim; Gröschel, Klaus; Wachter, Rolf

2014-10-01

Detecting paroxysmal atrial fibrillation (AF) in patients with ischemic strokes presenting in sinus rhythm is challenging because episodes are often short, occur randomly, and are frequently asymptomatic. If AF is detected, recurrent thromboembolism can be prevented efficiently by oral anticoagulation. Numerous uncontrolled studies using various electrocardiogram (ECG) devices have established that prolonged ECG monitoring increases the yield of AF detection, but most established procedures are time-consuming and costly. The few randomized trials are mostly limited to cryptogenic strokes. The optimal method, duration, and patient selection remain unclear. Repeated prolonged continuous Holter ECG monitoring to detect paroxysmal AF within an unspecific stroke population may prove to be a widely applicable, effective secondary prevention strategy. Find-AFRANDOMISED is a randomized and controlled prospective multicenter trial. Four hundred patients 60 years or older with manifest (symptoms ≥24 hours or acute computed tomography/magnetic resonance imaging lesion) and acute (symptoms ≤7 days) ischemic strokes will be included at 4 certified stroke centers in Germany. Those with previously diagnosed AF/flutter, indications/contraindications for oral anticoagulation, or obvious causative blood vessel pathologies will be excluded. Patients will be randomized 1:1 to either enhanced and prolonged Holter ECG monitoring (10 days at baseline and after 3 and 6 months) or standard of care (≥24-hour continuous ECG monitoring, according to current stroke guidelines). All patients will be followed up for at least 12 months. The primary end point is newly detected AF (≥30 seconds) after 6 months, confirmed by an independent adjudication committee. We plan to complete recruitment in autumn 2014. First results can be expected by spring 2016. Copyright © 2014 Mosby, Inc. All rights reserved.

Biological Signatures of Brain Damage Associated with High Serum Ferritin Levels in Patients with Acute Ischemic Stroke and Thrombolytic Treatment

Science.gov (United States)

Millán, Mónica; Sobrino, Tomás; Arenillas, Juan Francisco; Rodríguez-Yáñez, Manuel; García, María; Nombela, Florentino; Castellanos, Mar; de la Ossa, Natalia Pérez; Cuadras, Patricia; Serena, Joaquín; Castillo, José; Dávalos, Antoni

2008-01-01

Background and purpose: Increased body iron stores have been related to greater oxidative stress and brain injury in clinical and experimental cerebral ischemia and reperfusion. We aimed to investigate the biological signatures of excitotoxicity, inflammation and blood brain barrier disruption potentially associated with high serum ferritin levels-related damage in acute stroke patients treated with i.v. t-PA. Methods: Serum levels of ferritin (as index of increased cellular iron stores), glutamate, interleukin-6, matrix metalloproteinase-9 and cellular fibronectin were determined in 134 patients treated with i.v. t-PA within 3 hours from stroke onset in blood samples obtained before t-PA treatment, at 24 and 72 hours. Results: Serum ferritin levels before t-PA infusion correlated to glutamate (r = 0.59, p < 0.001) and interleukin-6 (r = 0.55, p <0.001) levels at baseline, and with glutamate (r = 0.57,p <0.001), interleukin-6 (r = 0.49,p <0.001), metalloproteinase-9 (r = 0.23, p = 0.007) and cellular fibronectin (r = 0.27, p = 0.002) levels measured at 24 hours and glutamate (r = 0.415, p < 0.001), interleukin-6 (r = 0.359, p < 0.001) and metalloproteinase-9 (r = 0.261, p = 0.004) at 72 hours. The association between ferritin and glutamate levels remained after adjustment for confounding factors in generalized linear models. Conclusions: Brain damage associated with increased iron stores in acute ischemic stroke patients treated with iv. tPA may be mediated by mechanisms linked to excitotoxic damage. The role of inflammation, blood brain barrier disruption and oxidative stress in this condition needs further research. PMID:19096131

Design and Rationale of the Intima-Medial Thickness Sub-Study of the PreventIon of CArdiovascular Events in iSchemic Stroke Patients with High Risk of Cerebral hemOrrhage (PICASSO-IMT) Study.

Science.gov (United States)

Seo, Woo-Keun; Kim, Yong Jae; Lee, Juneyoung; Kwon, Sun U

2017-09-01

Atherosclerosis is one of the main mechanisms of stroke and cardiovascular diseases and is associated with increased risk of recurrent stroke and cardiovascular events. Intima-medial thickness (IMT) is a well-known surrogate marker of atherosclerosis and has been used to predict stroke and cardiovascular events. However, the clinical significance of IMT and IMT change in stroke has not been investigated in well-designed studies. The PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage-Intima-Media Thickness (PICASSO-IMT) sub-study is designed to investigate the effects of cilostazol, probucol, or both on IMT in patients with stroke. PICASSO-IMT is a prospective sub-study of the PICASSO study designed to measure IMT and plaque score at 1, 13, 25, 37, and 49 months after randomization. The primary outcome is the change in mean carotid IMT, which is defined as the mean of the far-wall IMTs of the right and left common carotid arteries, between baseline and 13 months after randomization. PICASSO-IMT will provide the largest IMT data set in a stroke population and will provide valuable information about the clinical significance of IMT in patients with ischemic stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

Directory of Open Access Journals (Sweden)

Felipe Torres Pacheco

2015-05-01

Full Text Available Objective The potential of computed tomography angiography (CTA was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours. Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2% based on both clinical grounds and imaging follow-up (stroke group, with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86% while artery-to-artery embolization was the most common stroke mechanism (52%. Conclusion Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism.

The Potential Impact of Maintaining a 3-Hour IV Thrombolysis Window: How Many More Patients can we Safely Treat?

Science.gov (United States)

Lyerly, Michael J; Albright, Karen C; Boehme, Amelia K; Shahripour, Reza Bavarsad; Houston, James T; Rawal, Pawan V; Kapoor, Niren; Alvi, Muhammad; Sisson, April; Alexandrov, Anne W; Alexandrov, Andrei V

2013-09-13

In 2008, the European Cooperative Acute Stroke Study-3 (ECASS-3) demonstrated that intravenous-tissue plasminogen activator could be safely administered for acute stroke patients presenting between 3 and 4.5 hours from symptom onset. Recently, the Food and Drug Administration rejected expansion of this time window in the United States. We sought to determine how many fewer patients would be treated by maintaining this restricted time window. We reviewed charts from patients who received intravenous thrombolysis at the University of Alabama at Birmingham between January 2009 and December 2011. Patients were divided into two groups (treated within 3 hours of onset, treated between 3 and 4.5 hours from onset). Demographics, stroke severity and protocol deviations according to the ECASS-3 trial were collected. Our safety measures were any hemorrhagic transformation, symptomatic intracerebral hemorrhage and systemic hemorrhage. Two hundred and twelve patients were identified, of whom 192 were included in our analysis. A total of 36 patients (19%) were treated between 3 and 4.5 hours. No statistical differences were seen between age (p=0.633), gender (p=0.677), race (p=0.207) or admission stroke severity (p=0.737). Protocol deviations from the ECASS-3 criteria were found in 20 patients (56%). These were primarily age > 80 and aggressive blood pressure management. Despite these deviations, we did not see significant increases in the rates of adverse events in patients treated in the extended time window. Our data are consistent with previously reported international data that IV thrombolysis can safely be used up to 4.5 hours from symptom onset. Restricting the time window to 3 hours would have resulted in almost one-fifth fewer patients treated at our center.

Usefulness of diffusion-weighted images in the evolving stroke: correlation with clinical findings

International Nuclear Information System (INIS)

Kim, Hyun Sook; Yoon, Yong Kyu; Kim, Dong Ik; Yoon, Pyeong Ho; Lee, Seung Ik; Lee, Byung In; Suh, Bum Chun

2000-01-01

To determine the usefulness of repeat diffusion-weighted imaging (DWI) during the acute ischemic stroke stage for the prediction of evolving stroke and clinical course. Fifteen patients with acute ischemic stroke in MCA territory (less than 24 hours, 5 patients; greater than 24 hours, 10 patients; M:F =3D (:6; age 28-75 (mean, 61) years) were involved in this prospective study. All patients underwent initial DWI, follow-up DWI (within two weeks of the first attack) and T2WI (2-5 months later to assess final infarction territory). The National Institute of Health Stroke Scale (NIHSS) was used for clinical evaluation. 'Evolving stroke' was defined as progression NIHSS after admission. For statistical analysis, Fisher's exact test was used and a p value less than 0.05 was considered significant.In six patients (40%), the diagnosis was evolving stroke. In four of these (67%), follow-up DWI showed that the infarction territory was more extensive. Evolving stroke occurred 24-72 hours after the onset of symptoms. DWI obtained 72 hours after onset showed that one patient had developed new infarction. Patients in whom enlarged infarction territory was seen on follow-up DWI showed progression of NIHSS within three days of onset, while those in whom follow-up DWI demonstrated no change showed an improved NIHSS (p less than 0.05). Those who underwent initial DWI within 24 hours of onset showed larger infarction territory on follow-up DWI than those who underwent initial DWI later than this (p greater than 0.05). Repeat DWI during the acute ischemic stroke stage might be useful for the evaluation of evolving stroke. (author)

Perfusion computed tomography-guided intravenous thrombolysis for acute ischemic stroke beyond 4.5 hours: a case-control study.

Science.gov (United States)

García-Bermejo, Pablo; Calleja, Ana I; Pérez-Fernández, Santiago; Cortijo, Elisa; del Monte, José M; García-Porrero, Miguel; Fe Muñoz, M; Fernández-Herranz, Rosario; Arenillas, Juan F

2012-01-01

Extending the therapeutic window of intravenous thrombolysis for acute ischemic stroke beyond the established 4.5-hour limit is of critical importance in order to increase the proportion of thrombolysed stroke patients. In this setting, the capacity of MRI to select acute stroke patients for reperfusion therapies in delayed time windows has been and is being tested in clinical trials. However, whether the more available and cost-effective perfusion computed tomography (PCT) may be useful to select candidates for delayed intravenous thrombolysis remains largely unexplored. We aimed to evaluate the safety and efficacy of PCT-guided intravenous thrombolysis beyond 4.5 h after stroke onset. We prospectively studied all consecutive acute ischemic stroke patients treated with intravenous tissue plasminogen activator (tPA) in our stroke unit between January 2008 and December 2010. Patients treated within 0- 4.5 h were treated according to non-contrast CT (NCCT) criteria. Beyond 4.5 h, patients received intravenous tPA according to PCT criteria, i.e. an infarct core on cerebral blood volume (CBV) maps not exceeding one third of the middle cerebral artery (MCA) territory and tissue at risk as defined by mean transit time-CBV mismatch greater than 20%. Predetermined primary endpoints were symptomatic hemorrhagic transformation and favorable long-term outcome, while early neurological improvement and MCA recanalization were considered secondary endpoints. Statistical analysis included bivariate comparisons between the two groups for each endpoint and logistic regression models when significance was found in bivariate analyses. This study was approved by our local ethics committee. A total of 245 patients received intravenous thrombolysis. After the groups were matched by baseline National Institutes of Health Stroke Scale score, 172 patients treated at 4.5 h were finally included. Early and late groups were comparable regarding baseline variables; only cardioembolic etiology

Prevalence and Prognostic Significance of Runs of Premature Atrial Complexes in Ischemic Stroke Patients

DEFF Research Database (Denmark)

Høeg Vinther, Kristina; Tveskov, Claus; Möller, Sören

2016-01-01

BACKGROUND AND PURPOSE: Runs of premature atrial complexes (PACs) are common in stroke patients and perceived to be clinically insignificant, but their prognostic significance is unclear. This study investigated the association between runs of PACs in ischemic stroke patients and the risk...... of recurrent ischemic strokes/transient ischemic attacks (TIAs) or death. METHODS: The study included consecutive patients admitted with an ischemic stroke from August 2008 to April 2011. Patients with known and newly detected atrial fibrillation were excluded. Runs of PACs were defined as 3 or more PACs...... lasting less than 30 seconds during 48 hours of continuous inpatient cardiac telemetry. The patients were followed for 4 years or until death, whichever came first. They were stratified according to stroke severity. The combined primary endpoint was a recurrent ischemic stroke/TIA or death. RESULTS...

Patient and Process Factors Associated With Type of First Neuroimaging and Delayed Diagnosis in Childhood Arterial Ischemic Stroke.

Science.gov (United States)

Daverio, Marco; Bressan, Silvia; Gregori, Dario; Babl, Franz E; Mackay, Mark T

2016-09-01

In-hospital factors contribute more to delayed diagnosis of childhood arterial ischemic stroke (AIS) than prehospital factors. We aimed to explore process and patient factors associated with type of and timing to neuroimaging in childhood AIS in the emergency department (ED). This was a retrospective hospital registry-based study of children with AIS, presenting to an Australian tertiary pediatric ED between January 2003 and December 2012. Neuroimaging data and timelines of care were also collected from referring hospitals for transferred patients. Seventy-one AIS episodes and 19 transient ischemic attacks were recorded. The majority (56%) were initially seen at a referring hospital. Patients underwent computed tomography (CT) as first scan more frequently than magnetic resonance imaging (MRI) as first scan (61% vs. 32%) at both the referring and the tertiary hospitals. Time to first scan as CT was significantly shorter compared with MRI (median = 1.5 hours vs. 10.9 hours, p first presenting to a referring hospital and those directly accessing the tertiary center. Patient characteristics including age, past medical history, conscious state, focal symptoms, and signs on arrival were not associated with the type of first neuroimaging or time to diagnostic MRI. Patients presenting during weekends were less likely to receive an MRI as first scan (odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.1-0.8), while time to MRI was significantly longer for children presenting after hours (5 pm-8 am; median = 17.6 hours vs. 8.4 hours, p = 0.026). MRI overall and as first scan was associated with a higher use of sedation than CT (OR = 6.5, 95% CI = 1.3-32.9; and OR = 3.9, 95% CI = 1.3-11.8), particularly for children younger than 5 years of age (OR = 12.5, 95% CI = 3-52.4). Strategies to improve rapid diagnosis of pediatric stroke should include shared regional hospital networks protocols to optimize local imaging strategies and where possible rapid transfer to the

The role of calling EMS versus using private transportation in improving the management of stroke in France.

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Gache, Kristel; Couralet, Melanie; Nitenberg, Gérard; Leleu, Henri; Minvielle, Etienne

2013-01-01

To compare the time from symptom onset to brain imaging between patients calling emergency medical services (EMS) and those using private means for transportation. We focused on symptom onset-to-brain imaging times of ≤2 hours and ≤3 hours 30 minutes, assuming a one-hour interval between imaging and thrombolysis. Other variables were the patient's age, gender, stroke type, National Institutes of Health Stroke Scale (NIHSS) score, presence of an on-site stroke unit, and period of symptom onset. Univariate analyses and a hierarchical linear regression model were used, as appropriate, and adjusted for these variables. A total of 1,105 stroke patients (28%) were included in the analyses, 40.6% of them transported by EMS. Patients using EMS were significantly older (72.8 vs. 70.5 years; p = 0.008), they had a higher NIHSS score (8 vs. 6.1; p = 0.0001), fewer were ischemic (85.1% vs. 90.6%; p = 0.005), and more of them reached hospitals with an on-site stroke unit (81.3% vs. 72.9%; p = 0.002). For the EMS-call patients, the median symptom onset-to-brain imaging time was significantly shorter (3 hours 21 minutes vs. 5 hours 57 minutes), and after adjustment, maximum delays of 2 hours and 3 hours 30 minutes were independently associated with EMS call: 28% vs. 18% (p = 0.015) and 66% vs. 45% (p < 0.0001) of patients, respectively, leading to an adjusted odds ratio of 2.77 (95% confidence interval, 2.007-3.828; p < 0.0001) for the threshold of 3 hours 30 minutes. The symptom onset-to-brain imaging time was significantly shorter in case of EMS transportation, but most patients did not reach the hospital in time to be eligible for thrombolysis. Efforts are still needed to reduce delays, especially public education and EMS activation. These efforts should be combined with new approaches for the quality management of stroke patients.

Guidelines for the treatment of acute ischaemic stroke.

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

2014-03-01

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

The cardiovascular status of the black stroke patient

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

1989-01-01

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

Effects of art therapy using color on purpose in life in patients with stroke and their caregivers.

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Kim, Mi Kyoung; Kang, Sung Don

2013-01-01

Patients with stroke suffer from physical disabilities, followed by mental instability. Their caregivers also suffer from mental instability. The present study attempted to address the degree and the change of the level of Purpose in Life (PIL) in patients with stroke and caregivers by applying art therapy using colors. Twenty-eight stroke patients with a good functional recovery or a moderate disability and their 28 caregivers were selected and evaluated. The period of the study between the stroke and color therapy was more than 6 months. Patients and caregivers were divided into the color therapy (28) and control groups (28). A questionnaire, which measures the level of PIL was conducted separately for patients and caregivers prior to the first session of color therapy (2 hours per week, total 16 sessions). The final examination was performed 5 months after the last color therapy session. There was significant difference between before and after color therapy when the level of PIL was measured both in patients and caregivers (pcolor therapy group, compared with the control group (pcolor therapy progressed to the late phase, patients and caregivers applied increasing number of colors and color intensity. These results prove that color therapy will improve PIL of the patients with post-stroke disability and caregivers. Furthermore, color therapy would be a useful adjuvant for improving the quality of life of the patients with stroke and their caregivers.

Outcomes of a contemporary cohort of 536 consecutive patients with acute ischemic stroke treated with endovascular therapy.

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Abilleira, Sònia; Cardona, Pere; Ribó, Marc; Millán, Mònica; Obach, Víctor; Roquer, Jaume; Cánovas, David; Martí-Fàbregas, Joan; Rubio, Francisco; Alvarez-Sabín, José; Dávalos, Antoni; Chamorro, Angel; de Miquel, Maria Angeles; Tomasello, Alejandro; Castaño, Carlos; Macho, Juan M; Ribera, Aida; Gallofré, Miquel

2014-04-01

We sought to assess outcomes after endovascular treatment/therapy of acute ischemic stroke, overall and by subgroups, and looked for predictors of outcome. We used data from a mandatory, population-based registry that includes external monitoring of completeness, which assesses reperfusion therapies for consecutive patients with acute ischemic stroke since 2011. We described outcomes overall and by subgroups (age ≤ or >80 years; onset-to-groin puncture ≤ or >6 hours; anterior or posterior strokes; previous IV recombinant tissue-type plasminogen activator or isolated endovascular treatment/therapy; revascularization or no revascularization), and determined independent predictors of good outcome (modified Rankin Scale score ≤2) and mortality at 3 months by multivariate modeling. We analyzed 536 patients, of whom 285 received previous IV recombinant tissue-type plasminogen activator. Overall, revascularization (modified Thrombolysis In Cerebral Infarction scores, 2b and 3) occurred in 73.9%, 5.6% developed symptomatic intracerebral hemorrhages, 43.3% achieved good functional outcome, and 22.2% were dead at 90 days. Adjusted comparisons by subgroups systematically favored revascularization (lower proportion of symptomatic intracerebral hemorrhages and death rates and higher proportion of good outcome). Multivariate analyses confirmed the independent protective effect of revascularization. Additionally, age >80 years, stroke severity, hypertension (deleterious), atrial fibrillation, and onset-to-groin puncture ≤6 hours (protective) also predicted good outcome, whereas lack of previous disability and anterior circulation strokes (protective) as well as and hypertension (deleterious) independently predicted mortality. This study reinforces the role of revascularization and time to treatment to achieve enhanced functional outcomes and identifies other clinical features that independently predict good/fatal outcome after endovascular treatment/therapy.

Clinical and radiological characteristics of hemiplegic arm raising related to yawning in stroke patient

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Jian-yong LI

2018-03-01

Full Text Available Objective To investigate the clinical and radiological characteristics of parakinesia brachialis oscitans (PBD related to yawning in stroke patient and its mechanism. Methods We reported 4 patients with involuntary raising of the paralyzed limbs when yawning in neurological unit of Hainan Branch of Chinese PLA General Hospital, and analyzed their clinical characteristics together with published cases in literatures. Results In this group of stroke patients, when they yawned, their paralyzed upper limb could lift upward involuntarily. Totally 22 patients with ischemic (n=20 and hemorrhagic (n=2 stroke were enrolled. Brain imaging showed infarcts in the middle cerebral artery (MCA in 17 patients and in the brain stem in 5 patients. This phenomenon occurred 4 hours to 4 months (14.57±31.66d after stroke onset, and lasted from 1 week to 3 years (6.70±11.66 months. Corticobulbar tract and pyramidal tract were both damaged in these 22 patients. The mechanism might be that after corticobulbar tract and pyramidal tract damaged, their dominant role in the cranial nerve nuclei of the brainstem and the anterior horn cells of the spinal cord disappeared, and the projection of oxytocinergic neurons from paraventricular nucleus functions, thus causing yawning and muscle contraction. Conclusion PBO may be a rare phenomenon of abnormal movement after stroke. This phenomenon indicates damaging of pyramidal tract, and PBO disappears gradually with the recovery of pyramidal tract function. DOI: 10.11855/j.issn.0577-7402.2018.03.09

Stroke Risk Perception in Atrial Fibrillation Patients is not Associated with Clinical Stroke Risk.

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Fournaise, Anders; Skov, Jane; Bladbjerg, Else-Marie; Leppin, Anja

2015-11-01

Clinical risk stratification models, such as the CHA2DS2-VASc, are used to assess stroke risk in atrial fibrillation (AF) patients. No study has yet investigated whether and to which extent these patients have a realistic perception of their personal stroke risk. The purpose of this study was to investigate and describe the association between AF patients' stroke risk perception and clinical stroke risk. In an observational cross-sectional study design, we surveyed 178 AF patients with a mean age of 70.6 years (SD 8.3) in stable anticoagulant treatment (65% treatment duration >12 months). Clinical stroke risk was scored through the CHA2DS2-VASc, and patients rated their perceived personal stroke risk on a 7-point Likert scale. There was no significant association between clinical stroke risk assessment and patients' stroke risk perception (rho = .025; P = .741). Approximately 60% of the high-risk patients had an unrealistic perception of their own stroke risk, and there was no significant increase in risk perception from those with a lower compared with a higher risk factor load (χ(2) = .010; P = .522). Considering possible negative implications in terms of lack of motivation for lifestyle behavior change and adequate adherence to the treatment and monitoring of vitamin K antagonist, the apparent underestimation of risk by large subgroups warrants attention and needs further investigation with regard to possible behavioral consequences. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke.

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Zhao, Lu; Wang, Ruihao; Song, Bo; Tan, Song; Gao, Yuan; Fang, Hui; Lu, Jie; Xu, Yuming

2015-07-01

The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24-6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85-3·37). Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship. © 2015 World Stroke Organization.

Influential factors of clinical outcome of local intra-arterial thrombolysis using urokinase in patients with hyperacute ischemic stroke

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Song, Jae Min; Yoon, Woong; Kim, Jae Kyu; Seo, Jeong Jin; Heo, Sook Hee; Park, Jin Gyoon; Jeong, Yoon Yeon; Kang, Heoung Keun [Chonam University Hospital, Kwangju (Korea, Republic of)

2002-10-01

To evaluate the clinical outcome and other relevant factors in cases where local intra-arterial thrombolysis (LIT) is used for the treatment of hyperacute ischemic stroke. Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the national institutes of health stroke scale (NIHSS) score was used. Angiography recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected.

Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

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Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard

2013-03-01

The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.

Predictors of ischemic versus hemorrhagic strokes in hypertensive patients

International Nuclear Information System (INIS)

Khealani, B.A.; Syed, N.A.; Maken, S.; Mapari, U.U.; Hameed, B.; Ali, S.; Qureshi, R.; Akhter, N.; Hassan, A.; Sonawalla, A.B.; Baig, S.M.; Wasay, M.

2005-01-01

Objective: To identify the factors that predispose to ischemic versus hemorrhagic stroke in hypertensive patients. Materials and Methods: All the hypertensive patients, who were registered in AKUH acute stroke outcome data base, over a period of 22 months, were identified and from this cohort the patients with first ever stroke were selected. The data regarding demographics, stroke type (ischemic vs. hemorrhagic), pre-existing medical problems, laboratory and radiological investigations was recorded and analyzed. Results: Five hundred and nineteen patients with either ischemic stroke or parenchymal hemorrhage were registered over a period of 22 months. Three hundred and forty-eight patients (67%) had hypertension and of these, 250 had first ever stroke at the time of admission. Presence of diabetes mellitus (OR: 3.76; Cl:1.67-8.46) and ischemic heart disease (OR: 6.97; Cl:1.57-30.98) were found to be independent predictors of ischemic strokes. Conclusion: Presence of diabetes mellitus and ischemic heart disease predict ischemic stroke in a patient with hypertension. (author)

Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care.

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Walz, Stacy E; Smith, Maureen; Cox, Elizabeth; Sattin, Justin; Kind, Amy J H

2011-04-01

Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown. To determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries, for common sub-acute care populations. Retrospective cohort study. Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003-2005 (N = 564) Pending lab tests were abstracted from the laboratory information system (LIS) and from each patient's discharge summary, then grouped into 14 categories and compared. Microbiology tests were sub-divided by culture type and number of days pending prior to discharge. Of sub-acute care patients, 32% (181/564) were discharged with pending lab tests per the LIS; however, only 11% (20/181) of discharge summaries documented these. Patients most often left the hospital with pending microbiology tests (83% [150/181]), particularly blood and urine cultures, and reference lab tests (17% [30/181]). However, 82% (61/74) of patients' pending urine cultures did not have 24-hour preliminary results, and 19% (13/70) of patients' pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge. Approximately one-third of the sub-acute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved

A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with Stroke: A developing state scenario

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Vinayak Nagaraja

2010-10-01

Full Text Available Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics with mean (SD age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516, sex (p=0.460, number of episodes (0.795, underlying hypertension (p=0.905. Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004, in patients with right-sided compared with left

MEMORY SONGS DECREASE DEPRESSION FOR STROKE PATIENTS

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Harmayetty Harmayetty

2017-07-01

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

Polysomnographic indicators of mortality in stroke patients

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

2017-01-01

a 19-37-month follow-up period. RESULTS: Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher...... receive increased attention....

Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?

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Chaturvedi, Seemant; Ofner, Susan; Baye, Fitsum; Myers, Laura J; Phipps, Mike; Sico, Jason J; Damush, Teresa; Miech, Edward; Reeves, Mat; Johanning, Jason; Williams, Linda S; Arling, Greg; Cheng, Eric; Yu, Zhangsheng; Bravata, Dawn

2017-01-17

Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p 6 hours (74% had MRI, p = 0.0009) were associated with MRI performance. Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA. © 2016 American Academy of Neurology.

Predictors of Thrombolysis Administration in Mild Stroke: Florida-Puerto Rico Collaboration to Reduce Stroke Disparities.

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Asdaghi, Negar; Wang, Kefeng; Ciliberti-Vargas, Maria A; Gutierrez, Carolina Marinovic; Koch, Sebastian; Gardener, Hannah; Dong, Chuanhui; Rose, David Z; Garcia, Enid J; Burgin, W Scott; Zevallos, Juan Carlos; Rundek, Tatjana; Sacco, Ralph L; Romano, Jose G

2018-03-01

Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ≤5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis. We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus ≥3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12-1.62), faster door-to-computed tomography time (OR, 1.81; 95% CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39-2.95) were

Evaluation of serum oxidant/antioxidant balance in patients with acute stroke

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Abdullah, A.; Ssefer, V.; Ertugrul, U.; Osman, E.; Esref, A.; Ugur, C.M.; Adalet, A.; Yavuz, Y.; Faysal, E.; Nebahat, T

2013-01-01

Objectives: To investigate the alterations in the oxidant-antioxidant balance in patients with acute ischaemic stroke, and to locate any correlation between oxidant/antioxidant parameters and the National Institute of Health Stroke Scale. Methods: The case-control study was conducted at the Neurology Department of Dicle University Medical Faculty, Diyarbakir, Turkey, from June 2010 to June 2011. Blood samples were obtained from 53 patients with ischaemic stroke and 40 healthy controls without any history of ischaemic stroke or systemic disease. Venous blood was obtained within 24 hour after stroke onset. Serum malondialdehyde , total anti-oxidant capacity, paraoxanase and superoxide dismutase were measured. SPSS 11.5 used for statistical analysis. Results: There was no difference between the cases and the controls regarding age (64.5+-15.8 and 66.3+-13.9 respectively), gender (27 (51%) / 26 (49%), and 19 (48%) / 21 (52%) respectively), obesity (15 (28.3%) and 13 (37.5%), respectively), and hypertension (30 (56.6%) and 23 (57.5%), respectively). The cases had higher concentrations of malondialdehyde (147.3+-59.3 vs. 112.4+-28.5 nmol/gr protein, p<0.001), and superoxide dismutase (4.40+-0.79 vs. 3.35+-0.51, p<0.001) compared to the controls. However, the cases had lower concentrations of paraoxanase (23.2+-23.7 vs 64.7+-52.6, p<0.001), total anti-oxidant capacity (0.77+-0.38 vs. 0.95+-0.30, p<0.015), and nitric oxide (10.8+-7.1 vs. 17.5+-2.4 micro mol/gr protein, p<0.001), compared to the controls. In the stroke group, a significant negative correlation was found between the National Institute of Health Stroke Scale and total anti-oxidant capacity activity (p<0.021, r-0.32). Conclusion: The results support the hypothesis that sufficient anti-oxidant capacity has a beneficial effect on the clinical severity of acute ischaemic stroke. (author)

Acute management of stroke patients taking non-vitamin K antagonist oral anticoagulants Addressing Real-world Anticoagulant Management Issues in Stroke (ARAMIS) Registry: Design and rationale.

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Xian, Ying; Hernandez, Adrian F; Harding, Tina; Fonarow, Gregg C; Bhatt, Deepak L; Suter, Robert E; Khan, Yosef; Schwamm, Lee H; Peterson, Eric D

2016-12-01

Non-vitamin K antagonist oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) have been increasingly used as alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation. Yet there is substantial lack of information on how patients on NOACs are currently treated when they have an acute ischemic stroke and the best strategies for treating intracerebral hemorrhage for those on chronic anticoagulation with warfarin or a NOAC. These are critical unmet needs for real world clinical decision making in these emergent patients. The ARAMIS Registry is a multicenter cohort study of acute stroke patients who were taking chronic anticoagulation therapy prior to admission and are admitted with either an acute ischemic stroke or intracerebral hemorrhage. Built upon the existing infrastructure of American Heart Association/American Stroke Association Get With the Guidelines Stroke, the ARAMIS Registry will enroll a total of approximately 10,000 patients (5000 with acute ischemic stroke who are taking a NOAC and 5000 with anticoagulation-related intracerebral hemorrhage who are on warfarin or a NOAC). The primary goals of the ARAMIS Registry are to provide a comprehensive picture of current treatment patterns and outcomes of acute ischemic stroke patients on NOACs, as well as anticoagulation-related intracerebral hemorrhage in patients on either warfarin or NOACs. Beyond characterizing the index hospitalization, up to 2500 patients (1250 ischemic stroke and 1250 intracerebral hemorrhage) who survive to discharge will be enrolled in an optional follow-up sub-study and interviewed at 3 and 6 months after discharge to assess longitudinal medication use, downstream care, functional status, and patient-reported outcomes. The ARAMIS Registry will document the current state of management of NOAC treated patients with acute ischemic stroke as well as contemporary care and outcome of anticoagulation-related intracerebral hemorrhage. These

Allocation and preference of patients for domiciliary or institutional rehabilitation after a stroke.

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Weiss, Zwi; Snir, David; Zohar, Ruth; Klein, Bracha; Eyal, Pnina; Dynia, Aida; Eldar, Reuben

2004-06-01

On discharge from an acute-care hospital after a stroke, 191 patients were told that they needed rehabilitation and were offered the option of receiving care in an institution or in their homes. One hundred and one (52.4%) patients chose an institution and 91 (47.6%) preferred rehabilitation in their own home. A higher number of women than men chose to be rehabilitated at home. Multivariate logistic regression showed that odds for being included in the home rehabilitation group were higher for women and for those who had a stroke in the past. Odds for being included in the institutional rehabilitation group were individuals with diabetes and difficulty in ambulating and those who had a longer stay in the acute-care hospital. Findings of the study suggest that in Israel there is a sub-population of acute stroke survivors who may be appropriate for rehabilitation at home and accept the option when they are offered it.

Use of a Diagnostic Score to Prioritize Computed Tomographic (CT Imaging for Patients Suspected of Ischemic Stroke Who May Benefit from Thrombolytic Therapy.

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Wen Yea Hwong

Full Text Available A shortage of computed tomographic (CT machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging.From the Malaysian National Neurology Registry, we selected patients aged 18 years and over with clinical features suggesting of a stroke, who arrived in the hospital 4.5 hours or less from ictus. The prioritization of receiving CT imaging was left to the discretion of the treating physician. We applied the Siriraj Stroke Score to all patients, refitted the score and defined a cut-off value to best distinguish an ischemic stroke from a hemorrhagic stroke.Of the 2176 patients included, 73% had an ischemic stroke. Only 33% of the ischemic stroke patients had CT imaging within 4.5 hours. The median door-to-scan time for these patients was 4 hours (IQR: 1;16. With the recalibrated score, it would have been possible to prioritize 95% (95% CI: 94%-96% of patients with an ischemic stroke for urgent CT imaging.In settings where CT imaging capacity is limited, we propose the use of the Siriraj Stroke Score to prioritize patients with a probable ischemic stroke for urgent CT imaging.

Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

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

2017-07-01

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

Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

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Jittima Saengsuwan

2017-01-01

Full Text Available Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females. Using an open-ended questionnaire, nearly one-third of patients (31.4% could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%, dyslipidemia (28.6%, and diabetes (22.9%. Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%, sudden trouble with speaking (25.7%, and sudden trouble with walking, loss of balance, or dizziness (21.4%. Nineteen patients (13.6% could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

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

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Lampe Fiona

2001-03-01

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

Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

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Ayan Sen

2014-07-01

Full Text Available Introduction: Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements. Methods: This study was a secondary analysis of 7 stroke patients from a prospectively collected data set of patients that received 2 hours of hemodynamic monitoring in the ED. Stroke patients were included if hemorrhagic or ischemic stroke was confirmed by neuroimaging, and symptom onset was within 24 hours. They were excluded for the presence of a stroke mimic or transient ischemic attack. Monitoring was performed using the Nexfin device (Edwards Lifesciences, Irvine CA. Results: The mean age of the cohort was 71 ± 17 years, 43% were male, and the mean National Institute of Health Stroke Scale (NIHSS was 6.9 ± 5.5. Two patients had hemorrhagic stroke. We obtained 42,456 hemodynamic data points, including beat-to-beat blood pressure measurements with variability of 18 mmHg and cardiac indices ranging from 1.8 to 3.6 l/min/m2. The correlation coefficient between continuous blood pressure measurements with the Nexfin device and standard ED readings was 0.83. Conclusion: This exploratory investigation revealed that continuous, noninvasive monitoring in the ED is feasible in acute stroke. Further research is currently underway to determine how such monitoring may impact outcomes in stroke or replace the need for invasive monitoring. [West J Emerg Med. 2014;15(4:–0.

Safety and Efficacy of Acute Clopidogrel Load in Patients with Moderate and Severe Ischemic Strokes

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Amir Shaban

2016-01-01

Full Text Available Objective. To study the safety and efficacy of a clopidogrel loading dose in patients with moderate and severe acute ischemic strokes. Background. The safety of clopidogrel loading has been extensively investigated in patients with minor strokes and transient ischemic attacks. Methods. Acute ischemic stroke patients presenting consecutively to our center from 07/01/08 to 07/31/13 were screened. Clopidogrel loading was defined as at least 300 mg dose (with or without aspirin given within 6 hours of admission. We compared outcomes in patients with baseline NIHSS > 3 with and without clopidogrel loading. Results. Inclusion criteria were met for 1011 patients (43.6% females, 69.1% black, median age 63. Patients with clopidogrel loading had lower baseline NIHSS than patients who were not loaded (8 versus 9, p=0.005. The two groups had similar risk for hemorrhagic transformation (p=0.918 and symptomatic hemorrhage (p=0.599. Patients who were loaded had a lower rate of neurological worsening (38.9% versus 48.3%, p=0.031 and less in-hospital mortality (4.3% versus 13.4%, p=0.001 compared to those who were not loaded. The likelihood of having a poor functional outcome did not differ between the two groups after adjusting for NIHSS on admission (OR = 0.71, 95% CI 0.4633–1.0906, p=0.118. Conclusion. Clopidogrel loading dose was not associated with increased risk for hemorrhagic transformation or symptomatic intracranial hemorrhage in our retrospective study and was associated with reduced rates of neuroworsening following moderate and severe stroke.

Synthesis, structure and electronic configuration of [Rh{sub 6}Te{sub 8}(PPh{sub 3}){sub 6}].4C{sub 6}H{sub 6}

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Thiele, Guenther; Balmer, Markus [Marburg Univ. (Germany). Fachbereich Chemie; Dehnen, Stefanie [Marburg Univ. (Germany). Fachbereich Chemie and Wissenschaftliches Zentrum fuer Materialwissenschaften

2016-08-01

[Rh{sub 6}Te{sub 8}(PPh{sub 3}){sub 6}].4C{sub 6}H{sub 6}, the first compound with a molecular Chevrel-type [Rh{sub 6}Te{sub 8}] cluster core has been synthesized and structurally characterized. By means of quantum chemical calculation, the close relationship of its electronic configuration to that of the lighter homologue has been demonstrated. The different crystal solvent content prevents an isostructural crystallization.

Searching for the Smoker's Paradox in Acute Stroke Patients Treated With Intravenous Thrombolysis.

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Hussein, Haitham M; Niemann, Nicki; Parker, Emily D; Qureshi, Adnan I

2017-07-01

Inconsistent evidence supports better outcome in smokers after stroke. Our study examines this association in a large sample of ischemic stroke treated with intravenous thrombolysis. Virtual International Stroke Trials Archive (VISTA) database, composed of individual patient data of multiple clinical trials, was queried. The primary outcome was functional independence at 3 months noted by modified Rankin Scale (mRS; a 7-point scale ranging from 0 [no deficit] to 6 [death]) score≤ 2. The secondary outcomes were National Institutes of Health Stroke Scale (NIHSS; stroke severity measure, ranging from 0 [no deficit] to 42 [most severe]) score at 24 hours and the occurrence of symptomatic intractracranial hemorrhage. A total of 5383 patients were included: 1501 current smokers and 3882 nonsmokers. Smokers were younger (60 ± 13 vs. 71 ± 12 years, p vs. 13 [9-18], p smokers (49.7% vs. 39.5%, p non-significant after adjusting for age (OR 1.11, 95% CI 0.97-1.27). Subgroup analysis by age/gender strata showed that current smoking was associated with favorable outcome only in women ≥ 65 years. Current smoking was also associated with lower rates of symptomatic intracranial hemorrhage (adjusted OR 0.55, 95% CI 0.39-0.79). Smokers experience their first ever stroke 11 years younger than nonsmokers. This age difference explains the association between current smoking and favorable functional outcome. Smoking is associated with occurrence of first ever stroke at a younger age, therefore, focus should be on smoking prevention and treatment. The decision to treat ischemic stroke patients with intravenous thrombolysis should not be influenced by the patients' smoking status. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Importance of Patient Involvement in Stroke Rehabilitation

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

2016-01-01

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

Recovery of Patients with Pure Diffuse Axonal Injury Who Remained in a Coma for 6 Hours or More.

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Almeida Vieira, Rita de Cássia; Paiva, Wellingson Silva; de Oliveira, Daniel Vieira; de Paula Guirado, Vinícius Monteiro; Caetano Lança, Ellen de Fátima; de Sousa, Regina Márcia Cardoso

2018-01-01

Diffuse axonal injury (DAI) is a traumatic brain injury and one of the most common causes of unfavorable outcome and death. The aim of this study was to investigate the recovery of patients with pure DAI who remained in a coma for 6 hours or longer after brain injury. This was a follow-up study of 75 patients diagnosed with pure DAI, aged 18-60 years, with a Glasgow Coma Scale score ≤8 at hospital admission. Patient data were collected at hospital admission, hospital discharge, and 3 and 6 months after DAI. Recovery was assessed by score changes in the Katz Index of Independence in Activities of Daily Living and Extended Glasgow Outcome Scale. The percentage of patients in a coma for 6-24 hours, >24 hours without brainstem signs, and >24 hours with brainstem signs was 42.7%, 20%, and 37.3%, respectively. The 6-month mortality rate was 32.0%, and the mean Extended Glasgow Outcome Scale score among survivors decreased from 3.8 at discharge (SD = 1.2) to 2.1 at 3 months (SD = 1.6) and 1.2 at 6 months (SD = 1.6). The mean Katz Index of Independence in Activities of Daily Living scores were 8.5 (SD = 5.5), 3.5 (SD = 5.8), and 1.8 (SD = 4.5) at discharge and 3 and 6 months after trauma, respectively. Statistically significant differences were observed among the 3 evaluation periods. Mortality was high among patients with DAI, but almost all survivors had favorable outcomes at 6 months. Functional improvement was more pronounced in the first 3 months. Copyright © 2017. Published by Elsevier Inc.

Frequency of hyper-homocysteinaemia in ischaemic stroke patients of Karachi

International Nuclear Information System (INIS)

Sadiq, M.

2014-01-01

Objective: To find out the frequency of hyper-homocysteinaemia in ischaemic stroke patients and its relation with other risk factors. Methods: The cross-sectional study based on convenience sampling was conducted at the Civil Hospital, Karachi, from May to July 2012. It comprised ischaemic stroke patients selected from the Out Patient Department and Emergency Department. An overnight 8-hour fasting venous blood sample (4 ml in ethylenediamminetetraacetate) was drawn for analysis. Rest of the data was collected through a structured proforma and was analysed using SPSS 17.0. Results: The mean age of the 96 patients in the study was 64.9+-10.9 years (range: 40-85).Overall, 56(58.3%) cases had hyper-homocysteinemia. The frequency was significantly high in the age 60-79 age group (p<0.007). Conclusion: Hyper-homocysteinaemia, a modifiable risk factor, is associated with a high number of ischaemic stroke patients. Hence, steps should be taken to minimise this risk factor by screening and early intervention. (author)

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

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

2016-10-01

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

Continuing or Temporarily Stopping Prestroke Antihypertensive Medication in Acute Stroke:An Individual Patient Data Meta-Analysis

OpenAIRE

Woodhouse, Lisa J.; Manning, Lisa; Potter, John F.; Berge, Eivind; Sprigg, Nikola; Wardlaw, Joanna; Lees, Kennedy R.; Bath, Philip M.; Robinson, Thompson G.; , Blood Pressure in Acute Stroke Collaboration (BASC)

2017-01-01

Over 50% of patients are already taking blood pressure-lowering therapy on hospital admission for acute stroke. An individual patient data meta-analysis from randomized controlled trials was undertaken to determine the effect of continuation versus temporarily stopping pre-existing antihypertensive medication in acute stroke. Key databases were searched for trials against the following inclusion criteria: randomized design; stroke onset ≤48 hours; investigating the effect of continuation vers...

Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China.

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Fang, Jing; Yan, Weihong; Jiang, Guo-Xin; Li, Wei; Cheng, Qi

2011-02-01

To observe the time interval between stroke onset and hospital arrival (time-to-hospital) in acute ischemic stroke patients and analyze its putatively associated factors. During the period from November 1, 2006 to August 31, 2008, patients with acute ischemic stroke admitted consecutively to the Department of Neurology, Ninth Hospital, Shanghai, were enrolled in the study. Information of the patients was registered including the time-to-hospital, demographic data, history of stroke, season at attack, neurological symptom at onset, etc. Characteristics of the patients were analyzed and logistic regression analyses were conducted to identify factors associated with the time-to-hospital. There were 536 patients in the study, 290 (54.1%) males and 246 (45.9%) females. The median time-to-hospital was 8h (ranged from 0.1 to 300 h) for all patients. Within 3h after the onset of stroke, 162 patients (30.2%) arrived at our hospital; and within 6h, 278 patients (51.9%). Patients with a history of stroke, unconsciousness at onset, or a high NIHSS score at admission had significantly less time-to-hospital. The time interval between stroke onset and hospital arrival was importance of seeking immediate medical help after stroke onset of patients and their relatives could significantly influence their actions. Copyright © 2010 Elsevier B.V. All rights reserved.

Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke (MAAS): study protocol for a randomized controlled trial.

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Osei, Elizabeth; Fonville, Susanne; Zandbergen, Adrienne A M; Brouwers, Paul J A M; Mulder, Laus J M M; Lingsma, Hester F; Dippel, Diederik W J; Koudstaal, Peter J; den Hertog, Heleen M

2015-08-05

Impaired glucose tolerance is present in one third of patients with a TIA or ischemic stroke and is associated with a two-fold risk of recurrent stroke. Metformin improves glucose tolerance, but often leads to side effects. The aim of this study is to explore the feasibility, safety, and effects on glucose metabolism of metformin and sitagliptin in patients with TIA or minor ischemic stroke and impaired glucose tolerance. We will also assess whether a slow increase in metformin dose and better support and information on this treatment will reduce the incidence of side effects in these patients. The Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke trial (MAAS trial) is a phase II, multicenter, randomized, controlled, open-label trial with blinded outcome assessment. Non-diabetic patients (n = 100) with a recent (TIA, amaurosis fugax or minor ischemic stroke (modified Rankin scale ≤ 3) and impaired glucose tolerance, defined as 2-hour post-load glucose levels between 7.8 and 11.0 mmol/L after repeated standard oral glucose tolerance test, will be included. Patients with renal or liver impairment, heart failure, chronic hypoxic lung disease stage III-IV, history of lactate acidosis or diabetic ketoacidosis, pregnancy or breastfeeding, pancreatitis and use of digoxin will be excluded. The patients will be randomly assigned in a 1:1:2 ratio to metformin, sitagliptin or "no treatment." Patients allocated to metformin will start with 500 mg twice daily, which will be slowly increased during a 6-week period to a twice daily dose of 1000 mg. Patients allocated to sitagliptin will be treated with a daily fixed dose of 100 mg. The study has been registered as NTR 3196 in The Netherlands Trial Register. Primary outcomes include percentage still on treatment, percentage of (serious) adverse events, and the baseline adjusted difference in 2-hour post-load glucose levels at 6 months. This study will give more

Elevated Fasting Blood Glucose Is Predictive of Poor Outcome in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART.

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Ming Yao

Full Text Available Although increasing evidence suggests that hyperglycemia following acute stroke adversely affects clinical outcome, whether the association between glycaemia and functional outcome varies between stroke patients with\\without pre-diagnosed diabetes remains controversial. We aimed to investigate the relationship between the fasting blood glucose (FBG and the 6-month functional outcome in a subgroup of SMART cohort and further to assess whether this association varied based on the status of pre-diagnosed diabetes.Data of 2862 patients with acute ischemic stroke (629 with pre-diagnosed diabetics enrolled from SMART cohort were analyzed. Functional outcome at 6-month post-stroke was measured by modified Rankin Scale (mRS and categorized as favorable (mRS:0-2 or poor (mRS:3-5. Binary logistic regression model, adjusting for age, gender, educational level, history of hypertension and stroke, baseline NIHSS and treatment group, was used in the whole cohort to evaluate the association between admission FBG and functional outcome. Stratified logistic regression analyses were further performed based on the presence/absence of pre-diabetes history.In the whole cohort, multivariable logistical regression showed that poor functional outcome was associated with elevated FBG (OR1.21 (95%CI 1.07-1.37, p = 0.002, older age (OR1.64 (95% CI1.38-1.94, p<0.001, higher NIHSS (OR2.90 (95%CI 2.52-3.33, p<0.001 and hypertension (OR1.42 (95%CI 1.13-1.98, p = 0.04. Stratified logistical regression analysis showed that the association between FBG and functional outcome remained significant only in patients without pre-diagnosed diabetes (OR1.26 (95%CI 1.03-1.55, p = 0.023, but not in those with premorbid diagnosis of diabetes (p = 0.885.The present results demonstrate a significant association between elevated FBG after stroke and poor functional outcome in patients without pre-diagnosed diabetes, but not in diabetics. This finding confirms the importance of glycemic

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

Science.gov (United States)

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

2014-07-01

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

Stroke Risk and Mortality in Patients With Ventricular Assist Devices.

Science.gov (United States)

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

2016-11-01

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

The effects of golf training in patients with stroke: a pilot study.

Science.gov (United States)

Schachten, Tobias; Jansen, Petra

2015-05-01

Stroke is the most common neurological disease and the primary cause of lifelong disability in industrialized countries. Because of this it is important to investigate any kind of successful therapy. From the 24 recruited stroke patients who were between 23 and 72 years old, 14 patients were separated either in a golf training group (EG), or a social communication meeting (CG). Both groups met for one hour sessions, twice a week, for ten weeks. All participants completed assessment tests before and after the experimental period: cognitive tests measuring attention (Go/No-Go task), visual-spatial memory (Block-Tapping test) and mental rotation performance (MRT); a balance test (Berg Balance Scale), and an emotional well-being test (CES-D-Scale). The results show that both groups improved in the CES Scale, the block-tapping test and the balance test. In addition, stroke patients who received a golf training showed a significant improvement in the MRT comparing to the control group (CG). It is indicated that golf training can improve visual imagery ability in stroke patients, even late after stroke.

Diagnostic Yield of Extended Cardiac Patch Monitoring in Patients with Stroke or TIA

Directory of Open Access Journals (Sweden)

Christie E Tung

2015-01-01

Full Text Available Background: It is important to evaluate patients with TIA or stroke for atrial fibrillation (AF because the detection of AF changes the recommended anti-thrombotic regimen from treatment with an antiplatelet agent to oral anticoagulation. This study describes the diagnostic yield of a patch-based, single-use, and water-resistant 14-day continuous cardiac rhythm monitor (ZIO Patch in patients with stroke or TIA.Methods: We obtained data from the manufacturer and servicer of the ZIO Patch (iRhythm Technologies. Patients who were monitored between January 2012 and June 2013 and whose indication for monitoring was TIA or stroke were included. The duration of monitoring, the number and type of arrhythmias, and the time to first arrhythmia were documented. Results: 1,171 monitoring reports were analyzed. The mean monitor wear time was 10.9 days and the median wear time was 13.0 days (interquartile range 7.2-14.0. The median analyzable time relative to the total wear time was 98.7% (IQR 96.0-99.5%. AF was present in 5.0% of all reports. The mean duration before the first episode of paroxysmal AF (PAF was 1.5 days and the median duration was 0.4 days. 14.3% of first PAF episodes occurred after 48 hours. The mean PAF burden was 12.7% of the total monitoring duration. Conclusion: Excellent quality of the recordings and very good patient compliance coupled with a substantial proportion of AF detection beyond the first 48 hours of monitoring suggest that the cardiac patch is superior to conventional 48-hour Holter monitors for AF detection in patients with stroke or TIA.

Possible Anandamide and Palmitoylethanolamide involvement in human stroke

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Pizzolato Gilberto

2010-05-01

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

Atrial fibrillation is not uncommon among patients with ischemic stroke and transient ischemic stroke in China.

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Yang, Xiaomeng; Li, Shuya; Zhao, Xingquan; Liu, Liping; Jiang, Yong; Li, Zixiao; Wang, Yilong; Wang, Yongjun

2017-12-04

Atrial fibrillation (AF) is reported to be a less frequent cause of ischemic stroke in China than in Europe and North America, but it is not clear whether this is due to underestimation. Our aim was to define the true frequency of AF-associated stroke, to determine the yield of 6-day Holter ECG to detect AF in Chinese stroke patients, and to elucidate predictors of newly detected AF. Patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled in a prospective, multicenter cohort study of 6-day Holter monitoring within 7 days after stroke onset at 20 sites in China between 2013 and 2015. Independent predictors of newly-detected AF were determined by multivariate analysis. Among 1511 patients with ischemic stroke and TIA (mean age 63 years, 33.1% women), 305 (20.2%) had either previously known (196, 13.0%) or AF newly-detected by electrocardiography (53, 3.5%) or by 6-day Holter monitoring (56/1262, 4.4%). A history of heart failure (OR = 4.70, 95%CI, 1.64-13.5), advanced age (OR = 1.06, 95%CI, 1.04-1.09), NIHSS at admission (OR = 1.06, 95%CI, 1.02-1.10), blood high density lipoprotein (HDL) (OR = 1.52, 95%CI, 1.09-2.13), together with blood triglycerides (OR = 0.64, 95%CI, 0.45-0.91) were independently associated with newly-detected AF. Contrary to previous reports, AF-associated stroke is frequent (20%) in China if systemically sought. Prolonged noninvasive cardiac rhythm monitoring importantly increases AF detection in patients with recent ischemic stroke and TIA in China. Advanced age, history of heart failure, and higher admission NIHSS and higher level of HDL were independent indicators of newly-detected AF. NCT02156765 (June 5, 2014).

Associations between the organisation of stroke services, process of care, and mortality in England: prospective cohort study.

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Bray, Benjamin D; Ayis, Salma; Campbell, James; Hoffman, Alex; Roughton, Michael; Tyrrell, Pippa J; Wolfe, Charles D A; Rudd, Anthony G

2013-05-10

To estimate the relations between the organisation of stroke services, process measures of care quality, and 30 day mortality in patients admitted with acute ischaemic stroke. Prospective cohort study. Hospitals (n=106) admitting patients with acute stroke in England and participating in the Stroke Improvement National Audit Programme and 2010 Sentinel Stroke Audit. 36,197 adults admitted with acute ischaemic stroke to a participating hospital from 1 April 2010 to 30 November 2011. Associations between process of care (the assessments, interventions, and treatments that patients receive) and 30 day all cause mortality, adjusting for patient level characteristics. Process of care was measured using six individual measures of stroke care and summarised into an overall quality score. Of 36,197 patients admitted with acute ischaemic stroke, 25,904 (71.6%) were eligible to receive all six care processes. Patients admitted to stroke services with high organisational scores were more likely to receive most (5 or 6) of the six care processes. Three of the individual processes were associated with reduced mortality, including two care bundles: review by a stroke consultant within 24 hours of admission (adjusted odds ratio 0.86, 95%confidence interval 0.78 to 0.96), nutrition screening and formal swallow assessment within 72 hours (0.83, 0.72 to 0.96), and antiplatelet therapy and adequate fluid and nutrition for first the 72 hours (0.55, 0.49 to 0.61). Receipt of five or six care processes was associated with lower mortality compared with receipt of 0-4 in both multilevel (0.74, 0.66 to 0.83) and instrumental variable analyses (0.62, 0.46 to 0.83). Patients admitted to stroke services with higher levels of organisation are more likely to receive high quality care as measured by audited process measures of acute stroke care. Those patients receiving high quality care have a reduced risk of death in the 30 days after stroke, adjusting for patient characteristics and

Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke

DEFF Research Database (Denmark)

Hacke, Werner; Kaste, Markku; Bluhmki, Erich

2008-01-01

BACKGROUND: Intravenous thrombolysis with alteplase is the only approved treatment for acute ischemic stroke, but its efficacy and safety when administered more than 3 hours after the onset of symptoms have not been established. We tested the efficacy and safety of alteplase administered between ...

Frequency of inter-atrial blocks in patients with ischemic stroke

International Nuclear Information System (INIS)

Manzar, A.; Iftikhar, R.; Qadir, A.

2012-01-01

Objective: To determine the frequency and association of Interatrial block in hospitalized patients with Ischemic Stroke. Study Design: A case control study. Place and Duration of Study: Department of medicine, Military Hospital, Rawalpindi from 1 January 2009 to 30 December 2009. Methodology: It included 64 patients, 32 cases of diagnosed ischemic stroke and 32 patients were taken as controls not suffering from ischemic stroke or ischemic heart disease. ECG findings of both selected groups were evaluated for presence or absence of interatrial block. Results: Out of 32 ischemic stroke patients, 14 (43.85%) were found to have interatrial block on electrocardiogram (ECG). Whereas only 6 (18.80%) controls were found to have interatrial block on ECG. Odds ratio was 1.66. Conclusion: Interatrial block is more frequent in ischemic stroke patients and may represent a risk factor for such stroke. (author)

Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study

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Forrester, Larry W.; Roy, Anindo; Krywonis, Amanda; Kehs, Glenn; Krebs, Hermano Igo; Macko, Richard F.

2014-01-01

Background Modular lower extremity (LE) robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually-guided and visually-evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. Objective Assess the feasibility and efficacy of daily anklebot training during early sub-acute hospitalization post-stroke. Methods Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (N=18) or passive manual stretching (N=16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an “assist-as-needed” approach during > 200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. Results Both groups walked faster at discharge, however the robot group improved more in percent change of temporal symmetry (p=0.032) and also of step length symmetry (p=0.038), with longer nonparetic step lengths in the robot (133%) vs. stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (p≤ 0.001) and mean (p≤ 0.01) angular speeds, and increased movement smoothness (p≤ 0.01). There were no adverse events. Conclusion Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early sub-acute hospitalization is well tolerated and improves ankle motor control and gait patterning. PMID:24515923

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

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Koopmanschap Marc A

2003-02-01

Full Text Available Abstract Background Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. Methods Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. Results 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. Conclusion This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

Impact of stroke unit in a public hospital on length of hospitalization and rate of early mortality of ischemic stroke patients

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Maria Sheila G. Rocha

2013-10-01

Full Text Available We ascertained whether a public health stroke unit reduces the length of hospitalization, the rate of inpatient fatality, and the mortality rate 30 days after the stroke. Methods We compared a cohort of stroke patients managed on a general neurology/medical ward with a similar cohort of stroke patients managed in a str oke unit. The in-patient fatality rates and 30-day mortality rates were analyzed. Results 729 patients were managed in the general ward and 344 were treated at a comprehensive stroke unit. The in-patient fatality rates were 14.7% for the general ward group and 6.9% for the stroke unit group (p<0.001. The overall mortality rate 30 days after stroke was 20.9% for general ward patients and 14.2% for stroke unit patients (p=0.005. Conclusions We observed reduced in-patient fatalities and 30-day mortality rates in patients managed in the stroke unit. There was no impact on the length of hospitalization.

CHIMES-I: sub-group analyzes of the effects of NeuroAiD according to baseline brain imaging characteristics among patients randomized in the CHIMES study.

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Navarro, Jose C; Chen, Christopher Li Hsian; Lagamayo, Pedro Danilo J; Geslani, Melodia B; Eow, Gaik Bee; Poungvarin, Niphon; de Silva, Asita; Wong, Lawrence K S; Venketasubramanian, N

2013-08-01

The clinical effects of neuroprotective and/or neurorestorative therapies may vary according to location and size of the ischemic injury. Imaging techniques can be useful in stratifying patients for trials that may be beneficial against particular ischemic lesion characteristics. To test the hypothesis that the efficacy of NeuroAiD compared with placebo in improving functional outcome and reducing neurological deficit in patients with cerebral infarction of intermediate severity varies between sub-groups of patients randomized in the main Chinese Medicine Neuroaid Efficacy on Stroke study when categorized according to baseline imaging characteristics. This is a retrospective cohort sub-group analysis of patients who participated in the main Chinese Medicine Neuroaid Efficacy on Stroke study, a multicenter, double-blind, placebo-controlled trial that recruited 1100 patients within 72 h of ischemic stroke onset with National Institutes of Health Stroke Scale 6-14 and were randomized to either NeuroAiD or placebo taken four capsules three times daily for three months. Review of the baseline images to classify the acute stroke lesions in terms of size, location, and extent of involvement will be performed retrospectively by two readers who will remain blinded as to treatment allocation and outcomes of the subjects. The primary efficacy end-point in the main Chinese Medicine Neuroaid Efficacy on Stroke study is the modified Rankin Scale grades at three-months. Secondary efficacy end-points are the National Institutes of Health Stroke Scale score at three-months; difference of National Institutes of Health Stroke Scale scores between baseline and 10 days and between baseline and three-months; difference of National Institutes of Health Stroke Scale sub-scores between baseline and 10 days and between baseline and three-months; modified Rankin Scale at 10 days, one-month, and three-months; Barthel index at three-months; and Mini Mental State Examination at 10 days and

Anemia on admission increases the risk of mortality at 6 months and 1 year in hemorrhagic stroke patients in China.

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Zeng, Yi-Jun; Liu, Gai-Fen; Liu, Li-Ping; Wang, Chun-Xue; Zhao, Xing-Quan; Wang, Yong-Jun

2014-07-01

The relationship between anemia and intracerebral hemorrhage is not clear. We investigated the associations between anemia at the onset and mortality or dependency in patients with intracerebral hemorrhage (ICH) registered at the China National Stroke Registry (CNSR). The CNSR recruited consecutive patients with diagnoses of ICH in 2007-2008. Their vascular risk factors, clinical presentations, and outcomes were recorded. The mortality and dependency at 1, 3, and 6 months and at 1 year were compared between ICH patients with and without anemia. A favorable outcome was defined as a modified Rankin Scale (mRS) score of 2 or less and a poor outcome as an mRS score of 3 or more. Multivariable logistic regression was performed to analyze the association between anemia and the 2 outcomes after adjusting for age, gender, body mass index, history of smoking and heavy drinking, National Institutes of Health Stroke Scale score on admission, random glucose value on admission, and hematoma volume. Anemia was identified in 484 (19%) ICH patients. Compared with ICH patients without anemia, patients with anemia had no difference in mortality rate at discharge and at 1 month. The rate of mortality at 3 months, 6 months, 1 year, and dependency at 1 year were significantly higher for those patients with anemia than those without (Pmortality at 6 months and 1 year after the initial episode of intercerebral hemorrhage. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Experimental and theoretical studies of the C{sub 6}H{sub 5} + C{sub 6}H{sub 6} reaction

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Park, J.; Burova, S.; Rodgers, A.S.; Lin, M.C.

1999-11-11

The absolute rate constants for the C{sub 6}H{sub 5} + C{sub 6}H{sub 6} and C{sub 6}D{sub 6} reactions have been measured by cavity ringdown spectrometry at temperatures between 298 and 495 K at a constant 40 Torr Ar pressure. The new results, which reveal no detectable kinetic isotopic effect, can be represented by the Arrhenius equation, {kappa}{sub 1} = 10{sup (11.91{+-}0.13)} exp[{minus}(2,102 {+-} 106)/T] cm{sup 3}/(mol s). Low-temperature data for the addition/stabilization process, C{sub 6}H{sub 5} + C{sub 6}H{sub 6} {r{underscore}arrow} C{sub 12}H{sub 11}, can be correlated with those obtained in a low-pressure, high-temperature Knudsen cell study for the addition/displacement reaction, C{sub 6}H{sub 5} + C{sub 6}H{sub 6} {r{underscore}arrow} C{sub 12}H{sub 10} + H, by the RRKM theory using the molecular and transition-state parameters computed at the B3LYP/6-311G(d,p) level of theory. Combination of these two sets of data gives {kappa}{sub 1} = 10{sup (11.98{+-}0.03)} exp[{minus}(2168 {+-} 34)/T] cm{sup 3}/(mol s) covering the temperature range 298--1,330 K. The RRKM theory also correlates satisfactorily the forward reaction data with the high-temperature shock-tube result for the reverse H-for-C{sub 6}H{sub 5} substitution process with 2.7 and 4.7 kcal/mol barriers for the entrance (C{sub 6}H{sub 5} + C{sub 6}H{sub 6}) and reverse (H + C{sub 12}H{sub 10}) reactions, respectively. For modeling applications, the authors have calculated the forward reaction rate constants for the formation of the two competing products, H + C{sub 12}H{sub 10} and C{sub 12}H{sub 11}, at several pressures covering 300 K {lt} T {lt} 2,500 K.

Mapping patients' experiences after stroke onto a patient-focused intervention framework.

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Donnellan, C; Martins, A; Conlon, A; Coughlan, T; O'Neill, D; Collins, D R

2013-03-01

Stroke patients' involvement in the rehabilitation process including decision making has made significant advances clinically over the past two decades. However, development of patient-focused interventions in stroke rehabilitation is a relatively under developed area of research. The aim of this study was to interpret the explanations that patients gave of their experience after stroke and how these may validate an already established patient-focused intervention framework - the Quest for quality and improved performance (QQUIP) (2006) that includes seven quality improvement goals. A random purposive sample of eight stroke patients was interviewed between 3 and 6 months following discharge. Patients' reports of their experience after stroke were obtained using in-dept semi-structured interviews and analysed using Qualitative Content Analysis. Explanations given by patients included both positive and negative reports of the stroke experience. Regardless of consequences as a result of physical, psychological and social impairments, there were other life style disruptions that were reported by all patients such as taking new medication and adverse effects of these, experiencing increasing fatigue, difficulties with social activities and situations and having to make changes in health behaviours and lifestyle. Some of the core themes that emerged reflected the aims of QQUIP improvement goals that include improving health literacy, clinical decision-making, self-care, patient safety, access to health advice, care experience and service development. Further recommendations based on the findings from this study would be to consider using the QQUIP framework for developing intervention studies in stroke rehabilitation care that are person-centred. This framework provides a template that is equipped to address some of the main concerns that people have following the experience of stroke and also focuses on improving quality of care.

Intra-arterial thrombolytic therapy in the acute ischemic stroke

International Nuclear Information System (INIS)

Poncyljusz, W.; Walecka, A.

2008-01-01

To evaluate the clinical efficacy and safety of local intra-arterial thrombolysis with rt-Pa in patients suffering from MCA acute brain infarction within 6 hours of the onset of symptoms. Forty one patients with acute ischemic stroke of the middle cerebral artery (MCA) were qualified to the treatment (up to 6 hours after the beginning of the symptoms). Patient qualification was based on clinical examination, computed tomography (CT) and digital subtraction angiography (DSA). CT follow-up was performed after 24 hours and between 7-10 days. Continuous infusion of rt-Pa with a final dose of 40 mg was administered. The patients were evaluated before, at discharge and 90 days after the procedure on the basis of modified Rankin and NIHSS scores. At the primary outcome, 22 (53%) of the patients achieved modified Rankin scores of 2 or less after 90 days. The secondary clinical outcome at 90 day follow-up: (NIHSS score L1) - 9 (22%) of the patients, (NIHSS score L 50% decrease) - 24 (59%). A rate of recanalization was achieved in 76% of patients. Symptomatic hemorrhages occurred in 4 (10%). There were no deaths in the treated group after thrombolysis up to the time of discharge; however, the mortality during the 90-day follow-up period was 7%. Intra-arterial thrombolysis with the use of rt-Pa, in the treatment of ischemic brain stroke within 6 hours after the onset considerably improved the clinical condition of patients after 90 days. (authors)

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

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Michele Stornello

2013-04-01

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

Patient-specific prediction of functional recovery after stroke.

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Douiri, Abdel; Grace, Justin; Sarker, Shah-Jalal; Tilling, Kate; McKevitt, Christopher; Wolfe, Charles DA; Rudd, Anthony G

2017-07-01

Background and aims Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patient-specific prognostic model for monitoring recovery after stroke and assessed its clinical utility. Methods Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients' functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis. Results Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R 2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6-97.4]) and 93% [90.8-95.3], respectively, with a potential clinical utility measured by likelihood ratios (LR+:17 [10.8-26.8] at three months and LR+:11 [6.5-17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes. Conclusions A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.

Computed tomography perfusion as a diagnostic tool for seizures after ischemic stroke

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Koome, Miriam; Thevathasan, Arthur; Yan, Bernard [The Royal Melbourne Hospital, Melbourne Brain Centre, Parkville, VIC (Australia); Churilov, Leonid [University of Melbourne, Florey Neuroscience Institutes, Austin Health, Melbourne (Australia); Chen, Ziyuan [The Royal Melbourne Hospital, Melbourne Brain Centre, Parkville, VIC (Australia); Tsinghua University, School of Medicine, Beijing (China); Chen, Ziyi [The Royal Melbourne Hospital, Melbourne Brain Centre, Parkville, VIC (Australia); Sun Yat-Sen University, First Affiliated Hospital, Guangdong (China); Naylor, Jillian; Kwan, Patrick [The Royal Melbourne Hospital, Melbourne Brain Centre, Parkville, VIC (Australia); The University of Melbourne, Department of Medicine, Melbourne (Australia)

2016-06-15

Cerebral cortical ischemia is a risk factor for post-stroke seizures. However, the optimal imaging method is unclear. We investigated CT perfusion (CTP) in detecting cortical ischemia and its correlation with post-stroke seizures compared with non-contrast CT (NCCT). We included patients with acute ischemic stroke admitted to the Royal Melbourne Hospital between 2009 and 2014. Post-stroke seizure information was collected. Cortical involvement was determined on acute NCCT and CTP (T{sub max}, cerebral blood volume [CBV], and cerebral blood flow [CBF]). The association between cortical involvement detected by different imaging modalities and post-stroke seizures was examined. Three-hundred fifty-two patients were included for analysis. Fifty-nine percent were male, and median age was 73 years (inter-quartile range 61-82). Follow-up was available for 96 %; median follow-up duration was 377 days (inter-quartile range 91-1018 days). Thirteen patients had post-stroke seizures (3.9 %). Cortical involvement was significantly associated with post-stroke seizures across all modalities. CBV had the highest hazard ratio (11.3, 95 % confidence interval (CI) 1.1-41.2), followed by NCCT (5.3, 95 % CI 1.5-18.0) and CBF (4.2, 95 % CI 1.1-15.2). Sensitivity was highest for T{sub max} (100 %), followed by CBV and CBF (both 76.9 %) and NCCT (63.6 %). Specificity was highest for CBV (77.8 %), then NCCT (75.6 %), CBF (54.0 %), and T{sub max} (29.1 %). Receiver-operating characteristic area under the curve was significantly different between imaging modalities (p < 0.001), CBV 0.77, NCCT 0.70, CBF 0.65, and T{sub max} 0.65. CTP may improve sensitivity and specificity of cortical involvement for post-stroke seizures compared to NCCT. (orig.)

Collateral vessels on magnetic resonance angiography in endovascular-treated acute ischemic stroke patients associated with clinical outcomes.

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Jiang, Liang; Su, Hao-Bo; Zhang, Ying-Dong; Zhou, Jun-Shan; Geng, Wen; Chen, Huiyou; Xu, Quan; Yin, Xindao; Chen, Yu-Chen

2017-10-06

Collateral vessels were considered to be related with outcome in endovascular-treated acute ischemic stroke patients. This study aimed to evaluate whether the collateral vessels on magnetic resonance angiography (MRA) could predict the clinical outcome. Acute stroke patients with internal carotid artery or middle cerebral artery occlusion within 6 hours of symptom onset were included. All patients underwent MRI and received endovascular treatment. The collateral circulations at the Sylvian fissure and the leptomeningeal convexity were evaluated. The preoperative and postoperative infarct volume was measured. The clinical outcome was evaluated by mRS score at 3 months after stroke. Of 55 patients, Cases with insufficient collateral circulation at the Sylvian fissure and leptomeningeal convexity showed that the NIHSS score at arrival and preoperative infarct volume were significantly lower in mRS score of 0-2 (both P collateral status at the leptomeningeal convexity were independent of the clinical outcome at 3 months after stroke (odds ratio (95% confidence interval): 1.094 (1.025-1.168); 9.542 (1.812-50.245) respectively). The change of infarct volume in the group with mRS score of 0-2 was smaller than that with mRS score of 3-6. While multivariate logistic models showed that postoperative infarct volume was non-significant in predicting the clinical outcome after stroke. The extent of collateral circulation at the leptomeningeal convexity may be useful for predicting the functional recovery while the relationship between postoperative infarct volume and clinical outcome still requires for further study.

High blood pressure in acute ischemic stroke and clinical outcome.

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Manabe, Yasuhiro; Kono, Syoichiro; Tanaka, Tomotaka; Narai, Hisashi; Omori, Nobuhiko

2009-11-16

This study aimed to evaluate the prognostic value of acute phase blood pressure in patients with acute ischemic stroke by determining whether or not it contributes to clinical outcome. We studied 515 consecutive patients admitted within the first 48 hours after the onset of ischemic strokes, employing systolic and diastolic blood pressure measurements recorded within 36 hours after admission. High blood pressure was defined when the mean of at least 2 blood pressure measurements was ≥200 mmHg systolic and/or ≥110 mmHg diastolic at 6 to 24 hours after admission or ≥180 mmHg systolic and/or ≥105 mmHg diastolic at 24 to 36 hours after admission. The high blood pressure group was found to include 16% of the patients. Age, sex, diabetes mellitus, hypercholesterolemia, atrial fibrillation, ischemic heart disease, stroke history, carotid artery stenosis, leukoaraiosis, NIH Stroke Scale (NIHSS) on admission and mortality were not significantly correlated with either the high blood pressure or non-high blood pressure group. High blood pressure on admission was significantly associated with a past history of hypertension, kidney disease, the modified Rankin Scale (mRS) on discharge and the length of stay. On logistic regression analysis, with no previous history of hypertension, diabetes mellitus, atrial fibrillation, and kidney disease were independent risk factors associated with the presence of high blood pressure [odds ratio (OR), 1.85 (95% confidence interval (CI): 1.06-3.22), 1.89 (95% CI: 1.11-3.22), and 3.31 (95% CI: 1.36-8.04), respectively]. Multi-organ injury may be presented in acute stroke patients with high blood pressure. Patients with high blood pressure had a poor functional outcome after acute ischemic stroke.

Rehabilitative Games for Stroke Patients

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A. Pyae

2015-07-01

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

Protocol for a prospective collaborative systematic review and meta-analysis of individual patient data from randomized controlled trials of vasoactive drugs in acute stroke: The Blood pressure in Acute Stroke Collaboration, stage-3.

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Sandset, Else Charlotte; Sanossian, Nerses; Woodhouse, Lisa J; Anderson, Craig; Berge, Eivind; Lees, Kennedy R; Potter, John F; Robinson, Thompson G; Sprigg, Nikola; Wardlaw, Joanna M; Bath, Philip M

2018-01-01

Rationale Despite several large clinical trials assessing blood pressure lowering in acute stroke, equipoise remains particularly for ischemic stroke. The "Blood pressure in Acute Stroke Collaboration" commenced in the mid-1990s focussing on systematic reviews and meta-analysis of blood pressure lowering in acute stroke. From the start, Blood pressure in Acute Stroke Collaboration planned to assess safety and efficacy of blood pressure lowering in acute stroke using individual patient data. Aims To determine the optimal management of blood pressure in patients with acute stroke, including both intracerebral hemorrhage and ischemic stroke. Secondary aims are to assess which clinical and therapeutic factors may alter the optimal management of high blood pressure in patients with acute stroke and to assess the effect of vasoactive treatments on hemodynamic variables. Methods and design Individual patient data from randomized controlled trials of blood pressure management in participants with ischemic stroke and/or intracerebral hemorrhage enrolled during the ultra-acute (pre-hospital), hyper-acute (<6 h), acute (<48 h), and sub-acute (<168 h) phases of stroke. Study outcomes The primary effect variable will be functional outcome defined by the ordinal distribution of the modified Rankin Scale; analyses will also be carried out in pre-specified subgroups to assess the modifying effects of stroke-related and pre-stroke patient characteristics. Key secondary variables will include clinical, hemodynamic and neuroradiological variables; safety variables will comprise death and serious adverse events. Discussion Study questions will be addressed in stages, according to the protocol, before integrating these into a final overreaching analysis. We invite eligible trials to join the collaboration.

Update on the third international stroke trial (IST-3 of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited

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Sandercock Peter

2011-11-01

Full Text Available Abstract Background Intravenous recombinant tissue plasminogen activator (rtPA is approved in Europe for use in patients with acute ischaemic stroke who meet strictly defined criteria. IST-3 sought to improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of rtPA in acute ischaemic stroke, and to determine whether a wider range of patients might benefit. Design International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE trial of intravenous rtPA in acute ischaemic stroke. Suitable patients had to be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracranial haemorrhage and stroke mimics. Results The initial pilot phase was double blind and then, on 01/08/2003, changed to an open design. Recruitment began on 05/05/2000 and closed on 31/07/2011, by which time 3035 patients had been included, only 61 (2% of whom met the criteria for the 2003 European approval for thrombolysis. 1617 patients were aged over 80 years at trial entry. The analysis plan will be finalised, without reference to the unblinded data, and published before the trial data are unblinded in early 2012. The main trial results will be presented at the European Stroke Conference in Lisbon in May 2012 with the aim to publish simultaneously in a peer-reviewed journal. The trial result will be presented in the context of an updated Cochrane systematic review. We also intend to include the trial data in an individual patient data meta-analysis of all the relevant randomised trials. Conclusion The data from the trial will: improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of iv rtPA in acute ischaemic stroke; provide: new evidence on the balance of risk and benefit of intravenous rtPA among types of patients who do not clearly meet the terms of the current EU approval; and

Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke.

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Anderson, Craig S; Arima, Hisatomi; Lavados, Pablo; Billot, Laurent; Hackett, Maree L; Olavarría, Verónica V; Muñoz Venturelli, Paula; Brunser, Alejandro; Peng, Bin; Cui, Liying; Song, Lily; Rogers, Kris; Middleton, Sandy; Lim, Joyce Y; Forshaw, Denise; Lightbody, C Elizabeth; Woodward, Mark; Pontes-Neto, Octavio; De Silva, H Asita; Lin, Ruey-Tay; Lee, Tsong-Hai; Pandian, Jeyaraj D; Mead, Gillian E; Robinson, Thompson; Watkins, Caroline

2017-06-22

The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion. In a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death). The median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P<0.001). In a proportional-odds model, there was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the lying-flat group and patients in the sitting-up group (unadjusted odds ratio for a difference in the distribution of scores on the modified Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P=0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among the patients in the sitting-up group (P=0.83). There were

Single-crystal X-ray diffraction study of Cs{sub 2}Er[Si{sub 6}O{sub 14}]F and Cs{sub 2}Er[Si{sub 4}O{sub 10}]F

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Dabic, Predrag; Kremenovic, Aleksandar; Vulic, Predag [Belgrade Univ. (Serbia). Lab. of Crystallography; Kahlenberg, Volker; Schmidmair, Daniela [Innsbruck Univ. (Austria). Inst. of Mineralogy and Petrography

2016-07-01

Single-crystal growth experiments in the system CsF-Er{sub 2}O{sub 3}-SiO{sub 2} resulted in the simultaneous crystallization of two chemically related compounds within the same run: Cs{sub 2}Er[Si{sub 6}O{sub 14}]F (phase I) and Cs{sub 2}Er[Si{sub 4}O{sub 10}]F (phase II). They represent the first examples for cesium erbium silicates containing fluorine. Basic crystallographic data are - phase I: space group Cmca, a=17.2556(6) Aa, b=24.6565(7) Aa, c=14.4735(5) Aa, V=6157.9(3) Aa{sup 3}, Z=16; phase II: space group Pnma, a=22.3748(7) Aa, b=8.8390(2) Aa, c=11.9710(4) Aa, V=2367.5(1) Aa{sup 3}, Z=8. The structures were determined by direct methods and refined to residuals of R(vertical stroke F vertical stroke)=0.0229 for 2920 (phase I) and 0.0231 for 2314 (phase II) independent observed reflections with I>2σ(I). The structure of phase I represents a previously unknown structure type with a three dimensional tetrahedral framework consisting of Q{sup 3} and Q{sup 4} groups in the ratio 2:1. Basic building units of the network are unbranched sechser single-chains running parallel to [001]. The network can be conveniently built up from the condensation of tetrahedral layers parallel to (010) or (100), respectively. The crystal structure of phase II can be classified as a tubular or columnar chain silicate indicating that the backbones of the structure are multiple chains of silicate tetrahedra. This structure is isotypic to a Cs{sub 2}Y[Si{sub 4}O{sub 10}]F, a compound that has been characterized previously. Alternatively, both compounds can be described as mixed octahedral-tetrahedral frameworks, which can be classified according to their polyhedral microensembles. A topological analysis of both nets is presented.

False-negative diffusion-weighted imaging findings in acute stroke

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Ishikawa, Tatsuya; Yuasa, Naoki; Otomo, Takashi; Shiramizu, Hideki; Matsuda, Hiroshi; Kitagawa, Yasuhisa; Takagi, Shigeharu

2006-01-01

The utility of DWI (diffusion-weighted imaging) has been established in acute ischemic stroke. However, some patients with acute stroke show no abnormal signals on DWI, despite the presence of infarction (false-negative DWI). We analyzed the relationship between false-negative DWI and the clinical manifestations of acute ischemic stroke in 151 DWI-positive (89%) and 19 false-negative DWI (11%) patients. We performed MRI within 24 hours after onset at our hospital. Non-specific clinical manifestations, including vertigo and nausea, were frequently observed in false-negative DWI patients. As regards the vascular territory, false-negative DWI was noted in 15.3% of 59 patients with infarctions within the territory of the vertebrobasilar artery. Concerning the duration from onset to initial imaging, 73.7% of the patients with false-negative DWI findings underwent MRI examination within 6 hours after onset. Of the patients with false-negative DWI, 84.2% had lacunar infarction (χ 2 =16.4, P<0.001). In conclusion, false negative DWI is more frequently observed in lacunar infarction than in atherothrombotic infarction or cardiogenic embolism. It is important to examine carefully the neurological changes occurring in patients who present with acute stroke, but have negative DWI findings. (author)

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability.

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Slawski, Diana E; Salahuddin, Hisham; Shawver, Julie; Kenmuir, Cynthia L; Tietjen, Gretchen E; Korsnack, Andrea; Zaidi, Syed F; Jumaa, Mouhammad A

2018-04-01

The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0-2 or return to baseline. Of the 96 patients, 50 had mild baseline disability (mRS score 0-1) and 46 had moderate disability (mRS score 2-4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, p = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, p = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, p = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability ( p baseline disability, and delayed treatment are associated with sub-optimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment.

A validation study using a modified version of Postural Assessment Scale for Stroke Patients: Postural Stroke Study in Gothenburg (POSTGOT

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Danielsson Anna

2011-10-01

Full Text Available Abstract Background A modified version of Postural Assessment Scale for Stroke Patients (PASS was created with some changes in the description of the items and clarifications in the manual (e.g. much help was defined as support from 2 persons. The aim of this validation study was to assess intrarater and interrater reliability using this modified version of PASS, at a stroke unit, for patients in the acute phase after their first event of stroke. Methods In the intrarater reliability study 114 patients and in the interrater reliability study 15 patients were examined twice with the test within one to 24 hours in the first week after stroke. Spearman's rank correlation, Kappa coefficients, Percentage Agreement and the newer rank-invariant methods; Relative Position, Relative Concentration and Relative rank Variance were used for the statistical analysis. Results For the intrarater reliability Spearman's rank correlations were 0.88-0.98 and k were 0.70-0.93 for the individual items. Small, statistically significant, differences were found for two items regarding Relative Position and for one item regarding Relative Concentration. There was no Relative rank Variance for any single item. For the interrater reliability, Spearman's rank correlations were 0.77-0.99 for individual items. For some items there was a possible, even if not proved, reliability problem regarding Relative Position and Relative Concentration. There was no Relative rank Variance for the single items, except for a small Relative rank Variance for one item. Conclusions The high intrarater and interrater reliability shown for the modified Postural Assessment Scale for Stroke Patients, the Swedish version of Postural Assessment Scale for Stroke Patients, with traditional and newer statistical analyses, particularly for assessments performed by the same rater, support the use of the Swedish version of Postural Assessment Scale for Stroke Patients, in the acute stage after stroke both

Feeding practice in acute stroke patients in a tertiary care hospital.

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Miah, Md Titu; Al-Amin, Mohammad; Khan, Mohammad Ashik Imran; Ayaz, K F M; Zakaria, M H; Ahmed, Srijoni; Ahasan, H A M Nazmul

2010-12-01

Feeding is a basic component of care and it is the most common and difficult management issue for stroke patients. Objective of this study was to know the practice of feeding (oral & nasogastric tube feeding), different types of food used and their caloric value in stroke patients. This direct observational study was done from June 2010 to November 2010, in different medicine wards of Dhaka Medical College Hospital, and included 100 acute stroke patients confirmed by CT scan or MRI of brain and duration of hospital stay for at least 24 hours. Out of 100 cases, 22% took their feeding orally and 78% cases through nasogastric tube. Artificial milk powder 66% cases (NG tube vs. Orally, 58% vs. 8%), juice 18% (NG tube 13% vs. orally 5%), horlicks & juice & soup 10% (NG tube vs. Orally, 7% vs. 3%), khichury 2% orally, bread & egg & shuji 4% cases orally. In 100 cases studied, none of them fulfilled the calorie requirement up to the standard level according to the guideline of Nutrition & Food Science Institute, of Dhaka University, Bangladesh. Though this study was small scale but the magnitude of under nutrition among stroke patients revealed is alarming and needs urgent attention.

Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

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Popović Rade

2016-01-01

Full Text Available Introduction. Acute aortic dissection (AD is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA. The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic

Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

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Atay Vural

2016-04-01

Full Text Available Objective: Stroke is one of the most important public health issues worldwide, and ranks as the second highest cause of mortality in our country. Regular follow-up of stroke statistics and taking necessary precautions upon determining deficits by countries themselves constitute the most important way of improving prognosis and survival after stroke incidents. To achieve this goal, statistical studies should be performed at various levels of healthcare services. Tertiary care hospitals are the most suitable centers to perform these studies. However, the majority of the population receives service at secondary care centers where the actual statistics remain unknown. The objective of this study was to examine all patients with acute stroke who presented to a county hospital over a one-year period and obtain related data, discuss deficits, and provide solutionbased recommendations. Materials and Methods: All patients diagnosed as having acute stroke between July 2013-July 2014 were included in the study. Demographic, clinical, and radiologic data, in addition to the timing of presentation and baseline National Institutes of Health Stroke Scale (NIHSS scores were recorded retrospectively, and patients were classified by the type of stroke. All patients were followed up for at least one year after the stroke incident and cumulative survival scores were calculated using Kaplan-Meier analysis. Results: Hemorrhagic stroke was determined in four out of 49 patients with acute stroke; the 45 patients diagnosed as having ischemic stroke were included in the study. Among these, 44.4% (n=20 of the patients presented within the first three hours of onset of clinical symptoms, 4.4% (n=2 presented at 3.-4.5 hours. Baseline NIHSS was 1-4 (mild stroke in 50% (n=10 of patients who presented in the first three hours, and >5 (moderate or severe stroke in 50% (n=10 of the remaining patients. The etiologic cause was embolic in 37.1% (n=13, large artery atherosclerosis

Association of early National Institutes of Health Stroke Scale improvement with vessel recanalization and functional outcome after intravenous thrombolysis in ischemic stroke.

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Kharitonova, Tatiana; Mikulik, Robert; Roine, Risto O; Soinne, Lauri; Ahmed, Niaz; Wahlgren, Nils

2011-06-01

Early neurological improvement (ENI) after thrombolytic therapy of acute stroke has been linked with recanalization and favorable outcome, although its definition shows considerable variation. We tested the ability of ENI, as defined in previous publications, to predict vessel recanalization and 3-month functional outcome after intravenous thrombolysis recorded in an extensive patient cohort in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Of 21,534 patients registered between December 2002 and December 2008, 798 patients (3.7%) had CT- or MR angiography-documented baseline vessel occlusion and also angiography data at 22 to 36 hours post-treatment. ENI definitions assessed at 2 hours and 24 hours post-treatment were (1) National Institutes of Health Stroke Scale (NIHSS) score improvement ≥4 points from baseline; (2) NIHSS 0, 1, or improvement ≥8; (3) NIHSS ≤3 or improvement ≥10; (4) improvement by 20%; (5) 40% from baseline; or (6) NIHSS score 0 to 1. Receiver operating curve analysis and multiple logistic regression were performed to evaluate the association of ENI with vessel recanalization and favorable functional outcome (modified Rankin Scale score 0 to 2 at 3 months). ENI at 2 hours had fair accuracy to diagnose recanalization as derived from receiver operating curve analysis. Definitions of improvement based on percent of NIHSS score change from baseline demonstrate better accuracy to diagnose recanalization at 2 hours and 24 hours than the definitions based on NIHSS cutoffs (the best performance at 2 hours was area under the curve 0.633, sensitivity 58%, specificity 69%, positive predictive value 68%, and negative predictive value 59% for 20% improvement; and area under the curve 0.692, sensitivity 69%, specificity 70%, positive predictive value 70%, and negative predictive value 62% for 40% improvement at 24 hours). ENI-predicted functional outcome with OR 2.8 to 6.0 independently from

Fatigue after Stroke: The Patient's Perspective

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Victoria Louise Barbour

2012-01-01

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

Extracranial cerebral arterial atherosclerosis in Iranian patients suffering ischemic strokes

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Sayed Ali Mousavi

2006-12-01

Full Text Available BACKGROUND: To determine the distribution and severity of extracranial carotid arterial atherosclerosis in Iranian patients with ischemic stroke. METHODS: 328 patients with ischemic stroke were included in this study. Doppler ultrasound was used for evaluation of atherosclerosis in extracranial carotid arteries. The NASCET criteria were used to measure carotid stenosis. RESULTS: Ninety of 328 patients (27.4% were found to have atherosclerotic plaques; 40 of these patients were women and 50 were men. Sixty-eight patients (20.7% had artery stenosis <50%, 13 patients (3.95% had 50-70 % artery stenosis and 6 (1.8% had >70% artery stenosis. CONCLUSIONS: Extracranial atherosclerosis is not rare in Iranian patients with ischemic stroke, but most carotid artery lesions were plaques with <50% stenosis. KEY WORDS: Atherosclerosis, ischemic stroke, carotid stenosis.

Resistant hypertension, patient characteristics, and risk of stroke.

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Chen-Ying Hung

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

Resistant Hypertension, Patient Characteristics, and Risk of Stroke

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Hung, Chen-Ying; Wang, Kuo-Yang; Wu, Tsu-Juey; Hsieh, Yu-Cheng; Huang, Jin-Long; Loh, El-Wui; Lin, Ching-Heng

2014-01-01

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

The Australian National Sub-acute and Non-acute Patient Casemix Classification (AN-SNAP): its application and value in a stroke rehabilitation programme.

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Lowthian, P; Disler, P; Ma, S; Eagar, K; Green, J; de Graaff, S

2000-10-01

To investigate whether the Australian National Sub-acute and Non-acute Patient Casemix Classification (SNAP) and Functional Independence Measure and Functional Related Group (Version 2) (FIM-FRG2) casemix systems can be used to predict functional outcome, and reduce the variance of length of stay (LOS) of patients undergoing rehabilitation after strokes. The study comprised a retrospective analysis of the records of patients admitted to the Cedar Court Healthsouth Rehabilitation Hospital for rehabilitation after stroke. The sample included 547 patients (83.3% of those admitted with stroke during this period). Patient data were stratified for analysis into the five SNAP or nine FIM-FRG2 groups, on the basis of the admission FIM scores and age. The AN-SNAP classification accounted for a 30.7% reduction of the variance of LOS, and 44.2% of motor FIM, and the FIM-FRG2 accounts for 33.5% and 56.4% reduction respectively. Comparison of the Cedar Court with the national AN-SNAP data showed differences in the LOS and functional outcomes of older, severely disabled patients. Intensive rehabilitation in selected patients of this type appears to have positive effects, albeit with a slightly longer period of inpatient rehabilitation. Casemix classifications can be powerful management tools. Although FIM-FRG2 accounts for more reduction in variance than SNAP, division into nine groups meant that some contained few subjects. This paper supports the introduction of AN-SNAP as the standard casemix tool for rehabilitation in Australia, which will hopefully lead to rational, adequate funding of the rehabilitation phase of care.

Reperfusion is a more accurate predictor of follow-up infarct volume than recanalization: a proof of concept using CT in acute ischemic stroke patients.

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Soares, Bruno P; Tong, Elizabeth; Hom, Jason; Cheng, Su-Chun; Bredno, Joerg; Boussel, Loic; Smith, Wade S; Wintermark, Max

2010-01-01

The purpose of this study was to compare recanalization and reperfusion in terms of their predictive value for imaging outcomes (follow-up infarct volume, infarct growth, salvaged penumbra) and clinical outcome in acute ischemic stroke patients. Twenty-two patients admitted within 6 hours of stroke onset were retrospectively included in this study. These patients underwent a first stroke CT protocol including CT-angiography (CTA) and perfusion-CT (PCT) on admission, and similar imaging after treatment, typically around 24 hours, to assess recanalization and reperfusion. Recanalization was assessed by comparing arterial patency on admission and posttreatment CTAs; reperfusion, by comparing the volumes of CBV, CBF, and MTT abnormality on admission and posttreatment PCTs. Collateral flow was graded on the admission CTA. Follow-up infarct volume was measured on the discharge noncontrast CT. The groups of patients with reperfusion, no reperfusion, recanalization, and no recanalization were compared in terms of imaging and clinical outcomes. Reperfusion (using an MTT reperfusion index >75%) was a more accurate predictor of follow-up infarct volume than recanalization. Collateral flow and recanalization were not accurate predictors of follow-up infarct volume. An interaction term was found between reperfusion and the volume of the admission penumbra >50 mL. Our study provides evidence that reperfusion is a more accurate predictor of follow-up infarct volume in acute ischemic stroke patients than recanalization. We recommend an MTT reperfusion index >75% to assess therapy efficacy in future acute ischemic stroke trials that use perfusion-CT.

Evidence That Ly6C(hi) Monocytes are Protective in Acute Ischemic Stroke by Promoting M2 Macrophage Polarization.

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Chu, Hannah X; Broughton, Brad R S; Kim, Hyun Ah; Lee, Seyoung; Drummond, Grant R; Sobey, Christopher G

2015-07-01

Ly6C(hi) monocytes are generally thought to exert a proinflammatory role in acute tissue injury, although their impact after injuries to the central nervous system is poorly defined. CC chemokine receptor 2 is expressed on Ly6C(hi) monocytes and plays an essential role in their extravasation and transmigration into the brain after cerebral ischemia. We used a selective CC chemokine receptor 2 antagonist, INCB3344, to assess the effect of Ly6C(hi) monocytes recruited into the brain early after ischemic stroke. Male C57Bl/6J mice underwent occlusion of the middle cerebral artery for 1 hour followed by 23 hours of reperfusion. Mice were administered either vehicle (dimethyl sulfoxide/carboxymethylcellulose) or INCB3344 (10, 30 or 100 mg/kg IP) 1 hour before ischemia and at 2 and 6 hours after ischemia. At 24 hours, we assessed functional outcomes, infarct volume, and quantified the immune cells in blood and brain by flow cytometry or immunofluorescence. Gene expression of selected inflammatory markers was assessed by quantitative polymerase chain reaction. Ly6C(hi) monocytes were increased 3-fold in the blood and 10-fold in the brain after stroke, and these increases were selectively prevented by INCB3344 in a dose-dependent manner. Mice treated with INCB3344 exhibited markedly worse functional outcomes and larger infarct volumes, in association with reduced M2 polarization and increased peroxynitrite production in macrophages, compared with vehicle-treated mice. Our data suggest that Ly6C(hi) monocytes exert an acute protective effect after ischemic stroke to limit brain injury and functional deficit that involves promotion of M2 macrophage polarization. © 2015 American Heart Association, Inc.

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

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S. Yu. Martsevich

2015-01-01

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

How much exercise does the enhanced gait-oriented physiotherapy provide for chronic stroke patients?

Science.gov (United States)

Peurala, Sinikka H; Pitkänen, Kauko; Sivenius, Juhani; Tarkka, Ina M

2004-04-01

Physical exercise therapy in sensorimotor rehabilitation of stroke patients includes active and repetitive exercise and task-specific training. The time spent in active practice is fundamental. The purpose of this study was to analyse what was the actual amount of exercise and content of the performed exercise of the three-week gait-oriented physiotherapy program for chronic stroke patients in an in-patient setting. Twenty ambulatory post-stroke patients participated in an in-patient rehabilitation period during which a special effort was made to enhance gait training and the amount of therapy and its contents were recorded in structured form. Baseline and postintervention gait ability assessments were made, but the analysis concentrated on participation records in different forms of therapy. Patients received 19 hours of instructed physiotherapy in three weeks and together with self-initiated training they practised for 28 hours. The practice time in the upright position was 62% of the total duration of the instructed physiotherapy and 35% was performed while sitting. This amount of exercise resulted in improvement of the gait tests. In order to improve gait in the chronic state of disease, a sufficient amount of gait rehabilitation practice can be obtained with a combination of electromechanical gait trainer exercises, physiotherapy, instructed exercise groups and self-initiated training.

Stroke in a patient with tuberculous meningitis and HIV infection

Directory of Open Access Journals (Sweden)

Maria Bruna Pasticci

2013-02-01

Full Text Available Abstract. Tuberculous meningitis (TBM is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion.TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.

Limitations in thrombolytic therapy in acute ischemic stroke

International Nuclear Information System (INIS)

Kocak, S.; Kokcam, M.; Girisgin, A.S.; Dogan, E.; Bodur, S.

2012-01-01

Objective: The eligibility for thrombolytic therapy for patients who present to the emergency department with Acute Ischaemic Stroke (AIS) has been researched in this study. Methodology: Patients who had presented to the emergency department of our hospital between March 2008-2009 and diagnosed as AIS clinically and radiologically were included in the study prospectively. Results: One hundred and twelve patients were included in the study. Forty nine (43.8 %) were female and the mean age was 68.7+- 12.2 (median 71.5). The mean time from the onset of symptom to hospital admission was 12.2 +- 12.9 hours (median 6 hours). Two (1.8%) patients did not have any contraindication for thrombolytic therapy. Arrival time at the hospital of three hours and higher was the single contraindication in 40 (35.7%) patients. The most common four contraindications were delayed admission, multilobar infarct or hypo density of more than 1/3 of the hemisphere, hypertension and mild neurological symptoms respectively. Conclusions: Our data suggest that the primary barrier to the delivery of thrombolytic therapy for AIS is delayed arrival of the patient to a hospital, and up to 1/3 of our patients, the percentage arriving within 4 hours of the onset of stroke symptoms, might be eligible for attempted re-perfusion. (author)

Computed tomographic, electrocardiographic and clinical investigations in patients with ischemic strokes

International Nuclear Information System (INIS)

Manchev, L.; Mitev, M.; Milanova, V.; Zafirova, E.; Manolova, T.; Manchev, I.; Toneva, J.

2013-01-01

The Computed Tomography (CT) is a widely available and reliable method for the diagnosis of cerebrovascular disease. It allows in the first hours of the occurrence of vascular events to be established the type of brain stroke and creates conditions for timely fibrinolytic or surgical treatment. In many cases where it cannot be performed echocardiographic examination modern electrocardiography (ECG) makes it possible to demonstrate the presence of cardiac disease. These two methods in combination with neurological status create conditions for determining the treatment strategy for ischemic brain stroke (IBS). We studied 222 patients (92 men and 110 women with a middle age 59.7 years) selected randomized. At a computed tomography study in the early hours of IBS were found pathological findings in 115 patients (51.8%) slightly more often in women. IBS in the carotid system were greatly predominant in comparison with those in the vertebrobasilar system (VBS), which can be explained with the blood flow to the brain stem. When ECG is most commonly met diagnosis: hypertension HSSN 111 stage II - III functional class NYUHA, ischemic cardiomyopathy in 64 patients overall, with almost equal frequency in men 30 (17.5%) and women - 34 (19.8%). In neurological examination significantly predominant clinical symptoms karoditnata vasculature, in 154 patients (69.3%) compared to that of the VBS- 68 (30.7%). Fulfilled study shows the need for better coordination of the activities of specialists in diagnostic imaging and neurologists for their work in specialized hospitals (Stroke Units). (authors)

Quality in Acute Stroke Care (QASC): process evaluation of an intervention to improve the management of fever, hyperglycemia, and swallowing dysfunction following acute stroke.

Science.gov (United States)

Drury, Peta; Levi, Christopher; D'Este, Catherine; McElduff, Patrick; McInnes, Elizabeth; Hardy, Jennifer; Dale, Simeon; Cheung, N Wah; Grimshaw, Jeremy M; Quinn, Clare; Ward, Jeanette; Evans, Malcolm; Cadilhac, Dominique; Griffiths, Rhonda; Middleton, Sandy

2014-08-01

Our randomized controlled trial of a multifaceted evidence-based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunction in the first three-days following stroke improved outcomes at 90 days by 15%. We designed a quantitative process evaluation to further explain and illuminate this finding. Blinded retrospective medical record audits were undertaken for patients from 19 stroke units prior to and following the implementation of three multidisciplinary evidence-based protocols (supported by team-building workshops, and site-based education and support) for the management of fever (temperature ≥37·5°C), hyperglycemia (glucose >11 mmol/l), and swallowing dysfunction in intervention stroke units. Data from 1804 patients (718 preintervention; 1086 postintervention) showed that significantly more patients admitted to hospitals allocated to the intervention group received care according to the fever (n = 186 of 603, 31% vs. n = 74 of 483, 15%, P < 0·001), hyperglycemia (n = 22 of 603, 3·7% vs. n = 3 of 483, 0·6%, P = 0·01), and swallowing dysfunction protocols (n = 241 of 603, 40% vs. n = 19 of 483, 4·0%, P ≤ 0·001). Significantly more patients in these intervention stroke units received four-hourly temperature monitoring (n = 222 of 603, 37% vs. n = 90 of 483, 19%, P < 0·001) and six-hourly glucose monitoring (194 of 603, 32% vs. 46 of 483, 9·5%, P < 0·001) within 72 hours of admission to a stroke unit, and a swallowing screen (242 of 522, 46% vs. 24 of 350, 6·8%, P ≤ 0·0001) within the first 24 hours of admission to hospital. There was no difference between the groups in the treatment of patients with fever with paracetamol (22 of 105, 21% vs. 38 of 131, 29%, P = 0·78) or their hyperglycemia with insulin (40 of 100, 40% vs. 17 of 57, 30%, P = 0·49). Our intervention resulted in better protocol adherence in intervention stroke units

Value of Tc-99m HMPAO SPECT imaging in patients with TIA or acute stroke and normal CT

International Nuclear Information System (INIS)

Koster, K.; Brass, L.M.; Hoffer, P.B.; Gottschalk, A.; Smith, E.O.; Rehm, P.K.

1988-01-01

To determine the value of Tc-99m HMPAO single photon emission CT (SPECT) imaging, 51 patients with transient, acute, or chronic cerebrovascular disease were studied. Seventeen patients presented with recent transient ischemic attack (TIA) or acute stroke and underwent SPECT imaging and CT within 72 hours of presentation. SPECT image interpretation was independent of clinical history and CT findings. Four patients with acute stroke and eight patients with TIA had normal CT findings. All patients with acute stroke (three nonlacunar, one lacunar infarct) and three of eight patients with TIA also showed perfusion abnormalities on Tc-99m HMPAO scans. Thus, Tc-99m HMPAO SPECT may be useful in the early diagnosis and subtype determination of acute stroke and in the evaluation of TIA

Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke.

Science.gov (United States)

Joundi, Raed A; Martino, Rosemary; Saposnik, Gustavo; Giannakeas, Vasily; Fang, Jiming; Kapral, Moira K

2017-04-01

Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis.

Science.gov (United States)

Bruni, Maria Federica; Melegari, Corrado; De Cola, Maria Cristina; Bramanti, Alessia; Bramanti, Placido; Calabrò, Rocco Salvatore

2018-02-01

Studies about electromechanical-assisted devices proved the validity and effectiveness of these tools in gait rehabilitation, especially if used in association with conventional physiotherapy in stroke patients. The aim of this study was to compare the effects of different robotic devices in improving post-stroke gait abnormalities. A computerized literature research of articles was conducted in the databases MEDLINE, PEDro, COCHRANE, besides a search for the same items in the Library System of the University of Parma (Italy). We selected 13 randomized controlled trials, and the results were divided into sub-acute stroke patients and chronic stroke patients. We selected studies including at least one of the following test: 10-Meter Walking Test, 6-Minute Walk Test, Timed-Up-and-Go, 5-Meter Walk Test, and Functional Ambulation Categories. Stroke patients who received physiotherapy treatment in combination with robotic devices, such as Lokomat or Gait Trainer, were more likely to reach better results, compared to patients who receive conventional gait training alone. Moreover, electromechanical-assisted gait training in association with Functional Electrical Stimulations produced more benefits than the only robotic treatment (-0.80 [-1.14; -0.46], p > .05). The evaluation of the results confirm that the use of robotics can positively affect the outcome of a gait rehabilitation in patients with stroke. The effects of different devices seems to be similar on the most commonly outcome evaluated by this review. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of intensive arm training with the rehabilitation robot ARMin II in chronic stroke patients: four single-cases

Directory of Open Access Journals (Sweden)

Nef Tobias

2009-12-01

Full Text Available Abstract Background Robot-assisted therapy offers a promising approach to neurorehabilitation, particularly for severely to moderately impaired stroke patients. The objective of this study was to investigate the effects of intensive arm training on motor performance in four chronic stroke patients using the robot ARMin II. Methods ARMin II is an exoskeleton robot with six degrees of freedom (DOF moving shoulder, elbow and wrist joints. Four volunteers with chronic (≥ 12 months post-stroke left side hemi-paresis and different levels of motor severity were enrolled in the study. They received robot-assisted therapy over a period of eight weeks, three to four therapy sessions per week, each session of one hour. Patients 1 and 4 had four one-hour training sessions per week and patients 2 and 3 had three one-hour training sessions per week. Primary outcome variable was the Fugl-Meyer Score of the upper extremity Assessment (FMA, secondary outcomes were the Wolf Motor Function Test (WMFT, the Catherine Bergego Scale (CBS, the Maximal Voluntary Torques (MVTs and a questionnaire about ADL-tasks, progress, changes, motivation etc. Results Three out of four patients showed significant improvements (p Conclusion Data clearly indicate that intensive arm therapy with the robot ARMin II can significantly improve motor function of the paretic arm in some stroke patients, even those in a chronic state. The findings of the study provide a basis for a subsequent controlled randomized clinical trial.

What happens to stroke patients after hospital discharge?

LENUS (Irish Health Repository)

Noone, I

2001-05-01

Of 231 stroke patients discharged from hospital, 34 patients (14.7%) had died when reviewed 6 months later. Of 195 survivors, 115 (58%) were independent and living in the community. The remaining 80 (42%) patients were dependent. The majority of dependent patients were in institutional care but 29 (36%) were residing in the community of whom a substantial number were not receiving physiotherapy, occupational therapy or day care. Patients who were dependent in nursing homes were less likely to have received physiotherapy (48% versus 70%) or occupational therapy (28% versus 60%) compared to disabled patients in hospital based extended nursing care. 45 patients (24%) had been re-admitted to hospital although only 48% of patients had been reviewed in hospital outpatients since discharge. 64% of patients were on anti-thrombotic treatment. This survey suggests that 6 months after hospital discharge, most stroke patients are still alive and living in the community. Many of the dependent survivors have ongoing unmet medical and rehabilitation needs.

Neuro-Mechanics of Recumbent Leg Cycling in Post-Acute Stroke Patients.

Science.gov (United States)

Ambrosini, Emilia; De Marchis, Cristiano; Pedrocchi, Alessandra; Ferrigno, Giancarlo; Monticone, Marco; Schmid, Maurizio; D'Alessio, Tommaso; Conforto, Silvia; Ferrante, Simona

2016-11-01

Cycling training is strongly applied in post-stroke rehabilitation, but how its modular control is altered soon after stroke has been not analyzed yet. EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls. Patients were asked to walk over a GaitRite mat and standard gait parameters were computed. Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs. Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index (Spearman's coefficient = 0.521). The reduced coordination complexity resulted in a reduced biomechanical performance, with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side. These patients also exhibited locomotor impairments (reduced gait speed, asymmetrical stance time, prolonged double support time). Significant correlations were found between cycling-based metrics and gait parameters, suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions. Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke, mainly in the early phase, when patients can be unable to perform a safe and active gait training.

CT scanning in stroke patients: meeting the challenge in the remote and rural district general hospital.

Science.gov (United States)

Todd, A W; Anderson, E M

2009-05-01

National audit data allow crude comparison between centres and indicate that most Scottish hospitals fail to meet current guidelines for CT scanning of the brain in stroke patients. This study identifies some of the reasons for delay in performing CT scans in a largely rural population. This audit study assesses the delays from onset of symptoms, time of admission and request received to CT scan in stroke patients for three different in-patient groups as well as those managed in the community. The reasons for delay in CT scanning varied between different patient groups but for one group of in-patients, changes in booking procedure and introduction of a second CT scanner increased the proportion scanned within 48 hours of request from 65% to 96%. Further developments including the introduction of Saturday and Sunday routine CT scanning, radiologist reporting from home and additional CT scanners placed in remote hospitals may be expected to improve these figures further. Target times of three hours from onset of symptoms to scan to allow thrombolysis may however be impossible to meet for all stroke patients in rural areas.

Development and validation of a direct-comparison method for cardiac {sup 123}I-metaiodobenzylguanidine washout rates derived from late 3-hour and 4-hour imaging

Energy Technology Data Exchange (ETDEWEB)

Okuda, Koichi; Hashimoto, Mitsumasa [Kanazawa Medical University, Department of Physics, Kahoku, Ishikawa (Japan); Nakajima, Kenichi; Matsuo, Shinro; Taki, Junichi; Kinuya, Seigo [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa, Ishikawa (Japan); Sugino, Shuichi [Okayama Kyokuto Hospital, Department of Radiology, Okayama, Okayama (Japan); Kirihara, Yumiko [FUJIFILM RI Pharma Co., Ltd., Chuo-Ku, Tokyo (Japan)

2016-02-15

The washout rate (WR) has been used in {sup 123}I-metaiodobenzylguanidine (MIBG) imaging to evaluate cardiac sympathetic innervation. However, WR varies depending on the time between the early and late MIBG scans. Late scans are performed at either 3 or 4 hours after injection of MIBG. The aim of this study was to directly compare the WR at 3 hours (WR{sub 3h}) with the WR at 4 hours (WR{sub 4h}). We hypothesized that the cardiac count would reduce linearly between the 3-hour and 4-hour scans. A linear regression model for cardiac counts at two time-points was generated. We enrolled a total of 96 patients who underwent planar {sup 123}I-MIBG scintigraphy early (15 min) and during the late phase at both 3 and 4 hours. Patients were randomly divided into two groups: a model-creation group (group 1) and a clinical validation group (group 2). Cardiac counts at 15 minutes (count{sub early}), 3 hours (count{sub 3h}) and 4 hours (count{sub 4h}) were measured. Cardiac count{sub 4h} was mathematically estimated using the linear regression model from count{sub early} and count{sub 3h}. In group 1, the actual cardiac count{sub 4h}/count{sub early} was highly significantly correlated with count{sub 3h}/count{sub early} (r = 0.979). In group 2, the average estimated count{sub 4h} was 92.8 ± 31.9, and there was no significant difference between this value and the actual count{sub 4h} (91.9 ± 31.9). Bland-Altman analysis revealed a small bias of -0.9 with 95 % limits of agreement of -6.2 and +4.3. WR{sub 4h} calculated using the estimated cardiac count{sub 4h} was comparable to the actual WR{sub 4h} (24.3 ± 9.6 % vs. 25.1 ± 9.7 %, p = ns). Bland-Altman analysis and the intraclass correlation coefficient showed that there was excellent agreement between the estimated and actual WR{sub 4h}. The linear regression model that we used accurately estimated cardiac count{sub 4h} using count{sub early} and count{sub 3h}. Moreover, WR{sub 4h} that was mathematically calculated using

Cervicocranial fibromuscular dysplasia in Taiwanese ischemic stroke patients.

Science.gov (United States)

Liu, Chi-Hung; Wu, Dean; Chin, Shy-Chyi; Fu, Ser-Chen; Wu, Tai-Cheng; Chang, Chien-Hung; Peng, Tsung-I; Chang, Yeu-Jhy; Lee, Tsong-Hai

2012-01-01

Clinical research of cervicocranial fibromuscular dysplasia (FMD) is rare in Asian populations. Our study reviewed Taiwanese ischemic stroke patients with cervicocranial FMD and compared them with previous reports. Between 2000 and 2011, we collected 19 consecutive cervicocranial FMD patients who received demographic registration, a blood test for excluding vasculitis, and comprehensive angiography. Cerebral ultrasound, vascular images and clinical outcomes (Barthel index, modified Rankin scale, recurrent stroke, or death) were monitored during follow-up. Of the 19 patients, 16 (84%) had carotid FMD, while 7 (37%) had vertebral FMD. Only 2 investigated patients (13%) had renal FMD and 1 (5%) had cerebral aneurysm. 14 (74%) presented acute arterial dissection. All patients received medical treatment and had neither recurrent stroke nor dissection during follow-up. In the literature review of 225 FMD patients, 3.6% had recurrent stroke during follow-up, and some reported surgical procedure or angioplasty could give a good clinical outcome in progressing ischemia irrelevant to the cause of stenosis. In Taiwanese cervicocranial FMD patients, arterial dissection was one of the most common clinical presentations. Most of our patients had isolated involvement of the cervicocranial artery and carried a favorable outcome under medical treatment. Copyright © 2012 S. Karger AG, Basel.

Brisk walking can promote functional recovery in chronic stroke patients.

Science.gov (United States)

Batcho, Charles Sèbiyo; Stoquart, Gaëtan; Thonnard, Jean-Louis

2013-09-01

To determine whether regular brisk walking can promote functional recovery in community-dwelling stroke patients. A total of 44 chronic stroke patients, recruited in Belgium and Benin, respectively European high-income and African low-income countries. This longitudinal, single-cohort, observational study with 1 intervention period and 4 time-points of assessments (2 baseline, 1 post-intervention and 1 follow-up) was structured in 3 periods: pre-intervention period (1 month), intervention period (3 months) and follow-up period (3 month). Intervention consisted of a 3 times/week group-based brisk walking programme. Primary outcome measures were ACTIVLIM-Stroke questionnaire and the 6-minute walk test (6MWT). Secondary outcome measures were the Stroke Impairment Assessment Set (SIAS), the Hospital Anxiety and Depression Scale (HADS), and the Berg Balance Scale (BBS). All outcome measures were stable during the pre-intervention period (p ≥ 0.16). They all improved significantly after intervention (p ≤ 0.01), except the HADS (p = 0.058). However, during the follow-up period, SIAS (p = 0.002) and BBS (p = 0.001) decreased, while ACTIVLIM-Stroke, 6MWT and HADS showed no significant change (p ≥ 0.13). This study suggests regular brisk walking as an effective approach to promote functional recovery in chronic stroke survivors. However, further studies are required before generalizing these results to the whole stroke population.

Association of serial biochemical markers with acute ischemic stroke: the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator Stroke Study.

Science.gov (United States)

Jauch, Edward C; Lindsell, Christopher; Broderick, Joseph; Fagan, Susan C; Tilley, Barbara C; Levine, Steven R

2006-10-01

Biochemical markers of acute neuronal injury may aid in the diagnosis and management of acute ischemic stroke. Serum samples from the National Institute for Neurological Disorders and Stroke (NINDS) recombinant tissue plasminogen activator Stroke Study were analyzed for the presence of 4 biochemical markers of neuronal, glial, and endothelial cell injury. These biochemical markers, myelin basic protein (MBP), neuron-specific enolase (NSE), S100beta, and soluble thrombomodulin, were studied for an association with initial stroke severity, infarct volume, and functional outcome. In the original NINDS study, serum samples were drawn from all patients on presentation to the Emergency Department and at approximately 2 and 24 hours after initiation of study therapy. In this analysis, stored serum samples were available for 359 patients; 107 patients had samples for all 3 time points. Serum marker concentrations were measured by ELISA techniques. We examined the relation between serum concentrations of each marker and the degree of baseline neurological deficit, functional outcome, and infarct size on computed tomography at 24 hours and the effect of fibrinolytic therapy. Higher 24-hour peak concentrations of MBP, NSE, and S100beta were associated with higher National Institutes of Health Stroke Scale baseline scores (r=0.186, P<0.0001; r=0.117, P=0.032; and r=0.263, P<0.0001, respectively). Higher peak concentrations of MBP and S100beta (r=0.209, P<0.0001; r=0.239, P<0.0001) were associated with larger computed tomography lesion volumes. Patients with favorable outcomes had smaller changes in MBP and S100beta (P<0.05) concentrations in the first 24 hours. Soluble thrombomodulin was not associated with any severity or outcome measure. This study corroborates previous work demonstrating correlations of MBP, NSE, and S100beta with clinical and radiographic features in acute stroke. Despite significantly better outcomes in the tissue plasminogen activator-treated group, we

Usefulness of perfusion MR imaging in hyperacute ischemic stroke

International Nuclear Information System (INIS)

Park, Ji Hoon; Kim, Jae Hyoung; Shin, Tae Min; Lee, Eun Ja; Chung, Sung Hoon; Choi, Nack Cheon; Lim, Byeong Hoon; Kim, In One

1998-01-01

Perfusion MR imaging is a new technique for the assessment of acute ischemic stroke. The aim of this study was to evaluate the usefulness of this imaging in hyperacute ischemic stroke in comparison with conventional CT and MR imaging. Eight patients presenting the symptoms of acute ischemic stroke due to middle cerebral artery occlusion were included in this study. Within 2 hours of initial CT scan and 6 hours after the onset of stroke, perfusion MR imaging was performed in all patients using a single-section dynamic contrast-enhanced T2*-weighted imager in conjunction with conventional routine MR imaging and MR angiography. Cerebral blood volume (CBV) maps were then obtained from dynamic MR imaging data by using numerical integration techniques. The findings of CBV maps were compared with those of initial and follow-up CT or MR images. The findings of CBV maps were obviously abnormal in all patients, as compared with normal or focal subtle abnormal findings seen on initial CT and MR images. CBV in the occluded arterial territory was lower in all eight patients;two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. In all patients, regions of abnormal CBV were eventually converted to infarctions on follow-up images. Perfusion MR imaging was useful for the evaluation of hemodynamic change occurring during cerebral perfusion in hyperacute ischemic stroke, and prediction of the final extent of infarction. These results suggest that pertusion MR imaging can play an important role in the diagnosis and management of hyperacute ischemic stroke.=20

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

DEFF Research Database (Denmark)

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

1999-01-01

or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However......White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC...

Stroke Neurologist's Perspective on the New Endovascular Trials.

Science.gov (United States)

Grotta, James C; Hacke, Werner

2015-06-01

Before December 2014, the only proven effective treatment for acute ischemic stroke was recombinant tissue-type plasminogen activator (r-tPA). This has now changed with the publication of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits--Intra-Arterial (EXTEND IA), Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment Trial (SWIFT PRIME), and Randomized Trial of Revascularization With the Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset (REVASCAT) studies. We review the main results of these studies and how they inform stroke patient management going forward. The main take home points for neurologists are (1) intra-arterial thrombectomy is a potently effective treatment and should be offered to patients who have documented occlusion in the distal internal carotid or the proximal middle cerebral artery, have a relatively normal noncontrast head computed tomographic scan, severe neurological deficit, and can have intra-arterial thrombectomy within 6 hours of last seen normal; (2) benefits are clear in patients receiving r-tPA before intra-arterial thrombectomy; r-tPA should not be withheld if the patient meets criteria, and benefit in patients who do not receive r-tPA or have r-tPA exclusions requires further study; and (3) these favorable results occur when intra-arterial thrombectomy is performed in an endovascular stroke center by a coordinated multidisciplinary team that extends from the prehospital stage to the endovascular suite, minimizes time to recanalization, uses stent-retriever devices, and avoids general

Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke.

Science.gov (United States)

Mustanoja, Satu; Putaala, Jukka; Gordin, Daniel; Tulkki, Lauri; Aarnio, Karoliina; Pirinen, Jani; Surakka, Ida; Sinisalo, Juha; Lehto, Mika; Tatlisumak, Turgut

2016-06-01

High blood pressure (BP) in acute stroke has been associated with a poor outcome; however, this has not been evaluated in young adults. The relationship between BP and long-term outcome was assessed in 1004 consecutive young, first-ever ischemic stroke patients aged 15 to 49 years enrolled in the Helsinki Young Stroke Registry. BP parameters included systolic (SBP) and diastolic BP, pulse pressure, and mean arterial pressure at admission and 24 hours. The primary outcome measure was recurrent stroke in the long-term follow-up. Adjusted for demographics and preexisting comorbidities, Cox regression models were used to assess independent BP parameters associated with outcome. Of our patients (63% male), 393 patients (39%) had prestroke hypertension and 358 (36%) used antihypertensive treatment. The median follow-up period was 8.9 years (interquartile range 5.7-13.2). Patients with a recurrent stroke (n=142, 14%) had significantly higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure (Pstroke. Patients with SBP ≥160 mm Hg compared with those with SBP strokes (hazard ratio 3.3 [95% confidence interval, 2.05-4.55]; Pstroke, while the 24-hour BP levels were not. In young ischemic stroke patients, high acute phase BP levels are independently associated with a high risk of recurrent strokes. © 2016 American Heart Association, Inc.

Chinese medicine patterns in patients with post-stroke dementia.

Science.gov (United States)

Tang, Nou-Ying; Liu, Chung-Hsiang; Liu, Hsu-Jan; Li, Tsai-Chung; Liu, Jui-Chen; Chen, Ping-Kun; Hsieh, Ching-Liang

2012-04-01

A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP). Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I'Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. 100 patients (99.0%) were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, ), 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, ), 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, ), 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, ), 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, ), 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, ), and 39 participants (38.6%) were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, ); one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

Quality-of-life change associated with robotic-assisted therapy to improve hand motor function in patients with subacute stroke: a randomized clinical trial.

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Kutner, Nancy G; Zhang, Rebecca; Butler, Andrew J; Wolf, Steven L; Alberts, Jay L

2010-04-01

At 6 months poststroke, most patients cannot incorporate their affected hand into daily activities, which in turn is likely to reduce their perceived quality of life. This preliminary study explored change in patient-reported, health-related quality of life associated with robotic-assisted therapy combined with reduced therapist-supervised training. A single-blind, multi-site, randomized clinical trial was conducted. Seventeen individuals who were 3 to 9 months poststroke participated. Sixty hours of therapist-supervised repetitive task practice (RTP) was compared with 30 hours of RTP combined with 30 hours of robotic-assisted therapy. Participants completed the Stroke Impact Scale (SIS) at baseline, immediately postintervention, and 2 months postintervention. Change in SIS score domains was assessed in a mixed model analysis. The combined therapy group had a greater increase in rating of mood from preintervention to postintervention, and the RTP-only group had a greater increase in rating of social participation from preintervention to follow-up. Both groups had statistically significant improvement in activities of daily living and instrumental activities of daily living scores from preintervention to postintervention. Both groups reported significant improvement in hand function postintervention and at follow-up, and the magnitude of these changes suggested clinical significance. The combined therapy group had significant improvements in stroke recovery rating postintervention and at follow-up, which appeared clinically significant; this also was true for stroke recovery rating from preintervention to follow-up in the RTP-only group. LIMITATIONS OUTCOMES: of 30 hours of RTP in the absence of robotic-assisted therapy remain unknown. Robotic-assisted therapy may be an effective alternative or adjunct to the delivery of intensive task practice interventions to enhance hand function recovery in patients with stroke.

Blood Pressure Control: Stroke and Stroke Prevention

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Hans-Christoph Diener

2005-03-01

Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

Effects of melatonin in experimental stroke models in acute, sub-acute, and chronic stages

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Hsiao-Wen Lin

2009-03-01

Full Text Available Hsiao-Wen Lin, E-Jian LeeNeurophysiology Laboratory, Neurosurgical Service, Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, TaiwanAbstract: Melatonin (N-acetyl-5-methoxy-tryptamine, a naturally occurring indole produced mainly by the pineal gland, is a well known antioxidant. Stroke (cerebral ischemia is the second leading cause of death worldwide. To date, however, effective and safe treatment for stroke remains unavailable. Melatonin is both lipid- and water-soluble and readily crosses the blood–brain barrier (BBB. Increasing evidence has shown that, in animal stroke models, administering melatonin significantly reduces infarct volume, edema, and oxidative damage and improves electrophysiological and behavioral performance. Here, we reviewed studies that assess effects of melatonin on cerebral ischemia in acute, sub-acute, and chronic stages. In addition to its potent antioxidant properties, melatonin exerts antiapoptotic, antiexcitotoxic, anti-inflammatory effects and promotes mitochondrial functions in animals with cerebral ischemia. Given that melatonin shows almost no toxicity to humans and possesses multifaceted protective capacity against cerebral ischemia, it is valuable to consider using melatonin in clinical trials on patients suffering from stroke.Keywords: cerebral ischemia, melatonin, stroke, neuroprotection

Stroke Laterality Bias in the Management of Acute Ischemic Stroke.

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McCluskey, Gavin; Wade, Carrie; McKee, Jacqueline; McCarron, Peter; McVerry, Ferghal; McCarron, Mark O

2016-11-01

Little is known of the impact of stroke laterality on the management process and outcome of patients with acute ischemic stroke (AIS). Consecutive patients admitted to a general hospital over 1 year with supratentorial AIS were eligible for inclusion in the study. Baseline characteristics and risk factors, delays in hospital admission, imaging, intrahospital transfer to an acute stoke unit, stroke severity and classification, length of hospital admission, as well as 10-year mortality were measured and compared among right and left hemisphere AIS patients. There were 141 patients (77 men, 64 women; median age 73 [interquartile range 63-79] years), There were 71 patients with left hemisphere AIS and 70 with right hemisphere AIS. Delays to hospital admission from stroke onset to neuroimaging were similar among right and left hemisphere AIS patients. Delay in transfer to an acute stroke unit (ASU) following hospital admission was on average 14 hours more for right hemisphere compared to left hemisphere AIS patients (P = .01). Laterality was not associated with any difference in 10-year survival. Patients with mild and nondominant AIS merit particular attention to minimize their intrahospital transfer time to an ASU. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

The effect of the inspiratory muscle training on functional ability in stroke patients.

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Jung, Nam-Jin; Na, Sang-Su; Kim, Seung-Kyu; Hwangbo, Gak

2017-11-01

[Purpose] This study was to find out an inspiratory muscle training (IMT) program therapeutic effects on stroke patients' functional ability. [Subjects and Methods] Twenty stroke patients were assigned to one of two groups: inspiratory muscle training (n=10), and control (n=10), randomization. The inspiratory muscle training participants undertook an exercise program for 30 minute per times, 5 times a week for 6 weeks. The investigator measured the patients' trunk impairment scale (TIS) and 6 minute walking test (6MW) for functional ability before and after IMT. [Results] The TIS appeared some significant differences in both groups before and after the training. The 6MW test showed some significant differences in the inspiratory muscle training group, but didn't show any significant difference in the control group. And the differences in both groups after depending the inspiratory muscle training were significantly found in the tests of TIS and 6MW test [Conclusion] The results showed that the inspiratory muscle training in stroke patients are correlated with the trunk stability and locomotion ability, suggesting that physical therapist must take into consideration the inspiratory muscle training, as well as functional training to improve physical function in stroke patients.

Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study

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Stam Henk J

2011-07-01

Full Text Available Abstract Background Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing. Methods Ten chronic (≥ 6 months stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2 during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs, calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs or vigorous (> 6 METs according to the American College of Sports Medicine and the American Heart Association Guidelines. Results Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean (± SD energy expenditure during Wii Sports game play was 3.7 (± 0.6 METs for tennis and 4.1 (�

Measurement of τ decays into a charged hadron accompanied by neutral π-mesons and determination of the CKM matrix element vertical stroke V{sub us} vertical stroke

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Adametz, Aleksandra

2011-07-06

This thesis presents the branching fraction measurement of the τ{sup -}→K{sup -}(nπ{sup 0})ν{sub τ} (n=0,1,2,3) and τ{sup -}→π{sup -}(nπ{sup 0})ν{sub τ} (n=3,4) decays. The measurement is based on a data sample of 435 million τ pairs produced in e{sup +}e{sup -} collisions and collected with the BABAR detector in 1999-2008. The analysis is validated using precisely known τ decays as control modes. The measured branching fractions are B(τ{sup -}→K{sup -}ν{sub τ})=(7.100±0.033±0.156) x 10{sup -3}, B(τ{sup -}→K{sup -}π{sup 0}ν{sub τ})=(5.000±0.020±0.139) x 10{sup -3}, B(τ{sup -}→K{sup -}(2π{sup 0})ν{sub τ})=(5.654±0.144±0.323) x 10{sup -4}, B(τ{sup -}→K{sup -}(3π{sup 0})ν{sub τ})=(1.642±0.279±0.375) x 10{sup -4}, B(τ{sup -}→π{sup -}(3π{sup 0})ν{sub τ})=(1.216±0.010±0.047) x 10{sup -2}, B(τ{sup -}→π{sup -}(4π{sup 0})ν{sub τ})=(1.041±0.067±0.090) x 10{sup -3}, where the first uncertainty is statistical and the second systematic. The branching fraction B(τ{sup -}→π{sup -}(4π{sup 0})ν{sub τ}) is measured for the first time. The precision of the results is comparable or significantly improved with respect to previous measurements. The branching fraction B(τ{sup -}→K{sup -}ν{sub τ}) is combined with a lattice QCD calculation of the kaon decay constant to obtain the Cabibbo-Kobayashi-Maskawa matrix element vertical stroke V{sub us} vertical stroke =0.2224±0.0025(exp)±0.0029(theo). The branching fractions of the τ decays into a kaon are combined with the current world averages. The resulting averages are used in the determination of the total τ branching fraction, B{sub s}, into strangeness vertical stroke S vertical stroke =1 final states. B{sub s} is used in conjunction with vertical stroke V{sub ud} vertical stroke and a small SU(3)-symmetry breaking correction to compute vertical stroke V{sub us} vertical stroke =0.2176±0.0025(exp)±0.0010(theo).

Protein consumptions in stroke patients

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Zahra Maghsoudi

2013-01-01

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

A zero-footprint 3D visualization system utilizing mobile display technology for timely evaluation of stroke patients

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Park, Young Woo; Guo, Bing; Mogensen, Monique; Wang, Kevin; Law, Meng; Liu, Brent

2010-03-01

When a patient is accepted in the emergency room suspected of stroke, time is of the utmost importance. The infarct brain area suffers irreparable damage as soon as three hours after the onset of stroke symptoms. A CT scan is one of standard first line of investigations with imaging and is crucial to identify and properly triage stroke cases. The availability of an expert Radiologist in the emergency environment to diagnose the stroke patient in a timely manner only increases the challenges within the clinical workflow. Therefore, a truly zero-footprint web-based system with powerful advanced visualization tools for volumetric imaging including 2D. MIP/MPR, 3D display can greatly facilitate this dynamic clinical workflow for stroke patients. Together with mobile technology, the proper visualization tools can be delivered at the point of decision anywhere and anytime. We will present a small pilot project to evaluate the use of mobile technologies using devices such as iPhones in evaluating stroke patients. The results of the evaluation as well as any challenges in setting up the system will also be discussed.

Code stroke in Asturias.

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Benavente, L; Villanueva, M J; Vega, P; Casado, I; Vidal, J A; Castaño, B; Amorín, M; de la Vega, V; Santos, H; Trigo, A; Gómez, M B; Larrosa, D; Temprano, T; González, M; Murias, E; Calleja, S

2016-04-01

Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Validation of minor stroke definitions for thrombolysis decision making.

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Park, Tai Hwan; Hong, Keun-Sik; Choi, Jay Chol; Song, Pamela; Lee, Ji Sung; Lee, Juneyoung; Park, Jong-Moo; Kang, Kyusik; Lee, Kyung Bok; Cho, Yong-Jin; Saposnik, Gustavo; Han, Moon-Ku; Bae, Hee-Joon

2013-05-01

Patients with low National Institutes of Health Stroke Scale (NIHSS) scores are frequently excluded from thrombolysis, but more than 25% of them remain disabled. We sought to define a validated minor stroke definition to reduce the inappropriate treatment exclusion. From an outcome database, untreated patients with an NIHSS score of 5 or less presenting within a 4.5-hour window were identified and 3-month modified Rankin Scale (mRS) outcomes were analyzed according to individual isolated symptoms and total NIHSS scores. The validity of the following minor stroke definitions were assessed: (1) the National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator (NINDS-TPA) trials' definition, (2) the total NIHSS score, varying a cutoff point from 0 to 4, and (3) our proposed definition that included an NIHSS score = 0 or an NIHSS score = 1 on the items of level of consciousness (LOC), gaze, facial palsy, sensory, or dysarthria. Of 647 patients, 172 patients (26.6%) had a 3-month unfavorable outcome (mRS score 2-6). Favorable outcome was achieved in more than 80% of patients with an NIHSS score of 1 or less or with an isolated symptom on the LOC, gaze, facial palsy, sensory, or dysarthria item. In contrast, unfavorable outcome proportion was more than 25% in patients with an NIHSS score of 2 or more. When the NINDS-TPA trials' definition, our definition, or the definition of an NIHSS score of 1 or less were applied, more than 75% of patients with an unfavorable outcome were defined as a non-minor stroke and less than 15% of patients with an unfavorable outcome were defined as a minor stroke. Implementation of an optimal definition of minor stroke into thrombolysis decision-making process would decrease the unfavorable outcomes in patients with low NIHSS scores. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Topography of acute stroke in a sample of 439 right brain damaged patients.

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Sperber, Christoph; Karnath, Hans-Otto

2016-01-01

Knowledge of the typical lesion topography and volumetry is important for clinical stroke diagnosis as well as for anatomo-behavioral lesion mapping analyses. Here we used modern lesion analysis techniques to examine the naturally occurring lesion patterns caused by ischemic and by hemorrhagic infarcts in a large, representative acute stroke patient sample. Acute MR and CT imaging of 439 consecutively admitted right-hemispheric stroke patients from a well-defined catchment area suffering from ischemia (n = 367) or hemorrhage (n = 72) were normalized and mapped in reference to stereotaxic anatomical atlases. For ischemic infarcts, highest frequencies of stroke were observed in the insula, putamen, operculum and superior temporal cortex, as well as the inferior and superior occipito-frontal fascicles, superior longitudinal fascicle, uncinate fascicle, and the acoustic radiation. The maximum overlay of hemorrhages was located more posteriorly and more medially, involving posterior areas of the insula, Heschl's gyrus, and putamen. Lesion size was largest in frontal and anterior areas and lowest in subcortical and posterior areas. The large and unbiased sample of stroke patients used in the present study accumulated the different sub-patterns to identify the global topographic and volumetric pattern of right hemisphere stroke in humans.

Different utilization of intensive care services (ICSs) for patients dying of hemorrhagic and ischemic stroke, a hospital-based survey.

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Wang, Vinchi; Hsieh, Chieh-Chao; Huang, Yen-Ling; Chen, Chia-Ping; Hsieh, Yi-Ting; Chao, Tzu-Hao

2018-02-01

The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records. Statistics included chi-square and descriptive analyses.In this study, CI patients had a longer HSD (mean 14.3 days), as compared with ICH patients (mean 8.3 days); however, the ICH patients had a higher percentage of early entry within the first 24 hours of admission into ICS than CI group (95.1% vs 60.0%, P = .003). A higher rate of CI patients died in holidays or weekends than those with ICH (44.0% vs 21.4%, P = .051). DNR, requested mainly from direct descendants (children or grandchildren), was coded in all 25 CI patients (100.0%) and 38 ICH patients (90.5%). More cases with early DNR coded within 24 hours after admission occurred in ICH group (47%, 12% in CI patients, P = .003). None of the stroke patient had living wills. Withhold of endotracheal intubation (ETI) occurred among CI patients, more than for ICH patients (76.0% vs 18.4%, P mortality within holidays or weekends, and higher ETI withhold; but less percentage of ICS utilization expressed by a lower ISD/HSD ratio. This ICS utilization is a key issue of medical quality for stroke care.

Exercise after Stroke: Patient Adherence and Beliefs after Discharge from Rehabilitation.

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Miller, Kristine K; Porter, Rebecca E; DeBaun-Sprague, Erin; Van Puymbroeck, Marieke; Schmid, Arlene A

2017-03-01

Most people complete post-stroke rehabilitation within the first 6 months after stroke even though benefits from exercise are believed to persist well beyond 6 months. Physical and Occupational therapists provide home exercise programs (HEP) to instruct patients on exercises to continue after discharge from rehabilitation. Unfortunately, there is little known about HEP adherence rates in adults with stroke. The objectives of this project were to (1) determine the adherence rate with post-rehabilitation HEP and reasons for non-adherence, (2) assess for interactions between HEP adherence and self-report of depression and fatigue, and (3) determine patient beliefs about the benefit of exercise during stroke recovery. This was a cross-sectional, survey study. A survey was developed and distributed during stroke support group meetings to determine adherence rates with post rehabilitation HEP, reasons for non-adherence, and patient beliefs about the benefit of exercise. Eighty-nine percent of participants reported receiving a HEP and 65.3% of those reported being adherent with at least part of the HEP. Several reasons for non-adherence were identified, including 'doing different exercises than the ones given by the physical therapist', as the most frequently given reason. Study participants identified positive roles of exercise in their recovery from stroke. Patient adherence with HEP after discharge from rehabilitation is less than ideal. Reasons for non-adherence are varied. Rehabilitation therapists need to be able to identify and help patients manage barriers to HEP adherence to promote management of residual deficits.

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

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Jawgam Umbon

2016-07-01

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

Head Position in Stroke Trial (HeadPoST)--sitting-up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomised controlled trial.

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Muñoz-Venturelli, Paula; Arima, Hisatomi; Lavados, Pablo; Brunser, Alejandro; Peng, Bin; Cui, Liying; Song, Lily; Billot, Laurent; Boaden, Elizabeth; Hackett, Maree L; Heritier, Stephane; Jan, Stephen; Middleton, Sandy; Olavarría, Verónica V; Lim, Joyce Y; Lindley, Richard I; Heeley, Emma; Robinson, Thompson; Pontes-Neto, Octavio; Natsagdorj, Lkhamtsoo; Lin, Ruey-Tay; Watkins, Caroline; Anderson, Craig S

2015-06-05

Positioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0°) compared with sitting-up (≥ 30°) head positioning in the first 24 hours of hospital admission for patients with acute stroke. We plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0°) or sitting-up (≥ 30°) head position as a 'business as usual' stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (α 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period. HeadPoST is a large international clinical trial in

[Results of thrombolyses procedures in acute ischemic cerebral stroke realized in Kraków 2004-2007--Grant Ministry of Science and Information].

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Popiela, Tadeusz J; Urbanik, Andrzej; Słowik, Agnieszka

2010-01-01

To lower the number of complications of acute cerebral ischemic stroke and to reduce the time of rehabilitation in these patients it is necessary to induce treatment within the first 3 hours of the onset of the stroke. Early intervention however, is possible only in cases with the confirm localized ischemic focus visualized in one of the diagnostic imaging methods. The most widespread is CT, hovewer the first symptoms of ischemic stroke can be seen not beforel2 hours of the onset. The study evaluated the effectiveness of early diagnostics of ischemic stroke using perfusion CT (pCT) with subsequent intravenous or intra-arterial thrombolysis. The patients with ischemic stroke confirmed by pCT and qualified to thrombolysis in the first 3 hours of the onset of the stroke were randomly selected to intravenous or intra-arterial thrmobolysis. Those, who were 3 to 6 hours of the onset of the stroke were qualified to intra-arterial thrombolysis. A study group consisted of 377 patients hospitalized due to ischemic stroke. Of these pCT was performed in 76 cases, intravenous thrombolysis in 4 and intra-arterial thrombolysis in 2. Clinical condition substantially improved in 3 patients. Obtained results indicate the necessity to introduce pCT to the routine diagnostics of the acute ischemic stroke. A small number of patients eligible for thrombolysis does not allow to compare the effectiveness of intra-arterial and intravenous thrombolysis, however the project allowed to work out the efficient system of diagnostics and treatment of the acute ischemic stroke in the area of Krakow based on the standards used in the European countries.

Long working hours and risk of coronary heart disease and stroke

DEFF Research Database (Denmark)

Kivimäki, Mika; Jokela, Markus; Nyberg, Solja T

2015-01-01

, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working......BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. METHODS: We...... identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative...

The Impact of Timing and Dose of Rehabilitation Delivery on Functional Recovery of Stroke Patients

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Hsiu-Chen Huang

2009-05-01

Conclusion: There is a dose-dependent effect of rehabilitation on functional improvement of stroke patients for the first 6 months post-stroke, and earlier delivery of rehabilitation has lasting effects on the functional recovery of stroke patients up to 1 year.

Two anhydrous zeolite X crystal structures, Pd sub 1 sub 8 Tl sub 5 sub 6 Si sub 1 sub 0 sub 0 Al sub 9 sub 2 O sub 3 sub 8 sub 4 and Pd sub 2 sub 1 Tl sub 5 sub 0 Si sub 1 sub 0 sub 0 Al sub 9 sub 2 O sub 3 sub 8 sub 4

CERN Document Server

Yoon, B Y; Lee, S H; Kim, Y

2001-01-01

The crystal structures of fully dehydrated Pd sup 2 sup + - and Tl sup + -exchanged zeolite X, Pd sub 1 sub 8 Tl sub 5 sub 6 Si sub 1 sub 0 sub 0 Al sub 9 sub 2 O sub 3 sub 8 sub 4 (Pd sub 1 sub 8 Tl sub 5 sub 6 X, a = 24.935(4) A) and Pd sub 2 sub 1 Tl sub 5 sub 0 Si sub 1 sub 0 sub 0 Al sub 9 sub 2 O sub 3 sub 8 sub 4 (Pd sub 2 sub 1 Tl sub 5 sub 0 -X, a = 24.914(4) A), have been determined by single-crystal X-ray diffraction methods in the cubic space group Fd3 at 21(1) .deg. C. The crystals were prepared using an exchange solution that had a Pd(NH sub 3) sub 4 Cl sub 2 : TINO sub 3 mole ratio of 50 : 1 and 200 : 1, respectively, with a total concentration of 0.05 M for 4 days. After dehydration at 360 .deg. C and 2 x 10 sup - sup 6 Torr in flowing oxygen for 2 days, the crystals were evacuated at 21(1) .deg. C for 2 hours. They were refined to the final error indices R sub 1 = 0.045 and R sub 2 = 0.038 with 344 reflections for Pd sub 1 sub 8 Tl sub 5 sub 6 -X, and R sub 1 = 0.043 and R sub 2 = 0.045 with ...

PISA. The effect of paracetamol (acetaminophen and ibuprofen on body temperature in acute stroke: Protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690

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Kappelle Jaap

2002-03-01

Full Text Available Abstract Background During the first days after stroke, one to two fifths of the patients develop fever or subfebrile temperatures. Body temperature is a strong prognostic factor after stroke. Pharmacological reduction of temperature in patients with acute ischaemic stroke may improve their functional outcome. Previously, we studied the effect of high dose (6 g daily and low dose (3 g daily paracetamol (acetaminophen in a randomised placebo-controlled trial of 75 patients with acute ischemic stroke. In the high-dose paracetamol group, mean body temperature at 12 and 24 hours after start of treatment was 0.4°C lower than in the placebo group. The effect of ibuprofen, another potent antipyretic drug, on body-core temperature in normothermic patients has not been studied. Aim The aim of the present trial is to study the effects of high-dose paracetamol and ibuprofen on body temperature in patients with acute ischaemic stroke, and to study the safety of these treatments. Design Seventy-five (3 × 25 patients with acute ischaemic stroke confined to the anterior circulation will be randomised to treatment with either: 400 mg ibuprofen, 1000 mg acetaminophen, or with placebo 6 times daily during 5 days. Body-temperatures will be measured with a rectal electronic thermometer at the start of treatment and after 24 hours. An infrared tympanic thermometer will be used to monitor body temperature at 2-hour intervals during the first 24 hours and at 12-hour intervals thereafter. The primary outcome measure will be rectal temperature at 24 hours after the start of treatment. The study results will be analysed on an intent-to-treat basis, but an on-treatment analysis will also be performed. No formal interim analysis will be carried out.

Synthesis and characterization of the lead borate Pb{sub 6}B{sub 12}O{sub 21}(OH){sub 6}

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Schoenegger, Sandra; Ortner, Teresa S.; Wurst, Klaus; Heymann, Gunter; Huppertz, Hubert [Innsbruck Univ. (Austria). Inst. fuer Allgemeine, Anorganische und Theoretische Chemie

2016-11-01

A lead borate with the composition Pb{sub 6}B{sub 12}O{sub 21}(OH){sub 6} was synthesized through a hydrothermal synthesis, using lead metaborate in combination with sodium nitrate and potassium nitrate. The compound crystallizes in the trigonal, non-centrosymmetric space group P3{sub 2} (no. 145) with the lattice parameters a = 1176.0(4), c = 1333.0(4) pm, and V = 0.1596(2) nm{sup 3}. Interestingly, the data of Pb{sub 6}B{sub 12}O{sub 21}(OH){sub 6} correct the structure of a literature known lead borate with the composition ''Pb{sub 6}B{sub 11}O{sub 18}(OH){sub 9}''. For the latter compound, nearly identical lattice parameters of a = 1176.91(7) and c = 1333.62(12) pm were reported, possessing a crystal structure, in which the localization and refinement of one boron atom was obviously overlooked. The structure of Pb{sub 6}B{sub 12}O{sub 21}(OH){sub 6} is built up from trigonal planar BO{sub 3} and tetrahedral BO{sub 4} groups forming complex chains. The Pb{sup 2+} cations are located between neighboring polyborate chains. The here reported compound Pb{sub 6}B{sub 12}O{sub 21}(OH){sub 6} and ''Pb{sub 6}B{sub 11}O{sub 18}(OH){sub 9}'' were, however, produced under different synthesis conditions. While ''Pb{sub 6}B{sub 11}O{sub 18}(OH){sub 9}'' was synthesized via a hydrothermal synthesis including ethylenediamine and acetic acid, the here reported lead borate Pb{sub 6}B{sub 12}O{sub 21}(OH){sub 6} could be obtained under moderate hydrothermal conditions (240 C) without the addition of organic reagents.

Clinical and EEG features of ischemic stroke patients with abnormal discharges

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Jia-lei YANG

2016-05-01

Full Text Available Objective To investigate the clinical and EEG features of ischemic stroke patients with abnormal discharges.  Methods Clinical data and 24-hour EEG monitoring of 162 ischemic stroke patients were analyzed retrospectively. One-year follow-up was carried out and post-ischemic epilepsy was diagnosed.  Results Among 162 ischemic stroke patients, 24-hour EEG was abnormal in 87 cases (53.70%. According to the correspondence of site of infarcts and abnormal discharges, these 87 cases were classified into 2 groups: matched group (N = 24, 27.59% and unmatched group (N = 63, 72.41%. There was no significant difference between 2 groups in terms of Oxfordshire Community Stroke Project (OCSP and TOAST classification (P = 0.792, 0.111, while there was significant difference between 2 groups on the site of infarcts (P = 0.000. In matched group, the infarcts were mainly located in cortex (N = 23, 95.83%. However, in unmatched group, the infarcts were mainly located in cortex and basal ganglia (N = 27, 42.86%, or in basal ganglia only (N = 24, 38.10%. In matched group, 24-hour EEG showed slowing of background activities, and sharp waves and sharp and slow wave complex which were corresponding to the infarct sites. The abnormal discharges could only be recorded around the infarct unilaterally. In unmatched group, the epileptiform discharges were recorded in both contralateral and ipsilateral ischemic hemispheres, usually with widespread slow waves and asymmetric background. The infarcts were limited, but abnormal discharges were widespread. For example, the infarct was located in deep brain, while scalp abnormal discharges were recorded. Although there was no significant difference in terms of epilepsy incidence between 2 groups (P = 0.908, the types of epilepsy were statistically different between 2 groups (P = 0.000. In matched group, the main type was partial seizure. But in unmatched group, the main types of epilepsy were secondary generalized seizure and

Sex differences in cryptogenic stroke with patent foramen ovale.

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Nedeltchev, Krassen; Wiedmer, Sebastian; Schwerzmann, Markus; Windecker, Stephan; Haefeli, Tobias; Meier, Bernhard; Mattle, Heinrich P; Arnold, Marcel

2008-09-01

Sex differences in patients with patent foramen ovale (PFO) and cryptogenic stroke have not been systematically analyzed. We aimed to determine sex influences on demographics, vascular risk factors, clinical manifestations, stroke location, and clinical outcome. One thousand two hundred eighty-eight consecutive patients with ischemic stroke or transient ischemic attack (TIA) were admitted to a single stroke center. All patients underwent a complete stroke workup including clinical examination, standard blood tests, cerebral and vascular imaging, transesophageal echocardiography, and 24-hour electrocardiography. In 500 patients, no definite etiology could be established (cryptogenic stroke/TIA). Of them, 167 patients (107 men and 60 women, mean age 52 +/- 13 years) had an PFO. The prevalence of PFO in patients with cryptogenic stroke or TIA was higher in men than in women (38% vs 28%, P = .014). Stroke severity and the prevalence of risk factors did not differ between the 2 sexes. There was an independent association between male sex and stroke location in the posterior cerebral circulation (OR 3.0, 95% CI 1.4-6.5, P = .006). Men and women did not differ in respect to PFO grade, prevalence of right-to-left shunt at rest, or coexistence of atrial septal aneurysm. Clinical outcome at 3 months was similar in both sexes. Patent foramen ovale was more prevalent in men than in women with cryptogenic stroke. There were no sex influences on age, risk factors, echocardiographic characteristics of PFO, or clinical outcome. Male sex was independently associated with stroke in the posterior cerebral circulation.

The risk of ischaemic stroke in primary antiphospholipid syndrome patients

DEFF Research Database (Denmark)

Radin, M; Schreiber, K; Cecchi, I

2018-01-01

BACKGROUND AND PURPOSE: The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic...... thrombosis and were receiving vitamin K antagonist (VKA), with international normalized ratio target 2-3; one patient had a history of a previous arterial event receiving treatment with VKA target international normalized ratio 2-3 plus low dose aspirin; and one patient had a history of previous pregnancy...... morbidity receiving only low dose aspirin. Time in the therapeutic range for patients receiving VKA was 77.7% (SD 6.6%). Hypercholesterolaemia was significantly higher in patients with confirmed stroke compared to those without (P

Rehabilitation of a patient with stroke

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Apurba Barman

2013-01-01

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

Synthesis and luminescent properties of Sr{sub 2}Gd{sub 6.8}Eu{sub 1.2}Si{sub 6(1−x)}P{sub 6x}O{sub 26} oxyapatites

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Ishchenko, A.V., E-mail: a-v-i@mail.ru [Ural Federal University, 620002 Ekaterinburg (Russian Federation); Zuev, M.G. [Ural Federal University, 620002 Ekaterinburg (Russian Federation); Institute of Solid State Chemistry, Ural Branch of the Russian Academy of Sciences, 620990 Ekaterinburg (Russian Federation); Vasin, A.A. [Institute of Solid State Chemistry, Ural Branch of the Russian Academy of Sciences, 620990 Ekaterinburg (Russian Federation); Yagodin, V.V.; Viktorov, L.V.; Shulgin, B.V. [Ural Federal University, 620002 Ekaterinburg (Russian Federation)

2016-01-15

The solid solutions Sr{sub 2}Gd{sub 6.8}Eu{sub 1.2}Si{sub 6(1−x)}P{sub 6x}O{sub 26−δ} (where x=0–0.15 and δ is oxygen nonstoichiometry) were synthesized. The structural properties of the crystal lattice of the solid solutions and the peculiarities of Eu{sup 3+} and P{sup 5+} dopants substitution for matrix ions have been considered. The photo-, X-ray and pulsed cathode luminescence properties have been studied. It has been found that substitution of (SiO{sub 4}){sup 4−} by (PO{sub 4}){sup 3−} tetrahedron in Eu{sup 3+}-doped oxyapatites does not bring significant changes to bands structure Eu{sup 3+} in luminescence spectra under different excitation (UV, X-ray, pulse cathode beam). However, the increase of P{sup 5+} concentration in Sr{sub 2}Gd{sub 6.8}Eu{sub 1.2}Si{sub 6(1−x)}P{sub 6x}O{sub 26–δ} compounds leads to a decrease of integral intensity of Eu{sup 3+} luminescence bands due to local environment symmetry modifications and covalency degree changes. Two nonequivalent optical Eu{sup 3+} centers have been found. These compounds are of interest for efficient X-ray phosphors, display devices and LED engineering material creation. - Highlights: • The luminescence properties were studied upon UV, X-ray and pulse cathode beam. • P{sup 5+} doping of Sr{sub 2}Gd{sub 6.8}Eu{sub 1.2}Si{sub 6}O{sub 26} leads to luminescence intensity reduction. • At least two types of optical centers formed by Eu{sup 3+} ions were found. • The structural features of Sr{sub 2}Gd{sub 6.8}Eu{sub 1.2}Si{sub 6(1−x)}P{sub 6x}O{sub 26} were reported. • Partial replacement of Si by P does not change the Sr{sub 2}Gd{sub 6.8}Eu{sub 1.2}Si{sub 6}O{sub 26} structure.

Chinese Medicine Patterns in Patients with Post-Stroke Dementia

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Nou-Ying Tang

2012-04-01

Full Text Available A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP. Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I’Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. Results: 100 patients (99.0% were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, 腎精虧虛證, 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, 肝陽上亢證, 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, 氣血虧虛證, 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, 瘀血阻絡證, 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, 腑滯濁留證, 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, 火熱內盛證, and 39 participants (38.6% were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, 痰濁阻竅證; one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

Reporting time of ischemic stroke patients within the time window for thrombolysis in a tertiary care hospital at rawalpindi

International Nuclear Information System (INIS)

Tariq, M.; Ishtiaq, S.; Anwar, S.O.

2014-01-01

To determine the reporting time of ischemic stroke patients within the time window for thrombolysis at Military Hospital (MH) Rawalpindi. Design: A descriptive study. Place and duration of Study: Military Hospital Rawalpindi over a period of four months from Dec 2013 to Mar 2014. Patients and Methods: Patients admitted to MH Rawalpindi with symptoms suggestive of stroke and having objective focal neurologic deficits consistent with stroke were included in the study. A CT scan of brain was carried out immediately to rule out intracranial bleed. The CT scan of brain was either normal or revealed radiological findings suggestive of an infarct. Results: A total of 86 patients met the inclusion criteria of the study. Only 19 (22%) patients with ischemic stroke presented to the hospital within 4.5 hours after onset of their symptoms. Conclusion: Only a small number of ischemic stroke patients report to the hospital within the therapeutic window for thrombolytic therapy. (author)

Clues to occult cancer in patients with ischemic stroke.

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Suk Jae Kim

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

Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa - A survey based approach.

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Lin, Chen; Vakani, Ravi; Kussin, Peter; Guhwe, Mary; Farjat, Alfredo E; Choudhury, Kingshuk; Renner, David; Oduor, Chrispine; Graffagnino, Carmelo

2017-08-01

There is no published literature regarding sub-Saharan health-care providers' understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimize patient outcomes. A cross-sectional survey of acute stroke diagnosis, hospital management, and secondary prevention questions was administered to health-care providers working in one large Kenyan acute referral hospital. Due to the prevalence of medical students (61.8%), an experienced-focused analysis contrasted students with more experienced providers. Providers (n=199) anonymously responded to the surveys. Among the acute diagnosis most respondents stated that stroke scales should always used (58.3% of respondents), 3h was the time period for alteplase (t-PA) (53.8% of respondents), and CT scan should be always be obtained prior to administration of anticoagulant therapy (61.3% of respondents). Neither VTE prophylaxis nor dysphagia/swallowing screening were considered to be done a majority of time. Secondary prevention results were variable. The respondent's level of clinical experience made the most difference in correctly answering the most appropriate IV Fluid to use in stroke patients (adjusted p=0.003) and the ideal initiation time for antithrombotic therapy (adjusted p=0.0017). Healthcare providers demonstrated a wide variability in their responses. Future efforts to improve stroke care in sub-Saharan Africa should include education and process improvement initiatives to focus on more specific aspects of stroke management based on the results from this survey. Copyright © 2017 Elsevier Ltd. All rights reserved.

Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

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Josie Merchant

2016-01-01

Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy.

Science.gov (United States)

Payne, Richard J; Tewfik, Marc A; Hier, Michael P; Tamilia, Michael; Mac Namara, Elizabeth; Young, Jonathan; Black, Martin J

2005-09-01

Previous studies have established the efficacy of post-thyroidectomy hypocalcemia monitoring using parathyroid hormone (PTH) and corrected calcium levels at 1 and 6 hours. The goal of this study was to measure the impact of managing patients based on the above findings with respect to: duration of hospital stays, rates of transient hypocalcemia, number of blood tests, cost savings, and discharge from the hospital as early as 8 hours post-thyroidectomy without compromising safety. This is a prospective study involving 95 total thyroidectomy patients using historical data as controls. The previous protocol was modified in that all blood tests ceased for patients meeting the 6-hour critical level of PTH > or = 28 ng/L and simultaneous corrected calcium > or = 2.14 mmol/L (8.56 mg/dL). Furthermore, patients with 1-hour PTH levels cost savings of 766 Canadian dollars per patient. The new algorithm resulting from PTH and corrected calcium monitoring at 1 and 6 hours post-thyroidectomy has led to significant cost savings for our institution. It has also translated into greater patient satisfaction as a result of fewer blood tests, a lower incidence of transient hypocalcemia, and significantly shorter hospital stays.

Magnetic structures of Er{sub 6}Mn{sub 23} and Dy{sub 6}Mn{sub 23}

Energy Technology Data Exchange (ETDEWEB)

Ouladdiaf, B. [Institut Max von Laue - Paul Langevin, 38 - Grenoble (France); Deportes, J. [Laboratoire de Magnetisme L. Neel, C.N.R.S., BP 166, 38042 Grenoble Cedex 9 (France); Rodriguez-Carvajal, J. [Institut Max von Laue - Paul Langevin, 38 - Grenoble (France)]|[Laboratoire Leon Brillouin (CEA-CNRS), Centre d`Etudes de Saclay, Gif sur Yvette (France)

1995-08-01

The R{sub 6}Mn{sub 23} (R=rare earth) compounds crystallize in the cubic Th{sub 6}Mn{sub 23}-type structure with space group Fm3m. Powder neutron-diffraction experiments were performed on Dy{sub 6}Mn{sub 23} and Er{sub 6}Mn{sub 23}. The magnetic unit cell coincides with the chemical one. The R moments have a ferromagnetic non-collinear arrangement, whereas the Mn moments are parallel to the [1 1 1] direction. The magnetic structures belong to the three-dimensional {Gamma}{sub 5g} irreducible representation of Fm3m associated with the wave vector K=[0 0 0]. The spin configurations in both compounds result from the competition between the R-R, R-Mn magnetic interactions and the crystal electric field on the R ions. (orig.).

Suicidal ideation and attempts in patients with stroke: a population-based study.

Science.gov (United States)

Chung, Jae Ho; Kim, Jung Bin; Kim, Ji Hyun

2016-10-01

Stroke is known to be associated with an increase in the risk for suicide. However, there are very few population-based studies investigating the risk of suicidal ideation and attempts in patients with stroke. The purpose of this study was to compare the risk of suicidal ideation and attempts between patients with stroke and population without stroke using nationwide survey data. Individual-level data were obtained from 228,735 participants (4560 with stroke and 224,175 without stroke) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with stroke and population without stroke. Multivariable logistic regression was performed to investigate the independent effects of the stroke on suicidal ideation and attempts. Stroke patients had more depressive mood (12.6 %) than population without stroke (5.7 %, p suicidal ideation (24.4 %) and attempts (1.3 %) than population without stroke (9.8 and 0.4 %, respectively; both p suicidal ideation (OR 1.65, 95 % CI 1.52-1.79) and suicidal attempts (OR 1.64, 95 % CI 1.21-2.22), adjusting for demographics, socioeconomic factors, and physical health and mental health factors. We found that stroke increased the risk for suicidal ideation and attempts, independent of other factors that are known to be associated with suicidality, suggesting that stroke per se may be an independent risk factor for suicidality.

Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review.

Science.gov (United States)

Louie, Dennis R; Eng, Janice J

2016-06-08

Powered robotic exoskeletons are a potential intervention for gait rehabilitation in stroke to enable repetitive walking practice to maximize neural recovery. As this is a relatively new technology for stroke, a scoping review can help guide current research and propose recommendations for advancing the research development. The aim of this scoping review was to map the current literature surrounding the use of robotic exoskeletons for gait rehabilitation in adults post-stroke. Five databases (Pubmed, OVID MEDLINE, CINAHL, Embase, Cochrane Central Register of Clinical Trials) were searched for articles from inception to October 2015. Reference lists of included articles were reviewed to identify additional studies. Articles were included if they utilized a robotic exoskeleton as a gait training intervention for adult stroke survivors and reported walking outcome measures. Of 441 records identified, 11 studies, all published within the last five years, involving 216 participants met the inclusion criteria. The study designs ranged from pre-post clinical studies (n = 7) to controlled trials (n = 4); five of the studies utilized a robotic exoskeleton device unilaterally, while six used a bilateral design. Participants ranged from sub-acute (6 months) stroke. Training periods ranged from single-session to 8-week interventions. Main walking outcome measures were gait speed, Timed Up and Go, 6-min Walk Test, and the Functional Ambulation Category. Meaningful improvement with exoskeleton-based gait training was more apparent in sub-acute stroke compared to chronic stroke. Two of the four controlled trials showed no greater improvement in any walking outcomes compared to a control group in chronic stroke. In conclusion, clinical trials demonstrate that powered robotic exoskeletons can be used safely as a gait training intervention for stroke. Preliminary findings suggest that exoskeletal gait training is equivalent to traditional therapy for chronic stroke

Effects of a 6-Week Aquatic Treadmill Exercise Program on Cardiorespiratory Fitness and Walking Endurance in Subacute Stroke Patients: A PILOT TRIAL.

Science.gov (United States)

Han, Eun Young; Im, Sang Hee

2017-03-15

To assess the feasibility and safety of a 6-week course of water walking performed using a motorized aquatic treadmill in individuals with subacute stroke for cardiorespiratory fitness, walking endurance, and activities of daily living. Twenty subacute stroke patents were randomly assigned to aquatic treadmill exercise (ATE) or land-based exercise (LBE). The ATE group (n = 10) performed water-based aerobic exercise on a motorized aquatic treadmill, and the LBE group (n = 10) performed land-based aerobic exercise on a cycle ergometer. Both groups performed aerobic exercise for 30 minutes, 5 times per week for 6 weeks. Primary outcome measures were 6-minute walk test for walking endurance and cardiopulmonary fitness parameters of a symptom-limited exercise tolerance test, and secondary measures were Korean version of the Modified Barthel Index (K-MBI) for activities of daily living. All variables were assessed at baseline and at the end of the intervention. The ATE group showed significant improvements in 6-minute walk test (P = .005), peak oxygen uptake (V·o2peak; P = .005), peak heart rate (P = .007), exercise tolerance test duration (P = .005), and K-MBI (P = .008). The LBE group showed a significant improvement only in K-MBI (P = .012). In addition, improvement in V·o2peak was greater in the ATE than in the LBE group. This preliminary study showed that a 6-week ATE program improved peak aerobic capacity and walking endurance in patients with subacute stroke. The improvement in V·o2peak after an ATE exercise program was greater than that observed after an LBE program. Therefore, ATE effectively improves cardiopulmonary fitness in patients with subacute stroke.

The relationship between pneumonia and Glasgow coma scale assessment on acute stroke patients

Science.gov (United States)

Ritarwan, K.; Batubara, C. A.; Dhanu, R.

2018-03-01

Pneumonia is one of the most frequent medical complications of a stroke. Despite the well-documented association of a stroke associated infections with increased mortality and worse long-term outcome, on the other hand, the limited data available on independent predictors of pneumonia in acute stroke patients in an emergency unit. To determine the independentrelationship between pneumonia and Glasgow Coma Scale assessment on acute stroke patients. The cohort retrospective study observed 55 acute stroke patients who stayed in intensive care unit Adam Malik General Hospital from January until August 2017. Pneumonia was more frequent in patients with Ischemic stroke (OR 5.40; 95% CI: 1.28 – 6.40, p=0.003), higher National Institute of Health Stroke Scale (NIHSS) (p=0.014) and lower Glasgow Coma Scale (p=0.0001). Analysis multivariate logistic regression identified NIHSS as an independent of predictors of pneumonia (95% CI : 1.047 – 1.326, p=0.001). Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficits evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014.

Science.gov (United States)

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

2017-11-01

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 hemorrhagic 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.

Positioning and early mobilisation in stroke.

Science.gov (United States)

Keating, Moira; Penney, Maree; Russell, Petra; Bailey, Emma

Stroke unit care, providing early rehabilitation, improves long-term outcomes for patients following a stroke. Early mobilisation and good positioning are recognised as key aspects of care in stroke units. Nurses working on stroke units have an important role because they are able to implement positioning and early mobilisation strategies 24 hours a day, reducing the risk of complications and improving functional recovery. Patients benefit if nurses work effectively with the therapy team in positioning and early mobilisation. Nurses also need appropriate training and expertise to make best use of specialist equipment.

Hypercholesterolemia in patients of ischemic stroke

International Nuclear Information System (INIS)

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

2015-01-01

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

The evaluation of cerebral oxygenation by oximetry in patients with ischaemic stroke.

Directory of Open Access Journals (Sweden)

Demet G

2000-04-01

Full Text Available AIMS: To evaluate the clinical significance of estimation of the regional cerebral oxygen saturation (rSO2 in the patients with ischaemic stroke by the cerebral oximetry during acute, sub-acute and chronic phases. SUBJECTS AND METHODS: In this prospective study, 24 patients with ischaemic stroke in the middle cerebral artery territory were included. A detailed clinical examination and appropriate laboratory investigations were carried out. The rSO2 was determined by oximetery (INVOS 3100-SD bilaterally on the first, third, seventh, and fifteenth days. The blood pressure, the peripheral capillary oxygen saturation and the arterial blood gas values were noted too. the changes were evaluated along with Glasgow coma scale (GCS using unpaired student t-test and one way ANOVA test. RESULTS: There were significant differences between the rSO2 values in acute, subacute and chronic phases on the side of the lesion (p value < 0.05. The values of oxygen saturation gradually increased throughout the chronic phase. These values showed a positive correlation with GCS, but the results were not significant statistically. The rSO2 values were also significantly higher on the non-lesional side than those on the lesion side in the acute phase (p= 0.0034, the discrepancy disappeared during the sub-acute and chronic phases. CONCLUSION: Cerebral oximetry can be used as a measure to evaluate the cerebral oxygenation during the various phases of ischaemic stroke. It has a potential to serve as a useful marker for detection of cerebral oxygenation imbalances, to judge the effectiveness of the management and for the follow-up of patients with ischaemic stroke.

19 CFR 101.6 - Hours of business.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Hours of business. 101.6 Section 101.6 Customs... GENERAL PROVISIONS § 101.6 Hours of business. Except as specified in paragraphs (a) through (g) of this section, each CBP office shall be open for the transactions of general CBP business between the hours of 8...

Epilepsy after stroke

DEFF Research Database (Denmark)

Olsen, T S; Høgenhaven, H; Thage, O

1987-01-01

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....

Kinematic measures for upper limb motor assessment during robot-mediated training in patients with severe sub-acute stroke.

Science.gov (United States)

Duret, Christophe; Courtial, Ophélie; Grosmaire, Anne Gaelle

2016-01-01

Kinematic assessments are increasingly used as motor outcome measures during upper limb robot-assisted training, in addition to clinical scales. However, their relevance has not been evaluated much. Thirty-eight patients with severe sub-acute stroke (age 56 ± 17 [19-87] years; time since stroke, 55 ± 22 days) carried out 16 sessions (average 3/week, 35 ± 15 days) of upper limb robot-assisted training combined with standard therapy. Pre/post motor performance was evaluated using the Fugl-Meyer Assessment scale, Motor Status Scale (MSS) and kinematic measures. Motor outcomes were compared and relationships between clinical and kinematic outcomes were analyzed. All clinical and kinematic outcomes improved after training (p kinematic measures were strongly correlated with clinical scores. Correlations between clinical and kinematic changes were moderate (r = -0.65 for change in FM Proximal score and change in accuracy measure). However, smoothness and accuracy indicators were shown to be responsive measures. This study demonstrated that baseline kinematic measures and their pre/post training changes were significantly correlated with clinical motor outcome measures. However, even if kinematic measures are valid for the evaluation of motor impairment we cannot propose to substitute common clinical measures of motor function which also evaluate functional abilities of the upper limb.

Comparison of 44-hour and fixed 24-hour ambulatory blood pressure monitoring in dialysis patients.

Science.gov (United States)

Liu, Wenjin; Ye, Hong; Tang, Bing; Sun, Zhiping; Wen, Ping; Wu, Wenhui; Bian, Xueqing; Shen, Xia; Yang, Junwei

2014-01-01

The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44-hour and 24-hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24-hour period that correlated well with the 44-hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44-hour ABPM and extracted data for a fixed 24-hour ABPM. The fixed 24-hour ABPM started at 6 am on the nondialysis day. A strong correlation was found between all parameters of 44-hour and the fixed 24-hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters. Both 24-hour ABPM and 44-hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44-hour ambulatory arterial stiffness index (AASI), but not 24-hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44-hour systolic blood pressure, this association disappeared. Fixed 24-hour ABPM is a good surrogate of 44-hour ABPM to some extent, while 44-hour ABPM can provide more accurate and detailed information. ©2013 Wiley Periodicals, Inc.

Discrimination of acute ischemic stroke from nonischemic vertigo in patients presenting with only imbalance.

Science.gov (United States)

Honda, Shoji; Inatomi, Yuichiro; Yonehara, Toshiro; Hashimoto, Yoichiro; Hirano, Teruyuki; Ando, Yukio; Uchino, Makoto

2014-01-01

Some patients who present with an acute feeling of imbalance are experiencing an ischemic stroke that is not evident on computed tomography (CT) scans. The aim of this study was to compare ischemic stroke and nonischemic vertigo patient groups and to investigate independent factors associated with ischemic stroke. We examined 332 consecutive patients with an acute feeling of imbalance who showed no neurologic findings or responsible lesions on CT scan at the hyperacute phase. We examined their clinical backgrounds, physical findings, and laboratory examinations, with ischemic stroke diagnosed by later CT and/or magnetic resonance imaging (MRI). We identified 41 (12.3%) ischemic stroke patients. Atrial fibrillation (odds ratio 4.1; 95% confidence interval 1.4-11.5), white blood cell count (10(3)/μL, 1.4; 1.2-1.6), head and/or neck pain (4.6; 2.1-10.3), first attack of imbalance feeling (3.3; 1.1-12.2), and dizziness (3.7; 1.7-8.3) were significant and independent factors associated with ischemic stroke among patients with an acute feeling of imbalance. We used these factors to calculate an "imbalance score"; 1 point was given for the presence of each factor and a score of 3-5 points was independently associated with ischemic stroke. An awareness of these factors may indicate that further examinations including MRI are necessary to rule out ischemic stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Long-term use of antiplatelet drugs by stroke patients

DEFF Research Database (Denmark)

Ostergaard, Kamilla; Hallas, Jesper; Bak, Søren

2012-01-01

PURPOSE: Treatment with antiplatelet drugs is a key element of secondary stroke prevention. We investigated long-term antiplatelet drug use in stroke patients with a focus on non-persistence. METHODS: Population-based prescription register data were used to determine antiplatelet drug use...... the dosage of a previous prescription had run out, or within 180 days after discharge. Cox regression was used to identify risk factors for non-persistence. RESULTS: The cohort comprised 503 patients with ischaemic stroke discharged in 1999-2001. During follow-up (median 2.8 years, interquartile range 0......-persistent. Stroke severity was inversely associated with the risk of non-persistence [NIHSS score on admission 0-3 (reference); 4-6: hazard risk (HR) 0.87, 95 % confidence interval (CI) 0.61-1.25; 7+: HR 0.47, 95 % CI 0.29-0.74]. CONCLUSIONS: Long-term non-persistence with antiplatelet treatment was high and more...

Comparison of serum lipid profile in ischaemic and haemorrhagic stroke

International Nuclear Information System (INIS)

Mehmood, A.; Sharif, M.A.

2010-01-01

To compare serum lipid profile between patients of ischaemic and haemorrhagic strokes. Study Design: Cross sectional, comparative study. Place and Duration of Study: Military Hospital, Rawalpindi, from August 2004 to February 2005. Methodology: Patients with diagnosis of stroke comprising 100 consecutive patients each of ischaemic and haemorrhagic strokes were included in the study while patients on lipid lowering therapy were excluded from study. To determine the subtype of stroke, clinical examination followed by CT scan of brain was done. A serum sample after 8 hours of overnight fasting was taken on the next day of admission for both groups of patients. Total serum cholesterol, triglycerides, LDL cholesterol, VLDL-cholesterol and HDL-cholesterol was determined, using enzymatic colorimetric method. Statistical analysis was done by comparison of lipid profile in two subgroups, using proportion test for any significant difference. Results: The mean age at presentation of patients with stroke was 64.2+-12 years with a male to female ratio of 3.6:1. In 100 ischaemic stroke patients, raised serum total cholesterol was seen in 42, triglyceride in 04, LDL-cholesterol in 05 and VLDL-cholesterol in 07 patients. Serum HDL-cholesterol was below the normal reference in 31 cases. On the other hand, serum total cholesterol and triglycerides was raised in 05 patients each, LDL-cholesterol in 09 and VLDL-cholesterol in 03 patients of haemorrhagic stroke. Serum HDL-cholesterol was below normal in 04 patients of haemorrhagic stroke. On comparison, there were significantly greater number of patients with raised serum cholesterol and low HDL-cholesterol in ischaemic stroke than haemorrhagic stroke (p < 0.05). No statistical significance was found on comparing serum values of ischaemic and haemorrhagic stroke for triglycerides, LDL-cholesterol and VLDL-cholesterol. Conclusion: Ischaemic stroke patients had high serum total cholesterol and lower HDL-cholesterol levels as compared to

Default Mode Network Connectivity in Stroke Patients.

Science.gov (United States)

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

2013-01-01

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.

The prevalence of HIV among patients admitted with stroke at the ...

African Journals Online (AJOL)

lmboera

The respective proportions were 44% vs 24.7%; 26.7% vs 7.6%; 20.0% vs 2.9%; 13.3% vs 1.2%; ... Key words: HIV, stroke, prevalence, hospital, Tanzania ..... The clinical picture of patients with stroke and HIV infection is of importance. As.

Diffusion-weighted MRI in acute cerebral stroke

International Nuclear Information System (INIS)

Takayama, Hideichi; Kobayashi, Masahito; Suga, Sadao; Kawase, Takeshi; Nagasawa, Masakazu; Sadanaga, Humiko; Okamura, Miyuki; Kanai, Yoshihiro; Mihara, Ban

1999-01-01

Diffusion-weighted MRI has been demonstrated to be valuable in the assessment of cerebral stroke. Recent advance in MR systems of hardware with larger maximum gradient amplitude and faster imaging strategies, such as EPI, has made it possible to acquire whole brain diffusion-weighted imaging (DWI) in less that one minute. The purposes of this study are to evaluate clinical usefulness of DWI and to clarify pitfalls in the diagnosis of acute cerebral stroke. Seventeen patients with 18 ischemic lesions were studied. DWI were taken with 1.5 Tesla MRI (Magnetom Vision, Siemens, Germany) using EPI sequence. Fifteen lesions out of them (3 in cerebral cortex, 9 in basal ganglia/deep white matter and 3 in cerebellum) were studied serially at various times up to 147 days. Acute cerebral infarction was seen clearly as an area of hyperintensity with DWI and as hypointensity in apparent diffusion coefficient (ADC) maps which are indicative of decreased diffusion. DWI detected areas of hyperintense acute infarcts, as early as 2.5 hours after onset, which were not visualized on T 2 -weighted image (T2WI). The lesion of cerebral infarction became isointense in ADC maps at 14-28 days after onset, whereas with DWI it became isointense at about 2 months. Because ADC changed earlier than DWI, ADC maps were useful for differentiate acute from nonacute lesion in cases of recurrent stroke within a short period. In a patient with transient global amnesia for 7 hours, DWI did not show any lesion at 8 hours. In terms of cerebral hemorrhage, lesions were seen as area of hyperintensity in DWI at 3 days and were not distinguishable from that of infarct. Despite limitations in the diagnosis of transient ischemia and cerebral hemorrhage, DWI is a useful technique for early detection of cerebral infarction, especially within the first 6 hours after stroke onset. (author)

SECONDARY PREVENTION OF STROKE IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: THE CLINICIANS’ VIEWPOINT

Directory of Open Access Journals (Sweden)

E. A. Drozdova

2015-09-01

Full Text Available Atrial fibrillation is one of the main risk factor of ischemic stroke. Current problems of the management of patients with stroke due to non-valvular atrial fibrillation and secondary stroke prevention in these patients are considered. Data of own author’s observation for patients of this type during 6 months after discharge from the hospital are presented. The problems which patients faced with are analyzed. Comparative assessment of warfarin and dabigatran therapies is given.

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

DEFF Research Database (Denmark)

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

2011-01-01

Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation are at in......Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation.......96), and the combined endpoint of stroke progression, recurrent stroke, and death (D-dimer: 991 ng/ml vs 970 ng/ml, P = 0.91). Multivariable analyses did not alter the results. Conclusion -  D-dimer and other markers of hemostatic activation were not associated with stroke progression, recurrent stroke, or death...

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

Science.gov (United States)

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

2009-11-01

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

Sub-hour solar data for power system modeling from static spatial variability analysis

Energy Technology Data Exchange (ETDEWEB)

Hummon, Marissa R.; Ibanez, Eduardo; Brinkman, Gregory; Lew, Debra [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2012-07-01

High penetration renewable integration studies need high quality solar power data with spatial-temporal correlations that are representative of a real system. For instance, as additional solar power sites are added, the relative amount of variability should decrease due to spatial averaging of localized irradiance fluctuations. This presentation will summarize the research relating sequential point-source sub-hour global horizontal irradiance (GHI) values to static, spatially distributed GHI values. This research led to the development of an algorithm for generating coherent sub-hour datasets that span distances ranging from 10 km to 4,000 km. The algorithm, in brief, generates synthetic GHI values at an interval of one minute, for a specific location, using SUNY/Clean Power Research, satellite-derived, hourly irradiance values for the nearest grid cell to that location and grid cells within 40 km. During each hour, the observed GHI value for the grid cell of interest and the surrounding grid cells is related, via probability distributions, to one of live temporal cloud coverage classifications (class I, II, III, IV, V). Synthesis algorithms are used to select one-minute time step GHI values based on the classification of the grid cell of interest in a particular hour. Three primary statistical measures of the dataset are demonstrated: reduction in ramps as a function of aggregation; coherence of GHI values across sites ranging from 6 to 400 km apart over time scales from one minute to three hours; and ramp magnitude and duration distributions as a function of time of day and day of year. (orig.)

A comparative study of the sensitivity of diffusion-related parameters obtained from diffusion tensor imaging, diffusional kurtosis imaging, q-space analysis and bi-exponential modelling in the early disease course (24 h) of hyperacute (6 h) ischemic stroke patients.

Science.gov (United States)

Duchêne, Gaëtan; Peeters, Frank; Peeters, André; Duprez, Thierry

2017-08-01

To compare the sensitivity and early temporal changes of diffusion parameters obtained from diffusion tensor imaging (DTI), diffusional kurtosis imaging (DKI), q-space analysis (QSA) and bi-exponential modelling in hyperacute stroke patients. A single investigational acquisition allowing the four diffusion analyses was performed on seven hyperacute stroke patients with a 3T system. The percentage change between ipsi- and contralateral regions were compared at admission and 24 h later. Two out of the seven patients were imaged every 6 h during this period. Kurtoses from both DKI and QSA were the most sensitive of the tested diffusion parameters in the few hours following ischemia. An early increase-maximum-decrease pattern of evolution was highlighted during the 24-h period for all parameters proportional to diffusion coefficients. A similar pattern was observed for both kurtoses in only one of two patients. Our comparison was performed using identical diffusion encoding timings and on patients in the same stage of their condition. Although preliminary, our findings confirm those of previous studies that showed enhanced sensitivity of kurtosis. A fine time mapping of diffusion metrics in hyperacute stroke patients was presented which advocates for further investigations on larger animal or human cohorts.

Topographic Evaluation of Aphasia in 100 Stroke Patients

Directory of Open Access Journals (Sweden)

S Ghandehari

2005-07-01

Full Text Available Introduction: Aphasia is a common manifestation of stroke and evaluation of relationships of aphasia and brain topography could lead to better understanding of cognitive neurophysiology. Methods: 100 stroke patients with aphasia admitted in Valie-Asr hospital, Khorasan since April 2003 were enrolled in this prospective cross-sectional study. Diagnosis of stroke and aphasia was made by a neurologist and topography of involved cerebrovascular territories confirmed by topographic maps of brain in CT scan. Results: Global, Broca and Wernicke subtypes of aphasia constituted 52%, 40% and 6% of the cases, respectively. Based on the usual nourishment of Broca and Wernicke areas by anterior and posterior cortical branches of the middle cerebral artery, 79% of Global, 47% of Broca and 50% of Wernicke aphasias had compatible infarct topography. The infarct topography in other cases was not congruent with the involved linguistic areas of their brain. Conclusion: Specific cerebrovascular topography for subtypes of aphasia in stroke patients was not found. The effects of cerebrovascular lesions on linguistic functions are not predictable by their topography in CT scan.

Effects of edaravone on muscle atrophy and locomotor function in patients with ischemic stroke: a randomized controlled pilot study.

Science.gov (United States)

Naritomi, Hiroaki; Moriwaki, Hiroshi; Metoki, Norifumi; Nishimura, Hiroyuki; Higashi, Yasuto; Yamamoto, Yasumasa; Yuasa, Hiroyuki; Oe, Hiroshi; Tanaka, Kortaro; Saito, Kozue; Terayama, Yasuo; Oda, Tadafumi; Tanahashi, Norio; Kondo, Hisao

2010-01-01

Stroke patients with severe leg paralysis are often bedridden in the acute and subacute phase, which increases the risk of disuse muscle atrophy in the chronic phase. The evidence to date indicates that oxidative stress plays an important role in the mechanism of disuse muscle atrophy. Therefore, the aim of this study was to determine if long-term radical scavenger treatment with edaravone following an acute stroke prevents the progression of disuse muscle atrophy and improves leg locomotor function in the chronic phase. This randomized controlled pilot study was conducted at 19 acute stroke and rehabilitation centers across Japan. Forty-seven ischemic stroke patients with at least leg motor weakness admitted within 24 hours of onset were randomly assigned to receive continuous intravenous infusions of edaravone 30 mg twice daily for 3 days (short-term group) or 10-14 days (long-term group). The primary endpoints of the study included the degree of leg disuse muscle atrophy, as measured by the percentage change from baseline in femoral muscle circumference 15 cm above the knee, and the improvement in leg locomotor function, as assessed by the maximum walking speed over 10 m, 3 months after the onset of stroke. Three-month follow-up was completed by a total of 41 patients (21 in the short-term group and 20 in the long-term group). On admission, there was no significant difference in the severity of stroke or the grade of leg paresis between the two treatment groups. The grade of disuse muscle atrophy and incidence of gait impairment 3 weeks after stroke onset were also similar between the short- and long-term groups. However, disuse muscle atrophy of the paretic and non-paretic legs was significantly less severe in the long-term versus the short-term treatment group (3.6 ± 5.9% and 1.5 ± 6.0% vs 8.3 ± 5.2% and 5.7 ± 6.4%; p < 0.01 and p < 0.05) 3 months after stroke onset. Additionally, the maximum walking speed over a distance of 10 m

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

Science.gov (United States)

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

2017-01-01

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

[Commercial video games in the rehabilitation of patients with sub-acute stroke: a pilot study].

Science.gov (United States)

Cano-Manas, M J; Collado-Vazquez, S; Cano-de-la-Cuerda, R

2017-10-16

Stroke generates dependence on the patients due to the various impairments associated. The use of low-cost technologies for neurological rehabilitation may be beneficial for the treatment of these patients. To determine whether combined treatment using a semi-immersive virtual reality protocol to an interdisciplinary rehabilitation approach, improve balance and postural control, functional independence, quality of life, motivation, self-esteem and adherence to intervention in stroke patients in subacute stage. A longitudinal prospective study with pre and post-intervention evaluation was carried out. Fourteen were recruited at La Fuenfria Hospital (Spain) and completed the intervention. Experimental intervention was performed during eight weeks in combination with conventional treatment of physiotherapy and occupational therapy. Each session was increased in time and intensity, using commercial video games linked to Xbox 360° videoconsole and Kinect sensor. There were statistical significant improvements in modified Rankin scale (p = 0.04), baropodometry (load distribution, p = 0.03; support surface, p = 0.01), Barthel Index (p = 0.01), EQ-5D Questionnaire (p = 0.01), motivation (p = 0.02), self-esteem (p = 0.01) and adherence to the intervention (p = 0.02). An interdisciplinary rehabilitation approach supplemented with semi-immersive virtual reality seems to be useful for improving balance and postural control, functional independence in basic activities of daily living, quality of life, as well as motivation and self-esteem, with excellent adherence. This intervention modality could be adopted as a therapeutic tool in neurological rehabilitation of stroke patients in subacute stage.

Correlation of the L-Arginine Pathway with Thrombo-Inflammation May Contribute to the Outcome of Acute Ischemic Stroke

DEFF Research Database (Denmark)

Molnar, Tihamer; Pusch, Gabriella; Nagy, Lajos

2016-01-01

BACKGROUND: Immune responses contribute to secondary injury after acute ischemic stroke (AIS), and metabolites of the L-arginine pathway are associated with stroke outcome. Here, we analyzed the relationship of the L-arginine pathway with thrombo-inflammatory biomarkers in AIS and their additive...... and independent associations to outcome. METHODS: Serial changes in P-selectin, tPA, MCP-1, sCD40L, IL-6, IL-8, L-arginine, and asymmetric and symmetric dimethylarginine (ADMA, SDMA) were investigated in 55 patients with AIS and without infection within 6 and 72 hours after stroke onset. Outcomes were assessed...... as National Institutes of Health Stroke Scale (NIHSS) worsening by 24 hours, poststroke infection, and death by 1 month. RESULTS: Serum levels of L-arginine showed negative correlation, whereas ADMA and SDMA showed positive correlation with thrombo-inflammatory biomarkers in the hyperacute phase. Most...

Cocaine Use and Risk of Ischemic Stroke in Young Adults.

Science.gov (United States)

Cheng, Yu-Ching; Ryan, Kathleen A; Qadwai, Saad A; Shah, Jay; Sparks, Mary J; Wozniak, Marcella A; Stern, Barney J; Phipps, Michael S; Cronin, Carolyn A; Magder, Laurence S; Cole, John W; Kittner, Steven J

2016-04-01

Although case reports have long identified a temporal association between cocaine use and ischemic stroke (IS), few epidemiological studies have examined the association of cocaine use with IS in young adults, by timing, route, and frequency of use. A population-based case-control study design with 1090 cases and 1154 controls was used to investigate the relationship of cocaine use and young-onset IS. Stroke cases were between the ages of 15 and 49 years. Logistic regression analysis was used to evaluate the association between cocaine use and IS with and without adjustment for potential confounders. Ever use of cocaine was not associated with stroke with 28% of cases and 26% of controls reporting ever use. In contrast, acute cocaine use in the previous 24 hours was strongly associated with increased risk of stroke (age-sex-race adjusted odds ratio, 6.4; 95% confidence interval, 2.2-18.6). Among acute users, the smoking route had an adjusted odds ratio of 7.9 (95% confidence interval, 1.8-35.0), whereas the inhalation route had an adjusted odds ratio of 3.5 (95% confidence interval, 0.7-16.9). After additional adjustment for current alcohol, smoking use, and hypertension, the odds ratio for acute cocaine use by any route was 5.7 (95% confidence interval, 1.7-19.7). Of the 26 patients with cocaine use within 24 hours of their stroke, 14 reported use within 6 hours of their event. Our data are consistent with a causal association between acute cocaine use and risk of early-onset IS. © 2016 American Heart Association, Inc.

Effect of uv and gamma irradiation on vitamin B/sub 6/ content and protein constituents of feeds

Energy Technology Data Exchange (ETDEWEB)

Koesters, W W; Kirchgessner, M [Technische Univ. Muenchen, Weihenstephan (Germany, F.R.). Inst. fuer Tierernaehrung

1976-01-01

In irradiation studies using UV and gamma rays, the extent of loss of vitamin B/sub 6/ in different feeds was investigated. During UV irradiation for periods of 24, 48, 72 and 96 hours, a dependence of the vitamin B/sub 6/ destruction upon the length of irradiation was demonstrated. The extent of vitamin B/sub 6/ destruction after irradiation for 96 hours amounted to about of 33% in both dried skim milk and flaked oats. In fish meal, however, the decay of vitamin B/sub 6/ was only 17% even after 120 hours. Gamma irradiation of dried skim milk and a piglet prestarter at doses of 5, 7 and 14.3 Mrad resulted in an increasing loss of vitamin B/sub 6/ in response to the radiation dose. The addition of 0.03% ascorbic acid as an antioxidant increased the vitamin B/sub 6/ destruction, while vitamin E and smaller amounts of ascorbic acid remained without influence. In both feeds the loss of vitamin B/sub 6/ was about 40% after the dose of 14.3 Mrad. Simultaneous studies on amino acid composition and lysine availability revealed that high doses of gamma radiation may adversely affect the protein constituents of feeds.

The Importance of Patient Involvement in Stroke Rehabilitation

Science.gov (United States)

2016-01-01

Objective To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. Method Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. Results The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. Conclusions The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health

Helsinki Stroke Model Is Transferrable With “Real-World” Resources and Reduced Stroke Thrombolysis Delay to 34 min in Christchurch

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Teddy Y. Wu

2018-04-01

Full Text Available BackgroundChristchurch hospital is a tertiary hospital in New Zealand supported by five general neurologists with after-hours services provided mainly by onsite non-neurology medical residents. We assessed the transferrability and impact of the Helsinki Stroke model on stroke thrombolysis door-to-needle time (DNT in Christchurch hospital.MethodsKey components of the Helsinki Stroke model were implemented first in 2015 with introduction of patient pre-notification and thrombolysis by the computed tomography (CT suite, followed by implementation of direct transfer to CT on ambulance stretcher in May 2017. Data from the prospective thrombolysis registry which began in 2012 were analyzed for the impact of these interventions on median DNT.ResultsBetween May and December 2017, 46 patients were treated with alteplase, 25 (54% patients were treated in-hours (08:00–17:00 non-public holiday weekdays and 21 (46% patients were treated after-hours. The in-hours, after-hours, and overall median (interquartile range DNTs were 34 (28–43, 47 (38–60, and 40 (30–51 minutes. The corresponding times in 2012–2014 prior to interventions were 87 (68–106, 86 (72–116, and 87 (71–112 minutes, representing median DNT reduction of 53, 39, and 47 minutes, respectively (p-values <0.01. The interventions also resulted in significant reductions in the overall median door-to-CT time (from 49 to 19 min, CT-to-needle time (32 to 20 min and onset-to-needle time (168 to 120 min.ConclusionThe Helsinki stroke model is transferrable with real-world resources and reduced stroke DNT in Christchurch by over 50%.

Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis.

Science.gov (United States)

Ellis, Graham; Mant, Jonathan; Langhorne, Peter; Dennis, Martin; Winner, Simon

2010-05-12

Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing. To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'. We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators. Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care. We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain. We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P

Hip Hop Stroke: Study Protocol for a Randomized Controlled Trial to Address Stroke Literacy.

Science.gov (United States)

Williams, Olajide; Leighton-Herrmann, Ellyn; DeSorbo, Alexandra; Hecht, Mindy; Hedmann, Monique; Huq, Saima; Gerin, William; Chinchilli, Vernon; Ogedegbe, Gbenga; Noble, James

2015-10-01

Stroke is the fifth leading cause of death and the leading cause of serious long-term adult disability in the US. Acute stroke treatments with intravenous thrombolysis and endovascular therapy are proven to reduce disability, however a critical limitation on their effectiveness is the narrow time window for administration, which is 4.5 hours and 6 hours respectively from the onset of symptoms. Our overarching goal is to reduce pre-hospital delays to acute stroke treatments in economically disadvantaged minority communities where the greatest delays exist, using Hip Hop Stroke. Hip Hop Stroke (HHS) is a school-based, child-mediated, culturally-tailored stroke communication multimedia intervention developed using validated models of behavior change and designed to improve stroke literacy (knowledge of stroke symptoms, the urgent need to call 911, and prevention measures) of 4 th , 5 th and 6 th grade students and their parents residing in poor urban communities. Children in the intervention arm will receive the HHS intervention, while those in the attentional control arm will receive standardized nutrition education based on the USDA's MyPyramid program. Children will be trained and motivated to share stroke information with their parents or other adult caregiver. Both children and parents will complete a stroke knowledge assessment at baseline, immediately following the program, and at 3-months post-program. The primary outcome is the effect of the child mediation on parental stroke literacy. Stroke literate children, a captive audience in school systems, may represent a viable channel for spreading stroke information into households of poor urban communities where mass media stroke campaigns have shown the lowest penetration. These children may also call 911 when witnessing a stroke in their homes or communities. The HHS program may highlight the potential role of children in the chain of stroke recovery as a strategy for reducing prehospital delays to acute stroke

Prediabetes is associated with post-stroke cognitive impairment in ischaemic stroke patients.

Science.gov (United States)

Wang, Qiongzhang; Zhao, Kai; Cai, Yan; Tu, Xinjie; Liu, Yuntao; He, Jincai

2018-05-15

Diabetes mellitus is associated with post-stroke cognitive impairment. To the best of our knowledge, no study has explored the relationship between prediabetes and post-stroke cognitive impairment. The purpose of this study is to explore the association between prediabetes and cognitive impairment in ischaemic stroke patients at 1 month. Two hundred one acute ischaemic stroke patients were consecutively recruited within the first 24 h after admission and were followed up for 1 month. Patients were divided into a diabetes mellitus group, prediabetes group and non-diabetes mellitus group by fasting glucose levels, 2-h postprandial blood glucose levels and glycosylated haemoglobin levels at admission. Cognitive function was evaluated by the Mini-Mental State Examination at 1 month after stroke. The prediabetes group had a higher risk of post-stroke cognitive impairment than the non-diabetes group (35.7% vs. 18.1%, χ 2  = 4.252, P = .039). In logistical analyses, prediabetes was associated with post-stroke cognitive impairment after adjusting for potential confounding factors (odds ratio 3.062, 95% confidence interval 1.130-8.299, P = .028). Our findings show that prediabetes is associated with post-stroke cognitive impairment and may predict its development at 1 month post-stroke. Copyright © 2018 Elsevier B.V. All rights reserved.

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

Directory of Open Access Journals (Sweden)

M. K. M. Kathyayani

2016-10-01

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

[Primary emergencies: management of acute ischemic stroke].

Science.gov (United States)

Leys, Didier; Goldstein, Patrick

2012-01-01

The emergency diagnostic strategy for acute ischemic stroke consists of:--identification of stroke, based on clinical examination (sudden onset of a focal neurological deficit);--identification of the ischemic or hemorrhagic nature by MRI or CT;--determination of the early time-course (clinical examination) and the cause. In all strokes (ischemic or hemorrhagic), treatment consists of:--the same general management (treatment of a life-threatening emergency, ensuring normal biological parameters except for blood pressure, and prevention of complications);--decompressive surgery in the rare cases of intracranial hypertension. For proven ischemic stroke, other therapies consist of: rt-PA for patients admitted with 4.5 hours of stroke onset who have no contraindications, and aspirin (160 to 300 mg) for patients who are not eligible for rt-PA. These treatments should be administered within a few hours. A centralized emergency call system (phone number 15 in France) is the most effective way of achieving this objective.

Seizure development after stroke.

Science.gov (United States)

Misirli, H; Ozge, A; Somay, G; Erdoğan, N; Erkal, H; Erenoğlu, N Y

2006-12-01

Although there have been many studies on seizures following stroke, there is still much we do not know about them. In this study, we evaluated the characteristics of seizures in stroke patients. There were 2267 patients with a first-ever stroke, and after excluding 387 patients, 1880 were available for analysis. Of these 1880 patients, we evaluated 200 patients with seizures and 400 patients without seizures. We investigated the seizures according to age, gender, stroke type, the aetiology of ischaemic stroke and the localisation of the lesion. The seizures were classified as early onset and late onset and the seizure type as partial, generalised or secondarily generalised. Seizures occurred in 200 (10.6%) of 1880 strokes. The number of patients with seizures were 138 (10.6%) in ischaemic stroke group and 62 (10.7%) in haemorrhagic stroke group. Patients with ischaemic strokes had 41 embolic (29.7%) and 97 thrombotic (70.3%) origin, and these were not statistically significant in comparison with controls. Cortical involvement for the development of seizures was the most important risk factor (odds ratios = 4.25, p < 0.01). It was concluded that embolic strokes, being younger than 65 years old, and cortical localisation of stroke were important risks for developing seizures.

An individualized coaching program for patients with acute ischemic stroke: Feasibility study.

Science.gov (United States)

Vanacker, P; Standaert, D; Libbrecht, N; Vansteenkiste, I; Bernard, D; Yperzeele, L; Vanhooren, G

2017-03-01

An individualized stroke care program was developed to match patients' education with their needs regarding stroke knowledge, secondary prevention and rehabilitation. Our purpose was to assess feasibility of in-hospital and post-discharge, personalized stroke coaching service. Acute ischemic stroke patients enrolled in ASTRAL-B stroke registry (Sint-Lucashospital, Bruges Belgium) with: (a) hospitalization between 12/2014-12/2015, (b) hospital-to-home discharge, and (c) without cognitive decline, were selected. The stroke coach contacted patients individually twice during hospitalization (2×20min) and post-discharge via phone calls using the standardized WSO Post-Strokechecklist. Risk factor management, review of therapy and clinical evolution were discussed. Participants were contacted at 2 weeks, followed by repeat calls if necessary and ambulatory with the vascular neurologist at 1, 3, 6 and 12 months. Of all 255 patients meeting the inclusion criteria, 152 (59.7%) received individualized education during hospitalization by the stroke coach. Median age of our population was 74 years and median NIHSS 5. Majority of patients had at least two cardiovascular risk factors. Patients were not coached because of palliative care/decease (10%), unfavorable life expectancy (2%), dementia (8.5%) and lack of time due to short hospitalization (22%). A quarter of all patients were contacted at least once by phone, 12% were contacted at least twice after discharge. At three months, low stroke recurrence (5%) and mortality rates (4%) were identified, probably linked to improved adherence. We demonstrated feasibility of an individualized coaching service executed by well-trained stroke nurse. Future research will focus on developing an online portal delivering post-discharge services to patients and caregivers. Copyright © 2017 Elsevier B.V. All rights reserved.

Ocular disorders in stroke patients in a tertiary hospital in Nigeria

African Journals Online (AJOL)

2015-08-06

Aug 6, 2015 ... Abstract. Background: Stroke is a medical emergency of public health ... Aim: To determine the prevalence of ocular disorders in patients with stroke in a Tertiary Hospital in Nigeria. ... Risk factors include old age, high blood pressure, previous .... such as cataract, refractive errors, and age‑related changes.

Triangular Zn{sub 3} and Ga{sub 3} units in Sr{sub 2}Au{sub 6}Zn{sub 3}, Eu{sub 2}Au{sub 6}Zn{sub 3}, Sr{sub 2}Au{sub 6}Ga{sub 3}, and Eu{sub 2}Au{sub 6}Ga{sub 3}. Structure, magnetism, {sup 151}Eu Moessbauer and {sup 69;71}Ga solid state NMR spectroscopy