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Qi Y, Xing Y, Wang Q, Cao Y, Chen H, Chen Y. Analyzing post-endovascular treatment stroke prognosis with transcranial Doppler and quantitative electroencephalography. Ann Clin Transl Neurol 2024. [PMID: 39073260 DOI: 10.1002/acn3.52157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/31/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE Despite successful recanalization following acute ischemic stroke, patients may have a poor prognosis. We investigated whether transcranial Doppler combined with quantitative electroencephalography can identify patients with a poor prognosis at an early stage. METHODS Prospectively recruited patients with successful recanalization after endovascular treatment for acute ischemic stroke were assessed for prognosis at 90 days using the modified Rankin Scale. Clinical information and National Institute of Health Stroke Scale scores were recorded. Transcranial Doppler combined with quantitative electroencephalography was used to evaluate brain function. RESULTS Of the 37 patients (63.5 ± 11.7 years) studied, 18 had a poor prognosis at 90 days (modified Rankin Scale >3). Multivariable analysis revealed that transcranial Doppler indicators of the pulsatility index of the unaffected side, quantitative electroencephalography indicators of the pairwise-derived Brain Symmetry Index, and National Institute of Health Stroke Scale score were independent prognostic indicators. Modeling indicated that combining these independent predictors yielded superior accuracy and net clinical benefit to any single variable. With the final predictive model presented as a nomogram, internal validation by bootstrap resampling showed good discrimination with a concordance index of 0.961. The calibration curve displayed good agreement of predicted and actual probabilities. INTERPRETATION The nomogram prediction model combining transcranial Doppler with quantitative electroencephalography and National Institute of Health Stroke Scale scores can provide guidance for individualized risk prediction in patients with acute ischemic stroke after revascularization.
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Affiliation(s)
- Yajie Qi
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neuro Intensive Care Unit, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yingqi Xing
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China
| | - Qingduo Wang
- Cadiovascular Center, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yanting Cao
- Department of Neurology, Linyi People's Hospital, Linyi, China
| | - Hongxiu Chen
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China
| | - Ying Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Shivde S, Badachi S, Deepalam S, Nadig R, Huddar A, Mathew T, Sarma G, Gg SK, Sanjee SS, Kapparath S. Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India. Cureus 2024; 16:e63640. [PMID: 39092397 PMCID: PMC11292294 DOI: 10.7759/cureus.63640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES This study aimed to determine the risk factors and stroke subtypes for young ischemic stroke patients and their outcomes at the time of discharge. METHODS This is a retrospective cross-sectional study of ischemic stroke patients (n = 264) between the age groups of 18 and 45. The study population was divided into two broad age groups: 18 to 35 years and 36 to 45 years; and compared based on demographics, risk factors, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and outcomes. The outcomes were compared based on the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) systems at the time of admission and discharge. RESULTS The mean age of patients was 37.84±6.19 years. The male-to-female ratio was 2.5:1. The most common vascular risk factors identified were diabetes (29.16%), hypertension (49.62%), dyslipidaemia (DLP, 44.4%), and smoking (10.9%). The most common TOAST subtype was large vessel disease (38.63%), followed by the undetermined category (35.6%). The elderly group showed a high proportion of strokes secondary to small vessel disease (14.13%; p = 0.03), while cardioembolic strokes were common in the female subgroup (p = 0.05). The majority of strokes were in the anterior circulation (66.6%) as compared to the posterior (25.75%), and nearly 50% of the patients had intracranial disease. Overall, there was a favourable MRS outcome at discharge. CONCLUSION Conventional vascular risk factors are equally prevalent, even among young stroke patients. The benchmark for young stroke age is showing a downward shift as more stroke patients above the age of 35 are showing similar risk factor trends as those of their older counterparts. The majority of stroke burden still falls under the undermined category, which requires aggressive risk factor identification and management.
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Affiliation(s)
- Sonia Shivde
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Sagar Badachi
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Saikanth Deepalam
- Intervention Neuroradiology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Raghunandan Nadig
- Neurology, St. John's National Acedemy of Health Sciences, Bengaluru, IND
| | - Akshata Huddar
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Thomas Mathew
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Grk Sarma
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Sharath Kumar Gg
- Radiology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Swathi S Sanjee
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
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de Andrade JBC, Mohr JP, Lima FO, Barros LCM, de Meira GAR, Silva Junior EAB, Robles AC, Silva GS. Predictors of congruency between clinical and radiographic Oxfordshire Community Stroke Project Classification subtypes. J Clin Neurosci 2023; 115:47-52. [PMID: 37487447 DOI: 10.1016/j.jocn.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The Oxfordshire Community Stroke Project (OCSP) classification has been widely used to assess ischemic stroke patients based on clinical characteristics alone. However, the correlation between the clinical presentation evaluated using OCSP and imaging findings is yet to be determined. Our study aimed to describe the baseline characteristics of the OCSP subtypes of patients admitted with ischemic stroke and evaluate the predictors of the relationship between clinical and neuroimaging findings. METHODS Patients with a confirmed diagnosis of ischemic stroke admitted to a comprehensive stroke center in Brazil between February 2015 and October 2017 were eligible for the study. All participants underwent computed tomography (CT) at admission and follow-up neuroimaging within seven days, per the institutional protocol. Trained staff classified patients according to the OCSP at hospital admission. The radiographic OCSP classification was retrospectively assessed based on the last follow-up neuroimaging by investigators unaware of the clinical classification. RESULTS The overall agreement rates ranged from 65.5% to 88.7%. Lower NIHSS scores, absent hyperdense MCA sign, higher ASPECTS, and absent brainstem symptoms were related to a higher risk of misclassification. Treatment with intravenous tPA was associated with reclassification in patients with total anterior circulation syndrome. For predicting radiographic posterior circulation involvement, vertigo (OR 2.9, 95% CI 1.7-5.1, p < 0.001) and brainstem symptoms (OR 35, 95% CI 20.5-60.2, p < 0.001) were directly associated with correct classification, but motor and higher cerebral function were not correlated. CONCLUSION The clinical OCSP classification presented good congruency rates with the neuroimaging findings. However, patients with lacunar syndromes are often misclassified when radiological criteria are considered.
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Affiliation(s)
- Joao Brainer Clares de Andrade
- Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP, Brazil; Columbia University, Doris and Stanley Tananbaum Stroke Center, Neurological Institute of New York, 710 W 168th St., 6th Floor, NI 614, 10032 New York City, NY, USA; Centro Universitario Sao Camilo, Av Nazare, 1501, São Paulo, São Paulo, Brazil.
| | - Jay P Mohr
- Columbia University, Doris and Stanley Tananbaum Stroke Center, Neurological Institute of New York, 710 W 168th St., 6th Floor, NI 614, 10032 New York City, NY, USA.
| | | | | | | | | | | | - Gisele Sampaio Silva
- Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP, Brazil
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Serrano-Castro ML, Garro-Zúñiga M, Simon E, Tamayo A, Siepmann T. Clinical and Imaging Phenotypes and Outcomes in a Costa Rican Cohort of Acute Ischemic Stroke Survivors: A Retrospective Study. J Clin Med 2023; 12:1080. [PMID: 36769728 PMCID: PMC9917829 DOI: 10.3390/jcm12031080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We characterized clinical and imaging phenotypes and their association with clinical outcomes in acute ischemic stroke (AIS) survivors in the understudied region of Costa Rica. METHODS We conducted a retrospective cohort study in AIS patients treated at a tertiary stroke center in Costa Rica from 2011-2015. Participants underwent detailed phenotyping for cardiovascular risk factors and stroke etiology. We assessed the association of ischemic brain lesion features and clinical outcomes using the Oxfordshire Community Stroke Project (OCSP) classification. RESULTS We included 684 AIS survivors (60.2% males, aged 68.1 ± 13.6 years, mean ± SD). While the cardiovascular risk profiles and mortality rates of our patients were similar to populations in European and North American countries, only 20.2% of patients with atrial fibrillation (AF) received anticoagulation. On multivariable analysis, patients with total anterior circulation infarct (TACI) displayed an increased risk of complications (OR: 4.2; 95% CI: 2.2-7.8; p < 0.001), higher mortality (OR: 6.9; 95% CI: 2.9-16.1; p < 0.001) and lower chance of functional independence at discharge (OR: 8.9; 95% CI: 4.1-19; p < 0.001) compared to non-TACI. The comorbidity of bronchopneumonia increased the probability of death by 14.5 times. CONCLUSIONS Our observations in a Costa Rican cohort of AIS survivors might help improve local measures for preventing and managing AIS.
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Affiliation(s)
- María Lorena Serrano-Castro
- Department of Internal Medicine, Hospital Chacón Paut, Caja Costarricense de Seguro Social, San José 10101, Costa Rica
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
| | - Mónica Garro-Zúñiga
- Department of Neurology, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José 94088, Costa Rica
| | - Erik Simon
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany
| | - Arturo Tamayo
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Winnipeg Regional Health Authority (WRHA), Section of Neurology, Department of Medicine, The Max Rady Faculty of Health Sciences, Brandon Regional Health Centre, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany
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Ambawatte SB, Weerathunga DN, Dissanayake A, Somaratne SC, Athukorala K, Wijewickrama PSA. Ischemic Stroke Subtypes: Socio-demographic Factors, Risk Factors, and Outcomes in Southern Sri Lanka. Ethn Dis 2021; 31:509-518. [PMID: 34720554 DOI: 10.18865/ed.31.4.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a heterogeneous, catastrophic disease. A comprehensive clinical analysis of ischemic stroke (IS) risk factors and outcomes is crucial for optimum management in resource-poor settings. Methods A prospective cross-sectional study of acute cerebrovascular disease (ACVD) involving 592 patients was conducted in a tertiary care center in Sri Lanka from November 2018 to May 2019. We aimed to describe the ACVD subtypes and the relationship of IS subtypes and subtype-categories (as defined by the Oxfordshire Community Stroke Project clinical classification) with risk factors, severity, and outcome. Results The majority (63.3%) had IS. Partial anterior circulation syndromes (PACS), total anterior circulation syndrome (TACS), posterior circulation syndromes (POCS), and lacunar syndromes (LACS) accounted for 102 (29.7%), 58 (16.9%), 88 (25.7%) and 95 (27.7%) of the cases, respectively. The most common PACS sub-category was higher-cerebral-dysfunction-with-homonymous-hemianopia (HCD+HH,39 cases;38.2%). Cerebellar-signs-without-long-tract-signs (CS-LTS) sub-category constituted the highest among POCS (47 cases; 53.4%). The leading sub-category within LACS was pure-motor (PM) strokes (43 cases; 45.3%).Patients aged ≥50 years (adjusted-OR [AOR]2.439; 95%CI,1.163-5.116;P=.018), IHD(AOR 2.520; 95%CI,1.347-4.713; P=.004) and BMI>23kg/m2(AOR 2.607; 95% CI,1.420-4.784; P=.002) were 2.5 times more likely to associate with TACS. Patients with a history of TIA (AOR 1.910; 95%CI,1.036-3.524; P=.038) and arrhythmias (AOR 5.933; 95%CI,3.294-10.684; P<.001) were 1.9 and 5.9 times more likely to be associated with POCS respectively. Those with hypertension were 2.3 times more likely to associate with LACS (AOR 2.233; 95%CI,1.270-3.926; P=.005).NIHSS(P<.001), mRS on admission (P=.001) and in 3 months (P<.001), deaths during hospital stay (P=.003) and within 28 days (P<.001) had a stronger relationship with individual stroke subtypes. Conclusion The comparative risk of different IS subtypes depends on different risk factors. The findings of this study demonstrate that sub-categories within each stroke subtype may behave independently with regard to risk factors and outcomes, thus warranting the need for individual assessment.
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Chen LL, Wang WT, Zhang S, Liu HM, Yuan XY, Yang X, Gu P. Cohort study on the prognosis of acute cerebral infarction in different circulatory systems at 1-year follow-up. BMC Cardiovasc Disord 2021; 21:521. [PMID: 34715789 PMCID: PMC8557055 DOI: 10.1186/s12872-021-02291-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate the prognosis of acute cerebral infarction at 1-year follow-up in different circulation infarctions. Methods Clinical data of 858 consecutive patients with acute cerebral infarction were collected. Of the 858 cases, 21 (2.45%) were lost to follow-up and 837 completed follow-up and thus were enrolled in this study. At 1-year follow-up, death or moderate-to-severe dysfunction (modified Rankin Scale (mRS) ≥ 3 points) was regarded as the poor prognostic endpoint. Univariate analysis and multivariate logistic stepwise regression analysis were performed to assess the prognosis. The prediction probability of indicators was obtained for the multivariate model, and the receiver operating characteristic curve was delineated to calculate the area under the curve (AUC) to predict the fitness of the model. Results The older the age, the greater the probability of a poor prognosis. Patients with previous diabetes and cerebral infarction had a poor prognosis. The higher the National Institutes of Health Stroke Scale and mRS scores and the lower the Barthel index at admission, the worse the prognosis of the patients. The longer the hospital stay, the worse the prognosis of the patients. The prognosis of different circulation infarctions was different. The AUC of the multivariate model was AUC = 0.893, and the 95% confidence interval was 0.870–0.913, indicating a good fit. The prognosis of anterior circulation infarction (ACI) was worse than that of posterior circulation infarction (PCI) (P < 0.05). The prognosis of patients with ACI and PCI was not significantly different from that of patients with ACI or PCI alone (P > 0.05). Conclusions Diabetes, the Barthel index at admission and previous cerebral infarction are poor prognostic factors of acute cerebral infarction. The prognosis of ACI is worse than that of PCI. Different factors affect the prognosis of different circulatory system infarctions.
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Affiliation(s)
- Li-Li Chen
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Wen-Ting Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Sai Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Hui-Miao Liu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Xiao-Yang Yuan
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, China
| | - Ping Gu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China.
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Cai Y, Liu X, Zhang L, Guo H, Gong Q, Lv F. Prevalence and characteristics of atherosclerotic plaque: Left compared with right arteries and anterior compared with posterior circulation stroke. Eur J Radiol 2021; 142:109862. [PMID: 34298390 DOI: 10.1016/j.ejrad.2021.109862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate atherosclerotic plaque prevalence and characteristics between left and right cervicocephalic arteries and between anterior and posterior circulation stroke (ACS and PCS). METHODS This retrospective study included 284 patients with acute ischemic stroke (199 ACS and 85 PCS) involving large-artery atherosclerosis or small-artery occlusion. We assessed atherosclerotic plaque prevalence and characteristics (plaque type, plaque surface morphology, plaque distribution, location of calcified nodules and plaque thickness) in each segment and their comparisons between left and right arteries and between ACS and PCS. RESULTS The left subclavian artery (L-SA), common carotid artery (L-CCA) and intracranial vertebral artery (L-IVA) had significantly higher prevalence of atherosclerotic plaque than the right (R) corresponding arteries (70.1% versus 59.5%, P = 0.008), (48.1% versus 28.9%, P < 0.001), (23.9% versus 16%, P = 0.018), respectively. L-SA had a higher prevalence of mixed plaque (non-calcified > calcified) (19.6% versus 16.4%) and noncalcified plaque (51.9% versus 31.7%), and a lower prevalence of calcified plaque (8.9% versus 23.3%) and mixed plaque (calcified > non-calcified) (19.6% versus 28.6%) than R-SA, P < 0.001. The distribution of plaque type in the SA and extracranial vertebral artery (EVA) were significantly different between ACS and PCS. The soft plaque thickness of SA in PCS was significantly greater than that in ACS (3.85 ± 1.27 versus 3.51 ± 1.04, P = 0.032). CONCLUSIONS Atherosclerotic plaque prevalence and characteristics vary in different segments, sides and between ACS and PCS. These differences should be noted during plaque diagnosis.
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Affiliation(s)
- Yan Cai
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing 40016, China.
| | - Xiaoshuang Liu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing 40016, China.
| | - Lijuan Zhang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing 40016, China.
| | - Haoming Guo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing 40016, China.
| | - Qihui Gong
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing 40016, China.
| | - Fajin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing 40016, China.
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Comparison of Ischemic and Hemorrhagic Stroke in the Medical Ward of Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Study. Neurol Res Int 2021; 2021:9996958. [PMID: 34258063 PMCID: PMC8257343 DOI: 10.1155/2021/9996958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Distinguishing the category of stroke plays a vital role in planning patient care. Simple clinical findings help distinguish the type of stroke. However, there is a need for diagnostic imaging. In Ethiopia, stroke is the most common neurological condition in patients admitted to hospitals. Yet, there are limited data on comparisons of stroke subtypes. Thus, this study was designed to determine the prevalence of stroke and to compare ischemic and hemorrhagic strokes. Methods A retrospective cross-sectional study design was employed. Medical records containing complete information and confirmed diagnosis using imaging techniques were included. The data were entered into SPSS version 24.0 for analysis. Results with a P value of <0.05 were considered statistically significant. Results From a total of 312 stroke patients, 204 (65.4%) patients were admitted due to ischemic stroke. More females, 59 (18.9%), were admitted for hemorrhagic stroke than males. In both ischemic, 175 (56.1%) and hemorrhagic, 91 (29.2%) stroke cases, most of the patients were 45 years and above. Middle cerebral artery territory was the most common site of arterial territory infarctions in ischemic stroke, 158 (50.7%). Middle cerebral artery territory also was the most common site of hematoma in hemorrhagic stroke, 91 (29.2%). Infarctions in more than one lobe of the cerebrum (16.4%) and intracerebral hemorrhage in multiple areas of the cerebrum (7.4%) were observed in ischemic as well as hemorrhagic stroke cases. Most of the ischemic, 124 (39.8%), and hemorrhagic, 39 (12.5%), stroke patients presented loss of sensation and weakness of body parts. Hypertension was observed in 124 (39.8%) ischemic and 73 (23.4%) hemorrhagic stroke patients. The mortality rate of ischemic stroke, 47 (15.3%), was two times higher than hemorrhagic stroke, 20 (6.5%). Hypertension was the most common predictor of death in both ischemic and hemorrhagic stroke cases. Conclusions Ischemic stroke is a common type of stroke in the medical ward of the study hospital. More females were affected by hemorrhagic stroke than males. Middle cerebral artery territory was the most affected area of the brain in both ischemic and hemorrhagic strokes. Most ischemic and hemorrhagic stroke patients were admitted due to loss of sensation and weakness of body parts. Hypertension was the most common risk factor of stroke as well as a predictor of stroke-related deaths. Identification of the stroke subtypes may be important in the management of stroke. Thus, health professionals, government officials, community leaders, and the population at large could be involved in creating awareness about antecedent risk factors and clinical presentations of stroke subtypes.
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The association between telomere length and ischemic stroke risk and phenotype. Sci Rep 2021; 11:10967. [PMID: 34040069 PMCID: PMC8155040 DOI: 10.1038/s41598-021-90435-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
The chronological age of a person is a key determinant of etiology and prognosis in the setting of ischemic stroke. Telomere length, an indicator of biological aging, progressively shortens with every cell cycle. Herein, we determined telomere length from peripheral blood leukocytes by Southern blot analyses in a prospective cohort of ischemic stroke patients (n = 163) and equal number of non-stroke controls and evaluated its association with various ischemic stroke features including etiology, severity, and outcome. A shorter telomere length (i.e. lowest quartile; ≤ 5.5 kb) was significantly associated with ischemic stroke (OR 2.95, 95% CI 1.70–5.13). This significant relationship persisted for all stroke etiologies, except for other rare causes of stroke. No significant association was present between admission lesion volume and telomere length; however, patients with shorter telomeres had higher admission National Institutes of Health Stroke Scale scores when adjusted for chronological age, risk factors, etiology, and infarct volume (p = 0.046). On the other hand, chronological age, but not telomere length, was associated with unfavorable outcome (modified Rankin scale > 2) and mortality at 90 days follow-up. The association between shorter telomere length and more severe clinical phenotype at the time of admission, might reflect reduced resilience of cerebral tissue to ischemia as part of biological aging.
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Impact of revascularization therapies on outcome of posterior circulation ischemic stroke: The Indo-US stroke project. J Neurol Sci 2021; 427:117499. [PMID: 34029753 DOI: 10.1016/j.jns.2021.117499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/23/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Posterior circulation strokes (PCS) have been less extensively studied than anterior circulation strokes (ACS), especially regarding revascularization therapies. We analyzed the differences in baseline stroke characteristics, revascularization therapy and 3-month outcomes between PCS and ACS in a large prospective multicentre Indian stroke registry. METHODS Patients with acute ischemic stroke recruited in the Indo-US collaborative stroke project from January 2012 to August 2014 were classified into PCS and ACS based on imaging-confirmed infarct location. Demographics, stroke severity, risk factors, and mechanisms were compared. We further compared these parameters in the subgroups who received revascularization therapies (RT) and no revascularization therapies (NRT). The primary outcome was 3-month modified Rankin scale (mRS). RESULTS Of 1889 patients (1270 males), 1478 (78.2%) had ACS and 411 (21.8%) PCS. The median NIHSS was lower in PCS (7 vs 11, p < 0.001). Diabetes mellitus and hypertension were more common in PCS and rheumatic heart disease in ACS. Small artery occlusion was higher in PCS (23.8% vs 12.9%, p < 0.001). Only 28 (6.8%) PCS received RT compared to 213 (14.4%) ACS. At 90 days, a good functional outcome (mRS 0-2) was more common in PCS (56.4% vs 45.9%, p < 0.001) in NRT group, while no significant difference was noted in RT group. Stroke territory was not an independent predictor of 3-month outcome in regression analysis. In-hospital mortality was not different between the groups. CONCLUSIONS The 3-month functional outcome and in-hospital mortality were not different between ACS and PCS. Compared to ACS, PCS received revascularization therapies less often.
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Shahjouei S, Tsivgoulis G, Farahmand G, Koza E, Mowla A, Vafaei Sadr A, Kia A, Vaghefi Far A, Mondello S, Cernigliaro A, Ranta A, Punter M, Khodadadi F, Naderi S, Sabra M, Ramezani M, Amini Harandi A, Olulana O, Chaudhary D, Lyoubi A, Campbell BCV, Arenillas JF, Bock D, Montaner J, Aghayari Sheikh Neshin S, Aguiar de Sousa D, Tenser MS, Aires A, Alfonso MDL, Alizada O, Azevedo E, Goyal N, Babaeepour Z, Banihashemi G, Bonati LH, Cereda CW, Chang JJ, Crnjakovic M, De Marchis GM, Del Sette M, Ebrahimzadeh SA, Farhoudi M, Gandoglia I, Gonçalves B, Griessenauer CJ, Murat Hanci M, Katsanos AH, Krogias C, Leker RR, Lotman L, Mai J, Male S, Malhotra K, Malojcic B, Mesquita T, Mir Ghasemi A, Mohamed Aref H, Mohseni Afshar Z, Moon J, Niemelä M, Rezai Jahromi B, Nolan L, Pandhi A, Park JH, Marto JP, Purroy F, Ranji-Burachaloo S, Carreira NR, Requena M, Rubiera M, Sajedi SA, Sargento-Freitas J, Sharma VK, Steiner T, Tempro K, Turc G, Ahmadzadeh Y, Almasi-Dooghaee M, Assarzadegan F, Babazadeh A, Baharvahdat H, Cardoso FB, Dev A, Ghorbani M, Hamidi A, Hasheminejad ZS, Hojjat-Anasri Komachali S, Khorvash F, Kobeissy F, Mirkarimi H, Mohammadi-Vosough E, Misra D, Noorian AR, Nowrouzi-Sohrabi P, Paybast S, Poorsaadat L, Roozbeh M, Sabayan B, Salehizadeh S, Saberi A, Sepehrnia M, Vahabizad F, Yasuda TA, Ghabaee M, Rahimian N, Harirchian MH, Borhani-Haghighi A, Azarpazhooh MR, Arora R, Ansari S, Avula V, Li J, Abedi V, Zand R. SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group. Stroke 2021; 52:e117-e130. [PMID: 33878892 PMCID: PMC8078130 DOI: 10.1161/strokeaha.120.032927] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.
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Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.)
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Ashkan Mowla
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.).,Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Switzerland (A.V.S.)
| | - Arash Kia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York City, NY (A.K.)
| | - Alaleh Vaghefi Far
- Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy (S. Mondello)
| | | | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Martin Punter
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Faezeh Khodadadi
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Soheil Naderi
- Department of Neurosurgery (S.N.), Tehran University of Medical Sciences, Iran
| | - Mirna Sabra
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy)
| | - Mahtab Ramezani
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Ali Amini Harandi
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Oluwaseyi Olulana
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Durgesh Chaudhary
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Aicha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint-Denis, France (A.L.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.)
| | - Juan F Arenillas
- Department of Neurology, University of Valladolid, Spain (J.F.A., M.D.L.A.)
| | - Daniel Bock
- Department of Cardiology, Klinikum Frankfurt Höchst, Germany (D.B.)
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J. Montaner)
| | | | - Diana Aguiar de Sousa
- Department of Neurology (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S.)
| | - Matthew S Tenser
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Ana Aires
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | | | - Orkhan Alizada
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | | | - Gelareh Banihashemi
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | - Leo H Bonati
- Department of Neurology and Stroke Unit, University Hospital Basel, Switzerland (L.H.B.)
| | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC (J.J.C.)
| | - Miljenko Crnjakovic
- Intensive Care Unit, Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia (M.C.)
| | - Gian Marco De Marchis
- Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland (G.D.M.)
| | | | | | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Iran (M.F.)
| | | | - Bruno Gonçalves
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | - Christoph J Griessenauer
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Mehmet Murat Hanci
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.).,Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K.)
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany (C.K.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Lev Lotman
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Jeffrey Mai
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, DC (J. Mai)
| | - Shailesh Male
- Department of Neurosurgery, Vidant Medical Center, Greenville, NC (S. Male)
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Branko Malojcic
- Department of Neurology, TIA Clinic, University Hospital Centre Zagreb, Zagreb School of Medicine, University of Zagreb, Croatia (B.M.)
| | - Teresa Mesquita
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | | | - Hany Mohamed Aref
- Department of Neurology, Ain Shams University, Cairo, Egypt (H.M.A.)
| | - Zeinab Mohseni Afshar
- Infection Disease Research Center, Kermanshah University of Medical Sciences, Iran (Z.M.A.)
| | - Jusun Moon
- Department of Neurology, National Medical Center, Seoul, South Korea (J. Moon)
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Lawrence Nolan
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, South Korea (J.-H.P.)
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Sakineh Ranji-Burachaloo
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | - Nuno Reis Carreira
- Department of Internal Medicine (N.E.C.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Seyed Aidin Sajedi
- Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Iran (S.A.S.)
| | - João Sargento-Freitas
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal (J.S.-F.)
| | - Vijay K Sharma
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore (V.K.S.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.).,Department of Neurology, Heidelberg University Hospital, Germany (T.S.)
| | - Kristi Tempro
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | | | - Mostafa Almasi-Dooghaee
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Divisions of Vascular and Endovascular Neurosurgery (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran
| | | | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Iran (A.B.)
| | - Humain Baharvahdat
- Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Iran (H.B.)
| | | | - Apoorva Dev
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran
| | - Ava Hamidi
- Neurology Ward, Gheshm Hospital, Iran (A.H.)
| | - Zeynab Sadat Hasheminejad
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | | | - Fariborz Khorvash
- Neurology Department, Isfahan University of Medical Sciences, Iran (F. Khorvash)
| | - Firas Kobeissy
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy).,Program of Neurotrauma, Neuroproteomics and Biomarker Research, University of Florida (F. Kobeissy)
| | | | | | - Debdipto Misra
- Steele Institute of Health and Innovation, Geisinger Health System, PA (D.M.)
| | - Ali Reza Noorian
- Department of Neurology, Southern California Permanente Medical Group, Irvine, CA (A.R.N.)
| | | | - Sepideh Paybast
- Department of Neurology, Bou Ali Hospital, Qazvin University of Medical Sciences, Iran (S.P.)
| | - Leila Poorsaadat
- Department of Neurology, Arak University of Medical Sciences, Iran (L.P.)
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Roozbeh)
| | - Behnam Sabayan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (B.S.)
| | - Saeideh Salehizadeh
- Neurology Department, Salahadin Ayubi Hospital, Baneh, Iran (S. Salehizadeh)
| | - Alia Saberi
- Neurology Department, Poursina Hospital, Rasht, Guilan, Iran (S.A.S.N., A.S.)
| | - Mercedeh Sepehrnia
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | - Fahimeh Vahabizad
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | | | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Nasrin Rahimian
- Department of Neurology, Yasrebi Hospital, Kashan, Iran (N.R.)
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | | | | | - Rohan Arora
- Department of Neurology, Long Island Jewish Forest Hills, Queens, NY (R.A.)
| | - Saeed Ansari
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.)
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
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Risk factors among stroke subtypes and its impact on the clinical outcome of patients of Northern Portugal under previous aspirin therapy. Clin Neurol Neurosurg 2021; 203:106564. [PMID: 33714797 DOI: 10.1016/j.clineuro.2021.106564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Accepted: 02/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In Western European countries, acute ischemic stroke (AIS) remains the third leading cause of death. Among the risk factors for cerebrovascular disease, some have more influence than others in certain stroke subtypes. The aim of this study was to evaluate the impact of risk factors among Stroke Subtypes on the clinical outcome of Portuguese patients under previous aspirin therapy. MATERIALS AND METHODS We studied a cohort of 371 patients diagnosed with AIS and a clinical follow-up protocol was set up.The patients were admitted in a Department of Internal Medicine of a major hospital. Standardized data assessment and stroke subtype classification (Oxfordshire Community Stroke Project) were used. RESULTS Arterial hypertension (80.4 %), overweight (72.6 %) and dyslipidemia (62.0 %) were the most prevalent risk factors with no statistical differences among the group's subtypes. Current smoking was more prevalent in POCI(62.9 %) with differences among subtypes (p = 0.002). Atrial fibrillation was more commonly reported in TACI (39.3 %) and less common in POCI (8.1 %) (p < 0.001).Comparing TACI vs Non TACI Stroke Subtypes demonstrated major differences in cumulative survival,among the cases with no previous aspirin treatment, after 3 years (51.9 % vs 88.8 %).The increased risk of mortality at 12 months is consistently observed for the presence of a previous atrial fibrillation (OR 3.01 95 %CI 1.69-5.39), TACI subtype (OR 10.4 95 %CI 4.83-22.6) and NIHSS over 10 (OR 9.33 95 % CI 4,49-19.4). When we analyze the impact of previous aspirin treatment in the risk for a new stroke event, it seems to have a protective effect in a time frame of 12 months, but this protection is lost extending at 24 months (p = 0.094 vs p = 0.005). DISCUSSION Our results indicate that smoking, atrial fibrillation and age have different relevance in their distribution among ischemic stroke subtypes at the time of diagnosis. Concerning the influence of the main stroke risk factors on the clinical outcome, our results present a strong influence of atrial fibrillation and of age. Severity of disease at diagnosis, represented by TACI subtype is clearly associated to decreased survival among patients with no record of previous aspirin therapy. Our results reinforce the relevance cohort studies of different populations, to achieve a more comprehensive knowledge of the impact of risk factors on stroke subtypes and on its clinical outcome.
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Algeo C, Beh S, McDonald L, MacLeod AD, Reid JM. Examining Outcomes following Thrombolysis in An Increasingly Older and Dependent Stroke Population. J R Coll Physicians Edinb 2020; 50:372-378. [DOI: 10.4997/jrcpe.2020.405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Thrombolysis for acute ischaemic stroke (AIS) patients aged ≥80 years is evidence based, although its use in previously dependent patients is controversial. Methods Data from 831 thrombolysed AIS patients in our centre from 2009–2017 were used to compare demographic trends and outcomes (haemorrhage, mortality, three-month independence) in patients aged <80 and ≥80 years and with prior dependency. Comparison with UK and world registry data regarding age and pre-stroke dependency was made. Results The percentage of treated patients aged ≥80 years increased year-on-year, doubling from 25% to 50% (p<0.01), with increasing average age and pre-stroke dependency in world centres. Patients ≥80 years had higher (p<0.001) stroke severity, symptomatic intracerebral haemorrhage (5% vs. 1.5%), mortality (35% vs. 13%) and lower three month independent survival (24% vs. 60%). Patients with pre-stroke dependency had especially higher three month mortality (57–71%, OR 3.75 [95% CI 1.97–7.15]) in both age groups. Conclusion Patients aged ≥80 years and with dependency increasingly receive thrombolysis. Given poorer outcomes thrombolysis trials are needed in pre-stroke dependent patients.
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Affiliation(s)
- Charlotte Algeo
- Foundation Year 2 Doctor, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sean Beh
- Foundation Year 2 Doctor, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lindsey McDonald
- ST6 in Geriatric Medicine, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Angus D MacLeod
- Senior Clinical Lecturer in Neurology, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Consultant Neurologist, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - John M Reid
- Consultant Neurologist, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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14
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Sobolewski P, Brola W, Wilczyński J, Szczuchniak W, Wójcik T, Wach-Klink A, Kos M, Kozera G. Cerebral Thrombolysis in Rural Residents Aged ≥ 80. Clin Interv Aging 2020; 15:1737-1751. [PMID: 33061326 PMCID: PMC7522422 DOI: 10.2147/cia.s256070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged <80 and aged ≥80 were performed. Results The proportion of patients aged ≥80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% p = 0.24). Rural patients aged ≥80 were also characterized by lower incidence of cardiovascular risk factors and better patients’ conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, p = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, p < 0.001) and lower functional independence rate (34.0% vs 50.5%, p < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04–5.66, p = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21–10.99, p = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03–6.82, p = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01–1.20, p = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10–0.62, p = 0.003) were associated with mortality in rural patients over 80. Conclusion We suggest that rural patients aged ≥80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.
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Affiliation(s)
- Piotr Sobolewski
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Saint Lukas Hospital in Końskie, Końskie, Poland
| | | | - Wiktor Szczuchniak
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Tomasz Wójcik
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Aleksandra Wach-Klink
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Marek Kos
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.,Department of Public Health, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Kozera
- Medical Simulation Center, Medical University of Gdańsk, Gdańsk, Poland
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15
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De Potter T, Yodfat O, Shinar G, Neta A, Reddy VY, Neuzil P, Veltkamp R, Connolly SJ. Permanent Bilateral Carotid Filters for Stroke Prevention in Atrial Fibrillation. Curr Cardiol Rep 2020; 22:144. [PMID: 32910288 PMCID: PMC7496024 DOI: 10.1007/s11886-020-01388-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose of Review A novel permanent carotid filter device for percutaneous implantation was developed for the purpose of stroke prevention. In this review, we cover rationale, existing preclinical and clinical data, and potential future directions for research using such a device. Recent Findings The Vine™ filter was assessed for safety in sheep and in 2 observational human studies, the completed CAPTURE 1 (n = 25) and the ongoing CAPTURE 2 (planned n = 100). CAPTURE 1 has shown high procedural and long-term implant safety. A control group was not available for comparison. Summary A mechanical filter for permanent stroke prevention can be implanted bilaterally in the common carotid artery safely and efficiently. A randomized trial is planned for 2021 (n = 3500, INTERCEPT) to demonstrate superiority of a filter + anticoagulation strategy over anticoagulation alone in patients at high risk for ischemic stroke.
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Affiliation(s)
- Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, B-9300 Aalst, Belgium
| | | | | | | | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Roland Veltkamp
- Department of Brain Science, Imperial College London, London, UK
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
- Department of Neurology, University Heidelberg, Heidelberg, Germany
| | - Stuart J. Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario Canada
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16
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Paciaroni M, Agnelli G, Giustozzi M, Tsivgoulis G, Yaghi S, Grory BM, Furie KL, Tadi P, Zedde M, Abdul-Rahim AH, Dawson J, Lees KR, Alberti A, Venti M, Acciarresi M, D'Amore C, Mosconi MG, Bogini V, Cappellari M, Rigatelli A, Bonetti B, Putaala J, Tomppo L, Tatlisumak T, Bandini F, Marcheselli S, Pezzini A, Poli L, Padovani A, Masotti L, Grifoni E, Vannucchi V, Sohn SI, Lorenzini G, Tassi R, Guideri F, Acampa M, Martini G, Ntaios G, Athanasakis G, Makaritsis K, Karagkiozi E, Vadikolias K, Liantinioti C, Palaiodimou L, Mumoli N, Porta C, Galati F, Sacco S, Tiseo C, Corea F, Ageno W, Bellesini M, Silvestrelli G, Ciccone A, Scoditti U, Denti L, Mancuso M, Caselli MC, Maccarrone M, Ulivi L, Orlandi G, Giannini N, Tassinari T, Lodovici MLD, Rueckert C, Baldi A, Toni D, Gentile L, Letteri F, Giuntini M, Lotti EM, Flomin Y, Pieroni A, Kargiotis O, Karapanayiotides T, Monaco S, Mannino M, Baronello MM, Csiba L, Szabó L, Chiti A, Giorli E, Sette MD, Schirinzi E, Imberti D, Zabzuni D, Doronin B, Volodina V, Michel P, Eskandari A, Vanacker P, Barlinn K, Barlinn J, Deleu D, Gourbali V, Caso V. Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes. Eur Stroke J 2020; 5:374-383. [PMID: 33598556 DOI: 10.1177/2396987320937116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/02/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing. Materials and Methods Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of stroke recurrence, transient ischaemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke. Results A total of 2470 patients were available for the analysis: 473 (19.1%) with PS and 1997 (80.9%) with AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39-2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16-1.80). Discussion our findings suggest that, when deciding the time to initiate oral anticoagulation, the location of stroke, either anterior or posterior, does not predict the risk of outcome events. Conclusions Patients with PS or AS and AF appear to have similar risks of ischaemic or haemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT.
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Affiliation(s)
- Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Michela Giustozzi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Second Department of Neurology, National & Kapodistrian University of Athens, Athens, Greece
| | - Shadi Yaghi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian Mac Grory
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Karen L Furie
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Prasanna Tadi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Azmil H Abdul-Rahim
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kennedy R Lees
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Andrea Alberti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Michele Venti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Monica Acciarresi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Cataldo D'Amore
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Maria Giulia Mosconi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Valentina Bogini
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Manuel Cappellari
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Alberto Rigatelli
- SSO Pronto Soccorso, Ospedale Borgo Trento, DAI Emergenza e Accettazione, AOUI Verona, Italy
| | - Bruno Bonetti
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fabio Bandini
- Department of Neurology, Ospedale San Paolo, Savona, Italy
| | - Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Milano, Italy
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Loris Poli
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Luca Masotti
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Elisa Grifoni
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | | | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Gianni Lorenzini
- SC Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale Lotti Pontedera, Azienda USL Toscana Nordovest, Italy
| | | | | | | | | | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Athanasakis
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Makaritsis
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Chrissoula Liantinioti
- Second Department of Neurology, National & Kapodistrian University of Athens, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, National & Kapodistrian University of Athens, Athens, Greece
| | - Nicola Mumoli
- Department of Internal Medicine, Ospedale "Fornaroli" di Magenta (Milano), Italy
| | - Cesare Porta
- Department of Internal Medicine, Ospedale "Fornaroli" di Magenta (Milano), Italy
| | - Franco Galati
- Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Cindy Tiseo
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Francesco Corea
- Neurologia - Stroke Unit, San Giovanni Battista Hospital, Foligno, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marta Bellesini
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Alfonso Ciccone
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy
| | | | - Licia Denti
- Dipartimento Geriatrico Riabilitativo, University of Parma, Parma, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria C Caselli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Miriam Maccarrone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Leonardo Ulivi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Neurologia, Ospedale Apuano, Massa Carrara, Italy
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tiziana Tassinari
- Department of Neurology, Santa Corona Hospital, Pietra Ligure (Savona), Italy
| | | | | | - Antonio Baldi
- Stroke Unit, Ospedale di Portogruaro, Portogruaro (Venice), Italy
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luana Gentile
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Federica Letteri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Enrico M Lotti
- U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy
| | - Yuriy Flomin
- Stroke and Neurorehabilitation Unit MC 'Universal Clinic 'Oberig' Kyiv, Ukraine
| | - Alessio Pieroni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | - Laszló Csiba
- Stroke Unit, University of Debrecen, Debrecen, Hungary
| | - Lilla Szabó
- Stroke Unit, University of Debrecen, Debrecen, Hungary
| | - Alberto Chiti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Neurologia, Ospedale Apuano, Massa Carrara, Italy.,Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy
| | - Elisa Giorli
- Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy
| | - Massimo Del Sette
- Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy.,Divisione di Neurologia, Ospedale Galliera, Genoa, Italy
| | | | - Davide Imberti
- Department of Internal Medicine, Ospedale Civile di Piacenza, Piacenza, Italy
| | - Dorjan Zabzuni
- Department of Internal Medicine, Ospedale Civile di Piacenza, Piacenza, Italy
| | - Boris Doronin
- Municipal Budgetary Healthcare Institution of Novosibirsk, Novosibirsk State Medical University, Novosibirsk, Russia
| | - Vera Volodina
- Municipal Budgetary Healthcare Institution of Novosibirsk, Novosibirsk State Medical University, Novosibirsk, Russia
| | - Patrik Michel
- Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ashraf Eskandari
- Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Peter Vanacker
- Department of Neurology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Kristian Barlinn
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Dirk Deleu
- Neurology, Hamad Medical Corporation, Doha, Qatar
| | | | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
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17
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Wattanapan P, Lukkanapichonchut P, Massakulpan P, Suethanapornkul S, Kuptniratsaikul V. Effectiveness of Stroke Rehabilitation Compared between Intensive and Nonintensive Rehabilitation Protocol: A Multicenter Study. J Stroke Cerebrovasc Dis 2020; 29:104809. [PMID: 32312631 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/15/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND AIM Stroke is one of the leading causes of death, physical disability, and economic burden. Nowadays, various types of rehabilitation are available. Rehabilitation centers in Thailand provide services in different ways, including starting time, duration, and frequency of each therapy. In addition, many rehabilitation wards have a standing policy to reduce length of stay (LOS) due to economic considerations. This study aimed to compare the effectiveness and efficiency between intensive and nonintensive rehabilitation protocol for stroke patients. METHODS This prospective, multicenter cohort study was conducted among stroke patients who admitted to rehabilitation wards at 14 centers. All participants received either intensive or non-intensive rehabilitation program. Barthel Index (BI) at admission (BIad), BI at discharge (BIdc), and LOS were recorded. The effectiveness was difference in BIdc and BIad score (ΔBI), and the efficiency was ΔBI divided by LOS (ΔBI/LOS). RESULTS Seven hundred and eighty stroke patients were included. Mean age was 61.9 ± 13.3 years, and 59.7% were male. The majority of patients (79.5%) were admitted for intensive rehabilitation. Effectiveness and efficiency were significantly higher in the intensive group than in the nonintensive group (4.5 ± 3.4 versus 2.6 ± 3.2 and .24 ± .30 versus .18 ± .33, respectively). LOS, intensive rehabilitation, and quality of life were significantly positively correlated with effectiveness; whereas, age, onset to admission interval (OAI), and BIad were significantly negatively correlated with the effectiveness of stroke rehabilitation. CONCLUSIONS Stroke patients admitted for intensive rehabilitation had better effectiveness and efficiency than those admitted for non-intensive rehabilitation. Younger patients with shorter OAI, lower BIad, and longer LOS realized significantly enhanced effectiveness.
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Affiliation(s)
- Pattra Wattanapan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pranee Lukkanapichonchut
- Department of Rehabilitation Medicine, Ratchaburi Hospital, Ministry of Public Health, Ratchaburi, Thailand
| | - Pornpimon Massakulpan
- Department of Rehabilitation Medicine, Prasat Neurological Institute, Ministry of Public Health, Bangkok, Thailand
| | - Sumalee Suethanapornkul
- Department of Rehabilitation Medicine Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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18
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Lærum-Onsager E, Brovold T, Bergland A, Pripp AH, Bye A. Associations between health-related quality of life, body mass index, health status and sociodemographic variables in geriatric patients and non-hospitalized older people: A comparative cross-sectional study. Nutr Health 2020; 26:141-150. [PMID: 32297563 DOI: 10.1177/0260106020909047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Data on health-related quality of life (HRQoL) in geriatric patients and non-hospitalized older people are lacking, and the associations among HRQoL, body mass index (BMI) and health status are not sufficiently investigated in these groups. AIM This study aims to describe and compare HRQoL in a sample of geriatric patients and non-hospitalized people >70 years. It further aims to investigate the associations between HRQoL, BMI, health status and sociodemographic variables in geriatric patients and non-hospitalized people >70 years. METHODS This cross-sectional study included 107 geriatric patients and 328 non-hospitalized older people. HRQoL was measured with the 36-Item Short Form Survey (SF-36) and BMI was divided into three classes: underweight (<22 kg/m2), normal weight (22-27 kg/m2) and overweight (>27 kg/m2). RESULTS All SF-36 scores were lower for the geriatric patients than for the non-hospitalized people (p < .001). Underweight (BMI <22 kg/m2) was registered for 43.9% of the geriatric patients and for 13.7% of the non-hospitalized people. No significant associations were found between the SF-36 subscale scores and underweight, but overweight was associated with lower scores on physical functioning (B: -8.7) and vitality (B: -6.8) compared to those with normal BMI (p < .05). The participants with rheumatic diseases, pulmonary diseases, hypertension and digestive diseases had significantly lower scores on most SF-36 scales reflecting physical health. CONCLUSION HRQoL is substantially lower in geriatric patients than in non-hospitalized older people. The negative effects of both overweight and morbidity on HRQoL indicate that it is important to monitor weight and disease symptoms to promote HRQoL in older people, whether hospitalized or non-hospitalized.
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Affiliation(s)
- Ellisiv Lærum-Onsager
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway.,Department of Nursing, Lovisenberg Diaconal University College, Norway
| | - Therese Brovold
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway
| | - Are H Pripp
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway.,Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway
| | - Asta Bye
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Norway.,Department of Health, Nutrition and Management, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway
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19
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Frid P, Drake M, Giese AK, Wasselius J, Schirmer MD, Donahue KL, Cloonan L, Irie R, Bouts MJRJ, McIntosh EC, Mocking SJT, Dalca AV, Sridharan R, Xu H, Giralt-Steinhauer E, Holmegaard L, Jood K, Roquer J, Cole JW, McArdle PF, Broderick JP, Jimenez-Conde J, Jern C, Kissela BM, Kleindorfer DO, Lemmens R, Meschia JF, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Thijs V, Woo D, Worrall BB, Kittner SJ, Mitchell BD, Petersson J, Rosand J, Golland P, Wu O, Rost NS, Lindgren A. Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study. J Neurol 2020; 267:649-658. [PMID: 31709475 PMCID: PMC7035231 DOI: 10.1007/s00415-019-09613-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Posterior circulation ischemic stroke (PCiS) constitutes 20-30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. METHODS Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. RESULTS PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04-1.61; male sex, OR = 1.46; 95% CI 1.21-1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. CONCLUSION Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.
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Affiliation(s)
- Petrea Frid
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
- Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden.
- Department of Neurology, Skåne University Hospital, Jan Waldenströms gata 19, 205 02, Malmö, Sweden.
| | - Mattias Drake
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - A K Giese
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - J Wasselius
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - M D Schirmer
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
- Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - K L Donahue
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Cloonan
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Irie
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - M J R J Bouts
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - E C McIntosh
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - S J T Mocking
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - A V Dalca
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - R Sridharan
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
| | - H Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - E Giralt-Steinhauer
- Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - L Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Roquer
- Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J W Cole
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - P F McArdle
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - J Jimenez-Conde
- Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - C Jern
- Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - B M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - D O Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - R Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Louvain, Belgium
- VIB Center for Brain and Disease Research, Louvain, Belgium
- Department of Neurology, University Hospitals Leuven, Louvain, Belgium
| | - J F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - T Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - R L Sacco
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - R Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University Graz, Graz, Austria
| | - P Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Ashford and St Peter's Hospital, Ashford, UK
| | - A Slowik
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - V Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - D Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - B B Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - S J Kittner
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - B D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, MD, USA
| | - J Petersson
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden
| | - J Rosand
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
- Center for Genomic Research, Massachusetts General Hospital, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - P Golland
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
| | - O Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - N S Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
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Bergland A, Strand BH. Norwegian reference values for the Short Physical Performance Battery (SPPB): the Tromsø Study. BMC Geriatr 2019; 19:216. [PMID: 31395008 PMCID: PMC6686475 DOI: 10.1186/s12877-019-1234-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background The Short Physical Performance Battery (SPPB) is a common well-established instrument to measure physical performance. It involves a timed 4-m walk, timed repeated chair sit-to-stand test, and 10-s balance tests (side-by-side, semi-tandem, and full-tandem). We aimed to establish reference values for community-dwelling Norwegian adults aged 40 years or older in terms of (1) the total score; (2) the three subtest scores; and (3) the time to complete the repeated chair sit-to-stand test and the walking speed. Additionally, we explored floor and ceiling effects for the SPPB. Methods The study population comprised home dwellers aged 40 years or more who participated in the 7th wave of the Tromsø study. A sample of 7474 participants (53.2% women) completed the SPPB. Crude mean values and standard deviations (SD) were evaluated according to sex and age group. Mean values at specific ages were then estimated using linear regression, along with corresponding 95% confidence intervals. Additionally, quantile regression was used to estimate age-specific percentiles (5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles). Results Considerable variability in SPPB scores was observed. The mean SPPB total score of the entire sample was 11.4 (SD 1.3) points. On average, the SPPB total score was 0.28 points greater in men than in women (p < 0.001). Significant sex differences were observed in all five age groups (40–49, 50–59, 60–69, 70–74, 75–79, and 80+ years). The main decline in the physical function occurred in the mid-sixties, with a slightly earlier decline in women than in men. Ceiling effects were observed in all age groups. Conclusions The present study provides comprehensive, up-to-date normative values for SPPB measures in community-dwelling Norwegians aged at least 40 years that may be used to interpret the results of studies evaluating and establishing appropriate treatment goals. Because of ceiling effects, the SPPB has important limitations for the assessment of physical functioning across the full spectrum of the community-dwelling adults aged 40+ years. Furthermore, we conclude that performance on the SPPB should be reported in terms of the total sum score and registered time to complete the repeated chair sit-to stand test and timed 4-m walk test.
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Affiliation(s)
- Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway.
| | - Bjørn Heine Strand
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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Szőcs I, Bereczki D, Ajtay A, Oberfrank F, Vastagh I. Socioeconomic gap between neighborhoods of Budapest: Striking impact on stroke and possible explanations. PLoS One 2019; 14:e0212519. [PMID: 30785925 PMCID: PMC6382147 DOI: 10.1371/journal.pone.0212519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/04/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Hungary has a single payer health insurance system offering free healthcare for acute cerebrovascular disorders. Within the capital, Budapest, however there are considerable microregional socioeconomic differences. We hypothesized that socioeconomic deprivation reflects in less favorable stroke characteristics despite universal access to care. Methods From the database of the National Health Insurance Fund, we identified 4779 patients hospitalized between 2002 and 2007 for acute cerebrovascular disease (hereafter ACV, i.e. ischemic stroke, intracerebral hemorrhage, or transient ischemia), among residents of the poorest (District 8, n = 2618) and the wealthiest (District 12, n = 2161) neighborhoods of Budapest. Follow-up was until March 2013. Results Mean age at onset of ACV was 70±12 and 74±12 years for District 8 and 12 (p<0.01). Age-standardized incidence was higher in District 8 than in District 12 (680/100,000/year versus 518/100,000/year for ACV and 486/100,000/year versus 259/100,000/year for ischemic stroke). Age-standardized mortality of ACV overall and of ischemic stroke specifically was 157/100,000/year versus 100/100,000/year and 122/100,000/year versus 75/100,000/year for District 8 and 12. Long-term case fatality (at 1,5, and 10 years) for ACV and for ischemic stroke was higher in younger District 8 residents (41–70 years of age at the index event) compared to D12 residents of the same age. This gap between the districts increased with the length of follow-up. Of the risk diseases the prevalence of hypertension and diabetes was higher in District 8 than in District 12 (75% versus 66%, p<0.001; and 26% versus 16%, p<0.001). Discussion Despite universal healthcare coverage, the disadvantaged district has higher ACV incidence and mortality than the wealthier neighborhood. This difference affects primarily the younger age groups. Long-term follow-up data suggest that inequity in institutional rehabilitation and home-care should be investigated and improved in disadvantaged neighborhoods.
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Affiliation(s)
- Ildikó Szőcs
- Semmelweis University, Department of Neurology, Budapest, Hungary
- * E-mail:
| | - Dániel Bereczki
- Semmelweis University, Department of Neurology, Budapest, Hungary
| | - András Ajtay
- Semmelweis University, Department of Neurology, Budapest, Hungary
| | - Ferenc Oberfrank
- Institute of Experimental Medicine of the Hungarian Academy of Sciences, Budapest, Hungary
| | - Ildikó Vastagh
- Semmelweis University, Department of Neurology, Budapest, Hungary
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Musa KI, Keegan TJ. The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PLoS One 2018; 13:e0208594. [PMID: 30571691 PMCID: PMC6301695 DOI: 10.1371/journal.pone.0208594] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 11/20/2018] [Indexed: 02/05/2023] Open
Abstract
Background Acute stroke results in functional disability measurable using the well-known Barthel Index. The objectives of the study are to describe the change in the Barthel Index score and to model the prognostic factors for Barthel Index change from discharge up to 3 months post-discharge using the random intercept model among patients with acute first ever stroke in Kelantan, Malaysia. Methods A total 98 in-hospital first ever acute stroke patients were recruited, and their Barthel Index scores were measured at the time of discharge, at 1 month and 3 months post-discharge. The Barthel Index was scored through telephone interviews. We employed the random intercept model from linear mixed effect regression to model the change of Barthel Index scores during the three months intervals. The prognostic factors included in the model were acute stroke subtypes, age, sex and time of measurement (at discharge, at 1 month and at 3 month post-discharge). Results The crude mean Barthel Index scores showed an increased trend. The crude mean Barthel Index at the time of discharge, at 1-month post-discharge and 3 months post-discharge were 35.1 (SD = 39.4), 64.4 (SD = 39.5) and 68.8 (SD = 38.9) respectively. Over the same period, the adjusted mean Barthel Index scores estimated from the linear mixed effect model increased from 39.6 to 66.9 to 73.2. The adjusted mean Barthel Index scores decreased as the age increased, and haemorrhagic stroke patients had lower adjusted mean Barthel Index scores compared to the ischaemic stroke patients. Conclusion Overall, the crude and adjusted mean Barthel Index scores increase from the time of discharge up to 3-month post-discharge among acute stroke patients. Time after discharge, age and stroke subtypes are the significant prognostic factors for Barthel Index score changes over the period of 3 months.
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Affiliation(s)
- Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kbg Kerian, Kelantan, Malaysia
- * E-mail:
| | - Thomas J. Keegan
- The Centre for Health Informatics, Computing, and Statistics (CHICAS), Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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Differences in Ischemic Anterior and Posterior Circulation Strokes: A Clinico-Radiological and Outcome Analysis. J Stroke Cerebrovasc Dis 2018; 28:710-718. [PMID: 30501979 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are limited data comparing posterior (PC) and anterior (AC) circulation acute ischemic strokes (AIS). We aimed to identify specific features of PC and AC strokes regarding clinical, etiological, radiological, and outcome factors. METHODS Patients from the Acute STroke Registry and Analysis of Lausanne, a prospective cohort of consecutive AIS, from years 2003 to 2008 were included. The stroke territory was determined by a combination of neuroimaging and clinical symptoms. Patients with uncertain localization or with simultaneous AC and PC strokes were excluded. Multivariate associations between territory and multiple variables were investigated. RESULTS A total of 1449 patients were included, 466 (32.2%) had a PC territory stroke and 983 (67.8%) an AC. On multivariate analysis, those with PC AIS had lower National Institutes of Health Stroke Scale at admission, more often showed decreased consciousness, visual field defects, and vestibulo-cerebellar signs, but less hemisyndromes, dysarthria, and cognitive symptoms compared to AC AIS patients. Male sex, arterial dissection, lacunar mechanisms, and endovascular recanalization were more frequent in PC strokes, whereas cardioembolic strokes and IV-thrombolysis rates were lower. Less early ischemic signs on admission CT, overall arterial pathology, and 24-hour recanalization were present in PC strokes but intracranial arterial pathology was more prevalent than in AC. The adjusted clinical outcome at 3 months was similar in both groups. CONCLUSIONS In this large retrospective consecutive AIS series, there were specific differences in clinical presentation, etiology, and arterial pathology between PC and AC strokes which did not influence clinical outcome. These findings could lead to a tailored diagnostic work-up, acute treatment strategies, and secondary prevention.
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Di Carlo A, Lamassa M, Franceschini M, Bovis F, Cecconi L, Pournajaf S, Paravati S, Biggeri A, Inzitari D, Ferro S. Impact of acute-phase complications and interventions on 6-month survival after stroke. A prospective observational study. PLoS One 2018; 13:e0194786. [PMID: 29570742 PMCID: PMC5865737 DOI: 10.1371/journal.pone.0194786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/10/2018] [Indexed: 11/25/2022] Open
Abstract
The outcome of stroke patients is complex and multidimensional. We evaluated the impact of acute-phase variables, including clinical state, complications, resource use and interventions, on 6-month survival after first-ever stroke, taking into account baseline conditions exerting a possible effect on outcome. As part of a National Research Program, we performed a prospective observational study of acute stroke patients in four Italian Regions. Consecutive patients admitted for a period of 3 months to the emergency rooms of participating hospitals were included. A total of 1030 patients were enrolled (median age 76.0 years, 52.1% males). At 6 months, 816 (79.2%) were alive, and 164 (15.9%) deceased. Survival status at the 6-month follow-up was missing for 50 (4.9%). Neurological state in the acute phase was significantly worse in patients deceased at 6 months, who showed also higher frequency of acute-phase complications. Cox regression analysis adjusted for demographics, pre-stroke function, baseline diseases and risk factors, indicated as significant predictors of 6-month death altered consciousness (HR, 1.70; 95% CI, 1.14–2.53), total anterior circulation infarct (HR, 2.13; 95% CI, 1.44–3.15), hyperthermia (HR, 1.70; 95% CI, 1.18–2.45), pneumonia (HR, 1.76; 95% CI, 1.18–2.61), heart failure (HR, 2.87; 95% CI, 1.34–6.13) and nasogastric feeding (HR, 2.35; 95% CI, 1.53–3.60), while antiplatelet therapy during acute phase (HR, 0.56; 95% CI, 0.39–0.79), and early mobilisation (HR, 0.55; 95% CI, 0.36–0.84) significantly increased 6-month survival. In a prospective observational study, stroke severity and some acute-phase complications, potentially modifiable, significantly increased the risk of 6-month death, independently of baseline variables. Early mobilisation positively affected survival, highlighting the role of early rehabilitation after stroke.
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Affiliation(s)
- Antonio Di Carlo
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
- * E-mail:
| | - Maria Lamassa
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Marco Franceschini
- IRCCS San Raffaele Pisana, Rome, Italy
- San Raffaele University, Rome, Italy
| | - Francesca Bovis
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
- Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | | | | | | | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Salvatore Ferro
- Department of Hospital Services, Emilia-Romagna Region Health Authority, Bologna, Italy
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Simić-Panić D, Bošković K, Milićević M, Rabi Žikić T, Cvjetković Bošnjak M, Tomašević-Todorović S, Jovićević M. The Impact of Comorbidity on Rehabilitation Outcome after Ischemic Stroke. Acta Clin Croat 2018; 57:5-15. [PMID: 30256006 PMCID: PMC6400340 DOI: 10.20471/acc.2018.57.01.01] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Comorbidity decreases survival but it still remains unknown to what extent functional recovery after ischemic stroke is affected. The aim of this research was to determine the prevalence of the most common comorbidities in patients with ischemic stroke and to examine their predictive value on the functional status and recovery. In order to obtain relevant information for this research, we conducted a prospective study over a two-year period. It included patients with acute/subacute ischemic stroke who had inhospital rehabilitation treatment in our institution. Functional status of the patients was evaluated by the following three aspects at the beginning and at the end of rehabilitation treatment: Rivermead Mobility Index was used for mobility, Barthel Index for independence in activities of daily living, and modified Rankin Scale for total disability. Modified Charlston Comorbidity Index was used to assess comorbidity. Multivariate analysis was applied to evaluate the impact of recorded comorbidities on the patient functional outcome. Independent predictors of rehabilitation success in our study were the value of modified Charlston Comorbidity Index, atrial fibrillation and myocardial infarction. Our study demonstrated that patients with more comorbidities had worse functional outcome after stroke, so it is important to consider the comorbidity status when planning the rehabilitation treatment.
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Affiliation(s)
| | - Ksenija Bošković
- Faculty of Medicine, University of Novi Sad, Department of Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Marija Milićević
- Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Tamara Rabi Žikić
- Faculty of Medicine, University of Novi Sad, Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Mina Cvjetković Bošnjak
- Faculty of Medicine, University of Novi Sad, Department of Psychiatry, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Snežana Tomašević-Todorović
- Faculty of Medicine, University of Novi Sad, Department of Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Mirjana Jovićević
- Faculty of Medicine, University of Novi Sad, Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
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Norwegian reference values for the Short-Form Health Survey 36: development over time. Qual Life Res 2017; 27:1201-1212. [PMID: 28808829 PMCID: PMC5891566 DOI: 10.1007/s11136-017-1684-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 01/09/2023]
Abstract
Purpose Reference values for patient-reported outcome measures are useful for interpretation of results from clinical trials. The study aims were to collect Norwegian SF-36 reference values and compare with data from 1996 to 2002. Methods In 2015, SF-36 was sent by mail to a representative sample of the population (N = 6165). Time trends and associations between background variables and SF-36 scale scores were compared by linear regression models. Results The 2015 response rate was 36% (N = 2118) versus 67% (N = 2323) in 1996 and 56% (N = 5241) in 2002. Only 5% of the youngest (18–29 years) and 27% of the oldest (>70 years) responded in 2015. Age and educational level were significantly higher in 2015 relative to 1996/2002 (p < .001). The oldest age group in 2015 reported better scores on five of eight scales (p < 0.01), the exceptions being bodily pain, vitality, and mental health compared to 1996/2002 (NS). Overall, the SF-36 scores were relatively stable across surveys, controlled for background variables. In general, the most pronounced changes in 2015 were better scores on the role limitations emotional scale (7.4 points, p < .001) and lower scores on the bodily pain scale (4.6 points, p < .001) than in the 1996/2002 survey. Conclusions The low response rate in 2015 suggests that the results, especially among the youngest, should be interpreted with caution. The high response rate among the oldest indicates good representativity for those >70 years. Despite societal changes in Norway the past two decades, HRQoL has remained relatively stable.
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Choi N, Lee JY, Sunwoo JS, Roh H, Ahn MY, Park ST, Lee KB. Recently Uncontrolled Glycemia in Diabetic Patients Is Associated with the Severity of Intracranial Atherosclerosis. J Stroke Cerebrovasc Dis 2017; 26:2615-2621. [PMID: 28784278 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/22/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Diabetes mellitus is a specific risk factor for intracranial atherosclerosis (ICAS) regardless of race. However, it is largely unknown whether poor glycemic control is associated with the severity of ICAS in diabetic patients. METHODS We selected diabetic patients with acute ischemic stroke who were prospectively registered between March 2005 and December 2015. The patients who had a high-risk source of cardiogenic embolism were excluded. ICAS was graded from 0 to 3 by the number of significant (≥50%) stenoses on intracranial magnetic resonance angiography, and was divided into 4 types: unilateral anterior, bilateral anterior, posterior, and anterior plus posterior. Ordinal and multinomial regression tests were applied for the factors influencing the number and types of ICAS. RESULTS A total of 774 patients with noncardioembolic acute ischemic stroke with diabetes were enrolled. The multiplicity of ICAS was independently associated with age (odds ratio [OR], 1.035 per 1 year, 1.018-1.052; P < .001), hypertension (OR, 1.992, 1.336-2.965; P = .001), and glycated hemoglobin (HbA1c; OR, 1.207 per 1%, 1.089-1.338; P < .001) in the ordinal regression model. In multinomial regression, bilateral anterior stenosis tended to be correlated with age (OR, 1.042, 1.008-1.077; P = .016) and HbA1c (OR, 1.201 per 1%, .991-1.520; P = .057). Both anterior and posterior stenoses were significantly associated with age (OR, 1.056, 1.029-1.084; P < .001), hypertension (OR, 2.584, 1.404-4.762; P = .002), and HbA1c (OR, 1.272, 1.070-1.511; P = .006). CONCLUSIONS Age, concomitant hypertension, and HbA1c were factors associated with multiple intracranial stenoses. Further study is warranted to elucidate whether poor glycemic control facilitates ICAS in diabetic patients.
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Affiliation(s)
- Nari Choi
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Yoon Lee
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Jun-Sang Sunwoo
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Hakjae Roh
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Moo-Young Ahn
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Sung-Tae Park
- Departments of Radiology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Kyung Bok Lee
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
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Abstract
The modified-SOAR (mSOAR) score is composed of the stroke subtype, Oxfordshire Community Stroke Project classification, age, pre-stroke modified Rankin score (mRS) and the National Institutes of Health Stroke Scale score. It has previously been shown to be a reliable predictor of mortality and length of -hospital stay. This study sought to identify whether the mSOAR can also be used to predict patient disability on discharge. A post-hoc calculation of mSOAR using Sentinel Stroke National Audit Programme (SSNAP) data and electronic discharge -summaries was performed on all stroke admissions to Bridgend Hospital over an 11-month period. This study included 230 patients, of which 88% had suffered infarcts and 23% had experienced a previous cerebrovascular episode or transient ischaemic attack; 52% were female. The mortality rate was 13% and 57% had slight disability or less (mRS≤2) on discharge. Each increase in mSOAR score was associated with significantly worse discharge disability (p<0.05). We conclude that the mSOAR score is an excellent tool for predicting both discharge disability and mortality. As such, it's useful for admission prognosis discussions with patients, their relatives and the multidisciplinary team and for early supported discharge decision making.
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Dong K, Huang X, Zhang Q, Yu Z, Ding J, Song H. A lower baseline glomerular filtration rate predicts high mortality and newly cerebrovascular accidents in acute ischemic stroke patients. Medicine (Baltimore) 2017; 96:e5868. [PMID: 28151862 PMCID: PMC5293425 DOI: 10.1097/md.0000000000005868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population.Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients' outcomes.Of all patients, 130 patients (13.4%) had reduced eGFR (<60 mL/min/1.73 m), and 556 patients had a normal eGFR (≥90 mL/min/1.73 m). A total of 694 patients suffered from cerebral artery stenosis, in which 293 patients only had intracranial artery stenosis (ICAS), 110 only with extracranial carotid atherosclerotic stenosis (ECAS), and 301 with both ICAS and ECAS. The patients with eGFR <60 mL/min/1.73m had a higher proportion of death and newly ischemic events compared with those with a relatively normal eGFR. Multivariate analysis revealed that a baseline eGFR <60 mL/min/1.73 m increased the risk of mortality by 3.089-fold and newly ischemic events by 4.067-fold. In further analysis, a reduced eGFR was associated with increased rates of mortality and newly events both in ICAS patients and ECAS patients. However, only an increased risk of newly events was found as the degree of renal function deteriorated in ICAS patients (odds ratio = 8.169, 95% confidence interval = 2.445-14.127).A low baseline eGFR predicted a high mortality and newly ischemic events at 3 months in ischemic stroke patients. A low baseline eGFR was also a strong independent predictor for newly ischemic events in ICAS patients.
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von Sarnowski B, Schminke U, Grittner U, Tanislav C, Böttcher T, Hennerici MG, Tatlisumak T, Putaala J, Kaps M, Fazekas F, Enzinger C, Rolfs A, Kessler C. Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1). Cerebrovasc Dis 2017; 43:152-160. [PMID: 28088807 DOI: 10.1159/000454840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/24/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although 20-30% of all strokes occur in the posterior circulation, few studies have explored the characteristics of patients with strokes in the posterior compared to the anterior circulation so far. Especially data on young patients is missing. METHODS In this secondary analysis of data of the prospective multi-centre European sifap1 study that investigated stroke and transient ischemic attack (TIA) patients aged 18-55 years, we compared vascular risk factors, stroke aetiology, presence of white matter hyperintensities (WMH) and cerebral microbleeds (CMB) between patients with ischaemic posterior circulation stroke (PCS) and those having suffered from anterior circulation stroke (ACS) based on cerebral MRI. RESULTS We diagnosed PCS in 612 patients (29.1%, 407 men, 205 women) and ACS in 1,489 patients (70.9%). Their age (median 46 vs. 47 years, p = 0.205) and stroke severity (modified Rankin Scale: both 2, p = 0.375, Barthel Index 90 vs. 85, p = 0.412) were similar. PCS was found to be more frequent among the male gender (66.5 vs. 60.1% with ACS, p = 0.003). Vertebral artery (VA) dissection was more often the cause of PCS (16.8%) than was carotid artery dissection of ACS (7.9%, p < 0.001). Likewise, small vessel disease (Trial of Org 10172 in Acute Stroke Treatment [TOAST] = 3, PCS: 14.7%, ACS: 11.8%) and stroke of other determined aetiology (TOAST = 4, PCS: 24.5%, ACS: 16.0%) were more frequent in those with PCS. Furthermore, patent foramen ovale (PFO; PCS: 31.1%, ACS: 25.4%, p = 0.029) was more often detected in patients with PCS. In contrast, large-artery atherosclerosis (TOAST = 1, PCS: 15.4%, ACS: 22.2%) and cardio-embolic stroke (TOAST = 2, PCS: 15.6%, ACS: 18.0%) were less frequent in those with PCS (p < 0.001) as were preceding cerebrovascular events (10.1 vs. 14.1%, p = 0.014), TIA (4.8 vs. 7.7%, p = 0.016) and smoking (53.2 vs. 61.0%, p = 0.001). The presence, extent, and location of WMH and CMB did not differ between the 2 groups. CONCLUSIONS Our data suggested a different pattern of aetiology and risk factors in young patients with PCS compared to those with ACS. These findings especially call for a higher awareness of VA dissection and potentially for more weight of a PFO as a risk factor in young patients with PCS. Clinical trial registration-URL: http://www.clinicaltrials.gov; NCT00414583.
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Affiliation(s)
- Bettina von Sarnowski
- Department of Neurology, University Medicine, Ernst Moritz Arndt University, Greifswald, Germany
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Li Y, Cai Y, Zhao M, Sun J. Risk factors between intracranial–extracranial atherosclerosis and anterior–posterior circulation stroke in ischaemic stroke. Neurol Res 2016; 39:30-35. [PMID: 27796172 DOI: 10.1080/01616412.2016.1250856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yan Li
- Department of Second Clinical Medical Institution, Guangzhou University of Traditional Chinese Medicine , Guangzhou, China
| | - Yefeng Cai
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine , Guangzhou, China
| | - Min Zhao
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine , Guangzhou, China
| | - Jingbo Sun
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine , Guangzhou, China
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Jacobsen EL, Brovold T, Bergland A, Bye A. Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study. BMJ Open 2016; 6:e011512. [PMID: 27601491 PMCID: PMC5020767 DOI: 10.1136/bmjopen-2016-011512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Data on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status. DESIGN A cross-sectional study. SETTING Two acute geriatric hospital wards in Norway. PARTICIPANTS This study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination <23, language difficulties or severe aphasia. MAIN OUTCOME MEASURES Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification. RESULTS On the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β -3.3, 95% CI -4.9 to -1.7), pulmonary disease (β -2.1, 95% CI -3.7 to -0.46), cancer (β -1.7, 95% CI -3.4 to -0.033) and nutritional status. CONCLUSIONS Our study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer and pulmonary disease are significantly associated with declines in nutritional status, as measured by the MNA, in acute geriatric patients.
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Affiliation(s)
- Ellisiv Lærum Jacobsen
- Faculty of Health Sciences, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Therese Brovold
- Faculty of Health Sciences, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Asta Bye
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Department of Nursing and Health promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Wei WM, Wu XY, Li ST, Shen Q. PPARG gene C161T CT/TT associated with lower blood lipid levels and ischemic stroke from large-artery atherosclerosis in a Han population in Guangdong. Neurol Res 2016; 38:620-4. [PMID: 27264718 DOI: 10.1080/01616412.2016.1189056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Peroxisome proliferator-activated receptor gamma (PPARG) is a transcription factor involved in atherosclerosis and related diseases. In this study, we aimed to investigate whether PPARG C161T was associated with lipid levels and large-artery atherosclerosis (LAA) ischemic stroke in a Han Chinese population in Guangdong province. METHODS The genotype PPARG C161T in 149 LAA ischemic stroke patients and 125 healthy controls was examined by polymerase chain reaction-restriction fragment length polymorphism (RFLP) assay. Associations with LAA ischemic stroke were analyzed for PPARG C161T genotype, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), and a logistic regression analysis was performed to identify risk factors for LAA ischemic stroke. RESULTS The frequency of CC was higher than that of CT + TT and was significantly associated with LAA ischemic stroke. In both the LAA and control groups, TC and LDL-C levels were significantly higher in the CC type than the CT + TT, but TG and HDL-C levels were comparable. The only verified independent risk factors for LAA ischemic stroke were ischemic heart disease (OR: 2.784, 95% CI: 1.377-5.632; p = 0.004) and systolic blood pressure (OR: 1.014, 95% CI: 1.001-1.026; p = 0.029); the PPARG C161T allele was not independently associated with an increased risk of LAA ischemic stroke (OR = 0.697, 95% CI: 0.372-1.305; p = 0.260). CONCLUSION In this Han population, PPARG C161T CT/TT was associated with LAA ischemic stroke and lower levels of blood TC and LDL-C, but was not an independent risk factor for LAA ischemic stroke.
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Affiliation(s)
- Wei-Min Wei
- a Department of Neurology , The Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University) , Guangzhou , China
| | - Xiao-Yan Wu
- a Department of Neurology , The Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University) , Guangzhou , China
| | - Shu-Ting Li
- a Department of Neurology , The Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University) , Guangzhou , China
| | - QingYu Shen
- a Department of Neurology , The Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University) , Guangzhou , China
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Relationship between pre-stroke cardiovascular medication use and stroke severity. Eur J Clin Pharmacol 2015; 72:495-502. [PMID: 26706251 DOI: 10.1007/s00228-015-2001-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/18/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Stroke is a major health problem with important morbidity and mortality. Various risk factors and cardiovascular medication groups are known to have an influence on stroke incidence, but less is known about the relation between medication use and stroke severity. AIM To determine if relationships exist between the pre-stroke cardiovascular medication use and stroke severity. METHODS A retrospective study was conducted on a database with anonymized data of 1974 patients with a suspected stroke, admitted to the Universitair Ziekenhuis (UZ) Brussel. Stroke severity was quantified using the National Institute of Health Stroke Scale (NIHSS). Cardiovascular medication groups were first included in a multivariable linear regression model. Second, to obtain clinically interpretable results, all variables that were retained in the final linear regression model were introduced in a cumulative odds ordinal logistic regression model with proportional odds. RESULTS Angiotensin II receptor blockers (ARBs), statins, and antiarrhythmics were significantly associated with stroke severity at the 10 % α level in a multivariable linear regression model, suggesting a possible effect of these medication groups on stroke severity. Only pre-stroke statin use showed a significant relationship with the NIHSS score in the ordinal logistic regression model with an adjusted odds ratio of 0.740 (95 % CI 0.580-0.944; p = 0.015). CONCLUSION Pre-stroke use of statins is significantly associated with lower stroke severity. No significant relationship was detected between pre-stroke use of other medication groups and stroke severity, defined by the NIHSS score.
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Nakase T, Yamamoto Y, Takagi M, Hoshino H, Nakase T, Suzuki N, Taguchi Y, Takagi M, Tanahashi N, Tanaka K, Terayama Y, Yamamoto Y, Yasui K. The Impact of Diagnosing Branch Atheromatous Disease for Predicting Prognosis. J Stroke Cerebrovasc Dis 2015; 24:2423-8. [PMID: 26236003 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/22/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND We had reported that, in the acute phase of the brain penetrating artery infarction, patients with branch atheromatous disease (BAD) tended to be worsened compared with the lacunar infarction (LI). Because no prospective study has been reported, we composed a multicenter study (Japan Branch Atheromatous Disease [J-BAD] Registry) in which patients of penetrating artery infarction were prospectively enrolled for exploring the clinical features of BAD. METHODS From the associated 9 hospitals, acute ischemic stroke patients were asked to be enrolled in the J-BAD Registry and classified into the lenticulostriate arterial (LSA) infarction (n = 124) and the pontine penetrating arterial (PPA) infarction (n = 42) groups. The clinical courses and the repeated magnetic resonance imaging findings were investigated. RESULTS Neurologic worsening was observed at a significantly higher rate in BAD compared with the LI patients in both the LSA and PPA groups (P < .01, 45.1% versus 22.6% and 46.7% versus 0%, respectively). In the LSA group, the enlargement of the ischemic lesion was significantly more frequent in BAD compared with the LI patients (P < .01, 66.2% and 34.0%, respectively). There was a significant relation between the enlargement of the lesion and the worsening of neurologic deficits (P < .001). Moreover, the clinical features, which predict the lesion enlargement, were BAD and older age. CONCLUSIONS LSA infarction of BAD diagnosis or older age patients might show an increase of lesion size and a tendency of neurologic worsening. It could be important to discriminate BAD from other ischemic stroke subtypes, in regard to the prediction of prognosis.
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Tsai CF, Anderson N, Thomas B, Sudlow CLM. Risk Factors for Ischemic Stroke and its Subtypes in Chinese vs. Caucasians: Systematic Review and Meta-Analysis. Int J Stroke 2015; 10:485-93. [DOI: 10.1111/ijs.12508] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/06/2015] [Indexed: 11/30/2022]
Abstract
Background Chinese populations are reported to have a different distribution of ischemic stroke subtypes compared with Caucasians. Aims To understand this better, we aimed to evaluate the differences in prevalence of risk factors in ischemic stroke and their distributions among ischemic stroke subtypes in Chinese vs. Caucasians. Summary or review We systematically sought studies conducted since 1990 with data on frequency of risk factors among ischemic stroke subtypes in Chinese or Caucasians. For each risk factor, we calculated study-specific and random effects pooled estimates in Chinese and Caucasians separately for: prevalence among ischemic stroke; odds ratios, comparing prevalence for each ischemic stroke subtype vs. all others. We included seven studies among 16 199 Chinese, and eleven among 16 189 Caucasian ischemic stroke patients. Risk factors studied were hypertension, diabetes, atrial fibrillation, ischemic heart disease, hypercholesterolemia, smoking and alcohol. Chinese ischemic stroke patients had younger onset of stroke than Caucasians, similar prevalence of hypertension, diabetes, smoking and alcohol, and significantly lower prevalence of atrial fibrillation, ischemic heart disease and hypercholesterolemia. Risk factor associations with ischemic stroke subtypes were mostly similar among Chinese and Caucasian ischemic stroke patients. Compared with all other ischemic subtypes, diabetes was more common in large artery stroke, atrial fibrillation and ischemic heart disease in cardioembolic stroke, and hypertension and diabetes in lacunar stroke. Conclusion Our study showed a lower prevalence of atrial fibrillation, ischemic heart disease and hypercholesterolemia in Chinese, and mostly similar risk factor associations in Chinese and Caucasian ischemic stroke patients. Further analyses of individual patient data to allow adjustment for confounders are needed to confirm and extend these findings.
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Affiliation(s)
- Chung-Fen Tsai
- Department of Neurology, Cardinal Tien Hospital, Taiwan
- School of Medicine, Fu Jen Catholic University, Taiwan
- Division of Clinical Neurosicences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Niall Anderson
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Brenda Thomas
- Division of Clinical Neurosicences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cathie L. M. Sudlow
- Division of Clinical Neurosicences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Institute of Genetics and Molecular Medicine (C.L.M.S), University of Edinburgh, Edinburgh, UK
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Zeng Q, Tao W, Lei C, Dong W, Liu M. Etiology and Risk Factors of Posterior Circulation Infarction Compared with Anterior Circulation Infarction. J Stroke Cerebrovasc Dis 2015; 24:1614-20. [PMID: 25899158 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/24/2015] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Many clinicians regard posterior circulation infarction (PCI) as different from anterior circulation infarction (ACI), leading them to apply different treatments. Few studies have validated this practice by directly comparing the etiology and risk factors of PCI and ACI. METHODS We compared the etiology and risk factors of 2245 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. Stroke etiology in each patient was classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. RESULTS Our sample included 482 patients (21.5%) with PCI and 1763 (78.5%) with ACI. The most frequent etiology for both infarction types was small-artery occlusion, occurring in 37.6% of patients with PCI and 37.1% of those with ACI. Cardioembolism caused infarction in a significantly smaller proportion of patients with PCI (5.4%) than in patients with ACI (13.3%; odds ratio [OR] = .373; 95% confidence interval [CI], .245-.566). Frequencies of other stroke etiologies were similar between the 2 patient groups. Analysis of risk factor frequencies in the 2 groups showed hypertension to be the most common, occurring in 47.9% of patients in either group. Multivariable analysis identified 2 factors as conferring greater risk of PCI than ACI: male gender (OR = 1.392; 95% CI, 1.085-1.786) and diabetes mellitus (OR = 1.667; 95% CI, 1.275-2.180). The same analysis identified 2 factors as conferring greater risk of ACI: atrial fibrillation (OR = .530; 95% CI, .295-.951) and heart valve disease (OR = .433; 95% CI, .203-.922). Frequencies of other possible risk factors were similar between the 2 groups. CONCLUSIONS These findings suggest that PCI and ACI are more similar than different in their etiology and risk factors and that the 2 types of infarction should be treated based more on etiology and risk factors than on their posterior or anterior localization.
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Affiliation(s)
- Quantao Zeng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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Abstract
Stroke is the leading cause of acquired disability and the third leading cause of death in women worldwide. Sex differences in risk factors, treatment response and quality of life after stroke complicate stroke management in women. Women have an increased lifetime incidence of stroke compared to men, largely due to a sharp increase in stroke risk in older postmenopausal women. Women also have an increased lifetime prevalence of stroke risk factors, including hypertension and atrial fibrillation in postmenopausal women, as well as abdominal obesity and metabolic syndrome in middle-aged women. Controversy continues over the risks of oral contraceptives, hormone therapy and surgical intervention for carotid stenosis in women. Pregnancy and the postpartum period represent a time of increased risk, presenting challenges to stroke management. Recognition of these issues is critical to improving acute care and functional recovery after stroke in women.
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Affiliation(s)
- Matthew D Howe
- Department of Neuroscience, The University of Connecticut Health Center, Farmington, CT 06030, USA
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Lin MP, Tsivgoulis G, Alexandrov AV, Chang JJ. Factors affecting clinical outcome in large-vessel occlusive ischemic strokes. Int J Stroke 2014; 10:479-84. [PMID: 25472000 DOI: 10.1111/ijs.12406] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 12/01/2022]
Abstract
Clinical outcome after large-vessel occlusive strokes depends on admitting clinical condition, successful recanalization, and robust collateral circulation. However, predicting successful recanalization and quantifying collateral status in the acute setting remain elusive. Successful recanalization has many predictive factors. Strong evidence supports increasing clot length being associated with poor recanalization. Current imaging techniques completed in the acute setting suggest that clot length can be estimated with a clot burden score. In vitro evidence suggests that clots with more red blood cells and less thrombin lyse more easily after systemic fibrinolysis. Clinical correlations with clot composition have been mixed, although one study suggested that clot composition could be predicted with computed tomography and correlate with successful recanalization. Finally, overwhelming proof shows that robust collateral circulation correlates with improved clinical outcome. Imaging modalities in the acute setting remain promising, with studies suggesting that collaterals can be quantified with computed tomography angiography and perfusion studies. Patients with large-vessel occlusive strokes have variable clinical responses to fibrinolysis and thrombectomy. Independent predictive variables that can possibly alter clinical outcome appear to be successful recanalization and robust collateral circulation. Future studies that allow for better prediction of successful recanalization and quantification of collateral status may help clinical decision-making when evaluating large-vessel occlusions.
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Affiliation(s)
- Michelle P Lin
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Athens School of Medicine, Athens, Greece.,International Clinical Research Center, St. Anne's University, Brno, Czech Republic
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jason J Chang
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, Richardson M, Speechley M. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil 2014; 37:1316-23. [DOI: 10.3109/09638288.2014.963706] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew J. Meyer
- Graduate Program in Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
- Ontario Stroke Network, Toronto, Ontario, Canada,
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Shelialah Pereira
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Andrew McClure
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada,
| | - Robert Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, St Joseph's Health Care, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
- Centre for Studies in Family Medicine, Western University, London Ontario, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
| | - Marina Richardson
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
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Ursin MH, Ihle-Hansen H, Fure B, Tveit A, Bergland A. Balance and mobility in acute stroke: Association with subgroups of stroke and socio-demographic characteristics. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2014. [DOI: 10.3109/21679169.2014.934280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mitsumura H, Sakuta K, Bono K, Yamazaki M, Sengoku R, Kono Y, Kamiyama T, Suzuki M, Furuhata H, Iguchi Y. Stiffness Parameter β of Cardioembolism Measured by Carotid Ultrasound Was Lower Than Other Stroke Subtypes. J Stroke Cerebrovasc Dis 2014; 23:1391-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 11/25/2022] Open
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Sung SF, Chen YW, Hung LC, Lin HJ. Revised iScore to predict outcomes after acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23:1634-9. [PMID: 24709145 DOI: 10.1016/j.jstrokecerebrovasdis.2014.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/05/2014] [Accepted: 01/09/2014] [Indexed: 11/18/2022] Open
Abstract
The iScore is a validated tool to predict mortality and functional outcome after acute ischemic stroke. It incorporates stroke subtype according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification as one of its factors. However, the TOAST stroke subtype may not be easily determined without extensive investigations. We aimed to test if the stroke subtype can be substituted by the Oxfordshire Community Stroke Project (OCSP) classification. We applied the iScore and the revised iScore, in which the TOAST subtype was replaced by the OCSP classification, to patients admitted to a single hospital for acute ischemic stroke. Outcome measures included poor functional status (modified Rankin scale score, 3-6) at discharge and 3 months. The performance between the iScore and the revised iScore was assessed by determining the discrimination and calibration of the scores. We studied 3196 patients at the acute stage, and among them 2349 patients were available for the 3-month assessment. The discrimination of the revised iScore was comparable with the iScore for poor outcome at discharge (area under the receiver operating characteristic curve, .767 versus .775; P=.06) and at 3-month (.801 versus .810; P=.06). The correlation between the observed and the expected outcomes was high for both the iScore (Pearson correlation coefficient, .993 at discharge and .995 at 3 months; both P<.0001) and the revised iScore (.985 and .993, respectively; both P<.0001). The revised iScore reliably predicts clinical outcomes at discharge and 3 months for patients with acute ischemic stroke.
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Affiliation(s)
- Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yu-Wei Chen
- Department of Neurology, Landseed Hospital, Tao-Yuan County, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Chien Hung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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Katzan IL, Spertus J, Bettger JP, Bravata DM, Reeves MJ, Smith EE, Bushnell C, Higashida RT, Hinchey JA, Holloway RG, Howard G, King RB, Krumholz HM, Lutz BJ, Yeh RW. Risk adjustment of ischemic stroke outcomes for comparing hospital performance: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:918-44. [PMID: 24457296 DOI: 10.1161/01.str.0000441948.35804.77] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is the fourth-leading cause of death and a leading cause of long-term major disability in the United States. Measuring outcomes after stroke has important policy implications. The primary goals of this consensus statement are to (1) review statistical considerations when evaluating models that define hospital performance in providing stroke care; (2) discuss the benefits, limitations, and potential unintended consequences of using various outcome measures when evaluating the quality of ischemic stroke care at the hospital level; (3) summarize the evidence on the role of specific clinical and administrative variables, including patient preferences, in risk-adjusted models of ischemic stroke outcomes; (4) provide recommendations on the minimum list of variables that should be included in risk adjustment of ischemic stroke outcomes for comparisons of quality at the hospital level; and (5) provide recommendations for further research. METHODS AND RESULTS This statement gives an overview of statistical considerations for the evaluation of hospital-level outcomes after stroke and provides a systematic review of the literature for the following outcome measures for ischemic stroke at 30 days: functional outcomes, mortality, and readmissions. Data on outcomes after stroke have primarily involved studies conducted at an individual patient level rather than a hospital level. On the basis of the available information, the following factors should be included in all hospital-level risk-adjustment models: age, sex, stroke severity, comorbid conditions, and vascular risk factors. Because stroke severity is the most important prognostic factor for individual patients and appears to be a significant predictor of hospital-level performance for 30-day mortality, inclusion of a stroke severity measure in risk-adjustment models for 30-day outcome measures is recommended. Risk-adjustment models that do not include stroke severity or other recommended variables must provide comparable classification of hospital performance as models that include these variables. Stroke severity and other variables that are included in risk-adjustment models should be standardized across sites, so that their reliability and accuracy are equivalent. There is a pressing need for research in multiple areas to better identify methods and metrics to evaluate outcomes of stroke care. CONCLUSIONS There are a number of important methodological challenges in undertaking risk-adjusted outcome comparisons to assess the quality of stroke care in different hospitals. It is important for stakeholders to recognize these challenges and for there to be a concerted approach to improving the methods for quality assessment and improvement.
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Aliani M, Udenigwe CC, Girgih AT, Pownall TL, Bugera JL, Eskin MNA. Aroma and taste perceptions with Alzheimer disease and stroke. Crit Rev Food Sci Nutr 2013; 53:760-9. [PMID: 23638935 DOI: 10.1080/10408398.2011.559557] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chemosensory disorders of smell or taste in humans have been attributed to various physiological and environmental factors including aging and disease conditions. Aroma and taste greatly condition our food preference, selection and, consumption; the decreased appetite in patients with known neurodegenerative diseases may lead to dietary restrictions that could negatively impact nutritional and health status. The decline in olfactory and gustatory systems in patients with Alzheimer disease and various types of stroke are described.
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Affiliation(s)
- Michel Aliani
- Human Nutritional Sciences, Faculty of Human Ecology, University of Manitoba, Winnipeg, Manitoba, Canada.
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Tsai NW, Hung SH, Huang CR, Chang HW, Chang WN, Lee LH, Wang HC, Lin YJ, Lin WC, Cheng BC, Chiang YF, Su YJ, Tsai TR, Lu CH. The association between circulating endothelial progenitor cells and outcome in different subtypes of acute ischemic stroke. Clin Chim Acta 2013; 427:6-10. [PMID: 24076252 DOI: 10.1016/j.cca.2013.09.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/07/2013] [Accepted: 09/23/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study evaluated the relationship between serial changes in circulating endothelial progenitor cells (EPCs) and outcomes in patients with different subtypes of acute ischemic stroke (AIS). METHODS This prospective cohort study evaluated 65 patients with AIS, including 45 with small-vessel and 20 with large-vessel diseases. The circulating level of EPCs (CD133(+)/CD34(+) and KDR(+)/CD34(+) cells) was determined at different time points (within 48h and on Days 7 and 30 post-stroke). For comparison, the EPC levels of 65 age- and sex-matched controls were also evaluated. RESULTS The levels of CD133(+)/CD34(+) and KDR(+)/CD34(+) EPCs were significantly lower in the AIS group than in the control group (p<0.05). There were fewer CD133(+)/CD34(+) EPCs in the large-vessel disease group than in the small-vessel disease group on Day 1 post-stroke (p<0.05). After adjusting for covariance using stepwise logistic regression, only stroke subtype (OR: 30.2, 95% CI: 5.3-171.4; p<0.001) and KDR(+)/CD34(+) on admission (OR: 0.188, 95% CI: 0.04-0.86; p=0.031) were independently associated with 6-month outcome. CONCLUSIONS The number of circulating EPCs is significantly lower in patients with large-vessel disease than in those with small-vessel disease. Fewer number of EPCs on admission is an independent risk factor for poor 6-month outcome in patients with AIS.
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Affiliation(s)
- Nai-Wen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
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Fernandes TG, Goulart AC, Santos-Junior WR, Alencar AP, Benseñor IM, Lotufo PA. Educational levels and the functional dependence of ischemic stroke survivors. CAD SAUDE PUBLICA 2013; 28:1581-90. [PMID: 22892977 DOI: 10.1590/s0102-311x2012000800016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 05/03/2012] [Indexed: 11/21/2022] Open
Abstract
We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. ≥ 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.
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Kondziella D, Cortsen M, Eskesen V, Hansen K, Holtmannspötter M, Højgaard J, Stavngaard T, Søndergaard H, Wagner A, Welling KL. Update on acute endovascular and surgical stroke treatment. Acta Neurol Scand 2013; 127:1-9. [PMID: 22881403 DOI: 10.1111/j.1600-0404.2012.01702.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2012] [Indexed: 02/02/2023]
Abstract
Emergency stroke care has become a natural part of the emerging discipline of neurocritical care and demands close cooperation between the neurologist and neurointerventionists, neurosurgeons, and anesthesiologists. Endovascular treatment (EVT), including intra-arterial thrombolysis, mechanical thrombectomy and angioplasty/stenting, is under rapid development. Although EVT has yet to be shown in randomized controlled trials to improve clinical outcome compared to intravenous thrombolysis, it is far better in achieving recanalization of occluded large cerebral vessels, which is crucial for rescuing the penumbra. Moreover, decompressive craniectomy is now a well-established treatment option for malignant middle cerebral artery infarction and cerebellar stroke. Using a case-based approach, this article reviews recent achievements in advanced treatment options for patients with acute ischemic stroke.
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Affiliation(s)
- D. Kondziella
- Department of Neurology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - M. Cortsen
- Department of Neuroradiology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - V. Eskesen
- Department of Neurosurgery; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - K. Hansen
- Department of Neurology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - M. Holtmannspötter
- Department of Neuroradiology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - J. Højgaard
- Department of Neurology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - T. Stavngaard
- Department of Neuroradiology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - H. Søndergaard
- Department of Neurology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - A. Wagner
- Department of Neuroradiology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - K.-L. Welling
- Department of Neuroanesthesiology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
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Dowling MM, Hynan LS, Lo W, Licht DJ, McClure C, Yager JY, Dlamini N, Kirkham FJ, Deveber G, Pavlakis S. International Paediatric Stroke Study: stroke associated with cardiac disorders. Int J Stroke 2012; 8 Suppl A100:39-44. [PMID: 23231361 DOI: 10.1111/j.1747-4949.2012.00925.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS The aetiologies of arterial ischaemic stroke in children are diverse and often multifactorial. A large proportion occurs in children with cardiac disorders. We hypothesized that the clinical and radiographic features of children with arterial ischaemic stroke attributed to cardiac disorders would differ from those with other causes. METHODS Using the large population collected in the prospective International Paediatric Stroke Study, we analysed the characteristics, clinical presentations, imaging findings, and early outcomes of children with and without cardiac disorders. RESULTS Aetiological data were available for 667 children with arterial ischaemic stroke (ages 29 days to 19 years). Cardiac disorders were indentified in 204/667 (30.6%), congenital defects in 121/204 (59.3%), acquired in 40/204 (19.6%), and isolated patent foramen ovale in 31/204 (15.2%). Compared to other children with stroke, those with cardiac disorders were younger (median age 3.1 vs. 6.5 years; P < 0.001) and less likely to present with headache (25.6% vs. 44.6%; P < 0.001), but were similar in terms of gender and presentation with focal deficits, seizures, or recent infection. Analysis of imaging data identified significant differences (P = 0.005) in the vascular distribution (anterior vs. posterior circulation or both) between groups. Bilateral strokes and haemorrhagic conversion were more prevalent in the cardiac disorders group. CONCLUSIONS Cardiac disorders were identified in almost one-third of children with arterial ischaemic stroke. They had similar clinical presentations to those without cardiac disorders but differed in age and headache prevalence. Children with cardiac disorders more frequently had a 'cardioembolic stroke pattern' with a higher prevalence of bilateral strokes in both the anterior and posterior circulations, and a greater tendency to haemorrhagic transformation.
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Affiliation(s)
- Michael M Dowling
- The University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, USA
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A cross-national comparative study of blood pressure levels and hypertension prevalence in Canada and Hungary. J Hypertens 2012; 30:2105-11. [DOI: 10.1097/hjh.0b013e3283589ec3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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