Clinical update: management of stroke

Risk factors for mental disorders in patients with hypertensive intracerebral hemorrhage following neurosurgical treatment

BACKGROUND

Mental disorders are commonly observed among surgically treated patients with hypertensive intracerebral hemorrhage (HICH), leading to serious negative impacts on the patient's treatment, rehabilitation, and prognosis. The study aimed to establish the prevalence rates and risk factors for mental disorders following the surgical treatment of HICH.

METHODS

This was a prospective study. Surgically treated patients with HICH were assessed 6 months following surgical treatment. The sociodemographic data were obtained from each subject, and clinical characteristics were collected for each patient from his or her hospital records. Mental disorder-related risk factors were examined using unpaired t-tests for continuous variables and χ(2) for categorical data, respectively, followed by multiple logistic regression analysis.

RESULTS

A total of 96 patients were recruited for this study. The incidence of mental disorders following surgical treatment of HICH was 32.3%. Univariate analysis revealed that the occurrence of postoperative mental disorders was correlated with gender, income, social interaction, relationship between family members, hematoma localization, hematoma volume, preoperative Glasgow Coma Scale (GCS) score, surgical approach, Barthel Index, hospitalization time, and discharged patients' caregivers. Multivariate logistic regression analysis indicated that female patients, social barriers, surgical treatment with a craniotomy, and bad relationship between family members were the independent risk factors for mental disorders following surgical treatment of HICH.

CONCLUSIONS

Postoperative mental disorders in patients with HICH were more likely to occur in female patients and patients who faced social barriers, those who were treated with a craniotomy, and those who experienced bad relationships between their family members. More attention and supports should be provided to this group of patients.

Stroke Outcome in Clinical Trial Patients Deriving From Different Countries

Background and Purpose— Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix.

Methods— We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment.

Results— Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days ( P <0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days ( P =0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998.

Conclusion— We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.