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Fekete K, Tóth J, Horváth L, Márton S, Héja M, Csiba L, Árokszállási T, Bagoly Z, Sulina D, Fekete I. Neurophysiological Examinations as Adjunctive Tool to Imaging Techniques in Spontaneous Intracerebral Hemorrhage: IRONHEART Study. Front Neurol 2021; 12:757078. [PMID: 34777228 PMCID: PMC8578792 DOI: 10.3389/fneur.2021.757078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Intracerebral hemorrhage (ICH) is a devastating disease, which may lead to severe disability or even death. Although many factors may influence the outcome, neurophysiological examinations might also play a role in its course. Our aim was to examine whether the findings of electroencephalography (EEG) and transcranial magnetic stimulation (TMS) can predict the prognosis of these patients. Methods: Between June 1 2017 and June 15 2021, 116 consecutive patients with ICH were enrolled prospectively in our observational study. Clinical examinations and non-Contrast computed tomography (NCCT) scan were done on admission for ICH; follow-up NCCT scans were taken at 14 ± 2 days and at 3 months ± 7 days after stroke onset. EEG and TMS examinations were also carried out. Results: Of the patients in the study, 65.5% were male, and the mean age of the study population was 70 years. Most patients had a history of hypertension, 50.8% of whom had been untreated. In almost 20% of the cases, excessive hypertension was measured on admission, accompanied with >10 mmol/L blood glucose level, whereas their Glasgow Coma Scale was 12 on average. Presence of blood in the ventricles or subarachnoid space and high blood and perihematomal volumes meant poor prognosis. Pathological EEG was prognostic of a worse outcome. With TMS examination at 14 days, it might be possible to estimate outcome in a univariate model and the absence, or reduction of the amplitude of the motor evoked potentials was associated with poor prognosis. Conclusion: Together with the clinical symptoms, the volume of bleeding, perihematomal edema (or their combined volume), and neurophysiological examinations like EEG and TMS play an important role in the neurological outcome of patients with ICH. This might affect the patients' rehabilitation plans in the future, since with the help of the examinations the subset of patients with potential for recovery could be identified.
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Affiliation(s)
- Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Tóth
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Horváth
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Sándor Márton
- Institute of Political Science and Sociology, Faculty of Arts, University of Debrecen, Debrecen, Hungary
| | - Máté Héja
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,MTA-DE Cerebrovascular and Neurodegenerative Research Group, University of Debrecen, Debrecen, Hungary
| | - Tamás Árokszállási
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Bagoly
- MTA-DE Cerebrovascular and Neurodegenerative Research Group, University of Debrecen, Debrecen, Hungary.,Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Sulina
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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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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Seremwe F, Kaseke F, Chikwanha TM, Chikwasha V. Factors associated with hospital arrival time after the onset of stroke symptoms: A cross-sectional study at two teaching hospitals in Harare, Zimbabwe. Malawi Med J 2017; 29:171-176. [PMID: 28955428 PMCID: PMC5610291 DOI: 10.4314/mmj.v29i2.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Late presentation to hospital after onset of stroke affects management and outcomes of the patients. This study aimed to determine the factors associated with time taken to present to hospital after the onset of acute stroke symptoms. Methods A descriptive cross sectional study was conducted at two teaching hospitals in Zimbabwe. Participants included patients admitted with stroke and their relatives. A self-administered questionnaire was used to collect information on history of stroke occurrence and time taken to present to hospital. Data was analysed for means, frequencies, percentages and Odds ratios. Results Less than half (33%) of the participants were able to recognize symptoms of stroke. Not having money to pay for hospital bills was a predictor of late hospital presentation (OR =6.64; 95% CI, (2.05–21.53); p=0.002). The other factors, though not statistically significant included not perceiving stroke as a serious illness (OR = 2.43; 95% CI (0.78–5.51); p=0.083) and unavailability of transport (OR=2.33; 95% CI (0.71–7.56); p=0.161). Predictors for early presentation included receiving knowledge about stroke from the community (OR=0.46; 95% CI (0.15–1.39); p=0.170); seeking help at the hospital (OR=0.50; 95% CI (0.18–1.37); p=0.177) and having a stroke while at the workplace (OR =0.46; 95% CI (0.08–2.72); p=0.389). Conclusions Regarding stroke as an emergency that does not require prerequisite payment for services at hospitals and improved community awareness on stroke may improve time taken to present to hospital after the onset of stroke symptoms.
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Affiliation(s)
| | - Farayi Kaseke
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Theodora M Chikwanha
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Vasco Chikwasha
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Babyar SR, Peterson MG, Reding M. Case–Control Study of Impairments Associated with Recovery from “Pusher Syndrome” after Stroke: Logistic Regression Analyses. J Stroke Cerebrovasc Dis 2017; 26:25-33. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
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Long X, Lou Y, Gu H, Guo X, Wang T, Zhu Y, Zhao W, Ning X, Li B, Wang J, An Z. Mortality, Recurrence, and Dependency Rates Are Higher after Acute Ischemic Stroke in Elderly Patients with Diabetes Compared to Younger Patients. Front Aging Neurosci 2016; 8:142. [PMID: 27378914 PMCID: PMC4909745 DOI: 10.3389/fnagi.2016.00142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/30/2016] [Indexed: 02/01/2023] Open
Abstract
Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age <75 years) and elderly (age ≥75 years) patients. The elderly group included 692 patients (19.1%) overall. Elderly patients were more likely than younger patients to have a Trial of Org 10172 in Acute Stroke Treatment classification of stroke due to cardioembolism, moderate and severe stroke, and atrial fibrillation, but less likely to have hypertension and dyslipidemia, current smokers, and alcohol consumers. Mortality, dependency, and recurrence rates at 12 months after stroke were 19.0, 48.5, and 20.9% in the elderly group and 7.4, 30.9, and 15.4% in the younger group, respectively (all P < 0.05). Corresponding rates at 36 months after stroke were 35.4, 78.7, and 53.8% in the elderly group and 13.7, 61.7, and 43.0% in the younger group, respectively (all P < 0.001). The mortality, dependency, and recurrence rates at 12 and 36 months after stroke were significantly higher in the elderly group than in the younger group after adjusting for stroke subtypes, stroke severity, and risk factors. Odds ratios (95% confidence interval) at 12 and 36 months after stroke were 2.18 (1.64-2.89) and 3.10 (2.35-4.08), respectively, for mortality, all P < 0.001; 1.81 (1.49-2.20) and 2.04 (1.57-2.34), respectively, for dependency, all P < 0.001; and 1.37 (1.06-1.76) and 1.40 (1.07-1.85), respectively, for recurrence, P = 0.016. The findings from this study suggest that management and secondary prevention should be emphasized in elderly patients with diabetes in China to reduce mortality, recurrence, and dependency after stroke.
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Affiliation(s)
- Xue Long
- Department of Neurology, Tianjin Haibin People's HospitalTianjin, China; The Graduate School, Tianjin University of Traditional Chinese MedicineTianjin, China
| | - Yongzhong Lou
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Xiaofei Guo
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Tao Wang
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Yanxia Zhu
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General HospitalTianjin, China; Department of Epidemiology, Tianjin Neurological InstituteTianjin, China
| | - Bin Li
- Department of Neurology, Tianjin Haibin People's HospitalTianjin, China; The Graduate School, Tianjin University of Traditional Chinese MedicineTianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General HospitalTianjin, China; Department of Epidemiology, Tianjin Neurological InstituteTianjin, China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital Tianjin, China
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Folyovich A, Biczó D, Al-Muhanna N, Béres-Molnár AK, Fejős Á, Pintér Á, Bereczki D, Fischer A, Vadasdi K, Pintér F. Anomalous equivalent potential temperature: an atmospheric feature predicting days with higher risk for fatal outcome in acute ischemic stroke-a preliminary study. ENVIRONMENTAL MONITORING AND ASSESSMENT 2015; 187:547. [PMID: 26233665 DOI: 10.1007/s10661-015-4722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 07/01/2015] [Indexed: 06/04/2023]
Abstract
Acute stroke is a life-threatening condition. Fatal outcome is related to risk factors, some of these affected by climatic changes. Forecasting potentially harmful atmospheric processes may therefore be of practical importance in the acute care of stroke patients. We analyzed the history of all patients with acute ischemic stroke (N = 184) confirmed by neuroimaging including those who died (N = 35, 15 males) at our hospital department in the winter months of 2009. Patient data were anonymized, and the human meteorologists were only aware of patients' age, gender, and exact time of death. Of the meteorological parameters, equivalent potential temperature (EPT) has been chosen for analysis. EPT is generally used for forecasting thunderstorms, but in the case of synoptic scale airflow (10(6) m), it is suitable for characterizing the air mass inflowing from different regions. The behavior of measured EPT values was compared to the climatic (30 years) averages. We developed meteorological criteria for anomalous periods of EPT and tested if such periods are associated with higher rate of fatal outcome. The duration of anomalous and non-anomalous periods was nearly equal during the studied 3 months. Stroke onset distributed similarly between anomalous and non-anomalous days; however, of the 35 deaths, 27 occurred during anomalous periods: on average, 0.56 deaths occurred on anomalous days and 0.19 on non-anomalous days. Winter periods meeting the criteria of anomalous EPT may have a significant adverse human-meteorological impact on the outcome in acute ischemic stroke.
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Affiliation(s)
- András Folyovich
- Department of Neurology and Stroke Center, Szent János Hospital, Budapest, Hungary
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Folyovich A, Vastagh I, Kéri A, Majoros A, Kovács KL, Ajtay A, Laki Z, Gunda B, Erdei K, Lenti L, Dános Z, Bereczki D. Living standard is related to microregional differences in stroke characteristics in Central Europe: the Budapest Districts 8–12 Project. Int J Public Health 2015; 60:487-94. [DOI: 10.1007/s00038-015-0674-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 11/28/2022] Open
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New prognostic score for the prediction of 30-day outcome in spontaneous supratentorial cerebral haemorrhage. BIOMED RESEARCH INTERNATIONAL 2015; 2015:961085. [PMID: 25648158 PMCID: PMC4306393 DOI: 10.1155/2015/961085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 11/25/2022]
Abstract
Aims. The purpose of the present study was to evaluate predictors of outcome in primary supratentorial cerebral haemorrhage. Furthermore, we aimed to develop a prognostic model to predict 30-day fatality. Methods. We retrospectively analyzed a database of 156 patients with spontaneous supratentorial haemorrhage to explore the relationship between clinical and CT characteristics and fatal outcome within 30 days using multiple logistic regression analysis. The analyzed factors included volumetric data assessed by neuropathological and CT volumetry. A second CT scan in survivors or neuropathological ABC/2 volumetry in nonsurvivors was used along with the baseline CT to assess the growth index of haematoma. Results. Systolic blood pressure, serum potassium and glucose levels, platelet count, absolute and relative haematoma volumes, and presence and size of intraventricular haemorrhage statistically significantly predicted the fatal outcome within 30 days. Based on our results we formulated a six-factor scoring algorithm named SUSPEKT to predict outcome. Conclusions. After validation the SUSPEKT score may be applicable in general clinical practice for early patient selection to optimize individual management or for assessment of eligibility for treatment trials.
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Weiss A, Beloosesky Y, Kenett RS, Grossman E. Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly. Stroke 2013; 44:2434-40. [DOI: 10.1161/strokeaha.113.001894] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and Purpose—
The prognostic value of blood pressure (BP) levels during acute stroke has not been adequately studied. Most studies do not use continuous BP measurements, and patients are followed only for a short period. We designed a study to assess, with 24-hour BP monitoring (24H BPM), the impact of BP levels during the first day of stroke, on the short-term functional status and long-term mortality in elderly patients.
Methods—
We studied 177 patients with acute stroke (89 men), mean age 84±6 years. BP was measured on admission and 24H BPM was recorded within 24 hours of admission. After 7 days, patients were assessed for functional status according to the modified Rankin Scale and were subsequently followed up for mortality ≤5 years (mean, 2.07±1.48).
Results—
After 7 days, functional status improved and modified Rankin Scale decreased from 4.2 to 3.7. Follow-up analysis disclosed that 71 patients (27 men and 44 women) had died. Mortality rate was higher in women (50% versus 30%;
P
<0.01) and in patients with a history of congestive heart failure. Only average systolic BP, recorded by 24H BPM, predicted short-term functional status and long-term mortality. Cox proportional hazards model analysis demonstrated that age, sex, congestive heart failure, and average systolic BP >160 mm Hg, recorded by 24H BPM, were associated with increased mortality.
Conclusions—
High systolic BP recorded by 24H BPM on the first day of stroke was found to be associated with unfavorable short-term functional status and long-term mortality in elderly patients.
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Affiliation(s)
- Avraham Weiss
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
| | - Yichayaou Beloosesky
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
| | - Ron S. Kenett
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
| | - Ehud Grossman
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
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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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Lenti L, Brainin M, Titianova E, Morovic S, Demarin V, Kalvach P, Skoloudik D, Kobayashi A, Czlonkowska A, Muresanu DF, Shekhovtsova K, Skvortsova VI, Sternic N, Beslac Bumbasirevic L, Svigelj V, Turcani P, Bereczki D, Csiba L. Stroke care in Central Eastern Europe: current problems and call for action. Int J Stroke 2012; 8:365-71. [PMID: 22974486 DOI: 10.1111/j.1747-4949.2012.00845.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stroke is a major medical problem and one of the leading causes of mortality and disability all over in Europe. However, there are significant East-West differences in stroke care as well as in stroke mortality and morbidity rates. Central and Eastern European countries that formerly had centralized and socialist health care systems have serious and similar problems in organizing health and stroke care 20 years after the political transition. In Central and Eastern Europe, stroke is more frequent, the mortality rate is higher, and the victims are younger than in Western Europe. High-risk patients live in worse environmental conditions, and the socioeconomic consequences of stroke further weaken the economic development of these countries. To address these issues, a round table conference was organized. The main aim of this conference was to discuss problems to be solved related to acute and chronic stroke care in Central and Eastern European countries, and also, to exchange ideas on possible solutions. In this article, the discussed problems and possible solutions will be summarized, and introduce 'The Budapest Statement of Stroke Experts of Central and Eastern European countries'.
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Affiliation(s)
- Laura Lenti
- Department of Neurology, Semmelweis University, Budapest, Hungary
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Szabó KJ, Adány R, Balla J, Balogh Z, Boda Z, Edes I, Fekete I, Káplár M, Mátyus J, Oláh L, Olvasztó S, Paragh G, Páll D, Pfliegler G, Vajda G, Zeher M, Csiba L. [Advances in the prevention, diagnosis and therapy of vascular diseases]. Orv Hetil 2012; 153:483-98. [PMID: 22430004 DOI: 10.1556/oh.2012.29340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Atherosclerosis is a systemic disease affecting the coronary, carotid, intracerebral, renal and peripherial arteries. The early morphological and functional impairments could be detected in the second or third decades of life and their progression depend on the number and severity of risk factors and individual susceptility. Although the vascular risk factors (smoking, overweight, age, unhealthy diet, lack of physical exercise, hypertension, diabetes mellitus, chronic kidney disease and dyslipidemia) are the same and common in the different vascular diseases, the present clinical routine artificially classifies the diagnosis and therapy of different vascular diseases into different subfields of medicine with the negative impact of possible polypragmasia. Recently, worldwide health surveys (e.g. REACH registry) have proven the usefulness of a holistic approach in the diagnosis and therapy of multiorgan-affected vascular patients. This review summarizes the multidisciplinary advances and future perspective of vascular diseases.
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Affiliation(s)
- Katalin Judit Szabó
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Neurológiai Klinika Debrecen Nagyerdei krt 98. 4032
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Kaya D, Dincer A, Arman F, Bakirci N, Erzen C, Pamir MN. Ischemic involvement of the primary motor cortex is a prognostic factor in acute stroke. Int J Stroke 2011; 10:1277-83. [PMID: 21967572 DOI: 10.1111/j.1747-4949.2011.00640.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The location of the primary motor cortex can be detected in healthy adults using the findings of 'T2 hypointensity' and the 'double layer sign' on 3 T diffusion-weighted imaging. The aim of this study was to assess whether ischemic involvement of the primary motor cortex can be identified on 3 T diffusion-weighted imaging within six-hours after stroke onset and to evaluate whether this finding could predict clinical outcome three-months after ischemic stroke. METHODS Sixty-five patients who had paralysis and ischemia of the anterior circulation underwent 3 T magnetic resonance imaging within six-hours of symptom onset. Follow-up MRI was obtained at 72 h. Anatomic localization and ischemic involvement of the primary motor cortex were evaluated on diffusion-weighted imaging by two investigators. Ischemic involvement on the primary motor cortex was classified into three grades. Ischemic lesion volumes were measured. We compared the favorable outcomes at three-months between subjects with and without ischemic involvement on the primary motor cortex using the NIHSS and modified Rankin Scale. RESULTS Ischemic involvement on the primary motor cortex was identified in 52% of patients. Interrater agreement coefficients were 0·93 for the identification of ischemic involvement of primary motor cortex. As defined by scores on the modified Rankin Scale, among the patients with ischemic involvement of the primary motor cortex were worse than the patients without ischemic involvement of the primary motor cortex (P = 0·01). The mean ischemic lesion volume at baseline diffusion-weighted imaging was 38·7 ± 41·7 cm(3) and was 89·8 ± 93·6 cm(3) at follow-up T2-WI. Ischemic involvement on the primary motor cortex (odds ratio: 14·7) was a determinant for worse outcome. CONCLUSIONS 3T diffusion-weighted imaging can identify ischemic involvement on the primary motor cortex and may provide useful information for predicting outcome during the hyperacute stage. Ischemic involvement on the primary motor cortex has a significant negative impact on recovery.
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Affiliation(s)
- Dilaver Kaya
- Department of Neurology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Alp Dincer
- Department of Radiology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Fehim Arman
- Department of Neurology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Nadi Bakirci
- Department of Public Health, Acibadem University School of Medicine, Istanbul, Turkey
| | - Canan Erzen
- Department of Radiology, Acibadem University School of Medicine, Istanbul, Turkey
| | - M Necmettin Pamir
- Departments of Neurosurgery, Acibadem University School of Medicine, Istanbul, Turkey
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current world literature. Curr Opin Cardiol 2010; 25:411-21. [PMID: 20535070 DOI: 10.1097/hco.0b013e32833bf995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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