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Dymm B, Goldstein LB, Unnithan S, Al-Khalidi HR, Koltai D, Bushnell C, Husseini NE. Depression following small vessel stroke is common and more prevalent in women. J Stroke Cerebrovasc Dis 2024; 33:107646. [PMID: 38395097 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/19/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES We sought to examine the frequency of depression after small vessel-type stroke (SVS) and associated risk factors. MATERIALS AND METHODS We conducted a retrospective analysis of a prospective cohort of patients enrolled in the American Stroke Association-Bugher SVS Study, which included 200 participants within 2-years of SVS and 79 controls without a history of stroke from 2007 to 2012 at four sites. The primary outcome was PHQ-8, with scores ≥10 consistent with post-stroke depression (PSD). A logistic regression adjusted for age, race, sex, history of diabetes and Short-Form Montreal Cognitive Assessment score (SF-MoCA) was used to compare the risk of having depression after SVS compared to controls. Another logistic regression, adjusted for age, sex, race, level of education, SF-MoCA, white matter disease (WMD) burden, stroke severity (NIHSS), time between stroke and depression screen, history of diabetes, and history of hypertension was used to identify factors independently associated with depression in participants with SVS. RESULTS The cohort included 161 participants with SVS (39 excluded due to missing data) and 79 controls. The mean interval between stroke and depression screening was 74 days. Among participants with SVS, 31.7% (n = 51) had PSD compared to 6.3% (n = 5) of controls (RR = 5.44, 95% CI = 2.21-13.38, p = 0.0002). The only two variables independently associated with PSD in participants with SVS were female sex (RR = 1.84, 95% CI = 1.09-3.09, p = 0.020) and diabetes (RR 1.69, 95% CI 1.03-2.79). CONCLUSIONS After adjusting for several demographic and clinical variables, having a SVS was associated with an approximate 5-fold increased risk of depression and was more frequent in women and in those with diabetes. The extent of WMD was not independently associated with PSD, suggesting that small vessel disease in the setting of an overt SVS may not account for the increased prevalence of depression.
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Affiliation(s)
- Braydon Dymm
- Duke University Hospital, Department of Neurology, 2301 Erwin Rd, Durham, NC 27705, United States.
| | | | - Shakthi Unnithan
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, United States
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, United States
| | - Deborah Koltai
- Duke University Hospital, Department of Neurology, 2301 Erwin Rd, Durham, NC 27705, United States
| | - Cheryl Bushnell
- Wake Forest Atrium Health, Department of Neurology, United States
| | - Nada El Husseini
- Duke University Hospital, Department of Neurology, 2301 Erwin Rd, Durham, NC 27705, United States
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Dymm B, Wiggins W, Smith VL, El Husseini N, Pawar S, Feng W. Teaching NeuroImage: Diffuse Midline Glioma Mimicking Edema in Cerebral Venous Thrombosis. Neurology 2023; 101:e1945-e1947. [PMID: 37652698 PMCID: PMC10663001 DOI: 10.1212/wnl.0000000000207822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/10/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Braydon Dymm
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC.
| | - Walter Wiggins
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Vanessa L Smith
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Nada El Husseini
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Swaroop Pawar
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Wuwei Feng
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
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Dymm B, Goldstein LB, El Husseini NK, Bushnell CD, Koltai D. Abstract 139: Depression Following Small Vessel Stroke Is Common And More Prevalent In Women. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Post-stroke depression (PSD) affects about one third of stroke survivors and is associated with poorer quality of life. Little is known about the prevalence and independent risk factors for depression associated with small vessel stroke (SVS).
Methods:
We conducted a retrospective analysis of a prospective cohort of patients enrolled in the American Stroke Association-Bugher SVS Study, which enrolled 200 patients within 2 years of SVS and 79 controls without stroke history from 2007 to 2012 at four clinical sites. The primary outcome was PHQ-8 dichotomized at (≥10 and <10) with higher scores consistent with PSD. Chi-square test was used to compare the rates of depression between the two groups. Logistic regression was used to evaluate factors associated with depression in patients with SVS adjusted for age, sex, race/ethnicity, NIH Stroke Scale, white matter disease (WMD) burden, Montreal Cognitive Assessment short-form score, and history of diabetes.
Results:
The cohort included 161 participants with SVS (excluding 39 due to missing key variables) and 79 controls. Participant characteristics are described in Table 1. The mean time between stroke and depression screening was 74 days. Among participants with SVS, 31.7% (n=51) screened positive for PSD, compared to 6.3% (n=5) of controls, OR= 6.9 (95%CI 2.6-18.0%; p<0.0001). PSD was prevalent in 35.9% of participants with SVS who had good functional outcome (modified Rankin score ≤2). Female sex was the only variable associated with PSD in those with SVS (OR 2.3, 95%CI 1.0-5.2, p=0.041).
Conclusion:
In this well-characterized cohort of SVS with mostly mild stroke severity, depression within 3 months of the incident stroke was about 7 times more likely than those without a history of stroke. The extent of WMD was not associated with PSD, suggesting that small vessel disease other than the incident SVS does not account for the increased rates of PSD. Depression following SVS was more prevalent in women.
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Dymm B, Kolls B, Ehrlich M, Monk L, Shah S, Iversen E, Roettig ML, Xian Y, Jollis J, Granger C, Graffagnino C. Abstract TMP47: IMPROVING Time To Anti-Coagulation Reversal For Hemorrhagic Strokes. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed as quickly as possible, many health care systems have not developed a process for optimizing that aspect of care.
Methods:
Through the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their regional community hospitals, a systems of care improvement project was implemented. Performance reviews identified best practices which were disseminated throughout all centers. We compared the median door-to-reversal (DTR) time before and after an institutional campaign to speed the process with a target time of 60 minutes.
Results:
Over two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracranial hemorrhages. During that time, 36 hemorrhagic stroke patients received reversal agents emergently. The baseline median DTR time was 123 minutes (IQR 99, 361 minutes) for all comers. By the end of the program, the median DTR time had been reduced to 92.5 minutes (IQR 59, 163 minutes) which is a trend towards 59% reduction of DTR from baseline (p=0.08).
Conclusions:
Utilizing an integrated stroke systems of care approach we were able to reduce DTR times for patients presenting with acute ICH and concurrent use of anticoagulants in spite of the lack of definitive guidelines as to how quickly reversing agents should be given.
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Affiliation(s)
| | | | | | - Lisa Monk
- Duke Clinical Rsch Institute, Winston Salem, NC
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Dymm B, Meurer WJ, Kwicklis M, Lisabeth LD, Shi X. Abstract 29: Recurrent Stroke Arrival Time. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
All stroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical (EMS). The impact of this education is unclear. We aimed to measure the association between EMS use and timing of arrival within first ever and recurrent strokes.
Methodology:
The study analyzed data from validated strokes identified by the Brain Attack Surveillance in Corpus Christi (BASIC) project between 1/1/2000-1/1/2020. We analyzed 5,617 first-ever strokes (FES), 259 instances of recurrent stroke within 1 year of the first (RS1), and 2,044 recurrent strokes over 1 year or unknown duration from the first (RS0). Following imputation, recurrent stroke’s associations with both EMS arrival (available post-2010) and early arrival (< 3hrs) were assessed with logistic models, accounting for clustering with generalized linear models (GEEs).
Results:
Compared to FES, there was significantly higher unadjusted odds of arrival by EMS, but not early arrival, for one of the recurrent stroke groups (Table 1; RS0: OR = 1.29, 95% CI=1.10-1.50; RS1:OR=1.24, CI=0.87-1.75). The association was not significant after adjustment. Increasing stroke severity, married status and EMS use were associated with higher odds of early arrival, while African Americans (AAs) had lower odds than non-Hispanic Whites (NHWs, Table 1). However, AAs did have higher odds of EMS use relative to NHWs. Those who were married and living together had lower odds of EMS use compared to those who were not.
Conclusion:
Our study examines the association of repeat stroke on early arrival and EMS use as a surrogate for adequate stroke education. By examining subsets, we can identify groups that would benefit from targeted education. For example, younger, non-AA patients with smaller strokes would benefit from more education on EMS use and African American patients would benefit from education related to faster recognition or urgency of presentation.
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Affiliation(s)
| | | | | | | | - Xu Shi
- Michigan Medicine, Ann Arbor, MI
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Gottlieb-Smith R, Gelb DJ, Becker B, Dymm B, Gutgsell O, Patel N, Balmer DF. Longitudinal Qualitative Study of Career Decision-making of First-Year Medical Students: Why Neurology (or Not)? Neurol Clin Pract 2021; 11:e387-e396. [PMID: 34484935 DOI: 10.1212/cpj.0000000000001071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/19/2021] [Indexed: 11/15/2022]
Abstract
Objective The growing shortage of neurologists is in part due to suboptimal recruitment. Little is known about students' decision making regarding a career in neurology, particularly early in training. Using a longitudinal qualitative approach, we aimed to understand factors that influence first-year medical students' decisions about neurology. Methods We conducted 1-on-1 semistructured interviews with 15 first-year medical students at 1 institution before and after the preclinical neurology course (2018-2019). In the first interview, we asked about career intentions, factors likely to influence specialty choice, and perceptions of neurology. In the second interview, we asked about changes in students' views over the year. Using thematic analysis, we generated codes and clustered coded data into themes. Results The 2 most prominent factors influencing career choice in general were lifestyle and personal interest. No students expressed concerns about lifestyle in neurology. Most students were neutral about neurology or had a positive personal interest, which typically increased after the neurology course. Students frequently worried about content difficulty and the curative potential of neurology. Conclusions Interventions should include early education about the factors important to students in determining specialty choice, including lifestyle, and address potentially negative perceptions of neurology. Increasing time allotment to the preclinical neurology course may combat perception of the content as difficult.
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Affiliation(s)
- Rachel Gottlieb-Smith
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Douglas J Gelb
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Benjamin Becker
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Braydon Dymm
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Olivia Gutgsell
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Namrata Patel
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dorene F Balmer
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Kaplan K, Alam A, Dymm B, Valiuddin H, Nanthabalan S. Rare anoxic brain injury sequela of delayed posthypoxic leukoencephalopathy due to recreational drug overdose with benzodiazepines. Clin Case Rep 2020; 8:635-639. [PMID: 32274025 PMCID: PMC7141731 DOI: 10.1002/ccr3.2705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 11/07/2022] Open
Abstract
A growth in recreational drug use will lead to a rise in delayed posthypoxic leukoencephalopathy cases. Physicians may inadvertently misdiagnose this rare condition as a primary psychiatric disorder by not maintaining a broad differential diagnosis.
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Affiliation(s)
- Kara Kaplan
- Department of Internal MedicineSt Mary Mercy HospitalLivoniaMichigan
| | - Ariful Alam
- Department of Internal MedicineSt Mary Mercy HospitalLivoniaMichigan
| | - Braydon Dymm
- Department of Internal MedicineSt Mary Mercy HospitalLivoniaMichigan
| | - Hisham Valiuddin
- Department of Emergency MedicineSt Mary Mercy HospitalLivoniaMichigan
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Memon AB, Dymm B, Ahmad BK, Sripathi N, Schultz L, Chandok A. Suprascapular neuropathy: A review of 87 cases. Muscle Nerve 2019; 60:250-253. [DOI: 10.1002/mus.26630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Anza B. Memon
- Department of NeurologyHenry Ford Hospital Detroit Michigan
- School of MedicineWayne State University Detroit Michigan
| | - Braydon Dymm
- Department of NeurologyUniversity of Michigan Ann Arbor Michigan
| | | | - Naganand Sripathi
- Department of NeurologyHenry Ford Hospital Detroit Michigan
- School of MedicineWayne State University Detroit Michigan
| | - Lonni Schultz
- Department of NeurologyHenry Ford Hospital Detroit Michigan
| | - Arun Chandok
- Department of NeurologyHenry Ford Hospital Detroit Michigan
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