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Latest & greatest articles for stroke
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Cryotherapy Reduces Muscle Spasticity But Does Not Affect Proprioception in IschemicStroke: A Randomized Sham-Controlled Crossover Study. The aim of the study was to evaluate the immediate effects of cryotherapy (using an ice pack) on ankle joint position sense and the degree of spasticity after chronic hemiparetic stroke.We used a sham-controlled crossover design. Sixteen chronic hemiparetic patients were randomly assigned to two groups: (1) those who received cryotherapy followed
Comparative Effects of Different Assistance Force During Robot-Assisted Gait Training on Locomotor Functions in Patients With Subacute Stroke: An Assessor-Blind, Randomized Controlled Trial. The aim of the study was to compare the effects of progressive reducing assistance force versus full assistance force controlled robot-assisted gait training combined with conventional physiotherapy on locomotor functions in patients with subacute stroke.Inpatients with subacute stroke (N = 29; 16 men (...) to the full assistance force group, both at postintervention and at follow-up.Progressive reducing assistance force control during robot-assisted gait training combined with conventional physiotherapy may be more beneficial for improving locomotor functions in patients with subacute stroke.
Early CT score. MCA = middle cerebral artery. Thrombectomy provision and population size A recent study developed a decision-tree model based on data from international RCTs and national registries to estimate the number of ischaemicstroke patients eligible for mechanical thrombectomy each year in the UK 40 . Patients were excluded from the eligible population based on criteria such as small artery occlusion rather than large artery occlusion, mild stroke, presentation more than 12 hours after (...) ://www.stroke.org.uk/system/files/sotn_2018.pdf. 2. World Health Organization. Stroke, cerebrovascularaccident. [cited 2018 Oct 11]; Available from: http://www.who.int/topics/cerebrovascular_accident/en/. 3. Scottish Intercollegiate Guidelines Network. Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention. 2008 [cited 2018]; Available from: https://www.sign.ac.uk/assets/sign108.pdf. 4. EUnetHTA. Endovascular therapy using mechanical thrombectomy
Rate of peri-procedural stroke observed with cerebral embolic protection during transcatheter aortic valve replacement: a patient-level propensity-matched analysis The role of cerebral embolic protection (CEP) in transcatheter aortic valve replacement (TAVR) remains controversial. Randomized trials have not been powered to demonstrate a reduction in stroke rates. The aim of this patient level pooled analysis was to validate the impact of the dual-filter CEP device (Claret Medical Inc., CA, USA (...) ) on peri-procedural stroke in a large number of TAVR patients.Patients from the SENTINEL US IDE trial were combined with the CLEAN-TAVI and SENTINEL-Ulm study in a patient level pooled analysis (N = 1306). Propensity score matching was performed to adjust for possible confounders. The primary endpoint was procedural stroke within 72 h post-TAVR according to Valve Academic Research Consortium-2 criteria. The secondary endpoint was the combination of all-cause mortality or all-stroke within 72 h after
on outcome across the 2-year duration of support.MOMENTUM 3 is a randomized controlled trial of the HM3 centrifugal-flow pump versus the HMII axial-flow pump in patients with advanced heart failure, regardless of the intended goal of support (bridge to transplantation or destination therapy). Baseline and postimplantation clinical correlates of stroke events were assessed with multivariable analyses. Longitudinal patterns, including device association, type of stroke (hemorrhagic versus ischemic (...) ), changing severity of impairment assessed with the modified Rankin Scale (disabling [modified Rankin Scale score >3] versus nondisabling [modified Rankin Scale score ≤3]) over time, and association with outcome, were determined.In 361 patients with the intended implant (189 HM3 and 172 HMII), 65 strokes (40 ischemicstrokes and 25 hemorrhagic strokes) occurred in 52 patients at a median of 131 (range, 1-733) days. No difference in stroke rate was noted between 0 and 180 days of follow-up between devices
Relation of the CHA2DS2-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study) Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemicstroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA2DS2-VASc score, among community-dwelling (...) individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996 to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). During follow-up through 2008, incident AF cases (n = 760) and participants who started warfarin were censored. Incident AF was ascertained from study electrocardiograms and hospital discharge diagnosis codes, and stroke was physician-adjudicated. After 10 years of follow-up, 280 ischemicstrokes
Development and validation of a score to detect paroxysmal atrial fibrillation after stroke Prolonged monitoring times (72 hours) are recommended to detect paroxysmal atrial fibrillation (pAF) after ischemicstroke but this is not yet clinical practice; therefore, an individual patient selection for prolonged ECG monitoring might increase the diagnostic yield of pAF in a resource-saving manner.We used individual patient data from 3 prospective studies (ntotal = 1,556) performing prolonged (...) Holter-ECG monitoring (at least 72 hours) and centralized data evaluation after TIA or stroke in patients with sinus rhythm. Based on the TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guideline, a clinical score was developed on one cohort, internally validated by bootstrapping, and externally validated on 2 other studies.pAF was detected in 77 of 1,556 patients (4.9%) during 72 hours of Holter monitoring. After logistic regression analysis
Unilateral Strength Training and Mirror Therapy in Patients With Chronic Stroke: A Pilot Randomized Trial. The aim of the study was to investigate the feasibility and potential effectiveness of mirror-aided cross-education compared with cross-education alone in poststroke upper limb recovery.A pilot randomized controlled parallel group study was carried out. Thirty-two patients with chronic stroke followed a 4-wk isometric strength training program performed with the less-affected upper limb (...) Inventory.Compliance was high with no adverse effects. The use of the Biodex Dynamometer must be reviewed. Mirror therapy did not augment the cross-education effect (P > 0.05) in patients with chronic stroke when training isometrically.This pilot trial established the feasibility of a randomized controlled trial comparing mirror-aided cross-education with cross-education alone for poststroke upper limb recovery. Mirror therapy did not augment cross-education when training isometrically. However, results indicate
started within 7 days after symptom onset to detect improvement in functional outcomes and cardiovascular protection in nondepressed, first-ever ischemicstroke. Study medication was given as add-on to standard medical care and treatment duration and follow-up was 6 months. There were 2 coprimary outcomes: changes in functional disability from 1 to 6 months on the modified Rankin Scale, and a composite vascular end point of transientischemicattack/stroke, myocardial infarction, or vascular mortality (...) Neuroregeneration and Vascular Protection by Citalopram in Acute IschemicStroke (TALOS) Background and Purpose- Recent studies indicate a possible beneficial effect on neuroregeneration and vascular protection of selective serotonin reuptake inhibitors after stroke. We conducted a national multicentre study to explore these effects. Methods- The TALOS study (The Efficacy of Citalopram Treatment in Acute Stroke) is a Danish placebo-controlled, randomized, double-blind study of citalopram
Validation of the Simplified Stroke-Thrombolytic Predictive Instrument to Predict Functional Outcomes in Chinese Patients Background and Purpose- The simplified stroke-thrombolytic predictive instrument (s-Stroke-TPI) is useful for predicting the outcomes in thrombolysis-treated patients in Western populations. We aimed to validate its predictive value in Chinese patients. Methods- Data from thrombolysis implementation and monitor of acute ischemicstroke in China were analyzed. Patients (...) with acute ischemicstroke and treated with thrombolysis within 4.5 hours of symptom onset were included. The 3-month functional outcomes were assessed with the modified Rankin Scale (mRS). Model discrimination was quantified by calculating the area under receiver operating characteristic curve. s-Stroke-TPI was compared with dense artery sign, mRS score, age, glucose, onset to treatment time, and National Institutes of Health Stroke Scale or stroke prognostication using age and National Institutes
Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.A single-blinded, 2-sequence, 2-period, crossover-designed study.Rehabilitation clinics and participant's home environment.Individuals with disabilities poststroke.During each intervention
It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemicstroke with carotid stenosis. There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial.ENOS randomised 4011 patients with acute stroke (...) and raised systolic BP (140-220 mm Hg) to transdermal GTN or no GTN within 48 hours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: <30%; 30-<50%; 50-<70%; ≥70%. Data are ORs with 95% CIs adjusted for baseline prognostic factors.2023 (60.5%) ischaemicstroke participants had carotid imaging. As compared with <30%, ≥70% ipsilateral
the last three decades, we learnt about the value of risk stratification tools (eg, ABCD2, Oxford TIA, among others) that may help guide management decisions. 1 However, limited information is available on the recurrence of cardiovascular events, stroke, death 5 years after a transientischaemicattack (TIA) or minor stroke. 2 The TIAregistry.org prospectively included patients with a recent TIA or minor stroke to evaluate the short-term (3 months and 1 year) and long-term (5 years) outcomes. 3 Methods (...) or password? You are here Understanding Risk for Better Stroke Prevention Article Text Commentary General medicine Understanding Risk for Better Stroke Prevention Gustavo Saposnik 1 , 2 , 3 Statistics from Altmetric.com Commentary on: Amarenco P, Lavallée PC, Monteiro Tavares L, et al . Five-year risk of stroke after TIA or minor ischemicstroke. N Engl J Med . 2018;378:2182–2190 “Living at risk is jumping off the cliff and building your wings on the way down ” . Ray Bradbury (1920-2012) Context Over
General Medicine: Routine fluoxetine in stroke Routine fluoxetine in stroke | BMJ Evidence-Based Medicine Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Routine fluoxetine (...) in stroke Article Text EBM Verdict General Medicine Routine fluoxetine in stroke Carl Heneghan 1 , Kamal R Mahtani 2 Statistics from Altmetric.com A recent UK trial addressed whether routine use of fluoxetine in patients who had a stroke improved motor recovery at 6 months. EBM Verdict EBM Verdict on: Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. FOCUS Trial Collaboration. Lancet 2019;393:265–74. doi: 10.1016/S0140-6736
-eight centers across Australia, Asia, and Europe. Population: Two hundred twenty-five adult patients with ischemicstroke who were treated between 4.5 and 9 hours from onset of symptoms, or adjusted onset if awakening from sleep, and feasible ischemic penumbra detected on automated cerebral perfusion imaging. Intervention: Alteplase (0.9 mg/kg) or matching placebo. Primary and Secondary Outcomes: The primary outcome was the proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 (...) to premature termination of the trial. How Might This Study Affect Your Clinical Practice in the Emergency Department? The results of this trial may lead to consideration of alteplase for a subset of patients with acute ischemicstroke in the 4.5- to 9-hour window. However, most patients enrolled also manifested large-vessel occlusions and would otherwise have been treated with endovascular therapy. The addition of this narrow scope for alteplase, if any, would likely depend on available resources
. et al. The long-term use of warfarin among atrial fibrillation patients discharged from an emergency department with a warfarin prescription. Ann Emerg Med. 2015; 66 : 347-354 , Scheuermeyer F.X. Innes G. Pourvali R. et al. Missed opportunities for appropriate anticoagulation among emergency department patients with uncomplicated atrial fibrillation or flutter. Ann Emerg Med. 2013; 62 : 557-565 Given that atrial fibrillation is often associated with large-vessel ischemicstrokes, Barrett T.W (...) Stop the Clot: Should Emergency Clinicians Champion Stroke Prevention and Prescribe Anticoagulation for Patients With Atrial Fibrillation? Stop the Clot: Should Emergency Clinicians Champion Stroke Prevention and Prescribe Anticoagulation for Patients With Atrial Fibrillation? - Annals of Emergency Medicine Go search Please enter a term before submitting your search. , P419-421, April 01, 2019 Powered By Mendeley Share on Stop the Clot: Should Emergency Clinicians Champion Stroke Prevention
to calculate the cumulative lifetime risks of first stroke, ischemicstroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.The (...) estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemicstroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk
Effect of health empowerment intervention for stroke self-management on behaviour and health in stroke rehabilitation patients. 29938651 2018 12 11 2018 12 11 1024-2708 24 Suppl 2 1 2018 02 Hong Kong medical journal = Xianggang yi xue za zhi Hong Kong Med J Effect of health empowerment intervention for stroke self-management on behaviour and health in stroke rehabilitation patients. 12-15 Sit J Wh JW The Nethersole School of Nursing, The Chinese University of Hong Kong. Chair S Y SY (...) of Medicine and Rehabilitation, Tung Wah Eastern Hospital. eng Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't China Hong Kong Med J 9512509 1024-2708 IM Adult Aged Female Hong Kong Humans Male Middle Aged Power (Psychology) Regression Analysis Self-Management methods Stroke psychology therapy Stroke Rehabilitation methods Treatment Outcome 2018 6 26 6 0 2018 6 26 6 0 2018 12 12 6 0 ppublish 29938651
Stroke is an acute neurological deficit caused by cerebrovascular aetiology. It is further subdivided into ischaemicstroke and haemorrhagic stroke. Ischaemicstroke is lack of blood perfusion due to occlusion or critical stenosis of a cerebrospinal artery, and haemorrhagic stroke is due to rupture of a cerebrospinal artery, resulting in intraparenchymal, subarachnoid, and intraventricular haemorrhage. Intracerebral haemorrhage is further subdivided into primary and secondary aetiology. Primary (...) ) and ischaemicstroke differ radically. The primary treatment of haemorrhagic stroke involves supportive care and optimisation of intracranial haemodynamics. Surgical resection of intracerebral haematomas may be of benefit in select cases, but has yet to be demonstrated as effective in clinical trials. Newer minimally invasive surgical techniques are currently being investigated. Study results show that patients in dedicated stroke units have improved survival and reduced disability at 1 year. Definition
or stenosis) and haemorrhagic stroke (caused by vascular rupture, resulting in intraparenchymal and/or subarachnoid haemorrhage). Central venous sinus thrombosis is a rare form of stroke that occurs due to thrombosis of the dural venous sinuses. This monograph deals with ischaemicstroke. Transientischaemicattack (TIA) is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. Patients with TIAs are at high risk (...) survival and function. Intravenous recombinant tissue plasminogen activator is given within 4.5 hours of stroke onset. Endovascular interventions, such as clot retrieval devices or intra-arterial thrombolysis, can be used in carefully selected patients within 6 hours of ischaemicstroke onset. Definition Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology. It is further subdivided into ischaemicstroke (caused by vascularocclusion