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Latest & greatest articles for stroke
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Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemicstroke Essentials The risk of thrombosis among ischemicstroke patients using glucocorticoids is unknown. We examined the risk of thrombosis in 98 487 ischemicstroke patients, by glucocorticoid use. Myocardial infarction and venous thromboembolism risk was increased in glucocorticoid users. Hemorrhagic stroke risk was lower and recurrent ischemicstroke the same in glucocorticoid users. SUMMARY (...) redemption ≤ 90 days before admission), former use, and non-use. With non-users as reference, we studied the risks of recurrent ischemicstroke, hemorrhagic stroke, myocardial infarction and venous thromboembolism associated with glucocorticoid use. Comorbidity and comedication-adjusted 1-year hazard ratios (aHRs) with 95% confidence intervals (CIs) were computed on the basis of Cox regression analysis. Results We identified 98 487 patients with a first-time (index) ischemicstroke. After the index
Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemicstroke by promoting anterograde reperfusion and retrograde collateral flow The present study was undertaken to determine the efficacy of coadministration of fingolimod with alteplase in acute ischemicstroke patients in a delayed time window.This was a prospective, randomized, open-label, blinded endpoint clinical trial, enrolling patients with internal carotid artery or middle cerebral artery proximal (...) occlusion within 4.5 to 6 hours from symptom onset. Patients were randomly assigned to receive alteplase alone or alteplase with fingolimod. All patients underwent pretreatment and 24-hour noncontrast computed tomography (CT)/perfusion CT/CT angiography. The coprimary endpoints were the decrease of National Institutes of Health Stroke Scale scores over 24 hours and the favorable shift of modified Rankin Scale score (mRS) distribution at day 90. Exploratory outcomes included vessel recanalization
Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke Background and Purpose- We aimed to determine whether low-frequency electric field navigated repetitive transcranial magnetic stimulation to noninjured motor cortex versus sham repetitive transcranial magnetic stimulation avoiding motor cortex could improve arm motor function in hemiplegic stroke patients when combined with motor training. Methods- Twelve outpatient US
neuropsychological testing, the Clinical Dementia Rating (CDR) scale, the modified Rankin Scale (mRS), and Instrumental Activities of Daily Living (IADL) and analyzed with generalized estimating equations. All-cause mortality was investigated by Cox proportional hazard models. Analyses were adjusted for demographic variables, education, vascular risk factors, premorbid cognitive status, and NIH Stroke Scale scores. The additive predictive value of MoCA was examined with receiver operating characteristic (...) Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke To examine whether the Montreal Cognitive Assessment (MoCA) administered within 7 days after stroke predicts long-term cognitive impairment, functional impairment, and mortality.MoCA was administered to 274 patients from 2 prospective hospital-based cohort studies in Germany (n = 125) and France (n = 149). Cognitive and functional outcomes were assessed at 6, 12, and 36 months after stroke by comprehensive
Effects of robot-(Morning Walk((R))) assisted gait training for patients after stroke: a randomized controlled trial To investigate the effects of Morning Walk®-assisted gait training for patients with stroke.Prospective randomized controlled trial.Three hospital rehabilitation departments (two tertiary and one secondary).We enrolled 58 patients with hemiparesis following a first-time stroke within the preceding year and with Functional Ambulation Category scores ⩾2.The patients were randomly (...) improved more ( p = .047) in the Morning Walk® group (∆mean ± SD; 14.36 ± 9.01) than the control group (∆mean ± SD; 9.65 ± 8.14).Compared with conventional physiotherapy alone, our results suggest that voluntary strength and balance of stroke patients with hemiparesis might be improved with Morning Walk®-assisted gait training combined with conventional physiotherapy.
Return to work after ischemicstroke in young adults: A registry-based follow-up study We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemicstroke (IS) and during follow-up, and clinical factors associated with NRTW.Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were (...) Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.NRTW is a frequent adverse outcome after IS in young adults with mild to moderate
NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemicstroke To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemicstroke (AIS).Data are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics (...) , sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity 56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference in functional outcome or symptomatic intracranial hemorrhage between AIS types.In thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because thrombolysis treatment has low effect on stroke outcome in patients
Assoc. 2016;5:1-14. 1. Fugate JE, Rabinstein AA. Absolute and relative contraindicationstoIVrt-PAfor acute ischemicstroke. Neurohospitalist. 2015;5: 110-121. 2. Brown MD, Burton JH, Nazarian DJ, et al. Clinical policy: use of intravenous tissue plasminogen activator for the management of acute ischemicstroke in the emergency department. Ann Emerg Med. 2015;66: 322-333.e31. 3. Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase for acute ischaemicstroke in the Safe Implementation (...) of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet. 2007;369:275-282. 4. Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase 3-4.5 h after acute ischaemicstroke (SITS-ISTR): an observational study. Lancet. 2008;372: 1303-1309. 5. Luo S, Zhuang M, Zeng W, et al. Intravenous thrombolysis for acute ischemicstroke in patients receiving antiplatelet therapy: a systematic review and meta-analysis of 19 studies. J Am Heart Assoc. 2016;5:1-14. 6. Xian Y, Federspiel
Is Antibiotic Therapy Helpful for Preventing Infection After Acute Stroke? (SRS therapy) Is Antibiotic Therapy Helpful for Preventing Infection After Acute Stroke? TAKE-HOME MESSAGE In patients with acute ischemic or hemorrhagic stroke, prophylactic antibiotics reduce the overall infection rate, but do not reduce the risk of pneumonia, death or dependency. EBEM Commentators Latha Ganti, MD, MBA Department of Clinical Sciences University of Central Florida College of Medicine Orlando, FL Bryan (...) studies and ongoing trials. STUDY SELECTION Randomized trials that compared preventive antibiotictherapyversus control in patients with acute ischemic or hemorrhagic stroke were included. There were no limits on route of antibiotic administration (oral or parenteral) or duration, but therapy had to be started within 24 hours after the onset of stroke in patients without infection at presentation. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data with a standardized data collection
Mecobalamin and early functional outcomes of ischemicstroke patients with H-type hypertension. To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemicstroke and H-type hypertension.From October of 2014 to October of 2016, 224 cases of ischemicstroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy
Points Congestive heart failure 1 Hypertension 1 Age 65-75 Age >75 1 2 Diabetes 1 Prior stroke / TIA / systemic embolism (limb / gut / spleen etc) 2 Female sex 1 Vascular disease 1 The CHADSVASC has additional points for age >65, female sex and a history of vascular disease (such as aortic aneurysm or lower limb arterial disease). The Canadian Association of Emergency Physicians 1 and the Canadian Cardiovascular Society 2 recommend using yet another rule version, the CHADS65. The CHADS65 is a hybrid (...) fibrillation at a rate of 110 beats per minute. Now, four hours later, her heart rate is 80-90 and she is keen to go home. You are wondering if this new diagnosis will mean she is at risk of stroke. How do you assess this? There are several scores which estimate the stroke risk, including CHADS2, CHADSVASC and in Canada, we have the CHADS65. CHADS2 score Points Congestive heart failure 1 Hypertension 1 Age ≥ 75 1 Diabetes 1 Prior stroke / TIA / systemic embolism (limb / gut / spleen etc) 2 CHADSVASC score
Complex Left Atrial Appendage Morphology Is an Independent Risk Factor for Cryptogenic IschemicStroke Importance: Ischemicstrokes pose a significant health burden. However, the etiology of between 20 and 40% of these events remains unknown. Left atrial appendage morphology may influence the occurrence of thromboembolic events. Design: A retrospective cross-sectional study was conducted to investigate the role of LAA morphology in patients with atrial fibrillation (AF) and cardioembolic (...) -associated stroke and patients with cryptogenic stroke without atrial fibrillation. LAA morphology is classified into two groups: (1) simple (chicken-wing) vs. (2) complex (non-chicken wing) based on transesophageal echocardiography (TEE) findings. In addition to the LAA morphology, left atrial parameters, including orifice diameter, depth, emptying velocity, and filling velocity, were collected for both groups. Mathematical, computational models were constructed to investigate flow velocities in chicken
Advances in Stroke Prevention There have been recent advances in stroke prevention in nutrition, blood pressure control, antiplatelet therapy, anticoagulation, identification of high-risk asymptomatic carotid stenosis, and percutaneous closure of patent foramen ovale. There is evidence that the Mediterranean diet significantly reduces the risk of stroke and that B vitamins lower homocysteine, thus preventing stroke. The benefit of B vitamins to lower homocysteine was masked by harm from (...) monitoring for atrial fibrillation (AF), have revolutionized the prevention of cardioembolic stroke. Most patients (~90%) with asymptomatic carotid stenosis are better treated with intensive medical therapy; the few that could benefit from stenting or endarterectomy can be identified by a number of approaches, the best validated of which is transcranial Doppler (TCD) embolus detection. Percutaneous closure of patent foramen ovale has been shown to be efficacious but should only be implemented in selected
Electroconvulsive therapy and later stroke in patients with affective disorders The long-term effects of electroconvulsive therapy (ECT) on the risk of stroke are unknown. We examined the association between ECT and risk of incident or recurrent stroke. A cohort of 174 534 patients diagnosed with affective disorder between 2005 and 2016 in the Danish National Patient Registry were followed for stroke until November 2016. The association between ECT and stroke was analysed using Cox regression (...) with multiple adjustment and propensity-score matching on sociodemographic and clinical variables. In 162 595 patients without previous stroke, 5781 (3.6%) were treated with ECT. The total number of patients developing stroke during follow-up was 3665, of whom 165 had been treated with ECT. In patients <50 years, ECT was not associated with stroke (adjusted hazard ratio (HR) = 1.29, 95% CI 0.87-1.93). In patients ≥50, ECT was associated with a lower risk of stroke (adjusted HR = 0.69, 95% CI 0.57-0.89
were randomized to pioglitazone or placebo (1:1) within 180 days of an ischemicstroke or transientischemicattack and followed for ≤5 years. To identify patients at higher HF risk with pioglitazone, we performed a secondary analysis of IRIS participants without HF history at entry. HF episodes were adjudicated by an external review, and treatment effects were analyzed using time-to-event methods. A baseline HF risk score was constructed from a Cox model estimated using stepwise selection (...) Heart Failure After IschemicStroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone The IRIS trial (Insulin Resistance Intervention After Stroke) demonstrated that pioglitazone reduced the risk for both cardiovascular events and diabetes mellitus in insulin-resistant patients. However, concern remains that pioglitazone may increase the risk for heart failure (HF) in susceptible individuals.In IRIS, patients with insulin resistance but without diabetes mellitus
Prognostic Value of BEFAST vs. FAST to Identify Stroke in a Prehospital Setting Use of prehospital stroke scales may enhance stroke detection and improve treatment rates and delays. Current scales, however, may lack detection accuracy. As such, we examined whether adding coordination (Balance) and diplopia (Eyes) assessments increase the accuracy of the Face-Arms-Speech-Time (FAST) scale in a multisite prospective study of emergency response activations for presumed stroke.This (...) was a prospective study of emergency response activations for presumed stroke in Santa Clara County, California. Emergency medical responders were trained in the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale and administered the scale on scene to all patients who were within 6 hours of onset of neurological symptoms. Each patient's final diagnosis (stroke vs. no stroke) was based on review of hospital records. We compared the performance of the BEFAST and FAST scales for stroke detection.Three hundred fifty