Latest & greatest articles for stroke

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Top results for stroke

161. Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemic stroke Full Text available with Trip Pro

Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemic stroke Essentials The risk of thrombosis among ischemic stroke patients using glucocorticoids is unknown. We examined the risk of thrombosis in 98 487 ischemic stroke patients, by glucocorticoid use. Myocardial infarction and venous thromboembolism risk was increased in glucocorticoid users. Hemorrhagic stroke risk was lower and recurrent ischemic stroke 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 ischemic stroke, 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) ischemic stroke. After the index

2018 EvidenceUpdates

162. Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemic stroke by promoting anterograde reperfusion and retrograde collateral flow Full Text available with Trip Pro

Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemic stroke 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 ischemic stroke 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

2018 EvidenceUpdates

163. Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke Full Text available with Trip Pro

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

2018 EvidenceUpdates

164. Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke (Abstract)

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

2018 EvidenceUpdates

165. Ordinal vs dichotomous analyses of modified Rankin Scale, 5-year outcome, and cost of stroke Full Text available with Trip Pro

Ordinal vs dichotomous analyses of modified Rankin Scale, 5-year outcome, and cost of stroke To compare how 3 common representations (ordinal vs dichotomized as 0-1/2-6 or 0-2/3-6) of the modified Rankin Scale (mRS)-a commonly used trial outcome measure-relate to long-term outcomes, and quantify trial ineligibility rates based on premorbid mRS.In consecutive patients with ischemic stroke in a population-based, prospective, cohort study (Oxford Vascular Study; 2002-2014), we related 3-month mRS (...) and costs in survivors of ischemic stroke than either dichotomy. This finding favors using ordinal approaches in trials analyzing the mRS. Exclusion of patients with higher premorbid disability by use of dichotomous primary outcomes will also result in unrepresentative samples.Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

2018 EvidenceUpdates

166. Effects of robot-(Morning Walk((R))) assisted gait training for patients after stroke: a randomized controlled trial (Abstract)

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.

2018 EvidenceUpdates

167. Return to work after ischemic stroke in young adults: A registry-based follow-up study Full Text available with Trip Pro

Return to work after ischemic stroke 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 ischemic stroke (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

2018 EvidenceUpdates

168. NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemic stroke (Abstract)

NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemic stroke 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 ischemic stroke (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

2018 EvidenceUpdates

169. Does Prestroke Antiplatelet Therapy Increase the Risk of Symptomatic Intracranial Hemorrhage in Patients Receiving Tissue Plasminogen Activator for Acute Ischemic Stroke? (SRS harm)

Assoc. 2016;5:1-14. 1. Fugate JE, Rabinstein AA. Absolute and relative contraindicationstoIVrt-PAfor acute ischemic stroke. 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 ischemic stroke 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 ischaemic stroke 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 ischaemic stroke (SITS-ISTR): an observational study. Lancet. 2008;372: 1303-1309. 5. Luo S, Zhuang M, Zeng W, et al. Intravenous thrombolysis for acute ischemic stroke 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

2018 Annals of Emergency Medicine Systematic Review Snapshots

170. Is Antibiotic Therapy Helpful for Preventing Infection After Acute Stroke? (SRS therapy)

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

2018 Annals of Emergency Medicine Systematic Review Snapshots

171. Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

framework Abbreviations: AF=atrial fibrillation; DVT=deep vein thrombosis; KQ=Key Question; ICH=intracranial hemorrhage; PE=pulmonary embolism Thromboembolic outcomes: • Cerebrovascular infarctionTransient ischemic attack • Systemic embolism (excludes PE and DVT) Bleeding outcomes: • Hemorrhagic stroke • Intracranial hemorrhage • Major bleed • Minor bleed Other clinical outcomes: • Mortality • Myocardial infarction • Infection • Heart block • Esophageal fistula • Tamponade • Dyspepsia • Health (...) AHRQ Comparative Effectiveness Review (CER) evaluated questions related to stroke prevention in patients with AF and atrial flutter. 13 The original review found that CHADS2 (congestive heart failure, hypertension, age >75, diabetes, stroke/transient ischemic attack) and CHA2DS2-VASc (congestive heart failure/left ventricular ejection fraction =40%, hypertension, age =75, diabetes, stroke/TIA/thromboembolism, vascular disease, age 65-74, sex) scores have the best prediction ability for stroke

2018 Effective Health Care Program (AHRQ)

172. Mecobalamin and early functional outcomes of ischemic stroke patients with H-type hypertension. Full Text available with Trip Pro

Mecobalamin and early functional outcomes of ischemic stroke patients with H-type hypertension. To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemic stroke and H-type hypertension.From October of 2014 to October of 2016, 224 cases of ischemic stroke 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

2018 Revista da Associacao Medica Brasileira (1992) Controlled trial quality: uncertain

173. Blood & Clots Series: How do you choose an anticoagulant for stroke prevention in atrial fibrillation? Full Text available with Trip Pro

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

2018 CandiEM

174. Complex Left Atrial Appendage Morphology Is an Independent Risk Factor for Cryptogenic Ischemic Stroke Full Text available with Trip Pro

Complex Left Atrial Appendage Morphology Is an Independent Risk Factor for Cryptogenic Ischemic Stroke Importance: Ischemic strokes 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

2018 Frontiers in cardiovascular medicine

175. Advances in Stroke Prevention Full Text available with Trip Pro

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

2018 Journal of translational internal medicine

176. Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke. (Abstract)

Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke. Even though stroke presents as a variety of clinical syndromes, neuroimaging is the most important biomarker to help differentiate between stroke subtypes and assess treatment eligibility. Therapeutic advances have led to intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation being standard care (...) for acute ischaemic stroke. Providing access to this care has implications for existing systems of care for stroke and their organisation and has reintroduced the possibility of adjuvant and neuroprotective treatment strategies in acute ischaemic stroke. The use of neuroimaging for patient selection and speed of diagnosis and delivery of treatment are the dominant themes of modern ischaemic stroke care.Copyright © 2018 Elsevier Ltd. All rights reserved.

2018 Lancet

177. Prevention of stroke: a global perspective. (Abstract)

Prevention of stroke: a global perspective. Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus (...) of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO's non-communicable diseases programmes, across high-income and low-income countries.Copyright © 2018 Elsevier Ltd. All rights reserved.

2018 Lancet

178. Electroconvulsive therapy and later stroke in patients with affective disorders (Abstract)

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

2018 EvidenceUpdates

179. Heart Failure After Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone Full Text available with Trip Pro

were randomized to pioglitazone or placebo (1:1) within 180 days of an ischemic stroke or transient ischemic attack 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 Ischemic Stroke 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

2018 EvidenceUpdates

180. Prognostic Value of BEFAST vs. FAST to Identify Stroke in a Prehospital Setting (Abstract)

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

2018 EvidenceUpdates