Stroke Research and Treatment最新文献

{"title":"Minimally Invasive Parafascicular Surgery (MIPS) for Spontaneous Intracerebral Hemorrhage Compared to Medical Management: A Case Series Comparison for a Single Institution.","authors":"Victoria L Phillips, Anil K Roy, Jonathan Ratcliff, Gustavo Pradilla","doi":"10.1155/2020/6503038","DOIUrl":"10.1155/2020/6503038","url":null,"abstract":"<p><strong>Objective: </strong>We compared the safety and effectiveness of minimally invasive parafascicular surgery (MIPS) as a frontline treatment for spontaneous supratentorial ICH to medical management. <i>Patients</i>. The sample consisted of 17 patients who underwent MIPS from January 2014 to December 2016 and a comparison group of 23 patients who were medically managed from June 2012 to December 2013. All had an International Classification of Disease (ICD) diagnosis of 431 and were treated at Grady Memorial Hospital, an urban, public, safety-net hospital.</p><p><strong>Methods: </strong>The primary endpoint was risk of inpatient mortality. Secondary endpoints were rates of inpatient infection and favorable discharge status, defined as discharge to home or rehabilitation facility. Demographics and pre- and postclinical outcomes were compared using <i>t</i>-tests, the Mann-Whitney test, and chi-squared tests for continuous, ordinal and categorical measures, respectively. Cox proportional hazard models were used to estimate the time to inpatient death. Logistic regression analyses were used to determine treatment effects on secondary outcomes. We also conducted exploratory subgroup analyses which compared MIPS to two medical management subgroups: those who had surgery during their hospitalization and those that did not.</p><p><strong>Results: </strong>Two patients (12%) died in the MIPS group compared to three (12%) in the medical management group. MIPS did not increase the risk of inpatient mortality relative to medical management. Rates of inpatient infection did not differ significantly between the two groups; eight MIPS patients (47%) and 13 medically managed patients (50%) contracted infections. MIPS significantly increased the likelihood of favorable discharge status (odds ratio (OR) 1.77; 95% CI, 1.12-21.9) compared to medical management. No outcome measures were significantly different between MIPS and the medical management subgroup without surgery, while rates of favorable discharge were higher among the MIPS patients compared to the medical management group with surgery.</p><p><strong>Conclusions: </strong>These data suggest that MIPS, as a frontline treatment for spontaneous ICH, versus medical management for spontaneous ICH warrants further investigation.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2020 ","pages":"6503038"},"PeriodicalIF":1.8,"publicationDate":"2020-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38082288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and Mortality Risk Factors of Acute Ischemic Stroke in Emergency Department in Burkina Faso.","authors":"Alfred Anselme Dabilgou, Alassane Dravé, Julie Marie Adeline Kyelem, Saïdou Ouedraogo, Christian Napon, Jean Kaboré","doi":"10.1155/2020/9745206","DOIUrl":"10.1155/2020/9745206","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of ischemic stroke deaths and their predictive factors in the Emergency Department at Yalgado Ouedraogo University Teaching Hospital (YOUTH). <i>Methodology</i>. This was a retrospective study with an analytical and descriptive focus over a period of three years from January 1, 2015, to December 31, 2017.</p><p><strong>Results: </strong>During the study period, 302 acute ischemic stroke patients with a mean age of 62.2 ± 14.26 years were included. Atrial hypertension was the most common vascular risk factor in 52.5%. On admission, 34.8% of patients had loss of consciousness. The mean time to perform brain CT was 1.5 days. The average length of stay was 4 days. Electrocardiogram, echocardiography, and cervical Doppler were not performed during hospitalization in ED. The mortality rate was 39%, respectively, 37.6% in male and 41.6% in female. The mean age of patients who died in ED was 63.6 ± 13.52 years. Hypertension was the most common vascular risk factors in 54.2% of death. After logistic regression, the predictors of death were past history of heart disease, consciousness disorders, hyperthermia, hyperglycemia on admission, poststroke pneumonia, and urinary tract infection.</p><p><strong>Conclusions: </strong>Acute ischemic stroke was frequent in Emergency Department with high mortality rate. The mortality risk factors were the same than those found in literature. This higher mortality can be avoided by early diagnosis and an adequate management.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2020 ","pages":"9745206"},"PeriodicalIF":1.5,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38077646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke.","authors":"Majdi Al Qawasmeh, Belal Aldabbour, Aiman Momani, Deema Obiedat, Kefah Alhayek, Raid Kofahi, Ahmed Yassin, Khalid El-Salem","doi":"10.1155/2020/1920583","DOIUrl":"10.1155/2020/1920583","url":null,"abstract":"<p><strong>Objective: </strong>To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan.</p><p><strong>Methods: </strong>A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75^th percentile of the cohort's median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance \"ANOVA\" were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary.</p><p><strong>Results: </strong>The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD ± 1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD ± 1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD ± 1.78). Significant predictors of mRS score were smoking (<i>t</i> 3.24, <i>P</i> < 0.001), age (<i>t</i> 1.98, <i>P</i> < 0.049), and NIHSS score (<i>t</i> 9.979, <i>P</i> 0.000).</p><p><strong>Conclusion: </strong>Ischemic strokes have different etiologies that are associated with different levels of impact on the patient's clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2020 ","pages":"1920583"},"PeriodicalIF":1.5,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1920583","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38068289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Neurological and Functional Recovery in Patients with Moderate to Severe Ischemic Stroke: The EPICA Study.","authors":"Manuel Murie-Fernández, Mercedes Molleda Marzo","doi":"10.1155/2020/1419720","DOIUrl":"10.1155/2020/1419720","url":null,"abstract":"Background Improving our knowledge about the impact of restorative therapies employed in the rehabilitation of a stroke patient may help guide practitioners in prescribing treatment regimen that may lead to better post-stroke recovery and quality of life. Aims To evaluate the neurological and functional recovery for 3 months after an acute ischemic stroke occurred within previous 3 months. To determine predictors of recovery. Design Prospective observational registry. Population. Patients having suffered acute moderate to severe ischemic stroke of moderate to severe intensity within the previous 3 months with National Institutes of Health Stroke Scale (NIHSS) score from 10 to 20, 24 hours after arrival at emergency room (ER). Methods All prespecified variables (sociodemographic and clinical data, lifestyle recommendations, rehabilitation prescription, and neurological assessments) were assessed at three visits, i.e., baseline (D0), one month (M1), and three months (M3). Results Out of 143 recruited patients, 131 could be analysed at study entry within 3 months after stroke onset with a mean acute NIHSS score of 14.05, decreased to 10.8 at study baseline. Study sample was aged 64.9 ± 13.8 years, with 49.2% of women. Neurorehabilitation treatment was applied to 9 of 10 patients from the acute phase and for three months with different intensities depending on the centre. A large proportion of patients recovered from severe dependency on activities of daily living (ADL) at D0 to a mild or moderate disability requiring some help at M3: mean NIHSS = 10.8 to 5.7; median modified Rankin Scale (mRS) = 4 to 3; Barthel index (BI) = 40 to 70; all p values < 0.001. Multivariate analyses integrating other regression variables showed a trend in favour of rehabilitation and revascularization therapies on recovery although did not reach statistical significance and that the positive predictors of recovery improvement were baseline BI score, time to treatment, and dietary supplement MLC901 (NurAiD™II). A larger percentage of patients with more severe stroke (NIHSS > 14) who received MLC901 showed above median improvements on mRS compared to control group at M1 (71.4% vs. 29.4%; p = 0.032) and M3 (85.7% vs. 50%; p = 0.058). Older subjects and women tend to have less improvement by M3. Conclusions Our study in patients with moderate to severe stroke shows overall recovery on neurological and functional assessments during the 3 months of study observation. Apart from demonstrating traditional “non-modifiable” predictors of outcome after stroke, like age, sex, and stroke severity, we also detected association between the use of dietary supplement MLC901 and recovery.","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2020 ","pages":"1419720"},"PeriodicalIF":1.5,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1419720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37937354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors of Postcontrast Acute Kidney Injury in Patients with Acute Ischemic Stroke.","authors":"Sirichai Chusiri,&nbsp;Aurauma Chutinet,&nbsp;Nijasri Charnnarong Suwanwela,&nbsp;Chankit Puttilerpong","doi":"10.1155/2020/7182826","DOIUrl":"https://doi.org/10.1155/2020/7182826","url":null,"abstract":"<p><strong>Background: </strong>Multimodal computed tomography (CT) guides decision-making regarding use of thrombolytic agents in acute ischemic stroke patients. However, postcontrast acute kidney injury (PC-AKI) is a potential adverse effect of the contrast media used, which may require hemodialysis and cause a longer hospital stay. The incidence and risk factors of PC-AKI in acute ischemic stroke patients, particularly in Thailand, remain unclear. <i>Goal</i>. We aimed at determining the incidence and risk factors of PC-AKI in patients with acute ischemic stroke undergoing multimodal CT.</p><p><strong>Methods: </strong>We conducted a retrospective review of Thai acute ischemic stroke patients admitted to the King Chulalongkorn Memorial Hospital between January 2014 and December 2017 who received multimodal CT and thrombolytic treatment with alteplase.</p><p><strong>Result: </strong>Overall, 109 patients were included for analysis; eight patients (7.3%) developed PC-AKI. Estimated glomerular filtration rate (eGFR) ≤ 30 mL/min and mechanical thrombectomy were risk factors significantly associated with PC-AKI.</p><p><strong>Conclusion: </strong>The incidence of PC-AKI in a real practice setting did not differ from previous reports. Two factors were associated with PC-AKI, eGFR ≤ 30 mL/min and mechanical thrombectomy. Patients without these risk factors may not need to wait for the results of renal function testing prior to multimodal CT.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2020 ","pages":"7182826"},"PeriodicalIF":1.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/7182826","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37851362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke.","authors":"Lívia C G Caetano, Bruna D Pacheco, Giane A R Samora, Luci F Teixeira-Salmela, Aline A Scianni","doi":"10.1155/2020/2957623","DOIUrl":"10.1155/2020/2957623","url":null,"abstract":"<p><strong>Aim: </strong>To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke.</p><p><strong>Methods: </strong>For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity.</p><p><strong>Results: </strong>Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence.</p><p><strong>Conclusion: </strong>The findings showed that feeling able to perform physical exercise and having higher walking ability predicted higher exercise adherences in individuals with chronic stroke. The knowledge of potential contributors to exercise adherence may help in designing exercise programs for individuals with stroke.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2020 ","pages":"2957623"},"PeriodicalIF":1.5,"publicationDate":"2020-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37752055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Hospital Admission for Stroke Is Characterised by Inactivity","authors":"R. Sheedy, S. Kramer, L. Johnson, N. Shields, L. Churilov, D. Cadilhac, J. Bernhardt","doi":"10.1155/2020/5879295","DOIUrl":"https://doi.org/10.1155/2020/5879295","url":null,"abstract":"Background. Measuring physical activity behaviours of stroke survivors in the inpatient setting is challenging. Authors of observational studies of early poststroke report that stroke survivors are “inactive and alone”. Using activity monitoring devices may help refine clinical practice and inform therapeutic activity targets. Aim. To measure the physical activity behaviour of stroke survivors during acute inpatient hospitalisation. We hypothesized that greater levels of inactivity would be positively associated with stroke severity and age. Method. Using a cross-sectional study design, consecutive stroke patients admitted to an acute stroke unit (Geelong, Australia) and recruited within 48 hours of admission had their physical activity recorded using an ActivPAL™ accelerometer device over a minimum of 3 days. Activity was categorised as time spent inactive (lying or sitting), standing, or stepping. The number of steps per day was recorded. Demographic and ActivPal™ data are described. Results. Seventy-eight stroke survivors were recruited of whom 54 had complete data for 3 days, all starting within 2 days poststroke. Of the 54 participants, 32 had a mild stroke, 17 moderate, and five severe stroke. Nine were able to walk independently at admission. The median age was 82.5 years (interquartile range (IQR) 74-86), 26 were female. On average, during their inpatient stay, participants spent a median of 98% of their admission inactive. A median of 18 minutes per day was spent standing and less than a minute per day was spent walking amounting to a median of 169 steps taken per day. Conclusion. The ActivePal™ device was feasible to use in an acute stroke setting. We observed high levels of inactivity in the first days post-stroke, highlighting the ongoing challenge of promoting activity in the acute stroke period. To our knowledge, this is the largest study to provide objective data on time spent upright, walking, and sedentary using accelerometer data in an acute stroke setting.","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"22 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2020-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79989155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Predictors of Outcome in Spontaneous Intracerebral Hemorrhage from a Tertiary Care Centre in South India.","authors":"Ajay Hegde, Girish Menon, Vinod Kumar, G Lakshmi Prasad, Lakshman I Kongwad, Rajesh Nair, Raghavendra Nayak","doi":"10.1155/2020/2192709","DOIUrl":"10.1155/2020/2192709","url":null,"abstract":"<p><p><i>Background.</i> This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. <i>Materials and Methods.</i> Prospective data collection and analysis of patients with SICH admitted to our centre between 1^st January 2015 and 31^st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. <i>Results.</i> Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (<i>n</i> = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3-month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0-3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4-5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (<i>p</i> = <0.001, OR 4.806, 95% CI 3.064-7.54), admission GCS <8 (<i>p</i> = <0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (<i>p</i> = <0.001, OR 2.45, 95% CI 1.626-3.691). Intraventricular haemorrhage was an additional poor outcome predictor (<i>p</i> < 0.015, CI 1.105-2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. <i>Conclusions.</i> SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2020 ","pages":"2192709"},"PeriodicalIF":1.5,"publicationDate":"2020-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37937356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Outcomes of Younger Adults with Embolic Stroke of Undetermined Source (ESUS): A Retrospective Study.","authors":"Ali M Al Khathaami,&nbsp;Bayan Al Bdah,&nbsp;Abdulmjeed Alnosair,&nbsp;Abdulkarim Alturki,&nbsp;Rayan Alrebdi,&nbsp;Shorug Alwayili,&nbsp;Sulaiman Alhamzah,&nbsp;Fahad A M AlKhathaami,&nbsp;Nasser Alotaibi","doi":"10.1155/2019/4360787","DOIUrl":"https://doi.org/10.1155/2019/4360787","url":null,"abstract":"<p><strong>Introduction: </strong>Embolic stroke of undetermined source (ESUS) in younger adults may have different risk factors compared with ESUS in elderly, and the approach to ESUS in young adults may require new therapies. We aimed to investigate the characteristics and outcomes in younger adults with ESUS at a single centre in Saudi Arabia.</p><p><strong>Patients and methods: </strong>A retrospective study was conducted using the medical records of younger adults with ESUS according to the criteria of the Cryptogenic Stroke/ESUS International Working Group. Younger adults (aged ≤50 years) with ESUS were compared with older patients, on admission and discharge from hospital, using the modified Rankin scale (mRS) and the National Institute of Health Stroke Scale (NIHSS).</p><p><strong>Results: </strong>Among 147 patients with ESUS, 39 (26.5%) were younger adults. Younger adults compared with older adults with ESUS had fewer vascular risk factors, including lower rates of hypertension (43.6% vs. 70.3%; <i>P</i> = 0.004), diabetes (35.9% vs. 57.4%; <i>P</i> = 0.03), and dyslipidaemia (12.8% vs. 28.7%; <i>P</i> = 0.05). There was no significant difference in poor outcome at discharge (defined as mRS > 2), which was observed in 17.9% of younger adults and 28.7% of older adults. Further, there were no significant differences in stroke severity at discharge (NIHSS score ≤5) or median length of stay.</p><p><strong>Discussion: </strong>Although the outcomes of ESUS do not differ between younger and older patients, younger patients have fewer identified risk factors.</p><p><strong>Conclusion: </strong>This study showed that 26.5% of patients with ESUS were aged ≤50  years. Although younger adults with ESUS had fewer risk factors, there were no significant differences in neurologic disability or mortality at discharge, stroke severity, or median length of stay.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"4360787"},"PeriodicalIF":1.5,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/4360787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37499215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less Experienced Telestroke Consultants Are More Likely to Go On-Camera, but Less Likely to Give tPA","authors":"A. D. de Havenon, Lee S Chung, Jaleen Smith, Kirby Taylor, J. Majersik, N. Chauhan","doi":"10.1155/2019/1059369","DOIUrl":"https://doi.org/10.1155/2019/1059369","url":null,"abstract":"Background Stroke telemedicine (telestroke) increases tPA availability and administration. However, the effective use of telestroke requires training, which is not a standard component of vascular neurology training. As a result, many providers learn telestroke skills “on the job” after finishing their training. Aims We sought to explore if providers with more telestroke experience would be more efficient in the utilization of telemedicine, compared to providers with less experience. Methods We prospectively collected data on telestrokes between July 2014 and July 2017 at a Comprehensive Stroke Center. Telestrokes are initiated on the telephone and typically, but not always, followed by an on-camera consult. Decision to do a phone-only versus on-camera consult is at the provider's discretion. Results There were 1,029 telestrokes, of which 807 were on-camera (74%). Of the 8 telestroke providers, 4 had less experience, having just finished stroke fellowship, and 4 had more experience (mean = 7.8 years of telestroke experience at the beginning of the study). Providers with less experience were more likely to go on camera than providers with more experience (79% vs. 67% of consults, p = 0.021), but were less likely to give tPA when on-camera (25% vs. 33%, p = 0.023). The absolute rate of tPA administration, combining phone and camera administration, or the frequency of technical difficulties were not different. Conclusions Telestroke consultants with less experience do not triage as many cases by phone and are less likely to administer tPA on-camera, suggesting their use of telemedicine is not optimized. This supports the introduction of telestroke didactics during vascular neurology training.","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"4 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80700751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}