Cerebrovascular Diseases Extra最新文献

{"title":"Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network.","authors":"Nicolas Poupore,&nbsp;Camron Edrissi,&nbsp;Mareshah Sowah,&nbsp;Madison Stanley,&nbsp;Jonah Joffe,&nbsp;Donovan Lewis,&nbsp;Teanda Cunningham,&nbsp;Carolyn Breauna Sanders,&nbsp;Krista Knisely,&nbsp;Chase Rathfoot,&nbsp;Thomas I Nathaniel","doi":"10.1159/000525099","DOIUrl":"https://doi.org/10.1159/000525099","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigates gender differences among stroke patients treated in the telestroke network using specific risk factors that contribute to stroke severity.</p><p><strong>Methods: </strong>We examined gender differences in stroke severity among 454 patients hospitalized with acute ischemic stroke (AIS). The logistic regression model was used to predict clinical risk factors associated with stroke severity in men and women AIS patients.</p><p><strong>Results: </strong>In the adjusted analysis among women patients, increasing age (odds ratio [OR] = 1.05, 95% CI: 1.017-1.085, p = 0.003) and higher heart rate (OR = 1.031, 95% CI: 1.005-1.058, p = 0.021) were associated with worsening neurological functions, while direct admission (OR = 0.191, 95% CI: 0.079-0.465, p < 0.001) was associated with improving neurologic functions. Among men, hypertension (OR = 3.077, 95% CI: 1.060-8.931, p = 0.039) and higher international normalized ratio (INR) (OR = 21.959, 95% CI: 1.489-323.912, p = 0.024) were associated with worsening neurologic functions, while Caucasian (OR = 0.181, 95% CI: 0.062-0.526, p = 0.002) and obesity (OR = 0.449, 95% CI: 0.203-0.99, p = 0.047) were associated with neurologic improvement.</p><p><strong>Conclusion: </strong>Increasing age and heart rate in women, hypertension and greater INR in men contribute to worsening neurologic functions. There is a need to develop strategies to improve the care of both men and women in the telestroke network.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 2","pages":"93-101"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/c0/cee-0012-0093.PMC9574206.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9830005","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":"Long-Term Post-Stroke Functional Outcomes: A Comparison of Diabetics and Nondiabetics.","authors":"Deidre Anne De Silva,&nbsp;Kaavya Narasimhalu,&nbsp;Ian Wang Huang,&nbsp;Fung Peng Woon,&nbsp;John Carson Allen,&nbsp;Meng Cheong Wong","doi":"10.1159/000521442","DOIUrl":"https://doi.org/10.1159/000521442","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus (DM) is known to influence outcomes in the short term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and nondiabetic ischemic stroke patients, and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes. We also studied the influence of age on the diabetes-functional outcome association.</p><p><strong>Methods: </strong>This is a longitudinal observational cohort study of 802 acute ischemic stroke patients admitted to the Singapore General Hospital from 2005 to 2007. Functional outcomes were assessed using the modified Rankin Scale (mRS) with poor functional outcome defined as mRS ≥3. Follow-up data were determined at 6 months and at median follow-up durations of 29 and 86 months.</p><p><strong>Results: </strong>Among the 802 ischemic stroke patients studied (mean age 64 ± 12 years, male 63%), 42% had DM. In regression analyses adjusting for covariates, diabetic patients were more likely to have poor functional outcomes at 6 months (OR = 2.12, 95% CI: 1.23-3.67) and at median follow-up durations of 29 months (OR = 1.96, 95% CI: 1.37-2.81) and 86 months (OR = 2.27, 95% CI: 1.58-3.25). In addition, age modulated the effect of DM, with younger stroke patients (≤65 years) more likely to have long-term poor functional outcome at the 29-month (p = 0.0179) and 86-month (p = 0.0144) time points.</p><p><strong>Conclusions: </strong>DM was associated with poor functional outcomes following ischemic stroke in the long term, with the effect remaining consistent throughout the 7-year follow-up period. Age modified the effect of DM in the long term, with an observed increase in risk in the ≤65 age-group but not in the >65 age-group.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"7-13"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/db/cee-0012-0007.PMC8958600.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39731933","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":"Outcomes of Mild Stroke and High-Risk Transient Ischemic Attack in Current Clinical Practice.","authors":"Apiluk Wesanonthawech,&nbsp;Pornpatr A Dharmasaroja","doi":"10.1159/000526969","DOIUrl":"https://doi.org/10.1159/000526969","url":null,"abstract":"<p><strong>Introduction: </strong>Early assessment and management of patients with mild stroke and transient ischemic attack (TIA) by specialists were recommended. This study aimed to evaluate the outcomes of these patients and identify the predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke.</p><p><strong>Methods: </strong>Patients with mild ischemic stroke (NIHSS ≤5) and high-risk TIA were studied. All patients were managed by stroke specialists within 24 h of stroke onset. The outcomes of the patients at 3 months and final follow-up were studied. Predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke were analyzed.</p><p><strong>Results: </strong>254 patients were studied. Thirty-eight patients (15%) had clinical progression during admission. Large artery atherosclerosis (OR 2.49, 95% CI: 1.06-5.81), cardioembolism (OR 3.34, 95% CI: 1.26-8.87), and brainstem stroke (OR 2.78, 95% CI: 1.28-6.01) were associated with clinical progression. At the final follow-up, median 22 months, 81 patients (32%) had unfavorable outcomes. Previous disability (OR 1.81, 95% CI: 3.31-100), moderate to severe white matter lesions (OR 2.90, 95% CI: 1.44-5.84), clinical progression (OR 12.5, 95% CI: 5.08-31.25), and recurrent stroke (OR 8.47, 95% CI: 3.21-22.72) were related to unfavorable outcomes. Eleven patients (4%) had recurrent stroke within 3 months and 31 patients (12%) at the final follow-up. Older age (OR 6.68, 95% CI: 2.35-19.02), diabetes mellitus (OR 2.59, 95% CI: 1.07-6.27), and smoking (OR 4.26, 95% CI: 1.52-11.95) were related to recurrent stroke.</p><p><strong>Conclusion: </strong>Implementation of the up-to-date standard care in clinical practice would bring good clinical outcomes to the patients with mild stroke and high-risk TIA.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 3","pages":"109-116"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/c0/cee-0012-0108.PMC9710422.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10783251","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":"Serum Prealbumin Levels on Admission as a Prognostic Marker in Stroke Patients Treated with Mechanical Thrombectomy.","authors":"Begoña López,&nbsp;Maria Castañón-Apilánez,&nbsp;Javier Molina-Gil,&nbsp;Santiago Fernández-Gordón,&nbsp;Gemma González,&nbsp;Antía Reguera Acuña,&nbsp;Jose Maria Jimenez,&nbsp;Davinia Larrosa Campo,&nbsp;Montserrat González Delgado,&nbsp;Lorena Benavente-Fernández,&nbsp;Maria Rico-Santos,&nbsp;Carmen García-Cabo,&nbsp;Sergio Calleja Puerta,&nbsp;Elena López-Cancio","doi":"10.1159/000526354","DOIUrl":"https://doi.org/10.1159/000526354","url":null,"abstract":"<p><strong>Introduction: </strong>Prealbumin is a marker of malnutrition and inflammation. It has been associated with poor prognosis in cardiovascular disease, but less is known in stroke patients. Our objective was to evaluate the association of prealbumin levels at admission with prognosis in patients with stroke treated with mechanical thrombectomy.</p><p><strong>Methods: </strong>Retrospective study of a prospective database of consecutive patients treated with mechanical thrombectomy. Clinical, radiological, and blood parameters including serum prealbumin, and prognostic variables such as respiratory infection, in-hospital mortality, and the modified Rankin scale at 3 months were collected.</p><p><strong>Results: </strong>We included 319 patients between 2018 and 2019. Prealbumin levels were significantly lower in patients older than 80 years, women, patients with a prestroke Rankin score >2, a glomerular filtrate rate <60 mL/min, and in those with atrial fibrillation. Regarding prognostic variables, prealbumin levels were not associated with respiratory infection. Low prealbumin levels were associated with poor functional prognosis (Rankin score >2), in-hospital mortality, and 3-month mortality. In multivariate analysis, prealbumin was an independent risk factor associated with mortality at 3 months, OR 0.92 [0.86-0.98], p = 0.019.</p><p><strong>Conclusion: </strong>Lower prealbumin levels at admission behaved as an independent predictor of long-term mortality in patients treated with mechanical thrombectomy. These results should be replicated in other cohorts.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 3","pages":"103-108"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/8a/cee-0012-0102.PMC9941761.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10742879","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":"Stroke Burden and Stroke Services in Indonesia.","authors":"Narayanaswamy Venketasubramanian,&nbsp;Fenny L Yudiarto,&nbsp;Dodik Tugasworo","doi":"10.1159/000524161","DOIUrl":"https://doi.org/10.1159/000524161","url":null,"abstract":"<p><p>Stroke is a major cause of death and disability in Indonesia. Stroke requires high-quality, fast, and precise management to prevent and avoid disability and death. Stroke can be prevented by adequately controlling the risk factors and encouraging healthy lifestyles. Efforts are needed to organize health promotion programs at the community level. More and a better distribution of neurologists and neurointerventionalists is needed. All hospitals should have a CT scan machine and stroke units. Telemedicine for stroke patients is a very promising endeavor for an integrated acute stroke management system.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"53-57"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2a/92/cee-0012-0053.PMC9149342.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40311749","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":"Cerebral Amyloid Angiopathy with Lobar Haemorrhages and CAA-Related Inflammation in an Indian Family.","authors":"Boby Varkey Maramattom","doi":"10.1159/000522214","DOIUrl":"https://doi.org/10.1159/000522214","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral amyloid angiopathy (CAA) is a common cause of lobar intracerebral haemorrhage. Sporadic CAA is far more common than hereditary CAA (h-CAA). Familial CAA has not yet been described from India.</p><p><strong>Case report: </strong>Two elderly Indian women (a mother and daughter) presented 7 years apart with features of CAA. The mother had presented with features of CAA-related inflammation that responded to steroids, whereas the daughter presented with features of CAA-related intracerebral haemorrhage. Clinical exome testing did not reveal any known genetic variants associated with h-CAA.</p><p><strong>Discussion: </strong>Although clinical exome testing was inconclusive, the presentation of CAA in two generations (mother and daughter) in their 8th and 7th decades, respectively, raises the possibility of a familial CAA rather than a sporadic CAA in this Indian family. Genome-wide association studies are necessary to reveal if an Indian variant of familial CAA exists. We compare and contrast our familial CAA with the described h-CAA variants in the literature.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"23-27"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/8d/cee-0012-0023.PMC8958619.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39865827","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":"10th Anniversary of the Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia-Pacific.","authors":"Kay-Sin Tan,&nbsp;Byung-Woo Yoon,&nbsp;Ruey-Tay Lin,&nbsp;Man Mohan Mehndiratta,&nbsp;Nijasri C Suwanwela,&nbsp;Narayanaswamy Venketasubramanian","doi":"10.1159/000521272","DOIUrl":"https://doi.org/10.1159/000521272","url":null,"abstract":"<p><p>The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and consistency across the Asia-Pacific and beyond. The 10-year journey will be reviewed in the background of many internal and external developments including changes in Asia-Pacific stroke epidemiology, stroke care systems, and stroke service developments as well as major research studies in the Asia-Pacific.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"14-22"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/49/cee-0012-0014.PMC8958597.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39686692","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":"Stages and Processes of Change for Weight Loss in Acute Stroke or TIA Patients Living with Obesity.","authors":"Mitch Wilson,&nbsp;Hailey Orgass,&nbsp;Jennifer Dearborn-Tomazos","doi":"10.1159/000521387","DOIUrl":"https://doi.org/10.1159/000521387","url":null,"abstract":"<p><strong>Background: </strong>Obesity is associated with an increased prevalence of vascular risk factors and incidence of stroke. As such weight loss is recommended for patients living with obesity in the secondary prevention of stroke. Few studies, however, have examined the stages and processes of change for weight loss in stroke patients living with obesity.</p><p><strong>Objective: </strong>The aim of the study was to evaluate the stages and processes of change for weight loss in patients living with obesity who have had a recent stroke or TIA.</p><p><strong>Methods: </strong>Using a validated questionnaire, we assessed each patient's stage of behavioral change according to the transtheoretical model (precontemplation, contemplation, preparation, action, and maintenance). We also examined 4 processes of behavioral change, which quantify activities and experiences that patients undergo on the way to behavioral change: emotional reevaluation (EMR), weight management action (WMA), weight consequence evaluation, and supporting relationships. Processes scores were compared between patients in the action and maintenance stages and those in the precontemplation, contemplation, and preparation stages.</p><p><strong>Results: </strong>Out of 49 patients who provided informed consent, 44 met the inclusion/exclusion criteria. Of these 44 patients, 6 (14%) were in the precontemplation stage of change, 7 (16%) were in contemplation, 2 (5%) were in preparation, 13 (30%) were in action, and 16 (36%) were in maintenance. Those in the action and maintenance stages accounted for the majority of participants (n = 29, 66%). Patients in the action and maintenance stages (N = 29) had higher EMR scores (mean 79, SD 13 vs. mean 68, SD 19, t = 2.0, p = 0.03) and WMA scores (mean 69, SD 13 vs. mean 59, SD 19, t = 2.0, p = 0.03) as compared to those in the precontemplation, contemplation, and preparation stages (N = 15).</p><p><strong>Conclusions: </strong>Our results suggest that without counseling or specific intervention, approximately two-thirds of stroke/TIA patients living with obesity are in the action or maintenance stage of behavior change with respect to weight loss and therefore more likely to succeed in intensive lifestyle-based interventions targeted towards weight loss. Patients who score higher in EMR and WMA are more likely to be in the action or maintenance stage of change.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-6"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/1e/cee-0012-0001.PMC8958604.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39593887","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":"Stroke Burden in Malaysia.","authors":"Kay Sin Tan,&nbsp;Narayanaswamy Venketasubramanian","doi":"10.1159/000524271","DOIUrl":"https://doi.org/10.1159/000524271","url":null,"abstract":"<p><p>Malaysia is located in the heart of South East Asia with two land masses, Peninsular Malaysia and East Malaysia which are separated by the South China Sea. Stroke or cerebrovascular disease is Malaysia's third leading cause of death. There were 47, 911 incident cases, 19,928 deaths, 443,995 prevalent cases, and 512,726 DALYs lost due to stroke in 2019. Successive national health and morbidity surveys from 2006 demonstrated a continuous rise in the prevalence of risk factors such as diabetes, hyperlipidaemia, and obesity. These risk factors are implicated in an increase in stroke incidence in those under 65 years of age, the largest increase of 53.3% and 50.4% in men and women, respectively, from the age strata of 35-39 years. The neurologist-to-patient ratio is 1:323,000 with the majority of neurologists working in urban centres. The healthcare system is provided predominantly by the public and private sectors. Concurrent use of traditional and complementary medicine is common and widely accepted. Challenges include delivering adequate care to rural communities, the low overall ischaemic stroke thrombolysis rates, and the high cost of thrombectomy devices for use in large vessel occlusions which have to be borne out-of-pocket by patients and their families. Effort is required to continue improving stroke care services in parallel with primary and secondary prevention strategies in the future, given the ageing population and the rising number of strokes in young adults nationally. Strategies include careful planning, inter-hospital cooperation, and increased allocation of resources from the government.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"58-62"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/74/cee-0012-0058.PMC9149343.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40320273","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":"Ten Years of Cerebrovascular Diseases EXTRA","authors":"","doi":"10.1159/000515830","DOIUrl":"https://doi.org/10.1159/000515830","url":null,"abstract":"","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 1","pages":"44 - 44"},"PeriodicalIF":1.9,"publicationDate":"2021-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000515830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44610641","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}