Frontiers in stroke最新文献

{"title":"Identification of Specific Recommendations for Prehospital Stroke Care Associated with Shorter Door-to-CT Times - an analysis of Get with the Guidelines-Stroke registry and prehospital data.","authors":"Layne Dylla, Hannah M Higgins, Courtney D Wham, Michelle Leppert, Brandy C Ravare, Kerri A Jeppson, Heather T Bina, Andrew A Monte, Sharon N Poisson","doi":"10.3389/fstro.2024.1355889","DOIUrl":"10.3389/fstro.2024.1355889","url":null,"abstract":"<p><strong>Objective: </strong>Full compliance with American Heart Association (AHA) recommendations for prehospital care of stroke patients remains low. This study aims to identify components of prehospital care associated with shorter door-to-CT times.</p><p><strong>Methods: </strong>Data from a comprehensive stroke center's Get with the Guidelines-Stroke Registry was supplemented by prehospital medical records for ischemic stroke patients between January 1, 2018, and December 31, 2020. Descriptive statistics and multivariable linear regression modeling evaluated door-to-CT times for encounters compliant with AHA recommendations.</p><p><strong>Results: </strong>There were 621 ischemic stroke patients who presented via a prehospital provider, 452 of whom presented from the scene. Without adjusting for potential confounders, shorter door-to-CT times were observed with EMS documentation of a last known well time, measurement of a blood glucose lever, prenotification of suspected stroke, or full compliance with AHA recommendations. Documentation of classic stroke signs, but not documentation of a prehospital stroke scale, was also observed to have shorter door-to-CT times compared to encounters where this did not occur.</p><p><strong>Conclusions: </strong>During prehospital care of stroke, documentation of classic symptoms, obtaining a last known well time or time of symptom onset, obtaining a blood glucose level, prenotification of the receiving hospital of suspected stroke, and full guideline-compliance are associated with shorter door-to-CT times. Further studies are needed to understand if a shift in prehospital provider education, focusing on these key components of care, could lead to earlier diagnosis and treatment of acute stroke.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"3 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710061","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 patients have lower blood levels of nutrients that are relevant for recovery: a systematic review and meta-analysis","authors":"L.M. Broersen, S. Guida, Aysun Cetinyurek-Yavuz, N. van Wijk, A. van Helvoort, A.T. Michael-Titus, M. Lansink","doi":"10.3389/fstro.2023.1274555","DOIUrl":"https://doi.org/10.3389/fstro.2023.1274555","url":null,"abstract":"Malnutrition is common after stroke. Stroke patients often have a suboptimal energy intake, body weight and inadequate blood nutrient levels. Nutrient insufficiencies may not be detected, but their recognition is essential to provide adequate nutritional support after a stroke. This comprehensive summary of the literature is a collection of data on blood levels of a broad selection of nutrients involved in restoring cerebral blood flow and functional brain connectivity in stroke patients compared to controls.Embase and MEDLINE were searched for studies published in English in the period 1980–2022. Studies including adult stroke subjects and controls whose blood samples were analyzed for docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), uridine, choline, folate, vitamin B6, vitamin B12, vitamin C, vitamin E, selenium, coenzyme Q10 (CoQ10), carnitine, arginine, or taurine were selected. If there were >3 reports (k) per nutrient, results were generated with an unadjusted and age-adjusted random-effects meta-analysis model. Risk of bias was evaluated for relevant domains from the ROBINS-I tool and with Egger's test.One hundred five reports on blood nutrient levels were extracted from 56 eligible studies. Overall, meta-analyses showed lower blood levels of most nutrients in stroke patients compared to controls. The number of reports and the statistical significance for the unadjusted data were: folate (k = 27; p = 0.005), vitamin B12 (k = 23; p = 0.002), vitamin E (k = 11; p = 0.013), DHA (k = 7, p = 0.015), EPA (k = 7; p = 0.004), vitamin C (k = 6; p = 0.020), and selenium (k = 6; p = 0.018). No significant decreases were observed for vitamin B6 (k = 6; p = 0.52) and arginine (k = 4; p = 0.93). For other selected nutrients, there were insufficient reports to perform a meta-analysis. Available reports pointed toward lower (CoQ10, choline; k = 2), higher (taurine; k = 2), or unchanged (carnitine, uridine; k = 1) blood levels after stroke. In general, risk of bias was low.Our findings indicate that nutrient insufficiencies occur for many nutrients that are involved in repair processes after stroke. The low blood levels of folate, vitamin B12, EPA, DHA, vitamin C, vitamin E, selenium, and possibly CoQ10 and choline, highlight the presence of a suboptimal nutritional status after stroke. The inclusion of targeted nutritional interventions to further support recovery should receive consideration in the multidisciplinary context of stroke rehabilitation.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005851","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":"Case report: Acute audiovestibular presentation following hemi-pontine infarction","authors":"N. Koohi, Salman Haider, N. Kharytaniuk, D. Werring, D. Bamiou, Diego Kaski","doi":"10.3389/fstro.2023.1272796","DOIUrl":"https://doi.org/10.3389/fstro.2023.1272796","url":null,"abstract":"Posterior circulation stroke is an uncommon cause of sudden-onset sensorineural hearing loss (SSNHL). Anterior inferior cerebellar artery occlusion results in ipsilateral peripheral audiovestibular dysfunction. Few reports describe posterior circulation stroke presenting with contralateral SSNHL and acute vestibular and focal neurological signs. We present a case of contralateral SSNHL and isolated acute central vestibular dysfunction in the absence of other central focal neurological deficits. To the best of our knowledge, this has not been described to date. The patient was identified to have asymmetrical SSNHL, subtle skew deviation with left head tilt, and significant refixation saccades on video head impulse test despite bilaterally normal vestibulo-ocular reflex gains. Left pontine infarct was suspected and confirmed on magnetic resonance imaging. The patient was treated with an appropriate antiplatelet regimen. We highlight the importance of a thorough clinical diagnostic work-up as posterior circulation strokes with isolated audiovestibular deficits can be easily missed if other significant neurological deficits are absent.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"36 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010239","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":"Poor treatment outcomes and associated factors among hospitalized patients with stroke at Hiwot Fana Comprehensive Specialized Hospital, eastern Ethiopia","authors":"Zerihun Abera Ayele, Sisay Molla, Aliyi Ahmed, Teshager Worku, Addisu Seneshaw Bezabih, Biniyam Tedla Mamo","doi":"10.3389/fstro.2023.1304664","DOIUrl":"https://doi.org/10.3389/fstro.2023.1304664","url":null,"abstract":"Stroke is a significant health problem in both industrialized and developing nations. It is the world's second-leading cause of death worldwide. Stroke incidence, prevalence, and death rates have grown internationally, with low- and middle-income nations suffering the greatest proportion of the burden. Stroke is a leading cause of long-term physical impairment, affecting a person's quality of life, societal engagement, independence, emotions, and productivity.To determine the magnitude and factors associated with poor treatment outcomes in hospitalized adult patients with stroke.A hospital-based cross-sectional study was conducted from January 2019 to June 2021 in stroke patients admitted to the Hiwot Fana Comprehensive Specialized Hospital. This study included 290 patient charts. Data were collected by reviewing the medical charts using a well-developed data abstraction form. Data were entered into Epi-Data version 3.2 and exported to SPSS version 25.0. Descriptive statistics were used to describe study variables. Additionally, bivariable and multivariable logistic regression analyses were used to identify factors associated with poor stroke treatment outcomes. All statistical tests were set at 5% of significant threshold.Among 290 enrolled patients, 172 (59.3%) had poor stroke treatment outcomes. The mean age of the patients was 54.7(SD: ±16.1) years, and more than half 182 (62.8%) of the participants were males. The overall average length of hospital stays for stroke patients was 8 ± 3.3 days. Age of 45–64 years (adjusted odds ratio [AOR]: 2.17, 95% CI [1.06, 4.41]), aspiration pneumonia (AOR: 2.13, 95% CI [1.06, 4.26]), systolic blood pressure ≥ 140 mm Hg/dl (AOR: 2.35, 95% CI [1.24, 4.47]), Glasgow Coma Scale score of <8 (AOR: 7.26, 95% CI [3.82, 13.8]), and serum creatinine level of ≥1 mg/dl (AOR: 2.73, 95% CI [1.46, 5.10]) were significantly associated with poor treatment outcome in adult stroke patients.Six out of ten stroke patients had poor treatment outcomes. Age between 45 and 65 years, uncontrolled hypertension, aspiration pneumonia, low Glasgow Coma Scale score at admission, and renal injury were identified as significantly associated with poor treatment outcomes in stroke patients.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"53 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138587949","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":"Stroke unit and Neurocritical Care Unit for acute neurological diseases in the USL Toscana Centro: a pilot model of Santo Stefano Hospital in Prato","authors":"Raffaella Valenti, Alba Caruso, Anita E. Scotto Di Luzio, Donatella Accavone, Maria G. Cagliarelli, Guido Chiti, Enrico Grassi, Maria Briccoli Bati, Pasquale Palumbo","doi":"10.3389/fstro.2023.1218682","DOIUrl":"https://doi.org/10.3389/fstro.2023.1218682","url":null,"abstract":"Acute neurological diseases are leading causes of disability and death. The need for specialist neurocritical care skills for managing neurological emergencies has increased. Promising opportunities exist to improve outcomes in acute phases of neurological diseases, such as, for example, the concept of a stroke unit for stroke patients. A similar concept was introduced for a neurocritical care unit, which is associated with improved clinical outcomes compared with more traditional management. However, neurocritical care is often not recognized as a separate specialty. Significant progress in neurology has enabled better approaches for the critically ill neurologic patient, in particular those with stroke and hemorrhage, but also with epileptic seizures and epileptic status, traumatic brain injury (TBI), subdural/epidural hematoma, acute inflammatory polyradiculoneuritis, encephalitis, myasthenia gravis, acute myelitis, etc.Except for cerebrovascular diseases, for other acute neurological diseases, there is no standardized model care service recognized. A good patient outcome can be obtained by the choice of neurology setting for acute patients including nursing and medical staff with specific training in neurocritical care. As we believe neurocritical care practices should be implemented, we suggest a pilot model on the basis of our experience. In this report, we show a model of the 2A setting of the Santo Stefano Hospital (Prato, USL Toscana Centro), where, as well as stroke units for cerebrovascular events, we have neurocritical care unit and acute-neurology experts for all acute neurological diseases.The 2A setting of Stroke Unit/Neurocritical Care of the Santo Stefano Hospital includes 15 beds; 8 ± 2 beds are monitored by portable multi-parameter monitoring devices. Following acute treatment, diagnostic/etiologic work-up and automated monitoring of vital functions are performed in addition to adapted secondary prevention, early rehabilitation, and prevention of complications in all acute patients. We retrospectively assessed the diagnoses in the hospital discharge forms (HDF) of Stroke Unit/Neurocritical Care (2A) of 249 patients consecutively analyzed between 1 January 2022 and 30 June 2022. Out of the 249 patients affected by acute neurological diseases, 155 had cerebrovascular diseases (62.2%). In particular, 100 (64.5%) were diagnosed with ischemic stroke and 44 (28.4%) with hemorrhagic stroke. Thirty-two patients (12.8%) were hospitalized following a TBI. Sixteen patients (6.4%) had a new diagnosis of epilepsy and three (1.2%) of epileptic status. In our setting, the 3-month modified Rankin Scale (mRS) in the 36 stroke patients treated with recombinant-tissue plasminogen activator (r-TPA) was 0–2 (low disability) in 60% of cases. Additionally, 31% of 44 intracerebral haemorrhage (ICH) patients reported a moderate-severe degree of disability. Regarding TBI patients, the mRS ranged from 1 to 5, with significate difference between patients ","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"34 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138591958","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 and systems of care factors contributing to individual patient decision-making for early mobilization post-stroke","authors":"Venesha Rethnam, Kathryn S. Hayward, Hannah Johns, Lilian B. Carvalho, Leonid Churilov, Julie Bernhardt","doi":"10.3389/fstro.2023.1293942","DOIUrl":"https://doi.org/10.3389/fstro.2023.1293942","url":null,"abstract":"Many stroke guidelines recommend against starting intensive out-of-bed activity (mobilization) within 24 h post-stroke. Few guidelines address care after the first 24–48 h, and little information is provided about how early mobilization decisions should be tailored to patients. We aimed to identify clinical and systems of care factors contributing to individual patient decision-making for early mobilization post-stroke.Expert stroke clinicians were recruited to participate in an interactive one-on-one session that included an introductory semi-structured interview followed by an assisted data exploration session using an early mobilization data visualization tool.Thirty expert stroke clinicians with a median (interquartile range) 14 (10–25) years of experience were included. Stroke type and severity, and medical stability were identified as important clinical decision-making factors by the majority of expert stroke clinicians. Inadequate staffing and equipment were frequently indicated as barriers to early mobilization. The perceived characteristics of early mobilization responders were mild or moderate stroke severity, ischemic stroke, partial anterior circulation stroke, younger age, and one or fewer comorbidities. Perceived characteristics of early mobilization non-responders included severe stroke severity, hemorrhagic stroke, total anterior circulation stroke, older age, those with persistent vessel occlusion or high-grade stenosis, hemodynamic instability, multimorbidity and an altered state of consciousness. Some characteristics led to uncertainty amongst interviewees e.g., early mobilization decision-making were moderate stroke severity, older patients, and those with lacunar circulation infarcts.We gained unique, in-depth insights into patient and systems of care factors that contribute to individual patient decision-making related to early mobilization post-stroke. The identified areas would benefit from further empirical research to develop structured decision support for clinicians.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"52 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593985","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":"Editorial: Stroke in minority groups and populations","authors":"Narayanaswamy Venketasubramanian, Tatjana Rundek, Robert N. Gan","doi":"10.3389/fstro.2023.1315298","DOIUrl":"https://doi.org/10.3389/fstro.2023.1315298","url":null,"abstract":"","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139216237","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":"Empowering stroke survivors beyond inpatient rehabilitation: the STRIDE program","authors":"Jessica M. Cassidy, Ryan Fitzgerald, Rachel M. Vaughn, Anna Geib, Maureen Marquie, Anna Claire Trei, Blaise Morrison, Michael D. Lewek, John M. Baratta","doi":"10.3389/fstro.2023.1281703","DOIUrl":"https://doi.org/10.3389/fstro.2023.1281703","url":null,"abstract":"The timeframe from hospital discharge to the commencement of outpatient therapies represents a crucial yet often overlooked period in post-stroke recovery. We designed an eight-week post-stroke management program (STRIDE, Stroke Management Training and Inpatient Rehabilitation Discharge Education) targeting individuals discharging from an inpatient rehabilitation facility to home. The primary aims of this pilot study were to determine STRIDE feasibility and participant engagement.Participants with first or recurrent stroke were enrolled. Each week, participants monitored and recorded their daily activity, completed a 15-min educational module and quiz, and partook in weekly and biweekly communication with a fellow participant and STRIDE coordinator, respectively. Feasibility was evaluated by successful initiation of STRIDE and enrollment of the target population. We also assessed participant adherence and conducted semi-structured exit interviews.Of the 99 individuals screened, 20 individuals were enrolled (7 females, 28.6 ± 15.7 days post-stroke). Several participants were unable to begin the program (n = 6) or complete the program (n = 4). Overall, participants completing at least 1 week of STRIDE (n = 14) demonstrated adherence with education module and quiz completion and communication with the STRIDE coordinator. Participant feedback from interviews was largely positive, underscoring the value of STRIDE during early post-stroke recovery.These findings support the feasibility of an initiated multi-faceted stroke management program. Participant dropout was a limitation and serves as a consideration when designing future iterations of STRIDE. With the long-term goal of promoting autonomy and investment in one's continued recovery beyond the inpatient setting, STRIDE bridges the transition from hospital to home.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"128 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139246468","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":"Editorial: Intracranial pressure regulation in stroke","authors":"Daniel J. Beard, L. Murtha, D. McLeod","doi":"10.3389/fstro.2023.1323696","DOIUrl":"https://doi.org/10.3389/fstro.2023.1323696","url":null,"abstract":"","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139283812","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":"Stroke incidence in Indigenous, minority populations: a review of methods for studying stroke in Aboriginal and Torres Strait Islander Australians","authors":"Anna H. Balabanski, Lee Nedkoff, Angela Dos Santos, Alex Brown, Timothy J. Kleinig, Amanda G. Thrift, Judith M. Katzenellenbogen","doi":"10.3389/fstro.2023.1270136","DOIUrl":"https://doi.org/10.3389/fstro.2023.1270136","url":null,"abstract":"Declining worldwide or national stroke incidence rates are not always mirrored in disadvantaged, minority populations. Logistical barriers exist for effective measurement of incidence in minority populations; such data are required to identify targets for culturally appropriate interventions. In this comparative review, we aimed to examine whether “gold-standard” methodologies of stroke incidence studies are most effective for minority populations. We compared three studies of stroke incidence in Aboriginal Australians, each using different methodologies of case ascertainment. In Study 1, “gold-standard” population-based methods were used, while in Study 2, a retrospective hospital-based cohort design was utilized, and in Study 3, whole-of-population linked hospital and mortality data was employed. Study 1 captured both in-hospital and out-of-hospital stroke events but had a small sample size for Aboriginal patients. Study 2 provided a larger sample size while still allowing for clinical and radiological subtyping of stroke but was subject to selection bias and was limited to hospitalized cases. Study 3 had a large sample size and allowed for subgroup analysis, though lacked clinical adjudication and had large proportions of ‘undetermined stroke'. Despite diagnostic imprecision, we recommend a paradigm shift in measuring stroke incidence in Indigenous, minority populations, favoring the use of whole-of-population data linkage including non-hospitalized stroke deaths, over resource-intensive prospective methods, where more suitable for the target population.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"81 1-2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135271364","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}