Frontiers in stroke最新文献

{"title":"Caregiver burden and its associated factors among primary caregivers of stroke survivors at Amhara regional state tertiary hospitals: a multicenter study","authors":"Gebremariam Bekele, Melisew Mekie Yitayal, Yihalem Belete, Yisak Girma, Tesfa Kassa, Y. Assefa, S. Nigatu, G. A. Eriku","doi":"10.3389/fstro.2023.1226140","DOIUrl":"https://doi.org/10.3389/fstro.2023.1226140","url":null,"abstract":"Caregivers of stroke survivors play a crucial role in post-stroke functional recovery and the prevention of complications. Although the situation is incredibly stressful and intimidating and the caregiver burden is high, there is little evidence in the local Ethiopian context of the extent of the burden among caregivers of stroke survivors. Therefore, the aim of this study was to assess the level of caregiver burden and its associated factors among primary caregivers of stroke survivors in Ethiopia.A cross-sectional study was conducted in Amhara regional state tertiary hospitals from April to June 2022. A standardized questionnaire was used to record factors associated with caregiver burden, including sociodemographic, clinical, and care situation factors. The Zarit caregiver burden interview (short form) was used to assess the level of caregiver burden. A systematic random sampling method was employed to select the study participants. Multinomial logistic regression was employed to identify the potential factors associated with the level of caregiver burden.The overall prevalence burden among primary caregivers of stroke survivors was 67%. 61.1% had a mild to moderate burden, while 5.9% had a severe burden. In multivariable multinomial logistic regression analysis, sex, household income, duration of care, and duration of caregiving hours per day were factors significantly associated with the level of burden among caregivers of stroke survivors.Being female, having a low household income, caring for more than 3 months, and caring for more than 6 h per day were factors significantly associated with the burdens of the primary caregivers of stroke survivors. It is better: health care providers must recognize and screen for burdens and provide special attention.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88918730","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 among Māori in Aotearoa New Zealand and solutions to address persistent inequities","authors":"A. Ranta, B. Jones, M. Harwood","doi":"10.3389/fstro.2023.1248351","DOIUrl":"https://doi.org/10.3389/fstro.2023.1248351","url":null,"abstract":"Māori, the Indigenous people of Aotearoa New Zealand (Aotearoa), experience stroke at a younger age and at a greater rate than New Zealanders of European ethnicity (NZ Europeans). These disparities have persisted for decades and recent evidence suggests that the gap is widening. Māori also experience reduced access to some key stroke-management interventions and consequently worse post-stroke outcomes compared to non-Māori counterparts. Reasons for the ethnic differences in stroke rates and outcomes include differential exposure to stroke risk factors, differential access to early diagnosis and treatment, and unequal treatment. Recent Aotearoa-based research has suggested that the root causes for these ethnic inequities, including unconscious bias and institutional racism, are likely attributable to Aotearoa's colonial past and related inter-generational sequalae. With recent reforms to the national health system there is now a new mandate to actively move toward a more bicultural approach which emphasizes Indigenous rights, values, priorities, and approaches in healthcare. This presents important opportunities to address the well-described inequities using a genuine partnership model. This paper will discuss the latest evidence around stroke related health disparities affecting Māori, describe existing approaches to address inequitable health outcomes, and present additional novel avenues that are currently being explored.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"54 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91065549","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":"Hyperacute vestibular syndrome: the role of an acute vertigo service","authors":"William Bierrum, Salman Haider, M. Balaratnam, Ali Alim-Marvasti, A. Chandratheva, R. Simister, N. Koohi, D. Kaski","doi":"10.3389/fstro.2023.1265009","DOIUrl":"https://doi.org/10.3389/fstro.2023.1265009","url":null,"abstract":"Differentiating between peripheral and central causes of acute vertigo remains a clinical obstacle in the acute setting. Despite the availability of several validated diagnostic algorithms adoption and implementation of these tools is low because most emergency physicians are unfamiliar with them. Embedding an acute vertigo service within the emergency setting may help improve the diagnostic workup of patients presenting with this specific symptomatology and may have significant economic benefits, such as the avoidance of hospital admissions, reduction in unnecessary investigations, and decrease in length of hospital stay. In this work, we present four patients who were referred to the acute vertigo service at University College London Hospital (UCLH) for review. We discuss the indications for and limitations of implementing such a service.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84313156","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":"Determinants of post-stroke cognitive impairment and dementia: association with objective measures and patient-reported outcomes","authors":"Lara C. Oliveira, A. Bonkhoff, A. Ponciano, C. Tuozzo, A. Viswanathan, N. Rost, M. Etherton","doi":"10.3389/fstro.2023.1190477","DOIUrl":"https://doi.org/10.3389/fstro.2023.1190477","url":null,"abstract":"Post-stroke cognitive impairment and dementia (PSCID) is a sequel of ischemic stroke (IS), highly prevalent and linked to poor long-term outcomes. Thus, early recognition of the clinical determinants of PSCID is urgent for identifying high-risk individuals who are susceptible to PSCID. And investigating objective measures of PSCID in relation to patient-reported outcome measures (PROMs) is essential for understanding the impact of IS. Here we identify the clinical determinants associated with PSCID and the relationship of PSCID to patient-reported outcomes in a population with IS.This was a cohort study. We enrolled 138 patients who were admitted to our hospital between February 2017 and February 2020, with IS and no pre-stroke diagnosis of dementia. Clinical variables were acquired on admission. At 3 months, patients underwent a follow-up evaluation including the Telephone Interview for Cognitive Status (TICS), modified Rankin scale (mRS), Barthel Index (BI), and PROMs, using the Patient-Reported Outcomes Measurement information System Global Health (PROMIS GH). MCI/Dementia was defined as a TICS score of <36. Regression analyses were used to identify clinical, functional, and patient-reported outcome determinants of the 3-month TICS score. Analyses were adjusted for age, stroke severity, and prior IS.At follow-up, 113 participants (82%) were found to have MCI/Dementia. Patients with PSCID were more likely to be older, and at 3-months post-stroke they had lower rates of PROMIS GH T Mental (mean 47.69 vs. 52.13) and T Physical (mean 46.75 vs. 50.64). In multivariable linear regression analyses, increasing age (β = −0.07, p = 0.03) and Peripheral Artery Disease (PAD; β = −3.60, p = 0.03) were independently associated with a lower TICS score. Functional and patient-reported outcomes were also associated with worse TICS, including mRS ≥ 2, BI, T Mental, Global Mental, T Physical, and Global Physical in adjusted analyses. Individual components of PROMs were also associated with TICS, including quality of life, mental health, social satisfaction, and physical activities.In patients with IS, increased age and a pre-admission diagnosis of PAD are independently associated with worse objective measures of PSCID. Worse functional and patient-reported outcomes are also strongly linked to PSCID.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78451832","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":"Advancing stroke genetics in Hawai‘i and the Pacific Islands","authors":"Stacy C. Brown, Christine Anne T. Galang, Mālialani Kana'iaupuni, Leah Dowsett, Keolu Fox, Kazuma Nakagawa","doi":"10.3389/fstro.2023.1114785","DOIUrl":"https://doi.org/10.3389/fstro.2023.1114785","url":null,"abstract":"Stroke, the second leading cause of death worldwide, has partially heritable risk. Genome-wide association studies (GWAS) of stroke continue to identify increasing genetic risk loci. These discoveries point to novel disease mechanisms and causal risk factors, and herald genetics-based precision medicine strategies. In Hawai‘i, people of Indigenous communities who identify as Native Hawaiian or Pacific Islanders present with stroke at younger ages and suffer dramatically higher stroke mortality rates compared with other regional populations. This disparity is compounded by relative ancestral underrepresentation in stroke genetics research and, by extension, exclusion from cutting-edge medical opportunities based on genetic discovery. In this article, we discuss the issues contributing to the scientific biases experienced by Indigenous populations in the Pacific Islands, as well as community-based efforts now underway to address them.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82185523","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":"The effects of arts and crafts therapy on post-stroke executive dysfunction: a pilot randomized control test","authors":"Ruisheng Yun, Huanxia Zhou, Julie McLaughlin Gray, Jia Hua Cheng, Zhongzhi Zhao","doi":"10.3389/fstro.2023.1242724","DOIUrl":"https://doi.org/10.3389/fstro.2023.1242724","url":null,"abstract":"Executive function is an important determinant of independent living among stroke survivors. Patients with post-stroke executive dysfunction (PSED) have a lower engagement in therapy activities and reduced independent living abilities. One potential method for improving executive function and engagement is arts and crafts therapy (ACT). This study aimed to explore the effects of ACT on patients with PSED.The study was a pilot randomized controlled trial (RCT) with two groups: an experimental intervention group receiving ACT combined with individual rehabilitation therapy (IRT) and an active control group receiving IRT only. Fifty-seven patients with PSED participated. Outcome measures included the Trail Making Test (parts A and B), the Stroop test, the Tower of Hanoi (TOH), and the Lawton–Brody Instrumental Activities of Daily Living Scale. Two groups were compared at baseline and 4 weeks after the completion of the training.There were significant differences in the Trail Making Test part A (TMT-A; time; p < 0.01), the TMT part B (TMT-B; p < 0.05), the TMT-B (errors; p < 0.01), and the Stroop test (time; p < 0.01) between the experimental and the control group after 4 weeks. There were no significant differences in TMT-A (errors), Stroop test (errors), TOH, and Instrumental Activities of Daily Living Scale.The therapeutic use of arts and crafts could be an effective intervention to improve executive function and self-efficacy for stroke survivors.http://www.chictr.org.cn; Identifier: ChiCTR2200063547.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88486409","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":"Current challenges in the endovascular treatment of medium vessel occlusions","authors":"A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Dibas, Daniel Casanova, M. Galecio-Castillo, M. Farooqui, S. Ortega‐Gutierrez","doi":"10.3389/fstro.2023.1242961","DOIUrl":"https://doi.org/10.3389/fstro.2023.1242961","url":null,"abstract":"Medium vessel occlusions (MeVOs) account for 25%−40% of acute ischemic stroke (AIS). While mechanical thrombectomy is the standard-of-care for selected patients with large vessel occlusion (LVO), there is currently a lack of level I evidence of the safety and efficacy of endovascular treatment (EVT) for MeVOs. Several randomized clinical trials (RCTs) have attempted to answer this relevant clinical question. However, several questions related to the EVT of MeVO stroke may remain unanswered even after successful completion of these trials: What is the optimal EVT approach for secondary MeVOs? Is EVT beneficial for posterior circulation MeVOs? Is pre-EVT intravenous thrombolysis better than EVT alone? What is the optimal first line thrombectomy technique for these lesions? Are the outcome assessment tools used for LVOs appropriate for MeVOs? Upcoming evidence and the natural evolution and development of new technologies will aid in overcoming these challenges.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"2677 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72938487","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: Ethylene glycol intoxication presenting as a mimic of acute stroke: a report of three cases","authors":"M. Héja, László Oláh","doi":"10.3389/fstro.2023.1233229","DOIUrl":"https://doi.org/10.3389/fstro.2023.1233229","url":null,"abstract":"Stroke is a major cause of death and disability presenting with acute focal neurological symptoms of vascular origin. Several other disorders may cause symptoms similar to a stroke, referred to as stroke mimics. The misdiagnosis of stroke mimics may lead to potentially harmful treatments, including thrombolysis. Intoxication is a rare, but possible, cause of stroke mimic. We present three cases of ethylene glycol poisoning presenting as an acute stroke mimic within the time window of thrombolytic therapy. Two of three patients (a 54-year-old male and a 78-year-old male) had dysarthria, nystagmus, and truncal ataxia on admission. The third patient with a history of chronic alcoholism presented after an epileptic seizure with mixed aphasia and confusion. Non-contrast cerebral computed tomography and computed tomography angiography were negative in all three cases. As stroke could not be excluded in any of the patients, thrombolysis was performed. However, after some hours, two of the three patients developed agitation, somnolence, and hyperventilation. One patient's consciousness deteriorated rapidly, and he became comatose and tetraplegic. A blood gas analysis showed acidosis in two of the three patients, and toxicological screening revealed ethylene glycol intoxication in all three cases. Due to the appropriate treatment, two of the three patients became symptom-free; however, one of the three patients died. Our cases show that ethylene glycol intoxication in its early phase may mimic acute stroke, resulting in unnecessary thrombolytic therapy. Symptoms not characteristic of a stroke, such as hyperventilation, agitation, and disturbance of consciousness, may appear later and warn of intoxication. The final diagnosis of ethylene glycol intoxication can be established by severe metabolic acidosis and toxicological screening. Close monitoring of symptoms might contribute to the early recognition of ethylene glycol intoxication and its effective treatment.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78596779","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":"NLRP3 inflammasome inhibition protects against intracranial aneurysm rupture and alters the phenotype of infiltrating macrophages","authors":"W. Dodd, Devan Patel, K. Motwani, B. Lucke-Wold, K. Hosaka, B. Hoh","doi":"10.3389/fstro.2023.1202137","DOIUrl":"https://doi.org/10.3389/fstro.2023.1202137","url":null,"abstract":"Aneurysmal subarachnoid hemorrhage is a devastating cerebrovascular disease associated with high morbidity and mortality. Macrophage-mediated mural inflammation is a key pathogenic component contributing to aneurysm rupture.To investigate the effect of pharmacological inhibition of the NLRP3 inflammasome on aneurysm rupture.Cerebral aneurysms were induced in C57BL/6 mice with a combination of hypertension and an intracranial dose of elastase. Mice were treated with either 40 mg/kg of MCC950 or saline via intraperitoneal injections. Vascular tissue at the circle of Willis was harvested for analysis via immunofluorescent microscopy or qPCR.NLRP3+ cells are more common in the aneurysm tissue compared to the normal cerebral vasculature. The mRNA expression of the downstream NLRP3 pathway components caspase-1, IL-1β, and GSDMD is also increased in the aneurysm tissue compared to healthy vessels. There was no difference in the aneurysm formation rate between MCC950- and vehicle-treated mice; however, MCC950 treatment significantly reduced aneurysm rupture rate. There was no difference in systemic blood pressure between both groups. MCC950 treatment also extended the symptom-free survival of mice after aneurysm induction. Mechanistically, NLRP3 inhibition decreased the phenotype polarization of infiltrating macrophages without affecting the total number of macrophages in the vessel wall.Our results indicate that the NLRP3 inflammasome contributes to aneurysm rupture and macrophage polarization within the vessel wall. The NLRP3 pathway is a promising therapeutic target for the development of therapeutics to prevent aneurysmal hemorrhagic stroke.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"15 7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82881397","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":"Non-English primary language and disparities in stroke outcomes after mechanical thrombectomy: a single institution study","authors":"N. Karim, Suzanne Stone, A. Salter, M. Gebreyohanns, Mark D. Johnson, E. Jones","doi":"10.3389/fstro.2023.1224566","DOIUrl":"https://doi.org/10.3389/fstro.2023.1224566","url":null,"abstract":"Delays in acute treatment of ischemic stroke have been associated with worse outcomes. While having a non-English primary language has not been shown to delay receiving thrombolytic therapy, we assessed whether non-English primary language was associated with worse functional outcomes in patients receiving mechanical thrombectomy (MT).This is a retrospective study of our MT database from two comprehensive stroke centers from January 2016 to May 2021. Primary endpoint was discharge modified Rankin Scale (mRS) 0-2. Differences between English primary language (EPL) and non-English primary language (nEPL) groups were evaluated using an analysis of variance (ANOVA), Kruskal-Wallis and chi square test. Multivariable logistic regression was used to evaluate EPL vs. nEPL patients using data driven models determined by stepwise selection approach.We identified 276 patients receiving MT with 83% EPL and 17% nEPL patients. nEPL patients had higher mean hemoglobin A1c, were less likely to have insurance, and more likely to have symptomatic intracranial hemorrhage compared to EPL patients (Table). We observed a longer median ED arrival to groin puncture time in the nEPL group. No differences were observed in discharge or mRS 0-2 in the univariate or multivariable logistic regression.Despite finding longer ED length of stay among nEPL patients, there was no difference between nEPL and EPL in good functional outcome rates in patients treated with MT.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88848218","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}