Journal of stroke medicine最新文献_第9页

Intracranial Arterial Stenosis Among Filipino Ischemic Stroke Patients: A Single Center Study 菲律宾缺血性脑卒中患者颅内动脉狭窄:单中心研究

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520976243

Suzanne Marie Q. Ilagan-Gacita, Jennifer Ann P. Sanchez-Tapia, J. Navarro

{"title":"Intracranial Arterial Stenosis Among Filipino Ischemic Stroke Patients: A Single Center Study","authors":"Suzanne Marie Q. Ilagan-Gacita, Jennifer Ann P. Sanchez-Tapia, J. Navarro","doi":"10.1177/2516608520976243","DOIUrl":"https://doi.org/10.1177/2516608520976243","url":null,"abstract":"Introduction: Intracranial arterial stenosis (ICAS) is common among certain race. It is prevalent in Asians, Hispanics, and African Americans, who constitutes about 2/3 of the world population making it the most common cause of stroke worldwide. Objectives: The objectives are to describe the demographic data and risk factors of patients with ICAS and 1-year outcome. Methods: Patients who had ischemic stroke by cranial computed tomography scan or magnetic resonance imaging, magnetic resonance angiography, computed tomographic angiography, or transcranial Doppler with periodic follow-up for 1 year were consecutively collected. Patients without intracranial stenosis were also collected and served as control. The demographic data, risk factors, modified Rankin Scale, stroke recurrence and mortality between ICAS and large artery atherosclerosis (LAA) patients were compared. The distribution and the degree of steno-occlusive lesions were estimated. Results: A total of 258 cases were consecutively collected. ICAS was demonstrated in 109 patients and 149 were LAA patients. There were 62 (56.88%) males. The age range distribution was as follows: 18 to 45 year olds, 15 (13.76%); 46 to 60 year olds, 28 (25.69%); and 61 year olds and above 66 (60.55%). Risk factors were hypertension 82 (75.23%), diabetes mellitus 46 (42.20%), hyperlipidemia 27 (24.77%), atrial fibrillation 16 (14.68%), history of previous stroke 23 (21.10%), alcohol drinker 28 (25.69%), obesity 8 (7.34%), and family history of cerebrovascular disease 33 (30.28%). ICAS was seen in the middle cerebral artery 46 (46.9%), ICA 21 (21.4%), BA 11 (11.2%), VA 8 (8.16%), PCA 7 (7.14%), and ACA 5 (5.1%). Majority of the patients showed moderate to severe stenosis. Modified Rankin Scale ranged from 0 to 2 in the majority of the patients and showed not much difference compared to LAA patients. The recurrence of stroke and death rate showed no significant difference between the 2 groups. Conclusion: In this study, no difference was seen between ICAS and LAA patients.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83558632","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}

引用次数: 0

Mission Thrombectomy 2020 (MT2020)—India’s Biggest Healthcare Challenge Yet 2020年取栓任务(MT2020)——印度迄今最大的医疗保健挑战

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520984276

K. Sundar, Ajay Panwar, Dileep R. Yagaval, V. Huded, P. Sylaja

引用次数: 7

Serial Hemodynamic and Autonomic Changes in Acute Ischemic Stroke: Relation to Outcome, Stroke Type, and Location 急性缺血性卒中的一系列血流动力学和自主神经改变:与预后、卒中类型和部位的关系

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520940486

A. Gujjar, D. Jaju, P. Jacob, S. Ganguly, A. Al-Asmi

{"title":"Serial Hemodynamic and Autonomic Changes in Acute Ischemic Stroke: Relation to Outcome, Stroke Type, and Location","authors":"A. Gujjar, D. Jaju, P. Jacob, S. Ganguly, A. Al-Asmi","doi":"10.1177/2516608520940486","DOIUrl":"https://doi.org/10.1177/2516608520940486","url":null,"abstract":"Background: Hypertension and changes in autonomic functions commonly accompany the acute phase of ischemic stroke and are recognized to influence outcomes. Few studies have addressed hemodynamic and autonomic monitoring together in acute stroke. Aim: We aimed to study serial hemodynamic and cardiovascular autonomic changes among patients with acute ischemic stroke (AIS) using thoracic electrical bioimpedance and to explore their relation to stroke outcome, stroke type, location, and severity. Methods: Patients with AIS of <96 h duration underwent serial hemodynamic/autonomic function studies over the first 4 days of admission. Their association with stroke severity, type, location, and outcome was explored using univariate and multivariate analyses. Patients with arrhythmias, pulmonary edema, or cardiac failure were excluded. Results: Of the 55 patients (M:F::27:28; age: 62 + 12 yrs) with AIS, 33 had large artery stroke, 18-lacunar and 4-cardioembolic stroke, and 6 died. Mean blood pressure, systemic vascular resistance (SVR), and cardiac output (CO) decreased over 4 days. Several hemodynamic and autonomic parameters correlated with the outcome on univariate analysis, while CO and SVR independently predicted the outcome. Stroke type was related to few hemodynamic parameters (SI, cardiac index on days 2-4). Lacunar stroke type was associated with left ventricular ejection time and low-frequency/high-frequency ratio (P < .05). Conclusion: Among patients with AIS, early sympathetic autonomic dominance may explain decreasing hemodynamic trends observed over the initial 4 days. 2 hemodynamic parameters, CO and SVR, independently predicted stroke outcome, while blood pressure did not. Further studies are indicated to explore the possibility of influencing stroke outcomes through modification of CO or SVR.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88011243","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}

引用次数: 1

A Rare Case of Stroke Following Manual Strangulation 一例罕见的手勒死后中风病例

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520977590

C. Selvakumar, S. M., Sadeesh Kumar

引用次数: 0

Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital 亚洲首个流动脑卒中单元在科威医疗中心和医院的经验回顾和概念验证

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520968418

M. Cherian, P. Mehta, S. Varadharajan, Santosh Poyyamozhi, E. Swamiappan, Jenny Gandhi, Nithin Theckumparampil

{"title":"Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital","authors":"M. Cherian, P. Mehta, S. Varadharajan, Santosh Poyyamozhi, E. Swamiappan, Jenny Gandhi, Nithin Theckumparampil","doi":"10.1177/2516608520968418","DOIUrl":"https://doi.org/10.1177/2516608520968418","url":null,"abstract":"Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73721838","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}

引用次数: 0

Mirror Therapy in Stroke Rehabilitation: Why, How Early, and Effects: A Meta-analysis 镜像疗法在中风康复中的应用:原因、早期治疗和效果:一项荟萃分析

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520974512

D. Gandhi, A. Sterba, Himani Khatter, J. Pandian, Komal Bhanot

{"title":"Mirror Therapy in Stroke Rehabilitation: Why, How Early, and Effects: A Meta-analysis","authors":"D. Gandhi, A. Sterba, Himani Khatter, J. Pandian, Komal Bhanot","doi":"10.1177/2516608520974512","DOIUrl":"https://doi.org/10.1177/2516608520974512","url":null,"abstract":"Background and Aims: The use of visual stimuli to facilitate a desired response in the affected limb in mirror therapy (MT) makes it an effective treatment modality even in instances of a complete plegic upper extremity poststroke. This article analyzes the effects of MT on impairments, activity limitation, and participation restriction in the acute and chronic phases poststroke. Methods: In total, 16 out of 3871 studies were included in the meta-analysis, using PRISMA guidelines. Data were categorized based on application in stroke rehabilitation (acute/chronic, motor/sensory/neglect/activity of daily living, upper limb/lower limb), modes and dosage of intervention delivery, types of control, and outcome assessment. RevMan 5.0 software was used for analysis. Results: Studies were equally distributed between chronic and acute phases. Therapy durations lasted between 1 and 8 weeks. Most studies intervened for upper limb motor impairments showing improvement in Brunnstrom motor recovery stages of arm (P value: .04, 95% CI, 0.05-1.54, I2 = 59%) and hand (P value: <.001, 95% CI, 0.80-2.01, I2 = 0%) during acute phase (0-4 weeks). “Activity/function” measured by functional independence measure showed improvement only in self-care subsection (P value: <.001, 95% CI, 2.05-5.16, I2 = 0%). No long-term effects were analyzed in any of the included studies. Conclusion: A significant finding of this study is the role of MT in improving arm and hand impairments in acute phase poststroke. Rehabilitation protocols can be improved based on this finding. As MT is effective, affordable, and feasible, we have made suggestions toward its incorporation in physiotherapy protocols for low- and middle-income countries.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79027084","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}

引用次数: 1

Role of Factor V R2 Haplotype and Common Thrombophilia Markers as Genetic Risk Factors for Ischemic Stroke 因子vr2单倍型和常见血栓标志物作为缺血性卒中遗传危险因素的作用

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520973817

M. Michele, S. Lorenzano, N. Angelosanto, A. Serrao, L. Petraglia, A. Risitano, D. Toni, A. Chistolini

{"title":"Role of Factor V R2 Haplotype and Common Thrombophilia Markers as Genetic Risk Factors for Ischemic Stroke","authors":"M. Michele, S. Lorenzano, N. Angelosanto, A. Serrao, L. Petraglia, A. Risitano, D. Toni, A. Chistolini","doi":"10.1177/2516608520973817","DOIUrl":"https://doi.org/10.1177/2516608520973817","url":null,"abstract":"Background: Uncertainties remain about the role of common thrombophilia markers as determinants of the ischemic stroke (IS) risk. Polymorphism His1299Arg in the FV gene, named R2 haplotype (FVHR2), has been poorly investigated. The aim of the present study was to assess the prevalence of common thrombophilia markers and of FVHR2 in a cohort of IS patients compared to a nonmatched group of healthy individuals. Methods: We studied 156 consecutive patients survivors of a first ever IS and 124 healthy controls. All subjects were investigated for the gene polymorphisms factor V (FV) Leiden, prothrombin (PTH) G20210A, MTHFR C677T, and FVHR2. Protein C (PC), protein S (PS), antithrombin (ATIII), and lupus anticoagulant (LAC) activity was measured. Homocysteinemia was assessed within 48 hours and after 30 days from stroke onset. Univariate and multivariate analyses were performed. Results: Compared with controls, patients were significantly older (mean [SD] age, 50.5 [12.9] vs 37.5 [15.5] years, P < .001), less frequently females (48.1% vs 67.7%, P = .001) and had more frequently hyperhomocysteinemia (45.9% vs 11.0%) only in the acute phase (OR 6.899, CI 95% 2.993-15.899; P < .001). No differences were found in the prevalence of FV Leiden, PTH G20210A, and MTHFR C677T between patients and controls, whereas FVHR2 was present in 34/156 (22%) stroke patients and in 5/124 (4%) controls (OR 6.632, 95% CI 2.509-17.535, P < .001). In a multivariate logistic regression analysis, the FVHR2 resulted independently associated with the occurrence of IS (OR 6.071, 95% CI 1.762-20.923; P = .004). Conclusions: In our study, hyperhomocysteinemia was confirmed to be a transient consequence of the thrombotic event. FVHR2 seems to be a possible candidate prothrombotic condition related to arterial IS irrespective of age and sex in an Italian sample population.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86618114","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}

引用次数: 0

Louis R. Caplan, C. Miller Fisher: Stroke in the 20th Century 路易斯·r·卡普兰，c·米勒·费舍尔:《20世纪的中风》

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520954092

J. Pandian, I. Sebastian

引用次数: 0

Acute Stroke Mimics: Etiological Spectrum and Efficacy of FAST, BE FAST, and the ROSIER Scores 急性脑卒中模拟:FAST、BE FAST和ROSIER评分的病因谱和疗效

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520973520

S. Aaron, Prabhakar A. T., V. Mathew, L. Jeyaseelan, Kenneth Benjamin, K. Abhilash, Shaikh Atif Iqbal Ahmed, A. Nair

{"title":"Acute Stroke Mimics: Etiological Spectrum and Efficacy of FAST, BE FAST, and the ROSIER Scores","authors":"S. Aaron, Prabhakar A. T., V. Mathew, L. Jeyaseelan, Kenneth Benjamin, K. Abhilash, Shaikh Atif Iqbal Ahmed, A. Nair","doi":"10.1177/2516608520973520","DOIUrl":"https://doi.org/10.1177/2516608520973520","url":null,"abstract":"Background and Purpose: Stroke mimics constitute a good number of patients referred as acute strokes within the window period for acute therapies. Proper triaging can avoid unnecessary imaging and even thrombolytic therapies in these patients. This study looked at the etiological spectrum of acute stroke mimics presenting within the 4.5 hours therapeutic window. We also evaluated the FAST, BE FAST, and the ROSIER tools in picking true strokes. Methods: Prospective study conducted over a 2-year period. Results: Acute stroke mimics constituted 328/1635 (20%) of referrals for acute stroke after screening by the neurology stroke team. Focal and generalized seizures with transient weakness and peripheral vertigo were the commonest acute stroke mimics; followed by metabolic causes and psychiatric disorders. Females were more in the stroke mimic group (P = .02). Ischemic heart disease and atherosclerotic risk factors (except diabetes mellitus) were significantly higher among true strokes. In total, 4 (1.2%) of the stroke mimics were treated with IV thrombolysis. Diagnostic accuracy for different stroke differentiating tools are as follows: FAST (sensitivity 85.9%, specificity 52.8%, odds 6.8), BE FAST (sensitivity 97.0%, specificity 31.4%, odds 14.9), and ROSIER scale (sensitivity 85.7%, specificity 59.4%, odds 8.7%). Conclusions: Acute stroke mimics can constitute up to 20% of cases evaluated as acute strokes by neurology stroke teams. None of the triaging tools appear to have enough accuracy. A proper history and clinical examination should be given priority over fixed protocols whenever acute stroke mimic are suspected especially before administering acute costly interventions. Auditing stroke mimics is important to improve acute stroke pathways.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86167172","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}

引用次数: 1

Bridging Therapy and Direct Thrombectomy for Acute Ischemic Stroke: A Prospective Cohort Study 急性缺血性脑卒中的桥接治疗和直接取栓:一项前瞻性队列研究

Journal of stroke medicine Pub Date : 2020-12-01 DOI: 10.1177/2516608520976275

T. Q. Nguyen, A. L. T. Truong, H. Phan, D. Nguyen, K. Nguyen, Huong Nguyen, A. Nguyen, Dinh Chau Bao Hoang, Vu Thanh Tran, T. Q. Nguyen, Tracey Le, K. Nguyen, T. H. Nguyen

{"title":"Bridging Therapy and Direct Thrombectomy for Acute Ischemic Stroke: A Prospective Cohort Study","authors":"T. Q. Nguyen, A. L. T. Truong, H. Phan, D. Nguyen, K. Nguyen, Huong Nguyen, A. Nguyen, Dinh Chau Bao Hoang, Vu Thanh Tran, T. Q. Nguyen, Tracey Le, K. Nguyen, T. H. Nguyen","doi":"10.1177/2516608520976275","DOIUrl":"https://doi.org/10.1177/2516608520976275","url":null,"abstract":"Background: It remains controversial if intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MTE) is superior to MTE alone in patients with acute ischemic stroke caused by large vessel occlusion. We aim to compare functional outcomes, mortality, reperfusion, and intracranial hemorrhage rates in bridging therapy (IVT prior thrombectomy) and MTE alone groups within 6 h from symptom onset. Materials and Methods: Consecutive hospitalized patients (September 2017 and July 2018) with acute large artery occlusion within the anterior cerebral circulation eligible for MTE with or without prior IVT were included. A modified Rankin Scale score of 0 to 2 was considered as good functional outcome at 90 days. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction scale of 2b to 3. Results: Of the 124 patients included, 56 (45.2%) received bridging therapy and 68 (54.8%) received MTE alone. Patients receiving bridging therapy were younger (median, 56 vs 63, P = .045) and had shorter onset-to-groin time (median, 270 vs 370 min, P < .001) than those receiving MTE alone. Successful reperfusion rate was significantly greater in the bridging therapy group (87.5% vs 72.1%, P = 0.03). There were no statistically significant differences between the 2 groups in functional independence (bridging 58.9% vs 75.0%, P = 0.07), mortality at 90 days (bridging 14.3% vs 7.4%, P = 0.22), parenchymal hematoma type 2 (bridging 3.6% vs 2.9%, P > .99), and any hemorrhage (bridging 42.3% vs 26.5%, P = 0.07). Conclusion: Compared to MTE alone, bridging therapy with IVT improved the reperfusion rate but not other outcomes. Further clinical trials are needed to confirm our findings.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85294955","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}

引用次数: 1