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Clinically relevant findings on 24-h head CT after acute stroke therapy: The 24-h CT score. 急性脑卒中治疗后 24 小时头部 CT 的临床相关结果:24 小时 CT 评分。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-16 DOI: 10.1177/17474930241289992
Bowei Zhang, Andrew J King, Barbara Voetsch, Scott Silverman, Lee H Schwamm, Xunming Ji, Aneesh B Singhal

Background: Routine head computed tomography (CT) is performed 24 h post-acute stroke thrombolysis and thrombectomy, even in patients with stable or improving clinical deficits. Predicting CT results that impact management could help prioritize patients at risk and potentially reduce unnecessary imaging.

Methods: In this institutional review board (IRB)-approved retrospective study, data from 1461 consecutive acute ischemic stroke patients at our Comprehensive Stroke Center (n = 8943, 2012-2022) who received intravenous thrombolysis or endovascular therapy, exhibited stable or improving 24-h exams, and underwent 24-h follow-up head CT per standard acute stroke care guidelines. CT reports 24 h post-stroke were reviewed for edema, mass effect, herniation, and hemorrhage. The primary outcome was any clinically relevant 24-h CT finding that led to changes in antithrombotic treatment or blood pressure goals, extended intensive care unit (ICU) stays or hospitalizations, neurosurgical interventions, or administration of mannitol or hypertonic saline. Multivariable logistic regression identified independent predictors of clinically meaningful CT abnormalities. A 24-h CT score was developed and cross-validated.

Results: The mean age was 70 years, with 47% women. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 12 (interquartile range (IQR): 6-18). Stroke-related abnormalities on 24-h CT were present in 325 patients (22.2%), with 183 (12.5%) showing clinically relevant findings. Age, admission NIHSS, and blood glucose levels were independent predictors of clinically relevant 24-h CT findings. The final model C statistic was 0.72 (95% confidence interval (CI): 0.68-0.76) in the derivation cohort and 0.72 (95% CI: 0.67-0.75) in bootstrapping validation. The 24-h CT score was developed using these predictors: NIHSS score 5-15 (+3); NIHSS score ⩾16 (+5); age < 75 years (+1); admission glucose ⩾ 140 mg/dL (+1). The prevalence of clinically relevant CT findings was 4.3% in the low-risk group (24-h CT score ⩽ 4), 11.3% in the medium-risk group (score 5), and 21.4% in the high-risk group (score ⩾ 6). The 24-h CT score demonstrated good calibration.

Conclusion: In patients undergoing thrombolysis or thrombectomy who undergo routine 24-h head CT despite remaining clinically stable or improving, only one in eight prove to have 24-h head CT findings that impact management. The 24-h CT score provides risk stratification that may improve resource utilization.

Data access statement: A.S. and B.Z. have full access to the data used in the analysis in this article. Deidentified data will be shared after ethics approval if requested by other investigators for purposes of replicating the results.

背景:急性卒中溶栓和血栓切除术后 24 小时常规进行头部计算机断层扫描(CT),即使是临床功能障碍稳定或改善的患者。预测影响治疗的 CT 结果有助于确定高危患者的优先次序,并有可能减少不必要的影像学检查:在这项经 IRB 批准的回顾性研究中,我们的综合卒中中心连续收治了 1461 名急性缺血性卒中患者(n=8943,2012-2022 年),这些患者接受了静脉溶栓或血管内治疗,24 小时检查结果显示病情稳定或好转,并根据标准急性卒中治疗指南接受了 24 小时随访头部 CT。对中风后 24 小时的 CT 报告进行审查,以确定是否存在水肿、肿块效应、疝和出血。主要结果是任何导致抗血栓治疗或血压目标改变、重症监护室住院时间延长或住院、神经外科干预或使用甘露醇或高渗盐水的临床相关 24 小时 CT 发现。多变量逻辑回归确定了具有临床意义的 CT 异常的独立预测因素。制定了 24 小时 CT 评分标准并进行了交叉验证:平均年龄为 70 岁,女性占 47%。入院时NIH卒中量表(NIHSS)评分中位数为12(IQR为6-18)。325名患者(22.2%)的24小时CT出现了与卒中相关的异常,其中183名患者(12.5%)出现了临床相关的结果。年龄、入院 NIHSS 和血糖水平是 24 小时 CT 临床相关结果的独立预测因素。推导队列的最终模型 C 统计量为 0.72(95% CI,0.68-0.76),自引导验证的最终模型 C 统计量为 0.72(95% CI,0.67-0.75)。24 小时 CT 评分就是利用这些预测因子得出的:NIHSS评分5-15分(+3);NIHSS评分≥16分(+5);年龄 结论:在接受溶栓或血栓切除术的患者中,尽管临床症状保持稳定或有所改善,但接受常规 24 小时头部 CT 检查的患者中,只有八分之一的患者的 24 小时头部 CT 检查结果会对治疗产生影响。24 小时 CT 评分可提供风险分层,从而提高资源利用率。
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引用次数: 0
Association of aspirin use with risk of intracerebral hemorrhage in patients without history of stroke or transient ischemic attack in the UK Biobank. 英国生物库中无中风或短暂性脑缺血发作史患者服用阿司匹林与脑内出血风险的关系
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1177/17474930241288367
Zijie Wang, Xueyun Liu, Shanyu Zhang, Xiao Hu, Yanghua Tian, Qi Li

Background: The association between aspirin use and the risk of intracerebral hemorrhage (ICH) among individuals without previous stroke events is inconclusive.

Aim: We investigated the association between regular aspirin use and ICH risk in middle-aged and older adults without previous stroke or transient ischemic attack (TIA).

Methods: This prospective population-based study included participants older than 40 years with no history of stroke or TIA from the UK Biobank. The main exposure was regular aspirin use. Cox regression analyses and propensity score matching analyses estimated the hazard ratios (HRs) for aspirin use for incident fatal and non-fatal ICH. We conducted pre-specified subgroup analyses for selecting individuals at high risk of ICH when using aspirin. Multiple sensitivity analyses were performed to test the robustness of our results.

Results: A total of 449,325 participants were included into final analyses (median (IQR) age 58 (50-63) years, 54.6% females), of whom 58,045 reported aspirin use. During a median follow-up of 12.75 (IQR: 12.03-13.47) years, 1557 (0.3%) incident ICH cases were identified, of which 399 (25.6%) were fatal. Aspirin was not associated with increased risk of overall (hazard ratio (HR): 1.11, 95% confidence interval (CI): 0.95-1.27, P = 0.188), fatal (HR: 1.03, 95% CI: 0.78-1.36, P = 0.846) and non-fatal (HR: 1.12, 95% CI: 0.95-1.33, P = 0.186) ICH. Propensity score matching analysis showed similar results. Subgroup analysis indicated that aspirin use in individuals older than 65 years or with concurrent anticoagulant use was correlated with increased risk of ICH.

Conclusion: In this large cohort study of middle-aged and older adults without stroke or TIA events, there was no significant association between aspirin use and ICH risk in the real-world setting. However, it is possible that aspirin use in those aged over 65 years and concurrent anticoagulant treatment may increase the risk of ICH.

背景:目的:我们调查了无中风或短暂性脑缺血发作(TIA)史的中老年人定期服用阿司匹林与 ICH 风险之间的关系:这项基于人群的前瞻性研究纳入了英国生物库中 40 岁以上、无中风或 TIA 病史的参与者。主要暴露因素是定期服用阿司匹林。Cox 回归分析和倾向评分匹配分析估算了服用阿司匹林与发生致命性和非致命性 ICH 的危险比 (HRs)。我们进行了预设亚组分析,以筛选出使用阿司匹林时发生 ICH 的高风险人群。我们还进行了多重敏感性分析,以检验结果的稳健性:共有 449,325 名参与者被纳入最终分析(中位数 [IQR] 年龄 58 [50 - 63] 岁,54.6% 为女性),其中 58,045 人报告使用了阿司匹林。在中位数为 12.75(IQR 12.03 - 13.47)年的随访期间,共发现 1,557 例(0.3%)ICH 病例,其中 399 例(25-6%)为致命病例。阿司匹林与总体(HR 1.11,95% CI 0.95 - 1.27,P = 0.188)、致命(HR 1.03,95% CI 0.78 - 1.36,P = 0.846)和非致命(HR 1.12,95% CI 0.95 - 1.33,P = 0.186)ICH 风险增加无关。倾向评分匹配分析显示了相似的结果。亚组分析表明,65 岁以上人群服用阿司匹林或同时服用抗凝剂与 ICH 风险增加相关:结论:在这项针对无中风或 TIA 事件的中老年人的大型队列研究中,阿司匹林的使用与现实世界中的 ICH 风险无明显关联。然而,65 岁以上人群服用阿司匹林并同时接受抗凝治疗可能会增加 ICH 风险。
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引用次数: 0
Female hormonal and reproductive factors and the risk of subarachnoid hemorrhage. 女性荷尔蒙和生殖因素与蛛网膜下腔出血的风险。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-07 DOI: 10.1177/17474930241283377
Fang Cao, Junyu Liu, Yuge Wang, Qingyue He, Yuxin Guo, Junxia Yan

Background: Subarachnoid hemorrhage (SAH), primarily caused by rupture of intracranial aneurysm, has a high incidence rate in women. We aimed to evaluate the association between female hormonal and reproductive factors and SAH.

Methods: A prospective cohort of 226,469 participants from the UK Biobank was followed for a median period of 14.75 years. Cox proportional hazards models and restricted cubic splines were used to explore the associations between 13 major factors and SAH, including menarche age, menopausal status, age at menopause, reproductive lifespan, pregnancy history, age at first and last live births, number of live births, adverse fertility outcomes, history of oral contraception or hormone-replacement therapy (HRT) use, and surgical history of hysterectomy or bilateral oophorectomy.

Results: SAH occurred in 769 of participants during the follow-up period. Both women with a younger age at menarche (< 12 years) and post-menopausal women had a higher SAH risk (hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.06-1.54) and (HR, 1.48; 95% CI, 1.10-1.99), respectively. A higher risk of SAH was identified in those with an earlier age at menopause (< 40 years: HR, 2.09; 95% CI, 1.43-3.06; 40-44 years: HR, 1.68; 95% CI, 1.23-2.29). A shorter reproductive lifespan (< 30 years) was associated with increased SAH risk (HR, 1.64; 95% CI, 1.28-2.11), while a longer reproductive lifespan (> 42 years) showed a protective effect (HR, 0.65; 95% CI, 0.55-0.77). Younger age at first live birth (< 24 years) was associated with SAH (HR, 1.39; 95% CI, 1.13-1.72). Hysterectomy (HR, 2.55; 95% CI, 2.12-3.05) or bilateral oophorectomy (HR, 1.51; 95% CI, 1.14-2.01) also predisposed women to SAH. Age at last live birth, number of live births, pregnancy history, adverse fertility outcomes, and HRT or oral contraceptive use were not associated with SAH.

Conclusions: Female hormonal and reproductive factors are important for evaluating SAH risk in women. In particular, earlier menopause is associated with an increased risk of SAH.

Data access statement: The data utilized in this study were sourced from a third party and are not publicly accessible. The UK Biobank data that support the findings of this research are available from the UK Biobank (www.ukbiobank.ac.uk), subject to review and approval by the UK Biobank.

背景蛛网膜下腔出血(SAH)主要由颅内动脉瘤破裂引起,女性发病率较高。我们旨在评估女性荷尔蒙和生殖因素与蛛网膜下腔出血之间的关系。方法 对英国生物库中的 226,469 名前瞻性队列参与者进行了中位 14.75 年的随访。采用Cox比例危险模型和限制性三次样条来探讨13个主要因素与SAH之间的关系,包括初潮年龄、绝经状态、绝经年龄、生育年限、妊娠史、首次和最后一次活产的年龄、活产次数、不良生育结局、口服避孕药或激素替代疗法(HRT)使用史以及子宫切除术或双侧输卵管切除术的手术史。初潮年龄较小(42 岁)的女性具有保护作用(HR,0.65;95%CI,0.55-0.77)。首次活产年龄较小(42 岁)的女性具有保护作用(HR 值为 0.65;95%CI 为 0.55-0.77
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引用次数: 0
PCSK9 Inhibitor with Statin Therapy for Intracranial Artery Stenosis ( PISTIAS): Rationale and design of a multicenter randomized controlled trial. PCSK9抑制剂与他汀类药物治疗颅内动脉狭窄(PISTIAS):多中心随机对照试验的原理与设计。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-15 DOI: 10.1177/17474930241270447
Xinzhi Hu, Zongmuyu Zhang, Caiyan Liu, Mingli Li, Yiyang Liu, Anqi Cheng, Qiuyu Yu, Haoyao Guo, Yinxi Zou, Li Zhou, Hebo Wang, Bo Song, Yong You, Jian Xia, Jingfen Zhang, Zhibing Ai, Qinjian Sun, Ju Han, Jing Liu, Baoquan Lu, Qiwen Deng, Guanzeng Li, Peng-Fei Wang, Xiangqing Li, Yi An, Bo Wu, Zhongrui Yan, Yining Wang, Wei-Hai Xu

Rationale: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors enable an additional 54-75% reduction in low-density lipoprotein cholesterol (LDL-C) in statin-treated patients, demonstrating plaque regression in coronary artery disease. However, the impact of achieving an extremely low level of LDL-C with PCSK9 inhibitors (e.g. Evolocumab) on symptomatic intracranial atherosclerosis remains unexplored.

Aim and hypothesis: To determine whether combining Evolocumab and statins achieves a more significant symptomatic intracranial plaque regression than statin therapy alone.

Sample size estimates: With a sample size of 1000 subjects, a two-sided α of 0.05, and 20% lost to follow-up, the study will have 83.3% power to detect the difference in intracranial plaque burden.

Methods and design: This is an investigator-initiated multicenter, randomized, open-label, outcome assessor-blinded trial, evaluating the impact of combining Evolocumab and statins on intracranial plaque burden assessed by high-resolution magnetic resonance imaging at baseline in patients undergoing a clinically indicated acute stroke or transient ischemic attack due to intracranial artery stenosis, and after 24 weeks of treatment. Subjects (n = 1000) were randomized 1:1 into two groups to receive either Evolocumab 140 mg every 2 weeks with statin therapy or statin therapy alone.

Study outcomes: The primary endpoint is the change in intracranial plaque burden assessed by high-resolution magnetic resonance imaging, performed at baseline and at the end of the 24-week treatment period.

Discussion: This trial will explore whether more significant intracranial plaque regression is achievable with the treatment of combining Evolocumab and statins, providing information about efficacy and safety data.

Trial registration number: ChiCTR2300068868; https://www.chictr.org.cn/.

理论依据:Protein convertase subtilisin/kexin type 9 (PCSK9) 抑制剂可使他汀类药物治疗患者的低密度脂蛋白胆固醇(LDL-C)额外降低 54% 至 75%,显示出冠状动脉疾病斑块的消退。然而,使用 PCSK9 抑制剂(如 evolocumabEvolocumab)达到极低水平的 LDL-C 对无症状颅内动脉粥样硬化的影响仍有待探索:目的和假设:确定将 evolocumabEvolocumab 和他汀类药物结合使用是否比单纯他汀类药物治疗能更显著地减少症状性颅内斑块:样本量估计:样本量为1000名受试者,双侧为0.05,20%的受试者失去随访,该研究将有83.3%的力量检测到颅内斑块负担的差异:这是一项由研究者发起的多中心、随机、开放标签、结果评估者盲法试验,旨在评估 EvolocumabEvolocumab 对因颅内动脉狭窄导致的临床急性中风或短暂性脑缺血发作患者基线时和治疗 24 周后通过高分辨率磁共振成像评估的颅内斑块负荷的影响。受试者(n = 1000)将按 1:1 随机分为两组,接受 evolocumabEvolocumab 140 毫克,每两周一次,同时接受他汀类药物治疗或仅接受他汀类药物治疗:主要终点是在基线和24周治疗期结束时通过高分辨率磁共振成像评估斑块负担的变化:该试验将探索他汀类药物和 PCSK9 抑制剂联合治疗是否能实现更显著的斑块消退,提供重要的疗效、机制和安全性数据信息:ChiCTR2300068868;https://www.chictr.org.cn/。
{"title":"PCSK9 Inhibitor with Statin Therapy for Intracranial Artery Stenosis ( PISTIAS): Rationale and design of a multicenter randomized controlled trial.","authors":"Xinzhi Hu, Zongmuyu Zhang, Caiyan Liu, Mingli Li, Yiyang Liu, Anqi Cheng, Qiuyu Yu, Haoyao Guo, Yinxi Zou, Li Zhou, Hebo Wang, Bo Song, Yong You, Jian Xia, Jingfen Zhang, Zhibing Ai, Qinjian Sun, Ju Han, Jing Liu, Baoquan Lu, Qiwen Deng, Guanzeng Li, Peng-Fei Wang, Xiangqing Li, Yi An, Bo Wu, Zhongrui Yan, Yining Wang, Wei-Hai Xu","doi":"10.1177/17474930241270447","DOIUrl":"10.1177/17474930241270447","url":null,"abstract":"<p><strong>Rationale: </strong>Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors enable an additional 54-75% reduction in low-density lipoprotein cholesterol (LDL-C) in statin-treated patients, demonstrating plaque regression in coronary artery disease. However, the impact of achieving an extremely low level of LDL-C with PCSK9 inhibitors (e.g. Evolocumab) on symptomatic intracranial atherosclerosis remains unexplored.</p><p><strong>Aim and hypothesis: </strong>To determine whether combining Evolocumab and statins achieves a more significant symptomatic intracranial plaque regression than statin therapy alone.</p><p><strong>Sample size estimates: </strong>With a sample size of 1000 subjects, a two-sided α of 0.05, and 20% lost to follow-up, the study will have 83.3% power to detect the difference in intracranial plaque burden.</p><p><strong>Methods and design: </strong>This is an investigator-initiated multicenter, randomized, open-label, outcome assessor-blinded trial, evaluating the impact of combining Evolocumab and statins on intracranial plaque burden assessed by high-resolution magnetic resonance imaging at baseline in patients undergoing a clinically indicated acute stroke or transient ischemic attack due to intracranial artery stenosis, and after 24 weeks of treatment. Subjects (n = 1000) were randomized 1:1 into two groups to receive either Evolocumab 140 mg every 2 weeks with statin therapy or statin therapy alone.</p><p><strong>Study outcomes: </strong>The primary endpoint is the change in intracranial plaque burden assessed by high-resolution magnetic resonance imaging, performed at baseline and at the end of the 24-week treatment period.</p><p><strong>Discussion: </strong>This trial will explore whether more significant intracranial plaque regression is achievable with the treatment of combining Evolocumab and statins, providing information about efficacy and safety data.</p><p><strong>Trial registration number: </strong>ChiCTR2300068868; https://www.chictr.org.cn/.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1071-1076"},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment. 中风后的情绪化;诊断、病理生理学和治疗。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-04-11 DOI: 10.1177/17474930241242952
Niall M Broomfield, Joshua Blake, Fergus Gracey, Tom Steverson

Background: Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect.

Aim and methods: This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment.

Results: Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions.

Conclusions: More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.

每 5 名中风患者中就有 1 人在中风 6 个月后会出现中风后情绪低落,尽管这种情况很常见,但人们对这种中风症状的了解却很少。相关文献十分有限,尤其是与其他常见的神经系统疾病(如失语症和视力障碍)相比。本叙述性综述对这些文献进行了总结,为临床实践和未来研究提供参考。我们将讨论定义、发病率、神经生物学、诱发和促发因素以及治疗方法。越来越多的证据表明,与情绪表达或调节过程功能相关的特定区域受损、结构性通路中断以及相关血清素分泌和调节紊乱单独或共同导致了情绪化类型的表现。研究中使用了一系列情绪化测量工具,因此很难对不同研究进行比较。最近开发的 "近期卒中后情绪测试-问卷"(TEARS-Q)可以进行标准化评估。可供选择的治疗方案有限,而且很少有充分有效的治疗试验。抗抑郁药可能会减轻严重程度,但还需要更多的试验数据。目前还没有非药物干预的随机对照试验。我们需要开展更多的研究,以提高对这一常见致残症状的认识和治疗。最后,我们提出了该领域的研究重点和建议。
{"title":"Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment.","authors":"Niall M Broomfield, Joshua Blake, Fergus Gracey, Tom Steverson","doi":"10.1177/17474930241242952","DOIUrl":"10.1177/17474930241242952","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect.</p><p><strong>Aim and methods: </strong>This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment.</p><p><strong>Results: </strong>Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions.</p><p><strong>Conclusions: </strong>More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"857-866"},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Temporal trends of sex differences in acute reperfusion therapy and early outcomes of acute ischemic stroke in South Korea: 10-year analysis of the nationwide stroke registry. 韩国急性再灌注治疗和急性缺血性脑卒中早期预后的性别差异时间趋势:全国脑卒中登记处的十年分析。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-24 DOI: 10.1177/17474930241261877
Darda Chung, Ji Sung Lee, Mi-Sun Oh, Jong-Moo Park, Jong-Won Chung, Oh Young Bang, Gyeong-Moon Kim, Woo-Keun Seo

Background: Sex differences in stroke outcomes are notable, with women experiencing higher incidence rates, greater disability-adjusted life years, and poorer recovery compared to men, even after adjusting for age and comorbidities. Despite the disproportionate burden in women, studies have reported that women are less likely to receive appropriate stroke treatment than men.

Aim: This study investigated temporal trends of sex differences in acute reperfusion therapy and early outcomes in patients with acute ischemic stroke over 10 years in South Korea.

Methods: A retrospective analysis of Korean Stroke Registry included patients with acute ischemic stroke from 2012 to 2021. The study outcomes were the temporal trends of acute reperfusion therapy and early outcomes over 10 years in men and women, respectively. In addition, this study analyzed the temporal trends of sex differences in these parameters during the same period. Early outcomes include the proportions of favorable functional outcomes at discharge, discharge patterns, and in-hospital mortality.

Results: A total of 93,692 patients (68.4 years, 40.1% women) with acute ischemic stroke were finally enrolled. Women had a higher age at stroke onset, a higher prevalence of atrial fibrillation, and more severe strokes than men. Women had lower proportion of favorable functional outcomes at discharge and higher proportion of in-hospital mortality compared to men each year. The proportion of patients who received intravenous thrombolysis was lower or similar in women compared to men in most years, and the proportion of patients who received endovascular thrombectomy did not significantly differ between sexes annually. Sex differences in acute reperfusion therapy remained unchanged over 10 years.

Conclusion: Women have received acute reperfusion therapy at similar or lower rates than men and experienced poorer outcomes, despite having more stroke risk factors and often more severe strokes.

背景:与男性相比,女性的发病率更高、残疾调整生命年数更长、恢复更差,即使在调整年龄和合并症后也是如此。目的:本研究调查了韩国急性缺血性卒中患者急性再灌注治疗和早期预后 10 年来的性别差异时间趋势:方法:对韩国卒中登记处进行回顾性分析,纳入 2012 年至 2021 年的急性缺血性卒中患者。研究结果显示,男性和女性急性再灌注治疗和早期预后的时间趋势分别为 10 年。此外,本研究还分析了同期这些参数的性别差异时间趋势。早期预后包括出院时良好功能预后的比例、出院模式和院内死亡率:共有 93,692 名急性缺血性脑卒中患者(68.4 岁,40.1% 为女性)最终入选。与男性相比,女性中风发病年龄更高,心房颤动发生率更高,中风程度更严重。与男性相比,女性出院时获得良好功能预后的比例较低,每年的院内死亡率较高。在大多数年份中,女性与男性相比接受静脉溶栓治疗的比例较低或相似,而每年接受血管内血栓切除术的患者比例在性别上没有显著差异。急性再灌注治疗的性别差异在10年中保持不变:结论:女性接受急性再灌注治疗的比例与男性相似或更低,尽管她们有更多的中风风险因素,中风程度往往也更严重,但她们的治疗效果却更差。
{"title":"Temporal trends of sex differences in acute reperfusion therapy and early outcomes of acute ischemic stroke in South Korea: 10-year analysis of the nationwide stroke registry.","authors":"Darda Chung, Ji Sung Lee, Mi-Sun Oh, Jong-Moo Park, Jong-Won Chung, Oh Young Bang, Gyeong-Moon Kim, Woo-Keun Seo","doi":"10.1177/17474930241261877","DOIUrl":"10.1177/17474930241261877","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in stroke outcomes are notable, with women experiencing higher incidence rates, greater disability-adjusted life years, and poorer recovery compared to men, even after adjusting for age and comorbidities. Despite the disproportionate burden in women, studies have reported that women are less likely to receive appropriate stroke treatment than men.</p><p><strong>Aim: </strong>This study investigated temporal trends of sex differences in acute reperfusion therapy and early outcomes in patients with acute ischemic stroke over 10 years in South Korea.</p><p><strong>Methods: </strong>A retrospective analysis of Korean Stroke Registry included patients with acute ischemic stroke from 2012 to 2021. The study outcomes were the temporal trends of acute reperfusion therapy and early outcomes over 10 years in men and women, respectively. In addition, this study analyzed the temporal trends of sex differences in these parameters during the same period. Early outcomes include the proportions of favorable functional outcomes at discharge, discharge patterns, and in-hospital mortality.</p><p><strong>Results: </strong>A total of 93,692 patients (68.4 years, 40.1% women) with acute ischemic stroke were finally enrolled. Women had a higher age at stroke onset, a higher prevalence of atrial fibrillation, and more severe strokes than men. Women had lower proportion of favorable functional outcomes at discharge and higher proportion of in-hospital mortality compared to men each year. The proportion of patients who received intravenous thrombolysis was lower or similar in women compared to men in most years, and the proportion of patients who received endovascular thrombectomy did not significantly differ between sexes annually. Sex differences in acute reperfusion therapy remained unchanged over 10 years.</p><p><strong>Conclusion: </strong>Women have received acute reperfusion therapy at similar or lower rates than men and experienced poorer outcomes, despite having more stroke risk factors and often more severe strokes.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1028-1037"},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relationship between carotid web morphology on CT angiography and stroke: A pooled multicenter analysis. CT 血管造影上颈动脉网形态与中风之间的关系:多中心汇总分析
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1177/17474930241264141
Fouzi Bala, Ibrahim Alhabli, Nishita Singh, Faysal Benali, Shelagh Coutts, Mayank Goyal, Mohammed Almekhlafi, Michael D Hill, Bijoy K Menon

Background: The Carotid web (CaW) is a cause of stroke, particularly in younger individuals. However, the frequency and the radiological features of the web's morphology associated with stroke risk are uncertain. We determined the CaW radiological features on computed tomography (CT) angiography associated with ipsilateral stroke.

Materials and methods: Data from six studies of patients with acute ischemic stroke were pooled. Identification and measurement of CaWs were performed by experienced readers using baseline neck CT angiography. We assessed six 2D CaW radiological features on sagittal oblique images, namely, main axis length, thickness, height, base width, distance to wall, and angle between the web main axis and carotid wall, and CaW volume on 3D images. CaWs were divided into symptomatic if acute ischemic stroke was in the ipsilateral internal carotid artery territory and its etiology was undetermined and asymptomatic if one condition was unmet. Univariable and multivariable analyses were conducted to assess the association between each radiological CaW feature and symptomatic CaW.

Results: Of the 3442 patients in the pooled data with assessable CTAs, 60 (1.7%) had CaW. In patients with CaW, median age was 59 (interquartile range [IQR]: 50-68) years, 60% were women, and 3 patients had bilateral CaWs. There were 39 (62%) symptomatic and 24 (38%) asymptomatic CaWs. Patients with symptomatic CaW were younger (55 (IQR: 49-61) years versus 69 (IQR: 52-75) years), had lower rates of hypertension (9 (25.0%) versus 12 (57.1%)) and more intracranial large vessel occlusions compared to patients with asymptomatic CaWs. After adjusting for age, hypertension, and occlusion location, CaW length (adjusted odds ratio (aOR) 1.84 (95% confidence interval [CI]: 1.03-3.28)), thickness (aOR: 2.31 (95% CI 1.08-4.97)), volume (aOR: 1.07 per 1 mm3 increment (95% CI: 1.01-1.12)), and angle relative to the carotid wall (aOR: 0.95 (95% CI: 0.91-0.99)) were associated with symptomatic CaW.

Conclusion: Radiological assessment of CaW morphology may determine its potential causal role in ischemic stroke etiology. Symptomatic CaWs tend to be longer, larger, and oriented at more acute angles relative to the carotid wall as compared to asymptomatic CaWs.

背景:颈动脉网(CaW)是中风的诱因之一,尤其是在年轻人中。然而,它的发生频率以及与中风风险相关的颈动脉网形态学特征尚不确定。我们确定了 CT 血管造影上与同侧中风相关的颈动脉蛛网膜放射学特征:汇总了六项急性缺血性卒中患者的研究数据。由经验丰富的读者对基线颈部 CT 血管造影上的 CaW 进行识别和测量。我们在矢状斜面图像上评估了六个二维CaW放射学特征,即主轴长度、厚度、高度、基底宽度、与壁的距离、网状主轴与颈动脉壁之间的角度,以及三维图像上的CaW体积。如果急性缺血性卒中发生在同侧颈内动脉区域,且病因未确定,则将CaW分为有症状和无症状两种。研究人员进行了单变量和多变量分析,以评估各放射学CaW特征与无症状CaW之间的关联:在汇集数据的 3442 名可评估 CTA 的患者中,有 60 人(1.7%)有 CaW。CaW患者的中位年龄为59岁(IQR为50-68岁),60%为女性,3名患者为双侧CaW。有症状的 CaW 患者有 39 人(62%),无症状的有 24 人(38%)。与无症状颅脑损伤患者相比,有症状的颅脑损伤患者更年轻(55 [IQR 49-61] 岁对 69 [IQR 52-75] 岁),高血压发病率更低(9 [25.0%] 对 12 [57.1%]),颅内大血管闭塞更多。在对年龄、高血压和闭塞位置进行调整后,CaW 长度(调整后的几率比 [aOR] 1.84 [95%CI 1.03-3.28])、厚度(aOR 2.31 [95%CI 1.08-4.97])、体积(aOR 1.07 per 1 mm3 increment [95%CI 1.01-1.12])和相对于颈动脉壁的角度(aOR 0.95 [95%CI 0.91-0.99])与无症状 CaW 相关:结论:CaW 形态的放射学评估可确定其在缺血性卒中病因中的潜在作用。与无症状的CaW相比,有症状的CaW往往更长、更大,且相对于颈动脉壁的角度更尖锐。
{"title":"Relationship between carotid web morphology on CT angiography and stroke: A pooled multicenter analysis.","authors":"Fouzi Bala, Ibrahim Alhabli, Nishita Singh, Faysal Benali, Shelagh Coutts, Mayank Goyal, Mohammed Almekhlafi, Michael D Hill, Bijoy K Menon","doi":"10.1177/17474930241264141","DOIUrl":"10.1177/17474930241264141","url":null,"abstract":"<p><strong>Background: </strong>The Carotid web (CaW) is a cause of stroke, particularly in younger individuals. However, the frequency and the radiological features of the web's morphology associated with stroke risk are uncertain. We determined the CaW radiological features on computed tomography (CT) angiography associated with ipsilateral stroke.</p><p><strong>Materials and methods: </strong>Data from six studies of patients with acute ischemic stroke were pooled. Identification and measurement of CaWs were performed by experienced readers using baseline neck CT angiography. We assessed six 2D CaW radiological features on sagittal oblique images, namely, main axis length, thickness, height, base width, distance to wall, and angle between the web main axis and carotid wall, and CaW volume on 3D images. CaWs were divided into symptomatic if acute ischemic stroke was in the ipsilateral internal carotid artery territory and its etiology was undetermined and asymptomatic if one condition was unmet. Univariable and multivariable analyses were conducted to assess the association between each radiological CaW feature and symptomatic CaW.</p><p><strong>Results: </strong>Of the 3442 patients in the pooled data with assessable CTAs, 60 (1.7%) had CaW. In patients with CaW, median age was 59 (interquartile range [IQR]: 50-68) years, 60% were women, and 3 patients had bilateral CaWs. There were 39 (62%) symptomatic and 24 (38%) asymptomatic CaWs. Patients with symptomatic CaW were younger (55 (IQR: 49-61) years versus 69 (IQR: 52-75) years), had lower rates of hypertension (9 (25.0%) versus 12 (57.1%)) and more intracranial large vessel occlusions compared to patients with asymptomatic CaWs. After adjusting for age, hypertension, and occlusion location, CaW length (adjusted odds ratio (aOR) 1.84 (95% confidence interval [CI]: 1.03-3.28)), thickness (aOR: 2.31 (95% CI 1.08-4.97)), volume (aOR: 1.07 per 1 mm<sup>3</sup> increment (95% CI: 1.01-1.12)), and angle relative to the carotid wall (aOR: 0.95 (95% CI: 0.91-0.99)) were associated with symptomatic CaW.</p><p><strong>Conclusion: </strong>Radiological assessment of CaW morphology may determine its potential causal role in ischemic stroke etiology. Symptomatic CaWs tend to be longer, larger, and oriented at more acute angles relative to the carotid wall as compared to asymptomatic CaWs.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1046-1052"},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predicting post-stroke cognitive impairment using electronic health record data. 利用电子健康记录数据预测中风后的认知障碍。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-04-18 DOI: 10.1177/17474930241246156
Jeffrey M Ashburner, Yuchiao Chang, Bianca Porneala, Sanjula D Singh, Nirupama Yechoor, Jonathan M Rosand, Daniel E Singer, Christopher D Anderson, Steven J Atlas

Background: Secondary prevention interventions to reduce post-stroke cognitive impairment (PSCI) can be aided by the early identification of high-risk individuals who would benefit from risk factor modification.

Aims: To develop and evaluate a predictive model to identify patients at increased risk of PSCI over 5 years using data easily accessible from electronic health records.

Methods: Cohort study that included primary care patients from two academic medical centers. Patients were aged 45 years or older, without prior stroke or prevalent cognitive impairment, with primary care visits and an incident ischemic stroke between 2003 and 2016 (development/internal validation cohort) or 2010 and 2022 (external validation cohort). Predictors of PSCI were ascertained from the electronic health record. The outcome was incident dementia/cognitive impairment within 5 years and beginning 3 months following stroke, ascertained using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. For model variable selection, we considered potential predictors of PSCI and constructed 400 bootstrap samples with two-thirds of the model derivation sample. We ran 10-fold cross-validated Cox proportional hazards models using a least absolute shrinkage and selection operator (LASSO) penalty. Variables selected in >25% of samples were included.

Results: The analysis included 332 incident diagnoses of PSCI in the development cohort (n = 3741), and 161 and 128 incident diagnoses in the internal (n = 1925) and external (n = 2237) validation cohorts, respectively. The C-statistic for predicting PSCI was 0.731 (95% confidence interval (CI): 0.694-0.768) in the internal validation cohort, and 0.724 (95% CI: 0.681-0.766) in the external validation cohort. A risk score based on the beta coefficients of predictors from the development cohort stratified patients into low (0-7 points), intermediate (8-11 points), and high (12-23 points) risk groups. The hazard ratios (HRs) for incident PSCI were significantly different by risk categories in internal (high, HR: 6.2, 95% CI: 4.1-9.3; Intermediate, HR: 2.7, 95% CI: 1.8-4.1) and external (high, HR: 6.1, 95% CI: 3.9-9.6; Intermediate, HR: 2.8, 95% CI: 1.9-4.3) validation cohorts.

Conclusion: Five-year risk of PSCI can be accurately predicted using routinely collected data. Model output can be used to risk stratify and identify individuals at increased risk for PSCI for preventive efforts.

Data access statement: Mass General Brigham data contain protected health information and cannot be shared publicly. The data processing scripts used to perform analyses will be made available to interested researchers upon reasonable request to the corresponding author.

背景:目的:利用易于从电子健康记录中获取的数据,开发并评估一个预测模型,以识别5年内卒中后认知障碍(PSCI)风险增加的患者:方法:队列研究,包括两个学术医疗中心的初级保健患者。患者年龄在 45 岁或以上,既往无中风或普遍存在认知障碍,在 2003-2016 年(开发/内部验证队列)或 2010-2022 年(外部验证队列)期间接受过初级保健就诊并发生过缺血性中风。从电子健康记录中确定了 PSCI 的预测因素。结果是中风后 3 个月开始的 5 年内发生的痴呆/认知障碍,使用 ICD-9/10 编码确定。在选择模型变量时,我们考虑了 PSCI 的潜在预测因子,并用模型推导样本的三分之二构建了 400 个引导样本。我们使用最小绝对收缩和选择算子(LASSO)惩罚法运行了 10 倍交叉验证的 Cox 比例危险模型。结果:分析包括开发队列(n=3,741)中的 332 例 PSCI 诊断病例,以及内部(n=1,925)和外部(n=2,237)验证队列中的 161 例和 128 例诊断病例。内部验证队列中预测 PSCI 的 c 统计量为 0.731(95% CI:0.694-0.768),外部验证队列中预测 PSCI 的 c 统计量为 0.724(95% CI:0.681-0.766)。根据开发队列中预测因子的贝塔系数进行风险评分,将患者分为低(0-7 分)、中(8-11 分)和高(12-35 分)风险组。在内部(高危,HR:6.2,95% CI:4.1-9.3;中危,HR:2.7,95% CI:1.8-4.1)和外部(高危,HR:6.1,95% CI:3.9-9.6;中危,HR:2.8,95% CI:1.9-4.3)验证队列中,不同风险类别的患者发生 PSCI 的危险比存在显著差异:结论:利用常规收集的数据可以准确预测五年的 PSCI 风险。模型输出结果可用于风险分层,并识别出 PSCI 风险增加的个体,以便采取预防措施。数据访问声明:Mass General Brigham 数据包含受保护的健康信息,不能公开共享。用于执行分析的数据处理脚本将在向通讯作者提出合理要求后提供给感兴趣的研究人员。
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引用次数: 0
Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment. 尽管采用了最先进的中风治疗方法,但中风后认知障碍的发生率和致残率仍然很高。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-03-21 DOI: 10.1177/17474930241238637
Laura Gallucci, Christoph Sperber, Adrian G Guggisberg, Christoph P Kaller, Mirjam R Heldner, Andreas U Monsch, Arsany Hakim, Norbert Silimon, Urs Fischer, Marcel Arnold, Roza M Umarova

Background: State-of-the-art stroke treatment significantly reduces lesion size and stroke severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI).

Aims: In a cohort of patients receiving modern state-of-the-art stroke care including endovascular therapy, we assessed the frequency of PSCI and the pattern of domain-specific cognitive deficits, identified risk factors for PSCI, and determined the impact of acute PSCI on stroke outcome.

Methods: In this prospective monocentric cohort study, we examined patients with first-ever anterior circulation ischemic stroke without pre-stroke cognitive decline, using a comprehensive neuropsychological assessment ⩽10 days after symptom onset. Normative data were stratified by demographic variables. We defined PSCI as at least moderate (<1.5 standard deviation) deficits in ⩾2 cognitive domains. Multivariable regression analysis was applied to define risk factors for PSCI.

Results: We analyzed 329 non-aphasic patients admitted from December 2020 to July 2023 (67.2 ± 14.4 years old, 41.3% female, 13.1 ± 2.7 years of education). Although most patients had mild stroke (median National Institutes of Health Stroke Scale (NIHSS) 24 h = 1.00 (0.00; 3.00); 87.5% with NIHSS ⩽ 5), 69.3% of them presented with PSCI 2.7 ± 2.0 days post-stroke. The most severely and often affected cognitive domains were verbal learning, episodic memory, executive functions, selective attention, and constructive abilities (39.1%-51.2% of patients), whereas spatial neglect was less frequent (18.5%). The risk of PSCI was reduced with more years of education (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23-0.99) and right hemisphere lesions (OR = 0.47, 95% CI = 0.26-0.84), and increased with stroke severity (NIHSS 24 h, OR = 4.19, 95% CI = 2.72-6.45), presence of hyperlipidemia (OR = 1.93, 95% CI = 1.01-3.68), but was not influenced by age. After adjusting for stroke severity and depressive symptoms, acute PSCI was associated with poor functional outcome (modified Rankin Scale > 2, F = 13.695, p < 0.001) and worse global cognition (Montreal Cognitive Assessment (MoCA) score, F = 20.069, p < 0.001) at 3 months post-stroke.

Conclusion: Despite modern stroke therapy and many strokes having mild severity, PSCI in the acute stroke phase remains frequent and associated with worse outcome. The most prevalent were learning and memory deficits. Cognitive reserve operationalized as years of education independently protects post-stroke cognition.

背景:目的:在接受包括血管内治疗在内的现代最先进卒中治疗的患者队列中,我们评估了卒中后认知障碍的频率和特定领域认知障碍的模式,确定了卒中后认知障碍的风险因素,并确定了急性卒中后认知障碍对卒中结局的影响:在这项前瞻性单中心队列研究中,我们对症状发生后 10 天内首次发生前循环缺血性卒中且卒中前无认知功能下降的患者进行了全面的神经心理学评估。根据人口统计学变量对标准数据进行了分层。我们将 PSCI 定义为至少在 ≥ 2 个认知领域存在中度(< 1.5 SD)缺陷。多变量回归分析用于确定 PSCI 的风险因素:我们分析了 2020 年 12 月至 2023 年 7 月期间收治的 329 名非重症患者(67.2±14.4 岁,41.3% 为女性,13.1±2.7 年教育程度)。虽然大多数患者为轻度卒中(NIHSS 24h 中位数=1.00 [0.00; 3.00];87.5%的患者 NIHSS ≥ 5),但其中 69.3%的患者在卒中后 2.7±2.0 天出现 PSCI。受影响最严重和最常见的认知领域是言语学习、外显记忆、执行功能、选择性注意和建构能力(39.1%-51.2%的患者),而空间忽略较少见(18.5%)。受教育年限越长(几率比 [OR] 0.47,95% CI:0.23-0.99)、右半球病变(OR 0.47,95% CI:0.26-0.84),PSCI 的风险越低;中风严重程度(NIHSS 24h,OR 4.19,95% CI:2.72-6.45)、高脂血症(OR 1.93,95% CI:1.01-3.68)越高,PSCI 的风险越高,但不受年龄影响。在对卒中严重程度和抑郁症状进行调整后,急性 PSCI 与不良功能预后相关(改良 Rankin 量表 > 2,F=13.695,pF=20.069,pConclusions):尽管采用了现代中风治疗方法,且许多中风的严重程度较轻,但急性中风阶段的 PSCI 仍很常见,且与较差的预后有关。最常见的是学习和记忆障碍。以受教育年限为标准的认知储备可独立保护卒中后的认知能力。
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引用次数: 0
Author Index. 作者索引。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 DOI: 10.1177/17474930241293178
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引用次数: 0
期刊
International Journal of Stroke
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