Background & Objective: Despite the importance of physical activity, there is lack of evidence measuring the level of activity performed by the stroke survivors. This study aims to determine the level of physical activity amongst ambulant stroke patients in a tertiary centre in Malaysia and to investigate the factors that may impact their physical activity. Methods: A cross-sectional study was conducted on ambulant stroke participants at one year post stroke. International Physical Activity Questionnaire (IPAQ) was used to measure the level of physical activity, and 6 Minute Walk Test (6MWT) was recorded to assess the participants functional walking distance and endurance. The participants were categorised into low, moderate, or high physical activity levels. Age-matched healthy controls were recruited form community. Factors including presence of depression were tested in relation to physical activity. P-value of <0.05 was considered statically significant in all statistical analyses. Results: There were 45 stroke patients and 30 controls recruited in this study. Participants in the stroke group has significantly lower level of physical activity compared to the control group, especially in the high physical activity level (p<0.001); 55.6% reported having moderate, 31.1% low and 13.3% high physical activity level respectively. No significant factors were found to be associated with the physical activity. Only depression was found to have a weak negative correlation with level of physical activity (p=0.003). Conclusion: Stroke survivors have lower level of physical activity at one year post stroke despite having mild physical impairments. Rehabilitation strategies to promote physical activities should be implemented early to take advantage on the benefits of cardiovascular fitness as secondary prevention of stroke.
{"title":"The level of physical activity among ambulant stroke survivors at one year: a cross sectional study in a tertiary center in Malaysia","authors":"Mitchel Brian Jilimin, Mazlina Mazlan","doi":"10.54029/2023exj","DOIUrl":"https://doi.org/10.54029/2023exj","url":null,"abstract":"Background & Objective: Despite the importance of physical activity, there is lack of evidence measuring the level of activity performed by the stroke survivors. This study aims to determine the level of physical activity amongst ambulant stroke patients in a tertiary centre in Malaysia and to investigate the factors that may impact their physical activity. Methods: A cross-sectional study was conducted on ambulant stroke participants at one year post stroke. International Physical Activity Questionnaire (IPAQ) was used to measure the level of physical activity, and 6 Minute Walk Test (6MWT) was recorded to assess the participants functional walking distance and endurance. The participants were categorised into low, moderate, or high physical activity levels. Age-matched healthy controls were recruited form community. Factors including presence of depression were tested in relation to physical activity. P-value of <0.05 was considered statically significant in all statistical analyses. Results: There were 45 stroke patients and 30 controls recruited in this study. Participants in the stroke group has significantly lower level of physical activity compared to the control group, especially in the high physical activity level (p<0.001); 55.6% reported having moderate, 31.1% low and 13.3% high physical activity level respectively. No significant factors were found to be associated with the physical activity. Only depression was found to have a weak negative correlation with level of physical activity (p=0.003). Conclusion: Stroke survivors have lower level of physical activity at one year post stroke despite having mild physical impairments. Rehabilitation strategies to promote physical activities should be implemented early to take advantage on the benefits of cardiovascular fitness as secondary prevention of stroke.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"26 3","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139192401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: This study aims to evaluate the relationship between headaches and psychiatric symptoms in a psychiatric clinic. Methods: We compared 102 children aged 8-16 years (31 girls, 30.4%) who presented to the child and adolescent psychiatry clinic (study group) with 100 children aged 8-16 years, (52 girls, 52%) who did not (control group). Headache was evaluated with the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) Questionnaire. Psychiatric symptoms (depression, anxiety, sleep, attention, hyperactivity) were evaluated via standardized scales. Results: The study group had more headaches in the preceding year as well as the day before. Depression, anxiety and sleep problems were positively correlated with headache frequency in the preceding week in the study group, and in the study group, children with migraine had more depression, anxiety, and emotional problems. While the total quality of life (QoL) scores were not significantly different between groups, migraine decreased the QoL in both the study and control groups. Conclusion: This study indicates that headache type and burden should be evaluated in psychiatric clinics as depression and anxiety are associated with headache, especially migraine.
{"title":"Assessment of headache in children with psychiatric symptoms","authors":"Arzu Yavuz, Burcu Ersöz Alan, Tuna Çek Esen","doi":"10.54029/2023mwn","DOIUrl":"https://doi.org/10.54029/2023mwn","url":null,"abstract":"Background: This study aims to evaluate the relationship between headaches and psychiatric symptoms in a psychiatric clinic. Methods: We compared 102 children aged 8-16 years (31 girls, 30.4%) who presented to the child and adolescent psychiatry clinic (study group) with 100 children aged 8-16 years, (52 girls, 52%) who did not (control group). Headache was evaluated with the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) Questionnaire. Psychiatric symptoms (depression, anxiety, sleep, attention, hyperactivity) were evaluated via standardized scales. Results: The study group had more headaches in the preceding year as well as the day before. Depression, anxiety and sleep problems were positively correlated with headache frequency in the preceding week in the study group, and in the study group, children with migraine had more depression, anxiety, and emotional problems. While the total quality of life (QoL) scores were not significantly different between groups, migraine decreased the QoL in both the study and control groups. Conclusion: This study indicates that headache type and burden should be evaluated in psychiatric clinics as depression and anxiety are associated with headache, especially migraine.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"52 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139193147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background & Objective: Clinical course and prognosis in amyotrophic lateral sclerosis (ALS) patients were highly variable. The information in the Thai population is still lacking. This study aimed to determine the clinical association with disease progression and prognostic factors in ALS in Thailand. Methods: This prospective cohort study evaluated 62 patients who has a diagnosis of ALS and followed up at Neurological Institute of Thailand between January 2014 and December 2018. These patients were classified into an alive group and a deceased group. The demographics, clinical characteristics, disease-related severity, and prognosis were analyzed. Results: Of the included patients, there were 40 male and 22 female, the median age at onset was 53.2 years. The median diagnosis time was 13.1 months and median follow-up duration was 18.5 months; 72.6% of patients presented with spinal onset ALS, and 27.4% with bulbar-onset. There were 20 deaths during follow-up, and the median survival time in the deceased cases was 14 months. Worse prognosis factors were bulbar symptoms at onset and low amyotrophic lateral sclerosis functional rating scale (ALSFRS) at diagnosis. Conclusion: The factors associated with lower survival in ALS patients were bulbar symptoms at onset and low ALSFRS at diagnosis.
背景与目的：肌萎缩侧索硬化症（ALS）患者的临床病程和预后变化很大。有关泰国人群的信息仍然缺乏。本研究旨在确定泰国 ALS 患者疾病进展的临床关联和预后因素。研究方法这项前瞻性队列研究评估了 2014 年 1 月至 2018 年 12 月期间在泰国神经研究所随访的 62 名确诊为 ALS 的患者。这些患者被分为存活组和死亡组。研究人员对这些患者的人口统计学特征、临床特征、疾病相关严重程度和预后进行了分析。结果显示在纳入的患者中，男性 40 人，女性 22 人，中位发病年龄为 53.2 岁。中位确诊时间为 13.1 个月，中位随访时间为 18.5 个月；72.6% 的患者为脊髓型 ALS 发病，27.4% 为球部发病。随访期间有20人死亡，死亡病例的中位生存时间为14个月。预后较差的因素是发病时出现球部症状和确诊时肌萎缩侧索硬化症功能评分量表（ALSFRS）较低。结论是肌萎缩侧索硬化症患者存活率较低的相关因素是发病时出现球部症状和确诊时ALSFRS较低。
{"title":"Clinical characteristic and prognosis of amyotrophic lateral sclerosis in a cohort of Thai patients","authors":"Narupat Suanprasert, Narumon Tiawijit, Walaiphan Watcharachinnawong, Metha Apiwattanakul, Thanes Termglinjan, Saharat Aungsumart, Chaichana Sinthuwong, Arada Rojana-udomsart","doi":"10.54029/2023yjk","DOIUrl":"https://doi.org/10.54029/2023yjk","url":null,"abstract":"Background & Objective: Clinical course and prognosis in amyotrophic lateral sclerosis (ALS) patients were highly variable. The information in the Thai population is still lacking. This study aimed to determine the clinical association with disease progression and prognostic factors in ALS in Thailand. Methods: This prospective cohort study evaluated 62 patients who has a diagnosis of ALS and followed up at Neurological Institute of Thailand between January 2014 and December 2018. These patients were classified into an alive group and a deceased group. The demographics, clinical characteristics, disease-related severity, and prognosis were analyzed. Results: Of the included patients, there were 40 male and 22 female, the median age at onset was 53.2 years. The median diagnosis time was 13.1 months and median follow-up duration was 18.5 months; 72.6% of patients presented with spinal onset ALS, and 27.4% with bulbar-onset. There were 20 deaths during follow-up, and the median survival time in the deceased cases was 14 months. Worse prognosis factors were bulbar symptoms at onset and low amyotrophic lateral sclerosis functional rating scale (ALSFRS) at diagnosis. Conclusion: The factors associated with lower survival in ALS patients were bulbar symptoms at onset and low ALSFRS at diagnosis.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"34 3","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139187770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Plasma S100A1 protein is a novel inflammation biomarker associated with acute myocardial infarction and neurodegenerative diseases. This study aimed to investigate the predictive value of S100A1 protein for the three-month prognosis of acute ischemic stroke (AIS) patients and the potential pathophysiological mechanisms of AIS. Methods: A total of 206 people in a stroke center from April 2020 to February 2021 were studied. Clinically relevant data and blood indicators were recorded. The clinical outcome was disability or death at discharge or 90 days (defined as a modified Rankin Scale score of 3-6). The relationship between S100A1 protein, NF-κB p65, and IL-6 and functional outcomes was investigated by binary logistic regression analysis and further assessed by the receiver operating characteristic curve (ROC). The correlation between S100A1, NF-κB p65, and IL-6 was detected by Pearson or Spearman correlation analysis. Results: A total of 206 subjects were enrolled (Age, 67.17±10.74; 40.3% female). Patients with unfavorable outcome showed higher S100A1, NF-κB p65, and IL-6 than those with favorable outcome (S100A1, [252.72±25.15]vs[219.84±23.24], P<0.001; NF-κB p65, [4.45±0.71]vs[3.58±0.66], P<0.001; IL-6, [13.86±1.41]vs[12.18±1.73], P<0.001). In multivariate and ROC curve analysis, higher S100A1 (>227.155) (Area under the curve [AUC], 0.864; odds ratio [OR], 1.093; 95% confidence interval [CI], 1.052- 1.135; P <0.001) and higher NF-κB p65 (>3.685) (AUC, 0.807; OR, 6.416; 95% CI, 1.852- 22.229; P=0.003), higher IL-6 (>12.330) (AUC, 0.767; OR, 2.029; 95% CI, 1.136- 3.624; P=0.017) were independently associated with unfavorable outcome. The combined predictive value of the three indexes was higher than that of a single index. There was a significant statistical correlation between S100A1, NF-κB P65 and IL-6(P<0.001). Conclusion: Higher S100A1 protein may be an independent risk factor for predicting the three-month poor prognosis in AIS patients. This protein may mediate inflammatory response through the NF-κB pathway during the pathogenesis of AIS.
{"title":"Plasma S100A1 protein: An effective prognostic biomarker for 3-month clinical outcome in acute ischemic stroke patients","authors":"Guo Hong, Haina Zhao, Yuxuan Yin, Zhaohao Zeng, Yu Luo, Lili Zhang","doi":"10.54029/2023ijm","DOIUrl":"https://doi.org/10.54029/2023ijm","url":null,"abstract":"Background: Plasma S100A1 protein is a novel inflammation biomarker associated with acute myocardial infarction and neurodegenerative diseases. This study aimed to investigate the predictive value of S100A1 protein for the three-month prognosis of acute ischemic stroke (AIS) patients and the potential pathophysiological mechanisms of AIS. Methods: A total of 206 people in a stroke center from April 2020 to February 2021 were studied. Clinically relevant data and blood indicators were recorded. The clinical outcome was disability or death at discharge or 90 days (defined as a modified Rankin Scale score of 3-6). The relationship between S100A1 protein, NF-κB p65, and IL-6 and functional outcomes was investigated by binary logistic regression analysis and further assessed by the receiver operating characteristic curve (ROC). The correlation between S100A1, NF-κB p65, and IL-6 was detected by Pearson or Spearman correlation analysis. Results: A total of 206 subjects were enrolled (Age, 67.17±10.74; 40.3% female). Patients with unfavorable outcome showed higher S100A1, NF-κB p65, and IL-6 than those with favorable outcome (S100A1, [252.72±25.15]vs[219.84±23.24], P<0.001; NF-κB p65, [4.45±0.71]vs[3.58±0.66], P<0.001; IL-6, [13.86±1.41]vs[12.18±1.73], P<0.001). In multivariate and ROC curve analysis, higher S100A1 (>227.155) (Area under the curve [AUC], 0.864; odds ratio [OR], 1.093; 95% confidence interval [CI], 1.052- 1.135; P <0.001) and higher NF-κB p65 (>3.685) (AUC, 0.807; OR, 6.416; 95% CI, 1.852- 22.229; P=0.003), higher IL-6 (>12.330) (AUC, 0.767; OR, 2.029; 95% CI, 1.136- 3.624; P=0.017) were independently associated with unfavorable outcome. The combined predictive value of the three indexes was higher than that of a single index. There was a significant statistical correlation between S100A1, NF-κB P65 and IL-6(P<0.001). Conclusion: Higher S100A1 protein may be an independent risk factor for predicting the three-month poor prognosis in AIS patients. This protein may mediate inflammatory response through the NF-κB pathway during the pathogenesis of AIS.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"102 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ümit Görgülü, Recep Donmez, Berna Arlı, Gurdal Orhan
Background and Objectives: Suitable cases of extracranial internal carotid artery (ICA) stenosis can be treated with carotid artery stenting (CAS) or carotid endarterectomy. However, major complications in the peri-procedural period, like stroke and death, are more common with CAS. We therefore investigated the risk factors for stroke and death during the peri-procedural period following CAS. Methods: In this study, the files of patients who were treated with CAS by a neurology team during 2020–2022 were retrospectively analyzed. Patient age, gender, vascular risk factors, use of antiplatelet therapy, type of carotid artery stenosis (symptomatic or asymptomatic), measured stenosis degrees, contralateral carotid stenosis, types of aortic arch, balloon angioplasty, use of a filter-type embolism protection device, stent cell design (open or closed), and peri-procedural death, stroke, or myocardial infarction (MI) were recorded. All patients were followed up for the first 30 days after CAS. Results: The mean age of 219 patients included in our study was 67.8 ± 8.38 years and 68.5% were male. The most common comorbid diseases in the patients were hypertension (76.7%), hyperlipidemia (53.4%) and diabetes mellitus (DM) (43.4%). Stroke or death occurred in the peri-procedural period in 15 (6.85%) of the patients, but MI did not occur. No statistically significant difference was observed in terms of age or gender when comparing with the cases without stroke or death. Of the patients suffering stroke or death, ischemic stroke developed in 13 (86.67%), cerebral hemorrhage in two (13.33%) and two patients (13.33%) died. Two-thirds of the strokes were either minor (n=7, 46.67%) or moderate (n=4, 26.67%); 13 (86.67%) were ipsilateral, and 14 (93.33%) were in the anterior circulation. The complication risk was found to be significantly higher in patients with prior stroke (OR=3.865; 95% CI 1.282 to 11.652 p=.016), DM (OR=3.634; 95% CI 1.102 to 11.992 p=.034) and pre-dilation angioplasty (OR=13.100; 95% CI 1.762 to 97.422 p=.012). Conclusion: Prior stroke, DM and pre-dilation angioplasty increase peri-procedural stroke and death in CAS. However, even if a stroke complication develops after CAS, it is often not severe.
背景和目的：颅外颈内动脉（ICA）狭窄的合适病例可通过颈动脉支架植入术（CAS）或颈动脉内膜剥脱术进行治疗。然而，CAS术后的主要并发症，如中风和死亡更为常见。因此，我们研究了 CAS 术后围手术期中风和死亡的风险因素。方法：在这项研究中，我们对 2020-2022 年期间神经内科团队接受 CAS 治疗的患者档案进行了回顾性分析。记录了患者的年龄、性别、血管风险因素、抗血小板治疗的使用情况、颈动脉狭窄类型（无症状或无症状）、测量狭窄程度、对侧颈动脉狭窄、主动脉弓类型、球囊血管成形术、过滤型栓塞保护装置的使用情况、支架单元设计（开放式或封闭式）以及围手术期死亡、中风或心肌梗死（MI）。对所有患者进行了 CAS 术后 30 天的随访。结果：219 名患者的平均年龄为 67.8 ± 8.38 岁，68.5% 为男性。患者最常见的合并症是高血压（76.7%）、高脂血症（53.4%）和糖尿病（43.4%）。有 15 名患者（6.85%）在围手术期发生中风或死亡，但没有发生心肌梗死。与没有发生中风或死亡的病例相比，在年龄或性别方面没有发现明显的统计学差异。在中风或死亡的患者中，13 人（86.67%）发生缺血性中风，2 人（13.33%）发生脑出血，2 人（13.33%）死亡。三分之二的中风为轻微中风（7 例，46.67%）或中度中风（4 例，26.67%）；13 例（86.67%）为同侧中风，14 例（93.33%）为前循环中风。并发症风险在以下患者中明显较高：既往中风（OR=3.865；95% CI 1.282 至 11.652 p=.016）、DM（OR=3.634；95% CI 1.102 至 11.992 p=.034）和扩张血管成形术前（OR=13.100；95% CI 1.762 至 97.422 p=.012）。结论在 CAS 中，既往中风、DM 和扩张前血管成形术会增加围手术期中风和死亡。然而，即使 CAS 术后出现中风并发症，通常也不会很严重。
{"title":"Risk factors for peri-procedural stroke or death in internal carotid artery stenting: A neurology team experience","authors":"Ümit Görgülü, Recep Donmez, Berna Arlı, Gurdal Orhan","doi":"10.54029/2023rhu","DOIUrl":"https://doi.org/10.54029/2023rhu","url":null,"abstract":"Background and Objectives: Suitable cases of extracranial internal carotid artery (ICA) stenosis can be treated with carotid artery stenting (CAS) or carotid endarterectomy. However, major complications in the peri-procedural period, like stroke and death, are more common with CAS. We therefore investigated the risk factors for stroke and death during the peri-procedural period following CAS. Methods: In this study, the files of patients who were treated with CAS by a neurology team during 2020–2022 were retrospectively analyzed. Patient age, gender, vascular risk factors, use of antiplatelet therapy, type of carotid artery stenosis (symptomatic or asymptomatic), measured stenosis degrees, contralateral carotid stenosis, types of aortic arch, balloon angioplasty, use of a filter-type embolism protection device, stent cell design (open or closed), and peri-procedural death, stroke, or myocardial infarction (MI) were recorded. All patients were followed up for the first 30 days after CAS. Results: The mean age of 219 patients included in our study was 67.8 ± 8.38 years and 68.5% were male. The most common comorbid diseases in the patients were hypertension (76.7%), hyperlipidemia (53.4%) and diabetes mellitus (DM) (43.4%). Stroke or death occurred in the peri-procedural period in 15 (6.85%) of the patients, but MI did not occur. No statistically significant difference was observed in terms of age or gender when comparing with the cases without stroke or death. Of the patients suffering stroke or death, ischemic stroke developed in 13 (86.67%), cerebral hemorrhage in two (13.33%) and two patients (13.33%) died. Two-thirds of the strokes were either minor (n=7, 46.67%) or moderate (n=4, 26.67%); 13 (86.67%) were ipsilateral, and 14 (93.33%) were in the anterior circulation. The complication risk was found to be significantly higher in patients with prior stroke (OR=3.865; 95% CI 1.282 to 11.652 p=.016), DM (OR=3.634; 95% CI 1.102 to 11.992 p=.034) and pre-dilation angioplasty (OR=13.100; 95% CI 1.762 to 97.422 p=.012). Conclusion: Prior stroke, DM and pre-dilation angioplasty increase peri-procedural stroke and death in CAS. However, even if a stroke complication develops after CAS, it is often not severe.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":" 70","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiurui Nie, Yu Shen, Zhisheng Deng, Wenwen Xiang, Shenjian Chen, Guangmin Li
Background and Objective: Elderly people are at high prevalence of atherosclerotic cerebral infarction. Cerebral white matter lesions (WMLs) increase the risk of bleeding after intravenous thrombolysis (IVT) although they may also require the IVT. The aim of this study is to develop a clinical nomogram model for post-IVT symptomatic intracranial hemorrhage (sICH), with the aim to prevent sICH in elderly patients with severe WMLs when IVT is being considered. Methods: This is a large single-center retrospective analysis study of elderly patients with severe WMLs receiving IVT from January 2018 to December 2022. Univariate and multi-factor logistic regression analysis were used to construct nomogram model, and a series of validations were performed on the model. Results: More than 2,000 patients with IVT were screened for inclusion in this study after cranial magnetic resonance imaging evaluation. Out of these, 163 elderly patients had cerebral WMLs, and 25 had sICH. In univariate analysis, history of hypertension (p=0.037), hyperlipidemia (p<0.001), NIHSS score before IVT (p<0.001), low-density lipoprotein levels (p=0.016), cholesterol levels (p=0.020), platelet count (p=0.006), systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001) were significantly associated with sICH. In a multifactorial analysis, the NIHSS score before IVT (OR 42.056 CI 7.308-242.012, p<0.001), and diastolic blood pressure (OR 1.050 CI 1.002-1.100, p=0.040) were found to be significantly associated with sICH after IVT. The four most significant risk factors from logistic regression are subsequently fitted to create a predictive model. The accuracy was verified using calibration curves, decision curves, and clinical impact curves, and the model was considered to have strong stability. Conclusions: The NHISS score before IVT and diastolic blood pressure are independent risk factors for sICH after IVT in elderly patients with severe WMLs. The models are highly accurate and can be applied clinically to provide a reliable predictive basis for IVT in elderly patients with severe WMLs.
背景和目的：老年人是动脉粥样硬化性脑梗塞的高发人群。脑白质病变（WMLs）会增加静脉溶栓（IVT）后出血的风险，尽管它们也可能需要进行 IVT。本研究的目的是建立静脉溶栓后无症状性颅内出血（sICH）的临床提名图模型，以预防患有严重脑白质病变的老年患者在考虑静脉溶栓时发生 sICH。方法：这是一项大型单中心回顾性分析研究，研究对象为2018年1月至2022年12月期间接受IVT治疗的重度WMLs老年患者。采用单变量和多因素逻辑回归分析构建提名图模型，并对模型进行一系列验证。结果：经过头颅磁共振成像评估，2000 多名 IVT 患者被筛选纳入本研究。其中，163 名老年患者患有脑WML，25 名患有sICH。在单变量分析中，高血压病史（p=0.037）、高脂血症（p<0.001）、IVT 前的 NIHSS 评分（p<0.001）、低密度脂蛋白水平（p=0.016）、胆固醇水平（p=0.020）、血小板计数（p=0.006）、收缩压（p<0.001）、舒张压（p<0.001）与 sICH 显著相关。在多因素分析中，IVT 前的 NIHSS 评分（OR 42.056 CI 7.308-242.012，p<0.001）和舒张压（OR 1.050 CI 1.002-1.100，p=0.040）与 IVT 后的 sICH 显著相关。随后对逻辑回归中四个最重要的风险因素进行拟合，建立了一个预测模型。利用校准曲线、决策曲线和临床影响曲线验证了模型的准确性，并认为该模型具有很强的稳定性。结论：IVT 前的 NHISS 评分和舒张压是老年重度 WML 患者 IVT 后发生 sICH 的独立危险因素。模型的准确性很高，可应用于临床，为重度 WMLs 老年患者的 IVT 提供可靠的预测依据。
{"title":"Construction and validation of a nomogram model to predict symptomatic intracranial hemorrhage after intravenous thrombolysis in elderly population with severe white matter lesions","authors":"Qiurui Nie, Yu Shen, Zhisheng Deng, Wenwen Xiang, Shenjian Chen, Guangmin Li","doi":"10.54029/2023icn","DOIUrl":"https://doi.org/10.54029/2023icn","url":null,"abstract":"Background and Objective: Elderly people are at high prevalence of atherosclerotic cerebral infarction. Cerebral white matter lesions (WMLs) increase the risk of bleeding after intravenous thrombolysis (IVT) although they may also require the IVT. The aim of this study is to develop a clinical nomogram model for post-IVT symptomatic intracranial hemorrhage (sICH), with the aim to prevent sICH in elderly patients with severe WMLs when IVT is being considered. Methods: This is a large single-center retrospective analysis study of elderly patients with severe WMLs receiving IVT from January 2018 to December 2022. Univariate and multi-factor logistic regression analysis were used to construct nomogram model, and a series of validations were performed on the model. Results: More than 2,000 patients with IVT were screened for inclusion in this study after cranial magnetic resonance imaging evaluation. Out of these, 163 elderly patients had cerebral WMLs, and 25 had sICH. In univariate analysis, history of hypertension (p=0.037), hyperlipidemia (p<0.001), NIHSS score before IVT (p<0.001), low-density lipoprotein levels (p=0.016), cholesterol levels (p=0.020), platelet count (p=0.006), systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001) were significantly associated with sICH. In a multifactorial analysis, the NIHSS score before IVT (OR 42.056 CI 7.308-242.012, p<0.001), and diastolic blood pressure (OR 1.050 CI 1.002-1.100, p=0.040) were found to be significantly associated with sICH after IVT. The four most significant risk factors from logistic regression are subsequently fitted to create a predictive model. The accuracy was verified using calibration curves, decision curves, and clinical impact curves, and the model was considered to have strong stability. Conclusions: The NHISS score before IVT and diastolic blood pressure are independent risk factors for sICH after IVT in elderly patients with severe WMLs. The models are highly accurate and can be applied clinically to provide a reliable predictive basis for IVT in elderly patients with severe WMLs.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":" 30","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Fitri, Nicolas Farina, Y. Turana, I. Theresia, T. P. Sani, Ika Suswanti, Sube Banerjee
Background & Objective: Indonesia’s ageing population and increasing number of people living with dementia poses significant challenge to the health system. Better understanding of factors related to dementia prevalence is needed to mitigate risk, improve care, and ultimately reduce the incidence of dementia. In this study, we aimed to describe associations between potential risk factors and dementia in Indonesia. Methods: A cross-sectional study, part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, was conducted in two provinces in Indonesia, Jakarta and North Sumatra between September and December 2021. A total of 2,110 older adults and their informants completed questionnaires covering cognitive and functional status, socioeconomic, medical and lifestyle factors. Models for each potential modifiable risk factor were created and then adjusted by age, sex and literacy. Prevalence ratios (PRs) were calculated for each risk factor. Results: In the adjusted models, lower education, lower occupational attainment, unmanaged diabetes, stroke, head trauma within the past 5 years, hearing loss, and chronic obstructive airway disease were all associated with higher prevalence of dementia in Indonesia. Current smoking, historic depression and high blood pressure were associated with higher dementia prevalence, but not statistically significant. Conclusion: Improving socioeconomic status (i.e., education and employment) and reducing health- related risk factors may be viable solutions to reduce the high prevalence rates of dementia in Indonesia. Further longitudinal research is needed to confirm direction of effect and causality.
{"title":"Modifiable risk factors for dementia in Indonesia: Results from STRiDE project","authors":"F. Fitri, Nicolas Farina, Y. Turana, I. Theresia, T. P. Sani, Ika Suswanti, Sube Banerjee","doi":"10.54029/2023nxi","DOIUrl":"https://doi.org/10.54029/2023nxi","url":null,"abstract":"Background & Objective: Indonesia’s ageing population and increasing number of people living with dementia poses significant challenge to the health system. Better understanding of factors related to dementia prevalence is needed to mitigate risk, improve care, and ultimately reduce the incidence of dementia. In this study, we aimed to describe associations between potential risk factors and dementia in Indonesia. Methods: A cross-sectional study, part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, was conducted in two provinces in Indonesia, Jakarta and North Sumatra between September and December 2021. A total of 2,110 older adults and their informants completed questionnaires covering cognitive and functional status, socioeconomic, medical and lifestyle factors. Models for each potential modifiable risk factor were created and then adjusted by age, sex and literacy. Prevalence ratios (PRs) were calculated for each risk factor. Results: In the adjusted models, lower education, lower occupational attainment, unmanaged diabetes, stroke, head trauma within the past 5 years, hearing loss, and chronic obstructive airway disease were all associated with higher prevalence of dementia in Indonesia. Current smoking, historic depression and high blood pressure were associated with higher dementia prevalence, but not statistically significant. Conclusion: Improving socioeconomic status (i.e., education and employment) and reducing health- related risk factors may be viable solutions to reduce the high prevalence rates of dementia in Indonesia. Further longitudinal research is needed to confirm direction of effect and causality.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"21 2","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elzem Bolkan Günaydın, Mustafa Çağrı Öcalan, Aslıhan Uzunkulaoğlu, Saime Ay
Objectives: To evaluate the functional status of the unaffected hand in hemiplegic patients and its relationships with activities of daily living. Methods: This cross-sectional study included 30 right, 30 left hemiplegic patients with ischemic cerebrovascular accident history in last year, and 30 healthy volunteers. All participants were right-hand dominant. Data on age, gender, height, weight, comorbidities, duration of stroke, Brunnstrom recovery stages were recorded. Handgrip strength (with Jamar-type dynamometer), pinch strengths (with pinch-meter), and hand dexterity [with Nine Hole Peg Test (NHPT)] were evaluated in unaffected hand in patient groups and in both hands in control group. Lawton Instrumental Activities of Daily Living Scale (Lawton-IADL) and Functional Independence Measure (FIM) were applied to patient groups. Results: Hand grip and pinch strengths were lower, NHPT duration was longer in right (p=0.004, p=0.03, p<0.001) and left (p=0.03, p=0.02, p=0.002) hemiplegia groups compared to control group. Hand grip and pinch strengths were positively, NHPT duration was negatively correlated with FIM self-care performance (r:0.47 p<0.00, r:0.38 p=0.003, r:-0.40 p=0.002), and Lawton-IADL scores (r:0.48 p<0.001, r:0.42 p=0.001, r:-0.56 p<0.001). Conclusion: Ipsilesional hand, which is considered unaffected, functions are impaired in hemiplegic patients. This functional impairment is associated with greater dependence on activities of daily living.
{"title":"Evaluation of the functional status of the “unaffected” hand in hemiplegic patients","authors":"Elzem Bolkan Günaydın, Mustafa Çağrı Öcalan, Aslıhan Uzunkulaoğlu, Saime Ay","doi":"10.54029/2023imv","DOIUrl":"https://doi.org/10.54029/2023imv","url":null,"abstract":"Objectives: To evaluate the functional status of the unaffected hand in hemiplegic patients and its relationships with activities of daily living. Methods: This cross-sectional study included 30 right, 30 left hemiplegic patients with ischemic cerebrovascular accident history in last year, and 30 healthy volunteers. All participants were right-hand dominant. Data on age, gender, height, weight, comorbidities, duration of stroke, Brunnstrom recovery stages were recorded. Handgrip strength (with Jamar-type dynamometer), pinch strengths (with pinch-meter), and hand dexterity [with Nine Hole Peg Test (NHPT)] were evaluated in unaffected hand in patient groups and in both hands in control group. Lawton Instrumental Activities of Daily Living Scale (Lawton-IADL) and Functional Independence Measure (FIM) were applied to patient groups. Results: Hand grip and pinch strengths were lower, NHPT duration was longer in right (p=0.004, p=0.03, p<0.001) and left (p=0.03, p=0.02, p=0.002) hemiplegia groups compared to control group. Hand grip and pinch strengths were positively, NHPT duration was negatively correlated with FIM self-care performance (r:0.47 p<0.00, r:0.38 p=0.003, r:-0.40 p=0.002), and Lawton-IADL scores (r:0.48 p<0.001, r:0.42 p=0.001, r:-0.56 p<0.001). Conclusion: Ipsilesional hand, which is considered unaffected, functions are impaired in hemiplegic patients. This functional impairment is associated with greater dependence on activities of daily living.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuanyuan Zhuo, Min Pi, Xingxian Huang, Limin Liu, Zhuoxin Yang
Objectives: Prediction of recurrence risk after initial ischemic stroke helps improve patient outcomes. We estimated the validity of combining the Essen Stroke Risk Score (ESRS) with retinal characteristics to predict the two-year recurrent risk of ischemic stroke. Methods: A prospective cohort study was conducted at Shenzhen Traditional Chinese Medicine Hospital. Patients with initial ischemic stroke were recruited. ESRS was measured, and fundus photographs were taken by trained physicians. All patients were followed up for 2 years to determine the outcome of recurrent stroke. Logistic models were built using ESRS alone and combined with ESRS and retinal characteristics. The prognostic value of recurrence risk was evaluated by calculating the area under the receiver operating characteristic curve. Results: The total recurrence rate of ischemic events within 2 years was 20%. The risk of recurrence was significantly higher in patients with an ESRS score of >2. Regarding retinal characteristics, patients with recurrent stroke had a lower mean asymmetry index of venules (0.76 vs. 0.77, P=0.00) and bifurcation coefficient of venules (1.29 vs. 1.28, P=0.03) but a higher mean occlusion of arterioles (0.11 vs. 0.13, P=0.01). The area under the curve was 0.5985 based on the logistic regression model with ESRS alone to 0.7294 for the model with both ESRS and retinal characteristics. This study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR1800019648). Conclusion: A model combining ESRS with retinal characteristics can accurately predict the risk of recurrent stroke.
目的:预测初次缺血性脑卒中后的复发风险有助于改善患者预后。我们估计了埃森卒中风险评分(ESRS)与视网膜特征相结合预测缺血性卒中两年复发风险的有效性。方法:在深圳市中医院进行前瞻性队列研究。研究招募了初发缺血性脑卒中患者。测量ESRS，并由训练有素的医生拍摄眼底照片。所有患者随访2年，以确定复发性脑卒中的结局。Logistic模型分别使用ESRS单独建立，并结合ESRS和视网膜特征建立。通过计算受者工作特征曲线下面积来评价复发风险的预后价值。结果:2年内缺血性事件总复发率为20%。ESRS评分为>2的患者复发风险显著增高。在视网膜特征方面，卒中复发患者的平均小静脉不对称指数(0.76 vs. 0.77, P=0.00)和小静脉分叉系数(1.29 vs. 1.28, P=0.03)较低，但小动脉闭塞的平均值较高(0.11 vs. 0.13, P=0.01)。单独使用ESRS的logistic回归模型曲线下面积为0.5985，同时使用ESRS和视网膜特征的logistic回归模型曲线下面积为0.7294。本研究已在中国临床试验注册中心注册(注册号:ChiCTR1800019648)。结论:结合视网膜特征的ESRS模型能准确预测卒中复发风险。
{"title":"Estimating a two-year recurrence risk of ischemic stroke based on Essen Stroke Risk Score and retinal characteristics","authors":"Yuanyuan Zhuo, Min Pi, Xingxian Huang, Limin Liu, Zhuoxin Yang","doi":"10.54029/2023fxt","DOIUrl":"https://doi.org/10.54029/2023fxt","url":null,"abstract":"Objectives: Prediction of recurrence risk after initial ischemic stroke helps improve patient outcomes. We estimated the validity of combining the Essen Stroke Risk Score (ESRS) with retinal characteristics to predict the two-year recurrent risk of ischemic stroke. Methods: A prospective cohort study was conducted at Shenzhen Traditional Chinese Medicine Hospital. Patients with initial ischemic stroke were recruited. ESRS was measured, and fundus photographs were taken by trained physicians. All patients were followed up for 2 years to determine the outcome of recurrent stroke. Logistic models were built using ESRS alone and combined with ESRS and retinal characteristics. The prognostic value of recurrence risk was evaluated by calculating the area under the receiver operating characteristic curve. Results: The total recurrence rate of ischemic events within 2 years was 20%. The risk of recurrence was significantly higher in patients with an ESRS score of >2. Regarding retinal characteristics, patients with recurrent stroke had a lower mean asymmetry index of venules (0.76 vs. 0.77, P=0.00) and bifurcation coefficient of venules (1.29 vs. 1.28, P=0.03) but a higher mean occlusion of arterioles (0.11 vs. 0.13, P=0.01). The area under the curve was 0.5985 based on the logistic regression model with ESRS alone to 0.7294 for the model with both ESRS and retinal characteristics. This study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR1800019648). Conclusion: A model combining ESRS with retinal characteristics can accurately predict the risk of recurrent stroke.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eloquent area glioma surgery is technically demanding. Identification and preservation of the functional area determines the long term outcome. Here we discuss the use of transcranial magnetic stimulation (TMS) and 2D ultrasound (2DUSG) in resection of low grade glioma (LGG) located at motor strip area. In five patients where the LGG was located close to motor area were evaluated with TMS in the preoperative period and the functional area is marked. This information is used for planning the craniotomy. A 2DUSG is used to detect the margin of resection. Complete excision was feasible in two and partial resection in three without any added deficit. TMS is an useful tool for localizing motor area in the pre operative period for patients with tumor located close to the motor area. Additionally 2DUSG provides real time imaging to safeguard the eloquent brain area. Combination of these two offers low cost, easily available method for resecting eloquent area brain tumors in resource limited areas.
{"title":"Use of repetitive transcranial magnetic stimulation and 2D ultrasound in resection of low-grade glioma at motor strip area in resource limited setting","authors":"Sushanta Sahoo, Sujita Kar, Chhitij Srivastava","doi":"10.54029/2023wrw","DOIUrl":"https://doi.org/10.54029/2023wrw","url":null,"abstract":"Eloquent area glioma surgery is technically demanding. Identification and preservation of the functional area determines the long term outcome. Here we discuss the use of transcranial magnetic stimulation (TMS) and 2D ultrasound (2DUSG) in resection of low grade glioma (LGG) located at motor strip area. In five patients where the LGG was located close to motor area were evaluated with TMS in the preoperative period and the functional area is marked. This information is used for planning the craniotomy. A 2DUSG is used to detect the margin of resection. Complete excision was feasible in two and partial resection in three without any added deficit. TMS is an useful tool for localizing motor area in the pre operative period for patients with tumor located close to the motor area. Additionally 2DUSG provides real time imaging to safeguard the eloquent brain area. Combination of these two offers low cost, easily available method for resecting eloquent area brain tumors in resource limited areas.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135638087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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