Pub Date : 2023-09-18DOI: 10.3389/fstro.2023.1247326
Elizabeth Fracica, David E. Hale, Daniel R. Gold
The head impulse-nystagmus-test of skew (+ hearing) or HINTS+ exam is a well-established clinical bedside test used in evaluating whether patients with the acute vestibular syndrome have features concerning for a central etiology (e.g., stroke). There are other components of the ocular motor exam that are helpful in the acute setting, including smooth pursuit and saccades. We discuss the anatomy and physiology of the saccade and smooth pursuit pathways from the cortex to the infratentorial region in the context of anterior and posterior circulation strokes in general but with a particular emphasis on distinct vestibular stroke syndromes. For each stroke localization, we review the vascular supply and the expected findings on the HINTS+ exam and correlate this with the expected findings on the smooth pursuit and saccade exams to aid in bedside diagnosis.
{"title":"A review of pursuit and saccadic eye movements and their utility in stroke","authors":"Elizabeth Fracica, David E. Hale, Daniel R. Gold","doi":"10.3389/fstro.2023.1247326","DOIUrl":"https://doi.org/10.3389/fstro.2023.1247326","url":null,"abstract":"The head impulse-nystagmus-test of skew (+ hearing) or HINTS+ exam is a well-established clinical bedside test used in evaluating whether patients with the acute vestibular syndrome have features concerning for a central etiology (e.g., stroke). There are other components of the ocular motor exam that are helpful in the acute setting, including smooth pursuit and saccades. We discuss the anatomy and physiology of the saccade and smooth pursuit pathways from the cortex to the infratentorial region in the context of anterior and posterior circulation strokes in general but with a particular emphasis on distinct vestibular stroke syndromes. For each stroke localization, we review the vascular supply and the expected findings on the HINTS+ exam and correlate this with the expected findings on the smooth pursuit and saccade exams to aid in bedside diagnosis.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135206394","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}
Pub Date : 2023-09-14DOI: 10.3389/fstro.2023.1143372
Forrest Lin, Liisa Tomppo, Brady Gaynor, Kathleen Ryan, John W. Cole, Braxton D. Mitchell, Jukka Putaala, Steven J. Kittner
Background Oral contraceptives (OCs) are generally safe but vascular risk factors increase OC-associated ischemic stroke risk. We performed a case-control study to evaluate whether a genomic risk score for ischemic stroke modifies OC-associated ischemic stroke risk. Methods The Genetics of Early-Onset Stroke study includes 332 premenopausal women (136 arterial ischemic stroke cases and 196 controls) with data on estrogen-containing OC use within 30 days before the index event (for cases) or interview (for controls). Using a previously validated genetic risk score (metaGRS) for ischemic stroke based on 19 polygenic risk scores for stroke and stroke-associated risk factors, we stratified our combined case-control sample into tertiles of genomic risk. We evaluated the association between OC use and ischemic stroke within each tertile. We tested if the association between OC use and ischemic stroke depended on the genomic risk of stroke using logistic regression with an OC use × metaGRS interaction term. These analyses were performed with and without adjustment for smoking, hypertension, diabetes, coronary heart disease, and body mass index. Results After adjustment for vascular risk factors, the odds ratio of OC use was 3.2 (1.7–6.3) overall and increased from the lower, middle, and upper tertile of genomic risk from 1.6 (0.5–5.4) to 2.5 (0.08–8.2) to 13.7 (3.8–67.3) respectively, and a p -value for interaction of 0.001. Conclusions Our results suggest that genomic profile may modify the OC-associated ischemic stroke risk. Larger studies are warranted to determine whether a genomic risk score could be clinically useful in reducing OC-associated ischemic stroke.
{"title":"Genomic risk scores and oral contraceptive-associated ischemic stroke risk: a call for collaboration","authors":"Forrest Lin, Liisa Tomppo, Brady Gaynor, Kathleen Ryan, John W. Cole, Braxton D. Mitchell, Jukka Putaala, Steven J. Kittner","doi":"10.3389/fstro.2023.1143372","DOIUrl":"https://doi.org/10.3389/fstro.2023.1143372","url":null,"abstract":"Background Oral contraceptives (OCs) are generally safe but vascular risk factors increase OC-associated ischemic stroke risk. We performed a case-control study to evaluate whether a genomic risk score for ischemic stroke modifies OC-associated ischemic stroke risk. Methods The Genetics of Early-Onset Stroke study includes 332 premenopausal women (136 arterial ischemic stroke cases and 196 controls) with data on estrogen-containing OC use within 30 days before the index event (for cases) or interview (for controls). Using a previously validated genetic risk score (metaGRS) for ischemic stroke based on 19 polygenic risk scores for stroke and stroke-associated risk factors, we stratified our combined case-control sample into tertiles of genomic risk. We evaluated the association between OC use and ischemic stroke within each tertile. We tested if the association between OC use and ischemic stroke depended on the genomic risk of stroke using logistic regression with an OC use × metaGRS interaction term. These analyses were performed with and without adjustment for smoking, hypertension, diabetes, coronary heart disease, and body mass index. Results After adjustment for vascular risk factors, the odds ratio of OC use was 3.2 (1.7–6.3) overall and increased from the lower, middle, and upper tertile of genomic risk from 1.6 (0.5–5.4) to 2.5 (0.08–8.2) to 13.7 (3.8–67.3) respectively, and a p -value for interaction of 0.001. Conclusions Our results suggest that genomic profile may modify the OC-associated ischemic stroke risk. Larger studies are warranted to determine whether a genomic risk score could be clinically useful in reducing OC-associated ischemic stroke.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135551745","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}
Pub Date : 2023-09-07DOI: 10.3389/fstro.2023.1242901
Gonçalo Oliveira, Ana Catarina Fonseca, José M. Ferro, Arlindo L. Oliveira
The prediction of functional outcome after a stroke remains a relevant, open problem. In this article, we present a systematic review of approaches that have been proposed to predict the most likely functional outcome of ischemic stroke patients, as measured by the modified Rankin scale. Different methods use a variety of clinical information and features extracted from brain computed tomography (CT) scans, usually obtained at the time of hospital admission. Most studies have concluded that CT data contains useful information, but the use of this information by models does not always translate into statistically significant improvements in the quality of the predictions.
{"title":"Potential and limitations of computed tomography images as predictors of the outcome of ischemic stroke events: a review","authors":"Gonçalo Oliveira, Ana Catarina Fonseca, José M. Ferro, Arlindo L. Oliveira","doi":"10.3389/fstro.2023.1242901","DOIUrl":"https://doi.org/10.3389/fstro.2023.1242901","url":null,"abstract":"The prediction of functional outcome after a stroke remains a relevant, open problem. In this article, we present a systematic review of approaches that have been proposed to predict the most likely functional outcome of ischemic stroke patients, as measured by the modified Rankin scale. Different methods use a variety of clinical information and features extracted from brain computed tomography (CT) scans, usually obtained at the time of hospital admission. Most studies have concluded that CT data contains useful information, but the use of this information by models does not always translate into statistically significant improvements in the quality of the predictions.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87658521","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}
Pub Date : 2023-09-07DOI: 10.3389/fstro.2023.1226140
Gebremariam Bekele, Melisew Mekie Yitayal, Yihalem Belete, Yisak Girma, Tesfa Kassa, Y. Assefa, S. Nigatu, G. A. Eriku
Caregivers of stroke survivors play a crucial role in post-stroke functional recovery and the prevention of complications. Although the situation is incredibly stressful and intimidating and the caregiver burden is high, there is little evidence in the local Ethiopian context of the extent of the burden among caregivers of stroke survivors. Therefore, the aim of this study was to assess the level of caregiver burden and its associated factors among primary caregivers of stroke survivors in Ethiopia.A cross-sectional study was conducted in Amhara regional state tertiary hospitals from April to June 2022. A standardized questionnaire was used to record factors associated with caregiver burden, including sociodemographic, clinical, and care situation factors. The Zarit caregiver burden interview (short form) was used to assess the level of caregiver burden. A systematic random sampling method was employed to select the study participants. Multinomial logistic regression was employed to identify the potential factors associated with the level of caregiver burden.The overall prevalence burden among primary caregivers of stroke survivors was 67%. 61.1% had a mild to moderate burden, while 5.9% had a severe burden. In multivariable multinomial logistic regression analysis, sex, household income, duration of care, and duration of caregiving hours per day were factors significantly associated with the level of burden among caregivers of stroke survivors.Being female, having a low household income, caring for more than 3 months, and caring for more than 6 h per day were factors significantly associated with the burdens of the primary caregivers of stroke survivors. It is better: health care providers must recognize and screen for burdens and provide special attention.
{"title":"Caregiver burden and its associated factors among primary caregivers of stroke survivors at Amhara regional state tertiary hospitals: a multicenter study","authors":"Gebremariam Bekele, Melisew Mekie Yitayal, Yihalem Belete, Yisak Girma, Tesfa Kassa, Y. Assefa, S. Nigatu, G. A. Eriku","doi":"10.3389/fstro.2023.1226140","DOIUrl":"https://doi.org/10.3389/fstro.2023.1226140","url":null,"abstract":"Caregivers of stroke survivors play a crucial role in post-stroke functional recovery and the prevention of complications. Although the situation is incredibly stressful and intimidating and the caregiver burden is high, there is little evidence in the local Ethiopian context of the extent of the burden among caregivers of stroke survivors. Therefore, the aim of this study was to assess the level of caregiver burden and its associated factors among primary caregivers of stroke survivors in Ethiopia.A cross-sectional study was conducted in Amhara regional state tertiary hospitals from April to June 2022. A standardized questionnaire was used to record factors associated with caregiver burden, including sociodemographic, clinical, and care situation factors. The Zarit caregiver burden interview (short form) was used to assess the level of caregiver burden. A systematic random sampling method was employed to select the study participants. Multinomial logistic regression was employed to identify the potential factors associated with the level of caregiver burden.The overall prevalence burden among primary caregivers of stroke survivors was 67%. 61.1% had a mild to moderate burden, while 5.9% had a severe burden. In multivariable multinomial logistic regression analysis, sex, household income, duration of care, and duration of caregiving hours per day were factors significantly associated with the level of burden among caregivers of stroke survivors.Being female, having a low household income, caring for more than 3 months, and caring for more than 6 h per day were factors significantly associated with the burdens of the primary caregivers of stroke survivors. It is better: health care providers must recognize and screen for burdens and provide special attention.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88918730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-24DOI: 10.3389/fstro.2023.1248351
A. Ranta, B. Jones, M. Harwood
Māori, the Indigenous people of Aotearoa New Zealand (Aotearoa), experience stroke at a younger age and at a greater rate than New Zealanders of European ethnicity (NZ Europeans). These disparities have persisted for decades and recent evidence suggests that the gap is widening. Māori also experience reduced access to some key stroke-management interventions and consequently worse post-stroke outcomes compared to non-Māori counterparts. Reasons for the ethnic differences in stroke rates and outcomes include differential exposure to stroke risk factors, differential access to early diagnosis and treatment, and unequal treatment. Recent Aotearoa-based research has suggested that the root causes for these ethnic inequities, including unconscious bias and institutional racism, are likely attributable to Aotearoa's colonial past and related inter-generational sequalae. With recent reforms to the national health system there is now a new mandate to actively move toward a more bicultural approach which emphasizes Indigenous rights, values, priorities, and approaches in healthcare. This presents important opportunities to address the well-described inequities using a genuine partnership model. This paper will discuss the latest evidence around stroke related health disparities affecting Māori, describe existing approaches to address inequitable health outcomes, and present additional novel avenues that are currently being explored.
{"title":"Stroke among Māori in Aotearoa New Zealand and solutions to address persistent inequities","authors":"A. Ranta, B. Jones, M. Harwood","doi":"10.3389/fstro.2023.1248351","DOIUrl":"https://doi.org/10.3389/fstro.2023.1248351","url":null,"abstract":"Māori, the Indigenous people of Aotearoa New Zealand (Aotearoa), experience stroke at a younger age and at a greater rate than New Zealanders of European ethnicity (NZ Europeans). These disparities have persisted for decades and recent evidence suggests that the gap is widening. Māori also experience reduced access to some key stroke-management interventions and consequently worse post-stroke outcomes compared to non-Māori counterparts. Reasons for the ethnic differences in stroke rates and outcomes include differential exposure to stroke risk factors, differential access to early diagnosis and treatment, and unequal treatment. Recent Aotearoa-based research has suggested that the root causes for these ethnic inequities, including unconscious bias and institutional racism, are likely attributable to Aotearoa's colonial past and related inter-generational sequalae. With recent reforms to the national health system there is now a new mandate to actively move toward a more bicultural approach which emphasizes Indigenous rights, values, priorities, and approaches in healthcare. This presents important opportunities to address the well-described inequities using a genuine partnership model. This paper will discuss the latest evidence around stroke related health disparities affecting Māori, describe existing approaches to address inequitable health outcomes, and present additional novel avenues that are currently being explored.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"54 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91065549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-24DOI: 10.3389/fstro.2023.1265009
William Bierrum, Salman Haider, M. Balaratnam, Ali Alim-Marvasti, A. Chandratheva, R. Simister, N. Koohi, D. Kaski
Differentiating between peripheral and central causes of acute vertigo remains a clinical obstacle in the acute setting. Despite the availability of several validated diagnostic algorithms adoption and implementation of these tools is low because most emergency physicians are unfamiliar with them. Embedding an acute vertigo service within the emergency setting may help improve the diagnostic workup of patients presenting with this specific symptomatology and may have significant economic benefits, such as the avoidance of hospital admissions, reduction in unnecessary investigations, and decrease in length of hospital stay. In this work, we present four patients who were referred to the acute vertigo service at University College London Hospital (UCLH) for review. We discuss the indications for and limitations of implementing such a service.
{"title":"Hyperacute vestibular syndrome: the role of an acute vertigo service","authors":"William Bierrum, Salman Haider, M. Balaratnam, Ali Alim-Marvasti, A. Chandratheva, R. Simister, N. Koohi, D. Kaski","doi":"10.3389/fstro.2023.1265009","DOIUrl":"https://doi.org/10.3389/fstro.2023.1265009","url":null,"abstract":"Differentiating between peripheral and central causes of acute vertigo remains a clinical obstacle in the acute setting. Despite the availability of several validated diagnostic algorithms adoption and implementation of these tools is low because most emergency physicians are unfamiliar with them. Embedding an acute vertigo service within the emergency setting may help improve the diagnostic workup of patients presenting with this specific symptomatology and may have significant economic benefits, such as the avoidance of hospital admissions, reduction in unnecessary investigations, and decrease in length of hospital stay. In this work, we present four patients who were referred to the acute vertigo service at University College London Hospital (UCLH) for review. We discuss the indications for and limitations of implementing such a service.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84313156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-23DOI: 10.3389/fstro.2023.1190477
Lara C. Oliveira, A. Bonkhoff, A. Ponciano, C. Tuozzo, A. Viswanathan, N. Rost, M. Etherton
Post-stroke cognitive impairment and dementia (PSCID) is a sequel of ischemic stroke (IS), highly prevalent and linked to poor long-term outcomes. Thus, early recognition of the clinical determinants of PSCID is urgent for identifying high-risk individuals who are susceptible to PSCID. And investigating objective measures of PSCID in relation to patient-reported outcome measures (PROMs) is essential for understanding the impact of IS. Here we identify the clinical determinants associated with PSCID and the relationship of PSCID to patient-reported outcomes in a population with IS.This was a cohort study. We enrolled 138 patients who were admitted to our hospital between February 2017 and February 2020, with IS and no pre-stroke diagnosis of dementia. Clinical variables were acquired on admission. At 3 months, patients underwent a follow-up evaluation including the Telephone Interview for Cognitive Status (TICS), modified Rankin scale (mRS), Barthel Index (BI), and PROMs, using the Patient-Reported Outcomes Measurement information System Global Health (PROMIS GH). MCI/Dementia was defined as a TICS score of <36. Regression analyses were used to identify clinical, functional, and patient-reported outcome determinants of the 3-month TICS score. Analyses were adjusted for age, stroke severity, and prior IS.At follow-up, 113 participants (82%) were found to have MCI/Dementia. Patients with PSCID were more likely to be older, and at 3-months post-stroke they had lower rates of PROMIS GH T Mental (mean 47.69 vs. 52.13) and T Physical (mean 46.75 vs. 50.64). In multivariable linear regression analyses, increasing age (β = −0.07, p = 0.03) and Peripheral Artery Disease (PAD; β = −3.60, p = 0.03) were independently associated with a lower TICS score. Functional and patient-reported outcomes were also associated with worse TICS, including mRS ≥ 2, BI, T Mental, Global Mental, T Physical, and Global Physical in adjusted analyses. Individual components of PROMs were also associated with TICS, including quality of life, mental health, social satisfaction, and physical activities.In patients with IS, increased age and a pre-admission diagnosis of PAD are independently associated with worse objective measures of PSCID. Worse functional and patient-reported outcomes are also strongly linked to PSCID.
卒中后认知障碍和痴呆(PSCID)是缺血性卒中(is)的后遗症，非常普遍，并与不良的长期预后相关。因此，早期识别PSCID的临床决定因素对于识别易患PSCID的高危人群至关重要。研究PSCID的客观测量与患者报告的结果测量(PROMs)的关系对于理解is的影响至关重要。在这里，我们确定了与PSCID相关的临床决定因素，以及PSCID与IS患者报告结果的关系。这是一项队列研究。我们纳入了2017年2月至2020年2月期间入院的138名患者，他们患有IS，没有中风前的痴呆诊断。入院时获得临床变量。3个月时，使用患者报告的全球健康结果测量信息系统(PROMIS GH)对患者进行随访评估，包括认知状态电话访谈(TICS)、改良Rankin量表(mRS)、Barthel指数(BI)和PROMs。MCI/痴呆定义为TICS评分<36。回归分析用于确定临床、功能和患者报告的3个月TICS评分的结果决定因素。分析根据年龄、中风严重程度和既往IS进行调整。在随访中，113名参与者(82%)被发现患有轻度认知障碍/痴呆。PSCID患者的年龄更大，卒中后3个月，他们的PROMIS GH T Mental(平均47.69比52.13)和T Physical(平均46.75比50.64)的比率更低。在多变量线性回归分析中，年龄增加(β = - 0.07, p = 0.03)和外周动脉疾病(PAD;β =−3.60,p = 0.03)与较低的TICS评分独立相关。功能和患者报告的结果也与较差的tic相关，包括mRS≥2、BI、T Mental、Global Mental、T Physical和Global Physical。PROMs的个体成分也与tic相关，包括生活质量、心理健康、社会满意度和体育活动。在IS患者中，年龄的增加和入院前PAD的诊断与PSCID客观测量结果的恶化独立相关。较差的功能和患者报告的结果也与PSCID密切相关。
{"title":"Determinants of post-stroke cognitive impairment and dementia: association with objective measures and patient-reported outcomes","authors":"Lara C. Oliveira, A. Bonkhoff, A. Ponciano, C. Tuozzo, A. Viswanathan, N. Rost, M. Etherton","doi":"10.3389/fstro.2023.1190477","DOIUrl":"https://doi.org/10.3389/fstro.2023.1190477","url":null,"abstract":"Post-stroke cognitive impairment and dementia (PSCID) is a sequel of ischemic stroke (IS), highly prevalent and linked to poor long-term outcomes. Thus, early recognition of the clinical determinants of PSCID is urgent for identifying high-risk individuals who are susceptible to PSCID. And investigating objective measures of PSCID in relation to patient-reported outcome measures (PROMs) is essential for understanding the impact of IS. Here we identify the clinical determinants associated with PSCID and the relationship of PSCID to patient-reported outcomes in a population with IS.This was a cohort study. We enrolled 138 patients who were admitted to our hospital between February 2017 and February 2020, with IS and no pre-stroke diagnosis of dementia. Clinical variables were acquired on admission. At 3 months, patients underwent a follow-up evaluation including the Telephone Interview for Cognitive Status (TICS), modified Rankin scale (mRS), Barthel Index (BI), and PROMs, using the Patient-Reported Outcomes Measurement information System Global Health (PROMIS GH). MCI/Dementia was defined as a TICS score of <36. Regression analyses were used to identify clinical, functional, and patient-reported outcome determinants of the 3-month TICS score. Analyses were adjusted for age, stroke severity, and prior IS.At follow-up, 113 participants (82%) were found to have MCI/Dementia. Patients with PSCID were more likely to be older, and at 3-months post-stroke they had lower rates of PROMIS GH T Mental (mean 47.69 vs. 52.13) and T Physical (mean 46.75 vs. 50.64). In multivariable linear regression analyses, increasing age (β = −0.07, p = 0.03) and Peripheral Artery Disease (PAD; β = −3.60, p = 0.03) were independently associated with a lower TICS score. Functional and patient-reported outcomes were also associated with worse TICS, including mRS ≥ 2, BI, T Mental, Global Mental, T Physical, and Global Physical in adjusted analyses. Individual components of PROMs were also associated with TICS, including quality of life, mental health, social satisfaction, and physical activities.In patients with IS, increased age and a pre-admission diagnosis of PAD are independently associated with worse objective measures of PSCID. Worse functional and patient-reported outcomes are also strongly linked to PSCID.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78451832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-17DOI: 10.3389/fstro.2023.1114785
Stacy C. Brown, Christine Anne T. Galang, Mālialani Kana'iaupuni, Leah Dowsett, Keolu Fox, Kazuma Nakagawa
Stroke, the second leading cause of death worldwide, has partially heritable risk. Genome-wide association studies (GWAS) of stroke continue to identify increasing genetic risk loci. These discoveries point to novel disease mechanisms and causal risk factors, and herald genetics-based precision medicine strategies. In Hawai‘i, people of Indigenous communities who identify as Native Hawaiian or Pacific Islanders present with stroke at younger ages and suffer dramatically higher stroke mortality rates compared with other regional populations. This disparity is compounded by relative ancestral underrepresentation in stroke genetics research and, by extension, exclusion from cutting-edge medical opportunities based on genetic discovery. In this article, we discuss the issues contributing to the scientific biases experienced by Indigenous populations in the Pacific Islands, as well as community-based efforts now underway to address them.
{"title":"Advancing stroke genetics in Hawai‘i and the Pacific Islands","authors":"Stacy C. Brown, Christine Anne T. Galang, Mālialani Kana'iaupuni, Leah Dowsett, Keolu Fox, Kazuma Nakagawa","doi":"10.3389/fstro.2023.1114785","DOIUrl":"https://doi.org/10.3389/fstro.2023.1114785","url":null,"abstract":"Stroke, the second leading cause of death worldwide, has partially heritable risk. Genome-wide association studies (GWAS) of stroke continue to identify increasing genetic risk loci. These discoveries point to novel disease mechanisms and causal risk factors, and herald genetics-based precision medicine strategies. In Hawai‘i, people of Indigenous communities who identify as Native Hawaiian or Pacific Islanders present with stroke at younger ages and suffer dramatically higher stroke mortality rates compared with other regional populations. This disparity is compounded by relative ancestral underrepresentation in stroke genetics research and, by extension, exclusion from cutting-edge medical opportunities based on genetic discovery. In this article, we discuss the issues contributing to the scientific biases experienced by Indigenous populations in the Pacific Islands, as well as community-based efforts now underway to address them.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82185523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Executive function is an important determinant of independent living among stroke survivors. Patients with post-stroke executive dysfunction (PSED) have a lower engagement in therapy activities and reduced independent living abilities. One potential method for improving executive function and engagement is arts and crafts therapy (ACT). This study aimed to explore the effects of ACT on patients with PSED.The study was a pilot randomized controlled trial (RCT) with two groups: an experimental intervention group receiving ACT combined with individual rehabilitation therapy (IRT) and an active control group receiving IRT only. Fifty-seven patients with PSED participated. Outcome measures included the Trail Making Test (parts A and B), the Stroop test, the Tower of Hanoi (TOH), and the Lawton–Brody Instrumental Activities of Daily Living Scale. Two groups were compared at baseline and 4 weeks after the completion of the training.There were significant differences in the Trail Making Test part A (TMT-A; time; p < 0.01), the TMT part B (TMT-B; p < 0.05), the TMT-B (errors; p < 0.01), and the Stroop test (time; p < 0.01) between the experimental and the control group after 4 weeks. There were no significant differences in TMT-A (errors), Stroop test (errors), TOH, and Instrumental Activities of Daily Living Scale.The therapeutic use of arts and crafts could be an effective intervention to improve executive function and self-efficacy for stroke survivors.http://www.chictr.org.cn; Identifier: ChiCTR2200063547.
执行功能是脑卒中幸存者独立生活的重要决定因素。脑卒中后执行功能障碍(PSED)患者对治疗活动的参与度较低，独立生活能力下降。提高执行功能和参与度的一种潜在方法是工艺美术疗法(ACT)。本研究旨在探讨ACT对PSED患者的影响。该研究是一项先导性随机对照试验(RCT)，分为两组:实验组接受ACT联合个体康复治疗(IRT)，积极对照组只接受IRT。57例PSED患者参与了研究。结果测量包括造径测试(A和B部分)、Stroop测试、河内塔(TOH)和劳顿-布罗迪日常生活工具活动量表。两组在基线和训练完成后4周进行比较。在试道测试A部分(TMT-A)中存在显著性差异;时间;p < 0.01)， TMT B部分(TMT-B;p < 0.05)， TMT-B(误差;p < 0.01)， Stroop检验(时间;P < 0.01)。TMT-A(误差)、Stroop测试(误差)、TOH、日常生活工具活动量表(Instrumental Activities of Daily Living Scale)差异无统计学意义。艺术和手工艺的治疗性使用可能是一种有效的干预措施，可以改善中风幸存者的执行功能和自我效能。http://www.chictr.org.cn;标识符:ChiCTR2200063547。
{"title":"The effects of arts and crafts therapy on post-stroke executive dysfunction: a pilot randomized control test","authors":"Ruisheng Yun, Huanxia Zhou, Julie McLaughlin Gray, Jia Hua Cheng, Zhongzhi Zhao","doi":"10.3389/fstro.2023.1242724","DOIUrl":"https://doi.org/10.3389/fstro.2023.1242724","url":null,"abstract":"Executive function is an important determinant of independent living among stroke survivors. Patients with post-stroke executive dysfunction (PSED) have a lower engagement in therapy activities and reduced independent living abilities. One potential method for improving executive function and engagement is arts and crafts therapy (ACT). This study aimed to explore the effects of ACT on patients with PSED.The study was a pilot randomized controlled trial (RCT) with two groups: an experimental intervention group receiving ACT combined with individual rehabilitation therapy (IRT) and an active control group receiving IRT only. Fifty-seven patients with PSED participated. Outcome measures included the Trail Making Test (parts A and B), the Stroop test, the Tower of Hanoi (TOH), and the Lawton–Brody Instrumental Activities of Daily Living Scale. Two groups were compared at baseline and 4 weeks after the completion of the training.There were significant differences in the Trail Making Test part A (TMT-A; time; p < 0.01), the TMT part B (TMT-B; p < 0.05), the TMT-B (errors; p < 0.01), and the Stroop test (time; p < 0.01) between the experimental and the control group after 4 weeks. There were no significant differences in TMT-A (errors), Stroop test (errors), TOH, and Instrumental Activities of Daily Living Scale.The therapeutic use of arts and crafts could be an effective intervention to improve executive function and self-efficacy for stroke survivors.http://www.chictr.org.cn; Identifier: ChiCTR2200063547.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88486409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.3389/fstro.2023.1242961
A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Dibas, Daniel Casanova, M. Galecio-Castillo, M. Farooqui, S. Ortega‐Gutierrez
Medium vessel occlusions (MeVOs) account for 25%−40% of acute ischemic stroke (AIS). While mechanical thrombectomy is the standard-of-care for selected patients with large vessel occlusion (LVO), there is currently a lack of level I evidence of the safety and efficacy of endovascular treatment (EVT) for MeVOs. Several randomized clinical trials (RCTs) have attempted to answer this relevant clinical question. However, several questions related to the EVT of MeVO stroke may remain unanswered even after successful completion of these trials: What is the optimal EVT approach for secondary MeVOs? Is EVT beneficial for posterior circulation MeVOs? Is pre-EVT intravenous thrombolysis better than EVT alone? What is the optimal first line thrombectomy technique for these lesions? Are the outcome assessment tools used for LVOs appropriate for MeVOs? Upcoming evidence and the natural evolution and development of new technologies will aid in overcoming these challenges.
{"title":"Current challenges in the endovascular treatment of medium vessel occlusions","authors":"A. Rodriguez-Calienes, J. Vivanco-Suarez, M. Dibas, Daniel Casanova, M. Galecio-Castillo, M. Farooqui, S. Ortega‐Gutierrez","doi":"10.3389/fstro.2023.1242961","DOIUrl":"https://doi.org/10.3389/fstro.2023.1242961","url":null,"abstract":"Medium vessel occlusions (MeVOs) account for 25%−40% of acute ischemic stroke (AIS). While mechanical thrombectomy is the standard-of-care for selected patients with large vessel occlusion (LVO), there is currently a lack of level I evidence of the safety and efficacy of endovascular treatment (EVT) for MeVOs. Several randomized clinical trials (RCTs) have attempted to answer this relevant clinical question. However, several questions related to the EVT of MeVO stroke may remain unanswered even after successful completion of these trials: What is the optimal EVT approach for secondary MeVOs? Is EVT beneficial for posterior circulation MeVOs? Is pre-EVT intravenous thrombolysis better than EVT alone? What is the optimal first line thrombectomy technique for these lesions? Are the outcome assessment tools used for LVOs appropriate for MeVOs? Upcoming evidence and the natural evolution and development of new technologies will aid in overcoming these challenges.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"2677 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72938487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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