Frontiers in stroke最新文献

Background: stroke is one of the leading causes of death and disability globally. Despite advancements in acute stroke care, long-term outcomes have not been extensively studied in Tanzania. This study aimed to investigate the long-term post-stroke outcomes among adults admitted with stroke to a large tertiary hospital in northwestern Tanzania.

Methods: adults (≥18 years) with stroke who were enrolled in the Lake Zone Stroke Registry Study (LZSS) at Bugando Medical Center between March 2020 and October 2021 were prospectively followed up until October 2024. Stroke diagnosis and classification were confirmed using brain imaging, and baseline stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Data on case fatality were collected using the modified Rankin Scale along with information on secondary stroke prevention. The Kaplan-Meier analysis was used to describe survival, and the Cox regression model was used to examine independent factors associated with fatality.

Results: the study included 301 adults, with a mean age of 65.5 ± 14 years, of whom 51% (153/301) were female and 68% (205/301) had ischemic strokes. Case fatality rates were 42.9% (98/228) at 1 year, 75.9% (173/228) at 2 years, and 96.5% (220/228) at 3 years. Independent factors associated with fatality were severe stroke (adjusted hazard ratio (aHR) 7.9, 95% CI [2.3, 27.4], p = 0.001), moderate to severe stroke (aHR 4.6, 95% CI [1.3, 16.1], p = 0.017), a lack of health insurance coverage (aHR 3.7, 95% CI [1.9, 6.8], p < 0.001), and previous stroke (aHR 3.3, 95% CI [1.3, 8.3], p = 0.01). Attendance rates of follow-up clinics and physiotherapy among survivors were 28.6% (86/301) and 8.6% (26/301), respectively. Among stroke survivors with hypertension and diabetes, 32% (83/257) and 41% (20/49) were adherent to antihypertensive and diabetic medications, respectively.

Conclusion: this study highlights the high long-term case fatality rates among adults with stroke in northwestern Tanzania, with stroke severity, a lack of health insurance, and previous strokes being key factors associated with fatality. Low attendance rates at follow-up clinics and poor adherence to medications among survivors of stroke with hypertension and diabetes underline the importance of strengthening post-stroke care systems, including health insurance coverage, to improve survival and quality of life.

Introduction: Intravenous thrombolysis (IVT) is cornerstone of acute ischemic stroke(AIS) recanalization therapy. Clinical guidelines advocate achieving Door-to-Needle (DTN) time of 60 min or less, with recent evidence highlighting clinical advantages of even shorter DTN times. However, economic implications of reducing DTN time are less well-studied. This study aims to assess shorter DTN targets impact on clinical outcomes and healthcare costs.

Methods: This observational cohort study included consecutive patients with AIS treated with IVT in a comprehensive stroke center from January 2017 to December 2023. Patients were stratified by DTN time into 4 groups: ≤ 30, 31-45, 46-60, and >60 min. Multivariate linear and logistic regressions were performed to evaluate impact of DTN time on functional and financial outcomes, including modified Rankin's Score (mRS) at 3-months post-AIS, length-of-stay (LoS), total hospitalization cost, symptomatic intracerebral hemorrhage (SICH) and inpatient mortality.

Results: 1,146 patients (62.0% male) with mean age of 68.6 years were included. Overall, 47.6% of patients achieved a mRS of 0-2 at 3 months after AIS. Patients with DTN time of ≤ 30 min demonstrated higher odds of achieving mRS 0-2 at 3 months (OR 2.35, 95% CI 1.26-4.39) compared to DTN time of ≥60 min. They also experienced 4-day shorter length of stay (LoS) until rehabilitation (p = 0.005) and 22.7% reduction in total hospitalization costs (p = 0.004).

Conclusions: This study suggests that DTN time of ≤ 30 min is associated with improved functional outcomes and significant cost benefits, supporting consideration of this more aggressive target for acute stroke units. Further research is needed to assess feasibility and broader impact of implementing a 30-min DTN goal in routine clinical practice.

Background: Treatment of cerebral venous thrombosis has traditionally been based on anticoagulant therapy. However, in certain circumstances, such as deep cerebral venous thrombosis, anticoagulation may be insufficient, so endovascular treatment by mechanical thrombectomy has been used for some years. There is currently no clear indication of which device is the gold standard in the endovascular treatment of cerebral venous thrombosis, although stent retriever devices are the most commonly used.

Case presentation: We describe two cases of deep cerebral venous thrombosis refractory to anticoagulant treatment treated by mechanical thrombectomy with stent retriever devices, one of which has not been described to date as being used in the treatment of cerebral venous thrombosis (Tiger XL^®).

Conclusions: Some situations in like deep cerebral venous thrombosis may require endovascular treatment with mechanical thrombectomy if anticoagulation fails, with increasing evidence that it improves vital and functional prognosis.

This study evaluates the potential of the Linmot^® tapper as a precise tool for tracking spasticity changes in hemiparetic stroke survivors following cyproheptadine HCl administration. Spasticity, a significant health concern among stroke survivors, is characterized by increased muscle tone due to upper motor neuron dysfunction. Conventional clinical assessments, such as the Modified Ashworth Scale (MAS), often lack the sensitivity to accurately monitor treatment. In this study, we utilized the Linmot^® tapper to assess the stretch reflex threshold (SRT) in three stroke survivors and one control subject by progressively altering tendon indentation to change muscle length. The SRT was defined as the indentation depth at which consistent reflex responses of the biceps brachii were observed, as indicated by reflex force or rectified integrated EMG (RIEMG) signals. Measurements were taken at baseline and at 2, 4, and 6 h after drug administration. Results showed significant increases in SRT following cyproheptadine administration, indicating reduced motor neuron excitability and highlighting the drug's effect on spasticity. Both reflex force and RIEMG data consistently captured these changes, while MAS grades remained unchanged. The high correlation between SRTs derived from force and EMG further supports the tool's accuracy in detecting subtle neuromuscular changes. These findings highlight that the Linmot^® tapper offers a precise, quantitative method for monitoring spasticity dynamics, providing a more accurate alternative to conventional clinical assessments and demonstrating potential for enhancing stroke rehabilitation strategies.

Background: Malnutrition and nutritional care are significant challenges for healthcare professionals treating stroke patients, in both acute care and during rehabilitation. This study aimed to assess and synthesize the nutritional care recommendations in clinical practice guidelines (CPGs) for managing malnutrition risk in stroke patients, evaluate the supporting evidence, identify research gaps, and assess the quality of the CPGs.

Methods: Three databases, along with National Medical Association websites and nutrition journals, were searched for CPGs published between 2019 and 2024 that provided recommendations on nutritional care for stroke patients. Two independent reviewers performed data extraction, and three reviewers independently assessed CPG quality and clinical applicability (using AGREE II and AGREE-REX tools).

Results: 13 CPGs were included in this review. These were of varying quality, with overall moderate AGREE II total scores [mean (SD), 55.2% (21.8%)]. Only two CPGs had an overall quality score above 70% based on AGREE-REX total scores, while five were categorized as poor quality (scores < 40%). Most guidelines strongly recommended early dysphagia screening upon hospital admission, including the provision of texture-modified foods for patients with dysphagia. However, recommendations on malnutrition, nutritional support, and supplementation were often either absent or inconsistent across guidelines and recommendations were mostly based on moderate to weak evidence.

Conclusion: This study highlights the critical need for more rigorous research, standardized approaches, and patient-centered studies to improve and optimize nutritional care practices for stroke patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024498430, PROSPERO registration ID: CRD42024498430.

Aim: The National Institutes of Health Stroke Scale (NIHSS) score is an established marker of stroke severity. Its use is time-consuming and requires formal training for optimal results. In contrast, the neutrophil-lymphocyte ratio (NLR), known to be independently associated with stroke outcome, can be readily calculated from routine peripheral blood counts with minimal training. We hypothesized that the NLR may perform similarly to the NIHSS score, in discriminating persons with poor 30-day stroke outcome, in a low-resource setting.

Methods: We followed up 106 participants with clinico-radiologic diagnosis of first-ever acute ischemic stroke (AIS). Patients with clinico-laboratory features of fever, aspiration pneumonia, sepsis, or infection were excluded at baseline. The NLR was obtained at admission while the functional outcome was assessed using the modified Rankin scale (mRS) score at day 30. Receiver operating characteristics (ROC) curves and Cox proportional hazards were used to determine the discriminatory ability of the NLR compared with the NIHSS score in identifying patients with poor 30-day stroke outcome (mRS > 3). The respective areas under the curves (AUC) and HRs (95%CI) were documented.

Results: The median interquartile range (IQR) NLR of the study population was 2.87 (3.0). Patients in the higher tertiles of NLR had higher mean standard deviation 30-day mRS scores of 4.9 (1.2) compared to the middle 3.3 (1.2) and lower tertiles 2.3 (1.2) (p < 0.001). Admitting NLR had an AUC (95% CI) of 0.83 (0.75-0.91) and HR (95%CI) of 1.19 (1.01-1.40) compared to admitting NIHSS score with AUC of 0.89 (0.84-0.95) and HR of 1.25 (1.14-1.37) in discriminating poor 30-day outcome.

Conclusion: The NLR alone performed similarly to the NIHSS score and may help identify patients with adverse 30-day AIS outcome in low-resource settings.

Introduction: A key element of personalized stroke rehabilitation is early prediction of an individual's potential to walk in the community.

Objective: We aim to determine the predictive value of patient characteristics, clinical test results, and Inertial Measurement Units (IMU) based balance, clinical gait and daily-life measures, measured at admission and discharge in clinical stroke rehabilitation, for community walking 6 months after stroke.

Methods: Data were collected from people after stroke during clinical rehabilitation and at 6 months post stroke. The assessment during rehabilitation consisted of an IMU-based 2-min walk test (2MWT), three IMU-based balance tests, an IMU-based measurement of gait in daily life, and several standard clinical tests, including the Berg Balance Scale, Barthel Index, Functional Ambulation Categories, Motricity Index (MI), and Trunk Control Test (TCT). At 6-months, gait in daily life was measured with an IMU for two consecutive days. From this measurement, three gait features were calculated, namely the strides per day, and average and maximum gait speed. We assessed the predictive value of IMU-based balance, gait, and daily-life measures, the clinical tests and patient characteristics at admission and discharge for predicting daily-life measures at 6 months after stroke with univariate ordinary least squares regression. Subsequently, significant predictors were included in a multivariate ordinary least squares regression.

Results: Thirty-five individuals after stroke were included. Ordinary least squares regression analysis indicated that age, gait features and strides per day at admission and discharge had significant predictive value for the step count at 6 months. For the average and maximum gait speed in daily life at 6 months, the 2MWT gait speed, TCT, MI and the baseline average and maximum gait speed in daily life were significant predictors. Multivariate analysis indicated that the outcomes at admission had more predictive value than the outcomes at discharge, with adjusted R ² values for the strides per day, average and maximum gait speed models of 0.60, 0.42, and 0.53, respectively.

Conclusions: Age, trunk stability (TCT), affected leg strength (MI), and the clinical and daily-life gait had predictive value for community walking 6-months after stroke. Future research with a larger sample size is required to refine these findings.

Background: The most frequent electrolyte derangement in adults with stroke is hyponatremia, which is associated with increased morbidity, mortality, and prolonged hospital stay. The study aimed to investigate the hyponatremia incidence and 30-day outcomes among adults admitted with stroke at a large tertiary teaching hospital in Northwestern Tanzania.

Methods: This cohort study recruited adults presenting with first-ever stroke (as defined by the World Health Organization) between November 2023 to May 2024. Data were collected on demographics, the degree of neurological impairment at admission using the National Institutes of Health Stroke Scale (NIHSS), and laboratory workup, including sodium levels, on admission; the modified Rankin Scale was used to assess stroke outcomes. We used modified Poisson and logistic regressions to examine factors associated with hyponatremia and 30-day outcomes, respectively.

Results: In total, 167 adults were enrolled, of which 56.9% (n = 95) were female, with a median age of 60 years (interquartile range [IQR] 40-74), and 71.2% (n = 119) had hypertension and heart failure. The hyponatremia incidence was 29.3% (n = 49), and among these participants, 53% (n = 26) had mild hyponatremia. Factors associated with hyponatremia were the use of mannitol on admission (adjusted prevalence ratio [aPR] 3.14, 95% CI [1.81, 5.44], p < 0.001) and increasing NIHSS scores (aPR 1.03, 95% CI [1.00, 1.06], p < 0.05). There were no differences in 30-day mortality between those with and without hyponatremia (respectively, 38.3% vs. 36.7%, p = 0.79). The presence of leukocytosis was independently associated with 30-day mortality (adjusted odds ratio [aOR] = 2.7, 95% CI [1.39, 5.36], p = 0.004), and the median length of hospital stay was significantly higher in those with hyponatremia compared to those without: 7 days (IQR 4-9) vs. 5 days (IQR 3-9), p = 0.032.

Conclusion: Hyponatremia, which is associated with increased stroke severity, probable infections, and prolonged hospital stays, is prevalent among adults with stroke in Northwestern Tanzania. The high prevalence of hypertension and heart failure underscores the need for targeted preventive strategies. Early detection and appropriately managing hyponatremia are essential to improve stroke outcomes in this region.

Introduction: Whole blood viscosity (WBV), reflecting the intrinsic resistance of blood flow, is an established predictor of stroke events in individuals. This study aims to correlate the WBV at different shear rates with the outcome of mechanical thrombectomy, known to be an effective treatment for large vessel occlusion (LVO) stroke.

Method: This is a single-center retrospective study conducted at our comprehensive stroke center. The charts of 317 patients who underwent mechanical thrombectomy within 6 h of LVO stroke presentation were reviewed. The modified Rankin score (mRS) at discharge was used as the outcome measure, with individuals categorized as low (0-2) or high (3-6). WBV at different shear rates was calculated using De Simone's Formula. The T-test and Chi-square test were used to compare baseline continuous and categorical data, respectively, amongst the mRS study groups. We utilized multivariable logistic regression analyses to identify the independent risk factors associated with the outcome of interest following mechanical thrombectomy. In addition, Spearman rank order correlation was used to assess for r value between mRS and WBV at different shear rates.

Results: Baseline group characteristics, including demographics and medical history, were similar among the two study groups. Of note, our study found no significant differences in clinical outcomes between the two groups with WBV at high shear rate (OR 0.969, 95% CI 0.77-1.204, p = 0.780) and low shear rate (OR 0.998, 95% CI 0.988-1.008, p = 0.779) following mechanical thrombectomy. Spearman rank order correlation between mRS at discharge with WBV at high shear rate (r = 0.058, p = 0.123) and low shear rate (r = 0.048, p = 0.128) was non-significant.

Discussion: There is limited information of the effect of WBV at high and low shear rates on the clinical outcome following mechanical thrombectomy in patients with LVO. Our results revealed that WBV at high and low shear rates did not impact the functional outcome of mechanical thrombectomy. This result might be affected by the potential limitation of the formula used to derive the given shear rates. Despite this lack of association observed in our study, other contributors of viscosity may still potentially play a significant role in outcome following mechanical thrombectomy.