Frontiers in stroke最新文献

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.

Introduction: Stroke is a leading cause of adult neurologic disability, cognitive decline, and death worldwide, and particularly in Africa. Stroke research in Africa has exposed challenges militating against the translation of research evidence into practice and policy. The evidence-based, context-sensitive multilevel strategies required to surmount these challenges are presented in this report on the first African Stroke Leaders' Summit (ASLS) organized to tackle the burden of stroke in Africa.

Methods: The Africa-UK Stroke Partnership (AUKSP) Project had a Steering Committee (SC) and four theme-based Working Groups (WGs): stroke services, stroke training/capacity building, research and stroke advocacy, each with defined terms of reference. These groups generated 20 priorities (five per thematic area) during breakout sessions at the first ASLS which were further refined into four topmost priorities (one per thematic area) at the general consensus session.

Results: The topmost priorities included promoting the development of acute stroke services (stroke services), strengthening population-based stroke education focusing on prevention and symptom recognition (stroke training), research on hypertension control to reduce stroke risk (stroke research), and developing national stroke action plans (advocacy).

Conclusion: Sustained reduction of stroke burden in Africa requires the adaptation of best practices to the African context, building the capacity of African stroke care professionals and using available resources with political support. Improving stroke literacy in African communities is a complementary strategy to reinforce healthy lifestyle choices and improve screening and detection of hypertension and other modifiable stroke risk factors. This process will culminate in a strategic African Stroke Action Plan (ASAP), the blueprint for the control of stroke in Africa.

Background: Stroke is a leading cause of morbidity and mortality globally, yet its burden among adolescents and young adults (aged 15-39 years) in South East Asia (SEA) remains understudied. Understanding regional trends and risk factors in this population is critical for effective prevention and management strategies. This study aims to examine stroke trends from 1990 to 2021, focusing on ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in SEA.

Methods: Using data from the Global Burden of Disease (GBD) 2021 study, temporal trends in stroke incidence, mortality, and Disability-Adjusted Life Years (DALYs) were analyzed for the age group 15-39 years. Join point regression analysis was employed to identify significant changes in stroke trends, and gender specific patterns were also assessed.

Results: Ischemic stroke cases in SEA increased from 28030.85 to 40836.18, with a slight rise in incidence, particularly affecting males aged 30-39, while female mortality dropped by 23.81%. ICH incidence decreased annually by 0.6692%, with significant reductions in DALYs and mortality, especially among younger age groups and females. SAH incidence declined by 0.2142%, accompanied by a notable reduction in female mortality (31.83%). Countries with lower SDI experienced higher stroke incidence and mortality rates, highlighting socio-economic disparities. Geographic analysis revealed the Philippines had the highest rise in ischemic stroke, while most other countries saw declines in ICH and SAH rates.

Conclusion: The study highlights significant progress in managing ICH and SAH, especially among younger populations and females. However, ischemic stroke remains a growing challenge, particularly for males, necessitating targeted interventions to reduce the overall stroke burden.

Background: Severe upper-limb motor paralysis following chronic stroke presents a significant rehabilitation challenge, often with limited recovery. This case study explores the effects of repetitive peripheral magnetic stimulation (rPMS) combined with task-oriented training on motor recovery in a patient with chronic stroke and severe upper-limb impairment.

Methods: A 50-year-old male with right upper-limb paralysis post-hemorrhagic stroke underwent a 2-week intervention comprising 12 sessions of rPMS targeting the elbow and wrist extensors, combined with task-oriented training. Motor function was assessed using the Fugl-Meyer Assessment (FMA), kinematic analysis, Motor Activity Log (MAL), and electromyographic (EMG) analysis of wrist flexion-extension movements.

Results: The intervention resulted in a clinically meaningful increase in motor function, reflected in improved FMA scores and greater elbow extension during kinematic analysis. EMG analysis demonstrated reduced co-contractions of wrist flexors and extensors, indicating improved muscle coordination. Despite these gains, recovery of distal voluntary movements, such as wrist dorsiflexion and finger extension, remained limited. As assessed by MAL, upper-limb usage in daily activities showed minor improvements; however, qualitative reports indicated functional gains, including the ability to hold a bottle and assist in closing a car door.

Conclusion: rPMS combined with task-oriented training shows promise in enhancing motor function in patients with chronic stroke combined with severe upper-limb paralysis, particularly in proximal muscles. Further research involving control groups and objective measures of upper-limb use is necessary to validate these findings and refine intervention protocols.