Frontiers in stroke最新文献

Early Neurological Deterioration (END) following acute stroke is associated with worse long-term functional outcomes. END is poorly defined and its relationship to reperfusion therapies is not fully understood. NIHSS is commonly used to risk-stratify and identify END following acute stroke however its relationship to END is relatively unexplored. The electronic health record of 933 stroke patients admitted to the Hyperacute Stroke Unit at King's College Hospital in 2022 were manually reviewed for END up to 14-days post stroke to: (1) characterize etiology and risk factors associated with END following acute stroke, and (2) evaluate the association between END, reperfusion therapy and NIHSS. Age, sex and co-morbidity were not associated with END, whereas reperfusion therapy was associated with greater END risk. Admission NIHSS was associated with END in those receiving conventional therapy alone, however, was not associated with END in those receiving reperfusion therapy. For those receiving IVT or EVT, the change in NIHSS at 24-hours was associated with END whereas admission NIHSS was not. In patients with a stable NIHSS 24-hours post stroke, there remained a greater than 10% risk of END. In conclusion, demographic factors and co-morbidity appear less important in determining END risk than stroke severity and treatment type. Admission NIHSS had limited association with END risk in those undergoing reperfusion therapy whereas the change in NIHSS at 24-hours was useful. NIHSS alone appears insufficient in its sensitivity to END to act as a risk-stratification tool, as significant END risk remains in those with stable or improving NIHSS.

Background: Stroke is a principal cause of long-term disability worldwide, significantly impairing motor function, including gait and mobility. Conventional physical therapy, primarily focusing on repetitive, task-specific exercises, often falls short in addressing the complex rehabilitative needs of stroke survivors. Emerging technologies such as virtual reality (VR) and transcranial direct current stimulation (tDCS) have shown potential to enhance neuroplasticity and functional recovery, suggesting that their combined use could offer a novel pathway for stroke rehabilitation.

Objective: This study evaluated the efficacy of an integrated VR and tDCS treadmill training protocol in improving gait and mobility outcomes among individuals with chronic stroke.

Methods: Five chronic stroke patients were recruited for this study. Participants were randomly assigned to receive either anodal tDCS or sham stimulation in conjunction with VR treadmill training. The anodal stimulation was targeted at the ipsilesional motor cortex, specifically over the primary motor cortex (M1) area corresponding to the C3/C4 locations in the 10-20 EEG system. The intervention consisted of 10 30-min sessions over 2 weeks. Clinical assessments, including the Dynamic Gait Index (DGI), Berg Balance Scale (BBS), 10-meter Walk Test (10MWT), and the Timed Up and Go Test (TUG) were conducted pre-intervention, immediately post-intervention, and at a 2-week follow-up.

Results: All participants demonstrated improvements in the clinical measures post-intervention, irrespective of whether they received anodal tDCS or sham stimulation. Notably, clinically significant improvements, defined by an improvement greater or equal to the established minimal clinically important differences (MCIDs), were observed in DGI scores for four participants, suggesting enhanced gait functionality.

Conclusion: The combined VR and tDCS interventions promise to improve gait and mobility in chronic stroke survivors. While the observed improvements were not distinctly attributed to tDCS, the role of VR training was notably beneficial. These preliminary findings underscore the potential of integrating emerging technologies in stroke rehabilitation and highlight the need for future research with larger cohorts to explore the distinct contributions of each modality and validate this integrative approach.

Introduction: As stroke incidence rises with an aging population, hypertension remains a critical modifiable risk factor for both primary and secondary stroke prevention. Effective management of hypertension post-stroke requires a shift from fragmented care to integrated, patient-centered approaches. This study explores the perspectives of stroke survivors and healthcare professionals on hypertension management and evaluates the acceptability of innovative strategies, including 24-h ambulatory blood pressure monitoring (ABPM).

Methods: A qualitative study using grounded theory methodology was conducted through focus group interviews with stroke survivors and healthcare professionals in Wales and Scotland between January 2019 and December 2022. Participants included 48 individuals representing diverse backgrounds and experiences. Data were analyzed thematically to identify barriers and facilitators in hypertension management post-stroke.

Results: Key findings identified four major themes: the need for improved cooperation among multidisciplinary teams, knowledge gaps in stroke survivors regarding hypertension's role in stroke risk, the complexities of polypharmacy, and the potential benefits of ABPM for individualized care. Stroke survivors expressed a reliance on clinicians for hypertension management, while healthcare professionals emphasized the importance of empowering patients through education and self-management. ABPM emerged as a promising tool to enhance hypertension monitoring and support patient engagement, though practical challenges remain.

Discussion: The study underscores the importance of integrating patient education, multidisciplinary care, and advanced monitoring techniques like ABPM into hypertension management. Strengthening communication pathways between patients and healthcare providers can foster greater patient engagement and accountability. Addressing socio-economic barriers, improving patient-clinician communication, and implementing holistic care strategies are critical for reducing recurrent stroke risk. These findings emphasize the need for systemic reforms and targeted interventions to bridge gaps in hypertension care delivery post-stroke.

A 21-year-old Caucasian woman was admitted to our neurologic intermediate care unit after attempting suicide by ingesting an estimated 15 g venlafaxine (Trevilor retard^®), adding up to a serum concentration of approximately 17,943 μg/l. Brain magnetic resonance imaging (MRI) revealed bilateral cortical restricted-diffusion patterns, indicating ischemic lesions. We report a case of venlafaxine-induced serotonin syndrome most likely cumulating in diffuse artery vasospasm due to an autonomic effect mediated by the serotonergic and adrenergic systems, causing myocardial and cerebral injuries. The serotonin syndrome was treated symptomatically by administering fluids and benzodiazepines and managing the hyperthermia using paracetamol; also, medication with venlafaxine was stopped, and the hypoglycemia was treated. After 6 days, our patient was discharged to the psychiatric facility with no remaining neurologic deficit. The case report provides evidence of ischemic stroke as a rare adverse event of venlafaxine intoxication. Furthermore, we aim to increase awareness of hypoglycemia and epileptic seizures as complications of venlafaxine intoxication. In addition, we demonstrate important pitfalls in the diagnostic procedure and propose a treatment regimen for the underlying serotonin syndrome.

Empirical studies evaluating stroke team rehabilitation interventions from a sustainability perspective are scarce. This paper highlights the significant role of multidisciplinary stroke team rehabilitation in promoting sustainable healthcare by applying principles of sustainable healthcare. Climate change and air pollution are significant risk factors for stroke and other cardiovascular diseases. Healthcare contributes to 5% of global CO₂ emissions, exacerbating the disease burden associated with climate change. The vulnerability of individuals with disabilities to climate change has been highlighted, calling for global collaboration to address climate justice and health equity. This paper argues that multidisciplinary stroke team rehabilitation is essential for achieving sustainable stroke care, optimizing patient functioning, and contributing to all principles of sustainable healthcare: prevention, patient empowerment, lean pathways, low carbon alternatives, and efficient resource use. Timely assessments and dose-specific interventions are crucial for successful outcomes, providing significant co-benefits for healthcare resource use. Enhancing self-management and patient empowerment reduces healthcare utilization without compromising health outcomes. Telerehabilitation increases accessibility to healthcare services, particularly where transportation is challenging, and complements hospital-based procedures. Preventive healthcare activities, with their low carbon footprint, offer strong incentives for optimizing secondary prevention in stroke. Overall, multidisciplinary stroke team rehabilitation aligns with all sustainable healthcare principles, reducing overall healthcare consumption through optimized functioning and health. Increased investment in rehabilitation resources leads to better quality of care and reduced long-term resource use. By integrating sustainable practices, stroke team rehabilitation can significantly contribute to sustainable healthcare, addressing both human and planetary health.

With improvements in acute stroke treatment and more patients surving the acute stroke period, the identification and prognostication of post-stroke disability is paramount. Post-stroke cognitive impairment and dementia (PSCID) severely impacts the morbidity and mortality of stroke survivors. While clinical factors and imaging are useful in identifying patients at risk for PSCID, blood-based biomarkers are sorely needed to provide cost-effective identification and prognostication for patients at greatest risk. Furthermore, blood-based biomarkers can inform the biologic basis for PSCID and lead to potential treatment targets. This narrative review attempts to summarize currently available research on the use of fluid biomarkers to measure and quantify PSCID using a framework proposed for use in the DISCOVERY Network study of PSCID. In this framework, blood biomarkers are divided into broad pathologic categories including inflammation, neurodegeneration, neuroaxonal injury, and vascular injury. Key biomarkers that have been proposed as relevant to PSCID include interleukin-6, C-reactive protein, β-amyloid 42:40 ratio, neurofilament light chain, and 10 angiogenic molecules. Critical to the assessment of prior studies includes defining the sample collection period and cognitive assessment period of prior studies to assess the temporal pattern of biomarker levels in relation to an incident stroke event. In addition to this comprehensive review, we performed a protein-protein network analysis of the putative blood biomarkers for PSCID and (surprisingly) find they exist in a highly connected protein-protein interaction network centered on inflammatory and neurodegenerative biomarkers suggesting shared biology underlies the pathogenesis of PSCID. Both the literature and this network analysis point to a role for the use of combinatorial blood biomarkers as a methodology to enhance the specificity and sensitivity of putative prognostic biomarkers for PSCID. This review highlights the emerging role for blood biomarkers in evaluating risk for PSCID while also informing the underlying biology that creates synergy between stroke and dementia.

Introduction: Aphasia, a communication disorder often resulting from stroke, can have profound impacts on both health outcomes and financial wellbeing. While the physical and cognitive consequences of stroke are well documented, the financial strain, or "financial toxicity," associated with managing chronic conditions like aphasia remains underexplored. Furthermore, financial toxicity is not experienced equally across racial and ethnic groups, with disparities driven by socioeconomic factors, access to healthcare, and structural inequities. This study compares the financial toxicity of people with aphasia (PWA) to those with stroke alone, examining differences across racial and ethnic groups to highlight disparities in economic burden.

Methods: This study utilized data from the Medical Expenditure Panel Survey (MEPS) collected between 2018 and 2021 to examine the financial toxicity of PWA compared to those with stroke only. Financial toxicity was assessed using self-reported income and wealth data from the MEPS. Individual-level income and wealth values were calculated from the self-reported financial data to quantify the financial burden. Fixed effects regression models were employed to account for unobserved individual heterogeneity, controlling for time-invariant characteristics. Interaction terms were included in the models to capture the differential financial impacts of aphasia on Black and Hispanic individuals, compared to other racial and ethnic groups. The analysis examined both within-group and between-group differences in financial toxicity, highlighting potential racial and ethnic disparities among those affected by aphasia.

Results: Approximately 18.71% (N = 281) of respondents who reported having a stroke also had aphasia. After controlling for demographic, health, and household characteristics, PWA had 21% lower income and 7% lower wealth compared to stroke survivors without aphasia. Aphasia had a disparate impact on the income (-29%) and wealth (-24%) of Black stroke survivors. These findings were consistent across different model specifications, highlighting the robustness of the results indicating racial inequity in the financial toxicity of post-stroke aphasia.

Conclusion: This study showed the financial impact of post-stroke aphasia and the disparate burden among Black PWA. The findings highlight the need to address the financial ramifications of post-stroke morbidities such as aphasia among vulnerable populations.

Introduction: Nigeria has the highest proportion of children with sickle cell anemia (SCA) globally; without transcranial Doppler screening and ongoing treatment (regular blood transfusions or hydroxyurea therapy), 10% will have a stroke in childhood. In low-resource settings, training to recognize and prevent strokes in children with SCA is vital. A sustainable Sickle Cell Disease Stroke Prevention Teams program was established, as part of clinical trials, to address the need for stroke care in northern Nigeria. We describe our health professional stroke training curriculum and specific application to detect strokes in clinical trials in low-resource settings.

Methods: Children aged 5-12 and 2-16 years with SCA in northern Nigeria were enrolled in the SPRING and SPRINT primary and secondary stroke prevention trials, respectively. The primary outcome measure in both trials was a clinical stroke based on the World Health Organization definition. Non-neurologist physicians were trained in-person and via video lectures regarding stroke recognition, performing neurological examinations using the adapted Pediatric NIH Stroke Scale, and acute stroke care. Central stroke adjudicators, two pediatric neurologists, reviewed the case report forms and recorded videos of the neurological examinations.

Results: Six physicians completed the curriculum at three sites and were certified to detect strokes. Of 20 children with suspected stroke, 8 and 11 children had acute initial or acute recurrent strokes confirmed in the SPRING (N = 220) and SPRINT (N = 101) trials, respectively. The concordance rate between local stroke diagnoses and the central stroke adjudication process was 95% (19 of 20). One child presented with non-specific symptoms and hypertonia and was mislabeled locally as an acute stroke.

Discussion: A curriculum to train healthcare providers in pediatric acute stroke recognition and care in a low-resource setting is feasible and sustainable. We successfully identified strategies for task shifting from a single pediatric neurologist in the region to multiple non-neurologist physicians.

Stroke is a leading cause of death and disability globally, with significant long-term impacts such as post-stroke cognitive impairment (PSCI). PSCI affects up to one-third of stroke survivors, substantially increasing their risk of dementia, especially after recurrent strokes. Despite advances in acute stroke treatments, the mechanisms underlying PSCI remain poorly understood. Emerging evidence highlights that PSCI arises from a complex interplay of vascular damage, neurodegenerative pathologies, and chronic inflammation. This review explores the epidemiology and clinical characteristics of PSCI, emphasizing the role of age, education, vascular integrity, and comorbidities such as diabetes. Additionally, we examine experimental findings that utilize rodent models to elucidate the time course and biological mechanisms of PSCI. Notable contributions include insights from transgenic Alzheimer's disease (AD) mouse models, revealing how vascular and amyloid pathologies accelerate cognitive decline post-stroke. Moreover, studies on neuroinflammation and immune responses, such as those involving TREM2, underscore the significance of inflammatory pathways in PSCI. By integrating clinical and experimental findings, this literature review provides a comprehensive understanding of PSCI mechanisms, offering a foundation for developing targeted diagnostic tools and therapeutic interventions to mitigate the long-term cognitive effects of stroke.