Frontiers in stroke最新文献

Objective: This study aimed to determine whether brain volume at the time of ischemic stroke injury is a better biomarker for predicting functional outcomes than brain atrophy.

Background: Brain parenchymal fraction (BPF) has been used as a surrogate measure of global brain atrophy and a neuroimaging biomarker of brain reserve in studies evaluating clinical outcomes after brain injury. Brain volume itself is affected by natural aging, cardiovascular risk factors, and biological sex, among other factors. Recent studies have shown that brain volume at the time of injury can influence functional outcomes, with larger brain volumes being associated with better outcomes.

Methods: Acute ischemic stroke cases at a single center between 2003 and 2011, with neuroimaging obtained within 48 h of presentation were eligible for the study. Functional outcomes represented by the modified Rankin Scale (mRS) score at 90 days post-admission (mRS score ≤ 2 deemed a favorable outcome) were obtained through patient interviews or per chart review. Deep learning-enabled automated segmentation pipelines were used to calculate brain volume, intracranial volume, and BPF on the acute neuroimaging data. Patient outcomes were modeled through logistic regressions, and a model comparison was conducted using the Bayes information criterion (BIC).

Results: A total of 467 patients with arterial ischemic stroke were included in the analysis, with a median age of 65.8 years and 65.3% of the participants being male. In both models, age and a larger stroke lesion volume were associated with worse functional outcomes. Higher BPF and a larger brain volume were associated with favorable functional outcomes; however, a comparison of both models suggested that the brain volume model (BIC = 501) better explains the data than the BPF model (BIC = 511).

Conclusion: The extent of global brain atrophy (and its surrogate biomarker BPF) has been regarded as an important biomarker for predicting functional post-stroke outcomes and resilience to acute injury. In this study, we demonstrate that a higher global brain volume at the time of injury better explains favorable functional outcomes, which can be directly measured in a clinical setting.

Purpose: Prospective studies on vascular vertigo and dizziness (VVD) due to vertebrobasilar transient ischemic attack (VBTIA) have been sparse. This study aimed to characterize clinical features, response to treatments, and prognostic factors of VVD due to VBTIA using a cohort established in 2021.

Methods: We recruited 103 patients (58 female individuals, 56.3%), with a mean age of 70.9 ± 9.3 years (range = 37-85), between January 2021 and January 2024. All patients met the diagnostic criteria of "Probable transient VVD" published by the Bárány Society. The mean interval from symptom onset to recruitment was 11.8 months (range = 0.5-72). Treatments followed the current American Heart Association-American Stroke Association's Guidelines for Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Patients with recurrent strokes among TIAs, and patients who were already taking an antithrombotic agent and should maintain the same regimen were excluded.

Results: Imbalance (46.7%) and vertigo (39.8%) were the most frequent symptoms. The duration of attacks was <1 min in 35 patients (33.9%), 1-10 min in 34 patients (33.0%), 10-60 min in 15 patients (14.6%), and >60 min in 19 patients (18.5%). Trigger factors were reported in 20 patients (19.4%), which included eccentric neck position in 12 patients (11.7%), physical exercise in four patients (3.9%), positional changes in three patients (2.9%), and eccentric neck position and physical exercise in the remaining patient (0.9%). The frequency of attacks before the medication was 1 or <1/month in 32 (31.0%) patients, 1-4/month in 44 (42.7%) patients, 4-8/month in 21 patients (20.4%), and daily in six patients (5.9%). The treatment regimens were aspirin in 57 patients (55.3%), clopidogrel in 19 patients (18.5%), aspirin plus clopidogrel in 25 patients (24.3%), and rivaroxaban in two patients (1.9%). The attacks were reduced by 93.2% [IC 95% (88.34, 98.06), number needed to treat: 1] during the median follow-up of 12 months (range = 2-36 months). Only seven (6.8%) patients experienced a new attack with the medication. No prognostic factors could be identified for the recurrences.

Conclusion: VVD due to VBTIA has a broad clinical spectrum. Secondary stroke prevention is effective in VVD due to VBTIA even though no prognostic factors could be identified for symptom recurrence.

Introduction: Encouraging the activation of brain repair mechanisms and fostering spontaneous functional recovery in stroke patients hold great promise for alleviating the global burden of this condition and allowing an extended therapeutic time window. Cell-based regenerative therapy (with mesenchymal stem/stromal cells, such as adipose-derived stem cells [ADSCs]) is particularly attractive considering its excellent safety profile, low immunogenicity after allogeneic application, and well-established functional benefits on stroke recovery in animal models. This study aims to assess the efficacy and safety effects of intravenous (IV) infusion of freshly cultured allogeneic ADSCs on recovery after ischemic stroke.

Population and methods: RESSTORE is a multicentric, randomized 1:1 controlled double-blind clinical trial. Eighty patients will be enrolled in nine French stroke centers. The main inclusion criteria are ≥18 years of age, acute hemispheric ischemic stroke, and a National Institutes of Health Stroke Scale (NIHSS) score of ≥7, including a motor subscore of ≥3. According to the previous dose-escalation safety trial data, the maximum tolerated dose of 3 million ADSCs/kg was selected. IV infusion was performed within 10 days following stroke onset, with a follow-up over 2 years.

Outcomes: The primary endpoint is the motor NIHSS subscore, computed as the sum of the upper limb, lower limb, and hand scores, measured 6 months after stroke onset to assess motor recovery. The secondary outcomes are the occurrence of death/serious adverse events, clinical scores (the detailed NIHSS scores, Montreal Cognitive Assessment scores, modified Rankin Scale scores, Aphasia Handicap Scores, Depression Intensity Scale Circles scores, Fatigue Scale scores, etc.), immune monitoring (for the first 30 patients), and multimodal biomarkers derived from diffusion and functional magnetic resonance imaging.

Discussion: This study may provide some evidence for the effects of freshly cultured allogenic ADSCs IV infusion in subacute stroke that may help design a larger international randomized controlled trial.

Clinical trial registration: https://clinicaltrials.gov/, identifier: NCT03570450.

Background: Intracranial hemorrhage due to a ruptured aneurysm is one of the most serious neurosurgical emergencies. The patient mostly presents with severe headaches and neurological deterioration. A rapid diagnosis and an interdisciplinary approach play a major role in the fate of these patients. The treatment can vary from endovascular to surgical and must be carefully and individually planned. Neurovascular expertise and an interdisciplinary approach are of vital importance and obligatory for the best possible outcome.

Methods: In this narrative review, we scrutinize the current literature and discuss the actual data and guidelines in order to emphasize the importance of the interdisciplinary expertise and approach in patients with ruptured intracranial aneurysm.

Results: The current approach to patients with ruptured aneurysm is inhomogeneous and often ineffective due to internal disputes between different disciplines. Although there is plenty of literature and hard evidence to "show the way," many still choose to base their decisions on personal experience or opinion.

Conclusions: Every ruptured brain aneurysm should be approached in an interdisciplinary manor and treated according to the current evidence and guidelines.

Introduction: Sickle Cell Disease (SCD) ranks among the most prevalent genetic disorders globally. The incidence in sub-Saharan African countries has been estimated to be 230.000/y with a high prevalence (1%) in the Democratic Republic of Congo (DRC). Stroke is a significant complication of Sickle Cell Disease (SCD), and carries a high risk of disability and mortality. Transcranial Doppler (TCD) is currently the non-invasive exploration recommended for the prevention of stroke in young SCD patients.

Objective: To determine the prevalence of pathological TCD in a population of young Congolese SCA patients and to assess its association with hematological parameters.

Population and methods: This cross sectional study was carried out on 150 Congolese SS homozygous children between the ages 2-16 years old (mean age: 8.5 ± 4.0 years) in stable condition, and followed from January 1 to December 31, 2013. TCD was performed using the STOP I method in the main cerebral arteries. The risk of stroke was absent when the average maximum speed during a cycle (TAMMV) in middle cerebral artery (MCA) was < 170 cm/s, but present when TAMMV was borderline or conditional for values between 170 and 199 cm/s and pathological for values ≥ 200 cm/s.

Results: The prevalence of pathological TCD was 4% while the conditional TCD prevalence was 10%. The Mean blood velocity in MCA was 114.0 cm/s. There was a significant difference in the means of WBC (p = 0.003), Hb (p < 0.001), Hct (p < 0.001), MCV (p = 0.005) parameters when comparing normal and at risk TCD (conditional and abnormal). However, no significant association was found for the categorical corresponding parameters.

Conclusion: Globally, 14% of patients were at risk of stroke, hence the interest in integrating TCD in the routine monitoring of children with SCD in order to prevent overt stroke by implementing a chronic blood transfusion program or the use of hydroxycarbamide.

Background: Stroke survivors who receive more rehabilitation therapy achieve better functional outcomes. The amount of rehabilitation that patients receive is, however, limited due to constraints of the healthcare system.

Objective: To assess whether EngageHealth, a mobile device application designed to deliver stroke rehabilitation exercises using asynchronous video recordings, increases the amount of outpatient rehabilitation in stroke patients and improves their upper extremity function and quality of life.

Design: Prospective single-arm study consisting of a 2-week pre-intervention phase without EngageHealth followed by a 4-week intervention period with EngageHealth.

Setting: Ambulatory care.

Participants: Twenty-four stroke patients with upper extremity impairment were recruited at the Stanford Stroke Center outpatient clinic.

Interventions: Participants were instructed to use the EngageHealth application daily.

Main outcome measures: Adherence, user experience, and change in the upper extremity Fugl-Meyer (UE-FM), Quality of Life in Neurological Disorders (Neuro-QoL), and Stroke Impact Scale (SIS).

Results: Of 23 participants, five (22%) used the application for 17 days, six (26%) used the application for 9-16 days, and 12 (52%) used it < 9 days. Sixty-three percent of participants would recommend the application to other stroke survivors, with fifty percent indicating they would continue using the application, if available. During the pre-intervention phase, there were no changes in hand function. During the intervention period, participants improved by 4 points on the UE-FM (P < 0.01), and 15 points in the hand-function domain of SIS (P = 0.03). Videos of participants' exercises were successfully recorded, allowing the clinician to review videos of the participants' completed tasks asynchronously. In-depth interviews revealed that participants viewed the EngageHealth application favorably, and that their perceived usefulness of the exercises affected their motivation.

Conclusions: Use of the EngageHealth application in the home environment may improve upper extremity function in subacute/chronic stroke patients. Additional support strategies should be implemented in future studies to improve adherence. These findings from a prospective single-arm study, support the design of a randomized controlled trial to determine the efficacy of long-term use of the EngageHealth application.

Background: Patients with a positive prehospital stroke severity score and underlying intracerebral hemorrhage (ICH) may be harmed by longer onset-to-admission time. We aimed to investigate the interaction between ICH severity and time from onset to admission on functional outcome.

Methods: This is an individual patient data analysis with data from two randomized prehospital stroke trials using the same prehospital stroke scale. Patients were stratified according to the presence of a positive stroke severity score. They were grouped into early arrivers (admitted ≤ 90 min from onset) and late arrivers (admitted ≥90 min after onset). The primary outcome was a shift toward a better functional outcome on the modified Rankin Scale (mRS).

Results: A total of 212 patients had ICH. A positive stroke severity score was seen in 123 of these patients. Patients with ICH and a positive prehospital stroke severity score had a significantly worse outcome if they arrived 90 min or later at the hospital (adjusted odds ratio [aOR]: 2.02, 95% CI [1.01, 4.12]). This difference was not observed in patients without a positive severity score (aOR: 0.50, 95% CI [0.22, 1.14]). Patients with a positive score also had an increased risk of death or severe dependency (mRS of 5-6) of 9.1 percentage points (95% CI [-1.6%, 19.8%]) per hour if they were diagnosed with ICH.

Conclusion: Longer onset-to-admission time was harmful for patients with ICH and a positive prehospital stroke severity score.

Introduction: Posterior circulation stroke can lead to ataxia, manifesting in a loss of coordination and balance. Patients experience difficulty in activities of daily living and an increased risk of falling, both profoundly affecting quality of life. In individuals with neurodegenerative diseases, coordination exercises have been shown to lead to a reduction in ataxic symptoms. There is, however, limited evidence on the effect of physical therapy, specifically coordination exercises in patients with stroke-related ataxia. We therefore present a study protocol for a prospective trial.

Methods: The purpose of this trial is to investigate the effects of coordination exercises compared to standard physiotherapy on balance and walking in ataxic stroke patients. Therefore, a prospective, single-blinded randomized controlled trial is currently ongoing at the Clinical Department of Neurology, Medical University of Innsbruck, Austria, in collaboration with two local rehabilitation facilities in Austria, Hochzirl Hospital and the Clinic for Rehabilitation Münster. Balance is the primary outcome of the study as assessed using the Berg Balance Scale. Secondary outcomes are concerned with walking, risk and number of falls, independence in daily life, and quality of life, rated using appropriate scales and scores. Patients are allocated applying a 1:1 ratio and a stratified block randomization. In both groups recruited individuals undergo five 45-min treatment sessions per week, totaling 20 sessions of coordination exercises (IG) or standard physiotherapy (CG) over the course of 4 weeks. Data is collected at the baseline (T0), after the 4-week supervised practice (T1), and after another 8 weeks of independent home-based training (T2).

Discussion: This is the first randomized controlled trial investigating the effects of coordination exercises on balance and walking in people with stroke-related ataxia. As stroke guidelines emphasize the limited evidence of treatment for ataxic symptoms, this study aims to contribute further knowledge regarding tailored interventions for these patients.

Clinical trial registration: German Clinical Trials Registry (drks.de). Identifier: DRKS00020825.