Pub Date : 2024-04-02DOI: 10.1177/25166085241234721
Kshitij Bansal, V. Sardana, Bharat Bhushan, Dilip Maheshwari
Background: Cerebral Venous Thrombosis (CVT), accounting for 3% of strokes, can be assessed using non-invasive Transcranial Doppler (TCD) ultrasound to measure cerebrovascular function in real-time. The TCD-derived pulsatility index (PI), highly correlates with intracranial pressure (ICP) and serves as a reliable non-invasive monitoring tool. Aim: This study aims to correlate PI by TCD with clinical outcomes in CVT patients. Methods: A prospective observational study of 41 CVT patients admitted between June 2022 to December 2022 was conducted in the Department of Neurology of MBS Hospital. Each patient was subjected to TCD and the PI was also recorded. The results were analysed with SPSS. Results: Out of the 41 patients, two patients died and 39 patients were discharged. The PI at admission in the left middle cerebral artery (MCA) was 1.19 ± 0.20 amongst discharged and 1.64 ± 0.10 amongst those who died ( p = .003). Similarly, the PI at admission in the right MCA was 1.23 ± 0.21 amongst those discharged and 1.63 ± 0.20 amongst those who died ( p = .02). Also, PI in both left and right MCA positively and significantly correlated with CVT GS score at admission (r = 0.70, p < .05; r = 0.64, p < .05). Conclusion: PI at admission is both right and left MCA was found to be significantly higher in patients who died during the hospital stay. Also, PI significantly correlated with the CVT GS score at the presentation. Thus, PI at admission by TCD can predict the clinical outcome of patients with CVT.
{"title":"A Study of the Correlation of Pulsatility Index by Transcranial Doppler in the Clinical Outcome of Patients with Cerebral Venous Sinus \u2028Thrombosis","authors":"Kshitij Bansal, V. Sardana, Bharat Bhushan, Dilip Maheshwari","doi":"10.1177/25166085241234721","DOIUrl":"https://doi.org/10.1177/25166085241234721","url":null,"abstract":"Background: Cerebral Venous Thrombosis (CVT), accounting for 3% of strokes, can be assessed using non-invasive Transcranial Doppler (TCD) ultrasound to measure cerebrovascular function in real-time. The TCD-derived pulsatility index (PI), highly correlates with intracranial pressure (ICP) and serves as a reliable non-invasive monitoring tool. Aim: This study aims to correlate PI by TCD with clinical outcomes in CVT patients. Methods: A prospective observational study of 41 CVT patients admitted between June 2022 to December 2022 was conducted in the Department of Neurology of MBS Hospital. Each patient was subjected to TCD and the PI was also recorded. The results were analysed with SPSS. Results: Out of the 41 patients, two patients died and 39 patients were discharged. The PI at admission in the left middle cerebral artery (MCA) was 1.19 ± 0.20 amongst discharged and 1.64 ± 0.10 amongst those who died ( p = .003). Similarly, the PI at admission in the right MCA was 1.23 ± 0.21 amongst those discharged and 1.63 ± 0.20 amongst those who died ( p = .02). Also, PI in both left and right MCA positively and significantly correlated with CVT GS score at admission (r = 0.70, p < .05; r = 0.64, p < .05). Conclusion: PI at admission is both right and left MCA was found to be significantly higher in patients who died during the hospital stay. Also, PI significantly correlated with the CVT GS score at the presentation. Thus, PI at admission by TCD can predict the clinical outcome of patients with CVT.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753260","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 : 2024-03-28DOI: 10.1177/25166085241235989
M. Mengnjo, L. Ngarka, F. Yepnjio, Leonard Nfor Njamnshi, Stephanie Laure Mintya Oba, Alfred K. Njamnshi
Cerebrovascular accidents (CVA) remain one of the major causes of disabilities and mortality worldwide. In the young, carotid artery dissection (CAD) accounts for close to one-quarter of ischaemic strokes, occurring either spontaneously or due to a traumatic mechanism such as strangulation. We hereby, report a case of a young adult with large-vessel occlusion due to post-strangulation internal CAD. This case highlights the importance of raising awareness of the possibility of CAD in the presence of any focal neurologic deficit due to strangulation.
{"title":"Acute Ischaemic Stroke in a Young Adult in Sub-Saharan Africa: A Case Report of Post-strangulation Carotid Artery Dissection","authors":"M. Mengnjo, L. Ngarka, F. Yepnjio, Leonard Nfor Njamnshi, Stephanie Laure Mintya Oba, Alfred K. Njamnshi","doi":"10.1177/25166085241235989","DOIUrl":"https://doi.org/10.1177/25166085241235989","url":null,"abstract":"Cerebrovascular accidents (CVA) remain one of the major causes of disabilities and mortality worldwide. In the young, carotid artery dissection (CAD) accounts for close to one-quarter of ischaemic strokes, occurring either spontaneously or due to a traumatic mechanism such as strangulation. We hereby, report a case of a young adult with large-vessel occlusion due to post-strangulation internal CAD. This case highlights the importance of raising awareness of the possibility of CAD in the presence of any focal neurologic deficit due to strangulation.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140368802","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 : 2024-03-27DOI: 10.1177/25166085241235729
Helen Rynor, Kelly Nguyen, Jadthiel Oliva, Lisa Nirvanie-Persaud, Starlie C. Belnap, Felipe De Los Rios La Rosa
Background: Females are disproportionately affected by strokes when compared to males. This may be attributed to non-traditional stroke symptoms in females and stroke care sex variance. This study explored sex and ethnicity discrepancies in the FAST-ED and stroke outcomes. Methods: An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored patient outcomes. We assessed two cohorts, the 2017 cohort collected one year after FAST-ED implementation, and the 2019 cohort collected two years after FAST-ED implementation. Inclusion criteria included patients aged ≥18 years arriving via EMS as a stroke alert; walk-ins were excluded. EMS FAST-ED compliance, FAST-ED score, final diagnoses, door to needle time (DTN), door to puncture (DTP) time, and stroke treatment volumes were evaluated for sex differences. Results: 1,156 cases were analyzed, 638 (55%) were female. EMS FAST-ED compliance decreased by 17%, but did not differ by sex or ethnicity. EMS FAST-ED score was similar for females and males. Despite the similarity in FAST-ED score, females scored higher on the initial NIHSS ( F(1) = 6.25, p < .05) and discharge NIHSS ( F(1) = 8.588, p < .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p < .01, 95% CI [1.07–1.80]). Treatment rates did not vary between sex or ethnicity and overall DTN decreased by 10 minutes (2017 cohort M = 36 minutes, SE = 1.96; 2019 cohort M = 26 minutes, SE = 1.69). Conclusions: The FAST-ED demonstrated equitable implementation and scoring among a diverse population, regardless of sex or ethnicity. Additionally, patients were equally likely to receive treatment, while benefiting from a decrease in DTN times.
{"title":"The Effect of Biological Sex on a County Pre-hospital Stroke Initiative","authors":"Helen Rynor, Kelly Nguyen, Jadthiel Oliva, Lisa Nirvanie-Persaud, Starlie C. Belnap, Felipe De Los Rios La Rosa","doi":"10.1177/25166085241235729","DOIUrl":"https://doi.org/10.1177/25166085241235729","url":null,"abstract":"Background: Females are disproportionately affected by strokes when compared to males. This may be attributed to non-traditional stroke symptoms in females and stroke care sex variance. This study explored sex and ethnicity discrepancies in the FAST-ED and stroke outcomes. Methods: An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored patient outcomes. We assessed two cohorts, the 2017 cohort collected one year after FAST-ED implementation, and the 2019 cohort collected two years after FAST-ED implementation. Inclusion criteria included patients aged ≥18 years arriving via EMS as a stroke alert; walk-ins were excluded. EMS FAST-ED compliance, FAST-ED score, final diagnoses, door to needle time (DTN), door to puncture (DTP) time, and stroke treatment volumes were evaluated for sex differences. Results: 1,156 cases were analyzed, 638 (55%) were female. EMS FAST-ED compliance decreased by 17%, but did not differ by sex or ethnicity. EMS FAST-ED score was similar for females and males. Despite the similarity in FAST-ED score, females scored higher on the initial NIHSS ( F(1) = 6.25, p < .05) and discharge NIHSS ( F(1) = 8.588, p < .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p < .01, 95% CI [1.07–1.80]). Treatment rates did not vary between sex or ethnicity and overall DTN decreased by 10 minutes (2017 cohort M = 36 minutes, SE = 1.96; 2019 cohort M = 26 minutes, SE = 1.69). Conclusions: The FAST-ED demonstrated equitable implementation and scoring among a diverse population, regardless of sex or ethnicity. Additionally, patients were equally likely to receive treatment, while benefiting from a decrease in DTN times.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375937","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 : 2024-03-03DOI: 10.1177/25166085241231640
Shafaq Saleem, S. Hameed, Mohammad Wasay
The coronavirus disease-2019 (COVID-19) pandemic has been a major threat to global health. It primarily affects the respiratory system but multiple organs, including the nervous system, can be affected. Cerebral venous thrombosis (CVT) has been reported among COVID-19 patients as well as among recipients of COVID vaccines. CVT often remains a diagnostic challenge due to highly variable clinical presentation. We underwent a thorough narrative review of the published literature from January 2020 to April 2023 in the Medline (PubMed) database. Our search led to 66 studies in total, 30 related to COVID-CVT and 36 related to COVID vaccine-CVT. We further looked for differences between these COVID-CVT and COVID vaccine-associated-CVT and their possible pathophysiology, treatment options, and prognosis. A few things that were highlighted during our search: COVID increases CVT risk and can happen without respiratory manifestations. COVID-CVT is more common in middle-aged men and has a higher morality compared to traditional non-COVID-CVT. COVID vaccines also increase the risk of CVT but less than the COVID infection. COVID vaccine-CVT is further divided into two groups having either normal platelets or low platelets. The latter group is better reported and has a higher inpatient mortality and disability at discharge but these patients usually recover well in the follow-up period. Non-heparin anticoagulation, immunomodulation, and surgery are the main treatment options.
{"title":"COVID and Vaccine-related Cerebral Venous Thrombosis","authors":"Shafaq Saleem, S. Hameed, Mohammad Wasay","doi":"10.1177/25166085241231640","DOIUrl":"https://doi.org/10.1177/25166085241231640","url":null,"abstract":"The coronavirus disease-2019 (COVID-19) pandemic has been a major threat to global health. It primarily affects the respiratory system but multiple organs, including the nervous system, can be affected. Cerebral venous thrombosis (CVT) has been reported among COVID-19 patients as well as among recipients of COVID vaccines. CVT often remains a diagnostic challenge due to highly variable clinical presentation. We underwent a thorough narrative review of the published literature from January 2020 to April 2023 in the Medline (PubMed) database. Our search led to 66 studies in total, 30 related to COVID-CVT and 36 related to COVID vaccine-CVT. We further looked for differences between these COVID-CVT and COVID vaccine-associated-CVT and their possible pathophysiology, treatment options, and prognosis. A few things that were highlighted during our search: COVID increases CVT risk and can happen without respiratory manifestations. COVID-CVT is more common in middle-aged men and has a higher morality compared to traditional non-COVID-CVT. COVID vaccines also increase the risk of CVT but less than the COVID infection. COVID vaccine-CVT is further divided into two groups having either normal platelets or low platelets. The latter group is better reported and has a higher inpatient mortality and disability at discharge but these patients usually recover well in the follow-up period. Non-heparin anticoagulation, immunomodulation, and surgery are the main treatment options.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140080930","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 : 2024-02-29DOI: 10.1177/25166085241232510
M. V. P. Srivastava, M. Mehndiratta, Subhash Kaul, N. Ichaporia, P. Sylaja, M. Pradeep, Anand Alurkar, Deepak Arjundas, Jayanta Roy, Jeyraj Pandian, S. M. Sundaram, Anshu Rohatgi, Arvind Sharma, P. Vijaya, Ankush Gaikwad, Sachin Suryavanshi
The stroke burden in India is alarmingly high compared to Western industrialised countries, necessitating immediate action to develop stroke systems of care. Tailored stroke-prevention strategies, adequate resource allocation for stroke management and research, and increased awareness of specialised care in acute Stroke are critical. The COVID-19 pandemic has underscored the need for improved healthcare delivery and infrastructure. To address the rising stroke burden in India, comprehensive strategies encompassing prevention, awareness, specialised care and governmental support are urgently required. While the concept of ‘stroke-ready centres’ has emerged, their limited availability hinders widespread benefits. This expert consensus examines the current state of stroke care in India, identifies challenges, and proposes strategies to enhance stroke care systems. It offers valuable insights into stroke management at different levels, empowering healthcare professionals and administrators to assess their existing systems and make necessary improvements. Special attention is given to the role of physicians, including the use of thrombolytic therapies like Tenecteplase, in reducing the stroke burden and improving outcomes across the country. Significant strides can be made in stroke management and care in India by addressing these critical areas.
{"title":"Expert Consensus on Improving Stroke Care Ecosystem in India","authors":"M. V. P. Srivastava, M. Mehndiratta, Subhash Kaul, N. Ichaporia, P. Sylaja, M. Pradeep, Anand Alurkar, Deepak Arjundas, Jayanta Roy, Jeyraj Pandian, S. M. Sundaram, Anshu Rohatgi, Arvind Sharma, P. Vijaya, Ankush Gaikwad, Sachin Suryavanshi","doi":"10.1177/25166085241232510","DOIUrl":"https://doi.org/10.1177/25166085241232510","url":null,"abstract":"The stroke burden in India is alarmingly high compared to Western industrialised countries, necessitating immediate action to develop stroke systems of care. Tailored stroke-prevention strategies, adequate resource allocation for stroke management and research, and increased awareness of specialised care in acute Stroke are critical. The COVID-19 pandemic has underscored the need for improved healthcare delivery and infrastructure. To address the rising stroke burden in India, comprehensive strategies encompassing prevention, awareness, specialised care and governmental support are urgently required. While the concept of ‘stroke-ready centres’ has emerged, their limited availability hinders widespread benefits. This expert consensus examines the current state of stroke care in India, identifies challenges, and proposes strategies to enhance stroke care systems. It offers valuable insights into stroke management at different levels, empowering healthcare professionals and administrators to assess their existing systems and make necessary improvements. Special attention is given to the role of physicians, including the use of thrombolytic therapies like Tenecteplase, in reducing the stroke burden and improving outcomes across the country. Significant strides can be made in stroke management and care in India by addressing these critical areas.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140412117","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 : 2024-02-27DOI: 10.1177/25166085241231676
Passara Cheawprasit, Witoon Mitarnun
Background and Purpose: Cerebral venous thrombosis (CVT) is a rare form of stroke. The objective of this study was to investigate the characteristics, outcomes, and prognostic factors of CVT patients. Methods: This is a five-year retrospective study of CVT patients admitted to our Hospital from April 2016 to April 2021. Medical records were accessed to confirm the diagnosis and obtain the clinical, imaging, laboratory, and treatment data. Further, outcomes of the patients at three months were collected. Binary logistic regression was used to analyse the prognostic factors. Results: Seventy-three patients with CVT were analysed (35.6% male; mean age, 44.3 years). A poor outcome (modified Rankin scale score, 3–6) was 17.8% of patients, and mortality was 10.9%. Factors associated with poor outcomes in all patients with CVT included the duration of presenting symptoms <24 hours (OR: 3.95, 95% CI: 1.13–13.82), age ≥ 50 years (OR: 8.12, 95% CI: 2.16–30.71), a non-fasting glucose level of ≥ 200 mg/dL (OR: 9.58, 95% CI: 1.90–48.25), impaired consciousness (Glasgow coma scale score, 3–8) (OR: 5.63, 95% CI: 1.39–22.81), male sex (OR: 3.73, 95% CI: 1.07–12.98), and brain herniation (midline shift ≥ 5 mm) (OR: 8.75, 95% CI: 1.94–39.57). Headache and use of an oral contraceptive pill were associated with good outcomes in all of the patients. Conclusion: The non-fasting glucose level, a modifiable prognostic factor, exhibited the highest correlation with poor outcomes in CVT patients.
{"title":"Non-fasting Glucose Level at Admission Associated with Outcomes in Cerebral Venous Thrombosis","authors":"Passara Cheawprasit, Witoon Mitarnun","doi":"10.1177/25166085241231676","DOIUrl":"https://doi.org/10.1177/25166085241231676","url":null,"abstract":"Background and Purpose: Cerebral venous thrombosis (CVT) is a rare form of stroke. The objective of this study was to investigate the characteristics, outcomes, and prognostic factors of CVT patients. Methods: This is a five-year retrospective study of CVT patients admitted to our Hospital from April 2016 to April 2021. Medical records were accessed to confirm the diagnosis and obtain the clinical, imaging, laboratory, and treatment data. Further, outcomes of the patients at three months were collected. Binary logistic regression was used to analyse the prognostic factors. Results: Seventy-three patients with CVT were analysed (35.6% male; mean age, 44.3 years). A poor outcome (modified Rankin scale score, 3–6) was 17.8% of patients, and mortality was 10.9%. Factors associated with poor outcomes in all patients with CVT included the duration of presenting symptoms <24 hours (OR: 3.95, 95% CI: 1.13–13.82), age ≥ 50 years (OR: 8.12, 95% CI: 2.16–30.71), a non-fasting glucose level of ≥ 200 mg/dL (OR: 9.58, 95% CI: 1.90–48.25), impaired consciousness (Glasgow coma scale score, 3–8) (OR: 5.63, 95% CI: 1.39–22.81), male sex (OR: 3.73, 95% CI: 1.07–12.98), and brain herniation (midline shift ≥ 5 mm) (OR: 8.75, 95% CI: 1.94–39.57). Headache and use of an oral contraceptive pill were associated with good outcomes in all of the patients. Conclusion: The non-fasting glucose level, a modifiable prognostic factor, exhibited the highest correlation with poor outcomes in CVT patients.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426615","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 : 2024-02-27DOI: 10.1177/25166085241229871
Mairla Maracaba Moreira, J. B. C. de Andrade, Carlos Eduardo Lenis Rodriguez, Davi Said Araújo, Flávia Paiva Rolim, Marla Rochana Braga Monteiro, Norberto Anizio Frota, F. O. Lima, G. S. Silva
Introduction and objectives: Epileptic seizures (ES) are a recognized complication of stroke, commonly associated with extensive ischemic regions and cortical damage. Despite thorough investigation, reports on the incidence, risk factors, and functional implications of post-stroke ES vary widely in the literature. We aimed to evaluate the predictive factors for post-stroke ES and their effects on the clinical outcome at hospital discharge. Methods: Patients with acute ischemic stroke (AIS) admitted to our stroke unit from 2015 to 2017 were eligible to this study. A multivariable logistic regression modeling was built to assess associated variables with acute symptomatic seizures (AS). We defined AS as seizures that occurred within the period of hospitalization (stroke unit discharge) without a history of seizures with clinical or electroencephalographic evidence. Results: Four hundred ninety-two were included in the final analysis. The patients had a mean of 66.7 (±14.4) years; 56% were male. Thirty-eight (7.7%) patients experienced clinical ES in-hospital, with a higher incidence in those with total anterior circulation syndrome. The NIH Stroke Scale score (odds ratio [OR] 1.07, 95% confidence interval [CI], p = .03) and symptomatic hemorrhagic transformation (HT) (OR: 3.53, 95% CI: 1.38–8.99, p = .01) independently predicted ES. We did not find an association between the occurrence of seizures and unfavorable outcomes (Modified Rankin Scale 3–6) at discharge (OR1.26, 95% CI: 0.3–5.32, p = .75). Patients with seizures had a longer hospital stay (18.5 [11–35] vs. 9 [7–14] days). Conclusions: Patients presenting higher NIH Stroke Scale scores upon admission or experiencing symptomatic HT face an increased risk of in-hospital ES. Nonetheless, acute symptomatic ES following AIS does not independently predict adverse functional outcomes at discharge.
导言和目的：癫痫发作（ES）是公认的脑卒中并发症，通常与广泛的缺血区域和皮质损伤有关。尽管进行了深入研究，但文献中关于脑卒中后癫痫发作的发生率、风险因素和功能影响的报道却大相径庭。我们的目的是评估卒中后 ES 的预测因素及其对出院时临床预后的影响。研究方法2015年至2017年我院卒中科收治的急性缺血性卒中（AIS）患者均符合本研究的条件。我们建立了一个多变量逻辑回归模型，以评估急性症状性癫痫发作（AS）的相关变量。我们将 AS 定义为在住院（卒中单元出院）期间发生的、无临床或脑电图证据的癫痫发作史的癫痫发作。结果：最终分析纳入了 492 例患者。患者平均年龄为 66.7 (±14.4) 岁，56% 为男性。38名患者（7.7%）在院内出现临床ES，其中全前循环综合征患者的ES发生率更高。NIH 卒中量表评分（几率比 [OR] 1.07，95% 置信区间 [CI]，p = .03）和无症状出血转化（HT）（OR：3.53，95% CI：1.38-8.99，p = .01）可独立预测 ES。我们没有发现癫痫发作与出院时的不良预后（改良Rankin量表3-6）之间存在关联（OR1.26，95% CI：0.3-5.32，p = .75）。癫痫发作患者的住院时间较长（18.5 [11-35] 天 vs. 9 [7-14] 天）。结论：入院时 NIH 卒中量表评分较高或出现症状性 HT 的患者发生院内 ES 的风险较高。然而，AIS 后出现急性症状 ES 并不能独立预测出院时的不良功能预后。
{"title":"Prevalence, Risk Factors and Prognosis of Seizures After Ischemic Stroke","authors":"Mairla Maracaba Moreira, J. B. C. de Andrade, Carlos Eduardo Lenis Rodriguez, Davi Said Araújo, Flávia Paiva Rolim, Marla Rochana Braga Monteiro, Norberto Anizio Frota, F. O. Lima, G. S. Silva","doi":"10.1177/25166085241229871","DOIUrl":"https://doi.org/10.1177/25166085241229871","url":null,"abstract":"Introduction and objectives: Epileptic seizures (ES) are a recognized complication of stroke, commonly associated with extensive ischemic regions and cortical damage. Despite thorough investigation, reports on the incidence, risk factors, and functional implications of post-stroke ES vary widely in the literature. We aimed to evaluate the predictive factors for post-stroke ES and their effects on the clinical outcome at hospital discharge. Methods: Patients with acute ischemic stroke (AIS) admitted to our stroke unit from 2015 to 2017 were eligible to this study. A multivariable logistic regression modeling was built to assess associated variables with acute symptomatic seizures (AS). We defined AS as seizures that occurred within the period of hospitalization (stroke unit discharge) without a history of seizures with clinical or electroencephalographic evidence. Results: Four hundred ninety-two were included in the final analysis. The patients had a mean of 66.7 (±14.4) years; 56% were male. Thirty-eight (7.7%) patients experienced clinical ES in-hospital, with a higher incidence in those with total anterior circulation syndrome. The NIH Stroke Scale score (odds ratio [OR] 1.07, 95% confidence interval [CI], p = .03) and symptomatic hemorrhagic transformation (HT) (OR: 3.53, 95% CI: 1.38–8.99, p = .01) independently predicted ES. We did not find an association between the occurrence of seizures and unfavorable outcomes (Modified Rankin Scale 3–6) at discharge (OR1.26, 95% CI: 0.3–5.32, p = .75). Patients with seizures had a longer hospital stay (18.5 [11–35] vs. 9 [7–14] days). Conclusions: Patients presenting higher NIH Stroke Scale scores upon admission or experiencing symptomatic HT face an increased risk of in-hospital ES. Nonetheless, acute symptomatic ES following AIS does not independently predict adverse functional outcomes at discharge.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140427993","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}
Background: Cardioembolic strokes are a common cause of mortality and morbidity because they are usually big and multiple. Despite extensive advances in the determination and management of modifiable risk factors of these strokes, a significant proportion are attributed to non-modifiable factors. We wanted to test the hypothesis that cardioembolic strokes and no other subtypes of ischemic stroke are associated with inclement weather in Kashmir Valley where winter seasons have harsh weather. Results: A total of 540 ischemic stroke patients were included in the study of which cardioembolic strokes were most common. Cardioembolic strokes were more common in the winter season and associated with lower minimum and maximum temperatures. Conclusion: Evaluation and management of cardioembolic strokes during winter months may demand more attention, particularly in elderly individuals and those with risk factors for atrial fibrillation.
{"title":"Does Inclement Weather Increase the Risk of Cardioembolic Stroke in Kashmir Valley?","authors":"Waseem Dar, Maqbool Wani, Arjimand Yaqoob, Adnan Raina, Zubair Khwaja, Amit Chandra, Feroze Mir, Ravouf Asmi","doi":"10.1177/25166085231225905","DOIUrl":"https://doi.org/10.1177/25166085231225905","url":null,"abstract":"Background: Cardioembolic strokes are a common cause of mortality and morbidity because they are usually big and multiple. Despite extensive advances in the determination and management of modifiable risk factors of these strokes, a significant proportion are attributed to non-modifiable factors. We wanted to test the hypothesis that cardioembolic strokes and no other subtypes of ischemic stroke are associated with inclement weather in Kashmir Valley where winter seasons have harsh weather. Results: A total of 540 ischemic stroke patients were included in the study of which cardioembolic strokes were most common. Cardioembolic strokes were more common in the winter season and associated with lower minimum and maximum temperatures. Conclusion: Evaluation and management of cardioembolic strokes during winter months may demand more attention, particularly in elderly individuals and those with risk factors for atrial fibrillation.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139833875","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}
Background: Cardioembolic strokes are a common cause of mortality and morbidity because they are usually big and multiple. Despite extensive advances in the determination and management of modifiable risk factors of these strokes, a significant proportion are attributed to non-modifiable factors. We wanted to test the hypothesis that cardioembolic strokes and no other subtypes of ischemic stroke are associated with inclement weather in Kashmir Valley where winter seasons have harsh weather. Results: A total of 540 ischemic stroke patients were included in the study of which cardioembolic strokes were most common. Cardioembolic strokes were more common in the winter season and associated with lower minimum and maximum temperatures. Conclusion: Evaluation and management of cardioembolic strokes during winter months may demand more attention, particularly in elderly individuals and those with risk factors for atrial fibrillation.
{"title":"Does Inclement Weather Increase the Risk of Cardioembolic Stroke in Kashmir Valley?","authors":"Waseem Dar, Maqbool Wani, Arjimand Yaqoob, Adnan Raina, Zubair Khwaja, Amit Chandra, Feroze Mir, Ravouf Asmi","doi":"10.1177/25166085231225905","DOIUrl":"https://doi.org/10.1177/25166085231225905","url":null,"abstract":"Background: Cardioembolic strokes are a common cause of mortality and morbidity because they are usually big and multiple. Despite extensive advances in the determination and management of modifiable risk factors of these strokes, a significant proportion are attributed to non-modifiable factors. We wanted to test the hypothesis that cardioembolic strokes and no other subtypes of ischemic stroke are associated with inclement weather in Kashmir Valley where winter seasons have harsh weather. Results: A total of 540 ischemic stroke patients were included in the study of which cardioembolic strokes were most common. Cardioembolic strokes were more common in the winter season and associated with lower minimum and maximum temperatures. Conclusion: Evaluation and management of cardioembolic strokes during winter months may demand more attention, particularly in elderly individuals and those with risk factors for atrial fibrillation.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139774400","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 : 2024-02-06DOI: 10.1177/25166085231214875
Monali S. Malvankar-Mehta, Mushfiqur Rahman, Ashvinder Suri, Cindy M. L. Hutnik
Background: As the communal cause of irreversible vision loss in seniors, glaucoma affects more than 67 million people worldwide. Those who suffer from glaucoma have traditionally demonstrated a higher rate of developing stroke. Numerous studies have investigated the relationship between glaucoma and increased stroke risks, but they differ wildly in conclusive findings. To better elucidate the overall findings of the collective studies, a systematic review with the objective of determining the relationship between glaucoma and an increased risk of stroke. Methods: A systematic database search including MEDLINE, EMBASE, and Cochrane Library as well as unpublished literature was done. Distiller SR, a systematic review software was utilized. After two levels of screening, “Title and Abstract” and “Full text” screening, risk of bias assessment and extraction of the data from the included articles were conducted. STATA 14.0 was used to conduct the meta-analysis. The hazard ratio (HR) was the primary outcome measure. Results: Nine studies (376,650 subjects) were included in the analysis. Results indicated a significant hazard of stroke in patients with open-angle glaucoma (HR = 1.36, 95% confidence interval [CI]: [1.08, 1.71]), normal-tension glaucoma (HR = 6.34, 95% CI: [4.8, 8.38]), and neovascular glaucoma (HR = 2.07; CI: [1.41, 3.03]). Studies examining risks of stroke development showed a significant increase in the relative risks (RR) of developing stroke for those with glaucoma (RR = 2.10, CI: [1.64, 2.68]). Conclusions: The hazard of developing stroke could be greater for patients with glaucoma. However, randomized controlled trials with longer-term follow-ups need to be conducted in the future in order to make strong conclusions.
{"title":"Evidence of Stroke in Glaucoma Patients","authors":"Monali S. Malvankar-Mehta, Mushfiqur Rahman, Ashvinder Suri, Cindy M. L. Hutnik","doi":"10.1177/25166085231214875","DOIUrl":"https://doi.org/10.1177/25166085231214875","url":null,"abstract":"Background: As the communal cause of irreversible vision loss in seniors, glaucoma affects more than 67 million people worldwide. Those who suffer from glaucoma have traditionally demonstrated a higher rate of developing stroke. Numerous studies have investigated the relationship between glaucoma and increased stroke risks, but they differ wildly in conclusive findings. To better elucidate the overall findings of the collective studies, a systematic review with the objective of determining the relationship between glaucoma and an increased risk of stroke. Methods: A systematic database search including MEDLINE, EMBASE, and Cochrane Library as well as unpublished literature was done. Distiller SR, a systematic review software was utilized. After two levels of screening, “Title and Abstract” and “Full text” screening, risk of bias assessment and extraction of the data from the included articles were conducted. STATA 14.0 was used to conduct the meta-analysis. The hazard ratio (HR) was the primary outcome measure. Results: Nine studies (376,650 subjects) were included in the analysis. Results indicated a significant hazard of stroke in patients with open-angle glaucoma (HR = 1.36, 95% confidence interval [CI]: [1.08, 1.71]), normal-tension glaucoma (HR = 6.34, 95% CI: [4.8, 8.38]), and neovascular glaucoma (HR = 2.07; CI: [1.41, 3.03]). Studies examining risks of stroke development showed a significant increase in the relative risks (RR) of developing stroke for those with glaucoma (RR = 2.10, CI: [1.64, 2.68]). Conclusions: The hazard of developing stroke could be greater for patients with glaucoma. However, randomized controlled trials with longer-term follow-ups need to be conducted in the future in order to make strong conclusions.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139800386","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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