Pub Date : 2023-08-03DOI: 10.1177/25166085231188633
A. A. Hashmi, S. Aaron, Ahmed Al Sinani, S. Jose
The influence of climatic, weather conditions, and circadian variations on cerebrovascular diseases has been evaluated in many studies. However, the results have been controversial. This study aims at identifying the relationship between the circadian and circannual climatic patterns in the Governorate of Muscat and their impact on stroke and its subtype. From January 2016 to December 2019, a retrospective study of all confirmed acute stroke cases admitted to the central stroke unit was conducted. Only Omani Patients were included. The data was collected through a computerized medical record system. A total of 836 Omani patients were involved in the study. Ischemic stroke accounted for 731 cases (87.4%), while intracerebral hemorrhage (ICH) accounted for 105 (12.6%). 62.7% of the overall sample size was made up of men. Between different days times, there was a statistically significant difference in the occurrence of ischemic stroke and ICH (likelihood ratio, P = .010). The majority of ischemic strokes (62.2%) occurred between 6 am and 6 pm (daytime), and the majority of ICH (54%) occurred between 6 pm and 6 am (nighttime). The majority of ischemic strokes (52.9%) and ICH (61.9%) occurred during the winter months. The majority of both stroke subtypes were found to occur in the morning hours and during winter months. These findings might aid in the better organization of acute stroke care. Further analysis of these findings could aid in the development of better primary prevention strategies.
{"title":"Seasonal and Circadian Variations in Stroke Subtypes in the Muscat Governorate of the Sultanate of Oman","authors":"A. A. Hashmi, S. Aaron, Ahmed Al Sinani, S. Jose","doi":"10.1177/25166085231188633","DOIUrl":"https://doi.org/10.1177/25166085231188633","url":null,"abstract":"The influence of climatic, weather conditions, and circadian variations on cerebrovascular diseases has been evaluated in many studies. However, the results have been controversial. This study aims at identifying the relationship between the circadian and circannual climatic patterns in the Governorate of Muscat and their impact on stroke and its subtype. From January 2016 to December 2019, a retrospective study of all confirmed acute stroke cases admitted to the central stroke unit was conducted. Only Omani Patients were included. The data was collected through a computerized medical record system. A total of 836 Omani patients were involved in the study. Ischemic stroke accounted for 731 cases (87.4%), while intracerebral hemorrhage (ICH) accounted for 105 (12.6%). 62.7% of the overall sample size was made up of men. Between different days times, there was a statistically significant difference in the occurrence of ischemic stroke and ICH (likelihood ratio, P = .010). The majority of ischemic strokes (62.2%) occurred between 6 am and 6 pm (daytime), and the majority of ICH (54%) occurred between 6 pm and 6 am (nighttime). The majority of ischemic strokes (52.9%) and ICH (61.9%) occurred during the winter months. The majority of both stroke subtypes were found to occur in the morning hours and during winter months. These findings might aid in the better organization of acute stroke care. Further analysis of these findings could aid in the development of better primary prevention strategies.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87313331","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 : 2023-08-01DOI: 10.1177/25166085231185731
D. Gandhi, N. Chawla, Christy John, Amarjot Gill Singh, S. Zarreen, Pranay J. Vijayanand
Somatosensory impairments in the upper limb are a common occurrence in >50% of post-stroke individuals. The effects of a combined sensorimotor therapy program on improving functional outcomes have not been studied extensively especially in the acute and subacute phase post-stroke. Through a randomized controlled trial of PROBE design, participants, selected on a pre-set selection criteria will either receive the a structured regime of sensorimotor therapy in addition to routine care or only routine care for over 14 days or until discharge. Outcomes will be analyzed on the “Action Research Arm test” and “Erasmus modified Nottingham Sensory Assessment” scale at discharge and then at the third and sixth months. The proposed study will allow development and implementation of sensory rehabilitation components to the existing stroke rehabilitation protocols. Initiating intervention within the acute and subacute phase post-stroke in suitable patients will allow early intervention for sensorimotor impairments subsequently leading to improved upper limb outcomes.
{"title":"Effect of a Sensorimotor Exercise Regimefor Upper Limb Deficits in the In-HospitalPhase After a Supratentorial Stroke(SMULS)—Protocol for a RandomizedControlled Trial","authors":"D. Gandhi, N. Chawla, Christy John, Amarjot Gill Singh, S. Zarreen, Pranay J. Vijayanand","doi":"10.1177/25166085231185731","DOIUrl":"https://doi.org/10.1177/25166085231185731","url":null,"abstract":"Somatosensory impairments in the upper limb are a common occurrence in >50% of post-stroke individuals. The effects of a combined sensorimotor therapy program on improving functional outcomes have not been studied extensively especially in the acute and subacute phase post-stroke. Through a randomized controlled trial of PROBE design, participants, selected on a pre-set selection criteria will either receive the a structured regime of sensorimotor therapy in addition to routine care or only routine care for over 14 days or until discharge. Outcomes will be analyzed on the “Action Research Arm test” and “Erasmus modified Nottingham Sensory Assessment” scale at discharge and then at the third and sixth months. The proposed study will allow development and implementation of sensory rehabilitation components to the existing stroke rehabilitation protocols. Initiating intervention within the acute and subacute phase post-stroke in suitable patients will allow early intervention for sensorimotor impairments subsequently leading to improved upper limb outcomes.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83202927","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 : 2023-08-01DOI: 10.1177/25166085231186380
M. Lanza, Nathan G. Frakes, Kerry Callaghan, A. Shipper, Lateef Shabnam, V. Gray
The aim of this systematic review was to identify the association between muscle strength, activation, and structure of the hip abductor-adductor muscles and balance and mobility tasks in individuals post stroke. The present systematic review is comprised of 37 research articles, with 911 individuals that had a stroke. The extracted data included the study population, sample size, sex, stroke side of paresis, time poststroke, and evaluated measurements. We concluded that stronger hip abductors and adductors (both paretic and nonparetic legs) resulted in quicker voluntary step, and faster walking speed and cadence. Also, stronger paretic hip abductors were associated with a faster completion of the timed up and go test, higher ambulation ability, better control of the centre of mass, and quicker stair climbing. Overall, it demonstrated a lateral induced step to the paretic side, increased muscle activation of the gluteus medius of the paretic leg, and increased nonparetic hip abductor muscle activation. The strength and ability to activate the hip abductor and adductor muscles appears to be related to better performance during balance or mobility tasks in individuals with stroke. Therefore, the present systematic review results suggest that improving muscle strength and activation of the hip abductor and adductor muscles might help individuals with stroke to avoid falls.
{"title":"The Importance of Hip Abductor and Adductor Muscles in Balance and Mobility Tasks After a Stroke: A Systematic Review","authors":"M. Lanza, Nathan G. Frakes, Kerry Callaghan, A. Shipper, Lateef Shabnam, V. Gray","doi":"10.1177/25166085231186380","DOIUrl":"https://doi.org/10.1177/25166085231186380","url":null,"abstract":"The aim of this systematic review was to identify the association between muscle strength, activation, and structure of the hip abductor-adductor muscles and balance and mobility tasks in individuals post stroke. The present systematic review is comprised of 37 research articles, with 911 individuals that had a stroke. The extracted data included the study population, sample size, sex, stroke side of paresis, time poststroke, and evaluated measurements. We concluded that stronger hip abductors and adductors (both paretic and nonparetic legs) resulted in quicker voluntary step, and faster walking speed and cadence. Also, stronger paretic hip abductors were associated with a faster completion of the timed up and go test, higher ambulation ability, better control of the centre of mass, and quicker stair climbing. Overall, it demonstrated a lateral induced step to the paretic side, increased muscle activation of the gluteus medius of the paretic leg, and increased nonparetic hip abductor muscle activation. The strength and ability to activate the hip abductor and adductor muscles appears to be related to better performance during balance or mobility tasks in individuals with stroke. Therefore, the present systematic review results suggest that improving muscle strength and activation of the hip abductor and adductor muscles might help individuals with stroke to avoid falls.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88109650","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 : 2023-07-28DOI: 10.1177/25166085231186492
Abhilash Patra, Dr. Sureshkumar Kamalakannan, Hira Pant, V. Agiwal, Nirupama A.Y., Sirshendu Chaudhuri, G. Murthy
Mental health disorders were reported in more than 33% of stroke survivors, which lead to increased comorbidities, delayed care, affect recovery, and impact physical and social functioning. Furthermore, it diminishes the quality of life and has impact on the well-being of both their families and caregivers. However, existing screening tools available for diagnosis of mental health disorders post-stroke detect many undiagnosed and underreported stroke survivors. Globally and in India, there has been a significant prevalence of post-stroke depression and anxiety. Pseudobulbar affect (PBA) ranged from 11% to 34%, worldwide. However, in India, only few case reports were reported for post-stroke psychosis, mania, and PBA. Although guidelines exist in developed countries for screening, referral, and rehabilitation of mental health disorders, there are lack of such resources in India. Also, the District Mental Health Program (DMHP) has received conflicting evaluations regarding its successes and shortcomings. Hence, this situation highlights the need for robust evidence-based strategies to develop effective screening, referral, and rehabilitation guidelines tailored to the Indian context. Also, by leveraging existing resources and collaborating with experts in the field, India can develop a comprehensive and effective approach to addressing post-stroke mental health disorders.
{"title":"Mental Health Disorders Post-Stroke: A Scenario in India","authors":"Abhilash Patra, Dr. Sureshkumar Kamalakannan, Hira Pant, V. Agiwal, Nirupama A.Y., Sirshendu Chaudhuri, G. Murthy","doi":"10.1177/25166085231186492","DOIUrl":"https://doi.org/10.1177/25166085231186492","url":null,"abstract":"Mental health disorders were reported in more than 33% of stroke survivors, which lead to increased comorbidities, delayed care, affect recovery, and impact physical and social functioning. Furthermore, it diminishes the quality of life and has impact on the well-being of both their families and caregivers. However, existing screening tools available for diagnosis of mental health disorders post-stroke detect many undiagnosed and underreported stroke survivors. Globally and in India, there has been a significant prevalence of post-stroke depression and anxiety. Pseudobulbar affect (PBA) ranged from 11% to 34%, worldwide. However, in India, only few case reports were reported for post-stroke psychosis, mania, and PBA. Although guidelines exist in developed countries for screening, referral, and rehabilitation of mental health disorders, there are lack of such resources in India. Also, the District Mental Health Program (DMHP) has received conflicting evaluations regarding its successes and shortcomings. Hence, this situation highlights the need for robust evidence-based strategies to develop effective screening, referral, and rehabilitation guidelines tailored to the Indian context. Also, by leveraging existing resources and collaborating with experts in the field, India can develop a comprehensive and effective approach to addressing post-stroke mental health disorders.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87646149","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 : 2023-06-01DOI: 10.1177/25166085231174322
Dulari Gupta, Sreehari Dinesh, S. Narayan, S. Gorthi
Background There is paucity of data regarding knowledge about diagnosis, aetiology, investigations, and management of stroke amongst neurologists in India. Methodology A cross-sectional observational analytical study in which the Knowledge, Attitudes, and Practice about stroke were assessed amongst neurologists across India using a Google Form with 30 multiple-choice questions and 10 case scenarios about acute ischemic stroke, acute hemorrhagic stroke, and cerebral venous sinus thrombosis. This Google Form was circulated amongst all Indian Academy of Neurology groups online from October 2022 to December 2022. Responses were analyzed question wise. Results A total of 148 neurologists responded with 90.5% practicing in urban India. In acute ischemic stroke only 56% chose noncontrast CT brain as the mainstay of imaging in stroke diagnosis. Similarly only 50% said that vascular imaging (CT angiography or MRI angiography) was important in stroke imaging. Questionnaires pertaining to the indications and contraindications for intravenous thrombolysis were well responded. Most answers on intracerebral hemorrhage were correct. Many neurologists are using DOAC in treatment of CVT even though latest studies have hinted towards their safety, but randomized control trials are still underway. Conclusion Results show good knowledge and practice in the field of acute hemorrhagic stroke and moderate results in CVT while there are glaring knowledge gaps in acute ischemic stroke. This reflects the rapidly changing field of acute ischemic stroke. The aim of training programs and conferences should be to update neurologists on this rapidly evolving field.
{"title":"Knowledge Attitudes and Practice about Stroke amongst Neurologists in India","authors":"Dulari Gupta, Sreehari Dinesh, S. Narayan, S. Gorthi","doi":"10.1177/25166085231174322","DOIUrl":"https://doi.org/10.1177/25166085231174322","url":null,"abstract":"Background There is paucity of data regarding knowledge about diagnosis, aetiology, investigations, and management of stroke amongst neurologists in India. Methodology A cross-sectional observational analytical study in which the Knowledge, Attitudes, and Practice about stroke were assessed amongst neurologists across India using a Google Form with 30 multiple-choice questions and 10 case scenarios about acute ischemic stroke, acute hemorrhagic stroke, and cerebral venous sinus thrombosis. This Google Form was circulated amongst all Indian Academy of Neurology groups online from October 2022 to December 2022. Responses were analyzed question wise. Results A total of 148 neurologists responded with 90.5% practicing in urban India. In acute ischemic stroke only 56% chose noncontrast CT brain as the mainstay of imaging in stroke diagnosis. Similarly only 50% said that vascular imaging (CT angiography or MRI angiography) was important in stroke imaging. Questionnaires pertaining to the indications and contraindications for intravenous thrombolysis were well responded. Most answers on intracerebral hemorrhage were correct. Many neurologists are using DOAC in treatment of CVT even though latest studies have hinted towards their safety, but randomized control trials are still underway. Conclusion Results show good knowledge and practice in the field of acute hemorrhagic stroke and moderate results in CVT while there are glaring knowledge gaps in acute ischemic stroke. This reflects the rapidly changing field of acute ischemic stroke. The aim of training programs and conferences should be to update neurologists on this rapidly evolving field.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"24 1","pages":"24 - 32"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90519257","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 : 2023-06-01DOI: 10.1177/25166085231174687
Komal Bhanot, D. Gandhi, Mridul Makkar, Himani Khatter, J. Pandian
Background COVID-19 exposed the weakened healthcare sector and burdened the economic sector. Patients with neurological diseases require physical rehabilitation from the acute to chronic phase irrespective of their COVID positive status. Objective To evaluate the qualitative and quantitative changes in neurological physiotherapy at hospital/clinic and home-based settings in India during the COVID-19 pandemic. Methodology Using an online survey, a cross-sectional observational study was implemented among physiotherapists in India who treated neurological patients amidst the pandemic at hospital/clinic and for home-based settings using an online survey. Convenience sampling was used for recruiting participants in the study. Results and Conclusion Most of the physiotherapists, whether working in hospitals or in patients’ homes, indicated a decline in the number of referrals and therapy sessions given to their patients. Both groups resorted to the use of various forms of telerehabilitation in delivering therapy. Even though there is evidence supporting the necessity of physiotherapy for respiratory care, most of the respondents did not put it into practice. No protocols/guidelines for therapy delivery were implemented or used by our sample of respondents. This paper highlights the needs under 3 main categories: (a) development and implementation of contextualized clinical-practice-guidelines and clinical-monitoring systems for neurological physiotherapy, (b) incorporating respiratory physiotherapy sessions supported by research to treat neurological cases in such pandemics, and (c) to modify policies both at public and private domains ensuring incorporation and implementation of physiotherapy for neurological conditions, and to raise campaigns that educate the public on the significance of receiving uninterrupted physiotherapy, even during similar pandemics.
{"title":"Survey on Changes in Neurophysiotherapy at a Hospital/Clinic and Home-Based Settings in India During COVID-19 Pandemic","authors":"Komal Bhanot, D. Gandhi, Mridul Makkar, Himani Khatter, J. Pandian","doi":"10.1177/25166085231174687","DOIUrl":"https://doi.org/10.1177/25166085231174687","url":null,"abstract":"Background COVID-19 exposed the weakened healthcare sector and burdened the economic sector. Patients with neurological diseases require physical rehabilitation from the acute to chronic phase irrespective of their COVID positive status. Objective To evaluate the qualitative and quantitative changes in neurological physiotherapy at hospital/clinic and home-based settings in India during the COVID-19 pandemic. Methodology Using an online survey, a cross-sectional observational study was implemented among physiotherapists in India who treated neurological patients amidst the pandemic at hospital/clinic and for home-based settings using an online survey. Convenience sampling was used for recruiting participants in the study. Results and Conclusion Most of the physiotherapists, whether working in hospitals or in patients’ homes, indicated a decline in the number of referrals and therapy sessions given to their patients. Both groups resorted to the use of various forms of telerehabilitation in delivering therapy. Even though there is evidence supporting the necessity of physiotherapy for respiratory care, most of the respondents did not put it into practice. No protocols/guidelines for therapy delivery were implemented or used by our sample of respondents. This paper highlights the needs under 3 main categories: (a) development and implementation of contextualized clinical-practice-guidelines and clinical-monitoring systems for neurological physiotherapy, (b) incorporating respiratory physiotherapy sessions supported by research to treat neurological cases in such pandemics, and (c) to modify policies both at public and private domains ensuring incorporation and implementation of physiotherapy for neurological conditions, and to raise campaigns that educate the public on the significance of receiving uninterrupted physiotherapy, even during similar pandemics.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"7 1","pages":"33 - 39"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89210221","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 : 2023-06-01DOI: 10.1177/25166085231174796
B. Okeahialam, Anil I. Sirisena
Flow of fluids in channels obey the natural law of Physics. It is dependent on force of propulsion, length of channel, caliber of channel and viscosity of fluid flowing through. In humans, blood flow to the brain obeys these laws. When perturbed by disease, flow and oxygen delivery are compromised resulting in cerebrovascular disease or stroke. Flow to the human brain depends on the force generated by the heart, viscosity of blood, length of the vessels, and diameter of the vascular channels with their variability. In normal situation, the cerebrovascular vessels can automatically regulate itself to ensure adequate cerebral perfusion. With Atherosclerotic Cardiovascular disease in the cerebral vasculature, flow dynamics is deranged and the result is the disease called stroke. Atherosclerotic cardiovascular diseases make the vessels stiff thus increasing intraluminal pressure. This damages the inner lining, the endothelium, and prepares grounds for the development of plaques. Plaques narrow vascular caliber increasing flow pressure at the narrow point but decreasing it beyond that point. The flow ceases to be laminar and becomes turbulent. When the plaques are ruptured by the high pressure at the points of narrowing, the blood coagulation cascade is activated and blood viscosity rises. These predispose to thrombus formation. The vessels thin out having lost elasticity of the walls rupturing easily with sudden blood pressure surges. In this state, the vessels lose their intrinsic ability to vary their diameters to cushion these effects. Blood flow becomes precarious. Cerebral tissue beyond such points suffer from ischemia and may actually have blood egress into them. Metabolism is impaired and higher cerebral function suffers resulting in cerebrovascular disease or stroke. Understanding how disease alters flow dynamics will equip clinicians better with the knowledge required to counter development of atherosclerotic cardiovascular diseases that result in stroke.
{"title":"The Physics of Stroke","authors":"B. Okeahialam, Anil I. Sirisena","doi":"10.1177/25166085231174796","DOIUrl":"https://doi.org/10.1177/25166085231174796","url":null,"abstract":"Flow of fluids in channels obey the natural law of Physics. It is dependent on force of propulsion, length of channel, caliber of channel and viscosity of fluid flowing through. In humans, blood flow to the brain obeys these laws. When perturbed by disease, flow and oxygen delivery are compromised resulting in cerebrovascular disease or stroke. Flow to the human brain depends on the force generated by the heart, viscosity of blood, length of the vessels, and diameter of the vascular channels with their variability. In normal situation, the cerebrovascular vessels can automatically regulate itself to ensure adequate cerebral perfusion. With Atherosclerotic Cardiovascular disease in the cerebral vasculature, flow dynamics is deranged and the result is the disease called stroke. Atherosclerotic cardiovascular diseases make the vessels stiff thus increasing intraluminal pressure. This damages the inner lining, the endothelium, and prepares grounds for the development of plaques. Plaques narrow vascular caliber increasing flow pressure at the narrow point but decreasing it beyond that point. The flow ceases to be laminar and becomes turbulent. When the plaques are ruptured by the high pressure at the points of narrowing, the blood coagulation cascade is activated and blood viscosity rises. These predispose to thrombus formation. The vessels thin out having lost elasticity of the walls rupturing easily with sudden blood pressure surges. In this state, the vessels lose their intrinsic ability to vary their diameters to cushion these effects. Blood flow becomes precarious. Cerebral tissue beyond such points suffer from ischemia and may actually have blood egress into them. Metabolism is impaired and higher cerebral function suffers resulting in cerebrovascular disease or stroke. Understanding how disease alters flow dynamics will equip clinicians better with the knowledge required to counter development of atherosclerotic cardiovascular diseases that result in stroke.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"56 1","pages":"7 - 10"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88206019","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 : 2023-06-01DOI: 10.1177/25166085231176172
P. Sarma, Himani Khatter, Aneesh Dhasan, V. Nambiar, S. Narayan, Deepti Arora, S. Verma, Meenakshi Sharma, M. Kate, J. Pandian, P. Sylaja
Background Stroke often results in a loss of functional ability. The evaluation of recovery after a stroke is crucial for both treatment and research. The AyuRvedic TrEatment in the Rehabilitation of Ischemic STrOke Patients in India: A randomized controlled trial (RESTORE) aims to generate evidence-based data for creating a uniform rehabilitation protocol and initiating a cross-referral practice to support an integrative treatment approach. The objective is to develop a detailed statistical analysis plan for the RESTORE trial prior to data analysis. Methods The statistical analysis plan was developed by the trial statistician with the assistance of the RESTORE trial principal investigator and the trial management team. The statistical analysis plan was built using the specified primary and secondary outcome measures, as well as knowledge of important baseline data. All data collected will be thoroughly examined. Results The final statistical analysis plan corresponds to established criteria and will allow for transparent and efficient reporting. Conclusions The RESTORE trial statistical analysis plan is created to reduce analysis bias caused by prior knowledge of results and to explicitly outline prespecified analysis.
{"title":"Statistical Analysis Plan (SAP) for AyuRvedic TrEatment in the Rehabilitation of Ischemic STrOke Patients in India: A Randomized Controlled Trial (RESTORE)","authors":"P. Sarma, Himani Khatter, Aneesh Dhasan, V. Nambiar, S. Narayan, Deepti Arora, S. Verma, Meenakshi Sharma, M. Kate, J. Pandian, P. Sylaja","doi":"10.1177/25166085231176172","DOIUrl":"https://doi.org/10.1177/25166085231176172","url":null,"abstract":"Background Stroke often results in a loss of functional ability. The evaluation of recovery after a stroke is crucial for both treatment and research. The AyuRvedic TrEatment in the Rehabilitation of Ischemic STrOke Patients in India: A randomized controlled trial (RESTORE) aims to generate evidence-based data for creating a uniform rehabilitation protocol and initiating a cross-referral practice to support an integrative treatment approach. The objective is to develop a detailed statistical analysis plan for the RESTORE trial prior to data analysis. Methods The statistical analysis plan was developed by the trial statistician with the assistance of the RESTORE trial principal investigator and the trial management team. The statistical analysis plan was built using the specified primary and secondary outcome measures, as well as knowledge of important baseline data. All data collected will be thoroughly examined. Results The final statistical analysis plan corresponds to established criteria and will allow for transparent and efficient reporting. Conclusions The RESTORE trial statistical analysis plan is created to reduce analysis bias caused by prior knowledge of results and to explicitly outline prespecified analysis.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"76 1","pages":"52 - 58"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87292890","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 : 2023-05-29DOI: 10.1177/25166085231172869
Harini Pavuluri, S. M. Krishna Mohan Mavuru, D. Sharma, S. Sreedharan, P. Sylaja
A middle aged lady presented with thunderclap headache and vomiting without any deficits on examination. Her cerebral imaging including MR and CT angiogram were normal but lumbar puncture (LP) revealed uniformly blood stained CSF suggestive of SAH. Subsequent spine imaging revealed spontaneous spinal subdural hemorrhages (SSDH) in the dorsal and lumbosacral cord. Coagulopathy and other essential work up was normal. Digital subtraction angiography (DSA) done 3 weeks into ictus revealed extensive cerebral vasospasm with sausage like beaded appearance akin to reversible cerebral vasoconstriction syndrome (RCVS) with normal spinal vasculature. She was treated with Nimodipine for 6 weeks. Her headache improved without any recurrence. Repeat DSA and spine imaging was normal with resolution of both vasospasm and SSDH. Establishing the inciting event in this patient with 2 obvious pathologies, SSDH and possible RCVS, is a perplexing task and forms the central idea of discussion. We made an attempt to resolve this chicken egg paradox, ie, SSDH leading to intracranial vasospasm vs RCVS leading SSDH, by providing rational arguments for both the clinical scenarios. We would also like to highlight the necessity of spinal imaging in patients with thunderclap headache.
{"title":"Reversible Cerebral Vasoconstriction Syndrome with Spontaneous Spinal Subdural Hemorrhage—a Perplexing Conundrum!!!","authors":"Harini Pavuluri, S. M. Krishna Mohan Mavuru, D. Sharma, S. Sreedharan, P. Sylaja","doi":"10.1177/25166085231172869","DOIUrl":"https://doi.org/10.1177/25166085231172869","url":null,"abstract":"A middle aged lady presented with thunderclap headache and vomiting without any deficits on examination. Her cerebral imaging including MR and CT angiogram were normal but lumbar puncture (LP) revealed uniformly blood stained CSF suggestive of SAH. Subsequent spine imaging revealed spontaneous spinal subdural hemorrhages (SSDH) in the dorsal and lumbosacral cord. Coagulopathy and other essential work up was normal. Digital subtraction angiography (DSA) done 3 weeks into ictus revealed extensive cerebral vasospasm with sausage like beaded appearance akin to reversible cerebral vasoconstriction syndrome (RCVS) with normal spinal vasculature. She was treated with Nimodipine for 6 weeks. Her headache improved without any recurrence. Repeat DSA and spine imaging was normal with resolution of both vasospasm and SSDH. Establishing the inciting event in this patient with 2 obvious pathologies, SSDH and possible RCVS, is a perplexing task and forms the central idea of discussion. We made an attempt to resolve this chicken egg paradox, ie, SSDH leading to intracranial vasospasm vs RCVS leading SSDH, by providing rational arguments for both the clinical scenarios. We would also like to highlight the necessity of spinal imaging in patients with thunderclap headache.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":"15 1","pages":"69 - 72"},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80447710","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 : 2023-05-29DOI: 10.1177/25166085231172853
M. Nedunchelian, Gayathri Priyadharshinee, K. M. Athiyappan, Pudhiavan Arunachalam, M. Cherian, R. Iyer, S. Elumalai, S. Varadharajan
Cardiac CT studies to detect embolic sources can be a useful supplement to the imaging armamentarium of acute stroke patients and we explore its possibilities in 2 distinct populations in this technical note. Prior literature has looked at the yield of covering the heart during CT angiography (CTA) in addition to echocardiography and found that it can increase the detection rate of occult embolic sources such as mural thrombus, tumors, and infarcts. The advent of multiphasic CTA for acute stroke patients as part of vascular imaging prior to EVT selection has increased the likelihood of extending coverage or specifically screening the heart in such patients. Additionally, patterns of infarcts and imaging signs can help focus selective patients for dedicated cardiac screening, especially after initial negative echocardiography. We describe the technical aspects of cardiac CT screening in acute stroke patients in this brief report. Future studies in these specific cohorts can confirm the increased yield for early anticoagulation and address modifications for optimal balance with regard to additional radiation exposure.
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