Pub Date : 2022-04-10DOI: 10.1177/25166085221089745
V. Bhatia, N. Choudhary, A. Prabhakar, Ajay Kumar, D. Khurana
Objective: To report successful mechanical thrombectomy through transbrachial route in a patient with left middle cerebral artery (MCA) stroke and aortic bifurcation occlusion. Background: Mechanical thrombectomy is the standard therapeutic approach for eligible candidates of acute ischemic stroke according to American Heart Association/American Stroke Association guidelines. Mostly, a transfemoral approach is used to perform mechanical thrombectomy. Few studies have shown use of radial route for this procedure. Few reports have shown alternate access routes for performing mechanical thrombectomy when transfemoral or radial routes are not accessible. Design/Methods: Case report and literature review. Results: A 51-year-old female presented with left MCA stroke. Computed tomography angiography showed left internal carotid artery T occlusion extending into left MCA. Associated left atrial thrombus and occlusion at the aortic bifurcation were diagnosed in this patient. A transbrachial route was taken to perform mechanical thrombectomy in this patient resulting in complete recanalization. Conclusion: This case emphasizes the role of alternate access routes to perform mechanical thrombectomy in challenging situations.
{"title":"Transbrachial access for mechanical thrombectomy in a case of acute ischemic stroke with aortic bifurcation occlusion","authors":"V. Bhatia, N. Choudhary, A. Prabhakar, Ajay Kumar, D. Khurana","doi":"10.1177/25166085221089745","DOIUrl":"https://doi.org/10.1177/25166085221089745","url":null,"abstract":"Objective: To report successful mechanical thrombectomy through transbrachial route in a patient with left middle cerebral artery (MCA) stroke and aortic bifurcation occlusion. Background: Mechanical thrombectomy is the standard therapeutic approach for eligible candidates of acute ischemic stroke according to American Heart Association/American Stroke Association guidelines. Mostly, a transfemoral approach is used to perform mechanical thrombectomy. Few studies have shown use of radial route for this procedure. Few reports have shown alternate access routes for performing mechanical thrombectomy when transfemoral or radial routes are not accessible. Design/Methods: Case report and literature review. Results: A 51-year-old female presented with left MCA stroke. Computed tomography angiography showed left internal carotid artery T occlusion extending into left MCA. Associated left atrial thrombus and occlusion at the aortic bifurcation were diagnosed in this patient. A transbrachial route was taken to perform mechanical thrombectomy in this patient resulting in complete recanalization. Conclusion: This case emphasizes the role of alternate access routes to perform mechanical thrombectomy in challenging situations.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79527642","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 : 2022-04-10DOI: 10.1177/25166085221089731
S. Pujari, Pawan K. Ojha, R. Kulkarni, Dr Sumit Kharat, Dulari Gupta, R. Lalla, Keyur Panchal, P. Walzade, Nilesh Palasdeokar, D. Nadgir, S. Nirhale, Pramod Dhonde, N. Ichaporia, Sujit A. Jagtap, A. Dravid, B. Purandare, S. Jog, Z. Khan, C. Meshram
Background and Purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infection induces a prothrombotic state frequently associated with arterial ischemic strokes. Cerebral venous sinus thrombosis (CVST) is also reported with corona virus disease-19 (COVID-19) but a large cohort study is lacking. Our aim was to study the characteristics, treatment response, and outcomes of CVST occurring in association with COVID-19 (COVID-CVST) and the causal relationship with COVID-19. Methods: Data of 34 patients admitted in COVID facility and suffering from CVST and SARS-COV2 infection was studied with respect to their clinic-radiological and lab features, predisposing factors, treatment, and outcome. Observations and Results: 15 patients with CVST were detected positive for COVID but remained asymptomatic for the same. 14 patients had CVST along with symptoms of COVID, whereas 5 had CVST after recovery from COVID, at an average of 18 days after COVID-19. 4 patients were on aspirin as prophylaxis against thrombo-embolic events. The number of males exceeded females (22:12), conventional risk factors were seen in only 8 patients (postpartum state-3, alcohol abuse-2 and anemia-3), whereas the majority (26/34) showed none of them. The mean serum homocysteine level was normal and antiphospholipid antibody was tested normal in the assessed subjects. D-dimer and C reactive protein were elevated in all. 4 symptomatic patients who suffered from severe pneumonia died because of systemic complications. Conclusion: COVID-19 predisposes to CVST and the outcome is related to the severity of COVID pneumonia. CVST related to COVID occurs during or after a few weeks of COVID pneumonia and can also be seen in asymptomatic SARS-COV2 infection. COVID-19 can occur independently or in association with traditional thrombotic risk factors which increase the risk and severity of CVST in COVID. If recognized early, CVST associated with COVID can usually be treated effectively to achieve a very good outcome.
{"title":"Cerebral Venous Sinus Thrombosis (CVST) as a Complication of SARS-COV2 Infection","authors":"S. Pujari, Pawan K. Ojha, R. Kulkarni, Dr Sumit Kharat, Dulari Gupta, R. Lalla, Keyur Panchal, P. Walzade, Nilesh Palasdeokar, D. Nadgir, S. Nirhale, Pramod Dhonde, N. Ichaporia, Sujit A. Jagtap, A. Dravid, B. Purandare, S. Jog, Z. Khan, C. Meshram","doi":"10.1177/25166085221089731","DOIUrl":"https://doi.org/10.1177/25166085221089731","url":null,"abstract":"Background and Purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infection induces a prothrombotic state frequently associated with arterial ischemic strokes. Cerebral venous sinus thrombosis (CVST) is also reported with corona virus disease-19 (COVID-19) but a large cohort study is lacking. Our aim was to study the characteristics, treatment response, and outcomes of CVST occurring in association with COVID-19 (COVID-CVST) and the causal relationship with COVID-19. Methods: Data of 34 patients admitted in COVID facility and suffering from CVST and SARS-COV2 infection was studied with respect to their clinic-radiological and lab features, predisposing factors, treatment, and outcome. Observations and Results: 15 patients with CVST were detected positive for COVID but remained asymptomatic for the same. 14 patients had CVST along with symptoms of COVID, whereas 5 had CVST after recovery from COVID, at an average of 18 days after COVID-19. 4 patients were on aspirin as prophylaxis against thrombo-embolic events. The number of males exceeded females (22:12), conventional risk factors were seen in only 8 patients (postpartum state-3, alcohol abuse-2 and anemia-3), whereas the majority (26/34) showed none of them. The mean serum homocysteine level was normal and antiphospholipid antibody was tested normal in the assessed subjects. D-dimer and C reactive protein were elevated in all. 4 symptomatic patients who suffered from severe pneumonia died because of systemic complications. Conclusion: COVID-19 predisposes to CVST and the outcome is related to the severity of COVID pneumonia. CVST related to COVID occurs during or after a few weeks of COVID pneumonia and can also be seen in asymptomatic SARS-COV2 infection. COVID-19 can occur independently or in association with traditional thrombotic risk factors which increase the risk and severity of CVST in COVID. If recognized early, CVST associated with COVID can usually be treated effectively to achieve a very good outcome.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90670582","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 : 2022-04-08DOI: 10.1177/25166085221082407
Mukesh Kumar, D. Khurana, Aditya N. Choudhary, C. Ahuja
Paradoxical intracranial hemodynamic steal (IHS) is a contradictory reduction of cerebral blood flow volume in the territory of the impaired perfusion area occurring spontaneously or in response to vasodilatory stimuli, which can be recorded and evaluated on transcranial doppler (TCD). IHS followed by early neurological worsening (change in National Institute of Health Stroke Scale [NIHSS]> 2) in acute ischemic stroke patients has been described as reversed Robin Hood syndrome (RRHS). We describe two cases of RRHS following carotid artery stenting (CAS) in patients with contralateral carotid occlusion and its further management. Two patients with a history of anterior circulation strokes presented with recent complaints of dizziness and a sensation of being pulled back (patient 1), and episodic numbness of upper limbs (patient 2). On CT angiogram, both of the patients had severe extracranial internal carotid artery (ICA) stenosis on the symptomatic side associated with complete occlusion of the ICA on the contralateral side. In addition, both patients had impaired vasomotor reactivity (VMR) on TCD in the bilateral middle cerebral artery (MCA). Therefore, CAS on the symptomatic side was performed in both patients by femoral artery access without any periprocedural and postprocedural complications. However, on day 1 post CAS, complaints of transient upper limb tingling (patient 1) and limb shaking (patient 2) were reported corresponding to the completely occluded ICA, and TCD examinations confirmed RRHS in both patients. Patients were managed by decreasing the dose of antihypertensive medication to augment the blood pressure for 2 weeks. Normalization of the VMR on TCD was seen on follow-up, and both patients remain asymptomatic.
{"title":"Acute Revascularization Induced Reversed Robin Hood Syndrome","authors":"Mukesh Kumar, D. Khurana, Aditya N. Choudhary, C. Ahuja","doi":"10.1177/25166085221082407","DOIUrl":"https://doi.org/10.1177/25166085221082407","url":null,"abstract":"Paradoxical intracranial hemodynamic steal (IHS) is a contradictory reduction of cerebral blood flow volume in the territory of the impaired perfusion area occurring spontaneously or in response to vasodilatory stimuli, which can be recorded and evaluated on transcranial doppler (TCD). IHS followed by early neurological worsening (change in National Institute of Health Stroke Scale [NIHSS]> 2) in acute ischemic stroke patients has been described as reversed Robin Hood syndrome (RRHS). We describe two cases of RRHS following carotid artery stenting (CAS) in patients with contralateral carotid occlusion and its further management. Two patients with a history of anterior circulation strokes presented with recent complaints of dizziness and a sensation of being pulled back (patient 1), and episodic numbness of upper limbs (patient 2). On CT angiogram, both of the patients had severe extracranial internal carotid artery (ICA) stenosis on the symptomatic side associated with complete occlusion of the ICA on the contralateral side. In addition, both patients had impaired vasomotor reactivity (VMR) on TCD in the bilateral middle cerebral artery (MCA). Therefore, CAS on the symptomatic side was performed in both patients by femoral artery access without any periprocedural and postprocedural complications. However, on day 1 post CAS, complaints of transient upper limb tingling (patient 1) and limb shaking (patient 2) were reported corresponding to the completely occluded ICA, and TCD examinations confirmed RRHS in both patients. Patients were managed by decreasing the dose of antihypertensive medication to augment the blood pressure for 2 weeks. Normalization of the VMR on TCD was seen on follow-up, and both patients remain asymptomatic.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83071199","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 : 2022-03-31DOI: 10.1177/25166085221082409
J. Mathew
Selective infarction of the oculomotor nuclear complex without accompanying long tract involvement is an exceedingly rare event with distinctive clinical features. The complicated topographical distribution of the various nuclei within the complex can result in diverse clinical presentation.
{"title":"Isolated Oculomotor Nuclear Infarction: A Rare Clinical Scenario","authors":"J. Mathew","doi":"10.1177/25166085221082409","DOIUrl":"https://doi.org/10.1177/25166085221082409","url":null,"abstract":"Selective infarction of the oculomotor nuclear complex without accompanying long tract involvement is an exceedingly rare event with distinctive clinical features. The complicated topographical distribution of the various nuclei within the complex can result in diverse clinical presentation.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86563707","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 : 2022-03-17DOI: 10.1177/25166085221082410
A. Elavarasi, S. Narayan, Sai Chandran, D. Rath
Carotid stenosis is an important cause of recurrent transient ischemic attacks and stroke. Carotid stenting and endarterectomy are considered equally effective in treating this condition. We report a patient with recurrent TIA and bilateral carotid stenosis who had undergone anterior cervical diskectomy and fusion and who was found to have fibrous bands encasing the right carotid artery. He was treated with endarterectomy on the left side and carotid stenting on the right side. With the widespread availability of procedures like carotid endarterectomy, more older people would undergo this surgery, who might have undergone anterior cervical surgery. Prior neck surgery and adhesions may lead to altered anatomy, risk of increased blood loss, and surgical complications. In such cases, carotid stenting could be an alternative to endarterectomy.
{"title":"Bilateral Carotid Stenosis in a Patient with Previous Neck Surgery: Difficulties in Endarterectomy","authors":"A. Elavarasi, S. Narayan, Sai Chandran, D. Rath","doi":"10.1177/25166085221082410","DOIUrl":"https://doi.org/10.1177/25166085221082410","url":null,"abstract":"Carotid stenosis is an important cause of recurrent transient ischemic attacks and stroke. Carotid stenting and endarterectomy are considered equally effective in treating this condition. We report a patient with recurrent TIA and bilateral carotid stenosis who had undergone anterior cervical diskectomy and fusion and who was found to have fibrous bands encasing the right carotid artery. He was treated with endarterectomy on the left side and carotid stenting on the right side. With the widespread availability of procedures like carotid endarterectomy, more older people would undergo this surgery, who might have undergone anterior cervical surgery. Prior neck surgery and adhesions may lead to altered anatomy, risk of increased blood loss, and surgical complications. In such cases, carotid stenting could be an alternative to endarterectomy.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78598548","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 : 2022-03-17DOI: 10.1177/25166085221082433
A. Elavarasi, S. Narayan, S. Parameswaran, D. Gocchait
Nephrotic syndrome and hypereosinophilic syndrome both are uncommon causes of arterial stroke. We had a young patient with internal carotid artery occlusion, who had both these rare associations and was found to have membranous nephropathy. Idiopathic hypereosinophilia was treated with corticosteroids and conventional parasiticidal therapy with the intention of bringing down the eosinophil count. Nephrotic syndrome was also treated with corticosteroids and immunosuppression with cyclophosphamide. Hematologic abnormalities are an important cause of arterial thrombosis with effective secondary prevention strategies. Similarly, nephrotic syndrome is not to be missed as early treatment may prevent vascular complications. While cause-effect associations remained presumptive and a single diagnostic label elusive, the patient was recognized and treated early and had a good prognosis. However, other common causes of stroke should always be worked up for, and vigilant follow-up mandatory for prevention and treatment of recurrences which can have devastating sequelae such as total blindness and other vascular outcomes.
{"title":"Carotid Occlusion Associated With Eosinophilia and Proteinuria: Potential Diagnostic Clues or Red Herrings?","authors":"A. Elavarasi, S. Narayan, S. Parameswaran, D. Gocchait","doi":"10.1177/25166085221082433","DOIUrl":"https://doi.org/10.1177/25166085221082433","url":null,"abstract":"Nephrotic syndrome and hypereosinophilic syndrome both are uncommon causes of arterial stroke. We had a young patient with internal carotid artery occlusion, who had both these rare associations and was found to have membranous nephropathy. Idiopathic hypereosinophilia was treated with corticosteroids and conventional parasiticidal therapy with the intention of bringing down the eosinophil count. Nephrotic syndrome was also treated with corticosteroids and immunosuppression with cyclophosphamide. Hematologic abnormalities are an important cause of arterial thrombosis with effective secondary prevention strategies. Similarly, nephrotic syndrome is not to be missed as early treatment may prevent vascular complications. While cause-effect associations remained presumptive and a single diagnostic label elusive, the patient was recognized and treated early and had a good prognosis. However, other common causes of stroke should always be worked up for, and vigilant follow-up mandatory for prevention and treatment of recurrences which can have devastating sequelae such as total blindness and other vascular outcomes.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83562216","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 : 2022-03-16DOI: 10.1177/25166085221082440
S. Menon, G. Menon
Retinal vessels provide an indirect window to the status of cerebral vasculature. Pathological changes in cerebral vessels secondary to hypertension and other predisposing conditions precede the onset of hemorrhagic stroke. Retinal vessel assessment may help in early detection of these changes and several studies have shown that retinal vessel caliber assessment can be a valuable tool in the primary prevention of hemorrhagic stroke. Technical considerations have been a limiting factor in the widespread use of this simple user friendly tool. However, recent technological and software advances especially in the realm of artificial intelligence and machine learning have simplified the procedure. This article explores the current status and future prospects of this extremely promising tool.
{"title":"Role of Retinal Vessel Caliber Assessment in Predicting Hemorrhagic Stroke—Emerging Concepts","authors":"S. Menon, G. Menon","doi":"10.1177/25166085221082440","DOIUrl":"https://doi.org/10.1177/25166085221082440","url":null,"abstract":"Retinal vessels provide an indirect window to the status of cerebral vasculature. Pathological changes in cerebral vessels secondary to hypertension and other predisposing conditions precede the onset of hemorrhagic stroke. Retinal vessel assessment may help in early detection of these changes and several studies have shown that retinal vessel caliber assessment can be a valuable tool in the primary prevention of hemorrhagic stroke. Technical considerations have been a limiting factor in the widespread use of this simple user friendly tool. However, recent technological and software advances especially in the realm of artificial intelligence and machine learning have simplified the procedure. This article explores the current status and future prospects of this extremely promising tool.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74020408","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 : 2022-03-14DOI: 10.1177/25166085221082438
N. Ramrakhiani, Palak Mamodia, D. Sharma, Nitesh Agarwal
Patient, 19-year-old male, presented with fever, abdominal pain, headache, and vomiting presented after vaccination with ChAdOx1 CoV-19 (AstraZeneca, University of Oxford, and Serum Institute of India, and adenoviral-based vaccine) with alteration in sensorium and thrombocytopenia. He was diagnosed to have extensive venous sinus thrombosis with mass effect, midline shift, and underwent decompressive hemicraniotomy. He had a good outcome.
{"title":"Venous Sinus Thrombosis due to Vaccine-Induced Thrombotic Thrombocytopenia (VITT): A Case Report","authors":"N. Ramrakhiani, Palak Mamodia, D. Sharma, Nitesh Agarwal","doi":"10.1177/25166085221082438","DOIUrl":"https://doi.org/10.1177/25166085221082438","url":null,"abstract":"Patient, 19-year-old male, presented with fever, abdominal pain, headache, and vomiting presented after vaccination with ChAdOx1 CoV-19 (AstraZeneca, University of Oxford, and Serum Institute of India, and adenoviral-based vaccine) with alteration in sensorium and thrombocytopenia. He was diagnosed to have extensive venous sinus thrombosis with mass effect, midline shift, and underwent decompressive hemicraniotomy. He had a good outcome.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86015363","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 : 2022-03-11DOI: 10.1177/25166085221082425
M. Muraleedharan, Alaka Omprakash Chandak
Early treatment seeking during a stroke or heart attack is critical to prevent mortality and disability. This study has aimed to understand the perceptions of health-care experts in the state regarding the “emergency healthcare-seeking behavior of Kerala population during an acute stroke or heart attack.” An interpretative phenomenological analysis (IPA) was utilized in the study. Semi-structured interviews with health-care experts were conducted, and the data were analyzed linguistically. Later, interpretations were made based on the themes and literature review. We interviewed 7 health experts, and data were analyzed using the IPA method. Major concerns raised by the health experts include health financing issues, the disparity in treatment-seeking response based on socioeconomic status, less awareness regarding stroke in public, and so on.
{"title":"Treatment-Seeking Behavior of the Public During an Acute Stroke or Cardiac Event—Health-Care Expert’s Perspective From Kerala, India","authors":"M. Muraleedharan, Alaka Omprakash Chandak","doi":"10.1177/25166085221082425","DOIUrl":"https://doi.org/10.1177/25166085221082425","url":null,"abstract":"Early treatment seeking during a stroke or heart attack is critical to prevent mortality and disability. This study has aimed to understand the perceptions of health-care experts in the state regarding the “emergency healthcare-seeking behavior of Kerala population during an acute stroke or heart attack.” An interpretative phenomenological analysis (IPA) was utilized in the study. Semi-structured interviews with health-care experts were conducted, and the data were analyzed linguistically. Later, interpretations were made based on the themes and literature review. We interviewed 7 health experts, and data were analyzed using the IPA method. Major concerns raised by the health experts include health financing issues, the disparity in treatment-seeking response based on socioeconomic status, less awareness regarding stroke in public, and so on.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90357934","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 : 2022-03-08DOI: 10.1177/25166085221082403
R. Lotlikar, Karkala Saikiran, J. George, N. Namboodiri, P. Sylaja, S. Sreedharan
Background and Purpose: Ischemic stroke has highest recurrence risk in the first-year, ranging from 5.7% to 14%, depending on etiology, with highest reported following cardioembolism and large artery atherosclerosis (LAA), while it is not negligible in cryptogenic strokes. We evaluated the utility of clinical, imaging parameters along with electrographic and echocardiographic biomarkers of atrial dysfunction in 2 etiological groups, namely LAA and cryptogenic strokes and compared the predictors of recurrence risk at 1 year. Methodology: All acute ischemic strokes admitted to Comprehensive Stroke Care Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India for 1 year (July 2019 till June 2020) with 1 year completed follow-up were screened from electronic records. Strokes secondary to LAA and undetermined cause were compared for their clinical, imaging, and cardiac variables to predict risk of recurrence in the first year. Results: Of the 179 patients, 93 had strokes secondary to LAA and 86 had cryptogenic strokes (CS). Seventy-five patients had more than 1 event at presentation/follow-up. Recurrence risk did not differ between the 2 etiological subgroups at 1 year. Hypertension (P = .016), multiple territory strokes (P = .02), and dilated left ventricle (LA) chamber (P = .047) were independently associated with recurrence risk in the entire cohort as well as within the undetermined group. Early hospitalization within 48 h reduced the overall recurrence risk (P = .01), thus emphasizing the role of early etiological evaluation and initiation of secondary prevention in reducing future events, irrespective of etiology. Conclusion: In optimally managed LAA and cryptogenic strokes, presence of hypertension, multiterritorial infarcts, and dilated LA chambers increases the recurrence risk pointing to a likely cardiac substrate itself contributing to future stroke risk.
{"title":"Predictors of Recurrence in Symptomatic Large Artery Atherosclerosis and Cryptogenic Strokes—A Comparative Study","authors":"R. Lotlikar, Karkala Saikiran, J. George, N. Namboodiri, P. Sylaja, S. Sreedharan","doi":"10.1177/25166085221082403","DOIUrl":"https://doi.org/10.1177/25166085221082403","url":null,"abstract":"Background and Purpose: Ischemic stroke has highest recurrence risk in the first-year, ranging from 5.7% to 14%, depending on etiology, with highest reported following cardioembolism and large artery atherosclerosis (LAA), while it is not negligible in cryptogenic strokes. We evaluated the utility of clinical, imaging parameters along with electrographic and echocardiographic biomarkers of atrial dysfunction in 2 etiological groups, namely LAA and cryptogenic strokes and compared the predictors of recurrence risk at 1 year. Methodology: All acute ischemic strokes admitted to Comprehensive Stroke Care Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India for 1 year (July 2019 till June 2020) with 1 year completed follow-up were screened from electronic records. Strokes secondary to LAA and undetermined cause were compared for their clinical, imaging, and cardiac variables to predict risk of recurrence in the first year. Results: Of the 179 patients, 93 had strokes secondary to LAA and 86 had cryptogenic strokes (CS). Seventy-five patients had more than 1 event at presentation/follow-up. Recurrence risk did not differ between the 2 etiological subgroups at 1 year. Hypertension (P = .016), multiple territory strokes (P = .02), and dilated left ventricle (LA) chamber (P = .047) were independently associated with recurrence risk in the entire cohort as well as within the undetermined group. Early hospitalization within 48 h reduced the overall recurrence risk (P = .01), thus emphasizing the role of early etiological evaluation and initiation of secondary prevention in reducing future events, irrespective of etiology. Conclusion: In optimally managed LAA and cryptogenic strokes, presence of hypertension, multiterritorial infarcts, and dilated LA chambers increases the recurrence risk pointing to a likely cardiac substrate itself contributing to future stroke risk.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78898302","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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