Pub Date : 2021-04-29DOI: 10.1177/25166085211010229
M. Nedunchelian, S. Varadharajan, S. Keerthy, MA Karthikeyan, Santosh Poyyamozhi, P. Mehta, M. Cherian
Background: Arterial spin labelling (ASL) is a noncontrast, magnetic resonance perfusion technique which can provide information about the parenchymal perfusion status and collaterals in acute stroke. Its role in the setting of large vessel occlusion (LVO) is underutilized due to the limited availability of magnetic resonance imaging (MRI) in the emergency settings. However, it might serve as an useful adjunct to other perfusion modalities in future. Objective: To study ASL perfusion patterns in anterior circulation LVO stroke and evaluate the presence of arterial transit artefacts (ATA) as a surrogate marker of collaterals. Methods: We performed a retrospective analysis of our mechanical thrombectomy database over the last 2 years for acute stroke cases in which ASL perfusion as part of MRI was performed. ASL perfusion patterns in acute LVO stroke were reviewed, with respect to presence of ATA and diffusion-weighted imaging (DWI)-ASL mismatch. Inter-rater reliability was analyzed between 2 readers of varying experience. Baseline variables were analyzed between those with and without ATA. Results: Out of 95 patients, 78 had anterior circulation occlusions, among which 27 had ASL. Type I (with ATAs) was seen in 11 patients and all of these had DWI mismatch. Type II (without ATAs) was seen in 16 patients. Of these, 15 had mismatch with DWI and only 1 had no mismatch. Inter-rater reliability for the detection of ATA on ASL was substantial (Cohen’s k—0.64). No statistical significance was noted between ATA and clinical outcomes. Conclusion: ASL patterns vary amongst patients with LVO stroke and can be classified based on the presence of ATA since resulting DWI mismatch actually indicates a pseudo-perfusion deficit.
{"title":"Arterial Spin Labelling Patterns in Acute Large Vessel Occlusion Stroke","authors":"M. Nedunchelian, S. Varadharajan, S. Keerthy, MA Karthikeyan, Santosh Poyyamozhi, P. Mehta, M. Cherian","doi":"10.1177/25166085211010229","DOIUrl":"https://doi.org/10.1177/25166085211010229","url":null,"abstract":"Background: Arterial spin labelling (ASL) is a noncontrast, magnetic resonance perfusion technique which can provide information about the parenchymal perfusion status and collaterals in acute stroke. Its role in the setting of large vessel occlusion (LVO) is underutilized due to the limited availability of magnetic resonance imaging (MRI) in the emergency settings. However, it might serve as an useful adjunct to other perfusion modalities in future. Objective: To study ASL perfusion patterns in anterior circulation LVO stroke and evaluate the presence of arterial transit artefacts (ATA) as a surrogate marker of collaterals. Methods: We performed a retrospective analysis of our mechanical thrombectomy database over the last 2 years for acute stroke cases in which ASL perfusion as part of MRI was performed. ASL perfusion patterns in acute LVO stroke were reviewed, with respect to presence of ATA and diffusion-weighted imaging (DWI)-ASL mismatch. Inter-rater reliability was analyzed between 2 readers of varying experience. Baseline variables were analyzed between those with and without ATA. Results: Out of 95 patients, 78 had anterior circulation occlusions, among which 27 had ASL. Type I (with ATAs) was seen in 11 patients and all of these had DWI mismatch. Type II (without ATAs) was seen in 16 patients. Of these, 15 had mismatch with DWI and only 1 had no mismatch. Inter-rater reliability for the detection of ATA on ASL was substantial (Cohen’s k—0.64). No statistical significance was noted between ATA and clinical outcomes. Conclusion: ASL patterns vary amongst patients with LVO stroke and can be classified based on the presence of ATA since resulting DWI mismatch actually indicates a pseudo-perfusion deficit.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85170943","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 : 2021-03-22DOI: 10.1177/25166085211000915
J. Pandian, Yohanna Kusuma, L. S. Kiemas, Tsong-Hai Lee, J. C. Navarro, Y. Nilanont, N. Suwanwela, H. Chiu, S. Kwon, K. Tan, N. H. Thang, B. Yoon, Junjay Tan, N. Venketasubramanian
The COVID-19 pandemic has impacted the health system worldwide. Stroke is one of the leading causes of death and disability in the world. Asia has a diverse health system and more than two-thirds of strokes occur in this region. The Asian Stroke Advisory Panel (ASAP) conducted a survey among the member countries to explore the impact of COVID-19 on stroke care. The stroke admission numbers have fallen, as have the number of patients who received thrombolysis and mechanical thrombectomy. The stroke unit and rehabilitation beds have been reallocated for COVID-19 care. ASAP recommends emergency department screening of stroke patients for COVID-19 and protected stroke code to be activated for COVID-19 suspect stroke patients. Noncontrast computed tomography (CT), CT angiography, and CT chest are the imaging modalities of choice. All health care professionals involved in triaging, imaging, and stroke care should wear appropriate personal protective equipment. All eligible stroke patients (COVID suspect/positive/non-COVID) should receive intravenous thrombolysis/mechanical thrombectomy. Mobile stroke units and robots can be used wherever available for evaluation and triaging. All stroke patients should receive standard stroke unit care. Limited rehabilitation should be offered to patients and training of caregivers if needed. Telemedicine/telestroke should be used for rehabilitation and follow-up. The ASAP consensus statement can be adapted to suit local and national health care systems.
{"title":"Stroke Care During the COVID-19 Pandemic: Asian Stroke Advisory Panel Consensus Statement","authors":"J. Pandian, Yohanna Kusuma, L. S. Kiemas, Tsong-Hai Lee, J. C. Navarro, Y. Nilanont, N. Suwanwela, H. Chiu, S. Kwon, K. Tan, N. H. Thang, B. Yoon, Junjay Tan, N. Venketasubramanian","doi":"10.1177/25166085211000915","DOIUrl":"https://doi.org/10.1177/25166085211000915","url":null,"abstract":"The COVID-19 pandemic has impacted the health system worldwide. Stroke is one of the leading causes of death and disability in the world. Asia has a diverse health system and more than two-thirds of strokes occur in this region. The Asian Stroke Advisory Panel (ASAP) conducted a survey among the member countries to explore the impact of COVID-19 on stroke care. The stroke admission numbers have fallen, as have the number of patients who received thrombolysis and mechanical thrombectomy. The stroke unit and rehabilitation beds have been reallocated for COVID-19 care. ASAP recommends emergency department screening of stroke patients for COVID-19 and protected stroke code to be activated for COVID-19 suspect stroke patients. Noncontrast computed tomography (CT), CT angiography, and CT chest are the imaging modalities of choice. All health care professionals involved in triaging, imaging, and stroke care should wear appropriate personal protective equipment. All eligible stroke patients (COVID suspect/positive/non-COVID) should receive intravenous thrombolysis/mechanical thrombectomy. Mobile stroke units and robots can be used wherever available for evaluation and triaging. All stroke patients should receive standard stroke unit care. Limited rehabilitation should be offered to patients and training of caregivers if needed. Telemedicine/telestroke should be used for rehabilitation and follow-up. The ASAP consensus statement can be adapted to suit local and national health care systems.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73573580","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 : 2021-03-18DOI: 10.1177/2516608521998578
J. Agadi, L. Viswanathan, Sujit Kumar, M. N. Pramod
Cortical vein/venous sinus thrombosis (CVT) occurring in the context of a clinically isolated syndrome (CIS) is highly unusual. Our patient presented with dorsal cord demyelination and psoriasis. She developed severe headache post-lumbar puncture, which was followed by focal seizures. She had developed CVT with a hemorrhagic infarct in the left parietal region. Multiple factors, both patient related and as a consequence of treatment and management, may have contributed to this outcome. We aim to discuss the relevance of this rare finding with a brief review of literature.
{"title":"Cortical Vein Thrombosis in a Case of Clinically Isolated Syndrome and Psoriasis—A Case Report and Review of Literature","authors":"J. Agadi, L. Viswanathan, Sujit Kumar, M. N. Pramod","doi":"10.1177/2516608521998578","DOIUrl":"https://doi.org/10.1177/2516608521998578","url":null,"abstract":"Cortical vein/venous sinus thrombosis (CVT) occurring in the context of a clinically isolated syndrome (CIS) is highly unusual. Our patient presented with dorsal cord demyelination and psoriasis. She developed severe headache post-lumbar puncture, which was followed by focal seizures. She had developed CVT with a hemorrhagic infarct in the left parietal region. Multiple factors, both patient related and as a consequence of treatment and management, may have contributed to this outcome. We aim to discuss the relevance of this rare finding with a brief review of literature.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82836241","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: Ankle dorsiflexion movement restriction is a common presentation in most of the chronic stroke survivors. Spasticity and connective tissue changes around ankle, limits dorsiflexion, and interferes with balance and gait performances. Improving functional range of dorsiflexion is essential in post-stroke rehabilitation. Objectives: This meta-analysis analyzed the effects of ankle mobilization techniques in improving dorsiflexion range and gait parameters among chronic stroke survivors. Method: Articles published up to July 2020 were searched in CINAHL, PubMed, Embase, PsyINFO, and OpenGrey. English version of randomized controlled trials (RCTs) assessing the effects of ankle joint mobilization among chronic stroke subjects, with dorsiflexion range of motion (ROM) and gait parameters as outcome, were included. Characteristics of participants, interventions, outcome measure, and measures of variability were extracted. Methodological quality of included trials was assessed using PEDro scale and Cochrane Collaboration tool for the risk of bias. Pooled standardized mean difference was calculated using random effects model for dorsiflexion ROM, gait velocity, step length, cadence, and timed up and go (TUG). Results: Eight RCTs including 226 stroke patients, with mean methodological score of 6 out of 10 in PEDro, were eligible for this meta-analysis. Ankle joint mobilization demonstrated statistically significant improvement on passive dorsiflexion ROM, gait velocity, step length (affected side), and cadence outcomes. Nonsignificance was found in step length (unaffected side) and in TUG. Conclusion: The ankle mobilization techniques are effective in improving passive dorsiflexion ROM, gait velocity, and cadence in chronic stroke survivors. However, the retention effect of ankle mobilization among stroke subjects is not known.
背景:踝关节背屈运动受限是大多数慢性脑卒中幸存者的常见表现。踝关节周围痉挛和结缔组织改变，限制背屈，干扰平衡和步态表现。提高背屈的功能范围是卒中后康复的必要条件。目的:本荟萃分析分析了踝关节活动技术在改善慢性卒中幸存者背屈范围和步态参数方面的作用。方法:在CINAHL、PubMed、Embase、PsyINFO和OpenGrey中检索截至2020年7月发表的文章。我们纳入了以背屈活动范围(ROM)和步态参数为结果的评估慢性卒中受试者踝关节活动效果的随机对照试验(RCTs)的英文版。提取了参与者的特征、干预措施、结果测量和变异性测量。纳入试验的方法学质量采用PEDro量表和Cochrane协作工具评估偏倚风险。采用随机效应模型计算背屈ROM、步态速度、步长、步频和up and go (TUG)的合并标准化平均差。结果:8项随机对照试验纳入226例卒中患者，PEDro平均方法学评分为6分(满分10分)，符合本荟萃分析。踝关节活动对被动背屈ROM、步态速度、步长(受影响侧)和节奏结果有统计学上的显著改善。步长(未受影响侧)和TUG均无统计学意义。结论:踝关节活动技术可有效改善慢性脑卒中幸存者被动背屈ROM、步态速度和节奏。然而，踝关节活动对脑卒中患者的保留作用尚不清楚。
{"title":"The Effects of Ankle Joint Mobilization on Dorsiflexion Range and Gait Parameters in Chronic Stroke Survivors: A Systematic Review and Meta-analysis","authors":"Hariharasudhan Ravichandran, Balamurugan Janakiraman","doi":"10.1177/2516608520982874","DOIUrl":"https://doi.org/10.1177/2516608520982874","url":null,"abstract":"Background: Ankle dorsiflexion movement restriction is a common presentation in most of the chronic stroke survivors. Spasticity and connective tissue changes around ankle, limits dorsiflexion, and interferes with balance and gait performances. Improving functional range of dorsiflexion is essential in post-stroke rehabilitation. Objectives: This meta-analysis analyzed the effects of ankle mobilization techniques in improving dorsiflexion range and gait parameters among chronic stroke survivors. Method: Articles published up to July 2020 were searched in CINAHL, PubMed, Embase, PsyINFO, and OpenGrey. English version of randomized controlled trials (RCTs) assessing the effects of ankle joint mobilization among chronic stroke subjects, with dorsiflexion range of motion (ROM) and gait parameters as outcome, were included. Characteristics of participants, interventions, outcome measure, and measures of variability were extracted. Methodological quality of included trials was assessed using PEDro scale and Cochrane Collaboration tool for the risk of bias. Pooled standardized mean difference was calculated using random effects model for dorsiflexion ROM, gait velocity, step length, cadence, and timed up and go (TUG). Results: Eight RCTs including 226 stroke patients, with mean methodological score of 6 out of 10 in PEDro, were eligible for this meta-analysis. Ankle joint mobilization demonstrated statistically significant improvement on passive dorsiflexion ROM, gait velocity, step length (affected side), and cadence outcomes. Nonsignificance was found in step length (unaffected side) and in TUG. Conclusion: The ankle mobilization techniques are effective in improving passive dorsiflexion ROM, gait velocity, and cadence in chronic stroke survivors. However, the retention effect of ankle mobilization among stroke subjects is not known.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77798007","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 : 2021-03-12DOI: 10.1177/2516608520980547
Usha M. Khanapur, J. John, A. Mani, S. Aaron
Introduction: Caregivers have an important role in stroke recovery, especially after the acute phase of treatment. Caregiving for stroke survivors is associated with caregiver burden. Knowledge of factors influencing this caregiver burden is important for both the patient and the caregiver. Aim: To study the prevalence and predictors of major caregiver burden in survivors of moderate to severe stroke treated both conservatively and with surgical decompression. Methods: A community-based cross-sectional study where caregivers of stroke survivors with moderate to severe disability at discharge (modified Rankin Scale >3) were assessed between 3 months and 3 years of discharge. Results: Caregivers of 115 stroke survivors (82 conservatively treated and 33 who underwent decompressive hemicraniectomy) were studied. The majority (80%) were females. The mean period of caregiving was 18.8 ± 10.3 months (range 3-44 months). Major caregiver burden was seen in 36% (confidence interval [CI] = 27.3-44.7%). The significant predictors of major caregiver burden were daily caregiving for ≥4 hours (adjusted odds ratio [AOR] 5.3; CI = 1.84-15.3), patient activities of daily living dependency (AOR 3.66; CI = 1.03-13.03), and caregiver being the spouse (AOR 4.52; CI = 1.25-16.3). A total of 17% of the caregivers stopped working. Only (18%) had health insurance and 59% had borrowed money for treatment. A total of 88% of caregivers were happy regarding their decision to opt for surgery despite their current burden. Conclusion: Caregivers had stress in various domains. Shortening the caregiving hours especially in the initial months may help reduce the burden since the caregiver burden is also influenced by the patient’s dependency which improves over time.
{"title":"Predictors of Caregiver Burden of Moderate and Severe Stroke Survivors: A Cross-Sectional Study from South India","authors":"Usha M. Khanapur, J. John, A. Mani, S. Aaron","doi":"10.1177/2516608520980547","DOIUrl":"https://doi.org/10.1177/2516608520980547","url":null,"abstract":"Introduction: Caregivers have an important role in stroke recovery, especially after the acute phase of treatment. Caregiving for stroke survivors is associated with caregiver burden. Knowledge of factors influencing this caregiver burden is important for both the patient and the caregiver. Aim: To study the prevalence and predictors of major caregiver burden in survivors of moderate to severe stroke treated both conservatively and with surgical decompression. Methods: A community-based cross-sectional study where caregivers of stroke survivors with moderate to severe disability at discharge (modified Rankin Scale >3) were assessed between 3 months and 3 years of discharge. Results: Caregivers of 115 stroke survivors (82 conservatively treated and 33 who underwent decompressive hemicraniectomy) were studied. The majority (80%) were females. The mean period of caregiving was 18.8 ± 10.3 months (range 3-44 months). Major caregiver burden was seen in 36% (confidence interval [CI] = 27.3-44.7%). The significant predictors of major caregiver burden were daily caregiving for ≥4 hours (adjusted odds ratio [AOR] 5.3; CI = 1.84-15.3), patient activities of daily living dependency (AOR 3.66; CI = 1.03-13.03), and caregiver being the spouse (AOR 4.52; CI = 1.25-16.3). A total of 17% of the caregivers stopped working. Only (18%) had health insurance and 59% had borrowed money for treatment. A total of 88% of caregivers were happy regarding their decision to opt for surgery despite their current burden. Conclusion: Caregivers had stress in various domains. Shortening the caregiving hours especially in the initial months may help reduce the burden since the caregiver burden is also influenced by the patient’s dependency which improves over time.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77847008","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 : 2021-02-26DOI: 10.1177/2516608520980290
Ahmed Al Sinani, A. A. Hashmi, S. Aaron, Jospaul Lukas, Mohammed Al Zaabi
Antithrombin (AT III) is a potent inactivator of thrombin and factor Xa and plays a major role in the inhibition of coagulation. Inherited deficiencies of AT III are rare and pose a risk of developing venous thromboembolic disease. They can be subdivided into type I (quantitative) or type II (qualitative). Mild AT III deficiency is associated with a 2.4- to 3.5-fold risk of venous thromboembolism (VTE). Thrombosis in patients with AT III deficiency predominantly manifests as a deep vein thrombosis and may subsequently present as pulmonary embolism. It can also occur in uncommon sites such as cerebral, retinal, mesenteric, portal, hepatic, and splenic veins. We report a case of an unprovoked cerebral venous thrombosis in a 24-year-old Omani male, without any comorbidity, who was found to have quantitative deficiency of AT III. He has a significant history of family members having VTE in varying venous beds. This case highlights the wide spectrum of clinical manifestations of quantitative deficiency of AT III and stresses on the importance of taking a good family history and the need for testing for inherited thrombophilia since it can alter long-term management.
{"title":"Quantitative Antithrombin Deficiency Manifesting as Cerebral Sinus Thrombosis in a Patient With a Family History of Clinically Variable Venous Thromboembolic Events: A Case Report","authors":"Ahmed Al Sinani, A. A. Hashmi, S. Aaron, Jospaul Lukas, Mohammed Al Zaabi","doi":"10.1177/2516608520980290","DOIUrl":"https://doi.org/10.1177/2516608520980290","url":null,"abstract":"Antithrombin (AT III) is a potent inactivator of thrombin and factor Xa and plays a major role in the inhibition of coagulation. Inherited deficiencies of AT III are rare and pose a risk of developing venous thromboembolic disease. They can be subdivided into type I (quantitative) or type II (qualitative). Mild AT III deficiency is associated with a 2.4- to 3.5-fold risk of venous thromboembolism (VTE). Thrombosis in patients with AT III deficiency predominantly manifests as a deep vein thrombosis and may subsequently present as pulmonary embolism. It can also occur in uncommon sites such as cerebral, retinal, mesenteric, portal, hepatic, and splenic veins. We report a case of an unprovoked cerebral venous thrombosis in a 24-year-old Omani male, without any comorbidity, who was found to have quantitative deficiency of AT III. He has a significant history of family members having VTE in varying venous beds. This case highlights the wide spectrum of clinical manifestations of quantitative deficiency of AT III and stresses on the importance of taking a good family history and the need for testing for inherited thrombophilia since it can alter long-term management.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78203258","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 : 2021-02-22DOI: 10.1177/2516608520984289
V. Bhatia, C. Jain, S. Ray, J. Kumar
Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.
{"title":"Young Male with Bilateral ICA Dissection: Beyond CADISS Trial","authors":"V. Bhatia, C. Jain, S. Ray, J. Kumar","doi":"10.1177/2516608520984289","DOIUrl":"https://doi.org/10.1177/2516608520984289","url":null,"abstract":"Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81549542","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 : 2021-02-18DOI: 10.1177/2516608520984296
D. Gandhi, I. Sebastian, Komal Bhanot
Sensory dysfunction is one of the common impairments that occurs post stroke. With sensory changes in all modalities, it also affects the quality of life and incites suicidal thoughts. The article attempts to review and describe the current evidence of various approaches of assessment and rehabilitation for post-stroke sensory dysfunction. After extensive electronic database search across Medline, Embase, EBSCO, and Cochrane library, it generated 2433 results. After screening according to inclusion and exclusion criteria, we included 11 studies. We categorized data based on type of sensory deficits and prevalence, role of sensory system on motor behavior, type of intervention, sensory modality targeted, and dosage of intervention and outcome measures used for rehabilitation. Results found the strong evidence of involvement of primary and secondary motor areas involved in processing and responding to somatosensation, respectively. We divided rehabilitation approaches into sensory stimulation approach and sensory retraining approach focused on using external stimuli and relearning, respectively. However, with varied aims and targeted sensory involvement, the study applicability is affected. Thus, this emerges the need of extensive research in future for evidence-based practice of assessments and rehabilitation on post-stroke sensory rehabilitation.
{"title":"Rehabilitation of Post Stroke Sensory Dysfunction—A Scoping Review","authors":"D. Gandhi, I. Sebastian, Komal Bhanot","doi":"10.1177/2516608520984296","DOIUrl":"https://doi.org/10.1177/2516608520984296","url":null,"abstract":"Sensory dysfunction is one of the common impairments that occurs post stroke. With sensory changes in all modalities, it also affects the quality of life and incites suicidal thoughts. The article attempts to review and describe the current evidence of various approaches of assessment and rehabilitation for post-stroke sensory dysfunction. After extensive electronic database search across Medline, Embase, EBSCO, and Cochrane library, it generated 2433 results. After screening according to inclusion and exclusion criteria, we included 11 studies. We categorized data based on type of sensory deficits and prevalence, role of sensory system on motor behavior, type of intervention, sensory modality targeted, and dosage of intervention and outcome measures used for rehabilitation. Results found the strong evidence of involvement of primary and secondary motor areas involved in processing and responding to somatosensation, respectively. We divided rehabilitation approaches into sensory stimulation approach and sensory retraining approach focused on using external stimuli and relearning, respectively. However, with varied aims and targeted sensory involvement, the study applicability is affected. Thus, this emerges the need of extensive research in future for evidence-based practice of assessments and rehabilitation on post-stroke sensory rehabilitation.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90435771","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 : 2020-12-01Epub Date: 2020-10-28DOI: 10.1177/2516608520962349
Sima Kurmi, Elezebeth Mathews, Prakash Babu Kodali, K R Thankappan
Introduction: This study was undertaken with the following objectives: (a) to find out the awareness of warning symptoms and risk factors of stroke, (b) response to acute stroke, and (c) factors associated with awareness, risk factors, and response to acute stroke among community-dwelling adults in Biswanath district of Assam.
Methods: Using a cross-sectional design, a community-based study was done among 340 adults (mean age 38 years, men 55%) selected using multistage cluster sampling. Information on sociodemographic variables, stroke warning symptoms, risk factors, and response to acute stroke was collected using an adapted World Health Organization (WHO) STEPs stroke surveillance tool. Bivariate and logistic regression analysis were done to find out the factors associated with stroke warning symptoms, risk factors, and response to acute stroke. A "P" value < .05 was considered for statistical significance.
Results: Awareness of stroke was significantly higher among males (P < .01), better educated (P < .01), government employees (P < .05), high-income group (P < .01), and those who reported receiving information from a professional source (P < .01) compared to their counterparts. Knowledge of at least one stroke risk factor and providing at least one correct response to acute stroke was higher among males, better educated, government employees, higher income groups, and those who received information from professional source compared to their counterparts (P < .05).
Conclusion: Awareness of stroke warning symptoms, risk factors, and response to acute stroke needs to be improved focusing on women, low education groups, those working in the nongovernment sector, and low-income groups by health professionals.
{"title":"Awareness of Stroke Warning Symptoms, Risk Factors, and Response to Acute Stroke in Biswanath District, Assam, India.","authors":"Sima Kurmi, Elezebeth Mathews, Prakash Babu Kodali, K R Thankappan","doi":"10.1177/2516608520962349","DOIUrl":"https://doi.org/10.1177/2516608520962349","url":null,"abstract":"<p><strong>Introduction: </strong>This study was undertaken with the following objectives: (a) to find out the awareness of warning symptoms and risk factors of stroke, (b) response to acute stroke, and (c) factors associated with awareness, risk factors, and response to acute stroke among community-dwelling adults in Biswanath district of Assam.</p><p><strong>Methods: </strong>Using a cross-sectional design, a community-based study was done among 340 adults (mean age 38 years, men 55%) selected using multistage cluster sampling. Information on sociodemographic variables, stroke warning symptoms, risk factors, and response to acute stroke was collected using an adapted World Health Organization (WHO) STEPs stroke surveillance tool. Bivariate and logistic regression analysis were done to find out the factors associated with stroke warning symptoms, risk factors, and response to acute stroke. A \"P\" value < .05 was considered for statistical significance.</p><p><strong>Results: </strong>Awareness of stroke was significantly higher among males (<i>P</i> < .01), better educated (<i>P</i> < .01), government employees (<i>P</i> < .05), high-income group (<i>P</i> < .01), and those who reported receiving information from a professional source (<i>P</i> < .01) compared to their counterparts. Knowledge of at least one stroke risk factor and providing at least one correct response to acute stroke was higher among males, better educated, government employees, higher income groups, and those who received information from professional source compared to their counterparts (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>Awareness of stroke warning symptoms, risk factors, and response to acute stroke needs to be improved focusing on women, low education groups, those working in the nongovernment sector, and low-income groups by health professionals.</p>","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2516608520962349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39222764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.1177/2516608520972203
Sarah Boyko, O. Morgan, Kruti A. Shah, K. Chester
Background: Approximately 10% to 15% of patients who suffer intracranial hemorrhages (ICHs) are on therapeutic anticoagulation. Additionally, patients may develop an indication for anticoagulation after ICH. There is minimal guidance with starting anticoagulation after an ICH, and most evidence has evaluated vitamin K antagonists (VKA). Objective: The aim of this study was to evaluate the safety of anticoagulation prescribing following a nontraumatic ICH with VKA, low molecular weight heparin (LMWH), or direct oral anticoagulants (DOACs). Methods: A retrospective chart review was conducted of patients admitted with a nontraumatic ICH and an indication for anticoagulation between February 2015 to June 2018 at an urban tertiary comprehensive stroke center. The primary objective was to evaluate the safety of prescribing anticoagulation in these patients. Two groups were reviewed to evaluate the primary outcome: patients who were started on anticoagulation after ICH (anticoagulation group) and a comparator group not started on anticoagulation (control group). The primary endpoint was measured by a composite incidence of recurrent ICH, major bleeding events, and thromboembolic events. Results: Anticoagulation was started within 2 months in 23 patients with an indication for anticoagulation. Anticoagulation was held in 35 patients. There was no difference in the composite primary endpoint between the 2 groups (P = .29). The median time to starting anticoagulation was 21 days (IQR 7-28 days). Conclusions: This study shows the safety of starting anticoagulation in patients with recent ICH in our cohort of patients and highlights the need for more robust evidence to guide clinical decision making.
{"title":"Safety of Anticoagulation in Patients With an Intracranial Hemorrhage at a Comprehensive Stroke Center","authors":"Sarah Boyko, O. Morgan, Kruti A. Shah, K. Chester","doi":"10.1177/2516608520972203","DOIUrl":"https://doi.org/10.1177/2516608520972203","url":null,"abstract":"Background: Approximately 10% to 15% of patients who suffer intracranial hemorrhages (ICHs) are on therapeutic anticoagulation. Additionally, patients may develop an indication for anticoagulation after ICH. There is minimal guidance with starting anticoagulation after an ICH, and most evidence has evaluated vitamin K antagonists (VKA). Objective: The aim of this study was to evaluate the safety of anticoagulation prescribing following a nontraumatic ICH with VKA, low molecular weight heparin (LMWH), or direct oral anticoagulants (DOACs). Methods: A retrospective chart review was conducted of patients admitted with a nontraumatic ICH and an indication for anticoagulation between February 2015 to June 2018 at an urban tertiary comprehensive stroke center. The primary objective was to evaluate the safety of prescribing anticoagulation in these patients. Two groups were reviewed to evaluate the primary outcome: patients who were started on anticoagulation after ICH (anticoagulation group) and a comparator group not started on anticoagulation (control group). The primary endpoint was measured by a composite incidence of recurrent ICH, major bleeding events, and thromboembolic events. Results: Anticoagulation was started within 2 months in 23 patients with an indication for anticoagulation. Anticoagulation was held in 35 patients. There was no difference in the composite primary endpoint between the 2 groups (P = .29). The median time to starting anticoagulation was 21 days (IQR 7-28 days). Conclusions: This study shows the safety of starting anticoagulation in patients with recent ICH in our cohort of patients and highlights the need for more robust evidence to guide clinical decision making.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85505035","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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