Pub Date : 2020-12-01DOI: 10.1177/2516608520976243
Suzanne Marie Q. Ilagan-Gacita, Jennifer Ann P. Sanchez-Tapia, J. Navarro
Introduction: Intracranial arterial stenosis (ICAS) is common among certain race. It is prevalent in Asians, Hispanics, and African Americans, who constitutes about 2/3 of the world population making it the most common cause of stroke worldwide. Objectives: The objectives are to describe the demographic data and risk factors of patients with ICAS and 1-year outcome. Methods: Patients who had ischemic stroke by cranial computed tomography scan or magnetic resonance imaging, magnetic resonance angiography, computed tomographic angiography, or transcranial Doppler with periodic follow-up for 1 year were consecutively collected. Patients without intracranial stenosis were also collected and served as control. The demographic data, risk factors, modified Rankin Scale, stroke recurrence and mortality between ICAS and large artery atherosclerosis (LAA) patients were compared. The distribution and the degree of steno-occlusive lesions were estimated. Results: A total of 258 cases were consecutively collected. ICAS was demonstrated in 109 patients and 149 were LAA patients. There were 62 (56.88%) males. The age range distribution was as follows: 18 to 45 year olds, 15 (13.76%); 46 to 60 year olds, 28 (25.69%); and 61 year olds and above 66 (60.55%). Risk factors were hypertension 82 (75.23%), diabetes mellitus 46 (42.20%), hyperlipidemia 27 (24.77%), atrial fibrillation 16 (14.68%), history of previous stroke 23 (21.10%), alcohol drinker 28 (25.69%), obesity 8 (7.34%), and family history of cerebrovascular disease 33 (30.28%). ICAS was seen in the middle cerebral artery 46 (46.9%), ICA 21 (21.4%), BA 11 (11.2%), VA 8 (8.16%), PCA 7 (7.14%), and ACA 5 (5.1%). Majority of the patients showed moderate to severe stenosis. Modified Rankin Scale ranged from 0 to 2 in the majority of the patients and showed not much difference compared to LAA patients. The recurrence of stroke and death rate showed no significant difference between the 2 groups. Conclusion: In this study, no difference was seen between ICAS and LAA patients.
{"title":"Intracranial Arterial Stenosis Among Filipino Ischemic Stroke Patients: A Single Center Study","authors":"Suzanne Marie Q. Ilagan-Gacita, Jennifer Ann P. Sanchez-Tapia, J. Navarro","doi":"10.1177/2516608520976243","DOIUrl":"https://doi.org/10.1177/2516608520976243","url":null,"abstract":"Introduction: Intracranial arterial stenosis (ICAS) is common among certain race. It is prevalent in Asians, Hispanics, and African Americans, who constitutes about 2/3 of the world population making it the most common cause of stroke worldwide. Objectives: The objectives are to describe the demographic data and risk factors of patients with ICAS and 1-year outcome. Methods: Patients who had ischemic stroke by cranial computed tomography scan or magnetic resonance imaging, magnetic resonance angiography, computed tomographic angiography, or transcranial Doppler with periodic follow-up for 1 year were consecutively collected. Patients without intracranial stenosis were also collected and served as control. The demographic data, risk factors, modified Rankin Scale, stroke recurrence and mortality between ICAS and large artery atherosclerosis (LAA) patients were compared. The distribution and the degree of steno-occlusive lesions were estimated. Results: A total of 258 cases were consecutively collected. ICAS was demonstrated in 109 patients and 149 were LAA patients. There were 62 (56.88%) males. The age range distribution was as follows: 18 to 45 year olds, 15 (13.76%); 46 to 60 year olds, 28 (25.69%); and 61 year olds and above 66 (60.55%). Risk factors were hypertension 82 (75.23%), diabetes mellitus 46 (42.20%), hyperlipidemia 27 (24.77%), atrial fibrillation 16 (14.68%), history of previous stroke 23 (21.10%), alcohol drinker 28 (25.69%), obesity 8 (7.34%), and family history of cerebrovascular disease 33 (30.28%). ICAS was seen in the middle cerebral artery 46 (46.9%), ICA 21 (21.4%), BA 11 (11.2%), VA 8 (8.16%), PCA 7 (7.14%), and ACA 5 (5.1%). Majority of the patients showed moderate to severe stenosis. Modified Rankin Scale ranged from 0 to 2 in the majority of the patients and showed not much difference compared to LAA patients. The recurrence of stroke and death rate showed no significant difference between the 2 groups. Conclusion: In this study, no difference was seen between ICAS and LAA patients.","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":"83558632","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 : 2020-12-01DOI: 10.1177/2516608520984276
K. Sundar, Ajay Panwar, Dileep R. Yagaval, V. Huded, P. Sylaja
Large vessel occlusion has a disproportionately large contribution to overall mortality and morbidity from stroke. The Society of Vascular and Interventional Neurology in the year 2016 announced the launch of Mission Thrombectomy 2020 (MT2020), with the aim of increasing access to stroke thrombectomy globally. Despite 4 years since the start of MT2020, India is falling short in acute stroke therapy including thrombolysis and mechanical thrombectomy (MT). Access to timely MT leads to substantial mitigation of adverse stroke outcomes. This in turn leads to an enormous health benefit in that population. MT as a treatment is unevenly and unfairly distributed and increasing access to it is in need of strategies targeting political, economic, and environmental factors. Such strategies are slowly being adopted. In this article, we attempt to look at the major hurdles we face in improving acute stroke care in our country and we also explore options to address them.
大血管闭塞对卒中的总死亡率和发病率有不成比例的巨大贡献。2016年，血管与介入神经病学学会(Society of Vascular and Interventional Neurology)宣布启动Mission Thrombectomy 2020 (MT2020)，目的是在全球范围内增加卒中血栓切除术的可及性。尽管自MT2020开始已有4年，但印度在急性卒中治疗方面仍存在不足，包括溶栓和机械取栓(MT)。及时获得MT可大大减轻卒中的不良后果。这反过来又会给这些人口带来巨大的健康益处。MT作为一种治疗方法，其分布不均匀且不公平，需要针对政治、经济和环境因素制定策略来增加其可及性。这些策略正在慢慢被采纳。在这篇文章中，我们试图看看我们在改善我国急性中风护理方面面临的主要障碍，我们也探索了解决这些障碍的方法。
{"title":"Mission Thrombectomy 2020 (MT2020)—India’s Biggest Healthcare Challenge Yet","authors":"K. Sundar, Ajay Panwar, Dileep R. Yagaval, V. Huded, P. Sylaja","doi":"10.1177/2516608520984276","DOIUrl":"https://doi.org/10.1177/2516608520984276","url":null,"abstract":"Large vessel occlusion has a disproportionately large contribution to overall mortality and morbidity from stroke. The Society of Vascular and Interventional Neurology in the year 2016 announced the launch of Mission Thrombectomy 2020 (MT2020), with the aim of increasing access to stroke thrombectomy globally. Despite 4 years since the start of MT2020, India is falling short in acute stroke therapy including thrombolysis and mechanical thrombectomy (MT). Access to timely MT leads to substantial mitigation of adverse stroke outcomes. This in turn leads to an enormous health benefit in that population. MT as a treatment is unevenly and unfairly distributed and increasing access to it is in need of strategies targeting political, economic, and environmental factors. Such strategies are slowly being adopted. In this article, we attempt to look at the major hurdles we face in improving acute stroke care in our country and we also explore options to address them.","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":"80178296","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 : 2020-12-01DOI: 10.1177/2516608520940486
A. Gujjar, D. Jaju, P. Jacob, S. Ganguly, A. Al-Asmi
Background: Hypertension and changes in autonomic functions commonly accompany the acute phase of ischemic stroke and are recognized to influence outcomes. Few studies have addressed hemodynamic and autonomic monitoring together in acute stroke. Aim: We aimed to study serial hemodynamic and cardiovascular autonomic changes among patients with acute ischemic stroke (AIS) using thoracic electrical bioimpedance and to explore their relation to stroke outcome, stroke type, location, and severity. Methods: Patients with AIS of <96 h duration underwent serial hemodynamic/autonomic function studies over the first 4 days of admission. Their association with stroke severity, type, location, and outcome was explored using univariate and multivariate analyses. Patients with arrhythmias, pulmonary edema, or cardiac failure were excluded. Results: Of the 55 patients (M:F::27:28; age: 62 + 12 yrs) with AIS, 33 had large artery stroke, 18-lacunar and 4-cardioembolic stroke, and 6 died. Mean blood pressure, systemic vascular resistance (SVR), and cardiac output (CO) decreased over 4 days. Several hemodynamic and autonomic parameters correlated with the outcome on univariate analysis, while CO and SVR independently predicted the outcome. Stroke type was related to few hemodynamic parameters (SI, cardiac index on days 2-4). Lacunar stroke type was associated with left ventricular ejection time and low-frequency/high-frequency ratio (P < .05). Conclusion: Among patients with AIS, early sympathetic autonomic dominance may explain decreasing hemodynamic trends observed over the initial 4 days. 2 hemodynamic parameters, CO and SVR, independently predicted stroke outcome, while blood pressure did not. Further studies are indicated to explore the possibility of influencing stroke outcomes through modification of CO or SVR.
{"title":"Serial Hemodynamic and Autonomic Changes in Acute Ischemic Stroke: Relation to Outcome, Stroke Type, and Location","authors":"A. Gujjar, D. Jaju, P. Jacob, S. Ganguly, A. Al-Asmi","doi":"10.1177/2516608520940486","DOIUrl":"https://doi.org/10.1177/2516608520940486","url":null,"abstract":"Background: Hypertension and changes in autonomic functions commonly accompany the acute phase of ischemic stroke and are recognized to influence outcomes. Few studies have addressed hemodynamic and autonomic monitoring together in acute stroke. Aim: We aimed to study serial hemodynamic and cardiovascular autonomic changes among patients with acute ischemic stroke (AIS) using thoracic electrical bioimpedance and to explore their relation to stroke outcome, stroke type, location, and severity. Methods: Patients with AIS of <96 h duration underwent serial hemodynamic/autonomic function studies over the first 4 days of admission. Their association with stroke severity, type, location, and outcome was explored using univariate and multivariate analyses. Patients with arrhythmias, pulmonary edema, or cardiac failure were excluded. Results: Of the 55 patients (M:F::27:28; age: 62 + 12 yrs) with AIS, 33 had large artery stroke, 18-lacunar and 4-cardioembolic stroke, and 6 died. Mean blood pressure, systemic vascular resistance (SVR), and cardiac output (CO) decreased over 4 days. Several hemodynamic and autonomic parameters correlated with the outcome on univariate analysis, while CO and SVR independently predicted the outcome. Stroke type was related to few hemodynamic parameters (SI, cardiac index on days 2-4). Lacunar stroke type was associated with left ventricular ejection time and low-frequency/high-frequency ratio (P < .05). Conclusion: Among patients with AIS, early sympathetic autonomic dominance may explain decreasing hemodynamic trends observed over the initial 4 days. 2 hemodynamic parameters, CO and SVR, independently predicted stroke outcome, while blood pressure did not. Further studies are indicated to explore the possibility of influencing stroke outcomes through modification of CO or SVR.","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":"88011243","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 : 2020-12-01DOI: 10.1177/2516608520977590
C. Selvakumar, S. M., Sadeesh Kumar
Stroke following manual strangulation is a rare presentation. We report a case of 61-year-old man with no known comorbidities presenting with right hemiplegia following manual strangulation. Neuroimaging showed left middle cerebral artery territory infarct along with left posterior watershed infarct. Although isolated cases of thromboembolic stroke and watershed infarcts have been reported, combined watershed infarct and thromboembolic stroke in a person has not been reported till date to the best of our knowledge. The probable mechanism is discussed based on literature review. The need for anticipation of delayed cerebrovascular injuries and appropriate investigations in all strangulation victims who arrive at emergency department is also stressed upon based on this case report.
{"title":"A Rare Case of Stroke Following Manual Strangulation","authors":"C. Selvakumar, S. M., Sadeesh Kumar","doi":"10.1177/2516608520977590","DOIUrl":"https://doi.org/10.1177/2516608520977590","url":null,"abstract":"Stroke following manual strangulation is a rare presentation. We report a case of 61-year-old man with no known comorbidities presenting with right hemiplegia following manual strangulation. Neuroimaging showed left middle cerebral artery territory infarct along with left posterior watershed infarct. Although isolated cases of thromboembolic stroke and watershed infarcts have been reported, combined watershed infarct and thromboembolic stroke in a person has not been reported till date to the best of our knowledge. The probable mechanism is discussed based on literature review. The need for anticipation of delayed cerebrovascular injuries and appropriate investigations in all strangulation victims who arrive at emergency department is also stressed upon based on this case report.","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":"89961145","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 : 2020-12-01DOI: 10.1177/2516608520968418
M. Cherian, P. Mehta, S. Varadharajan, Santosh Poyyamozhi, E. Swamiappan, Jenny Gandhi, Nithin Theckumparampil
Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.
{"title":"Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital","authors":"M. Cherian, P. Mehta, S. Varadharajan, Santosh Poyyamozhi, E. Swamiappan, Jenny Gandhi, Nithin Theckumparampil","doi":"10.1177/2516608520968418","DOIUrl":"https://doi.org/10.1177/2516608520968418","url":null,"abstract":"Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.","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":"73721838","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 : 2020-12-01DOI: 10.1177/2516608520974512
D. Gandhi, A. Sterba, Himani Khatter, J. Pandian, Komal Bhanot
Background and Aims: The use of visual stimuli to facilitate a desired response in the affected limb in mirror therapy (MT) makes it an effective treatment modality even in instances of a complete plegic upper extremity poststroke. This article analyzes the effects of MT on impairments, activity limitation, and participation restriction in the acute and chronic phases poststroke. Methods: In total, 16 out of 3871 studies were included in the meta-analysis, using PRISMA guidelines. Data were categorized based on application in stroke rehabilitation (acute/chronic, motor/sensory/neglect/activity of daily living, upper limb/lower limb), modes and dosage of intervention delivery, types of control, and outcome assessment. RevMan 5.0 software was used for analysis. Results: Studies were equally distributed between chronic and acute phases. Therapy durations lasted between 1 and 8 weeks. Most studies intervened for upper limb motor impairments showing improvement in Brunnstrom motor recovery stages of arm (P value: .04, 95% CI, 0.05-1.54, I2 = 59%) and hand (P value: <.001, 95% CI, 0.80-2.01, I2 = 0%) during acute phase (0-4 weeks). “Activity/function” measured by functional independence measure showed improvement only in self-care subsection (P value: <.001, 95% CI, 2.05-5.16, I2 = 0%). No long-term effects were analyzed in any of the included studies. Conclusion: A significant finding of this study is the role of MT in improving arm and hand impairments in acute phase poststroke. Rehabilitation protocols can be improved based on this finding. As MT is effective, affordable, and feasible, we have made suggestions toward its incorporation in physiotherapy protocols for low- and middle-income countries.
{"title":"Mirror Therapy in Stroke Rehabilitation: Why, How Early, and Effects: A Meta-analysis","authors":"D. Gandhi, A. Sterba, Himani Khatter, J. Pandian, Komal Bhanot","doi":"10.1177/2516608520974512","DOIUrl":"https://doi.org/10.1177/2516608520974512","url":null,"abstract":"Background and Aims: The use of visual stimuli to facilitate a desired response in the affected limb in mirror therapy (MT) makes it an effective treatment modality even in instances of a complete plegic upper extremity poststroke. This article analyzes the effects of MT on impairments, activity limitation, and participation restriction in the acute and chronic phases poststroke. Methods: In total, 16 out of 3871 studies were included in the meta-analysis, using PRISMA guidelines. Data were categorized based on application in stroke rehabilitation (acute/chronic, motor/sensory/neglect/activity of daily living, upper limb/lower limb), modes and dosage of intervention delivery, types of control, and outcome assessment. RevMan 5.0 software was used for analysis. Results: Studies were equally distributed between chronic and acute phases. Therapy durations lasted between 1 and 8 weeks. Most studies intervened for upper limb motor impairments showing improvement in Brunnstrom motor recovery stages of arm (P value: .04, 95% CI, 0.05-1.54, I2 = 59%) and hand (P value: <.001, 95% CI, 0.80-2.01, I2 = 0%) during acute phase (0-4 weeks). “Activity/function” measured by functional independence measure showed improvement only in self-care subsection (P value: <.001, 95% CI, 2.05-5.16, I2 = 0%). No long-term effects were analyzed in any of the included studies. Conclusion: A significant finding of this study is the role of MT in improving arm and hand impairments in acute phase poststroke. Rehabilitation protocols can be improved based on this finding. As MT is effective, affordable, and feasible, we have made suggestions toward its incorporation in physiotherapy protocols for low- and middle-income countries.","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":"79027084","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 : 2020-12-01DOI: 10.1177/2516608520973817
M. Michele, S. Lorenzano, N. Angelosanto, A. Serrao, L. Petraglia, A. Risitano, D. Toni, A. Chistolini
Background: Uncertainties remain about the role of common thrombophilia markers as determinants of the ischemic stroke (IS) risk. Polymorphism His1299Arg in the FV gene, named R2 haplotype (FVHR2), has been poorly investigated. The aim of the present study was to assess the prevalence of common thrombophilia markers and of FVHR2 in a cohort of IS patients compared to a nonmatched group of healthy individuals. Methods: We studied 156 consecutive patients survivors of a first ever IS and 124 healthy controls. All subjects were investigated for the gene polymorphisms factor V (FV) Leiden, prothrombin (PTH) G20210A, MTHFR C677T, and FVHR2. Protein C (PC), protein S (PS), antithrombin (ATIII), and lupus anticoagulant (LAC) activity was measured. Homocysteinemia was assessed within 48 hours and after 30 days from stroke onset. Univariate and multivariate analyses were performed. Results: Compared with controls, patients were significantly older (mean [SD] age, 50.5 [12.9] vs 37.5 [15.5] years, P < .001), less frequently females (48.1% vs 67.7%, P = .001) and had more frequently hyperhomocysteinemia (45.9% vs 11.0%) only in the acute phase (OR 6.899, CI 95% 2.993-15.899; P < .001). No differences were found in the prevalence of FV Leiden, PTH G20210A, and MTHFR C677T between patients and controls, whereas FVHR2 was present in 34/156 (22%) stroke patients and in 5/124 (4%) controls (OR 6.632, 95% CI 2.509-17.535, P < .001). In a multivariate logistic regression analysis, the FVHR2 resulted independently associated with the occurrence of IS (OR 6.071, 95% CI 1.762-20.923; P = .004). Conclusions: In our study, hyperhomocysteinemia was confirmed to be a transient consequence of the thrombotic event. FVHR2 seems to be a possible candidate prothrombotic condition related to arterial IS irrespective of age and sex in an Italian sample population.
背景:常见血栓形成标志物作为缺血性卒中(IS)风险决定因素的作用仍不确定。FV基因中的His1299Arg多态性被称为R2单倍型(FVHR2)，目前对其多态性研究较少。本研究的目的是评估IS患者队列中常见血栓形成标志物和FVHR2的患病率，并与非匹配组的健康个体进行比较。方法:我们研究了156例首次IS的连续幸存者和124例健康对照。检测所有受试者的基因多态性因子V (FV) Leiden、凝血酶原(PTH) G20210A、MTHFR C677T和FVHR2。测定蛋白C (PC)、蛋白S (PS)、抗凝血酶(ATIII)和狼疮抗凝血剂(LAC)活性。同型半胱氨酸血症在中风发作后48小时内和30天后进行评估。进行单因素和多因素分析。结果:与对照组相比，患者明显变老(平均[SD]年龄，50.5 [12.9]vs 37.5[15.5]岁，P < .001)，女性较少(48.1% vs 67.7%， P = .001)，高同型半胱氨酸血症仅在急性期更频繁(45.9% vs 11.0%) (OR 6.899, CI 95% 2.993-15.899;P < 0.001)。FV Leiden、PTH G20210A和MTHFR C677T的患病率在患者和对照组之间没有差异，而FVHR2在34/156(22%)脑卒中患者和5/124(4%)脑卒中对照组中存在(OR 6.632, 95% CI 2.505 -17.535, P < 0.001)。在多因素logistic回归分析中，FVHR2结果与IS的发生独立相关(OR 6.071, 95% CI 1.762-20.923;P = .004)。结论:在我们的研究中，高同型半胱氨酸血症被证实是血栓事件的短暂后果。在意大利样本人群中，无论年龄和性别，FVHR2似乎都是与动脉IS相关的可能的候选血栓前病变。
{"title":"Role of Factor V R2 Haplotype and Common Thrombophilia Markers as Genetic Risk Factors for Ischemic Stroke","authors":"M. Michele, S. Lorenzano, N. Angelosanto, A. Serrao, L. Petraglia, A. Risitano, D. Toni, A. Chistolini","doi":"10.1177/2516608520973817","DOIUrl":"https://doi.org/10.1177/2516608520973817","url":null,"abstract":"Background: Uncertainties remain about the role of common thrombophilia markers as determinants of the ischemic stroke (IS) risk. Polymorphism His1299Arg in the FV gene, named R2 haplotype (FVHR2), has been poorly investigated. The aim of the present study was to assess the prevalence of common thrombophilia markers and of FVHR2 in a cohort of IS patients compared to a nonmatched group of healthy individuals. Methods: We studied 156 consecutive patients survivors of a first ever IS and 124 healthy controls. All subjects were investigated for the gene polymorphisms factor V (FV) Leiden, prothrombin (PTH) G20210A, MTHFR C677T, and FVHR2. Protein C (PC), protein S (PS), antithrombin (ATIII), and lupus anticoagulant (LAC) activity was measured. Homocysteinemia was assessed within 48 hours and after 30 days from stroke onset. Univariate and multivariate analyses were performed. Results: Compared with controls, patients were significantly older (mean [SD] age, 50.5 [12.9] vs 37.5 [15.5] years, P < .001), less frequently females (48.1% vs 67.7%, P = .001) and had more frequently hyperhomocysteinemia (45.9% vs 11.0%) only in the acute phase (OR 6.899, CI 95% 2.993-15.899; P < .001). No differences were found in the prevalence of FV Leiden, PTH G20210A, and MTHFR C677T between patients and controls, whereas FVHR2 was present in 34/156 (22%) stroke patients and in 5/124 (4%) controls (OR 6.632, 95% CI 2.509-17.535, P < .001). In a multivariate logistic regression analysis, the FVHR2 resulted independently associated with the occurrence of IS (OR 6.071, 95% CI 1.762-20.923; P = .004). Conclusions: In our study, hyperhomocysteinemia was confirmed to be a transient consequence of the thrombotic event. FVHR2 seems to be a possible candidate prothrombotic condition related to arterial IS irrespective of age and sex in an Italian sample population.","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":"86618114","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 : 2020-12-01DOI: 10.1177/2516608520954092
J. Pandian, I. Sebastian
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Pub Date : 2020-12-01DOI: 10.1177/2516608520973520
S. Aaron, Prabhakar A. T., V. Mathew, L. Jeyaseelan, Kenneth Benjamin, K. Abhilash, Shaikh Atif Iqbal Ahmed, A. Nair
Background and Purpose: Stroke mimics constitute a good number of patients referred as acute strokes within the window period for acute therapies. Proper triaging can avoid unnecessary imaging and even thrombolytic therapies in these patients. This study looked at the etiological spectrum of acute stroke mimics presenting within the 4.5 hours therapeutic window. We also evaluated the FAST, BE FAST, and the ROSIER tools in picking true strokes. Methods: Prospective study conducted over a 2-year period. Results: Acute stroke mimics constituted 328/1635 (20%) of referrals for acute stroke after screening by the neurology stroke team. Focal and generalized seizures with transient weakness and peripheral vertigo were the commonest acute stroke mimics; followed by metabolic causes and psychiatric disorders. Females were more in the stroke mimic group (P = .02). Ischemic heart disease and atherosclerotic risk factors (except diabetes mellitus) were significantly higher among true strokes. In total, 4 (1.2%) of the stroke mimics were treated with IV thrombolysis. Diagnostic accuracy for different stroke differentiating tools are as follows: FAST (sensitivity 85.9%, specificity 52.8%, odds 6.8), BE FAST (sensitivity 97.0%, specificity 31.4%, odds 14.9), and ROSIER scale (sensitivity 85.7%, specificity 59.4%, odds 8.7%). Conclusions: Acute stroke mimics can constitute up to 20% of cases evaluated as acute strokes by neurology stroke teams. None of the triaging tools appear to have enough accuracy. A proper history and clinical examination should be given priority over fixed protocols whenever acute stroke mimic are suspected especially before administering acute costly interventions. Auditing stroke mimics is important to improve acute stroke pathways.
背景和目的:在急性治疗的窗口期，卒中模拟患者构成了大量的急性卒中患者。适当的分诊可以避免不必要的影像学检查，甚至对这些患者进行溶栓治疗。这项研究观察了在4.5小时治疗窗口内出现的急性卒中模拟的病因谱。我们还评估了FAST, BE FAST和ROSIER工具在选择真实笔画方面的效果。方法:前瞻性研究，为期2年。结果:经神经卒中小组筛选，急性卒中模拟患者占转诊急性卒中患者的328/1635(20%)。局灶性和全身性发作伴短暂性虚弱和周围性眩晕是最常见的急性卒中模拟;其次是代谢原因和精神疾病。卒中模拟组女性患者较多(P = 0.02)。缺血性心脏病和动脉粥样硬化的危险因素(糖尿病除外)在真正的中风中显著升高。总共有4例(1.2%)脑卒中模拟患者接受静脉溶栓治疗。不同脑卒中鉴别工具的诊断准确性如下:FAST(敏感性85.9%，特异性52.8%，比值6.8)、BE FAST(敏感性97.0%，特异性31.4%，比值14.9)和ROSIER量表(敏感性85.7%，特异性59.4%，比值8.7%)。结论:急性中风模拟可以构成高达20%的病例评估急性中风由神经卒中团队。所有的分类工具似乎都没有足够的准确性。当怀疑急性卒中模拟时，特别是在实施昂贵的急性干预措施之前，应优先考虑适当的病史和临床检查，而不是固定的方案。听析卒中模拟对改善急性卒中通路非常重要。
{"title":"Acute Stroke Mimics: Etiological Spectrum and Efficacy of FAST, BE FAST, and the ROSIER Scores","authors":"S. Aaron, Prabhakar A. T., V. Mathew, L. Jeyaseelan, Kenneth Benjamin, K. Abhilash, Shaikh Atif Iqbal Ahmed, A. Nair","doi":"10.1177/2516608520973520","DOIUrl":"https://doi.org/10.1177/2516608520973520","url":null,"abstract":"Background and Purpose: Stroke mimics constitute a good number of patients referred as acute strokes within the window period for acute therapies. Proper triaging can avoid unnecessary imaging and even thrombolytic therapies in these patients. This study looked at the etiological spectrum of acute stroke mimics presenting within the 4.5 hours therapeutic window. We also evaluated the FAST, BE FAST, and the ROSIER tools in picking true strokes. Methods: Prospective study conducted over a 2-year period. Results: Acute stroke mimics constituted 328/1635 (20%) of referrals for acute stroke after screening by the neurology stroke team. Focal and generalized seizures with transient weakness and peripheral vertigo were the commonest acute stroke mimics; followed by metabolic causes and psychiatric disorders. Females were more in the stroke mimic group (P = .02). Ischemic heart disease and atherosclerotic risk factors (except diabetes mellitus) were significantly higher among true strokes. In total, 4 (1.2%) of the stroke mimics were treated with IV thrombolysis. Diagnostic accuracy for different stroke differentiating tools are as follows: FAST (sensitivity 85.9%, specificity 52.8%, odds 6.8), BE FAST (sensitivity 97.0%, specificity 31.4%, odds 14.9), and ROSIER scale (sensitivity 85.7%, specificity 59.4%, odds 8.7%). Conclusions: Acute stroke mimics can constitute up to 20% of cases evaluated as acute strokes by neurology stroke teams. None of the triaging tools appear to have enough accuracy. A proper history and clinical examination should be given priority over fixed protocols whenever acute stroke mimic are suspected especially before administering acute costly interventions. Auditing stroke mimics is important to improve acute stroke pathways.","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":"86167172","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 : 2020-12-01DOI: 10.1177/2516608520976275
T. Q. Nguyen, A. L. T. Truong, H. Phan, D. Nguyen, K. Nguyen, Huong Nguyen, A. Nguyen, Dinh Chau Bao Hoang, Vu Thanh Tran, T. Q. Nguyen, Tracey Le, K. Nguyen, T. H. Nguyen
Background: It remains controversial if intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MTE) is superior to MTE alone in patients with acute ischemic stroke caused by large vessel occlusion. We aim to compare functional outcomes, mortality, reperfusion, and intracranial hemorrhage rates in bridging therapy (IVT prior thrombectomy) and MTE alone groups within 6 h from symptom onset. Materials and Methods: Consecutive hospitalized patients (September 2017 and July 2018) with acute large artery occlusion within the anterior cerebral circulation eligible for MTE with or without prior IVT were included. A modified Rankin Scale score of 0 to 2 was considered as good functional outcome at 90 days. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction scale of 2b to 3. Results: Of the 124 patients included, 56 (45.2%) received bridging therapy and 68 (54.8%) received MTE alone. Patients receiving bridging therapy were younger (median, 56 vs 63, P = .045) and had shorter onset-to-groin time (median, 270 vs 370 min, P < .001) than those receiving MTE alone. Successful reperfusion rate was significantly greater in the bridging therapy group (87.5% vs 72.1%, P = 0.03). There were no statistically significant differences between the 2 groups in functional independence (bridging 58.9% vs 75.0%, P = 0.07), mortality at 90 days (bridging 14.3% vs 7.4%, P = 0.22), parenchymal hematoma type 2 (bridging 3.6% vs 2.9%, P > .99), and any hemorrhage (bridging 42.3% vs 26.5%, P = 0.07). Conclusion: Compared to MTE alone, bridging therapy with IVT improved the reperfusion rate but not other outcomes. Further clinical trials are needed to confirm our findings.
背景:对于大血管闭塞引起的急性缺血性卒中患者，在机械取栓(MTE)前静脉溶栓(IVT)是否优于单纯机械取栓(MTE)仍存在争议。我们的目标是在症状出现后6小时内比较桥接治疗组(IVT前取栓)和单独MTE组的功能结局、死亡率、再灌注和颅内出血率。材料与方法:纳入2017年9月至2018年7月连续住院的脑前循环急性大动脉闭塞患者，合并或不合并IVT，符合MTE治疗条件。修改后的Rankin量表评分0到2分被认为是90天的良好功能结局。再灌注成功定义为脑梗死溶栓评分2b ~ 3。结果:124例患者中，56例(45.2%)接受桥接治疗，68例(54.8%)单独接受MTE治疗。接受桥接治疗的患者更年轻(中位数，56 vs 63, P = 0.045)，与单独接受MTE治疗的患者相比，从发病到腹股沟的时间更短(中位数，270 vs 370分钟，P < 0.001)。桥接治疗组再灌注成功率显著高于桥接治疗组(87.5% vs 72.1%， P = 0.03)。两组患者在功能独立性(桥接58.9% vs 75.0%， P = 0.07)、90天死亡率(桥接14.3% vs 7.4%， P = 0.22)、2型实质血肿(桥接3.6% vs 2.9%， P > 0.99)和任何出血(桥接42.3% vs 26.5%， P = 0.07)方面均无统计学差异。结论:与单纯MTE治疗相比，桥接与IVT治疗提高了再灌注率，但没有改善其他结果。需要进一步的临床试验来证实我们的发现。
{"title":"Bridging Therapy and Direct Thrombectomy for Acute Ischemic Stroke: A Prospective Cohort Study","authors":"T. Q. Nguyen, A. L. T. Truong, H. Phan, D. Nguyen, K. Nguyen, Huong Nguyen, A. Nguyen, Dinh Chau Bao Hoang, Vu Thanh Tran, T. Q. Nguyen, Tracey Le, K. Nguyen, T. H. Nguyen","doi":"10.1177/2516608520976275","DOIUrl":"https://doi.org/10.1177/2516608520976275","url":null,"abstract":"Background: It remains controversial if intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MTE) is superior to MTE alone in patients with acute ischemic stroke caused by large vessel occlusion. We aim to compare functional outcomes, mortality, reperfusion, and intracranial hemorrhage rates in bridging therapy (IVT prior thrombectomy) and MTE alone groups within 6 h from symptom onset. Materials and Methods: Consecutive hospitalized patients (September 2017 and July 2018) with acute large artery occlusion within the anterior cerebral circulation eligible for MTE with or without prior IVT were included. A modified Rankin Scale score of 0 to 2 was considered as good functional outcome at 90 days. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction scale of 2b to 3. Results: Of the 124 patients included, 56 (45.2%) received bridging therapy and 68 (54.8%) received MTE alone. Patients receiving bridging therapy were younger (median, 56 vs 63, P = .045) and had shorter onset-to-groin time (median, 270 vs 370 min, P < .001) than those receiving MTE alone. Successful reperfusion rate was significantly greater in the bridging therapy group (87.5% vs 72.1%, P = 0.03). There were no statistically significant differences between the 2 groups in functional independence (bridging 58.9% vs 75.0%, P = 0.07), mortality at 90 days (bridging 14.3% vs 7.4%, P = 0.22), parenchymal hematoma type 2 (bridging 3.6% vs 2.9%, P > .99), and any hemorrhage (bridging 42.3% vs 26.5%, P = 0.07). Conclusion: Compared to MTE alone, bridging therapy with IVT improved the reperfusion rate but not other outcomes. Further clinical trials are needed to confirm our findings.","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":"85294955","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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