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Latest & greatest articles for stroke
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NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemicstroke To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemicstroke (AIS).Data are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics (...) , sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity 56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference in functional outcome or symptomatic intracranial hemorrhage between AIS types.In thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because thrombolysis treatment has low effect on stroke outcome in patients
Assoc. 2016;5:1-14. 1. Fugate JE, Rabinstein AA. Absolute and relative contraindicationstoIVrt-PAfor acute ischemicstroke. Neurohospitalist. 2015;5: 110-121. 2. Brown MD, Burton JH, Nazarian DJ, et al. Clinical policy: use of intravenous tissue plasminogen activator for the management of acute ischemicstroke in the emergency department. Ann Emerg Med. 2015;66: 322-333.e31. 3. Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase for acute ischaemicstroke in the Safe Implementation (...) of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet. 2007;369:275-282. 4. Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase 3-4.5 h after acute ischaemicstroke (SITS-ISTR): an observational study. Lancet. 2008;372: 1303-1309. 5. Luo S, Zhuang M, Zeng W, et al. Intravenous thrombolysis for acute ischemicstroke in patients receiving antiplatelet therapy: a systematic review and meta-analysis of 19 studies. J Am Heart Assoc. 2016;5:1-14. 6. Xian Y, Federspiel
Is Antibiotic Therapy Helpful for Preventing Infection After Acute Stroke? (SRS therapy) Is Antibiotic Therapy Helpful for Preventing Infection After Acute Stroke? TAKE-HOME MESSAGE In patients with acute ischemic or hemorrhagic stroke, prophylactic antibiotics reduce the overall infection rate, but do not reduce the risk of pneumonia, death or dependency. EBEM Commentators Latha Ganti, MD, MBA Department of Clinical Sciences University of Central Florida College of Medicine Orlando, FL Bryan (...) studies and ongoing trials. STUDY SELECTION Randomized trials that compared preventive antibiotictherapyversus control in patients with acute ischemic or hemorrhagic stroke were included. There were no limits on route of antibiotic administration (oral or parenteral) or duration, but therapy had to be started within 24 hours after the onset of stroke in patients without infection at presentation. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data with a standardized data collection
Mecobalamin and early functional outcomes of ischemicstroke patients with H-type hypertension. To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemicstroke and H-type hypertension.From October of 2014 to October of 2016, 224 cases of ischemicstroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy
Points Congestive heart failure 1 Hypertension 1 Age 65-75 Age >75 1 2 Diabetes 1 Prior stroke / TIA / systemic embolism (limb / gut / spleen etc) 2 Female sex 1 Vascular disease 1 The CHADSVASC has additional points for age >65, female sex and a history of vascular disease (such as aortic aneurysm or lower limb arterial disease). The Canadian Association of Emergency Physicians 1 and the Canadian Cardiovascular Society 2 recommend using yet another rule version, the CHADS65. The CHADS65 is a hybrid (...) fibrillation at a rate of 110 beats per minute. Now, four hours later, her heart rate is 80-90 and she is keen to go home. You are wondering if this new diagnosis will mean she is at risk of stroke. How do you assess this? There are several scores which estimate the stroke risk, including CHADS2, CHADSVASC and in Canada, we have the CHADS65. CHADS2 score Points Congestive heart failure 1 Hypertension 1 Age ≥ 75 1 Diabetes 1 Prior stroke / TIA / systemic embolism (limb / gut / spleen etc) 2 CHADSVASC score
Complex Left Atrial Appendage Morphology Is an Independent Risk Factor for Cryptogenic IschemicStroke Importance: Ischemicstrokes pose a significant health burden. However, the etiology of between 20 and 40% of these events remains unknown. Left atrial appendage morphology may influence the occurrence of thromboembolic events. Design: A retrospective cross-sectional study was conducted to investigate the role of LAA morphology in patients with atrial fibrillation (AF) and cardioembolic (...) -associated stroke and patients with cryptogenic stroke without atrial fibrillation. LAA morphology is classified into two groups: (1) simple (chicken-wing) vs. (2) complex (non-chicken wing) based on transesophageal echocardiography (TEE) findings. In addition to the LAA morphology, left atrial parameters, including orifice diameter, depth, emptying velocity, and filling velocity, were collected for both groups. Mathematical, computational models were constructed to investigate flow velocities in chicken
Advances in Stroke Prevention There have been recent advances in stroke prevention in nutrition, blood pressure control, antiplatelet therapy, anticoagulation, identification of high-risk asymptomatic carotid stenosis, and percutaneous closure of patent foramen ovale. There is evidence that the Mediterranean diet significantly reduces the risk of stroke and that B vitamins lower homocysteine, thus preventing stroke. The benefit of B vitamins to lower homocysteine was masked by harm from (...) monitoring for atrial fibrillation (AF), have revolutionized the prevention of cardioembolic stroke. Most patients (~90%) with asymptomatic carotid stenosis are better treated with intensive medical therapy; the few that could benefit from stenting or endarterectomy can be identified by a number of approaches, the best validated of which is transcranial Doppler (TCD) embolus detection. Percutaneous closure of patent foramen ovale has been shown to be efficacious but should only be implemented in selected
Electroconvulsive therapy and later stroke in patients with affective disorders The long-term effects of electroconvulsive therapy (ECT) on the risk of stroke are unknown. We examined the association between ECT and risk of incident or recurrent stroke. A cohort of 174 534 patients diagnosed with affective disorder between 2005 and 2016 in the Danish National Patient Registry were followed for stroke until November 2016. The association between ECT and stroke was analysed using Cox regression (...) with multiple adjustment and propensity-score matching on sociodemographic and clinical variables. In 162 595 patients without previous stroke, 5781 (3.6%) were treated with ECT. The total number of patients developing stroke during follow-up was 3665, of whom 165 had been treated with ECT. In patients <50 years, ECT was not associated with stroke (adjusted hazard ratio (HR) = 1.29, 95% CI 0.87-1.93). In patients ≥50, ECT was associated with a lower risk of stroke (adjusted HR = 0.69, 95% CI 0.57-0.89
were randomized to pioglitazone or placebo (1:1) within 180 days of an ischemicstroke or transientischemicattack and followed for ≤5 years. To identify patients at higher HF risk with pioglitazone, we performed a secondary analysis of IRIS participants without HF history at entry. HF episodes were adjudicated by an external review, and treatment effects were analyzed using time-to-event methods. A baseline HF risk score was constructed from a Cox model estimated using stepwise selection (...) Heart Failure After IschemicStroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone The IRIS trial (Insulin Resistance Intervention After Stroke) demonstrated that pioglitazone reduced the risk for both cardiovascular events and diabetes mellitus in insulin-resistant patients. However, concern remains that pioglitazone may increase the risk for heart failure (HF) in susceptible individuals.In IRIS, patients with insulin resistance but without diabetes mellitus
Prognostic Value of BEFAST vs. FAST to Identify Stroke in a Prehospital Setting Use of prehospital stroke scales may enhance stroke detection and improve treatment rates and delays. Current scales, however, may lack detection accuracy. As such, we examined whether adding coordination (Balance) and diplopia (Eyes) assessments increase the accuracy of the Face-Arms-Speech-Time (FAST) scale in a multisite prospective study of emergency response activations for presumed stroke.This (...) was a prospective study of emergency response activations for presumed stroke in Santa Clara County, California. Emergency medical responders were trained in the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale and administered the scale on scene to all patients who were within 6 hours of onset of neurological symptoms. Each patient's final diagnosis (stroke vs. no stroke) was based on review of hospital records. We compared the performance of the BEFAST and FAST scales for stroke detection.Three hundred fifty
stroke not eligible for thrombolytic therapy, hypertension in the setting of acute ischemicstroke or transientischemicattack should not be routinely treated (Grade D; revised wording ). Extreme BP increases (e.g., SBP >220 mm Hg or DBP >120 mm Hg) may be treated to reduce the BP by approximately 15% (Grade D), and not more than 25%, over the first 24 hours with gradual reduction thereafter (Grade D). Avoid excessive lowering of BP because this might exacerbate existing ischemia or might induce (...) be given to the initiation of antihypertensive therapy after the acute phase of a stroke or transientischemicattack (Grade A). It is well established that antihypertensive therapy is associated with substantial reductions in cardiovascular events in patients who have suffered a stroke or TIA . Patients with hypertension who have had a stroke are at a high risk of recurrence, which can be reduced by antihypertensive therapy (RR, 0.72; 95%CI, 0.61 to 0.85) . 2. After the acute phase of a stroke, BP
. Warfarin was the base case, and non-vitamin K antagonist oral anticoagulants (NOACs) were modeled in a secondary analysis.Community-dwelling adults.33 434 adults with incident AF.Quality-adjusted life-years (QALYs).Of the 33 434 patients, 27 179 had a CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease) score of 2 or more. The population benefit of warfarin anticoagulation for these patients was least using stroke rates from the ATRIA (AnTicoagulation (...) Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation. Stroke rates in patients with nonvalvular atrial fibrillation (AF) who are not receiving anticoagulant therapy vary widely across published studies; the resulting effect on the net clinical benefit of anticoagulation in AF is unknown.To determine the effect of variation in published AF stroke rates on the net clinical benefit of anticoagulation.Markov model decision analysis
Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute IschemicStroke. Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemicstroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design.To examine recanalization over time across a range (...) of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemicstroke treated with intravenous alteplase or not treated with alteplase.Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemicstroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA).Demographics, clinical characteristics, time from alteplase to recanalization
Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability (...) and safety of the therapy.We searched the Cochrane Stroke Group's Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant
Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial Family caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing (...) their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers.To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver's depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential
Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required to detect differences in stroke rates between CABG and PCI.This study sought (...) to compare rates of stroke after CABG and PCI and the impact of procedural stroke on long-term mortality.We performed a collaborative individual patient-data pooled analysis of 11 randomized clinical trials comparing CABG with PCI using stents; ERACI II (Argentine Randomized Study: Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease) (n = 450), ARTS (Arterial Revascularization Therapy Study) (n = 1,205), MASS II (Medicine, Angioplasty, or Surgery