Pre Hospital Interventions to Improve Acute Ischemic Stroke Outcome in Urban Settings

2020 ◽  
Vol 112 (5) ◽  
pp. S34
Author(s):  
Shannon Anderson ◽  
Danielle Thompson ◽  
Erin Adams ◽  
Marcus Spady ◽  
Efosa Aghimien ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Outcome ◽  
Urban Settings

Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry

2021 ◽  
pp. 1-7
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Kuniyuki Nakamura ◽  
Tetsuro Ago ◽  
Masahiro Kamouchi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neurological Deterioration ◽  
Stroke Outcome ◽  
Matched Cohort ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Chei Treatment

Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3–6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46–0.99]) and neurological deterioration (0.52 [0.31–0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40–0.92]) and between the treatment and neurological deterioration (0.47 [0.25–0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.

scholarly journals Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial

2017 ◽  
Vol 31 (7) ◽  
pp. 638-647 ◽  
Author(s):  
Daryoush Savadi Oskouie ◽  
Ehsan Sharifipour ◽  
Homayoun Sadeghi Bazargani ◽  
Mazyar Hashemilar ◽  
Masoud Nikanfar ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trial ◽  
Stroke Outcome

Effectiveness of t-PA in acute ischemic stroke: Outcome relates to appropriateness

Neurology ◽  
2000 ◽  
Vol 54 (3) ◽  
pp. 679-679 ◽  
Author(s):  
A. M. Buchan ◽  
P. A. Barber ◽  
N. Newcommon ◽  
H. G. Karbalai ◽  
A. M. Demchuk ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Outcome

scholarly journals How to Design Economic Predictive Laboratory Panel Evaluating Acute Ischemic Stroke Outcome

2019 ◽  
Vol 10 (01) ◽  
pp. 1-14 ◽  
Author(s):  
Hasnaa A. Abo-Elwafa ◽  
Hazem K. Ibrahim ◽  
Hassan M. El-Nady ◽  
Asmaa H. Abbas
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Outcome

scholarly journals Pre-hospital causes for delayed arrival in acute ischemic stroke before and during the COVID-19 pandemic: A study at two stroke centers in Egypt

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254228
Author(s):  
Hany M. Aref ◽  
Hossam Shokri ◽  
Tamer M. Roushdy ◽  
Fatma Fathalla ◽  
Nevine M. El Nahas
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Medical Staff ◽  
Pronounced Effect ◽  
Previous Experience ◽  
Stroke Outcome ◽  
The Public ◽  
Early Arrival ◽  
To Receive

Background In the current study we investigated the causes of pre-hospital delay as this can compromise the patient’s chance to receive thrombolytic therapy and thus impact stroke outcome. Methods We surveyed 254 patients regarding reasons for delayed and early arrival to hospital after acute ischemic stroke. The survey was performed over five months, spanning a period pre- and during COVID-19 (between December 7, 2019 and May 10, 2020). Results A total of 71.2% of patients arrived beyond four hours of onset of ischemic stroke. The commonest cause for delay pre-Covid-19 was receiving treatment in a non-stroke hospital, while that during COVID-19 was fear of infection and lock down issues. Not realizing the urgency of the condition and stroke during sleep were common in both periods. Early arrival because of the patient’s previous experience with stroke accounted for approximately 25% of cases in both periods. The effect of media was more evident during COVID-19, accounting for 47.7% of cases. Conclusion Pre-hospital delay secondary to misperception of the urgency of stroke and management in a non-stroke hospital reflect the lack of awareness among the public and medical staff. This concept is emphasized by early arrival secondary to previous experience with stroke and the pronounced effect of media in the time of COVID-19.

scholarly journals The Incremental Prognostic Value of Hepatocyte Growth Factor in First-Ever Acute Ischemic Stroke: An Early Link Between Growth Factor and Interleukins

2021 ◽  
Vol 12 ◽  
Author(s):  
Fangfang Li ◽  
Ping Liu ◽  
Yuyou Huang ◽  
Lingzhi Li ◽  
Sijia Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Growth Factor ◽  
Hepatocyte Growth Factor ◽  
Acute Ischemic Stroke ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Stroke Outcome ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
Hepatocyte Growth

Hepatocyte growth factor (HGF) is a potential prognostic factor for acute ischemic stroke (AIS). In this study, we sought to validate its earlier predictive accuracy within 24 h for first-ever AIS. Moreover, as HGF interacts with interleukins, their associations may lead to novel immunomodulatory therapeutic strategies. Patients with first-ever AIS (n = 202) within 24 h were recruited. Plasma HGF and related interleukin concentrations were measured by multiplex immunoassays. The primary and secondary outcomes were major disability (modified Rankin scale score ≥3) at 3 months after AIS and death, respectively. Elastic net regression was applied to screen variables associated with stroke outcome; binary multivariable logistic analysis was then used to explore the relationship between HGF level and stroke outcome. After multivariate adjustment, upregulated HGF levels were associated with an increased risk of the primary outcome (odds ratio, 7.606; 95% confidence interval, 3.090–18.726; p < 0.001). Adding HGF to conventional risk factors significantly improved the predictive power for unfavorable outcomes (continuous net reclassification improvement 37.13%, p < 0.001; integrated discrimination improvement 8.71%, p < 0.001). The area under the receiver operating characteristic curve value of the traditional model was 0.8896 and reached 0.9210 when HGF was introduced into the model. An elevated HGF level may also be a risk factor for mortality within 3 months poststroke. The HGF level was also positively correlated with IL-10 and IL-16 levels, and HGF before interaction with all interleukins was markedly negatively correlated with the lymphocyte/neutrophil ratio. HGF within 24 h may have prognostic potential for AIS. Our findings reinforce the link between HGF and interleukins.

EARLY PREDICTION OF ACUTE ISCHEMIC STROKE OUTCOME BY USING ALBERTA STROKE PROGRAM EARLY CT SCORE (ASPECTS)

2014 ◽  
pp. 168-176
Author(s):  
Vu Xuan Loc Doan ◽  
Thanh Thao Nguyen ◽  
Minh Loi Hoang ◽  
Trong Hao Vo
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Early Prediction ◽  
Stroke Outcome ◽  
Good Outcome ◽  
Poor Outcome

Background and Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) scale semiquantitatively assesses extent and location of ischemic changes within the middle cerebral artery (MCA) territory using a 10-point grading system. ASPECTS measured at baseline using noncontrast computed tomography (CT) scan. The aim of this study was to assess early prediction of clinical outcome after acute ischemic stroke by ASPECTS scale. Methods: The study based on convenience sample which included 82 first-ever acute ischemic stroke patients, admitted to Hue Central Hospital within 72 hours of stroke onset, from October 2013 to October 2014. Ischemic territory changes were defined as parenchymal CT hypoattenuation. We assessed all baseline CT scans, dichotomized ASPECTS at ≤ 7 and >7, defined good outcome (0 to 2) and poor outcome (3 to 6) as modified Rankin Scale (mRS) score at discharge. Univariate analysis and multivariable logistic regression analysis were performed to define the independent predictors for stroke outcome. Results: Mean age was 68.35 ± 13.93 years, proportion of male (51.2%) and female (48.8%) are approximately the same. ASPECTS score > 7 in 57 patients and ≤ 7 in 25 patients. Mean ASPECTS was 7.51 ± 2.25. Mean mRS at discharge was 2.28 ± 1.33. Good outcome (mRS ≤ 2) and poor outcome (mRS > 2) at discharge were 63.4% and 36.6% respectively. There is a negative correlation between ASPECTS and mRS (r = -0.86, p < 0.001). In the univariate analysis, atrial fibrillation, Glasgow Coma Scale (GCS) score at admisison, ASPECT score and infarct volume were significantly associated with stroke outcome. All of aforementioned variables underwent multivariate analysis, but none of them was proven to be an independent predictor of early outcome. Conclusion: In patients with first-ever acute ischemic stroke, ASPECT score which bases on conventional computed tomography scan is not independent predictor for clinical outcome at discharge. Key words: ischemic stroke, ASPECTS, outcome

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