Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype

2007 ◽  
Vol 14 (7) ◽  
pp. 630-634 ◽  
Author(s):  
P. Claire Langdon ◽  
Andy H. Lee ◽  
Colin W. Binns
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Severity ◽  
Stroke Subtype

scholarly journals Cerebral Haemodynamics following Acute Ischaemic Stroke: Effects of Stroke Severity and Stroke Subtype

2018 ◽  
Vol 8 (2) ◽  
pp. 80-89 ◽  
Author(s):  
Osian Llwyd ◽  
Angela S.M. Salinet ◽  
Ronney B. Panerai ◽  
Man Y. Lam ◽  
Nazia P. Saeed ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Arteries ◽  
Correlation Coefficients ◽  
Stroke Severity ◽  
Stroke Subtype ◽  
Cerebral Haemodynamics ◽  
Anterior Circulation ◽  
Mean Values

Background: Acute ischaemic stroke (AIS) patients often show impaired cerebral autoregulation (CA). We tested the hypothesis that CA impairment and other alterations in cerebral haemodynamics are associated with stroke subtype and severity. Methods: AIS patients (n = 143) were amalgamated from similar studies. Data from baseline (< 48 h stroke onset) physiological recordings (beat-to-beat blood pressure [BP], cerebral blood flow velocity (CBFV) from bilateral insonation of the middle cerebral arteries) were calculated for mean values and autoregulation index (ARI). Differences were assessed between stroke subtype (Oxfordshire Community Stroke Project [OCSP] classification) and severity (National Institutes of Health Stroke Scale [NIHSS] score < 5 and 5–25). Correlation coefficients assessed associations between NIHSS and physiological measurements. Results: Thirty-two percent of AIS patients had impaired CA (ARI < 4) in affected hemisphere (AH) that was similar between stroke subtypes and severity. CBFV in AH was comparable between stroke subtype and severity. In unaffected hemisphere (UH), differences existed in mean CBFV between lacunar and total anterior circulation OCSP subtypes (42 vs. 56 cm•s–1, p < 0.01), and mild and moderate-to-severe stroke severity (45 vs. 51 cm•s–1, p = 0.04). NIHSS was associated with peripheral (diastolic and mean arterial BP) and cerebral haemodynamic parameters (CBFV and ARI) in the UH. Conclusions: AIS patients with different OCSP subtypes and severity have homogeneity in CA capability. Cerebral haemodynamic measurements in the UH were distinguishable between stroke subtype and severity, including the association between deteriorating ARI in UH with stroke severity. More studies are needed to determine their clinical significance and to understand the determinants of CA impairment in AIS patients.

scholarly journals European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE)

2019 ◽  
Vol 4 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Guillaume Turc ◽  
Pervinder Bhogal ◽  
Urs Fischer ◽  
Pooja Khatri ◽  
Kyriakos Lobotesis ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Patient Selection ◽  
Acute Ischaemic Stroke ◽  
Randomized Trials ◽  
Mechanical Thrombectomy ◽  
Treatment Modalities ◽  
Stroke Severity ◽  
Prehospital Management ◽  
Grade Approach

Background Mechanical thrombectomy (MT) has become the cornerstone of acute ischaemic stroke management in patients with large vessel occlusion (LVO). The aim of this guideline document is to assist physicians in their clinical decisions with regard to MT. Methods These Guidelines were developed based on the standard operating procedure of the European Stroke Organisation and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 15 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. Results We found high quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO-related acute ischaemic stroke within 6 hours after symptom onset. We found moderate quality of evidence to recommend MT plus BMM in the 6-24h time window in patients meeting the eligibility criteria of published randomized trials. These guidelines further detail aspects of prehospital management, patient selection based on clinical and imaging characteristics, and treatment modalities. Conclusions MT is the standard of care in patients with LVO-related acute stroke. Appropriate patient selection and timely reperfusion are crucial. Further randomized trials are needed to inform clinical decision making with regard to the mothership and drip-and-ship approaches, anesthaesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.

scholarly journals Association between fasting blood glucose and outcomes and mortality in acute ischaemic stroke patients with diabetes mellitus: a retrospective observational study in Wuhan, China

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037291
Author(s):  
Tao Yao ◽  
Yanqiang Zhan ◽  
Jing Shen ◽  
Lu Xu ◽  
Bo Peng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Fasting Blood Glucose ◽  
Chinese Patients ◽  
Stroke Severity ◽  
Unfavourable Outcome ◽  
Cox Regression Analysis ◽  
Risk Of Death

ObjectiveTo evaluate the predictive value of fasting blood glucose (FBG) on unfavourable outcomes and mortality in diabetes mellitus (DM) patients after acute ischaemic stroke (AIS).Study designA hospital-based observational cohort study was conducted. Clinical data, including sex, age, body mass index, vascular risk factors and systolic/diastolic blood pressure, were routinely collected. National Institutes of Health Stroke Scale score was used to assess stroke severity on admission. FBG was determined on the first day after fasting for at least 8 hours. The modified Rankin Scale was used to assess functional outcome at 90 days: 3–6, unfavourable outcome and 6, death.SettingRenmin Hospital of Wuhan University, Wuhan, China.ParticipantsPatients who had AIS with DM, who were consecutively admitted within 24 hours of onset from January 2018 to June 2019.ResultsFor the 568 patients, the median age was 65 years (IQR, 55–74 years). There were 377 (66.4%) men. The median FBG values were 7.37 mmol/L (IQR, 5.99–10.10 mmol/L), and the median glycated haemoglobin (HbA1c) values were 6.6 (IQR, 5.8–8.3). Multivariable logistic and Cox regression analysis of confounding factors showed that FBG at the time of admission was an independent predictor of unfavourable outcome (OR, 1.25 (1.14–1.37); p<0.0001) and mortality (HR, 1.10 (1.03–1.15); p<0.05) at 90 days after onset. Time to death was analysed by Kaplan-Meier curves based on FBG quartiles. The risk of death in the two highest quartile groups (FBG, 7.38–10.10 mmol/L; FBG, ≥10.11 mmol/L) was significantly higher than that in the two lowest quartile groups (FBG, ≤6.00 mmol/L; FBG, 6.01–7.37 mmol/L; p<0.0001).ConclusionsHigher FBG levels are associated with unfavourable outcomes and mortality in Chinese patients who had AIS with DM. Our data contribute to the knowledge regarding the relationship between FBG and prognosis in patients with DM who had AIS.

scholarly journals Developing a multivariable prediction model for functional outcome after reperfusion therapy for acute ischaemic stroke: study protocol for the Targeting Optimal Thrombolysis Outcomes (TOTO) multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e038180 ◽  
Author(s):  
Elizabeth Holliday ◽  
Thomas Lillicrap ◽  
Timothy Kleinig ◽  
Philip M C Choi ◽  
Jane Maguire ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Significant Risk ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Stroke Severity ◽  
Local Health ◽  
Predictive Algorithms

IntroductionIntravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is the only approved pharmacological reperfusion therapy for acute ischaemic stroke. Despite population benefit, IVT is not equally effective in all patients, nor is it without significant risk. Uncertain treatment outcome prediction complicates patient treatment selection. This study will develop and validate predictive algorithms for IVT response, using clinical, radiological and blood-based biomarker measures. A secondary objective is to develop predictive algorithms for endovascular thrombectomy (EVT), which has been proven as an effective reperfusion therapy since study inception.Methods and analysisThe Targeting Optimal Thrombolysis Outcomes Study is a multicenter prospective cohort study of ischaemic stroke patients treated at participating Australian Stroke Centres with IVT and/or EVT. Patients undergo neuroimaging using multimodal CT or MRI at baseline with repeat neuroimaging 24 hours post-treatment. Baseline and follow-up blood samples are provided for research use. The primary outcome is good functional outcome at 90 days poststroke, defined as a modified Rankin Scale (mRS) Score of 0–2. Secondary outcomes are reperfusion, recanalisation, infarct core growth, change in stroke severity, poor functional outcome, excellent functional outcome and ordinal mRS at 90 days. Primary predictive models will be developed and validated in patients treated only with rt-PA. Models will be built using regression methods and include clinical variables, radiological measures from multimodal neuroimaging and blood-based biomarkers measured by mass spectrometry. Predictive accuracy will be quantified using c-statistics and R2. In secondary analyses, models will be developed in patients treated using EVT, with or without prior IVT, reflecting practice changes since original study design.Ethics and disseminationPatients, or relatives when patients could not consent, provide written informed consent to participate. This study received approval from the Hunter New England Local Health District Human Research Ethics Committee (reference 14/10/15/4.02). Findings will be disseminated via peer-reviewed publications and conference presentations.

scholarly journals Micro-albuminuria in non-diabetic acute ischaemic stroke: prevalence and its co-relation with stroke severity

2017 ◽  
Vol 5 (3) ◽  
pp. 982 ◽  
Author(s):  
Sumeet Singh ◽  
Harpreet Singh ◽  
Tarsem Pal Singh
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Urinary Albumin ◽  
P Value ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Urine Albumin Excretion ◽  
Albumin Excretion ◽  
Urine Albumin ◽  
History Of

Background: Microalbuminuria is not only a predictor of subsequent kidney disease, but also an indicator of generalised endothelial injury and a manifestation of endothelial dysfunction. The present study is aimed to determine the prevalence of microalbuminuria among non–diabetic ischaemic stroke patients and find its correlation with ischaemic stroke which eventually will aid us in coming up with potent strategies to provide better prevention and cure.Methods: The present study was conducted in Department of Medicine in collaboration with Department of Biochemistry and Department of Radiology, Guru Nanak Dev Hospital, Amritsar, Punjab, India after taking approval from institutional thesis and ethical committee. The study included 60 patients (30 Cases + 30 Controls) in age group 20-80 years diagnosed as stroke and haemorrhage ruled out by NCCT Brain/MRI Brain at admission. Cases were patients with history of hypertension with acute ischaemic stroke. Controls were age and sex matched patients with no history of hypertension with acute ischaemic stroke. The microalbuminuria was assayed by immunoturbimetry. The stroke severity was assessed by NIH Stroke Severity scale. P value less than 0.05 was considered the level of significance.Results: The overall prevalence of microalbuminuria in acute ischaemic stroke patients was 41.67%. When comparing NIH SS (National Institutes of Health Stroke Scale) score with the levels of albumin in urine, there was a significant positive correlation with urinary albumin levels and stroke severity in the patients having urinary albumin levels in microalbuminuria range both in Case group and Control group with P value less than 0.05.Conclusions: Urine albumin excretion had a positive correlation with the NIH SS Score of the patient in acute ischemic stroke. Those with a higher NIH SS Score had a higher rate of urine albumin excretion and vice versa. Therefore, measurement of microalbuminuria may help to assess those who are at increased risk of severe stroke and may require a more aggressive management.

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