Hospitalized Hemorrhagic Stroke Patients with Renal Insufficiency: Clinical Characteristics, Care Patterns, and Outcomes

2014 ◽  
Vol 23 (9) ◽  
pp. 2265-2273 ◽  
Author(s):  
Bruce Ovbiagele ◽  
Lee H. Schwamm ◽  
Eric E. Smith ◽  
Maria V. Grau-Sepulveda ◽  
Jeffrey L. Saver ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Clinical Characteristics ◽  
Hemorrhagic Stroke ◽  
Stroke Patients ◽  
Care Patterns

Abstract P84: Covid-19 and Stroke in the Latin American Stroke Registry (LASE)

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Virginia Pujol-Lereis ◽  
Alan F Flores ◽  
Antonio Arauz ◽  
Carlos Abanto ◽  
Pablo Amaya ◽  
...  
Keyword(s):  
Latin America ◽  
Ischemic Stroke ◽  
Latin American ◽  
Clinical Characteristics ◽  
Hemorrhagic Stroke ◽  
Reperfusion Therapy ◽  
Infection Frequency ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Stroke Registry

Background: Ischemic stroke has been reported to occur in approximately 5% of COVID-19 patients, although some reports are contradictory. Proposed mechanisms of this association are hypercoagulable state, vasculitis and cardiomyopathy, together with traditional vascular risk factors. We analyzed the frequency and clinical characteristics of COVID-19 positive stroke cases during the first months of the pandemic in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March - June 2020). We assessed acute stroke cases associated to COVID-19 infection. Clinical characteristics, stroke etiology and severity, acute care and functional outcomes, were compared between non-COVID-19 and COVID-19 cases. Results: There were a total of 1037 stroke cases; sixty-two of them (6.0%) were diagnosed with COVID-19 infection. This group consisted of 38 men [61.3%], with a median age of 68 years [IQR 59-79 years]. From these cases, 80.6% were ischemic stroke, 16.1% hemorrhagic stroke, and 1.6% transient ischemic attack and cerebral venous thrombosis respectively. The most common etiology reported for ischemic cases was atherosclerotic large vessel occlusion (30.6% vs. 12.7% in non-COVID cases, p<0.001), and undetermined etiology for hemorrhagic stroke (55.6%). Median NIHSS for COVID-stroke patients was higher (7 IQR 2-16 vs. 5 IQR 2-11, p=0.05). Five (8.1%) patients received acute reperfusion therapy, with no differences in door-to-CT, door-to-needle and door-to-groin times, compared to non-COVID cases. Most characteristics did not differ from those of COVID-19 negative patients. Mortality was higher in COVID-stroke cases (20.9% vs. 9.6%, p<0.001). Conclusions: COVID-19 infection frequency in stroke patients in Latin America is similar to that reported in several series worldwide, with a higher frequency of atherosclerotic ischemic strokes and mortality compared to non COVID-19 strokes

Diagnosis of cerebral hemorrhage before the era of computed tomography

2013 ◽  
Vol 154 (44) ◽  
pp. 1743-1746
Author(s):  
Gergely Hofgárt ◽  
Rita Szepesi ◽  
Bertalan Vámosi ◽  
László Csiba
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Hemorrhagic Stroke ◽  
Cranial Computed Tomography ◽  
Cerebral Stroke ◽  
Daily Routine ◽  
Stroke Patients ◽  
The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

KUALITAS HIDUP PASIEN STROKE DI POLIKLINIK RAWAT JALAN RUMAH SAKIT SWASTA YOGYAKARTA

2019 ◽  
Vol 7 (3) ◽  
pp. 232-237
Author(s):  
Hana Larasati ◽  
Theresia Titin Marlina
Keyword(s):  
Quality Of Life ◽  
Social Relations ◽  
Hemorrhagic Stroke ◽  
Poor Quality ◽  
Social Dimension ◽  
Stroke Patients ◽  
Sampling System ◽  
Post Stroke ◽  
Psychological Dimension

Background: stroke is a disorder of nervous system function that occurs suddenly and is caused by brain bleeding disorders that can affect the quality of life physical dimensions, social dimensions, psychological dimensions, environmental dimensions. Based on the result of Lumbu study (2015) the number of samples were 71 people collected data using the (WHOQOL-BREF). There were 56 people (78,9%) had the poor quality of life of post stroke. The mean of post-stroke quality of life domain was physical domain (45,27%), psychological domain (49,87%), social relations domain (48,15%) and environmental domain (50.01%). Objective: the purpose of the study was know the quality of life of the stroke patients in Outpatient Polyclinic of Private Hospital in Yogyakarta. Methods: used descriptive quantitative by using questionnaire test of purposive sampling system based on patients who have been affected of ischemic or hemorrhagic stroke before, number 30 respondents. Result: quality of life of stroke patient of medium physical dimension (67%), psychological dimension (71%), social dimension (67%), dimension good environment (63%). Conclusion: the quality of life of stroke patients of physical dimension, psychological dimension, and moderate social dimension, while the quality of life of stroke patients were good environmental dimension.   Keywords: Hemorrhagic stroke, ischemic stroke, quality of life

scholarly journals Adrenomedullin Is a Diagnostic and Prognostic Biomarker for Acute Intracerebral Hemorrhage

2021 ◽  
Vol 43 (1) ◽  
pp. 324-334
Author(s):  
Francisco J. Julián-Villaverde ◽  
Laura Ochoa-Callejero ◽  
Eva Siles ◽  
Esther Martínez-Lara ◽  
Alfredo Martínez
Keyword(s):  
Hemorrhagic Stroke ◽  
Prognostic Biomarker ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Nitroso Compounds ◽  
Healthy Controls ◽  
Stroke Patients ◽  
Important Health ◽  
Acute Intracerebral Hemorrhage ◽  
Changes Over Time

Hemorrhagic stroke remains an important health challenge. Adrenomedullin (AM) is a vasoactive peptide with an important role in cardiovascular diseases, including stroke. Serum AM and nitrate–nitrite and S-nitroso compounds (NOx) levels were measured and compared between healthy volunteers (n = 50) and acute hemorrhagic stroke patients (n = 64). Blood samples were taken at admission (d0), 24 h later (d1), and after 7 days or at the time of hospital discharge (d7). Neurological severity (NIHSS) and functional prognosis (mRankin) were measured as clinical outcomes. AM levels were higher in stroke patients at all times when compared with healthy controls (p < 0.0001). A receiving operating characteristic curve analysis identified that AM levels at admission > 69.0 pg/mL had a great value as a diagnostic biomarker (area under the curve = 0.89, sensitivity = 80.0%, specificity = 100%). Furthermore, patients with a favorable outcome (NIHSS ≤ 3; mRankin ≤ 2) experienced an increase in AM levels from d0 to d1, and a decrease from d1 to d7, whereas patients with unfavorable outcome had no significant changes over time. NOx levels were lower in patients at d0 (p = 0.04) and d1 (p < 0.001) than in healthy controls. In conclusion, AM levels may constitute a new diagnostic and prognostic biomarker for this disease, and identify AM as a positive mediator for hemorrhagic stroke resolution.

scholarly journals Effect of COPD on the Hospital Outcomes and Mortality among Hemorrhagic Stroke Patients. Sex Differences in a Population-Based Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2491
Author(s):  
Javier de Miguel-Diez ◽  
Marta Lopez-Herranz ◽  
Rodrigo Jiménez-García ◽  
Valentín Hernández-Barrera ◽  
Isabel Jimenez-Trujillo ◽  
...  
Keyword(s):  
Sex Differences ◽  
Decompressive Craniectomy ◽  
Hemorrhagic Stroke ◽  
Population Based ◽  
Stroke Patients ◽  
National Hospital ◽  
Population Based Study ◽  
Factors Associated ◽  
Adjusted Incidence ◽  
Discharge Database

(1) Background: It is not well known whether there is an association between COPD and hemorrhagic stroke (HS). We aim to analyze the incidence, clinical characteristics, procedures, and outcomes of HS in patients with and without COPD and to assess sex differences. Secondly, to identify factors associated with in-hospital mortality (IHM). (2) Methods: Patients aged ≥40 years hospitalized with HS included in the Spanish National Hospital Discharge Database (2016–2018) were analyzed. Propensity score matching (PSM) was used to compare patients according to sex and COPD status. (3) Results: We included 55,615 patients (44.29% women). Among men with COPD the HS adjusted incidence was higher (IRR 1.31; 95% CI 1.24–1.57) than among non-COPD men. COPD men had higher adjusted incidence of HS than COPD women (IRR 1.87; 95% CI 1.85–1.89). After matching, COPD men had a higher IHM (29.96% vs. 27.46%; p = 0.032) than non-COPD men. Decompressive craniectomy was more frequently conducted among COPD men than COPD women (6.74% vs. 4.54%; p = 0.014). IHM increased with age and atrial fibrillation, while decompressive craniectomy reduced IHM. (4) Conclusions: COPD men had higher incidence and IHM of HS than men without COPD. COPD men had higher incidence of HS than COPD women. Decompressive craniectomy was more frequently conducted in COPD men than COPD women and this procedure was associated to better survival.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

Abstract W MP53: The Prevalence and Characteristics of Attention Disorders in The Patients with First-onset Mild Hemorrhagic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Haruki Tokida ◽  
Masakazu Nishigaki ◽  
Masaru Kuriyama
Keyword(s):  
Selective Attention ◽  
Acute Phase ◽  
Hemorrhagic Stroke ◽  
False Negative ◽  
Previous History ◽  
Attention Deficits ◽  
Stroke Patients ◽  
Attention Disorders ◽  
First Onset ◽  
Mild Stroke

Objectives: Recent study revealed that over 50 % of stroke patients had some form of attention deficits. However, few reports focused on acute phase and mild stroke patients. This study aimed to investigate the prevalence of attention disorders and the change of their symptoms during the hospitalization in the patients with first-onset mild hemorrhagic stroke. Methods: Study subjects were 231 consecutive patients diagnosed as hemorrhage stroke and treated at our hospital from 2011 to 2012. Patients with severe hemorrhage (i.e., amount of bleeding >5cc), with previous history of cerebrovascular diseases or dementia, with decreased level of consciousness or with impaired activity of daily living were not eligible to this study. Neuropsychological assessments were conducted by speech therapists at 1 and 2 week after stroke onset using Clinical Assessment for Attention (CAT) and examined how they changed. CAT was a test battery developed by the Japan Society for Higher Brain Dysfunction to evaluate deficit of attention disorders. Results: Among the study subjects, 46 patients met the selection criteria and 16 patients (34.8%, 6 men, mean age was 66) were identified as having attention disorders. Bleeding lesions were left putamen (n=3), right putamen (n=9) and right thalamus (n=4). Significant improvements were observed in two types of focused attention and auditory selective attention measures: percentage of correct answers of Visual Cancellation Task (VCT, p=0.027) and Auditory Detection Task (ADT, p = 0.01). Additionally, working hours in VCT was significantly shortened, and the false-negative rate was also significantly decreased (p= 0.028). In ADT, the false-positive rate was significantly decreased (p= 0.012). No significant changes were observed in other type of tasks. Discussion: More than one-third of patients showed attention deficits even though they had mild stroke. Only focused and selective attentions were improved in acute phase of mild stroke. These results suggested that improvement in focused and selective attention precede improvement in other attentional functions.

Abstract T P243: Mortality Among Transferred Hemorrhagic Stroke Patients in United States: An Analysis From National Database

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Malik M Adil ◽  
Shyam Prabhakaran
Keyword(s):  
Hospital Mortality ◽  
Hemorrhagic Stroke ◽  
Inpatient Rehabilitation ◽  
National Database ◽  
Stroke Patients ◽  
Discharge Outcomes ◽  
Hospital Transfer ◽  
Transferred Patients ◽  
Surgical Treatments ◽  
Acute Rehabilitation

Background: Hemorrhagic stroke patients may require inter-facility transfer for higher level of care. Limited data are available on outcome of transferred patients. Objective: To determine in-hospital mortality and discharge outcomes among transferred hemorrhagic stroke patients. Methods: Data from all patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of hemorrhagic stroke [intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)] were identified by ICD-9 codes (ICH: 431; SAH: 430). In separate models for ICH and SAH using logistic regression, the odds ratio (OR) and 95% confidence intervals (CI) for in-hospital mortality and good outcome (discharge home or inpatient rehabilitation) among transfer vs. non-transfers were estimated, after adjusting for potential confounders. Results: Of 290,395 patients with ICH, 48,749 (16.8%) arrived by inter-hospital transfer; for SAH, 25,726 (33%) of 78,156 were transfers. In-hospital mortality was lower among ICH transfers (21.2% vs. 23.2%; p=0.004). In adjusted analyses, in-hospital mortality was not significantly different (p=0.20) while discharge to home or inpatient rehabilitation was more likely among transferred ICH patients (OR 1.1, 95% CI 1.0-1.2, p=0.05). In-hospital mortality was lower for SAH transfers (17.4% vs. 22.9%, p<0.001) and remained significant in adjusted analyses (OR 0.7, 95% CI 0.6-0.8). Transferred SAH patients were also more likely to be discharged to home or inpatient rehabilitation (OR 1.2, 95% CI 1.1-1.4, p<0.001). Coiling and clipping procedures were significantly more common in SAH transferred patients while cerebral angiography, mechanical ventilation and gastrostomy were significantly higher in both ICH and SAH transfer patients. Conclusion: While ICH patients arriving by transfer have similar mortality as non-transfers, they are more likely to be discharged to home or acute rehabilitation. For SAH, transfer confers both mortality and outcome benefit. Definitive surgical treatments and aggressive medical supportive care at receiving hospitals may mediate the benefits of inter-hospital transfer in hemorrhagic stroke patients.

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