Are There Differences in Long-Term Functioning and Recovery Between Hemorrhagic and Ischemic Stroke Patients Receiving Rehabilitation?

Author(s):  
Daniëlla M. Oosterveer ◽  
Marieke J.H. Wermer ◽  
Gerard Volker ◽  
Thea P.M. Vliet Vlieland
2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ting-Ann Wang ◽  
Tzy-Haw Wu ◽  
Shin-Liang Pan ◽  
Hsiu-Hsi Chen ◽  
Sherry Yueh-Hsia Chiu

AbstractAspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  

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.


Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Zahra Abuzaid ◽  
Sara Almuslem ◽  
Farah Aleisa

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Angelina Gronberg ◽  
Ingrid Henriksson ◽  
Arne Lindgren

Background: Establishing aphasia prevalence and outcome after ischemic stroke can facilitate strategies for treatment of aphasia. Few studies of aphasia recovery after ischemic stroke have included consecutive, unselected patients. Our aim was to identify acute and chronic prevalence of aphasia in an unselected consecutive cohort of patients with ischemic stroke. Methods: 218 patients with first-ever acute ischemic stroke were included prospectively and consecutively in the Lund Stroke Register Study. Patients with 1) dementia or psychiatric disorders; 2) non-native Swedish language; or 3) decreased consciousness were not included. Language assessment was made at baseline (within 6 days, median 3 days) after stroke onset by trained research nurses using the NIHSS sub-item 9, “Best Language” to screen for aphasia. Patients with aphasia (score of 1-3 on NIHSS item 9) were re-assessed with NIHSS item 9 by speech and language pathologists at 1 month, 3 months and 12 months after stroke. Results: Of 218 first-ever ischemic stroke patients 52 patients (24%) had aphasia according to NIHSS item 9 (median age 75 years; n=25 female). The distribution of the scores 1-3 at baseline were n=32, n=11, and n=9, respectively. At the 1 year follow-up, 31 patients (67%; n=5 deceased, n=1 drop out) had recovered from aphasia (n=28 with initial NIHSS item 9 score of 1, n=2 with initial NIHSS item 9 score of 2), even though all patients with initial global aphasia (NIHSS item 9 score of 3) had remaining aphasia (NIHSS item 9 score ≥ 1). Figure 1shows aphasia recovery (n=52) according to NIHSS item 9. Conclusions: A majority of patients with mild aphasia recover substantially from aphasia within 1 year after stroke. Patients with initial global aphasia all suffer from remaining aphasia 1 year after stroke. This suggests that this population might especially benefit from an early onset comprehensive, long-term aphasia treatment plan.


2019 ◽  
Vol 79 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Etienne de Montmollin ◽  
Stephane Ruckly ◽  
Carole Schwebel ◽  
Francois Philippart ◽  
Christophe Adrie ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document