Change in stroke outcomes over 20 years

2021 ◽  
Author(s):  
Sarah Lempriere
Keyword(s):  
Stroke Outcomes

Aerobic Exercise Training in Stroke Rehabilitation: Any Gap in Knowledge

2015 ◽  
Author(s):  
Tal-hatu Kolapo Hamzat ◽  
Nelson Echezona Ekechukwu
Keyword(s):  
Aerobic Exercise ◽  
Methodological Quality ◽  
Interval Training ◽  
Aerobic Exercise Training ◽  
Stroke Survivors ◽  
Secondary Complications ◽  
Stroke Outcomes ◽  
Haematological Profile ◽  
Cardio Respiratory Fitness

Background: Most stroke survivors live with residual physical impairments that may promote a sedentary lifestyle and resultant secondary complications, especially poor cardio-respiratory fitness. This systematic review was conceived to examine the extent of research on the effect of aerobic exercise on health outcomes of stroke survivors as a prelude to a clinical trial.Method: Electronic databases were searched with the last search performed in May, 2014. The methodological quality of studies was assessed using the PEDro scale. High-quality randomized controlled trials (RCTs) were considered level 1 evidence while lower-quality RCTs were considered level 2 evidence. Result: A total of 642 articles were generated from the search strategy; 10 articles fulfilled all criteria and were selected for this review. 50% of these studies recruited stroke survivors with ischaemic type of stroke while 30% had individuals with either ischaemic or haemorrhagic types. 70% of the studies had good scores while 30% had fair scores in methodological quality. The majority of the studies used VO2max as the outcome for assessing aerobic fitness; a few studies (10% each) assessed anthropometric outcomes and biochemical profile. No study assessed a haematological profile nor compared the effects of continuous and interval aerobic exercise on stroke outcomes. Conclusion: A gap in clinical trials on the effects of aerobic exercise on biochemical, haematological and anthropometric profiles of stroke survivors exists as well as in the comparative effects of continuous and interval training on stroke outcomes.

scholarly journals Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes

2020 ◽  
Vol 5 (2) ◽  
pp. 128-137
Author(s):  
Huimin Chen ◽  
Yuesong Pan ◽  
Lixia Zong ◽  
Jing Jing ◽  
Xia Meng ◽  
...  
Keyword(s):  
Regression Models ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Arterial Stenosis ◽  
Small Vessel ◽  
Minor Stroke ◽  
Bleeding Events ◽  
Stroke Outcomes ◽  
Vessel Disease ◽  
Increased Risk

BackgroundThe effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear.MethodsData of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models.ResultsAmong the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability.InterpretationCSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes.Trial registration numberNCT00979589

scholarly journals Exploring the predictive value of lesion topology on motor function outcomes in a porcine ischemic stroke model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kelly M. Scheulin ◽  
Brian J. Jurgielewicz ◽  
Samantha E. Spellicy ◽  
Elizabeth S. Waters ◽  
Emily W. Baker ◽  
...  
Keyword(s):  
Motor Function ◽  
Pearson Correlation ◽  
Topological Analysis ◽  
Brain Atlas ◽  
Analysis Approach ◽  
Lesion Volume ◽  
Stroke Outcomes ◽  
Correlation Analyses ◽  
Diagnostic Potential ◽  
Functional Gait

AbstractHarnessing the maximum diagnostic potential of magnetic resonance imaging (MRI) by including stroke lesion location in relation to specific structures that are associated with particular functions will likely increase the potential to predict functional deficit type, severity, and recovery in stroke patients. This exploratory study aims to identify key structures lesioned by a middle cerebral artery occlusion (MCAO) that impact stroke recovery and to strengthen the predictive capacity of neuroimaging techniques that characterize stroke outcomes in a translational porcine model. Clinically relevant MRI measures showed significant lesion volumes, midline shifts, and decreased white matter integrity post-MCAO. Using a pig brain atlas, damaged brain structures included the insular cortex, somatosensory cortices, temporal gyri, claustrum, and visual cortices, among others. MCAO resulted in severely impaired spatiotemporal gait parameters, decreased voluntary movement in open field testing, and higher modified Rankin Scale scores at acute timepoints. Pearson correlation analyses at acute timepoints between standard MRI metrics (e.g., lesion volume) and functional outcomes displayed moderate R values to functional gait outcomes. Moreover, Pearson correlation analyses showed higher R values between functional gait deficits and increased lesioning of structures associated with motor function, such as the putamen, globus pallidus, and primary somatosensory cortex. This correlation analysis approach helped identify neuroanatomical structures predictive of stroke outcomes and may lead to the translation of this topological analysis approach from preclinical stroke assessment to a clinical biomarker.

Impact of Mediterranean Diet prior to Stroke on the Prognosis of Patients Undergoing Endovascular Treatment

2021 ◽  
pp. 1-7
Author(s):  
Carmen García-Cabo ◽  
Maria Castañón-Apilánez ◽  
Lorena Benavente-Fernández ◽  
Jose Maria Jimenez ◽  
Juan Arenillas ◽  
...  
Keyword(s):  
Olive Oil ◽  
Mediterranean Diet ◽  
Daily Consumption ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Outcomes ◽  
Multicenter Observational Study ◽  
Adherence Score ◽  
Cholesterol Levels ◽  
Item Scale

Introduction: Mediterranean diet (MeDiet) has been associated with lower risk of stroke. Additionally, animal models suggested that some components of MeDiet are associated with better outcomes after ischemic stroke (IS). We aimed to evaluate the association between global adherence to the MeDiet and the consumption of particular components of the MeDiet with stroke outcomes. Material and Methods: Multicenter observational study of consecutive IS patients treated with endovascular therapy. Inclusion criteria were large anterior circulation vessel occlusion and pre-stroke modified Rankin scale (mRS) <2. Adherence to MeDiet prior to stroke was evaluated using MEDAS 14-item scale. We evaluated the total score and also individual components of the scale. Clinical, radiological, and prognostic variables were collected. Good functional prognosis was considered as mRS ≤2 and complete recanalization as thrombolysis in cerebral infarction 3. Results: From January 1 to October 30, 2018, 239 patients were included (mean age 71 years, 48% women, median baseline NIHSS 16). Median MEDAS scale was 8 points (7–10). Patients with a higher adherence to MeDiet had significantly lower total and LDL-cholesterol levels. Total adherence score was not associated with stroke outcomes. In multivariate analyses, consumption of olive oil as the principal source of fat was independently associated with good functional outcome at 3 months, OR 3.2 (1.1–10.1) and daily consumption of wine was independently associated with complete recanalization, OR 2.0 (1.1–3.8). Conclusions: Our study suggests that some components of MeDiet, such as olive oil and wine consumption, are related to better prognosis after stroke. More studies are needed to confirm these findings.

scholarly journals Activation of Glutamate Transporter-1 (GLT-1) Confers Sex-Dependent Neuroprotection in Brain Ischemia

2021 ◽  
Vol 11 (1) ◽  
pp. 76
Author(s):  
Flavia A. Tejeda-Bayron ◽  
David E. Rivera-Aponte ◽  
Christian J. Malpica-Nieves ◽  
Gerónimo Maldonado-Martínez ◽  
Héctor M. Maldonado ◽  
...  
Keyword(s):  
Infarct Size ◽  
Glutamate Transporter ◽  
Triphenyltetrazolium Chloride ◽  
Stroke Outcomes ◽  
Female Mice ◽  
Protein Levels ◽  
Translational Activator ◽  
Glutamate Transporter 1 ◽  
Sensorimotor Performance

Stroke is one of the leading causes of long-term disability. During ischemic stroke, glutamate is released, reuptake processes are impaired, and glutamate promotes excitotoxic neuronal death. Astrocytic glutamate transporter 1 (GLT-1) is the major transporter responsible for removing excess glutamate from the extracellular space. A translational activator of GLT-1, LDN/OSU 0212320 (LDN) has been previously developed with beneficial outcomes in epileptic animal models but has never been tested as a potential therapeutic for ischemic strokes. The present study evaluated the effects of LDN on stroke-associated brain injury. Male and female mice received LDN or vehicle 24 h before or 2 h after focal ischemia was induced in the sensorimotor cortex. Sensorimotor performance was determined using the Rung Ladder Walk and infarct area was assessed using triphenyltetrazolium chloride staining. Males treated with LDN exhibited upregulated GLT-1 protein levels, significantly smaller infarct size, and displayed better sensorimotor performance in comparison to those treated with vehicle only. In contrast, there was no upregulation of GLT-1 protein levels and no difference in infarct size or sensorimotor performance between vehicle- and LDN-treated females. Taken together, our results indicate that the GLT-1 translational activator LDN improved stroke outcomes in young adult male, but not female mice.

scholarly journals Comparison of Ischemic Stroke Outcomes and Patient and Hospital Characteristics by Race/Ethnicity and Socioeconomic Status

Stroke ◽  
2013 ◽  
Vol 44 (2) ◽  
pp. 469-476 ◽  
Author(s):  
Amresh D. Hanchate ◽  
Lee H. Schwamm ◽  
Wei Huang ◽  
Elaine M. Hylek
Keyword(s):  
Socioeconomic Status ◽  
Ischemic Stroke ◽  
Stroke Outcomes ◽  
Race Ethnicity ◽  
Hospital Characteristics

scholarly journals Impact of Comorbidities on Ischemic Stroke Outcomes in Women

Stroke ◽  
2008 ◽  
Vol 39 (7) ◽  
pp. 2138-2140 ◽  
Author(s):  
Cheryl D. Bushnell ◽  
Jeanne Lee ◽  
Pamela W. Duncan ◽  
L. Kristin Newby ◽  
Larry B. Goldstein
Keyword(s):  
Ischemic Stroke ◽  
Stroke Outcomes

scholarly journals Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

2016 ◽  
Vol 42 (1-2) ◽  
pp. 81-89 ◽  
Author(s):  
Mohamed Al-Khaled ◽  
Christine Matthis ◽  
Andreas Binder ◽  
Jonas Mudter ◽  
Joern Schattschneider ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Fatality ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Increased Risk ◽  
Reduced Risk

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

Sign in / Sign up

Export Citation Format

Share Document