Verbal and oral apraxia in patients with acute stroke: Frequency, relationship, and some risk factors

AbstractDiagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

Download Full-text

Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis

Neurological Sciences ◽

10.1007/s10072-016-2570-5 ◽

2016 ◽

Vol 37 (8) ◽

pp. 1195-1202 ◽

Cited By ~ 19

Author(s):

Weibin Zhong ◽

Na Geng ◽

Pengfei Wang ◽

Zhenguang Li ◽

Lili Cao

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Stroke ◽

Transient Ischemic Attack ◽

Meta Analysis ◽

Hospital Readmissions ◽

Ischemic Attack ◽

Causes And Risk Factors

Download Full-text

Risk Factors for Chest Infection in Acute Stroke

Stroke ◽

10.1161/strokeaha.106.478156 ◽

2007 ◽

Vol 38 (8) ◽

pp. 2284-2291 ◽

Cited By ~ 152

Author(s):

Cameron Sellars ◽

Lynsey Bowie ◽

Jeremy Bagg ◽

M. Petrina Sweeney ◽

Hazel Miller ◽

...

Keyword(s):

Risk Factors ◽

Acute Stroke ◽

Chest Infection

Download Full-text

Abstract TP208: Sleep Disordered Breathing (SDB) - An Overlooked Modifiable Risk Factor in Acute Stroke Care

Stroke ◽

10.1161/str.48.suppl_1.tp208 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Vishal Shah ◽

Ashrai Gudlavalleti ◽

Julius G Latorre

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Modifiable Risk Factor ◽

Inclusion Criteria ◽

Risk Of Death ◽

Disordered Breathing

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.

Download Full-text

Abstract W MP60: Atrial Fibrillation is Associated with Worse Collaterals in Acute Stroke: Angiography in the ENDOSTROKE Registry

Stroke ◽

10.1161/str.45.suppl_1.wmp60 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

David S Liebeskind ◽

Christian H Nolte ◽

Georg Bohner ◽

Tobias Neumann-Haefelin ◽

Erich Hofmann ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Acute Stroke ◽

Endovascular Therapy ◽

Cardioembolic Stroke ◽

Baseline Risk ◽

Anterior Circulation ◽

Stroke Treatment ◽

Stroke Etiology ◽

The Impact

Background: Risk factors for stroke may alter hemodynamics or invoke ischemic preconditioning, yet the impact of such factors on response to acute stroke treatment and the potential relationship with collateral circulation remains unknown. Methods: Consecutive cases enrolled in the International Multicenter Registry for Mechanical Recanalization Procedures in Acute Stroke (ENDOSTROKE) were analyzed with respect to collateral status on baseline angiography before endovascular therapy. ASITN/SIR collateral grade (0-1/2/3-4) was scored by the core lab, blind to all other data. Collateral grade was analyzed with respect to numerous baseline risk factors, demographics and outcomes after endovascular intervention. Results: 109 patients (median age 69 years (25 th , 75 th percentiles: 56, 77); 51% women; median baseline NIHSS 15 (13, 18)) with complete (TICI 0) anterior circulation occlusions (M1, n=71; ICA, n=28; M2, n=10) at baseline were evaluated based on collateral grade (0-1, n=12; 2, n=41; 3-4, n=56). Worse collaterals were noted in patients with atrial fibrillation (ASITN grades 0-1/2/3-4: 21%/30%/49%) as compared to patients without atrial fibrillation (5%/42%/53%, p=0.024), yet cardioembolic stroke etiology was unrelated. Other baseline features such as age, gender, time to presentation, other co-morbidities and labs were unrelated to collateral grade. Post-procedure reperfusion (TICI 2b-3) was significantly associated with better collaterals (OR 2.58 (1.343-4.957, p=0.004). Similarly, final infarct size was significantly smaller in those with better collaterals. Good clinical outcomes (mRS 0-2 at day 90) were less frequent in those with poorer collaterals (OR 0.403 (0.199-0.813, p=0.011). Conclusions: Atrial fibrillation, but not cardioembolic stroke etiology, is associated with worse collaterals. Hemodynamic implications, such as diminished cardiac output due to atrial fibrillation, may result in less favorable outcomes after endovascular therapy for acute stroke.

Download Full-text

Frequency and Risk Factors of Pneumonia and Urinary Tract Infection during Hospitalization in Acute Stroke Patients.

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v32i2.57444 ◽

2016 ◽

Vol 32 (2) ◽

pp. 74-84

Author(s):

Shahed Ahmad ◽

Matiur Rahman ◽

Mostafa Hosen ◽

Abul Kalam ◽

Mohammed Shoab ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Acute Stroke ◽

Female Gender ◽

Older Age ◽

Stroke Patients ◽

Severe Stroke ◽

Wide Range

Background: Acute stroke Patients are at risk of developing a wide range of complications. Among these medical complications the most common are infections, including pneumonia and urinary tract infection (UTI). This study was designed to see the frequency and risk factors of pneumonia and UTI after acute stroke in hospitalized patients. Methods : This prospective observational study was done in the Department of Neurology and Department of Medicine, Sylhet M.A.G Osmani Medical College Hospital, from May 2014 to November 2014. After hospitalization, a total number of 80 acute stroke patients were enrolled in this study. All patients of both sexes, presented with acute stroke, were confirmed by CT scan of head; vascular risk factors were recorded and relevant investigations were done. Results: Among the study subjects Urinary tract infection was found in 23 (28.8%) patients. Statistically significant risk factors for UTI were : > 65 years age (OR=2.926; 95% of CI=1.044-8.202; p=0.037). Female gender (OR=0.327; 95% of CI=0.120-0.889; p=0.026), diabetes (OR=2.015; 95% of CI=1.019-7.780; p=0.042), Severe stroke (OR=3.331; 95% of CI=1.217-9.116; p=0.017), Foley tube catheterization (OR=4.229; 95% of CI=1.492-11.982; p=0.005). Pneumonia developed in 17 (21.2%) patients and no pneumonia in 63 (78.8%) patients. Conclusion : UTI and pneumonia are common occurrence after acute stroke during stroke hospitalization. Older age, female gender, diabetes mellitus, severe stroke at presentation and urinary catheterization were found the risk factors of UTI; whereas older age, severe stroke at presentation, nasogastric tube feeding, oropharyngeal suction and difficulty in swallowing were found the risk factors of pneumonia in acute stroke. Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 74-84

Download Full-text

Pattern, risk factors, and outcome of acute stroke in a Nigerian university teaching hospital: A 1-year review

Nigerian Journal of Medicine ◽

10.4103/njm.njm_8_21 ◽

2021 ◽

Vol 30 (3) ◽

pp. 252

Author(s):

Babawale Arabambi ◽

Olajumoke Oshinaike ◽

OluwakemiOluwabunmi Akilo ◽

Yakub Yusuf ◽

ShamsideenAbayomi Ogun

Keyword(s):

Risk Factors ◽

Acute Stroke ◽

Teaching Hospital ◽

University Teaching ◽

Nigerian University

Download Full-text

Eligibility for intravenous thrombolysis in acute stroke: A multicenter prospective study

Stroke ◽

10.1161/str.32.suppl_1.372-c ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 372-372

Author(s):

Enrique Mostacero ◽

Sonia Santos ◽

Antonio Davalos ◽

Alberto Gil-Peralta ◽

Jose Castillo ◽

...

Keyword(s):

Risk Factors ◽

Prospective Study ◽

Acute Stroke ◽

Life Support ◽

Advanced Life Support ◽

Stroke Onset ◽

Stroke Severity ◽

Street Hospital ◽

Modifiable Factors ◽

Dispatch System

P182 Objective: To elucidate the proportion of patients who would have been eligible for alteplase treatment following the ECASS II criteria in a prospective study conducted in 20 Spanish general or university hospitals. Methods: The first 100 consecutive patients with an acute stroke admitted between 9/98 and 4/99 in each participating hospital were evaluated. Data concerning exclusion criteria for tPA, demographic variables, distance to hospital (<5km,5–20km,>20km), time (0–6am,6–12,12–6pm,6–12pm) and place (home, work/street, hospital) of symptoms onset, subject detecting the event (victim, family member, bystander), dispatch system (own initiative, EMS, primary physician, community hospital), delay and type of transport (own transport, basic, or advanced life support ambulance), cardiovascular risk factors, stroke severity (Canadian scale) and type of stroke were recorded. Results: Out of 1599 screened patients, 166 (10.4%) fulfilled all criteria for tPA treatment. Multiple reasons for exclusion were time from onset >6h in 23%, or unknown in 23%, delay in neurological attention >6h in 39%, TC not available within 6h from onset in 34%, hemorrhage in 14%, early signs of infarction involving >33% MCA in 8%, TIA or rapidly improving symptoms in 24%, coma or hemiplegia plus forced eye deviation in 5%, hypertension >185/110 in 2%, coagulation abnormalities in 1%, and other reasons in 6%. Univariate analyses showed that high eligibility for tPA was associated with type of the first medical intervention (emergency medical system)(p=0.006), type of transport (basic or advanced life support ambulance)(p<0.0001), stroke severity (p<0.001), and type of stroke (cardioembolic) (p=0.0027). Age, distance to hospital, time and place of stroke onset, subject detecting the event, and risk factors were not significantly related to eligibility. Conclusions: Candidates for intravenous tPA treatment within 6 hours from stroke onset are 10% of patients admitted in general hospitals of an EU country. Delay in neurologic attention and CT examination were the main reasons for exclusion. Dispatch system, and type of transport were modifiable factors related to eligibility.

Download Full-text

Stroke prediction in patients presenting with isolated dizziness in the emergency department

10.21203/rs.3.rs-118052/v1 ◽

2020 ◽

Author(s):

June-sung Kim ◽

Hong Jun Bae ◽

Muyeol Kim ◽

Shin Ahn ◽

Chang Hwan Sohn ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Multivariate Analysis ◽

Acute Stroke ◽

Neurological Deficits ◽

Cerebrovascular Injury ◽

Risk Patients ◽

History Of ◽

Independent Risk Factors ◽

Record Review

Abstract Diagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. This study tried to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2,215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1,239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1,239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

Download Full-text