scholarly journals Structural brain networks and functional motor outcome after stroke—a prospective cohort study

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Eckhard Schlemm ◽  
Robert Schulz ◽  
Marlene Bönstrup ◽  
Lutz Krawinkel ◽  
Jens Fiehler ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischaemic Stroke ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Brain Networks ◽  
Symptom Burden ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Residual Symptom ◽  
Structural Brain

Abstract The time course of topological reorganization that occurs in the structural connectome after an ischaemic stroke is currently not well understood. We aimed to determine the evolution of structural brain networks in stroke patients with motor deficits and relate changes in their global topology to residual symptom burden and functional impairment. In this prospective cohort study, ischaemic stroke patients with supratentorial infarcts and motor symptoms were assessed longitudinally by advanced diffusion MRI and detailed clinical testing of upper extremity motor function at four time points from the acute to the chronic stage. For each time point, structural connectomes were reconstructed, and whole-hemisphere global network topology was quantified in terms of integration and segregation parameters. Using non-linear joint mixed-effects regression modelling, network evolution was related to lesion volume and clinical outcome. Thirty patients were included for analysis. Graph-theoretical analysis demonstrated that, over time, brain networks became less integrated and more segregated with decreasing global efficiency and increasing modularity. Changes occurred in both stroke and intact hemispheres and, in the latter, were positively associated with lesion volume. Greater change in topology was associated with larger residual symptom burden and greater motor impairment 1, 3 and 12 months after stroke. After ischaemic stroke, brain networks underwent characteristic changes in both ipsi- and contralesional hemispheres. Topological network changes reflect the severity of damage to the structural network and are associated with functional outcome beyond the impact of lesion volume.

scholarly journals Connecting to motor recovery after stroke

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Jill H Fowler ◽  
Raj N Kalaria
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Brain Networks ◽  
Motor Recovery ◽  
Motor Outcome ◽  
Structural Brain

This scientific commentary refers to ‘Structural brain networks and functional motor outcome after stroke –a prospective cohort study’, by Schlemm et al. (https://doi.org/10.1093/braincomms/fcaa001) in Brain Communications and ‘Brain responsivity provides an individual readout for motor recovery after stroke’ by Tscherpel et al. (https://doi.org/10.1093/brain/awaa127) in Brain

scholarly journals Evaluation of anticoagulation status for atrial fibrillation on early ischaemic stroke outcomes: a registry-based, prospective cohort study of acute stroke care in Surrey, UK

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019122 ◽  
Author(s):  
Thang S Han ◽  
Christopher H Fry ◽  
David Fluck ◽  
Brendan Affley ◽  
Giosue Gulli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischaemic Stroke ◽  
Scale Score ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Severe Stroke ◽  
Increased Risk ◽  
Relationship Of ◽  
The Relationship

ObjectiveThe relationship of anticoagulation therapies with stroke severity and outcomes have been well documented in the literature. However, none of the previous research has reported the relationship of atrial fibrillation (AF)/anticoagulation therapies with urinary tract infection (UTI), pneumonia and length of stay in hyperacute stroke units (HASUs). The present study aimed to evaluate AF and anticoagulation status in relation to early outcomes in 1387 men (median age=75 years, IQR=65–83) and 1371 women (median age=83 years, IQR=74–89) admitted with acute ischaemic stroke to HASUs in Surrey between 2014 and 2016.MethodsWe conducted this registry-based, prospective cohort study using data from the Sentinel Stroke National Audit Programme. Association between AF anticoagulation status with severe stroke on arrival (National Institutes of Health Stroke Scale score ≥16), prolonged HASU stay (>3 weeks), UTI and pneumonia within 7 days of admission, severe disability on discharge (modified Rankin Scale score=4 and 5) and inpatient mortality was assessed by logistic regression, adjusted for age, sex, hypertension, congestive heart failure, diabetes and previous stroke.ResultsCompared with patients with stroke who are free from AF, those with AF without anticoagulation had an increased adjusted risk of having more severe stroke: 5.8% versus 14.0%, OR=2.4 (95% CI 1.6 to 3.6, P<0.001), prolonged HASU stay: 21.5% versus 32.0%, OR=1.4 (1.0–2.0, P=0.027), pneumonia: 8.2% versus 19.1%, OR=2.1 (1.4–2.9, P<0.001), more severe disability: 24.2% versus 40.4%, OR=1.6 (1.2–2.1, P=0.004) and mortality: 9.3% versus 21.7%, OR=1.9 (1.4–2.8, P<0.001), and AF patients with anticoagulation also had greater risk for having UTI: 8.6% versus 12.3%, OR=1.9 (1.2–3.0, P=0.004), pneumonia: 8.2% versus 11.5%, OR=1.6 (1.1–2.4, P=0.025) and mortality: 9.7% versus 21.7%, OR=1.9 (1.4–2.8, P<0.001). The median HASU stay for stroke patients with AF without anticoagulation was 10.6 days (IQR=2.8–26.4) compared with 5.8 days (IQR=2.3–17.5) for those free from AF (P<0.001).ConclusionsPatients with AF, particularly those without anticoagulation, are at increased risk of severe stroke, associated with prolonged HASU stay and increased risk of early infection, disability and mortality.

Serum Periostin and Cognitive Impairment in Ischemic Stroke Patients: a Prospective Cohort Study

2021 ◽  
Author(s):  
Guangzong Li ◽  
Jie Li ◽  
Chen Zhu ◽  
Jing Ye ◽  
Bin Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Enzyme Linked Immunosorbent Assay ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Increased Risk ◽  
Serum Periostin

Abstract Background. Recent evidence suggest elevated periostin is associated with cardiovascular diseases. The aim of this study was to investigate the relationship between serum periostin and post-stroke cognitive impairment (PSCI) at 3 months. Methods. In this prospective cohort study, we enrolled patients with ischemic stroke and hospitalized within 7 days of symptoms onset from January 2019 to January 2020. Serum periostin levels were measured using enzyme-linked immunosorbent assay after admission. Cognitive function assessment was performed at 3-month follow-up visit using the Montreal Cognitive Assessment (MoCA). We defined the PSCI as total MoCA score < 25. Results. A total of 315 ischemic stroke patients were enrolled for the study. PSCI was observed in 173 patients, which accounted for 54.9% (95% confidence interval [CI] 52.1%–57.7%) of the cohort. Serum periostin levels were higher in patients with PSCI than in those without PSCI (median 19.6 vs 14.8 ng/mL; P = 0.001). In logistic regression analysis, the highest quartile of periostin levels were significantly correlated to PSCI (odds ratio [OR], 9.69; 95% CI, 5.06–25.61; P = 0.001), as compared with the lowest quartile. This association remained significant after adjustment for age, gender, educational years, stroke severity, and vascular risk factors. Subgroup analyses further confirmed these results. Furthermore, restricted cubic spline regression demonstrated a linear association between periostin levels and PSCI (P = 0.001 for linearity).Conclusions. This study found that higher serum periostin levels are associated with an increased risk of PSCI at 3 months after ischemic stroke onset.

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