Hyperglycemia as a Prognostic Factor In Acute Ischemic Stroke Patients

Abstract Background Hyperglycemia is encountered in 20% to 40% of acute stroke patients, with or without a pre-morbid diagnosis of diabetes mellitus. Hyperglycemia is a risk factor for infarct expansion and poor outcome through the first 72 hours of hospitalization in both diabetics and non-diabetics. Aim of the Work to study the glycemic status after acute ischemic stroke and assess its role in influencing stroke out-come as regards the duration of hospital stay, motor deficit outcome and mortality. Patients and Methods This retrospective study was conducted in Elzaiton specialized hospital and Ain Shams University from June 2016 to June 2017 on 80 patients after approval of local medical ethical committee. Patients with acute ischemic stroke without other major comorbidities within 24 hours of onset of symptoms were evaluated. Results The study revealed that hospital stay mean was 12.04 ± 9.61 (in control group) and 21.36 ± 12.49 (in uncontrolled group), with p-value < 0.022 S. A highly statistically significant difference between controlled and uncontrolled according to increase motor power at ICU admission in controlled a highly statistically significant difference between controlled and uncontrolled according to increase motor power discharge in controlled group. A highly statistically significant difference was found between both groups as regards outcome (mortality). Conclusion Hyperglycemia is common among acute stroke patients and is associate with less favorable outcome as regards mortality, hospital stay and functional outcome and euglycemic control is recommended in these patients.

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Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.52.suppl_1.p201 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

RAJAN R GADHIA ◽

Farhaan S Vahidy ◽

Tariq Nisar ◽

Destiny Hooper ◽

David Chiu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Combined Treatment ◽

Stroke Patients ◽

Stroke Treatment ◽

Intravenous Tissue Plasminogen Activator ◽

Significant Difference ◽

Acute Stroke Treatment ◽

Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

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Abstract 2223: Diagnoses and Outcomes of t-PA Treated Patients with No Imaging Evidence of Acute Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a2223 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Ilana Spokoyny ◽

Rema Raman ◽

Karin Ernstrom ◽

Brett C Meyer ◽

Thomas M Hemmen

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Clinical Diagnosis ◽

Surrogate Marker ◽

Stroke Patients ◽

Correct Treatment ◽

Stroke Mimics ◽

Stroke Imaging ◽

Significant Difference

Background/Purpose: Intravenous Alteplase (t-PA) improves outcome in patients with acute ischemic stroke. Of those who recover fully, some may not have had ischemia. We analyzed the frequency and post-treatment outcomes of patients with no imaging evidence of stroke and aimed to delineate the frequency of strokes with full recovery from that of stroke mimics treated with t-PA. Methods: We included all adult stroke patients treated with IV t-PA within 3 hours of stroke onset from the UCSD SPOTRIAS database. Group 1: Patients with neuroimaging evidence of acute stroke (IPS); Group 2: no neuroimaging evidence of acute stroke (INS). All diagnoses were established by an independent adjudicating body. We reviewed medical records, neuroimaging, and compared discharge diagnosis, 90-day mRS, and incidence of intracranial hemorrhage. We adjusted for age, admission NIHSS, and pre-stroke mRS in multivariable models. Results: We identified 61patients with IPS and 25 with INS, with similar baseline characteristics, except for baseline NIHSS (IPS 13.4±8.2, INS 8.4±5.9, p=0.007) and incidence of cardiac arrhythmias (IPS 36.1%, INS 4.0%, p=0.002). Adjusted for age and baseline NIHSS, we found no difference in outcome. ICH was found in 23% of the IPS patients and was symptomatic in 4.9%. None of the INS patients had ICH. Conclusions: Radiologic evidence of acute ischemic stroke was absent in 10.5% of the 86 patients in the UCSD SPOTRIAS database who were treated with t-PA and given a clinical diagnosis of acute ischemic stroke on adjudicating body review at discharge. The majority (64%) of imaging negative stroke patients in our study ultimately received the clinical diagnosis of acute stroke. No significant difference in outcomes (mRS) was found between imaging negative and imaging positive stroke code patients, aside from the increased ICH frequency in imaging positive patients. This lack of outcome difference emphasizes that while imaging plays an important role as a surrogate marker in determining the diagnosis, a detailed clinical evaluation is essential in the correct treatment of acute ischemic stroke. Imaging negative stroke patients are common and future larger scale prospective data is required to analyze the true frequency of stroke mimics versus imaging negative stroke.

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DWI Lesion Characteristics As A Predictor For Outcome In Acute Stroke Patients Treated By IV-tPA

QJM ◽

10.1093/qjmed/hcab102.012 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

H Aref ◽

S Farag ◽

S Helmy ◽

H Mahmoud

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Type ◽

P Value ◽

Stroke Patients ◽

Tissue Type Plasminogen Activator ◽

Type Plasminogen Activator ◽

Iv Tpa

Abstract Background Thrombolysis with tissue-type plasminogen activator (IV-tPA) is a well-proved, widely used treatment in acute ischemic stroke patients, many predictors of functional outcome have been proposed as Age, vascular risk factors, initial clinical evaluation on admission using National institute of health stroke scale(NIHSS), functional state of patient(b.L) baseline before stroke and 3 months (3m) after stroke using modified Rankin stroke scale (MRS)and the most controversial Diffusion weighted image characteristics (volume, heterogeneity) Objective To evaluate DWI MRI characteristics (volume, heterogeneity) as a predictor for outcome in Acute stroke patients treated by IV-tPA Patients and Methods This study will be done on a sample of 100 acute ischemic stroke Egyptian patients receiving intra-venous tissue -type plasminogen activator presenting to Ain-Shams university hospitals Results Highly statistically significant (p-value < 0.001) Positive correlation (r = 0.394) between volume (DWI) and MRS (3m) post discharge in studied patients, No statistically significant (pvalue > 0.05) relation between heterogeneity and other studied parameters (MRS, NIHSS D & ADC values) in studied patients Conclusion DWI infarct volume is a predictor for outcome in acute ischemic stroke patients treated by tPA

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The effect of addition protein, phosphatidylcholine, phosphatidylserine, and inulin on GFAP levels of acute ischemic stroke patients at Dr. Kariadi Hospital, Semarang

JURNAL GIZI INDONESIA ◽

10.14710/jgi.9.2.184-197 ◽

2021 ◽

Vol 9 (2) ◽

pp. 184-197

Author(s):

Diah Retno Wahyuningrum ◽

Retnaningsih Retnaningsih ◽

Martha Irene Kartasurya

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

G Protein ◽

Intervention Group ◽

Circulatory System ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Stroke Patients ◽

Significant Difference ◽

Enteral Formula

Background: The occurrence of ischemia causes a loss of energy to switch to anaerobic processes resulting in acidosis due to reduced Adenosina Triphosphate (ATP). This condition makes neuron cells apoptotic. Apoptotic of several biochemical substrates in the brain, such as Glial Fibrillary Acidic Protein (GFAP) exit into the circulatory system which is associated with dysbiosis through immunological pathways.Objectives: To determine the effect of giving enteral formula containing protein, phosphatidylcholine, phosphatidylserine, and inulin on GFAP levels in patients with acute ischemic stroke Dr. Kariadi Hospital.Materials and Methods: This study was done in a single-blind RCT. Eighteen ischemic stroke patients were randomly divided into intervention (9 subjects) and control groups (9 subjects). The intervention group received 69 g of the powdered enteral formula three times a day for seven days. The formula contained protein (15 g), phosphatidylcholine (128 mg), phosphatidylserine (32 mg), and inulin (3 g). The subject who had diabetes mellitus received for 14 days at a dose of 34.5 g per day (7.5 g protein with additions 64mg phosphatidylcholine, 16mg phosphatidylserine, 1.5 g inulin). The control group received the standard enteral formula from the hospital, which contains (11.8 g protein without additions protein, phosphatidylcholine, phosphatidylserine, and inulin). GFAP levels by ELISA method (Enzyme-linked immunosorbent Assay) at pre and post-intervention.Results: There was a trend of decreasing GFAP levels before and after in the intervention group towards a better direction from 8.37±4.25 to 8.30±4.9 compared with the control group which experienced an increasing trend from 5.4±1.8 to 7.5±4. There was no significant difference in GFAP levels after intervention between groups (p = 0.7).Conclusions: The addition of protein, phosphatidylcholine, phosphatidylserine, and inulin had no significant effect on GFAP levels.

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Serum magnesium levels in patients of ischemic stroke and its correlation with neurological disability

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201084 ◽

2020 ◽

Vol 8 (4) ◽

pp. 1241

Author(s):

Vishali Kotwal ◽

Rajesh Maini

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Glutamate Release ◽

Serum Magnesium ◽

Normal Subjects ◽

Control Group ◽

P Value ◽

Stroke Patients ◽

Neurological Disability ◽

Neuroprotective Effects

Background: Stroke is a leading cause of death and disability worldwide acute ischaemic stroke accounts for 87% of strokes and mostly affects persons at the peak of their lives. Magnesium is known to have neuroprotective effects in ischemic stroke through a variety of mechanisms including decrease in glutamate release and inhibition of NMDA receptors and vasodilation. Previous studies on serum magnesium levels in stroke patients have shown variable results with many of them finding lower levels than in normal subjects. This study was undertaken to compare serum magnesium levels in patients of acute ischemic stroke with those of controls and also find a correlation if any between serum magnesium levels and neurological disability.Methods: This was a prospective non-interventional case-control study in which 50 patients of acute ischemic stroke in the age group of 20 to 80 years admitted in the department of Medicine Government Medical College Jammu from October 2019 to January 2020 were taken. Their serum magnesium levels were analysed within first 24 hours of admission and neurological disability was measured using modified Rankin Score. Serum magnesium levels were also estimated in 35 healthy controls for comparison.Results: Serum magnesium was lower in the study group (mean of 1.85±0.36) as compared to the control group (mean of 2.4±0.21) which was statistically significant (p value =0.001). Modified Rankin Score was 4 to 5 in 27 patients and 2 to 3 in 23 patients and it was negatively correlated with serum magnesium levels (r =-0.67).Conclusions: Ischemic stroke patients had lower serum magnesium levels as compared to healthy subjects in our study and also lower levels were seen in those with higher neurological disability.

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Sertraline for Functional Recovery After Acute Ischemic Stroke: A Prospective Observational Study

Frontiers in Neurology ◽

10.3389/fneur.2021.734170 ◽

2021 ◽

Vol 12 ◽

Author(s):

Isabella Stuckart ◽

Timo Siepmann ◽

Christian Hartmann ◽

Lars-Peder Pallesen ◽

Annahita Sedghi ◽

...

Keyword(s):

Regression Analysis ◽

Ischemic Stroke ◽

Observational Study ◽

Acute Ischemic Stroke ◽

Functional Recovery ◽

Prospective Observational Study ◽

Functional Independence ◽

Motor Deficit ◽

Control Group ◽

Stroke Patients

Background: Neuroprotective and neurorestorative effects have been postulated for selective serotonin-reuptake inhibitors (SSRI). We hypothesized that sertraline, which is characterized by less severe adverse effects and more stable pharmacokinetics than classic SSRI, is associated with improved functional recovery in acute ischemic stroke patients with motor deficits.Methods: Prospective observational study of consecutive acute ischemic stroke patients who received sertraline for clinically suspected post-stroke depression (PSD) or at high risk for PSD. Eligibility comprised acute motor deficit caused by ischemic stroke (≥2 points on NIHSS motor items) and functional independence pre-stroke (mRS ≤1). Decision to initiate treatment with SSRI during hospital stay was at the discretion of the treating stroke physician. Patients not receiving sertraline served as control group. Favorable functional recovery defined as mRS ≤2 was prospectively assessed at 3 months. Multivariable logistic regression analysis was used to explore the effects of sertraline on 3-months functional recovery. Secondary outcomes were frequency of any and incident PSD (defined by BDI ≥10) at 3 months.Results: During the study period (03/2017–12/2018), 114 patients were assigned to sertraline (n = 72, 62.6%) or control group (n = 42, 37.4%). At study entry, patients in sertraline group were more severely neurologically affected than patients in the control group (NIHSS: 8 [IQR, 5–11] vs. 5 [IQR, 4–7]; p = 0.002). Also, motor NIHSS scores were more pronounced in sertraline than in control group (4 [IQR 2–7] vs. 2 [IQR 2–4], p = 0.001). After adjusting for age and baseline NIHSS, multivariable regression analysis revealed a significant association between sertraline intake and favorable functional outcome at 3 months (OR 3.10, 95% CI 1.02–9.41; p = 0.045). There was no difference between both groups regarding the frequency of any depression at 3 months (26/53 [49.1%] vs. 14/28 [50.0%] patients, p = 0.643, BDI ≥10). However, fewer incident depressions were observed in sertraline group patients compared to patients in control group (0/53 [0%] vs. 5/28 [17.9%] patients, p = 0.004).Conclusions: In this non-randomized comparison, early treatment with sertraline tended to favor functional recovery in patients with acute ischemic stroke. While exploratory in nature, this hypothesis needs further investigation in a clinical trial.

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Effect of Simvastatin in Serum Interleukin-6 Level in Patients with Acute Ischemic Stroke

Folia Medica Indonesiana ◽

10.20473/fmi.v56i3.24508 ◽

2021 ◽

Vol 56 (3) ◽

pp. 165

Author(s):

Maria Lettisia Meo ◽

Abdulloh Machin ◽

Didik Hasmono

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Acute Ischemic Stroke ◽

University Hospital ◽

Neurological Deficits ◽

Control Group ◽

Stroke Severity ◽

Stroke Patients ◽

Permanent Disability ◽

Significant Difference

Acute ischemic stroke is the leading cause of death and causing permanent disability in adults worldwide. In acute ischemic stroke, IL-6 levels positively correlated to more severe neurological deficits, more extensive brain damage and worse prognoses. The use of statin was associated with milder initial stroke severity, better functional outcome and lower mortality. This clinically randomized controlled trial study was aimed to analyze the serum levels of IL 6 in acute ischemic stroke patients who treated with Simvastatin 20 mg compare to placebo. Samples were taken using consecutive sampling method from hospitalized acute ischemic stroke patients in Neurology Department of Dr. Soetomo Teaching Hospital Surabaya and Airlangga University Hospital Surabayafrom August to November 2017. Total of 44 patients met the inclusion criteria, consisting of 22 patients in treatment group and 22 patients in control group.There were no significant difference in the characteristic of the patients in both groups (p>0.05). Averages of serum IL-6 in the control and the treatment group are 38.594±74.313 and 17.760±25.253(p=0,438) while averages of serum IL-6 post in the control group and the treatment are 46.586±103.484 and 15.275±17.183 (p=0,589). There were no significant level escalation in pre and post of control group (p = 0.205) and also no significant level reduction in pre and post of treatment group (p = 0.411), while the average difference in the control group (-7.992 + 78.912 pg/ml) and in the treatment group (2.485 + 23.738 pg/ml).

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The Effectivity of Mirror Therapy on Arm Motoric Improvement in Acute Ischemic Stroke Patients

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.7n.1p.6 ◽

2019 ◽

Vol 7 (1) ◽

pp. 6

Author(s):

Jumraini Tammasse ◽

Machyono Andi Kurnia Bintang

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Standard Therapy ◽

Cerebrovascular Diseases ◽

Control Group ◽

Mirror Therapy ◽

Stroke Patients ◽

Motor Action ◽

Significant Difference ◽

Experimental Group

Cerebrovascular diseases (stroke) ranked the second cause of death worldwide. This research aimed at investigating the effectiveness of mirror therapy on artery therapy by ARAT (ARAT) score. The research was carried out by the clinical trials study towards 32 acute ischemic stroke patients who were divided into an experimental group got the combination of mirror therapy and standard therapy, and the control group only got the standard therapy. The level of the motor action was tested by Action Research Arm Test (ARAT) score. The research then compared the ARAT score difference between the two groups. The result of the research reveals that the ARAT score differences on the group who gets the combination of mirror therapy and standard therapy (15.56±4.38) higher than the group who only gets the standard therapy (7.69±1, 66). By using T-test, it is obtained the significant difference of P <0.05 (0.001).

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Effect of Simvastatin in Serum Interleukin-6 Level in Patients with Acute Ischemic Stroke

Folia Medica Indonesiana ◽

10.20473/fmi.v56i3.22162 ◽

2020 ◽

Vol 56 (3) ◽

pp. 165

Author(s):

Maria Lettisia Meo ◽

Abdulloh Machin ◽

Didik Hasmono

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Acute Ischemic Stroke ◽

University Hospital ◽

Neurological Deficits ◽

Control Group ◽

Stroke Severity ◽

Stroke Patients ◽

Permanent Disability ◽

Significant Difference

Acute ischemic stroke is the leading cause of death and causing permanent disability in adults worldwide. In acute ischemic stroke, IL-6 levels positively correlated to more severe neurological deficits, more extensive brain damage and worse prognoses. The use of statin was associated with milder initial stroke severity, better functional outcome and lower mortality. This clinically randomized controlled trial study was aimed to analyze the serum levels of IL 6 in acute ischemic stroke patients who treated with Simvastatin 20 mg compare to placebo. Samples were taken using consecutive sampling method from hospitalized acute ischemic stroke patients in Neurology Department of Dr. Soetomo Teaching Hospital Surabaya and Airlangga University Hospital Surabaya from August to November 2017. Total of 44 patients met the inclusion criteria, consisting of 22 patients in treatment group and 22 patients in control group. There were no significant difference in the characteristic of the patients in both groups (p>0.05). Averages of serum IL-6 in the control and the treatment group are 38.594±74.313 and 17.760±25.253 (p=0,438) while averages of serum IL-6 post in the control group and the treatment are 46.586±103.484 and 15.275±17.183 (p=0,589). There were no significant level escalation in pre and post of control group (p=0.205) and also no significant level reduction in pre and post of treatment group (p=0.411), while the average difference in the control group (-7.992 ± 78.912 pg/ml) and in the treatment group (2.485 ± 23.738 pg/ml).

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Effect and Safety of Naomaili Granules (脑脉利颗粒) for the Treatment of Acute Ischemic Stroke: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial

10.21203/rs.3.rs-54570/v1 ◽

2020 ◽

Author(s):

Xiaogang Li ◽

Dongjing Song ◽

Peiyang Zhou ◽

Huagang Wang ◽

Chengfang Zhou ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Western Medicine ◽

Treatment Plan ◽

Integrated Treatment ◽

Acute Stage ◽

Control Group ◽

Significant Difference ◽

Experimental Group

Abstract Background: It is of vital importance for the treatment and prognosis of Acute Stroke to find effective Chinese medicine that can be combined with western medicine in the acute stage. The purpose of this study is to investigate the effect and safety of Naomaili Granules (脑脉利颗粒, NML) for the treatment of acute stroke, hoping to provide a new idea and drug choice for the integrated treatment of Chinese and Western medicine in the acute stage of ischemic stroke, and at the same time to improve the treatment plan in the acute stage of ischemic stroke from the perspective of TCM syndromes. Methods: A total of 187 patients with acute ischemic stroke were randomly divided into the NML group (93 cases) and the placebo group (94 NML mimics), 1 bag (10g/bag), thrice daily for 20 days. Basic medications during the trial: Aspirin enteric-coated tablets, 1 tablet (0.1g/tablet), once a day. After treatment, the modified Rankin scale, the incidence of cardiovascular events and TCM Syndrome effect were the main efficacy indicators. Meanwhile, adverse events (AEs) were evaluated during the whole clinical trial. Results: In the FAS 90 days after the onset, the experimental group was 70.00%, and the control group was 45.24%. There was a statistically significant difference between the two groups. The incidence of acute cardio-cerebrovascular events was 1 case (1.08%) in the experimental group and 0 in the control group after 20 days of FAS treatment. Conclusion: The combined application of NML in the acute stage of ischemic stroke can effectively improve the prognosis of patients, and improve the independent survival ability of patients, and its safety is reliable, providing a new way of thinking and medication choice for the treatment of acute ischemic stroke with integrated traditional Chinese and western medicine.Trial registration: ChiCTR, ChiCTR2000033619. Registered 7 June 2020 - Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=54619

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