Auditory Hallucinations in Acute Stroke

Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

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Consciousness Emanates from the Neuronal Network of Coordination, A Fact Endorsed by Preserved Consciousness in Focal Ischemic Infarctions

NeuroQuantology ◽

10.14704/nq.2021.19.3.nq21023 ◽

2021 ◽

Vol 19 (3) ◽

pp. 17-25

Author(s):

Dr. Sohail Adnan ◽

Dr. Mubasher Shah ◽

Dr. Syed Fahim Shah ◽

Dr. Fahad Naim ◽

Dr. Akhtar Ali ◽

...

Keyword(s):

Cerebral Cortex ◽

Neuronal Network ◽

Brain Activity ◽

Cross Sectional Study ◽

Difficult Problem ◽

Altered Consciousness ◽

Cross Sectional ◽

Consciousness Disorder ◽

The Right ◽

The Brain

Background: Consciousness has remained a difficult problem for the scientists to explore its relationship to the brain activity. This is the first paper that presents the significance of focal areas of the cerebral cortex for consciousness. Objectives: To determine if consciousness is produced by the activity of the whole brain or one of its focal areas. Methods: We have performed a prospective cross-sectional study in eighty patients of acute ischemic stroke. The neurovascular territory of the middle cerebral artery (MCA) was sectioned into four similar areas. The association of any of these focal areas to consciousness was observed after their dysfunction with ischemic strokes. Results: Of the eighty patients, 57.5 % were males and 42.5 % were females. Mean age was 63 years ± 7 SD. The righthanded patients were 90 % (72) of the whole sample. Focal areas of the right MCA were generally less prone to consciousness disorder. Average statistics of the focal infarctions of the right MCA showed no tendency for consciousness disorder on the Glasgow coma scale (GCS) [Mean GCS of all focal areas; 14.5, SD; 0.71, 95 % CI; 14.27 to 14.72, P= 0.0000004]. Altered consciousness with focal infarctions of the territory of left MCA was also less likely [Mean GCS of all focal areas; 14.2, SD; 1.01, 95 % CI; 13.88 to 14.51, P= 0.0004]. Conclusion: Consciousness is not determined by the activity of a focal area of the cerebral cortex. Perhaps, we get our consciousness from the activity of “Neuronal Network of Coordination”.

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Testing Conclusions From Functional Imaging of Working Memory with Data From Acute Stroke

Behavioural Neurology ◽

10.1155/2007/396946 ◽

2007 ◽

Vol 18 (1) ◽

pp. 37-43 ◽

Cited By ~ 15

Author(s):

Lisa E. Philipose ◽

Hannah Alphs ◽

Vivek Prabhakaran ◽

Argye E. Hillis

Keyword(s):

Working Memory ◽

Acute Stroke ◽

Functional Imaging ◽

Right Hemisphere ◽

Spatial Working Memory ◽

Verbal Working Memory ◽

Stroke Patients ◽

Imaging Results ◽

Cortical Stroke ◽

The Right

Functional imaging studies indicate that the left hemisphere mediates verbal working memory, while the right hemisphere mediates both verbal and spatial working memory. We evaluated acute stroke patients with working memory tests and imaging to identify whether unilateral dysfunction causes deficits in spatial and/or verbal working memory deficits. While left cortical stroke patients had verbal working memory impairments (p< 0.003), right cortical stroke patients had both verbal (p< 0.007) and spatial working memory (p< 0.03) impairments, confirming functional imaging results. Patients with transient ischemic stroke and patients with non-cortical stroke did not have significant deficits in working memory in either modality.

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Correlation of blood glucose levels, HbA1c, hemoglobin and leukocytes with outcome on acute stroke

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191629 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1430

Author(s):

Meiriani . ◽

Yuneldi Anwar ◽

Puji Pinta Omas Sinurat

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Acute Stroke ◽

Hemorrhagic Stroke ◽

Cross Sectional Study ◽

P Value ◽

Stroke Patients ◽

Cross Sectional ◽

Glucose Levels ◽

Blood Glucose Levels

Background: Diabetes and higher HbA1c level have increased the incidence of stroke. Hemoglobin levels both high and low are associated with poor outcomes. Leukocytes play an important role in the initiation of the atherosclerosis process.Methods: This was a cross-sectional study with a sample size of 62 people selected by non-random sampling method on a consecutive basis, patients with acute stroke were taken blood to measure blood glucose levels, HbA1c, Hb and Leucocytes when entering the hospital room. Outcomes were assessed using NIHSS and MRS. The calculation of NIHSS and MRS scores was performed on the first day of admission and the fourteenth day. To analyze the correlation of blood sugar levels during HbA1c, Hb and leukocytes in acute stroke, this study used Spearman's correlation test. The p value <0.05 was considered statistically significant.Results: The study subjects of 62 acute stroke patients (acute ischemic stroke 31 people and 31 people hemorrhagic stroke). Acute stroke patients were consisted of 38 men (61.3%) and 24 women (38.7%). Of 31 people with hemorrhagic stroke, there were 16 men (51.6%) and 15 women (48.4%), ischemic stroke patients were consisted of 22 people (71, 0%) and women were 9 people. Spearrman repair test showed no symptoms between blood glucose levels, HbA1c, Hemoglobin and leukocytes with outcomes in acute stroke.Conclusions: There was no significant association between blood glucose levels, HbA1c, hemoglobin and leukocytes with outcomes in acute stroke.

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The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study

BMC Neurology ◽

10.1186/s12883-019-1578-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Yared Zenebe Zewde ◽

Abenet Tafesse Mengesha ◽

Yeweynhareg Feleke Gebreyes ◽

Halvor Naess

Keyword(s):

Acute Stroke ◽

Cross Sectional Study ◽

Stroke Severity ◽

Sectional Study ◽

Stroke Management ◽

Stroke Patients ◽

Short Term ◽

Cross Sectional ◽

Specialized Hospital ◽

Tikur Anbessa Specialized Hospital

Abstract Background Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting. Methods A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively. Results A total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10–19) compared to normoglycemic patients 11 (IQR 8–15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99–6.19) more likely to be functionally impaired (mRS = 3–5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association. Conclusions Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

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Structural Magnetic Resonance Imaging Correlated with Motor Function of Upper Extremity in Patients with Chronic Stroke

QJM ◽

10.1093/qjmed/hcab102.008 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Dalia Maher Samy ◽

Mohamed Mahmoud Mostafa ◽

Eman Mahmoud ◽

Ahmed Mohamed Hazzou ◽

Mohamed Khaled Ahmed Elewa ◽

...

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Cross Sectional Study ◽

Chronic Stroke ◽

Neurological Dysfunction ◽

Stroke Patients ◽

Cross Sectional ◽

Function Impairment ◽

Cerebrovascular Stroke ◽

The Brain

Abstract Background Ischemic cerebrovascular stroke is defined as an acute neurological dysfunction caused by focal cerebral infarction after decrease in the blood supply of the brain either by stenosis or occlusion leading to gross physical impairment or disability lasting more than 24 hours. Objective To assess correlation between site of infarction and upper extremity ( UE) function in chronic stroke patients. Methodology A cross sectional study with (30) Patients with chronic ischemic stroke ( >3 months) suffering from persistent UE motor function impairment, MRI brain done to assess the site of infarction. UE motor function assessment using the Fugl Meyer Assessment (FMA-UE) Scale. Results The current study found that no significant correlation between the site of infarction and UE motor function. Conclusion We concluded that the site of infarction not correlated with UE motor function in chronic stroke patients.

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The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia: a cross-sectional study

10.21203/rs.2.13261/v2 ◽

2019 ◽

Author(s):

Yared Zenebe Zewde ◽

Abenet Tafesse Mengesha ◽

Yeweyenhareg Feleke Gebreyes ◽

Halvor Naess

Keyword(s):

Blood Glucose ◽

Acute Stroke ◽

Functional Recovery ◽

Cross Sectional Study ◽

Stroke Severity ◽

Sectional Study ◽

Stroke Management ◽

Stroke Patients ◽

Short Term ◽

Cross Sectional

Abstract Background: Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.Methods: A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 hours of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as >140mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.Results: A total of 103 first-ever acute stroke patients were included (mean age = 55.5+15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (p = 0.041).Older age (≥ 65 years) (p = 0.017) and stroke severity (NIHSS >14) (p = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among the patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.Conclusions: Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-days of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

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Correlation between Acute Stroke and Concentration of Creatine Kinase Myocardial Band, Troponin T, Hemoglobin, and Electroyltes

Jurnal Kesehatan Masyarakat ◽

10.15294/kemas.v14i1.11846 ◽

2018 ◽

Vol 14 (1) ◽

pp. 71-80

Author(s):

Destika Fahrina ◽

Puji Pinta Sinurat ◽

Aldy Sjarifuddin Rambe

Keyword(s):

Creatine Kinase ◽

Acute Stroke ◽

Troponin T ◽

Demographic Data ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional ◽

The Difference ◽

Mean Concentration

Currently, there were only a few studies regarding the correlation between concentration of creatine kinase-myocardial band (CKMB), troponin T, hemoglobin, and electrolytes and acute stroke. This study aimed to understand the difference of mean concentration of CKMB, troponin T, hemoglobin, and electrolytes and their relationship with acute stroke. This was a cross sectional study using samples of 30 subjects who were selected with consecutive non random sampling. The subjects were acquired from acute stroke patients who were proven clinically and using computed tomography (CT) scan at Haji Adam Malik General Hospital. Demographic data were analyzed using descriptive statistic. The result showed that there were no difference in demographical characteristics between the subjects. In conclusion, there were no differences in mean of CKMB, troponin T, hemoglobin, and electrolytes in acute stroke. No correlation was found between acute stroke and concentration of CKMB, troponin T, hemoglobin, and electrolytes.

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The Association of Plasma Fractalkine and Inflammation After Ischemic Stroke

The Indonesian Biomedical Journal ◽

10.18585/inabj.v8i2.205 ◽

2016 ◽

Vol 8 (2) ◽

pp. 109

Author(s):

Lucia Herminawati ◽

Andi Wijaya ◽

Mansyur Arief ◽

Suryani As'ad

Keyword(s):

Ischemic Stroke ◽

Tissue Injury ◽

Cross Sectional Study ◽

Stroke Onset ◽

C Reactive Protein ◽

Stroke Patients ◽

Cross Sectional ◽

Reactive Protein ◽

The Brain ◽

Sensitive Marker

BACKGROUND: Inflammation affects the brain after stroke with main functions to rapidly eliminate the source of the disturbance, remove damaged tissue and then restore tissue homeostasis. High sensitive C-reactive protein (hsCRP) is a sensitive marker of inflammation and tissue injury in the arterial wall, while fractalkine is a distinct chemokine that promotes inflammatory signaling after neuronal death on ischemic stroke. We aim to investigate the association of fractalkine with hsCRP as a marker of inflammation in ischemic stroke patients.METHODS: This study was designed as a cross-sectional study. Soon after patients with ischemic stroke admitted to hospital, plasma fractalkine and hsCRP concentrations were assesed. Subjects had to be at least 30 years old and maximum 30 days of stroke onset. High inflammation was defined as hsCRP value >3 mg/L.RESULTS: High fractalkine levels were found on 24 ischemic stroke patients (49%) and mean of fractalkine 0.719 ng/mL on patients with stroke onset <7 days was higher than patients with stroke onset 7-30 days. Low fractalkine levels (<0.527 ng/mL) were found on ischemic stroke patients with onset 7-30 days accompanied by high inflammation (hsCRP >3 mg/L), but no significant correlation between fractalkine and hsCRP (p=0.613).CONCLUSION: High inflammation and low plasma fractalkine profile was found after 7 days of onset in ischemic stroke patients. No significant correlation between fractalkine and hsCRP in ischemic stroke patients.KEYWORDS: CRP, fractalkine, inflammation, ischemic stroke

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Frequency of deep vein thrombosis at admission for acute stroke and associated factors: a cross-sectional study

Thrombosis Journal ◽

10.1186/s12959-021-00315-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Takahisa Mori ◽

Kazuhiro Yoshioka ◽

Yuhei Tanno

Keyword(s):

Acute Stroke ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional ◽

Vein Thrombosis ◽

Hs Crp ◽

Deep Vein ◽

D Dimer ◽

Significant Factors

Abstract Background Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission, IPC of the legs with DVT may cause migration of the thrombi, resulting in pulmonary emboli. Whole-leg ultrasonography (wl-US) is a practical tool to detect DVT; however, wl-US is not always performed at admission in all stroke patients. This retrospective cross-sectional study aimed to investigate DVT frequency and identify significant factors indicating the presence of DVT at admission for acute stroke. Methods We included patients admitted within 24 h of stroke onset between 2017 and 2019. Patients who did not undergo blood tests for D-dimer or wl-US within 72 h of arrival were excluded. We collected patient data on age; sex; anthropometric variables; presence of DVT on wl-US; and biomarkers such as D-dimer, high-sensitivity C-reactive protein (hs-CRP), and lipids. Results Of 1129 acute stroke patients, 917 met our inclusion criteria. DVT was detected in 161 patients (17.6 %). Patients with DVT were older; were more likely to be female; had lower body weight; had higher D-dimer and hs-CRP levels; had lower albumin, hemoglobin, and triglyceride levels; and had higher National Institutes of Health Stroke Scale and pre-stroke modified Rankin scale scores than patients without DVT (n = 756). In addition, multiple logistic regression analysis showed that sex (female) and D-dimer levels (≥ 1.52 µg/mL) were independent significant factors for the presence of DVT. Among 161 patients with DVT, 78 (48.4 %) had both these significant factors. Among 756 patients without DVT, 602 (79.6 %) had no or one significant factor. The odds ratio of the presence of DVT in patients with both significant factors was 6.29, using patients without any significant factors as the group for comparison. Conclusions The frequency of DVT is high in acute stroke patients at admission. Female sex and a high D-dimer level were independent significant factors for the presence of DVT. Therefore, in patients with these two significant factors at admission, IPC should be avoided or wl-US should be performed before IPC.

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Abstract 207: Signal Averaged Electrocardiogram can Indicate the Arrhythmogenic Potential of Right Insular Stroke

Stroke ◽

10.1161/str.47.suppl_1.207 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Hee-Kwon Park ◽

Cindy W Yoon ◽

Ji-Won Kwon ◽

Soo-Jeong Kim ◽

Eung-Seok Lee ◽

...

Keyword(s):

Acute Stroke ◽

Insular Cortex ◽

Wave Dispersion ◽

P Wave ◽

Stroke Patients ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

The Right

Backgrounds: The right insular cortical stroke is believed to have arrhythmogenic potential such as secondary atrial fibrillation (AF). The P wave-triggered signal-averaged electrocardiogram (SA-ECG) can reveal the P wave dispersion which is associated with the risk of AF in the future. However, there has been no relevant clinical study and we investigated the P wave dispersion after stroke involving right insula. Methods: We recruited acute stroke patients consecutively, who admitted from February 2012 to October 2013 and took routine work-up with SA-ECG. Patients who had AF on admission were excluded. SA-ECG was followed up two years after stroke onset. Significant P-wave dispersion was defined as ‘P-wave duration (PWD) >125ms for the predictor of future AF risk. We analyzed the difference of SA-ECG between the right insular cortex lesion and other stroke. Results: A total of 252 subjects were enrolled and 49 among them had right insular involvement. Follow up SA-ECG were available in 69 patients. In acute stroke period, the patients with right insular lesion had longer P wave duration than the other stroke patients (154.0+29.6 vs. 133.5+26.5 ms, p<0.001). In the patients with right insular involvement, prolonged P wave duration in acute period was shortened in follow up SA-ECG after two years (n=17, 164.5+35.2 vs. 131.7+22.3 ms, p=0.003). However, patients with other stroke lesion did not show such interval change. During observation period, AF occurred more frequently in the subjects with right insular lesion than other stroke patients (33% vs 17%, p=0.01). Conclusion: Our data suggest that the right insular lesion is associated with increased P wave dispersion transiently in acute stroke period and this might explain the development of secondary AF shortly after right insular cortex stroke.

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