Abstract T P75: Vertex Analysis Demonstrates Significant Changes in Contralesional Thalamus 3 Months After Ischemic Stroke

Objective: Changes in remote brain structures after stroke may correlate with functional outcomes. We sought to investigate contralesional subcortical structural change after stroke. Methods: 15 patients with carotid territory ischemic stroke underwent 3T MRI within 7 days of onset and at 3 months. Imaging involved a 1mm T1 axial MPRAGE. In 6 patients with left hemispheric stroke, scans were inverted across the midline to allow group comparison. FIRST (Part of FSL) was used to segment subcortical structures including thalamus, pallidum, caudate, putamen, hippocampus, accumbens and brainstem. Analysis was restricted to the non-stroke hemisphere due to the confounding effect of stroke lesions and edema in the lesional hemisphere. Change in volume was assessed as percentage change between the time points. A vertex analysis was performed in order to also identify areas of significant surface atrophy. Briefly, a surface mesh is created for each structure at each time point. Vertex wise statistical analysis then allows for the identifications of areas of significant surface atrophy between baseline and follow-up within the group. Results: Mean age was 71y. Median baseline NIHSS was 9. Vertex analysis demonstrated atrophy over the superior and inferior surface of the contralesional thalamus between baseline and 3 months (figure, p<0.05 multiple comparisons corrected). The median overall change in contralesional thalamic volume was -0.96% (IQR -0.11 - -1.98%), but this difference was not statistically significant (p=0.1). No statistically significant changes in other subcortical structures were found. Contralesional thalamus (blue) superior (A) and inferior (B) views with areas of significant atrophy (red) Conclusions: We have described post stroke surface changes in the contralesional thalamus. This may be a result of deafferentation occurring during the recovery phase. An analysis in a larger number of patients may allow correlation with clinical endpoints.

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The onset of dementia in patients with an acute ischemic stroke

European Psychiatry ◽

10.1016/s0924-9338(11)72191-5 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 484-484

Author(s):

C. Bacila

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cognitive Deficits ◽

De Novo ◽

Cognitive Disorder ◽

Number Of Patients ◽

Great Prevalence ◽

Dsm Iv ◽

Anxiety Depression

IntroductionStroke is a disorder that has great prevalence, defined vascular territories and psychiatric signs generally emerge in association with specific cognitive deficits.ObjectiveDementia occurs frecquently after acute ischemic stroke. The incidence of dementia six months after stroke is about 42%. Fortunately, in recent years, more attention has been paid to organic disorders provoked by strokes, especially to dementia.AimTo follow up the occuring dementia after stroke and also to follow the various psychiatric disorders with the onset during or after an acute ischemic stroke.MethodsAltogether 110 patients were recruited to this observational and non-interventional study, patients who were suffering from a psychiatric disorder after an ischemic stroke (according to DSM IV TR). The screening was followed by four visits during six months, when CGI, 17-HAMD, CROCQ and MMSE scales were used.ResultsOf 110 patients, 39,09% has been diagnosed with dementia. A number of these patients (n = 26) developed an onset like paroxistic disorder (60,46%), or an acute syndrom (20,93%) and 8 patients were considered “de novo” (with the onset of cognitive impairement after 60 days). There were various acute disorders occuring in the onset of dementia, that includes: amnestic syndrom, organic delirium, organic anxiety syndrom and a small number of patients (n=2) who developed mild cognitive disorder.ConclusionsThe literature considers vascular dementia occuring after an ischemic stroke and increasing step by step mnestic deficits; our study releaved a metamorphosis of various types of onset (anxiety, depression, delirium) or cognitive impairement could occurs after 30 days.

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Abstract WP497: Investigation of Cognitive Impairment in Ischemic Stroke Patients After Endovascular Treatment in Acute Phase and at 6 Months Follow-Up

Stroke ◽

10.1161/str.51.suppl_1.wp497 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Toru Nakagami ◽

Satoshi Suda ◽

Junya Aoki ◽

Takuya Kanamaru ◽

Kanako Muraga ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Cognitive Function ◽

Endovascular Treatment ◽

Acute Phase ◽

Cognitive Assessment ◽

Internal Carotid ◽

Stroke Patients ◽

Number Of Patients

Purpose and Objective: There have been limited reports that focused on cognitive impairment in acute ischemic stroke after endovascular treatment. The aim of this study, therefore, was to investigate cognitive function in patient after endovascular treatment in acute phase and at 6 months follow-up. Method: In this prospective study, from December 2016 to November 2018, the patients who were diagnosed as ischemic stroke with occlusion of the internal carotid artery and of the middle cerebral artery and treated with endovascular treatment were enrolled. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA-J) test within 5 days of onset and at 6 months follow-up. We defined cognitive impairment as a score of <24 in MoCA-J. Results: 150 patients were enrolled. MoCA-J was feasible in 69 patients (median 76 years; 49 female) (46%), in acute phase (Figure A). 63 patients (91%) had cognitive impairment and no significant differences were found in the naming and the abstraction domains between MoCA-J <24 group and ≧24 group. At 6 months follow-up, 48 patients (median 72 years; 12 female) were assessed with MoCA-J and 35 patients (73%) had cognitive impairment. However, only one patient scored less at 6 months follow-up than in acute phase (Figure B), which resulted in the significant increase in the median MoCA-J score (7 vs. 21, P<0.05) (Figure C) and in all the domains except for the language (P=0.078) (Figure D). Conclusion: In acute phase of ischemic stroke after endovascular treatment, MoCA-J was feasible in about 45%, in which 91% had cognitive impairment. However, at 6 months follow-up, the median MoCA-J score was significantly higher and less number of patients had cognitive impairment. The present results suggest that cognition recovers with time after endovascular treatment in ischemic stroke.

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P01-229-Emotional incontinence or bipolar disorder?about a case report

European Psychiatry ◽

10.1016/s0924-9338(11)71940-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 230-230

Author(s):

L. Mnif ◽

J. Masmoudi ◽

N. Charfi ◽

I. Baâti ◽

S. Kolsi ◽

...

Keyword(s):

Bipolar Disorder ◽

Ischemic Stroke ◽

Case Report ◽

Potential Risk ◽

Emotional Regulation ◽

Clinical Case ◽

Antidepressant Treatment ◽

Brain Structures ◽

Subcortical Structures ◽

Post Stroke

IntroductionPost-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible of emotional regulation.The objective of this work is to study the links between these disorders through a clinical case.Case reportIt was a 43 year old patient who consulted for an emotional incontinence appeared after an ischemic stroke with lenticulocapsular and right semioval center lesions.Treatment with antidepressant was marked by the appearance of hypomania.Discussion and conclusionThe appearance of a pharmacologically induced hypomania in this patient could suggest a link between emotional incontinence and bipolar disorder.Especially that periventricular areas and deep subcortical structures, involved in emotional regulation, are affected in these disorders.More attentiveness against antidepressant treatment is required, because of the potential risk of a pharmacological hypomania.

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U-Shaped Relationship Between Functional Outcome and Serum Uric Acid in Ischemic Stroke

Cellular Physiology and Biochemistry ◽

10.1159/000491609 ◽

2018 ◽

Vol 47 (6) ◽

pp. 2369-2379 ◽

Cited By ~ 4

Author(s):

Yimin Yang ◽

Ying Zhang ◽

Yanhua Li ◽

Lili Ding ◽

Lulu Sheng ◽

...

Keyword(s):

Uric Acid ◽

Ischemic Stroke ◽

Functional Outcome ◽

Serum Uric Acid ◽

High Performance ◽

Unfavorable Outcome ◽

Chinese Patients ◽

Number Of Patients ◽

Consecutive Number

Background/Aims: We sought to assess a consecutive number of patients with first-ever acute ischemic stroke (AIS), the clinical relevance in regard to functional outcome of the serum uric acid (SUA) measured at admission. Methods: In 2 prospective centers for observational study, serum concentrations of SUA were measured on admission in the serum of 710 consecutive patients with AIS. SUA concentrations were determined by high-performance liquid chromatography. SUA, NIH stroke scale (NIHSS), and conventional risk factors were evaluated to determine their value to predict functional outcome within 3 months. Results: During the follow-up, an unfavorable functional outcome (defined as a mRS score > 2) was found in 219 (30.8%) patients. The unfavorable functional outcome distribution across the SUA quartiles ranged between 12.4% (third quartile) and 50.6% (first quartile). After adjusting for all other significant outcome predictors, SUA concentration remained an independent unfavorable outcome predictor with an adjusted OR of 0.996 (95% CI, 0.993-0.998; P< 0.001). Conclusions: The data show that the U-shaped nature of the exposure-risk relationship was more prominent when the data were assessed in deciles (based on the SUA values). This model predicted the lowest relative risk of unfavorable outcome in the 67th percentile (corresponding to 309 µmol/L). SUA was significantly associated with the risk of poor functional outcomes in Chinese patients with stroke.

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Abstract WP326: Improving Follow-up Visits for Patients from the Stroke Service

Stroke ◽

10.1161/str.47.suppl_1.wp326 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kimberly P Gannon ◽

Scott Kasner

Keyword(s):

Ischemic Stroke ◽

Post Discharge ◽

Future Directions ◽

Stroke Service ◽

Appointment Attendance ◽

Clinic Appointment ◽

Number Of Patients ◽

Discharge Location ◽

Scheduling Tool

Background: Follow-up services after stroke may improve functional outcome and decrease readmissions. We aimed to improve discharge of patients from the stroke service by ensuring that they have a follow up appointment with Neurology scheduled at the time of discharge, to evaluate factors impacting appointment scheduling, and to evaluate factors impacting appointment attendance. Hypothesis: We hypothesized that access to an online scheduler would increase appointments scheduled at the time of discharge. Methods: This retrospective analysis included patients diagnosed with ischemic stroke, TIA, intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (1/2013 - 9/2014 time) discharged from the stroke service, but excluded patients who were deceased, transferred to another inpatient facility, clinical trial patients, and those with outside providers. The following metrics were collected from 975 patient discharges: diagnosis, date of hospitalization, length of hospitalization, discharge location, time from discharge to clinic appointment, if appointment was made at the time of discharge, and if the clinic appointment was attended. Results: Access to an online scheduling tool did not increase the number of patients who were discharged with an appointment (35% v. 41%; p=0.087). However, appointments were scheduled significantly more frequently for patients hospitalized for > 5 days, ICH and Ischemic stroke patients, and those discharged to a facility (Figure 1). Patients for whom an appointment was made prior to discharge did not follow up more frequently than those who were asked to call to make an appointment (45% v. 43%, p=0.64); however, follow up was influenced by length of stay, diagnosis, discharge location and time to appointment (Figure 2). Conclusion: Scheduling an appointment prior to discharge did not improve post-discharge follow-up. Future directions will work to elucidate the reason for poor clinic attendance and increase follow-up.

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First experience with intravenous thrombolysis in ischemic stroke in Serbia

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0712621j ◽

2007 ◽

Vol 135 (11-12) ◽

pp. 621-628 ◽

Cited By ~ 2

Author(s):

Dejana Jovanovic ◽

Ljiljana Beslac-Bumbasirevic ◽

Vladimir Kostic

Keyword(s):

Ischemic Stroke ◽

Median Time ◽

Symptom Onset ◽

Intravenous Thrombolysis ◽

Favourable Outcome ◽

Nihss Score ◽

Number Of Patients ◽

Systemic Thrombolytic Therapy ◽

Neurological Exam

Introduction Systemic thrombolytic therapy in the first three hours of acute ischemic stroke (IS) significantly improves its outcome. This therapy was approved for treatment in USA in 1997, and in most European countries in 2002. First intravenous thrombolysis of IS in Serbia was carried out in February 2006. Objective We present our preliminary experience with intravenous thrombolysis in treating patients with acute IS and compare it with the results of other clinical studies. Method All patients with IS treated with intravenous thrombolysis in our department were included in the study. The time of stroke onset, first neurological exam, time of CT exam and beginning of therapy were recorded. The early CT signs of ischemia were graded by the ASPECTS score. Neurological deficit was assessed with NIHSS score and functional outcome with modified Rankin Scale (mRS). Results During the eight-month period intravenous thrombolysis was given to 12 patients with acute IS, aged 18 to 66 years, of whom 75% were younger than 55 years. Median time from symptom onset to hospital door was 57.5 minutes, median time door-to-CT was 32.5 minutes, and the time from symptom onset to treatment was 155 minutes. Early CT signs of ischemia were present in 10 patients with median ASPECTS score 9. Median initial NIHSS score was 16.5 with its decline during the first 24 hours for at least 5 points in 58% of patients. Symptomatic intracerebral haemorrhage was present in one patient. After 30 days of follow-up 42% of patients had favourable outcome (mRS?1). In only 2 patients the outcome was poor (mRS 4-5). One patient died with signs of cardiac failure. Conclusion Despite a small number of patients with short time of follow up, these results with thrombolysis in acute IS were found to be consistent with other authors? reports. Uniqueness of our series of patients who received thrombolysis as compared to other studies was their very young age.

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Abstract NS5: Improvement of Follow-up Rate After Discharge of Acute Ischemic Stroke Patients by the Man-to-man Education for Stroke During Admission

Stroke ◽

10.1161/str.47.suppl_1.ns5 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Hee Sun Yu ◽

Na Young Yun ◽

Jong Wook Shin ◽

Hye Seon Jeong ◽

Sangeun Yoo ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Education Program ◽

Drug Information ◽

Warning Signs ◽

Stroke Patients ◽

Nutrition Behavior ◽

Number Of Patients ◽

Stroke Education

Background: We have executed a man-to-man stroke education program for acute ischemic stroke patients during admission since 2012. The contents of the man-to-man stroke education includes warning signs of stroke, guidance for prompt actions after symptom onset, drug information, and exercise and nutrition behavior after discharge. We evaluated whether the man-to-man education given during admission is effective to improve follow-up rates after discharge for acute ischemic stroke patients. Methods: We compared clinical data including modified Rankin Scale (mRS) at discharge and length of stay and follow-up data after discharge of 697 acute ischemic stroke patients (Male:Female=283:414, mean age±SD, 69.0±12.1 years) admitted in 2013, who received the man-to-man education during admission, with the data of 602 patients (M:F=254:348, 67.1±12.2 years) admitted in 2008, who did not receive the active education during admission. To evaluate follow-up rates, we first checked the follow-up status of all included patients within 1, 4, 8, 12, 16 months after discharge. Then, follow-up rates at each time point were calculated as the ratio of the number of patients followed at the point to the all patients discharged in 2008 or 2013. Differences of the follow-up rates between 2008 and 2013 were compared at individual follow-up time points using one-sided x2-test. Results: Even though the favorable outcome defined as 0-3 of mRS at discharge was similar between 2008 and 2013 (2008 vs. 2013, 88.3 vs. 87.4%, p=0.342), length of admission was significantly shorter in 2013 than 2008 (2008 vs. 2013, 10.2 vs. 6.6 days, p<0.001). On follow-up rates evaluations, follow-up at 1 month was significantly higher in 2013 (89.8%) than 2008 patients (83.7%) (p=0.001). The follow-up rates subsequently decreased at 4months (2008 vs. 2013, 77.3 vs. 81.5%, p=0.040), 8 months (70.1 vs. 74.3%, p=0.051), 12 months (63.1vs. 67.6%, p=0.052), and 16 months (57.6 vs. 63.0%, p=0.028). However, the follow-up rates of 2013 patients was consistently higher than 2008 ones. Conclusion: The present data suggested that active education program for acute ischemic stroke patients could improve to follow-up rates of the patients after discharge.

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Re-Increased Male Suicide Rates in the Recovery Phase Following the Great East Japan Earthquake

Crisis ◽

10.1027/0227-5910/a000656 ◽

2020 ◽

Vol 41 (6) ◽

pp. 422-428 ◽

Cited By ~ 1

Author(s):

Masatsugu Orui

Keyword(s):

Social Connectedness ◽

Recovery Phase ◽

Great East Japan Earthquake ◽

Temporary Housing ◽

Period Analysis ◽

Suicide Rates ◽

Male Suicide ◽

The Social ◽

The Difference

Abstract. Background: Monitoring of suicide rates in the recovery phase following a devastating disaster has been limited. Aim: We report on a 7-year follow-up of the suicide rates in the area affected by the Great East Japan Earthquake, which occurred in March 2011. Method: This descriptive study covered the period from March 2009 to February 2018. Period analysis was used to divide the 108-month study period into nine segments, in which suicide rates were compared with national averages using Poisson distribution. Results: Male suicide rates in the affected area from March 2013 to February 2014 increased to a level higher than the national average. After subsequently dropping, the male rates from March 2016 to February 2018 re-increased and showed a greater difference compared with the national averages. The difference became significant in the period from March 2017 to February 2018 ( p = .047). Limitations: Specific reasons for increasing the rates in the recovery phase were not determined. Conclusion: The termination of the provision of free temporary housing might be influential in this context. Provision of temporary housing was terminated from 2016, which increased economic hardship among needy evacuees. Furthermore, disruption of the social connectedness in the temporary housing may have had an influence. Our findings suggest the necessity of suicide rate monitoring even in the recovery phase.

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STRUCTURAL AND DYNAMIC FEATURES OF EAR-LY DISABILITY DUE TO MENTAL DISEASES

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2020-22-10-62-67 ◽

2020 ◽

pp. 62-67

Author(s):

Shmakova O.P.

Keyword(s):

People With Disabilities ◽

Child And Adolescent Psychiatry ◽

Child Psychiatrist ◽

Childhood And Adolescence ◽

Disabled Children ◽

Dynamic Features ◽

Factors Affecting ◽

Number Of Children ◽

Number Of Patients

Prevention of disability is one of the most significant tasks of child and adolescent psychiatry. Obtaining data on the dynamics of the number of people with disabilities and the factors affecting this indicator seems to be one of the relevant aspects. Aim: to trace the dynamics of the number of children with disabili-ties and to assess the change in the structure of early disability over the past decades. Materials and Meth-ods. A comparative analysis of two cohorts of patients was carried out: 1st - patients born in 1990-1992. (1203 patients (men - 914, 76%; women - 289, 24%)) who applied to the district neuropsychiatric dispensa-ry for outpatient care in childhood and adolescence; II - children and adolescents born in 2005 - 2018 (602 patients (male - 410, 68%; female - 192, 32%), ob-served at the time of the study by a child psychiatrist in the neuropsychiatric dispensary. Research methods: clinical and psychopathological; follow-up; statisti-cal. Results. Comparison of the number and nosologi-cal distribution of disabled children in two cohorts showed that over the 15th year there has been a shift towards an increase in the proportion of disabled children among patients observed by child and ado-lescent psychiatrists. The increase in the number of children with disabilities was due to those suffering from childhood autism and other disorders of general development. There were no statistically significant differences in the number of people with disabilities who received benefits before the age of 7, as well as differences in gender ratios among disabled people in the two cohorts. Conclusion. Early disability is a mul-tifactorial phenomenon, prevalence, dynamics, the structure of which depends not only on clinical, but also on socio-administrative realities. Children with autism require increased attention, since there has been a multiple increase in the number of patients with this diagnosis.

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Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.9.peds18242 ◽

2019 ◽

Vol 23 (3) ◽

pp. 363-368 ◽

Cited By ~ 1

Author(s):

Bing Zhou ◽

Xiao-Chuan Wang ◽

Jun-Yi Xiang ◽

Ming-Zhao Zhang ◽

Bo Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Balloon Dilation ◽

Stent Retriever ◽

National Institutes Of Health ◽

Clinical Prognosis ◽

Nihss Score ◽

Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

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