Abstract WP190: Clinical Features of Sarcoid Patients With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ahmed Z Obeidat ◽  
Heidi Sucharew ◽  
Charles J Moomaw ◽  
Dawn O Kleindorfer ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Current Knowledge ◽  
Case Reports ◽  
Brain Mri ◽  
Sporadic Case ◽  
Prior History ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Stroke Event ◽  
History Of

Background: Current knowledge on ischemic stroke in sarcoid patients stems from sporadic case reports. The mechanism is thought to be related to granulomatous involvement of brain vasculature. However, clinical, demographic, and radiographic features of sarcoid patients with ischemic stroke are lacking. If sarcoid patients are at higher risk for ischemic stroke event, we hypothesized that the risk factors for ischemic stroke and stroke subtype distribution would differ between sarcoid and non-sarcoid ischemic stroke patients. Methods: Cases of ischemic stroke were identified for the years 2005 and 2010 from the population-based Greater Cincinnati/Northern Kentucky Stroke Study (population 1.3 million). Ischemic stroke cases were physician study confirmed and patients with a history of sarcoid were identified through medical chart review. Clinical variables were compared between stroke patients with history of sarcoid and those with no prior sarcoid history. Results: A total of 4258 cases of ischemic stroke were identified; of them, only 18 had prior diagnosis of sarcoid (0.04%). Brain MRI showed diffusion restriction in 14 out of 15 (93%) MRIs performed in sarcoid patients. The table presents risk factor and subtype data on sarcoid patients compared with non-sarcoid patients. Conclusions: We identified only a few cases of prior sarcoid history in our two-year ascertainment of ischemic stroke patients in our population. In comparison with stroke patients with no prior history of sarcoid, the sarcoid patients tended to be of younger age at presentation, female, have a history of diabetes and hyperlipidemia, and more likely of African descent, perhaps related to the diagnosis of sarcoid itself. We were unable to detect differences in stroke subtype distributions between sarcoid and non-sarcoid ischemic stroke patients.

Abstract WP226: Short Lasting Runs (<30 sec) of Atrial Fibrillation are More Commonly Observed in Ischemic Stroke Patients in Comparison to Controls

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ethem Murat Arsava ◽  
Ezgi Yetim ◽  
Ugur Canpolat ◽  
Necla Ozer ◽  
Kudret Aytemir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Multivariate Analyses ◽  
Holter Monitoring ◽  
Female Gender ◽  
Prior History ◽  
Consecutive Series ◽  
Stroke Patients ◽  
Cross Sectional ◽  
History Of

Background: The role of short-lasting (<30 sec) runs of atrial fibrillation (AF) in ischemic stroke pathophysiology is currently unknown. Although these non-sustained attacks are considered as a risk factor for future development of longer lasting, classical AF episodes, prior research has highlighted that associated clinical stroke features are not entirely similar between these two types of arrhythmias. In this study we determined the prevalence of short-lasting AF in stroke-free controls and compared it to a consecutive series of ischemic stroke patients. Methods: A total 235 controls, without any prior history stroke or AF, were evaluated with ECG and 24-hour Holter monitoring for the presence of <30-sec or ≥30-sec lasting AF episodes. The results were compared to a consecutive series of ischemic stroke patients without prior history of AF (n=456). Univariate and multivariate analyses were performed to determine demographic and cardiovascular factors related to <30-sec lasting AF and its association with ischemic stroke. Results: Expectedly, the frequency of newly diagnosed ≥30-sec lasting AF, detected either on ECG or Holter monitoring, was significantly higher in patients with ischemic stroke (18% vs. 2%; p<0.01). Non-sustained AF was positively related to old age (p<0.01), female gender (p=0.01) and hypertension (p<0.01) in univariate analyses. In multivariate analyses, after adjustment for demographic and cardiovascular risk factors, presence of non-sustained AF was significantly higher among both cryptogenic (OR 1.78; 95% CI 1.02-3.10) and non-cryptogenic (OR 1.84; 95% CI 1.15-2.94) stroke patients with respect to controls. Conclusion: Our study shows a higher prevalence of non-sustained AF episodes in ischemic stroke patients in comparison to controls. Whether this cross-sectional association translates into causality in terms of stroke pathophysiology will be the subject of future studies.

Abstract TMP14: Thrombolysis in Ischemic Stroke Patients with Prior History of Intracranial Hemorrhage

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Stacy Y Chu ◽  
Samuel Sommaruga ◽  
David Hwang ◽  
Jennifer Dearborn ◽  
Lauren Sansing ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Prior History ◽  
Stroke Patients ◽  
History Of

Hypercoagulable States and Stroke: A Selective Review

CNS Spectrums ◽  
2005 ◽  
Vol 10 (7) ◽  
pp. 567-578 ◽  
Author(s):  
Steven R. Levine
Keyword(s):  
Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Clinical Trial Data ◽  
Epidemiological Studies ◽  
Hypercoagulable State ◽  
Prior History ◽  
Clinical Approach ◽  
Stroke Patients ◽  
Increased Risk ◽  
History Of

AbstractBlood disorders have been implicated in ~5% to 10% of ischemic stroke, with an increased frequency in younger patients. Most disorders are associated with an increased thrombotic tendency and, therefore, an increased risk of ischemic stroke. Less commonly, a bleeding diathesis may predispose a patient to intracranial hemorrhage. While many conditions predisposing to thrombosis have been associated with stroke, there are relatively few prospective, epidemiological studies addressing hypercoagulable states and arterial stroke compared with the number of studies on the genetic thrombophilias, which are predominantly associated with venous thrombosis. When ordering tests of coagulation in stroke patients, one should keep in mind whether the results will influence therapy and/or patient outcome. It is generally not advocated to screen all stroke patients for a “hypercoagulable workup”. Typically, patients to be screened for coagulation defects will have a prior history of one or more unexplained thromboembolic events. The yield for diagnosing a hypercoagulable state is typically greatest for young stroke patients or those with a family history of thrombosis and who have no other explanations for their stroke (cryptogenic stroke). The yield in typically low in unselected ischemic stroke patients and older patients. Treatment of a first stroke with a documented hypercoagulable state is typically long-term or indefinite duration warfarin, although there is a paucity of clinical trial data supporting this clinical approach.

Abstract P654: Predicting Afib in Cryptogenic Ischemic Stroke Patients With Implantable Loop Recorders

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Claribel D Wee ◽  
Tejeswi Suryadevara ◽  
Husitha Vanguru ◽  
Rashid Ahmed ◽  
Danielle Hawley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Median Time ◽  
Scoring System ◽  
Cryptogenic Stroke ◽  
Stroke Patients ◽  
Stroke Event ◽  
Loop Recorder ◽  
Index Stroke ◽  
Chart Abstraction ◽  
History Of

Paroxysmal atrial fibrillation (Afib) detection in cryptogenic stroke is difficult but essential because it changes management. We describe a scoring system that discriminates between cryptogenic ischemic stroke patients with implantable loop recorder (ILR) that were and were not found to have Afib. Consecutive cryptogenic stroke cases from cardiology’s ILR registry for a 2-year period (7/2017-7/2019) were reviewed. We used standardized case report forms to perform chart abstraction. Cases were excluded if ILR was not placed after the index stroke event, stroke etiology workup was not available, or data was incomplete. Patients found to have Afib on ILR were compared to those without evidence of Afib on ILR. We devised a novel scoring system using variables associated with Afib detection and compared its ability to classify Afib detection against CHA2DS2-VASc and LADS. One hundred fifty-seven patients met inclusion criteria. Afib was detected in 12% of cases (9% at 6 months, 10% at 12 months). The median time from ILR placement to Afib detection was 110 days (IQR 37, 507). Median time from Afib detection to the start of anticoagulation was 3 days (IQR 0, 8). The PAL-CrISP score ranges 0 to 7: age (70=0, ≥70=4), history of antihypertensive medication (no=0, yes=2), PR interval (≤200msec=0, >200msec=1). Of those found to have Afib via ILR, 74% (14/19) had a PAL-CrISP score ≥ 6. PAL-CrISP performed better at predicting Afib detection in cryptogenic ischemic stroke patients with ILR (AUC 0.810, 95% CI 0.706-0.913) than CHA2DS2-VASc (AUC 0.650, 95% CI 0.525-0.774) and LADS (AUC 0.745, 95% CI 0.624-0.866). Using only age, home medication review, and an EKG, the novel PAL-CrISP score performs better at predicting Afib detection than the CHA2DS2-VASc and LADS scores in cryptogenic ischemic stroke patients with an ILR.

Abstract WP255: Can Normal Electrocardiogram Rule Out Newly Diagnosed Atrial Fibrillation in Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joshua Santucci ◽  
Takashi Shimoyama ◽  
Ken Uchino
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Large Artery ◽  
Newly Diagnosed ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
History Of

Introduction: Electrocardiogram (ECG) findings of premature atrial contraction and prolonged PR interval are associated with risk of onset atrial fibrillation (AF) in cryptogenic stroke. We sought to see if normal ECG and AF incidence is incompletely understood. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who had ECG done on admission for review. We excluded patients with AF on admission ECG, history of AF, and implanted device with cardiac monitoring capability. Normal ECG was interpreted based on the standardized reporting guidelines for ECG studies evaluating risk stratification of emergency department patients. Stroke subtype was diagnosed according to the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism, others/undetermined and embolic stoke of undetermined source (ESUS) criteria. We compared the incidence of newly diagnosed AF during hospitalization and from outpatient cardiac event monitoring between normal and abnormal ECG. Results: Of the 558 consecutive acute ischemic stroke patients, we excluded 135 with AF on admission ECG or history of AF and 9 with implanted devices. Of the remaining 414 patients that were included in the study, ESUS (31.2%) was the most frequent stroke subtype, followed by LAA (30.0%), SVO (14.0%), others/undetermined (15.7%), and cardioembolism (9.2%). Normal ECG was observed in 125 patients (30.2%). Cardioembolic subtype was less frequent in the normal versus abnormal ECG group (1.6% vs. 12.5%, p<0.001). New AF was detected in 17/414 patients (4.1%) during hospitalization. Of these 17 patients, none had normal ECG (0/125) and all had abnormal ECG (17/289, 5.9%) (p=0.002). After discharge, of 111 patients undergoing 4-week outpatient cardiac monitoring, new AF was detected in 16 (14.4%). Of these 16 patients, only 1 had a normal ECG (1/35, 2.9%) while 15 had abnormal ECG (15/76, 19.7%) (p=0.02). Conclusions: Normal ECG at admission for acute ischemic stroke is associated with low likelihood of detection of new atrial fibrillation in either the inpatient or outpatient setting.

Abstract TP222: Prevalence of Carotid Web in Patients With Cryptogenic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Anusha Boyanpally ◽  
Sleiman El Jamal ◽  
Michael Reznik ◽  
Tina Burton ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
A Priori ◽  
Cryptogenic Stroke ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Anterior Circulation ◽  
Web Based ◽  
Calcified Tissue ◽  
History Of ◽  
Stroke Mechanism

Introduction: Carotid web is a putative mechanism of cryptogenic ischemic stroke. We aimed to determine the prevalence of carotid web based on assigned stroke mechanism, and hypothesized that carotid webs would be found more frequently in younger cryptogenic stroke patients. Methods: We performed a single-center retrospective cohort study using institutional registry data from consecutive patients with confirmed anterior circulation ischemic stroke between July 2015-September 2017. We reviewed all available computed tomography angiogram (CTA) studies of the neck, and excluded patients who did not have a high-quality CTA of the neck performed. Carotid web was defined as a thin shelf of non-calcified tissue protruding into the lumen of the internal carotid artery immediately distal to the bifurcation, best visualized on sagittal oblique imaging and evident as a small septum on axial imaging. Stroke subtype was adjudicated a priori using validated methods, and we compared relevant risk factors in patients with cryptogenic stroke with and without carotid web. Results: We identified 882 patients with anterior circulation stroke who had a CTA neck available for review (49.3% male, 30% cryptogenic). A total of 7 patients (0.8%) were found to have carotid webs, of which 4 were ipsilateral to a patient’s stroke; all patients with ipsilateral carotid webs were adjudicated to have cryptogenic stroke. Patients with carotid web were younger than other patients in our cohort (age 49.0±14.6 vs. 72.2±14.9 years, p=0.003), and none of them had a history of hypertension (0% vs. 72%, p=0.04). In patients with cryptogenic stroke, overall prevalence of carotid webs was 1.5%, but the prevalence was significantly higher in younger cryptogenic stroke patients (age <60: 4.8%; age ≥60: 0.5%; p=0.01). Imaging findings that mimicked carotid webs, including non-calcified atherosclerosis and small protruding lesions, were prevalent in 8.3% of all patients. Discussion: Carotid web may represent an under-recognized occult mechanism of cryptogenic stroke, particularly amongst younger patients.

Abstract WP122: The Coexisting Leukoaraiosis In Ischemic Stroke Patients: How Does It Change Over Time?

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
A-hyun Cho ◽  
Seung-Jae Lee ◽  
Si Baek Lee ◽  
Soo-Jeong Han ◽  
Woojoon Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Brain Mri ◽  
Time Interval ◽  
Stroke Patients ◽  
Flair Image ◽  
Stroke Subtype ◽  
Vessel Disease ◽  
Over Time

Background: The prevalence of leukoaraiosis or white matter hyperintensities (WMH) is getting higher with the easy accessibility of brain imaging. Their clinical significance has not been known yet. Herein, we aimed to investigate how they progress or regress over time in patients with ischemic stroke. Methods: We consecutively enrolled ischemic stroke patients who underwent brain MRI (T2-weighted image or fluid-attenuated inverse recovery (FLAIR) image) more than twice with at least a 6 month time-interval. Patients with pathologic lesions which cannot be distinguished from WMH were excluded. Clinical variables (age, sex, risk factors, stroke subtypes, and imaging time) were obtained by reviewing medical records. T2-weighted image or FLAIR image was used to assess the presence of WMH. WMH was visually measured with use of modified Fazekas grading by an independent investigator. The change of WMH was interpreted as 1)no change, 2)progress, 3)regression, 4)distinctive progress and regression. The descriptive analysis of the pattern of WMH change over time and factors associated with each pattern were analyzed. Results: The total number of enrolled patients were 100. Their age (mean±SD) was 67.5±11.8 years and 63 were male. The most common stroke subtype was small vessel disease (SVD, 43%), followed by large vessel disease (LVD, 27%), and cardioembolism (9%). The imaging time-interval (mean±SD) was 28.0±16.6 months. In 64 patients, WMH was observed on brain MRI. Among them, the WMH pattern didn’t change in 25 patients, progressed in 28, regressed in 10 and progressed in distinctive region and regressed in others in 4 patients. Three patients had newly developed WMH on their follow-up MRI. 51.9% (14/27) of patients with LVD showed progress, whereas 30.2% (13/43) of SVD showed progress. Regarding regression, 16.3% (7/43) of patients with SVD, 11.1% (3/27) of LVD showed regression. The presence of LVD was significantly associated with WMH progression (14/27 vs. 18/73, p=0.015). The WMH changing pattern was not affected by risk factors. Conclusions: Over half of patients with stroke showed progress of WMH on their follow-up MRI. In addition, regression of WMH was also observed in 21.8% patients. Stroke subtype of LVD was associated with WMH progression.

Abstract 13201: Atrial Fibrillation Detection in Community Ischemic Stroke Patients is Improved With Implantable Cardiac Monitors

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jia Guo ◽  
James R Brorson ◽  
Andrew Beaser ◽  
Zaid A Aziz ◽  
Cevher Ozcan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Community Setting ◽  
Prior History ◽  
Stroke Patients ◽  
Logrank Test ◽  
Data Set ◽  
Kaplan Meier ◽  
History Of ◽  
Artery Disease

Introduction: Although implantable cardiac monitors (ICM) improve atrial fibrillation (AF) detection relative to Holters or other extended ambulatory cardiac monitors (EACMs) (e.g., 30-day event monitors or outpatient telemetry) in clinical trials, data are limited on their performance in the community setting. We investigated AF detection in ischemic stroke patients and subsequent initiation of oral anticoagulation (OAC) in a real-world setting. Methods: We identified patients with ischemic stroke (2010-2015) in IBM MarketScan, a national prospectively acquired data set in whom Holters, EACMs, or ICMs were ordered. We further selected patients with no prior history of AF or OAC and continuous database enrollment 6 mos pre- and 24 mos post monitoring. Propensity score matching (PSM) was used to adjust for baseline characteristics differences between monitoring types. Logrank test was used to compare the Kaplan-Meier (KM) curves for AF detection and OAC initiation in patients with AF. Results: A total of 6,287 patients were analyzed: 4,107 Holter (age 63±14 yrs, 46% female, 28% coronary artery disease [CAD], 71% hypertension [HTN]), 1,829 EACM (age 61±14 yrs, 49% female, 27% CAD, 73% HTN), and 351 implanted with ICM (age 63±13 yrs, 51% female, 38% CAD, 82% HTN). After 1:1 PSM, the Holter-ICM cohort comprised of 664 patients and the EACM-ICM cohort comprised of 676 patients. In the Holter-ICM pair, 2 yr AF diagnoses rate was 14.5% for Holter vs 38.3% for ICM (logrank p<0.01, Panel A). In the EACM-ICM pair, 2 yr AF diagnoses rate was 15.4% for EACM vs 38.2% for ICM (logrank p<0.01, Panel B). Initiation of OAC in AF patients by 2 yrs was 41.7% for Holters vs 49.6% for ICMs (logrank p=0.30, Panel C) and 61.5% for EACM vs 49.6% for ICM (logrank p=0.16, Panel D). Conclusion: In community patients with ischemic stroke with no history of AF or prior OAC, rates of OAC initiation are comparable between monitoring types when AF is detected, and ICM outperforms Holter and EACM for the detection of AF.

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 250-257 ◽  
Author(s):  
Jiann-Der Lee ◽  
Ya-Han Hu ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Ya-Wen Kuo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Prior History ◽  
Multivariate Logistic Regression ◽  
Cart Analysis ◽  
Younger Age ◽  
History Of ◽  
One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

scholarly journals Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

2020 ◽  
Vol 15 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Adnan I Qureshi ◽  
Foad Abd-Allah ◽  
Fahmi Al-Senani ◽  
Emrah Aytac ◽  
Afshin Borhani-Haghighi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Intravenous Thrombolysis ◽  
Adult Patients ◽  
World Health ◽  
Stroke Patients ◽  
International Panel ◽  
Health Organization ◽  
Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

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