Elevated levels of adiponectin associated with major adverse cardiovascular and cerebrovascular events and mortality risk in ischemic stroke

Cerebrovascular diseases are a problem of the world today, and according to the forecast, the problem of the near future arises. The main risk factors for the development of ischemic disorders of the cerebral circulation include oblique and aging, arterial hypertension, smoking, diabetes mellitus and heart disease. An effective strategy for the prevention of cerebrovascular events is based on the implementation of large-scale risk control measures, including the use of antiagregant and anticoagulant therapy, invasive interventions such as atheromectomy, angioplasty and stenting. In this connection, the efforts of neurologists, cardiologists, angiosurgery, endocrinologists and other specialists are the basis for achieving an acceptable clinical outcome. A review of the SF-36 method for assessing the quality of life in patients with the effects of transient ischemic stroke is presented. The assessment of quality of life is recognized in world medical practice and research, an indicator that is also used to assess the quality of the health system and in general sociological research.

Download Full-text

Abstract P75: Cerebrovascular Events and Outcomes in Hospitalized Patients With Covid-19: The Society of Vascular and Interventional Neurology Multinational Registry

Stroke ◽

10.1161/str.52.suppl_1.p75 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

James E Siegler ◽

Pere Portela ◽

Juan F Arenillas ◽

Alba Chavarria-Miranda ◽

Ana Guillen ◽

...

Keyword(s):

Ischemic Stroke ◽

Mortality Rate ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Cryptogenic Stroke ◽

Significant Risk ◽

Stroke Severity ◽

Cerebrovascular Event ◽

Cerebrovascular Events ◽

Observational Cohort

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in 4 countries (2/1/2020 - 06/16/2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) of whom were female and 96/172 (55.8%) were between the ages 60-79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130 - 280/100,000) and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p<0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p<0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p=0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98 p=0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19 associated cerebrovascular complications, therefore aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

Download Full-text

Patient-reported outcomes across cerebrovascular event types

Neurology ◽

10.1212/wnl.0000000000006626 ◽

2018 ◽

Vol 91 (23) ◽

pp. e2182-e2191 ◽

Cited By ~ 10

Author(s):

Irene L. Katzan ◽

Andrew Schuster ◽

Christopher Newey ◽

Ken Uchino ◽

Brittany Lapin

Keyword(s):

Ischemic Stroke ◽

Executive Function ◽

Physical Function ◽

Patient Reported Outcomes ◽

Social Roles ◽

Factors Associated ◽

Cerebrovascular Events ◽

Patient Reported ◽

Health Domains ◽

Domain Scores

ObjectivesTo compare the degrees to which 8 domains of health are affected across types of cerebrovascular events and to identify factors associated with domain scores in different event types.MethodsThis was an observational cohort study of 2,181 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or TIA in a cerebrovascular clinic from February 17, 2015, to June 2, 2017 who completed Quality of Life in Neurologic Disorders executive function and the following Patient-Reported Outcomes Measurement Information System scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance.ResultsAll health domains were affected to similar degrees in patients with ICH, SAH, and ischemic stroke after adjustment for disability and other clinical factors, whereas patients with TIA had worse adjusted scores for 5 of the 8 domains of health. Female sex, younger age, lower income, and event <90 days were associated with worse scores in multiple domains. Factors associated with health domain scores were similar for all cerebrovascular events. Most affected domains for all were physical function, satisfaction with social roles, and executive function.ConclusionsThe subtype of stroke (ischemic stroke, ICH, and SAH) had similar effects in multiple health domains, while patients with TIA had worse adjusted outcomes, suggesting that the mechanisms for outcomes after TIA may differ from those of other cerebrovascular events. The most affected domains across all event types were physical function, satisfaction with social roles, and executive function, highlighting the need to develop effective interventions to improve these health domains in survivors of these cerebrovascular events.

Download Full-text

Abstract P338: Cardiovascular And Cerebrovascular Events Associated With Cancer Surgery In The United States

Circulation ◽

10.1161/circ.141.suppl_1.p338 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Anshul Saxena ◽

Muni Rubens ◽

Venkataraghavan Ramamoorthy ◽

Sankalp Das ◽

Chintan B Bhatt ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Perioperative Period ◽

The United States ◽

National Database ◽

Perioperative Morbidity ◽

Cerebrovascular Events ◽

Colon And Rectum ◽

National Trends ◽

Over Time

Background: Major adverse cardiovascular and cerebrovascular events (MACCE) are significant causes of perioperative morbidity and mortality but, the incidence and effects following cancer surgeries are unknown. The aims of this study were to evaluate national trends in MACCE after major cancer surgeries and to identify cancer types associated with cardiovascular events using a large national database. Methods: Patients who had major cancer surgeries from 2005 to 2014 were identified from the National Inpatient Sample database. Hospitalizations for surgeries for cancer of prostate, bladder, esophagus, pancreas, lung, liver, breast, colon and rectum were identified by ICD9 diagnosis and procedure codes. The main outcome was perioperative MACCE, defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, and was evaluated over time. Results: Among 2,854,810 hospitalizations for major cancer surgeries, perioperative MACCE occurred in 67,316 hospitalizations (2.4%). Mean (SE) age of patients was 65.4 (0.07) years and 54.2% were male patients. MACCE occurred most frequently in patients undergoing surgeries for lung (6.8%), pancreatic (4.5%), and colorectal (3.3%) cancers. Between 2005 and 2014, the frequency of MACCE declined from 2.7% to 2.2% ( P <0.001) and was driven by a decline in the frequency of perioperative death ( P <0.001) and AMI ( P = 0.002). However, no significant changes were observed for acute ischemic stroke ( P = 0.6) during the study period. Conclusion: Perioperative MACCE occurs in 1 out of every 42 hospitalizations for major cancer surgeries. Despite reductions in the rate of death and AMI among patients undergoing major cardiac surgeries, perioperative ischemic stroke remained constant over time. The lack of improvements in perioperative ischemic stroke rate is concerning and requires additional interventions. Significant efforts should be directed towards improving cardiovascular care during the perioperative period of cancer surgeries.

Download Full-text

Acute ischemic stroke in adolescents

Neurology ◽

10.1212/wnl.0000000000008783 ◽

2019 ◽

Vol 94 (2) ◽

pp. e158-e169 ◽

Cited By ~ 1

Author(s):

Thomas Rambaud ◽

Nicolas Legris ◽

Yannick Bejot ◽

Céline Bellesme ◽

Bertrand Lapergue ◽

...

Keyword(s):

Ischemic Stroke ◽

Transition Period ◽

Cryptogenic Stroke ◽

Hemorrhagic Transformation ◽

National Database ◽

Limited Information ◽

Treatment Rate ◽

Anterior Circulation ◽

Cerebrovascular Events ◽

Male Patients

ObjectiveAdolescence represents a transition period between childhood and adulthood, and only limited information exists about stroke characteristics in this population. Our aim was to describe the clinical and neuroradiologic features, etiologies, initial management, and outcome of ischemic stroke in adolescents.MethodsThis retrospective cohort study evaluated all consecutive patients 10 to 18 years with a first-ever ischemic stroke hospitalized between 2007 and 2017 in 10 French academic centers representing a population of ≈10 million. Extracted data from the national database served as validation.ResultsA total of 60 patients were included (53% male, median age 15.2 years). Diagnosis at first medical contact was misevaluated in 36%, more frequently in posterior than anterior circulation strokes (55% vs 20% respectively, odds ratio 4.8, 95% confidence interval 1.41–16.40, p = 0.01). Recanalization treatment rate was high (n = 19, 32%): IV thrombolysis (17%), endovascular therapy (11.7%), or both IV and intra-arterial thrombolysis (3.3%); safety was good (only 1 asymptomatic hemorrhagic transformation). Despite thorough etiologic workup, 50% of strokes remained cryptogenic. The most common determined etiologies were cardioembolism (15%), vasculitis and autoimmune disorders (12%, occurring exclusively in female patients), and arterial dissections (10%, exclusively in male patients). Recurrent ischemic cerebrovascular events occurred in 12% (median follow-up 19 months). Recurrence rate was 50% in patients with identified vasculopathy but 0% after cryptogenic stroke. Functional outcome was favorable (Rankin Scale score 0–2 at day 90) in 80% of cases.ConclusionsIschemic strokes in adolescents harbor both pediatric and adult features, emphasizing the need for multidisciplinary collaboration in their management. Recanalization treatments appear feasible and safe.

Download Full-text

Association of Antiplatelet Therapy With Lower Risk of Death and Recurrent Cerebrovascular Events After Ischemic Stroke

Circulation Journal ◽

10.1253/circj.cj-09-0337 ◽

2009 ◽

Vol 73 (12) ◽

pp. 2342-2347 ◽

Cited By ~ 8

Author(s):

Ding Ding ◽

Chuan-Zhen Lu ◽

Jian-Hui Fu ◽

Zhen Hong ◽

The China Ischemic Stroke Registry

Keyword(s):

Ischemic Stroke ◽

Antiplatelet Therapy ◽

Lower Risk ◽

Risk Of Death ◽

Cerebrovascular Events

Download Full-text

ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging

Neurology ◽

10.1212/wnl.0000000000003814 ◽

2017 ◽

Vol 88 (15) ◽

pp. 1468-1477 ◽

Cited By ~ 69

Author(s):

Alexander Andrea Tarnutzer ◽

Seung-Han Lee ◽

Karen A. Robinson ◽

Zheyu Wang ◽

Jonathan A. Edlow ◽

...

Keyword(s):

Ischemic Stroke ◽

Diagnostic Accuracy ◽

Clinical Presentation ◽

False Negative ◽

False Negative Rate ◽

Diagnostic Errors ◽

Risk Of Bias ◽

Future Research ◽

Negative Rate ◽

Cerebrovascular Events

Objective:With the emergency department (ED) being a high-risk site for diagnostic errors, we sought to estimate ED diagnostic accuracy for identifying acute cerebrovascular events.Methods:MEDLINE and Embase were searched for studies (1995–2016) reporting ED diagnostic accuracy for ischemic stroke, TIA, or subarachnoid hemorrhage (SAH). Two independent reviewers determined inclusion. We identified 1,693 unique citations, examined 214 full articles, and analyzed 23 studies. Studies were rated on risk of bias (QUADAS-2). Diagnostic data were extracted. We prospectively defined clinical presentation subgroups to compare odds of misdiagnosis.Results:Included studies reported on 15,721 patients. Studies were at low risk of bias. Overall sensitivity (91.3% [95% confidence interval (CI) 90.7–92.0]) and specificity (92.7% [91.7–93.7]) for a cerebrovascular etiology was high, but there was significant variation based on clinical presentation. Misdiagnosis was more frequent among subgroups with milder (SAH with normal vs abnormal mental state; false-negative rate 23.8% vs 4.2%, odds ratio [OR] 7.03 [4.80–10.31]), nonspecific (dizziness vs motor findings; false-negative rate 39.4% vs 4.4%, OR 14.22 [9.76–20.74]), or transient (TIA vs ischemic stroke; false discovery rate 59.7% vs 11.7%, OR 11.21 [6.66–18.89]) symptoms.Conclusions:Roughly 9% of cerebrovascular events are missed at initial ED presentation. Risk of misdiagnosis is much greater when presenting neurologic complaints are mild, nonspecific, or transient (range 24%–60%). This difference suggests that many misdiagnoses relate to symptom-specific factors. Future research should emphasize studying causes and designing error-reduction strategies in symptom-specific subgroups at greatest risk of misdiagnosis.

Download Full-text

Transient mutism and cerebellar ischemic stroke: case report

Romanian Neurosurgery ◽

10.2478/romneu-2013-0011 ◽

2013 ◽

Vol 20 (3) ◽

pp. 275-280

Author(s):

Luis Rafael Moscote-Salazar ◽

Hernando Alvis-Miranda ◽

Angel Lee ◽

Hector Farid Escorcia ◽

Sandra Milena Castellar-Leones

Keyword(s):

Ischemic Stroke ◽

Case Report ◽

Rare Disease ◽

Posterior Fossa ◽

Cerebellar Infarction ◽

Posterior Fossa Surgery ◽

Cerebellar Hemorrhage ◽

Cerebrovascular Events ◽

Autopsy Series ◽

Cerebral Ischemic

Abstract The ischemic stroke is one of the most common conditions in our hospitals, representing 50% of revenues of neurology services. A variety of processes is cerebral ischemic myocardial cerebellum. Cerebellar infarction is not a rare disease, representing between 2 to 4% of all cerebrovascular events in clinical and autopsy series, and their ratio is 4-5 times higher than cerebellar hemorrhage. Although it is increasingly documented, it rarely Recognized stills like a phenomenon. Mutism occurs primarily in children and occasionally in adults as a well-recognized complication of posterior fossa surgery. Rarely been reported transient mutism associated with cerebellar infarction as isolated episode

Download Full-text

Cardiovascular and Hematological Risk Factors and Mortality Risk in Pediatric Arterial Ischemic Stroke: Analysis Report From Hospitals in the United States

Cureus ◽

10.7759/cureus.10859 ◽

2020 ◽

Author(s):

Nitya Beriwal ◽

Hira Imran ◽

Edmond Okotcha ◽

Kosisochukwu Oraka ◽

Saurabh Kataria ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Ischemic Stroke ◽

Mortality Risk ◽

The United States ◽

Arterial Ischemic Stroke

Download Full-text

Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis

Bioscience Reports ◽

10.1042/bsr20171178 ◽

2018 ◽

Vol 38 (2) ◽

Cited By ~ 8

Author(s):

Yu Fan ◽

Menglin Jiang ◽

Dandan Gong ◽

Changfeng Man ◽

Yuehua Chen

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mortality Risk ◽

Cardiac Troponin ◽

Prognostic Value ◽

Meta Analysis ◽

Stroke Patients ◽

Troponin Elevation ◽

Increased Risk ◽

All Cause Mortality

Cardiac troponins are specific biomarkers of cardiac injury. However, the prognostic usefulness of cardiac troponin in patients with acute ischemic stroke is still controversial. The objective of this meta-analysis was to investigate the association of cardiac troponin elevation with all-cause mortality in patients with acute ischemic stroke. PubMed and Embase databases were searched for relevant studies up to April 31, 2017. All observational studies reporting an association of baseline cardiac troponin-T (cTnT) or troponin-I (cTnI) elevation with all-cause mortality risk in patients with acute ischemic stroke were included. Pooled adjusted risk ratio (RR) and corresponding 95% confidence interval (CI) were obtained using a random effect model. Twelve studies involving 7905 acute ischemic stroke patients met our inclusion criteria. From the overall pooled analysis, patients with elevated cardiac troponin were significantly associated with increased risk of all-cause mortality (RR: 2.53; 95% CI: 1.83–3.50). The prognostic value of cardiac troponin elevation on all-cause mortality risk was stronger (RR: 3.54; 95% CI: 2.09–5.98) during in-hospital stay. Further stratified analysis showed elevated cTnT (RR: 2.36; 95% CI: 1.47–3.77) and cTnI (RR: 2.79; 95% CI: 1.68–4.64) level conferred the similar prognostic value of all-cause mortality. Acute ischemic stroke patients with elevated cTnT or cTnI at baseline independently predicted an increased risk of all-cause mortality. Determination of cardiac troponin on admission may aid in the early death risk stratification in these patients.

Download Full-text