Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation

Prevalence and risk factors associated with memory disturbance and dementia were determined in acute ischemic stroke (AIS) patients in hospitals before discharge, three and six months after stroke. A prospective cohort study was conducted during January-December 2017 with 401 AIS patients admitted to Srinagarind Hospital, Khon Kaen Hospital and Chum Phae Hospital, Khon Kaen, Thailand. The demographics and clinical characteristics, previous illness and past medical history, and laboratory test results of the patients were collected from the medical records, while depression screening, NIH stroke scale (NIHSS) scoring and mini mental state examination (MMSE) were performed using particular medical record forms. The prevalence of memory disturbance and dementia was 56.6, 41.6 and 38.2% before discharge, three and six months after stroke, respectively. Based on logistic regression analysis, age, education and stroke severity were the risk factors associated with the studied disorders before discharge and three months after stroke. Meanwhile, age and education were the risk factors for six months after stroke. Our findings suggested that the prevalence of memory disturbance and dementia remained high at all study periods.

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Trends in the seeking of emergency service for ischemic stroke and its risk factors during the COVID-19 pandemic, a study from Taiwan

Neurology Asia ◽

10.54029/2021axy ◽

2021 ◽

Vol 26 (3) ◽

pp. 441-447

Author(s):

Yi Te Tsai ◽

Yachung Jeng ◽

Hsiu-Hsi Chen ◽

Kai-Chieh Chang

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Emergency Services ◽

Stroke Care ◽

University Hospital ◽

Minor Stroke ◽

Stroke Severity ◽

Health Seeking ◽

Stroke Patients ◽

Ich Score

Background & Objectives: COVID-19 may influence the health seeking behavior of acute ischemic stroke patients. This study aimed to determine the characteristics of the patients who visited the emergency room in a centre designated for stroke care in Taiwan. Methods: This was a retrospective database-based study comparing the severity of ischemic stroke, intracerebral hemorrhage (ICH), and risk factors of patients seen between 2019 and 2020 in the National Taiwan University Hospital Yunlin Branch. Patients with or without thrombolysis therapy were analysed. Results: The median NIHSS of ischemic stroke patients were lower in 2019 than in 2020 (p = 0.015). The difference was seen in non-thrombolysis patients (2019: 3[1-6] vs. 4 [2-7.5], p = 0.012) but not in thrombolysis patients. The frequency of minor stroke was higher in 2019 (45.1%) than in 2020 (37.9%, p = 0.038). The discharge mRS was lower overall (p = 0.004) and in non-thrombolysis patients (0.003), but not in thrombolysis patients in 2019. As for the ICH patients, the severity of ICH score (p = 0.021) and discharge mRS (p = 0.001) were also lower in 2019. The frequencies of risk factors of stroke were higher in 2019 than in 2020, including smoking (24% vs. 18.2%, p = 0.046), alcohol (11.9% vs. 7.5%, p = 0.039), hypertension (72.9% vs. 66.2%, p = 0.039), history of stroke (16.5% vs. 11.6%, p = 0.047), and atrial fibrillation (11.9% vs. 7.5%, p = 0.039). Conclusions: This study in Taiwan revealed a decline in the willingness to seek emergency services under the influence of COVID-19 among patients with lower stroke severity, especially those with more risk factors.

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Another Look at Obesity Paradox in Acute Ischemic Stroke: Association Rule Mining

Journal of Personalized Medicine ◽

10.3390/jpm12010016 ◽

2021 ◽

Vol 12 (1) ◽

pp. 16

Author(s):

Pum-Jun Kim ◽

Chulho Kim ◽

Sang-Hwa Lee ◽

Jong-Hee Shon ◽

Youngsuk Kwon ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Beneficial Effect ◽

Acute Ischemic Stroke ◽

Association Rule ◽

Association Rule Mining ◽

Obesity Paradox ◽

Stroke Severity ◽

Obese Patients ◽

Rule Mining

Though obesity is generally associated with the development of cardiovascular disease (CVD) risk factors, previous reports have also reported that obesity has a beneficial effect on CVD outcomes. We aimed to verify the existing obesity paradox through binary logistic regression (BLR) and clarify the paradox via association rule mining (ARM). Patients with acute ischemic stroke (AIS) were assessed for their 3-month functional outcome using the modified Rankin Scale (mRS) score. Predictors for poor outcome (mRS 3–6) were analyzed through BLR, and ARM was performed to find out which combination of risk factors was concurrently associated with good outcomes using maximal support, confidence, and lift values. Among 2580 patients with AIS, being obese (OR [odds ratio], 0.78; 95% CI, 0.62–0.99) had beneficial effects on the outcome at 3 months in BLR analysis. In addition, the ARM algorithm showed obese patients with good outcomes were also associated with an age less than 55 years and mild stroke severity. While BLR analysis showed a beneficial effect of obesity on stroke outcome, in ARM analysis, obese patients had a relatively good combination of risk factor profiles compared to normal BMI patients. These results may partially explain the obesity paradox phenomenon in AIS patients.

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The Role of Prestroke Glycemic Control on Severity and Outcome of Acute Ischemic Stroke

Stroke Research and Treatment ◽

10.1155/2014/694569 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Clara Hjalmarsson ◽

Karin Manhem ◽

Lena Bokemark ◽

Björn Andersson

Keyword(s):

Ischemic Stroke ◽

Glycemic Control ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

University Hospital ◽

Stroke Severity ◽

Term Survival ◽

Long Term Mortality

Background/Aim. Relatively few studies have investigated the association of prestroke glycemic control and clinical outcome in acute ischemic stroke (IS) patients, regardless of presence of diabetes mellitus (DM). The aim of this study was to investigate the importance of prestroke glycemic control on survival, stroke severity, and functional outcome of patients with acute IS.Methods. We performed a retrospective survival analysis of 501 patients with IS admitted to Sahlgrenska University Hospital from February 15, 2005, through May 31, 2009. The outcomes of interest were acute and long-term survival; the stroke severity (NIHSS) and the functional outcome, mRS, at 12 months.Results. HbA1c was a good predictor of acute (HR 1.45; CI, 1.09 to 1.93,P=0.011) and long-term mortality (HR 1.29; CI 1.03 to 1.62;P=0.029). Furthermore, HbA1c >6% was significantly correlated with acute stroke severity (OR 1.29; CI 1.01 to 1.67;P=0.042) and predicted worse functional outcome at 12 months (OR 2.68; CI 1.14 to 6.03;P=0.024).Conclusions. Our study suggests that poor glycemic control (baseline HbA1c) prior to IS is an independent risk factor for poor survival and a marker for increased stroke severity and unfavorable long-term functional outcome.

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Thrombectomy in acute ischemic stroke: estimations of increasing demands

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012575 ◽

2016 ◽

Vol 9 (9) ◽

pp. 830-833 ◽

Cited By ~ 7

Author(s):

Åsa Kuntze Söderqvist ◽

Tommy Andersson ◽

Niaz Ahmed ◽

Nils Wahlgren ◽

Magnus Kaijser

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Artery Occlusion ◽

University Hospital ◽

Stroke Severity ◽

Large Artery ◽

Anterior Circulation ◽

Stroke Treatment ◽

Stroke Registry ◽

New Treatment

BackgroundNew recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy.MethodsThe new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007. Using our local thrombectomy data (2009–2011), we calculated the proportion of thrombectomies performed at our hospital by level of stroke severity according to the National Institutes of Health Stroke Scale score (0–5, 6–11, 12–19, and 20–35). We then estimated the total number of potential thrombectomies expected in Sweden by extrapolating our treatment proportions to the rest of Sweden through the use of data from the Swedish National Stroke Registry.ResultsThe number of potential thrombectomies would have been more than five times higher (1268 estimated compared with 232 actually reported in the National Stroke Registry) if the new recommendations for thrombectomy in acute ischemic stroke had been implemented in 2013 (the year from which we had the most recent available data from the Swedish Stroke Registry).ConclusionsWhen the new recommendations are implemented broadly, there may be a substantial increase in demand for thrombectomies. Our study highlights the need for policymakers and healthcare professionals to prepare for the increasing demands for advanced endovascular stroke treatment.

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Neutrophil to lymphocyte ratio, stroke severity and short term clinical outcomes in acute ischemic stroke

Neurology Asia ◽

10.54029/2021cmz ◽

2021 ◽

Vol 26 (3) ◽

pp. 479-484

Author(s):

Ilkin Iyigundogdu ◽

Eda Derle ◽

Seda Kibaroglu ◽

Ufuk Can

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Neutrophil To Lymphocyte Ratio ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Short Term ◽

Lymphocyte Ratio ◽

Potential Indicator

Background: Neutrophil to lymphocyte ratio is an easily evaluated systemic inflammation indicator. However, there are limited reports on neutrophil to lymphocyte ratio and functional outcome in ischemic stroke. In this study, we aimed to evaluate the association of neutrophil to lymphocyte ratio and stroke severity, short term functional outcomes and mortality in patients with acute ischemic stroke. Methods: The clinical data of patients who were > 18 age-old and hospitalized with acute ischemic stroke in Baskent University Hospital, Ankara, Turkey between January 2018 and May 2019 were studied retrospectively. Neutrophil to lymphocyte ratio were measured. The neutrophil to lymphocyte ratio and National Institute of Health Stroke Scale (NIHSS) score at admission, mortality during hospitalization and Modified Rankin Scale (mRS) score at discharge of the patients with acute ischemic stroke were correlated. Results: Among the acute ischemic stroke patients due to the exclusion criteria, the data of 134 patients were evaluated. Median age of the patients were 76± 12.5 years and 82 patients (61.2%) were male. The median NIHSS scores of the patients at admission was 5±4.5. Mortality during the hospitalization was seen in 8 patients (6%). The median neutrophil to lymphocyte ratio value of the patients at admission were found to be 2.6±3.4. Neutrophil to lymphocyte ratio and NIHSS scores of the patients at admission, duration of the hospitalization, mRS scores at discharge and mortality during hospitalization were found to be positively correlated. Conclusion: Neutrophil to lymphocyte ratio is a simple and easily measured marker and can be used as a potential indicator for prognosis in acute ischemic stroke. However further prospective multicenter investigations are required to confirm the role of neutrophil to lymphocyte ratio for predicting the prognosis in acute ischemic stroke patients.

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Abstract P593: Association Between Troponin and Ischemic Stroke Recurrence in the Greater Cincinnati/Northern Kentucky Stroke Study

Stroke ◽

10.1161/str.52.suppl_1.p593 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Alexander E Merkler ◽

Heidi Sucharew ◽

Kathleen S Alwell ◽

Mary Haverbusch ◽

Florence Rothenberg ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Proportional Hazards Model ◽

Vascular Risk Factors ◽

Cox Proportional Hazards Model ◽

Stroke Recurrence ◽

Stroke Severity ◽

Vascular Risk ◽

Acute Mi

Introduction: Elevations in troponin (cTn) are common in patients with acute ischemic stroke, yet their significance remains uncertain. Hypothesis: Elevated cTn at the time of acute ischemic stroke is associated with ischemic stroke recurrence. Methods: We included all adult patients with acute ischemic stroke who were residents of the Greater Cincinnati/Northern Kentucky region and who presented to an emergency department (ED) in 2015 and who had a cTn measured within 24 hours of ED arrival. Our exposure variable was an elevated cTn, defined as a value exceeding the laboratory’s 99 th percentile. Our primary outcome was ischemic stroke recurrence, defined as a new ischemic stroke with radiographic confirmation in the 3 years following the index ischemic stroke event. Cox proportional hazards model was used to evaluate the association between elevated cTn and ischemic stroke recurrence while adjusting for demographics, vascular risk factors, and stroke severity. In a secondary analysis, we excluded patients with a concomitant adjudicated myocardial infarction (MI) at the time of the index ischemic stroke. Results: Among 2,334 patients with acute ischemic stroke, 1,992 (85%) had a cTn assay within 24 hours of ED arrival and were included in the analysis. 402 (20%) patients had an elevated cTn and 259 (13%) patients had a recurrent ischemic stroke. 66 (3%) patients had an elevated cTn and a concomitant acute MI and 336 (17%) patients had an elevated cTn without a concomitant acute MI. After adjustment for demographics, vascular risk factors, and stroke severity, we found an association between elevated cTn and recurrent ischemic stroke (hazards ratio [HR], 1.5; 95% CI, 1.1-2.0). Our results were unchanged after excluding patients with a concomitant adjudicated MI (HR 1.4; 95% CI, 1.03-2.0). Conclusions: Among patients with acute ischemic stroke, elevated cTn even in the absence of concomitant adjudicated MI, was associated with ischemic stroke recurrence. Further mechanistic studies are necessary to explore the underlying etiology of hypertroponinemia among patients with acute ischemic stroke in order to guide targeted therapies to reduce stroke recurrence.

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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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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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Sex Differences in Patients with Acute Ischemic Stroke in Tuzla Region, Bosnia and Herzegovina

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2010.2705 ◽

2010 ◽

Vol 10 (2) ◽

pp. 116-120 ◽

Cited By ~ 2

Author(s):

Denisa Salihović ◽

Dževdet Smajlović ◽

Osman Sinanović ◽

Biljana Kojić

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Sex Differences ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Bosnia And Herzegovina ◽

Heart Diseases ◽

Favourable Outcome ◽

Stroke Severity

Although many aspects of stroke are similar at both sexes, however, there are some differences and characteristics as well. The aim of this study was to analyze sex differences in patients with acute ischemic stroke (IS) regarding to risk factors, subtypes, stroke severity and outcome.From January 1st 2001 to December 31st 2005 at the Department of Neurology Tuzla 2833 patients were admitted with acute ischemic stroke (IS). We were analyzed risk factors, subtypes, stroke severity (Scandinavian Stroke Scale), and thirty-day outcome.There were 1484 (52,3%) female, and they were older than male (67,8 ±10,6 vs. 65,7 ± 10,5, p<0,0001). Hypertension (78% vs. 67%, p<0,0001), heart diseases (50% vs. 45%, p=0,009), atrial fibrillation (22% vs. 14%, p<0,0001) and diabetes mellitus (33% vs. 21%, p<0,0001) were frequently in female, while smoking (45% vs. 14%) and alcohol overuse (18% vs. 0,6%) in male (p<0,0001). Atherothrombotic type of ischemic stroke was frequently in male (37,4% vs. 31,6%, p=0,0013) and cardioembolic in female (21,7% vs. 15,5%, p<0,0001). At admission female had lower SS (SS 31,0±15 vs. 34,0± 15, p<0,0001). Thirty-day mortality was significantly higher in female (23,3% vs. 18,4%, p=0,0015), and favourable outcome within one month (Rankin Scale < 2) had 58% male and 51% female (p=0,001).The frequency of ischemic stroke is higher in female who are older than male. There are some sex differences according to the distribution of risk factors and subtypes of ischemic stroke. Stroke severity at admission, thirty-day mortality, and disability are higher in female.

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