scholarly journals Post-stroke dementia: frequency, predictors, and health impact

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Bastawy Al Fawal ◽  
Ahmed Ibrahim ◽  
Mohamed Abd Elhamed
Keyword(s):  
Risk Factors ◽  
Recurrent Stroke ◽  
Demographic Data ◽  
Health Impact ◽  
Stroke Severity ◽  
Post Stroke ◽  
Abnormal Gait ◽  
Psychotic Features ◽  
Demographic Data Collection

Abstract Background Cognitive impairment is an important aspect for stroke survivors. Little data are available about the frequency and risk factors of post-stroke dementia in Egypt. Objectives The aim of this study is to evaluate the frequency and predictors of post-stroke dementia and its impact on outcome. Methods A total of 380 patients with acute stroke were included. Patients were subjected to demographic data collection, neurological examination, and assessment of vascular risk factors. Furthermore, assessment of stroke severity by Barthel Index was done. After 6 months, patients were assessed for outcome and development of post-stroke dementia. Results Post-stroke dementia was detected in 20.8% of patient. It was recorded more in old ages, illiterates, unmarried, unemployed, and those with recurrent stroke and with cerebral infarction (significantly with cardio-embolic). Conclusion Post-stroke dementia is high in Egypt, especially in those with illiteracy, atrial fibrillation, brain atrophy, severe strokes, and those presented with hemiplegia, sphincter affection, abnormal gait, and psychotic features. Assessment for post-stroke dementia should be done during follow up of stroke patients.

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

2021 ◽  
pp. 000348942110155
Author(s):  
Leonard Haller ◽  
Khush Mehul Kharidia ◽  
Caitlin Bertelsen ◽  
Jeffrey Wang ◽  
Karla O’Dell
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Assessment Tool ◽  
Demographic Data ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Long Term Follow Up

Objective: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). Methods: About 56 patients who underwent ACDF between May 2017 to February 2019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks—3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. Results: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 ( P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. Conclusion: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia.

Abstract W P21: Should We Perform Thrombectomy In Patients With Wake-up Strokes? A Case Series Using Ct Perfusion For Patient Selection

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Gabriel Vidal ◽  
James Milburn ◽  
Garrett Bennett ◽  
Vivek Sabharwal ◽  
Mustafa Al Hasan
Keyword(s):  
Risk Factors ◽  
Ct Perfusion ◽  
Medical Center ◽  
Case Series ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Single Center Experience ◽  
Aspiration Technique ◽  
Group 2

Background and objectives: Approximately 25% of patients who present with acute ischemic stroke are wake-up strokes. These patients are often not treated with IV thrombolytics because of unclear onset of symptoms. Little data exists on endovascular therapy as acute treatment for this population, particularly with an aspiration technique. The objective of this study is to compare outcomes of patients who presented with wake-up strokes due to large vessel occlusion treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012-2013), single center experience at Ochsner Medical Center in New Orleans, LA. Method: 24 consecutive patients, who presented with wake-up strokes, were outside the IV tPA window, and had both CTA confirmed intracranial LVO and CT-perfusion data upon arrival to our institution were retrospectively studied. Patients with hemorrhages, tandem lesions, or high-grade carotid stenosis were excluded from this analysis. Decision to perform endovascular treatment was made by the vascular neurologist and neuro-interventionalist based on stroke severity and CTA/perfusion data. Patients in group 1 (n = 8) underwent endovascular revascularization procedures; patients in group 2 (n = 16) were treated conservatively (medical management alone). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were compared. Results: There were no statistical differences in patient population regarding age, gender, and risk factors. There was no statistical difference in their initial NIHSS (16.8 vs. 21.8, p=0.05162), or mortality (0% vs 21%, pr=0.262). The two groups were statistically different in their discharge NIHSS (7.25 vs 21.81, p<0.00045), discharge mRS (2 vs 5, p<0.00001), clinic follow up mRS (1.37 vs 4.94, p<0.00001), and good outcome at discharge (mRS 0-2)(75% vs 0%, pr<0.0002). Conclusion: Patients with wake-up strokes, LVO, and favorable CT-perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes in our population, despite similar stroke severity at presentation. This suggests that with careful selection, neuroendovascular therapy for wake-up strokes may lead to improved outcomes.

Abstract T P42: Patients With a Clinical Diagnosis of Non-disabling Stroke, and a Normal MRI are Clinically Indistinguishable From Patients With a MRI Lesion at 1 Year Post Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Stephen Makin ◽  
Martin Dennis ◽  
Joanna M Wardlaw
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Expert Panel ◽  
Recurrent Stroke ◽  
Final Diagnosis ◽  
Cognitively Impaired ◽  
Post Stroke ◽  
Mild Stroke ◽  
One Year

Background: Up to one third of patients with a clinically apparent mild stroke and no other apparent cause of their symptoms have a normal MRI. We examined disability, recurrent stroke, and cognitive impairment at one year compared to patient with an MRI-DWI lesion. Methods: We recruited consecutive patients with a non-disabling ischaemic stroke, and performed clinical assessment and MRI (with DWI) . An expert panel reviewed all cases, we included patients with a final diagnosis of stroke and excluded patients with another diagnosis. At one year post stroke we recorded modified Rankin scale (mRs), stroke and TIA recurrence, Addenbrookes Cognitive Assessment Revised (ACE-R) and the Beck Depression index (BDI) and performed another MRI. Non-attenders were assessed by telephone or post. We defined cognitive impairment as ACE-R of <88, and depression as a BDI of >9. Results: Almost one third (75/264) (median NIHSS=2) of patients had a no relevant lesion on MRI DWI. There was no difference in age, sex, symptoms, or risk factors in patients with and without a lesion, 197 had MRI at 1 year (all had clinical follow-up). Of 75 with no lesion, 41% were mRs ≥2, 13% had recurrent stroke or TIA, 36% were cognitively impaired and 46% had depression. This was not significantly different from the patients with a lesion. Of the 197 who had a follow-up MRI 50 patients with no initial lesion had follow-up MRI and one had a new lesion, (versus 20/147 patients with a lesion) (p=0.016). Conclusions: Patients with a clinical stroke and no other obvious cause for their symptoms are clinically indistinguishable from patients with the same NIHSS who have a lesion on DWI-MRI, in terms of recurrence, disability, or cognitive impairment. Suggesting that these patients have had a stroke that does not appear on MRI. The presence of an initial lesion increases the liklihood of a lesion on 1 year MRI, however without a difference in clinical stroke this is of doubtful significance.

scholarly journals P.1.37 A study of the incidence rate and risk factors of metabolic syndrome among workers of different job categories in taiwan

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A86.3-A87
Author(s):  
Chen-Chang Yang ◽  
Hsin-Chien Wu
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Incidence Rate ◽  
Demographic Data ◽  
Blood Cholesterol ◽  
Health Examination ◽  
Transportation Industry ◽  
The Us ◽  
Job Category

BackgroundIn Taiwan, the prevalence of metabolic syndrome among people over the age of 20 years is as high as 19.7%. With the increase in age, the prevalence of metabolic syndrome is even higher, with the prevalence being more than 30 years among those aged 45–65 years. Notably, very limited follow-up studies have examined the incidence and risk factors of metabolic syndrome among workers of different job categories in Taiwan.MethodsWe conducted a retrospective follow-up study that included 6,284 Taiwanese subjects who had been working in the same job category for 5 years and who received periodic health checkups at a regional hospital from 2006 to 2017 to better understand the incidence rate and risk factors of metabolic syndrome in Taiwan. All participants’ demographic data and health examination data were then analyzed. Metabolic syndrome was diagnosed according to the criteria proposd by the US National Cholesterol Education Program (NCEP) Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III).ResultsAfter an average follow-up of 6.0 years, the incidence rate of metabolic syndrome among workers who had been working in the same job category for five years was 32.42 per 1000 person-years. Moreover, the largest number of cases with metabolic syndrome appeared in the transportation industry.ConclusionThe results of this study should help the employers of various industries to better plan health education and monitoring programs of their employees to ameliorate the incidence of metabolic syndrome.

scholarly journals Sex differences in risk factors, treatment, and prognosis in acute stroke

2020 ◽  
Vol 16 ◽  
pp. 174550652095203
Author(s):  
Solveig Dahl ◽  
Clara Hjalmarsson ◽  
Björn Andersson
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Independent Living ◽  
University Hospital ◽  
Stroke Severity ◽  
Stroke Registry ◽  
Study Population

Objectives: Stroke is a major cause of long-term disability and death worldwide. Several studies have shown that women in general have more severe symptoms at arrival to hospital and are less likely to return home and independent living. Our aim with the present study was to update previous results concerning sex differences in baseline characteristics, stroke management, and outcome in a population study from Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: This study included patients with acute ischemic and hemorrhagic stroke in 2014 at Sahlgrenska University Hospital. All data were collected from The Swedish National Stroke Registry (Riksstroke). Results: The study population consisted of 1453 patients, with 46.7% females. Women were 5 years older than men. There was no sex difference in acute stroke severity. Frequency of revascularization was equal between men and women. The stroke mortality rate was the same between the sexes. At 3-months follow-up, women had a worse functional outcome and a higher frequency of depression and post-stroke fatigue. Conclusion: Our results show that there are no sex differences in management of acute stroke. However, the cause of worse functional outcome in women at 3-months follow-up, independent of other risk factors, is not clear and warrants further investigations.

PERFIL EPIDEMIOLÓGICO Y FACTORES DE RIESGO DE MORTALIDAD EN ADULTOS CON COVID-19: ESTUDIO RETROSPECTIVO.

2020 ◽  
Vol 31 (1) ◽  
Author(s):  
Dayami Martínez Sosa ◽  
Oswaldo Vásconez Hatt ◽  
Katherine Rosero Arboleda ◽  
Fabian Zurita Alvarado ◽  
Mónica Hernández Lojano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Course ◽  
Demographic Data ◽  
Severity Of Illness ◽  
Factors Associated ◽  
Related Risk ◽  
Factores De Riesgo ◽  
New Type ◽  
Epidemiological Characteristics

By the ending of 2019 a new type of coronavirus was identified named SARS-CoV 2, and now known to be the etiological agent of the acute respiratory syndrome coronavirus (SARS-CoV-2). Known as coronavirus 2019 disease or (COVID-19) constitutes a challenge for the world in many unknown aspects and problems in public health. In Ecuador the first reported of a confirmed appeared on February 29 2020, and in March 12 an emergency health status is declared. Objective: To determine the epidemiological characteristics and factors related to death and survival in patients with COVID-19. Design: The study is of transversal retrospective design, the patients chosen were those seen in the respiratory or suspicious of COVID-19 area of Hospital Vozandes Quito between March 2 and April 30. Demographic data and related risk factors for mortality were obtained using the EPI-1 individual form, epidemiological research files, the VI Epi system and electronic promptuary of patients. Results: 250 patients were obtained for this study, 87 of those were confirmed COVID-19, out those eight died and 79 were alive at the ending of the follow up. Regarding the severity of illness, 61% of the patients were classified as mild and 6 % critical (p =<0.001). Elevated values of CRP (OR 1 IC 95% 1.000 – 1.024), age about 55 years old to diagnosis (OR 42,040 IC 95% 36,320 – 47,760) and the presence of hiporexia (OR 24 IC 95% 1.183 – 504.413) were associated with higher mortality levels amongst COVID-19 positive patients. Conclusions The majority of COVID-19 cases showed no serious manifestations, were treated symptomatically and home isolation. Elevated values of CRP and the presence of hiporexia at the diagnosis are factors consistently with death. Future investigations are required to determine the risk factors associated with worst clinical course and prognosis.

Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

2019 ◽  
Vol 47 (1-2) ◽  
pp. 24-31 ◽  
Author(s):  
Tanya N. Turan ◽  
Sami Al Kasab ◽  
Alison Smock ◽  
George Cotsonis ◽  
David Bachman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Medical Management ◽  
Physical Inactivity ◽  
Recurrent Stroke ◽  
Older Age ◽  
Aggressive Medical Management

Background: Cerebrovascular disease is an important cause of cognitive impairment. The aim of this study is to report the relationship between cognitive function and risk factors at baseline and during follow-up in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial. Methods: Subjects in the SAMMPRIS trial were included in this study. In order to have an assessment of cognitive function independent of stroke, patients with a stroke as a qualifying event whose deficits included aphasia or neglect were excluded from these analyses as were those with a cerebrovascular event during follow-up. The Montreal Cognitive Assessment (MoCA) score was used to assess cognitive impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA < 26. A multivariate analysis was performed to determine what risk factors were independent predictors of cognitive function at baseline, 12 months and closeout. Among patients randomized to aggressive medical management only, the percentage of patients with cognitive impairment was compared between patients in versus out of target for each risk factor at 12 months and closeout. Results: Of the 451 patients in SAMMPRIS, 371 patients met the inclusion criteria. MoCA < 26 was present in 55% at baseline. Older age and physical inactivity were associated with cognitive impairment at baseline. Older age, non-white race, lower baseline body mass index, and baseline cognitive impairment were associated with cognitive impairment at 12 months. In the aggressive medical management group, at 12 months, physical inactivity during follow-up was the strongest risk factor associated with cognitive impairment. Conclusion: Cognitive impairment is common in patients with severe symptomatic intracranial atherosclerosis. Physical inactivity at baseline and during follow-up is a strong predictor of cognitive impairment.

scholarly journals Novel Predictors of Future Vascular Events in Post-stroke Patients—A Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Diana Schrick ◽  
Erzsebet Ezer ◽  
Margit Tokes-Fuzesi ◽  
Laszlo Szapary ◽  
Tihamer Molnar
Keyword(s):  
Ex Vivo ◽  
Platelet Reactivity ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Vascular Events ◽  
Post Stroke ◽  
Coronary Syndrome ◽  
Impedance Aggregometry ◽  
Selection Of

Introduction: A modified platelet function test (mPFT) was recently found to be superior compared to impedance aggregometry for selection of post-stroke patients with high on-treatment platelet reactivity (HTPR). We aimed to explore some peripheral blood cell characteristics as predictors of recurrent ischemic episodes. The predictive value of mPFT was also assessed in a cohort followed up to 36 months regarding recurrent ischemic vascular events.Methods: As a novelty, not only whole blood (WB), but after 1-h gravity sedimentation the separated upper (UB) and lower half blood (LB) samples were analyzed including neutrophil antisedimentation rate (NAR) in 52 post-stroke patients taking clopidogrel. Area under the curve (AUC, AUCupper and AUClower, respectively) was separately measured by Multiplate in the WB, UB and LB samples to characterize ex vivo platelet aggregation in the presence of ADP. Next, the occurrence of vascular events (stroke, acute coronary syndrome, ACS) were evaluated during 36-month follow-up.Results: A total of 11 vascular events (stroke n = 5, ACS n = 6) occurred during the follow-up period. The AUCupper was significantly higher in patients with recurrent stroke compared to those with uneventful follow-up (p = 0.03). The AUCupper with a cut-off value ≥70 based on the mPFT, was able to predict all stroke events (p = 0.01), while the total vascular events were independently predicted by NAR with a sensitivity of 82% and specificity of 88%.Conclusions: A combination of NAR reflecting the inflammatory state and AUCupper indicating HTPR may provide a better prediction of recurrent ischemic events suggesting a better selection of patients at risk, thus providing an individually tailored vascular therapy.

scholarly journals Coombs test positivity in cord blood: early detection of risky newborns and the assessment of their follow-up results

2021 ◽  
Vol 28 (1) ◽  
pp. 42-47
Author(s):  
Ali Ulaş Tuğcu ◽  
Faika Ceylan Çiftçi ◽  
Esra Aktepe Keskin
Keyword(s):  
Risk Factors ◽  
Cord Blood ◽  
Hemolytic Anemia ◽  
Demographic Data ◽  
Early Period ◽  
Serum Total Bilirubin ◽  
Specific Method ◽  
Coombs Test ◽  
Direct Coombs Test

Objective Direct Coombs test (DCT) is a screening process to detect antibodies which are produced against the antigens in the red blood cells of newborns and cause hemolytic disease. In our study, we aimed to compare the demographic data and early period outcomes of the newborns with and without DCT positivity. Methods The data of all newborns who were born in our hospital between January 2019 and September 2019, of whose mothers gave informed consent before the labor and whose cord blood samples were examined were reviewed retrospectively. The data were analyzed by using SPPS 25 (IBM Corp. Released 2017; IBM SPSS Statistics for Windows, Version 25.0; IBM Corp., Armonk, NY, USA) statistics software. Results A total of 302 newborns were included in the study. The results of Direct Coombs test were positive in 27 cases. The phototherapy rate of the cases with positive DCT results was 74% (20/27). It was found that the cases with positive DCT results underwent more phototherapy, started to undergo phototherapy earlier, were hospitalized longer and had lower serum total bilirubin levels compared to the cases with negative DCT results, and these differences were statistically significant (p=0.003, p=0.015, p=0.038 and p=0.026, respectively). Conclusion Today, there is no specific method to prevent jaundice particularly for the newborns with a risk factor. The only thing to do for newborns at this point is to detect if they have risk factors or not, and to follow up newborns with risk factors appropriately. Direct Coombs test has still been playing an important role to predict hemolytic anemia and potential manifestation of hyperbilirubinemia in association with hemolytic anemia in the newborns, and to initiate treatment process as soon as possible.

scholarly journals Low T3 Level and Prognosis of Acute Ischemic Stroke: A Comparative Analysis

2018 ◽  
Vol 18 (2) ◽  
pp. 145-148
Author(s):  
Hosne Ara Rahman ◽  
Mahbub Ur Rahman ◽  
Jasmine Ara Haque ◽  
Samira Sharmin ◽  
Anup Kumar Saha
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Impairment ◽  
Functional Improvement ◽  
Stroke Severity ◽  
Cross Sectional ◽  
Post Stroke ◽  
Low T3 ◽  
Level Group

Objectives: Neuroendocrine profile is significantly altered in acute ischemic stroke. Increasing evidences suggested that low T3 levels immediately following acute ischemic stroke is associated with greater stroke severity, higher mortality rates and poorer functional outcome. The objective of this study was to see the possible association of serum T3 level with severity of acute ischemic stroke as well as post stroke recovery.Material & Methods: It was a prospective cross sectional study. From October 2014 to June 2015 patients with acute ischemic stroke, presented within 48 hours of onset of symptoms having radiologically confirmed cerebral infarct were enrolled in this study. Blood for thyroid hormone estimation was collected within 48 hours of onset of symptom. Neurological impairment and improvement were assessed using National Institute of Health Stroke Scale (NIHSS) score together with modified Rankin Scale (mRS) on admission day and at 4 weeks post stroke follow-up visit.Result: A total 83 patients met all inclusion criteria were studied. Mean age was 63.4 ± 15.6 years (range 47-79 years). Among eighty three patients 49 (59%) had normal T3 level and rest 34 (41%) had low T3 level. Mean T3 level was 0.4 ± 0.3 ng/ml and 1.8 ±0.5 ng/ml in lowT3 and normal T3 level group respectively. Based on NIHSS scores on admission, a much higher portion of patients (73.5%) belonged to lowT3 level group fell into moderate-to-severe category while majority of patients (53.0%) fell into mild category for normal T3 level group. In post stroke follow up, about 63.2 % patients with normal T3 level showed favorable neurological functional improvement compared to 38.2% having low T3 level (Chi square=4.9, P<0.05).Conclusion: In patients with acute ischemic stroke lower T3 level elevated the risk of poor functional outcome.Bangladesh J. Nuclear Med. 18(2): 145-148, July 2015

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