Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 91 (21) ◽  
pp. e1971-e1978 ◽  
Author(s):  
Jinjing Wang ◽  
Fengli Li ◽  
Lulu Xiao ◽  
Feng Peng ◽  
Wen Sun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Odds Ratio ◽  
Serum Levels ◽  
Severity Scale ◽  
Index Stroke ◽  
Fatigue Severity

ObjectiveTo investigate whether thyroid function profiles can predict poststroke fatigue (PSF) in patients with acute ischemic stroke.MethodsPatients with stroke were consecutively recruited within 3 days of onset in Jinling Hospital. Serum levels of thyroid hormones, thyroid antibodies, hematologic indexes, and biochemical indexes were measured on admission. Fatigue was scored using the Fatigue Severity Scale. Associations were analyzed with multivariate regression and restricted cubic splines.ResultsOf the 704 patients with stroke, 292 (41.5%) were diagnosed with fatigue in the acute stage and 224 (35.3%) 6 months after the index stroke. The serum levels of thyroid-stimulating hormone (TSH) were inversely associated with the risk of PSF in both the acute phase and at follow-up evaluations after adjusting for potential confounders (odds ratio 0.30, 95% confidence interval 0.24–0.37 in the acute phase, and odds ratio 0.70, 95% confidence interval 0.58–0.84 at follow-up). The subgroup analysis indicated that in the acute phase of ischemic stroke, TSH was associated with severity of PSF in the groups with euthyroidism (β = −0.70, p < 0.001), subclinical hypothyroidism (β = −0.44, p < 0.001), and low-T3 syndrome (β = −0.34, p = 0.008). Higher TSH was associated with better Fatigue Severity Scale scores in patients with low-T3 syndrome 6 months after the index stroke (β = −0.35, p = 0.01). Furthermore, in the group with low-T3 syndrome, FT3 serum level could also indicate a higher risk of PSF (β = −2.54, p < 0.001 in the acute phase, and β = −2.67, p < 0.001 at follow-up).ConclusionThyroid function profiles may predict fatigue after acute ischemic stroke, suggesting that neuroendocrine responses could have a role in PSF.

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Tan Xu ◽  
Yonghong Zhang ◽  
Yingxian Sun ◽  
Chung-Shiuan Chen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT)

2018 ◽  
Vol 33 (4) ◽  
pp. 773-783 ◽  
Author(s):  
Carina M Samuelsson ◽  
Per-Olof Hansson ◽  
Carina U Persson
Keyword(s):  
Confidence Interval ◽  
Postural Control ◽  
Acute Phase ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Inpatient Rehabilitation ◽  
Stroke Onset ◽  
Multivariable Regression ◽  
Walking Aid

Objective: To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12 months after stroke onset, following discharge from inpatient rehabilitation. Design: Prospective follow-up study. Setting: Stroke unit and outpatient department. Subjects: A total of 490 individuals with acute stroke. Methods: Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at three months after discharge and six and 12 months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12 months were investigated using univariable and multivariable regression analyses. Main measures: The endpoint was a self-reported fall. Results: Within three months after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12 months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07–7.45, P < 0.0001) and using a walking aid (odds ratio 2.84, 95% confidence interval 1.71–4.72, P < 0.0001) were predictors of falls after discharge within 12 months after stroke onset. The same variables were independent predictors of falls within six months. Conclusion: Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12 months after stroke onset.

Abstract TP170: Persistently Elevated Factor VIII In Acute Ischemic Stroke Is Associated With Higher CRP, Lower Baseline NIHSS, And Longer Length Of Hospital Stay

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Adrianne M Dorsey ◽  
Amelia K Boehme ◽  
Laurie Schluter ◽  
Karen C Albright ◽  
Tiffany R Chang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Factor Viii ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Clinical Course ◽  
Length Of Hospital Stay ◽  
Lower Baseline ◽  
Persistent Elevation

Objective: We sought to determine the proportion of patients with elevated factor VIII (FVIII) levels whose FVIII levels remain elevated after the acute phase of stroke, and the patient characteristics that predict sustained elevation of FVIII levels. Background: Factor VIII plays a major role in the fluid phase of blood coagulation. Elevated FVIII has been shown to increase risk of venous and arterial thrombosis. The importance of screening for elevated FVIII after a first thrombotic event especially acute ischemic stroke (AIS) has not been adequately investigated. Design/Methods: We reviewed FVIII levels taken at baseline and follow-up in patients with AIS treated at our stroke center from July 2008 to June 2012. Elevated FVIII was defined as >150%. Baseline demographics, laboratory data, clinical course, outcomes, and time to follow-up were collected in patients with elevated FVIII at baseline and data was compared in patients who had normalized FVIII with patients whose FVIII remained elevated at least 7 days later. Results: Repeat FVIII levels were available for 34/111 patients with elevated FVIII level with AIS. FVIII remained elevated in 68% after a median interval of 110 days. Factors associated with persistent elevation included higher baseline FVIII level (239 vs 185%, p=0.015), elevated CRP (73.3 vs 12.5%, p=0.008), lower baseline NIHSS (4 vs 8, p=0.046), and longer length of hospital stay (8 vs. 3, p=0.0063). Normalization of FVIII was associated with tPA use (54.5% vs 13%, p=0.016). No relationship was found between persistently elevated FVIII and baseline demographics, clinical course and outcomes. Conclusion: Persistently elevated FVIII after AIS may be predicted by higher baseline levels and elevations in CRP. Despite worse baseline stroke severity, patient with normalization of FVIII had similar outcomes as those with persistent elevation, which may be explained by the higher use of tPA in the normalized group. The relevance of elevated FVIII in stroke is not well understood. Our preliminary results suggest elevations persist in the majority and may not merely represent an acute phase reactant.

Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 91 (11) ◽  
pp. e1067-e1076 ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Nitin Goyal ◽  
Ali Kerro ◽  
Aristeidis H. Katsanos ◽  
Rashi Krishnan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Dual Antiplatelet Therapy ◽  
Safety And Efficacy ◽  
Favorable Functional Outcome

ObjectiveWe sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study.MethodsWe compared the following outcomes between DAPP+ and DAPP− IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0–1), and 3-month mortality.ResultsAmong 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP− patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47–8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06–5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP− patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes.ConclusionsDAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates.Classification of evidenceThis study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.

scholarly journals Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness

Stroke ◽  
2021 ◽  
Author(s):  
Manon Kappelhof ◽  
Manon L. Tolhuisen ◽  
Kilian M. Treurniet ◽  
Bruna G. Dutra ◽  
Heitor Alves ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Infarct Volume ◽  
Treatment Allocation ◽  
Common Odds Ratio

Background and Purpose: Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. Methods: We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B–3), and follow-up infarct volume (in mL). Results: Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly ( P =0.03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1.2 [95% CI, 1.1–1.3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1.0 [95% CI, 0.9–1.1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7.0–17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0.83 [95% CI, 0.70–0.97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Conclusions: Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.

Abstract 2642: Prevalence and Importance of Cardiac Arrhythmias after Acute Ischemic Stroke

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jesper K Jensen ◽  
James L Januzzi ◽  
Dan Atar ◽  
Hans Mickley
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Heart Rhythm ◽  
Torsades De Pointes ◽  
Holter Monitoring ◽  
Stroke Severity ◽  
Potential Threat ◽  
True Rate

Although heart rhythm monitoring following acute ischemic stroke is widely practiced, the prevalence of arrhythmia during the acute phase of ischemic stroke is debated. Several studies have claimed the potential threat of QT prolongation possibly leading to Torsades de Pointes ventricular tachycardia (VT) or ventricular fibrillation (VF). Furthermore, knowledge of the true rate of occult atrial fibrillation (AF) among ischemic stroke patients is sparse. 224 consecutive patients with acute ischemic stroke underwent daily 12-lead ECG during the first 5 days after hospital admission; as well as 24 hour Holter monitoring was performed in all patients. Patients with prior AF, established ischemic heart disease and heart failure were excluded. Patients were followed for 40 months for vital status. The mean age of the patients was 69 years. No patient had VT or VF. Previously unsuspected AF could be demonstrated in only 13 of 224 patients (6%). All 13 were detected by Holter monitoring, while nearly half were missed by ECG. During follow-up 53 (24 %) patients died. The presence of AF was significantly associated with mortality (log-rank p <0.0001; Figure ). In Cox analysis, patients with AF had an increased mortality compared to patients without AF (HR=2.44; [95 % CI, 1.00 – 6.00], P = 0.05) with adjustment for age and stroke severity and renal failure. The fear of serious ventricular arrhythmias in the acute phase of ischemic stroke appears to be groundless. However, new onset AF can be demonstrated in one of 20 patients with acute ischemic stroke and seems to be associated with an increased mortality during long-term follow-up.

scholarly journals Predicting Clinical Outcomes After Thrombolysis Using the iScore

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2755-2759 ◽  
Author(s):  
Gustavo Saposnik ◽  
Mathew J. Reeves ◽  
S. Claiborne Johnston ◽  
Philip M.W. Bath ◽  
Bruce Ovbiagele
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Favorable Outcome ◽  
Tissue Type ◽  
Modified Rankin Scale ◽  
Secondary Outcomes

Background and Purpose— The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA). Methods— We applied the iScore ( www.sorcan.ca/iscore ) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4–6), and Barthel index >90 at 3 months. Results— Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P <0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P =0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30–1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45–1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. Conclusions— The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.

scholarly journals Body mass index is a risk factor for hemorrhagic transformation in older ischemic stroke patients after intravenous thrombolysis: a single center retrospective study

2019 ◽  
Author(s):  
Changqing Miao ◽  
Xiaoyan Yin ◽  
Chunying Mu ◽  
Yan Qu ◽  
Guogang Luo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Body Mass ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Tomography Scan

Abstract Background: The aim of our study was to determine whether body mass index is a predictor of hemorrhagic transformation in acute ischemic stroke patients after intravenous thrombolysis. Methods: A retrospective observational study was conducted to recruit 261 participants from a single center in China (67.0% males, median age 65 years). A head computed tomography scan was performed after 24 hours to evaluate hemorrhagic transformation occurrence, and a computed tomography scan was performed immediately in cases of clinical worsening. Multivariate logistic regression was used to estimate the association between risk factors and hemorrhagic transformation in acute ischemic stroke patients after intravenous administration of recombinant tissue plasminogen activator. Results: Of 261 patients, 40 (15.3%) developed hemorrhagic transformation (55% males, median age 70 years). Body mass index was higher in patients with hemorrhagic transformation than in patients without hemorrhagic transformation (25.7 vs 23.7; P value, 0.013). The multivariate logistic regression model showed that body mass index was an independent predictor of hemorrhagic transformation in patients aged ≥ 73 years (odds ratio, 1.74; 95% confidence interval, 1.22-2.49) but not in patients aged < 73 years (odds ratio, 1.01; 95% confidence interval, 0.87-1.18). In addition, the odds ratio was 5.16 (95% confidence interval, 2.21-12.04) when the body mass index was ≥ 25 kg/m2 compared to a body mass index < 25 kg/m2. Conclusions: The present study demonstrated that body mass index was an independent predictor of hemorrhagic transformation in older acute ischemic stroke patients after intravenous thrombolysis. Keywords: Body mass index, Hemorrhagic transformation, Intravenous thrombolysis, Ischemic stroke, Older patients.

scholarly journals Acute and episodic vestibular syndromes caused by ischemic stroke: predilection sites and risk factors

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091803
Author(s):  
DaoMing Tong ◽  
XiaoDong Chen ◽  
YuanWei Wang ◽  
Ying Wang ◽  
Li Du ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Insular Cortex ◽  
Large Vessel ◽  
Posterior Thalamus ◽  
Vessel Stenosis ◽  
Tertiary Teaching ◽  
Ischemic Events

Objective This study was performed to investigate the predilection sites of acute vestibular syndrome (AVS) and episodic vestibular syndrome (EVS) caused by acute infarcts. Methods This retrospective cohort study was performed at a stroke center in a tertiary teaching hospital. We diagnosed patients with AVS/EVS caused by acute ischemic stroke using diffusion-weighted imaging (DWI) and magnetic resonance angiography. Results Among all patients with AVS/EVS, 68 had DWI-positive ischemic events and 113 had DWI-negative ischemic events. Of the 68 patients with positive DWI findings, 42.6% had acute infarcts in the anterior circulation and 41.2% had acute infarcts in the posterior circulation. The main stroke predilection sites were the insular cortex (22.1%) and posterior thalamus (11.8%). Large vessel stenosis/occlusion (odds ratio, 0.12; 95% confidence interval, 0.04–0.36) and focal neurological symptoms/signs (odds ratio, 0.27; 95% confidence interval, 0.10–0.72) were significantly associated with the risk of AVS/EVS in patients with acute ischemic stroke. Conclusions The main predilection sites of AVS/EVS caused by ischemic stroke are the insular cortex and posterior thalamus. The risk of AVS/EVS is associated with large vessel stenosis and focal symptoms.

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