Is segmental muscle strength recovery different in patients with dominant versus non-dominant hemispheric ischemic stroke?

Abstract Introduction & objectives: Starting from the well-known functional hemispheric asymmetry and concomitantly, from the clinical findings of practitioners involved in the post-stroke rehabilitation process, the aim of this study was to evaluate whether ischemic stroke in the dominant hemisphere results in more severe initial motor deficit and if its motor recovery is decreased compared to that of the non-dominant hemisphere. Material and method: This was a retrospective study, comprising 39 patients with ischemic stroke in the middle cerebral artery territory, divided into two groups depending on the hemispheric location of the lesion (left/right). They were evaluated for their segmental muscle strength using the Medical Research Council Muscle Strength Grading Scale, both in terms of initial value and evolution between two successive admissions. Results and conclusions: No significant difference was found for motor deficit evaluated on the occasion of the first admission between patients with left-side stroke and those with right-side stroke. Motor recovery was more obvious proximally in the paretic limbs, but without statistical significance. Key words: hemispheric dominance, functional laterality, stroke, motor rehabilitation,

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Posterior-Lateral Foraminotomy as an Exclusive Operative Technique for Cervical Radiculopathy: A Review of 846 Consecutively Operated Cases

Neurosurgery ◽

10.1227/00006123-198311000-00004 ◽

1983 ◽

Vol 13 (5) ◽

pp. 504-512 ◽

Cited By ~ 274

Author(s):

Charles M. Henderson ◽

Robert G. Hennessy ◽

Henry M. Shuey ◽

E. Grant Shackelford

Keyword(s):

Lumbar Disc ◽

Operative Procedure ◽

Venous Pressure ◽

Air Embolism ◽

Cervical Radiculopathy ◽

Clinical Findings ◽

Motor Deficit ◽

Arm Pain ◽

Significant Difference ◽

The Mean

Abstract Between 1963 and 1980, one or more posterior-lateral foraminotomies were performed for simple cervical radiculopathy as the sole operative procedure for 736 patients. One hundred three patients (14%) required a second posterior procedure, but only 24 (3%) cases represented true recurrent radiculopathy. There were 13 minor complications (1.5%) and no deaths or detectable incidence of air embolism. All operations were done with the patient in the sitting position. Central venous pressure monitoring was used only infrequently. There was a 96% incidence of relief of significant arm pain and/or paresthesia and a 98% incidence of resolution of preoperatively present motor deficit. Eight hundred twenty-eight procedures (98%) were preceded by Pantopaque cervical myelography. There was a 71.5% incidence of correlation between preoperative clinical findings (both sensory and motor) and operative findings. In 13% of the cases, two spaces were thought by the operating surgeon to be equally involved by the spondylotic process. Most (91.5%) of the patients describe themselves as either “good or excellent” postoperatively. There was no significant difference postoperatively regarding results or recurrence between patients with suspected soft or hard disc protrusions and those with strictly spondylotic radiculopathy. Nor was there any statistical difference in results among the three patient population groups (“private” vs. compensation vs. liability). The mean length of time to return to work or other “normal” activities was 9.4 weeks. The mean length of follow-up time was 146 weeks (2.8 years). There was an associated incidence of significant lumbar disc and/or foraminal disease requiring operation of 33.4%.

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Temporal and Spatial Expression Characteristics of MiR-155 and Rheb/mTOR Signaling Pathway in Ischemia–Reperfusion Injury of Rats

10.21203/rs.3.rs-710287/v1 ◽

2021 ◽

Author(s):

Yu-E Yan ◽

Xu-Rong Zhu ◽

Fang He ◽

Jing Xiong ◽

Ye Tian ◽

...

Keyword(s):

Ischemic Stroke ◽

Ischemia Reperfusion ◽

Statistical Significance ◽

Mrna Level ◽

Intervention Strategy ◽

Mtor Pathway ◽

Mrna Levels ◽

Significant Difference ◽

Ischemic Core ◽

Expression Characteristics

Abstract Backgrouds: Stroke is the second most prevalent cause of death and the first cause of longterm disability worldwide. Inhibition of miR-155 was found playing a protective role in ischemic stroke, one possible mechanism was regulating Ras-homolog enriched in brain (Rheb)/mammalian target of rapamycin (mTOR) pathway. For possible specific intervention strategy, further exploring the expression characteristics of miR-155 and mRNAs of the Rheb/mTOR pathway in ischemic stroke is neccesary. Results: Our results demonstrated that the infarction volume decreased with the prolongation of the reperfusion in the MCAO/R model rats (P < 0.05). Meanwhile, the miR155 expression obviously increased in both the ischemic core and the ischemic penumbra (IP) area of the model rats, but this trend weakened as the reperfusion time increased. Besides, the expression of mRNAs of Rheb, mTOR, S6kb1, and 4Ebp1 seemed to increase in both the ischemic core and the IP area of the model rats.Interestingly, the mRNA level of S6kb1 obviously increased of all model groups in both the ischemic core and the IP area (P < 0.05),while the mRNA levels of Rheb, mTOR, and 4Ebp1 increased in the first 24 h and rapidly decreased after 48 h and as a result, a statistically significant difference was found only in the 48-h group (P < 0.05). Conclusion: Along with the shrinked infarct volume, the levels of miR-155 decreased and the S6kb1 mRNA level increased as the leghtening of re-perfusion, as to the mRNA levels of Rheb, mTOR, and 4Ebp1,statistical significance was found only in the 48-h group. Unexpectedly, there was no difference between the ischemic core and the IP area for all the above molecules.Indicating that intervention measures targeting to miR155 should be taken systemicly as early as possible after stroke onset,especially within the early 48 hours.

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Agreement between Impression of Stroke in the Emergency Department and Diagnosis at the Neurology Department

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.7n.3p.7 ◽

2019 ◽

Vol 7 (3) ◽

pp. 7

Author(s):

Samad Shams-Vahdati ◽

Alireza Ala ◽

Eliar Sadeghi-Hokmabad ◽

Neda Parnianfard ◽

Maedeh Gheybi ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Statistical Significance ◽

Retrospective Chart Review ◽

Chi Square ◽

Prevention Therapy ◽

Significant Difference ◽

Chi Square Test ◽

Academic Teaching Hospital ◽

The Mean

Background: Missing to detect an ischemic stroke in the emergency department leads to miss acute interventions and treatment with secondary prevention therapy. Our study examined the diagnosis of stroke in the emergency department (ED) and neurology department of an academic teaching hospital. Methods and Materials: A retrospective chart review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a stroke neurologist to collect the clinical diagnosis and characteristics of ischemic stroke patients. For determining the cases of misdiagnosed and over diagnosed data, the administrative data codes were compared with the chart adjudicated diagnosis. The adjusted estimate of effect was estimated through testing the significant variables in a multivariable model. The comparisons were done with chi square test. Statistical significance was considered at P < 0.05. Results: Of 861 patients of the study, 54% were males and 43% were females; and the mean age of them was 66.51 ± 15.70. We find no statically significant difference between patient’s Glasgow Coma Scale (GCS) in the emergency department (12.87±3.25) and patients GCS in the neurology department (11.77±5.15). There were 18 (2.2%) overdiagnosed of ischemic stroke, 8 (0.9%) misdiagnosed of ischemic stroke and 36 (4.1%) misdiagnosed of hemorrhagic strokes in the emergency department. Conclusion: There was no significant difference between impression of stroke in the emergency department and diagnosis at the neurology department.

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Abstract P13: Faster Treatment Speed is Not Associated With Bleeds: Intravenous Alteplase Treatment in the Ultra-Early Time Window is Safe

Stroke ◽

10.1161/str.52.suppl_1.p13 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Michelle Provencher ◽

Ashley Scherman ◽

Elizabeth Baraban ◽

Robert Jackson ◽

Tamela L Stuchiner ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Time Window ◽

Statistical Significance ◽

Hospital Length Of Stay ◽

Bleeding Complications ◽

Stroke Patients ◽

Related Complication ◽

Discharge Disposition ◽

Significant Difference

Previous studies have shown that faster Door to Needle (DTN) treatment times are associated with better outcomes for acute ischemic stroke patients. With the continued push for faster times, we aimed to determine if DTN treatment times in the 30- vs 45-minute time window yielded statistically significant differences in outcomes or complications. Data obtained from a multi-state stroke registry included acute ischemic stroke patients ≥18 years of age discharged between January 2017 and April 2020, and treated with IV alteplase with DTN times between 25-30 or 40-45 minutes. Outcomes were 90-day Modified Rankin Score (mRS) (0-2 vs 3-6), discharge disposition [home or inpatient rehabilitation facility (IRF) vs other location], complications (any treatment-related complication vs none), and hospital length of stay (LOS). Patients with a documented reason for delay or who received thrombectomy were excluded. Outcomes of patients with 25- to 30-minute DTN times were compared to those with 40- to 45-minute DTN times using generalized linear models and multiple linear regression, adjusting for admission NIHSS, age, gender, race/ethnicity, and medical history. Compared to the 20-25 minute group, patients treated in the 40-45 minute window had higher odds of a documented 90-day mRS of 3 or more (Adjusted Odds Ratio (AOR)=1.19, p=0.253, n=201 ) and treatment-related complication (AOR=1.35, p=0.569) and lower odds of discharge to home or IRF (AOR=0.846, p=0.359). There was little difference in LOS (β=-0.008, p=0.847). None of the outcomes reached statistical significance. Administering alteplase in the 25- to 30-minute window is safe and did not result in an increase in bleeding complications. Although faster treatment times trended toward better outcomes, there was no statistically significant difference between the 25-30 and 40-45 minute DTN treatment times.

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THE EFFECTIVENESS OF THE ACUPUNCTURE REDUCING POINT ON THE IMPROVEMENT OF MUSCULAR STRENGTH OF STROKE PATIENTS

Nurse and Holistic Care ◽

10.33086/nhc.v1i1.2115 ◽

2021 ◽

Vol 1 (1) ◽

pp. 39-47

Author(s):

Dodik Hartono ◽

Deny Prasetyanto ◽

Ainul Yaqin Salam ◽

Erna Handayani ◽

Grido Handoko Sriyono ◽

...

Keyword(s):

Data Analysis ◽

Muscle Strength ◽

Controlled Trial ◽

Statistical Significance ◽

Intervention Group ◽

Wilcoxon Test ◽

Stroke Patients ◽

Significant Difference ◽

Before And After ◽

Acupuncture Meridian

Background: Stroke is a disease caused by disruption of blood flow to areas of the brain that are blocked in the cerebral or cervical arteries which result in decreased or even loss of function controlled by brain tissue. One of the effects caused by stroke is hemiparesis. Rehabilitation therapy plays an important role in a comprehensive restoration of bodily functions due to stroke, this program aims to restore function to reduce disability, one of the treatments is to use acupuncture meridian points. Purpose: The purpose of this study was to determine the effectiveness of acupuncture meridian points in increasing muscle strength in stroke patients. Methods: The research design used in this study was a randomized controlled trial (RCT) design. The number of samples of all stroke patients at the Holistic nursing therapy clinic in Probolinggo and the Healer School Jember Clinic that met the inclusion criteria from October 2020 to March 2021 were 270 respondents. Data collection techniques used observation sheets to assess muscle strength before and after the intervention of acupuncture meridian points in stroke patients. Data analysis used was the Wilcoxon test with a statistical significance value accepted if p <0.05. Results: The results of the data analysis of the intervention group showed a significant value of hand muscle strength (p 0.003; α 0.05) and leg (p 0.005, α 0.05) where (p <0.05) it can be concluded that there is a significant difference in strength. A muscle in the intervention group before and after being given acupuncture. The findings of this study suggest that there is a significant effect of acupuncture on lower and upper muscle strength. Conclusion: In general, the use of acupuncture meridian points can increase muscle strength in stroke patients, so the use of acupuncture meridian points can provide benefits for restoring muscle strength in stroke patients.

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Effect of sex differences on prognosis of intravenous thrombolysis: data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000351 ◽

2020 ◽

pp. svn-2020-000351 ◽

Cited By ~ 1

Author(s):

Hongyu Zhou ◽

Weiqi Chen ◽

Yuesong Pan ◽

Yue Suo ◽

Xia Meng ◽

...

Keyword(s):

Sex Differences ◽

Ischemic Stroke ◽

Ischaemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Statistical Significance ◽

Intravenous Thrombolysis ◽

Chinese Patients ◽

Nihss Score ◽

Significant Difference

Background and purposePrevious studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy. This study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic stroke.MethodsThe patients enrolled in this study were from the Chinese Acute Ischemic Stroke Thrombolysis Monitoring and Registration study. The primary outcome was poor functional outcome, defined as a 3-month modified Rankin score of 3–6. The safe outcome was symptomatic intracranial haemorrhage (SICH) and mortality within 7 days and 90 days. Multiple Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and prognosis. Furthermore, the interaction of preonset Rankin scores, baseline National Institute of Health Stroke Scale (NIHSS) scores and Trial of Org 10172 in Acute Stroke Treatment (TOAST) types was statistically analysed.ResultsA total of 1440 patients were recruited, including 541 women and 899 men. The baseline information indicated that women were older at the time of onset (66.2±11.2 years vs 61.0±11.3 years, p<0.001), and more likely to have a history of atrial fibrillation (25.3% vs 11.2%, p<0.001), and had a higher NIHSS score on admission (12.3±6.8 vs 11.6±6.7, p=0.04). According to the prognosis analysis of unsatisfactory functional recovery, there was no significant difference between women and men (45.9% vs 37.1%; adjusted OR 1.01, 95% CI 0.75 to 1.37). As for the safe outcome, the proportion of SICH and mortality in women is relatively high but did not reach statistical significance. There was no significant interaction with sex, age, preonset Rankin score, NIHSS score, TOAST classification and the prognosis of intravenous thrombolysis.ConclusionsFor Chinese patients with ischaemic stroke, although women are older and more severe at the time of onset, the prognosis after intravenous thrombolysis is not significantly different from men.

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Abstract T P298: Impact of Accurate Weight Based Dosing of IV tPA in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.46.suppl_1.tp298 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Vishal B Jani ◽

Sopan Lahewala ◽

Shilpkumar Arora ◽

Erin Shell ◽

Anmar Razak ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Statistical Significance ◽

Categorical Variables ◽

Stroke Severity ◽

Fisher Exact Test ◽

Weight Estimation ◽

Stroke Patients ◽

Significant Difference ◽

Iv Tpa

Background: Accurate weight-based dosing is essential for efficacy and safety of thrombolysis in acute ischemic stroke (AIS). Stroke patients may be unable to communicate correct body weight (BW). Dosing may be estimated which can lead to error. Objective: To assess accuracy of weight estimation and the effect of weight and dosing discrepancy on outcome of patients with AIS Methods: 94 patients receiving IV tpa for AIS in a CSC registry between Feb, 2013 and Jul, 2014 were reviewed. All were given estimated weight based tPA- per patient input or agreement of 2 providers in ER. Accurate weights were obtained and recorded later. Actual weight was used to calculate the ideal TPA doses and compared to the weights and doses used. The cohort was separated into two groups based on weight discrepancy to those 10 kg (non forgiven) discrepancy. Rate of hemorrhage, NIHSS and hospice/mortality were assessed. Difference between categorical variables was tested using the chi-square and Fisher’ Exact Test. Differences between continuous variables were tested using Wilcoxon Rank Sum test and presented with median and IQ range. Results: 86.1% (forgiven cohort) were given the optimal tPA dose despite estimation. There was a significant difference in stroke severity based on admission NIHSS between the cohorts (33.3% in forgiven vs. 69.2% non-forgiven. P=0.04). Stroke severity based on discharge NIHSS did not reach statistical significance (mild: 71.8% vs 63.6%, moderate: 16.9% vs 9.1% and severe: 11.3% vs 27.3%, p = 0.32). 30 days modified Rankin Scale (mRS) was available for 52 pts without any significant difference (good outcome 44.4% vs 57.1%, poor outcome 35.6 % vs 28.6 %, p = 0.82). Statistically non significance toward higher rate of hemorrhagic conversion (6.4% vs 7.7%, p = 0.41), and higher mortality in non-forgiven group (7.41% vs 15.38%, p= 0.33). Conclusion: Accurate BW measurement prior tPA still remains challenging. In this study, weight estimation by 2 providers is fairly accurate. 14 % of the patients with discrepancy of > 10 kg had higher rate of mortality and hemorrhage although this was not statistically significant. Further studies with larger sample sizes are needed to examine the safety of weight estimation in AIS patients who receive IV tpa

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Predictors for early motor improvement in patients with ischemic stroke

Balneo Research Journal ◽

10.12680/balneo.2019.263 ◽

2019 ◽

Vol 10 (Vol.10, No.3) ◽

pp. 236-242 ◽

Cited By ~ 5

Author(s):

Ioana C. STANESCU ◽

Angelo C. BULBOACA ◽

Gabriela B. DOGARU ◽

Gabriel GUSETU ◽

Dana M. FODOR

Keyword(s):

Ischemic Stroke ◽

Motor Evoked Potentials ◽

Continuous Process ◽

Complete Recovery ◽

Motor Recovery ◽

Motor Deficit ◽

Motor Deficits ◽

Key Words Ischemic Stroke ◽

Clinical Methods ◽

Motor Improvement

Disability as a stroke consequence is reported by 3% males and 2% females in general population. Motor deficits are common in stroke patients, but their complete recovery is seen only in a minority of cases. Assessment of motor deficits uses clinical methods, especially standardized scales, but also electrophysiological and imagistic methods. The motor recovery is a continuous process, maximal in the first month after stroke, decreasing gradually over the first 6 months. Most powerful predictors for motor recovery are clinical parameters: severity of motor deficit, onset of first voluntary movements after stroke in the first 48-72 hours, a continuous improvement in motor function during the first 8 weeks, a good postural control during the first month, young age, male sex, left hemispheric stroke and absence of other neurological impairments are strong positive predictors. Presence of motor-evoked potentials in paretic muscles and imagistic parameters as location, stroke volume and motor pathways integrity are paraclinical predictors for recovery. There are no specific biomarker which is efficient in predicting recovery. In patients with poor chances for recovery according to actual predictors, the development of more precise algorithms to assess functional outcome is needed, in order to support the choice of appropriate methods and intensity of rehabilitation treatment. Key words: ischemic stroke rehabilitation, functional assessment, motor improvement, recovery predictors, prognostic factors,

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Direct aspiration for thrombectomy in ischemic stroke: Impact of dwell time

Interventional Neuroradiology ◽

10.1177/1591019919886410 ◽

2019 ◽

Vol 26 (2) ◽

pp. 211-215

Author(s):

Cyril Chivot ◽

Julie Renier ◽

Hervé Deramond ◽

Roger Bouzerar ◽

Thierry Yzet

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Dwell Time ◽

Rescue Therapy ◽

Statistical Significance ◽

Significant Difference ◽

First Pass ◽

Group 2 ◽

The Impact ◽

Group 1

Objective To evaluate the impact of dwell time on the efficacy of the direct aspiration thrombectomy in ischemic stroke. Methods The study is a review of our prospective cerebral thrombectomy database of subjects admitted from January to December 2017. We performed direct aspiration with 2 min dwell time as recommended by the manufacturer (group 1) and 5 min dwell time (group 2) between January–June and July–December, respectively. The primary outcome was successful reperfusion after the first pass defined as modified Thrombolysis in Cerebral Infarction scores 2 b/3. Results Eighty-five patients had a cerebral thrombectomy by direct aspiration, 45 in group 1 and 40 in group 2. There was no statistically significant difference between the two groups but a trend toward a better modified Thrombolysis in Cerebral Infarction first pass 2 b/3 rate in group 2 (70% versus 48.8%, p = 0.06). Although not statistically significant (p = 0.07), the ratio of rescue therapy with stent retriever was higher in group 1 (40%) than in group 2 (22.5%). After all passes, modified Thrombolysis in Cerebral Infarction 2 b-3 was obtained in 82.2% (37/45) of cases in group 1 and in 90% (36/40) of cases in group 2. Among 76 patients (89.5%) with modified Rankin Scale assessment at three months, no significant difference (p = 0.3) was found in the proportion of functionally independent individuals between groups 1 and 2 (51.8% versus 55.6%, respectively). Conclusion Although statistical significance was not reached, our retrospective analysis exhibited a strong trend toward modified Thrombolysis in Cerebral Infarction first pass improvement when dwell time was increased from 2 to 5 min.

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Pediatric Arterial Ischemic Stroke

Cell Medicine ◽

10.1177/2155179018760330 ◽

2018 ◽

Vol 10 ◽

pp. 215517901876033

Author(s):

María José Hidalgo ◽

Daniela Muñoz ◽

Fernanda Balut ◽

Mónica Troncoso ◽

Susana Lara ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Clinical Presentation ◽

Statistical Significance ◽

Complete Information ◽

Motor Deficit ◽

Arterial Ischemic Stroke ◽

Anterior Circulation ◽

Male Predominance

Stroke is an important cause of morbidity and mortality in children. Clinical presentation is diverse, and multiple risk factors have been described. The aim of this retrospective study is to describe the clinical presentation, risk factors, and the Pediatric National Institute of Health Stroke Scale (PedNIHSS) in a series of pediatric Chilean patients with the diagnosis of arterial ischemic stroke (AIS). Children diagnosed with AIS aged between 29 d and 18 y were enrolled (1989 to 2016). Clinical characteristics and risk factors were described. PedNIHSS severity score was estimated for patients older than 4 mo of age. Sixty-two patients were included, 66% were male, and the mean age of presentation was 3.5 y. Seventy-nine percent presented motor deficit, 45% seizures, and 15% consciousness impairment. Eighty-two percent had a unilateral stroke and 73% had anterior circulation territory affected. The main risk factors were arteriopathy (63%) and infection (43%). The PedNIHSS mean was 7.6, ranging between 0 and 17. In the categories in which it was possible to apply χ2 test, only the acute systemic conditions category was statistically significant ( P = 0.03), being higher in the group of patients younger than 3 y old. We confirmed male predominance in AIS and the most frequent presenting symptom was motor deficit. We found at least 1 risk factor in all patients with complete information. We confirmed arteriopathy as the most frequent risk factor, and acute systemic conditions were higher in patients younger than 3 y old with statistical significance ( P = 0.03). The majority of patients presented mild to moderate severity in the PedNIHSS score.

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