Brain–body communication in stroke

Neuroforum ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Katarzyna Winek ◽  
Daniel Cuervo Zanatta ◽  
Marietta Zille
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Treatment Strategies ◽  
The Body ◽  
Cns Injury ◽  
Stroke Risk Factors ◽  
The Central Nervous System ◽  
New Treatment ◽  
The Brain

Abstract Stroke is a leading cause of death and disability worldwide with limited therapeutic options available for selected groups of patients. The susceptibility to stroke depends also on systemic parameters, and some stroke risk factors are modifiable, such as atrial fibrillation (AF) or hypertension. When considering new treatment strategies, it is important to remember that the consequences of stroke are not limited to the central nervous system (CNS) injury, but reach beyond the boundaries of the brain. We provide here a brief overview of the mechanisms of how the brain communicates with the body, focusing on the heart, immune system, and gut microbiota (GM).

scholarly journals CHA2DS2-VASc score, left atrial size and atrial fibrillation as stroke risk factors in the Tromsø Study

Open Heart ◽  
2016 ◽  
Vol 3 (2) ◽  
pp. e000439 ◽  
Author(s):  
Sweta Tiwari ◽  
Maja-Lisa Løchen ◽  
Bjarne K Jacobsen ◽  
Laila A Hopstock ◽  
Audhild Nyrnes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Left Atrial Size ◽  
Stroke Risk Factors ◽  
Atrial Size

Embolic stroke of undetermined source correlates to atrial fibrosis without atrial fibrillation

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. e381-e387 ◽  
Author(s):  
Karman Tandon ◽  
David Tirschwell ◽  
W.T. Longstreth ◽  
Bryn Smith ◽  
Nazem Akoum
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Embolic Stroke ◽  
Cardioembolic Stroke ◽  
Healthy Controls ◽  
Atrial Fibrosis ◽  
Stroke Risk Factors ◽  
Causal Pathway

ObjectiveTo examine the hypothesis that atrial fibrosis and associated atrial cardiopathy may be in the causal pathway of cardioembolic stroke independently of atrial fibrillation (AF) by comparing atrial fibrosis burden between patients with embolic stroke of undetermined source (ESUS), patients with AF, and healthy controls.MethodsWe used late-gadolinium-enhancement MRI to compare atrial fibrosis in 10 patients with ESUS against 10 controls (no stroke, no AF) and 10 patients with AF. Fibrosis was compared between groups, controlling for stroke risk factors.ResultsMean age was 51 ± 15 years, and 43% of participants were female. Patients with ESUS had more atrial fibrosis than controls (16.8 ± 5.7% vs 10.6 ± 5.7%, p = 0.019) and similar fibrosis compared to patients with AF (17.8 ± 4.8%, p = 0.65). Odds ratios of ESUS per quartile of fibrosis were 3.22 (95% CI [CI] 1.11–9.32, p = 0.031, unadjusted) and 3.17 (95% CI 1.05–9.52, p = 0.041, CHA2DVASc score adjusted). Patients with >12% fibrosis had a higher percentage of ESUS (77.8% vs 27.3%, p = 0.02), and patients with >20% fibrosis had the highest proportion of ESUS (4 of 5).ConclusionsPatients with ESUS exhibit similar atrial fibrosis compared to patients with AF and more fibrosis than healthy controls. Fibrosis is associated with ESUS after controlling for stroke risk factors, supporting the hypothesis that fibrosis is in the causal pathway of cardioembolic stroke independently of AF. Prospective studies are needed to assess the role of anticoagulation in primary and secondary stroke prevention in patients with high atrial fibrosis.

Abstract 18738: Use of Antithrombotic Therapies and Outcomes in Patients with Atrial Fibrillation and Heart Failure: Insights from the GARFIELD Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ramon Corbalan ◽  
Antonio C Pereira Barretto ◽  
Giuseppe Ambrosio ◽  
Wael Al Mahmeed ◽  
Jean-Yves Le Heuzey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Stroke Risk ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors

Background: Atrial fibrillation (AF) is commonly associated with heart failure (HF) and this combination is associated with a worse prognosis than either alone. However, it is unclear if these patients receive appropriate antithrombotic therapies and if they have a higher incidence of stroke or systemic embolism (SE). Methods: We compared clinical characteristics, antithrombotic therapies, and outcomes in patients with and without HF in the GARFIELD Registry, an ongoing, international, observational registry of consecutively recruited patients with newly diagnosed non-valvular AF and ≥1 additional stroke risk factor. A total of 12,458 prospective patients were enrolled in 30 countries between March 2010 and January 2013. Results are reported at 1-year follow-up. HF was defined at baseline as New York Heart Association (NYHA) I-II or III-IV. Antithrombotic therapy use and 1-year outcomes in patients with and without HF were analysed. Results: In total, 20% of patients had HF; they were older and had higher CHA2DS2-VASc and HAS-BLED scores compared with patients without HF. A higher proportion of patients with HF received antithrombotic therapies. The incidence of all-cause death was higher in HF patients than non-HF patients. Patients with NYHA class III-IV HF had a higher unadjusted incidence of all-cause death and stroke/SE compared with non-HF patients: 10.5 (95% confidence interval 8.8 to 12.7) vs 2.9 (2.7 to 3.2) per 100 person-years and 1.9 (1.2 to 3.0) vs 1.0 (0.8 to 1.2) per 100 person-years, respectively. Event rates slightly changed after adjustment for stroke risk factors. Conclusion: More AF patients with HF received antithrombotic therapies compared with those without HF. They also showed a higher incidence of all-cause death with increasing HF severity compared with AF patients without HF. After adjustment for stroke risk factors, this association was slightly attenuated.

scholarly journals Awareness of stroke risk factors and warning signs in southern Brazil

2009 ◽  
Vol 67 (4) ◽  
pp. 1076-1081 ◽  
Author(s):  
Asdrubal Falavigna ◽  
Alisson Roberto Teles ◽  
Viviane Maria Vedana ◽  
Fabrício Diniz Kleber ◽  
Gabriela Mosena ◽  
...  
Keyword(s):  
Risk Factors ◽  
Educational Level ◽  
Stroke Risk ◽  
Warning Signs ◽  
Lower Income ◽  
Lower Educational Level ◽  
Stroke Risk Factors ◽  
The Brain ◽  
Insufficient Knowledge ◽  
Lack Of Knowledge

OBJECTIVE: To evaluate the knowledge about stroke in Caxias do Sul. METHOD: A closed-ended, self-administered questionnaire was used to assess the knowledge about stroke among residents of Caxias do Sul. In order to verify variables associated to lack of knowledge we defined three main end points: (1) the inability to recognize that stroke is a disease that affects the brain; (2) insufficient knowledge of risk factors; (3) insufficient knowledge of signs and symptoms of acute stroke. RESULTS: A total of 952 subjects answered the questionnaire. Lower income and lower educational level were independent factors associated to inability to recognize that stroke affects the brain. Lower income and being under 50 years old were independent risk factors to lack of knowledge concerning stroke risk factors. Lower educational level was the unique risk factor for insufficient knowledge about stroke warning signs. CONCLUSION: There is a lack of knowledge about stroke in Caxias do Sul. People with lower socioeconomic status and lower education level should be the targets of educational campaigns.

scholarly journals Role of the Gut Microbiota in Ischemic Stroke

2017 ◽  
Vol 01 (04) ◽  
pp. E287-E293 ◽  
Author(s):  
Katarzyna Winek ◽  
Ulrich Dirnagl ◽  
Andreas Meisel
Keyword(s):  
Risk Factors ◽  
Experimental Data ◽  
Central Nervous System ◽  
Gut Microbiota ◽  
Stroke Risk ◽  
Stroke Outcome ◽  
Stroke Risk Factors ◽  
The Central Nervous System ◽  
Peripheral Immune Response

AbstractRecent studies have provided evidence for the role of the gut microbiota in the homeostasis of the central nervous system (CNS) and in the pathophysiology of its disorders, e. g. by regulation of the peripheral immune response. In this article, we discuss the importance of the gut microbiota in stroke by providing a summary of available clinical and experimental data suggesting that 1) stroke changes the gut microbiome, 2) microbiota modulates stroke outcome and 3) microbiota plays an important role in the pathogenesis of stroke (risk factors). Currently available clinical and experimental evidence suggests an important role of gut microbiota in stroke and promises clinically relevant discoveries within coming years.

Stroke and thromboembolism in atrial fibrillation: A systematic review of stroke risk factors, risk stratification schema and cost effectiveness data

2008 ◽  
Vol 99 (02) ◽  
pp. 295-304 ◽  
Author(s):  
Michael Hughes ◽  
Gregory Y. H. Lip ◽  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Risk Stratification ◽  
Antithrombotic Therapy ◽  
Stroke Risk ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Stroke Risk Factors

SummaryThe risk of stroke in atrial fibrillation (AF) needs to be assessed in each patient to determine the clinical and cost-effectiveness of thromboprophylaxis, with the aim of appropriate use of antithrombotic therapy. To achieve this, stroke risk factors in AF populations need to be identified and stroke risk stratification models have been devised on the basis of these risk factors. In this article, we firstly provide a systematic review of studies examining the attributable stroke risk of various clinical, demographic and echocardiographic patient characteristics in AF populations. Secondly, we performed a systematic review of published stroke risk stratification models, in terms of the results of the review of stroke risk factors and their ability to accurately discriminate between different levels of stroke risk. Thirdly, we review the health economic evidence relating to the cost-effectiveness of anticoagulation and antiplatelet therapy as thromboprophylaxis in AF patients. The studies included in the systematic review of stroke risk factors identified history of stroke or TIA, increasing age, hypertension and structural heart disease (left-ventricular dysfunction or hypertrophy) to be good predictors of stroke risk in AF patients. The evidence regarding diabetes mellitus, gender and other patient characteristics was less consistent. Three stroke risk stratification models were identified that were able to discriminate between different categories of stroke risk to at least 95% accuracy. Few models had addressed the cumulative nature of risk factors where a combination of risk factors would confer a greater risk than either factor alone. In patients at high risk of stroke, anticoagulation is cost effective, but not for those with a low risk of stroke. With the evidence available for stroke risk factors and the various alternative stroke risk stratification models, a review of these models in terms of the evidence on which they are devised and their performance in representative AF populations is important. The appropriate administration of thromboprophylaxis in AF patients would need to balance the risks and benefits of antithrombotic therapy with its cost-effectiveness.

scholarly journals Knowledge of stroke risk factors among the patients with previous stroke or transient ischemic attack in a tertiary care hospital of Bangladesh

2020 ◽  
Vol 11 (1) ◽  
pp. 22-29
Author(s):  
Md Rashedul Islam ◽  
Tanbin Rahman ◽  
Rafi Nazrul Islam ◽  
Mohammad Sakhawat Hossen Khan ◽  
Mofizul Islam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Carotid Stenosis ◽  
Analysis Of Variance ◽  
Stroke Risk ◽  
Categorical Variables ◽  
Care Hospital ◽  
Stroke Risk Factors ◽  
Previous Stroke ◽  
History Of

Background: Patients of stroke or transient ischaemic attacks (TIA) are at risk of further stroke. Our objective was to study patients admitted with stroke/TIA regarding their knowledge about risk factors for having anew event of stroke/TIA, possible associations between patient characteristics and patients’ knowledge about risk factors, and patients’ knowledge about their preventive treatment for stroke/TIA. Methods: A questionnaire was used for 200 patients with stroke/TIA diagnoses. We asked 13 questions about diseases/conditions and lifestyle factors known to be risk factors and four questions regarding other diseases/ conditions (“distractors”). Additional questions concerned with the patients’ social and functional status and their drug use were asked. Categorical variables were analyzed using chi square test, while one-way analysis of variance and univariate analysis of variance were used for continuous variables. Logistic regression was employed to describe risk. A p value of, p < 0.05 was considered statistically significant. Results: The risk factors that were most often identified by the patients were Diabetes(75.9%), hypertension(83.3%), previous stroke or TIA(81.5%), smoking (85.2%), regular exercise(75.9%), older age(83.3%), overweight (75.9%) and patients with ischemic heart disease (70.4%). Atrial fibrillation and carotid stenosis were identified by less than 50% of the patients. 44.5% of the patients could identify 10 or more stroke/TIA risk factors. We observed that higher age, having a diagnosis of cerebral infarction/TIA, patients residing in urban area, high income group, businessman/retired service holder, family history of cardiovascular disease, past history of stroke / TIA were related to better knowledge of stroke/TIA risk factors. Anticoagulants and antiplatelets are important drugs for stroke/TIA prevention but only 20(9.3%) of the patients who reported anticoagulants and 76(35.2%) of the patients taking these drugs marked them as intended for prevention. Conclusion: Knowledge about diabetes, hypertension and smoking as risk factors was good, and patients who suffered from atrial fibrillation or carotid stenosis seemed to be less informed about these conditions as risk factors. The knowledge level was low regarding the use of anticoagulants and antiplatelets for stroke/TIA prevention. Better patient educational strategies for stroke/TIA patients should be developed. Furthermore, individuals with less knowledge should be given special consideration when developing strategies and programmes thus improving awareness of stroke risk factors. Birdem Med J 2021; 11(1): 22-29

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