Strokes Following Attempted Suicide: Frequency, Mechanisms, Outcome and Review of the Literature

2021 ◽  
Author(s):  
Mauro Silva ◽  
Laurent Michaud ◽  
Pamela Correia ◽  
Masaki Nishida ◽  
Patrik Michel
Keyword(s):  
World Literature ◽  
Early Mortality ◽  
Stroke Severity ◽  
Systematic Observation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
Stroke Mechanism ◽  
Work Up

Abstract Background: Only a few patients with strokes following suicide attempt (SFSA) are described in the literature and dissection of cervical arteries is the best-known mechanism. We aimed to determine the frequency, clinical presentation, mechanisms and outcomes of such patients by systematic observation in a single academic institution.Method: We retrospectively identified in our acute ischemic stroke registry all SFSA over 11 years. A thorough work-up was performed to establish the stroke mechanism. We also searched all published SFSA in the world literature for further analysis of demographics, comorbidities and long-term outcome. Results: Work-up showed multiple stroke mechanisms as well as multiple psychiatric. After adding 7 already published SFSA and comparing all SFSA with our stroke registry, SFSA were younger, had similar stroke severity, higher early mortality, and similar long-term functional outcome.Conclusions: SFSA is rare, affects younger patients and may be missed without an appropriate level of suspicion and neuroimaging. Long-term outcome seems comparable to other stroke patients despite an increased early mortality.

scholarly journals Preconditioning by Preceding Ischemic Cerebrovascular Events

2021 ◽  
Author(s):  
Pamela N. Correia ◽  
Ivo A. Meyer ◽  
Ashraf Eskandari ◽  
Michael Amiguet ◽  
Lorenz Hirt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
University Hospital ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
Cerebral Ischemic ◽  
The Impact ◽  
Ischemic Events

Background Emerging yet contrasting evidence from animal and human studies associates ischemic preconditioning with improvement of subsequent stroke severity, although long‐term outcome remains unclear. The purpose of this study was to analyze how preceding cerebral ischemic events influence subsequent stroke severity and outcome. Methods and Results Data for this retrospective cohort study were extracted from ASTRAL (Acute Stroke Registry and Analysis of Lausanne). This registry includes a sample of all consecutive patients with acute ischemic strokes admitted to the stroke unit and/or intensive care unit of the Lausanne University Hospital, Switzerland. We investigated associations between preceding ischemic events (transient ischemic attacks or ischemic strokes) and the impact on subsequent stroke severity and clinical improvement within 24 hours, measured through National Institute of Health Stroke Scale, as well as 3‐month outcome, determined through a shift in the modified Rankin Scale. Of 3530 consecutive patients with ischemic stroke (43% women, median age 73 years), 1001 (28%) had ≥1 preceding cerebral ischemic events (45% transient ischemic attack, 55% ischemic stroke; 31% multiple events). After adjusting for multiple prehospital, clinical, and laboratory confounders, admission stroke severity was significantly lower in patients preconditioned through a preceding ischemic event, but 24‐hour improvement was not significant and 3‐month outcome was unfavorable. Conclusions Preceding ischemic events were independently associated with a significant reduction in subsequent stroke severity but worsened long‐term clinical outcome. These results, if confirmed by future randomized studies, may help design neuroprotective strategies. The unfavorable effect on stroke outcome is probably a consequence of the cumulative disability burden after multiple ischemic events.

Abstract TP421: Ischemic Preconditioning From Preceding Cerebrovascular Events in Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Pamela N Correia ◽  
Ivo A Meyer ◽  
Ashraf Eskandari ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Ischemic Stroke ◽  
Ischemic Preconditioning ◽  
Multivariate Regression Analysis ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cerebrovascular Events ◽  
Independent Association ◽  
Stroke Mechanism

Introduction: Preconditioning improves acute ischemic stroke (AIS) outcomes in animals and possibly in humans. The influence of a preceding ischemic event (PIE), such as a TIA or AIS occurring at different intervals, sites and for different durations, needs to be studied in humans. Hypothesis: We aimed to identify whether a PIE can have a preconditioning effect on a subsequent AIS. Methods: Using consecutive AIS from the ASTRAL registry we determined demographics, risk factors, past medical history,stroke mechanism,PIE and other features that were associated with initial stroke severity measured by NIHSS. We used a multivariate linear regression model with NIHSS as the dependent variable to compare groups with and without PIE. Results: Of 3501 consecutive AIS patients (43% females, median age 73 y), 996 (28.4%) had preceding PIEs (15.7% TIA, 12.9% ischemic stroke, 2.4% retinal ischemia, 8.8% multiple events). There were 162 acute PIE in the preceding 24 h, and 94 subacute PIE up to 7 d before the stroke, respectively with a median delay between the PIE and the subsequent stroke of 180 days.Results of the adjusted multivariate regression analysis are shown as forest plots below. Conclusions: In patients with AIS, we found an independent association between lesser stroke severity and PIE, suggesting a possible beneficial role of ischemic preconditioning in stroke in humans. The effect of timing, severity,location of PIE and long-term outcome of such patients needs to be analyzed in further studies.

scholarly journals Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

2021 ◽  
pp. 239698732110195
Author(s):  
P Correia ◽  
S Machado ◽  
I Meyer ◽  
M Amiguet ◽  
A Eskandari ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Tobacco Use ◽  
Migraine With Aura ◽  
Hormonal Contraceptives ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Female Patients

Introduction Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users. Patients and methods Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis. Results Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all. Conclusion Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.

Long-term Outcome of Patients With a Negative Work-up for Asymptomatic Microhematuria

Urology ◽  
2010 ◽  
Vol 75 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Ralph Madeb ◽  
Dragan Golijanin ◽  
Joy Knopf ◽  
Matthew Davis ◽  
Changyong Feng ◽  
...  
Keyword(s):  
Term Outcome ◽  
Long Term Outcome ◽  
Negative Work ◽  
Work Up

Long-term follow-up of benign positional vertical opsoclonus in infants: retrospective cohort

2017 ◽  
Vol 102 (6) ◽  
pp. 757-760 ◽  
Author(s):  
Amir Sternfeld ◽  
Daniella Lobel ◽  
Hana Leiba ◽  
Judith Luckman ◽  
Shalom Michowiz ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Clinical Investigation ◽  
Clinical Findings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Ocular Symptoms ◽  
Long Term Follow Up ◽  
Work Up

Background/AimsBenign positional vertical opsoclonus in infants, also described as paroxysmal tonic downgaze, is an unsettling phenomenon that leads to extensive work-up, although benign course has been reported in sporadic cases. We describe long-term follow-up of a series of infants with the phenomenon.MethodsThis retrospective cohort included all infants diagnosed with rapid downgaze eye movement in 2012–2015 and followed until 2016. The databases of two medical centres were retrospectively reviewed. Benign positional vertical opsoclonus was diagnosed based on clinical findings of experienced neuro-ophthalmologists. Data were collected on demographics, symptoms and signs, neuro-ophthalmological and neurological evaluations, and outcome. Imaging studies were reviewed. Main outcome measures were long-term outcome and findings of the thorough investigation.ResultsThe cohort included six infants. All infants were born at term. Age at presentation was several days to 12 weeks. Episodes lasted a few seconds and varied in frequency from <10 to dozens per day. In five infants, symptoms occurred in the supine position. There was a wide variability in the work-up without any pathological findings. Follow-up ranged from 1 to 2.5 years. Ocular symptoms gradually decreased until resolution. Infants reached normal developmental milestones.ConclusionsOur identification of six patients in only 3 years suggests benign positional vertical opsoclonus may be more prevalent than previously described. In our experience, it affects otherwise healthy infants and resolves spontaneously. In view of the good long-term outcome, a comprehensive clinical investigation may not be necessary.

Rhabdomyosarcoma of the trachea: first reported case treated with proton beam therapy

2012 ◽  
Vol 126 (9) ◽  
pp. 966-969 ◽  
Author(s):  
R Exley ◽  
J M Bernstein ◽  
B Brennan ◽  
M P Rothera
Keyword(s):  
Proton Beam ◽  
World Literature ◽  
Proton Beam Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Conventional Radiotherapy ◽  
The Usa ◽  
History Of ◽  
The Uk

AbstractObjective:We report a case of rhabdomyosarcoma of the trachea in a 14-month-old child, and we present the first reported use of proton beam therapy for this tumour.Case report:A 14-month-old girl presented acutely with a seven-day history of biphasic stridor. Emergency endoscopic debulking of a posterior tracheal mass was undertaken. Histological examination revealed an embryonal rhabdomyosarcoma with anaplasia. Multimodality therapy with surgery and chemotherapy was administered in the UK, and proton beam therapy in the USA.Conclusion:Only three cases of rhabdomyosarcoma of the trachea have previously been reported in the world literature. This is the first reported case of treatment of this tumour with proton beam therapy. Compared with conventional radiotherapy, proton beam therapy may confer improved long-term outcome in children, with benefits including reduced irradiation of the spinal cord.

Serum calcium and long-term outcome after ischemic stroke: Results from the China National stroke registry III

2021 ◽  
Vol 325 ◽  
pp. 24-29
Author(s):  
Jun-Fang Zhang ◽  
Xia Meng ◽  
Jing Jing ◽  
Yuesong Pan ◽  
Yi-Long Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Serum Calcium ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry

Abstract T P150: NIHSS Zero Strokes: Immeasurable but Not Innocent

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Elissavet Eskioglou ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Laboratory Finding ◽  
Recurrence Rates ◽  
Laboratory Findings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
Stroke Disability ◽  
Current Deficit ◽  
Unadjusted Analysis

Aims: Patients with acute ischemic stroke (AIS) lasting >24 hours may have an immeasurable deficit on the admission NIHSS score. We sought to better characterize factors that are associated with NIHSS zero strokes and evaluate their long term outcome. Methods: We used all AIS patients with a measurable admission NIHSS in the Acute STroke Registry and Analysis and of Lausanne (ASTRAL) from 2003 - 2012. We then retrospectively analyzed and compared patients with an admission NIHSS of zero with all other patients regarding demographics, clinical characteristics, radiological and laboratory findings in uni- and multivariate analyses. Patients with a pre-stroke NIHSS>0 were also considered “NIHSS zero strokes” if a clearly described preexisting deficit accounted for the current deficit and no new NIHSS points were found. Outcome was assessed at 3 months using the modified Rankins score corrected for pre-stroke disability (corrected mRS) and considered favorable if it was ≤ 1. Combined stroke & TIA recurrences and rehospitalisation rates over 12 months were compared. Results: Comparing 109 NIHSS zero with 2’189 other strokes in multivariate analysis, patients with NIHSS zero stroke had lower pre-stroke disability levels, longer onset-to-hospital delays, and more lacunar and infratentorial strokes. When comparing radiological and laboratory finding in the two groups, NIHSS zero patients were less likely to have acute ischemic changes on acute NCCT, less arterial pathology on acute cervical and intracranial imaging and lower creatinine levels. In unadjusted analysis, NIHSS zero patients were more likely to have favorable corrected mRS (zero vs. others: 83.2% vs. 44.6%) and less likely to die (3.9% vs. 13.3%) at 12 months. Recurrence rates were similar (9.2% vs. 12.9%). Conclusion: Patients with NIHSS zero strokes as compared with all other patients have more frequently lacunar and infrantentorial strokes, normal acute CT, and less arterial pathology. However a significant minority faces persisting handicap at 12 months and recurrent ischemic events. These findings suggest that NIHSS zero stroke patients have better outcomes but still require support and aggressive secondary prevention.

scholarly journals Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Roos E. Barth ◽  
Hugo A. Tempelman ◽  
Robert Moraba ◽  
Andy I. M. Hoepelman
Keyword(s):  
Treatment Failure ◽  
Virological Failure ◽  
Hiv Treatment ◽  
Early Mortality ◽  
Term Outcome ◽  
Rural South ◽  
Long Term Outcome ◽  
Hiv Rna ◽  
Low Performance

Objective. To define the long-term (2–4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa.Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA testing, was performed. Primary endpoint was patient retention; virological suppression (HIV-RNA < 50 copies/mL) and failure (HIV-RNA > 1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed.Results. 63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure.Conclusions. An “all or nothing” phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available.

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