scholarly journals THE EFFICACY OF COMBINED NEUROPROTECTION IN MOTOR AND COGNITIVE RECOVERY FOLLOWING THE ACUTE PHASE OF ISCHEMIC STROKE

2019 ◽  
Vol 33 (4) ◽  
pp. 131-135
Author(s):  
A. E. Shoboev ◽  
I. M. Balkhayev
Keyword(s):  
Ischemic Stroke ◽  
Retrospective Analysis ◽  
Acute Phase ◽  
Functional Recovery ◽  
Neurological Deficit ◽  
Cognitive Status ◽  
Modified Rankin Scale ◽  
Focal Neurological Deficit ◽  
Clinical Indicators ◽  
Acute Period

The clinical efficacy of combined neuroprotection with citicoline and cortexin in the acute period of ischemic stroke is discussed in the paper. A retrospective analysis of 127 cases with a primary ischemic stroke was carried out. For unbiased evaluation of the severity of the condition, extent of the focal neurological deficit and the assessment of the dynamics in clinical indicators, the National Institute of Health Stroke Scale was used; the degree of functional recovery was assessed by the modified Rankin Scale; the cognitive status score was measured by the MMSE scale. The obtained data suggest the effectiveness of combined neuroprotection with cortexin and citicoline in the acute period of ischemic stroke in comparison with monotherapy.

Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails

2020 ◽  
Vol 15 (4) ◽  
pp. 420-422
Author(s):  
Dhruvkumar M. Patel ◽  
Mukundkumar V. Patel ◽  
Jayanti K. Gurumukhani ◽  
Maitri M. Patel ◽  
Himal J. Mahadevia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Neurological Deficit ◽  
Clinical Case ◽  
Complete Recovery ◽  
Acute Onset ◽  
Diabetic Patients ◽  
Focal Neurological Deficit ◽  
Random Blood Sugar ◽  
Resident Doctor

Background: Hypoglycemia may rarely present as hemiparesis and sometimes it is difficult to differentiate from ischemic stroke. When random blood sugar (RBS) value is between 50 and 80 mg % in patients presenting with focal neurological deficit, no guideline exists to consider the possibility of hypoglycemia before initiating thrombolytic therapy. Clinical Case: A 58-year-old male, who was a known case of diabetes and hypertension, was brought to the emergency room with acute onset of right hemiparesis and dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis. Resident doctor not aware of previous sugar repeated RBS before thrombolysis which was surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis, intravenous 25 % dextrose was administered considering the possibility of hypoglycemia. He made a complete recovery within 20 minutes and thrombolytic therapy was withheld. : In Diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS should be rechecked and in appropriate cases should be challenged with IV dextrose considering the possibility of hypoglycemia before commencing thrombolytic therapy.

Influence of insulin resistance on the course of ischemic stroke in the acute period

2020 ◽  
Vol 18 (5) ◽  
pp. 93-98
Author(s):  
L. B. NOVIKOVA ◽  
◽  
G. I. IZHBULDINA ◽  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Carbohydrate Metabolism ◽  
Neurological Deficit ◽  
Glucose Metabolism Disorders ◽  
C Peptide ◽  
Acute Period

Among the reasons that increase the risk of stroke, its severity and outcome, a special place is given to disorders of carbohydrate metabolism. However, to date, there is no consensus on the role of hyperglycemia in stroke, whether it is physiological or pathological. The purpose to study the effect of insulin resistance on the course and clinical outcome of ischemic stroke (IS) in the acute period. Material and methods. A total of 862 patients with IS (370 men, 492 women), mean age was 66,1 ± 10,8 years. The degree of neurological deficit (NIHSS scale) and clinical outcome were assessed. When admitted to hospital, the level of glycemia, insulin, and C-peptide in the fasting blood were found. Results. In 186 (21,6%) patients type 2 diabetes mellitus (DM) was diagnosed. In 27,8% of patients without DM and 76,3% of patients with DM hyperglycemia was detected. In patients without DM with hyperglycemia, compared with patients with normoglycemia, a higher representation of severe neurological deficit (by 14,7%), a lower frequency of noticeable positive dynamics (by 14,8%), and a higher mortality rate (by 11,5%) were found. In patients with DM, hyperglycemia was associated with a lower incidence of noticeable positive dynamics (by 27,7%). The development of IS is accompanied by an increase in the blood level of C-peptide more than twice. High values of the C-peptide/insulin ratio are associated with a higher frequency of severe neurological deficit in patients with DM (by 32,4%) and without DM (by 23,8%), and a decrease in the incidence of noticeable positive dynamics (by 23,5% and 20,9%, respectively). Conclusion. Development of IS is characterized by high representation of disorders of carbohydrate metabolism. The severity of glucose metabolism disorders is interrelated with the severity and clinical outcome of the disease.

scholarly journals Sex, Diastolic Blood Pressure, and Outcome after Thrombolysis for Ischemic Stroke

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
David Nathanson ◽  
Cesare Patrone ◽  
Thomas Nyström ◽  
Mia von Euler
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Functional Status ◽  
Functional Outcome ◽  
Diastolic Blood Pressure ◽  
Functional Recovery ◽  
Modified Rankin Scale

Background. The goal of this study was to identify differences in risk factors and functional outcome between the two sexes in patients treated with thrombolysis for ischemic stroke.Methods. This cohort study audited data from patients treated with thrombolysis for ischemic stroke during a 3-year period at Södersjukhuset, Stockholm.Results. Of the 355 patients included in the study, 162 (45%) were women and 193 (54%) were men. Women were older with a median age of 76 years; median age for men was 69 years (P<0.0001). Diastolic blood pressure was lower for women compared to men (P=0.001). At admission fewer women had a favorable modified Rankin Scale score compared to men (93.8% versus 99%,P=0.008). Three months after discharge functional status did not differ significantly between the two sexes. Diastolic blood pressure was associated to functional outcome only in men when sex specific odds ratios were calculated (OR, 5.7; 95% CI, 1.7–20).Conclusion. The study indicates that females appear to gain a relatively greater benefit from thrombolytic therapy than men due to a better functional recovery. A higher diastolic blood pressure increases the risk for a worse prospective functional status in men.

scholarly journals The experience of application of prolonged craniopuncture in acute period of ischemic stroke

2020 ◽  
Vol 17 (3) ◽  
pp. 153-156
Author(s):  
Elena Evgenievna Molchanova
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Classical Method ◽  
Main Group ◽  
Fear Of Failure ◽  
Control Group ◽  
Acute Period ◽  
Test Motivation ◽  
Level Of Motivation ◽  
Failure Monitoring

The purpose of this research was to study the effect of prolonged craniopuncture on the rate of regression of the neurological deficit, the degree of adaptation to daily life, and the level of motivation among patients in the acute period of ischemic stroke. All patients (60 people) were divided into 2 groups, identical by sex, age and severity of the stroke. In the main group of patients (n=30) prolonged scalp therapy was performed simultaneously with classical acupuncture. The peculiarity of this modification of craniopuncture is the use of seven main areas of the scalp with their symmetrical stimulation and duration of exposure for up to 4 hours. Patients of the control group (n=30) underwent acupuncture in combination with scalp therapy according to the classical method. Assessment of the severity of neurological deficit was carried out on the scale NIHSS, while Barthel ADL index was used to assess the patient's daily live activities after stroke. The level of motivation among the patients was studied by using the questionnaire test Motivation for Success and Motivation for Fear of Failure. Monitoring was carried out on the 1st and 15th day from the start of treatment. In the main group of patients, the reduction in the severity of the neurological deficit occurred on the 15th day according to the data NIHSS scale was 5.0 (64,9%), the Barthel index increased by 31.0 points (55,1%). In the control group, similar indicators were 3.5 (50,7%) (on the NIHSS scale) and 23.5 points (40,5%) (Barthel's index). Both groups of patients experienced an increase in the level of motivation and were already oriented to success, but in the main group, these changes appeared to be more significant. Thus, the use of prolonged craniopuncture significantly accelerates the restoration of lost functions and the adaptation of patients to everyday life, in comparison with the classical method of scalp therapy, and has a beneficial effect on increasing the level of patients motivation.

First Experience of Mechanical Thrombectomy Outcomes Without Bridging Technique: A 3-Year Retrospective Analysis

2019 ◽  
Vol 2 (2) ◽  
pp. 105-110
Author(s):  
Saima Ahmad ◽  
Umair Rashid Chaudhry ◽  
Ossama Yassin Mansour
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Retrospective Analysis ◽  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Large Vessel ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Bridging Technique

Introduction: Mechanical thrombectomy has become the cornerstone and standard of care for acute stroke patients. Early reperfusion in patients experiencing acute ischemic stroke is the most important factor. The motivation behind this investigation is to display the aftereffects of mechanical thrombectomy in patients with large vessel occlusion in anterior and posterior circulation and to demonstrate that it lessens the level of handicap 3 months post stroke. Methods: A retrospective analysis was conducted of patients who presented with acute ischemic stroke at our center from 2015 to 2018 and received mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters without the bridging technique. Result factors including recanalization rate and modified Rankin Scale at 90 days post procedure were assessed. An aggregate of 30 patients were included. Results: About 30 patients presented at the institute and met the inclusion criteria for the study. Successful recanalization (the Thrombolysis in Cerebral Infarction Score [TICI 2B]) was accomplished in 90% of patients, TICI 3 score was accomplished in 56% of the patients. 67% of the patients had good modified Rankin Scale score 0-2 result at 90 days. There were 3 symptomatic hemorrhages and 3 procedure and comorbidity-related deaths (10%). Conclusion: Mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters alone without the bridging technique is an effective and safe procedure for endovascular revascularization of large vessel occlusion presenting with acute ischemic stroke.

scholarly journals CLINICAL-NEUROPHYSIOLOGICAL FEATURES IN PATIENTS WITH REPEATED CEREBRAL ISCHEMIC HEMISPHERIC STROKE IN ACUTE PHASE OF DISEASE

2019 ◽  
pp. 22-28
Author(s):  
O. A. Kozolkin ◽  
L. V. Novikova
Keyword(s):  
Ischemic Stroke ◽  
Acute Phase ◽  
Neurological Deficit ◽  
Hemispheric Asymmetry ◽  
Cognitive Deficit ◽  
Spectral Power ◽  
Nihss Score ◽  
Moderate Dementia ◽  
Cerebral Ischemic ◽  
Δ Rhythm

Summary. In order to study the clinical and neurophysiological features in patients with recurrent cerebral ischemic hemispheric ischemic stroke (RCHIS), a comprehensive clinical-paraclinical study of 49 patients (28 men and 21 female, mean age 72 (63; 76) years) in the acute period of the disease was conducted. It was found domination of mild and moderate dementia, the median total NIHSS score in the debut of the disease consisted 10 (7; 13), which corresponded to the average severity of the stroke. It was found that the parameters of δ-rhythm APS, δ-rhythm RSP and β rhythm  relative spectral power have the strongest correlation with level of neurological deficit by NIHSS score and with  level of disability by MRS, as well as parameters of occipital-frontal grade of  βhi-rythm and hemispheric asymmetry of αlo-subband correlated with the level of cognitive deficit.

scholarly journals Efficacy of beveled tip aspiration catheter in mechanical thrombectomy for acute ischemic stroke

2020 ◽  
pp. neurintsurg-2020-016695
Author(s):  
Jan Vargas ◽  
Jonathan Blalock ◽  
Anand Venkatraman ◽  
Vania Anagnostakou ◽  
Rrobert M King ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Retrospective Analysis ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Aspiration Thrombectomy ◽  
Patient Demographics ◽  
Significant Difference ◽  
Tissue Plasminogen

BackgroundDirect aspiration thrombectomy techniques use large bore aspiration catheters for mechanical thrombectomy. Several aspiration catheters are now available. We report a bench top exploration of a novel beveled tip catheter and our experience in treating large vessel occlusions (LVOs) using next-generation aspiration catheters.MethodsA retrospective analysis from a prospectively maintained database comparing the bevel shaped tip aspiration catheter versus non-beveled tip catheters was performed. Patient demographics, periprocedural metrics, and discharge and 90-day modified Rankin Scale (mRS) scores were collected. Patients were divided into two groups based on which aspiration catheter was used.ResultsOur data showed no significant difference in age, gender, IV tissue plasminogen activator administration, admission NIH Stroke Scale score, baseline mRS, or LVO location between the beveled tip and flat tip groups. With the beveled tip, Thrombolysis in Cerebral Infarction (TICI) 2C or better recanalization was more frequent overall (93.2% vs 74.2%, p=0.017), stent retriever usage was lower (9.1% vs 29%, p=0.024), and patients had lower mRS on discharge (median 3 vs 4, p<0.001) and at 90 days (median 2 vs 4, p=0.008).ConclusionPatients who underwent mechanical thrombectomy with the beveled tip catheter had a higher proportion of TICI 2C or better and had a significantly lower mRS score on discharge and at 90 days.

scholarly journals Be-Fast Faster and Fastest

2019 ◽  
Vol 1 (1) ◽  
pp. 7-10
Author(s):  
Karuna Tamrakar
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Critical Time ◽  
Recombinant Tissue Plasminogen Activator ◽  
Reperfusion Therapy ◽  
Time Frame ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Focal Neurological Deficit ◽  
Undetermined Etiology

Annual incidence of stroke is 2.5%/1000 people or 200000 stroke /year. Every 5 seconds undergo stroke all over the world. 15-20 % die in first month of brain attack and 75% lives with focal neurological deficit. Ischemic stroke is the most common (85%) after hemorrhagic stroke and subarachnoid hemorrhage (15%). Among all 5 subtypes, large artery atherosclerosis, cardio embolism, small vessel occlusion, stroke of other determined etiology, undetermined etiology, ischemic stroke carries poor prognosis of increasing morbidity and mortality. Window of opportunity is a critical time that need to be addressed to reverse neurological stroke symptoms either partially or completely through active interventional approaches either noninvasive or invasive methods. Thrombolysis has radically changed the prognosis of acute ischemic stroke. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) is effective in reducing the neurological deficit. Time is brain, either you be fast or faster and fastest, early or timely reperfusion therapy within a time frame of 4.5 hours helps to restore normal neurological function.

scholarly journals Clinical Features, Risk Factors and Hospital Mortality of Acute Stroke Patients

2020 ◽  
pp. 9-14
Author(s):  
Mahfuj-Ul Anwar ◽  
Sajeda Afrin ◽  
ASM Rahenur Mondol ◽  
Mohammad Nurul Islam Khan ◽  
Narayan Chandra Sarkar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patient ◽  
Neurological Deficit ◽  
Hemorrhagic Stroke ◽  
Acute Onset ◽  
Stroke Patients ◽  
Focal Neurological Deficit ◽  
Alteration Of Consciousness ◽  
Acute Hemorrhagic Stroke

Background: Stroke is a leading cause of mortality and disability worldwide. To prevent complications and permanent defects, early diagnosis, distinguishing the type and risk factor of stroke is crucial. Methodology: It was a hospital based cross sectional study, purposive sampling method was used, and a total of 469 stroke patients admitted into Department of Medicine, Rangpur medical college hospital, Bangladesh were included in this study. Results: In this study we have studied of 469 acute stroke patients. Among them 81% (380) were ischemic stroke patients and 19% (89) were hemorrhagic stroke. Overall male were more than female 308 (65.7%) vs 161(34.4%). The mean age for the ischemic stroke group was 64.1 ± 10.9 years, which was significantly higher than that of the hemorrhagic group (59.8 ± 9.60years) (P<0.05). Acute hemorrhagic stroke patients presented with acute onset of focal neurological deficit 61.8%, headache 64%, vomiting 59.6%, alteration of consciousness 48.3% and convulsion 27%. On the other hand, acute ischemic stroke patient presented with alteration of consciousness 65.5%, acute onset of focal neurological deficit 39.5%, paralysis 41%, deficit after awakening 32.4% and aphasia 34.7%. Among the risk factors of stroke in acute ischemic stroke patients hypertension was 59.2%, diabetes mellitus 20%, history of previous stroke 16.1%, ischemic heart disease 14.5% and atrial fibrillation 10.3% were present, on the other hand in acute hemorrhagic stroke patients hypertension 76.4%, smoking 70.8% and diabetes mellitus 6.7% were present. 26.97% of the acute hemorrhagic stroke and 13.9% of the acute ischemic stroke patients died in hospital. Conclusion: Common presentation of stroke was acute onset of focal neurological deficit; headache and vomiting were more in hemorrhagic stroke patient; alteration of consciousness, paralysis was predominant in ischemic stroke patient.

scholarly journals Initial Stroke Severity in Patients With Atrial Fibrillation According to Antithrombotic Therapy Before Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2733-2741 ◽  
Author(s):  
Yo Han Jung ◽  
Young Dae Kim ◽  
Jinkwon Kim ◽  
Sang Won Han ◽  
Mi Sun Oh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Scale Score ◽  
Neurological Deficit ◽  
Odds Ratio ◽  
Medication Use ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Antithrombotic Medication

Background and Purpose: Atrial fibrillation (AF) is the leading cause of ischemic stroke. Preventive antithrombotic use, especially for anticoagulation, reduces the incidence of ischemic stroke in patients with AF. Using data from the nationwide multicenter stroke registry, we investigated the trends of preceding antithrombotic medication use in patients with acute ischemic stroke (AIS) with AF and its association with initial stroke severity and in-hospital outcomes. Methods: This study included 6786 patients with AIS with known AF before stroke admission across 39 hospitals between June 2008 and December 2018. We collected the data on antithrombotic medication use (no antithrombotic/antiplatelet/anticoagulant) preceding AIS. Initial stroke severity was measured using the National Institutes of Health Stroke Scale, and in-hospital outcome was determined by modified Rankin Scale score at discharge. Results: During the study period, anticoagulant use continued to increase. However, nearly one-third of patients with AIS with known AF did not receive antithrombotics before stroke. Initial National Institutes of Health Stroke Scale scores varied according to preceding antithrombotic therapy ( P <0.001). It was higher in patients who did not receive antithrombotics than in those who received antiplatelets or anticoagulants (median National Institutes of Health Stroke Scale score: 8 versus 7 and 8 versus 6, respectively). Favorable outcome at discharge (modified Rankin Scale score, 0–2) was more prevalent in patients who received antiplatelets or anticoagulants ( P <0.001). Use of antiplatelets (odds ratio, 1.23 [95% CI, 1.09–1.38]) and anticoagulants (odds ratio, 1.31 [95% CI, 1.15–1.50]) was associated with a mild initial neurological deficit (National Institutes of Health Stroke Scale score ≤5) in patients with AIS with AF. Conclusions: Throughout the study period, the proportion of patients taking anticoagulants increased among patients with AIS with known AF. However, a large portion of AF patients still did not receive antithrombotics before AIS. Furthermore, prehospitalization use of anticoagulants was associated with a significantly higher likelihood of a mild initial neurological deficit and favorable outcome at discharge.

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