The Impact of Transient Ischemic Attack (TIA) on Brain and Behavior

The developmental origins of health and disease hypothesis applied to neurodevelopmental outcomes asserts that the fetal origins of future development are relevant to mental health. There is a third pathway for the familial inheritance of risk for psychiatric illness beyond shared genes and the quality of parental care: the impact of pregnant women's distress—defined broadly to include perceived stress, life events, depression, and anxiety—on fetal and infant brain–behavior development. We discuss epidemiological and observational clinical data demonstrating that maternal distress is associated with children's increased risk for psychopathology: For example, high maternal anxiety is associated with a twofold increase in the risk of probable mental disorder in children. We review several biological systems hypothesized to be mechanisms by which maternal distress affects fetal and child brain and behavior development, as well as the clinical implications of studies of the developmental origins of health and disease that focus on maternal distress. Development and parenting begin before birth.

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Gonadal steroids, brain, and behavior: role of context

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2002.4.2/drubinow ◽

2002 ◽

Vol 4 (2) ◽

pp. 123-137 ◽

Cited By ~ 1

Keyword(s):

Mood Disorders ◽

Steroid Hormones ◽

Differential Susceptibility ◽

Reproductive Function ◽

Gonadal Steroids ◽

Wide Range ◽

Reproductive Endocrine ◽

Brain And Behavior ◽

And Behavior ◽

The Impact

The nature and extent of the impact of gender and reproductive function on mood has been the subject of speculation and controversy for centuries. Over the past 50 years, however, it has become increasingly clear that not only is the brain a major target of reproductive steroid hormones, but additionally, the steroid hormones, as neuroregulators, create a context thai influences a broad range of brain activities; ie, neural actions and resultant behaviors are markedly different in the presence and absence of gonadal steroids. In turn, the actions of gonadal steroids are themselves context-dependent. Thus, even where it can be demonstrated thai gonadal steroids trigger mood disorders, the triggers are normal levels of gonadal steroids (to be contrasted with the mood disturbances accompanying endocrinopathies), and the mood disorders appear only in a subset of susceptible individuals. The context specificity and differential susceptibility to affective dysregulation seen in women with reproductive endocrine-related mood disorders are undoubtedly important underlying characteristics of a wide range of psychiatric disorders in which the triggers have not yet been identified. Consequently, reproductive endocrine-related mood disorders offer unparalleled promise for the identification of those contextual variables that permit biological stimuli to differentially translate into depression in individuals at risk.

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Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care

Stroke ◽

10.1161/strokeaha.121.034150 ◽

2021 ◽

Author(s):

Clotilde Balucani ◽

J. Ricardo Carhuapoma ◽

Joseph K. Canner ◽

Roland Faigle ◽

Brenda Johnson ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Unintended Consequences ◽

Stroke Subtype ◽

Hospital Arrival ◽

Time Period ◽

Ischemic Attack ◽

The Impact ◽

Emergency Measures

Background and Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, the various emergency measures implemented to contain the spread of the virus and to overcome the volume of affected patients presenting to hospitals may have had unintended consequences. Several studies reported a decrease in the number of stroke admissions. There are no data on the impact of the COVID-19 pandemic on stroke admissions and stroke care in Maryland. Methods: A retrospective analysis of quality improvement data reported by stroke centers in the State of Maryland. The number of admissions for stroke, overall and by stroke subtype, between March 1 and September 30, 2020 (pandemic) were compared with the same time period in 2019 (prepandemic). Median last known well to hospital arrival time, the number of intravenous thrombolysis and thrombectomy were also compared. Results: During the initial 7 months of the pandemic, there were 6529 total admissions for stroke and transient ischemic attack, monthly mean 938 (95% CI, 837.1–1038.9) versus prepandemic 8003, monthly mean 1156.3 (CI, 1121.3–1191.2), P <0.001. A significant decrease was observed in intravenous thrombolysis treatments, pandemic 617, monthly mean 88.1 (80.7–95.6) versus prepandemic 805, monthly mean 115 (CI, 104.3–125.6), P <0.001; there was no significant decrease for thrombectomies. The pandemic decreased the probability of admissions for stroke and transient ischemic attack by 19%, for acute ischemic stroke by 20%, for the number of intravenous thrombolysis performed by 23%. There was no difference in the number of admissions for subarachnoid hemorrhage, pandemic 199, monthly mean 28.4 (CI, 22.5–34.3) versus prepandemic 217, monthly mean 31 (CI, 23.9–38.1), respectively, P =0.507. Conclusions: Our findings suggest that the COVID-19 pandemic adversely affected the acute care of unrelated cerebrovascular emergencies.

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Abstract TP316: Appraising the Quality of Patient Care in Hospitalization for Transient Ischemic Attack

Stroke ◽

10.1161/str.47.suppl_1.tp316 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kavelin Rumalla ◽

Adithi Y Reddy ◽

Ashna Rajan ◽

Manoj K Mittal

Keyword(s):

Risk Factors ◽

Transient Ischemic Attack ◽

Pressure Ulcers ◽

Artery Bypass ◽

Bypass Graft ◽

Healthcare Research ◽

Adjusted Risk ◽

Patient Safety Indicators ◽

Ischemic Attack ◽

The Impact

Introduction: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital-acquired conditions (HACs) are federally implemented quality metrics. The necessity of hospitalization for transient ischemic attack (TIA) remains controversial. Here, we report the incidence, risk factors, and in-hospital outcomes associated with HACs and PSIs in this population. Methods: The Nationwide Inpatient Sample (2002-2011) was queried for all records coded as primary diagnoses of TIA. The impact of demographics, insurance status, comorbidities, and in-hospital procedures on the occurrence of PSIs and HACs and the effect of these events on length of stay (LOS), hospital costs, and mortality was examined in bivariate and multivariate analyses. Results: A total of 52,969 PSIs and 21,612 HACs were identified among 2,117,247 TIA hospitalizations. The most frequent PSIs were pressure ulcers (1,173 per 100,000 patients), deep vein thrombosis (376 per 100,000 patients), and respiratory failure (329 per 100,000 patients) while the most frequent HACs were falls/trauma (942 per 100,000 patients), poor glycemic control (33 per 100,000 patients), and stage III/IV pressure ulcers (31 per 100,000 patients). In adjusted analyses, age 85+ (odds ratios [ORs]: 3.81, 1.50), Medicare (ORs: 1.62, 1.37), Medicaid (ORs: 2.01, 1.34), and 3+ comorbidities (ORs: 2.83, 1.30) were independent predictors of PSI or HAC occurrence, respectively (all p<0.0001). Adjusted risk factors of PSI occurrence included: black race (OR: 1.21), in-hospital ischemic stroke (OR: 1.97), thrombolytic therapy (OR: 2.54), coronary angioplasty (OR: 1.81), and coronary artery bypass graft (OR: 7.18) (all p<0.0001). PSI or HAC in TIA patients independently predicted prolonged LOS, increased total costs, and adverse discharges (all p<0.0001). In TIA patients suffering a PSI or HAC, odds of mortality were increased by factors of 30.1 and 4.08, respectively (all p<0.0001). Conclusion: Among TIA hospitalizations, patient age, race, payer status, pre-existing comorbidity, hospital characteristics, and procedural management significantly impact the occurrence of PSIs and HACs, further affecting patient outcomes.

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The impact of blood pressure in the emergency department on survival in transient ischemic attack

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2004.07.387 ◽

2004 ◽

Vol 44 (4) ◽

pp. S120

Author(s):

L.G. Stead ◽

B. Peake ◽

A.L. Weaver ◽

R.D. Brown ◽

W.W. Decker

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Transient Ischemic Attack ◽

Ischemic Attack ◽

The Impact

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Redefinition of Transient Ischemic Attack Improves Prognosis of Transient Ischemic Attack and Ischemic Stroke

Stroke ◽

10.1161/strokeaha.111.627877 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3612-3613 ◽

Cited By ~ 16

Author(s):

Michael T. Mullen ◽

Brett L. Cucchiara

Keyword(s):

Magnetic Resonance Imaging ◽

Sensitivity Analysis ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Transient Ischemic Attack ◽

Stroke Risk ◽

Resonance Imaging ◽

Acute Infarction ◽

Ischemic Attack ◽

The Impact

Background and Purpose— The recent redefinition of transient ischemic attack (TIA) reclassifies patients with acute infarction on magnetic resonance imaging as ischemic stroke. Redefinition will improve the prognosis of both TIA and ischemic stroke, an epidemiological paradox known as the Will Rogers phenomenon. We sought to quantify the impact of this phenomenon. Methods— Incidence of TIA, risk of death/disability after stroke, rate of acute infarction on magnetic resonance imaging after TIA, and 90-day stroke risk after TIA with and without infarction on magnetic resonance imaging were determined based on published data. The impact on poststroke disability in the redefined cohort of patients with ischemic stroke was computed. A sensitivity analysis was performed to account for uncertainty in input variables. Results— Using the new TIA definition, the 90-day risk of stroke following TIA is 1%. In the United States, redefinition will increase annual ischemic stroke incidence from 691 650 to 747 755 and result in a 3.4% absolute reduction in poststroke disability. In a sensitivity analysis, this risk reduction varies from 1.5 to 6.5%, and is most dependent on the incidence of TIA. Conclusions— Redefinition of TIA reduces stroke risk after TIA to approximately 1% at 90 days, and reduces the rate of poststroke disability by approximately 3.4%.

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Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

CJEM ◽

10.1017/cem.2016.3 ◽

2016 ◽

Vol 18 (5) ◽

pp. 331-339 ◽

Cited By ~ 4

Author(s):

Gregory W. Hosier ◽

Stephen J. Phillips ◽

Steve P. Doucette ◽

Kirk D. Magee ◽

Gordon J. Gubitz

Keyword(s):

Myocardial Infarction ◽

Transient Ischemic Attack ◽

Disease Risk ◽

Survival Curve ◽

Cox Proportional Hazards ◽

Vascular Imaging ◽

Vascular Death ◽

Ischemic Attack ◽

The Impact

AbstractObjectives1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic.MethodsRetrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission.ResultsOf the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p<0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08–0.99, p=0.048).ConclusionThe majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death.

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Satellite Imaging of Global Urbanicity relates to Brain and Behavior in Young People

10.21203/rs.3.rs-155206/v1 ◽

2021 ◽

Author(s):

Gunter Schumann ◽

JIAYUAN XU ◽

Xiaoxuan Liu ◽

Alex Ing ◽

QIAOJUN LI ◽

...

Keyword(s):

Mental Illness ◽

Prefrontal Cortex ◽

Young People ◽

Population Density ◽

Urban Life ◽

Depression Symptoms ◽

General Measure ◽

Brain And Behavior ◽

And Behavior ◽

The Impact

Abstract Urbanicity is a growing environmental challenge for mental-health. While the impact of urban life on brain and behavior might be distinct in different sociocultural conditions and geographies, there might exist features shared between regions. To investigate correlations of urbanicity with brain structure and function, neuropsychology and mental illness symptoms in young people from China and Europe, we developed a remote-sensing satellite-measure termed ‘UrbanSat’ quantifying population-density, a general measure of urbanicity. UrbanSat is correlated with brain volume, surface area and brain-network-connectivity in the medial prefrontal cortex and cerebellum, which mediate its effect on perspective-taking and depression- symptoms. Susceptibility to high population-density is greatest during childhood for the cerebellum and from childhood to adolescence for the prefrontal cortex. As UrbanSat can be generalized to different geographies, it will enable assessing the impact of urbanicity on mental illness and resilience globally, especially in young people where prevention and early interventions are most effective.

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The decrease in hospitalizations for transient ischemic attack and ischemic stroke, especially in mild cases, during the COVID-19 epidemic in Japan

10.1101/2020.11.17.20233692 ◽

2020 ◽

Author(s):

Hiroyuki Nagano ◽

Daisuke Takada ◽

Jung-ho Shin ◽

Tetsuji Morishita ◽

Susumu Kunisawa ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Hemorrhagic Stroke ◽

Hospital Admissions ◽

Health Care Systems ◽

Number Of Patients ◽

Stroke Diagnosis ◽

Before And After ◽

Ischemic Attack ◽

The Impact

AbstractBackground and PurposeThe epidemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study was to assess the impact of the COVID-19 epidemic on hospital admissions for stroke in Japan.MethodsWe analyzed administrative (Diagnosis Procedure Combination) data for cases of inpatients aged 18 years and older who were diagnosed with stroke (ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, or subarachnoid hemorrhage (SAH)) and discharged from hospital during the period July 1, 2018 to June 30, 2020. The number of patients with each stroke diagnosis, various patient characteristics, and treatment approaches were compared before and after the epidemic. Changes in the trend of the monthly number of inpatients with each stroke diagnosis were assessed using interrupted time-series analyses.ResultsA total of 111,922 cases (ischemic stroke: 74,897 cases; TIA: 5,374 cases; hemorrhagic stroke: 24,779 cases; SAH: 6,872 cases) in 253 hospitals were included. The number of cases for all types of stroke decreased (ischemic stroke: -13.9%; TIA: -21.4%; hemorrhagic stroke: -9.9%; SAH: -15.2%) in April and May 2020, compared to the number of cases in 2019. Ischemic stroke and TIA cases, especially mild cases (modified Rankin Scale = 0), decreased, with a statistically significant change in trend between the before- and after-epidemic periods.ConclusionsThese data showed a marked reduction in the number of hospital admissions due to stroke during the COVID-19 epidemic. The change in Ischemic stroke and TIA cases, especially mild cases, was statistically significant.

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The Impact of Terrorism on Brain, and Behavior: What We Know and What We Need to Know

Neuropsychopharmacology ◽

10.1038/sj.npp.1300817 ◽

2005 ◽

Vol 30 (10) ◽

pp. 1773-1780 ◽

Cited By ~ 26

Author(s):

Rachel Yehuda ◽

Steven E Hyman

Keyword(s):

Brain And Behavior ◽

And Behavior ◽

The Impact

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