scholarly journals The Effect of the 2019 Novel Coronavirus Pandemic on Stroke and TIA Patient Admissions: Perspectives and Risk Factors

2021 ◽  
Vol 10 (7) ◽  
pp. 1357
Author(s):  
Luke Carson ◽  
Christopher Kui ◽  
Gemma Smith ◽  
Anand K. Dixit
Keyword(s):  
Risk Factors ◽  
Transient Ischaemic Attack ◽  
Posterior Circulation ◽  
Modifiable Risk Factors ◽  
Presentation Time ◽  
Ischaemic Attack ◽  
Stroke Mimic ◽  
Novel Coronavirus ◽  
The Impact ◽  
Posterior Circulation Infarct

Background: The 2019 novel coronavirus pandemic has generated concern from stroke specialist centres across the globe. Reductions in stroke admissions have been reported, despite many expecting an increase due to the pro-thrombotic nature of 2019 novel coronavirus. Aims: To assess the impact of the pandemic and subsequent lockdown on stroke admissions and transient ischaemic attack referrals at the Royal Victoria Infirmary, Newcastle-Upon-Tyne, and additionally on patient behaviours affecting modifiable risk factors or perspectives related to accessing healthcare. Methods: A single-centre retrospective data analysis was carried out on a “lockdown” cohort of suspected stroke patients admitted between 11 March to 26 May 2020 and a “pre-lockdown” cohort admitted in 2019. Differences in weekly admissions, weekly referrals, onset-to-presentation time and weekly thrombolysis cases were examined. Further analysis interrogated these cohorts separated by Bamford classification and stroke mimics (such as seizure/hemiplegic migraine/functional neurology). A binary-format questionnaire was separately administered to admitted patients from 15 April to 5 June 2020. Results: Significant reductions in weekly posterior circulation infarct (−43%, p = 0.017) and stroke-mimic (−47%, p < 0.001) admissions and weekly referrals diagnosed as non-transient ischaemic attack (−55%, p = 0.002) were observed in the lockdown cohort, with no differences in onset-to-presentation time. Over 25% of questionnaire respondents reported less physical activity, increased isolation and delaying their presentation due to the pandemic. Conclusions: This study provides evidence of reduced stroke-mimic and posterior circulation infarct admissions. Questionnaire findings suggest that patients need to be informed to ensure they appropriately seek medical advice. Significant communication at the stroke-primary care interface is needed to support referral pathways and management of modifiable risk factors.

History-taking in the stroke patient

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Stroke Patient ◽  
Transient Ischaemic Attack ◽  
Posterior Circulation ◽  
History Taking ◽  
Posterior Circulation Stroke ◽  
Ischaemic Attack ◽  
Stroke Mimic ◽  
Symptoms And Signs

In this history-taking in the stroke patient chapter, general principles of how to approach history taking are outlined. Clinical definitions of both stroke and transient ischaemic attack are discussed, and pointers given as to how to diagnose stroke mimic conditions. Symptoms and signs associated with anterior and posterior circulation stroke are covered as well as how to systematically assess the underlying aetiological cause of stroke in an individual patient.

scholarly journals Aerobic exercise interventions reduce blood pressure in patients after stroke or transient ischaemic attack: a systematic review and meta-analysis

2018 ◽  
Vol 53 (24) ◽  
pp. 1515-1525 ◽  
Author(s):  
Cheng Wang ◽  
Jessica Redgrave ◽  
Mohsen Shafizadeh ◽  
Arshad Majid ◽  
Karen Kilner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Transient Ischaemic Attack ◽  
Meta Analysis ◽  
Vascular Risk Factors ◽  
Cochrane Library ◽  
Vascular Risk ◽  
Exercise Interventions ◽  
Ischaemic Attack

ObjectiveSecondary vascular risk reduction is critical to preventing recurrent stroke. We aimed to evaluate the effect of exercise interventions on vascular risk factors and recurrent ischaemic events after stroke or transient ischaemic attack (TIA).DesignIntervention systematic review and meta-analysis.Data sourcesOVID MEDLINE, PubMed, The Cochrane Library, Web of Science, The National Institute for Health and Care Excellence, TRIP Database, CINAHL, PsycINFO, SCOPUS, UK Clinical Trials Gateway and the China National Knowledge Infrastructure were searched from 1966 to October 2017.Eligibility criteriaRandomised controlled trials evaluating aerobic or resistance exercise interventions on vascular risk factors and recurrent ischaemic events among patients with stroke or TIA, compared with control.ResultsTwenty studies (n=1031) were included. Exercise interventions resulted in significant reductions in systolic blood pressure (SBP) −4.30 mm Hg (95% CI −6.77 to −1.83) and diastolic blood pressure −2.58 mm Hg (95% CI −4.7 to −0.46) compared with control. Reduction in SBP was most pronounced among studies initiating exercise within 6 months of stroke or TIA (−8.46 mm Hg, 95% CI −12.18 to −4.75 vs −2.33 mm Hg, 95% CI −3.94 to −0.72), and in those incorporating an educational component (−7.81 mm Hg, 95% CI −14.34 to −1.28 vs −2.78 mm Hg, 95% CI −4.33 to −1.23). Exercise was also associated with reductions in total cholesterol (−0.27 mmol/L, 95% CI −0.54 to 0.00), but not fasting glucose or body mass index. One trial reported reductions in secondary vascular events with exercise, but was insufficiently powered.SummaryExercise interventions can result in clinically meaningful blood pressure reductions, particularly if initiated early and alongside education.

scholarly journals How stress mediators can cumulatively contribute to Alzheimer’s disease An allostatic load approach

2019 ◽  
Vol 13 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Tatiane Martins Matos ◽  
Juliana Nery De Souza-Talarico
Keyword(s):  
Risk Factors ◽  
Cognitive Decline ◽  
Disease Progression ◽  
Chronic Stress ◽  
Allostatic Load ◽  
Stress Hormones ◽  
Modifiable Risk Factors ◽  
Cognitive Changes ◽  
Stress Mediators ◽  
The Impact

ABSTRACT. Allostatic load is defined as the frequent activation of the neuroendocrine, immunological, metabolic and cardiovascular systems, which makes individuals more susceptible to stress-related health problems. According to this model, physiological dysregulations start to emerge decades before diseases manifest. Consequently, stress research has shifted its attention to anticipating the degree of this dysregulation to better understand the impact of stress hormones and other biomarkers on disease progression. In view of the growing number of studies that demonstrate the influence of modifiable risk factors on cognitive decline, in addition to the effects of chronic stress mediators, the objective of the present review was to present an overview of the development of cognitive changes based on studies on stress and its mediators.

scholarly journals 237 Systematic Review of Fibrinogen and Risk of Recurrent Stroke and Vascular Events after Ischaemic Stroke or Transient Ischaemic Attack (TIA)

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
John J McCabe ◽  
Eimear O'Reilly ◽  
Sarah Coveney ◽  
Ronan Collins ◽  
Simon Cronin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Prognostic Value ◽  
Recurrent Stroke ◽  
Multivariable Analysis ◽  
Positive Association ◽  
Case Control Studies ◽  
Vascular Events ◽  
Ischaemic Attack

Abstract Background Inflammation is thought to play an important role in atherosclerotic stroke mechanisms. There is growing interest in the prognostic role of inflammatory biomarkers as risk factors for recurrent vascular events, after ischaemic stroke or transient ischaemic attack (TIA). Elevated fibrinogen levels are independently-associated with the risk of first-ever stroke. However, the prognostic value of fibrinogen, after ischaemic cerebrovascular events is uncertain. Methods We searched EMBASE and Ovid Medline, from 1970-January 2019, for any study that measured Fibrinogen after stroke or TIA, and related it to the risk of recurrent stroke or recurrent vascular events. All records were assessed by 2 independent reviewers. Any disagreements between authors regarding eligibility were resolved by consensus. Results We identified 2,520 publications, of which, 15 articles from 16 individual studies were eligible (11 observational cohorts, 3 cohort studies within randomized control trials, 2 case-control studies). The sample size for recurrent stroke and recurrent vascular events was 9,963 and 7,381 patients, in 11 and 10 studies, respectively. The time from event to phlebotomy was <7 days in 5, 7-90 days in 6, and >90 days in 5 studies, respectively. There was marked heterogeneity in statistical methodologies employed to examine the relationship between fibrinogen and outcomes, which did not allow valid meta-analysis (above/below specified threshold (n=4), differences in means/medians (n=5), risk per unit increase (n=1), per standard deviation (n=3), per quartile (n=1), per decile (n=1) or not specified (n=1)). 4 studies adjusted for all conventional vascular risk factors (age, smoking, diabetes, hypercholesterolaemia/statin use, and hypertension). 2 of 11 studies found a positive association with recurrent stroke. 5 of 10 studies found a positive association with recurrent vascular events. Conclusion The prognostic value of Fibrinogen after stroke or TIA remains unclear. Standardised methods and fully-adjusted multivariable analysis are needed in future prognostic studies.

scholarly journals Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme

2019 ◽  
Vol 69 (687) ◽  
pp. e706-e714 ◽  
Author(s):  
Neil Heron ◽  
Frank Kee ◽  
Jonathan Mant ◽  
Margaret E Cupples ◽  
Michael Donnelly
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Transient Ischaemic Attack ◽  
Standard Care ◽  
Minor Stroke ◽  
Home Based ◽  
Ischaemic Attack

BackgroundAlthough the importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context.AimTo pilot a randomised controlled trial (RCT) of a novel home-based prevention programme (The Healthy Brain Rehabilitation Manual) for patients with TIA or ‘minor’ stroke.Design and settingPilot RCT, home-based, undertaken in Northern Ireland between May 2017 and March 2018.MethodPatients within 4 weeks of a first TIA or ‘minor’ stroke received study information from clinicians in four hospitals. Participants were randomly allocated to one of three groups: standard care (control group) (n = 12); standard care with manual and GP follow-up (n = 14); or standard care with manual and stroke nurse follow-up (n = 14). Patients in all groups received telephone follow-up at 1, 4, and 9 weeks. Eligibility, recruitment, and retention were assessed; stroke/cardiovascular risk factors measured at baseline and 12 weeks; and participants’ views were elicited about the study via focus groups.ResultsOver a 32-week period, 28.2% of clinic attendees (125/443) were eligible; 35.2% of whom (44/125) consented to research contact; 90.9% of these patients (40/44) participated, of whom 97.5% (39/40) completed the study. After 12 weeks, stroke risk factors [cardiovascular risk factors, including blood pressure and measures of physical activity] improved in both intervention groups. The research methods and the programme were acceptable to patients and health professionals, who commented that the programme ‘filled a gap’ in current post-TIA management.ConclusionFindings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or ‘minor’ stroke.

scholarly journals Appropriateness of general practitioner imaging requests for transient ischaemic attack patients: secondary analysis of a cluster randomised controlled trial

2017 ◽  
Vol 9 (2) ◽  
pp. 131 ◽  
Author(s):  
Annemarei Ranta ◽  
Mark Weatherall ◽  
John Gommans ◽  
Murray Tilyard ◽  
Des Odea ◽  
...  
Keyword(s):  
Decision Support ◽  
Randomised Controlled Trial ◽  
Transient Ischaemic Attack ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Electronic Decision Support ◽  
Investigation Methods ◽  
Ischaemic Attack ◽  
Randomised Controlled ◽  
The Impact

Abstract AIMS Many transient ischaemic attack (TIA) patients receive initial assessments by general practitioners (GPs). In a randomised controlled trial (RCT) we showed that BPAC Inc. TIA/stroke electronic decision support (EDS) for GPs improves patient outcomes and guideline adherence. This secondary analysis assesses the impact of trial associated enhanced GP access to radiological investigation. METHODS Post-hoc analysis of a multi-centre, single blind, parallel group, cluster RCT comparing TIA/stroke EDS guided GP management with usual care to assess whether imaging requests and their appropriateness differed between study groups. RESULTS GPs requested 15/291 (5.2%) carotid ultrasounds and 19/291 (6.5%) computed tomography (CT) head scans. Scans were obtained more frequently in the intervention group (ultrasound cluster adjusted OR (95% CI) 1.41 (0.44 to 4.49), P = 0.56 and CT 13.8 (1.7 to 110.7), P < 0.001). All CTs were clinically appropriate. More ultrasounds were appropriate in the EDS group (cluster adjusted OR (95% CI) of 8.4 (0.39 to 92.3), P = 0.18). Overall investigation costs did not differ between groups (P = 0.83). Some apparent avoidable imaging duplication occurred where patients were subsequently assessed by secondary services. CONCLUSION In the setting of a RCT assessing GP electronic decision support, frequency of GP initiated imaging requests was low and largely appropriate especially in the setting of EDS use. Thus enhanced GP imaging access as part of the EDS tool did not result in inappropriate or excessive GP imaging requests. However, some duplication occurred and practitioners need to ensure that test referrals and results are adequately communicated between sectors.

scholarly journals Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Jittima Saengsuwan ◽  
Pathitta Suangpho ◽  
Somsak Tiamkao
Keyword(s):  
Risk Factors ◽  
Transient Ischaemic Attack ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Warning Signs ◽  
High Risk Population ◽  
Cross Sectional ◽  
Stroke Risk Factors ◽  
Ischaemic Attack ◽  
Structured Interventions

Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack) have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females). Using an open-ended questionnaire, nearly one-third of patients (31.4%) could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%), dyslipidemia (28.6%), and diabetes (22.9%). Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%), sudden trouble with speaking (25.7%), and sudden trouble with walking, loss of balance, or dizziness (21.4%). Nineteen patients (13.6%) could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

Abstract TP166: The Topmost Modifiable Risk Factors for Stroke Among People of African Ancestry

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mayowa O Owolabi ◽  
Fred S Sarfo ◽  
Onoja Akpa ◽  
Mulugeta Gebregziabher ◽  
Rufus Akinyemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Ancestry ◽  
Vascular Risk Factors ◽  
Systematic Evaluation ◽  
Modifiable Risk Factors ◽  
Large Artery ◽  
Vascular Risk ◽  
Geographical Variations ◽  
Catchment Areas ◽  
The Impact

Background: Regional and geographical variations exist in stroke burden and risk factor distribution. The unique and dominant risk factors for stroke among people of African ancestry where the burden of stroke is escalating, are poorly understood. Such information is crucial in prioritizing tailor-made interventions to tackle the menace of stroke in developing countries. Purpose: We aimed to identify and quantify the contributions of the topmost modifiable risk factors for stroke occurrence in people of African ancestry within the context of the Stroke Investigative Research and Educational Network (SIREN), the largest study of stroke in Africa. Methods: The SIREN study is an ongoing, multicenter, case-control study involving several sites in Nigeria and Ghana. Cases included adults aged >18 years with first clinical stroke within 8 days of current symptom onset with CT scan confirmation. Controls were stroke-free adults, mostly from the communities in the catchment areas of the SIREN hospitals where cases were recruited. A systematic evaluation of traditional vascular risk factors as well as lifestyle and behavioral factors were assessed for cases and controls. Results: 1,638 cases and 1,653 controls with mean ages of 58.52 and 57.76 years respectively were recruited. Ischemic and hemorrhagic stroke types constituted 62.4% and 36.1% of stroke respectively. Among ischemic stroke subjects, 45.7%, 36.3%, 13.6%, 1.0% and 3.4% had small-vessel, large-artery atherosclerosis, cardio-embolic, others and unknown subtypes according to the TOAST classification. Leading vascular risk factors identified among stroke subjects compared with controls were hypertension- 79.3% vs 34.6%, p<0.001; Dyslipidemia 20.8% vs 6.6%, p<0.001; Diabetes mellitus- 24.4% vs 12.8% and history of cardiac diseases 15.4% vs 7.9%, p<0.001. Adjusted ORs (95% CI) for hypertension, dyslipidemia, cardiac disease and diabetes among stroke subjects compared with controls were 6.43 (5.84-7.54), 2.08 (1.61-2.69), 1.48 (1.15-1.91) and 1.29 (1.05-1.60) respectively. Conclusion: Implementation of interventions towards mitigating the impact of vascular risk factors at the population level would be essential in curtailing the growing burden of stroke in Africans.

An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not?

2021 ◽  
pp. 1-6
Author(s):  
X Huang ◽  
N Grimmond ◽  
G Kontorinis
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
White Matter ◽  
Cardiovascular Risk Factors ◽  
Transient Ischaemic Attack ◽  
White Matter Hyperintensities ◽  
Resonance Imaging ◽  
Vascular Events ◽  
Ischaemic Attack

Abstract Background Magnetic resonance imaging of the internal auditory meatus frequently detects incidental white matter hyperintensities. This study investigated the association between these and the risk of stroke and transient ischaemic attack, or myocardial infarction. Methods The records of patients with incidental white matter hyperintensities were reviewed, and data were collected on: age, sex, cardiovascular risk factors, and incidence of stroke and transient ischaemic attack, or myocardial infarction, five years later. The risk factors associated with vascular events were explored. Results Of 6978 patients, 309 (4.4 per cent) had incidental white matter hyperintensities. Of these, 20 (6.5 per cent) had a stroke or transient ischaemic attack within five years, and 5 (1.7 per cent) had a myocardial infarction. The number of cardiovascular risk factors was significantly associated with the incidence of stroke and transient ischaemic attack (p = 0.004), and myocardial infarction (p = 0.023). Conclusion The number of cardiovascular risk factors predicts the likelihood of vascular events; appropriate risk factor management is recommended for patients with incidental white matter hyperintensities of presumed vascular origin.

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