scholarly journals Actigraphic Measurement of the Upper Limbs for the Prediction of Ischemic Stroke Prognosis: An Observational Study

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2479
Author(s):  
Giuseppe Reale ◽  
Silvia Giovannini ◽  
Chiara Iacovelli ◽  
Stefano Filippo Castiglia ◽  
Pietro Picerno ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Stroke Unit ◽  
Prognostic Model ◽  
Recovery Process ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Movement Asymmetry

Background: It is often challenging to formulate a reliable prognosis for patients with acute ischemic stroke. The most accepted prognostic factors may not be sufficient to predict the recovery process. In this view, describing the evolution of motor deficits over time via sensors might be useful for strengthening the prognostic model. Our aim was to assess whether an actigraphic-based parameter (Asymmetry Rate Index for the 24 h period (AR2_24 h)) obtained in the acute stroke phase could be a predictor of a 90 d prognosis. Methods: In this observational study, we recorded and analyzed the 24 h upper limb movement asymmetry of 20 consecutive patients with acute ischemic stroke during their stay in a stroke unit. We recorded the motor activity of both arms using two programmable actigraphic systems positioned on patients’ wrists. We clinically evaluated the stroke patients by NIHSS in the acute phase and then assessed them across 90 days using the modified Rankin Scale (mRS). Results: We found that the AR2_24 h parameter positively correlates with the 90 d mRS (r = 0.69, p < 0.001). Moreover, we found that an AR2_24 h > 32% predicts a poorer outcome (90 d mRS > 2), with sensitivity = 100% and specificity = 89%. Conclusions: Sensor-based parameters might provide useful information for predicting ischemic stroke prognosis in the acute phase.

scholarly journals Fasting lipid profile in acute ischemic stroke patients who are already on lipid-lowering drugs: An observational study

2020 ◽  
Vol 19 (4) ◽  
pp. 286-291
Author(s):  
Muhammad Sohaib Asghar ◽  
◽  
Muhammad Nadeem Ahsan ◽  
Zara Saeed ◽  
Faran Khalid ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Lipid Profile ◽  
Lipid Lowering ◽  
Stroke Patients ◽  
Lipid Lowering Drugs

scholarly journals Admitting Acute Ischemic Stroke Patients to a Stroke Care Monitoring Unit Versus a Conventional Stroke Unit

Stroke ◽  
2003 ◽  
Vol 34 (1) ◽  
pp. 101-104 ◽  
Author(s):  
Geert Sulter ◽  
Jan Willem Elting ◽  
Marc Langedijk ◽  
Natasha M. Maurits ◽  
Jacques De Keyser
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Stroke Care ◽  
Stroke Patients

scholarly journals Sertraline for Functional Recovery After Acute Ischemic Stroke: A Prospective Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Isabella Stuckart ◽  
Timo Siepmann ◽  
Christian Hartmann ◽  
Lars-Peder Pallesen ◽  
Annahita Sedghi ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Functional Recovery ◽  
Prospective Observational Study ◽  
Functional Independence ◽  
Motor Deficit ◽  
Control Group ◽  
Stroke Patients

Background: Neuroprotective and neurorestorative effects have been postulated for selective serotonin-reuptake inhibitors (SSRI). We hypothesized that sertraline, which is characterized by less severe adverse effects and more stable pharmacokinetics than classic SSRI, is associated with improved functional recovery in acute ischemic stroke patients with motor deficits.Methods: Prospective observational study of consecutive acute ischemic stroke patients who received sertraline for clinically suspected post-stroke depression (PSD) or at high risk for PSD. Eligibility comprised acute motor deficit caused by ischemic stroke (≥2 points on NIHSS motor items) and functional independence pre-stroke (mRS ≤1). Decision to initiate treatment with SSRI during hospital stay was at the discretion of the treating stroke physician. Patients not receiving sertraline served as control group. Favorable functional recovery defined as mRS ≤2 was prospectively assessed at 3 months. Multivariable logistic regression analysis was used to explore the effects of sertraline on 3-months functional recovery. Secondary outcomes were frequency of any and incident PSD (defined by BDI ≥10) at 3 months.Results: During the study period (03/2017–12/2018), 114 patients were assigned to sertraline (n = 72, 62.6%) or control group (n = 42, 37.4%). At study entry, patients in sertraline group were more severely neurologically affected than patients in the control group (NIHSS: 8 [IQR, 5–11] vs. 5 [IQR, 4–7]; p = 0.002). Also, motor NIHSS scores were more pronounced in sertraline than in control group (4 [IQR 2–7] vs. 2 [IQR 2–4], p = 0.001). After adjusting for age and baseline NIHSS, multivariable regression analysis revealed a significant association between sertraline intake and favorable functional outcome at 3 months (OR 3.10, 95% CI 1.02–9.41; p = 0.045). There was no difference between both groups regarding the frequency of any depression at 3 months (26/53 [49.1%] vs. 14/28 [50.0%] patients, p = 0.643, BDI ≥10). However, fewer incident depressions were observed in sertraline group patients compared to patients in control group (0/53 [0%] vs. 5/28 [17.9%] patients, p = 0.004).Conclusions: In this non-randomized comparison, early treatment with sertraline tended to favor functional recovery in patients with acute ischemic stroke. While exploratory in nature, this hypothesis needs further investigation in a clinical trial.

scholarly journals The follow-up of patients of sixty-five years of age and younger with acute ischemic stroke and transient ischemic attacks, and elevated D-dimer levels in plasma

2009 ◽  
Vol 1 (1) ◽  
pp. 11
Author(s):  
Magnus Vrethem ◽  
Tomas Lindahl
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Cardioembolic Stroke ◽  
Transient Ischemic Attacks ◽  
Stroke Patients ◽  
Follow Up Study ◽  
Cerebrovascular Events ◽  
D Dimer

D-dimer levels in plasma, a degradation product of fibrin, have been shown to correlate with the severity of ischemic stroke. In order to investigate the outcome of patients with elevated D-dimer we have carried out a follow-up study of patients of 65 years of age and younger with acute ischemic stroke or transient ischemic attacks (TIA) admitted to our stroke unit from 1991 to 1992. Twenty-two of the 57 patients had elevated D-dimer levels in the plasma. High levels were associated with cardioembolic stroke. On follow-up after a mean of 12 years, 15 patients had died and six patients had suffered another stroke or TIA (three of whom were dead). Ten patients had suffered other cardiovascular events and seven of them were dead. We concluded that high levels of D-dimer in acute ischemic stroke patients on admission were associated with cardioembolic stroke and might have prognostic value for the development of further cardio- or cerebrovascular events. Advanced age was found to be an independent risk factor.

Abstract W P232: Lower Rates of Delirium in Stroke Units May Reflect Selection Bias

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Eric M Liotta ◽  
Carlos Corado ◽  
Deborah L Bergman ◽  
Richard A Bernstein ◽  
Fan Z Caprio ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Selection Bias ◽  
Stroke Unit ◽  
Cardioembolic Stroke ◽  
Stroke Patients ◽  
Stroke Units ◽  
Entire Cohort ◽  
Stroke Mechanism

Introduction: Studies of delirium after acute stroke focus on stroke units (SUs). A protective effect of SUs against delirium has been suggested. We hypothesized that selection bias against medically complex patients accounts for this apparent effect. Methods: An observational cohort of acute ischemic stroke patients was screened for post-stroke delirium. Delirium was diagnosed using the Confusion Assessment Method (CAM). Key patient variables were prospectively recorded including initial NIHSS score and medical complications. Univariate associations with delirium were identified and a logistic regression model was developed for the entire cohort. Separate logistic regression models were also developed for non-stroke unit (NSU) and SU patients. The SU consisted of a specialized stroke ward, step-down stroke unit, and a neuroscience ICU. Results: Over 10 months 246 patients (56% male, mean 65 years, 29% in NSUs) met inclusion criteria. Delirium occurred in 30 (12%) patients and was less frequent in the SU (8.0% vs 22.5%, p=0.002). Frequency of CAM checks differed between NSU and SU (median 4.1 vs 3.7 per day; p=0.03). NSU patients had similar NIHSS scores as SU patients (median [interquartile range], 3 [1-8] vs 3 [1-5]; p=0.18) but more ICU admissions (48% vs 27%, p=0.001) and more infections (18% vs 9.7%, p=0.06). In the entire cohort, initial NIHSS (OR 1.07, 95% CI 1.02-1.13; p=0.006), cardioembolic stroke mechanism (OR 3.0, 95% CI 1.3-6.9; p=0.009) and SU care (OR 0.39, 95% CI 0.17-0.88; p=0.02) predicted delirium after correcting for covariates, including frequency of CAM checks. In the NSU model, age (OR 1.06, 95% CI 1.01-1.11; p=0.02) and infections (OR 6.8, 95% CI 1.5-30.2; p=0.01) were associated with delirium. Only cardioembolic stroke mechanism (OR 5.4, 95% CI 1.7-16.7; p=0.003) was associated with delirium in the SU model. Conclusion: Associations with delirium after acute ischemic stroke differ between NSU and SU patients. Stroke patients treated in NSUs are fundamentally different than SU patients. Given the potential for residual confounding, the lower incidence of delirium after stroke in SUs than NSUs may reflect selection bias rather than a specific effect of SU care.

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