Faculty Opinions recommendation of Stroke-unit care for acute stroke patients: an observational follow-up study.

Introduction: Cerebrovascular diseases are important causes of disability and death. Cardiovascular diseases and stroke share most of the risk factors and there is an intense relation between cerebral and cardiac homeostasis. Electrocardiogram can be used as measurement of neurogenic cardiac abnormalities as it has been suggested that lesions in the insula may result in abnormal electrocardiographic (ECG) findings and increased risk of sudden death. We assessed the hypothesis that electrocardiographic changes in acute stroke could predict neurological outcome at 90 days Methods: It was a longitudinal prospective study, with stroke patients admitted in an acute Stroke Unit from March 2012 to March 2013. We included all stroke patients within 24h of symptom onset and diagnosis confirmed with head CT scans. We excluded patients with history of cardiac surgery, myocardial infarct and pulmonary thromboembolism within 2 weeks before stroke. We collect data about clinical history and demography, admission NIHSS score and ECG. All patients were followed and in hospital complications, length of stay and modified Rankin score at 90 days were registered. Follow up visits were done by a Neurologist blinded to admission ECG findings; and ECG were analyzed by a Cardiologist blinded to clinical aspects. Statistical analysis was done with logistic regression with correction to gender, admission NIHSS, presence of clinical complications and blood pressure control. Results: Of 247 admitted to stroke unit, 112 fulfilled inclusion criteria and agreed to participate. It was observed positive correlation between ST segment abnormalities on admission ECG and cardiac complications during hospitalization (OR 4.73, IC(95%) 1.49 - 14.98, p: 0.008), worse neurologic outcome at 90 days measured by Rankin 3 - 6 (OR 3.4, IC(95%) 1.07-11.12, p: 0.038), and death at the end of follow up (OR 4.25, IC(95%) 1.17-15.49, p: 0.028). Conclusions: In conclusion, this study showed that ECG findings at admission, especially ST segment abnormalities, were correlated to higher chance of in hospital cardiac complications, worse neurologic outcomes and mortality at 90 days.

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Stroke unit care: recurrence, mortality and institutionalisation rates—a four year follow-up study

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-008-0144-0 ◽

2008 ◽

Vol 177 (2) ◽

pp. 183-183

Author(s):

T. Walsh ◽

T. Donnelly ◽

S. Carew ◽

C. O’ Connor ◽

R. O’ Riordan ◽

...

Keyword(s):

Stroke Unit ◽

Follow Up Study ◽

Stroke Unit Care

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Poor Functional Status of Stroke Patients after Hospital Discharge: Scope for Intervention?

British Journal of Occupational Therapy ◽

10.1177/030802269205501006 ◽

1992 ◽

Vol 55 (10) ◽

pp. 383-385 ◽

Cited By ~ 13

Author(s):

Susan Corr ◽

Antony Bayer

Keyword(s):

Social Services ◽

Stroke Unit ◽

Inpatient Rehabilitation ◽

Stroke Patients ◽

Outdoor Activities ◽

Health And Social Services ◽

Follow Up Study ◽

Poor Functional Status ◽

Hospital Rehabilitation

In a follow-up study of stroke patients discharged from hospital after inpatient rehabilitation in a stroke unit, day-to-day functioning was assessed using the Barthel Index and the Frenchay Activities Index. Levels of dependency recorded at discharge tended to persist or worsen over the subsequent 7 to 12 months and very few patients returned to any domestic, leisure or outdoor activities once they were back in the community. Those in residential care were especially disadvantaged. Contact with health and social services was minimal. The findings suggest that there is considerable need for continuing support and intervention for stroke patients after in-hospital rehabilitation. The occupational therapist would seem potentially well-suited to this role.

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Stroke unit care: recurrence, mortality and institutionalisation rates—a four year follow-up study

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-007-0110-2 ◽

2007 ◽

Vol 177 (2) ◽

pp. 135-139 ◽

Cited By ~ 2

Author(s):

T. Walsh ◽

T. Donnelly ◽

S. Carew ◽

C. O’ Connor ◽

R. O’ Riordan ◽

...

Keyword(s):

Stroke Unit ◽

Follow Up Study ◽

Stroke Unit Care

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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

Neurology International ◽

10.4081/ni.2009.e11 ◽

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.

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Treatment with Diazepam in Acute Stroke Prevents Poststroke Seizures: A Substudy of the EGASIS Trial

Cerebrovascular Diseases ◽

10.1159/000512799 ◽

2021 ◽

pp. 1-6

Author(s):

Julia H. van Tuijl ◽

Elisabeth P.M. van Raak ◽

Robert J. van Oostenbrugge ◽

Albert P. Aldenkamp ◽

Rob P.W. Rouhl

Keyword(s):

Placebo Group ◽

Acute Stroke ◽

Incidence Rate Ratio ◽

Day Treatment ◽

Stroke Patients ◽

Early Administration ◽

Anterior Circulation ◽

Double Blind

Objective: The frequency of seizures after stroke is high, with a severe impact on the quality of life. However, little is known about their prevention. Therefore, we investigated whether early administration of diazepam prevents the development of seizures in acute stroke patients. Methods: We performed a substudy of the EGASIS trial, a multicenter double-blind, randomized trial in which acute stroke patients were treated with diazepam or placebo for 3 days. Follow-up was after 2 weeks and 3 months. The occurrence of seizures was registered prospectively as one of the prespecified secondary outcomes. Results: 784 EGASIS patients were eligible for this substudy (389 treated with diazepam [49.6%] and 395 treated with placebo [50.4%]). Seizures were reported in 19 patients (2.4% of the total patient group). Seizures occurred less frequently in patients treated with diazepam (1.5 vs. 3.3% in the placebo group); however, this difference was only statistically significant in patients with a cortical anterior circulation infarction (0.9% in the diazepam group vs. 4.6% in the placebo group, incidence rate ratio 0.20, 95% CI: 0.05–0.78, p = 0.02, NNT = 27). Conclusion: We found that a 3-day treatment with diazepam after acute cortical anterior circulation stroke prevents the occurrence of seizures in the first 3 months following stroke.

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