scholarly journals Predictors of functional dependence at hospital discharge in a stroke unit

2021 ◽  
Author(s):  
Isadora Souza Rocha ◽  
Paola Nabhan Leonel dos Santos ◽  
João Guilherme Bochnia Küster ◽  
Maria Angélica Vieira Lizama ◽  
Vinícius Riegel Giugno ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
High Frequency ◽  
Stroke Unit ◽  
Hemorrhagic Stroke ◽  
Functional Dependence ◽  
Hemorrhagic Transformation ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Unit Design ◽  
Specialized Care

Introduction: Functional dependence is a common condition poststroke. The specialized care offered at the stroke unit can provide patients with better rehabilitation. We designed a study to evaluate risk factors for functional dependence at hospital discharge in a stroke unit. Design and setting: Prospective cohort study at Hospital Geral Roberto Santos. Methods: Patients were admitted within 72h of ictus. Functional dependence was defined as scores 3-5 on the modified Rankin Scale (mRS). Results: 389 patients were enrolled, with a mean age of 59.3 (±17.9) years, of whom 55.8% were men. The frequency of functional dependence at discharge was 57.1%, 50.3% at 30 days, and 38.8% at 90 days of the ictus. Higher risk of dependence at hospital discharge were associated with stroke recurrence [RR 1.2 (1.0 - 1.5)], polypharmacy [RR 1.3 (1.1 - 1.6)], female sex [RR 1.3 (1.1 - 1.6)], hemorrhagic stroke [RR 1.4 (1.2 - 1.7)], large artery atherosclerosis by TOAST [RR 1.6 (1.2 - 2.0)], hemorrhagic transformation [RR 1.57 (1.3 - 1.9)], infection [RR 1.7 (1.5 - 2.0)] and delirium [RR 1.8 (1.5 - 2.0)] during hospitalization. Conclusions: We have demonstrated a high frequency of functional dependence at hospital discharge from the stroke unit. Understanding which patients may have a worse functional outcome can be a good strategy to articulate access to the rehabilitation.

scholarly journals Young Adult Stroke in Taiwan: etiologies and outcomes

2019 ◽  
Author(s):  
Chun-Yu Chen ◽  
Po-Tso Lin ◽  
Ruei-Wun Syu ◽  
Shao-lun Hsu ◽  
Li-Hsin Chang ◽  
...  
Keyword(s):  
Early Onset ◽  
Hemorrhagic Stroke ◽  
Age Of Onset ◽  
Familial Aggregation ◽  
The Elderly ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Monogenic Diseases ◽  
History Of ◽  
Hypertensive Intracerebral Hemorrhage

Abstract Background Early-onset adult stroke has not been fully characterized in Asians. Objectives We investigated the etiologic subtypes, risk factors and 1-year outcomes of early-onset stroke (16 – 55 years of age) in a Taiwanese cohort. Methods We retrospectively reviewed consecutive patients with acute stroke admitted to the Taipei Veterans General Hospital in Taiwan between 2009 and 2017. Patients were classified by age of onset (≤ or > 55) and etiologic subtypes and regularly followed for 1 year. Results Among all stroke patients (n=8155), 17.6% (n=1310) were early-onset, who had slightly more spontaneous hemorrhagic stroke (50.8%) than ischemic stroke (49.2%). The most common etiologic subtypes of hemorrhagic stroke were hypertensive intracerebral hemorrhage (ICH), subarachnoid hemorrhage and undetermined ICH. The most common subtypes of infarction were large artery atherosclerosis, other determined diseases (52.5% arterial dissection) and embolic stroke of undetermined source. Smoking, alcohol overdrink, obesity, ischemic heart disease and family history of stroke were more in the early-onset than the elderly patients. The early-onset patients with familial stroke (n=87, 6.6%) were more males and more commonly had infarction than those without familial stroke. Monogenic diseases accounted for 5.7% of young familial stroke. At 1-year follow-up, the early-onset patients with infarction displayed greater functional improvements but more stroke recurrence than those with ICH. Conclusions Hypertensive hemorrhagic stroke and large artery atherosclerosis or dissection occlusion are characteristically common etiologies of young stroke in Taiwan. Early-onset infarction had higher recurrence yet better 1-year outcomes than early-onset ICH. Patients with familial versus non-familial aggregation had more ischemic infarction and monogenic diseases.

Abstract TP438: Japanese versus Non-Japanese Patients With Transient Ischemic Attack or Minor Stroke: Five-Year Risk of Stroke and Vascular Events

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shinichiro Uchiyama ◽  
Takao Hoshino ◽  
Hugo Charles ◽  
Kenji Kamiyama ◽  
Taizen Nakase ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Transient Ischemic Attack ◽  
Japanese Patients ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Vascular Events ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Background: We have reported 5-year risk of stroke and vascular events after a transient ischemic attack (TIA) or minor ischemic stroke in patients enrolled into the TIAregistry.org, which was an international multicenter-cooperative, prospective registry (N Engl J Med 2018;378:2182-90). We conducted subanalysis on the 5-year follow-up data of Japanese patients in comparison with non-Japanese patients. Methods: The patients were classified into two groups on ethnicity, Japanese (n=345) and non-Japanese (n=3502), and their 5-year event rates were compared. We also determined predictors of five-year stroke in both groups. Results: Death from vascular cause (0.9% vs 2.7%, HR 0.28, 95% CI 0.09-0.89, p=0.031) and death from any cause (7.8% vs 9.9%, HR 0.67, 95% CI 0.45-0.99, p=0.045) were fewer in Japanese patients than in non-Japanese patients, while stroke (13.9% vs 7.2%, HR 1.78, 95% CI 1.31-2.43, p<0.001) and intracranial hemorrhage (3.2% vs 0.8%, HR 3.61. 95% CI 1.78-7.30, p<0.001) were more common in Japanese than non-Japanese patients during five-year follow-up period. Caplan-Meyer curves at five-years showed that the rates of stroke was also significantly higher in Japanese than non-Japanese patients (log-rank test, p=0.001). Predictors for stroke recurrence at five years were large artery atherosclerosis (HR 1.81, 95% CI 1.31-2.52, p<0.001), cardioembolism (HR 1.71, 95% CI 1.18-2.47, p=0.004), multiple acute infarction (HR 1.77, 95% CI 1.27-2.45, p<0.001) and ABCD 2 score 6 or 7 (HR 1.96, 95% CI 1.38-2.78, p<0.001) in non-Japanese patients, although only large artery atherosclerosis (HR 3.28, 95% CI 1.13-9.54, p=0.029) was a predictor for stroke recurrence in Japanese patients. Conclusions: Recurrence of stroke and intracranial hemorrhage were more prevalent in Japanese than non-Japanese patients. Large artery atherosclerosis was a predictor for stroke recurrence not only in non-Japanese patients but also in Japanese patients.

Abstract P72: The Obesity Paradox: Association Between Body Mass Index (BMI) and Disability After Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brianna R Helms
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Functional Status ◽  
Hospital Discharge ◽  
Body Mass ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Stroke Recurrence ◽  
Inverse Association ◽  
Stroke Patients

Background: Present rise in the incidence of obesity has led to several opposing reports regarding the association between obesity and stroke outcomes. The objective of this study was to investigate a proposed paradoxical relationship between body mass index (BMI) and functional status in ischemic stroke patients at time of hospital discharge. Methods: Saint Francis Hospital Comprehensive Stroke Center patient databases were utilized in identifying 948 patients eligible for retrospective chart review over a period of 15 months. Subjects were divided into 4 groups according to BMI: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), and obese (BMI ≥ 30.0 kg/m 2 ). Covariates, such as age, gender, prior to event modified Rankin scale (mRS), stroke recurrence, and smoking, were considered. Functional status and disability of stroke patients was scored via mRS at hospital discharge. Ordered logistic regression, Pearson’s chi-squared test, and Pearson’s r correlation were used for analysis to assess the association of BMI and functional status in ischemic strokes. Results: Of 948 eligible subjects, 49.9% were female and mean (SD) age was 69.4 (14.5) years. According to BMI, 22 (2.3%) were underweight, 247 (26.1%) normal weight, 319 (33.7%) overweight, and 360 (37.9%) obese. After adjusting for covariates, ischemic stroke patients with an increased BMI (OR, 0.98; 95% CI, 0.96-0.99) were not associated with increased disability risk upon discharge. Obese (16.2%) and overweight (14.1%) patients discharged with a mRS of 0 (back to baseline) or 1 more frequently compared to normal weight (6.1%) and underweight (0.21%) patients ( P <0.001). Furthermore, an inverse association between BMI status and disability was significantly evident ( r = -0.17, P < 0.001). Conclusion: Obese and overweight stroke patients discharge with a lower risk of disability than normal weight and underweight patients, supporting the existence of the “obesity paradox” in stroke. An inverse association between obesity status and functional outcome was identified and remained significant regardless of covariates.

Clinical Effects of Dual Antiplatelet Therapy or Aspirin Monotherapy after Acute Minor Ischemic Stroke or Transient Ischemic Attack, a Meta-Analysis

2021 ◽  
Vol 27 ◽  
Author(s):  
Francesco Condello ◽  
Gaetano Liccardo ◽  
Giuseppe Ferrante
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Stroke Recurrence ◽  
Controlled Trials ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

scholarly journals Modafinil for Wakefulness in the Critical Care Units: A Literature Review and Case Series including COVID-19 Patients at a Tertiary Care Saudi Hospital

2021 ◽  
Author(s):  
Marwa Amer ◽  
Mohammed Bawazeer ◽  
Abid Shahzad Butt ◽  
Talal I. Dahhan ◽  
Eiad Kseibi ◽  
...  
Keyword(s):  
Median Duration ◽  
Hemorrhagic Stroke ◽  
Tertiary Care ◽  
Case Series ◽  
Hemorrhagic Transformation ◽  
Critical Care Units ◽  
Cognitive Improvement ◽  
Obstructive Sleep ◽  
All Cause Mortality ◽  
Speed Up

AbstractCognitive improvement after critical illness is complex. Neuro-stimulants are used to speed up physical and mental processes through the increase in arousal, and wakefulness. In this case series, we reviewed the literature and described the effect of modafinil for wakefulness in a cohort of adult patients admitted to our COVID and non-COVID intensive care unit (ICU) between January 2017 and June 2020. A total of 8 patients included; 3 admitted to COVID-19, 4 surgical, and 1 transplant ICU. Obstructive sleep apnea was noted in 2 (25%), 2 patients (25 %) had an initial neuroimaging that showed hemorrhagic stroke, and 1 (12.5%) showed ischemic stroke with hemorrhagic transformation. Modafinil 100-200 mg daily was started for a median duration of 4 days and the median initiation time in relation to ICU admission was 11 (IQR 9-17) days. Glasgow coma Scale improvement was noted on 5 patients (62.5%). The median duration of mechanical ventilation was 17.5 (IQR 15-31.75) days, and the median ICU stay was 28.5 (IQR 20.25-48) days. All-cause mortality rate was 25 % at 28 days and 62.5 % at 90 days. Modafinil prevented tracheostomy in 1 COVID-19 patient. No significant adverse drug reactions were documented. In our case series, we described our experience for modafinil use for wakefulness in ICU ventilated patients including COVID-19 patients. Based on our observations, the known effects of modafinil, and its safety profile, it holds the potential to facilitate recovery from cognitive impairment. Larger studies are warranted to fully evaluate its role for this indication.

scholarly journals Trends in the treatment of risk factors for stroke in a Czech stroke unit

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Libor Simunek ◽  
Dagmar Krajickova ◽  
Oldrich Vysata ◽  
Martin Valis
Keyword(s):  
Risk Factors ◽  
Stroke Unit ◽  
Stroke Risk ◽  
Beta Blockers ◽  
University Hospital ◽  
Stroke Recurrence ◽  
Channel Blockers ◽  
Motivation To Change ◽  
The University ◽  
Insulin Use

AbstractThe goal of this study is to evaluate therapeutic trends for several diseases that represent risk factors for stroke. The relative frequency of therapy with compounds that influence the risk factors for stroke was monitored in a group of 3,290 patients who were hospitalised in the Stroke Unit at the University Hospital in Hradec Kralove between 2005 and 2012. For most drugs monitored, the reasons for the significant decrease or increase in use were causes other than the reduction of stroke risk. Despite this finding, the majority of statistically significant changes had, according to review of comparative studies, a posi- tive effect on prevention of stroke. Motivation to change treatment of stroke risk factors, such as hypertension, diabetes mellitus and hypercholesterolemia, was mainly aimed at sufficient disease management with a minimum of adverse effects. On the other hand, optimization of stroke recurrence and economic factors were motivations to treatment changes in prevention with antiplatelets. Antidiabetics were associated with an increase in met- formin use and reduction in insulin use. For antihyperten- sives, the most significant reduction was associated with the use of diuretics, although calcium channel blockers and beta-blockers are also less used. Additionally, the use of the ACE inhibitor ramipril increased

Abstract T P98: Effect of Atrial Fibrillation and/or Large Artery Atherosclerosis on Stroke Recurrence and Long-term Outcome in Japanese Minor Stroke ~Fukuoka Strok Registry~

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shigeru Fujimoto ◽  
Masato Ohsaki ◽  
Masaya Kumamoto ◽  
Takao Ishitsuka ◽  
Takanari Kitazono
Keyword(s):  
Scale Score ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Good Outcome ◽  
Group A ◽  
Group D

Background & Purpose: Atrial fibrillation (AF) and large artery atherosclerosis (LAA) can be associated with a bad outcome even in minor stroke. We investigated stroke recurrence and outcome in Japanese minor stroke patients with AF and/or LAA. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 7 days after the onset, 3725 patients with acute ischemic stroke with the initial NIH stroke scale score of 7 or less and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. In accordance with AF and intracranial or extracranial LAA (stenosis of 50% or more in diameter), they were classified into 4 subgroups: patients without both AF and LAA (Group A, n=2154), patients with only AF (Group B, n=475), patients with only LAA (Group C, n=937), and patients with both AF and LAA (Group D, n=159). We observed stroke recurrence and outcome during one year. Results: On the multivariate analysis, age (OR, 0.94; 95%CI 0.93~0.95), initial NIH stroke scale score (OR, 0.70; 95%CI, 0.67~0.74), chronic kidney disease (OR, 0.72; 95%CI, 0.55~0.95), initial HbA1c value (OR 0.87, 95%CI 0.79~0.95), and LAA (OR 0.70, 95%CI 0.55~0.88) had a negative association with a good outcome. Acute stroke recurrences within 3 weeks after the onset were observed in 2.0%, 2.5%, 6.1%, and 9.4% in Group A-D patients respectively (p<0.0001). Stroke recurrences during 1 year were observed 7.0%, 10.7%, 11.6%, and 13.8% in Group A-D patients respectively (p<0.0001). A good outcome (mRS of 0-1) 1 year after the onset was observed in 77.0%, 6.4%, 67.9%, and 65.8% in Group A-D patients respectively (p<0.0001). With regard to the Kaplan-Meier method, there was a significant difference in stroke recurrence among the 4 subgroups, and stroke recurrences were most frequent in Group D (p<0.0001, Log-rank test). Conclusions: In Japanese minor stroke, age, NIH stroke scale score, chronic kidney disease, HbA1c, and LAA were significant predictors for the long-term outcome. In patients with both AF and LAA, stroke recurrences were most frequent, especially in the acute phase, and a long-term good outcome was least frequent consequently.

scholarly journals The role of cardiologists on the stroke unit

2020 ◽  
Vol 22 (Supplement_M) ◽  
pp. M3-M12
Author(s):  
Wolfram Doehner ◽  
David Manuel Leistner ◽  
Heinrich J Audebert ◽  
Jan F Scheitz
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Stroke Care ◽  
Cardiovascular Complications ◽  
Large Artery ◽  
Stroke Management ◽  
Acute Stroke Care ◽  
Daily Work ◽  
Cardiovascular Comorbidity ◽  
Treatment And Prevention

Abstract Cardiologists need a better understanding of stroke and of cardiac implications in modern stroke management. Stroke is a leading disease in terms of mortality and disability in our society. Up to half of ischaemic strokes are directly related to cardiac and large artery diseases and cardiovascular risk factors are involved in most other strokes. Moreover, in an acute stroke direct central brain signals and a consecutive autonomic/vegetative imbalance may account for severe and life-threatening cardiovascular complications. The strong cerebro-cardiac link in acute stroke has recently been addressed as the stroke-heart syndrome that requires careful cardiovascular monitoring and immediate therapeutic measures. The regular involvement of cardiologic expertise in daily work on a stroke unit is therefore of high importance and a cornerstone of up-to-date comprehensive stroke care concepts. The main targets of the cardiologists’ contribution to acute stroke care can be categorized in three main areas (i) diagnostics workup of stroke aetiology, (ii) treatment and prevention of complications, and (iii) secondary prevention and sub-acute workup of cardiovascular comorbidity. All three aspects are by themselves highly relevant to support optimal acute management and to improve the short-term and long-term outcomes of patients. In this article, an overview is provided on these main targets of cardiologists’ contribution to acute stroke management.

scholarly journals Luminal and Wall Changes in Intracranial Arterial Lesions for Predicting Stroke Occurrence

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2495-2504 ◽  
Author(s):  
Hyung Jun Kim ◽  
Eun-Hyeok Choi ◽  
Jong-Won Chung ◽  
Jae-Hwan Kim ◽  
Ye Sel Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Moyamoya Disease ◽  
Ring Finger ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Gene Variant ◽  
Resonance Imaging ◽  
Asian Patients

Background and Purpose: Luminal imaging (degree of stenosis) currently serves as the gold standard to predict stroke recurrence and guide therapeutic strategies in patients with intracranial large artery diseases (ILADs). We comparatively evaluated the importance of vessel wall and luminal changes in predicting stroke occurrence. Methods: Consecutive patients with ILAD in the proximal middle cerebral artery or distal internal carotid artery without proximal sources of embolism from the carotid and heart underwent time-of-flight magnetic resonance angiography, high-resolution magnetic resonance imaging, and the ring finger protein 213 ( RNF213 ) gene variant test. Patients were followed up for >3 months. Results: Of the 675 patients, 241 (35.7%) had atherosclerotic ILAD and 434 (64.3%) showed nonatherosclerotic ILAD (315 [46.7%] moyamoya disease cases and 119 [17.6%] dissection cases). The RNF213 variant was detected in 74.9%, 33.6%, and 3.4% patients with moyamoya disease, atherosclerosis, and dissection, respectively. Three hundred (44.4%) patients had asymptomatic ILAD, whereas 375 (55.6%) patients had symptomatic ILAD. Multivariate analysis showed that vessel enhancement and etiological subtypes, not degree of stenosis, determined by high-resolution magnetic resonance imaging and RNF213 gene variant analysis were independently associated with symptomatic ILAD. The presence of the RNF213 variant was also independently associated with recurrent cerebrovascular events. Conclusions: This study demonstrates the prevalence of nonatherosclerotic ILAD in East Asian patients with ILAD. Unlike luminal changes, wall changes determined by high-resolution magnetic resonance imaging and presence of the RNF213 variant could predict stroke occurrence in patients with ILADs.

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