scholarly journals Stroke in young adults in Malaysia: 1 year outcome and functional status

2021 ◽  
Vol 26 (4) ◽  
pp. 657-664
Author(s):  
Yean Koon Chan ◽  
Kay Sin Tan ◽  
Lydia Abdul Latif
Keyword(s):  
Small Vessel Disease ◽  
Case Fatality ◽  
Haemorrhagic Stroke ◽  
Education Level ◽  
Stroke Recurrence ◽  
Stroke Survivors ◽  
Large Artery ◽  
Stroke Registry ◽  
Young Stroke ◽  
Post Stroke

Background & Objectives: Young stroke has socioeconomic implications. We aim to describe the demography and evaluate the long-term functional outcomes of young stroke survivors in Malaysia. Methods: First-ever Malaysian young stroke patients (18-50 years) from 1st October 2016 until 30th June 2018 were recruited from the University of Malaya Medical Centre Young Stroke Registry and other sources. Participants were interviewed in person or via telephone at one year post-stroke. Demographic information collected were age, sex, ethnicity, and education level. Results: Out of 120 eligible cases, there were 6 deaths (5%) and 7 recurrent strokes (5.8%) within 1 year. Seventy five patients were recruited for the study with mean assessment time at 14.8 months. Survivors are predominantly male (69.2%), aged ≥41 years old (73%) with racial profile representative of the locality. Ischaemic stroke (IS) is the commonest stroke type (72%) with majority TOAST classified as large-artery atherosclerosis and small-vessel disease. Hypertension and smoking are the leading risk factors. Greater than half are independent and returned to work (RTW); comparatively IS has better outcomes than haemorrhagic stroke (HS). Lesser educated survivors (≤secondary school education, 56%) are more likely to not RTW (OR 5, p = 0.005). There is no significant change in marital status and residence post stroke. Conclusion: In a single centre study in Malaysia, major findings for young stroke survivors, mainly male in their 40s, at 1 year are case fatality of 5%, stroke recurrence of 5.8%, and more than half achieved independence and RTW (IS > HS) with education level influencing RTW.

EXPRESS: Characteristics and Prognosis of Patients with Embolic Stroke of Undetermined Source in China

2021 ◽  
pp. 174749302110280
Author(s):  
Xiaomeng Yang ◽  
Jing Jing ◽  
Xia Meng ◽  
Zixiao Li ◽  
Yuesong Pan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Stroke Recurrence ◽  
Cumulative Probability ◽  
Large Artery ◽  
Stroke Registry ◽  
Vessel Disease ◽  
Ischemic Attack ◽  
Diagnostic Work

Background and purpose: We aimed to explore the frequencies, risk factors, and natural history of ESUS through a national prospective registry in China. Methods: Between August 2015 and March 2018, the Third China National Stroke Registry (CNSR-III) recruited consecutive patients with ischemic stroke or transient ischemic attack (TIA) in China. The baseline characteristics, risks of stroke, and mortality in patients with ESUS were described and compared with that in patients with other causative subtypes. Results: A total of 15166 TIA and ischemic stroke patients were enrolled in CNSR-III. Among 8528 ischemic stroke with standard diagnostic work-up, 2415 (28.3%) patients were diagnosed with ESUS. The mean age was 61 years and 70% of them were male. Compared to patients with cardioembolic strokes and small vessel disease, patients with ESUS had higher prevalence of nonstenosing large artery atherosclerosis (37.93% vs 31.26%, P=0.008 and 37.93% vs 34.40%, P=0.044 respectively). The cumulative probability of stroke recurrence in patients with ESUS at 3 month and 1 year was 5.59% and 8.74%. Compared with ESUS patients (0.70% and 1.99%), patients with the large artery atherosclerosis and cardioembolic strokes had higher cumulative probability of death at 3 month (1.94% and 3.22%) and 1 year (4.17% and 7.39%). Conclusions: ESUS is a common cause of ischemic stroke in Chinese population with a higher stroke recurrence of ESUS than previous reported. It was more likely to have nonstenosing large artery atherosclerosis in patients with ESUS than with cardioembolic strokes and small vessel disease.

Post-Stroke Seizures and the Risk of Dementia Among Young Stroke Survivors

2021 ◽  
Author(s):  
Alain Lekoubou ◽  
Djibril M. Ba ◽  
Clever Nguyen ◽  
Guodong Liu ◽  
Douglas L. Leslie ◽  
...  
Keyword(s):  
Stroke Survivors ◽  
Young Stroke ◽  
Post Stroke

scholarly journals Facilitating Exercise Engagement among Community Dwelling Stroke Survivors: Is a once Per Week Group Session Sufficient?

2019 ◽  
Vol 16 (23) ◽  
pp. 4746
Author(s):  
Nor Azlin Mohd Nordin ◽  
Nor Asma Husna Yusoff ◽  
Devinder Kaur Ajit Singh
Keyword(s):  
Physical Performance ◽  
Low Frequency ◽  
Community Dwelling ◽  
Exercise Session ◽  
Stroke Recurrence ◽  
Stroke Survivors ◽  
Group Exercise ◽  
Post Stroke ◽  
Sit To Stand ◽  
Balance Ability

Although exercise is proven as an effective strategy to combat post-stroke complications and the risk of stroke recurrence, many stroke survivors fail to engage in this activity following rehabilitation. In this study, we assessed the feasibility and usefulness of a low-frequency group exercise to determine its suitability as an approach to facilitate exercise engagement among stroke survivors. Forty-one stroke survivors, mean (SD) age 59.34 (10.02) years, mean time post-stroke 17.13 (17.58) months, completed a 90 minute, once per week, group exercise supervised by therapists for 12 weeks. The exercise outcomes were measured using standardized clinical tests. We observed improvement in the group’s physical performance; balance score by 3 units (Z = −3.88, p < 0.001), speed of repetitive sit to stand by 3.4 s (Z = −4.69, p < 0.001), and walking speed by 8.22 m/min (Z = −3.25, p < 0.001). Scores of seven out of 14 Berg’s balance scale items increased significantly, indicating better balance ability among the survivors. In conclusion, a 12-week, once per week group exercise session seems feasible and sufficient to improve the physical performance of community dwelling stroke survivors. This exercise arrangement may be offered to stroke survivors to facilitate exercise practice following rehabilitation.

Central poststroke pain in young ischemic stroke survivors in the Helsinki Young Stroke Registry

Neurology ◽  
2014 ◽  
Vol 83 (13) ◽  
pp. 1147-1154 ◽  
Author(s):  
H. Harno ◽  
E. Haapaniemi ◽  
J. Putaala ◽  
M. Haanpaa ◽  
J. P. Makela ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Survivors ◽  
Stroke Registry ◽  
Young Stroke ◽  
Young Ischemic Stroke

scholarly journals Fatal and non-fatal events within 14 days after early, intensive mobilization post stroke

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011106
Author(s):  
Julie Bernhardt ◽  
Karen Borschmann ◽  
Janice M. Collier ◽  
Amanda G. Thrift ◽  
Peter Langhorne ◽  
...  
Keyword(s):  
Usual Care ◽  
Case Fatality ◽  
Early Mobilization ◽  
Haemorrhagic Stroke ◽  
High Dose ◽  
Stroke Severity ◽  
Serious Adverse Events ◽  
Significant Treatment ◽  
Intensive Training ◽  
Post Stroke

ObjectiveThis tertiary analysis from AVERT examined fatal and non-fatal Serious Adverse Events (SAEs) at 14 days.MethodAVERT was a prospective, parallel group, assessor blinded, randomized international clinical trial comparing mobility training commenced <24 hours post stroke, termed very early mobilization (VEM) to usual care (UC). Primary outcome was assessed at 3 months. Included: Patients with ischaemic and haemorrhagic stroke within 24 hours of onset. Treatment with thrombolytics allowed. Excluded: Patients with severe premorbid disability and/or comorbidities. Interventions continued for 14 days or hospital discharge if less. The primary early safety outcome was fatal SAEs within 14 days. Secondary outcomes were non-fatal SAEs classified as neurologic, immobility-related, and other. Mortality influences were assessed using binary logistic regression adjusted for baseline stroke severity (NIHSS) and age.Results2,104 participants were randomized to VEM (n = 1,054) or UC (n = 1,050) with a median age of 72 years (IQR 63–80) and NIHSS 7 (IQR 4–12). By 14 days, 48 had died in VEM, 32 in UC, age and stroke severity adjusted Odds Ratio of 1.76 (95% CI 1.06–2.92, p = 0.029). Stroke progression was more common in VEM. Exploratory subgroup analyses showed higher odds of death in intracerebral haemorrhage and >80 years subgroups, but there was no significant treatment by subgroup interaction. No difference in non-fatal SAEs found.ConclusionWhile the overall case fatality at 14 days post-stroke was only 3.8%, mortality adjusted for age and stroke severity was increased with high dose, intensive training compared to usual care. Stroke progression was more common in VEM.Classification of evidenceThis study provides Class I evidence that very early mobilization increases mortality at 14 days post stroke.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12606000185561.

Atrial cardiopathy in patients with embolic strokes of unknown source and other stroke etiologies

Neurology ◽  
2018 ◽  
Vol 92 (4) ◽  
pp. e288-e294 ◽  
Author(s):  
Shirin Jalini ◽  
Rajasumi Rajalingam ◽  
Rosane Nisenbaum ◽  
Angelo Dave Javier ◽  
Anna Woo ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
P Wave ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Cross Sectional ◽  
Unknown Source

ObjectiveTo investigate the prevalence and clinical determinants of atrial cardiopathy in patients with embolic stroke of unknown source (ESUS) and compare with other established stroke etiologies.MethodsIn a cross-sectional study of 846 consecutive patients with ischemic stroke, we compared the prevalence of atrial cardiopathy (defined by p-wave terminal force in V1 >5,000 µV·ms or severe left atrial enlargement) between ESUS patients and patients with large artery atherosclerosis (LAA) and small vessel disease (SVD) strokes. Baseline characteristics were also compared between ESUS and cardioembolic (CE) patients.ResultsOf all, 158 (19%) patients met ESUS diagnostic criteria, while others were classified into LAA (n = 224, 26%), SVD (n = 154, 18%), and CE (n = 310, 37%). The prevalence of atrial cardiopathy was higher in ESUS patients compared to noncardioembolic stroke patients (26.6% vs 12.1% in LAA vs 16.9% in SVD; p = 0.001). ESUS patients were younger, were less hypertensive, and had higher cholesterol and low-density lipoprotein levels, but also had less left ventricular or atrial abnormalities when compared to CE patients.ConclusionThe prevalence of atrial cardiopathy was high in ESUS patients compared with patients with nonembolic strokes. Interestingly, ESUS patients were also clinically different from CE patients. While the presence of atrial cardiopathy may reflect a unique mechanism of thromboembolism in ESUS patients, it is still unclear if they may benefit from anticoagulation, or if the presence of atrial cardiopathy in this population could serve as a risk-stratifying marker for stroke recurrence. Further efforts are necessary to provide better characterization of the ESUS population in order to develop better stroke preventive strategies.

Short telomere length in blood leucocytes contributes to the presence of atherothrombotic stroke and haemorrhagic stroke and risk of post-stroke death

2013 ◽  
Vol 125 (1) ◽  
pp. 27-43 ◽  
Author(s):  
Weili Zhang ◽  
Yu Chen ◽  
Yuyao Wang ◽  
Peng Liu ◽  
Mei Zhang ◽  
...  
Keyword(s):  
Telomere Length ◽  
Haemorrhagic Stroke ◽  
Stroke Recurrence ◽  
Biological Aging ◽  
Post Stroke ◽  
Paired Samples ◽  
Potential Marker ◽  
Increased Risk ◽  
Stroke Death

Inter-individual differences in biological aging could affect susceptibility to stroke. To date, the relationship between stroke and telomere shortening remain inconclusive; and sparse data are available for haemorrhagic stroke. A Chinese case-control study was conducted, comprising 1756 cases (767 atherothrombosis, 503 lacunar infarction and 486 haemorrhagic strokes) and 1801 controls. Stroke patients were prospectively followed up for a median of 4.5 (range, 0.1–6.0) years. Individuals with shorter telomere length had a higher presence of atherothrombotic stroke {multivariate OR (odds ratio) 1.37 [95% CI (confidence interval), 1.06–1.77]; P=0.015} or haemorrhagic stroke [multivariate OR 1.48 (95% CI, 1.08–2.02); P=0.016] in comparison of the lowest to highest tertile of telomere length. Particularly, in subjects with a family history of stroke, there was a significant 2.55-fold increased presence of atherothrombotic stroke (95% CI, 1.87–3.48; Ptrend<0.0001) and a 2.33-fold increased presence of haemorrhagic stroke (95% CI, 1.62–3.36; Ptrend<0.0001). During the follow-up, 338 recurrent strokes and 312 deaths (181 from stroke or coronary heart disease and 131 from other causes) were documented. Associations with stroke recurrence were not observed in the follow-up patients, whereas atherothrombotic stroke cases with shorter telomeres had 69% increased risk of post-stroke death [relative risk, 1.69 (95% CI, 1.07–2.67); P=0.02]. Finally, we compared telomere lengths in 12 paired samples of circulating leucocytes and carotid atherosclerotic plaques from patients undergoing carotid endarterectomy; there was a positive correlation between vessel wall tissue and leucocyte telomere length. In conclusion, shorter telomere length may serve as a potential marker for the presence of atherothrombotic and haemorrhagic stroke and for the risk of post-stroke death.

scholarly journals Estonian young stroke registry: High burden of risk factors and high prevalence of cardiomebolic and large-artery stroke

2021 ◽  
pp. 239698732110409
Author(s):  
Riina Vibo ◽  
Siim Schneider ◽  
Liisa Kõrv ◽  
Sandra Mallene ◽  
Liisi-Anette Torop ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Young Patients ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Young Stroke ◽  
Stroke Risk Factors ◽  
High Prevalence

Background and aims The aim of the present study was to assess the risk factor burden and stroke etiology of young stroke patients in Estonia and to compare the results with similar cohorts from other countries. Methods This study includes ischemic stroke patients aged 18–54 years from the prospective Estonian Young Stroke Registry between 2013 and 2020. All patients were managed in a stroke unit following a prespecified detailed protocol. Data on stroke risk factors, etiology, and stroke severity were analyzed. Results A total of 437 patients (mean age 44.7 ± 8.3 years; 62% males) were included in the registry during the 8-year study period. A total of 50.2% of patients had ≥ 3 well-documented risk factors (higher for men: odds ratio (OR) 3.8; 95% cardiac index confidence interval (CI) 1.8–8.3; p < .001) and 6.2% of patients had ≥ 3 less well-documented risk factors. While 42% of patients had undetermined cause of stroke (34% of them cryptogenic), the second most frequent etiologies were large-artery atherosclerosis and cardioembolism (both 19%). 60 percent of cardioembolic strokes were due to high-risk causes. Large-artery atherosclerosis was more prevalent in men (OR 1.8; 95% CI 1–3.3; p = .05) and among older patients (OR 6.2; 95% CI 1.8–21.4; p = .008). The median National Institutes of Health Stroke Scale score on admission was 3 (interquartile ranges 2–6), stroke was more severe in men ( p = .05). Conclusions Our study revealed that young patients with stroke in Estonia have higher burden of well-documented risk factors, higher prevalence of high-risk cardioembolic causes and higher prevalence of large-artery stroke compared to other young stroke cohorts.

scholarly journals Socio-demographic and Clinical Correlates of Community Reintegration of Stroke Survivors in Nigeria

2020 ◽  
pp. 1-7
Author(s):  
Muhammad Usman Ali ◽  
Auwal Yahaya Garba ◽  
Adewale Luqman Oyeyemi ◽  
Mamman Ali Masta ◽  
Fatima Kachallah Gujba ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Sampling Technique ◽  
Haemorrhagic Stroke ◽  
Public Hospitals ◽  
Rehabilitation Services ◽  
Stroke Survivors ◽  
Community Reintegration ◽  
Post Discharge ◽  
Post Stroke ◽  
The Impact

Background: Low level of community reintegration among stroke survivors is a major obstacle to rehabilitation services post discharge from acute care. Few studies have assessed the impact of community reintegration on stroke survivors in Nigeria. This study investigates community reintegration and associated factors among stroke survivors in Maiduguri, Nigeria. Methodology: Purposive sampling technique was used to recruit 55 stroke survivors attending rehabilitation services from two public hospitals in Maiduguri. Community reintegration was assessed with the Reintegration to Normal Living Index (RNLI) questionnaire, while information on sociodemographics (e.g., age group, gender, employment status, educational status) and clinical characteristics (e.g., post stroke duration, types of stroke, side of affectation) was obtained using the data form. Logistic regression analyses with odd ratios were used to test the associations between community reintegration and sociodemographic and clinical characteristics. Results: The mean age and post stroke duration of the participants were 44.69±13.06 years and 17.25±24.90 months respectively. The participants’ community reintegration scores showed that 60%, 38.2% and 1.8% have no integration, mild to moderate reintegration and complete reintegration respectively. The results indicated that stroke survivors with a stroke duration greater than 8 months (OR=3.32, C.I=1.08-10.27) and those with haemorrhagic stroke (OR=4.67, C.I=1.05-20.66) were more likely to be reintegrated into the community than their counterparts with 6-8 months post stroke duration and ischaemic stroke, respectively. There was significant association between community reintegration and sociodemographic characteristics such as post stroke duration and type of stroke. Conclusions: Rehabilitation strategies should focus on clinical characteristics of the stroke survivors when planning and delivering effective community reintegration interventions.

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