Agitated Saline Contrast Echocardiogram In Cardio-Pulmonary Evaluation

Agitated saline contrast echocardiogram (ASC) is a very useful technique to detect various intracardiac and extra cardiac shunts in daily cardiology practice . Conventional 2D and color echocardiogram may not be well effective in ruling out various intracardiac shunts especially with patients having poor echo window. The introduction of agitated saline with bubbles formed during the study can help delineate different right to left shunt physiology commonly like patent foramen ovale (PFO) which is often sought for in evaluation of cases with young stroke . Various other etiologies like atrial septal defects, atrial septal aneurysm, large right to left shunts with eisenmengerisation can also be evaluated with this simple bedside study.

How information affects attributions for ambiguous behaviours resulting from stroke

<p>Research has shown that when people see young survivors of stroke, they often misattribute the person’s symptoms to other factors (Wainwright et al., 2013). Consequently, these stroke survivors may suffer feelings of resentment towards, and from their acquaintances. They may also struggle to obtain or retain a job. This thesis examines whether these misattributions for stroke survivors’ symptoms are affected by the information people have about the stroke survivor and the rapidity of the change in their behaviours. Experiment 1 investigated if the stroke survivor’s age (72, 32 or unstated) and the level of information (no information, implied stroke or explicit stroke) for their behaviours influenced people’s attributions. Experiment 1 showed that people attributed the behavioural changes to factors other than stroke when no additional information is present, and they attributed the behaviours to stroke when stroke was explicitly described. When stroke was implied, participants rated stroke as the best explanation but only when the target person was 72. Experiment 2 manipulated the rapidity of the stroke survivor’s behavioural changes to assess the effect on attributions. Experiment 2 showed that people attributed the behaviours to stroke more if only one week had passed, and if the target person was 72, but not when he was 32. It was concluded that young stroke survivors may need to disclose their stroke in order for others to correctly attribute their behaviours, as this could improve their rehabilitation.</p>

How information affects attributions for ambiguous behaviours resulting from stroke

<p>Research has shown that when people see young survivors of stroke, they often misattribute the person’s symptoms to other factors (Wainwright et al., 2013). Consequently, these stroke survivors may suffer feelings of resentment towards, and from their acquaintances. They may also struggle to obtain or retain a job. This thesis examines whether these misattributions for stroke survivors’ symptoms are affected by the information people have about the stroke survivor and the rapidity of the change in their behaviours. Experiment 1 investigated if the stroke survivor’s age (72, 32 or unstated) and the level of information (no information, implied stroke or explicit stroke) for their behaviours influenced people’s attributions. Experiment 1 showed that people attributed the behavioural changes to factors other than stroke when no additional information is present, and they attributed the behaviours to stroke when stroke was explicitly described. When stroke was implied, participants rated stroke as the best explanation but only when the target person was 72. Experiment 2 manipulated the rapidity of the stroke survivor’s behavioural changes to assess the effect on attributions. Experiment 2 showed that people attributed the behaviours to stroke more if only one week had passed, and if the target person was 72, but not when he was 32. It was concluded that young stroke survivors may need to disclose their stroke in order for others to correctly attribute their behaviours, as this could improve their rehabilitation.</p>

Cerebrovascular Risk Profiles in a Saudi Arabian Cohort of Young Stroke Patients

Background: The constantly increasing incidence of stroke in younger individuals substantiates an urgent need for research to elucidate underlying risk factors and etiologies. Heretofore, the vast majority of studies on stroke in the young have been carried out in European and North American regions. We aimed to characterize cerebrovascular risk profiles in a Saudi Arabic cohort of consecutive young stroke patients.Methods: We retrospectively analyzed data from consecutive ischemic stroke patients aged 15 to 49 years who underwent detailed cardiocerebrovascular evaluation at a tertiary stroke care center in Makkah, Saudi Arabia. Distributions of risk factors and stroke etiologies were assessed in the entire cohort and in two strata of very young (15–40 years) and young to middle-aged patients (41–49) to account for variability in suggested age cutoffs.Results: In the entire cohort [n = 63, ages 44 (34–47) median, interquartile range], dyslipidemia (71.4%) and small vessel occlusion (31.7%) displayed highest prevalence followed by diabetes (52.4%) and cardioembolism (19%). In very young patients, cardioembolism was the most prevalent etiology (27.3%). Risk profiles were similar between both age strata except for a higher prevalence of diabetes among the older cohort (31.8 vs. 63.4%, p = 0.01). Logistic regression identified diabetes as strongest predictor for association to the older strata (odds ratio = 4.2, 95% confidence interval = 1.2–14.1, p = 0.02).Conclusion: Cerebrovascular risk profiles and stroke etiologies in our cohort of young stroke patients differ from those of previous cohorts, suggesting the need for tailored prevention strategies that take into account local epidemiological data on cerebrovascular health.

MSC 2021 Virtual E-Abstract

1. A Malaysian Single Centre Experience of NOAC Efficacy And Safety For Stroke Prevention in NVAF.2. An Observational Study On The Overview Of Young Stroke Patients.3. An Overview of Stroke Patterns from A Stroke Ready Hospital.4. Mortality After Stroke: A 9-Month Observational Study.5. The Characteristics of Post-Stroke Patients from Hospital Seberang Jaya.6. The Impact of COVID-19 Pandemic on Acute Stroke Care: An Experience from a Primary Stroke Centre in Malaysia.7. Young Stroke On Prevalence Of Epidemiological Factors, Stroke Subtypes And Stroke Events - An Observational Study.

Smoking Status and Functional Outcomes in Young Stroke

Objective: Stroke in young adults is uncommon, and the etiologies and risk factors of stroke in young adults differ from those in older populations. Smoker's paradox is an unexpected favorable outcome, and age difference is used to explain the association between smoking and the favorable functional outcome. This study aimed to investigate the existence of this phenomenon in young stroke patients.Methods: We analyzed a total of 9,087 young stroke cases registered in the nationwide stroke registry system of Taiwan between 2006 and 2016. Smoking criteria included having a current history of smoking more than one cigarette per day for more than 6 months. After matching for sex and age, a Cox model was used to compare mortality and function outcomes between smokers and non-smokers.Results: Compared with the non-smoker group, smoking was associated with older age, higher comorbidities, and higher alcohol consumption. Patients who report smoking with National Institutes of Health Stroke Scale scores of 11–15 had a worse functional outcome (adjusted odds ratio, 0.81; 95% confidence interval, 0.76 – 0.87).Conclusion: Smokers had a higher risk of unfavorable functional outcomes at 3 months after stroke, and therefore, we continue to strongly advocate the importance of smoking cessation.

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

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.

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

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.