Physical methods of motor function correction in the acute period of rehabilitation after ischemic stroke

The paper presents the data on the use of percutaneous electrical spinal cord stimulation in patients in the acute period of rehabilitation treatment after ischemic stroke. It was revealed that inclusion of percutaneous electrostimulation of the spinal cord into the rehabilitation program improves the quality of motor skills recovery and can be used in the correction of locomotor functions during rehabilitation after ischemic stroke. Key words: ischemic stroke, percutaneous electrical spinal cord stimulation.

Frequency of Elevated Homocysteine Levels in Patients with Ischemic Stroke

Objective: To determine the frequency of elevated homocysteine levels in patients with ischemic stroke. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine Unit II, Jinnah Hospital, Lahore from 13th October 2017 to 12th April 2018. Methodology: Two hundred and fifty subjects of ischemic cerebral stroke were included in this study using non probability sampling technique. Diagnosis of ischemic stroke was confirmed by CT brain and serum homocysteine level was measured in micromoles/L. Results: The average age of our studied population was 64.9±11.5 years with 141 males (56.4%) and 109 (43.6%) females. Mean total homocysteine levels were 55.5±2.9 μm/L and the range was 8-148.7. Elevated homocysteine levels were found in 239 (95.6%) and were normal in 11 (4.4%). Highly elevated levels were present in 18 (7.5%), moderately elevated in 179 (74.9%) and lightly elevated levels were found in 82 (17.6%). Conclusion: The elevated homocysteine levels are a strong risk factor for ischemic cerebral Stroke. About 74.9% of the patients with ischemic stroke had moderately elevated levels whereas 7.5% had highly elevated serum homocysteine levels. Key words: Ischemic stroke, Elevated homocysteine levels

Mechanical thrombextraction in patient with acute ischemic stroke on background of oral anticoagulant therapy

Thrombolytic therapy, which is a priority treatment strategy in patients with acute ischemic stroke in the first 3-4.5 hours after start of the disease, has significant limitations in case of background anticoagulant therapy. Mechanic thrombextraction is considered to be an alternative therapeutic strategy in case of inefficacy or contraindications to thrombolytic therapy. The article presents a clinical case of the 75-year old female patient with acute cardioembolic stroke on background of heart failure and atrial fibrillation. Long-term background usage of the direct oral anticoagulant due to atrial fibrillation is a limitation to use thrombolytic therapy, therefore mechanical thrombextraction was performed. The case presents possibilities of the successful interventional treatment of acute cardioembolic ischemic stroke. An example of a possible drug-drug interaction possibly leading to reduction of the effectiveness of anticoagulant therapy is shown. Key words: ischemic stroke, anticoagulants, mechanical trombextraction.

Statins in preventing stroke

Abstact. The results of a comprehensive analysis of Simvastatin (at a dose of 20 mg per day) on the functional state of the brain in patients with atherothrombotic ischemic stroke are presented. Simvastatin provokes vasoactive action (increases linear rate of systolic blood flow velocity (LBFVsys) and decreases peripheral resistance in separate vessels of the carotid and vertebra-basilar basins), posseses antiatherogenic action (a drug decrease in the intima size, in the frequency of the atherosclerotic plagues, in the level of cholesterol, triglycerides and low density lipoproteids (LDLs). This medication leads to a positive reorganization of the bioelectric activity of the brain (increases the frequency of alpha rhythm and decreases the power of the slow rhythms), being more marked in the patients with a left-sided ischemic localization. Complex positive effects of the Simvastatin on the cerebral hemodynamic, bioelectric activity of the brain and lipid metabolism in the patients after athrothrombotic ischemic stroke allow us to recommend Simvastatin not only for the secondary prevention of stroke but also for the correction of CNS functioning in stroke patients during their rehabilitation. Key words: ischemic stroke; statins; bioelectric activity of the brain; cerebral blood flow; atherothrombotic ischemic stroke

Thrombolysis and Mechanical Thrombectomy as Leading Treatments for Acute Ischemic Stroke

Brain vascular diseases, especially strokes, are still a very serious public health and medicine problem. The world is still facing an epidemic of stroke. With the impact load increasing all over the world, there is a continuing need to understand the characteristics of this disease and its impact in different countries. Despite significant improvements in primary prevention and treatment efficacy over the past decades, stroke is still a debilitating disease. Early treatment is the key to successful recovery of patients with ischemic stroke. The aim of the study is to show the most effective methods of treating patients in the acute phase of ischemic stroke. (JNNN 2019;8(4):177–181) Key Words: ischemic stroke, treatment, thrombolysis, thrombectomy

Predictors for early motor improvement in patients with ischemic stroke

Disability as a stroke consequence is reported by 3% males and 2% females in general population. Motor deficits are common in stroke patients, but their complete recovery is seen only in a minority of cases. Assessment of motor deficits uses clinical methods, especially standardized scales, but also electrophysiological and imagistic methods. The motor recovery is a continuous process, maximal in the first month after stroke, decreasing gradually over the first 6 months. Most powerful predictors for motor recovery are clinical parameters: severity of motor deficit, onset of first voluntary movements after stroke in the first 48-72 hours, a continuous improvement in motor function during the first 8 weeks, a good postural control during the first month, young age, male sex, left hemispheric stroke and absence of other neurological impairments are strong positive predictors. Presence of motor-evoked potentials in paretic muscles and imagistic parameters as location, stroke volume and motor pathways integrity are paraclinical predictors for recovery. There are no specific biomarker which is efficient in predicting recovery. In patients with poor chances for recovery according to actual predictors, the development of more precise algorithms to assess functional outcome is needed, in order to support the choice of appropriate methods and intensity of rehabilitation treatment. Key words: ischemic stroke rehabilitation, functional assessment, motor improvement, recovery predictors, prognostic factors,

The Level of Independence Among Seniors with a History of Ischemic Stroke

Introduction. Stroke is currently among the most dangerous civilization diseases and the most common cause of death and secondary disability in people over 65 years of age. Disease-related disability significantly affects all spheres of human functioning, leading to dependence on third parties’ assistance. One of the most important activities to be undertaken in relation to a disabled patient is diagnosing the level of disability and implementing active efforts for the patient to regain optimal performance and/or accept the disability. Limitation in daily activities is a considerable stress factor that has a negative effect on the seniors’ recovery and becomes a cause of institutionalization. Aim. To investigate the impact of ischemic stroke on the level of independence in elderly people. Material and Methods. Medical records of 186 patients of a neurological ward were analysed. The majority of participants were women (55.91%), seniors aged 76–85 (36.02%), living in a city (55.38%) and being widowed (41.93%). The standardized Norton and Tinetti scales were applied in the analyses. Results. The most important factors influencing the incidence and course of stroke were the patient’s age and the presence of concomitant diseases: diabetes (81.72%) and arterial hypertension (73.65%). Among the stroke complications, the majority of patients presented aphasia (76.88%), hemiparesis (67.20%), dysphagia (63.44%) and urinary bladder dysfunction (60.21%). The study subjects were predominantly (86.56%) classified in the third category of care; 38.17% were referred for further rehabilitation in a post-hospital rehabilitation unit, 19.89% were referred to a medical care and treatment institution, and 19.36% died. The majority of the respondents achieved less than 14 points (77.96%) in the Norton scale and less than 19 points (34.41%) in the Tinetti scale. Conclusions. Ischemic stroke reduces or completely terminates the patient’s ability to function independently. The patient’s age is of greatest significance for the level of his independence and functioning immediately after ischemic stroke. (JNNN 2019;8(3):112–118) Key Words: ischemic stroke, disability, elderly people

STUDY ON THRIVE SCORE IN THE PROGNOSIS OF ISCHEMIC STROKE

Background and Purpose: Stroke is the second cause of mortality and the leading cause of disability. Using the clinical scale to predict the outcome of the patient play an important role in clinical practice. The Totaled Health Risks in Vascular Events (THRIVE) score has shown broad utility, allowing prediction of clinical outcome and death. Methods: A cross-sectional study conducting on 102 patients with acute ischemic stroke using THRIVE score. The outcome of patient was assessed by mRankin in the day of 30 after stroke. Statistic analysis using SPSS 15.0. Results: There was 60.4% patient in the group with THRIVE score 0 – 2 points having a good outcome (mRS 0 - 2), patient group with THRIVE score 6 - 9 having a high rate of bad outcome and mortality. Having a positive correlation between THRIVE score on admission and mRankin score at the day 30 after stroke with r = 0.712. THRIVE score strongly predicts clinical outcome with ROC-AUC was 0.814 (95% CI 0.735 - 0.893, p<0.001), Se 69%, Sp 84% and the cut-off was 2. THRIVE score strongly predicts mortality with ROC-AUC was 0.856 (95% CI 0.756 - 0.956, p<0.01), Se 86%, Sp 77% and the cut-off was 3. Analysis of prognostic factors by multivariate regression models showed that THRIVE score was only independent prognostic factor for the outcome of post stroke patients. Conclusions: The THRIVE score is a simple-to-use tool to predict clinical outcome, mortality in patients with ischemic stroke. Despite its simplicity, the THRIVE score performs better than several other outcome prediction tools. Key words: Ischemic stroke, THRIVE, prognosis, outcome, mortality

Association of Diabetes Mellitus and Smoking with Ischaemic Stroke

Diabetes mellitus is one of the most important modifiable risk factors for ischemic stroke.Cigarette smoking is a risk factor for atherosclerotic disease. There is a strong relationship between diabetes mellitus and cigarette smoking with ischemic stroke. A case control study was designed to see the association of diabetes mellitus and cigarette smoking with ischaemic stroke. The study was done from January 2009 to December 2009. Sixty subjects were selected as study population which were taken from Dhaka medical college hospital, Dhaka. Among them 30 were diagnosed case of ischemic stroke and 30 were age and sex matched control. The study showed that 33.33% patients of case group and 10 % respondents of control group had diabetes mellitus. It also revealed that 56.66% of case group and 53.33% of control group were smoker and the mean duration of smoking was 27.41 ± 2.98 years in case group and 15.63 ± 2.85 years in control group. The study suggests that diabetes mellitus is significantly associated with ischemic stroke and longer duration of smoking is also associated with ischaemic stroke. Key words: Ischemic stroke; cigarette smoking; diabetes mellitus. DOI: http://dx.doi.org/10.3329/jdmc.v20i1.8565 J Dhaka Med Coll. 2011; 20(1) : 12-14