Hypertension Risk Factor Control Effort In Post Stroke Patients

Post-stroke patients have risk factors for recurrent stroke. The main risk factor is hypertension. The purpose of this community service activity is to improve the ability of the community, especially post-stroke patients, to control hypertension as a risk factor for recurrent stroke through identification of risk factors, health education and the application of light activity and deep breathing exercises. Before education is given, post-stroke patients and their families are given prestest first and after education, posttest returns to evaluate the patient's understanding. The results of the activity, there was a significant difference between the knowledge before and after being given education to post-stroke patients and their families with p value <0.05. To the head of the room and the neuroscientific nurse, dr. M. Djamil Padang can continue the activity of identifying recurrent stroke risk factors and health education related to control of recurrent stroke risk factors in post-stroke patients by involving the Health Promotion (Promkes) department of Dr. M. Djamil Padang.

Brain–body communication in stroke

Stroke is a leading cause of death and disability worldwide with limited therapeutic options available for selected groups of patients. The susceptibility to stroke depends also on systemic parameters, and some stroke risk factors are modifiable, such as atrial fibrillation (AF) or hypertension. When considering new treatment strategies, it is important to remember that the consequences of stroke are not limited to the central nervous system (CNS) injury, but reach beyond the boundaries of the brain. We provide here a brief overview of the mechanisms of how the brain communicates with the body, focusing on the heart, immune system, and gut microbiota (GM).

Giant cell arteritis complicated by tongue necrosis and bilateral cerebellar ischaemic stroke

Giant cell arteritis (GCA) typically presents with headache, scalp tenderness or visual disturbance. Other symptoms include orofacial pain, constitutional symptoms and ischaemic stroke. An 81-year-old woman with a background of type-2 diabetes and hypertension presented with headache, oral pain and right visual loss. Examination showed hypertension, nodular temporal arteries, reduced visual acuity and suspected oral candida. Inflammatory markers were raised and she was diagnosed with GCA and commenced on corticosteroids. During treatment she developed tongue ulceration, then acute vertigo and incoordination with nystagmus and ataxia. Neuroimaging confirmed bilateral, cerebellar ischaemic strokes and temporal artery biopsy was consistent with GCA. With corticosteroids and secondary prevention of stroke measures she is now functionally independent. Oral pain is an uncommon symptom of GCA and delays in recognition may lead to catastrophic consequences. Clinicians should be aware of uncommon presentations and to optimise additional ischaemic stroke risk-factors.

Awareness of the risk factors of stroke among non-teaching staff of the Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria

Background The prevalence of stroke is increasing in Nigeria due to a lack of awareness of their predisposing factors. There is therefore a need for good knowledge and awareness of stroke risk factors in the general populations. Thus, this study assessed the level of awareness of stroke risk factors among non-teaching staff in Nnamdi Azikiwe University, Nnewi Campus, Nigeria. Results Most of the participants were female, 89 (69%), and had a post-graduate degree, 84 (65.1%). A total of 129 participants participated in this survey, and 91 (70.5%) were familiar with the term “stroke.” The commonest risk factors were high blood pressure (86%), stress (74.4%), and lack of exercise (63.6%). The study showed that the awareness of stroke risk factors among the participants was poor (40.3%). Conclusion Stroke awareness was poor among the participants with the highest risk of stroke despite their high literacy level. Female participants, with a postgraduate level qualification and working as senior non-teaching staff, had a better awareness of stroke risk factors than their male colleagues. This shows a need to increase stroke awareness campaigns in the community.

Understanding the Connection Between Common Stroke Comorbidities, Their Associated Inflammation, and the Course of the Cerebral Ischemia/Reperfusion Cascade

Despite the enormous progress in the understanding of the course of the ischemic stroke over the last few decades, a therapy that effectively protects neurovascular units (NVUs) and significantly improves neurological functions in stroke patients has still not been achieved. The reasons for this state are unclear, but it is obvious that the cerebral ischemia and reperfusion cascade is a highly complex phenomenon, which includes the intense neuroinflammatory processes, and comorbid stroke risk factors strongly worsen stroke outcomes and likely make a substantial contribution to the pathophysiology of the ischemia/reperfusion, enhancing difficulties in searching of successful treatment. Common concomitant stroke risk factors (arterial hypertension, diabetes mellitus and hyperlipidemia) strongly drive inflammatory processes during cerebral ischemia/reperfusion; because these factors are often present for a long time before a stroke, causing low-grade background inflammation in the brain, and already initially disrupting the proper functions of NVUs. Broad consideration of this situation in basic research may prove to be crucial for the success of future clinical trials of neuroprotection, vasculoprotection and immunomodulation in stroke. This review focuses on the mechanism by which coexisting common risk factors for stroke intertwine in cerebral ischemic/reperfusion cascade and the dysfunction and disintegration of NVUs through inflammatory processes, principally activation of pattern recognition receptors, alterations in the expression of adhesion molecules and the subsequent pathophysiological consequences.

Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

Background Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients and methods We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence. Results Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%–6.85%) compared to men (5.67%; 95% CI, 4.83%–6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80–1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42–1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk. Discussion and Conclusion Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.

Abstract 1122‐000239: Understanding The Gap in Public Stroke Awareness in India’s Younger Generation

Introduction : Stroke is one of the major leading causes of death and disability in India. One reason is the lack of stroke awareness in India. With the adoption of an unhealthy lifestyle like a lack of physical exercise, smoking, and excessive alcohol consumption, newer stroke cases are more prevalent in young adults. I surveyed about 100 high school students from urban cities in India to assess their stroke knowledge and decide how to take measures to bring more awareness about its symptoms, risk factors, and new effective treatments. Methods : I randomly selected high school students(9th‐12th graders) from Uttarakhand, Uttar Pradesh, Madhya Pradesh, Maharashtra, and Karnataka states to participate in the survey I created. I distributed multiple‐choice anonymous questionnaires to hundreds of high school students. The participants completed survey questions to the best of their ability. The survey assessed candidates' demographic characteristics, knowledge of stroke symptoms, stroke risk factors, ability to identify stroke symptoms, and knowledge about stroke‐related surgeries. It is important to note that these surveys were primarily sent to high school students in urban areas, where the knowledge and resources are relatively better than the rural areas. Results : I received a total of 91 survey responses from high schoolers across different states in India (30% were from Madhya Pradesh, 40% were from Maharashtra and 30% were from Karnataka and Uttar Pradesh). Even though 53.8% of the respondents reported some level of prior knowledge about the stroke, the rest of the respondents simply did not know or had misconceptions about stroke. Nearly ¾ did not know any stroke risk factors, warning signs, or recognize that the brain gets affected during the stroke. Only 27.5% of the students have heard of the popular acronym BE FAST(Balance Eyes Face Arms Speech Time) which is used to detect stroke in a patient. It is shocking that only 12.1% of the respondents have received an education on stroke at least once in their lifetime. Conclusions : The high schoolers have a good recognition of some basic facts of stroke. However, they have a poor understanding of stroke risk factors, the severity of the disease, and the treatment availability. However, there is hope. More than 57% of the high schoolers in my survey mentioned that they were willing to learn about stroke and ways to prevent and detect it. So it is our duty to educate the younger generation about the dangers of stroke and how to prevent, as well as to detect it. We should strive to provide access to these children in the hope of helping spread awareness all around India one step at a time.

Atrial fibrillation and stroke risk factors in patients with cardiac implantable electronic devices

Purpose. Determination the proportion and burden of new-onset atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIED) and without prior AF and assessing the incidence of risk factors for stroke in patients with AF.Methods. The medical history of 111 patients with CIED with remote monitoring function were analyzed. AF diagnosed by the device was interpreted by an arrhythmologist and cases of significant AF were selected. The group of patients with and without AF was compared for several factors. To clarify the influence of risk factors on the duration of AF, all AF cases were divided into 3 categories depending on the AF burden per day. The first group included patients with an AF burden per day of 0.1% or less (n=10, (45.5%)), the second - from 0.3% to 12.2% (n=7, (31.8%)), and the third group - with 100% (n=5, (22.7%)). Patients with a burden of 0.2%, 12.3-99.9% were absent.Results. Newly diagnosed AF was registered in 19.8% of cases. The risk of stroke among these patients was high - 2 [1; 3] points on the CHA2 DS2 -VASc for men, and 3 [2,75; 3,75] points for women. Hypertension of 2 and 3 degrees was recorded in all patients in the group with an AF burden of 100% per day. That significantly differed from the other 2 groups (p=0.043). In the group with an AF burden of 100%, the levels of NT-proBNP, D-dimer, and creatinine were significantly higher than in the other groups (p=0.037, p=0.031 and p=0.036, respectively). When analyzing the dependence of creatinine level on the presence of AF, the area under the ROC-curve was 0.653 with 95% confidence interval 0.528-0.779 (p=0.017). The proportion of right ventricular pacing in patients with ICD was higher in the group of patients with AF.Conclusion. AF occurs in 1/5 of patients with CIED. All patients with AF were potential candidates for anticoagulation due to their high risk of stroke. The daily burden of AF is positively correlated with the presence and degree of hypertension, as well as with markers of renal dysfunction, chronic heart failure, and thrombosis. Elevated creatinine levels are a predictor of AF.

Relationships of Ischemic Stroke Occurrence and Outcome with Gene Variants Encoding Enzymes of Tryptophan Metabolism

Ischemic stroke is among the leading causes of mortality and long-term disability worldwide. Among stroke risk factors the importance of genetic background is gaining interest. There is a growing body of evidence of changes of metabolite levels and enzyme activities involved in the conversion of Trp during the course of cerebral ischemia. We compared the frequencies of ten SNPs of five genes related to Trp metabolism between groups of 122 ischemic stroke patients and 120 control individuals. Furthermore, we examined the mRNA levels of TPH1, IDO1 and KYAT1 genes in peripheral venous blood with the aim of assessing (i) whether there are changes in their expression during the course of stroke and (ii) does any of their investigated SNPs have an impact on gene expression. In seven cases out of ten studied polymorphisms we detected significant differences in frequencies in relation to ischemic stroke occurrence, etiology, and clinical parameters. We also detected changes in the expression of TPH1 and IDO1 genes during the course of the disease. We found that those IDO1 variants which show a trend towards elevated mRNA level are more frequent in stroke patients than in controls. Our results are important novel observations which suggest a causal relationship between elevated IDO1 expression and stroke etiology.