Acute Hemorrhagic Stroke Research Articles

Differential Approach to Surgical and Endovascular Treatments of Pulmonary Thromboembolism in Patients with Neurological and Neurosurgical Problems

INTRODUCTION: Pulmonary embolism (PE) is one of the most threatening complications in patients with neurological and neurosurgical problems. The high epidemiological threshold values and mortality in the considered group of patients attracted the interest of researchers in the methods of early diagnosis and selection of methods of reperfusion of the pulmonary arterial bed.
 AIM: To analyze clinical and hemodynamic results of the surgical and endovascular treatment of PE of the high and intermediatehigh risks in the group of patients with neurological and neurosurgical problems.
 MATERIALS AND METHODS: This study involved 24 patients with PE of high and intermediate high-risks. The first group involved seven patients with neurosurgical problems who underwent thromboembolectomy from the main and lobular branches of the pulmonary artery in conditions of parallel perfusion of the artificial circulation. The duration of perfusion was 26.0 7.4 min. The second group consisted of 17 patients with acute hemorrhagic stroke, in whom endovascular mechanical fragmentation of thromboemboli was performed using a modified Pig-Tail type catheter introduced by puncture through the subclavian or jugular vein. The first clinical manifestations of PE appeared 4.78 2.02 days after the neurosurgical intervention and 8.45 2.6 days after the onset of stroke. The initial systolic pressure in the pulmonary artery was 67.24 5.15 mm Hg in the first group and 70.53 4.53 mm Hg in the second group. Both groups had American Society of Anesthesiologist physical status IV and V classes of surgical risk and Pulmonary Embolism Severity Index class V (130174 points).
 RESULTS: The hospital survival rates were 100% and 82.36% in the first and second groups, respectively (three lethal cases due to progressing right-ventricular failure in the first 18 h after the procedure). On discharge, signs of reverse remodeling of the right heart chambers and reduction of the mean and systolic pressure in the pulmonary artery to 21 2.16 and 31 4.12 mm Hg, respectively, were noted in the first group and to 46 5.23 and 57 3.16 mm Hg, respectively, in the second group.
 CONCLUSION: Surgical treatment of PE is effective and safe with predictable results. Endovascular catheter induced destruction of the thromboembolus substrate is an alternative to the surgical treatment of patients with a high-risk of open surgery and absolute contraindications for thrombolytic therapy.

The Monocyte-to-Lymphocyte Ratio Predicts Acute Kidney Injury After Acute Hemorrhagic Stroke.

ObjectivesAcute kidney injury (AKI) is a serious complication of acute hemorrhagic stroke (AHS). Early detection and early treatment are crucial for patients with AKI. We conducted a study to analyze the role of the monocyte-to-lymphocyte ratio (MLR) in predicting the development of AKI after AHS.MethodsThis retrospective observational study enrolled all subjects with AHS who attended the neurosurgical intensive care unit (NSICU) at the First Affiliated University of South China between 2018 and 2021. Patient demographics, laboratory data, treatment details, and clinical outcomes were recorded.ResultsOf the 771 enrolled patients, 180 (23.3%) patients developed AKI. Compared to patients without AKI, those with AKI had a higher MLR and the neutrophil-lymphocyte ratio (NLR) at admission (P < 0.001). The MLR and the NLR at admission were associated with an increased AKI risk, with odds ratios (ORs) of 8.27 (95% CI: 4.23, 16.17, p < 0.001) and 1.17 (95% CI: 1.12, 1.22, p < 0.001), respectively. The receiver operating characteristic curve (ROC) analysis was conducted to analyze the ability of the MLR and NLR to predict AKI, and the areas under the curve (AUCs) of the MLR and the NLR were 0.73 (95% CI: 0.69, 0.77, p < 0.001) and 0.67 (95% CI: 0.62, 0.72, p < 0.001), with optimal cutoff values of 0.5556 and 11.65, respectively. The MLR and the NLR at admission were associated with an increased in-hospital mortality risk, with ORs of 3.13 (95% CI: 1.08, 9.04) and 1.07 (95% CI: 1.00, 1.14), respectively. The AUCs of the MLR and the NLR for predicting in-hospital mortality were 0.62 (95% CI: 0.54, 0.71, p = 0.004) and 0.52 (95% CI: 0.43, 0.62, p = 0.568), respectively. The optimal cutoff value for the MLR was 0.7059, with a sensitivity of 51% and a specificity of 73.3%.ConclusionsMLR and NLR measurements in patients with AHS at admission could be valuable tools for identifying patients at high risk of early AKI. The MLR was positively associated with in-hospital mortality and the NLR showed a weak ability for the prediction of in-hospital mortality.

Association of intermittent versus continuous hemodialysis modalities with mortality in the setting of acute stroke among patients with end-stage renal disease

Patients with end-stage renal disease (ESRD) are 8–10 times more likely to suffer from a stroke compared with the general public. Despite this risk, there are minimal data elucidating which...

Circulating miRNA-195-5p and -451a in Patients with Acute Hemorrhagic Stroke in Emergency Department.

(1) Background: In our previous study, acute ischemic stroke (AIS) patients showed increased levels of circulating miRNAs (-195-5p and -451a) involved in vascular endothelial growth factor A (VEGF-A) regulation. Here, we evaluated, for the first time, both circulating miRNAs in acute intracerebral hemorrhagic (ICH) patients. (2) Methods: Circulating miRNAs and serum VEGF-A were assessed by real-time PCR and ELISA in 20 acute ICH, 21 AIS patients, and 21 controls. These were evaluated at hospital admission (T0) and after 96 h (T96) from admission. (3) Results: At T0, circulating miRNAs were five-times up-regulated in AIS patients, tending to decrease at T96. By contrast, in the acute ICH group, circulating miRNAs were significantly increased at both T0 and T96. Moreover, a significant decrease was observed in serum VEGF-A levels at T0 in AIS patients, tending to increase at T96. Conversely, in acute ICH patients, the levels of VEGF-A were significantly decreased at both T0 and T96. (4) Conclusions: The absence of a reduction in circulating miRNAs (195-5p and -451a), reported in acute ICH subjects after 96 h from hospital admission, together with the absence of increment of serum VEGF-A, may represent useful biomarkers indicating the severe brain damage status that characterizes acute ICH patients.

Beyond the Golden Hour: Treating Acute Stroke in the Platinum 30 Minutes.

To emphasize treatment speed for time-sensitive conditions, emergency medicine has developed not only the concept of the golden hour, but also the platinum half-hour. Patients with acute stroke treated within the first half-hour of onset have not been previously characterized. In this cohort study, we analyzed patients enrolled in the FAST-MAG (Field Administration of Stroke Therapy-Magnesium) trial, testing paramedic prehospital start of neuroprotective agent ≤2 hours of onset. The features of all acute cerebral ischemia, and intracranial hemorrhage patients with treatment starting at ≤30 m of last known well were compared with later-treated patients. Among 1680 patients, 203 (12.1%) received study agents within 30 minutes of last known well. Among platinum half-hour patients, median onset-to-treatment time was 28 minutes (interquartile range, 25-30), and final diagnoses were acute cerebral ischemia in 71.8% (ischemic stroke, 61.5%, TIA 10.3%); intracranial hemorrhage in 26.1%; and mimic in 2.5%. Clinical features among platinum half-hour patients were largely similar to later-treated patients and included age 69 (interquartile range, 57-79), 44.8% women, prehospital Los Angeles Motor Scale median 4 (3-5), and early-postarrival National Institutes of Health Stroke Scale deficit 8 (interquartile range, 3-18). Platinum half-hour acute cerebral ischemia patients did have more severe prehospital motor deficits and younger age; platinum half-hour intracranial hemorrhage patients had more severe motor deficits, were more often female, and less often of Hispanic ethnicity. Outcomes at 3 m in platinum half-hour patients were comparable to later-treated patients and included freedom-from-disability (modified Rankin Scale score, 0-1) in 35.5%, functional independence (modified Rankin Scale score, 0-2) in 53.2%, and mortality in 17.7%. Prehospital initiation permits treatment start within the platinum half-hour after last known well in a substantial proportion of acute ischemic and hemorrhagic stroke patients, accounting for more than 1 in 10 enrolled in a multicenter trial. Hyperacute platinum half-hour patients were largely similar to later-treated patients and are an attainable target for treatment in prehospital stroke trials.

Acute glycemic variability and mortality of patients with acute stroke: a meta-analysis

BackgroundIncreased glucose fluctuation has been related to poor prognosis in patients with critical illnesses, while its prognostic role in patients with acute stroke remains unknown. The meta-analysis aimed to evaluate the association between the acute glycemic variation (GV) and mortality risk in patients with acute stroke.MethodsCohort studies were obtained by searching Medline, Web of Science, Embase, Wanfang and CNKI databases. A random-effect model which incorporates the intra-study heterogeneity was chosen to pool the results.ResultsTen cohort studies with 1433 patients were included, and 280 (19.5%) of them died within 90 days of disease onset. Results of the meta-analyses showed that a higher acute GV was associated with an increased risk of early mortality in patients with acute stroke, as indicated by GV measured with the coefficient of variation of blood glucose (CVBG, odds ratio [OR]: 2.24, 95% CI 1.40 to 3.58, p < 0.001, I2 = 73%), the standard deviation of blood glucose (SDBG, OR: 2.31, 95% CI 1.70 to 3.13, p < 0.001, I2 = 50%), and the mean amplitude of glycemic excursion (OR: 3.57, 95% CI 1.44 to 8.85, p = 0.006, I2 = 23%). For acute GV measured with CVBG and SDBG, subgroup analyses showed consistent results in patients with acute ischemic and hemorrhagic stroke, and for studies reporting 28-day and 90-day all-cause mortality (p for subgroup analysis all > 0.05).ConclusionsHigher acute GV may be an independent risk factor of early mortality in patients with acute stroke.

Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation

ImportanceMany patients with severe stroke have impaired airway protective reflexes, resulting in prolonged invasive mechanical ventilation.ObjectiveTo test whether early vs standard tracheostomy improved functional outcome among patients with stroke receiving mechanical ventilation.Design, Setting, and ParticipantsIn this randomized clinical trial, 382 patients with severe acute ischemic or hemorrhagic stroke receiving invasive ventilation were randomly assigned (1:1) to early tracheostomy (≤5 days of intubation) or ongoing ventilator weaning with standard tracheostomy if needed from day 10. Patients were randomized between July 28, 2015, and January 24, 2020, at 26 US and German neurocritical care centers. The final date of follow-up was August 9, 2020.InterventionsPatients were assigned to an early tracheostomy strategy (n = 188) or to a standard tracheostomy (control group) strategy (n = 194).Main Outcomes and MeasuresThe primary outcome was functional outcome at 6 months, based on the modified Rankin Scale score (range, 0 [best] to 6 [worst]) dichotomized to a score of 0 (no disability) to 4 (moderately severe disability) vs 5 (severe disability) or 6 (death).ResultsAmong 382 patients randomized (median age, 59 years; 49.8% women), 366 (95.8%) completed the trial with available follow-up data on the primary outcome (177 patients [94.1%] in the early group; 189 patients [97.4%] in the standard group). A tracheostomy (predominantly percutaneously) was performed in 95.2% of the early tracheostomy group in a median of 4 days after intubation (IQR, 3-4 days) and in 67% of the control group in a median of 11 days after intubation (IQR, 10-12 days). The proportion without severe disability (modified Rankin Scale score, 0-4) at 6 months was not significantly different in the early tracheostomy vs the control group (43.5% vs 47.1%; difference, −3.6% [95% CI, −14.3% to 7.2%]; adjusted odds ratio, 0.93 [95% CI, 0.60-1.42]; P = .73). Of the serious adverse events, 5.0% (6 of 121 reported events) in the early tracheostomy group vs 3.4% (4 of 118 reported events) were related to tracheostomy.Conclusions and RelevanceAmong patients with severe stroke receiving mechanical ventilation, a strategy of early tracheostomy, compared with a standard approach to tracheostomy, did not significantly improve the rate of survival without severe disability at 6 months. However, the wide confidence intervals around the effect estimate may include a clinically important difference, so a clinically relevant benefit or harm from a strategy of early tracheostomy cannot be excluded.Trial RegistrationClinicalTrials.gov Identifier: NCT02377167

Stroke care indicators in the Republic of Moldova – the RES-Q registry

Introduction. There were no data on in-hospital stroke care indicators until Moldova’s accession to the international Registry of Stroke Care Quality (RES-Q) platform in 2016. The aim of this paper was to assess the acute stroke care quality in Moldova based on the data of the RES-Q registry. Material and methods. We analyzed the data of all patients with acute ischemic and hemorrhagic stroke of the RES-Q from 15 Moldovan hospitals. Data were collected for one month each year, during a 3-year period (2017-2019). Data analysis was performed between hospitals according to their access to a brain CT facility for Moldovan participating hospitals. Additionally, Moldovan data were compared with other three ESO-EAST (European Stroke Organization Enhancing and Accelerating Stroke Treatment) project countries: Romania, Lithuania, and Georgia. Results. A total of 1660 patients were recruited in the study, mean age of 68 years (49% men). Moldova registered poorer results in number of brain CT performed (81% [95% CI 79-84%]), dysphagia screening (29% [95% CI 27-32%]), IV thrombolysis performed (3% [95% CI 2-4%]), administration of anticoagulants (44% [95% CI 39-49%]) and statins (42% [95% CI 39-45%]) at discharge, in-hospital stroke mortality (17% [95% CI 15- 19%]). Within Moldova the stroke care quality was driven by the access to CT scan. Conclusions. Our study highlighted some serious gaps of in-hospital stroke care performance in Moldova, such as the lack of CT scans in many public hospitals, the absence of a national stroke center network, extremely low accessibility of IV thrombolysis and unsatisfactory implementation of secondary stroke prevention treatment

SERUM FERRITIN LEVEL IN PATIENTS WITH ACUTE HAEMORRAGIC STROKE AND ITS ASSOCIATION WITH OUTCOME

Background:Stroke is characterized by acute onset of focal neurological deficit lasting 24 hours or longer. With the increasing incidence of hemorrhagic stroke in Indians, the use of biochemical markers like Ferritin can predict outcome. This study was undertaken to study level of Serum Ferritin levels in patients with acute hemorrhagic stroke and it association with the outcome. Materials and Methods: This was a hospital based cross sectional observational study with 90 patients with acute hemorrhagic stroke admitted into the Department of Medicine, JMCH since 1st July 2020 till June 30th 2021. All the patients subjected to investigations and inclusion and exclusion criteria. Equal number of age and sex matched healthy individuals were included in the study as control Results: In this study the mean age group with Acute Hemorrhagic Stroke was 63.3 +-7.2 years. Of the total cases 57 were males (63.3%) and 33 female (37.7%). Hypertension was the most common risk factor associated present in 67.8% patients which is 53.3. The most common site of bleed was the basal ganglia. The mean serum Ferritin value was 333.44 +92.12ng/ml in patients with acute hemorrhagic stroke .The serum ferritin values correlated with the hematoma volume and higher values were associated with increased mortality . Conclusion: In the study Serum Ferritin values were significantly higher 445.29+-97.70 ng/ml (p value&lt;.001) in patients which deteriorated and showed a positive correlation.

The Effects of COVID-19 on Patients with Acute Ischemic and Hemorrhagic Stroke

ObjectiveThe objective of this study was to evaluate how COVID-19 affects patients with acute ischemic or hemorrhagic stroke outcome. Materials and methodsThis retrospective study was performed on adult patients (> 18 years old) with stroke (ischemic or hemorrhagic) who were admitted to hospital with or without COVID-19. The primary outcome was stroke-related disability, which was measured by mRS at baseline and discharge. Hospital duration, intensive care unit (ICU) admission, and mortality were considered the secondary outcomes. ResultsFrom February 2019 until August 2020, we recruited and analyzed 151 patients, 42 of whom had COVID-19 based on RT-PCR tests or lung CT scan findings. COVID-19 positive patients had higher baseline and final mRS scores than the control group (4.46 ± 0.67 vs 4.79 ± 0.61, P: 0.001, 3.83 ± 1.22 vs 4.46 ± 0.67, P: 0.001). Moreover, stroke patients with COVID-19 experienced a more severe disease and required a higher rate of ICU admission (17 vs 0, P:0.001) and longer hospitalization compared to those without COVID-19 (8.50 ± 7.86 vs 7.5 ± 11.20, P: 0.021). Also, mortality was higher in the COVID-19 group (19 vs 13, P:0.001). There was not any significant differences between the two groups in terms of the involvement of cerebral arteries and type of stroke. Male sex, COVID-19, and ICU admission were the main independent risk factors for death. ConclusionThe results of the study showed stroke patients (ischemic or hemorrhagic) with COVID-19 can have more disabilities and incur more hospital complications and mortality than non-COVID-19 patients.

Recovery from aphasia in the first year after stroke.

Most individuals who experience aphasia after a stroke recover to some extent, with the majority of gains taking place in the first year. The nature and time course of this recovery process is only partially understood, especially its dependence on lesion location and extent, which are the most important determinants of outcome. The aim of this study was to provide a comprehensive description of patterns of recovery from aphasia in the first year after stroke. We recruited 334 patients with acute left hemisphere supratentorial ischaemic or haemorrhagic stroke and evaluated their speech and language function within 5 days using the Quick Aphasia Battery (QAB). At this initial time point, 218 patients presented with aphasia. Individuals with aphasia were followed longitudinally, with follow-up evaluations of speech and language at 1 month, 3 months, and 1 year post-stroke, wherever possible. Lesions were manually delineated based on acute clinical MRI or CT imaging. Patients with and without aphasia were divided into 13 groups of individuals with similar, commonly occurring patterns of brain damage. Trajectories of recovery were then investigated as a function of group (i.e. lesion location and extent) and speech/language domain (overall language function, word comprehension, sentence comprehension, word finding, grammatical construction, phonological encoding, speech motor programming, speech motor execution, and reading). We found that aphasia is dynamic, multidimensional, and gradated, with little explanatory role for aphasia subtypes or binary concepts such as fluency. Patients with circumscribed frontal lesions recovered well, consistent with some previous observations. More surprisingly, most patients with larger frontal lesions extending into the parietal or temporal lobes also recovered well, as did patients with relatively circumscribed temporal, temporoparietal, or parietal lesions. Persistent moderate or severe deficits were common only in patients with extensive damage throughout the middle cerebral artery distribution or extensive temporoparietal damage. There were striking differences between speech/language domains in their rates of recovery and relationships to overall language function, suggesting that specific domains differ in the extent to which they are redundantly represented throughout the language network, as opposed to depending on specialized cortical substrates. Our findings have an immediate clinical application in that they will enable clinicians to estimate the likely course of recovery for individual patients, as well as the uncertainty of these predictions, based on acutely observable neurological factors.

Obstetric Outcomes of Pregnant Women with Eclampsia: A study in a Tertiary Care Hospital

Introduction: Usually, eclampsia is the commonest cause of convulsions in pregnancy next being epilepsy. Moreover, in developing countries like Bangladesh, perinatal condition in eclampsia is a major concern of infant injury. So, proper treatment planning and initiatives against eclampsia can save many lives by decreasing the total mortality and morbidity of child and mother. The aim of our study was to assess the perinatal outcomes of pregnant women with eclampsia in a tertiary care hospital in Bangladesh. Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology in Rangpur Medical College, Rangpur, Bangladesh during the period from January 2020 to December 2020. Proper written consents form all the participants were obtained and the ethical committee of the mentioned hospital had approved the study before starting the intervention. In total 78 pregnant women with eclampsia were selected as the study population. A predesigned questioner was used in collecting patient data. All data were processed, analyzed and disseminated by using MS Office and SPSS version 23 as per need. Result: As final outcome we observed, there was not any case of multiple pregnancy or maternal mortality. Among total 78 fetus, cases of stillbirth (SB), early neonatal death (END), perinatal death (END + SB) and death after birth were found as 8%, 12%, 19% and 4% respectively. So, total case of neonatal death was found 35% whereas the survival rate was 65%. As neonatal complication among survived babies, frequencies of jaundice, septicemia and respiratory distress were found in 27%, 24% and 18% babies respectively who were noticeable. As maternal complication, cases of ICU admission, acute kidney injury and haemorrhagic stroke were found as 4%, 3% and 1% respectively. Conclusion: Stillbirth may be considered as the main component and prematurity may be considered as another important cause of perinatal mortality in obstetric management of delivery in pregnant mothers with eclampsia. Early referral of eclamptic patients, early resuscitative measures as well as good neonatal care can improve perinatal outcomes in such cases.

Comparison of Siriraj Stroke Score with Computed Tomography to Differentiate Acute Embolic and Hemorrhagic Stroke in a Tertiary Care-Teaching Center

Comparison of Siriraj Stroke Score with Computed Tomography to Differentiate Acute Embolic and Hemorrhagic Stroke in a Tertiary Care-Teaching Center

FREQUENCY OF SEVERELY ELEVATED BLOOD PRESSURE ON ADMISSION IN KNOWN HYPERTENSIVE PATIENTS PRESENTING WITH ACUTE HAEMORRHAGIC STROKE

Objectives: To determine the frequency of severely elevated blood pressure on admission in known hypertensive patients presenting with acute hemorrhagic stroke. Methodology: This cross-sectional Study conducted at Neurology Department, Lady Reading Hospital, Peshawar, the duration of study is 6 months from 2/12/2020 to 2/5/2021. In the present study a total of 90 patients 20 to 70 years old patients of either sex with a known history of hypertension (HTN) who present with acute hemorrhagic stroke were included in the study. The blood pressure of these patients was measured at the time of admission. The weight of the patient in kilograms was measured with the help of a digital electronic scale and height was measured with the help of a stadio-meter. Results: In the present study mean age was 53 years with standard deviation (SD) ± 10.02. Sixty two percent patients were male and 38% patients were female. Mean body mass index (BMI) was 26 kg/m2 with SD ± 3.31. Mean duration of hypertension was 3 years with SD ± 3.14. Eighty eight percent patients had use of antihypertensive medications while 12% patients’ did not had use of antihypertensive medications. Eighty percent patients had compliance with antihypertensive medications while 20% patients didn’t had compliance with antihypertensive medications. More over 18% patients had extremely raised blood pressure while 82% patients’ didn’t had very high blood pressure. Conclusion: Our study concludes that the frequency of severely elevated blood pressure was 18% on admission in known hypertensive patients presenting with acute hemorrhagic stroke.

Blood Pressure Goals in Acute Stroke.

Antihypertensive treatment is highly effective in both primary and secondary prevention of stroke. However, current guideline recommendations on the blood pressure goals in acute stroke are clinically empirical and generally conservative. Antihypertensive treatment is only recommended for severe hypertension. Several recent observational studies showed that the relationship between blood pressure and unfavorable clinical outcomes was probably positive in acute hemorrhagic stroke but J- or U-shaped in acute ischemic stroke with undetermined nadir blood pressure. The results of randomized controlled trials are promising for blood pressure management in hemorrhagic stroke but less so in ischemic stroke. A systolic blood pressure goal of 140 mm Hg is probably appropriate for acute hemorrhagic stroke. The blood pressure goal in acute ischemic stroke, however, is uncertain, and probably depends on the time window of treatment and the use of revascularization therapy. Further research is required to investigate the potential benefit of antihypertensive treatment in acute stroke, especially with regard to the possible reduction of blood pressure variability and more intensive blood pressure lowering in the acute and subacute phases of a stroke, respectively.

Electroencephalography at the height of a pandemic: EEG findings in patients with COVID-19

ObjectiveTo characterize continuous video electroencephalogram (VEEG) findings of hospitalized COVID-19 patients. MethodsWe performed a retrospective chart review of patients admitted at three New York City hospitals who underwent VEEG at the peak of the COVID-19 pandemic. Demographics, comorbidities, neuroimaging, VEEG indications and findings, treatment, and outcomes were collected. ResultsOf 93 patients monitored, 77% had severe COVID-19 and 40% died. Acute ischemic or hemorrhagic stroke was present in 26% and 15%, respectively. Most common VEEG indications were encephalopathy/coma (60%) and seizure-like movements (38%). Most common VEEG findings were generalized slowing (97%), generalized attenuation (31%), generalized periodic discharges (17%) and generalized sharp waves (15%). Epileptiform abnormalities were present in 43% and seizures in 8% of patients, all of whom had seizure risk factors. Factors associated with an epileptiform VEEG included increasing age (OR 1.07, p = 0.001) and hepatic/renal failure (OR 2.99, p = 0.03). ConclusionsMost COVID-19 patients who underwent VEEG monitoring had severe COVID-19 and over one-third had acute cerebral injury (e.g., stroke, anoxia). Seizures were uncommon. VEEG findings were nonspecific. SignificanceVEEG findings in this cohort of hospitalized COVID-19 patients were those often seen in critical illness. Seizures were uncommon and occurred in the setting of common seizure risk factors.

Clinical and epidemiological profile of elderly patients seen in a hypertensive emergency at a public hospital in the state of Rio de Janeiro – Hypertensive emergency in the elderly

Introduction: Hypertensive emergencies (HE) are clinicalentities characterized by an acute and significant increasein blood pressure (BP) associated with severe symptoms thatevidence target organ damage. Objective: To analyze the clinicaland epidemiological profile of elderly patients treated ina hypertensive emergency at a public hospital in the state ofRio de Janeiro. Method: This study is prospective and descriptive.Information was collected from August to October, 2020using medical records and processed using the Statistic Statsoftprogram. Pearson’s test was performed for univariate analysis.Results: The sample consisted of 109 patients. The averageage found was 73 years old, with a predominance of males(69.72%) and brown skin (36.69%). Approximately 72.48% ofthe patients had a history of Systemic Arterial Hypertension(SAH), however, (50.46%) reported that they did not regularlyuse antihypertensive medication. Target organ injuries wereischemic stroke (58.71%), followed by acute coronary syndrome(24.77%), hemorrhagic stroke (9.17%) and edema acutelung disease (7.33%). Regarding the BP values found at admission,the mean systolic pressure was 205.0 mmHg, while themean diastolic pressure was 127.0 mmHg. Conclusion: Ischemicstroke was the most frequent HE in the sample. It is necessaryto put in place measures to prevent risk factors associated withSAH, as well as to control blood pressure levels to reduce thenumber of consultations due to hypertensive emergencies andother complications of cardiovascular diseases.Keywords: Emergency; Hypertension; Prevalence.

Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Early enteral nutrition is crucial for preventing malnutrition and improving outcomes in patients with severe stroke, but previous trials have provided conflicting results regarding the optimal nutritional strategy. We aimed to compare the efficacy and safety of three enteral feeding strategies in patients with severe stroke. The Optimizing Early Enteral Nutrition in Severe Stroke (OPENS) study was a multicentre, investigator-initiated, prospective, open-label, randomised controlled trial, with blinded outcome assessment, in 16 tertiary and district general hospitals in the west of China. Adult patients with acute severe ischaemic or haemorrhagic stroke (Glasgow Coma Scale score ≤12 or National Institutes of Health Stroke Scale score ≥11 on admission) who were expected to receive enteral nutrition for more than 7 days were randomly assigned (1:1:1) to full enteral nutrition (70-100% of estimated caloric requirements), modified full enteral nutrition (full enteral nutrition plus prokinetic agents), or hypocaloric enteral nutrition (40-60% of estimated caloric requirements) via a centralised web-based randomisation system. The assigned nutrition was initiated within 24 h after enrolment and continued for 7 days. The computer-generated randomisation sequence was prepared by a statistician not involved with the rest of the study. Randomisation was done with an automated permuted block size of six. The allocation was unblinded to participants and investigators. The primary efficacy outcome was the proportion of participants with poor outcome (modified Rankin Scale score ≥3) at day 90 and the prespecified primary safety outcome was mortality at day 90, assessed in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT02982668. Between Jan 15, 2017, and Sept 23, 2020, 321 patients were randomly assigned (107 in each group) and 315 patients (175 [56%] men, median age 71 years, IQR 60-78) were included in the final analysis. The study was terminated ahead of schedule on Sept 23, 2020, because a significant difference between groups was detected in mortality. The proportion of participants with poor outcomes at 90 days did not differ (modified full enteral nutrition 86 [82%] of 105 patients vs full enteral nutrition 85 [80%] of 106 patients, adjusted odds ratio [OR] 0·87, 95% CI 0·41-1·86, p=0·721; hypocaloric enteral nutrition 76 [73%] of 104 patients vs full enteral nutrition 0·61, 0·30-1·27, p=0·186; hypocaloric enteral nutrition vs modified full enteral nutrition 0·70, 0·34-1·46, p=0·340). Hypocaloric enteral nutrition showed significantly higher 90-day mortality than did modified full enteral nutrition (35 [34%] of 104 patients vs 18 [17%] of 105 patients, adjusted OR 2·89, 95% CI 1·46-5·72; p=0·0023), whereas the difference was not significant between hypocaloric enteral nutrition and full enteral nutrition (24 [23%] of 106 patients; adjusted OR 1·92, 95% CI 1·00-3·69; p=0·049), and between modified full enteral nutrition and full enteral nutrition (adjusted OR 0·61, 0·29-1·28; p=0·187). The most common adverse event was pneumonia, the incidence of which showed no significant difference among groups (full enteral nutrition 82 [78%] of 105 patients, modified full enteral nutrition 83 [81%] of 103 patients, hypocaloric enteral nutrition 78 [75%] of 104 patients; p=0·625). In the early phase of severe stroke, modified full enteral nutrition or hypocaloric enteral nutrition did not significantly reduce the risk of a poor outcomes compared with full enteral nutrition over a 90-day period. Hypocaloric enteral nutrition might be associated with increased mortality compared with modified full enteral nutrition. Further studies are needed to investigate whether modified full enteral nutrition might be the optimal strategy. Shaanxi province Key Research and Development Project.

Glycemic Status and Outcome of Neurological Patients with COVID-19 Admitted at Referral Neuroscience Institute of Bangladesh

Background: The presentation of corona virus disease 2019 (COVID-19) may include neurological features and patients with neurological disorders may develop concomitant COVID-19 during pandemic. Hyperglycemia leads to higher propensity to COVID-19 infection with higher disease severity.&#x0D; Objective: To assess the neurological diagnoses, glycemic status and outcome in patients hospitalized primarily for neurological problems and subsequently diagnosed as COVID-19.&#x0D; Methods: This retrospective cohort study was conducted in National Institute of Neurosciences (NINS) &amp; Hospital, Dhaka, Bangladesh. Patients admitted to adult Neurology ward during April to November 2020 primarily for neurological problems and diagnosed as confirmed COVID-19 (with positive RT-PCR test for COVID-19) were included. The hospital records were reviewed and recorded in a checklist. Outcome of patients referred to COVID-19 dedicated hospitals was obtained over telephone.&#x0D; Results: The study included 85 patients with COVID-19 [median age 60 years (IQR: 45-65); 63.5% male]. Acute ischemic stroke was the most common neurological diagnosis (32.9%), followed by acute hemorrhagic stroke and subarachnoid hemorrhage (22.4% and 15.3% respectively). Other neurological diagnoses were meningoencephalitis (7.1%), Guillain Barre Syndrome (4.7%), Myasthania Gravis (1.2%), brain abscess (1.2%) and intracranial space occupying lesion (1.2%). Fourteen percent patients had no definite neurological diagnosis, they were admitted for delirium. History of diabetes was present in 18% patients. The mortality was 27% and the proportion of mortality was significantly higher in patients known to have DM in comparison to those who were not (p=0.012). The mean age and proportion of male sex was significantly higher among those who expired.&#x0D; Conclusion: There is high rate of mortality in neurological patients with COVID-19 who have variable neurological diagnosis including stroke, autoimmune disease and cerebral infections. Co-existent diabetes further increases the rate of mortality.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 97-102

Maximizing Brain Health After Hemorrhagic Stroke: Bugher Foundation Centers of Excellence.

Maximizing Brain Health After Hemorrhagic Stroke: Bugher Foundation Centers of Excellence.