Acute Post-stroke Period Research Articles

Mortality and Place of Residence One Year Post Stroke in an Irish Cohort

Abstract Background Transition from hospital to community post stroke is a critical period in a patient's recovery. Understanding where post-stroke patients are living a year after discharge can provide valuable insights into the effectiveness of discharge planning and rehabilitation strategies. We aimed to identify location of patients one year post stroke and examine the influences on that location. Methods We performed a retrospective cohort study of stroke patients admitted to an acute hospital over a one-year period. Data on demographics, function, length of stay, stroke severity, mortality and discharge location were obtained from the in-hospital stroke registry. Patients were interviewed one year post stroke and follow up data on place of residence obtained. Results 260 strokes occurred during the 1-year period. 11% died as inpatients and 5% were uncontactable leaving 206 stroke patients included in this study. Twenty-five patients (12%) died between discharge and 1 year follow up. 150 (73%) returned home post discharge rising to 157 (76%) one year post stroke. 32 (16%) were discharged to nursing homes falling to 22 (11%) at one year. Patients in nursing homes were older (80 vs 68 years, p = 0.001), had longer inpatient stays (37 vs 9 days, p = 0.000) and had higher Modified Rankin Scores (5 vs 2, p=0.0001). Conclusion Almost one in four stroke patients died within the first year of stroke consistent with international data. Mortality was highest in the acute post stroke period, but half of all deaths occurred post hospital discharge highlighting the importance of secondary vascular prevention and advanced care planning in this population. Older age, higher functional dependence and longer length of hospital stay were all associated with nursing home admission. Post stroke morbidity and mortality remains high after hospital discharge. Further study is needed to understand cause of death in the post discharge period in this population.

Adaptation of the Aphasia Bedside Check for Russian

The Aphasia Bedside Check for Russian (ABC-Ru) is a screening test that allows the medical staff of a neurological ward to detect speech/language disorders in the first days post-stroke onset. To evaluate whether this test follows modern psychometric standards, we performed two studies. In Study 1, we reported the results of the standardization of the ABC-Ru in a clinical group of people with chronic speech/language disorders (N = 80) and a cohort of neurologically healthy individuals (N = 120). In Study 2, we validated the results in a group of people in the acute post-stroke period (N = 20) with and without speech/language disorders. According to the results of the study, the ABC-Ru can be considered as a valid instrument and can potentially be used in neurological departments for the screening of speech and language disorders

The Aphasia Rapid Test: adaptation and standardisation for Russian

ABSTRACT Background: The Aphasia Rapid Test (ART) is a screening test developed for fast speech/language assessment of people in the acute stroke period. This test has been developed for French and English and was recently adapted for Portuguese and Italian. Nowadays, such a standardised screening test is in a great need at clinics with Russian-speaking patients. To fill this gap, the ART was adapted for Russian. Aims: The current study investigated whether the Russian ART meets all the psychometric standards, and whether it is suitable for detecting speech/language disorders and estimating their severity, as well as for the evaluation of improvement in the acute post-stroke period. Methods & Procedure: First, we evaluated the validity, sensitivity, specificity, accuracy, test-retest reliability, inter-item consistency and inter-rater reliability of the test in a group of people with chronic speech/language disorders (N = 55) and in an age-matched control group of non-brain-damaged individuals (N = 50). Participants performed the Russian ART, and their linguistic status was confirmed by the Russian e-version of the Token Test. Second, to test the appropriateness of the Russian ART in the acute post-stroke period, a clinical group of such individuals (N = 43) performed the ART and the Token Test, as well as the Vasserman’s scale which is widely used in Russian clinics. Finally, 16 people in the acute stroke period performed the Russian ART twice to prove that the test can detect early changes in an acute patient’s linguistic status. Outcomes & Results: The results showed that the Russian ART can be considered as a valid, sensitive, specific, and accurate screening tool with the high test-retest reliability, inter-item consistency, and inter-rater reliability. In the acute post-stroke group, the correlation between the ART and the Token Test was high and significant; a moderate correlation and no significant correlation were found between the Vasserman’s scale and the Russian ART and the Token Test correspondingly. The Russian ART also allowed us to detect the improvement in speech/language status in the acute post-stroke period. Conclusion: The study confirmed that the Russian ART meets all required standards to be suggested for usage in a Russian-speaking clinical population. This test was relevant for detecting the presence and severity of speech/language disorders and to measure the improvement in the acute post-stroke period.

Features of the dynamics of inflammation and apoptosis markers in patients with different acute post-stroke period

The purpose of this was to study the dynamics of markers of inflammation and apoptosis in the serum of patients with ischemic stroke in the early post-stroke period. Materials and methods. The study involved 22 patients (mean age 60 ± 5.5 years) with different dynamics of neurological symptoms in the acute post-stroke period. Patients were examined twice: on the 1st and 10th day of observation. Quantitative assessment of the severity of neurological deficit using ESS and NIHSS scales was carried. Enzymatic activity of leukocyte elastase, functional activity of a1-proteinase inhibitor, level of autoantibodies to MBP (inflammatory markers), as well as the content of p53 and Bcl-2 proteins (markers of apoptosis) were determined in serum. The control group consisted of 35 somatically healthy people of the appropriate age and sex. Results. Identified the different features of the spectrum of the analyzed markers of inflammation and apoptosis in patients with positive and negative dynamics of neurological symptoms in the acute period of ischemic stroke assessed according to the ESS and NIHSS scales. The observed clinical and biological relationships reflect the features of the course of the early post-stroke period and can be considered as possible predictors of the development trajectory of acute brain ischemia.

Timing of Initiation of Oral Anticoagulation after Acute Ischemic Stroke in Patients with Atrial Fibrillation.

Patients with atrial fibrillation (AF) who suffer an acute ischemic stroke are at risk for both hemorrhagic transformation and recurrent ischemic stroke in the acute post-stroke period. Oral anticoagulants are recommended for secondary stroke prevention in patients with AF. The optimal time to initiate anticoagulant therapy after acute ischemic stroke in patients with AF is uncertain. There is concern that early initiation increases the risk of hemorrhagic transformation, whereas delayed initiation leaves the patient at risk for recurrent ischemic stroke. In this article, we provide a review of the risk of hemorrhagic transformation of acute ischemic stroke as well as review the literature and major guidelines addressing the timing of anticoagulation initiation after an acute ischemic stroke in patients with AF. Relevant articles published from 1990 to the present were identified using the PubMed and Embase databases. The majority of available literature is observational data. Large ischemic lesions, cerebral microbleeds, thrombolytic therapy, and other clinical factors may increase the risk of hemorrhagic transformation of an acute ischemic stroke. Parenteral anticoagulation within 48hours is associated with an increased risk of hemorrhagic transformation and is not recommended. Insufficient data exist to support the safety of routine oral anticoagulant (direct oral anticoagulants or warfarin) initiation within 48hours of an acute ischemic stroke. Direct oral anticoagulant initiation within 2days of an acute ischemic stroke is associated with a 5% rate of hemorrhagic transformation. Infarct size and presence of hemorrhage are important factors in identifying the optimal time to initiation and should guide decisions when available. A recommended framework for patient decision making is provided. Randomized controlled trials in this area are needed to identify the optimal timing of anticoagulation initiation, and such trials are under way.

Cortical connectivity from EEG data in acute stroke: A study via graph theory as a potential biomarker for functional recovery

Cerebral post-stroke plasticity has been repeatedly investigated via functional neuroimaging techniques mainly based on blood flow/metabolism. However, little is known on predictive value of topological properties of widely distributed neural networks immediately following stroke on rehabilitation outcome and post-stroke recovery measured by early functional outcome. The utility of EEG network parameters (i.e. small world organization) analysis as a potential rough and simple biomarker for stroke outcome has been little explored and needs more validation. A total of 139 consecutive patients within a post-stroke acute stage underwent EEG recording. A group of 110 age paired healthy subjects constituted the control group. All patients were clinically evaluated with 3 scales for stroke: NIHSS, Barthel and ARAT. As a first result, NIHSS, Barthel and ARAT correlated with Small World index as provided by the proportional increment/decrement of low (delta) and viceversa of high (beta2 and gamma) EEG frequency bands. Furthermore, in line with the aim of the present study, we found a strong correlation between NIHSS at follow up and gamma Small World index in the acute post-stroke period, giving SW index a significant weight of recovery prediction. This study aimed to investigate possible correlations between functional abnormalities of brain networks, measured by small world characteristics detected in resting state EEG source investigation, and early post-stroke clinical outcome in order to find a possible predictive index of functional recovery to address and/or correct the rehabilitation program.

Effect of Nebivolol and Olmesartan on 24-Hour Brachial and Aortic Blood Pressure in the Acute Stage of Ischemic Stroke.

Background Elevated blood pressure (BP) in the acute phase of ischemic stroke is associated with heightened risk of early disability and death. However, whether BP-lowering in this setting is beneficial and the exact levels at which BP should be targeted remain unclear. This study aimed to evaluate the effect of nebivolol, olmesartan, and no-treatment on 24-hour BP in patients with hypertension during the acute poststroke period. Methods In a single-blind fashion, 60 patients with acute ischemic stroke and clinic systolic BP (SBP) 160–220 mmHg were randomized to nebivolol (5 mg/day), olmesartan (20 mg/day), or no-treatment between Day 4 and Day 7 of stroke onset. BP-lowering efficacy was assessed through 24-hour BP monitoring using the Mobil-O-Graph device (IEM, Germany). Results Between baseline and Day 7, significant reductions in 24-hour brachial SBP were noted with nebivolol and olmesartan, but not with no-treatment. Change from baseline (CFB) in 24-hour brachial SBP was not different between nebivolol and olmesartan groups (between-group difference: −3.4 mmHg; 95% confidence interval (CI): −11.2, 4.3), whereas nebivolol was superior to no-treatment in lowering 24-hour brachial SBP (between-group difference: −7.8 mmHg; 95% CI: −7.8 mmHg; 95% CI: −15.6, −0.1). Similarly, nebivolol and olmesartan equally lowered 24-hour aortic SBP (between-group difference: −1.9 mmHg; 95% CI: −10.1, 6.2). Nebivolol and olmesartan provoked similar reductions in 24-hour heart rate-adjusted augmentation index and pulse wave velocity. Conclusion This study suggests that during the acute phase of ischemic stroke, nebivolol is equally effective with olmesartan in improving 24-hour aortic pressure and arterial stiffness indices. ClinicalTrials.gov identifier number: NCT03655964.

EFFECT OF NEBIVOLOL AND OLMESARTAN ON 24-HOUR AORTIC PRESSURE AND ARTERIAL SRIFFNESS DURING THE ACUTE PHASE OF ISCHEMIC STROKE

Objective:Elevated blood pressure (BP) in the acute phase of ischemic stroke is associated with heightened risk of early disability and death. However, whether BP-lowering in the acute post-stroke period is beneficial and the exact levels at which BP should be targeted remain unclear. This study aim

Early poststroke seizures following thrombolysis and/or thrombectomy for acute stroke: Clinical and stroke characteristics

In this retrospective study, we explored the clinical and stroke characteristics of patients treated with thrombolysis and/or mechanical thrombectomy for an acute stroke and experiencing early poststroke seizures within 7 days of the cerebrovascular accident. Patients with prior epilepsy, primary intracerebral hemorrhage or transient ischemic attacks, or taking antiepileptic drugs were excluded. We retrospectively identified 32 patients admitted between 2010 and 2016 (mean age 75 years; range: 49–90; 14 females and 18 males). A cortical stroke was found in more than 70% of patients. Most epileptic seizures were focal aware (46.7%) or generalized convulsive (43.3%). The median time between stroke onset and seizure occurrence was 2 days; in 75.9% of the cases, seizures occurred within the first 3 days. This retrospective case series is the largest published so far providing details on clinical features of patients with early poststroke seizures following different reperfusion therapies, not only restricted to intravenous (i.v.) thrombolysis. Early poststroke seizures following reperfusion therapies are associated with cortical stroke involvement, are usually focal without impairment of awareness or generalized convulsive, and occur mostly within the first 3 days. Further studies are needed to clarify whether the low prevalence of focal impaired awareness seizures (and nonconvulsive seizures/status) is real or reflects the failure to recognize and correctly diagnose this seizure type in the acute poststroke period (risk of underascertainment due to the lack of systematic video-electroencephalogram (EEG) recording in patients with stroke and difficulties in recognizing these seizures).This article is part of the Special Issue “Seizures & Stroke”.

Achieved blood pressure level and target organ damage in post-stroke hypertensive patients

Objective. To assess the impact of the achieved blood pressure level on the structure and function of kidneys, carotid arteries and depression level in hypertensive post-stroke survivors.Design and methods.Carotid arteries and kidneys were assessed by ultrasound study. All parameters including depression level (Hamilton scale) were evaluated depending on the achieved systolic blood pressure level (SBP) in 88 hypertensive patients in acute post-stroke period and at follow-up (8–12 months after stroke). Multiple regression analysis was applied to assess the associations between the factors.Results.Office SBP directly correlates with the creatinine level (r = 0,5; р = 0,01). Moderate direct correlation was found between mean office SBP at the follow-up visit and intima-media thickness (IMT) (r = 0,47; р = 0,004), resistance index of the right common carotid artery (CCA) (r = 0,47; р = 0,006), resistance index of the left CCA (r = 0,5; р = 0,002), and resistance index of the left internal carotid artery (ICA) (r = 0,4; р = 0,02). Regression analysis demonstrated that mean office SBP has an impact on the following parameters: plasma creatinine level (β = 0,43; р = 0,04) and CCA IMT (β = 0,36; р = 0,03). The depression decreased in subjects with SBP 125–134 mmHg.Conclusion. SBP stabilization at the level 125–134 mmHg leads to the decrease in the resistance index of the carotid arteries, improves renal function and reduces depression level in post-stroke survivors.

Immunological predictors of acute post-stroke period

At the present time, there is an increased interest in the search for biological predictors of the course and outcome of ischemic stroke (IS). Numerous studies have shown the relationship between neuroinflammation (in the brain) and systemic inflammatory response (in the blood). To study the relationship of inflammatory and autoimmune markers in blood serum of patients with acute ischemic stroke (on the 1st day) with the dynamics of the severity of neurological deficit (on the 1st and 10th day) and to assess the predictive ability of these indicators. Twenty-two patients in the acute period of IS (mean age 60±15.5 years) were examined. The severity of neurological deficit was assessed by ESS and NIHSS. The enzymatic activity of leukocyte elastase (LE), α1-proteinase inhibitor (α1-PI), level of autoantibodies to S-100B and MBP in serum was determined. The control group consisted of 33 healthy subjects. Blood samples were carried out on the 1st day of the post-stroke period, the clinical examination was performed on the 1st and 10th day of observation. Depending on the dynamics of neurological symptoms by the 10th day of observation, two subgroups of patients were identified. The1st subgroup was characterized by the normalization of neurological deficit (n=10). In the 2nd group, the negative dynamics of neurological deficit/lack of any positive changes was observed (n=12). Both subgroups demonstrated the increase in the LE and α1-PI activity as compared to the control (p=0.0019, p=0.00079; p=0.038, p=0.00041, respectively). The highest LE activity was detected in the 1st subgroup (p=0.035). The high level of autoantibodies to MBP was also observed in the 1st subgroup as compared to the control and the 2nd group (p=0.047, p=0.03, respectively). The 2nd subgroup was characterized by a higher functional activity of acute phase protein α1-PI (p=0.04). Using regression analysis, a model for predicting the course of the early post-stroke period depending on the determined immunological parameters was developed. The results suggest that the studied inflammatory and autoimmune markers may be possible predictors of the course of the early post-stroke period.

COGNITIVE IMPAIRMENT, THEIR DYNAMICS AND STRUCTURE IN THE ACUTE AND RECOVERY PERIODS OF STROKE, DEPENDING ON ARTERIAL HYPERTENSION SEVERITY AND DURATION

Relevance. Cognitive impairment is common in the post-stroke period. Different characteristics of arterial hypertension (AH), namely its severity, duration and variability of blood pressure, can affect the development of cognitive impairment in stroke patients.
 Objective: to investigate cognitive impairment, their dynamics and structure in acute and recovering stroke periods, depending on the arterial hypertension severity and duration.
 Materials and methods. 150 patients with a primary ischemic stroke and history of hypertension: 74 (49,3 %) women and 76 (50,7 %) men, the mean age (67,4±0,7) years have been examined. Neurological deficits was evaluated by the NIHSS scale. The cognitive status was evaluated by the MMSE scale at the end of an acute period of 21 days and 1 year. Diagnosis of hypertension was based on the clinical and instrumental examination results and medical documents. Daily blood pressure monitoring was using on admission and every 4 hours during 6 days of acute stroke stage. Mean SBP, mean DBP, maximum SBP and DBP, standard deviation (SD) of SBP and DBP were studied.
 Results. By the mean score on the MMSE scale, there are differences in patients during acute post-stroke period, depending on the severity of hypertension: 27,2±0,6 points in the case of hypertension stage 1, 24,3±0,6 in the case of hypertension stage 2 and 20,7±0,8 in case of AH stage 3, (p=0.001). By this indicator, patients with different AH duration were different: 26,4±0,9 points; 25,1±0,5 points; 20,5±0,7 points, respectively. The significance of these differences by the mean values of MMSE score was obtained in patients with a duration of AH less than 5 years and more than 10 years, as well as when comparing the group of "6-10 years" and "over 10 years" (p=0,001).
 Significant differences in the structure of cognitive deficits severity, depending on the hypertension stage and its duration, were observed only in patients with moderate and severe stroke (p=0,006).
 Cognitive deterioration a year after a stroke was observed in 40 (31,5 %) patients. They have significantly higher mean values SD 1-3, SD 1-6, SBP on the first day after a stroke, and duration of hypertension.
 Conclusions. The relationship between the degree of intellectual decline and the duration of hypertension (r=0,592, p=0,001), severity of hypertension (r=0,459, p=0,001) was found. The severity of the neurological deficiency affects the structure of cognitive impairment at discharge in patients with different severity and duration of hypertension, and higher mean values of the variability of blood pressure from 1 to 6 days, SBP on the first day after stroke and higher duration of hypertension in the history is associated with a negative dynamics of cognitive impairment in stroke patients in a year after stroke.

Acute Predictors of Social Integration Following Mild Stroke

Despite an acknowledged need to accurately predict stroke outcome, there is little empirical evidence regarding acute predictors of participation restriction post stroke. The current study examines prediction of social integration following mild stroke, using combinations of acute poststroke factors. In a prospective, longitudinal study, a cohort of 60 stroke survivors was followed up at 6 months post stroke. Hierarchical multiple regression analyses were employed to evaluate the value of acute poststroke variables in predicting social integration at 6 months post stroke. A combination of age, number of comorbidities, stroke severity, social support factors, and general self-efficacy in the acute poststroke period accounted for 42% of the variance in 6-month social integration. The largest amount of variance (20%) was explained by inclusion of social support factors, including number and types of support. Post hoc analysis was conducted to establish whether marital status was the mediating variable through which early poststroke social support factors exerted influence upon subsequent social integration. The new combination of acute variables accounted for 48% of the variance in 6-month social integration. Results suggested that subjects with partners perceived higher levels of functional social support and lower levels of participation restriction. Stroke survivors with partners may receive greater amounts of companionship and encouragement from their partners, which enhances self-esteem and confidence. Such individuals are possibly more able to participate in and maintain relationships, thus improving social integration. Social support factors, mediated via marital status, are the strongest predictors of subsequent social integration following mild stroke.

Where to now? AVERT answered an important question, but raised many more.

A Very Early Rehabilitation Trial (AVERT) was a Phase 3 randomized trial with over 2100 subjects post stroke that had unexpected results with better outcomes for usual care than those receiving very early mobilization. This review of published stroke clinical practice guidelines highlights that recommendations for mobilization have changed after publication of AVERT but also that developers have struggled to provide recommendations for appropriate dose, duration and intensity of mobilization in the acute post stroke period with available analyses from AVERT and other literature. This review highlights the priority research questions about early rehabilitation post stroke that need to be addressed through future large scale randomized controlled trials.

Alterations in anxiety and social behaviour in Npas4 deficient mice following photochemically-induced focal cortical stroke

In addition to causing widespread cell death and loss of brain function, cerebral ischaemia also induces extensive neuroplasticity. In humans, stroke is often accompanied by severe cognitive and psychiatric changes that are thought to arise as a consequence of this infarct-induced remodelling. A candidate for producing these post-stroke neuropsychiatric changes is Npas4, an activity-dependent transcription factor involved in synaptic plasticity whose expression is aberrantly up-regulated following ischaemic injury. In this study we investigated the role of Npas4 in modulating these stroke-induced neuropsychiatric responses by comparing the performance of wildtype and Npas4−/− mice in various cognitive and behavioural tasks in a photochemical model of focal cortical stroke. We show that this stroke model results in impaired spatial recognition memory and a reduction in despair-like behaviour that affect both genotypes to a similar degree. Moreover, mice lacking Npas4 also show differences in some aspects of post-stroke sociability and anxiety. Specifically, we show that while stroke had no effect on anxiety levels in wildtype mice, Npas4−/− mice became significantly more anxious following stroke. In addition, Npas4−/− mice retained a greater level of sociability in the acute post-stroke period in comparison to their wildtype littermates. Thus, our findings suggest that Npas4 may be involved in post-stroke psychiatric changes related to anxiety and sociability.

True Effects or Bias? MMP-2 and MMP-9 Serum Concentrations after Acute Stroke

Background: Average serum matrix metalloproteinase (MMP) concentrations in patients with acute stroke have shown to be varying across studies. Possibly, next to true effects, other factors may influence MMP levels. The aim of this study was to investigate the dynamics of these enzymes in repeated measurements in the acute post-stroke period, in respect to different stroke etiologies, and highlight potential sources for variability. Methods: Serum in 233 patients with acute ischemic or hemorrhagic stroke (stroke cohort; SC) was ascertained within 24 h after onset and then 1, 3 and 7 days thereafter. One hundred five controls (control cohort; Co) were recruited. Multi-variable adjustment was carried out using salient extraneous covariates including stroke etiology, clinical severity and lesion size next to a set of routine laboratory parameters. Results: Unadjusted SC MMP-2 concentrations are significantly lower (SC 165.4, 95% CI 158.5-172.4; Co 203.7 ng/ml, 95% CI 190.7-216.5; p < 0.001) and MMP-9 concentrations significantly higher than in controls (SC 608.5 ng/ml, 95% CI 555.3-661.8; Co 475.6 ng/ml, 95% CI 413.6-537.6; p < 0.001). Adjustment mitigates associations between MMP concentrations and stroke etiology, clinical severity, lesion size or differences in temporal profile shown present without adjustment. Salient covariates absorb much of the effect: age, leukocyte count and albumin concentrations are associated significantly with MMP-2 concentrations; only leukocyte count is significantly associated with MMP-9. Conclusions: Concentrations of MMP-2 and MMP-9 in serum in humans measured after acute stroke are potentially influenced by extraneous covariates rather than being directly associated with characteristics of the underlying stroke.

Obstructive Sleep Apnea in Acute Stroke: A Role for Systemic Inflammation.

Sleep-disordered breathing is common among patients with stroke resulting in 4- to 6-fold higher prevalence of obstructive sleep apnea (OSA). We prospectively evaluated clinical characteristics and laboratory markers of inflammation and coagulability associated with OSA severity during the acute post stroke period. Consecutive patients admitted to the department of Neurology after an acute ischemic stroke were evaluated during the first 48 hours of symptom onset using Watch peripheral arterial tonometry, a wrist-worn ambulatory sleep study device that utilizes peripheral arterial tonometry. Morning blood samples of the patient were tested for tumor necrosis factor, interleukin-6, and plasminogen activator inhibitor-1 levels. A total of 43 patients with acute stroke were admitted during the study period, 22 (51%) of which have been found to have moderate sleep apnea (apnea hypopnea index [AHI]≥15), AHI≥5 was found in 86% of the patients, and severe OSA (AHI≥30) in 32.5%. Patients with OSA (AHI≥15) did not differ from the rest in stroke severity or symptoms, yet they had higher prevalence of recurrent stroke and atrial fibrillation. All 3 biomarkers levels were higher among patients with AHI≥15: tumor necrosis factor (6.39 versus 3.57 pg/mL), interleukin-6 (6.64 versus 3.14 pg/mL), and plasminogen activator inhibitor-1 (176.64 versus 98.48 pg/mL). After the stratification of AHI into 3 groups (AHI<5, 5-14, and ≥15), the analysis showed that only the highest AHI group differed from the other 2 groups in biomarkers levels. Use of bed-side somnography technology revealed that in an unselected sample of patients with acute ischemic stroke, almost 90% had sleep-disordered breathing with third having severe form of the disorder. Sleep-disordered breathing was associated with significantly increased levels of inflammatory biomarkers, providing possible pathophysiological explanation of OSA-associated stroke risk. These results warrant prospective screening of patients with stroke for the presence of sleep-disordered breathing and lay the rationale for an interventional trial.

Statins Reduced Seizures in Acute Post-Stroke Period

Statins Reduced Seizures in Acute Post-Stroke Period

Abstract T P362: Blood Pressure, Blood Glucose, Temperature and Outcome after Childhood Stroke

Objective: To determine the prevalence of abnormal blood pressure (BP), blood glucose and temperature in the acute phase after ischemic stroke (IS) and explore any relationship to outcome. We hypothesized that high and low BP, hyperglycemia, and fever after pediatric IS were all associated with poor outcome. Methods: We performed a retrospective review of children aged 1 month to 18 years with first IS admitted to a tertiary hospital between 2009 and 2013. Blood pressure, glucose and temperature readings recorded over the first 5 days after diagnosis. Morbidity or mortality and BP at 3 months post-stroke were documented. Hypertension (HTN) was defined as systolic or diastolic BP ≥95th% percentile for age, sex, and height for two consecutive recordings and two consecutive days. Results: Ninety-eight children were identified (median age 6 years). Prevalence of hypertension, hypotension, hyperglycemia and fever was 65%, 68%, 18%, and 41%, respectively. In multivariable analysis, the strongest association with poor outcome (defined as pediatric stroke outcome measure ≥1) was infarct size &gt;4% of brain volume [odds ratio (OR) 5.3, CI 1.8-15.3, p=0.002]. Blood glucose ≥200mg/dL was also independently associated with poor outcome (OR 4.6, CI 1.3-16.3, p=0.015). Hypotension requiring treatment (p=0.02, Fisher Exact Test) and fever ≥37.8°C (p=0.03, X2=4.6) were associated with poor outcome in univariable testing only. Hypertension was not significantly associated with stroke size, poor outcome, or death. During the acute post-stroke period 18% were treated with anti-hypertensive medication. At 3-months post-stroke, 11 children had died; 90% of the survivors followed up. Of these, 15 of 78 (19%) were receiving anti-hypertensive medication, an additional 9 children were hypertensive but untreated. Conclusions: Abnormalities of BP, blood glucose and temperature are prevalent in children with IS during the first 5 days after diagnosis. Infarct size and hyperglycemia were associated with poor outcome, hypertension was not. Prospective studies involving systematic recording of BP, blood glucose and temperature are required to better assess whether these factors impact outcome and are amenable to intervention to reduce morbidity after stroke in children.

Can’t swallow, can’t transfer, can’t toilet: Factors predicting infections in the first week post stroke

Post stroke infections are a significant clinical problem. Dysphagia occurs in approximately half of stroke patients and is associated with respiratory infections; however it is unclear what other factors contribute to an increased risk. This study aimed to determine which factors are most strongly predictive of infections in the first 7days post stroke admission. A retrospective review of 536 stroke patients admitted to Australian hospitals in 2010 was conducted. Data were collected on 37 clinical and demographic parameters. Univariate and multivariate logistic regression analysis was performed. The overall incidence of infection was 21%. Full assistance with mobility and incontinence on admission were associated with increased odds of general infection. Nil by mouth and presence of a nasogastric tube were significantly associated with patients developing respiratory infections. Urinary incontinence was a significant predictor for a urinary tract infection. Incidence of infection was highest on day two post admission. This study found enteral feeding, requiring full assistance with mobility and incontinence were significantly associated with developing infections in acute stroke. It contributes valuable new data from a large cohort of stroke patients demonstrating a period of susceptibility to infection in the very acute post stroke period.