Clinical Diagnosis Of Stroke Research Articles

Safety and Efficacy of Trospium Chloride and Solifenacin in Stroke-Induced Neurogenic Lower Urinary Tract Dysfunction: A Randomized Controlled Trial.

Neurogenic dysfunction of the lower urinary tract is one of the challenging diseases with high burdens in urology. Our study aims to evaluate the efficacy of a 4-week treatment with Solifenacin and Trospium chloride and assess their safety and impact on quality of life. Following the selection of 206 stroke patients from two centers who met specific eligibility criteria, including a clinical diagnosis of stroke, normal cognitive function, and the presence of lower urinary tract symptoms (LUTS), participants were randomly assigned to receive oral Solifenacin, Trospium chloride, or a placebo. Under the supervision of the Ethics Committee, the baseline characteristics, compliance with medication, and outcomes were monitored, gathered, and analyzed. The majority of participants were male, with a mean age of 67.3, and most had ischemic stroke. The groups had no significant difference in urinary symptoms after stroke. All of the symptoms in the study groups, according to the NBSS questionnaire, were decreased following treatment compared to the baseline (p < 0.05). After treatment, ICIQ-OAB, and ICIQ-LUTS-QOL total scores and bothersome scores decreased significantly compared to baseline (p < 0.001). When compared to the placebo, both Trospium chloride and Solifenacin alleviated symptoms according to the NBSS questionnaire and ICIQ-LUTS-QOL, total ICIQ-OAB, and the total score of ICIQ-OAB-Bothersome. However, the total LUTS-QOL-Bothersome score did not change in the active treatment groups compared to the placebo. While comparing the two drugs, these values were similar except for the total score of LUTS-QOL-Bothersome, ICIQ-OAB, and ICIQ-OAB-Bothersome in favor of the Solifenacin group. Moreover, Solifenacin had fewer side effects compared to Trospium chloride or placebo. The study analyzed 206 stroke patients in two international centers and found both drug arms effective in treating overactive bladder. However, inconsistencies were found in efficacy and safety, necessitating further studies with larger populations. This triple-blind, multicenter, randomized controlled trial was done on 206 stroke patients after getting Ethical Committee approval and registering the project on IRCT (IRCT20160606028304N2).

CT Scan Versus Clinical Diagnosis in Stroke-A Comparative Retrospective Study on 257 Cases in one Year

Cerebrovascular disease (CVD) is one of the three leading causes of death in the world along with cancer and heart disease. CVD or stroke is a major cause of morbidity and mortality. For any treatment to be contemplated it is important to know whether we are dealing with a bleed or an infarct. Differentiation between cerebral infarction and intracerebral hemorrhage is necessary nowadays for proper management of acute stroke syndrome based on the correct diagnosis of the pathological type. This study compared clinical and CT scans diagnosis of stroke and determined the clinical reliability of the clinical diagnosis in cases of stroke. This study was conducted retrospectively on 257 patients. CT scan was requested to rule out nature of acute cases of stroke for one year duration at Hospital Duchess of Kent (HDOK) from July 2006 to June 2007. Clinical diagnosis was made in conformity with criteria for clinical diagnosis of intracranial hemorrhage, cerebral infarction due to embolism or thromboses. The CT scan findings were compared with clinical diagnosis of stroke. The patients included 148 males and 109 females with an age range of 11 to 90 years. Clinically, 91(35.40%) subjects were suspected to have cerebral infarction, 64(24.60%) intracerebral bleed and 102(40%) indeterminate. CT scan brain showed 174 (67.96%) cases of abnormal findings and 83 (32.29%) cases of normal findings other than different degree of degenerative changes. Out of 174 cases of abnormal findings, CT showed 119 (46.31%) cases of cerebral infarction, 52 (20.23%) cases of cerebral hemorrhage and 3 (1.17%) cases of space occupying lesion subjects. In order to make a clinical diagnosis of stroke, a detailed history, thorough clinical examination and to follow the definite criteria chart for stroke to be diagnosed is mandatory as well as to avoid unnecessary CT request of brain which are more concerned with radiation hazard and cost. As far as treatment planning is concerned clinical diagnosis .....

Effectiveness of computed tomography perfusion imaging in stroke management.

Current guidelines do not support the use of computed tomography perfusion (CTP) in stroke, except when identifying the penumbra during an extended treatment window. Therefore, this study aimed to define the yield of CTP in diagnosing a stroke diagnosis beyond the imaging of the penumbra in the hyperacute phase (0-6 h) and an extended time window (6-24 h). All consecutive patients with acute onset of symptoms within a 24-h window underwent CTP imaging. The diagnostic value of CTP was calculated against the clinical and radiological diagnoses of stroke. A positive CTP result was determined by the presence of either a core or penumbra on the RAPID summary. Clinical diagnoses corresponded to discharge diagnoses of stroke. A radiological diagnosis was established if early ischemic changes [Alberta Stroke Program Early CT Score (ASPECTS) <10] were observed on the baseline CT scan, acute infarction was confirmed on follow-up imaging, or symptomatic occlusion was evident on baseline CTA. Between November 2018 and November 2019, 585 consecutive patients with an acute neurological deficit underwent multimodal CT imaging. A total of 500 patients (85%) were included, where 274 (55%) were within the hyperacute phase, 153 (31%) had a radiological diagnosis of stroke, and 122 (24%) had a clinical diagnosis of stroke. CTP yielded positive results only in patients with a confirmed stroke (positive predictive value and specificity of 100%). When CTP results were negative, 43% of the cases turned out to stroke mimics. Patients with stroke mimics were younger (66 ± 17 vs. 73 ± 13) and had lower scores on the National Institutes of Health Stroke Scale [median 0; interquartile range (IQR) 0-2 vs. median 4; IQR 2-6] compared to patients with CTP-negative strokes. In our study, CTP consistently indicated brain ischemia; therefore, in stroke management, CTP is most beneficial when it yields a positive result. A positive CTP result should prompt adequate stroke management actions without any delay. Conversely, a negative CTP result necessitates the consideration of both stroke and non-stroke diagnoses.

Computed Tomography Findings in Acute Stroke Patients in a Tertiary center

Background: Stroke, or "cerebrovascular accident," is a medical disorder in which the brain's cells die due to insufficient blood flow. Successful stroke treatment varies according to the type of stroke, whether an infarct or a bleed, and it can be lethal without brain damage. The study aim was to compare clinical stroke diagnosis with computed tomography (CT) scan findings to determine stroke type (hemorrhagic or Ischemic). Methods: This is a descriptive cross-sectional type of study conducted at the Department of Radiology &amp; Imaging in a diagnostic center at central Nepal from December 2023 to February 2024. A total of 120 patients from the inclusion criteria were taken for the study purpose. Data of clinical diagnosis were compared individually with CT findings. Results: Out of 120 patients, 76 were males and 44 were females and they were in the age range of 40 to &gt;70 years. Clinically 59 patients were suspected to have Inermediate (hemorrhagic) infarct, 44 acute cerebral infarct and 17 Intra cerebral hemorrhage. CT scan of the brain showed 58 acute cerebral infarct, 36 Hemorrhagic infarct, 15 Intra cerebral hemorrhage and 7 Space occupying lesion. Conclusion: The study found that CT should be the first thing to do when a person has a stroke because it's easy, quick, and accurate at figuring out infarct and hemorrhage which decides the treatment at a glance.

Automatic assessment of DWI-ASPECTS for acute ischemic stroke based on deep learning.

Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a standardized semi-quantitative method for early ischemic changes in acute ischemic stroke. However, ASPECTS is still affected by expert experience and inconsistent results between readers in clinical. This study aims to propose an automatic ASPECTS scoring model based on diffusion-weighted imaging (DWI) mode to help clinicians make accurate treatment plans. Eighty-two patients with stroke were included in the study. First, we designed a new deep learning network for segmenting ASPECTS scoring brain regions. The network is improved based on U-net, which integrates multiple modules. Second, we proposed using hybrid classifiers to classify brain regions. For brain regions with larger areas, we used brain grayscale comparison algorithm to train machine learning classifiers, while using hybrid feature training for brain regions with smaller areas. The average DICE coefficient of the segmented hindbrain area can reach 0.864. With the proposed hybrid classifier, our method performs significantly on both region-level ASPECTS and dichotomous ASPECTS. The sensitivity and accuracy on the test set are 95.51% and 93.43%, respectively. For dichotomous ASPECTS, the intraclass correlation coefficient (ICC) between our automated ASPECTS score and the expert reading was 0.87. This study proposed an automated model for ASPECTS scoring of patients with acute ischemic stroke based on DWI images. Experimental results show that the method of segmentation first and then classification is feasible. Our method has the potential to assist physicians in the Alberta Stroke Program with early CT scoring and clinical stroke diagnosis.

Risk Factors for the Development of Pneumonia in Stroke Patients: A Systematic Review and Meta-Analysis.

Pneumonia is one of the most prevalent medical complications post-stroke. It can have negative impacts on the prognosis of stroke patients. This study aimed to determine the predictors of pneumonia in stroke patients. The authors devised, reviewed, and enhanced the search strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were gathered from various electronic databases, including Medline, CINAHL, Cochrane, Embase, and Web of Science, from January 1st, 2011, to February 25th, 2024. The review encompassed studies involving patients aged 18 years and older who were hospitalized for acute stroke care. Inclusion criteria required patients to have received a clinical diagnosis of stroke, confirmed via medical imaging (CT or MRI), hospital primary diagnosis International Classification of Diseases 10th Revision discharge codes, or pathology reporting. A total of 35 studies met the criteria and were included in our pooled analysis. Among them, 23 adopted a retrospective design, while the remaining 12 were prospective. The pooled incidence of pneumonia among patients with stroke was found to be 14% (95% confidence interval = 13%-15%). The pooled analysis reported that advancing age, male gender, a history of chronic obstructive pulmonary disease (COPD), the presence of a nasogastric tube, atrial fibrillation, mechanical ventilation, stroke severity, dysphagia, and a history of diabetes were identified as significant risk factors for pneumonia development among stroke patients. Our results underscore the importance of proactive identification and management of these factors to mitigate the risk of pneumonia in stroke patients.

Computerized Tomographic Brain Findings in Hypertensives with Stroke in Abuja, Nigeria

Abstract Background: Stroke has become an increasingly significant health problem, and early diagnosis of the stroke type with prompt management improves prognosis. Neuroimaging is crucial to the management of stroke, and computed tomography (CT) scan is a cardinal diagnostic tool in identifying the subtypes, the knowledge of which will improve the management of the patients. Aims and Objectives: The study was aimed at establishing the cranial CT findings in hypertensives with stroke, ascertain the type of stroke, frequency of specific features, such as sites, vascular territories, and secondary effects of the primary lesion. Associations of CT findings with variables such as age and coexisting risk factors were also explored. Materials and Methods: Eighty-four adult hypertensive patients with clinical diagnosis of stroke were serially recruited and cranial CT scan was performed, using 16-slice multidetector CT machine (Toshiba Activion 16®), within 24 h of presentation at the emergency department. All clinical findings, demographic parameters, and radiological findings were documented. The data obtained were analyzed using the Statistical Package for Social Sciences (IBM SPSS version 23.0. Armonk, NY, USA). Results: The mean age of the patients was 57.94 ± 12.05 (mean ± standard deviation) and females were more than males with a male:female ratio of 1:1.3. Ischemic stroke constituted 59.5% while hemorrhagic stroke was 40.5%, and the left middle cerebral artery territory was the most common area affected by both stroke types (P &lt; 0.01). Most of the intracerebral bleed occurred in the basal ganglia (50%), and hemorrhagic stroke was more associated with severe neurological deficits (67.6%) (P &lt; 0.001). Conclusion: Ischemic stroke was more common than hemorrhagic stroke, and more women were affected on a general note. The middle cerebral artery territory is the most common site of affectation, and positive association was established between noncompliance with anti-hypertensive medication and stroke.

Abstract 14671: Investigating Health Disparities in Arrival From Last Known Well Times in Queens, NY

Background: Stroke is a leading cause of death in the US and the third leading cause of disability worldwide, so timely access to care must be considered as it is a salient predictor of prognosis and outcomes. 1,2 Specifically, because the recommended treatment window for IV tPA (alteplase) is within 4.5hr of last known well (LKW), it is imperative for patients to present to the facility within 3.5hr from symptom onset to receive treatment. 3 There are known health disparities in stroke treatment/outcomes 4 , and this study seeks to explore the population of patients that disproportionately have unknown or LKW &gt;4.5hr to arrival, and the impacts of such. Methods: Stroke patients entered into the Get With The Guidelines™-Stroke excluding patients whose symptoms began after hospital arrival and were discharged from October 2021 to December 2022 from NYC Health + Hospitals/Queens were included. Arrival from LKW time was categorized into ≤0-4.5hr and &gt;4.5hr. Covariates collected and included are age, Hispanic ethnicity, sex, race, final clinical diagnosis of stroke, and history of previous stroke. Logistic regression models were used to analyze data and results are presented as adjusted odds ratios at 0.05 significance. Results: A total of 342 patients were included in this study with 211 patients arriving after 4.5hr. The median time to arrival from LKW was 829min. Notably, patients identifying as Asian were more likely to arrive within 4.5hr of LKW (3.21 adjusted OR, 95% CI 1.30-7.91, p = 0.01) compared to their Black counterparts. White patients were also more likely to arrive within the 4.5hr treatment window compared to Black patients (11.69 adjusted OR, 95% CI 3.39-40.36, p = 0.0001). Increase in age was associated with decrease in timely arrival from LKW (0.98 adjusted OR, 95% CI 0.96-0.99, p = 0.04). Clinically, those that were diagnosed with ischemic stroke were more likely to arrive within 4.5hr of LKW (2.55 adjusted OR, 95% CI 1.37-4.77, p = 0.003) as well as those with a history of previous stroke (2.74 adjusted OR, 95% CI 1.39-5.40, p = 0.004). Conclusion: There are health disparities in stroke treatment because of prolonged patient arrival from or unknown LKW, and these findings will help inform further practices in community education and outreach.

Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews

Virtual reality (VR) is an innovative neurorehabilitation modality that has been variously examined in systematic reviews. We assessed VR effectiveness and safety after cerebral stroke. In this overview of systematic reviews, we searched eleven databases (Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, SCOPUS, ISI Web of Science, CINAHL, PsycINFO, Pedro, Otseeker, Healthevidence.org, Epistemonikos) and grey literature from inception to January 17, 2023. Studies eligible for inclusion were systematic reviews published in English that included adult patients with a clinical diagnosis of stroke (acute to chronic phase) undergoing any kind of immersive, semi-immersive or non-immersive VR intervention with or without conventional therapy versus conventional therapy alone. The primary outcome was motor upper limb function and activity. The secondary outcomes were gait and balance, cognitive and mental function, limitation of activities, participation, and adverse events. We calculated the degree of overlap between reviews based on the corrected covered area (CCA). Methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Certainty of Evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Discordances between results were examined using a conceptual framework based on the Jadad algorithm. This overview is registered with PROSPERO, CRD42022329263. Of the 58 reviews included (n=345 unique primary studies), 42 (72.4%) had conducted meta-analysis. More than half of the reviews (58.6%) were published between 2020 and 2022 and many (77.6%) were judged critically low in quality by AMSTAR 2. Most reported the Fugl Meyer Assessment scale (FMA-UE) to measure upper limb function and activity. For the primary outcome, there was a moderate overlap of primary studies (CCA 9.0%) with discordant findings. Focusing on upper limb function (FMA-UE), VR with or without conventional therapy seems to be more effective than conventional therapy alone, with low to moderate CoE and probable to definite clinical relevance. For secondary outcomes there was uncertainty about the superiority or no difference between groups due to substantial heterogeneity of measurement scales (eg, methodological choices). A few reviews (n=6) reported the occurrence of mild adverse events. Current evidence suggests that multiple meta-analyses agreed on the superiority of VR with or without conventional therapy over conventional therapy on FME-UE for upper limb. Clinicians may consider embedding VR technologies into their practice as appropriate with patient's goals, abilities, and preferences. However, caution is needed given the poor methodological quality of reviews. Italian Ministry of Health.

Correlation of magnetic resonance angiography and transcranial doppler ultrasound in acute stroke patients

The incidence of cerebrovascular diseases increases with age, and the number of strokes is projected to increase as the elderly population grows. Most cerebrovascular diseases are manifest by the abrupt onset of a focal neurologic deficit. Computed Tomography images identify or exclude hemorrhage as the cause of stroke, and they identify extra-parenchymal hemorrhages, neoplasms, abscesses, and other conditions masquerading as stroke. Non-contrast CT brain is the 1st imaging investigation usually performed in acute stroke patients. Magnetic Resonance Imaging (MRI) reliably documents the extent and location of infarction in all areas of the brain, including the posterior fossa and cortical surface. It also identifies intracranial hemorrhage and other abnormalities but is less sensitive than CT for detecting acute blood. Diffusion-weighted imaging is more sensitive for early brain infarction than standard MR sequences or CT, as is fluid-attenuated inversion recovery (FLAIR) imaging. Using IV administration of gadolinium contrast, MR perfusion studies can be performed. Thus it is evident that both TCD and MRA are promising modalities in the evaluation of acute stroke. This dissertation aims to compare and correlate the findings of MRA and TCD and their advantages and disadvantages in the practical hospital set-up. Total 50 patients – 30 Male and 20 Females – with a clinical diagnosis of stroke (Acute or Chronic) were evaluated with MRI and MR Angiography and Transcranial Doppler(TCD) with TCD being performed prior to MRI/MRA in all patients. Time interval between these two examinations was 2 to 8 hours. Out of 50 patients studied, 10 patients were excluded due to inadequate insonation windows. Of the 40 patients, 24 patients showed abnormality on MRA. Of the MRA abnormal 24 patients, 20 were abnormal on TCD (True positive on TCD), while 4 were normal on TCD (False negative on TCD). Also of the 16 MRA normal patients, 9 were normal on TCD (True negative) while 7 were abnormal on TCD (False positive). Analysis of above findings revealed, Sensitivity 83.33 %, Specificity 56.25%, Positive predictive value 74.07 %, Negative predictive value 69.23 % for TCD compared to MRA in Assessment of the Anterior circulation.

Correlation between clinical and brain computed tomography findings of stroke patients: A cross-sectional study.

In developing countries, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. Neuroimaging plays a crucial role in differentiating ischemic stroke from an intracerebral hemorrhage, as well as entities other than stroke. This study sought to determine the correlation between the clinical and brain CT scan findings of stroke patients attending three hospitals in Kampala, Uganda. This was a cross-sectional study of clinically suspected stroke patients who were sent for brain CT scan at three selected hospitals in Kampala, Uganda. All brain CT scans of patients with suspected stroke were evaluated and the Alberta stroke program early CT score (ASPECTS) was used for middle cerebral artery (MCA) strokes. Univariate analysis was used to describe the clinico-demographic and brain CT features of stroke and summarized them as percentages. Bivariate and multivariate analysis were used to determine the adjusted odds ratios as a measure of association with a 95% confidence interval (CI). Of the 270 study participants, 141 (52.2%) were male. 162 (60%) had CT findings of stroke, and 90 (33.3%) had normal brain CT findings. Eighteen (6.7%) had other CT findings like tumor, dural hemorrhage, epidermoid cyst, and others. Ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage accounted for 124 (45.9%), 34 (12.6%), and 4 (1.5%) respectively. Limb weakness (55.2%), headache (41.1%), and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30 (73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95% CI: 1.58-306.09) p = 0.021]. More than a third of patients with a clinical diagnosis of stroke had either no CT features of stroke or had other findings. The most commonly affected vascular territory was left MCA. Old age was strongly associated with having the worst ASPECTS score.

Rehabilitation of the upper limb functioning in patients with post-stroke by the physical therapy methods

The article is devoted to the problem of rehabilitation of the upper limb functioning with the help of physical therapy in patients after stroke. The upper limb as a result of stroke loses in function, and as a consequence in the activity and participation of the patient, this leads to a significant impairment in the quality of life and significantly affects the social adaptation.&#x0D; The aim of the study was to test the effectiveness of the developed physical therapy program to rehabilitation of the upper limb of patients after stroke in the acute period.&#x0D; The methods used were the analysis of scientific literature, mathematical analysis, methods of assessing the functioning of patients: muscle strength (MMT), Barthel activity of daily living (ADL), pain assessment (VAS).&#x0D; The study was conducted on the basis of the Department of Physical and Rehabilitation Medicine of the City Clinical Hospital №4 in Dnipro. The study involved 12 patients with a clinical diagnosis of stroke.&#x0D; Patients had physical therapy sessions that included exercises to increase muscle strength, neuromuscular training, improve selective control, improve balance, coordination and reduce the risk of falling. The program was not static and changed based on positive changes in the patient's functional state.&#x0D; The proposed physical therapy program proved to be effective in restoring the functioning of patients after stroke. There are prospects for continuing research on the impact on the functioning of physical therapy at an early stage after a stroke.

Computed Tomography Findings in Acute Stroke Patients: A Hospital-Based Cross-Sectional Study

Introduction: Stroke, or "cerebrovascular accident," is a medical disorder in which the brain's cells die due to insufficient blood flow. Successful stroke treatment varies according to the type of stroke, whether an infarct or a bleed, and it can be lethal without brain damage. Objective: The study aim was to compare clinical stroke diagnosis with computed tomography (CT) scan findings to determine stroke type (hemorrhagic or Ischemic). Method: This was a cross-sectional type of observational study conducted at the Department of Radiology &amp; Imaging in Medical College for Women and Hospital (MCWH), Uttara and Catharsis Hospital, Pubail, Dhaka from January 2018 to December 2020. A total of 120 patients from the inclusion criteria were taken for the study purpose. Data of clinical diagnosis were compared individually with CT findings. Result: Out of 120 patients, 84 were males and 36 were females and they were in the age range of 20-80 years. Clinically 52 patients were suspected to have cerebral infarction, 38 intracerebral bleeds and 30 indeterminate. CT scan of the brain showed 58 cerebral infarcts, 42 intracerebral hemorrhages, 06 space-occupying lesions and 14 hemorrhagic infarcts. Conclusion: The study found that CT should be the first thing to do when a person has a stroke because it's easy, quick, and accurate at figuring out what happened.

Evaluation of Pattern of Lesions Depicted on Brain Computed Tomography Scan of Patients Presenting with Stroke in Zaria, Nigeria.

Stroke is a major public health problem worldwide and it is the third leading cause of death in industrialized countries and ranks among the five most common causes of hospital deaths in adults in Africa. Accurate stroke diagnosis has a high significance for patient's outcome. Computed tomography (CT) brain scan is the imaging of choice for patients presenting to the emergency department with stroke. The study aimed at evaluating the pattern of lesion depicted on CT brain of patients presenting with stroke in ABUTH, Zaria. A prospective review of CT findings in 155 patients who presented in the Radiology Department of Ahmadu Bello University Teaching Hospital (ABUTH) with clinical diagnosis of stroke was undertaken over a period of six months (from October 2017 to April 2018).. Of the 155 patients seen within the period under review, 88 (56.8%) were males while 67 (43.2%) were females. Age range was 11-90 years (mean 56, standard deviation (SD) 16, 44(28.4%) of patients were in the age group of 61-70 years. Ninety six patients (61.9%) had ischaemic stroke, 27(17.4%) had hemorrhagic stroke, eight (5.2%) was stroke mimic, six patients (3.9%) mixed lesions (ie both ischaemic and haemorrhagic). Eighteen patients (11.6%) had normal brain CT findings. The region most affected by stroke was the parietal region 52(38%). Ischaemic stroke is the most common form of stroke in this study.

Age-specific information resources to address the needs of young people with stroke: a scoping review protocol

Background and aimsYoung people with stroke (YPwS) persistently experience challenges with disability, social reintegration, employment, and financial stability to provide for themselves and their families. The aims of this scoping review are to (1) identify and collate information resources for YPwS and evidence-based self-managements programs and (2) identify gaps in age-specific resources available for YPwS after traditional rehabilitation services have ended and/or who are returning to live in the community.MethodsWe will include both qualitative and quantitative studies, including all study designs. Participants will be community-dwelling adults aged between 18 and 65 years with a clinical diagnosis of stroke. We will include information resources and evidence-based self-managements programs for YPwS. Search terms will include stroke, young people, and community dwelling. We will search electronic databases such as MEDLINE. The reference lists of included studies, systematic reviews, and stroke guidelines and stroke-specific websites will also be searched. We will also contact Stroke Support Organizations and international/national allied health professional organisations to gather information resources about YPwS. We will also conduct a comprehensive environmental scan of additional resources using the search engine Google.The titles, abstracts, full-text articles, and contents of the resources identified by the search will be assessed against the inclusion and exclusion criteria to identify potentially relevant resources.Results and conclusionsExisting resources and self-management programs will be collated and categorized according to the type of needs addressed such as physical, emotions, activities of daily living, information, relationships, and social needs as well as the key gaps identified.

Neuropsychiatric symptoms are associated with exacerbated cognitive impairment in covert cerebral small vessel disease.

Neuropsychiatric symptoms are related to disease progression and cognitive decline over time in cerebral small vessel disease (SVD) but their significance is poorly understood in covert SVD. We investigated neuropsychiatric symptoms and their relationships between cognitive and functional abilities in subjects with varying degrees of white matter hyperintensities (WMH), but without clinical diagnosis of stroke, dementia or significant disability. The Helsinki Small Vessel Disease Study consisted of 152 subjects, who underwent brain magnetic resonance imaging (MRI) and comprehensive neuropsychological evaluation of global cognition, processing speed, executive functions, and memory. Neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory Questionnaire (NPI-Q, n = 134) and functional abilities with the Amsterdam Instrumental Activities of Daily Living questionnaire (A-IADL, n = 132), both filled in by a close informant. NPI-Q total score correlated significantly with WMH volume (rs = 0.20, p = 0.019) and inversely with A-IADL score (rs=-0.41, p < 0.001). In total, 38% of the subjects had one or more informant-evaluated neuropsychiatric symptom. Linear regressions adjusted for age, sex, and education revealed no direct associations between neuropsychiatric symptoms and cognitive performance. However, there were significant synergistic interactions between neuropsychiatric symptoms and WMH volume on cognitive outcomes. Neuropsychiatric symptoms were also associated with A-IADL score irrespective of WMH volume. Neuropsychiatric symptoms are associated with an accelerated relationship between WMH and cognitive impairment. Furthermore, the presence of neuropsychiatric symptoms is related to worse functional abilities. Neuropsychiatric symptoms should be routinely assessed in covert SVD as they are related to worse cognitive and functional outcomes.

An Examination of Modifiable Risk Factors in Stroke Survivors, with a view to recurrent stroke prevention

BackgroundStroke is a major public health problem worldwide, as more people survive their initial stroke event and subsequently live with chronic disability. While extensive research has focused upon preventing primary strokes comparatively little research has examined secondary stroke prevention. MethodsWe analysed data collected from a survey of 576 participants from the 45 and Up Study who had a clinical diagnosis of stroke. Health status was assessed using a variety of validated instruments. Demographics and modifiable risk factors, including health behaviours and diagnosed conditions, were also measured. Logistic regression model building was used to examine the relationship between each modifiable risk factor and the independent variables of demographics and health status measures. ResultsThe average time since the most recent stroke for study participants was 10.4 (SD = 8.9) years, with the majority of participants (73.2%) having had only one stroke in total. Regression modelling revealed that health-related hardiness, quality of life, depression and fatigue scores were all statistically significantly associated with heart disease, anxiety, depression and physical activity. For stroke characteristics, years since the most recent stroke was associated with heart disease and the number of strokes was associated with anxiety/nervous disorder, diabetes and alcohol consumption. ConclusionAmong other identified targets for secondary stroke prevention, fatigue and depressive symptoms appear to be common factors affecting several modifiable stroke risk factors. Addressing fatigue and depressive symptoms may therefore have a positive effect on secondary stroke prevention strategies in post stroke adults. All practitioners providing care for post-stroke adults can work towards improving these health factors thereby enhancing and prioritising secondary stroke prevention strategies.

The health care utilisationand out-of-pocket expenditure associated with Australian stroke survivors aged 55 and over.

ObjectiveStroke is a major cause of mortality and disability worldwide. People with stroke have a number of options available to treat post-stroke related symptoms and challenges. The aim of this study was to assess the use of healthcare services, self-care practices and out-of-pocket expenses associated with post-stroke healthcare.MethodsWe retrospectively analysed data collected between April and October 2017 from a survey of 576 participants aged 55 to 96 from the 45 and Up Study, NSW (Australia), who had earlier reported a clinical diagnosis of stroke. Participants were asked about their use of health care services, including conventional medicine practitioners and medications, complementary medicine practitioners, practices and products and the respective associated out-of-pocket expenditure for each.ResultsAmongst the total of 576 individuals who participated in the study, 39% consulted a doctor, 18% consulted an allied health practitioner, and 8% consulted a complementary medicine practitioner in the previous year for their stroke. Participants’ average combined out-of-pocket expenditure for post-stroke related healthcare was AU$386.4 per annum. Extrapolated to all Australians with stroke, aged 55 years and over, the total out-of-pocket expenditure for post-stroke related healthcare is estimated to be AU$42 million per annum.ConclusionsPost-stroke individuals used a wide range of health services and various self-care practices for stroke rehabilitation. Such healthcare utilisation is associated with significant annual out-of-pocket expenditure. Given the socioeconomic burden of stroke, further research is required to identify the barriers and facilitators of self-care among patients with stroke and explore the cost-effectiveness of the wide range of treatments(s) utilised for post-stroke care.

RISK FACTORS AND OUTCOMES OF HIV-ASSOCIATED STROKE IN ZAMBIA

<h2>ABSTRACT</h2><h3>Objective</h3> To compare risk factors and clinical outcomes between people living with HIV (PLWH) and HIV-uninfected (HIV-) adults with stroke hospitalized in Zambia. <h3>Methods</h3> Weretrospectively reviewed charts of all adults admitted to the University Teaching Hospital in Lusaka, Zambia with a clinical diagnosis of stroke between October 2018 and March 2019. Standardized data collection instruments were used to collect demographic, clinical, laboratory and imaging results. Comparison between individuals with and without HIV infection was made using t-tests for continuous parametric variables, Wilcoxon rank-sum tests for continuous non-parametric variables, and chi-square analyses for categorical variables. <h3>Results</h3> 272adults with stroke were admitted of whom 58 (21%) were PLWH. Compared to HIV- participants, PLWH were younger (48 ± 14) years versus 62 ± 18) years, p<0.001). PLWH were less likely to have hypertension (65% vs 83%, p=0.003) and more likely to have no traditional cerebrovascular risk factors (34% vs 15%, p=0.01). Deep vein thrombosis (DVT) (4% vs 1%, p=0.04) was more common during hospitalization amongst PLWH, but there was no difference in in-hospital mortality (21% vs 23%, p=0.65). Among PLWH with stroke, factors associated with in-hospital mortality were Glasgow Coma Scale (GCS) on admission (7 vs 10, p=0.046), hypertension (92% vs 59%, p=0.04) and fever (58% vs 13%, p=0.003). <h3>Conclusion</h3> This Zambian cohort of PLWH and stroke is notable for being significantly younger with fewer traditional stroke risk factors but higher rates of DVT than their HIV-uninfected counterparts. GCS on admission, hypertension and fever were associated with in-hospital mortality.

Should Primary Stroke Centers Perform Advanced Imaging?

Should Primary Stroke Centers Perform Advanced Imaging?