Degree Of Stroke Severity Research Articles

Effect of Care Capacity on Stroke Patients’ Recovery in Activities of Daily Living: A Multi-Hospital Study

BackgroundThis study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity. DesignRetrospective, observational, longitudinal study. SettingAcute phase hospitals. ParticipantsFrom 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0–3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8–60 days. Main outcome measuresThe main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation. ResultsAmong patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke. ConclusionsThese results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke.

Poststroke depression among stroke survivors in Sub-Himalayan region.

Introduction:Stroke is a leading cause of long-term disability and loss of productive life in developing countries, including India. Ischemic stroke accounts for 85% of all types of stroke with a prevalence of 5%–15% among acute stroke incidents. The prevalence of poststroke depression among acute stroke survivors is varied from 5 to 54%. The study focused on depression among stroke survivors who actively involved in a home-based rehabilitation.Materials and Methods:A descriptive cross-sectional survey was conducted by enrolling 138 stroke survivors consecutively at tertiary care public hospital, North India. A sociodemographic and clinical profile sheet was used to seek information on personal and clinical variables. Information on disability, depression, performance in the activity of daily living, and degree of stroke severity was ascertained by using the Modified Rankin Scale (MRS), Physical Health Questionnaire (PHQ-9), Barthel Index, and National Institutes of Health Stroke (NIHSS). After binary logistic regression model, a multivariate logistic regression was applied to detect the independent predictor of depression.Results:Over 86% (119) of the stroke survivors had no symptoms of depression, and only 14% (19) were reported to have symptoms of depression. Poststroke depression found significant association with disability (P = 0.029) and functional independence (P = 0.0001). A significant difference was observed in the gender (P = 0.018), types of stroke (P = 0.0001), and location of lesion (P = 0.0001) with depression. Binary logistic regression model shows that disability (MRS) status of stroke survivor (P < 0.0001; 95% CI 1.998–2.638) and functional independence (BI) (P < 0.0001; 95% CI –0.034–0.020) are same as independent predictors for depression.Conclusion:Clinician should use the community reintegration, referral, and mandatory screening of the stroke survivors at follow-up visit to rule out the probability of occurrence of poststroke depression.

Effect of General Anaesthesia versus Conscious Sedation on Clinical and Procedural Outcome in Patients Undergoing Endovascular Stroke Treatment: A Matched-Pair Analysis

Introduction: General anaesthesia (GA) during mechanical thrombectomy (MT) might lead to an inferior clinical outcome compared to conscious sedation (CS). It was hypothesised that using CS might avoid a critical drop in cerebral perfusion, shorten the time of the intervention and therefore might result in better clinical outcome. In this study, we compared the procedural and clinical results of patients who underwent MT under GA or CS at two tertiary neuro-vascular centres on the basis of a matched-pair analysis. Methods: Using a matched-pair approach, we compared the data of 56 patients that were treated under CS at centre A (n = 28) with selected patients who were treated under GA at the centre B (n = 28). Patients were matched for age, sex, site of vessel occlusion, NIHSS at admission (±3 points), time from symptom onset to initial stroke imaging, intravenous-lysis and co-morbidities. All patients had an ASPECT-score of ≥8. To exclude the effect of technical failures, only patients with successful recanalization of the occluded vessel (TICI 2b and 3) were included into the study. The primary endpoint was the proportion of patients with early good clinical outcome after MT, defined by a modified Ranking Scale (mRS)-score ≤2 at discharge. Secondary endpoints were the time from symptom onset to the start of the procedure, the duration of the procedure and the rate of procedural complications. Results: There were no differences concerning gender, age, the site of vessel occlusion and the degree of stroke severity at baseline. The proportion of patients with an early good clinical outcome (mRS ≤2 at discharge) was 60.4% (17/28) in both groups. The time from symptom onset to the start of the procedure was shorter at centre B, while the duration of the procedure was significantly faster at A, resulting in an overall time from symptom onset to complete recanalization of 152.2 ± 68.0 min for patients treated at centre A and 171.1 ± 43.5 min for patients at centre B (ns). Conclusion: Our study revealed no differences in the investigated clinical outcome for patients undergoing endovascular stroke treatment under GA versus CS.

Comparation between slow frequency quantitative eeg and nihss in acute ischaemic stroke

Background In acute phase of stroke, the severity is one of the important output predictors. There is a high correlation between patient clinical improvement and tissue volume surviving in functional tissue (ischemic penumbra). In some studies show that NIHSS is a good predictor of stroke output whereas quantitative EEG is a tool that can be used to assess functional brain that reflects evolution of penumbra. Purpose To determine the quantitative EEG suitability with severity of acute ischemic stroke (NIHSS) patient in Sardjito hospital Method This study was conducted using observational cross sectional design with Spearman test. The subjects of this study were taken from patients at RSUP Dr Sardjito Yogyakarta in January 2018 – March 2018 that has been diagnosed ischemic stroke through anamnesis, physical examination and head CT scan and has been assessed the degree of stroke severity with NIHSS. Performed an absolute power and relative power assessment of qEEG against NIHSS on the subject and for secondary outcomes, we also performed delta alpha ratio (DAR) and delta tetha alpha betha ratio (DTABR). Result and conclusion The value of delta and tetha band were not significant but delta alpha ratio (r = 0,419) and delta tetha alpha betha ratio (r = 0,453) were positively correlated with sufficient strength with NIHSS in acute ischaemic stroke patients.

Abstract WP196: MicroRNA and IGF-1 as Predictive Biomarkers for Stroke Outcomes

Background: Although several studies focus on biomarkers for stroke diagnosis, few studies have identified biomarkers that predict stroke recovery. In our preclinical studies, we identified that the peptide hormone insulin-like growth factor (IGF-1) and specific small non-coding RNA (miRNA) are inversely corelated with stroke severity as measured by infarct volume. The objective of this study is to assess the potential of miRNA and IGF-1 to serve as predictors of stroke outcomes in patients as assessed by NIHSS at 90 days after stroke. Methods: Male and female patients ages (19-91) years were enrolled at the emergency department of a local hospital. NIHSS scores were obtained at presentation, discharge from the hospital, and 90-day follow-up. Scores were binned into mild (1-4), moderate (5-20) and severe (≥ 21). Prospective blood specimens were collected from the participant within 24 hours of presentation to the emergency department and at 90 + 7 days after initial presentation. Plasma IGF-1 levels were estimated using the Quantikine ELISA for human IGF-1 and and miR-363 expression was determined by qRT-PCR using hsa-miR-363-3p primers. IGF-1 and mir363-3p levels from blood samples collected within 24h of presentation were correlated with binned NIHSS-90 days, separately for males and females. Results: In males, there was no correlation between the degree of stroke severity at 90 days with either IGF-1 levels or mir363-3p. In females, there was significant inverse correlation between IGF-1 levels and NIHSS-90d scores (r=-0.467; p&lt;0.05), indicating that higher IGF-1 levels were predictive of better stroke recovery. However, miR-363 levels did not correlate with the 90d NIHSS. Conclusion: These pilot data suggest that IGF-1 is a strong predictor of stroke severity in females and has the potential to serve as a surrogate measure for stroke recovery. Supported by TAMUOVPR and TBSI seed grant to FS

Plasma Translocator Protein Levels and Outcomes of Acute Ischemic Stroke: A Pilot Study.

Translocator protein 18 kDa (TSPO) has been used as a biomarker of brain injury and inflammation in various neurological diseases. In this study, we measured the level of TSPO in acute ischemic stroke patients and determined its association with the degree of stroke severity and its ability to predict stroke functional outcomes. In total, 38 patients with moderate to severe acute ischemic stroke were enrolled. Demographic information, cerebral risk factors, and stroke severity were examined at the baseline. The National Institutes of Health Stroke Scale, modified Rankin Scale, and Barthal Index were assessed at discharge as measures of poor functional outcomes and severe disability. The baseline fasting plasma TSPO level was assessed within 24 h after the incident stroke and during hospitalization (on days 8–10). The proportion of patients with poor functional outcomes was significantly higher in the higher-TSPO group (compared to the lower group) in terms of clinical worsening (odds ratio (OR) = 11.69, 95% confidence interval (CI) = 2.08–65.6), poor functional outcomes (OR = 10.5, 95% CI = 1.14–96.57), and severe disability (OR = 4.8, 95% CI = 1.20–19.13). Plasma TSPO may be intimately linked with disease progression and worse functional outcomes in acute ischemic stroke patients.

Prolonged Activation of Invariant Natural Killer T Cells and TH2-Skewed Immunity in Stroke Patients.

Infection is highly prevalent and contribute significantly to mortality of stroke patients. In addition to the well described robust systemic lymphocytopenia and skewed T helper 2 (TH2)-immunity after stroke, emerging experimental evidence demonstrate that the development of infection poststroke is attributed by the activation of invariant natural killer T (iNKT) cells. In this prospective study, we examined the levels of a broad spectrum of inflammatory mediators, the activation status of iNKT cell in the blood of patients with various degree of stroke severity, and investigate whether these parameters differ in patients who later develop poststroke infections. We obtained blood from stroke patients and matching controls to perform flow cytometry and multiplex measurement of inflammatory mediators. Our data suggest a pronounced activation of iNKT cells in stroke patients as compared with matched Healthy and Hospital control patients. The magnitude of iNKT activation is positively correlated with the severity of stroke, supporting the hypothesis that iNKT cells may contribute in the modulation of the host immune response after stroke-associated brain injury. In addition, stroke severity is closely correlated with decreased TH1/TH2 ratio, increased production of interleukin (IL)-10, with infected stroke patients showing exacerbated production of IL-10. Stroke triggers a robust and sustained shift in systemic immunity in patients, including specific lymphopenia, robust activation of iNKT cells, systemic production of IL-10, and a prolonged TH2-skewed immunity, all are potential contributors to severe immune suppression seen in patients after stroke. Future studies with large sample size will provide potential causality relationship insights.

Improving thrombolysis for acute ischemic stroke in Lombardia stroke centers

The purpose of this study is to identify which factors are able to limit or hamper the access to systemic thrombolysis (evTPA) in Lombardia to define corrective interventions. We analyzed 1,015 patients with ischemic stroke admitted to emergency departments (ED) participating to the Lombardia Stroke Unit Registry and eligible for evTPA; 303 (29.9%) patients were treated with evTPA (evTPA+ group) and 712 (70.1%) were not (evTPA- group). We collected case-mix and stroke care process variables.The evTPA+ group was characterized by a shorter ED arrival time, a greater neurological impairment, a more chance to be admitted to ED linked to comprehensive stroke center (CSC) and a shorter waiting time to access to diagnostic procedures. The chance to be treated with evTPA was greater if neurological evaluation anticipated neuroimaging (p = 0.0003). The multivariate analysis confirmed that the admission to ED linked to CSC (OR: 2.50, 95% CI: 1.39-4.48, p < 0.0001) and neurological evaluation performed before neuroimaging (OR: 2.34, 95% CI: 1.35-4.04, p = 0.002) increased the probability to receive rtPA. The evTPA treatment is strictly dependent on pre-hospital and ED care process phases and strongly influenced by the degree of stroke severity. Door-to-needle time is shorter in patients with a greater stroke severity and a shorter ED arrival time. A 24-h/week availability of the neurologist in ED can increase the percentage of thrombolysis optimizing the selection of patients and the timing of the diagnostic procedures.

Sensory Loss in Hospital-Admitted People With Stroke: Characteristics, Associated Factors, and Relationship With Function

Objective: To characterize the nature of sensory impairments after stroke, identify associated factors, and assess the relationships between sensory impairment, disability, and recovery. Methods: Prospective cross-sectional survey of 102 people with hemiparesis following their first stroke. Tactile and proprioceptive sensation in the affected arm and leg were measured using the Rivermead Assessment of Somatosensory Perception 2-4 weeks post-stroke. Demographics, stroke pathology, weakness, neglect, disability, and recovery were documented. Results: Tactile impairment was more common than proprioceptive (P < .000), impairment of discrimination was more common than detection (P < .000), and tactile sensation was more severely impaired in the leg than the arm ( P < .000). No difference in proprioception between the arm and leg (P = .703) or between proximal and distal joints (P = .589, P = .705) was found. The degree of weakness and the degree of stroke severity were significantly associated with sensory impairment; demographics, stroke side and type, and neglect were not associated. All the sensory modalities were significantly related to independence, mobility, and recovery (r = 0.287 [P < .011] to r = 0.533 [P < .000]). Conclusion: Sensory impairments of all modalities are common after stroke, although tactile impairment is more frequent than proprioceptive loss, especially in the leg. They are associated with the degree of weakness and the degree of stroke severity but not demographics, stroke pathology, or neglect, and they are related to mobility, independence in activities of daily living, and recovery.

The Effect of Stroke and Stroke Prophylaxis With Aspirin or Warfarin on Quality of Life

Because most strokes cause neurological impairment rather than death, stroke prophylaxis may improve quality of life more than length of life. Thus, an understanding of how stroke and stroke prophylaxis affect quality of life is central to clinical decision making for many patients. We elicited quality-of-life estimates, known as utilities, for 3 degrees of severity of anticipated stroke-mild, moderate, and major- and for stroke prophylaxis with either warfarin sodium or aspirin therapy. We used the time tradeoff and standard gamble methods to elicit these utilities from 83 patients who had atrial fibrillation. Seventy patients completed the interview successfully. Their utilities for stroke ranged from worse than death (< 0) to as good as current health (1.0). The median utilities for mild, moderate, and major stroke were 0.94, 0.07, and 0.0, respectively. Although the median utilities decreased with increasing severity of stroke (P < .001), there was high interpatient variability within each degree of stroke severity. For example, 7 subjects (10%) rated a major stroke above 0.5, while 58 subjects (83%) rated it as equal to or worse than death. In contrast to the stroke utilities, the median utilities for warfarin and aspirin therapy were high-0.997 and 1.0, respectively. However, the interpatient variability for warfarin therapy was also important: 11 patients (16%) with atrial fibrillation rated the utility of warfarin therapy so low that their quality-adjusted life expectancy would be greater with aspirin. Patients' utilities for stroke prophylaxis and anticipated stroke vary substantially. Many patients view the quality of life with major stroke as tantamount to or worse than death. These findings highlight the relevance of incorporating patient preferences when choosing stroke prophylaxis.