Diagnosis Of Ischemic Stroke Research Articles

Differential diagnosis of ischemic stroke in the arteries of the vertebrobasilar system

Stroke in the arteries of the vertebrobasilar system is characterized by a variety of nonspecific symptoms, many mimickers, and often atypical clinical presentation, which, together with the low sensitivity of CT and MRI of the brain, leads to incorrect and untimely diagnosis. This article addresses in detail the issues of differential diagnosis of this disease with Guillain–Barre syndrome, myasthenic crisis, central pontine myelinolysis, multiple sclerosis, Wernicke encephalopathy, vestibular neuronitis, Meniere's disease, and vestibular migraine.

Decompressive Craniectomy in Extensive Ischemic Stroke. An Experience in a Single Institution

Abstract Introduction Decompressive craniectomy (DC) is a valuable treatment for reducing early lethality in malignant intracranial hypertension (IH); however, it has been shown that the decision to implement DC in patients with extensive ischemic stroke should not be based solely on the detection of IH with the use of intracranial pressure (ICP) devices. Objective To establish the usefulness of DC in patients with extensive ischemic stroke who came to the emergency room during the period between May 2018 and March 2019. Methods This was an analytical, prospective, and longitudinal study whose population corresponded to all patients with a diagnosis of extensive ischemic stroke. Results The sample consisted of 5 patients, of which 3 were female and 2 males, the average age was 62.2 years old (minimum 49 years old, maximum 77 years old). Of all the patients who underwent DC, it was found that 80% of the patients did not present an increase in intracranial pressure. Decompressive craniectomy was not performed in a case that responded adequately to medical treatment. The mean values of ICP were 25 mmHg with a minimum value of 20 mmHg and a maximum value of 25 mmHg; in patients with a moderate value, the ICP averages were < 20 mmHg. The mortality was of 40% (RANKIN of 6 points). Conclusions Decompressive craniectomy is useful in extensive ischemic stroke. The decision to implement DC in patients with extensive stroke rests on clinicoradiological parameters. The monitoring of the IPC was not particularly useful in the early detection of the neurological deterioration of the patients studied.

Bedside Ultrasound to Identify and Predict Severity of Dysphagia Following Ischemic Stroke: Human Versus Artificial Intelligence

Dysphagia is a significant ischemic stroke complication that can lead to aspiration. Identification of at-risk patients can be logistically difficult and costly. Researchers investigated whether quantitative ultrasound assessment of hyoid bone movement during induced swallowing would predict failure of videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing (FEES), as determined by a penetration-aspiration scale (PAS) score. Additionally, ability of a machine learning (ML) algorithm to predict PAS success or failure from real-time ultrasound video recordings was assessed. A prospective, single-blinded, observational pilot study was conducted from June 2019 through March 2020 at a comprehensive stroke center on a convenience sample of patients admitted with diagnosis of acute ischemic stroke undergoing VFS or FEES as part of dysphagia assessment. Researchers performed a midsagittal airway ultrasound during swallowing in patients receiving an objective swallowing assessment by speech language pathologists who were blinded to ultrasound results. Sonologists measured hyoid bone movement, and researchers then constructed an ML algorithm designed for real-time video analysis using a long short-term memory network with an embedded VGG16 convolutional neural network. Videos from 69 patients were obtained with their respective PAS results. In total, 90% of available videos were used for algorithm training. After training, the ML algorithm was challenged with the 10% previously unseen videos and then compared with PAS outcomes. Statistical analysis included logistic regression and correlation matrix testing on human ultrasound measurements. Cohen's κ was calculated to compare deep learning algorithm prediction with PAS results. Measurement of hyoid bone elevation, forward displacement, total displacement and mandible length was unable to predict PAS assessment outcome (p values=0.36, 0.13, 0.11 and 0.32, respectively). The ML algorithm showed substantial agreement with PAS testing results for predicting test outcome (κ=0.79; 95% confidence interval: 0.52-1.0) CONCLUSION: Manual ultrasound measurement of hyoid movement during swallowing in stroke patients failed to predict PAS swallowing results. However, an ML algorithm showed substantial agreement with PAS results despite a small data set, which could greatly improve access to dysphagia assessment in the future.

Diagnostic efficiency of individual systems for automatic analysis of computed tomography images in the detection of ischemic stroke in the basin of the middle cerebral artery

Background. The diagnosis of ischemic stroke is of high importance in modern medical practice. One of the most promising methods for solving this problem is the introduction of machine learning algorithms into physicians’ work as an auxiliary tool for the interpretation of beam images.Aim: To compare automated computed tomography (CT) image analysis systems in detecting middle cerebral artery stroke.Material and Methods. The study included three anonymized (A, B, C) machine learning algorithms. Analytical validation was carried out on a database of one hundred patients admitted in St. Petersburg vascular center with suspected middle cerebral artery stroke, who underwent noncontrast head CTs. Ischemic stroke in half of the patients was confirmed on the basis of clinical examination findings and CT-angiography and CT-perfusion. The study evaluated the performance indicators (sensitivity, specificity, positive predictive value, negative predictive value, accuracy) for detecting a set of signs of early ischemic changes (by automatic segmentation and predicting a score on the ASPECTS scale). The article also provides a graph that allows you to evaluate the quality of a binary classification – characteristic curves (ROC-curves).Results. The meta-analyses showed all the considered automated algorithms did not reach the threshold values of accuracy (range from 0.67 to 0.75) required for programs according to clinical guidelines (0.80). The algorithms showed variability in sensitivity and specificity. One of the automatic analysis systems (A) had a high sensitivity (0.88), but at the same time a low specificity (0.46), which indicates its overtraining and a tendency to overdiagnoses. The remaining algorithms (B, C) showed low sensitivity (0.6; 0.55) and high specificity (0.9; 0.8).

Hsa-miR-877-5p Expression in Acute Ischemic Stroke Based on Bioinformatics Analysis and Clinical Validation.

Inflammation and immunity play important roles in the pathogenesis of ischemic stroke. This study aimed to explore key regulatory genes in acute ischemic stroke (AIS) and their underlying mechanisms to provide new research targets for the diagnosis and treatment of ischemic stroke. We searched for differentially expressed mRNAs and miRNAs in patients with AIS and healthy populations in GEO databases, constructed a miRNA-mRNA network, and screened key miRNAs using least absolute shrinkage and selection operator regression and the support vector machine-recursive feature elimination model. Correlations between key miRNAs and infiltrating immune cells and inflammatory factors were analyzed using CIBERSORT and immunoassays and verified using clinical experiments. Bioinformatics analysis identified hsa-miR-877-5p as a key regulatory miRNA in AIS that can modulate immune and inflammatory responses. In clinical studies, it was verified by quantitative PCR analysis that the expression of hsa-miR-877-5p in the blood of AIS patients was higher than that of the healthy group. Then, enzyme-linked immunosorbent assay revealed that the expression of IL-23 and TNF-α related to inflammation in AIS patients was higher than that of the healthy. Quantitative PCR further found that the relative mRNA expression of IL-23, CXCR3, and TNF-α in AIS group was higher than that of the healthy group. This study may provide a basis for a more comprehensive understanding of the potential mechanism of the occurrence and development of AIS, and hsa-miR-877-5p and its downstream effectors IL-23, CXCR3, and TNF-α may be potential intervention targets in AIS.

Epidemiology, organization, diagnosis and treatment of acute ischemic stroke

The management of acute ischemic stroke is changing. Over the period of 2010–2050, the number of incident strokes is expected to be more than double. Rapid access to mechanical thrombectomy for patients with large vessel occlusion is critically associated with their functional outcome. Moreover, patients with first pass effect had a better clinical outcome, lower mortality, and fewer procedural adverse events. We discuss some advances in acute ischemic stroke regarding the organization, the diagnosis and the treatment.

Acute management of childhood stroke.

The purpose of this paper is to review recent updates in the acute management of childhood arterial ischemic stroke, including reperfusion therapies and neuroprotective measures. With the emergence of pediatric stroke centers in recent years, processes facilitating rapid diagnosis and treatment have resulted in improved implementation of early targeted neuroprotective measures as well as the increased use of reperfusion therapies in childhood arterial ischemic stroke. Retrospective data has demonstrated that alteplase is safe in carefully selected children with arterial ischemic stroke in the first 4.5 h from symptom onset, though data regarding its efficacy in children are still lacking. There is also increasing data that suggests that thrombectomy in children with large vessel occlusion improves functional outcomes. Recent adult studies, including the use of Tenecteplase as an alteplase alternative and expansion of late thrombectomy to include patients with large ischemic cores, also are reviewed along with limitations to application of the adult data to pediatric care. There have been significant advances in the hyperacute care of children with ischemic stroke and early diagnosis and targeted management are of the upmost importance in improving long-term outcomes.

Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States.

Medicaid serves as a safety net for low-income US Medicare beneficiaries with limited assets. Approximately 7.7 million Americans aged ≥65 years rely on a combination of Medicare and Medicaid to obtain critical medical services, yet little is known about whether these patients have worse outcomes after stroke than patients with Medicare alone. We compared geographic patterns in dual Medicare-Medicaid eligibility and ischemic stroke hospitalizations and examined whether these dual-eligible beneficiaries had worse post-stroke outcomes than those with Medicare alone. We identified fee-for-service Medicare beneficiaries aged ≥65 years who were discharged from US acute-care hospitals with a principal diagnosis of ischemic stroke in 2014. Medicare beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We mapped risk-standardized stroke hospitalization rates and percentages of beneficiaries with dual eligibility. Mixed models and Cox regression were used to evaluate relationships between dual-eligible status and outcomes up to 1 year after stroke, adjusting for demographic and clinical factors. At the national level, 12.5% of beneficiaries were dual eligible. Dual-eligible rates were highest in Maine, Alaska, and the southern half of the United States, whereas stroke hospitalization rates were highest in the South and parts of the Midwest (Pearson's r = 0.469, p<0.001). Among 254,902 patients hospitalized for stroke, 17.4% were dual eligible. In adjusted analyses, dual-eligible patients had greater risk of all-cause readmission within 30 days (hazard ratio 1.06, 95% confidence interval [CI] 1.03-1.09) and 1 year (hazard ratio 1.03, 95% CI 1.02-1.05) and had greater odds of death within 1 year (odds ratio 1.20, 95% CI 1.17-1.23) when compared with Medicare-only patients; there was no difference in in-hospital or 30-day mortality. Dual-eligible stroke patients had higher readmissions and long-term mortality than other patients, even after comorbidity adjustment. A better understanding of the factors contributing to these poorer outcomes is needed.

Focal ischemic stroke modifies microglia-derived exosomal miRNAs: potential role of mir-212-5p in neuronal protection and functional recovery

BackgroundIschemic stroke is a severe type of stroke with high disability and mortality rates. In recent years, microglial exosome-derived miRNAs have been shown to be promising candidates for the treatment of ischemic brain injury and exert neuroprotective effects. Mechanisms underlying miRNA dysregulation in ischemic stroke are still being explored. Here, we aimed to verify whether miRNAs derived from exosomes exert effects on functional recovery.MethodsMiR-212-5p agomir was employed to upregulate miR-212-5p expression in a rat model of middle cerebral artery occlusion/reperfusion (MCAO/R) as well as an oxygen-glucose deprivation/reoxygenation (OGD/R) in vitro. Western blot analysis, qRT–PCR and immunofluorescence staining and other methods were applied to explore the underlying mechanisms of action of miR-212-5p.ResultsThe results of our study found that intervention with miR-212-5p agomir effectively decreased infarct volume and restored motor function in MCAO/R rats. Mechanistically, miR-212-5p agomir significantly reduced the expression of PlexinA2 (PLXNA2). Additionally, the results obtained in vitro were similar to those achieved in vivo.ConclusionIn conclusion, the present study indicated that PLXNA2 may be a target gene of miR-212-5p, and miR-212-5p has great potential as a target for the treatment and diagnosis of ischemic stroke.

Remote Ischemic Conditioning for Acute Stroke

Despite some promising preclinical and clinical data, it remains uncertain whether remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is an effective treatment for acute stroke. To evaluate the effect of RIC when initiated in the prehospital setting and continued in the hospital on functional outcome in patients with acute stroke. This was a randomized clinical trial conducted at 4 stroke centers in Denmark that included 1500 patients with prehospital stroke symptoms for less than 4 hours (enrolled March 16, 2018, to November 11, 2022; final follow-up, February 3, 2023). The intervention was delivered using an inflatable cuff on 1 upper extremity (RIC cuff pressure, ≤200 mm Hg [n = 749] and sham cuff pressure, 20 mm Hg [n = 751]). Each treatment application consisted of 5 cycles of 5 minutes of cuff inflation followed by 5 minutes of cuff deflation. Treatment was started in the ambulance and repeated at least once in the hospital and then twice daily for 7 days among a subset of participants. The primary end point was improvement in functional outcome measured as a shift across the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) at 90 days in the target population with a final diagnosis of ischemic or hemorrhagic stroke. Among 1500 patients who were randomized (median age, 71 years; 591 women [41%]), 1433 (96%) completed the trial. Of these, 149 patients (10%) were diagnosed with transient ischemic attack and 382 (27%) with a stroke mimic. In the remaining 902 patients with a target diagnosis of stroke (737 [82%] with ischemic stroke and 165 [18%] with intracerebral hemorrhage), 436 underwent RIC and 466 sham treatment. The median mRS score at 90 days was 2 (IQR, 1-3) in the RIC group and 1 (IQR, 1-3) in the sham group. RIC treatment was not significantly associated with improved functional outcome at 90 days (odds ratio [OR], 0.95; 95% CI, 0.75 to 1.20, P = .67; absolute difference in median mRS score, -1; -1.7 to -0.25). In all randomized patients, there were no significant differences in the number of serious adverse events: 169 patients (23.7%) in the RIC group with 1 or more serious adverse events vs 175 patients (24.3%) in the sham group (OR, 0.97; 95% CI, 0.85 to 1.11; P = .68). Upper extremity pain during treatment and/or skin petechia occurred in 54 (7.2%) in the RIC group and 11 (1.5%) in the sham group. RIC initiated in the prehospital setting and continued in the hospital did not significantly improve functional outcome at 90 days in patients with acute stroke. ClinicalTrials.gov Identifier: NCT03481777.

Association of Circulating Circular RNAs (hg38_circ_0008980, and CircDLGAP4) in Diagnosis, Diseases Severity, and Prognosis of Ischemic Stroke.

Fast diagnosing ischemic stroke (IS) is a critical issue in clinical studies, as it allows more effective therapy and stops the progression of IS. The blood level of circular RNAs (CircRNAs) after stroke may be a rapid diagnostic marker. In this study, the blood level of circRNAs was evaluated using a real-time polymerase chain reaction (PCR). We used logistic and linear regression analysis to assess the potential of circRNAs levels with the risk of IS. circRNA DLG associated protein 4 (CircDLGAP4) was decreased in patients compared with controls, and logistic regression showed its expression negatively associated with IS risk. The expression level of human genome version 38_Circular_0008980 (hg38_circ_0008980) was reduced significantly in patients with small vessel disease (SVD), and the linear regression analysis showed a negative relationship between hg38_circ_0008980 expressions with SVD subtype. hg38_circ_0008980 expression relative to controls showed a significant association with IS risk. Taken together, we found a significant decrease in the level of hg38_circ_0008980 after IS; it may act as a novel circRNA in IS pathophysiology with a positive correlation with stroke severity.

Prognostic utility of MicroRNA-221 and interleukin-6 in cerebral ischemic stroke

Cerebral ischemic stroke has a significant mortality rate and persistent impairment. The initial diagnosis of stroke occurs by magnetic resonance imaging and computed tomography. There is a strong need for more accessible, less expensive, and non-invasive methods besides the neuroimaging methods. MicroRNAs (miRNAs) are critical regulators for ischemic stroke as they are involved in stroke pathophysiology. The goal of the current study was to determine whether microRNA-221 (miR-221) could be used as a diagnostic biomarker for patients with ischemic stroke, and whether it can serve as a promising indicator of the disease severity especially if combined with interleukin-6 (IL-6). The study included 90 subjects, 45 cerebral ischemic stroke patients and 45 controls. MiR-221 was evaluated by quantitative real-time polymerase chain reaction (q-PCR) and IL-6 by enzyme-linked immunosorbent assay (ELISA). Our study results revealed that the serum miR-221 level was significantly reduced in cerebral ischemic stroke patients when compared to the control group (p&lt;0.0001). In addition, serum miR-221 showed a significant negative correlation with cerebral stroke severity (p&lt;0.0001), whereas serum IL-6 showed a significant positive correlation with cerebral stroke severity (p &lt; 0.0001). We also analyzed the receiver operator characteristic (ROC) curve and found that area under the ROC curve (AUC) for severity of ischemic stroke by miR-221 was 0.97 (95% confidence intervall0.93–1, p&lt;0.001). Notably, the combination of serum miR-221 with IL-6 for prediction of ischemic stroke severity showed both increased sensitivity/specificity (AUC=0.99, 95% confidence interval 0.96-1, p&lt;0.001) than miR-221 alone. We concluded that miR-221 constituted a non-invasive, sensitive, and specific biomarker that could be used for diagnosis of ischemic stroke and for prediction of its severity.

Sinus vein thrombosis and epileptic seizures: outcomes of long term follow-up

Purpose: In the acute phase of Cerebral Venous Sinus Thrombosis (CVST), approximately 35-50 % of patients diagnosed epileptic seizures. This study aimed to investigate the demographic and clinical characteristics, frequency of seizures, prognosis of patients during a one-year follow-up period.&#x0D; Materials and Methods: The files of patients who were followed up with the diagnosis of acute ischemic stroke between January 1, 2018 and January 1, 2022 were evaluated in this retrospective study. Demographic features, presence of seizure history and seizure frequency, neuroimaging findings, affected cerebral venous sinuses, and anti-seizure medication use were recorded.&#x0D; Results: A total of 701 patients with acute stroke had their medical records reviewed. Thirty-two of 701 patients (4.56 %) were diagnosed with CVST; 37.5 % of patients experienced early-onset seizures. Seizure control was achieved with monotherapy in 88.8 % (n:8) of patients with seizures. Involved sinuses in patients with seizures; 50 % (n=6) superior sagittal sinus was the most commonly involved sinus and inferior sagittal sinus and sinus rectus were not involved. In terms of sinus involvement, there was no statistically significant difference between patients with and without seizures. On cerebral magnetic resonance imaging, venous infarcts were detected in 66.7 % (n=8) of patients with seizures, compared to 35 % of patients without seizures.&#x0D; Conclusion: This retrospective study revealed that seizures typically occur early in the disease, have a favorable prognosis over the long term, and can be managed with monotherapy.

Non-coding RNAs versus protein biomarkers to diagnose and differentiate acute stroke: Systematic review and meta-analysis

BackgroundStroke diagnosis is dependent on lengthy clinical and neuroimaging assessments, while rapid treatment initiation improves clinical outcome. Currently, more sensitive biomarker assays of both non-coding RNA- and protein biomarkers have improved their detectability, which could accelerate stroke diagnosis. This systematic review and meta-analysis compares non-coding RNA- with protein biomarkers for their potential to diagnose and differentiate acute stroke (subtypes) in (pre-)hospital settings. MethodsWe performed a systematic review and meta-analysis of studies evaluating diagnostic performance of non-coding RNA- and protein biomarkers to differentiate acute ischemic and hemorrhagic stroke, stroke mimics, and (healthy) controls. Quality appraisal of individual studies was assessed using the QUADAS-2 tool while the meta-analysis was performed with the sROC approach and by assessing pooled sensitivity and specificity, diagnostic odds ratios, positive- and negative likelihood ratios, and the Youden Index. Summary of review112 studies were included in the systematic review and 42 studies in the meta-analysis containing 11627 patients with ischemic strokes, 2110 patients with hemorrhagic strokes, 1393 patients with a stroke mimic, and 5548 healthy controls. Proteins (IL-6 and S100 calcium-binding protein B (S100B)) and microRNAs (miR-30a) have similar performance in ischemic stroke diagnosis. To differentiate between ischemic- or hemorrhagic strokes, glial fibrillary acidic protein (GFAP) levels and autoantibodies to the NR2 peptide (NR2aAb, a cleavage product of NMDA neuroreceptors) were best performing whereas no investigated protein or non-coding RNA biomarkers differentiated stroke from stroke mimics with high diagnostic potential. ConclusionsDespite sampling time differences, circulating microRNAs (< 24 h) and proteins (< 4,5 h) perform equally well in ischemic stroke diagnosis. GFAP differentiates stroke subtypes, while a biomarker panel of GFAP and UCH-L1 improved the sensitivity and specificity of UCH-L1 alone to differentiate stroke.

Near Infrared Emissive Lanthanide Luminescence Nanoparticle Used in Early Diagnosis and Brain Temperature Detection for Ischemic Stroke.

Ischemic stroke (IS) is one of the most dangerous medical conditions resulting in high mortality and morbidity. The increased brain temperature after IS is closely related to prognosis, making it highly significant for the early diagnosis and the progression evaluation of IS. Herein, a temperature-responsive near infrared (NIR) emissive lanthanide luminescence nanoparticle is developed for the early diagnosis and brain temperature detection of IS. After intravenous injection, the nanoparticles can pass through the damaged blood-brain barrier of the ischemic region, allowing the extravasation and enrichment of nanoparticles into the ischemic brain tissue. The NIR luminescence signals of the nanoparticles are used not only to judge the location and severity of the cerebral ischemic injury but also to report the brain temperature variation in the ischemic area through a visualized way. The results show that the designed nanoparticles can be used for the early diagnosis of ischemic stroke and minimally invasive temperature detection of cerebral ischemic tissues in transient middle cerebral artery occlusion mice model, which is expected to make the clinical diagnosis of ischemic stroke more rapid and convenient, more accurately evaluate the state of brain injury in stroke patients and also guide stroke hypothermia treatment.

Dyslipidemia and Obesity in Ischemic Stroke.

Background Dyslipidemia and obesity are both important risk factors for the first and recurrent ischemic strokes. Dyslipidemia is highly prevalent among Asian populations, and the prevalence of obesity is also noted to be progressively increasing in this population. This study was carried out to determine the prevalence of dyslipidemia and central obesity and their association with each other and various cardiovascular risk factors among patients who presented with an acute ischemic stroke to a tertiary care university hospital in Nepal. Methods This study is a secondary analysis done on data from a prospective observational study that was carried out on patients who were either acutely admitted to or visited the outpatient department of the hospital with a diagnosis of ischemic stroke. Dyslipidemia was defined according to the third report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Obesity was defined as central obesity by measuring waist circumference. Data were collected by convenience sampling and analyzed by IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Significant variables were compared with logistic regression analysis. Other data were expressed as frequencies and percentages. Results Out of 145 patients, 77 were male (53.1%). The mean age of the patients was 60.15 years. Dyslipidemia and central obesity were present in 96.6% and 57.9% of the patients, respectively. The most common lipid abnormality was low-density lipoprotein cholesterol, present in 82.8% of the patients, followed by high triglycerides, present in 21.4% of them. Dyslipidemia was not associated with any vascular risk factors. Central obesity was significantly associated with female gender, diabetes, and low-density lipoprotein cholesterol in univariate analysis. However, in multivariate logistic regression analysis, it was significantly associated with only female gender (p=0.003) and diabetes (p=0.012). Conclusion Dyslipidemia and central obesity are very common in patients with ischemic stroke. Dyslipidemia is not associated with any vascular risk factors. However, central obesity is significantly associated with the female gender and diabetes.

145 Audit of yearly prevalence of atrial fibrillation in ischemic stroke patients admitted to a level III acute Irish hospital

Abstract Background Global AF burden in acute ischemic stroke patients is studied in some evidence at 30%, with similar results in Ireland. We therefore sought to perform an audit of prevalence of atrial fibrillation in acute ischemic stroke patients in a level III hospital in republic of Ireland, to study its comparability with available evidence nationally and internationally. Methods The study was retrospective observational audit study of all patients admitted with a diagnosis of acute ischemic stroke to the concerned hospital from January, 2022 to December, 2022. Patients were identified via their diagnosis recorded in HIPE coding and in-hospital stroke registry. All patients with the diagnosis of acute ischemic stroke were screened for presence of atrial fibrillation via 72 hours R-testing. Data was collected via charts review and R test result review, compiled via flow charts, graphs and excel sheets, and studied. Results 156 patients were admitted to the hospital’s stroke service with ischemic stroke in the set time frame. 41% (N = 65) had Atrial Fibrillation (AF) which was deemed to be the cause of their stroke. 18% (N = 29) had newly diagnosed Atrial fibrillation. 23% (N = 36) had known AF. In those with known AF (N = 36), 13.8% (N = 5) were not on anticoagulation, 58.3% (N = 21) were on the adjusted dose, and 27.7% (N = 10) were not fully compliant. All new and existing AF patients not anticoagulated, were commenced on anticoagulation. Conclusion The audit shows that total atrial fibrillation burden and rate of pick-up of new atrial fibrillation in the acute ischemic stroke patients in the concerned hospital, were comparable to international evidence. Under dosage and poor compliance were major causes of anticoagulation failure in patients who were anticoagulated with known AF.

The Recent Applications of PLGA-Based Nanostructures for Ischemic Stroke.

With the accelerated development of nanotechnology in recent years, nanomaterials have become increasingly prevalent in the medical field. The poly (lactic acid-glycolic acid) copolymer (PLGA) is one of the most commonly used biodegradable polymers. It is biocompatible and can be fabricated into various nanostructures, depending on requirements. Ischemic stroke is a common, disabling, and fatal illness that burdens society. There is a need for further improvement in the diagnosis and treatment of this disease. PLGA-based nanostructures can facilitate therapeutic compounds' passage through the physicochemical barrier. They further provide both sustained and controlled release of therapeutic compounds when loaded with drugs for the treatment of ischemic stroke. The clinical significance and potential of PLGA-based nanostructures can also be seen in their applications in cell transplantation and imaging diagnostics of ischemic stroke. This paper summarizes the synthesis and properties of PLGA and reviews in detail the recent applications of PLGA-based nanostructures for drug delivery, disease therapy, cell transplantation, and the imaging diagnosis of ischemic stroke.

The main etiopathogenetic factors, features of the clinical course, diagnosis and treatment of ischemic stroke in young people

This article deals with the topical issue of today — ischemic strokes in young people. Currently, there are more than 150 identified causes of ischemic stroke, the most common of them are antiphospholipid syndrome, Fabry disease, genetic mutations, acquired and congenital thrombophilia, heart defects, a number of infectious agents, comorbid nosologies (migraine), and the use of narcotic agents. Special attention was paid to the monogenic disorders, which begin from an ischemic stroke or in which this type of stroke is one of the leading characteristics. The article shows in detail the characteristic features of each pathology, methods of diagnosis and ways of treatment, which is necessary in the work of a neuropathologist and doctors of other specialties.

Importance of Serum Biomarkers for Early Diagnosis of Acute Ischemic Stroke: What’s New

Importance of Serum Biomarkers for Early Diagnosis of Acute Ischemic Stroke: What’s New