Characteristics Of Ischemic Stroke Research Articles

Magnetic resonance imaging features and stroke etiology of ischemic stroke in essential thrombocythemia

BackgroundVarious essential thrombocythemia (ET)-related stroke mechanisms have been proposed, including microcirculatory disturbance due to coagulopathy, vasculitis, and embolism due to thrombus formation in large vessels. However, the stroke mechanism in ET remains largely unexplored. The purpose of this study was to evaluate magnetic resonance image (MRI) features of ischemic stroke in ET and determine the potential stroke mechanism. MethodsWe retrospectively collected data from 21 acute ischemic stroke patients with ET who were admitted to two stroke centers between 2010 and 2023. ET was diagnosed according to the World Health Organization criteria. We evaluated MRI features including the diffusion-weighted image (DWI) lesion pattern, and the presence of hemorrhagic transformation and intracranial artery steno-occlusive lesion, as well as other etiological workup results. ResultsOf 21 patients, 20 exhibited multiple ischemic lesions on DWI, mainly within a single vascular territory. Cortical infarcts were observed in 19 patients. Hemorrhagic transformation occurred in 15 patients. Additionally, 15 patients had intracranial steno-occlusive arteries, which regressed to normal in 11 patients during follow-up. Out of all patients, only 2 had potential causes of stroke other than ET (1 with atrial fibrillation and 1 with intracranial atherosclerotic stenosis). The remaining 19 patients had ET as the only identified potential cause. ConclusionsMRI features, including DWI lesion pattern in ischemic stroke patients with ET, suggested embolic etiology despite the absence of major embolic sources. Intra-arterial thrombus appears to be part of the stroke mechanism related to ET and may contribute to ischemic stroke in ET.

Abstract TP269: Determining Differences in the Association Between Atrial Fibrillation and Ischemic Stroke Outcomes by Acute Therapy Received

Introduction: Whether the association between atrial fibrillation (AF) and ischemic stroke (IS) outcomes differs by IS therapy is unknown. Hypothesis: AF IS patients will have a worse discharge NIH Stroke Scale (NIHSS) and 90-day modified Rankin Scale (mRS) scores than non-AF, with differences by IS therapy. Methods: We studied a cohort of AF and non-AF IS patients from Johns Hopkins (2020-2023) with IS characteristics and demographics who received acute IS therapy (intravenous tissue plasminogen activator (IVtPA), mechanical thrombectomy (MT), or both). Multivariable regression models were used to examine the association between AF and either NIHSS (continuous or dichotomized at the mean (5)) or mRS (ordinal) separately, with interaction terms for IS therapy as appropriate. Results: Of the 240 patients (mean age 67, 52.5% female, 56.2% Black), 26.2% received IVtPA, 45.8% MT, and 27.9% both. There was no association between AF and NIHSS (β 1.53, 95% CI 0.38-3.4) in the final model, but there were higher odds of an NIHSS > 5 among AF patients (OR 3.46, 95% CI 1.16-10.30). AF patients had an increased odds of a worse mRS (Ordinal OR 2.05, 95% CI 1.14-3.71), but not after adjustment (Ordinal OR 1.07, 95% CI 0.52-2.20). The association between AF and IS outcomes differed by IS therapy (Table 1). AF patients who did not receive MT had a worse NIHSS and higher odds of a one unit increase in mRS, compared to AF patients who received MT (p-interaction 0.07, 0.01 respectively). Conversely, AF patients who received IVtPA had a worse NIHSS, compared to those who did not receive IVtPA (p-interaction 0.07), with essentially no difference in the association between AF and mRS in the final model when considering IVtPA use (p-interaction 0.09). Conclusion: In this study, AF patients had a higher mRS and worse discharge NIHSS versus non-AF, with differences by treatment; not receiving MT was detrimental for AF patients while our found worse outcome with IVtPA may reflect AF-associated treatment delays.

DACA Aneurysm Presenting as Ischemic Stroke

AbstractAneurysms rarely present with features of ischemic stroke. The data on treatment of such strokes is limited. We present a case of multiple aneurysms and an ischemic stroke caused by distal anterior cerebral artery (DACA) aneurysm treated with flow diverter placement, the first case of endovascular treatment of DACA aneurysmal ischemic stroke reported to our knowledge.

Identification of immune characteristic landscapes related to autophagy in ischemic stroke.

Ischemic stroke (IS) is a common and grievous nervous system disease. Both autophagy activation and immune response after cerebral ischemia play important roles in the development of IS. Many studies have revealed a close interplay between autophagy and immunity. However, little is known about how autophagy influences the immune characteristics of IS. Hence, the study aims to systematically explore the role of autophagy and its impact on immune characteristics in IS. We first compared the expression differences of autophagy genes in a training set and identified 20 dysregulated autophagy genes between healthy and IS samples. An autophagy-related classifier composed of seven genes was further established and could well distinguish healthy and IS samples. Then, the association between autophagy and immune characteristics, including infiltrating immunocytes, activity of immune reactions, and HLA gene expression, was investigated. The results showed that autophagy closely correlated with immune characteristics, such as NAMPT and ARNT significantly related to infiltrating immunocytes; PPP1R15A and CASP3 significantly related to activity of immune reactions; and NAMPT and ATG16L2 significantly related to HLA genes. Next, two distinct autophagy expression patterns were identified by unsupervised clustering analysis, and diverse immune characteristics were discovered between them. A total of 5481 autophagy phenotype-related genes were obtained between two expression patterns, and their biological functions revealed that these genes were involved in immune-related biological pathways. Finally, five dysregulated autophagy genes (FOS, MAP1LC3B, ERO1L, ARNT, and PPP1R15A) were proved between IS and healthy samples using another two validation sets. Our results illustrated that autophagy had a dramatic effect on the immunity of IS and provided a novel sight into understanding the pathogenesis of IS.

An Improved Detection Algorithm for Ischemic Stroke NCCT Based on YOLOv5.

Cerebral stroke (CS) is a heterogeneous syndrome caused by multiple disease mechanisms. Ischemic stroke (IS) is a subtype of CS that causes a disruption of cerebral blood flow with subsequent tissue damage. Noncontrast computer tomography (NCCT) is one of the most important IS detection methods. It is difficult to select the features of IS CT within computational image analysis. In this paper, we propose AC-YOLOv5, which is an improved detection algorithm for IS. The algorithm amplifies the features of IS via an NCCT image based on adaptive local region contrast enhancement, which then detects the region of interest via YOLOv5, which is one of the best detection algorithms at present. The proposed algorithm was tested on two datasets, and seven control group experiments were added, including popular detection algorithms at present and other detection algorithms based on image enhancement. The experimental results show that the proposed algorithm has a high accuracy (94.1% and 91.7%) and recall (85.3% and 88.6%) rate; the recall result is especially notable. This proves the excellent performance of the accuracy, robustness, and generalizability of the algorithm.

Ischemic stroke in the debut of coronavirus infection

Introduction. The risk of ischemic stroke (IS) on the background of COVID-19 is about 5% and is associated with a more severe course of coronavirus infection (CVI).The aim of the study was to identify risk factors and clinical features of IS in a debut of CVI in neurological inpatients.Materials and methods. A prospective analysis of the neurological status, clinical, biochemical parameters, ultrasound examination of brachiocephalic vessels, computed tomography (CT) of the brain and the lungs was performed in 15 patients in the acute period of IS with a later detected PCR SARS-Cov-2.Results. The average age of patients is 70.3±7 years. Risk factors for IS in the debut of CVI: stenosis of 30-50% of the internal carotid artery (ICA), arterial hypertension in 100%; dyslipidemia in 86.7%; type 2 diabetes mellitus in 46.7%; coronary heart disease in a third of cases. Lung damage according to CT did not exceed 50%. There is no clear correlation between IS severity, its localization and degree of respiratory failure. The localization of IS corresponded to the side of ICA stenosis. The young patient had signs of antiphospholipid syndrome, extravasal compression of both vertebral arteries, hypoplasia of the posterior connective artery corresponding to the focus of extensive infarction in the middle cerebral artery basin.Discussion. A feature of the debut of CVI in the acute period of IS was the absence of subfebrility in the presence of increased CRP, thrombocytopenia, hyperfibrinogenemia, and a more than 3-fold increase in D-dimer, indicating early activation of platelet-vascular hemostas. The fact of the development of IS according to the side of the stenotic vessel is explained by the manifestation of latent organic pathology under the influence of CVI, thanks to the affinity of SARS-CoV-2 for the ACE2 receptors present in the vascular endothelium.Conclusion. In connection with the present epidemiological situation, the fact of the onset of IS in CVI without hyperthermia suggests an early PCR test with subsequent adequate treatment of CVI in a specialized institution together with neurologists.

The role of hypertension and diabetes mellitus on the etiology of middle cerebral artery disease.

BackgroundIschemic stroke (IS) caused by middle cerebral artery (MCA) disease is the most common type of IS caused by intracranial artery disease in the Chinese population. Hypertension and diabetes mellitus are the common risk factors of cerebral small vessel disease and large artery atherosclerosis (LAA). However, little is known about whether hypertension and diabetes mellitus had different correlations with the small artery occlusion (SAO) and LAA etiology of MCA disease. Therefore, our aim was to identify the predictors of the etiology of MCA disease.MethodsWe consecutively enrolled 967 patients with noncardiogenic IS in unilateral MCA territory. Vascular risk factors and the clinical–radiologic features of IS were analyzed. The etiology of IS were classified as SAO or LAA according to the Stop Stroke Study Trial of Org 10172 in Acute Stroke Treatment classification criteria. Multivariable logistic regression was used to identify the differences in the predictors between SAO and LAA etiology of MCA disease.ResultsMultivariable logistic regression identified male and hypertension as the predictors of the SAO etiology of MCA disease, however diabetes mellitus, repeated transient ischemic attack before the stroke, gaze palsy, aphasia, headache at admission, and disability at discharge as the predictors of the LAA etiology of MCA disease.ConclusionHypertension and diabetes mellitus are related with the different etiology of MCA disease.

Abstract 157: Ischemic Strokes In Patients With Atrial Fibrillation On Oral Anticoagulant: The Neuro-AFib Study

Background: Ischemic stroke (IS) admissions in patients with atrial fibrillation (AF) using either direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA) are commonly seen in stroke units but data on their prevalence and causes are scarce. Understanding the frequency/causes of failures of current FDA-approved preventive methods in patients with AF is important to reduce stroke risk and related death/disability. Methods: The Neuro-AFib study is a multicenter effort geared toward elucidating the causes and consequences of IS and hemorrhagic stroke in a contemporary AF cohort. Detailed clinical, laboratory and multimodal neuro- and cardiac imaging data from known AF patients consecutively admitted to 22 US academic stroke centers with an IS between 1/2018-12/2019 were used to compare characteristics of IS on vs off oral anticoagulants. Results: Out of 6443 IS patients with AF, 4898 (76%) had known AF prior to the acute stroke. Among these patients with known AF, 2204 (45%) were using oral anticoagulants [OAC= DOAC (59.3%) or VKA (40.7%)]. Patients who had IS on OAC were younger (76.8 + 11 vs 78 + 12, p=0.001), had higher mean CHA 2 DS 2 -VASc scores (4.17 + 1.5 vs 3.9 + 1.5, p<0.0001), and more likely to have a past history of IS/TIA when compared to non-OAC group (35% vs 23%, p<0.0001). In a multivariable logistic regression model, history of IS/TIA, diabetes, hyperlipidemia, heart failure, prosthetic heart valve, sleep apnea, permanent atrial fibrillation, left atrial dilation and ischemic arterial disease were all independently associated with IS on OAC (all p<0.05). Imaging data were complete in 15% of the cohort and IS on OAC group had more acute lacunar infarcts, and extracranial and intracranial atherosclerotic disease causing 50% or more ipsilateral stenosis compared to patients with IS off OAC (all p<0.05). Conclusions: Based on a large multicenter contemporary cohort of IS patients with known AF, the numbers of patients who failed OACs (and especially DOACs) are high. These patients have severe vascular risk factor loads, concurrent etiologies, and they are more likely to have recurrent ischemic events. Further detailed data focused on imaging and IS mechanisms from this contemporary cohort will be ready to be presented during ISC 2022.

Abstract WP182: Association Of The RNF213 p.R4810k Variant With Thyroid Disease And Autoantibodies In Ischemic Stroke

Background: Thyroid diseases and elevated thyroid autoantibodies are associated with moyamoya disease (MMD). MMD susceptibility variant RNF213 p.R4810K is known to increase the risk of ischemic stroke (IS), but whether thyroid diseases and thyroid autoantibody levels are altered in IS patients carrying the RNF213 p.R4810K variant remains elusive. Methods: Of the consecutive adult IS patients from 2011 to 2020 admitted in our institute, patients who signed a consent form for RNF213 genotyping were included, while definitive MMD patients were excluded. We compared the patient background, history of thyroid disease (hyperthyroidism or hypothyroidism), and levels of serum triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), antithyroperoxidase antibody (TPOAb), and antithyroglobulin antibody (TgAb) between the variant carrier and non-carrier. Each thyroid autoantibody was measured by the electro-chemiluminescent immunoassay method. Results: Of the 1570 patients (525 women; 72 years of median age) analyzed, 74 (4.7%) patients had the RNF213 p.R4810K variant. The variant carriers were more likely to be female (52.7% vs. 35.3%, P <0.01), younger (58 years vs. 73 years, P <0.01), and have a history of hypothyroidism (18.9% vs. 1.8%, P =0.01), middle cerebral artery M1 stenosis (29.7% vs. 6.0%, P =0.01), and large-artery atherosclerosis (47.3% vs. 25.0%, P <0.01) than the variant non-carriers. Both mean TPOAb (17.60 IU/mL vs. 3.96 IU/mL, P <0.01) and TgAb levels (25.09 IU/mL vs. 15.64 IU/mL, P <0.01) were higher in the variant carriers, and there were no inter-group differences for history of hyperthyroidism, TSH, free T3/T4, and administration of levothyroxine sodium hydrate. A multivariate regression analysis showed that hypothyroidism(odds ratio [OR], 8.30; 95% confidential interval [CI], 2.83-24.33) and the elevated TPOAb levels (OR per 1 IU/mL increment, 3.32; 95% CI, 1.43-7.78) were independently associated with variant carriers versus non-carriers. Conclusions: Hypothyroidism and elevated TPOAb levels were frequently observed in IS patients with the RNF213 p.R4810K variant, which may be associated with immune aberrancies relevant to or underlying thyroid autoimmunity, contributing to the different features of IS.

Abstract 154: Sex-specific Genome Wide Association Study Of Early-onset Ischemic Stroke

Introduction: Genetic studies of early-onset disease have been an effective strategy to identify novel pathways and drug targets generalizable also to later-onset disease. Few studies have investigated the sex-specific genetic associations with early-onset ischemic stroke even though several features of ischemic stroke differ between males and females. We hypothesized that stratifying the GWAS by sex would reveal novel stroke loci. Methods: We performed a transethnic ischemic stroke GWAS of 3,056 female cases and 4,462 male cases < 60 years-old and 16,192 and 16,048 sex-matched controls, respectively, from the Early Onset Stroke Genetics Consortium. Results: We identified a significant association in women with a locus in close proximity to TMX1 , a transmembrane platelet protein that inhibits platelet function. Additionally, we identified 2 other suggestive (P < 5 x 10 -6 ) loci in females (see Table), i.e., at APOH , which encodes beta2-glycoprotein I, an established GWAS locus for lipoprotein(a), and LRFN2 which has been previously reported to associate with obesity-related measures and type II diabetes. We observed suggestive evidence for association in males with MMP3/MMP12 , a known stroke susceptibility locus. Conclusions: Despite a very modest sample size, sex-specific analyses identified suggestive associations at biologically important novel loci in females and a known stroke locus in males. Further studies of sex-specific associations in both early- and later-onset ischemic stroke are needed.

Methionine synthase reductase A66G polymorphism and ischemic stroke in younger patients

In the past decade, stroke incidence in younger adults increased. Methionine synthase reductase (MTRR) A66G polymorphism is one of the risk factors for ischemic stroke (IS). However, clinical features of IS in MTRR A66G polymorphism are not yet studied.Objective: to investigate clinical features of IS in MTRR A66G polymorphism.Patients and methods. One hundred forty-one younger patients with IS, hospitalized in the neurological department of Sverdlovsk Regional Clinical Hospital №1, were included in the study. MTRR A66G polymorphism was detected by the real-time polymerase chain reaction in all participants.Results and discussion. MTRR A66G polymorphism was present in 83.7% of younger patients with IS. Participants with MTRR A66G polymorphism had a significantly higher prevalence of arterial hypertension (р=0.029). In addition, protein C level was significantly lower in patients with MTRR A66G mutation (р=0.001).Conclusion. The majority of younger patients with IS have MTRR A66G polymorphism. Therefore, the inclusion of MTRR A66G polymorphism screening in the diagnostic algorithm of stroke in young adults seems necessary.

Causes of ischemic stroke in patients younger than 45 years: analysis of data from the regional vascular center

In young patients, the causes of ischemic stroke (IS) are substantially different from those in older patients. Understanding the causes of the disease in patients younger than 45 years is needed to elaborate examination algorithms used in the country’s vascular departments.Objective: to present the nosological characteristics of IS in patients younger than 45 years according to the hospital register of the regional vascular center.Patients and methods. The data of the hospital register of the neurological unit for patients with acute cerebral circulatory disorders, who were in the Perm Territorial Vascular Center, City Clinical Hospital Four, in 2014 to 2020, were analyzed. The analysis included 126 patients under the age of 45 years with IS verified by magnetic resonance imaging.Results and discussion. The pathogenetic subtypes of IS according to the TOAST criteria were large artery atherosclerosis [n=10 (7.9%)], cardioembolism [n=27 (21.4%)], small vessel disease [n=15 (11.9%)], IS of other determined etiology [n=23 (18.3%)], and IS of undetermined etiology [n=51 (40.5%)]. After excluding incomplete examination cases (n=29), the most common causes of IS were cardiac embolism (patent foramen ovale, atrial septal defect, prosthetic valves, acute infective endocarditis, and chronic cardiac aneurysm) (27.8%), large artery disease (atherosclerosis and unspecified arteriopathy) (21.6%), small artery disease (15.5%), as well as cervical and cerebral artery dissection (10.3%). Cryptogenic stroke was observed in 13% of patients. There was a preponderance of cryptogenic IS in the age subgroup of 21–25 years, cardiac embolism (mainly patent foramen ovale) in the subgroup of 26–35 years; the proportions of cardiac embolism, large and small artery diseases, and dissections were comparable in the subgroup of 36–40 years; large and small artery diseases prevailed in the subgroup of 41–44 years.Conclusion. The most common causes of IS in 18–44-year-old patients are cardiac embolism (mainly through the mechanism of paradoxical embolism) and large artery disease, including dissection. The etiology of IS depended on age: cardiac embolism prevailed in the younger age range, whereas large and small artery diseases were dominant in the older age range.

Clinical neurological characteristics of ischemic stroke subtypes in acute phase

Objectives. The aim of the present study was to clarify clinical neurological characteristics and different ischemic stroke subtypes unfavorable course predictors in acute phase. Material and Methods. 482 patients with different ischemic stroke subtypes were observed. Among them there were 125 (25.9 %) with cardioembolic infarct (CEI), 119 (24.7 %) with large artery atherosclerosis (LAAS) infarct, 122 (25.3 %) with lacunar stroke (LAC), 116 (24.1 %) with stroke of undetermined etiology (UDE). The comparative analysis of clinical picture was performed. The predictors of unfavorable course of acute phase were established. Results. We have found out that severe neurological deficit, high mortality and the worst functional outcome during the first 14 days were observed in patients with CEI and LAAS. The highest frequency of early neurological deterioration (END) was detected at LAC (in 22.7 % of patients). There was a relationship between END and presence of transient ischemic attack (TIA) in past medical history, the level of systolic blood pressure (SBP) at the beginning of the disease and the degree of carotid arteries stenosis on the side of lesion. The patients with LAC had mild neurological deficit and better prognosis compared with other ischemic stroke subtypes. Among the clinical factors that have impact on the CEI, LAAS and UDE acute phase course were: the size of lesion, the level of consciousness on the 1st day, the baseline SBP, patient’s age. At LAAS, the presence of transient ischemic attack (TIA) in past medical history and low SBP in the onset of the disease (less than140 mm Hg) has an additional prognostic value for an unfavorable functional outcome. The severity of LAC in acute period depended on its localization and size. Localization of LAC in the internal capsule, thalamus and pons were characterized by the highest severity. Conclusions. Clinical neurological features of ischemic stroke depend on its subtype and have some prognostic value for the course of different ischemic stroke subtypes in acute phase.

Clinical and pathogenic features of ischemic stroke among representatives of different gender and age groups

We observed 1410 patients of different gender and age with ischemic stroke of 4 main clinical and pathogenic types - atherothrombotic, cardioembolic, hemodynamic and lacunar. The dependence of the pathogenic type of stroke, background options for stroke pathology and risk factors of stroke on sex and age of patients was analyzed. We founded out that atherothrombotic ischemic stroke is more common for persons of retirement age, and in working paeople - gap and hemodynamic once, although atherothrombotic strokes in this age group were more frequently observed among men. The importance of hypertension in the development of ischemic stroke reduces with age, but the role of cerebral atherosclerosis, ischemic heart disease and cardiac arrhythmias increases. As risk factors for ischemic stroke in the pension age physical inactivity, overweight and dyslipidemia play the main role, when reducing the role of smoking and stress, more relevant for working people. The frequency of the presence of certain risk factors and background for ischemic stroke disease depends on the patient's gender, but in different age periods and under different pathogenic types of ischemic stroke this dependence changes and in people of retired age it is less distinct than in working people.

Clinical features of ischemic stroke in patients with nasopharyngeal carcinoma

To investigate the clinical features of ischemic stroke in patients with nasopharyngeal carcinoma. The clinical data of the nasopharyngeal carcinoma patients with ischemic stroke treated at the First Affiliated Hospital of Guangxi Medical University between January 2006 and December 2013 were collected. Among 3 822 patients with nasopharyngeal carcinoma 10 patients suffered from acute ischemic stroke. The 10 patients were males and their age ranged from 39 to 70 years old, with an average age of 51 years. All of the patients were found with squamous cell carcinoma, with metastasis in 7 of them. Among the 10 patients, only 3 patients had with traditional risk factors for ischemic stroke, but no traditional risk factor was found in other 7 patients; 2 patients showed single lesion in brain and 8 patients with two or more lesions due to the blockage of multiple cerebral arteries; 7 patients showed an elevated plasma D-dimer level. It is suggested that the acute ischemic stroke occurring in the patients with nasopharyngeal carcinoma commonly lacks traditional risk factors, with elevated plasma D-dimer levels and multiple lesions due to involvement of several cerebral arteries.

経食道心エコーのみで肺動静脈瘻が疑われた脳梗塞と一過性脳虚血発作19例の臨床的特徴

経食道心エコーのみで肺動静脈瘻が疑われた脳梗塞と一過性脳虚血発作19例の臨床的特徴

Study of Sites of Lesion in Ischemic Stroke and Intracerebral Hemorrhage

Methodology: This retrospective cross sectional observational study was carried out in the Department of Neurology and Department of Medicine of Dhaka Medical College Hospital. (DMCH), during March, 2010 to February, 2011 in patients admitted with a history of first ever stroke. The duration of the study was one year .For this purpose, a total number of 140 patients, of which 70 were included in ischemic stroke and 70 in intracerebral haemorrhage group. CT scan of head of each patient was done at least 6 hours after the onset of the event .CT diagnosed cases of infarct and ICH were included in this study and subarachnoid haemorrhage cases were excluded. CT negative cases were further investigated by MRI brain when the clinical suspicions of stroke were strong.
 Results: The mean age of the patients having features of ischemic stroke and intracerebral haemorrhage were 59.81±11.08 and 57.21±10.09 respectively. Male female ratio was 1.92:1 and 1.69:1 in IS group and ICH group respectively. Regarding the risk factor hypertension and smoking were observed most common risk factors in the study patients in both groups. However, diabetes mellitus, arrhythmia, ischemic heart disease and dyslipidemia were observed more common in patients of ischemic stroke than ICH patients. Among the studied patients, ischemic stroke was observed more common in parietal region (20% of patients), internal capsule/ capsular region (17.14% of patients) and caudate nucleus region (10% of patients). ICH was observed most frequently 32.86% (n=23), 15.71% (n=11) and 5.71% (n=4) in lentiform nucleus/putamen, thalamus and combined gangliothalamic region respectively. In both group left sided lesion prevailed more than right side. In case of ischemic strokes, left side lesion was 61.43% .In intracerebral haemorrhage, left side lesion was 58.57%. It was also observed that deep intracerebral haemorrhage is the most common location (74.29%) than the lobar region (25.71%).
 Conclusion: Site of predilection of lesions and their distribution pattern differ in ischemic stroke and intracerebral haemorrhage. This study revealed that infarcts were more common in parietal and capsular region and haemorrhage were more common in putamen, thalamus and combined gangliothalamic regions. Ischemic stroke and ICH also have differences in clinical presentation and risk factor profile.
 Bangladesh Journal of Neuroscience 2014; Vol. 30 (2): 69-76

Kurashiki Prehospital Stroke Subtyping Score (KP3S) as a Means of Distinguishing Ischemic from Hemorrhagic Stroke in Emergency Medical Services

Background and Purpose: The aim of this study was to devise a new ischemic stroke (IS)/hemorrhagic stroke (HS) stroke score to distinguish IS from HS for emergency medical services (EMS). Materials and Methods: We studied patients with IS and HS who were admitted within 6 h of onset and transferred by the EMS. We compared characteristics of IS and HS to devise a new IS/HS score. Results: A total of 227 patients (median age, 71 years; 139 males; IS, 127 patients; HS, 100 patients) were included in the study. On multivariate analysis following univariate analysis, presence of atrial fibrillation, diastolic blood pressure <100 mm Hg and lack of disturbance of consciousness were independently associated with IS. The following score was devised to distinguish IS from HS in EMS: Kurashiki Prehospital Stroke Subtyping Score (KP3S) = (presence of atrial fibrillation) · 2 + (diastolic blood pressure <100 mm Hg) + (lack of disturbance of consciousness). When KP3S was greater than 1, sensitivity for IS was 64% and specificity 85%. The C statistic of KP3S was 0.805. Conclusion: KP3S is useful for distinguishing IS from HS and for the evaluation of stroke patients by EMS.