First Episode Of Ischemic Stroke Research Articles

Analysis of readmission and hospitalization expenditures of patients with ischemic stroke suffering from different comorbidities

BackgroundThe comorbidities of ischemic stroke (IS) are increasing worldwide. This study aimed to quantitatively assess the effect of different types of comorbidity on readmission and hospitalization expenditures of patients with IS. MethodsA retrospective observational study was conducted from the basic insurance claims database of a large city in China, between January 1, 2018, and May 31, 2022. We identified patients with IS aged 18 years and over, who experienced the first episode of IS and had one-year follow-up records. This study divided eighteen different comorbid conditions into two categories (concordant comorbidity and discordant comorbidity) and the IS patients were further categorized into four groups. Multivariable logistic regression models and generalized linear models with log-link and gamma distribution were to estimate the effect of different comorbidity groups on one-year readmission rates and annual hospitalization expenditures. ResultsIn total, 99,649 adult patients with IS were identified. Approximately 94.0 % of patients with IS had at least one comorbidity, and 63.8 % reported concordant comorbidity only. Patients with IS had a readmission rate of 26.7 %, and the mean of annual hospitalization expenditure and annual hospitalization out-of-pocket expenditure (OOPE) were 28086.6 Chinese Yuan (CNY) and 8267.3 CNY, respectively. After adjustment for covariates, the concordant comorbidity-only group had the highest readmission rate, annual hospitalization expenditure, and OOPE compared with the other groups, furthermore, these results increased as the number of comorbidity increased and had statistically significant positive associations. ConclusionsThe readmission and annual hospitalization expenditures of patients with IS were associated with different comorbidities. Concordant comorbidity increased hospital readmission risk and health expenditures. To better manage the comorbidities of patients with IS, especially concordant comorbidities, it is necessary to establish a routine care strategy specifically for comorbid conditions.

Altered functional connectivity in patients with post-stroke fatigue: A resting-state fMRI study

BackgroundPost-stroke fatigue (PSF) was a common complication after stroke. This study aimed to explore the neuroimaging mechanism of PSF, which was rarely studied. MethodsPatients with the first episode of ischemic stroke were recruited from the First Affiliated Hospital of Wenzhou Medical University between March 2021 and December 2022. The fatigue severity scale (FSS) was used to assess fatigue symptoms. PSF was diagnosed by a neurologist based on the FSS score and PSF diagnostic criteria. All the patients were scanned by resting-state functional MRI (rs-fMRI). Precuneus, the posterior node of default-mode network (pDMN), was related to fatigue. Therefore, imaging data were further analyzed by the seed-based resting-state functional connectivity (FC) approach, with the left (PCUN.L) and right precuneus (PCUN.R) being the seeds. ResultsA total of 70 patients with acute ischemic stroke were finally recruited, comprising 40 patients with PSF and 30 patients without PSF. Both the PCUN.L and PCUN.R seeds (pDMN) exhibited decreased FC with the prefrontal lobes located at the anterior part of DMN (aDMN), and the FC values were negatively correlated with FSS scores (both p < 0.001). These two seeds also exhibited increased FC with the right insula, and the FC values were positively correlated with FSS scores (both p < 0.05). ConclusionThe abnormal FC between the aDMN and pDMN was associated with PSF. Besides, the insula, related to interoception, might also play an important role in PSF.

Risk Factors and Clinical Characteristics of First-ever Ischemic Stroke Caused by ICAS with Leukoaraiosis.

Background: Previous studies have mostly investigated the risk factors affecting the occurrence of leukoaraiosis and the risk factors affecting the severity of leukoaraiosis in patients with ischemic stroke, but there are relatively few studies on the risk factors and clinical characteristics affecting the severity of leukoaraiosis in the population with the most common type of first-episode ischemic stroke caused by intracranial atherosclerotic stenosis in China. Methods: We retrospectively studied patients with first-ever ischemic stroke due to intracranial atherosclerotic stenosis. All patients underwent diffusion weight magnetic resonance imaging and adjunctive examinations such as magnetic resonance angiography and/or computed tomography angiography and/or digital subtraction angiography. The characteristics and clinical data were also statistically analyzed. Results: Of the 504 patients enrolled, 176 (34.92%), 202 (40.08%), and 126 (25.00%) patients were in the mild, moderate, and severe groups, respectively, and the patients were older in the severe group compared with the moderate and mild groups (p < 0.05). Hypertension was more severe in the severe group compared with the severe and mild groups (p < 0.05). The time to hospital admission was shorter in the severe group compared with the moderate and mild groups (p < 0.05). The admission National Institutes of Health stroke scale was higher in the severe group than in the moderate and mild groups (p < 0.05). homocysteine, glucose, glycohemoglobin A1c, neutrophil-lymphocyte ratio, and ultrasensitive C-reactive protein to albumin ratio levels were significantly different between the three groups (p < 0.05). There was no significant correlation between the distribution of infarct foci in the anterior and posterior circulation in the three groups (p > 0.05). Conclusion: Age and homocysteine were independent risk factors for leukoaraiosis severity in patients with acute ischemic stroke, and all were positively associated with leukoaraiosis severity. Hypertension, glucose, glycohemoglobin A1c, neutrophil-lymphocyte ratio and ultrasensitive C-reactive protein to albumin ratio levels were highly significant in evaluating the prognosis of patients.

Study of the neutrophil percentage-to-albumin ratio as a biomarker for predicting recurrence of first-episode ischemic stroke

ObjectiveNeutrophils and albumin are associated with recurrence in patients with acute ischemic stroke. The purpose of this study was to evaluate the association between the neutrophil percentage-to-albumin ratio (NPAR) and recurrence in patients with first-episode acute ischemic stroke to identify a more predictive biomarker for ischemic stroke recurrence. MethodsIn this study, the clinical data of patients with first-episode acute ischemic stroke admitted to the Department of Neurology of Shanxi Bethune Hospital from June 2021 to June 2022 were retrospectively collected, and a total of 829 patients who met the inclusion and exclusion criteria were followed up for 3 months. We evaluated the recurrence of patients within 3 months after acute ischemic stroke. Univariable and multivariable analyses were performed to determine the relationship between the NPAR and recurrence within 3 months in patients with AIS. Finally, ROC curves were used to compare the predicted values of albumin, neutrophil percentage, the neutrophil-to-lymphocyte ratio, and the NPAR. ResultsA total of 829 first-episode acute ischemic stroke patients were included. The median NPAR was 1.60 (IQR 1.44-1.79). The percentage of patients with a 3-month recurrence was 6.0 % (50/829). The multivariate analysis showed that the NPAR was independently associated with the risk of recurrence within 3 months in acute ischemic stroke (OR 9.71, 95 % CI: 3.05-31.62, P < 0.001). The optimal cutoff value of the NPAR for predicting recurrence of acute ischemic stroke within 3 months was 1.78, with a sensitivity of 0.80 and a specificity of 0.75. Compared with the NLR, albumin and neutrophil percentage, the NPAR showed the greatest area under the curve (AUC) [0.78 (0.73, 0.83)]. The AUC test showed that the difference in the NPAR and neutrophil-to-lymphocyte ratio (P = 0.019), NPAR and albumin (P = 0.013), and NPAR and neutrophil percentage (P = 0.007) were statistically significant, while the difference between the other two were not statistically significant (P > 0.05). Conclusion1. The recurrence rate within 3 months among patients with a first episode of acute ischemic stroke was 6.0 %.2. The NPAR was independently associated with recurrence within 3 months among patients with a first episode of acute ischemic stroke. Moreover, the NPAR may be a more effective biomarker for predicting recurrence in acute ischemic stroke patients than the albumin level, neutrophil percentage, and neutrophil-to-lymphocyte ratio.

Tele-ultrasound in community with limited resources: The association of hypertension on reduced carotid artery circumferential strain

Introduction: Stroke is one of the leading causes of death worldwide, in majority triggered by modifiable risk factors such as hypertension. AIM: to assess relations between hypertension and carotid arteries radial and circumferential deformation, assessing a population of participants after a first ischemic stroke and healthy controls. Methods: Retrospective study, from 2016 to 2017, with a sample of the PAI project control group, an urban population of the São Francisco Valley in the Northeast of Brazil, 105 people between 40-80 years-old, including patients after a first episode of ischemic stroke in the absence of known cardiovascular disease; and a control group of healthy volunteers, matched by age, sex, and presence of hypertension. Asynchronous analysis was performed by tele-ultrasonography of carotid artery ultrasound with images acquisition of EKG-synchronized videos in cross-section of the common carotid artery bilaterally and then strain values were acquired by Speckle Tracking technique, computing the mean circumferential and radial peaks of both carotids. Univariate and multivariable analyses assessed the association between carotid strain and hypertension. Results: 84 participants had analyzable images (29 patients after a first episode of stroke). The mean age was 60.5 + 11.6 years, 46.5% were women, 70.2% had hypertension. Radial deformation was lower but non-significant in participants with hypertension compared to those without hypertension (-3.13% vs. -3.35%, respectively, p = 0.54). There was significantly less circumferential deformation among participants who had hypertension compared to those without hypertension (4.16% vs. 5.3%, respectively, p = 0.003). Hypertension maintained association with lower circumferential strain in multivariate analysis (coef = -1.13; p = 0.019). Conclusion: hypertension was independently associated with the decrease in the carotid artery circumferential deformation. Tele-ultrasound associated with carotid strain analysis shows promising results for the evaluation of subclinical changes in carotid arteries in populations with limited resources in remote regions such as the Northeast of Brazil.

ASSOCIATION OF DYSLIPIDEMIA AS A RISK FACTOR FOR THE FIRST EPISODE OF ISCHEMIC STROKE

Objective: To determine the frequency and association of dyslipidemia in patients with the first episode of ischem­ic stroke. Methodology: This observational, descriptive study of 126 patients of the first episode of ischemic stroke was conducted in the Medicine department of Lady Reading Hospital Peshawar from August 2020 to March 2021. After approval of the study by the hospital's Ethical Review Board, patients were enrolled by non-probability con­secutive sampling technique. Relevant investigations of the patients were carried out, including fasting serum li­pids and brain scan/MRI. SPSS® version 21 was used for data entry and statistical analysis; a Chi-square p-value &lt;0.05 was considered significant. Results: A total of 126 patients, 70(55.6%) men and 56(44.4%) women with the first-ever ischemic stroke, had a mean age of 54.56 years ±9.74SD. Dyslipidemia was found in 51.6% of patients; 53.8% of men and 46.2% of women, however, the gender difference was insignificant (X2 (df1)=0.159, p=0.690). Among 51.6% of pa­tients with dyslipidemia, hypercholesterolemia was the most common abnormality in 29.4% while raised levels of Low-density lipoproteins-cholesterol (LDL-C) were seen in 7.1% of patients. No significant difference in dyslipi­demia was observed in different age groups (X2 (df3)=2.263, p=0.520). Gender-wise, ischemic stroke occurred significantly in the younger men compared to women (X2(df3)=8.762, p=0.033). Conclusion: The present study concludes that dyslipidemia was not significantly associated with patients with the first episode of ischemic stroke. Ischemic stroke occurred more significantly in younger men compared to women; however, both genders were equally affected in older age.

Relationship between perceptions of recurrence risk and depression state among first-episode ischemic stroke patients in rural areas: The mediating role of coping style.

To investigate the relationship between stroke survivors' perceptions of recurrence risk, coping styles and depression state, and the role coping styles play in mediating that relationship. A cross-sectional descriptive study. From one hospital in Huaxian, China, 320 stroke survivors were randomly selected as a convenience sample. In this research, the Simplified Coping Style Questionnaire, the Patient Health Questionnaire-9 and the Stroke Recurrence Risk Perception Scale were all used. Structural equation modelling and correlation analysis were used to analyse the data. This research followed the EQUATOR and STROBE checklists. There were 278 valid survey responses. There were mild to severe depressive symptoms in 84.8% of stroke survivors. In stroke survivors, there was a significant negative relationship (p< 0.01) between the positive coping of perceptions of recurrence risk and their depression state. Recurrence risk perception's impact on depression state was partly mediated, according to mediation studies, by coping style, with the mediation effect accounting for 44.92% of the overall effect. The connection between perceptions of recurrence risk and depression state was mediated by the coping mechanisms of stroke survivors. A lower degree of depression state among survivors was connected with positive coping to the beliefs of recurrence risk.

Cross sectional descriptive study of clinical and radiological profile of patients presenting with recurrent ischemic stroke in a tertiary care centre of South India

Even with recent advances in the management of ischemic stroke, incidence of recurrence is quite frequent. Identification of risk factors is of prime importance especially during the first episode of ischemic stroke. Imaging in stroke has pivotal role to play in understanding the stroke and also the recurrence risk. Hence we present a study about clinical and radiological profile of recurrent ischemic stroke patients. The study was conducted for a period of five consecutive years with a sample size of 100 patients. It is a cross sectional descriptive study where in data was collected and analysed among various variables necessary. Patients with recurrent ischemic stroke were examined and investigated. Continuous variable is expressed as mean +SD or median (Range) if non- normally distributed. Categorical data is expressed in proportions. Recurrence of the ischemic stroke was commonly seen in the patients with uncontrolled blood pressure, hyperglycemia, dyslipidemia, ischemic heart disease and patients with large artery atherosclerosis. Incidence was higher among male patients, patients above 60 years of age and stroke involving MCA and ACA territories. Identification of the risk factors responsible for the recurrence at the first episode of ischemic stroke and appropriate management are of prime importance. Apart from clinical and biochemical parameters, considering the radiological parameters like extent of stenosis and appropriate dosing and choice of medication also is of utmost importance in preventing the recurrence of stroke.

Cadasil: case report / Cadasil: relato de caso

A 48-year-old patient, male, previously healthy, started migraine with aura at 46 years old of age. After two years, he evolved with the first episode of Ischemic Stroke, with motor and sensory deficit of the left hemibody with partial recovery of symptoms. Stroke protocol and etiological investigation were performed without alterations. Two months later, he presented convulsive crisis requiring the use of medication still for control. It evolved with mild cognitive impairment and depression. Three years later, he had a new episode of stroke, performed Magnetic Resonance Imaging of the Skull, evidencing areas of hypersignal in T2/ FLAIR in the poles of the temporal lobes, also diffusely affecting the supratentorial white substance, with small focal alterations of a means suggestive of small ischemic sequelae, also present in the callous body, deep gray substantial and brainstem, of probable vascular nature. Thus, CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) was suspected, requested genetic testing showing alteration in the DNA sequence of the NOTCH-3 gene, Allelo1: t C transition, nucleotide 514; códon 146; exchange of the amino acid cysteine Arginine. Allelo 2: Transition C G, nucleotide 1272; códon 398; no amino acid exchange, confirming diagnostic suspicion. The patient is monitored in the neurology outpatient clinic with multidisciplinary rehabilitation therapy, secondary prevention treatment for stroke, antidepressant medication and topiramate for migraine treatment.

P-Cresyl Sulfate Predicts Ischemic Stroke among Patients on Hemodialysis: A Prospective Cohort Study.

Method Patients on hemodialysis over 6 months were enrolled in this prospective cohort study and were divided into 2 groups based on plasma p-cresyl sulfate level. The primary end point was the first episode of ischemic stroke during follow-up. The association between p-cresyl sulfate and ischemic stroke incidence was analyzed by Kaplan-Meier method and Cox proportional hazard model. Results 220 patients were enrolled in this study. 44 patients experienced episodes of first ischemic stroke during follow-up for 87.8 (47.6-119.5) months. Kaplan-Meier analysis demonstrated that the incidence of ischemic stroke in the high p-cresyl sulfate group was significantly higher than that in the low p-cresyl sulfate group (Log-Rank P = 0.007). Cox regression analysis as well proved that p-cresyl sulfate level was significantly associated with the first incidence of ischemic stroke (HR (hazard ratio) 2.332, 95% CI (95% confidence interval) 1.236-4.399, P = 0.009). After being adjusted for other confounding risk factors, the results persisted significant (model 11: HR 2.061, 95% CI 1.030-4.125, P = 0.041). Conclusion Plasma p-cresyl sulfate predicts the first incidence of ischemic stroke in hemodialysis patients.

Development and validation of nomograms for predicting stroke recurrence after firstepisode ischemic stroke

To explore the risk factors for recurrence in first-episode ischemic stroke survivors and establish a model for predicting stroke recurrence using a nomogram. We collected the data from a total of 821 first-episode ischemic stroke survivors admitted in the Department of Neurology, West China Hospital, Sichuan University from January, 2010 to December, 2018. R software was used for random sampling of the patients, and 70% of the patients were included in the training set to establish the prediction model and 30% were included in the validation set. Cox proportional risk regression model was used to analyze the factors affecting stroke recurrence, and R software rms package was used to construct the histogram and establish the visual prediction model. C-index and calibration curve were used to evaluate the performance of the model for predicting stroke occurrence. Among the 821 survivors, the recurrence rate was 16.81% at 3 years and 19.98% at 5 years. Multivariate analysis of the training set by Cox regression model showed that an age over 65 years (HR= 2.596, P=0.024), an age of 45-64 years (HR=2.510, P=0.006), a mRS score beyond 3 (HR=2.284, P=0.004) and a history of coronary heart disease (HR=1.353, P=0.034) were all risk factors for stroke recurrence. The C-indexes of the nomogram for the 3-and 5-year relapse prediction model were 0.640 and 0.671, respectively. Age, mRS score and peripheral vascular disease are the factors affecting stroke recurrence in first-episode ischemic stroke survivors, and the nomogram has a high discrimination and predictive power for predicting ischemic stroke recurrence.

Detecting the Early Infarct Core on Non-Contrast CT Images with a Deep Learning Residual Network

PurposeTo explore a new approach mainly based on deep learning residual network (ResNet) to detect infarct cores on non-contrast CT images and improve the accuracy of acute ischemic stroke diagnosis. MethodsWe continuously enrolled magnetic resonance diffusion weighted image (MR-DWI) confirmed first-episode ischemic stroke patients (onset time: less than 9 h) as well as some normal individuals in this study. They all underwent CT plain scan and MR-DWI scan with same scanning range, layer thickness (4 mm) and interlayer spacing (4 mm) (The time interval between two examinations: less than 4 h). Setting MR-DWI as gold standard of infarct core and using deep learning ResNet combined with a maximum a posteriori probability (MAP) model and a post-processing method to detect the infarct core on non-contrast CT images. After that, we use decision curve analysis (DCA) establishing models to analyze the value of this new method in clinical practice. Results116 ischemic stroke patients and 26 normal people were enrolled. 58 patients were allocated into training dataset and 58 were divided into testing dataset along with 26 normal samples. The identification accuracy of our ResNet based approach in detecting the infarct core on non-contrast CT is 75.9%. The DCA shows that this deep learning method is capable of improving the net benefit of ischemic stroke patients. ConclusionsOur deep learning residual network assisted with optimization methods is able to detect early infarct core on non-contrast CT images and has the potential to help physicians improve diagnostic accuracy in acute ischemic stroke patients.

Clinical risk factors associated with recurrence of ischemic stroke within two years: A cohort study.

To identify the clinical risk factors and investigate the efficacy of a classification model based on the identified factors for predicting 2-year recurrence after ischemic stroke.From June 2017 to January 2019, 358 patients with first-ever ischemic stroke were enrolled and followed up in Shenzhen Traditional Chinese Medicine Hospital. Demographic and clinical characteristics were recorded by trained medical staff. The outcome was defined as recurrence within 2 years. A multivariate logistic regression model with risk factors and their interaction effects was established and evaluated.The mean (standard deviation) age of the participants was 61.6 (12.1) years, and 101 (28.2%) of the 358 patients were female. The common comorbidities included hypertension (286 patients, 79.9%), diabetes (148 patients, 41.3%), and hyperlipidemia (149 patients, 41.6%). The 2-year recurrence rate was 30.7%. Of the 23 potential risk factors, 10 were significantly different between recurrent and non-recurrent subjects in the univariate analysis. A multivariate logistic regression model was developed based on 10 risk factors. The significant variables include diabetes mellitus, smoking status, peripheral artery disease, hypercoagulable state, depression, 24 h minimum systolic blood pressure, 24 h maximum diastolic blood pressure, age, family history of stroke, NIHSS score status. The area under the receiver operating characteristic curve (ROC) was 0.78 (95% confidence interval: 0.726–0.829) with a sensitivity of 0.61 and a specificity of 0.81, indicating a potential predictive ability.Ten risk factors were identified, and an effective classification model was built. This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction.The clinical trial registration number: ChiCTR1800019647

Increased interleukin-18 level contributes to the development and severity of ischemic stroke.

Although interleukin-18 (IL-18) has been implicated in the pathophysiology of stroke, research findings concerning IL-18 level in stroke have been inconsistent. Thus, we performed a cross-sectional study in patients with first-episode ischemic stroke and then extracted relevant data from databases to validate our results. A total of 252 patients and 259 healthy subjects were recruited, and serum IL-18 level was evaluated in a cross-sectional study. Then, we extracted data and conducted a meta-analysis, including 2,928 patients and 3,739 controls to support our results. A 95% confidence interval for standardized mean difference (SMD) was calculated using a Z test. We found IL-18 was higher in stroke patients than in controls (2.39 ± 0.25 vs. 2.25 ± 0.28, F=8.60, p=0.004) and was negatively associated with the NIHSS scale (r = -0.14, p=0.028). A subsequent meta-analysis confirmed that IL-18 level was higher in stroke patients than in controls (SMD = 2.14, 95% CI = 1.54 ∼ 2.73, P< 0.001). IL-18 level increased with the severity of the stroke (p< 0.01). These findings revealed increased IL-18 level contributed to the development and severity of ischemic stroke, suggesting the potential of this biomarker to become an important reference for the early monitoring of ischemic stroke.

Biomarkers levels and brachial and central blood pressure during the subacute phase of lacunar stroke and other ischemic stroke subtypes.

We aimed to evaluate brachial and central blood pressure (BP) estimates and biomarker levels in lacunar ischemic stroke (IS) and other IS subtypes (nonlacunar stroke). We studied 70 functionally independent subjects consecutively admitted to our institution after a first episode of IS. Subjects with previous heart failure were excluded. BP was measured at admission and during the subacute phase of stroke (5-7 days after stroke onset). Aortic pulse wave velocity (aPWV), augmentation index (AIx), and 24 h brachial and central BP (24h-ABPM) were measured by means of a Mobil-O-Graph device during the subacute phase of stroke. Determination of N-terminal prohormone of brain natriuretic peptide (NT-proBNP), urinary albumin excretion, and echocardiography were performed in all subjects. After adjusting for age and clinical severity, lacunar IS had significantly higher levels of BP at admission (systolic BP 173 ± 37 vs 153 ± 28 mmHg, p = 0.006; diastolic BP: 97 ± 21 vs 86 ± 16 mmHg, p = 0.035) and during the subacute phase of stroke (systolic BP 152 ± 23 vs 134 ± 19 mmHg, p = 0.001; diastolic BP: 84 ± 14 and 77 ± 10 mmHg, respectively; p = 0.038) but lower NT-proBNP levels (median: 36,277 vs 274 pg/mL, p = 0.009) than nonlacunar IS. Central BP, aPWV, and AIx were not different between lacunar and nonlacunar IS, neither the rate of target organ damage. In conclusion, patients with a first episode of lacunar IS have higher BP values at admission and during the subacute phase of stroke and lower levels of NT-proBNP, suggesting a closer relationship with hypertension of this IS subtype.

Resilience and its correlates among first ischemic stroke survivors at acute stage of hospitalization from a tertiary hospital in China：a cross-sectional study

Objectives: To measure the resilience of elderly patients with first ischemic stroke in mainland China and to identify variables that may be correlated with resilience at the acute stage of hospitalization.Methods: A cross-sectional survey was carried out in departments of neurology of two tertiary hospitals, where a convenience sample of one hundred and forty-seven elderly patients with first ischemic stroke voluntarily participated in our study. Resilience was assessed using the Chinese version of Connor-Davidson Resilience Scale with three dimensions (tenacity, strength, and optimism). The General Self-Efficacy Scale and Medical Coping Modes Questionnaire were applied to evaluate the respondents’ general self-efficacy and coping style. Functional independency was also measured using the Functional Independency Measure.Results: The mean score of the 147 respondents’ resilience was 62.51 ± 14.69. Together, general self-efficacy, resignation, confrontation, per capital monthly income, and being main source of family income explained 68.1% of the variance in resilience. General self-efficacy, resignation, and confrontation were the strongest explanatory factors. Specifically, 63.4% of the variance in tenacity was explained for general self-efficacy, resignation, being main source of family income, surgical history, and per capital monthly income. 63.2% of the variance in strength was ascribed to general self-efficacy, resignation, per capital monthly income and avoidance. 32.5% of the variance in optimism was attributed to general self-efficacy, religion, and resignation.Conclusion: General self-efficacy and coping style may be implied orientation in enhancing resilience of elderly patients with first ischemic stroke at acute hospitalization. Moreover, economic status may predict level of resilience.HighlightsResilience was measured in 147 older first-episode ischemic stroke survivors at acute hospitalization.General-efficacy was the strongest predictor of resilience.Resilience was significantly influenced by resignation.Coping strategy should be emphasized early after stroke.

Asymptomatic Coronary Artery Disease in Japanese Patients With the Acute Ischemic Stroke

ObjectiveTo investigate the prevalence and outcomes of asymptomatic coronary artery disease (CAD) in patients with the first episode of ischemic stroke. MethodsPatients admitted to our hospital between November 2001 and January 2009 for the episode of an acute ischemic stroke/transient ischemic attack were included. Stress-Tl-201 scintigraphy was performed and followed by coronary angiography (CAG). The prevalence and risks for asymptomatic CAD, and long-term outcomes were studied. ResultsOf 1309 patients, only 15 (1.1%) patients presented with a history of CAD. Excluding 406 patients because of severity, systemic infection, early transfer to another hospital, or a refusal to participate, myocardial scintigraphy was performed in 903 patients (mean age, 72 ± 10 years, male 63.9%), and myocardial ischemia was diagnosed in 214 patients (23.7%). Of these patients, 76 patients underwent CAG, and showed significant stenosis (>75%) of a coronary artery in 61 (80.3%) patients. The risk factors for positive scintigraphy findings and CAG were high-grade premature complexes via Holter monitoring (P < .0001), enlarged left ventricle (P = .0051) and wall motion abnormalities (P = .0014) observed on echocardiography, and carotid artery stenosis observed in magnetic resonance angiography imaging (P < .0001). During the follow-up periods of 83 ± 47 months and of 91 ± 47 months, 17.2% of scintigraphy-positive and 2.8% of scintigraphy-negative patients developed episodes of myocardial ischemia, respectively (P < .001). ConclusionsSymptomatic CAD was rare in Japanese patients with the first episode of ischemic stroke, but asymptomatic CAD was identified by stress Tl-201 myocardial scintigraphy in one-quarter of the patients. Positive scintigraphy was associated with asymptomatic CAD and future cardiac events.

Reversed ophthalmic artery flow following ischemic stroke: a possible predictor of outcomes following carotid artery stenting

ABSTRACTStroke is the leading cause of death worldwide and stenosis of the carotid artery accounts for more than half of all cases. Carotid duplex is an effective non-invasive ultrasound test which identifies stroke patients with moderate to severe carotid stenosis who are candidates for preventative intervention to reduce the risk of recurrence.In patients with moderate to severe carotid stenosis, reversed ophthalmic artery flow (ROAF) is often observed at the time of the carotid duplex scan. In this study, we investigated whether ROAF, denoting exhaustion of cerebral collateral flow in ischemic stroke patients affected mid-term functional outcomes following carotid artery stenting (CAS) procedures.In total, 144 consecutive patients with a first episode of ischemic stroke and subsequent CAS procedure conducted between January 2010 and November 2014 at Changhua Christian Hospital, Taiwan were included. Clinical data were obtained by medical record review. Disability was assessed at two time points by utilising the Barthel Index (BI) and modified Rankin Scale (mRS) before CAS and 12 months post-CAS.Among 85 patients presenting without ROAF, 48/85 (56.4%) had improved mRS scores following stenting. The condition remained unchanged (stationary) in 36/85 (43.5%) patients after stenting and one patient exhibited deteriorated condition 1/85(1.1%).In contrast, among the 59 patients presenting with ROAF, 24/59 (40.6%) had improved mRS score following stenting. The condition remained unchanged (stationary) in the remaining 35/59 (59.3%) patients after stenting, and no patient exhibited deteriorated condition 0/59 (0 %).This study provides evidence that CAS is a valid and effective treatment option regardless of whether patients exhibited ROAF or not. Patients without ROAF were significantly more likely to have improved mid-term functional outcomes compared to those with ROAF. In the group without ROAF admission, CRP may play a role in predicting subsequent functional outcomes, whereas admission Barthel Index was a predictor of outcome in the ROAF group.

DIFFERENCES IN BIOMARKERS LEVELS AND BRACHIAL AND CENTRAL BLOOD PRESSURE DURING THE ACUTE PHASE OF STROKE BETWEEN LACUNAR AND OTHER ISCHEMIC STROKES SUBTYPES

Objective: We aimed to evaluate the differences in biomarker levels and brachial and central blood pressure estimates during the acute and subacute phase of stroke, between lacunar infarcts and other ischemic stroke subtypes. Design and method: Patients > 18 years old, with a first episode of ischemic stroke, admitted to our institution between July 2015 and July 2017 were consecutively included. Subjects with Rankin > 2 and patients with history of previous heart failure were excluded. Blood pressure (BP) was measured at admission and during the acute phase of stroke. Determination of proBNP, urinary albumin excretion (UAE) and an echocardiographic study were performed in all subjects. The aortic pulse wave velocity (aPWV) and 24 h brachial and central BP (24h-ABPM) were measured by means of Mobil-O-Graph device during the subacute phase of stroke. Results: 71 subjects with a first episode of ischemic stroke were included, mean age: 64.7 ± 13.9 years, 62% men: 22 lacunar stroke (31%), and 49 cases (69%) with non lacunar ischemic stroke. The levels of proBNP were significantly lower in patients with lacunar stroke as compared as atherothrombotic and cardioembolic stroke (median: 36, 277 and 274 pg/mL, respectively; p = 0.009). After adjusting for age, patients with lacunar stroke had significantly higher levels of BP in the emergency department: systolic BP 173 ± 37 vs 153 ± 28 mm Hg respectively; p = 0.006, diastolic BP: 97 ± 21 vs 86 ± 16 mm Hg; p = 0.035, and during the acute phase of stroke: systolic BP 142 ± 19 vs 128 ± 16 mm Hg; p = 0.002; diastolic BP: 79 ± 12 and 73 ± 12 mm Hg respectively; p = 0.025. Regarding 24h-ABPM, patients with lacunar stroke showed higher values of daytime pulse pressure, daytime brachial systolic BP, daytime brachial diastolic BP and central BP estimates, after adjusting for age. No significant differences were observed in target organ damage between the different ischemic stroke subtypes. Conclusions: Patients with a first episode of lacunar stroke had lower levels of proBNP and higher BP levels during acute and subacute phase of stroke, suggesting a closer relationship with hypertension.

Incidence of aphasia in patients experiencing an ischemic stroke

Sequelae after a stroke are common and may lead to disability. Aphasia - defined as an acquired language disturbance - can cause important limitations in quality of life. To describe the epidemiological features of patients who had an aphasia after a first episode of ischemic stroke and their functional outcome at six months. Review of a database of a population study on the incidence, 30-day case fatality rate, and prognosis of stroke performed in a northern Chilean city between 2000 and 2002. Aphasia was diagnosed in 28 of 142 patients in whom the disorder was sought (20%). The projected incidence rate in the city where the study was carried out is 7.06 per 100,000 inhabitants. The mean age of these 28 patients was 66 ± 20 years and 53% were women. The main risk factor for stroke was hypertension in 62%. The etiology of stroke was undetermined in 64% of these patients. Partial anterior circulation infarction was the most common stroke location in 61%. Twenty percent of patients with a first episode of ischemic stroke have aphasia.