First-ever Acute Ischemic Stroke Patients Research Articles

Advanced Coronary Artery Calcification Is Associated with Ischemic Stroke

Background: Coronary artery calcification (CAC) is widely accepted as a quantitative index of subclinical atherosclerosis in the coronary artery, and is utilized as a valuable tool for the global risk assessment of cardiovascular events in individuals at intermediate risk. However, the association between CAC and ischemic stroke has not been evaluated. Methods: CAC scores were measured in 401 consecutive first-ever acute ischemic stroke patients and in 5,420 healthy subjects who underwent detailed medical health screening. The authors randomly matched case:referent sets (1:2) for gender, age, hypertension, diabetes and hyperlipidemia. Accordingly, 290 stroke cases were matched with 580 referent controls. Results: Moderate-to-extensive CAC (CAC ≧100) was detected in 78 (26.9%) of the ischemic stroke cases and in 120 (20.7%) of the referent controls. Conditional logistic regression analysis, which was conducted to investigate the association between categorized CAC scores and ischemic stroke, and adjusted for other relevant confounders, revealed that moderate-to-extensive CAC was associated with the occurrence of ischemic stroke (OR 1.72, 95% CI 1.05–2.80, compared to the subjects with no CAC). The mean ± SE of the AUC-ROC curve for Framingham risk score (FRS) plus CAC score (0.760 ± 0.018) was significantly greater than that of FRS alone (0.748 ± 0.018; p = 0.005). Conclusions: Our results demonstrate that moderate-to-extensive CAC is associated with an increased occurrence of ischemic stroke. In view of the contribution made by CAC to the risk assessment of cardiovascular diseases, the CAC score may be utilized to evaluate the risk of ischemic stroke.

Statin therapy after first stroke reduces 10-year stroke recurrence and improves survival

To determine whether statin therapy after hospital discharge affects ischemic stroke recurrence and long-term mortality in patients admitted for a first-ever occurrence of ischemic stroke. This was a retrospective observational study involving linked hospitalization and death records. The cohort comprised a series of 794 consecutive, first-ever acute ischemic stroke patients from the Athenian Stroke Registry, admitted to the acute stroke unit and the general medicine and neurology ward of our institutions since January 1997 for whom there was available information covering a 10-year follow-up period. Cox proportional hazards model was used to identify risk factors for stroke recurrence and death. The recurrence rate was 16.3% among stroke patients not receiving a statin after hospital discharge compared with 7.5% among those who received statin therapy (p = 0.002). Cox regression analyses revealed only statin therapy postdischarge to be a significant independent predictor of stroke recurrence (adjusted hazard ratio [HR], 0.65, 95% confidence interval [CI] 0.39 to 0.97, p < 0.01). Similarly, patients receiving a statin had a significantly lower mortality during the 10-year period after the acute cerebrovascular event (adjusted HR, 0.43; 95% CI 0.29 to 0.61, p < 0.01). Prescribing statin therapy upon hospital discharge to patients with first-ever acute stroke lowers the risk of 10-year stroke recurrence and improves survival.

Effect Of Admission Hyperglycaemia On Short-Term Outcome In Adult Nigerians With A First Acute Ischaemic Stroke

Background There is no information from a prospective study on the relationship between admission hyperglycaemia and stroke outcome in Nigerians. This study was designed to determine the impact of admission hyperglycaemia on short-term stroke outcome (case fatality rate and functional outcome) in adult Nigerians with acute ischaemic stroke. Methods 100 consecutively attending first-ever acute ischemic stroke patients attending our tertiary facility within 72 hours of stroke onset were recruited. Stroke severity on the NIHSS and random blood glucose levels were documented on admission. The outcome measures (case fatality rate and functional status on the NIHSS in survivors) were assessed at 30 days from stroke onset. Results The frequency of admission hyperglycaemia (random blood glucose &#8805;140mg/dL) was 34%. Baseline stroke severity on the NIHSS was worse in hyperglycaemic patients (median NIHSS 14) compared to normoglycaemic patients (median NIHSS 8). The 30-day case fatality rate was significantly higher in hyperglycaemic compared to normoglycaemic patients (41.2% vs. 21.2%, p

Vocal Cord Paresis in Acute Ischemic Stroke

We prospectively determined the frequency of vocal cord paresis (VCP) among first-ever acute ischemic stroke patients. Vocal cords were examined endoscopically within 48 h of stroke onset, at 1 week and 1 month. Of the 54 study patients, 64.8% had lacunar (group 1), 22.2% cortical/large subcortical (group 2), 9.3% lateral medulla (group 3) and 3.7% other brainstem (group 4) infarcts. VCP was found in 11 (20.4%): 11.4% of group 1, 16.4% of group 2, 100% of group 3 and 0% of group 4. VCP was contralateral to the brain lesion in groups 1 and 2, and ipsilateral in 80% of group 3. VCP was strongly correlated with dysphonia (p < 0.0001) and resolved in 2/11 patients after 1 week and in 5/11 after 1 month. Our finding of VCP among acute ischemic stroke patients questions the belief that the nucleus ambiguous is invariably bilaterally innervated by supranuclear centers.