Hemorrhagic Stroke Research Articles

Protective effects of flavonoids against intracerebral and subarachnoid hemorrhage (Review).

Intracerebral hemorrhage (ICH), known as non-traumatic cerebrovascular rupture and hemorrhage, often occurs in the deep basal brain segment. It is known for its high morbidity and mortality rates. Subarachnoid hemorrhage (SAH) is a clinical syndrome caused by the rupture of blood vessels at the base or surface of the brain that allows blood to flow directly into the subarachnoid space. It progresses quickly and typically manifests at younger ages compared with ICH. ICH and SAH are both devastating events in the category of hemorrhagic strokes and are attracting increasing attention from researchers. Flavonoids, being important natural molecules, have remarkable anti-inflammatory and antioxidant effects. Flavonoids have extensive biological activities in inflammation and oxidative stress (OS), and have protective effects in vascular function associated with cerebrovascular diseases. They have an impact on the onset of ICH and SAH by targeting various pathways, including the suppression of inflammation and OS. Recently, the role of flavonoid compounds in ICH and SAH has also received increasing interest. Thus, to serve as a resource for the prevention and treatment of ICH and SAH, the present review provided an overview of the research on flavonoid compounds in the prevention of brain damage after these two conditions have occurred.

Relationship between the Injury Location and Swallowing Difficulty among Stroke Patients, A Retrospective Cohort Study

Post-stroke dysphagia (PSD), a neurological or mechanical disorder that hinders food transport from the oral cavity to the stomach. It has been widely associated with severe complications with higher mortality and morbidity rates. Traditional therapies for the treatment of dysphagia mainly focused on compensatory methods and behavioural rehabilitation approaches. The retrospective cohort study aimed to determine the association and correlation between developments of dysphagia in relation to the location of the stroke and to identify the swallowing recovery period following the stroke. A retrospective cohort study investigated swallowing difficulties in 64 stroke patients at an ambulatory care centre over a year. Data collection involved reviewing medical records and imaging reports, with analyses conducted using SPSS software, ANOVA and chi-square methods to assess associations between injury location and swallowing difficulty. Hemorrhagic stroke was more prevalent (65.6%) than ischemic stroke (34.4%). A significant association was found between gender and stroke type, with males exhibiting a higher prevalence of ischemic strokes (71.4%) compared to females (29.8%). Age differences between stroke types, gender and affected swallowing phases and stroke type and affected swallowing phase revealed no significant associations. Distinct differences were noted in swallowing difficulties across stroke types. Furthermore, recovery time varied depending on the intervention method, with speech therapy linked to shorter recovery periods. The study underscores the importance of considering gender and stroke-type-specific differences in stroke prevalence, age distribution, and swallowing difficulties. These findings contribute valuable insights to understanding stroke characteristics and their implications for clinical management and rehabilitation strategies.

Cerebral Small Vessel Disease in Children and Adolescents with Type 1 Diabetes Presenting with Diabetic Ketoacidosis during COVID-19 Era

Abstract Aim Cerebrovascular insult (CVI) is a known and significant morbidity of diabetic ketoacidosis (DKA); yet, its prevalence is underestimated. Untreated cerebral hypoperfusion in DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. This study assesses the cerebral perfusion status among children and adolescents with DKA during and after the resolution of DKA. Methodology Forty children and adolescents with type 1 diabetes mellitus (T1DM) presenting with DKA were assessed for severity of DKA, diabetes-duration, insulin therapy, Rappaport coma/ Near coma scale, Rancho los amigos levels of cognitive functioning scale, glycated-hemoglobin (HbA1c), D-dimer, INR and brain magnetic resonance imaging (MRI) during DKA and repeated neuro cognitive scoring, laboratory and MRI after resolution of the DKA. Results The mean age of the children and adolescents with T1DM presenting with DKA was 11.40 ± 2.82 years; their median diabetes-duration was 3 year; their mean HbA1c was 13.54 ± 2%. There was significant increase in platelet (P = 0.005), D-dimer (P < 0.001), Creatinine (P < 0.001) and Pulse wave velocity (P = 0.004) during attack of DKA while there was significance decrease in Apparent diffusion coefficient (P < 0.001). There was 30% of children and adolescents with T1DM had ischemic MRI changes during DKA. In children and adolescent with ischemic changes there was significant increase in severity of DKA (P = 0.003), HbA1c (P = 0.016), INR (P = 0.002), D-dimer (P < 0.001), Creatinine (P = 0.003). Conclusion Significant cerebral hypoperfusion occur during the DKA which is correlated with the DKA severity and D-dimer levels.

Prognostic Value of Prolonged QT Interval in Patients with Acute Ischemic Stroke

Abstract Background Early predictors of mortality and poor functional outcome are crucial for planning the level of care and optimizing resource utilization. Nonetheless, rapid and noninvasive methods for assessing the prognosis of patients with acute hemorrhagic stroke in the emergency department (ED) are currently lacking. Aim of the Work The aim of this work is to assess and evaluate the QT- prolongation in patients with acute stroke without known cardiac disease and to correlate between prolonged QT interval and different neurological outcomes. Patients and Methods This was a case control study. Data from patients with acute ischemic stroke (stroke patients) who were admitted to the neurological intensive care unit were collected for the period from June 2021 to December 2021 at the First Affiliated Ahmad Maher teaching hospital, and patients in other departments were enrolled as controls. Results This study had several limitations. First, the study was performed in a single center, which may reduce its generalizability. In addition, we were unable to determine non-fatal long-term outcomes, such as major adverse cerebro-cardiovascular events (MACCE). Second, the mechanism underlying QTc interval prolongation remains tentative because ECG was performed at single time points, not overtime. Furthermore, major cardiac and non-cardiac comorbidities were defined as the previous history and/or ECG results at admission, thus possibly underestimating subclinical conditions. In addition, the contribution of each cardiac and non-cardiac condition to QTc interval prolongation is not equally the same. We also could not absolutely exclude patients with coronary artery disease who shared similar risk factors because we did not conduct echocardiography or coronary angiography, and this may have affected the QTc interval changes in ECG. Conclusion Prolonged QTc interval was associated with the increased risk of long-term mortality, in parallel with the increasing trend of the prevalence of cardiovascular risk profiles and stroke severity, across sex differences, such as different distributions of age, comorbidities, morality, and QTc intervals in AIS patients. Acute ischemic stroke patients may have a longer QT interval and a higher incidence of electrocardiogram abnormalities. In clinical practice, careful attention should be paid to acute ischemic stroke patients to prevent malignant arrhythmia.

Early Menarche as a Protective Factor Against Cardiovascular Events: A Systematic Review and Meta-analysis.

Women are often neglected in cardiovascular health prevention. Age at menarche (AAM) has been linked to cardiovascular (CVD) disease in women and is potentially identified as one of the significant CVD risk factor. However, there is still limited comprehensive evidence addressing this issue. This systematic review and meta-analysis aimed to investigate how early menarche affects the outcome of all-cause mortality, CVD mortality, total cardiovascular disease event, stroke (ischemic, hemorrhagic, and total stroke), and coronary heart disease (CHD). The Cochrane Library, MEDLINE, Embase, ScienceDirect, and Google Scholar databases were searched from March 2013 to March 2023 for cohorts investigating the effect of early onset of menarche on CVD events with a minimum follow-up period of 5 years. Studies that observed specific population and/or included women with a history of CVD at baseline were excluded. The Newcastle-Ottawa scale was used for risk of bias assessment for each cohort included. The data were presented as dichotomous measure using risk ratios. I2 statistics were utilized to evaluate the heterogeneity of presented data. Thirteen cohorts included 18 626 799 female patients with ages ranging from 43 to 62.6 years. These reported 6 estimates each for CHD (5 483 298 patients) and all-cause mortality (1 595 878 patients), 5 estimates each for total stroke (2 941 321 patients) and CVD mortality (1 706 742 patients), 4 estimates each for total CVD events (3 988 311 patients) and ischemic stroke (2 434 580 patients), and 1 estimate for hemorrhagic stroke (66 104 patients). Our study found that events of CHD were significantly lower in early menarche (RR 0.57; 95% CI 0.41-0.78; P <.00001), as well as total stroke (RR 0.51; 95% CI 0.35-0.73; P =.0003), CVD mortality (RR 0.47; 95% CI 0.22-0.98; P =.04), total CVD events (RR 0.44; 95% CI 0.25-0.76; P =.003), ischemic stroke (RR 0.31; 95% CI 0.15-0.61; P <.0008), and hemorrhagic stroke (RR 0.12; 95% CI 0.07-0.20; P <.00001); and insignificantly higher in all-cause mortality (RR 0.90, 95% CI 0.76-1.06, P =.20). In our study, cardiovascular events are lower in women with early menarche; hence, the later age of menarche is a potential risk factor to be considered when assessing CVD risk in a patient. However, our sample characteristics were heterogenous, and we did not consider other female hormonal factors that might potentially contribute to the CVD outcomes observed; thus, further studies are needed to clarify.

The Aggregate Index of Systemic Inflammation as a Predictor of Mortality in Stroke Patients.

Background and objectives Stroke, a leading cause of mortality and disability, involves significant inflammation both before and after onset. This study investigates the relationship between the aggregate index of systemic inflammation (AISI) and mortality in stroke patients. The objective is to determine if AISI, an easily accessible biomarker, can predict stroke prognosis. Materials and methods In this retrospective study, the medical records of patients who presented to Harran University Neurology Clinic between January 2018 and September 2023 were reviewed. A total of 200 patients, 106 of whom were diagnosed as having an ischaemic stroke and 94 of whom were diagnosed as having a haemorrhagic stroke, were included in the study. A control group was also formed, which consisted of 100 people of similar age and sex with the patient group. The controls had neither chronic disease nor chronic drug use. Using biochemical and full blood count parameters, neutrophil-to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), monocyte to lymphocyte ratio (MLR), neutrophil to high-density cholesterol ratio (NHR), monocyte to high-density cholesterol ratio, systemic immune inflammation index (SII), systematic immune response index (SIRI) and the AISIwere calculated for all patients and the control group. Results A comparison of the two groups revealed significantly higher NLR, NHR, PLR, LMR, MLR, SII, SIRI and AISI values compared with the controls. NLR, PLR, SII, SIRI and AISI values were significantly higher in haemorrhagic stroke than in ischaemic stroke. Elevated NLR level and SII were correlated to mortality (respectively p:0.000, p = 0.017). SIRI (p = 0.189) and AISI (p = 0.162) were not correlated to mortality. However, receiver operating characteristic curve analysis determined that mortality increased for patients with AISI values above 507.45 (p = 0.003). Conclusions The AISI was found to be high among stroke patients, especially in haemorrhagic strokes. A relationship was observed between the increase in AISI above a certain value and mortality. The AISI is an accessible biomarker that shows inflammation in stroke patients. Therefore, it can be used to predict the prognosis of stroke.

Unravelling the Role of Plasma Fibrinogen in Acute Stroke

Background: A stroke is described as a sudden neurological deficit with a focused vascular origin. Atrial fibrillation, carotid stenosis, myocardial infarction, hypertension, diabetes, hyperlipidaemia, obesity, smoking and atrial myxomas are all risk factors for stroke. Stroke mortality in urban India accounts for 1% of all hospital admissions, 4% of all medical cases, and around 20% of all central nervous system illnesses. Diabetes, hypertension, smoking, and hyperlipidaemia are risk factors for stroke and have been linked to alterations in haematology and coagulation, including elevated fibrinogen levels. Methodology: The present case-control study was conducted among 50 cases of acute stroke and 50 controls without stroke history. Plasma fibrinogen of 50 consecutive patients with acute stroke presenting to the OPD/Casualty or getting admitted to Shri Ram Murti Smark Institute of Medical Sciences was compared with 50 controls who is not suffering from stroke. An unpaired t-test was applied to compare the mean fibrinogen level of the two groups. For statistical significance p value less than 0.05 was taken with 95% confidence interval. Result: fibrinogen level among the control group (267.0±98) was low compared to patients with overall stroke (428.8±97.8), either ischemic (470±80.5) or haemorrhagic stroke (387.6±97.6). Conclusion: Patients with Ischemic Stroke having a mean Fibrinogen level of (508.8 mg/dL ± 74.6) and haemorrhagic stroke with 487.5±66 mean fibrinogen level had the worst outcome. There was a significant difference in mean fibrinogen levels among survival and non-survival groups of patients in ischemic and haemorrhagic stroke.

Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis.

Extreme temperatures contribute significantly to global mortality. While previous studies on temperature and stroke-specific outcomes presented conflicting results, these studies were predominantly limited to single-city or single-country analyses. Their findings are difficult to synthesize due to variations in methodologies and exposure definitions. Within the Multi-Country Multi-City Network, we built a new mortality database for ischemic and hemorrhagic stroke. Applying a unified analysis protocol, we conducted a multinational case-crossover study on the relationship between extreme temperatures and stroke. In the first stage, we fitted a conditional quasi-Poisson regression for daily mortality counts with distributed lag nonlinear models for temperature exposure separately for each city. In the second stage, the cumulative risk from each city was pooled using mixed-effect meta-analyses, accounting for clustering of cities with similar features. We compared temperature-stroke associations across country-level gross domestic product per capita. We computed excess deaths in each city that are attributable to the 2.5% hottest and coldest of days based on each city's temperature distribution. We collected data for a total of 3 443 969 ischemic strokes and 2 454 267 hemorrhagic stroke deaths from 522 cities in 25 countries. For every 1000 ischemic stroke deaths, we found that extreme cold and hot days contributed 9.1 (95% empirical CI, 8.6-9.4) and 2.2 (95% empirical CI, 1.9-2.4) excess deaths, respectively. For every 1000 hemorrhagic stroke deaths, extreme cold and hot days contributed 11.2 (95% empirical CI, 10.9-11.4) and 0.7 (95% empirical CI, 0.5-0.8) excess deaths, respectively. We found that countries with low gross domestic product per capita were at higher risk of heat-related hemorrhagic stroke mortality than countries with high gross domestic product per capita (P=0.02). Both extreme cold and hot temperatures are associated with an increased risk of dying from ischemic and hemorrhagic strokes. As climate change continues to exacerbate these extreme temperatures, interventional strategies are needed to mitigate impacts on stroke mortality, particularly in low-income countries.

Long‐Term Hemorrhagic Morbidity for Children With Moyamoya Treated With Revascularization Surgery in a Single Center Retrospective Cohort

Background Children with moyamoya arteriopathy have reduced subsequent ischemic risk after revascularization surgery and it is also suggested that hemorrhagic risk may also be reduced by minimizing hemodynamic stress on collateral vasculature recruited within the brain parenchyma, but this has been studied only in intermediate follow‐up or follow‐up for more than a decade in East Asian populations. We aimed to evaluate the incidence of hemorrhagic stroke in long‐term follow‐up and identify at‐risk subpopulations. Methods A single surgeon's personal case series with decades of follow‐up was reviewed for children (18 years or younger) treated with revascularization surgery. This included medical records and the surgeon's personal correspondence. Results Hemorrhagic stroke occurred in 2.6% of 302 children followed for a median of 21 years after surgery. Occurring at a median of 19 years (interquartile range 14–22.75) after surgery, these hemorrhages would not be recognized in series that discontinue follow‐up at transition from pediatric to adult neurosurgical care. There was a higher proportion (5.5‐fold hazard, 95% CI, 1.1–27.6) of patients who had prior radiation therapy in the group with hemorrhagic stroke compared with the overall group. Close retrospective evaluation of vascular imaging suggests aneurysms of the collateral periventricular vessels as a common culprit. Conclusion Children who have moyamoya treated with revascularization surgery remain at long‐term risk of hemorrhagic stroke during adulthood, even though their ischemic stroke risk is significantly mitigated. These patients would benefit from continued clinical and radiological follow‐up, potentially with advanced imaging modalities.

Relationship between coagulopathy score and ICU mortality: Analysis of the MIMIC-IV database

ObjectiveCoagulopathy score has been applied as a new prognostic indicator for sepsis, heart failure and acute respiratory failure. However, its ability to forecast intensive care unit (ICU) mortality in patients with an acute cerebral hemorrhage (ICH) has not been assessed. The purpose of this study was to clarify the relationship between ICU mortality and early coagulation problem score. MethodsData from the Medical Information Mart for Intensive Care (MIMIC-IV) (v2.0) database were used in this retrospective cohort analysis. The association between the coagulation disorder score and ICU mortality was examined using multivariate logistic regression. Furthermore, the impact of additional variables on the results was investigated by a subgroup analysis. Results3174 patients (57.3 % male) were enrolled in total. The ICU mortality reached 18.2 %. After adjusting for potential confounders, the ICU mortality of patients rose with the increase of coagulation disorder score. The ROC curve revealed the predictive accuracy of coagulation dysfunction score to mortality in patients with ICU. The coagulation disorder score had a lower AUC value (0.601, P < 0.001) than the SAPSII(AUCs of 0.745[95 % CI, 0.730–0.761]) and the combined indicators(AUCs of 0.752[95 % CI, 0.737–0.767]), but larger than single indicators platelet, INR and APTT. In the subgroup analysis, most subgroups showed no significant interaction, but only age showed significant interaction in the adjusted model. ConclusionThe coagulopathy score and ICU mortality were found to be strongly positively correlated in this study, and its ability to predict ICU mortality was better than that of a single measure (platelet, INR, or APTT), but worse than that of the SAPSII score, GCS system.

The neuroprotective effects of normobaric oxygen therapy after stroke.

Stroke, including ischemic and hemorrhagic stroke, is a severe and prevalent acute cerebrovascular disease. The development of hypoxia following stroke can trigger a cascade of pathological events, including mitochondrial dysfunction, energy deficiency, oxidative stress, neuroinflammation, and excitotoxicity, all of which are often associated with unfavorable prognosis. Nonetheless, a noninvasive intervention, referred to as normobaric hyperoxia (NBO), is known to have neuroprotective effects against stroke. NBO can exert neuroprotective effects through various mechanisms, such as the rescue of hypoxic tissues, preservation of the blood-brain barrier, reduction of brain edema, alleviation of neuroinflammation, improvement of mitochondrial function, mitigation of oxidative stress, reduction of excitotoxicity, and inhibition of apoptosis. These mechanisms may help improve the prognosis of stroke patients. This review summarizes the mechanism by which hypoxia causes brain injury and how NBO can act as a neuroprotective therapy to treat stroke. We conclude that NBO has significant potential for treating stroke and may represent a novel therapeutic strategy.

Remote ischemic conditioning prevents ischemic cerebrovascular events in children with moyamoya disease: a randomized controlled trial.

Moyamoya disease (MMD) is a significant cause of childhood stroke and transient ischemic attacks (TIAs). This study aimed to assess the safety and efficacy of remote ischemic conditioning (RIC) in children with MMD. In a single-center pilot study, 46 MMD patients aged 4 to 14years, with no history of reconstructive surgery, were randomly assigned to receive either RIC or sham RIC treatment twice daily for a year. The primary outcome measured was the cumulative incidence of major adverse cerebrovascular events (MACEs). Secondary outcomes included ischemic stroke, recurrent TIA, hemorrhagic stroke, revascularization rates, and clinical improvement assessed using the patient global impression of change (PGIC) scale during follow-up. RIC-related adverse events were also recorded, and cerebral hemodynamics were evaluated using transcranial Doppler. All 46 patients completed the final follow-up (23 each in the RIC and sham RIC groups). No severe adverse events associated with RIC were observed. Kaplan-Meier analysis indicated a significant reduction in MACEs frequency after RIC treatment [log-rank test (Mantel-Cox), P = 0.021]. At 3-year follow-up, two (4.35%) patients had an ischemic stroke, four (8.70%) experienced TIAs, and two (4.35%) underwent revascularization as the qualifying MACEs. The clinical improvement rate in the RIC group was higher than the sham RIC group on the PGIC scale (65.2% vs. 26.1%, P < 0.01). No statistical difference in cerebral hemodynamics post-treatment was observed. RIC is a safe and effective adjunct therapy for asymptomatic children with MMD. This was largely due to the reduced incidence of ischemic cerebrovascular events.

Increased risk of developing cerebro-cardiovascular diseases in police officers: a nationwide retrospective cohort study

BackgroundPolice officers face an increased risk of developing cerebro-cardiovascular diseases (CVD). However, current literature lacks population-based cohort studies specifically focusing on this association. This study aimed to investigate the association between police officers and the risk of developing CVD compared with education officers, while accounting for socioeconomic and demographic factors.MethodsWe used the Korean National Health Insurance Service data spanning from 2009 to 2020. In this population-based retrospective matched cohort study, we identified age, sex, and calendar years of job-enrollment–matched education officers for each police officer. This study evaluated the CVD occurrence, including acute myocardial infarction, ischemic stroke, and hemorrhagic stroke. Using multivariable Cox regression analysis, we determined the risk of developing CVD, expressed as a hazard ratio (HR) and 95% confidence interval (CI).ResultsAmong 104,134 police officers and 104,134 education officers, 4,391(42.2%) cases and 3,631(34.9%) cases of CVD occurred, respectively. The mean ± standard deviation age was 38.4 ± 9.4 years in police officers and 38.6 ± 9.5 years in education officers. The proportion of men was 84.8 % in both groups. Police officers were significantly associated with a higher risk of developing CVD compared with education officers, with an adjusted HR of 1.15 (95% CI, 1.09–1.22). In addition, police officers had significantly higher risks for acute myocardial infarction (adjusted HR, 1.16; 95% CI, 1.06–1.26) and ischemic stroke (adjusted HR, 1.17; 95% CI, 1.09–1.25).ConclusionsThe findings of our study highlight a significant increase in the risk of developing CVD among police officers, particularly among those aged 45 years and older and those with uncontrolled blood pressure compared to their education officer counterparts. Future cohort studies are required to confirm this association.

The Role of Neurosurgical Techniques in Management of Acute and Chronic Stroke: A Comprehensive Literature Review.

Stroke is a medical condition that results from a decreased or completely diminished supply of blood to the brain, and it is considered one of the major causes of morbidity and mortality globally. Stroke is categorized as ischemic and hemorrhagic stroke, both of which demand prompt and particular timely intervention. This extensive review is done to investigate the precise management of acute and chronic manifestations of stroke in relation to neurosurgical interventions, ultimately providing a thorough analysis regarding indications, procedures, outcomes, and complications that are associated with it. In this regard, a pervasive review of literature was carried out, which was primarily sourced from literature databases such as PubMed. This paper particularly outlines a sound relative analysis of anticipating the competence of each neurosurgical technique in use. Endovascular clot retrieval (ECR) has been particularly highlighted, as its effectiveness has been profoundly observed when selected as a treatment option within a time period of 6-24 hours following an ischemic stroke. In less than a time frame of 48 hours, decompressive hemicraniectomy (DH) is usually considered the most suitable treatment for cases of intracranial hypertension resulting from middle cerebral artery (MCA) infarction. Hemorrhages that occur due to ruptured aneurysms are most commonly dealt with clipping and neuroendovascular techniques. Additionally, considering that revascularization surgery is time-sensitive, the results can ultimately vary. Competent results have been linked with stereotactic surgery, which includes deep brain stimulation (DBS) and focused ultrasound ablation (FUSA), which are also famous for being minimally invasive in nature. However, the broader application of these techniques is hindered by the absence of established protocols. This review highlights the importance of timely interventions, advanced equipment, and precise medical protocols to optimize treatment outcomes.

Socioeconomic Differences in Patient Reported Outcome Measures 3 Months After Stroke: A Nationwide Swedish Register-Based Study.

There is a well-known association between low socioeconomic status (SES), poor survival, and clinician-reported outcomes after stroke. We aimed to assess socioeconomic differences in Patient Reported Outcome Measures 3 months after stroke. This nationwide cohort study included patients registered with acute stroke in the Swedish Stroke Register 2015-2017. Patient Reported Outcome Measures included activities of daily living (mobility, toileting, and dressing), and poststroke symptoms (low mood, fatigue, pain, and poor general health). Information on SES prestroke was retrieved from Statistics Sweden and defined by a composite measure based on education and income tertiles. Associations between SES and Patient Reported Outcome Measures were analyzed using logistic regression adjusting for confounders (sex and age) and additionally for potential mediators (stroke type, severity, cardiovascular disease risk factors, and living alone). Subgroup analyses were performed for stroke type, men and women, and younger and older patients. The study included 44 511 patients. Of these, 31.1% required assistance with mobility, 18% with toileting, and 22.2% with dressing 3 months after stroke. For poststroke symptoms, 12.3% reported low mood, 39.1% fatigue, and 22.7% pain often/constantly, while 21.4% rated their general health as poor/very poor. Adjusted for confounders, the odds of needing assistance with activities of daily living were highest for patients with low income and primary school education, for example, for mobility, odds ratio was 2.06 (95% CI, 1.89-2.24) compared with patients with high income and university education. For poststroke symptoms, odds of poor outcome were highest for patients with low income and university education (eg, odds ratio, 1.79 [95% CI, 1.49-2.15] for low mood). Adjustments for potential mediators attenuated but did not remove associations. The associations were similar in ischemic and hemorrhagic strokes and more pronounced in men and patients <65 years old. There are substantial SES-related differences in Patient Reported Outcome Measures poststroke. The more severe outcome associated with low SES is more pronounced in men and in patients of working age.

Cardiovascular Risk Factors and Disparities in Management of Embolic Stroke: A Western Sydney Perspective

Ischaemic stroke remains one of the leading causes of death and disability worldwide. The population of Western Sydney has a unique demographic with lower socioeconomic status and a culturally and linguistically diverse population. This study aims to investigate the demographics and cardiovascular risk factors of patients in Western Sydney, focusing on the prevalence and profile of cardioembolic (CE) strokes and embolic strokes of undetermined source (ESUS). Prospective data were collected in 463 patients with ischaemic stroke presenting to a tertiary centre in Western Sydney, who underwent predischarge transthoracic echocardiography. Patients with haemorrhagic strokes or unclear stroke diagnosis were excluded. Analysis of stroke subtype (CE, ESUS, or non-embolic) and clinical characteristics was performed based on age, gender, and prior atrial fibrillation (AF) prevalence. Of the 463 patients, 147 (32%) had CE strokes, and 147 (32%) had ESUS. Cardioembolic (CE) strokes were associated with older age (≥65 years) and a history of congestive cardiac failure. Older patients had higher rates of hypertension, ischaemic heart disease, AF, and congestive heart failure. History of AF was present in 67 patients (14.5%); however, only 51% received anticoagulation before admission despite a low bleeding risk. The transthoracic echocardiography characteristics of ESUS/non-embolic strokes differed from those of CE strokes; 20% of patients with ESUS had an enlarged left atrium, suggesting a subset of patients with ESUS with a left atrial myopathy. Patients with ischaemic stroke in Western Sydney have a high prevalence of cardiovascular risk factors which were often undertreated. Half of the patients with prior AF did not receive anticoagulation despite low bleeding risk, indicating a gap in optimal stroke prevention. There were distinct echocardiographic characteristics among stroke subtypes. Further analysis of left atrium parameters may provide greater insights into the pathogenesis and prevention of embolic strokes.

PROFILE OF DYSPHAGIA IN ACUTE STROKE PATIENTS

Background: Stroke has been a leading cause of mortality and disability since 2013, and its incidence continues to rise. Dysphagia is a common complication following stroke, contributing to increased rates of aspiration, pneumonia, and prolonged hospital stays for stroke patients. Objective: This study aims to investigate the profile and distribution of acute stroke patients experiencing dysphagia who are admitted to RSUD dr. Saiful Anwar in East Java. Methods: The assessment was conducted on acute stroke patients with compos mentis consciousness in the Stroke Unit from July to September 2023, using the GUSS (Gugging Swallowing Screen) questionnaire. The assessment categories included no dysphagia (20), mild dysphagia (15-19), moderate dysphagia (10-14), and severe dysphagia (0-9). Results: Data collected during the period from July to September 2023 yielded a total of 35 samples. Based on gender, there were 22 male patients (62.9%) and 13 female patients (37.1%). Regarding age distribution, 15 patients fell into the productive age range (20 to 59 years), while 20 patients were over 60 years old. The majority of cases were ischemic strokes, with 25 patients, and 10 patients had hemorrhagic strokes. Dysphagia assessment using the GUSS method on the 35 samples revealed 2 samples with GUSS scores of 12 and 14 (moderate) and 1 sample with a score of 18 (mild). Conclusion: The profile and distribution of acute stroke patients experiencing dysphagia were identified, including gender, age, type of stroke, and GUSS scores in acute stroke patients in the stroke unit with Compos Mentis consciousness.

The National Institutes of Health Stroke Scale is comparable to the ICH score in predicting outcomes in spontaneous acute intracerebral hemorrhage.

Validating the National Institutes of Health NIH Stroke Scale (NIHSS) as a tool to assess deficit severity and prognosis in patients with acute intracerebral hemorrhage would harmonize the assessment of intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) patients, enable clinical use of a readily implementable and non-imaging dependent prognostic tool, and improve monitoring of ICH care quality in administrative datasets. Among randomized trial ICH patients, the relation between NIHSS scores early after Emergency Department arrival and 3-month outcomes of dependency or death (modified Rankin Scale, mRS 3-6) and case fatality was examined. NIHSS predictive performance was compared to a current standard prognostic scale, the intracerebral hemorrhage score (ICH score). Among the 384 patients, the mean age was 65 (±13), with 66% being male. The median NIHSS score was 16 (interquartile range (IQR) 9-25), the mean initial hematoma volume was 29 mL (±38), and the ICH score median was 1 (IQR 0-2). At 3 months, the mRS had a median of 4 (IQR 2-6), with dependency or death occurring in 70% and case fatality in 26%. The NIHSS and ICH scores were strongly correlated (r = 0.73), and each was strongly correlated with the 90-day mRS (NIHSS, r = 0.61; ICH score, r = 0.62). The NIHSS performed comparably to the ICH score in predicting both dependency or death (c = 0.80 vs. 0.80, p = 0.83) and case fatality (c = 0.78 vs. 0.80, p = 0.29). At threshold values, the NIHSS predicted dependency or death with 74.1% accuracy (NIHSS 17.5) and case fatality with 75.0% accuracy (NIHSS 18.5). The NIHSS forecasts 3-month functional and case fatality outcomes with accuracy comparable to the ICH Score. Widely documented in routine clinical care and administrative data, the NIHSS can serve as a valuable measure for clinical prognostication, therapy development, and case-mix risk adjustment in ICH patients.Clinical trial registrationClinicaltrials.gov, NCT00059332.

Cerebral Microbleeds Associate with Brain Endothelial Cell Activation-Dysfunction and Blood-Brain Barrier Dysfunction/Disruption with Increased Risk of Hemorrhagic and Ischemic Stroke.

Globally, cerebral microbleeds (CMBs) are increasingly being viewed not only as a marker for cerebral small vessel disease (SVD) but also as having an increased risk for the development of stroke (hemorrhagic/ischemic) and aging-related dementia. Recently, brain endothelial cell activation and dysfunction and blood-brain barrier dysfunction and/or disruption have been shown to be associated with SVD, enlarged perivascular spaces, and the development and evolution of CMBs. CMBs are a known disorder of cerebral microvessels that are visualized as 3-5 mm, smooth, round, or oval, and hypointense (black) lesions seen only on T2*-weighted gradient recall echo or susceptibility-weighted sequences MRI images. CMBs are known to occur with high prevalence in community-dwelling older individuals. Since our current global population is the oldest recorded in history and is only expected to continue to grow, we can expect the healthcare burdens associated with CMBs to also grow. Increased numbers (≥10) of CMBs should raise a red flag regarding the increased risk of large symptomatic neurologic intracerebral hemorrhages. Importantly, CMBs are also currently regarded as markers of diffuse vascular and neurodegenerative brain damage. Herein author highlights that it is essential to learn as much as we can about CMB development, evolution, and their relation to impaired cognition, dementia, and the exacerbation of neurodegeneration.

Neurological outcomes and mortality of hyperoxaemia in patients with acute brain injury: protocol for a systematic review and meta-analysis

IntroductionOxygen is frequently prescribed in neurocritical care units. Avoiding hypoxaemia is a key objective in patients with acute brain injury (ABI). However, several studies suggest that hyperoxaemia may also be...