Hemorrhagic Stroke Research Articles

Incidence and risk factors associated with stroke when utilizing peripheral VA-ECMO

BackgroundMechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has brought forward a paradigm shift in the management of cardiogenic shock. Neurological complications associated with VA-ECMO represent a significant source of morbidity and mortality and serve as a limiting factor in its application and duration of use. MethodsWe performed a single-center retrospective case-control study of patients who developed stroke while managed with peripheral VA-ECMO from January 2018 to September 2022 at a quaternary center. We included consecutive patients above the age of 18 who were admitted to the cardiac intensive care unit and were managed with peripheral VA-ECMO. All patients who developed a stroke while on VA-ECMO were included in the case cohort, and compared to those who did not suffer stroke. Multivariable logistic regression was performed to identify risk factors associated with stroke on VA-ECMO. In-hospital outcomes were assessed out to 30 days. ResultsA total 244 patients were included in the final analysis, 36 (14.7 %) of whom developed stroke on VA-ECMO. Ischemic stroke was seen in 20 patients (55.6 %) whereas hemorrhagic stroke was seen in 16 patients (44.4 %). The use of P2Y12 antagonists (aOR 2.70, p = 0.019), limb ischemia (aOR 4.41, p = 0.002), and blood transfusion requirement (aOR 8.55, p = 0.041) were independently associated with development of stroke on VA-ECMO. Female sex trended towards statistical significance (aOR 2.19, p = 0.053) while age was not independently associated with development of stroke on VA-ECMO. There was no significant association between stroke development and outcomes of VA-ECMO duration, hospital length of stay, and all-cause mortality out to 30-days. ConclusionsVA-ECMO carried a considerable risk of neurological complications. Mortality and duration of hemodynamic support was not associated with stroke risk. Awareness regarding stroke risk is imperative in facilitating early identification and management of ischemic and hemorrhagic stroke. Research involving clinical trials and multicenter studies are necessary to empower centers in mitigating this source of significant morbidity and mortality in patients on mechanical circulatory support.

Relationship between socioeconomic status and stroke: an observational and network Mendelian randomization study

BackgroundThe relationship between socioeconomic status (SES) and stroke remains controversial, and the underlying mediator is unclear. This study aimed to assess the causal relationship of SES with stroke and its subtypes and to identify potential modifiable risk factors responsible for this relationship. MethodsThe study included 372,437 participants from the UK Biobank. Over an average period of 12.13 years, 6,457 individuals (2.7%) were recorded as having experienced a stroke. Cox proportional hazards model was used to determine the relationship between SES (average annual household income before tax and age at the end of full-time education) and stroke, ischemic stroke, and hemorrhagic stroke. Two-sample Mendelian randomization (MR) was employed to assess the causal relationship between SES and stroke and its subtypes. Furthermore, network MR was utilized to evaluate the potential mediating role of modifiable risk factors for stroke in this causal relationship. ResultsAfter adjusting for factors such as sociodemographic characteristics, health behaviors, health status, and past medical history, participants in the second highest income group showed the lowest risk of stroke, with a hazard ratio (HR) of 0.780 (95% confidence interval [CI]: 0.702–0.866), and for ischemic stroke, the HR was 0.701 (95% CI: 0.618–0.795). Those who completed full-time education at the latest age group(>18 years) had the lowest risk of stroke (HR: 0.906, 95% CI: 0.830–0.988) and ischemic stroke (HR: 0.897, 95% CI: 0.811–0.992). MR analysis showed that higher income and education were both associated with a lower risk of stroke (income: inverse-variance-weighted odds ratio [ORIVW] =0.796, 95% CI: 0.675–0.940, education: ORIVW = 0.631, 95% CI: 0.557–0.716) and ischemic stroke (income: ORIVW = 0.813, 95% CI: 0.684–0.966, education: ORIVW = 0.641, 95% CI: 0.559–0.735). Additionally, hypertension had the highest mediating effect on this relationship. It accounted for 57.12% of the effect of income on stroke, 51.24% on ischemic stroke, and 27% and 24% for education. ConclusionHigher SES was associated with a lower risk of stroke and ischemic stroke, and hypertension had the highest mediating effect on this causal relationship. The results have significant public health implications, emphasizing the importance of early intervention to reduce the risk of stroke in low SES populations.

Impacts of the COVID-19 pandemic on deprivation-level differences in cardiovascular hospitalisations: a comparison of England and Denmark using the OpenSAFELY platform and National Registry Data

ObjectivesTo examine the impact of the COVID-19 pandemic on deprivation-related inequalities in hospitalisations for cardiovascular disease (CVD) conditions in Denmark and England between March 2018 and December 2021.DesignTime-series studies in...

S3842 Hemorrhagic Stroke Secondary to Inflammatory Bowel Disease

S3842 Hemorrhagic Stroke Secondary to Inflammatory Bowel Disease

Predictors of Poststroke Fatigue in Stroke Patients: A Prospective Cohort Study

ABSTRACTPoststroke fatigue (PSF) is a common, underestimated sequel of stroke that affects the quality of life of patients. In this study, the authors investigate the prevalence of PSF in three equal groups: control, ischemic, and hemorrhagic stroke patients. Some of the multidimensional factors that predict PSF are examined, and the implications for improvement of stroke management are highlighted.

Long-Term Clinical Outcomes After Cerebral Revascularization in Moyamoya Disease With Extracranial Internal Carotid Artery Occlusion

ObjectiveThe aim of this study is to evaluate the efficacy of cerebral revascularization for Moyamoya disease (MMD) with extra-cranial internal carotid artery occlusion (ICAO). MethodsThis study retrospectively analyzed 37 patients diagnosed with MMD with extra-cranial ICAO who underwent cerebral revascularization surgery. We conducted propensity score matching for MMD patients without extra-cranial ICAO from database of 932 MMD patients. Outcome data, recurrent strokes and modified Rankin Scale (mRS) were collected during follow-up. ResultsA total of 37 MMD patients with extra-cranial ICAO were included in the study. The average follow-up time of MMD patients with extra-cranial ICAO included in the study was 74 months. During the follow-up period, there were 15 hemispheres recurred stroke events. All hemispheres underwent surgery, and the follow-up mRS score was significantly reduced (P <0.001). Kaplan-Meier analysis showed no significant statistical difference in stroke events between the indirect bypass (IB), direct bypass (DB), and combined bypass (CB) groups (P = 0.131). After propensity matching, 48 hemispheres of MMD patients without extra-cranial ICAO were identified from a review of 932 MMD patients. There was no significant statistical difference in stroke events between the MMD patients with extra-cranial ICAO group and the MMD group (P = 0.271). ConclusionsCerebral revascularization can prevent recurrent ischemic and hemorrhagic stroke events for MMD patients with extra-cranial ICAO. There was no difference on long-term clinical outcomes after CB, DB, and IB surgery. The cerebral revascularization has similar effect on the MMD patients with extra-cranial ICAO and MMD patients without.

Low-density Lipoprotein Cholesterol Reduction Therapies for Secondary Prevention in Patients with Stroke: A Network Meta-analysis.

Patients with previous strokes are at a higher risk of stroke recurrence. Current guidelines recommend a range of low-density lipoprotein cholesterol (LDL-C)-lowering treatments to reduce the risk of recurrent stroke. However, the optimal agent for decreasing LDL-C to lower the risk of recurrent stroke remains unclear. This study aimed to assess the relative effects of various LDL-C -lowering agents for secondary stroke prevention. Several databases were searched from inception up to 2022. Only randomized controlled trials that compared different LDL-C-lowering agents in adult patients with previous strokes were included. The primary endpoint was a recurrent stroke. The surface under the cumulative ranking curve (SUCRA) was also applied to estimate the overall ranking probability of the treatment agents for each outcome. Overall, nine trials comprising 17,226 patients were included. Ezetimibe plus statins (RR: 0.56, 95% CrI: 0.35-0.87) and statins alone (RR: 0.90, 95% CrI: 0.81-1.00) reduced the risk of stroke recurrence. Ezetimibe plus statins was superior to statins alone in decreasing the incidence of recurrent stroke (RR: 0.62, 95% CrI: 0.39-0.95). However, treatment with statins was related to an increased risk of hemorrhagic stroke compared to placebo (RR: 1.57, 95% CrI: 1.13-2.21). All agents were related to a decreased incidence of major adverse cardiovascular events. Treatment with ezetimibe plus statins was suggested as the most efficacious in decreasing the incidence of recurrent stroke. The analysis also revealed that statin monotherapy was related to an increased risk of hemorrhagic stroke.

Endothelial pyroptosis-driven microglial activation in choroid plexus mediates neuronal apoptosis in hemorrhagic stroke rats

BackgroundSpontaneous intracerebral hemorrhage (ICH) is associated with alarmingly high rates of disability and mortality, and current therapeutic options are suboptimal. A critical component of ICH pathology is the initiation of a robust inflammatory response, often termed “cytokine storm,” which amplifies the secondary brain injury following the initial hemorrhagic insult. The precise sources and consequences of this cytokine-driven inflammation are not fully elucidated, necessitating further investigation. MethodsTo address this knowledge gap, our study conducted a comprehensive cytokine profiling using Luminex® assays, assessing 23 key cytokines. We then employed single-cell RNA sequencing and spatial transcriptomics at three critical time points post-ICH: the hyperacute, acute, and subacute phases. Integrating these multimodal analyses allowed us to identify the cellular origins of cytokines and elucidate their mechanisms of action. ResultsLuminex® cytokine assays revealed a significant upregulation of IL-6 and IL-1β levels at the 24-h post-ICH time point. Through the integration of scRNA-seq and spatial transcriptomics in the hemorrhagic hemisphere of rats, we observed a pronounced activation of cytokine-related signaling pathways within the choroid plexus. Initially, immune cell presence was sparse, but it surged 24 h post-ICH, particularly in the choroid plexus, indicating a substantial shift in the immune microenvironment. We traced the source of IL-1β and IL-6 to endothelial cells, establishing a link to pyroptosis. Endothelial pyroptosis post-ICH induced the production of IL-1β and IL-6, which activated microglial polarization characterized by elevated expression of Msr1, Lcn2, and Spp1 via the NF-κB pathway in the choroid plexus. Furthermore, we identified neuronal populations undergoing apoptosis, mediated by the Lcn2-SLC22A17 pathway in response to IL-1β and IL-6 signaling. Notably, the inhibition of pyroptosis using VX-765 significantly mitigated neurological impairments. ConclusionsOur study provides evidence that endothelial pyroptosis, characterized by the release of IL-1β and IL-6, triggers microglial polarization through NF-κB pathway activation, ultimately leading to microglia-mediated neuronal apoptosis in the choroid plexus post-ICH. These findings suggest that targeted therapeutic strategies aimed at mitigating endothelial cell pyroptosis and neutralizing inflammatory cytokines may offer neuroprotection for both microglia and neurons, presenting a promising avenue for ICH treatment.

Returning A Thalamic Hemorrhagic Stroke Survivor To Pre-stroke Ability

Returning A Thalamic Hemorrhagic Stroke Survivor To Pre-stroke Ability

Effects of Apricot Kernel Oil Extract on the Cognitive Function and Expression Profile of Inflammatory Factors in a Rat Model of Hemorrhagic Stroke: A Biochemical, Immunohistochemical and Molecular Approach

Effects of Apricot Kernel Oil Extract on the Cognitive Function and Expression Profile of Inflammatory Factors in a Rat Model of Hemorrhagic Stroke: A Biochemical, Immunohistochemical and Molecular Approach

The relationship between serum uric acid and gastrointestinal bleeding in peritoneal dialysis patients: a propensity score analysis

Purpose Gastrointestinal bleeding is an important gastrointestinal complication among peritoneal dialysis patients and correlated with a higher risk of mortality. Increased uric acid levels are a significant complication for peritoneal dialysis patients and have been associated with an increased risk of hemorrhagic stroke. The objective of the present study was to investigate the relationship between serum uric acid levels and gastrointestinal bleeding in peritoneal dialysis patients. Methods A total of 2498 peritoneal dialysis patients were recruited. Based on the optimal uric acid cutoff value, two groups of patients were divided. We constructed a propensity-score-matched population of 1762 patients by matching sex, age, and body mass index. Survival outcomes between the two groups were compared using adjusted Kaplan–Meier curves. We constructed the restricted cubic splines regression to assess the correlation between levels of uric acid and gastrointestinal bleeding. A multivariate Cox proportional hazards regression was performed to test whether higher levels of uric acid are an independent risk factor for gastrointestinal bleeding. We performed a forest plot to show interaction effects in different subgroups. Results According to restricted cubic splines regression, uric acid levels were positively correlated with the risk of gastrointestinal bleeding events. After adjusted different confounding factors, patients with high levels of uric acid were prone to experience gastrointestinal bleeding (HR 1.868, 95%CI 1.001–3.486). In subgroups, the interaction between higher levels of uric acid and utilizing proton pump inhibitors was significant (P for interaction = 0.034). Further research found that taking proton pump inhibitors could decrease the risk of gastrointestinal bleeding in peritoneal dialysis patients accompanied high levels of uric acid. Conclusion The baseline high levels of uric acid are an independent risk factor for gastrointestinal bleeding in patients undergoing peritoneal dialysis.

Evaluation of knowledge of risk factors and warning signs of stroke among paramedical students

Stroke is a medical emergency caused by a blockage or rupture in the blood vessels that supply blood to the brain. This prevents brain tissue from receiving oxygen, leading to the death of brain cells within minutes and causing neurological damage, disability, or death. Aim: The aim of the present study was to assess baseline knowledge regarding stroke risk factors, symptoms, treatment, and information resources. The “golden hour” is a time span of 60 minutes or less after stroke symptoms begin. There are two types of stroke, namely ischemic and hemorrhagic stroke. Ischemic stroke is further divided into thrombotic and embolic stroke. Hemorrhagic stroke is further divided into intracerebral hemorrhage and subarachnoid hemorrhage. Methods: The research method used in the study is a quantitative research approach. Purposive sampling techniques were used and 1050 participants were assessed The questionnaire consists of demographic details such as department, level of education, family history, and knowledge questions based on risk factors and management. Results: This study comprises 1040 patients who fulfill the inclusion criteria. The survey assessed the knowledge of risk factors and warning signs of stroke among future healthcare professionals (pharmacy, nursing, and AHS). The current findings reported that 51.8% of the paramedical students had knowledge about stroke, while the majority of them reported poor knowledge overall. The findings identified that 57.4% of the student population were knowledgeable about risk factors, 69.9% were knowledgeable about warning signs, and 51.8% were knowledgeable about management. These results were similar to many previous studies conducted around the world. Conclusion: Better knowledge about stroke, recognizing the risk factors, and being able to provide immediate management are essential for paramedical students. This is crucial for reducing stroke incidence and improving survival rates of patients by providing better medical help through early detection, rapid intervention, and better long-term health outcomes not only in a medical setup but also in their respective environments.

Impact of Systolic and Diastolic Blood Pressure on Cardiovascular Health Outcomes

Background: One well-known risk factor for cardiovascular (CV) disease that significantly raises morbidity and mortality rates globally is hypertension. Optimising treatment options requires an understanding of the distinct effects of diastolic and systolic blood pressure on CV outcomes. The study aims to examine into how the effects of both systolic hypertension (SH) and diastolic hypertension (DH) affected the frequency of major CV events, such as hemorrhagic, ischemic, and myocardial infarction (MI). Methods: A retrospective cohort research comprising 180 patients was carried out, with automated oscillometric cuffs being used to measure blood pressure. The burdens of SH and DH, which were determined as continuous variables from weighted average blood pressure, were the main predictors. A composite of ischemic stroke, MI, or hemorrhagic stroke was the main result. Logistic regression and bivariate and multivariable Cox survival analyses were included in the statistical studies. Results: The study population had average age of 65.4 years, with 52% males and 48% females. During the observation period, 45 composite outcome events occurred (25% incidence rate). Bivariate Cox analysis showed significant associations between SH burden (HR: 1.45, p&lt;0.001) and diastolic hypertension burden (HR: 1.30, p=0.015) with the composite outcome. Multivariable analysis confirmed these associations, with consistent findings in logistic regression models. Conclusion: Both SH and DH burdens are significant predictors of adverse CV outcomes. Effective management of both blood pressure components is essential for reducing the risk of ischemic stroke, MI, and hemorrhagic stroke. Recommendations: To lower the risk of significant CV events, clinicians should monitor and treat both systolic and diastolic blood pressure in individuals with hypertension. Subsequent studies ought to investigate the underlying mechanisms of these correlations and assess the effectiveness of focused interventions. Keywords: Hypertension, Cardiovascular Outcomes, Diastolic Blood Pressure, Systolic Blood Pressure.

Prevalence of Early Seizures in Acute Stroke Patients

A stroke is defined as a sudden neurological deficit of cerebrovascular cause that persists beyond 24 hours. Stroke is associated with a whole spectrum of complications, especially post-stroke seizures. These seizures may adversely affect the outcome of stroke in terms of mortality and morbidity. This study was designed to find out the frequency of early post-stroke seizures. Objective: To determine the frequency of early-onset seizures after stroke among patients presenting to tertiary care hospitals. Methods: Two hundred and forty patients, presenting on the Medical floor of Jinnah Hospital Lahore with acute stroke and fulfilling the selection criteria, were approached after informed consent. The patients were followed for 14 days for the development of early seizures after the stroke. Results: Among 240 stroke patients, there were 123 (51.3%) male patients and 117 (48.8%) female patients. The minimum age observed was 30 years and the maximum was noted as 77 years. In 45% of patients, hemorrhagic stroke was detected and 55% of patients had ischemic stroke. From 108 cases of hemorrhagic stroke, there were 10.4% cases in which an episode of seizure occurred within 14 days of stroke. On the other hand, in 132 patients with ischemic stroke, 15.9% of patients developed seizure episodes. Conclusions: It was concluded that ischemic stroke was more common in frequency than hemorrhagic stroke in our population and the occurrence of episode early seizure within 14 days of stroke was more prevalent in ischemic stroke patients.

Evaluation of Rituximab in Immunothrombocytopenia Splenectomized and Non-Splenectomized Patient

Stroke carries a high risk of death. Survivors can experience loss of vision and/or speech, paralysis and confusion. The risk of death depends on the type of stroke and its incidence increases with advancing age. Post-stroke aphasia and language impairment are significant health problems among stroke patients and may result in considerable activity limitation. Different types of aphasia might develop according to the location of the stroke. To identify the types of aphasia in patients with stroke and to assess the relationship between the age and types of aphasia in each type of stroke in those patients. This was a hospital-based cross-sectional study conducted at Bagdad Teaching Hospital, Medical City and Al Imamin Al Kazmain Medical City during the period from October 2014 to the end of September 2015. One hundred patients were enrolled and assessed at neurology and general medical wards. Clinical assessment of the aphasic patient was performed through clinical and language examination was performed. Statistical analysis was performed using the statistical package for Social Sciences version 22 and the appropriate statistical tests were used accordingly. The mean age of the studied group was 62.1 ± 13.2 (range: 37-87) years and the majority of the patients aged more than 50 years. Females represented 55% of the patients. Ischemic and hemorrhagic strokes were reported in 76% and 24% of patients, respectively. Global aphasia was found in 32%, Broca´s(17%), Thalamic 17 (17%), Putaminal(11%), and Werneck’s (11%) of the patients, other types were less frequent. Hypertension was the most frequent risk factor reported among the patients Heart failure was the commonest reported cardiac factor. Aphasia was more frequent among patients older than 50 years. No statistically significant association had been found between the age and the types of aphasia (P&gt;0.05). Global, Broca´sWernick´saphasia were significantly associated with ischemic stroke, while Thalamic, Putaminal conduction and anomia were associated with hemorrhagic stroke, (P&lt;0.05). Hyperlipidemia and diabetes mellitus were significantly associated with Ischemic stroke rather than hemorrhagic (P=0.010). Cardiac risk factors were significantly associated with Ischemic stroke, (P = 0.038).7 Aphasia was more frequent with older age, and no significant association had been found between the type of aphasia and the age, generally, no significant association had been found between the types of aphasia and the risk factors, but some types were associated significantly with hypertension, smoking and diabetes mellitus. Further studies are suggested for further assessment.

Quantitative electroencephalography to assess post-stroke functional disability: A systematic review and meta-analysis

ObjectiveQuantitative electroencephalography (QEEG) is a non-invasive, reliable and easily accessible modality to assess neuronal activity. QEEG in acute stroke may predict short and long-term functional outcomes. The role of individual indices has not been studied in a meta-analysis. We aim to assess individual QEEG-derived indices to predict post-stroke disability. MethodsWe included studies (sample size ≥ 10) with stroke patients who underwent EEG and a follow-up outcome assessment was available either in the form of modified Rankin scale (mRS) or National Institute of Stroke scale (NIHSS) or Fugl-Meyer scale (FMA). QEEG indices analysed were delta-alpha ratio (DAR), delta-theta-alpha-beta ratio (DTABR), brain symmetry index (BSI) and pairwise derived brain symmetry (pdBSI). ResultsNine studies (8 had only ischemic stroke, and one had both ischemic and haemorrhagic stroke), including 482 participants were included for meta-analysis. Higher DAR was associated with worse mRS (n=300, Pearson's r 0.26, 95 % CI 0.21-0.31). Higher DTABR was associated with worse mRS (n=337, r=0.32, 95 % CI 0.26-0.39). Higher DAR was associated with higher NIHSS (n=161, r=0.42, 95 % CI0.24-0.6). Higher DTABR was associated with higher NIHSS (n=158, r=0.49, 95 % CI 0.31-0.67). ConclusionsQEEG-derived indices DAR and DTABR have the potential to assess post-stroke disability. Adding QEEG to the clinical and imaging biomarkers in the acute phase may help in better prediction of post-stroke recovery. RegistryPROSPERO 2022 CRD42022292281

Impact of vitamin D deficiency on ischemic stroke severity: Insights from a prospective study

Background. Ischemic stroke, characterized by the obstruction of blood flow to the brain, is a major cause of morbidity and mortality globally. The severity of ischemic stroke is typically assessed using the National Institutes of Health Stroke Scale (NIHSS), which predicts patient outcomes. Recent research suggests a potential link between low vitamin D levels and an increased risk of cerebrovascular events, including ischemic stroke. However, the specific relationship between vitamin D deficiency and stroke severity remains underexplored. Objective. This study aimed to investigate the correlation between serum vitamin D levels and NIHSS scores in patients with ischemic stroke to determine if vitamin D deficiency contributes to the severity of neurological deficits observed in these patients. Materials and methods. This prospective observational study was conducted at Saveetha Medical College, Chennai, involving 86 patients presenting with acute ischemic stroke. Inclusion criteria included age ≥ 18 years, confirmed diagnosis of acute ischemic stroke by neuroimaging, and presentation within 24 hours of symptom onset. Exclusion criteria included hemorrhagic stroke, conditions affecting vitamin D metabolism, and vitamin D supplementation. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using chemiluminescence immunoassay (CLIA), and NIHSS scores were assessed within 24 hours of admission. Statistical analyses included Pearson’s correlation and multivariate linear regression to adjust for confounders. Results. The study found a significant negative correlation between serum 25(OH)D levels and NIHSS scores at admission (Pearson correlation coefficient r = -0.4081, p &lt;0.001). Multivariate regression analysis confirmed this association (β = -0.3994, p &lt;0.001) after adjusting for age, sex, and comorbidities. Age (β = 0.1123, p = 0.009) and comorbid conditions (β= 0.9565, p = 0.008) were also significantly associated with higher NIHSS scores. Conclusion. The study demonstrates a significant negative correlation between serum 25-hydroxyvitamin D levels and ischemic stroke severity, suggesting that higher vitamin D levels may be associated with less severe strokes. Further research is needed to explore the mechanistic pathways and therapeutic potential of vitamin D in stroke management, emphasizing the importance of maintaining adequate vitamin D levels to potentially reduce stroke severity and improve patient outcomes.

Differences in Presentation of Ischaemic and Haemorrhagic Stroke: A Systematic Review and Meta-Analysis

Abstract Background Stroke is the 2nd leading cause of death worldwide. Stroke is diagnosed by the combination of clinical symptoms and signs, and neuroimaging. Clinical features may differ between the subtypes of ischaemic and haemorrhagic stroke. We investigated whether there are differences in clinical presentation of acute ischaemic and haemorrhagic stroke. Methods We conducted a systematic review and meta-analysis according to the PRISMA statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, randomised controlled trial, systematic review or meta-analysis; (2) consecutive admissions of adult individuals with an acute ischaemic or haemorrhagic stroke, confirmed by neuroimaging and (3) comparisons possible between stroke subtypes in acute stroke symptom(s). A random-effects model was used for our analyses. Results We included 58 studies (n=12,878,716; ischaemic stroke=10,814,293; haemorrhagic stroke=2,064,423). The mean age of participants was 65.54+13.84 with 44.98% women. In haemorrhagic stroke, altered GCS occurred more frequently than in ischaemic stroke (OR, 3.93 [95% CI, 2.81–5.49]; AIS/ICH=382,110/59,877, 40 studies), as did headache (OR, 3.34 [95% CI, 2.68–4.17]; AIS/ICH=22,413/6,018; 43 studies), seizure (OR, 2.42 [95% CI, 1.62–3.65]; AIS/ICH=10,427,262/2,004,681; 20 studies), vomiting (OR, 3.82 [95% CI, 2.62–5.57]; AIS/ICH=7,736/3,225; 25 studies), neck stiffness (OR, 5.21 [95% CI, 2.22–12.21]; AIS/ICH=511/168; 3 studies), syncope (OR, 2.95 [95% CI, 2.12–4.12]; AIS/ICH=2,427/494; 6 studies) and dizziness (OR, 1.33 [95% CI, 1.05–1.68]; AIS/ICH=4,730/1,213; 11 studies). Hemiplegia occurred more frequently in ischaemic stroke (OR, 0.67 [95% CI, 0.49–0.91]; AIS/ICH=15,857/4,338; 31 studies) than haemorrhagic stroke, as did ataxia (OR, 0.73 [95% CI, 0.61–0.86]; AIS/ICH=7,741/2,244; 8 studies) and morning onset (OR, 0.41 [95% CI, 0.32– 0.54]; AIS/ICH=2,721/495; 4 studies). Conclusion This review focused on synthesizing existing evidence on differences in clinical presentation between ischaemic and haemorrhagic stroke. It suggests there are substantive differences in stroke symptoms between these subtypes. These results may provide insights into future directions for clinical prediction tool development.

Implementasi Range Of Motion (ROM) Pasif Untuk Meningkatkan Mobilitas Fisik Pada Pasien Dengan Stroke Hemoragik Di Rumah Sakit Vita Insani Pematangsiantar

Stroke is a functional brain disorder in the form of death of neurological nerve cells due to disruption of blood flow in one part of the brain. Hemorrhagic stroke is a ruptured blood vessel in the brain which results in intracranial bleeding. The prevalence of stroke cases every year is 13.7 million and around 5.5 million deaths occur due to stroke. One of the nursing problems that arises in cases of hemorrhagic stroke is impaired physical mobility. Efforts that can be made to overcome physical mobility disorders are passive range of motion (ROM). This research design uses the Case Study method. The sampling method used is purposive sampling. The samples taken were 2 respondents, namely patients with hemorrhagic stroke who were hospitalized at Vita Insani Hospital, Pematangsiantar. The results showed that there was an increase in mobility experienced by hemorrhagic stroke patients, a decrease in muscle strength, Mr. U scales (3) to (4) and in Mr. S scales (2) to (3). Passive range of motion (ROM) is effective in cases of hemorrhagic stroke in increasing physical mobility. Nurses are expected to be able to accompany patients to apply passive range of motion (ROM) in an effort to increase physical mobility in hemorrhagic stroke patients.

The Adaptive Physical Activity Study for Stroke: A Feasibility Sequential Multiple Assignment Randomized Trial

Abstract Background Between 1990 and 2017, stroke cases nearly doubled, ranking as the second leading cause of death and disability globally. Inadequate physical activity (PA) is a leading risk factor. Recent guidelines advise stroke survivors to follow population-based PA guidelines. Given stroke heterogeneity personalised PA interventions are recommended. Therefore, this study used a Sequential Multiple-Assignment Randomized Trial (SMART) design to develop an adaptive mHealth intervention to improve PA post-stroke. Methods This SMART is in progress, with recruitment completed and follow-up data ending November 2024. A 12-week intervention programme was developed incorporating public patient involvement (PPI), empirical evidence and behavioural change theory to increase participation in Structured Exercise (SE), Lifestyle Physical Activity (LPA), or both. The study enrolled 54 ambulatory, community-dwelling people who were randomly assigned to either SE or LPA treatment groups. Participants used Fitbit Inspire 2 devices to monitor step counts and set personalized weekly step goals. At six weeks post-randomisation, participants were evaluated and classified as responders or non-responders based on their step count target achievement. Non-responders were re-randomized to switch treatments or augment their current regime with an additional intervention. Responders maintained their original treatment protocol. Primary outcomes address recruitment, retention and adherence rates. Secondary outcomes encompass overall health. Results Preliminary results include 54 participants (56% male) aged 51.58 (± 15.12) with Ischaemic (44%), Haemorrhagic (28%) or unknown (28%) stroke type at baseline. The mean weekly step was 7046 (±3797) while the mean Fatigue Severity Scale score was 38.02 (± 14.60). Participants had a mean Hospital Anxiety and Depression Scale score of 12.33 (± 6.98). Additionally, the mean Stroke Specific Quality of Life was 155.04 (58.84). Conclusion This is the first trial to use a SMART to design an adaptive intervention post-stroke internationally. Findings will inform the development of a PA intervention and subsequently will be evaluated against treatment as usual in a definitive trial.