History Of Transient Ischemic Attack Research Articles

Burden and determinants of renal dysfunction and in-hospital mortality among acute stroke patients in Ethiopia: A hospital-based observational study.

Stroke, a leading global cause of mortality and neurological impairment, is often complicated by renal failure, exacerbating in-hospital risks and mortality. Limited understanding exists regarding renal failure prevalence in Ethiopian acute stroke patients. This study examines renal function abnormalities in acute stroke patients at Jimma Medical Center (JMC). A hospital-based cross-sectional study was conducted at JMC from December 5, 2023, to March 15, 2024. A structured data collection tool was developed after comprehensive review of pertinent literature, encompassing variables pertinent to the study objectives. Following data quality assurance, information was coded and inputted into EpiData version 3.1, subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Multivariable logistic regression analysis was performed to adjust for confounding variables, with statistical significance set at P < .05. The mean age of participants was 60.5 ± 15.5 years, with 129 (64.5%) being male. Forty-five participants (22.5%, 95% confidence interval [CI] = 16.9, 28.9) exhibited renal dysfunction. Advanced age (≥70 years), hypertension, diabetes mellitus (DM), cardiac disease, history of transient ischemic attack (TIA)/stroke, and hemorrhagic stroke type were identified as significant predictors of renal dysfunction among hospitalized stroke patients. The mortality rate was 3.7 times higher in stroke patients with renal dysfunction compared to those with normal renal function (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.41, 6.22). Renal function abnormalities were prevalent among hospitalized acute stroke patients, emphasizing the significance of renal dysfunction as a frequent comorbidity. Older age, hypertension, DM, cardiac disease, history of TIA/stroke, and hemorrhagic stroke type emerged as statistically significant predictors of renal dysfunction. Furthermore, renal dysfunction was identified as a significant predictor of in-hospital mortality following stroke.

Effects of a perioperative educational pathway on ostomy self-care, level of independence and need for visiting nurse services: a comparative observational cohort study.

Most new ostomy patients are not able to manage ostomy self-care when they are discharged and rely on visiting nurse services for ostomy care. The aim of this study was to determine if a perioperative ostomy educational pathway increases the level of independence and decreases the need for visiting nurse services in new ostomy patients. A prospective longitudinal study was conducted between July 2018 and February 2020. Patients who received a colostomy or ileostomy and were treated on the surgery ward were included. Patients who followed a perioperative ostomy educational pathway were compared to a historical control group. The primary outcome measure was the level of independence in ostomy care and the need for visiting nurse services. After discharge, 67.6% of patients in the intervention group (n = 244) were able to independently perform ostomy care and were therefore not relying on visiting nurse services, compared to 15.2% of the patients in the control group (n = 33). The need for visiting nurse services was higher in patients aged ≥70 years (OR 3.20, P < 0.001), those who did not attend the preoperative practice session (OR 3.02, P = 0.002), those with a history of transient ischaemic attack (OR 10.22, P = 0.045) and those with mild cognitive impairment (OR 28.98, P = 0.002). A perioperative ostomy educational pathway effectively increased the level of independence and decreased the need for visiting nurse services in new ostomy patients.

Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke.

Distal medium vessel occlusions (DMVOs) are a significant contributor to acute ischemic stroke (AIS), with collateral status (CS) playing a pivotal role in modulating ischemic damage progression. We aimed to explore baseline characteristics associated with CS in AIS-DMVO. This retrospective analysis of a prospectively collected database enrolled 130 AIS-DMVO patients from two comprehensive stroke centers. Baseline characteristics, including patient demographics, admission National Institutes of Health Stroke Scale (NIHSS) score, admission Los Angeles Motor Scale (LAMS) score, and co-morbidities, including hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation, and history of transient ischemic attack or stroke, were collected. The analysis was dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) <.3, versus poor CS, reflected by HIR ≥.3. Good CS was observed in 34% of the patients. As to the occluded location, 43.8% occurred in proximal M2, 16.9% in mid M2, 35.4% in more distal middle cerebral artery, and 3.8% in distal anterior cerebral artery. In multivariate logistic analysis, a lower NIHSS score and a lower LAMS score were both independently associated with a good CS (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.82-0.95, p<.001 and OR: 0.77, 95% CI: 0.62-0.96, p=.018, respectively). Patients with poor CS were more likely to manifest as moderate to severe stroke (29.1% vs. 4.5%, p<.001), while patients with good CS had a significantly higher chance of having a minor stroke clinically (40.9% vs. 12.8%, p<.001). CS remains an important determinant in the severity of AIS-DMVO. Collateral enhancement strategies may be a worthwhile pursuit in AIS-DMVO patients with more severe initial stroke presentation, which can be swiftly identified by the concise LAMS and serves as a proxy for underlying poor CS.

Safety Profile of Intra-Arterial Tirofiban as a Rescue Therapy during Mechanical Thrombectomy in Acute Ischemic Stroke

Abstract Purpose This article studies the safety profile and role of intra-arterial (IA) tirofiban as a rescue therapy in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy. Methods This is a retrospective observational study conducted among AIS patients with large vessel occlusion (LVO) eligible for endovascular revascularization and in whom IA tirofiban is given as rescue therapy. If the target vessel shows reocclusion following initial recanalization, flow limiting or significant residual stenosis after thrombectomy, or requires balloon angioplasty or stenting, IA tirofiban at a dose of 0.4 μg/kg/min was administered through the microcatheter in the target vessel followed by intravenous infusion of 0.1 μg/kg/min. The primary safety measure of the study was the incidence of symptomatic hemorrhage. Results The total number of patients in the study group was 82, 36 were in the tirofiban group and 46 were in the non-tirofiban group. Immediate successful reperfusion was achieved in 31 patients (86.1%) and 41 patients (89%) in the tirofiban and non-tirofiban groups, respectively. Note that 19.4 and 25% of patients in the tirofiban group required adjunct techniques of angioplasty and stenting, respectively. Also, 2.7% patient in the tirofiban group had a symptomatic hemorrhage, while 8.7% in the non-tirofiban group had symptomatic intracranial hemorrhage. On multinomial logistic regression, history of transient ischemic attack, truncal occlusion and watershed infarct pattern predicted the usage of IA tirofiban during mechanical thrombectomy. Conclusion Usage of IA tirofiban with or without adjunct techniques as a rescue therapy during mechanical thrombectomy in LVO improved recanalization rates without increasing the risk of symptomatic hemorrhage.

A young woman with acute coronary syndrome and antiphospholipid syndrome. Is it the antiphospholipid syndrome or COVID-19 vaccination or classical risk as the risk factor? a case report

BackgroundAcute coronary syndrome (ACS) in young women is poorly understood due to underdiagnosis and undertreatment. One of the possible risk factors for ACS in young women is antiphospholipid syndrome (APS). Coronavirus disease 2019 (COVID-19) vaccination also emerged as one of the possible risk factors for ACS during the COVID-19 pandemic.Case presentationOur patient, a 39-year-old Batak woman with dyslipidemia and family history of cardiovascular disease, experienced chest pain slightly improved at rest accompanied by autonomic symptoms. She was diagnosed with non-ST-elevation myocardial infarction (NSTEMI) based on her clinical features, dynamic electrocardiogram changes, troponin elevation, and multislice computed tomography angiography confirmed with diagnostic catheterization. The patient was managed by percutaneous coronary intervention with implantation of drug-eluting stents. On follow-up, the patient was diagnosed with APS based on history of preeclampsia with severe features in the first and third pregnancy, spontaneous abortion in the second pregnancy, history of transient ischemic attack, moderately positive lupus anticoagulant on two occasions with an interval of 12 weeks, and ACS. Further investigation revealed a history of COVID-19 vaccination with Sinovac four and six weeks before presentation. The patient was recommended for lifelong warfarin and short-term dual antiplatelet (aspirin and ticagrelor).ConclusionsYoung women are not completely immune to ACS as evident in this case of ACS in a young woman with classical risk factors (dyslipidemia and family history of cardiovascular disease) and APS. Further studies are required to fill the knowledge gap on whether COVID-19 vaccination had any contribution to the ACS in the young woman.

Unilateral Agenesis of the Internal Carotid Artery: A Report of Two Rare Cases

Background: Internal carotid artery (ICA) agenesis occurs when one or both of the blood vessels that supply blood to the brain do not develop. Congenital agenesis of the ICA rarely occurs. It is usually asymptomatic but may sometimes associate with neurological symptoms such as migraine and pulsatile tinnitus. Moreover, differentiating it from occlusion of ICA is important in patients with stroke. Case Report: We report two cases (63-years-old man and 69-year-old woman) of asymptomatic unilateral ICA agenesis who were referred to our cardiovascular hospital for coronary artery bypass graft. Due to a suspicious history of transient ischemic attack, the patients underwent carotid ultrasonography. With findings suggestive of unilateral ICA agenesis at color Doppler, patients underwent computed tomography angiography that confirmed the diagnosis. Conclusion: Suspecting ICA agenesis at color Doppler imaging of the neck and differentiating it from occluded ICA at CT angiography is important for correct diagnosis and management of the patients.

Thrombocytopenia - Is It an Impactful Prognostic Indicator in Patients with Liver Cirrhosis?

Background: Several prognostic scores have been developed to guide management strategies in cirrhotic patients. Child-Pugh and Model of End-stage Liver Disease (MELD) are the typical scores currently used to predict outcomes in cirrhosis, however both do not include platelet count. Although platelet count may provide clues regarding severity of the disease, there is scarcity of data supporting its utility as a prognostic factor in patients with cirrhosis. Hence our study aimed to investigate the association between thrombocytopenia and development of complications as well as mortality in cirrhotic patients. Methods: TheNational Inpatient Sample (NIS) Database was used to sample individuals with liver cirrhosis between 2016 and 2018. Baseline demographics and comorbidities were collected using ICD-10-DM codes. Patients younger than 18, those with missing data, and with history of thromboembolism were excluded. Study patients were then stratified into those with and without thrombocytopenia. Greedy propensity matching using R was performed to match the two cohorts in 1:1 ratio on age, gender, race, use of anti-thrombotic agents, smoking, and nine other comorbidities including diabetes, dyslipidemia, hypertension, morbid obesity, chronic kidney disease, end stage renal disease, chronic heart failure, history of cancer, and history of transient ischemic attack or stroke. Multivariate logistic regression model was used to analyze outcomes. P-value of &amp;lt;0.05 was considered statistically significant. Results: Out of a total of 402,104 cirrhotic patients, 129,461 had thrombocytopenia. Thrombocytopenic patients were younger, male pre-dominant, and healthier with lower prevalence of all comorbidities and anti-thrombotic use. Thrombocytopenic patients had statistically significant higher mortality (6.4% vs 5.6%), venous thromboembolism (1.6% vs 1.5%), variceal bleeding (6.9% vs 4.3%), spontaneous bacterial peritonitis (3.9% vs 3%), portal hypertension (35.8% vs 23.9%), hepatorenal syndrome (5.5% vs 3.8%), hyponatremia (23.7% vs 19%), jaundice (0.6% vs 0.4%) and abnormal coagulation profile (2.2% vs 1.6%). Multivariate logistic regression model after matching showed similar outcomes with thrombocytopenic patients having higher mortality (OR: 1.13 [1.09 - 1.18];p&amp;lt;0.001) and statistically significant higher rates of all other complications. Conclusion: Thrombocytopenia was significantly associated with higher mortality and complications in liver cirrhosis. These findings highlight the importance of considering thrombocytopenia as a poor prognostic factor when evaluating patients with liver cirrhosis. Further randomized controlled trials are needed to corroborate these findings and explore the benefit of addition of platelet count to the current prognostic scores used in clinical practice to estimate outcomes in liver cirrhosis.

Development and validation of a clinical prediction model for 90-day venous thromboembolism risk following total hip and total knee arthroplasty: a multinational study

BackgroundThe risk of venous thromboembolism (VTE) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is 1.0% to 1.5%, despite uniform thromboprophylaxis. ObjectivesTo develop and validate a prediction model for 90-day VTE risk. MethodsA multinational cohort study was performed. For model development, records were used from the Oxford Royal College of General Practitioners Research and Surveillance Centre linked to Hospital Episode Statistics and Office of National Statistics UK routine data. For external validation, data were used from the Danish Hip and Knee Arthroplasty Registry, the National Patient Registry, and the National Prescription Registry. Binary multivariable logistic regression techniques were used for development. ResultsIn the UK data set, 64 032 THA/TKA procedures were performed and 1.4% developed VTE. The prediction model consisted of age, body mass index, sex, cystitis within 1 year before surgery, history of phlebitis, history of VTE, presence of varicose veins, presence of asthma, history of transient ischemic attack, history of myocardial infarction, presence of hypertension and THA or TKA. The area under the curve of the model was 0.65 (95% CI, 0.63-0.67). Furthermore, 36 169 procedures were performed in the Danish cohort, of whom 1.0% developed VTE. Here, the area under the curve was 0.64 (95% CI, 0.61-0.67). The calibration slope was 0.92 in the validation study and 1.00 in the development study. ConclusionThis clinical prediction model for 90-day VTE risk following THA and TKA performed well in both development and validation data. This model can be used to estimate an individual’s risk for VTE following THA/TKA.

Co-Diagnosis of Sickle Cell and Chronic Myelogenous Leukemia: Exploratory Analysis from a Nationally Representative Database

Background: Chronic myelogenous leukemia (CML) developing in patients with sickle cell disease (SCD) has been reported infrequently in case studies to date (1). Prevalent thought relates its infrequency to the shortened life expectancy in the SCD population. However, with advancements in medical care, longevity of these patients has been increasing. Resultingly, risk factors for CML related to their disease and its treatments may accumulate, including chronic inflammation, heightened cell turnover, iron overload, immunomodulation from frequent transfusions, blood and marrow transplantation, and hydroxyurea use (2,3). Most specifically, the elevated and continuous inflammatory cell stimulation due to vaso-occlusion may enhance changes in granulocytic cell differentiation, increasing the risk for CML (3). By leveraging a nationwide database, we aim to describe characteristics associated with the development of CML in SCD patients. Methods: Hospitalizations for SCD and CML were identified using ICD-10 coding from the 2020 National Inpatient Sample (NIS). Those hospitalizations with a co-diagnosis of SCD and CML were included in this study, and further evaluated for demographics, comorbidities, transfusion status, length of stay, mortality, and charges during admission. The NIS is the largest all-payer inpatient database in the US and approximates a 20% stratified sample of inpatient discharges from &amp;gt;5000 hospitals across 48 states (98% of U.S. population). Sampling weights were applied to generate nationally representative estimates. Results: In the 2020 NIS sample upon weighting, there were 60 hospitalizations with a co-diagnosis of SCD and CML. The vast majority of these patients presented with active CML (92%) and in sickle cell crisis (83%). Overall, half of the sample comprised those patients who were between the ages of 29.5-49 years old, with a median age of 40.5. Fifty percent (n=30) of the hospitalizations were female; 92% (n=55) were African American; 58% were hospitalized in the Southern region; 25% in the West, and 17% in the Northeastern United States. The majority of hospitalizations (92%) occurred in teaching hospitals and 83% were in large-bed size hospitals. Common comorbidities were similar to that expected in the general SCD population, including history of transient ischemic attack (42%), history of pulmonary embolism/venous thromboembolism (42%), chronic kidney disease (33%), anemia (33%), and pulmonary hypertension (33%). Seventeen percent of patients had a transfusion during the hospitalization (n=15). The mean length of stay among these hospitalizations was 4.25 days. There were no deaths during these hospitalizations. Mean charges during hospitalization were $53,973. Conclusion: Previously observed in rare case studies, here we present an exploratory analysis from a national inpatient database demonstrating a population of 60 adult patients with SCD and a co-diagnosis of CML. Specifically, we observe concomitant development of CML in the SCD patient population correlated with a younger age (median age 40.5) than expected compared to traditional CML patients (median age 64). There is some evidence to suggest that chronic inflammation associated with sickle cell with extended life expectancies and treatment burden may be associated with myeloid cancers. These studies will need to be followed up with prospective analyses to investigate a potential increased risk of CML in the SCD population. Literature Cited: 1. Chen L et al., Chronic myelogenous leukemia in sickle cell anemia. Arch Pathol Lab Med. 2005;129(3):423-424. doi:10.5858/2005-129-423-CMLISC 2. Brunson A et al., Increased risk of leukemia among sickle cell disease patients in California. Blood. 2017;130(13):1597-1599. doi:10.1182/blood-2017-05-78323. 3. Stankovic et al., Chronic myeloid leukaemia and sickle cell disease: could imatinib prevent vaso-occlusive crisis?. Br J Haematol. 2011;155(2):271-272. doi:10.1111/j.1365-2141.2011.08670.x

Short-term effects of ambient oxidation, and its interaction with fine particles on first-ever stroke: A national case-crossover study in China

Stroke is a significant global cause of disability and death, and its burden has been on the rise, while ambient air pollution has been conclusively linked to stroke incidence. However, knowledge about effects of atmospheric oxidation on stroke and its interactions with fine particles (PM2.5) are still limited. In this study, we investigated the short-term effects of ambient NO2, O3, and their combined oxidation (Owt) on first-ever stroke, based on data from the China National Stroke Screening Survey (CNSSS) conducted from 2013 to 2015. We found significant association between ambient NO2 exposure at lag0 day with first-ever stroke, with a 13.1 % (95 % CI: 3.5 %, 23.6 %) increase in the first-ever stroke risk per 10 μg/m3 exposure. We also found a significant interaction between NO2 and PM2.5 (p < 0.05): first-ever stroke risk increased 23.8 % (95 % CI: 9.6 %, 39.8 %) per 10 μg/m3 NO2 exposure in population exposed to higher PM2.5 concentrations, while no significant association was found in population exposed to lower PM2.5 concentrations. The results of stratified analyses indicated that physical inactivity enhanced the detrimental effects of O3 and Owt exposure, while smoking and transient ischemic attack (TIA) history enhanced the detrimental effects of NO2 exposure. However, TIA history appeared to mitigate the adverse effects of O3 exposure. This study is helpful to better understand the impact of ambient oxidation on stroke, as well as its interaction with PM2.5, and has implications for policies and standards for atmospheric protection and governance.

Vessel wall MRI in moyamoya disease: arterial wall enhancement varies depending on age, arteries, and disease progression

ObjectiveTo investigate the relationship of followings for patients with moyamoya disease (MMD): arterial wall enhancement on vessel wall MRI (VW-MRI), cross-sectional area (CSA), time-of-flight MR angiography (MRA), age, locations from intracranial internal carotid artery (ICA) to proximal middle cerebral artery (MCA), disease progression, and transient ischemic attack (TIA).MethodsPatients who underwent VW-MRI between October 2018 and December 2020 were enrolled in this retrospective study. We measured arterial wall enhancement (enhancement ratio, ER) and CSA at five sections of ICA and MCA. Also, we scored MRA findings. Multiple linear regression (MLR) analysis was performed to explore the associations between ER, age, MRA score, CSA, history of TIA, and surgical revascularization.ResultsWe investigated 102 sides of 51 patients with MMD (35 women, 16 men, mean age 31 years ± 18 [standard deviation]). ER for MRA score 2 (signal discontinuity) was higher than ER for other scores in sections D (end of ICA) and E (proximal MCA) on MLR analysis. ER in section E was significantly higher in patients for MRA score 2 with TIA history than without. ER significantly increased as CSA increased in section E, which suggests ER becomes less in decreased CSA due to negative remodeling.ConclusionArterial wall enhancement in MMD varies by age, location, and disease progression. Arterial wall enhancement may be stronger in the progressive stage of MMD. Arterial wall enhancement increases with history of TIA at proximal MCA, which may indicate the progression of the disease.Clinical relevance statementArterial wall enhancement in moyamoya disease varies by age, location of arteries, and disease progression, and arterial wall enhancement may be used as an imaging biomarker of moyamoya disease.Key PointsIt has not been clarified what arterial wall enhancement in moyamoya disease represents.Arterial wall enhancement in moyamoya disease varies by age, location of arteries, and disease progression.Arterial wall enhancement in moyamoya disease increases as the disease progresses.Graphical abstract

A clinical case of successful treatment of coronary artery dissection and left ventricular thrombosis in a young man carrier of factor V Leiden gene and transient ischemic attack

One of the causes of transient ischemic attack or ischemic stroke are mass formations in the left heart. One of the predisposing factors for thrombosis is the presence of the Leiden mutation, as the most common form of hereditary thrombophilia in the European population. At the same time, spontaneous dissection of the coronary arteries (SCA) can be one of the reasons of an acute vascular accident. Of particular difficulty is differential diagnosis, which requires additional examination methods (intravascular ultrasound, optical coherence tomography) in addition to coronary angiography. The presented clinical case describes the diagnosis and successful treatment of spontaneous anterior interventricular artery dissection, left ventricular thrombosis, detection of factor V Leiden gene mutation in a young man with a history of transient ischemic attack

Risk factors for ischemic stroke in men and women aged 45–74 years

Stroke is one of the leading causes of death and primary disability and contributes significantly to the global burden of disease. Identification of individuals at high risk of ischemic stroke (IS) is an important component of disease prevention. The differences between risk factors (RF) for stroke in men and women are not well understood.Objective: to determine the predictive value of RF for the development of IS in men and women aged 45–74 years.Material and methods. The study included 728 patients (380 men and 348 women) aged 45–74 years, including 392 patients (247 men and 145 women) with IS in the carotid artery basin (main group) and 336 patients (133 men and 203 women) with vascular cognitive impairment (comparison group). To build predictive models to assess the impact of RF on the development of IS in men and women, we used the logistic regression method with stepwise exclusion of variables according to the Wald algorithm.Results. The predictive regression model of IS in men includes atherosclerotic stenosis of the internal carotid arteries [odds ratio (OR) 3.571; 95% confidence interval (CI) 1.792–7.114], in a predictive regression model in women – diabetes mellitus type 2 (OR 5.074; 95% CI 1.768–14.561) and a history of IS (OR 6.857; 95% CI 1.825–25.762). Other risk factors for the development of IS (atrial fibrillation, history of transient ischemic attack, arterial hypertension stage) affected both men and women.Conclusion. Atherosclerotic stenosis of the internal carotid arteries was found to be a sex-specific prognostic factor for IS in men, and type 2 diabetes mellitus and a history of IS in women.

Risk Factors for Cerebral Hyperperfusion Syndrome following Carotid Revascularization

Cerebral hyperperfusion syndrome (CHS) is a rare but known complication of carotid revascularization that can result in severe postoperative disability and death. CHS is a well-described sequela of carotid endarterectomy (CEA) and, more recently, of transfemoral carotid artery stenting (TFCAS), but its incidence after transcarotid artery revascularization (TCAR) has not been delineated. The aims of this study were to determine the impact of procedure type (CEA versus TCAR versus TFCAS) on the development of CHS as well as to identify perioperative risk factors associated with CHS. The Society for Vascular Surgery Vascular Quality Initiative was queried for patients aged ≥18years who underwent CEA, TCAR, or TFCAS from 2015-2021. Emergent procedures were excluded. The primary outcome was postoperative development of CHS, defined as the presence of postoperative seizures, intracerebral hemorrhage due to hyperperfusion, or both. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with CHS. 156,003 procedures were included (72.7% CEA, 12.4% TCAR, and 14.9% TFCAS). The incidence of CHS after CEA, TCAR, and TFCAS were 0.15%, 0.18%, and 0.53%, respectively. There was no significant difference in risk of CHS after TFCAS compared to CEA (odds ratio [OR]: 1.21; 95% confidence interval [CI] 0.76-1.92; P=0.416), nor was there a difference between TCAR and CEA (OR: 0.91; 95% CI 0.57-1.45; P=0.691). Perioperative risk factors associated with an increased risk of CHS included previous history of transient ischemic attack or stroke (OR: 2.50; 95% CI 1.69-3.68; P<0.0001), necessity for urgent intervention within 48hr (OR: 2.03; 95% CI 1.43-2.89; P<0.0001), treatment of a total occlusion (OR: 3.80; 95% CI 1.16-12.47; P=0.028), and need for postoperative intravenous blood pressure medication (OR: 5.45; 95% CI 3.97-7.48; P<0.0001). Age, preoperative hypertension, degree of ipsilateral stenosis less than or equal to 99%, and history of prior carotid procedures were not statistically associated with an increased risk of CHS. Discharging patients on an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker was associated with a decreased risk of developing CHS (OR: 0.47; 95% CI 0.34-0.65; P<0.0001). Compared with CEA, TCAR and TFCAS were not statistically associated with an increased risk of postoperative CHS. Patients with a previous history of transient ischemic attack or stroke, who require urgent intervention or postoperative intravenous blood pressure medication, or who are treated for a total occlusion are at a higher risk of developing CHS. Using an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker on discharge appears to be protective against CHS and should be considered for the highest risk patients.

Pulmonary vein flow split effects in patient-specific simulations of left atrial flow

Disruptions to left atrial (LA) blood flow, such as those caused by atrial fibrillation (AF), can lead to thrombosis in the left atrial appendage (LAA) and an increased risk of systemic embolism. LA hemodynamics are influenced by various factors, including LA anatomy and function, and pulmonary vein (PV) inflow conditions. In particular, the PV flow split can vary significantly among and within patients depending on multiple factors. In this study, we investigated how changes in PV flow split affect LA flow transport, focusing for the first time on blood stasis in the LAA, using a high-fidelity patient-specific computational fluid dynamics (CFD) model. We use an Immersed Boundary Method, simulating the flow in a fixed, uniform Cartesian mesh and imposing the movement of the LA walls with a moving Lagrangian mesh generated from 4D Computerized Tomography images. We analyzed LA anatomies from eight patients with varying atrial function, including three with AF and either a LAA thrombus or a history of Transient Ischemic Attacks (TIAs). Using four different flow splits (60/40% and 55/45% through right and left PVs, even flow rate, and same velocity through each PV), we found that flow patterns are sensitive to PV flow split variations, particularly in planes parallel to the mitral valve. Changes in PV flow split also had a significant impact on blood stasis and could contribute to increased risk for thrombosis inside the LAA, particularly in patients with AF and previous LAA thrombus or a history of TIAs. Our study highlights the importance of considering patient-specific PV flow split variations when assessing LA hemodynamics and identifying patients at increased risk for thrombosis and stroke. This knowledge is relevant to planning clinical procedures such as AF ablation or the implementation of LAA occluders.

Does bariatric surgery change the risk of acute ischemic stroke in patients with a history of transient ischemic attack? A nationwide analysis.

Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults. We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery. Academic hospital, United States. Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment). A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group. After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.

Diagnosing Functional Neurological Disorder through History and Physical Examination: A Case Report

Differentiating between stroke and stroke mimics (i.e., non-vascular conditions) is a major challenge, as they often involve similar presenting symptoms. A common type of stroke mimic is functional neurological disorder (FND), a somatic disorder caused by severe stress, emotional conflict, or a psychiatric disorder usually presenting with one or more neurologic symptoms. This condition is associated with voluntary motor and sensory symptoms that are internally inconsistent with identifiable neurological diseases and lack structural lesions. We describe a 54-year-old female with a history of transient ischemic attack resulting in bilateral blindness and recent social stressors, who presented with right-sided facial and extremity motor and sensory deficits, bilateral diplopia, and dysphagia. Her left upper and lower extremities had 2 out of 5 motor strength, a weak hand squeeze, and a positive Babinski reflex on the contralateral side of her weakness, which resolved the next day. In addition, decreased sensation to light touch and temperature over the right arm and leg were appreciated without a dermatomal pattern. Given the negative stroke work-up, atypical physical exam findings, prior history of blindness, and in the setting of recent psychological stressors, her acute motor and sensory deficits were diagnosed as FND after evaluation by the Neurology service. The current case demonstrates the following important features of making a FND diagnosis: 1) careful history taking in eliciting potential psychological stressors; 2) a comprehensive neurological examination assessing the presence of findings specific for FND (e.g., greater weakness with active rather than passive movements, fluctuating weakness); 3) multidisciplinary collaboration with neurology and psychiatry providers to aid in performing a comprehensive assessment.

Factors that pre-determine the main subtypes of ischemic stroke in middle-aged and senior women

Introduction. Brain health and active longevity are affected by a number of stroke risk factors. We should identify their relative impact on the main subtypes of ischemic stroke (IS) in middle-aged and senior women to consider prevention and management strategies.&#x0D; Objective. To assess prevalence of isolated and combined factors that may contribute with a high probability to development of the various IS subtypes in women aged 4574 years.&#x0D; Materials and methods. The study included 348 female patients aged 4574 years including 145 inpatients with carotid IS (main group) from Neurology Department 2, the Research Center of Neurology, and 203 women with cognitive disorders due to the chronic cerebral ischemia (controls). To assess the impact of various risk factors on the main IS subtypes, we generated multivariate predictive models using logistic regression and the Wald test.&#x0D; Results. Predictive modeling of atherothrombotic IS demonstrated that type 2 diabetes mellitus increases IS risk by over 5 times (odds ratio [OR] = 5.961; 95% confidence interval [CI] 1.10232.257; р = 0.038); internal carotid artery stenosis, by 7 times (OR = 7.187; 95% CI 1.82728.273; р = 0.005); history of transient ischemic attacks (TIA), by 61 times (OR = 61.442; 95% CI 7.673491.998; р 0.001); excessive alcohol intake, by 49 times (OR = 49,382; 95% CI 4.557535.121; р = 0.001); and HTN severity, by 4 times (OR = 4.445; 95% CI 2.3318.476; р 0.001). Predictive modeling of cardioembolic IS demonstrated that post-infarction cardiosclerosis increases IS risk by over 118 times (OR = 118.025; 95% CI 5.2102673.796; р = 0.003), atrial fibrillation, by 108 times (OR = 108.493; 95% CI 24.312484.159; р 0.001), history of TIA, by over 71 times (OR = 71.558; 95% CI 7.945644.535; р 0.001); and HTN severity, by over 3 times (OR = 3.957; 95% CI 2.0697.566; р 0.001). Predictive modeling of lacunar IS demonstrated that type 2 diabetes mellitus increases IS risk by 8 times (OR = 8.324; 95% CI 1.92336.041; р = 0.005), history of IS, by over 8 times (OR = 8.99; 95% CI 1.77245.598; р = 0.008); and HTN severity, by 7 times (OR = 7.139; 95% CI 3.49114.599; р 0.001).&#x0D; Conclusion. We identified a number of risk factors that may contribute to the development of the main IS subtypes in middle-aged and senior women.

Association of vascular and degenerative brain pathologies and past medical history from the National Alzheimer's Coordinating Center Database.

The relationship between past medical histories (PMH) and dementia-related neuropathologies is not well understood. Using the National Alzheimer's Coordinating Center (NACC) database, we explored the relationship between patient-reported PMH and various vascular and degenerative neuropathologies. We examined the following PMH: transient ischemic attack (TIA), stroke, traumatic brain injury, seizures, hypertension, cardiovascular events, hypercholesterolemia, B12 deficiency, diabetes mellitus, and thyroid disease. We dichotomized the following neuropathologies: atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy (CAA), Alzheimer disease neuropathology (ADNP), Lewy bodies (LB), hippocampal sclerosis, frontotemporal lobar degeneration (FTLD), and TAR DNA-binding protein-43 (TDP-43). Separate logistic regression models assessed the relationship between the outcome of individual neuropathologies and all PMHs. Additional logistic regressions were stratified by sex to further examine these associations. Hypertension history was associated with an increased likelihood of atherosclerosis (OR = 1.7) and arteriolosclerosis (OR = 1.3), but decreased odds of ADNP (OR = 0.81), CAA (OR = 0.79), and LB (OR = 0.78). History of TIA was associated with an increased likelihood of atherosclerosis (OR = 1.3) and arteriolosclerosis (OR = 1.4) and lower odds of ADNP (OR = 0.72). Seizure history was associated with an increased likelihood of ADNP (OR = 1.9) and lower odds of FTLD (OR = 0.49). Hypertension history was associated with a greater likelihood of vascular pathologies yet a lower likelihood of ADNP and other neurodegenerative pathologies.

Cardiometabolic risk factors and antithrombotic treatment in a Mexican population with atrial fibrillation and heart failure with reduced ejection fraction.

Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.