Male Stroke Patients Research Articles

Factors Predicting the Ability to Perform Activities of Daily Living among Stroke Patients in Rural Community Southern Thailand.

The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand. In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05. Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05). Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.

P.017 Ischemic stroke in young adults: a comparison of outcomes, stroke risk factors and etiologies between males and females

Background: The primary aim was to determine if functional outcomes among young adults with stroke differed based on sex. The secondary aim was to identify differences in stroke risk factors and etiologies between females and males. Methods: Retrospective analysis of acute ischemic stroke patients aged 18 to 55 years from a stroke registry between 2018 to 2022. Multivariable logistic regression to analyse if modified Rankin Scale at 3-6 months (mRS, 0-2 versus 3-6) was associated with sex. Results: 315 patients (127 female), median age 48 years (IQR 42-52), median NIHSS 10 (IQR 4-19, median mRS (3-6 months) 2 (IQR 1-3). Following adjustment for vascular risk factors, clinical stroke characteristics, baseline mRS and stroke time metrics no significant difference in mRS (3-6 months) based on sex (p=0.40). Females more frequently had an unknown time of stroke onset (p=0.03). Large-artery atherosclerosis as a stroke etiology (p=0.01), known atrial fibrillation (p=0.03) and drug use (p=0.003) were more frequent in males. Conclusions: Patient-oriented outcomes maybe of interest in future studies as functional mRS outcomes do not differ between young male and female stroke patients. Males had a higher prevalence of large-artery atherosclerosis and risk factors including drug use and atrial fibrillation. These findings could help develop targeted stroke prevention strategies.

Association of Metallic and Nonmetallic Elements with Fibrin Clot Properties and Ischemic Stroke.

Objectives-Metallic elements and fibrin clot properties have been linked to stroke. We examined metallic and nonmetallic elements, fibrin clot lysis time (CLT), and maximum absorbance (Absmax) in relation to ischemic stroke. Design-A case-control study of ischemic stroke patients vs. healthy individuals. Subjects and Methods-Plasma and serum were collected from 260 ischemic stroke patients (45.0% women; age, 68 ± 12 years) and 291 healthy controls (59.7% women; age, 50 ± 17 years). Fibrin CLT and Absmax were measured using a validated turbidimetric assay. Serum elements were quantified by inductively coupled plasma mass spectrometry (ICP-MS) and optical emission spectrometry (ICP-OES). Data were analyzed by bivariate correlations and multiple or logistic regression. Results-In female stroke patients, copper, lithium, and aluminum were significantly lower compared with controls; in male stroke patients, potassium was lower, and beryllium was elevated. In female and male stroke patients, iron, zinc, nickel, calcium, magnesium, sodium, and silicon were significantly lower, while strontium was elevated. Positive correlations between fibrin clot properties and metals, observed in healthy controls, were lost in ischemic stroke patients. In multivariate regression analysis, fibrin CLT and/or Absmax was associated with zinc, calcium, potassium, beryllium, and silicon in stroke patients and with sodium, potassium, beryllium, and aluminum in controls. In logistic regression analysis, stroke was independently associated with lithium, nickel, beryllium, strontium, boron, and silicon and with sodium, potassium, calcium, and aluminum but not with fibrin CLT/Absmax. Conclusions-Various elements were associated with fibrin clot properties and the risk of ischemic stroke. Lithium, sodium, calcium, and aluminum abrogated the association of fibrin clot properties with ischemic stroke.

Homocysteine thiolactone and other sulfur-containing amino acid metabolites are associated with fibrin clot properties and the risk of ischemic stroke

Homocysteine (Hcy) and Hcy-thiolactone (HTL) affect fibrin clot properties and are linked to cardiovascular disease. Factors that influence fibrin clot properties and stroke are not fully understood. To study sulfur-containing amino acid metabolites, fibrin clot lysis time (CLT) and maximum absorbance (Absmax) in relation to stroke, we analyzed plasma and urine from 191 stroke patients (45.0% women, age 68 ± 12 years) and 291 healthy individuals (59.7% women, age 50 ± 17 years). Plasma and urinary levels of sulfur-containing amino acid metabolites and fibrin clot properties were significantly different in stroke patients compared to healthy individuals. Fibrin CLT correlated with fibrin Absmax in healthy males (R2 = 0.439, P = 0.000), females (R2 = 0.245, P = 0.000), female stroke patients (R2 = 0.187, P = 0.000), but not in male stroke patients (R2 = 0.008, P = ns). Fibrin CLT correlated with age in healthy females but not males while fibrin Absmax correlated with age in both sexes; these correlations were absent in stroke patients. In multiple regression analysis in stroke patients, plasma (p)CysGly, pMet, and MTHFR A1298C polymorphism were associated with fibrin Absmax, while urinary (u)HTL, uCysGly, and pCysGly were significantly associated with fibrin CLT. In healthy individuals, uHTL and uGSH were significantly associated with fibrin Absmax, while pGSH, and CBS T833C 844ins68 polymorphism were associated with fibrin CLT. In logistic regression, uHTL, uHcy, pCysGly, pGSH, MTHFR C677T polymorphism, and Absmax were independently associated with stroke. Our findings suggest that HTL and other sulfur-containing amino acid metabolites influence fibrin clot properties and the risk of stroke.

Prevalence and pattern of dyslipidemia among patients with ischemic stroke in a tertiary care center in south- south Nigeria

Background: Stroke is a major public health problem worldwide. Dyslipidemia is a significant risk factor for ischemic stroke, but its prevalence and characteristics in this population remain understudied. Therefore, this study aims to investigate the prevalence and patterns of dyslipidemia among individuals diagnosed with ischemic stroke in a tertiary care center in South-South Nigeria. Materials and Method: This is a retrospective hospital-based study on Ischaemic stroke patients admitted to GoodHeart Medical Consultant Hospital, Port- Harcourt, Rivers state, Nigeria, from July 2022 to June 2023. Results: The study comprised 33 subjects consisting of 18(54.5%) males and 15(45.5%) females. The mean age of the total population was 62.6 ± 12.49. The most prevalent age group was elderly (&gt;61 years) 20 (60.6%). The females were older than the males with a mean age of 64.1 ± 2.50 and 61.3 ± 12.69 respectively. The overall prevalence of dyslipidaemia was 97%, whereas the most common form of dyslipidaemia was reduced HDL (57.6%). There was no significant difference in dyslipidaemia among male and female stroke patients, nevertheless 63.6% of the males had dyslipidaemia. Conclusion: Dyslipidaemia was common in the overall study population particularly reduced HDL and elevated LDL. The study revealed no statistically significant difference between gender and dyslipidaemia in stroke patients, nevertheless dyslipidaemia was more in the male stroke patients than females. Hence, prevention of dyslipidaemia as well as other risk factors is key to reducing the burden of stroke in our country.

Correlation between plasma lipoprotein-associated phospholipase A2 levels and risk of ischaemic stroke recurrence by gender in the Chinese population

ABSTRACT Objective To investigate the correlation between gender differences in plasma lipoprotein phospholipase A2 (Lp-PLA2) levels and the risk of recurrent stroke in patients with acute ischaemic stroke in China. Methods We conducted a prospective follow-up study that included baselineLp-PLA2 levels and NIH Stroke Scale (NIHSS) scores in patients with ischaemic stroke upon admission. The diagnostic efficacy of the baseline Lp-PLA2 level for stroke recurrence was evaluated. And Kaplan‒Meier method was used to analyse the difference in the risk of recurrent stroke between these two groups among males and females. A paired t test was used to analyse the difference in Lp-PLA2 levels in male and female patients after follow-up. Results Baseline plasma Lp-PLA2 was higher in men and women with recurrent stroke than in those without recurrent stroke. The correlation between baseline Lp-PLA2 and neurological impairment was higher in female than male stroke patients (R = 0.338 and 0.253, respectively). Although weakly correlated with neurological impairment, baseline Lp-PLA2 was more effective in predicting recurrent stroke (AUC = 0.705 in men, 0.788 in women). A Cox model was used to compare the risk of stroke between the high- and low-Lp-PLA2 groups (OR = 3.98 in men, 2.61 in women). According to the follow-up time of 6 months as the node, Lp-PLA2 will give different risk indicators. Conclusion Elevated plasma Lp-PLA2 is an independent risk factor for recurrent ischaemic stroke but is not strongly associated with the degree of cerebral damage. The predictive value of baseline Lp-PLA2 for stroke recurrence risk was higher in females than in males.

Prevalence and Pattern of Stroke Cases Seen at the Neurology Clinic of Physiotherapy Department, University of Port Harcourt Teaching Hospital, Port Harcourt: A Ten-Year Retrospective Study .

Background: Stroke is a condition of public health concern. It affects people of different age brackets, leading to long-term debilitation with a significant percentage of survivors left with permanent disabilities Methods: The study adopted a descriptive retrospective study design in which the data of a total of 338 adult male and female stroke patients who attended the neurology clinic of Physiotherapy Department, University of Port Harcourt Teaching Hospital (UPTH), between December 2012 and December 2022 were retrieved and studied following ethical clearance. Data were analysed using the Statistical Package for Social Science (SPSS) version 25. Descriptive statistics was used to present the data in frequency tables. Results: Majority of the stroke patients were male 208 (61.5%), married 300 (88.8%), and between the ages of 51 and 60 (28.7%). The most common type of stroke was ischaemic stroke 295 (87.2%) with majority between the age bracket of 61-70 (26.6%). First episode of stroke was the most prevalent 301 (89.0%) with majority of the survivors between the age bracket of 51-60 (25.7%). Hypertension was the most prevalent risk factor 195 (57.7%) and was also most prevalent among the age bracket of 51-60 (16.0%). Lastly, majority of the stroke patients had right sided hemiparesis 192 (56.9%). Conclusion: The risk factors and clinical presentation of stroke vary from individuals to individuals. Adequate education, counseling, medical, and financial support should be given to stroke survivors in order to prevent and manage the condition.

Feasibility of Sarcopenia Diagnosis Using Stimulated Muscle Contraction Signal in Hemiplegic Stroke Patients.

Sarcopenia, a condition characterized by muscle weakness and mass loss, poses significant risks of accidents and complications. Traditional diagnostic methods often rely on physical function measurements like handgrip strength which can be challenging for affected patients, including those with stroke. To address these challenges, we propose a novel sarcopenia diagnosis model utilizing stimulated muscle contraction signals captured via wearable devices. Our approach achieved impressive results, with an accuracy of 93% and 100% in sarcopenia classification for male and female stroke patients, respectively. These findings underscore the significance of our method in diagnosing sarcopenia among stroke patients, offering a non-invasive and accessible solution.

Effect of Sit-to-Stand Training on Balance, Muscle Strength, and Activities of Daily Living in Patients with Stroke: A Randomised Controlled Trial

Introduction: Patients who have had a stroke often experience issues with static balance while sitting and standing. Additionally, they may encounter problems with dynamic balance, particularly when transitioning between sitting and standing positions, leading to reduced postural stability in both static and dynamic standing. This also contributes to weakness in the affected lower limb and decreased engagement in Activities of Daily Living (ADL). Nevertheless, few studies have investigated the impact of sit-to-stand training on balance, muscle strength, and ADL in stroke patients. Aim: To assess the impact of sit-to-stand training on balance, muscle strength, and ADL in patients who have had a stroke. Materials and Methods: This trial was an experimental, parallel, and assessor-blinded allocation with a computer-generated randomisation sequence. Sixty-six stroke patients (33 in each group) were enrolled from the inpatient Department of Medicine and the neurosurgery ward of Justice KS Hegde Charitable Hospital in Deralakatte, Mangaluru, Karnataka, India based on specific selection criteria. The trial was conducted from March 2022 to March 2023. Inclusion criteria included patients who had experienced a stroke involving the Anterior Cerebral Artery (ACA) and Middle Cerebral Artery (MCA), encompassing both ischaemic and haemorrhagic types of stroke, aged between 35-60 years, and including both male and female stroke patients who were able to effectively communicate and comprehend instructions. Other criteria included a Mini-Mental State Examination (MMSE) score greater than or equal to 23, the ability to independently have a transition from a supine position to a seated position, and a minimum score on the trunk impairment scale. In the experimental group, participants received sit-to-stand training for 45 minutes over five days, while the control group received conventional physical therapy, including tandem walking, single leg stance, double leg stance, early mobilisation, position and balance training exercises for 45 minutes over five days. The primary outcomes used for balance assessment were the Berg Balance Scale (BBS), and for ADL, the Barthel Index (BI) Scale was used, with muscle strength being measured using a push and pull dynamometer. The independent sample t-test was used to compare between groups, and within-group comparisons were conducted using the paired t-test. A p-value &lt;0.05 was considered significant. Results: Significant differences (p-value=0.044) were observed in BBS score and muscle strength between the groups during both the pretest (Day-1) and post-test (Week-1). The BI exhibited a significant difference (p-value=0.016) during the post-test (Week-1) only. Additionally, a significant difference (p-value&lt;0.001) was found in muscle strength, specifically in the Hip Extensors (HE) between the groups. Conclusion: The results of the current study showed a statistically significant difference in muscle strength of the HE. However, no significant difference was observed in BI and BBS between the groups. No side-effects or harms were reported, indicating that the approach is safe and feasible for stroke patients.

Sex Differences in Severity and Risk Factors for Ischemic Stroke in Patients With Hyperlipidemia.

This study aims to determine sex differences in poststroke hypertriglyceridemia (serum triglyceride levels ⩾ 200 mg/dl) and high stroke severity in ischemic stroke patients. Our study analyzed data from 392 males and 373 females with hypertriglyceridemia. Stroke severity on admission was measured using the National Institute of Health Stroke Scale (NIHSS) with a value ⩽7 indicating a more favorable post-stroke prognosis while a score of >7 indicates poorer post-stroke outcomes. Logistic regression models adjusted for demographic and risk factors. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each clinical risk factor were used to predict the increasing odds of an association of a specific clinical baseline risk factor with the male or female AIS with hypertriglyceridemia. In the adjusted analysis, male patients with hypertriglyceridemia, diastolic blood pressure (OR = 1.100, 95% CI, 1.034-1.171, P = .002), and Ischemic stroke mortality (OR = 6.474, 95% CI, 3.262-12.847, P < .001) were significantly associated with increased stroke severity. In female patients with hypertriglyceridemia, age (OR = 0.920, 95% CI, 0.866-0.978, P = .008) was associated with reduced stroke severity, while ischemic stroke mortality score (OR = 37.477, 95% CI, 9.636-145.756, P < .001) was associated with increased stroke severity. Increased ischemic stroke mortality risk score was associated with increased severity in both male and female AIS patients with hypertriglyceridemia. Our findings provide information about sex differences in specific risk factors that can be managed to improve the care of male and female ischemic stroke patients with hypertriglyceridemia.

Effect of Diurnal Temperature Range on the Number of Residents Hospitalized Due to Stroke in Lanzhou

Objective To analyze the relationship between diurnal temperature range (DTR) and the hospitalization of stroke in Lanzhou,so as to provide a scientific basis for probing into the mechanism of temperature changes in inducing stroke and formulating comprehensive prevention and control measures for stroke by relevant departments.Methods The information of the patients hospitalized due to stroke in Lanzhou during January 2014 to December 2019 and the air pollutants (PM10,SO2,and NO2) and meteorological data in the same period were collected for statistical analysis.Spearman rank correlation analysis was performed to analyze the correlations between air pollutants and meteorological factors.The distributed lag nonlinear model was adopted to fit the relationship between DTR and the number of stroke inpatients,and three-dimensional diagrams and the correlation diagrams of DTR against stroke risk were established.The stratified analysis was performed according to gender and age (< 65 years and ≥65 years).Results From 2014 to 2019,a total of 92 812 stroke patients were hospitalized in Lanzhou,with a male-to-female ratio of 1.35:1.There was a nonlinear relationship between DTR and the number of stroke inpatients in Lanzhou,which presented a lag effect.The low DTR at 4.5 ℃ had the largest RR value of 1.25 (95%CI=1.16-1.35) for stroke inpatients at a cumulative lag of 18 d.The effect of high DTR (18.5 ℃) on the hospitalization of stroke patients peaked at a cumulative lag of 21 d,with an RR value of 1.09 (95%CI=1.01-1.18).The stratified analysis results suggested that low levels of DTR had greater effects on the hospitalization of male stroke patients and stroke patients <65 years.Conclusions Short-term exposure to different levels of DTR had an impact on the number of stroke inpatients,and low levels of DTR had a slightly greater impact on stroke inpatients than high levels of DTR.Importance should be attached to the protection of males and people aged <65 years at low levels of DTR.

COVID-19 Pandemic Brings Challenges to the Management of Stroke-The Differences Between Stroke Cases Admitted to a Tertiary Hospital Before and During COVID-19 Pandemic in China.

An international public health emergency has resulted from the emergence of the new coronavirus-2. Both direct and indirect influences have been felt on the treatment of acute stroke. However, no conclusive link between COVID-19 and the alleged decline in admissions for stroke-related reasons has been established, and the findings of recent studies are contentious. Most of those researches are not made use of authentic data. Therefore, the goal of this study is to examine how the COVID-19 pandemic has affected hospital admissions for stroke patients, to provide a basis for managing stroke patients in hospitals during COVID-19 pandemic. This retrospective study took place at the People's Hospital of Peking University in Beijing, China. For each patient, interventions such as the application of tissue plasminogen activator (tPA) were examined. We recorded each patient's outcomes. The stroke patients' hospital admissions were compared to the average of the prior year. As the time span of interest, we selected the epidemic period (January 2020 to December 2020). When compared to the previous year in the pre-COVID period, mean monthly stroke hospitalizations decreased during the pandemic by 54.42% (P<0.001); average lengths of stay (ALOS) increased; and non-emergency admissions decreased by 78.8% (P<0.001). The monthly volume of stroke patients exceeding the intravenous thrombolysis (IVT) window decreased by 25% and 59.73%, respectively (P <0.001). There was a 5.3% increase in the percentage of IVT or within IVT time window in male stroke patients (p=0.019; p=0.049). During COVID-19, the proportion of non-local patients among male stroke patients decreased by 10% compared with the previous year (p=0.006). The COVID-19 epidemic has had a negative impact on stroke management in China, healthcare systems must work to assess and adapt to the new reality.

Abstract 238: Gender Differences In Clinical Factors In Obese Ischemic Stroke Patients With A History Of Smoking

Introduction Clinical risk factors and co‐morbidities in obese male and female ischemic stroke patients with a history of smoking may contribute to differing stroke outcomes. The objective of this study is to determine gender differences in risk factors in obese ischemic stroke patients with a history of smoking. Methods A retrospective study was conducted on 6‐year data from 5469 patients with an ischemic stroke event from a regional stroke center. A logistic regression model was used to predict clinical risk factors associated with male or female patients. Multicollinearity was assessed using variance inflation factors (VIFs), with values &gt;5 suggestive of multicollinearity Results In the adjusted analysis, (OR = 1.806, 95% CI, 1.028–3.174, P =0.040*), a history of drugs and alcohol (OR = 2.873, 95% CI, 1.349–6.166, P =0.006), Serum Creatinine (OR = 4.724, 95% CI, 2.171–10.281, P&lt;0.001), Age (OR = 1.024, 95% CI, 1.022–1.047, P=0.033), and systolic blood pressure (OR = 1.029, 95% CI, 1.011–1.047, P&lt;0.002) were associated with males. Depression (OR = 0.432, 95% CI, 0.244–0.764, P&lt;0.004), Previous TIA (OR = .319, 95% CI, 0.142–0.714, P&lt;0.005), and higher levels of HDL (OR = 0.938, 95% CI, 0.915–0.962, P&lt;0.001) were associated with female gender. Conclusion Gender differences were observed in the clinical factors and comorbidities within the population of AIS patients who were smoking and obese. Further studies should evaluate the effect of specific risk factors to develop specific strategies for the management of identified risk factors to improve the care of obese male and female ischemic stroke patients with a history of smoking.

In Hospital Mortality and Short-Term Outcomes of Acute Ischemic Stroke Patients Contracting SARS CoV-2 Infection: Experience from a Dedicated Stroke Unit in Bangladesh

Background: The influence of COVID-19 on in hospital mortality and short-term outcome of acute ischemic stroke is not well known. Objective: The purpose of the present study was to analyze the overall impact of COVID-19 patients and 30-day outcomes of acute ischemic stroke patients. Methodology: This was a hospital-based case-control study from February to May 2021 conducted in stroke unit of National Institute of Neurosciences and Hospital. Consecutive ischemic stroke patients contracting COVID-19 infection was considered as case group and similar patients, negative for SARS CoV-2 on RT-PCR from nasal swab were considered for control group following the inclusion and exclusion criteria. Results: A total number of 50 cases and 99 similar control were taken. Although a significant proportion of control group were male (76.8% vs 50%), there was similar age distribution in both groups. Diabetes and Multiple comorbid conditions and lymphopenia were significantly (p value of &lt;0.001) more common among the case (1% versus 22%, 28.3% versus 56% and 5.1% versus 54%) in contrast to hypertension and lymphocytosis which was more frequent in control group (42.4% versus 10% and 94.9% versus 46%). Though the cases had a significantly (p value &lt;0.001) higher NIHSS score at admission (median IQR 7 versus 13) and longer hospital stay (median IQR 6 days versus 14 days). Male stroke patients were 4.7 times more likely to die in-hospital compared to female patients. The risk of mortality were 5 times higher among cases. Conclusion: COVID positive stroke cases have more severe disease at admission and longer hospital stays and the risk of mortality is 5 times higher in COVID positive stroke cases with a significant male dominance. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):11-15

Effects of task-oriented balance training with sensory integration in post stroke patients

Background: Balance and functional mobility is greatly affected in stroke patients. Balance training integrated with sensory input is more beneficial for improving balance and mobility in stroke patients. Objective: To determine the effects of task-oriented balance training with and without sensory integration on balance, postural stability, and mobility in post-stroke patients. Methods: A randomized control trial was conducted at RHS Rehabilitation Centre, Islamabad. A total of n=60 post-stroke patients were included in the study through a non-probability purposive sampling technique. Male and female stroke patients above 40 years of age, having the ability to maintain a standing position without aid for at least 5 minutes, and patients on Grades II, III, IV on the Functional Mobility Scale were included in this study. They were randomly allocated into Group A (n=30) and Group B (n=30). Both groups received Task oriented balance training while group B was treated with additional sensory integration. The Berg Balance Scale, Dynamic Gait Index, Activities Specific Balance Confidence Scale, and Balance Error Scoring system were used for balance assessment. The assessment was done at baseline and after 6th week. Results: The mean age of the participants was 54.47 years. After 6 weeks of intervention, a significant difference was found in group A as compared to group B for Dynamic mobility measured by Dynamic gait index with p-value (p=0.06) and for balance measured by BBS with p-value (p=0.05). Conclusion: The task-oriented balance training with sensory integration is effective in improving dynamic balance and mobility in stroke patients. Keywords: balance training; Sensory Integration; stroke rehabilitation; task-oriented balance exercises.

Epilepsi Paska Stroke: Laporan Kasus

Post-stroke seizures is a common complication in post-stroke patients, it is reported that about 8-15 % of cases may develop into post-stroke epilepsy. A 54-year-old man was referred from Primary Health Care with a complaint of seizures on the right side of the body for more than 30 minutes. Seizures have often occurred since last year after the patient had a stroke attack. The patient has had 2 strokes attack in 2021 and 2022. The seizure stopped right before the patient arrived in the emergency room. The patient experienced weakness on the right side of the body and was unable to speak since his 1st stroke attack. When the patient was transferred to the neurology ward, he experienced another seizures, the duration of seizure &lt; 2 minutes, with the frequency &gt;3 times, the patient remained conscious during the event. We give phenytoin 100 mg/8 hours. Head CT in 2022 shows an infarction in the middle cerebral artery. Brain ischemia causes damage to neurons which causes an imbalance between inhibitory neurons and excitatory neurons which causes seizures. Seizures in post-stroke patients are divided into early-onset and late-onset seizures. Male stroke patients aged &lt;65 years with history of hypertension, history of stroke involving the territorial MCA have a higher risk of developing Post Stroke Epilepsy (PSE). The patient in this case has a high risk of experiencing PSE because his past stroke involving the territorial MCA, besides that there is history of uncontrolled hypertension and age &lt; 65 years.

Women and stroke: disparities in clinical presentation, severity, and short- and long-term outcomes.

There are limited data from the Middle East on sex-related differences in short- and long-term stroke outcomes. We present 8 years of experience based on the Qatar stroke database. The Qatar stroke database prospectively collects data on all stroke patients admitted to Hamad General Hospital. For this study, we compared female and male acute ischemic stroke patients on their characteristics at admission, short-term outcomes [modified Rankin Scale (mRS) score], and long-term outcomes [incidence of major adverse cardiovascular events (MACEs)]. A total of 7,300 patients [F: 1,406 (19.3%), M: 5,894 (80.7%); mean age 55.1 ± 13.3 (F: 61.6 ± 15.1, M: 53.5 ± 12.3; p < 0.001)] were admitted with acute ischemic stroke. Significantly fewer women presented within 4.5 h of onset (F: 29% vs. M: 32.8%; p = 0.01). Although women were more likely to experience severe stroke (NIHSS >10; F: 19.9% vs. M: 14.5%; p < 0.001), fewer were treated with thrombolysis (F: 9.8% vs. M: 12.1%; p = 0.02). Women experienced more medical complications (F: 11.7% vs. M: 7.4%; p < 0.001) and tended to have a more prolonged length of stay in the hospital (F: 6.4 ± 7.6 days vs. M: 5.5 ± 6.8 days; p < 0.001). Good outcomes at 90 days (mRS score of 0-2) were less frequent in women (F: 53.3% vs. M: 71.2%; p < 0.001). Fewer female patients were taking antiplatelets (F: 78% vs. M: 84.8%; p < 0.001) or statins (F: 81.2% vs. M: 85.7%; p < 0.001). Significantly more female patients experienced a MACE (F: 12.6% vs. M: 6.5%; p < 0.001). Older age at presentation contributes to poor outcomes following acute stroke in women. Other contributing factors include delays in admission to the hospital, lower rates of thrombolysis, and lower rates of provision of preventative treatments.

Trunk Impairment Scale for Predicting Lumbar Spine Bone Mineral Density in Young Male Patients With Subacute Stroke

To investigate the relationship between Trunk Impairment Scale (TIS) and lumbar spine bone mineral density (BMD) in subacute stroke patients. Twenty-three subacute male stroke patients under the age of 65 were prospectively enrolled to exclude both postmenopausal and senile effects on BMD. The TIS, Berg Balance Scale, the Korean version of the Modified Barthel Index, and manual muscle test were measured at admission and 3 months after stroke onset. BMD of the bilateral lower extremities and lumbar vertebrae was measured by dual-energy X-ray absorptiometry 3 months after stroke onset. TIS at baseline (TIS_B) and TIS at 3 months after stroke (TIS_3m) showed significant correlations with lumbar BMD (TIS_B, r=0.522; TIS_3m, r=0.517). Through multiple regression analysis, the TIS_B was associated with lumbar BMD (adjusted R2=0.474). However, BMD of the bilateral lower extremities was not correlated with any clinical measurements except body mass index. We found a relationship between TIS_B and lumbar BMD in subacute young male stroke patients. Stroke patients with poor trunk control in the early subacute stage would have low BMD of vertebral bones at 3 months. The TIS can be useful for estimating bone fragility in the lumbar vertebrae of subacute stroke patients.

Efficacy of rhythmic auditory stimulation on gait parameters in hemiplegic stroke patients: a randomized controlled trial

BackgroundGait disorders which caused by stroke are one of the most common causes of functional disabilities in hemiparetic stroke patients that leads to significant impact on quality of life and financial cost. In this study, we focused on how certain gait metrics in stroke patients were affected by rhythmic auditory stimulation and treadmill training.ResultsIn this randomized controlled experiment, which involved 30 male stroke patients, there was a significant increase in post treatment walking speed, step cycle, step length, percent of time on each foot and ambulation index in both groups. The post treatment improvement in gait parameters was significantly higher in the study group compared to the controls.ConclusionsCombination of rhythmic auditory stimulation with treadmill training enhances the gait performance.

Disagreement about perceptions of patient disability between the stroke patient and caregiver: a cross sectional study exploring the association to patient and caregiver quality of life

Objectives This study explored the association of disagreement in the perception of patient disability between patients and family caregivers with physical and psychological quality of life (QOL) in both parties. Methods A cross-sectional analysis of data collected from male stroke patients and family caregivers was conducted. Physical and psychological QOL in patients and caregivers were measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule 2.0 (DAS). Using DAS scores reported independently by patients and caregivers, dyads were categorized into one of four groups representing agreement or disagreement about patient disability. Generalized estimating equations were used to examine the associations between WHOQOL scores in patients and caregivers and these four groups. Results Among 56 dyads enrolled, approximately 52% were categorized into ‘agreement’ groups and 48% were categorized into ‘disagreement’ groups. The disagreement in perception about patient disability were significantly associated with poor patient physical QOL. However, the disagreement in perception were not significantly associated with caregiver QOL. Conclusion Findings suggest the association of disagreement with QOL differs between patients and caregivers. Further research is needed to carefully appraise the relationship and interaction between patient and caregiver.