Management Of Stroke Patients Research Articles

COMPARATIVE ANALYSIS OF LIPID PROFILE IN PATIENTS WITH HEMORRHAGIC VERSUS ISCHEMIC STROKE: A CROSS-SECTIONAL STUDY

Objective: Stroke is a major cause of morbidity and mortality worldwide resulting from either an ischemic insult or rupture of a blood vessel in the brain. It not only leads to significant physical disability but also imposes emotional and economic burdens on patients and their families. Assessing the lipid profile in stroke patients is crucial, especially in ischemic stroke, where dyslipidemia plays a key role in atherosclerosis development. Elevated low-density lipoprotein (LDL) and triglycerides (TG) are important modifiable risk factors, and managing these can reduce the incidence and recurrence of strokes. Comprehensive lipid management should be a core component of stroke prevention and treatment strategies. Methods: This was a cross-sectional study in which 80 adult stroke patients (40 ischemic and 40 hemorrhagic strokes) were included on the basis of a predefined inclusion and exclusion criteria. The diagnosis of stroke was made on the basis of imaging and neurological examination. A comprehensive medical history, physical measurements (including body mass index), and lipid profiles (total cholesterol [TC], LDL, High-density lipoprotein [HDL], and TG) were recorded for all participants. Blood samples were taken after overnight fasting to ensure accuracy. Statistical analysis using SPSS version 21.0 compared lipid levels between the groups. An unpaired t-test and Chi-square test were used, with significance defined as a p<0.05. Results: There was a significant difference in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had markedly higher levels of LDL with a mean of 129.84±36.54 mg/dL compared to 106.32±26.68 mg/dL in hemorrhagic stroke patients (p=0.0015). TC levels were also significantly elevated in ischemic stroke patients, averaging 236.22±56.26 mg/dL versus 196.48±46.24 mg/dL in hemorrhagic stroke patients (p=0.0009). Total TG were higher in ischemic stroke patients (158.54±44.68 mg/dL) compared to hemorrhagic stroke patients (128.62±39.16 mg/dL, p=0.0021). HDL levels were slightly lower in ischemic stroke patients (34.54±8.26 mg/dL) compared to hemorrhagic stroke patients (38.12±9.12 mg/dL), although this difference was not statistically significant (p=0.0696). Conclusion: There were significant differences in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had higher levels of LDL, TC, and TG, indicating a stronger association with dyslipidemia and atherosclerosis. These findings highlight the importance of aggressive lipid management in ischemic stroke patients to reduce recurrence risk and improve outcomes.

A Study on Clinical Diagnosis of Hemorrhagic Stroke Based on Random Forest and LSTM Neural Networks

This study is dedicated to the application of artificial intelligence technology to assist the clinical management of hemorrhagic stroke patients. By combining patients' clinical information and imaging features, we successfully predicted the probability of hematoma expansion, which provides an important reference for clinical decision-making. Further, we modeled the progression of perihematomal edema and investigated the effect of therapeutic interventions on edema progression. Through K-means clustering and least squares, we fitted the model effectively, which provided a basis for the development of personalized treatment plans. In addition, we used LSTM neural network to predict patients' prognostic MRS scores, which provided new ideas for optimizing patients' rehabilitation pathways. These findings will help to improve the treatment outcome of hemorrhagic stroke patients and reduce the burden on society and families, which is of great clinical significance.

Stroke thrombectomy for large infarcts with limited penumbra: Systematic review and meta-analysis of randomized trials.

Recent randomized trials have suggested that endovascular thrombectomy (EVT) is superior to medical management (MM) for stroke patients with large infarcts. However, whether or how perfusion metrics should be used to guide optimal patient selection for treatment is largely unknown. This was a meta-analysis of randomized controlled trials reporting the effectiveness of EVT for large infarcts stratified by perfusion mismatch profiles. Patients with mismatch ratio 1.2-1.8 or penumbra volume 10-15cc (intermediate mismatch) or mismatch ratio <1.2 or volume <10cc (low mismatch) were included. Odds of 90-day modified Rankin scale (mRS) 0 to 3 (good) and 5 to 6 (poor) were calculated and effect sizes were pooled using Mantel-Haenszel fixed-effects models. Two trials - SELECT2 and ANGEL-ASPECT - were included; 140 intermediate mismatch (75 EVT and 65 MM) and 60 low mismatch patients (23 EVT and 37 MM) were identified. EVT was significantly associated with higher odds of mRS 0 to 3 for intermediate mismatch (pooled OR 2.77 [95%CI 1.11-6.89], p=0.028; Figure 1), but not low mismatch (pooled OR 1.47 [95%CI 0.444.94], p=0.54; Figure 1). Similarly, in terms of 90-day poor outcomes (mRS 5 or 6), EVT for intermediate mismatch patients was significantly associated with lower odds (OR 0.49 [95%CI 0.24 to 0.99], p=0.046; Figure 2), while EVT for the low mismatch cohort was not (OR 0.66 [95%CI 0.22 to 1.96], p=0.45; Figure 2). There was no significant inter-study heterogeneity observed across study estimates. For patients with large infarcts, EVT appears to be likely beneficial for patients with perfusion mismatch ratio and volume of at least 1.2 and 10cc, but not for those with mismatch ratio <1.2 or volume <10cc. These data generally support the continued use of perfusion imaging to select patients with large infarcts for EVT if it is available at the treating institution. Future studies and trials should consider investigating the efficacy and safety of EVT for patients with large infarcts and low mismatch profiles. EVT = endovascular thrombectomy; MM = medical management; OR = odds ratio; CI = confidence interval.

The role of artificial intelligence in optimizing management of atrial fibrillation in acute ischemic stroke.

Atrial fibrillation (AF) is a severe condition associated with high morbidity and mortality, including an increased risk of stroke and poor outcomes poststroke. Our understanding of the prognosis in AF remains poor. Machine learning (ML) has been applied to the diagnosis, management, and prognosis of AF in the context of stroke but remains suboptimal for clinical use. This article endeavors to provide a comprehensive overview of current ML applications to AF patients at risk of stroke, as well as poststroke patients without AF. Strategies to develop effective ML involve the validation of a variety of ML algorithms across internal and external datasets as well as exploring their predictive powers in hypothetical and realistic settings. Recent literature of this rapidly evolving field has displayed much promise. However, further testing and innovation of medical artificial intelligence are required before its imminent introduction to ensure complete patient trust within the community. Prioritizing this research is imperative for advancing the optimization of ongoing care for AF patients, as well as the management of stroke patients with AF.

High Hypoperfusion Intensity Ratio Is Independently Associated with Very Poor Outcomes in Large Ischemic Core Stroke.

Recent advances have highlighted the efficacy of endovascular thrombectomy (EVT) in patients with large ischemic core stroke, yet asignificant portion still experience very poor outcomes, defined as a90-day modified Rankin Score (mRS) of 5-6. This study aims to investigate the hypoperfusion intensity ratio (HIR) as aprognostic imaging parameter for these outcomes. In amulticenter retrospective cohort study, data from consecutive patients undergoing EVT for acute ischemic stroke with large vessel occlusion (AIS-LVO) at two comprehensive stroke centers were analyzed. The study included patients with an Alberta Stroke Program Early CT Score (ASPECTS) of5 or less and utilized pretreatment perfusion imaging to calculate HIR. The primary outcome was very poor outcomes (90days mRS 5-6). Among 102 patients included, 59 (57.8%) had very poor outcome (90days mRS 5-6). Multivariable logistic regression analysis adjusting for multiple covariates including admission National Institutes of Health Stroke Scale (NIHSS) and EVT revealed that higher admission NIHSS (adjusted odds ratio [aOR] 1.224, 95% CI 1.089-1.374, p = 0.001) and HIR (aOR per 0.1 incremental change, 1.34, 95% CI 1.02-1.82, P = 0.042) were independently associated with very poor outcomes. This study demonstrates that admission NIHSS and HIR are independently associated with very poor outcome (90days mRS 5-6) in patients with large ischemic core strokes. These findings highlight the importance of collateral status and perfusion imaging in predicting outcomes in this patient population, suggesting apotential role for HIR in the triage and management of large core stroke patients.

Association between stroke subtypes and outcomes of endovascular therapy: a post-hoc analysis of the ANGEL-ASPECT Trial

ObjectivesOur study aims to examine the value of endovascular therapy (EVT) and its comparison to medical management (MM) in ischaemic stroke patients accompanied by large artery atherosclerosis (LAA) and non-LAAMethodsmodified...

APIS: a paired CT-MRI dataset for ischemic stroke segmentation - methods and challenges

Stroke, the second leading cause of mortality globally, predominantly results from ischemic conditions. Immediate attention and diagnosis, related to the characterization of brain lesions, play a crucial role in patient prognosis. Standard stroke protocols include an initial evaluation from a non-contrast CT to discriminate between hemorrhage and ischemia. However, non-contrast CTs lack sensitivity in detecting subtle ischemic changes in this phase. Alternatively, diffusion-weighted MRI studies provide enhanced capabilities, yet are constrained by limited availability and higher costs. Hence, we idealize new approaches that integrate ADC stroke lesion findings into CT, to enhance the analysis and accelerate stroke patient management. This study details a public challenge where scientists applied top computational strategies to delineate stroke lesions on CT scans, utilizing paired ADC information. Also, it constitutes the first effort to build a paired dataset with NCCT and ADC studies of acute ischemic stroke patients. Submitted algorithms were validated with respect to the references of two expert radiologists. The best achieved Dice score was 0.2 over a test study with 36 patient studies. Despite all the teams employing specialized deep learning tools, results reveal limitations of computational approaches to support the segmentation of small lesions with heterogeneous density.

Fluid excess on intensive care unit after mechanical thrombectomy after acute ischemic stroke is associated with unfavorable neurological and functional outcomes: An observational cohort study.

Endovascular thrombectomy stands as a pivotal component in the standard care for patients experiencing acute ischemic stroke with large vessel occlusion. Subsequent care for patients often extends to a neurological intensive care unit. While fluid management is integral to intensive care, the association between early fluid balance and neurological and functional outcomes post-thrombectomy has not yet been thoroughly investigated. In a retrospective analysis of an observational, single-center study spanning from 2015 to 2021 at the University Medical Center Hamburg-Eppendorf, Germany, we enrolled stroke patients who underwent thrombectomy and received subsequent treatment in the ICU. Unfavorable functional and neurological outcome was defined as a mRS > 2 on day 90 after admission (mRS d90) or NIHSS > 5 at discharge, respectively. A multivariate regression model, adjusting for confounders, utilized the average fluid balance in the first 5 days to predict outcomes. Patients were dichotomized by their average fluid balance (>1 L vs <1 L) within the first 5 days, and a multivariate mRS d90 shift analysis was conducted after adjusting for covariates. Between 2015 and 2021, 1252 patients underwent thrombectomy, and 553 patients met the inclusion criteria (299 women [54%]). Unfavorable functional outcome was significantly associated with a higher daily average fluid balance in the first 5 days in the ICU (mRS d90 ⩽ 2: 0.3 ± 0.5 L, mRS d90 > 2: 0.7 ± 0.7 L, p = 0.02). The same association was observed for the NIHSS at discharge (NIHSS ⩽ 5: 0.3 ± 0.5 L; NIHSS > 5: 0.6 ± 0.6 L; p = 0.03). The mRS d90 shift analysis revealed significance for patients with an average fluid balance <1 L for better functional outcomes (adjusted odds ratio [AOR] 2.17; 95% confidence interval [CI] 1.54-3.07; p < 0.01). Fluid retention in post-thrombectomy stroke patients in the ICU is associated with poorer functional and neurological outcomes. Consequently, fluid retention emerges as an additional potential predictor for post-intervention stroke outcomes. Our findings provide an initial indication that preventing excessive fluid retention in stroke patients after endovascular thrombectomy could be beneficial for both functional and neurological recovery. Therefore, fluid retention might be an element to consider in optimizing fluid management for stroke patients.

The individual and combined impacts of pre-existing diabetes and dementia on ischemic stroke outcomes: a registry-based cohort study

BackgroundIndividually, diabetes mellitus and dementia are associated with poorer outcomes after stroke. However, the combined impact of these pre-existing factors on acute ischemic stroke (AIS) outcomes has not been examined.MethodsAll consecutive patients with AIS admitted to Norfolk and Norwich University Hospitals between 2003 and 2016 (catchment population ~ 900,000) were divided into four groups: those with neither diabetes nor dementia (reference), with diabetes without dementia, with dementia without diabetes, and with both co-morbidities. In-hospital mortality, length of hospital stay (LoS), and disability outcomes were analysed using logistic regressions. Post-discharge mortality and recurrence were assessed using Cox regressions. Additionally, interaction terms were added to the models for the short-term outcomes and long-term mortality to test for synergistic effects of diabetes and dementia. Models were adjusted for age, sex, Oxfordshire Community Stroke Project classification, comorbidities, hematological and biochemical measures, and antithrombotic medications.ResultsThe cohort was 10,812 patients with 52% females and a median age of 80. The median follow-up was 3.8 years for stroke recurrence and 5.5 years for mortality. No significant differences between the four groups existed for in-hospital mortality and post-stroke disability. Patients with dementia had significantly longer LoS (OR 2.25 [95% CI: 1.34–3.77] and 1.31 [1.02–1.68] with and without diabetes, respectively). Patients with both comorbidities had the highest risk of stroke recurrence (HR 2.06 [1.12–3.77]), followed by those with only dementia (1.59 [1.15–2.20]) and only diabetes (1.25 [1.06–1.49]). Similarly, the patient group with both diabetes and dementia had the highest long-term mortality risk (1.76 [1.33–2.37]). The hazard ratios for patients with only dementia and only diabetes were 1.71 [1.46–2.01] and 1.19 [1.08–1.32], respectively. No significant interactions were seen between diabetes and dementia with regards to their effects on the outcomes.ConclusionIndividual and cumulative impacts of the two conditions on long-term mortality and stroke recurrence were notable. However, no synergistic impact of the two comorbidities were seen on the stroke outcomes tested in our study. Therefore, tailoring the management of stroke patients based on additional requirements associated with each pre-existing condition will be more impactful towards improving outcomes.

Correlation between Mean Platelet Volume, Fibrinogen and D-dimer with NIHSS Score

Introduction: Stroke is a clinical syndrome that develops rapidly due to focal or global brain disorders with symptoms last for &gt;24 hours and potentially cause death. Due to the consideration that this Mean Platelet Volume (MPV) marker is not invasive, easy to do and is in line with the pathogenesis of stroke, researchers are interested in carrying out this research. And hopefully this research can provide information for the world of education and health about changes in MPV, fibrinogen and D-dimer in ischemic stroke patients. So it can be taken as consideration in the early management of ischemic stroke patients. Subject and Methods: This research was an observational study with a cross-sectional design at Haji Adam Malik General Hospital from October to November 2023. The research subjects were stroke patients who were treated in emergency room and met inclusion criteria. This research was to study about correlation of MPV, fibrinogen, and D-dimer with NIHSS scores of ischemic stroke patients. The method used in this research is the Pearson correlation test where data was normally distributed. All statistical tests with a p value &lt; 0.05 were considered significant. Results: The mean MPV was 10.4 ± 1.6, while the mean NIHSS value was 19.9 ± 8.7, and there was a statistically significant correlation between the MPV value and the NIHSS score (p&lt;0.05). The mean fibrinogen was 421.9 ± 109.3, while mean NIHSS value was 19.9 ± 8.7, and there was a statistically significant correlation between fibrinogen values and NIHSS scores (p&lt;0.001). The mean D-Dimer was 8.0 ± 11.3, while the mean NIHSS value was 19.9 ± 8.7, and showed a statistically significant correlation between D-Dimer value and NIHSS score (p&lt;0.05). The r value of MPV, fibrinogen, and D-dimer on NIHSS score was 0.494; 0.495; and 0.504. The regression coefficient for MPV variable is 0.093, therefore MPV variable influence on NIHSS variable is positive. Conclusion: There is a strong correlation between D-dimer and the NIHSS score, and a moderate correlation between MPV and fibrinogen with NIHSS score.

Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations

BackgroundVideo consultations between hospital-based neurologists and Emergency Medical Services (EMS) have potential to increase precision of decisions regarding stroke patient assessment, management and transport. In this study we explored the use of real-time video streaming for neurologist–EMS consultation from the ambulance, using highly realistic full-scale prehospital simulations including role-play between on-scene EMS teams, simulated patients (actors), and neurologists specialized in stroke and reperfusion located at the remote regional stroke center.MethodsVideo streams from three angles were used for collaborative assessment of stroke using the National Institutes of Health Stroke Scale (NIHSS) to assess symptoms affecting patient’s legs, arms, language, and facial expressions. The aim of the assessment was to determine appropriate management and transport destination based on the combination of geographical location and severity of stroke symptoms. Two realistic patient scenarios were created, with severe and moderate stroke symptoms, respectively. Each scenario was simulated using a neurologist acting as stroke patient and an ambulance team performing patient assessment. Four ambulance teams with two nurses each all performed both scenarios, for a total of eight cases. All scenarios were video recorded using handheld and fixed cameras. The audio from the video consultations was transcribed. Each team participated in a semi-structured interview, and neurologists and actors were also interviewed. Interviews were audio recorded and transcribed.ResultsAnalysis of video-recordings and post-interviews (n = 7) show a more thorough prehospital patient assessment, but longer total on-scene time, compared to a baseline scenario not using video consultation. Both ambulance nurses and neurologists deem that video consultation has potential to provide improved precision of assessment of stroke patients. Interviews verify the system design effectiveness and suggest minor modifications.ConclusionsThe results indicate potential patient benefit based on a more effective assessment of the patient’s condition, which could lead to increased precision in decisions and more patients receiving optimal care. The findings outline requirements for pilot implementation and future clinical tests.

Analysis of Dominant Factors Affecting Pre-Hospital Stroke Management in Kupang City

The incidence of stroke is increasing every year, and effective management comprises both pre-hospital and hospital care. The key to successful management is for families to recognise the clinical symptoms and promptly seek medical attention. Delayed assistance frequently leads to complications, underscoring the importance of timely intervention to save lives and prevent long-term disabilities. The key to successful management is identifying a stroke and prompt transportation to a medical facility. This study used a quantitative approach with a cross-sectional design, and the total sample was 300 people, while data analysis was performed using the Chi-Square test and logistic regression. The results showed that the family decision-making time in taking a stroke patient to the hospital, individually or collectively, significantly affected the Accuracy of Pre-Hospital Stroke Patient Management with a value of P (Sig) &lt; 0.05. The magnitude of the influence was indicated by the value of EXP (B), also known as ODDS RATIO (OR). Specifically, the Decision-Making Time by the family to take stroke patients to the hospital exhibited an OR of 20.714. This implied that respondents capable of making the right decision to take stroke patients to the hospital were 20.714 times more likely to be accurate in pre-hospital stroke patient management. Based on the results, it can be concluded that the dominant factor influencing pre-hospital stroke attack management is the family decision-making time to take the stroke patient to the hospital. Therefore, the Kupang City government needs to improve ambulance facilities for the public, making it easier to access services, specifically in emergencies.

Summary of best evidence for rehabilitation management of patients with motor dysfunction after stroke.

The rehabilitation work for patients with motor dysfunction after stroke is crucial. However, there is currently a lack of summarized evidence regarding the rehabilitation management of stroke patients in rehabilitation wards, communities, and at home. This study aims to compile relevant evidence on the rehabilitation management of patients with motor dysfunction after stroke, providing a reference for clinical and community health professionals to carry out rehabilitation interventions. A systematic search was conducted in BMJ Best Practice, UpToDate, National Guidebook Clearinghouse, American Heart Association/American Stroke Association, Canadian Medical Association, National Institute for Health and Clinical Excellence, United States Department of Veterans Affairs/ Department of Defense, Registered Nurses Association of Ontario, JBI Evidence-Based Healthcare Center Database, The Cochrane Library, PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang Database, SinoMed, and other databases for all literature on the rehabilitation management of patients with motor dysfunction after stroke. This included clinical decision-making, guidelines, expert consensuses, recommended practices, systematic reviews, and evidence summaries, with the search period spanning from the establishment of each database to October 2023. Two researchers independently evaluated the quality of the literature. A total of twenty-one documents were included, consisting of 11 guidelines, 2 expert consensus, and 8 systematic reviews. Evidence was extracted and integrated from the included literature, summarizing forty-five pieces of evidence across nine areas: rehabilitation management model, rehabilitation institutions, rehabilitation teams, timing of rehabilitation interventions, rehabilitation assessment, rehabilitation programs, rehabilitation duration and frequency, rehabilitation intensity, and rehabilitation support These covered comprehensive rehabilitation management content for stroke patients in the early, subacute, and chronic phases. The best evidence summarized in this study for the rehabilitation management of patients with motor dysfunction after stroke is comprehensive and of high quality. It provides important guidance for clinical and community healthcare professionals in carrying out rehabilitation interventions. When applying the evidence, it is recommended to consider the current condition of the stroke patient, the extent of motor dysfunction, environmental factors, and the patient's preferences. Then, select the most appropriate rehabilitation plan, and adjust the type and intensity of training according to each patient's specific needs and preferences.

Succesful Management of Ischemic Stroke Patients with Pneumonia, Diabetes Mellitus and Hypertension in the ICU

Background:Stroke is one of the main causes of death worldwide. Although neurological complications are the leading cause of death, half of acute stroke patients may die from other medical complications, including pulmonary infections.Case Presentation :It has been reported that a patient aged 65 years with ischemic stroke who was treated in the ICU accompanied by diabetes mellitus, acute kidney injury, and hypertension. During treatment in the ICU the patient experienced complications of pneumonia. The patient underwent endotracheal intubation and ventilator installation as well as a percutaneous dilatational tracheostomy (PDT). During treatment the patient received antibiotic therapy, blood sugar regulation with insulin, administration of antihypertensive drugs. The patient experienced clinical improvement and was discharged from the ICU after 18 days of treatment and was subsequently treated in the HCU.Conclussion:The length of stay of stroke patients in the ICU requires attention, especially with regard to the problem of nosocomial infections that may accompany the patient during the treatment. If there is infection or other complications, appropriate selection of antibiotics and supportive therapy is necessary during treatment.

Mechanical Thrombectomy via Transbrachial Approach in the Emergency Management of Acute Ischemic Stroke Patients with Aortic Pathologies: Our Experience and Literature Review.

Mechanical thrombectomy (MT) via the transbrachial approach (TBA) is a very rare option used in cases of patients with aortic pathologies and acute ischemic stroke (AIS) due to the insufficient evidence in the literature, the difficulty from a technical point of view and the result of this technique influenced by the complications that frequently accompany it. Only a few cases of patients with aortic pathologies and acute ischemic stroke where MT via TBA were reported in the literature, and its application in the emergency management of AIS has still not been dealt with in detail. Out of a need to clarify and clearly emphasize the effectiveness of this approach in emergency MT via TBA in patients with AIS and aortic pathologies, this literature review and case report has the following objectives: the first one is the presentation of an emergency MT via transbrachial approach performed in a 44-year-old patient with AIS and diagnosed aortic coarctation during transfemural approach (TFA), with successful reperfusion in our department and the second one is to review the cases reports of patients with different aortic pathologies and AIS reperfusion therapy performed by MT via TBA from the literature. A total of nine cases (one personal case and eight published cases) were revised in terms of aortic pathologies type, reperfusion therapy type, and the complication of both mechanical thrombectomy and local transbrachial approach. Mechanical thrombectomy through the transbrachial approach was the first choice in more than half of these cases (55.55%, n = 5 cases) in the treatment of acute ischemic stroke in the presence of previously diagnosed aortic pathologies. In one-third of all cases (33.33%, n = 3, our case and 2 case reports from the literature), the transbrachial approach was chosen after attempting to advance the guiding catheter through the transfemoral approach and intraprocedural diagnosis of aortic pathology. In only one case, after an ultrasound evaluation of the radial artery that showed a monophasic flow, MT was performed via TBA. Local transbrachial complication was reported in one case, and in two other cases, it was not stated if there were such complications. Hemorrhagic transformation of AIS was reported in two cases that underwent MT-only cerebral reperfusion via TBA, one with acute aortic dissection type A and our case of previously undiagnosed aortic coarctation. In the cases in whom short and long-term follow-up was reported, the outcome of treatment, which was not exclusively endovascular (77.77% cases with only MT and 33.33% with association of first thrombolysis and after MT), was good (six from nine patients). In two case reports, the outcomes were not stated, and one patient died after a long hospitalization in the intensive care unit from respiratory complications (our patient). Being a clinical emergency, acute ischemic stroke requires urgent medical intervention. In patients with aortic pathologies, where acute ischemic stroke emergency care is a challenge, mechanical thrombectomy via the transbrachial approach is a safe alternative method for cerebral reperfusion.

Triad of Rehabilitation, Oral Management and Nutrition in Stroke Patients

Triad of Rehabilitation, Oral Management and Nutrition in Stroke Patients

Alleviating sleep disturbances and modulating neuronal activity after ischemia: Evidence for the benefits of zolpidem in stroke recovery.

Sleep disorders are prevalent among stroke survivors and impede stroke recovery, yet they are still insufficiently considered in the management of stroke patients, and the mechanisms by which they occur remain unclear. There is evidence that boosting phasic GABA signaling with zolpidem during the repair phase improves stroke recovery by enhancing neural plasticity; however, as a non-benzodiazepine hypnotic, the effects of zolpidem on post-stroke sleep disorders remain unclear. Transient ischemic stroke in male rats was induced with a 30-minute middle cerebral artery occlusion. Zolpidem or vehicle was intraperitoneally delivered once daily from 2 to 7 days after the stroke, and the electroencephalogram and electromyogram were recorded simultaneously. At 24 h after ischemia, c-Fos immunostaining was used to assess the effect of transient ischemic stroke and acute zolpidem treatment on neuronal activity. In addition to the effects on reducing brain damage and mitigating behavioral deficits, repeated zolpidem treatment during the subacute phase of stroke quickly ameliorated circadian rhythm disruption, alleviated sleep fragmentation, and increased sleep depth in ischemic rats. Immunohistochemical staining showed that in contrast to robust activation in para-infarct and some remote areas by 24 h after the onset of focal ischemia, the activity of the ipsilateral suprachiasmatic nucleus, the biological rhythm center, was strongly suppressed. A single dose of zolpidem significantly upregulated c-Fos expression in the ipsilateral suprachiasmatic nucleus to levels comparable to the contralateral side. Stroke leads to suprachiasmatic nucleus dysfunction. Zolpidem restores suprachiasmatic nucleus activity and effectively alleviates post-stroke sleep disturbances, indicating its potential to promote stroke recovery.

Abstract NS7: Improving Emergency Department Hemorrhagic Stroke Management

Background and Issues: The Emergency Department lacked a formal hemorrhagic stroke process for the management and care of non-traumatic hemorrhagic patients which resulted in increased length of stay in the department and poor patient outcomes. Purpose: The purpose of this quality improvement project was to develop and implement a standard process of care for hemorrhagic stroke in our emergency department. Methods: This project was aimed at improving the overall emergency department management of hemorrhagic stroke patients by developing a standard process of care for this patient population. Project analysis began by identifying care opportunities. Our action plan was aimed at: developing a hemorrhagic stroke algorithm of care, implementing a hemorrhagic stroke paging process, implement best practice care for hemorrhagic stroke, develop a consulting services process, develop a power plan for hemorrhagic stroke, develop a data gathering method for tracking, and develop a hemorrhagic stroke feedback method. Results: Lessons learned from this project were that developing a standard process of care around this patient population led to better adherence to hemorrhagic stroke goals, management, and patient care. Conclusion: In conclusion, developing an emergency department hemorrhagic stroke process of care led to decreased length of stay in our emergency department, better adherence to hemorrhagic stroke goals, better management of blood pressure in this patient population, early recognition and awareness by caregivers and stroke team, and clearly defined consultation guidelines for streamlined patient care. Development of such a process raised the standard of care for this patient population and leads to overall improvement in patient management.

Abstract WP146: Critical Care After Thrombolytic Therapy in Acute Stroke: Who Really Needs the ICU?

Introduction: Intravenous thrombolytic therapy remains the cornerstone of management in acute ischemic stroke (AIS) patients. Given the potential adverse effects of thrombolysis, patients are admitted to an intensive care unit (ICU) for close monitoring following administration. Alternative post-thrombolytic pathways may provide for safe cost-effective care in certain populations. We aimed to determine the proportion of patients treated with thrombolytics who required ICU care for reasons other than frequent neurologic monitoring and define their characteristics. Methods: We retrospectively reviewed patients ≥ 18 years of age who received TNK/ tPA for AIS at our community-based stroke center between May 2020 and August 2022. Patients were classified as requiring ICU care if they required intubation within 24 hours of admission or neurosurgical intervention, had symptomatic hemorrhagic conversion or brain compression, required a continuous infusion for hemodynamic management, or were in status epilepticus. Univariate and multivariate statistical analysis was performed. The study protocol was deemed exempt by our institutional IRB. Results: 262 patients met inclusion criteria. 54 (20.6%) required ICU level of care. Characteristics of those requiring ICU level of care are described in Table 1. Multivariate analysis showed that patients on antiplatelet or anticoagulant therapies prior to arrival (AOR: 2.205, p= 0.021) or who presented with higher initial NIH stroke scale (AOR: 1.108, p &lt; 0.001) had significantly higher likelihood of requiring ICU level of care. Conclusions: In our cohort, approximately 21% of patients required critical care. Anticoagulant or antiplatelet therapy prior to admission and greater NIH stroke scale on arrival were associated with an increased likelihood of requiring ICU level of care. Further prospective studies are indicated to assess the efficacy of alternative settings for post-thrombolytic care in selected AIS patients.

Enhancing Ischemic Stroke Management with Cluster Nursing: A Comparative Study on the Effects of Ginkgo biloba Diterpene Lipid Amine Treatment

This study aimed to investigate the effect of cluster nursing on the management of ischemic stroke patients receiving Ginkgo biloba diterpene lipid amine treatment. This study was conducted on 197 patients from the Neurology Department of the author’s hospital from December 2021 to December 2022. These patients were divided based on their admission time into two groups: a control group comprising 98 patients who received routine nursing care and an observation group of 99 patients who were administered cluster nursing. This study evaluated and compared the incidence of nutritional intolerance events, nursing-related adverse events, and the overall quality of life among these groups. Results indicated a statistically significant reduction in the incidence of nutritional intolerance (P &lt; 0.05) and nursing adverse events associated with enteral nutrition support (P &lt; 0.05) in the observation group compared to the control group. Furthermore, the observation group exhibited higher scores in family role, energy, and verbal ability (P &lt; 0.05), suggesting an improvement in the quality of life. These findings highlight the effectiveness of the cluster nursing approach in improving the management and outcomes for ischemic stroke patients in terms of reducing nutritional intolerance and nursing adverse events, thereby significantly enhancing the quality of life.