Mean National Institutes Of Health Stroke Scale Score Research Articles

Study of APACHE II score and National Institutes of Health Stroke Scale as prognostic indicators in cerebrovascular accidents patients admitted in a tertiary care center, Rewa

Background: Stroke is the 2nd largest cause of mortality world over. In the intensive care unit (ICU), severity scales are crucial adjuncts of treatment for anticipating patient outcomes, comparing quality of care, and stratification for clinical studies. They are an important aspect of making better health-care judgments and identifying people with unusual outcomes. This study was conducted to assess and compare Acute Physiology and Chronic Health Evaluation II (APACHE II) score and National Institutes of Health Stroke Scale (NIHSS) score as predictors of mortality in cerebrovascular accident (CVA) patients admitted in medical intensive care unit (ICU) of tertiary care center, Rewa. Aims and Objectives: To evaluate APACHE II score, NIHSS score and APACHE II + NIHSS score as a predictor of short term mortality in CVA patients. Materials and Methods: This was a cross-sectional, analytical study conducted in the Department of Medicine, Sanjay Gandhi Memorial Hospital, associated with Shyam Shah Medical College, Rewa (M.P), between January 2020 and June 2021. The APACHE II score, NIHSS score, and APACHE II+NIHSS scores were calculated for each patient on day of admission and patients were followed up for a maximum period of 7 days. The area under receiver operating characteristic (ROC) curve was used to measure the ability of these scoring systems to forecast the prognosis, to find the best dividing value. Results: Out of 154 patients of CVA, 102 were male and 52 were female. In both sexes, the highest frequency of CVA was seen in those over 55 years of age. The mean age of the participants in the study was 62.70±12.62 years while it was 61.98±12.83 years for males and 64.13±12.19 years for females. The mean APACHE II score in death group was 29.45±10.095, mean NIHSS score in death group was 32.45±6.486, and the mean of both scores combined in death group was 61.91±14.017 and the mean of APACHE II score in survival group was 12.92±6.478, mean NIHSS score in survival group was 14.09±8.099, and the mean of both scores combined in survival group was 27.76±14.090. The APACHE II score had an area under the curve (AUC) of 0.919 which is slightly more than the NIHSS score which had the AUC of 0.913 and the sum of the two scores had the highest area under the ROC curve which is 0.947. According to Youden’s index, the dividing value for the APACHE II score is 21, the NIHSS score is 22, and APACHE II+NIHSS score was 42. Conclusions: Application of APACHE II and NIHSS scores provides an objective method to decide prognosis and plan management of CVA patients. It also helps in deciding whether the patient needs to manage in neurology ward or ICU depending on the dividing value. Both the scores have good ability to predict the short-term prognosis of CVA patients and the combination of these two can provide an even better measure of mortality.

First-line Double Stentriever Thrombectomy for M1/TICA Occlusions

BackgroundMechanical thrombectomy is the standard of care for acute ischemic stroke due to large-vessel occlusion; however, mechanical thrombectomy fails to achieve adequate recanalization in nearly one third of these cases. Rescue therapy using two stentrievers simultaneously yields good results in clots refractory to single stentriever treatment. We aimed to determine the safety and efficacy of first-line double stentriever thrombectomy for acute occlusion of the M1 segment of the middle cerebral artery and/or terminal internal carotid artery (TICA).MethodsThis single-center study prospectively enrolled consecutive patients with a single M1/TICA occlusion to undergo double stentriever thrombectomy between May and October 2020. Outcomes included successful recanalization (modified thrombolysis in cerebral infarction, TICI 2b/3), first-pass effect, procedure times, number of device passes, symptomatic intracerebral hemorrhage, National Institutes of Health Stroke Scale Score (NIHSS) at discharge, 90-day functional independence (modified Rankin scale 0–2), and 90-day mortality.ResultsWe analyzed 39 patients median age 79 years (range 42–96 years); 23 (58.9%) female; 19 (48.7%) with TICA occlusions; 5 (12.8%) with mRS 3–5 at admission; mean NIHSS at admission, 17 ± 4.39). Mean time from symptom onset to final angiogram was 238.0 ± 94.6 min; mean intervention duration was 36.0 ± 24.2 min. The mean number of device passes was 1.5 ± 1.07. All patients had final TICI 2b/3, and 27 (69%) had TICI 2c/3 after the first pass. We observed 3 (7.9%) cases of intracerebral symptomatic hemorrhages. At 90 days, 16 (41%) patients were functionally independent and 9 (23%) had died. The percentage of patients with good clinical outcome at 90 days was 55.5% in the first-pass subgroup.ConclusionOur findings suggest that first-line double stentriever thrombectomy is safe and effective for M1/TICA occlusions.

Stroke in Airplane Passengers: A Study from a Large International Hub

IntroductionStroke in air travelers is being increasingly recognized. We report on stroke among passengers arriving at or transiting through a busy air travel hub. MethodsThe stroke database of the sole tertiary care center for stroke in a large busy international hub was interrogated. Demographic data of transit passengers, their stroke risk factors, stroke severity, National Institutes of Health Stroke Scale (NIHSS), acute stroke interventions, discharge status and outcome utilizing the Modified Raking scale (mRS) were retrieved and compared between passengers and non-passenger controls. ResultsForty-three flight-related stroke patients were compared to 2564 non-passenger stroke patients. The mean age in the flight-related stroke group was 59.53±10.83 years, 30/43 (69.8%) were males. The stroke subtypes were ischemic in 30 (69.8%) patients, hemorrhagic in 9 (20.9%), and transient ischemic attack in 3 (7.0%), with one cerebral sinus venous thrombosis (2.3%). The mean NIHSS score was 7.79±6.44 in passengers, demonstrating moderate severity. Ten patients (23.3%) received thrombolysis, one (2.3%) received thrombectomy, and one (2.3%) received both thrombolysis and thrombectomy. Outcomes, 54.8% had a good outcome (mRS 0-2), and 45.2% had dependence/death (mRS 3-6). ConclusionAir passengers with stroke were found to be older with more severe strokes and a higher probability of receiving acute stroke treatment compared to non-passengers. Increased awareness with appropriate and timely recognition and triaging of transit passengers with stroke is warranted.

The relationship of vitamin D deficiency with severity and outcome of acute stroke.

Background. There are currently conflicting results regarding the link between vitamin D deficiency and the increased risk for stroke and its poor prognosis. The present study aimed to assess the relationship between vitamin D deficiency and prognosis of acute stroke. Methods. This bi-center cross-sectional study was performed on 140 consecutive patients who referred to two general hospitals in Iran with the diagnosis of acute stroke. The levels of 25-hydroxy vitamin D were evaluated by Electrochemiluminescence (ECL) technique. Clinical severity of stroke on admission as well as on discharge time were evaluated using the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin (mRS) tools. Results. Mean serum level of vitamin D was 25.51 ± 18.87 ng/mL, ranging from 3.0 to 98.6 ng/ml. There was a significant difference between the two groups (with and without vitamin D deficiency) in terms of stroke severity and disability, as reflected by mRS (P=0.003) and NIHSS evaluation (14.24 ± 9.23 versus 9.73 ± 7.36, P=0.003). Also, regarding patients' clinical condition, the mean NIHSS score in those with deficient and normal levels of vitamin D was 14.24 ± 9.23 and 9.73 ± 7.36, respectively with NIHSS score > 5 in 76.1% and 61.5%, respectively (P = 0.003). Conclusion. According to the results of study, vitamin D status can be related to the severity of stroke. However, considering the cross-sectional design of our study, it could not point out the causality between vitamin D deficiency and acute stroke and further studies are warranted. It is not possible to draw any conclusions in terms of causality. Further studies are required in order to assess the relationship between the serum vitamin D levels and stroke severity.

Initial Experience Performing Mechanical Thrombectomy With the CatchView Mini Device for Distal M2 Segment Middle Cerebral Artery Occlusions.

Background: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke due to large vessel occlusion; however, its safety and efficacy in patients with distal strokes remains unclear. In this study, we investigated the safety and efficacy of MT for distal middle cerebral artery (MCA) occlusions using the CatchView Mini (CVM; Balt, Montmorency, France).Methods: This was a prospective single-center analysis of patients with a single MCA-M2 occlusion treated with the CVM device. Consecutive patients were prospectively enrolled from October 2018 to March 2020. Efficacy outcomes included successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3], procedure times, and number of device passes. Clinical outcomes included National Institutes of Health Stroke Scale Score (NIHSS) at discharge, 90-day functional independence (modified Rankin Scale 0–2) and safety outcomes included hemorrhagic complications, and 90-day mortality.Results: A total of 45 patients (mean age: 74.0 ± 12.6; 53.3% [24/45] female) were included in the study. Upon admission, 33.3% (15/45) of patients were mRS 3–5; and mean NIHSS was 13.2 ± 4.2 Mean time from symptom onset to final angiography was 250.0 ± 83.4 min with a mean intervention duration of 34.0 ± 12.6 min. The mean number of device passes was 1.8 ± 1.5 final mTICI 2b/3 was achieved in 91.1% (41/45) of patients. Eight hemorrhagic complications (17.8%, 8/34) occurred, none of which were symptomatic. At 90-days, 57.8% (26/45) patients were functionally independent and the rate of mortality was 15.6% (7/45).Conclusions: The present analysis demonstrates a low risk profile and high recanalization success for patients with distal M2 occlusions treated with the CVM device.

The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study.

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

Combined Approach to Stroke Thrombectomy Using a Novel Short Flexible Aspiration Catheter with a Stent Retriever

BackgroundLarge-bore aspiration catheters enabling greater flow rates and suction force for mechanical thrombectomy might improve outcomes in patients with stroke secondary to large-vessel occlusion. Complete or near-complete reperfusion after a single thrombectomy pass (first-pass effect) is associated with improved clinical outcomes. We assessed the efficacy and safety of novel MIVI Q™ aspiration catheters in combination with stent-retriever devices.MethodsWe retrospectively analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute anterior large-vessel occlusion treated with a combined approach using MIVI Q™ aspiration catheters and stent retrievers. Reperfusion was defined according to the modified thrombolysis in cerebral infarction (mTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores.ResultsWe included 52 patients (median age, 75 y IQR: 64–83); 31 (59.6%) women; 14 (26.9%) with terminal internal carotid artery occlusions, 26 (50%) middle cerebral artery (MCA) segment M1 occlusions, and 12 (23.1%) MCA segment M2 occlusions; median NIHSS score at admission was 19 (IQR: 13–22). After the first pass, 25 (48%) patients had mTICI ≥ 2c. At the end of the procedure, 47 (90.4%) had mTICI ≥ 2b and 35 (67.3%) had mTICI ≥ 2c. No serious device-related adverse events were observed. Symptomatic intracranial hemorrhage developed in 1 patient. Mean NIHSS score was 13 at 24 h and 5 at discharge. At 90 days, 24 (46.2%) patients were functionally independent (mRS 0–2).ConclusionThis preliminary study found good efficacy and safety for MIVI Q™ aspiration catheters used in combination with stent-retriever devices.

Comparison of Sub-Types and Severity of Ischemic Stroke among Both Genders

Background: It has been noted that there is an increased prevalence and serious clinical implications of stroke in women. However, local studies focused on stroke among female gender are still scarce. Aim: To find frequency of female patients with ischemic stroke and to compare the sub-types of ischemic stroke, mean NIHSS score and mean MRS scores among both genders. Methodology: This descriptive case series was conducted in indoor and outdoor department of Neurology at Mayo Hospital, Lahore for six months [Feb 6, 2018 till August 6, 2018]. After taking demographics and clinical characteristics of patients, the severity of stroke was taken using National Institute of Health Stroke Scale (NIHSS) at admission in hospital. The functional outcome was measured using Modified Rankin Scale (MRS). Subtype of acute ischemic stroke was assigned using Oxfordshire classification for acute ischemic stroke. All data was taken on a structured proforma and was entered and analyzed using SPSS version 21. Results: The mean age of cases was 53.58 ± 9.42 years with 73(60.83%) male and 47(39.17%) female cases. Among TACS, there were 15(50%) female cases whereas 9(34.6%) female case were found in PACS and 10(33.3%) female cases were found in LACS. The frequency of gender in all subtypes was statistically same in both groups, p-value &gt; 0.05. The mean modified Rankin scale in male and female cases was 2.93 ± 1.58 and 4.30 ±1.50 respectively with significantly higher mean MMR score in females than male cases, p-value &lt; 0.05. Conclusion: This study concludes that females make up a considerable percentage of patients with ischemic stroke. Though, no statistically significant difference could be found in terms of subtypes of ischemic stroke, the mean NIHSS score and mean MRS were statistically higher among females compared to male cases. Keywords: Stroke, subtypes, severity, ischemia, gender difference, NIHSS, MRS

Decreased Stroke Applications During Pandemic: Collateral Effects of COVID-19

Objective: Our study aimed to investigate the effects of the pandemic on human behavior and stroke management by comparing hospital admissions made due to stroke during the pandemic period with the same period of the previous year. Materials and Methods: This retrospective study was conducted on patients with stroke admitted to our hospital between April 1st, 2020, and May 31st, 2020, and April 1st, 2019, and May 31st, 2019. Strokes were divided into three subgroups: ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA). The total number of strokes, stroke subtypes, vascular risk factors, sociodemographic and clinical characteristics, National Institutes of Health Stroke Scale (NIHSS) scores, presence of large vessel occlusion, thrombolytic therapy use, intensive care unit requirement, and in-hospital mortality values were compared for both periods. Results: A total of 133 patients, 75 males, 58 females, 44 during the pandemic period and 89 in the previous year, were included in the study. The mean age of the patients was 71.29 +/- 13.12 years. During the pandemic period, compared with the same period one year ago, there was a 50% decrease in the number of strokes, a 44% decrease in the number of ischemic strokes, a 62.5% decrease in the number of intracranial hemorrhages, and an 87.5% decrease in the number of TIA. During the pandemic period, the rate of patients who received intravenous thrombolytic therapy, the rate of patients with large vessel occlusion, the inhospital mortality rate, and the mean NIHSS scores were found to be significantly higher during the pandemic, but the rate of patients who had a minor stroke was significantly lower. Conclusion: The pandemic period has brought along many unknowns. It is a matter of curiosity how the effects of the pandemic on human behavior and functioning in health institutions will affect the diagnosis, treatment, and long-term follow-up of diseases other than coronavirus disease-2019.

Association between in-hospital frailty and health-related quality of life after stroke: the Nor-COAST study

BackgroundStroke survivors are known to have poorer health-related quality of life (HRQoL) than the general population, but less is known about characteristics associated with HRQoL decreasing through time following a stroke. This study aims to examine how in-hospital frailty is related to HRQoL from 3 to 18 months post stroke.MethodSix hundred twenty-five participants hospitalised with stroke were included and followed up at 3 and/or 18 months post stroke. Stroke severity was assessed the day after admission with the National Institutes of Health Stroke Scale (NIHSS). A modified Fried phenotype was used to assess in-hospital frailty; measures of exhaustion, physical activity, and weight loss were based on pre-stroke status, while gait speed and grip strength were measured during hospital stay. HRQoL at 3- and 18-months follow-up were assessed using the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-5D VAS). We conducted linear mixed effect regression analyses unadjusted and adjusted for sex, age, and stroke severity to investigate the association between in-hospital frailty and post-stroke HRQoL.ResultsMean (SD) age was 71.7 years (11.6); mean NIHSS score was 2.8 (4.0), and 263 (42.1%) were female. Frailty prevalence was 10.4%, while 58.6% were pre-frail. The robust group had EQ-5D-5L index and EQ-5D VAS scores at 3 and 18 months comparable to the general population. Also at 3 and 18 months, the pre-frail and frail groups had significantly lower EQ-5D-5L indices than the robust group (p < 0.001), and the frail group showed a larger decrease from 3 to 18 months in the EQ-5D-5L index score compared to the robust group (− 0.056; 95% CI − 0.104 to − 0.009; p = 0.021). There were no significant differences in change in EQ-5D VAS scores between the groups.ConclusionThis study on participants mainly diagnosed with mild strokes suggests that robust stroke patients have fairly good and stable post-stroke HRQoL, while post-stroke HRQoL is impaired and continues to deteriorate among patients with in-hospital frailty. This emphasises the importance of a greater focus on frailty in stroke units.Trial registrationClinicalTrials.gov (NCT02650531).

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse. To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. This multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. Mechanical thrombectomy or standard medical treatment with or without IVT. Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was -2.4 points (95% CI, -3.2 to -1.6) in the standard medical treatment cohort and -3.9 points (95% CI, -5.4 to -2.5) in the mechanical thrombectomy cohort, with a mean difference of -1.5 points (95% CI, 3.2 to -0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, -5.6; 95% CI, -10.9 to -0.2; P = .04) and in the subgroup of patients without IVT (mean difference, -3.0; 95% CI, -5.0 to -0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort. This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.

Effect of Serum Uric Acid Level on Acute Ischaemic Stroke Patients in South Indian Population: A Prospective Cohort Study

Introduction: Stroke is one of the most common causes of morbidity and mortality in the world. Various studies have shown the correlation between the uric acid levels and acute ischaemic stroke. There are several studies which project the cerebro-protective effect of uric acid in acute ischaemic stroke patients by its antioxidant effect. However, still it is a wide area of controversy. Aim: To assess the short term (14 days) clinical outcomes in acute ischaemic stroke patients with reference to their serum uric acid levels on day of admission day. Materials and Methods: This prospective cohort study, which included a total of 74 acute ischaemic stroke patients who presented to Emergency Department in a Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry (a tertiary care hospital in South India) within 48 hours from the month of April 2018 and June 2019. The severity of stroke was quantified in all patients using National Institute of Health Stroke Scale (NIHSS) during admission and serum uric acid levels and other routine investigations were measured in all cases. All patients were managed as per American Heart Association (AHA) guidelines and at the end of 14 days their outcome was reassessed by modified Rankin Scale (mRS). The correlation between severity of stroke and the clinical outcome on 14 days with reference to admission day serum uric acid was analysed. Results: A total of 74 patients were analysed, 51 were male and 23 were females and mean serum uric acid was 6.07±0.78 (mg/dL), and mean NIHSS score at admission was 18.32±3.8. Severity assessment by NIHSS scoring system showed majority percentage of population in elevated serum uric acid group were in moderate and severe categories (73.7%, 62.9%, respectively) in adjunct with normal uric acid group. Outcome assessment by mRS showed major percentage population in elevated uric acid group with score 2,3 (score 2-89.3%, score 3-80%) in relation to normal uric acid group. Conclusion: The present study supported the hypothesis that acute ischaemic stroke patients with elevated serum uric acid levels at the time of admission had reduced severity and favourable short term clinical outcome due to its neuroprotective effect secondary to antioxidant property.

Statistical analysis for efficacy of tirofiban combined with ozagrel in the treatment of progressive cerebral infarction patients out of thrombolytic therapy time window

OBJECTIVES:To investigate the safety and efficacy of combined tirofiban-ozagrel therapy for treating progressive stroke patients out of thrombolytic therapy time window.METHODS:This prospective, double-blind, randomized controlled study included 337 patients who had experienced an acute ischemic stroke between November 2017 and December 2018. All patients were randomized into three groups: 1) the tirofiban/ozagrel group (n=113), 2) the tirofiban group (n=110), and 3) the ozagrel group (n=114). The platelet aggregation (PAG), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) levels in the patients from these groups were evaluated before starting treatment and then, at 24h, 7 days, and 14 days after treatment. The National Institutes of Health Stroke Scale (NIHSS) scores were evaluated before treatment and then, 24h, 1 week, 2 weeks, and 4 weeks after treatment. The Barthel Index (BI) score was used to measure safety, and the modified Rankin scale (mRS) was used to evaluate disability following 3 months of treatment. The risk factors affecting clinical outcomes were analyzed using logistic multivariate regression.RESULTS:The mean NIHSS score for all the patients was 13.17±3.13 before treatment, and no significant difference between the basic clinical parameters of the three patient groups was found. Following treatment, both PAG and FIB were significantly reduced compared with the baseline (p<0.05). The levels of PAG and FIB in the tirofiban/ozagrel group were significantly lower than those in the tirofiban and ozagrel groups at 24h and 7 days after treatment (p<0.05). The NIHSS score decreased significantly in all treatment groups (p<0.05). The tirofiban/ozagrel NIHSS scores were significantly lower than that of the tirofiban and ozagrel groups at 24h, 1 week, and 2 weeks post initiation (p<0.05 for all). There were no significant differences in the BI and mRS scores or the intracranial hemorrhage rates; further, age, sex, Trial of ORG 10172 in acute stroke treatment (TOAST) type, baseline NIHSS and 24-h NIHSS scores, baseline thrombus-related factors, and treatment methods were shown to not be independent risk factors for clinical outcomes.CONCLUSION:The combination of tirofiban and ozagrel, as well as monotherapy with either tirofiban or ozagrel, transiently improves the neural function of patients and reduces platelet aggregation and fibrinogen formation in the first 4 weeks following a stroke event; additionally, none of these treatments increased the risk for hemorrhage in these progressive stroke patients over a 3-month period.

Initial experience with the CatchView thrombectomy device for acute ischemic stroke

BackgroundWe report our initial experience with the CatchView (CV) thrombectomy device in patients with acute ischemic stroke (AIS).MethodsA retrospective analysis of 53 of 284 AIS patients (mean age 66.6±14.8 years,...

Escitalopram improves neural functional prognosis and endothelial dysfunction in patients with acute cerebral infarction.

Escitalopram is one of the most commonly used SSRIs at present, which has the characteristics of quick onset, less interactions with other drugs, and relative safety. This study aims to investigate the effects of escitalopram on neural functional prognoses and endothelial dysfunction after acute ischemic stroke. One hundred eligible patients afflicted with acute ischemic stroke were randomized into two groups: control and treatment groups. Patients in the treatment group received escitalopram in addition to the basic therapies in the control group over a period of 90 days. Neurological deficits were quantified using the National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI) score, cognitive impairment was determined using the Mini-Mental State Examination (MMSE) score, depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAMD). Furthermore, post-stroke depression (PSD) was defined based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), with a HAMD score ≥17. Flow-mediated vascular dilatation (FMD) of the brachial artery was use as a surrogate indicator for endothelial dysfunction assessment with ultrasound. The mean NIHSS and HAMD scores on day 90 after treatment were significantly lower in the treatment group than in the control group (2.17±0.36 vs. 4.24±0.85; 5.81±1.35 vs. 10.43±4.91; P < 0.01), while the mean BI score and FMD were significantly higher in the treatment group (93.08±6.23 vs. 79.64±7.56, P < 0.01; 8.71±2.35 vs. 5.83±1.21, P < 0.05) than in the control group. The improvement in MMSE score was not significantly different between the two groups. Treatment with escitalopram early after ischemic stroke can improve neural functional prognoses and endothelial dysfunction. Escitalopram had less side effects, which is worthy of clinical prophylactic application.

Validity of National Institutes of Health Stroke Scale for Severity of Stroke to Predict Mortality Among Patients Presenting With Symptoms of Stroke

IntroductionCerebrovascular accident (CVA), also termed as stroke, is the third leading cause of mortality and the most common cause of disability globally. The National Institutes of Health Stroke Scale (NIHSS) is a valid assessment tool utilized to determine the severity of the stroke and can be used to prioritize patients to design treatment plans, rehabilitation, and better clinical outcomes. The primary objective of this study was to determine the validity of the NIHSS to predict mortality among patients presenting with symptoms of a stroke.Material and methodsThis was a descriptive case-series conducted over a period of six months between September 2019 and February 2020 at a tertiary care hospital in Nawabshah, Pakistan. The sample population included 141 patients admitted within 24 hours of the onset of symptoms of a stroke. A neurological examination of the patients was performed. On admission, stroke severity was evaluated with the NIHSS. After an initial clinical evaluation, patients underwent a non-enhanced computed tomography (CT) scan of the brain. The score of NIHSS and mortality at 72 hours were recorded on the pre-defined proforma by the investigators. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0 (Armonk, NY: IBM Corp).ResultsThe mean age of the participants was 52.37±8.61 years. 68.1% of patients were hypertensive, 29.1% were diabetic, and 36.9% of patients were found with hyperlipidemia. The mortality rate was 41.1%. The mean NIHSS score was 16.68±6.72 points. The findings of this study demonstrated that the score of 14.9% cases was good (0-6 points), the score of 29.1% cases was moderate (7-15 points), and the score of 56% cases was poor (≥16 points). There was a significant association of NIHSS score with mortality (p<0.001).ConclusionsBaseline NIHSS score has a profound association with mortality after acute stroke. It can help clinicians decide whether to provide thrombolytic treatment, rehabilitation or a combination of both in these patients and decrease the mortality rate. However, more studies are needed to potentiate these conclusions.

A study on elevation of troponin I in ischemic stroke as an independent prognostic marker of outcomes

Background: Stroke is the second leading cause of death worldwide, comprising approximately 10% of all deaths. A substantial number of stroke patients have elevated cardiac troponin levels and are associated with poorer prognosis.&#x0D; Methods: This was a prospective observational study conducted for 1 year at Tribhuvan University Teaching Hospital, in which 101 acute ischemic stroke patients were enrolled. Data included vital signs, laboratory parameters, and clinical features evaluated at the time of admission. The National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) were used to assess stroke severity and outcomes.&#x0D; Results: Elevated troponin I (&gt; 0.034 ng/mL) was observed in eight (7.9%) patients. Compared to patients with normal troponin I, patients with elevated troponin I were older(mean age 61vs 59.68 years), had higher blood glucose( 10.6 vs. 7.04 mmol/L), higher median white blood cells( 9.3 vs. 8.9 1,000/m3) and creatinine levels(119.5 μmol/L vs. 95.9 μmol/L), higher mean NIHSS scores on admission(16 vs. 8.6), and discharge(14.5 vs. 6.8), higher median mRS scores( 4.13 vs. 1.8) at discharge(p&lt;0.001). Poor outcomes were observed in 34(33.66%) patients of 101 patients and death occurred in five (4.9%) patients. Patients with abnormal troponin I had poorer outcomes than normal troponin I level patients (p=&lt;0.001) and significantly higher deaths (p=0.006). Univariate analysis of continuous variables revealed that patients with poor outcomes compared to good outcomes had higher troponin levels (0.029 vs. 0.013 ng/mL, p=0.001), creatinine levels (113.5 vs. 89.8μmol/L, p=0.007), NIHSS score on admission (13.4 vs. 5.10, p&lt;0.001),discharge (12.4 vs. 5.1, p&lt;0.001), and higher mRS scores at discharge (3.71 vs. 1.16, p&lt;0.001).Multiple logistic regression analysis revealed that NIHSS score on admission&gt;13(OR 15.902; 95%CI[3.65-69.28],p=&lt;0.001) and abnormal troponin I level, troponin I&gt;0.029 ng/mL (odds ratio[OR]:28.451; 95% CI[2.785-290.6],p=0.005) were significant predictors of poor outcomes. Significant predictor of in hospital mortality only included troponin I level &gt;0.04 ng/mL (0R 0.071; 95% CI [0.005-1.037], P=0.05).&#x0D; Conclusion: Troponin I provide better information than age and other laboratory parameters in the prediction of outcomes of stroke. Elevation of troponin I during acute stroke is a strong predictor of both poor outcomes and in-hospital mortality.

Post-stroke Cognitive Impairment-Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study.

Background: Post-stroke cognitive impairment (PSCI) is common, but evidence of cognitive symptom profiles, course over time, and pathogenesis is scarce. We investigated the significance of time and etiologic stroke subtype for the probability of PSCI, severity, and cognitive profile.Methods: Stroke survivors (n = 617) underwent cognitive assessments of attention, executive function, memory, language, perceptual-motor function, and the Montreal Cognitive Assessment (MoCA) after 3 and/or 18 months. PSCI was classified according to DSM-5 criteria. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was categorized as intracerebral hemorrhage (ICH), large artery disease (LAD), cardioembolic stroke (CE), small vessel disease (SVD), or un-/other determined strokes (UD). Mixed-effects logistic or linear regression was applied with PSCI, MoCA, and z-scores of the cognitive domains as dependent variables. Independent variables were time as well as stroke subtype, time, and interaction between these. The analyses were adjusted for age, education, and sex. The effects of time and stroke subtype were analyzed by likelihood ratio tests (LR).Results: Mean age was 72 years (SD 12), 42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8). Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51–0.66) and 0.51 (0.52–0.60), respectively and remained constant over time. Global measures and most cognitive domains were assessed as impaired for the entire stroke population and for most stroke subtypes. Executive function and language improved for the entire stroke population (LR) = 9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively). After dividing the sample according to stroke subtypes, language improved for ICH patients (LR = 18.02, p = 0.003). No significant differences were found in the severity of impairment between stroke subtypes except for attention, which was impaired for LAD and CE in contrast to no impairment for SVD (LR = 56.58, p < 0.001).Conclusions: In this study including mainly minor strokes, PSCI is common for all subtypes, both early and long-term after stroke, while executive function and language improve over time. The findings might contribute to personalizing follow-up and offer new insights into underlying mechanisms. Further research is needed on underlying mechanisms, PSCI prevention and treatment, and relevance for rehabilitation.

The predictive value of mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio in acute middle cerebral artery infarction patients

Objective: The aim of this study was to determine the predictive value of mean platelet volume (MPV), neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) in patients with acute middle cerebral artery (MCA)branch infarction. Method: This examination was performed on the files of 50 patients followed up at the Anesthesia and Reanimation ICU of Onsekiz Mart University Hospital between April 2017 and September 2019 for acute occlusion in the MCA branch, with no previous history of an ischemic stroke. These patients were assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Score (mRS). The ratios of the neutrophil and platelet countsto the lymphocyte count (NLR and PLR ratios) within the first hour of the stroke and MPV were compared to a control group. Results: The study included 50 patients with the acute ischemia of the MCA branch, of which 28 (56%) were female. The control group consisted of 50 healthy people, and 24 (48%) of these were female. The mean NIHSS score of the patients was 11.4 ± 2.6, and their mean mRS was 2.5 ± 1.5. Conclusions: In our study with patients who had acute middle cerebral artery infarction, we found that the NLR, PLR, and MPV levels within the first hour of stroke were higher in the patient group in comparison to the control group ona statistically significant level. However, multicenter studies with larger subject groups are needed for the use of hematological parameters as biomarkers in an ischemic stroke

Evidence for a Beneficial Effect of Oral N-acetylcysteine on Functional Outcomes and Inflammatory Biomarkers in Patients with Acute Ischemic Stroke.

PurposeNumerous preclinical studies have demonstrated the potential neuroprotective effects of N-acetylcysteine (NAC) in the treatment of brain ischemia. Accordingly, the present study aimed to assess the potential therapeutic effects of oral NAC in patients with acute ischemic stroke.Patients and MethodsIn a randomized, double-blind, placebo-controlled trial study, 68 patients with acute ischemic stroke with the onset of symptoms less than 24 hours were randomly assigned to either the NAC-treated group or placebo-treated group. NAC and matched placebo were administrated by a 72-hour oral protocol (initially 4 grams loading dose and after on, 4 g in 4 equal divided doses for more 2 days). The primary outcomes were quantification of any neurologic deficit by the use of the National Institute of Health Stroke Scale (NIHSS) score and functional disability by the use of the modified Rankin scale (mRS) at 90 days after stroke. Additionally, serum levels of markers of oxidative stress and inflammation as a main mechanism of its action were assessed at baseline and the end of 3-day treatment protocol.ResultsNAC-treated patients in comparison with placebo-treated patients showed a significantly lower mean NIHSS scores at day 90 after stroke. A favorable functional outcome which was defined as an mRS score of 0 or 1, also in favor of NAC compared to placebo was noted on day 90 after stroke (57.6% in the NAC-treated group compared with 28.6% in the placebo-treated group). Further, compared to the placebo, NAC treatment significantly decreased serum levels of proinflammatory biomarkers such as interleukin 6 (IL-6), soluble intercellular cell adhesion molecule-1 (sICAM-1), nitric oxide (NO), malondialdehyde (MDA), and neuron-specific enolase (NSE) and significantly increased serum levels of anti-oxidant biomarkers such as superoxide dismutase (SOD), glutathione peroxidase (GPx), and total thiol groups (TTG).ConclusionThe pattern of results suggests that oral NAC administration early after an acute ischemic stroke is associated with a better outcome profile in terms of acute neurological deficit and disability grade compared to placebo. NAC may improve neurological outcomes of patients with stroke at least in part by its antioxidant and anti-inflammatory effects.