NIHSS Research Articles

Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India.

This study aimed to determine the risk factors and stroke subtypes for young ischemic stroke patients and their outcomes at the time of discharge. This is a retrospective cross-sectional study of ischemic stroke patients (n = 264) between the age groups of 18 and 45. The study population was divided into two broad age groups: 18 to 35 years and 36 to 45 years; and compared based on demographics, risk factors, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and outcomes. The outcomes were compared based on the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) systems at the time of admission and discharge. The mean age of patients was 37.84±6.19 years. The male-to-female ratio was 2.5:1. The most common vascular risk factors identified were diabetes (29.16%), hypertension (49.62%), dyslipidaemia (DLP, 44.4%), and smoking (10.9%). The most common TOAST subtype was large vessel disease (38.63%), followed by the undetermined category (35.6%). The elderly group showed a high proportion of strokes secondary to small vessel disease (14.13%; p = 0.03), while cardioembolic strokes were common in the female subgroup (p = 0.05). The majority of strokes were in the anterior circulation (66.6%) as compared to the posterior (25.75%), and nearly 50% of the patients had intracranial disease. Overall, there was a favourable MRS outcome at discharge. Conventional vascular risk factors are equally prevalent, even among young stroke patients. The benchmark for young stroke age is showing a downward shift as more stroke patients above the age of 35 are showing similar risk factor trends as those of their older counterparts. The majority of stroke burden still falls under the undermined category, which requires aggressive risk factor identification and management.

First-Line Aspiration Thrombectomy of M2 Occlusions with a Novel Reperfusion Catheter (REDTM 62): Real-World Experience from Two Tertiary Comprehensive Stroke Centers.

The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical features and initial results of a novel reperfusion catheter (REDTM 62) used for frontline aspiration thrombectomy of M2 occlusions in acute ischemic stroke patients. Appropriate aspiration catheters are crucial for a successful ADAPT maneuver; however, the selection of catheters suitable for smaller-sized vessels is scarce compared to the ones for large vessel occlusions. All patients treated with ADAPT using REDTM 62 as the frontline treatment approach for acute M2 occlusions between December 2022 and February 2024 were retrospectively enrolled. Demographic data, procedural timings and safety, recanalization rates, and outcome data were recorded. Twenty patients with a median admission National Institutes of Health Stroke Scale (NIHSS) score of 8 were identified. Successful revascularization (DMVO-thrombolysis in cerebral infarction [TICI]≥2b) with REDTM 62 aspiration thrombectomy was obtained in 65.0% (13/20) of cases. The first pass effect was 45.0% (9/20). In 2 cases, the REDTM 62 did not reach the clot due to marked distal vessel tortuosity. Stent retrievers were additionally used in 9 cases and led to an overall DMVO-TICI 2c/3 of 90.0% (18/20). Mean procedural time was 48 minutes. No complications directly related to ADAPT occurred. In-hospital mortality rate was 20.0% (4/20). The median discharge NIHSS score was 2.5. A good functional outcome at discharge (modified Rankin scale 0-2) was achieved in 55.0% (11/20) of cases. Our initial experiences with the novel REDTM 62 reperfusion catheter for treatment of M2 occlusions is in line with published data. ADAPT using this catheter may be considered as a safe and effective first-line treatment option. Further studies are warranted to validate the initial results.

The National Institutes of Health Stroke Scale is comparable to the ICH score in predicting outcomes in spontaneous acute intracerebral hemorrhage.

Validating the National Institutes of Health NIH Stroke Scale (NIHSS) as a tool to assess deficit severity and prognosis in patients with acute intracerebral hemorrhage would harmonize the assessment of intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) patients, enable clinical use of a readily implementable and non-imaging dependent prognostic tool, and improve monitoring of ICH care quality in administrative datasets. Among randomized trial ICH patients, the relation between NIHSS scores early after Emergency Department arrival and 3-month outcomes of dependency or death (modified Rankin Scale, mRS 3-6) and case fatality was examined. NIHSS predictive performance was compared to a current standard prognostic scale, the intracerebral hemorrhage score (ICH score). Among the 384 patients, the mean age was 65 (±13), with 66% being male. The median NIHSS score was 16 (interquartile range (IQR) 9-25), the mean initial hematoma volume was 29 mL (±38), and the ICH score median was 1 (IQR 0-2). At 3 months, the mRS had a median of 4 (IQR 2-6), with dependency or death occurring in 70% and case fatality in 26%. The NIHSS and ICH scores were strongly correlated (r = 0.73), and each was strongly correlated with the 90-day mRS (NIHSS, r = 0.61; ICH score, r = 0.62). The NIHSS performed comparably to the ICH score in predicting both dependency or death (c = 0.80 vs. 0.80, p = 0.83) and case fatality (c = 0.78 vs. 0.80, p = 0.29). At threshold values, the NIHSS predicted dependency or death with 74.1% accuracy (NIHSS 17.5) and case fatality with 75.0% accuracy (NIHSS 18.5). The NIHSS forecasts 3-month functional and case fatality outcomes with accuracy comparable to the ICH Score. Widely documented in routine clinical care and administrative data, the NIHSS can serve as a valuable measure for clinical prognostication, therapy development, and case-mix risk adjustment in ICH patients.Clinical trial registrationClinicaltrials.gov, NCT00059332.

Dynamic change of neutrophil-to-lymphocyte ratio and its predictive value of prognosis in acute ischemic stroke.

The present research aimed to explore the dynamic change of the neutrophil-to-lymphocyte ratio (NLR) and its relationship with functional outcome following an acute ischemic stroke (AIS), whether receiving intravenous thrombolysis (IVT) or not. We retrospectively analyzed data that were prospectively acquired from patients with AIS treated with IVT or not. For patients receiving IVT, the NLR was based on a blood test performed prior to IVT (d0) and at different time points after disease onset (d1, d3, d7). In addition, in the non-IVT group, the NLR was obtained at different time points after disease onset (d1, d3, d7). Follow-ups were performed 3 months after onset via telephone. In addition, a good outcome was defined as a modified Rankin scale (mRS) ≤1; a poor outcome means 2≤mRS≤6. A total of 204 AIS patients were included in this study. The NLR presented a dynamic change as it increased to its peak at day 1 and gradually declined to its baseline at day 7, no matter whether patients were receiving IVT or not. Patients with poor outcomes have a higher NLR at various time points. The results of multivariate logistic regression analysis demonstrated that the National Institutes of Health Stroke Scale (NIHSS), NLR d1, NLR d3, and NLR d7 were independently associated with functional outcomes. The area under the receiver operating characteristic curve of NLR in predicting outcomes was as follows: NLR d3 demonstrated robust predictive power within the IVT therapy cohort, whereas NLR d7 was predictive in the non-IVT cohort. However, the most potent predictor emerged as the combination of NIHSS and NLR. NLR has the potential to predicate diagnosis for AIS, especially when combined with the NIHSS score.

Demographic Characteristics and Functional Outcome in Posterior Circulation Strokes.

The constantly increasing incidence of stroke in Saudi Arabia substantiates an urgent need to elucidate underlying risk factors and etiologies. In terms of improving outcomes, the predictors of functional outcomes need to be identified as well. As posterior circulation strokes (PCS) have not been studied in detail, the current study aimed to identify the risk factors, etiology, and predictors of outcome in PCS. This retrospective study included the data for 138 patients with PCS. Demographics, risk factors, clinical signs/symptoms, etiology, and outcome at discharge and 3-month follow-up were recorded. Factors associated with outcomes were identified, and the difference was ascertained using Chi-square, odds ratios, and 95% confidence intervals. The mean participant age was 58 ± 14.8 years with 73% being males. The mean arrival time was 26.5 ± 31.6 h; with a mean National Institute of Health Stroke scale (NIHSS) score of 7.2 ± 5.6. Motor deficit and dysarthria were the most common presentations. Twenty percent of patients received intravenous recombinant tissue plasminogen activator, whereas endovascular thrombectomy was performed in 9 (6.5%). Follow-up outcome at 3 months was available in 113 (81.8%). Male sex, baseline modified Rankin scale of <2, low baseline NIHSS, and stable or improvement in baseline NIHSS during 24 h of admission were documented as predictors of a good outcome, whereas history of atrial fibrillation and prior stroke, high NIHSS at admission and worsening of symptoms during 24 h of admission, as well as bilateral body involvement were associated with poor outcome. The functional outcomes and the predictors of functional outcomes did not differ from the previously published literature; however, significant differences were observed in the risk factors and etiological profile in our population. These differences are of potential interest to the researchers and clinicians, as they carry important therapeutic and prognostic implications and need to be verified through large prospective studies.

THE SAFETY AND OUTCOME OF ACUTE ISCHAEMIC STROKE PATIENTS WITH COVID-19 TREATED WITH INTRAVENOUS RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR: A SYSTEMATIC REVIEW

Background: Strokes associated with SARS-CoV-2 may be linked to increased mortality rates. The utilization of intravenous thrombolysis is anticipated to enhance the clinical results in such patients. Moreover, emerging evidence underscores the importance of evaluating the safety and effectiveness of intravenous thrombolysis in individuals suffering from Acute Ischaemic Stroke along with COVID-19. Objective: To assess the safety and effectiveness of intravenous thrombolysis in Acute Ischaemic Stroke patients with COVID-19. Methods: A systematic literature search (Pubmed, Elsevier, and Cochrane database) with keywords (((intravenous thrombolysis) AND (acute ischemic stroke)) AND (covid-19)) AND (outcome))). We selected research studies for evaluation based on specific inclusion and eligibility criteria. Two independent reviewers then proceeded to extract and analyze various data points, including the name of the first author, the year of publication, the study's design, the National Institute of Health Stroke Scale (NIHSS) scores at admission and post-treatment, hospitalization-related mortality, and the occurrence of hemorrhagic transformation. Results: Three studies (n=153 patients) were included, mostly men with advanced age with the most common comorbidity being hypertension. Median of NIHSS Score of subjects on admission is 11, 12, and 13, with interquartile range from 3 to 20 (minor to severe stroke). The mRS at discharge and 1 month after admission is: 0–2 pts in 57 patients, ≥2 in 43 patient. Hemorrhagic transformation involved 3.23% of patients from total samples, death within hospitalization and 1-month mortality were in 23 patients (15%). In numerous studies, there was inadequate data available to determine the precise reason for mortality. Conclusion: Following IV-rTPA therapy, our COVID-19 infection subjects' mRS scores ranged from mild to moderate disability. Fifteen percents of all subjects died, and 3.23% of subjects experienced hemorrhagic transformation. However, majority of our subjects have high median NIHSS scores at admission, advanced age, complicated with baseline risk factors as high blood pressure, diabetes, and hyperlipidemia.

CASE SERIES: EFFICACY OF THROMBOLYSIS USING INTRAVENOUS ALTEPLASE IN ACUTE ISCHEMIC STROKE WITH ONSET LESS THAN 6 HOURS (CODE STROKE)

Background: The gold standard therapy for acute ischemic stroke is timely reperfusion of ischemic brain tissue. Intravenous thrombolysis with tPA is the only proven medical therapy for acute ischemic stroke within 4.5 hours of symptom onset using intravenous alteplase at a dose of 0.9 mg per kilogram of body weight. Hemorrhagic transformation is one of the complications of thrombolytic therapy and East Asian population having a higher prevalence of cerebral hemorrhage. This study will examine several cases of ischemic stroke that were treated with thrombolysis using a standard dose (0.9 mg/kg) of intravenous alteplase in acute ischemic stroke with an onset of less than 6 hours in the Special Region of Yogyakarta, especially at the UGM Academic Hospital. Objective: To determine the efficacy of standard dose thrombolysis using intravenous alteplase (rTPA-recombinant tissue plasminogen activator) in acute ischemic stroke with an onset of less than 6 hours through activation of the Code Stroke. Methods: Descriptive research design using a case series, the hyperacute stroke patients with an onset of less than 6 hours who received intravenous alteplase which were then assessed by the National Institutes of Health Stroke Scale (NIHSS) score at initial admission, 24 hours post-alteplase and 30 days post -alteplase. The study took place and was conducted from May to October 2022 by administering intravenous alteplase at a dose of 0.9 mg/kg body weight in acute ischemic stroke patients at UGM RSA who are eligible for thrombolysis therapy with a maximum administration time of 6 hours after stroke onset with the maximum dose of alteplase is 50 mg. Results: The study sample was 8 patients with acute ischemic stroke who were treated between May to October 2022. There were 2 patients who died before completing the 3-month follow-up. One of the patients died within the second week of treatment from sepsis which may have occurred from a pre-existing pneumonia. Another patient died from ileus that occurred 1 month after tissue plasminogen activator (tPA). However, the patient with this ileus showed clinical improvement at the 24-hour post-tPA follow-up, i.e. the initial NIHSS score of 12 improved to an NIHSS score of 6. Conclusion: The modified Alteplase dose, which is 0.9 mg/kg body weight with a maximum dose of 50 mg, at the onset of stroke less than 6 hours can be an option to maximize thrombolytic therapy while still considering the efficiency of treatment costs.

Relationship Between the Gut Microbiota and Neurological Deficits in Patients With Cerebral Ischemic Stroke

Objective The aim of the paper was to investigate the composition and structure of intestinal flora in patients with cerebral ischemic stroke (CIS), and to investigate the relationship between gut microbiota (GM) and different levels of stroke severity. Methods In this study, 47 CIS patients (16 mild, 21 moderate, and 10 severe) and 15 healthy controls were included. General information, clinical data, and behavioral scores of the enrolled subjects were collected. Deoxyribonucleic acid in fecal intestinal flora was extracted and detected using high-throughput Illumina 16S ribosomal ribonucleic acid sequencing technology. Finally, the correlation between the community composition of intestinal microbiota and National Institutes of Health Stroke Scale (NIHSS) score in CIS patients was analyzed. Results Compared with healthy controls, there was no statistically significant difference in Alpha diversity among CIS patients, but the principal coordinate analysis showed significant differences in the composition of the GM among stroke patients with different degrees of severity and controls. In CIS patients, Streptococcus was significantly enriched, and Eshibacter—Shigella, Bacteroides, and Agathobacter were significantly down-regulated (P < .05). In addition, the relative abundance of Blautia was negatively correlated with the NIHSS score. Conclusions Our results show that different degrees of CIS severity exert distinct effects on the intestinal microbiome. This study reveals the intestinal microecological changes after brain injury from the perspective of brain–gut axis. Intestinal microorganisms not only reveal the possible pathological process and indicate the severity of neurologic impairment, but also make targeted therapy possible for CIS patients.

Study of Serum Gamma-Glutamyl Transferase Levels in Patients With Acute Ischemic Stroke.

Background Gamma-glutamyl transferase (GGT) mediates intracellular uptake of glutathione which is a known antioxidant. GGT levels are found to be elevated in conditions of oxidative stress. Ischemic stroke results in anoxic injury, which liberates free radicals, causing glutathione to rise, which may be accompanied by a rise in serum GGT levels. This study aimed to compare serum GGT levels in acute ischemic stroke patients with normal controls and to ascertain the relation of serum GGT levels with National Institute of HealthStroke Scale (NIHSS) scores. Materials and methods This cross-sectional study was carried out in a tertiary care hospital in South India from August 2023 to February 2024. The study included 57 patients who presented with acute ischemic stroke within 24 hours of onset and 57 age- and sex-matched controls. The serum GGT levels of the cases were compared with age- and sex-matched controls using an independent t-test. Mean serum GGT levels were compared among groups with varying NIHSS scores and different locations of infarction using the ANOVA test. Serum GGT levels were also compared based on age, gender, and various comorbidities. Results The mean serum GGT levels were significantly increased (p < 0.0001) in acute ischemic stroke patients, 43.96 ± 28.02 (mean ± SD), when compared to controls, 26.14 ± 5.93 (mean ± SD). The difference in serum GGT levels with NIHSS scores of 5-15 (moderate strokes) with 34.17 ± 18.39 (mean ± SD), 16-20 (moderate-severe strokes) with 46.64 ± 21.95 (mean ± SD), and >21 (severe stroke) with84.62 ± 39.35 (mean ± SD) was significant (p < 0.00001).Serum GGT levels were not significant while comparing age, gender, location of infarction, type 2 diabetes mellitus, and hypertension. Conclusion Serum GGT levels were significantly elevated in acute ischemic stroke patients within 24 hours of presentation. Serum GGT levels were significantly elevated with increasing severity of stroke as calculated by NIHSS scores at the time of presentation. Serum GGT levels are a potential marker of ischemic stroke and its severity.

Multimodal imaging evaluation of early neurological deterioration following acute ischemic stroke.

Early neurologic deterioration occurs in up to one-third of patients with acute ischemic stroke (IS), often leading to poor functional outcomes. At present, few studies have applied amide proton transfer (APT) imaging to the evaluation of early neurological deterioration (END). This study analyzed the value of computed tomography perfusion (CTP) combined with multimodal magnetic resonance imaging (MRI) in patients with acute IS with END. This retrospective study included patients with acute IS who were admitted to the neurology inpatient department in a tertiary hospital from October 2021 to June 2023. Patients with acute IS underwent CTP within 24 hours of stroke onset and MRI [arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), and APT] within 7 days. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 7 days of stroke onset. Univariable and multivariable analyses were used to compare clinical and imaging biomarkers in patients with acute IS with and without END. The performance of potential biomarkers in distinguishing between the two groups was evaluated using receiver operating characteristic (ROC) curve analysis. Among the 70 patients with acute IS, 20 (29%) had END. After conducting univariable analysis, variables were selected for entry into a binary logistic regression analysis based on our univariable analysis results, previous research findings, clinical experience, and methodological standards. The results indicated that relative cerebral blood volume (CBV) on CTP, relative cerebral blood flow (CBF) on ASL, and relative signal intensity on amide proton transfer-weighted (APTw) imaging were independent risk factors for END. The areas under the ROC curves for these risk factors were 0.710 [95% confidence interval (CI): 0.559-0.861, P=0.006], 0.839 (95% CI: 0.744-0.933, P<0.001), and 0.804 (95% CI: 0.676-0.932, P<0.001), respectively. The combined area under the curve (AUC), sensitivity, and specificity of the four indices (0.941, 100%, and 78%, respectively) were higher than those of the four indices alone. CTP combined with multi-modal MRI better evaluated hemodynamics, tissue metabolism, and other relevant patient information, providing an objective basis for the clinical assessment of patients with acute IS with END and facilitating the development of accurate and personalized treatment plans.

Successful Recanalization by Mechanical Thrombectomy in a Child with Arterial Thrombotic Stroke Involving Posterior Circulation: A Case Report with Review of the Literature

Background: Mechanical thrombectomy (MT) for arterial ischemic stroke, although established in adults, is not endorsed routinely for children. The procedure is even rare in children with stroke involving posterior circulation. Here we describe, a child with ischemic stroke due to thrombotic occlusion in the posterior circulation, which was successfully treated with MT. Clinical Description: A 12-year-old boy presented with sudden-onset vertigo, imbalance, slurring of speech, inability to stand, associated with headache and vomiting for 8 hours, without any associated fever, trauma, or seizures. On initial examination, his National Institute of Health Stroke Scale (NIHSS) score was 8. Other systems were within normal limits and there was no cutaneous rash. Management and Outcome: Investigations revealed a normal complete hemogram, lipid profile, serum homocysteine, fibrinogen, and D-dimer levels along with a normal hemoglobin electrophoresis profile. The electrocardiography, two-dimensional echocardiography were normal and even antinuclear antibodies, antiphospholipid antibodies were negative. Magnetic resonance imaging (MRI) of the brain demonstrated multiple acute infarcts in bilateral cerebellar hemispheres, pons, and right anterior thalamus. Noncontrast MR angiography (MRA) of the head and digital subtraction angiography showed distal basilar artery cutoff and right vertebral artery dominance. As the NIHSS score worsened to 10, a MT with solitaire was done (after 12 hours of onset of symptoms), and reperfusion was achieved in two passes. The child showed remarkable improvement in NIHSS score to 2 by 5 days. At discharge, the child had residual mild ataxia. Despite investigations, the cause of thrombosis remained unknown. Conclusion: Our case highlights that in case of significant large arterial occlusion with rapid worsening of symptoms, MT may be considered, even if it involves posterior circulation, and the child presents beyond the usual window of 4–6 hours.

Predictors of outcome in large vessel occlusion stroke patients with intravenous tirofiban treatment: a post hoc analysis of the RESCUE BT clinical trial

ObjectiveThe aim of this study was to investigate the factors influencing good outcomes in patients receiving only intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke.MethodsPost hoc exploratory analysis using the RESCUE BT trial identified consecutive patients who received intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke in 55 comprehensive stroke centers from October 2018 to January 2022 in China.ResultsA total of 521 patients received intravenous tirofiban, 253 of whom achieved a good 90-day outcome (modified Rankin Scale [mRS] 0–2). Younger age (adjusted odds ratio [aOR]: 0.965, 95% confidence interval [CI]: 0.947–0.982; p < 0.001), lower serum glucose (aOR: 0.865, 95%CI: 0.807–0.928; p < 0.001), lower baseline National Institutes of Health Stroke Scale (NIHSS) score (aOR: 0.907, 95%CI: 0.869–0.947; p < 0.001), fewer total passes (aOR: 0.791, 95%CI: 0.665–0.939; p = 0.008), shorter punctures to recanalization time (aOR: 0.995, 95%CI:0.991–0.999; p = 0.017), and modified Thrombolysis in Cerebral Infarction (mTICI) score 2b to 3 (aOR: 8.330, 95%CI: 2.705–25.653; p < 0.001) were independent predictors of good outcomes after intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke.ConclusionYounger age, lower serum glucose level, lower baseline NIHSS score, fewer total passes, shorter punctures to recanalization time, and mTICI scores of 2b to 3 were independent predictors of good outcomes after intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke.Chinese clinical trial registry identifierChiCTR-IOR-17014167.

Effects of Hyperbaric Oxygen Therapy Combined with Music Therapy on Brain Function and Mental Health of Patients with Aneurismal Subarachnoid Hemorrhage: A Retrospective Study.

Hyperbaric oxygen therapy (HBOT), which is widely used in clinical practice, is aimed at improving nerve function impairment after brain injury. Meanwhile, the effects of music therapy on brain function are unclear. This retrospective study was conducted to explore the application effect of HBOT combined with music therapy on patients suffering from aneurysmal subarachnoid hemorrhage (aSAH). For this retrospective study, 130 patients with aSAH after HBOT were selected from our hospital from June 2021 to June 2022. The patients were divided into the observation (n = 70) and control (n = 60) groups based on whether they received music therapy. Comparisons were made on general demographic data, blood flow rate in median cerebral artery (MCA), cerebral vasospasm (CVS), National Institutes of Health Stroke Scale (NIHSS), activities of daily living (ADL) score, Self-Rating Depressive Scale (SDS), and Self-Rating Anxiety Scale (SAS) of patients. Baseline data between the two groups showed no statistically significant difference (P > 0.05). After management, patients in the observation group presented significantly lower SAS and SDS scores (P < 0.05), lower blood flow rate in MCA, CVS and NIHSS scores (P < 0.05), and higher ADL scores than the control group (P < 0.05). The combination of HBOT and music therapy can considerably improve cerebral neurological deficits, slow down cerebral arterial blood flow, promote the recovery of postoperative cerebral function in aSAH patients, and improve anxiety and depression and the patients' ADL.

A Case Study of Cerebral Infarction Patients with Dysesthesia and Weakness Treated with Sunghyuangjunggi-san (Xingxiang zhengqi san)

Objectives: The purpose of this study was to address a case of cerebral infarction with dysesthesia and weakness.Methods: A patient diagnosed with cerebral infarction with dysesthesia and weakness was treated with Korean medicine therapies including herbal medication (Sunhyunagjunggi-san) for 8 days. To evaluate the therapeutic effect, we used the National Institute of Health Stroke Scale (NIHSS) and Numerical Rating Scale (NRS).Results: After the treatment, the NIHSS and NRS scores dramatically decreased, and the symptoms no longer disturbed the patient. Although the symptoms of dysesthesia did not disappear completely, fine therapeutic effects were noted.Conclusion: These results suggested that Korean medicine therapies with Sunghyuangjunggi-san have a beneficial effect on the dysesthesia and weakness of cerebral infarction.

The Effect of Gammaekdaejo-tang for Post-stroke Depression: A Systemic Review and Meta-Analysis

Objective: This study assessed the effectiveness of Gammaekdaejo-tang for post-stroke depression through a systematic review and meta-analysis of randomized controlled trials (RCTs).Methods: A search was conducted using keywords such as “Post-stroke Depression”, “PSD”, “Gammaekdaejo”, and “Ganmai-dazao” on April 30, 2024. A meta-analysis was conducted according to outcome measurements, such as total effective rate (TER), HDRS (Hamilton Depression Rating Scale), and NIHSS (National Institute of Health Stroke Scale), using the Review Manager website.Results: A total of 10 RCTs was selected. The treatment group ((Gammaekdaejo-tang) or (Gammaekdaejo-tang combined with other ingredients or decoction)+Western medicine) showed significant improvement effects in terms of TER, HDRS, and NIHSS compared to the control group (Western medicine). [TER] RR: 1.19, 95% CI: 1.11 to 1.27, P&lt;0.00001, RR: 1.24, 95% CI: 1.11 to 1.38, P&lt;0.00001; [HDRS] MD: -2.29, 95% CI: -2.58 to -2.00, P&lt;0.00001), MD: -3.28, 95% CI: -4.21 to -2.35, P&lt;0.00001) [NIHSS] MD: -7.70, 95% CI: -8.52 to -6.89, P&lt;0.00001.Conclusion: This study suggests that Gammaekdaejo-tang is effective in treating PSD. However, there are limitations, such as the small number of included studies, inability to clearly determine the effect of Gammaekdaejo-tang, inability to use various evaluation tools, and risk of bias. This research must be supplemented through systematic research design and implementation.

Study to estimate the NIHS score and volume of stroke in predicting 30-day mortality in acute ischemic stroke patients

Background. Stroke is defined as a sudden onset of a neurological deficit attributed to a focal vascular cause. It is one of the leading causes of mortality and morbidity all over the world. The present study aimed to estimate the NIHS score and volume of stroke in predicting 30-day mortality in acute ischemic stroke patients. Material and methods. The present study was a prospective cross-sectional study conducted in 100 patients above 18 years old, of either gender, with symptoms of stroke for less than 24 hours, diagnosis of acute ischemic stroke based on history, physical examination, CT scan and/or diffusion weighted MRI scan performed during the first 24 hours. Results. In the present study, the mean age was 57.4±13.36 years. The volume of stroke on 1st day was 40.75±38.51, and on 30th day it was reduced to 31.94±33.20 which was statistically significant. NIHSS (National Institutes of Health Stroke Scale) score on day 1 was 9.70±5.22, and on day 30 it was 7.77±5.25, with a statistically significant difference (p=0.000). At the end of the 30 days, 10% mortality was observed. NIHSS score and volume of stroke were significantly associated with the 30-day outcome. Conclusion. In conclusion, integrating NIHSS scoring and stroke volume assessment into routine clinical practice enhances predictive accuracy for 30-day mortality in acute ischemic stroke patients. These findings advocate for early intervention strategies aimed at reducing stroke volume and improving neurological outcomes. Further research is recommended to validate these findings across diverse populations and settings, potentially refining acute stroke management protocol.

Predict Factors that Influence Stroke Recovery and Function Using FIM Score at Discharge in a Tertiary Hospital

Background: To assess the use of the National Institute of Health Stroke Scale (NIHSS) in predicting functional outcomes after hospital discharge using the functional independence measure (FIM) in patient’s post-stroke. Methods: This retrospective cohort study included 99 patients who were admitted to NGHA hospitals between January 2020 and January 2022 and had been discharged and scheduled for rehabilitation sessions in the hospital. All data were extracted from medical health records during the study period. Data on patient characteristics, NIHSS score, FIM admission and discharge scores, stroke type, rehabilitation sessions, smoking status, hypertension, and length of stay were collected. Results: Most patients had moderate stroke, and 88.9% of all the patients had ischemic stroke. There was a statistically significant improvement in the FIM score from admission to discharge [2.84 (+1.63) to 4.47 (+1.55), p= 0.01]. After adjusting for all other potential predictor variables, the NIHSS score for moderate stroke significantly predicted the FIM score upon discharge. Conclusion: This study showed the significance of using the NIHSS score for newly admitted patients with moderate stroke in predicting recovery. Conclusion: The study illustrated a significant improvement in the FIM scores from admission to discharge, demonstrating the importance of early and intensive rehabilitation post-stroke.

Assessment of the Functional Status of Patients after Ischemic Stroke Treated with Thrombolytic Therapy

Introduction. One of the most effective methods for treating acute ischemic stroke is thrombolytic therapy, which involves intravenous administration of recombinant tissue plasminogen activator (rtPA) within a narrow therapeutic window of up to 4.5 hours from symptom onset. Aim. The aim of this study was to assess the functional status of patients with ischemic stroke treated with thrombolytic therapy. Material and Methods. The study was conducted in the Neurological Department with a Stroke Subunit on a group of 90 patients hospitalized due to ischemic stroke and eligible for thrombolytic treatment. Functional status was assessed using the modified Rankin Scale, the National Institutes of Health Stroke Scale (NIHSS), and the Barthel Index on admission and at discharge from the hospital. Results. The mean scores on the modified Rankin Scale, NIHSS, and Barthel Index on admission were 4.3, 13.1, and 14.2, respectively. At discharge, the scores were 2.4, 6.0, and 59.5, respectively. Conclusions. Based on the conducted research, it was observed that thrombolytic therapy contributed to the improvement of functional status. (JNNN 2024;13(2):47–53)

Functioning of Stroke Patients during Hospitalisation

Introduction. Brain strokes remain a major cause of disability in adults, disrupting their daily functioning. Aim. This study aimed to assess the functioning of stroke patients. Material and Methods. The study involved sixty stroke patients hospitalised at the Department of Neurology of the Antoni Jurasz University Hospital No. 1 in Bydgoszcz. A diagnostic survey method was used, with the following research tools employed: a questionnaire survey containing demographic data, the Barthel Index, the Beck Depression Scale and the National Institutes of Health Stroke Scale (NIHSS). Results. According to the Barthel Index, more than half of the patients (53%) had a moderately severe condition, those with a severe condition accounted for 32% of the group, and 15% were those with a mild condition — independent patients. According to the Beck Depression Scale, most subjects (73%) had no symptoms of depression; mild depressive symptoms were noted in 17%. The mean NIHSS score was 3.13, with most people scoring between 0 and 4. Conclusions. Stroke patients were dependent on the help of others or were completely impaired in terms of self-care and self-keeping; no significant emotional disturbance was demonstrated. Gender did not affect the patients’ dexterity, independence and neurological condition. The patients’ independence and neurological condition significantly deteriorated with age. Rural residents manifested greater self-care and self-keeping deficits and worse neurological conditions. Economically active patients showed the highest fitness; pensioners had the lowest fitness. A low level of education had a negative impact on the fitness of stroke patients. Married people functioned better than single patients. (JNNN 2024;13(2):54–61)

Time factors of clinical effectiveness of mechanical thrombectomy in acute ischemic stroke

It is known that time plays an important role in acute occlusion of large vessels, in particular, the clinical effect of treatment often depends on it. Along with this, there are often delays at the hospitalization stage, the causes of which require analysis and correction. Objective ‒ to analyze the relationship between the severity of the patient’s condition at admission, delays before the start of thrombectomy and the influence of the time factor on the functional outcome at discharge. Materials and methods. Informed consent was obtained from each patient (parent or guardian) enrolled in the study and the study protocol conforms to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the Institutional Ethical Review Board (Institution's Human Research Committee). From January to July 2023 72 patients with acute occlusion of cerebral vessels who underwent thrombectomy at the «1 TMO of Lviv» were examined. Among them there were 40 (55,6 %) men and 32 (44,4 %) women. The age of the patients ranged from 34 to 90 years (on average ‒ 68.4±10.9). Stroke severity was assessed at admission using the National Institutes of Health Stroke Scale (NIHSS) (from 5 to 28 points). The functional capacity of patients was assessed on the modified Rankin scale (mRS) at the time of discharge from the hospital as positive (mRS 0‒3 points) and negative (mRS 4‒6 points). We compared the time from onset of symptoms to admission and from admission to puncture in patients with a positive and negative functional result at the time of discharge, as well as the time from admission to puncture in patients with gross (NIHSS &gt;15 points) and moderately expressed (NIHSS ≤15 points) neurological deficit at admission. mRS was compared between the NIHSS &gt;15 and NIHSS ≤15 groups. Results. The time from onset of symptoms to admission was from 25 to 300 minutes, and the time from admission to puncture ‒ from 30 to 215 minutes. Reduction in time from onset of symptoms to admission (97.9±8.7 min. vs. 131.7±12.6 min, p=0.05) was associated with a positive functional outcome. The time from admission to puncture in this group was also significantly shorter compared to the group of patients with a negative functional result at discharge and amounted to 75.5±4.1 min vs. 94.8±5.7 min, respectively (p=0.01). Patients with gross neurological deficits on admission had a longer period from admission to puncture (on average 91.9±5.9 min) compared to patients with NIHSS ≤15 (77.2±6.1 min, p&lt;0,05). In the group of patients with NIHSS &gt;15 at the time of discharge, an excellent result of mRS (0‒2) was noted in 16.7 % of patients, mRS 3–4 ‒ in 55.5 %, mRS 5–6 ‒ in 27, 8 %; in the NIHSS ≤15 group ‒ in 53.1, 40.6 and 6.3 %, respectively. Conclusions. Factors associated with a positive clinical effect (mRS 0‒3) were early hospitalization from the time of onset of symptoms to the start of surgery without delays in the hospitalization stage. In the group of patients with gross neurological deficit at admission, the period from admission to puncture was longer than in the NIHSS ≤15 group. Patients from the group with moderately pronounced neurological deficits, in the vast majority, have a better functional result at the time of discharge.