Partial Anterior Circulation Infarct Research Articles

Ischemic Stroke During the Pandemic in a Secondary Care Hospital: COVID-19 and Its Collateral Effects

Aim: Ischemic stroke is among the leading causes of death and disability. Although recent studies have
 shown a possible relationship between COVID-19 and ischemic stroke, the effect of the pandemic period,
 which may be another factor in the increase of ischemic stroke risk factors, has not been investigated.
 Therefore, in current study, we assessed how the COVID-19 pandemic affected ischemic strokes.
 Material and Methods: Patients were divided as two years before and after the first COVID-19 case
 in Turkey, and their COVID-19 history, demographic characteristics and clinical features (comorbid
 diseases, etc.) were obtained.
 Results: There were 588 ischemic stroke patients pre-pandemic and 694 ischemic stroke patients
 post-pandemic. In post-pandemic periods, 322 patients were vaccinated, and 288 patients were not.
 No significant difference in ischemic stroke was found between vaccinated and unvaccinated groups
 (p = 0.168) and between different vaccine-type groups (p = 0.873). Partial anterior circulation infarct
 (PACI) was the most common ischemic stroke subtype in both groups; there was no difference between
 them (p=0.719). The number of ischemic stroke were significantly increased in the post-pandemic
 period (p

Determinants of First-Ever Stroke Severity in West Africans: Evidence From the SIREN Study.

Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub-Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43-2.73]), low vegetable consumption (aOR, 2.45 [95% CI, 1.93-3.12]), and lesion volume, with an aOR of 1.67 (95% CI, 1.03-2.72) for lesion volume of 10 to 30 cm3 and aOR of 3.88 (95% CI, 1.93-7.81) for lesion volume >30 cm3. Severe ischemic stroke was independently associated with total anterior circulation infarction (aOR, 3.1 [95% CI, 1.5-6.9]), posterior circulation infarction (aOR, 2.2 [95% CI, 1.1-4.2]), and partial anterior circulation infarction (aOR, 2.0 [95% CI, 1.2-3.3]) compared with lacunar stroke. Increasing age (aOR, 2.6 [95% CI, 1.3-5.2]) and lesion volume >30 cm3 (aOR, 6.2 [95% CI, 2.0-19.3]) were independently associated with severe intracerebral hemorrhage. Conclusions Severe stroke iscommon among indigenous West Africans, where modifiable dietary factors are independently associated with it. These factors could be targeted to reduce the burden of severe stroke.

Prevalencia y factores asociados de la discapacidad moderada y severa en pacientes con enfermedad cerebrovascular aguda y fibrilación auricular en un hospital universitario de Bogotá

Introducción: Existe escasa información en Colombia acerca de la discapacidad en enfermedad cerebrovascular isquémica (ECVi) y fibrilación auricular (FA).
 Objetivo: Determinar la prevalencia y los factores asociados a discapacidad moderada a severa en pacientes con ECVi y FA.
 Materiales y métodos: Se analizó una serie consecutiva de pacientes con ECVi y FA, que ingresó de julio de 2013 a febrero de 2014, con estancia hospitalaria de 11,88 ± 8,1 días. Analizamos la prevalencia puntual, discapacidad (eRm) y mortalidad al egreso.
 Resultados: Pacientes con ECVi: 368; de ellos, 63 (17%) con FA (54% hombres; 77,6 ± 10,25 años), hipertensión arterial (77,8%), ECVi previo (58,7%), cardiopatía dilatada (46%), antiplaquetarios o anticoagulantes previos (58,7%), arteria cerebral media (74,6%), infartos parciales circulación anterior (PACI) (47,6%), dilatación auricular (60,3%), afasia (36,5%), convulsión (7,9%), discapacidad moderada a severa (eRm 3-5) (41,3%) y mortalidad (17,4%). Observamos que el sexo femenino (OR 3,68; IC 1,01-13,39; p = 0,048), ECVi previo (OR 3,94; IC 1,15-13,57; p = 0,03) y afasia (OR 6,86; IC 1,7-27,66; p = 0,007) fueron factores asociados independientes para discapacidad moderada-severa y mortalidad.
 Conclusión: En esta serie el sexo femenino, antecedente de ECVi previo y afasia, son los principales factores asociados a morbimortalidad en nuestros pacientes.

Amide proton transfer-weighted MRI features of acute ischemic stroke subtypes.

Stroke is a highly heterogeneous disorder with distinct subtypes, and the stroke subtype influences the outcome. Amide proton transfer-weighted (APTW) MRI has been demonstrated to be promising in stroke patients, but the image characteristics of stroke subtypes have not been sufficiently investigated. The purpose of this study was to investigate the APTW MRI features of different subtypes of acute ischemic stroke (AIS). Ninety-two AIS patients presenting within 96 h of symptom onset were enrolled and examined with a 3.0-T MRI system. Patients were grouped into four subtypes: lacunar circulation infarcts (LACI, n = 33); total anterior circulation infarcts (TACI, n = 9); partial anterior circulation infarcts (PACI, n = 28); and posterior circulation infarcts (POCI, n = 22). APTW values in the lesion (APTWlesion ) and the contralateral normal-appearing region (APTWcontral ) were measured. The change in APTW values between the acute ischemic lesion and the contralateral normal-appearing region (APTWles-con ) was calculated. A two-sample t-test, one-way ANOVA, and the Chi-square method were used. There were significant differences between APTWlesion and APTWcontral in the three categories of nonlacunar strokes (TACI, PACI, and POCI, all p < 0.01), but not for lacunar strokes (LACI, p = 0.080). TACI patients had the lowest APTWlesion and APTWles-con in all groups (p < 0.05). In the POCI group, patients with supratentorial infarcts showed significant differences between APTWlesion and APTWcontral (p = 0.001), while the differences were not significant for infratentorial infarcts (p = 0.135). Our results suggest that the APT effect was heterogeneous in different stroke subtypes, and that APTW MRI gave an excellent performence in depicting nonlacunar AIS in supratentorial locations.

Investigation of the relationship between inflammatory markers and grade of disease in patients with acute ischemic stroke with partial anterior circulation infarct

Objectives: The aim of this study was to investigate the relationship between National Institutes of Health Stroke Scale scores and Glasgow coma scores of patients with partial anterior ischemic stroke and laboratory results, particularly serum CRP, albumin, platelet and other complete blood count data, and prognosis. Methods: In this retrospective study 226 of patients with partial anterior circulation infarction who were admitted to the Bolu Abant İzzet Baysal University Neurology Clinic between January 2021 and 2022 with the diagnosis of acute ischemic stroke and hospitalized within the first 24 hours were investigated. The demographic data, stroke etiology and risk factors, National Institutes of Health Stroke Scale, Glasgow coma scores, complete blood count, certain inflammatory markers and biochemical parameters, length of hospital stay and mortality rates were examined. And the relationship between inflammatory markers and grade of disease was evaluated statistically. Results: The patients with moderate Glasgow coma score had a lower lymphocyte level, severe patients had higher PCT level and moderate patients had higher CRP level among others. Patients with moderate GCS had higher CRP/ALB val­ues than those with mild. Patients with moderate and moderate-severe National Institutes of Health Stroke Scale had higher RBC and HGB levels than the patients with mild. Moderate-severe patients had lower albumin lev­els. Conclusion: CRP-albumin ratio, serum platelet and serum albumin levels may have prognostic value in acute partial anterior ischemic stroke patients.

Characteristics and perioperative complications of hip fracture in the elderly with acute ischemic stroke: a cross-sectional study

BackgroundPatients with acute ischemic stroke (AIS) after hip fracture in the elderly have worse prognosis. We aimed to describe the characteristics and complications of hip fracture with AIS in the elderly.MethodsThis cross-sectional study selected patients with hip fracture (age ≥65 years) from January 2018 to September 2020. The collected data included age, sex, fracture types, comorbidities. In above screened patients, we further collected cerebral infarction related information of AIS patients. The least absolute shrinkage and selection operator (LASSO) logistic regression was performed to identify the strongest predictors of AIS after hip fracture. Multivariate logistic regression analysis was conducted to find independent risk factors for AIS after hip fracture.ResultsSixty patients (mean age 79.7 years;female 56.7%) occurred AIS after hip fracture in 1577 cases. The most common infarction type was partial anterior circulation infarction (PACI) (70.0%). The majority of these infarction lesions were single (76.7%) and most infarction lesions(65.0%) were located in the left side. 81.7% of AIS patients had mild (Health stroke scale NIHSS <4) AIS. Older patients with AIS after hip fracture were more frequently complicated by hypertension(73.3%), prior stroke (46.7%), diabetes(35.0%) and were more likely to have hypoproteinemia(68.3%), electrolyte disorders ( 66.7%), anemia (65.0%), deep vein thrombosis (51.6%), pneumonia (46.6%),cardiac complications (45.0%). Combined with hypertension (OR 2.827, 95%CI 1.557-5.131) and male sex(OR 1.865, 95%CI 1.095-3.177) were associated with the increased risk of AIS after hip fracture.ConclusionsOlder patients combined with hypertension are more likely to have AIS after hip fracture. For these patients, early preventions should be administered. AIS patients after hip fracture are prone to have multiple complications under traumatic stress, and we should enhance the management of these patients to reduce the stress and avoid occurrence of complications.

Analysis of the demographic characteristics and clinical profile of acute ischemic strokes admitted to the emergency centre in the Somalia population.

BackgroundStroke is a leading cause of death and chronic disability worldwide. In Sub-Saharan Africa (SSA), which includes Somalia, stroke represents a significant part of the chronic disease burden. However, there is relatively little data on risk factors, demographics, and clinical profiles. This study aimed to define the etiological, demographic characteristics, classification of stroke and functional status of patients with acute ischemic stroke (AIS) admitted to the emergency centre, and to create projections to evaluate the incidence and genetic aspects of stroke.MethodsThe study population consisted of patients who applied to the emergency centre between 1 May 2017 and 1 May 2021 and were diagnosed with acute ischemic stroke (AIS). Patient demographics, season of onset, risk factors, laboratory data, imaging results, infarct location, AIS subtype and treatment outcomes were collected, and compared.ResultsA total of 3,968 patients diagnosed with ischemia stroke were included in the study. The mean age was 51.12 ± 16.43 years, and we reported male predominance (65.7%). While hypertension, hyperlipidaemia, Diabetes mellitus (DM) were more frequent among the risk factors, smoking history and alcohol consumption history were very low. HIV-infected ischemic stroke was detected at a high rate (20.9%) and was common in a relatively young age group (31.8 ± 14.3). Large-artery atherosclerosis (LAA) subtype was detected with a high rate of 67.7%. The most common clot localization was in Supratentorial location (74.3%), and according to OSCP classification, partial anterior circulation infarcts (PACI) subtype (56.3%) was the most common. And these results were again different from other studies.DiscussionWhile the incidence of stroke and especially HIV-associated youthful ischemic stroke continues to increase rapidly in developing countries such as Somalia, with the addition of inadequate primary health care services, stroke has become a major public health problem in African countries regarding its costs at social, psychological, and economic levels.

Effect of transverse sinus variation on the clinical outcomes of atherosclerotic anterior circulation infarction.

BackgroundHypoplasia of the transverse sinus (TS) is a common anatomical variation. The aim of this study was to investigate the effects of TS variation (i.e., TS hypoplasia) and no variation (i.e., TS symmetry) and their subgroups on the clinical outcomes of patients with atherosclerotic anterior circulation cerebral infarction (CI).MethodsA total of 75 patients were included in the study and were divided into the no TS variation group and the TS variation group. The TS variation group was further divided into the following subgroups: the TS variation with ipsilateral CI group and the TS variation with contralateral CI group. We retrospectively analyzed the correlations of the endpoint events of patients with large atherosclerotic anterior circulation infarction and TS no variant, and subgroups of TS variants.ResultsWe found that the diameter of the ipsilateral IJV in patients with TS variants were significantly smaller than those without TS variants, which was statistically significant (P<0.05). The differences in primary endpoint events, secondary endpoint events, and responsible vessel stenosis were not statistically significant when comparing the TS variant and no TS variant groups, and the TS variant subgroup (P>0.05). We found statistically significant differences in the National Institute of Health stroke scale (NIHSS) and Modified Rankin Scale (mRS) scores after 90 days of CI between the total anterior circulation infarct (TACI) TS variant group, the ipsilateral CI TS variant group, and the partial anterior circulation infarct (PACI) TS hypoplasia group and the ipsilateral CI TS variant group (P<0.05). There was a statistically significant difference (P<0.05) between the TS variant group with TACI, the TS variant group with ipsilateral CI, and the TS no variant group and the TS variant with contralateral CI group when comparing patients’ mRS scores after 90 days of CI.ConclusionsThe diameter of the internal jugular vein (IJV) ipsilateral to the TS variant was significantly smaller than that of the TS no variant. Patients with TACI in the TS variant group and one of its subgroups (the TS variant with ipsilateral CI group) had more severe clinical symptoms and a worse prognosis than patients in the same group with PACI.

Distinguishing transient from persistent tactile agnosia after partial anterior circulation infarcts – Behavioral and neuroimaging evidence for white matter disconnection

From a cohort of 36 patients presenting apperceptive tactile agnosia after first cortical ischemic stroke, 14 showed temporary impairment at admission. A previous multi-voxel analysis of the cortical lesions, using as explanatory variable the course of tactile object recognition performance over the recovery period of 9 months, partitioned the cohort into three subgroups. Of the 14 patients constituting two of the subgroups, 7 recovered from their impairment whereas 7 did not. These two subgroups could not be distinguished at admission. The primary aim of the present study is to present two assessments that can do so.The first assessment comprises a pattern of behavioral measures, determined via principal component analysis, encoded in three tests: picking small objects, macrogeometrical discrimination and tactile object recognition. The receiver operating characteristic curve derived from permutation of the behavioral test scores yielded an 80% probability of correct identification of the patient subgroup and an 8% probability for false identification. As done with the permuted scores, the pattern could predict the persistence of affliction of new stroke patients with tactile agnosia.The second predictive assessment extends our previous evaluation of cortical MRI lesion maps to include subcortical regions. Confirming our previous study, the lesions of the persistently impaired subgroup disrupted significantly the anterior arcuatus fasciculus and associated superior longitudinal fasciculus III in the ipsilesional hemisphere, impeding reciprocal information transfer between supramarginal gyrus and both the ventral premotor cortex and Brodmann area 44. Due to the importance of interhemispheric information transfer in tactile agnosia, we performed a supplementary analysis of tactile object recognition scores. It showed that haptic information transfer from the non-affected to the affected hands in the persistent cases partly restored function during the nine months, possibly following restoration of functional interhemispheric haptic information transfer at the border of posterior corpus callosum and splenium.In conclusion, the combined findings of the cortical lesion at subarea PFt of the inferior parietal lobule and the associated subcortical tract lesions permit almost perfect prediction of persistent impairment of tactile object recognition. The study substantiates the need for combined analysis of both cortical lesions and white matter tract disconnections.

Stroke Burden in Agrı: Stroke Situation in Underdeveloped Region of Turkey.

Stroke is the second cause of mortality and the third cause of disability worldwide in adults. There is no published data about stroke in Agrı.We aim to define stroke subtypes and associated risk factors. Thus, we can be aware of stroke burden in rural areas and can develop strategies to reduce the stroke risk. Records of Agrı State Hospital were investigated for a period of 3 years retrospectively. Patients were divided to ischemic and hemorrhagic stroke groups. Hemorrhagic strokes were classified as subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH). Ischemic strokes were classified according to localization and etiology. Vascular risk factors for ischemic stroke were assessed and compared between groups. The differences between variables were evaluated using Pearson κi square test and one-way ANOVA. There were 1246 patients evaluated for stroke in Emergency Department and 525 (42% of prediagnosis) patients were diagnosed as stroke. There were 25.3% hemorrhagic (5.1% SAH and 20.1% ICH) versus 74.6% ischemic stroke. Intensive care required for 61.6% of hemorrhagic and 22.4% of ischemic patients. The most prevalent localization was partial anterior circulation infarction, and the most known etiology was cardioembolism after unknown cause in ischemic strokes. The most encountered risk factor was hypertension (HT). Coronary artery disease history, HT, and atrial fibrillation (AF) were risk factors for recurrent stroke (P = .001). Stroke types in Agrı resembles more to Asian population than Europe. Awareness for stroke, HT, and AF treatment could be the primary targets for stroke reduction in underdeveloped regions.

Clinical manifestation of acute cerebral infarcts in multiple arterial territories.

ObjectivesWe aimed to assess frequencies and radiological aspects of single‐ and multiterritory clinical manifestation among patients with acute cerebral infarcts in multiple arterial territories (MACI).Materials & methodsWe retrospectively reviewed admission records and diffusion‐weighted magnetic resonance imaging of patients with MACI admitted to our stroke unit between 2006 and 2017. MACI was defined as acute cerebral ischemic lesions in at least two out of three arterial cerebral territories, that is, the left anterior, right anterior and the bilateral posterior territory. Patients with single‐ and multiterritory clinical manifestation were then compared for topographical distribution of the ischemic lesions, the number of ischemic lesions, and The Oxfordshire Community Stroke Project classification.ResultsOut of 311 patients with MACI, 222 (71.4%) presented with single‐territory clinical manifestation. Involvement of the left hemisphere (OR = 0.37, 95% CI 0.16–0.82), less than five ischemic lesions (OR = 0.58, 95% CI 0.35–0.97), and partial anterior circulation infarct clinical stroke syndrome (OR = 0.57, 95% CI 0.34–0.97) were associated with single‐territory clinical manifestation. Involvement of all three territories (OR = 2.58, 95% = 1.48–4.50), more than 10 ischemic lesions (OR = 2.30, 95% CI 1.32–4.01) and total anterior circulation infarct clinical stroke syndrome (OR = 3.31, 95% CI 1.39–7.86) were associated with multiterritory clinical manifestation.ConclusionMost patients with MACI present with single‐territory clinical manifestation on admission. Diffusion‐weighted magnetic resonance imaging is therefore necessary for a definite diagnosis.

P-OT024. Stroke subtypes and in-hospital mortality in patients with systemic lupus erythematosus in dr. sardjito hospital yogyakarta

Introduction . Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that associated with an increased risk of stroke especially in young patient. Individuals with SLE have a two-fold higher risk of stroke infarct and three-fold higher for intracerebral hemorrhage. Survival after stroke in SLE patient is lower compared to the general population. This study was conducted to determine the subtypes of stroke and in-hospital mortality in patients with SLE. Methods . A descriptive cross-sectional study. Subjects were SLE patients that had stroke and hospitalised at Dr. Sardjito Hospital from January 1st, 2015 until December 31st, 2019. Patients were diagnosed with SLE based on American College of Rheumatology Classification Criteria and stroke diagnosis was made by neurological examination and imaging finding (head CT scan/MRI). Results . All of the subjects were female with total 23 patients. The mean age was 33,65 (12,86) years old. There were 16 (69,6%) subjects having stroke infarct, 6 (26,1%) subjects having intracerebral hemorrhage and only one (4,3%) having subarachnoid hemorrhage. The most common subtypes of stroke infarct based on Oxfordshire Community Stroke Project (OCSP) classification was partial anterior circulation infarction (PACI) that was found in 11 (68,8%) subjects. In-hospital mortality was found in 10 (43,5%) subjects which 7 (30,4%) of them have had stroke infarct and 6 (26,0%) of them were categorized into age group below 40 years old. Conclusion . Subject in this study was female predominance. It was because SLE typically affects females rather than males. The most common subtypes of stroke was partial anterior circulation infarction. SLE could trigger the formation of blood clots that leads to inflammatory changes in blood vessels, which create a prothrombotic state, and increase risk of thromboembolism. In-hospital mortality was mostly found in stroke infarct and young subjects.

Factors Associated with Benzodiazepines Prolonged-Term Use in Post-Stroke Subjective Sleep Disturbance: A Single-Centre Retrospective Study from China.

PurposeTo investigate the prevalence of short- and long-term benzodiazepine and z-drugs (BZD) for the treatment of post-stroke subjective sleep disturbance (SSD) and to evaluate the risk factors associated with prolonged BZD treatment in this patient body.Patients and MethodsBetween 1st January 2018 and 1st December 2018, we identified 542 inpatients suffering from acute stroke in Heyuan People’s Hospital. Of these, 290 inpatients were included in our final analysis. These patients were divided into three groups according to the treatment they received: non/occasional BZD (non-BZD), short-term BZD (short-term) and prolonged-term BZD (prolonged-term) treatment. We investigated the prevalence of each BZD treatment term and identified differences between the groups. Univariate logistic regression analysis was used to identify potential predictors for the prolonged use of BZD. Multinomial logistic regression analysis was used to assess the correlation between the prolonged use of BZD and potential predictors.ResultsThe prevalence of cases receiving short and prolonged BZD treatments were 40.35% and 31.72%, respectively; none of the patients received polysomnography (PSG) screening from obstructive sleep apnoea (OSP). Treatment strategies were limited to BZD and traditional Chinese medicine; none of the patients received cognitive-behavioral treatment (CBT) or other forms of treatment. Logistic regression analysis showed that the short-term use was associated with z-drugs (odds ratio [OR]: 2.189, 95% confidence interval [CI]: 1.419–3.378), non-communication barriers (OR =0.535, 95% CI: 0.325–0.880) and posterior circulation infarct (POCI) (OR =2.199, 95% CI: 1.112–4.349). The prolonged-term use was associated with z-drugs (OR =3.012, 95% CI: 1.637–5.542), non-communication barriers (OR =0.530, 95% CI: 0.307–0.916), partial anterior circulation infarct (PACI) (OR =0.455, 95% CI: 0.250–0.827), and non pain after stroke (OR =0.315, 95% CI: 0.207–0.480).ConclusionThe status of BZD abuse for post-stroke SSD is worrying. Additional research attention and treatment options are needed for the treatment of post-stroke SSD. In particular, the potential combination of stroke and OSP appears to be underestimated and neglected. Post-stroke SSD patients should receive more comprehensive assessment and rigid follow-up to avoid the prolonged use of BZD. Additional and effective therapeutic strategies (such as positive pressure ventilation treatment or CBT) are urgently needed for cause-specific intervention.

Risk factors, types and outcomes of arterial ischemic stroke in Polish pediatric patients: a retrospective single-center study.

IntroductionVarious neurological complications may occur as a consequence of arterial ischemic stroke (AIS) and have an impact on daily activity of the patients, costs of their medical care and rehabilitation. The aim of this study was to analyze risk factors, stroke symptoms and post-stroke consequences in Polish pediatric patients depending on stroke subtype.Material and methodsWe retrospectively reviewed 77 children under the age of 18 years following their first AIS. Patients were white, Polish Caucasians, recruited in the Department of Pediatric Neurology at the Medical University of Silesia in Katowice (Poland). Statistical analysis was performed using Statistica 12.0.ResultsGender differed significantly between stroke subgroups (p = 0.030). The presence of focal cerebral arteriopathy (FCA) and chronic diseases was associated with type of AIS (p = 0.003 and p = 0.050, respectively). An outcome without neurological deterioration (normal outcome) was observed in 43% of children with lacunar anterior circulation infarct (LACI). Hemiparesis was present in almost all children with total anterior circulation infarct (TACI), in two thirds of children with partial anterior circulation infarct (PACI) and in almost 50% of children with LACI or posterior circulation infarct (POCI). In every child with hemiplegia the stroke symptom evolved into hemiparesis at follow-up. Additionally, patients with a normal outcome were older at the time of AIS than those with at least one neurological consequence (OR = 0.894, p = 0.034).ConclusionsThe presence and number of neurological outcomes depend on stroke subtypes. A relation between the presence of post-stroke deficits and age at onset was observed. The odds of deficit after ischemic stroke decreases by an average of 10.6% if the child is 1 year older at the time of AIS.

Does the Occurrence of Particular Symptoms and Outcomes of Arterial Ischemic Stroke Depend on Sex in Pediatric Patients?-A Pilot Study.

Arterial ischemic stroke (AIS) in childhood is reported to occur more frequently in boys, which may lead to the assumption that the prevalence of post-stroke deficits is sex related. The present study aimed to evaluate sex-related differences in functional outcomes (hemiparesis, seizures, aphasia, and motor disturbances other than hemiparesis) in pediatric patients with AIS. A total of 89 children (52 boys and 37 girls; mean age at stroke onset: 8.4 ± 5.6 years) were evaluated retrospectively based on data from medical records. The patients were divided into subgroups according to age (i.e., infants and toddlers, children, and adolescents), stroke subtype (i.e., lacunar anterior circulation infarct (LACI), total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI)) and stroke location (i.e., anterior stroke, posterior stroke). Significant differences in the prevalence of stroke subtypes between girls and boys were observed (p = 0.034). POCI stroke were found to be more frequent in boys than in girls (OR = 8.57 95%CI 1.05–70.23, p = 0.023). Males predominated in the total group and in all analyzed age subgroups. The proportions of boys within the subgroups according to stroke subtype were extremely high for the POCI and TACI stroke subgroups. On the other hand, girls predominated in the LACI stroke subgroup. Frequency of central type facial nerve palsy and other symptoms of AIS were found to significantly differ between male subgroups according to stroke subtype (p = 0.050 and p < 0.001, respectively), as well as between children with anterior stroke and those with posterior stroke (p = 0.059 and p < 0.001, respectively). Post-stroke seizures appeared significantly more commonly in girls with TACI and POCI stroke than in girls with LACI and PACI stroke (p = 0.022). In turn, the prevalence of post-stroke hemiparesis differed between stroke subtypes in boys (p = 0.026). In conclusion, sex may have an impact in predisposing to a certain type of AIS in the patient. Post-stroke seizure may be related to stroke subtype in girls and hemiparesis in boys. However, further studies are needed to confirm the results.

Ethnic differences in characteristics and outcome of acute ischemic stroke in China: A single center experience

BackgroundThis study aimed to explore ethnic differences of acute ischemic stroke (AIS) in patients' characteristics, management and outcome in Chinese population in an institutional retrospective study. MethodsData of consecutive patients with AIS treated at our center from January 2018 to December 2019 were retrospectively reviewed. Ethnic differences in demographics, risk factors, treatment, and outcomes were evaluated. ResultsA total of 400 patients were included in the present analysis. Compared with Han patients, patients in ethnic group showed shorter interval between symptom onset and admission, lower baseline Glasgow coma scale (GCS) score, lower prevalence of diabetes, higher prevalence of medical history of anticoagulation or antiplatelet treatment, lower rates of partial anterior circulation infarct (PACI), lacunar infarct (LACI) and posterior circulation infarct (POCI). They were less likely to receive antiplatelet therapy and more likely to present higher risks of pulmonary infection. Furthermore, multivariable analysis revealed that the ethnic group was associated with unfavorable outcomes in AIS patients at discharge. In subgroup analysis after adjustment, only pulmonary infection remained an independent predictor of poor outcomes at discharge in ethnic group, while in Han group, baseline GCS score, total anterior circulation infarct (TACI), LACI and pulmonary infection were determined to be independent predictors of poor outcomes at discharge. ConclusionsPatients from ethnic minority groups presented distinctive characteristics in their baseline measurements, background cerebrovascular risk factors, treatment after admission, risk of in-hospital complications compared with Han patients. The ethnic difference of the AIS appeared to affect the neurological outcome.

Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke.

Background:Stroke is a leading cause of death worldwide. The cases of acute ischemic stroke are on the increase in the Asia Pacific, particularly in Malaysia. Various health organizations have recommended guidelines for managing ischemic stroke, but adherence to key performance indicators (KPI) from the guidelines and impact on patient outcomes, particularly mortality, are rarely explored.Objective:This study aims to evaluate the impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke.Methods:We included all first-ever ischemic stroke patients enrolled in the multiethnic Malaysian National Neurology Registry (NNeuR) - a prospective cohort study and followed-up for six months. Patients’ baseline clinical characteristics, risk factors, neurological findings, treatments, KPI and mortality outcome were evaluated. The KPI nonadherence (NAR) and relationship with mortality were evaluated. NAR>25% threshold was considered suboptimal.Results:A total of 579 first-ever ischemic stroke patients were included in the final analysis. The overall mortality was recorded as 23 (4.0%) in six months, with a median (interquartile) age of 65 (20) years. Majority of the patients (dead or alive) had partial anterior circulation infarct, PACI (43.5%; 34.0%) and total anterior circulation infarct, TACI (26.1%; 8.8%). In addition, DVT prophylaxis (82.8%), anticoagulant for atrial fibrillation (AF) patients (48.8%) and rehabilitation (26.2%) were considered suboptimal. NAR < 2 was significantly associated with a decrease in mortality (odds ratio 0.16; 0.02-0.12) compared to NAR>2. Survival analysis showed that death is more likely in patients with NAR>2 (p=0.05).Conclusions:KPI nonadherence was associated with mortality among ischemic stroke patients. The adherence to the KPI was sub-optimal, particularly in DVT prophylaxis, anticoagulant for AF patients and rehabilitation. These findings reflect the importance of continuous quality measurement and implementation of evidence recommendations in healthcare delivery to achieve optimal outcome among stroke patients.

Long-term follow-up of post-stroke epilepsy after ischemic stroke: Room for improved epilepsy treatment

PurposeTo assess long-term incidence and predictors of post-stroke epilepsy (PSE) and to evaluate the antiepileptic drug (AED) treatment in a well characterized cohort of middle-aged patients. MethodsThe study is based on the Sahlgrenska Study on Ischemic stroke, and included 1066 adult patients with first-ever or recurrent acute ischemic stroke (AIS) before the age of 70. Early seizures (ES) were defined as seizures within one week and PSE as unprovoked seizures occurring more than one week from index stroke. Cardiovascular risk factors, subtype of AIS, and stroke severity were determined at baseline. ES, PSE, treatment with AEDs, recurrent stroke and mortality were assessed through national registers and medical records. Cox regression models were used for identifying predictors of PSE. ResultsTwenty-six patients (2.4 %) developed ES. After a median follow-up of 8.0 (IQR 4.1–10.9) years, 84 (7.9 %) had PSE, and 160 (15.0 %) had experienced a non-fatal recurrent stroke. Stroke location (total anterior and partial anterior circulation infarct, both P < 0.001), ES (P < 0.001), stroke recurrence (P < 0.001), artery dissection (P < 0.002), and previous coronary heart disease (P < 0.006) were independent predictors of PSE. Only 10 (11.9 %) had the first seizure more than four years after index stroke. In 24 (30 %) PSE patients, seizure control was not achieved. ConclusionsIn addition to well-known risk factors for PSE development, our data also identified stroke recurrence, artery dissection and established coronary disease. Seizure control was less common than expected and in a significant proportion of patients AEDs had not been adjusted despite continuing seizures.

Stroke Type, Etiology, Clinical Features and Prognosis of Diabetic Patients in Southern China.

To analyze the type, etiology, clinical features and prognosis of stroke in southern China diabetic patients. From January to August 2019, acute stroke patients were prospectively enrolled in the Wenzhou Stroke Registry within 7 days of admission to the Hospital. The differences between the 2 groups of stroke patients with or without diabetes were in the following aspects: bleeding site of hemorrhagic stroke, different ischemic stroke etiology, Oxfordshire Community Stroke Project (OCSP) classification, death and disability within 3 months. Of the 497 patients enrolled, 104 (20.9%) were diabetic patients. 114(22.9%) patients had hemorrhagic stroke. The incidence of hemorrhagic stroke in the diabetic group was 10.6%, deep hemorrhage stroke account for 90.9%.In patients with ischemic stroke, the proportions of the new Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiological subtype classifications (atherothrombosis (AT), cardioembolism (CE), small artery disease (SAD), stroke of other determined etiology (SOD) and stroke of undetermined etiology (SUD)) in the diabetic (non-diabetic) group was 43% (31%), 7.5% (14.1%), 27.9% (16.9%), 1% (0.3%), and 20.4% (37.6%), respectively; the proportion of The OCSP classifications(total anterior circulation infarcts(TACI), partial anterior circulation infarcts(PACI), lacunar infarcts(LACI) and posterior circulation infarcts(POCI)) in the diabetic (non-diabetic) group was16.1% (22%), 30.1%(37.2%), 42% (31.4%), and 10.8% (9%), respectively. The 3-month poor prognosis of the diabetic and non-diabetic groups was 23.1% and 28.2%. For diabetic patients, the incidence of hemorrhagic stroke is low, deep hemorrhage is common; SAD and LACI are common in the ischemic stroke; There was no significant difference in the 3-month prognosis between the 2 groups.

An investigation on prevalence and severity of cerebral microbleeds in patients with different stroke classifications of cerebral infarction

Objective To investigate the prevalence and severity of cerebral microbleeds(CMBs) in patients with different stroke classifications of cerebral infarction. Methods From October 2016 to December 2017, the clinical data of patients with acute cerebral infarction in the Second Affiliated Hospital of Xuzhou Medical University were collected through the prospective study.The SWI technique was used to screen the CMBs.According to the TOAST and OCSP classifications, the prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction were analyzed. Results A total of 254 patients with cerebral infarction were enrolled, there were 136 patients(53.54%) in CMBs group and 118 patients(46.46%) in no CMBs group.The prevalence of CMBs in patients with different TOAST classifications was large artery atherosclerosis(54.29%), small-artery occlusion(64.15%), cardioembolism(40.43%), stroke of other determined etiology(33.33%), stroke of undetermined etiology(38.46%), and the difference was statistically significant(χ2=12.206, P=0.016). The prevalence of CMBs in patients with different OCSP classifications was total anterior circulation infarcts(43.75%), partial anterior circulation infarcts(51.19%), posterior circulation infarcts(49.18%), lacunar infarcts(67.53%), and the difference was statistically significant(χ2=8.944, P=0.030). The severity of CMBs in patients with different TOAST classifications was large artery atherosclerosis[mild(55.26%), moderate(26.32%), severe(15.79%)], small-artery occlusion[mild(25.00%), moderate(33.82%), severe(41.18%)], cardioembolism[mild(57.89%), moderate(26.32%), severe(15.79%)), stroke of other determined etiology[mild(50.00%), moderate(33.33%), severe(16.67%)], stroke of undetermined etiology[mild(60.00%), moderate(20.00%), severe(20.00%)], and the difference was statistically significant(Fisher exact test, P=0.025). The severity of CMBs in patients with different OCSP classifications was total anterior circulation infarcts[mild(57.14%), moderate(28.57%), severe(14.29%)], partial anterior circulation infarcts[mild(52.50%), moderate(32.50%), severe(15.00%)], posterior circulation infarcts[mild(50.00%), moderate(33.33%), severe(16.67%)], lacunar infarcts[mild(25.00%), moderate(32.69%), severe(42.31%)], and the difference was statistically significant(Fisher exact test, P=0.023). Conclusion The prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction are variable.The prevalence of CMBs in small-artery occlusion and lacunar infarcts are the highest and give first place to severe CMBs(number of lesions≥10). We should pay attention to these two stroke classifications by early recognition and taking targeted clinical strategies. Key words: Stroke; Cerebral infarction; Cerebral hemorrhage; Prevalence; Magnetic resonance imaging