Prognosis Of Stroke In Patients Research Articles

Prognosis of the post COVID-19 stroke based on D-dimer and inflammatory markers: A mixed model meta-regression analysis

Background & Objective: With regard to the importance of inflammatory biomarker and stroke in COVID-19 prognosis, this study aims to compare the mortality of stroke in COVID-19 patients based on the level of inflammatory biomarkers, considering the temporality of stroke occurrence after COVID-19 infection. Methods: As a secondary study, aggregate data were collected by a systematic review. Mixed model meta-regression analyses were conducted to study the effects of stroke, inflammatory biomarkers and D-dimer on mortality of patient with COVID-19 as main effects and interactions. The effect measure was death rate. The protocol was registered in PROSPERO with registration number CRD42023383065. Results: A total of 2,725 COVID-19 patients, consisting of 96 patients with stroke with a temporal precedence of COVID-19 were investigated from three studies. Among the inflammatory biomarkers, only CRP found eligible for pooled analysis. In the interaction model of CRP, significant positive interactions with CRP were found for both groups of stroke and non-stroke (P <0.001), in which the interaction with stroke group was more severe. In the interaction model of D-dimer, a significant positive interaction with D-dimer was found for the stroke group (P <0.001), while the interaction with the non-stroke group was not statistically significant (P =0.158). Conclusion: The present study found the role CRP and D-dimer in prognosis of stroke in patients with COVID-19 as both main effect and interaction modeling. The evidence obtained from these mixed model meta-regression analyses was of moderate quality.

Risk Factors and Prognosis of Stroke in Gynecologic Cancer Patients.

Increased life expectancy and cancer prevalence rates expose patients to a higher risk of developing other comorbidities such as stroke. This study aimed to evaluate the risk factors for and prognosis of stroke in patients with gynecological cancers. A single-center retrospective cohort study was conducted on patients with cervical, endometrial, and epithelial ovarian cancers. Patients were classified into three groups based on the period of stroke onset: at least one year before cancer diagnosis, within one year before cancer diagnosis to six months after the last treatment date, and six months after the last treatment date. Among the 644 patients, stroke occurred in 54 (8.4%). In univariate analysis, stroke was significantly associated with overall survival. In contrast, in multivariate analysis, stroke was significantly associated with age and hypertension, but not with overall survival. Age, pulmonary thromboembolism/deep vein thrombosis, histological grade, and tumor stage were significantly associated with overall survival. Therefore, it is important to establish an appropriate examination and treatment plan for patients with gynecologic cancers using a multidisciplinary approach that incorporates the patient's age, medical condition, and tumor characteristics rather than excessively considering the adverse effects of stroke on cancer prognosis.

COVID-19-Induced Cerebrovascular Disease

As the number of COVID-19 cases continues to rapidly increase worldwide, a corresponding increase in COVID-19-induced neurological complications is being observed in clinical practice. COVID-19 is shown to trigger a pro-thrombotic state, which increases the risk of ischemic stroke. However, the incidence of COVID-19-induced ischemic stroke in 2022 was lower than that observed during the early stages of the pandemic. In this chapter, we describe the association between COVID-19 and stroke and the pathophysiology and prognosis of stroke in patients with COVID-19, together with a review of the latest literature.

Association of Body Mass Index and Risk of Stroke After Acute Minor Stroke or TIA: a Post Hoc Analysis of a Randomized Controlled Trial.

The "obesity paradox" was reported in patients with stroke. We aimed to evaluate the pattern and magnitude of association between body mass index (BMI) and prognosis of stroke in patients with minor ischemic stroke or transient ischemic attack (TIA). A total of 5163 patients with available BMI data from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial were included. Patients were classified into three groups according to their BMI values: normal weight (< 23.9kg/m2), overweight (24-27.9kg/m2), and obese (≥ 28.0kg/m2). The efficacy outcomes included a new stroke (ischemic or hemorrhagic), poor functional outcome defined as modified Rankin scale ≥ 2 points and death from any cause within 90days. The interaction effects were determined using multivariable Cox or logistic regression models. After 90days of follow up, there were 513 new strokes. Overweight (BMI 24-27.9kg/m2) patients had a higher risk of recurrent strokes than those with normal weight (10.8% vs 8.8%; HR = 1.24, 95% CI 1.02-1.50) after adjusting for the baseline covariates, but no significant association was observed for those who were obese (P = 0.37). No significant association was found between being overweight or obese and poor functional outcome or death. For patients with a minor ischemic stroke or TIA, being overweight was associated with an increased risk of recurrent stroke compared to being of normal weight in our study.Trial registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00979589.

QUANTITATIVE PROCESSING OF T2-WEIGHTED CEREBRAL MRI CONCOMITANT WITH THIN-SLICE CORTEX MEASUREMENTS IN PATIENTS WITH SEVERE CAROTID ATHEROSCLEROSIS FOR PROGNOSIS OF CEREBRAL COMPLICATIONS AFTER INVASIVE CARDIOVASCULAR INTERVENTIONS

Fim of the study. We attempted to select a complex of signs for prognosis of early post-intervention stroke in patients referred for extensive invasive cardiovascular surgery or intravascular procedures, from the data of routine MRI of the brain.Material and methods. Basing on the histories of 540 patients underwent non-carotid cadiosurgical or invasive intravascular procedures we selected ten in whom the post-operation early stroke was diagnosed and who also underwent pre-surgically the MRI study of the brain. The control comparative group comprised twelve persons in whom no post-intervention stroke was observed and also pre-intervention MRI was present. At the admission before surgery or intervention in everybody the T2-weighted MRI has been carried out in T2-weighted and T1-weighted thin slice (1,5– 3 mm) modes with subsequent quantification of cerebral ischemic preconditioning from quantitatification of T2-w. Imaged and with measurement of cortex’thickness.Results. In patients of both post-surgical stroke and control groups the coexistance of critical carotid stenosis or carotid occlusion with contralateral subcritical or mild/minimal contralateral carotid stenosis was detected. The post-operation ishemic stroke was detected in those persons obly, in whom pre-surgically the region of ishaemic leucodystrophy (unilateral leucoarayosis) was detected as signal-enhanced region on T2-weighted MRI scans on the side of carotid occlusion/critical stenosis, simultaneously with cortical thinning on the side. The index of physical volume of the T2-w.hyperintence region was in patients in whom post-surgically the ischemic stroke occurred as high as 18–51 сm3, whereas the volume of irreversibly damaged tissue diffusely distributed over the T2-w.hyperintensive leucoarayosis area 3,9–14,7 сm3. The ratio of volumes of irreversibly damaged tissue to the physical volume of damage was 0,17–0,29. Simultaneously in these persons in the middle cerebral artery perfusion region ipsilaterally the relative thinning of the cortex was seen with no cerebral stroke in the personal history. The cortex was in these patients on the side of ICA critical stenosis/ ICA occlusion 1,7–3,1 mm, and contralaterally 2,5–3,2 mm, with asimmetry index 0,65–0,82. This syndrome of «ischemic preconditioning of the brain» seen as combination {T2-hyperintensity &amp; cortical dystrophy} was also detected in hree patients in whom the ishaemic stroke after cardiovascular surgery did not occur, and all these persons were treated befor the operation with high — up to 750 mg daily — doses ethylmethyl hydroxypiridine succinate (mexidol). The sensitivity of MRI syndrome {T2-hyperintensity &amp; cortical dystrophy} in prognosis of post-operation ischemic stroke was as high as 100%, whereas specificity 75%, and diagnostic accuracy 86%.Conclusion. Thus, the detection of extensive unilateral area of T2-hyperintensity in the internal carotid artery region (unilateral leucoarayosis) concomitant with thinning of cortex in the region, on the side of occlusion or critical stenosis of internal carotid artery can be accepted as factor of high risk of ishemic stroke early after extensive vascular surgery or intervention. It is necessary to carry out the MRI study of the brain in every patient before and after extensive cardiovascular intervention, for scoring of stroke risk early after procedure.

The effects of temporary hyperglycemia on the prognosis of stroke in patients with acute ischaemıc stroke

OBJECTIVE: In this study, frequency of temporary hyperglycemia and effects of the hyperglycemia on the severity and prognosis of stroke were examined in patients with acute ischaemic stroke. MATERIAL and METHODS: One hundred patients, who applied for acute ischaemic stroke and met the inclusion criteria, were included in the study. Patients were diveded into three groups: normoglycemic, temporary hyperglycemic and diabetes mellitus (DM), according to the baseline blood glucose, fasting blood glucose, oral glucose tolerance test (OGTT) test and HbA1c value. These groups’ National Institue of Stroke Scale (NIHSS), Fugl–Meyer (FM) and Functional Independence Measure (FIM) scores were measured at baseline and at the 3rd month of the follow up; then, these data were compared in terms of the severity and prognosis of stroke. In addition, according to the fasting blood glucose, hyperglycemic and normoglycemic patients becoming permanent diabetics were evaluated. ANOVA, Paired t test and Mann-Whitney U tests were used in the statistical analyses. RESULTS: Of the patients 52 were normoglycemic, 21 were hyperglycemic and 27 were diabetic. At the 3rd month of the _____________________________________________________________________________________________________________________________ Yazisma Adresi: Dr. Murat GULTEKIN Kayseri Egitim ve Arastirma Hastanesi Noroloji Klinigi, Kayseri E-posta: gultekin@erciyes.edu.tr Gelis Tarihi: 08.06.2012 Kabul Tarihi: 28.08.2012 Received: 08.06.2012 Accepted: 28.08.2012 Bu makale su sekilde atif edilmelidir: Kilic S, Gultekin M, Soyuer F, Hizarci KU, Soyuer A. Akut iskemik inmeli hastalarda gecici hipergliseminin inme prognozu uzerine etkileri. Turk Beyin Damar Hastaliklari Dergisi 2012; 18 (3): 72-76.

Acute stroke with atrial fibrillation. The Copenhagen Stroke Study.

Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke. Many physicians remain reluctant to provide stroke prevention by anticoagulant therapy especially for elderly individuals with AF. Using multivariate regression analyses, we studied the characteristics and the prognosis of stroke in patients with AF. The study is part of the Copenhagen Stroke Study, a prospective, community-based study of 1197 patients with acute stroke treated on a stroke unit from the time of acute admission to the end of rehabilitation. Initial stroke severity was measured by the Scandinavian Neurological Stroke Scale (SSS). Neurological and functional outcomes were evaluated by the SSS and the Barthel Index. AF was diagnosed in 18% of the patients. AF increased steeply with age in the stroke population, from 2% in patients < 50 years old, 15% in patients in their 70s, and 28% in patients in their 80s, to 40% in patients > or = 90 years of age. In a multivariate analysis AF was associated with age (odds ratio [OR], 2.0 per 10-year increase; 95% confidence ratio [CI], 1.6 to 2.6), ischemic heart disease (OR, 3.4; 95% CI, 2.4 to 4.8), previous stroke (OR, 1.8; 95% CI, 1.2 to 2.6), and systolic blood pressure (OR, 0.93 per 10-mm Hg increases; 95% CI, 0.88 to 0.99), but not with sex, diabetes, hypertension, previous transient ischemic attack, or silent infarction on computed tomography. Patients with AF had a higher mortality rate (OR, 1.7; 95% CI, 1.2 to 2.5), longer hospital stays (50 days versus 40 days, P < .001), and a lower discharge rate to their own homes (OR, 0.60; 95% CI, 0.44 to 0.85). Neurological and functional outcomes were markedly poorer in patients with AF. Poorer outcome was exclusively explained by initially more-severe strokes. Stroke in patients with AF is generally more severe and outcome markedly poorer than in patients with sinus rhythm. This accentuates the importance of anticoagulant treatment of individuals with AF. A lower blood pressure in the acute stage of stroke may contribute to the increased stroke severity in patients with AF.

The size of subcortical ischemic infarction in patients with and without diabetes mellitus

Diabetes mellitus is associated with a higher frequency and poorer outcome of ischemic stroke. Determinants of the poorer prognosis of stroke in patients with diabetes are not well defined. We investigated whether size of cerebral infarction differs in patients with and without diabetes mellitus. We compared ischemic lesions in 41 consecutive stroke patients with subcortical infarction -22 with and 19 without diabetes mellitus. The location and size of the ischemic infarct were derived from magnetic resonance images obtained on day 3 or 4 post stroke onset. Cross-sectional infarct area was determined by direct measurement from film. The age of patients was similar in both groups. Patients with diabetes had higher prevalence of arterial hypertension, and previous stroke, and higher admission triglyceride and glucose levels compared to patients without diabetes. We found no significant difference in the size of ischemic lesions in patients with and without diabetes mellitus (1.87 vs. 1.72 cm2, respectively). We conclude that among patients with subcortical ischemic stroke the size of infarction is not different between patients with and without diabetes mellitus.