Scandinavian Stroke Scale Score Research Articles

Explaining predictors of discharge destination assessed along the patients’ acute stroke journey

Introduction: Accurate prediction of outcome destination at an early stage would help manage patients presenting with stroke. This study assessed the predictive ability of three machine learning (ML) algorithms to predict outcomes at four different stages as well as compared the predictive power of stroke scores.Methods: Patients presenting with acute stroke to the Canberra Hospital between 2015 and 2019 were selected retrospectively. 16 potential predictors and one target variable (discharge destination) were obtained from the notes. k-Nearest Neighbour (kNN) and two ensemble-based classification algorithms (Adaptive Boosting and Bootstrap Aggregation) were employed to predict outcomes. Predictive accuracy was assessed at each of the four stages using both overall and per-class accuracy. The contribution of each variable to the prediction outcome was evaluated by the ensemble-based algorithm and using the Relief feature selection algorithm. Various combinations of stroke scores were tested using the aforementioned models.Results: Of the three ML models, Adaptive Boosting demonstrated the highest accuracy (90%) at Stage 4 in predicting death while the highest overall accuracy (81.7%) was achieved by kNN (k=2/City-block distance). Feature importance analysis has shown that the most important features are the 24-hour Scandinavian Stroke Scale (SSS) and 24-hour National Institutes of Health Stroke Scale (NIHSS) scores, dyslipidaemia, hypertension and premorbid mRS score. For the initial and 24-hour scores, there was a higher correlation (0.93) between SSS scores than for NIHSS scores (0.81). Reducing the overall four scores to InitSSS/24hrNIHSS increased accuracy to 95% in predicting death (Adaptive Boosting) and overall accuracy to 85.4% (kNN). Accuracies at Stage 2 (pre-treatment, 11 predictors) were not far behind those at Stage 4.Conclusion: Our findings suggest that even in the early stages of management, a clinically useful prediction regarding discharge destination can be made. Adaptive Boosting might be the best ML model, especially when it comes to predicting death. The predictors’ importance analysis also showed that dyslipidemia and hypertension contributed to the discharge outcome even more than expected. Further, surprisingly using mixed score systems might also lead to higher prediction accuracies.

Association between Serum Triglycerides and Severity of Stroke

Abstract Background: The purpose of the present research was to study the correlation between serum triglyceride (TG) levels and the severity of stroke as limited data are available on the role of TGs. The severity of stroke was determined using the Scandinavian Stroke Scale (SSS). Methods: In this cross-sectional study, 60 patients with acute ischemic stroke were included, who were diagnosed on clinical examination and 3-dimensional magnetic resonance imaging scan of the brain. Serum TG levels were categorized according to the National Cholesterol Education Program and the Adult Treatment Panel. Stroke severity was assessed with the help of SSS. Results: The mean serum TG levels in the study were found to be 147.7 mg/dl ± 92 mg/dl. The mean SSS score in the study was 27.93 ± 3.86. There was a statistically significant association between the serum TG levels and SSS (P = 0.001). The association was suggested by a positive Pearson correlation coefficient (r = 0.481). Patients with low serum TG levels (≤150 mg/dl) had severe strokes as assessed by the SSS (≤25). Conclusion: This study confirms that low levels of TG are associated with poor outcome of acute ischemic stroke, which can be explained by the fact that low serum TG levels indicate malnutrition, which is a poor prognostic factor.

Labour market participation and retirement after stroke in Denmark: registry based cohort study

ObjectiveTo examine labour market participation and retirement among patients with stroke and matched people in the general population according to stroke subtype.DesignNationwide, population based, matched cohort study.SettingDanish Stroke Registry, covering...

Analysis of Clinical Effects of Comprehensive Nursing Based on Enhanced Recovery after Surgery in Patients with Embolization for Intracranial Aneurysms.

Objective This research sets out to elucidate the clinical effect of comprehensive nursing based on the concept of enhanced recovery after surgery (ERAS) in patients with embolization for intracranial aneurysms (IAs). Methods This study enrolled 119 patients with embolization for IAs in the Zhongnan Hospital of Wuhan University from January 2020 to January 2021 and divided them into two groups according to the perioperative care they received: a control group (n = 39) treated with routine perioperative nursing and an observation group (n = 80) treated with ERAS-based comprehensive nursing. Surgical indicators, neurological function (National Institute of Health Stroke Scale (NIHSS) score; Scandinavian Stroke Scale (SSS) score), anxiety and depression (Self-Rating Anxiety Scale (SAS) score; Self-Rating Depression Scale (SDS) score), incidence of adverse events, and patient satisfaction were compared. Results The observation group had better surgical indicators and lower scores of NIHSS, SSS, SAS, and SDS than the control group, accompanied by a lower incidence of adverse events and higher patient satisfaction. Conclusions ERAS-based comprehensive nursing can better promote patients' neurological recovery after embolization for IAs, relieve unhealthy emotions (depression, anxiety, etc.), and reduce the occurrence of adverse reactions, facilitating patient discharge.

Efficacy and Safety of Xiaoyao Recipe in the Treatment of Poststroke Depression: A Systematic Review and Meta-Analysis.

Background Poststroke depression (PSD) is a common neuropsychiatric disorder that affects the disability, mortality, functional recovery, and quality of daily life of patients. Xiaoyao Recipe (XYR) is often used to treat PSD and has achieved good clinical effects, but it lacks reliable evidence. Objective This study aims to evaluate the effectiveness and safety of XYR on PSD through meta-analysis. Methods A comprehensive literature search was carried out in multiple databases, including PubMed, the Cochrane Library, Chinese Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and ClinicalTrials, from inception to July 1, 2021, to collect randomized controlled trials that applied XYR for patients with PSD. For a controlled trial, the search time limit was set from the time of the database's establishment to July 2021. Two experienced researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, evaluated the quality of the literature, and used RevMan 5.3 software for meta-analysis. Results A total of 12 studies were included in this study, involving 882 patients with PSD who were hospitalized or outpatients. The meta-analysis results showed that the total effective rate (p < 0.00001) of the test group (XYR or XYR combined with antidepressants) after treatment was high; Hamilton's Depression Scale score (p < 0.000001), Scandinavian Stroke Scale score (p=0.004 < 0.05), and Barthel index (p < 0.00001) were improved; the incidence of adverse reactions (p < 0.00001) was low; and the serum serotonin content (p < 0.00001) was high. Conclusion Compared with antidepressant drugs, XYR is more effective and safer in the treatment of PSD patients. However, more high-quality studies are needed to further support the above conclusions.

Transcranial Color Coded Duplex Sonography Findings in Stroke Patients Undergoing Rehabilitation: An Observational Study.

Background Transcranial color-coded duplex sonography (TCCD) provides information on intracranial blood flow status in stroke patients and can predict rehabilitation outcomes. Objective This study aimed to assess middle cerebral artery (MCA) parameters using TCCD in MCA territory stroke patients admitted for rehabilitation and correlate with clinical outcome measures. Materials and Methods Patients aged 18 to 65 years with a first MCA territory stroke, within 6 months of onset were recruited. The clinical outcome scales and TCCD parameters were assessed at both admission and discharge. The scales used were the Scandinavian stroke scale (SSS), Barthel Index (BI), modified Rankin Scale (mRS), Fugl–Meyer upper extremity scale (FMA-UE), modified motor assessment scale (mMAS) scores. TCCD parameters measured were MCA peak systolic, end diastolic, mean flow velocities (MFV), and index of symmetry (SI) and were correlated with clinical scores. Results Fourteen patients were recruited with median age of 56.5 years, median duration of stroke was 42.5 days. Mean flow velocities of affected and unaffected MCA were 46.2 and 50.7 cm/s, respectively. Flow velocities and SI did not change between the two assessments. There was significant improvement in clinical outcome scores at discharge. Significant correlation was observed for patient group with SI > 0.9 at admission with FMA-UE, SSS, and BI scores at discharge ( p < 0.05). Conclusion Flow velocity parameters did not change during in-patient rehabilitation. Patients with symmetric flow at admission had improved clinical outcomes measure scores at discharge. Thus SI can predict rehabilitation outcomes in stroke survivors.

Улучшение исходов ишемического инсульта у пациентов с высоким уровнем свободного трийодтиронина по сравнению с пациентами с гипо- и эутиреозом

Актуальность. Известно, что дисфункция щитовидной железы ассоциирована с повышенным риском развития цереброваскулярных заболеваний. Однако накопленные в течение последних лет экспериментальные данные свидетельствуют о том, что гормоны щитовидной железы могут иметь определенные нейропротекторные эффекты. Цель исследования: определить взаимосвязь между уровнем свободного трийодтиронина в дебюте острого ишемического инсульта и функциональным исходом инсульта через 6 месяцев. Материалы и методы. В исследование был включен 121 пациент с впервые развившимся острым ишемическим инсультом. Концентрации свободного трийодтиронина (свT3), свободного тироксина (свT4), тиреотропного гормона и наличие базисных факторов риска инсульта оценивались в течение 24 часов с момента появления симптомов. Неврологический дефицит оценивался по Скандинавской шкале инсульта (SSS). Неблагоприятный функциональный исход определялся как показатель mRs ≥ 3 баллов через 6 месяцев после перенесенного инсульта. Результаты. Тест ANOVA показал, что пациенты с уровнем свT3 в 4-м квартиле (≥ 5,35 пмоль/л) имели значительно более тяжелый неврологический дефицит по сравнению с пациентами с уровнем свТ3 во 2–3-м квартилях (медиана SSS 48 баллов против 37 баллов, p = 0,0481) и особенно по сравнению с пациентами с уровнем свТ3 в 1-м квартиле (≤ 3,4050 пмоль/л, медиана SSS 48 против 30, p = 0,0018). Согласно тесту Краскала — Уоллиса, пациенты с уровнем свободного Т3 выше 75-го процентиля имели более благоприятный функциональный исход со средним значением по модифицированной шкале Рэнкина 2,5 балла по сравнению с пациентами с уровнем свT3 в 25–75-м процентилях (со средним значением по модифицированной шкале Рэнкина 4 балла). Результаты анализа пробит-регрессии свидетельствуют о дозозависимом влиянии уровня свT3 на вероятность благоприятного исхода инсульта. Уровень свободного Т3 6,56 пмоль/л был связан с 50% вероятностью благоприятного исхода, а уровень свободного Т3 выше 8,67 пмоль/л был ассоциирован с 75% вероятностью благоприятного исхода инсульта. Выводы. Исследование показало, что пациенты с высоким уровнем свободного трийодтиронина при дебюте ишемического инсульта имеют более благоприятный функциональный исход, даже по сравнению с пациентами с нормальным уровнем свободного Т3. Более высокие уровни свободного трийодтиронина также ассоциируются с менее тяжелым неврологическим дефицитом в острой фазе. Выявлено дозозависимое влияние уровня свободного трийодтиронина на вероятность благоприятного исхода инсульта. Полученные данные свидетельствуют о том, что тиреоидный профиль является не только фактором, влияющим на течение ишемического инсульта, но и потенциальной мишенью для терапевтической коррекции.

The Clinical Efficacy of Clopidogrel Bisulfate Tablets Combined with Olmesartan Medoxomil for Ischemic Stroke with Hypertension and the Effect of Angiotensin II Type 1 Receptor Level on Prognosis.

Background Ischemic stroke combined with hypertension can increase risks of stroke recurrence and death. Aim The aim of this study is to investigate the clinical efficacy of clopidogrel bisulfate tablets combined with olmesartan medoxomil in the treatment of ischemic stroke patients with hypertension and the effect of angiotensin II type 1 receptor (AT1R) level on prognosis. Methods Ninety ischemic stroke patients with hypertension were chosen for continuous treatment with clopidogrel bisulfate tablets and olmesartan medoxomil for 12 months. The Modified Edinburgh Scandinavian Stroke Scale (MESSS) score, Brunnstrom score, Barthel score, death, recurrence, and progression of cerebrovascular residual lesions were observed and recorded during the treatment period. According to the plasma AT1R expression of the patients before treatment, the patients were divided into a high-AT1R group and low-AT1R group. Then, survival analysis was performed. Results Compared with pretreatment, the MESSS scores of the patients at the first, second, third, sixth, ninth, and twelfth months after treatment were reduced (p < 0.01) while the Brunnstrom score and Barthel score were prominently boosted (p < 0.01). Compared with the low-AT1R group, patients in the high-AT1R group had higher rates of stroke recurrence and progression of residual cerebrovascular lesions (p < 0.05). Conclusion Clopidogrel bisulfate tablets combined with olmesartan medoxomil has prominent clinical effects in the treatment of ischemic stroke patients with hypertension, evidently improving the prognosis. In addition, the level of AT1R may be a vital factor affecting the prognosis.

Computed Tomography Image Segmentation Algorithm to Detect the Curative Effect of Radial Shock Wave Therapy for Knee Osteoarthritis.

The aim of this study was to investigate the values of computed tomography (CT) imaging technology based on image segmentation algorithm (ISA). It was applied in the radial shock wave therapy (RSWT) to treat knee osteoarthritis (KOA), so its curative effect and rehabilitation effect on nerve function were mainly analyzed in this study. 84 patients with KOA were selected and grouped into an ultrasonic treatment group (group A) and a RSW group (group B). All the patients received the ISA-based CT examination and high-quality nursing intervention. There were comparisons on the effects of pain improvement, knee joint function, and nerve function rehabilitation of patients in groups A and B. Results showed that visual analogue scale (VAS) scores before and after treatment were markedly different among all patients, and the pain degree of patients in group B was lower than the degree of group A (P < 0.05). The knee joint function of group B after treatment was greatly better than group A (P < 0.05). Scandinavian stroke scale (SSS) scores of nerve function rehabilitation after nursing in patients from group B were sharply lower than the scores of group A (P < 0.05). Results indicated that ISA-based CT images could be applied in analysis of curative effect on KOA, and there was more obvious effect of RSWT in the treatment of KOA.

Nationwide Trends in Incidence and Mortality of Stroke Among Younger and Older Adults in Denmark.

To investigate the extent to which the incidence and mortality of a first-time stroke among younger and older adults changed from 2005 to 2018 in Denmark using nationwide registries. We used the Danish Stroke Registry and the Danish National Patient Registry to identify patients 18 to 49 years of age (younger adults) and those ≥50 years of age (older adults) with a first-time ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. We computed age-standardized incidence rates and 30-day and 1-year mortality risks separately for younger and older adults and according to smaller age groups, stroke subtype, sex, and severity (Scandinavian Stroke Scale score). Average annual percentage changes (AAPCs) were computed to assess temporal trends. We identified 8,680 younger adults and 105,240 older adults with an ischemic stroke or intracerebral hemorrhage. The incidence rate per 100,000 person-years of ischemic stroke (20.8 in 2005 and 21.9 in 2018, AAPC -0.6 [95% confidence interval (CI) -1.5 to 0.3]) and intracerebral hemorrhage (2.2 in 2005 and 2.5 in 2018, AAPC 0.6 [95% CI -1.0 to 2.3]) remained steady in younger adults. In older adults, rates of ischemic stroke and intracerebral hemorrhage declined, particularly in those ≥70 years of age. Rates of subarachnoid hemorrhage declined, but more so in younger than older adults. Stroke mortality declined over time in both age groups, attributable largely to declines in the mortality after severe strokes. Most trends were similar for men and women. The incidence of ischemic stroke and intracerebral hemorrhage was steady in younger adults from 2005 to 2018, while it dropped in adults >70 years of age. Stroke mortality declined during this time.

Incidence and prognostic factors for recurrence of intracerebral hemorrhage in patients with and without atrial fibrillation: A cohort study

BackgroundIntracerebral hemorrhage is a devastating vascular event. Clinical factors prognostic of recurrence facilitating individualized post-bleeding patient management are sparsely described. We aimed to describe incidence of recurrence of intracerebral hemorrhage and explore the prognostic value of 25 clinical characteristics in patients with and without atrial fibrillation. MethodsCohort study of patients with incident intracerebral hemorrhage diagnosed from 2003 to 2016 identified using nationwide Danish administrative registries. Results reported as cumulative incidence of intracerebral recurrence accounting for competing risk of death. Univariate and multivariate prognostic factors for recurrence estimated using Cox regression (hazard ratios [HRs], 95% confidence intervals [CI]). ResultsWe identified 9255 patients with incident intracerebral hemorrhage (median age 73 years, 46.6% females, 16% with atrial fibrillation). Five-year risks of recurrence of intracerebral hemorrhage were approximately 10% in the study population, although slightly higher for patients without atrial fibrillation. Prognostic factors for recurrence were broadly similar for patients with and without atrial fibrillation. Age in categories <60 years (reference), age 60–70 years (HR 1.29, 95% CI 1.02–1.64), age 70–80 years (HR 1.59, 95% CI 1.26–2.00), age >80 years (HR 1.19, 95% CI 0.91–1.55), nursing home residency (HR 1.48, 95% CI 1.02–2.13), and Scandinavian Stroke Scale score (‘mild’ versus ‘moderate’ (HR 1.40, 95% CI 1.13–1.72) and ‘severe’ (HR 1.96, 95% CI 1.61–2.39)) were the strongest prognostic factors. ConclusionRisk of recurrence of intracerebral hemorrhage after five years was approximately 10%. Clinical characteristics associated with recurrence were few and broadly similar for patients with and without atrial fibrillation, with age and measure of incident bleeding severity, as reflected by Scandinavian Stroke Scale score, being the most important.

ASSESSMENT OF THE NEURONAL DAMAGE AND OXIDATIVE STRESS MARKERS LEVEL IN POST STROKE PATIENTS

Relevance. 100-110 000 acute disorders of cerebral circulation are registered in Ukraine annually, about 57% of which are ischemic stroke (IS). Study of dynamics of the neuronal damage markers level and their correlation with oxidative stress indicators may be informative for estimating the prognosis of the IS recovery period.&#x0D; Objective: to study the features of of neuronal damage markers level, the pro- and antioxidant systems status and their effect on the of neurological deficiency manifestations and the functional status of post stroke patients.&#x0D; Materials and methods. 120 patients in the early recovery period of first-ever hemispheric atherothrombotic IS were examined. The control group (CG) included 20 healthy individuals, representative by age and gender. Assessment of neurological deficiency and functional status of patients was performed with the help of the NIHSS scale, the Scandinavian Stroke Scale (SSS), the modified Rankin Scale (mRS) and the Bartel Index (BI). The level of neuron-specific enolase (NSE) in serum was determined by enzyme-linked immunosorbent assay. The determination of the level of oxidative protein modification (OPM) products in serum, glutathione reductase (GR) and glutathione peroxidase (GP) activity was performed spectrophotometrically. Statistical processing of the results was carried out using Statistica 6.0 statistical analysis package (StatSoft, Inc.) with the help of nonparametric results estimation methods.&#x0D; Results. In patients after 1 month after IS an increase of AFGn (356 nm) content by 33.9% (p&lt;0.05) compared to CG was observed. KFGn (370 nm) level was increased by 26.0% (p&lt;0.05), AFGo (430 nm) - by 76.2% (p&lt;0.01), CFG (530 nm) - 125.0% (p&lt;0.01). The general OPM products was 37.0% higher than in CG (p&lt;0.05), while the activity of GP and GR decreased by 31.6% and 28.6%, respectively (p&lt;0, 05), and the NSE level was increased by 150.6% (p&lt;0.05).&#x0D; The NIHSS score correlated with the level of AFGn (356 nm) (r=0.24; p=0.032), KFGo (530 nm) (r=0.41; p=0.047) and the general OPM products level (r=0.25 ; p=0.039), whereas the GR activity significantly influenced the NIHSS score (r=-0.27; p=0.048), SSS score (r=0.23; p=0.034) and BI (r=0.31; p=0.038). Also significant correlations were found between the NSE level and the concentration of all OPM products, GP ans GR activity.&#x0D; Conclusions. The NSE level increase is characteristic for the post stroke patients, which correlates with the degree of neurological deficiency manifestations and the patients’ functional status. The NSE level increases due to the increase of OPM products concentration and the decrease of GP and GR activity, which may indicate a worsening of the neuronal damage degree, linked to the pro- and antioxidant systems imbalance. These processes adversely affect the functional status of patients, with the greatest influence of the KFGo (530 nm) concentration, the general OPM products level and the GR activity.

P665Incidence and predictors of intracerebral haemorrhage recurrence in patients with and without atrial fibrillation: a cohort study

Abstract Background Intracerebral haemorrhage is a devastating vascular event. Clinical predictors of recurrence facilitating individualised post-bleeding patient management are sparsely described. Concomitant atrial fibrillation is common in patients with intracerebral haemorrhage due to widespread use of oral anticoagulation in this specific population. Objective We aimed to describe incidence of intracerebral haemorrhage recurrence and explore the prognostic value of 25 clinical predictors for recurrence in patients with and without atrial fibrillation, including various comorbidities, civil status, lifestyle, medication, and measures of bleeding severity reflected by the Scandinavian Stroke Scale score. Methods Cohort study of patients with incident intracerebral haemorrhage diagnosed from 2003–2016 identified using nationwide Danish administrative registries. Results reported as cumulative incidence of intracerebral recurrence accounting for competing risk of death. Univariate and multivariate predictors of recurrence were estimated using Cox regression analyses (hazard ratios [HRs], 95% confidence intervals [CI]). Results We identified 9,255 patients with incident intracerebral haemorrhage (median age 73 years, 46.6% females, 16% with atrial fibrillation). Five-year risks of intracerebral haemorrhage recurrence were approximately 10% in the study population, although slightly higher for patients without atrial fibrillation (Figure). Predictors of recurrence were broadly similar for patients with and without atrial fibrillation. Age in categories &lt;60 years (reference), age 60–70 years (HR 1.30, 95% CI 1.03–1.65), age 70–80 years (HR 1.60, 95% CI 1.27–2.01), age &gt;80 years (HR 1.20, 95% CI 0.91–1.57), nursing home residency (HR 1.48, 95% CI 1.03–2.15), and Scandinavian Stroke Scale score (“mild” versus “moderate” (HR 1.40, 95% CI 1.13–1.72) and “severe” (HR 1.94, 95% CI 1.59–2.37) were the strongest predictors of intracerebral haemorrhage recurrence. Conclusions Intracerebral haemorrhage recurrence risk after five years was approximately 10%. Robust clinical predictors of recurrence were few and broadly similar for patients with and without atrial fibrillation, with age and measures of bleeding severity being the most important. Acknowledgement/Funding The study was supported by “The BMS/Pfizer ERISTA Program 2016”. The sponsor had no role in the preparation of the manuscript

Efficacy Analysis of Robot-Assisted Minimally Invasive Surgery for Small-Volume Spontaneous Thalamic Hemorrhage

To test whether robot-assisted surgery can improve prognosis of small-volume thalamic hemorrhage and to provide a surgical basis for treatment of small-volume thalamic hemorrhage. This retrospective study included patients with thalamic hemorrhage and hematoma volume of 5-15 mL treated from December 2015 to December 2018. Patients were divided into an operation group and a nonoperation group. General data, types of hematoma, incidence of complications, Scandinavian Stroke Scale score, and modified Rankin Scale score were recorded and analyzed. Retrospectively, 84 cases met inclusion criteria: 35 cases in operation group and 49 cases in nonoperation group. At 90 days after onset, mortality was 11.4% in the operation group and 4.1% in the nonoperation group (P > 0.05). The Scandinavian Stroke Scale score in the operation group (43.3 ± 8.5) was higher than in the nonoperation group (36.1 ± 10.0) (P < 0.05). The modified Rankin Scale score in the operation group (2.9 ± 0.3) was lower than in the nonoperation group (3.7 ± 0.2) (P < 0.05). The incidence of pneumonia (8.6%) and renal dysfunction (14.3%) was lower in the operation group than in the nonoperation group (28.6% and 34.7%, respectively) (P < 0.05). There was no significant difference between the 2 groups in the incidence of central fever (5.7% vs. 12.2%), stress ulcer (11.4% vs. 16.3%), and ion balance disturbance (20.0% vs. 26.5%) (P > 0.05). Robot-assisted drainage of thalamic hemorrhage can improve prognosis and reduce the incidence of pneumonia and renal dysfunction.

A study to find out relationship in between serum uric acid level and stroke

Background: The role of uric acid as a risk factor in cases of acute ischaemic stroke is controversial. The present study was conducted with the aim to study the clinical profile and the incidence of stroke in patients with normal and elevated uric acid and its correlation with other risk factors.Methods: This study was conducted in 100 patients with acute ischaemic stroke who were admitted in NSCB Hospital Jabalpur from August 2009 to July 2010.Clinical records of patients and their serum uric acid level was investigated. The severity of neurological deficit was recorded according to the scandinavian stroke scale (SSS). Patients were followed up during hospital stay and outcome was graded by using modified Rankin’s scale (mRS). Finally, collected data were analyzed using Chi square and student t test wherever appropriate. P value &lt;0.05 was considered significant.Results: A total of 100 patients were included in the study. Majority of the patients (57%) were in the age group of 50 to 70 years. Males (54%) were more affected than females (46%). Out of 100, 71 had normal serum uric acid levels in which 35 (49%) patients were above 60 years of age. 29 of them had hyperuricemia in which 20 (69%) were above the age of 60 years. Of 54 males and 46 females hyperuricemia was observed in 16 (55%) and 13 (45%) patients respectively. A significant correlation was observed between hyperuricemia and hypertension (p&lt;0.05). Non-significant correlation was seen between hyperuricemia, diabetes and hyperlipidemia (p&gt;0.05). Significant, positive correlation p&lt;0.05 was present amongst male alcoholics. Association of uric acid with smoking in acute ischaemic stroke patients was found to be statistically insignificant (p&gt;0.05). Majority (83%) of patients were having infarct in MCA artery territory. Majority of patients 20 (69%) with elevated serum uric acid were having SSS score &gt;30. Statistically insignificant (p&gt;0.05) association was observed between mean mRS score in patients with normal serum uric acid Vs patients with hyperuricemia.Conclusions: The prevalence of hyperuricemia in acute ischaemic stroke patients was lower than in normal population. Age, hypertension and alcoholism amongst males showed statistically significant positive correlation with hyperuricemia in patient with acute ischaemic stroke and hence they are considered to be the significant risk factors.

Neglect and aphasia in the acute phase as predictors of functional outcome 7 years after ischemic stroke.

Visuospatial inattention (VSI) and language impairment (LI) are often present early after stroke and associations with an unfavorable short-term functional outcome have been reported. The purpose of this study was to investigate whether a screening of VSI and LI as indicators of cortical symptoms early after stroke could predict long-term functional outcomes. A consecutive cohort of 375 patients with ischemic stroke was assessed for the occurrence of VSI at a median of 7 days after admission (interquartile range, 1-5 days) using the Star Cancellation Test and for LI (within the first 7 days) with the language item in the Scandinavian Stroke Scale. Seven years later, functional outcomes were assessed by the modified Rankin scale and Frenchay Activities Index in 235 survivors without recurrent stroke. Relationships between baseline predictors and functional outcome at 7 years were analyzed with bivariate correlations and multiple categorical regressions with optimal scaling. The regression model significantly explained variance in the modified Rankin scale (R2 = 0.435, P < 0.001) and identified VSI (P = 0.001) and neurological deficits (P < 0.001; Scandinavian Stroke Scale score without the language item) as the significant independent predictors. The model for Frenchay Activities Index was also significant (R2 = 0.269, P < 0.001) with VSI (P = 0.035) and neurological deficits (P < 0.001) as significant independent predictors. Visuospatial inattention at acute stroke has an independent impact on long-term functional outcomes. Early recognition may enable targeted rehabilitative interventions.

Study of association of severity of sleep disordered breathing and functional outcome in stroke patients

ObjectiveSleep disordered breathing (SDB) is a prevalent yet underrecognized condition that may have major adverse consequences for those affected by it. We performed a prospective observational study to seek a correlation of severity of SDB with the severity of stroke and its functional outcome. MethodsPatients with history of recent-onset stroke were recruited and underwent overnight polysomnography (PSG) after the acute phase of the stroke was over; for defining hypopneas, 3% and 4% desaturation limits were used, and the apnea−hypopnea index was respectively calculated as AHI3% and AHI4%. Stroke severity was graded using the Scandinavian Stroke Scale. Functional disability and neurological impairment was evaluated six weeks after the PSG using the Barthel Index (<80 = functional dependence; ≥80 = functional independence) and modified Rankins Scale (>2 = poor outcome; ≤2 = good outcome). ResultsA total of 50 patients were enrolled, 30 (60%) with ischemic stroke and 20 (40%) with hemorrhagic strokes. Of the patients, 39 (78%) had an AHI4% of >5/h, 23 (46%) had an AHI4% of >15/h, and 9 (18%) had an AHI4% of >30/h. Multivariate analysis showed that body mass index (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.04–1.54, p = 0.019) and Scandinavian Stroke Scale score (stroke severity) (OR = 0.86; 95% CI = 0.76–0.96, p = 0.009) were significant risk factors for predicting SDB (AHI4% > 15) in patients of stroke. When we looked for factors predicting outcomes, only AHI4% (OR = 1.20; 95% CI 1.01–1.43, p value 0.041) was predictive of the functional dependence (based on Barthel Index) of the patient and AHI4% (OR = 1.14; 95% CI 1.03–1.25, p = 0.008) and body mass index (OR = 0.75; 95% CI 0.59–0.96, p = 0.024) were found to be predictive of poor outcome (based on modified Rankins Scale). We obtained similar results, regardless of the hypopnea definition used. ConclusionIn conclusion, given the high frequency of SDB in stroke patients and its correlation with poor outcome, screening for obstructive sleep apnea in all stroke and transient ischemic attack patients may be warranted.

Do studies of the weekend effect really allow for differences in illness severity? An analysis of 14 years of stroke admissions.

An increased mortality rate among patients admitted to hospital at weekends has been found in many studies, and this ‘weekend effect’ has been used to justify major health service reorganisation. Most studies have used routine administrative data to adjust for potential confounding factors, and are unable to measure differences in illness severity due to the tendency of patients with milder symptoms to stay home at weekends. We set out to estimate the importance of such unmeasured ‘confounding by severity’, using data from a hospital stroke register. All suspected acute stroke admissions in Gateshead were prospectively registered over a period of 14.3 years, including information on premorbid factors, measures of stroke severity and survival to hospital discharge. We examined whether each factor differed between weekday and weekend admissions, then used logistic regression to estimate the main contributors to variation in mortality rates. Stroke severity, measured by the Scandinavian Stroke Scale (SSS), was significantly greater among weekend admissions and strongly associated with mortality, and after adjustment for SSS score in logistic regression, the weekend effect completely disappeared. By contrast, most indicators of pre-stroke function, comorbidity or stroke type did not differ between weekday and weekend admissions, although some of them had prognostic significance. The sorts of factors measurable in administrative databases only account for a small part of the prognostically important differences in case-mix between weekday and weekend stroke admissions. While increasing weekend staffing might improve adherence to care standards, evidence that it could save lives is unreliable.

High sensitivity C-reactive protein as a prognostic marker in ischaemic and haemorrhagic stroke

Background: Stroke is the leading cause of death worldwide and one of the main causes of long-term disability. Many patients with elevated CRP levels within 72 hours of stroke have an increased risk of death. However, vascular inflammation is more related to high-sensitivity CRP (hsCRP).There is a distinct possibility that elevated hsCRP may be a direct response to the extent of cerebral tissue injury. The aim of this study was to compare the high sensitivity C-reactive protein (hsCRP) level in patients of stroke and assess its utility in predicting the functional outcome. Methods: A prospective study of 50 patients presenting with a history of focal neurological deficit of acute onset in the form of hemiparesis/hemianaesthesia and having evidence of presence of infarct/haemorrhage in CT/MRI scan of brain and 50 age and sex matched healthy controls was done. In all patients hsCRP levels were measured within 24 hours of presentation. Admission hsCRP levels were then compared to the scandinavian stroke scale scores. Results: Mean hsCRP levels were significantly higher in patients with stroke than controls. Patients with a good long term outcome had a statistically significant lower hsCRP levels. 8 patients died during follow/hospitalisation. They had higher hsCRP levels than patients who survived. hsCRP levels and scandinavian score showed a significant correlation both with ischemic and haemorrhagic stroke. Conclusion: hsCRP can be used as a marker for prognosis in cases with stroke. hsCRP levels are higher in ischemic stroke than in haemorrhagic stroke.

Peripheral frequency of CD4+ CD28- cells in acute ischemic stroke: relationship with stroke subtype and severity markers.

CD4+ CD28− T cells also called CD28 null cells have been reported as increased in the clinical setting of acute coronary syndrome. Only 2 studies previously analyzed peripheral frequency of CD28 null cells in subjects with acute ischemic stroke but, to our knowledge, peripheral frequency of CD28 null cells in each TOAST subtype of ischemic stroke has never been evaluated. We hypothesized that CD4+ cells and, in particular, the CD28 null cell subset could show a different degree of peripheral percentage in subjects with acute ischemic stroke in relation to clinical subtype and severity of ischemic stroke.The aim of our study was to analyze peripheral frequency of CD28 null cells in subjects with acute ischemic stroke in relation to TOAST diagnostic subtype, and to evaluate their relationship with scores of clinical severity of acute ischemic stroke, and their predictive role in the diagnosis of acute ischemic stroke and diagnostic subtypeWe enrolled 98 consecutive subjects admitted to our recruitment wards with a diagnosis of ischemic stroke. As controls we enrolled 66 hospitalized patients without a diagnosis of acute ischemic stroke. Peripheral frequency of CD4+ and CD28 null cells has been evaluated with a FACS Calibur flow cytometer.Subjects with acute ischemic stroke had a significantly higher peripheral frequency of CD4+ cells and CD28 null cells compared to control subjects without acute ischemic stroke. Subjects with cardioembolic stroke had a significantly higher peripheral frequency of CD4+ cells and CD28 null cells compared to subjects with other TOAST subtypes. We observed a significant relationship between CD28 null cells peripheral percentage and Scandinavian Stroke Scale and NIHSS scores. ROC curve analysis showed that CD28 null cell percentage may be useful to differentiate between stroke subtypes.These findings seem suggest a possible role for a T-cell component also in acute ischemic stroke clinical setting showing a different peripheral frequency of CD28 null cells in relation of each TOAST subtype of stroke.