Scandinavian Stroke Scale Research Articles

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 <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 >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.

Effect of morning blood pressure peak on early progressive ischemic stroke: a prospective clinical study

ObjectiveTo prospectively evaluate the effect of morning blood pressure peak (MBPP) on early progressive ischemic stroke (EPIS). Patients and MethodsA total of 135 patients with acute ischemic stroke were enrolled and completed all assessments. The patients were divided into EPIS group and non-EPIS group, with 22 and 113 cases in each group, respectively, according to the assessment of Scandinavian stroke scale within three days after onset. All cases received conventional treatment for stroke and its risk factors. 24 -h dynamic blood pressure monitoring was performed within 24 h after admission. Based on the 24 -h mean blood pressure, MBPP, morning blood pressure, and other risk factors for EPIS, we conducted a logistic regression analysis to evaluate whether MBPP was an independent risk factor for EPIS. ResultsMean systolic blood pressure, systolic and diastolic MBPP, morning systolic and diastolic blood pressure were all significantly higher in EPIS group than in non-EPIS group (p = 0.037, p = 0.001, p = 0.035, p = 0.003, p = 0.042, respectively). Logistic regression analysis showed that MBPP was an independent risk factor for EPIS (OR = 1.057, 95% CI 1.014–1.102, p = 0.009). Further stratified analysis showed that incidences of EPIS in patients with elevated MBPP combined with large artery atherosclerosis or small artery occlusion were comparable (41.2% vs. 25.0%, p = 0.367), and the systolic MBPP was significantly higher in morning EPIS group than in non-morning EPIS group (p = 0.041). ConclusionElevated systolic MBPP might be an independent risk factor for EPIS, and play a more obvious effect on EPIS manifesting in the morning especially.

Effect of Home-Based High-Intensity Interval Training in Patients With Lacunar Stroke: A Randomized Controlled Trial.

Background: High-intensity interval training (HIIT) is superior to moderate-intensity continuous training in improving cardiorespiratory fitness in patients with cardiovascular disease, but is it safe, feasible and effective in patients with stroke? We investigated feasibility and effect of early, home-based HIIT in patients with lacunar stroke combined with usual care vs. usual care, only.Methods: Patients with minor stroke (severity: 55/58 point on the Scandinavian Stroke Scale) were randomized to HIIT or usual care in a randomized, controlled trial. We measured the following outcomes at baseline and post-intervention: cardiorespiratory fitness monitored as power output from the Graded Cycling Test with Talk Test (GCT-TT; primary outcome), physical activity, fatigue, depression, well-being, stress, cognition, endothelial function, blood pressure, body mass index, and biomarkers.Results: We included 71 patients (mean age 63.7 ± 9.2), 49 men, 31 in intervention group. Home-based HIIT was feasible with no reported adverse events in relation to the intervention. No significant change between the groups in GCT-TT power output was detected (p = 0.90). The change in time spent on vigorous-intensity activity was 2 h/week and 0.6 h/week, intervention and usual care, respectively (p = 0.045). There were no significant differences between groups in the remaining secondary outcomes.Conclusion: HIIT was feasible and safe in patients with lacunar stroke. Patients can engage early in home-based HIIT when involved in choosing exercise modality and guided by weekly motivational phone calls. Within 3 months, HIIT did, however, not yield effect on cardiorespiratory fitness. We await further evaluation of long-term effects of this intervention on continued regular physical exercise and cardiovascular event.Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT02731235

ИЗМЕНЕНИЯ ЦЕРЕБРО-КАРДИАЛЬНЫХ ВЗАИМОДЕЙСТВИЙ ПРИ ВЕГЕТАТИВНОМ СОСТОЯНИИ В ОТВЕТ НА НЕЙРОТРОПНУЮ ТЕРАПИЮ

Целью исследования было изучение особенностей цереброкардиальных взаимодействий у пациентов с острой церебральной недостаточностью различного генеза с исходом в вегетативное состояние, исследование эффективности холина альфосцерата у данной категории пациентов. Материалы и методы. В статье использованы данные открытого проспективного исследования по типу «случай-контроль» в 2011-2018 годах на базе Донецкого клинического территориального медицинского объединения. Группу исследования составили 11 пациентов с острой церебральной недостаточностью в результате тяжелой черепно-мозговой травмы (5 пациентов), мозгового инсульта (3 больных), после «постасистолического синдрома» (3 пациента). Диагноз вегетативного состояния у пациентов ГИ был выставлен на основании принятых международных критериев (Vegetative State and Minimally Conscious State, 2010). Проводили анализ уровня сознания по шкалам ком Глазго, Глазго-Питсбургской шкалы ком, Скандинавской шкалы инсультов и исходов Глазго, количественной ЭЭГ (система Nihon Kohden Corporation EEG-1200K), вариабельности сердечного ритма (Ютас ЮМ 200). Церебро-кардиальные взаимодействия исследовали на фоне фармакологических проб с препаратом холина альфосцерата. Длительность наблюдения пациентов от 2 до 8 месяцев. Статистическая обработка данных включала исследование плотности корреляционной связи (программа MedStat). Результаты и обсуждения. В результате лечения была зафиксирована трансформация вегетативного состояния в «состояние малого сознания» у 5 больных. Состояние без изменений – у 3 пациентов. Трое больных умерло.В ответ на введение препарата холина альфосцерата были выявлены статистически значимые (р≤0,05) увеличения параметров относительной спектральной мощности в ЭЭГ-диапазоне бета1-, бета2- ритма (максимально в правой гемисфере), в диапазоне альфа- активности (максимально в области центральных и окципитальных отведений билатерально), в «узких» диапазонах 14-16 Гц и 11-12 Гц, что отражало значимую активацию ГАМК-ергических и дофаминергических нейромедиаторных систем ЦНС. Не было выявлено статистически значимых изменений (р&gt;0,05) относительной спектральной мощности в ЭЭГ-диапазоне тета- ритма, в диапазоне 6-7,5 Гц, связанном с активацией холинергический нейромедиаторных структур. В ответ на введение холина альфосцерата было зафиксировано значительное увеличение плотности с изменением характера корреляционных связей между параметрами вариабельности сердечного ритма и количественной ЭЭГ. Выводы. Особенности церебро-кардиальных взаимодействий у пациентов, у которых кома трансформировалась в вегетативное состояние, свидетельствовали о формировании нескольких патологических систем в ЦНС, связано с межполушарным разобщением и отсутствием взаимодействий между ретикулярной формацией верхнестволового и диэнцефального уровня. Изучение церебро-кардиальных взаимодействий позволяет выявить нейромедиаторные (холин-, ГАМК-, дофамин- и серотонинергические) предикторы в формировании вегетативного состояния. Применение центрального холиномиметика холина альфосцерата уже на первом этапе исследования позволяло выявить нетипичные изменения в т.н. «холинергический» нейромедиаторных структурах, связанные с формированием патологических систем.

Determinants of quality of life in patients with hemorrhagic stroke: A path analysis.

Identifying the determinants of health-related quality of life (HRQOL) improved assessment and decision-making in clinical practice. A few studies have focused on the determinants of HRQOL and their interrelationships in patients with hemorrhagic stroke. The aim of this study was to identify the factors contributing to HRQOL and exam their interrelationships.A total of 202 patients with hemorrhagic stroke who were discharged from the neurological unit participated in this study. Stroke-specific quality of life was used to assess HRQOL. The Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, the Scandinavian Stroke Scale and the Barthel Index were collected as potential predictors as well as social-demographic data. A path analysis was used to explore the potential interrelationships between various factors based on the International Classification of Functioning model.The final model reasonably fitted the data. The activities of daily living, neurological function and anxiety had direct effects on quality of life. Age, comorbidities, hemorrhage type, financial status, anxiety, and neurological function also had indirect influences on quality of life. All these factors explained 82.0% of all variance in quality of life.HRQOL in patients with stroke can be predicted by anxiety, neurological function, activities of daily living and other personal and environmental factors. These identified predictors and their interrelationships may assist clinical professions focusing their assessments and developing strategies for modifiable factors to improve HRQOL.

Abstract TP266: Patient and Bystanders Perceived Seriousness of Stroke Symptoms at Onset

Background: Prehospital delay has several causes, most of them being patient-dependent. Knowledge of how patients and bystanders actually experience and react to symptoms at onset are essential. Purpose: Our aim is to characterize symptoms described by patients and bystanders at onset, perceived symptom seriousness, and whether this was associated with calling EMS directly. Methods: A cross-sectional study of consecutive acute stroke and TIA patients admitted at two stroke centres in the Central Denmark Region, in a three months period in 2018. Structured interviews of pre-stroke independent patients and bystanders were performed separately. Questions were open-ended. Symptoms identified as indicating stroke were classified as being focal or non-focal and perceived seriousness as mild or moderate/severe. Analysis were performed using logistic regression analysis. Results: A total of 1210 patients had a stroke/TIA in the period, of these 469 were included. We performed 654 interviews of patients and/or bystanders in median 1 day after stroke admission. Most frequent recognized symptoms by patients were limb palsy (31%), speech difficulties (26%) and dizziness (21 %). For bystanders: speech difficulties (47%), limb palsy (39%) and facial palsy (26%). Of patients and bystanders, 29 % and 23 % could not describe at least one focal symptom at onset. Focal symptoms were perceived as more serious in both patients and bystanders, OR (95% CI) 2.2 (1.29-3.76) and 2.61 (1.32-5.14). Patients who perceived symptoms as serious were more likely to make a direct EMS call, OR 2.10 (1.23-3.61). For bystanders, symptoms perceived as serious, were strongly associated with a direct EMS call: OR 22.7 (3.05-169.61). In patients being alone at stroke onset (98 (21%)) only 16% were able to call EMS directly and median (IQR) stroke severity (Scandinavian Stroke Scale) was lower among those calling EMS directly 57(52-58) vs 51(43-52), p&lt;0.001. Conclusion: Approximately 1 in 3 patients did not recognize focal stroke symptoms, but when focal symptoms were recognized and perceived as serious, this was associated with direct EMS call. The role of a bystander is pivotal and bystanders role to step in of importance.

Risk factors for post-stroke depression in Sohag University Hospital

BackgroundDepression is one of the important complications of stroke. Post-stroke depression is associated with more physical disability, especially in daily activities, poor functional outcome, and high mortality rate.ObjectiveOur study aimed to investigate the risk factors for development of post-stroke depression 3 months following stroke.MethodsThis is a comparative study, comparing stroke patients with and without depression 3 months after the onset. Hamilton Depression Rating Scale (HDRS), Mini-Mental State Examination (MMSE), Scandinavian Stroke Scale (SSS), and modified Rankin scale (mRS) were used to evaluate patients 3 months post-stroke for depression, cognition, and physical disability. The patients were divided into two groups: patients’ group with depression and patients’ group without depression according to DSM-IV criteria. The clinical characteristics and scores on the HDRS, MMSE, SSS, and mRS were compared between depressive group and non-depressive group. Logistic regression analysis was performed to identify risk factors for depression 3 months after stroke.ResultsA total 102 stroke patients were recruited. Of these, 62 patients (60.78%) had depression. Multivariate logistic regression indicated that smoking, hypertension, increased physical disability, and impaired cognitive function were associated with post-stroke depression.ConclusionImportant risk factors found for PSD included smoking, hypertension, increased physical disability, and impaired cognitive function.

How to Design Economic Predictive Laboratory Panel Evaluating Acute Ischemic Stroke Outcome

Background: acute ischemic stroke (AIS) remains the third cause of death and disability, and acute phase responses, both increasing international normalized ratio (INR) and activated partial thromboplastin time (APTT) are associated with worse outcome. Erythrocyte sedimentation rate (ESR) serves as severity marker, and non-fasting triglycerides (TG) indicates remnants of chylomicrons and very low density lipoproteins potentially pro-inflammatory. Aims: to design predictive economic panel evaluating AIS. Patients and methods: 100(AIS) patients were included, clinically evaluated by Scandinavian Stroke Scale (SSS) and Modified Rankin Score (MRS), subjected to complete blood count (CBC) on Cell-Dyne3700, manual ESR, INR and APTT on SYSMEX-CA1500, serum uric acid (SUA), serum albumin and non-fasting (TG) on Beckman Coulter AU480. Statistical analysis: STATA intercooled version 9.2. Results: odd ratio (OR), confidence interval (CI) of (MRS) in correlation to WBCs count in quartile (Q)3, 4 (OR 8.14, CI 2.29 - 8.90, significant P = 0.01; and OD13.5, CI 3.39 - 53.68, high significant P = 0.001 respectively), to APTT in Q3 (OD 4.15, CI 1.09 - 15.82, P = 0.04), SUA in Q3 (OD 0.19, CI 0.05 - 0.68, P = 0.01), TG in Q3,4 (OD 0.24 CI 0.06 - 0.88, P = 0.03; and OD 0.09, CI 0.02 - 0.34 P = 0.001 respectively) and serum albumin in Q3(OD 0.13, CI 0.04 - 0.51, P = 0.003), insignificant correlations to ESR, INR and platelets. Conclusion: according to (MRS), the economic predictive panel should be included WBCs, APTT, SUA, and non-fasting TG with serum albumin as prognostic tool evaluating functional disability in AIS.

Does the severity of depressive symptoms after stroke affect long-term survival? An 18-year follow-up.

ObjectiveWe tested whether the severity of depressive symptoms in acute stroke and 4 years later are predictors of long-time survival.MethodWe evaluated the severity of stroke in 82 patients with acute stroke by the Barthel index, the Scandinavian Stroke Scale and the Orgogozo scale, and we also quantified the severity of depressive symptoms by the Beck and the Hamilton scales in the first week of stroke, in 1995. We re-evaluated the scales 4 years after stroke in 41 out of 48 survivors. We checked the survival status of the initial cohort 18 years after stroke. In the assessment Kaplan-Meier graphs were constructed and the outcomes between groups were compared with log-rank tests.ResultsClinically important depressive symptoms (≥10 on the Beck scale) was present in 16 patients (19,5%) with acute stroke one week after admission. Case fatality was 41% at 4 years and 84% at 18 years after stroke. Those patients who survived at 4 years were significantly younger (p<0,05). Depressive symptoms in acute stage were not independent predictor of the length of survival. More severe strokes were associated with more severe depressive symptoms 4 years after stroke. In the survival subgroup of patients, those who had more severe depression (≥10 on the Beck scale) at 4 years, had shorter post-stroke survival than those with milder or no depression (Mann-Whitney test, p = 0.022; log-rank-test, p = 0.047). In multivariate analyses, adjusted for age, sex, stroke severity and the severity of depressive symptoms, age, sex and stroke severity remained the significant predictors of the length of survival.ConclusionsThe severity of depressive symptoms either in the acute phase or 4 years after stroke is not an independent predictor of the length of survival in an 18-year follow-up.

The impact of stroke on people living in central Uganda: A descriptive study

BackgroundKnowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions.ObjectivesTo explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda.MethodA cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation.ResultsThe mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample.ConclusionPeople with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.

Effectiveness of paroxetine in the treatment of poststroke depression.

This study retrospectively investigated the effectiveness of paroxetine for the treatment of poststroke depression (PSD).Seventy patient cases with PSD were included in this study, and were assigned to an intervention group and a control group equally. All patients received routine treatment in both groups. Additionally, patients in the intervention group underwent paroxetine, while patients in the control group received psychotherapy for a total of 8 weeks intervention. The primary outcomes included depression, measured by Hamilton depression rating scale (HAMD); and anxiety, measured by Hamilton Anxiety Rating Scale (HAMA). The secondary outcomes consisted of neurological impairment, measured by Scandinavian Stroke Scale (SSS), and activities of daily living, measured by Barthel index (BI), as well as the adverse events. All outcomes were assessed before and after 8-week treatment.After 8-week treatments, patients in the intervention group did not show greater effectiveness in depression, measured by HAMD (P = .11), and anxiety, assessed by HAMA (P = .13), as well as the neurological impairment, evaluated by SSS (P = .24), and activities of daily, performed by BI (P = .19), compared with patients in the control group. In addition, no significant differences regarding adverse events were found between the 2 groups.The results of this study indicated that paroxetine may not bring promising effectiveness for patients with PSD. Future studies are still needed to warrant the results of this study.

Comparison of the clinical efficacy of craniotomy and craniopuncture therapy for the early stage of moderate volume spontaneous intracerebral haemorrhage in basal ganglia: Using the CTA spot sign as an entry criterion

ObjectivesSurgical treatment is widely used for haematoma removal in spontaneous intracerebral haemorrhage (ICH) patients, but there is controversy about the selection of surgical methods. The CT angiography (CTA) spot sign has been proven to be a promising factor predicting haematoma expansion and is recommended as an entry criterion for haemostatic therapy in patients with ICH. This trial was designed to evaluate the clinical efficacy of two surgical methods (haematoma removal by craniotomy and craniopuncture combined with urokinase infusion) for patients in the early stage (≤6h from symptom onset) of spontaneous ICH with a moderate haematoma volume (30 ml – 60 ml). Patients and MethodsFrom January 2012 to July 2017, 196 eligible patients treated in our institution were enrolled according to the inclusion criteria. The patients were divided into the CTA spot sign positive type and CTA spot sign negative type according to the presence or absence of the CTA spot sign. For each type, the patients were randomly assigned to two groups, i.e., the craniotomy group, in which patients underwent craniotomy with haematoma removal, and the craniopuncture group, in which patients underwent minimally invasive craniopuncture combined with urokinase infusion therapy. Neurological function was evaluated with the Scandinavian Stroke Scale (SSS) at day 14. The disability level and the activities of daily living were assessed using a modified Rankin Scale (mRS) and Barthel Index (BI) at day 90. Case fatalities were recorded at day 14 and 90. Complications were recorded during hospitalization. ResultsFor the CTA spot sign positive type, the craniotomy group had a higher SSS than that in the craniopuncture group (P < 0.05) at day 14. The rebleeding rate was higher in the craniopuncture group than that in the craniotomy group (P < 0.05) during hospitalization. The craniotomy group had a lower mRS than that in the craniopuncture group (P < 0.01) and had a higher BI than that in the craniopuncture group (P < 0.05) at day 90. There was no statistically significant difference in the fatality rate between the two groups. For the CTA spot sign negative type, there were no significant differences in the SSS, mRS, BI, fatality rate and complication rate between the two groups. ConclusionICH can be divided into the CTA spot sign positive and negative type according to the presence or absence of the CTA spot sign. For the CTA spot sign positive type, patients can benefit from craniotomy with haematoma removal, which can reduce the postoperative rebleeding rate and improve the prognosis. For the CTA spot sign negative type, both craniotomy and craniopuncture are applicable. Considering simple procedure and minor surgical injury, craniopuncture can be a more reasonable choice.

Validity and prognostic value of serum albumin level in emergency acute ischemic stroke egyptian patients

There are two main types of stroke: ischemic and hemorrhagic. Some studies showed the favorable relationship of serum albumin levels on the outcome of patients who suffer from ischemic stroke (IS). Some experimental studies have suggested a neuroprotective effect of albumin either by reducing brain edema or by its antioxidative or antiapoptotic effects. To detect serum albumin level and evaluate its prognostic value in patients with acute ischemic stroke in emergency department in compared to Scandinavian Stroke Scale (SSS). The study was carried out as descriptive (cross-sectional) study conducted on 60 patients with ischemic stroke attending emergency department in Suez Canal University hospital. It was found that all of died patients (100%) had hypoalbuminemia. While (92.5%) of patients who discharged from hospital had normal serum albumin level in follow up. but (7.5%) of them had hypoalbuminemia. And the ROC curve of both SSS and Serum albumin level on admission had Sensitivity: 100% and Specificity: 83% among studied patients. Thus serum albumin level has a direct correlation with short term prognosis of acute ischemic stroke patients. Patients with a lower SSS on admission and had higher levels of serum albumin had good short-term prognosis, and those with a high SSS and had a lower level of albumin had bad prognosis. higher levels of serum albumin is associated with a better short term prognosis. So they may act as indicators of short term prognosis.

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.

Route of Feeding as a Proxy for Dysphagia After Stroke and the Effect of Transdermal Glyceryl Trinitrate: Data from the Efficacy of Nitric Oxide in Stroke Randomised Controlled Trial

Post-stroke dysphagia is common, associated with poor outcome and often requires non-oral feeding/fluids. The relationship between route of feeding and outcome, as well as treatment with glyceryl trinitrate (GTN), was studied prospectively. The Efficacy of Nitric Oxide in Stroke (ENOS) trial assessed transdermal GTN (5 mg versus none for 7 days) in 4011 patients with acute stroke and high blood pressure. Feeding route (oral = normal or soft diet; non-oral = nasogastric tube, percutaneous endoscopic gastrostomy tube, parenteral fluids, no fluids) was assessed at baseline and day 7. The primary outcome was the modified Rankin Scale (mRS) measured at day 90. At baseline, 1331 (33.2%) patients had non-oral feeding, were older, had more severe stroke and more were female, than 2680 (66.8%) patients with oral feeding. By day 7, 756 patients had improved from non-oral to oral feeding, and 119 had deteriorated. Non-oral feeding at baseline was associated with more impairment at day 7 (Scandinavian Stroke Scale 29.0 versus 43.7; 2p < 0.001), and worse mRS (4.0 versus 2.7; 2p < 0.001) and death (23.6 versus 6.8%; 2p = 0.014) at day 90. Although GTN did not modify route of feeding overall, randomisation ≤6 h of stroke was associated with a move to more oral feeding at day 7 (odds ratio = 0.61, 95% confidence intervals 0.38, 0.98; 2p = 0.040). As a proxy for dysphagia, non-oral feeding is present in 33% of patients with acute stroke and associated with more impairment, dependency and death. GTN moved feeding route towards oral intake if given very early after stroke.Clinical Trial RegistrationClinical Trial Registration-URL: http://www.controlled-trials.com. Unique identifier: ISRCTN99414122.

English

BACKGROUND AND OBJECTIVES: Stroke is a life threatening neurological disorder. Identification of predictors of mortality is vital so that prompt therapeutic measures can be instituted to improve outcome. Animal studies have shown neuroprotective effect of albumin in ischemic stroke. But this has not been studied well enough in humans to recommend supplementation of albumin as a therapeutic measure in stroke. The objective of this study is to determine the association between the serum albumin at admission and the stroke severity as well as functional outcome at 7 days. METHODS: The study was done over a period of 6 months and included 100 subjects with first ever stroke which was proved to be ischemic by CT Brain. After a detailed history and clinical examination, lab investigations including serum albumin were sent. Patients with history of previous stroke and those with conditions predisposing to hypoalbuminemia were excluded from the study. The severity of stroke was measured using Scandinavian Stroke Scale and the functional status at 7days was assessed using modified Rankin scale. Statistical analysis was done to determine the association between serum albumin and stroke severity as well as functional outcome and to find out the correlation between these. RESULTS: There was no significant variation in serum albumin with age and sex. There was definite association between serum albumin at admission and the severity of stroke. There was negative correlation between serum albumin value and the MRS score thereby indicating better outcome with higher albumin level. CONCLUSION: 1. Serum Albumin levels have significant association with the severity as well as short term functional outcome of ischemic stroke. 2. Improving serum albumin levels may improve the functional outcome of acute ischemic stroke. So the study concludes that higher the serum albumin, lesser the stroke severity and better the prognosis.

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.

Role of Vitamin D in the Outcome of Ischemic Stroke- A Randomized Controlled Trial.

Vitamin D deficiency has reached epidemic proportions in India with prevalence rates of 70-100% in the general population. Low vitamin D levels are associated with worse outcomes in ischemic strokes. The outcome of stroke after vitamin D replenishment has not been much studied. To compare the stroke outcome between patients receiving vitamin D supplementation and patients without vitamin D supplementation by Scandinavian Stroke Scale (SSS) and thus, to assess the long term outcome of ischemic stroke patients with low vitamin D level by supplementation of vitamin D. This is a non blinded randomized controlled trial conducted in ischemic stroke patients. The patients were divided into two groups (A and B) where Group A received a single dose of 6 lac IU of Cholecalciferol Intramascular (IM) injection and Group B were not given vitamin D. Finally 30 patients in each group were analyzed. SSS was applied to evaluate the stroke severity at the onset and at the follow up after three months in both groups. The difference in SSS was analyzed using SPSS software. Independent t-test was applied and p-value < 0.05 was taken as significant. Mean±SD of vitamin D levels in Group A and Group B were 17.98±3.81ng/ml and 18.44±4.69 ng/ml respectively. Mean±SD of SSS at time of admission and after three months for Group A was 32.50±11.61 and 38.89±8.34; and for Group B 35.82±8.56 and 38.32±7.10. The difference in SSS from time of admission and after three months, in Group A (6.39±4.56) and Group B (2.50±2.20) were analyzed statistically and found to be highly significant (p<0.001). The results showed that there is a significant improvement in the stroke outcome after three months in those patients who were supplemented with vitamin D. Thus screening for vitamin D deficiency in stroke patients is essential and vitamin D replenishment will improve the stroke outcome.