Stroke In Adults Research Articles

Upper limb practice with a dynamic hand orthosis to improve arm and hand function in people after stroke: a feasibility study

BackgroundDynamic hand orthosis may help upper limb recovery by keeping the wrist and hand in an optimal position while executing a grasp. Our aim was to investigate the feasibility of combining a dynamic hand orthosis with task-oriented upper limb practice after stroke.MethodFifteen adult stroke survivors were recruited in a single-group, pre-post intervention study. They received 12 weeks of task-oriented upper limb training with a dynamic hand orthosis with 3 weeks supervised at a community rehabilitation unit followed by 9 weeks unsupervised at home. Feasibility was determined by recruitment (proportion of eligible/enrolled and enrolled/retained participants), intervention (adherence, acceptability, and safety) and measurement (time taken to collect outcomes and proportion of participants where all measures were collected). Clinical outcomes were measured at baseline (Week 0), end of Week 3 and Week 12.ResultsFifteen (46%) of eligible volunteers were enrolled in the study. Eight (53%) of those enrolled completed the 12-week intervention. Eighty eight percent were satisfied or very satisfied with the dynamic hand orthosis. Clinical measures were collected for all participants at baseline and in all those who completed the intervention but often took over one hour to complete. At 12 weeks, participants had improved by 7 points out of 57 (95% CI 2 to 13) on the ARAT and by 8 points out of 66 (95% CI 0 to 15) on the FMA-UE.ConclusionThe intervention appears to be feasible in terms of acceptability and safety, while recruitment and measurement need further consideration. The magnitude of the clinical outcomes suggests that the intervention has a potential to improve both upper limb activity and impairment, and this study provides useful information for the design of a pilot randomized trial.Trial registrationClinicalTrials.gov Identifier: NCT03396939.

Race and Sex Disparities in Lower Extremity Total Joint Arthroplasty: A Retrospective Database Study.

Total joint arthroplasty (TJA) is successful in improving health-related quality of life. However, outcomes vary in the literature due to modifiable and non-modifiable factors. Modifiable factors consist of body mass index (BMI), nutrition, and tobacco use. Non-modifiable risk factors include age, race, sex, and socioeconomic status. Prior literature has focused on racial disparities in terms of the utilization of lower extremity arthroplasty. The purpose of this study is to determine the effect of race and sex on the in-hospital complication rate, length of stay, and charges associated with primary TJA. This retrospective cohort utilized complex survey data from the National Inpatient Sample (NIS) between 2016 and 2019. The use of the International Classification of Disease-10 Procedure Codes (ICD-10 PCS) for right hip, left hip, right knee, and left knee TJA yielded a preliminary total of 2,660,280 patients. The exclusion criteria were bilateral arthroplasty and concomitant unilateral hip and knee arthritis. Major complications were defined as acute myocardial infarction, cardiac arrest, pulmonary embolism, adult respiratory distress syndrome, stroke, shock, and septicemia. Odds ratio (OR) and beta coefficients were adjusted for age, sex, primary payer, hospital region, hospital teaching status, and year. Total charges were adjusted for inflation using the Consumer Price Index data reported by the US Bureau of Labor Statistics. A total of 2,589,510 patients met our inclusion criteria; 87.6%, 5.9%, 4.8%, 1.4%, and 0.3% of people were 'White', 'Black', 'Hispanic', 'Asian, or Pacific Islander', and 'Native American', as defined by the National (Nationwide) Inpatient Sample (NIS) Variable 'RACE'. Black individuals experienced a significantly greater major complication rate compared to White individuals (0.87% vs. 0.74%, OR 1.25, p-value = 0.0004). Black and Hispanic individuals experienced a significantly greater minor complication rate compared to White individuals (6.39% vs. 4.12%, odds ratio (OR) 1.61, p-value < 0.0001; 4.68% vs. 4.12%, OR 1.17, p-value < 0.0001). Black, Hispanic, Asian or Pacific Islander, and Native American individuals stayed, on average, 0.33, 0.19, 0.19, and 0.25 days longer than White individuals (2.78, 2.54, 2.55, 2.56 vs. 2.37 days, p<0.0001). None of these statistically significant differences exceeded the established minimal clinically important difference of two days. Black, Hispanic, and Asian or Pacific Islander patients were charged $5,751, $18,656, and $12,119 more than White patients ($72,122, $85,027, $78,490, and $59,297 vs. $66,371, p ≤ 0.0165). Native American patients were charged $7,074 less than White patients ($59,297 vs. $66,371, p < 0.0001). Black and Hispanic TJA patients may have higher complication rates than White TJA patients. The differences in length of stay between race groups may not affect outcomes. Hispanic patients received significantly more charges than White patients, and Native American patients received significantly fewer charges than White patients after controlling for non-modifiable risk factors. Addressing the charge disparities may reduce the total national cost burden associated with TJA. The present study highlights the need for further studies on healthcare outcomes related to race and sex.

Pearls for the Emergency Clinician: Posterior Circulation Stroke

BackgroundPosterior circulation (PC) stroke in adults is a rare, frequently misdiagnosed, serious condition that carries a high rate of morbidity. Objective of the ReviewThis review evaluates the presentation, diagnosis, and management of PC stroke in the emergency department (ED) based on current evidence. DiscussionPC stroke presents most commonly with dizziness or vertigo and must be distinguished from more benign diagnoses. Emergency clinicians should consider this condition in patients with dizziness, even in younger patients and those who do not have traditional stroke risk factors. Neurologic examination for focal neurologic deficit, dysmetria, dysarthria, ataxia, and truncal ataxia is essential, as is the differentiation of acute vestibular syndrome vs. spontaneous episodic vestibular syndrome vs. triggered episodic vestibular syndrome. The HINTS (head impulse, nystagmus, and test of skew) examination can be useful for identifying dizziness presentations concerning for stroke when performed by those with appropriate training. However, it should only be used in patients with continuous dizziness who have ongoing nystagmus. Contrast tomography (CT), CT angiography, and CT perfusion have limited sensitivity for identifying PC strokes, and although magnetic resonance imaging is the gold standard, it may miss some PC strokes early in their course. Thrombolysis is recommended in patients presenting within the appropriate time window for thrombolytic therapy, and although some data suggest endovascular therapy for basilar artery and posterior cerebral artery infarcts is beneficial, its applicability for all PC strokes remains to be determined. ConclusionsAn understanding of PC stroke can assist emergency clinicians in diagnosing and managing this disease.

Insomnia complaints correlated with higher risk of cognitive impairment in older adults following stroke: a National Representative Comparison Study.

Although associations among insomnia, cognitive impairment, and stroke have been demonstrated, whether insomnia increases the risk of cognitive impairment after stroke remains unclear. The aim ofthis studywasto examine whether insomnia complaints moderated the association between stroke and cognitive impairment in older adults. This study was a secondary data analysis that used data from the National Health Interview Survey 2009. A total of 447 older adults with a mean age of 74.63years (50.1% men) were included. Self-reported insomnia and stroke occurrence were determined using a questionnaire. Cognitive impairment was assessed using the Mini-Mental State Examination. We used multivariate logistic regression to analyze the association between insomnia complaints and cognitive impairment. Participants were categorized into four groups: those with stroke and insomnia (58), those with stroke without insomnia (91), those without stroke with insomnia (116), and those without stroke or insomnia (182). The prevalence of insomnia complaints was 38.9%, and the frequency of poststroke cognitive impairment was 50.3%. After controlling for potential confounders, participants with stroke (with or without insomnia) had a significantly higher risk of cognitive impairment than those without stroke or insomnia (adjusted odds ratios: 4.16 and 2.91, 95% confidence intervals: 1.91-9.07 and 1.56-5.43, respectively). Stroke with or without insomnia complaints was associated with a higher risk of cognitive impairment relative to older adults without stroke or insomnia. The risk of cognitive impairment was the highest among participants with both stroke and insomnia.

Characteristics and outcomes amongst stroke patients in symptomatic and asymptomatic COVID-19: a systematic review

Link of Video Abstract: https://www.youtube.com/watch?v=1zdsWuZBGgcIntroduction: Stroke has been reported in symptomatic and asymptomatic COVID-19 patients with undetermined characteristics and outcomes. Stroke is one of the non-respiratory pathology reported amongst COVID-19 patients with various manifestations. We elucidated the characteristics and outcomes in symptomatic and asymptomatic COVID-19 patients. Methods: A systematic review was performed from 01/01/2020 to 16/03/2022 in EBSCOhost, Google Scholar, Pubmed, Scopus, and Web of Science with search terms, i.e., COVID-19, Coronavirus, SARS-CoV-2, Coronavirus Disease-19, stroke, CVA (cerebrovascular accident), brain MRI, head MRI, magnetic resonance imaging, antithrombotic agent, thrombectomy, using the PRISMA guidelines. Inclusion criteria include case reports or series of adult stroke patients with confirmed COVID-19 written in English; other articles were excluded. Results: From 239 articles screened initially, 23 articles were included. Twenty-five patients are classified as symptomatic (n=17) and asymptomatic (n=8). In symptomatic patients, motor and sensory abnormalities with loss of consciousness and alteration of memory were detected. Eight symptomatic patients had elevated D-dimer, and 2 had elevated fibrinogen levels. Complete resolution was found 6 times higher in symptomatic vs. asymptomatic cases, while the mortality rate was lower in symptomatic compared to asymptomatic patients. Conclusions: Stroke in symptomatic patients occurred more frequently than the asymptomatic and was observed pre- or post-diagnosis of COVID-19; thus could be the comorbidity and/ or complication.

Application of Prognostic Nutritional Index in the Predicting of Prognosis in Young Adults with Acute Ischemic Stroke

The incidence of ischemic stroke in young adults (18-45years old) is increasing gradually. However, performing nutritional assessment in stroke patients is often challenging due to the lack of an accepted standard for nutritional assessment. Two hundred sixty young stroke patients were recruited in this study and 144 cases in the good prognosis group and 116 cases in the poor prognosis group were scored according to the modified Rankin scale 90days after treatment. The National Institutes of Health Stroke Scale was performed on admission and discharge of patients. Serum interleukin 6 and high-sensitivity C-reactive protein were detected at patient presentation. The Prognostic Nutritional Index (PNI) was assessed on admission. Calculation formula of PNI score: serum albumin (g/L)+5× total lymphocyte count (109/L). The PNI at admission of young stroke patients with poor prognosis was higher than that of those with good prognosis. PNI at admission was significantly negatively correlated with National Institutes of Health Stroke Scale at discharge and modified Rankin scale score after 90days in young stroke patients. PNI at admission was also significantly negatively correlated with serum levels of high-sensitivity C-reactive protein and interleukin -6 at admission. PNI has a statistically predictive value for the 90-day prognosis of young stroke patients.

Substance use disorder in young adults with stroke: clinical characteristics and outcome.

Stroke incidence among young adults has risen in the last decade. This research attempts to determine the effect of substance use disorder (SUD) on the clinical characteristics of stroke, mortality, outcome after IV thrombolysis, and functional dependency after 1 month among young adults. Through a retrospective study, data were extracted from the electronic medical records of stroke in young adults admitted to intensive care units in Kasr Al-Ainy Hospital (February 2018-January 2021). The National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale were documented at the onset and after 1 month. The study included 225 young adults with stroke (median age of 40, IQR: 34-44). Only 93 young adults (41%) met the criteria of SUD. Anabolic steroid use disorder was significantly associated with cerebral venous thrombosis (P-value = 0.02), while heroin use disorder was significantly associated with a hemorrhagic stroke (P-value = 0.01). Patients with tramadol, cannabis, and cocaine use disorders had significantly more frequent strokes in the posterior than the anterior circulation. Patients with heroin use disorders had significantly higher mortality than those without heroin use disorders (P-value = 0.01). The risk of poor outcomes was doubled by alcohol or heroin use disorder, while it was tripled by cocaine use disorder (P-value = 0.01 for each). Forty-one percent of young adults diagnosed with a stroke had SUD, with a relatively higher posterior circulation involvement. Increased mortality was associated with heroin use disorder more than other substances. Poor stroke outcome was associated with alcohol, heroin, and cocaine use disorders.

Effect of a Hospital-To-Home Transitional Intervention Based on an Interaction Model of Client Health Behavior for Adult Patients with Stroke

ABSTRACT To develop and identify the effectiveness of a hospital-to-home transitional intervention based on an interaction model of client health behavior in adult patients with stroke. A non-equivalent control group pretest-posttest. Thirty-eight patients participated (18=intervention, 20=control); the intervention group received 12 weeks of the intervention. The intervention influenced anxiety, disease severity, health behavior adherence, patient satisfaction, and quality of life in adult patients with stroke. Transitional programs have potential to improve the health behaviors of subjects, and community health nurses can assist in the implementation of these programs. Health behaviors and quality of life scores were significantly higher in the intervention group than in the control group; these findings support the need for continuity of nursing care during the transitional period for patients with stroke. Given the challenges faced by adult stroke patients after stroke, community nurses should pay attention to patients’ transitional experiences.

Clinical characteristics and outcome in expansive compared with steno-occlusive mural hematoma in spontaneous cervical artery dissection.

Spontaneous cervical artery dissection (sCeAD) is one of the prime causes of ischemic stroke in young adults. Based on vessel wall imaging, steno-occlusive or expansive wall hematomas can be distinguished. It is unclear whether these two distinct morphological phenotypes reflect different pathophysiological processes. We aim to evaluate differences in clinical characteristics and long-term recurrence between patients with expansive and steno-occlusive mural wall hematoma in the acute phase. Participants of the ReSect-study, one of the largest single-center cohort studies with long-term follow-up of sCeAD patients, with sufficient magnetic resonance imaging (MRI) were included. All available MRI scans were retrospectively evaluated for patients dichotomized to two groups: (1) mural hematoma causing steno-occlusive pathologies without expansion of total vessel diameter (steno-occlusive hematoma), and (2) mural hematoma causing vessel diameter expansion without lumen stenosis (expansive hematoma). Patients with mixed steno-occlusive and expansive vessel pathologies were excluded from the analysis. In total, 221 individuals were available for analysis. The pathognomonic vessel wall hematoma was steno-occlusive in 187 (84.6%) and expansive in 34 (15.4%). No difference was seen in patient demographics, clinical status at admission, laboratory parameters, family history, or the frequency of clinical stigmata for connective tissue disorders. Both patients with expansive and steno-occlusive mural hematoma had a high likelihood of suffering cerebral ischemia (64.7 vs 79.7). Still, time from symptom onset to diagnosis was significantly longer in those with expansive dissection (17.8 vs 7.8 days, p = 0.02). Those with expansive dissections were more likely to have upper respiratory infection within 4 weeks prior to dissection (26.5% vs 12.3%, p = 0.03). Upon follow-up, functional outcome was identical and groups did not differ in rate of sCeAD recurrence, but those with expansive mural hematoma at baseline more frequently had residual aneurysmal formation (41.2% vs 11.5%, p < 0.01). As cerebral ischemia was frequent in both, our clinical results do not advise for differential treatment or follow-up based on the acute morphological phenotype. There was no clear evidence of a different aetiopathogenesis between patients with steno-occlusive or expansive mural hematoma in the acute phase. More mechanistic approaches are needed to elucidate potential differences in pathomechanism between both entities. Anonymized data not published within this article will be made available by request from any qualified investigator.

Utilities Estimated from PROMIS Scales for Cost-Effectiveness Analyses in Stroke.

The EQ-5D and Health Utilities Index Mark 3 (HUI-3) are preference-based measures used in cost-effectiveness studies. The Patient Reported Outcomes Measurement Information System (PROMIS) Preference scoring system (PROPr) is a new preference-based measure. In addition, algorithms were previously developed to map PROMIS Global Health (PROMIS-GH) items to HUI-3 using linear equating (HUILE) and 3-level EQ-5D using linear (EQ5DLE). We sought to evaluate and compare estimated utilities based on PROPr and PROMIS-GH in adult stroke survivors. We performed a retrospective cohort study of adults diagnosed with 1 of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage seen in an outpatient clinic between 2015 and 2019. Patients completed PROMIS scales and other measures. We computed a modified version of PROPr (mPROPr) and compared the distributional characteristics and correlations with stroke outcomes for mPROPr, HUILE, and EQ5DLE. T toal of 4,159 stroke survivors (average age 62.7 ± 14.7 y, 48.4% female, 77.6% ischemic stroke) were included. Mean utility estimates for mPROPr, EQ5DLE, and HUILE were 0.333 ± 0.244, 0.739 ± 0.201, and 0.544 ± 0.301, respectively. Correlations between the modified Rankin Scale and each of mPROPr and HUILE were both -0.48 and -0.43 for EQ5DLE. Regression analyses indicated that mPROPr scores may be too low for stroke patients in good health and that EQ5DLE scores may be too high for stroke patients in poor health. All 3 PROMIS-based utilities were associated with measures of stroke disability and severity, but the distributions of utilities were very different. Our study highlights the problem cost-effectiveness researchers face of valuing health states with certainty. For researchers using utilities estimated from PROMIS scales, our study indicates that mapping PROMIS-GH item scores to HUI-3 via linear equating may be most appropriate in stroke patients. A new preference-based measure has been developed from the Patient Reported Outcomes Measurement Information System (PROMIS), known as the PROMIS-Preference (PROPr) scoring system, and published equations mapping PROMIS Global Health (PROMIS-GH) items to the Health Utilities Index Mark 3 (HUI-3) and EQ-5D-3L are available for use in cost-effectiveness studies.Our study provides distributional characteristics and comparisons of utilities estimated using a modified version of PROPr and equations mapping PROMIS-GH items to EQ-5D-3L and HUI-3 in a sample of stroke survivors.The results of our study show large differences in the distributions of utilities estimated using the different health state measures, and these differences highlight the ongoing difficulty researchers face in valuing health states with certainty.

Associations between homocysteine and B vitamins and stroke: a cross-sectional study.

Homocysteine (Hcy) is a predictor for stroke. B vitamins are required for the metabolism of Hcy. We designed a study to investigate the associations of plasma Hcy and B vitamins with the prevalence of stroke in adults. A total of 8,371 adults were included in the National Health and Examination Survey (NHANES) between 2003-2006 in the United States. Multivariate regression analysis and smooth curve fitting were conducted to evaluate the associations of stroke prevalence with Hcy, folate, vitamin B6, and B12. A segmented regression model was used to analyze the threshold effects. Sample weights were calculated to ensure the results' generalizability. The mean age of all participants was 46.43 years (51.8% women), and the prevalence of stroke was 2.72%. A nonlinear and positive association was found between plasma Hcy levels and the prevalence of stroke. Furthermore, L-shaped associations were found between plasma vitamin B6 and folate levels and stroke, with the turning point at 65.2 nmol/L for vitamin B6 and 26 nmol/L for folate, respectively. Vitamin B12 revealed a U-shaped relationship with stroke, with the turning points at 492.98 pmol/L for vitamin B12. Non-linear associations of plasma Hcy and B vitamins levels with stroke prevalence were found in American adults. These associations may have an implication that higher plasma Hcy levels should be reduced, and plasma vitamin B6, vitamin B12 and folate levels should be moderately improved in stroke prevention. Future studies are needed to verify the causality of these associations and elucidate the underlying mechanisms.

A pediatric case series of acute ischemic stroke with concurrent influenza

PurposeTo highlight a case series of three pediatric patients who presented with acute ischemic stroke (AIS) in the setting of influenza illness. MethodsRetrospective chart review was performed. ResultsThree patients of ages 23 months (patient 1), 2 years (patient 2), and 4 years (patient 3) presented with acute hemiparesis or focal status epilepticus. Two patients had trisomy 21 and trivial cardiac septal defects, and one was previously healthy. All patients tested positive for influenza within a week of symptoms. Neuroimaging showed AIS involving right deep grey matter and bilateral posterior cortex in patient 1, left parietal lobe in patient 2, and right parietotemporal and deep grey matter in patient 3. Vascular abnormalities were found and included moyamoya syndrome in two patients and focal arteriopathy in one patient. For secondary stroke prevention, patients 2 and 3 were started on clopidogrel initially and later transitioned to aspirin after the resolution of the acute influenza infection. Patient 1 was started on aspirin at diagnosis since he was not acutely ill. ConclusionsThis case series highlights three pediatric patients with AIS with underlying arteriopathy in the setting of influenza infection. Pediatric AIS is a separate entity from adult stroke. There is limited understanding of its underlying pathophysiology. The most common risk factors described in literature for pediatric AIS are arteriopathy and cardiac disorders. Minor infection may be a significant risk factor in a child that is predisposed to vascular insult. There is some evidence in literature to suggest that vaccination against such illnesses may be protective for AIS.

Risk Factors for Acute Ischaemic Stroke in Young Adults in Armed Forces Medical Institute of Dhaka

Background: Stroke is a leading cause of death and disability in developing countries, afflicting individuals at a young age. The affection of economically productive group adds further to the overall disease burden. The contribution of established vascular risk factors to ischaemic stroke in young adults has not been evaluated systematically in CMH, Dhaka Cantonment. The purpose of the study is to detect the risk factors for acute Ischaemic stroke in adults. Materials and methods: The case-control study was carried out in the department of Neurology and Medicine, CMH Dhaka during October 2019 to August 2020. Consecutive ischemic stroke patients who met the inclusion criteria and were hospitalized in the Department of Neurology and Medicine at CMH Dhaka were included in the study. Results: The mean age of young patients with ischaemic stroke was 40.1 (SD± 6.6) years (Range 17-45 years). There were 40 (59.7%) male and 27 (40.3%) female with ratio of male to female was 1.5:1. Risk of acute ischaemic stroke was 2.7 times higher in smoker [36 (53.7%) vs 20 (29.9%) OR=2.7, 95% of 01=1.34-5.55, p&lt;0.01] 2.4 times higher in diabetic [23 (34.3%) vs 12 (17.9%), OR=2.4, 95% of 01=1.07-5.35, p&lt;0.05], 2.6 times higher in hypertensive patients [27 (40.3%) vs 14 (20.9%), OR=2.6, 95% of 01=1.19-5.49; p&lt;0.05], 4.2 times higher in patients with atrial fibrillation [11 (16.4%) vs 3 (4.5%)]. The mean BMI of the respondents was 21.8 (SD± 3.3) Kg/M2 in stroke patients of young and was 22.3 (SD 2.9) Kg/M2 in control group (p&gt;0.05). Conclusion: Ischemic stroke in young patients has wider risk factors. Hypertension, diabetes mellitus, smoking and atrial fibrillation are the most common risk factors of acute ischemic stroke in young adults. Early identification of risk factors and proper prevention, treatment and life style modification may reduce the morbidity and mortality in young stroke patients. IAHS Medical Journal Vol 5(2), Dec 2022; 52-57

Association of Stroke and Memory in Young Adults- A Survey

Stroke leading to cognitive impairment and memory problems are frequent symptoms that have a substantial impact on the quality of life for survivors. Within a year of the stroke's start, dementia is quite likely to occur in stroke patients. The consequences of stroke on the brain are now being studied, especially in the early stages. It is possible to examine and distinguish between cognitive impairment and dementia after a stroke using a variety of neuropsychological tests. Methodology was to find the association between stroke and memory in young adults diagnosed with acute and chronic stroke. Neuropsychological assessments post stroke memory assessment and mini mental state examination was used with patients from age 18- 59 years; 2 groups each with 10 patients were assessed as a survey. Result came to be strong positive association between PSMA and MMSE in both acute and chronic stroke. The study concluded with memory deficit more in chronic stroke than acute stroke.

Left atrial stiffness in young patients with cryptogenic stroke: insights from the SECRETO-study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Finnish Medical Foundation. DC recieves funding from Helse Vest Background Cryptogenic ischemic stroke (CIS) in young adults is an increasing health issue with potentially different etiologies than stroke at older age. Low left atrial (LA) reservoir strain (LASr) is a predictor of both recurrent stroke and subclinical cerebral infarct in older populations. LASr and LA stiffness have not yet been explored in young CIS patients. Purpose To assess LA stiffness and associated factors in patients experiencing CIS before the age of 50 years. Methods In the prospective, multi-center SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome) study, patients aged 18–49 years with first-ever imaging-proven CIS underwent echocardiography within 2 weeks after admission. LA volumes were measured at end-diastole (minimum) and end-systole (maximum) and LA strain assessed as LASr and contractile strain. LA stiffness was derived from the ratio: mitral peak E-wave velocity divided by the mitral annular e’ velocity (E/e´) / LASr and classified as increased for age if ≥ 0.22. Systemic arterial compliance (SAC) was calculated as the left ventricular Doppler stroke volume divided by pulse pressure. Results Among 146 CIS patients (mean age 39 ± 8 years, 45% women, 34% normal weight), LA stiffness was increased in 34% of patients and more often in overweight and obese patients with low SAC (p&amp;lt;0.001, Figure 1A). Patients with high LA stiffness for age had larger minimum LA volumes and LV mass, and lower LA ejection fraction (EF) and LA contractile strain (p&amp;lt;0.001, Figure 1B). In multivariate regression analysis, increased LA stiffness was independently associated with higher age and body mass index, and lower LA EF and SAC after adjustment for sex and LV EF. In subsequent models, replacing LA EF with LA volume, increased LA stiffness was associated with larger minimum LA volume (p&amp;lt;0.001), but not maximum LA volume. Conclusion LA stiffness is increased in one-third of young patients with CIS, reflecting in part the cardiac remodeling induced by increased body mass index, reduced SAC, and ageing. This provides mechanistic insights into the link between these risk factors and the occurrence of CIS in young patients.

Associations of Chinese visceral adiposity index and new-onset stroke in middle-aged and older Chinese adults: an observational study

BackgroundStroke represents the second most prevalent contributor to global mortality. The Chinese Visceral Adiposity Index (CVAI) serves as an established metric for assessing visceral adiposity in the Chinese population, exhibiting prognostic capabilities. This investigation aimed to explore the association of CVAI and new-onset stroke among middle-aged and older Chinese populations.MethodsThe study employed data from the 2011 and 2018 China Health and Retirement Longitudinal Study (CHARLS) to assess the association of CVAI and the incidence of new-onset stroke. Utilizing a directed acyclic graph (DAG), 10 potential confounders were identified. Moreover, to explore the association between CVAI and new-onset stroke, three multifactor logistic regression models were constructed, accounting for the identified confounders and mitigating their influence on the findings.ResultsThe study comprised 7070 participants, among whom 417 (5.9%) experienced new-onset strokes. After controlling for confounding variables, regression analysis suggested that the new-onset stroke’s highest risk was linked to the fourth quartile (Q4) of the CVAI, with an odds ratio (OR) of 2.33 and a 95% confidence interval (CI) of 1.67–3.28. The decision tree analysis demonstrated a heightened probability of new-onset stroke among hypertensive individuals with a CVAI equal to or greater than 83, coupled with a C-reactive protein level no less than 1.1 mg/l. Age seemed to have a moderating influence on the CVAI and new-onset stroke association, exhibiting a more prominent interaction effect in participants under 60 years.ConclusionsIn middle-aged and older Chinese populations, a linear relationship was discerned between CVAI and the probability of new-onset stroke. CVAI provides a predictive framework for stroke incidence in this demographic, laying the groundwork for more sophisticated risk prediction models that improve the precision and specificity of stroke risk evaluations.

PREVALENCE AND DISEASE SPECTRUM OF FIBROMUSCULAR DYSPLASIA IN PATIENTS WITH SPONTANEOUS CEREBROVASCULAR ARTERY DISSECTION

Objective: Spontaneous cervical artery dissection (sCeAD) is the most frequent cause of ischemic stroke in young adults and has been associated to various arteriopathies, such as fibromuscular dysplasia (FMD). The aim of this study was to assess the prevalence of both cervical and extra-cervical FMD in patients with a diagnosis of CeAD. Design and method: All patients discharged from the Stroke Unit of A.O.U. Città della Salute e della Scienza of Turin from 2016 to 2020 with a diagnosis of CeAD underwent a contrast-enhanced CTA from chest to pelvis to look for FMD-related lesions (multifocal stenosis, aneurysms, dissections, arterial tortuosity). FMD diagnosis was assessed in the presence of at least a multifocal stenosis in one of the vascular beds explored. Results: Among 56 patients with spontaneous CeAD, 72.7% were male of middle age (52±8.5 y.o.). According to radiological findings, 43.2% of patients showed extra-cervical arterial lesions, with a prevalence of overall FMD (defined as the presence of at least a multifocal stenosis) reaching 47.3% of the studied sample and affecting carotid (36.4%), renal (18.9%), visceral (16.2%), iliac (22.2%) and coronary arteries (2.7%) respectively. Renal involvement included multifocal renal stenosis (13.5%) and arterial aneurysms (5.4%). Visceral involvement included multifocal stenosis (13.5%), visceral aneurysms (2.7%) and silent mesenteric artery dissection (5.4%). Iliac involvement included multifocal stenosis (2.7%), silent artery dissection (2.7%) and tortuosity (16.7%). Furthermore, two spontaneous dissections, one of the left external iliac artery and the other of the coeliac trunk, clinically asymptomatic, were reported in two males with no multifocal stenosis. Two women suffered also from SCAD. Multivascular extra-cervical involvement was observed in almost one third of the patients (27.0%) with sever lesions (multifocal high degree stenosis and/or arterial dissections) affecting 13.5% of the population. Conclusions: According to our results, we demonstrated that FMD is frequently associated to CeAD and that silent FMD-related lesions, even severe as arterial dissections, may coexist in such patients. Therefore, FMD should always be taken in consideration in the differential diagnosis of spontaneous arterial dissection, especially in young subjects without major cardiovascular risk factors.

Rare variants in ANO1, encoding a calcium-activated chloride channel, predispose to moyamoya disease.

Moyamoya disease, a cerebrovascular disease leading to strokes in children and young adults, is characterized by progressive occlusion of the distal internal carotid arteries and the formation of collateral vessels. Altered genes play a prominent role in the aetiology of moyamoya disease, but a causative gene is not identified in the majority of cases. Exome sequencing data from 151 individuals from 84 unsolved families were analysed to identify further genes for moyamoya disease, then candidate genes assessed in additional cases (150 probands). Two families had the same rare variant in ANO1, which encodes a calcium-activated chloride channel, anoctamin-1. Haplotype analyses found the families were related, and ANO1 p.Met658Val segregated with moyamoya disease in the family with an LOD score of 3.3. Six additional ANO1 rare variants were identified in moyamoya disease families. The ANO1 rare variants were assessed using patch-clamp recordings, and the majority of variants, including ANO1 p.Met658Val, displayed increased sensitivity to intracellular Ca2+. Patients harbouring these gain-of-function ANO1 variants had classic features of moyamoya disease, but also had aneurysm, stenosis and/or occlusion in the posterior circulation. Our studies support that ANO1 gain-of-function pathogenic variants predispose to moyamoya disease and are associated with unique involvement of the posterior circulation.

Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data.

Brain arteriovenous malformations (AVMs) account for 25% of hemorrhagic strokes in young adults. Although embolization has been widely performed as a stand-alone procedure to cure brain AVM, it is undermined whether patients benefit from this treatment. This study aimed to compare the long-term outcome of hemorrhagic stroke or death in patients with either conservative management or stand-alone embolization for AVM. The study population was derived from a nationwide multicenter prospective collaboration registry (the *BLINDED* registry) between 2011.08 and 2021.08. The propensity score-matched survival analysis was performed in the overall and stratified AVM cases (unruptured and ruptured) respectively, to compare the long-term outcome of hemorrhagic stroke or death, and neurological status. The efficacy of distinct embolization strategies was also evaluated. Hazard ratios (HRs) with 95% confidence intervals were calculated using Fine-Gray competing risk models. Of the 3,682 consecutive AVMs, 906 underwent either conservative management or embolization as the stand-alone management strategy. After propensity score matching, a total of 622 (311 pairs) patients constituted an overall cohort. The unruptured and ruptured subgroups were composed of 288 cases (144 pairs) and 252 cases (126 pairs), respectively. In the overall cohort, embolization did not prevent long-term hemorrhagic stroke or death compared with conservative management (2.07 vs. 1.57 per 100 patient-years; HR, 1.28 [95%CI, 0.81-2.04]). Similar results maintained in both unruptured AVMs (1.97 vs. 0.93 per 100 patient-years; HR, 2.09 [95%CI, 0.99-4.41]) and ruptured AVMs (2.36 vs. 2.57 per 100 patient-years; HR, 0.76 [95%CI, 0.39-1.48]). Stratified analysis showed that the target embolization might be beneficial for unruptured AVMs (HR, 0.42 [95%CI, 0.08-2.29]), while the curative embolization improved the outcome of ruptured AVMs (HR, 0.29 [95%CI, 0.10-0.87]). The long-term neurological status was similar between these two strategies. This prospective cohort study did not support a substantial superiority of embolization over conservative management for AVMs in preventing long-term hemorrhagic stroke or death.

Long Noncoding Rna GAS5 And Mir-137 And Two Of Their Genetic Polymorphisms Contribute To Acute Ischaemic Stroke Risk In An Egyptian Population.

To assess the serum expression levels of long non-coding ribonucleic acid growth arrest specific-5 and micro-ribonucleic acid-137, and the different genotypes of long non-coding ribonucleic acid growth arrestspecific-5 rs2067079 (C>T) and micro-ribonucleic acid-137 rs1625579 (T>G) in acute ischaemic stroke patients. The case-control study was conducted at Cairo University, Cairo, Egypt, from January to August 2020, and comprised adult acute ischaemic stroke patients of either gender selected from the stroke unit of the Neurology Department at Kasr Alainy Hospital of Cairo University. Healthy individuals matched for age and gender were enrolled as controls. Quantitative real-time polymerase chain reaction was used to quantify serum expression levels of long non-coding ribonucleic acid growth arrest specific-5 and micro-ribonucleic acid-137, and to genotype long non coding ribonucleic acid lncRNA growth arrest specific-5 rs2067079 and micro-ribonucleic acid-137 rs1625579 using TaqMan allelic discrimination. Data was analysed using SPSS 22. Of the 100 subjects, 50(50%) were patients; 34(68%) males and 16(32%) females with mean age 60.4±10.0 years. The remaining 50(50%) were controls; 28(56%) males and 22(44%) females with mean age 56.9±12.2 years (p>0.05). The patients had more smokers, more hypertensives and more diabetics than the controls (p<0.05). Long non-coding ribonucleic acid growth arrest specific-5 expression levels were significantly increased, while microribonucleic acid-137 expression levels were significantly reduced among the patients(p<0.05). Acute ischaemic stroke risk was significantly higher in patients with growth arrest specific-5 rs2067079 (C>T) recessive model (homozygous minor TT genotype), while micro-ribonucleic acid-137 rs1625579 (T>G) was protective against acute ischaemic stroke in allelic (G minor allele), codominant (GT genotype), dominant (GT+GG), and over-dominant (GT genotype) models (p<0.05). Long non-coding ribonucleic acid growth arrest specific-5 rs2067079 and micro-ribonucleic acid-137 rs1625579 may act as novel genetic markers of acute ischaemic stroke risk.