Stroke In Individuals Research Articles

Abstract TP97: Experimental Stroke During Aging: Docosahexaenoic Acid Therapy Provides Robust Neuroprotection

Introduction: Recently we have shown that docosahexaenoic acid (DHA) is neuroprotective after experimental stroke in young rats. The purpose of this study was to determine whether treatment with DHA would be protective in aged rats after focal cerebral ischemia. Methods: Isoflurane/nitrous oxide-anesthetized normothermic (brain temperature 36-36.5 o C) male Sprague-Dawley aged rats (16-months old) received 2h middle cerebral artery occlusion (MCAo) by poly-L-lysine-coated intraluminal suture. The behavioral function was evaluated during occlusion (60 min), and on days 1, 3 and 7 after MCAo; a grading scale of 0-12 was employed (0=normal and 12=maximal deficit). The agent (DHA, 5 mg/kg; n=6) or vehicle (saline; n=7) was administered i.v. at 3h after MCAo onset. The composite neuroscore comprises two different neurological tests, the postural reflex test and the forelimb placing test, to measure visual, tactile and proprioceptive stimuli, which were evaluated on days 1, 2, 3 and 7. High resolution ex vivo MRI using an 11.7T Bruker was performed on day 7. The core and penumbra were automatically identified using the Hierarchical Region Splitting method for penumbra identification. Histopathology and immunostaining were conducted after completion of MRI on day 7. Results: DHA treatment improved neurological scores on days 1 (by 18%), 2 (by 25%), 3 (by 22%) and 7 (by 36%). Total, cortical and subcortical lesion volumes computed from T2WI were significantly reduced by DHA treatment (by 62-75%). DHA treatment also reduced cortical, subcortical and total brain infarction (by 65- 80%). In addition, DHA therapy decreased ED-1 positive microglia/microphages (by 62%), GFAP-positive astrocytes (by 21%), and NeuN-positive neurons (by34%), and it increased SMI-71-positive vessels (by 46%) in the ischemic penumbra. Conclusion: DHA therapy is highly neuroprotective in aged rats following focal cerebral ischemia and has potential for the effective treatment of ischemic stroke in aged individuals.

Associations between matrix metalloproteinase gene polymorphisms and the development of cerebral infarction

The aim of this study was to investigate the association between MMP3 rs3025058 and MMP9 rs3918242 polymorphisms and the development of ischemic stroke in a Chinese population. Between May 2013 and January 2015, 335 patients with ischemic stroke and 335 health control subjects were enrolled in this study. The MMP3 rs3025058 and MMP9 rs3918242 polymorphisms were analyzed using polymerase chain reaction coupled with restriction fragment length polymorphism. By multivariate logistic regression analysis, the CC genotype of MMP9 rs3918242 was shown to be associated with a significantly increased risk of ischemic stroke when compared with the TT genotype [OR (95%CI) = 5.47 (2.64-12.38)]. The TC+CC genotype of MMP9 rs3918242 was furthermore found to be associated with an elevated risk of ischemic stroke in higher BMI individuals [OR (95%CI) = 1.81 (1.03-3.22)]. The findings of this study suggest that the MMP9 rs3918242 polymorphism is associated with an elevated risk of ischemic stroke and that this gene polymorphism interacts with BMI in the risk of ischemic stroke.

Isolated Ventricular Non-Compaction Syndrome, Rare Cause of Recurrent Stroke in Young - A Case Report

Strokes in young adults are uncommon and often a diagnostic challenge. It can cause morbidity, motality and hamper quality of life. A cardiogenic cerebral embolus is one of the most common causes of stroke in the young, accounting for up to one third of the cases. In this article we describe a rare case of isolated left ventricle non compaction as an etiology for recurrent strokes in young individuals. Echocardiography often provides the first clue to diagnose. Furthermore, lifelong systemic anticoagulation is indicated to obviate risk for thromboembolism and reduce the recurrences of further morbid states.

Clinical Pharmacology and Role of Edoxaban in Contemporary Antithrombotic Therapy.

Edoxaban is a factor Xa inhibitor that is approved for prevention of stroke in individuals with atrial fibrillation and treatment of venous thromboembolic disease at once daily 60 mg dose for individuals with normal renal function. A decrease of dose to 30 mg is recommended for those with moderate renal insufficiency, weight ≤ 60 kg or simultaneous administration of strong P-glycoprotein inhibitors. At this time, it is not recommended for use in persons with either end stage renal disease or with GFR exceeding 95 mL/min. Shorter half-life averaging 8-10 hours may translate into a safer profile. With a fast onset of action of ~1.5 hours and relatively high bioavailability, edoxaban is an alternative for patients who may not be good candidates for warfarin therapy due to multiple limitations that vitamin K anticoagulation entails. No clear benefits of edoxaban have been reported to date compared to the other available factor Xa inhibitors.

How Big is the Hole?

Transcranial Doppler (TCD) with agitated saline injection and transesophageal echocardiography (TEE) are used to evaluate cryptogenic stroke and transient ischemic attack (TIA) patients for patent foramen ovale (PFO). The role of the PFO may be to serve as a passageway for emboli from the peripheral venous system to the brain ( Figure 1 ). Alternatively, thrombi may form in situ at the PFO, especially with a concurrent atrial septal aneurysm. Blood coagulopathies can also contribute to clot formation. Clearly, the mere presence of a PFO cannot explain stroke in any given individual. Secondary stroke prevention includes anticoagulation or endovascular closure or both. Management controversies still exist. Regardless, sensitive and specific diagnostic procedures form the bedrock of our understanding. TCD is equal or superior in its sensitivity to the presence of any right-to-left shunt compared with echocardiography.1 Insurance carriers generally require a registered vascular technologist perform the technical portion of the TCD-PFO test.

Metabolic syndrome related to cardiovascular events in a 10-year prospective study.

BackgroundMetabolic syndrome (MetS) becomes a serious society health problem. The main risk factors of MetS are related to the increased risk of cardiovascular diseases, appearance of stroke, type 2 diabetes mellitus and the growing risk of mortality. MetS stimulates the appearance of early atherosclerosis, its progress and accelerates the frequency of cardiovascular complications related to atherosclerosis and diabetes mellitus.Objective To evaluate the risk of cardiovascular events (myocardial infarction, stroke) among the individuals with MetS in a 10 year prospective study; to identify MetS components that determine risk and character of cardiovascular events.MethodsThe study design was prospective. It was started in 2003 to assess the risk factors, clinical components, diagnostic criteria of MetS. At the second stage in 2013 the individuals were repeatedly invited to evaluate cardiovascular pathology that was confirmed by cardiologist and neurologist. The 45 years old and older citizens of Lithuanian district participated in the study. 1115 individuals (562 men and 553 women) were randomly selected in 2003. 538 respondents: 278 (51.70 %) men and 260 (48.30 %) women participated in the repeated study in 2013.ResultsDuring the study myocardial infarction (MI) was confirmed to 7.43 % individuals taken part in the study, stroke—to 4.28 % individuals. The odds’ ratio (OR) of MI between individuals with MetS and without MetS was 1.80 (95 % CI 1.67–1.97), p < 0.05. The OR of stroke for individuals with MetS and without MetS was 2.05 (95 % CI 1.21–2.54), p < 0.05. The OR of MI between men with abdominal obesity and identified MetS was 3.12 (95 % CI 2.77–3.53), p < 0.05. The OR of stroke between men with low level of high density lipoprotein cholesterol and identified MetS was 4.98 (95 % CI 4.40–5.65), p < 0.05. The OR of stroke between men with hypertriglyceridemia and identified MetS was 8.43 (95 % CI 7.45–9.54), p < 0.05.ConclusionsIndividuals with identified MetS have 1.80 and 2.05 times higher statistically significant probability, respectively, for MI and stroke events, than individuals without MetS. Separate components or MetS increase risk of cardiovascular events in men: abdominal obesity increases risk of MI, and low level of high density lipoprotein cholesterol and hypertriglyceridemia increase risk of stroke.

Frequency of MELAS main mutation in a phenotype-targeted young ischemic stroke patient population.

Mitochondrial diseases, predominantly mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS), may occasionally underlie or coincide with ischemic stroke (IS) in young and middle-aged individuals. We searched for undiagnosed patients with MELAS in a target subpopulation of unselected young IS patients enrolled in the Stroke in Young Fabry Patients study (sifap1). Among the 3291 IS patients aged 18-55 years recruited to the sifap1 study at 47 centers across 14 European countries, we identified potential MELAS patients with the following phenotypic features: (a) diagnosed cardiomyopathy or (b) presence of two of the three following findings: migraine, short stature (≤165 cm for males; ≤155 cm for females), and diabetes. Identified patients' blood samples underwent analysis of the common MELAS mutation, m.3243A>G in the MTTL1 gene of mitochondrial DNA. Clinical and cerebral MRI features of the mutation carriers were reviewed. We analyzed blood samples of 238 patients (177 with cardiomyopathy) leading to identification of four previously unrecognized MELAS main mutation carrier-patients. Their clinical and MRI characteristics were within the expectation for common IS patients except for severe hearing loss in one patient and hyperintensity of the pulvinar thalami on T1-weighted MRI in another one. Genetic testing for the m.3243A>G MELAS mutation in young patients with IS based on phenotypes suggestive of mitochondrial disease identifies previously unrecognized carriers of MELAS main mutation, but does not prove MELAS as the putative cause.

‘Real-world’ haemorrhagic rates for warfarin and dabigatran using population-level data in New Zealand

BackgroundAnticoagulants such as warfarin and dabigatran can significantly reduce the risk of stroke in individuals with atrial fibrillation that may lead to increased risk of bleeding, especially in older people. Evidence for bleeding risks with anticoagulants within the context of doses, multimorbidity and impaired renal function in real world setting is lacking.Therefore we aimed to assess and compare real world bleeding risks with warfarin and dabigatran. Secondary analyses involved examining risk of fatal haemorrhages. Methods and resultsWe formed two inception cohorts of propensity score (PS) matched older patients (≥65years), who initiated dabigatran or warfarin between July 2011 and December 2012. A total of 4835 dabigatran users were matched to 4385 warfarin users in dose independent binary PS matching. A dose dependent PS matching resulted in 2383 warfarin, 2153 dabigatran 150mg and 3395 dabigatran 110mg users. In the first cohort, compared to warfarin, the hazard ratios (95% confidence intervals) for dabigatran were 0.45 (0.37–0.55) for any haemorrhage; 1.16 (0.87–1.56) for gastrointestinal haemorrhage; and 0.29 (0.09–0.86) for intracerebral haemorrhage. Similar associations were observed in the first 30days of treatment. In dose dependent matched cohort, the risk of any haemorrhage was lower in individuals receiving dabigatran 110mg (HR; 95% CI: 0.40 (0.31–0.52)) and 150mg (HR; 95% CI: 0.29 (0.19–0.41)) compared to warfarin. ConclusionsThe risk of any haemorrhage and intracerebral haemorrhage was lower in dabigatran users compared to warfarin users. Importantly no increased risk of gastrointestinal haemorrhage was found in dabigatran users. The incidence rates for any haemorrhage were found to be higher in first 30days of any anticoagulant treatment, but hazard ratios remained similar during the study period.

Abstract 12125: The CHARGE-AF Risk Score Performs Better at Predicting Risk of Atrial Fibrillation than the CHA2DS2-VASc Risk Score in the Framingham Heart Study

Introduction: Atrial fibrillation (AF) is a common arrhythmia that affects more than 30 million individuals worldwide and confers serious complications, such as stroke, heart failure, dementia and death. The CHARGE-AF risk score was developed in 2013 to predict risk of AF in the general population. It was derived from the Framingham Heart Study, the Cardiovascular Health Study and the Atherosclerosis Risk In Communities study and validated in the Age, Gene/Environment Susceptibility Study and the Rotterdam Study, with more than 26,000 individuals of European, European-American, and African-American ancestry in total. The CHA2DS2-VASc risk score was derived in 2010 to predict risk of stroke in individuals already diagnosed with AF. CHA2DS2-VASc has not been validated for prediction of AF, but it has been used for this purpose in recent studies. Hypothesis: We hypothesized that the CHARGE-AF risk score would perform better than the CHA2DS2-VASc risk score for predicting risk of AF in a community-based cohort. Methods: Individuals from the Framingham Heart Study aged 45-94 years, without missing covariates or prevalent AF were included. For both risk scores, we performed Cox proportional hazards regression to assess the predicted risk of AF. Model fit was assessed using the likelihood ratio X2 statistic. We evaluated discrimination and calibration of each model using the C-statistic and Hosmer-Lemeshow X2 statistic. Results: We included 9722 observations (mean age 63.9±10.6 years, 56% women) from 4548 unique individuals: 752 (16.5%) developed incident AF and 793 (17.4%) died. The mean CHARGE-AF score was 12±1.2 and mean CHA2DS2-VASc score 2.0±1.5. The CHARGE-AF risk score was associated with a 115% increased risk of AF (95% CI, 99-131%; p&lt;0.0001) per unit increase, corresponding numbers for CHA2DS2-VASc were 43% (95% CI, 37-51%; p&lt;0.0001). CHARGE-AF had better model fit than CHA2DS2-VASc (Wald X2 = 403 vs. 209, both with 1 df), improved discrimination (C-statistic=0.75, 95% CI, 0.73-0.76 vs. C-statistic=0.71, 95% CI, 0.69-0.73) and better calibration (X2=5.6, p=0.69 vs. X2=28.5, p&lt;0.0001). Conclusions: The CHARGE-AF risk score performed better than the CHA2DS2-VASc risk score at predicting AF in a European-American ancestry cohort.

Heart Rate Variability Is Associated with Motor Outcome 3-Months after Stroke

The primary objective of this paper was to determine whether heart rate variability (HRV) acquired upon admission to inpatient rehabilitation is associated with motor outcome 3 months after stroke. The secondary objective of this paper was to determine whether HRV shows a strong association with the motor outcome 3 months after stroke in individuals with severe initial motor impairments. We recruited 13 patients with acute stroke from an acute inpatient rehabilitation hospital. A Holter monitor was placed upon admission and Fugl-Meyer Upper Extremity and Lower Extremity Subscales were used to assess the movement of the affected upper and lower extremities 3 months after admission. The standard deviation of R-R intervals was used to quantify HRV. A Spearman rank correlation revealed a strong positive and significant correlation between HRV upon admission and movement of the affected upper extremity (r = .70, P = .01) and affected lower extremity (r = .60, P = .03) at 3 months. For patients with severe initial motor impairments, HRV showed a strong positive association with the movement of the affected upper (r = .61, P = .04) and lower (r = .70, P = .04) extremities at 3 months. HRV is strongly associated with motor outcome after stroke and provides a promising marker to explore the mechanisms associated with motor recovery after stroke.

Intracranial and extracranial arterial dissection presenting with ischemic stroke: Lesion location and stroke mechanism

Background and purposeAlthough cervicocranial artery dissections (CADs) are common causes of ischemic stroke in young individuals, anatomical locations and mechanisms of ischemic strokes are still unclear.We evaluate the prevalence, location, and pathogenic mechanisms of ischemic stroke caused by CADs. MethodsWe reviewed CAD patients who presented with acute (<7days) ischemic events and who had undergone diffusion weighted magnetic resonance imaging (MRI) and appropriate vascular imagings (MR angiography, computed tomography angiography, digital subtraction angiography, and high-resolution MRI). Stroke mechanisms were categorized as artery-to-artery (AA) embolism, local branch occlusion, in situ thrombotic occlusion and hemodynamic impairment. ResultsOne hundred and thirty-five patients with cerebral infarcts (n=125) or transient ischemic attacks (n=10) were included. The locations of 159 dissected vessels were: 77 vertebral, 29 internal carotid, 24 middle cerebral, 12 basilar, eight posterior inferior cerebellar, five anterior cerebral, and four posterior cerebral arteries. Among stroke mechanisms, A–A embolism (n=70, 55.5%) was the most common followed by local branch occlusions (n=40, 31.7%) and in situ thrombotic occlusions (n=8, 6.3%). Intracranial CADs were more common (89 vs. 44), less often associated with trauma (21.3% vs. 40.9%, p=0.018) and A–A embolism (32.9% vs. 97.6%, p<0.001), and more often treated with intravenous thrombolysis (15.7% vs. 2.3%. p=0.021) than extracranial CADs. ConclusionsIn our cohort, intracranial CADs are more common than extracranial CADs, and the vertebral artery is the most frequently involved site. Although A–A embolism is the main stroke mechanism, local branch occlusion is another important stroke mechanism.

Risk of Recurrent Stroke and Death After First Stroke in Long-Distance Ski Race Participants.

BackgroundPhysical activity is of benefit for primary prevention of cardiovascular diseases, but it appears to increase the risk for atrial fibrillation. We aimed to study a cohort of patients following a first stroke in individuals with previous high physical activity, compare them to the general population with respect to recurrent stroke and death, and relate these to atrial fibrillation.Methods and ResultsFrom the participants of the Vasaloppet, the world's largest ski‐race, and matched individuals from the general population (n=708 604), we identified 5964 patients hospitalized with a first‐time stroke between 1994 and 2010. Individuals with severe diseases were excluded. One half percent of skiers and 1% of nonskiers were hospitalized due to stroke. The incidence rate was 8.3 per 100 person‐years among skiers and 11.1 among nonskiers. The hazard ratio (HR) for recurrent stroke or death between the 2 groups was 0.76 (95% CI 0.67 to 0.86). The result was consistent in subgroups. The HR for death was 0.66 (95% CI 0.56 to 0.78) and for recurrent stroke 0.82 (95% CI 0.70 to 0.96). After adjustment for smoking and socioeconomic factors, the HR for death was consistent at 0.70 (95% CI 0.56 to 0.87) while the HR for recurrent stroke was not statistically significant. Outcomes for skiers with atrial fibrillation tended to show a lower risk than for nonskiers.ConclusionsThis large cohort study supports the hypothesis that patients with a stroke and with prior regular physical activity have a lower risk of death, while their risk for recurrent stroke is similar to that of nonskiers. The skiers had a higher incidence of atrial fibrillation, but still no increased risk of recurring stroke.

30-Day Mortality after Cardiovascular Events in Persons with or without Alzheimer's Disease.

Persons with Alzheimer's disease (AD) have been suggested to receive suboptimal treatment. We studied the 30-day mortality after ischemic stroke, hemorrhagic stroke, or myocardial infarction in individuals with or without AD. An exposure matched cohort of all Finnish community-dwellers diagnosed with clinically verified AD in 2005-2012 (n = 73,005) and 1-4 matched comparison persons/AD-affected person (n = 215,449). Data on 30-day mortality after ischemic stroke (n = 16,419; deaths: n = 2,748), hemorrhagic stroke (n = 3,570; deaths: n = 1,224), and myocardial infarction (n = 15,304; deaths: n = 3,804) were obtained from the National Hospital Discharge register. The main analyses were restricted to first-ever events. Persons with AD had slightly higher 30-day mortality after ischemic stroke (adjusted HR 1.36, 95% Confidence interval (CI) 1.24,1.49), hemorrhagic stroke (adjusted HR 1.11, 95% CI 0.98,1.25), or myocardial infarction (adjusted HR, 1.40, 9% CI 1.30,1.51). The associations were not affected by age, gender, or co-morbidities and remained similar when patients with previous ischemic strokes or infarctions were included. The absolute risk increase in 30-day mortality after ischemic or hemorrhagic stroke and myocardial infarction were 4.9% (95% CI 3.3,6.5), 3.3% (95% CI - 1.6,8.2), and 7.5% (95% CI 5.0,10.0), respectively. Although the 30-day mortality was somewhat higher in the AD cohort, the absolute differences were small indicating that acute treatment was not notably inferior in AD patients. The slightly higher mortality was not explained by co-morbidities but may reflect the higher mortality of AD persons in general, or treatment practice of patients with severe cognitive impairment.

Atorvastatin prescription before and after Percutaneous Coronary Intervention: Effects on Left Ventricular Ejection Fraction and blood circulating Pentraxin3

Introduction: Statins can reduce risk of myocardial infarction, stroke and mortality in high risk individuals and improve clinical outcomes in patients undergoing Percutaneous Coronary Intervention (PCI). The major challenge of physicians at the emergency condition is the fact that patients are not stable and cannot take several pills, wholesale. Methods: This study was carried out on 100 patients who suffered from AMI with the early plan for primary PCI. All patients were divided to two group, randomly; fifty patients received conventional drug including Atorvastatin (80 mg/day), Aspirin (325 mg/day) and Clopidogrel (600 mg/day) at the time of admitting to the emergency and before primary-PCI; the other 50 patients take same drug regime without Atorvastatin just like the control group, before primary-PCI and a single dose Atorvastatin (80 mg/day) after primary PCI. A paired T-test was employed to study the result of PTX3 and LVEF before and after primary PCI among all patients. An independent T-test was also used for statistical analysis of the result of PTX3 value and EF after primary PCI for both drug plan intervention groups. Results: PTX3 and LVEF values in the group with Atorvastatin pre-treatment changed from 6.07 ± 2.31 ng/dL to 4.92 ± 1.98 ng/ dL and 40.8 ± 8.88 to 45 ± 6.77, respectively after primary PCI. Both mentioned indexes in the Atorvastatin post-treatment group were also changed from 5.91 ± 3.24 ng/dL to 5.37 ± 3.6 and 41.2 ± 8.66 to 44.9 ± 7.79, respectively, after primary PCI. None statistically significant difference were seen in comparison the results of both LVEF (P value = 0.946) and PTX3 (0.445) values between two groups. Conclusion: Our results indicate that Atorvastatin therapy after primary-PCI may has same beneficial effects on Cardiac functions compared with conventional drug regime before PCI.

Association study between C-reactive protein polymorphisms and ischaemic stroke.

C-reactive protein (CRP), a marker of inflammation, is strongly related to cardiovascular disease. Elevated CRP levels are considered to be a predictor of ischaemic stroke in elderly individuals. Recently, some single nucleotide polymorphisms (SNPs) within the CRP gene have been associated with serum CRP levels. However, associations between these SNPs and ischaemic stroke remain controversial. In this study, we accessed the association between two CRP SNPs and ischaemic stroke in Chinese Han population. A population-based case-control study was conducted in 158 patients with ischaemic stroke and 290 control subjects. Two CRP SNPs, rs1130864 and rs3093059 were genotyped from patients using the PCR-restriction fragment length polymorphism (PCR-RFLP)-based analysis. The haplotype-based association study was assessed with a permutation test. rs1130864 and rs3093059 were in Hardy-Weinberg equilibrium in control subjects. The genotype distributions of both genotypes were not statistically different between patients and controls. Because rs1130864 and rs3093059 presented strong linkage disequilibrium, three major haplotypes were identified as C-T, T-T, C-C. None of these haplotypes was associated with ischaemic stroke or its subtype before and after adjustment for traditional risk factors. There is no association between rs1130864 or rs3093059 and ischaemic stroke in Chinese Han population.

Study of Risk Factors and Clinical Profile of Stroke in Young Adults

Background: According to the Global Health Observatory, stroke is the second most common cause of death during last decade with a rising trend. Although stroke is considered to be the disease of older population, with the demographic shift the disease incidence is now shifting to younger age group. This shifting trend to younger age group pose a great concern to the world in terms of days lost to work and mortality. There is paucity of information on stroke in young individuals covering important types of stroke. Aims&Objectives: To study the clinical profile and risk factors associated with the stroke in young adults. Materials & Methods: The present descriptive study was carried out at tertiary care Hospital of Nasik from June 2011 to June 2013. A total of 40 consecutive cases between 15-45 years presenting with stroke were recruited for the study after taking prior informed consent. All cases underwent a detailed history taking, general and clinical examination along with all required Investigations. Data was analysed by SPSS software ver. 17 using appropriate statistical tests. Results: Ischemic stroke was the most common presentation and stroke prevalence was similar across both genders. Headache was the most common symptom followed by vomiting in all types of stroke patients. OC Pills and parity was found to significantly associated with CVST. Obesity, smoking and abnormal lipid profile was found to be significantly associated with thromboemblic stroke. Only 3 out of 40 stroke patients died during the course of study. Conclusion: OC Pills and parity were significantly associated with CVST while obesity, smoking and dyslipidemia were significantly associated with thromboemblic stroke. Outcome in young stroke patients was fairly good.

Study of Risk Factors and Clinical Profile of Stroke in Young Adults

&lt;strong&gt;Background:&lt;/strong&gt; According to the Global Health Observatory, stroke is the second most common cause of death during last decade with a rising trend. Although stroke is considered to be the disease of older population, with the demographic shift the disease incidence is now shifting to younger age group. This shifting trend to younger age group pose a great concern to the world in terms of days lost to work and mortality. There is paucity of information on stroke in young individuals covering important types of stroke. &lt;strong&gt;Aims&amp;amp;Objectives:&lt;/strong&gt; To study the clinical profile and risk factors associated with the stroke in young adults. &lt;strong&gt;Materials &amp;amp; Methods:&lt;/strong&gt; The present descriptive study was carried out at tertiary care Hospital of Nasik from June 2011 to June 2013. A total of 40 consecutive cases between 15-45 years presenting with stroke were recruited for the study after taking prior informed consent. All cases underwent a detailed history taking, general and clinical examination along with all required Investigations. Data was analysed by SPSS software ver. 17 using appropriate statistical tests. &lt;strong&gt;Results:&lt;/strong&gt; Ischemic stroke was the most common presentation and stroke prevalence was similar across both genders. Headache was the most common symptom followed by vomiting in all types of stroke patients. OC Pills and parity was found to significantly associated with CVST. Obesity, smoking and abnormal lipid profile was found to be significantly associated with thromboemblic stroke. Only 3 out of 40 stroke patients died during the course of study. &lt;strong&gt;Conclusion:&lt;/strong&gt; OC Pills and parity were significantly associated with CVST while obesity, smoking and dyslipidemia were significantly associated with thromboemblic stroke. Outcome in young stroke patients was fairly good.

Association of TOMM40 and SLC22A4 polymorphisms with ischemic stroke.

Recent genome-wide association studies (GWASs) and their meta-analyses have identified various genes and loci underlying the predisposition to ischemic stroke or coronary artery disease in Caucasian populations. Given that ischemic stroke and coronary artery disease may have a shared genetic architecture, certain polymorphisms may confer genetic susceptibility to these two diseases. The aim of the present study was to examine the possible association of ischemic stroke with 29 single-nucleotide polymorphisms (SNPs) previously identified by the meta-analyses of GWASs as susceptibility loci for coronary artery disease. The study population comprised 3,187 Japanese individuals, including 894 subjects with ischemic stroke and 2,293 controls. The genotypes for the 29 SNPs of the 28 genes were determined by a method that combines the polymerase chain reaction and sequence-specific oligonucleotide probes with suspension array technology. Comparisons of the allele frequencies by the χ2 test between subjects with ischemic stroke and controls revealed that rs9319428 (G→A) of the fms-related tyrosine kinase 1 gene (P=0.0471), rs2075650 (G→A) of the translocase of outer mitochondrial membrane 40 homolog gene (TOMM40, P=0.0102) and rs273909 (T→C) of the solute carrier family 22, member 4 gene (SLC22A4, P=0.0097) were significantly (P<0.05) associated with the prevalence of ischemic stroke. Multivariable logistic regression analysis with adjustment for age, gender, body mass index, smoking status and the prevalence of hypertension, diabetes mellitus and dyslipidemia revealed that rs2075650 of TOMM40 (P=0.0443; recessive model; odds ratio=0.50) and rs273909 of SLC22A4 (P=0.0123; dominant model; odds ratio=0.45) were significantly associated with ischemic stroke with the minor G and C allele, respectively, being protective against this condition. TOMM40 and SLC22A4 may thus be susceptibility loci for ischemic stroke in Japanese individuals.

High Pulse Pressure is a Risk Factor for Stroke in Elderly Individuals with Coronary Heart Disease and Diabetes Mellitus

Background : The association between pulse pressure and the risk of stroke in elderly patients with multiple comorbidities is not well understood. The present study aimed to investigate the association between pulse pressure and the risk of stroke in elderly patients. Measurements : We retrospectively assessed stroke/ transient ischemic attack (TIA) risk factors in 623 patients (33% female, median age, 74 years) with coronary heart disease (CHD) and diabetes mellitus (DM) at Chinese PLA General Hospital. The effects of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure on the risk of stroke/TIA were assessed using a binary logistic regression analysis. The ability of changes in blood pressure to predict the risk of stroke/TIA was assessed using a receiver operating characteristics curve. Results : 228 (36.59%) patients had a stroke/TIA. DBP was significantly lower in the patients with stroke/TIA than in those without (75.83 ± 11.14 vs. 78.91 ± 11.85, P = 0.001). Pulse pressure was markedly higher in the stroke/TIA compared with the non-stroke/TIA group (61.34 ± 14.59 vs. 56.01 ± 14.65, P < 0.001). SBP was not significantly different between the groups. The multivariate analysis revealed pulse pressure (odds ratio, (OR), 1.02, 95% confidential interval (CI), 1.01–1.04, P < 0.001) and DBP ≤70 mmHg (OR, 95% CI, 1.44, 1.01–2.06, P =0.044) were independently associated with the risk of stroke/TIA. The c -statistics (95% CI) for pulse pressure and DBP ≤70 mmHg for predicting stroke/TIA were 0.62 (0.57–0.66; P <0.001) and 0.56 (0.51-0.61; P =0.006), respectively. A cutoff of 38 mmHg pulse pressure showed good predictive ability for the risk of stroke/TIA (sensitivity 97%, specificity 96%). Conclusion : Low DBP and high pulse pressure, most likely the result of the low DBP, were risk factors for stroke/TIA in elderly patients with CHD and DM.

Primary stroke prevention in China – a new approach

The growing burden of stroke in China, along with the increasing cost of health care calls for new, more effective strategies for stroke prevention. These strategies should include increasing awareness of stroke symptoms, awareness of risk factors, and provision of easily available information on means of modifying risk factors. The Stroke Riskometer App is exactly such a tool, available in Mandarin, for adult individuals to calculate their risk of stroke over the next 5 and 10 years, and to identify their individual stroke risk factors and linking them to possible means of modifying these risk factors. The use of this App could reduce the risk of stroke for individuals in the Chinese population and contribute to significant reduction in stroke burden in China.