Stroke-related Complications Research Articles

Elder Mistreatment Within Stroke Family Caregiving.

This secondary data analysis sought to identify characteristics associated with mistreatment among chronic stroke survivors who transition to dementia. We examined baseline data from a multi-time series survey study (n = 453; where caregivers of those with stroke n = 107, and those without stroke, n = 346) on caregiving experiences influencing dementia family caregivers' abusive or neglectful behaviors. Inferential statistical analysis indicated that baseline mistreatment rates were similar across stroke and non-stroke subgroups, though this finding was not significant. Caregiver depression was significantly associated with mistreatment. Multi-morbidity, prescription medication use, and limited mobility were more common among stroke survivors. Stroke-related complications may impose a greater burden of care upon family caregivers whose care recipients also have dementia. Determining timepoints of heightened mistreatment risk for stroke survivors may significantly impact long-term trajectories of stroke management to screen and identify those who may benefit from added support and intervention.

Clinical Outcome of Pipeline Embolization Device with and without Coil to Treat Intracranial Aneurysm: A Systematic Review and Meta-Analysis.

The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients since the results have varied. This study aimed to investigate the clinical outcome of PEDC compared to PED in treating intracranial aneurysms. We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024. We selected studies comparing PEDC vs. PED to treat intracranial aneurysms. Patients treated with PEDC but using dense coiling were excluded from the study. The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤ 2), complete occlusion rate, and retreatment rate. Forest plot was used to analyze pooled Odds Ratio (OR) of clinical outcomes. A total of 3001 subjects from nine observational studies were included. PEDC was mainly used to treat larger aneurysms. PEDC has a significantly higher complete occlusion rate at 6 months [OR= 2.66, 95% CI(1.26, 5.59), p= 0.01], a lower retreatment rate [OR= 0.18, 95% CI(0.05, 0.07), p= 0.010], higher stroke-related complications [OR= 1.66, 95% CI(1.16, 2.37), p= 0.005], and higher hemorrhage-related complications [OR= 1.98, 95% CI(1.22, 3.21), p = 0.005]. There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study. No randomized controlled trials have been performed comparing PEDC and PED. Considering that all the included studies were observational, the patients' baseline characteristics were not completely balanced. This meta-analysis study showed that PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms. F = female; FDDs = flow-diverter devices; M = male; NOS = Newcastle-Ottawa Scale; PED = pipeline embolization device; PEDC = pipeline embolization device in combination with coils.

Diabetes and Stroke—A Focused Review

Abstract Globally, diabetes mellitus (DM) and stroke are two common chronic illnesses that have a substantial impact on rates of morbidity and mortality. There is significant evidence linking diabetes to an increased risk of stroke in terms of incidence, severity, and mortality. This extensive review looks at shared risk factors, underlying pathophysiological mechanisms, epidemiological trends, and evidence-based therapy approaches to give a thorough analysis of the causal relationship between diabetes mellitus and stroke. Studies using epidemiological data regularly show that people with diabetes have a higher incidence of stroke than people without the disease. Furthermore, diabetes is linked to a less favorable outcome following a stroke, as well as an elevated chance of stroke recurrence. Determining the pathophysiological pathways that connect diabetes and stroke is essential to understanding their relationship. Key pathophysiological processes associated with these disorders include endothelial dysfunction, inflammation, oxidative stress, hyperglycemia, and dyslipidemia. Due to microvascular complications, these mechanisms raise the risk of hemorrhagic stroke and predispose diabetics to an increased risk of ischemic stroke by creating a prothrombotic and atherosclerotic milieu. Diabetes and stroke are linked due to shared risk factors like smoking, obesity, dyslipidemia, hypertension, and poor glycemic control. Lifestyle changes, blood pressure control, lipid-lowering therapy, antiplatelet medicines, and a nutritious diet are essential for stroke risk reduction. Reducing the risk of stroke in people with diabetes requires the implementation of management techniques that focus on both diabetes control and stroke prevention. Optimizing results and lowering the frequency of stroke-related complications in diabetics requires multidisciplinary care. The intricate interactions between diabetes mellitus and stroke are highlighted in this review’s conclusion, which also highlights the value of patient education, risk factor treatment, the effect of antidiabetic therapy on stroke, and integrated care in lowering the incidence of stroke in people with diabetes.

Contemporary outcomes of acute ischemic stroke in atrial fibrillation patients on anticoagulation

BackgroundLong-term anticoagulation (AC) therapy reduces the risk of stroke in patients with Atrial Fibrillation (AF). However, data on the impact of AC on in-hospital stroke outcomes is lacking. MethodsThe National Inpatient Sample was used to identify adult inpatients with AF and a primary diagnosis of ischemic stroke between 2016 and 2020. Data was stratified between AC users and nonusers. A multivariate regression model was used to describe the in-hospital outcomes, adjusting for significant comorbidities. ResultsA total of 655,540 hospitalizations with AF and a primary hospitalization diagnosis of ischemic stroke were included, of which 194,560 (29.7 %) were on long-term AC. Patients on AC tended to be younger (mean age, 77 vs. 78), had a higher average CHA2DS2VASc score (4.48 vs. 4.20), higher rates of hypertension (91 % vs. 88 %), hyperlipidemia (64 % vs. 59 %), and heart failure (34 % vs. 30 %) compared to patients not on long-term AC. Use of AC was associated with decreased in-hospital mortality (aOR [95 % CI]: 0.62 [0.60–0.63]), decreased stroke severity (mean NIHSS, 8 vs. 10), decreased use of tPA (aOR 0.42 [0.41–0.43]), mechanical thrombectomy (aOR 0.85 [0.83–0.87]), intracranial hemorrhage (aOR 0.69 [0.67–0.70]), gastrointestinal bleeding (aOR 0.74 [0.70–0.77]), and discharge to skilled nursing facilities (aOR 0.90 [0.89–0.91]), compared to patients not on AC (P<0.001 for all comparisons). ConclusionAmong patients with AF admitted for acute ischemic stroke, AC use prior to stroke was associated with decreased in-hospital mortality, decreased stroke severity, decreased discharge to SNF, and fewer stroke-related and bleeding complications.

Segmentation and classification techniques used to detect early stroke diagnosis using brain magnetic resonance imaging: a review

&lt;p&gt;Stroke is a leading cause of disability and death worldwide. Early diagnosis and treatment are crucial in reducing the risk of stroke-related complications. Brain magnetic resonance imaging (MRI) is a common diagnostic tool used for stroke evaluation. However, manual interpretation of MRI images can be time-consuming and subjective. Machine learning (ML) algorithms have shown promise in automating and improving stroke diagnosis accuracy. This article focuses on classification and segmentation techniques used to detect early stroke diagnosis using brain magnetic imaging. The diagnosis, treatment, and prognosis of complications and patient outcomes in a number of neurological diseases are currently made possible by ML through pattern recognition algorithms. However, the use of MRI is limited because of MRI plays an important role in diagnosing lumbar disc disease. However, the use of MRI is limited due to its high cost and significant operational and processing time. More importantly, MRI is contraindicated in some patients who are claustrophobic or have pacemakers due to the potential for damage. Recent studies have shown that treatment within six hours of a stroke can save a patient's life. Unfortunately, Malaysia is facing a shortage of neuroradiologists, hampering efforts to treat its growing number of stroke patients.&lt;/p&gt;

Clinical Implications of Various Electroencephalographic Patterns in Post-Stroke Seizures. The Utility of Routine Electroencephalogram.

Objective: Post-stroke seizures (PSS) are one of the major stroke-related complications. Early therapeutic interventions are critical therefore using electroencephalography (EEG) as a predictive tool for future recurrence may be helpful. We aimed to assess frequencies of different EEG patterns in patients with PSS and their association with seizure recurrence and functional outcomes. Methods: All patients admitted with PSS were included and underwent interictal EEG recording during their admission and monitored for seizure recurrence for 24 months. Results: PSS was reported in 106 patients. Generalized slow wave activity (GSWA) was the most frequent EEG pattern observed (n = 62, 58.5%), followed by Focal sharp wave discharges (FSWDs) (n = 57, 55.8%), focal slow wave activity (FSWA) (n = 56, 52.8%), periodic discharges (PDs) (n = 13, 12.3%), and ictal epileptiform abnormalities (n = 6, 5.7%). FSWA and ictal EAs were positively associated with seizure recurrence (p < .001 and p = .015 respectively) and it remained significant even after adjusting for age, sex, stroke severity, stroke subtype, or use of anti-seizure medications (ASMs). Other positive associations were status epilepticus (SE) (p = .015), and use of older ASM (p < .001). FSWA and GSWA in EEG were positively associated with severe functional disability (p = .055, p = .015 respectively). Other associations were; Diabetes Mellitus (p = .034), Chronic Kidney Disease (p = .002), use of older ASMs (p = .037), presence of late PSS (p = .021), and those with Ischemic stroke (p = .010). Conclusions: Recognition and documentation of PSS-related EEG characteristics are important, as certain EEG patterns may help to identify the patients who are at risk of developing recurrence or worse functional outcomes.

The Burden of Post-Stroke Depression and Anxiety Among Stroke Patients Admitted to Tertiary Care Teaching Hospitals of Khyber Pakhtunkhwa.

Background: Stroke, a leading cause of disability and mortality worldwide, is often accompanied by post-stroke depression (PSD) and anxiety, significantly impacting the quality of life of survivors. In Khyber Pakhtunkhwa, there is a notable prevalence of stroke-related complications, influenced by factors like obesity, hypertension, and diabetes mellitus. Objective: This study aimed to determine the frequency of PSD and anxiety among stroke patients admitted to tertiary care hospitals in Khyber Pakhtunkhwa, with a focus on understanding the distribution of these conditions among different demographic groups. Methods: A descriptive cross-sectional study was conducted over six months (March 2021 - August 2021). Participants included both genders, aged above 18, who were victims of acute post-stroke events, and capable of communication. The sample size of 109 was calculated using Raosoft software. Data collection employed the Hospital Anxiety and Depression Scale (HADS), and SPSS version 25 was used for data analysis. Descriptive statistics, histograms, pie charts, and tables were utilized for data representation. Results: The study revealed that 63.3% of participants suffered from depression and 83.5% from anxiety. Of these, 46.8% scored in the 'abnormal' range for anxiety, and 42.2% for depression. Females constituted 54.13% of the participants, while 45.87% were males. Hemorrhagic stroke (51.85%) was more common than ischemic stroke (48.15%). Conclusion: The high prevalence of PSD and anxiety among stroke patients in Khyber Pakhtunkhwa necessitates the incorporation of comprehensive mental health care in stroke rehabilitation programs. Tailored interventions addressing PSD and anxiety are crucial for improving patient outcomes.

Stroke and Translational Research – Review of Experimental Models with a Focus on Awake Ischaemic Induction and Anaesthesia

Animal models are an indispensable tool in the study of ischaemic stroke with hundreds of drugs emerging from the preclinical pipeline. However, all of these drugs have failed to translate into successful treatments in the clinic. This has brought into focus the need to enhance preclinical studies to improve translation. The confounding effects of anaesthesia on preclinical stroke modelling has been raised as an important consideration. Various volatile and injectable anaesthetics are used in preclinical models during stroke induction and for outcome measurements such as imaging or electrophysiology. However, anaesthetics modulate several pathways essential in the pathophysiology of stroke in a dose and drug dependent manner. Most notably, anaesthesia has significant modulatory effects on cerebral blood flow, metabolism, spreading depolarizations, and neurovascular coupling. To minimise anaesthetic complications and improve translational relevance, awake stroke induction has been attempted in limited models. This review outlines anaesthetic strategies employed in preclinical ischaemic rodent models and their reported cerebral effects. Stroke related complications are also addressed with a focus on infarct volume, neurological deficits, and thrombolysis efficacy. We also summarise routinely used focal ischaemic stroke rodent models and discuss the attempts to induce some of these models in awake rodents.

Clinical Characteristics and Treatment Outcomes of Acute Ischemic Stroke with Atrial Fibrillation Among Patients Admitted to Tertiary Care Hospitals in Amhara Regional State: Retrospective-Cohort Study.

Atrial fibrillation (AF) is the leading cause of a surge in hospital expenses for the treatment of strokes. However, evidence regarding clinical features and survival of patients admitted with acute ischemic stroke (AIS) plus AF in Ethiopia is lacking. We assess clinical characteristics, survival, and predictors of mortality of patients with acute ischemic stroke and atrial fibrillation among patients admitted to Tertiary Care Hospitals in Amhara regional state. A retrospective cohort study was done on patients diagnosed with AIS who received care at Tibebe Ghion and Felege Hiwot hospitals from November 2018 to November 2021. Data were analyzed using SPSS version 25. Cox regression analysis was used to identify predictors of in-hospital mortality. Kaplan-Meier analysis was used to identify survival rates and mean survival time. The hazard ratio was used as a measure of the strength of the association and statistical significance was declared at p-value <0.05. Of 378 patients with AIS, 58.7% were male. AF was diagnosed in 102 (26.9%) patients. Compared with patients without AF, patients with AF were more likely to have Glasgow Coma Scale <8 (83.3 vs 4%), valvular heart disease (56.9 vs 4.7%), and coronary heart disease (11.8 vs 4%). Patients with AF had a significant incidence of in-hospital mortality (38 per 1000 vs 17 per 1000) person-days. Glasgow Coma Scale <8: (AHR=12.69, 95% CI: [2.603-61.873]), aspirational pneumonia (AHR=2.602, 95% CI: 1.085-6.242), acute renal failure (AHR=6.114, 95% CI: [1.817-20.576]), hypokalemia (AHR=1.179, 95% CI: [1.112,-3.373]), atrial fibrillation (AHR=1.104, 95% CI: [1.015-5.404]), HIV/AIDS (AHR=8.302, 95% CI: [1.585-43.502]) and chronic liver disease (AHR=4.969, 95% CI: [1.192-20.704]) were indicators of in-hospital mortality. In the current study, hospital mortality was greater in AIS associated with atrial fibrillation. Stroke-related complications were significant predictors of mortality. Hence, effective strategies should be in place to curb the impacts of these factors.

Predictive Modelling of Stroke Occurrence among Patients using Machine Learning

Stroke is a global public health concern with severe consequences. Early detection and accurate prediction of stroke occurrence are crucial for effective prevention and targeted interventions. This study proposes a machine learning-based approach to predict the likelihood of stroke among patients. A comprehensive dataset encompassing demographic, clinical, and lifestyle factors of a large patient cohort was employed. Variables such as age, gender, hypertension, diabetes, smoking status, BMI, and medical history were considered. Advanced machine learning algorithms, including logistic regression, decision trees, random forests, and support vector machines, were utilized to analyses the dataset and develop a predictive model. The results demonstrate that the machine learning-based approach achieved high predictive accuracy in identifying individuals at risk of stroke. The model exhibited excellent sensitivity and specificity, enabling effective stratification of patients based on their stroke likelihood. Developing an accurate stroke prediction model using machine learning holds immense potential for proactive healthcare strategies and personalized patient care. Early identification of high-risk patients enables timely intervention and implementation of preventive measures, potentially reducing the burden of stroke-related complications. This study showed that the supervised K-Nearest Neighbors Algorithm (K-NN) model outperforms the other methods, with an accuracy of 95% compared with other models.

Outcomes of Castor Single-Branched Stent Graft for Reconstruction of Multiple Supra-Aortic Branches in Aortic Arch Disease.

To report the outcomes of a combination of Castor single-branched stent grafts with other techniques for the reconstruction of multiple supra-aortic branches in aortic arch disease. Between December 2019 and December 2021, 20 patients with aortic arch disease underwent thoracic endovascular aortic repair (TEVAR) at our institution using a Castor single-branched stent graft combined with the fenestration, chimney, or bypass techniques. Thoracic endovascular aortic repair is indicated for complicated or acute type B aortic dissection (TBAD), nonruptured aneurysms with a maximum aneurysm diameter >5.5 cm or showing rapidly expanded, ruptured, or threatened aneurysms, and penetrating aortic ulcers (PAUs) with a maximal aortic diameter >5.5 cm or with PAUs >10 mm deep or >20 mm in diameter. Preoperative, intraoperative, and postoperative clinical data were recorded. The median age of the patients was 56 (range=52-69 years) years, and 19 patients were men. Seven patients underwent the Castor single-branched stent graft and left common carotid artery (LCCA) chimney technique, 8 patients underwent the Castor single-branched stent graft and fenestration technique, and 5 patients underwent the Castor single-branched stent graft and bypass technique. The technical success rate was 100%. Major adverse events included 2 endoleaks, 1 spinal cord ischemia, and 1 early-stage retrograde type A aortic dissection. No cerebral stroke-related complications were observed. The mortality rate was 10% (2/20 patients). One patient with thoracic aortic aneurysm (TAA) died because of a sudden decrease in oxygen saturation and blood pressure after surgery. Relatives declined autopsy, and the cause of death was not determined. Another patient died of a retrograde type A dissection after surgery. The median follow-up period was 6 months (range=3.5-12 months). During follow-up, 1 patient with type I endoleak underwent thoracotomy again after a year. The remaining patients recovered well. The combination of a Castor single-branched stent graft with fenestration, chimney, or bypass techniques may be an effective treatment for preserving multiple supra-aortic branches in aortic arch disease. This study introduced three methods of reconstruction of multiple supra-aortic branches using a Castor single-branched stent graft (Castor single-branched stent graft combined with fenestration, chimney, or bypass technique) and analysed their advantages and shortcomings to provide experience for the future treatment of aortic arch diseases.

Neurological Applications of Celery (Apium graveolens): A Scoping Review.

Apium graveolens is an indigenous plant in the family Apiaceae, or Umbelliferae, that contains many active compounds. It has been used traditionally to treat arthritic conditions, gout, and urinary infections. The authors conducted a scoping review to assess the quality of available evidence on the overall effects of celery when treating neurological disorders. A systematic search was performed using predetermined keywords in selected electronic databases. The 26 articles included upon screening consisted of 19 in vivo studies, 1 published clinical trial, 4 in vitro studies and 2 studies comprising both in vivo and in vitro methods. A. graveolens and its bioactive phytoconstituent, 3-n-butylphthalide (NBP), have demonstrated their effect on neurological disorders such as Alzheimer's disease, Parkinson's disease, stroke-related neurological complications, depression, diabetes-related neurological complications, and epilepsy. The safety findings were minimal, showing that NBP is safe for up to 18 weeks at 15 mg/kg in animal studies, while there were adverse effects (7%) reported when consuming NBP for 24 weeks at 600 mg daily in human trials. In conclusion, the safety of A. graveolens extract and NBP can be further investigated clinically on different neurological disorders based on their potential role in different targeted pathways.

Major complications associated with unfavorable outcome in right-sided large hemisphere infarctions: A single-center study.

To identify the major complications independently associated with unfavorable outcomes in right-sided large hemisphere infarction (RLHI) patients. We retrospectively enrolled consecutive patients admitted within 24h with the diagnosis of RLHI. The unfavorable outcome was defined as a modified Rankin Scale score of 4-6 at 3 months. Univariate and multivariate analyses were performed to identify the major complications independently associated with 3-month unfavorable outcomes. Of the 171 cases with RLHI included, 126 (73.7%) had unfavorable outcomes at 3 months: A total of 64 (37.4%) cases died, and 62 (36.3%) lived with severe disability. Stroke-related complications occurred in 168 (98.2%) patients during hospitalization. The five most common stroke-related complications were pulmonary infection (75.4%), electrolyte disorder (61.4%), hypoalbuminemia (49.1%), malignant brain edema (MBE) (48.5%), and hemorrhagic transformation (48.0%). RLHI patients with unfavorable outcomes had more frequent MBE (58.7% vs. 21.4%, p<.001), pulmonary infection (86.5% vs. 42.9%, p<.001), gastrointestinal bleeding (46.8% vs. 28.6%, p=.038), electrolyte disorder (68.3% vs. 40.5%, p=.001), acute renal failure (32.5% vs. 4.8%, p<.001), and hypoalbuminemia (61.1% vs. 11.9%, p<.001) than patients with favorable outcome. Multivariate analyses suggested that only MBE (adjusted OR 4.06, 95% confidence interval [CI] 1.14-14.48, p=.031), pulmonary infection (adjusted OR 4.69, 95%CI 1.48-14.85, p=.009), and hypoalbuminemia (adjusted OR 6.58, 95%CI 1.74-24.86, p=.005) were independently associated with 3-month unfavorable outcome in patients with RLHI. Most of the RLHI patients have at least one stroke-related complication during hospitalization, and nearly three-quarters suffered unfavorable outcomes. Only MBE, pulmonary infection, and hypoalbuminemia are independently associated with 3-month unfavorable outcome.

Stroke in Sierra Leone: Case fatality rate and functional outcome after stroke in Freetown.

There is limited information on long term outcomes after stroke in Sub-Saharan Africa (SSA). Current estimates of case fatality rate (CFR) in SSA are based on small sample sizes with varying study design and report high heterogeneity. We report CFR and functional outcomes from a large, prospective, longitudinal cohort of stroke patients in Sierra Leone and describe factors associated with mortality and functional outcome. A prospective longitudinal stroke register was established at both adult tertiary government hospitals in Freetown, Sierra Leone. It recruited all patients ≥18 years with stroke, using the World Health Organization definition, from May 2019 until October 2021. To reduce selection bias onto the register all investigations were paid by the funder and outreach conducted to raise awareness of the study. Sociodemographic data, National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI) was collected on all patients on admission, at seven days, 90 days, one year and two years post stroke. Cox proportional-hazards models were constructed to identify factors associated with all-cause mortality. A binomial logistic regression model reports odds ratio (OR) for functional independence at one year. 986 patients with stroke were included, of which 847 (85.9%) received neuroimaging. Follow up rate was 81.5% at one year, missing item data was <1% for most variables. Stroke cases were equally split by sex and mean age was 58.9 (SD: 14.0) years. 625 (63%) were ischaemic, 206 (21%) primary intracerebral haemorrhage, 25 (3%) subarachnoid haemorrhage and 130 (13%) were of undetermined stroke type. Median NIHSS was 16 (9-24). CFR at 30 days, 90 days, 1 year and 2 years was 37.1%, 44.4%, 49.7% and 53.2% respectively. Factors associated with increased fatality were male sex HR:1.28 (1.05-1.56), previous stroke HR:1.34 (1.04-1.71), atrial fibrillation HR:1.58(1.06-2.34), subarachnoid haemorrhage HR:2.31 (1.40-3.81), undetermined stroke type HR: 3.18(2.44-4.14) and in-hospital complications HR: 1.65 (1.36-1.98). 93% of patients were completely independent prior to their stroke, declining to 19% at one year after stroke. Functional improvement was most likely to occur between 7 and 90-days post stroke with 35% patients improving, and 13% improving between 90 days to one year. Increasing age OR: 0.97(0.95-0.99), previous stroke OR: 0.50 (0.26-0.98), NIHSS OR 0.89 (0.86-0.91), undetermined stroke type OR:0.18 (0.05-0.62) and ≥1 in hospital complication OR:0.52 (0.34-0.80) were associated with lower OR of functional independence at one year. Whilst hypertension OR:1.98 (1.14-3.44) and being the primary breadwinner of the household OR:1.59 (1.01-2.49) were associated with functional independence. Stroke in Sierra Leone affected younger people, and resulted in high rates of fatality and functional impairment relative to global averages. Key clinical priorities for reducing fatality include preventing stroke-related complications through evidence-based stroke care; improved detection and management of atrial fibrillation, and increasing coverage of secondary prevention. Further research into care pathways and interventions to encourage care seeking for less severe strokes should be prioritized. Requests for access to anonymized data for academic use should be made to the SISLE team https://www.kcl.ac.uk/research/stroke.

Trends in Prehospital Visits as a Cause of Delayed Admission in Korean Stroke Patients over a 10-Year Period: A National Health Insurance Claims Data Study.

A prehospital delay from symptom onset to hospital arrival resulted in stroke-related complications or in-hospital deaths in acute stroke patients. We aimed to investigate trends in prehospital visits as a cause of prehospital delay using data from the Korean Health Insurance Service. This nationwide, population-based, retrospective cohort study included 524,524 newly-diagnosed stroke patients admitted via the emergency departments of secondary and tertiary hospitals. We obtained the prehospital visits rate from 2010 to 2019 and identified the related characteristics. Prehospital visits were observed in 111,465 patients (21.3%). The prehospital visits rate decreased from 25.1% in 2010 to 17.8% in 2019, but the number of patients increased from 11,255 cases in 2010 to 11,747 cases in 2019. Fortunately, the rate of delayed admission for more than one day decreased from 26.7% to 21.3%. However, 10.4% of patients were diagnosed more than two days later. Young, females, or patients with higher income status and living in low urbanization areas exhibited a higher rate of prehospital visits. Prehospital visits in Korean stroke patients decreased from 25.1% in 2010 to 17.8% in 2019. However, more than 10,000 patients still visited other medical institutions before admission to treatment.

Postpartum stroke trends, risk factors, and associated adverse outcomes

Management of postpartum stroke has been the focus of several quality improvement efforts in the past decade. However, there is little recent national trends data for postpartum stroke readmissions. To determine trends, risk factors, and complications associated with postpartum stroke readmission. The 2013-2019 Nationwide Readmissions Database was used to perform a retrospective cohort study evaluating risk for readmission for stroke within 60 days of delivery hospitalization discharge. Temporal trends in readmissions were analyzed using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change (AAPC) with 95% CIs. Stratified trends were analyzed for hemorrhage stroke, ischemic stroke, and stroke readmissions 1-10, 11-30, and 31-60 days after delivery discharge. Risk factors for stroke were analyzed with unadjusted and adjusted logistic regression models with odds ratios (ORs) with 95% CIs as measures of association. Risk for stroke complications was analyzed including mechanical ventilation, seizures, death, and prolonged stay ≥14 days. Of an estimated 21,754,603 delivery hospitalizations, 5,006 were complicated by a 60-day postpartum readmission with a diagnosis of stroke. The average annual percent change for all stroke readmissions over the study period was not significant (AAPC 0.1%, 95% CI -2.2%, 2.4%). When trends in readmission for ischemic and hemorrhagic stroke were analyzed, results were similar as were stratified analyses by readmission timing. Risk factors associated with increased odds included superimposed preeclampsia (OR 4.8, 95% CI 3.9, 5.9), preeclampsia with severe features (OR 3.7, 95% CI 3.0, 4.4), maternal cardiac disease (OR 3.0, 95% CI 2.5, 3.7), chronic kidney disease (OR 5.0, 95% CI 3.4, 7.5), and lupus (OR 7.0, 95% CI 4.9, 10.2). Risk was retained in adjusted analyses. Common stroke-related complications included prolonged hospital stay ≥14 days (12.1 per 1000 stroke-related readmissions), seizures (9.9 per 1000 stroke-related readmissions), and mechanical ventilation (6.6 per 1,000 stroke-related readmissions). This analysis of nationally representative data demonstrated no change in the rate of 60-day postpartum hospitalizations with stroke from 2013 to 2019. Further clinical research is indicated to optimize risk reduction for stroke after delivery hospitalization discharge.

A step-by-step guide for the diagnosis and management of hyponatraemia in patients with stroke.

Hyponatraemia is common in patients with stroke and associated with adverse outcomes and increased mortality risk. The present review presents the underlying causes and provides a thorough algorithm for the diagnosis and management of hyponatraemia in stroke patients. Concomitant diseases and therapies, such as diabetes, chronic kidney disease and heart failure, along with diuretics, antidepressants and proton pump inhibitors are the most common causes of hyponatraemia in community. In the setting of acute stroke, the emergence of hyponatraemia might be attributed to the administration of hypotonic solutions and drugs (ie. mannitol and antiepileptics), poor solute intake, infections, as well as stroke-related conditions or complications, such as the syndrome of inappropriate secretion of antidiuretic hormone, cerebral salt wasting syndrome and secondary adrenal insufficiency. Diagnostically, the initial step is to differentiate hypotonic from non-hypotonic hyponatraemia, usually caused by hyperglycaemia or recent mannitol administration in patients with stroke. Determining urine osmolality, urine sodium level and volume status are the following steps in the differentiation of hypotonic hyponatraemia. Of note, specific parameters, such as fractional uric acid and urea excretion, along with plasma copeptin concentration, may further improve the diagnostic yield. Therapeutic options are based on the duration and symptoms of hyponatremia. In the case of acute or symptomatic hyponatraemia, hypertonic saline administration is recommended. Hypovolaemic chronic hyponatremia is treated with isotonic solution administration. Although fluid restriction remains the first-line treatment for the rest forms of chronic hyponatraemia, therapies increasing renal free water excretion may be necessary. Loop diuretics and urea serve this purpose in patients with stroke, whereas sodium-glucose transport protein-2 inhibitors appear to be a promising therapy. Nevertheless, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in such patients. Randomized trials designed to compare therapeutic strategies in managing hyponatraemia in patients with stroke are required.

An IoMT-Based Approach for Real-Time Monitoring Using Wearable Neuro-Sensors.

The Internet of Things (IoT) has demonstrated over the past few decades to be a powerful tool for connecting various medical equipment with in-built sensors and healthcare professionals to deliver superior health services that also reach remote areas. In addition to reducing healthcare costs, increasing access to clinical services, and enhancing operational effectiveness in the healthcare industry, it has also enhanced patient health safety. Recent research has focused on using EEG to assist and comprehend brain changes in rehabilitation facilities. These technologies can spot fluctuations in EEG constraints during treatment, which could result in more effective therapy and better functional outcomes. As a result, we have tried to use an IoT-based system for real-time monitoring of the constraints. Another unknown patient who is suffering from acute ischemic stroke may experience stroke-in-evolution or an early worsening of neurological symptoms, which is frequently associated with poor clinical outcomes. Because of this, managing an acute stroke requires early detection of these indications. The present investigation work will act as a standard reference for academic researchers, medical professionals, and everyone else involved in the use of IoMT. This study aims to anticipate strokes sooner and prevent their consequences by early intervention using an Internet of Things (IoT)-based system. Also, this study proposes usage of wearable equipment that can monitor and analyze brain signals for improved treatment and the prevention of stroke-related complications.

Neurologic outcomes of carotid and other emergent interventions for ischemic stroke over 6years with dataset enhanced by machine learning.

The current mainstays of ischemic stroke treatment include the use of thrombolysis (tissue plasminogen activator [tPA]), urgent carotid endarterectomy (uCEA) or urgent carotid artery stenting (uCAS), and mechanical endovascular reperfusion/thrombectomy (MER). Scarce data describe the presenting stroke severity and neurologic outcomes for these acute ischemic stroke interventions, alone or in combination. The authors hypothesize that patients undergoing carotid interventions experience better functional neurologic outcomes than other stroke interventions. A comprehensive stroke center dataset was combined with data for stroke-related procedures, comorbidities, complications, and physician documentation collected from electronic medical record data. A total of 10,975 patient encounter records from January 1, 2015, through July 31, 2021, were retrieved. The presenting stroke severity was determined by vascular/stroke neurologists using the National Institutes of Health Stroke Scale (NIHSS). Functional neurologic outcomes were reported using the modified Rankin scale (mRS) score, which quantifies the degree of neurologic disability. Because mRS values were only available for 3627 encounters in the original dataset, the authors developed a machine learning algorithm to analyze physician documentation and assign an mRS value. After the exclusion and machine learning analysis, a total of 5170 patient encounters were included for statistical analysis. Statistical analyses included the χ2 test, one-way analysis of variance and logistic regression on 30-day complications, stroke severity, and neurologic outcomes. Patients were divided into five cohorts: (1) uCEA or uCAS (n= 189), (2) tPA alone (n= 1053), (3) MER alone (n= 418), (4) tPA+ MER (n= 199), and (5) no intervention (n= 3311). Patients undergoing uCEA/uCAS were significantly more likely to be male, smokers, and have a history of peripheral arterial disease compared with other stroke cohorts. The length of stay was shortest for patients who only received tPA or no intervention (6days), followed by uCEA/uCAS (7.2days), MER (10.2days), and tPA+ MER (8.8days) cohorts (P< .001). The 30-day mortality was highest in the MER cohort (12.2%) and lowest in the uCEA/uCAS cohort (2.6%). The uCEA/uCAS cohort compared with other cohorts had the lowest presenting stroke severity (NIHSS 4.9 vs NIHSS 6.9-16.0), and best neurologic outcomes (mRS 1.7 vs mRS 1.8-2.6). After an ischemic stroke, patients undergoing urgent carotid interventions had the lowest presenting stroke severity (NIHSS) and highest rate of independent neurologic outcomes (mRS) compared with other stroke interventions. Incoming stroke severity correlates with functional neurologic outcomes, and patients who present with an NIHSS of 10 or less who undergo uCEA/uCAS have a high likelihood of independent neurologic functional outcome (mRS of ≤2).

Risk factors for constipation in patients with acute and subacute ischemic stroke: A retrospective cohort study

BackgroundThe objective of this study was to examine the incidence of constipation and the risk factors for patients with ischemic stroke in acute and subacute stage. MethodsIn this retrospective cohort study, patients with acute and subacute ischemic stroke in the Department of Rehabilitation, First Affiliated Hospital, Zhejiang University School of Medicine between 2019 and 2021 were analyzed. Univariate and multivariate analysis were conducted using demographic characteristics, clinical evaluations, and stroke related complications, to explore the risk factors of constipation after stroke. ResultsOf the 222 patients with acute and subacute ischemic stroke, 128 (57.7 %) developed constipation. Univariate analysis revealed that pulmonary infection, NIHSS, ADL, KWST scores and nutritional status were significantly associated with post-stroke constipation (p < 0.05). Binomial logistic regression showed that NIHSS score is the independent risk factors of the poststroke constipation, and patients with NIHSS score >8.5 had higher risk for constipation. ConclusionsCurrent findings suggested a significant interaction between constipation and NIHSS score in stroke patients, providing new insights into therapeutic target for neural functional recovery among patients with acute and sub-acute ischemic stroke.