Supratentorial Stroke Research Articles

Focal Hypoperfusion in Acute Ischemic Stroke Perfusion CT: Clinical and Radiologic Predictors and Accuracy for Infarct Prediction.

Perfusion CT may improve the diagnostic performance of noncontrast CT in acute ischemic stroke. We assessed predictors of focal hypoperfusion in acute ischemic stroke and perfusion CT performance in predicting infarction on follow-up imaging. Patients from the Acute STroke Registry and Analysis of Lausanne data base with acute ischemic stroke and perfusion CT were included. Clinical and radiologic data were collected. We identified predictors of focal hypoperfusion using multivariate analyses. From the 2216 patients with perfusion CT, 38.2% had an acute ischemic lesion on NCCT and 73.3% had focal hypoperfusion on perfusion CT. After we analyzed 104 covariates, high-admission NIHSS, visual field defect, aphasia, hemineglect, sensory deficits, and impaired consciousness were positively associated with focal hypoperfusion. Negative associations were pure posterior circulation, lacunar strokes, and anticoagulation. After integrating radiologic variables into the multivariate analyses, we found that visual field defect, sensory deficits, hemineglect, early ischemic changes on NCCT, anterior circulation, cardioembolic etiology, and arterial occlusion were positively associated with focal hypoperfusion, whereas increasing onset-to-CT delay, chronic vascular lesions, and lacunar etiology showed negative association. Sensitivity, specificity, and positive and negative predictive values of focal hypoperfusion on perfusion CT for infarct detection on follow-up MR imaging were 66.5%, 79.4%, 96.2%, and 22.8%, respectively, with an overall accuracy of 76.8%. Compared with NCCT, perfusion CT doubles the sensitivity in detecting acute ischemic stroke. Focal hypoperfusion is independently predicted by stroke severity, cortical clinical deficits, nonlacunar supratentorial strokes, and shorter onset-to-imaging delays. A high proportion of patients with focal hypoperfusion developed infarction on subsequent imaging, as did some patients without focal hypoperfusion, indicating the complementarity of perfusion CT and MR imaging in acute ischemic stroke.

Predicting Motor Outcomes in Stroke Patients Using Diffusion Spectrum MRI Microstructural Measures.

Improved understanding of neuroimaging signal changes and their relation to patient outcomes after ischemic stroke is needed to improve ability to predict motor improvement and make therapy recommendations. The posterior limb of the internal capsule (PLIC) is a hub of afferent and efferent motor signaling and this work proposes new, image-based methods for prognosis based on interhemispheric differences in the PLIC. In this work, nine acute supratentorial ischemic stroke patients with motor impairment received a baseline, 203-direction diffusion brain MRI and a clinical assessment 3–12 days post-stroke and were compared to nine age-matched healthy controls. Asymmetries based on the mean and Kullback-Leibler divergence in the ipsilesional and contralesional PLIC were calculated for diffusion tensor imaging (DTI) and diffusion spectrum imaging (DSI) measures from the baseline MRI. Predictions of upper extremity Fugl-Meyer (FM) scores at 5-weeks follow-up from baseline measures of PLIC asymmetry in diffusion tensor imaging (DTI) and diffusion spectrum imaging (DSI) models were evaluated. For the stroke participants, the baseline asymmetry measures in the PLIC for the orientation dispersion index of the neurite orientation dispersion and density imaging (NODDI) model were highly correlated with upper extremity FM outcomes (r2 = 0.83). Use of DSI and the NODDI orientation dispersion index parameter shows promise of being more predictive of stroke recovery and to help better understand white matter changes in stroke, beyond DTI measures. The new finding that baseline interhemispheric differences in the PLIC calculated from the orientation dispersion index of the NODDI model are highly correlated with upper extremity functional outcomes may lead to improved image-based motor-outcome prediction after middle cerebral artery ischemic stroke.

The Influence of Stroke Location on Cognitive and Mood Impairment. A Voxel-Based Lesion-Symptom Mapping Study

Background and purpose: The role of stroke location as a determinant of mood and cognitive symptoms is still a matter of debate. The aim of this study was to identify the predictive value of ischemic stroke location, on a voxel basis, for mood and cognitive outcome. Materials and methods: A prospective monocentric study including patients with a supratentorial ischemic stroke was conducted. A 3 Tesla brain MRI was performed at baseline. Mood and cognition were assessed using Hospital Anxiety and Depression scale (HAD), apathy inventory (AI), and Montreal Cognitive Assessment scale subscores, performed at 3 months poststroke. Statistical maps of ischemic stroke location associated with 3 months mood and cognitive scores were obtained using a voxel-based lesion-symptom mapping approach (Brunner and Munzel test). Significant voxels (false discovery rate [FDR] corrected-P < .01) were identified using the standard Montreal Neurological Institute-152 space template. Results: Two hundred and sixty-five nonsevere stroke patients were included (64% men, mean age 66 ± 14, median National Institute of Health Stroke Score 3, interquartile range 2-6). Ischemic stroke location was not associated with HAD or AI scores. Language, abstraction, and delayed recall performances were mainly associated with left-side hemispheric lesions. Lesions in both hemispheres were associated with lower performances in visuospatial and executive functions, naming, attention, and orientation. Conclusion: Ischemic stroke location does not predict mood outcome at 3 months but is a determinant of cognitive outcome in specific domains.

Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion: A STROBE-complaint retrospective study.

Although stroke is one of the most common causes of dysphagia, no studies have investigated the radionuclide salivagram as a predictor of aspiration pneumonia in patients with stroke. In addition, few researches on the risk factors of aspiration pneumonia in patients with subacute and chronic stroke undergoing rehabilitation in the rehabilitation unit have been rarely conducted. In this study, therefore, we investigated whether a radionuclide salivagram could predict aspiration pneumonia, and tried to find other clinical factors that may be helpful in predicting aspiration pneumonia in stroke patients undergoing rehabilitation in the rehabilitation department.From March 2013 and January 2018, a retrospective review of the medical records of 1182 subacute and chronic stroke patients who were admitted to rehabilitation department (South Korea) was carried out. We included 117 stroke patients with swallowing difficulties who were admitted to our rehabilitation department and satisfied our criteria retrospectively. Stroke lesion, the degree of paralysis, sex, age, onset duration, feeding methods, the Mini-Mental State Examination (MMSE), the Global Deterioration Scale (GDS), the presence of aspiration in VFSS or salivagram, the penetration-aspiration scale (PAS), and the total score of the Modified Barthel Index (MBI) were investigated by reviewing medical records.To evaluate the predictor of aspiration pneumonia for patients with stroke, multivariate logistic regression analysis with forward stepwise was performed. In the results of this study, only MMSE was significant as a clinical predictor, but not aspiration in VFSS or salivagram in multivariate analysis of supratentorial stroke patients (OR, 0.895) (95% CI, 0.830–964). In multivariate analysis of infratentorial stroke patients, combined results of salivagram and VFSS (aspiration in a salivagram or VFSS) (OR, 0.956) (95% CI, 0.919–995), and total MBI scores were significant as clinical predictors (OR, 24.882) (95% CI, 1.298–477.143).In conclusion, MMSE can be a clinical predictor of the occurrence of aspiration pneumonia in patients with supratentorial stroke. In contrast, total MBI score and combined results of a salivagram and VFSS can be clinical predictors of the occurrence of aspiration pneumonia in patients with infratentorial stroke.

Relationships Between Affected-Leg Motor Impairment, Postural Asymmetry, and Impaired Body Sway Control After Unilateral Supratentorial Stroke

Background. The relationships between motor impairment of the affected leg, postural control asymmetry, and impaired body sway control after stroke are not well understood. Objective. To examine the relationship between motor impairment of the affected leg and reduced contribution of this leg to body sway control (ie, dynamic control asymmetry [DCA]) and to determine the relationships between impaired body sway control, DCA, and weight-bearing asymmetry (WBA). Methods. We assessed quiet-standing balance with eyes open in 70 persons with a unilateral supratentorial chronic stroke using 2 force plates. Center-of-pressure (COP) velocity was calculated for both feet together in the anteroposterior (AP) and mediolateral (ML) directions as a measure of body sway control. Bilateral AP COP velocities were used to calculate an index for DCA and weight borne on each side to calculate WBA. Fugl-Meyer assessment of the lower extremity (FMA-LE; range: 0-28) served as a measure of affected-leg motor impairment. Results. All participants with FMA-LE <24 showed pronounced DCA, but this was also true for 21% of those with FMA ⩾24. Higher DCA values were related to more WBA (rs = 0.496; P < .001), and less ML sway control (rs = 0.268; P = .025). AP sway control was not significantly related to either DCA or WBA. Conclusions. Even clinically well-recovered stroke survivors with (near) maximal FMA-LE scores may show clear postural asymmetry in terms of the relative contribution of the affected leg to body sway control. WBA seems to be an effective compensatory mechanism to optimize the contribution of the less-affected leg to balance, particularly in the AP direction.

Intravenous infusion of mesenchymal stem cells for protection against brainstem infarction in a persistent basilar artery occlusion model in the adult rat.

Morbidity and mortality in patients with posterior circulation stroke remains an issue despite advances in acute stroke therapies. The intravenous infusion of mesenchymal stem cells (MSCs) elicits therapeutic efficacy in experimental supratentorial stroke models. However, since there are few reliable animal models of ischemia in the posterior circulation, the therapeutic approach with intravenous MSC infusion has not been tested. The objective of this study was to test the hypothesis that intravenously infused MSCs provide functional recovery in a newly developed model of brainstem infarction in rats. Basilar artery (BA) occlusion (BAO) was established in rats by selectively ligating 4 points of the proximal BA with 10-0 nylon monofilament suture. The intravenous infusion of MSCs was performed 1 day after BAO induction. MRI and histological examinations were performed to assess ischemic lesion volume, while multiple behavioral tests were performed to evaluate functional recovery. The MSC-treated group exhibited a greater reduction in ischemic lesion volume, while behavioral testing indicated that the MSC-infused group had greater improvement than the vehicle group 28 days after the MSC infusion. Accumulated infused MSCs were observed in the ischemic brainstem lesion. Infused MSCs may provide neuroprotection to facilitate functional outcomes and reduce ischemic lesion volume as evaluated in a newly developed rat model of persistent BAO.

NIHSS cut point for predicting outcome in supra- vs infratentorial acute ischemic stroke.

To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemic stroke (AIS). Data are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics of clinically defined supratentorial and infratentorial AIS patients and poor functional outcome, defined by scores 3-6 on the modified Rankin Scale, were evaluated in logistic regression models, with area under the curve (AUC) receiver operating characteristics defining the optimal NIHSS predictor cut point. Patients with infratentorial AIS (n = 289) had lower baseline NIHSS scores than those with supratentorial AIS (n = 2,613) (median 7 vs 9; p < 0.001). NIHSS cut points for poor outcome were 10 (AUC 76, sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity 56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference in functional outcome or symptomatic intracranial hemorrhage between AIS types. In thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because thrombolysis treatment has low effect on stroke outcome in patients with infratentorial AIS when baseline NIHSS score is more than 6, additional treatment such as endovascular treatment should be considered to improve stroke outcome. NCT01422616.

Brain mapping of motor and functional recovery after supratentorial stroke.

The present study aimed to identify the brain regions involved in upper and lower limb motor and functional recovery after stroke. Twenty-five patients (mean age 73.4 years; average duration from stroke onset 50.1 months) were examined. Fractional anisotropy (FA) mapping using diffusion tensor imaging, and clinical measures, including the Fugl-Meyer motor assessment of upper and lower limbs, the Modified Barthel Index (MBI), and Functional Ambulation Category, were used for examinations. Linear regression analyses were carried out with the FA map as a dependent variable, each clinical measure as an independent variable, and patient age as a covariate. FA in the internal capsule of the posterior limb of the lesioned hemisphere was significantly associated with Fugl-Meyer motor assessment scores for the upper limbs, whereas FAs in the internal capsule of the posterior limb of the lesioned hemisphere, the posterior corpus callosum of the lesioned hemisphere, and the middle cerebellar peduncle of the contralateral hemisphere were associated with Fugl-Meyer motor assessment scores for the lower limb. FA in brain regions with bilateral connection fibers was commonly associated with the score on the Korean version of the MBI and participants' functional ambulation. Furthermore, the FA in the corticospinal tract in the contralesional hemisphere was also associated with the score on the Korean version of the MBI (corrected P<0.05). Motor and functional recovery of upper and lower limbs involves different brain regions. This finding is of particular relevance for treatment and recovery in stroke.

Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

Background: For the early detection of post-stroke dysphagia (PSD), valid screening parameters are crucial as part of a step-wise diagnostic procedure. This study examines the role of the National Institute of Health Stroke Scale (NIH-SS) as a potential low-threshold screening parameter. Methods: During a ten-year period, 687 newly admitted patients at University Hospital Muenster were included in a retrospective analysis, if they had ischemic or haemorrhagic stroke confirmed by neuroimaging and had received NIH-SS scoring and endoscopic swallowing evaluation upon admission. The NIH-SS score was correlated with dysphagia severity as measured by the validated 6-point fiberoptic endoscopic dysphagia severity score (FEDSS), and the ideal cut-off score to predict PSD, defined as FEDSS > 1, was calculated. Supra- and infratentorial strokes were analysed separately due to their differing role in the pathophysiology of neurogenic dysphagia. Results: NIH-SS and dysphagia severity show a significant positive correlation in the whole study population (R² = 0.745) as well as in both analysed subgroups (R² = 0.494 for supra- and R² = 0.646 for infratentorial strokes, p < 0.0005, respectively). For supratentorial strokes, the ideal NIH-SS cut-off is > 9 (sensitivity 68.3%, specificity 61.5%, positive predictive value 89.7%, negative predictive value 28.4%). For infratentorial strokes, a lower ideal cut-off > 5 was calculated (sensitivity 67.4%, specificity 85.0%, positive predictive value 95.1%, negative predictive value 37.8%). Conclusions: NIH-SS may be used as an adjunct to predict dysphagia in acute stroke patients with moderate sensitivity and specificity. Differentiation between supra- and infratentorial regions is essential not to miss dysphagia in infratentorial stroke.

Differences in motor network dynamics during recovery between supra- and infra-tentorial ischemic strokes.

Most previous stroke studies have been performed in heterogeneous patient populations. Moreover, the brain network might demonstrate different recovery dynamics according to lesion location. In this study, we investigated variation in motor network alterations according to lesion location. Forty patients with subcortical ischemic stroke were enrolled. Patients were divided into two groups: 21 patients with supratentorial stroke (STS) and 19 patients with infratentorial stroke (ITS). All patients underwent resting-state functional magnetic resonance imaging and behavioral assessment at 2 weeks and 3 months poststroke. Twenty-four healthy subjects participated as a control group. To compare altered connectivity between groups, measures used in previous studies to evaluate interhemispheric balance and global network reorganization were investigated and the relationship between network measures and motor functions were examined. Cortico-cerebellar connectivity was also extracted to investigate its relationship with interhemispheric connectivity. In the STS group, measures related to interhemispheric balance were disrupted compared to the control group 2 weeks poststroke, while this was not found in the ITS group. During recovery, measures related to global network reorganization in the STS group and measures related to interhemispheric balance in the ITS group demonstrated significant changes, respectively. Moreover, motor functions were correlated with altered network measures in both groups. There was an interactive relationship between cortico-cerebellar and interhemispheric cortical connectivity only in the ITS group. Different changes in the motor network were observed depending on the location of stroke lesions. These results might originate from differences in the interactions between cortico-cerebellar and interhemispheric connectivity.

Differences in alteration of motor network between supra- and infratentorial ischemic stroke patients

In recent stroke studies, connectivity-based approaches have been used to investigate recovery-related indicators. However, most of previous studies were performed in heterogenous patients with different lesion locations or different types of stroke. In addition, there is not enough investigation on recovery-related network analysis in the infratentorial stroke (ITS), which may show different network dynamics from the supratentorial stroke (STS). In this study, we investigated the differences in alteration of motor network between STS and ITS in ischemic stroke patients. Forty first-onset ischemic stroke patients were recruited within 2 weeks after stroke onset. Patients were divided into STS and ITS groups according to their lesion location. All patients underwent resting-state fMRI scans twice (2 weeks and 3 months after onset). Twenty-four healthy subjects participated as an age-matched control group. To investigate the altered connectivity during recovery and to compare between groups, various analysis methods such as interhemispheric connectivity, network symmetry, and graph theoretical analysis which were already established in the previous studies were used. In STS group, interhemispheric connectivity was significantly decreased and network symmetry was disrupted compared to control group at 2 weeks post-stroke, while the ITS group did not show differences compared to control group at this time point. During recovery, global efficiency and global reorganization including increasing network efficiency and randomization showed only in the STS group. In contrast, the ITS group demonstrated significantly increased interhemispheric connectivity during recovery. There was an interactive relationship between cortico-cerebellar connectivity and interhemispheric connectivity in the ITS group. Alterations of recovery-related motor network connectivity in ITS patients were very different from that of STS patients. These results may be caused by differences of damage of diverse motor-related pathways by stroke lesion.

Isokinetic muscle assessment and strengthening in central neurology: Stroke patients

It is important to solicit the brain in many ways, through very different exercises, to support the rehabilitation of people with stroke. The training and the repetition of the physical exercise is a major factor in secondary prevention after stroke. However, our main goal is to strengthen a hemiparetic patient muscularly through eccentric muscular work to increase his strength to transfer to his autonomy. Twenty-three adults hospitalized with single episode of supra-tentorial stroke (less than eight months), with normal evaluation (spasticity, syncinesia, sensitivity, Functional Independence Measure), be able to perform the exercise requested on the horizontal press, and be voluntary. 3 sets of 5 repetitions each of eccentric contraction (second leg for control) according to the maximum resistance (MR) evaluated. Two series at 40% of the MR and 1 series at 60% during 4 weeks. We test, the 10-meter test, the isokinetic test, the International Muscular Testing and the 6 minutes walking test. We observe a significant increase in the performance of these patients on all parameters analyzed between before and after the various rehabilitation sessions. This means that the progression in terms of strength and muscle power has impacted the functional component of the patients. We observed no change in spasticity. Our exercises did not modify a physiological component that could negatively affect the standard therapeutic management proposed to these patients. This study provides additional information on the current trend in the use of muscle strengthening versus resistance. Moreover, this study shows that apart from the positive effects on muscular power, there is also a tendency to increase the functional capacities of the non-spastic hemiparetic patient in the subacute phase. At the central level, deficiencies in motor control have been identified, but no study has undertaken to evaluate the effect of specific training on the functioning of the predictive system.

Dysphagia severity by side of lesion for acute stroke patients

This purpose of this study was to investigate the difference in dysphagia of stroke patients based on side of lesion. 164 stroke patients referred to our department from August to November 2017. 134 patients underwent bedside swallowing assessment; BSA. Out of 110 (right lesion (R): 46, left lesion (L): 64) unilateral supratentorial stroke patients,patients (R: 18, L: 26) with dysphagia were recruited. Median age was 79 years. The mean time from hospital admission to BSA was 4 days. 44. BSA used Repetitive saliva swallowing test, Modified water swallowing test, and 30 ml water swallowing test. Dysphagia severity was evaluated by Dysphagia Severity Scale; DSS. The following data was collected through the database: Stroke Impairment Assessment Set; SIAS (Items of Affected-side Motor Function), National Institutes of Health Stroke Scale; NIHSS, Functional Independence Measure; FIM. Statistical analyses were considered significant with P < 0.05. The average of initial SIAS score was R12/L9, and final was R14/L11. The average of initial NIHSS score was R12/L15, and final was R11/L14. The average of initial FIM score was R22/L24, and final was R58/L50. Approximately 5, 28, 28, 39, and 0% of patients with R, and 11, 31, 31, 23, and 4% of patients with L had pre-treatment DSS of 1 (Saliva aspiration), 2 (Food aspiration), 3 (Water aspiration),4 (Occasional aspiration), 5 (oral problems), respectively. Post-treatment, 17, 22, 11, 17, 0, 11, and 22% of patients with R, and 4,23,8,15,4,15,and 31% with L had DSS of 1, 2, 3, 4, 5, 6 (Minimum problem), 7 (Normal). Approximately 61% patients with R and 69% patients with L relied on oral intake post-treatment. There were not significant differences in dysphagia severity between patients with R and L. Future studies are necessary with large sample size to examine the difference for distribution of dysphagia severity scale.

Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke

The prognostic relevance of strokes in different locations is debated. For example, insular strokes have been associated with increased mortality, but this association could reflect their greater severity. In two independent cohorts of patients with supratentorial ischemic stroke (n = 90 and 105), we studied the prognostic consequences of lesion size and location using voxel-based lesion-symptom mapping before and after volume control, which better accounts for total lesion volume. Strokes affecting the insula were larger than non-insular strokes (28 vs 2cc and 25 vs 3cc, p < 0.001 in both cohorts). A number of supratentorial areas (mainly in the left hemisphere), including the insula, were associated with poor functional outcome in both cohorts before (4014 voxels) and after volume control (1378 voxels), while the associations with death were greatly reduced after volume control (from 8716 to 325 voxels). Exploratory analyses suggested that the method of lesion volume quantification, the National Institutes of Health Stroke Scale hemispheric bias and patient selection can result in false associations between specific brain lesions and outcomes. In conclusion, death in the first months after stroke is mainly explained by large infarct volumes, whereas lesions of specific supratentorial structures, mostly in the left hemisphere, also contribute to poor functional outcomes.

Brain mapping for long-term recovery of gait after supratentorial stroke: A retrospective cross-sectional study.

The recovery of independent gait after stroke is a main goal of patients and understanding the relationship between brain lesions and the recovery of gait can help physicians set viable rehabilitation plans. Our study investigated the association between variables of gait parameters and brain lesions.Fifty poststroke patients with a mean age of 67.5 ± 1.3 years and an average duration after onset of 62.2 ± 7.9 months were included. Three-dimensional gait analysis and magnetic resonance imaging were conducted for all patients. Twelve quantified gait parameters of temporal-spatial, kinematic, and kinetic data were used. To correlate gait parameters with specific brain lesions, we used a voxel-based lesion symptom mapping analysis. Statistical significance was set to an uncorrected P value <.005 and cluster size >10 voxels.Based on the location of a brain lesion, the following results were obtained: The posterior limb of the internal capsule was significantly associated with gait speed and increased knee extension in the stance phase. The hippocampus and frontal lobe were significantly associated with cadence. The proximal corona radiata was significantly associated with stride length and affected the hip maximal extension angle in the stance phase. The paracentral lobule was significantly associated with the affected knee maximal flexion angle in the swing phase and with the affected ankle maximal dorsiflexion angle in the stance phase. The frontal lobe, thalamus, and the lentiform nucleus were associated with kinetic gait parameters.Cortical, proximal white matter, and learning-related and motor-related areas are mainly associated with one's walking ability after stroke.

Possibilities of clinical neuroimaging assessment scales using for patient severity in the onset of cerebral hemorrhagic supratentorial stroke to predict the outcome of the disease acute period

The main purpose of the study was to determine the criteria for the vital and functional prognosis of the cerebral hemorrhagic supratentorial stroke (CHSS) acute period outcome based on the Hemphill Intracerebral Hemorrhage (Hemphill-ICH) Scale and ICH-Grading Scale (ICH-GS) in the onset of the disease.Materials and methods. A prospective, cohort, complex clinical and paraclinical study was conducted in 124 patients (72 men and 52 women, mean age 64.7 ± 1.1 years) with CHSS. This study included clinical assessment using National Institute of Health Stroke Scale and Glasgow Coma Scale, visualization of cerebral structures and integrated assessment of health state severity using the Hemphill-ICH Scale and ICH-GS. The functional outcome of the acute period was determined by the modified Rankin Scale.Results. The Hemphill-ICH Scale score ≥2 and ICH-GS score ≥8 are associated with an increased risk of CHSS acute period lethal outcome, at 7.1 [2.8–18.0] (P < 0.01) and 4.4 [2.2–9.3] times (P < 0.01), respectively. The Hemphill-ICH Scale is characterized by a higher informative value for CHSS acute period lethal outcome prediction (AUC = 0.84) in comparison with the ICH-GS (AUC = 0.78, P < 0.05). The ICH-GS is characterized by a higher informative value for the functional prognosis of CHSS acute period outcome (AUC = 0.69) in comparison with the Hemphill-ICH Scale (AUC = 0.61, P < 0.05).Conclusions. Predictors of CHSS acute period lethal outcome are Hemphill-ICH Scale score ≥ 2 and ICH-GS score ≥8. The Hemphill-ICH Scale score = 0 and ICH-GS score = 5 are the criteria for the favourable functional outcome of CHSS acute period (mRS score ≤3 on the 21st day). The informative value of the Hemphill-ICH Scale and ICH-GS is higher for the vital prognosis than for the functional prognosis of CHSS acute period outcome verification.

Influence of Kinesitherapy on Functional Independence in Patients with Supratentorial Unilateral Stroke in Chronic Period

Aim: The aim of the study is to evaluate the effect of the specialized kinesitherapeutic (KT) methodology (SKTM) on functional independence in patients with supratentorial unilateral stroke in the chronic period (SUSChP). Material and Methods: The study was conducted with 67 patients with SUSChP (56 patients included in the experimental group - 32 men and 24 women, with duration of the disease 7.8 ± 2.0 months, and 11 patients in the control group - 9 men and 2 women, with duration of the disease 7.3 ± 1.5 months). To evaluate the changes in functional independence, test for Functional Independence Measure (FIM) was used. Patients in the experimental group were treated with a specialized 10-day KT, which later continued to be performed as an adapted exercise program at home for a period of one month. Control patients perform a regular 10-day KT. This was done using SKTM principles of modern neurorehabilitation and motor learning as opposed to usual kinesitherapy. Results: After applying SKTM, the highest trend towards the improvement of functional independence was established after the 1st month with a level of significance during treatment p&lt;0.001. Conclusion: In conclusion, the enclosed SKTM in the experimental group continued later as an adapted exercise program at home. It significantly improves the functional independence in patients with supratentorial unilateral stroke in the chronic period (SUSChP) compared with the usual kinesitherapeutic methodology applied in the control group.

An investigation of oral stereognostic ability in patients with stroke : A cross-sectional study

목적: 본 연구는 뇌졸중 환자의 일반적 특성에 따른 구강 입체인지지각 능력의 차이를 알아보고 구강 입체인지지각 능력과 인지기능 사이에 상관관계를 조사하였다. 방법: 본 연구에 84명의 뇌졸중 환자가 참여하였다. 구강 입체인지지각 검사(Oral Stereognostic Test; OST)는 입 안에 각기 다른 도형 20개를 넣고 구분하였다. 구강 입체인지지각 검사는 구강 입체인지지각 총점과 검사 동안 응답에 대한 반응속도(Respone Time; RT)를 확인하였다. 간이 정신상태 검사(Mini-Mental State Examination; MMSE)로 인지기능을 확인하였다. 모든 측정은 임상경력 3년 이상의 작업치료사가 수행하였다. 결과: 실험 후, 흡인과 같은 부작용은 발생하지 않았다. 뇌졸중 환자의 성별, 마비측, 뇌졸중 유형에 따른 구강 입체인지지각 총점, 반응시간, 인지기능의 차이는 보이지 않았다. 손상위치에 따른 인지기능은 유의한 차이가 있었다. 천막상 뇌졸중 환자는 천막하 뇌졸중 환자보다 인지기능에서 유의하게 더 낮은 점수를 나타냈다. 구강 입체인지지각 총점과 인지기능은 유의한 상관관계를 보였다. 결론: 본 연구의 결과는 구강 입체인지지각과 인지기능이 상관이 있으므로 임상에서 이를 고려한 훈련을 실시해야 함을 의미한다. 또한 뇌졸중 환자의 구강 입체인지지각에 대한 기초자료로 유용하게 쓰일 수 있을 것이다.This study was to investigate the differences in oral stereognosis according to general characteristics of stroke patients and the correlation relationship between oral stereognosis and cognitive function. Eighty four stroke patients have participated in this study. The Oral Stereognostic Test (OST) was to tell between 20 different pieces placed in the mouth. OST test was measured in two ways: One is OST total score and the other is the response time (RT) of the test. MMSE was used to identify the cognitive function. Occupational therapists who had over three years of clinical career conducted all measurements. After the experiment, there was no adverse event such as aspiration. No difference was found in OST, RT, and MMSE by sex, hemiplegia side, and stroke type in stroke patients (p>.05). There was a significant difference in MMSE according to the lesion site; the patients with supratentorial strokes showed significantly lower scores on MMSE than those with infratentorial strokes (p<.05). OST and MMSE showed a significant correlation (p<.05). These results demonstrate that one should consider this when conducting clinical training because oral stereognosis and cognitive function are each correlated. It may also be useful as a neuroanatomical basis for oral stereognosis in stroke patients.

Prediction of cerebral hemorrhagic supratentorial stroke acute period outcome on the basis of the assessment of secondary intraventricular hemorrhage severity in the onset of the disease

Критерии краткосрочного витального и функционального прогноза исхода острого периода мозгового геморрагического супратенториального инсульта (МГСИ), которые бы учитывали выраженность вторичного внутрижелудочкового кровоизлияния (ВЖК) в дебюте заболевания, в настоящее время отсутствуют. Цель работы – разработать критерии прогнозирования исхода острого периода МГСИ на основании оценки выраженности вторичного ВЖК в дебюте заболевания. Материалы и методы. Проведено комплексное клинико-параклиническое исследование 70 пациентов (38 мужчин и 32 женщин, возраст – 66 (58; 74) лет) с подтвержденным по данным клинико-нейровизуализационного исследования МГСИ и вторичного ВЖК, которые были госпитализированы в первые 24 часа от дебюта заболевания и получали консервативную терапию. Выраженность вторичного ВЖК оценивалась в баллах по Graeb Scale, Intraventicular hemorrhage (IVH) Scale и LeRoux Scale. Для определения критериев прогнозирования использовался ROC-анализ с расчетом параметров чувствительности (Se) и специфичности (Sp). Результаты. Летальный исход был зарегистрирован в 18,6 % случаев, относительно неблагоприятный исход в форме значения 4–5 баллов по модифицированной шкале Рэнкина (мШР) на 21 сутки заболевания – у 44,3 % пациентов. Выявлено, что IVH Scale (AUC = 0,94, p < 0,05) превосходит по информативности Graeb Scale (AUC = 0,89, р ˂ 0,05) и LeRoux Scale (AUC = 0,88, р ˂ 0,05) для прогнозирования летального исхода острого периода МГСИ. Установлено, что Graeb scale, IVH scale и LeRoux scale более информативны для определения витального, нежели функционального прогноза исхода острого периода МГСИ (АUC = 0,89 против АUC = 0,74 для Graeb scale, р < 0,05; АUC = 0,94 против АUC = 0,79 для IVH scale, р < 0,05; АUC = 0,88 против АUC = 0,72 для LeRoux scale, р < 0,05). Выводы. Предикторами летального исхода острого периода МГСИ выступают значения ˃5 баллов по Graeb Scale (Se = 84,6 %, Sp = 77,2 %), ˃16 баллов IVH Scale (Se = 84,6 %, Sp = 96,5 %) и ˃9 баллов по LeRoux Scale (Se = 84,6 %, Sp = 86,0 %). Критериями благоприятного функционального исхода острого пери ода МГСИ (≤3 балла по мШР на 21 сутки заболевания) являются значения по Graeb Scale ≤3 (Se = 69,2 %, Sp = 72,7 %), IVH Scale ˂8 (Se = 69,2 %, Sp = 79,5 %) и LeRoux Scale ≤3 (Se = 69,2 %, Sp = 72,7 %).

Clinical Outcomes of Repeated Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells in Chronic Haemorrhagic Stroke. A One-Year Follow Up

Object:Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients.Method:This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed.Result:The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation.Conclusion: Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect.