Transient Ischemic Attack Research Articles

Values of LncRNA SNHG14 in the Differential Diagnosis and Prognosis Evaluation of Acute Ischemic Stroke.

The long non-coding RNA (LncRNA) SNHG14 has been investigated for its potential in acute ischemic stroke (AIS) and transient ischemic attack (TIA) diagnosis. Thirty-two healthy people, 85 patients with AIS, and 40 patients with TIA had their blood tested to determine SNHG14 mRNA transcript levels using quantitative real-time polymerase chain reaction (qRT-PCR). A stroke's severity was measured using the Stroke Severity Scale developed by the National Institutes of Health (NIHSS). After 30days, individuals with AIS were evaluated for progress using a modified Rankin Scale (mRS). There was no significant difference in SNHG14 LncRNA levels between TIA patients and controls, despite the huge rise in AIS incidence (p > 0.05) (all p < 0.001). Compared to those who did well on the AIS test, those who performed poorly had substantially greater levels of SNHG14 LncRNA (mRS 0-1 points) (mRS 0-2). LncRNA SNHG14 had an AUC of 0.714 (80%, 61.18%) when used to identify AIS in TIA patients, and a comparable finding was seen when predicting a poor 30-day prognosis of AIS (73%, 66.67%). There are also graphical representations of the findings. Improvements in NIHSS and mRS scores were associated with increases in SNHG14 LncRNA mRNA levels in individuals diagnosed with AIS. It is critical that we focus entirely on this decision (all p < 0.05). Analysis of the long non-coding RNA known as SNHG14 in the patient's blood can be used to diagnose AIS, rule out TIA, forecast the intensity of the disease, and evaluate the prognosis. You can accomplish everything on that list simultaneously.

Cardiovascular events following coronavirus disease 2019 vaccination in adults: a nationwide Swedish study.

While the rationale for coronavirus disease 2019 (COVID-19) vaccination is to reduce complications and overall mortality, some cardiovascular complications from the vaccine itself have been demonstrated. Myocarditis and pericarditis are recognized as rare acute adverse events after mRNA vaccines in young males, while evidence regarding other cardiovascular events remains limited and inconsistent. This study assessed the risks of several cardiovascular and cerebrovascular events in a Swedish nationwide register-based cohort. Post-vaccination risk of myocarditis/pericarditis, dysrhythmias, heart failure, myocardial infarction, and cerebrovascular events (transient ischaemic attack and stroke) in several risk windows after each vaccine dose were assessed among all Swedish adults (n = 8 070 674). Hazard ratios (HRs) with 95% confidence intervals (95% CIs) compared with unvaccinated were estimated from Cox regression models adjusted for potential confounders. For most studied outcomes, decreased risks of cardiovascular events post-vaccination were observed, especially after dose three (HRs for dose three ranging from .69 to .81), while replicating the increased risk of myocarditis and pericarditis 1-2 weeks after COVID-19 mRNA vaccination. Slightly increased risks, similar across vaccines, were observed for extrasystoles [HR 1.17 (95% CI 1.06-1.28) for dose one and HR 1.22 (95% CI 1.10-1.36) for dose two, stronger in elderly and males] but not for arrhythmias and for transient ischaemic attack [HR 1.13 (95% CI 1.05-1.23), mainly in elderly] but not for stroke. Risk of myopericarditis (mRNA vaccines only), extrasystoles, and transient ischaemic attack was transiently increased after COVID-19 vaccination, but full vaccination substantially reduced the risk of several more severe COVID-19-associated cardiovascular outcomes, underscoring the protective benefits of complete vaccination.

Evaluation of Neutrophil to Lymphocyte Ratio with Neurological Severity and Short-Term Outcome in Acute Ischemic Stroke

Introduction: Stroke represents a significant global health care challenge, ranking as the second most common cause of mortality and disability worldwide. Inflammatory process plays an important role in pathophysiology of acute ischemic stroke. These inflammatory responses increase the brain damage and cause neurological deterioration. Neutrophils and lymphocytes serve as pivotal mediators of inflammatory response. Aims and Objectives: This study aims to evaluate the association between the Neutrophils to lymphocyte ratio (NLR) with the initial severity of stroke and the short-term functional outcome using the NIHSS and BARTHEL index respectively. Materials and Methods: We conducted an observational cross-sectional study on 80 patients admitted at Father Muller Medical College Hospital, which is a tertiary care centre in Mangalore between May 2023 to April 2024. Diagnosis of stroke was based on clinical evaluation and Radiological imaging. Peripheral blood samples were collected for complete blood count within 24 hours of stroke onset. The NLR was determined by dividing the absolute neutrophil count (ANC) to the absolute lymphocyte count (ALC). This was then correlated with the NIHSS and the BARTHEL index. Results: This study included 80 patients, with the mean age of 65.1 years. Majority of the patients were in the age group 51-70years (55%). The mean NLR was found to be 13.39. The mean NIHSS and BARTHEL index was 11.08 and 63.69 respectively. The NLR showed significant correlation with the initial stroke severity and the short-term functional outcomes. For the purpose of correlation NLR was divided into three groups i.e. &gt;3, 3-5 and &gt;5. Patients with higher NLR (&gt;5) were more likely to have a severe stroke and greater dependency. Conversely, those with lower NLR (&lt;3) had a minor stroke and slight dependency. 80% of the patients with severe stroke had a NLR above 5, while 82% of the patients with minor stroke had a NLR below 3 (p value &lt;0.001). This study also found a strong correlation between NIHSS and the BARTHEL index - patients with lower NIHSS and NLR were found to have a better short term function outcome. Conclusion: NLR was found to be significantly associated with the initial severity of stroke and the shortterm functional outcome. Because of its high specificity, low cost, routine use NLR can be used for the prediction of severity of stroke and patients can be prioritised for specialised treatment thus reducing the mortality rates.

Antiseizure Medications and Cardiovascular Events in Older People With Epilepsy

How epilepsy may promote cardiovascular disease remains poorly understood. To estimate the odds of new-onset cardiovascular events (CVEs) over 6 years in older people with vs without epilepsy, exploring how enzyme-inducing antiseizure medications (EIASMs) and traditional cardiovascular risk factors mediate these odds. This was a prospective cohort study using the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA), with 6 years of follow-up (2015-2021, analysis performed in December 2023). The CLSA is an ongoing, national study of 51 338 adults aged 45 to 85 years at baseline who are recruited in Canada. The comprehensive cohort includes 30 097 individuals living near 1 of 11 data collection centers. Participation in the CLSA was voluntary; participation rate was 45%. Among those in the comprehensive cohort, individuals reporting no previous history of CVEs (ie, stroke, transient ischemic attack [TIA], or myocardial infarction [MI]) at baseline were excluded. No other exclusion criteria were applied. A total of 86% of participants completed follow-up. Lifetime history of epilepsy. The primary outcome was new-onset CVEs over 6 years. Secondary outcomes were new-onset strokes, TIAs, and MIs. Logistic models were fitted for these outcomes as a function of epilepsy, age, sex, household income, and education level. Mediation analyses were conducted for strong EIASM use, weak EIASM use, Framingham score, Physical Activity Scale for the Elderly (PASE) score, and waist to hip ratio. Among the 30 097 individuals in the comprehensive cohort, a total of 27 230 individuals (mean [SD] age, 62.3 [10.1] years; 14 268 female [52.4%]) were included, 431 with a lifetime history of epilepsy. New-onset CVEs were more likely in epilepsy, with an adjusted odds ratio of 2.20 (95% CI, 1.48-3.27). The proportion of the effect of epilepsy on new-onset CVEs was mediated as follows by each of the following variables: strong EIASM use, 24.6% (95% CI, 6.5%-54.6%), weak EIASM use, 4.0% (95% CI, 0.8%-11.0%), Framingham score, 1.4% (95% CI, -1.6% to 4.5%), PASE score, 3.3% (95% CI, 1.4%-6.8%), and waist to hip ratio, 1.6% (95% CI, 0.4%-3.7%). Results of this cohort study reveal that epilepsy was associated with new-onset CVEs. Nearly one-third of this association can be explained by EIASMs. These findings should be considered when choosing an antiseizure medication for a person at risk for cardiovascular disease.

Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial.

Chronic kidney disease (CKD) is associated with a substantial risk of progression to end-stage renal disease and vascular events. The nonsteroidal mineralocorticoid receptor antagonist (MRA), finerenone, offers cardiorenal protection for people with CKD and diabetes, but there is uncertainty if the steroidal MRA, spironolactone, provides the same protection. In this prospective, randomized, open, blinded endpoint trial, we assessed the effectiveness of 25 mg spironolactone in addition to usual care or usual care alone for reducing cardiovascular outcomes in stage 3b CKD among an older community cohort (mean age = 74.8 years and s.d. = 8.1). We recruited 1,434 adults from English primary care, of whom 1,372 (96%) were included in the primary analysis. The primary outcome was time from randomization until the first occurrence of death, hospitalization for heart disease, stroke, heart failure, transient ischemic attack or peripheral arterial disease, or first onset of any condition listed not present at baseline. Across 3 years of follow-up, the primary endpoint occurred in 113 of 677 participants randomized to spironolactone (16.7%) and 111 of 695 participants randomized to usual care (16.0%) with no significant difference between groups (hazard ratio = 1.05, 95% confidence interval: 0.81-1.37). Two-thirds of participants randomized to spironolactone stopped treatment within 6 months, predominantly because they met prespecified safety stop criteria. The most common reason for stopping spironolactone was a decrease in the estimated glomerular filtration rate that met prespecified stop criteria (n = 239, 35.4%), followed by participants being withdrawn due to treatment side effects (n = 128, 18.9%) and hyperkalemia (n = 54, 8.0%). In conclusion, we found that spironolactone was frequently discontinued due to safety concerns, with no evidence that it reduced cardiovascular outcomes in people with stage 3b CKD. Spironolactone should not be used for people with stage 3b CKD without another explicit treatment indication. ClinicalTrials.gov registration: ISRCTN44522369 .

The Draw-a-Person Test in Neuropsychological Assessment

The Draw-a-Person test (former Draw a Man test) comes from the intelligence diagnostics of children, but the procedure also gives a wealth of interesting results in patients with brain damage. Goal: The aim of the study was to investigate to what extent drawing ability is impaired in people with brain damage and how strong the connection is with other neuropsychological investigations. Methods: The result of the Draw-a-Person test (DAPT) was compared with the: Mini-Mental Status Examination, Verbal Learning and Memory Test, Number Connection Test, “Personalities” test from Kaufmann's Test battery, Hooper's Visual Organization Test and Mosaic test of the Hamburg Wechsler intelligence Scale. Participants: The data was collected as part of a field study in a clinic for Neurology and a neuropsychological practice, so there are often only preliminary diagnoses. Since this study is about the correlations of the tests only, differences in diagnosis are not considered as a bias. For the present study, the data from a total of 50 patients (mean age 70.2 ±13.0 years, 24 males, 26 females) were evaluated. The patients suffered from: stroke (n=19), dementia (n=10), traumatic brain injury (n=5), transient ischemic attack (n=4), heart attack (n=3), encephalitis (n=2), Parkinson's disease (n=2), cerebral hemorrhage (n=1), other diagnoses (n=4, e.g. vitamin-B12 deficiency, seizures, confusion). Results: The correlations to the DAP-Test were: Mini-Mental Status Examination Rho=0.66*; Verbal Learning and Memory Test 1st round: Rho=0.34*; 5th round: Rho=0.44*; 6th round: Rho=0.23 (n.s.); 7th round: Rho=0.30 (n.s.); Number Connection Test Rho= -0.29*; “Personalities” test Rho = 0.44*; Hooper’s Visual Organization Test Rho = 0.61*; Mosaic Test Rho = 0.57*. Conclusion: The DAP test is an easy-to-perform procedure that only takes a few minutes and is very economical. The test gives initial indications for many visual-constructive deficits as e.g. neglect, visual agnosia and correlates significantly with many other neuropsychological instruments.

Patent Foramen Ovale and Other Cardiopathies as Causes of Embolic Stroke With Unknown Source.

In patients with stroke caused by cardiac embolism, the responsible heart diseases include atrial fibrillation, acute myocardial infarction, sick sinus syndrome, valvular disease, and significant heart failure. When there is no clear source of the embolism, the condition is referred to as "embolic stroke with unknown source (ESUS)." Recent studies have shown that the most common cause of ESUS is a right-to-left cardiac shunt through a patent foramen ovale (PFO). However, considering that PFOs are found in up to 25% of the general population, their presence does not necessarily indicate causality. In patients with ESUS associated with a PFO, either anticoagulants or antiplatelets are used for the prevention of future strokes or transient ischemic attacks. However, it currently remains unclear which treatment is superior. Nevertheless, recent randomized clinical trials have shown that percutaneous closure of the PFO more effectively reduces the incidence of recurrent strokes compared to medical therapy alone in patients with PFO-related strokes. This benefit is especially significant when the PFO carries high-risk features, such as a large shunt or the presence of an atrial septal aneurysm. Furthermore, the effectiveness of PFO closure has been well documented in young patients (<60 years) with a high-risk PFO development. In other cases, the therapeutic decision should be made through discussion among neurologists, cardiologists, and patients. Notably, in ESUS patients without a PFO, the underlying heart condition itself may be the source of embolism, with left atrial enlargement being the most important factor. Theoretically, anticoagulants such as non-vitamin K antagonist oral anticoagulants (NOACs) would be an effective therapy in these cases. However, recent trials have failed to show that NOACs are superior to antiplatelets in preventing further strokes in these patients. This may be due to the still uncertain definition of emboligenic cardiopathy and the presence of other potential embolic sources, such as mild but emboligenic arterial diseases. Overall, further research is needed to elucidate the source of embolism and to determine an effective management strategy for patients with ESUS.

Neurosarcoidosis presenting as transient ischemic attacks: A Case Report

Sarcoidosis is a multi-organ granulomatous disease of unknown etiology characterized by the presence of non-caseating granulomas. It has the potential to affect multiple organs including the nervous system. Neurosarcoidosis is present in around 5% of sarcoidosis patients. The clinical manifestations of neurosarcoidosis are heterogeneous, as granulomas can affect the brain, spinal cord and peripheral nervous system, separately or in different combinations. We report a case of neurosarcoidosis with pulmonary involvement in a young female patient presented with multiple episodes of transient ischemic attacks (TIAs). She was treated with boluses of cyclophosphamide followed by azathioprine which led to marked clinical and radiological improvement.

Serum Uric Acid Level and its Association with Severity in Acute Ischemic Stroke

Background: Cerebrovascular diseases (CVDs) are a major public health issue around the world. Elevated serum uric acid levels may predict an increased risk for cerebrovascular events particularly acute ischemic stroke. Aim of the study: The aim of our study was to assess the association between serum uric acid level and severity of acute ischemic stroke. Methods: This observational case control study was conducted at the department of Neurology and at the department of Medicine in Dhaka Medical College Hospital from July 2018 to June 2020. This study included 50 acute ischemic stroke patients and 50 age and gender matched healthy controls. Along with the routine investigations, estimation of serum uric acid was done in all participants. The severity of stroke was assessed as per national institutes of health stroke scale (NIHSS). After collection of all the required data, analysis was done by SPSS 23.0. Results: The mean age and distribution of the age in different age group were matched between case and control groups (p=0.607 and 0.763 respectively). The mean age of the ischemic stroke cases was 62.14±9.77 years. The mean NIHSS score of the patients was 16.34±10.34. Of all, 18% had minor stroke, 32% had moderate stroke, 20% had moderate to severe stroke and 30% had severe stroke. Among stroke patients 58% had elevated uric acid level and among controls 20% had raised uric acid in serum. The number of patients having elevated serum uric acid is statistically significantly higher in case group than control group (p&lt;0.001). Multivariate regression analysis showed hypertension (OR 4.046; 95% CI 1.432–11.432; p=0.008), DM (OR 3.063; 95% CI 1.030-9.105; p=0.044), dyslipidemia (OR 3.031; 95% CI 1.062-8.654; p=0.038) and elevated serum uric acid level (OR 6.019, 95% CI 2.220–16.317; p&lt;0.001) independently associated with acute ischemic stroke (p&lt;0.05). Conclusion: This study shows elevated serum uric acid level significantly associated with severity of acute...........

Prognostic significance of microalbuminuria in non-diabetic patients with acute ischemic stroke

Microalbuminuria (MA) is nowadays recognized as an independent risk factor for ischemic stroke. In our study we investigate MA in acute ischemic stroke without diabetes and it’s correlation with severity of stroke. This is a prospective observational study done on 50 patients with non diabetic ischemic stroke. All the patients were subjected to a detailed history, clinical examination, biochemical and radiological investigations and assessment of the National Institutes of Health Stroke Scale (NIHSS) for grading the severity of ischemic stroke with the measurement of microalbuminuria. Cases with a mean NIHSS of 26 ± 11.418 were positive for MA, while cases with a mean NIHSS of 12.85 ± 9.06 were negative for MA, indicating that higher NIHSS were positive for MA. The relationship between MA and NIHSS was statistically significant (p &lt;0.0001). At admission, the mean NIHSS Score for Minor stroke patients was 3.55556 ± 0.527, while 14.3125 ± 0.4787 for moderate stroke cases, 19.0769 ± 1.605 for moderate to severe stroke, and 38.4545 ± 0.478 for severe stroke patients. The correlation between microalbuminuria and NIHHS score is 0.650, with a significant p-value of 0.0001. MA was associated with the severity of cerebral infarction at admission and clinical outcomes 1 month after onset, and it could be used as a potential indicator of poor prognosis in patients with ischemic stroke.

An Audit of Carotid Dopplers in Sligo University Hospital

Abstract Background Stroke is a common and often disabling condition impacting thousands of individuals in Ireland annually 1. Timely screening for underlying etiologies is important in all patients presenting with stroke or transient ischaemic attack (TIA) to reduce recurrence risk. Carotid artery disease is frequently implicated as the cause 3. The 2023 National Clinical Guideline for Stroke for the United Kingdom and Ireland recommends carotid imaging be completed within one week of diagnosis of ischemic stroke or TIA for patients in whom potential carotid intervention would be appropriate. We aimed to assess the timing of Carotid Doppler scans in our hospital for patients presenting clinically with stroke or TIA. Methods The National Integrated Medical Imaging System (NIMIS) was used to generate a list of patients that had a Carotid Doppler scan over a six- month period (1st July 2022 to 31st December 2022). NIMIS was also used to identify the indication, setting, requesting department and timeliness of scans. Results A total of 96 Carotid &amp; Vertebral Dopplers were performed. Majority of studies were performed on males (65%). The mean age of patients was 70 (±11.5) years. Most studies (55%) were done in an inpatient setting. Of all Carotid Dopplers performed, 94 (97%) had an appropriate indication. With regards to timeliness of carotid imaging, the median time from order to study completion varied between inpatients [2 days (IQR 1-3)] and outpatients [16 days (IQR 9-38)]. The majority (95%) of inpatient studies were completed within 7-days of order, while only 14% of outpatient studies were performed in this timeframe. Of the untimely outpatient scans done to investigate stroke or TIA, 2/33 (6%) had significant carotid stenosis. Conclusion Majority of Carotid Dopplers were done for appropriate indications. While inpatients studies were largely done in a timely manner, there is a significant delay in the completion of most outpatient studies.

Effects of white matter hyperintensity burden on functional outcome after mild versus moderate-to-severe ischemic stroke

It is uncertain whether the prognostic power of white matter hyperintensity (WMH) on post-stroke outcomes is modulated as a function of initial neurological severity, a critical determinant of outcome after stroke. This multi-center MRI study tested if higher WMH quintiles were associated with 3-month poor functional outcome (modified Rankin Scale ≥ 3) for mild versus moderate-to-severe ischemic stroke. Mild and moderate-to-severe stroke were defined as admission National Institute of Health Stroke Scale scores of 1–4 and ≥ 5, respectively. Mean age of the enrolled patients (n = 8918) was 67.2 ± 12.6 years and 60.1% male. The association between WMH quintiles and poor functional outcome was modified by stroke severity (p-for-interaction = 0.008). In mild stroke (n = 4994), WMH quintiles associated with the 3-month outcome in a dose-dependent manner for the 2nd to 5th quintile versus the 1st quintile, with adjusted-odds-ratios (aOR [95% confidence interval]) being 1.29 [0.96–1.73], 1.37 [1.02–1.82], 1.60 [1.19–2.13], and 1.89 [1.41–2.53], respectively. In moderate-to-severe stroke (n = 3924), however, there seemed to be a threshold effect: only the highest versus the lowest WMH quintile was significantly associated with poor functional outcome (aOR 1.69 [1.29–2.21]). WMH burden aggravates 3-month functional outcome after mild stroke, but has a lesser modulatory effect for moderate-to-severe stroke, likely due to saturation effects.

A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform

Abstract Background Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management. Methods An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform. Results A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform. Conclusion Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.

Diagnostic Challenges in Identifying Atrial Myxoma as a Cause of Transient Ischemic Attacks: A Case Report

Abstract Background A 67-year-old woman presented to hospital on multiple occasions with transient neurological symptoms over a period of 20 months. Initial diagnostics, including computed tomography (CT), carotid Dopplers, and electrocardiogram, were unremarkable. Magnetic resonance imaging (MRI) was arranged following the third neurological event which revealed multi-territory acute ischemic events, suggestive of a cardioembolic source. Transoesophageal echocardiography identified a large mobile atrial myxoma, histologically confirmed. Atrial myxoma, though rare, is an important cause of thromboembolic stroke, underscoring the need for comprehensive cardiac evaluation in cerebrovascular incidents. Methods The patient's case was reviewed, focusing on initial presentations, diagnostic workup, and subsequent management. Initial presentations included transient visual disturbances and transient leg weakness. Routine tests were conducted, including CT brain, carotid Dopplers, and blood tests. MRI and transoesophageal echocardiography were performed which ultimately identified the underlying cause of the patient’s neurological events. Results Initial evaluations (CT, carotid Dopplers) were normal. An MRI performed 20 months after her initial presentation revealed small acute infarcts in the right cerebellar hemisphere and left superior parietal lobe. Transoesophageal echocardiography subsequently detected a large atrial myxoma. The patient's transient symptoms and negative initial workup delayed the diagnosis, highlighting the necessity of including cardiac imaging early in the stroke workup, especially in cases of suspected cardioembolic events. Conclusion This case illustrates the critical role of thorough cardiac evaluation, including echocardiography, in diagnosing the cause of transient ischemic attacks (TIA) and strokes. The patient’s initial negative findings delayed the identification of a cardioembolic source, emphasizing the importance of comprehensive diagnostic protocols for suspected cerebrovascular events. Urgent surgical resection is essential for atrial myxoma to prevent recurrent embolic events. This report highlights the diagnostic and management challenges of cardiac myxomas, advocating for a more rigorous approach to stroke evaluation and timely intervention.

Preventability of ischemic stroke/transient ischemic attack in a tertiary care center in Argentina

IntroductionCardiovascular disease remains a leading cause of morbidity and mortality worldwide, with many individuals presenting with acute ischemic stroke or transient ischemic attack (AIS/TIA) due to underlying vascular risk factors (VRF). While these patients typically undergo routine evaluations for acute treatment, the prevention of these conditions is often underestimated. This study reports the prevalence of non-optimized VRF and estimates their degree of avoidability in a cohort of patients treated in a tertiary care center following AIS/TIA. MethodsThis retrospective study enrolled patients older than 18 years who experienced AIS/TIA over a two-year period. Preventability was defined as the degree to which an acute cerebrovascular event could have been prevented if the VRF had been appropriately treated. Using the variables determined at the onset of AIS or TIA, we developed a 10-point scale to classify the degree of preventability (not preventable [score of 0], low preventability [score of 1–3], and high preventability [score of 4 or higher]). We further defined sub-scores based on the effectiveness of treatment of high blood pressure [HBP] (0-2 points), dyslipidemia [DLP] (0-2 points), atrial fibrillation [AF] (1 point), active smoking [AS] (1 point), obesity (1 point), previous coronary heart disease [CHD] (1 point), and previous AIS/TIA (2 points). Demographic factors, etiologies, and imaging findings were evaluated, tabulated independently, and subsequently correlated with clinical findings extracted from the available patient records. ResultsOf the 395 patients (334 with AIS and 61 with TIA), 376 (95.19 %) exhibited some degree of preventability, whereas 19 (4.81 %) presented with a nonpreventable event. In total, 296 (74.94 %) presented a low preventable event, and 80 (20.25 %) presented a high preventable event. Applying the Chi-square test of independence to stroke etiology highlighted cardio-aortic embolism and large artery atherosclerosis as groups with a significantly higher burden of risk factors necessitating intervention, while patients with stroke of other etiologies had more adequate control of VRF. In terms of stroke severity, as determined by the National Institutes of Health Stroke Scale (NIHSS), patients with NIHSS scores >5 were more likely to experience preventable events. According to the ABCD2 score, higher risk scores were significantly associated with a higher preventive factor burden; however, age, sex, vascular territory, and Canadian TIA scores were not related to the prevention of AIS/TIA. ConclusionsThe high percentage of preventable events reflects the need to study other factors that may contribute to unhealthy lifestyles in this population. Potential reasons for poor health include high levels of stress, sleep deprivation, working conditions and an unhealthy diet. Further studies are required to better understand these phenomena.

Medical Management of Acute Stroke based on Japan Stroke Society Guidelines and the Japan Stroke Data Bank.

Stroke is a leading cause of death and disability in Japan, necessitating standardized treatment guidelines. The Japan Stroke Society (JSS) periodically revises its guidelines to incorporate new research. This review provides a short overview of acute stroke management based on JSS Guideline 2021 (revised 2023) and the Japan Stroke Data Bank (JSDB), and discusses future directions in stroke management. Acute stroke management emphasizes systemic support and complication management. Risk factor control during acute hospitalization is also crucial for preventing recurrent strokes in the chronic phase.In ischemic stroke, super-acute recanalization therapies, including intravenous thrombolysis and mechanical thrombectomy, are the most important and effective. Antiplatelet therapy, particularly aspirin and clopidogrel, is recommended for noncardiogenic stroke and high-risk transient ischemic attack. In cardioembolic stroke, early initiation of direct oral anticoagulants might be considered according to stroke severity.For brain hemorrhage, early blood pressure management is recommended. Specific reversal agents are advised for patients on anticoagulant therapy. Minimally invasive hematoma removal may improve outcomes for intracerebral hemorrhage.Subarachnoid hemorrhage treatments reported from Japan include intravenous drugs to prevent vasospasm.The JSDB revealed improvements in functional outcomes in patients with ischemic stroke over the past 20 years, although patients with hemorrhagic stroke showed no clear improvement. The evolving guidelines and research underscore the importance of stratified and timely intervention in stroke care.

Recurrent Ischemic Stroke and Transient Ischemic Attack: Risk of Single and Multiple Recurrence.

Background/Objectives: Efforts have been made toward primary or secondary stroke or transient ischemic attack (TIA) prevention. However, little attention has been paid to recurrent stroke or TIA. This study investigated risk factors for multiple or single recurrent stroke or TIA. Methods: Data from 3646 patients with ischemic stroke or TIA were obtained from the Korea University Ansan Hospital Stroke Center between March 2014 and December 2021, using the prospective institutional database of the Korea University Stroke Registry. The associations between clinical features and recurrent stroke or TIA were assessed using bivariable and multivariable Cox models. Results: Recurrent stroke or TIA was associated with male sex (adjusted hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.42-2.80), hypertension (HR 1.49, 95% CI 1.00-2.23), diabetes mellitus (HR 1.54, 95% CI 1.13-2.13), an etiologic subtype of transient ischemic attack (HR 1.88, 95% CI 1.09-3.16), white matter changes (HR 1.62, 95% CI 1.05-2.38), and cerebral microbleeds (HR 1.79, 95% CI 1.26-2.59). Multiple recurrent stroke or TIA was associated with male sex (HR 3.86, 95% CI 1.94-11.55), diabetes mellitus (HR 2.40, 95% CI 1.31-4.53), and anemia (HR 4,58, 95% CI 2.31-10.44). Conclusions: Given the risk factor profiles for recurrent stroke or TIA, risks differed among patient subgroups and were based on multiple or single recurrences. It may exert an effect as a prognostic indicator in the high risk of recurrences.

Fractalkine/CX3CR1 axis is critical for neuroprotection induced by hypoxic postconditioning against cerebral ischemic injury

Microglial activation-mediated neuroinflammation is a major contributor to neuronal damage after cerebral ischemia. The Fractalkine (FKN)/CX3C chemokine receptor 1 (CX3CR1) axis plays a critical role in regulating microglial activation and neuroinflammation. The aim of this study is to ascertain the role and mechanism of FKN/CX3CR1 axis in hypoxic postconditioning (HPC)-induced anti-inflammatory and neuroprotective effects on transient global cerebral ischemia (tGCI). We found that HPC suppressed microglial activation and alleviated neuroinflammation in hippocampal CA1 after tGCI. Meanwhile, HPC upregulated the expression of FKN and CX3CR1 in neurons, but it downregulated the expression of CX3CR1 in glial cells after tGCI. In addition, the overexpression of FKN induced by the administration of FKN-carried lentivirus reduced microglial activation and inhibited neuroinflammation in CA1 after tGCI. Furthermore, silencing CX3CR1 with CX3CRi-carried lentivirus in CA1 after tGCI suppressed microglial activation and neuroinflammation and exerted neuroprotective effects. Finally, the overexpression of FKN caused a marked increase of neuronal CX3CR1 receptors, upregulated the phosphorylation of Akt, and reduced neuronal loss of rats in CA1 after tGCI. These findings demonstrated that HPC protected against neuronal damage in CA1 of tGCI rats through inhibiting microglial activation and activating Akt signaling pathway via FKN/CX3CR1 axis.

Neuroprotective effects of Gastrodia elata Blume on promoting M2 microglial polarization by inhibiting JNK/TLR4/T3JAM/NF-κB signaling after transient ischemic stroke in rats.

Gastrodia elata Blume, also called Tian Ma (TM), has been used to treat stroke for centuries. However, its effects on inflammation in acute cerebral ischemic injury and underlying mechanisms involved in microglial polarization remain unknown. The present study explored the effects of the TM extract on the modulation of microglial M1/M2 polarization 2days after transient cerebral ischemia. Male Sprague Dawley rats were intracerebroventricularly administered with 1% dimethyl sulfoxide 25min before cerebral ischemia and subsequently intraperitoneally administered 0.25g/kg (DO + TM-0.25g), 0.5g/kg (DO + TM-0.5g), or 1g/kg (DO + TM-1g) of the TM extract after cerebral ischemia onset. DO + TM-0.5g and DO + TM-1 g treatments downregulated the following: phospho-c-Jun N-terminal kinase (p-JNK)/JNK, tumor necrosis factor (TNF) receptor-associated factor 3 (TRAF3), TRAF3-interacting JNK-activating modulator (T3JAM), p-nuclear factor-kappa B p65 (p-NF-κB p65)/NF-κB p65, ionized calcium-binding adapter molecule 1 (Iba1), CD86, TNF-α, interleukin (IL)-1β, and IL-6 expression and toll-like receptor 4 (TLR4)/Iba1, CD86/Iba1, and p-NF-κB p65/Iba1 coexpression. These treatments also upregulated IL-10, nerve growth factor, and vascular endothelial growth factor A expression and YM-1/2/Iba1 and IL-10/neuronal nuclei coexpression in the cortical ischemic rim. The JNK inhibitor SP600125 exerted similar treatment effects as the DO + TM-0.5g and DO + TM-1 g treatments. DO + TM-0.5g and DO + TM-1 g/kg treatments attenuate cerebral infarction by inhibiting JNK-mediated signaling. TM likely exerts the neuroprotective effects of promoting M1 to M2 microglial polarization by inhibiting JNK/TLR4/T3JAM/NF-κB-mediated signaling in the cortical ischemic rim 2days after transient cerebral ischemia.

Role of inpatient rehabilitation facility functional measures to predict community discharge after stroke.

This study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and community discharge from IRF. Aim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF-PAI self-care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF-PAI admission functional measures to predict community discharge from IRF after stroke. Retrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019. Academic hospital-based IRF. Five hundred forty-four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hoursof IRF admission. Not applicable. Admission IRF-PAI self-care and mobility scores and discharge status from IRF. Of the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF-PAI admission self-care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF-PAI admission mobility score. IRF admission self-care and mobility scores were each statistically significant predictors of community discharge (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.03-1.17; OR = 1.10, CI: 1.03-1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47-1.04) from IRF. IRF-PAI self-care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF-PAI self-care and mobility measures each predict community discharge.