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Objective To respectively analyze the patterns and possible predictors of recurrent strokes among patients with initial ischemic stroke.Methods Three hundred and sixty-one patients with recurrent strokes (acute ischemic stroke or intracerebral hemorrhage) after initial ischemic strokes were collected from Jan 2004 to Dec 2009.The data about conventional risk factors such as smoking,heavy alcohol drinking,hypertension,diabetes,hyperlipidemia,heart diseases,head trauma,migraine,family history of cardiovascular disease,and the use of preventive medications were collected and analyzed among patients with different types of recurrent strokes.Results Patients (n =361) were divided into ischemic stroke group (n =321) and hemorrhagic stroke group (n =40) according to the recurrent stroke type.The ischemic stroke group was further divided into the anterior circulation stroke subgroup (n =234),the posterior circulation stroke subgroup (n =75) and watershed cerebral infarction or multiple infarction subgroup (n =12).Multivariate logistic regression analysis revealed that older age at initial stroke onset (OR =1.036,95 ％ CI 1.006-1.067,P =0.02) and hyperlipidemia (OR =2.253,95 ％ CI 1.092-4.647,P =0.028) were both the independent risk factors for the recurrent ischemic stroke.Comparing the subgroups,multivariate logistic regression analysis showed that atrial fibrillation (OR =4.217,95％ CI 1.489-11.942,P =0.007) was the independent risk factor for the recurrent ischemic stroke in the posterior circulation territory.Conclusion Aging and hyperlipidemia are possible predictors of recurrent ischemic stroke after the initial ischemic stroke which would be useful for individualized secondary prevention of stroke.
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Objective To compare distribution difference in risk factors of patients with first-ever ischemic stroke (IS) of different age and gender.Methods A total of 1027 patients admitted to the neurological department in Shanghai Renji Hospital with first-ever IS were recruited and divided into young adult group ( ＜ 50 years old),middle-aged group (50-80 years old),and very old group ( ＞ 80 years old)according to their ages.Risk factor analysis included history of smoking,high alcohol consumption,hypertension (HT),diabetes mellitus (DM),heart diseases,atrial fibrillation (AF) and family history of cardiovascular diseases.Results Female patients were globally older than male patients (71.1 vs 65.7,P ＜ 0.001 ) at the first attack of IS and having higher prevalence of DM (26.8％ vs 19.2％,P =0.004 ),heart diseases (28.8％ vs 19.2％,P＜0.001) and AF (7.6％ vs 3.9％,P=0.009).However,female patients were less likely to drink heavily ( 1.0％ vs 31.6％,P ＜0.001 ) or smoke (4.4％ vs 59.9％,P ＜0.001 ) than the male patients.The rates of smoking and heavy drinking in young adult group were higher than that in other two groups.Patients in very old group had higher prevalence of heart diseases and AF but lower proportion of positive family cardiovascular diseases history than patients in other two groups.HT and DM were equally frequent among three groups.In young adult group,female patients were more likely to have heart diseases and family history of heart diseases (P =0.015 and P =0.048).In middle-old group,HT,DM,heart disease and AF were more common in women than in men (P =0.021,P =0.004,P =0.001 and P =0.039).Conclusion There are differences in risk factor distribution in patients with first-ever IS of different age and gender.Therefore,screening and health education should be performed in allusion to different risk factors.
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Objective To describe the impact of stroke clinic on the usage of statins for secondary prevention of ischemic stroke.Methods Data about the demography, social economic status, personal histories, blood lipid profiles, and the status of the usage of statins from 568 serial ischemic stroke patients were retrospectively analysed.Results A total of 51.3% patients followed up in stroke clinic ( 306 patients) and 7.6% patients followed up in general clinic (262 patients) were treated with statins.71.6% patients with and 44.8% patients without hyperlipidemia in stroke clinics were taking statins, which were higher than that patients in the general clinics(27.1% and 2.0% respectively).The patients in the stroke clinics with high LDL-C level ( ＞ 3.4 mmol/L) were more likely to be treated with statins than those with lower level (25.6% vs 14.7%, P = 0.017).Conclusions The rate of statins usage is extremely low in stroke patients followed up in a general clinic, but it can been improved greatly in a stroke clinic.Stroke clinic can narrow the gap between the clinical practice and the guideline for secondary prevention of ischemic stroke.
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Objective To investigate the relationship between the acute phase blood glucose and the severity and prognosis of stroke in patients with stroke. Methods One hundred seventy-three consecutive patients with acute stroke were randomly allocated into either a hyperglycemia group (n =72) or a normal group (n = 101) according to whether their random blood glucose levels were > 7.8 mmol/L or not. The average time from stroke onset to admis-sion was 6.5 ± 5.1 hours. The patients were evaluated by the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Stroke (GCS) scores within 20 minutes after clinical reception, The plasma blood glucose detection and bead CT scan were completed in 40 minutes.The patients with cerebral infarction were classified according to the Oxfordshire Community Stroke Project (OCSP) criteria, and the survivors were evaluated by the modified Rankin scale (mRS) after 3 months. Results There were no significant differences between the two groups in age, gender, vascular risk factors, stroke property and treatment principle. There were significant differences between the NIHSS and GCS at the first admission and the mRS scores at 3 months (P<0.01). The proportion of the patients with the history of diabetic mellitus in the random hyperglycemia group was significantly higher than that in the normal group (P<0.01).The random blood glucose levels were not correlated with the severity of stroke between the 2 groups of patients with the history of diabetes mellitus; the increased random blood glucose levels were significantly correlated with the severity and prognosis of stroke between the 2 groups of patients without the history of diabetes mellitus (P<0.01). Conclusions The increased blood glucose in patients with stroke without the history of diabetes mellitus in acute phase is an independent risk factor for the severity and prognosis. The increased random blood glucose in patients with stroke in acute phase may also suggest having the history of diabetes mellitus.
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Objectives To identify the prevalence and risk factors that were associated with poststroke cognitive impairment(PSCI)among a large cohort of consecutive ischemic stroke patients.Methods 526 consecutive patients.who had suffered from ischemic stroke 3 months ago were recruited in this study. Patients were classified as having no cognitive impairment(NCI),cognitive impairment but no dementia (CIND)and vascular dementia(VaD)according to their cognitive function.They were also categorized as with subcortical ischemic vascular diseases(SIVD)or cortical ischemic vascular diseases(CIVD)with neuroimaging findings.Their demographic data.vascular risk factors and stroke characteristics were also dacumented.Results The overall prevalence of PSCI(CIND+VaD)Was 36.7%.Compared with the NCI subjects.PSCI SObjects were older,more dominant femininely,less educated,with more cases of right hemi-paralysis and higher depression scores.but did not have more specific vascular risk factor.Separately,VaD patients demonstrated lower economic level,less spouse-caring,more prevalence of dysphasia,hisher rate of incontinence and more cases with CIVD.while CIND patients had more cases with SIVD.The VaD patients had more cortical lesions and lower depression scores than the CIND patients.On logistic regression analysis,older age,female gender,lower economic level,dysphasia,SIVD,CIVD and hisher depression scores were independent risk factors for PSCI.ConclusionPSCI is common among ischemic stroke patients and related to demographic factors.stroke types,and depression.