Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study

Abstract BACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.

Hypointensity on Susceptibility-Weighted Images Prior to Signal Change on Diffusion-Weighted Images in a Hyperacute Ischemic Infarction: a Case Study

Susceptibility-weighted imaging (SWI) is well known for detecting the presence of hemorrhagic transformation, microbleeds and the susceptibility of vessel signs in acute ischemic stroke. But in some cases, it can provide the tissue perfusion state as well. We describe a case of a patient with hyperacute ischemic infarction that had a slightly hypodense, patchy lesion at the left thalamus on the initial SWI, with a left proximal posterior cerebral artery occlusion on a magnetic resonance (MR) angiography and delayed time-to-peak on an MR perfusion performed two hours after symptom onset. No obvious abnormal signals at any intensity were found on the initial diffusion-weighted imaging (DWI). On a follow-up MR image (MRI), an acute ischemic infarction was seen on DWI, which is the same location as the lesion on SWI. The hypointensity on the initial SWI reflects the susceptibility artifact caused by an increased deoxyhemoglobin in the affected tissue and vessels, which reflects the hypoperfusion state due to decreasing arterial flow. It precedes the signal change on DWI that reflects a cytotoxic edema. This case highlights that, in some hyperacute stages of ischemic stroke, hypointensity on an SWI may be a finding before the hyperintensity is seen on a DWI.

Discussion on differences of Chinese medicine syndromes evolution regularity between acute stroke patients with and without hypertension / 国际中医中药杂志

Objective To discuss evolution regularity of Chinese Medicine Syndromes and neurological impairment of acute stroke patients with and without hypertension,and to contrast differences between the two groups.Methods Case observation table of ＂Clinical diagnosis and treatment of stroke patients dialectical law mining and verification of the program of treatment was adopted to record clinical diagnostic messages of 63 cases of non-hypertension and hypertension acute stroke patients.Results ①Contrasting syndrome dements between the two groups it showed that on the tenth day,scores of yin deficiencyin non-hypertension group score (12.83 ±9.97) increased significantly than hypertension group score (8.64±5.90) with statistical significance (P＜0.05) ; on the fourteenth day,scores ofblood deficiency in hypertension group score (12.21±7.71)increased significantly than non-hypertension group score (8.07±8.61),with statistical significance (P＜0.05).② In hypertension group,from the first day to the fourteenth day of admission,scores of wind,hot and phlegm gradually reduced,but scores of blood deficiency gradually score (9.85 ±7.23) increased,with statistical significance.In non-hypertension group,from the first day to the fourteenth day of admission,scores of wind,hot and phlegm gradually reduced,but scores of yin deficiency gradually score (12.21±7.71)increased,with statistical significance (P＜0.05).Conclusion Hypertension turns blood defiency more prominent in evolution of Chinese medicine syndromes of stroke.

The therapeutic effects of neuromuscular electric stimulation on patients with swallowing disorders after stroke / 中华物理医学与康复杂志

Objective To investigate the clinical therapeutic effects of neuromuscular electric stimulation (NMES) on patients with swallowing disorders after stroke. MethodsA total of 98 patients with a swallowing disorder after stroke were randomly divided into an NMES group (38 cases),a rehabilitation group (30 cases) and a control group (30 cases).In the control group the patients were treated with medication only; the in rehabilitation group they were treated with medication and swallowing rehabilitation training; in the NMES group they were treated with medication and NMES.The treatments lasted for 3 weeks in all groups.The swallowing function of patients in each group were observed and assessed with dysphagia scoring pre-and post-treatment.Complications of the swallowing disorders,side effects of treatment and the stomach tube leaving rate were observed. ResultsAfter treatment,the dysphagia scores of patients in the NMES and rehabilitation groups both increased,but the average scores in the NMES group were significantly higher than in the rehabilitation and control groups.The difference in therapeutic effect between the three groups was statistically significant.After treatment,the incidence of aspiration pneumonia in the NMES group was significantly lower than that in the control and rehabilitation groups.The average stomach tube leaving rate in the NMES group was significantly lower than that in the control group,but there was no significant difference in stomach tube leaving rates between the rehabilitation group and the NMES group.There was no significant difference among the three groups in malnutrition.No side effect was observed in any group.Conclusions NMES could alleviate post-stroke dysphagia and decrease the incidence of aspiration.The short-term therapeutic effect of NMES was better than that of swallowing rehabilitation training,but the long-term therapeutic effects were about the same in the two groups.

Effect of Scalp Acupuncture Combined with Cognitive Training on Cognitive Function of Acute Stroke Patients / 中国康复理论与实践

@#Objective To observe the effect of scalp acupuncture combined with cognitive training on the cognitive function of stroke patients in the acute stage. Methods 68 stroke patients with cognitive disorder were divided into the treatment group (n=34) and the control group (n=34). All patients of two groups were treated with routine therapy and cognitive rehabilitation training by professional physiotherapists, but the treatment group were added with scalp acupuncture. They were regularly evaluated with Loewenstein Occupational Therapy Cognition Assessment (LOTCA) before and 2 months after treatment. Results The scores of LOTCA significantly improved in the two groups after treatment (P<0.05), and improvement of the treatment group was better than those of the control group（P<0.05）. Conclusion The scalp acupuncture combined with cognitive training can significantly improve the acute stroke patients with cognitive disorder.

Guideline for intra-arterial thrombolysis of hyperacute ischemic stroke patients: Preliminary Report / 신경중재치료의학

The success of the PROACT II trial has set the standard for IAT therapy of hyperacute ischemic stroke patients. Through this article, the Guideline Committee of the Korean Society of Interventional Neuroradiology aims at presenting a summary of the latest evidence and a generalized guideline for endovascular thrombolytic management of hyperacute ischemic stroke patients. This guideline should be updated periodically to reflect the latest evidence.

Risk Factors for Acute Cardioembolic Brain Stroke in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: An ischemic brain stroke following acute myocardial infarction (AMI) has a poor clinical prognosis, which primarily results from a thromboembolism. We determined the risk factors of acute cardioembolic brain stroke events that developed concurrently with, or soon after, the onset of AMI. SUBJECTS AND METHODS: We evaluated 38 AMI patients, who developed subsequent acute cardioembolic brain stroke during their index admission, by comparing their clinical and angiographic characteristics with those of 1,443 consecutive patients that had not experienced a brain stroke. Strokes that occurred between the onset of the AMI and patient discharge were analyzed. The incidences of cardiovascular risk factors, and the clinical and angiographic characteristics, of patients admitted to Ewha Womans University Mokdong Hospital, with a diagnosis of AMI over a 10-year period, were compared. RESULTS: In the univariate analysis, the frequencies of atrial fibrillation (21% vs. 4%, p=0.011) and hypertension (71% vs. 48%, p=0.030), and a left ventricular ejection fraction <40% (52% vs. 33%, p=0.039) were significantly higher in patients that had had an acute cardioembolic brain stroke. In a logistical regression analysis, atrial fibrillation was found to be a significant contributor to the subsequent development of an acute cardioembolic brain stroke in the AMI patients (p=0.023, beta=2.025, odds ratio=7.6). Mean follow-up period, which was mainly determined as the time to death after the AMI, was shorter in the acute cardioembolic brain stroke patients (8.5 month vs. 24.3 month, p=0.002). The death rate during the mean follow-up period was much higher in these patients (50% vs. 29%). CONCLUSION: We found that the presence of atrial fibrillation at the time of admission for an AMI was associated with an increased risk of a subsequent acute cardioembolic brain stroke.

Hypertension management in acute ischaemic stroke / 医学研究生学报

The blood pressure changes is very common in patients with acute ischaemic stroke.However,the optimal management of the blood pressure in acute ischaemic stroke remains unclear.There is a very important clinical significance on how to manage hypertension in acute ischaemic stroke.The review summarizes recent guidelines on blood pressure management after acute ischaemic stroke.The aim of the review is to expound the treated principle of hypertension in acute ischaemic stroke.