ACV isquémico en población joven: ¿existe un enfoque diferencial del riesgo? / Ischemic stroke in a young population: is there a differential approach to risk factors?

Introducción: El ataque cerebrovascular isquémico en el adulto joven se define como aquel que ocurre en la población entre los 18 y los 55 años, y representa el 15-18 % de todos los ACV isquémicos. Los factores de riesgo en jóvenes son comunes a los encontrados en adultos mayores. El objetivo de este trabajo es describir las características clínicas y los factores de riesgo de una población menor de 55 años con ACV isquémico atendida en un centro de referencia hospitalario en Colombia. Materiales y métodos: Estudio descriptivo, retrospectivo de corte transversal en pacientes entre los 18 y los 55 años; se incluyeron 100 pacientes sobrevivientes a un primer ACV isquémico agudo confirmado por neuroimagen, atendidos entre enero de del 2019 y noviembre del 2021. Resultados: De 1023 pacientes con diagnóstico de ACV isquémico agudo, el 9,8 % fueron adultos jóvenes. La media de edad fue de 45 ± 8,7 años, y el 59 % de estos pacientes fueron hombres. Discusión: Los factores de riesgo "tradicionales" se presentan en la mayoría de los jóvenes con ACV isquémico. La hipertensión arterial se mantiene como el antecedente más frecuente. Las mujeres presentan eventos de mayor severidad y peor desenlace funcional. Conclusión: Los pacientes mayores de 45 años tienen un perfil de factores de riesgo similar a lo observado en adultos mayores con ACV, mientras que en los menores de 45 años se encuentra un perfil de factores de riesgo diferente que plantea un diagnóstico etiológico particular de esta población.

Introduction: Ischemic stroke in young adults is defined as occurring in individuals between the ages of 18 and 55, representing 15-18 % of all ischemic strokes. Risk factors in young adults are similar to those found in older adults. The objective of this study is to describe the clinical characteristics and risk factors of a population under 55 years of age with ischemic stroke treated at a hospital reference center in Colombia. Materials and methods: Descriptive, retrospective cross-sectional study in patients between 18 and 55 years old. A total of 100 patients between 18 and 55 years old who survived a first confirmed acute ischemic stroke, as confirmed by neuroimaging, were included. The study period was from January 2019 to November 2021. Results: Out of 1023 patients diagnosed with acute ischemic stroke, 9.8 % occurred in young adults. The mean age was 45 ± 8.7 years, of which 59 % were male. Discussion: "Traditional" risk factors are present in the majority of young adults with ischemic stroke. Hypertension remains the most common antecedent. Women experience more severe events and worse functional outcomes. Conclusion: Patients over 45 years old have a risk factor profile similar to what is observed in older adults with stroke, while in those under 45, a different risk factor profile is found, which poses a particular etio-logical diagnosis for this population.

Tendencia De Egresos Hospitalarios Con Diagnóstico De Accidente Cerebrovascular Agudo Entre Los Años 2018-2021 En Chile: Análisis Descriptivo / Hospital Discharge Trend With Diagnosis Of Acute Stroke Between The Years 2018 And 2021 In Chile: Descriptive Analysis

Introducción: El accidente cerebrovascular (ACV) es una afección con alta morbimortalidad, producida por la interrupción de la perfusión cerebral. Este artículo tiene como objetivo analizar la tendencia de egresos hospitalarios por ACV agudo en el periodo 2018-2021 en Chile. Metodología: Estudio descriptivo observacional, que incluyó egresos hospitalarios con diagnóstico de ACV agudo en el periodo 2018-2021, en Chile (n=19.274), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calculó la tasa de egreso hospitalario (TEH) según variable, utilizando datos del censo chileno 2017. No requirió comité de ética. Resultados: El 2018 tuvo la mayor TEH por ACV agudo (28,99) y el 2021 la menor (26,39). El grupo de "80 años y más" presenta la mayor TEH, mientras que el de "5-9 años" la menor. La mayor y menor TEH las tienen las regiones de Ñuble (263,00) y Tarapacá (10,29), respectivamente. Discusión: La disminución de TEH durante dicho periodo podría deberse al fortalecimiento de la Ley de Urgencia, al Programa Nacional de Telesalud y el impacto de la reciente pandemia. A mayor edad, aumenta la prevalencia y gravedad de las comorbilidades, lo cual explicaría la mayor TEH en el grupo más longevo. La mayor TEH masculina podría ser porque los hombres presentan mayor cantidad y severidad de factores de riesgo. La mayor TEH en la región del Ñuble posiblemente sea por los elevados niveles de pobreza y ruralidad, y la menor TEH en Tarapacá podría relacionarse con la presencia de una población nacional más joven.

Introduction: Stroke (CVA) is a condition with high morbidity and mortality, produced by the interruption of cerebral perfusion. This article aims to analyze the trend of hospital discharges for acute stroke in the period 2018-2021 in Chile. Methodology: Descriptive observational study, which included hospital discharges with a diagnosis of acute stroke in the period 2018-2021, in Chile (n=19,274), according to data from the Chilean Department of Health Statistics and Information. The hospital discharge rate (HTE) was calculated according to variable, using data from the 2017 Chilean census. No ethics committee was required. Results: 2018 had the highest HTE for acute stroke (28.99) and 2021 the lowest (26.39). The group aged "80 years and older" had the highest TEH, while the group aged "5-9 years" had the lowest TEH. The regions of Ñuble (263.00) and Tarapacá (10.29) have the highest and lowest HTE, respectively. Discussion: The decrease in HTE during this period could be due to the strengthening of the emergency law, the National Telehealth Program and the impact of the recent pandemic. The higher the age, the higher the prevalence and severity of comorbidities, which would explain the higher HTE in the older group. The higher male HTE may be due to the fact that men have a greater number and severity of risk factors. The higher HTE in the Ñuble region is possibly due to the high levels of poverty and rurality, and the lower HTE in Tarapacá would be related to having a younger national population.

Perceived and Actual Risk Factors in Patients with Acute Stroke in South India

Risk perceptions are crucial in understanding people's thoughts about stroke risk and their preventive health behaviours. Management of risk factors plays a vital role in preventing stroke. This study aimed to identify the perceived and actual risk factors in patients with acute stroke. It was a cross-sectional descriptive study conducted in Sri Ramachandra University Hospital, India. A total of 210 in-patients of a stroke unit were included. Patients’ data were obtained by interviewing the patient and /or accompanying family member and by reviewing their medical records using a standard questionnaire. Data were analysed using descriptive and inferential statistics. The median self-perceived risk factor was three. The most commonly perceived risk factor was hypertension (53.8%), followed by stress, diabetes, hyperlipidaemia, alcohol intake, smoking and family history. The perception of risk was low when compared to actual risk (p < 0.016). The patients with coronary heart disease, family history of stroke and congestive heart failure have higher risk of having ischaemic stroke. There was a positive correlation between the actual risk and perceived risk.

Rehabilitación neuromotora en unidades de tratamiento del ataque cerebrovascular / Neuromotor rehabilitation in stroke treatment units

RESUMEN: Introducción: El Ataque Cerebro Vascular (ACV) es la segunda causa de muerte a nivel mundial y primera causa de discapacidad en el adulto. Su complejidad requiere de una atención integral a través de un equipo multiprofesional, implementado en las denominadas Unidades de Tratamiento del Ataque Cerebrovascular (UTAC). Considerando su relevancia e impacto en el pronóstico, es fundamental conocer las acciones desarrolladas en el ámbito de la rehabilitación neuromotora en estas unidades, información que actualmente es limitada. Método: Estudio descriptivo de corte transversal, la muestra fue por conveniencia, participaron 5 kinesiólogos de establecimientos públicos de salud. La recolección de información se realizó con una encuesta en línea enfocada a las acciones que se realiza en la UTAC. El análisis de datos se realizó con STATA 15 y ATLAS TI 8.0. Resultados: El inicio y frecuencia de la rehabilitación neuromotora es variable, ocurre entre las 24 y 48 horas posterior al diagnóstico. Diariamente se realizan entre una a tres sesiones por usuario, su duración varía desde 25 a 90 minutos. Las acciones neuromotoras son de carácter integral y multiprofesional, el abordaje incluye el componente neuromotor, respiratorio y estado cognitivo. Las acciones neuromotoras incorporan técnicas de facilitación de la postura más alta lograda por el usuario y estimulación sensorial, entre otras. Conclusiones: La rehabilitación neuromotora en las UTAC de Chile muestra realidades diferentes en cuanto a la identificación, funcionamiento y la intervención neuromotora.

ABSTRACT Background: Stroke is the second leading cause of death in the world and the first cause of disability in adults. Its complexity requires comprehensive care provided by a multiprofessional team, implemented in the so-called Stroke Treatment Units (STUs). In view of their relevance and impact on the prognosis, identifying activities developed in the framework of neuromotor rehabilitation is of fundamental importance, information which, at present, is not readily available. Methods: Cross-sectional descriptive study, convenience sampling with the participation of 5 kinesiologists from public health centers in Chile. Information was collected by means of an online survey focused on the work being carried out in the STUs. Data analysis was performed using STATA 15 and ATLAS TI 8.0 software. Results: Initiation and frequency of neuromotor rehabilitation is variable and occurs between 24 and 48 hours after diagnosis. Between one and three daily sessions per user are performed and their duration varies from 25 to 90 minutes. Neuromotor activities are integral and multiprofessional; the approach includes neuromotor, respiratory and cognitive components. Neuromotor activities incorporate facilitation techniques for the most advanced user posture achieved and sensory stimulation, among others. Conclusions: Neuromotor rehabilitation in Chile´s STUs shows different realities in terms of identification, functioning and neurokinetic intervention.

Effects of high-protein enteral nutritional preparation on blood glucose levels in acute stroke patients with type 2 diabetes mellitus / 中华临床营养杂志

Objective:To explore the effects of diabetic enteral nutrition preparation with whey protein addition on blood glucose levels in acute stroke patients with type 2 diabetes mellitus (T2DM).Methods:A total of fifty-six acute stroke patients with T2DM were enrolled in this study from January 2020 to May 2021. These patients were randomly divided into the experimental group or the control group. Enteral nutrition were initiated within 24~48 hours after admission. Both groups were given diabetic enteral nutritional preparation while whey protein power was added at 15 g per 500 ml nutrient solution only in the experimental group. Fasting plasma glucose (FPG), 2 hour postprandial blood glucose (2h-PBG), serum albumin, lymphocyte counts, insulin dose, hypoglycemia incidence and the maximal fluctuation of blood glucose were compared between groups before and after intervention.Results:Compared with the control group, 2h-PBG [9.85 (5.9) mmol/L vs 12.95 (2.2) mmol/L, P=0.049] on Day 7 , FPG [(9.71±1.94) mmol/L vs (11.01±2.19) mmol/L, P=0.029] and 2h-PBG [(10.75±2.16) mmol/L vs (12.23±2.21) mmol/L, P=0.019] on Day 15 in experimental group were significantly decreased. The levels of serum albumin [(34.93±4.37) g/L vs (30.11±5.97) g/L, P=0.002] and lymphocyte counts [(1.12±0.50)×10 9 /L vs (0.86±0.29)×10 9 /L, P=0.025] in experimental group were increased significantly. While Insulin usage [2.5 (6) d vs 9 (11) d, P<0.001] and dose [0.06 (0.17) U/(kg·d) vs 0.19 (0.17) U/(kg·d), P=0.002] as well as maximal fluctuation of blood glucose [6.0 (2.1) mmol/L vs 8.4 (6.6) mmol/L, P=0.003] were significantly lower. Conclusion:Increasing the proportion of protein in diabetic enteral nutrition can improve serum albumin level and is beneficial to blood glucose control in acute stroke patients with T2DM, but the underlying mechanisms and effects on long-term prognosis need further exploration.

Evaluation on the effects of multidisciplinary cooperative nutrition management model in acute stroke patients with dysphagia / 中华临床营养杂志

Objective:To analyze the effects of multidisciplinary cooperative nutrition management model in acute stroke patients with dysphagia.Methods:From February 2019 to February 2020, 69 acute stroke patients with dysphagia were enrolled in this study. After exclusion of those unable to complete the trial, patients were randomized into control group ( n=30) and experimental group ( n=30). Patients in the control group were given routine nutrition management, while patients in the experimental group were treated under multidisciplinary cooperative nutrition management model. Nutritional indicators were compared between the two groups on Day 1, 7 and 14 after admission, including levels of albumin (ALB), pre-albumin (PALB), hemoglobin (HB), triceps skin-fold (TSF) thickness on the uninjured side, upper arm muscle circumference etc. Incidence of gastrointestinal complications and infectious complications was also recorded. Results:There was no difference between two groups in the levels of HB, TSF thickness and upper arm muscle circumference on the uninjured side (all P>0.05). However, the serum levels of ALB and PALB on Day 7 and 14 in the experimental group were higher than that in the control group(all P<0.05), The incidence of gastrointestinal complications ( P=0.015)and infectious complications ( P=0.016) in the experimental group was lower than that in the control group. Conclusion:Multidisciplinary collaborative nutrition management improved nutritional indicators, reduced the incidence of gastrointestinal complications and infectious complications in acute stroke patients with dysphagia, making multidisciplinary collaborative nutrition management model worthy of clinical promotion and application.

Wake-Promoting Effect of Bloodletting Puncture at Hand Twelve Jing-Well Points in Acute Stroke Patients: A Multi-center Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To assess the effect and safety of bloodletting puncture at hand twelve Jing-Well points (HTWPs) in acute stroke patients with conscious disturbance.@*METHODS@#In this multi-center and randomized controlled trial, 360 patients suffered from ischemic or hemorrhagic stroke with conscious disturbance within 48 h from the onset of symptom were divided into bloodletting (180 cases) and control (180 cases) groups using a block randomization. Patients in both groups received routine Western medicine, and patients in the bloodletting group received additional bloodletting puncture at HTWPs on admission immediately before conventional treatment. The primary outcome measure was Glasgow Coma Scale (GCS) score and the secondary outcomes included blood pressure, respiratory rate and pulse rate. All variables were evaluated at baseline (before bloodletting), 0 (after bloodletting immediately), 15, 30, 50 and 80 min post bloodletting.@*RESULTS@#At 80 min post bloodletting, the proportion of patients with improved consciousness in the bloodletting group was greater than the control group (P0.05).@*CONCLUSION@#The bloodletting puncture at HTWPs was safe and could improve conscious levels of ischemic stroke patients, highlighting a first-aid intervention for acute stroke. (Registration No. ChiCTR-INR-16009530).

Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience / Dosis reducida de alteplase en el accidente cerebrovascular isquémico después del estudio Enchanted y sus determinantes, una experiencia de un solo centro

Abstract Background: Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability. Objective: We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage. Methods: Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018. Results: 160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient's age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37‒14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98‒32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81‒357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37‒14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10‒0.40) remained independently associated. Conclusions: Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs.

RESUMEN Introducción: Dosis reducidas de trombolitico (LrtPA) podrían no ser inferiores en muerte/discapacidad. Objetivo: Evaluar el porcentaje de pacientes tratados con LrtPA en nuestro centro después del ensayo ENCHANTED, y los factores asociados con el uso de esta dosis. Métodos: Estudio prospectivo de pacientes consecutivos con infarto cerebral ingresados ​entre junio de 2016 y noviembre de 2018. Resultados: 160 pacientes fueron tratados con trombólisis intravenosa, 50% mujeres; edad media 65,4±18,5 años. 48 casos (30%) recibieron LrtPA. En el análisis univariado, LrtPA se asoció con la edad del paciente (p=0,000), escala de Rankin modificadas (mRS) (p<0,000), hipertensión arterial (p=0,076), diabetes mellitus (p=0,021), hipercolesterolemia (p=0,19), tabaquismo (p=0,06), fibrilación auricular (p=0,10), antecedentes de enfermedad coronaria (p=0,06), tratamiento previo con antiplaquetarios (p<0,000), International Normalized Ratio-INR (p=0,18), recuento de plaquetario (p=0,045), leucoaraiosis en neuroimagen (p<0,003), contraindicaciones para el tratamiento trombolítico (p=0,000) y tratamiento endovascular (p=0,027). Las hemorragias previas relevantes fueron determinantes para el tratamiento con LrtPA. El diagnóstico al alta de imitador de accidente cerebrovascular fue significativo (p=0,02) para el tratamiento con dosis estándar. El análisis multivariado demostró que mRS (OR: 2,21; IC95% 1,37‒14,19), tratamiento antiplaquetario previo (OR: 11,41; IC95% 3,98‒32,7), contraindicaciones para trombólisis (OR: 56,1; IC95% 8,81‒357,8), leucoaraiosis (OR: 4,41; IC95% 1,37‒14,1) y un diagnóstico de imitador de accidente cerebrovascular (OR: 0,22; IC95% 0,1‒0,40) fueron asociados con la dosis recibida. Conclusiones: LrtPA está restringido al 30% de nuestros pacientes. Los criterios para tomar esta decisión se basan en variables que podrían aumentar el riesgo de hemorragia cerebral/sistémica o excluir al paciente del tratamiento con fármacos líticos.

Electrolyte disturbances and lipid profiles in ischaemic and hemorrhagic stroke patients in Aisyiyah Bojonegoro Hospital, Indonesia

Background: The prevalence of stroke continues to increase every year. Electrolyte imbalance and metabolic disorder can cause high morbidity and mortality of stroke. There are very few studies conducted on serum electrolytes and lipid levels in stroke patients. Authors aimed to know the electrolyte disturbance and lipid profiles in acute stroke.Methods: Retrospective case analysis was used in this study. Patients who diagnosed with hemorrhagic and ischaemic stroke in Aisyiyah Bojonegoro Hospital from January to September 2019 were selected trough electronic medical records system. Authors examine the electrolyte levels and lipid profiles. Patients with a previous history of stroke, complication that might affect electrolyte level and incomplete data in medical records were excluded. Independent T-test or Mann Whitney test were used to analyze the difference of parameters between hemorrhagic and ischaemic stroke patients. P value was considered as significant at p<0.05.Results: Most common electrolyte imbalance in both hemorrhagic and ischaemic stroke was hypokalemia which is statistically significant. Comparison between stroke patients was statistically significant for mean potassium and high density lipoprotein (HDL), while other mean serum values were not different. Potassium significantly lower (p=0.002) in hemorrhagic stroke and HDL significantly lower (p=0.034) in ischaemic stroke.Conclusions: This study reveals that hypokalemia was higher in hemorrhagic stroke and HDL was lower in ischaemic stroke. Regular monitoring of lipid levels in patients with high risk factors and correction of electrolytes imbalance for stroke patients will help in decreasing the mortality and morbidity.

Ataque cerebrovascular isquémico agudo de territorio anterior: Tratamiento endovascular / Acute ischemic stroke in anterior territory: endovascular treatment

La terapia endovascular (TEV) es el tratamiento estándar del ataque cerebrovascular isquémico (ACVi) con oclusión de gran vaso (OGVC). Aún no se conoce si esos resultados pueden generalizarse a la práctica diaria. Se describen los resultados de la TEV en pacientes con ACVi por OGVC dentro de las 24 horas, en un análisis retrospectivo entre enero 2013 y diciembre 2017 que incluyó 139 casos consecutivos con ACVi y OGVC en arteria cerebral media (ACM), hasta 24 horas del inicio de los síntomas, que recibieron TEV en nuestra institución. El resultado primario medido fue la escala de Rankin modificada (mRS) ≤ 2 a 90 días. Se evaluaron también: reperfusión exitosa, según la escala modificada de trombólisis en infarto cerebral (mTICI) 2b/3, hemorragia intracraneal sintomática (HIS) y mortalidad a 90 días. La edad media: 67.5 ± 15.0, siendo el 51.8% mujeres. La mediana basal de National Institute of Health Stroke Scale (NIHSS) fue 14 (IIC 8-18); la mediana del tiempo desde inicio de síntomas hasta punción inguinal: 331 min (IIC 212-503). El 45.3%, 63 pacientes, fueron tratados > 6 horas después del inicio de síntomas. La tasa de mRS ≤ 2 fue 47.5%. Se logró una reperfusión exitosa en el 74.8%. La tasa de mortalidad a 90 días fue del 18.7% y la HIS del 7.9%. Nuestro registro de pacientes de la vida real con ACVi por OGVC tratados con TEV dentro de las 24 horas mostró altas tasas de reperfusión, buenos resultados funcionales y pocas complicaciones, acorde con las recomendaciones internacionales.

Endovascular treatment (EVT) has become the standard of care for acute ischemic stroke (AIS) with proximal large vessel occlusions (LVO). However, it is still unknown whether these results can be generalized to clinical practice. We aimed to perform a retrospective review of patients who received EVT up to 24 hours, and to assess safety and efficacy in everyday clinical practice. We performed a retrospective analysis, from January 2013 to December 2017, on 139 consecutive patients with AIS for anterior circulation LVO strokes up to 24 h from symptoms onset, who received EVT in our institution. The primary outcome measured was a modified Rankin scale (mRS) ≤ 2 at 90 days. Secondary outcomes included successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) scale 2b/3, mortality rate at 90 days and symptomatic intracranial hemorrhage (sICH). The mean age was 67.5 ± 15.0, with 51.8% female patients. Median baseline National Institute of Health Stroke Scale (NIHSS) was 14 (IQR 8-18); median time from symptom onset to groin puncture was 331 min (IQR 212-503). Sixty-three patients (45.3%) were treated beyond 6 hours after symptoms onset. The rate of mRS ≤ 2 was 47.5%. Successful reperfusion was achieved in 74.8 %. Mortality rate at 90 days was 18.7 % and sICH was 7.9 %. Our registry of real-life patients with AIS due to LVO who received EVT within 24 hours showed high reperfusion rates, and good functional results with few complications, according to international recommendations.

Mechanical thrombectomy for reperfusion of acute ischemic stroke in a Stroke Unit in Argentina / Trombectomía mecánica para la reperfusión en el accidente cerebrovascular agudo en una Unidad Cerebrovascular de Argentina

Abstract Stroke is an important cause of morbidity and mortality worldwide. Reperfusion therapy with intravenous tissue plasminogen activator (IV-tPA) was first implemented in 1996. More recently, endovascular reperfusion with mechanical thrombectomy (MT) demonstrated a robust beneficial effect, extending the 4.5 h time window. In our country, there are difficulties to achieve the implementation of both procedures. Objective: Our purpose is to report the early experience of a Comprehensive Stroke Center in the use of MT for acute stroke. Methods: Analysis of consecutive patients from January 2015 to September 2018, who received reperfusion treatment with MT. Demographic data, treatment times, previous use of IV-tPA, site of obstruction, recanalization, outcomes and disability after stroke were assessed. Results: We admitted 891 patients with acute ischemic stroke during this period. Ninety-seven received IV-tPA (11%) and 27 were treated with MT (3%). In the MT group, mean age was 66.0±14.5 years. Median NIHSS before MT was 20 (range:14‒24). The most prevalent etiology was cardioembolic stroke (52%). Prior to MT, 16 of 27 patients (59%) received IV-tPA. Previous tPA treatment did not affect onset to recanalization time or door-to-puncture time. For MT, door-to-puncture time was 104±50 minutes and onset to recanalization was 289±153 minutes. Successful recanalization (mTICI grade 2b/3) was achieved in 21 patients (78%). At three-month follow-up, the median NIHSS was 5 (range:4‒15) and mRS was 0‒2 in 37%, and ≥3 in 63%. Conclusions: With adequate logistics and strict selection criteria, MT can be implemented in our population with results like those reported in large clinical trials.

Resumen El accidente cerebrovascular isquémico (ACVi) es una importante causa de morbi-mortalidad a nivel mundial. La reperfusión con trombólisis endovenosa es utilizada desde 1996. Más recientemente, la reperfusión con trombectomía mecánica (TM) ha demostrado un beneficio consistente extendiendo la ventana terapéutica. En nuestro país existen dificultades para que su implementación sea una práctica habitual. Objetivo: Reportamos la experiencia de un Centro Integral de Neurología Vascular en el uso de TM como tratamiento del ACVi agudo. Métodos: Análisis retrospectivo de pacientes consecutivos desde enero 2015 a septiembre 2018, que recibieron reperfusión con TM. Se registraron datos demográficos, tiempos de tratamiento, uso de rtPA, sitio de obstrucción, recanalización, severidad del evento y discapacidad. Resultados: Se evaluaron 891 pacientes con ACVi en este periodo. 97 recibieron rtPA (11%) y 27 recibieron TM (3%). En el grupo TM, la edad promedio fue 66 años (±14.5). Mediana de NIHSS previo a TM: 20 (RIC 14‒24). La etiología más frecuente fue cardioembolia (52%). Previo a TM, 16 pacientes (59%) recibieron rtPA endovenoso. No hallamos efecto del rtPA en tiempo de recanalización por TM o tiempo puerta-punción. Para la TM, el tiempo puerta-punción fue 104±50 minutos y el tiempo entre inicio de síntomas-recanalización fue 289±153 minutos. En 21 pacientes (78%) se logró recanalización exitosa (TICI 2B/3). En el seguimiento a tres meses, el mRS fue 0‒2 en el 37% y ≥3 en el 63%. Conclusión: Una logística adecuada y un estricto criterio de selección ha posibilitado el uso de TM en nuestra población, obteniendo resultados similares a aquellos reportados en los estudios clínicos publicados.

Socio-demographics and clinical characteristics affecting pre-hospital delays in acute stroke patients: A 6-year registry study from a Malaysian stroke hospital

@#Background and objectives: The cumulative time spent without medical intervention in acute stroke patients may affect clinical outcomes. As the onset-to-arrival time to the hospital is crucial for effective treatment interventions, this study aimed to explore the factors associated with pre-hospital delays amongst acute stroke patients. Methods: We explored 932 patients data retrieved from the National Neurology Registry of Seberang Jaya Hospital between January 2013 and December 2018. Data on patient demographics and stroke manifestations were analysed using descriptive, univariate and multivariate logistic regressions. Results: Most patients were men (62.9%) with an average age of 62 years old. In the final multivariate regression model, pre-hospital delay was significantly lower among Chinese patients (aOR=0.6, 95% CI 0.4–0.9, p=0.016) and those using hospital ambulance (aOR=0.4, 95% CI 0.3–0.7, p<0.001), but higher among patients with lacunar infarcts (aOR=2.5, 95% CI 1.4–3.3; p<0.001). Conclusions: Demographic characteristic (ethnicity) and stroke manifestations, particularly stroke subtypes, and mode of transport were mainly associated with pre-hospital delays among acute stroke patients.

Effectiveness of Prophylactic Use of Antibiotics for Preventing Infection after Acute Stroke ：A Meta-analysis / 中国药房

OBJECTIVE：To systematically evaluate the effectiveness of prophylactic use of antibiotics for infection after acute stroke，and to provide evidence-based reference for clinical treatment for infection after acute stroke. METHODS ：Retrieved from PubMed，Embase，Cochrane library ，CJFD，VIP，Wanfang database and trial registration platforms such as Central ，randomized controlled trials （RCTs）about the effectiveness of prophylactic use of antibiotics （trial group ）versus placebo or non-prophylactic use of antibiotics （control group ）in the prevention of infection after acute stroke were collected during the inception to Dec. 2019. After data extraction ，the quality of included literatures were evaluated with Cochrane bias risk assessment tool 5.1.0 and modified Jadad scale. Meta-analysis was carried out by using Rev Man 5.3 statistical software. GRADE system was used to analysis the result of Meta-analysis. RESULTS ：A total of 7 RCTs were included ，involving 4 310 patients. The results of Meta-analysis showed that there was no statistical significance in the mortality of patients [RR ＝1.05，95％CI（0.92，1.20），P＝0.47] or the incidence of pneumonia [RR ＝0.92，95％CI（0.77，1.11），P＝0.40] between 2 groups. The total infection rate [RR ＝0.69，95％CI（0.57， 0.85），P＝0.000 3] and the incidence of urinary tract infection [RR ＝0.38，95％CI（0.29，0.49），P＜0.000 01] in the trial group were significantly lower than control group ，and the difference was statistically significant. Result of GRADE showed the out- comes were in high-quality grade. CONCLUSIONS ：Prophylactic use of antibiotics can reduce the total infection rate and the incidence of urinary tract infection after acute stroke ，but can not significantly affect the mortality and the incidence of pneumonia.

A Prospective Study of Factors affecting Mortality in Acute Stroke

Introduction: Stroke is leading cause of death after cardiacdisease and there has been a paradigm shift in the managementof stroke after the advent of intravenous thrombolysis andmechanical thrombectomy. Clinicians are often challengedregarding the outcome as the morbidity and mortality are highif not managed appropriately. As there are various factorswhich influence the mortality in each type of stroke, our studyhas been designed out find the mortality rates and to identifythe factors influencing in each type of stroke.Material and methods: This prospective study was conductedat tertiary care centre for a period of one year among 190patients who presented with acute stroke. All patients wereevaluated by complete medical history, meticulous physicaland neurological examination, necessary blood investigationsand brain imaging. All the patients were categorized intoischemic and haemorrhagic stroke. The outcome of patientswas noted in terms of mortality. Various parameters thatinfluenced the mortality were analysed using statisticalpackage for social sciences and compared.Results: Out of the 190 patients, 151 had ischemic and 39had a haemorrhagic stroke. Regarding the outcome 22.6%died. Elderly patients, patients with stress hyperglycemia anddiabetes, patients with prior history of CVA, raised intracranialtension, low Glascow coma scale, higher BP on admission,altered renal function and presence of nosocomial infectionswere predictors of mortality in both stroke types. Additionallyin ischemic stroke we found that the involvement of more thanone vascular territory of the brain and the presence of atrialfibrillation have higher mortality.Conclusion: Considering these factors with larger sample sizein both tertiary and other care centres we can evolve bettercriteria and guideline in the management of stroke.

Comparative Diagnostic Test Accuracy of Multiparametric MRI versus CT Scan in Emergency Assessment of Patients with Suspected Acute Stroke

Background: The non-contrast computed tomography (CT) isa routine brain imaging modality for stroke diagnosis. However,the multiparametric magnetic resonance imaging (MRI) isincreasingly being used for acute stroke diagnosis owing to itsbetter sensitivity in detecting ischaemic brain infarcts.Objectives: To evaluate the best available evidence on thecomparative diagnostic test accuracies between CT andmultimodal MRI for the diagnosis of acute haemorrhagic andischaemic strokes in patients presenting to the emergencydepartment within 6 hours after the onset of stroke-likesymptoms.Methods: MEDLINE-Ovid, AMED, CINAHL and ENBASEelectronic bibliographic databases were searched in Englishfrom January 2004 to August 2014 and supplemented withmanual bibliographic hand search. Prospective andretrospective cohort studies, which directly compared thediagnostic test accuracies between CT (as reference standard)and DW-MRI or GRE-MRI in detecting ischaemic orhaemorrhagic stroke in the same patient population within 6hours after the onset of stroke-like symptoms, were consideredin the review. Only studies with diagnostic outcomes in termsof sensitivity and specificity of MRI versus CT in detectingacute stroke were considered. The quality of the selectedstudies in terms of risk of bias and clinical applicability wereappraised using the QUality Assessment of DiagnosticAccuracy Studies-2 (QUADAS-2) tool.Results: A total of 780 patients were evaluated in the fourselected cohort studies. Three and two studies contributeddata on the diagnosis of acute ICH and ischaemic stroke,respectively. Three studies were of good quality while one wasof poor quality. GRE-MRI exhibited high sensitivity of 83-100%(95% CI) in detecting acute ICH compared to 100% for CTused as the reference standard. CT exhibited poor sensitivity(12-81%) but better specificity (88-100%) in detecting acuteischaemic stroke as compared to DW-MRI, which had asensitivity of 73% (95% CI) and specificity of 92% (95% CI).Conclusions: It appears that GRE-MRI has comparablesensitivity as CT in detecting acute ICH. Similarly, DWI isexcellently sensitive and specific in detecting acute ischaemiclesions. These strongly suggest that MRI is sufficientlyaccurate for routine evaluation of patients with suspected acutestroke in the emergency setting. However, the studiesgenerally lack applicability aspects to the general populationand current clinical practice therefore, warranting furtherresearch. In the meantime, CT and/or MRI tests can be usedfor routine assessment of patients with suspected stroke in theemergency setting.

A comparative study of MoCA-B and MMSE in screening for cognitive dysfunction in patients with / 中国神经精神疾病杂志

Objective To compare Montreal cognitive assessment-basic ( MoCA-B ) and mini-mental state examination (MMSE) in screening cognitive dysfunction of acute stroke patients. Methods The cognitive function of patients (n=83) with acute stroke onset within 10 days (including new cerebral infarction and cerebral hemorrhage) were assessed using MMSE and MoCA-B. The classification of patients with cognitive impairment was compared between the two scales. The consistency of cognitive impairment and affected domains assessed by MMSE or MoCA with experts were evaluated. Results ①There were 32 cases (38.6%) with abnormal MMSE score and 40 cases (51.8%) with abnormal MoCA-B score. ②The the diagnostic consistency of MoCA-B with experts was 89.16%. The false positive of MMSE was 2.41%and the false negative (rate of missed diagnosis) was 16.87%.False positives of MoCA-B were 4.82%and false negatives (rate of missed diagnosis) were 6.02%.③Among the 51 patients with normal MMSE, 15 had abnormal MoCA-B (29.4%). There were significant differences between these two score system in executive function, verbal fluency, directivity, abstraction, delayed recall, visual perception, naming and other cognitive domains (P＜0.05). Conclusion MoCA-B scale may be more sensitive and better than MMSE scale in screening for cognitive impairment in patients with acute stroke.

Effect of emergency nursing combined with predictive rehabilitation nursing on rehabilitation and prognosis of patients with acute stroke / 中国中西医结合急救杂志

Objective To explore the effect of emergency nursing combined with predictive rehabilitation nursing on rehabilitation and prognosis of patients with acute stroke. Methods One hundred and thirty patients with acute stroke admitted to Zhejiang Hospital from June 2017 to December 2018 were enrolled, and they were divided into an emergency nursing group and a combined nursing group according to different nursing methods, 65 cases in each group. The emergency nursing group was given emergency nursing; and the combined nursing group was given emergency nursing combined with predictive rehabilitation nursing. After 2 weeks, the clinical efficacy was evaluated. The neurological function, motor ability, cognitive function, activities of daily living, clinical efficacy and the incidence of complications were observed in the two groups. Results After treatment, the scores of American National Institutes of Health Stroke Scale (NIHSS) in two groups was significantly lower than that before treatment, the scores of simple Fugl-Meyer motor function (FMA) and simple intelligent mental state examination scale (MMSE), Barthel index (BI) were obviously higher than those before treatment, and the changes of the above indexes in the combined nursing group were more significant than those in the emergency nursing group after treatment (NIHSS score: 13.68±4.01 vs. 19.47±3.82, FMA score: 31.65±4.11 vs. 26.47±4.53, MMSE: 25.34±3.71 vs. 20.07±3.08, BI: 54.68±7.01 vs. 47.37±6.51), the differences were statistically significant (all P < 0.05). The total effective rate of the combined nursing group was significantly higher than that of the emergency nursing group [90.77% (59/65) vs. 75.39% (49/65), P < 0.05], and the incidence of complications in the combined nursing group was obviously lower than that in the emergency nursing group [21.51% (14/65) vs. 40.00% (26/65), P < 0.05]. Conclusion The emergency nursing combined with predictive rehabilitation nursing has good clinical effect on patients with acute stroke, it can effectively elevate the neurological function, motor ability, cognitive function and daily living ability, improve blood lipid and coagulation function indicators, reduce the incidence of complications, facilitate rehabilitation and improve prognosis.

Study of ECG changes in patients with acute stroke: a hospital based cross sectional study

Background: Physicians are confronted on having ECG in patients with acute stroke as it can mimic that of myocardial infarction/ischemia. They should be aware of these changes taking place in patients with acute stroke and not due to myocardial infarction/ischemia. The objective of the present study was to study ECG changes in patients with acute stroke.Methods: A hospital based cross sectional study was carried out for a period of six months at Malla Reddy Hospital. A total of 100 patients were included who were eligible for the presents study as per the inclusion and exclusion criteria. Detailed clinical examination, history, lipid profile, blood pressure, BMI, addictions, RBS and ECG were done for all selected patients. Data was analysed using means, proportions. Statistical tests like chi square test and t test were used.Results: Majority of patients with acute stroke were above 60 years of age, males, urban residents, professional and skilled persons, and alcoholics. Based on the study of ECG among patients with acute stroke it was found that T wave inversion was the most common ECG change found in 33% and this was more in females (36.1%) compared to 31.3% in males. LVH was next common condition found on ECG of acute stroke patients but this time its incidence was more in males (25%) compared to females with only 13.9%. Factors like age, BMI, SBP, DBP, TC, TG, LDL, VLDL, HDL, addictions, residence, sex, family history were not found to be associated with ECG changes.Conclusions: T wave inversion and left axis deviation along with left ventricular hypertrophy were common ECG changes in patients with acute stroke. No studied factor was found to be associated with ECG changes in patients with acute stroke.

Swallowing and Aspiration Risk: A Critical Review of Non Instrumental Bedside Screening Tests

BACKGROUND AND PURPOSE: The presence of dysphagia and aspiration in stroke patients is associated with increased mortality and morbidity. Early recognition and management of these two conditions via reliable, minimally invasive bedside procedures before complications arise remains challenging in everyday clinical practice. This study reviews the available bedside screening tools for detecting swallowing status and aspiration risk in acute stroke by qualitatively observing reference population study design, clinical flexibility, reliability and applicability to acute-care settings. METHODS: The primary search was conducted using the PubMed, Embase, and Cochrane Library databases. The search was limited to papers on humans written in English and published from 1991 to 2016. Eligibility criteria included the consecutive enrollment of acute-stroke inpatients and the development of a protocol for screening aspiration risk during oral feeding in this population. RESULTS: Of the 652 sources identified, 75 articles were reviewed in full however, only 12 fulfilled the selection criteria. Notable deficiencies in most of the bedside screening protocols included poor methodological designs and inadequate predictive values for aspiration risk which render clinicians to be more conservative in making dietary recommendations. CONCLUSIONS: The literature is dense with screening methods for assessing the presence of dysphagia but with low predictive value for aspiration risk after acute stroke. A standard, practical, and cost-effective screening tool that can be applied at the bedside and interpreted by a wide range of hospital personnel remains to be developed. This need is highlighted in settings where neither trained personnel in evaluating dysphagia nor clinical instrumentation procedures are available.