Mortalité à long terme des survivants d'accidents vasculaires cérébraux ischémiques à Bobo Dioulasso, Burkina Faso / Long-term mortality of ischaemic stroke survivors in Bobo-Dioulasso, Burkina Faso

Contexte et objectif. La survie à long terme des accidents vasculaires cérébraux ischémiques (AVCI) reste un défi majeur. L'objectif de ce travail était d'analyser la mortalité à long terme des survivants d'AVCI. Méthodes. Il s'est agi d'une cohorte rétrospective portant sur les patients hospitalisés du 1er janvier 2017 au 31 décembre 2019, sortis vivants du service de neurologie au Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso après un AVCI. Nous avons recouru aux méthodes de Kaplan Meier et la regression de Cox pour décrire respectivement la survie et les prédicteurs de la mortalité. Résultats. Au total, 87 patients dossiers ont été colligés. L'âge moyen était de 61,2 ans (±13,7). Le sex-ratio M/F était de 1,23/1. L'hypertension artérielle était le principal facteur de risque cardiovasculaire (65,5 %). Les antécédents de cardiopathies étaient présents chez 6 patients. La conscience était normale chez 82 patients et les complications de décubitus ont été observées chez 20 patients au cours de l'hospitalisation. La durée moyenne d'hospitalisation était de 15,8 jours. La mortalité cumulée en post hospitalisation était de 40,2 % à 4 ans. Les facteurs prédictifs de la mortalité étaient l'âge > 60 ans (p=0,008; HRa= 3,05 ; IC 95 % : 1,33-6,99), le score de Glasgow>9 (p<0,001; HRa = 0,09; IC 95 % : 0,02-0,31) et l'absence de complication de décubitus (p=0,009; HRa = 0,34; IC95 % : 0,15-0,76). Conclusion. Dans ce contexte, la mortalité à long terme des AVCI est élevée. Le renforcement du suivi vis-à-vis des groupes spécifiques pourrait contribuer à réduire considérablement cette mortalité à long terme.

Context and objective. Long-term survival from ischaemic stroke remains a major challenge. The aim of this study was to analyse the long-term mortality of stroke survivors at the Sourô Sanou University Hospital in Bobo-Dioulasso. Methods. This was a retrospective cohort of hospitalized patients from January 1, 2017 to December 31, 2019, discharged alive from the neurology service after ischaemic stroke. We used Kaplan Meier and Cox regression methods to describe survival and predictors of mortality, respectively. Results. A total of 87 patients were included in this study. The mean age was 61.2 years (±13.7). The sex ratio M/F was 1.23. Hypertension was the main cardiovascular risk factor (65.5%). A history of heart disease was present in 6 patients (6.9%). Consciousness was normal in 82 patients (94.2%) and decubitus complications were observed in 20 patients (23%) during hospitalisation. The average length of hospital stay was 15.8 days. Cumulative post-hospital mortality was 40.2% at 4 years. Factors predictive of mortality were age >60 years (p=0.008; aHR= 3.05; 95%CI: 1.33-6.99), Glasgow score>9 (p<0.001; aHR = 0.09; 95% CI: 0.02-0.31) and absence of decubitus complication (p=0.009; aHR = 0.34; 95%CI: 0.15-0.76). Conclusion. In this context, long-term mortality in ischaemic stroke is high. Closer monitoring of specific groups could help to reduce considerably this long-term mortality.

MRI as a Diagnostic Tool for the Determination of Acute Ischaemic Stroke: A Study in a Tertiary Care Hospital

Background: Stroke is a prevalent and potentially fatal medical condition that affects individuals worldwide. Ischemic strokes, caused by arterial blockages, are the most common type, accounting for about 80% of all cases. Hemorrhagic strokes, on the other hand, are less frequent but can have more severe consequences. Accurate and timely diagnosis of stroke is critical for effective treatment and optimal patient outcomes. In this context, diffusion-weighted imaging (DWI) has emerged as a valuable tool for identifying and monitoring ischemic stroke. This article provides an overview of the role of DWI in stroke assessment and management, with a focus on early detection and intervention. The aim of this study is to investigate the reliability of diffusion-weighted MRI (DWI) as an imaging modality in the evaluation of acute ischemic stroke. Material & Methods: This prospective cross-sectional study was conducted at the Department of Radiology and Imaging at the Combined Military Hospital (CMH) in Dhaka, Bangladesh, between June 2020 and June 2021. The study aimed to examine 120 patients clinically diagnosed with acute ischemic stroke. Prior to the study, verbal consent was obtained from all patients. The Study subjects were identified in the emergency and casualty department and had undergone an MRI of the brain in the Department of Radiology and Imaging at CMH, Dhaka. . Data were collected on pre-designed forms, and the relevant information was compiled on a master chart for statistical analysis using SPSS software. Descriptive analysis and frequency of results were presented in the form of tables, pie charts, and bar graphs. The ethical clearance of this study was obtained from the Institutional Ethics Committee of CMH, Dhaka, Bangladesh. Results: The study included 64 males and 56 females with a mean age of 65.2 ± 7.83 years. The majority of patients had an acute ischemic lesion (88.30%) in the MCA (50.0%) with small-sized lesions (41.7%) and low ADC values (90.0%). The most common clinical presentation was hemiplegia (100%), and diffusion-weighted MRI had a high diagnostic accuracy in detecting acute ischaemic lesions (96.3%). Overall, these findings highlight the importance of MRI in the evaluation of stroke patients and can guide clinical decision-making. Conclusion: The present study concluded that DWI in conjunction with ADC map MR imaging is a gold standard diagnostic modality in the evaluation and management of acute ischaemic stroke.

Stroke Code Implementation in A Physician-Led District Hospital in Malaysia

@#Introduction: The past few years have shown a marked improvement in acute ischaemic stroke (AIS) thrombolysis therapy in Malaysia. We analysed our data on stroke code activation performed in a non-neurologist hospital. Methods: Data of all stroke code activated patients from September 2019 to September 2020 was collected. Demographic, clinical characteristics and outcomes of these patients were analysed and reviewed with published data in Malaysia. Results: Seventy cases were stroke code activated. Majority of the stroke cases (80%) were ischaemic in nature with the highest subgroups of lacunar infarct at 60.7%. Hypertension is the most prevalent risk factor followed by dyslipidaemia and diabetes. The median time for onset-to-door was 95minutes, door-to-CT was 24minutes, door-to-decision was 46.5 minutes and door-to-needle was 80minutes. There was a sequential reduction in median door-to-CT and door-to-needle time to 16.5 and 65.5minutes respectively. Fifteen patients (21.4%) were given thrombolysis therapy. The median NIHSS score was 7.5 on arrival and 6 upon discharge. They had an improvement of mRS from a median of 4 upon discharge to 1 at six months follow-up. There were no haemorrhage incidences post thrombolysis. The outcome of LACI strokes versus non-LACI strokes was similar at 3 and 6-months follow-up despite non-LACI strokes having a more severe presentation upon admission. Conclusion: With AIS thrombolysis therapy, non-LACI strokes may have similar functional outcomes as LACI strokes. With backup support from hospitals with neurologists and neurosurgeons, physician-led AIS thrombolysis therapy is implementable in a non-neurologist centre. Strong adherence to protocol is pertinent to ensure success.

Overview of systematic reviews/Meta-analysis of Xingnaojing Injection in treatment of cerebral ischaemic stroke / 中国中药杂志

There have been many clinical trials, systematic reviews/Meta-analysis proving that Xingnaojing Injection has a good clinical efficacy in treatment of cerebral ischaemic stroke, but with fewer comprehensive descriptions. In this study, an overview of systematic reviews/Meta-analysis of Xingnaojing Injection in treating cerebral ischaemic stroke was performed to provide current situation of evidences and basis for clinical practice. CNKI, Wanfang, VIP, CBM, EMbase, PubMed, Cochrane Library, Web of Science were retrieved through computers. A total of 6 literatures were included in this study. By AMSTAR-2 checklist and GRADE, the quality of included systematic reviews and the efficacy of Xingnaojing Injection were evaluated. The results of AMSTAR-2 checklist showed an extremely low quality for all of the 6 systematic reviews. According to the results of GRADE evaluation, among 55 outcomes, there were 2 outcomes with a medium quality, 4 outcomes with a low quality and 49 outcomes with an extremely low quality. The 6 systematic reviews reached a consistent conclusion that Xingnaojing Injection was effective in the treatment of cerebral ischaemic stroke. This therapy could improve the total efficacy, neurological deficit scores, hemodynamic and hemodynamic parameters. However, the methodolo-gical quality of all literatures was extremely low. The evidence levels of outcomes were between extremely low to medium. The effectiveness of Xingnaojing Injection in the treatment of cerebral ischaemic stroke still needs to be further verified by more high-quality studies. In the future, relevant clinical studies and systematic reviews/Meta-analysis shall be carried out in a strict accordance with relevant regulations.

Clinical outcomes of acute stroke thrombolysis in neurologist and non-neurologist centres – A comparative study in Malaysia

@#Acute ischaemic stroke (AIS) is a devastating disease and one of the leading causes of disabilities worldwide. From 2010 to 2014, the incidence of stroke in Malaysia had increased from 65 to 187 per 100,000 population.1 Thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rtPA) within 4.5 hours of symptom onset has been shown to be an effective treatment for AIS. Patients who receive thrombolysis are 30 percent more likely to achieve excellent functional outcome (modified Rankin scale of 0 to 1) at 3 months compared to placebo.2 Unfortunately, the delivery of stroke thrombolysis service in Malaysia is often limited by the availability of neurologists. To date, the ratio of neurologists capable of performing thrombolysis serving in public hospitals to the Malaysian population is 1:1.4 million.3 To counteract this disparity and to cope with the increasing stroke burden in Malaysia, there has been an advocacy for greater involvement of non-neurologists, i.e., general and emergency physicians in performing of stroke thrombolysis.4 Emerging data based on short term outcomes appear to support this notion. Based on a 2015 single center study on 49 AIS patients in Australia, A. Lee et al., reported that there was no significant difference in door to needle time, rates of symptomatic intracranial bleeding (SICH), and mortality between patients thrombolysed by neurologists versus stroke physicians.5 In 2016, a larger multicentre study in Thailand reported that patients thrombolysed in hospitals without neurologists had lower National Institute of Health Stroke Scale (NIHSS) scores at discharge and lower inpatient mortality rate compared to patients treated in neurologist hospitals.6 Based on these short term outcomes, both studies suggest that nonneurologists are able to thrombolyse AIS patients safely and effectively. Data comparing long term functional outcomes in thrombolysis prescribed by neurologists and nonneurologists are still very limited. The primary objective of this study was to evaluate and compare the 3-month functional outcomes of thrombolytic therapy between hospitals with and without on-site neurologists. The secondary objective was to assess the doorto-needle time and complication rates of thrombolysis service in both hospitals

ACT-FAST: a quality improvement project to increase the percentage of acute stroke patients receiving intravenous thrombolysis within 60 minutes of arrival at the emergency department

INTRODUCTION@#Stroke is a leading cause of death and disability, with the administration of recombinant transcriptase-plasminogen activator (rtPA) improving outcomes in a time-dependent manner. Only 52.3% of eligible stroke patients at our institution received rtPA within 60 minutes of arrival. We aimed to improve the percentage of acute stroke patients receiving rtPA within 60 minutes of arrival at the emergency department (ED).@*METHODS@#This study presents results from the first year of a clinical practice improvement project that implemented quality improvement interventions. The primary outcome measure was percentage of acute ischaemic stroke patients receiving rtPA within 60 minutes of arrival at the ED. Secondary outcome measures included components of total door-to-needle (DTN) time and factors for delay to thrombolysis. Interventions were establishment of standardised acute stroke activation guidelines, screening question at ED registration, prehospital notification of stroke activation, public education, scripting for thrombolysis consent and easy access to equipment.@*RESULTS@#The percentage of patients thrombolysed within 60 minutes increased to 60.6% (p = 0.27), and DTN time decreased from 59 minutes to 54.5 minutes (p = 0.15). This was attributable to reduced door-to-physician time, door-to-imaging time and decision time, although the results were not significant. There was no significant increase in symptomatic intracranial haemorrhage or mortality secondary to stroke. Length of stay was significantly reduced by 1.5 days (p < 0.048).@*CONCLUSION@#The interventions resulted in an increasing but non-significant trend of acute stroke patients receiving thrombolysis within 60 minutes. Outcomes will be monitored for a longer duration to demonstrate trends and sustainability.

Prospective study of clinical profile of acute ischemic stroke in a tertiary care hospital of North India

Background: Owing to the recent demographic shifts and negative lifestyle changes, stroke is one of the leading causes of mortality across every income group in most of the countries. It is of the utmost importance to devolve into the clinical profile, etiology and management of patients with acute ischaemic stroke.Methods: It is a prospective case control study. Data was collected using a pre-tested pro forma meeting the objectives of the study. Patients who consented were divided into two groups and complete examination and investigations were carried out.Results: There were 94 patients with AIS enrolled for the study. The mean age was 56.2 years, of which 68.08% were males and 31.92% were females. The mean time for these patients to reach the health facility was 12.6 hours and only 36.17% of patients reached in the window period of 4.5 hours and were eligible for thrombolysis. Hypertension, Diabetes and smoking were the most common risk factors in this order among others.Conclusions: There is poor awareness regarding identification of stroke related symptoms and warning signs as majority of patients were unable to reach the hospital in the window period making them ineligible for thrombolysis. The leading etiology runs in the direction of modifiable risk factors which can be corrected at a primary prevention level.

Thrombolysis may be safely given in an acute stroke patient with Marfan’s syndrome: A case report

@#Marfan’s syndrome is a systemic disorder of connective tissue typically involving cardiovascular, musculoskeletal and ocular systems. Given the relative rarity of neurovascular complications in Marfan’s syndrome, there is currently little published data on the use of thrombolysis in patients with Marfan’s syndrome and acute ischaemic stroke. Of concern is the possibility of underlying cerebral artery dissection in patients with Marfan’s syndrome presenting with stroke and the risk of haemorrhagic complications with thrombolysis. We report the third known case of a patient with Marfan’s syndrome with an acute ischaemic stroke without evidence of cerebral artery dissection who received thrombolysis successfully with neurological improvement. A 47-year-old woman with a history of Marfan’s syndrome and previous left middle cerebral artery (MCA) territory infarct presented to our emergency department with sudden onset of right facial, arm and leg weakness with a NIHSS score of 15 and clinical examination findings of a right upper motor neurone facial palsy and right hemiparesis. CT brain revealed a dense right MCA sign and no evidence of haemorrhage. She received 0.9mg/kg of alteplase without complications. There was a suspicion for cerebral artery dissection but this was not evident on both CT angiography and MRI angiogram with black blood sequences. She recovered well with a NIHSS score of 1 and mild residual dysphasia. This case demonstrates that thrombolysis may be given safely in a patient with Marfan’s syndrome and acute ischaemic stroke and exclusion of underlying cerebral artery dissection should always be a consideration.

Types And Risk Factors Of First Time Stroke: A Saudi Hospital- Based Study

Background: The purpose of this study was to explore the stroke types and the risk factors of the first-time stroke in the holy city of Madinah Munawarah. Methods: A prospective hospital-based research study was carried out over the year of 2014. The patients with the diagnosis of the cerebrovascular accident were enrolled in the study. The details of patients’ history, demographic data, stroke type, and risk factors were collected. Results: First-time stroke were determined in 164 patients (91 male and 73 female) during the entire periods of this study with a mean age of 67.52 ± 2.31 years. The prevalence of types of stroke was ischaemic strokes in 133 patients (% 81.1), intercerebral hemorrhage in 24 patients (14.63%), and subarachnoid hemorrhage in one patient (0.6%). The most common risk factors recorded were hypertension (86.6%), diabetes mellitus (63.4%), and ischaemic heart disease (41.5%). There was no significant relationship between the frequency of ischaemic stroke and intercerebral hemorrhage stroke ( p> 0.05). Conclusion: The study indicates that hypertension, diabetes, and ischaemic heart disease are critical risk factors for developing stroke and fairly commensurate with the global reported risk factors. Further research is needed to investigate stroke patterns and other possible risk factors concurrently with Saudi national prevention programs.

Cardioembolic Stroke in Young Patients – A Prospective Analysis

Introduction: One in six ischemic strokes is caused bycardiogenic embolism. The current knowledge regardingthe natural history, diagnosis, prevention, and treatment ofcardioembolic stroke is reviewed in this study. Nonrheumaticatrial fibrillation is the most frequent substrate for brainembolism and patients with this dysrhythmia have a fivefoldincrease in the risk of stroke. Study aimed to evaluate theclinical assessment of the patients with ischemic stroke lessthan 45 years of age.Material and Methods: 50 patients who were admitted inthe medical and neurology wards of Govt. Stanley medicalcollege, Chennai during the study period from December 2003to May 2004 for ischaemic stroke were clinically examined.The inclusion and exclusion criteria were satisfied, resultswere clinically and statistically assessed and the relevance oftransthoracic echocardiography was studied in them.Results: Cardiogenic embolism mostly affects the malepopulation more frequently and the most commonly affectedage group is 30-45 years. The clinically identifiable cardiaclesion was present in 77% of the cases. The most commondisease is rheumatic valvular disease as seen in about 5 casesfollowed by ischemic heart disease which was found in about3 cases. Abnormal ECG findings were observed in 12% ofcases in the form of atrial fibrillation. Left atrial enlargement,old infarct changes, conduction abnormality and recurrentstroke(12%) were the other findings. In these, 66% (4 cases)were due to the cardioembolic origin. The echocardiographicstudy increases the sensitivity of detecting cardiac lesion by22%.Conclusion: Cardiac lesion accounts for 36% of brainembolism. Hemiparesis is the most common presentation(88% of cases) followed by Hemiplegia. The middle cerebralartery is most commonly affected by embolism. Rheumaticheart disease (39%) and Ischemic heart disease are theimportant causes of brain embolism in this study.

A study on prevalence of carotid artery stenosis in acute ischaemic stroke patients in Amalapuram, Andhra Pradesh, India

Background: Extra cranial carotid disease due to arteriosclerosis is usually associated with hypercholesterolemia and hyperlipidemia. Extra cranial carotid stenosis has been found to be less prevalent in black American and in Egyptians while intracranial disease is far more common Various methods includes transcranial doppler (TCD) ultrasonography, cerebral angiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA).Methods: All patients with ischaemic stroke of acute onset admitted in the medical wards of Konaseema institute of medical sciences between June 2018 and January 2019 were included in the study. All patients were subjected to CT scan brain study and colour Doppler study of extra cranial carotid arteries and vertebral arteries. Systolic and diastolic velocity of blood flow, carotid intimal medial thickness, presence of athermanous plaque and thrombus was looked for and then the percentage of stenosis of the affected arteries was calculated.Results: In the present study 0ut of 23 patients with carotid stenosis 9 patients had mild carotid stenosis, 8 patients had moderate stenosis and 6 patients had severe stenosis. Out of 23 patients with carotid stenosis the 11 patients have stenosis in the right carotid and 12 patients had stenosis in the left side. The site of stenosis is ICA in 17 patients and CCA in 6 patients.Conclusions: In present study every patient with carotid artery stenosis had one or the other risk factor for carotid atherosclerosis. In other words, there was no patient with carotid artery stenosis, without any risk factor in present study. Hence asymptomatic patients with these risk factors should be screened for carotid stenosis to prevent stroke.

Complicaciones neurológicas tras intervencionismo cardíaco percutáneo / Neurological complications following percutaneous coronary intervention

Resumen Introducción: Las complicaciones neurológicas agudas del intervencionismo cardiaco percutáneo (ICP) son variadas e infrecuentes, pero pueden resultar fatales. Casos: Presentamos un ictus isquémico -II- (caso 1), y dos casos de encefalopatía por contraste -EC- (2 y 3). Dos varones (1 y 2) y una mujer (3), con FRCV y edad media de 76 años. Los tres pacientes debutaron con focalidad neurológica aguda (FNA) al finalizar el procedimiento, lo que motivó la activación de código ictus intrahospitalario desde cardiología. 2 y 3 asociaron, además, agitación. El TC multimodal fue normal en 2 y 3, y mostró oclusión de M1 izquierda en 1. Se desestimó tratamiento de reperfusión cerebral en 1 por anticoagulación. El EEG fue normal en 2 y mostró paroxismos focales en hemisferio izquierdo de baja persistencia en 3.2 y 3 fueron tratados con sueroterapia y anticomiciales (3), quedando asintomáticos en las primeras doce horas. 1 falleció a los diez días por infección respiratoria. Conclusiones: En presencia de FNA tras ICP, la sospecha clínica resulta vital para establecer un diagnóstico diferencial precoz entre II y EC, y considerar tratamiento específico urgente, ya que puede modificar el pronóstico del paciente.

Introduction: Percutaneous coronary intervention (PCI) related neurological complications are wide and rare, but may be fatal. Cases: We present an ischaemic stroke -IS- (case 1), and two cases of contrast induced encephalopathy-CIE- (2 and 3). Two males (1 and 2) and one woman (3), with vascular risk factors and an average age of 76. All of them presented with acute focal neurological symptoms at the end of the procedure and Stroke Code was activated inmediately. 2 and 3 also associated psychomotor agitation. Multimodal CT head was normal in 2 and 3, whereas it showed a left Ml occlusion in 1. Reperfusion treatment was contraindicated 1 due to anticoagulation. EEG was normal in 2 and showed focal paroxisms in left hemisphere in 3.2 and 3 were successfully treated with fluids and antiepileptics (3). 1 died due to respiratory infection. Conclusions: Acute focal neurological symptoms following PCI should make us consider IS and CIE and provide the patient with urgent specific treatment.

The Study of Serum Uric Acid Levels in Ischemic Stroke Patients

Introduction: Stroke is defined by (WHO) World HealthOrganization as ‘a clinical syndrome consisting of rapidlydeveloping clinical signs of focal (or global in case of coma)disturbance of cerebral function lasting more than 24 hour orleading to death with no apparent cause other than a vascularorigin.’ There are few studies conducted in Indian scenario,which shows the role of serum uric acid in cases of acuteischaemic stroke. So the present study aimed at evaluatingrole of uric acid in assessing severity of acute ischemic stroke.Material and methods: It was an Analytical, Noninterventional Prospective study conducted among 100 casesof acute ischaemic stroke admitted in medicine ward and ICUat Krishna hospital, Karad over the period of 18 months, whofulfilled inclusion criteria were included in our study.Results: In the present study, serum uric acid levels and itsdistribution was carried out. Mean levels of Serum Uric acidwas 4.92 ± 1.89 mg/dl. Maximum value being 8.4 mg/dl andminimum value was 1.2 mg/dl.Conclusion: The severity of acute ischaemic stroke wasproved to be directly proportional to the mean serum uric acidlevels in the present study.

Intracranial atherosclerosis in ischemic stroke with posterior circulation: A high-resolution magnetic resonance imaging study / 中国脑血管病杂志

Objective: To explore the characteristics of intracranial atherosclerosis and possible pathogenesis of posterior circulation ischaemic stroke by 3. 0 T high-resolution magnetic resonance imaging. Methods: The imaging and clinical features of intracranial atherosclerosis in 21 patients with posterior ischemic symptoms admitted in the Department of Neurology of Hebei General Hospital from December 2016 to December 2018 were retrospectively analyzed. The recruited patients were divided into the posterior circulation ischemic stroke group(10cases and 45 plaques) and the non-stroke group(11 cases and 25 plaques) according to their clinical symptoms, signs and imaging manifestations. Clinical data of all patients were collected, and high-resolution 3D time-of-flight MR angiography was used to evaluate the degree of vascular stenosis. Also, plaque characteristics including burden, enhancement, hyperintensity and morphology were counted on high-resolution Tl weighted imaging axial images. Results: The The proportion of diabetes was significantly different between the two groups (P = 0. 024). There were no significant differences in age, sex, smoking, alcohol consumption, hypertension, hyperuricemia, hyperlipidemia, hyperhomocysteinemia, stroke history and history of coronary atherosclerotic heart disease between the two groups (all P > 0. 05). The plaque burden in the posterior circulation ischemic stroke group was higher than that in the non-stroke group ([4. 5 ±1.6] vs. [2. 3 ±1.6]) with significant difference (t = 3. 190, P = 0.005). Plaque enhancement between the two groups was significant different (40.0% [18/45] vs. 16. 0% [4/25], X2 =4. 295, P = 0. 038). There was no significant difference in plaque high signal and plaque morphology between the two groups(all P > 0. 05). Conclusion: Patients in the posterior ischemic stroke group had a higher prevalence of diabetes, and intracranial atherosclerotic plaque burden and plaque enhancement were more common, suggesting that the posterior ischemic stroke group had a higher vulnerability of plaque.

Incidence and risk factors of delirium in patients with acute ischaemic stroke

@#Background & Objectives: The reported incidence of post-stroke delirium varies substantially in current medical literature. The impact of delirium on mortality and morbidity is significant and there is need for sustained research on the topic. We aimed to determine the incidence, risk factors and outcome of delirium in acute ischaemic stroke. Methods: We conducted a cross-sectional observational study on consecutive patients with ischaemic stroke. The Confusion Assessment Method was used to diagnose delirium within seven days of stroke onset. Results: Two hundred and eighty patients were recruited (mean age 63.6 years) and 36 (12.9%) developed delirium. After adjustments for covariates, age >65 years (odds ratio, OR 5.2; 95% confidence interval 1.6-17.5); pre-existing dementia (6.5; 1.1-38.2); TACI (7.2; 1.5-35); and a National Institute of Health Stroke Scale of ≥10 (6.8; 1.7-26.4), were independently associated with a risk of developing delirium. Lacunar infarcts were not associated with delirium (0.07; 0.03-0.16). The majority of patients with delirium were cared for in a dedicated stroke unit but this proportion was not significant compared to those without delirium (69.4% vs 58.2%, p=0.20). Delirious patients had significantly higher in-patient mortality (8.3% vs 0%, p=0.002) and longer length of hospital stay (6.94 vs 3.98 days, p< 0.001). Conclusions: One in 8 patients with ischaemic stroke in our centre developed delirium. Older age, pre-existing dementia and severe stroke were independent predictors of delirium. Patients with lacunar infarcts did not develop delirium as often as those with other stroke types. Delirium significantly increased in-patient mortality and length of hospital stay.

The Study of Relationship of Glycated Haemoglobin with Carotid Artery Intimal Thickness in Patients with Ischaemic Stroke

Background:Long term uncontrolled hyperglycemia, which is indicated by HbA1c levels, is strongly suspected of promoting atheogensis.An accurate marker for assessing the risk of stroke is the carotid artery intima-media thickening (IMT), assessed by Doppler ultrasound. Increased common carotid artery IMT is correlated with silent cerebral infarcts.This study aimed to show the association between marker of uncontrolled long term hyperglycemia (HbA1C) and marker of atherosclerosis (Carotid intima media thickness [CIMT]) in ischemic stroke patients. Methods: This study was conducted In Deptt. of Medicine, Rajindra hospital Patiala in collabroration with Deptt. Of Radiology and Deptt. of Biochemistry. Results: This study included a total number of 75 patients admitted in various ward of Medicine Deptt. Rajindra Hospital Patiala.CIMT was found to be significantly increased in the patients having diabetics mellitus than non diabetic patients.Conclusion:There is seen a positive correlation of HbA1C with CIMT in our study which included only the ischemic stroke patients.

Complicaciones neurológicas tras intervencionismo cardíaco percutáneo / Neurological complications following percutaneous coronary intervention

Resumen Introducción: Las complicaciones neurológicas agudas del intervencionismo cardiaco percutáneo (ICP) son variadas e infrecuentes, pero pueden resultar fatales. Casos: Presentamos un ictus isquémico -II- (caso 1), y dos casos de encefalopatía por contraste -EC- (2 y 3). Dos varones (1 y 2) y una mujer (3), con FRCV y edad media de 76 años. Los tres pacientes debutaron con focalidad neurológica aguda (FNA) al finalizar el procedimiento, lo que motivó la activación de código ictus intrahospitalario desde cardiología. 2 y 3 asociaron además agitación. El TC multimodalfue normal en 2y 3, y mostró oclusión de M1 izquierda en 1. Se desestimó tratamiento de reperfusión cerebral en 1 por anticoagulación. El EEG fue normal en 2 y mostró paroxismos focales en hemisferio izquierdo de baja persistencia en 3.2 y 3 fueron tratados con sueroterapia y anticomiciales (3), quedando asintomáticos en las primeras doce horas. 1 falleció a los diez días por infección respiratoria. Conclusiones: En presencia de FNA tras ICP, la sospecha clínica resulta vital para establecer un diagnóstico diferencial precoz entre II y EC, y considerar tratamiento específico urgente, ya que puede modificar el pronóstico del paciente.

Introduction: Percutaneous coronary intervention (PCI) related neurological complications are wide and rare, but may be fatal. Cases: We present an ischaemic stroke -IS- (case 1), and two cases of contrast induced encephalopathy -CIE- (2 and 3). Two males (1 and 2) and one woman (3), with vascular risk factors and an average age of 76. All of them presented with acute focal neurological symptoms at the end of the procedure and Stroke Code was activated inmediately. 2 and 3 also associated psychomotor agitation. Multimodal CT head was normal in 2 and 3, whereas it showed a left Ml occlusion in 1. Reperfusion treatment was contraindicated 1 due to anticoagulation. EEG was normal in 2 and showed focal paroxisms in left hemisphere in 3.2 and 3 were successfully treated with fluids and antiepileptics (3). 1 died due to respiratory infection. Conclusions: Acute focal neurological symptoms following PCI should make us consider IS and CIE and provide the patient with urgent specific treatment.

Study of cholesterol levels in patients with ischaemic stroke and their outcome

Background: Stroke is a major health problem in India. Stroke burden has been rising in India as compared to the developed countries. Recent studies have shown that high serum cholesterol is associated with clinically less severe ischaemic strokes and better outcome. Aim: The primary objective of the study was to compare the outcome of patients with ischaemic stroke to their cholesterol levels and to correlate the cholesterol levels to the stroke outcome. Materials and methods: This hospital based prospective follow-up study was conducted in 140 patients admitted with ischaemic stroke in the medical wards of Medical College hospital, Trivandrum. Patients were divided into 2 groups based on cholesterol levels as <160 mg/dl and >160 mg/dl. Their clinical severity at presentation was calculated by Scandinavian stroke scale (0=worst, 58=best) and outcome of these patients at the end of 1 year was measured by Modified Rankin scale (0=best, 6=worst).Serum cholesterol was measured using enzymatic method. Results: Mean age of 140 patients of at presentation was 63.4±11.9 years of which 53.5% (n=75) males, the mean Scandinavian stroke scale (SSS) being 28.3±12.5. The mean SSS score of high cholesterol group was 39.6 whereas 17 in the low cholesterol group (p<0.001). Similarly, the size of infarct in CT brain, outcome variables of modified Rankin scale and mortality were statistically significant between these groups (p<0.001). Bivariate correlation analysis showed that increased serum cholesterol level is associated with increased SSS score (positive correlation) with high statistical significance (p<0.001). Logistic regression adjustedwith other risk factors showed high cholesterol levels are associated with better outcome and decreased mortality, which is supported by Kaplan-Meier survival analysis. Sreenath S, Santhosh Kumar T.S., Parthiban, Jasen Joseph, Ratheesh Kumar V.R. Study of cholesterol levels in patients with ischaemic stroke and their outcome. IAIM, 2017; 4(10): 194-202. Page 195 Conclusion: Hypercholesterolemia is associated with clinically minor strokes and better outcome, whereas major strokes are commonly seen in patients in the low cholesterol group. Hence post stroke outcome is inversely related to serum cholesterol levels in ischaemic stroke patients.

Comparison of acute ischaemic stroke adult patients with atrial fibrillation to without atrial fibrillation in the effect on renal dysfunction / 实用医学杂志

Objective To find out whether inpatients with acute ischaemic stroke and atrial fibrillation (AF) have higher rate of renal dysfunction than without AF,and analyze risk factors associated with renal dysfunction.Method 374 patients with acute ischaemic stroke and AF were enrolled,which cases have complete data.500 patients were randomly selected as the non-AF group.To compare the prevalence of renal dysfunction [eGFR ＜ 60 mL/(min· 1.73 m2)] of two groups.Non-conditional Logistic regression analysis was used to detemmine the factors associated with renal dysfunction.Results 374 patients in AF group,114 (30.5％) were renal dysfunction;500 patients in non-AF group,75 (15％) were renal dysfunction (P =0.000,OR =2.485).The eGFR of AF and non-AF group was (77.75 ± 39.89) mL/(min· 1.73 m2) and (96.93±39.14) mL/(min · 1.73 m2).In Logis tic regression analysis,heart dysfunction (OR =2.057),hypertension (OR =1.826),diabetes (OR =1.897),hypevuricemia (OR =3.161) were found to be associated with renal dysfunction.Conclusions Adult patients with acute ischaemic stroke and AF have a higher rate of renal dysfunction than acute ischaemic stroke without AF.Heart dysfunction,hypertension,diabetes,hyperuricemia were factors associated with renal dysfunction.

Effect of Climatological Variables for all Seasons on the Frequency of Incident Stroke Hospitalizations in Scotland.

Background: Stroke is a disease, which has a complex multi-factorial etiology. Non-modifiable risk factors are genetics, familial history, age, sex, ethnicity and race, whereas smoking, drinking, physical activity and diet can be modified to reduce the risk of stroke significantly. Aims: The aim of the present study was to see the association between climate variations and incidence of stroke in Scotland. Methods: We have obtained the stroke data as SMR01 (Scottish Morbidity Record 01) as 1,57,639 incident stroke hospitalization in Scotland between 1986 and 2005. To observe for variation in weather parameter, with first stroke incidences per day, daily mean temperature, total rainfall and average daily atmospheric pressure were compared with the frequency of incident strokes per day using ANOVA (Analysis of Variance). Result: An overall meteorological analysis of incident strokes per day reveals an inverse statistically significant relationship for average daily temperature (P<0.001) whereas total daily rainfall (P=0.03) and average daily atmospheric pressure (P=0.05) exhibit borderline significance. Correlation of low temperature with stroke might be due to the concurrent occurrence of respiratory infections. We suggest some precautionary measures to minimize the chance of stroke i.e. protection from cold weather, decrease alcohol consumption and maintaining blood pressure within a safe range during winter season. Conclusion: Overall, high stroke incidence during winter season is a combined effect of temperature, rainfall, atmospheric pressure.