Factors Influencing Depression In Patients Of Cerebrovascular Accidents-A Study

Background: Post Stroke Depression (PSD) is one of the most frequent Neuropsychiatric consequences of stroke. It affects almost 29%-70% of Stroke Survivors (SS). There is paucity of research data in determining the risk factors and especially severity and associa?on of depression with site of lesion loca?on in Indian community. Aim and Objec?ves: To determine factors associated with PSD and associa?on between Socio-demographic profiles, Stroke symptoms, Site of lesion with depression. Materials and Methods: It’s a cross-sec?onal study including par?cipants from the outpa?ents sec?on of Department of Neurology at Prathima Ins?tute of Medical Sciences. A predetermined sample size of 60 pa?ents with CVA pa?ents was enrolled in the study and their socio demographic details are collected along with administering Beck’s Depression Inventory for Depression. Neuro-imaging provided informa?on on lesion loca?on. Collected data was analysed using SPSS version 19 and using descrip?ve and inferen?al sta?s?cs. Results: In this study 18 out of 60 subjects with stroke were diagnosed with PSD. Risk factors found to be mainly associated with PSD are lack of family support, Joint family types, Stroke with Aphasia, Cranial Nerve involvement and Motor System weakness whereas, Substance use is found to be a protec?ve factor. Significant numbers of subjects were found to have le?-anterior-sub-cor?cal lesions associated with PSD. Conclusion: This study highlights the variables which are to be considered in the recogni?on of PSD for Neurologists and Mental health care workers for early interven?on and a be?er outcome in view of stroke recovery

The etiologies of post-stroke depression: Different between lacunar stroke and non-lacunar stroke

Abstract Objectives: Depression is common after both lacunar stroke and non-lacunar stroke and might be associated with lesion locations as proven by some studies. This study aimed to identify whether lesion location was critical for depression after both lacunar and non-lacunar strokes. Methods: A cohort of ischemic stroke patients was assigned to either a lacunar stroke group or a non-lacunar stroke group after a brain MRI scan. Neurological deficits and treatment response was evaluated during hospitalization. The occurrence of depression was evaluated 3 months later. Logistic regressions were used to identify the independent risk factors for depression after lacunar and non-lacunar stroke respectively. Results: 83 of 246 patients with lacunar stroke and 71 of 185 patients with non-lacunar stroke developed depression. Infarctions in the frontal cortex, severe neurological deficits, and a high degree of handicap were identified as the independent risk factors for depression after non-lacunar stroke, while lesion location was not associated with depression after lacunar stroke. Conclusion: The main determinants for depression after lacunar and non-lacunar stroke were different. Lesion location was critical only for depression after non-lacunar stroke.

Multimodal deep learning model for staging diabetic retinopathy based on ultra-widefield fluorescence angiography / 中华眼底病杂志

Objective:To apply the multi-modal deep learning model to automatically classify the ultra-widefield fluorescein angiography (UWFA) images of diabetic retinopathy (DR).Methods:A retrospective study. From 2015 to 2020, 798 images of 297 DR patients with 399 eyes who were admitted to Eye Center of Renmin Hospital of Wuhan University and were examined by UWFA were used as the training set and test set of the model. Among them, 119, 171, and 109 eyes had no retinopathy, non-proliferative DR (NPDR), and proliferative DR (PDR), respectively. Localization and assessment of fluorescein leakage and non-perfusion regions in early and late orthotopic images of UWFA in DR-affected eyes by jointly optimizing CycleGAN and a convolutional neural network (CNN) classifier, an image-level supervised deep learning model. The abnormal images with lesions were converted into normal images with lesions removed using the improved CycleGAN, and the difference images containing the lesion areas were obtained; the difference images were classified by the CNN classifier to obtain the prediction results. A five-fold cross-test was used to evaluate the classification accuracy of the model. Quantitative analysis of the marker area displayed by the differential images was performed to observe the correlation between the ischemia index and leakage index and the severity of DR.Results:The generated fake normal image basically removed all the lesion areas while retaining the normal vascular structure; the difference images intuitively revealed the distribution of biomarkers; the heat icon showed the leakage area, and the location was basically the same as the lesion area in the original image. The results of the five-fold cross-check showed that the average classification accuracy of the model was 0.983. Further quantitative analysis of the marker area showed that the ischemia index and leakage index were significantly positively correlated with the severity of DR ( β=6.088, 10.850; P<0.001). Conclusion:The constructed multimodal joint optimization model can accurately classify NPDR and PDR and precisely locate potential biomarkers.

Relationship between lesion location and onset symptoms of cerebral infarction caused by acute basilar arterial occlusion / 医学研究生学报

Objective The clinical manifestations of cerebral infarction caused by acute basilar arterial occlusion are complex.The purpose of this study is to explore the relationship between lesion location and onset symptoms of cerebral infarction caused by acute basilar arterial occlusion.Methods Fifty three patients diagnosed with cerebral infarction caused by acute artery occlusion were collected from Nanjing Stroke Registry.They were hospitalized in Jinling Hospital from January 2007 to July 2016 and were divided into sudden onset group and progressive onset group.Their clinical and digital subtraction angiography data were analyzed retrospectively.Results Middle and distal segment of the basilar artery occlusions were usually found in sudden onset group.Patients in progressive onset group were more likely to present with proximal segment of the basilar artery occlusions.Significant statistical difference was found between two groups (P<0.05).Logistic regression analysis showed that the symptoms of patients with proximal segment basilar artery occlusion tended to be progressive onset, compared with patients affected by distal segment occlusion (OR=14.77,95%CI:1.57-139.00, P=0.019).Conclusion There was significant relationship between lesion location and onset symptoms of cerebral infarction caused by acute basilar arterial occlusion.Early diagnosis and timely treatment may improve clinical prognosis in patients.

Predictors of Apathy in Acute Stage of Cerebral Infarction / 中国康复理论与实践

@# Objective To explore the relationship between apathy and lesion location and serum homocysteine during the acute stage of ischemic stroke. Methods 152 patients with acute cerebral infarction were recruited. 152 volunteers from medical center were as control group. The Apathy Scale (AS) was used to assess poststroke apathy (PSA). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was used to evaluate the lesion location. Modified Fazekas Scale was used to assess leukoaraiosis. The serum levels of homocysteine of patients were determined. Results The prevalence of PSA was significantly higher in the patients than in the control group (P<0.001). Multivariate logistic regression demonstrated that frontal lesion (P=0.001), basal ganglia lesion (P=0.006), pons lesion (P=0.002) and higher homocysteine level (P<0.001) significantly related with PSA. Conclusion Frontal lesion, basal ganglia lesion, pons lesion and higher homocysteine level may be predictors for apathy in acute stage of ischemic stroke.

Predictors of Apathy in Acute Stage of Cerebral Infarction / 中国康复理论与实践

Objective To explore the relationship between apathy and lesion location and serum homocysteine during the acute stage of ischemic stroke. Methods 152 patients with acute cerebral infarction were recruited. 152 volunteers from medical center were as control group. The Apathy Scale (AS) was used to assess poststroke apathy (PSA). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was used to evaluate the lesion lo-cation. Modified Fazekas Scale was used to assess leukoaraiosis. The serum levels of homocysteine of patients were determined. Results The prevalence of PSA was significantly higher in the patients than in the control group (P<0.001). Multivariate logistic regression demon-strated that frontal lesion (P=0.001), basal ganglia lesion (P=0.006), pons lesion (P=0.002) and higher homocysteine level (P<0.001) signifi-cantly related with PSA. Conclusion Frontal lesion, basal ganglia lesion, pons lesion and higher homocysteine level may be predictors for apathy in acute stage of ischemic stroke.

A prospective study on the prevalence of post stroke depression and its relationship with lesion laterality and socio-demographic factors

Background: Post Stroke depression (PSD) is considered as a frequent neuropsychiatric consequence of stroke. Approximately one third of stroke survivors experience major depression. This condition can have adverse effects on cognitive function, functional recovery and survival. Aim: The current study examined prevalence of depression in post stroke survivors, its relation with site of lesion, laterality and. sociodemographic factors. Method: After obtaining consent, selected sample of post stroke survivors were diagnosed as post stroke depression based on ICD10 diagnostic criteria. Depression was quantified using HDRS and MADRS before discharge, at the end of first month and three months. Socio demographic profile was obtained. Statistical analysis was done using SPSS. Results: 32 patients of mean age (46.25yrs) and post stroke duration (2 weeks – 3 months) were included in the study. Twenty of thirty two post stroke survivors( 62.5%) met the criteria for depression at the time of discharge i.e. 2 weeks post stroke period, prevalence of PSD was 19 (59.37%) during 2nd assessment and 13(48.15%) during 3rd assessment. PSD was significantly associated with right sided lesions (p value = 0.013). In patients with left sided lesion, it is most commonly seen with sub cortical (p value = 0.003). Middle age was significantly associated with PSD (p value = 0.03). Female sex was associated with PSD in left sided lesions (p value = 0.02). No significant difference was found between first, second and third assessment of HAMD, MADRSS scores in depressed patients. No change in depression scores was found in both left and right sides at all assessments. Conclusion: This study emphasizes the need for early detection of depression in post stroke survivors. PSD is related to laterality of lesion, middle aged group and female sex. PSD is maintained at 3 months follow up. These results highlight the need to investigate, diagnose and treat post stroke depression.

The analysis of the correlation between lesion location of the first onset acute cerebral infarction, stroke severity and post-stroke depression / 中国基层医药

Objective To explore the relationship between iesion location ot the frst onset acute cerebral infarction(ACI),stroke severity and post-stroke depression (PSD).Methods The lesion Iocations of ACI were observed by CT or MRI.100 patients with the first onset ACI were assessed by Hamilton Depression Scale and the National Institutes of Health Stroke Scale two weeks after stroke.Results There was no significant difference in the incidence of PSD among the patients with left,right and bilateral lesions in acute stroke(23.91％,25.00％,33.33％,x2 =0.2512,P ＞0.05 ).The incidence of PSD had significant difference between the anterior-circulation and posterior-circulation infarction(33.96％,14.89％,x2 =4.8307,P ＜ 0.05 ).Stroke severity was positively correlated withthe incidence of PSD( 16.67％,31.37％,36.36％,x2 =3.9188,P ＜ 0.05 ).Conclusion The incidence of PSD was no significant correlation with the stroke site of patients with the first onset ACI,and the patients with anterior circulation infarction and severe neurological deficit have high incidence of PSD.

Correlation between Duration of Dysphagia and Magnetic Resonance Image Findings in Patients with Stroke

OBJECTIVE: To evaluate the correlation between duration of dysphagia and magnetic resonance image (MRI) findings in patients with stroke. METHOD: Ninety seven patients, who were evaluated by video fluoroscopic swallowing studies (VFSS), were recruited for 28 months. They were divided into two groups (transient group (n=52), prolonged group (n=45)) by removing time of NG tube from onset of stroke. Their MRI findings (lesion location and lesion size) were interpreted by one experienced radiologist retrospectively. RESULTS: The duration of dysphagia had statistically significant correlation with lesion size but there was no statistically significant correlation between lesion location and duration of dysphagia in patients with stroke. Compared with transient group (51.5+/-53.8 cm3), a larger lesion was found in prolonged group (95.5+/-107.7 cm3). CONCLUSION: Lesion size, not lesion location, can be a more important factor to predict early removal of NG tube in patients with stroke. More careful interventions about dysphagia are needed in patients with larger stroke lesion.

The Correlation between Post-stroke Depression and Lesion Location

OBJECTIVE: To localize lesions which correlate with depression after stroke. METHOD: This study was performed in 98 stroke patients who admitted at two hospitals in Daegu in 2006. Lesions on magnetic resonance imaging were reviewed by same neuroradiologist and depression was diagnosed by same phychiatrist using DSM-III-R and ICD-10 criteria. We tried to find the correlation between the lesion location and depression. RESULTS: Depression was not related to age, sex, dominant hemisphere, underlying disease (HTN, DM, heart disease), and many lesions of interest of brain. Lesions in prefrontal area, limbic lobe, cingulate gyrus, post white matter and frontal lobe correlated significantly with depression. CONCLUSION: We found that there was a strong correlation between post stroke depression and the pathologic lesion which is frontal-subcortical circuit except basal ganglion and thalamus.