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Journal of Cardiac Surgery Feb 2022Strokes are a longstanding complication of acute type A aortic dissection (ATAAD) repair. Understanding the neuroanatomy, mechanism, and severity of stroke will...
BACKGROUND
Strokes are a longstanding complication of acute type A aortic dissection (ATAAD) repair. Understanding the neuroanatomy, mechanism, and severity of stroke will facilitate efforts to improve prediction, prevention, and treatment strategies.
METHODS
Retrospective review of patients who sustained stroke from a consecutive series of patients undergoing ATAAD repair. Neuroimaging was interpreted by two stroke neurologists blinded to clinical results. Severity of stroke was assessed by the National Institutes of Health Stroke Scale (NIHSS). Residual disability at 30 days was assessed using the modified Rankin Scale (mRS).
RESULTS
Twenty percent (38/189) of patients undergoing repair for ATAAD had stroke (unilateral 58%, bi-hemispheric 42% [p = .33]). All strokes were ischemic. No significant lateralization (right vs. left) was noted with unilateral strokes (26% vs. 32%, p = .67). Etiology of stroke was embolic (58%), hypoperfusion (26%), mixed (11%), and unknown (5%). There were no intraoperative variables that correlated with the neuroanatomy or mechanism of stroke. Preoperative carotid dissection was seen in 40% (n = 15), while postoperatively 10% (n = 4) sustained intracranial large vessel occlusion (LVO). Strokes were moderate or severe (NIHSS ≥ 9) in 97% of cases, with 66% incidence of moderate residual disability (mRS ≥ 3) at 1 month postoperatively.
CONCLUSIONS
Strokes associated with ATAAD are severe at presentation resulting in significant disability. One in 10 strokes is due to LVO and potentially amenable to endovascular treatment. Heterogeneity in both location and etiology of stroke makes prevention challenging. Future trials may evaluate the role of early neuroimaging and simultaneous treatment of stroke given advancements in endovascular therapy.
Topics: Aortic Dissection; Brain Ischemia; Endovascular Procedures; Humans; Neuroanatomy; Neuroimaging; Retrospective Studies; Stroke; Treatment Outcome
PubMed: 34783113
DOI: 10.1111/jocs.16136 -
Journal of the Neurological Sciences May 2015Aphasia is an important stroke sequel that impacts negatively on the HQoL of stroke patients. Although a number of stroke patients with aphasia will have good functional... (Review)
Review
BACKGROUND
Aphasia is an important stroke sequel that impacts negatively on the HQoL of stroke patients. Although a number of stroke patients with aphasia will have good functional recovery, many are left with language deficits.
METHOD
Papers were identified through PubMed and MEDLINE search, with keywords such as: 'stroke', 'aphasia', 'post-stroke aphasia', 'factors that predict aphasia recovery', 'aphasia outcomes' and 'aphasia prognosis'.
RESULTS
The most important factors that determine recovery are the lesion location and size, aphasia type and severity and to some extent the nature of early haemodynamic response, and treatment received. Anagraphic factors like gender, age, handedness and education have not been found to be robust predictors of recovery.
CONCLUSIONS
Predicting post-stroke aphasia recovery is difficult, because of the interplay between lesion, anagraphic, and treatment-related factors, in addition to the role of neuroplasticity.
Topics: Aphasia; Brain; Humans; Language; Prognosis; Recovery of Function; Severity of Illness Index; Stroke
PubMed: 25888529
DOI: 10.1016/j.jns.2015.03.020 -
American Family Physician Jul 2023Ischemic stroke is a major cause of morbidity and mortality worldwide. Ischemic stroke and transient ischemic attack exist on a continuum of the same disease process....
Ischemic stroke is a major cause of morbidity and mortality worldwide. Ischemic stroke and transient ischemic attack exist on a continuum of the same disease process. Ischemic stroke is common, and more than 85% of stroke risk is attributed to modifiable risk factors. The initial management of acute stroke is usually performed in the emergency department and hospital settings. Family physicians have a key role in follow-up, ensuring that a complete diagnostic evaluation has been performed, addressing modifiable risk factors, facilitating rehabilitation, and managing chronic sequelae. Secondary prevention of ischemic stroke includes optimization of chronic disease management (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia), nonpharmacologic lifestyle interventions (e.g., diet changes, exercise, substance use counseling), and pharmacologic interventions. Dual antiplatelet therapy with aspirin and clopidogrel is generally indicated for minor noncardioembolic ischemic strokes and high-risk transient ischemic attacks and should be converted to single antiplatelet therapy after 21 to 90 days. Secondary prevention of cardioembolic stroke requires long-term anticoagulation. Direct oral anticoagulants are preferred over warfarin for patients with nonvalvular atrial fibrillation. Poststroke problems with mobility, balance, cognition, dysphagia, and depression are common. Rehabilitation involves a multidisciplinary, multimodal approach that includes physical therapy, speech therapy, and treatment of chronic pain and poststroke depression.
Topics: Humans; Platelet Aggregation Inhibitors; Ischemic Stroke; Diabetes Mellitus, Type 2; Patient Transfer; Stroke; Ischemic Attack, Transient; Anticoagulants; Atrial Fibrillation
PubMed: 37440741
DOI: No ID Found -
Current Neurology and Neuroscience... Feb 2019Neurological complications are common during cardiac procedures. The type of procedure influences the profile of neurological complications and their management. In this... (Review)
Review
PURPOSE OF REVIEW
Neurological complications are common during cardiac procedures. The type of procedure influences the profile of neurological complications and their management. In this article, we review the different neurological complications encountered following cardiac procedures, and treatment strategies for managing those complications.
RECENT FINDINGS
Recent clinical trials have expanded the time window of eligibility for mechanical thrombectomy and intravenous thrombolysis. As a result, more options are now available for the treatment of periprocedural strokes. Early recognition of neurological complications, particularly stroke, will allow more patients to be treated effectively. The expanded window for intravenous thrombolysis and mechanical thrombectomy using advanced neuroimaging for selection provides more opportunities for treatment of periprocedural stroke. There is a paucity of data on the management of cerebrovascular complications, such as ischemic and hemorrhagic strokes, in the setting of left ventricular assist device or mechanical valve.
Topics: Brain Ischemia; Cardiovascular Surgical Procedures; Humans; Intracranial Hemorrhages; Neuroimaging; Organophosphates; Stroke; Thrombectomy; Treatment Outcome
PubMed: 30739219
DOI: 10.1007/s11910-019-0923-1 -
Brain and Nerve = Shinkei Kenkyu No... Jul 2016Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke. Current evidence suggests that 25-30% of ischemic...
Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke. Current evidence suggests that 25-30% of ischemic stroke survivors develop immediate or delayed vascular cognitive impairment or vascular dementia. The type of stroke can be either ischemic, hemorrhagic or hypoperfusive. There are multiple risk factors for PSD including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischemic attack or recurrent stroke and depressive illness. Pre-stroke dementia refers to the occurrence of cognitive impairment before the index stroke, which may be caused by a vascular burden as well as insidious neurodegenerative changes. Neuroimaging determinants of dementia after stroke include silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Published clinical trials have not been promising and there is little information on whether PSD can be prevented using pharmacological agents. Control of vascular disease risk and prevention of recurrent strokes are key to reducing the burden of cognitive decline and post-stroke dementia. Modern imaging and analysis techniques will help to elucidate the mechanism of PSD and establish better treatment.
Topics: Brain; Cognition; Dementia; Humans; Risk Factors; Stroke
PubMed: 27395459
DOI: 10.11477/mf.1416200506 -
European Journal of Internal Medicine Feb 2018Cardiovascular disease (CVD) is the major cause of morbidity and mortality for individuals with type 2 diabetes (T2D). In particular, the risk for stroke is twice that... (Review)
Review
Cardiovascular disease (CVD) is the major cause of morbidity and mortality for individuals with type 2 diabetes (T2D). In particular, the risk for stroke is twice that of patients without diabetes, and diabetes may be responsible for >8% of first ischemic strokes. Therefore, the way to prevent stroke in these patients has become an important issue. Traditionally, glucose-lowering drugs had not been shown to protect against stroke. Moreover, several antidiabetic drugs (i.e., sulfonylureas, rosiglitazone) have been reported to be associated with increased risks of CVD and stroke. On the contrary, data on the CV risks and benefits associated with new antidiabetic treatment in patients with T2D are emerging - and look promising. Therefore, it could be of great value to find out if any type of these new antidiabetic agents has protective effect against stroke. We review the available evidence regarding the risk of stroke in individuals taking non-insulin antidiabetic agents. To date, several antidiabetic agents have shown to have a positive effect on stroke prevention. The accumulated evidence suggests that metformin, pioglitazone and semaglutide reduce stroke risk. These agents do not represent only a way of controlling blood glucose and but also offer the opportunity to reduce stroke risk. Surely, new data from ongoing and future studies will provide additional information to select the best treatment for decreasing stroke risk in T2D patients.
Topics: Blood Glucose; Diabetes Mellitus, Type 2; Glucagon-Like Peptides; Humans; Hypoglycemic Agents; Metformin; Pioglitazone; Randomized Controlled Trials as Topic; Risk Factors; Stroke; Thiazolidinediones
PubMed: 28939005
DOI: 10.1016/j.ejim.2017.09.019 -
Stroke Aug 2022A polypill-type strategy for primary prevention was first published at the turn of the century and advised that a multi-ingredient pill applied to an adult population... (Review)
Review
A polypill-type strategy for primary prevention was first published at the turn of the century and advised that a multi-ingredient pill applied to an adult population would prevent up to 80% of cardiovascular and stroke events. Such a pill should contain small doses of antihypertensives, lipid-lowering drugs, and some nutrients. The startling increase of the global stroke burden has led to a revival of this concept and the propagation of a population-based prevention strategy. Recent cardiovascular fixed-dose combination trials have shown a significant effect in reducing not only blood pressure and cholesterol levels but also in reducing cardiovascular and stroke events. In most of the studies, the study population was for secondary prevention and the total number of strokes was small. Nevertheless, it is now clear that a large proportion of primary prevention must take this path. It is especially promising when combined with community health workers interventions for modifying risk behavior. While a polypill-type approach seems most efficacious in underserved regions of high-income countries as well as in low- and middle-income countries, it seems to have a large overall effect in spite of some problems with nonadherence or potential side effects. It should be available and affordable for large target populations. Larger phase 4 studies are under way.
Topics: Adult; Antihypertensive Agents; Cardiovascular Diseases; Drug Combinations; Humans; Secondary Prevention; Stroke
PubMed: 35726621
DOI: 10.1161/STROKEAHA.122.037313 -
The Journal of Clinical Endocrinology... Oct 2023
Topics: Humans; Diabetes Mellitus, Type 2; Sodium-Glucose Transporter 2 Inhibitors; Hypoglycemic Agents; Myocardial Infarction; Stroke
PubMed: 37061813
DOI: 10.1210/clinem/dgad216 -
Topics in Stroke Rehabilitation Dec 2016Each year approximately 100,000 stroke survivors are diagnosed with aphasia. Although stroke is associated with age, the relationship between age and aphasia is less... (Review)
Review
BACKGROUND
Each year approximately 100,000 stroke survivors are diagnosed with aphasia. Although stroke is associated with age, the relationship between age and aphasia is less clear.
OBJECTIVES
To complete a review of the literature to examine the relationship between age and: (a) presence or likelihood of aphasia after stroke, (b) aphasia type, (c) aphasia recovery patterns, and (d) aphasia clinical outcomes.
DATA SOURCES
Articles were identified by a comprehensive search of "OneSearch," PubMed, and individual journals: Aphasiology, Stroke and the Journal of Stroke and Cerebrovascular Diseases.
STUDY SELECTION
Inclusion criteria included: age and incidence of aphasia, likelihood of aphasia, aphasia recovery, and aphasia clinical outcome.
DATA EXTRACTION
Independent searches were completed by the authors. Each author independently assessed the full text of reports meeting inclusion criteria. Differences regarding study eligibility and need to proceed with data extraction were resolved by consensus.
RESULTS
1617 articles were identified during the initial search. Forty studies including 14,795 study participants were included in the review. The review generally demonstrated that: (a) stroke patients with aphasia are typically older than stroke with patients without aphasia and (b) aphasia type and age are associated as younger patients with aphasia are more likely to exhibit non-fluent or Broca's type of aphasia. In contrast, studies examining aphasia recovery and aphasia clinical outcomes did not demonstrate a positive relationship between age and recovery or clinical outcomes.
CONCLUSIONS
Stroke is a condition of the elderly. However, age appears to only influence likelihood of aphasia and aphasia type.
Topics: Age Factors; Aphasia; Humans; Outcome Assessment, Health Care; Stroke
PubMed: 26916396
DOI: 10.1080/10749357.2016.1150412 -
Journal of Neurosurgery Oct 2023Strokes affect almost 13 million new people each year, and whereas the outcomes of stroke have improved over the past several decades in high-income countries, the same... (Review)
Review Meta-Analysis
OBJECTIVE
Strokes affect almost 13 million new people each year, and whereas the outcomes of stroke have improved over the past several decades in high-income countries, the same cannot be seen in low-income and lower-middle-income countries. This is the first study to identify the availability of diagnostic tools along with the rates of stroke mortality and other poststroke complications in low-income and lower-middle-income countries.
METHODS
A review of the literature was completed with a search of the MEDLINE, Embase, and Scopus databases, with adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they reported any outcomes of stroke in low-income and lower-middle-income countries as designated by the World Bank classification. A meta-analysis calculating pooled prevalence rates of diagnostic characteristics and stroke outcomes was completed for all endpoint variables.
RESULTS
A total of 19 studies were included, of which 6 came from Ethiopia, 3 from Zambia, and 2 each from Tanzania and Iran. Single studies from Zimbabwe, Botswana, Senegal, Cameroon, Uganda, and Sierra Leone were included. A total of 5265 (61.7%) patients had an ischemic stroke, 2124 (24.9%) had hemorrhagic stroke, with the remaining 1146 (13.4%) having an unknown type. Among 6 studies the pooled percentage of patients presenting to hospital within 1 day was 48.37% (95% CI 38.59%-58.27%; I2 = 97.0%, p < 0.01). The pooled in-hospital mortality rate was 19.81% (95% CI 15.26%-25.31%; I2 = 91%, p < 0.01), but was higher in a hemorrhagic subgroup (27.07% [95% CI 22.52%-32.15%; I2 = 54%, p = 0.05]) when compared to an ischemic group (13.16% [95% CI 8.60%-19.62%; I2 = 87%, p < 0.01]). The 30-day pooled mortality rate was 23.24% (95% CI 14.17%-35.70%; I2 = 93%, p < 0.01). At 30 days, the functional independence (modified Rankin Scale score 0-2) pooled rate was 13.10% (95% CI 7.50%-21.89%; I2 = 82%, p < 0.01).
CONCLUSIONS
A severe healthcare disparity is present in low-income and lower-middle-income countries, where there is delayed diagnosis of strokes and increased rates of poor clinical outcomes for these patients.
Topics: Humans; Developing Countries; Stroke; Income; Uganda
PubMed: 37856884
DOI: 10.3171/2023.2.JNS222807