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European Journal of Paediatric... May 2019With a birth-prevalence of 37-67/100,000 (mostly term-born), perinatal stroke encompasses distinct disease-states with diverse causality, mechanism, time of onset, mode... (Review)
Review
With a birth-prevalence of 37-67/100,000 (mostly term-born), perinatal stroke encompasses distinct disease-states with diverse causality, mechanism, time of onset, mode of presentation and outcome. Neonatal primary haemorrhagic stroke and ischemic events (also divided into neonatal arterial ischemic stroke and neonatal cerebral sinus venous thrombosis) that manifest soon after birth are distinguished from presumed perinatal - ischemic or haemorrhagic - stroke. Signs of the latter become apparent only beyond the neonatal period, most often with motor asymmetry or milestones delay, and occasionally with seizures. Acute or remote MRI defines the type of stroke and is useful for prognosis. Acute care relies on homeostatic maintenance. Seizures are often self-limited and anticonvulsant agents might be discontinued before discharge. Prolonged anticoagulation for a few weeks is an option in some cases of sinovenous thrombosis. Although the risk of severe impairment is low, many children develop mild to moderate multimodal developmental issues that require a multidisciplinary approach.
Topics: Child; Developmental Disabilities; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pregnancy; Prognosis; Risk Factors; Stroke; Syndrome
PubMed: 30879961
DOI: 10.1016/j.ejpn.2019.02.013 -
BMC Emergency Medicine Jun 2022The worldwide burden of stroke remains high, with increasing time-to-treatment correlated with worse outcomes. Yet stroke subtype determination, most importantly between... (Review)
Review
BACKGROUND
The worldwide burden of stroke remains high, with increasing time-to-treatment correlated with worse outcomes. Yet stroke subtype determination, most importantly between stroke/non-stroke and ischemic/hemorrhagic stroke, is not confirmed until hospital CT diagnosis, resulting in suboptimal prehospital triage and delayed treatment. In this study, we survey portable, non-invasive diagnostic technologies that could streamline triage by making this initial determination of stroke type, thereby reducing time-to-treatment.
METHODS
Following PRISMA guidelines, we performed a scoping review of portable stroke diagnostic devices. The search was executed in PubMed and Scopus, and all studies testing technology for the detection of stroke or intracranial hemorrhage were eligible for inclusion. Extracted data included type of technology, location, feasibility, time to results, and diagnostic accuracy.
RESULTS
After a screening of 296 studies, 16 papers were selected for inclusion. Studied devices utilized various types of diagnostic technology, including near-infrared spectroscopy (6), ultrasound (4), electroencephalography (4), microwave technology (1), and volumetric impedance spectroscopy (1). Three devices were tested prior to hospital arrival, 6 were tested in the emergency department, and 7 were tested in unspecified hospital settings. Median measurement time was 3 minutes (IQR: 3 minutes to 5.6 minutes). Several technologies showed high diagnostic accuracy in severe stroke and intracranial hematoma detection.
CONCLUSION
Numerous emerging portable technologies have been reported to detect and stratify stroke to potentially improve prehospital triage. However, the majority of these current technologies are still in development and utilize a variety of accuracy metrics, making inter-technology comparisons difficult. Standardizing evaluation of diagnostic accuracy may be helpful in further optimizing portable stroke detection technology for clinical use.
Topics: Emergency Medical Services; Humans; Intracranial Hemorrhages; Stroke; Time-to-Treatment; Triage
PubMed: 35710360
DOI: 10.1186/s12873-022-00663-z -
Stroke Aug 2022Mechanical thrombectomy is a highly effective treatment for acute ischemic stroke caused by large-vessel occlusion in the anterior cerebral circulation, significantly... (Review)
Review
Mechanical thrombectomy is a highly effective treatment for acute ischemic stroke caused by large-vessel occlusion in the anterior cerebral circulation, significantly increasing the likelihood of recovery to functional independence. Until recently, whether intravenous thrombolysis before mechanical thrombectomy provided additional benefits to patients with acute ischemic stroke-large-vessel occlusion remained unclear. Given that reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke-large-vessel occlusion and the efficacy of both intravenous thrombolysis and mechanical thrombectomy is time-dependent, achieving complete reperfusion with a single pass should be the primary angiographic goal. However, it remains undetermined whether extending the procedure with additional endovascular attempts or local lytics administration safely leads to higher reperfusion grades and whether there are significant public health and cost implications. Here, we outline the current state of knowledge and research avenues that remain to be explored regarding the consistent therapeutic benefit of intravenous thrombolysis in anterior circulation strokes and the potential place of adjunctive intra-arterial lytics administration, including alternative thrombolytic agent place.
Topics: Brain Ischemia; Fibrinolytic Agents; Humans; Ischemic Stroke; Plasminogen; Stroke; Thrombectomy; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome
PubMed: 35506385
DOI: 10.1161/STROKEAHA.122.039287 -
Neuropsychology Review Sep 2017Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been... (Meta-Analysis)
Meta-Analysis Review
Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been reported. This systematic review and meta-analysis aims to provide a comprehensive and up-to-date evaluation of imaging markers associated with PSD and PSA. Databases (Medline, Embase, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews) were searched from inception to July 21, 2016. Observational studies describing imaging markers of PSD and PSA were included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the association between PSD or PSA and stroke lesion laterality, type, and location, also stratified by study phase (acute, post-acute, chronic). Other imaging markers were reviewed qualitatively. The search retrieved 4502 studies, of which 149 studies were included in the review and 86 studies in the meta-analyses. PSD in the post-acute stroke phase was significantly associated with frontal (OR 1.72, 95% CI 1.34-2.19) and basal ganglia lesions (OR 2.25, 95% CI 1.33-3.84). Hemorrhagic stroke related to higher odds for PSA in the acute phase (OR 2.58, 95% CI 1.18-5.65), whereas ischemic stroke related to higher odds for PSA in the post-acute phase (OR 0.20, 95% CI 0.06-0.69). Frequency of PSD and PSA is modestly associated with stroke type and location and is dependent on stroke phase. These findings have to be taken into consideration for stroke rehabilitation programs, as this could prevent stroke patients from developing PSD and PSA, resulting in better clinical outcome.
Topics: Apathy; Biomarkers; Brain; Depression; Humans; Observational Studies as Topic; Stroke
PubMed: 28831649
DOI: 10.1007/s11065-017-9356-2 -
Dimensions of Critical Care Nursing :...There are 2 classification of strokes: ischemic, if caused by an arterial occlusion from a clot or obstruction by atherosclerosis, and hemorrhagic, if caused by the...
BACKGROUND
There are 2 classification of strokes: ischemic, if caused by an arterial occlusion from a clot or obstruction by atherosclerosis, and hemorrhagic, if caused by the rupture of a vessel and subsequent bleeding. Each type of stroke is influenced by platelet counts and platelet function. The intention of this article is to discuss the role of the platelet in the pathophysiology of acute stroke processes. This serves as a prelude to discussing these processes as disrupted with thrombocytopenia (low platelet counts). Platelets initiate clot formation and obstruct blood flow through the creation of a platelet plug. They also extend the penumbra in ischemic and hemorrhagic strokes. Thrombocytopenia can be a causal factor in an ischemic stroke, a risk factor for hemorrhagic stroke, and a risk factor for hemorrhagic stroke conversion.
METHODS
The aims of this study were to review 1 case study that illustrates the pivotal role of the platelet in strokes and to review the aspect that was impacted by autoimmune thrombocytopenia.
DISCUSSION
Thrombocytopenia is a hematologic disorder not often included in stroke care discussions. Thrombocytopenia sets up strokes to occur and, paradoxically, may also set the patient up for bleeding complications in the brain or groin.
CONCLUSION
Acknowledging the impact of both platelet and thrombocytopenia on stroke causation, stroke interventions, and outcomes is a pivotal aspect of comprehensive stroke care. Platelet function processes are impactful in each point of the continuum of stroke care, prevention, intervention, and discharge.
Topics: Anemia; Hemorrhagic Stroke; Hemostasis; Humans; Stroke; Thrombocytopenia
PubMed: 33792271
DOI: 10.1097/DCC.0000000000000471 -
Journal of Neurology Nov 2014Haemorrhagic stroke is a severe stroke subtype with high rates of morbidity and mortality. Although this condition has been recognised for a long time, the progressing... (Review)
Review
Haemorrhagic stroke is a severe stroke subtype with high rates of morbidity and mortality. Although this condition has been recognised for a long time, the progressing haemorrhagic stroke has not received adequate attention, and it accounts for an even worse clinical outcome than the nonprogressing types of haemorrhagic stroke. In this review article, we categorised the progressing haemorrhagic stroke into acute progressing haemorrhagic stroke, subacute haemorrhagic stroke, and chronic progressing haemorrhagic stroke. Haematoma expansion, intraventricular haemorrhage, perihaematomal oedema, and inflammation, can all cause an acute progression of haemorrhagic stroke. Specific 'second peak' of perihaematomal oedema after intracerebral haemorrhage and 'tension haematoma' are the primary causes of subacute progression. For the chronic progressing haemorrhagic stroke, the occult vascular malformations, trauma, or radiologic brain surgeries can all cause a slowly expanding encapsulated haematoma. The mechanisms to each type of progressing haemorrhagic stroke is different, and the management of these three subtypes differs according to their causes and mechanisms. Conservative treatments are primarily considered in the acute progressing haemorrhagic stroke, whereas surgery is considered in the remaining two types.
Topics: Cerebral Hemorrhage; Disease Management; Disease Progression; Humans; Stroke
PubMed: 24595959
DOI: 10.1007/s00415-014-7291-1 -
Headache Mar 2019Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of... (Review)
Review
INTRODUCTION
Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of cerebrovascular disease.
METHOD
This is a narrative review.
RESULTS
The prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% of cases and of headache attributed to transient ischemic attack, from 26% to 36%. Headache attributed to ischemic stroke is more frequent in younger patients, in migraineurs, in those who have suffered a larger stroke, a posterior circulation infarction, or a cortical infarction, and is less frequent in lacunar infarctions. The most common pattern of headache attributed to ischemic stroke is a mild to moderate bilateral pain, not associated with nausea, vomiting, photophobia, or phonophobia. This headache usually has a concomitant onset with focal neurologic deficit and improves over time. The few studies that have assessed the value of headache for a prognosis of ischemic strokes have demonstrated conflicting results. There are no clinical trials on pain management or prophylactic treatment of persistent headache attributed to ischemic stroke.
CONCLUSION
Headache attributed to ischemic stroke is frequent and usually has a tension-type headache pattern. Its frequency varies according to the stroke's etiology. Further studies are required on pain management, prophylactic treatment, and characteristics of this headache.
Topics: Brain Ischemia; Headache; Humans; Ischemic Attack, Transient; Observational Studies as Topic; Stroke
PubMed: 30667047
DOI: 10.1111/head.13478 -
International Journal of Epidemiology Jun 2023Whether changes in stroke mortality are affected by age distribution and birth cohorts, and if the decline in stroke mortality exhibits heterogeneity by stroke type,...
BACKGROUND
Whether changes in stroke mortality are affected by age distribution and birth cohorts, and if the decline in stroke mortality exhibits heterogeneity by stroke type, remains uncertain.
METHODS
We undertook a sequential time series analysis to examine stroke mortality trends in the USA among people aged 18-84 years between 1975 and 2019 (n = 4 332 220). Trends were examined for overall stroke and by ischaemic and haemorrhagic subtypes. Mortality data were extracted from the US death files, and age-sex population data were extracted from US census. Age-standardized stroke mortality rates and incidence rate ratio (IRR) with 95% confidence interval [CI] were derived from Poisson regression models.
RESULTS
Age-standardized stroke mortality declined for females from 87.5 in 1975 to 30.9 per 100 000 in 2019 (IRR 0.27, 95% CI 0.26, 0.27; average annual decline -2.78%, 95% CI -2.79, -2.78). Among males, age-standardized mortality rate declined from 112.1 in 1975 to 38.7 per 100 000 in 2019 (RR 0.26, 95% CI 0.26, 0.27; average annual decline -2.80%, 95% CI -2.81, -2.79). Stroke mortality increased sharply with advancing age. Decline in stroke mortality was steeper for ischaemic than haemorrhagic strokes.
CONCLUSIONS
Stroke mortality rates have substantially declined, more so for ischaemic than haemorrhagic strokes.
Topics: Male; Female; Humans; Hemorrhagic Stroke; Stroke; Censuses; Age Distribution; Incidence; Mortality
PubMed: 36343092
DOI: 10.1093/ije/dyac210 -
Critical Care Nurse Feb 2017Cardioembolic stroke is a critical health condition that requires immediate intervention. Cardiac emboli are the most common type of embolism and account for 14% to 30%... (Review)
Review
Cardioembolic stroke is a critical health condition that requires immediate intervention. Cardiac emboli are the most common type of embolism and account for 14% to 30% of all ischemic strokes. Atrial fibrillation is the most common cause of cardioembolic strokes, and its prevalence increases substantially with age. Other factors that increase the risk for cardioembolic stroke include hypertension, diabetes mellitus, hyperlipidemia, cardiac disease, and lifestyle choices. General supportive care and treatment of the acute phase and subsequent complications should be started immediately. Nurses must play an active role in screening patients for stroke subtypes, using appropriate diagnostic tools, and providing medical and nursing interventions. Nurses also play a crucial role in prevention by providing education to patients and patients' families on how to recognize stroke signs and symptoms. This case study discusses the course of illness, treatment, and prevention strategies for patients who have suffered cardioembolic stroke due to atrial fibrillation.
Topics: Aged; Anticoagulants; Atrial Fibrillation; Combined Modality Therapy; Coronary Thrombosis; Critical Illness; Early Diagnosis; Emergency Service, Hospital; Follow-Up Studies; Humans; Intracranial Embolism; Male; Risk Assessment; Severity of Illness Index; Stroke; Thrombectomy; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28148612
DOI: 10.4037/ccn2017127 -
Stroke Mar 2021Medium vessel occlusions (MeVOs, ie, M2, M3, A2, A3, P2, and P3 segment occlusions) are increasingly recognized as a target for endovascular treatment in acute ischemic... (Review)
Review
Medium vessel occlusions (MeVOs, ie, M2, M3, A2, A3, P2, and P3 segment occlusions) are increasingly recognized as a target for endovascular treatment in acute ischemic stroke. It is important to note that not all MeVOs are equal. Primary MeVOs occur de novo with the underlying mechanisms being very similar to large vessel occlusion strokes. Secondary MeVOs arise from large vessel occlusions through clot migration or fragmentation, either spontaneously or following treatment with intravenous thrombolysis or endovascular treatment. Currently, there are little data on the prevalence, management, and prognosis of acute ischemic stroke due to secondary MeVOs. This type of stroke is, however, likely to become more relevant in the future as indications for endovascular treatment continue to broaden. In this article, we describe different types of secondary MeVOs, imaging findings associated with them, challenges related to the diagnosis of secondary MeVOs, and their potential implications for treatment strategies and clinical outcomes.
Topics: Arterial Occlusive Diseases; Cerebral Angiography; Endovascular Procedures; Humans; Ischemic Stroke
PubMed: 33467882
DOI: 10.1161/STROKEAHA.120.032799