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Scientific Reports Dec 2020The hemorrhagic and the ischemic types of stroke have similar symptoms in the early stage, but their treatments are completely different. The timely and effective...
The hemorrhagic and the ischemic types of stroke have similar symptoms in the early stage, but their treatments are completely different. The timely and effective discrimination of the two types of stroke can considerable improve the patients' prognosis. In this paper, a 16-channel and noncontact microwave-based stroke detection system was proposed and demonstrated for the potential differentiation of the hemorrhagic and the ischemic stroke. In animal experiments, 10 rabbits were divided into two groups. One group consisted of five cerebral hemorrhage models, and the other group consisted of five cerebral ischemia models. The two groups were monitored by the system to obtain the Euclidean distance transform value of microwave scattering parameters caused by pathological changes in the brain. The support vector machine was used to identify the type and the severity of the stroke. Based on the experiment, a discrimination accuracy of 96% between hemorrhage and ischemia stroke was achieved. Furthermore, the potential of monitoring the progress of intracerebral hemorrhage or ischemia was evaluated. The discrimination of different degrees of intracerebral hemorrhage achieved 86.7% accuracy, and the discrimination of different severities of ischemia achieved 94% accuracy. Compared with that with multiple channels, the discrimination accuracy of the stroke severity with a single channel was only 50% for the intracerebral hemorrhage and ischemia stroke. The study showed that the microwave-based stroke detection system can effectively distinguish between the cerebral hemorrhage and the cerebral ischemia models. This system is very promising for the prehospital identification of the stroke type due to its low cost, noninvasiveness, and ease of operation.
Topics: Animals; Humans; Microwaves; Monitoring, Physiologic; Rabbits; Stroke; Support Vector Machine; Thrombolytic Therapy
PubMed: 33303768
DOI: 10.1038/s41598-020-78647-x -
Journal of Stroke and Cerebrovascular... Jun 2023Stroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical services (EMS)....
BACKGROUND
Stroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical services (EMS). The impact of this education is unclear. We aimed to measure the associations between EMS use and timing of hospital arrival and first-ever and recurrent strokes as a proxy for stroke education.
METHODS
The study analyzed data from validated strokes identified by the Brain Attack Surveillance in Corpus Christi (BASIC) project between 1/1/2000-1/1/2020. We analyzed 5,617 first-ever strokes, 259 instances of recurrent stroke within 1 year of the first (early recurrence), and 451 recurrent strokes over 1 year from the first (late recurrence). Following imputation, associations of both EMS arrival (available starting late 2011) and early arrival (< 3 hours) with first-ever versus recurrent stroke (early and late) were assessed with logistic models, accounting for the clustering of multiple strokes per participant with generalized estimating equations. Full model covariates included stroke type, initial stroke severity, marital status, race/ethnicity, gender, age, insurance, education, and EMS use (early arrival model only).
RESULTS
Compared to first-ever stroke, there were significantly higher unadjusted odds of arrival by EMS for the late recurrence group (late recurrence OR = 1.54, 95% CI = 1.18-1.99; early arrival OR = 1.24, 95% CI = 0.87-1.76). The association for late recurrence remained significant after adjustment (aOR = 1.46, 95% CI = 1.09-1.95). The pre-2010 unadjusted odds of early arrival were non-significant for both early and late recurrence groups (late recurrence OR = 1.05, CI = 0.70-1.56; early recurrence OR = 0.85, CI = 0.54-1.33), while late recurrence was associated with early arrival after 2010 (OR = 1.32, 95% CI = 1.03-1.69). After full adjustment, it was no longer significant (aOR = 1.25, 95% CI = 0.96-1.62). Higher initial stroke severity, married status, and EMS use were associated with higher odds of early arrival, while African Americans (AAs) had lower odds than non-Hispanic Whites (NHWs). However, AAs did have higher odds of EMS use relative to NHWs. Those who were married and living together had borderline significant lower odds of EMS use compared to those who were not.
CONCLUSIONS
Our study examines the association of repeat stroke on early arrival and EMS use as a surrogate for adequate stroke education. Recurrence at least one year after the first stroke was associated with higher EMS usage, but there was not enough evidence to establish a relationship with early arrival after accounting for EMS usage and possible confounders. By examining subsets, we can identify groups that would benefit from targeted education. For example, younger, non-AA patients with smaller strokes would benefit from more education on EMS use and African American patients would benefit from education related to faster recognition or urgency of presentation.
Topics: Humans; Stroke; Emergency Medical Services; Cerebral Infarction; Ethnicity; White
PubMed: 37037176
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107069 -
Journal of the American Heart... Nov 2022Background Patients with type A aortic dissection (TAAD) have a high short-term risk of stroke. However, whether patients with TAAD have an increased long-term risk of...
Background Patients with type A aortic dissection (TAAD) have a high short-term risk of stroke. However, whether patients with TAAD have an increased long-term risk of stroke is still undetermined, and our study aims to address this knowledge gap. Methods and Results A nationwide retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database. We included patients with TAAD as well as age- and sex-matched aortic disease-free individuals between 2003 and 2016. Inverse probability of treatment weighting was performed to balance patient characteristics between the groups. The primary outcome was the development of stroke, regardless of subtype; the secondary outcomes were the risk of developing either ischemic or hemorrhagic stroke. The hazard ratios (HRs) of stroke were estimated using the Cox proportional hazards model. After inverse probability of treatment weighting, 3556 and 7023 patients were categorized into the TAAD and aortic disease-free cohorts, respectively. The mean follow-up period was 5.71 years. The HRs for overall, ischemic, and hemorrhagic strokes in the TAAD cohort were 3.01 (95% CI, 2.40-3.78), 3.18 (95% CI, 2.47-4.10), and 2.32 (95% CI, 1.58-3.41), respectively, compared with the aortic disease-free cohort. Consistent trends of higher stroke risk in patients with TAAD were revealed in the analyses stratified by age; sex; antiplatelet use; and history of hypertension, diabetes, or dyslipidemia. Conclusions Our study findings revealed that patients with TAAD had an increased long-term risk of both ischemic and hemorrhagic strokes. Further studies are warranted to establish optimal strategies for stroke prevention in these patients.
Topics: Humans; Cohort Studies; Retrospective Studies; Hemorrhagic Stroke; Risk Factors; Stroke; Aortic Dissection; Ischemia
PubMed: 36326053
DOI: 10.1161/JAHA.122.027178 -
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 -
Deutsches Arzteblatt International Oct 2009Stroke is the third most common cause of death in industrialized countries, accounting for more than 10% of deaths over age 65. Most strokes are due to arteriosclerosis.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Stroke is the third most common cause of death in industrialized countries, accounting for more than 10% of deaths over age 65. Most strokes are due to arteriosclerosis. Regular physical activity lowers arterial blood pressure and body weight and improves glucose and lipid metabolism, thereby slowing the development of arteriosclerosis and its cardiovascular complications, particularly myocardial infarction. This review focuses on the question whether physical activity might also have a preventive effect on cerebral infarction and hemorrhage.
METHODS
This analysis is based on 33 prospective cohort studies and 10 case-control studies that addressed the potential effect of physical activity on stroke-related morbidity and mortality.
RESULTS
Our meta-analysis shows that physical activity reduces the risk of all types of stroke (infarction, hemorrhage, and stroke of unspecified type). The relative risk (RR) of fatal or non-fatal cerebral infarction is 0.75, while the corresponding figures for cerebral hemorrhage and stroke of unspecified type are 0.67 and 0.71, respectively. The reduction of risk is only statistically significant for men. The case-control studies show an RR of 0.32 for men and women combined.
CONCLUSIONS
When a multivariate analysis is performed that takes other vascular risk factors into account, physical activity is found to have an independent protective effect against cerebrovascular events. The effect is statistically significant only for men, not for women.
Topics: Clinical Trials as Topic; Exercise; Exercise Therapy; Humans; Incidence; Motor Activity; Risk Assessment; Risk Factors; Risk Reduction Behavior; Stroke; Survival Analysis; Survival Rate; Treatment Outcome
PubMed: 19997550
DOI: 10.3238/arztbl.2009.0715 -
Seminars in Neurology Oct 2022Ischemic stroke is by far the most common type of cerebrovascular event and remains a major cause of death and disability globally. Despite advancements in acute stroke...
Ischemic stroke is by far the most common type of cerebrovascular event and remains a major cause of death and disability globally. Despite advancements in acute stroke care, primary prevention is still the most cost-effective approach in reducing the burden of ischemic stroke. The two main strategies for primary stroke prevention include population-wide versus high-risk group interventions. Interventions such as increasing access to primary care, regulation of salt and sugar contents in processed foods, public education, and campaigns to control cerebrovascular risk factors are examples of population-wide interventions. High-risk group interventions, on the other hand, focus on recognition of individuals at risk and aim to modify risk factors in a timely and multifaceted manner. This article provides an overview on conventional modifiable risk factors for ischemic stroke and highlights the emerging risk factors and approaches for high-risk group identification and treatment.
Topics: Humans; Ischemic Stroke; Stroke; Risk Factors; Primary Prevention
PubMed: 36395819
DOI: 10.1055/s-0042-1758703 -
Indian Journal of Pediatrics Mar 2003Stroke is a thrombohemorrhagic disorder of the central nervous system, with a fairly good outcome in pediatric age group except for the infancy period. In children... (Review)
Review
Stroke is a thrombohemorrhagic disorder of the central nervous system, with a fairly good outcome in pediatric age group except for the infancy period. In children ischemic type is more common than hemorrhagic type. Though it is difficult to distinguish between thrombotic and embolic phenomenon but it is largely due to cardiovascular lesions, at times it may be the first symptom to appear. The signs and symptoms also appear to be vague in children, hence difficult to pinpoint the etiology. The treatment of stroke is largely for stabilization of the patient, but it is very important to know the cause to prevent future strokes. Use of heparin in ischemic stroke is very promising and thrombolytic therapy is under trial.
Topics: Adolescent; Anticoagulants; Anticonvulsants; Brain Ischemia; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Intracranial Hemorrhages; Male; Risk Factors; Stroke; Thrombolytic Therapy
PubMed: 12785278
DOI: No ID Found -
Continuum (Minneapolis, Minn.) Apr 2020This article reviews the evidence base and recommendations for medical management for secondary stroke prevention. (Review)
Review
PURPOSE OF REVIEW
This article reviews the evidence base and recommendations for medical management for secondary stroke prevention.
RECENT FINDINGS
Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant-associated hemorrhage, and aspirin rather than presumptive anticoagulation with a direct oral anticoagulant for embolic stroke of undetermined source.
SUMMARY
Most strokes are preventable. The mainstays of medical management for secondary stroke prevention include antihypertensive therapy; antithrombotic therapy, with antiplatelet agents for most stroke subtypes or anticoagulants such as warfarin or a direct oral anticoagulant for cardioembolic stroke specifically; cholesterol-lowering therapy, principally with statins, but with potential roles for ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors in selected patients; and glycemic control to prevent microvascular complications from diabetes mellitus or pioglitazone in selected patients with insulin resistance but not diabetes mellitus.
Topics: Anticholesteremic Agents; Anticoagulants; Antihypertensive Agents; Fibrinolytic Agents; Humans; Hypoglycemic Agents; Platelet Aggregation Inhibitors; Secondary Prevention; Stroke
PubMed: 32224760
DOI: 10.1212/CON.0000000000000849 -
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 -
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