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1
Zhang, Cen, and Scott Kasner. "Diagnosis, prognosis, and management of cryptogenic stroke." F1000Research 5 (February 12, 2016): 168. http://dx.doi.org/10.12688/f1000research.7384.1.
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Despite many advances in our understanding of ischemic stroke, cryptogenic strokes (those that do not have a determined etiology) remain a diagnostic and therapeutic challenge. Previous classification approaches to cryptogenic stroke have led to inconsistent definitions, and evidence to determine optimal treatment is scarce. These limitations have prompted international efforts to redefine cryptogenic strokes, leading to more rigorous diagnostic criteria, outcome studies, and new clinical trials. Improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. Further, better understanding of acute biomarkers has helped to identify otherwise occult mechanisms. Together, these strategies will inform long-term outcomes and shape management.
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Somasundaran, Abhilash, Hashik Mohammed, Jayaraj Kezhukatt, Alvin Treasa George, and S. Narayanan Potty. "Accuracy of Siriraj stroke scale in the diagnosis of stroke subtypes among stroke patients." International Journal of Research in Medical Sciences 5, no. 3 (February 20, 2017): 1084. http://dx.doi.org/10.18203/2320-6012.ijrms20170666.
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Background: Early detection of intracranial blood is essential for the rational use of anti hemostatic drugs in stroke patients. CT scan is quite expensive as well as it is not easily available especially in the rural areas. Clinical stroke scores were developed to overcome these limitations. Aim of present study is to identify the stroke subtype using Siriraj stroke scoring and thus asses its accuracy by comparing with CT scan reports.Methods: A cross sectional study was conducted in a tertiary centre that evaluated 464 patients admitted with a diagnosis of stroke. Siriraj Stroke score was calculated for each patient and a CT scan of brain was also taken. The results of diagnosis made by Siriraj stroke scoring were compiled and compared with the diagnosis obtained by CT Scan.Results: Of the total 464 patients, the incidence of hemorrhagic stroke was 27.8% and ischemic stroke was 72.2%, as per the CT scan reports, while the Siriraj stroke score diagnosed 16.8% patients to have hemorrhagic stroke and 74.6% to have ischemic stroke and no definite diagnosis was made in rest of the patients (8.6%). The sensitivity of the scoring was found to be 59.2% in diagnosing hemorrhagic stroke and 95.5% in ischemic stroke.Conclusions: Our study has shown that siriraj stroke scoring has a high degree of accuracy in detecting both types of strokes, with roughly 80% of both hemorrhagic and ischemic strokes being correctly identified. However there is a low sensitivity in diagnosing hemorrhagic strokes and higher sensitivity in diagnosing ischemic strokes.
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Mahdi, Jasia, Alicia Bach, Alyssa Smith, Stuart Tomko, Melanie Fields, Jennifer Griffith, Stephanie Morris, et al. "IMMU-07. “STROKE MIMICS” ARE NOT BENIGN IN IMMUNOCOMPROMISED CHILDREN." Neuro-Oncology 23, Supplement_1 (June 1, 2021): i28. http://dx.doi.org/10.1093/neuonc/noab090.115.
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Abstract Objective To determine the clinical variances between strokes and stroke mimics in a pediatric immunocompromised population that consists of children with central nervous system (CNS) and non-CNS malignancies and a history of solid organ transplantation. Methods We performed a retrospective cohort analysis of stroke alert activations in patients with high-grade gliomas, low-grade gliomas, atypical teratoid rhabdoid tumors, rare CNS tumors, B-cell acute lymphoblastic leukemia, T-cell acute lymphoblastic leukemia, osteosarcoma, and solid organ transplants at St. Louis Children’s Hospital between February 2013 and September 2019. We categorized final diagnoses as strokes or stroke mimics. We classified diagnoses as a neurologic emergency if the diagnosis necessitated changes in management. Results Out of 217 stroke alerts, 31 alerts occurred for 28 patients meeting inclusion criteria. All final diagnoses constituted neurologic emergencies, including: stroke (39%), chemotherapy-related neurotoxicity (29%), tumor progression (19%), and seizures/posterior reversible encephalopathy syndrome (13%). Patients meeting inclusion criteria with strokes and stroke mimics presented similarly, with the exception of altered mental status, which was more prevalent in patients with strokes than stroke mimics (p = 0.03). One child received hyperacute thrombectomy for stroke. Only 58% of children with stroke mimics had complete resolution of their presenting neurologic symptoms. Children with strokes and stroke mimics had similar mortality incidences of 33% and 37%, respectively. Conclusions Although all acute neurologic changes in immunocompromised children are not strokes, stroke mimics in this population are neither benign nor self-limited and carry long-term neurologic morbidity and mortality. This study highlights the utility of an acute stroke evaluation infrastructure and the need for acute and long-term neurology involvement in the care of these patients.
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Kotlęga, Dariusz, Barbara Peda, Tomasz Trochanowski, Monika Gołąb-Janowska, Sylwester Ciećwież, and Przemysław Nowacki. "STROKE MIMICS: A PSYCHOGENIC STROKE PATIENT TREATED WITH ALTEPLASE." Acta Neuropsychologica 17, no. 1 (February 12, 2019): 97–102. http://dx.doi.org/10.5604/01.3001.0013.1852.
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For rtPA treatment to be effective it should be initiated within the first 4.5 hours following the onset of a stroke. Such a short therapeutic window demands a rapid diagnosis and decision making on the part of the physician. There are patients with stroke-like symptoms and an initial diagnosis of a stroke, but who are finally diagnosed as suffering from another condition. According to the subject literature, stroke mimics are diagnosed in about 1.4 – 3.5% of patients initially diagnosed as having had an ischemic stroke. Psychogenic strokes (conversion disorders) may be found in as many as 8.2% of stroke patients. Proper diagnosis is especially important in patients eligible for thrombolytic treatment when there is usually not enough time to establish the diagnosis of a stroke mimic, especially one of psychogenic origin. A patient with an initial diagnosis of an ischemic stroke who was treated with intravenous alteplase infusion. The previous two ischemic strokes treated in the same manner had been diagnosed one and two years earlier. In all hospitalizations no rtPA treatment complications had been observed. In our patient a proper neuropsychological examination was performed and a conversion disorder diagnosed. We would like to underline the importance of cooperation between the neuropsychologist and neurology physician within clinical practice.
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Deeg, Karl-Heinz. "Sonographic and Doppler Sonographic Diagnosis of Neonatal Ischemic Stroke." Ultraschall in der Medizin - European Journal of Ultrasound 38, no. 04 (July 13, 2017): 360–76. http://dx.doi.org/10.1055/s-0043-114409.
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AbstractChildren are particularly at risk for stroke in the neonatal period. 1/3 of all strokes in children occur during the perinatal period. The incidence of perinatal stroke is 1:4000. A differentiation is made between ischemic stroke and hemorrhagic stroke. Ischemic strokes are caused by arterial occlusion due to thrombosis or embolism. As a result of the nonspecific clinical symptoms in this age group, diagnosis is usually made too late. The only relatively specific symptom is focal cerebral seizure during the first week of life. Therefore, stroke should be ruled out by diagnostic imaging in the case of any seizure in the first days of life. Although the diagnostic method of choice is MRI, it is not always available. Most neonatal ischemic strokes can be detected with high-resolution duplex ultrasound. On ultrasound, ischemic stroke appears as a wedge-shaped focal increase in echogenicity in the supply region of an artery, typically the middle cerebral artery. The corresponding arterial inflow can be visualized with duplex ultrasound and measured with spectral Doppler. Doppler ultrasound can be used to differentiate between complete occlusion and severe stenosis. The success of therapeutic measures can be determined in the further course with Doppler ultrasound on the basis of the recanalization of vessels and the morphological consequences of stroke (cyst formation due to liquefactive necrosis).
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Raza, Naheed, and Karisa C. Schreck. "Neurosarcoidosis Presenting With Recurrent Strokes." Neurohospitalist 7, no. 2 (July 7, 2016): 91–95. http://dx.doi.org/10.1177/1941874416656730.
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Neurosarcoidosis is a rare but important cause of stroke as it is treatable. Cases reported thus far have primarily been in young people who are relatively healthy. Here we report the case of a 73-year-old woman presenting with recurrent strokes and high-grade intracranial stenosis caused by probable neurosarcoidosis. This is unique as neurosarcoidosis is not usually considered as an etiology for recurrent strokes in our patient’s age-group. We review and categorize published cases of neurosarcoidosis causing stroke and describe a classification scheme for certainty of diagnosis. Given the implications of this diagnosis for secondary stroke prevention, we recommend that neurosarcoidosis be considered in the differential for patients with few vascular risk factors, recurrent strokes refractory to medical treatment, or possible vasculitis even in the elderly patients.
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Natteru, P., M. R. Mohebbi, P. George, D. Wisco, J. Gebel, and C. R. Newey. "Variables That Best Differentiate In-Patient Acute Stroke from Stroke-Mimics with Acute Neurological Deficits." Stroke Research and Treatment 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/4393127.
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Introduction. Strokes and stroke-mimics have been extensively studied in the emergency department setting. Although in-hospital strokes are less studied in comparison to strokes in the emergency department, they are a source of significant direct and indirect costs. Differentiating in-hospital strokes from stroke-mimics is important. Thus, our study aimed to identify variables that can differentiate in-hospital strokes from stroke-mimics. Methods. We present here a retrospective analysis of 93 patients over a one-year period (2009 to 2010), who were evaluated for a concern of in-hospital strokes. Results. About two-thirds (57) of these patients were determined to have a stroke, and the remaining (36) were stroke-mimics. Patients with in-hospital strokes were more likely to be obese (p=0.03), have been admitted to the cardiology service (p=0.01), have atrial fibrillation (p=0.03), have a weak hand or hemiparesis (p=0.03), and have a prior history of stroke (p=0.05), whereas, when the consults were called for “altered mental status” but no other deficits (p<0.0001), it is likely a stroke-mimic. Conclusion. This study demonstrates that in-hospital strokes are a common occurrence, and knowing the variables can aid in their timely diagnosis and treatment.
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Borowsky, Leila H., Susan Regan, Yuchiao Chang, Alison Ayres, Steven M. Greenberg, and Daniel E. Singer. "First Diagnosis of Atrial Fibrillation at the Time of Stroke." Cerebrovascular Diseases 43, no. 3-4 (2017): 192–99. http://dx.doi.org/10.1159/000457809.
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Background: Atrial fibrillation (AF) is a major cause of ischemic stroke. Individuals with undiagnosed AF lack the stroke protection afforded by oral anticoagulants. We obtained a contemporary estimate of the percentage of AF patients newly diagnosed at the time of stroke. Methods: We identified patients admitted to the Massachusetts General Hospital (MGH) from January 1, 2010 to December 31, 2013 with acute ischemic stroke and either previously or newly diagnosed AF using hospital stroke registry data and stroke and AF ICD-9 code searches of hospital databases. Reviewers categorized AF as previously known or newly diagnosed, and collected comorbidity and outcome data. To confirm AF as newly diagnosed, we searched patients' pre-event electronic medical records (EMRs) for AF terms. Results: AF was considered newly diagnosed in 156/856 patients (18%; 95% CI 16-21). In 136/156 cases, AF was diagnosed using 12-lead EKG, telemetry, or rhythm strips. New AF strokes had a median NIH stroke scale of 12; 60% had mRankin ≥3 at discharge, including 15% deaths. Pre-stroke CHA2DS2-VASc score was ≥2 in 89%. About half (76/156) had prior records in the MGH EMR. Evidence of pre-stroke AF, often peri-procedural, was found in 8/76, but the AF diagnosis was not carried forward. Conclusions: In this contemporary cohort, nearly one in 5 AF-related strokes occurred without a pre-stroke AF diagnosis. AF was readily diagnosed using standard rhythm monitoring. The vast majority of patients with newly diagnosed AF were at high enough pre-stroke risk to merit anticoagulation. In conclusion, our findings support screening for AF before stroke. Patients with past transient AF may merit more intensive screening.
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Chojdak-Łukasiewicz, Justyna, Edyta Dziadkowiak, and Sławomir Budrewicz. "Monogenic Causes of Strokes." Genes 12, no. 12 (November 23, 2021): 1855. http://dx.doi.org/10.3390/genes12121855.
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Strokes are the main cause of death and long-term disability worldwide. A stroke is a heterogeneous multi-factorial condition, caused by a combination of environmental and genetic factors. Monogenic disorders account for about 1% to 5% of all stroke cases. The most common single-gene diseases connected with strokes are cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) Fabry disease, mitochondrial myopathy, encephalopathy, lactacidosis, and stroke (MELAS) and a lot of single-gene diseases associated particularly with cerebral small-vessel disease, such as COL4A1 syndrome, cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), and Hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS). In this article the clinical phenotype for the most important single-gene disorders associated with strokes are presented. The monogenic causes of a stroke are rare, but early diagnosis is important in order to provide appropriate therapy when available.
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Lestienne, Fanny, Chiara Bruno, David Bertora, Jeanne Benoit, Marie-Hélène Mahagne, and Laurent Suissa. "Ischemic Stroke in a Young Patient Heralding a Left Ventricular Noncompaction Cardiomyopathy." Case Reports in Neurology 9, no. 2 (August 29, 2017): 204–9. http://dx.doi.org/10.1159/000479957.
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Strokes in young patients may be the clinical expression of many complex and extremely rare diseases. Uncommon causes constitute less than 5% of all strokes, but are present in 30% of strokes in young patients. We report the case of a young woman whose ischemic stroke led to the diagnosis of a rare embolic cardiomyopathy, left ventricular noncompaction cardiomyopathy, requiring a heart transplant.
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Guraieb-Chahín, P., C. Cantú-Brito, A. Soto-Mota, L. Guerrero-Torres, F. Flores-Silva, E. Chiquete, H. Fragoso-Loyo, A. González-Duarte, and SI Valdés-Ferrer. "Stroke in systemic lupus erythematosus: epidemiology, mechanism, and long-term outcome." Lupus 29, no. 5 (March 9, 2020): 437–45. http://dx.doi.org/10.1177/0961203320908947.
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Objective To determine stroke prevalence, mechanisms, and long-term outcome in a cohort of Hispanic patients with systemic lupus erythematosus (SLE). Methods We analyzed demographical data, the timing between SLE diagnosis and stroke onset, stroke type, recurrence, and outcomes from an institutional database of 4451 patients with SLE followed from 1993 to 2018. Results We observed 139 strokes (3.1%), for an incidence rate of 1.25 per 1000 person-years: 81 (58.3%) acute ischemic stroke (AIS), 19 (13.7%) subarachnoid hemorrhage (SAH), 17 (12.2%) cerebral venous thrombosis, 13 (9.4%) intracerebral hemorrhage (ICH), and 9 (6.5%) transient ischemic attack. Median time from SLE diagnosis to acute stroke was 60 months (interquartile range 12–132 months). AIS had a bimodal presentation with 26% occurring within the first year and 30% >10 years after SLE diagnosis. In contrast, 75% of ICH cases occurred >3 years (and 34% >10 years) after SLE diagnosis. The most important cause of AIS was secondary antiphospholipid syndrome (48%). Hypertension was associated with 69% of ICH cases, while aneurysmal rupture was observed in 78% of SAH cases. Excellent recovery at hospital discharge was observed in 65%. Stroke recurrence was observed in 7%. The long-term all-cause fatality rate was 8%. Conclusions The prevalence of stroke in this cohort was 3.1%. Ischemic strokes had a bimodal presentation, occurring either early after SLE diagnosis or after a several-year delay. Half of the hemorrhagic strokes occurred >10 years after the diagnosis of SLE. Clinical outcome was usually good with a relatively low recurrence rate.
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Kaur, Mandeep, Sachin R. Sakhare, Kirti Wanjale, and Farzana Akter. "Early Stroke Prediction Methods for Prevention of Strokes." Behavioural Neurology 2022 (April 11, 2022): 1–9. http://dx.doi.org/10.1155/2022/7725597.
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The emergence of the latest technologies gives rise to the usage of noninvasive techniques for assisting health-care systems. Amongst the four major cardiovascular diseases, stroke is one of the most dangerous and life-threatening disease, but the life of a patient can be saved if the stroke is detected during early stage. The literature reveals that the patients always experience ministrokes which are also known as transient ischemic attacks (TIA) before experiencing the actual attack of the stroke. Most of the literature work is based on the MRI and CT scan images for classifying the cardiovascular diseases including a stroke which is an expensive approach for diagnosis of early strokes. In India where cases of strokes are rising, there is a need to explore noninvasive cheap methods for the diagnosis of early strokes. Hence, this problem has motivated us to conduct the study presented in this paper. A noninvasive approach for the early diagnosis of the strokes is proposed. The cascaded prediction algorithms are time-consuming in producing the results and cannot work on the raw data and without making use of the properties of EEG. Therefore, the objective of this paper is to devise mechanisms to forecast strokes on the basis of processed EEG data. This paper is proposing time series-based approaches such as LSTM, biLSTM, GRU, and FFNN that can handle time series-based predictions to make useful decisions. The experimental research outcome reveals that all the algorithms taken up for the research study perform well on the prediction problem of early stroke detection, but GRU performs the best with 95.6% accuracy, whereas biLSTM gives 91% accuracy and LSTM gives 87% accuracy and FFNN gives 83% accuracy. The experimental outcome is able to measure the brain waves to predict the signs of strokes. The findings can certainly assist the physicians to detect the stroke at early stages to save the lives of the patients.
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Silva, Carlos Eduardo Amaral Pereira da, Thiago Cardoso Vale, Flávio José Barbosa Leite, Thais Gomes Casali, Gustavo de Moraes Ramalho, and Marcelo Maroco Cruzeiro. "Ischemic stroke and patent foramen ovale: case report." Arquivos de Neuro-Psiquiatria 64, no. 3b (September 2006): 858–61. http://dx.doi.org/10.1590/s0004-282x2006000500028.
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Approximately 40% of ischemic strokes have no clearly definable etiology and are termed cryptogenic strokes. Patent foramen ovale, a small communication between the left and right atria, is considered to be a risk factor for cerebral embolism. In this study, we report the case of a 29-year-old woman with diagnosis of ischemic stroke due to patent foramen ovale who has undergone percutaneous endovascular closure. The aim of this report is to discuss the relevant aspects of the patent foramen ovale and the cryptogenic stroke, its clinical presentation, diagnosis, management and recurrence.
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Stanković, Sanja, and Nada Majkić-Singh. "Advances in the Genetic Basis of Ischemic Stroke." Journal of Medical Biochemistry 27, no. 2 (January 1, 2008): 123–34. http://dx.doi.org/10.2478/v10011-008-0004-5.
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Advances in the Genetic Basis of Ischemic StrokeAs one of the leading causes of death within both the developed and developing world, stroke is a world-wide problem. About 80% of strokes are ischemic. It is caused by multiple genetic factors, environmental factors, and interactions among these factors. There is a long list of candidate genes that have been studied for a possible association with ischemic stroke. Among the most widely investigated genes are those involved in haemostasis, inflammation, nitric oxide production, homocysteine and lipid metabolism, renin-angiotensin-aldosterone system. Combined link-age/association studies have demonstrated that genes encoding PDE4D and ALOX5AP confer risk for stroke. We review the studies of these genes which may have potential application on the early diagnosis, prevention and treatment ischemic stroke patients.
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Chen, Patrick M., Dawn M. Meyer, Robert Claycomb, Kunal Agrawal, and Brett C. Meyer. "“Encephalopathy Only Stroke Codes” (EoSC) Rarely Result in Stroke as Final Diagnosis." Neurology Research International 2019 (February 11, 2019): 1–5. http://dx.doi.org/10.1155/2019/2105670.
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Stroke codes prompted by isolated encephalopathy often result in nonstroke final diagnoses but require intensive stroke center resources. We assessed the likelihood of “Encephalopathy only Stroke Codes (EoSC)” resulting in a true stroke (EoSC CVA+) final diagnosis. 3860 patients were analyzed in a prospective stroke code registry from 2004 to 2016. EoSC was defined using a standard and an exploratory definition. Definition 1 included EoSC patients as stroke codes where NIHSS was nonzero for LOC questions (questions la, 1b, and lc) but remainder of the NIHSS was zero. Definition 2 included the same definition but allowed symmetric pairings on motor questions (5a/5b, 6a/6b, or Question 4 scoring a 3). Groups were assessed for final diagnosis of stoke (EoSC CVA+) or not stroke (EoSC CVA-). EoSC accounted for 60/3860 (1.55%) of total stroke codes. EoSC CVA+ was found in 5/3860 (0.13%) of all stroke codes, 5/60 (8.33%) of EoSC stroke codes, and 5/1514 (0.33%) of all strokes. For Definition 2, EoSC accounted for 96/3860 (2.5%) of total stroke codes. EoSC CVA+ was found in 9/3860 (0.23%) of all stroke codes, 9/96 (9.38%) of EoSC stroke codes, and 9/1514 (0.59%) of all strokes. On multivariable logistic regression analysis, diabetes was the highest predictor of stroke (p=0.05). Encephalopathy only Stroke Codes only rarely result in cases with a true final diagnosis of stroke (EoSC CVA+), accounting for 0.1-0.2% of all stroke codes and 8-9% of EoSC stroke codes. This may have important significance for mobilization of limited acute stroke code resources in the future.
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Andersen, Klaus Kaae, Anne Julie Tybjerg, Alejandro Daniel Babore, and Tom Skyhøj Olsen. "Occult primary brain cancers manifesting in the aftermath of ischaemic and haemorrhagic stroke." European Stroke Journal 5, no. 3 (April 15, 2020): 237–44. http://dx.doi.org/10.1177/2396987320920101.
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Introduction Symptoms of occult brain cancer may mimic stroke. Misdiagnosis may lead to improper treatment and delayed diagnosis. We characterised strokes associated with occult primary brain cancer and determined risk that ischaemic and haemorrhagic strokes are associated with occult primary brain cancer. Patients and methods All patients with incident stroke in Denmark 2003–2015 were identified through the Danish Stroke Registry (n = 85,893) and matched 1:10 on age and sex to the Danish background population without a stroke history (n = 858,740). This cohort was linked to the Danish Cancer Registry and prevalence of occult primary brain cancer defined as the event of previously unknown primary brain cancer during a one-year follow-up was estimated. We used Cox regression models to study risk of occult primary brain cancer in comparison to the background population. Results Of 77,484 patients with ischaemic strokes, 39 (1 in 2000) were associated with primary brain cancer; of 8409 with haemorrhagic strokes, it was 126 (1 in 66). In the background cohort, 205 (1 in 4000) had occult primary brain cancer. The multivariate stroke risk factor analysis showed that patients with occult primary brain cancer differed significantly from those without occult primary brain cancer indicating they might have stroke mimics rather than true strokes. Discussion and conclusions: Strokes associated with occult primary brain cancer tend to be stroke mimics rather than true strokes. Primary brain cancer is rare in patients with ischaemic stroke (1 in 2000); risk that misdiagnosis results in maltreatment is, therefore, very low. Occult primary brain cancers are mainly found among patients with haemorrhagic stroke; they are not uncommon (1 in 66) and should always be kept in mind.
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Gujjar, Arunodaya R., Mortada El-Tigani, Darshan Lal, Anupam K. Kakaria, and Abdullah R. Al-Asmi. "“Different Strokes”: A management dilemma." Sultan Qaboos University Medical Journal [SQUMJ] 18, no. 2 (September 9, 2018): 202. http://dx.doi.org/10.18295/squmj.2018.18.02.013.
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Stroke is a common medical emergency resulting from numerous pathophysiological mechanisms and with varied clinical manifestations; as such, the diagnosis of stroke requires diligent clinical assessment. When different stroke syndromes occur in the same patient, it may cause a dilemma in terms of diagnosis and management. This continuing medical education article describes an interesting patient with recurrent neurological events, highlighting the complex pathophysiological processes associated with cerebrovascular syndromes. It offers readers the opportunity to apply their own basic neuroscience knowledge and clinical skills to solve the challenges encountered during the course of diagnosing and treating this patient. Specifically, the article aims to familiarise readers with an approach to diagnosing brainstem strokes and the diverse manifestations of a common stroke syndrome.Keywords: Stroke; Lacunar Stroke; Cerebral Hemorrhage; Cerebral Small Vessel Disease; Continuing Medical Education.
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Weinberger, Jesse. "Diagnosis and Prevention of Atherosclerotic Cerebral Infarction." CNS Spectrums 10, no. 7 (July 2005): 553–66. http://dx.doi.org/10.1017/s1092852900010208.
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AbstractAtherosclerotic disease accounts for ~25% of ischemic strokes. Atherosclerotic stroke is caused mainly by embolic events from the carotid artery bifurcation or the aortic arch, although intracranial thrombosis can occur, more often in African Americans, Asians, and diabetes patients. Primary prevention of stroke is critical for patients with risk factors for atherosclerosis, including hypertension, diabetes, smoking and hypercholesterolemia. Stroke can be prevented in patients with established atherosclerotic disease by identification and management of patients with carotid artery stenosis by non-invasive testing. Particular attention must be paid to patients with transient symptoms of brain ischemia.
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Pizzamiglio, Chiara, Enrico Bugiardini, William L. Macken, Cathy E. Woodward, Michael G. Hanna, and Robert D. S. Pitceathly. "Mitochondrial Strokes: Diagnostic Challenges and Chameleons." Genes 12, no. 10 (October 19, 2021): 1643. http://dx.doi.org/10.3390/genes12101643.
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Mitochondrial stroke-like episodes (SLEs) are a hallmark of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). They should be suspected in anyone with an acute/subacute onset of focal neurological symptoms at any age and are usually driven by seizures. Suggestive features of an underlying mitochondrial pathology include evolving MRI lesions, often originating within the posterior brain regions, the presence of multisystemic involvement, including diabetes, deafness, or cardiomyopathy, and a positive family history. The diagnosis of MELAS has important implications for those affected and their relatives, given it enables early initiation of appropriate treatment and genetic counselling. However, the diagnosis is frequently challenging, particularly during the acute phase of an event. We describe four cases of mitochondrial strokes to highlight the considerable overlap that exists with other neurological disorders, including viral and autoimmune encephalitis, ischemic stroke, and central nervous system (CNS) vasculitis, and discuss the clinical, laboratory, and imaging features that can help distinguish MELAS from these differential diagnoses.
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Kichloo, Asim, Shakeel M. Jamal, El-Amir Zain, Farah Wani, and Navya Vipparala. "Artery of Percheron Infarction: A Short Review." Journal of Investigative Medicine High Impact Case Reports 7 (January 2019): 232470961986735. http://dx.doi.org/10.1177/2324709619867355.
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One uncommon type of ischemic stroke is occlusion of the artery of Percheron (AOP) leading to infarction of the paramedian thalami and mesencephalon. There are several variants of thalamic blood supply, and identifying the potential presence and infarction of an AOP is important in diagnosis and treatment of ischemic strokes affecting the thalami and mesencephalon, especially because of the unusual and variable presentation of these forms of ischemic strokes. This short review includes and discusses the case of a 58-year-old woman with an AOP infarct and indicates the importance of recognizing an AOP infarct early despite its clinical variations in order to treat the stroke in a timely fashion. This short review also includes a discussion of imaging modalities in such cases and clinical differential diagnoses to consider with management strategies.
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Llombart, Víctor, Albert Antolin-Fontes, Alejandro Bustamante, Dolors Giralt, Natalia S. Rost, Karen Furie, Kensaku Shibazaki, et al. "B-Type Natriuretic Peptides Help in Cardioembolic Stroke Diagnosis." Stroke 46, no. 5 (May 2015): 1187–95. http://dx.doi.org/10.1161/strokeaha.114.008311.
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Background and Purpose— Determining the underlying cause of stroke is important to optimize secondary prevention treatment. Increased blood levels of natriuretic peptides (B-type natriuretic peptide/N-terminal pro-BNP [BNP/NT-proBNP]) have been repeatedly associated with cardioembolic stroke. Here, we evaluate their clinical value as pathogenic biomarkers for stroke through a literature systematic review and individual participants’ data meta-analysis. Methods— We searched publications in PubMed database until November 2013 that compared BNP and NT-proBNP circulating levels among stroke causes. Standardized individual participants’ data were collected to estimate predictive values of BNP/NT-proBNP for cardioembolic stroke. Dichotomized BNP/NT-proBNP levels were included in logistic regression models together with clinical variables to assess the sensitivity and specificity to identify cardioembolic strokes and the additional value of biomarkers using area under the curve and integrated discrimination improvement index. Results— From 23 selected articles, we collected information of 2834 patients with a defined cause. BNP/NT-proBNP levels were significantly elevated in cardioembolic stroke until 72 hours from symptoms onset. Predictive models showed a sensitivity >90% and specificity >80% when BNP/NT-proBNP were added considering the lowest and the highest quartile, respectively. Both peptides also increased significantly the area under the curve and integrated discrimination improvement index compared with clinical models. Sensitivity, specificity, and precision of the models were validated in 197 patients with initially undetermined stroke with final pathogenic diagnosis after ancillary follow-up. Conclusions— Natriuretic peptides are strongly increased in cardioembolic strokes. Future multicentre prospective studies comparing BNP and NT-proBNP might aid in finding the optimal biomarker, the best time point, and the optimal cutoff points for cardioembolic stroke identification.
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Conforto, Adriana Bastos, Fabio Iuji Yamamoto, Sueli Mieko Oba-Shinjo, Julio Guy C. Pinto, Maurício Hoshino, Milberto Scaff, and Suely Kazue Nagahashi Marie. "Screening for MELAS mutations in young patients with stroke of undetermined origin." Arquivos de Neuro-Psiquiatria 65, no. 2b (June 2007): 371–76. http://dx.doi.org/10.1590/s0004-282x2007000300001.
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PURPOSE: It has been suggested that mitochondrial disease may be responsible for a substantial proportion of strokes of indetermined origin. We have preliminarily screened for MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) mutations in young patients with cryptogenic strokes. METHOD: The mitochondrial mutations A3243G and T3271C were investigated in 38 subjects aged less than 46 years. Group 1: 15 patients with cryptogenic strokes; Group 2: 3 patients with diagnosis of MELAS syndrome, including stroke-like episodes; Group 3: 20 healthy subjects. RESULTS: The A3243G mutation was absent in all subjects in Groups 1 and 3 but was present in all subjects in Group 2. CONCLUSION: Our results do not support screening for these mutations to diagnose oligosymptomatic forms of MELAS in cryptogenic strokes in the absence of other features of the syndrome. We suggest that clinical findings should guide mitochondrial genetic testing.
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Stanescu, Ioana, Angelo Bulboaca, Dana Fodor, and Gabriela Dogaru. "Functional outcome after symtomatic internal carotid artery occlusion." Balneo Research Journal 10, no. 10.2 (May 20, 2019): 134–38. http://dx.doi.org/10.12680/balneo.2019.252.
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Abstract Internal carotid artery occlusion accounts for 15-20% of ischemic strokes, caused by atherosclerosis or dissection. Clinical symptoms are variable, from asymptomatic cases to minor or severe strokes. Diagnosis in internal carotid artery (ICA) occlusion is based on imaging techniques. Prognosis after ICA occlusion depends on many factors: severity of neurologic deficit, spontaneous recanalization of the artery, and the occurrence of recurrent strokes. Patients with spontaneous recanalization of the occluded ICA tend to have a retained functional ability and favorable clinical outcomes. Medical treatment, recanalization techniques and intensive rehabilitation program are essential in improving functional outcome of patients with stroke produced by ICA occlusion. We present the case of a young patient diagnosed with ischemic stroke produced by internal carotid artery occlusion, with consecutive severe neurologic deficit, and an unfavorable functional outcome, as evaluated with the Modified Rankin Scale. Spontaneous recanalization of the occluded ICA was observed after 6 weeks, suggesting a carotid dissection. The patient was included in an intensive rehabilitation program, associated with best medical therapy, showing improvement of its functional status at 3 months follow up. Key words: ischemic stroke, carotid artery occlusion, carotid dissection, spontaneous recanalization, functional outcome,
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Semenov, S. E., I. V. Moldavskaia, E. A. Yurkevich, M. G. Shatokhina, and A. S. Semenov. "DIAGNOSIS OF VENOUS ISCHEMIC STROKE. PART I (CLINICAL POLYMORPHISM). A REVIEW ARTICLE." Complex Issues of Cardiovascular Diseases 8, no. 2 (June 23, 2019): 125–34. http://dx.doi.org/10.17802/2306-1278-2019-8-2-125-134.
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Venous stroke being “relatively unknown cerebrovascular disease” occurs in 0.55% of all strokes. Specific diagnostic concerns to venous stroke and the expansion of the volume of radiologic examinations from routinely used non-contrast CT to angiographic and perfusion CT- and MRI, diffusion MRI allowed us to increase the number of diagnosed and verified venous ischemic stroke from 0.4% of all strokes treated in our center to 2.4%, resulting in a 6-fold increase within the 5-year period. Symptoms of cerebral venous sinus thrombosis depend on the size and the growth rate of thrombus. In addition, focal neurological symptoms are diverse and largely dependent on thrombus localization and safety of collateral blood flow, as well as patients’ age and severity of cerebral edema. Cerebral symptoms are nonspecific and may occur in varying degrees of severity related to the localization of the pathological process. The routinely used assessment scales such as the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, Rankin Scale do not reliably identify this type of acute ischemic stroke. The leading symptom is headache with the mean visual analogue scale of 7.3±1.6. The tendency towards a less pronounced neurologic deficit at admission and mild disability status at discharge have been found among patients with venous stroke. The clinical course of venous stroke mostly demonstrated a tendency towards rapid regression of focal symptomatology and neurological deficit in comparison with arterial ischemic stroke.
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Garg, Aayushi, Girish Bathla, Vaelan Molian, Kaustubh Limaye, David Hasan, Enrique C. Leira, Colin P. Derdeyn, Harold P. Adams, and Amir Shaban. "Differential Risk Factors and Outcomes of Ischemic Stroke due to Cervical Artery Dissection in Young Adults." Cerebrovascular Diseases 49, no. 5 (2020): 509–15. http://dx.doi.org/10.1159/000510437.
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<b><i>Introduction:</i></b> Cervical artery dissection (CeAD) is a major cause of ischemic stroke in young adults. Our understanding of the specific risk factors and clinical course of CeAD is still evolving. In this study, we evaluated the differential risk factors and outcomes of CeAD-related strokes among young adults. <b><i>Methods:</i></b> The study population consisted of young patients 15–45 years of age consecutively admitted with acute ischemic stroke to our comprehensive stroke center between January 1, 2010, and November 30, 2016. Diagnosis of CeAD was based on clinical and radiological findings. Univariate and multivariable logistic regression analyses were used to assess the risk factors and clinical outcomes associated with CeAD-related strokes. <b><i>Results:</i></b> Of the total 333 patients with acute ischemic stroke included in the study (mean ± SD age: 36.4 ± 7.1 years; women 50.8%), CeAD was identified in 79 (23.7%) patients. As compared to stroke due to other etiologies, patients with CeAD were younger in age, more likely to have history of migraine and recent neck manipulation and were less likely to have hypertension, diabetes, and previous history of stroke. Clinical outcomes of CeAD were comparable to strokes due to other etiologies. Within the CeAD group, higher initial stroke severity and history of tobacco use were associated with higher modified Rankin Scale score at follow-up. <b><i>Conclusions:</i></b> While history of migraine and neck manipulation are significantly associated with CeAD, most of the traditional vascular risk factors for stroke are less prevalent in this group when compared to strokes due to other etiologies. For CeAD-related strokes, higher initial stroke severity and history of tobacco use may be associated with higher stroke-related disability, but overall, patients with CeAD have similar outcomes as compared to strokes due to other etiologies.
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Lun, Ronda, Danielle Carole Roy, Tim Ramsay, Deborah Siegal, Risa Shorr, Dean Fergusson, and Dar Dowlatshahi. "Incidence of stroke in the first year after diagnosis of cancer—A protocol for systematic review and meta-analysis." PLOS ONE 16, no. 9 (September 1, 2021): e0256825. http://dx.doi.org/10.1371/journal.pone.0256825.
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Introduction There is an increased risk of stroke in patients with cancer–this risk is particularly heightened around the time of cancer diagnosis, although no studies have systematically quantified this risk in the literature. Patients newly diagnosed with cancer without prior stroke represent a highly susceptible population in whom there is a window of opportunity to study and implement primary prevention strategies. Therefore, the objective of this systematic review and meta-analysis is to identify the cumulative incidence of ischemic and hemorrhagic strokes during the first year after a diagnosis of cancer. Methods and analysis MEDLINE, EMBASE, and PubMed will be searched with the assistance from a medical information specialist, from 1980 until present. Eligible studies will include observational studies that have enrolled adult patients newly diagnosed with cancer and report outcomes of stroke during the first year of cancer diagnosis. We will exclude all randomized and non-randomized interventional studies. Data on participant characteristics, study design, baseline characteristics, and outcome characteristics will be extracted. Study quality will be assessed using the Newcastle-Ottawa Scale for cohort studies, and heterogeneity will be assessed using the I2 statistic. Pooled cumulative incidence will be calculated for ischemic and hemorrhagic strokes separately using a random-effects model. Ethics and dissemination No formal research ethics approval is necessary as primary data collection will not be done. We will disseminate our findings through scientific conference presentations, peer-reviewed publications, and social media/the press. The findings from this review will inform clinicians and patients regarding the risk of stroke in patients newly diagnosed with cancer by quantifying the cumulative incidence of each subtype of stroke during the first year after a diagnosis of cancer. This represents a window of opportunity to implement prevention strategies in a susceptible population. Registration ID with Open Science Framework osf.io/ucwy9.
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Aaron, Sanjith, Divyan Pancharatnam, and Amal Al Hashmi. "Acute isolated anterior cerebral artery infarcts: A clinical – radiological study." Neurology Asia 26, no. 3 (September 2021): 459–64. http://dx.doi.org/10.54029/2021yks.
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Background: The anterior cerebral artery (ACA) supplies many eloquent areas and can have anatomical variations making ACA strokes clinically and radiologically challenging. This study looks at the clinical and radiological features of isolated acute ACA strokes from a stroke centre in Oman. Methods: A retrospective study conducted over a 2 year period on ACA strokes presenting within 12 hours of symptom onset. TOAST classification was used for aetiology. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to assess stroke severity. Fischer’s classification was used for assessing the arterial segments with CT angiogram. Heidelberg Bleeding Classification was used for haemorrhagic conversion. Results: Isolated ACA strokes constituted 25/1180 (2.1 %) of ischemic strokes. Males 15/25 (60%) Mean age was 68.4 years (Range 42 -97 years). Twenty eight percent of patients had earlier strokes. Hemiparesis (68%) was the commonest clinical presentation. Twenty percent had only lower limb weakness. Hypertension 22/25 (88%) followed by diabetes mellitus 12/25 (48%) was the commonest risk factor. The mean NIHSS was 9 (range 3 to 13). In 36% of patients there was progression of stroke. Plain CT Picked the infarct only in 6/24 (25%). Left side involvement in 18/25 (72%) Artery of Hubner was involved in 6/25 (24%); 44% had an embolic aetiology. There was no mortality and at discharge, 11/25 (44%) had mRS3 or less. Conclusions: In acute ACA infarcts a CT scan can miss the diagnosis in 74%. An embolic aetiology has to be considered in any Isolated ACA stroke and the outcome appears to be good.
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Jaakkola, Jussi, Päivi Hartikainen, Tuomas O. Kiviniemi, Ilpo Nuotio, Antti Palomäki, Juha E. K. Hartikainen, Antti Ylitalo, Pirjo Mustonen, and K. E. Juhani Airaksinen. "Distribution of ischemic strokes in patients with atrial fibrillation." Neurology: Clinical Practice 9, no. 4 (July 17, 2019): 330–36. http://dx.doi.org/10.1212/cpj.0000000000000683.
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BackgroundWe aimed to determine the relative frequency of affected cerebrovascular territories in patients with atrial fibrillation (AF) suffering an ischemic stroke.MethodsAltogether, 1,976 patients who suffered their first-ever ischemic stroke during 2003–2012 and were diagnosed with AF either before or within 30 days after the event were included in this retrospective multicenter cohort study. Strokes were classified radiographically to be located either within the anterior or the posterior cerebrovascular territory, and the effect of the CHA2DS2-VASc score, oral anticoagulant (OAC) use, and timing of AF diagnosis on lesion localization was determined.ResultsThe median age of the patients was 78.4 (interquartile range: 71.7–84.2) years, 1,137 (57.5%) of them were women, their mean CHA2DS2-VASc score was 3.5 (95% confidence interval: 3.4–3.5), 656 (33.2%) were receiving OAC drugs, and altogether, 1,450 (73%) had a previous AF diagnosis. The localization of ischemic lesions between the anterior and the posterior cerebrovascular territories was not affected by the timing of AF diagnosis (p = 0.46), use of OACs (p = 0.70), or the CHA2DS2-VASc score (p = 0.10). Within the anterior territory, altogether 774 strokes (53.2%) were located in the left hemisphere and 3 (0.2%) were bilateral. The timing of AF diagnosis (p = 0.84), use of OACs (p = 0.90), or the CHA2DS2-VASc score (p = 0.21) did not affect the location of the ischemic lesion between the hemispheres.ConclusionsThe timing of AF diagnosis, use of OAC drugs, or the CHA2DS2-VASc score did not affect the distribution of ischemic strokes. Anterior territory strokes were slightly more often located within the left hemisphere.
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Huang, Xiaoyan, Lijun Zhang, Jinxian Huang, and Jifu Cai. "A Rare Cause of Young Stroke: What Rheumatologists Should Know about Fabry Disease." Journal of Clinical Rheumatology and Immunology 21, no. 01 (May 20, 2021): 47–50. http://dx.doi.org/10.1142/s2661341721720032.
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Systemic vasculitis is a category of autoinflammatory diseases usually involving multiple organs. Involvement of the central nervous system (CNS) may mimic other disorders, hence resulting in overdiagnosis. This is a case report of a young man who presented with acrodynia, episodic pyrexia, and recurrent strokes. He was treated for systemic vasculitis with glucocorticoids and immunosuppressants, which failed to prevent the stroke. Finally, Fabry disease was diagnosed after [Formula: see text]-galactosidase A gene mutation analysis was done. Rheumatologists should be aware of Fabry disease, which may present with multi-system involvement that mimics vasculitis. To avoid inappropriate treatment, a comprehensive differential diagnosis should be considered before a diagnosis of primary systemic vasculitis is made. Recurrent strokes, especially in males younger than 40, should raise suspicions of Fabry disease.
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Damiza-Detmer, Agnieszka, Izabela Damiza, and Małgorzata Pawełczyk. "Wake-up stroke – diagnosis, management and treatment." Aktualności Neurologiczne 20, no. 2 (October 30, 2020): 66–70. http://dx.doi.org/10.15557/an.2020.0009.
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Wake-up stroke is defined as ischaemic stroke with unknown time of symptom onset, when patients go to sleep normal and awaken with neurological symptoms. This type of stoke accounts for about 20% (14–24%) of all ischaemic strokes. The high incidence of wake-up stroke may be associated with diurnal variability of heart rate and blood pressure, coagulation processes, as well as episodes of atrial fibrillation, which are more common in the morning. The risk of wake-up stroke increases during REM sleep. Individuals with obstructive sleep apnoea account for the majority of patients with wake-up stroke. Until recently, wake-up stroke was considered a contraindication for reperfusion treatment due to the unknown time of onset and a potential risk of intracranial bleeding. The latest research has shown that wake-up stroke occurs shortly before awakening. Therefore, these patients could be qualified for reperfusion treatment, which would improve their clinical status.
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Minas, Elizabeth, Susan Hesni, and Katy Edmonds. "Different strokes for different folks – imaging and diagnosis of paediatric stroke." Clinical Radiology 73 (September 2018): e7. http://dx.doi.org/10.1016/j.crad.2018.07.139.
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Yang, Wuyang, Risheng Xu, Jose L. Porras, Clifford M. Takemoto, Syed Khalid, Tomas Garzon-Muvdi, Justin M. Caplan, et al. "Effectiveness of surgical revascularization for stroke prevention in pediatric patients with sickle cell disease and moyamoya syndrome." Journal of Neurosurgery: Pediatrics 20, no. 3 (September 2017): 232–38. http://dx.doi.org/10.3171/2017.1.peds16576.
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OBJECTIVESickle cell disease (SCD) in combination with moyamoya syndrome (MMS) represents a rare complication of SCD, with potentially devastating neurological outcomes. The effectiveness of surgical revascularization in this patient population is currently unclear. The authors’ aim was to determine the effectiveness of surgical intervention in their series of SCD-MMS patients by comparing stroke recurrence in those undergoing revascularization and those undergoing conservative transfusion therapy.METHODSThe authors performed a retrospective chart review of patients with MMS who were seen at the Johns Hopkins Medical Institution between 1990 and 2013. Pediatric patients (age < 18 years) with confirmed diagnoses of SCD and MMS were included. Intracranial stroke occurrence during the follow-up period was compared between surgically and conservatively managed patients.RESULTSA total of 15 pediatric SCD-MMS patients (28 affected hemispheres) were included in this study, and all were African American. Seven patients (12 hemispheres) were treated with indirect surgical revascularization. The average age at MMS diagnosis was 9.0 ± 4.0 years, and 9 patients (60.0%) were female. Fourteen patients (93.3%) had strokes before diagnosis of MMS, with an average age at first stroke of 6.6 ± 3.9 years. During an average follow-up period of 11.6 years, 4 patients in the conservative treatment group experienced strokes in 5 hemispheres, whereas no patient undergoing the revascularization procedure had any strokes at follow-up (p = 0.029). Three patients experienced immediate postoperative transient ischemic attacks, but all recovered without subsequent strokes.CONCLUSIONSIndirect revascularization is suggested as a safe and effective alternative to the best medical therapy alone in patients with SCD-MMS. High-risk patients managed on a regimen of chronic transfusion should be considered for indirect revascularization to maximize the effect of stroke prevention.
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Nistor, Raluca Ileana. "CRYPTOGENIC STROKE – FROM A HYPOTHESIS TO DEFINITE PROOF. CASE REPORT." Romanian Journal of Neurology 14, no. 2 (June 30, 2015): 93–97. http://dx.doi.org/10.37897/rjn.2015.2.6.
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Current diagnostic standards do not answer all questions regarding the etiology of ischemic stroke. Nowadays, the cryptogenic ischemic stroke (without an obvious cause) still represents 20-30% of all acute strokes. In the end, this terminology is used in the absence of a definite medical and scientific diagnosis. The clinical case that will be presented highlights how difficult the differential diagnosis is regarding an ischemic stroke in a young patient, apparently healthy before the acute neurologic event.
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Song, Sarah, Richard E. Burgess, and Chelsea S. Kidwell. "Racial Differences by Ischemic Stroke Subtype: A Comprehensive Diagnostic Approach." Stroke Research and Treatment 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/735097.
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Background. Previous studies have suggested that black populations have more small-vessel and fewer cardioembolic strokes. We sought to analyze racial differences in ischemic stroke subtype employing a comprehensive diagnostic workup with magnetic resonance-imaging-(MRI-) based evaluation including diffusion-weighted imaging (DWI).Methods. 350 acute ischemic stroke patients admitted to an urban hospital with standardized comprehensive diagnostic evaluations were retrospectively analyzed. Ischemic stroke subtype was determined by three Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification systems.Results. We found similar proportions of cardioembolic and lacunar strokes in the black and white cohort. The only subtype category with a significant difference by race was “stroke of other etiology,” more common in whites. Black stroke patients were more likely to have an incomplete evaluation, but this did not reach significance.Conclusions. We found similar proportions by race of cardioembolic and lacunar strokes when employing a full diagnostic evaluation including DWI MRI. The relatively high rate of cardioembolism may have been underappreciated in black stroke patients when employing a CT approach to stroke subtype diagnosis. Further research is required to better understand the racial differences in frequency of “stroke of other etiology” and explore disparities in the extent of diagnostic evaluations.
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Masotti, Luca, Rinaldo Innocenti, Stefano Spolveri, Irene Chiti, Grazia Panigada, Cristiana Seravalle, Giancarlo Landini, et al. "Stroke prevention in atrial fibrillation: findings from Tuscan FADOI Stroke Registry." Italian Journal of Medicine 9, no. 2 (May 8, 2015): 134. http://dx.doi.org/10.4081/itjm.2014.450.
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Despite vitamin K antagonists (VKAs) are considered the first choice treatment for stroke prevention in atrial fibrillation (AF), literature shows their underuse in this context. Since data about VKAs use prior and after acute stroke lack, the aim of this study was to focus on management of anticoagulation with VKAs in this context. Data were retrieved from Tuscan FADOI Stroke Registry, an online data bank aimed to report on characteristics of stroke patients consecutively admitted in Internal Medicine wards in 2010 and 2011. In this period 819 patients with mean age 76.5±12.3 years were enrolled. Data on etiology were available for 715 of them (88.1%), 87% being ischemic and 13% hemorrhagic strokes. AF was present in 238 patients (33%), 165 (69.3%) having a known AF before hospitalization, whereas 73 patients (31.7%) received a new diagnosis of AF. A percentage of 89% of strokes in patients with known AF were ischemic and 11% hemorrhagic. A percentage of 86.7% of patients with known AF had a CHADS<sub>2</sub> ≥2, but only 28.3% were on VKAs before hospitalization. A percentage of 78.8% of patients treated with VKAs before stroke had an international normalized ratio (INR) ≤2.0; 68.7% of patients with VKAs-related hemorrhagic strokes had INR ≤3.0. Combined endpoint mortality or severe disability in patients with ischemic stroke associated with AF was present in 47%, while it was present in 19.30% and 19.20% of atherothrombotic and lacunar strokes, respectively. At hospital discharge, VKAs were prescribed in 25.9% of AF related ischemic stroke patients. AF related strokes are burdened by severe outcome but VKAs are dramatically underused in patients with AF, even in higher risk patients. Efforts to improve anticoagulation in this stroke subtype are warranted.
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Cuciureanu, Dan Iulian, Cristian Statescu, Radu Andy Sascau, Tudor Cuciureanu, Victor Alexandru Constantinescu, Delia Hinganu, Cristina Preda, Marius Valeriu Hinganu, and Mihaela Dana Turliuc. "Particularities of Using Contrast Agents in Diagnosis of Stroke." Revista de Chimie 70, no. 2 (March 15, 2019): 685–88. http://dx.doi.org/10.37358/rc.19.2.6985.
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Stroke is the first cause of disability, the second cause of dementia and the third cause of mortality in industrialized countries. Due to its increasing incidence, there is a need to study the possibilities of early prevention and diagnosis. Our study was conducted on a group of 165 selected patients diagnosed with different forms of ischemic strokes, aged between 25 and 50 years. We explored them using contrast injected MRI technique, to show the usefulness of this radiologic method and to propose a protocol for the investigation of clinically diagnosed patients with stroke. Contrast injected MRI is demonstrated to be a gold technique in exploring early cases of ischemic stroke with different anomalies. Special agents combined with this technique allows assessment of the functionality of the blood-brain barrier, revealing the real ischemic penumbra.
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Perera, Kanjana S., Thomas Vanassche, Jackie Bosch, Mohana Giruparajah, Balakumar Swaminathan, Katie R. Mattina, Scott D. Berkowitz, et al. "Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry." International Journal of Stroke 11, no. 5 (April 11, 2016): 526–33. http://dx.doi.org/10.1177/1747493016641967.
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Background Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). Aims We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. Methods Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS. Results Of 2144 patients with recent ischemic stroke, 351 (16%, 95% CI 15% to 18%) met ESUS criteria, similar across global regions (range 16% to 21%), and an additional 308 (14%) patients had incomplete evaluation required for ESUS diagnosis. The mean age of ESUS patients (62 years; SD = 15) was significantly lower than the 1793 non-ESUS ischemic stroke patients (68 years, p ≤ 0.001). Excluding patients with atrial fibrillation ( n = 590, mean age = 75 years), the mean age of the remaining 1203 non-ESUS ischemic stroke patients was 64 years ( p = 0.02 vs. ESUS patients). Among ESUS patients, hypertension, diabetes, and prior stroke were present in 64%, 25%, and 17%, respectively. Median NIHSS score was 4 (interquartile range 2–8). At discharge, 90% of ESUS patients received antiplatelet therapy and 7% received anticoagulation. Conclusions This cross-sectional global sample of patients with recent ischemic stroke shows that one-sixth met criteria for ESUS, with additional ESUS patients likely among those with incomplete diagnostic investigation. ESUS patients were relatively young with mild strokes. Antiplatelet therapy was the standard antithrombotic therapy for secondary stroke prevention in all global regions.
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Genyk, S. I., S. M. Genyk, V. A. Gryb, Ya I. Genyk, L. T. Maksymchuk, O. O. Doroshenko, A. V. Sorokhman, and V. R. Gerasymchuk. "CRYPTOGENIC STROKE? LOOK FOR THROMBOPHILIA." PRECARPATHIAN BULLETIN OF THE SHEVCHENKO SCIENTIFIC SOCIETY Pulse, no. 5(57) (April 24, 2019): 9–15. http://dx.doi.org/10.21802/2304-7437-2019-5(57)-9-15.
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About 25% of ischemic strokes remain without an established cause. The article describes the characterization of some hereditary and acquired thrombophilias, which play a significant role in genesis of stroke. One of the ways to solve the problem of etiological diagnosis of thrombotic states is to identify the markers of hereditary or acquired pathology and to conduct molecular genetic typing of the hemostasis system factors. Thrombophilia screening is required for all patients with ischemic strokes of unknown etiology.
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Genyk, S. I., S. M. Genyk, V. A. Gryb, Ya I. Genyk, L. T. Maksymchuk, O. O. Doroshenko, A. V. Sorokhman, and V. R. Gerasymchuk. "CRYPTOGENIC STROKE? LOOK FOR THROMBOPHILIA." PRECARPATHIAN BULLETIN OF THE SHEVCHENKO SCIENTIFIC SOCIETY Pulse, no. 5(57) (April 24, 2019): 9–15. http://dx.doi.org/10.21802/10.21802/2304-7437-2019-5(57)-9-15.
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About 25% of ischemic strokes remain without an established cause. The article describes the characterization of some hereditary and acquired thrombophilias, which play a significant role in genesis of stroke. One of the ways to solve the problem of etiological diagnosis of thrombotic states is to identify the markers of hereditary or acquired pathology and to conduct molecular genetic typing of the hemostasis system factors. Thrombophilia screening is required for all patients with ischemic strokes of unknown etiology.
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Gliński, Paweł, Aleksandra Czapla, Alina Rak-Pasikowska, and Agnieszka Sapa-Wojciechowska. "Usefulness of selected laboratory markers in stroke diagnosis." Diagnostyka Laboratoryjna 54, no. 4 (December 17, 2019): 275–84. http://dx.doi.org/10.5604/01.3001.0013.7770.
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Strokes and their complications are major clinical and social problems. Stroke diagnosis is limited to clinical and imaging evaluation – mainly by computed tomography (CT), which is particularly low sensitive to early ischemic stroke. Due to diagnostic problems, there are many studies conducted to find a laboratory marker of stroke, which can play similar role to troponins in the diagnosis of acute coronary syndrome. The aim of this article is to review scientific research in which the usefulness of potential stroke markers was assessed. Among analyzed parameters there are: inflammatory mediators (CRP, IL-1, IL-6, TNF– α, MCP-1, MMP-9), neural tissue markers (S100B protein, NSE, GFAP), coagulation and fibrinolysis components (vWF, D-dimer) and other markers – BNP, NT-proBNP, and osteoprotegerin. Some studies show the potential of laboratory markers in the differential diagnosis of the type of stroke, predicting the risk of mortality, or in patient’s condition assessment but yet none of the markers fulfill the criteria of a diagnostic test in stroke.
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Saida, Imen Ben, Helmi Ben Saad, Maroua Zghidi, Emna Ennouri, Radhouane Ettoumi, and Mohamed Boussarsar. "Artery of Percheron Stroke as an Unusual Cause of Hypersomnia: A Case Series and a Short Literature Review." American Journal of Men's Health 14, no. 4 (July 2020): 155798832093894. http://dx.doi.org/10.1177/1557988320938946.
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The thalamus and the mesencephalon have a complex blood supply. The artery of Percheron (AOP) is a rare anatomical variant. Occlusion of this artery may lead to bithalamic stroke with or without midbrain involvement. Given its broad spectrum of clinical features, AOP stroke is often misdiagnosed. Usually, it manifests with the triad of vertical gaze palsy, memory impairment, and coma. In this article, we report three cases of bilateral thalamic strokes whose clinical presentations were dominated by a sudden onset of hypersomnia. We also reviewed last 5 years’ publications related to the AOP strokes in males presenting sleepiness or equivalent terms as a delayed complication. The AOP stroke may present a diagnostic challenge for clinicians which should be considered in the differential diagnosis of hypersomnia.
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Chowdhury, Farah N., G. Sanjaya Chandrarathne, Kristopher D. Masilamani, Jennifer T. N. LaBranche, Shaun Malo, Lawrence W. Svenson, Thomas Jeerakathil, and Dilini P. Vethanayagam. "Links Between Strokes and Hereditary Hemorrhagic Telangiectasia: A Population-Based Study." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, no. 1 (December 6, 2018): 44–50. http://dx.doi.org/10.1017/cjn.2018.360.
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AbstractBackgroundHereditary hemorrhagic telangiectasia (HHT) is a disease of abnormal vasculature where patients are predisposed to strokes of multiple etiologies. We assessed yearly stroke incidence among Albertans with HHT and compared with the general population. Given the tendency for stroke in HHT patients, we expected HHT patients to have higher stroke incidence, in particular at younger ages.MethodsPopulation-based administrative health data on inpatient and ambulatory admissions were extracted over a 16-year period using International Classification of Diseases (ICD)-9 and ICD-10, Canada codes. We analyzed overall occurrence of strokes in Alberta by age, gender, stroke subtype, and diagnosis of HHT.ResultsThe age-standardized incidence rate of stroke in HHT was 450 per 100,000 compared with 260 per 100,000 in the general population with a rate ratio of 1.73 (95% confidence interval (CI) [1.046-2.842]). This study found a higher HHT prevalence in Alberta (1 in 3800) compared to the world average of 1 in 5000. Women were also more likely to be diagnosed with HHT, with a 3.25:1 female gender preponderance in the yearly incidence.InterpretationThis study not only shows that HHT patients are at higher risk of having a stroke but also quantifies that risk using an age-adjusted metric in Alberta. This province has a higher than expected disease burden of HHT, with the majority of cases affecting women. Our study found that acute ischemic strokes and transient ischemic attacks are far more common than hemorrhage in HHT. As HHT is a rare, multi-system, chronic disease, these patients should be referred to an HHT Centre of Excellence.
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Kristoffersen, Espen Saxhaug, Silje Holt Jahr, Kashif Waqar Faiz, Bente Thommessen, and Ole Morten Rønning. "Stroke admission rates before, during and after the first phase of the COVID-19 pandemic." Neurological Sciences 42, no. 3 (January 11, 2021): 791–98. http://dx.doi.org/10.1007/s10072-021-05039-y.
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Abstract Background There was a significant decrease in stroke admissions during the first phase of the COVID-19 pandemic. There are concerns that stroke patients have not sought medical attention and in the months after the lockdown suffer recurrent severe strokes. The aims of this study were to investigate how stroke admission rates and distributions of severity varied before, during and after the lockdown in a representative Norwegian hospital population. Methods All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke from January to September 2020 were identified by hospital chart review. Results We observed a transient decrease in weekly stroke admissions during lockdown from an average of 21.4 (SD 4.7) before to 15.0 (SD 4.2) during and 17.2 (SD 3.3) after (p < 0.011). The proportion of mild ischemic and haemorrhagic strokes was also lower during lockdown with 66% before, 57% during and 68% after (p = 0.011). Conclusion The period of COVID-19 lockdown was associated with a temporary reduction in total admissions of strokes. In particular, there were fewer with TIA and mild stroke. Given the need to prevent the worsening of symptoms and risk of recurrence, it is necessary to emphasise the importance to seek medical care even in states of emergency.
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Nakamura, Asako, Junya Kuroda, Tetsuro Ago, Jun Hata, Ryu Matsuo, Shuji Arakawa, Takahiro Kuwashiro, et al. "Causes of Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation." Cerebrovascular Diseases 42, no. 3-4 (2016): 196–204. http://dx.doi.org/10.1159/000445723.
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Background: Oral anticoagulants (OACs) reduce the incidence of embolic events associated with non-valvular atrial fibrillation (NVAF); however, ischemic stroke can still occur in such patients. Although there are various causes of ischemic stroke in patients with NVAF, their medication status at onset has scarcely been studied. This retrospective study aimed to determine the underlying causes of ischemic stroke in patients with NVAF in relation to pre-stroke anticoagulation. Methods: Among Japanese patients with acute ischemic stroke enrolled in the Fukuoka Stroke Registry from June 2007 to May 2013, 1,302 patients with NVAF who had been hospitalized within 24 h of onset were included in this study, and their backgrounds, pre-stroke use of OACs and prothrombin time-international normalized ratio (PT-INR) on admission were investigated. Strokes were regarded as being non-cardioembolic (CE) type when causes other than NVAF had been identified. The sub-therapeutic range (TR) for warfarin was defined according to Japanese guidelines for pharmacotherapy of atrial fibrillation. Results: Atrial fibrillation had been diagnosed prior to onset of stroke in 704 of 1,302 patients (54%). However, it had not been detected before or on admission, but identified later during hospitalization in 270 patients (21%). Of the patients who had atrial fibrillation on admission but had not been diagnosed as having it, 108 (8%) had not received any medication before onset of stroke and 220 (17%) had received medications other than OACs. OACs had been administered to 415 (59%) of the patients with known atrial fibrillation. The proportion of pre-stroke CHADS2 or CHA2DS2-VASc scores ≥1 ranged from 93 to 99% depending on whether atrial fibrillation had been diagnosed or anticoagulation therapy administered before stroke onset. The PT-INR was in the sub-TR on admission in 283 of 399 patients (71%) receiving warfarin. Male sex, smoking and previous stroke were more prevalent in patients with values within or over the TR of PT-INR than in those in the sub-TR. Non-CE stroke was more prevalent in patients with values above the lower therapeutic limit of the recommended PT-INR than in those in the sub-TR (p < 0.001). The number of CE strokes was much smaller in patients with high admission PT-INR values; this was not observed for non-CE ischemic strokes (p < 0.001). Conclusions: In the clinical setting, under-diagnosis, underuse and sub-therapeutic doses of OACs are major causes of ischemic stroke in patients with NVAF. However, non-CE ischemic strokes may develop in patients receiving therapeutic doses of warfarin.
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Newman-Toker, David E., Ernest Moy, Ernest Valente, Rosanna Coffey, and Anika L. Hines. "Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample." Diagnosis 1, no. 2 (June 1, 2014): 155–66. http://dx.doi.org/10.1515/dx-2013-0038.
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AbstractSome cerebrovascular events are not diagnosed promptly, potentially resulting in death or disability from missed treatments. We sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics.Cross-sectional analysis using linked inpatient discharge and ED visit records from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases and 2008–2009 State ED Databases across nine US states. We identified adult patients admitted for stroke with a treat-and-release ED visit in the prior 30 days, considering those given a non-cerebrovascular diagnosis as probable (benign headache or dizziness diagnosis) or potential (any other diagnosis) missed strokes.There were 23,809 potential and 2243 probable missed strokes representing 12.7% and 1.2% of stroke admissions, respectively. Missed hemorrhages (n=406) were linked to headache while missed ischemic strokes (n=1435) and transient ischemic attacks (n=402) were linked to headache or dizziness. Odds of a probable misdiagnosis were lower among men (OR 0.75), older individuals (18–44 years [base]; 45–64:OR 0.43; 65–74:OR 0.28; ≥75:OR 0.19), and Medicare (OR 0.66) or Medicaid (OR 0.70) recipients compared to privately insured patients. Odds were higher among Blacks (OR 1.18), Asian/Pacific Islanders (OR 1.29), and Hispanics (OR 1.30). Odds were higher in non-teaching hospitals (OR 1.45) and low-volume hospitals (OR 1.57).We estimate 15,000–165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. Physicians evaluating these symptoms should be particularly attuned to the possibility of stroke in younger, female, and non-White patients.
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Gorey, Sarah, and Tim Cassidy. "317 Incidence of Cognitive Impairment after Stroke: a Retrospective Cohort of Rehabilitation Patients." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.204.
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Abstract Background Pendlebury and Rothwell’s recent paper reports the incidence of cognitive impairment and dementia post stroke as 5% for TIA, 8% for minor stroke and 34% for severe stroke. 1We wanted to explore if these trends were reproducible in an Irish cohort. Methods We conducted a retrospective review of a random sample of 100 discharges from a dedicated stroke rehabilitation unit between 2017 and 2018. Diagnosis of cognitive impairment or dementia was extracted from MDT discharge documentation, along with results of cognitive assessments. This cohort required inpatient rehabilitation post stroke, so we can infer that these were severe strokes. As a surrogate marker of disability, the average Barthel Index of this sample on admission to rehabilitation was 13, indicating moderate functional dependency. Results Complete information was available for 94/100 patients. The average age was 67 years (age range 33-95 years) 37 of 94 (39%) were judged to have cognitive impairment on discharge. Demonstration of functional impairment was central to this assessment. 30 (81%) of these diagnoses were supported by abnormal cognitive tests. 3 of those judged to have cognitive impairment, were unable to complete cognitive assessment. 2 of those judged to have cognitive impairment had cognitive scores which were within the normal range. None of the discharge letters mentioned a diagnosis of post stroke or vascular dementia. Conclusion This study replicates Pendlebury and Rothwell’s findings that over a third of people suffering from severe strokes will develop cognitive impairment. This is of critical importance to stroke clinicians as it should prompt frank discussions with stroke patients and their families about prognosis, recovery and future planning.
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Alrabghi, Lujain, Raghad Alnemari, Rawan Aloteebi, Hamad Alshammari, Mustafa Ayyad, Mohammed Al Ibrahim, Mohsen Alotayfi, Turki Bugshan, Abdullah Alfaifi, and Hussain Aljuwayd. "Stroke types and management." International Journal Of Community Medicine And Public Health 5, no. 9 (August 24, 2018): 3715. http://dx.doi.org/10.18203/2394-6040.ijcmph20183439.
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Strokes are a leading cause of morbidity and mortality across the world, in fact the third leading cause after heart diseases and cancer. Additionally, among the survivors of stroke, one-third suffers from permanent disabilities. Strokes can be classified broadly as ischemic and hemorrhagic, which account for 80% and 20% of total respectively. The prognosis of cerebrovascular accidents depends on quick diagnosis of the type, followed by appropriate and fast management. We conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE, from January 1982 to March 2017. The following search terms were used: stroke, cerebrovascular accidents, ischemic stroke, hemorrhagic stroke, stroke types, management of stroke, rehabilitation, CVA prevention. The most critical part about approaching a stroke patient is to identify the type of stroke, whether hemorrhagic or ischemic, as each type requires a different guideline of management. Also, time is the key in preserving neuronal function and preventing further damage. At the same time, the general population must be educated about methods of preventing stroke by making positive lifestyle changes.
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Andreev, Vladislav V., Alexander Y. Podunov, Daniil S. Lapin, Zarema L. Gilyaeva, Ekaterina N. Nikiforova, Konstantin V. Golikov, and Dmitry I. Rudenko. "Analysis of the clinical manifestations of cerebral stroke in patients with the novel coronavirus infection (COVID-19)." Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), no. 12 (December 1, 2020): 30–45. http://dx.doi.org/10.33920/med-01-2012-03.
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Objective: To improve the diagnosis and treatment of acute cerebrovascular accident in patients with community-acquired pneumonia caused by the novel coronavirus infection (COVID-19). Materials and methods: For the first time, clinical manifestations of strokes in patients with diagnosed new coronavirus infection (COVID-19) were analyzed in 130 patients. The study was conducted in two groups. The main group consisted of 69,2 % (n = 90) with a clinical and instrumental diagnosis: novel coronavirus infection in combination with stroke. The control group (30,8 %; n = 40) included the cases of ischemic and hemorrhagic stroke without signs of SARS-CoV-2. In both groups, the severity of the disease and pathogenetic subtypes were compared, and the features of the laboratory biochemical data were studied. Statistical analysis of the outcomes was carried out taking into account the severity of brain and lung tissue damage. Results: In patients with cerebral stroke against the background of the new coronavirus infection (COVID-19), the prevalence of ischemic stroke cases (86,4 %) was noted for undetermined (41,4 %) and cardioembolic (35,7 %) pathogenetic subtypes (according to TOAST) with localization in the carotid basin (89,7 %). In hemorrhagic stroke, parenchymal hemorrhage was observed with a greater frequency (54,5 %). The severity of the diagnosed strokes according to the NIHSS scale was up to 13,16 (8,80) points with less severe brain damage — Glasgow coma scale (14,0 (12,0 15,0). In the group of the patients, a widespread lesion of the lung tissue was diagnosed in 82,2 % of cases. No significant increase in the incidence of clinically significant manifestations of systemic and organ hypercoagulation was established. Conclusions: In stroke patients with COVID-19, ischemic manifestations with undetermined and cardioembolic subtypes without age and gender features prevail, with no differences in the severity of the course and a large number of favorable outcomes. A high activity of inflammatory and infectious changes was established by clinical laboratory.
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Raimondo, Domenico Di, Salvatore Corrao, Riccardo Di Sciacca, Giuseppe Licata, Antonino Tuttolomondo, and Antonio Pinto. "Immuno-inflammatory activation in acute cardio-embolic strokes in comparison with other subtypes of ischaemic stroke." Thrombosis and Haemostasis 101, no. 05 (2009): 929–37. http://dx.doi.org/10.1160/th08-06-0375.
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SummaryFew studies have examined the relationship between inflammatory biomarker blood levels, cardioembolic stroke subtype and neurological deficit. So the aim of our study is to evaluate plasma levels of immuno-inflammatory variables in patients with cardio-embolic acute ischaemic stroke compared to other diagnostic subtypes and to evaluate the relationship between immuno-inflammatory variables, acute neurological deficit and brain infarct volume. One hundred twenty patients with acute ischaemic stroke and 123 controls without a diagnosis of acute ischaemic stroke were evaluated. The type of acute ischaemic stroke was classified according to the TOAST classification. We evaluated plasma levels of IL-1β, TNF-α, IL-6 and IL-10, E-selectin, P-selectin, sICAM-1,sVCAM-1, vWF, TPA and PAI-1. Patients with ischaemic stroke classified as cardio-embolic (CEI) showed, compared to other subtypes, significantly higher median plasma levels of TNF-α , IL-6 and IL-1β. Furthermore stroke patients classified as lacunar showed, compared to other subtypes, significantly lower median plasma levels of TNF-α, IL-6 and IL-1β. Multiple linear regression showed a significant association between the Scandinavian Stroke Scale (SSS) score at admission and diagnostic subtype, infarct volume of cardio-embolic strokes and some inflammatory variables. Our findings confirm that cardio-embolic strokes have a worse clinical presentation and produce larger and more disabling strokes than other ischaemic stroke subtypes reporting a possible explanation of higher immuno-inflammatory activation of the acute phase.
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Giebel, Godwin D. "Use of mHealth Devices to Screen for Atrial Fibrillation: Cost-Effectiveness Analysis." JMIR mHealth and uHealth 8, no. 10 (October 6, 2020): e20496. http://dx.doi.org/10.2196/20496.
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Background With an estimated prevalence of around 3% and an about 2.5-fold increased risk of stroke, atrial fibrillation (AF) is a serious threat for patients and a high economic burden for health care systems all over the world. Patients with AF could benefit from screening through mobile health (mHealth) devices. Thus, an early diagnosis is possible with mHealth devices, and the risk for stroke can be markedly reduced by using anticoagulation therapy. Objective The aim of this work was to assess the cost-effectiveness of algorithm-based screening for AF with the aid of photoplethysmography wrist-worn mHealth devices. Even if prevented strokes and prevented deaths from stroke are the most relevant patient outcomes, direct costs were defined as the primary outcome. Methods A Monte Carlo simulation was conducted based on a developed state-transition model; 30,000 patients for each CHA2DS2-VASc (Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category [female]) score from 1 to 9 were simulated. The first simulation served to estimate the economic burden of AF without the use of mHealth devices. The second simulation served to simulate the economic burden of AF with the use of mHealth devices. Afterwards, the groups were compared in terms of costs, prevented strokes, and deaths from strokes. Results The CHA2DS2-VASc score as well as the electrocardiography (ECG) confirmation rate had the biggest impact on costs as well as number of strokes. The higher the risk score, the lower were the costs per prevented stroke. Higher ECG confirmation rates intensified this effect. The effect was not seen in groups with lower risk scores. Over 10 years, the use of mHealth (assuming a 75% ECG confirmation rate) resulted in additional costs (€1=US $1.12) of €441, €567, €536, €520, €606, €625, €623, €692, and €847 per patient for a CHA2DS2-VASc score of 1 to 9, respectively. The number of prevented strokes tended to be higher in groups with high risk for stroke. Higher ECG confirmation rates led to higher numbers of prevented strokes. The use of mHealth (assuming a 75% ECG confirmation rate) resulted in 25 (7), –68 (–54), 98 (–5), 266 (182), 346 (271), 642 (440), 722 (599), 1111 (815), and 1116 (928) prevented strokes (fatal) for CHA2DS2-VASc score of 1 to 9, respectively. Higher device accuracy in terms of sensitivity led to even more prevented fatal strokes. Conclusions The use of mHealth devices to screen for AF leads to increased costs but also a reduction in the incidence of stroke. In particular, in patients with high CHA2DS2-VASc scores, the risk for stroke and death from stroke can be markedly reduced.