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Plamondon, Réjean, Christian O'Reilly, and Claudéric Ouellet-Plamondon. "Strokes against stroke—strokes for strides." Pattern Recognition 47, no. 3 (March 2014): 929–44. http://dx.doi.org/10.1016/j.patcog.2013.05.004.
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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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Chen, Shuo, Ravinder-Jeet Singh, Noreen Kamal, and Michael D. Hill. "Improving care for acute in-hospital ischemic strokes—A narrative review." International Journal of Stroke 13, no. 9 (July 17, 2018): 905–12. http://dx.doi.org/10.1177/1747493018790029.
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In-hospital strokes, that is new strokes occurring among hospitalized patients, account for 6.5–15% of all strokes. Compared to community-onset stroke patients, in-hospital stroke patients tend to have worse functional and mortality outcomes. This review addresses the characteristics of acute in-hospital ischemic strokes, reasons these patients have worse outcomes compared to community-onset stroke patients, and future steps to improve outcomes.
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Wang, Shuxia, Shouxia Wang, Weiping He, and Shengfeng Qin. "Tolerance Zone-Based Grouping Method for Online Multiple Overtracing Freehand Sketches." Mathematical Problems in Engineering 2020 (April 14, 2020): 1–12. http://dx.doi.org/10.1155/2020/7393846.
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Multiple overtracing strokes are common drawing behaviors in freehand sketching; that is, additional strokes are often drawn repeatedly over the existing ones to add more details. This paper proposes a method based on stroke-tolerance zones to group multiple overtraced strokes which are drawn to express a 2D primitive, aiming to convert online freehand sketches into 2D line drawings, which is a base for further 3D reconstruction. Firstly, after the user inputs a new stroke, a tolerance zone around the stroke is constructed by reference to its polygonal approximation points obtained from the stroke preprocessing. Then, the input strokes are divided into stroke groups, each representing a primitive through the stroke grouping process based on the overtraced ratio of two strokes. At last, each stroke group is fitted into one or more 2D geometric primitives including line segments, polylines, ellipses, and arcs. The proposed method groups two strokes together based on their screen-space proximity directly instead of classifying and fitting them firstly, so that it can group strokes of arbitrary shapes. A sketch-recognition prototype system has been implemented to test the effectiveness of the proposed method. The results showed that the proposed method could support online multiple overtracing freehand sketching with no limitation on drawing sequence, but it only deals with strokes with relatively high overtraced ratio.
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McNutt, Michelle K., Cedar Slovacek, David Rosenbaum, Hari Kishan Reddy Indupuru, Xu Zhang, Bryan A. Cotton, John Harvin, Charles E. Wade, Sean I. Savitz, and Lillian S. Kao. "Different strokes: differences in the characteristics and outcomes of BCVI and non-BCVI strokes in trauma patients." Trauma Surgery & Acute Care Open 5, no. 1 (September 2020): e000457. http://dx.doi.org/10.1136/tsaco-2020-000457.
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BackgroundAlthough strokes are rare in trauma patients, they are associated with worse functional and cognitive outcomes and decreased mobility. Blunt cerebrovascular injury (BCVI)–related strokes and mortality have decreased, likely due to refined screening and treatment algorithms in trauma literature; however, there is a paucity of research addressing non-BCVI strokes in trauma. The purpose of this study is to evaluate the incidence, etiology, and risk factors of stroke in our trauma population in order to identify preventive strategies.MethodsThis study was a retrospective review of all adult trauma patients admitted to a level 1 trauma hospital who suffered a stroke during trauma admission from 2010 to 2017. Data were collected from the prospectively maintained trauma and stroke databases. Stroke etiology was determined by a vascular neurologist.ResultsOf the 43 674 adult trauma patients admitted during the study period, 99 (0.2%) were diagnosed with a stroke during the index admission. Twenty-one (21%) strokes were due to BCVI. Seventy-eight (79%) strokes were due to non-BCVI etiologies. Patients with non-BCVI strokes were older, less severely injured, and had more medical comorbidities compared with patients with a BCVI stroke. While patients with a BCVI stroke were more likely to suffer multiple traumatic injuries from MVC (76% vs 28%, p<0.001), non-BCVI strokes had more isolated extremity injuries from fall mechanism (55% vs 10%, p<0.001). Over the study period, the age and incidence of stroke and BCVI (p<0.001) increased. However, the rate of BCVI strokes decreased while the rate of non-BCVI strokes increased.DiscussionThe incidence of stroke has increased despite aggressive screening and treatment of BCVI. This increase is primarily due to non-BCVI strokes which are associated with advanced age and medical comorbidities after low mechanism traumatic injury. Medical optimization of comorbid conditions during trauma hospitalization will become increasingly important for stroke prevention as the population ages.Level of evidence: Level III
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Ghimire, Bal Ram, Roshan Giri, and Shanker Prasad Chimouriya. "STUDY OF CHRONOLOGICAL ORDER IN INTERSECTING PRINTED AND PEN STROKES WITH THE HELP OF CHROMATICITY DIAGRAM." Acta Scientifica Malaysia 6, no. 2 (2022): 38–42. http://dx.doi.org/10.26480/asm.02.2022.38.42.
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Writing cross stroke examination is one of the difficult and challenging problem in forensic document examination. In this work, we tried to find sequence of order in crossing printed and pen strokes. The study mainly deals with application of chromaticity diagram generated by Video Spectral Comparator (VSC)-6000. Chromaticity co-ordinates are generated from three different points of first, second and cross strokes. When two strokes cross each other, then surface on point of intersection corresponds to second stroke. So, we have started this work with the assumption that chromaticity co-ordinate (x,y) of the crossing stroke should be similar to that of second stroke. We perform our experiment in both homogeneous and heterogeneous crossing strokes. We repeat the same experiment five times by preparing different samples each time to establish more valid conclusion but we get positive and conclusive results only in the case of heterogeneous crossing strokes where printed stroke is above the pen strokes.
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Giri, R., S. P. Chimouriya, and B. R. Ghimire. "Application of Absorption Spectra to Study Order of Sequence in Intersecting Printed and Pen Strokes." Journal of Nepal Physical Society 8, no. 3 (December 30, 2022): 1–8. http://dx.doi.org/10.3126/jnphyssoc.v8i3.50696.
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This work is performed to establish chronological order in crossing strokes between printed stroke and pen strokes. Nine different types of pens including cello maxriter pen (black and blue), pilot pen (red and black), cello pointec pen (black and blue) and cello techno tip pen (red, black and blue) are used to produce pen strokes and for printed stroke Canon LBP 3300 printer is used. In the case of printed stroke, only black color stroke is applied. As a result, samples of both homogeneous and heterogeneous intersecting strokes are prepared. This work is based on the assumption that nature and peak characteristics of absorption spectra from crossing stroke should be similar to that of second stroke. Here, absorption spectra is generated by Video Spectral Comparator-6000 by using light of wavelength ranging from 400 nm to 1000 nm. From this experiment, it is found to be possible to find chronological order for heterogeneous crossing strokes (crossing stroke of different colors) only if printed stroke is over pen stroke. It means, only if print is done over writing strokes from red and blue pen, then order of sequence of writing can be determined whereas in other cases it is not possible.
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Leker, Ronen R., Jose E. Cohen, Anat Horev, David Tanne, David Orion, Guy Raphaeli, Jacob Amsalem, et al. "Impact of previous stroke on outcome after thrombectomy in patients with large vessel occlusion." International Journal of Stroke 14, no. 9 (April 4, 2019): 887–92. http://dx.doi.org/10.1177/1747493019841244.
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Background Many patients with large vessel occlusion (LVO) who are otherwise candidates for endovascular treatment (EVT) have had previous strokes. We aimed to examine the effect of previous stroke on outcome after EVT. Methods Consecutive patients with LVO were prospectively entered into a National Acute Stroke registry of patients undergoing EVT. Patients treated with EVT were divided into those with and without previous strokes. The rates of favorable reperfusion status, mortality, and excellent outcome at 90 days post-stroke as well as symptomatic intracranial hemorrhage (sICH) were evaluated. Results A total of 390 underwent EVT and 35 had previous strokes. Patients with previous strokes were significantly older; more frequently had a history of prior myocardial infarction and more often had pre-existing functional disability. Favorable target vessel recanalization was less frequently achieved in patients with previous strokes (60% vs. 82%; p = 0.005) and ordinal regression analysis for functional outcome revealed higher frequency of deterioration at three months in patients with previous strokes. Nevertheless, 9% of these patients maintained their previous disability state and sICH rates did not differ between the groups. Mortality rates at one year post stroke were significantly higher in patients with previous strokes (37% vs. 16%; p = 0.005). Conclusions Previous strokes are associated with higher likelihoods of mortality and unfavorable outcome in patients with LVO undergoing EVT. However, because some of these patients maintain their previous disability state, the presence of previous stroke should not be used as an exclusion criterion from EVT.
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Ullah, Imran, Bakth Jamal, Fawad Ali, Hanif Ur Rehman, Zia Ullah, and Said Ali. "Comparison of the CNN and RNN Approaches with Respect to Brain Tumor using MRI Image Datasets." Scholars Journal of Applied Medical Sciences 10, no. 3 (March 31, 2022): 398–404. http://dx.doi.org/10.36347/sjams.2022.v10i03.022.
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Introduction: Heart disease and cancer are the top two killers in the world, but strokes are the third most common cause of death worldwide. Furthermore, one-third of stroke victims are left with long-term disabilities. An Ischemic-strokes account for 80% of all strokes, while hemorrhagic strokes account for 20% of all strokes. Aim of this study: The main aim of this study is comparing the haemorrhagic and ischemic stroke patients – analysis of mortality, clinical development and relationship between stroke variables. Research Methodology: The design of this research is descriptive and exploratory. The current study included 100 patients with an acknowledged stroke incidence (57 men and 43 women). The difference of statistics between infarct and haemorrhage on the demographic & clinical variables was discovered through the use of univariate and Multivariate analysis. Data analysis: The data have been analyzed on a total of 100 patients based on the two types of strokes using various statistical tools on clinical and demographic variables. Conclusion: It is concluded that in comparison to ischemic stroke, hemorrhagic stroke affected a younger age group. Stroke patients with a history of hypertension had a statistically insignificant link between their hypertensive history and the occurrence of the disease, according to the univariate analysis.
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Masina, Marco, Annalena Cicognani, Carla Lofiego, Simona Malservisi, Riccardo Parlangeli, and Alessandro Lombardi. "Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit." Italian Journal of Medicine 10, no. 3 (September 30, 2016): 202. http://dx.doi.org/10.4081/itjm.2016.690.
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The new clinical construct of embolic stroke of undetermined source (ESUS) suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42) were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembolic strokes (3.5%) and significantly higher than in cryptogenic non-ESUS (1.2%) (P<0.0001). This is the first description of a cohort of ESUS patients in an Italian stroke unit. Patients with ESUS have a significantly higher risk of recurrence than in those with non-ESUS cryptogenic strokes, and slightly higher than in those with cardioembolic strokes. Results support the hypothesis of a more extensive diagnostic evaluation in cryptogenic strokes and the feasibility of such approach.
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Bernick, Charles B., Lewis H. Kuller, Will T. Longstreth, Corinne Dulberg, Teri A. Manolio, Norman J. Beauchamp, and Thomas R. Price. "Silent Brain MRI Infarcts and Subsequent Stroke Type In the Cardiovascular health Study." Stroke 32, suppl_1 (January 2001): 363. http://dx.doi.org/10.1161/str.32.suppl_1.363-d.
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P136 Objective: Silent infarcts seen on cranial MRI scans are a risk factor for subsequent clinical stroke in the elderly. This study examines the type of clinical strokes seen in those with silent infarcts. Methods: Cranial MRI examination was completed on 3324 Cardiovascular Health Study (CHS) participants aged 65+ who were without a prior history of clinical stroke. Incident strokes were identified over an average follow-up of 4 years and classified as hemorrhagic or ischemic. Ischemic strokes were further subdivided into lacunar, cardioembolic, atherosclerotic or other/unknown. Results: Silent MRI infarcts >3mm were found in approximately 28% (n=923). Of these, 7% (n=67) subsequently had a clinically evident stroke. The characteristics of the silent MRI infarcts in those who sustained an incident stroke were as folows: 56 had only subcortical infarcts, of which 55 were <20mm; 4 had only cortical infarcts; and 7 had both cortical and subcortical infarcts. Of those with only subcortical silent MRI infarcts, 16% (n=9) went on to a hemorrhagic stroke and 84% (n=47) sustained an ischemic stroke. The ischemic strokes were subtyped as 12 cardioembolic, 3 lacunar, 2 atherosclerotic and 30 unknown/other. Considering only those with cortical silent infarcts, either alone or in combination with subcortical infarcts, there was 1 hemorrhagic stroke and 10 ischemic strokes. Half of the ischemic strokes were cardioembolic and half were unknown type. Conclusion: Elderly individuals with silent subcortical infarcts who go onto subsequent stroke may be at risk not only for lacunar infarcts but also cardioembolic or hemorrhagic strokes.
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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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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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Blake, Margaret Lehman. "Right Hemisphere Strokes." Perspectives of the ASHA Special Interest Groups 1, no. 2 (March 31, 2016): 63–65. http://dx.doi.org/10.1044/persp1.sig2.63.
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Although strokes occur about as often on the right as on the left side of the brain, much more attention is given to left hemisphere (LH) strokes, which results in biases in stroke severity assessments and medical treatment.
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Davern, Recie, Helena Hobbs, Hannah Murugan, and Paul Cotter. "306 The Changing Face of Stroke in the DOAC Era." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.196.
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Abstract Background Patients prescribed oral anticoagulants (OAC) for atrial fibrillation (AF) can still present with stroke. The mechanism for stroke in these patients can be due to multiple factors including subtherapeutic dosing and non-compliance. With the increasing use of direct-acting OACs (DOACs) in favour of warfarin, it is unclear if the incidence of stroke in those already taking OAC has reduced. Methods Data was extracted from our unit’s stroke registry, a prospectively maintained database, for patients who presented with stroke while receiving OAC for AF from 2013 to 2017. Type of OAC, type of stroke, OAC dosing at time of event including non-compliance, stroke management and outcome were recorded. Results 67 patients were included for analysis, with 55 ischaemic and 12 haemorrhagic strokes. 52 patients were receiving warfarin at the time of their stroke vs. 15 receiving DOACs. 33/55 (60%) of ischaemic strokes occurred in patients taking warfarin with a sub-therapeutic INR. In 3/55 (5%) of ischaemic strokes, the OAC was held for a procedure while in 6/55 cases (11%) the OAC had been stopped for another reasons e.g. bleeding. 5/55 (7%) were due to non-compliance. 1 ischaemic stroke was due to under-dosing of a DOAC (dabigatran). 16 strokes were recorded in 2013 for patients prescribed OAC vs. 3 in 2017. Overall the number of ischaemic strokes due to subtherapeutic OAC decreased from 14 in 2013 to 1 in 2017 (p value 0.06). Conclusion The majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.
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Hauser, Eric. "Solution strokes." Gesture 14, no. 3 (December 31, 2014): 297–319. http://dx.doi.org/10.1075/gest.14.3.02hau.
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Downward stroke gestures which are produced in conjunction with the solution of speaking trouble, such as a word search, during English language discussions among Japanese university students, are described and labeled solution strokes. Similar gestures that involve striking something are labeled solution strikes. These gestures can be understood as the gestural component of the utterance which solves the trouble. They index the subjective experience of the trouble and its solution and possibly a positive affective stance toward the solution. Solution strokes are argued to be the gestural component of a solution and it is shown that understanding the meaning of a solution stroke requires attending to how it is situated in the local context.
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HSIEH, CHEN-CHUNG, and HSI-JIAN LEE. "A PROBABILISTIC STROKE-BASED VITERBI ALGORITHM FOR HANDWRITTEN CHINESE CHARACTERS RECOGNITION." International Journal of Pattern Recognition and Artificial Intelligence 07, no. 02 (April 1993): 329–52. http://dx.doi.org/10.1142/s0218001493000170.
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This paper proposes a probabilistic approach to recognize handwritten Chinese characters. According to the stroke writing sequence, strokes and interleaved stroke relations are built manually as a 1-D string, called an on-line model, to describe a Chinese character. In an input character, strokes are first extracted by a tree searching method. The recognition problem is then formulated as an optimization matching problem in a multistage directed graph, where the number of stages is the length of the modelled stroke sequence. Nodes in a stage represent extracted strokes that have the same stroke type as defined in the on-line model and the link between two neighboring nodes corresponds to the relationship between the two extracted strokes. The probability that the extracted stroke belongs to the predefined stroke type is calculated from the stroke line segments, and the transition probability between two extracted strokes is the degree of satisfaction of the relationship defined in the on-line model. The Viterbi algorithm, which can handle stroke insertion, deletion, splitting, and merging, is applied to recover the sequence of strokes consisting of the unknown character. The similarity is defined to be the product of stroke probabilities and stroke transition probabilities in the stroke sequence. The unknown character is matched with all modelled characters and is recognized as the one with the highest similarity. Experiments with 540 characters uniformly selected from the database CCL/HCCR1 (250 variations/class) are conducted, and the recognition rate is about 92.8%, which proves the feasibility of the proposed recognition system.
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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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Maciąg, Anna, Michał Mazurek, Ewa Jędrzejczyk-Patej, and Beata Średniawa. "Embolic stroke of undetermined source (ESUS) – current state of knowledge." In a good rythm 3, no. 60 (December 30, 2021): 13–17. http://dx.doi.org/10.5604/01.3001.0015.7296.
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Ischemic strokes account for over 80% of strokes. However, the cause of about 25% of them remains undetermined. This kind of ischemic stroke is termed cryptogenic (CS, cryptogenic stroke). In most cases, cryptogenic stroke has an embolic origin, which is marked by worse prognosis compared to strokes of another origin. Therefore, the term Embolic Stroke of Undetermined Source (ESUS) was separated from the group of CS in 2014. Cryptogenic stroke, in the broad sense, is a complex case, which presents a challenge to both cardiologists and neurologists. We described the steps, which are essential to take in patients, who have undergone ESUS.
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Teitelbaum, Jeanne S., Rüdiger von Kummer, Knut Gjesdal, Arni Kristinsson, Georg Gahn, and Gregory W. Albers. "Effect of Ximelagatran and Warfarin on Stroke Subtypes in Atrial Fibrillation." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 35, no. 2 (May 2008): 160–65. http://dx.doi.org/10.1017/s031716710000857x.
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ABSTRACTBackground and Purpose:The most common stroke subtype among atrial fibrillation (AF) patients not receiving anticoagulants is cardioembolic. In the SPORTIF III and V trials, the oral direct thrombin inhibitor ximelagatran was as effective as warfarin in reducing the risk of stroke in patients with nonvalvular AF. We assessed any differential effect of warfarin versus ximelagatran on the risk and outcome of cardioembolic and noncardioembolic stroke.Methods:7329 patients with AF and ≥1 risk factors for stroke were randomized to treatment with warfarin (target international normalized ratio 2.0-3.0) or fixed-dose ximelagatran. Strokes were classified into specific subtypes. Therapeutic effect of warfarin and ximelagatran, adverse events, and stroke outcomes were assessed according to stroke subtype.Results:The annual stroke rate was low for both cardioembolic (ximelagatran, 0.39%; warfarin, 0.47%) and noncardioembolic stroke (ximelagatran, 0.57%; warfarin, 0.37%). In ischemic strokes, 33.9% (ximelagatran) and 34.3% (warfarin) had strokes of presumed cardioembolic origin. When fatal stroke, disabling stroke, myocardial infarction, and death from any cause were combined as poor outcome, patients with cardioembolic strokes had the highest rate of poor outcome (40%) but this was non- significant.Conclusions:In SPORTIF III and V the efficacy of warfarin and ximelagatran were similar for prevention of cardioembolic and noncardioembolic strokes. Overall outcome tended to be worse following cardioembolic stroke. Ximelagatran has been withdrawn from the market due to hepatic side effects, but similar compounds are presently being studied.
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Klochikhina, O. A., V. V. Shprakh, L. V. Stakhovskaya, and E. A. Polunina. "Prevalence of recurrent stroke in different age groups." Siberian Medical Review, no. 6 (2020): 51–56. http://dx.doi.org/10.20333/2500136-2020-6-51-56.
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The aim of the research is to study and to analyze the prevalence of recurrent strokes in the Russian regions included in Federal program from 2009 to 2016 on reorganization of care for patients with stroke in different age groups. Material and methods. The research method is territory and population register. The study included seven territories with 7124 of cases of recurrent stroke in total. The examined patients were divided into four age groups: of young age - 25-44 years old; of average age - 45-59 years old; of old age - 60-74 years old, and of senile - 75 years and older. Statistical analysis was carried out using programming language for statistical calculations R version 3.3.2. Results. The maximum number of recurrent stroke cases was registered in old age (46.6%), and the minimum number of cases of recurrent stroke was among young people (2.4%). When analyzing the incidence of recurrent strokes, depending on the year, the most systematic percentage decrease of recurrent strokes was observed among elderly people. The highest percentage of recurrent strokes was determined among the elderly people in 2013 - 26.38%; and the lowest percentage of recurrent strokes was recorded among young people. Conclusion. Among the surveyed age groups statistically significant decrease in recurrent strokes among young, middle-aged and elderly people was revealed during 2009 - 2016. It is the criterion for the effectiveness of recurrent stroke prevention conducted in the studied areas. There was no statistically significant decrease in the prevalence of recurrent stroke among elderly people by 2016. It indicates that the prevention of recurrent strokes in old age is a difficult task due to concomitant diseases and associated pathology in these patients.
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R, Mahesh, Nandini N S, and Dr Ravikumar G K. "Automated Prediction of Brain Stroke Disease Classification Using Machine Learning Algorithm Techniques." International Journal for Research in Applied Science and Engineering Technology 10, no. 6 (June 30, 2022): 965–70. http://dx.doi.org/10.22214/ijraset.2022.43905.
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Abstract: The brain is the human body's primary upper organ. Strokes might leave you unable for a long time. Stroke is the top cause of death throughout the world. A stroke occurs when the brain's blood supply becomes exhausted and stops working. There are 2 main causes of stroke: an obstructed passage (ischemic stroke) or a leak or burst of vessels (hemorrhagic stroke).Predicting strokes early produces a better quantity that is cost-effective for the time of onset. Strokes are mainly caused by people's decisions about their habits, especially in the current scenario by changing people who like high blood sugar, strokes, obesity, diabetes, and hypertension. This evaluation used various deep learning (DL) algorithms such as CNN, Densenet and VGG16. The model is exploited with great accuracy in each of the subsequent algorithms in this study work to forecast the event for the fresh provided inputs. Keywords: Tensorflow, Opencv, Image Processing, Model File.
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Bhatt, Archit, Muhammad U. Farooq, Sailaja Enduri, Clement Pillainayagam, Bharath Naravetla, Anmar Razak, Adnan Safdar, Syed Hussain, Mounzer Kassab, and Arshad Majid. "Clinical Significance of Serum Zinc Levels in Cerebral Ischemia." Stroke Research and Treatment 2010 (2010): 1–4. http://dx.doi.org/10.4061/2010/245715.
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Background. Zinc mediates several vital physiological, enzymatic and cellular functions. The association between serum zinc and stroke outcome has not been previously evaluated.Methods. This single center retrospective study was conducted on consecutive stroke () and TIA () patients. We sought to determine whether serum zinc concentrations in patients with acute ischemic strokes were associated with stroke severity and poor functional status at discharge, respectively.Results. Overall, out of the 224 patients analyzed (mean age 67 years), 35.7% patients had low zinc levels (65 mcg/dL). Patients with stroke () were more likely to have low zinc levels (, CI , ) compared to patients with TIA (). For patients with stroke (), multivariate analysis showed that low serum zinc levels (OR 2.82, CI , ) and strokes with admission severe strokes () (OR 2.68, CI , ) were independently associated with poor functional status () at discharge from the hospital.Conclusion. Low serum zinc concentrations are associated with more severe strokes on admission and poor functional status at discharge.
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fitria candradewi, susan, and Shinta Dewi Nur Rahmah. "ANALISIS HUBUNGAN TERAPI ANTIHIPERTENSI SEBAGAI PENCEGAHAN SEKUNDER TERHADAP KEJADIAN SERANGAN ULANG STROKE ISKEMIK PADA PASIEN STROKE ISKEMIK." Jurnal Insan Farmasi Indonesia 5, no. 1 (May 29, 2022): 1–8. http://dx.doi.org/10.36387/jifi.v5i1.923.
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Individuals who survive a first ischemic stroke are at high risk for recurrent stroke. This study aims to analyze the relationship between antihypertensives on the incidence of ischemic stroke recurrence in ischemic stroke patients. Type of research is analytic observational with a retrospective cohort approach. The research sample was taken using purposive sampling technique. The research sample was patients who had an ischemic stroke at PKU Muhammadiyah Hospital Yogyakarta in 2018. There were 201 samples that met the inclusion criteria. Consisting of 135 treatment groups and 66 patients as the control group. In the treatment group, 110 patients did not have recurrent strokes and 25 patients had recurrent strokes. In the control group there were 58 patients who did not have recurrent strokes and 8 patients had recurrent strokes. Statistical analysis showed an RR value of 0.927 (95% CI: 0.822-1.046) and p-value of 0.344. The conclusion from the results of this study is that there is no relationship between the administration of antihypertensive therapy with the incidence of ischemic stroke recurrence in ischemic stroke patients at PKU Muhammadiyah Hospital Yogyakarta.
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Castilla-Guerra, L., A. Espino-Montoro, M. C. Fernandez-Moreno, and J. M. López-Chozas. "Abnormal Blood Pressure Circadian Rhythm in Acute Ischaemic Stroke: are Lacunar Strokes Really Different?" International Journal of Stroke 4, no. 4 (August 2009): 257–61. http://dx.doi.org/10.1111/j.1747-4949.2009.00314.x.
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Background A pathologically reduced or abolished circadian blood pressure variation has been described in acute stroke. However, studies on alterations of circadian blood pressure patterns after stroke and stroke subtypes are scarce. The objective of this study was to evaluate the changes in circadian blood pressure patterns in patients with acute ischaemic stroke and their relation to the stroke subtype. Aims We studied 98 consecutive patients who were admitted within 24 h after ischaemic stroke onset. All patients had a detailed clinical examination, laboratory studies and a CT scan study of the brain on admission. To study the circadian rhythm of blood pressure, a continuous blood pressure monitor (Spacelab 90217) was used. Patients were classified according to the percentage fall in the mean systolic blood pressure or diastolic blood pressure at night compared with during the day as: dippers (fall ≥ 10–20%); extreme dippers (≥20%); nondipper (<10%); and reverse dippers (<0%, that is, an increase in the mean nocturnal blood pressure compared with the mean daytime blood pressure). Data were separated and analysed in two groups: lacunar and nonlacunar infarctions. Statistical testing was conducted using the SSPS 12.0. Methods We studied 60 males and 38 females, mean age: 70·5 ± 11 years. The patient population consisted of 62 (63·2%) lacunar strokes and 36 (36·8%) nonlacunar strokes. Hypertension was the most common risk factor (67 patients, 68·3%). Other risk factors included hypercholesterolaemia (44 patients, 44·8%), diabetes mellitus (38 patients, 38·7%), smoking (24 patients, 24·8%) and atrial fibrillation (19 patients, 19·3%). The patients with lacunar strokes were predominantly men ( P = 0·037) and had a lower frequency of atrial fibrillation ( P = 0·016) as compared with nonlacunar stroke patients. In the acute phase, the mean systolic blood pressure was 136±20 mmHg and diastolic blood pressure was 78·7 ± 11·8. Comparing stroke subtypes, there were no differences in 24·h systolic blood pressure and 24-h diastolic blood pressure between patients with lacunar and nonlacunar infarction. However, patients with lacunar infarction showed a mean decline in day–night systolic blood pressure and diastolic blood pressure of approximately 4 mmHg [systolic blood pressure: 3·9 (SD 10) mmHg, P = 0·003; diastolic blood pressure 3·7 (SD 7) mmHg, P = 0·0001] compared with nonlacunar strokes. Nonlacunar strokes showed a lack of 24-h nocturnal systolic blood pressure and diastolic blood pressure fall. The normal diurnal variation in systolic blood pressure was abolished in 87 (88·9%) patients, and the variation in diastolic blood pressure was abolished in 76 (77·5%) patients. On comparing lacunar and nonlacunar strokes, we found that the normal diurnal variation in systolic blood pressure was abolished in 53 (85·4%) lacunar strokes and in 34 (94·4%) nonlacunar strokes ( P = nonsignificant). In terms of diurnal variation in diastolic blood pressure, it was abolished in 43 (69·3%) lacunar strokes and in 33 (91·6%) nonlacunar strokes ( P = 0·026). Conclusions Our results show clear differences in the blood pressure circadian rhythm of acute ischaemic stroke between lacunar and nonlacunar infarctions by means of 24-h blood pressure monitoring. The magnitude of nocturnal systolic and diastolic blood pressure dip was significantly higher in lacunar strokes. Besides, patients with lacunar strokes presented a higher percentage of dipping patterns in the diastolic blood pressure circadian rhythm. Therefore, one should consider the ischaemic stroke subtype when deciding on the management of blood pressure in acute stroke.
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Bandi, Vamsi, Debnath Bhattacharyya, and Divya Midhunchakkravarthy. "Prediction of Brain Stroke Severity Using Machine Learning." Revue d'Intelligence Artificielle 34, no. 6 (December 31, 2020): 753–61. http://dx.doi.org/10.18280/ria.340609.
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In recent years strokes are one of the leading causes of death by affecting the central nervous system. Among different types of strokes, ischemic and hemorrhagic majorly damages the central nervous system. According to the World Health Organization (WHO), globally 3% of the population are affected by subarachnoid hemorrhage, 10% with intracerebral hemorrhage, and the majority of 87% with ischemic stroke. In this research work, Machine Learning techniques are applied in identifying, classifying, and predicting the stroke from medical information. The existing research is limited in predicting risk factors pertained to various types of strokes. To address this limitation a Stroke Prediction (SPN) algorithm is proposed by using the improvised random forest in analyzing the levels of risks obtained within the strokes. This research of the Stroke Predictor (SPR) model using machine learning techniques improved the prediction accuracy to 96.97% when compared with the existing models.
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Nagazi, Mouna, Mouna Aissi, Asma Achour, Mabrouk Abdelali, Mariem Mhiri, and Mahbouba Frih-Ayed. "Prevalence and overlap of potential embolic sources in embolic stroke of undetermined source: a retrospective cohort." Emerging Neurologist 1, no. 1 (November 28, 2022): 16–24. http://dx.doi.org/10.53480/emerg-neurol.a67b.
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Introduction: Embolic strokes of an undetermined source may be caused by various potential embolic sources, which can be better managed by anticoagulant or antiplatelet therapy. Identifying these sources may have diagnostic and therapeutic implications. Our objectives were to assess the prevalence and overlap of different potential embolic sources identified in a population of patients with embolic strokes of undetermined sources, and to evaluate the stroke recurrence rate according to the type and number of potential embolic sources.
Methods: We used data from consecutive patients with ischemic stroke admitted to the department of neurology in Fattouma Bourguiba hospital (Monastir, Tunisia), between January 2017 and December 2020. Patients who met the embolic strokes of undetermined source diagnostic criteria according to the criteria of the Cryptogenic Stroke “embolic strokes of undetermined source” International Working Group were selected. The presence of each potential embolic source was assessed, and patients were categorised according to the identified potential embolic sources. The main outcome was ischemic stroke recurrence, and it was collected prospectively during follow-up after the index stroke.
Results: Among 330 patients admitted between 2017 and 2020, 66 (20.6%) were classified as embolic strokes of undetermined source (68.2% were men, mean age 57 ±11 years). The three most prevalent potential embolic sources were atrial cardiopathy (N = 47/66; 71.2%), arterial atherosclerosis (N = 46/66; 69.7%) and left ventricular disease (N = 26/66; 39.4%). Most patients (N = 56/66; 84.8%) had ≥2 potential embolic sources. After 6-month of follow up, ischemic stroke recurrence occurred in 18 (27.3%) patients. In survival analysis, the type and the number of potential embolic sources were not statistically associated with stroke recurrence.
Conclusion: Most patients with embolic strokes of undetermined source had multiple potential embolic sources, which overlap considerably. The type and number of potential sources were not associated with stroke recurrence. This finding may explain the negative results of large trials of secondary prevention in the Embolic strokes of undetermined source population.
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Shehata, Mishkat. "Prevention of stroke in primary care." InnovAiT: Education and inspiration for general practice 12, no. 5 (March 21, 2019): 252–57. http://dx.doi.org/10.1177/1755738019829780.
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Stroke is a clinical syndrome that is characterised by rapidly developing signs of global or focal disturbance of cerebral function and lasting for more than 24 hours. Stroke is the leading cause of adult disability in the UK and a major cause of morbidity and mortality worldwide. Half of strokes occur in patients over 70 years in age. Strokes and the associated disability have a major socioeconomic impact, and prevention of stroke is an important challenge for primary care. Important modifiable risk factors for stroke have been identified. This article briefly outlines the types of stroke that occur, before detailing how GPs and other health professionals can prevent strokes by lifestyle modification and pharmacotherapy.
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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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Hulbert, Monica L., Robert C. McKinstry, JoAnne L. Lacey, Christopher J. Moran, Julie A. Panepinto, Alexis A. Thompson, Sharada A. Sarnaik, et al. "Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease." Blood 117, no. 3 (January 20, 2011): 772–79. http://dx.doi.org/10.1182/blood-2010-01-261123.
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Abstract Children with sickle cell disease (SCD) and strokes receive blood transfusion therapy for secondary stroke prevention; despite this, approximately 20% experience second overt strokes. Given this rate of second overt strokes and the clinical significance of silent cerebral infarcts, we tested the hypothesis that silent cerebral infarcts occur among children with SCD being transfused for secondary stroke prevention. A prospective cohort enrolled children with SCD and overt strokes at 7 academic centers. Magnetic resonance imaging and magnetic resonance angiography of the brain were scheduled approximately every 1 to 2 years; studies were reviewed by a panel of neuroradiologists. Eligibility criteria included regularly scheduled blood transfusion therapy. Forty children were included; mean pretransfusion hemoglobin S concentration was 29%. Progressive cerebral infarcts occurred in 45% (18 of 40 children) while receiving chronic blood transfusion therapy; 7 had second overt strokes and 11 had new silent cerebral infarcts. Worsening cerebral vasculopathy was associated with new cerebral infarction (overt or silent; relative risk = 12.7; 95% confidence interval, 2.65-60.5, P = .001). Children with SCD and overt strokes receiving regular blood transfusion therapy experience silent cerebral infarcts at a higher rate than previously recognized. Additional therapies are needed for secondary stroke prevention in children with SCD.
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Mukherjee, Prosenjit, Shibaprasad Sen, Kaushik Roy, and Ram Sarkar. "Recognition of Online Handwritten Bangla Characters Using Supervised and Unsupervised Learning Approaches." International Journal of Computer Vision and Image Processing 10, no. 3 (July 2020): 18–30. http://dx.doi.org/10.4018/ijcvip.2020070102.
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This paper explores the domain of online handwritten Bangla character recognition by stroke-based approach. The component strokes of a character sample are recognized firstly and then characters are constructed from the recognized strokes. In the current experiment, strokes are recognized by both supervised and unsupervised approaches. To estimate the features, images of all the component strokes are superimposed. A mean structure has been generated from this superimposed image. Euclidian distances between pixel points of a stroke sample and mean stroke structure are considered as features. For unsupervised approach, K-means clustering algorithm has been used whereas six popular classifiers have been used for supervised approach. The proposed feature vector has been evaluated on 10,000-character database and achieved 90.69% and 97.22% stroke recognition accuracy in unsupervised (using K-means clustering) and supervised way (using MLP [multilayer perceptron] classifier). This paper also discusses about merit and demerits of unsupervised and supervised classification approaches.
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Shiber, Joseph R., Emily Fontane, and Ademola Adewale. "Stroke registry: hemorrhagic vs ischemic strokes." American Journal of Emergency Medicine 28, no. 3 (March 2010): 331–33. http://dx.doi.org/10.1016/j.ajem.2008.10.026.
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Kamalova, Malika, Nodir Khaydarov, and Shavka Islamov. "MODERN UNDERSTANDING OF RISK FACTORS AND PREVENTION OF BRAIN INFARCTION(LITERATURE REVIEW)." JOURNAL OF NEUROLOGY AND NEUROSURGICAL RESEARCH 3, no. 1 (March 30, 2020): 16–20. http://dx.doi.org/10.26739/2181-0982-2020-3-3.
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Stroke is the leading cause of death and disability in the world. Statistics from Uzbekistan show that over 60,000 new strokes occur each year. At the same time, more than 160 new cases occur daily in the country. In Tashkent alone, 25-30 cases of stroke occur every day. In Tashkent alone, 25-30 strokes areobserved daily [1,7]. The main risk factors for atherothromboembolic ischemic stroke are, high blood pressure, high blood cholesterol, smoking and diabetes; and the main risk factors for cardiogenic ischemic stroke are atrial fibrillation and coronary heartdisease. Strategies to reduce the frequency of strokes include the prevention of primary and secondary (repeated) stroke, as well as the rehabilitation period of patients. With a qualitative approach, the mortality and disability of patients is reduced
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Leppert, Michelle H., P. Michael Ho, James Burke, Tracy E. Madsen, Dawn Kleindorfer, Stefan Sillau, Stacie Daugherty, Cathy J. Bradley, and Sharon N. Poisson. "Young Women Had More Strokes Than Young Men in a Large, United States Claims Sample." Stroke 51, no. 11 (November 2020): 3352–55. http://dx.doi.org/10.1161/strokeaha.120.030803.
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Background and Purpose: Cardiovascular risk factors, which are overall more prevalent in men, are considered the major risk factors for strokes among young adults. However, recent European data found the incidence of strokes to be higher in young women. Using a large US claims sample, we examined sex differences in the index stroke rate of young adults. Methods: We performed a retrospective cohort study of enrollees in a 10% random sample of PharMetrics, a nationally representative claims database of insured Americans from 2001 to 2014. Outcomes were index ischemic stroke events, based on inpatient admissions using International Classification of Diseases-Ninth Revision codes. The index stroke rate was estimated from Poisson rate models with time varying covariates for 2-year periods, stratified by sex and age groups. Results: We identified 20 554 index strokes (50.4% women; mean age 63) including 5198 in young adults ages 15 to 54. There was no difference by sex in the index stroke rate in the extremes of age groups 15 to 24 and ≥75 years old. However, in the 25 to 34 and 35 to 44 year age groups, more women had strokes than men (incidence rate ratio: men:women, 0.70 [95% CI, 0.57–0.86]; 0.87 [95% CI, 0.78–0.98], respectively). In contrast, in the 45 to 54, 55 to 64, and 65 to 74 year age groups, more men had strokes (incidence rate ratio, 1.25 [95% CI, 1.16–1.33]; 1.41 [95% CI, 1.18–1.34]; 1.18 [95% CI, 1.12–125], respectively). Conclusions: More young women than men have strokes, suggesting possible importance of sex-mediated etiologies of stroke. Understanding these drivers is critical to stroke treatment and prevention efforts in young adults.
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Hawkes, Maximiliano A., Mauricio F. Farez, Lucia Pertierra, Maia M. Gomez-Schneider, José M. Pastor-Rueda, and Sebastián F. Ameriso. "Differential characteristics, stroke recurrence, and predictors of covert atrial fibrillation of embolic strokes of undetermined source." International Journal of Stroke 13, no. 2 (July 31, 2017): 190–94. http://dx.doi.org/10.1177/1747493017724624.
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Background and purpose Identifying embolic strokes of undetermined source (ESUS) patients likely to harbor atrial fibrillation may have diagnostic and therapeutic implications. Our aim was to examine differences between ESUS and cardioembolic strokes, to evaluate stroke recurrence rate among ESUS and to identify baseline characteristics of ESUS patients who were later diagnosed with atrial fibrillation. Materials and methods We assessed all ischemic stroke patients admitted between June 2012 and November 2013. ESUS were compared to cardioembolic strokes at discharge. After at least 12-month follow-up, ESUS patients diagnosed with atrial fibrillation were compared to those who remained as ESUS. Results There were 236 ischemic strokes, 32.6% were ESUS. Compared to cardioembolic strokes, ESUS were younger (p < 0.0001), had milder strokes (p < 0.05), less prevalence of hypertension (p < 0.05), peripheral vascular disease (p < 0.05), and previous ischemic stroke (p < 0.05). After follow-up, 15% of ESUS patients had stroke recurrences and 12% evidenced paroxysmal atrial fibrillation. ESUS patients diagnosed with atrial fibrillation in the follow-up were older (p < 0.0001), had higher erythrocyte sedimentation rate (p < 0.05), and were more likely to have ≥2 infarcts in the same arterial territory in the initial magnetic resonance imaging (p < 0.05). Conclusions Older age, small-scattered infarcts on initial magnetic resonance imaging and high erythrocyte sedimentation rate levels appear to identify ESUS patients more likely to be diagnosed of atrial fibrillation during follow-up.
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Englyst, Nicola A., Gill Horsfield, Joseph Kwan, and Christopher D. Byrne. "Aspirin Resistance is More Common in Lacunar Strokes than Embolic Strokes and is Related to Stroke Severity." Journal of Cerebral Blood Flow & Metabolism 28, no. 6 (March 5, 2008): 1196–203. http://dx.doi.org/10.1038/jcbfm.2008.9.
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The aim of this study was to investigate the relationship between aspirin resistance, ischaemic stroke subtype, stroke severity, and inflammatory cytokines. Aspirin resistance was assessed by thrombelastography in 45 people with ischaemic stroke and 25 controls. Plasma interleukin (IL)-6 was measured. Stroke severity was assessed using the modified Rankin scale and National Institute of Health Stroke Score within 72 h of stroke. Aspirin resistance was more common in the stroke than the control group (67% versus 40%, P=0.028), and within the stroke group the aspirin-resistant group had a higher Rankin score (4.0 versus 2.0, P=0.013). Aspirin resistance was greater in lacunar than embolic strokes (platelet activation 79% versus 59%, P=0.020). The stroke aspirin-resistant group had higher levels of IL-6 than the stroke aspirin-sensitive group (2.4±1 versus 1.8±0.9 ng/mL, P=0.037). Using multivariate analysis, we examined the interrelationships between aspirin resistance, IL-6, and stroke severity. These analyses showed that IL-6 was independently associated with stroke severity as the outcome ( B=3.738, P=0.036), and aspirin resistance was independently associated with IL-6 ( B=0.765, P=0.005) as the outcome. In conclusion, aspirin resistance is related to stroke severity and aspirin resistance is more common in lacunar strokes than embolic strokes.
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Salehi Omran, Setareh, Salama Chaker, Mackenzie P. Lerario, Alexander E. Merkler, Babak B. Navi, and Hooman Kamel. "Relationship between Lambl’s excrescences and embolic strokes of undetermined source." European Stroke Journal 5, no. 2 (January 21, 2020): 169–73. http://dx.doi.org/10.1177/2396987319901201.
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Introduction About one-fourth of ischaemic strokes are classified as embolic strokes of undetermined source. Lambl’s excrescences are commonly seen on cardiac valves, and data are limited on whether they may be a source of embolization. We examined the relationship between Lambl’s excrescences and embolic stroke of undetermined source. Patients and Methods We performed a case-control study of patients in the Cornell AcutE Stroke Academic Registry. Stroke aetiologies were adjudicated using the Trial of Org 10172 in Acute Stroke Treatment and embolic stroke of undetermined source criteria. We included patients with acute ischaemic stroke between 2011 and 2016 who underwent transthoracic or transoesophageal echocardiography within six months of hospitalisation. Cases were embolic stroke of undetermined source patients and controls were patients with an identified, non-cardioembolic stroke aetiology (i.e. small- or large-vessel strokes). Multiple logistic regression was used to evaluate the association between Lambl’s excrescences and embolic stroke of undetermined source after adjustment for demographics, comorbidities and mode of echocardiography. Results A total of 923 patients met the criteria for this analysis, including 530 with embolic stroke of undetermined source and 393 with small- or large-vessel strokes. Lambl’s excrescences were identified in 47 (8.9%) patients with embolic stroke of undetermined source and 11 (2.8%) patients with small- or large-artery strokes, but the majority (54/58) of Lambl’s excrescences were visualised on transoesophageal echocardiogram and embolic stroke of undetermined source patients were more likely to undergo transoesophageal echocardiogram. After adjustment for demographics, comorbidities and mode of echocardiography, we found no association between the presence of Lambl’s excrescences and embolic stroke of undetermined source (odds ratio 0.9; 95% confidence interval 0.4–2.3). Conclusion We found no association between Lambl’s excrescences and embolic stroke of undetermined source. These results do not support the hypothesis that Lambl’s excrescences are an occult cause of embolic stroke of undetermined source.
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Bosch, Jackie, Eva M. Lonn, Gilles R. Dagenais, Peggy Gao, Patricio Lopez-Jaramillo, Jun Zhu, Prem Pais, et al. "Antihypertensives and Statin Therapy for Primary Stroke Prevention: A Secondary Analysis of the HOPE-3 Trial." Stroke 52, no. 8 (August 2021): 2494–501. http://dx.doi.org/10.1161/strokeaha.120.030790.
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Background and Purpose: The HOPE-3 trial (Heart Outcomes Prevention Evaluation–3) found that antihypertensive therapy combined with a statin reduced first stroke among people at intermediate cardiovascular risk. We report secondary analyses of stroke outcomes by stroke subtype, predictors, treatment effects in key subgroups. Methods: Using a 2-by-2 factorial design, 12 705 participants from 21 countries with vascular risk factors but without overt cardiovascular disease were randomized to candesartan 16 mg plus hydrochlorothiazide 12.5 mg daily or placebo and to rosuvastatin 10 mg daily or placebo. The effect of the interventions on stroke subtypes was assessed. Results: Participants were 66 years old and 46% were women. Baseline blood pressure (138/82 mm Hg) was reduced by 6.0/3.0 mm Hg and LDL-C (low-density lipoprotein cholesterol; 3.3 mmol/L) was reduced by 0.90 mmol/L on active treatment. During 5.6 years of follow-up, 169 strokes occurred (117 ischemic, 29 hemorrhagic, 23 undetermined). Blood pressure lowering did not significantly reduce stroke (hazard ratio [HR], 0.80 [95% CI, 0.59–1.08]), ischemic stroke (HR, 0.80 [95% CI, 0.55–1.15]), hemorrhagic stroke (HR, 0.71 [95% CI, 0.34–1.48]), or strokes of undetermined origin (HR, 0.92 [95% CI, 0.41–2.08]). Rosuvastatin significantly reduced strokes (HR, 0.70 [95% CI, 0.52–0.95]), with reductions mainly in ischemic stroke (HR, 0.53 [95% CI, 0.37–0.78]) but did not significantly affect hemorrhagic (HR, 1.22 [95% CI, 0.59–2.54]) or strokes of undetermined origin (HR, 1.29 [95% CI, 0.57–2.95]). The combination of both interventions compared with double placebo substantially and significantly reduced strokes (HR, 0.56 [95% CI, 0.36–0.87]) and ischemic strokes (HR, 0.41 [95% CI, 0.23–0.72]). Conclusions: Among people at intermediate cardiovascular risk but without overt cardiovascular disease, rosuvastatin 10 mg daily significantly reduced first stroke. Blood pressure lowering combined with rosuvastatin reduced ischemic stroke by 59%. Both therapies are safe and generally well tolerated. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00468923.
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Verma, Nishant, Paul D. Ziegler, Shufeng Liu, and Rod S. Passman. "Incidence of atrial fibrillation among patients with an embolic stroke of undetermined source: Insights from insertable cardiac monitors." International Journal of Stroke 14, no. 2 (September 10, 2018): 146–53. http://dx.doi.org/10.1177/1747493018798554.
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Background Prophylactic use of direct oral anticoagulants for recurrent stroke prevention in patients with embolic strokes of undetermined source is currently being investigated. It is uncertain whether the bleeding risks associated with prophylactic direct oral anticoagulants use will outweigh any stroke prevention benefit in embolic strokes of undetermined source patients who lack underlying atrial fibrillation. Methods We determined the proportion of cryptogenic stroke patients in the CRYSTAL atrial fibrillation trial who met inclusion criteria for the NAVIGATE embolic stroke of undetermined source and RE-SPECT embolic stroke of undetermined source trials and their atrial fibrillation incidence. Both embolic strokes of undetermined source trials impose requirements on age, modified Rankin Score, antiplatelet use, and type of infarction. Insertable cardiac monitors were used to determine the atrial fibrillation detection rates at 30 days and 3 years using Kaplan–Meier’s estimates. Results Among 441 patients enrolled in the CRYSTAL atrial fibrillation trial, 189 (42.9%) and 236 (53.5%) met the inclusion criteria of the NAVIGATE embolic stroke of undetermined source and RE-SPECT embolic stroke of undetermined source trials, respectively. Atrial fibrillation detection rates at 3 years among insertable cardiac monitors patients eligible for the NAVIGATE embolic stroke of undetermined source and RE-SPECT embolic stroke of undetermined source trials were 35.8% and 33.6% while detection rates at 30 days were 5.6% and 3.5%, respectively. Conclusion Only half of cryptogenic stroke patients in CRYSTAL atrial fibrillation met the inclusion criteria for the ongoing embolic strokes of undetermined source trials. Approximately, two-thirds of patients with embolic strokes of undetermined source do not have any atrial fibrillation despite continuous rhythm monitoring for up to three years. The benefits of prophylactic use of direct oral anticoagulants in the absence of atrial fibrillation is unknown and therefore embolic strokes of undetermined source patients could benefit from prolonged atrial fibrillation monitoring until more robust data are available. ClinicalTrials.gov Registration NCT00924638. https://clinicaltrials.gov/ct2/show/NCT00924638 .
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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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Brissette, V., B. Rioux, T. Choisi, and AY Poppe. "P.065 Emergency medical services activation Following Face, Arm, Speech, Time (FAST) public awareness campaigns in Quebec, Canada." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 49, s1 (June 2022): S25—S26. http://dx.doi.org/10.1017/cjn.2022.166.
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Background: Face, Arm, Speech, Time (FAST) campaigns improve stroke recognition in the general population. We assessed the effect of five consecutive FAST campaigns on emergency medical services (EMS) calls for suspected strokes in Quebec, Canada. Methods: We compared with t-tests the daily EMS call volume changes in the greater Montreal area before and after five FAST campaigns held between 2015 and 2019. We used interrupted time-series to measure changes in EMS daily call volume for suspected strokes following each FAST campaign (all calls, calls <5 hours from symptom onset, calls rated 3/3 on the Cincinnati Prehospital Stroke Scale [CPSS]) and used calls for acute headaches as a comparator. Results: After five FAST campaigns, mean daily calls increased by 28% (p<0.001) for suspected strokes, compared to 10% for acute headaches (p=0.012). Significant increases in daily stroke calls were only observed after three campaigns (highest OR=1.26, 95% CI: 1.11, 1.43; p<0.001). There were no significant changes in calls after individual campaigns for strokes <5 hours from symptom onset and 3/3 CPSS strokes. Conclusions: The individual effect of FAST campaigns on daily stroke calls to EMS was inconsistent. Further refinement of FAST campaigns may help improve prompt EMS activation.
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Rebello, L. C., M. Bouslama, D. C. Haussen, J. A. Grossberg, S. Dehkharghani, A. Anderson, S. R. Belagaje, et al. "Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes." European Journal of Neurology 24, no. 6 (April 21, 2017): 762–67. http://dx.doi.org/10.1111/ene.13287.
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Hu, Xue, Eakachat Joneurairatana, and Sone Simatrang. "Decoding the Visual Characteristics of Chinese Painting Strokes-A Study on Gao Gu You Si Stroke." E3S Web of Conferences 236 (2021): 05093. http://dx.doi.org/10.1051/e3sconf/202123605093.
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The architect Le Corbusier once said this theory: Design has local characteristics and universal characteristics. Local characteristics are greatly influenced by culture. The strokes are the one essence of Chinese painting that characteristics of the strokes are unique to Chinese visual culture. Among Chinese painting strokes, Eighteen Strokes are the typical representative of the aesthetics of Chinese visual culture. However, the current research on the cultural characteristics of Eighteen Strokes is insufficient. The objective of this article is taking Xie He’s Six Canons as the theory to decode the content of the aesthetic characteristics of the Gao Gu You Si Stroke (one of the Eighteen Strokes), then to get the visual cultural characteristics of Chinese painting strokes and the fundamental perspective characteristics of the inheritance visual cultural. Based on this, this article will use the Content Analysis Approach to conduct research, by decoding the aesthetic content of the Chinese painting strokes to construct the personality and characteristics required by Chinese visual design.
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Dutta, Dipankar, Emily Bowen, and Chris Foy. "Four-Year Follow-Up of Transient Ischemic Attacks, Strokes, and Mimics." Stroke 46, no. 5 (May 2015): 1227–32. http://dx.doi.org/10.1161/strokeaha.114.008632.
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Background and Purpose— There is limited information on outcomes from rapid access transient ischemic attack (TIA) clinics. We present 4-year outcomes of TIAs, strokes, and mimics from a UK TIA clinic database. Methods— All patients referred between April 2010 and May 2012 were retrospectively identified and outcomes determined. End points were stroke, myocardial infarction, any vascular event (TIA, stroke, or myocardial infarction), and all-cause death. Data were analyzed by survival analysis. Results— Of 1067 patients, 31.6% were TIAs, 18% strokes, and 50.4% mimics. Median assessment time was 4.5 days from onset and follow-up was for 34.9 months. Subsequent strokes occurred in 7.1% of patients with TIA, 10.9% of patients with stroke, and 2.0% of mimics at the end of follow-up. Stroke risk at 90 days was 1.3% for patients diagnosed as TIA or stroke. Compared with mimics, hazard ratios for subsequent stroke were 3.88 (1.90–7.91) for TIA and 5.84 (2.81–12.11) for stroke. Hazard ratio for any subsequent vascular event was 2.91 (1.97–4.30) for TIA and 2.83 (1.81–4.41) for stroke. Hazard ratio for death was 1.68 (1.10–2.56) for TIA and 2.19 (1.38–3.46) for stroke. Conclusions— Our results show a lower 90-day stroke incidence after TIA or minor stroke than in earlier studies, suggesting that rapid access daily TIA clinics may be having a significant effect on reducing strokes.
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Samuel, Mbaki Bula, Nkodila Natuhoyila Aliocha, and Lelo Tshikwela Michel. "Stroke in the Brain Scanner at Kinshasa University Clinics and Marie Biamba Mutombo Hospital: A Case Series Study." International Journal of Health Sciences and Research 11, no. 4 (April 5, 2021): 34–39. http://dx.doi.org/10.52403/ijhsr.20210404.
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Background and objective: Strokes represent a significant cause of morbidity and mortality throughout the world. But data relating to this in sub-Saharan Africa is scarce. The objective of this study is to identify traumatic pathologies with CT scan in patients followed in hospitals in Kinshasa, Democratic Republic of Congo. Methods: descriptive cross-sectional study of data from the medical records of patients having performed a cerebral CT scan covering a period of 24 months at the University Clinics of Kinshasa and at the Biamba Marie Mutombo Hospital. The study parameters are of three kinds, those relating to socio-demographic data (age, sex, date of the CT scan); those relating to the clinical data and the indications for the examination and the CT data. Results: Among the 717 cases of stroke diagnosed by CT scan, 529 were of the ischemic type while 188 were of the hemorrhagic type (Figure 1). The ischemic stroke / hemorrhagic stroke ratio was 3/1. The demographic transition was very characteristic for all strokes increasing with advancing age 18.4% in the age 0-19 years, 14% in the age group 20-49 years, 27.8%, and 56.6% in age ≥ 60 years. Comparisons of the proportions of ischemic and hemorrhagic strokes by sex and age groups. There was no statistically significant difference in the sex of patients between the types of stroke (P> 0.05) when there was a statistically significant difference in the proportions of hemorrhagic and ischemic strokes between age groups. There was therefore an exponential type curve of the proportions of ischemic-type strokes according to age advancement: the highest frequency at age ≥ 60 years. Conclusion: strokes are frequent in Kinshasa; they are characterized by a high frequency of ischemic stroke and increase with age. Key words: Stroke, CT scan, Epidemiological transition hospitals in Kinshasa.
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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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Nau, R. "Rehabilitation after a cerebral stroke." Neurology Bulletin XXXI, no. 1-4 (September 15, 1999): 54–57. http://dx.doi.org/10.17816/nb80933.
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In Germany, a cerebral stroke affects 2 out of 1000 inhabitants per year, which corresponds to 160 thousand strokes per year, according to other sources - up to 250 thousand. Currently, significant progress has been achieved in the treatment of acute strokes. The mortality rate for strokes in the early stages of the disease, which previously exceeded 50%, has significantly decreased.
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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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Khan, Muhammad D., Zeeshan Chaughtai, Shaheryar Qazi, Sobaan Taj, Henna Pervaiz, Khurram Irshad, Syed Muhammad A. Bukhari, Sheikh Afraz, and Muhammad T. Kamran. "Types and clinical presentation of stroke." International Journal of Research in Medical Sciences 8, no. 5 (April 27, 2020): 1784. http://dx.doi.org/10.18203/2320-6012.ijrms20201927.
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Background: Stroke is one of the leading causes of mortality and morbidity worldwide. In this study, authors worked on clinical presentation and types of stroke. The two main types of strokes are ischemic and haemorrhagic. Brain infarction is caused by decrease blood flow due to either narrowing of artery or complete obstruction to blood flow owing to embolism. While haemorrhage is caused by rupture of artery or aneurysms leading to accumulation of blood in the brain parenchyma.Methods: Cross sectional study of group of patients in Nishtar hospital Multan, Pakistan who presented with variety of neurological symptoms who were subsequently diagnosed as non-traumatic stroke. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent.Results: Of 122 patient, 66 patients were male and 56 were female. Ischemic stroke was more common: present in 76 patients as compared to 46 patients with hemorrhagic stroke. Hypertension was present in 40.9% of ischemic stroke and 27.8% of hemorrhagic strokes. Most of the patients (67.2%) had altered sensorium at presentation followed by hemiplegia in 39.3 % of patients.Conclusions: Prevalence of ischemic strokes is higher than that of haemorrhagic stroke. Hypertension is associated with both types of these strokes. Moreover, hyperglycaemia and high blood pressure are common in early phase of stroke. Vomiting in stroke favors haemorrhagic stroke.
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Otani, Shinji, Satomi Funaki Ishizu, Toshio Masumoto, Hiroki Amano, and Youichi Kurozawa. "The Effect of Minimum and Maximum Air Temperatures in the Summer on Heat Stroke in Japan: A Time-Stratified Case-Crossover Study." International Journal of Environmental Research and Public Health 18, no. 4 (February 9, 2021): 1632. http://dx.doi.org/10.3390/ijerph18041632.
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An increase in the global surface temperature and changes in urban morphologies are associated with increased heat stress especially in urban areas. This can be one of the contributing factors underlying an increase in heat strokes. We examined the impact of summer minimum air temperatures, which often represent nighttime temperatures, as well as a maximum temperature on a heat stroke. We collected data from the records of daily ambulance transports for heat strokes and meteorological data for July and August of 2017–2019 in the Tottori Prefecture, Japan. A time-stratified case-crossover design was used to determine the association of maximum/minimum air temperatures and the incidence of heat strokes. We used a logistic regression to identify factors associated with the severity of heat strokes. A total of 1108 cases were identified with 373 (33.7%) calls originating in the home (of these, 59.8% were the age of ≥ 75). A total of 65.8% of cases under the age of 18 were related to exercise. Days with a minimum temperature ≥ 25 °C had an odds ratio (95% confidence interval) of 3.77 (2.19, 6.51) for the incidence of an exercise-related heat stroke (reference: days with a minimum temperature < 23 °C). The odds ratio for a heat stroke occurring at home or for calls for an ambulance to the home was 6.75 (4.47, 10.20). The severity of the heat stroke was associated with older age but not with air temperature. Minimum and maximum air temperatures may be associated with the incidence of heat strokes and in particular the former with non-exertional heat strokes.