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Stroke - recientes

Occupational Therapy for Adults With Problems in Activities of Daily Living After Stroke [Cochrane Corner]
23/10/2017
Lynn A. Legg, Sharon R. Lewis, Oliver J. Schofield-Robinson, Avril Drummond, Peter Langhorne
ver resumen

Incorporating Nonphysician Stroke Specialists Into the Stroke Team [InterSECT]
23/10/2017
Emily Anderson, Samuel Fernandez, Adam Ganzman, Eliza C. Miller
ver resumen

Letter by Gross et al Regarding Article, “Immediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers” [Letter to the Editor]
23/10/2017
Bradley A. Gross, Ashutosh P. Jadhav, Tudor G. Jovin
ver resumen

Response by Boulouis and Schwamm to Letter Regarding Article, “Immediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers” [Letter to the Editor]
23/10/2017
Gregoire Boulouis, Lee H. Schwamm
ver resumen

Letter by Ganesh and Renoux Regarding Article, “Sex Differences and Functional Outcome After Intravenous Thrombolysis” [Letter to the Editor]
23/10/2017
Aravind Ganesh, Christel Renoux
ver resumen

Response by Spaander et al to Letter Regarding Article, “Sex Differences and Functional Outcome After Intravenous Thrombolysis” [Letter to the Editor]
23/10/2017
Fianne H. Spaander, Paul J. Nederkoorn
ver resumen

Letter by Tsivgoulis et al Regarding Article, “Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis: Individual Patient Data Meta-Analysis” [Letter to the Editor]
23/10/2017
Georgios Tsivgoulis, Aristeidis H. Katsanos, Ramin Zand
ver resumen

Response by Werring and Charidimou to Letter Regarding Article, “Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis: Individual Patient Data Meta-Analysis” [Letter to the Editor]
23/10/2017
David J. Werring, Andreas Charidimou
ver resumen

Letter by Tsivgoulis et al Regarding Article, “Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis” [Letter to the Editor]
23/10/2017
Georgios Tsivgoulis, Aristeidis H. Katsanos, Andrei V. Alexandrov
ver resumen

Response by Mistry et al to Letter Regarding Article, “Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis” [Letter to the Editor]
23/10/2017
Eva A. Mistry, Akshitkumar M. Mistry, Matthew R. Fusco
ver resumen

Correction to: ICES (Intraoperative Stereotactic Computed Tomography-Guided Endoscopic Surgery) for Brain Hemorrhage: A Multicenter Randomized Controlled Trial [Corrections]
23/10/2017
ver resumen

Using the Telephone Interview for Cognitive Status and Telephone Montreal Cognitive Assessment for Evaluating Vascular Cognitive Impairment [Editorial]
23/10/2017
Ronald A. Cohen, Gene E. Alexander
ver resumen

Statins for Neuroprotection After Acute Ischemic Stroke [Editorial]
23/10/2017
Peter Kelly, Shyam Prabhakaran
ver resumen

Stroke: Highlights of Selected Articles [Stroke: Highlights of Selected Articles]
23/10/2017
ver resumen

Increase of Stroke Incidence in Young Adults in a Middle-Income Country [Clinical Sciences]
23/10/2017
Norberto Luiz Cabral, Aracelli Tavares Freire, Adriana Bastos Conforto, Nayara dos Santos, Felipe Ibiapina Reis, Vivian Nagel, Vanessa V. Guesser, Juliana Safanelli, Alexandre L. Longo
ver resumen
Background and Purpose—The incidence of stroke is on the rise in young adults in high-income countries. However, there is a gap of knowledge about trends in stroke incidence in young adults from low- and middle-income countries. We aimed to measure trends in incidence of ischemic stroke (IS) and intracerebral hemorrhage (IH) in young people from 2005 to 2015 in Joinville, Brazil.Methods—We retrospectively ascertained all first-ever IS subtypes and IH that occurred in Joinville in the periods of 2005 to 2006, 2010 to 2011, and 2014 to 2015. Poisson regression was used to calculate incidence rate ratios of all strokes, IS, and IH. We also compared the prevalence of risk factors and extension of diagnostic work-up across the 3 periods.Results—For 10 years, we registered 2483 patients (7.5% aged <45 years). From 2005 to 2006 to 2014 to 2015, overall stroke incidence significantly increased by 62% (incidence rate ratios, 1.62; 95% confidence interval, 1.10–2.40) in subjects <45 years and by 29% in those <55 years (incidence rate ratios, 1.29; 95% confidence interval, 1.04–1.60). Incidence of IS increased by 66% (incidence rate ratios, 1.66; 95% confidence interval, 1.09–2.54), but there was no significant change in incidence of IH in subjects <45 years. Smoking rates decreased by 71% (odds ratio, 0.29; 95% confidence interval, 0.12–0.68).Conclusions—Stroke incidence is rising in young adults in Joinville, Brazil, because of increase in rates of ischemic but not hemorrhagic strokes. We urgently need better policies of cardiovascular prevention in the young.

Incidence and Outcomes of Myocardial Infarction in Patients Admitted With Acute Ischemic Stroke [Clinical Sciences]
23/10/2017
Fahad Alqahtani, Sami Aljohani, Abdul Tarabishy, Tatiana Busu, Amelia Adcock, Mohamad Alkhouli
ver resumen
Background and Purpose—Data on the incidence and outcomes of acute myocardial infarction (AMI) complicating acute ischemic stroke (AIS) are limited. We aim to evaluate the incidence, treatment patterns, and outcomes of AMI in patients with AIS using a nationwide database.Methods—The National Inpatient Sample was used to identify patient with AIS between 2003 and 2014. Trends of incidence of AMI and its associated in-hospital mortality were evaluated. Univariate and multivariate logistic regressions were used to evaluate predictors of AMI. The impact of AMI on in-hospital outcomes was assessed in a comparative analysis of propensity-matched groups of patients with and without AMI.Results—Patients with AIS (n=864 043) were identified in the national inpatient sample, of whom 13 573 patients (1.6%) had an AMI (79.5% non–ST-segment–elevation myocardial infarction and 20.5% ST-segment–elevation myocardial infarction). In-hospital mortality was 21.4% and 7.1% in propensity-matched cohorts of patients with and without AMI, P<0.001. In-hospital length of stay and cost of care were 50% higher in the AMI group. In a multivariate logistical regression analysis, the strongest predictors of having AMI after AIS were older age, history of coronary artery disease, chronic renal insufficiency, undergoing mechanical thrombectomy, and rhythm and conduction abnormalities. In the AMI group, undergoing coronary angiography and undergoing percutaneous coronary intervention both strongly correlated with lower in-hospital mortality (odds ratio, 0.34 [confidence interval, 0.23–0.51] and 0.26 [confidence interval, 0.20–0.34], respectively, P<0.001). However, these were only performed in 7.5% and 2% of patients, respectively.Conclusions—AMI complicating stroke carries a substantial in-hospital mortality and cost of care. Patients who underwent coronary angiography with or without intervention may have improved survival although it was only utilized in a minority of patients. Further studies needed to discern the ideal approach in AMI in patients with AIS.

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014 [Clinical Sciences]
23/10/2017
Camille Lecoffre, Christine de Peretti, Amelie Gabet, Olivier Grimaud, France Woimant, Maurice Giroud, Yannick Beȷot, Valerie Olie
ver resumen
Background and Purpose—Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014.Methods—Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model.Results—From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years.Conclusions—An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management.

Minimal Clinically Important Difference for Safe and Simple Novel Acute Ischemic Stroke Therapies [Clinical Sciences]
23/10/2017
Jessica S. Cranston, Brett D. Kaplan, Jeffrey L. Saver
ver resumen
Background and Purpose—Determining the minimal clinically important difference (MCID) is essential for evaluating novel therapies. For acute ischemic stroke, expert surveys have yielded MCIDs that are substantially higher than the MCIDs observed in actual expert behavior in guideline writing and clinical practice, potentially because of anchoring bias.Methods—We administered a structured, internet-based survey to a cross-section of academic stroke neurologists in the United States. Survey responses assessed demographic and clinical experience, and expert judgment of the MCID of the absolute increase needed in the proportion of patients achieving functional independence at 3 months to consider a novel, safe neuroprotective agent as clinically worthwhile. To mitigate anchoring bias, the survey response framework used a base 1000 rather than base 100 patient framework.Results—Survey responses were received from 122 of 333 academic stroke neurologists, there were 23% women, 72.8% had ≥6 years of practice experience, and neurovascular disease accounted for more than half of practice time in >70%. Responder–nonresponder and continuum of resistance tests indicated that responders were representative of the full expert population. Among respondents, the median MCID was 1.3% (interquartile range, 0.8% to >2%).Conclusions—Stroke expert responses to MCID surveys are affected by anchoring and centrality bias. When survey design takes these into account, the expert-derived MCID for a safe acute ischemic stroke treatment is 1.1% to 1.5%, in accord with actual physician behavior in guideline writing and clinical practice. This revised MCID value can guide clinical trial design and grant-funding and regulatory agency decisions.

Validation of the Telephone Interview of Cognitive Status and Telephone Montreal Cognitive Assessment Against Detailed Cognitive Testing and Clinical Diagnosis of Mild Cognitive Impairment After Stroke [Clinical Sciences]
23/10/2017
Vera Zietemann, Anna Kopczak, Claudia Muller, Frank Arne Wollenweber, Martin Dichgans
ver resumen
Background and Purpose—Assessment of cognitive status poststroke is recommended by guidelines but follow-up can often not be done in person. The Telephone Interview of Cognitive Status (TICS) and the Telephone Montreal Cognitive Assessment (T-MoCA) are considered useful screening instruments. Yet, evidence to define optimal cut-offs for mild cognitive impairment (MCI) after stroke is limited.Methods—We studied 105 patients enrolled in the prospective DEDEMAS study (Determinants of Dementia After Stroke; NCT01334749). Follow-up visits at 6, 12, 36, and 60 months included comprehensive neuropsychological testing and the Clinical Dementia Rating scale, both of which served as reference standards. The original TICS and T-MoCA were obtained in 2 separate telephone interviews each separated from the personal visits by 1 week (1 before and 1 after the visit) with the order of interviews (TICS versus T-MoCA) alternating between subjects. Area under the receiver-operating characteristic curves was determined.Results—Ninety-six patients completed both the face-to-face visits and the 2 interviews. Area under the receiver-operating characteristic curves ranged between 0.76 and 0.83 for TICS and between 0.73 and 0.94 for T-MoCA depending on MCI definition. For multidomain MCI defined by multiple-tests definition derived from comprehensive neuropsychological testing optimal sensitivities and specificities were achieved at cut-offs <36 (TICS) and <18 (T-MoCA). Validity was lower using single-test definition, and cut-offs were higher compared with multiple-test definitions. Using Clinical Dementia Rating as the reference, optimal cut-offs for MCI were <36 (TICS) and approximately 19 (T-MoCA).Conclusions—Both the TICS and T-MoCA are valid screening tools poststroke, particularly for multidomain MCI using multiple-test definition.

Predictors of Outcome in Aneurysmal Subarachnoid Hemorrhage Patients [Clinical Sciences]
23/10/2017
James P. Galea, Louise Dulhanty, Hiren C. Patel
ver resumen
Background and Purpose—The mortality and morbidity after aneurysmal subarachnoid hemorrhage has improved because of better diagnosis, early treatment to secure the aneurysm, and better management of disease-specific complications. With these improvements in care, it is not clear if the previously identified independent predictors of a negative outcome have changed. The aim of this study was to identify the independent predictors of an unfavorable outcome (Glasgow Outcome Score 1, 2, and 3) in aneurysmal subarachnoid hemorrhage patients.Methods—Univariate and multivariate analysis of prospectively collected data on patients presenting with an aneurysmal subarachnoid hemorrhage was performed. Outcome was assessed at discharge. Data were collected from 14 centers in the United Kingdom over a period of 4 years (September 2011–2015).Results—The median age (interquartile range) at presentation of 3341 patients with aneurysmal subarachnoid hemorrhage was 55 (18) years. Most patients were female (n=2288 [68.5%]), presented in good grade (2397 [70%]; World Federation of Neurological Surgeons grade 1 and 2), and were treated by endovascular coiling (n=2600; 75%). The independent predictors of an unfavorable outcome (95% confidence interval [CI]) were increasing age (odds ratio [OR], 1.04; 95% CI, 1.03–1.05; P<0.001), World Federation of Neurological Surgeons grade (OR, 2.06; 95% CI, 1.91–2.22; P<0.001), preoperative rebleeding (OR, 7.41; 95% CI, 4.48–12.30; P<0.001), need for cerebrospinal fluid diversion (OR, 3.25; 95% CI, 2.58–4.09; P<0.001), and delayed cerebral ischemia (OR, 2.21; 95% CI, 1.72–2.83; P<0.001).Conclusions—These data suggest that potentially modifiable risk factors of preoperative rebleeding and delayed cerebral ischemia are associated with unfavorable outcomes. Understanding the reasons why patients requiring cerebrospinal fluid diversion have 3.25-fold higher adjusted odds of a poor outcome at discharge needs to be studied.







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