Recurrent Ischemic Stroke – A Systematic Review and Meta-Analysis

ObjectivesRecurrent stroke remains a challenge though secondary prevention is initiated immediately post-stroke. Stroke subtype may determine the risk of recurrent stroke and require specific preventive measures. We aimed to identify subtype-specific stroke recurrence and associated risk factors over time.Methods and materialsA systematic review was performed using PubMed and Embase for studies including adults >18 years, first-ever ischemic stroke in population-based observational studies or registries, documented TOAST-criteria and minimum 1-year follow-up. Meta-analysis on stroke recurrence rate was performed. Final search: November 2019.ResultsThe search retrieved 26 studies (between 1997 and 2019). Stroke recurrence rate ranged from 5.7% to 51.3%. Recurrent stroke was most frequent in large artery atherosclerosis (LAA) and cardioembolic (CE) stroke with recurrent stroke similar to index stroke subtype. We identified a lower recurrence rate for small vessel occlusion (SVO) stroke with recurrence frequently of another stroke subtype. Based on a meta-analysis the summary proportion recurrence rate of recurrent stroke in studies using TOAST-criteria = 0.12 and = 0.14 in studies using TOAST-like criteria. Hypertension, diabetes mellitus, atrial fibrillation previous transient ischemic attack, and high stroke severity were independent risk factors for recurrence.ConclusionStroke recurrence rates seem unchanged over time despite the use of secondary prevention. The highest recurrence rate is in LAA and CE stroke eliciting same subtype recurrent stroke. A lower recurrence rate is seen with SVO stroke with a more diverse recurrence pattern. Extensive workup is important in all stroke subtypes - including SVO stroke. Future research needs to identify better preventive treatment and improve compliance to risk factor prevention to reduce stroke recurrence.     

Changes of Blood Flow Perfusion by MR and NF-κβ Expression in the Region of Perihematoma after Experimental Intracerebral Hemorrhage: A Correlation Study

Objective: Tostudy the correlation between dynamic changes of regional cerebral blood flow (rCBF) and nuclear factor-kappa β (NF-κβ) expression in the region of perihematoma after intracerebral hemorrhage (ICH). Methods: Twenty-seven healthy domestic cats were divided into control group (n = 3) and ICH group (n = 24) at random. They were observed at 3 hr, 6 hr, 12 hr, 24 hr, 48 hr, 72 hr, 7 days, and 15 days, respectively, for the dynamic changes of rCBF in the perihematomal region using perfusion-weighted imaging (PWI), and NF-κβ expressions using immunohistochemistry method. Results: In the perihematomal region, a noticeable decrease in rCBF had been observed within 12 hr, i.e. in a hypoperfusion state. However, cats then presented reperfusion or hyperperfusion during 12–24-hr period, and marginally hypoperfusion after 48 hr. NF-κβ positive cells were first found at 3–6 hr and peaked at 12–48 hr. At 72 hr to 7 days they showed a decreasing trend and nearly disappeared at 15 days. Conclusions: NF-κβ expression was significantly increased due to ischemia reperfusion in the perihematomal region after cerebral ischemia, and the resulting inflammatory and immune reaction were the major causes for ischemia reperfusion injury in the perihematomal region.     

Is Traumatic Brain Injury A Risk Factor for Schizophrenia? A Meta-Analysis of Case-Controlled Population-Based Studies

Traumatic brain injury (TBI) is known to lead to a range of adverse psychiatric sequelae but the question of whether TBI is a risk factor for psychosis and, in particular, schizophrenia remains unclear. Studies examining this issue have yielded conflicting results. We carried out a systematic review of the literature on TBI and psychosis in order to identify all population-based controlled studies which provide estimates of risk for schizophrenia following TBI. Odds ratios (ORs) were combined using random effects meta-analysis. Our literature search yielded 172 studies which were considered to be potentially relevant. From these, we identified 9 studies that could provide estimates of risk in the form of ORs. The pooled analysis revealed a significant association between TBI and schizophrenia (OR = 1.65; 95% CI = 1.17-2.32), with significant heterogeneity between the studies. Estimates from the family studies (OR = 2.8: 95% CI =1.76-4.47) were higher than those from the cohort/nested case-control studies (OR = 1.42: 95% CI = 1.02-1.97) by a factor of almost 2. There did not appear to be a dose-response relationship between severity of head injury and subsequent risk of schizophrenia. This meta-analysis supports an increased risk of schizophrenia following TBI, with a larger effect in those with a genetic predisposition to psychosis. Further epidemiological and neuroscientific studies to elucidate the mechanisms underlying this association are warranted.     

Minimally Invasive Procedures for Evacuation of Intracerebral Hemorrhage Reduces Perihematomal Glutamate Content,Blood–Brain Barrier Permeability and Brain Edema in Rabbits

Background  

To observe the effects of the minimally invasive removal of an intracerebral hematoma on the glutamate concentration, blood–brain barrier (BBB) permeability and brain water content in the brain tissue surrounding the hematoma and to provide a theoretical basis for minimally invasive removal of intracerebral hematomas.     

Impact of Type of Intervention on Youth Reoffending: Are Gender and Risk Level Involved?

The objective of this study was to analyse the impact of the type of intervention on youth reoffending. Moreover, the possible influence that the offender's gender and level of risk could have on this relationship was also explored. Juvenile offenders from four different types of educational interventions participated in the study (N = 210): victim–offender mediation (VOM) as a diversion procedure, and case closure, reprimand, and community service as dispositions. Aged between 14-18 years, they were assessed by means of the Youth Level of Service/Case Management Inventory (YLS/CMI). Recidivism rates were evaluated as the number of new records in a follow-up period of 24 months. Results of this study showed that type of intervention (diversion versus dispositions) had no apparent effect on youth recidivism. Furthermore, an important aspect to consider in youth assessment was the different impact that risk level had on boys’ and girls’ recidivism.     

Risk factors of future suicide in suicide attempters – A comparison between suicides and matched survivors

The objective of this study was to find risk factors for suicide by looking for clinical and care/treatment consumption differences between 15 hospitalized suicide attempters, who later committed suicide (“completers”), and 15 suicide attempters who did not (“non-completers”), matched according to sex, age and principal diagnosis. Completers had significantly more often attempted suicide after the index admission. After index, completers had received more psychiatric care and treatment than non-completers. Comorbidity was common in both groups of patients. Personality disorders according to the DSM III-R, axis II, Cluster B, however, tended to be more common in the completer group. Increased comorbidity over time could also be seen to a larger extent in completers. In spite of the matching of principal diagnosis, completers tended to have higher Montgomery–Åsberg Depression Rating Scale ratings than non-completers. They also had significantly higher Suicide Assessment Scale (SUAS) scores. From this study, it is apparent that suicide attempters at risk of future suicide have major and multiple psychiatric problems, which cause difficulties in the care and treatment.