Comparison of stroke ward care versus mobile stroke teams in the Hungarian stroke database project

Although previous studies have proved that both stroke wards and mobile stroke teams are considerably better than non-specialized stroke care, an unresolved debate in vascular neurology is whether or not stroke wards provide better outcomes in some specific cases to stroke victims. Our prospective, multicenter, cohort study compared dedicated stroke wards versus specialist stroke team care at general hospital wards in 11 centers nationwide for 8743 consecutive stroke events during 18 months. Twenty-eight-day case-fatality rate was 12.6% at stroke wards versus 15.2% at stroke teams for all patients ( P  = 0.002), and stroke ward care also predicted better outcome when analyzed with multivariate logistic regression model (odds ratio 1.701; confidence interval: 1.025–2.822). Case-fatality rates were not significantly different in patients with modified Rankin score ≥2 (case-fatality rate: 17.8% vs. 20.3%; P  = 0.163), and over 60 (case-fatality rate: 14.8% vs. 15.9%; P  = 0.250), however these patients were more probably at home after 4 weeks when treated at stroke wards (56.1% vs. 50.6%; P  = 0.03, and 69.5% vs. 64.5%; P  = 0.004). In our study, stroke ward admission provided lower case-fatality rate below 60 and for those independent prior to their strokes, and lower institutionalization over 60 and amongst previously dependent patients, when compared with stroke teams.     

Metabolic syndrome and three of its components as risk factors for recurrent ischaemic stroke presenting as large-vessel infarction

Background and purpose:  Although a clear protocol for reduction of recurrent ischaemic stroke (RIS) has been established, few studies have compared the stroke subtype distribution and risk factors between RIS and first-ever stroke (FES).
Methods:  This one-year hospital-based study enrolled 587 FES and 475 RIS patients. Patients were categorized into four stroke subtypes according to a modified TOAST stroke subtype classification system. Risk factor profiles were compared between the two major stroke groups and between the corresponding four subtypes to discriminate the significant risk factors for RIS.
Results:  A multivariate regression analysis identified hypertension (OR, 1.87; 95% CI, 1.34–2.62), diabetes mellitus (DM) (OR, 1.57; 95% CI, 1.22–2.02), low high-density lipoprotein (LHDL) (OR, 1.43; 95% CI, 1.08–1.88) and older age as significant RIS risk factors. The significance of the former three RIS factors was further recognized in its large-vessel subtype. Moreover, metabolic syndrome was significantly more common in the recurrent stroke group ( P  = 0.01), including its large-vessel subtype ( P  = 0.04). Progressively increasing odds ratios from 1.49 to 2.02, in accordance with increased number of diagnostic components of metabolic syndrome for recurrent large-vessel ischaemic stroke, were noted.
Conclusions:  Metabolic syndrome likely plays a crucial role in the development of RIS, including large-vessel infarction in modern-day Taiwan.     

Metabolic syndrome is more associated with intracranial atherosclerosis than extracranial atherosclerosis

To elucidate the relationship between metabolic syndrome (MetS) and cerebrovascular stenosis, we performed comparative studies of MetS and its components between ischemic stroke patients with intra- and extracranial atherostenosis. We evaluated 378 acute ischemic stroke patients who underwent brain magnetic resonance (MR) imaging and MR angiography. Stenosis was diagnosed in cases showing a degree of luminal narrowing of ≥ 50%. The stroke subtypes were categorized as large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioembolism (CE), and stroke of undetermined etiology (SUE). MetS was defined using the criteria of the Adult Treatment Panel III. The mean carotid intimal medial thickness values showed increased tendency as the number of MetS components increased ( P  < 0.001). Regardless of stroke subtype, the MetS (+) group showed an increasing tendency toward stenosis (LAA, SAO, all P  < 0.001; CE, P  = 0.001; SUE, P  = 0.077). MetS was independently associated with intracranial atherosclerosis (odds ratio, 3.58; 95% CI, 2.28–5.63), which was prominent with more severe MetS components after adjustment for other risk factors ( P  < 0.001). Amongst the component conditions, elevated blood pressure, increased blood glucose/hyperglycemia, and abdominal obesity were dominantly associated with stenosis (all P  < 0.001). Modifications of the individual MetS components need to be considered for stroke prevention because of intracranial atherogenic progression.     

Prevalence of disabling spasticity 1 year after first-ever stroke

Objective:  To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke.
Design:  Cross-sectional survey 1 year after first-ever stroke.
Methods:  Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability.
Results:  The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS ( P  = 0.009) and the BI ( P  = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9–125) and age below 65 years (OR 9.5, CI 1.5–60).
Conclusions:  The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment .     

High prevalence of unrecognized cerebral infarcts in first-ever stroke patients with cardioembolic sources

Background:  With magnetic resonance imaging (MRI) analysis, we investigated the prevalence, clinical significance, and factors related to the presence of unrecognized cerebral infarcts in patients with first-ever ischaemic stroke.
Methods:  We consecutively included patients who were admitted with first-ever stroke. Unrecognized cerebral infarct was defined as an ischaemic infarction or primary intracerebral hemorrhage on MRI irrelevant to the index stroke, without acute lesions on diffusion-weighted image.
Results:  Of the total 203 patients, 78 (39.4%) patients were observed as having unrecognized cerebral infarct. Patients with high-risk cardioembolic sources (e.g., atrial fibrillation) more frequently had unrecognized stroke than those without ( P  = 0.008, 21/36 [58.3%] vs. 57/167 [34.1%]). On univariate analysis, male sex ( P  = 0.027) and cardioembolic source ( P  = 0.008) were associated with the presence of unrecognized cerebral infarcts. After adjustment for gender, age and risk factors, the presence of cardioembolic sources independently increased the risk of unrecognized cerebral infarct ( P  = 0.002, odds ratio 3.56, 95% confidence interval 1.58–8.02). Regarding clinical outcome at 3 months, the presence of unrecognized cerebral infarct was not associated with the poor clinical outcome.
Conclusion:  In our study, the presence of cardioembolic sources was an independent risk factor for the unrecognized cerebral infarct in patients with first-ever stroke.     

Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study

Introduction:  Limited information is available about the impact of seizures on stroke outcome, health care delivery and resource utilization.
Objective:  To determine whether the presence of seizures after stroke increases disability, mortality and health care utilization (length of hospital stay, ICU admission, consults, discharge to a long-term care facility).
Methods:  This cohort study included consecutive patients with acute stroke between July 2003 and June 2005 from the Registry of the Canadian Stroke Network (RCSN), the largest clinical database of patients in Canada with acute stroke seen at selected acute care hospitals. We compared clinical characteristics and outcomes amongst patients experiencing stroke without and with seizures occurring during inpatient stay. Main outcome measures included: case-fatality, disability at discharge, length-of-stay, and discharge disposition. A logistic regression analysis was used to determine whether the presence of seizures was associated with poor stroke outcomes.
Results:  Amongst 5027 patients included in the study; seizures occurred in 138 (2.7%) patients with stroke. Patients with seizures had a higher mortality at 30-day (36.2% vs. 16.8%, P  < 0.0001) and at 1-year post-stroke (48.6% vs. 27.7%, P  < 0.001), longer hospitalization, and greater disability at discharge ( P  < 0.001). Multivariate analysis revealed that stroke severity, hemorrhagic stroke, and presence of neglect were associated to occurrence of seizures after stroke.
Conclusions:  The presence of seizures after stroke was associated with increased resources utilization, length of hospital stay, whilst decreasing both 30-day and 1-year survival. Quality improvement strategies targeting patients with seizures may help optimize the management of this subgroup of more disabled patients.     

Perception of stroke in Croatia – knowledge of stroke signs and risk factors amongst neurological outpatients

Background and purpose:  The aim of this hospital-based survey was to determine baseline stroke knowledge in Croatian population attending the outpatient services at the Department of Neurology.
Methods:  A multiple choice questionnaire was designed, divided into three sections: (i) demographic data, (ii) knowledge of stroke risk factors and stroke signs and (iii) actions the patients would undertake if confronted with risk of stroke and information resources regarding health.
Results:  The analysis included 720 respondents (54.9% women). The respondents most frequently indicated stroke symptoms as following: speech disorder 82%, paresthesiae on one side of the body 71%, weakness of arm or leg 55%, unsteady gait 55%, malaise 53%, monocular loss of vision 44%. The risk factors most frequently identified were hypertension 64%, stress 61%, smoking 59%, elevated lipids 53%, obesity 52%, coagulation disorder 47%, alcoholism 45%, low-physical activity 42%, elderly age 39%, cardiac diseases 38%, weather changes 34%, drugs 33% and diabetes 32%. If confronted with stroke signs 37% of respondents would consult the general practitioner and 31% would call 911 or go to a neurologist. Amongst patients with a risk factor, only diabetics were aware that their risk factor might cause stroke ( P  < 0.001). Respondents with lowest education had the least knowledge regarding stroke signs ( P  < 0.01).
Discussion:  The results of this study indicate that respondents showed a fair knowledge about stroke signs and risk factors for stroke. The results of our study will help to create and plan programmes for improvement of public health in Croatia.     

The gender gap in stroke: a meta-analysis

Giralt D, Domingues‐Montanari S, Mendioroz M, Ortega L, Maisterra O, Perea‐Gainza M, Delgado P, Rosell A, Montaner J. The gender gap in stroke: a meta‐analysis.
Acta Neurol Scand: 2012: 125: 83–90.
© 2011 John Wiley & Sons A/S. Several studies have indicated that gender differences might exist in stroke. Objectives and methods – Our goal was to perform a comprehensive meta‐analysis in order to evaluate and quantify stroke gender disparities through a systematic search of relevant articles published up to October 2009 and addressing gender related differences in ischemic stroke risk factors, stroke subtype and severity, diagnostic tests, and acute phase and secondary prevention treatments. Results – Forty‐five articles were included in the analysis, representing a total of 673,935 patients. Women were globally older than men (+5.2 years) and suffered more hypertension (P = 0.017) and atrial fibrillation (P < 0.001), although they were less likely to drink alcohol (P < 0.001), smoke cigarettes (P < 0.001), present hyperlipidemia (P = 0.033) or diabetes (P = 0.003) than men. Baseline stroke severity was not different between genders. Women suffered more cardioembolic strokes, while men had more atherothrombotic strokes. Moreover, women were less likely to receive stroke‐related treatments, such as antiplatelets (P < 0.001), statins (P < 0.001), and tPA (P < 0.001) than men. Although meta‐regression did not identify age or stroke etiology as sources of heterogeneity, caution should be taken as that analysis was possible only for gender differences in secondary prevention with antiplatelets because of limited data for other end points. Conclusions – Gender differences have been identified on the risk factors profile and diagnostic and therapeutic management of patients with ischemic stroke. Active measures should thus be taken to avoid bias in clinical practice.     

Variation in the management of acute physiological parameters after ischaemic stroke: a European perspective

Studies have shown significant variation in stroke case fatality across Europe. These variations suggest the need to explore whether differences in physiological support in acute stroke exist across Europe. Data were collected in four European centres over 6 months. These included clinical status and management of acute physiology (hydration, oxygenation, nutrition, hypertension, hyperglycaemia and temperature in the first week of ischaemic stroke) and survival at 3 months. Differences in acute supportive care between centres were adjusted for case mix. Patients admitted to centres in London (n = 106), Dijon (n = 95), Erlangen (n = 91) and Warsaw (n = 72) were studied. There were significant differences in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity between centres. After adjusting for case mix, there were significant differences in intravenous fluid use (P = 0.04), enteral feeding (P = 0.003), initiation of new antihypertensive therapy (P = 0.0006) and insulin therapy (P = 0.004) between centres, with the London centre having the lowest uptake of interventions. Three-month case fatality rates varied from 10 to 28%. This pilot study shows significant variation in acute physiological support in acute stroke across four European centres, which remains unexplained by case mix. Further research is required to link variation in acute care with stroke outcome, to identify which interventions appear to be the most effective.     

Off‐hour effects on stroke care and outcome in stroke centres

Background and purpose: Poorer stroke care processes and outcomes have been reported for acute stroke patients arriving at centres during off hours and weekends. Objective: To compare each step of the continuous specialized care that Stroke Centres (SC) provide according to time of admission and final outcome. Methods: Observational study of consecutive stroke patients admitted to SC during 2008 and 2009. Patients were classified into two groups according to their arrival time: Work Hours (WH) and Off Hour (OH) (weekends and any time other than 8:00 am to 3:00 pm on weekdays). Differences in time to diagnostic procedures, tPA administration, stroke outcome [modified Rankin Scale, (mRS)] and in‐hospital fatality rates were analysed. Results: A total of 912 patients were admitted. Data from 674 patients fulfilling study criteria were analysed. A total of 434 (64.4%) patients arrived during OH. No differences in stroke severity were found when comparing OH and WH. Time to blood test results was higher for WH (median 67 min vs. 47 min; P < 0.01), but time to cranial CT scan was similar. Intravenous tPA was administered to 58 (16.4%) OH vs. 26 (13.1%) WH patients (P = 0.33). OH arrival was not associated with poorer outcome (mRS ≥ 3) at discharge (32.8% vs. 37%; P = 0.27), or at the 3‐month follow‐up (30.6% vs. 27.6%, P = 0.52). No differences were found for in‐hospital fatality rates (5.8% vs. 5.4%, P = 1.00). Conclusions: The care provided by SC with neurologists on call 24/7 prevents differences in outcomes associated with time of admission and guarantees equal attention to stroke patients.     

Quality of life among young patients with ischaemic stroke compared with patients with multiple sclerosis

Objectives –  We aimed to evaluate the quality of life among young ischaemic stroke (IS) patients at long-term follow-up by comparing them with multiple sclerosis (MS) patients with secondary progressive course. The mean age at stroke onset was 41.6 years.
Methods –  Nottingham Health Profile scores were obtained from 191 IS patients 6 years (mean) after the index stroke, from 337 MS patients 5 years (mean) after the onset of the secondary progressive course and from 216 controls.
Results –  The mean age of IS patients was 47.8 years and MS patients 44.5 years at follow-up. The MS patients as a group had worse subscores than the IS patients. When adjusting for physical mobility, complaints of fatigue ( P  = 0.012) were more frequent among MS patients, whereas pain ( P  < 0.001) and sleep ( P  = 0.007) disturbances were more frequent among IS patients.
Conclusion –  The comparison of IS and MS patients highlights the importance of pain and sleep disturbances among IS patients when adjusting for physical mobility.     

Ischaemic stroke – impact of renal dysfunction on in-hospital mortality

Renal dysfunction predicts mortality in patients with myocardial infarction but less is known about the impact of renal dysfunction on in-hospital mortality after ischaemic stroke. All 361 patients (185 men, 176 women; mean age 72.1 years) with ischaemic stroke and glomerular filtration rate (GFR) <90 ml/min/1.73 m² were followed-up. GFR was calculated according to abbreviated modification of diet in renal disease (MDRD) formula. Stroke severity was determined by National Institutes of Health Stroke Scale (NIHSS).
The mean GFR was 61.5 ± 16.6 ml/min/1.73 m². There were 49 (13.6%) in-hospital deaths. Patients who died had higher NIHSS ( P  = 0.0001), were older ( P  = 0.024), had lower GFR ( P  = 0.028), higher hs-C-reactive protein ( P  = 0.001) and lower albumin ( P  = 0.048). No differences in presence of diabetes and hypertension, cholesterol (total, HDL and LDL), triglycerides and BMI between patients who died or survived were found. With univariate analysis association between in-hospital mortality and NIHSS ( P  = 0.0001), GFR ( P  = 0.041), total cholesterol ( P  = 0.021) and LDL cholesterol ( P  = 0.034) was found. With Cox multivariable regression analysis of risk factors, NIHSS ( P  = 0.0001), GFR ( P  = 0.018), total cholesterol ( P  = 0.008) and LDL cholesterol ( P  = 0.011) were only predictors of in-hospital mortality. In patients with ischaemic stroke, decreased GFR was associated with higher in-hospital mortality.     

Relevance of the genetic polymorphism of NOD1 in Chlamydia pneumoniae seropositive stroke patients

Background and purpose:  Chronic infections with certain pathogens, such as Chlamydia pneumoniae , and genetic parameters that influence inflammatory reactions have been suggested to contribute to ischaemic stroke. NOD1 is a potent cytosolic receptor for C. pneumoniae. The aim of this study was to investigate the genetic polymorphism of NOD1 from the aspect of the development of stroke.
Materials and methods:  A total of 280 patients with ischaemic stroke were enrolled in the study; 150 healthy blood donors served as controls. The G796A (E266K) NOD1 polymorphism was determined by restriction fragment length polymorphism. Chlamydia pneumoniae seropositivity was tested by ELISA.
Results:  There was a significant difference in NOD1 G796A genotype distribution between the controls and the stroke patients with C. pneumoniae seropositivity. The AA homozygote and GA heterozygote mutant variants were detected in 16% (25 of 152) and in 50% (77 of 152) of the C. pneumoniae- positive stroke patients, as compared with 8% (6 of 84), and 28% (24 of 84), respectively, in the C. pneumoniae- positive healthy controls. (OR = 2.559; 95% CI = 1.105–6.517, P  = 0.04 and OR = 2.567; 95% CI = 1.451–4.540 P  < 0.001, respectively). The stroke patients with the large vessel pathology exhibited the highest frequency of the mutant allele A (51%). In contrast, amongst the C. pneumoniae- negative subjects, no difference in genotype frequency was observed between the stroke patients and the controls.
Conclusion:  Polymorphism in NOD1 G796A alone did not prove to be a risk factor for stroke in general, but in association with C. pneumoniae infection it appeared to be accompanied by an increased risk of the development of stroke.     

TOAST classification of subtypes of ischaemic stroke: diagnostic and therapeutic procedures in stroke. A four-year observation

BACKGROUND: The purpose of this study was to classify ischaemic strokes according to TOAST in patients treated in the internal disease and neurological wards of a hospital in Lower Silesia, evaluate diagnostic and therapeutic methods, and compare their treatment effectiveness according to the Rankin scale. METHODS: Two hundred and seventy-nine patients below 80 and 77 patients over 80 years of age suffering from ischaemic stroke were covered by the retrospective study. RESULTS: Patients with large-artery atherosclerosis according to the TOAST classification and over 80 years old (p = 0.001) were more frequently hospitalised in the internal disease ward (p = 0.005). Strokes caused by small-vessel occlusion were more frequent in the neurological ward (p = 0.017). CONCLUSIONS: The authors suggest the general use of the TOAST classification and an active information campaign among doctors of various specialisations about standard procedures in stroke according to AHA and EUSI guidelines.     

Associations between meteorological variables and acute stroke hospital admissions in the west of Scotland

Background –  We combined a large clinical stroke registry with the UK Met Office database to assess the association between meteorological variables and specific clinical subtypes of acute stroke.
Methods –  We used negative binomial regression and Poisson regression techniques to explore the effect of meteorological values to hospital with acute stroke. Differential effects of atmospheric conditions upon stroke subtypes were also investigated.
Results –  Data from 6389 patients with acute stroke were examined. The mean age (SD) was 71.2 (13.0) years. About 5723 (90%) patients suffered ischaemic stroke of which 1943 (34%) were lacunar. Six hundred and sixty-six patients (10%) had haemorrhagic stroke. Every 1°C increase in mean temperature during the preceding 24 h was associated with a 2.1% increase in ischaemic stroke admissions ( P  = 0.004). A fall in atmospheric pressure over the preceding 48 h was associated with increased rate of haemorrhagic stroke admissions ( P  = 0.045). Higher maximum daily temperature gave a greater increase in lacunar stroke admissions than in other ischaemic strokes ( P  = 0.035).
Conclusion –  We report a measurable effect of atmospheric conditions upon stroke incidence in a temperate climate.     

Intravenous thrombolysis in stroke patients with hyperdense middle cerebral artery sign

Background and purpose:  We assessed the safety and efficacy of intravenous thrombolysis (IVT) in acute stroke patients with hyperdense middle cerebral artery sign (HMCAS).
Patients and methods:  Data from consecutive patients with acute (within 6 h of symptom onset) ischaemic stroke admitted between January 1999 and November 2007, in whom HMCAS was diagnosed on admission CT scan was retrospectively analysed. Seventy-one patients, admitted within the 3-h window, were treated with IVT, whilst further 42, admitted 3–6 h after symptom onset, were not. At 3-month clinical follow-up, outcome, mortality at 3 months and incidence of symptomatic intracranial haemorrhage were evaluated.
Results:  The two groups were comparable concerning age, stroke risk factors, prior antithrombotic treatment and NIHSS scores on admission. Good outcome (mRS score ≤ 1) was observed in 12/71 (17%) patients who were treated with IVT and in 1/42 (2%) patients who were not ( P  = 0.02). IVT treatment was identified as independent predictor of good outcome ( P  = 0.05). Mortality was 20% in patients treated with IVT and 12% in remaining patients ( P  = 0.3). Symptomatic intracranial haemorrhage occurred in 1 patient of each group (2%).
Conclusions:  These findings suggest that IVT in patients with HMCAS results in significantly better outcome, without significantly influencing mortality.     

A pilot study regarding knowledge of stroke risk factors in an urban community

Background The premise of the "brain attack" concept is that early intervention may salvage ischemic neurons. Early intervention depends on adequate knowledge of stroke so that patients seek urgent medical attention. Objective: To assess knowledge of stroke risk factors and warning signs in an urban, predominantly black community. Methods: A 20-item questionnaire was administered to two patient groups. Group 1 had a diagnosis of first-ever stroke or transient ischemic attack (TIA). Group 2 (controls) was without a history of cerebral ischemia. Results: Thirty patients in group 1 answered 57.5% of the questions correctly. Thirty patients in group 2 answered 63.1% of the questions correctly (P=.15). Patients showed misperceptions regarding the warning signs of a stroke and were unfamiliar, with the concept of a TIA. Conclusions: Although preliminary because of a limited sample size, the results from our urban medical center suggest that knowledge of stroke is deficient among high-risk individuals who developed cerebral or retinal ischemia. This would mean that opportunities for effective prevention and treatment of stroke are being missed in minority patients. Recruitment of patients for acute stroke trials will also face impediments in urban communities unless a massive educational effort is undertaken.     

缺血性卒中患者二级预防相关脑微出血形成的危险因素分析

目的 探讨缺血性卒中患者二级预防时脑微出血(CMBs)形成的危险因素,为脑血管病的防治提供依据和指导.方法 收集明确诊断为急性缺血性卒中的患者,且在应用抗血小板聚集药物治疗4 d内完成磁敏感加权成像(SWI)检查,对纳入的患者随访12个月,12个月后复查SWI,记录随访前后CMBs的数量和部位.结果 共纳入了94例患者,其中发现伴CMBs患者50(53.2%)例,经二分类Logistics回归分析发现:高血压病史(OR=1.2,95%CI=1.07~1.61,P=0.004)、年龄(OR=2.2,95%CI=1.25~3.92,P=0.006)是CMBs形成的独立危险因素,且年龄每增加10岁,CMBs患病率增加2.2倍,经ROC曲线分析发现:年龄曲线下面积为0.695(95%CI=0.588~0.802),年龄预测CMBs的最佳cutoff值为62岁,当患者年龄≥62岁时,发生CMBs的风险明显增高.在12个月的随访中有22例患者复查SWI检查,发现新增CMBs病灶33个,经Wilcoxon非参数配对秩和检验结果显示随访后CMBs数量的中位数是2.5个,基线时是1个(Z=-3.1,P=0.002),随访前后CMBs数量差异有统计学意义.结论 对于年龄≥62岁、高血压病史、规律应用抗血小板聚集药物的缺血性卒中患者,应定期监测CMBs的数量和部位,以指导二级预防治疗方案.     

急性缺血性卒中TOAST分型与外周血中内皮祖细胞含量的相关性

目的观察外周血中内皮祖细胞含量变化与急性卒中TOAST(trial of org 10172 in acute stroketreatment)分型的相关性,为临床缺血性卒中的防治提供新的思路和理论基础。方法运用影像学和超声检查等方式,选择不同TOAST分型的缺血性卒中患者62例,同时选择健康体检者17例作为对照研究。运用流式细胞仪检测不同患者外周血中内皮祖细胞的含量,经统计学分析,观察不同组别患者外周血中内皮祖细胞的含量与TOAST分型是否具有相关性。结果外周血中内皮祖细胞的含量与急性缺血性卒中疾病的发生具有紧密的相关性。不同TOAST分型的内皮祖细胞数差异有统计学意义(F=5.063,P=0.001)。结论检测外周血中内皮祖细胞的含量对急性期缺血性卒中的危险分层有积极的指导作用。     

Comparison of the characteristics for in-hospital and out-of-hospital ischaemic strokes

Background and purpose:  Patients who are being admitted to a hospital due to diseases other than stroke may develop a stroke (in-hospital stroke; IHS).
Methods:  We enrolled 111 consecutive patients who developed IHS outside a neurology ward during a 5-year period at a single hospital. The frequency, characteristics, and outcomes for IHS patients were compared with patients who develop ischaemic stroke outside of the hospital (out-of-hospital stroke; OHS).
Results:  Forty-six percent of IHS occurred in the department of cardiology or cardiovascular surgery and 60% were associated with surgery or procedures. In comparison with the OHS patient group, the IHS patient group showed an increased frequency of cardiac disease, leukocytosis, and anemia. Cardioembolism, stroke of other determined etiologies, and an incomplete evaluation were more common in the IHS group, whereas large artery atherosclerosis was more frequent in the OHS group. The IHS group had up to a 10-fold higher mortality than the OHS group, with sepsis being the most common cause of death in the IHS group.
Conclusions:  IHS has distinct etiologies and stroke mechanisms from OHS. The prevention and management of infection could decrease mortality in IHS patients.