Diagnostics,treatment and secondary prevention of ischemic stroke in the Silesian Province,Poland between 2009 and 2015

Background

The available data on diagnostics and treatment of ischemic stroke (IS) in Poland come mainly from non-representative cohorts or are outdated.

Current status of stroke epidemiology in Greece: A panorama

Although strokes have been documented since about 3 millennia, they remain today as one of the leading causes of mortality, as well as of subsequent serious long-term physical and mental morbidity, among patients in many different countries all over the world. Greece presents an increase in mortality rates according to World Health Organization, and this fact underlines the need for early diagnosis and treatment, as well as, the need to implement effective prevention strategies for strokes. This review makes an effort to describe the current status of stroke epidemiological features, as well as to present the risk factors prevalent in Greece. The incidence rate is 261–319/100,000 based on the recent population based registry. Stroke appears to be more prevalent in men than in women, and the mean age of stroke onset in Greece is at 70 years of age. Hypertension, atrial fibrillation, dyslipidaemia and diabetes mellitus are the major risk factors of stroke in the Greek population, while smoking is the most commonly documented modifiable risk factor in young adults with ischemic stroke. Similar to other parts of the world, ischemic stroke is the most common stroke type. The 28-day case fatality rate for men and women was 26.5%. The mean in-hospital cost per stroke patient was 3624.9 € and the mean rehabilitation cost of outpatients with stroke was 5553.3 €, while the cost proportion of hemorrhagic stroke is higher when compared to ischemic stroke. Stroke is a devastating condition with recognized challenges in identifying effective prevention programs. In Greece, limited data exists regarding the epidemiology of strokes. As a result, the need to conduct new studies and researches across the country is well documented.     

Noninfectious complications of acute stroke and their impact on hospital mortality in patients admitted to a stroke unit in Warsaw from 1995 to 2015

Background

Medical complications often worsen the prognosis after stroke. Our aim was to investigate the association between particular noninfectious complications and hospital mortality of acute stroke patients admitted to an urban Polish stroke center, and changes in their occurrence from 1995 to 2015.

The epidemiology of stroke and transient ischaemia in Brisbane, Australia

This study presents the crude and age-adjusted annual incidence rates and diagnostic classifications of acute strokes and identified transient ischaemia cases in persons 25 years and over in an urban population slightly over one million.Ot the total of 2676 hospital admissions 1244 were stroke patients (the other 89 were unsubstantiated, 144 were resident outside the incidence area, 555 were asymptomatic lesions and 644 were TIA admissions); 139 patients were in chronic care facilities; 134 were managed in their own homes by their medical practitioners, with 84 certified community and 455 medical practitioners' reported deaths giving a total of 2056 strokes. Including the TIAs treated at home and admissions to hospitals there were 1877 TIAs (population at risk 660,598). The overall age-adjusted incidence rate for stroke was 1.22 or 40 percent of the crude rate per 1000 persons at risk, while the overall TIA age-adjusted rate was 1.20 or 43 percent. Aetiological classifications revealed thrombosis 0.46, embolism 0.09, intracerebral haemorrhage 0.19, subaracnoid 0.14, and acute but ill-defined events were 0.34 per 1000 persons. Early mortality was 32 percent with a significant winter peak with incidence unrelated to mean ambient temperature.

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Sommario Lo studio riporta il tasso di incidenza (globale e aggiustato per età) e la classificazione diagnostica dei casi di ictus e ischemia transitoria occorrenti in soggetti sopra i 25 anni di età in una popolazione urbana di poco superiore al milione di abitanti.Dei 2676 pazienti ospedalizzati 1244 avevano presentato un ictus (degli altri, 144 erano residenti fuori dall'area di incidenza considerata, 555 presentavano lesioni asintomatiche e 644 avevano presentato un TIA; in altri 89 la diagnosi di incidente cerebrovascolare non fu confermata); 139 pazienti erano ricoverati in strutture per lungodegenti; 134 erano seguiti a domicilio dal medico di base. A questi 1517 casi di ictus vanno aggiunti 539 pazienti deceduti (84 identificati attraverso il certificato di morte e 455 attraverso la segnalazione del medico di base) per un totale di 2056 ictus. Ai 644 TIA ricoverati ne vanno aggiunti 1233 trattati a domicilio per un totale di 1877 TIA (popolazione a rischio 660.598). Il tasso di incidenza aggiustato per età per l'ictus risultò del 1.22 o 40 per cento del tasso globale per 1000 persone a rischio, mentre quello per il TIA rispettivamente 1.20 o 43 per cento.La classificazione etiologica rivelò trombosi nello 0.46, embolia nello 0.09, emorragia intraparenchimale nello 0.19, emorragia subaracnoidea nello 0.14 e incidente acuto mal definito nello 0.34 per 1000 persone. La mortalità precoce fu del 32 percento con picco invernale significativo non correlato con la temperatura ambiente media.

     

Stroke and migraine in the oxfordshire community stroke project

Summary A total of 323 cases of first-ever stroke were registered in the first 2 years of the Oxfordshire Community Stroke Project. Of these patients, 244 (76%) had a stroke due to cerebral infarction. There was a past history of migraine headaches in 56 (17%) of the 323 cases of stroke and in 44 (18%) of the 244 cases of cerebral infarction. A past history of migraine headaches was no commoner in patients with stroke due to cerebral infarction than in those with stroke due to intracranial haemorrhage. One hundred and seventy-three (71%) patients with cerebral infarction had at least one risk factor for ischaemic stroke; the frequency of such risk factors was similar in patients with and without a history of migraine. In 7 (3%) of the 244 patients the cerebral infarction was presumed to be migrainous; however, only 3 of these 7 (1.2% of the 24) were free of risk factors for ischaemic stroke. If all 7 cases were considered migrainous, the incidence rate of first migrainous cerebral infarction was 3.36 per 100,000 per year (95% confidence limits 0.87–5.86). If only the 3 patients who were free of risk factors were included, the incidence was 1.44 per 100,000 per year (95% confidence limits 0–3.07).J. B. Henrich (Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA) undertook this work while a visiting research fellow at the Department of Clinical Neurology, University of Oxford     

Factors predicting early stroke fatality in Poland. Preliminary report of the Polish National Stroke Registry

Abstract. Poland has one of the highest rates of death due to stroke in Europe, which, in contrast to many industrialized countries, has not changed since at least 1984. To improve this unfavorable situation, the entire approach to stroke management needs to be recognized. For this purpose, an analysis of stroke epidemiology regarding regional differences was one of the the strategic points of the Polish National Project of Stroke Prevention and Treatment. The Polish National Stroke Registry was maintained from 1 January to 31 December 2000 in 59 Neurological Department in all 16 districts of Poland. In total 11,107 patients were included: 11% with intracerebral hemorrhage, 63.4% with ischemic stroke, and 25.6% with unclassfied stroke. Computed tomography (CT) was performed in 73.6% of patients. Analysis of in-hospital deaths showed great differences between the centers (from 8% to 36%). According to multifactorial analysis, not only well-known predictors of early death (decrease in consciousness at the onset of stroke, decrease in functional state prior to stroke, and severity of stroke) influence the prognosis. In centers with high risk of death, CT, especially CT on admission, was performed significantly less often (4.2% vs. 62.6%), early rehabilitation was delayed (38.3% vs. 73.4%), and secondary prevention treatment was prescribed to fewer patients (antiplatelettherapy 36.4% vs. 77.4%; antithrombotic therapy 4.9% vs. 13%).     

Regional disparities in acute and post-acute care of stroke patients in France, 2015

Objective

The aim of this study was to assess regional variations of the hospital management of stroke patients during acute and post-acute phases in France in 2015.

The relationship between homocysteine, cognition and stroke subtypes in acute stroke

BACKGROUND: Elevations in plasma homocysteine (Hcy) have been associated with an increased risk of stroke and dementia. The mechanisms underlying these associations remain poorly understood. OBJECTIVES: This study examines the relationships between Hcy, cognition, and stroke subtype. We hypothesize that: 1) Hcy levels are inversely related to cognition, 2) Hcy levels are unrelated to stroke subtype, and 3) stroke subtype affects cognition. METHODS: We studied 169 consenting patients admitted for acute stroke during a 4 month period. Blood was drawn for Hcy levels and the Mini-Mental State Examination (MMSE) was administered within 9 days of admission. The Oxfordshire Community Stroke Project Classification was used to characterize stroke subtypes. Correlation between Hcy and MMSE scores was examined as was the relationships between Hcy and stroke subtype, and between stroke subtypes and MMSE scores. RESULTS: A significant inverse correlation between Hcy levels and MMSE scores was demonstrated (r=-0.243, p=0.001). MMSE scores also differed according to the type of stroke, with Total or Partial Anterior Circulation Infarcts (TACI/PACI) scoring lowest (F=8.77, df=2, p<0.001). Hcy levels did not differ between the various stroke subtypes (F=0.21, df=2, p=0.81). Multivariate linear regression analysis showed that age, education, and stroke subtype, but not Hcy, were independent predictors of acute MMSE scores. CONCLUSIONS: In this study sample, there was an inverse relationship between Hcy and cognition in acute stroke patients. However, Hcy was not an independent predictor for cognition in acute stroke after other factors such as stroke subtype and patient age were taken into account. These results suggest that during the acute stage of stroke, stroke subtype is a more important factor in determining cognition than Hcy levels.     

2015～2019年烟台市脑卒中高危人群危险因素暴露情况对比分析

目的 分析2015～2019年烟台市东厅街道社区卫生服务中心居民的脑卒中高危人群危险因素暴露变化情况,了解社区脑卒中防控项目成效,为烟台地区脑卒中筛查防治提供依据,指导今后的筛查防治工作.方法 根据国家卫生健康委脑卒中高危人群筛查和干预项目的筛选标准,采用整群抽样方法对2015、2017及2019年烟台市筛查点40岁以...     

中国脑卒中的发病与趋势——三大城市的研究结果

分析1991～2000年北京、上海、长沙3城市社区年登记的卒中病例,了解3大城市90年代脑卒中及其亚型的发病率和变化趋势。经年龄标化后北京初发脑卒中的发病率为135．0/10万人年、上海为76．1/10万人年、长沙为150．0/10万人年,其中北京缺血性卒中的发病率最高,其次为上海和长沙;而长沙颅内出血的发生率最高,其次是北京和上海;蛛网膜下腔出血的顺序同脑出血。社区≥50岁的人群总卒中和颅内出血年龄标化后的发病率普遍高于西方国家。从10年变化趋势来看,北京、上海、长沙3大城市颅内出血的年下降率分别为12．0%、4．4%和7．7%,而脑缺血的年增长率除长沙外北京和上海分别为5．0%和7．7%。这种颅内出血减少和缺血性卒中增加的现象反映出中国人群脑卒中危险因素的变化情况。     

Mechanisms of in-hospital acute ischemic stroke and their relevance to prognosis: A retrospective analysis

ObjectivesIn-hospital stroke (IHS) is common and has a poor prognosis. Limited data were about the mechanisms of IHS, posing a challenge in taking measures to prevent stroke during hospitalization. This study aims to investigate the mechanisms of IHS and their relevance to prognosis.Materials and MethodsPatients with in-hospital acute ischemic stroke at Peking Union Medical College Hospital from June 2012 to April 2022 were consecutively enrolled. The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification of stroke and detailed mechanisms were evaluated by two experienced neurologists. Functional outcome at discharge was evaluated.ResultsA total of 204 IHS patients were included, with a median age of 64 (IQR 52-72) and 61.8% male. The most common mechanism was embolism (57.8%), followed by hypoperfusion (42.2%), hypercoagulation (36.3%), small vessel mechanism (19.1%), discontinuation of antithrombotic drugs (13.2%), and iatrogenic injury (9.8%). Iatrogenic injury (P = 0.001), hypoperfusion (P = 0.006), embolism (P = 0.03), and discontinuation of antithrombotic drugs (P = 0.004) were more common in perioperative stroke compared to non-perioperative stroke. Median NIHSS improvement (2 vs 1, P = 0.002) and median mRS improvement (1 vs 0.5, P = 0.02) at discharge were higher in perioperative patients. Advanced age and higher NIHSS at onset were significantly associated with a poorer prognosis, whereas embolism mechanism was associated with a better prognosis.ConclusionsThe etiologies and mechanisms of IHS are complex. Perioperative and non-perioperative IHS have different mechanisms and prognostic features. Determining the causes and mechanisms of IHS will help to identify the population at risk and prevent stroke appropriately during hospitalization.     

The incidence of cases of aphasia following first stroke referred to speech and language therapy services in Scotland

Background: Key to the provision of appropriate services is an understanding of the number of cases in a given population. This study examined the incidence of aphasia following first ever stroke. It was part of a larger study, the Aphasia in Scotland Study, which examined the provision of services for people with aphasia in Scotland.

Aims: The present study examines the incidence of aphasia referred to speech and language therapy services in people who have experienced their first ever stroke. The specific questions addressed were: What is the incidence of aphasia following first ever stroke? What is the percentage of aphasia following first ever stroke? What are the crude figures for aphasia following first ever stroke by age? What are the crude figures for aphasia following first ever stroke by gender? What are the crude figures for aphasia following first ever stroke by severity?

Methods & Procedures: All 14 health boards in Scotland were approached but only 3, NHS Borders, Orkney, and Shetland, were able to provide the level of information required. Respondents were asked to provide information about the age and gender and level of communication need of referred cases over a given year.

Outcomes & Results: Results suggested that the incidence of aphasia following first ever stroke was found to be 54, 57, and 77.5 per 100,000, for NHS Borders, Orkney, and Shetland respectively. This is slightly higher than in other comparable studies. The percentage of new cases of aphasia following a first ever stroke across NHS Borders, Orkney, and Shetland was 19, 22, and 34% respectively. The variability across the three sites is probably a function of the potential effect of small changes in the relatively low numbers. The majority of cases were, unsurprisingly, over 65 years of age but a substantial minority—17% (Shetland), 26% (Borders) and 36% (Orkney)—were below 65 years of age. One third of new cases resulted in severe aphasia. Although the proportions of men and women with aphasia were similar, women tended to be older at the point at which they experienced their first stroke.

Conclusions: The results are discussed in terms the practicalities of this sort of data collection exercise and the implications of the results for service delivery. There is a need for comparable local data collection exercises tied in to current epidemiological studies.     

Population-based stroke and dementia incidence trends: Age and sex variations

Introduction

We discovered a concomitant decline in stroke and dementia incidence rates at a whole population level in Ontario, Canada. This study explores these trends within demographic subgroups.

Incidence and case-fatality rates of stroke in Burgundy (France). Comparison between a rural (Avallon) and an urban (Dijon) population,between 1989 and 1993

The decline of mortality from stroke observed in some countries may result from a fall in incidence or a decrease in case-fatality rates from stroke. The present study was conducted to evaluate the role of geographical parameters, comparing an urban and a rural population in Burgundy, France to look for differences in risk factor distribution. The study was a prospective, and complete case-ascertainment in a population-based survey. It was conducted on a well-defined population-based survey in a rural town (Avallon 8900 subjects) and an urban town (Dijon 140,000 subjects) in the area of Burgundy (France), from 1989 through 1993. All first-ever stroke events occurring in these two populations, whatever the age, were registered by a special six-level case-registration system. 1118 strokes cases were identified, 986 in Dijon and 132 in Avallon. In the rural area (Avallon), the incidence and case-fatality rates at 28 days were higher than those of Dijon. The higher incidence rate in Avallon may be explained by the fact that there was a higher rate of non-treated hypertension. The higher case-fatality rate in Avallon may be explained by a higher rate of hemorrhagic strokes and of comatous patients. Rural and urban populations perhaps have not the same risk factors for stroke. The differences observed in incidence and case-fatality rates should lead to a survey on the risk factors and their diagnosis and treatment between rural and urban populations.     

广东省脑卒中流行病学调查

目的调查广东省居民脑卒中患病率、发病率、死亡率及主要危险因素状况。方法本研究是2013年中国脑卒中流行病学调查的一部分,采用多阶段分层整群抽样的方法,对样本人群进行逐户家访,共调查了广东省内6个监测点的16724名成年居民。脑卒中后至2013年8月31日仍幸存者被认为是患病病例,2012年9月1日至2013年8月31日一年内的首次发病者被认为是发病病例,死亡者被认为是死亡病例。结果16724名受调查者中,共有脑卒中患者155例,患病率为926.8/10万;一年内病例33例,发病率为197.3/10万;死亡病例10例,死亡率为59.8/10万。年龄标化后,患病率、发病率和死亡率分别为773.7/10万、168.6/10万和49.4/10万。男性脑卒中患病粗率为1081.1/10万,明显高于女性的777.2/10万,城市居民脑卒中患病粗率为1785.7/10万,明显高于农村居民的706.3/10万。共有130例(83.9%)患病病例在起病7 d内住院治疗。在155例患病病例中,脑梗死121例(78.1%),脑出血28例(18.1%),蛛网膜下腔出血2例(1.3%),不确定型4例(2.6%)。脑卒中患者中,99例合并高血压(63.9%)、36例合并血脂异常(23.2%),33例合并吸烟(21.9%)。结论广东省脑卒中患病率、发病率和死亡率高,城市地区的脑卒中负担比农村更重,流行病学状况值得高度重视。     

Incidence of seizures in the acute phase of stroke: a population-based study

Purpose: The incidence of seizures within 24 h of acute stroke has not been studied extensively. We aimed to establish the incidence of acute poststroke seizures in a biracial cohort and to determine whether acute seizure occurrence differs by race/ethnicity, stroke subtype, and/or stroke localization.
Methods: We identified all stroke cases between July 1993 and June 1994 and in 1999 within the population of the Greater Cincinnati metropolitan region. Patients with a prior history of seizures/epilepsy were excluded from analysis.
Results: A total of 6044 strokes without a history of seizure(s) were identified; 190 (3.1%) had seizures within the first 24 h of stroke onset. Of ICH/SAH patients, 8.4% had a seizure within the first 24 h of stroke onset (p ≤ 0.0001 vs. all other stroke subtype). Of the patients with ischemic stroke, we observed higher incidence of seizures in cardioembolic versus small or large vessel ischemic (p = 0.02) strokes. Patients with seizures experienced higher mortality than patients without seizures (p < 0.001) but seizures were not an independent risk factor of mortality at 30 days after stroke. Independent risk factors for seizure development included hemorrhagic stroke, younger age, and prestroke Rankin score of ≥1. Race/ethnicity or localization of the ischemic stroke did not influence the risk for seizure development in the studied population.
Discussion: The overall incidence of acute seizures after stroke was 3.1%, with a higher incidence seen in hemorrhagic stroke, younger patients, and those presenting with higher prestroke Rankin scores. Acute seizures were associated with a higher mortality at 30 days after stroke.     

Incidence and trends of stroke and its subtypes in Changsha,China from 2005 to 2011

During the 1990s no significant changes were found for the high incidence of ischemic stroke (IS) in Changsha, in contrast to the increase observed in Beijing and Shanghai. However, the epidemiological patterns of stroke may change with economic development. This study aimed to examine the characteristics of stroke incidence transition in Changsha from 2005 to 2011. In 2007 two communities with a registered population of about 100,000 were selected and data from stroke patients who presented between 2005 and 2007 were retrospectively collected from January to June 2008. From January to December 2007 a stroke surveillance network was established and stroke patients who presented between 2008 and 2011 were prospectively registered. From 2005 to 2011 the mean annual age-adjusted incidence of first-ever stroke was 168.5/100,000 (95% confidence interval [CI] 159.0–178.0/100,000), with 189.3/100,000 (95% CI 175.1–178.0/100,000) for men and 148.7/100,000 (95% CI 136.0–161.4/100,000) for women. The mean annual age-adjusted incidence of IS, intracranial hemorrhage and subarachnoid hemorrhage was 72.6/100,000 (95% CI 66.3–78.9/100,000), 85.1/100,000 (95% CI 78.3–91.9/100,000) and 9.4/100,000 (95% CI 7.1–11.7/100,000), respectively. During the study period, the age-adjusted incidence of stroke increased at an annual rate of 3.7% (p = 0.001); at 4.2% for men (p = 0.001) and 3.1% for women (p = 0.026). The age-adjusted incidence of IS increased at an annual rate of 3.5% (p = 0.003) but no significant changes were seen for hemorrhagic stroke. Characteristics of stroke incidence transition may reflect underlying changes in risk factors and there is an urgent need to identify these factors and launch appropriate public health campaigns.     

Clinical study of childhood acute disseminated encephalomyelitis,multiple sclerosis,and acute transverse myelitis in Fukuoka Prefecture,Japan

Acute disseminated encephalomyelitis (ADEM) has recently been studied in several countries owing to the development and wide spread use of imaging technology, but few epidemiological studies of childhood ADEM have been undertaken in Asian countries. To perform a comprehensive survey of ADEM and related diseases in Japanese children, we conducted a multicenter, population-based study on childhood ADEM, multiple sclerosis, and acute isolated transverse myelitis in Fukuoka Prefecture, Japan. We identified 26 children with ADEM, 8 with multiple sclerosis, and 4 with acute transverse myelitis during 5 years between September 1998 and August 2003. The incidence of childhood ADEM under the age of 15 years was 0.64 per 100,000 person-years, mean age at onset was 5.7 years, and male–female ratio was 2.3:1. The prevalence of childhood multiple sclerosis was 1.3 per 100,000 persons. The mean age at onset of multiple sclerosis, 9.3 years, was significantly higher than that of ADEM. Nineteen (73%) and four (15%) patients with ADEM experienced antecedent infectious illnesses and vaccinations, respectively, within 1 month before the onset. Clinical and radiological findings of ADEM revealed that the frequency of seizures, mean white blood cell counts in cerebrospinal fluid, and the frequency of subcortical lesions in Fukuoka study, seemed to be higher than those in previous non-Asian studies. These findings suggest that there are ethnic or geographical differences in the incidence and clinical features of ADEM, and that there might be potent genetic or environmental risk factors for ADEM distinct from those for multiple sclerosis.     

Temporal trends of stroke in Valle d'Aosta, Italy. Incidence and 30-day fatality rates

The objective of this study was to evaluate temporal changes of stroke in an Italian community by comparing the present incidence rates with those reported in the same area for 1989. The two studies were conducted by the same research group and met almost all the criteria proposed for an “ideal” stroke incidence study. The annual incidence rate per 1000 inhabitants increased (p < 0.01) by 29% from 2.23 (95% CL, 1.96–2.50) in 1989 to 2.89 (95% CL, 2.58–3.20) in 1997. No statistically significant change was found when these rates were adjusted to the 1991 Italian population. The overall incidence rate was 2.40 (95% CL, 2.14–2.66) in 1989 and 2.65 (95% CL, 2.39–2.91) in 1997. The thirty-day case fatality rate declined dramatically (p < 0.001) from 31% (95% CL, 26– 36) to 20% (95% CL, 16–24) between 1989 and 1997. Ageing of the population and better identification of cases could explain the high incidence rate, whereas the decrease of fatality rate may be due to a general improvement in acute care and inclusion of milder cases. Received: 24 August 1999 / Accepted in revised form: 2 December 1999     

Early thrombolysis in stroke due to basilar artery occlusion

Basilar artery occlusion is usually associated with a poor prognosis. Nevertheless, intra-arterial thrombolysis has been shown to improve clinical outcome in selected cases. We report the case of a 29-year-old patient who suffered a severe ischemic stroke due to basilar artery occlusion and who was treated with intra-arterial thrombolysis within 3 h of symptoms onset; treatment was followed by an almost full functional recovery. The young age of the patient, short segment occlusion in the middle tract of the artery, good collateral supply, and early recanalization may account for the favorable prognosis. Received: 7 August 2001 / Accepted in revised form: 18 October 2001