卒中后高血糖与缺血性脑卒中

20～40％的脑卒中患者,无论其此前是否诊断为糖尿病,均可在卒中发生后出现高血糖,称为卒中后高血糖（post stroke hyperglycemia,PSH）。PSH是脑卒中预后的一个重要预测因子,PSH能预测脑卒中患者的死亡风险及神经功能恢复情况。     

Depression in stroke patients 7 years following stroke

OBJECTIVE: To study the frequency of depression in stroke patients many years following stroke, most previous studies having concentrated on the first few years. METHOD: Participants of a previous study of post-stroke depression (99 stroke patients and 28 control subjects) were re-examined 7 years later. Depression was diagnosed using research diagnostic criteria. The test battery comprised the Mini Mental State Examination, the Raven Matrices A+B and Word Pair Learning. Subjective experience of changes in memory, concentration, mood, irritability and fatigue during the 7-year period was also examined. RESULTS: Twenty per cent of the stroke patients fulfilled the criteria for major or minor depression compared with 11% of the control subjects. No differences in cognitive function were found between depressed and non-depressed stroke patients. The stroke patients reported experiencing more lability of mood and irritability during the 7-year period following stroke than the control subjects. Depressed stroke patients experienced more impairment of concentration and memory function than non-depressed stroke patients. CONCLUSION: Affective symptoms are common among stroke patients 7 years following stroke.     

Ischaemic stroke

There are about 25.7 million stroke survivors worldwide. Ischaemic stroke remains the most common type of stroke. Numerous modifiable risk factors have been identified, including behaviors such as cigarette smoking and sedentary lifestyle and treatable medical comorbidities such as hypertension, hyperlipidemia and atrial fibrillation. Once considered irreversible, acute ischaemic stroke is now amenable to acute medical and endovascular therapies to reduce infarct volume. Many advances are expected in the years to come, particularly in the areas of prevention and recovery.     

Long-term prevention of ischaemic stroke and stroke recurrence

Stroke is the third most important cause of mortality, but the leading cause of severe handicap, dependency, and loss of social competence. Because of the high recurrence rate, active secondary prevention is mandatory once a stroke has occurred. Secondary prevention of stroke implies the primary prevention of cardiovascular disorders as well. Among the modifiable risk factors hypertension is worst and should be normalized according to recent WHO criteria, also in the elderly. Smoking is another major risk factor and hard to delete. Diabetes mellitus and hyperlipidaemia are also important risk factors and should be treated consequently by diet and medication. Moderate alcohol intake, normalization of body weight and regular physical activity also contribute considerably to prevention of stroke. Whether hyperhomocysteinaemia should be normalized has not yet been clarified. Cardiovascular disorders are an important source of ischemic strokes, particularly atrial fibrillation. Low dose anticoagulation can dramatically reduce stroke risk. Carotid endarterectomy in symptomatic stenoses is the most expensive means of stroke prevention. In less severe stenoses, or ICA occlusions, antiplatelet agents are the treatment of choice. Composite drugs with ASS and other antiplatelet agents seem to be superior to either compound alone. Dissections of the cervical arteries should not be operated on but may be treated by anticoagulation or antiplatelet agents in the acute and subacute phase. The potency of a consequent and comprehensive stroke prevention in preventing disability and death is much greater than any sophisticated acute stroke treatment.     

From stroke unit care to stroke care unit

In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring facilities should be named 'stroke care units' by analogy with coronary care units. The goal of a stroke care unit is early detection and rapid correction of extracranial factors which may aggravate cerebral damage in ischemic brain, including hypoxia, hyperglycemia, hypotension, cardiac arrhythmias, and elevated body temperature.     

Cryptogenic stroke

In about a quarter of ischaemic strokes the cause is undetermined, because the investigation is incomplete or delayed, because there are multiple causes or because the stroke is truly cryptogenic. Cryptogenic stroke can be further classified as non‐embolic or embolic. Embolic stroke of undetermined source can be due to paroxysmal atrial fibrillation, minor emboligenic cardiac conditions, atheroembolism, cancer associated and paradoxical embolism through a patent foramen ovale (PFO) or less often a pulmonary fistula. Currently, risk factor control, statins and antiplatelets are the main therapeutic measures to prevent recurrent stroke. There is no evidence to implement routine closure of PFO in patients with cryptogenic stroke. Direct anticoagulants are being evaluated in randomized controlled trials including embolic stroke of undetermined source patients. Advances in high resolution ultrasound or magnetic resonance imaging of extracranial and intracranial vessels and of the heart and prolonged heart rhythm monitoring will be instrumental techniques to identify arterial and cardiac hidden causes of stroke.     

Awareness of stroke risk in chagasic stroke patients

BACKGROUND: Reduction in stroke risk may depend on the general population's knowledge of stroke. In South America, chagasic myocardiopathy is independently associated with ischemic stroke. OBJECTIVE: The aim of this study was to evaluate awareness of Chagas' disease (CD) as a stroke risk factor and to determine the frequency of stroke patients that are diagnosed as having CD after stroke. METHODS: Eighty CD stroke patients and 140 non-chagasic stroke patients (53.2% males; mean age 60 years), consecutively admitted to the hospital during 2005 were interviewed with a questionnaire. Demographic variables included age, sex, ethnicity, education, previous history of stroke, vascular risk factors, social background information and several questions regarding awareness of CD as a stroke risk factor. A logistic regression model was developed to identify social variables that could predict the risk of CD stroke. RESULTS: The diagnosis of CD was established after stroke in 42.5% of CD stroke patients. Most respondents (95%) were not aware of stroke risk in CD. Chagasic patients had the lowest rate of awareness about stroke risk (2.5 vs 7.1%), although they had the greatest knowledge about the kissing bug vector (83.7 vs 62.1%; p<0.001). The main social variables associated with CD stroke were: having family members with Chagas' disease (p<0.0001; odds ratio 10.1; 95% CI 3.6-16.1) and a past history of living in a mud-brick house during childhood (p<0.001; odds ratio 8.9; 95% CI: 4.1-24.6). CONCLUSION: Awareness about CD as a risk factor of stroke is low. Educational campaigns about risk of stroke in CD patients are encouraged.     

Perioperative stroke

It is increasingly recognized that one can identify a higher risk patient for perioperative stroke. The risk of stroke around the time of operative procedures is fairly substantial and it is recognized that patients initially at risk for vascular events are those most likely to have this risk heightened by invasive procedures. Higher risk patients include those of advanced age and there is a cumulative risk, over time, of coexistent hypertension, atherosclerosis, diabetes mellitus, cardiac disease and clotting disorders. There are a number of possible mechanisms associated with the procedure (e.g., preoperative hypercoagulability, holding of antithrombic therapy at the time of the procedure and cardiac arrhythmia) that can promote a thrombo-embolic event. Examples of these include: direct mechanical trauma to extracranial vessels related to operations on the head and neck; and vascular injury as a consequence of vascular and innovative endovascular procedures affecting the cerebral circulation (e.g., carotid endarterectomy, extracranial or intracranial angioplasty with stenting, and use of the MERCI clot retrieval device), as well as various endovascular methods that have been developed to obliterate cerebral aneurysms and arteriovenous malformations as an alternative to surgical clipping and surgical resection, respectively.     

Hemorrhagic stroke

Neuroimaging by CT or MR imaging is necessary for the identification of hemorrhagic stroke and provides information about its cause. The appearance of intracranial hematoma (ICH) on CT and MR imaging evolves over time and must be understood to facilitate accurate diagnosis. The cause of ICH varies by location. New evidence suggests that MR imaging alone may be adequate to identify hemorrhagic stroke in the acute setting, and that MR imaging is superior to CT for identification of chronic microbleeds and hemorrhagic conversion of infarction.     

Pediatric stroke

Introduction  

Pediatric stroke, while increasingly recognized among practitioners as a clinically significant, albeit infrequent entity, remains challenging from the viewpoint of clinicians and researchers.     

Migraine stroke

Because the cause of stroke during migraine is not known, we studied 22 (17 females, 5 males; mean age, 32.7 years) classic migraine sufferers who had an ischemic stroke during an attack of migraine, with CT, Doppler ultrasound, cerebral angiography, and two-dimensional echocardiography. We found no cardiac or arterial lesion in 91% of the patients, as compared with 9% of age- and sex-matched migraineurs with stroke remote from a migraine attack and 18% of age- and sex-matched nonmigraineurs with stroke (p less than 0.00001). Mitral valve prolapse, arterial dissection, and vasospasm were not significant causes of stroke during migraine. These patients had longer previous attacks of migraine and their infarct was more frequently in the territory involved during the attacks than the controls, supporting the hypothesis that a prolongation of the migrainous process beyond usual limits may explain most migraine strokes.