共查询到20条相似文献，搜索用时 31 毫秒
1.
Shashvat M. Desai Marcelo Rocha Matthew Starr Bradley J. Molyneaux Cynthia L. Kenmuir Bradley A. Gross Brian T. Jankowitz Tudor G. Jovin Ashutosh P. Jadhav 《Journal of stroke and cerebrovascular diseases》2018,27(11):3172-3176
Objective
Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) is offered to select patients meeting strict criteria. One of the criteria is stroke severity as indicated by the National Institute of Health Stroke Scale (NIHSS). Inherently, NIHSS is biased towards left hemisphere strokes (LHS) with median NIHSS score 4 points higher than right hemisphere strokes (RHS). This may potentially affect clinical decision making and thrombectomy eligibility. We sought to test this hypothesis.Methods
Data were analyzed from consecutive AIS patients with LVO admitted to our comprehensive stroke center (June 2015-December 2016). Following variables were studied: NIHSS score, occlusion location, time to presentation, and treatment received.Results
Three hundred and fifty-one proximal-anterior circulation LVOs (ACLVO) were identified. 211 patients harboring a proximal ACLVO, were treated <24-hour from symptom onset, had a baseline mRS 0-1, ASPECTS ≥6, and NIHSS score ≥6. One hundred and twelve (53%) were LHS and 99 (47%) were RHS. ET was performed in 87% of LHS and 78% of RHS (P = .09). In the NIHSS score >12 range, 88% of LHS and RHS received ET (P = .93). In the NIHSS score 6-12 range, 81% of LHS and 52% of RHS received ET (P = .03).Conclusions
We find comparable rates of ET between right and LHS in patients with high NIHSS but lower rates of ET of RHS than LHS in patients at lower NIHSS. A hemisphere-laterality based adjustment to the NIHSS may better identify the full extent of patients that may benefit from ET. 相似文献2.
Yang Liu Xue Liang Xiaomin Xu Meixue Dong Shiyu Jia Changqi Lu Youdong Wei 《Journal of stroke and cerebrovascular diseases》2019,28(1):21-25
Background
Stroke is one of the most common causes of disability and death. Higher alkaline phosphatase (ALP) levels have been associated with poor functional outcomes and mortality in previous studies. We investigated alterations in serum ALP concentrations and functional outcomes in patients with acute ischemic stroke (AIS).Methods
Patients with first-ever AIS were recruited to participate in the study. Serum ALP levels were measured using a Cobas Integra 400 Plus automatic biochemical analyzer, and severity of stroke was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score on admission. Functional outcome was measured using the modified Rankin scale 1 year after admission.Results
Serum ALP concentration was increased in patients with AIS (81.75 ± 20.49 versus 69.93 ± 16.12 U/L, P?=?.000) and the optimal ALP cutoff point for diagnosing patients with AIS was 81.50 U/L, with a sensitivity of 49.5% and specificity of 78.9%. However, there was no significant correlation between ALP and NIHSS scores (r?=?.170, P?=?.085) and ALP was not significantly different between favorable and unfavorable functional outcomes (81.76 ± .60 versus 81.70 ± 20.54 U/L, P?=?.802).Conclusions
Serum ALP concentration, which was increased in patients with AIS, might represent a low-potency biomarker for the diagnosis of AIS. However, this was not significantly correlated with NIHSS scores or the functional outcome after 1 year. 相似文献3.
Yongwoo Kim Mohammad Faysel Clotilde Balucani Daohai Yu Nadege Gilles Steven R Levine 《Journal of stroke and cerebrovascular diseases》2018,27(12):3419-3424
Objects
To identify predictors of acute ischemic stroke (AIS) among patients presenting to the Emergency Department (ED) with dizziness, imbalance, or vertigo (DIV) based on demographic and clinical characteristics.Methods
We identified patients admitted to the hospital after presenting to the ED with DIV from the Statewide Planning and Research Cooperative System database of New York from 2010 to 2014. Demographic and clinical characteristics were systematically collected. Multivariable logistic regression was used to determine predictors of a discharge diagnosis of AIS.Results
Among 77,993 patients with DIV, 3857 (4.9%) had a discharge diagnosis of AIS. Admission presentation of imbalance, African-American race, history of hypertension, diabetes mellitus, hypercholesterolemia, tobacco use, atrial fibrillation, and prior AIS due to extracranial artery atherosclerosis were each positively associated with an AIS diagnosis independently. Factors negatively associated with an AIS discharge diagnosis included: admission presentation of vertigo, female sex, age > 81, history of anemia, coronary artery disease, asthma, depressive disorders, and anxiety disorders.Conclusions
Multiple potential positive and negative predictive AIS risk factors were identified. Combining with currently available centrally-caused dizziness prediction tools, these newly identified factors could provide more accurate AIS risk stratifying method for DIV patients. 相似文献4.
Wan-Qian Ge Jie Chen Hong Pan Fei Chen Cheng-Ye Zhou 《Journal of stroke and cerebrovascular diseases》2018,27(12):3587-3590
Background
The purpose of this study was to analyze the risk factors of hemorrhagic transformation (HT) after intravenous thrombolysis using a recombinant tissue plasminogen activator (r-tPA) in acute ischemic stroke (AIS).Methods
We included 199 consecutive patients in the First Affiliated Hospital of Wenzhou Medical University from January 2016 to October 2017 with a diagnosis of AIS. The patients were divided into 2 groups: HT and non-HT. The related risk factors were recruited before and after receiving r-tPA thrombolysis.Results
Using univariate analysis, we found that there was a significant difference between the HT and non-HT group (P < .05) in the level of age, atrial fibrillation, baseline National Institute of Health Stroke Scale (NIHSS) score and NIHSS score after 2 hours of thrombolytic therapy, hyperlipidemia. Multivariate logistic regression analysis indicated that NIHSS score after 2 hours of thrombolytic therapy (odds ratio [OR]?=?1.091, 95% confidence interval [CI] = 1.015-1.173 P?=?.018) and atrial fibrillation (OR?=?2.188, 95%CI ?=?1.024-4.672 P?=?.043) are the risk factors of HT.Conclusions
NIHSS score after 2 hours of thrombolytic therapy and atrial fibrillation were risk factors for HT after thrombolysis. Age (OR?=?1.022, 95%CI = .988-1.056 P?=?.205), Hyperlipidemia (OR?=?.591, 95%CI = .29-1.206 P?=?.148), and Baseline NIHSS score (OR?=?.998, 95%CI = .914-1.089 P?=?.043) were not significant independent predictors but showed an association with HT. These 5 factors should be carefully taken into account. 相似文献5.
Jung-Soo Park Hyo-Sung Kwak Gyung Ho Chung Seungbae Hwang 《Journal of stroke and cerebrovascular diseases》2018,27(10):2797-2803
Background
The objective of this study was to investigate the prognostic value of computed tomographic angiography (CTA) based on leptomeningeal collateral (LMC) status and other parameters in acute ischemic stroke (AIS) patients with internal carotid artery (ICA) terminus occlusion treated with endovascular treatment (EVT).Methods
All eligible patients from January 2013 to December 2017 undergoing EVT were retrospectively reviewed. The regional leptomeningeal score was used to assess the LMCs on baseline CTA. The collateral status measured by the LMC score (0-20) was trichotomized into 3 groups: good (17-20), intermediate (11-16), and poor (0-10).Results
Our sample included a total of 119 eligible patients (60 males; mean age, 73 years) with a median baseline National Institute of Health Stroke Scale (NIHSS) score of 14. Patients with a good LMC score had a lower baseline mean NIHSS score, a higher mean Alberta Stroke Program Early CT score, and a higher mean clot burden score (CBS). Baseline NIHSS score <15 (odds ratio [OR] 3.69 95% confidence ratio [CI]: 1.32-10.29, P?=?.013), CBS ≥ 6 (OR 3.97 95%CI: 1.05-14.99, P?=?.042), good LMC score (OR 5.14 95%CI: 1.62-16.26, P?=?.005) and successful recanalization (OR 11.55 95%CI: 2.72-48.99 P?=?.001) were independent predictors of good clinical outcomes.Conclusions
CTA-based LMC status and CBS are powerful predictors of clinical outcomes in patients with an acute ICA terminus occlusion treated with EVT. 相似文献6.
Rajan Gadhia David McCane Jason Lee Ken Chyuan Ling Kevin Jiang David Chiu 《Journal of stroke and cerebrovascular diseases》2018,27(11):2973-2976
Background
We present a single institution registry with the novel feature of 90-day outcome assessments on all hospitalized acute stroke patients, inclusive of every patient with a primary discharge diagnosis of transient ischemic attack (TIA), acute ischemic stroke (AIS), nontraumatic subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH).Methods
Patient data obtained in the HOPES registry include demographics, comorbid diagnoses, medications, health behaviors, laboratory values, imaging studies, vital signs, and outcome measures, most notably the modified Rankin Scale (mRS) at 90days.Results
From May 2016 to December 31, 2017, 1607 patients were enrolled in the HOPES registry. 90-day outcome assessments were captured on 1555 patients (97%): 1096 AIS, 230 ICH, 110 SAH, and 119 TIA patients. Mortality rates and 90-day outcomes were most favorable for TIA patients. Mortality and 90-day disability scores were poorest for patients in the ICH group.Conclusions
The inclusion of 90-day outcomes data will allow HOPES to stand apart among stroke registries as a new standard for stroke outcomes research. The registry will provide the necessary comprehensive data that the field needs as we transition our focus of stroke research to poststroke recovery. 相似文献7.
Jianfeng Qu Yangkun Chen Genpei Luo Huohua Zhong Weimin Xiao Hanpeng Yin 《Journal of stroke and cerebrovascular diseases》2018,27(10):2641-2647
Objective
The aim of this prospective cohort study was to assess the incidence and risk factors of delirium following acute ischemic stroke, as well as its effects on functional outcome.Methods
Two hundred and sixty-one patients with acute ischemic stroke were screened for delirium during the first week after admission. Delirium was diagnosed according to the Confusion Assessment Method. If delirium was present, delirium rating scale-revised-98 was used to assess its severity. Neurologic deficits were assessed with the National Institutes of Health Stroke Scale (NIHSS). Brain magnetic resonance imaging assessment quantified the infarction, white matter lesions, and medial temporal lobe atrophy. Functional outcome assessment included the modified Rankin Scale and Lawton Instrumental Activities of Daily Living scale at 3 and 6 months after the index stroke.Results
Thirty-eight (14.6%) patients with acute ischemic stroke developed delirium during the first week of admission. Patients with poststroke delirium (PSD) were older, had higher NIHSS scores on admission, and were more likely to have a previous stroke, an infection, and a left cortical infarct. Furthermore, left cortical infarction, older age, severer neurological deficit and having a previous stroke increased the risk of PSD. PSD was associated with a worse functional outcome.Conclusion
The incidence of delirium was 14.8% in the first week after admission with acute ischemic stroke. Age, having a previous stroke, stroke severity, and left-cortical infarction were independently predictors of PSD. PSD may result in a significantly worse functional outcome. 相似文献8.
Aryandhito Widhi Nugroho Hisatomi Arima Naoyuki Takashima Takako Fujii Satoshi Shitara Naomi Miyamatsu Yoshihisa Sugimoto Satoru Nagata Masaru Komori Yoshikuni Kita Katsuyuki Miura Kazuhiko Nozaki 《Journal of stroke and cerebrovascular diseases》2018,27(10):2579-2586
Background and Purpose
Most available scoring system to predict outcome after acute ischemic stroke (AIS) were established in Western countries. We aimed to develop a simple prediction score of 1-month severe disability/death after onset in AIS patients ineligible for recanalization therapy based on readily and widely obtainable on-admission clinical, laboratory and radiological examinations in Asian developing countries.Methods
Using the Shiga Stroke Registry, a large population-based registry in Japan, multivariable logistic regression analysis was conducted in 1617 AIS patients ineligible for recanalization therapy to yield ß-coefficients of significant predictors of 1-month modified Rankin Scale score of 5-6, which were then multiplied by a specific constant and rounded to nearest integer to develop 0-10 points system. Model discrimination and calibration were evaluated in the original and bootstrapped population.Results
Japan Coma Scale score (J), age (A), random glucose (G), untimely onset-to-arrival time (U), atrial fibrillation (A), and preadmission dependency status according to the modified Rankin Scale score (R), were recognized as independent predictors of outcome. Each of their β-coefficients was multiplied by 1.3 creating the JAGUAR score. Its area under the curve (95% confidence interval) was .901 (.880- .922) and .901 (.900- .901) in the original and bootstrapped population, respectively. It was found to have good calibration in both study population (P = .27).Conclusions
The JAGUAR score can be an important prediction tool of severe disability/death in AIS patients ineligible for recanalization therapy that can be applied on admission with no complicated calculation and multimodal neuroimaging necessary, thus suitable for Asian developing countries. 相似文献9.
Yong Huang Yasuyuki Ohta Jingwei Shang Xianghong Li Xia Liu Xiaowen Shi Tian Feng Toru Yamashita Kota Sato Mami Takemoto Nozomi Hishikawa Eriko Suzuki Keiji Hasumi Koji Abe 《Journal of stroke and cerebrovascular diseases》2018,27(12):3521-3528
Background
Stachybotrys microspora triprenyl phenol-7 (SMTP-7) has both thrombolytic and anti-inflammatory effects, but its neuroprotective effects on cerebral ischemia are still unclear. The present study assessed the antioxidative and neurovascular unit (NVU) protective effects of SMTP-7 using transient middle cerebral artery occlusion (tMCAO) mice.Methods
After 60 minutes tMCAO, 0.9% NaCl, tissue-type plasminogen activator (tPA), SMTP-7 or tPA?+?SMTP-7 was intravenously administrated through subclavian vein just before the reperfusion, and these mice were examined at 24 hours after reperfusion. We histologically assessed the hemorrhage and expressive changes of antioxidative markers in brains.Results
SMTP-7 treatment showed a similar antithrombotic effect to tPA, but significantly decreased the hemorrhage volumes and the number of 4-HNE, 3-NT and 8-OHdG positive cells, meanwhile, ameliorated the decrease of collagen IV in the ischemic brains. However, tPA?+?SMTP-7 treatment did not decrease hemorrhage volumes nor showed NVU protective effect.Conclusions
The present study suggested that SMTP-7 provided therapeutic benefits for ischemic stroke through antioxidative and NVU protective effects unlike tPA alone or tPA?+?SMTP-7. 相似文献10.
Wenwen Zhang Skye Coote Tanya Frost Helen M. Dewey Philip M.C. Choi 《Journal of stroke and cerebrovascular diseases》2018,27(10):2707-2711
Background
Thrombolytic therapy in patients with pre-existing disability presenting with acute ischemic stroke (AIS) is controversial because of concerns regarding poor outcomes and futility of treatment. We hypothesized that a similar proportion of patients with and without pre-existing disability would return to their premorbid functional status following thrombolysis.Methods
This was a retrospective study at a single high-volume academic primary stroke center. All patients with AIS treated with intravenous alteplase between January 2005 and July 2016 were included. Premorbid functional status was assessed using modified Rankin scale (mRS) and dichotomized as independent premorbid (mRS 0-1) or disabled premorbid (mRS 2-4) groups for comparison. Functional outcome was assessed by mRS at 90 days and compared between groups.Results
Six hundred eighty patients independent premorbid (mean age 71.8 ± 13.1 years, 57.9% male) and 140 disabled premorbid (mean age 82.1 ± 8.7 years, 40.7% male) were included. Patients with pre-existing disability were older and had more vascular risk factors and more severe stroke on presentation (P < 0.05). A greater proportion of patients in the disabled premorbid group were dead at 90 days (35.7% versus 12.8%, P < 0.05). At 90 days, among patients with premorbid mRS 0, 1, 2, 3, and 4: 25%, 38%, 32%, 30%, and 25% of them returned to their respective premorbid mRS status.Conclusions
Irrespective of premorbid functional level, approximately one fourth to one third of thrombolyzed patients had returned to their premorbid functional levels at 90 days. Thrombolytic treatment should be considered in patients with mild-to-moderate pre-existing disability, taking into account the value placed on the chance of a return to premorbid functional status. 相似文献11.
Bo Shen Xu YANG Ru-bo Sui Bo Yang 《Journal of stroke and cerebrovascular diseases》2018,27(10):2877-2886
Background
Acute ischemic stroke (AIS) has a higher morbidity and mortality rate. Many prediction tools have been developed to predict the risk of poor outcomes in patients after AIS, such as the THRIVE score, the iScore score, and the ASTRAL score. However, the predictive value of above 3 prediction tools in Chinese patients with AIS need to be further verified. So, this study aimed to determine the ability of the THRIVE score, the iScore score, and the ASTRAL score in predicting clinical poor outcomes in Chinese patients with AIS at 1 year.Methods
A total of 772 patients with AIS were included in this study. The baseline data of all patients were collected. The THRIVE score, the iScore score, and the ASTRAL score were calculated. All patients were followed up at 1 year. The poor outcome was defined as death, moderate/severe disabilities (modified Rankin scale, mRS > 2), most severe disability (mRS ≥ 5). Model discrimination was quantified by calculating the area under the receiver operating characteristic curve (AUC). The calibration was assessed using Hosmer–Lemeshow goodness-of-fit test and Pearson correlation coefficient.Results
We identified 576 (74.6%) patients with good prognosis and 196 (25.4%) patients with poor prognosis. AUC values of THRIVE score in predicting 1-year poor prognosis was lower than the iScore score and the ASTRAL scores (P < .05). The chi-square values of Hosmer-Lemeshow for the 3 prediction tools were 2.114, 4.877, 5.838 (all P < .05), respectively. There was a high correlation between the observed and the expected poor prognosis (Pearson correlation coefficient, .985, .693, and .620; all P < .05). AUC values of THRIVE score in predicting 1-year mortality and severe disability were lower than the iScore scores (all P < .05).Conclusions
The iScore score and the ASTRAL score reliably predict 1-year poor outcomes in Chinese patients with AIS, and the iScore score can accurately predict 1-year mortality and severe disability in Chinese AIS patients. 相似文献12.
Background
Several studies have reported on predictors for caregiver burden in patients with stroke, but the magnitude of the impact of these variables remains unclear. The aim of the study was to determine the magnitude of relationship between each predictor and caregiver burden.Methods
Articles related to this filed were search in PUBMED, MEDLINE and Cochrane Library electronic database from the upset to May 2018. Of the 812 articles identified, 22 were included in the final analysis (3025 patients and 2887 caregivers). Weighted correlation coefficient (r-index) was computed as effect size for each predictor.Results
Of predictor variables of patients, the activity of daily living and anxiety had moderate to large effect sizes; gender, neurological function and depression had the small to moderate effect sizes. Of caregivers’ predictors, depression, anxiety, and sense of coherence had large effect sizes; gender, daughter in law, physical health and employment status had small to moderate effect sizes.Conclusions
The most powerful predictors of caregiver burden using meta-analysis were identified to direct future research and evidence-based practice. 相似文献13.
Yong Huang Yasuyuki Ohta Jingwei Shang Ryuta Morihara Yumiko Nakano Yusuke Fukui Xia Liu Xiaowen Shi Tian Feng Toru Yamashita Kota Sato Mami Takemoto Nozomi Hishikawa Eriko Suzuki Keiji Hasumi Koji Abe 《Journal of stroke and cerebrovascular diseases》2018,27(11):3084-3094
Background
Stachybotrys microspora triprenyl phenol-7 (SMTP-7) has both potentials of thrombolytic and neuroprotective effects, but its detailed neuroprotective mechanisms in ischemic stroke are still unclear. Here, we assessed the neuroprotective effects of SMTP-7 for anti-inflammatory and antiapoptosis mechanisms after 60 minutes of transient middle cerebral artery occlusion (tMCAO) in mice.Methods
After 60minutes of tMCAO, 0.9% NaCl, tissue-type plasminogen activator (tPA), SMTP-7 or tPA+SMTP-7 was intravenously administrated through subclavian vein just before the reperfusion, and these mice were examined at 24hours after reperfusion. We histologically assessed the antineuroinflammatory effect of SMTP-7 on the expressive changes of inflammatory markers in ischemic mouse brains.Results
Compared with the vehicle and tPA groups, SMTP-7 treatment significantly improved clinical scores and decreased the infarct volume and the numbers of TNF-α, nuclear factor-κB (NF-κB), nucleotide oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3), and cleaved caspase-3-positive cells in the brain of mice at 24hours after tMCAO but not p62-positive cells. However, tPA+SMTP-7 treatment did not show such effects.Conclusions
The present study suggested that SMTP-7 provides a therapeutic benefit for ischemic stroke mice through anti-inflammatory and antiapoptotic effects but not antiautophagic effect. 相似文献14.
Signe Voigt Lauridsen Anne-Mette Hvas Emilie Sandgaard Tua Gyldenholm Christian Rahbek Niels Hjort Else Kirstine Tønnesen Christine Lodberg Hvas 《Journal of stroke and cerebrovascular diseases》2018,27(11):2951-2961
Background
Intracerebral hemorrhage (ICH) causes death or disability and the incidence increases with age. Knowledge of acute hemostatic function in patients with ICH without anticoagulant and antiplatelet therapy is sparse. Increased knowledge of the coagulation profile in the acute phase of ICH could improve acute treatment and recovery. We investigated coagulation at admission and changes in coagulation during the first 24hours after symptom onset.Methods
Enrolled were 41 ICH patients without anticoagulant or antiplatelet therapy admitted to Aarhus University Hospital, Denmark. Blood samples were collected at admission, 6, and 24hours after symptom onset. Thromboelastometry (ROTEM), thrombin generation, and thrombin-antithrombin (TAT) complex were analyzed. Clinical outcome was evaluated using the National Institute of Health Stroke Scale, the Modified Rankin Score, and mortality.Results
At admission, compared with healthy individuals, ICH patients had increased maximum clot firmness (EXTEM P < .0001; INTEM P < .0001; FIBTEM P < .0001), increased platelet maximum clot elasticity (P < .0001) in ROTEM, higher peak thrombin (P < .0001) and endogenous thrombin potential (P?=?.01) in thrombin generation, and elevated TAT complex levels. During 24hours after significantly, while thrombin generation showed decreased peak thrombin (P < .0001) and endogenous thrombin potential (P < .0001). Coagulation test results did not differ between patients when stratified according to clinical outcome.Conclusions
ICH patients without anticoagulant or antiplatelet therapy demonstrated activated coagulation at admission and within 24hours after symptom onset. 相似文献15.
Sedigheh Behrouzifar Abedin Vakili Mehdi Barati 《Journal of stroke and cerebrovascular diseases》2018,27(11):3272-3279
Background
Our recent research showed that resistin has a neuroprotective effect against stroke-induced injury through suppressing apoptosis and oxidative stress. However, the molecular mechanism of neuroprotection of resistin is unclear. This work was designed to examine the effect of mouse recombinant resistin on mRNA expression of Tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-10 (IL-10), Transforming growth factor-β1 (TGF- β1), and Heat shock protein-70 (HSP-70) in mouse model of stroke.Materials and Methods
Transient focal cerebral ischemia was induced by the middle cerebral artery occlusion (MCAO) in mice. TNF-α, IL-1β, IL-10, TGF-β1, and HSP-70 mRNA were detected at sham (0 hour), 3 hours, 6 hours, 12 hours, and 24 hours after MCAO using real-time QRT-PCR method. Moreover, animals were treated with resistin at the dose of 400ng/mouse at the commencement of MCAO, and mRNA expression of the cytokines and HSP-70 was measured 24 hours after MCAO.Results
Tumor necrosis factor-α and IL-1β mRNA expression markedly increased at 12-hour time point and then returned to the basal level at 24 hours after MCAO; but HSP-70 mRNA expression increased at 24-hour time point. Furthermore, resistin (400 ng/mouse) significantly increased TGF-β1 and IL-10 and decreased HSP-70 gene expression at 24 hours after MCAO.Conclusions
Our findings revealed that a molecular mechanism of attenuating ischemic damage by resistin administration probably is increased mRNA expression of anti-inflammatory cytokines. However, applying resistin in the clinical settings for the treatment of stroke deserves further researches in the future. 相似文献16.
Kamal Narayan Arya Shanta Pandian Vinod Puri 《Journal of stroke and cerebrovascular diseases》2018,27(11):3236-3246
Background
Poststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects.Methods Design
Randomized controlled trial.Setting
Functional therapy laboratory of Rehabilitation Institute.Participants
Thirty-one chronic poststroke subjects (17 experimental and 14 controls), aged between 30 and 60years, with ≤ diminished light touch in the hand.Outcome Measure
Semmes Weinstein Monofilament (cutaneous threshold), 2-Point discrimination test (touch discrimination) and Fugl-Meyer Assessment (hand motor recovery).Intervention
The experimental group received sensory stimulus such as tactile perception and motor tasks on the less-affected hand using mirror box. The control counterparts underwent only dose-matched conventional program. 30 sessions with a frequency of 5/week were imparted to the groups.Results
Post intervention, there was a significant (P < .004) increase up to 30% positive touch-response for the hand quadrants among the experimental group in comparison to only 13.5% rise for the same among the controls. The cutaneous threshold of the less-affected palm also improved significantly among the experimental subjects in comparison to the controls (P = .04).Conclusion
MT may be considered as a promising regime for enhancing cutaneous sensibility in stroke. The mirror illusion induced by MT may be utilized for sensory and motor deficits as well as for the more-affected and less-affected hands. 相似文献17.
Gustaf Magaard Per Wester Richard Levi Peter Lindvall Emma Gustafsson Arzhang Nazemroaya Sedeh Malin Lönnqvist Stina Berggren Kristin Nyman Xiaolei Hu 《Journal of stroke and cerebrovascular diseases》2018,27(11):3224-3235
Background
Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic “Rehab-Compass,” a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.Methods
A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-CompassTM was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross-sectionalstudy with 48 patients at 5-month follow-ups after subarachnoid hemorrhage.Results
The Rehab-CompassTM identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-CompassTM appeared to be feasible and time-efficientin clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-CompassTM graph. In the studied stroke patients, the Rehab-CompassTM identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems.Conclusions
The graphic Rehab-CompassTM seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-CompassTM more concise and evaluate the instrument among different stroke subgroups. 相似文献18.
Yitzchok S. Lederman Clotilde Balucani Leah R. Steinberg Charles Philip Jason M. Lazar Jeremy Weedon Gautam Mirchandani Sarah Z. Weingast Giovanna Viticchi Lorenzo Falsetti Mauro Silvestrini James J. Gugger David Aharonoff Pirouz Piran Zachary Adler Steven R. Levine 《Journal of stroke and cerebrovascular diseases》2019,28(1):44-48
Background
QT dispersion, maximal interlead difference in QT interval on 12-lead electrocardiogram (ECG), measures cardiac repolarization abnormalities. Data are conflicting whether QT dispersion predicts adverse outcome in acute ischemic stroke (AIS) patients. Our objective is to determine if QT dispersion predicts: (1) short-term clinical outcome in AIS, and (2) stroke location (insular versus noninsular cortex).Methods
Admission ECGs from 412 consecutive patients with acute stroke symptoms from 2 university-based stroke centers were reviewed. QT dispersion was measured. A neuroradiologist reviewed brain imaging for insular cortex involvement. Favorable clinical outcomes at discharge were modified Rankin Scale (mRS) score of 0-1, discharge National Institutes of Health Stroke Scale (NIHSS) score less than 2, and discharge to home. Multiple logistic regressions were performed for each outcome measure and to determine the association between insular infarct and QT dispersion.Results
Of 145 subjects in the final analysis, median age was 65 years (interquartile range [IQR] 56-75), male patients were 38%, black patients were 68%, median QT dispersion was 78 milliseconds (IQR 59-98), and median admission NIHSS score was 4 (IQR 2-6). QT dispersion did not predict short-term clinical outcome for mRS score (odds ratio [OR] = 1.001, 95% confidence interval [CI] .99-1.01, P = .85), NIHSS at discharge (OR = .994, 95% CI .98-1.01, P = .30), or discharge disposition (OR?=?1.001, 95% CI .99-1.01, P = .81). Insular cortex involvement did not correlate with QT dispersion magnitude (OR?=?1.009, 95% CI .99-1.02, P = .45).Conclusions
We could not demonstrate that QT dispersion is useful in predicting short-term clinical outcome at discharge in AIS. Further, the magnitude of QT dispersion did not predict insular cortical stroke location. 相似文献19.
Eyad Almallouhi Sami Al Kasab Jillian B. Harvey Christopher Reardon Ali Alawieh Tarun Girotra Patricia Aysse Raymond D. Turner Christine A. Holmstedt 《Journal of stroke and cerebrovascular diseases》2019,28(1):185-190
Objective
To assess the long-term functional outcome of stroke in patients treated with mechanical thrombectomy (MT) performed during work hours (on-hours) versus after-hours, weekends, and official holidays (off-hours).Methods
Data on all patients receiving MT at a comprehensive stroke center was collected between December 2014-December 2016. Our primary outcomes were the discharge and 90-day modified Rankin Scale (mRS). We developed propensity scores for off-hours treatment and used inverse probability of treatment weights to address confounding. We estimated logistic regression to assess the relationship between off-hours treatment and favorable patient outcomes. Independent variables include receiving thrombectomy during the off-hours, admission National Institute of Health Stroke Scale (NIHSS), door to groin time in minutes, age, and race.Results
During the study period, 80 (41%) patients underwent thrombectomy during on-hours and 116 (59%) during off-hours. Mean age was 69.1 years for the on-hours group and 64.1 years for the off-hours group (P?=?.02). There were no statistically significant differences in median admission NIHSS, rate of alteplase administration, mean time from last known well to thrombectomy, rate of revascularization, and rate of hemorrhagic transformation between the 2 groups. Logistic regression analysis showed the probability of a favorable outcome at discharge (mRS ≤ 2) is 12.6 % lower for off-hours patients (P?=?.038, [95%CI ?.25 to ?.01]). For patients with a 90-day mRS (n?=?117), the probability of a favorable outcome was 18.7% lower for those treated during the off-hours (P?=?.029, [95%CI ?.36 to ?.02]).Conclusions
There is a higher probability of a good functional outcome in acute ischemic stroke patients who receive MT when performed during regular work hours. 相似文献20.
Diana Baptista Pedro Abreu Elsa Azevedo Rui Magalhães Manuel Correia 《Journal of stroke and cerebrovascular diseases》2018,27(11):3115-3123