scholarly journals Scalp acupuncture enhances local brain regions functional activities and functional connections between cerebral hemispheres in acute ischemic stroke patients

2021 ◽  
Author(s):  
Huacong Liu ◽  
Yijing Jiang ◽  
Ningning Wang ◽  
Han Yan ◽  
Lanpin Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Brain Regions ◽  
Scalp Acupuncture ◽  
Cerebral Hemispheres ◽  
Stroke Patients ◽  
Functional Activities ◽  
Functional Connections ◽  
Local Brain

Abstract WP38: Early Progressive Ischemia Predicts Worse Clinical Outcome In Acute Ischemic Stroke and Is Decreased With tPA Treatment

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Hongyu An ◽  
Katie D Vo ◽  
William J Powers ◽  
Weili Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Mean Transit Time ◽  
Multivariable Analysis ◽  
Brain Regions ◽  
Perfusion Deficit ◽  
Stroke Patients ◽  
Median Volume ◽  
Multivariable Regression

Background: While some ischemic stroke patients improve rapidly after onset, many show no improvement or even worsening in the first days after stroke. We hypothesized that development of brain regions with “progressive ischemia” within hours of stroke onset may predict poor clinical outcome. Methods: Acute ischemic stroke patients underwent two MR scans: within 4.5 hrs (tp1) and at 6 hrs (tp2) after onset. Mean transit time (MTT) maps measured tp1 and tp2 perfusion deficits. “Perfusion deficit” was defined as MTT > 6 s longer than the contralateral median. Volume of progressive ischemia (V PR ) was defined by regions of normal perfusion (MTT<6) at tp1 which became abnormal (MTT>6) at tp2. Bivariate analyses between V PR and ΔNIHSS from admission to 1 month, V PR and 1 month mRS, and V PR and 1 month mortality were performed. Multivariable regression identified if V PR predicted ΔNIHSS, mRS, and mortality after adjusting for admission NIHSS, volume of reperfusion (V rep ), and volume of tp1 perfusion deficit (V tp1 ). Regression analysis determined if tPA treatment predicted V PR after adjusting for admission NIHSS and V tp1 . Results: Fifty patients were scanned at 2.9 (tp1) and 6.4 hrs (tp2) after onset. Mean NIHSS=14; 74% received IV tPA. Progressive ischemia was found in 34 (68%) patients (Fig. shows patient example). Mean V tp1 , V rep , and V PR were 50, 14.4, and 6.4ml, respectively. V PR correlated with ΔNIHSS (r=-.25, p=0.096), mRS (r=.44, p=0.002), and mortality (r=.31, p=0.034). In multivariable analysis, V PR predicted less improvement in ΔNIHSS (β=-.19, p=0.019) and greater disability on mRS (β=0.06, p=0.016). In multivariable analysis, tPA treatment negatively predicted V PR (β=-3.6, p=0.050). Conclusion: Progressive ischemia, identified in 2/3 of our cohort, predicted worse outcomes. As tPA treatment predicted less progressive ischemia, therapies aimed at preventing progressive ischemia in acute ischemic stroke may be considered in addition to promoting reperfusion.

scholarly journals Functional Connection Changes among Cerebral Regions and between Hemispheres in the Acute Ischemic Stroke Patients Treated by Scalp Acupuncture: A Rs-fMRI Study

2020 ◽  
Author(s):  
Huacong Liu ◽  
Yijing Jiang ◽  
Ningning Wang ◽  
Lanpin Chen ◽  
Jingchun Gao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Scalp Acupuncture ◽  
Middle Temporal Gyrus ◽  
Control Group ◽  
Middle Temporal ◽  
Functional Activities ◽  
Before And After

Abstract Objective: Resting State Functional Magnetic Resonance Imaging (Rs-fMRI) was used to explore the changes on the functional connections between cerebral hemispheres and local functional activities in patients with acute ischemic stroke dysfunction treated by International Standard Scalp Acupuncture.Methods: 30 patients of acute ischemic stroke in the middle cerebral artery supply area of the dominant hemisphere were selected and randomly divided into treatment group and control group at a ratio of 1:1 according to the random number table method, with 15 patients in each group. Patients in the control group were treated with conventional western medicine, while patients in the treatment group combined the International Standard Scalp Acupuncture (MS5, MS6 and MS7). All the patients were evaluated for efficacy and received whole brain fMRI scan before and after the treatment. The observation indicators included (1) NHISS score and its sub-item scores related to dyskinesia before and after treatment. (2) the amplitude of low-frequency fluctuations (ALFF), regional homogeneity (ReHo), and voxel-mirror homotopy connection (VMHC) analyzed based on Matlab 2012a platform, SPM12, and REST1.8 before and after treatment.Results: 1. The difference of NHISS scores between the two groups was statistically significant before and after treatment (P<0.05), indicates that patients in the treatment group were improved better. 2. The changes in brain area activation between the two groups of patients were as follows: (1) The values of VMHC increased in brain regions dominated by bilateral BA6 and BA8; (2) The values of ALFF increased mainly in the left BA39 and the adjacent superior temporal gyrus and middle temporal gyrus . (3) The values of ReHo increased in the brain region of left middle temporal gyrus (including BA21) and its extending to BA37, and the left BA40 and angular gyrus and its extending to BA7. Conclusion: Scalp acupuncture can help the recovery of the patients with acute infarction of superior middle cerebral artery and its mechanism possibly related to the special changes in the regional functional activities of sensory integration, language processing and motor coordination, also the bilateral motor control of frontal lobe.Trial registration: Trial Registration Number: Chinese Clinical Trial Registry ChiCTR-IOR-15007672. Registration date: November 7, 2015.

scholarly journals Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

2020 ◽  
Vol 15 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Adnan I Qureshi ◽  
Foad Abd-Allah ◽  
Fahmi Al-Senani ◽  
Emrah Aytac ◽  
Afshin Borhani-Haghighi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Intravenous Thrombolysis ◽  
Adult Patients ◽  
World Health ◽  
Stroke Patients ◽  
International Panel ◽  
Health Organization ◽  
Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

scholarly journals Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

2021 ◽  
Vol 14 ◽  
pp. 175628642110211
Author(s):  
Georgios Magoufis ◽  
Apostolos Safouris ◽  
Guy Raphaeli ◽  
Odysseas Kargiotis ◽  
Klearchos Psychogios ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Treatment Algorithms ◽  
Late Presenters

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

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