scholarly journals Stroke after Initiating IV Penicillin for Neurosyphilis: A Possible Jarisch-Herxheimer Reaction

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Vineet Punia ◽  
Appaji Rayi ◽  
Adithya Sivaraju
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vascular Occlusion ◽  
Penicillin G ◽  
Stroke Risk Factors ◽  
The Us ◽  
Clonic Seizures ◽  
Penicillin Treatment ◽  
The Brain ◽  
Drug Adverse Reactions

Introduction.Syphilis incidence has increased in the US in the last decade. Jarisch-Herxheimer reaction (JHR) is a well-documented adverse effect of penicillin treatment in syphilis. Stroke has not been reported as part of its phenomenology.Case Report.A 57-year-old man presented with worsening memory. His minimental status examination score was 14/30. Serum RPR test was positive and VDRL test in the CSF was reactive. Within six hours of first dose of IV crystalline penicillin G, he was found to have hemineglect and difficulty moving the left leg. MRI of the brain showed multiple acute ischemic strokes. Immediate MRA ruled out vascular occlusion. Penicillin treatment was stopped. Four hours later, he was found to be febrile and had two episodes of generalized tonic-clonic seizures.Conclusions.We report a case of confirmed neurosyphilis with no known modifiable stroke risk factors, who developed acute ischemic stroke and other constitutional symptoms consistent with JHR after IV penicillin. This is the first reported case in literature where an acute ischemic stroke can be attributed to Jarisch-Herxheimer reaction. Given an increase in incidence of syphilis in recent years, our case underlies the importance of keeping in mind potential catastrophic drug adverse reactions in neurosyphilis patients.

Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Urvish K Patel ◽  
Priti Poojary ◽  
Vishal Jani ◽  
Mandip S Dhamoon
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Stroke Risk ◽  
Behavioral Risk Factors ◽  
Behavioral Risk ◽  
Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

Abstract MP16: Excessive White Matter Hyperintensity Burden and Functional Outcomes After Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sungmin Hong ◽  
Anne-katrin Giese ◽  
Markus D Schirmer ◽  
Adrian V Dalca ◽  
Anna Bonkhoff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Life Time ◽  
Stroke Recovery ◽  
White Matter Hyperintensity ◽  
Brain Health ◽  
Stroke Outcomes ◽  
The Brain

Objective: Ability of the brain to recover after an acute ischemic stroke (AIS) is linked to the pre-stroke burden of white matter hyperintensity (WMH), a radiographic marker of brain health. We sought to determine the excessive WMH burden in an AIS population and investigate its association with 3-month stroke outcomes. Data: We used 2,435 subjects from the MRI-GENIE study. Three-month functional outcomes of 872 subjects among those subjects were measured by 90-day modified Ranking Scale (mRS). Methods: We automatically quantified WMH volume (WMHv) on FLAIR images and adjusted for a brain volume. We modeled a trend using the factor analysis (FA) log-linear regression using age, sex, atrial fibrillation, diabetes, hypertension, coronary artery disease and smoking as input variables. We categorized three WMH burden groups based on the conditional probability given by the model (LOW: lower 33%, MED: middle 34%, and HIGH: upper 33%). The subgroups were compared with respect to mRS (median and dichotomized odds ratio (OR) (good/poor: mRS 0-2/3-6)). Results: Five FA components out of seven with significant relationship to WMHv (p<0.001) were used for the regression modeling (R 2 =0.359). The HIGH group showed higher median (median=2, IQR=2) mRS score than LOW (median=1, IQR=1) and MED (median=1, IQR=1). The odds (OR) of good AIS outcome for LOW and MED were 1.8 (p=0.0001) and 1.6 (p=0.006) times higher than HIGH, respectively. Conclusion: Once accounted for clinical covariates, the excessive WMHv was associated with worse 3-month stroke outcomes. These data suggest that a life-time of injury to the white matter reflected in WMH is an important factor for stroke recovery and an indicator of the brain health.

Abstract 1122‐000034: Systematic CT‐Perfusion acquisition in All Suspected Stroke Patients Increases Vascular Occlusion Detection and Thrombectomy Rates

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Marta Olive‐Gadea ◽  
Manuel Requena ◽  
Facundo Diaz ◽  
Alvaro Garcia‐Tornel ◽  
Marta Rubiera ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Symptoms ◽  
Ct Perfusion ◽  
False Negative ◽  
False Negative Rate ◽  
Vascular Occlusion ◽  
Stroke Patients ◽  
Imaging Protocols ◽  
The Impact

Introduction : In acute ischemic stroke patients, current guidelines recommend noninvasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols on VO diagnosis and EVT rates. Methods : We included patients with a suspected acute ischemic stroke that underwent urgent non‐contrast CT, CTA and CTP from April to October 2020. Hypoperfusion areas defined by Tmax>6s delay (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered due to a VO (CTP‐VO). Cases in which mechanical thrombectomy was performed were defined as therapeutically relevant VO (EVT‐VO). For patients that received EVT, site of VO according to digital subtraction angiography was recorded. Two experienced neuroradiologists blinded to CTP but not to clinical symptoms, retrospectively evaluated NCCT and CTA to identify intracranial VO (CTA‐VO). We analyzed CTA‐VO sensitivity and specificity at detecting CTP‐VO and EVT‐VO respecitvely. We performed a logistic regression to test the association of Tmax>6s volumes with CTA‐VO identification and indication of EVT. Results : Of the 338 patients included in the analysis, 157 (46.5%) presented a CTP‐VO, (median Tmax>6s: 73 [29‐127] ml). CTA‐VO was identified in 83 (24.5%) of the cases. Overall CTA‐VO sensitivity for the detection of CTP‐VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with an increased CTA‐VO detection, with an odds ratio of 1.03 (95% confidence interval 1.02‐1.04) (figure). DSA was indicated in 107 patients; in 4 of them no EVT was attempted due to recanalization or a too distal VO in the first angiographic run. EVT was performed in 103 patients (30.5%. Tmax>6s: 102 [63‐160] ml), representing 65.6% of all CTP‐VO. Overall CTA‐VO sensitivity for the detection of EVT‐VO was 69.9%. The CTA‐VO sensitivity for detecting patients with indication of EVT according to clinical guidelines was as follows: 91.7% for ICA occlusions and 84.4% for M1‐MCA occlusions. For all other occlusion sites that received EVT, the CTA‐VO sensitivity was 36.1%. The overall specificity was 95.3%. Among patients who received EVT, CTA‐VO was not detected in 31 cases, resulting in a false negative rate of 30.1%. False negative CTA‐VO cases had lower Tmax>6s volumes (69[46‐99.5] vs 126[84‐169.5]ml, p<0.001) and lower NIHSS (13[8.5‐16] vs 17[14‐21], p<0.001). Conclusions : Systematically including CTP perfusion in the acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

scholarly journals Non-Coding RNA in Acute Ischemic Stroke: Mechanisms, Biomarkers and Therapeutic Targets

2018 ◽  
Vol 27 (12) ◽  
pp. 1763-1777 ◽  
Author(s):  
Sheng-Wen Wang ◽  
Zhong Liu ◽  
Zhong-Song Shi
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neural Development ◽  
Therapeutic Targets ◽  
Circular Rnas ◽  
Non Coding Rna ◽  
Non Coding Rnas ◽  
Cerebral Ischemic ◽  
Functional Rnas ◽  
The Brain

Non-coding RNAs (ncRNAs) are a class of functional RNAs that regulate gene expression in a post-transcriptional manner. NcRNAs include microRNAs, long non-coding RNAs and circular RNAs. They are highly expressed in the brain and are involved in the regulation of physiological and pathophysiological processes, including cerebral ischemic injury, neurodegeneration, neural development, and plasticity. Stroke is one of the leading causes of death and physical disability worldwide. Acute ischemic stroke (AIS) occurs when brain blood flow stops, and that stoppage results in reduced oxygen and glucose supply to cells in the brain. In this article, we review the latest progress on ncRNAs in relation to their implications in AIS, as well as their potential as diagnostic and prognostic biomarkers. We also review ncRNAs acting as possible therapeutic targets in future precision medicine. Finally, we conclude with a brief discussion of current challenges and future directions for ncRNAs studies in AIS, which may facilitate the translation of ncRNAs research into clinical practice to improve clinical outcome of AIS.

Abstract 16: Racial Disparities in Clinical Outcomes and Resource Utilization in Acute Ischemic Stroke Hospitalizations in the United States: Results from the 2012 National Inpatient Sample

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nilay Kumar ◽  
Anand Venkatraman ◽  
Neetika Garg
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Racial Minorities ◽  
National Inpatient Sample ◽  
The Us ◽  
To Receive ◽  
Total Charges

Background and objectives: There are limited data on racial differences in clinical and economic outcomes of acute ischemic stroke (AIS) hospitalizations in the US. We sought to ascertain the effect of race on AIS outcomes in a population based retrospective cohort study. Methods: We used the 2012 National Inpatient Sample (NIS), which is the largest database of inpatient stays in the US, to identify cases of AIS using ICD9-CM codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91 and 437.1 in patients >=18 years of age. Cases with missing data on race were excluded (5% of study sample). Primary outcome was in-hospital mortality. Secondary outcomes included proportion receiving endovascular mechanical thrombectomy (EMT) or thrombolysis, mean inflation adjusted charges and length of stay. Linear and logistic regression was used to test differences in continuous and categorical outcomes respectively. Survey techniques were used for all analyses. Results: There were 452, 330 hospitalizations for AIS in patients >=18 years in 2012. In univariate logistic regression using race as predictor, in-hospital mortality was significantly lower for Blacks (p<0.001), Hispanics (p=0.025) and Native Americans (p=0.047) compared to Whites. However, after adjusting for age, sex, Charlson comorbidity index, EMT and thrombolysis only blacks had a significantly lower mortality compared to whites (OR 0.74, 95% CI 0.66 - 0.82, p<0.001). Black patients were less likely to receive thrombolysis (OR 0.87, 95% CI 0.79 - 0.95; p=0.003) whereas Asian or Pacific Islanders were more likely to receive thrombolysis (OR 1.20, 95% CI 1.01 - 1.44; p=0.043) compared to whites. There was no difference in rates of EMT by race (p=0.18). Total charges and length of stay were significantly higher in racial minorities compared to whites (table). Conclusions: Blacks hospitalized for AIS have significantly lower in-hospital mortality compared to whites but are significantly less likely to receive thrombolysis compared to whites. Total charges and length of stay are significantly higher for racial minorities. Future studies should investigate mechanisms of this apparent protective effect of black race on in-hospital mortality in AIS.

Abstract TP284: The Risk of Venous Thromboembolism Among Patients Hospitalized for Acute Ischemic Stroke in the US

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Alpesh Amin ◽  
Richey Neuman ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
Jay Lin
Keyword(s):  
Ischemic Stroke ◽  
Venous Thromboembolism ◽  
Acute Ischemic Stroke ◽  
The Us

Remote ischemic conditioning for acute ischemic stroke: dawn in the darkness

2016 ◽  
Vol 27 (5) ◽  
pp. 501-510 ◽  
Author(s):  
Jingrui Pan ◽  
Xiangpen Li ◽  
Ying Peng
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ischemic Preconditioning ◽  
Research Progress ◽  
High Morbidity ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Remote Ischemic Perconditioning ◽  
Neuroprotective Strategy ◽  
The Brain

AbstractStroke is a leading cause of disability with high morbidity and mortality worldwide. Of all strokes, 87% are ischemic. The only approved treatments for acute ischemic stroke are intravenous thrombolysis with alteplase within 4.5 h and thrombectomy within 8 h after symptom onset, which can be applied to just a few patients. During the past decades, ischemic preconditioning has been widely studied to confirm its neuroprotection against subsequent ischemia/reperfusion injury in the brain, including preconditioning in situ or in a remote organ (such as a limb) before onset of brain ischemia, the latter of which is termed as remote ischemic preconditioning. Because acute stroke is unpredicted, ischemic preconditioning is actually not suitable for clinical application. So remote ischemic conditioning performed during or after the ischemic duration of the brain was then designed to study its neuroprotection alone or in combination with alteplase in animals and patients, which is named as remote ischemic perconditioning or remote ischemic postconditioning. As expected, animal experiments and clinical trials both showed exciting results, indicating that an evolution in the treatment for acute ischemic stroke may not be far away. However, some problems or disputes still exist. This review summarizes the research progress and unresolved issues of remote ischemic conditioning (pre-, per-, and post-conditioning) in treating acute ischemic stroke, with the hope of advancing our understanding of this promising neuroprotective strategy for ischemic stroke in the near future.

Acute Ischemic Stroke Treatment with Mechanical Embolectomy Has Doubled in the US from 2008 to 2010 (IN2-1.005)

Neurology ◽  
2012 ◽  
Vol 78 (Meeting Abstracts 1) ◽  
pp. IN2-1.005-IN2-1.005
Author(s):  
P. Khatri ◽  
K. Meganathan ◽  
O. Adeoye ◽  
R. Hornung ◽  
D. Kleindorfer
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Treatment ◽  
The Us

scholarly journals New Advances in Acute Ischemic Stroke Management: Review Article

2020 ◽  
Vol 7 (2) ◽  
pp. 55-60
Author(s):  
Hossein Aghamiri ◽  
Sepideh Paybast ◽  
Behnam Safarpour Lima ◽  
Behnam Mansoori
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Web Of Science ◽  
State Of The Art ◽  
Data Extraction ◽  
Treatment Strategies ◽  
Recent Advances ◽  
The Brain ◽  
Arterial Thrombolysis

Cerebrovascular disease is the second cause of death and the sixth cause of morbidity worldwide, which will rise to fourth place by 2020. The treatment strategies for acute ischemic stroke (AIS) divided into two groups, including intravenous or intra-arterial thrombolysis and mechanical thrombectomy. Regarding growing development in the realm of diagnosis and treatment of stroke through state-of-the-art approaches, including emergent thrombectomy, there are new opportunities for investigation in this area. This is while a rough rate of 85% for strokes is occupied by, and the remained is hemorrhagic. Hence, the present study aimed to review recent advances in AIS with a focus on emergent thrombectomy. Here, we first provided the relevant history, and then the recent advances were discussed. The library data collection method was employed so that such databases as Web of Science, PubMed, and Science Direct used for data extraction. The evidence confirms the importance of emergent thrombectomy as all believe the famous statement "time is the brain." However, further investigations are required to find more strong evidence accordingly.

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