scholarly journals Triggers of Ischemic Stroke: Results from the Stroke Onset Pilot Study

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 366-367
Author(s):  
Murray A Mittleman ◽  
Barbara Voetsch ◽  
Louis R Caplan
Keyword(s):  
Ischemic Stroke ◽  
Pilot Study ◽  
Sexual Intercourse ◽  
Illicit Drugs ◽  
Small Vessel Disease ◽  
Smoking Behavior ◽  
Physical Exertion ◽  
Structured Interview ◽  
Stroke Onset ◽  
Case Crossover

P153 Despite progress in the identification of risk factors for stroke, relatively little is known about the immediate precipitants or triggers of acute ischemic stroke (IS). We therefore conducted a pilot study to determine the presence of potential triggers within 24 hours preceding the onset of IS to establish the feasibility of conducting a case-crossover study of potential triggers of IS. The case-crossover design is an epidemiologic method that uses each patient as his/her own control, developed to evaluate the effect of potential triggers on the incidence of acute events. During the time of the pilot, we recruited 50 patients (88% of all eligible hospitalized patients) mean age 62±16 years, including 32% women. Patients were typically interviewed in hospital within 2 or 3 days of the onset of IS. The structured interview covered use of medications, caffeinated beverages, alcohol, smoking behavior, illicit drugs including marijuana and cocaine, timing of meals particularly unusually large meals, episodes of straining for defecation or urination, sexual intercourse and heavy physical exertion. Separate questions emphasized lifting heavy objects, and psychometric evaluations of anger, anxiety and depression. Large vessel atherothrombotic lesions were responsible for 39% of strokes, cardioembolic sources for 28%, small vessel disease (lacunar infarcts) for 22%, and other etiologies for 11%. The prevalence of exposure in the year prior to stroke varied from 10% for marijuana to 88% for caffeinated beverages. Exposure to potential triggers in the 24 hours before stroke onset was reported in over 30% of cases, including heavy exertion ≥ 6 METs (8%), lifting ≥ 50lbs (10%), straining for urination or defecation (4%), sexual intercourse (2%), outbursts of anger (4%), alcohol (28%), and marijuana (6%). The Stroke Onset Study Pilot demonstrates that potential triggers are present in approximately one-third of patients with IS. A larger study is required to assess whether external stressors can trigger the onset of stroke. Identifying and understanding the mechanisms by which particular exposures trigger the onset of stroke may lead to novel preventive strategies.

Etiologies and Mechanisms of Ischemic Stroke Associated with Sexual Intercourse: A Literature Review

2021 ◽  
pp. 1-9
Author(s):  
Shouyue Jin ◽  
Qingwei Yang ◽  
Xingyu Chen ◽  
Yajing Zhan
Keyword(s):  
Ischemic Stroke ◽  
Literature Review ◽  
Sexual Intercourse ◽  
Illicit Drugs ◽  
Early Recognition ◽  
Warning Sign ◽  
Paroxysmal Sympathetic Hyperactivity ◽  
Cerebral Vasoconstriction ◽  
Search Terms ◽  
Special Events

<b><i>Background:</i></b> Exposure to some special events, also called stroke triggers, can precipitate the onset of ischemic stroke (IS). Previous studies have presented preliminary hypotheses about sexual intercourse as a trigger of IS in predisposed individuals, but the mechanisms of IS associated with sexual intercourse are still not well defined. This literature review summarizes the etiologies and mechanisms of IS associated with sexual intercourse. Further studies on stroke triggers are warranted, and early recognition and appropriate preventive strategies directed against the short-term risks posed by stroke triggers may complement the long-term risk factor reduction approach. <b><i>Methods:</i></b> Articles were selected from PubMed (1946–2021) and Web of Science Core Collection (1990–2021) using the following search terms: ischemic stroke, ischaemic stroke, stroke, cerebral infarction, cerebral ischemia, cerebral embolism, embolism, sexual intercourse, sexual activity, intercourse, coitus, coition, and coital. <b><i>Results:</i></b> A total of 20 studies, which included 26 patients with IS associated with sexual intercourse, were included. This literature review found that IS associated with sexual intercourse is not rare but has not received enough attention, and paradoxical embolization and postcoital arterial dissection are common etiologies. Other etiologies include drug usage (such as sexual adjuvant drugs and illicit drugs), paroxysmal sympathetic hyperactivity, and reversible cerebral vasoconstriction syndrome. <b><i>Discussion/Conclusion:</i></b> Sexual intercourse should be considered an important trigger for IS. Clinicians should be aware that IS associated with sexual intercourse is not subjective but may be a warning sign of multiple etiologies and mechanisms.

Feasibility study of technology-enabled prevention intervention for children and families (Preprint)

2019 ◽  
Author(s):  
Nikki Theofanopoulou ◽  
Katherine Isbister ◽  
Julian Edbrooke-Childs ◽  
Petr Slovák
Keyword(s):  
Emotion Regulation ◽  
Pilot Study ◽  
Low Cost ◽  
Digital Camera ◽  
Well Being ◽  
Structured Interview ◽  
Object A ◽  
Intervention Delivery ◽  
Parents And Children

BACKGROUND A common challenge within psychiatry and prevention science more broadly is the lack of effective, engaging, and scale-able mechanisms to deliver psycho-social interventions for children, especially beyond in-person therapeutic or school-based contexts. Although digital technology has the potential to address these issues, existing research on technology-enabled interventions for families remains limited. OBJECTIVE The aim of this pilot study was to examine the feasibility of in-situ deployments of a low-cost, bespoke prototype, which has been designed to support children’s in-the-moment emotion regulation efforts. This prototype instantiates a novel intervention model that aims to address the existing limitations by delivering the intervention through an interactive object (a ‘smart toy’) sent home with the child, without any prior training necessary for either the child or their carer. This pilot study examined (i) engagement and acceptability of the device in the homes during 1 week deployments; and (ii) qualitative indicators of emotion regulation effects, as reported by parents and children. METHODS In this qualitative study, ten families (altogether 11 children aged 6-10 years) were recruited from three under-privileged communities in the UK. The RA visited participants in their homes to give children the ‘smart toy’ and conduct a semi-structured interview with at least one parent from each family. Children were given the prototype, a discovery book, and a simple digital camera to keep at home for 7-8 days, after which we interviewed each child and their parent about their experience. Thematic analysis guided the identification and organisation of common themes and patterns across the dataset. In addition, the prototypes automatically logged every interaction with the toy throughout the week-long deployments. RESULTS Across all 10 families, parents and children reported that the ‘smart toy’ was incorporated into children’s emotion regulation practices and engaged with naturally in moments children wanted to relax or calm down. Data suggests that children interacted with the toy throughout the duration of the deployment, found the experience enjoyable, and all requested to keep the toy longer. Child emotional connection to the toy—caring for its ‘well-being’—appears to have driven this strong engagement. Parents reported satisfaction with and acceptability of the toy. CONCLUSIONS This is the first known study investigation of the use of object-enabled intervention delivery to support emotion regulation in-situ. The strong engagement and qualitative indications of effects are promising – children were able to use the prototype without any training and incorporated it into their emotion regulation practices during daily challenges. Future work is needed to extend this indicative data with efficacy studies examining the psychological efficacy of the proposed intervention. More broadly, our findings suggest the potential of a technology-enabled shift in how prevention interventions are designed and delivered: empowering children and parents through ‘child-led, situated interventions’, where participants learn through actionable support directly within family life, as opposed to didactic in-person workshops and a subsequent skills application.

scholarly journals Unhealthy life habits associated with self-induced vomiting and laxative misuse in Brazilian adolescents

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ana Luiza Gomes de Souza ◽  
Alexandre Aparecido de Almeida ◽  
Priscilla Rayanne E. Silva Noll ◽  
Matias Noll
Keyword(s):  
Eating Disorders ◽  
Sexual Intercourse ◽  
Illicit Drugs ◽  
Social Cognitive ◽  
Strong Association ◽  
Educational History ◽  
First Sexual Intercourse ◽  
Psychosocial Disorders ◽  
Life Habits ◽  
Physical Changes

AbstractAdolescence is a stage in life characterized by important social, cognitive, and physical changes. Adolescents are vulnerable to various psychosocial disorders, including eating disorders. We aimed to investigate the association between unhealthy habits, sociodemographic characteristics, and the practice of self-induced vomiting or laxative misuse in a representative sample of Brazilian adolescent girls and boys. Data from 102,072 students who participated in the National Adolescent School-based Health Survey were analyzed using the dependent variable: presence or absence of self-induced vomiting and/or laxative misuse; independent variables: consumption of unhealthy and high-calorie food items, age during first sexual intercourse, and the use of tobacco, alcohol, and/or illicit drugs. Associations between exposure and outcome were estimated using Poisson’s regression models stratified by sex, and including region, school, age group, and mother's educational history as adjustment variables. Eating ultra-processed foods and age during first sexual intercourse were associated with self-induced vomiting and laxative misuse only for girls; all other variables (consuming unhealthy foods and using legal or illicit substances) were associated with these behaviors for both sexes after applying adjustment variables. Early interventions focusing on changing unhealthy behaviors may prevent development of eating disorders in adolescents. Our findings demonstrate a strong association of many unhealthy habits with laxative misuse and self-induced vomiting practices in Brazilian adolescents.

scholarly journals Efficacy and Safety of Intravenous rtPA in Ischemic Strokes Due to Small-Vessel Occlusion: Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Bartosz Karaszewski ◽  
Adam Wyszomirski ◽  
Bartosz Jabłoński ◽  
David J. Werring ◽  
Dominika Tomaka
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Efficacy And Safety ◽  
Eligibility Criteria ◽  
Vessel Occlusion ◽  
Excellent Outcome ◽  
Symptomatic Intracerebral Hemorrhage

AbstractIntravenous recombinant tissue plasminogen activator (iv-rtPA) has been routinely used to treat ischemic stroke for 25 years, following large clinical trials. However, there are few prospective studies on the efficacy and safety of this therapy in strokes attributed to cerebral small vessel disease (SVD). We evaluated functional outcome (modified Rankin scale, mRS) and symptomatic intracerebral hemorrhage (sICH) using all available data on the effects of iv-rtPA in SVD-related ischemic stroke (defined either using neuroimaging, clinical features, or both). Using fixed-effect and random-effects models, we calculated the pooled effect estimates with regard to excellent and favorable outcomes (mRS=0–1 and 0–2 respectively, at 3 months), and the rate of sICH. Twenty-three studies fulfilled the eligibility criteria, 11 of which were comparative, and there were only 3 randomized clinical trials. In adjusted analyses, there was an increased odds of excellent outcome (adjusted OR=1.53, 95% CI: 1.29–1.82, I2: 0%) or favorable outcome (adjusted OR=1.68, 95% CI: 1.31–2.15,I2: 0%) in patients who received iv-rtPA compared with placebo. Across the six studies which reported it, the incidence of sICH was higher in the treatment group (M-H RR = 8.83, 95% CI: 2.76–28.27). The pooled rate of sICH in patients with SVD administered iv-rtPA was only 0.72% (95% CI: 0.12%–1.64%). We conclude that when ischemic stroke attributed to SVD is considered separately, available data on the effects of iv-rtPA therapy are insufficient for the highest level of recommendation, but it seems to be safe. Although further therapeutic trials in SVD-related ischemic stroke appear to be justified, our findings should not prevent its continued use for this group of patients in clinical practice.

scholarly journals Intra-domain task-adaptive transfer learning to determine acute ischemic stroke onset time

2021 ◽  
Vol 90 ◽  
pp. 101926
Author(s):  
Haoyue Zhang ◽  
Jennifer S Polson ◽  
Kambiz Nael ◽  
Noriko Salamon ◽  
Bryan Yoo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Transfer Learning ◽  
Onset Time ◽  
Stroke Onset

EXPRESS: Evolving Ischemic Stroke Subtypes in 15 years: A hospital-based observational study

2021 ◽  
pp. 174749302110059
Author(s):  
Yiu Ming Bonaventure Ip ◽  
Lisa Au ◽  
Yin Yan Anne Chan ◽  
Florence Fan ◽  
Hing Lung Ip ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Recurrence Rate ◽  
Small Vessel Disease ◽  
Mainland China ◽  
Cardioembolic Stroke ◽  
Large Artery ◽  
Risk Factor Control ◽  
Stroke Subtypes ◽  
Artery Disease ◽  
Ischemic Attack

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment. Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018. Methods: We determined the stroke etiology of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the 2-year recurrence rate of major ischemic stroke subtypes. Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p<0.001), driven by the decrease in large artery disease (43.0 to 9.67 per 100,000 population (p<0.001)) and small vessel disease (71.9 to 45.7 per 100,000 population (p<0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p=0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p<0.001). 2-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p<0.001) with increased prescriptions of statin (p<0.001) and dual anti-platelet therapy (<0.001). In parallel with increased anticoagulation use across the study period (p<0.001), the 2-year recurrence of AF-related stroke reduced from 18.9% to 6% (p<0.001). Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

Statistical analysis plan of the head position in acute ischemic stroke trial pilot (HEADPOST pilot)

2016 ◽  
Vol 12 (2) ◽  
pp. 211-215
Author(s):  
Verónica V Olavarría ◽  
Hisatomi Arima ◽  
Craig S Anderson ◽  
Alejandro Brunser ◽  
Paula Muñoz-Venturelli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Statistical Analysis ◽  
Pilot Study ◽  
Acute Ischemic Stroke ◽  
Transcranial Doppler ◽  
Controlled Trial ◽  
Statistical Analysis Plan ◽  
Head Position ◽  
Process Of Care ◽  
Anterior Circulation

Background The HEADPOST Pilot is a proof-of-concept, open, prospective, multicenter, international, cluster randomized, phase IIb controlled trial, with masked outcome assessment. The trial will test if lying flat head position initiated in patients within 12 h of onset of acute ischemic stroke involving the anterior circulation increases cerebral blood flow in the middle cerebral arteries, as measured by transcranial Doppler. The study will also assess the safety and feasibility of patients lying flat for ≥24 h. The trial was conducted in centers in three countries, with ability to perform early transcranial Doppler. A feature of this trial was that patients were randomized to a certain position according to the month of admission to hospital. Objective To outline in detail the predetermined statistical analysis plan for HEADPOST Pilot study. Methods All data collected by participating researchers will be reviewed and formally assessed. Information pertaining to the baseline characteristics of patients, their process of care, and the delivery of treatments will be classified, and for each item, appropriate descriptive statistical analyses are planned with comparisons made between randomized groups. For the outcomes, statistical comparisons to be made between groups are planned and described. Results This statistical analysis plan was developed for the analysis of the results of the HEADPOST Pilot study to be transparent, available, verifiable, and predetermined before data lock. Conclusions We have developed a statistical analysis plan for the HEADPOST Pilot study which is to be followed to avoid analysis bias arising from prior knowledge of the study findings. Trial registration The study is registered under HEADPOST-Pilot, ClinicalTrials.gov Identifier NCT01706094.

A Virtual Reality Version of the Trier Social Stress Test: A Pilot Study

2011 ◽  
Vol 20 (4) ◽  
pp. 325-336 ◽  
Author(s):  
Mattias Wallergård ◽  
Peter Jönsson ◽  
Gerd Johansson ◽  
Björn Karlson
Keyword(s):  
Virtual Reality ◽  
Stress Response ◽  
Pilot Study ◽  
Social Stress ◽  
Stress Test ◽  
Structured Interview ◽  
Trier Social Stress Test ◽  
Physiological Data ◽  
Virtual Humans ◽  
Arithmetic Task

One of the most common methods of inducing stress in the laboratory in order to examine the stress response in healthy and clinical populations is the Trier Social Stress Test (TSST). Briefly, the participant is asked to deliver a speech and to perform an arithmetic task in front of an evaluating committee. The committee, consisting of three trained actors, does not respond emotionally during the test, which makes the situation very stressful for the participant. One disadvantage of the TSST is that it can be difficult to hold the experimental conditions constant. In particular, it may be difficult for actors to hold their acting constant across all sessions. Furthermore, there are several practical problems and costs associated with hiring professional actors. A computerized version of the TSST using virtual humans could be a way to avoid these problems provided that it is able to induce a stress response similar to the one of the original TSST. The purpose of the present pilot study was therefore to investigate the stress response to a virtual reality (VR) version of the TSST visualized using an immersive VR system (VR-TSST). Seven healthy males with an average age of 24 years (range: 23–26 years) performed the VR-TSST. This included delivering a speech and performing an arithmetic task in front of an evaluating committee consisting of three virtual humans. The VR equipment was a CAVE equipped with stereoscopy and head tracking. ECG and respiration were recorded as well as the participant's behavior and comments. Afterward, a semi-structured interview was carried out. In general, the subjective and physiological data from the experiment indicated that the VR version of the TSST induced a stress response in the seven participants. In particular, the peak increase in heart rate was close to rates observed in studies using the traditional TSST with real actors. These results suggest that virtual humans visualized with an immersive VR system can be used to induce stress under laboratory conditions.

Abstract TP476: White Matter Hyperintensity Burden is Associated With Poor Collateral Flow and Worse Outcomes in an Acute Ischemic Stroke Cohort

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rami-James Assadi ◽  
Hongyu An ◽  
Yasheng Chen ◽  
Andria Ford ◽  
Jin-Moo Lee
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Pearson Correlation ◽  
Stroke Onset ◽  
White Matter Hyperintensity ◽  
Flow Index ◽  
Acute Ischemia ◽  
Collateral Flow ◽  
Core Volume

Introduction: White matter hyperintensity volume (WMHv), a quantitative neuroimaging biomarker of cerebral small vessel disease (CSVD), is associated worse outcomes after ischemic stroke. In this study, we hypothesized that worse outcomes in CSVD patients were due to poor collateral flow during acute ischemia. Methods: 47 patients with acute ischemic stroke (AIS) were prospectively enrolled in this study. Serial MRIs were performed at 3 hours and 30 days after stroke onset. 3-hour FLAIR images were used to determine WMHv, after manually delineating lesions with MIPAV. An index of collateral flow (delayed perfusion to the penumbra) was determined by subtracting core volume (volume of tissue with ADC<600) from the volume of brain tissue with Tmax>2. Patient’s NIHSS was scored at 3 hours and 30 days after stroke onset and the difference was calculated (ΔNIHSS). Log-transformed WMHv was correlated to ΔNIHSS and the collateral flow index, using Pearson correlation. Results: Mean age = 63.9 years (SD 13.5); 37% female; median 3-hour NIHSS = 13 (IQR 6.5-20); median change in NIHSS between 3h and 30d = 4 (IQR: 0-7); median core volume = 13cm3 (IQR 4.3-35.6); median WMHv = 1.257cm3 (IQR 641-3595). WMHv was associated with reduced improvement in ΔNIHSS (R=-0.42, ρ=0.005). Furthermore, WMHv demonstrated a trend for association with poor collateral flow (R=-0.28, ρ=0.062). In this dataset, we will explore the relationship between WMHv and other tissue-based metrics of collateral flow, including the hypoperfusion intensity ratio (HIR) and the cerebral blood volume ratio (rCBV). Conclusions: Our study confirms that patients with CSVD have worse outcomes after AIS. The data also raise the possibility that these worse outcomes in CSVD patients may be mediated by compromised collateral flow in the setting of acute ischemia.

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