scholarly journals Delirium in an Acute Stroke Setting, Occurrence, and Risk Factors

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3265-3268 ◽  
Author(s):  
Robert Shaw ◽  
Bogna Drozdowska ◽  
Martin Taylor-Rowan ◽  
Emma Elliott ◽  
Gillian Cuthbertson ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Odds Ratio ◽  
Alcohol Misuse ◽  
Stroke Severity ◽  
Clinical Trial Registration ◽  
Statistical Manual ◽  
Stroke Population ◽  
Risk Factor Data ◽  
Specific Factors ◽  
Factor Data

Background and Purpose— Delirium is a common and serious complication of acute illness. We describe delirium occurrence in an unselected, acute stroke population. Methods— We collected data from consecutive stroke admissions. We performed comprehensive cognitive assessment within the first week including Diagnostic Statistical Manual-5–based delirium diagnosis. We reported proportion with delirium and the clinical and demographic associations with delirium using multiple logistic regression. Results— Of 708 patients, median age of 71 years (interquartile range, 59–80), we recorded delirium in 187 of 708 (26.4%; 95% CI, 23.0–30.0). Across 395 patients with complete risk factor data (105 delirium), factors independently associated with delirium were: age (odds ratio, 1.05; 95% CI, 1.03–1.08), drug/alcohol misuse (odds ratio, 2.64; 95% CI, 1.10–6.26), and stroke severity (odds ratio, 1.22; 95% CI, 1.14–1.31). Conclusions— Delirium is common in acute stroke, affecting 1 in 4. It may be possible to predict those at risk using prestroke and stroke-specific factors. Clinical Trial Registration— URL: researchregistry.com . Protocol: 1147.

scholarly journals Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT)

Neurology ◽  
2018 ◽  
Vol 91 (16) ◽  
pp. e1461-e1467 ◽  
Author(s):  
Malin Reinholdsson ◽  
Annie Palstam ◽  
Katharina S. Sunnerhagen
Keyword(s):  
Physical Activity ◽  
Acute Stroke ◽  
Odds Ratio ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Activity Level ◽  
Stroke Severity ◽  
Cross Sectional ◽  
Severe Stroke ◽  
Younger Age

ObjectiveTo investigate the influence of prestroke physical activity (PA) on acute stroke severity.MethodsData from patients with first stroke were retrieved from registries with a cross-sectional design. The variables were PA, age, sex, smoking, diabetes, hypertension and statin treatment, stroke severity, myocardial infarction, new stroke during hospital stay, and duration of inpatient care at stroke unit. PA was assessed with Saltin-Grimby's 4-level Physical Activity Level Scale, and stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Logistic regression was used to predict stroke severity, and negative binomial regression was used to compare the level of PA and stroke severity.ResultsThe study included 925 patients with a mean age of 73.1 years, and 45.2% were women. Patients who reported light or moderate PA levels were more likely to present a mild stroke (NIHSS score 0 to 5) compared with physically inactive patients in a model that also included younger age as a predictor (odds ratio = 2.02 for PA and odds ratio = 0.97 for age). The explanatory value was limited at 6.8%. Prestroke PA was associated with less severe stroke, and both light PA such as walking at least 4 h/wk and moderate PA 2–3 h/wk appear to be beneficial. Physical inactivity was associated with increased stroke severity.ConclusionsThis study suggests that PA and younger age could result in a less severe stroke. Both light PA such as walking at least 4 h/wk and moderate PA 2–3 h/wk appear to be beneficial.

Frequency of Screening and Prevalence of Neurosyphilis in Stroke Population

2020 ◽  
Vol 49 (3) ◽  
pp. 301-306
Author(s):  
Rodrigo Targa Martins ◽  
Raphael Machado Castilhos ◽  
Pablo Silva da Silva ◽  
Leticia Scaranto Costa
Keyword(s):  
Acute Stroke ◽  
Venereal Disease ◽  
International Classification Of Diseases ◽  
Stroke Severity ◽  
Positive Serology ◽  
Csf Analysis ◽  
Stroke Population ◽  
Classification Of Diseases ◽  
Stroke Center ◽  
Ischemic Attack

Background and Aims: Syphilis and stroke are high prevalent diseases in south Brazil and estimates of concomitance and possible role of syphilis in acute stroke are lacking. Our aims are to estimate the prevalence of syphilis and neurosyphilis (NS) in a cohort of tertiary stroke center. Methods: We reviewed all hospital records of stroke/transitory ischemic attack (TIA) using International Classification of Diseases, 10th revision, at discharge, frequency of syphilis screen, serology positivity, cerebrospinal fluid (CSF) analysis, and prevalence of NS in this stroke population applying CDC criteria. Results: Between 2015 and 2016, there were 1,436 discharges for cerebrovascular events and in 78% (1,119) of these cases, some syphilis screening was performed. We have found a frequency of positive serology for syphilis of 13% (143/1,119), and higher stroke severity was the main determinant for non-screening. Applying standard NS criteria, 4.7% (53/1,119) cases with CSF analysis had NS diagnosis: 8 based on CSF-Venereal Disease Research Laboratory (VDRL) positive and 45 based on abnormal CSF white cells or protein, but CSF VDRL negative. NS VDRL positive cases were younger, had higher serum VDRL title, had more frequent HIV infection, and received NS treatment more often. Demographic and clinical characteristics were not different between NS VDRL negative and non-NS cases. Conclusion: Positive syphilis serology is frequent in patients with acute stroke/TIA in our region. Acute post-stroke CSF abnormalities make the diagnosis of NS difficult in the context of CSF VDRL negative.

Abstract TMP74: Evaluation of NIHSS-Onset to Groin Time and Prehospital Acute Stroke Severity Scale-onset to Groin Time Scores in Prediction of Outcomes After Endovascular Treatment in Acute Ischemic Stroke Patients: A Retrospective Single-center Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Muhammad H Niazi ◽  
Mohammad El-Ghanem ◽  
Kevin Cockroft ◽  
Kathy Morrison ◽  
Alicia Richardson ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Sensitivity And Specificity ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Small Sample Size ◽  
Diagnostic Odds Ratio ◽  
Small Sample ◽  
Stroke Severity ◽  
Severity Scale

Background: Prehospital triage tools are essential to identify large vessel occlusion (LVO) in order to triage patients to a comprehensive stroke center for timely endovascular treatment (ET). Prehospital Acute Stroke Severity Scale (PASS) (score range 0-3) was recently identified as a valuable tool to predict LVO. Several studies have shown that in patients treated with IV tPA, a score calculated by multiplying admission NIHSS by the time from symptom onset to tPA treatment (in hours) can predict outcome. In our study, we applied similar concept for patients with LVO who underwent successful ET. Methods: We retrospectively reviewed all LVO patients between January 2015 and June 2016 who received ET. We analyzed the association of time of symptom onset to groin time (OGT), NIHSS, PASS, NIHSS-OGT, and PASS-OGT with modified Rankin scale (mRS) at the time of discharge. Results: Fifty-four patients underwent ET during the study period. Patients with posterior circulation LVO and those treated after 6 hours from last known normal were excluded. A total of 34 patients were left for final analysis. Patients with a good outcome (mRS ≤2) had an average NIHSS-OGT score of 43.2 (95% CI: 29.7-56.8) and PASS-OGT score of 5.52 (95% CI: 4.48-6.56). Patient’s with poor to miserable outcomes (mRS 3-6) average NIHSS-OGT 84.7 (95% CI: 72.8-96.6) and PASS-OGT average 9.8 (95% CI: 8.3-11.2). For NIHSS-OGT cut off of 55 the sensitivity and specificity was 0.75 and 0.85 respectively; diagnostic odds ratio 16.5 (96% CI: 2.41-112.83). For PASS-OGT cut off of 6.5 the sensitivity and specificity were 0.88 and 0.76 respectively; diagnostic odds ratio 23.33 (95% CI: 2.37-229.33). The wide confidence intervals can be attributed to small sample size. Conclusion: Our study indicates NIHSS–OGT and PASS-OGT scores have a linear relationship with discharge mRS and can reliably predict early clinical outcomes after ET. Further confirmation with randomized control trials is needed.

scholarly journals A2DS2 Score to Predict the Risk of Stroke-Associated Pneumonia in Acute Stroke: An Indian Perspective

2019 ◽  
Vol 10 (03) ◽  
pp. 465-471
Author(s):  
Limesh Vyas ◽  
Dinkar Kulshreshtha ◽  
Pradeep Maurya ◽  
Ajai Singh ◽  
Abdul Qavi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Odds Ratio ◽  
Binary Logistic Regression ◽  
High Sensitivity ◽  
Risk Scores ◽  
Binary Logistic Regression Analysis ◽  
Stroke Severity ◽  
The Mean ◽  
Strength Of Association ◽  
Indian Perspective

Abstract Background Stroke-associated pneumonia (SAP) is an important cause of poststroke morbidity and mortality. Several clinical risk scores predict the risk of SAP. In this study, we used the A2DS2 score (age, atrial fibrillation, dysphagia, sex, and stroke severity) to assess the risk of SAP in patients admitted with acute stroke. Methods A high (5–10) and a low (0–4) A2DS2 score was assigned to patients with acute stroke admitted to the neurology ward. Univariate binary logistic regression analysis was performed to find the strength of association of SAP and A2DS2 score. Results There were 250 patients with acute stroke of which 46 developed SAP. Forty-four patients developed SAP in high score as against 2 in low-score group (odds ratio [OR] = 0.03, 95% confidence interval [CI] = 0.01–0.15, p = 0.0001). A2DS2 score >5 had sensitivity of 82.6% and specificity of 65.1% to predict SAP. The mean A2DS2 score in patients with pneumonia was 7.02 ± 1.40 compared to 4.75 ± 1.92 in patients without pneumonia (p = 0.0001). Conclusions A2DS2 score has a high sensitivity of 82% in predicting the risk of SAP and is a useful tool to monitor patients after acute stroke. A2DS2 score can help in timely detection and prevention of SAP and reduction in caregiver’s burden.

scholarly journals Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
George Ntaios ◽  
Patrik Michel ◽  
Georgios Georgiopoulos ◽  
Yutao Guo ◽  
Wencheng Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Case Series ◽  
Severe Disability ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Patient Pathways

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4–18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4–18] versus 6 [IQR, 3–14]), P =0.03; (odds ratio, 1.69 [95% CI, 1.08–2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2–6] versus 2 [IQR, 1–4], P <0.001) and death (odds ratio, 4.3 [95% CI, 2.22–8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

scholarly journals Effect of Prior Aspirin Use on Stroke Severity in the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

Stroke ◽  
2001 ◽  
Vol 32 (12) ◽  
pp. 2836-2840 ◽  
Author(s):  
Janet L. Wilterdink ◽  
Birgitte Bendixen ◽  
Harold P. Adams ◽  
Robert F. Woolson ◽  
William R. Clarke ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Severity ◽  
Stroke Treatment ◽  
Acute Stroke Treatment

Abstract 13379: Cause-specific Mortality by Diffuse Coronary Artery Calcium Phenotypes: Results From the Coronary Artery Calcium Consortium

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ramzi Dudum ◽  
Zeina A Dardari ◽  
David Feldman ◽  
Daniel Berman ◽  
Matthew J Budoff ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Subclinical Atherosclerosis ◽  
Clinical Predictors ◽  
Specific Mortality ◽  
Risk Factor Data ◽  
Impact Risk ◽  
Traditional Risk Factors ◽  
Factor Data ◽  
Vessel Involvement

Objectives: We sought to assess characteristics of diffuse coronary artery calcium (CAC) phenotypes and their associations with cause-specific mortality. Background: CAC is a measure of subclinical atherosclerosis and improves risk stratification. CAC characteristics including vessel involvement, number of vessels, volume, and density have been shown to differentially impact risk. Less is known about clinical predictors of a diffuse CAC phenotype and its impact on cause-specific mortality. Methods: The CAC Consortium is a retrospective, multi-site cohort of 66,636 participants without CHD who underwent CAC scoring. Risk factor data were collected at enrollment or scan. Participants with CAC>0 were included—CAC area, CAC density, and the CAC index of diffusion (the percentage of total CAC in the vessel with the highest CAC score) were calculated and the association between CAC characteristics and CVD- and CHD-specific mortality was assessed. Results: In 28,147 study participants (mean age 58.3 years, 25% female, and 89.6% white), ~66% had ≥2 calcified vessels. Diabetes, hypertension, and hyperlipidemia were predictors of multivessel involvement (p<0.001). After controlling for CAC score, those with 4-vessel CAC had more CAC area involved with less dense calcification compared to those with 1-vessel involvement. After adjustment, those with CAC score 1-299 had a graded increase in CVD- and CHD-specific mortality with increasing vessel number compared with 1-vessel CAC. No difference was seen for individuals with CAC >300. Among those with multivessel CAC involvement, all-cause survival was significantly worse in diffuse compared to other phenotypes. Conclusion: Diffuse CAC involvement was characterized by less dense calcification, more CAC area, multiple coronary vessel involvement, and presence of certain traditional risk factors. Multivessel CAC is associated with increased CVD- and CHD-specific mortality, particularly among CAC scores 1-299.

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