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STROKE September 2010

• Dr. Amer Jafar

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Alcohol consumption and stroke

• Previous research suggests that regular heavy
  alcohol consumption increases the risk for
  ischaemic stroke
• The risk of ischaemic stroke associated with
  transient exposure to alcohol remains unclear
• This is a casecrossover study to test the
  hypothesis that alcohol consumption affects the
  acute risk of ischaemic stroke, to determine the
  length of time between alcohol intake and the
  onset of symptoms (induction time), and to
  examine whether the risk varies by the type of
  alcohol.

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• Of the 390 patients, 248 (64) reported alcohol
  consumption in the prior year, 104 within 24
  hours and 14 within 1 hour of stroke onset
• Conclusion The risk of stroke onset is
  transiently elevated in the hour after alcohol
  ingestion

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NSAID AND RISK OF STROKE

• This study is aiming to evaluate the risk of
  ischaemic and haemorrhagic stroke associated with
  short-term use of selective and nonselective
  NSAIDs in a Chinese population with a high
  incidence of stroke
• A retrospective casecrossover study was
  conducted by analyzing the Taiwan National Health
  Insurance Database

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• A pharmacy prescription database was searched for
  NSAID use during the case and control periods
• The study concluded that Use of selective and
  nonselective NSAIDs was associated with an
  increased risk of both ischemic and hemorrhagic
  stroke, strikingly high for parenteral ketorolac

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Treating Carotid stenosis in women

• Gender differences in carotid endarterectomy
  (CEA) rates after transient ischemic attack are
  not well studied
• This study retrospectively identified all
  patients diagnosed with transient ischemic attack
  and 70 carotid stenosis on ultrasound in 2003 to
  2004 from 19 emergency departments

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• Of 299 patients identified, 47 were women
• Women were older with higher presenting systolic
  blood pressure and less likely to smoke or to
  have coronary artery disease or diabetes
• This study concluded that Women with severe
  carotid stenosis and recent transient ischaemic
  attack are less likely to undergo CEA than men,
  and surgeries are more delayed.

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NOMASS STUDY

• The Northern Manhattan Stroke Study
• This study is aiming to determine whether
  depressed mood acutely after stroke predicts
  subsequent disability and mortality
• Participants were asked about depressed mood
  within 7 to 10 days after stroke
• The were followed every 6 months the first 2
  years and yearly thereafter for 5 years for death
  and disability measured by the Barthel Index

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• A question about depressed mood within 7 to 10
  days after stroke was asked in 340 of 655
  patients with ischemic stroke enrolled, and 139
  reported that they felt depressed
• The study concluded that Depressed mood after
  stroke is associated with disability but not
  mortality after stroke. Early screening and
  intervention for mood disorders after stroke may
  improve outcomes and requires further research.

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Cerebral Vein Thrombosis

• After cerebral vein and dural sinus thrombosis
  (CVT), there is an increased risk of further
  venous thromboembolic events (VTEs)
• The research team used the International Study on
  Cerebral Vein and Dural sinus Thrombosis, which
  included 624 patients with CVT followed up for a
  median of 13.9 months
• Of the 624 included patients, 36 (5.8) had at
  least 1 venous thromboembolic event

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• Conclusions
• The risk of recurrence of CVT is low but is
  moderate for other VTEs. Recurrence of venous
  thrombosis after CVT is more frequent among men
  and in patients with polycythemia/thrombocythemia.
  

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eGFR and stroke

• Consecutive patients with acute stroke (N378)
  subjected to MRI and serum creatinine
  determination were included in the study and
  prospectively followed-up up to 12 years
• Of the patients, 71.2 had died during the
  follow-up, 152 (40.2) had moderate (eGFR lt60
  mL/min/1.73 m2), and 226 (59.8) had normal or
  mildly impaired eGFR (60 mL/min/1.73 m2 )

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• Of the patients, 108 (28.6) had mild, 68 (18.0)
  had moderate, and 202 (53.4) had severe WMLs
  (White matter lesions)
• Cerebral small vessel disease is closely
  associated with kidney function in patients with
  acute stroke. Cerebral small vessel disease and
  kidney function are closely associated predictors
  of poor poststroke survival

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Microbleeds and the Risk of Recurrent Stroke

• This study is about the risk of recurrent
  cerebrovascular events in patients who had a
  transient ischaemic attack or ischaemic stroke
  and who had evidence of microbleeds on MRI
• A prospective follow-up study was performed on
  hospitalized patients who were at least 50 years
  old with a transient ischemic attack or an
  ischaemic stroke
• The presence and number of microbleeds were
  assessed on gradient echo MRI

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• Patients were followed up by phone every 6 months
• End points were intracerebral hemorrhage,
  ischaemic stroke, and unclassified stroke
• A total of 487 patients with a mean age of 72
  years were followed up for a median of 2.2 years
• Microbleeds were identified in 129 patients
  (25.6)

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• Conclusions
• In this European cohort, patients with
  microbleeds who have had cerebral ischaemia have
  a higher risk of developing new ischaemic strokes
  than of intracerebral haemorrhage. Lobar
  microbleeds or combined lobar and deep
  microbleeds might be independent predictors of
  recurrent stroke.

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Spasticity After Ischaemic Stroke

• In a prospective cohort study, 301 consecutive
  patients with clinical signs of central paresis
  due to a first-ever ischaemic stroke were
  examined in the acute stage and 6 months later
• Spasticity was assessed on the Modified Ashworth
  Scale and defined as Modified Ashworth Scale gt1
  in any of the examined joints

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• Two hundred eleven patients (70.1) were
  reassessed after 6 months
• Of these, 42.6 (n90) had developed spasticity
• A more severe degree of spasticity (Modified
  Ashworth Scale 3) was observed in 15.6 of all
  patients
• The prevalence of spasticity did not differ
  between upper and lower limbs, but in the upper
  limb muscles, higher degrees of spasticity
  (Modified Ashworth Scale 3) were more frequently
  (18.9) observed than in the lower limbs (5.5)

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• Conclusions
• Spasticity was present in 42.6 of patients with
  initial central paresis
• Severe spasticity was relatively rare.
  Predictors for the development of spasticity were
  a severe degree of paresis and hemihypersthesia
  at stroke onset.

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Guidelines for the Management of Spontaneous
Intracerebral Haemorrhage

• Intracerebral haemorrhage is a serious medical
  condition for which outcome can be impacted by
  early, aggressive care
• The guidelines offer a framework for
  goal-directed treatment of the patient with
  intracerebral haemorrhage

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Thrombolysis and complications

• This is a single-center, retrospective analysis
  of consecutive acute stroke patients treated with
  IV rt-PA between January 2006 and December 2008
• Aim to define the incidence of early neurologic
  deterioration (4-point drop on the National
  Institutes of Health Stroke Scale within 72
  hours) and its mechanism

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• Of 228 consecutive IV rt-PAtreated patients, 34
  (15) developed early neurologic deterioration,
  18 (8) secondary to incident strokes 10 (4.4)
  due to SICH, and 6 (2.6) due to early recurrent
  ischaemic events, which were significantly
  associated with atrial fibrillation
• Conclusion the incidence of early recurrent
  ischaemic stroke after IV rt-PA was 2.6 and was
  associated with previous atrial fibrillation.