1
Stroke May 2011

• Dr. Amer Jafar

2
Genetics of Lacunar Stroke

• Previous studies showed that a positive family
  history of stroke (FHstroke) is an
  independent risk factor for lacunar stroke
• The aim of the present study was to
  determine whether familial aggregation of stroke
  was different for lacunar stroke phenotypes

3
Stroke Family History

• In 157 patients with a first-ever lacunar stroke,
  a complete first-degree FHstroke was obtained by
  a standardized questionnaire and additional
  interview
• Fifty-two percent of patients reported a positive
  FHstroke in at least one of their first-degree
  relatives
• A family history of stroke might be an
  independent risk factor for the lacunar stroke
  phenotype with aLACs at younger ages, suggesting
  a role for genetic factors in this phenotype
  caused by diffuse vasculopathy

4
Immunodepression syndrome

• High infection rate after severe stroke may
  partly relate to brain-induced immunodepression
  syndrome
• Aim  to investigate the role of autonomic shift
  in increased susceptibility to infection after
  acute intracerebral hemorrhage (ICH)
• The authors retrospectively analyzed 62 selected
  patients with acute ICH from a prospective
  database
• Autonomic shift was assessed using the
  cross-correlational baroreflex sensitivity (BRS)

5
Infections and Brain Haemorrhage

• They identified 36 (58) patients with infection
  during the first 5 days of hospital stay
• Patients with infections had significantly lower
  BRS, higher initial NIHSS scores, larger
  haemorrhages, and more frequently had
  intraventricular blood extension and underwent
  invasive procedures

6
Autonomic shift

• Conclusion
• Decreased BRS was independently associated with
  infections after ICH
• Autonomic shift may play an important role in
  increased susceptibility to infections after
  acute brain injury including ICH

7
Helicopter transport and the tPA

• This austrian study addresses the value of
  helicopter transport compared with other means of
  transportation to a stroke unit and compares
  their rates of thrombolysis on a nationwide basis
• Prospective data collection 2 stroke units
  between 2003 and 2009 were used
• Results Of 21 712 ischaemic stroke patients, 905
  patients (4.1) were transported by helicopter

8
Results and conclusions

• Of these, 752 patients (3.4) were transported by
  direct HEMS, and 153 patients (0.7) were
  transported by indirect HEMS
• Thrombolysis rates were highest for HEMS
  (24 direct, 29 indirect)
• Conclusion The shortest hospital arrival times
  and highest thrombolysis rates were seen in
  ischaemic stroke patients transported by
  helicopter.

9
Statin Treatment and Functional Outcome

• Multiple studies suggest that statin use before
  acute ischaemic stroke is associated with
  improved functional outcome
• The authors performed a systematic literature
  search and meta-analysis of studies investigating
  the association between prestroke statin use and
  clinical outcome
• Results Meta-analysis of all available data
  identified an association between prestroke
  statin use and improved functional outcome

10
Interpretation

• Larger positive effects for small vessel strokes
  compared with other subtypes
• However, evidence of publication bias in the
  existing literature suggests these findings
  should be interpreted with caution

11
Botulinum Toxin for the Upper Limb After Stroke

• BoTULS trial
• Botulinum toxin is increasingly used to treat
  upper limb spasticity due to stroke, but its
  impact on arm function is unclear
• The researchers evaluated botulinum toxin for
  upper limb spasticity and function poststroke
• Three hundred thirty-three patients with stroke
  with upper limb spasticity and reduced arm
  function participated in a multicenter randomized
  controlled trial

12
The details

• The intervention group received botulinum toxin
  type A injection(s) plus a 4-week therapy program
• The control group received the therapy program
  alone
• The primary outcome was upper limb function at 1
  month (Action Research Arm Test). Secondary
  outcomes included measures of impairment,
  activity limitation, and pain at 1, 3, and 12
  months

13
The results

• Results There was no significant difference in
  achievement of improved arm function (Action
  Research Arm Test) at 1 month
• Significant differences in favor of the
  intervention group were seen in muscle tone at 1
  month upper limb strength at 3 months basic arm
  functional tasks (hand hygiene, facilitation of
  dressing) at 1, 3, and 12 months and pain at 12
  months

14
Botulinum ToxinImproves pain

• Botulinum toxin type A is unlikely to be useful
  for improving active upper limb function (eg,
  reaching and grasping) in the majority of
  patients with spasticity after stroke, but it
  may improve basic upper limb tasks (hand hygiene,
  facilitation ofdressing) and pain.

15
Review articles

• Early Prediction of Outcome of Activities of
  Daily Living After Stroke
• Risk and Cumulative Risk of Stroke Recurrence
• Translational Stroke Research of the Combination
  of Thrombolysis and Antioxidant Therapy