Predictive value of the combination of lesion location and volume of ischemic infarction with rehabilitation outcomes.

PURPOSE: In acute ischemic stroke, infarct location and volume have, separately, been used to determine long-term outcomes after stroke. Little information exists on the combination of these imaging characteristics on rehabilitation outcomes. We evaluated the association between infarct lesion location volume with the Functional Independence Measure (FIM) measure during inpatient rehabilitation facility (IRF) in ischemic stroke patients. METHODS: Between 2012 and 2014, we prospectively enrolled consecutive acute ischemic stroke patients admitted from a Comprehensive Stroke Center and followed to an IRF in Chicago, Illinois. We adjudicated infarct volumes in specific lesion locations using a validated brain atlas. Volumes were calculated using an automated pipeline. FIM measure was extracted from IRF charts. We analyzed the association between acute infarct characteristics and functional measures using adjusted Spearman's correlation. RESULTS: Among 162 stroke patients (mean age 67.6 years, 48.1% male, 58.6% Caucasian), the median FIM at IRF was 52 (IQR 36-62). In an adjusted analysis, infarct volumes in the left basal ganglia (rs = - 0.45, p = 0.02) and left frontal lobe (rs = - 0.38, p = 0.04) were negatively correlated with FIM scores. CONCLUSIONS: There is an association between specific infarct lesion location volume and subsequent FIM scores assessed at IRF. Our findings suggest that imaging during index stroke hospitalization could be used to predict outcomes assessed during IRF.

Rotational vertigo associated with putaminal infarction.

A 57-year-old man was admitted because of left hemiparesis. A magnetic resonance imaging scan of the brain revealed a recent infarct from the dorsal side of the right putamen to the corona radiata. Three hours after onset, he complained of rotational vertigo. Truncal ataxia was also found on standing a few days later, which persisted until the chronic phase. Repeat magnetic resonance imaging scans on days 2 and 11 revealed no additional lesions. The present case indicates that rotational vertigo might result from a small, supratentorial, subcortical lesion.

Neurotransplantation for patients with subcortical motor stroke: a phase 2 randomized trial.

OBJECT: No definitive treatment exists to restore lost brain function following a stroke. Transplantation of cultured neuronal cells has been shown to be safe and effective in animal models of stroke and safe in a Phase 1 human trial. In the present study the authors tested the usefulness of human neuron transplantation followed by participation in a 2-month stroke rehabilitation program compared with rehabilitation alone in patients with substantial fixed motor deficits associated with a basal ganglia stroke. METHODS: Human neuronal cells (LBS-Neurons; Layton BioScience, Inc.) were delivered frozen and then thawed and formulated on the morning of surgery. The entry criteria in this randomized, observer-blinded trial of 18 patients included age between 18 and 75 years, completed stroke duration of 1 to 6 years, presence of a fixed motor deficit that was stable for at least 2 months, and no contraindications to stereotactic surgery. Patients were randomized at two centers to receive either 5 or 10 million implanted cells in 25 sites (seven patients per group) followed by participation in a stroke rehabilitation program, or to serve as a nonsurgical control group (rehabilitation only; four patients). The surgical techniques used were the same at both centers. All patients underwent extensive pre- and postoperative motor testing and imaging. Patients received cyclosporine A for 1 week before and 6 months after surgery. The primary efficacy measure was a change in the European Stroke Scale (ESS) motor score at 6 months. Secondary outcomes included Fugl-Meyer, Action Research Arm Test, and Stroke Impact Scale scores, as well as the results of other motor tests. Nine strokes were ischemic in origin and nine were hemorrhagic. All 14 patients who underwent surgery (ages 40-70 years) underwent uncomplicated surgeries. Serial evaluations (maximum duration 24 months) demonstrated no cell-related adverse serological or imaging-defined effects. One patient suffered a single seizure, another had a syncopal event, and in another there was burr-hole drainage of an asymptomatic chronic subdural hematoma. Four of seven patients who received 5 million cells (mean improvement 6.9 points) and two of seven who received 10 million cells had improved ESS scores at 6 months; however, there was no significant change in the ESS motor score in patients who received cell implants (p = 0.756) compared with control or baseline values (p = 0.06). Compared with baseline, wrist movement and hand movement scores recorded on the Fugl-Meyer Stroke Assessment instrument were not improved (p = 0.06). The Action Research Arm Test gross hand-movement scores improved compared with control (p = 0.017) and baseline (p = 0.001) values. On the Stroke Impact Scale, the 6-month daily activities score changed compared with baseline (p = 0.045) but not control (p = 0.056) scores, and the Everyday Memory test score improved in comparison with baseline (p = 0.004) values. CONCLUSIONS: Human neuronal cells can be produced in culture and implanted stereotactically into the brains of patients with motor deficits due to stroke. Although a measurable improvement was noted in some patients and this translated into improved activities of daily living in some patients as well, this study did not find evidence of a significant benefit in motor function as determined by the primary outcome measure. This experimental trial indicates the safety and feasibility of neuron transplantation for patients with motor stroke.

Terapias artísticas en la rehabilitación de los pacientes tras un ictus / Art therapies in the rehabilitation of patients after ictus

Introducción: las enfermedades cerebrovasculares son un problema de salud mundial. Objetivo: evaluar la utilidad de las terapias artísticas en la rehabilitación de los pacientes tras un ictus. Materiales y Métodos: se realizó un estudio experimental, longitudinal y prospectivo en el Hospital Militar de Matanzas. El universo estuvo constituido por los pacientes con hemiplejia secundaria a un ictus que cumplieron con los criterios de la investigación. Los 62 pacientes se dividieron en dos grupos que recibieron el tratamiento rehabilitador habitual y al grupo estudio se le adicionaron las terapias artísticas. Se aplicó la escala de Yesavage para valorar la depresión en los pacientes y el índice de Barthel para evaluar la independencia para realizar las actividades de la vida diaria. Resultados: se logró disminuir la depresión y la dependencia para las actividades de la vida diaria en la mayor parte de los pacientes tratados con terapias artísticas, existiendo diferencias significativas con respecto al grupo control. El 70,9 % de los pacientes tratados con terapias artísticas obtuvieron evaluación final de bien, en el grupo control solo el 38,7 % de los pacientes obtuvo esta evaluación. Conclusiones: las terapias artísticas resultaron muy útiles en la rehabilitación de los pacientes tras un ictus (AU).

Introduction: cerebrovascular diseases are a worldwide health problem. Objective: to appraise the usefulness of the art therapies in the rehabilitation of patients after ictus. Materials and methods: A prospective, longitudinal and retrospective study was carried out in the Military Hospital of Matanzas. The universe was formed by the patients with ictus-secondary hemiplegia fulfilling the research criteria. The 62 patients were divided into two groups that received the usual treatment and the ones in the study group also received art therapies. The Yesavage scale was applied to assess depression in the patients and the Barthel index to assess the independency in performing daily activities. Results: depression and dependency in performing daily life activities decreased in most of the patients treated with art therapies, showing significant differences with the control group. 70,9 % of the patients treated with art therapies got a final evaluation of good; in the control group only 38,7 % of the patients got this evaluation. Conclusions: art therapies were very useful in the rehabilitation of patients after ictus (AU).