Posterior versus anterior circulation infarction: how different are the neurological deficits?

BACKGROUND AND PURPOSE: Distinguishing between symptoms of posterior circulation infarction (PCI) and anterior circulation infarction (ACI) can be challenging. This study evaluated the frequency of symptoms/signs in the 2 vascular territories to determine the diagnostic value of particular symptoms/signs for PCI. METHODS: Neurological deficits were reviewed and compared from 1174 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. The diagnostic value of specific symptoms/signs for PCI was determined by measuring their sensitivity, specificity, positive predictive value (PPV), and the OR. RESULTS: Homolateral hemiplegia (PCI, 53.6% versus ACI, 74.9%; P<0.001), central facial/lingual palsy (PCI, 40.7% versus ACI, 62.2%; P<0.001), and hemisensory deficits (PCI, 36.4% versus ACI, 34.2%; P=0.479) were the 3 most common symptoms/signs in PCI and ACI. The signs with the highest predictive values favoring a diagnosis of PCI were Horner's syndrome (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), crossed sensory deficits (3.0% versus 0%; P<0.001; PPV=100.0%; OR=3.98), quadrantanopia (1.3% versus 0%; P<0.001; PPV=100.0%; OR=3.93), oculomotor nerve palsy (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), and crossed motor deficits (4.0% versus 0.1%; P<0.001; PPV=92.3%; OR=36.04); however, all had a very low sensitivity, ranging from 1.3% to 4.0%. CONCLUSIONS: This study indicates that the symptoms/signs considered typical of PCI occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate PCI from ACI. Neuroimaging is vital to ensure accurate localization of cerebral infarction.

Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a Chinese hospital-based stroke study.

BACKGROUND: There is scant information on characteristics, treatment, functional outcome and case fatality of ischemic stroke with atrial fibrillation (AF) in China. METHODS: For this study, first-ever ischemic stroke patients who were admitted within 1 month of stroke onset during the period of March 2002 through December 2008 were included. Data on ischemic stroke patients were collected which included: demographics, risk factors, treatment administered, stroke-related complications and 3-month, 6-month and 1-year death and disability. Multivariate regression models were used to analyze predictors for death and disability. RESULTS: Of the 2,683 patients included in this study, 366 (13.6%) had AF. In this group, valvular AF was observed in 153 (41.8%) patients. Compared to patients without AF, patients with AF were older (66.1 vs. 63.6, p = 0.001) and had a higher NIHSS score on admission (median 10 vs. 4, p < 0.001) and more frequently suffered from hemorrhagic transformation (7.3 vs. 2.8%, p < 0.001), pulmonary infection (27 vs. 10.6%, p < 0.001), urinary tract infection (8.5 vs. 3.0%, p < 0.001), acute gastrointestinal tract hemorrhage (4.1 vs. 1.9%, p = 0.008), electrolyte disturbance (5.2 vs. 1.8%, p < 0.001), acute renal failure (1.1 vs. 0.5%, p = 0.005) and urinary incontinence (3.8 vs. 0.6%, p < 0.001) during hospitalization. The percentages of patients with AF who received oral anticoagulants were 3.3% before stroke onset and 14.2% at discharge. Moreover, patients with AF had a higher proportion of disability (determined as modified Rankin Scale score 3-5) in 3-month, 6-month and 1-year follow-ups (46.6, 41.9 and 37.6 vs. 29.1, 24.0 and 19.3%, respectively, p < 0.001) and higher case fatality in hospitalization, 3-month, 6-month and 1-year follow-ups (10.1, 25.5, 29.1 and 34.0 vs. 2.0, 7.4, 8.8 and 11.6%, respectively, p < 0.001). Multivariate logistic regression determined that AF, age and NIHSS score were the independent predictors for the 3-month, 6-month and 1-year death. CONCLUSIONS: Ischemic stroke patients with AF have a poorer outcome, a higher frequency of stroke-related complications and a higher case fatality than patients without AF. Oral anticoagulants were underused in AF patients.

Association between renal function and clinical outcome in patients with acute stroke.

BACKGROUND AND PURPOSE: Data on the association between renal dysfunction and outcome in patients with stroke are controversial and scarce. We investigated the predictors of renal dysfunction upon admission and the association between renal dysfunction and clinical outcome in patients with acute stroke in a hospitalized Chinese population. METHODS: 1,758 acute stroke patients were consecutively enrolled into the study. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease equation. Reduced estimate of the glomerular filtration rate was defined as eGFR <60 ml/min/1.73 m(2). Multivariate logistical regression was used to evaluate the predictors of renal dysfunction upon admission and to examine the association between renal dysfunction and outcomes. The main outcome measures were death and death/disability (disability defined as modified Rankin Scale score >2) at 12 months after stroke. RESULTS: Of the included 1,758 cases (ischemic stroke: n = 1,192; hemorrhagic stroke: n = 566), 463 cases had reduced eGFR, which accounted for 26.3% of the total number. The distribution of eGFR upon admission was normal and the mean was 75.87 +/- 38.31 ml/min/1.73 m(2) (ischemic stroke: 75.07 +/- 29.89 ml/min/1.73 m(2); hemorrhagic stroke: 77.57 +/- 51.73 ml/min/1.73 m(2)). There was no significant difference between the two groups (p = 0.285). The independent predictors of eGFR upon admission were age (OR = 1.039, 95% CI = 1.028-1.050), male gender (OR = 0.658, 95% CI = 0.504-0.859), hematocrit on admission (OR = 1.008, 95% CI = 1.003-1.013), history of hypertension (OR = 1.307, 95% CI = 1.034-1.653), history of diabetes (OR = 1.411, 95% CI = 1.012-1.967) and NIHSS scores upon admission (OR = 1.497, 95% CI = 1.286-1.743). After adjustment for confounders, the patients with renal dysfunction had a significantly higher risk of death/disability (OR = 1.864, 95% CI = 1.170-2.970) compared with patients whose eGFR was more than 90 ml/min/1.73 m(2) at the end of the 12th month. Further analysis on type of stroke showed that reduced eGFR was an independent predictor of death/disability at the end of the 12th month in patients with hemorrhagic stroke (OR = 2.353, 95% CI = 1.063-5.209), but not for ischemic stroke (OR = 1.625, 95% CI = 0.881-2.999). CONCLUSIONS: Our study indicated that more than 1/4 of all patients with acute stroke presented with renal dysfunction. Reduced eGFR on admission is a strong predictor of poor outcome for hemorrhagic stroke but not for ischemic stroke.

One-year case fatality and disability after posterior circulation infarction in a Chinese hospital-based stroke study.

BACKGROUND AND PURPOSE: Controversy exists as to whether posterior circulation infarction (PCI) has a poorer outcome compared to anterior circulation infarction (ACI). We aimed to investigate whether PCI had different clinical outcomes from ACI in Chinese patients with ischemic stroke. METHODS: Data on ischemic stroke patients with ACI or PCI were collected including demographics, risk factors and 1-month, 3-month, and 1-year case fatality and disability (defined as modified Rankin Scale 3-5). Multivariate regression models were used to analyze predictors for death and disability. RESULTS: Of the 1,962 enrolled cases, 433 (22.1%) had PCI. The case fatality of PCI at 1-month, 3-month and 1-year follow-up (FU) were lower than that of ACI (3.93, 5.3 and 9.7% vs. 7.26, 9.3 and 13.7%, p <0.05), and the proportion of disability was also lower in PCI at 3-month FU (19.6 vs. 29.1%, p<0.001) and 1-year FU (6.5 vs. 15.2%, p<0.001). The adjusted hazard ratio of death for PCI was 0.52 at 1 month (95% CI 0.29-0.94) and 0.52 at 3 months (95% CI 0.31-0.85), and the adjusted odds of disability in patients with PCI was 0.53 at 1 year (95% CI 0.35-0.81). CONCLUSIONS: In our cohort, patients with PCI have a lower risk of death at 1- and 3-month FU and a lower proportion of disability at 1-year FU, which needs to be verified by future studies.

[Incidence rates of human immunodeficiency virus and syphilis as well as the rate of retention in a 6-month follow-up study of female sex workers in areas with heavy drug use in Xichang of Sichuan province, China].

OBJECTIVE: To investigate the human immunodeficiency virus (HIV) and syphilis incidence rates as well as the retention rate in a cohort with 6-month follow-up study among female sex workers (FSWs). METHODS: From December, 2004, to January, 2005, a community-based baseline survey was conducted to recruit 343 FSWs for a prospective cohort study in Xichang county of Sichuan province, China. Follow-up visits were conducted at 6 months to analyze risk factors associated with cohort retention for subjects' baseline sociodemographic and sexual behavioral characteristics. Blood specimens were also collected to test antibodies against HIV and syphilis. RESULTS: During the 6-month follow-up period, HIV and syphilis incidence appeared to be 1.00 per 100 person-years and 6.23 per 100 person-years, respectively. The rate of retention in the cohort was 53.6% (184/343). Results from multivariate logistic regression model showed that factors were significantly associated with cohort retention including people with minority ethnic background (OR = 0.36; 95% CI: 0.18-0.74), people having participated in AIDS prevention program (OR = 1.83; 95% CI: 1.17-2.86) or being clients in the last 6 months > or = 50 (OR = 1.75; 95% CI: 1.11-2.77) and having changed living/working place (OR = 0.56; 95% CI: 0.33-0.94). CONCLUSION: The results of this study showed that the syphilis incidence and unprotected sex behavior were high among local FSWs. People belonged to Han nationality, having participated in AIDS prevention program and having a steady living/working place were associated with cohort retention at 6-month follow-up study among FSWs, respectively.