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1.
J Assoc Physicians India ; 69(1): 56-60, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34227777

RESUMO

Background and Objectives: Stroke is the second leading cause of death and third most common cause of disability-adjusted life years in the world. Atherosclerosis plays a key role in the pathogenesis of stroke and inflammation is central in the initiation, progression and complications of atherosclerosis by mediating every stage of atheroma development. High platelet counts may increase thrombocyte activation and aggravate the release of inflammatory mediators. In contrast, lymphocytes exert anti-inflammatory response in atherosclerosis development. The advantage of platelet to lymphocyte ratio (PLR) is that it reflects the condition of both inflammation and thrombosis pathways and is more valuable than either platelet or lymphocyte counts alone. This emerging marker has not been frequently studied with acute ischemic stroke; hence aim of the present study was to find out the role of PLR (Platelet to lymphocyte ratio) in patients of acute ischemic stroke and correlating with NIHSS for predicting the prognosis. Material and Methods: 100 cases of AIS and equal number of age and gender matched control were enrolled in the study. NIHSS score and PLR (from the CBC test) was calculated both at admission and on day 7 or discharge. Results: Maximum subjects in our study were in the age range of 61-70 years with males (69%) outnumbering females (31%). Incidence of hypertension, diabetes mellitus, hyperlipidemia, smoking and alcoholism was more in the cases than controls. Mean PLR was higher in the patients of AIS (235.98±93.92) as compared to control group (115.60±27.87) (p=0.0001). Moreover, there was statistically significant, positive correlation between PLR and NIHSS score both at admission and discharge. PLR value increased significantly from the baseline in patients who deteriorated (263.42±108.98 to 346.28±125.35; p=0.016), decreased drastically in patients who improved (242.27±75.14 to 167.19±57.91; p=0.0001) and did not change much in patients who tend to remain static (181.35±105.40 to 183.36±111.61; p=0.955). Conclusion: Platelet to lymphocyte ratio (PLR) is a simple, cost effective and easily obtainable novel inflammatory marker that may help in predicting the severity of disease and prognosis in terms of functional outcome as evidenced by its increased value in patients of acute ischemic stroke as well as its linear positive correlation with NIHSS score.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Plaquetas , Isquemia Encefálica/diagnóstico , Feminino , Humanos , Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico
2.
Trials ; 22(1): 439, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243808

RESUMO

BACKGROUND: Many therapeutic interventions are performed by physiotherapists to improve upper extremity function and/or activities of daily living (ADL) in stroke patients. Mirror therapy (MT) is a simple technique that can be self-administered by the patients with intact cognition following patient education by a skilled physiotherapist. However, the effectiveness of self-administered MT in post-stroke patients in upper extremity function remains unclear. Therefore, the objective of this study is to examine the effectiveness of MT in improving upper extremity function and recovery in acute stroke patients. METHODS: This study is a single-center, prospective, randomized, open-label, controlled trial with blinded outcome evaluation (PROBE design), in which a total of 36 eligible acute stroke patients will be randomly assigned to control (n=18) and experimental group (n=18). Participants in the control group will receive regular rehabilitation interventions whereas participants in the experimental group will receive MT education in addition to their regular interventions for 4 weeks. STUDY OUTCOME: The primary outcome measure will be upper extremity function that will be measured using the Fugl-Meyer Assessment scale and the Wolf Motor Function Test. The secondary outcome measure will be behaviors related to ADL as estimated using the Modified Barthel Index. Outcome measures will be assessed at baseline and at 4 weeks post-rehabilitation intervention/MT. RESULTS: A two-way repeated analysis of variance (ANOVA) with time and group effects will be used to analyze between-group differences. The level of significance will be set at P < 0.05. CONCLUSION: The results of the study will provide critical information to include self-administered MT as an adjuvant to regular interventions and may facilitate recovery of the upper extremity function of stroke patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04542772 . Registered on 9 September 2020. Protocol version: Final 1.0.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Extremidade Superior
3.
Trials ; 22(1): 430, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225764

RESUMO

BACKGROUND: Sensorimotor impairments of upper limb (UL) are common after stroke, leading to difficulty to use the UL in daily life. Even though many have sensory impairments in the UL, specific sensory training is often lacking in stroke rehabilitation. Thus, the aim of this paper is to provide a detailed description of the novel intervention "SENSory re-learning of the UPPer limb after stroke (SENSUPP)" that we have developed to improve functioning in the UL in persons with mild to moderate impairments after stroke. METHODS: The SENSUPP protocol was designed using information from literature reviews, clinical experience and through consultation of experts in the field. The protocol integrates learning principles based on current neurobiological knowledge and includes repetitive intensive practice, difficulty graded exercises, attentive exploration of a stimulus with focus on the sensory component, and task-specific training in meaningful activities that includes feedback. For reporting the SENSUPP protocol, the Template for Intervention Description and Replication (TIDieR) checklist was used. RESULTS: The essential features of the SENSUPP intervention comprise four components: applying learning principles based on current neurobiological knowledge, sensory re-learning (exercises for touch discrimination, proprioception and tactile object recognition), task-specific training in meaningful activities, and home-training. The training is performed twice a week, in 2.5-h sessions for 5 weeks. CONCLUSION: Since there is close interaction between the sensory and motor systems, the SENSUPP intervention may be a promising method to improve UL functioning after stroke. The TIDieR checklist has been very useful for reporting the procedure and development of the training. TRIAL REGISTRATION: ClinicalTrials.gov NCT03336749 . Registered on 8 November 2017.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Lista de Checagem , Terapia por Exercício , Humanos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Extremidade Superior
4.
Ann Palliat Med ; 10(6): 6715-6725, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237974

RESUMO

BACKGROUND: A systematic evaluation of the therapeutic effects of calcium channel blockers (CCB) on stroke is carried out to provide clinical evidence for their application. METHODS: A search for randomized controlled trials (RCTs) of CCB in the treatment of stroke patients in the electronic databases of PubMed, Embase, Medline, Spring, and Ovid from their establishment to January 31, 2021 was performed, and the collected studies were then screened for the exclusion criteria. The Cochrane Handbook version 5.0.2 system evaluation writing manual was adopted to evaluate the risk of bias for the included literature, and a meta-analysis using Review Manager 5.3 software was applied. RESULTS: A total of 13 RCTs were included, comprising 1,067 subjects. The meta-analysis showed that the recurrence rate of stroke in patients from the observation group reduced sharply after CCB treatment [mean difference (MD) =0.41, 95% confidence interval (CI): 0.24-0.70, Z=3.31, P=0.0009], the Mini-Mental State Examination (MMSE) score improved markedly (MD =2.82, 95% CI: 1.69-3.95, Z=4.89, P<0.00001), and the Montreal Cognitive Assessment (MoCA) score was obviously increased (MD =6.07, 95% CI: 0.34-11.81, Z=2.08, P=0.04). Moreover, the diastolic blood pressure of the observation group decreased steeply after CCB treatment (MD =-1.11, 95% CI: -2.06-0.15, Z=2.27, and P=0.02). However, the effective rate of clinical treatment did not increase hugely (MD =1.70, 95% CI: 0.50-5.83, Z=0.85, P=0.40), and systolic blood pressure did not drop sharply (MD =-1.24, 95% CI: -2.85-0.37, Z=1.51, P=0.13). DISCUSSION: CCB treatment of stroke effectively prevented stroke recurrence, and showed faster recovery of cognitive function, and better lowering of blood pressure, all of which makes CCBs suitable for the treatment of stroke.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Pressão Sanguínea , Bloqueadores dos Canais de Cálcio/farmacologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diagnóstico Precoce , Humanos , Hipertensão/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico
5.
Trials ; 22(1): 457, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271979

RESUMO

BACKGROUND: Stroke results in neurologic impairments and aerobic deconditioning that contribute to limited walking capacity which is a major barrier post-stroke. Current exercise recommendations and stroke rehabilitation guidelines recommend moderate-intensity aerobic training post-stroke. Locomotor high-intensity interval training is a promising new strategy that has shown significantly greater improvements in aerobic fitness and motor performance than moderate-intensity aerobic training in other populations. However, the relative benefits and risks of high-intensity interval training and moderate-intensity aerobic training remain poorly understood following stroke. In this study, we hypothesize that locomotor high-intensity interval training will result in greater improvements in walking capacity than moderate-intensity aerobic training. METHODS: Using a single-blind, 3-site randomized controlled trial, 50 chronic (> 6 months) stroke survivors are randomly assigned to complete 36 locomotor training sessions of either high-intensity interval training or moderate-intensity aerobic training. Main eligibility criteria are age 40-80 years, single stroke for which the participant received treatment (experienced 6 months to 5 years prior to consent), walking speed ≤ 1.0 m/s, able to walk at least 3 min on the treadmill at ≥ 0.13 m/s (0.3 mph), stable cardiovascular condition (American Heart Association class B), and the ability to walk 10 m overground without continuous physical assistance. The primary outcome (walking capacity) and secondary outcomes (self-selected and fast gait speed, aerobic fitness, and fatigue) are assessed prior to initiating training and after 4 weeks, 8 weeks, and 12 weeks of training. DISCUSSION: This study will provide fundamental new knowledge to inform the selection of intensity and duration dosing parameters for gait recovery and optimization of aerobic training interventions in chronic stroke. Data needed to justify and design a subsequent definitive trial will also be obtained. Thus, the results of this study will inform future stroke rehabilitation guidelines on how to optimally improve walking capacity following stroke. TRIAL REGISTRATION: ClinicalTrials.gov NCT03760016 . Registered on November 30, 2018.


Assuntos
Treinamento Intervalado de Alta Intensidade , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Caminhada
6.
BMJ Case Rep ; 14(6)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34088684

RESUMO

A 76-year-old man was admitted to the hospital with acute onset of involuntary movements of the left side of his body. His neurological examination revealed he was oriented only to himself, and aforementioned movements of his left arm and leg. CT head demonstrated old infarcts in his right aspect of his pons and basal ganglia. Cerebrospinal fluid analysis was unremarkable. He initially had a normal blood glucose with an elevated anion gap and elevated creatine kinase. Brain MRI showed a small lacunar-type ischaemic infarct within the anteromedial aspect of the right cerebral peduncle, which localised to his haemiballism. To prevent worsening rhabdomyolysis associated with his haemiballism, the primary team initiated both tetrabenazine and diazepam. His movements improved after 1 week of medication therapy. This report discusses a thorough workup for this movement disorder and when to intervene for this distressing condition.


Assuntos
Isquemia Encefálica , Discinesias , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/etiologia , Discinesias/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia
7.
Trials ; 22(1): 400, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127032

RESUMO

BACKGROUND: Stroke is a leading cause of disability, injury, and death in elderly people and represents a major public health problem with substantial medical and economic consequences. The incidence of stroke rapidly increases with age, doubling for each decade after age 55 years. Gait impairment is one of the most important problems after stroke, and improving walking function is often a key component of any rehabilitation program. To achieve this goal, a robotic gait trainer seems to be promising. In fact, some studies underline the efficacy of robotic gait training based on end-effector technology, for different diseases, in particular in stroke patients. In this randomized controlled trial, we verify the efficacy of the robotic treatment in terms of improving the gait and reducing the risk of falling and its long-term effects. METHODS: In this single-blind randomized controlled trial, we will include 152 elderly subacute stroke patients divided in two groups to receive a traditional rehabilitation program or a robotic rehabilitation using G-EO system, an end-effector device for the gait rehabilitation, in addition to the traditional therapy. Twenty treatment sessions will be conducted, divided into 3 training sessions per week, for 7 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group, using the G-EO system, will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. The primary outcome of the study is the evaluation of the falling risk. Secondary outcomes are the assessment of the gait improvements and the fear of falling. Further evaluations, such as length and asymmetry of the step, walking and functional status, and acceptance of the technology, will be carried. DISCUSSION: The final goal of the present study is to propose a new approach and an innovative therapeutic plan in the post-stroke rehabilitation, focused on the use of a robotic device, in order to obtain the beneficial effects of this treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04087083 . Registered on September 12, 2019.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Acidentes por Quedas , Idoso , Terapia por Exercício , Medo , Marcha , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
10.
Medicine (Baltimore) ; 100(26): e26498, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190179

RESUMO

ABSTRACT: There was a controversy for the electrocardiogram (ECG) changes and their relationship with disease severity in old patients with acute cerebral ischemic stroke (CIS). This study was aim to provide referential data for this topic.Totally 200 old patients with acute CIS in our hospital from January 2017 to December 2019 were included into this study. According to the ST-T segment changes in ECG, these patients were divided into 3 groups: persistent ischemic group (n = 38), transient ischemic group (n = 106) and non-ischemic group (n = 56). The characteristics and incidence of abnormal ECG and their relationship with disease severity, infarct size and prognosis were respectively analyzed under the severe, moderate and mild type of disease.The ECG changes of patients were mainly characterized by myocardial ischemic ST-T segment changes with a abnormal ECG incidence of 72.00%, the arrhythmia with a abnormal ECG incidence of 9.50%, which were the second most common in clinical features. There were statistically significant differences of myocardial ischemic ST-T segment changes among different disease severity, infarct size and prognosis of acute CIS patients (P < .05). The ischemic ST-T segment changes of ECG reflected that the disease severity, and more ECG abnormalities indicated more severe pathological conditions in CIS patients.The characteristics of ischemic ST-T segment changes have important reference value in the evaluation of severity and prognosis of acute CIS in old patients.


Assuntos
Encéfalo , Eletrocardiografia , AVC Isquêmico , Isquemia Miocárdica , Acidente Vascular Cerebral , Idoso , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , China/epidemiologia , Correlação de Dados , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , AVC Isquêmico/fisiopatologia , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/fisiopatologia , Prognóstico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia
11.
Medicine (Baltimore) ; 100(26): e26515, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190182

RESUMO

BACKGROUND: Reablement is 1 approach to conduct rehabilitation in the community (ie, home environment), which aims to enhance an individual's functional ability to perform everyday activities that individuals perceive as important. We investigated the effects of a home-reablement program on different rehabilitation outcomes in people with stroke. METHODS: A single-blind randomized clinical trial was conducted. Twenty-six people with stroke were randomly assigned to the home-reablement group or control group. For 6 weeks, participants in the home-reablement group received training for activities of daily living (ADL) that they perceived as important but difficult to perform. Participants in the control group received conventional rehabilitation in the hospital. Outcome measures included the Fugl-Meyer Assessment for the upper-extremity (FMA-UE) and the Stroke Impact Scale 3.0 (SIS 3.0) subscales. RESULTS: No statistically significant differences between the 2 groups were noticed in the FMA-UE and the SIS 3.0 subscales (P = .226-1.000). Small effect size (success rate difference = 0.12-0.25) were noticed in the FMA-UE and the 5 SIS 3.0 subscales. The home-reablement group exhibited a greater proportion of participants with scores greater than the minimal detectable change in the FMA-UE and the 6 SIS 3.0 subscales (ie, strength, ADL/instrumental ADL, mobility, emotion, memory, and participation). CONCLUSIONS: People with stroke that underwent the 6-week home-reablement program showed potential for improving their motor function, ADL/instrumental ADL, emotion, memory, and activity participation.


Assuntos
Atividades Cotidianas , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral , Idoso , Eficiência Organizacional , Feminino , Estado Funcional , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-34129501

RESUMO

Subjective clinical rating scales represent the gold-standard for diagnosis of motor function following stroke. In practice however, they suffer from well-recognized limitations including assessor variance, low inter-rater reliability and low resolution. Automated systems have been proposed for empirical quantification but have not significantly impacted clinical practice. We address translational challenges in this arena through: (1) implementation of a novel sensor suite combining inertial measurement and mechanomyography (MMG) to quantify hand and wrist motor function; and (2) introduction of a new range of signal features extracted from the suite to supplement predicted clinical scores. The wearable sensors, signal features, and machine learning algorithms have been combined to produce classified ratings from the Fugl-Meyer clinical assessment rating scale. Furthermore, we have designed the system to augment clinical rating with several sensor-derived supplementary features encompassing critical aspects of motor dysfunction (e.g. joint angle, muscle activity, etc.). Performance is validated through a large-scale study on a post-stroke cohort of 64 patients. Fugl-Meyer Assessment tasks were classified with 75% accuracy for gross motor tasks and 62% for hand/wrist motor tasks. Of greater import, supplementary features demonstrated concurrent validity with Fugl-Meyer ratings, evidencing their utility as new measures of motor function suited to automated assessment. Finally, the supplementary features also provide continuous measures of sub-components of motor function, offering the potential to complement low accuracy but well-validated clinical rating scales when high-quality motor outcome measures are required. We believe this work provides a basis for widespread clinical adoption of inertial-MMG sensor use for post-stroke clinical motor assessment.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Dispositivos Eletrônicos Vestíveis , Humanos , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Extremidade Superior
13.
BMJ Case Rep ; 14(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112633

RESUMO

A man in his early 40s with no significant vascular risk factors was managed within a period of 6 months for recurrent vascular events: ischaemic stroke, transient ischaemic attack and isolated third nerve palsy. He was extensively investigated throughout the course of illness. The only potential aetiological factor identified was a positive janus kinase 2 (JAK 2) mutation after screening on account of mildly elevated platelet count noted during his most recent admission. Bone marrow aspiration confirmed essential thrombocythaemia. He was started on hydroxycarbamide and has remained relatively symptom free since then.This case reiterates the known associations between thrombosis and JAK 2 mutation even without overt myeloproliferative neoplasms. It also highlights the need for specialists in stroke to consider screening for JAK 2 mutation in a young patient with cryptogenic stroke with or without polycythemia or thrombocytosis.


Assuntos
Isquemia Encefálica , Ataque Isquêmico Transitório , Neoplasias , Doenças do Nervo Oculomotor , Acidente Vascular Cerebral , Adulto , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/etiologia , Janus Quinase 2/genética , Masculino , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
15.
J Ayub Med Coll Abbottabad ; 33(2): 274-278, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137544

RESUMO

BACKGROUND: Stroke is a worldwide disease with high morbidity. Various scales are used to measure the severity and outcome of stroke. National Institute of Health Stroke Scale (NIHSS) is a quantifiable scale used to assess stroke severity. However, it is biased towards anterior circulation stroke as compared to posterior circulation stroke, giving higher values in the former. Therefore, it is imperative to know the mean values of NIHSS in each group to predict the functional outcome. The main aim of the study is to compare the mean NIHSS at the time of admission for determining favourable and unfavourable functional outcome in anterior and posterior circulation ischemic stroke. METHODS: It is a descriptive case study of six months' duration done in a Tertiary Care Hospital. All patients of 18 years and above with ischemic stroke involving single arterial territory presented in hospital within 72 hours were included. With the help of the WHO sample size calculator, a target population of 100 patients was determined with a confidence level of 95%. For mean difference we applied independent t test and t score with mean differences for NIHSS at admission and location of stroke has been calculated. Patients with haemorrhagic stroke, venous stroke secondary to Dural Sinus thrombosis, with concomitant disability because of any reason including previous stroke, stroke involving watershed areas and concomitant Acute Coronary Syndrome were excluded. A favourable outcome was defined as Modified Ranking scale score of ≤3 at 1-month post stroke. RESULTS: In anterior circulation, mean baseline NIHSS was 11.3 [SD 7.4], while in posterior circulation, mean NIHSS was 7.30 [SD 7.6]. Comparing the means for functional outcome in anterior circulation using independent t test score, a lower baseline NIHSS score was independently predictive of a favourable outcome for patients with AC (OR 1.268, 95% CI 1.76 -1.358) and PC (OR 1.534, 95% CI 1.321-1.891) stroke. CONCLUSIONS: The mean NIHSS of good functional outcome group is much lower for posterior circulation stroke as compared to anterior circulation stroke which highlights the need for basing the decision of acute stroke emergency management on full neurological examination, rather than a single scale, especially if the posterior circulation stroke is in question.


Assuntos
Acidente Vascular Cerebral/fisiopatologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento , Adulto Jovem
17.
Ugeskr Laeger ; 183(24)2021 06 14.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34120686

RESUMO

Neurological sequelae occur in more than 50% of children with arterial ischemic stroke. Early recognition and treatment are essential in improving outcome. However, diagnostic delay in paediatric stroke often extends beyond 24 hours, and children rarely access hyperacute recanalisation therapies. This review describes clinical presentations, risk factors and treatment of paediatric ischaemic stroke. Additionally, we share our experience from a systematic paediatric stroke pathway implemented in Eastern Denmark since 2017.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Criança , Diagnóstico Tardio , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia
18.
Int J Health Geogr ; 20(1): 31, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187473

RESUMO

PURPOSE: Rapid accessibility of (intensive) medical care can make the difference between life and death. Initial care in case of strokes is highly dependent on the location of the patient and the traffic situation for supply vehicles. In this methodologically oriented paper we want to determine the inequivalence of the risks in this respect. METHODS: Using GIS we calculate the driving time between Stroke Units in the district of Münster, Germany for the population distribution at day- & nighttime. Eight different speed scenarios are considered. In order to gain the highest possible spatial resolution, we disaggregate reported population counts from administrative units with respect to a variety of factors onto building level. RESULTS: The overall accessibility of urban areas is better than in less urban districts using the base scenario. In that scenario 6.5% of the population at daytime and 6.8% at nighttime cannot be reached within a 30-min limit for the first care. Assuming a worse traffic situation, which is realistic at daytime, 18.1% of the population fail the proposed limit. CONCLUSIONS: In general, we reveal inequivalence of the risks in case of a stroke depending on locations and times of the day. The ability to drive at high average speeds is a crucial factor in emergency care. Further important factors are the different population distribution at day and night and the locations of health care facilities. With the increasing centralization of hospital locations, rural residents in particular will face a worse accessibility situation.


Assuntos
Acesso aos Serviços de Saúde , Acidente Vascular Cerebral , Demografia , Alemanha , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Transportes
19.
Acute Med ; 20(2): 140-143, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34190741

RESUMO

Internal carotid artery dissection commonly affects younger patients. We present a case of a previously fit and well 43-year-old gentleman who presented with a sudden onset of slurring of speech, with right-sided tongue deviation and fasciculation on examination. Signs and symptoms began following participation in a home workout class. Magnetic resonance angiography revealed right-sided extracrainal internal carotid artery dissection leading to right-sided unilateral twelfth cranial nerve palsy.


Assuntos
Dissecação da Artéria Carótida Interna , Acidente Vascular Cerebral , Adulto , Disartria/diagnóstico , Disartria/etiologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
20.
J Am Geriatr Soc ; 69(7): 1713-1721, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33955546

RESUMO

BACKGROUND/OBJECTIVE: Emergency department (ED) visits have declined while excess mortality, not attributable to COVID-19, has grown. It is not known whether older adults are accessing emergency care differently from their younger counterparts. Our objective was to determine patterns of ED visit counts for emergent conditions during the COVID-19 pandemic for older adults. DESIGN: Retrospective, observational study. SETTING: Observational analysis of ED sites enrolled in a national clinical quality registry. PARTICIPANTS: One hundred and sixty-four ED sites in 33 states from January 1, 2019 to November 15, 2020. MAIN OUTCOME AND MEASURES: We measured daily ED visit counts for acute myocardial infarction (AMI), stroke, sepsis, fall, and hip fracture, as well as deaths in the ED, by age categories. We estimated Poisson regression models comparing early and post-early pandemic periods (defined by the Centers for Disease Control and Prevention) to the pre-pandemic period. We report incident rate ratios to summarize changes in visit incidence. RESULTS: For AMI, stroke, and sepsis, the older (75-84) and oldest old (85+ years) had the greatest decline in visit counts initially and the smallest recovery in the post-early pandemic periods. For falls, visits declined early and partially recovered uniformly across age categories. In contrast, hip fractures exhibited less change in visit rates across time periods. Deaths in the ED increased during the early pandemic period, but then fell and were persistently lower than baseline, especially for the older (75-84) and oldest old (85+ years). CONCLUSIONS: The decline in ED visits for emergent conditions among older adults has been more pronounced and persistent than for younger patients, with fewer deaths in the ED. This is concerning given the greater prevalence and risk of poor outcomes for emergent conditions in this age group that are amenable to time-sensitive ED diagnosis and treatment, and may in part explain excess mortality during the COVID-19 era among older adults.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Envelhecimento , COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Infarto do Miocárdio , Sepse , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , COVID-19/prevenção & controle , Emergências/epidemiologia , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Mortalidade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , SARS-CoV-2 , Sepse/diagnóstico , Sepse/mortalidade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Estados Unidos/epidemiologia
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