‘STROKE’ September 2010 Dr. Amer Jafar

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 case–crossover 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.

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

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 case–crossover study was conducted by analyzing the Taiwan National Health Insurance Database

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

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

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.

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

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.

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

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.

eGFR and stroke Consecutive patients with acute stroke (N=378) 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 <60 mL/min/1.73 m2), and 226 (59.8%) had normal or mildly impaired eGFR (60 mL/min/1.73 m2 )

Of the patients, 108 (28. 6%) had mild, 68 (18 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

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

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%)

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.

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 >1 in any of the examined joints

Two hundred eleven patients (70.1%) were reassessed after 6 months Of these, 42.6% (n=90) 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%)

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.

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

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

Of 228 consecutive IV rt-PA–treated 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.