Transcript 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 followedup 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 (18.0%) 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.
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