Stroke

BACKGROUND Recent studies have focused on mechanical thrombectomy as a means to reduce the time required for revascularization and increase the revascularization rate in acute stroke. To date no systematic evaluation has been made of the different mechanical devices in this novel and fast-developing field of endovascular interventions. To facilitate such evaluations, we developed a specific in vivo model for mechanical thrombectomy that allows visualization of dislocation or fragmentation of the thrombus during angiographic manipulation. METHODS Angiography and embolization with a preformed thrombus was performed in 8 swine. The thrombus was generated by mixing 25 IU bovine thrombin and 10 mL autologous blood. For visualization during angiography, 1 g barium sulfate was added. RESULTS The preformed thrombus exhibited mechanical stability, reproducibility, and high radiographic absorption, providing excellent visibility during angiography. The setting allowed selective embolization o...

Background A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. Objective The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment studies. Methods This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. Results Five essential outcome constructs were identified: Language, communication, patient-reported...

The National Quality Forum (NQF) recently endorsed a performance measure for time to intravenous thrombolytic therapy which allows exclusions for circumstances in which fast alteplase treatment may not be possible. However, the frequency and impact of unavoidable patient reasons for long door-to-needle time (DNT), such as need for medical stabilization, are largely unknown in clinical practice. As part of the Hurry Acute Stroke Treatment and Evaluation-2 (HASTE-2) project, we sought to identify patient and systems reasons associated with longer DNT. From 06/2012 to 06/2013 we collected data on DNT and potential reasons for delays from 102 consecutive patients presenting directly to the ED who were treated with alteplase within 4.5 hours of symptom onset. Mean age was 71, 56/113 (54%) were women, median NIH Stroke Scale score was 13 and median DNT was 53 minutes. Potential delays were noted in 59/102 (58%), of which 31/102 (31%) were unavoidable patient-related or eligibility reasons...

Background: We wished to examine the impact of antiplatelet
drug discontinuation on recurrent stroke and all-cause
mortality. Methods: We identified a cohort of incident ischaemic
stroke patients in a Danish stroke registry, 2007–2011.
Using population-based registries we assessed subjects’
drug use and followed them up for stroke recurrence, or allcause
death. Person-time was classified by antiplatelet drug
use into current use, recent use ( ≤ 150 days after last use),
and non-use (>150 days after last use). Lipid-lowering drug
(LLD) use was classified by the same rules. We used Cox proportional
hazard models to calculate the adjusted hazard ratio
(HR) and corresponding 95% confidence intervals (CIs) for
the risk of recurrent stroke or death associated with discontinuation
of antiplatelet or LLD drugs. Results: Among 4,670
stroke patients followed up for up a median of 1.5 years, 237
experienced a second stroke and 600 died. Compared with
current antiplatelet drug use, both recent use (1.3 (0.8–2.0)),
and non-use (1.3 (0.8–1.9)) were associated with increased
recurrent stroke risk. The corresponding HRs of death were
1.9 (1.4–2.5) for recent and 1.8 (1.4–2.3) for non-use of antiplatelet
drugs. Recent statin use was associated with markedly
increased risk of death (2.1 (1.7–2.6)), and only marginally
with recurrent stroke (1.2 (0.9–1.6)). Conclusions: Antiplatelet
drug discontinuation may be associated with an
increased recurrent stroke risk. Our results on death risk indicate
that non-pharmacological biases, such as ‘sick stopper’,
may threaten the validity of this risk estimate.

Posture control appears deeply impaired in patients with severe Acquired Brain Injury (ABI). One of the main goals of neurorehabilitation specialists is to try to assess this neural function in a standardized manner. However, the tests available to evaluate posture control recovery after brain damage were developed for patients with focal neurological signs. We therefore developed a new test, the Trunk Recovery Scale (TRS). To evaluate the inter-rater reliability, internal consistency, external validity, and sensitivity of TRS in patients with ABI. Validation study. We examined 59 patients hospitalized after a brain injury in the Intensive and the Extensive Rehabilitation Units of our hospital. Patients with diagnosis of severe ABI with the capacity to respond to simple verbal orders and with a Level of Cognitive Functioning Scale (LCF scale) ≥ 4. Three raters independently assessed 20 subjects. One of the raters also assessed 39 additional subjects using TRS, Trunk Control Test (TC...

Stroke is defined as an abnormality in brain function resulting from disruption of cerebral circulation. It is the third leading cause of death in the United States and the primary cause of long-term disability. The economic burden of stroke will only increase as the population ages, making prevention and treatment of stroke one of the most important public health issues

Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calcu...

Cerebral ischemia initiates a cascade of detrimental events including glutamate-associated excitotoxicity, intracellular calcium accumulation, formation of Reactive oxygen species (ROS), membrane lipid degradation, and DNA damage, which lead to the disruption of cellular homeostasis and structural damage of ischemic brain tissue. Cerebral ischemia also triggers acute inflammation, which exacerbates primary brain damage. Therefore, reducing oxidative stress (OS) and downregulating the inflammatory response are options that merit consideration as potential therapeutic targets for ischemic stroke. Consequently, agents capable of modulating both elements will constitute promising therapeutic solutions because clinically effective neuroprotectants have not yet been discovered and no specific therapy for stroke is available to date. Because of their ability to modulate both oxidative stress and the inflammatory response, much attention has been focused on the role of nitric oxide donors (...

Abstract: Background and Objective Stroke patients with severe leg paralysis are often bedridden in the acute and subacute phase, which increases the risk of disuse muscle atrophy in the chronic phase. The evidence to date indicates that oxidative stress plays an ...

Background and Purpose— Tirofiban is a highly selective, fast-acting nonpeptide glycoprotein IIb/IIIa platelet receptor antagonist with a short half-life time. Glycoprotein IIb/IIIa antagonists are effective for the treatment of acute coronary syndromes proven in large clinical trials. Safety and efficacy in patients with ischemic stroke are uncertain. This was addressed in the Safety of Tirofiban in acute Ischemic Stroke (SaTIS) trial. Methods— Two hundred sixty patients with acute ischemic stroke were randomized in a placebo-controlled, prospective, open-label treatment, blinded outcome reading multicenter trial. Subjects with a National Institutes of Health Stroke Scale between 4 and 18 received intravenously either tirofiban or placebo within 3 to 22 hours after symptom onset for 48 hours. The primary end point was the rate of cerebral bleeding as measured in follow-up CT scans 2 to 7 days after inclusion. The secondary end point was clinical efficacy within 1 week (National Ins...

Functional outcome in acute stroke trials among others is usually measured on the modified Rankin Scale. However, new onset of depression, cognitive decline, and communication deficits alone or in combination affect more than 25% of patients. This report summarizes the findings and conclusions of a workshop by the European Stroke Organization held in February 2011 We propose that assessment of mood disorders, cognitive impairment/dementia, language or communication dysfunction, and quality of life should supplement outcome measures after acute stroke.

Аннотация. В профилактике инсультов и борьбе с их последствиями важна не только работа системы здравоохранения, но и самосохранительное поведение населения, которое в значимой мере обусловлено компетентностью в данном вопросе. Изучение информированности населения об инсульте и выработка рекомендаций по информационной политике – основные задачи данного исследования. Проведено 2 опроса в Москве в октябре-декабре 2019 г., выборка каждого – 800 человек. Исследование обнаружило рост между волнами числа тех, кто считает, что знает признаки инсульта (до 65%). Несмотря на большинство правильных ответов, данная самооценка не всегда подтверждается реальными знаниями, в т.ч. инсульт путают с ишемической болезнью сердца, инфарктом и эпилепсией. Меньшую компетентность демонстрируют мужчины и люди с начальным/средним образованием, более молодые респонденты. 94% респондентов при появлении признаков инсульта вызовут скорую помощь, 16% начнут самостоятельно оказывать помощь, в основном их действия будут корректными, хотя встречается ряд заблуждений. Среди основных факторов риска инсульта респонденты называют наличие вредных привычек. Население чаще обращается к таким источникам информации, как родственники/знакомые (25%) и интернет (22%). Исследование выявило запрос населения на корректную информацию об инсультах. Желательна большая представленность экспертно рецензируемых материалов в информационном поле.

Scene text recognition brings various new challenges occurs in recent years. Detecting and recognizing text in scenes entails some of the equivalent problems as document processing, but there are also numerous novel problems to face for recognizing text in natural scene images. Recent research in these regions has exposed several promise but present is motionless much effort to be entire in these regions. Most existing techniques have focused on detecting horizontal or near-horizontal texts. In this paper, we propose a new scheme which detects texts of arbitrary directions in natural scene images. Our algorithm is equipped with two sets of characteristics specially designed for capturing both the natural characteristics of texts using MSER regions using Otsu method. To better estimate our algorithm and compare it with other existing algorithms, we are using existing MSRA Dataset, ICDAR Dataset, and our new dataset, which includes various texts in various real-world situations. Experiments results on these standard datasets and the proposed dataset shows that our algorithm compares positively with the modern algorithms when using horizontal texts and accomplishes significantly improved performance on texts of random orientations in composite natural scenes images.

Intractable central post-stroke pain (CPSP) is one of the most common sequelae of stroke, but has been inadequately studied to date. In this study, we first determined the relationship between the lesion site and changes in mechanical or thermal pain sensitivity in a rat CPSP model with experimental thalamic hemorrhage produced by unilateral intra-thalamic collagenase IV (ITC) injection. Then, we evaluated the efficacy of gabapentin (GBP), an anticonvulsant that binds the voltage-gated Ca(2+) channel α2δ and a commonly used anti-neuropathic pain medication. Histological case-by-case analysis showed that only lesions confined to the medial lemniscus and the ventroposterior lateral/medial nuclei of the thalamus and/or the posterior thalamic nucleus resulted in bilateral mechanical pain hypersensitivity. All of the animals displaying CPSP also had impaired motor coordination, while control rats with intra-thalamic saline developed no central pain or motor deficits. GBP had a dose-relat...