جستجوی مقالات مرتبط با کلیدواژه « acute ischemic stroke » در نشریات گروه « پزشکی »

Echocardiography is routinely ordered in acute ischemic stroke workup. No standardized or structured criteria is used to select or exclude echocardiography in such settings. Moreover, the diagnostic yield of echocardiography in stroke is low in our medical center. This article presents newly proposed selection criteria for echocardiography in ischemic stroke workup.

A quality improvement project was implemented in a 385-bed community hospital in Maryland, USA. A computerized decision support tool consisting of new criteria for selecting echocardiography in ischemic stroke workup was created. 639 patients hospitalized with ischemic stroke were followed-up over 12 months after intervention, and 686 matched-controls with ischemic stroke were retrospectively analyzed from the 12 months prior to intervention. Cost-effectiveness and diagnostic yield of echocardiography in ischemic stroke were measured before and after intervention.

Following intervention, the diagnostic yield of echocardiography in ischemic stroke workup significantly increased by 51% (from 3.8% to 7.8%, odds ratio (OR) 2.1, P= 0.01). The number of echocardiography studies needed to detect and treat one patient with a cardiac source of embolism was reduced from 50 to 25 studies. The overall use of echocardiography in stroke workup significantly decreased (OR 0.4, p < 0.001). Patients with lacunar infarcts or atrial fibrillation had significant reduction in echocardiography (OR 0.2, p < 0.001 and OR 0.4, p < 0.001, respectively).

The new criteria for echocardiography selection in hospitalized patients with ischemic stroke significantly improved the cost-effectiveness and the diagnostic yield of echocardiography and reduced unnecessary echocardiography in lacunar infarcts or atrial fibrillation.

 People with diabetes, exhibit increased platelet reactivity. Both insulin resistance and insulin deficiency increase platelet reactivity. Platelets play a vital role in the pathogenesis of acute coronary syndromes (ACS). It has been shown that PC and MPV are independent predictors for poor outcome in primary intracerebral hemorrhage. The aim of the study is to analyze the platelet parameters in patients with some non-hematological disorders such as diabetes mellitus type 2, acute coronary syndrome, and acute ischemic stroke.

 Blood samples were collected from 400 subjects and analysed using the Sysmex KX-21 automated hematology analyser. 300 patients presenting with non-hematological disorders and 100 age and sex matched healthy controls were checked for Platelet indices such as PC, MPV, PDW and P-LCR. The platelet morphology was studied on peripheral blood smear for considering the arrangement, granularity and size of platelets.

 In total non-hematological disorders, DM type 2 accounts 37.33% (n=112), followed by 35.67% of ACS (n=107), and 27% of AIS (n=81). In diabetes mellitus type 2, PC was statistically elevated along with MPV compared with healthy controls. MPV and PDW were significantly raised in the patients admitted with ACS. In acute ischemic stroke, we noted that there was an elevation in MPV and a decrease in PC compared to them in the control group. Study showed discrete arrangement of platelets in 90% of DM type 2, 88% of ACS, and 80% of AIS patients. PBS in various clinical conditions showed granularity of platelets in 84 % of DM type 2, 81% of ACS and 83% of AIS patients.  Study showed increased percentage of macrothrombocytes as 60% of DM type 2, 56% of ACS and 52% of AIS patients. The percentage of large platelets on PBS was increased beyond normal limits in DM type 2, ACS and AIS cases, indicating that there is an increase in size of the platelets supporting an increase in MPV.

 The measurement of platelet indices may provide useful diagnostic and prognostic information to emergency physicians caring for patients with ACS and AIS.

Neurological manifestations of coronavirus disease 2019 (COVID‑19) have been highlighted. COVID‑19 potentially increases the risk of thromboembolism. We aimed to compare patients with COVID‑19 with and without new‑onset acute ischemic stroke (AIS).

In this single‑center retrospective case–control study, demographics, clinical characteristics, laboratory findings, and clinical outcomes were compared between 51 patients with both COVID‑19 and AIS (group A) and 160 patients with COVID‑19 and without AIS (group B).

Patients in group A were significantly older, more likely to present with critical COVID‑19 (P = 0.004), had higher rates of admission in the intensive care unit (P < 0.001), more duration of hospitalization (P < 0.001), and higher in‑hospital mortality (P < 0.001). At the time of hospitalization, O2 saturation (P = 0.011), PH (P = 0.04), and HCO3 (P = 0.005) were lower in group A. White blood cell count (P = 0.002), neutrophil count (P < 0.001), neutrophil‑lymphocyte ratio (P = 0.001), D‑Dimer (P < 0.001), blood urea nitrogen (BUN) ( P < 0.001), and BUN/Cr ratio (P < 0.001) were significantly higher in patients with AIS.

Stroke in COVID‑19 is multifactorial. In addition to conventional risk factors of ischemic stroke (age and cardiovascular risk factors), we found that patients with more severe COVID‑19 are more prone to ischemic stroke. Furthermore, leukocyte count, neutrophil count, neutrophil‑lymphocyte ratio, D‑Dimer, BUN, and BUN/Cr ratio were higher in patients with AIS following COVID‑19 infection.

Cerebrovascular accidents (CVA) are of the main causes of mortality and morbidity in the world. This study aimed to investigate the two training protocols in patients with acute ischemic stroke (AIS), and their relationship with the patients’ prognosis.

This experimental study included 45 patients whose ages ranged from 45 to 65 years. Patients were recruited by convenience sampling and purposive method. The participants were categorized into two intervention groups high-intensity anaerobic training (HIT) and continuous aerobic exercise). The control group individuals had no history of exercise. All three scores were assessed at the beginning of the study and after 28 days.
SPSS 22 was used to analyze the collected data and the following statistical tests were performed: independent samples t-test, ANOVA and Tukey post hoc test. The level was considered to be 0.05.

The National Institutes of Health Stroke Scale (NIHSS) score reduced in both exercise groups compared to the controls, in the post-intervention period (frame 9 to 7). The Mini- Mental State Examination (MMSE) score also increased in the continuous exercise group (from 21.93 to 23.4 in the HIT group and from 22.4 to 24.14 in the continuous group), while the Modified Rankin Scale (MRS) score reduced (frame 3 to 2) (P=0.001).

Performing intermittent exercise over four weeks can improve the overall prognosis quality of CVA patients by reducing the MRS score.

Myxoma may cause systemic embolization and frequently presents as ischemic stroke. 

There have been debates about whether it is safe to use recombinant tissue plasminogen activator (rt-PA) in patients with cardiac myxoma who referred with ischemic stroke to the hospitalchr('39')s emergency. 

The patient was a young case of atrial myxoma with initial presentation of acute cerebral infarction symptoms who was treated with intravenous rt-PA with no complications.

The case provides an evidence of the efficacy and safety of intravenous rt-PA in cases of cardiac myxoma. However, we cannot always expect thrombolytic therapy to be effective, especially in tumor emboli.

Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA.

A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled. Inclusion and exclusion criteria were based on updated guidelines. Probable prognostic variables were examined separately in three distinct groups; the occurrence of ICH within 24 hours after treatment, poor 3-month outcome on the basis of modified Rankin Scale (mRS) and 3-month mortality.

Patients were 83 men (62.9%) and 49 women (37.1%) with a median age of 66 years [interquartile range (IQR)of 55-72]. Any type of hemorrhage, symptomatic hemorrhage [based on the European Cooperative Acute Stroke Study III (ECASS III) definition] within 24 hours posttreatment, poor 3-month outcome (mRS 3-6), and 3-month mortality were documented in 10.6%, 4.5%, 53.2%, and 23.6% of patients, respectively. Increased baseline blood glucose was a significant but dependent predictor of hemorrhage within the first 24 hours posttreatment. Dependent predictors of a 3-month poor outcome were high age, the National Institutes of Health Stroke Scale (NIHSS) at baseline, decreased admitting glomerular filtration rate (GFR), and the presence of atrial fibrillation (AF) rhythm, and ICH within 24 hours posttreatment. Only age [Odds ratio (OR) adjusted 1.05] and initial NIHSS (OR adjusted 1.23), however, were recognized as the independent variables in this regard. The only independent predictor of 3-month mortality was the initial NIHSS (OR adjusted 1.18).

According to the findings of the present study, advanced age and high baseline NIHSS are two independent prognostic factors in patients with AIS treated with tPA.