‘STROKE’ March 2011 - PowerPoint PPT Presentation

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  1. ‘STROKE’ March 2011 Dr AmerJafar

  2. Early Dementia After First-Ever Stroke • From 1985 to 2008, overall first-ever strokes occurring withinthe population of the city of Dijon, France (150 000 inhabitants)were recorded • The presence of dementia was diagnosed duringthe first month after stroke, according to Diagnostic and StatisticalManual of Mental Disorders

  3. Over the 24 years, 3948 first-ever strokes were recorded. Amongpatients with stroke, 3201 (81%) were testable of whom 653 (20.4%)had poststroke dementia (337 women and 316 men) • The prevalenceof poststroke dementia associated with lacunar stroke was 7times higher than that in intracerebral haemorrhage but declinedover time as did prestroke antihypertensive medication

  4. Age,several vascular risk factors, hemiplegia, and prestrokeantiplateletagents were associated with an increased prevalence of poststrokedementia

  5. Cerebral Microbleeds • Predictive of Mortality in the Elderly • To investigate the prognostic value of cerebral microbleeds(CMB) regarding overall, cardiovascular-related, and stroke-relatedmortality • Authors included 435 subjects who were participants from the nestedMRI substudy of the PROspective Study of Pravastatin in theElderly at Risk (PROSPER)

  6. Subjects with >1 CMB had a 6-fold risk of stroke-relateddeath compared to subjects without CMB • Conclusion: the diagnosis of microbleeds is potentially ofclinical relevance • Larger studies are needed to expand ourobservations and to address potential clinical implications

  7. Predict Stroke Outcome • A 5-Item Scale • Predict Stroke Outcome After Cortical Middle Cerebral Artery Territory Infarction • The authors retrospectively reviewed 129 patients over a 2-year periodand considered demographic, clinical, laboratory, and radiographicparameters as potential predictors of outcome.

  8. Inclusion criteriawere unilateral hemispheric infarcts within the middle cerebralartery territory >15 mm in diameter • The primary outcomemeasure was a favourable recovery defined as a modified RankinScore was 2 at 30 days

  9. The 5 independent predictors of outcome were as follows: • Age • National Institutesof Health Stroke Scale score • infarct volume • admission white blood cell count • presence of hyperglycemia

  10. this model serves as a useful clinical and research tool topredict stroke recovery after cortical middle cerebral arteryterritory infarction.

  11. Stenting and Endarterectomy • TheCarotid Revascularization Endarterectomy Versus Stenting Trial(CREST) data were analyzed to determine safety in symptomaticand asymptomatic patients. • CREST is a randomized trial comparing safety and efficacy ofCAS versus CEA in patients with high-grade carotid stenoses

  12. For 1321 symptomatic and 1181 asymptomatic patients, the periproceduralaggregate of stroke, myocardial infarction, and death did notdiffer between CAS and CEA • The stroke and death ratewas higher for CAS versus CEA

  13. Conclusions: • There were no significant differences between CAS versus CEAby symptomatic status for the primary CREST end point • Periproceduralstroke and death rates were significantly lower for CEA in symptomaticpatients

  14. Thrombolysis • Acute ischemic stroke patients who receive recombinant tissueplasminogen activator (rt-PA) within 3 hours of symptom onsetare 30% more likely to have minimal to no disability at 3 months • retrospective analysis of all patients with ischemicstroke who presented within the original three hour window forintravenous thrombolysis, and who were admitted to the Universityof Texas Houston Medical School Stroke Service

  15. Out of 2225 patients with acute ischemic stroke, 1019 were dischargedto home, 719 to inpatient rehabilitation, 371 to a skilled nursingfacility and 116 to subacute care • Conclusion: Patients who receive intravenous recombinant tissue plasminogenactivator as treatment for acute ischemic stroke are more likelyto be discharged directly home after hospitalization

  16. Deep Vein Thrombosis Prophylaxis • Patients with intracerebralhemorrhage (ICH) are at high riskfor development of deep venous thrombosis. • Current guidelinesstate that low-dose subcutaneous low molecular weight heparinor unfractionated heparin may be considered at 3 to 4 days fromonset

  17. insufficient data exist on hematoma volume inpatients with ICH before and after pharmacological deep venousthrombosis prophylaxis • The authors identified 73 patients with a mean age of 63 years and medianNational Institutes of Health Stroke Scale score 11.5

  18. The meanbaseline total hematoma volume was 25.8 mL±23.2 mL • Repeat analysis of patients given pharmacological deepvenous thrombosis prophylaxis within 2 or 4 days after ICH foundno increase in hematoma size • Pharmacological deep venous thrombosis prophylaxis given subcutaneouslyin patients with ICH and/or intraventricularhemorrhage in thesubacute period is generally not associated with hematoma growth

  19. Sulfonylurea Use Before Stroke • Sulfonylureas block nonselectivecation channels and lower serumglucose and are neuroprotective in animal models of ischemicstroke • Human data on sulfonylureas in acute stroke are sparseand conflicting • aimed to measure the potential neuroprotectiveeffect of prestroke sulfonylurea use in diabetic patients

  20. The authors analyzed data from a prospective cohort of individuals withdiabetes mellitus (DM) enrolled in nonreperfusion ischemic stroketrials within Virtual International Stroke Trials Archive (VISTA)comprising 1050 patients, 298 with sulfonylurea use before strokeonset

  21. The primary outcome measures were baseline National Institutesof Health Stroke Scale score and 90-day modified Rankin Scalescore • Compared with patients on no DM medications, those with sulfonylureause before stroke onset presented with less severe stroke but had similar modified RankinScale scores at 90 days

  22. Sulfonylurea use before stroke onset did not affect stroke severityor long-term functional outcome compared with other DM treatments • This finding casts doubt on the use of sulfonylureas for prophylacticneuroprotection. Furthermore, patients not using any medicationfor DM appear to have more severe strokes and worse outcomes