JournalTOCs

Journal of Stroke Medicine
Number of Followers: 3

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2516-6085 - ISSN (Online) 2516-6093
Published by Sage Publications

[1176 journals]

A Study of the Correlation of Pulsatility Index by Transcranial Doppler in
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  Authors: Kshitij Bansal, Vijay Sardana, Bharat Bhushan, Dilip Maheshwari
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Background: Cerebral Venous Thrombosis (CVT), accounting for 3% of strokes, can be assessed using non-invasive Transcranial Doppler (TCD) ultrasound to measure cerebrovascular function in real-time. The TCD-derived pulsatility index (PI), highly correlates with intracranial pressure (ICP) and serves as a reliable non-invasive monitoring tool.Aim: This study aims to correlate PI by TCD with clinical outcomes in CVT patients.Methods: A prospective observational study of 41 CVT patients admitted between June 2022 to December 2022 was conducted in the Department of Neurology of MBS Hospital. Each patient was subjected to TCD and the PI was also recorded. The results were analysed with SPSS.Results: Out of the 41 patients, two patients died and 39 patients were discharged. The PI at admission in the left middle cerebral artery (MCA) was 1.19 ± 0.20 amongst discharged and 1.64 ± 0.10 amongst those who died (p = .003). Similarly, the PI at admission in the right MCA was 1.23 ± 0.21 amongst those discharged and 1.63 ± 0.20 amongst those who died (p = .02). Also, PI in both left and right MCA positively and significantly correlated with CVT GS score at admission (r = 0.70, p < .05; r = 0.64, p < .05).Conclusion: PI at admission is both right and left MCA was found to be significantly higher in patients who died during the hospital stay. Also, PI significantly correlated with the CVT GS score at the presentation. Thus, PI at admission by TCD can predict the clinical outcome of patients with CVT.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-04-02T07:44:07Z
  DOI: 10.1177/25166085241234721
Acute Ischaemic Stroke in a Young Adult in Sub-Saharan Africa: A Case
Report of Post-strangulation Carotid Artery Dissection
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  Authors: Michel K. Mengnjo, Leonard Ngarka, Faustin N. Yepnjio, Leonard Nfor Njamnshi, Stephanie Laure Mintya Oba, Alfred K. Njamnshi
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Cerebrovascular accidents (CVA) remain one of the major causes of disabilities and mortality worldwide. In the young, carotid artery dissection (CAD) accounts for close to one-quarter of ischaemic strokes, occurring either spontaneously or due to a traumatic mechanism such as strangulation. We hereby, report a case of a young adult with large-vessel occlusion due to post-strangulation internal CAD. This case highlights the importance of raising awareness of the possibility of CAD in the presence of any focal neurologic deficit due to strangulation.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-03-28T10:44:45Z
  DOI: 10.1177/25166085241235989
The Effect of Biological Sex on a County Pre-hospital Stroke Initiative
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  Authors: Helen Rynor, Kelly Nguyen, Jadthiel Oliva, Lisa Nirvanie-Persaud, Starlie C. Belnap, Felipe De Los Rios La Rosa
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Background: Females are disproportionately affected by strokes when compared to males. This may be attributed to non-traditional stroke symptoms in females and stroke care sex variance. This study explored sex and ethnicity discrepancies in the FAST-ED and stroke outcomes.Methods: An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored patient outcomes. We assessed two cohorts, the 2017 cohort collected one year after FAST-ED implementation, and the 2019 cohort collected two years after FAST-ED implementation. Inclusion criteria included patients aged ≥18 years arriving via EMS as a stroke alert; walk-ins were excluded. EMS FAST-ED compliance, FAST-ED score, final diagnoses, door to needle time (DTN), door to puncture (DTP) time, and stroke treatment volumes were evaluated for sex differences.Results: 1,156 cases were analyzed, 638 (55%) were female. EMS FAST-ED compliance decreased by 17%, but did not differ by sex or ethnicity. EMS FAST-ED score was similar for females and males. Despite the similarity in FAST-ED score, females scored higher on the initial NIHSS (F(1) = 6.25, p < .05) and discharge NIHSS (F(1) = 8.588, p < .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p < .01, 95% CI [1.07–1.80]). Treatment rates did not vary between sex or ethnicity and overall DTN decreased by 10 minutes (2017 cohort M = 36 minutes, SE = 1.96; 2019 cohort M = 26 minutes, SE = 1.69).Conclusions: The FAST-ED demonstrated equitable implementation and scoring among a diverse population, regardless of sex or ethnicity. Additionally, patients were equally likely to receive treatment, while benefiting from a decrease in DTN times.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-03-27T08:30:05Z
  DOI: 10.1177/25166085241235729
COVID and Vaccine-related Cerebral Venous Thrombosis
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  Authors: Shafaq Saleem, Sajid Hameed, Mohammad Wasay
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  The coronavirus disease-2019 (COVID-19) pandemic has been a major threat to global health. It primarily affects the respiratory system but multiple organs, including the nervous system, can be affected. Cerebral venous thrombosis (CVT) has been reported among COVID-19 patients as well as among recipients of COVID vaccines. CVT often remains a diagnostic challenge due to highly variable clinical presentation. We underwent a thorough narrative review of the published literature from January 2020 to April 2023 in the Medline (PubMed) database. Our search led to 66 studies in total, 30 related to COVID-CVT and 36 related to COVID vaccine-CVT. We further looked for differences between these COVID-CVT and COVID vaccine-associated-CVT and their possible pathophysiology, treatment options, and prognosis. A few things that were highlighted during our search: COVID increases CVT risk and can happen without respiratory manifestations. COVID-CVT is more common in middle-aged men and has a higher morality compared to traditional non-COVID-CVT. COVID vaccines also increase the risk of CVT but less than the COVID infection. COVID vaccine-CVT is further divided into two groups having either normal platelets or low platelets. The latter group is better reported and has a higher inpatient mortality and disability at discharge but these patients usually recover well in the follow-up period. Non-heparin anticoagulation, immunomodulation, and surgery are the main treatment options.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-03-04T07:27:18Z
  DOI: 10.1177/25166085241231640
Expert Consensus on Improving Stroke Care Ecosystem in India
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  Authors: M. V. Padma Srivastava, Man Mohan Mehndiratta, Subhash Kaul, N. R. Ichaporia, P. N. Sylaja, M. Pradeep, Anand Alurkar, Deepak Arjundas, Jayanta Roy, Jeyraj Pandian, S. Meenakshi Sundaram, Anshu Rohatgi, Arvind Sharma, P. Vijaya, Ankush Gaikwad, Sachin Suryavanshi
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  The stroke burden in India is alarmingly high compared to Western industrialised countries, necessitating immediate action to develop stroke systems of care. Tailored stroke-prevention strategies, adequate resource allocation for stroke management and research, and increased awareness of specialised care in acute Stroke are critical. The COVID-19 pandemic has underscored the need for improved healthcare delivery and infrastructure. To address the rising stroke burden in India, comprehensive strategies encompassing prevention, awareness, specialised care and governmental support are urgently required. While the concept of ‘stroke-ready centres’ has emerged, their limited availability hinders widespread benefits. This expert consensus examines the current state of stroke care in India, identifies challenges, and proposes strategies to enhance stroke care systems. It offers valuable insights into stroke management at different levels, empowering healthcare professionals and administrators to assess their existing systems and make necessary improvements. Special attention is given to the role of physicians, including the use of thrombolytic therapies like Tenecteplase, in reducing the stroke burden and improving outcomes across the country. Significant strides can be made in stroke management and care in India by addressing these critical areas.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-02-29T09:21:36Z
  DOI: 10.1177/25166085241232510
Non-fasting Glucose Level at Admission Associated with Outcomes in
Cerebral Venous Thrombosis
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  Authors: Passara Cheawprasit, Witoon Mitarnun
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Background and Purpose: Cerebral venous thrombosis (CVT) is a rare form of stroke. The objective of this study was to investigate the characteristics, outcomes, and prognostic factors of CVT patients.Methods: This is a five-year retrospective study of CVT patients admitted to our Hospital from April 2016 to April 2021. Medical records were accessed to confirm the diagnosis and obtain the clinical, imaging, laboratory, and treatment data. Further, outcomes of the patients at three months were collected. Binary logistic regression was used to analyse the prognostic factors.Results: Seventy-three patients with CVT were analysed (35.6% male; mean age, 44.3 years). A poor outcome (modified Rankin scale score, 3–6) was 17.8% of patients, and mortality was 10.9%. Factors associated with poor outcomes in all patients with CVT included the duration of presenting symptoms
  Citation: Journal of Stroke Medicine
  PubDate: 2024-02-27T10:55:14Z
  DOI: 10.1177/25166085241231676
Prevalence, Risk Factors and Prognosis of Seizures After Ischemic Stroke
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  Authors: Mairla Maracaba Moreira, João Brainer Clares de Andrade, Carlos Eduardo Lenis Rodriguez, Davi Said Araújo, Flávia Paiva Rolim, Marla Rochana Braga Monteiro, Norberto Anizio Frota, Fabrício Oliveira Lima, Gisele Sampaio Silva
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Introduction and objectives: Epileptic seizures (ES) are a recognized complication of stroke, commonly associated with extensive ischemic regions and cortical damage. Despite thorough investigation, reports on the incidence, risk factors, and functional implications of post-stroke ES vary widely in the literature. We aimed to evaluate the predictive factors for post-stroke ES and their effects on the clinical outcome at hospital discharge.Methods: Patients with acute ischemic stroke (AIS) admitted to our stroke unit from 2015 to 2017 were eligible to this study. A multivariable logistic regression modeling was built to assess associated variables with acute symptomatic seizures (AS). We defined AS as seizures that occurred within the period of hospitalization (stroke unit discharge) without a history of seizures with clinical or electroencephalographic evidence.Results: Four hundred ninety-two were included in the final analysis. The patients had a mean of 66.7 (±14.4) years; 56% were male. Thirty-eight (7.7%) patients experienced clinical ES in-hospital, with a higher incidence in those with total anterior circulation syndrome. The NIH Stroke Scale score (odds ratio [OR] 1.07, 95% confidence interval [CI], p = .03) and symptomatic hemorrhagic transformation (HT) (OR: 3.53, 95% CI: 1.38–8.99, p = .01) independently predicted ES. We did not find an association between the occurrence of seizures and unfavorable outcomes (Modified Rankin Scale 3–6) at discharge (OR1.26, 95% CI: 0.3–5.32, p = .75). Patients with seizures had a longer hospital stay (18.5 [11–35] vs. 9 [7–14] days).Conclusions: Patients presenting higher NIH Stroke Scale scores upon admission or experiencing symptomatic HT face an increased risk of in-hospital ES. Nonetheless, acute symptomatic ES following AIS does not independently predict adverse functional outcomes at discharge.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-02-27T10:53:54Z
  DOI: 10.1177/25166085241229871
Does Inclement Weather Increase the Risk of Cardioembolic Stroke in
Kashmir Valley'
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  Authors: Waseem Dar, Maqbool Wani, Arjimand Yaqoob, Adnan Raina, Zubair Khwaja, Amit Chandra, Feroze Mir, Ravouf Asmi
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Background: Cardioembolic strokes are a common cause of mortality and morbidity because they are usually big and multiple. Despite extensive advances in the determination and management of modifiable risk factors of these strokes, a significant proportion are attributed to non-modifiable factors. We wanted to test the hypothesis that cardioembolic strokes and no other subtypes of ischemic stroke are associated with inclement weather in Kashmir Valley where winter seasons have harsh weather.Results: A total of 540 ischemic stroke patients were included in the study of which cardioembolic strokes were most common. Cardioembolic strokes were more common in the winter season and associated with lower minimum and maximum temperatures.Conclusion: Evaluation and management of cardioembolic strokes during winter months may demand more attention, particularly in elderly individuals and those with risk factors for atrial fibrillation.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-02-15T10:37:09Z
  DOI: 10.1177/25166085231225905
Evidence of Stroke in Glaucoma Patients
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  Authors: Monali S. Malvankar-Mehta, Mushfiqur Rahman, Ashvinder Suri, Cindy M. L. Hutnik
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Background: As the communal cause of irreversible vision loss in seniors, glaucoma affects more than 67 million people worldwide. Those who suffer from glaucoma have traditionally demonstrated a higher rate of developing stroke. Numerous studies have investigated the relationship between glaucoma and increased stroke risks, but they differ wildly in conclusive findings. To better elucidate the overall findings of the collective studies, a systematic review with the objective of determining the relationship between glaucoma and an increased risk of stroke.Methods: A systematic database search including MEDLINE, EMBASE, and Cochrane Library as well as unpublished literature was done. Distiller SR, a systematic review software was utilized. After two levels of screening, “Title and Abstract” and “Full text” screening, risk of bias assessment and extraction of the data from the included articles were conducted. STATA 14.0 was used to conduct the meta-analysis. The hazard ratio (HR) was the primary outcome measure.Results: Nine studies (376,650 subjects) were included in the analysis. Results indicated a significant hazard of stroke in patients with open-angle glaucoma (HR = 1.36, 95% confidence interval [CI]: [1.08, 1.71]), normal-tension glaucoma (HR = 6.34, 95% CI: [4.8, 8.38]), and neovascular glaucoma (HR = 2.07; CI: [1.41, 3.03]). Studies examining risks of stroke development showed a significant increase in the relative risks (RR) of developing stroke for those with glaucoma (RR = 2.10, CI: [1.64, 2.68]).Conclusions: The hazard of developing stroke could be greater for patients with glaucoma. However, randomized controlled trials with longer-term follow-ups need to be conducted in the future in order to make strong conclusions.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-02-06T10:20:31Z
  DOI: 10.1177/25166085231214875
Amaurosis Fugax Due to Radiationinduced Carotid Stenosis Treated by
Carotid Artery Stenting
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  Authors: Shashank Nagendra, Avinash Gutte, Abhijit Gaikwad
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  59-year-old male had four episodes of transient, painless vision loss in right eye in the last 20 days which had resolved spontaneously. Three years ago, patient had been diagnosed with oropharyngeal squamous cell carcinoma, which had been treated with six cycles of chemotherapy and radiotherapy. MRI brain angiogram showed diffuse long segment wall thickening of Right Internal Carotid Artery with luminal narrowing with no acute infarct or haemorrhage; which was later confirmed by four vessel DSA. He was treated with Right Carotid Artery angioplasty with a cutting balloon while using a distal protection device, followed up by stenting. The patient recovered well on follow-up and there were no further episodes. Thus, amaurosis fugax may be a presentation of carotid artery stenosis, especially after radiotherapy and such patients can be treated by carotid angioplasty and stenting.
  Citation: Journal of Stroke Medicine
  PubDate: 2024-01-10T01:39:01Z
  DOI: 10.1177/25166085231220087
Burden of Caregiving for Young Stroke Survivors in the Community: A
Cross-sectional Study
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  Authors: Rajeswari Aghoram, Done Indira Priya, Sunil K. Narayan
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Introduction:Caring for young stroke survivors presents challenges for carers. Little is known about the burden experienced by them.Aim:In this study, we estimated the caregiving burden among carers of young stroke survivors and explored its patterns and determinants.Methods:One hundred and fifty young stroke survivors (aged
  Citation: Journal of Stroke Medicine
  PubDate: 2024-01-10T01:38:33Z
  DOI: 10.1177/25166085231217563
Our Experience with rTMS in a Stroke
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  Authors: Pawan T. Ojha, Abhijit Gaikwad, Sumit Kharat, Nishu Ojha, Shashank Nagendra, Jayendra Yadav, Aamna Maniyar
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  BackgroundRepetitive Transcranial Magnetic Stimulation (r-TMS), a non-invasive brain stimulation method, appears promising in augmenting post-stroke recovery and requires further evaluation.Aims and ObjectiveTo study the effect of r-TMS treatment on motor function in patients with strokes of different duration and types.MethodsA prospective, single center study was conducted to study the effect of bilateral motor cortex rTMS treatment in 100 consecutive patients with either ischemic or hemorrhagic stroke of any duration. Measured outcomes were changes in NIHSS, MRC grading for motor power, MAS (modified Ashworth scale) for spasticity and mRS (modified Rankin Score) from baseline to follow-up visit at 90 days. Paired T test was used for comparing the outcomes.Results77% subjects were males, 82% had ischemic stroke, median age was 58.5 years, and median NIHSS score was 11. We observed favorable changes in outcome measures after treatment. mRS < = 2 at 90 days was observed in 85.71% of patients with acute stroke, 64.51% of subacute and 55.88% of chronic strokes (p value < 0.002). Acute stroke had higher rates of limb power improvement (94.28%) than subacute (70.96%) or chronic strokes (41.17%) (p value = < 0.01). Post-stroke spasticity reduction was also observed after rTMS. Patients with infarcts or hemorrhages had no significant differences. No significant adverse events were seen.ConclusionrTMS appears to be safe in our study population and could be effectively delivered at different time points to augment post-stroke motor recovery.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-11-07T11:58:37Z
  DOI: 10.1177/25166085231207606
Global Insights: A Bibliometric Analysis of Research Trends in Stroke
Thrombolysis
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  Authors: Manesh Muraleedharan, Alaka Omprakash Chandak
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Bibliometric analyses shed light on domain-specific research trends such as leading contributors and geographical distribution. This article examines these aspects in the context of stroke thrombolysis research over the past decade. Our review highlights the United States as the most prolific contributor with significant input from organizations in China, Sweden, and other countries. Overlay visualization further elucidates focus areas such as thrombolysis pharmacological agents, stroke risk factors, and advancements in assessment and diagnostic techniques.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-11-02T11:24:22Z
  DOI: 10.1177/25166085231200766
A Rare Case of Ischemic Optic Chiasmopathy Following Left Ventricular
Dysfunction in a Patient with Coronary Artery Disease
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  Authors: Bhavana Murugesh, Mary Anne Poovathingal, Geofi George
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  We report a case of transient bitemporal hemianopia following a hypotensive episode in a patient of coronary artery disease (CAD). A 51-year-old male presented with anterior wall myocardial infarction (AWMI) and underwent percutaneous coronary artery intervention (PCI). On the second day post procedure, he developed an acute ischemic event following a cardioembolic infarct to the left middle cerebral artery (MCA) region. Over the next few days, the patient had persistent drop in blood pressure, during which he developed a transient bitemporal hemianopia, which improved after blood pressure correction, consistent with ischemic chiasmopathy.As such in literature, ischemic optic chiasmopathy is a very rare entity. This case report emphasizes that clinicians should consider that sustained hypotension associated with a cardiac event may lead to transient ischemic phenomenon such as the witnessed visual impairment due to hypoperfusion of the optic chiasm.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-10-23T10:31:21Z
  DOI: 10.1177/25166085231202622
Ischaemic Stroke After Chronic Subdural Haematoma: An Uncommon
Complication in a Common Disease
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  Authors: Debajyoti Datta, Debarshi Chatterjee
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  BackgroundChronic subdural haematoma (CSDH) is a common neurosurgical disease, particularly among the elderly, especially those on antiplatelet or anticoagulation with trivial trauma. While anticoagulants/antiplatelets increase the chance of rebleeding in cases of CSDH, discontinuation may increase the risk of stroke in these patients.Case Description:We report two cases of CSDH in elderly patients with risk factors who suffered from an ischaemic stroke after undergoing surgery. The first case was an elderly gentleman who had a history of percutaneous coronary intervention, presenting with a CSDH. He developed an anterior cerebral artery infarct in the immediate postoperative period. The second was an elderly gentleman with a history of hypertension presenting with a concomitant left thalamic infarct and large left-sided CSDH. He developed a second middle cerebral artery infarct of the opposite side in the immediate postoperative period.Conclusion:The medications used for stroke prophylaxis, that is, antiplatelets and anticoagulants are predisposing factors for the development of CSDH. However, the perioperative period of these patients remains vulnerable to the development of new-onset ischaemic stroke.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-09-12T10:23:39Z
  DOI: 10.1177/25166085231197567
Susceptibility Vessel Sign as a Predictor of Intracranial Large Vessel
Occlusion
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  Authors: Aiswarya Raj, Ashraf V. Valappil, Paul Johny, Paul J. Alapatt, K. P. Abdurehiman, L. K. Sreevidya, Noufal Basheer
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  BackgroundThe susceptibility vessel sign (SVS), which can be seen on susceptibility-weighted imaging (SWI), is typically described as a dark blooming artifact.ObjectiveSVS, which can be seen on T2*-weighted gradient echo imaging, is typically described as a dark blooming artifact. The hypointense vessel’s diameter is thus larger on imaging than the opposing vessel’s diameter. We conducted a study to investigate the reliability of this sign on SWI in the principal intracranial arteries in 156 individuals with acute stroke and to assess the 3-month outcome using the modified Rankin Scale (mRS) in these patients.ResultsAmong the 106 patients with large vessel occlusion (LVO) on magnetic resonance angiography (MRA), 73 patients demonstrated a positive SVS on magnetic resonance imaging (MRI), while 33 patients did not. Among the 50 patients without LVO, only 4 patients showed a false-positive SVS, while 46 patients showed a negative SVS. The sensitivity, specificity, positive predictive value, and negative predictive value of SVS as a screening tool were 67.05%, 90.7%, 93.65%, and 57.35% in anterior circulation LVO, and 77.8%, 100%, 100%, and 63.6% in posterior circulation LVO, respectively. The chi-square test showed p < .05, demonstrating a significant association. With a modified thrombolysis in cerebral infarction (mTICI) score of 2B or 3, 83.3% of SVS-positive patients had a successful recanalization, while 64.4% had an mRS score of less than 3.InterpretationSVS is a good screening tool for the presence of intracranial LVO, with good sensitivity, high specificity, and positive predictive value for LVO (posterior> anterior). SVS positivity may also indicate successful recanalization and a good 90-day mRS outcome.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-09-11T05:43:17Z
  DOI: 10.1177/25166085231197573
Analyzing the Role of Arterial Spin Labelling in Patients Undergoing
Endovascular Thrombectomy for Large Vessel Occlusion—a Prospective
Single Center Study
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  Authors: Suhaila Parveen, Aiswarya Raj, Noufal Basheer, Paul J. Alapatt, Sujith Janardhanan, Abdurehiman KP, KG Ramakrishnan
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Acute stroke is one of the leading causes of death globally. Imaging remains the most common modality to diagnose and predict outcomes in patients with stroke. Conventionally, computed tomography (CT) was the preferred choice; however, imaging has expanded to include newer modalities such as Dynamic Susceptibility Contrast (DSC), Dynamic Contrast-Enhanced MRI (DCE), and Arterial Spin Labelling MRI. An alternative method of assessing perfusion, ASL uses the spins of endogenous water protons as a tracer rather than administering a contrast agent. In this manner, endogenous water in the arterial blood is labelled electromagnetically and employed as a freely diffusible tracer. ASL, as opposed to CT, DSC or DCE, allows estimation of cerebral blood flow without exposure to radiation or the administration of contrast material, which is advantageous for patients with impaired renal function or repetitive perfusion imaging. Thus a prospective study was conducted to explore the use of Arterial Spin Labelling MRI in the setting of acute ischemic stroke in both pre and post-thrombectomy patients. Our study is significant as there are no existing prospective studies comparing the cerebral perfusion measured using ASL with neurological outcomes.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-08-08T06:59:28Z
  DOI: 10.1177/25166085231186921
Primary Brainstem Hemorrhage—An Institutional Series From a Stroke
Register and Evaluation of Outcome Determinants
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  Authors: Namrata Gupta, Aseem Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, Girish Menon
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  ObjectivePrimary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients.MethodsA single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant.ResultsA total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, (P < .001) large clot volume (>10 mL) (P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) (P < .03) was found to have significant correlation with mortality.ConclusionBrainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-08-07T08:21:05Z
  DOI: 10.1177/25166085231186377
Seasonal and Circadian Variations in Stroke Subtypes in the Muscat
Governorate of the Sultanate of Oman
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  Authors: Amal. M. Al Hashmi, Sanjith Aaron, Ahmed Al Sinani, Sachin Jose
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  IntroductionThe influence of climatic, weather conditions, and circadian variations on cerebrovascular diseases has been evaluated in many studies. However, the results have been controversial.ObjectiveThis study aims at identifying the relationship between the circadian and circannual climatic patterns in the Governorate of Muscat and their impact on stroke and its subtype.MethodFrom January 2016 to December 2019, a retrospective study of all confirmed acute stroke cases admitted to the central stroke unit was conducted. Only Omani Patients were included. The data was collected through a computerized medical record system.ResultsA total of 836 Omani patients were involved in the study. Ischemic stroke accounted for 731 cases (87.4%), while intracerebral hemorrhage (ICH) accounted for 105 (12.6%). 62.7% of the overall sample size was made up of men. Between different days times, there was a statistically significant difference in the occurrence of ischemic stroke and ICH (likelihood ratio, P = .010). The majority of ischemic strokes (62.2%) occurred between 6 am and 6 pm (daytime), and the majority of ICH (54%) occurred between 6 pm and 6 am (nighttime). The majority of ischemic strokes (52.9%) and ICH (61.9%) occurred during the winter months.ConclusionThe majority of both stroke subtypes were found to occur in the morning hours and during winter months. These findings might aid in the better organization of acute stroke care. Further analysis of these findings could aid in the development of better primary prevention strategies.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-08-03T08:23:58Z
  DOI: 10.1177/25166085231188633
The Importance of Hip Abductor and Adductor Muscles in Balance and
Mobility Tasks After a Stroke: A Systematic Review
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  Authors: Marcel B Lanza, Nathan Frakes, Kerry Callaghan, Andrea Goldstein Shipper, Lateef Shabnam, Vicki Gray
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  The aim of this systematic review was to identify the association between muscle strength, activation, and structure of the hip abductor-adductor muscles and balance and mobility tasks in individuals post stroke. The present systematic review is comprised of 37 research articles, with 911 individuals that had a stroke. The extracted data included the study population, sample size, sex, stroke side of paresis, time poststroke, and evaluated measurements. We concluded that stronger hip abductors and adductors (both paretic and nonparetic legs) resulted in quicker voluntary step, and faster walking speed and cadence. Also, stronger paretic hip abductors were associated with a faster completion of the timed up and go test, higher ambulation ability, better control of the centre of mass, and quicker stair climbing. Overall, it demonstrated a lateral induced step to the paretic side, increased muscle activation of the gluteus medius of the paretic leg, and increased nonparetic hip abductor muscle activation. The strength and ability to activate the hip abductor and adductor muscles appears to be related to better performance during balance or mobility tasks in individuals with stroke. Therefore, the present systematic review results suggest that improving muscle strength and activation of the hip abductor and adductor muscles might help individuals with stroke to avoid falls.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-08-01T10:52:05Z
  DOI: 10.1177/25166085231186380
Effect of a Sensorimotor Exercise Regimefor Upper Limb Deficits in the
In-HospitalPhase After a Supratentorial Stroke(SMULS)—Protocol for a
RandomizedControlled Trial
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  Authors: Dorcas B.C. Gandhi, Nistara Singh Chawla, Christy John, Amarjot Gill Singh, Sania Zarreen, Pranay J. Vijayanand
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  BackgroundSomatosensory impairments in the upper limb are a common occurrence in>50% of post-stroke individuals. The effects of a combined sensorimotor therapy program on improving functional outcomes have not been studied extensively especially in the acute and subacute phase post-stroke.MethodsThrough a randomized controlled trial of PROBE design, participants, selected on a pre-set selection criteria will either receive the a structured regime of sensorimotor therapy in addition to routine care or only routine care for over 14 days or until discharge. Outcomes will be analyzed on the “Action Research Arm test” and “Erasmus modified Nottingham Sensory Assessment” scale at discharge and then at the third and sixth months.Results and ConclusionThe proposed study will allow development and implementation of sensory rehabilitation components to the existing stroke rehabilitation protocols. Initiating intervention within the acute and subacute phase post-stroke in suitable patients will allow early intervention for sensorimotor impairments subsequently leading to improved upper limb outcomes.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-08-01T10:47:54Z
  DOI: 10.1177/25166085231185731
Mental Health Disorders Post-Stroke: A Scenario in India
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  Authors: Abhilash Patra, Sureshkumar Kamalakannan, Hira B. Pant, Varun Agiwal, Nirupama A.Y., Sirshendu Chaudhuri, Gudlavalleti S. Murthy
  Abstract: Journal of Stroke Medicine, Ahead of Print.
  Mental health disorders were reported in more than 33% of stroke survivors, which lead to increased comorbidities, delayed care, affect recovery, and impact physical and social functioning. Furthermore, it diminishes the quality of life and has impact on the well-being of both their families and caregivers. However, existing screening tools available for diagnosis of mental health disorders post-stroke detect many undiagnosed and underreported stroke survivors. Globally and in India, there has been a significant prevalence of post-stroke depression and anxiety. Pseudobulbar affect (PBA) ranged from 11% to 34%, worldwide. However, in India, only few case reports were reported for post-stroke psychosis, mania, and PBA. Although guidelines exist in developed countries for screening, referral, and rehabilitation of mental health disorders, there are lack of such resources in India. Also, the District Mental Health Program (DMHP) has received conflicting evaluations regarding its successes and shortcomings. Hence, this situation highlights the need for robust evidence-based strategies to develop effective screening, referral, and rehabilitation guidelines tailored to the Indian context. Also, by leveraging existing resources and collaborating with experts in the field, India can develop a comprehensive and effective approach to addressing post-stroke mental health disorders.
  Citation: Journal of Stroke Medicine
  PubDate: 2023-07-28T07:16:09Z
  DOI: 10.1177/25166085231186492

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