management of stroke

Disability acceptance has been conceptualized as an internalization of oneself as a person experiencing disability and associated with better coping and motivation for rehabilitation. This is particularly pertinent to individuals experiencing stroke because many are initially not fully aware of their stroke-related impairments, which affects the acceptance process. This qualitative metasynthesis aimed to synthesize qualitative findings regarding disability acceptance in stroke and identify barriers and facilitators associated with it...

OBJECTIVES: First, this registry-based study aimed to comprehensively analyze patients' medical histories and treatments based on ischemic strokes' etiology. We focused on the management of atrial fibrillation among patients diagnosed with cardioembolic stroke. Then, our objective was to identify prognostic factors associated with 28-day mortality. MATERIALS AND METHODS: All ischemic strokes occurring in adults between 2014 and 2021 in Lille, France, were categorized using the TOAST classification...

This editorial provides an overview of recent advancements in the understanding and treatment of neurological disorders, focusing on aging, immunity, and blood flow, as featured in this special issue. The first section explores the importance of identifying biomarkers of aging and aging-related diseases, such as Alzheimer's Disease, highlighting the emerging role of saliva-based biomarkers and the gut-brain axis in disease diagnosis and management. In the subsequent section, the dysregulated immune systems associated with aging are discussed, emphasizing the intricate landscape of the immune system during aging and its bidirectional relationship with neuroinflammation...

The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military's training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period...

BACKGROUND: Cardiovascular diseases (CVDs) are a leading cause of global mortality, motivating research into novel approaches for their management. Lipoprotein(a) (Lp(a)), a unique lipoprotein particle, has been implicated in atherosclerosis and thrombosis, suggesting its potential as a therapeutic target for CVDs. AIM: This study aimed to investigate the association of Lp(a) levels with various cardiovascular parameters and events among patients with confirmed cardiovascular disease...

Background: Goal-directed fluid therapy, as a crucial component of accelerated rehabilitation after surgery, plays a significant role in expediting postoperative recovery and enhancing the prognosis of major surgical procedures. Methods: In line with this, the present study aimed to investigate the impact of target-oriented fluid therapy on volume management during ERAS protocols specifically for gastrointestinal surgery. Patients undergoing gastrointestinal surgery at our hospital between October 2019 and May 2021 were selected as the sample population for this research...

BACKGROUND: Cerebrovascular accident dramatically impacts patients' lives. However, this chronic disease could be managed by boosting self-care and following healthy behaviors. Accordingly, this trial sought to specify the impact of a training program established on the theory of planned behavior on the self-care of clients with this condition. MATERIALS AND METHODS: This trial was performed on 80 clients, who were selected using a random numbers table and divided into two equal groups to receive either usual care alone or usual care plus a training program based on the theory of planned behavior (five in-hospital individual sessions for 5 weeks and weekly phone follow-ups for 2 months after discharge)...

Migraine, a common affliction, manifests as debilitating headaches often accompanied by auras. However, hemiplegic migraine presents an unusual symptomatology, inducing unilateral paralysis during attacks. This condition, occurring in two forms, familial and sporadic, merits attention due to its rarity. To raise awareness of this ailment, we recount the case of a 33-year-old woman. This instance serves as a poignant reminder of the potential severity and complexity of hemiplegic migraines. By shedding light on this less-understood variant, we aim to enhance recognition and understanding within medical communities and among the general public...

BACKGROUND AND OBJECTIVES: Population-based studies on stroke can help guide the care of patients with acute ischemic stroke (AIS) by providing health care communities with information regarding the current usage of stroke treatments. It remains unclear how rapidly new techniques, particularly endovascular stroke treatment (EST), are being adopted and whether there is any disparity in their availability. Although studies using the National Inpatient Sample (NIS) have been conducted, updated studies over a longer period may provide further insights...

Ischemic stroke, particularly embolic stroke, stands as a significant global contributor to mortality and long-term disabilities. This paper presents a comprehensive simulation of emboli motion through the middle cerebral artery (MCA), a prevalent site for embolic stroke. Our patient-specific computational model integrates major branches of the middle cerebral artery reconstructed from magnetic resonance angiography images, pulsatile flow dynamics, and emboli of varying geometries, sizes, and material properties...

BACKGROUND: Despite maximal treatment, heart failure (HF) remains a major clinical challenge. Besides neurohormonal overactivation, myocardial energy homoeostasis is also impaired in HF. Trimetazidine has the potential to restore myocardial energy status by inhibiting fatty acid oxidation, concomitantly enhancing glucose oxidation. Trimetazidine is an interesting adjunct treatment, for it is safe, easy to use and comes at a low cost. OBJECTIVE: We conducted a systematic review to evaluate all available clinical evidence on trimetazidine in HF...

BACKGROUND: Transcarotid artery revascularization (TCAR) is an increasingly popular technique for the management of extracranial carotid stenosis. Its off-label use in the treatment of intracranial neurovascular disease is poorly described. Our objective is to describe the use of a dedicated open transcarotid access system for the treatment of neurovascular pathologies other than extracranial carotid stenosis. METHODS: We conducted a retrospective review of a prospectively maintained database of consecutive patients who underwent treatment of neurovascular disease at a single academic center using the ENROUTE Transcarotid Arterial Sheath...

BACKGROUND: Carotid free-floating thrombus (CFT) is a rare cause of stroke describing an intraluminal thrombus that is loosely associated with the arterial wall and manifesting as a filling defect fully surrounded by flow on vascular imaging. Unfortunately, there is no clear consensus among experts on the ideal treatment for this pathology. METHODS: Retrospective analysis of acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients diagnosed with CFT on computed tomography angiogram (CTA) between January 2015-March 2023...

INTRODUCTION: Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand. METHODS: Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between 1st May 2018 and 30th October 2018 including an outcome survey at 12 months among those who provided consent...

BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the world. AF increases the risk of stroke 5-fold, though the risk can be reduced with appropriate treatment. Therefore, early diagnosis is imperative but remains a global challenge. In low-and middle-income countries (LMICs), a lack of diagnostic equipment and under-resourced healthcare systems generate further barriers. The rapid development of digital technologies that are capable of diagnosing AF remotely and cost-effectively could prove beneficial for LMICs...

BACKGROUND: Ischemic and hemorrhagic stroke incidence tends to be higher among minority racial and ethnic groups. The effect of race and ethnicity following an aneurysmal subarachnoid hemorrhage (aSAH) remains poorly understood. Thus, we aimed to explore the association between race and ethnicity and aSAH outcomes. METHODS: Single-center retrospective review of patients with aSAH from January 2009 to March 2023. Primary outcome was in-hospital mortality. Secondary outcomes included delayed cerebral ischemia, cerebral infarction, radiographic and symptomatic vasospasm, pulmonary complications, epileptic seizures, external ventricular drain placement, and modified Rankin Scale score at discharge and 3-month follow-up...

BACKGROUND: Posterior Circulation Syndrome (PCS) presents a diagnostic challenge characterized by its variable and nonspecific symptoms. Timely and accurate diagnosis is crucial for improving patient outcomes. This study aims to enhance the early diagnosis of PCS by employing clinical and demographic data and machine learning. This approach targets a significant research gap in the field of stroke diagnosis and management. METHODS: We collected and analyzed data from a large national Stroke Registry spanning from January 2014 to July 2022...

BACKGROUND: The global surge in obesity presents a significant health challenge, leading to increased adoption of bariatric surgery as an intervention. However, the correlation between bariatric surgery and cardiovascular outcomes during subsequent pregnancies remains unclear. The aim of our study was to determine the prevalence of cardiovascular complications during delivery hospitalizations in patients with bariatric procedure. METHODS: We performed a retrospective analysis utilizing the National Inpatient Sample database to examine data from delivery admissions of pregnant women with obesity and a history of bariatric surgery...

OBJECTIVE: Poststroke spasticity (PSS) reduces arm function and leads to low levels of independence. This study suggested applying machine learning (ML) from routinely available data to support the clinical management of PSS. DESIGN: 172 patients with acute first-ever stroke were included in this prospective cohort study. Twenty clinical information and rehabilitation assessments were obtained to train various ML algorithms for predicting 6-month PSS defined by a modified Ashworth scale (MAS) score ≥ 1...

BACKGROUND: Type 2 diabetes mellitus (DM) remains the most common type of DM and is associat-ed with disabling complications, reduced quality of life and reduced life expectancy. Satisfactory control of carbohydrate metabolism remains the key way to manage them. AIM: To perform a retrospective analysis of carbohydrate metabolism (in terms of glycated hemoglobin - HbA1c ), the prevalence of complications, and features of hypoglycemic and concomitant therapy in patients with type 2 DM...