Alireza Baratloo; Mahtab Ramezani; Hosein Rafiemanesh; Meisam Sharifi; Somayeh Karimi
Volume 22, Issue 1 , January 2023, , Pages 58-62
Abstract
Background: We believe that designing a new tool which is comparable in terms of both sensitivity and specificity may play an important role in rapid and more accurate diagnosis of acute ischemic stroke (AIS) in prehospital stage. Therefore, we intended to develop a new clinical tool for the diagnosis ...
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Background: We believe that designing a new tool which is comparable in terms of both sensitivity and specificity may play an important role in rapid and more accurate diagnosis of acute ischemic stroke (AIS) in prehospital stage. Therefore, we intended to develop a new clinical tool for the diagnosis of AIS in the prehospital stage.Methods: This was a cross-sectional diagnostic accuracy study. All patients transferred to the emergency department (ED) who underwent brain magnetic resonance imaging (MRI) with impression of AIS were evaluated by 9 clinical tools for stroke diagnosis in the pre-hospital phase including Rapid Arterial Occlusion Evaluation (RACE), Cincinnati Prehospital Stroke Scale (CPSS), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Medic Prehospital Assessment for Code Stroke (Med PACS), Ontario Prehospital Stroke Screening Tool (OPSS), PreHospital Ambulance Stroke Test (PreHAST), Recognition of Stroke in the Emergency Room (ROSIER), and Face Arm Speech Test (FAST), and totally 19 items were reviewed and recorded. The new clinical tool was developed based on backward method of multivariable logistic regression analysis. The discrimination power of the new clinical tool for diagnosis of AIS was assessed with the area under the receiver operating characteristic curve (AUC-ROC).Results: Data from 806 patients were analyzed; of them, 57.4% were men. The mean age of the study patients was 66.9 years [standard deviation (SD) = 13.9]. In the multivariable model, 8 items remained. The AUC-ROC of the new clinical tool was 0.893 [95% confidence interval (CI): 0.869-0.917], and its best cut-off point was score ≥ 3 for positive AIS. At this cut-off point, sensitivity and specificity were 84.42% and 79.72%, respectively.Conclusion: We introduced a new nomogram-based clinical tool for the diagnosis of AIS in the prehospital stage, which has acceptable specificity and sensitivity; moreover, it is comparable with previous tools.
Abbas Rahimi-Jaberi; Yadollah Askari; Khojasteh Rahimi-Jaberi; Mohammad Moghadam
Abstract
Background: Swallowing is one of the most complex functions of the central nervous system (CNS), which is controlled by different parts of the brain. Oropharyngeal dysphagia (OD) is one of the most common complications after stroke. Despite a variety of behavioral, compensatory, and rehabilitative methods, ...
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Background: Swallowing is one of the most complex functions of the central nervous system (CNS), which is controlled by different parts of the brain. Oropharyngeal dysphagia (OD) is one of the most common complications after stroke. Despite a variety of behavioral, compensatory, and rehabilitative methods, many stroke patients still suffer from swallowing disorders that adversely affect their quality of life (QOL). The aim of this study was to evaluate the effect of pyridostigmine on patients with post-stroke dysphagia.Methods: A randomized, double-blind, placebo-controlled clinical trial was carried out on 40 patients suffering from post-stroke dysphagia. Patients were assigned randomly into two groups: intervention and control groups (20 in each group). The intervention group was treated with pyridostigmine (60 mg, three times a day, 30 minutes before each meal for three weeks), and the control group received placebo treatment in the same way. All patients (intervention and control) were evaluated according to National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Functional Communication Measures (FCM)/American Speech-Language-Hearing Association (ASHA) criteria at baseline and after three weeks of intervention. Values of P < 0.05 were considered statistically significant.Results: In the intervention group, the mean values of NIHSS, mRS, and ASHA/FCM were significantly reduced following three weeks of treatment with pyridostigmine (P = 0.002, P = 0.003, and P < 0.001, respectively), but no significant differences were found in the mean NIHSS, mRS, and ASHA/FCM in the placebo group.Conclusion: Although pyridogestamine is somewhat effective in post-stroke dysphagia, it has not been shown to be more important in preventing aspiration pneumonia and length of hospital stay.
Maedeh Asadi; Etrat Hooshmandi; Fatemeh Emaminia; Hanieh Mardani; Ali Mohammad Keshtvarz-Hesamabadi; Mojtaba Rismanchi; Abbas Rahimi-Jaberi; Vahid Reza Ostovan; Nima Fadakar; Afshin Borhani-Haghighi
Abstract
Background: Remote ischemic preconditioning (RIPC) has been proposed as a possible potential treatment for ischemic stroke. This study aimed to investigate the frequency of micro-embolic brain infarcts after RIPC in patients with stroke who underwent elective carotid artery stenting (CAS) treatment.Methods: ...
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Background: Remote ischemic preconditioning (RIPC) has been proposed as a possible potential treatment for ischemic stroke. This study aimed to investigate the frequency of micro-embolic brain infarcts after RIPC in patients with stroke who underwent elective carotid artery stenting (CAS) treatment.Methods: This study was managed at Shiraz University of Medical Sciences in southwest Iran. Patients undergoing CAS were randomly allocated into RIPC and control groups. Patients in the RIPC group received three intermittent cycles of 5-minute arm ischemia followed by reperfusion using manual blood cuff inflation/deflation less than 30 minutes before CAS treatment. Afterward, stenting surgery was conducted. Magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC), was acquired within the first 24 hours after CAS.Results: Seventy-four patients were recruited (79.7% men, age: 72.30 ± 8.57). Both groups of RIPC and control had no significant difference in baseline parameters (P > 0.05). Fifteen patients (40.5%) in the RIPC group and 19 (54.1%) patients in the control group developed restricted lesions in DWI MRI. In DWI+ patients, there were no significant differences according to the number of lesions, lesion surface area, largest lesion diameter, cortical infarcts percent, and ipsilateral and bilateral infarcts between the two groups.Conclusion: Although RIPC is a safe and non-invasive modality before CAS to decrease infarcts, this study did not show the advantage of RIPC in the prevention of infarcts following CAS. It may be because of the small sample size.
Shima Fardipour; Mohammad Hadadi
Abstract
Background: Over the past decades, wearable robotic gloves due to their positive features are used by clinicians to improve motor function in the upper extremity. This systematic review aims to evaluate the studies that investigated the therapeutic effects of wearable robotic gloves to improve hand function ...
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Background: Over the past decades, wearable robotic gloves due to their positive features are used by clinicians to improve motor function in the upper extremity. This systematic review aims to evaluate the studies that investigated the therapeutic effects of wearable robotic gloves to improve hand function in stroke patients.Methods: The most related databases including MEDLINE (PubMed), ISI Web of Knowledge, Scopus, IEEE, and Google Scholar were systematically searched and studies were collected up to September 2021. The methodological quality assessment was done using an adapted version of the Downs and Black checklist.Results: Of the 2674 articles searched, 5 studies were recognized as being relevant in this systematic review. The methodological quality of all included studies was between 7 to 10 points of adapted 12-point score of Downs and Black checklist. All studies concluded that the introduced robotic device had a good therapeutic effect on investigated patients' hand function. The studies had limitations in terms of the level of evidence, sample size, stroke patient groups, and therapeutic process.Conclusion: There is no standard approach with definite intervention timing to evaluate the effect of such devices. Therefore, more comprehensive studies are needed to confirm the therapeutic effects of wearable robotic gloves on improving hand function after a stroke.
Mazyar Hashemilar; Parla Tohidi; Nasrin Forghani; Elyar Sadeghi-Hokmabadi; Ehsan Sharifipour
Abstract
Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and ...
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Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and pathophysiology of these two types of BZI are still debated. This study aimed to determine the etiologic differences of two types of BZI to guide tailor appropriate treatment strategies for these patients.Methods: In this prospective study, patients with BZIs were enrolled from patients with acute ischemic stroke admitted to the hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from 2017 to 2019. Appropriate clinical and laboratory workups were applied to determine possible etiologies of ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system.Results: The study included 106 patients with BZI, 53 patients in each group. Both types of BZI were more frequent in males. However, there was no significant difference between the two types concerning sex, age, and profile of major stroke risk factors. The results showed no correlation between the type of BZI and hemodynamic factors (P = 0.086). However, large artery atherosclerosis (LAA) was the most frequent etiology within each subtype of BZI; LAA in internal (P = 0.016) and cardioembolism (P = 0.046) in external BZI were more frequent etiologic subtypes of cerebral infarction.Conclusion: LAA might be the most common etiology for internal and external cerebral BZIs. Cardioembolism might have a more important etiologic role in the external subtype.
Riwaj Bhagat; Allison Muha; Kerri Remmel; Wei Liu
Abstract
Background: Computed Tomography Perfusion (CTP) maps ischemic core volume (CV) and penumbra following a stroke; however, its accuracy in early symptom onset is not well studied. We compared the accuracy of CTP RAPID estimated CV with diffusion weighted imaging (DWI) infarct volume (IV) in patients following ...
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Background: Computed Tomography Perfusion (CTP) maps ischemic core volume (CV) and penumbra following a stroke; however, its accuracy in early symptom onset is not well studied. We compared the accuracy of CTP RAPID estimated CV with diffusion weighted imaging (DWI) infarct volume (IV) in patients following thrombectomy.Methods: Charts of anterior circulation large vessel occlusion post-thrombectomy cases with thrombolysis in cerebral infarction (TICI) 2b/3 reperfusion from 2017 to 2019 were reviewed. CTP time was dichotomized as 0-3 hours and ≥ 3 hours from the last known normal (LKN) cognition. The volumetric difference (VD), defined as DWI IV minus CTP CV, core volume overestimation (CVO), defined as CTP CV minus DWI IV and Alberta stroke programme early CT score (ASPECTS) were calculated. Large CV was defined as ≥ 50 ml CV. Modified Rankin Score (mRS) at 90 days were reviewed. We performed independent sample t-test and Spearman correlation coefficient test.Results: Total cases (n) were 61. In < 3 hours window from LKN (n = 27), the mean VD was 58.3 ± 0.1 ml (P = 0.990) and CVO (n = 11; 40.7%) was39.6 ± 35.7 ml (P = 0.008). Mean large CV (n = 8) was 78.3 ± 25.4 ml with median ASPECTS of 8 [interquartile range (IQR) = 6.5-9.0]and median mRS at 90 days of 2 (IQR = 0.8-3.3). In ≥ 3 hours window from LKN (n = 34), CVO (n = 5) was uncommon and large CV had median mRS at 90 days of 5 (IQR = 4.0-6.0).Conclusion: CTP more frequently overestimates CV in patients who are < 3 hours from LKN. The treated patients with large CV in < 3 hours and > 3 hours had good and poor functional outcomes, respectively.
Shahram Oveisgharan; Fariborz Ghaffarpasand; Peter Sörös; Mustafa Toma; Nizal Sarrafzadegan; Vladimir Hachinski
Abstract
During the past 30 years, rate of coronary artery disease, as the main cause of sudden death, has decreased more than rate of sudden death. Likewise, cause of sudden death remains elusive in not a trivial portion of its victims. One possible reason is attention to only one organ, the heart, as the cause ...
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During the past 30 years, rate of coronary artery disease, as the main cause of sudden death, has decreased more than rate of sudden death. Likewise, cause of sudden death remains elusive in not a trivial portion of its victims. One possible reason is attention to only one organ, the heart, as the cause of sudden death. In fact, sudden death literature focuses more on the heart, less on the brain, and seldom on both. A change is required. In this paper, we first review the pathological findings seen in heart autopsies of sudden death victims after psychological stressors such as physical assault victims without internal injuries. Then, we summarize new studies investigating brain areas, like the insula, whose malfunctions and injuries are related to sudden death. Then, we review prototypes of neurological diseases and psychological stressors associated with sudden death and look at heart failure related sudden death providing evidence for the brain-heart connection. Finally, we propose a new look at sudden death risk factors considering both brain and heart in their association with sudden death, and review strategies for prevention of sudden death from this perspective.
Elyar Sadeghi-Hokmabadi; Abdoreza Ghoreishi; Reza Rikhtegar; Payam Sariaslani; Shahram Rafie; Alireza Vakilian; Ehsan Sharifipour; Masoud Mehrpour; Mohammad Saadatnia; Mohammad Mirza-Aghazadeh-Attari; Mehdi Farhoudi
Abstract
Background: Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending on ethnicity, one reason that few Eastern countries have approved a lower dose of alteplase. Data in this regard are scarce in the Middle Eastern region. Methods: The present retrospective study ...
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Background: Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending on ethnicity, one reason that few Eastern countries have approved a lower dose of alteplase. Data in this regard are scarce in the Middle Eastern region. Methods: The present retrospective study was performed on data extracted from the Safe Implementation of Treatments in Stroke (SITS) registry. Computed tomography (CT) image analysis was based on the SITS-Monitoring Study (SITS-MOST) definition for symptomatic ICH (SICH). Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS). Multivariate logistic regression including adjusted analysis was used for comparison between groups. Results: Of 6615 patients, 1055 were enrolled. A total of 86% (n = 906) received a standard dose and 14% (n = 149) received a low dose of alteplase. Favorable 3-month outcome was achieved in 481 (53%) patients in the standard group and 71 (48%) patients in the low-dose group [adjusted odds ratio (AOR) = 1.24, 95% confidence interval (CI): 0.87-1.75, P = 0.218]. SICH occurred in 14 (1.5%) patients in the standard group and 3 (2%) patients in the low-dose group [odds ratio (OR) = 2.77, 95% CI: 0.36-21.04, P = 0.120]. At 3 months, mortality occurred in 145 (16.0%) patients in the standard group and 29 (19.4%) patients in the low-dose group (OR = 1.22, 95% CI: 0.78-1.91, P = 0.346). Conclusion: Low-dose compared to standard-dose alteplase for patients with acute ischemic stroke (AIS) was not associated with fewer hemorrhagic events and there was no significant difference in the favorable 3-month outcome (mRS: 0-2) or mortality rate.
Somayeh Karimi; Farhad Heydari; Sahar Mirbaha; Mohamed Elfil; Alireza Baratloo
Abstract
Background: Andsberg et al. have recently introduced a novel scoring system entitled “PreHospital Ambulance Stroke Test (PreHAST)”, which helps to early identification of patients with acute ischemic stroke (AIS) even in prehospital setting. Its validity has not been assessed in a study yet, ...
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Background: Andsberg et al. have recently introduced a novel scoring system entitled “PreHospital Ambulance Stroke Test (PreHAST)”, which helps to early identification of patients with acute ischemic stroke (AIS) even in prehospital setting. Its validity has not been assessed in a study yet, and the purpose of this study was to assess this scoring system on a larger scale to provide further evidence in this regard. Methods: This was a cross-sectional multi-center accuracy study, in which, sampling was performed prospectively. All patients over 18 years of age admitted to the emergency department (ED) and suspected as AIS cases were included. All required data were recorded in a form consisting of 3 parts: baseline characteristics, neurological examination findings required for calculating PreHAST score, and the ultimate diagnosis made from interpretation of their brain magnetic resonance imaging (MRI). Results: Data from 805 patients (57.5% men) with the mean age of 67.1 ± 13.6 years were analyzed. Of all the patients presenting with suspected AIS, 562 (69.8%) had AIS based on their MRI findings. At the suggested cut-off point (score ≥ 1), PreHAST had a specificity of 46.5% [95% confidence interval (CI): 40.1%-53.0%) and a sensitivity of 93.2% (95% CI: 90.8%-95.2%). Conclusion: According to the findings of our study, at the suggested cut-off point (score ≥ 1), PreHAST had 93.2% sensitivity and 46.5% specificity in detection of patients with AIS, which were somewhat different from those reported in the original study, where 100% sensitivity and 40% specificity were reported for this scoring system.
Mahmoud Reza Ashrafi; Mahmoud Mohammadi; Gholamreza Zamani; Nahid Khosroshahi; Reza Shervin Badv; Alireza Tavasoli; Morteza Heidari; Bahram Yarali; Reza Azizimalamiri
Vishakha Darak; Suruliraj Karthikbabu
Abstract
Background: Poor motor recovery of hip muscles affect the walking post-stroke. The study objective was to examine how lower extremity motor function and hip muscle weakness are related to weight-bearing asymmetry (WBA), excessive pelvic tilt, and gait speed in stroke survivors. Methods: Eighty patients ...
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Background: Poor motor recovery of hip muscles affect the walking post-stroke. The study objective was to examine how lower extremity motor function and hip muscle weakness are related to weight-bearing asymmetry (WBA), excessive pelvic tilt, and gait speed in stroke survivors. Methods: Eighty patients with chronic stroke, a mean and standard deviation (SD) of post-stroke duration of 350 ± 664 days, age of 30-70 years, independent standing, and 10-meter walking capacity participated in the study. Hip muscular strength was measured using a handheld dynamometer (HHD) and motor function was assessed by Fugl-Meyer Assessment of lower extremity (FMA-LE). The WBA was recorded using two weighing scales; whereas the pelvic tilt and gait speed were evaluated using palpation meter (PALM) and 10-meter walk test, respectively. Results: The muscles strength of hip flexors, extensors, abductors, and adductors of the paretic side ranged between 22.0 and 24.4 pounds. The mean score of FMA-LE was 22 points. Following Pearson product-moment correlation with statistically significant P < 0.05, the relationship of hip muscles strength and FMA with WBA, lateral pelvic tilt (LPT) and anterior pelvic tilt (APT), and speed are as follows: flexors (r = 0.47, r = 0.31, r = 0.44, r = 0.44), extensors (r = 0.45, r = 0.38, r = 0.37, r = 0.35), abductors (r = 0.49, r = 0.32, r = 0.38, r= 0.40), adductors (r = 0.45, r = 0.31, r = 0.23, r = 0.34), and motor function (r = 0.62, r = 0.33, r = 0.38, r = 0.62). Conclusion: Motor performance of the paretic lower limb was highly correlated with WBA and gait speed in stroke survivors. Overall hip muscle strength of paretic side had a moderate correlation with WBA, excessive pelvic tilt, and gait speed.
Miguel Angel Saucedo; Laura De Francesco; Anibal Chertcoff; Lucrecia Bandeo; Luciana Leon Cejas; Manuel Maria Fernandez Pardal; Ariel Miquelini; Ricardo Reisin; Pablo Bonardo
