| 1. |
- Acciarresi, M., et al.
(författare)
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Prestroke CHA(2)DS(2)-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study
- 2017
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 26:6, s. 1363-1368
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: The aim of this study was to investigate for a possible association between both prestroke CHA(2)DS(2)-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). Methods: This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS >= 10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS < 3 or >= 3). Multiple logistic regression was used to correlate prestroke CHA(2)DS(2)-VASc and severity of stroke, as well as disability and mortality at 90 days. Results: Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS >= 3. A linear correlation was found between the prestroke CHA(2)DS(2)-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA(2)DS(2)-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS = 3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA(2)DS(2)-VASc score and lesion size. Conclusions: In patients with AF, in addition to the risk of stroke, a high CHA(2)DS(2)-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
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| 2. |
- Appelros, Peter, et al.
(författare)
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Comorbidity in Stroke-Survivors : Prevalence and Associations with Functional Outcomes and Health
- 2021
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier. - 1052-3057 .- 1532-8511. ; 30:10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The purpose of this study was to evaluate the prevalence and impact of stroke-related comorbidity in a community-based sample of stroke survivors. We sought to find out which types of comorbidity that were most important with respect to the patients' functional outcomes and general health.MATERIALS AND METHODS: All stroke survivors (n = 330) living in a medium-sized Swedish municipality were included. Patient records were reviewed to determine the presence of comorbidities. A selection of patient reported outcomes were used to assess subjective symptoms, functional outcomes, and general health. Logistic regression models were used to investigate the association between comorbidities, residual symptoms, and subjective symptoms on the one hand, and functional outcomes and general health on the other hand.RESULTS: Hypertension (80%) was the most common cardiovascular risk factor. Ischemic heart disease was found in 18% and congestive heart failure in 10%. Of non-cardiovascular disorders, orthopaedic diseases were commonest (30%). Psychiatric disorders and cognitive impairment were present in 11% and 12% respectively. Hemiparesis is associated with both functional outcomes and general health. Additionally, orthopedic disorders, vertigo, cognitive impairment, nicotine use, chronic pulmonary disorders, and age, are associated with different functional outcomes. Psychiatric, orthopedic and neurological disorders are related to general health. The patient-reported outcome measure "feeling of tiredness" is important for many of the outcomes, while "feeling depressed" and "having pain" are associated with general health.CONCLUSIONS: Many medical conditions, several of which have received little attention so far, are associated with functional outcome and general health in stroke survivors. If the intention is to describe comorbidity relevant to function and general health in stroke patients, disorders that hitherto have received little attention, must be considered.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
- Bergersen, Hilde, et al.
(författare)
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Anxiety, depression, and psychological well-being 2 to 5 years poststroke.
- 2010
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Ingår i: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. - : Elsevier BV. - 1532-8511. ; 19:5, s. 364-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We sought to explore psychological well-being and the psychosocial situation in persons with stroke, 2 to 5 years after discharge from a specialized rehabilitation hospital. METHODS: The Hospital Anxiety and Depression Scale; the 30-item General Health Questionnaire; and a questionnaire were mailed to 255 former patients. RESULTS: A total of 64% answered (36% women), and the average age was 58 years. The Hospital Anxiety and Depression Scale identified problems in 47% (anxiety in 36% and depression in 28%) and 30-item General Health Questionnaire in 54%. About half had experienced periods of anxiety, depression, or both since discharge. Most were satisfied with support by family/friends (88%), home ward (68%), and community therapy services (57%). Marital status was as in the general population. CONCLUSIONS: Long after stroke, almost half of the investigated patients with stroke had psychiatric problems according to the questionnaires. This is higher than in the general population but is comparable with some other chronic, somatic populations in Norway.
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| 7. |
- Björkdahl, Ann, 1959-, et al.
(författare)
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How can we tell who is aware? Where does the veracity lie?
- 2012
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057 .- 1532-8511. ; 21:8, s. 812-818
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The first aim of this study was to compare the subjective experiences of social, cognitive, and emotional problems of the patient and his/her next of kin, and explore if this related to cognitive testing. The second aim was to explore how these results reflect the patient's awareness.METHODS: This is a subanalysis from a longitudinal study in the first year after discharge with comparisons of patient and next of kin scores on the European Brain Injury Questionnaire (EBIQ) and analyses of the relationship of their scores to an objective cognitive screening on 3 occasions. A paired t test was used to explore differences between 35 stroke patients and their next of kin on the EBIQ. Gamma analyses were made to explore the relationship between the EBIQ scores and the Barrow Neurological Institute Screening (BNIS) of higher cognitive functions, with the entire sample grouped into aware and unaware according to the BNIS item of awareness.RESULTS: We found significant differences between the patient and next of kin assessments on all occasions, apart from at discharge. When grouped, only the group of aware patients differed significantly from their next of kin. Significant relations of the patient ratings on the EBIQ and BNIS were only found at the 1-year follow-up for the unaware group and the entire sample. Next of kin EBIQ scores did not correlate with the BNIS.CONCLUSIONS: Neither next of kin ratings nor an objective measurement was feasible to use for evaluation of the patient's awareness of social, cognitive, and emotional problems.
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| 8. |
- Björkdahl, Ann, 1959-, et al.
(författare)
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The structural properties of the European Brain Injury Questionnaire.
- 2004
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057 .- 1532-8511. ; 13:3, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We sought to examine the reliability and validity of the European Brain Injury Questionnaire as an evaluation tool in a stroke population by applying the Rasch methodology.METHODS: The European Brain Injury Questionnaire was distributed to 54 patients with stroke and 36 next of kin at discharge from the rehabilitation ward and at a 1-year follow-up. Rasch analysis was used for evaluating the psychometric characteristic and the quality of the measures produced with focus on reliability and validity. The reliability was determined by the separation. The construct validity was determined by examining the hierarchy of the tasks and by evaluating the fit of individual tasks to the latent construct. Analyses of differences across occasions, and across patients and next of kin, were made to examine the stability of the instrument.RESULTS: The reliability was good as the instrument met the criteria for separation. Two items at discharge and 5 items at 1-year follow-up were misfits. If not more than 5% of the items fail to fit the Rasch model the instrument can be considered unidimensional, which in this case only concerned the 1-year follow-up. The instrument was stable over time and across patients and next of kin.CONCLUSION: With some alterations the European Brain Injury Questionnaire seems to be a useful instrument in clinical practice and research, and a help to capture the social, emotional, and cognitive impacts of a stroke.
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| 9. |
- Csecsei, P., et al.
(författare)
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Risk analysis of post-procedural intracranial hemorrhage based on STAY ALIVE Acute Stroke Registry
- 2020
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - New York : Demos Publishing. - 1052-3057 .- 1532-8511. ; 29:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intracranial hemorrhages (ICH) are classified as symptomatic or asymptomatic according to the presence of clinical deterioration. Here, we aimed to find predictive factors of symptomatic intracranial bleeding in a registry-based stroke research.Methods: Data of consecutive patients with acute ischemic stroke (AIS) were extracted from the prospective STAY ALIVE stroke registry. Analysis of the total population and treatment sugroups such as endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or their combination (IVT+EVT) were also done. Outcome measures were ICH, 30- and 90-day clinical outcome based on the modified Rankin Scale (mRS:0-2 as favorable outcome). The hemorrhage was captured by a non-enhanced CT of the skull within 24 h after procedure.Results: A total of 355 patients (mean age: 68 +/- 11; female N=177 (49.9%); EVT n=131 (36.9%); IVT n=157 (44.2%); IVT+EVT n=67 (18.9%) were included in the analysis. The total number of ICH was 47 (13%), symptomatic (sICH) 12 (3.4%) and asymptomatic (aICH) 35 (9.9%) in the whole population. NIHSS >= 15.5 at 24 post stroke hours predicted sICH with a sensitivity of 100% and a specificity of 92% (p<0.001). Furthermore, lower age, good collateral circulation on initial CT angiography and lower NIHSS score measured at 24 h independently associated with a favorable 90-day outcome, whereas baseline NIHSS and ASPECT score were not.Conclusion: Although partial recanalization, ASPECT< 6, and poor collaterals were significantly associated with sICH, the only independent predictor was NIHSS >= 15.5 at 24 post stroke hours. This suggests a careful evaluation of patients with worsening NIHSS despite an adequate therapy.
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| 10. |
- Cvetkovic, Jasmina Trifunovic, et al.
(författare)
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Polymorphisms of IL-1beta, IL-1Ra, and TNF-alpha genes : A nested case-control study of their association with risk for stroke
- 2005
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057 .- 1532-8511. ; 14:1, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- Certain alleles of cytokine genes interleukin-1 beta (IL-1β), interleukin-1 receptor antagonist (IL-1Ra), and tumor necrosis factor alpha (TNF-α) are correlated with increased production of the proteins. The aim of this study was to investigate polymorphisms of these genes and their possible correlation with the development of stroke. This matched case-control study was nested within the population-based Västerbotten Intervention Program (VIP) cohort and the Northern Sweden World Health Organization MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) cohort, based on individuals who were free from cardiovascular events when the cohorts were established. After an average period of 34.1 months, 113 individuals developed stroke and to each case 2 individuals not suffering from cardiovascular events were matched to serve as controls. Polymerase chain reaction amplification was used to analyze genetic polymorphisms. There was no association between polymorphic sites of the IL-1β and IL-1Ra genes and stroke. Carriage of haplotype A2+IL-1β/A2+IL-1Ra was significantly increased in normotensive cases (23.1%) compared with normotensive controls (8.9%) (odds ratio [OR] = 3.07; P = .045). In hypertensive male cases, there was an association between the A1A1 genotype of TNF-α and risk of stroke (OR = 2.46; P = .034). Our findings indicate an association between allele A1 of the TNF-α NcoI polymorphism and stroke in hypertensive male cases, as well as an association between haplotype A2+IL-1β/A2+IL-1Ra and stroke in normotensive cases.
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| 11. |
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| 12. |
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| 13. |
- Eleftheriou, Andreas, et al.
(författare)
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Tick-borne Encephalitis: Stroke-like Presentation
- 2019
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : ELSEVIER. - 1052-3057 .- 1532-8511. ; 28:8, s. E119-E122
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Tidskriftsartikel (refereegranskat)abstract
- Tick-borne encephalitis, caused by the tick-borne virus (TBEV), is endemic in central, eastern, and northern Europe eastwards through Russian Siberia and China. For the year 2009, the highest incidence in Scandinavian countries was in Sweden. The clinical symptoms have a wide spectrum. We report a unique case of clinical symptoms and radiological findings compatible with a stroke-like inflammatory lesion in the thalamus, suggesting microangiopathy from TBEV. Our case shows that TBEV could be a possible cause of stroke-like lesions.
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| 14. |
- Ellström, Katarina, et al.
(författare)
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Associations of carotid artery flow parameters with MRI markers of cerebral small vessel disease and patterns of brain atrophy
- 2023
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1532-8511 .- 1052-3057. ; 32:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: A growing body of evidence links age related brain pathologies to systemic vascular processes. We aimed to study the prevalence and interrelations between magnetic resonance imaging (MRI) markers of cerebral small vessel disease and patterns of brain atrophy, and their association to carotid duplex ultrasound flow parameters.MATERIALS AND METHODS: We investigated a population based randomised cohort of older adults (n=391) aged 70-87, part of the Swedish Good Aging in Skåne Study. Peak systolic and end diastolic velocities of the carotid arteries were measured by ultrasound, and resistivity- and pulsatility indexes were calculated. Subjects with increased peak systolic velocity indicating carotid stenosis were excluded from analysis. Nine MRI findings were rated by visual scales: white matter changes, pontine white matter changes, microbleeds, lacunar infarctions, medial temporal lobe atrophy, global cortical atrophy, parietal atrophy, precuneus atrophy and central atrophy.RESULTS: MRI pathologies were found in 80% of subjects. Mean end diastolic velocity in common carotid arteries was inversely associated with white matter hyperintensities (OR=0.92; p=0.004), parietal lobe atrophy (OR=0.94; p=0.039), global cortical atrophy (OR=0.90; p=0.013), precuneus atrophy (OR=0.94; p=0.022), "number of CSV pathologies" (β=-0.07; p<0.001) and "MRI-burden score" (β=-0.11; p<0.001), after adjustment for age and sex. The latter three were also associated with pulsatility and resistivity indexes.CONCLUSIONS: Low carotid end diastolic velocity, as well as increased carotid resistivity and pulsatility, were associated with signs of cerebral small vessel disease and patterns of brain atrophy, indicating a vascular component in the process of brain aging.
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| 15. |
- Esbjörnsson, Magnus, et al.
(författare)
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Safety and usability of wearable accelerometers for stroke detection the STROKE ALARM PRO 1 study
- 2022
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Ingår i: Journal of Stroke and Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 31:11
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The introduction of time-dependent reperfusion therapies in acute ischemic stroke has increased the need for early identification. We explore the safety and feasibility of STROKE ALARM which detects sudden arm paresis, the most frequent symptom in stroke. Materials and methods: Consecutive patients admitted with a stroke or TIA at Skåne University Hospital were screened according to inclusion and exclusion criteria, and included in the STROKE ALARM PRO 1 Study aiming to explore the feasibility of prolonged use (30 days) of the system in the community. STROKE ALARM consists of paired arm bracelets with accelerometers, coupled with a stroke test in a smartphone application. In case of an imbalance in arm movements, the user is prompted to perform an app-based stroke test. Failure to respond or to complete the stroke test correctly, triggers notification by SMS to predefined emergency contacts. Patients were followed up by telephone after completion. Results: Thirty patients were included and 28 completed follow-up. Median age was 68 years and 36.7% were female. No stroke events were recorded during follow-up. False indications occurred in all but one patient, and 22 (78.6%) experienced alarms to their emergency contacts. Despite a high level of false alarms, general user experience was rated in a positive or neutral manner by almost 90%. Very frequent alarms were probably due to mild arm paresis not detected in routine clinical assessment. Conclusions: Use of STROKE ALARM for 30 days after stroke/TIA was well tolerated warranting further study for early automated detection of stroke recurrence.
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| 16. |
- Fatemi, Shahab, et al.
(författare)
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Pro B-type Natriuretic Peptide and Midregional Proadrenomedullin are Associated with Incident Carotid Stenosis During Long Term Follow-up
- 2021
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Ingår i: Journal of Stroke and Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Plasma biomarkers may be useful to detect healthy individuals at increased risk for atherosclerotic manifestations, such as carotid artery stenosis. The aim of this longitudinal cohort study was to evaluate new biomarkers in relation to C-reactive protein and conventional risk factors for carotid artery stenosis during long term follow-up Methods: The following markers were measured in 5550 middle-aged subjects: C-reactive protein, lipoprotein-associated phospholipase A2, proneurotensin, midregional pro-adrenomedullin, midregional pro-atrial natriuretic peptide, N-terminal pro B-type natriuretic peptide, copeptin, and cystatin C. Subjects with prevalent carotid artery stenosis were excluded. Subjects were followed in national patient registers for 23.4 (interquartile range 19.5–24.3) years regarding incident carotid artery stenosis, both operated and non-operated. Results: When including conventional risk markers in Cox regression, N-terminal pro B-type natriuretic peptide (Hazard ratio 1.36; 95% confidence interval 1.12–1.65; p = 0.002) was independently associated with incident carotid artery stenosis, whereas there were trends for C-reactive protein (HR 1.20; 95% confidence interval 0.98–1.48; p = 0.071), and midregional pro-adrenomedullin (Hazard ratio 1.21; 95% confidence interval 0.99–1.47; p = 0.061). Midregional pro-adrenomedullin (Hazard ratio 1.30; 95% confidence interval 1.03–1.65; p = 0.029) was independently associated with incident surgery for carotid artery stenosis, whereas there was a trend for N-terminal pro B-type natriuretic peptide (Hazard ratio 1.31; 95% confidence interval 1.00–1.72; p = 0.052). Conclusions: N-terminal pro B-type natriuretic peptide and midregional pro-adrenomedullin can be used as predictors for clinically detected carotid artery stenosis during long-term follow-up of healthy subjects.
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| 17. |
- Fitzgerald, Seán, et al.
(författare)
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Large Artery Atherosclerotic Clots are Larger than Clots of other Stroke Etiologies and have Poorer Recanalization rates.
- 2021
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Ingår i: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. - : Elsevier BV. - 1532-8511. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- There is a paucity of knowledge in the literature relating to the extent of clot burden and stroke etiology. In this study, we measured the Extracted Clot Area (ECA) retrieved during endovascular treatment (EVT) and investigated relationships with suspected etiology, administration of intravenous thrombolysis and recanalization.As part of the multi-institutional RESTORE registry, the ECA retrieved during mechanical thrombectomy was quantified using ImageJ. The effect of stroke etiology (Large-artery atherosclerosis (LAA), Cardioembolism, Cryptogenic and other) and recombinant tissue plasminogen activator (rtPA) on ECA and recanalization outcome (mTICI) was assessed. Successful recanalization was described as mTICI 2c-3.A total of 550 patients who underwent EVT with any clot retrieved were included in the study. The ECA was significantly larger in the LAA group compared to all other etiologies. The average ECA size of each etiology was; LAA=109mm2, Cardioembolic=52mm2, Cryptogenic=47mm2 and Other=52mm2 (p=0.014*). LAA patients also had a significantly poorer rate of successful recanalization (mTICI 2c-3) compared to all other etiologies (p=0.003*). The administration of tPA was associated with a smaller ECA in both LAA (p=0.007*) and cardioembolic (p=0.035*) groups.The ECA of LAA clots was double the size of all other etiologies and this is associated with a lower rate of successful recanalization in LAA stroke subtype. rtPA administration prior to thrombectomy was associated with reduced ECA in LAA and CE clots.
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| 18. |
- Frid, P., et al.
(författare)
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Migraine-associated common genetic variants confer greater risk of posterior vs. anterior circulation ischemic stroke☆
- 2022
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Ingår i: Journal of Stroke and Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 31:8
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine potential genetic relationships between migraine and the two distinct phenotypes posterior circulation ischemic stroke (PCiS) and anterior circulation ischemic stroke (ACiS), we generated migraine polygenic risk scores (PRSs) and compared these between PCiS and ACiS, and separately vs. non-stroke control subjects. Methods: Acute ischemic stroke cases were classified as PCiS or ACiS based on lesion location on diffusion-weighted MRI. Exclusion criteria were lesions in both vascular territories or uncertain territory; supratentorial PCiS with ipsilateral fetal posterior cerebral artery; and cases with atrial fibrillation. We generated migraine PRS for three migraine phenotypes (any migraine; migraine without aura; migraine with aura) using publicly available GWAS data and compared mean PRSs separately for PCiS and ACiS vs. non-stroke control subjects, and between each stroke phenotype. Results: Our primary analyses included 464 PCiS and 1079 ACiS patients with genetic European ancestry. Compared to non-stroke control subjects (n=15396), PRSs of any migraine were associated with increased risk of PCiS (p=0.01–0.03) and decreased risk of ACiS (p=0.010–0.039). Migraine without aura PRSs were significantly associated with PCiS (p=0.008–0.028), but not with ACiS. When comparing PCiS vs. ACiS directly, migraine PRSs were higher in PCiS vs. ACiS for any migraine (p=0.001–0.010) and migraine without aura (p=0.032–0.048). Migraine with aura PRS did not show a differential association in our analyses. Conclusions: Our results suggest a stronger genetic overlap between unspecified migraine and migraine without aura with PCiS compared to ACiS. Possible shared mechanisms include dysregulation of cerebral vessel endothelial function.
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| 19. |
- Fujioka, Masayuki, et al.
(författare)
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A Mismatch Between the Abnormalities in Diffusion- and Susceptibility-Weighted Magnetic Resonance Imaging May Represent an Acute Ischemic Penumbra with Misery Perfusion
- 2013
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1532-8511 .- 1052-3057. ; 22:8, s. 1428-1431
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Tidskriftsartikel (refereegranskat)abstract
- Susceptibility-weighted imaging (SWI) has recently attracted attention for its ability to investigate acute stroke pathophysiology. SWI detects an increased ratio of deoxyhemoglobin to oxyhemoglobin in cerebral venous compartments, which can illustrate cerebral misery perfusion with a compensatory increase of oxygen extraction fraction in the hypoperfused brain. In this study we make the first case report of blunt cervical trauma leading to a stroke, demonstrating the disparity between diffusion-weighted imaging (DWI) and SWI changes, or DWI-SWI mismatch, in the acute ischemic brain. The area of mismatch between a smaller DWI cytotoxic edema and a larger SWI misery perfusion in our patient matured into a complete infarction with time. The DWI-SWI mismatch may signify the presence of an ischemic penumbra, and provide information about viability of the brain tissue at risk of potential infarction if without early reperfusion.
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| 20. |
- González-Giraldo, Yeimy, et al.
(författare)
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Ischemic Stroke and Six Genetic Variants in CRP, EPHX2, FGA, and NOTCH3 Genes : A Meta-Analysis
- 2016
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 25:9, s. 2284-2289
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ischemic stroke (IS) is a leading cause of death and disability worldwide. As genetic heritability for IS is estimated at about 35%-40%, the identification of genetic variants associated with IS risk is of great importance. The main objective of this study was to carry out a meta-analysis for polymorphisms in CRP, EPHX2, FGA, and NOTCH3 genes and the risk for IS. Methods: Literature search for 6 candidate polymorphisms and IS was conducted using HuGE Navigator, PubMed, and Google Scholar databases. Meta-Analyst program was used to calculate pooled odds ratios (ORs) with a random effects model. Results: Twenty-five published studies for 6 candidate polymorphisms were included: CRP-rs1800947 (5 studies), CRP-rs1205 (3 studies), EPHX2-rs751141 (5 studies), FGA-rs6050 (6 studies), NOTCH3-rs3815188 (3 studies), and NOTCH3-rs1043994 (3 studies), for a total number of 7,825 IS cases and 56,532 control subjects. We did not find significant pooled ORs (P values > .05) for any of the genetic variants evaluated in this work. Conclusions: Our meta-analysis results did not show significant associations between these 6 polymorphisms in 4 candidate genes and IS, despite the functional role of some of these single nucleotide polymorphisms (e.g., rs6050 in FGA gene). Future studies are needed to identify additional main genetic risk factors for IS in different populations.
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| 21. |
- Hamre, Charlotta, et al.
(författare)
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Factors Associated with Level of Physical Activity After Minor Stroke
- 2021
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier. - 1052-3057 .- 1532-8511. ; 30:4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To explore factors from the acute phase, and after three and 12 months, associated with level of self-reported physical activity 12 months after a minor ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 in persons 70 years or younger.MATERIALS AND METHOD: In this longitudinal cohort study patients were recruited consecutively from two stroke units. Activity level were measured with three sets of questions addressing the average number of frequency (times exercising each week), the average intensity, and duration (the average time), and a sum score was constructed. The association between physical activity 12 months after stroke and sociodemographic factors, NIHSS, body mass index, balance, and neuropsychiatric symptoms were explored using multiple linear regression.RESULTS: ) 0.0 (0.0, 1.0), and 20 % were female. Multiple linear regression analyses showed sick leave status at stroke onset, balance at three and 12 months, and anxiety, depression, apathy, and fatigue at 12 months to be factors associated with physical activity at 12 months after stroke.CONCLUSION: We found that pre-stroke sick leave, post-stroke balance, and neuropsychiatric symptoms were associated with the level of physical activity one year after minor stroke. This might be of importance when giving information about physical activity and deciding about post-stroke follow-up.
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| 22. |
- Hart, Robert G., et al.
(författare)
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Predictors of Recurrent Ischemic Stroke in Patients with Embolic Strokes of Undetermined Source and Effects of Rivaroxaban Versus Aspirin According to Risk Status : The NAVIGATE ESUS Trial
- 2019
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Ingår i: Journal of Stroke and Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 28:8, s. 2273-2279
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Tidskriftsartikel (refereegranskat)abstract
- Background: Embolic stroke of undetermined source (ESUS) identifies patients with cryptogenic ischemic stroke presumed due to embolism from several unidentified sources. Among patients with recent ESUS, we sought to determine independent predictors of recurrent ischemic stroke during treatment with aspirin or rivaroxaban and to assess the relative effects of these treatments according to risk. Methods: Exploratory analyses of 7213 participants in the NAVIGATE ESUS international trial who were randomized to aspirin 100 mg/day or rivaroxaban 15 mg/day and followed for a median of 11 months, during which time there were 309 first recurrent ischemic strokes (4.6% per year). Baseline features were correlated with recurrent stroke by multivariate analysis. Results: The 7 independent predictors of recurrent stroke were stroke or transient ischemic attack (TIA) prior to the qualifying stroke (hazard ratio [HR] 2.03 95% confidence internal [CI] 1.58-2.60), current tobacco user (HR 1.62, 95% CI 1.24-2.12), age (HR 1.02 per year increase, 95%CI 1.01-1.03), diabetes (HR 1.28, 95% CI 1.01-1.64), multiple acute infarcts on neuroimaging (HR 1.49, 95% CI 1.09-2.02), aspirin use prior to qualifying stroke (HR 1.34, 95% CI 1.02-1.70), and time from qualifying stroke to randomization (HR .98, 95% CI .97-.99). The rate of recurrent stroke rate was 2.6% per year for participants without any of these risk factors, and increased by an average of 45% for each independent predictor (P < .001). There were no significant interactions between treatment effects and independent stroke predictors or stroke risk status. Conclusions: In this large cohort of ESUS patients, several features including prior stroke or TIA, advanced age, current tobacco user, multiple acute infarcts on neuroimaging, and diabetes independently identified those with an increased risk of ischemic stroke recurrence. The relative effects of rivaroxaban and aspirin were similar across the spectrum of independent stroke predictors and recurrent stroke risk status.
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| 23. |
- Ihle-Hansen, Håkon, et al.
(författare)
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Carotid Atherosclerosis and Longitudinal Changes of MRI Visual Rating Measures in Stroke Survivors : A Seven-Year Follow-Up Study
- 2021
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier. - 1052-3057 .- 1532-8511. ; 30:10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We aimed to assess longitudinal changes in MRI measures of brain atrophy and white matter lesions in stroke and transient ischemic attack (TIA) survivors, and explore whether carotid stenosis predicts progression of these changes, assessed by visual rating scales.MATERIALS AND METHODS: All patients with a first-ever stroke or TIA admitted to Bærum Hospital, Norway, in 2007/2008, were invited in the acute phase and followed for seven years. Carotid ultrasound was performed during the hospital stay. Carotid stenosis was defined as ≥50% narrowing of lumen. MRI was performed one and seven years after the index event and analyzed according to the visual rating scales Fazekas scale (0-3), Medial Temporal Lobe Atrophy (MTLA) (0-4) score, and Global Cortical Atrophy (GCA) scale (0-3). Patients with MRI scans at both time points were included in this sub-study.RESULTS: Of 227 patients recruited, 76 had both MRI examinations. Mean age 73.9±10.6, 41% women, and 9% had ≥50% carotid stenosis. Mean Fazekas scale was 1.7±0.9 and 1.8±1.0, mean MTLA score 1.0 ±1.0 and 1.7±1.0, and mean GCA scale score 1.4±0.7 and 1.4±0.6 after one and seven years, respectively. 71% retained the same Fazekas scale score, while 21% showed progression. Deterioration in GCA scale was seen in 20% and increasing MTLA score in 57%. Carotid stenosis was not associated with progression on Fazekas score, MTLA score or GCA scale.CONCLUSIONS: Three out of five showed progression on the MTLA score. Carotid stenosis was not associated with longitudinal change of visual rating scales.
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- Jaakonmäki, N., et al.
(författare)
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Obesity and the Risk of Cryptogenic Ischemic Stroke in Young Adults
- 2022
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Ingår i: Journal of Stroke and Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 31:5
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We examined the association between obesity and early-onset cryptogenic ischemic stroke (CIS) and whether fat distribution or sex altered this association. Materials and Methods: This prospective, multi-center, case-control study included 345 patients, aged 18-49 years, with first-ever, acute CIS. The control group included 345 age- and sex-matched stroke-free individuals. We measured height, weight, waist circumference, and hip circumference. Obesity metrics analyzed included body mass index (BMI), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), and a body shape index (ABSI). Models were adjusted for age, level of education, vascular risk factors, and migraine with aura. Results: After adjusting for demographics, vascular risk factors, and migraine with aura, the highest tertile of WHR was associated with CIS (OR for highest versus lowest WHR tertile 2.81, 95%CI 1.43-5.51; P=0.003). In sex-specific analyses, WHR tertiles were not associated with CIS. However, using WHO WHR cutoff values (>0.85 for women, >0.90 for men), abdominally obese women were at increased risk of CIS (OR 2.09, 95%CI 1.02-4.27; P=0.045). After adjusting for confounders, WC, BMI, WSR, or ABSI were not associated with CIS. Conclusions: Abdominal obesity measured with WHR was an independent risk factor for CIS in young adults after rigorous adjustment for concomitant risk factors. © 2022 The Author(s)
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