‘STROKE’ March 2011Dr Amer Jafar

Early Dementia After First-Ever Stroke

From 1985 to 2008, overall first-ever strokes occurring within the population of the city of Dijon, France (150 000 inhabitants) were recorded

The presence of dementia was diagnosed during the first month after stroke, according to Diagnostic and Statistical Manual of Mental Disorders

Over the 24 years, 3948 first-ever strokes were recorded. Among patients with stroke, 3201 (81%) were testable of whom 653 (20.4%) had poststroke dementia (337 women and 316 men)

The prevalence of poststroke dementia associated with lacunar stroke was 7 times higher than that in intracerebral haemorrhage but declined over time as did prestroke antihypertensive medication

Age, several vascular risk factors, hemiplegia, and prestroke antiplatelet agents were associated with an increased prevalence of poststroke dementia

Cerebral Microbleeds

Predictive of Mortality in the ElderlyTo investigate the prognostic value of

cerebral microbleeds (CMB) regarding overall, cardiovascular-related, and stroke-related mortality

Authors included 435 subjects who were participants from the nested MRI substudy of the PROspective Study of Pravastatin in the

Elderly at Risk (PROSPER)

Subjects with >1 CMB had a 6-fold risk of stroke-related death compared to subjects without CMB

Conclusion: the diagnosis of microbleeds is potentially of clinical relevance

Larger studies are needed to expand our

observations and to address potential clinical implications

Predict Stroke Outcome

A 5-Item ScalePredict Stroke Outcome After Cortical

Middle Cerebral Artery Territory Infarction

The authors retrospectively reviewed 129 patients over a 2-year period and considered demographic, clinical, laboratory, and radiographic parameters as potential predictors of outcome.

Inclusion criteria were unilateral hemispheric infarcts within the middle cerebral artery territory >15 mm in diameter

The primary outcome measure was a favourable recovery defined as a modified Rankin Score was 2 at 30 days

The 5 independent predictors of outcome were as follows:

AgeNational Institutes of Health Stroke Scale

scoreinfarct volumeadmission white blood cell countpresence of hyperglycemia

this model serves as a useful clinical and research tool to predict stroke recovery after cortical middle cerebral artery territory infarction.

Stenting and Endarterectomy

The Carotid Revascularization Endarterectomy Versus Stenting Trial

(CREST) data were analyzed to determine safety in symptomatic and asymptomatic patients.

CREST is a randomized trial comparing safety and efficacy of CAS versus CEA in patients with high-grade carotid stenoses

For 1321 symptomatic and 1181 asymptomatic patients, the periprocedural

aggregate of stroke, myocardial infarction, and death did not differ between CAS and CEA

The stroke and death rate was higher for CAS versus CEA

Conclusions:There were no significant differences

between CAS versus CEA by symptomatic status for the primary CREST end point

Periprocedural stroke and death rates were significantly lower for CEA in symptomatic

patients

Thrombolysis

Acute ischemic stroke patients who receive recombinant tissue plasminogen activator (rt-PA) within 3 hours of symptom onset are 30% more likely to have minimal to no disability at 3 months

retrospective analysis of all patients with ischemic stroke who presented within the original three hour window for intravenous thrombolysis, and who were admitted to the University of Texas Houston Medical School Stroke Service

Out of 2225 patients with acute ischemic stroke, 1019 were discharged to home, 719 to inpatient rehabilitation, 371 to a skilled nursing facility and 116 to subacute care

Conclusion: Patients who receive intravenous recombinant tissue plasminogen activator as treatment for acute ischemic stroke are more likely to be discharged directly home after hospitalization

Deep Vein Thrombosis Prophylaxis

Patients with intracerebral hemorrhage (ICH) are at high risk for development of deep venous thrombosis.

Current guidelines state that low-dose subcutaneous low molecular weight heparin

or unfractionated heparin may be considered at 3 to 4 days from onset

insufficient data exist on hematoma volume in patients with ICH before and after pharmacological deep venous thrombosis prophylaxis

The authors identified 73 patients with a mean age of 63 years and median National Institutes of Health Stroke Scale score 11.5

The mean baseline total hematoma volume was 25.8 mL±23.2 mL

Repeat analysis of patients given pharmacological deep venous thrombosis prophylaxis within 2 or 4 days after ICH found

no increase in hematoma sizePharmacological deep venous thrombosis

prophylaxis given subcutaneously in patients with ICH and/or intraventricular hemorrhage in the subacute period is generally not associated with hematoma growth

Sulfonylurea Use Before Stroke

Sulfonylureas block nonselective cation channels and lower serum glucose and are neuroprotective in animal models of ischemic

strokeHuman data on sulfonylureas in acute stroke

are sparse and conflictingaimed to measure the potential

neuroprotective effect of prestroke sulfonylurea use in diabetic patients

The authors analyzed data from a prospective cohort of individuals with diabetes mellitus (DM) enrolled in nonreperfusion ischemic stroke trials within Virtual International Stroke Trials Archive (VISTA) comprising 1050 patients, 298 with sulfonylurea use before stroke onset

The primary outcome measures were baseline National Institutes of Health Stroke Scale score and 90-day modified Rankin Scale

scoreCompared with patients on no DM

medications, those with sulfonylurea use before stroke onset presented with less severe stroke but had similar modified Rankin

Scale scores at 90 days

Sulfonylurea use before stroke onset did not affect stroke severity or long-term functional outcome compared with other DM treatments

This finding casts doubt on the use of sulfonylureas for prophylactic

neuroprotection. Furthermore, patients not using any medication for DM appear to have more severe strokes and worse outcomes