International journal of stroke : official journal of the International Stroke Society
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Comparative Study Controlled Clinical Trial
N-terminal probrain natriuretic peptide as a biomarker of cardioembolic stroke.
and purpose N-terminal probrain natriuretic peptide, which is mainly produced by the heart, is increased in acute stroke. We aimed to determine if N-terminal probrain natriuretic peptide could be a biomarker for ischemic stroke with a cardioembolic cause. ⋯ N-terminal probrain natriuretic peptide is a biomarker with a good accuracy to predict ischemic stroke of cardioembolic cause, namely associated with atrial fibrillation.
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Abnormalities in nocturnal blood pressure control identified using ambulatory blood pressure monitoring are associated with adverse cardiovascular outcomes. Sleep and wake episodes during such studies are usually identified by means of sleep diaries but these may be inaccurate in stroke patients. We performed a study to determine whether sleep-wake data obtained using wrist-mounted actimeters would significantly influence the results of routinely performed nocturnal ambulatory blood pressure monitoring when compared with diary-based sleep-wake recording and fixed time-period data. ⋯ Calculation of nocturnal and sleeping blood pressure is lower in subjects with stroke and transient ischaemic attack when objective actimeter-derived sleep/wake data are used.
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Multicenter Study
Preventing recurrence of thromboembolic events through coordinated treatment in the District of Columbia.
PROTECT DC examines whether stroke navigators can improve cardiovascular risk factors in urban underserved individuals newly hospitalized for stroke or ischemic attack. Within one-year of hospital discharge, up to one-third of patients no longer adhere to secondary prevention behaviors. Adherence rates are lower in minority-underserved groups, contributing to health disparities. In-hospital programs increase use of stroke prevention therapies but may not be as successful in underserved individuals. In these groups, low literacy, limited healthcare access, and sparse community resources may reduce adherence. Lay community health workers (navigators) improve adherence in other illnesses through education and assisting in overcoming barriers to achieving desired health behaviors and obtaining needed healthcare services. ⋯ PROTECT DC will determine whether a Phase III trial of stroke navigation for urban underserved individuals to improve adherence to secondary stroke prevention behaviors is warranted.
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Patients with moderate to severe acute ischemic stroke without intracranial vessel occlusion are an intriguing subset of stroke patients. They pose diagnostic and therapeutic challenges to the physician. We sought to study these patients with an emphasis on their radiological and clinical outcomes. ⋯ Stroke without intracranial occlusions are not a benign entity. Factors that are independently associated with decreased likelihood of a good outcome are higher baseline NIHSS, and older age. Treatment with tissue plasminogen activator is not a predictor of outcome.