Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Oct 2016
Comparative StudyInterhemispheric Asymmetry in Distribution of Infarct Lesions among Acute Ischemic Stroke Patients Presenting to Hospital.
This study aimed to investigate the possible asymmetric distribution of acute ischemic infarct lesions between patients with right-sided stroke versus left-sided stroke. ⋯ Acute ischemic infarcts of the left insular ribbon and lentiform nucleus are asymmetrically more common compared to mirrored counterpart regions, presumably due to more severe symptoms at presentation. Otherwise, distribution of symptomatic infarcts to the rest of the brain is roughly symmetric.
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J Stroke Cerebrovasc Dis · Oct 2016
Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes.
A critical mission of acute care hospitals is to reduce hospital readmissions to improve patient care and avoid monetary penalties. We speculated that stroke patients with enteral tube feeding are high-risk patients and sought to evaluate their hospital readmissions. ⋯ Stroke patients with a PEG tube placement during their index hospital stay are twice as likely to be readmitted within 30 days compared to stroke patients without PEG tube placements. The primary readmission diagnosis for some patients was directly linked to PEG tube complications. We have identified risk factors that can be used to focus resources for readmission prevention.
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J Stroke Cerebrovasc Dis · Oct 2016
Controlled Clinical TrialA Home- and Community-Based Physical Activity Program Can Improve the Cardiorespiratory Fitness and Walking Capacity of Stroke Survivors.
The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardiorespiratory fitness. This pilot study aims to determine the feasibility, safety, and preliminary efficacy of an individually tailored home- and community-based exercise program to improve cardiorespiratory fitness and walking capacity in stroke survivors. ⋯ Our individually tailored approach with once-weekly telephone or e-mail support was feasible and effective in selected stroke survivors. The 16% greater improvement in VO2peak during the 6MWT achieved in the intervention versus control group is comparable to improvements attained in supervised, center-based programs.
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J Stroke Cerebrovasc Dis · Oct 2016
Comparative StudySex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke.
Infectious complications after ischemic stroke are frequent and lead to neurological deterioration, poor functional outcomes, and higher mortality. Local and systemic inflammatory responses to brain ischemia differ between males and females, but little is known about differences in poststroke susceptibility to infection by sex. The purpose of this study was to compare sex-related differences in the risk of hospital-acquired sepsis and pneumonia after acute ischemic stroke (AIS). ⋯ Female sex was associated with a lower risk of hospital-acquired sepsis and pneumonia after AIS. Further investigation is needed to determine the mechanisms underlying this clinical observation.
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J Stroke Cerebrovasc Dis · Oct 2016
Case ReportsContinuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage.
Delayed cerebral ischemia (DCI) is a prominent complication after aneurysmal subarachnoid hemorrhage (aSAH). Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolarization (CSD), and spreading ischemia are thought to be involved in DCI after aSAH. Here, we describe a patient with aSAH in whom CSD and cerebrovascular autoregulation were evaluated using simultaneous electrocorticography and monitoring of the pressure reactivity index (PRx) after surgical clipping of a ruptured posterior communicating artery aneurysm. ⋯ Based on this observation, we propose a relationship between these factors and DCI. Assessment of cerebrovascular autoregulation may permit detection of the inverse hemodynamic response to cortical depolarization. Detection of DCI may be achieved through simultaneous monitoring of CSD and PRx in patients with aSAH.