Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Aug 2015
The Effects of Pretreatment versus De Novo Treatment with Selective Serotonin Reuptake Inhibitors on Short-term Outcome after Acute Ischemic Stroke.
Selective serotonin reuptake inhibitors (SSRIs) administered in patients following acute ischemic stroke have shown to improve clinical recovery independently of changes in depression. Animal studies have demonstrated that sustained SSRI treatment is superior to short-term SSRI in evoking neurogenesis but how this benefit translates into humans remains to be answered. We hypothesized that in acute ischemic stroke patients, SSRI treatment started before the event leads to improved short-term outcomes compared to de novo SSRI treatment poststroke. ⋯ Our data suggest that SSRI pretreatment may improve clinical outcomes in the early stages of acute ischemic stroke supporting the hypothesis that prolonged SSRI treatment started prestroke is superior to poststroke SSRI.
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J Stroke Cerebrovasc Dis · Aug 2015
Potential Augmentation of the Risk of Ischemic Cerebrovascular Accident by Chronic Obstructive Pulmonary Disease in Patients with Atrial Fibrillation.
Atrial fibrillation (AF) is a potent risk factor for ischemic cerebrovascular accident (ICVA). Inflammation is a potential pathogenic factor for atherosclerosis and ICVA. Chronic obstructive pulmonary disease (COPD) is associated with increased inflammatory markers. Subjects who frequently experience COPD and AF together may have higher risk of ICVA. The objective of the study is to compare the prevalence of ICVA in patients with atrial fibrillation and COPD together versus atrial fibrillation alone. ⋯ COPD may increase the risk of ischemic stroke in subjects with AF. Presence of COPD may increase the risk of ischemic stroke in subjects with AF.
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J Stroke Cerebrovasc Dis · Jul 2015
Self-Care Self-Efficacy Correlates with Independence in Basic Activities of Daily Living in Individuals with Chronic Stroke.
(1) To characterize the self-care self-efficacy (SCSE) of community dwelling individuals with chronic stroke and (2) to determine the contribution of SCSE to the independence in basic and instrumental activities of daily living (BADL and IADL) and the participation of individuals with chronic stroke. SCSE is the confidence in one's own ability to perform self-care activities. ⋯ Higher SCSE of individuals with chronic stroke contributes to more independence in BADL. Additional questionnaires regarding self efficacy for IADL should be developed and investigated.
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J Stroke Cerebrovasc Dis · Jul 2015
ReviewBiomarker Discovery in Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage.
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating problem. Overall, the mortality rate associated with aSAH is 32% to 67%, which makes it the most lethal type of hemorrhagic stroke. Once the aneurysm has been treated, cerebral vasospasm is the leading cause of morbidity and mortality associated with aSAH. Thus, ability to effectively prevent or treat cerebral vasospasm could result in significantly improved survival and quality of life for aSAH patients. Unfortunately, partly because of poor understanding of the mechanisms of vasospasm, current diagnosis and treatment can be inconsistent and/or ineffective. Current treatment methods include primarily medical therapy and endovascular methods. Alone, or in combination, these measures can be of benefit in some patients. However, they are not uniformly efficacious and, on an individual basis, they can present significant risks. These risks include stroke, cardiovascular compromise, and death. More effective diagnosis and treatment strategies could significantly improve patient outcomes after aSAH. Unfortunately, clinically reliable biomarker for cerebral vasospasm has yet to be identified. Biomarker discovery may facilitate earlier diagnosis of vasospasm and improved monitoring of the response to treatment. It may help in stratifying patients into categories of risk to develop vasospasm, which could subsequently guide therapy. Indeed, biomarker research may suggest "vasospasm phenotypes" that can be used to guide the most effective type of therapy for that particular patient. The purpose of this manuscript is to review the current cerebral vasospasm biomarker literature. ⋯ Although multiple molecules have been proposed, no single molecule has been shown to be a clinically reliable biomarker for cerebral vasospasm. This is not surprising based on the complex pathogenesis of cerebral vasospasm. Indeed, it is unlikely that a single biomarker will be clinically effective and reliable for predicting cerebral vasospasm. Instead, cerebral vasospasm may be best predicted by a panel of markers and the temporal progression of their relative levels after aSAH. Many such candidate molecules are reviewed herein and can be categorized as markers of cell damage, inflammation, changes in metabolism and vascular tone as well as microparticle-derived biomarkers. Among these, microparticle-derived biomarkers seem to be promising and lend themselves to further study. Biomarker discovery may facilitate earlier diagnosis of vasospasm and improved monitoring of the response to treatment. Ultimately, it may guide in the development of safer and more effective therapies for the most dreaded of aSAH complications.
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J Stroke Cerebrovasc Dis · Jul 2015
Comparative StudyLarge-Vessel Occlusion Stroke: Effect of Recanalization on Outcome Depends on the National Institutes of Health Stroke Scale Score.
Arterial recanalization is currently considered the main standard of successful early management of acute ischemic stroke. Intravenous (IV) thrombolysis with tissue plasminogen activator (tPa) is the only Food and Drug Administration-approved medical treatment. Large-vessel occlusion, estimated to account for up to 40% of all acute ischemic strokes, is often refractory to IV thrombolysis and is associated with a poor patient outcome. Mechanical recanalization procedures are therefore increasingly used in the treatment of large-vessel occlusion refractory to, or presenting outside the accepted time window for, IV thrombolysis. The aim of this study was to investigate the effect of early vessel recanalization on clinical outcome in patients with large-vessel occlusion stroke. ⋯ In this study of acute large-vessel occlusion stroke, we found that clinical outcome following early recanalization was dependent on the patient's pretreatment NIHSS score. A non-negligible proportion of patients with milder strokes did well despite persistent large-vessel occlusion. These results may suggest that in patients who are able to maintain adequate collateral flow despite proximal arterial occlusion, effective adaptive mechanisms are present, which for some patients are long-lasting. This may influence the process of appropriate patient selection for endovascular therapy.