Same Stroke, Same Treatment?

Same Stroke, Same Treatment?

This article was first published on ESO website | Author: Giuseppe Reale, MD – ESO YSPR Committee

Same stroke, same treatment and lower limb weakness, but forget about upper motor neurons!

Sometimes it seems that stroke treatment is all about time, tissue and recanalization, whatever it takes. However, it is important to remember that danger might be just around the corner, even after a successful recanalization.

A 66-year old man was carried to our Emergency Department 4 hours after the acute onset of right hemiplegia and aphasia. CT-Angiography (CTA) showed a M1 left middle cerebral artery (MCA) occlusion and the patient underwent to systemic thrombolysis followed by mechanical thrombectomy in general anesthesia with right femoral access. When the patient was admitted to the Stroke Unit, he presented only right lower limb weakness, being able to flex the thigh at hip, but not to extend the leg at knee. The right patellar tendon reflex was absent, while the left was elicitable. The segmental weakness pattern and the reflex asymmetry suggested a femoral neuropathy. CTA of lower extremities excluded the presence of iliacus hematoma or femoral artery aneurysm. The patient had a spontaneous recovery of the neurological deficits within one week. The electromyography performed three weeks later did not show any finding of denervation at the quadriceps muscle, suggesting a previous femoral neuropraxic block.

An 82-year old woman with the same symptoms and radiological findings of the previous patient underwent thrombolysis and thrombectomy with right femoral access in general anesthesia.

When transferred to the Stroke Unit, she presented just a mild drift of the right lower limb, but the day after she developed a complete plegia of the right lower limb associated with “mild pain and an unpleasant cold sensation”. The right lower limb was cold and distal pulses were absent. CTA of the lower extremities demonstrated a pseudoaneurysm of the common femoral artery, associated with distal arterial occlusion. The patient underwent emergency femoral endarterectomy without any complication.

You can read the full article here.

Real cost of heart attacks and strokes: Double the direct medical expense

Real cost of heart attacks and strokes: Double the direct medical expense

First published on ScienceDaily.com

The full financial cost of a heart attack or stroke is twice as much as the medical costs when lost work time for patients and caregivers is included.

That’s the finding of research published today, World Health Day, in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1 The study concludes that victims of heart attack and stroke who return to work are 25% less productive in their first year back.

In the year after the event, heart patients lost 59 workdays and caregivers lost 11 workdays, for an average cost of €13,953, and ranging from €6,641 to €23,160 depending on the country. After stroke, 56 workdays were lost by patients and 12 by caregivers, for an average €13,773, ranging from €10,469 to €20,215.

Study author Professor Kornelia Kotseva, of Imperial College London, UK, said: “Patients in our study returned to work, meaning their events were relatively mild. Some still had to change jobs or careers, or work less, and caregivers lost around 5% of work time. Not included in our study are those with more severe events who quit work altogether and presumably need even more help from family and friends.”

The study enrolled 394 patients from seven European countries — 196 with acute coronary syndrome (86% heart attack, 14% unstable chest pain) and 198 with stroke — who returned to work 3 to 12 months after the event. Patients completed a questionnaire2,3 during a visit to a cardiologist, neurologist, or stroke physician. Hours lost were valued according to country labour costs in 2018. The average age of patients was 53 years.

According to published estimates for Europe, the direct medical costs of acute coronary syndrome are €1,547 to €18,642, and €5,575 to €31,274 for stroke.4 “This is the metric commonly used to estimate the costs of medical conditions while indirect costs from productivity loss are often not taken into account by clinicians, payers or policymakers,” said Professor Kotseva. “Taken together, the actual burden on society is more than twice the amount previously reported.”

You can read the full article here.

The stroke care paradox: Close-knit social networks increase delays in hospital arrival

The stroke care paradox: Close-knit social networks increase delays in hospital arrival

First published on ScienceDaily.com

Newly developed treatment strategies can minimize the size of a patient’s stroke and, in many cases, change what would have been a life-altering cerebrovascular event into a minor one with the prospect of excellent recovery. But these therapies are time sensitive — delays in seeking care can put them out of reach. Each year in the U.S., 795,000 patients will have a stroke and approximately 70 percent of them will arrive at the hospital more than six hours after the onset of symptoms. Investigators from Brigham and Women’s Hospital examined how social networks may influence delays in arrival times for patients experiencing the symptoms of a stroke. Paradoxically, they found that patients with closer-knit social networks, including family members and spouses, were more likely to delay seeking hospital care whereas those with a more dispersed network of acquaintances were more likely to seek care faster. The team’s analysis is published in Nature Communications.

“Closed networks are like echo chambers in which there is a tendency for everyone to agree to watch and wait,” said corresponding author Amar Dhand, MD, DPhil, of the Department of Neurology at the Brigham. “A major problem in stroke care is patients’ delayed arrival to the hospital, and we show that this problem is related to the influence of patients’ social networks.”

Dhand and colleagues surveyed 175 patients within five days of suffering from a stroke. They collected information from each participant about personal social networks, creating network maps. The team focused on patients with milder symptoms because this population is at higher risk for delay and were able to engage in the survey during hospitalization.

You can read the full article here.

Genetic variants may influence poststroke recovery

Genetic variants may influence poststroke recovery

First published on ScienceDaily.com

Our genes may have a bearing not only on our stroke risk, but probably also on how well we recover after stroke. For the first time, in international collaboration, scientists at the University of Gothenburg and elsewhere have identified common genetic variants that are associated with outcome after ischemic stroke.

The study, a meta-analysis of 12 international stroke studies, was led by research groups at two Swedish universities: Gothenburg and Lund. The study comprised more than 6,000 patients with ischemic stroke, the most common form of stroke, in which a blood clot causes a lack of oxygen in a region of the brain. Stroke can also be caused by a hemorrhage in the brain.

For the study, the patients were divided into two groups depending on their outcome at three months after ischemic stroke. One group was composed of people who had not survived and those who were dependent on help from others to cope with activities of daily living.

Those assigned to the second group were, three months after their stroke onset, able to cope unaided. By comparing analyses of the patients’ genomes, the researchers were able to find several different genetic variants that appear to have played a part in the patients’ outcomes.

“One of the common genetic variants we found was significant — that is, clearly associated with a worse outcome in the large volumes of data we were able to access,” says Annie Pedersen, a PhD student at Sahlgrenska Academy, University of Gothenburg, one of the lead authors of the study.

The genetic variant identified can be linked to another gene that is part of a major process involved in brain plasticity, which is the nerve cells’ ability to adapt and take over functions when other nerve cells in the brain die.

The study took into account several other factors — age, sex and the extent of the patient’s brain damage — that can also affect outcome after stroke. After adjustment for these factors, the association remained between the genetic variant and elevated risk of being in the group of patients who still, three months after the stroke onset, were unable to manage without assistance.

“Even if two patients seem to have the same prospects of recovering, their outcomes can be different. Studies on animals have indicated that there are genes that may contribute to the explanation, and we’ve now found support for them in humans as well,” Pedersen says.

Our limited knowledge of why some patients recover well while others incur lasting functional impairments after the same type of stroke has made it difficult to develop new treatment methods, thinks Professor Christina Jern of Sahlgrenska Academy, who ran the study in collaboration with Professor Arne Lindgren of Lund University.

“In the long run we hope the research may enable us to identify new targets for medication that might help to improve poststroke outcome, but there’s a lot of research to be done before we get there,” Jern says.

You can read the full article here.

Stroke risk drops in both black and white older adults

Stroke risk drops in both black and white older adults

First published on ScienceDaily.com

Recent reductions in hospitalization and death due to stroke extend to both black and white Medicare beneficiaries, reports a study in the April issue of Medical Care.

The reductions in mortality after initial stroke have been even greater in black Medicare patients, according to the new research by Margaret C. Fang, MD, MPH, of the University of California, San Francisco, and colleagues. Dr. Fang comments,” Despite these promising trends, our study also found that black men and women continue to be at higher risk for stroke than white patients.”

Stroke Risks Decline Over 25 Years — Trends Linked to Improving Risk Factors

Using Medicare data from 1988 to 2013, the researchers analyzed trends in hospitalization and mortality after an initial stroke in black or white men and women aged 65 or older. The study included more than 1 million hospitalizations for ischemic stroke, caused by blockage or narrowing of the brain blood vessels; and nearly 150,000 hospitalizations for hemorrhagic stroke, caused by bleeding into or around the brain.

Over the 25-year study period, hospitalizations for stroke decreased for both black and white patients. Adjusted for age, ischemic stroke risk decreased from 1,185 to 551 per 100,000 Medicare beneficiaries among black men and from 932 to 407 per 100,000 among white men. Risk fell from 1,222 to 641 per 100,000 for black women and from 892 to 466 per 100,000 for white women.

Mortality after ischemic stroke also fell, with greater reductions in black patients. Risk of death within 30 days after ischemic stroke decreased from approximately 16 to 8 percent in black men and from 16 to 12 percent in white men. Ischemic stroke mortality declined from about 14 to 9 percent in black women versus 16 to 15 percent in white women.

Read the full article here.

Five Ways of Fighting Depression

Five Ways of Fighting Depression

Author: Cornelius J Johnson

When you’re battling depression it’s difficult not to just let the pills do the work and hope for the best. As any good mental health professional will tell you, combating the symptoms of depression can take some self-governance and work. But when our mind is working against us at these times, where do we focus our attention?

Here are five simple areas to focus on in order to reduce the impact of depression.

Sleep

When suffering from depressive thought patterns, sometimes we are prone to staying in bed for as long as possible. We take ourselves out of the equation and enjoy the warmth and comfort of the bed. But that doesn’t necessarily mean we get good rest. Often it means lying in bed worrying or thinking about things we cannot control.

“We should try view our bed as a vehicle for sleep, rather than a retreat from the world,” writes William Cosgrove, an author at Researchpapersuk and LastMinuteWriting. “It’s important that we foster a routine for ourselves of going to bed at a reasonable hour, and waking up having had a good nights sleep.”

Eat

Depression can have varied effects on how we use or view food. For some, the thought of eating can make us nauseous, and for others, we seem unable to get enough. When going through depressive periods we may either eat one particular kind of food or binge on snacks and junk food.

This fluctuation in our diets can have radical effects on our state of mind. The more we randomize our intake of nutrients the more likely it is that we’ll find ourselves in a bad place. Regular, healthy eating is vital to a good state of mind. If you face depression, keep motivated to maintain a strong routine of eating healthy food.

Exercise

If you’re suffering from depression, the last thing you want to do is go out to the gym. Depression can be linked to body image or how we interact socially. As the gym combines both of these elements, it is understandable that those who suffer from depression aren’t likely to hit the gym any time soon. But this doesn’t mean you should abandon exercise totally.

Exercise is a great way of releasing endorphins. Many who suffer from depression take up solo activities, such as long distance running, walking or cycling. These activities offer us an opportunity to zone our minds on the simple act of physical movement rather than the abstract thoughts that come with depression.

Socialize

Depression is a lonely state of being, and it can be tempting to fuel that loneliness by refusing to inflict on others. We get caught up with the notion that we are no fun to be around when we are depressed. It’s important to remember that our good friends are able to support us at these times.

As a society, people are becoming more open and honest about mental health, and those who suffer from depression should no longer feel they have to be secretive about it. Explain to your close circle the issue you are facing and you’ll soon find that you have allies to help you fight your corner.

Express yourself

“History is full of people who have turned depression to their advantage,” says Miranda Rhodes, a regular contributor to Draftbeyond and Writinity. “20th-century writers were often prone to depressive or anxious states. Though you need not expect yourself to write ‘A Farewell to Arms’ or ‘The Bell Jar’, writing or painting are excellent ways of channeling your depression into something beautiful.“

In getting our depression out into something we can read or view, we are able to objectify it and analyze it without being too close to it.

Cornelius J Johnson specializes in marketing and different aspects of entrepreneurship. He writes on a variety of subjects such as finance and marketing as well as lifestyle and personal development and is a regular contributor to Lucky Assignments and Gum Essays, academic writing websites.