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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The signs and symptoms of ischemic stroke are based on the area of the brain that is damaged. Neurologic deficits usually indicate which artery is affected, but not precisely. The abnormalities reach their maximal levels within only several minutes. This is typical of embolic strokes. In fewer cases, deficits evolve over 24–48 hours. This is called an evolving stroke and is usually an atherothrombotic stroke. In most evolving strokes, unilateral neurologic dysfunction develops without any fever, headache, or pain. They often begin in one arm and spread ipsilaterally. There is usually a step-by-step progression, with periods of stability. A stroke is referred to as submaximal when it is over, and later there is some residual function in the area of ischemia, indicating some tissue that is still viable, but at risk of being damaged.
Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
People who have had a TIA are at high risk of a further vascular event, such as a stroke, within the next few days, which necessitates urgent assessment. Specialist neurovascular services should assess all people with suspected transient cerebrovascular symptoms within 24 hours of the onset.6 When symptoms have fully resolved within 24 hours, 300 mg of aspirin should be given immediately (unless contraindicated). Following specialist confirmation of the diagnosis, an immediate 300 mg single dose of clopidogrel followed by 75 mg daily is recommended. If a cardioembolic source is suspected (e.g. AF) then anticoagulation, rather than antiplatelets, is recommended once intracerebral haemorrhage has been excluded (unless there is a contraindication). Typically, this would be with a non-vitamin K antagonist oral anticoagulant (NOAC) due to rapid onset of action. High-intensity statin therapy should also be commenced (e.g. atorvastatin 20–80 mg daily). TIAs share the same risk factors and secondary prevention strategies with ischaemic stroke (see later).
Nonclassical Ion Channels and Ischemia
Published in Tian-Le Xu, Long-Jun Wu, Nonclassical Ion Channels in the Nervous System, 2021
Stroke is the second leading cause of death in the world, with high mortality in China, which has nearly 20% of the world’s population [1]. Stroke can be classified to mainly two types: hemorrhagic stroke and ischemic stroke, and the latter constitutes about two-thirds of all stroke patients [2]. Ischemic stroke is caused by thrombosis, which reduces blood flow and interrupts blood supply, inducing localized damage in brain-specific tissues under hypoxia, leading to a complex syndrome in the brain. Ischemic stroke survivors suffer different dysfunction in sensory function, motor skills, cognition, and learning and memory. Currently in clinical practice, stroke patients can receive recombination tissue plasminogen activator (tPA) for injection within a therapeutic window of 4.5 hours. This has promising effectiveness but is only suitable for 3%–4% of patients and still has a risk of hemorrhage [3]. With acute ischemia, the ischemic core suffers an irreversible injury and subsequent cell death in minutes, and the ischemic penumbra progressively converts to ischemic core over several hours or days. Understanding the differences between penumbra and core, many treatments have tried to focus on the preservation of the penumbral brain, which can be salvaged and recover its normal function [4]. Besides, along with the development of new therapeutic intervention, more and more researches explore the complex molecular mechanism of ischemia to find potential strategies for treatment.
Predictive value of motor-evoked potentials for motor recovery in patients with hemiparesis secondary to acute ischemic stroke
Published in Annals of Medicine, 2023
Cheng-Chang Yen, Hsin-Hung Chen, Chao-Hsien Lee, Ching-Huang Lin
Ischemic stroke was diagnosed by a neurologist based on clinical manifestations and either brain computed tomography (CT) or magnetic resonance imaging (MRI). All patients with acute ischemic stroke received routine rehabilitation and treatment according to the treatment guidelines of the Taiwan Stroke Society for acute ischemic stroke. We collected the patients’ baseline information, including age, sex, smoking habit, drinking habit, body weight, height, comorbidities, and the National Institutes of Health Stroke Scale (NIHSS) score. NIHSS was assessed by a neurologist. Stroke location was determined using a brain CT scan and/or MRI and was categorized as cortical, subcortical, or brain stem. Motor function of the upper extremities was measured with the FMA (range: 0–66) at ≤10 days and 30 and 90 days after stroke onset by another neurologist. Proportional recovery was calculated as follows: Proportional recovery = (subsequent FMA score − initial FMA score)/(66 − initial FMA score). The subsequent FMA score was the score at 30 days and 90 days after the stroke. Post-stroke functional outcome was evaluated using the mRS at 90 days after stroke onset by the same neurologist. An mRS score of ≤1 was defined as a good functional outcome.
Analysis of risk factors for the efficacy of tirofiban in the treatment of acute ischemic stroke
Published in Neurological Research, 2023
Chong Liu, Lu Yin, Yinqin Hu, Zhizhen Shi, Qiaoyan Zhu, Qian Xiao, Guoyi Li, Jiwei Cheng, Yangbo Hou
Acute ischemic stroke, also known as acute cerebral infarction (ACI), is one of the most common diseases in neurology. ACI is characterized by high morbidity, disability and mortality, and poses a serious threat to human health [1]. The main purpose of treating acute ischemic stroke is to restore the blood perfusion of patients with cerebral infarction timely to rescue the ischemic penumbra. At present, intravenous thrombolysis is considered to be an effective method for treating acute ischemic stroke in the hyperacute stage, but the strict treatment time window and numerous contraindications limit the clinical application of this technique. Clinically, only a small number of patients are candidates for treatment with alteplase [2]. Patients in the acute stage of ischemic stroke are prone to neurological deterioration, resulting in irreversible damage. Therefore, finding safe and effective drug treatment is the most important step in improving the prognosis of acute ischemic stroke.
A prognostic study on the effect of post-traumatic stress disorder on cerebral ischaemia reperfusion-induced stroke
Published in The World Journal of Biological Psychiatry, 2022
Subramanyam Polopalli, Amulya Rani Yetukuri, Ravi Chandra Sekhara Reddy Danduga, Phani Kumar Kola
Many clinical and non-clinical investigations corroborated that co-morbid disorders are major risk factors for the progression of vascular conditions, including stroke. For instance, some huge risk factors promote ischaemic stroke prevalence, including transient ischaemic attack (TIA), atrial fibrillation, obesity, arterial diseases, and lethargy to physical exercise (Kwon et al. 2014). Stroke arises from fractional or complete blood supply blockage to the brain’s corresponding regions (Grysiewicz et al. 2008). It can cause long-term disabilities, including cognitive impairment, language impairment, hemiplegia, communication problems, and emotional disorders. As a consequence of post-stroke disabilities, long-term rehabilitation is necessary for patients such as speech therapy, physical therapy, and occupational therapy, which turns into a dreadful psychological and financial burden on victims (Jun et al. 2015). By the reports from WHO, stroke is accountable for the second major cause of death, and the third principal cause of long-term disability is regarded as a dominant health complication worldwide (Kumar and Gupta 2016, Poustchi et al. 2021). Up-to-date researchers have confirmed that stroke can promote post-traumatic stress disorder (PTSD) in humans, but no study has emphasised the risk of developing stroke after experiencing PTSD. The present study is designed to investigate single prolonged stress (SPS) induced PTSD on cerebral ischaemic reperfusion injury.