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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Anterior circulation syndromes are subdivided into partial (PACS) and total (TACS) depending on the extent of the infarct. They are more likely than a lacunar stroke to be due to either a cardiac or large vessel embolus, or haemorrhage.
IVIM MRI: A Window to the Pathophysiology Underlying Cerebral Small Vessel Disease
Published in Denis Le Bihan, Mami Iima, Christian Federau, Eric E. Sigmund, Intravoxel Incoherent Motion (IVIM) MRI, 2018
Jacobus F. A. Jansen, Sau May Wong, Walter H. Backes
Current therapies of lacunar stroke, one of the most common clinical manifestations of cSVD [33], include antiplatelet therapy, blood pressure reduction, and statin therapy [34]. Quantitative IVIM imaging measures were associated with WMHs and may act as potential surrogate markers for structural damage in cSVD [17, 18, 20]. Tissue injury, including lacunae and WMHs, is linked to cognitive decline and physical and psychiatric disabilities [3]. Since the imaging measures may be potential surrogate markers of structural damages in cSVD, these measures can be employed as a neurobiological readout of treatment for patients with cSVD in the short term. For example, vascular risk factors (e.g., smoking, blood pressure, and diabetes) are known to be correlated with WMH severity and the occurrence of lacunae [35]. It can be investigated whether an intervention to improve the vascular condition could lead to less tissue injury in the future. However, prior to conducting this intervention study, which will likely require a long follow-up time, the effect of this intervention on the imaging measures can be studied in the shorter term to gain an early insight into biological responses. For this purpose, longitudinal studies are required to explore the role of imaging measures as surrogate markers of cSVD in more detail. These studies could evaluate whether functional impairment (e.g., abnormal microvasculature and/or parenchyma as shown through IVIM) indeed precedes morphological abnormalities.
Therapeutic Options to Enhance Poststroke Recovery in Aged Humans
Published in Shamim I. Ahmad, Aging: Exploring a Complex Phenomenon, 2017
Aurel Popa-Wagner, Dumbrava Danut, Roxana Surugiu, Eugen Petcu, Daniela-Gabriela Glavan, Denissa-Greta Olaru, Raluca Sandu Elena
Spontaneous recovery is common if the infarct is located in the striatum, a subcortical structure that exhibits activity-dependent plasticity and is important for controlling movement and motor learning. The enhanced recovery was associated with structural and synaptic plasticity in the contralesional striatum [46] (Figure 19.1). This may explain why patients with subcortical lacunar stroke are more likely to have early functional recovery after stroke [47,48]. Other studies suggest that the beneficial effect could be due to in situ secretion of neuroprotective factors by the transplanted cells. For example, human-derived inducible pluripotent cells (iPSCs) implanted into the striatum of young animals at 1 week after MCAO protected substantia nigra from atrophy, probably through a trophic effect [49].
Mobilization within 24 hours of new-onset stroke enhances the rate of home discharge at 6-months follow-up: a prospective cohort study
Published in International Journal of Neuroscience, 2021
Tokio Kinoshita, Tatsuya Yoshikawa, Yukihide Nishimura, Yoshi-ichiro Kamijo, Hideki Arakawa, Takeshi Nakamura, Takamasa Hashizaki, Sven P. Hoekstra, Fumihiro Tajima
The home-discharge rate was higher by 20% in patients who started PROr within 24 hrs of stroke onset in the present study. The discharge destination of patients with acute stroke is influenced by a variety of factors, including demographic background, socioeconomic status, and clinical severity [20–22]. Previous studies demonstrated that stroke type, FIM score on admission, and comorbidities were independent and significant predictors of home return in Japan, and that the home-discharge rate was higher in patients with cerebral infarction than those with cerebral hemorrhage [23]. However, the ratio of hemorrhage/infarction for the patients who could be followed up to 6 months after stroke tended to be higher in VEM than the other categories. However, there were no differences in the types and severity of stroke among the categories at admission. Furthermore, it has previously been reported that in-hospital mortality in patients with cardioembolic infarction is highest (27%), while this is low after a lacunar stroke (0.8%) [24]. Indeed, good functional recovery is usually expected at discharge after a lacunar stroke [25]. Thus, although the distribution in cerebral infarctions did not differ among groups in the present study, future studies should take into account that the presence of lacunar and non-lacunar ischemic strokes could influence the outcome of post-stroke rehabilitation.
Prevalence and risk factors of microalbuminuria in patients with lacunar infarction
Published in Postgraduate Medicine, 2019
Fei Li, Qian-Xue Chen, Yan Chen, Guan Wang, Bo Peng, Tao Yao
Our study has certain limitations. First, we did not collected day-to-day variability of ACR for each individual. Instead, we collected the average of the two measurements of urine specimens because of a large variability in albumin excretion rates that did not ensure an objective evaluation of MAU. Second, we excluded patients with diseases leading to glomerular disorders, sever heart or liver diseases, and so on, and this might limit the generalization of our findings. Third, there may be other factors that may influence the development of MAU in lacunar infarction patients. Finally, we excluded patients with recurrent lacunar stroke. Given one in every five infarction patients was a recurrent lacunar stroke, and hypertension and diabetes were significant factors related to recurrent lacunar infarction [33], follow-up studies for the prevalence and risk factors that predispose to MAU in recurrent lacunar infarction patients are therefore recommended.
Immunity and inflammation predictors for short-term outcome of stroke in young adults
Published in International Journal of Neuroscience, 2018
Xiaoqing Zhou, Fang Yu, Xianjing Feng, Junyan Wang, Zhibin Li, Qiong Zhan, Jian Xia
In our study, we found small-artery occlusion presented favorable stroke outcome in 15.8% of cases and unfavorable in 9.0%, it was not statistically significant, but the P value was 0.082. Our results were in line with a previous study; they assessed the clinical features of lacunar stroke in 51 patients aged ≤55 years and 813 patients aged >55 years, and their findings indicated that lacunar stroke in younger patients is infrequent and differs from lacunar stroke in older patients in several aspects, but early outcome was similar in young adults and older patients [40]. The possible interpretation is that majority of patients with lacunar stroke are between the sixth and seventh decades of life [41], and that our group of lacunar stroke patients is rather small (13.2%).