Forlivesi S.,Stroke Unit
Blood Coagulation and Fibrinolysis | Year: 2017
The most effective treatment of patients with stroke due to tandem occlusion is still unclear. We report the case of a man with stroke due to tandem internal carotid artery/middle cerebral artery occlusion, who underwent initially ineffective intravenous thrombolysis (IVT) and endovascular treatment. Early anticoagulation with apixaban was started after 48?h of IVT, given a newly diagnosed nonvalvular atrial fibrillation. Spontaneous partial recanalization of the cervical internal carotid artery was noted, and carotid endarterectomy was performed 72?h after IVT and 8?h after the last dose of apixaban. Surgery was conducted without any complication and the patient was discharged 7 days after onset with a residual mild hemiparesis. This is the first report of urgent carotid endarterectomy in an anticoagulated patient receiving a direct oral anticoagulant. This case highlights the importance of an early multidisciplinary approach to achieve a successful treatment of stroke due to tandem occlusion. Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
Markus H.S.,St George's, University of London |
King A.,St George's, University of London |
Shipley M.,University College London |
Topakian R.,St George's, University of London |
And 4 more authors.
The Lancet Neurology | Year: 2010
Background: Whether surgery is beneficial for patients with asymptomatic carotid stenosis is controversial. Better methods of identifying patients who are likely to develop stroke would improve the risk-benefit ratio for carotid endarterectomy. We aimed to investigate whether detection of asymptomatic embolic signals by use of transcranial doppler (TCD) could predict stroke risk in patients with asymptomatic carotid stenosis. Methods: The Asymptomatic Carotid Emboli Study (ACES) was a prospective observational study in patients with asymptomatic carotid stenosis of at least 70% from 26 centres worldwide. To detect the presence of embolic signals, patients had two 1 h TCD recordings from the ipsilateral middle cerebral artery at baseline and one 1 h recording at 6, 12, and 18 months. Patients were followed up for 2 years. The primary endpoint was ipsilateral stroke and transient ischaemic attack. All recordings were analysed centrally by investigators masked to patient identity. Findings: 482 patients were recruited, of whom 467 had evaluable recordings. Embolic signals were present in 77 of 467 patients at baseline. The hazard ratio for the risk of ipsilateral stroke and transient ischaemic attack from baseline to 2 years in patients with embolic signals compared with those without was 2·54 (95% CI 1·20-5·36; p=0·015). For ipsilateral stroke alone, the hazard ratio was 5·57 (1·61-19·32; p=0·007). The absolute annual risk of ipsilateral stroke or transient ischaemic attack between baseline and 2 years was 7·13% in patients with embolic signals and 3·04% in those without, and for ipsilateral stroke was 3·62% in patients with embolic signals and 0·70% in those without. The hazard ratio for the risk of ipsilateral stroke and transient ischaemic attack for patients who had embolic signals on the recording preceding the next 6-month follow-up compared with those who did not was 2·63 (95% CI 1·01-6·88; p=0·049), and for ipsilateral stroke alone the hazard ratio was 6·37 (1·59-25·57; p=0·009). Controlling for antiplatelet therapy, degree of stenosis, and other risk factors did not alter the results. Interpretation: Detection of asymptomatic embolisation on TCD can be used to identify patients with asymptomatic carotid stenosis who are at a higher risk of stroke and transient ischaemic attack, and also those with a low absolute stroke risk. Assessment of the presence of embolic signals on TCD might be useful in the selection of patients with asymptomatic carotid stenosis who are likely to benefit from endarterectomy. Funding: British Heart Foundation. © 2010 Elsevier Ltd. All rights reserved.
News Article | November 10, 2016
SURREY, BRITISH COLUMBIA--(Marketwired - Nov. 9, 2016) - When the first donor calls the 93.1 RED FM station early on Monday morning, November 14, the 10th Gurupurab Radiothon will be officially underway. This is a special year for RED FM, as it marks the 10th year that the popular station has devoted the day's airtime to raising money for local hospitals. This outpouring of generosity from the South Asian community has made a significant impact for all patients and families at Surrey Memorial Hospital, which has benefited from more than $5 million in donations. Since 2007, Radiothon donations have equipped the Emergency Department, transformed the Family Birthing Unit and supported the hospital's Stroke Unit. This annual event organized by RED FM has also created a new tradition for the South Asian community within Metro Vancouver and beyond. People of all ages visit or phone the station to make donations in celebration of the birthday of Guru Nanak. Over the years, donations have come in from as far away as Australia, New Zealand and the United Kingdom. This year's goal is to raise funds for Surrey Hospital & Outpatient Centre Foundation to enable Surrey Memorial to extend the Kidney Centre, providing dialysis closer to home for more patients. When the target of $1 million is reached, the unit will be named Dukh Bhanjan Kidney Centre. Foundation President Jane Adams looks forward to the radiothon each year. "The members of our generous South Asian community always inspire me with their passion for the causes they believe to be important," she says. "Last year alone, we had more than 4,500 donations and we raised $820,000." Jas Cheema, a member of the Foundation board when the partnership with RED FM was formed, has been a radiothon donor and volunteer since the first event in 2007. "I feel so inspired when I see families lining up at the station to make their donations in honour of Guru Nanak Dev Ji," she says. "I am proud of my community's generosity to others on this special day, and it's wonderful to see that the seeds that we planted 10 years ago are bearing fruit." Kulwinder Sanghera, president of RED FM and the South Asian Broadcasting Corporation, says that the radiothon has far exceeded the station's original expectations. "The South Asian community has truly embraced the idea of supporting the health care programs that are important to all families," he says. The Surrey radiothon was so successful that in 2013 Sanghera added another at sister station 106.7 RED FM in Calgary. Together, the stations have raised almost $8 million. We need your support! Here's how to donate To donate right now, visit the Surrey Hospital & Outpatient Centre Foundation website www.championsforcare.com. If you would like to donate during the radiothon on November 14, drop into the RED FM station or call the donation line at 604-598-9311.
Santos C.O.,University of Lisbon |
Caeiro L.,University of Lisbon |
Ferro J.M.,Stroke Unit |
Figueira M.L.,University of Lisbon
Cerebrovascular Diseases | Year: 2011
Background: Mania is a rare consequence of stroke and according to the sparse published information it is difficult to describe its demographic, clinical and prognostic characteristics. Methods: We performed a systematic review of all cases of mania and stroke to describe those characteristics. Studies were identified from comprehensive searches of electronic databases, reference lists of the studies collected and handbooks. Two authors independently assessed abstracts, and collected and extracted data. Results: From 265 abstracts, 139 were potentially relevant. For the first analysis, which tries to answer the clinical question of the relationship between mania and stroke, 49 studies met the inclusion criteria and described 74 cases. For the second analysis, we looked for an explicit temporal and causal relationship between manic symptoms and stroke, and selected 32 studies describing 49 cases. In both analyses, the typical patient was male, without a personal or family history of psychiatric disorder, with at least one vascular risk factor, but without subcortical atrophy and had suffered a right cerebral infarct. The majority of patients (92%) presented elevated mood as the first symptom. The other frequent symptoms were an increased rate or amount of speech (71%), insomnia (69%) and agitation (63%). Conclusions: Post-stroke mania should be considered in any manic patient who presents concomitant neurological focal deficits and is older than expected for the onset of primary mania. The results of a systematic study of mania in acute stroke with subsequent follow-up and data from diffusion MR or perfusion CT in a multicenter study with a central database would be relevant. © 2011 S. Karger AG, Basel.
Caeiro L.,Institute of Molecular Medicine |
Caeiro L.,Stroke Unit |
Ferro J.M.,Stroke Unit |
Costa J.,Center for Evidence Based Medicine and Cochrane Coordinating Center Portugal
Cerebrovascular Diseases | Year: 2013
Background: Apathy is a disturbance of motivation, frequent in survivors of stroke. Several studies have evaluated the rate of apathy secondary to stroke and risk factors. Different conclusions and contradictory findings have been published. We aimed to perform a systematic review and meta-analysis of all studies evaluating apathy secondary to stroke to better estimate its rate and risk factors, and explore associations with poorer outcomes. Methods: We searched PubMed, Cochrane Library, PsychINFO and PsycBITE databases and screened references of included studies and review articles for additional citations. Search results and data extraction was performed independently. We systematically reviewed available publications reporting investigations on ischemic and intracerebral hemorrhagic stroke and apathy. Quality assessment of the studies was performed independently. Subgroup analyses were performed according to stroke phase (acute and post-acute), stroke past history (first-ever and any-stroke) and patient age (younger and older patients). Pooled odds ratios (OR) and standardized mean difference, and 95% confidence intervals (CI), were derived by random-effects meta-analysis. Heterogeneity was assessed with I2 test. Results: From the initial 1,399 publications, we included 19 studies (2,221 patients). The pooled rate of apathy was 36.3% (95% CI 30.3-42.8; I2 = 46.8), which was similar for acute [39.5% (95% CI 28.9-51.1)] and post-acute phase [34.3% (95% CI 27.8-41.4)], and about three times higher than the rate of depression [12.1% (95% CI 8.2-17.3)]. Apathetic patients were on average 2.74 years older (95% CI 1.25-4.23; I2 = 0%). No gender differences were found. Depression (OR 2.29; 95% CI 1.41-3.72; I2 = 44%) and cognitive impairment (OR 2.90; 95% CI 1.09-7.72; I 2 = 14%) were more frequent and severe in apathetic patients. Apathy rate was similar for ischemic and hemorrhagic stroke type and for left- and right-sided hemispheric lesions. Clinical global outcome was similar between apathetic and nonapathetic patients. Conclusion: Apathy secondary to stroke is a more frequent neuropsychiatric disturbance than depression. Apathetic patients are more frequently and severely depressed and cognitively impaired. A negative impact of apathy secondary to stroke on clinical global outcome cannot be ascribed. Future research should properly address its predictor factors and evaluate the impact of apathy treatment options in stroke patients. Copyright © 2013 S. Karger AG, Basel.
News Article | November 15, 2016
SURREY, BRITISH COLUMBIA--(Marketwired - Nov. 15, 2016) - Metro Vancouver's South Asian community celebrated the 10th year of the RED FM Gurupurab Radiothon by donating $715,000 to expand the Kidney Centre at Surrey Memorial Hospital. Donors called the phone lines or visited the 93.1 RED FM station in Surrey to make their donations to honour the birthday of Guru Nanak. As RED FM organizes the radiothon and donates the airtime, all the funds raised will go to Surrey Hospital & Outpatient Centre Foundation to increase the capacity of the hospital's busy kidney centre, which will be named the Dukh Bhanjan Kidney Centre. Long time radiothon supporters Raghbir and Manjit Atwal, owners of Atwal's Insurance and Financial Centre, made a special contribution in honour of the 10th year of the radiothon. The Atwals' $100,000 donation is the largest in the history of this successful fundraising event. "We believe that it is not money alone that can help people - it is how you put the money to use," says Raghbir Atwal. "When we donate to the hospital, we know that the money is in good hands and it will be used to help others in the community." At Surrey Memorial, more than $5 million in radiothon donations have already made a difference in the Emergency Department, the Family Birthing Centre and the Stroke Unit, according to Jane Adams, president of Surrey Hospital & Outpatient Centre Foundation. "Since 2007, we've used the radiothon donations to transform some of the busiest areas at Surrey Memorial, so that thousands of patients and families benefit from the generosity of the South Asian community every year," she says. "Our thanks to everyone who supported the 10th radiothon, and to RED FM for creating this inspired tradition of giving." RED FM President Kulwinder Sanghera is grateful to the community for their outstanding support. "In the past 10 years, we have been organizing radiothons every year. Whether it is for a local cause or for an international tragedy, the South Asian community always steps forward to make enormous contributions. On behalf of RED FM, I would like to thank our community for their exemplary generosity," Sanghera says. There's still time to make your donation. Visit the Surrey Hospital & Outpatient Centre Foundation website www.championsforcare.com to give online, or call 604-588-3371.
Koton S.,Tel Aviv University |
Tanne D.,Stroke Center |
Green M.S.,Haifa University |
Bornstein N.M.,Stroke Unit
Neuroepidemiology | Year: 2010
Background: Despite declining age-adjusted stroke mortality rates, the disease remains the third most common cause of death in Israel. Based on a national survey, we examined mortality rates during the first 3 years after a first-ever acute ischemic stroke (IS) and the major predictors of short-term (1 month) and long-term (3 years) mortality. Methods: In the National Acute Stroke Israeli Survey (NASIS 2004), data were collected on all hospitalized stroke patients in Israel during a 2-month period. Mortality rates for first-ever IS were assessed at 1 month and 3 years and predictors of death were evaluated using the Cox proportional hazard model. Results: A total of 1,079 first-ever IS patients were included. Survival data were complete for over 99% of patients. Cumulative mortality rates were 9.9% at 1 month and 31.1% at 3 years. Of the survivors at 1 month, 23.5% did not survive for 3 years. At 1 month, the hazard ratio (HR) for death significantly increased with stroke severity. One-month mortality was also associated with a decreased level of consciousness (HR 2.9, 95% CI 1.7-5.1), total anterior circulation infarction (TACI); HR 4.9, 95% CI 1.6-15.2), temperature on admission (HR 1.5, 95% CI 1.1-2.1 per 1°C), age (HR 1.04, 95% CI 1.02-1.07 per year) and glucose levels on admission (HR 1.003, 95% CI 1.001-1.006 per 1 mg/dl). Age-adjusted proportions of diabetes and chronic heart failure were considerably higher in the deceased compared with survivors at 3 years (48 vs. 38 and 21 vs. 9%, respectively). In the multivariate survival analyses, predictors of death at 1 month also predicted death at 3 years; however, history of dementia (HR 1.5, 95% CI 1.0-2.4), diabetes (HR 1.6, 95% CI 1.0-2.4), peripheral artery disease (HR 1.7, 95% CI 1.1-2.8), chronic heart failure (HR 1.6, 95% CI 1.1-2.4) and malignancy (HR 1.7, 95% CI 1.1-2.7) were additional predictors of long-term mortality for patients surviving the first month after stroke. Conclusions: Approximately one third of patients did not survive 3 years after the first-ever IS. While age and markers of severe stroke were the major predictors of death at 1 month, comorbidities and variables associated with atherosclerotic vascular disease predicted long-term mortality. Improved control of these factors can potentially reduce long-term mortality in stroke victims. Copyright © 2009 S. Karger AG.
Mathew S.,Stroke Unit |
Pandian J.D.,Stroke Unit
Journal of Stroke and Cerebrovascular Diseases | Year: 2010
Background: Central nervous system infections are one of the common causes of stroke in developing countries. Stroke after dengue is uncommon. Case Reports: A total of 1148 dengue cases were seen in a tertiary referral hospital during the epidemic from September to November 2008. We present 3 patients who had stroke caused by dengue. The first patient was a 45-year-old woman with dengue hemorrhagic fever who developed sudden right arm and leg weakness. Magnetic resonance imaging (MRI) revealed multiple hemorrhagic foci in the left parietal and temporal lobes. The second patient was a 35-year-old man who developed fever that was followed by altered sensorium and quadriparesis. MRI showed bilateral cerebellar hemorrhages with edema, obstructive hydrocephalus, and multiple watershed infarcts. The third patient was a 70-year-old woman who presented with giddiness for 2 days followed by sudden weakness of the left side of the body. She developed fever after admission. MRI showed infarct in the right parietal lobe. All the patients had low platelet count and one patient died. Conclusions: Dengue might be an important cause of stroke in epidemic regions when patients present with fever, focal neurologic deficits, and encephalopathy. © 2010 National Stroke Association.
Raju R.S.,Stroke Unit |
Sarma P.S.,Sree Chitra Tirunal Institute for Medical Science and Technology |
Pandian J.D.,Stroke Unit
Stroke | Year: 2010
Background and Purpose- Data regarding psychosocial problems and quality of life (QoL) among stroke survivors from developing countries are scarce. The purpose of this study is to examine QoL, anxiety, depression, and functional independence of stroke survivors and the relationship of these variables with stroke characteristics. Methods- This was a prospective hospital-based study. Patients were interviewed after ≥1 month post stroke. World Health Organization QoL-BREF was used to assess QoL. Anxiety and depression measures were recorded using the Hospital Anxiety Depression Scale, and functional independence was evaluated using the Functional Independence Measure. Demography, stroke severity (measured by the National Institute of Health Stroke Scale), and stroke outcome (measured by the modified Rankin scale) were also documented. Univariate and multivariate analysis were completed using SPSS Statistics version 17.0 (SPSS, Inc, Chicago, Ill). Results- One hundred sixty-two patients participated (men=113, 69.8%); mean age was 54.3±12.9 years (range, 21-88 years). The mean duration of follow-up was 18.3 ±24.9 months (range, 1-180 months), and the mean National Institute of Health Stroke Scale score was 2.1±2.1 (range, 0-10). Presence of anxiety (odds ratio [OR] 0.20, CI 0.80-0.51, P=0.001), depression (OR 0.22, CI 0.10 to 0.47, P<0.0001), and functional dependence in Functional Independence Measure (OR 3.56, CI 1.70 to 7.42, P=0.001) were predictors of impaired QoL in the multivariate logistic regression analysis. Anxiety was seen in 39 patients (24%), and 60 patients (37%) had depression. Poor outcome predicted depression in logistic regression model (OR 4.40, CI 1.80 to 10.76, P=0.001). Functionally dependent patients were more likely to be older (OR 0.94, CI 0.92 to 0.97, P=0.001) and had severe stroke (OR 0.69, CI 0.53 to 0.88, P=0.004). Conclusion- Presence of anxiety, depression, and functional dependence were associated with impaired QoL. There was low prevalence of anxiety and depression. Older age and stroke severity resulted in increased functional dependence. © 2010 American Heart Association, Inc.
Censori B.,Stroke Unit
Expert Review of Neurotherapeutics | Year: 2014
Dual antiplatelet therapy with aspirin plus clopidogrel is not recommended for secondary stroke prevention because of lack of effectiveness and increased hemorrhagic risk. Recent studies show that in patients with a very recent transient ischemic attack or minor ischemic stroke loading with 300 mg clopidogrel plus aspirin, followed by clopidogrel 75 mg plus aspirin once daily for up to 90 days significantly decreases the rate of recurrent stroke, especially strokes that occur within few days from the event that led to medical attention, without an increase in severe bleedings. This article reviews the pharmacokinetics and pharmacodynamics of clopidogrel, focusing on loading doses, and summarizes the results of the studies that have shown the effectiveness of the front-loading approach in the early secondary prevention of stroke. © Informa UK, Ltd.