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‘Stroke’ May 2011

‘Stroke’ May 2011. Dr. Amer Jafar. Genetics of Lacunar Stroke. Previous studies showed that a positive family history of stroke (FHstroke) is an independent risk factor for lacunar stroke

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‘Stroke’ May 2011

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  1. ‘Stroke’ May 2011 Dr. Amer Jafar

  2. Genetics of Lacunar Stroke Previous studies showed thata positive family history of stroke (FHstroke) is an independentrisk factor for lacunar stroke The aim of the present study was to determinewhether familial aggregation of stroke was different for lacunarstroke phenotypes

  3. Stroke Family History • In 157 patients with a first-ever lacunar stroke, a completefirst-degree FHstroke was obtained by a standardized questionnaireand additional interview • Fifty-two percent of patients reported a positive FHstroke inat least one of their first-degree relatives • A family history of stroke might be an independent risk factorfor the lacunar stroke phenotype with aLACs at younger ages,suggesting a role for genetic factors in this phenotype causedby diffuse vasculopathy

  4. Immunodepression syndrome • High infection rate after severe stroke may partly relate tobrain-induced immunodepression syndrome • Aim:  to investigate the role of autonomic shift in increasedsusceptibility to infection after acute intracerebralhemorrhage(ICH) • The authors retrospectively analyzed 62 selected patients with acuteICH from a prospective database • Autonomic shift was assessedusing the cross-correlationalbaroreflex sensitivity (BRS)

  5. Infections and Brain Haemorrhage They identified 36 (58%) patients with infection during the first5 days of hospital stay Patients with infections had significantlylower BRS, higher initial NIHSS scores, larger haemorrhages,and more frequently had intraventricular blood extension andunderwent invasive procedures

  6. Autonomic shift Conclusion: Decreased BRS was independently associated with infections afterICH Autonomic shift may play an important role in increasedsusceptibility to infections after acute brain injury includingICH

  7. Helicopter transport and the tPA • This austrian study addresses the value of helicopter transportcompared with other means of transportation to a stroke unitand compares their rates of thrombolysis on a nationwide basis • Prospective data collection: 2 stroke units between 2003 and 2009 were used • Results: Of 21 712 ischaemic stroke patients, 905 patients (4.1%) weretransported by helicopter

  8. Results and conclusions • Of these, 752 patients (3.4%) weretransported by direct HEMS, and 153 patients (0.7%) were transportedby indirect HEMS • Thrombolysis rates were highest for HEMS (24%direct, 29% indirect) • Conclusion: The shortest hospital arrival times and highest thrombolysisrates were seen in ischaemic stroke patients transported by helicopter.

  9. Statin Treatment and Functional Outcome • Multiple studies suggest that statin use before acute ischaemicstroke is associated with improved functional outcome • The authors performed a systematic literature search and meta-analysisof studies investigating the association between prestrokestatinuse and clinical outcome • Results: Meta-analysis of all available data identified an associationbetween prestrokestatin use and improved functional outcome

  10. Interpretation Larger positive effects for small vessel strokes comparedwith other subtypes However, evidence of publication bias in the existing literaturesuggests these findings should be interpreted with caution

  11. Botulinum Toxin for the Upper Limb After Stroke • BoTULS trial • Botulinum toxin is increasingly used to treat upper limb spasticitydue to stroke, but its impact on arm function is unclear • The researchersevaluated botulinum toxin for upper limb spasticity and functionpoststroke • Three hundred thirty-three patients with stroke with upper limbspasticity and reduced arm function participated in a multicenterrandomized controlled trial

  12. The details • The intervention group receivedbotulinum toxin type A injection(s) plus a 4-week therapy program • The control group received the therapy program alone • The primary outcome was upper limb function at 1 month (ActionResearch Arm Test). Secondary outcomes included measures ofimpairment, activity limitation, and pain at 1, 3, and 12 months

  13. The results • Results: There was no significant difference in achievement of improvedarm function (Action Research Arm Test) at 1 month • Significant differences in favor of the intervention group wereseen in muscle tone at 1 month; upper limb strength at 3 months;basic arm functional tasks (hand hygiene, facilitation of dressing)at 1, 3, and 12 months; and pain at 12 months

  14. BotulinumToxin:Improves pain Botulinum toxin type A is unlikely to be useful for improvingactive upper limb function (eg, reaching and grasping) in themajority of patients with spasticity after stroke, but it mayimprove basic upper limb tasks (hand hygiene, facilitation ofdressing) and pain.

  15. Review articles Early Prediction of Outcome of Activities of Daily Living After Stroke Risk and Cumulative Risk of Stroke Recurrence Translational Stroke Research of the Combination of Thrombolysis and Antioxidant Therapy

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