Dr. Amer Jafar

Alcohol consumption and strokePrevious research suggests that regular heavy

alcohol consumption increases the risk for ischaemic stroke

The risk of ischaemic stroke associated with transient exposure to alcohol remains unclear

This is a case–crossover study: to test the hypothesis that alcohol consumption affects the acute risk of ischaemic stroke, to determine the length of time between alcohol intake and the onset of symptoms (induction time), and to examine whether the risk varies by the type of alcohol.

Of the 390 patients, 248 (64%) reported alcohol consumption in the prior year, 104 within 24 hours and 14 within 1 hour of stroke onset

Conclusion: The risk of stroke onset is transiently elevated in the hour after alcohol ingestion

NSAID AND RISK OF STROKEThis study is aiming to evaluate the risk of

ischaemic and haemorrhagic stroke associated with short-term use of selective and nonselective NSAIDs in a Chinese population with a high incidence of stroke

A retrospective case–crossover study was

conducted by analyzing the Taiwan National Health Insurance Database

A pharmacy prescription database was searched for NSAID use during the case and control periods

The study concluded that: Use of selective and nonselective NSAIDs was associated with an increased risk of both ischemic and hemorrhagic stroke, strikingly high for parenteral ketorolac

Treating Carotid stenosis in womenGender differences in carotid endarterectomy

(CEA) rates after transient ischemic attack are not well studied

This study retrospectively identified all patients diagnosed with transient ischemic attack and 70% carotid stenosis on ultrasound in 2003 to 2004 from 19 emergency departments

Of 299 patients identified, 47% were womenWomen were older with higher presenting

systolic blood pressure and less likely to smoke or to have coronary artery disease or diabetes

This study concluded that: Women with severe carotid stenosis and recent transient ischaemic attack are less likely to undergo CEA than men, and surgeries are more delayed.

NOMASS STUDYThe Northern Manhattan Stroke StudyThis study is aiming to determine whether

depressed mood acutely after stroke predicts subsequent disability and mortality

Participants were asked about depressed mood within 7 to 10 days after stroke

The were followed every 6 months the first 2 years and yearly thereafter for 5 years for death and disability measured by the Barthel

Index

A question about depressed mood within 7 to 10 days after stroke was asked in 340 of 655 patients with ischemic stroke enrolled, and 139 reported that they felt depressed

The study concluded that: Depressed mood after stroke is associated with disability but not mortality after stroke. Early screening

and intervention for mood disorders after stroke may improve outcomes and requires further research.

Cerebral Vein ThrombosisAfter cerebral vein and dural sinus

thrombosis (CVT), there is an increased risk of further venous thromboembolic events (VTEs)

The research team used the International Study on Cerebral Vein and Dural sinus Thrombosis, which included 624 patients with

CVT followed up for a median of 13.9 months Of the 624 included patients, 36 (5.8%) had

at least 1 venous thromboembolic event

Conclusions:

The risk of recurrence of CVT is low but is moderate for other VTEs. Recurrence of venous thrombosis after CVT is more frequent among men and in patients with polycythemia/thrombocythemia.

eGFR and strokeConsecutive patients with acute stroke

(N=378) subjected to MRI and serum creatinine determination were included in the study and prospectively followed-up up to 12 years

Of the patients, 71.2% had died during the follow-up, 152 (40.2%) had moderate (eGFR <60 mL/min/1.73 m2), and 226 (59.8%) had normal or mildly impaired eGFR (60 mL/min/1.73 m2 )

Of the patients, 108 (28.6%) had mild, 68 (18.0%) had moderate, and 202 (53.4%) had severe WMLs (White matter lesions)

Cerebral small vessel disease is closely

associated with kidney function in patients with acute stroke. Cerebral small vessel disease and kidney function are closely

associated predictors of poor poststroke survival

Microbleeds and the Risk of Recurrent Stroke

This study is about the risk of recurrent

cerebrovascular events in patients who had a transient ischaemic attack or ischaemic stroke and who had evidence of microbleeds on MRI

A prospective follow-up study was performed on hospitalized patients who were at least 50 years old with a transient ischemic attack or an ischaemic stroke

The presence and number of microbleeds were assessed on gradient echo MRI

Patients were followed up by phone every 6 months

End points were intracerebral hemorrhage, ischaemic stroke, and unclassified stroke

A total of 487 patients with a mean age of 72

years were followed up for a median of 2.2 years

Microbleeds were identified in 129 patients (25.6%)

Conclusions:In this European cohort, patients with

microbleeds who have had cerebral ischaemia have a higher risk of developing new ischaemic strokes than of intracerebral haemorrhage. Lobar microbleeds or combined lobar and deep microbleeds might be

independent predictors of recurrent stroke.

Spasticity After Ischaemic StrokeIn a prospective cohort study, 301

consecutive patients with clinical signs of central paresis due to a first-ever ischaemic stroke were examined in the acute stage and 6 months later

Spasticity was assessed on the Modified Ashworth Scale and defined as Modified Ashworth Scale >1 in any of the examined joints

Two hundred eleven patients (70.1%) were reassessed after 6 months

Of these, 42.6% (n=90) had developed spasticityA more severe degree of spasticity (Modified

Ashworth Scale 3) was observed in 15.6% of all patients

The prevalence of spasticity did not differ between upper and lower limbs, but in the upper limb muscles, higher degrees of spasticity (Modified

Ashworth Scale 3) were more frequently (18.9%) observed than in the lower limbs (5.5%)

Conclusions:Spasticity was present in 42.6% of patients

with initial central paresis Severe spasticity was relatively rare.

Predictors for the development of spasticity

were a severe degree of paresis and hemihypersthesia at stroke onset.

Guidelines for the Management of Spontaneous Intracerebral HaemorrhageIntracerebral haemorrhage is a serious

medical condition for which outcome can be impacted by early, aggressive care

The guidelines offer a framework for goal-directed treatment of the patient with intracerebral haemorrhage

Thrombolysis and complicationsThis is a single-center, retrospective analysis

of consecutive acute stroke patients treated with IV rt-PA between January 2006 and December 2008

Aim: to define the incidence of early

neurologic deterioration (4-point drop on the National Institutes of Health Stroke Scale within 72 hours) and its mechanism

Of 228 consecutive IV rt-PA–treated patients, 34 (15%) developed early neurologic deterioration, 18 (8%) secondary to incident strokes 10 (4.4%) due to SICH, and 6 (2.6%) due to early recurrent ischaemic events, which were significantly

associated with atrial fibrillation Conclusion: the incidence of early recurrent

ischaemic stroke after IV rt-PA was 2.6% and

was associated with previous atrial fibrillation.