Asian countries are in various stages of epidemiological transition and therefore exhibit a great diversity in disease patterns. Collectively, they comprise almost two-third of the world's total ...mortality due to stroke. The purpose of this review is to explore existing epidemiological data on stroke, highlight the temporal trends in stroke epidemiology in various regions of Asia and predict future patterns based on these observations. Our search revealed that there is a lack of good epidemiological data from most Asian countries. Whatever data exist are not comparable due to lack of standardised methodology for ascertaining stroke and its subtypes. For this and other reasons, these estimates exhibit country-to-country variation and also within-country variability. We have also reviewed temporal trends in stroke incidence and prevalence in 12 Asian countries and the evolution of stroke subtypes over the past two decades. Important observations include a rise in stroke incidence in most Asian countries, an earlier age at onset compared with the West, a relative increase in the proportion of ischaemic strokes and a decline in haemorrhagic strokes. Among ischaemic stroke subtypes, lacunar strokes, which were once the commonest variety, are now declining. Emerging data suggest that large artery atherosclerosis and in particular that of intracranial vessels is the predominant aetiology in most Asian countries. The review also identified important gender differences in terms of stroke risk factors, prevalence and outcomes. There is need for sound epidemiological data from most countries to understand the disease better and plan policy-level interventions to decrease the burden. We identify a need for standard format or guidelines for conducting stroke epidemiological studies especially in developing Asian countries. This region must be identified as a priority region for stroke-related interventions and preventive strategies by global healthcare authorities and organisations.
Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes ...differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes.
Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as compared to women overall, the long- and short-term outcomes in Asian women tend to be poorer. Both conventional and gender-specific risk factors contribute to stroke risk. Oral contraceptive use and addictions such as tobacco and alcohol are less prevalent among Asian women due to socio cultural differences. There is however, a much higher preponderance of pregnancy-related stroke and cardio-embolic stroke secondary to rheumatic heart disease and heavy use of chewing tobacco. The overall outcome is poor due to poor access to health care and lack of resources. Key Messages: Our review exposed the gaps in our knowledge about stroke risk factors and differences in stroke care provided to Asian women. While there are sociocultural barriers that impede the provision of immediate care to these stroke patients, much needs to be done by way of prevention of recurrent stroke and treatment of risk factors.
The human prion diseases, or transmissible spongiform encephalopathies, have captivated our imaginations since their discovery in the Fore linguistic group in Papua New Guinea in the 1950s. The ...mysterious and poorly understood "infectious protein" has become somewhat of a household name in many regions across the globe. From bovine spongiform encephalopathy (BSE), commonly identified as mad cow disease, to endocannibalism, media outlets have capitalized on these devastatingly fatal neurological conditions. Interestingly, since their discovery, there have been more than 492 incidents of iatrogenic transmission of prion diseases, largely resulting from prion-contaminated growth hormone and dura mater grafts. Although fewer than 9 cases of probable iatrogenic neurosurgical cases of Creutzfeldt-Jakob disease (CJD) have been reported worldwide, the likelihood of some missed cases and the potential for prion transmission by neurosurgery create considerable concern. Laboratory studies indicate that standard decontamination and sterilization procedures may be insufficient to completely remove infectivity from prion-contaminated instruments. In this unfortunate event, the instruments may transmit the prion disease to others. Much caution therefore should be taken in the absence of strong evidence against the presence of a prion disease in a neurosurgical patient. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have devised risk assessment and decontamination protocols for the prevention of iatrogenic transmission of the prion diseases, incidents of possible exposure to prions have unfortunately occurred in the United States. In this article, the authors outline the historical discoveries that led from kuru to the identification and isolation of the pathological prion proteins in addition to providing a brief description of human prion diseases and iatrogenic forms of CJD, a brief history of prion disease nosocomial transmission, and a summary of the CDC and WHO guidelines for prevention of prion disease transmission and decontamination of prion-contaminated neurosurgical instruments.
In 1995, the NINDS (National Institute of Neurological Disorders and Stroke) tPA (tissue plasminogen activator) Stroke Study Group published the results of a large multicenter clinical trial ...demonstrating efficacy of intravenous tPA by revealing a 30% relative risk reduction (absolute risk reduction 11%-15%) compared with placebo at 90 days in the likelihood of having minimal or no disability. Since approval in 1996, tPA remains the only drug treatment for acute ischemic stroke approved by the US Food and Drug Administration. Over the years, an abundance of research and clinical data has supported the safe and efficacious use of intravenous tPA in all eligible patients. Despite such supporting data, it remains substantially underutilized. Challenges to the utilization of tPA include narrow eligibility and treatment windows, risk of symptomatic intracerebral hemorrhage, perceived lack of efficacy in certain high-risk subgroups, and a limited pool of neurological and stroke expertise in the community. With recent US census data suggesting annual stroke incidence will more than double by 2050, better education and consensus among both the medical and lay public are necessary to optimize the use of tPA for all eligible stroke patients. Ongoing and future research should continue to improve upon the efficacy of tPA through more rapid stroke diagnosis and treatment, refinement of advanced neuroimaging and stroke biomarkers, and successful demonstration of alternative means of reperfusion.
Background To determine how intravenous thrombolysis (IV‐tPA) and mechanical thrombectomy (MT) use has changed in patients with acute ischemic stroke (AIS) with cancer (AIS‐C) compared with patients ...with AIS and noncancer (AIS‐NC) in the United States since publication of pivotal MT trials. Methods All primary AIS‐NC and AIS‐C admissions (weighted N=5 748 357) were identified from the 2007 to 2019 Nationwide Inpatient Sample. Joinpoint and multivariable‐adjusted models with interaction terms were used to compare the rate of change in IV‐tPA and MT use between AIS‐C and AIS‐NC. Results From 2007 to 2019, 4.4% of AIS admissions had active cancer. Overall IV‐tPA use in AIS‐C (6.4%) was lower than that of AIS‐NC (8.5%) ( P <0.001) but use differed by cancer subtype (hematologic, 7.2%; metastatic, 4.2%). IV‐tPA use increased over time in all cancers, but analysis of status‐by‐time interaction revealed that the pace of increase was slower in metastatic compared with AIS‐NC admissions (rate ratio, 0.98; P =0.015) per year. In contrast, MT use in AIS‐C (2.2%) was greater than that of AIS‐NC (1.9%), but use was highest in metastatic (2.5%) and lowest in hematologic cancers (1.6%) ( P values for all pairwise comparisons <0.001). MT use increased at a faster pace in metastatic AIS‐C (rate ratio, 1.06; P =0.001)/year compared with AIS‐NC. In‐hospital all‐cause mortality in AIS‐NC was 4.2% compared with 8.2% in AIS‐C ( P <0.001). Mortality declined over time in all cancer groups, but the pace of decline was faster in solid and metastatic AIS‐C compared with AIS‐NC ( P values <0.01). Conclusions Use of IV‐tPA and MT has increased in AIS‐C over the past decade. Contrary to prior studies, the current frequency and pace of increase in MT use is greater in metastatic AIS‐C compared with AIS‐NC. Future studies are needed to determine whether AIS‐C are more predisposed to large‐vessel occlusion.
Amyloid angiopathy-associated intracerebral hemorrhage (ICH) comprises 12%-15% of lobar ICH in the elderly. This growing population has an increasing incidence of thrombolysis-related hemorrhages, ...causing the management of hemorrhages associated with cerebral amyloid angiopathy (CAA) to take center stage. A concise reference assimilating the pathology and management of this clinical entity does not exist. Amyloid angiopathy-associated hemorrhages are most often solitary, but the natural history often progresses to include multifocal and recurrent hemorrhages. Compared with other causes of ICH, patients with CAA-associated hemorrhages have a lower mortality rate but an increased risk of recurrence. Unlike hypertensive arteriolar hemorrhages that occur in penetrating subcortical vessels, CAA-associated hemorrhages are superficial in location due to preferential involvement of vessels in the cerebral cortex and meninges. This feature makes CAA-associated hemorrhages easier to access surgically. In this paper, the authors discuss 3 postulates regarding the pathogenesis of amyloid hemorrhages, as well as the established clinicopathological classification of amyloid angiopathy and CAA-associated ICH. Common inheritance patterns of familial CAA with hemorrhagic strokes are discussed along with the role of genetic screening in relatives of patients with CAA. The radiological characteristics of CAA are described with specific attention to CAA-associated microhemorrhages. The detection of these microhemorrhages may have important clinical implications on the administration of anticoagulation and antiplatelet therapy in patients with probable CAA. Poor patient outcome in CAA-associated ICH is associated with dementia, increasing age, hematoma volume and location, initial Glasgow Coma Scale score, and intraventricular extension. The surgical management strategies for amyloid hemorrhages are discussed with a review of published surgical case series and their outcomes with a special attention to postoperative hemorrhage.
Characteristics of Wake-up Stroke Tanimoto, Aki, BA; Mehndiratta, Prachi, MBBS, MD; Koo, Brian B., MD
Journal of stroke and cerebrovascular diseases,
07/2014, Letnik:
23, Številka:
6
Journal Article
Recenzirano
Background Wake-up stroke (WUS) accounts for up to 29.6% of ischemic strokes, but its mechanisms are poorly understood. The purpose of this study is to identify risk factors and characteristics of ...WUS. Methods Seven-two ischemic strokes were classified as WUS or non-WUS. Collected were demographic information, medical history, cholesterol profile, and stroke characteristics including severity (National Institutes of Health Stroke Scale NIHSS) and mechanism (Trial of Org 10172 in Acute Stroke Treatment criteria). Subjects completed questionnaires screening for sleep apnea (Berlin questionnaire) and assessing sleep characteristics. Results There were 72 ischemic strokes, of which 28 WUS (38.9%). WUS and non-WUS patients were similar in regard to stroke risk factors. WUS patients tended to be African American and were significantly younger. WUS was significantly more likely to result from small-vessel disease mechanism (42.9% versus 14.0%; P = .006) and tended to be less severe WUS (NIHSS score 3 1, 4 versus 4 2, 11; P = .13) than non-WUS. Groups did not differ in regard to scoring positively on the Berlin questionnaire, but WUS sufferers were more likely to snore frequently (90.5% versus 70.0%, P = .08). The lipid profile was significantly worse in WUS compared with non-WUS (low-density lipoprotein 124.6 ± 38.4 versus 103.7 ± 36.8; P = .03; cholesterol to high-density lipoprotein ratio 5.2 ± 1.6 versus 4.3 ± 1.6; P = .02). Conclusions WUS is more likely to result from small-vessel disease mechanism. Poorer cholesterol profile and frequent snoring may contribute to WUS.
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