MOTIVATION: The association between weather conditions and stroke incidence has been a subject of interest for several years, yet the findings from various studies remain inconsistent. Additionally, predictive modelling in this context has been infrequent. This study explores the relationship of extremely high ischaemic stroke incidence and meteorological factors within the Slovak population. Furthermore, it aims to construct forecasting models of extremely high number of strokes. METHODS: Over a five-year period, a total of 52,036 cases of ischemic stroke were documented. Days exhibiting a notable surge in ischemic stroke occurrences (surpassing the 90th percentile of historical records) were identified as extreme cases. These cases were then scrutinized alongside daily meteorological parameters spanning from 2015 to 2019. To create forecasts for the occurrence of these extreme cases one day in advance, three distinct methods were employed: Logistic regression, Random Forest for Time Series, and Croston's method. RESULTS: For each of the analyzed stroke centers, the cross-correlations between instances of extremely high stroke numbers and meteorological factors yielded negligible results. Predictive performance achieved by forecasts generated through multivariate logistic regression and Random Forest for time series analysis, which incorporated meteorological data, was on par with that of Croston's method. Notably, Croston's method relies solely on the stroke time series data. All three forecasting methods exhibited limited predictive accuracy. CONCLUSIONS: The task of predicting days characterized by an exceptionally high number of strokes proved to be challenging across all three explored methods. The inclusion of meteorological parameters did not yield substantive improvements in forecasting accuracy.
- MeSH
- incidence MeSH
- ischemická cévní mozková příhoda * epidemiologie MeSH
- lidé MeSH
- logistické modely MeSH
- meteorologické pojmy MeSH
- počasí * MeSH
- předpověď * metody MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Slovenská republika MeSH
BACKGROUND: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled. METHODS: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied. RESULTS: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48-65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4-22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3-85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4-18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9-4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49-7.88, p = 0.004) stroke were associated with increased 1-year mortality. CONCLUSIONS: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.
- MeSH
- cévní mozková příhoda etiologie epidemiologie MeSH
- hemoragická cévní mozková příhoda etiologie epidemiologie MeSH
- incidence MeSH
- ischemická cévní mozková příhoda etiologie epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- podpůrné srdeční systémy * škodlivé účinky MeSH
- registrace * MeSH
- retrospektivní studie MeSH
- senioři MeSH
- srdeční selhání terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications.
- MeSH
- aneurysma hrudní aorty * chirurgie mortalita MeSH
- disekce aorty * chirurgie mortalita MeSH
- hemoragická cévní mozková příhoda epidemiologie MeSH
- ischemická cévní mozková příhoda * epidemiologie MeSH
- ischemie mozku etiologie epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití trendy MeSH
- mortalita v nemocnicích * trendy MeSH
- pooperační komplikace * epidemiologie MeSH
- prognóza MeSH
- registrace * MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND AND OBJECTIVES: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION: The study was registered under ClinicalTrials.gov identifier NCT04895462.
- MeSH
- cerebrální krvácení komplikace MeSH
- cévní mozková příhoda * epidemiologie terapie diagnóza MeSH
- COVID-19 * komplikace MeSH
- endovaskulární výkony * škodlivé účinky MeSH
- fibrinolytika terapeutické užití MeSH
- intrakraniální krvácení etiologie MeSH
- ischemická cévní mozková příhoda * epidemiologie chirurgie MeSH
- ischemie mozku * komplikace epidemiologie chirurgie MeSH
- kohortové studie MeSH
- lidé MeSH
- registrace MeSH
- trombolytická terapie škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
INTRODUCTION: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. PATIENTS AND METHODS: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. RESULTS: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90-4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63-26.43) per 100,000 and 17.14% (95% CI: 12.98-21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96-9.77) per 100,000 and 6.91% (95% CI: 5.15-8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. CONCLUSION: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.
BACKGROUND: There are few contemporary epidemiological data on stroke for Central Europe. We performed a population-based study evaluating the incidence of stroke, stroke types, and ischemic stroke (IS) subtypes in Brno, the second biggest city in the Czech Republic (CR). METHODS: Using the National Registry of Hospitalized Patients, and hospital databases, we identified all patients hospitalized with a stroke diagnosis in Brno hospitals in 2011. For Brno residents with validated stroke diagnosis, we calculated (a) the overall incidence of hospitalized stroke, (b) incidence rates for IS, subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), and (c) incidence rates for IS subtypes. We calculated the average annual age- and sex-standardized incidence (European Standard Population and World Health Organization), to compare our results with other studies. RESULTS: The overall crude incidence of stroke in Brno was 213/100,000 population. The incidence of stroke for stroke types were as follows: SAH, 6.9; ICH, 26.4; and IS, 180 cases per 100,000 population, respectively. The WHO-standardized annual stroke incidence was 107 for all strokes and 88 for IS, 14.4 for ICH, and 5 for SAH. For IS subtypes, the WHO-standardized incidence was large artery atherosclerosis 25.8, cardioembolism 27.8, lacunar 21.6, other determined etiology 6.2, and undetermined etiology 6.5 cases per 100,000 population. CONCLUSIONS: The stroke incidence is lower than that previously reported for the CR and Eastern Europe probably reflecting socioeconomic changes in post-communistic countries in the region. These findings could contribute to stroke prevention strategies and influence health policies.
- MeSH
- cerebrální krvácení diagnóza epidemiologie MeSH
- databáze faktografické MeSH
- dítě MeSH
- dospělí MeSH
- embolická cévní mozková příhoda diagnóza epidemiologie MeSH
- hemoragická cévní mozková příhoda diagnóza epidemiologie MeSH
- incidence MeSH
- ischemická cévní mozková příhoda diagnóza epidemiologie MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- registrace MeSH
- rozložení podle pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- subarachnoidální krvácení diagnóza epidemiologie MeSH
- věkové rozložení MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: To describe sex differences in the presentation, diagnosis, and revision of diagnosis after early brain MRI in patients who present with acute transient or minor neurologic events. METHODS: We performed a secondary analysis of a prospective multicenter cohort study of patients referred to neurology between 2010 and 2016 with a possible cerebrovascular event and evaluated with brain MRI within 8 days of symptom onset. Investigators documented the characteristics of the event, initial diagnosis, and final diagnosis. We used multivariable logistic regression analyses to evaluate the association between sex and outcomes. RESULTS: Among 1,028 patients (51% women, median age 63 years), more women than men reported headaches and fewer reported chest pain, but there were no sex differences in other accompanying symptoms. Women were more likely than men to be initially diagnosed with stroke mimic (54% of women vs 42% of men, adjusted odds ratio (OR) 1.60, 95% confidence interval [CI] 1.24-2.07), and women were overall less likely to have ischemia on MRI (10% vs 17%, OR 0.52, 95% CI 0.36-0.76). Among 496 patients initially diagnosed with mimic, women were less likely than men to have their diagnosis revised to minor stroke or TIA (13% vs 20%, OR 0.53, 95% CI 0.32-0.88) but were equally likely to have acute ischemia on MRI (5% vs 8%, OR 0.56, 95% CI 0.26-1.21). CONCLUSIONS: Stroke mimic was more frequently diagnosed in women than men, but diagnostic revisions were common in both. Early brain MRI is a useful addition to clinical evaluation in diagnosing transient or minor neurologic events.
- MeSH
- chybná diagnóza * MeSH
- diabetes mellitus epidemiologie MeSH
- diferenciální diagnóza * MeSH
- difuzní magnetická rezonance MeSH
- hyperlipidemie epidemiologie MeSH
- hypertenze epidemiologie MeSH
- ischemická cévní mozková příhoda diagnostické zobrazování epidemiologie patofyziologie MeSH
- ischemická choroba srdeční epidemiologie MeSH
- ischemie mozku diagnostické zobrazování epidemiologie patofyziologie MeSH
- kohortové studie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- magnetická rezonanční tomografie MeSH
- migréna diagnóza epidemiologie MeSH
- mozek diagnostické zobrazování MeSH
- multivariační analýza MeSH
- prospektivní studie MeSH
- psychický stres epidemiologie MeSH
- senioři MeSH
- sexuální faktory MeSH
- somatoformní poruchy diagnóza MeSH
- stupeň závažnosti nemoci MeSH
- tranzitorní ischemická ataka diagnostické zobrazování epidemiologie patofyziologie MeSH
- úzkostné poruchy diagnóza MeSH
- vestibulární nemoci diagnóza MeSH
- záchvaty diagnóza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
Nestr.
In the proposed prospective study, 120-150 consecutive ischemic stroke (IS) patients under 50 years will undergo a study protocol involving: 1) epidemiological questionnaire (demographic and life style characteristics, relevant epidemiologic, social and economic parameters, traditional risk factors), 2) comprehensive, extensive and detailed diagnostics of cause of IS including transoesofageal echocardiography focused on “low-risk” structural and functional heart abnormities, 24h and 3week ECG Holter monitoring, laboratory assessment of specific cardio-markers, 3) 24hour home blood pressure Holter monitoring to exclude masked arterial hypertension and 4) follow-up clinical controls. The achieved data will allow establish frequency and spectrum of investigated parameters and risk factors in this affected population and assess possible relationship to investigated causes of IS. The results of proposed project may have impact on primary and secondary prevention of cerebrovascular events and may lead to a significant reduction of recurrent IS and first-ever IS.
V rámci navrhovaného projektu bude zařazeno 120-150 konsekutivních pacientů s akutní ischemickou cévní mozkovou příhodou (iCMP) do 50 let, kteří podstoupí následující studijní protokol: 1) epidemiologický dotazník (demografické, relevantní epidemiologické, sociální a ekonomické parametry, tradiční rizikové faktory a charakteristiky životního stylu), 2) komplexní, extenzivní a detailní diagnostika příčiny iCMP zahrnující jícnovou echokardiografii zaměřenou na“low-risk” strukturální a funkční srdeční abnormality, 24h a 3týdenní EKG Holter monitoring, laboratorní stanovení specifických srdečních markerů, 3) 24h domácí tlakový Holter monitoring k vyloučení maskované arteriální hypertenze a 4) následující klinické sledování. Získaná data umožní stanovit frekvenci a spektrum vyšetřovaných parametrů a rizikových faktorů a jejich možný vztah ke zjištěným příčinám iCMP. Výsledky projekty mohou mít dopad na primární a sekundární prevenci iCMP, což může vést k významné redukci recidiv iCMP a incidenci iCMP jako takové.
- MeSH
- dospělí MeSH
- ischemická cévní mozková příhoda diagnóza epidemiologie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- socioekonomické faktory MeSH
- věkové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- angiologie
- neurologie
- epidemiologie
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
Přes pokroky v primární i sekundární prevenci zůstávají cévní mozkové příhody (CMP) jednou z nejčastějších příčin morbidity a mortality. Etiologie ischemických cévních mozkových příhod (iCMP) je heterogenní. V rámci sekundární prevence se snažíme o její objasnění a následnou cílenou terapii. Přibližně u 30 % iCMP se nedaří etiologii objasnit. Nově rozlišujeme skupinu pacientů s cévní mozkovou příhodou z nejasného zdroje (embolicstrokeofundetermined source, ESUS), pro kterou se hledá optimální diagnostický a terapeutický postup. Papilární fibroelastom (PFE) je vzácný srdeční tumor, který patří mezi raritní příčiny kardioembolizačníchischemických CMP (iCMP), a může být diagnostikovaný již při transtorakálním echokardiografickém vyšetření (TTE). V tomto sdělení prezentujeme kazuistiku pacienta s PFE komplikovaným iCMP.
Despite recent advances in primary and secondary prevention, ischemic stroke remains one of the leading causes of morbidity and mortality in western countries. The etiology of ischemic stroke is heterogenous. Unravelling the causality of ischemic stroke enables subsequent targeted therapy as part of secondary prevention. However, in 30% of all cases, the etiology of ischemic stroke remains unclear. Embolic stroke of undetermined source (ESUS) has been recently proposed as a new entity, for which the optimal diagnostic and therapeutic algorithm needs to be defined. Papillary fibroelastoma is an uncommon heart tumor and a rare cause of embolic stroke. Here we present a case of papillary fibroelastoma complicated by ischemic stroke.
- Klíčová slova
- embolizační potenciál,
- MeSH
- aortální chlopeň chirurgie diagnostické zobrazování patologie MeSH
- diferenciální diagnóza MeSH
- echokardiografie transezofageální MeSH
- histologické techniky MeSH
- infarkt arteria cerebri media chirurgie etiologie MeSH
- ischemická cévní mozková příhoda * chirurgie diagnóza epidemiologie etiologie klasifikace MeSH
- koronární angiografie MeSH
- koronární cévy chirurgie MeSH
- lidé MeSH
- papilární fibroelastom srdce * chirurgie diagnostické zobrazování epidemiologie komplikace patologie MeSH
- paréza etiologie MeSH
- senioři MeSH
- stenóza chirurgie diagnostické zobrazování patologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
