Welcome to the WSC 2022 Interactive Program

Background and Aims

The impact of heart failure with reduced ejection fraction (HFrEF) on AIS patients undergoing mechanical thrombectomy (MT) has been evaluated. However, there is a paucity of large-scale data on the burden and impact of HFpEF (heart failure with preserved ejection fraction) on patients with AIS undergoing MT (AIS-MT).

Methods

We queried the National Inpatient Sample (2018) to identify adult AIS-MT admissions in patients with vs. without HFpEF (excluding HFrEF) with ICD-10 codes. Propensity score-matched analysis (1:1) was performed adjusting for sociodemographics to obtain HFpEF and non-HFpEF cohorts which were then compared for comorbidities and in-hospital outcomes.

Results

Of AIS-MT admissions, matched cohorts consisted of 1380 patients with HFpEF (66.3% female) vs. without HFpEF (71.0% female). Both demographically matched cohorts had patients with comparable age (78 years), racial groups (>70% white), and income quartiles. The HFpEF cohort demonstrated higher rates of hypertension, renal failure, AF, PVD, obesity, AF, prior VTE, valvular heart disease, COPD, coagulopathy, fluid-electrolyte disorders, deficiency anemias, drug abuse, other neurological disorders, and hypothyroidism (p<0.05). The HFpEF cohort showed higher mortality (14.5% vs 10.9%, p=0.004, adjusted OR 1.13, 95CI=0.40-3.22, p=0.816), higher rate of transfers to other care facilities (60.1% vs 59.1%) with a prolonged hospital stay (median 8 vs 6 days), and higher costs vs. non-HFpEF cohort.

Conclusions

In this propensity-matched analysis, HFpEF cohort in AIS-MT admissions showed higher rate and non-significantly higher odds of mortality when adjusted for confounders vs. non-HFpEF cohort. Future large-scale prospective studies are warranted to confirm these findings and evaluate the long-term outcomes of HFpEF.

Background and Aims

Acute ischemic stroke, the most common and disabling neurological disorders has a very variable outcome and data on the factors which influence are lacking in India.

Objectives : to study the impact of socioeconomic status on the incidence, mortality and outcome in acute ischemic stroke.

Methods

It is a prospective hospital based cohort study from August 2016 to October 2021

Inclusion criteria :

All adults between 45 to 70 years with Anterior circulation stroke of NIHSS 15 – 25 were enroled . Their socioeconomic status data using the Kuppu swamy scale were collected.

mRS - 9 Q was administered on day 10 of stroke and after 3 months.

Multivariate regression analysis was used to determine which variables were associated with poor outcome at three months .

Results

n= 1858

The incidence and mortality rates were high in the patients belonging to low socioeconomic strata;

Better improvements in mRS 9 scores were seen in patients belonging to upper middle and lower upper classes (63.3%) as compared to 25.2% in the higher strata

Education level did not correlate with overall quality of life, and cognitive and social functioning scores.

Need to go back for work , family support and counseling sessions were found to be the factors that brought good outcome in our patients.

Conclusions

Contrary to the available evidence, our patients with low socioeconomic status showed good improvements in mRS scores.

Large scale data are necessary to establish the correlation such that effective management strategies can be planned.

Background and Aims

Background: Subclinical abnormalities detected in surface electroencephalography (EEG) may be a useful predictor of functional outcomes in patients with ischemic stroke.

Aim: We aimed to assess the EEG findings in anterior circulation ischemic strokes and tried to correlate the findings with clinical outcomes on follow-up.

Methods

Methods: It was a hospital-based prospective longitudinal study including all consecutive first-ever ischemic strokes of anterior circulation. Hemorrhagic strokes, prior seizures, use of psychoactive drugs, severe metabolic dysfunction or encephalopathy, and intubated patients were excluded from the study. Clinical details were noted and EEG was done within 48 hours from the onset of stroke. Functional outcome was assessed by follow-up mRS and Barthel’s Index at 3 months.

Results

Results: A total of 65 patients with 65% males were recruited. 35(53.8%) involved the dominant hemisphere. Median admission NIHSS was 11(IQR 7-15). Hypertension (58.5%), diabetes (35.4%), and smoking (29.2%) were the most common risk factors. 29 (44.6%) were thrombolyzed and 2 underwent mechanical thrombectomy. Admission EEG was abnormal in 53 (81.5%). Background asymmetry was seen in 52 (80%) with 26 (40%) showing focal slowing, and 9 (13.8%) showing generalized slowing. Epileptiform potentials (EPs) were seen in 14 (52.3%) while periodic discharges occurred in 15 (23.1%). On univariate analysis, EPs (OR 2.69 (1.62-4.46)), generalized slowing (OR 1.66 (1.43-3.34)), and periodic discharges ((OR 1.32 (1.12- 1.58)) were significantly associated with poorer outcome mRS>3.

Conclusions

Conclusion: Subclinical EEG abnormalities are common in acute stroke. EPs, generalized slowing, and periodic discharges during admission EEG were associated with poorer functional outcomes at 90days.

Background and Aims

Red cell distribution width (RDW) measures variation in red blood cell size or volume and is said to be a prognostic marker in vascular diseases. Different studies have suggested that elevation of RDW in stroke is related to poor prognosis. Our aim is to estimate the importance of RDW in stroke outcome.

Methods

In this prospective study data is collected from patients admitted to Stroke Unit during the last three months of 2021. Complete blood count elements such as: red blood cells, Hemoglobin, Hematocrit and RDW from the first and the last day are compared. NIHSS is used to show the severity of stroke and a variable called Score Difference, calculated by subtracting the NIHSS in admission from NIHSS in the end of hospitalization, is used to show the prognosis of Stroke. Our study is still ongoing.

Results

183 patients are included in the study, 101 males and 82 females. The mean age was 67.29 years old with a standard deviation 11.64. Only 44.3% of patients were residents in Tirana. 76.5% had ischemic stroke. Among comorbidities, Diabetes Mellitus and age showed statistical significance. Considering the last RDW and Hematocrit measured, Multiple Linear Regression model showed that each unit increase of them, would lead to an increase with 4.080 and 3.040 units of NIHSS respectively, resulting in worsening of the patient.

Conclusions

RDW seems to be an important prognostic factor in severity, mortality and outcome of stroke patients, both ischemic and hemorrhagic; the higher the RDW, the more severe the stroke is.

Background and Aims

Stroke is all forms of brain or central nervous system disorders caused by blood flow disorders that cause acute symptoms and cause death and disability. The high rate of morbidity and mortality due to stroke, it is necessary to have a quick and precise examination in assessing the severity of stroke on the results of a head CT scan. Alberta Stroke Program Early CT Score (ASPECTS) is a method for assessing the severity of ischemic stroke which will be associated with the clinical outcome of acute ischemic stroke based on the National Institutes of Health Stroke Scale (NIHSS).

Methods

An analytical descriptive study with a cross sectional design in ischemic stroke patients since December 2020 on 76 research samples using a consecutive sampling technique. Each sample that met the inclusion criteria was assessed for ASPECTS and NIHSS clinical outcomes on the first and seventh days.

Results

A study of 76 samples showed high ASPECTS (63%), low ASPECTS (17.1%), NIHSS clinical outcomes improved (76%), persisted (13%) and worsened (11%). The relationship between these variables is statistically significant (p-value 0.025), OR = 6.6

Conclusions

There is a significant relationship between ASPECTS and the clinical outcome of acute ischemic stroke in the form of NIHSS

Background and Aims

Among ischemic strokes(IS),16-21% are embolic strokes from undetermined source(ESUS),with annual recurrence risk around 5%.Here we studied the predictors of recurrence risk and outcome in ischemic stroke patients with embolic stroke of undetermined sourceAmong ischemic strokes(IS),16-21% are embolic strokes from undetermined source(ESUS),with annual recurrence risk around 5%.Here we studied the predictors of recurrence risk and outcome in ischemic stroke patients with embolic stroke of undetermined source

Methods

Single centre retroprospective study of all IS patients over 18 years with a diagnosis of Cryptogenic Stroke satisfying the criteria for ESUS from 1/1/2017 till 31/12/2020 with 1 year completed follow-up were recruited. Clinical and risk factor profile, neuroimaging and cardiac parameters were compared between those with single versus recurrent strokes.

Results

234 people satisfying criteria for ESUS were included in the study.46 subjects had recurrent events at admission. Multiple embolic pattern was the commonest imaging finding(34.6%) ,followed by superficial watershed pattern(29.5%).Commonest ECG abnormality in our cohort was atrial ectopics followed by ventricular ectopics. 4.2% had mild left atrial enlargement. At 1 year follow-up, 22 patients had recurrent events. Bivariate analysis showed significant association between vascular risk factors-DM, hypertension, total cholesterol, CAD, imaging pattern of superficial watershed infarcts with recurrent events. However, only infarct pattern and CAD (p value=0.012 and 0.014 respectively) showed an independent association with recurrence risk on multivariate analysis.

Conclusions

Among patients with ESUS, co-existing CAD and neuroimaging parameters can help to predict the recurrence risk at 1 year. Risk factor control has a definite role in preventing recurrences in ESUS as well.

Background and Aims

Background: Cerebral small-vessel disease (CSVD) is associated with mood disturbances and impaired health-related quality of life (HRQOL). Data on HRQOL and mood in Cerebral amyloid angiopathy (CAA), a subtype of CSVD characterized by intracerebral haemorrhage and cognitive decline, are limited. We aim to estimate the prevalence and history of depression, and to asses value-based HRQOL and the impacted domains of life in three different cohorts of CAA-patients.

Methods

Methods: We performed a cross-sectional questionnaire-based study in patients recruited from our prospective hospital sCAA- and D-CAA databases. We included patients diagnosed with either (i) ‘probable CAA’ according to the modified Boston criteria, (ii) ‘mixed-type small-vessel disease/CAA’, (iii) hereditary Dutch-type (D-)CAA. Subjects are asked to complete the Hospital Anxiety and Depression Scale, Center for Epidemiological Studies Depression Scale (CESD), EuroQol 5D-5L (EQ-5D-5L) and Short-Form 36 (SF-36) questionnaires via e-mail or post. Patient characteristics are derived from the electronic patient file.

Results

Main study parameters: SF-36 domain scores, and physical- and mental composite scores; descriptions and between-group comparisons of EQ-5D-5L health-profiles and EQ-index scores, calculated with the Dutch value-set. Frequency of depressive episodes (HADS depression subscale ≥8 and/or CESD≥16) compared between subgroups and to the Dutch census measurements.

Conclusions

Current status: Since September 2021, three-hundred-twenty-three (98%) of 331 eligible subjects have been approached; in 5 informed consent is pending, 22 (7%) had passed away, 39 (12%) were unwilling to participate, 21 (7%) declined due to poor medical condition and 4 (1%) were unreachable. In total 183/240 (76%) questionnaires have been returned.

Background and Aims

Intravenous thrombolysis improves the neurological function in AIS patients. There is no universally accepted tool for outcome in acute stroke. The MBI assesses activities of daily living and has shown to have internal consistency in stroke patients. The aim of this audit was to assess functional outcome using MBI in AIS post thrombolysis patients after 6 and 12 months.

Methods

Retrospective case reviews of AIS post thrombolysis patients admitted at the Brunei Neuroscience Stroke and Rehabilitation Centre from 1^st January 2020 to 31^st December 2020 was performed. Functional outcome was measured using MBI on admission, 6 and 12 months post stroke.

Results

22 patients underwent intravenous thrombolysis. 2 were excluded (died next day and repatriated). 20 patients (14 males, 6 females, mean age 58, mean admission MBI=67±27) were included. On admission, 45% of patients were in severe and total dependence group, 30% in moderate dependence group and 20% in slight dependence group and 5% in fully independent group. At 6 months (mean MBI=90±26), improved to 10%, 10%, 5% and 75% consecutively. 1 of the 2 patients in the total dependence group on admission died within 12 months. The others remained at the same MBI groups (mean MBI=93±23).

Conclusions

Majority of AIS post intravenous thrombolysis patients were fully independent after 6 months. All patients with slight dependence level became fully independent and patients with total dependence level on admission have very high mortality rate at 6 months. Whilst all stroke outcome measures have limitations, MBI can readily be incorporated into clinical performance audit of AIS thrombolysis service.

Background and Aims

The purpose of this study is to describe the characteristics of patients who were admitted to our inpatient rehabiitation unit after a posterior circulation stroke. We looked at the demographics and the type of impairments that the patients presented with, co-morbidities, employment status prior to stroke, their length of stay in inpatients, their FIM scores, as well as their walking ability on admission and at 3 months.

Methods

The data was collected from the inpatient rehabilitation unit in Sengkang General Hospital.

Results

74 patients with posterior circulation stroke were included in this study. More than half of them had weakness, impaired coordination and balance as their impairments, lesser had visual and sensory impairments. On admission to the hospital, only one patient could ambulate independently. At 3 months, 45 out were able to walking independently. At 3 months, 67 patients had discharged home, 4 had gone to a nusring home, 2 went to community hospital to continue their rehabilitaiton and there was 1 death.

Walking outcomes at 3 months were divided into being able to walk independently with or without walking aid, and unable to walk independently (which includes walking requring assistance, or unable to ambulate). Each impairment was futher examined, to determine if there was a relationship between type of impairment and better/ worse walking outcomes.

Conclusions

This may in the future help clinicians prognosticate walking outcomes and stroke recovery based on the clinical presentation of the patient. Co-morbidities and non-physical impairments such as cognitive impairment, are also important to examine as they impact on functional outcomes.

Background and Aims

Empathy has not been well studied in patients after ischemic stroke. This study aimed to examine the potential correlation of multimodal neuroimaging evidence and the impairment of empathy in patients with subacute ischemic stroke.

Methods

Patients with first-event acute ischemic stroke were recruited prospectively. We assessed the patients’ empathy status using the Chinese version of the Empathy Quotient (EQ) 3 months after the index stroke. Multimodal magnetic resonance imaging (MRI) was conducted in all participants. We quantified the brain volume of various subcortical structures, ventricles, and cortical lobar atrophy. The microstructural integrity of the white matter was reflected by the mean fractional anisotropy (FA) and mean diffusivity (MD).

Results

Twenty-three (56.1%) men and 18 (43.9%) women (mean age: 61.73 y) were prospectively recruited in this study. In a univariate analysis, the EQ was correlated with right cortical infarction (r=-0.39, P=0.012), putamen volume (r=0.382, P=0.014), right putamen volume (r=0.338, P=0.031), and the FA value of the right sagittal stratum. Multiple stepwise linear regression models were used to test the putative correlated factors for the EQ. After adjusting for confounders, the presence of right cortical infarcts was negatively correlated with the EQ (standardized β = -0.358, 95% confidence interval = -0.708 to -0.076, P=0.016), and the putamen volume was positively correlated with the EQ (standardized β = 0.328, 95% confidence interval = 0.044 to 0.676, P=0.027).

Conclusions

In patients with subacute ischemic stroke, right cortical infarction and a smaller putamen volume are associated with the impairment of empathy.

Background and Aims

Intravenous thrombolysis is the prompt treatment of acute ischemic stroke that shows a neurologic improvement after 3 months follow up, but recent studies also showed good outcome in early phase within 24 hours. Thus, this study was conducted to evaluate which factors that play a role in predicting early neurologic improvement within 24 hours post thrombolysis in acute ischemic stroke.

Methods

This cross sectional study gathered 141 subjects from stroke registry of National Brain Centre Hospital Prof. Dr. dr. Mahar Mardjono. Groupings were done based on all independent variables of sociodemographic, risk factor, thrombolysis dose selection, and neurologic condition of the subjects; and dependent variables of stroke severity scale of NIHSS difference within 24 hours post thrombolysis, which then were analyzed by using STATA version 17 for univariate analysis and multivariate regression logistic analysis

Results

Early onset-to-needle (OTN) and NIHSS pre thrombolysis showed significant association in NIHSS improvement (p<0.05), with odds ratio (OR) [95% CI] of 0.379 [0.165-0.874] and 4.131 [1.571-10.866] respectively according to multivariate regression logistic analysis.

Conclusions

Variables such OTN and NIHSS pre thrombolysis can be considerated as independent factors of early neurologic improvement within 24 hours post thrombolysis patients

Background and Aims

Stroke outcomes depends upon multiple factors. Our aim was to assess the outcomes of ischemic stroke according to TOAST criteria. And we used mRS for evaluation of outcome. The aim of this study was to determine the outcome of treatment procedure of subtypes of ischemic stroke parients on (mRS) scale.

Methods

This was a prospective observational cross-sectional study, undertaken at the Department of Neurology in BSMMU in Dhaka, Bangladesh during June-2021 to January-2022 and it comprised a total of 240 ischemic stroke patients who were selected by purposive sampling as per inclusion criteria.

Results

Among 240 patients 68.3% were male and 31.7% were female. The mean age was 56.7 with ±SD ±12.77. 42.9% had diabetes mellitus, 69.2% had hypertension, 39.6% had Dyslipidaemia and 15.4% had coronary artery disease. Only age was shown to be statistically significant in association to mRS after one week of observation. mRS outcome with respect to sub types of stroke showed that after 1 week highest (15.4%) good outcome was in SVO and highest (29.6%) bad outcome was in LAA and p=0.00 which suggests strong association. After 1 month and 3 months mRS outcome showed that highest good outcome was 20.8% & 23.1% respectively in SVO and highest bad outcome was in LAA 24.2% & 16.8% respectively.

Conclusions

In comparison to others, LAA has bad outcome after 1 week, 1 month and 3 months. Among risk factors, age has associated significantly with outcome.

Background and Aims

Time taken to access post-acute stroke rehabilitation can significantly influence functional outcomes. This study evaluated differences in functional and psychosocial outcomes at discharge from stroke rehabilitation based on the time between injury and admission to post-acute services.

Methods

Retrospective cohort study of n=292 adults with stroke who received post-acute neurorehabilitation and disability support services through Brightwater Care Group in Western Australia (WA), 1991–2020. The study used internal electronic medical record data, and linked hospital, emergency department and mortality data from the WA Data Linkage System. The cohort was categorised into three groups based on time between stroke and admission to post-acute services: Early (<1 year, n=179), Middle (1-2 years, n=53), and Late (>2 years, n=60). Sociodemographic data, clinical, functional and psychosocial outcomes, and risk of death during post-acute care were compared across groups.

Results

Early admissions to rehabilitation demonstrated significantly greater functional improvement at discharge relative to those admitted late (p=0.004). However, individuals admitted late had better psychosocial functioning (p=0.001), better quality of life (p<0.001), and were significantly more likely to achieve rehabilitation goals on discharge (p<0.001), although death during rehabilitation was also higher for this group (p=0.003).

Conclusions

Findings indicate differential functional and psychosocial outcomes based on time since stroke injury to post-acute admission. The extent to which individuals are able to relearn functional skills and achieve rehabilitation goals is impacted by the stage at which they enter rehabilitation and may influence the trajectory of recovery. Implications for service delivery at different stages of stroke recovery will be discussed.

Background and Aims

Multimorbidity is commonly measured by the Charlson Comorbidity Index (CCI; based on 15 medical conditions), but there are few data on its prognostic value in cerebrovascular disease. Moreover, more complicated indexes have been proposed, such as the Elixhauser Index (EI) based on 32 conditions, including important stroke-related comorbidities (such as hypertension and cardiac arrhythmias). We aimed to compare the prognostic value of the CCI and EI for all-cause mortality and recurrent stroke after TIA and stroke.

Methods

In patients ascertained in the Oxford Vascular Study from 2002-2012 with 5-year follow-up, pre-event CCI and EI were assessed at baseline and supplemented by electronic records. Predictive value of both indexes for all-cause mortality and recurrent stroke at 5 years were estimated with C-statistics and with hazard ratios based on cut points, adjusted for, and stratified by, age, sex, and stroke severity (NIHSS).

Results

Among 2298 patients (mean/SD age=74.4/13.0 years; 1131 (49.0%) male), 565 (24.6%) had ≥2 CCI comorbidities and 1335 (58.1%) had ≥2 EI comorbidities. Both were modestly predictive of all-cause mortality overall by the C-statistic (both=0.59, 95%CI=0.57-0.61), but high levels of multimorbidity had a poor prognosis (≥3 CCI - adjusted HR vs 0 comorbidities=2.14, 1.74-2.64, p<0.001; ≥4 EI vs 0 - aHR=1.93, 1.50-2.47, p<0.001). Associations were consistent by age, sex, and severity, and findings were broadly similar for prediction of recurrent stroke.

Conclusions

High levels of multimorbidity are associated with a poor prognosis after TIA or stroke, but the additional complexity of the EI compared with the CCI does not improve prognostication.