Submit to JCM Review for JCM Propose a Special Issue

Journal Browser

Acute Stroke: An Update on the Assessment and Management Approaches

Special Issue Editors
Special Issue Information
Keywords
Published Papers

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 13335

Share This Special Issue

Special Issue Editor

Dr. Jan Purrucker

E-Mail Website
Guest Editor

Heidelberg University Hospital, Heidelberg, Germany
Interests: stroke; ischemic stroke; hemorrhagic stroke; intracranial bleeding; intracerebral hemorrhage; thrombectomy; thrombolysis; telemedicine; teleneurology; telestroke; anticoagulation

Special Issue Information

Dear Colleagues,

Recent technological and medical advances have changed the assessment and management of acute ischemic and hemorrhagic stroke. In ischemic stroke, there is a lot of effort done in streamlining the process in emergency care, including the use of prehospital triage and telemedicine. Optimizing the assessment of heart rhythm disorders, with focus on atrial fibrillation, is still in the scope of clinical interest, and many questions remain unanswered.

For acute hemorrhagic stroke, management has focused on blood pressure control, as well as control of coagulation. In both ischemic and hemorrhagic stroke, rapid management of coagulation in patients with oral anticoagulation including non-vitamin K antagonists oral anticoagulants place a pivotal yet challenging role in emergency assessment of patients. During the world-wide pandemic situation due to COVID-19, management of acute stroke has become especially challenging, but innovative concepts have developed.

We are pleased to invite you to submit manuscript covering basic research, clinical research, and (systematic) reviews or a metaanalysis to the Special Issue.

The aim of this Special Issue is to boundle articles focusing primarily on the acute prehospital and inhospital phase of stroke with regard to assessment and management, but the Guest Editor is open to consider manuscripts, focusing on the bridge towards post-acute care as well.

I look forward to receiving your contributions.

Dr. Jan Purrucker
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Stroke
Ischemic Stroke
Hemorrhagic Stroke
Intracranial Bleeding
Intracerebral hemorrhage
thrombectomy
thrombolysis
telemedicine
teleneurology
telestroke
anticoagulation

Published Papers (6 papers)

Download All Papers

Research

6 pages, 212 KiB

Open AccessArticle

Differences in Cardiac Etiologies for Ischemic Stroke in Young and Middle-Aged Patients: A Single-Center Experience in Taiwan

by Wen-Hwa Wang

J. Clin. Med. 2022, 11(8), 2120; https://doi.org/10.3390/jcm11082120 - 11 Apr 2022

Cited by 1 | Viewed by 1235

Abstract

Background: The cardiac etiology of acute ischemic stroke (AIS) plays an important role in young adults; therefore, complete cardiac workups and subsequent prevention methods are important for treating young AIS patients. However, the definition of a young age for AIS patients could be below 45 years old, while in some previous studies, it has been below 55 years old. It remains unclear whether cardiac workups are equally important for AIS patients in the young (the age of 20–45 years old) and middle-aged (46–55 years old) categories. Materials and methods: This prospective study included 103 patients admitted due to a first AIS attack younger than 55 years old during the period from 1 October 2018 to 31 December 2020. All the patients received cardiologist consultations and cardiac workups accordingly. The characteristics of patients, cardiac workups, clinical findings, and management were analyzed. Results: AIS patients in the 46–55-year-old group had a higher prevalence of hypertension (61.4% vs. 39.0%), diabetes mellitus (27.3% vs. 15.3%), a previous history of coronary artery disease (9.1% vs. 1.7%), and atrial fibrillation (9.1% vs. 1.7%) compared to the 20–45-year-old group. After cardiologist consultations, a higher prevalence of newly diagnosed coronary artery disease (6.8% vs. 1.7%) and congestive heart failure (11.4% vs. 1.7%) was noted. Both groups disclosed similar percentages of patent foramen ovale (PFO) (27.3% vs. 22.0%) and valvular disease. These results led to subsequent changes in treatment in both groups. The 20–45-year-old group had higher percentages of receiving PFO occluders (11.9%) compared to the 46–55-year-old group (6.8%). Conclusion: Cardiologist consultations with thorough cardiac workups for AIS patients can reveal many cardiac findings in both young and middle-aged patients. This leads to a subsequent change in treatment, including medical and surgical aspects, which are important as secondary prevention for AIS. Full article

(This article belongs to the Special Issue Acute Stroke: An Update on the Assessment and Management Approaches)

15 pages, 1285 KiB

Open AccessArticle

Standardized Classification of Cerebral Vasospasm after Subarachnoid Hemorrhage by Digital Subtraction Angiography

by Helena Merkel, Dirk Lindner, Khaled Gaber, Svitlana Ziganshyna, Jennifer Jentzsch, Simone Mucha, Thilo Gerhards, Sabine Sari, Annika Stock, Felicitas Vothel, Lea Falter, Ulf Quäschling, Karl-Titus Hoffmann, Jürgen Meixensberger, Dirk Halama and Cindy Richter

J. Clin. Med. 2022, 11(7), 2011; https://doi.org/10.3390/jcm11072011 - 03 Apr 2022

Cited by 9 | Viewed by 2294

Abstract

Background: During the last decade, cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) was a current research focus without a standardized classification in digital subtraction angiography (DSA). This study was performed to investigate a device-independent visual cerebral vasospasm classification for endovascular treatment. Methods: The analyses are DSA based rather than multimodal. Ten defined points of intracranial arteries were measured in 45 patients suffering from cerebral vasospasm after SAH at three time points (hospitalization, before spasmolysis, control after six months). Mathematical clustering of vessel diameters was performed to generate four objective grades for comparison. Six interventional neuroradiologists in two groups scored 237 DSAs after a new visual classification (grade 0–3) developed on a segmental pattern of vessel contraction. For the second group, a threshold-based criterion was amended. Results: The raters had a reproducibility of 68.4% in the first group and 75.2% in the second group. The complementary threshold-based criterion increased the reproducibility by about 6.8%, while the rating deviated more from the mathematical clustering in all grades. Conclusions: The proposed visual classification scheme of cerebral vasospasm is suitable as a standard grading procedure for endovascular treatment. There is no advantage of a threshold-based criterion that compensates for the effort involved. Automated vessel analysis is superior to compare inter-group results in research settings. Full article

(This article belongs to the Special Issue Acute Stroke: An Update on the Assessment and Management Approaches)

► Show Figures

Figure 1

13 pages, 969 KiB

Open AccessArticle

Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department

by Aiham Qdaisat, Sai-Ching J. Yeung, Cristhiam H. Rojas Hernandez, Pavani Samudrala, Mona Kamal, Ziyi Li and Adriana H. Wechsler

J. Clin. Med. 2022, 11(3), 643; https://doi.org/10.3390/jcm11030643 - 27 Jan 2022

Cited by 2 | Viewed by 1699

Abstract

Intracranial hemorrhage (ICH) is a dreaded complication of both cancer and its treatment. To evaluate the characteristics and clinical outcomes of cancer patients with ICH, we identified all patients with ICH who visited The University of Texas MD Anderson Cancer Center emergency department between 1 September 2006 and 16 February 2016. Clinical and radiologic data were collected and compared. Logistic regression analyses were used to determine the association between clinical variables and various outcomes. During the period studied, 704 confirmed acute ICH cases were identified. In-hospital, 7-day, and 30-day mortality rates were 15.1, 11.4, and 25.6%, respectively. Hypertension was most predictive of intensive care unit admission (OR = 1.52, 95% CI = 1.09–2.12, p = 0.013). Low platelet count was associated with both in-hospital mortality (OR = 0.96, 95% CI = 0.94–0.99, p = 0.008) and 30-day mortality (OR = 0.98, 95% CI = 0.96–1.00, p = 0.016). Radiologic findings, especially herniation and hydrocephalus, were strong predictors of short-term mortality. Among known risk factors of ICH, those most helpful in predicting cancer patient outcomes were hypertension, low platelet count, and the presence of hydrocephalus or herniation. Understanding how the clinical presentation, risk factors, and imaging findings correlate with patient morbidity and mortality is helpful in guiding the diagnostic evaluation and aggressiveness of care for ICH in cancer patients. Full article

(This article belongs to the Special Issue Acute Stroke: An Update on the Assessment and Management Approaches)

► Show Figures

Figure 1

9 pages, 1947 KiB

Open AccessArticle

Covert Brain Infarcts in Patients with Philadelphia Chromosome-Negative Myeloproliferative Disorders

by Polina I. Kuznetsova, Anton A. Raskurazhev, Rodion N. Konovalov, Marina V. Krotenkova, Andrey O. Chechetkin, Olga V. Lagoda, Anait L. Melikhyan and Marine M. Tanashyan

J. Clin. Med. 2022, 11(1), 13; https://doi.org/10.3390/jcm11010013 - 21 Dec 2021

Cited by 1 | Viewed by 2718

Abstract

Backgrounds and Purpose. Philadelphia chromosome-negative myeloproliferative disorders (Ph-negative MPD) are a rare group of hematological diseases, including three distinct pathologies: essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). They most often manifest with thrombotic complications, including cerebrovascular events. Covert brain infarcts (CBIs) are defin ed as predominantly small ischemic cerebral lesions that are detected using magnetic resonance imaging (MRI) in the absence of clinical stroke events. The relationship between MPD and CBIs remains unclear. Methods. Included in the study were 103 patients with the diagnosis of Ph-MPD (according to WHO 2016 criteria) (median age—47 (35; 54) years; 67% female). In total, 38 patients had ET, 42 had PV, and 23 had PMF. They underwent clinical examination, routine laboratory analyses (complete blood count), brain MRI, ultrasound carotid artery, flow-mediated dilatation (as a measure of endothelial dysfunction—FMD). Results. Overall, 23 patients experienced an ischemic stroke (as per MRI and/or clinical history), of which 16 (15.5%) could be classified as CBIs. The rate of CBIs per MPD subtype was statistically non-significant between groups (p = 0.35): ET–13.2%, PV–21.4%, and PMF–8.7%. The major vascular risk factors, including arterial hypertension, carotid atherosclerosis, and prior venous thrombosis, were not associated with CBIs (p > 0.05). Age was significantly higher in patients with CBIs compared to patients without MRI ischemic lesions: 50 (43; 57) years vs. 36 (29; 48) (p = 0.002). The frequency of headaches was comparable between the two groups. CBIs were associated with endothelial dysfunction (OR - 0.71 (95% CI: 0.49–0.90; p = 0.02)) and higher hemoglobin levels (OR—1.21 (95% CI: 1.06–1.55); p =0.03). Conclusions. CBIs are common in patients with Ph-negative MPD. Arterial hypertension and carotid atherosclerosis were not associated with CBIs in this group of patients. The most significant factors in the development of CBIs were endothelial dysfunction (as measured by FMD) and high hemoglobin levels. Patients with Ph-negative MPD and CBIs were older and had more prevalent endothelial dysfunction. Full article

(This article belongs to the Special Issue Acute Stroke: An Update on the Assessment and Management Approaches)

► Show Figures

Figure 1

8 pages, 539 KiB

Open AccessArticle

Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage

by Felix Lehmann, Lorena M. Schenk, Joshua D. Bernstock, Christian Bode, Valeri Borger, Florian Gessler, Erdem Güresir, Motaz Hamed, Anna-Laura Potthoff, Christian Putensen, Matthias Schneider, Julian Zimmermann, Hartmut Vatter, Patrick Schuss and Alexis Hadjiathanasiou

J. Clin. Med. 2021, 10(24), 5939; https://doi.org/10.3390/jcm10245939 - 17 Dec 2021

Cited by 3 | Viewed by 1819

Abstract

The impact of dehydration at admission of patients with spontaneous intracerebral hemorrhage (ICH) on short-term mortality remains ambiguous due to scarce data. All of the consecutive patients with spontaneous ICH, who were referred to our neurovascular center in 2018/19, were assessed for hydration status on admission. Dehydration was defined by a blood urea-to-creatinine ratio > 80. In a cohort of 249 patients, 76 patients (31%) were dehydrated at the time of admission. The following factors were significantly and independently associated with increased 30-day mortality in multivariate analysis: “signs of cerebral herniation” (p = 0.008), “initial midline shift > 5 mm” (p < 0.001), “ICH score > 3” (p = 0.007), and “admission dehydration status” (p = 0.007). The results of the present study suggest that an admission dehydration status might constitute a significant and independent predictor of short-term mortality in patients with spontaneous ICH. Full article

(This article belongs to the Special Issue Acute Stroke: An Update on the Assessment and Management Approaches)

► Show Figures

Figure 1

8 pages, 10289 KiB

Open AccessArticle

Prevalence and Clinical Characteristics of Subclavian Steal Phenomenon/Syndrome in Patients with Acute Ischemic Stroke

by Zoltan Bajko, Anca Motataianu, Adina Stoian, Laura Barcutean, Sebastian Andone, Smaranda Maier, Iulia-Adela Drăghici, Andrada Cioban and Rodica Balasa

J. Clin. Med. 2021, 10(22), 5237; https://doi.org/10.3390/jcm10225237 - 10 Nov 2021

Cited by 2 | Viewed by 2343

Abstract

There are no published clinical studies regarding the prevalence of subclavian steal among acute ischemic stroke patients. The aim of this study was to evaluate the prevalence and clinical significance of subclavian steal among a large number of consecutive ischemic stroke patients. Materials and methods: We reviewed the medical records of 2192 consecutive cases of acute ischemic stroke at a tertiary neurology clinic in Targu Mures, Romania, between 2018 and 2020. In total, 47 patients (2.2%) were diagnosed with subclavian steal phenomenon/syndrome. Results: Stroke patients with associated steal phenomenon were significantly younger (64.2 ± 11.1 versus 70.2 ± 12.8, p = 0.005) and predominantly male (68.1%). From among the 47 patients with subclavian steal phenomenon, nine (19.1%) presented stroke symptomatology in the vertebrobasilar territory. Overall, 83.3% of the stroke patients with associated steal phenomenon presented cerebral infarction and 16.7% presented TIA. There was no difference between groups regarding the affected vascular territory (VB versus carotid). Large artery atherosclerosis was more frequent in the stroke group with associated steal phenomenon (81.3% versus 43.5%, p = 0.0033). The NIHSS score at admission was higher in the patient group with associated steal phenomenon, but there was no difference in mRS at discharge. Associated carotid artery occlusion was more frequent in the stroke group with steal phenomenon (p < 0.01). Smoking and peripheral arteriopathy were more frequent in the patient group with associated steal phenomenon. Of the nine symptomatic patients, five underwent revascularization treatment. Conclusions: The prevalence of subclavian steal phenomenon among acute ischemic stroke patients was not higher than in other cohorts with heterogenous peripheral vascular pathologies. Similar to the general population, in acute ischemic stroke patients, the associated subclavian steal behaved like a benign hemodynamical condition, without severe consequences. Full article

(This article belongs to the Special Issue Acute Stroke: An Update on the Assessment and Management Approaches)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Acute Stroke: An Update on the Assessment and Management Approaches

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (6 papers)

Research

Further Information

Guidelines

MDPI Initiatives

Follow MDPI