Neurology International

Research

17 pages, 1634 KiB

Open AccessArticle

Pretreatment Cranial Computed Tomography Perfusion Predicts Dynamic Cerebral Autoregulation Changes in Acute Hemispheric Stroke Patients Having Undergone Recanalizing Therapy: A Retrospective Study

by Lehel-Barna Lakatos, Manuel Bolognese, Mareike Österreich, Martin Müller and Grzegorz Marek Karwacki

Neurol. Int. 2024, 16(6), 1636-1652; https://doi.org/10.3390/neurolint16060119 - 25 Nov 2024

Viewed by 344

Abstract

Objectives: Blood pressure (BP) management is challenging in patients with acute ischemic supratentorial stroke undergoing recanalization therapy due to the lack of established guidelines. Assessing dynamic cerebral autoregulation (dCA) may address this need, as it is a bedside technique that evaluates the transfer [...] Read more.

Objectives: Blood pressure (BP) management is challenging in patients with acute ischemic supratentorial stroke undergoing recanalization therapy due to the lack of established guidelines. Assessing dynamic cerebral autoregulation (dCA) may address this need, as it is a bedside technique that evaluates the transfer function phase in the very low-frequency (VLF) range (0.02–0.07 Hz) between BP and cerebral blood flow velocity (CBFV) in the middle cerebral artery. This phase is a prognostically relevant parameter, with lower values associated with poorer outcomes. This study aimed to evaluate whether early cranial computed tomography perfusion (CTP) can predict this parameter. Methods: In this retrospective study, 165 consecutive patients with hemispheric strokes who underwent recanalizing therapy were included (median age: 73 years; interquartile range (IQR) 60–80; women: 43 (26%)). The cohort comprised 91 patients treated with intravenous thrombolysis (IV-lysis) alone (median National Institute of Health Stroke Scale (NIHSS) score: 5; IQR 3–7) and 74 patients treated with mechanical thrombectomy (median NIHSS: 15; IQR 9–18). Regression analysis was performed to assess the relationship between pretreatment CTP-derived ischemic penumbra and core stroke volumes and the dCA VLF phase, as well as CBFV assessed within the first 72 h post-stroke event. Results: Pretreatment penumbra volume was a significant predictor of the VLF phase (adjusted r² = 0.040; β = −0.001, 95% confidence interval (CI): −0.0018 to −0.0002, p = 0.02). Core infarct volume was a stronger predictor of CBFV (adjusted r² = 0.082; β = 0.205, 95% CI: 0.0968–0.3198; p = 0.0003) compared to penumbra volume (p = 0.01). Additionally, in the low-frequency range (0.07–0.20 Hz), CBFV and BP were inversely related to the gain, an index of vascular tone. Conclusion: CTP metrics appear to correlate with the outcome-relevant VLF phase and reactive hyperemic CBFV, which interact with BP to influence vascular tone and gain. These aspects of dCA could potentially guide BP management in patients with acute stroke undergoing recanalization therapy. However, further validation is required. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Figure 1

16 pages, 1176 KiB

Open AccessArticle

Evaluating the Usability of a Remote Ischemic Conditioning Device for Pre-Hospital Stroke Management: Insights from Paramedic Simulations

by Bogna Anna Drozdowska, Kaden Lam, Cody Doolan, Efrem Violato and Aravind Ganesh

Neurol. Int. 2024, 16(6), 1405-1420; https://doi.org/10.3390/neurolint16060105 - 9 Nov 2024

Viewed by 708

Abstract

Background/Objectives: In acute stroke, often-prolonged hospital transport times present an opportunity for early interventions to salvage brain tissue. Remote ischemic conditioning (RIC), where brief cycles of ischemia–reperfusion in a limb are induced to protect the brain, is a promising treatment for this setting. [...] Read more.

Background/Objectives: In acute stroke, often-prolonged hospital transport times present an opportunity for early interventions to salvage brain tissue. Remote ischemic conditioning (RIC), where brief cycles of ischemia–reperfusion in a limb are induced to protect the brain, is a promising treatment for this setting. We assessed the usability of a novel RIC system in a simulated emergency response scenario. Methods: Paramedics were asked to use the RIC device in an emergency stroke care and ambulance transport simulation, overseen by a confederate. Feedback on device use was collected through questionnaires, including the System Usability Scale (SUS) and the NASA Task Load Index (NASA-TLX), and a semi-structured interview. Questionnaire responses were summarized using descriptive statistics; interview transcripts were analyzed thematically. Results: Nine paramedics (including the confederate) participated, with a mean of 10.0 ± 10.3 years of professional experience. Questionnaire responses indicated high device usability (mean SUS score: 85.3 ± 12.9 out of 100) and low task-related demands, effort, and frustration (mean NASA-TLX domain scores: ≤3.9 out of 20). Seven paramedics stated they would use the device in daily practice. They expressed concerns related to display screen clarity, interference with standard procedures, cable management, device fragility, and patient discomfort. Suggested improvements included adding indicators of device performance and refining the cuff design. Conclusions: While the device was considered easy to use, paramedics also identified important areas of improvement. With a small, localized study sample, our findings are primarily applicable to the refinement of the RICovery system for use in future clinical trials in the same healthcare setting. However, feedback on the importance of mitigating potential interference of newly introduced procedures with those already established, robustness of equipment, and effective paramedic–patient communication may also help inform the design of other pre-hospital interventions. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Figure 1

11 pages, 919 KiB

Open AccessArticle

Redefining Infarction Size for Small-Vessel Occlusion in Acute Ischemic Stroke: A Retrospective Case–Control Study

by Yen-Chu Huang, Hsu-Huei Weng, Leng-Chieh Lin, Jiann-Der Lee, Jen-Tsung Yang, Yuan-Hsiung Tsai and Chao-Hui Chen

Neurol. Int. 2024, 16(5), 1164-1174; https://doi.org/10.3390/neurolint16050088 - 21 Oct 2024

Viewed by 1234

Abstract

Background/Objectives: Small-vessel occlusion, previously referred to as lacunar infarcts, accounts for approximately one-third of all ischemic strokes, using an axial diameter of less than 20 mm on diffusion-weighted imaging. However, this threshold may not adequately differentiate small-vessel occlusion from other pathologies, such as [...] Read more.

Background/Objectives: Small-vessel occlusion, previously referred to as lacunar infarcts, accounts for approximately one-third of all ischemic strokes, using an axial diameter of less than 20 mm on diffusion-weighted imaging. However, this threshold may not adequately differentiate small-vessel occlusion from other pathologies, such as branch atheromatous disease (BAD) and embolism. This study aimed to assess the clinical significance and pathological implications of acute small subcortical infarctions (SSIs) based on infarct diameter. Methods: We conducted a retrospective case–control study using data from stroke patients recorded between 2016 and 2021 of the Stroke Registry in Chang Gung Healthcare System. Patients with acute SSIs in penetrating artery territories were included. Key variables such as patient demographics, stroke severity, and medical history were collected. Infarcts were categorized based on size, and the presence of early neurological deterioration (END) and favorable functional outcomes were assessed. Results: Among the 855 patients with acute SSIs, the median age was 70 years and the median National Institutes of Health Stroke Scale (NIHSS) score at arrival was four. END occurred in 97 patients (11.3%). Those who experienced END were significantly less likely to achieve a favorable functional outcome compared to those who did not (18.6% vs. 59.9%, p < 0.001). The incidence of END increased progressively with infarct sizes of 15 mm or larger, with the optimal threshold for predicting END identified as 15.5 mm and for BAD, it was 12.1 mm. A multiple logistic regression analysis revealed that motor tract involvement [adjusted odds ratio (aOR) 2.3; 95% confidence interval (CI) 1.1–4.7], an initial heart rate greater than 90 beats per minute (aOR 2.3; 95% CI 1.2–4.3), and a larger infarct size (15 mm to less than 20 mm vs. 10 mm to less than 15 mm; aOR 3.0; 95% CI 1.4–6.3) were significantly associated with END. Conclusions: Our findings suggest that setting the upper limit for small-vessel occlusion at 15 mm would be more effective in distinguishing it from BAD. However, these findings should be interpreted in the context of the retrospective design and study population. Further multi-center research utilizing high-resolution vessel wall imaging is necessary to refine this threshold and enhance diagnostic accuracy. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Figure 1

11 pages, 275 KiB

Open AccessArticle

Communicating Arteries and Leptomeningeal Collaterals: A Synergistic but Independent Effect on Patient Outcomes after Stroke

by Sara Sablić, Krešimir Dolić, Danijela Budimir Mršić, Mate Čičmir-Vestić, Antonela Matana, Sanja Lovrić Kojundžić and Maja Marinović Guić

Neurol. Int. 2024, 16(3), 620-630; https://doi.org/10.3390/neurolint16030046 - 2 Jun 2024

Viewed by 1120

Abstract

The collateral system is a compensatory mechanism activated in the acute phase of an ischemic stroke. It increases brain perfusion to the hypoperfused area. Arteries of the Willis’ circle supply antegrade blood flow, while pial (leptomeningeal) arteries direct blood via retrograde flow. The [...] Read more.

The collateral system is a compensatory mechanism activated in the acute phase of an ischemic stroke. It increases brain perfusion to the hypoperfused area. Arteries of the Willis’ circle supply antegrade blood flow, while pial (leptomeningeal) arteries direct blood via retrograde flow. The aim of our retrospective study was to investigate the relationship between both collateral systems, computed tomography perfusion (CTP) values, and functional outcomes in acute stroke patients. Overall, 158 patients with anterior circulation stroke who underwent mechanical thrombectomy were included in the study. We analyzed the presence of communicating arteries and leptomeningeal arteries on computed tomography angiography. Patients were divided into three groups according to their collateral status. The main outcomes were the rate of functional independence 3 months after stroke (modified Rankin scale score, mRS) and mortality rate. Our study suggests that the collateral status, as indicated by the three groups (unfavorable, intermediate, and favorable), is linked to CT perfusion parameters, potential recuperation ratio, and stroke outcomes. Patients with favorable collateral status exhibited smaller core infarct and penumbra volumes, higher mismatch ratios, better potential for recuperation, and improved functional outcomes compared to patients with unfavorable or intermediate collateral status. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

10 pages, 257 KiB

Open AccessArticle

The Usefulness of Factor XIII Concentration Assessment in Patients in the Acute Phase of Ischaemic Stroke Treated with Thrombolysis

by Małgorzata Wiszniewska, Urszula Włodarczyk, Magdalena Sury, Artur Słomka, Natalia Piekuś-Słomka, Anna Żdanowicz and Ewa Żekanowska

Neurol. Int. 2024, 16(3), 551-560; https://doi.org/10.3390/neurolint16030041 - 10 May 2024

Viewed by 980

Abstract

Background and Aims: In recent years, there has been a growing interest in factor XIII in ischaemic stroke. The study’s main aim was to assess the usefulness of factor XIII concentration determination in patients with acute ischaemic stroke (AIS) treated with thrombolysis with [...] Read more.

Background and Aims: In recent years, there has been a growing interest in factor XIII in ischaemic stroke. The study’s main aim was to assess the usefulness of factor XIII concentration determination in patients with acute ischaemic stroke (AIS) treated with thrombolysis with recombinant tissue plasminogen activator (t-PA). Methods: The study was conducted in two groups of 84 patients with AIS: group I—with thrombolytic therapy and group II—without thrombolysis. A physical examination, neurological status (using the National Institutes of Health Stroke Scale, NIHSS), daily patients’ activities measured with the Barthel Index and Modified Rankin Scale (mRS), and blood parameters were conducted on day 1 and day 7. The following parameters were assessed: highly sensitive C-reaction protein (CRP), fibrinogen, D-dimers (DD), neutrophil–lymphocyte ratio (NLR index), and the concentration of factor XIII-A. Results: In group I, the concentration of XIII-A decreased significantly between day 1 and 7 (p < 0.001). In group I, the concentration of XIII-A on day 7 in Total Anterior Circulation Infarct (TACI) was significantly lower than in non-TACI stroke. XIII-A concentration in group I was significantly lower in patients < 31 points with Acute Stroke Registry and Analysis of Lausanne (ASTRAL). A greater decrease in XIII-A between the first sampling on day 1 and the second sampling on day 7 was associated with a worse patient neurological state in group I. Conclusions: In patients with AIS treated with t-PA, factor XIII concentrations decrease in the acute phase of stroke, and the largest decrease occurs in the TACI stroke. Determination of factor XIII concentration in patients with AIS can be used in clinical practice as an additional parameter supporting the assessment of stroke severity and may play a role in the prognosis; lower factor XIII-A activity may be a predictor of a worse prognosis. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

10 pages, 892 KiB

Open AccessArticle

Safety and Efficacy of Low-Dose Eptifibatide for Tandem Occlusions in Acute Ischemic Stroke

by Paweł Latacz, Tadeusz Popiela, Paweł Brzegowy, Bartłomiej Lasocha, Krzysztof Kwiecień and Marian Simka

Neurol. Int. 2024, 16(1), 253-262; https://doi.org/10.3390/neurolint16010017 - 9 Feb 2024

Viewed by 1688

Abstract

Objectives: The optimal treatment strategy for ischemic stroke in patients presenting with tandem occlusions of the internal carotid artery remains controversial. Several studies have demonstrated better clinical outcomes after eptifibatide, which is a short half-life antiplatelet agent. This retrospective analysis focused on the [...] Read more.

Objectives: The optimal treatment strategy for ischemic stroke in patients presenting with tandem occlusions of the internal carotid artery remains controversial. Several studies have demonstrated better clinical outcomes after eptifibatide, which is a short half-life antiplatelet agent. This retrospective analysis focused on the safety and efficacy of low-dose eptifibatide administration in stroke patients with tandem lesions. Methods: We evaluated the results of endovascular treatment in 148 stroke patients with tandem lesions. Patients in whom balloon angioplasty alone resulted in satisfactory cerebral flow did not receive eptifibatide (33 patients); others received this drug together with stent implantation (115 patients). Eptifibatide was given as an intravenous bolus of 180 μg/kg and then in a modified low dose of 1 μg/kg/min for 24 hours. Results: There were no statistically significant differences between both groups regarding 30-day mortality, frequency of thrombotic events, or hemorrhagic complications. An analysis of clinical status at 30-day follow-up revealed that the administration of eptifibatide was associated with a statistically significant better outcome: a higher rate of either no neurological symptoms or only mild symptoms (4 NIHSS points maximally). Conclusions: The administration of eptifibatide in stroke patients presenting with tandem lesions is relatively safe. Moreover, treatment with this drug can improve clinical outcomes in these challenging patients. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Graphical abstract

10 pages, 472 KiB

Open AccessArticle

Physical Rehabilitation and Post-Stroke Pneumonia: A Retrospective Observational Study Using the Japanese Diagnosis Procedure Combination Database

by Takehiro Nishimura, Ryutaro Matsugaki and Shinya Matsuda

Neurol. Int. 2023, 15(4), 1459-1468; https://doi.org/10.3390/neurolint15040094 - 4 Dec 2023

Cited by 1 | Viewed by 1609

Abstract

In this study, the relationship between the duration of physical rehabilitation and occurrence of pneumonia after ischemic stroke was examined. We included 426,508 patients aged

\geq

75 years with acute ischemic stroke. A multilevel logistic regression analysis nested at the hospital level was [...] Read more.

In this study, the relationship between the duration of physical rehabilitation and occurrence of pneumonia after ischemic stroke was examined. We included 426,508 patients aged

\geq

75 years with acute ischemic stroke. A multilevel logistic regression analysis nested at the hospital level was conducted to examine the association between the duration of physical rehabilitation and occurrence of pneumonia. The duration of physical rehabilitation refers to the hours of physical rehabilitation performed daily until the 7th day of hospitalization. In the multivariable analysis, the intensity of rehabilitation for durations of 20–39 min/day (adjusted odds ratio [aOR]: 0.78, 95% Confidence Interval [CI]: 0.75–0.81, p < 0.001), 40–59 min/day (aOR: 0.68, 95% CI: 0.66–0.71, p < 0.001), 60–79 min/day (aOR:0.56, 95% CI: 0.53–0.58, p < 0.001), and

\geq

80 min/day (aOR: 0.46, 95% CI: 0.44–0.48, p < 0.001) were significantly associated with a reduced incidence of pneumonia. In addition, the trend identified for duration of rehabilitation was significant (p < 0.001). The results of this study suggest the usefulness of high-duration physical rehabilitation for preventing pneumonia in older patients with ischemic stroke. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Graphical abstract

Review

Jump to: Research, Other

13 pages, 766 KiB

Open AccessReview

Application of Muscle Synergies for Gait Rehabilitation After Stroke: Implications for Future Research

by Jaehyuk Lee, Kimyung Kim, Youngchae Cho and Hyeongdong Kim

Neurol. Int. 2024, 16(6), 1451-1463; https://doi.org/10.3390/neurolint16060108 - 13 Nov 2024

Viewed by 553

Abstract

Background/Objective: Muscle synergy analysis based on machine learning has significantly advanced our understanding of the mechanisms underlying the central nervous system motor control of gait and has identified abnormal gait synergies in stroke patients through various analytical approaches. However, discrepancies in experimental conditions [...] Read more.

Background/Objective: Muscle synergy analysis based on machine learning has significantly advanced our understanding of the mechanisms underlying the central nervous system motor control of gait and has identified abnormal gait synergies in stroke patients through various analytical approaches. However, discrepancies in experimental conditions and computational methods have limited the clinical application of these findings. This review seeks to integrate the results of existing studies on the features of muscle synergies in stroke-related gait abnormalities and provide clinical and research insights into gait rehabilitation. Methods: A systematic search of Web of Science, PubMed, and Scopus was conducted, yielding 10 full-text articles for inclusion. Results: By comprehensively reviewing the consistencies and differences in the study outcomes, we emphasize the need to segment the gait cycle into specific phases (e.g., weight acceptance, push-off, foot clearance, and leg deceleration) during the treatment process of gait rehabilitation and to develop rehabilitation protocols aimed at restoring normal synergy patterns in each gait phase and fractionating reduced synergies. Conclusions: Future research should focus on validating these protocols to improve clinical outcomes and introducing indicators to assess abnormalities in the temporal features of muscle synergies. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Figure 1

23 pages, 669 KiB

Open AccessReview

The Effectiveness of Paired Associative Stimulation on Motor Recovery after Stroke: A Scoping Review

by Andrea Baroni, Annibale Antonioni, Giulia Fregna, Nicola Lamberti, Fabio Manfredini, Giacomo Koch, Alessandro D’Ausilio and Sofia Straudi

Neurol. Int. 2024, 16(3), 567-589; https://doi.org/10.3390/neurolint16030043 - 14 May 2024

Cited by 2 | Viewed by 1301

Abstract

Paired associative stimulation (PAS) is a non-invasive brain stimulation technique combining transcranial magnetic stimulation and peripheral nerve stimulation. PAS allows connections between cortical areas and peripheral nerves (C/P PAS) or between cortical regions (C/C PAS) to be strengthened or weakened by spike-timing-dependent neural [...] Read more.

Paired associative stimulation (PAS) is a non-invasive brain stimulation technique combining transcranial magnetic stimulation and peripheral nerve stimulation. PAS allows connections between cortical areas and peripheral nerves (C/P PAS) or between cortical regions (C/C PAS) to be strengthened or weakened by spike-timing-dependent neural plasticity mechanisms. Since PAS modulates both neurophysiological features and motor performance, there is growing interest in its application in neurorehabilitation. We aimed to synthesize evidence on the motor rehabilitation role of PAS in stroke patients. We performed a literature search following the PRISMA Extension for Scoping Reviews Framework. Eight studies were included: one investigated C/C PAS between the cerebellum and the affected primary motor area (M1), seven applied C/P PAS over the lesional, contralesional, or both M1. Seven studies evaluated the outcome on upper limb and one on lower limb motor recovery. Although several studies omit crucial methodological details, PAS highlighted effects mainly on corticospinal excitability, and, more rarely, an improvement in motor performance. However, most studies failed to prove a correlation between neurophysiological changes and motor improvement. Although current studies seem to suggest a role of PAS in post-stroke rehabilitation, their heterogeneity and limited number do not yet allow definitive conclusions to be drawn. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Graphical abstract

13 pages, 1479 KiB

Open AccessReview

A Comprehensive Review on the Role of Resting-State Functional Magnetic Resonance Imaging in Predicting Post-Stroke Motor and Sensory Outcomes

by Foteini Christidi, Ilias Orgianelis, Ermis Merkouris, Christos Koutsokostas, Dimitrios Tsiptsios, Efstratios Karavasilis, Evlampia A. Psatha, Anna Tsiakiri, Aspasia Serdari, Nikolaos Aggelousis and Konstantinos Vadikolias

Neurol. Int. 2024, 16(1), 189-201; https://doi.org/10.3390/neurolint16010012 - 19 Jan 2024

Cited by 1 | Viewed by 2703

Abstract

Stroke is a major leading cause of chronic disability, often affecting patients’ motor and sensory functions. Functional magnetic resonance imaging (fMRI) is the most commonly used method of functional neuroimaging, and it allows for the non-invasive study of brain activity. The time-dependent coactivation [...] Read more.

Stroke is a major leading cause of chronic disability, often affecting patients’ motor and sensory functions. Functional magnetic resonance imaging (fMRI) is the most commonly used method of functional neuroimaging, and it allows for the non-invasive study of brain activity. The time-dependent coactivation of different brain regions at rest is described as resting-state activation. As a non-invasive task-independent functional neuroimaging approach, resting-state fMRI (rs-fMRI) may provide therapeutically useful information on both the focal vascular lesion and the connectivity-based reorganization and subsequent functional recovery in stroke patients. Considering the role of a prompt and accurate prognosis in stroke survivors along with the potential of rs-fMRI in identifying patterns of neuroplasticity in different post-stroke phases, this review provides a comprehensive overview of the latest literature regarding the role of rs-fMRI in stroke prognosis in terms of motor and sensory outcomes. Our comprehensive review suggests that with the advancement of MRI acquisition and data analysis methods, rs-fMRI emerges as a promising tool to study the motor and sensory outcomes in stroke patients and evaluate the effects of different interventions. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Figure 1

16 pages, 2052 KiB

Open AccessReview

Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?

by Pietro Crispino

Neurol. Int. 2023, 15(4), 1443-1458; https://doi.org/10.3390/neurolint15040093 - 30 Nov 2023

Cited by 2 | Viewed by 2396

Abstract

Coagulation and fibrinolytic system disorders are conditions in which the blood’s ability to clot is impaired, resulting in an increased risk of thrombosis or bleeding. Although these disorders are the expression of two opposing tendencies, they can often be associated with or be [...] Read more.

Coagulation and fibrinolytic system disorders are conditions in which the blood’s ability to clot is impaired, resulting in an increased risk of thrombosis or bleeding. Although these disorders are the expression of two opposing tendencies, they can often be associated with or be a consequence of each other, contributing to making the prognosis of acute cerebrovascular events more difficult. It is important to recognize those conditions that are characterized by dual alterations in the coagulation and fibrinolytic systems to reduce the prognostic impact of clinical conditions with difficult treatment and often unfortunate outcomes. Management of these individuals can be challenging, as clinicians must balance the need to prevent bleeding episodes with the potential risk of clot formation. Treatment decisions should be made on an individual basis, considering the specific bleeding disorder, its severity, and the patient’s general medical condition. This review aims to deal with all those forms in which coagulation and fibrinolysis represent two sides of the same media in the correct management of patients with acute neurological syndrome. Precision medicine, personalized treatment, advanced anticoagulant strategies, and innovations in bleeding control represent future directions in the management of these complex pathologies in which stroke can be the evolution of two different acute events or be the first manifestation of an occult or unknown underlying pathology. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Figure 1

Other

Jump to: Research, Review

8 pages, 1003 KiB

Open AccessBrief Report

Functional Outcomes After Decompressive Surgery in Patients with Malignant Space-Occupying Cerebellar Infarction

by Enayatullah Baki, Lea Baumgart, Victoria Kehl, Felix Hess, Andreas Wolfgang Wolff, Arthur Wagner, Moritz Roman Hernandez Petzsche, Tobias Boeckh-Behrens, Bernhard Hemmer, Bernhard Meyer, Jens Gempt and Silke Wunderlich

Neurol. Int. 2024, 16(6), 1239-1246; https://doi.org/10.3390/neurolint16060094 - 28 Oct 2024

Viewed by 605

Abstract

Background and Purpose: Decompressive surgery is a potentially life-saving treatment in patients with malignant space-occupying cerebellar infarction. However, there is only limited literature on functional outcomes and complications after surgery. Our aim was to establish markers which predict poor outcome. Methods: [...] Read more.

Background and Purpose: Decompressive surgery is a potentially life-saving treatment in patients with malignant space-occupying cerebellar infarction. However, there is only limited literature on functional outcomes and complications after surgery. Our aim was to establish markers which predict poor outcome. Methods: We retrospectively analyzed data of all patients who underwent surgery due to malignant swelling of a space-occupying cerebellar infarction in our hospital between 2005 and 2023. Statistical analyses were conducted on multiple parameters to identify predictors of poor functional outcome (mRS 4–6) 90 days after surgery. Complications during hospitalization were reviewed for each patient. Results: In total, 58 patients received decompressive surgery. The 90-day mortality rate was 27.6% (n = 16). A good functional outcome (mRS 0–3) 90 days after surgery was achieved in 24 patients (41.4%). Multivariable analysis revealed multiple factors associated with a poor outcome on day 90 (mRS 4–6): a higher premorbid mRS score (OR 2.715 [95% CI, 1.166–6.323]; p = 0.021), higher NIHSS score on admission (OR 1.088 [95% CI, 1.014, 1.168]; p = 0.019) and the presence of an additional brainstem infarction (OR 7.035, [95% CI, 1.255, 39.424], p = 0.027). Hyperactive delirium was associated with good clinical outcome (OR 0.020 [95%CI, 0.001–0.623]; p = 0.026). Aspiration pneumonia (n = 22, 37.9%), urinary tract infection (n = 15, 25.9%), and hyperactive delirium (n = 8, 13.8%) were the most common complications during hospitalization. Conclusions: Decompressive surgery is a safe, life-saving treatment for malignant space-occupying cerebellar infarction. Higher premorbid mRS, higher NIHSS score on admission and the presence of brainstem infarction are associated with a poor functional outcome. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Figure 1

23 pages, 858 KiB

Open AccessEditor’s ChoiceSystematic Review

Pulmonary Function Tests Post-Stroke. Correlation between Lung Function, Severity of Stroke, and Improvement after Respiratory Muscle Training

by Fotios Drakopanagiotakis, Konstantinos Bonelis, Paschalis Steiropoulos, Dimitrios Tsiptsios, Anastasia Sousanidou, Foteini Christidi, Aimilios Gkantzios, Aspasia Serdari, Styliani Voutidou, Chrysoula-Maria Takou, Christos Kokkotis, Nikolaos Aggelousis and Konstantinos Vadikolias

Neurol. Int. 2024, 16(1), 139-161; https://doi.org/10.3390/neurolint16010009 - 11 Jan 2024

Viewed by 2623

Abstract

Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs [...] Read more.

Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs in stroke survivors are limited. We reviewed the correlation between PFTs and stroke severity or degree of disability. Furthermore, we reviewed the PFT change in stroke patients undergoing a respiratory muscle training program. We searched PubMed until September 2023 using inclusion and exclusion criteria in order to identify studies reporting PFTs post-stroke and their change after a respiratory muscle training program. Outcomes included lung function parameters (FEV₁, FVC, PEF, MIP and MEP) were measured in acute or chronic stroke survivors. We identified 22 studies of stroke patients, who had undergone PFTs and 24 randomised controlled trials in stroke patients having PFTs after respiratory muscle training. The number of patients included was limited and studies were characterised by great heterogeneity regarding the studied population and the applied intervention. In general, PFTs were significantly reduced compared to healthy controls and predicted normal values and associated with stroke severity. Furthermore, we found that respiratory muscle training was associated with significant improvement in various PFT parameters and functional stroke parameters. PFTs are associated with stroke severity and are improved after respiratory muscle training. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

► Show Figures

Graphical abstract

Journal Menu

Journal Browser

Treatment Strategy and Mechanism of Acute Ischemic Stroke

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (13 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI