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Trends in oral anticoagulation for acute ischemic stroke prevention in patients with preexisting atrial fibrillation
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Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
Background: Emotional well-being is closely related to health. A lot of medical illnesses are closely linked to disrupted mental health. Men with introvert personality are particularly at high risk of ischaemic stroke. Hypothesis/objective: Suppressed anger within the past 2 weeks is a risk for stroke. Patients with introvert personality are more likely to develop ischaemic stroke, whereas those with bad temper and recent rage outburst tend to present with intracranial haemorrhage. Patients and methods: Patients admitted to the ward with stroke (both ischaemic and haemorrhagic) were interviewed about whether they have suppressed anger over the past 2 weeks. Results: More than 50% of strokes admitted that they have suppressed anger or upset within the past 2 weeks. The suppressed anger intensified to maximum just 1–2 weeks prior to onset of the disease. In cryptogenic young stroke group who has no other medical risks, suppressed anger was clearly identified. Conclusion: Our findings suggest that suppressed anger is a clear risk for stroke. We hope that the public will become aware these finding. In order to prevent recurrent stroke, it is advisable not to suppress the anger and instead try to channel out the suppressed anger.
doi:10.1016/j.jns.2013.07.820
Abstract — WCN 2013 No: 1559 Topic: 3 — Stroke Hyperhomocysteinemia and hyperlactatemia in lacunar ischemic stroke in young adults S. Evtushenko, D. Filimonov. Department of Pediatric and General Neurology, M. Gorky Donetsk National Medical University, Donetsk, Ukraine Background: The recent studies suggested a possible effect of high levels of homocysteine (Hcy) on the redox potential of the cells, which may be important in the formation of ischemic penumbra. Objective: To determine the possible correlation relationship between Hcy and indicators of the lactate-pyruvate metabolism in acute lacunar ischemic stroke (IS) in young adults. Materials and methods: The study included 30 patients aged from 32 to 45 years with lacunar IS in the acute phase. The risk factors had been presented by hypertension, hypercholesterolemia, and metabolic syndrome. The diagnosis of lacunar stroke had been confirmed by typical clinical symptoms, MR imaging, as well as the lack of data in favor of cardiac or another source embolism. In addition to conventional methods, the survey included an analysis of Hcy, lactate and pyruvate. Results: 21 patients (70%) with lacunar IS had elevated Hcy up to 14.12 ± 1.18 mkmol/L, lactate up to 5.2 ± 1.34 mmol/L, and a slight increase in pyruvate up to 0.16 ± 0.05 mmol/L. There was a statistically significant correlation relationship between Hcy and lactate levels (r = 0.37, p b 0.05). There was no correlation between Hcy and pyruvate. Conclusions: This research revealed statistically significant correlation between homocysteine and lactate levels in the lacunar stroke in young adults. Despite the controversies in the literature, hyperhomocysteinemia may have its role in the developing of the lacunar stroke, especially in young adults.
doi:10.1016/j.jns.2013.07.821
Abstract — WCN 2013 No: 1586 Topic: 3 — Stroke Trends in oral anticoagulation for acute ischemic stroke prevention in patients with preexisting atrial fibrillation J.P. Bembenek, M. Karliński, A. Kobayashi, A. Członkowska. 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland Background: Effective anticoagulation with vitamin K antagonists (VKA) is the standard treatment for stroke prevention in the majority of patients with atrial fibrillation (AF). The proper anticoagulation in AF patients is still problematic and many of them receive suboptimal treatment. Hence, further efforts are necessary in this field. Objective: Our aim was to evaluate the changes in the use of VKA for ischemic stroke prevention in patients with preexisting AF over the past 15 years. Methods: We analyzed consecutive patients admitted to our center due to acute ischemic stroke between 1995 and 2011. Data regarding the use of VKA were analyzed. We distinguished between periods: 1995–2000, 2001–2005 and 2006–2011. Results: In the analyzed time periods prestroke history of AF was reported with similar frequency (years 1995–2000: 25.2%; years 2001–2005: 24.3%; years 2006–2011: 24.7%). The proportion of patients with AF using VKA before stroke was significantly (p b 0.001) increasing (8.5%, 14.6%, 27.4%), as well as the proportion of AF patients using antiplatelets (37.6%, 47.3%, 47.2%). However, the proportion of AF patients using VKA with INR 2–3 has decreased (29.4%, 11.9%, 9.6%). It explains why the number of strokes due to AF did not change during the observation period. During hospital stay AF was diagnosed in additional 2.9%, 4.9% and 7.0% of patients. Conclusions: The number of acute stroke patients with AF treated with VKA before the stroke onset is systematically growing. However, high ratio of patients receiving suboptimal doses suggests the constantly low guideline adherence among physicians and/or patient noncompliance. doi:10.1016/j.jns.2013.07.822
Abstract — WCN 2013 No: 1579 Topic: 3 — Stroke A case of infant with ischemic stroke after varicella infection Z. Albahria, L. Minxováa, O. Pozlera, A. Lukeša, P. Rozsívala, R. Kračmarováb, J. Kučerovác, M. Talábovác, Š. Štefáčkovác. aPediatrics, University in Prague, Faculty Hospital, Hradec Králové, Czech Republic; b Infectious and Tropical Disease, University in Prague, Faculty Hospital, Hradec Králové, Czech Republic; cNeurology, Charles University in Prague, Faculty Hospital, Hradec Králové, Czech Republic Stroke due to central nervous system vasculopath is a recognized as rare complication of varicella-zoster virus infections. We describe a case of an 18-month-old previously healthy infant presented with partial seizures and left faciobrachial paresis 2 months after varicella infection. Magnetic resonance imaging of the brain showed acute and subacute ischemic lesions in the right cerebral hemisphere and in the basal ganglia. VZV-DNA was detected by PCR analysis in the CSF and blood, the patient was treated with intravenous acyclovir followed by oral treatment for 4 weeks and low doses of corticosteroids. doi:10.1016/j.jns.2013.07.823
Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214
Background: Emotional well-being is closely related to health. A lot of medical illnesses are closely linked to disrupted mental health. Men with introvert personality are particularly at high risk of ischaemic stroke. Hypothesis/objective: Suppressed anger within the past 2 weeks is a risk for stroke. Patients with introvert personality are more likely to develop ischaemic stroke, whereas those with bad temper and recent rage outburst tend to present with intracranial haemorrhage. Patients and methods: Patients admitted to the ward with stroke (both ischaemic and haemorrhagic) were interviewed about whether they have suppressed anger over the past 2 weeks. Results: More than 50% of strokes admitted that they have suppressed anger or upset within the past 2 weeks. The suppressed anger intensified to maximum just 1–2 weeks prior to onset of the disease. In cryptogenic young stroke group who has no other medical risks, suppressed anger was clearly identified. Conclusion: Our findings suggest that suppressed anger is a clear risk for stroke. We hope that the public will become aware these finding. In order to prevent recurrent stroke, it is advisable not to suppress the anger and instead try to channel out the suppressed anger.
doi:10.1016/j.jns.2013.07.820
Abstract — WCN 2013 No: 1559 Topic: 3 — Stroke Hyperhomocysteinemia and hyperlactatemia in lacunar ischemic stroke in young adults S. Evtushenko, D. Filimonov. Department of Pediatric and General Neurology, M. Gorky Donetsk National Medical University, Donetsk, Ukraine Background: The recent studies suggested a possible effect of high levels of homocysteine (Hcy) on the redox potential of the cells, which may be important in the formation of ischemic penumbra. Objective: To determine the possible correlation relationship between Hcy and indicators of the lactate-pyruvate metabolism in acute lacunar ischemic stroke (IS) in young adults. Materials and methods: The study included 30 patients aged from 32 to 45 years with lacunar IS in the acute phase. The risk factors had been presented by hypertension, hypercholesterolemia, and metabolic syndrome. The diagnosis of lacunar stroke had been confirmed by typical clinical symptoms, MR imaging, as well as the lack of data in favor of cardiac or another source embolism. In addition to conventional methods, the survey included an analysis of Hcy, lactate and pyruvate. Results: 21 patients (70%) with lacunar IS had elevated Hcy up to 14.12 ± 1.18 mkmol/L, lactate up to 5.2 ± 1.34 mmol/L, and a slight increase in pyruvate up to 0.16 ± 0.05 mmol/L. There was a statistically significant correlation relationship between Hcy and lactate levels (r = 0.37, p b 0.05). There was no correlation between Hcy and pyruvate. Conclusions: This research revealed statistically significant correlation between homocysteine and lactate levels in the lacunar stroke in young adults. Despite the controversies in the literature, hyperhomocysteinemia may have its role in the developing of the lacunar stroke, especially in young adults.
doi:10.1016/j.jns.2013.07.821
Abstract — WCN 2013 No: 1586 Topic: 3 — Stroke Trends in oral anticoagulation for acute ischemic stroke prevention in patients with preexisting atrial fibrillation J.P. Bembenek, M. Karliński, A. Kobayashi, A. Członkowska. 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland Background: Effective anticoagulation with vitamin K antagonists (VKA) is the standard treatment for stroke prevention in the majority of patients with atrial fibrillation (AF). The proper anticoagulation in AF patients is still problematic and many of them receive suboptimal treatment. Hence, further efforts are necessary in this field. Objective: Our aim was to evaluate the changes in the use of VKA for ischemic stroke prevention in patients with preexisting AF over the past 15 years. Methods: We analyzed consecutive patients admitted to our center due to acute ischemic stroke between 1995 and 2011. Data regarding the use of VKA were analyzed. We distinguished between periods: 1995–2000, 2001–2005 and 2006–2011. Results: In the analyzed time periods prestroke history of AF was reported with similar frequency (years 1995–2000: 25.2%; years 2001–2005: 24.3%; years 2006–2011: 24.7%). The proportion of patients with AF using VKA before stroke was significantly (p b 0.001) increasing (8.5%, 14.6%, 27.4%), as well as the proportion of AF patients using antiplatelets (37.6%, 47.3%, 47.2%). However, the proportion of AF patients using VKA with INR 2–3 has decreased (29.4%, 11.9%, 9.6%). It explains why the number of strokes due to AF did not change during the observation period. During hospital stay AF was diagnosed in additional 2.9%, 4.9% and 7.0% of patients. Conclusions: The number of acute stroke patients with AF treated with VKA before the stroke onset is systematically growing. However, high ratio of patients receiving suboptimal doses suggests the constantly low guideline adherence among physicians and/or patient noncompliance. doi:10.1016/j.jns.2013.07.822
Abstract — WCN 2013 No: 1579 Topic: 3 — Stroke A case of infant with ischemic stroke after varicella infection Z. Albahria, L. Minxováa, O. Pozlera, A. Lukeša, P. Rozsívala, R. Kračmarováb, J. Kučerovác, M. Talábovác, Š. Štefáčkovác. aPediatrics, University in Prague, Faculty Hospital, Hradec Králové, Czech Republic; b Infectious and Tropical Disease, University in Prague, Faculty Hospital, Hradec Králové, Czech Republic; cNeurology, Charles University in Prague, Faculty Hospital, Hradec Králové, Czech Republic Stroke due to central nervous system vasculopath is a recognized as rare complication of varicella-zoster virus infections. We describe a case of an 18-month-old previously healthy infant presented with partial seizures and left faciobrachial paresis 2 months after varicella infection. Magnetic resonance imaging of the brain showed acute and subacute ischemic lesions in the right cerebral hemisphere and in the basal ganglia. VZV-DNA was detected by PCR analysis in the CSF and blood, the patient was treated with intravenous acyclovir followed by oral treatment for 4 weeks and low doses of corticosteroids. doi:10.1016/j.jns.2013.07.823