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Villagra Moran VM, Nila IS, Madhuvilakku R, Sumsuzzman DM, Khan ZA, Hong Y. Elucidating the role of physical exercises in alleviating stroke-associated homeostatic dysregulation: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2024; 10:e001906. [PMID: 39650569 PMCID: PMC11624745 DOI: 10.1136/bmjsem-2024-001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 10/10/2024] [Indexed: 12/11/2024] Open
Abstract
Background This study aimed to investigate the role of physical exercises as a non-pharmacological intervention for ameliorating post-stroke dysregulated homeostatic parameters. Methods Embase, PubMed, PEDro, ISI Web of Science and CENTRAL were searched until April 2024. Parallel randomised controlled trials (RCTs) analysing the effect of post-stroke physical exercises (PSPE) on homeostatic parameters such as blood glucose, oxygen consumption (VO2), high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic (SBP) and diastolic blood pressure (DBP) in individuals with stroke were selected. Results Sixteen RCTs (n=698) were included. PSPE reduced fasting glucose levels (MD=-0.22; 95% CI -0.22 to -0.02; p=0.00) and increased the VO2 (MD=2.51; 95% CI 1.65 to 3.37; p=0.00) and blood HDL levels (MD=0.07; 95% CI 0.00 to 0.13; p=0.00). However, we did not observe beneficial effects on LDL, SBP and DBP parameters. Further analyses demonstrated that both low and moderate exercises are more suitable for improving blood glucose and VO2 in this population. Discussion PSPE have the potential to improve dysregulated post-stroke parameters by reducing blood glucose levels and increasing VO2 and HDL levels. However, the small size and limited number of included studies limited the precision of our results. Further research is needed to comprehensively analyse the effects of PSPE, particularly on LDL levels and blood pressure. PROSPERO registration number CRD42023395715.
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Affiliation(s)
- Vanina Myuriel Villagra Moran
- Department of Physical Therapy, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Irin Sultana Nila
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Digital Anti-aging Healthcare, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Rajesh Madhuvilakku
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Dewan Md Sumsuzzman
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Zeeshan Ahmad Khan
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Yonggeun Hong
- Department of Physical Therapy, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Digital Anti-aging Healthcare, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
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Rigual R, Fuentes B, Díez-Tejedor E. Management of acute ischemic stroke. Med Clin (Barc) 2023; 161:485-492. [PMID: 37532617 DOI: 10.1016/j.medcli.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
Ischemic stroke is a serious neurological condition that requires urgent attention. As a time-dependent disease, acute stroke management must be coordinated and effective to provide the best treatment as early as possible. The treatment of the acute phase of ischemic stroke includes general measures to ensure patient hemodynamic stability, the use of reperfusion therapies (intravenous thrombolytics and mechanical thrombectomy), improving cerebral protection by monitoring the homeostasis of certain variables as blood pressure, glycemia, temperature, or oxygenation, as well as preventing cerebral and systemic complications. Also, it is necessary an early planning of comprehensive rehabilitation. To prevent early recurrences, control of vascular risk factors and antithrombotic treatment is recommended. The management of patients with acute ischemic stroke aims to reverse initial symptoms, to prevent further brain damage, improve functional outcomes and avoid ischemic recurrences.
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Affiliation(s)
- Ricardo Rigual
- Servicio de Neurología y Centro de Ictus, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ (Hospital Universitario La Paz - Universidad Autónoma de Madrid), Madrid, España.
| | - Blanca Fuentes
- Servicio de Neurología y Centro de Ictus, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ (Hospital Universitario La Paz - Universidad Autónoma de Madrid), Madrid, España
| | - Exuperio Díez-Tejedor
- Servicio de Neurología y Centro de Ictus, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ (Hospital Universitario La Paz - Universidad Autónoma de Madrid), Madrid, España.
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Ouro A, Correa-Paz C, Maqueda E, Custodia A, Aramburu-Núñez M, Romaus-Sanjurjo D, Posado-Fernández A, Candamo-Lourido M, Alonso-Alonso ML, Hervella P, Iglesias-Rey R, Castillo J, Campos F, Sobrino T. Involvement of Ceramide Metabolism in Cerebral Ischemia. Front Mol Biosci 2022; 9:864618. [PMID: 35531465 PMCID: PMC9067562 DOI: 10.3389/fmolb.2022.864618] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 12/12/2022] Open
Abstract
Ischemic stroke, caused by the interruption of blood flow to the brain and subsequent neuronal death, represents one of the main causes of disability in worldwide. Although reperfusion therapies have shown efficacy in a limited number of patients with acute ischemic stroke, neuroprotective drugs and recovery strategies have been widely assessed, but none of them have been successful in clinical practice. Therefore, the search for new therapeutic approaches is still necessary. Sphingolipids consist of a family of lipidic molecules with both structural and cell signaling functions. Regulation of sphingolipid metabolism is crucial for cell fate and homeostasis in the body. Different works have emphasized the implication of its metabolism in different pathologies, such as diabetes, cancer, neurodegeneration, or atherosclerosis. Other studies have shown its implication in the risk of suffering a stroke and its progression. This review will highlight the implications of sphingolipid metabolism enzymes in acute ischemic stroke.
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Affiliation(s)
- Alberto Ouro
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Clara Correa-Paz
- Translational Stroke Laboratory Group (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Elena Maqueda
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Antía Custodia
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Marta Aramburu-Núñez
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Daniel Romaus-Sanjurjo
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Adrián Posado-Fernández
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María Candamo-Lourido
- Translational Stroke Laboratory Group (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maria Luz Alonso-Alonso
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Hervella
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Translational Stroke Laboratory Group (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Appunni S, Rubens M, Ramamoorthy V, Sharma H, Singh AK, Swarup V, Singh HN. Differentially Expressed Genes and Their Clinical Significance in Ischaemic Stroke: An In-Silico Study. Malays J Med Sci 2021; 27:53-67. [PMID: 33447134 PMCID: PMC7785266 DOI: 10.21315/mjms2020.27.6.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Ischaemic stroke (IS), a multifactorial neurological disorder, is mediated by interplay between genes and the environment and, thus, blood-based IS biomarkers are of significant clinical value. Therefore, this study aimed to find global differentially expressed genes (DEGs) in-silico, to identify key enriched genes via gene set enrichment analysis (GSEA) and to determine the clinical significance of these genes in IS. Methods Microarray expression dataset GSE22255 was retrieved from the Gene Expression Omnibus (GEO) database. It includes messenger ribonucleic acid (mRNA) expression data for the peripheral blood mononuclear cells of 20 controls and 20 IS patients. The bioconductor-package ‘affy’ was used to calculate expression and a pairwise t-test was applied to screen DEGs (P < 0.01). Further, GSEA was used to determine the enrichment of DEGs specific to gene ontology (GO) annotations. Results GSEA analysis revealed 21 genes to be significantly plausible gene markers, enriched in multiple pathways among all the DEGs (n = 881). Ten gene sets were found to be core enriched in specific GO annotations. JunD, NCX3 and fibroblast growth factor receptor 4 (FGFR4) were under-represented and glycoprotein M6-B (GPM6B) was persistently over-represented. Conclusion The identified genes are either associated with the pathophysiology of IS or they affect post-IS neuronal regeneration, thereby influencing clinical outcome. These genes should, therefore, be evaluated for their utility as suitable markers for predicting IS in clinical scenarios.
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Affiliation(s)
| | | | | | - Hina Sharma
- National Network of Depression Centers India Foundation, New Delhi, India
| | | | - Vishnu Swarup
- All India Institute of Medical Sciences, New Delhi, India
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Association of hyperglycemia, systolic and diastolic hypertension, and hyperthermia relative to baseline in the acute phase of stroke with poor outcome after intravenous thrombolysis. Blood Coagul Fibrinolysis 2018; 29:167-171. [PMID: 29227292 DOI: 10.1097/mbc.0000000000000689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: In the acute phase of ischemic stroke, the trend of some physiological variables, such as blood glucose (BG), blood pressure, and body temperature (BT), might influence outcome. We aimed to assess the association of hyperglycemia, systolic and diastolic hypertension, and hyperthermia relative to baseline BG, systolic blood pressure, diastolic blood pressure and BT, respectively, in the first 12 h with poor outcome after intravenous thrombolysis (IVT). We conducted a retrospective analysis of data prospectively collected from 200 consecutive anterior ischemic stroke patients treated with IVT. Outcome measures were no neurological improvement at 24 h (National Institutes of Health Stroke Scale (NIHSS) score at 24 h ≥NIHSS score at baseline), and unfavorable functional outcome [modified Rankin Scale (mRS) score 3-6] at 3 months. No neurological improvement at 24 h was noted in 52 (26%) patients and mRS 3-6 at 3 months in 68 (34%) patients. The multivariate analyses showed that odds ratios (ORs) for no neurological improvement at 24 h were higher in patients with hyperglycemia relative to baseline [OR 3.50, 95% confidence interval (CI) 1.43-8.57, P = 0.006], and hyperthermia relative to baseline (OR 2.88, 95% CI 1.20-6.91, P = 0.018). OR for 3-month mRS score 3-6 was higher in patients with hyperthermia relative to baseline (OR 3.05, 95% CI 1.20-7.74, P = 0.019). Hyperglycemia and hyperthermia relative to baseline in the first 12 h after IVT are associated with no neurological improvement at 24 h. Hyperthermia relative to baseline is also associated with unfavorable functional outcome at 3 months.
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Godoy DA, Piñero GR, Koller P, Masotti L, Napoli MD. Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage. World J Crit Care Med 2015; 4:213-229. [PMID: 26261773 PMCID: PMC4524818 DOI: 10.5492/wjccm.v4.i3.213] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/03/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse different stages dominated by the possibility of re-bleeding, edema, intracranial hypertension, inflammation and neurotoxicity due to blood degradation products, mainly hemoglobin and thrombin. Neurological deterioration and death are common in early hours, so it is a true neurological-neurosurgical emergency. Time is brain so that action should be taken fast and accurately. The most significant prognostic factors are level of consciousness, location, volume and ventricular extension of the bleeding. Nihilism and early withdrawal of active therapy undoubtedly influence the final result. Although there are no proven therapeutic measures, treatment should be individualized and guided preferably by pathophysiology. The multidisciplinary teamwork is essential. Results of recently completed studies have birth to promising new strategies. For correct management it’s important to establish an orderly and systematic strategy based on clinical stabilization, evaluation and establishment of prognosis, avoiding secondary insults and adoption of specific individualized therapies, including hemostatic therapy and intensive control of elevated blood pressure. Uncertainty continues regarding the role of surgery.
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Alonso de Leciñana M, Egido J, Casado I, Ribó M, Dávalos A, Masjuan J, Caniego J, Martínez Vila E, Díez Tejedor E, Fuentes (Secretaría) B, Álvarez-Sabin J, Arenillas J, Calleja S, Castellanos M, Castillo J, Díaz-Otero F, López-Fernández J, Freijo M, Gállego J, García-Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Martí-Fábregas J, Martínez-Sánchez P, Molina C, Morales A, Nombela F, Purroy F, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J, Vivancos J. Guidelines for the treatment of acute ischaemic stroke. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2011.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Gutiérrez-Fernández M, Rodríguez-Frutos B, Ramos-Cejudo J, Otero-Ortega L, Fuentes B, Díez-Tejedor E. Stem cells for brain repair and recovery after stroke. Expert Opin Biol Ther 2013; 13:1479-83. [PMID: 23915288 DOI: 10.1517/14712598.2013.824420] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Stroke is a major worldwide cause of death and disability. Currently, intravenous thrombolysis and reperfusion therapies, but not the so-called neuroprotectant drugs, have been shown to be effective for acute ischemic stroke. Thus, new strategies to promote brain plasticity are necessary. Stem cell administration is an attractive future therapeutic approach. AREAS COVERED Brain protection and repair mechanisms are activated after stroke. This article is focused on the capacity of stem cell-based therapy to enhance this postinfarct brain plasticity and recovery. Future therapeutic considerations and prospects for stroke are discussed. EXPERT OPINION Although cell therapy is promising in stroke treatment, mechanisms of action need to be characterized in detail. Further, the different mechanisms of axonal plasticity and remodeling involucrated in brain repair, not only in the gray but also in white matter, must be investigated through noninvasive techniques, and a multidisciplinary approach is fundamental in this.
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Affiliation(s)
- María Gutiérrez-Fernández
- Autonoma University of Madrid, Neuroscience Area of IdiPAZ (Health Research Institute), La Paz University Hospital, Department of Neurology and Stroke Centre, Neuroscience and Cerebrovascular Research Laboratory , Madrid , Spain
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Alonso de Leciñana M, Gutiérrez-Fernández M, Romano M, Cantú-Brito C, Arauz A, Olmos LE, Ameriso SF, Díez-Tejedor E. Strategies to improve recovery in acute ischemic stroke patients: Iberoamerican Stroke Group Consensus. Int J Stroke 2013; 9:503-13. [PMID: 23802573 DOI: 10.1111/ijs.12070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/31/2012] [Indexed: 12/20/2022]
Abstract
Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.
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Affiliation(s)
- M Alonso de Leciñana
- Stroke Unit, Deparment of Neurology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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Martínez-Martínez MM, Fernández-Travieso J, Fuentes B, Ruiz-Ares G, Martínez-Sánchez P, Cazorla García R, Rodríguez de Antonio LA, Alonso-Singer P, Oliva-Navarro J, Díez-Tejedor E. Off-hour effects on stroke care and outcome in stroke centres. Eur J Neurol 2012; 19:1140-5. [DOI: 10.1111/j.1468-1331.2012.03692.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guidelines for the treatment of acute ischaemic stroke. Neurologia 2011; 29:102-22. [PMID: 22152803 DOI: 10.1016/j.nrl.2011.09.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 09/11/2011] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. DEVELOPMENT Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. CONCLUSION Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated.
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Salat D, Delgado P, Alonso S, Ribó M, Santamarina E, Quintana M, Alvarez-Sabín J, Montaner J. Ischemic stroke outcome and early infection: its deleterious effect seems to operate also among tissue plasminogen activator-treated patients. Eur Neurol 2011; 65:82-7. [PMID: 21346358 DOI: 10.1159/000322903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 11/18/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infection has been recognized as a significant predictor of outcome for ischemic stroke patients, although the mechanisms by which this association is operative have not been fully established, and their potential roles in a setting of close clinical monitoring, such as that of stroke units offering reperfusion therapies, have not been evaluated. METHODS We reviewed the medical records of 139 consecutive tissue plasminogen activator-treated stroke patients admitted to our stroke unit to evaluate potential predictors of neurological outcome. RESULTS 57 patients (41%) did not show neurological improvement by discharge, and 11.5% died during admission. Infections were related to lack of improvement (29.8 vs. 14.6%; p = 0.03) and PH-type hemorrhagic transformation (42.1 vs. 17.5%; p = 0.014); the latter was associated with a higher mortality rate (26.3 vs. 9.2%; p = 0.03). CONCLUSIONS Infection may be associated with poor functional outcome among tissue plasminogen activator-treated stroke patients.
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Affiliation(s)
- David Salat
- Neurovascular Research Laboratory and Neurovascular Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
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Abstract
Background The development of specialized stroke units has been a landmark innovation in acute stroke care. However, the high scientific evidence level for the recommendation for stroke units to provide clinical attention for acute stroke patients does not correspond to the level of stroke unit implementation. A narrative, nonsystematic review on published studies on stroke units was conducted, with special emphasis on those demonstrating their efficacy and effectiveness. We also attempt to provide some answers to several open questions regarding practical issues of stroke units.
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Affiliation(s)
- Blanca Fuentes
- Stroke Unit, Department of Neurology, University Hospital La Paz, Autonomous University of Madrid, Madrid, Spain
| | - Exuperio Diez-Tejedor
- Stroke Unit, Department of Neurology, University Hospital La Paz, Autonomous University of Madrid, Madrid, Spain
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Arterial ischemic stroke in children--recent advances. Indian J Pediatr 2008; 75:1149-57. [PMID: 19132317 DOI: 10.1007/s12098-008-0239-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
Childhood stroke syndromes are an important cause of mortality and morbidity. This paper focuses on the recent advances in arterial ischaemic stroke beyond the neonatal period. Vascular risk factors are identified in the majority of children and guide both acute and longer term treatments, as well as determining prognosis. Contrary to popular belief many children have residual impairments encompassing a wide range of domains. National and international collaborations are facilitating an increase in the understanding of childhood stroke and have the eventual aim of conducting trials of potential therapeutic interventions.
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Wong AA, Read SJ. Early changes in physiological variables after stroke. Ann Indian Acad Neurol 2008; 11:207-20. [PMID: 19893676 PMCID: PMC2771993 DOI: 10.4103/0972-2327.44555] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 09/23/2008] [Accepted: 09/23/2008] [Indexed: 01/04/2023] Open
Abstract
Several aspects of physiology, notably blood pressure, body temperature, blood glucose, and blood oxygen saturation, may be altered after an ischemic stroke and intracerebral hemorrhage. Generally, blood pressure and temperature rise acutely after a stroke, before returning to normal. Blood glucose and oxygen levels may be abnormal in individuals, but they do not follow a set pattern. Several aspects of these physiological alterations remain unclear, including their principal determinants - whether they genuinely affect prognosis (as opposed to merely representing underlying processes such as inflammation or a stress response), whether these effects are adaptive or maladaptive, whether the effects are specific to certain subgroups (e.g. lacunar stroke) and whether modifying physiology also modifies its prognostic effect. Hypertension and hyperglycemia may be helpful or harmful, depending on the perfusion status after an ischemic stroke; the therapeutic response to their lowering may be correspondingly variable. Hypothermia may provide benefits, in addition to preventing harm through protection from hyperthermia. Hypoxia is harmful, but normobaric hyperoxia is unhelpful or even harmful in normoxic patients. Hyperbaric hyperoxia, however, may be beneficial, though this remains unproven. The above-mentioned uncertainties necessitate generally conservative measures for physiology management, although there are notably specific recommendations for thrombolysis-eligible patients. Stroke unit care is associated with better outcome, possibly through better management of poststroke physiology. Stroke units can also facilitate research to clarify the relationship between physiology and prognosis, and to subsequently clarify management guidelines.
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Affiliation(s)
- Andrew A Wong
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. Central Clinical School, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
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Fuentes B, Díez-Tejedor E. General Care in Stroke: Relevance of Glycemia and Blood Pressure Levels. Cerebrovasc Dis 2007; 24 Suppl 1:134-42. [DOI: 10.1159/000107389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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