Objective Few studies have examined frailty in patients with first-ever stroke who were independent in activities of daily living (ADLs) prior to onset. This study aimed to investigate the characteristics of pre-stroke frailty and its impact on ADLs at discharge. Methods In this prospective cohort study, 152 patients aged ≥65 years with first-ever stroke admitted to the stroke unit of a university hospital were enrolled. Pre-frailty/frailty was assessed using the Clinical Frailty Scale (CFS). Associations between frailty status and clinical characteristics were evaluated. Multivariate regression analysis identified independent predictors of the Barthel Index (BI) at discharge. Results Pre-frailty/frailty was present in 35.5% of patients, and was associated with higher rates of atrial fibrillation (p = 0.043) and cardioembolic stroke (p = 0.001). Compared with the robust group, the pre-frailty/frailty group had significantly lower BI scores at both admission and discharge, as well as more extended hospital stays. Both groups, however, demonstrated significant improvement in BI at discharge (p < 0.001). Multivariate analysis revealed that NIH Stroke Scale score (p < 0.001), stroke type (p = 0.010), and CFS score (p = 0.044) independently predicted BI at discharge. Conclusion Pre-stroke frailty is associated with a higher risk of cardioembolic stroke and poorer functional status during hospitalization. Nevertheless, patients with frailty still achieved significant ADL improvement with rehabilitation, underscoring the importance of active rehabilitation strategies in this population.
Cerebral venous thrombosis (CVT) is a rare multifactorial disease which has been associated with inherited thrombophilic factors. The present study was performed to assess the association of genetic markers such as factor V of Leiden (FVL), methylenotetrahydrofolate reductase (MTHFR), Plasminogen Activator Inhibitor-1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI) polymorphisms and underlying conditions as risk factors for CVT in Tunisian patients.Fifty-two patients with radiologically confirmed CVT and 60 age- and sex-matched healthy controls were enrolled in the study. The DNAs of both groups were tested. We found that the frequency of 4G/4G of PAI-1 gene was higher among CVT group in comparison to controls (p < 0.001) and significantly associated with CVT of undetermined origin (p < 0.001). Heterozygous and homozygous models of C1040T -TAFI genotypes were associated with an increased risk of CVT compared to controls (p = 0.01; OR 6.6 and 9.15 respectively) as well as homozygous mutation of the PAI gene (p < 0.001; OR = 12.32). The risk of CVT was relevant in the presence of combined mutant genotypes of MTHFR (CT)/ PAI-1 (4G4G) and PAI-1 (4G4G)/ TAFI (CT) mutations (P = 0.035; OR: 10.68 and 13.19 respectively).This is the first case-control study from Tunisia establishing PAI-1 4G/4G and C1040T-TAFI variants as a strong risk factor for CVT in comparison to healthy controls as well as combined mutant genotypes of MTHFR, PAI-1and TAFI, so they should be included in laboratory testing panel of thrombophilia. Knowing the subset of patients carrying these genetic thrombophilia markers enables physicians to take appropriate measures to prevent future CVT recurrence.
Swallowing is regulated by cortical networks and the caudal brainstem. Damage to central pattern generators, commonly seen after stroke, can result in severe dysphagia with limited treatment options. Pharyngeal electrical stimulation (PES) presents a promising therapy as it may enhance sensory input to impaired brainstem networks by targeting pharyngeal sensory afferents, the primary site of dysfunction in brainstem infarction. This single-case study reports on a 78-year-old woman with a confirmed left-sided infarction in the dorsolateral medulla oblongata, resulting in severe dysphagia. PES was delivered 2 days after the onset of symptoms using the Phagenyx® system via a nasogastric catheter. The stimulation was applied at 5 Hz for 10 min daily over 4 days. The initial fiberoptic endoscopic evaluation of swallowing (FEES) showed severe dysphagia with saliva aspiration. Assessment revealed a Penetration-Aspiration-Scale (PAS) score of 8 for half a tablespoon of ice chips, alongside a score of 3 on Murray's Secretion Scale (MSS) and 7 on the New Zealand Secretion Scale (NZSS). No other consistencies were tested. After 4 consecutive days of stimulation followed by a 48-h period without stimulation, follow-up FEES revealed normal swallowing frequency and adequate saliva control, with a score of 0 on MSS. The patient safely swallowed all tested consistencies, scoring 1 on the PAS. On the NZSS, both fluids and solids scored 0. With pudding, residue in the pyriform fossae resulted in a score of 1. PES appears to be a targeted and effective approach for the treatment of severe dysphagia after brainstem stroke.
Background Despite abundant evidence linking hyperglycemia to stroke, its heterogeneous effects across stroke etiologies and lesions remain unclear. We examined the associations between admission glycated hemoglobin (HbA1c) levels and stroke subtypes, lesions, and functional outcomes. Methods Adults with acute ischemic stroke admitted between 2016 and 2020 were analyzed using a Japanese nationwide registry. Patients were grouped by admission HbA1c (<6.0%, 6.0–6.9%, 7.0–7.9%, and ≥ 8.0%). Stroke subtypes were determined using the Trial of Org 10,172 in Acute Stroke Treatment criteria. Lesion was categorized as cerebral cortex, basal ganglia/corona radiata, thalamus, brainstem, or cerebellum. Unfavorable outcome was defined as discharge modified Rankin Scale (mRS) >2 for patients with premorbid mRS ≤2, or higher discharge mRS than premorbid mRS for others. Associations were assessed using multivariable mixed-effects logistic regression analysis. Results Among 13,569 patients, HbA1c was <6.0% in 7001 (51.6%), 6.0–6.9% in 4201 (31.0%), 7.0–7.9% in 1264 (9.3%), and ≥ 8.0% in 1103 (8.1%). Higher HbA1c levels were associated with a greater proportion of large artery atherosclerosis (adjusted OR for HbA1c ≥8.0% vs <6.0%, 1.40; 95% CI, 1.19–1.65) and lower proportion of cardioembolism (0.63; 0.50–0.79). Elevated HbA1c levels were associated with higher prevalence of brainstem lesions (2.35; 1.82–3.02) and lower prevalence of cerebral cortex and basal ganglia/corona radiata lesions, even after adjusting for stroke subtype. Unfavorable outcomes were more common in patients with higher HbA1c levels (overall, 1.56; 1.31–1.85), particularly in those with large artery atherosclerosis and cardioembolism. Conclusions Higher admission HbA1c levels were associated with a higher proportion of large artery atherosclerosis and a lower proportion of cardioembolism, with a higher proportion of brainstem lesions and a lower proportion of cortical and basal ganglia/corona radiata lesions, and with worse functional outcomes.
Background:Stroke as the major cause of mortality and morbidity worldwide, requires early assessment of severity and prognosis for effective treatment. There is an emerging role of inflammatory markers in stroke severity. Thus, we aimed to determine the correlation of neutrophil to HDL-cholesterol ratio (NHR) and monocyte to HDL-cholesterol ratio (MHR) with the severity of acute ischemic stroke (AIS). Methodology:A single Centre cross-sectional study involving adult patients with AIS. Patients were grouped into mild and moderate-severe stroke by National Institute of Health Severity Scale (NIHSS). Demographic, clinical and laboratory data of participants were collected.Spearman correlation analysis, univariate and multiple logistic regression analysis were utilized to explore the correlation between MHR with AIS severity. A receiver operating characteristic curve was created to determine the discriminatory ability of MHR in assessing stroke severity. Results:Male gender, diabetes, hypertension, monocyte count, triglyceride, total cholesterol, CRP, uric acid and MHR were found statistically significant between the mild and moderate-severe stroke groups. Spearman correlation analysis produced a weak but statistically significant positive correlation between MHR and NIHSS score with a correlation coefficient of 0.201 (P = 0.026). Binary logistic regression analysis demonstrated that MHR had statistically insignificant positive association with higher NIHSS scores (OR = 2.275, 95% CI: 0.924-5.6, p = 0.074). Multiple logistic regression analysis revealed that MHR was not independently associated with stroke severity scale (adjusted OR = 1.527, 95% CI: 0.559-4.173, p = 0.409). The area under the curve (AUC) for MHR association with AIS was 0.588 (95% CI: 0.485-0.691, p = 0.101) with specificity of 87.5% and sensitivity of 40.5%. Conclusion:MHR could serve as a new, readily accessible and inexpensive indicator of the severity of AIS.
