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Severe Stroke (severe + stroke)
Selected AbstractsStroke education: discrepancies among factors influencing prehospital delay and stroke knowledgeINTERNATIONAL JOURNAL OF STROKE, Issue 3 2010Yvonne Teuschl Background Time is essential for the treatment of acute stroke. Much time is lost outside the hospital, either due to failure in identifying stroke symptoms or due to a delay in notification or transport. We review studies reporting factors associated with better stroke knowledge and shorter time delays. We summarise the evidences for the effect of stroke knowledge and education on people's reaction in the acute situation of stroke. Methods We searched MEDLINE for studies reporting factors associated with prehospital time of stroke patients, or knowledge of stroke symptoms. Further, we searched for studies reporting educational interventions aimed at increasing stroke symptom knowledge in the population. Findings We included a total of 182 studies. Surprisingly, those factors associated with better stroke knowledge such as education and sociodemographic variables were not related to shorter time delays. Few studies report shorter time delays or better stroke knowledge in persons having suffered a previous stroke. Factors associated with shorter time delays were more severe stroke and symptoms regarded as serious, but not better knowledge about the most frequent symptoms such as hemiparesis or disorders of speech. Only 25,56% of patients recognised their own symptoms as stroke. While stroke education increases the knowledge of warning signs, a few population studies measured the impact of education on time delays; in such studies, time delays decreased after education. This may partly be mediated by better organisation of EMS and hospitals. Interpretation There is a discrepancy between theoretical stroke knowledge and the reaction in an acute situation. Help-seeking behaviour is more dependent on the perceived severity of symptoms than on symptom knowledge. Bystanders play an important role in the decision to call for help and should be included in stroke education. Education is effective and should be culturally adapted and presented in a social context. It is unclear which educational concept is best suited to enhance symptom recognition in the acute situation of stroke, especially in view of discrepancies between knowledge and action. [source] Depression predicts unfavourable functional outcome and higher mortality in stroke patients: The Bergen Stroke StudyACTA NEUROLOGICA SCANDINAVICA, Issue 2010H. Naess Naess H, Lunde L, Brogger J, Waje-Andreassen U. Depression predicts unfavourable functional outcome and higher mortality in stroke patients: The Bergen Stroke Study. Acta Neurol Scand: 2010: 122 (Suppl. 190): 34,38. © 2010 John Wiley & Sons A/S. Objective,,, To assess the influence of depression prior to stroke (PD) on stroke severity on admittance, functional outcome (short- and long-term), mortality, and long-term depression (PSD). Methods,,, Consecutive acute stroke patients were screened for PD. The National Institute of Health Stroke Scale score was obtained on admission. Short-term functional state was registered by the modified Rankin scale and on long-term functional outcome by the Barthel Index. PSD was defined as depression subscale of the hospital anxiety and depression scale (HADSD) ,11. HADSD and Barthel Index were obtained by postal questionnaire. Survival analyses were performed. Results,,, Among 771 patients 21.7% had PD. Among 376 patients returning the questionnaire, 8.8% were depressed. On logistic regression analyses severity of stroke on admission, short-term, and long-term functional outcome were independently associated with PD. Logistic regression showed PSD to be independently associated with PD and being unmarried. Cox regression analyses showed that both PD and PSD were associated with high long-term mortality. Conclusions,,, This study has identified several factors associated with PSD. PD predicts more severe stroke on admittance and less functional improvement both in the short- and the long-term. Both PD and PSD predict higher long-term mortality. [source] The Debrecen Stroke Database: demographic characteristics, risk factors, stroke severity and outcome in 8088 consecutive hospitalised patients with acute cerebrovascular diseaseINTERNATIONAL JOURNAL OF STROKE, Issue 5 2009D. Bereczki Background High stroke mortality in central,eastern European countries might be due to higher stroke incidence, more severe strokes or less effective acute care than in countries with lower mortality rate. Hospital databases usually yield more detailed information on risk factors, stroke severity and short-term outcome than population-based registries. Patients and methods The Debrecen Stroke Database, data of 8088 consecutively hospitalised patients with acute cerebrovascular disease in a single stroke centre in East Hungary between October 1994 and December 2006, is analysed. Risk factors were recorded and stroke severity on admission was scored by the Mathew stroke scale. The modified Glasgow outcome scale was used to describe patient condition at discharge. Results Mean age was 68±13 years, 11·4% had haemorrhagic stroke. The rate of hypertension on admission was 79% in men, and 84% in women, 40·3% of men and 19·8% of women were smokers, and 34% of all patients had a previous cerebrovascular disease in their history. Case fatality was 14·9%, and 43% had some disability at discharge. Outcome at discharge was worse with higher age, higher glucose, higher blood pressure, higher white cell count and erythrocyte sedimentation rate and more severe clinical signs on admission. In multivariate analysis admission blood pressure lost its significance in predicting outcome. Conclusions In this large Hungarian stroke unit database hypertension on admission, smoking and previous cerebrovascular disease were more frequent than in most western databases. These findings indicate major opportunities for more efficient stroke prevention in this and probably other eastern European countries. [source] A review on sex differences in stroke treatment and outcomeACTA NEUROLOGICA SCANDINAVICA, Issue 6 2010P. Appelros Appelros P, Stegmayr B, Terént A. A review on sex differences in stroke treatment and outcome. Acta Neurol Scand: 2010: 121: 359,369. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Background,,, Beyond epidemiological differences, it has been controversial whether any important sex differences exist in the treatment of stroke. In this review paper, the following areas are covered: thrombolysis, stroke unit care, secondary prevention, surgical treatment, and rehabilitation. Additionally, symptoms at stroke onset, as well as outcome measures, such as death, dependency, stroke recurrence, quality of life, and depression are reviewed. Methods,,, Search in PubMed, tables-of-contents, review articles, and reference lists after studies that include information about sex differences in stroke care. Results,,, Ninety papers are included in this review. Women suffer more from cortical and non-traditional symptoms. Men and women benefit equally from thrombolysis and stroke unit care. Women with cardioembolic strokes may benefit more from anticoagulant therapy. Most studies have not found any tendency towards sexism in the choice of treatment. Post-stroke depression and low quality-of-life seem to be more common among women. Mortality rates are higher among men in some studies, while long-term ADL-dependency seems to be more common among women. Conclusions,,, Sex differences in stroke treatment and outcome are small, with no unequivocal proof of sex discrimination. Women have less favourable functional outcome because of higher age at stroke onset and more severe strokes. [source] | ||||||||||