Silent Infarcts, White Matter Integrity, and Oxygen Metabolic Stress in Young Adults With and Without Sickle Cell Trait

Stroke, Ahead of Print. Background:Individuals with sickle cell anemia have heightened risk of stroke and cognitive dysfunction. Given its high prevalence globally, whether sickle cell trait (SCT) is a risk factor for neurological injury has been of interest; however, data have been limited. We hypothesized that young, healthy adults with SCT would show normal cerebrovascular structure and hemodynamic function.Methods:As a case-control study, young adults with (N=25, cases) and without SCT (N=24, controls) underwent brain magnetic resonance imaging to quantify brain volume, microstructural integrity (fractional anisotropy), silent cerebral infarcts (SCI), intracranial stenosis, and aneurysms. Pseudocontinuous arterial spin labeling and asymmetric spin echo sequences measured cerebral blood flow and oxygen extraction fraction, respectively, from which cerebral metabolic oxygen demand was calculated. Imaging metrics were compared between SCT cases and controls. SCI volume was correlated with baseline characteristics.Results:Compared with controls, adults with SCT demonstrated similar normalized brain volumes (SCT 0.80 versus control 0.81,P=0.41), white matter fractional anisotropy (SCT 0.41 versus control 0.43,P=0.37), cerebral blood flow (SCT 62.04 versus control, 61.16 mL/min/100 g,P=0.67), oxygen extraction fraction (SCT 0.27 versus control 0.27,P=0.31), and cerebral metabolic oxygen demand (SCT 2.71 versus control 2.70 mL/min/100 g,P=0.96). One per cohort had an intracranial aneurysm. None had intracranial stenosis. The SCT cases and controls showed similar prevalence and volume of SCIs; however, in the subset of participants with SCIs, the SCT cases had greater SCI volume versus controls (0.29 versus 0.07 mL,P=0.008). Of baseline characteristics, creatinine was mildly elevated in the SCT cohort (0.9 versus 0.8 mg/dL,P=0.053) and correlated with SCI volume (ρ=0.49,P=0.032). In the SCT cohort, SCI distribution was similar to that of young adults with sickle cell anemia.Conclusions:Adults with SCT showed normal cerebrovascular structure and hemodynamic function. These findings suggest that healthy individuals with SCT are unlikely to be at increased risk for early or accelerated ischemic brain injury.

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Maggio 2022

307 Dispatcher-assisted cardiopulmonary resuscitation is affected by a bystanders emotional stress state in out-of-hospital cardiac arrest

BackgroundThe study aimed to investigate whether a bystander’s emotional stress state affects DA-CPR in OHCA. The primary outcome was time from recognition of OHCA by the medical dispatcher until first chest compression delivered. Secondarily, we investigated time from recognition of OHCA until initiation of CPR-instructions as well as quality of DA-CPR instructions according to the caller’s emotional stress state.MethodThe study was a retrospective and observational study of OHCA emergency call recordings from the Capital Region of Denmark. Callers were evaluated by five raters using a simplified emotional content and cooperation score (ECCS).Results894 call were included of which 250 callers were registered as emotional stressed. We found a significantly longer time from recognition of OHCA until first chest compression delivered in the emotional stressed callers vs. the not emotional stressed callers (65 s vs.38 s; P < 0.001). There was no significant difference in time from recognition of OHCA until initiation of CPR-instructions (P = 0.12). Furthermore, there was a significant higher incidence of the medical dispatcher being assertive and encouraging when instructing, and of the medical dispatcher instructing on speed and depth of chest compressions in calls with an emotional stressed caller (P = 0.006, P < 0.001 and P < 0.001).ConclusionThe emotional stressed callers had a significantly longer time from recognition of OHCA by the medical dispatcher until first chest compression was delivered. In addition, the quality of DA-CPR instructions given was significantly higher in the emotional stressed group.Conflict of interestNone.FundingNone.

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Maggio 2022

Posttraumatic Stress Symptoms After Stroke: The Effects of Anatomy and Coping Style

Stroke, Ahead of Print. Background:Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical emergencies, such as stroke. Data suggest that up to 25% of stroke survivors will develop PTSD symptomatology, but little is known about predisposing factors. We sought to examine whether neuroimaging measures and coping styles are related to PTSD symptoms after stroke.Methods:Participants were survivors of first-ever, mild-moderate ischemic stroke, or transient ischemic attack from the TABASCO study (Tel Aviv Brain Acute Stroke Cohort). All participants underwent a 3T magnetic resonance imaging at baseline and were examined 6, 12, and 24 months thereafter, using neurological, neuropsychological, and functional evaluations. At baseline, coping styles were evaluated by a self-reported questionnaire. PTSD symptoms were assessed using the PTSD checklist. Data were available for 436 patients.Results:Forty-eight participants (11%) developed probable PTSD (PTSD checklist ≥44) during the first year after the stroke/transient ischemic attack. Stroke was more likely to cause PTSD than transient ischemic attack. Stroke severity, larger white matter lesion volume, and worse hippocampal connectivity were associated with PTSD severity, while infarct volume or location was not. In a multivariate analysis, high-anxious and defensive coping styles were associated with a 6.66-fold higher risk of developing poststroke PTSD ([95% CI, 2.08–21.34];P

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Marzo 2022