Risultati per: Low Back Pain: raccomandazioni

Stroke, Volume 53, Issue Suppl_1, Page AWP223-AWP223, February 1, 2022. Introduction:Patent foramen ovale (PFO) is present in a significant number of ESUS patients and paradoxical embolism from venous thromboembolism (VTE) is often assumed to be the primary stroke mechanism. We hypothesized that paradoxical embolism is not the primary cause of stroke among ESUS patients with PFO based on markers of coagulation and hemostatic activation (MOCHA).Methods:ESUS patients presenting to the Emory Clinic from January 1, 2017 to December 31, 2020 were followed for a median of 13 months (IQR 8.1 – 21.7). MOCHA testing (d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) was done ≥14 days after stroke and considered abnormal if ≥2 markers were elevated.Results:Among 333 ESUS patients (median age 66 years, IQR 53 – 75), 70 (21%) had a PFO. Compared to PFO-, the PFO+ group was younger, had less comorbidities and higher frequency of migraine (Table). No significant difference in abnormal MOCHA among PFO+ and PFO- patients was found (34% vs 45%, p=0.127), including younger patients (

Stroke, Volume 53, Issue Suppl_1, Page AWP103-AWP103, February 1, 2022. Introduction:Size and location of the acute infarct is a major determinant of stroke outcome and eligibility for therapy. Recently, there have been efforts to train deep learning networks to detect lesions on Non-Contrast CT (NCCT) using concurrent DWI imaging as the gold standard. However, little is known about the radiological correspondence between concurrent NCCT and DWI lesion sizes. We performed an exploratory analysis comparing the stroke lesion volume on acute NCCT to that on DWI and FLAIR images performed shortly after.Methods:Population: DEFUSE 3 trial patients scanned 6-16h after last known well with DWI and NCCT

Stroke, Volume 53, Issue Suppl_1, Page ATMP59-ATMP59, February 1, 2022. Background/Purpose:Inherited thrombophilia testing in the acute inpatient setting is controversial and expensive, and in many cases does not change clinical management. We sought to determine the value of inpatient inherited thrombophilia testing for patients who presented with an isolated acute ischemic stroke or transient ischemic attack (TIA) without concurrent venous thromboembolism.Methods:We retrospectively analyzed a database comprising patients who were admitted for acute ischemic stroke or TIA in 2019 at Thomas Jefferson University Hospitals in Philadelphia, PA and had inherited thrombophilia testing performed during the hospital admission. Charts were reviewed to determine stroke risk factors, test results, and clinical management.Results:The study included 102 patients (median age 49.0 years, 53.9% female) who presented with acute ischemic stroke or TIA (including branch and central retinal artery occlusions) and underwent inpatient testing for factor V Leiden, prothrombin G20210A variant, hyperhomocysteinemia, PAI-1 elevation, and deficiencies of protein C and S and antithrombin. 406 tests were ordered, among which 14.0% resulted abnormal, and 41.2% of patients had at least one abnormal test. Patients without stroke risk factors were more likely to have an abnormal result (60.0% vs 35.1%, P = .028). However, 40% of abnormal tests were borderline positive antigen or activity assays that likely represented false positives. Considering only definitively positive results, there was no significant difference in the likelihood of a positive test in patients with vs without stroke risk factors (32.0% vs 26.0%, P = .557) or those under vs over age 50 years (30.2% vs 24.5%, P = .519). No patients with an abnormal result had their clinical management changed as a result. Charges for the tests totaled $182,994 USD.Conclusions:Inpatient inherited thrombophilia testing immediately following isolated acute arterial ischemic stroke or TIA was associated with high rates of false positive results and was expensive. Positive results did not change clinical management in a single case.

Stroke, Ahead of Print. Background and Purpose:Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans.Methods:Using a retrospective cohort study design of veterans hospitalized between 2002 and 2007 with a first ischemic stroke and with ≥1 outpatient BP measurements 1 to 18 months before admission, we defined 6 categories each of average prestroke systolic BP (SBP) and diastolic BP, and 7 categories of pulse pressure. Patients were followed-up to 12 years for primary outcomes of all-cause and cardiovascular mortality. We used Cox models to relate prestroke BP indices to mortality and stratified analyses by the presence of preexisting comorbidities (smoking, myocardial infarction, heart failure, atrial fibrillation/flutter, cancer, and dementia), race and ethnicity.Results:Of 29 690 eligible veterans with stroke (mean±SD age 67±12 years, 98% men, 67% White), 2989 (10%) had average prestroke SBP

Stroke, Volume 53, Issue 2, Page 514-522, February 1, 2022. Background and Purpose:Associations of APOE genotypes with intracerebral hemorrhage (ICH) in preterm infants were previously described. In adults, APOE-ε4 genotype has been proposed as susceptibility factor for impaired recovery after cerebral insult. We here aim to determine APOE genotype-specific neurological consequences of neonatal ICH at school age.Methods:In this multicenter observational cohort study, very low birth weight (