Publications by authors named "Réza Behrouz"

67 Publications

Fewer Hospital Visits for Acute Stroke and Acute Coronary Syndrome During the COVID-19 Pandemic: A Reality or a Myth?

J Neurol Res 2020 Jun 1;10(3):53-55. Epub 2020 Jun 1.

Stroke Program, Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14740/jnr601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040453PMC
June 2020

Regular physical activity postpones age of occurrence of first-ever stroke and improves long-term outcomes.

Neurol Sci 2021 Aug 25;42(8):3203-3210. Epub 2020 Nov 25.

Department of Epidemiology & Biostatistics, Western University, London, Canada.

Objective: Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes.

Methods: Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL ≥ 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data.

Results: Inactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 ± 15.5) than active patients (67.0 ± 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14-4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05-3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients.

Conclusions: In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10072-020-04903-7DOI Listing
August 2021

12 versus 24 h bed rest after acute ischemic stroke thrombolysis: a preliminary experience.

J Neurol Sci 2020 Feb 5;409:116618. Epub 2019 Dec 5.

Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America.

Background: The practice of ≥24 h of bed rest after acute ischemic stroke thrombolysis is common among hospitals, but its value compared to shorter periods of bed rest is unknown.

Methods: Consecutive adult patients with a diagnosis of ischemic stroke who had received intravenous thrombolysis treatment from 1/1/2010 until 4/13/2016, identified from the local ischemic stroke registry, were included. Standard practice bed rest for ≥24 h, the protocol prior to 1/27/2014, was retrospectively compared with standard practice bed rest for ≥12 h, the protocol after that date. The primary outcome was favorable discharge location (defined as home, home with services, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, NIHSS at discharge, and length of stay.

Results: 392 patients were identified (203 in the ≥24 h group, 189 in the ≥12 h group). There was no significant difference in favorable discharge outcome in the ≥24 h bed rest protocol compared with the ≥12 h bed rest protocol in multivariable logistic regression analysis (76.2% vs. 70.9%, adjusted OR 1.20 CI 0.71-2.03). Compared with the ≥24 h bed rest group, pneumonia rates (8.3% versus 1.6%, adjusted OR 0.12 CI 0.03-0.55), median discharge NIHSS (3 versus 2, adjusted p = .034), and mean length of stay (5.4 versus 3.5 days, adjusted p = .006) were lower in the ≥12 h bed rest group.

Conclusion: Compared with ≥24 h bed rest, ≥12 h bed rest after acute ischemic stroke reperfusion therapy appeared to be similar. A non-inferiority randomized trial is needed to verify these findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jns.2019.116618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250250PMC
February 2020

Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017.

BMC Med 2019 10 24;17(1):191. Epub 2019 Oct 24.

Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden.

Methods: We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017.

Results: Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3-161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0-1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9-82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1-71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries.

Conclusions: Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12916-019-1397-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813111PMC
October 2019

Direct Assessment of Health Utilities Using the Standard Gamble Among Patients With Primary Intracerebral Hemorrhage.

Circ Cardiovasc Qual Outcomes 2019 09 13;12(9):e005606. Epub 2019 Sep 13.

Department of Neurology and Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School (K.B.S., E.G.M., A.B.B., J.R.M., L.D.M., S.I.S., F.S.V.), UTHealth, Houston, TX.

Background: Standard gamble (SG) directly measures patients' valuation of their health state. We compare in-hospital and day-90 SG utilities (SGU) among intracerebral hemorrhage patients and report a 3-way association between SGU, EuroQoL-5 dimension, and modified Rankin Scale at day 90.

Methods And Results: Patients with intracerebral hemorrhage underwent in-hospital and day-90 assessments for the modified Rankin Scale, EuroQoL-5 dimension, and SG. SG provides patients a choice between their current health state and a hypothetical treatment with varying chances of either perfect health or a painless death. Higher SGU (scale, 0-1) indicates lower risk tolerance and thus higher valuation of the current health state. Logistic regression was used to estimate the likelihood of low SGU (≤0.6), and Wilcoxon paired signed-rank test compared in-hospital and day-90 SGU. In-hospital and day-90 SG was obtained from 381 and 280 patients, respectively, including 236 paired observations. Median (interquartile range) in-hospital and day-90 SGUs were 0.85 (0.40-0.98) and 0.98 (0.75-1.00; <0.001). In-hospital SGUs were lower with advancing age (=0.007), higher National Institutes of Health Stroke Scale, and intracerebral hemorrhage scores (<0.001). Proxy-based assessments resulted in lower SGUs; median difference (95% CI), -0.2 (-0.33 to -0.07). After adjustment, higher National Institutes of Health Stroke Scale and proxy assessments were independently associated with lower SGU, along with an effect modification of age by race. Day-90 SGU and modified Rankin Scale were significantly correlated; however, SGUs were higher than the EuroQoL-5 dimension utilities at higher modified Rankin Scale levels.

Conclusions: Divergence between directly (SGU) and indirectly (EuroQoL-5 dimension) assessed utilities at high levels of functional disability warrant careful prognostication of intracerebral hemorrhage outcomes and should be considered in designing early end-of-life care discussions with families and patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCOUTCOMES.119.005606DOI Listing
September 2019

Prognostic factors in pontine haemorrhage: A systematic review.

Authors:
Réza Behrouz

Eur Stroke J 2018 Jun 8;3(2):101-109. Epub 2018 Jan 8.

Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.

Background: Pontine haemorrhage comprises approximately 10% of intracerebral haemorrhages. There is a common presumption that pontine haemorrhage is inherently associated with poor outcome.

Purpose: The aim of the review was to identify chief predictors of prognosis in (pontine haemorrhage) through systematic review of published literature.

Methods: A query of PubMed/MEDLINE was conducted in search of studies in English language since, 1980 focusing specifically on outcome in pontine haemorrhage. References for each publication were reviewed for additional studies not detected by the PubMed/MEDLINE probe. Surgical outcome studies were excluded from the review.

Findings: The query identified 7867 titles, after removal of duplicates and irrelevant studies, 20 titles were included in the review. In a total of 1437 pontine haemorrhage patients included in the 20 studies, the overall rate for early all-cause mortality was 48.1%. Level of consciousness on admission and haemorrhage size were the most consistent predictors of mortality in patients with pontine haemorrhage. Haemorrhage localisation within the pons was also a prognostic factor, but not consistently. Age and intraventricular extension were not found to be powerful prognostic predictors.

Discussion/conclusion: Based on this review, level of consciousness on admission and haemorrhage size were the most influential prognostic factors in pontine haemorrhage, whereas age, haemorrhage localisation, and intraventricular haemorrhage did not consistently predict prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2396987317752729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460408PMC
June 2018

Socioeconomic Status and Long-Term Stroke Mortality, Recurrence and Disability in Iran: The Mashhad Stroke Incidence Study.

Neuroepidemiology 2019 16;53(1-2):27-31. Epub 2019 Apr 16.

Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada,

Background: Little is known about the association between socioeconomic status and long-term stroke outcomes, particularly in low- and middle-income countries.

Methods: Patients were recruited from the Mashhad Stroke Incidence Study in Iran. We identified different socioeconomic variables including the level of education, occupation, household size, and family income. Residential location according to patient's neighbourhood was classified into less privileged area (LPA), middle privileged area and high privileged area (HPA). Using Cox regression, competing risk analysis and logistic regression models, we determined the association between socioeconomic status and 1- and 5-year stroke outcomes. Generalized linear model was used for adjusting associated variables for stroke severity.

Results: Six hundred twenty-four patients with first-ever stroke were recruited in this study. Unemployment prior to stroke was associated with an increased risk of 1- and 5-year post-stroke mortality (1 year: adjusted hazard ratio [aHR] 3.3; 95% CI 1.6-7.06: p = 0.001; 5 years: aHR 2.1; 95% CI 1.2-3.6: p = 0.007). The 5-year mortality rate was higher in less educated patients (<12 years) as compared to those with at least 12 years of schooling (aHR 1.84; 95% CI 1.05-3.23: p = 0.03). Patients living in LPA compared to those living in HPAs experienced a more severe stroke at admission (aB 3.84; 95% CI 0.97-6.71, p = 0.009) and disabling stroke at 1 year follow-up (OR 6.1; 95% CI 1.3-28.4; p = 0.02).

Conclusion: A comprehensive stroke strategy should also address socioeconomic disadvantages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000494885DOI Listing
June 2020

The Association between Inflammatory Markers in the Acute Phase of Stroke and Long-Term Stroke Outcomes: Evidence from a Population-Based Study of Stroke.

Neuroepidemiology 2019 16;53(1-2):20-26. Epub 2019 Apr 16.

Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada,

Background: Little is known about the association between inflammatory markers in the acute stroke phase and long-term stroke outcomes.

Methods: In a population-based study of stroke with 5 years follow-up, we measured the level of serum heat shock protein 27 immunoglobulin G antibody (anti-HSP27), C-reactive protein (CRP), and pro-oxidant antioxidant balance (PAB) in the acute stroke phase. We analyzed the association between these inflammatory biomarkers and stroke outcomes (recurrence, death and disability/functional dependency) with using multivariable Cox proportional hazard models.

Results: Two hundred sixty-five patients with first-ever stroke were included in this study. The severity of stroke at admission, measured by National Institute of Health Score Scale was associated with serum concentration of CRP (Spearman's rank correlation coefficient rs = 0.2; p = 0.004). CRP also was associated with 1-year combined death and recurrence rate ([adjusted hazard ratio 1.06, 95% CI 1.01-1.12; p = 0.02]). However, we did not find any association between the concentrations of CRP, anti-HSP27, PAB, and 5-year death and stroke recurrence rates. None of 3 biomarkers was associated with the long-term disability rate (defined as modified Rankin Scale >2) and functional dependency (defined as Barthel Index <60).

Conclusion: CRP has a significant direct, yet weak, correlation to the severity of stroke. In addition, the level of CRP at admission may have a clinical implication to identify those at a higher risk of death or recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000494685DOI Listing
June 2020

Long-term disability after stroke in Iran: Evidence from the Mashhad Stroke Incidence Study.

Int J Stroke 2019 01 17;14(1):44-47. Epub 2018 Aug 17.

5 Department of Epidemiology & Biostatistics, Western University, London, Canada.

Background: Accurate information about disability rate after stroke remains largely unclear in many countries. Population-based studies are necessary to estimate the rate and determinants of disability after stroke.

Methods: Patients were recruited from the Mashhad Stroke Incidence Study and followed for five years after their index event. Disability was measured using the modified Rankin scale and functional dependency was measured using the Barthel index.

Results: Among 684 patients registered in this study, 624 were first-ever strokes. In total, 69.0% (n = 409) of patients either died or remained disabled at five-year follow-up. Among the first-ever stroke survivors, 18.5% (n = 69) at one year and 15.9% (n = 31) at five years required major assistance in their daily activities. Patients with a history of stroke (before the study period) compared with first-ever strokes were more likely to be disabled at one year (modified Rankin scale>2 in 40.0% vs. 19.1%; P < 0.001). Advanced age, severity of stroke at the time of admission, diabetes mellitus, and educational level (<12 years) were independently associated with greater disability and functional dependency.

Conclusion: We found that significant disability and functional dependency after stroke in Northeast Iran were largely attributable to the effects of stroke severity and prior dependency.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1747493018789839DOI Listing
January 2019

Network meta-analysis of patent foramen ovale management strategies in cryptogenic stroke.

Neurology 2018 07 6;91(1):e1-e7. Epub 2018 Jun 6.

From the Departments of Neurology (H.S., S.K., N.S.-B.) and Cardiology (M.P.), Wayne State University School of Medicine, Detroit, MI; Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, London, Canada; and Department of Neurology (R.B.), School of Medicine, University of Texas Health Science Center, San Antonio.

Objective: To compare the outcomes of patent foramen ovale (PFO) closure vs antiplatelet agent (APA) vs oral anticoagulation therapy (OAT) for secondary prevention of stroke in patients with cryptogenic stroke, using direct and indirect evidence from existing randomized data.

Methods: Relevant randomized controlled trials were identified by a systematic review. The efficacy outcome was stroke recurrence, and safety outcomes were atrial fibrillation and bleeding complications at the end of follow-up. Bayesian network meta-analysis was performed to calculate risk estimates and the rank probabilities using APA therapy as the reference.

Results: In a network meta-analysis of 6 randomized controlled trials consisting of 3,497 patients (1,732 PFO closure, 1,252 APA, 513 OAT), PFO closure and OAT were associated with lower rates of recurrent stroke (odds ratio [OR] 0.30, 95% credibility interval [CrI] 0.17-0.49 and OR 0.42, 95% CrI 0.22-0.78, respectively) with equal efficacy of OR 0.70 (95% CrI 0.37-1.49). PFO closure had the highest top rank probability of atrial fibrillation and OAT had the highest risk of bleeding complications.

Conclusions: These findings suggest that closure and OAT may be equally effective in recurrent stroke prevention in patients with PFO. There is an increased risk of atrial fibrillation and bleeding with closure and OAT therapy, respectively. A randomized trial is needed to identify patients who would benefit most from each strategy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000005736DOI Listing
July 2018

The Rise and Fall of Transcranial Doppler Ultrasonography for the Diagnosis of Vasospasm in Aneurysmal Subarachnoid Hemorrhage.

Authors:
Réza Behrouz

J Neurosurg Anesthesiol 2019 01;31(1):79-80

Department of Neurology, Division of Cerebrovascular Diseases, School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ANA.0000000000000490DOI Listing
January 2019

Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study: A Population-Based Cohort Study of Stroke in the Middle East.

Neuroepidemiology 2018 10;50(1-2):18-22. Epub 2018 Jan 10.

Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Little is known about the risk of recurrent stroke in low- and middle-income countries. This study was designed to identify the long-term risk of stroke recurrence and its associated factors.

Methods: From November 21, 2006 for a period of 1 year, 624 patients with first-ever stroke (FES) were registered from the residents of 3 neighborhoods in Mashhad, Iran. Patients were followed up for the next 5 years after the index event for any stroke recurrence or death. We used competing risk analysis and cause-specific Cox proportional hazard models to estimate the cumulative incidence of stroke recurrence and its associated variables.

Results: The cumulative incidence of stroke recurrence was 14.5% by the end of 5 years, with the largest rate during the first year after FES (5.6%). Only advanced age (adjusted hazard ratio [HR] 1.02; 95% CI 1.01-1.04) and severe stroke (National Institutes of Health Stroke Scale score >20; HR 2.23; 95% CI 1.05-4.74) were independently associated with an increased risk of 5-year recurrence. Case fatality at 30 days after first recurrent stroke was 43.2%, which was significantly greater than the case fatality at 30 days after FES of 24.7% (p = 0.001).

Conclusion: A substantial number of our patients either died or had stroke recurrences during the study period. Advanced age and the severity of the index stroke significantly increased the risk of recurrence. This is an important finding for health policy makers and for designing preventive strategies in people surviving their stroke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000485509DOI Listing
September 2019

Laboratory characteristics of ischemic stroke patients with atrial fibrillation on or off therapeutic warfarin.

Clin Cardiol 2017 Dec 18;40(12):1347-1351. Epub 2017 Dec 18.

Department of Neurology, University of Texas Lozano Long School of Medicine, San Antonio.

Background: In patients with atrial fibrillation (AF), despite adequate anticoagulation, ischemic stroke (IS) is an uncommon yet concerning occurrence.

Hypothesis: Specific laboratory parameters may affect the efficacy of warfarin despite therapeutic international normalized ratio (INR) in patient with AF who present with IS.

Methods: We used the database from a multicenter clinical trial to identify AF patients who presented with IS. We trichotomized the cohort into patients with therapeutic INR on warfarin, subtherapeutic INR on warfarin, and on no anticoagulants. We then compared baseline laboratory characteristics and other baseline features among the groups.

Results: Patients with therapeutic INR presented with higher serum creatinine (P = 0.01) and blood urea nitrogen (P = 0.02) and lower glomerular filtration rates (P = 0.001) compared with other groups. Other laboratory parameters were not different among the 3 groups. Patients with therapeutic INR also presented with milder stroke symptoms (P = 0.01). Medical history of the 3 groups was not different, except for history of valvular heart disease, which was more prevalent in patients with therapeutic INR (P = 0.004). In-hospital mortality rates and 90-day disability were not different among the 3 groups.

Conclusions: AF patients who presented with IS on therapeutic warfarin had higher average serum creatinine and blood urea nitrogen, and lower glomerular filtration rates, compared with others. Impaired renal function may be a factor contributing to occurrence of IS in AF patients despite adequate anticoagulation. Larger, targeted studies are needed to confirm these findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/clc.22838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490348PMC
December 2017

Long-Term Outcomes of Ischemic Stroke of Undetermined Mechanism: A Population-Based Prospective Cohort.

Neuroepidemiology 2017 21;49(3-4):160-164. Epub 2017 Nov 21.

Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.

Background And Purpose: Little is known about the short- and long-term outcomes of ischemic stroke of undetermined mechanism (ISUM).

Methods: Subjects were recruited from the Mashhad Stroke Incidence Study. Ischemic stroke (IS) was classified on the basis of the TOAST criteria. We further categorized patients with ISUM into ISUMneg (negative clinical/test results for large artery, small artery) and ISUMinc (incomplete investigations). Cox proportional hazard models and the competing-risk regression model were used to compare 1 and 5 years mortality (all-causes) and recurrent rate among IS subtypes.

Results: Overall, 1-year mortality was higher in those with ISUMinc than in ISUMneg (adjusted hazard ratio [aHR] 1.6, 95% CI 1.01-2.8; p = 0.04) and in other stroke subtypes. Cardioembolic stroke was associated with the greatest risk of stroke recurrence at one year (aHR 4.9, 95% CI 1.8-12.9; p = 0.001) and 5 years (HR 2.1, 95% CI 1.1-3.7; p = 0.01) as compared to ISUMneg.

Conclusions: The classification of ISUM as a single group may lead to over- or underestimation of mortality and recurrence in this major category of IS. A better definition of ISUM is necessary to predict death and recurrence accurately.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000482019DOI Listing
July 2019

The Incidence and Characteristics of Stroke in Urban-Dwelling Iranian Women.

J Stroke Cerebrovasc Dis 2018 Mar 31;27(3):547-554. Epub 2017 Oct 31.

Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Science, University Hospital, London Health Science Center, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address:

Background: Population-based data regarding stroke among women are scarce in developing countries. This study was designed to determine whether sex differences exist in stroke incidence, mortality, and recurrence.

Methods: The Mashhad Stroke Incidence Study is a population-based cohort study in Iran. For a period of 1 year, all patients with stroke in 3 geographical regions in Mashhad were recruited and then followed up for 5 years. Age- and sex-specific crude incidence rates were standardized to the World Health Organization New World Population. Male-to-female incidence rate ratios were assessed for all age groups and all subtypes of first-ever stroke (FES).

Results: The annual crude incidence rate of FES (per 100,000 population) was similar in men (144; 95% confidence interval [CI]: 129-160) and women (133; 95% CI: 119-149). Standardized FES annual incidence rates were 239 (95% CI: 213-267) for men and 225 (95% CI 200-253) for women, both greater than in most western countries. There were no significant differences in stroke recurrence or case-fatality between women and men during early and long-term follow-up.

Conclusion: The similar incidence of stroke between men and women highlights the importance of equally prioritizing adequate preventive strategies for both sexes. The greater relative incidence of stroke in women in Mashhad compared with other countries warrants improvement of primary and secondary stroke prevention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.09.050DOI Listing
March 2018

Outcomes of Nonagenarians with Acute Ischemic Stroke Treated with Intravenous Thrombolytics.

J Stroke Cerebrovasc Dis 2018 Jan 19;27(1):246-256. Epub 2017 Sep 19.

Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy; The Neurological Section, Neuro-epidemiology Unit, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, L'Aquila, Italy.

Background: Nonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established.

Materials And Methods: We used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors. Coarsened exact matching (CEM) was utilized before evaluating outcome by balancing both groups in the sensitivity analysis.

Results: We identified 227 previously independent nonagenarians with AIS; 122 received intravenous thrombolytics and 105 did not. In the unmatched cohort, ordinal analysis showed a significant treatment effect (adjusted common odds ratio [OR]: .61, 95% confidence interval [CI]: .39-.96). There was an absolute difference of 8.1% in the rate of excellent outcome in favor of thrombolysis (17.4% versus 9.3%; adjusted ratio: .30, 95% CI: .12-.77). Rates of sICH and in-hospital mortality were not different. Similarly, in the matched cohort, CEM analysis showed a shift in the primary outcome distribution in favor of thrombolysis (adjusted common OR: .45, 95% CI: .26-.76).

Conclusions: Nonagenarians treated with thrombolytics showed lower stroke-related disability at 90 days than those not treated, without significant difference in sICH and in-hospital mortality rates. These observations cannot exclude a residual confounding effect, but provide evidence that thrombolytics should not be withheld from nonagenarians because of age alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.08.031DOI Listing
January 2018

Epidemiology of Intracranial and Extracranial Large Artery Stenosis in a Population-Based Study of Stroke in the Middle East.

Neuroepidemiology 2017 11;48(3-4):188-192. Epub 2017 Aug 11.

Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.

Background: Intracranial large-artery disease (LAD) is a predominant vascular lesion found in patients with stroke of Asian, African, and Hispanic origin, whereas extracranial LAD is more prevalent among Caucasians. These patterns are not well-established in the Middle East. We aimed to characterize the incidence, risk factors, and long-term outcome of LAD strokes in a Middle-Eastern population.

Methods: The Mashhad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. Ischemic strokes were classified according to the TOAST criteria. Duplex-ultrasonography (98.6%), MR-angiography (8.3%), CT-angiography (11%), and digital-subtraction angiography (9.7%) were performed to identify involvements. Vessels were considered stenotic when the lumen was occluded by >50%.

Results: We identified 72 cases (15.99 per 100,000) of incident LAD strokes (mean age 67.6 ± 11.7). Overall, 77% had extracranial LAD (58% male, mean age 69.8 ± 10.3; 50 [89%] carotid vs. 6 [11%] vertebral artery), and the remaining 23% (56% male, mean age 60.2 ± 13.4; 69% anterior-circulation stenosis) had intracranial LAD strokes. We were unable to detect differences in case-fatality between extracranial (1-year: 28.6%; 5-year: 59.8%) and intracranial diseases (1-year: 18.8%; 5-year: 36.8%; log-rank; p = 0.1).

Conclusion: Extracranial carotid stenosis represents the majority of LAD strokes in this population. Thus, public health strategies may best be developed in such a way that they are targeted toward the risk factors that contribute to extracranial stenosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000479519DOI Listing
May 2018

Transient ischemic attack: A diagnosis of convenience.

Authors:
Réza Behrouz

Am J Emerg Med 2017 Dec 23;35(12):1979-1981. Epub 2017 Jun 23.

Department of Neurology, School of Medicine, University of Texas Health Science Center San Antonio, TX, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2017.06.045DOI Listing
December 2017

The Effect of Morbid Obesity on Subarachnoid Hemorrhage Prognosis in the United States.

World Neurosurg 2017 Sep 20;105:732-736. Epub 2017 Jun 20.

Department of Neurology, School of Medicine, University of Texas Health at San Antonio, Texas, USA; Department of Neurosurgery, School of Medicine, University of Texas Health at San Antonio, Texas, USA. Electronic address:

Objective: The association between obesity and nontraumatic subarachnoid hemorrhage (SAH) patient outcome is unclear. The aim of this study was to determine the impact of morbid obesity (body mass index ≥40 kg/m) on nontraumatic SAH outcomes.

Methods: Using the Nationwide Inpatient Sample, we identified hospitalized, nontraumatic SAH patients who received their diagnoses from 2008 to 2013 and tested the effect of obesity on their mortality and clinical outcomes. Odds ratios were estimated with a mixed effects linear logistic model with adjustment for hospital clustering. All statistical testing was 2-sided, with a significance level of 5%.

Results: Out of 224,561 discharged patients with a diagnosis of nontraumatic SAH, 4714 (2.10%) were defined as morbidly obese. Patients with morbid obesity were younger (54.3 ± 0.44 vs. 59.5 ± 0.08 years; P < 0.001) and had longer length of stay (LOS) (13 ± 0.46 vs. 11.5 ± 0.06 days; P = 0.002). Morbid obesity was associated with significantly higher hospital costs (P < 0.001) and charges (P < 0.001). The risk of acute respiratory failure was higher in morbidly obese patients (odds ratio [OR] 1.49, 95% confidence interval [CI]: 1.3-1.71, P < 0.001). In a multivariate analysis of hospital mortality, obesity had a negative impact on mortality (OR 0.83, 95% CI: 0.74-0.92, P < 0.001). Overall, in-hospital mortality was associated with age, morbid obesity, LOS, clipping and coiling, and acute respiratory failure but not the symptomatic vasospasm.

Conclusions: Morbid obesity is associated with increased LOS, hospital costs and charges and with acute respiratory failure. However, it is also associated with a decrease in hospital mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2017.06.068DOI Listing
September 2017

Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage.

J Crit Care 2017 10 1;41:247-253. Epub 2017 Jun 1.

Neurocritical Care Unit, Sanatorio Pasteur, Catamarca, Argentina; Unidad de Terapia Intensiva, Hospital Interzonal de Agudos "San Juan Bautista", Catamarca, Argentina.

Purpose: Hypoalbuminemia and systemic inflammatory response syndrome (SIRS) are reported in critically-ill patients, but their relationship is unclear. We sought to determine the association of admission serum albumin and SIRS with outcomes in patients with intracerebral hemorrhage (ICH).

Methods: We used a multicenter, multinational registry of ICH patients to select patients in whom SIRS parameters and serum albumin levels had been determined on admission. Hypoalbuminemia was defined as the lowest standardized quartile of albumin; SIRS according to standard criteria. Primary outcomes were modified Rankin Scale (mRS) at discharge and in-hospital mortality. Regression models were used to assess for the association of hypoalbuminemia and SIRS with discharge mRS and in-hospital mortality.

Results: Of 761 ICH patients included in the registry 518 met inclusion criteria; 129 (25%) met SIRS criteria on admission. Hypoalbuminemia was more frequent in patients with SIRS (42% versus 19%; p<0.001). SIRS was associated with worse outcomes (OR: 4.68, 95%CI, 2.52-8.76) and in-hospital all-cause mortality (OR: 2.18, 95% CI, 1.60-2.97), while hypoalbuminemia was not associated with all-cause mortality.

Conclusions: In patients with ICH, hypoalbuminemia is strongly associated with SIRS. SIRS, but not hypoalbuminemia, predicts poor outcome at discharge. Recognizing and managing SIRS early may prevent death or disability in ICH patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcrc.2017.06.002DOI Listing
October 2017

Letter by Behrouz and Aachi Regarding Article, "Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45 000 Swedish Men".

Stroke 2017 05 7;48(5):e133. Epub 2017 Apr 7.

Department of Neurology, University of Texas School of Medicine, San Antonio.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.117.016872DOI Listing
May 2017

Clinical Course and Outcomes of Small Supratentorial Intracerebral Hematomas.

J Stroke Cerebrovasc Dis 2017 Jun 3;26(6):1216-1221. Epub 2017 Feb 3.

Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy; The Neurological Section, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.

Background And Purpose: Intracerebral hemorrhage (ICH) volume, particularly if ≥30 mL, is a major determinant of poor outcome. We used a multinational ICH data registry to study the characteristics, course, and outcomes of supratentorial hematomas with volumes <30 mL.

Methods: Basic characteristics, clinical and radiological course, and 30-day outcomes of these patients were recorded. Outcomes were categorized as early neurological deterioration (END), hematoma expansion, Glasgow Outcome Scale (GOS), and in-hospital death. Poor outcome was defined as composite of in-hospital death and severe disability (GOS ≤ 3). Comparison was conducted based on hemorrhage location. Logistic regression using dichotomized outcome scales was applied to determine predictors of poor outcome.

Results: Among 375 cases of supratentorial ICH with volumes <30 mL, expansion and END rates were 19.2% and 7.5%, respectively. Hemorrhage growth was independently associated with END (odds ratio: 28.7, 95% confidence interval [CI]: 8.51-96.5; P < .0001). Expansion rates did not differ according to ICH location. Overall, 13.9% (exact binomial 95% CI: 10.5-17.8) died in the hospital and 29.1% (CI: 24.5-34.0) had severe disability at 30 days; there was a cumulative poor outcome rate of 42.9% (CI: 37.9-48.1). Age, admission Glasgow Coma Scale, intraventricular extension, and END were independently associated with poor outcome. There was no difference in poor outcome rates between lobar and deep locations (40.2% versus 43.8%, P = .56).

Conclusion: Patients with supratentorial ICH <30 mL have high rates of poor outcome at 30 days, regardless of location. Nearly 1 in 5 hematomas <30 mL expands, leading to END or death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.01.010DOI Listing
June 2017

Incidence, recurrence, and long-term survival of ischemic stroke subtypes: A population-based study in the Middle East.

Int J Stroke 2017 10 3;12(8):835-843. Epub 2017 Jan 3.

5 Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.

Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1747493016684843DOI Listing
October 2017

Bacterial Endocarditis and Cerebrovascular Disease.

Curr Neurol Neurosci Rep 2016 12;16(12):104

U.F. Health, Department of Neurology, University of Florida, Jacksonville, 580 W. 8th St., Jacksonville, FL, 32209, USA.

Cerebrovascular complications of endocarditis occur in 25-70% of patients with infective endocarditis. The cornerstone of treatment is early initiation of antibiotic treatment, which significantly reduces the risk of embolization after 1 week of treatment. In general, thrombolysis and anticoagulation of these patients should be avoided, while antiplatelet therapy may be considered in those with other indications. Endovascular treatment of acute septic emboli is uncertain, but a few case reports have demonstrated benefit. Other complications of infective endocarditis include intracerebral hemorrhage, which may be predicted by the presence of two or more cerebral microbleeds on gradient echo sequences. Intracranial mycotic aneurysms can often be managed with serial imaging and coiled if there is evidence of failure to reduce in size, or enlargement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11910-016-0705-yDOI Listing
December 2016

Impact of Infection on Stroke Morbidity and Outcomes.

Curr Neurol Neurosci Rep 2016 09;16(9):83

Division of Cerebrovascular Diseases, Department of Neurology, School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.

Each year, millions of persons worldwide are disabled by stroke. The burden of stroke is expected to increase as a consequence of growth in our elderly population. Outcome is dependent upon limitation of secondary medical processes in the acute setting that lead to deterioration and increased long-term disability. The prevalence of infection after stroke is greater that seen in other medical conditions with similar acuity and its impact upon morbidity and mortality is substantial. Physical impairment and immune modulation are chief determinants in rate of infection after stroke. Each of these factors has been a target for therapeutic intervention. Current best practices for acute stroke management implement strategies for prevention, prompt identification, and treatment of infection. Novel therapies are currently being explored which have the opportunity to greatly minimize infectious complications following stroke. Fever commonly accompanies infection and independently influences stroke outcome. Targeted temperature management provides an additional chance to improve stroke recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11910-016-0679-9DOI Listing
September 2016

Focal Neurological Deficit at Onset of Aneurysmal Subarachnoid Hemorrhage: Frequency and Causes.

J Stroke Cerebrovasc Dis 2016 Nov 29;25(11):2644-2647. Epub 2016 Jul 29.

Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.

Background And Aim: Focal neurological deficit (FND) is a recognized presenting symptom of aneurysmal subarachnoid hemorrhage (SAH). However, little is known on how often aneurysmal SAH patients present with FND and what the responsible mechanisms are. The aim of this study was to examine the frequency and causes of FND at onset in aneurysmal SAH.

Methods: We reviewed the records of consecutive aneurysmal SAH patients over 5 years and identified those who presented with FND. We developed several potential mechanisms for FND based on consensus between 2 separate evaluating neurologists. We then compared the characteristics of aneurysmal SAH patients who presented with and without FND. Logistic regression models were used to assess for association of FND with poor outcome.

Results: Of a total of 213 patients, 10.3% presented with FND. The junction of the internal carotid and posterior communicating arteries was the most common aneurysm location in patients with FND (36.4%). Causes of FND at presentation were intraparenchymal hematoma in 45.5%, early cerebral infarction in 22.7%, parenchymal compression by subarachnoid thrombus in 18.2%, and seizure with Todd's paralysis in 13.6%. Patients with FND were older (P = .001) and had higher rates of in-hospital death and severe disability at discharge (P < .0001), compared to those without focal deficit. FND was independently associated with poor outcome (odds ratio: 4.62, confidence interval: 1.41-15.14; P = .01).

Conclusion: One in every 10 aneurysmal SAH patients presents with FND. FND at presentation has diverse mechanisms, is not associated with a specific aneurysm location, and is independently associated with poor outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.07.009DOI Listing
November 2016

Older Stroke Patients with High Stroke Scores Have Delayed Door-To-Needle Times.

J Stroke Cerebrovasc Dis 2016 Nov 28;25(11):2668-2672. Epub 2016 Jul 28.

Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Baptist Health System, San Antonio, Texas.

Introduction: The timely administration of intravenous (IV) tissue plasminogen activator (t-PA) to acute ischemic stroke patients from the period of symptom presentation to treatment, door-to-needle (DTN) time, is an important focus for quality improvement and best clinical practice.

Methods: A retrospective review of our Get With The Guidelines database was performed for a 5-hospital telestroke network for the period between January 2010 and January 2015. All acute ischemic stroke patients who were triaged in the emergency departments connected to the telestroke network and received IV t-PA were included. Optimal DTN time was defined as less than 60 minutes. Logistic regression was performed with clinical variables associated with DTN time. Age and National Institutes of Health Stroke Scale (NIHSS) score were categorized based on clinically significant cutoffs.

Results: Six-hundred and fifty-two patients (51% women, 46% White, 45% Hispanic, and 8% Black) were included in this study. The mean age was 70 years (range 29-98). Of the variables analyzed, only arrival mode, initial NIHSS score, and the interaction between age and initial NIHSS score were significant. DTN time more than or equal to 60 minutes was most common in patients aged more than 80 years with NIHSS score higher than 10.

Conclusions: The cause of DTN time delay for older patients with higher NIHSS score is unclear but was not related to presenting blood pressure or arrival mode. Further study of this subgroup is important to reduce overall DTN times.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.07.013DOI Listing
November 2016

Role of emergent chest radiography in evaluation of hyperacute stroke.

Neurology 2016 Aug 13;87(8):782-5. Epub 2016 Jul 13.

From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Objective: To use data from a large multicenter trial to assess the role and significance of chest radiograph (CXR) in the initial evaluation of acute stroke.

Methods: Predefined clinical characteristics of patients who had recorded data on CXR examination during the initial evaluation were collected. We compared features of patients who had a CXR done before IV thrombolytics with those who did not. Rates of adverse cardiopulmonary events, intubation, and in-hospital mortality were also compared. Logistic regression analysis was performed to evaluate for the association of CXR performance with door-to-needle time ≥60 minutes.

Results: In a cohort of 615 patients, 243 had CXR done before IV thrombolytics. Patients with CXR before treatment had significantly higher admission neurologic deficit, initial respiratory rates, and door-to-needle time than those with CXR after treatment. The rates of cardiopulmonary adverse events in the first 24 hours of admission, endotracheal intubation in the first 7 hours, and in-hospital mortality were not different between the 2 groups. Patients with CXR done before treatment had longer mean door-to-needle times than those without pretreatment radiography (75.8 vs 58.3 minutes, p = 0.0001). Performance of CXR was independently associated with door-to-needle time ≥60 minutes (odds ratio 2.78, 95% confidence interval 1.97-3.92; p = 0.00001).

Conclusions: Performance of CXR prior to IV thrombolytics prolongs door-to-needle time in acute ischemic stroke patients. CXR before treatment should be reserved for situations wherein acute cardiopulmonary conditions would otherwise preclude the administration of IV thrombolytics or substantially influence management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000002964DOI Listing
August 2016

Clinical Reasoning: Proptosis, headache, and fever in a healthy young woman.

Neurology 2016 04;86(16):e168-72

From the Intensive Care Unit (J.O., D.A.G.), Hospital San Juan Bautista, Catamarca, Argentina; Department of Neurology (R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; Neuroscience Critical Care Unit (A.R.), Mayo Clinic College of Medicine, Rochester, MN; Neurological Service (M.D.N.), San Camillo de' Lellis General Hospital, Rieti; and Neurological Section (M.D.N.), SMDN-Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000002591DOI Listing
April 2016

Cannabis Use and Outcomes in Patients With Aneurysmal Subarachnoid Hemorrhage.

Stroke 2016 05 7;47(5):1371-3. Epub 2016 Apr 7.

From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio.

Background And Purpose: The incidence of cannabis use in patients with aneurysmal subarachnoid hemorrhage (aSAH) and its impact on morbidity, mortality, and outcomes are unknown. Our objective was to evaluate the relationship between cannabis use and outcomes in patients with aSAH.

Methods: Records of consecutive patients admitted with aSAH between 2010 and 2015 were reviewed. Clinical features and outcomes of aSAH patients with negative urine drug screen and cannabinoids-positive (CB+) were compared. Regression analyses were used to assess for associations.

Results: The study group consisted of 108 patients; 25.9% with CB+. Delayed cerebral ischemia was diagnosed in 50% of CB+ and 23.8% of urine drug screen negative patients (P=0.01). CB+ was independently associated with development of delayed cerebral ischemia (odds ratio, 2.68; 95% confidence interval, 1.03-6.99; P=0.01). A significantly higher number of CB+ than urine drug screen negative patients had poor outcome (35.7% versus 13.8%; P=0.01). In univariate analysis, CB+ was associated with the composite end point of hospital mortality/severe disability (odds ratio, 2.93; 95% confidence interval, 1.07-8.01; P=0.04). However, after adjusting for other predictors, this effect was no longer significant.

Conclusions: We offer preliminary data that CB+ is independently associated with delayed cerebral ischemia and possibly poor outcome in patients with aSAH. Our findings add to the growing evidence on the association of cannabis with cerebrovascular risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.116.013099DOI Listing
May 2016
-->