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  • 1
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    Neuroregeneration and Vascular Protection by Citalopram in Acute Ischemic Stroke (TALOS) : A Randomized Controlled Study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 11 ( 2018-11), p. 2568-2576
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 11 ( 2018-11), p. 2568-2576
    Abstract: Recent studies indicate a possible beneficial effect on neuroregeneration and vascular protection of selective serotonin reuptake inhibitors after stroke. We conducted a national multicentre study to explore these effects. Methods— The TALOS study (The Efficacy of Citalopram Treatment in Acute Stroke) is a Danish placebo-controlled, randomized, double-blind study of citalopram started within 7 days after symptom onset to detect improvement in functional outcomes and cardiovascular protection in nondepressed, first-ever ischemic stroke. Study medication was given as add-on to standard medical care and treatment duration and follow-up was 6 months. There were 2 coprimary outcomes: changes in functional disability from 1 to 6 months on the modified Rankin Scale, and a composite vascular end point of transient ischemic attack/stroke, myocardial infarction, or vascular mortality during the first 6 months. Results— We enrolled 642 patients randomized to either citalopram (n=319) or placebo (n=323). Median National Institutes of Health Stroke Scale was 5.3 (range, 0–27) versus 4.8 (range, 0–28) at admission. Improvement in functional recovery from 1 to 6 months occurred in 160 (50%) patients on citalopram and 136 (42%) on placebo (odds ratio, 1.27; 95% CI, 0.92–1.74; P =0.057). When dropouts before 31 days were excluded (n=90), the analysis population showed an odds ratio of 1.37 (95% CI, 0.97–1.91; P =0.07). During a median follow-up of 150 days, 23 (7%) patients in the citalopram group and 26 (8%) patients in the placebo group had a primary, vascular end point (hazard ratio, 0.89; 95% CI, 0.50–1.60; P =0.24). A total of 28 patients (4%) died (16 versus 12; P =0.42) during the study. Conclusions— Early citalopram treatment did not improve functional recovery in nondepressed ischemic stroke patients within the first 6 months, although a borderline statistical significant effect was observed in the analysis population. The risk of cardiovascular events was similar between treatment groups, and citalopram treatment was well tolerated. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01937182. URL: https://www.clinicaltrialsregister.eu/ . EudraCT number: 2013-002253-30.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.020067
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Pre‐morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study
    Wiley ; 2024
    In:  European Journal of Neurology
    Details
    In: European Journal of Neurology, Wiley
    Abstract: Whilst sleep disturbances are associated with stroke, their association with stroke severity is less certain. In the INTERSTROKE study, the association of pre‐morbid sleep disturbance with stroke severity and functional outcome following stroke was evaluated. Methods INTERSTROKE is an international case–control study of first acute stroke. This analysis included cases who completed a standardized questionnaire concerning nine symptoms of sleep disturbance (sleep onset latency, duration, quality, nocturnal awakening, napping duration, whether a nap was planned, snoring, snorting and breathing cessation) in the month prior to stroke ( n = 2361). Two indices were derived representing sleep disturbance (range 0–9) and obstructive sleep apnoea (range 0–3) symptoms. Logistic regression was used to estimate the magnitude of association between symptoms and stroke severity defined by the modified Rankin Score. Results The mean age of participants was 62.9 years, and 42% were female. On multivariable analysis, there was a graded association between increasing number of sleep disturbance symptoms and initially severe stroke (2–3, odds ratio [OR] 1.44, 95% confidence interval [CI] 1.07–1.94; 4–5, OR 1.66, 95% CI 1.23–2.25; 〉 5, OR 2.58, 95% CI 1.83–3.66). Having 〉 5 sleep disturbance symptoms was associated with significantly increased odds of functional deterioration at 1 month (OR 1.54, 95% CI 1.01–2.34). A higher obstructive sleep apnoea score was also associated with significantly increased odds of initially severe stroke (2–3, OR 1.48; 95% CI 1.20–1.83) but not functional deterioration at 1 month (OR 1.19, 95% CI 0.93–1.52). Conclusions Sleep disturbance symptoms were common and associated with an increased odds of severe stroke and functional deterioration. Interventions to modify sleep disturbance may help prevent disabling stroke/improve functional outcomes and should be the subject of future research.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Article
    DOI: 10.1111/ene.16193
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2020241-6
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  • 3
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    Strengthening nursing role and functions in stroke rehabilitation 24/7: A mixed‐methods study assessing the feasibility and acceptability of an educational intervention programme
    Wiley ; 2019
    In:  Nursing Open Vol. 6, No. 1 ( 2019-01), p. 162-174
    Details
    In: Nursing Open, Wiley, Vol. 6, No. 1 ( 2019-01), p. 162-174
    Abstract: To assess the feasibility of a nursing educational intervention for inpatient stroke rehabilitation and its acceptability from the nursing staff’s perspective. Background There is currently a lack of interventions that integrate the diversity of nurses’ role and functions in stroke rehabilitation and explore their effect on patient outcomes. Design We used a convergent, parallel, mixed‐method design with data interviews and questionnaires. Methods Data collection was undertaken between February ‐ July 2016. Data from questionnaires ( N  = 31) were analysed using descriptive statistics. The interviews ( N  = 10) were analysed using deductive content analysis. Results There was a high level of satisfaction with the educational programme in terms of its acceptability and feasibility. The qualitative findings disclosed the nursing staff's experiences with the educational programme. Mixed‐methods analysis showed confirmatory results that were convergent and expanded. Only minor adjustments are required before an effect study can be conducted.
    Type of Medium: Online Resource
    ISSN: 2054-1058 , 2054-1058
    URL: Issue
    URL: Article
    DOI: 10.1002/nop2.2019.6.issue-1
    DOI: 10.1002/nop2.202
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2809556-X
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  • 4
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    Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study
    Springer Science and Business Media LLC ; 2023
    In:  BMC Neurology Vol. 23, No. 1 ( 2023-01-17)
    Details
    In: BMC Neurology, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-01-17)
    Abstract: Autonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care. Patients and method In a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up. Results The cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1–4) and modified Ranking Scale 2 (1–3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10–100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time. Conclusion In this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.
    Type of Medium: Online Resource
    ISSN: 1471-2377
    URL: Article
    DOI: 10.1186/s12883-023-03054-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2041347-6
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  • 5
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    Incidence of stroke, transient ischaemic attack and determinants of poststroke mortality among immigrants in Denmark, 2004‒2018: a population-based cohort study
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 10 ( 2021-10), p. e049347-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 10 ( 2021-10), p. e049347-
    Abstract: Using recent registry data, we aimed to quantify the incidence of stroke and transient ischaemic attack (TIA) and to examine factors influencing the risk of poststroke mortality among immigrants compared with Danish-born individuals. Design Population-based cohort study between 2004 and 2018. We estimated age-standardised incidence rate ratios (IRR) of stroke, stroke types and TIA for each ethnic group using Danish-born individuals as the reference by direct method of standardisation. We calculated the risk of poststroke mortality using Cox proportional hazard regression. Setting The study was conducted using Danish nationwide registers. Participants All cases of first-ever stroke and TIA by country of origin (n=132 936) were included. Results Overall, Western immigrants (IRR=2.25; 95% CI 2.20 to 2.31) and non-Western immigrants (IRR=1.37; 95% CI 1.30 to 1.44) had a higher risk of stroke than Danish-born individuals. The risk of TIA was higher in Western immigrants (IRR=2.08; 95% CI 1.93 to 2.23) followed by non-Western immigrants (IRR=1.45; 95% CI 1.27 to 1.63) than in Danish-born individuals. All-cause 1-year mortality hazard was higher but not significantly different in non-Western men (adjusted HR=1.38; 95% CI 0.92 to 2.08) compared with Danish-born men and additional adjustment for comorbidities reduced the HR to 0.85 (0.51 to 1.40) among ischaemic stroke cases. Among intracerebral haemorrhage cases, the adjusted mortality hazard was decreased in Western men (from HR of 1.76; 95% CI 1.09 to 2.85 to HR of 1.30; 95% CI 0.80 to 2.11) compared with Danish-born men after adjustment for stroke severity. Immigrants with ≤15 years of residence had a lower poststroke mortality hazard than Danish-born individuals after additional adjustment for sociodemographic factors (HR=0.36; 95% CI 0.14 to 0.91). Conclusions The age-standardised risk of stroke and TIA was significantly higher among the majority of immigrants than Danish-born individuals. Interventions that reduce the burden of comorbidities, improve acute stroke care and target sociodemographic factors may address the higher risk of poststroke mortality among immigrants.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-049347
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 6
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    Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment
    Springer Science and Business Media LLC ; 2014
    In:  Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Vol. 22, No. 1 ( 2014-12)
    Details
    In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2014-12)
    Type of Medium: Online Resource
    ISSN: 1757-7241
    URL: Article
    DOI: 10.1186/s13049-014-0065-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2014
    detail.hit.zdb_id: 2455990-8
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  • 7
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    Table_1.DOCX
    Frontiers Media SA ; 2022
    In:  Frontiers in Neurology Vol. 13 ( 2022-9-23)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 13 ( 2022-9-23)
    Abstract: Functional outcome following mechanical thrombectomy (MT) in patients with acute ischemic stroke and large vessel occlusion is time-dependent and worsens with increasing delay. Time to endovascular reperfusion is potentially modifiable with changes in organizational structure. We investigated the changes in time to reperfusion of relocating the intravenous thrombolysis (IVT) services from a non-MT center to a MT-capable center. Methods We present an observational, consecutive, retrospective, single-center cohort study of 253 stroke patients treated with MT, 2017–2019. The observation period was divided into before and after the relocation of IVT services in 2018, period 1 and period 2, respectively. The two hospitals were located 13 km apart in an urban area, and following the relocation, IVT was administered at the MT-capable center. Time metrics were registered and divided into two main intervals, namely, ambulance departure from stroke onset location to imaging (ambulance-imaging) and imaging to reperfusion (imaging-reperfusion). The interval imaging-reperfusion included inter-hospital transfer to the MT-capable center in period 1. The association of the imaging-reperfusion duration and functional outcome at 90 days was analyzed using ordinal logistic regression. Results No significant change in ambulance-imaging was observed from a median of 27 min (interquartile range [IQR] 22–37) in period 1 to 30 min (IQR 23–40) in period 2, p = 0.19, while the median time of imaging-reperfusion decreased from 173 min (IQR 137–230) to 114 min (IQR 84–152), p & lt; 0.001. The largest absolute time reduction from imaging to reperfusion was seen from imaging to arrival at the angio suite from 89 min (IQR 76–111) to 42 min (IQR 28–63), p & lt; 0.001, which included inter-hospital transfer in period 1. In multivariate analysis, every 10 min of increased delay from imaging to reperfusion was associated with poorer functional outcome with an adjusted odds ratio of 0.95 (95% CI: 0.95–0.98), p & lt; 0.001. Conclusion Relocation of IVT services to an MT-capable center was the main cause of reduced time to reperfusion for patients treated with MT and was implemented without affecting prehospital transportation time. These results suggest that patient outcome can be improved by optimizing the organization of IVT and MT services in urban areas.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2022.989607
    DOI: 10.3389/fneur.2022.989607.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2564214-5
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  • 8
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    Sudden Bilateral Deafness in a Patient with Transient Ischemic Attack: A Case Report
    S. Karger AG ; 2021
    In:  Case Reports in Neurology Vol. 13, No. 1 ( 2021-2-16), p. 119-122
    Details
    In: Case Reports in Neurology, S. Karger AG, Vol. 13, No. 1 ( 2021-2-16), p. 119-122
    Abstract: Sudden-onset bilateral cortical deafness is a very rare symptom of stroke, but must be recognized as stroke, as it is a treatable condition, and the treatment is highly time dependent. We report a 53-year-old man with an acute onset of complete bilateral hearing loss that gradually improved spontaneously over 4 h. The hearing loss was explained by an infarction visualized on magnetic resonance imaging, which showed a subacute temporoparietal ischemic lesion in the left cerebral hemisphere involving the insular cortex and an older infarction in the right temporoparietal region. The location of these kinds of lesions may typically not cause motor deficits, but sensory and cognitive (e.g., aphasia) symptoms, which can be challenging to recognize in a suddenly deaf patient. Taking the possible differential diagnoses into account, immediate stroke workup should always be prioritized in patients with sudden bilateral deafness, as acute revascularizing treatment is possible.
    Type of Medium: Online Resource
    ISSN: 1662-680X
    URL: Article
    DOI: 10.1159/000512403
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 2505302-4
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  • 9
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    Abstract WP341: Is it Safe to Treat Patients With Acute Minor Stroke and Tia as Outpatients?
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Objective: To evaluate the effects of an acute 7-day outpatient clinic for minor stroke or transient ischemic attack (TIA). Methods: We performed a prospective cohort-study using all patients from an outpatient clinic for patient with suspected minor stroke and TIA between September 2013 and August 2014. The clinic opened in May 2012 as part of centralization of the stroke services in Central Region Denmark. For comparison, we used a matched historic cohort from the same hospital between May 2011 and April 2012 (before the outpatient clinic) and a contemporary cohort from a comparable university hospital from the Capital Region without an outpatient clinic. A risk-assessment tool was used in the outpatient clinic to determine the risk of recurrent stroke and hence a need for a hospital admission. Results: The outpatient clinic cohort (OCC) consisted of 1076 patients and we confirmed a neurovascular diagnosis in 510 of the patients (47.4%). Of these, 215 had a stroke and 94 (43.7%) were discharged direct from the outpatient clinic. TIA was confirmed in 171 patients and of these 121 (70.8%) were handled without a hospitalization. In the stroke patients from the OCC there was a shorter length of acute hospital stay (median 1 day) compared to the matched historic cohort (median 3 days); adjusted length of stay ratio of 0.49 (0.33-0.71). Furthermore these stroke patients had a 30-day readmission rate on 3.2 % (0.6-5.7) compared to 11.6 % (6.99-16.2) in the historic cohort; adjusted hazard ratio of 0.23 (0.09-0.59) and increased quality of care captured in 10 process performance measures. We found similar results in comparison with the contemporary cohort. Furthermore, we saw a similar pattern when we compared TIA patients from the OCC to a matched contemporary cohort. According to the risk-assessment, 170 stroke or TIA patients had a ‘low risk’ and were treated without being admitted as inpatients. Only one of these patients experienced a stroke within 7 days (0.59%). Conclusions: Overall, the results showed the outpatient set up for minor stroke and TIA was safe and may be an advance compared to hospitalization in stroke units despite use of less bed days. Furthermore, the risk assessment used to select patients in need of an inpatient course seems useful.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.WP341
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Carbonated Beverage, Fruit Drink, and Water Consumption and Risk of Acute Stroke: the INTERSTROKE Case-Control Study
    Korean Stroke Society ; 2024
    In:  Journal of Stroke Vol. 26, No. 3 ( 2024-09-30), p. 391-402
    Details
    In: Journal of Stroke, Korean Stroke Society, Vol. 26, No. 3 ( 2024-09-30), p. 391-402
    Abstract: Background and Purpose Cold beverage intake (carbonated drinks, fruit juice/drinks, and water) may be important population-level exposures relevant to stroke risk and prevention. We sought to explore the association between intake of these beverages and stroke.Methods INTERSTROKE is an international matched case-control study of first stroke. Participants reported beverage intake using food frequency questionnaires or were asked “How many cups do you drink each day of water?” Multivariable conditional logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with stroke.Results We include 13,462 cases and 13,488 controls; mean age was 61.7±13.4 years and 59.6% (n=16,010) were male. After multivariable adjustment, carbonated beverages were linearly associated with ischemic stroke (OR 2.39 [95% CI 1.64–3.49]); only consumption once/day was associated with intracerebral hemorrhage (ICH) (OR 1.58 [95% CI 1.23–2.03] ). There was no association between fruit juice/drinks and ischemic stroke, but increased odds of ICH for once/day (OR 1.37 [95% CI 1.08–1.75)] or twice/day (OR 3.18 [95% CI 1.69–5.97] ). High water intake ( 〉 7 cups/day) was associated ischemic stroke (OR 0.82 [95% CI 0.68–0.99]) but not ICH. Associations differed by Eugeographical region—increased odds for carbonated beverages in some regions only; opposing directions of association of fruit juices/drinks with stroke in selected regions.Conclusion Carbonated beverages were associated with increased odds of ischemic stroke and ICH, fruit juice/drinks were associated with increased odds of ICH, and high water consumption was associated with reduced odds of ischemic stroke, with important regional differences. Our findings suggest optimizing water intake, minimizing fruit juice/drinks, and avoiding carbonated beverages.
    Type of Medium: Online Resource
    ISSN: 2287-6391 , 2287-6405
    URL: Article
    DOI: 10.5853/jos.2024.01543
    Language: English
    Publisher: Korean Stroke Society
    Publication Date: 2024
    detail.hit.zdb_id: 2814366-8
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