The ABCD and ABCD2 Scores and the Risk of Stroke following a TIA: A Narrative Review

The California, ABCD, and ABCD2 risk scores (ABCD system) were developed to help stratify short-term stroke risk in patients with TIA (transient ischemic attack). Beyond this scope, the ABCD system has been extensively used to study other prognostic information such as DWI (diffusion-weighted imaging) abnormalities, large artery stenosis, atrial fibrillation and its diagnostic accuracy in TIA patients, which are independent predictors of subsequent stroke in TIA patients. Our comprehensive paper suggested that all scores have and equivalent prognostic value in predicting short-term risk of stroke; however, the ABCD2 score is being predominantly used at most centers. The majority of studies have shown that more than half of the strokes in the first 90 days, occur in the first 7 days. The majority of patients studied were predominantly classified to have a higher ABCD/ABCD2 > 3 scores and were particularly at a higher short-term risk of stroke or TIA and other vascular events. However, patients with low risk ABCD2 score < 4 may have high-risk prognostic indicators, such as diffusion weighted imaging (DWI) abnormalities, large artery atherosclerosis (LAA), and atrial fibrillation (AF). The prognostic value of these scores improved if used in conjunction with clinical information, vascular imaging data, and brain imaging data. Before more data become available, the diagnostic value of these scores, its applicability in triaging patients, and its use in evaluating long-term prognosis are rather secondary; thus, indicating that the primary significance of these scores is for short-term prognostic purposes

Predictors of Occult Paroxysmal Atrial Fibrillation in Cryptogenic Strokes Detected by Long-Term Noninvasive Cardiac Monitoring

Background and Purpose. Paroxysmal Atrial fibrillation/Flutter (PAF) detection rates in cryptogenic strokes have been variable. We sought to determine the percentage of patients with cryptogenic stroke who had PAF on prolonged non-invasive cardiac monitoring. Methods and Results. Sixty-two consecutive patients with stroke and TIA in a single center with a mean age of 61 (+/− 14) years were analyzed. PAF was detected in 15 (24%) patients. Only one patient reported symptoms of shortness of breath during the episode of PAF while on monitoring, and 71 (97%) of these 73 episodes were asymptomatic. A regression analysis revealed that the presence of PVCs (ventricular premature beats) lasting more than 2 minutes (OR 6.3, 95% CI, 1.11–18.92; P = .042) and strokes (high signal on Diffusion Weighted Imaging) (OR 4.3, 95% CI, 5–36.3; P = .041) predicted PAF. Patients with multiple DWI signals were more likely than solitary signals to have PAF (OR 11.1, 95% CI, 2.5–48.5, P < .01). Conclusion. Occult PAF is common in cryptogenic strokes, and is often asymptomatic. Our data suggests that up to one in five patients with suspected cryptogenic strokes and TIAs have PAF, especially if they have PVCs and multiple high DWI signals on MRI

Triple mesh technique in repair of recurrent lumbar incisional hernia

Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), post-traumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions for which various surgical method in context of meshplasty are available. In this case 60 yr. male hypertensive patient presented to the outpatient clinic of institute with recurrent left side lumbar incisional hernia, patient was previously operated for left side nephrolithiasis 15 years back and onlay meshplasty 2 years back for incisional hernia. The patient was operated under high risk for recurrent incisional hernia repair by triple layered meshplasties in the same sitting. Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice with adjuvant clinical findings, which allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures for which our surgical approach included a triple mesh repair consisting of underlay, inlay and onlay meshplasty thereby anticipating further such incidences of incisional hernia

Clinical Significance of Serum Zinc Levels in Cerebral Ischemia

Background. Zinc mediates several vital physiological, enzymatic and cellular functions. The association between serum zinc and stroke outcome has not been previously evaluated. Methods. This single center retrospective study was conducted on consecutive stroke (n = 158) and TIA (n = 74) patients. We sought to determine whether serum zinc concentrations in patients with acute ischemic strokes were associated with stroke severity and poor functional status at discharge, respectively. Results. Overall, out of the 224 patients analyzed (mean age 67 years), 35.7% patients had low zinc levels (65 mcg/dL). Patients with stroke (n = 152) were more likely to have low zinc levels (OR = 2.62, CI 1.92–3.57, P < .003) compared to patients with TIA (n = 72). For patients with stroke (n = 152), multivariate analysis showed that low serum zinc levels (OR 2.82, CI 1.35–5.91, P = .035) and strokes with admission severe strokes (NIHSS > 8) (OR 2.68, CI 1.1–6.5, P = .03) were independently associated with poor functional status (MRS > 3) at discharge from the hospital. Conclusion. Low serum zinc concentrations are associated with more severe strokes on admission and poor functional status at discharge

Helicobacter pylori: transtornos neurológicos e oftalmológicos

Helicobacter pylori infection has been associated with many intestinal and extraintestinal infections. It has been linked with many neurological and ophthalmological disorders including cerebrovascular diseases, migraine, Alzheimer’s disease, epilepsy, Parkinson’s disease, multiple sclerosis, peripheral neuropathies, glaucoma, and non-arteritic anterior ischemic optic neuropathy. The pathophysiological mechanisms could involve various immunological processes in response to an infectious agent or different antigens released during tissue destruction resulting in activation of cellular and humoral immunity; platelet activation and aggregation; different vasoactive and inflammatory substances; reactive oxygen species; and apoptotic processes. The long-term effects of H. pylori eradication therapy on the course of these disorders still need to be explored and warrant further studies.A infecção por Helicobacter pylori tem sido associada a muitas infecções intestinais e extra-intestinais. Tem sido relacionada com muitas doenças neurológicas e oftalmológicas, incluindo as doenças cerebrovasculares, enxaqueca, doença de Alzheimer, epilepsia, doença de Parkinson, esclerose múltipla, neuropatias periféricas, glaucoma, e neuropatia ótica isquêmica. Os mecanismos fisiopatológicos podem envolver vários processos imunológicos em resposta a um agente infeccioso ou diferentes antígenos liberados durante a destruição do tecido, resultando em ativação da imunidade celular e humoral; ativação e agregação plaquetária; diferentes substâncias vasoativas e inflamatórias; espécies reativas de oxigênio e processos apoptóticos. Os efeitos a longo prazo do H. pylori no curso desses transtornos ainda precisam ser explorados

Revista de Ciências Médicas e Biológicas

Keywords: Helicobacter pylori – Cerebrovascular diseases – Alzheimer’s disease – Parkinsn’s Disease – Migraine – Seizure disorders – Multiple sclerosis – Peripheral neuropathies – Glaucoma.Abstract: Helicobacter pylori infection has been associated with many intestinal and extraintestinal infections. It has been linked with many neurological and ophthalmological disorders including cerebrovascular diseases, migraine, Alzheimer’s disease, epilepsy, Parkinson’s disease, multiple sclerosis, peripheral neuropathies, glaucoma, and non-arteritic anterior ischemic optic neuropathy. The pathophysiological mechanisms could involve various immunological processes in response to an infectious agent or different antigens released during tissue destruction resulting in activation of cellular and humoral immunity; platelet activation and aggregation; different vasoactive and inflammatory substances; reactive oxygen species; and apoptotic processes. The long-term effects of H. pylori eradication therapy on the course of these disorders still need to be explored and warrant further studies.Salvado

Increase in Video Evaluations but Not Complications Over Time in a Large Stroke Network

Introduction: Telestroke technology allows evaluation of stroke patients remotely. We sought to determine if there was any change in the standard of care and evaluation of stroke patients over time and whether there were differences in complication rates between those who were evaluated using telestroke technology and those who were not. Methods: Data from April 2010 to May 2018 from a large stroke network were used. Acute ischemic stroke patients who presented to the emergency departments (ED) with last-known-well-to-door less than 4.5 hours and were treated with IV-alteplase were included. The number of facilities ranged from 7 in 2010 to 18 in 2017. Primary outcomes included the number and percentage of cases that were treated using telepresence (Beam-In) versus conventional care (no Beam-In) over time, as well as their discharge status and complications. Chi-squared or Linear By Linear Association were used to compare categorical variables and Mann-Whitney U Tests were used to compare continuous variables. Results: A total of 1,150 patients were treated from 2010 to 2018, 75.8 % (n=872) via Beam-In. The number of Beam-Ins increased overtime and there was a significant increased trend in the percentage of treated Beam-Ins (p\u3c.001) (graph). There were fewer patients discharged home (38.0% vs 50.4%, p\u3c.001), more transferred to acute care facilities (37.6% vs 13.8%, p\u3c.001) and fewer hospice or deaths (5.9% vs 12.9%, p\u3c.001) for those treated via Beam-In. There was no significant difference in number of symptomatic intracranial hemorrhage, life threatening systemic hemorrhage or other serious complications. Conclusion: Stroke care has evolved from traditional bedside care to more video evaluations in patients who received alteplase without increase in complications.https://digitalcommons.psjhealth.org/other_pubs/1068/thumbnail.jp