No abstract available.
Aphasia* ; Humans ; Stroke*

BACKGROUND AND PURPOSE: Sickle cell disease (SCD) is strongly linked to stroke across all haplotypes in the pediatric population. Transcranial Doppler (TCD) ultrasound is known to identify the highest risk group in African-Americans who need to receive and stay on blood transfusions, but it is unclear if the same flow velocity cut-offs can be applied to the Iranian population. We aimed to evaluate baseline TCD findings in Iranian children with SCD and no prior strokes. METHODS: Children with genetically confirmed SCD (Arabian haplotype, homozygote) and without SCD (controls) were prospectively recruited from pediatric outpatient clinic over a period of 9 months. We performed TCD in both groups to determine flow velocities in the middle cerebral (MCA) and terminal internal carotid arteries (TICA). RESULTS: Of 74 screened children, 60 met the inclusion/exclusion criteria (62% female; mean age 10+/-4 years). Baseline characteristics did not differ between the cases and controls, except hemoglobin (Hb) which was significantly lower in the SCD group (P<0.001). The right MCA TAMM (Time Averaged Maximum Mean) was significantly higher than in controls (125+5.52 cm/s vs. 92.5+1.63 cm/s, P<0.001). Left MCA did not show differences. The TICA TAMM was also different between cases and controls (P<0.05). CONCLUSIONS: Among Iranian children with asymptomatic SCD and without receiving recent transfusion TCD velocities are higher as compared to healthy controls but appear much lower than those observed in STOP (Stroke Prevention Trial in Sickle Cell Anemia) studies. We hypothesize that some children at high risk may be present with velocities lower than 170-200 cm/s thresholds. A prospective validation of ethnicity-specific prognostic criteria is warranted.
Ambulatory Care Facilities ; Anemia, Sickle Cell* ; Blood Transfusion ; Carotid Artery, Internal ; Child* ; Female ; Haplotypes ; Humans ; Prospective Studies ; Stroke ; Ultrasonography

BACKGROUND AND PURPOSE: Stroke is common among cancer patients. However, risk factors and biomarkers of stroke in cancer patients are not well established. This study aimed to investigate risk factors and biomarkers as well as etiology of ischemic stroke in cancer patients. METHODS: A retrospective review was conducted in cancer patients with ischemic stroke who were admitted to a general hospital in Busan, Korea, between January 2003 and December 2012. The risk factors and biomarkers for stroke and stroke subtypes in cancer patients were compared with age- and sex-matched noncancer patients with ischemic stroke who were admitted to the same hospital during the same period. RESULTS: One hundred fifty-six cancer patients with ischemic stroke were identified. Cancer patients with ischemic stroke were found to have a significantly lower proportion of hypertension, atrial fibrillation, hyperlipidemia, and ischemic heart disease than noncancer patients with ischemic stroke. However, stroke biomarkers, such as erythrocyte sedimentation rate and high-sensitivity C-reactive protein, fibrinogen, pro-brain natriuretic peptide, and D-dimer levels, were significantly increased in cancer patients with ischemic stroke than in noncancer patients. Large-artery atherosclerosis and stroke of undetermined cause were more common in cancer patients with ischemic stroke than in noncancer patients with ischemic stroke. CONCLUSIONS: Cancer patients with ischemic stroke showed different risk factors, stroke biomarkers, and stroke etiology compared with noncancer patients with ischemic stroke.
Atherosclerosis ; Atrial Fibrillation ; Biomarkers* ; Blood Sedimentation ; Busan ; C-Reactive Protein ; Fibrinogen ; Hospitals, General ; Humans ; Hyperlipidemias ; Hypertension ; Korea ; Myocardial Ischemia ; Retrospective Studies ; Risk Factors* ; Stroke*

BACKGROUND AND PURPOSE: Smartphone applications have been increasingly identified as a novel platform for dissemination of healthcare related information. However, there have been no studies done to evaluate the availability and content of stroke related apps. Purpose: This study aims to identify and analyze stroke-related applications available on the Apple iTunes and Android Google Play Store. METHODS: The Apple iTunes store and Android Google Play Store were searched for stroke-related applications on July 27, 2013 using keywords: stroke, brain attack, intracranial hemorrhage, subarachnoid hemorrhage, cerebral infarction. The content of the applications was analyzed by two independent investigators. RESULTS: A total of 93 relevant applications (46.2% android and 53.8% iPhone) were identified of which 47.3% were available free of cost. 92% of apps were identified as useful by users and over 60% had scientifically valid information. There is a significant participation of healthcare agencies in dissemination of stroke related information through apps with 47.3% apps being uploaded by them. Over half of all stroke related apps were aimed towards health care workers (51.6%), 75% of which could be utilized as bedside tools for patient care and remainder had information related to recent research advances. The difference in scientific validity between the apps aimed at general population versus healthcare professionals was statistically significant (P<0.01). There was no statistical association between cost of app and scientific validity or usefulness. CONCLUSIONS: Smartphone apps are a significant source of information related to stroke. An increasing participation of healthcare agencies should be encouraged to promote dissemination of scientifically valid information.
Brain ; Cerebral Infarction ; Delivery of Health Care ; Humans ; Intracranial Hemorrhages ; Mobile Applications ; Patient Care ; Research Personnel ; Stroke* ; Subarachnoid Hemorrhage ; Smartphone

BACKGROUND AND PURPOSE: Clinical practice guidelines (CPGs) are regarded as an essential guidance tool for practicing physicians. We surveyed physicians in Korea in order to evaluate their attitudes toward the Korean CPGs for stroke. METHODS: We obtained participation agreement for our survey from 27 centers of the 33 most actively contributing to the Korean Stroke Registry. A total of 174 neurologists participated in a questionnaire interview regarding their attitudes toward CPGs for stroke. RESULTS: Of 174 participating neurologists, 65 (37.4%) were stroke neurologists. The average age was 33.6+/-7.1 and 49 (28.2%) were female. Most of the respondents held positive attitudes and opinions regarding the use of the guidelines, whereas only a small percentage (14.9%) responded negatively. More than 60% of the physicians in the survey reported adherence to the Korean CPGs in dyslipidemia management for the secondary prevention of stroke. CONCLUSIONS: The positive attitudes and opinions toward the guidelines imply that physicians' attitudes should not be regarded as a potential barrier to the implementation of Korean CPGs for stroke practiced by general physicians.
Surveys and Questionnaires ; Dyslipidemias ; Female ; Humans ; Korea ; Secondary Prevention ; Stroke*

Atrial fibrillation (AF) is an emerging epidemic in both high-income and low-income countries, mainly because of global population aging. Stroke is a major complication of AF, and AF-related ischemic stroke is more disabling and more fatal than other types of ischemic stroke. However, because of concerns about bleeding complications, particularly intracranial hemorrhage, and the limitations of a narrow therapeutic window, warfarin is underused. Four large phase III randomized controlled trials in patients with non-valvular AF (RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE-AF-TIMI 48) demonstrated that new oral anticoagulants (NOACs) are superior or non-inferior to warfarin as regards their efficacy in preventing ischemic stroke and systemic embolism, and superior to warfarin in terms of intracranial hemorrhage. Among AF patients receiving warfarin, Asians compared to non-Asians are at higher risk of stroke or systemic embolism and are also more prone to develop major bleeding complications, including intracranial hemorrhage. The extra benefit offered by NOACs over warfarin appears to be greater in Asians than in non-Asians. In addition, Asians are less compliant, partly because of the frequent use of herbal remedies. Therefore, NOACs compared to warfarin may be safer and more useful in Asians than in non-Asians, especially in stroke patients. Although the use of NOACs in AF patients is rapidly increasing, guidelines for the insurance reimbursement of NOACs have not been resolved, partly because of insufficient understanding of the benefit of NOACs and partly because of cost concerns. The cost-effectiveness of NOACs has been well demonstrated in the healthcare settings of developed countries, and its magnitude would vary depending on population characteristics as well as treatment cost. Therefore, academic societies and regulatory authorities should work together to formulate a scientific healthcare policy that will effectively reduce the burden of AF-related stroke in this rapidly aging society.
Aging ; Anticoagulants* ; Asian Continental Ancestry Group* ; Atrial Fibrillation ; Delivery of Health Care ; Developed Countries ; Embolism ; Health Care Costs ; Hemorrhage ; Humans ; Insurance ; Intracranial Hemorrhages ; Population Characteristics ; Stroke* ; Warfarin

Moyamoya disease is characterized by a progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology is still unknown, recent genome-wide and locus-specific association studies identified RNF213 as an important susceptibility gene of moyamoya disease among East Asian population. A polymorphism in c.14576G>A in RNF213 was identified in 95% of familial patients with moyamoya disease and 79% of sporadic cases, and patients having this polymorphism were found to have significantly earlier disease onset and a more severe form of moyamoya disease, such as the presentation of cerebral infarction and posterior cerebral artery stenosis. The exact mechanism by which the RNF213 abnormality relates to moyamoya disease remains unknown, while recent reports using genetically engineered mice lacking RNF213 by homologous recombination provide new insight for the pathogenesis of this rare entity. Regarding biomarkers of moyamoya disease, moyamoya disease is characterized by an increased expression of angiogenic factors and pro-inflammatory molecules such as vascular endothelial growth factors and matrix metalloproteinase-9, which may partly explain its clinical manifestations of the pathologic angiogenesis, spontaneous hemorrhage, and higher incidence of cerebral hyperperfusion after revascularization surgery. More recently, blockade of these pro-inflammatory molecules during perioperative period is attempted to reduce the potential risk of surgical complication including cerebral hyperperfusion syndrome. In this review article, we focus on the genetics and biomarkers of moyamoya disease, and sought to discuss their clinical implication.
Angiogenesis Inducing Agents ; Animals ; Asian Continental Ancestry Group ; Biomarkers* ; Brain ; Carotid Artery, Internal ; Cerebral Infarction ; Constriction, Pathologic ; Genetics* ; Hemorrhage ; Homologous Recombination ; Humans ; Incidence ; Matrix Metalloproteinase 9 ; Mice ; Moyamoya Disease* ; Neovascularization, Pathologic ; Perioperative Period ; Posterior Cerebral Artery ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke, it was successful to increased annual smoke cessation rate through the 2009 Tobacco Hazards Prevention Act and decreased obesity rate through a nationwide weight-loss program conducted by Health Promotion Administration from 2011 to 2013 in Taiwan.
Aging ; Atrial Fibrillation ; Cause of Death ; Critical Pathways ; Health Promotion ; Humans ; Hyperlipidemias ; Hypertension ; Life Expectancy ; Mortality ; Obesity ; Risk Factors* ; Smoke ; Smoking ; Stroke* ; Taiwan* ; Tissue Plasminogen Activator ; Tobacco

No abstract available.
Atrial Fibrillation* ; Stroke*

No abstract available.
Cause of Death* ; Korea ; Stroke*