As the number of elderly people increases, the incidence of stroke, especially the hemorrhagic stroke, is increasing. A large-scale survey of the entire country pertaining to the incidence and demographic characteristics of hemorrhagic stroke in elderly is necessary. Through information garnered from a basic survey and clinical study, we must design a treatment program to reduce the mortality of elderly people through elucidating the specific properties of stroke pathophysiology.
Aged* ; Humans ; Incidence* ; Mortality ; Stroke*

BACKGROUNDStroke unit is the most effective treatment method to benefit stroke patients. Our study is to evaluate the early effectiveness of a hospital stroke unit (SU).

METHODSThree hundred and ninety-two patients who had suffered from acute strokes and who were admitted to our hospital between December 2001 and January 2003 were recruited for this controlled study. All patients were sent at random to either the SU or the general ward (GW) for treatment. The following indices were measured by: Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS).

RESULTSThe mean change in BI score between the day of admission and the day of discharge was 20.00 +/- 24.36 for the SU group and 10.63 +/- 23.59 for the GW group. A difference that is statistically significant (P = 0.000). The mean change in NIHSS score was -2.01 +/- 6.61 for the SU group and 0.55 +/- 7.44 for the GW group. A difference that is also statistically significant (P = 0.000). Finally, the mean change in OHS score was -0.74 +/- 1.04 for the SU group and -0.28 +/- 0.98 for the GW group, also a statistically significant difference (P = 0.000). Among SU patients, patient satisfaction was higher (P = 0.000), the rehabilitation success rate was higher (P = 0.000), and there were fewer complications (P = 0.000).

CONCLUSIONCompared to GW patients, stroke patients treated in a special SU were able to return to normal daily activities earlier, with better social abilities, and have reduced neurological defects, without increasing the overall economic burden.

Pediatric stroke is relatively rare but may lead to significant morbidity and mortality. Along with the advance of brain imaging technology and clinical awareness, diagnosis of pediatric stroke is increasing wordwide. Pediatric stroke differs from adults in variable risk factor/etiologies, diverse and nonspecific clinical presentation depending on ages. This review will be discussed pediatric stroke focusing on their clinical presentations, diagnosis and etiologies/risk factors.
Adult ; Diagnosis ; Humans ; Mortality ; Neuroimaging ; Risk Factors ; Stroke*

Intracerebral hemorrhage is a lethal stroke type with a high morbidity and mortality. Hematoma growth is one of the independent determinants of neurological and functional outcomes after intracerebral hemorrhage. Attenuation of growth is an important therapeutic strategy. Hemostatic therapeutic intervention, given ultra-early in the course of intracerebral hemorrhage, may thus improve clinical outcomes by arresting ongoing bleeding and limiting in turn the size of the hematoma. Recombinant factor VIIa is a hemostatic drug approved to treat bleeding in hemophilia or other coagulopathy; it has also been reported to arrest bleeding in nonhemophilic cases. We reviewed of the published articles specifically addressing clinical trials of recombinant factor VIIa treatment for acute intracerebral hemorrhage and evaluate the safety and feasibility of it.
Cerebral Hemorrhage* ; Factor VIIa* ; Hematoma ; Hemophilia A ; Hemorrhage ; Mortality ; Stroke

PURPOSE: The purpose of this study was to compare the general characteristics that affect the prognosis and evaluate the influence of stroke on one-year postoperative mortality and recovery of ambulatory status in elderly patients over 65 years old with femoral intertrochanteric fracture. MATERIALS AND METHODS: This study included 80 patients who were followed-up for one year after proximal femoral nailing for femur intertrochanteric fracture between January 2008 and December 2013. We analyzed the relationship among the one-year postoperative mortality, recovery of ambulatory status and the associated factors (age, gender, associated underlying disease, American Society of Anesthesiologists [ASA] grade, comminution of the fracture, dementia). RESULTS: The one-year postoperative mortality rate in all patients and patients with stroke was 28.8% and 42.9%, respectively. The one-year postoperative mortality rate was significantly higher in patients with stroke, high ASA grade, and unstable fracture. Decrease of the one-year postoperative ambulatory status was 50.9% in all patients and was significantly associated with grade III or IV ASA rating. No significant relationships were observed between the one-year postoperative recovery of ambulatory status and stroke. CONCLUSION: Stroke, ASA grade, and unstable fracture were prognostic factors associated with one-year postoperative mortality following intertrochanteric fracture. ASA rating was the only prognostic factor affecting one-year postoperative recovery of ambulatory status.
Aged ; Femur ; Hip Fractures* ; Humans ; Mortality ; Prognosis* ; Stroke*

BACKGROUND AND PURPOSE: The recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke. METHODS: In total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models. RESULTS: CMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67). CONCLUSIONS: The total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.
Brain ; Cause of Death ; Follow-Up Studies* ; Humans ; Magnetic Resonance Imaging ; Mortality* ; Stroke* ; Stroke, Lacunar

OBJECTIVE: We evaluated the effect of endovascular treatment (EVT) for acute ischemic stroke in patients over 80 years of age. MATERIALS AND METHODS: The records of 156 acute stroke patients aged over 80 years who were considered as candidates for EVT were analyzed. Fifty-six patients (35.9%, EVT group) underwent EVT and 100 patients (64.1%, non-EVT group) did not. Outcomes, in terms of functional outcomes and rates of symptomatic hemorrhage, in-hospital morbidity and mortality, were compared between groups. Each comparison was adjusted for age, time from onset, initial National Institute of Health Stroke Scale, and pre-stroke modified Rankin Scale (mRS). RESULTS: More patients in the EVT group achieved good outcomes (mRS score of 0-2) at 3 months (35.7% vs. 11.0%, adjusted odds ratio [OR] 4.779 [95% confidence interval 1.972-11.579], p = 0.001) and 12 months (35.7% vs. 14.0%, adjusted OR 3.705 [1.574-8.722], p = 0.003) after stroke. During admission, rates of hospital-acquired infection including pneumonia (12.5% vs. 29.0%, adjusted OR 0.262 [0.098-0.703], p = 0.008) and urinary tract infection (16.0% vs. 34.0%, adjusted OR 0.256 [0.099-0.657], p = 0.005) were significantly lower in the EVT group. More symptomatic hemorrhages (10.7% vs. 2.0%, adjusted OR 6.859 [1.139-41.317], p = 0.036) occurred in the EVT group, but no significant difference was observed in in-hospital mortality rate (12.5% vs. 8.0%, adjusted OR 1.380 [0.408-4.664], p = 0.604). CONCLUSION: EVT improved functional outcome and reduced the risk of hospital-acquired infections in acute stroke patients over 80 years of age without increasing the risk of in-hospital mortality, although symptomatic hemorrhage occurred more frequently after EVT.
Hemorrhage ; Hospital Mortality ; Humans ; Mortality ; Odds Ratio ; Pneumonia ; Stroke* ; Thrombolytic Therapy ; Urinary Tract Infections

OBJECTIVE: We evaluated the effect of endovascular treatment (EVT) for acute ischemic stroke in patients over 80 years of age. MATERIALS AND METHODS: The records of 156 acute stroke patients aged over 80 years who were considered as candidates for EVT were analyzed. Fifty-six patients (35.9%, EVT group) underwent EVT and 100 patients (64.1%, non-EVT group) did not. Outcomes, in terms of functional outcomes and rates of symptomatic hemorrhage, in-hospital morbidity and mortality, were compared between groups. Each comparison was adjusted for age, time from onset, initial National Institute of Health Stroke Scale, and pre-stroke modified Rankin Scale (mRS). RESULTS: More patients in the EVT group achieved good outcomes (mRS score of 0-2) at 3 months (35.7% vs. 11.0%, adjusted odds ratio [OR] 4.779 [95% confidence interval 1.972-11.579], p = 0.001) and 12 months (35.7% vs. 14.0%, adjusted OR 3.705 [1.574-8.722], p = 0.003) after stroke. During admission, rates of hospital-acquired infection including pneumonia (12.5% vs. 29.0%, adjusted OR 0.262 [0.098-0.703], p = 0.008) and urinary tract infection (16.0% vs. 34.0%, adjusted OR 0.256 [0.099-0.657], p = 0.005) were significantly lower in the EVT group. More symptomatic hemorrhages (10.7% vs. 2.0%, adjusted OR 6.859 [1.139-41.317], p = 0.036) occurred in the EVT group, but no significant difference was observed in in-hospital mortality rate (12.5% vs. 8.0%, adjusted OR 1.380 [0.408-4.664], p = 0.604). CONCLUSION: EVT improved functional outcome and reduced the risk of hospital-acquired infections in acute stroke patients over 80 years of age without increasing the risk of in-hospital mortality, although symptomatic hemorrhage occurred more frequently after EVT.
Hemorrhage ; Hospital Mortality ; Humans ; Mortality ; Odds Ratio ; Pneumonia ; Stroke* ; Thrombolytic Therapy ; Urinary Tract Infections

BACKGROUND AND PURPOSE: Ascertaining stroke severity and predicting risk of in-hospital mortality is crucial to advise patients and families about medical decisions. We developed and tested the validity of a new stroke score, the 6S Score (Stroke Severity Score based on Six Signs and Symptoms), for quantifying ischemic stroke severity and predicting in-hospital mortality. METHODS: We prospectively assessed 210 consecutive acute ischemic stroke patients. The cohort was further divided into a derivation (n=120) and a validation (n=90) sample. From a total of 10 stroke signs and symptoms, we selected those with likelihood ratio's P<0.005. We tested the validity of the score for predicting in-hospital mortality by using receiver operating characteristic curves. We used a scatterplot and the Spearman's test to evaluate the correlation between the 6S Score and the National Institutes of Health Stroke Scale as a marker of stroke severity. We used principal component and exploratory factor analyses for assessing qualitative aspects of the 6S Score. RESULTS: The C statistic for in-hospital mortality was 0.82 for the 6S Score and 0.86 for the National Institutes of health Stroke Scale, respectively, with no significant differences between each other (P=0.79). The correlation between both scores was strong (Spearman's rho 0.68, P<0.001). The factor analyses showed a good balance between left/right hemispheres and anterior/posterior circulations. CONCLUSIONS: The 6S Score may constitute a tool for easily assessing stroke severity and predicting stroke mortality. Further research is needed for further assessing its external validity.
Cohort Studies ; Hospital Mortality* ; Humans ; Mortality ; National Institutes of Health (U.S.) ; Prospective Studies ; ROC Curve ; Stroke*

PURPOSE: Although early neurological deterioration (END) during the acute stroke period is known to be associated with poor functional outcomes, there is little data regarding the impact of END on long-term outcomes according to the characteristics of END. The aim of this study was to investigate whether there are differences in long-term mortality according to the characteristics of END among acute ischemic stroke or transient ischemic attack patients. MATERIALS AND METHODS: END was defined as any increase (> or =1) in National Institute of Health Stroke Scale score within 7 days after admission. We assessed the characteristics of END, such as the etiology and severity of END, as well as recovery after END. The relationship between 30-day or long-term mortality and each characteristic of END was investigated using multiple logistic analysis or Cox regression model. RESULTS: Among 2820 patients, END was observed in 344 patients (12.2%). After adjustment for age, sex, underlying cardiovascular diseases, stroke severity, and stroke subtypes, END was associated with long-term mortality, whether it was mild or severe and whether or not it was followed by recovery. However, 30-day mortality was strongly related to the severity of END or the absence of recovery after END. Among the causes of END, recurrent stroke and medical illness were related to 30-day mortality, as well as long-term mortality, while brain herniation and intracranial hemorrhagic complications were only associated with 30-day mortality. CONCLUSION: The results of the present study demonstrated that END is associated with higher mortality and the effects of END on short-term and long-term mortality depend on END characteristics.
Aged ; Brain Ischemia/mortality/*physiopathology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stroke/mortality/*physiopathology