Background and Objective: There is a lack of international collaborative studies on young adults with ischaemic stroke in Asia. The aim of this study was to investigate risk factors, aetiology and outcome at hospital discharge of these patients across 8 participating countries in Asia. Methods: This was a prospective, observational, multicentre, hospital based cohort study. Consecutive young stroke patients with confirmed cerebral infarction between the ages of 18-49 were recruited from December 2011 to May 2012. Data was collected for patient demography, risk factors, investigations, clinical profile and TOAST classification. Outcome measures were death and independence (modified Rankin score≤ 2) at hospital discharge. Results: Two hundred and eighteen patients with the mean age was 40.8±6.7 years were recruited. There was a larger proportion of male patients with a ratio of 1.9:1. Traditional risk factors observed were hypertension (n=103; 47.3%), dyslipidaemia (n=93; 42.4%), smoking (n=85; 38.8%), diabetes (n=53; 24.3%), alcohol use (n=33; 15.0%), a previous history of stroke and transient ischaemic attacks (6.4%), family history (n=12; 5.5%), migraine (n=6;2.8%), pregnancy related (n=5; 2.3%) and numerous cardiac risk factors (0.9-5.5%). The majority suffered arterial infarction; n=216 (99.4%) while n=2 (0.6%) had venous strokes. The predominant stroke subtypes were large artery atherosclerosis (LAA); 29.8% and small vessel occlusion (SVO); 20.2%. LAA and SVO accounted for 37.5% of all stroke subtypes in the ≤36 year age-group. Cardioembolism (15.1%) and stroke of determined aetiology (14.7%) contributed to the other categories of identified stroke subtypes. Mortality on hospital discharge was 3.1% while 65.1% of patients were independent on discharge. Conclusion: This study demonstrated the substantial presence of premature atherosclerosis and conventional risk factors in young ischaemic stroke patients from 8 Asian cities. Venous infarction from cerebral venous thrombosis was rare in this study. Outcome on hospital discharge was poorer compared to Western studies. Detection of vascular risk factors and primary prevention measures should be initiated during late adolescence or early adulthood in urban Asia.

BACKGROUND: Stroke is an emergency. In order to provide proper acute stroke treatment, there must be prompt activation of a stroke response system designed to deliver timely and optimum care. In our institution, the Brain Attack Team (BAT) was initiated upon the inception of the neurology residency training program.

OBJECTIVES:to ascertain the number and nature of BAT referral cases; to determine the time frames of the acute stroke response system observed in our institution. The time frames were compared to target times recommended by the National Institute of Neurological Disorders and Stroke (NINDS).

METHOD: We reviewed records of 399 BAT referral cases - both emergency room (ER) and floor referrals -over a ten-month period from January to October 2007. Frequency and percentage distributions were computed for the number of BAT referrals. Median time intervals in minutes were computed.

RESULTS: January had the most number of BAT calls at 17% (68 of 399). Fifty-five percent (220 of 399) of BAT calls were made during the night duty shift. Ischemic strokes had the highest incidence at 49.6% (198 of 399). Fifty-three percent (211 of 399) of patients were able to arrive at the ER within 3 hours; 47% (99 of 211) of these patients were ischemic stroke cases, and therefore eligible for possible thrombolysis. Of the 99 eligible patients, 8 passed our hospital criteria for thrombolysis. Intravenous recombinant tissue-plasminogen activator (rTPA) was administered in 6 out of 8 patients. Median time values were as follows: Ictus-to-Door time was 180 minutes, Door/Ictus at the floors-to-BAT referral was 30 minutes, BAT referral-to-BAT response was 5 minutes, Door/Order-to CT scan was 43 minutes. Door/Ictus at the floors-to-Drug median time among thrombolysed patients was 102.5 minutes.

CONCLUSION: Median time of BAT referral-to-BAT response was immediate. This was true even during night shift. Among those cases of patients who were given thrombolytic therapy, Door/Order-to-CT scan was within the NINDS target.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Stroke ; Brain ; Neurology ; Neurosciences

INTRODUCTION: Intravenous administration of Recombinant Tissue Plasminogen Activator (IV-rTPA) has been an essential component of reperfusion treatment strategies in the aftermath of the 1995 National Institute of Neurological Disorders and Stroke (NINDS) TPA Stroke Study. However, it remains to be under-utilized both nationally and worldwide. Local data on thrombolytic use are very limited.

OBJECTIVES: This study aims to document our institution's experience with the use of intravenous thrombolysis in acute ischemic stroke cases by describing the demographic, clinical, radiographic, and management profiles of all our patients who were given IV - rTPA and their functional outcomes upon discharge and after three months.

METHOD: This is a descriptive study utilizing a clinical series design. Chart review of eighteen (18) patients who were admitted in our institution--a tertiary private hospital--due to acute ischemic stroke from January 2007 to August 2009 and who has given IV- rTPA was done. The patients' functional outcomes measured by the Modified Rankin Scale (MRS) upon discharge and at three months after stroke onset were documented by reviewing the patients' inpatient and outpatient records and by telephone interview conducted with the patients and/or their relatives.

RESULTS: The mean age of patients thrombolysed in our institution was 57.11 + 13.5 years (range: 31 to 80 years). All cases, except for one vertebrobasilar stroke, were anterior circulation strokes. Mean ictus-to-needle time frame for all thrombolysed patients was 174.3 + 56.6 minutes. The mean rTPA dose given to our patients was 0.87 + 0.08 mg/kg. A total 77.8% patients (14 of 18) received the standard rTPA dose of 0/9 mg/kg. Fourteen patients had follow-up imaging post-rTPA. Among these, 21.4% (3 of 14) developed non-symptomatic intracerebral hemorrhage (NSICH); 7.1% (1 of 14) developed a fatal symptomatic intracerebral hemorrhage (SICH). The mean baseline National Institutes of Health Stroke Scale (NIHSS) score of all patients was 14.9 + 5.9 (range: 4 to 24). Mean NIHSS score within the first 24 hours post-rTPA was 8.8 ± 6.1 (range: 0 to 19)--a 41% improvement from baseline. Eleven patients (11 of 18) or 61.1% were noted to have early improvement or an improvement of NIHSS score within the first 24 hours by ≥ 4. The mean follow-up NIHSS score beyond the first 24 hours post-rTPA was 5.5 ± 5.3 (range: 0 to 18), obtained at an average of 4.8 ± 2.4 days post-thrombolysis--a 63% improvement from the baseline mean NIHSS score. The mean MRS score of all patients upon hospital discharge was 3.17 ± 1.69. Two patients (2 of 18) or 11.1% expired 4 and 5 days post-thrombolysis; two (2 of 18) were lost to follow-up. For those who survived to discharge and not lost to follow-up (n=14), the mean MRS score at three months was noted to be 1.50 ± 1.09--a 53% improvement from mean MRS upon discharge. Seven of 18 patients (39%) had a favorable outcome defined as MRS ≤ 1 at three months post thrombolysis. Protocol deviations in our hospital were reported in 16.7% (3 of 18).

CONCLUSION: Our study showed trends to early improvement and favorable outcomes among stroke patients given IV-rTPA within 3 to 4.5 hours from ictus in our institution--with NIHSS scores improving by 40 to 60% during the course of their hospital stay, and 39% of patients having minimal or no disability at 3 months using the MRS. Our institution has more experience the standard rTPA dose of 0.9 mg/kg. A hospital brain rack team (BAT) that is on-call 24 hours' aids in the facilitation of thrombolytic treatment in acute ischemic strokes.

Human ; Aged 80 And Over ; Tissue Plasminogen Activator ; National Institute Of Neurological Disorders And Stroke (u.s.) ; Stroke ; Length Of Stay ; Brain Ischemia ; Inpatients ; Outpatients ; Follow-up Studies ; Lost To Follow-up ; Fibrinolytic Agents ; Cerebral Hemorrhage ; Reperfusion ; Administration, Intravenous ; Brain ; Hospitals, Private ; Demography ; Telephone

Background and Objective: There is a paucity of studies looking into the frequency of complications after stroke among Asians. We sought to determine the frequency and rate of complications among Asians after acute stroke. Methods: Consecutive patients with acute stroke among 10 participating Asian countries were included in the study. The frequency and timing of pre-determined complications, and their relation to area of admission were noted. Results: Of the 1,153 patients included in the study, 423 (41.9%) developed complications within the first 2 weeks of stroke. Recurrent stroke, chest infections and urinary tract infections were most commonly encountered, and were most frequent within the first week of stroke onset. A lower rate of complications was noted among patients admitted at an organized stroke unit. Conclusion: There is a similar rate of frequency and timing of complications after acute stroke among Asians as compared with other populations.