BACKGROUND AND OBJECTIVE

The incidence of ischemic stroke typically increases with age; however, recent studies have shown a concerning trend of stroke cases among adults under the age of 45. This neurologic condition is called “Stroke in the Young” (SITY). SITY poses public health concerns due to its long-term consequences on individuals and their families. Despite significant impact, published literature on SITY among Filipinos is scarce. Given the potential differences in genetic background and lifestyle, the clinical characteristics and outcomes of SITY Filipinos may vary considerably from other populations. Therefore, the aim of this study is to describe the clinical features and outcomes of ischemic SITY Filipinos.

METHODS

The study was a two-center, five-year retro- spective cohort design involving 19- to 45-year-old  patients admitted between January 1, 2017, and December 31, 2022, diagnosed clinically and radiologically with ischemic stroke for the first time. Medical records were reviewed, including demographic data, stroke symptoms, cardiovascular or non-cardiovascular risk factors, and laboratory results. Ischemic stroke subtypes were categorized into cardioembolic, small artery occlusion, stroke of other determined causes, and stroke of undetermined cause through the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Functional outcomes on hospital discharge were assessed by the Modified Rankin Scale (mRS). All data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS software, version 29).

RESULTS

A total of 205 cases of ischemic SITY were chart reviewed. The mean age was 37.30, with a female predominance of 68.3%. The most reported cardiovascular risk factors were obesity (56.6%), hypertension (51.2%), heavy alcohol consumption (36.5%), and diabetes mellitus type 2 (19.5%). Concurrently, the non-cardiovascular risk factors identified were pregnancy, particularly in the postpartum period (4.8%), use of estrogen-containing pills (4.8%), and migraine without aura (4.4%). Based on TOAST classification, small vessel occlusion (42.1%) and large artery atherosclerosis (30.2%) were the most frequent ischemic stroke subtypes of SITY Filipino females. Mostly showed no symptoms of disability (35.1%) on hospital discharge.

CONCLUSION

This study highlights the difference in the clinical profile of young Filipino adults with ischemic stroke. Contrary to previous studies, ischemic stroke was more predominant among young females. Aside from hypertension, obesity has emerged as the leading cardio- vascular risk factor for ischemic SITY. Moreover, noncardiovascular risk factors, specific to females (pregnancy, use of estrogen-containing pills, and migraine), were also identified in the study. With regards to stroke subtypes, small vessel occlusion and large artery atherosclerosis were frequently seen in young female patients. These f indings suggest a need for gender-specific approaches in the evaluation, management, and prevention of ischemic SITY.

Human ; Young Adult: 19-24 Yrs Old ; Ischemic Stroke

Objective To investigate the association of baseline cerebral blood flow （CBF） and cerebral metabolic rate of oxygen （CMRO2） with sleep structure disorder after thrombolytic therapy in stroke patients， as well as their value in clinical assessment. Methods A total of 145 patients with stroke were enrolled as subjects， and all of them received thrombolytic therapy in our hospital from January 2023 to June 2025. Before thrombolytic therapy， 3.0 T magnetic resonance imaging was used to obtain relative CBF （rCBF） and relative CMRO2 （rCMRO2）， and rCBF/rCMRO2 ratio was calculated. At week 1 after thrombolysis， overnight polysomnography （PSG） was conducted to obtain parameters such as total sleep time， sleep efficiency， the proportion of each NREM stage， and REM sleep duration. According to the presence or absence of sleep structure disorder， the subjects were divided into disorder group and non-disorder group. The Pearson correlation method was used for correlation analysis. A multivariate logistic regression analysis was used to identify the influencing factors for sleep structure disorder in subjects after thrombolytic therapy. The receiver operating characteristic （ROC） curve was plotted to analyze the performance of rCBF/rCMRO2 ratio in predicting sleep structure disorder in subjects after thrombolytic therapy. Results Compared with the non-disorder group， the disorder group had significantly higher age， infarct volume， NIHSS score on admission， and proportion of patients with infarction in the thalamus （P<0.05）. Compared with the non-disorder group， the disorder group had significantly lower rCBF， rCMRO2， rCBF/rCMRO2 ratio， total sleep time， proportion of NREM 3 sleep， proportion of REM sleep， and sleep efficiency （P<0.05） and significantly higher proportion of NREM 1 sleep and sleep arousal index （P<0.05）. The Pearson correlation analysis showed that rCBF， rCMRO2， and rCBF/rCMRO2 ratio were positively correlated with total sleep time， proportion of NREM 3 sleep， proportion of REM sleep， and sleep efficiency （P<0.001） and were negatively correlated with the proportion of NREM 1 sleep and sleep arousal index （P<0.001）. The Logistic regression analysis showed that age， infarct volume， infarction location （thalamus）， and NIHSS score on admission were risk factors for sleep structure disorder in stroke patients after thrombolytic therapy （P<0.05）， while rCBF， rCMRO2， and rCBF/rCMRO2 ratio were protective factors against sleep structure disorder （P<0.05）. The ROC curve analysis showed that rCBF/rCMRO2 ratio had an area under the ROC curve of 0.901 （95% CI 0.869-0.938） in predicting sleep structure disorder in stroke patients after thrombolytic therapy， with a sensitivity of 95.50% and a specificity of 82.40%. Conclusion Baseline rCBF， rCMRO2， and rCBF/rCMRO2 ratio are closely associated with sleep structure disorder in stroke patients after thrombolytic therapy， among which rCBF/rCMRO2 ratio has excellent performance in predicting sleep structure disorder and can be used as a sensitive indicator for clinical assessment of high-risk patients.
Stroke

Objective To investigate the influence of sleep disorders after stroke on the risk of recurrence of cerebrovascular events based on propensity score matching （PSM）. Methods A retrospective analysis was performed for the clinical data of 173 stroke patients who were admitted to our hospital from March 2021 to October 2023， and according to the presence or absence of sleep disorders， they were divided into sleep disorders group with 88 patients and non-sleep disorders group with 85 patients.The two groups of patients were matched by PSM at a ratio of 1∶1 based on the baseline data of sex， age， body mass index（BMI）， and smoking and drinking history， and the recurrence of cerebrovascular events was compared between the two groups before and after matching. The Cox regression model was used to investigate the influence of sleep disorders after stroke on the risk of recurrence of cerebrovascular events after matching. Results A total of 69 cases were successfully matched by PSM. After matching， there were no significant differences between the two groups in sex， age， BMI， drinking history，smoking history， past medical history， stroke type， diastolic blood pressure， systolic blood pressure，National Institutes of Health Stroke Scale score， triglyceride， total cholesterol， low-density lipoprotein cholesterol， high-density lipoprotein cholesterol， fasting blood glucose， glycosylated hemoglobin， C-reactive protein， homocysteine， anxiety， and depression（P>0.05）.Compared with the non-sleep disorders group， the sleep disorders group had a significantly higher incidence rate of transient ischemic attack and a significantly higher overall incidence rate of cerebrovascular events before and after matching （P<0.05）.After matching，the Cox regression model analysis showed that sleep disorders after stroke was an independent risk factor for recurrence of cerebrovascular events（P<0.05）. Conclusion After PSM of the baseline data of stroke patients，sleep disorder after stroke is an independent risk factor for recurrence of cerebrovascular events.
Stroke

BACKGROUND AND OBJECTIVES

Telerehabilitation is the remote delivery of rehabilitation services using telecommunication technologies. Its local adoption was catalyzed by the COVID-19 pandemic, prompting the need to assess user acceptance. This study aimed to determine the acceptance of stroke telerehabilitation among patients, carers, and rehabilitation providers in the Department of Physical Medicine and Rehabilitation at St. Luke’s Medical Center – Global City and Quezon City.

METHODS

This descriptive cross-sectional study used purposive sampling to recruit 73 rehabilitation providers and 10 consumers. Data were collected using a self-administered survey based on the Technology Acceptance Model, covering perceived ease of use, usefulness, and behavioral intent. Descriptive and inferential statistics were used for analysis.

RESULTS

Most providers (94.4%) were familiar with telerehabilitation, while only half of the consumers were aware of it. Acceptance was moderate among providers (mean score: 35.75 ± 8.67) and high among consumers (mean score: 31.6 ± 7.52). Female providers were less likely to accept telerehabilitation (p=0.049). Consumers identified financial constraints and lack of a companion as key barriers, while providers cited internet issues and technology use. Both groups viewed telerehabilitation positively for teleconsultation, teletherapy, and telemonitoring. Smartphones were the preferred device; Viber and Facebook Messenger were the most commonly chosen platforms.

CONCLUSION

Stroke telerehabilitation was moderately to highly accepted by rehabilitation stakeholders in two tertiary private hospitals in Manila. Findings may guide institutional planning for telerehabilitation services. Training, infrastructure support, and awareness campaigns can help address implementation barriers.

Human ; Male ; Female ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Remote Consultation ; Physical And Rehabilitation Medicine ; Tertiary Care Centers ; Telecommunications ; Telerehabilitation ; Cross-sectional Studies ; Technology ; Stroke ; Covid-19

INRODUCTION

Stroke is one of the top five leading causes of disability in the Philippines. It has a significant impact on the quality of life (QoL) of patients, particularly in the functional and psycho-emotional aspects. Thus, it is important to understand the health-related quality of life in stroke patients (HRQoLISP), which focuses on the clinical impact of the disease and disability. The assessment of a stroke patient’s QoL is prognostically significant as it can predict a patient’s treatment success and survival.

OBJECTIVE

This study aims to translate the HRQoLISP-26 into Filipino and assess its content validity for Filipino adult stroke patients.

METHODOLOGY

The HRQoLISP-26 was translated into Filipino using a forward translation protocol and an expert analyzed the forward translation. Selected expert committee members reviewed the first version to assess for content validity and the questionnaire was modified accordingly. The content validity index (CVI) was used for content validity.

RESULTS

Majority of the revisions made were done to improve the semantic and grammatical accuracy of items in the Filipino version of the HRQoLISP-26. Only a few items had no revisions implemented. No revisions were done in the final version of the translated questionnaire as each item had a CVI of 1 indicating that it has good content validity.

CONCLUSION

The Filipino translated HRQoLISP-26 questionnaire is a validated questionnaire that allows assessment of a stroke survivor’s QoL.

Quality Of Life ; Patients ; Life ; Health ; Adult ; Stroke

INTRODUCTION

Takayasu arteritis (TA) is a rare chronic large vessel vasculitis that affects the aorta and its major branches with a median age of onset of 25 years. The disease has a worldwide incidence of 1-2 per million, primarily affecting females with a 9:1 ratio. It is considered as an autoimmune disease that leads to progressive vessel thickening and stenosis, or aneurysmal dilatation. Coronary artery involvement is observed in 5.9%-58.2% of TA cases. We present a case of TA in a Filipino male presenting concurrently with myocardial infarction (MI) and ischemic stroke.

CASE REPORT

A 41-year-old Filipino male smoker with hypertension presented with chest pain, left-sided paresthesia and hemiparesis. Initial assessment revealed differential blood pressure between the arms, sensory and motor deficits, and abnormal ABI. Electrocardiogram confirmed anteroseptal ST-elevation MI and cranial computed tomography (CT) showed ischemic stroke. Arterial duplex scan had findings suggestive of hemodynamically significant lower extremity stenosis. A CT aortogram revealed multiple occlusions, including in the left subclavian artery, suggesting TA. Coronary angiography was attempted but was deferred due to peripheral arterial occlusion. A CT coronary angiogram revealed severe stenosis of the left anterior descending artery and moderate stenosis of the other coronaries. The patient was treated with dual antiplatelet therapy, statins, anticoagulation, corticosteroids and methotrexate. He experienced significant improvement in neurological symptoms and was chest pain-free upon discharge. At the 1-month follow-up, the patient remained asymptomatic.

DISCUSSION

Coronary involvement in TA can manifest as angina, MI, or other coronary lesions. The coexistence of MI and ischemic stroke in the same event is rare. Traditional risk factors for ischemic heart disease (IHD) in this patient such as hypertension and smoking may have contributed to the presentation, though TA itself is known to accelerate atherosclerosis. Limited vascular access hindered coronary intervention in this case and revascularization strategies remain challenging in active TA. The formation of extensive collateral arteries, along with early initiation of immunosuppressive therapy, likely contributed to the patient’s survival.

CONCLUSION

This case illustrates a rare and complex case of TA in a male patient with concurrent MI and ischemic stroke. Although coronary revascularization was not pursued due to occluded access, immunosuppressive therapy successfully managed the patient’s condition. Extensive collateral artery formation and early therapeutic intervention were key factors in the patient’s favorable outcome.

Human ; Male ; Adult: 25-44 Yrs Old ; Takayasu Arteritis ; Myocardial Infarction ; Ischemic Stroke ; Vasculitis ; Constriction, Pathologic

BACKGROUND

Stroke is a leading cause of morbidity and mortality in the Philippines. Telestroke systems have been introduced to improve timely recognition and referral; however, their effectiveness depends on utilization at the community level.

OBJECTIVE

To assess stroke and telestroke knowledge, attitudes, practices, and barriers among barangay health workers (BHWs), and to determine factors associated with telestroke utilization.

METHODS

A cross-sectional study was conducted among 202 BHWs. Data were collected using a structured questionnaire assessing knowledge, attitudes, practices, and perceived barriers. Descriptive statistics were used to summarize responses. Associations between variables were analyzed using appropriate statistical tests, with significance set at p < 0.05.

RESULTS

Respondents had high stroke knowledge (75.5%, SD = 17.45) and telestroke knowledge (85.5%, SD = 18.82), as well as favorable attitudes (mean = 4.37). However, only 31.1% reported telestroke utilization. The most commonly reported barriers were lack of training (61.4%) and poor internet connectivity (15.8%). Telestroke familiarity was significantly associated with higher knowledge (p = 0.005) and more favorable attitudes (p = 0.001). Stroke-related training (p = 0.001) and years of experience (p = 0.001) were significantly associated with higher utilization.

CONCLUSION

Despite high knowledge and favorable attitudes, telestroke utilization among BHWs remains low. Training, familiarity, and infrastructure appear to play key roles in bridging the gap between knowledge and practice. Strengthening these factors may improve the effectiveness of community-based telestroke systems.

Human ; Occupational Groups ; Knowledge ; Attitude ; Stroke ; Technology

BACKGROUND

Medication compliance contributes to preventing significant morbidities, such as stroke, among hypertensive patients.

OBJECTIVE

This study aimed to examine the factors affecting hypertensive patients' medication compliance in Sambag II, Cebu City.

METHODS

This study is an observational cross-sectional study. The study was conducted in Barangay Sambag II of Cebu City and involved 170 random, voluntary, self-reporting hypertensive patients. The Tao Yamane formula was used to determine the sample size. An interviewer-guided survey questionnaire was utilized to collect the data for the pilot study. The data were analyzed using Cronbach’s Alpha Test for internal consistency and reliability.

RESULTS

Three factors were shown to influence compliance with antihypertensive medications. These are the source of medication, access to medication, and symptoms experienced before intake of anti-hypertensive medications. A factor that significantly affects compliance is the source of medication, wherein hypertensive patients prefer medications from retail pharmacies compared to the free medications supplied by the local health center.

CONCLUSION

Residents of Sambag II, Cebu City preferred medications from retail pharmacies over the free medications provided by the local health center. Local health units may use this information to implement information drugs regarding the efficacy of medications provided by government agencies. Further studies are recommended to use subgroup analysis on factors influencing compliance and non-compliance to anti-hypertensive medicines.

Human ; Medication Compliance ; Medication Adherence ; Hypertension ; Stroke

Objective To explore macrophage subpopulations in ischemic stroke (IS) by using single-cell RNA sequencing (scRNA-seq) data analysis and High-Dimensional Weighted Gene Co-Expression Network Analysis (hdWGCNA). Methods Based on single-cell sequencing data, transcriptomic information for different cell types was obtained, and macrophages were selected for subpopulation identification. hdWGCNA, cell-cell communication, and pseudotime trajectory analysis were used to explore the characteristics of macrophage subpopulations following IS. Key genes related to IS were identified using microarray data and validated for diagnostic potential through Receiver Operating Characteristic (ROC) analysis. Gene Set Enrichment Analysis (GSEA) was conducted to investigate the potential functions of these genes. Results The scRNA-seq data analysis revealed significant changes in macrophage subpopulation composition after IS. A specific macrophage subpopulation enriched in the stroke group was identified and designated as MCAO-specific macrophages (MSM). Pseudotime trajectory analysis indicated that MSM cells were in an intermediate stage of macrophage differentiation. Cell-cell communication analysis uncovered complex interactions between MSM cells and other cells, with the CCL6-CCR1 signaling axis potentially playing a crucial role in neuroinflammation. Two gene modules associated with MSM were identified via hdWGCNA, significantly enriched in pathways related to NOD-like receptors and antigen processing. By integrating differentially expressed MSM genes with conventional transcriptomic data, three IS-related hub genes were identified: Arg1, CLEC4D, and CLEC4E. Conclusion This study reveals the characteristics and functions of macrophage subpopulations following IS and identifies three hub genes with potential diagnostic value, providing novel insights into the pathological mechanisms of IS.
Macrophages/metabolism* ; Computational Biology/methods* ; Single-Cell Analysis/methods* ; Transcriptome ; Ischemic Stroke/metabolism* ; Animals ; Gene Regulatory Networks ; Gene Expression Profiling ; Humans ; Male

Objective To investigate the effects and underlying mechanisms of human placental chorionic plate-derived mesenchymal stem cells (hpcMSCs) on cognitive dysfunction, neuroinflammation, neuronal damage and synaptic plasticity in a mouse model of stroke. Methods A mouse model of middle cerebral artery occlusion (MCAO) was adopted. The mice were randomly divided into three groups: sham operation group, MCAO group and hpcMSCs treatment group, with seven mice in each group. The hpcMSCs treatment group received hpcMSCs transplantation on the 1st, 3rd and 10th day after MCAO. One month after MCAO, the cognitive ability of the mice was evaluated by Morris water maze and Y maze behavioral tests; the morphological changes and synaptic functions of hippocampal neurons were analyzed by HE staining, Nissl staining, Golgi staining and immunofluorescence staining techniques; the density and activation status of microglia was analyzed by Fluorescent labeling method; the levels of tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β) and IL-6 in brain tissue were analyzed by ELISA; the expressions of phosphorylated-mitogen-activated protein kinase kinase 1 (p-MEK1), phosphorylated-extracellular regulated protein kinase (p-ERK) and phosphorylated-cAMP-response element binding protein (p-CREB) and other proteins related to neuroprotection in the signal pathways were detected by Western blotting; and electrophysiological detection was performed using hippocampal slices in vitro. Results Compared with the MCAO group, mice in the hpcMSCs treatment group showed significant improvements, including improved cognitive ability, alleviated neuroinflammation (demonstrated by reduced microglial activation and decreased levels of inflammatory factors TNF-α, IL-1β and IL-6), and increased neuronal density with normalized morphology of neurons in the hippocampal CA1 region. The treatment group also demonstrated a significantly increased number of Nissl-positive cells and density of dendritic spines of hippocampal neurons, along with restored frequency of miniature excitatory postsynaptic potential (mEPSP). Moreover, hpcMSCs treatment significantly increased the expression levels of p-MEK1, p-ERK and p-CREB in the hippocampus. Conclusion Transplantation of hpcMSCs ameliorates cognitive dysfunction and hippocampal neuronal injury in stroke mice through the reduction of neuroinflammation, restoration of hippocampal neuronal function, promotion of synaptic plasticity and activation of the MEK/ERK/CREB signaling pathway. These findings suggest a new potential therapeutic approach for post-stroke neural repair.
Animals ; Hippocampus/physiopathology* ; Mice ; Cognitive Dysfunction/etiology* ; Mesenchymal Stem Cell Transplantation ; Male ; Neurons/metabolism* ; Stroke/metabolism* ; Humans ; Neuroinflammatory Diseases/therapy* ; Female ; Cyclic AMP Response Element-Binding Protein/metabolism* ; Disease Models, Animal ; Mesenchymal Stem Cells/cytology* ; Mice, Inbred C57BL