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Eastwood, M. R., S. L. Rifat, H. Nobbs, and J. Ruderman. "Mood Disorder Following Cerebrovascular Accident." British Journal of Psychiatry 154, no. 2 (February 1989): 195–200. http://dx.doi.org/10.1192/bjp.154.2.195.
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Depression appears to be common after stroke, and therefore may have a bearing upon rehabilitation. To examine whether the depression is due to a specific brain lesion, or is reactive to the consequent disability, this study looked at the frequency and associations of depressed mood in a stroke rehabilitation unit in-patient population, unselected for site of lesion. Depression affected 50% of the patients; history of previous psychiatric disorder and cerebrovascular accident appeared to be important risk factors. There were hemispheric differences in the relationships between measures, with both the site-of-lesion and reactive viewpoints being upheld.
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Rowe, Fiona J., David Wright, Darren Brand, Carole Jackson, Shirley Harrison, Tallat Maan, Claire Scott, et al. "Profile of Gaze Dysfunction following Cerebrovascular Accident." ISRN Ophthalmology 2013 (October 10, 2013): 1–8. http://dx.doi.org/10.1155/2013/264604.
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Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud’s syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility.
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BUZZO (PRIHOI), Elena Lăcrămioara. "Speech therapy in stroke (cerebrovascular accident- CVA)." Revista Română de Terapia Tulburărilor de Limbaj şi Comunicare 1, no. 1 (October 15, 2015): 41–47. http://dx.doi.org/10.26744/rrttlc.2015.1.1.06.
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Gupta, Gaurav, Saurabh Kishor, and Aditya Kumar. "Serum uric acid, lipid profile and alkaline phosphatase levels in ischemic cerebrovascular accident patients." International Journal of Advances in Medicine 8, no. 8 (July 23, 2021): 1171. http://dx.doi.org/10.18203/2349-3933.ijam20212862.
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Background: Stroke or cerebrovascular accident (CVA) is noted as the second cause of mortality, especially in the elderly population. Recent studies indicated that higher concentrations of uric acid are involved in various vascular diseases. The findings of previous investigations suggest that, elevated serum alkaline phosphatase (ALP) levels may have a pathophysiological character in the occurrence of atherosclerotic vascular disease (AVD) of the heart and brain. This study evaluated the association between serum uric acid (SUA) levels, serum lipid levels, serum alkaline phosphatase (ALP) levels, and changes in ischemic cerebrovascular accident patients.Methods: All patients with Ischemic cerebrovascular accident age >50 years were included based on their clinical, laboratory, and radiological findings (including computed tomography (CT)/magnetic resonance imaging (MRI)) those admitted in our hospital. As control group 200 healthy individuals matched for sex and age were recruited from the same demographic area.Result: Multiple logistic regression analysis findings proposed four components as significant predictors in ischemic cerebrovascular accident (serum uric acid, serum ALP, LDL and HDL. In this study, it was found, that patients with ischemic cerebrovascular accident had significant difference (p<0.001) in serum uric acid and serum ALP than normal patients (non-ischemic cerebrovascular accident patients).Conclusions: Patients with ischemic cerebrovascular accident had significant difference (p<0.001) in SUA and serum ALP than normal patients (non-ischemic cerebrovascular accident patients). High SUA levels were observed to be associated significantly with ischemic stroke. On the basis of our study design, we cannot clarify that the elevated levels are the risk of ischemic stroke and it requires further studies.
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Rahman, Md Siddiqur, Md Monowarul Islam, Mohammad Asaduzzaman, Shahana Afroze, Is mot Ara Zannat, and Mohammad Mahbubul Haque. "Voiding Disorders in Patients with Cerebrovascular Accident." Bangladesh Journal of Urology 23, no. 2 (November 15, 2020): 136–41. http://dx.doi.org/10.3329/bju.v23i2.50304.
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Background: Cerebrovascular accident often happens in elderly group, frequently causing voiding dysfunction. The aim of the study was to determine the magnitudes of various types of voiding disorders among patients of cerebrovascular accidents attending in Dhaka Medical College Hospital.
Methods: It was a cross-sectional study conducted at the department of Urology ofDhaka Medical College Hospital from July 2009 to June 2011. Hundred and eight patients were enrolled in the study.
Results: More than 61% subjects were male (n=66).Leading number of patients (45.4%) had three to six months disease duration. In this group 67.3% had overactive bladder, 64.7% had underactive bladder and 24.5% had normal activity of bladder. In patients with irritative symptoms majority had overactive bladder (71.4%) while in patients with obstructive symptoms half of the subjects had overactive bladder (50.0%). Majority of the subjects with DM (71.4%) and HTN (82.6%) had overactive bladder. Seventy percent (n=) subjects with overactive bladder had arterial stroke while around 82% (n=) of the underactive bladder subjects had venous stroke. More than 85% subjects with underactive bladder and around 78% subjects with overactive bladder had infection.
Conclusion: Voiding dysfunction is a common sequel of acute stroke and most of the patients with irritative symptoms and about half of the subjects with obstructive symptoms had overactive bladder. Diabetes mellitus, hypertension and arterial stroke were found to be associated with overactive bladder.
Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.136-141
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Korolev, M. P., Yu A. Spesivtsev, L. E. Fedotov, A. V. Klimov, I. S. Terekhov, A. N. Kondratyev, and Sh Kh Doniyarov. "Gastroduodenal bleeding in patients with acute cerebrovascular accident." Grekov's Bulletin of Surgery 178, no. 4 (September 9, 2019): 20–25. http://dx.doi.org/10.24884/0042-4625-2019-178-4-20-25.
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INTRODUCTION. Gastroduodenal bleedings often occurs among patients with cerebrovascular accident (CVA). The frequency, causes and treatment tactics for bleeding from the upper gastrointestinal tract (GIT) in this group of patients have not been sufficiently studied. There were no well established guidelines of treatment for this group of patients, that could be a reason for high mortality. The OBJECTIVE of the study was to improve the treatment outcome of gastroduodenal bleeding cases in patients with cerebrovascular accident (CVA) by using conservative and endoscopic methods that could be used to stop bleeding and developing tactics of treatment in this category of patients. MATERIAL AND METHODS. There were 105 patients with cerebrovascular accident (CVA) and signs of bleeding from the upper gastrointestinal tract in the study. Patients were admitted to the St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. Patients were divided into 2 groups, regarding the type of cerebrovascular accident (CVA): patients with ischemic stroke and patients with hemorrhagic stroke. All patients underwent esophagogastroduodenoscopy (EGD) during 2 hours from identifying the signs of bleeding. RESULTS. In this study, we analyzed medical files and records of patients with diagnosis of ischemic or hemorrhagic stroke, who were admitted to St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. During the observation of patients with diagnosis of ischemic or hemorrhagic stroke, 7483 patients and 1919 patients respectively were treated in the clinic. Among these patients, 58 patients were with diagnosis of acute stroke with ischemic type and 47 patients with acute hemorrhagic stroke in combination with bleeding from upper parts of a GIT. The frequency of the upper GI bleeding was 0.77 % (58 of 7483) in the group with ischemic type of stroke; in the group of patients with hemorrhagic stroke, gastroduodenal bleeding was diagnosed in 2.45 % (47 of 1919) cases. CONCLUSIONS. Endoscopic treatment of gastroduodenal bleeding in cases of ischemic and hemorrhagic stroke was the method of choice. The combined endoscopic hemostasis method was preferred. To achieve hemostasis in cases of superficial lesions of the mucous membrane of the upper gastrointestinal tract and acute ulcers of the gastroduodenal zone in combination with CVA, Argon plasma coagulation (APC) was effective. It was possible to combine APC with other methods of endoscopic hemostasis that improved the results of treatment and reduced the risk of recurrent bleeding. If bleeding was from chronic ulcers of the stomach and / or duodenum, the method of clipping was effective in combination with APC and / or with injection method. When signs of recurrence of bleeding appeared, all patients with CVA should have undergone esophagogastroduodenoscopy (EGD) and hemostasis by endoscopic methods. All patients with CVA and gastroduodenal hemorrhages combination should have undergone anti-ulcer drug therapy.
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Rajesh Kumar, Sonal, and T. A. Vidya. "High sensitivity C-reactive protein level in cerebrovascular accident." International Journal of Advances in Medicine 7, no. 4 (March 21, 2020): 666. http://dx.doi.org/10.18203/2349-3933.ijam20201120.
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Background: Stroke is the second leading cause of death worldwide according to WHO. High sensitivity C-Reactive Protein (hs-CRP) is an acute phase reactant which is being studied extensively to delineate its role in development of stroke as well as in prognostication. This study was done to assess correlation of hs-CRP with risk factors of stroke and its association with types of stroke and prognosis.Methods: A prospective case control study of 100 patients with acute stroke along with 100 controls was conducted with informed consent. At baseline, hs-CRP levels were measured and Modified Rankin Scale (MRS) was assessed. On day 90 the Modified Rankin Scale was assessed again. Patients were divided into groups based on hs-CRP levels and MRS and the results were analysed.Results: Prevalence of stroke was more in men than women (p=0.0002). Statistically significant difference was found between mean hs-CRP levels in men (4.722±0.8982 mg/L) and women (4.133±0.9446 mg/L) (p=0.005) and between cases and controls (p=0.0003). There was no significant association with type of stroke (p=0.456). Mean total cholesterol levels between cases and controls showed statistically significant difference (p=0.0005). High MRS was significantly associated with high hs-CRP levels (p=0.003). Higher hs-CRP on day 1 correlated with higher MRS on day 90.Conclusions: hs-CRP level is increased in stroke and shows significant association with severity of stroke and prognosis.
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Bhuvaneshwari G and Somiya C. "Effectiveness of dysphagia exercises on swallowing ability among patients with Cerebrovascular Accidents." International Journal of Research in Pharmaceutical Sciences 11, no. 2 (April 4, 2020): 1515–18. http://dx.doi.org/10.26452/ijrps.v11i2.2027.
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Cerebrovascular accident (CVA) is one of the foremost reasons leading to mortality and morbidity throughout the world. It is the third biggest killer in India after a heart attack and cancer. It is like a chronic health condition which negatively impacts on quality of life. Dysphagia is one of the most successive side effects in patients with a stroke which is a loss of motion of throat muscles. This condition can disturb the gulping procedure and make eating, drinking, taking prescription and breathing trouble. Dysphagiaexercises are designed toenhancing muscles and coordinatingthe nervesandmuscles involved in swallowing.The pre-experimental design was used with 60 samples who matched the inclusion criteria who were selected by purposive sampling technique.The study aims is to assess the swallowing ability before and after dysphagia exercisesamong patients with cerebrovascular accidents. Demographical variables were collected by using self- structured questionnaires and Modified Mann Assessment of Swallowing Ability Scale.The study uncovered that the pre-test mean swallowing ability score was 42.45 with a standard deviation of 8.63 among the cerebrovascular accident patients. The post-test swallowing ability mean score of 50.54% with a standard deviation of 8.23 among the cerebrovascular accident patients. The study findings concluded thatDysphagia practices which was an effective, inexpensive, simple measure for improving swallowing ability among patients with cerebrovascular accident.
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Cornelis, Cosette, Sanne J. den Hartog, Carla M. Bastemeijer, Bob Roozenbeek, Paul J. Nederkoorn, and Renske M. Van den Berg-Vos. "Patient-Reported Experience Measures in Stroke Care." Stroke 52, no. 7 (July 2021): 2432–35. http://dx.doi.org/10.1161/strokeaha.120.034028.
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Background and Purpose: Patient-reported experience measures (PREMs) assess patients’ perception of health care. We aimed to identify all reported PREMs for stroke care and critically appraise psychometric properties of PREMs validated for patients with stroke. Methods: Studies on the development, validation, or utilization of PREMs for adult patients with stroke were systematically identified. The Consensus-Based Standards for the Selection of Health Measurement Instruments criteria were used to appraise psychometric performance. Results: We included 18 studies, examining 13 PREMs. Two PREMs had been developed for stroke care: Consumer Quality Index: Cerebrovascular Accident and Riksstroke. Consumer Quality Index: Cerebrovascular Accident was given a positive psychometric assessment, but its length and limited language applicability impede clinical implementation. Riksstroke was appraised as doubtful. Eleven PREMs were generic. The psychometric performance of 5 generic PREMS, validated for patients with stroke, received conflicting assessments. Six generic PREMs had not been validated in patients with stroke and were therefore not assessed for instrument performance. Conclusions: Thirteen PREMs have been published for use in stroke care. The stroke-specific Consumer Quality Index: Cerebrovascular Accident has favorable psychometric performance but lacks practical feasibility. Other PREMs have inadequate or unknown psychometric properties. This indicates the need for developing stroke-specific PREMs to support quality improvement and enhance patient-centered care.
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Ramazanov, G. R., T. A. Magomedov, L. T. Khamidova, N. V. Rybalko, S. S. Petrikov, and N. A. Shamalov. "Etiology of Cryptogenic Stroke." Russian Sklifosovsky Journal "Emergency Medical Care" 8, no. 3 (November 6, 2019): 302–14. http://dx.doi.org/10.23934/2223-9022-2019-8-3-302-314.
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Ischemic stroke is a heterogeneous syndrome with a plurality of potential etiological factors. The routine diagnosis does not always allow the cause of acute cerebrovascular accident to be found, in such cases we talk about cryptogenic ischemic stroke, which incidence is 20-40%. The category of patients with cryptogenic stroke was first characterized and assigned to a separate group in the database of the National Institute of Neurological Diseases and Stroke in the USA, and later in the TOAST study. The diagnosis of cryptogenic stroke is usually based on the exclusion of well-known causes of acute cerebrovascular accidents, such as atherosclerosis, cardiac arrhythmias, arterial hypertension. Due to the considerable variability of concepts for cryptogenic stroke, the term ESUS (Embolic Stroke of Undetermined Source) appeared in 2014 and formulated criteria which accurately characterized these patients: non-lacunar cerebral infarction by CT and/or MRI, no atherosclerotic lesion stenosing a stroke-associated artery of more than 50%, no sources of high-risk cardioembolism, no other causes of stroke such as dissection of the artery supplying the area of infarction in the brain, migraine, arteritis. Among the potential causes and sources of cerebral embolism in patients with cryptogenic stroke are heart, veins of lower extremities and pelvis, nonstenosing atherosclerosis of brachiocephalic artery, atheroma of aortic arch, paradoxical embolism non-atherosclerotic vasculopathy, monogenic diseases, hypercoagulable states, and others. We should note that there is a lot of studies on the possible causes of cryptogenic stroke in the available literature, but no common approach to classification of etiologic factors and examination algorythms were developed. The high incidence of cryptogenic stroke, the significant heterogeneity of its etiopathogenetic mechanisms and the need for differentiated approaches to the secondary prevention of this type of acute cerebrovascular accident determine the relevance of further studies in this field.
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Mattana, J., C. Effiong, R. Gooneratne, and P. C. Singhal. "Risk of fatal cerebrovascular accident in patients on peritoneal dialysis versus hemodialysis." Journal of the American Society of Nephrology 8, no. 8 (August 1997): 1342–47. http://dx.doi.org/10.1681/asn.v881342.
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Several reports have suggested that the incidence of hemorrhagic stroke may be greater on hemodialysis as compared with that among the general population and that patients with intracranial hemorrhage should be treated with peritoneal dialysis rather than hemodialysis. However, whether the risk of fatal stroke is greater on hemodialysis versus peritoneal dialysis has not been systematically examined. In this study, the case of a diabetic patient with extensive peripheral vascular disease who, after 7 years on hemodialysis, was changed to peritoneal dialysis and subsequently suffered two strokes over a 5-month period, is reported. Recent data from the United States Renal Data System, which allow a comparison of death rates from stroke in large numbers of hemodialysis versus peritoneal dialysis patients, are reviewed. These data suggest that the risk of death from stroke may actually be greater for patients on peritoneal dialysis versus hemodialysis in spite of their having a lesser prevalence of preexisting cerebrovascular disease. This risk was greatest for elderly diabetic black patients and women, who experienced a nearly twofold-greater odds favoring death from stroke on peritoneal dialysis versus hemodialysis. Selection of a dialysis modality for a patient beginning renal replacement therapy may require the consideration of such data, particularly in those patients with extensive preexisting vascular disease.
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Privalova, M. A., L. A. Karasaeva, G. A. Alekseev, and A. A. Okhotnikova. "Problems of post-hospital rehabilitation of patients suffering from post-stroke depression." Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), no. 9 (September 1, 2020): 31–37. http://dx.doi.org/10.33920/med-01-2009-03.
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The article covers the issues of organization of rehabilitation at the post-hospital stage for patients who have suffered an acute cerebrovascular accident. According to statistics, almost half of patients who have suffered an acute cerebrovascular accident have a risk of a repeated stroke in the next five years of life against the background of manifestations of post-stroke depression. It is established that in these cases, one of the causes of repeated cerebrovascular accidents is the failure of patients to take prescribed antidepressant medications. The article analyzes two groups of patients who were observed in dynamics up to 6–12 months after the rehabilitation treatment in the Department of Neurology of the hospital. The main group included the patients with diagnosed post-stroke depression. The control group included patients without signs of clinically apparent depression. As a result of a retrospective study, it was found that 85,7 % of patients in the main group who had a repeated stroke did not adhere to the regime for taking antidepressant medications. Among the patients who continue to take antidepressants, there have not been repeated cases of cerebral circulatory disorders. Therefore, timely detection and correction of post-stroke depression in the early stroke recovery period and maintaining the principle of continuity at the post-hospital stage of rehabilitation contributes not only to the recovery of neurological deficit, but also reduces the risk of developing repeated disorders of cerebral circulation.
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Chouhan, Mahendra, and Rakesh K. Sisodia. "The study of serum uric acid in cerebrovascular accident patients and correlation with hypertension." International Journal of Advances in Medicine 7, no. 3 (February 24, 2020): 418. http://dx.doi.org/10.18203/2349-3933.ijam20200517.
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Background: Cerebrovascular accident (CVA) is also called Stroke. These is a well-recognized epidemiological link between elevated serum uric acid and increased cerebrovascular risk. Several studies have identified as elevated serum uric acid concentration as a predictor of cerebrovascular events. The aim of this study was to correlate serum uric acid in cerebrovascular accident (CVA) patients with Hypertension.Methods: A prospective study was conducted on 100 patients aged >18 years of admitted with new onset focal/global neurological deficit/event with cerebrovascular accident (CVA). Brain imaging (CT/MRI) was performed on the patients within 24-48 hrs of admission. Data was collected with regards to patient’s demography, medical history, risk factors for stroke or vascular disease. Serum uric acid was measured as part of fasting biochemical profile taken within 24-48 hrs of admission by standard analytical methods in Biochemistry department.Results: Out of 100 patients included in this study 74 of them were male and 26 were female. Among 100 patients 61 patients had hemorrhage, out of which 45 (73.77%) were male and 16 (26.23%) were female, followed by 39 patients had infract, out of which 29 (74.35%) were male and 10 (25.65%) were female. Mean value of serum uric acid levels in hypertensive patients was significantly high in comparison to normotensive patients.Conclusions: Concluded that correlation of serum uric acid in cerebrovascular accident (CVA) patients with Hypertension was found statistically significant.
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Itagi, Avinash, Bharat G., Pooja Biradarpatil, and Laxmi Pattanashetti. "A study on clinical profile of acute stroke." International Journal of Advances in Medicine 7, no. 12 (November 23, 2020): 1809. http://dx.doi.org/10.18203/2349-3933.ijam20204966.
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Background: Stroke or cerebrovascular accident is one of the leading causes of morbidity and mortality in adult life. Ischemic strokes are most common type of strokes and they account for 80-85% of cerebrovascular accidents worldwide. Hypertension, diabetes, dyslipidemia and smoking have been identified as major risk factors. Present study was undertaken to evaluate the clinical and investigation profile of different types of strokes.Methods: A total of 100 patients with brain stroke from November 2015 to October 2016 were included. Adult patients with stroke who attended the emergency department within 24 hours of attack were included. Patients with known chronic liver or kidney diseases, transient ischemic attack, active infections, history of neoplasia and alcoholic patients were excluded from the study. A thorough physical examination was conducted and stroke was defined as per World Health Organization criteria. Blood investigations were done including Magnetic resonance imaging and computed tomography scan. The data obtained was coded and entered into Microsoft excel worksheet. The data was analyzed using SPSS statistics software version 20.0. Results: Majority of the patients (71.00%) were males and 29.0% of the patients were females. Most of the patients were aged between 61 to 70 years (27.00%). Most of the patients had ischaemic stroke (80.00%) followed by haemorrhagic stroke (20%).Conclusions: Ischemic stroke is the more common as compared to hemorrhagic stroke. Detection of vascular risk factors and primary prevention measures should be initiated during late adolescence or early adulthood.
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Kravchenko, M. V., L. S. Korostovtseva, M. S. Golovkova-Kucheriavaia, M. V. V. Bochkarev, and Y. V. Sviryaev. "Sleep breathing disorders in ischemic stroke: relationship with the localization and toast classification subtypes." Translational Medicine 7, no. 3 (August 4, 2020): 14–20. http://dx.doi.org/10.18705/2311-4495-2020-7-3-14-20.
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Stroke is one of the leading causes of death and disability worldwide, despite successful strategies to manage the main risk factors for ischemic stroke (hypertension, atrial fibrillation, diabetes mellitus and others). Sleep-disordered breathing (SDB) is poorly studied, but potentially significant and modifiable risk factor for stroke, so it draws attention of investigators. In this review we have focused on some aspects and analyzed the relationship of different variants of SBD with the lesions localization and the type of acute ischemic stroke according to TOAST criteria. During the analysis, it was shown that in the early period after cerebrovascular accident, the frequency and severity of respiratory disturbances in sleep were higher, mainly due to the presence of central apnea, which develops when the vertebro-basilar pool is involved in the blood supply zone. However, impaired cerebral circulation of supratentorial localization can also be a factor contributing to the appearance or exacerbation of respiratory failure in a dream. With regard to the relationship of respiratory disorders in a dream with a type of cerebrovascular accident according to the TOAST classification, we can talk about the likely relationship of obstructive sleep apnea with a cerebrovascular accident of cardioembolic and atherothrombotic origin.
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Fringuello, Anthony, Philip D. Tatman, Tadeusz Wroblewski, John A. Thompson, Xiaoli Yu, Kevin O. Lillehei, Robert G. Kowalski, and Michael W. Graner. "Cytokine-Laden Extracellular Vesicles Predict Patient Prognosis after Cerebrovascular Accident." International Journal of Molecular Sciences 22, no. 15 (July 22, 2021): 7847. http://dx.doi.org/10.3390/ijms22157847.
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Background: A major contributor to disability after hemorrhagic stroke is secondary brain damage induced by the inflammatory response. Following stroke, global increases in numerous cytokines—many associated with worse outcomes—occur within the brain, cerebrospinal fluid, and peripheral blood. Extracellular vesicles (EVs) may traffic inflammatory cytokines from damaged tissue within the brain, as well as peripheral sources, across the blood–brain barrier, and they may be a critical component of post-stroke neuroinflammatory signaling. Methods: We performed a comprehensive analysis of cytokine concentrations bound to plasma EV surfaces and/or sequestered within the vesicles themselves. These concentrations were correlated to patient acute neurological condition by the Glasgow Coma Scale (GCS) and to chronic, long-term outcome via the Glasgow Outcome Scale-Extended (GOS-E). Results: Pro-inflammatory cytokines detected from plasma EVs were correlated to worse outcomes in hemorrhagic stroke patients. Anti-inflammatory cytokines detected within EVs were still correlated to poor outcomes despite their putative neuroprotective properties. Inflammatory cytokines macrophage-derived chemokine (MDC/CCL2), colony stimulating factor 1 (CSF1), interleukin 7 (IL7), and monokine induced by gamma interferon (MIG/CXCL9) were significantly correlated to both negative GCS and GOS-E when bound to plasma EV membranes. Conclusions: These findings correlate plasma-derived EV cytokine content with detrimental outcomes after stroke, highlighting the potential for EVs to provide cytokines with a means of long-range delivery of inflammatory signals that perpetuate neuroinflammation after stroke, thus hindering recovery.
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Kas, I. V., I. S. Petukhova, and T. P. Ustymenko. "STAGES OF REHABILITATION OF PATIENTS WITH ACUTE CEREBROVASCULAR ACCIDENT." International Medical Journal, no. 1 (February 18, 2021): 56–62. http://dx.doi.org/10.37436/2308-5274-2021-1-10.
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One of the urgent tasks of modern medicine is organizing the rehabilitation for patients who have suffered a stroke at different stages of rehabilitation. Restoration of impaired functions in such patients occurs in the first 3−5 months from the onset of the disease, that is influenced by a number of factors: duration of the stroke, size of the lesion and pool of lesions, active participation in the process of a patient him−/herself. The main principles of rehabilitation include its early onset in an acute period of stroke; regularity and duration; complexity and multidisciplinarity (formation of multidisciplinary teams); adequacy of rehabilitation measures, i.e. creation of individual programs taking into account the severity of neurological deficit and dysfunction; stages. Different methods of recovery are applied to each patient individually or in combination, or sequentially according to the rehabilitation program, which is based on the analysis of the patient's condition by all members of the multidisciplinary team, taking into account the results of functional testing and objective examination. Medical support, postural correction, kinesitherapy, mechanotherapy (including robotic), field therapy, hardware physiotherapy, massage, acupuncture according to the indications, functional neurotraining and cardiotraining, neuropsychological training are used. The results of research confirm that the integrated use of kinesitherapy, physical factors, balneotherapy, the methods of psychological rehabilitation of patients after stroke provides a faster recovery of neurological deficit, activates non−specific brain systems, restores mental and somatic functions of the body. Therefore, in addition to health, the patient needs to renew his ability to work and social status. Key words: acute cerebrovascular accident, medical rehabilitation, stages of rehabilitation.
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Sebastian, Sajith, and Jenny Susan Roy. "Electocardiographic changes in acute cerebrovascular accidents-a tertiary centre experience in South India." IP Journal of Nutrition, Metabolism and Health Science 3, no. 4 (February 15, 2021): 132–34. http://dx.doi.org/10.18231/j.ijnmhs.2020.026.
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Cerebrovascular accident plays an important role in the morbidity and mortality of adults posing serious medical, socio-economic and rehabilitation problems. Electrocardiographic abnormalities have been known to occur in the context of neurological disease. The current study is an observational study aimed at elucidating the relation between cerebrovascular accident and ECG. To determine the frequency of ECG changes in cerebrovascular accident and to determine the variations in ECG manifestations and mortality in different types of stroke. 100 patients of acute stroke were considered. ECG was recorded in these patients within 24 hours of admission. Follow up of admitted patients was done to know the prognosis. ECG abnormalities noted among cerebral ischemic patients were presence of T Wave inversion (34.48%) and ST segment depression (32.76%) followed by QTc Prolongation (29.31%) and presence of U waves (27.59%). In cases of haemorrhagic Stroke, T wave inversion (33.33%) and arrhythmias (33.33%) were followed by U waves (30.95%) and ST segment depression (23.81%). Mortality was higher in patients with ST-T changes in ischemic group (66.66%) and in patients with positive U waves (60%) in haemorrhagic group. Studying ECG changes will provide insight in prognosis and management of stroke patients and may alter their management in coming future. ECG changes occurred very commonly in acute stroke. The changes are thought to be independent of the nature of stroke. It was noted that ST and T inversion being common in ischemic while T inversions and arrhythmias common in haemorrhagic CVA. It was also noted that the mortality was higher in patients with abnormal ECG following an acute Cerebrovascular event.
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Gonzalez-Bossolo, Alex, Alexis Gonzalez-Rivera, and Santiago Coste-Sibilia. "Cerebrovascular Accident due to Thyroid Storm: Should We Anticoagulate?" Case Reports in Endocrinology 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/5218985.
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Thyroid storm is a life-threatening condition that occurs secondary to an uncontrolled hyperthyroid state. Atrial fibrillation is a cardiovascular complication occurring in up to 15% of patients experiencing thyroid storm, and if left untreated this condition could have up to a 25% mortality rate. Thyroid storm with stroke is a rare presentation. This case report details a left middle cerebral artery (MCA) stroke with global aphasia and thyroid storm in a 53-year-old Hispanic male patient. Although uncommon, this combination has been reported in multiple case series. Although it is well documented that dysfunctional thyroid levels promote a hypercoagulable state, available guidelines from multiple entities are unclear on whether anticoagulation therapy is appropriate in this situation.
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Cooke, Mathew, Michael A. Cuddy, Brad Farr, and Paul A. Moore. "Cerebrovascular Accident Under Anesthesia During Dental Surgery." Anesthesia Progress 61, no. 2 (June 1, 2014): 73–77. http://dx.doi.org/10.2344/0003-3006-61.2.73.
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Abstract Stroke, or cerebrovascular accident (CVA), is a medical emergency that may lead to permanent neurological damage, complications, and death. The rapid loss of brain function due to disruption of the blood supply to the brain is caused by blockage (thrombosis, arterial embolism) or hemorrhage. The incidence of CVA during anesthesia for noncardiac nonvascular surgery is as high as 1% depending on risk factors. Comprehensive preoperative assessment and good perioperative management may prevent a CVA. However, should an ischemic event occur, appropriate and rapid management is necessary to minimize the deleterious effects caused to the patient. This case report describes a patient who had an ischemic CVA while under general anesthesia for dental alveolar surgery and discusses the anesthesia management.
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Radhakrishnan, Srinivasan, Swathy Moorthy, Sudish Gadde, and Krishnaswamy Madhavan. "Role of Cardiac Biomarkers in the Assessment of Acute Cerebrovascular Accident." Journal of Neurosciences in Rural Practice 12, no. 01 (January 2021): 106–11. http://dx.doi.org/10.1055/s-0040-1721198.
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Abstract Background Stroke (cerebrovascular accident) has for long been a global burden in terms of its morbidity and mortality. Serum levels of cardiac enzymes such as creatine kinase-MB (CK-MB) component, troponin T, and brain natriuretic peptide have been found to be elevated among the patients with stroke and also serve to prognosticate these patients. The serum levels of these enzymes correlate directly to the severity of stroke in these patients. Objective Elevated cardiac enzymes among patients with acute cerebrovascular accidents are not uncommon despite the patients not having any cardiac problems. We aimed to identify the occurrence of elevated cardiac enzymes among patients with acute stroke and their correlation with the severity of stroke. Materials and Methods Our study included 100 patients of acute stroke with no previous history of cardiac ailments. Serum levels of troponin I and CK-MB were analyzed among these patients using enzyme-linked immunosorbent assay method within the first 2 hours of admission. Patients outcome during the hospital stay were analyzed. Stroke severity was assessed using the National Institute of Health Stroke score (NIHS score) and the modified Rankin Score (mRS). The cardiac enzyme levels were correlated with these scores. Results Twenty-eight percent of patients had elevated troponin I, while 72% patients had normal levels with the mean values of 10.36 to 106.54 ng/mL and 0.00 to 0.02 ng/mL, respectively. CK-MB levels were found elevated among 14% patients and normal among 86% patients with mean values of 5.8 to 124.36 and 0.0 to 4.3 ng/mL, respectively. Among the six patients who succumbed to death, three patients had increased troponin I and four had elevated CK-MB. NIHS scores of 21.0357±6.79 and 105.277±5.564 were seen in patients with elevated and normal troponin I, whereas NIHS scores of 20.4285±8.658 and 11.8721±9.273 were seen among patients with increased and normal CK-MB, respectively. The mRS scores were 4.3214±0.367, 2.4305±1.374, 4.2143±1.412, and 2.756±1.749 ng/mL among the patients with elevated and normal troponin I and CK-MB, respectively. Conclusion The mean values of cardiac enzymes troponin I and CK-MB were higher among patients with higher scores of NIHS and mRS. Among them, troponin I was very significant and it may serve as an early biomarker for the severity of stroke and hint on early cardiac evaluation among these patients.
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Devarapu, Chandrababu, and Lokesh S. "A prospective study of electrocardiographic and echocardiographic changes in patients with cerebrovascular accidents." International Journal of Advances in Medicine 5, no. 4 (July 23, 2018): 891. http://dx.doi.org/10.18203/2349-3933.ijam20182928.
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Background: Cerebrovascular accident also called as stroke is defined as the sudden onset of neurological deficit that can be attributable to a focal vascular cause. Many studies in the past have demonstrated the fact that neurological abnormalities produce Electrocardiographic changes without any underlying cardiac lesions. Present study is done to analyze different changes in Electrocardiogram and echocardiographic patterns in the cases of cerebrovascular accidents and to assess whether these different changes have got any prognostic significance in these patients.Methods: In this study 100 patients of acute stroke admitted between May 2011 to August 2012 in Vydehi institute of medical sciences and research centre were considered and subjected to CT scan of brain, Electrocardiogram and 2D echocardiography within 24 hours of admission. Follow-up was done within the hospital to know the prognosis of all the patients.Results: Out of 100 patients majority of them had ischemic stroke accounting for 80% and remaining 20% of patients had haemorrhagic stroke. Abnormal Electrocardiographic changes were seen in 64% patients and 58% patients showed abnormal Echocardiography. ECG changes seen are Tachycardia, QTc prolongation, T wave inversion, ST depression, U waves and Bradycardia. Commonly seen echocardiographic changes were LV dysfunction, mitral valve abnormality, aortic valve abnormality. Overall mortality in patients with abnormal ECG was 28.12% compared to 11.11% in patients with normal ECG and it was statistically not significant. Overall mortality in patients with abnormal 2D echocardiography was 31.03% compared to patients with normal 2D Echocardiography which was 4.76% and it was statistically significant.Conclusions: From this study we conclude that ECG abnormalities in stroke patients do not have any prognostic significance. But LV dysfunction has prognostic significance in predicting mortality in cerebrovascular accident.
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Allen, Brandon, Bobby Desai, and Michael Falgiani. "Endocarditis-Induced Mycotic Brain Aneurysm following Right MCA Stroke." Case Reports in Emergency Medicine 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/606921.
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The diagnosis of cerebrovascular accident is extremely common in emergency medicine; however, CVA resulting from hemorrhage following mycotic brain aneurysm following embolic stroke is extremely uncommon. This case reports such an event.
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Drummond, Avril E. R. "Stroke: The Impact on the Family." British Journal of Occupational Therapy 51, no. 6 (June 1988): 193–94. http://dx.doi.org/10.1177/030802268805100605.
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This article reviews the literature on the effect of stroke on the family. Although there is comparatively little information on this particular aspect of cerebrovascular accident, the little there is highlights a depressing problem. The article also looks at ways in which many of the difficulties experienced could be lessened by the services available.
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Shrestha, Elina, Narayan Bikram Thapa, and SBS Rajbhandari. "Pattern of computerized tomography findings of the brain in cerebrovascular accidents." Nepal Journal of Medical Sciences 5, no. 1 (February 15, 2020): 62–70. http://dx.doi.org/10.3126/njms.v5i1.36955.
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Introduction: Semi-industrialized countries like Nepal have high mortality and disability rates due to cerebrovascular accident, representing for more than 80% of all stroke deaths globally. Stroke is the most common neurological disorder requiring prolonged hospital stay. Aims of our study was to evaluate the role of computerized tomography in evaluation of cerebrovascular accident by differentiating ischemia from hemorrhage and proper identification of negative cases.
Methods: A descriptive cross sectional study of total 155 patients, clinically diagnosed as stroke, referred to our department of radiology for computerised tomography evaluation during six month period, were enrolled into study. The clinical information, proper history, computerised tomography findings were properly documented and analysed in SPSS version 20 software.
Results: Out of total 155 patients, 85 cases (55 %) were males and 70 cases (45 %) were females with male: female ratio of 1.2:1. The mean age of the patients was 63±15 years. There was significant correlation between clinical with neuroradiological findings as evidenced by p value of 0.000. Sensitivity, specificity, positive predictive value, negative predictive value of clinical findings when correlated to CT in diagnosing ischemic infarction were 84.3%, 67.3%, 82.6%, 70%. Similarly, sensitivity, specificity, positive predictive value, negative predictive value in diagnosing hemorrhagic infarction were 67.3%, 84.3%, 70%, 82.6% respectively.
Conclusions: Computerised tomography is the first line reliable imaging modality for diagnosis, management of cerebrovascular accident and exclusion of stroke mimicker lesions. Education regarding prevention and control of modifiable risk factors can minimize the incidence of stroke.
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Luchian, Mihaela, and Adriana Săceleanu. "Haemorrhagic Cerebrovascular Accident (CVA) Etiology and Case Report." Acta Medica Transilvanica 25, no. 4 (December 1, 2020): 16–18. http://dx.doi.org/10.2478/amtsb-2020-0061.
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Abstract A haemorrhagic cerebrovascular accident refers to a spontaneous bleeding in the cerebral parenchyma, located either supratentorial or infratentorial, that occurs in the absence of a surgical or traumatic cause. The incidence is estimated at 12-15 new cases per 100.000 inhabitants per year. Intracranial haemorrhage is the third most frequent cause of stroke, the vast majority being represented by primary/hypertensive (spontaneous) intracerebral haemorrhage, ruptured saccular aneurysm, a vascular malformation or haemorrhage associated with the use of anticoagulants or thrombolytic agents. A cerebral tomography computer examination is the examination of choice in diagnosis of haemorrhagic CVAs. The treatment can be either therapeutic or surgical, depending on the case, with the consideration that an immediate medical treatment is mandatory for the best odds of recovery.(1)
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Erhan, Hulya, Elizabeth Ochoa, Joan Borod, and Todd Feinberg. "Consequences of Right Cerebrovascular Accident on Emotional Functioning: Diagnostic and Treatment Implications." CNS Spectrums 5, no. 3 (March 2000): 25–38. http://dx.doi.org/10.1017/s1092852900012943.
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AbstractThe relationship between lesion location and neuropsychiatric sequelae in stroke patients has been extensively studied. Emotional disorders associated with right hemisphere stroke include depression, anxiety, anger, and/or mania. Pharmacotherapy, electroconvulsive therapy, and/or psychotherapy are common treatments for these disorders. This article reviews the clinical presentations of seven right hemisphere stroke patients. The treatment rationale and course of treatment are described for two of these patients. The aims of this paper are to explore the appropriateness of various assessment tools and treatment modalities for stroke patients as well as to demonstrate the techniques of psychotherapy as applied to the two cases featured in this article. Specific factors that may significantly influence treatment outcome, such as lesion location and degree of cognitive impairment, are considered.
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Ismagilov, M. F. "The state of emergency care for patients with acute cerebrovascular accident." Neurology Bulletin XXXIII, no. 1-2 (May 15, 2001): 59–63. http://dx.doi.org/10.17816/nb79745.
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At the turn of the second and third millennia, one of the main health problems was acute cerebrovascular accident - cerebral stroke (CS), which is the second leading cause of death in the industrially developed countries of the world and the main cause of disability in the adult population of the most working age. The social costs associated with the cost of treating stroke patients are a major source of depletion of scarce health resources in every country.
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Brown, D. C., J. H. Livingston, R. A. Minns, and O. B. Eden. "Protein C and S Deficiency Causing Childhood Stroke." Scottish Medical Journal 38, no. 4 (August 1993): 114–15. http://dx.doi.org/10.1177/003693309303800407.
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The annual incidence of cerebrovascular disease in children is 2.5/100,000 and cerebral infarction is being increasingly recognised in neonates.1 Deficiency of proteins C and S and their roles in thrombosis have only recently been recognised.2 Immunologic and functional assays of these proteins now make it possible to determine whether deficiency of them is associated in any particular case of childhood cerebrovascular accident (CVA).3 We describe two patients, both presenting with stroke in childhood, who were found to be deficient, one in protein C and one in protein S.
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Barboza, Raíssa B., Gabriel R. De Freitas, Fernanda Tovar-Moll, and Leonardo F. Fontenelle. "Delayed-Onset Post-Stroke Delusional Disorder: A Case Report." Behavioural Neurology 27, no. 3 (2013): 287–91. http://dx.doi.org/10.1155/2013/745104.
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Although the prevalence of neuropsychiatric disorders among patients with cerebrovascular illness is relatively high, there are only few case reports describing post-stroke psychotic symptoms. In general, post-stroke psychoses have been reported to emerge few days after the vascular event and to vanish soon afterwards. In this report, we describe delayed-onset post-stroke delusional disorder, persecutory type. A middle-aged female patient developed a persistent delusional disorder with homicidal behavior about one year after a cerebrovascular accident affecting the right fronto-temporo-parietal region and a long period of chronic post-stroke mixed anxiety and depressive symptoms. Our case suggests that there might be long intervals between stroke and the appearance of psychotic symptoms.
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Ali Dasti, Mashooq, Syed Fasih Ahmed Hashmi Ahmed Hashmi, Mukhtiar Hussain Jaffery, Syed Fasih Ahmed Hashmi, Hamid Nawaz Ali Memon, Athar Hussain Memon, Arshad Maqbool Jalbani, and Syed Zulfiquar Ali Shah. "ACUTE ISCHEMIC STROKE." Professional Medical Journal 23, no. 05 (May 10, 2016): 535–38. http://dx.doi.org/10.29309/tpmj/2016.23.05.1579.
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Objectives: To determine the electrocardiographic and echocardiographicfindings in patients with acute ischemic stroke (potential source of cardiac emboli). StudyDesign: Cross section descriptive study. Period: Six months. Setting: Liaquat University HospitalHyderabad. Patients and Methods: The subjects with history and clinical features suggestiveof cerebrovascular accident (CVA). After establishing the diagnosis of acute ischemic strokethe electrocardiography (ECG) was advised and those subjects had abnormal findings onECG were went for echocardiography to evaluate the specific cause related to acute ischemicstroke. The two-dimensional and M-mode echocardiography was performed by consultantcardiologist had ≥ five years experienced in echocardiography because echocardiographicstudy in patients with cerebrovascular accident (confirmed on CT scan) is evidence of potentialcardiac abnormalities as a predisposing cause for the vascular event. The data was collectedon pre-designed proforma and was analyzed in SPSS 16 and the frequency and percentagewas calculated. Results: Total one hundred patients with acute ischemic stroke were studiedfor electrocardiographic and echocardiographic findings during six months study period. Themean ±SD for age of patients with acute ischemic stroke was 43.67±10.62. Majority of thepatients were males and 69% while the age and gender cross tabulation was also statisticallysignificant (p=0.03). The electrocardiographic abnormalities were indentified in 80% patients(AF in 16.2%, LVH in 22.5%, LBBB in 10%, wide QRS complex in 10% and ischemic changesin 8.7%) while the echocardiographic abnormalities were detected in 70% patients of whichglobal hypokinesia (28.5%), LVH (25.7%) and diastolic dysfunction (17.14)% were predominant.Conclusion: The cardiac embolic source is the major cause for acute ischemic stroke anddetected by echocardiography as it is the main tool in diagnosing the source of embolus.
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A., Chamelee, Iniyan Selvamani, Venkatraman N., Shanthi Nambi, and G. S. Chandraleka. "A cross sectional study of prevalence of depression among patients with cerebrovascular accident." International Journal of Research in Medical Sciences 7, no. 11 (October 24, 2019): 4306. http://dx.doi.org/10.18203/2320-6012.ijrms20195006.
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Background: Depression is one of the most common neuropsychiatric condition in patients with stroke. Early identification of depression for stroke patients can improve the outcome leading to better quality of life. Prevalence and determinants of post stroke depression are highly variable and there is paucity of data in Indian literature.Methods: This cross-sectional study was conducted at neurology department of Saveetha Medical College, Chennai. All patients with history of stroke within past one month attending neurology department who fulfilled the inclusion criteria were taken up for the study after getting consent. Neurological examination and CT brain findings were noted with the site of lesion. All patients were evaluated for depression using ICD 10 criteria. MADRS score was used to assess the severity of depression. Chi square was used for statistical analysis.Results: The mean age of subjects in the study was 56.54±10.82 years. The prevalence of depression among patients with stroke in our study was 75.8%. Among classifying those with depression based on severity using MADRS score, 35% had mild depression and 65% had moderate depression. There was no severe depression in our sample. There was no statistically significant difference between prevalence of depression based on side of lesion.Conclusions: In this study the prevalence of depression among patients with cerebrovascular accident was found to be 75.8%. From this study we learn that the prevalence of depression in patients with stroke is high and this shows that regular screening of patients with stroke for depression might help in earlier detection and management of depression.
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PERMINOVA, S. K., A. A. YAKUPOVA, A. Ya NAZIPOVA, and R. T. GAYFUTDINOV. "Assessment of the Willis circle pathology in patients with acute cerebrovascular accident." Practical medicine 18, no. 5 (2020): 99–104. http://dx.doi.org/10.32000/2072-1757-2020-5-99-104.
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The purpose — to evaluate the Willis circle pathology in patients with acute cerebral circulatory disorders using the National Institutes of Health Stroke Scale, to assess the degree of functional disorders and the long-term perspective. Material and methods. Data from magnetic resonance imaging of the brain and magnetic resonance angiography of the brain were analyzed in 47 patients with acute cerebrovascular accident. The study included 21 (44,6%) men and 26 (55,4%) women, with an average age of 67,08 ± 16,03. All patients underwent neurological examination using the National Institutes of Health Stroke Scale, assessment of functional disorders using the Rivermead scale, and assessment of long-term perspective using the Rankin scale before and after treatment. Results. Patients with the absence of one posterior connective artery showed a significant stroke severity according to the National Institutes of Health Stroke Scale. The largest subgroup with the absence of both posterior connective arteries was identified, having the best indicators on the Rivermead scale before treatment and a good recovery for neurological deficit after treatment. Significant positive results by the Rivermead scale after treatment were shown in the subgroup with the absence of all connecting arteries. Conclusion. The variant of the Willis circle structure in the form of the absence of both posterior connective arteries in patients with acute cerebrovascular accident is most often found with a good recovery of neurological deficit.
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Permana, Khrisna R., and Athaya F. Purnomo. "Ischemic cerebrovascular accident and its secondary renal impairment." International Journal of Advances in Medicine 5, no. 5 (September 22, 2018): 1081. http://dx.doi.org/10.18203/2349-3933.ijam20183892.
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Background: Renal impairment is one of the most frequent but anticipated potential complications. The objective of this meta-analysis was to evaluate the renal impairment following ischemic cerebrovascular accident (CVA) patients worldwide.Methods: Authors were using meta-analysis. Studies were obtained from several databases like Pubmed, Cochrane, Karger and JNS. Keywords were "renal" or "kidney" and "stroke" and "ischemic". Included studies were full-text observational study or randomized control trial (RCT). Subjects in study were newly diagnosed acute kidney disease (AKI) after ischemic CVA, with age range 18-100 years old. From 425 studies, total 5 studies were eligible for this study.Results: From those 5 studies, it is shown that the pooled risk ratio (RR) for mortality ischemic CVA with AKI was 2.56. AKI appeared insignificantly in both ischemic CVA and intracerebral haemorrhage (ICH) (RR 0.75; p=0.01). The pooled risk ratio had wide heterogeneity (I2 = 0.95) so random effect model was used.Conclusions: Renal impairment and its mortality appeared more frequent in ischemic CVA with AKI. It still needs more multicentre and long-term period researches in the future to get better understanding AKI in ischemic CVA.
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RANGANATHAN, MAHARISHI, and MAYA RATHNASABAPATHY. "Cognitive Impairment of Stroke Patient with Cerebrovascular Accident (CVA) - Acute Ischemic Stroke (AIS) - Left Middle Cerebral Artery (MCA) Territory Stroke with Left Internal Carotid Artery (ICA) Occlusion." Journal of Research on the Lepidoptera 50, no. 2 (June 25, 2019): 68–73. http://dx.doi.org/10.36872/lepi/v50i2/201009.
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Romanowicz, Magdalena, Bruce Sutor, and Christopher Sola. "Safety and efficacy of electroconvulsive therapy for depression following cerebrovascular accident." Acta Neuropsychiatrica 24, no. 4 (August 2012): 226–29. http://dx.doi.org/10.1111/j.1601-5215.2011.00624.x.
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Introduction: Depressive syndromes are common following cerebrovascular accident (CVA) and many patients do not respond to pharmacotherapy. Electroconvulsive therapy (ECT) is a safe and effective treatment for mood disorders arising with many comorbid medical conditions. In this paper, we describe the successful treatment of post-CVA depression with ECT.Methods: Retrospective chart review of 24 patients hospitalised for depression on an in-patient Medical Psychiatry unit between 2000 and 2010. Medical, neurologic and psychiatric histories, physical examination findings, results of laboratory, imaging and neurophysiologic investigations and treatment response with medications and ECT were recorded.Results: Twenty patients (83%) showed a positive response to treatment with ECT. None had worsening of depression after the ECT or experienced exacerbation of post-stroke neurological deficits. Three patients suffered from minor complications of ECT (prolonged confusion or short-term memory problems).Conclusions: This review supports the use of ECT after a stroke with appropriate clinical observation. The treatment was well tolerated and the majority obtained clinical benefit.
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Thomas, Lisa, Qi Shi, Arjinder Sethi, Sathyanarayanan Ramakrishnan, Jihua Jia, and Linda Thomas-Hemak. "Ischemic Stroke in Young Patients with Cardiac Abnormalities and Hypercoagulable State: 2 Case Reports and Literature Review to Assess Diagnostic and Prevention Options." Blood 118, no. 21 (November 18, 2011): 4663. http://dx.doi.org/10.1182/blood.v118.21.4663.4663.
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Abstract Abstract 4663 Background Stroke is the third leading cause of death and the leading cause of severe, long-term disability in the United States. The incidence of cerebrovascular accident (CVA) in young adults has been increasing. Since the etiology of CVA in young adults is more heterogeneous, making a diagnosis is often a challenge requiring extensive clinical investigation. We report 2 cases of ischemic stoke in young adults with multiple risk factors. Case Report No. 1. A 46-year-old male presented to the ER with loss of consciousness. Past medical history was unremarkable. MRA confirmed occlusion of the left posterior cerebral artery. Transesophageal Echocardiogram (TEE) revealed a patent foramen ovale (PFO) and atrial septal aneurysm (ASA). Hypercoagulable evaluation confirmed increased IgM anticardiolipin antibody, a lupus anticoagulant, and heterozygous MTHFR (Methylenetetrahydrofolate reductase) C677T mutation. Anticoagulation therapy was started with Heparin and then switched to Coumadin. Aspirin was also initiated along with folic acid, Vitamin B6 and B12, and smoking cessation therapy. Unfortunately, the patient developed hemiparesis and dementia after stroke. No. 2. A 50-year-old female presented to the ER with headache and blurred vision for one hour. Patient had cerebrovascular accident (CVA) 7 years prior to that event. She has been taking aspirin. MRI confirmed encephalomalacia in the left cerebellar hemisphere. TEE revealed a PFO. During the PFO closure procedure, an atrioseptal defect and a myxomatous were diagnosed. Patient was directed to use clopidogrel for at least six months after procedure, and aspirin indefinitely. Discussion The differential diagnosis for potential etiology in young people (under 55 years of age) of CVA is broader than that for older adults. Ischemic strokes are much more common than hemorrhagic in this group of patients. The atypical causes are more prevalent in the younger population, including cardiogenic cerebral embolus, hypercoagulable states, and autoimmune disease needs to be considered. Cardiogenic cerebral embolus is the most common cause of stroke in young adults. Stroke can be associated with abnormalities of the atrial septum, specifically PFO, atrial septal defect (ASD), aneurysm, and cardiac myxomas. Studies show that the prevalence of PFO in patients who have stroke of unknown cause (cryptogenic stroke) may be about 40 percent. More specifically, PFO increases the rate of paradoxical thromboembolic stroke that occurs by allowing blood clots from the venous system to enter the arterial system. This is particularly true in patients who have had a stroke at an age less than 55 years. PFO closure procedures may help to identify underlying causes of CVA, as was discussed in case 2. Some studies have described an association between atrial septal aneurysm (ASA) and embolic strokes. The embolus might originate in an ASA or from a clot around the edges of a PFO. The mechanism of cerebrovascular events with ASA may be platelet/thrombus formation at the site of the aneurysm. Aspirin may be effective therapy for preventing CVA. Emboli from cardiac myxomas also can lead to cerebral ischemia, infarction, and aneurysm formation. Up to half of cardiac myxomas produce systemic emboli. Consequently, studies show that inherited thrombophilic disorders in the pathogenesis of stroke might relate to congenital heart diseases. The data suggests that Factor V Leiden G1691A mutation or Prothrombin G20210A variant may be associated with PFO. An increased prevalence of right-to-left shunts in patients with cerebrovascular accident CVA and activated protein C resistance has also been documented. Antiphospholipid Antibody Syndromes (APS) are recognized as independent risks for Cerebrovascular Accident (CVA). APS are associated with a heterogeneous group of disorders that result in hypercoagulable states involving arterial and venous thrombosis. Cerebral circulation is particularly affected in APS. Conclusion Based on these observations, the authors conclude that hypercoagulable testing should be performed in young patients with CVA. In addition, PFO closure procedures may be an important diagnostic tool that helps to identify a subset of patients in whom the etiology of CVA was not apparent. Disclosures: No relevant conflicts of interest to declare.
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Hołda, Mateusz K., and Mateusz Koziej. "Morphometric Features of Patent Foramen Ovale as a Risk Factor of Cerebrovascular Accidents: A Systematic Review and Meta-Analysis." Cerebrovascular Diseases 49, no. 1 (2020): 1–9. http://dx.doi.org/10.1159/000506433.
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Introduction: It is still disputable whether specific morphometric features of the patent foramen ovale (PFO) may stratify patients by the related probability that a discovered PFO is incidental or stroke related. Objective: We aimed to determine whether certain morphometrical characteristics of PFO are associated with an increased risk of cerebrovascular accidents, using a meta-analytical approach. Methods: We performed a systematic review of electronic databases for studies that compared morphometric parameters of PFO assessed by transesophageal echocardiography (TEE) in subjects with cryptogenic cerebrovascular accidents (Group 1) and control (Group 2). Data were extracted and pooled into a meta-analysis. Results: A total of 895 patients with PFO were reported (Group 1: 493, Group 2: 402). No difference was found in the PFO channel length (Group 1: 10.8 [8.6–12.9] mm vs. Group 2: 10.4 [9.1–11.7] mm), as well as in PFO height measured at rest (Group 1: 2.4 [1.5–3.3] mm vs. Group 2: 1.8 [1.4–2.2] mm). The PFO height measured during a Valsalva maneuver was larger in Group 1 (3.5 [2.8–4.1] mm) than in Group 2 (1.7 [1.2–2.2] mm). Also, the septal excursion distance was found to be larger in Group 1 (6.4 [5.1–7.8] mm) than in Group 2 (3.1 [1.8–4.4] mm). The risk of cerebrovascular accident was higher in patients with PFO and concomitant septal aneurysm (OR 4.00; 95% CI 2.63–6.09; p < 0.001) and with large right-to-left shunt PFO (OR 3.81; 95% CI 2.21–6.55; p < 0.001), no such relationship was found for the presence of a Eustachian valve or Chiari’s network (OR 1.90; 95% CI 0.90–4.05; p = 0.094). Conclusions: The TEE may help in identifying PFO that are of high risk of cerebrovascular accident. Greater PFO height during a Valsalva maneuver, larger septal excursion distance, concomitant atrial septal aneurysm, and large right-to-left shunt are associated with stroke-related PFOs.
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Acharya, Sumnima, and Shyam Kishore Chaturvedi. "Significance of Computed Tomography in the Diagnosis of Cerebrovascular Accidents." Journal of Lumbini Medical College 2, no. 1 (June 30, 2014): 18. http://dx.doi.org/10.22502/jlmc.v2i1.49.
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Introduction: Cerebrovascular Accident (CVA) is defined as abrupt onset of a neurological deficit that is attributable to a focal vascular cause. CT scan is a widely available, affordable, non-invasive and relatively accurate investigation in patients with stroke and is important to identify stroke pathology and exclude mimics. Aim of this study is to establish the diagnostic significance of computed tomography in cerebrovascular accident and to differentiate between cerebral infarction and cerebral haemorrhage with CT for better management of CVA.
Methods: A one year observational cross sectional study was conducted in 100 patients that presented at the department of radiodiagnosis from emergency or ward within the one year of study period with the clinical diagnosis of stroke, and had a brain CT scan done within one to fourteen days of onset.
Results: A total of 100 patients were studied. 66 were male and 34 were female with a male/female ratio of 1.9:1. Maximum number of cases (39%) was in the age group of 61-80 yrs. Among 100 patients, 55 cases were clinically diagnosed as hemorrhagic stroke and 45 cases were clinically diagnosed with an infarct. Out of the 55 hemorrhagic cases, two cases were diagnosed as both hemorrhage and infarct by CT scan, one case had normal CT scan findings and one had subdural haemorrhage. These four cases were excluded while comparing the clinical diagnosis with CT scan finding. Among 51 clinically diagnosed cases of hemorrhagic stroke, 32(62.7%) cases were proved by CT scan as hemorrhagic stroke and among clinically diagnosed cases of infarct, 39(86.7%) cases were proved by CT scan as infarct which is statistically significant (p <0.001). A significant agreement between clinical and CT diagnosis was observed as indicated by kappa value of 0.49. Sensitivity, specificity, positive predictive value and negative predictive value of clinical findings as compared to CT in diagnosing hemorrhage were 84.2%, 67.2%, 62.8% and 86.7% respectively. The accuracy of clinical diagnosis is 74%.
Conclusion: This study showed that CT scan is a useful diagnostic modality to identify stroke pathology and to exclude mimics.
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Maheshwari, Sunil G., Muhammad Iqbal, Sayed Fasih Ahmed Hashmi, and Bikharam Devrajani. "STROKE PATIENTS." Professional Medical Journal 22, no. 05 (May 10, 2015): 541–45. http://dx.doi.org/10.29309/tpmj/2015.22.05.1263.
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Objective: To assess the cognitive impairment in stroke patients. Study Design:Observational study. Setting: Department of Medicine, Liaquat University of Medical & HealthSciences Hospital Jamshoro and Hyderabad. Period: 01stAugust 2013 to 1stFeburary 2014.Methods: One hundredpatients with the established diagnosis of cerebrovascular accident(CVA)or stroke were recruited by purposive sampling technique after obtaining a well informedconsent. Socio-demographic data on a semi-structured proforma were recorded. Mini-MentalState Examination test was used to assess the cognitive impairment. Results: Cognitiveimpairment was found in all the patients with stroke. Moderate cognitive impairment was foundin 57%, mild cognitive impairment in 29% and severe cognitive impairment in 14% of strokepatients. Conclusion: Cognitive impairment was present in almost all the stroke patients andwe noticed that moderate cognitive impairment was very common.
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Túbero, Grazieli Silva, Sebastião Gobbi, Camila Vieira Ligo Teixeira, Jessica Rodrigues Pereira, Ryosuke Shigematsu, and Ana Paula Canonici. "Effects of square stepping exercise in patients with sequel of cerebrovascular accident." Fisioterapia em Movimento 27, no. 2 (June 2014): 229–37. http://dx.doi.org/10.1590/0103-5150.027.002.ao08.
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Introduction Cerebral stroke is the interruption of blood flow to the brain and can be classified into hemorrhagic and ischemic. It may result in serious body balance and cognition complications. Kinesiotherapy is a privileged means of rehabilitation.Objective Verify the effects of Square Stepping Exercise (SSE) on cognitive functions, depressive symptoms and the body balance of cerebral stroke sequel patients.Methods Thirteen brain stroke sequel patients were divided into two groups: SSE (SSEG n = 8) and conventional physiotherapy group (PG, n = 5). The SSEG participated only of the SSE training protocol, while the PG participated of its physical therapy routine group, both for 4 months. They were evaluated using the Mini Mental State Examination (MMSE), the Brief Cognitive Screening Battery (BBRC), the Geriatric Depression Scale (GDS),Berg Balance Scale(BBS) and Timed Up and Go(TUG).Results The U Mann Whitney test showed no significant differences between groups. In intragroup analysis, the Wilcoxon test showed significant improvement in global cognitive status for PG (p < 0.042), and for SSEG there were positive results for verbal fluency (p < 0.04) and in TUG for number of steps (p < 0.04) and the time (p < 0.02).Conclusion The SSE seems to benefit dynamic balance, influencing gait agility, cognition related to verbal fluency and may have contributed to maintain other cognitive functions.
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Gupta, Nitin, Sandeep Joshi, Udit Narang, Rosy Bala Gupta, Ruby Sharma, and Aseem Singla. "SERUM HOMOCYSTEINE AS A RISK FACTOR FOR STROKE: A PROSPECTIVE STUDY FROM A RURAL TERTIARY CARE CENTRE." Asian Journal of Pharmaceutical and Clinical Research 11, no. 11 (November 7, 2018): 174. http://dx.doi.org/10.22159/ajpcr.2018.v11i11.27595.
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Objective: Stroke is one of the leading causes of mortality and long-term disability in both developed and developing countries. Serum homocysteine level is one of the emerging modifiable risk factors for atherosclerosis which may result into a cerebrovascular accident. This study was designed to study the association of Serum Homocysteine level with the development of acute stroke at a rural tertiary care centre in North India.Methods: The present study was a prospective cross-sectional study conducted in the Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. The study population included 100 patients presenting with Stroke (either ischemic or hemorrhagic) in the indoor and outdoor facilities in the Department of Medicine. 50 age and sex-matched healthy individuals were taken as controls. Serum total Homocysteine level was measured in all the cases and controls.Results: Majority of the patients suffered from ischemic stroke (78%), while only 22% patients had hemorrhagic stroke. The mean Serum Homocysteine level in stroke patients (19.88±8.78 μmol/l) was significantly higher than in controls (10.48±4.39 μmol/l) (p<0.01). In a subgroup analysis, stroke patients with a positive history of smoking had significantly higher homocysteine level as compared to non-smokers (p<0.05).Conclusion: Increased level of Serum Homocysteine is significantly associated with risk of cerebrovascular accident, which is independent of the risk attributed to traditional risk factors.
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LaFontaine, Tom. "Strength and Conditioning in the Prevention and Management of Cerebrovascular Accident (Stroke)." Strength and Conditioning Journal 23, no. 6 (December 2001): 49–52. http://dx.doi.org/10.1519/00126548-200112000-00012.
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Zrelak, Patricia A. "Why Stroke Is Not a Cerebrovascular Accident and There Are No Victims." Journal of Neuroscience Nursing 53, no. 1 (November 11, 2020): 24–25. http://dx.doi.org/10.1097/jnn.0000000000000558.
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Gupta, R., S. Gupta, S. Sharma, D. N. Sinha, and R. Mehrotra. "Association of smokeless tobacco and cerebrovascular accident: a systematic review and meta-analysis of global data." Journal of Public Health 42, no. 2 (May 8, 2019): e150-e157. http://dx.doi.org/10.1093/pubmed/fdz054.
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Abstract Background The association of smokeless tobacco (SLT) with stroke has been dealt with in only a few reviews. The present meta-analysis aims to present the updated comprehensive summary risk of stroke in adult SLT users along with sub group analysis. Methods A systematic literature search for articles evaluating risk of stroke in SLT users was conducted. The study characteristics and risk estimates were extracted independently by two authors (RG and SG). Random-effect model was used to estimate the summary relative risks. Results The overall risk of stroke in SLT users was found to be significantly higher (1.17, 95% CI 1.04–1.30) compared to non-users, especially for users in Southeast Asian region. The results remained unchanged even after strict adjustment for smoking (1.18, 95% CI 1.04–1.32). SLT users had 1.34 times or 13.4% higher risk of fatal stroke, though risk of nonfatal stroke was not enhanced. Significantly higher risk of stroke was seen in users of chewing tobacco (1.35, 95% CI 1.20–1.50) in comparison to non-chewers. Gender-based analysis showed enhanced risk of fatal stroke in both male and female users. SLT-attributable fraction of fatal stroke was highest for India at 14.8%. Conclusion The significant higher risk of stroke with SLT use, even after adjustment for smoking, emphasizes the imperative need to include SLT cessation advice for control and prevention of stroke.
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Gohardani, Amir S., and Jin Woo Sung. "The Quest for Managing Stroke through A Mobile Device Application: A Review Study of Innovative Technologies Related to Cerebrovascular Accident." Westcliff International Journal of Applied Research 3, no. 1 (November 1, 2019): 47–53. http://dx.doi.org/10.47670/wuwijar201931agjws.
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Stroke, also known as a cerebrovascular accident (CVA), is the fifth leading cause of death for Americans, accounting for 140,000 lives each year (“Stroke facts,” 2017). CVA marks 1 out of every 20 deaths and nearly 75% of all strokes occur in people aged 65 years and above (Centers for disease control,” 2017). As a leading cause of long-term disability, stroke can have devastating effects on patients and their caregivers. Despite a number of emerging technologies that could potentially be helpful in the prevention, evaluation, and rehabilitation of strokes, typically, such technologies are limited and only considered for millennials. Similarly, at the present time, there is not a single platform designed specifically for stroke management. This makes access to relevant CVA information for baby boomers and the elderly challenging and the potential edification process rather inefficient. The key objective of this review is to identify and discuss effective technologies that can assist baby boomers, born between 1946 and 1964 in the United States, to manage CVA and further explore possible concerns of baby boomers associated with awareness and accessibility of the aforementioned technologies.
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Abel, William F., Christopher Ronald Funk, and Anna V. Blenda. "Galectins in the Pathogenesis of Cerebrovascular Accidents: An Overview." Journal of Experimental Neuroscience 13 (January 2019): 117906951983679. http://dx.doi.org/10.1177/1179069519836794.
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Due to limitations of neuroimaging, such as the isodense appearance of blood to neuronal tissue in subacute hemorrhagic stroke, a body of studies have been performed to evaluate candidate biomarkers which may aid in accurate determination of cerebrovascular accident type. Beyond aiding in the delineation of stroke cause, biomarkers could also confer useful prognostic information to help clinicians plan use of resources. One of the candidate biomarkers studied for detection of cerebrovascular accident (CVA) includes a class of proteins called galectins. Galectins bind β-galactoside through a highly conserved carbohydrate recognition domain, endowing an ability to interact with carbohydrate moieties on glycoproteins, some of which are relevant to CVA response. Furthermore, galectins-1, -2, -3, -9, and -12 are expressed in tissues relevant to CVA, and some exhibit characteristics (eg, extracellular secretion) that could render feasible their detection in serum. Galectins-1 and -3 appear to have the largest amounts of preclinical evidence, consistently demonstrating increased activity and expression levels during CVA. However, a lack of standardization of biochemical assays across cohort studies limits further translation of these basic science studies. This review aims to increase awareness of the biochemical roles of galectins in CVA, while also highlighting challenges and remaining questions preventing the translation of basic science observations into a clinically useful test.
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Butler-Hinz, Susan, David Caplan, and Gloria Waters. "Characteristics of Syntactic Comprehension Deficits Following Closed Head Injury Versus Left Cerebrovascular Accident." Journal of Speech, Language, and Hearing Research 33, no. 2 (June 1990): 269–80. http://dx.doi.org/10.1044/jshr.3302.269.
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Two studies examined the ability to assign thematic roles and to coindex referentially dependent noun phrases in closed head injured adults, adult stroke patients, and normal adults. The subjects’ task was to enact target sentences by manipulating toy animals. Closed head injured and stroke patients demonstrated a significant effect of syntactic structure on sentence comprehension, and the patterns of breakdown in the ability to assign thematic roles and coindex referentially dependent noun phrases were strikingly similar in the two groups. These findings suggest that syntactic comprehension disturbances are similar following left cerebral hemisphere infarction and closed head injury.
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Endres, Kaitlin, Omar Anjum, and Nicholas Costain. "Arterial-embolic Strokes and Painless Vision Loss Due to Phase II Aortitis and Giant Cell Arteritis: A Case Report." Clinical Practice and Cases in Emergency Medicine 2, no. 5 (April 19, 2021): 174–77. http://dx.doi.org/10.5811/cpcem.2021.2.51143.
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Introduction: Aortitis refers to abnormal inflammation of the aorta, most commonly caused by giant cell arteritis (GCA). Herein, we present a 57-year-old female with aortitis and arterial-embolic strokes secondary to GCA. Case Report: Our patient presented to the emergency department following an episode of transient, monocular, painless vision loss. Computed tomography angiogram head and neck demonstrated phase II aortitis, and magnetic resonance imaging revealed evidence of arterial-embolic strokes. Conclusion: Cerebrovascular accident is a rare complication of large-vessel vasculitis and can occur due to multiple underlying etiologies including intracranial vasculitis, aortic branch proximal occlusion, or arterial-embolic stroke.
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Gouveia, Maria Aquino, Maria Fernanda Vinagre, Émerson Soares Pontes, Carlos Eduardo Porto da Silva, Ivana Araújo Pereira, and Ana Karênina De Freitas Jordão do Amaral. "Ventilação não invasiva em idosos após o acidente vascular cerebral." Revista de Enfermagem UFPE on line 12, no. 7 (July 3, 2018): 2031. http://dx.doi.org/10.5205/1981-8963-v12i7a231357p2031-2038-2018.
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RESUMOObjetivo: conhecer as publicações sobre o uso de ventilação mecânica não invasiva em idosos após o acidente vascular cerebral. Método: revisão integrativa nas bases de dados LILACS, MEDLINE, Portal CAPES e biblioteca SCIELO. Selecionaram-se artigos publicados em texto completo; nos idiomas português ou inglês; disponíveis na íntegra na internet e publicados no período de 2007-2016 obrigatoriamente constando os descritores “idoso” e “acidente vascular cerebral” e um dos descritores “ventilação mecânica não invasiva”, “respiração artificial” ou “respiração com pressão positiva”, sendo dez artigos selecionados. Foi realizada a leitura analítica utilizando roteiro estruturado. Os dados coletados foram organizados em tabela e submetidos à análise. Resultados: os artigos selecionados abordaram o acidente vascular cerebral e a apneia obstrutiva do sono. Em oito artigos, a modalidade ventilatória foi a pressão positiva contínua e houve maior quantitativo de publicações no ano de 2009. Conclusão: a ventilação não invasiva apresenta benefícios na otimização, manutenção e restabelecimento da função pulmonar do idoso após o acidente vascular cerebral. O número baixo de publicações e a ausência de protocolos reforçam a necessidade de construção de instrumento para esta temática. Descritores: Idosos; Acidente Vascular Cerebral; Respiração Artificial; Respiração Com Pressão Positiva; Ventilação Não Invasiva. ABSTRACT Objective: to get to know the publications about the use of non-invasive mechanical ventilation in the elderly after stroke. Method: integrative review in the databases LILACS, MEDLINE, CAPES Portal and SCIELO library. Selected articles were published in full text; in Portuguese or English; available in full on the internet and published in the 2007-2016 period, with the descriptors "elderly" and "stroke" and one of the descriptors "non-invasive mechanical ventilation", "artificial respiration" or "positive pressure breathing", being ten selected articles. The analytical reading was performed using a structured script. The collected data were organized in table and submitted to the analysis. Results: selected articles addressed stroke and obstructive sleep apnea. In eight articles, the ventilatory modality was continuous positive pressure and there were more publications in the year 2009. Conclusion: noninvasive ventilation presents benefits in the optimization, maintenance and reestablishment of the pulmonary function of the elderly after stroke. The low number of publications and the absence of protocols reinforce the need to build an instrument for this theme. Descriptors: Elders; Cerebrovascular Accident; Artificial Respiration; Positive Pressure Breathing; Non-Invasive Ventilation. RESUMEN Objetivo: conocer las publicaciones sobre el uso de ventilación mecánica no invasiva en ancianos post accidentes cerebrovasculares. Método: revisión integrativa en las bases de datos LILACS, MEDLINE, Portal CAPES y biblioteca SCIELO. Se seleccionaron artículos publicados en texto completo, en los idiomas portugués y / o inglés; disponibles en su totalidad en Internet y publicados en el período 2007-2016, obligatoriamente constando los descriptores "anciano" y "accidente cerebrovascular", y uno de los descriptores "ventilación mecánica no invasiva", "respiración artificial" o "respiración con presión positiva". Siendo diez artículos seleccionados. Se realizó la lectura analítica, utilizando guión estructurado. Los datos recolectados fueron organizados en tabla y sometidos al análisis. Resultados: los artículos seleccionados abordaron el accidente cerebrovascular y la apnea obstructiva del sueño. En ocho artículos, la modalidad ventilatoria fue la presión positiva continua y hubo mayor cuantitativo de publicaciones en el año 2009. Conclusión: la ventilación no invasiva presenta beneficios en la optimización, mantenimiento y restablecimiento de la función pulmonar del anciano después del accidente cerebrovascular. El número bajo de publicaciones y la ausencia de protocolos, refuerzan la necesidad de construir un instrumento para esta temática. Descriptores: Personas De Edad; Accidente Cerebrovascular; Respiración Artificial; Presión Positiva De Respiración; Ventilación no Invasiva.