Alcohol Consumption and Stroke Risk

1. ‘STROKE’ September 2010 Dr. Amer Jafar

2. Alcohol consumption and stroke • Previous research suggests thatregular heavy alcohol consumption increases the risk for ischaemicstroke • The risk of ischaemic stroke associatedwith transient exposure to alcohol remains unclear • This is a case–crossover study: to test the hypothesisthat alcohol consumption affects the acute risk of ischaemicstroke, to determine the length of time between alcohol intakeand the onset of symptoms (induction time), and to examine whetherthe risk varies by the type of alcohol.

3. Of the 390 patients, 248 (64%) reported alcoholconsumption in the prior year, 104 within 24 hours and 14 within1 hour of stroke onset • Conclusion: The risk of stroke onset is transiently elevatedin the hour after alcohol ingestion

4. NSAID AND RISK OF STROKE • This study is aiming to evaluate the risk of ischaemic and haemorrhagic stroke associatedwith short-term use of selective and nonselective NSAIDs ina Chinese population with a high incidence of stroke • A retrospective case–crossover study wasconducted by analyzing the Taiwan National Health InsuranceDatabase

5. A pharmacy prescriptiondatabase was searched for NSAID use during the case and controlperiods • The study concluded that: Use of selective and nonselective NSAIDswas associated with an increased risk of both ischemic and hemorrhagicstroke, strikingly high for parenteral ketorolac

6. Treating Carotid stenosis in women • Gender differences in carotidendarterectomy (CEA) rates after transient ischemic attack arenot well studied • This study retrospectively identified all patients diagnosedwith transient ischemic attack and 70% carotid stenosis on ultrasoundin 2003 to 2004 from 19 emergency departments

7. Of 299 patients identified, 47% were women • Womenwere older with higher presenting systolic blood pressure andless likely to smoke or to have coronary artery disease or diabetes • This study concluded that: Women with severe carotid stenosis and recenttransient ischaemic attack are less likely to undergo CEA thanmen, and surgeries are more delayed.

8. NOMASS STUDY • The Northern Manhattan Stroke Study • This study is aiming to determinewhether depressed mood acutely after stroke predicts subsequentdisability and mortality • Participants were asked aboutdepressed mood within 7 to 10 days after stroke • The were followed every 6 months the first 2 years and yearly thereafterfor 5 years for death and disability measured by the BarthelIndex

9. A question about depressed mood within 7 to 10days after stroke was asked in 340 of 655 patients with ischemicstroke enrolled, and 139 reported that they felt depressed • The study concluded that: Depressed mood after stroke is associatedwith disability but not mortality after stroke. Early screeningand intervention for mood disorders after stroke may improveoutcomes and requires further research.

10. Cerebral Vein Thrombosis • After cerebral vein and duralsinus thrombosis (CVT), there is an increased risk of furthervenous thromboembolic events (VTEs) • The research team used the International Study on Cerebral Veinand Dural sinus Thrombosis, which included 624 patients withCVT followed up for a median of 13.9 months • Of the 624 included patients, 36 (5.8%) had atleast 1 venous thromboembolic event

11. Conclusions: • The risk of recurrence of CVT is low butis moderate for other VTEs. Recurrence of venous thrombosisafter CVT is more frequent among men and in patients with polycythemia/thrombocythemia.

12. eGFR and stroke • Consecutive patients with acutestroke (N=378) subjected to MRI and serum creatinine determinationwere included in the study and prospectively followed-up upto 12 years • Of the patients, 71.2% had died during the follow-up,152 (40.2%) had moderate (eGFR <60 mL/min/1.73 m2), and 226(59.8%) had normal or mildly impaired eGFR (60 mL/min/1.73 m2 )

13. Of the patients, 108 (28.6%) had mild, 68 (18.0%) had moderate,and 202 (53.4%) had severe WMLs (White matter lesions) • Cerebral small vessel disease is closelyassociated with kidney function in patients with acute stroke.Cerebral small vessel disease and kidney function are closelyassociated predictors of poor poststroke survival

14. Microbleeds and the Risk of Recurrent Stroke • This study is about the risk of recurrentcerebrovascular events in patients who had a transient ischaemicattack or ischaemic stroke and who had evidence of microbleedson MRI • A prospective follow-up study was performed onhospitalized patients who were at least 50 years old with atransient ischemic attack or an ischaemic stroke • The presenceand number of microbleeds were assessed on gradient echo MRI

15. Patientswere followed up by phone every 6 months • End points were intracerebralhemorrhage, ischaemic stroke, and unclassified stroke • A total of 487 patients with a mean age of 72years were followed up for a median of 2.2 years • Microbleeds were identified in129 patients (25.6%)

16. Conclusions: • In this European cohort, patients with microbleedswho have had cerebral ischaemia have a higher risk of developingnew ischaemic strokes than of intracerebral haemorrhage. Lobarmicrobleeds or combined lobar and deep microbleeds might beindependent predictors of recurrent stroke.

17. Spasticity After Ischaemic Stroke • In a prospective cohort study, 301 consecutivepatients with clinical signs of central paresis due to a first-everischaemic stroke were examined in the acute stage and 6 monthslater • Spasticity was assessed on the Modified Ashworth Scale and definedas Modified Ashworth Scale >1 in any of the examined joints

18. Two hundred eleven patients (70.1%) were reassessedafter 6 months • Of these, 42.6% (n=90) had developed spasticity • A more severe degree of spasticity (Modified Ashworth Scale3) was observed in 15.6% of all patients • The prevalence ofspasticity did not differ between upper and lower limbs, butin the upper limb muscles, higher degrees of spasticity (ModifiedAshworth Scale 3) were more frequently (18.9%) observed thanin the lower limbs (5.5%)

19. Conclusions: • Spasticity was present in 42.6% of patientswith initial central paresis • Severe spasticity wasrelatively rare. Predictors for the development of spasticitywere a severe degree of paresis and hemihypersthesia at strokeonset.

20. Guidelines for the Management of Spontaneous Intracerebral Haemorrhage • Intracerebral haemorrhage is a serious medicalcondition for which outcome can be impacted by early, aggressivecare • The guidelines offer a framework for goal-directed treatmentof the patient with intracerebral haemorrhage

21. Thrombolysis and complications • This is a single-center, retrospective analysisof consecutive acute stroke patients treated with IV rt-PA betweenJanuary 2006 and December 2008 • Aim: to define the incidence of earlyneurologic deterioration (4-point drop on the National Institutesof Health Stroke Scale within 72 hours) and its mechanism

22. Of 228 consecutive IV rt-PA–treated patients,34 (15%) developed early neurologic deterioration, 18 (8%) secondaryto incident strokes 10 (4.4%) due to SICH, and 6 (2.6%) dueto early recurrent ischaemic events, which were significantlyassociated with atrial fibrillation • Conclusion: the incidenceof early recurrent ischaemic stroke after IV rt-PA was 2.6% andwas associated with previous atrial fibrillation.