Wytyczne postępowania w udarze mózgu

Błażejewska-Hyżorek, Beata; Czernuszenko, Anna; Członkowska, Anna; Ferens, Antoni; Gąsecki, Dariusz; Kaczorowski, Rafał; Karaszewski, Bartosz; Karliñski, Michał; Kaźmierski, Radosław; Kłysz, Bożena; Kobayashi, Adam; Kozera, Grzegorz; Kozubski, Wojciech; Krawczyk, Maciej; Kuczyńska, A; Kurkowska‐Jastrzębska, Iwona; Kwołek, Andrzej; Luchowski, Piotr; Niewada, Maciej; Nowacki, Przemysław; Nyka, Walenty M.; Opala, Grzegorz; Opara, Józef; Poncyljusz, Wojciech; Rejdak, Konrad; Rózniecki, J; Ryglewicz, Danuta; Sarzyńska‐Długosz, Iwona; Seniów, Joanna; Skowrońska, Marta; Sobolewski, Piotr; Staszewski, Jacek; Szczepańska-Szerej, Anna; Szczudlik, Andrzej; Wiszniewska, Małgorzata

doi:10.5603/ppn.2019.0001

Cited by 41 publications

(49 citation statements)

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“…1 in Bydgoszcz, Poland is recognized as a stroke unit according to the Polish national criteria and is equipped with appropriate monitoring and diagnostic facilities. 19 The stroke unit provides a 24-h stroke service seven days a week. All patients were examined at the time of admission by a stroke physician.…”

Section: Study Groupmentioning

confidence: 99%

Effect of IL-6 and hsCRP Serum Levels on Functional Prognosis in Stroke Patients Undergoing IV-Thrombolysis: Retrospective Analysis

Pawluk¹,

Grześk²,

Kołodziejska³

et al. 2020

CIA

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Purpose We evaluated the relationship between pretreatment IL-6 and hsCRP levels, symptom severity and functional outcome of patients with acute ischemic stroke (AIS) treated with IV-thrombolysis. Patients and Methods IL-6 and hsCRP samples were obtained from 83 consecutively treated Caucasian patients with AIS prior to initiation of IV-thrombolysis. Severity of stroke symptoms was assessed using the National Institutes of Health Stroke Scale (NIHSS), whereas functional outcome was assessed with modified Rankin Scale (mRS). The commercially available sets of enzymatic immune tests were used to estimate the concentrations of inflammatory markers in serum. Results Medians of IL-6 serum concentrations prior to IV-thrombolysis were lower in patients with favorable (mRS 0–2 pts) functional outcome than in those with unfavorable (mRS 3–6 pts) functional outcome, both at hospital dismission (5.92: 2.30–7.71 vs 9.46: 3.79–17.29 pg/mL; p <0.01) and on the ninetieth day from stroke onset (5.87: 2.30–10.58 vs 10.9: 5.94–17.28 pg/mL; p <0.01). There were no existing differences regarding hsCRP levels between groups (2.49: 0.11–9.82 vs 4.44: 0.32–9.87 mg/dL; p =0.30 and 2.57: 0.11–2.57 vs 2.83: 0.32–9.32 mg/dL; p =0.75, respectively). Patients with lacunar strokes were characterized by lower median of IL-6 (5.96: 2.87–13.0% vs 7.29: 2.30–17.28; p =<0.02) and hsCRP (2.25: 0.11–9.82 vs 4.84: 0.35–9.87; p =0.01) than those with nonlacunar infarctions. Multivariate analysis showed an impact of IL-6 on mRS measured on hospital dismission and after three months, regardless of their initial NIHSS, presence of hemorrhagic transformation and type 2 diabetes. No impact of hsCRP, lacunar etiology and patients’ age on functional outcome existed. Conclusion Regardless of the stroke etiology, pretreatment of IL-6, but not of hsCRP levels, may help to predict functional outcome after IV-thrombolysis independently of symptom severity and stroke complications.

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Section: Study Groupmentioning

confidence: 99%

Effect of IL-6 and hsCRP Serum Levels on Functional Prognosis in Stroke Patients Undergoing IV-Thrombolysis: Retrospective Analysis

Pawluk¹,

Grześk²,

Kołodziejska³

et al. 2020

CIA

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“…[7][8][9] The Polish recommendation (2013) listed age restrictions on IVT which still remains the most frequent method of effective stroke treatment despite the introduction of endovascular thrombectomy. 10 The share of older people in the age structure is higher in rural areas than in urban areas. 11 Sparse studies have previously reported on the safety and efficacy of thrombolytic therapy in patients from rural regions, showing inequalities compared to urban areas.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Thrombolysis in Rural Residents Aged ≥ 80

Sobolewski

Brola

Wilczyński

et al. 2020

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The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods: This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged <80 and aged ≥80 were performed. Results: The proportion of patients aged ≥80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% p = 0.24). Rural patients aged ≥80 were also characterized by lower incidence of cardiovascular risk factors and better patients' conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, p = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, p < 0.001) and lower functional independence rate (34.0% vs 50.5%, p < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04-5.66, p = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21-10.99, p = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03-6.82, p = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01-1.20, p = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10-0.62, p = 0.003) were associated with mortality in rural patients over 80. Conclusion: We suggest that rural patients aged ≥80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.

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“…Jeśli chory jest w stanie połknąć tę objętość, można kontynuować test z 90 ml płynu. W przypadku braku współpracy, zmiany jakości głosu po przełknięciu mniejszych objętości lub wystąpienia kaszlu trzeba przerwać test (Błażejewska-Hyżorek et al, 2019;Czernuszenko, Przesiewowe testy połykania;Lewicka i Krzystanek, 2017). Do oceny przesiewowej może też być wykorzystywany test Daniels (czułość 92%, swoistość 62%), łączący elementy badania klinicznego z testem połykania wody.…”

Section: Dysfagiaunclassified

“…Wykazano, że wczesne (w ciągu 72 godzin od zachorowania) rozpoczęcie żywienia za pomocą sondy nosowo-żołądkowej zwiększa bezwzględne szanse przeżycia o niemal 6%. Wskazaniami do założenia sondy są poważne trudności w połykaniu, które nie pozwalają na wystarczające doustne przyjmowanie pokarmu i prawdopodobnie będą utrzymywać się dłużej niż tydzień (Błażejewska-Hyżorek et al, 2019;Wirth et al, 2013). U pacjentów, którzy według przewidywań nie powrócą do żywienia drogą doustną, w kolejnym kroku należy wyłonić PEG, przy czym wykonanie procedury odracza się do czasu stabilizacji stanu ogólnego pacjenta (14-28 dni od momentu zachorowania) (Błażejewska-Hyżorek et al, 2019).…”

Section: Dysfagiaunclassified

“…choroby, niedożywieniem, odwodnieniem i wydłużonym czasem hospitalizacji, a w rezultacie -z wyższymi kosztami leczenia. Dotknięci dysfagią pacjenci częściej wymagają wykonania radiogramów klatki piersiowej, leczenia antybiotykami i kontynuowania hospitalizacji w oddziałach rehabilitacyjnych (Błażejewska-Hyżorek et al, 2019;Chmielewska et al, 2017;Chojin et al, 2017;Crary et al, 2013;Kłęk et al, 2017;Krajczy et al, 2019;Martino et al, 2005;Sura et al, 2012;Wirth et al, 2013). Co istotne, dysfagia należy do najlepiej udokumentowanych czynników ryzyka SAP i prawdopodobnie odpowiada za większość jego przypadków.…”

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Pneumonia in patients with stroke: risk factors, identification of at-risk patients, and methods of prevention

Turlakiewicz¹,

Anna²

2020

Aktualn Neurol

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Stroke-associated pneumonia (SAP) is the most common complication of the early stage of ischaemic stroke. The prevalence of SAP is difficult to determine precisely, but it is estimated to affect 2–22% of patients in the acute phase of stroke. Strokeassociated pneumonia is a clinically significant problem, as it markedly increases the risk of death compared to the population of acute stroke patients without pneumonia. In addition, SAP is associated with poorer final functional status, greater dependence on other people’s help after hospital discharge, extended hospital stay, and higher treatment costs. The paper presents the risk factors for stroke-related pneumonia, including the two best documented: dysphagia and stroke-induced immunodepression syndrome (SIDS). An attempt is made to identify patients in the acute phase of stroke who should be evaluated for the risk of developing pneumonia, and tools useful in the identification of such patients (A2DS2, ISAN scoring systems) are discussed. Also, based on expert recommendations, measures to minimise the risk of stroke-related pneumonia are proposed, and the recommended therapeutic regimen is described.

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Wytyczne postępowania w udarze mózgu

Cited by 41 publications

References 0 publications

<p>Effect of IL-6 and hsCRP Serum Levels on Functional Prognosis in Stroke Patients Undergoing IV-Thrombolysis: Retrospective Analysis</p>

<p>Effect of IL-6 and hsCRP Serum Levels on Functional Prognosis in Stroke Patients Undergoing IV-Thrombolysis: Retrospective Analysis</p>

<p>Cerebral Thrombolysis in Rural Residents Aged ≥ 80</p>

Pneumonia in patients with stroke: risk factors, identification of at-risk patients, and methods of prevention

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