Lasting impairments following transient ischemic attack and minor stroke: a systematic review protocol

Provision of information, secondary stroke prevention and holistic care for post-transient ischemic attack patients: A scoping review

Epidemiological evidence suggests that following a Transient Ischemic Attack (TIA), there are residual impairments which threaten quality of life. Despite these consequences, studies addressing post-TIA care remain limited. TIA patients' needs were summarized into 3 domains: Information, Stroke prevention, and Holistic care. Therefore, this scoping review will evaluate the existing reported care programs with the aim of identifying the scope of the care and its adequacy in fulfilling the patients' needs. Based on a question "Do available post-TIA care programs sufficiently cover the needs for information, stroke prevention and holistic care?" and using keywords related to TIA and care, this scoping review was conducted in accordance with an established 5-step framework. Searched databases included Scopus, PubMed, Cochrane Library, and EBSCOhost to retrieve potentially relevant studies. Sixteen studies were selected from 1003 relevant articles published between the years 2014 and 2022. We found that all 16 studies included stroke secondary prevention, involving medical treatment, advice on lifestyle changes and exercises, and counseling to post-TIA patients. However, only 4 studies included education and information sharing about post-TIA impairments, while only one study reported the effects of the care on post-TIA impairment namely fatigue. We found no studies which looked into the care impacts on the patients' overall quality of life. There is a gap in the existing literature regarding holistic care for post-TIA patients, with the management of residual impairments being missed. Further studies targeting a holistic management approach for post-TIA patients are warranted.

Cognitive impairment after intravenous thrombolysis in mild stroke: assessment of cerebral blood flow covariance network

Background

Mild stroke may lead to cognitive impairment, and it remains unclear whether intravenous thrombolysis (IVT) can mitigate cognitive deficits. This study investigates whether IVT can help alleviate cognitive function impairment in patients and further explores changes in the topological properties of cerebral blood flow (CBF) networks.

Methods

This observational study prospectively enrolled 94 patients with acute mild ischemic stroke (44 IVT vs. 50 non-IVT) from two hospitals. A battery of neuropsychological tests and arterial spin labeling were performed to evaluate their cognitive functioning and CBF in 116 brain regions. Voxel-wise CBF was compared between patients and health controls. The CBF covariance network of patients was constructed by calculating across-subject CBF covariance among 116 brain regions. Network properties were calculated and compared between IVT and no-IVT groups.

Results

The mild stroke group demonstrated significantly lower Montreal Cognitive Assessment (MoCA) scores compared to healthy controls (p < 0.001). Patients receiving IVT showed superior performance on the Trail Making Test-B (p = 0.043), Clock Drawing Test (p = 0.001), and Verbal Fluency Test (p = 0.033). Multivariate regression analysis adjusted for covariates demonstrated significant associations between IVT and cognitive outcomes: Montreal Cognitive Assessment (β = 2.85; 95% CI, 0.64-5.13), Trail Making Test-A (β = -16.90; 95% CI, -32.89--0.90), Trail Making Test-B (β = -43.27; 95% CI, -78.78--7.76), Hopkins Verbal Learning Test-Revised total recall (β = 3.57; 95% CI, 1.36-5.78), HVLT-R delayed recall (β = 1.53; 95% CI, 0.43-2.63), Clock Drawing Test (β = 7.09; 95% CI, 2.40-11.79), and Verbal Fluency Test (β = 3.00; 95% CI, 1.33-4.68). IVT patients exhibited higher small-worldness, clustering coefficient, and global efficiency of the network compared to non-IVT patients.

Conclusion

Intravenous thrombolysis demonstrated early cognitive benefits across multiple domains in patients with mild stroke. Improvement in the brain CBF covariance network properties may be the underlying mechanism.

Improving follow-up care for people after minor stroke using early personalised care: A protocol for a randomised, mixed-methods, feasibility study

Background

Of the 150 000 people per year in the UK who have strokes, third to half will experience a so-called 'minor stroke'. Although appearing benign these strokes put a person at increased risk of further strokes and survivors are usually considered 'too good' for referral onto community stroke services. When back at home the hidden effects of stroke like fatigue and changes in mood and cognition become apparent and impact return to work, relationships and everyday activities. Alongside this, managing the risk of recurrence, highest early after an initial stroke, is a priority. People with stroke report feeling abandoned after discharge with unmet information and support needs.

Methods

To address this issue, we reviewed the literature, met with people with stroke and other stakeholders to develop an early, personalised follow-up programme of care for those who currently only receive routine medical follow-up appointments. The design of this complex intervention is informed by the NIHR/MRC framework for complex intervention development and the framework of action described by O'Cathain and colleagues. The intervention is underpinned by self-determination theory. We will be conducting a randomised, mixed methods, single-centre feasibility study to explore the acceptability and feasibility of the intervention. Sixty participants will be recruited from a Hyperacute Stroke Unit and Rapid Assessment Clinic and randomised to the intervention or control group. The intervention group will receive personalised follow-up appointments at two- and six-weeks post-discharge. All participants will have outcome measures taken at baseline and twelve-weeks post-stroke. Patient reported outcomes will be reviewed to assess their suitability for a later definitive trial. Qualitative interviews will be conducted to gain a deeper understanding of life after stroke from those who did and did not receive the intervention.

Conclusions

Study findings will be used to further refine the intervention, methods and outcome measurements used. These refinements will inform a future multicentre randomised controlled trial.

Analysis of Non-Cardiogenic Young Minor Ischemic Stroke Patients' Risk Factors in Chinese Han Population

BACKGROUND Young adults with minor ischemic stroke (MIS) often experience early onset and mild symptoms but face a high recurrence rate. Research into risk factors and etiology of young adult MIS in developing countries is limited. We investigated these aspects in young non-cardiogenic MIS patients from the Chinese Han population and identified risk factors for initial stroke and long-term poor prognosis. MATERIAL AND METHODS Data from MIS patients aged 18 to 50 years and a healthy control group at The First Affiliated Hospital of Anhui Medical University and The Third People's Hospital of Hefei City from January 2019 to July 2023 were analyzed. Risk factors and stroke etiology were compared. ROC curves assessed the predictive ability of original and modified Essen Stroke Risk Scores (ESRS). RESULTS Among 155 patients, 25 (16.1%) experienced recurrence within a year. Patients with MIS differed significantly from the control group in sex, hypertension history, diabetes, dyslipidemia, smoking, higher biomarkers (SBP, TG, VLDL-C, hs-CRP, WBC, RBC, NEUT, HB), and lower HDL-C. Univariate analysis found dyslipidemia, moderate to severe vascular stenosis, resting heart rate, and modified ESRS scores linked to recurrence. Multivariate analysis identified dyslipidemia, vascular stenosis, and resting heart rate as key risk factors. Large artery atherosclerosis was the most common stroke etiology (59.2%). ROC curves revealed areas under the curve for ESRS, modified ESRS-1, and modified ESRS-2 as 0.550, 0.660, and 0.937, respectively. CONCLUSIONS MIS was associated with a high recurrence rate and specific risk factors. Improved ESRS effectively predicted stroke recurrence within 1 year, with large artery atherosclerosis being the predominant etiology.

Role of the gut microbiota in complications after ischemic stroke

Ischemic stroke (IS) is a serious central nervous system disease. Post-IS complications, such as post-stroke cognitive impairment (PSCI), post-stroke depression (PSD), hemorrhagic transformation (HT), gastrointestinal dysfunction, cardiovascular events, and post-stroke infection (PSI), result in neurological deficits. The microbiota-gut-brain axis (MGBA) facilitates bidirectional signal transduction and communication between the intestines and the brain. Recent studies have reported alterations in gut microbiota diversity post-IS, suggesting the involvement of gut microbiota in post-IS complications through various mechanisms such as bacterial translocation, immune regulation, and production of gut bacterial metabolites, thereby affecting disease prognosis. In this review, to provide insights into the prevention and treatment of post-IS complications and improvement of the long-term prognosis of IS, we summarize the interaction between the gut microbiota and IS, along with the effects of the gut microbiota on post-IS complications.