Search

Background Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke.Patients and methods In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment.Results One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R2: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02).Conclusions Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.

BackgroundMechanical thrombectomy (MT) rates for the treatment of acute ischaemic stroke due to large vessel occlusion are steadily increasing, but are delivered in heterogenic settings. We aim to investigate effects of procedural load in centers with established MT-structures by comparing high- vs. low-volume centers with regard to procedural characteristics and functional outcomes.MethodsData from 5,379 patients enrolled in the German Stroke Registry Endovascular Treatment (GSR-ET) between June 2015 and December 2019 were compared between three groups: high volume: ≥180 MTs/year, 2,342 patients; medium volume: 135–179 MTs/year, 2,202 patients; low volume:

Objective: Motor recovery after stroke shows a high inter-subject variability. The brain's potential to form new connections determines individual levels of recovery of motor function. Most of our daily activities require visuomotor integration, which engages parietal areas. Compared to the frontal motor system, less is known about the parietal motor system's reconfiguration related to stroke recovery. Here, we tested if functional connectivity among parietal and frontal motor areas undergoes plastic changes after stroke and assessed the behavioral relevance for motor function after stroke. Methods: We investigated stroke lesion-induced changes in functional connectivity by measuring high-density electroencephalography (EEG) and assessing task-related changes in coherence during a visually guided grip task with the paretic hand in 30 chronic stroke patients with variable motor deficits and 19 healthy control subjects. Quantitative changes in task-related coherence in sensorimotor rhythms were compared to the residual motor deficit. Results: Parietofrontal coupling was significantly stronger in patients compared to controls. Whereas motor network coupling generally increased during the task in both groups, the task-related coherence between the parietal and primary motor cortex in the stroke lesioned hemisphere showed increased connectivity across a broad range of sensorimotor rhythms. Particularly the parietofrontal task-induced coupling pattern was significantly and positively related to residual impairment in the Nine-Hole Peg Test performance and grip force. Interpretation: These results demonstrate that parietofrontal motor system integration during visually guided movements is stronger in the stroke-lesioned brain. The correlation with the residual motor deficit could either indicate an unspecific marker of motor network damage or it might indicate that upregulated parietofrontal connectivity has some impact on post-stroke motor function. Keywords: EEG, Coherence, Motor recovery, Stroke, Parietal lobe

Zusammenfassung  Die multiparametrische MRT mit Diffusions- und Perfusionsbildgebung gibt in einem Untersuchungsgang Informationen über das Ausmaß des bereits ischämisch geschädigten Gewebes, die Größe des kritisch minderperfundierten Areals und den Gefäßstatus. Über das Perfusions-Diffusions-Mismatch lässt sich vom Untergang bedrohtes Gewebe identifizieren, das auch noch nach 3 h nach Symptombeginn durch eine erfolgreiche Reperfusionstherapie gerettet werden kann. Neuere Studien zum Mismatch-Konzept haben gezeigt, dass Reperfusion eine entscheidende Bedingung für ein gutes Ergebnis nach einer Thrombolyse darstellt. Große Fallserien und nichtrandomisierte Kohortenstudien ergaben, dass bei mittels Perfusions-Diffusions-Mismatch ausgewählten Patienten eine intravenöse Thrombolyse jenseits des 3-Stunden-Zeitfensters sicher und effektiv durchgeführt werden kann; randomisierte kontrollierte Studien zur Effektivität der Mismatch-basierten Thrombolyse jenseits des 3-Stunden-Zeitfensters existieren allerdings bisher nicht. Bis eine solche Studie durchgeführt wird, kann in erfahrenen Zentren auch nach 3 h nach Symptombeginn eine Thrombolyse nach individueller Risikoabwägung anhand moderner Bildgebungsbefunde durchgeführt werden. [ABSTRACT FROM AUTHOR]

Summary Space-occupying middle cerebral artery (MCA) infarction is characterized by massive brain edema associated with deterioration of consciousness. Progressive brainstem function occurs finally leading to death as a result of transtentorial herniation. We analyzed whether acute stroke MRI with perfusion weighted imaging (PWI), diffusion weighted imaging (DWI) and MR angiography (MRA) allows the prediction of space-occupying MCA stroke in patients with proximal brain vessel occlusion (MCA main stem, carotid-T). Thirty-seven patients with acute MCA stroke and proximal vessel occlusion were studied by PWI, DWI and MRA within 6 hours of symptom onset. Eleven patients developed space-occupying MCA infarction. The DWI lesion was defined by a reduction of the apparent diffusion coefficient (ADC) of less than 80% (ADC <80%) compared with the unaffected hemisphere. The PWI lesion was defined as a time to peak (TTP) delay of more than 4 seconds (TTP >+4 s), respectively. Neurological deficit was assessed using the National Institutes of Health Stroke Scale (NIHSS). Outcome was assessed 90 days after stroke with the Barthel Index (BI) and the modified Rankin Scale (MRS).Patients with space-occupying MCA infarction showed larger diffusion- and perfusion lesion volumes (median ADC <80%: 157 vs 22 ml, p<0.001; TTP >+4 s: 208 vs 125 ml), a higher frequency of carotid-T occlusion (64 vs 15%, p=0.006) and higher NIHSS scores at admission (20 vs 15, p=0.001). Clinical outcome was worse in patients with space-occupying MCA infarction (MRS: 4 vs 1, p<0.001; BI: 13 vs 100, p=0.001). The following parameters served as predictors of space-occupying MCA infarction (sensitivity, specificity): ADC <80% >82 ml (87%, 91%), TTP >+4 s >162 ml (83%, 75%), NIHSS score at admission =19 (96%, 72%).Stroke MRI with the combination of PWI, DWI and MRA allows the prediction of space-occupying MCA stroke within the 6-hour time window and can help select patients for aggressive and potentially life-saving therapies such as decompressive hemicraniectomy. [ABSTRACT FROM AUTHOR]