Background: Finding an acute brain lesion by diffusion-weighted (DW) MRI upon an episode of transient ischemic attack (TIA) is a predictor of imminent stroke in the near future. Therefore, exploring risk factors associated with lesions in DW-MRI of the brain is important in adopting an approach to TIA management. In the current study, we tried to determine the risk factors associated with lesions in DW-MRI of the brain in patients experiencing TIA episodes.
Methods: Fifty patients with TIA were recruited consecutively in Sina Hospital, Tehran, Iran, over a 6-month period between July 2008 and January 2009. All of the patients underwent a complete neurological examination and laboratory tests. Brain DW-MRIs were performed for all the patients within 72 hours of a TIA episode.
Results: DW-MRI revealed an acute lesion in 16% of the participants. There was a significant correlation between presence of an acute lesion in DW-MRI and TIA duration, history of diabetes mellitus and presence of unilateral facial palsy (P=0.0003, P=0.02 and P=0.008, respectively). Other variables such as age, hypertension, hyperlipidemia, past history of TIA, headache, vertigo, and sensory or visual disturbances had no significant relation with the presence of an acute lesion in DW-MRI.
Conclusion: Duration of TIA, presence of diabetes mellitus and unilateral facial palsy are risk factors for an acute lesion in DW-MRI, meaning that patients with such risk factors are at risk for stroke in the near future.
Results: According to the results, the mean age of the patients was 54.78±11.54 years, 73% of whom were women. The prevalence of depression, anxiety, and stress was high (72.4, 80.3, and 59.5%, respectively). Although the prevalence of depression, anxiety, and stress in patients with a negative report of ischemia was higher and evaluated as 73.2, 78.7, and 58.3% respectively, there was not a significant difference with the subjects whose heart scan results were positive (P>0.05). Moreover, a weak positive correlation was observed between the severity of depression, anxiety, and stress with the severity of cardiac ischemia in study patients.
Conclusion: The results of this study revealed that the depressive, anxiety, and stress symptoms in patients before a cardiac nuclear scan are often moderate to mild. Likewise, among the different demographic characteristics of patients, only gender played an important role in these disorders. Regardless of the negative nuclear scan results in most patients (77.9%), the prevalence of these psychological symptoms in the studied patients was high. Therefore, considering the possibility of psychological disorders with clinical manifestations mimicking cardiovascular can prevent additional costs for diagnostic and therapeutic procedures in these patients. |
Stroke is a medical condition in which occluded blood flow to the brain causes cell necrosis. The main types of stroke are ischemic (due to lack of blood flow with much higher prevalence) and hemorrhagic (due to bleeding with low prevalence). Ischemic stroke is caused by the reduction of blood to the brain tissue or complete occlusion of brain vessels by a blood clot following arterial plaques rapture of cerebral arteries due to atherosclerosis, cerebral myocardial infarction and small vascular lesion infarction. Inflammatory reactions, increased oxidative stress, cell death and autophagy are the most aggravating factors in this condition. Instead, hemorrhagic stroke is caused by spontaneous intracranial hemorrhage and subarachnoid hemorrhage, highly common in men. To prevent the possible causes of stroke, investigators attempted to study about the ways that may decrease the risk factors such as trauma, high arterial hypertension, alcohol, low-density lipoprotein and glycerides, tobacco and drugs. Physical activity is a potent inhibitory factor which reported to be effective in prevention of stroke and post-stroke rehabilitation. Aerobic, combined or strenuous activities protect brain tissue by balancing apoptotic and anti-apoptotic pathways, stimulating angiogenesis, reducing oxidative stress, increasing antioxidant activity, optimizing Integrity and preservation of the blood-brain barrier, improving nerve functions and preventing neuronal death. The mechanisms involved in rehabilitation after ischemic stroke with physical activity mostly refer to improved dendrites and synapses, synaptic flexibility, regulation of inotropic receptors with glutamate, increased BDNF, GAP43 and insulin-like growth factor. In patients with cognitive impairments following acute ischemic stroke, high intensity exercise improves processing timing and attention allocation, self-independence, walking ability, aerobic power and reduces memory degradation. Moreover, early start of physical activity after ischemic stroke inhibits the initial physiological response to stroke and prevents optimal recovery. In contrary, reports show positive effects of onset of physical exercise a day after stroke. In hemorrhagic stroke, exercise reduces systolic blood pressure, moderates resting blood pressure via parasympathetic regulations and triggers angiogenesis in the nervous system. Light to moderate or long-term physical training is recommended in comparison to short-term high-intensity training. In addition, early onset of physical activity during recovery after stroke may be beneficial.
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Results: In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10. Conclusion: The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay. |
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