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Gastrointestinal complications after ischemic stroke. Camara-Lemarroy Carlos R,Ibarra-Yruegas Beatriz E,Gongora-Rivera Fernando Journal of the neurological sciences Ischemic stroke is an important cause of morbidity and mortality, and currently the leading cause of adult disability in developed countries. Stroke is associated with various non-neurological medical complications, including infections and thrombosis. Gastrointestinal complications after stroke are also common, with over half of all stroke patients presenting with dysphagia, constipation, fecal incontinence or gastrointestinal bleeding. These complications are associated with increased hospital length of stay, the development of further complications and even increased mortality. In this article we review the epidemiology, pathophysiology, diagnosis, management and prevention of the most common gastrointestinal complications associated with ischemic stroke. 10.1016/j.jns.2014.08.027
Prognostic value of lipoprotein-associated phospholipase A mass for all-cause mortality and vascular events within one year after acute ischemic stroke. Han Liyuan,Zhong Chongke,Bu Xiaoqing,Xu Tan,Wang Aili,Peng Yanbo,Xu Tian,Wang Jinchao,Peng Hao,Li Qunwei,Ju Zhong,Geng Deqing,Zhang Yonghong,He Jiang, Atherosclerosis BACKGROUND AND AIMS:We performed a prospective investigation of the longer-term prognostic value of lipoprotein-associated phospholipase A (Lp-PLA) mass for all-cause mortality and vascular events within one year after acute ischemic stroke. METHODS:We examined the Lp-PLA mass among 3401 participants enrolled in the China Antihypertensive Trial in Acute Ischemic Stroke. The primary outcome was all-cause mortality. Cox proportional hazard ratios (HRs) and 95% confidence intervals (95% CIs) were constructed to assess the independent associations between the baseline Lp-PLA mass and the outcomes after adjustment for variables in models 1, 2, and 3 [further adjusted for low-density lipoprotein cholesterol (LDL-C)]. RESULTS:Overall, 3278 patients completed the follow-up, during which, 188 all-cause death events occurred. The Kaplan-Meier survival curve showed that the cumulative incidence rate of all-cause mortality increased across quartiles of Lp-PLA mass (log-rank p = 0.018). Compared with the lowest quartile of Lp-PLA, the HRs (95% CIs) for the highest quartile of Lp-PLA were 1.89 (1.22-2.91), 2.16 (1.31-3.55), and 2.17 (1.32-3.58) for all-cause mortality after adjusting for the covariables in models 1, 2, and 3, respectively. In addition, patients in the highest quartile of Lp-PLA mass coupled with higher LDL-C had significantly highest risk of all-cause mortality (HR, 1.81; 95% CI, 1.05 to 3.11; p = 0.032). CONCLUSIONS:The elevated Lp-PLA mass was associated with all cause-death independently of other risk factors within one year after acute ischemic stroke. 10.1016/j.atherosclerosis.2017.09.013
Outcomes after stroke: risk of recurrent ischemic stroke and other events. Elkind Mitchell S V The American journal of medicine Stroke is a common and debilitating disease, and much is known about the incidence and risk factors for first stroke. Much less is known, however, about outcomes after stroke. The epidemiology of outcomes after stroke has been relatively less studied for several reasons, including the traditional study of populations in which rates of cardiac disease are higher than those of stroke, the heterogeneity of stroke, and the absence until recently of effective therapies. The importance of recurrent stroke, cardiac events, dementia, depression, and other vascular and nonvascular events will increase as the population ages and as more patients survive a first stroke. This article discusses the relative importance of recurrent stroke and other events after initial ischemic stroke or transient ischemic attack, and proven and potential risk factors for recurrent stroke. Based on growing evidence regarding the high rates of cardiovascular events after stroke, and the efficacy of statin therapy in reducing the risk of stroke as well as cardiac disease, it may be time to consider expanding the "coronary risk equivalent" category to include patients with stroke. Patients who have had a stroke are likely at high enough risk for subsequent events to warrant the same aggressive treatment, including statins and antihypertensive drugs, as would be given to patients with other forms of cardiovascular disease. Future clinical trials will better define the optimal management of patients after stroke. 10.1016/j.amjmed.2009.02.005