Spinal cord injury (SCI) is a life-shattering neurological condition that affects between 250,000 and 500,000 individuals each year with an estimated two to three million people worldwide living with an SCI-related disability. The incidence in the USA and Canada is more than that in other countries with motor vehicle accidents being the most common cause, while violence being most common in the developing nations. Its incidence is two- to fivefold higher in males, with a peak in younger adults. Apart from the economic burden associated with medical care costs, SCI predominantly affects a younger adult population. Therefore, the psychological impact of adaptation of an average healthy individual as a paraplegic or quadriplegic with bladder, bowel, or sexual dysfunction in their early life can be devastating. People with SCI are two to five times more likely to die prematurely, with worse survival rates in low- and middle-income countries. This devastating disorder has a complex and multifaceted mechanism. Recently, a lot of research has been published on the restoration of locomotor activity and the therapeutic strategies. Therefore, it is imperative for the treating physicians to understand the complex underlying pathophysiological mechanisms of SCI.
Background: Delayed cerebral ischemia (DCI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH). Though many clinical trials have looked at therapies for DCI and vasospasm in aSAH, along with reducing rebleeding risks, none have led to improving outcomes in this patient population. We present an up-to-date review of the pathophysiology of DCI and its association with early brain injury (EBI). Recent Findings: Recent studies have demonstrated that EBI, as opposed to delayed brain injury, is the main contributor to downstream pathophysiological mechanisms that play a role in the development of DCI. New predictive models, including advanced monitoring and neuroimaging techniques, can help detect EBI and improve the clinical management of aSAH patients. Summary: EBI, the severity of subarachnoid hemorrhage, and physiological/imaging markers can serve as indicators for potential early therapeutics in aSAH. The microcellular milieu and hemodynamic pathomechanisms should remain a focus of researchers and clinicians. With the advancement in understanding the pathophysiology of DCI, we are hopeful that we will make strides toward better outcomes for this unique patient population.
Introduction: Prior epidemiological studies have reported ethnic differences in cerebrovascular risk factors. There is a paucity in the literature detailing the burden of these risk factors in the Native American population. We aim to elucidate the risk factor prevalence in the Native Americans with IS. Methods: Data were extracted from the Cerner electronic health record database which is a nationwide database of about 700 hospitals across the United States. We retrospectively identified IS patients encompassing all ages who were of Native American ethnicity during the years 2000-2016. Demographic parameters and cerebrovascular risk factors were collected. Results: Of the 5540 patients belonging to Native American ethnicity diagnosed with stroke from 2000 to 2016, 4729 had IS. Of these patients, 2175 (46%) were male, 3145 (66.6%) had a diagnosis of hypertension (HTN), 1834 (38.8%) had diabetes mellitus (DM), 1102 (23.4%) had coronary artery disease (CAD), 1020 (21.6%) were smokers, 583 (12.3%) had heart failure (HF), 495 (10.5%) had atrial fibrillation, and 65 (1.4%) had a diagnosis of atrial flutter. Trends in risk factors over time were analyzed using logistic regression model adjusted for age and gender, with year range of subgroup as the independent variable. Except for DM all other cerebrovascular risk factors including HF (p=0.02), HTN (p<0.001), CAD (p<0.015), atrial fibrillation (p<0.006), atrial flutter (p=0.01), and smoking (p<0.001) showed a statistically significant increasing prevalence during the years 2000 to 2016. Conclusion: We recognized increasing prevalence of cerebrovascular risk factors in Native American patients with ischemic stroke. These results highlight the importance of stroke prevention aimed at the Native American population by targeting individual cerebrovascular risk factors.
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