No abstract

Our study demonstrated that substantial hematoma retraction and perihematoma hypodensity occurs in ICH in the absence of any new bleeding or biological activity of surrounding brain. Such observations suggest that active bleeding is underestimated in patients with no or small hematoma expansion and our understanding of perihematoma hypodensity needs to be reconsidered.

INTRODUCTION: Vitamin D deficiency might be involved in the development of several diseases including hypertension, diabetes mellitus and cardiovascular disease. An inverse association between 25(OH) D levels and stroke was also emphasized in recent studies. Objective: To determine the rate of vitamin D deficiency among stroke survivors and risk of associated osteoporosis in a nationally representative population. Methods: Participants from the National Health and Nutritional Examination Survey (NHANES) from 2001 through 2006 were included. Serum 25(OH) D levels were measured using the DiaSorin RIA kit (Stillwater MN) and history of previous stroke and osteoporosis was ascertained by standard interview. Stroke survivors were then divided into 2 groups depending on serum 25(OH) D levels: <30ng/dL as vitamin D deficiency and ≥30ng/dL as normal. Comparisons of demographics and risk factors between two groups were performed using the SAS software. Multivariate analysis was performed to determine the association between vitamin D deficiency and osteoporosis in stroke survivors after adjusting for potential confounding factors. Results: There were 415 (4.0%) stroke survivors among the total 10,255 participants in NHANES. The mean age [±SD] of stroke survivors was 67.56 [±17.3] years and 211 (50.8%) were men. Mean 25(OH) D concentrations were found to be not significantly different in patients with stroke (20.35 versus 21.82ng/mL, p=0.657) although the rate of osteoporosis was significantly higher among stroke survivors (17.92% versus 6.99%, p<0.0001). Out of 415 stroke patients, vitamin D deficiency was seen in 71.0% of the patients (mean concentration of 17.3±6.4ng/dL) and was normal in 29.0% patients (mean concentration of 34.6±5.3ng/dL). The rates of osteoporosis were similar between patients with or without Vitamin D deficiency. After adjusting for potential confounders, there was no association between vitamin D deficiency and osteoporosis. Conclusion: Vitamin D deficiency and osteoporosis are highly prevalent among stroke survivors, however, there does not appear to be a relationship between the two entities.

No abstract

The effects of acute systolic blood pressure levels achieved with continuous intravenous administration of nicardipine for Japanese patients with acute intracerebral hemorrhage on clinical outcomes were determined. A systematic review and individual participant data analysis of articles were performed based on prospective studies involving adults developing hyperacute intracerebral hemorrhage who were treated with intravenous nicardipine. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4–6, and hematoma expansion, defined as an increase 6 mL or more from baseline to 24 h computed tomography. Of the total 499 Japanese patients (age 64.9 ± 11.8 years, 183 women, initial BP 203.5 ± 18.3/109.1 ± 17.2 mmHg) studied, death or disability occurred in 35.6%, and hematoma expansion occurred in 15.6%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio 1.25, 95% confidence interval 1.03–1.52 per 10 mmHg) and hematoma expansion (1.49, 1.18–1.87). These odds ratios were relatively high as compared to the reported ones for overall global patients of this individual participant data analysis [1.12 (95% confidence interval 1.00–1.26) and 1.16 (1.02–1.32), respectively]. In conclusion, lower levels of systolic blood pressure by continuous intravenous nicardipine were associated with lower risks of hematoma expansion and 90-day death or disability in Japanese patients with hyperacute intracerebral hemorrhage. The impact of systolic blood pressure lowering on better outcome seemed to be stronger in Japanese patients than the global ones.

No abstract

No abstract

Background and Purpose: Asian Indians are one of the largest groups of Asians living in the United States. Due to a paucity of data, we performed this study to better characterize the stroke mortality and risk factors among Asian Indians in the United States. Methods: Analysis of the U.S. multiple-cause-of-death files for 2004 to 2009 and National Health and Interview Survey (2004-2005 and 2009-2010) were analyzed. Age-adjusted fatal stroke incidence, stroke rate ratio with 95% confidence interval (CI), and average annual percentage change over 5 years were also calculated. Results: The annual incidence of fatal strokes was lowest among Asian Indians (194 per 100,000) followed by American Indians and Alaska Natives (207 per 100,000), Whites (282 per 100,000) and African Americans (362 per 100,000). Compared with Whites, the stroke rate ratio was 0.7(95% CI 0.5-0.8) for Asian Indians. Significantly lower rates of hypertension and cigarette smoking among Asian Indians in 2004-2005 (compared with whites) explained the lower rates of fatal stroke. The average annual percentage change over 5 years was 12.2%, -0.6%, -2.6%, and -2.6% Asian Indians, American Indians and Alaska Natives, Whites, and African Americans, respectively. The increase in stroke mortality among Asian Indians was observed despite lower rates of hypertension and cigarette smoking in 2009-2010. Conclusions: The paradoxical increase in stroke mortality among Asian Indians over the last 5 years (in contrast to other population subsets) is concerning. A better understanding of the predisposing factors for the observed increase is required through targeted efforts.