Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, February 24, 2022

White matter hyperintensities increase long-term risk for ischemic stroke, death

My doctor told me I had a bunch of white matter hyperintensities but never showed me them on any scan, so I don't know the size, location or any intervention needed, because my doctor knew nothing and did nothing. 16 years and no further strokes or death.

 

White matter hyperintensities increase long-term risk for ischemic stroke, death

White matter hyperintensity volume, type and shape correlated with an increased risk for mortality and ischemic stroke among patients with manifest arterial disease, according to findings from the SMART-MR study published in Neurology.

“The relationship between advanced white matter hyperintensity markers and long-term clinical outcomes ... is not clear. Examining this relationship is of importance as [white matter hyperintensity] markers may aid in future patient selection for preventive treatment to ameliorate the risk [for cerebral small vessel disease]-related death and ischemic stroke,” Rashid Ghaznawi, MD, MSc, researcher in the department of radiology at University Medical Center Utrecht and Utrecht University, and colleagues wrote.

For this reason, Ghaznawi and colleagues sought to assess whether a relationship existed between volume, type and shape of white matter hyperintensities found on baseline MRI and long-term risk for mortality and ischemic stroke among 999 patients (median age, 59 years; 79% men) with manifest arterial disease. Most (78%) had periventricular white matter hyperintensities and 22% had confluent white matter hyperintensities.

The researchers reported results over a median follow-up period of 12.5 years, at which time 274 patients died and 75 patients experienced an ischemic stroke.

After adjusting for demographics, cardiovascular risk factors and cerebrovascular disease, Ghaznawi and colleagues found that greater periventricular or confluent white matter hyperintensity volume was independently associated with an increased risk for vascular death (HR = 1.29; 95% CI, 1.13-1.47 per 1 unit increase in natural log-transformed white matter hyperintensity volume) and ischemic stroke (HR = 1.53; 95% CI, 1.26-1.86).

They additionally observed an independent association between confluent white matter hyperintensity type and an increased risk for both vascular (HR = 2.05; 95% CI, 1.2-3.48) and nonvascular death (HR = 1.65; 95% CI, 1.01-2.73) as well as ischemic stroke (HR = 4.01; 95% CI, 1.72-9.35). Patients with a more irregular shape of periventricular or confluent white matter hyperintensity, as expressed by an increase in concavity index, were also at increased risk for vascular (HR = 1.20; 95% CI, 1.05-1.38 per standard deviation increase) and nonvascular death (HR = 1.21; 95% CI, 1.03-1.42) as well as ischemic stroke (HR = 1.28; 95% CI, 1.05-1.55).

“These findings suggest that white matter hyperintensity markers on MRI may be useful in determining [a] patient’s prognosis and may aid in future patient selection for preventive treatment,” the researchers wrote.

The study by Ghaznawi and colleagues “is an important addition to the literature in this field as it focuses not only on the absolute volume of [white matter hyperintensity], but on identifying additional geometric and topographic features which may convey an increased risk of stroke and death,” according to an editorial accompanying the study by Nawaf Yassi, PhD, and Bruce C.V. Campbell, PhD, both researchers in the department of medicine and neurology at Melbourne Brain Center at The Royal Melbourne Hospital in Australia.

“The study ... also builds upon a large and ever-growing body of literature confirming associations between imaging markers of cerebrovascular disease (including specifically [white matter hyperintensity] and adverse health outcomes,” they wrote. “However, the field is also in need of therapeutic strategies to attenuate the potential risk of [white matter hyperintensity] lesions on health outcomes in those predicted to be at the highest risk. To our knowledge, there are as yet no prospective randomized clinical trial data to support any specific interventions in patients selected based on the presence of significant white matter hyperintensity burden (notwithstanding that an agreed threshold is yet to be defined).”

 

No comments:

Post a Comment