The Virtual Physiological Human (VPH) initiative

With this in place your competent? doctor could see which sequelae might result from your stroke and prevent those problems. At least if your doctor had any brains at all! Does s/he? 12 years to get up-to-date!

The Virtual Physiological Human (VPH) initiative

The Virtual Physiological Human (VPH) initiative is a worldwide effort to develop next-generation computer technologies to integrate all information available for each patient, and generated computer models capable of predicting how the health of that patient will evolve under certain conditions.

In this video Professor Professor Marco Viceconti provides an overview of the Virtual Physiological Human (VPH) initiative to the audience at TEDxSheffield 2012.

Marco Viceconti

Marco Viceconti is one of the key figures in the emerging Virtual Physiological Human (VPH) community. Co-author of the first white paper on VPH, scientific co-ordinator of the seminal VPH research roadmap, “VPH ambassador” for the VPH Network of Excellence, Co-ordinator of one the VPHOP integrated projects, he is also currently chairing the Board of Directors of the VPH Institute.

Marco Viceconti is full Professor of Biomechanics at the Department of Mechanical Engineering and Scientific Director of the Insigneo Institute at the University of Sheffield.

His main research interests are related to the development and validation of medical technology, especially that involving simulation, and primarily in relation to musculoskeletal diseases. He has published over 200 papers, mostly indexed in Medline, and serves as reviewer for many international funding agencies and peer-reviewed journals.

Low Prevalence of Stroke in Patients With COVID-19

I think this is diminishing the problems from COVID-19 too much. Your doctor better not rely on this in not preventing all sequelae from COVID-19. I'd be more worried about this research showing problems. YOUR DOCTOR'S RESPONSIBILITY to prevent any problems.

A third of COVID-19 survivors are diagnosed with conditions like stroke, dementia, and psychosis

The latest here:

Low Prevalence of Stroke in Patients With COVID-19

A review of nearly 28,000 emergency department records shows less than 2% of patients diagnosed with coronavirus disease 2019 (COVID-19) suffered an ischaemic stroke, but those who did had an increased risk of requiring long-term care after hospital discharge.

The findings are published in the journal Stroke.

Adnan I. Qureshi, MD, University of Missouri Institute for Data Science and Informatics, Columbia, Missouri, and colleagues found that, among 8,163 patients with COVID-19, 103 (1.3%) developed ischaemic stroke, compared with 199 (1.0%) of 19,513 patients who didn’t have COVID-19.

“Patients with COVID-19 who developed acute ischaemic stroke were older, more likely to be black, and had a higher frequency of cardiovascular risk factors,” said Dr. Qureshi, MD.

The mean age of patients with COVID-19 who experienced a stroke was 68.8 years compared with 54.4 years for those who did not experience a stroke. Among those with COVID-19 and stroke, 45% were Black, 36% were white, and 6% were Hispanic. These patients also tended to have higher rates of hypertension (84%), triglycerides, (75%) and diabetes (56%).

“We also found that patients with COVID-19 with stroke had a significantly higher rate of discharge to a destination other than home compared to stroke patients without COVID-19,” said Dr. Qureshi. “Patients with COVID-19 tend to have multisystem involvement and elevated markers of inflammation, which have been shown to increase the rate of death or disability.”

He noted that the findings are somewhat different from earlier studies that suggested patients with COVID-19 who developed stroke were younger and did not have pre-existing cardiovascular risk factors.

“Even if COVID-19 was a predisposing factor, the risk was mainly seen in those who were already at risk for stroke due to other cardiovascular risk factors,” said Dr. Qureshi.

Reference: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.031786

SOURCE: University of Missouri-Columbia

Quantitative Lesion Water Uptake in Acute Stroke Computed Tomography Is a Predictor of Malignant Infarction

I had never heard of this problem before. I would expect a public database of all sequelae from stroke and the protocols necessary to treat them. This hiding of stroke interventions needs to stop. We should know the exact percentage of cases that have this and the morbidity rate from them. Only by quantifying the problem will anyone ever try to solve it.

Quantitative Lesion Water Uptake in Acute Stroke Computed Tomography Is a Predictor of Malignant Infarction

Gabriel Broocks, Fabian Flottmann, Alexandra Scheibel, Annette Aigner, Tobias D. Faizy, Uta Hanning, Hannes Leischner, Sabine I. Broocks, Jens Fiehler, Susanne Gellissen, Andre Kemmling

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https://doi.org/10.1161/STROKEAHA.118.020507

Stroke. 2018;STROKEAHA.118.020507

Originally published July 5, 2018

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Abstract

Background and Purpose—Early selection of patients with acute middle cerebral artery infarction at risk for malignant edema is critical to initiate timely decompressive surgery. Net water uptake (NWU) per brain volume is a quantitative imaging biomarker of space-occupying ischemic edema which can be measured in computed tomography. We hypothesize that NWU in early infarct lesions can predict development of malignant edema. The aim was to compare NWU in acute brain infarct against other common predictors of malignant edema.

Methods—After consecutive screening of single-center registry data, 153 patients with acute proximal middle cerebral artery occlusion fulfilled the inclusion criteria. A total of 29 (18.2%) patients developed malignant edema defined as end point in follow-up imaging leading to decompressive surgery and death as a direct implication of mass effect. Early infarct lesion volume and NWU were quantified in multimodal admission computed tomography; time from symptom onset to admission imaging was recorded.

Results—Mean time from onset to admission imaging was equivalent between patients with and without malignant infarcts (mean±SD: 3.3±1.4 hours and 3.3±1.7 hours, respectively). Edematous tissue expansion by NWU within infarct lesions occurred across all patients in this cohort (NWU: 9.1%±6.8%; median, 7.9%; interquartile range, 8.8%; range, 0.1%–35.6%); 7.0% (±5.2) in nonmalignant and 18.0% (±5.7) in malignant infarcts. Based on univariate receiver operating characteristic curve analysis, NWU >12.7% or an edema rate >3.7% NWU/h identified malignant infarcts with high discriminative power (area under curve, 0.93±0.02). In multivariate binary logistic regression, the probability of malignant infarct was significantly associated with early infarct volume and NWU.

Conclusions—Computed tomography–based quantitative NWU in early infarct lesions is an important surrogate marker for developing malignant edema. Besides volume of early infarct, the measurements of lesion water uptake may further support identifying patients at risk for malignant infarction.

High Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Pneumonia

Hopefully your doctor has protocols for testing all the possible sequelae from a stroke. Then s/he needs rehab protocols for all the sequelae. But there will be none, you are completely on your own to figure out how to recover.  Your doctor won't tell you that but it is true.

High Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Pneumonia

Ki-Woong Nam, Tae Jung Kim, Ji Sung Lee, Hyung-Min Kwon, Yong-Seok Lee, Sang-Bae Ko, Byung-Woo Yoon

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https://doi.org/10.1161/STROKEAHA.118.021228

Stroke. 2018;STROKEAHA.118.021228

Originally published July 2, 2018

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• Supplemental Materials
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Abstract

Background and Purpose—Although there are a variety of risk factors and predictive models for stroke-associated pneumonia (SAP), more objective and easily accessible markers are still needed. In this study, we evaluated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and SAP in patients with acute ischemic stroke.

Methods—We assessed 1317 consecutive patients with acute ischemic stroke. SAP was defined according to the modified Centers for Disease Control and Prevention criteria. The severity of pneumonia was rated using scores from the Pneumonia Severity Index, the quick Sequential Organ Failure Assessment, and the Acute Physiology and Chronic Health Evaluation II. The NLR was calculated after dividing absolute neutrophil counts by absolute lymphocyte counts.

Results—Among the total patients, SAP occurred in 112 (9.0%) patients. Using a multivariable analysis, the NLR (adjusted odds ratio=1.55; 95% confidence interval, 1.15–2.11; P=0.005) remained significant after adjusting for confounders. In addition, age, atrial fibrillation, previous stroke history, initial National Institutes of Health Stroke Scale score, and high-sensitivity C-reactive protein were also significant, independent of NLR. The NLR was higher in the severe pneumonia group when it was assessed by Pneumonia Severity Index (P<0.001), and Acute Physiology and Chronic Health Evaluation II scores (P=0.004). Furthermore, patients who had SAP had worse clinical outcomes both during hospitalization and after discharge.

Conclusions—We demonstrated that a higher NLR predicted SAP in patients with acute ischemic stroke. The NLR may help to identify high-risk patients in time and provide clues for further studies about preventive antibiotic therapy.

infection

inflammation

lymphocyte

neutrophils

pneumonia

prognosis

• Received February 15, 2018.
• Revision received

May 22, 2018.

Accepted

May 31, 2018.

• © 2018 American Heart Association, Inc.

Study: 2.6% of pediatric patients hospitalized for stroke die in the hospital

So figure out the EXACT reason for the death and get researchers to solve for that problem. Stroke is not the reason for the death, EXACTLY which brain cells died causing the sequelae to end in death? Since we have NO stroke leaders, everyone in stroke will just throw up their hands and say, 'Oh my, something needs to be done'. Leaders solve problems, they don't 

RUN AWAY!

and ignore them. Is anyone in your hospital a leader? Or are they all CHICKENSHITS?
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'. 
Politeness will never solve anything in stroke.
Study: 2.6% of pediatric patients hospitalized for stroke die in the hospital

A major international study has found that 2.6 percent of infants and children hospitalized for stroke die in the hospital.

Loyola Medicine neurologist José Biller, MD, a nationally known expert on strokes in children, is among the co-authors of the study, published in the journal Pediatrics. First author is Lauren A. Beslow, MD, of the Children's Hospital of Philadelphia.

The retrospective study included 915 infants younger than one month and 2,273 children aged one month to 18 years who were stroke patients at 87 hospitals in 24 countries. The type of stroke examined in the study, called ischemic, is caused by blood clots and is the most common type.

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The study found that during their hospitalizations for ischemic stroke, 1.5 percent of the infants and 3.1 percent of the children died, with an overall mortality rate of 2.6 percent.

Researchers classified the causes of death as stroke alone, a combination of an underlying disease and stroke or simply an underlying disease. Nearly two-thirds (65 percent) of hospital deaths with a known cause were related to the stroke and/or subsequent deficits.

Risk factors for dying in the hospital included congenital heart disease and having a severe type of ischemic stroke known as "posterior plus anterior circulation."

Hispanic ethnicity also was associated with higher mortality, but black infants and children were not at higher risk of dying. The reason for the higher Hispanic mortality rate is not known. Future studies "should explore whether ethnic differences in mortality rates are related to disparities in care," researchers wrote.

Also at higher risk of dying were infants and children who did not have seizures. The reason may be that infants who present with seizures might be diagnosed and treated more quickly for their strokes, researchers wrote.

Childhood ischemic strokes affect 1.2 to 2.4 per 100,000 children per year in developed countries. Although deaths from ischemic and other types of stroke appear to have declined, stroke remains among the top 10 causes of death among children in the United States.

Researchers wrote that improved stroke recognition, earlier supportive care, more rapid intervention and neuroprotective treatments "are critical for decreasing mortality after stroke in the pediatric population."

Source:

http://www.luhs.org/

Neuropsychiatric sequelae of stroke

This is so dammed easy to explain. Your doctors have no clue how to get you to 100% recovery. In fact they know nothing about stroke recovery at all. Ask them what their prescriptions to OT, PT, and ST say. I bet it says E.T. - Evaluate and Treat. I'd be bummed out also when my supposed experts in stroke know nothing and do nothing. You're screwed if you have a stroke. 

Neuropsychiatric sequelae of stroke

Ferro JM¹, Caeiro L², Figueira ML¹.

Author information

Abstract

Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. About one-third of stroke survivors experience depression, anxiety or apathy, which are the most common neuropsychiatric sequelae of stroke. Neuropsychiatric sequelae are disabling, and can have a negative influence on recovery, reduce quality of life and lead to exhaustion of the caregiver. Despite the availability of screening instruments and effective treatments, neuropsychiatric disturbances attributed to stroke are currently underdiagnosed and undertreated. Stroke severity, stroke-related disabilities, cerebral small vessel disease, previous psychiatric disease, poor coping strategies and unfavourable psychosocial environment influence the presence and severity of the psychiatric sequelae of stroke. Although consistent associations between psychiatric disturbances and specific stroke locations have yet to be confirmed, functional MRI studies are beginning to unveil the anatomical networks that are disrupted in stroke-associated psychiatric disorders. Evidence regarding biochemical and genetic biomarkers for stroke-associated psychiatric disorders is still limited, and better understanding of the biological determinants and pathophysiology of these disorders is needed. Investigation into the management of these conditions must be continued, and should include pilot studies to assess the benefits of innovative behavioural interventions and large-scale cooperative randomized controlled pharmacological trials of drugs that are safe to use in patients with stroke.

PMID:

27063107

[PubMed - in process]

Contracture: understanding mechanisms and testing treatments

One more sequelae about stroke we know nothing about.  Damn, is there anything that our doctors know about treating stroke problems?
From NeuRA Blog is an initiative of Neuroscience Research Australia

The latest here:

Contracture: understanding mechanisms and testing treatments 

NeuRA Blog is an initiative of Neuroscience Research Australia - See more at: http://blog.neura.edu.au/about/#sthash.XtTRZ8p5.dpuf

NeuRA Blog is an initiative of Neuroscience Research Australia - See more at: http://blog.neura.edu.au/about/#sthash.XtTRZ8p5.dpuf

There has been surprisingly little research into the mechanisms of contracture. As a result, the mechanisms are poorly understood. - See more at: http://blog.neura.edu.au/2014/08/18/contracture/?utm_source=rss&utm_medium=rss&utm_campaign=contracture#sthash.eOop3nIO.dpuf

 There has been surprisingly little research into the mechanisms of contracture. As a result, the mechanisms are poorly understood. 

Who the hell is tasked with solving these problems? They've only been around since stroke was known about.
One more thing you as a survivor is going to have to solve or prevent on your own.