The Clinton Herald, Clinton, Iowa

February 20, 2014

Head, neck injuries may increase stroke risk

American Heart Association
The Clinton Herald

---- — Suffering an injury to the head or neck increases ischemic stroke risk three-fold among trauma patients younger than 50, according to research presented at the American Stroke Association’s International Stroke Conference 2014.

“These findings are important because strokes after trauma might be preventable,” said Christine Fox, M.D., M.A.S., lead author and assistant professor of neurology at the University of California San Francisco.

Researchers studied the health records of 1.3 million patients younger than 50 years who had been treated in emergency trauma rooms. About 11 of every 100,000 patients (145) suffered a stroke within four weeks. Since 2 million patients are seen in U.S. trauma rooms each month, this suggests 214 young people a month have an ischemic stroke after a trauma.

Researchers also noted that:

n About 48 in 100,000 young adults and 11 of 100,000 children who had a head or neck injury had a stroke.

n Patients with stroke were an average 37 years old, while those who didn’t have a stroke were an average 24.

n One cause of stroke after trauma is a tear in the head or neck blood vessels that lead to the brain, which can be a source of blood clots that cause a stroke. If a tear in these arteries can be diagnosed at the time of the trauma, a patient could be treated with an anti-clotting medicine to help prevent stroke. In the study, 10 percent of the people who had a stroke were diagnosed with this kind of tear, but not all the patients were diagnosed with it prior to stroke.

The incidence rate of stroke among trauma patients found in this study was determined using a fairly broad definition of trauma. One of the next steps in the study will be to measure stroke incidence after different types of trauma (such as car collisions) and injuries (such as vertebral fractures) in order to determine who might be at higher stroke risk, Fox said.

Stroke emergency mobile increases timely delivery of clot-bustingtreatment in Germany

Pre-hospital administration of clot busting treatment in a specialized stroke emergency mobile made it 10 times more likely than in conventional care that patients received clot-busting medication within 60 minutes of stroke onset, according to research presented at the American Stroke Association’s International Stroke Conference 2014.

The study compared weeks of ambulance calls made by a stroke emergency mobile unit, equipped with a computed tomography scanner and staffed with a neurologist trained in emergency medicine, paramedic and technician, to weeks of calls with a conventional ambulance.

Among the findings:

n Patients who received clot-busting treatment within 60 minutes were nearly two times more likely to be discharged home, compared to patients who were treated later.

n Treatment started within the first hour of stroke onset or in the stroke emergency mobile did not result in any higher risk of death in the first week and first three months after treatment.

Stroke linked to immediate,persistent declines in mental ability

Stroke is associated with notable declines in mental ability that tend to last for years, according to research presented at the American Stroke Association’s International Stroke Conference 2014.

Researchers studied the mental abilities of nearly 12,000 people ages 45 to 84. They followed the participants for six to 10 years, assessing their mental functioning every 18-24 months with two tests. One test measured memory; the other, their ability to organize and prioritize thoughts and information (also known as executive function).

There were 127 individuals who had an acute stroke and tests of mental ability before and after the event.

The researchers found:

n Stroke was associated with a significant decrease in memory at the time of the event.

n Executive function declined significantly faster after a stroke than it did before a stroke.

n In the years following a stroke, the changes in memory were similar to those over time before a stroke, but these findings require more research.

These findings suggest that acute stroke contributes to problems with mental ability, namely memory and executive function that can persist years after the event.

Stroke patients’ hand functionimproves when targeted brainstimulation added to therapy

Stroke patients receiving a combination of navigated brain stimulation and occupational therapy recovered more than twice the arm and hand movement six months after their strokes, compared to patients who received therapy alone.

Researchers presented the findings at the American Stroke Association’s International Stroke Conference 2014.

The stimulation noninvasively stimulates the non-injured brain hemisphere in stroke patients to help prevent the non-injured part of the brain from inhibiting the hemisphere injured from stroke. This is thought to allow the injured brain to become more active during occupational therapy treatment, making rehabilitation more effective.

Researchers studied 30 stroke patients with hand weakness on one side months after their strokes. Patients were randomly selected to receive either navigated brain stimulation or sham stimulation for 20 minutes before going to 1.5 hours of arm and hand therapy. Researchers measured the patients’ arm and hand movement and hand dexterity after six weeks of therapy. Those with the stimulation had twice the improvement in arm and hand movement and were more likely to maintain significant improvements at six months.

While both groups improved in control of arm and hand movement over time, 80 percent of patients in the navigated brain stimulation group maintained functional improvement noticeable in everyday life six months after treatment compared to only 50 percent in the sham group.

Since notable improvements from the stimulation therapy can be seen six months after the therapy, non-invasive brain stimulation could offer stroke patients long-lasting functional benefit when added to standard occupational therapy, researchers said.

Stroke survivors often return to driving without being evaluated for ability

Stroke survivors often resume driving without being formally evaluated for ability — though stroke can cause deficits that can impair driving, according to research presented at the American Stroke Association’s International Stroke Conference 2014.

Researchers surveyed 162 stroke survivors a year after their strokes and found:

n More than 51 percent returned to driving — many a month after suffering a stroke.

n Only 5.6 percent received a formal driving evaluation.

n Eleven percent of those who returned to driving reported their strokes had greatly impacted their abilities to perform important life activities.

n Among those who returned to driving and reported no effect on their abilities to perform important life activities, more than 45 percent limited their driving.

Researchers suggest stroke survivors may benefit from formal evaluation before resuming driving.