Risk stratification can contribute to individualised optimal secondary prevention in patients with cerebrovascular disease.
Objective:
To prospectively investigate the prediction of the Essen Stroke Risk Score (ESRS) and a pathological Ankle Brachial Index (ABI) in consecutive patients hospitalised with acute ischaemic stroke or transient ischaemic attack (TIA) in 85 neurological stroke units throughout Germany.
Methods:
852 patients were prospectively documented on standardised case report forms, including assessment of ESRS and ABI. After 17.5 months, recurrent cerebrovascular events, functional outcome or death could be assessed in 729 patients predominantly via central telephone interview.
Results:
After discharge from the documenting hospital, recurrent stroke occurred in 41 patients (5.6%) and recurrent TIA in 15 patients (2.1%). 52 patients (7.1%) had died, 33 (4.5%) from cardiovascular causes. Patients with an ESRS ⩾3 (vs <3) had a significantly higher risk of recurrent stroke or cardiovascular death (9.7% vs 5.1%; odds ratio (OR) 2.00, 95% confidence interval (CI) 1.08 to 3.70) and a higher recurrent stroke risk (6.9% vs 3.7%; OR 1.93, 95% CI 0.95 to 3.94). Patients with an ABI ⩽0.9 (vs >0.9) had a significantly higher risk of recurrent stroke or cardiovascular death (10.4% vs 5.5%; OR 2.00, 95% CI 1.12 to 3.56) and a higher recurrent stroke risk (6.6% vs 4.6%; OR 1.47, 95% CI 0.76 to 2.83).
Conclusion:
Our prospective follow-up study shows a significantly higher rate of recurrent stroke or cardiovascular death and a clear trend for a higher rate of recurrent stroke in patients with acute cerebrovascular events classified as high risk by an ESRS ⩾3 or a pathological ABI.
SUMMARY Feedback and feedforward (anticipatory) adjustments of stance were investigated in 58 children with normal development aged between seven months and 14 years, and in 14 children with motor and mental retardation aged between 21 months and seven years. Feedback responses after tilting the body were elicited in all but the two youngest children, aged seven and nine months. The observed rapid decrease in feedback response latency with age suggests considerable acceleration of central transmission. Effective anticipatory postural adjustments (feedforward) were elicited only in the normal children over four years of age. The development of both feedback and feedforward continued until adolescence. RÉSUMÉ Développement des contrôles en retour et anticipateurs de la tenue debout Les ajustements de posture en retour et anticipateurs ont été etudies chez 58 enfants de developpement normal, âgès de sept mois à 14 ans, et chez 14 enfants avec retard moteur et mental, âgès de 21 mois à sept ans. Les réponses en retour après poussée sur le corps ont été obtenues chez tous les enfants, sauf les deux plus jeunes, de sept et neuf mois. Une décroissance rapide de la latence des réponses en retour en fonction de l'âge suggèrent une accélération considérable de la transmission centrale. Les ajustements anticipateurs efficaces n'étaient obtenus chez les enfants normaux qu'après l'âge de quatre ans. Le développement des réponses en retour et anticipatrices continuait jusq'à l'adolescence. ZUSAMMENFASSUNG Die Entwicklung der Feedback‐ und Feedforwardkontrolle des aufrechten Stehens Bei 58 Kindern mit normaler Entwicklung im Alter zwischen sieben Monaten und 14 Jahren und bei 14 Kindern mit motorischer und geistiger Retardierung im Alter zwischen 21 Monaten und sieben Jahren wurden die Rückkopplungsmechanismen (feedback) und die anticipatorischen (feedforward) RESUMEN Desarrolio del control retroalimentado y prealimentado de la postura erecta Se investigaron los ajustes retroalimentados y prealimentados (anticipatorios) de la postura erecta en 58 nin̈os con desarrolio normal y de edad de siete meses a 14 an̈os, y en 14 nin̈os con retraso motor y mental de entre 21 meses y siete an̈os. Las respuestas retro después de una inclinacién del cuerpo se observaron en todos los casos, excepto en los dos niños mis pequeflos, que tenian siete y nueve meses. La rápida disminución de la latencia de la retrorespuesta con la edad sugiere una acentuada aceleración de la transmisién central. Ajustes posturales anticipatorios (pre‐alimentación) efectivos sólo se demonstraron en los niños normales de más de cuatro años de edad. El desarrolio de la retro y pre‐alimentacién continua hasta la adolescencia.
Abstract Embolic stroke of undetermined source (ESUS) replaces the old term cryptogenic stroke. ESUS is defined by an ischaemic stroke shown on brain imaging and exclusion of a cardiac source of embolism, large vessel disease, and lacunar stroke. Ongoing trials are investigating the possible efficacy and safety of non-vitamin K antagonist oral anticoagulants versus aspirin in patients with ESUS.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)