Incidence, subtypes, sex differences and trends of stroke in Taiwan
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Background Chinese populations have been reported higher incidence of all strokes and intracerebral hemorrhage. However, few large-scale studies have evaluated changes of stroke epidemiology in the 21st century. Methods We explored the rates of incidence of all first-ever strokes, subtypes, and 1-month case fatality by using data from the Taiwan National Health Insurance Research Database since 2004. Also, we investigated sex differences in stroke. Time-trend analysis was performed for incidence and case fatality rates of all strokes and subtypes in both sexes. Results The age-adjusted incidence of all strokes per 100,000 person-years decreased by 16%, from 251 (95% confidence interval [CI] 249–253) in 2004 to 210 (95% CI 209–212) in 2011 (p<0.001); it was always higher in Chinese men than in women. Among pathological subtypes, the incidence of intracerebral hemorrhage markedly decreased by 26% over the years (p<0.001), while that of ischemic stroke slightly decreased by 8%. However, when stratified by sex, the incidence of ischemic stroke decreased significantly in only women, not in men (men: p = 0.399, women: p = 0.004). Regarding the incidence of subarachnoid hemorrhage, it remained unchanged. Furthermore, the rate of 1-month case fatality decreased significantly for all strokes in both sexes (p<0.001). Conclusions In Taiwan, the incidence rate of first-ever stroke decreased in both Chinese men and women in the early 21st century. Men had a higher incidence rate than women. Furthermore, a marked decrease was noted in the incidence of intracerebral hemorrhage, while a slight decrease was noted in that of ischemic stroke; however, the decreased incidence of ischemic stroke was significant in only women.Keywords:
Stroke
Case fatality rate
Introduсtion: Acute symptomatic seizure (ASS) is a most frequently complication after a stroke. Seizures could be associated with the worse outcome. Nowadays the prophylactic antiepileptic treatment after the stroke is not advisable. However this question have to be discussed in a particular groups of patients. The aim: To study the prevalence of ASS in the particular groups of patients after intracerebral hemorrhage as well as to determine the predictors of the sizure occurrence in these groups of patients.Materials and methods: The retrospective analysis of the clinical features of intracerebral hemorrhage for 305 patients was performed. Among them there were 127 patients with aneurysmal subarachnoid hemorrhage as well as 178 patients were with nonaneurysmal intracerebral hemorrhage.Results: In 12 patients from 127 with subarachnoid hemorrhage were occurred onset seizures. 4 patients from 12 with subarachnoid hemorrhage died (28.5% of all deaths in the group of patients with subarachnoid hemorrhage (SAH)). In the group of patients with seizures 10 of them had aneurysm in anterior part of Willi's Circle. In 11 patients from 178 with nonaneurysmal intracerebral hemorrhage occurred onset seizures. Only one patient from 72 with medial localization of intracerebral hemorrhage had seizures.Conclusions: Prevalence of ASS after intracerebral hemorrhage reaches 7.5%, in the group of patients with SAH - 9.5%, in the group of patients with intracerebral nonaneurysmal hemorrhage - 6.25%. Initial seizures at the onset of subarachnoid hemorrhage is an unfavorable prognostic criteria and is associated with higher mortality. Localization of aneurysm in anterior part of Willi's Circle and lateral localisation of intracerebral hemorrhage are associated with a higher risk of the ASS development.
Stroke
Subdural hemorrhage
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Spontaneous non-traumatic intracerebral hemorrhage (ICH) has a worse prognosis than ischemic stroke. The purpose of this review was to update the reader on epidemiology, prognosis and secondary prevention strategies of ICH.We performed a selected review from the literature including recent original articles and meta-analyses.ICH has an overall incidence of 24.6 per 100.000 patient years, which is considerably higher in Asian populations. Despite some progress in acute interventions and a great increase in clinical studies over the last decade, mortality of ICH remains high. In addition, survivors remain at increased risk of recurrent hemorrhagic as well as ischemic stroke.Knowledge on risk factors and prevention strategies can greatly decrease the incidence of ICH and improve prognosis of ICH survivors.
Stroke
Secondary Prevention
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Intracerebral Hemorrhage and Subarachnoid Hemorrhage as a Result of InfectiveEndocarditis : A Case Report
Infective Endocarditis
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Objective To investigate the expression of HIF-1αin intracerebral hemorrhage and find out its significance and its correlation with the time of intracerebral hemorrhage.Methods The expression of HIF-1α were assessed by Immunohistochemistry staining.Results In 65 cease of intracerebral hemorrhage positive expression rates of HIF-1α was 61.5%(40/65) and 0 in normal braintissues.The positive rate was significantly higher in intracerebral hemorrhage than in normal brain tissues(P0.05).HIF-1α positive expression rates were 20%(3/15) in 6h,62.5%(20/32) between 6h to 24h and 94.4%(17/18) after 24h of intracerebral hemorrhage.HIF-1α expression was closely related with time of operation after intracerebral hemorrhage(P0.05).Conclusion HIF-1α was over expressed in intracerebral hemorrhage,and there is a significant correlation with the time after intracerebral hemorrhage.It can help hypoxic neurons survive in the condition of hypoxia.
Positive correlation
Hypoxia
Negative correlation
Spontaneous intracerebral hemorrhage
Clinical Significance
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Objective To observe the expression on distribution of NGF and BDNF in rat brain with intracerebral hemorrhage,in order to explore the fuction of the neurotrophic factors against intracerebral hemorrhage injury. Methods Adult male Sprague-Dawle rats were randomly seperated into three groups:normal group,sham operation group,intracerebral hemorrhage group,then the model of intracerebral hemorrhage(ICH) was established in rats by intracerebral injection with autogenous blood. The protein expression of BDNF and NGF was detected by immunohisto-chemistry at 3,6,12,24,48,72h,7d after intracerebral hemorrhage. Results The NGF expression was found increasing in the perienchyma at 6h and BDNF expression increasing in 12h,both peaking at 24h after hemorrhage. Comparing with normal group and sham operation group,the increases of the indexes of BDNF and NGF were statistically signifi cant(P0.05). Conclusion The expression of NGF and BDNF increases as the inducement in the brain of rats after intracerebral hemorrhage,and it is benefi cial for the protection and repair of brain neurons.
Autologous blood
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Our purpose was to describe and further understand the determinants of the time of onset of parenchymatous intracerebral hemorrhage and subarachnoid hemorrhage in patients enrolled in the Stroke Data Bank.We analyzed the observed times of onset of intracerebral hemorrhage (n = 237 patients) and subarachnoid hemorrhage (n = 243 patients) compared with expected times of onset if the probability of onset was constant across all time intervals. We also analyzed the role of clinical features (if any) in explaining the findings.For intracerebral hemorrhage, 52.5% of patients reported onset times between 0600 hours and 1400 hours, with peak onset between 1000 and 1200 hours (chi 2 = 62.94, df = 11, p less than 0.001). Patients with subarachnoid hemorrhage were more likely to lack a history of hypertension compared with patients who had intracerebral hemorrhage (chi 2 = 23.3, df = 1, p less than 0.001). Patients with subarachnoid hemorrhage were more likely to have more uniform onset time throughout the day (chi ...
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Spontaneous intracerebral hemorrhage
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Stroke
Case fatality rate
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To investgate the relationship between epidemiological diagnosis and fatality rate in patients with severe acute respiratory syndrome (SARS).Epidemiological evidences and the outcomes of 304 patients with confirmed SARS were retrospectively analyzed. Patients included highly contagious cases, cluster cases, and sporadic cases.The case fatality rate was 8.2%. The fatality rate had a tendency of increase in an order of sporadic cases, cluster cases, and highly contagious cases (3.9%, 11.4%, and 17.2%, respectively, chi2trend=7.561, P < 0.01). Chi square-test also proved that the fatality rate was higher in older people (chi2trend=27.024, P < 0.01) and in male (male vs female: 12.2% vs 5.5%). A logistic regression model showed that the epidemiological evidence, age, and gender were correlated to fatality rate. By observing changes of the odds ratio for epidemic evidence, age, and gender using forward method, we found epidemic evidence was an independent risk factor related to fatality rate in SARS patients.The epidemiological evidence is an independent factor related to fatality rate in SARS patients. Highly contagious case has a worse prognosis and higher fatality rate than sporadic cases and cluster cases.
Case fatality rate
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