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OBJECTIVE: Endovascular treatment (EVT) has been demonstrated superior to pharmacological thrombolysis in acute ischemic stroke (AIS) induced by extracranial internal carotid artery occlusion. This paper aims to summarize clinical evidence about EVT and assess its efficacy and safety on acute extracranial carotid occlusion. MATERIALS AND METHODS: We systematically reviewed all studies that reported endovascular therapy as carotid stenting, stent retriever, aspiration, and angioplasty for acute extracranial carotid occlusion. Literature retrieval was performed in PubMed, Embase, and Cochrane library, dated from January 1st, 2005 to December 31st, 2020. The primary endpoint was a favorable outcome rate. Major secondary endpoints were SICH incidence, 90-day mortality rate, and complications. Meta-analysis and subgroup analysis were conducted to identify predictors for prognosis. This systematic review has been registered in PROSPERO (CRD42020181154) on July 18, 2020. RESULTS: 10 studies with 620 patients were included in total. Endovascular approach presented a favorable outcome rate of 0.47 (0.37, 0.56), an acceptable 90-day mortality rate of 0.16 (0.13, 0.19), and a mild SICH rate of 0.07 (0.05, 0.10). Age and NIHSS at admission were negatively associated with favorable outcome, with odds ratio of 0.95 (0.92, 0.98) and 0.74 (0.62, 0.88) respectively. Lower age (p=0.049) and aspiration thrombectomy (p=0.041) predicted less SICH events. In subgroup in which time window > 6 hours, endovascular therapy presented similar encouraging results, with favorable outcome rate of 0.59 (0.51, 0.66), 90-day mortality rate of 0.11 (0.07, 0.17), and SICH rate of 0.04 (0.02, 0.09). CONCLUSIONS: EVT can effectively improve neurological function and reduce 90-day mortality for acute extracranial carotid occlusion patients without increasing the risk of symptomatic intracranial hemorrhage. Endovascular therapy is safe to perform from 6 to 24 hours after symptom onset. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence for music-based interventions in neurorehabilitation, improving mood and functional outcomes. In response, there is growing interest from health-care providers in setting up Neurologic Music Therapy (NMT) services. This paper presents some preliminary data on the feasibility and acceptability of NMT in the acute stroke, multidisciplinary team setting, about which little is known. Objectives: To assess the feasibility and acceptability of a two-day per-week NMT service over 24 months. Methods: Data were collected on the number of referrals received, sessions attended, sessions declined and reasons why. Staff completed questionnaires, and collected them from patients and their relatives, rating interventions: 1. Not helpful, 2. Quite helpful, 3. Helpful, 4. Very helpful. Patients completed the Visual Analogue Mood Scale (VAMS) pre-/post- a single session. Results: Of 201 patients referred, 177 received treatment and 675 sessions were delivered. Twenty-four patients were discharged before sessions were scheduled and 28 sessions were declined, predominantly due to fatigue. Mean scores (SD) from questionnaire data were: patients (n = 99) 3.34 (0.825), relatives (n = 13) 3.83 (0.372), staff (n = 27) 3.85 (0.388). Mean, post-session VAMS data (n = 52) showed a non-significant reduction in 'Sad' (7.5, p =.007, CI = 2.1, 12.9) and an increase in 'Happy' (+ 6.2, p =.013, CI = −11.0, −1.4). Conclusions: Data suggest the service was feasible and helpful, particularly for patient mood, possibly improving engagement in rehabilitation. Research to determine generalizability in different stroke environments and treatment effects within them is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to assess the efficacy of paracetamol (acetaminophen) on body temperature in acute stroke.Methods: Medline, Cochrane Central Register of Controlled Trials, EMBASE, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and the World Health Organization (WHO) International Clinical Trials Registry Platform were searched electronically. Relevant journals and references of studies included were hand-searched for randomized controlled trials (RCT) and controlled clinical trials (CCT) regarding the efficacy of paracetamol (acetaminophen) on body temperature in acute stroke. Two reviewers independently performed data extraction and quality assessment. Data were analyzed using RevMan 5.3 software by the Cochrane Collaboration.Results: Five studies were included. To compare the efficacy of paracetamol (acetaminophen) in acute stroke, the pooled RR (Risk Ratio) and its 95% CI of body temperature reduction at 24h from the start of treatment were -0.3 (95% CI: -0.52 to -0.08), with statistical significance (P=0.007). Consistently, the pooled RR (Risk Ratio) and its 95% CI of body temperature at 24h from the start of treatment were -0.22 (-0.29, -0.15), with statistical significance (P<0.00001). When analyzing the body temperature reduction after 5days from the start of treatment, the pooled RR (Risk Ratio) and its 95% CI were 0.04 (95% CI: -0.20 to 0.29), with no statistical significance (P=0.73). For functional outcome (mRS≤2) analysis, the pooled RR and its 95% CI were 1.08 (0.88, 1.32), with no statistical significance (P=0.45). In addition, the difference of serious adverse events between acetaminophen and placebo was 0.86 (95% CI: 0.62 to 1.2), with no statistical significance (P=0.27).Conclusion: Acetaminophen was revealed to have some favorable influence in body temperature reduction in acute stroke, but showed no important effect on improving functional outcome and reducing adverse events of patients.What This Paper Adds: What is already known on this subject? Paracetamol (acetaminophen) is one of the most commonly used antipyretic drugs and has some capability to reduce body temperature through acting on central nervous system.What This Study Adds: Acetaminophen showed some capability to decrease body temperature for acute stroke. Acetaminophen could not improve functional outcome and reduce adverse events of patients with acute stroke. [ABSTRACT FROM AUTHOR]

Background and Aim: A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device. In this paper, the clinical significance of and diagnostic methods for cryptogenic stroke and covert atrial fibrillation are explained, along with our proposal for the clinical indications for this new device.Methods, Results, and Conclusion: The majority of cryptogenic ischemic strokes are considered to be embolic. In particular, covert atrial fibrillation is drawing attention as the causal emboligenic disease, and it was identified in 30% of patients with long-term observation using an insertable cardiac monitor. Should atrial fibrillation be present, there is a high risk of recurrent stroke, and the cardioembolic stroke that appears is generally severe. The ability to identify atrial fibrillation would be beneficial for preventing stroke recurrence, as anticoagulants can then be used as an established method of secondary prevention. Because the use of insertable cardiac monitors is somewhat invasive, and long-term care systems are also needed, patients suitable for examination using the new device would need to be identified on the basis of detailed diagnostics in accordance withcurrent medical practice in Japan. [ABSTRACT FROM AUTHOR]

Stroke is a major cause of long-term disability among adults in many countries. Post stroke rehabilitation consumes a huge amount of health care resources in terms of costs related to hospital and home assistance. Recently, robot-assisted rehabilitation has been introduced to support physiotherapists in providing high-intensity and repetitive rehabilitation sessions. It has been observed that robotics offers an objective and reliable tool to monitor patient's progress and to accurately assess their motor function. This paper presents a novel finger rehabilitation approach for acute paralyzed stroke survivors using a wearable device for hand motor function restoration. After analyzing four main working mechanisms for hand assistance and rehabilitation, i.e. pneumatic cylinders, artificial rubber muscles, linkage mechanism and cable-driven mechanism, a new device called Pneumatic Actuated Finger Exoskeleton (PAFEx) has been designed. The prototype development was carried out in four stages involving simulation of the assisted structure of the MCP joint and the PIP joint, algorithm development, design and fabrication of prototype as well as product function evaluation. Offering ease of use and affordability, the device has great potential to be deployed for individualized rehabilitation session for patients who have to undergo therapy in their home. [ABSTRACT FROM AUTHOR]