Effect of Atrial Fibrillation on Acute Ischemic Stroke Severity
Author(s)
Taha Kamel Alloush,
Mahmoud Haroun Ibrahim,
Nahed Salah El Dein Ahmed Ibrahim,
Ghada Samir El-Shahed,
Lobna Mohamed Nabil El-Sayed,
Mohamed Hamdy Ibrahim*,
Hosam Ahmed Azmy
Affiliation(s)
Faculty of Medicine, Ain Shams University, Cairo, Egypt. Ministry of Health, Cairo, Egypt.
Faculty of Medicine, Ain Shams University, Cairo, Egypt. Ministry of Health, Cairo, Egypt.
ABSTRACT
Objectives: To assess the impact of atrial fibrillation on stroke severity and short-term (1 month) mortality. Materials and Methods: Totally 200 patients admitted to Ain Shams University Specialized Hospital were recruited and diagnosed clinically to have acute ischemic stroke within 3 days. Patients with hemorrhagic infarctions were excluded. History taking about previous heart disease was taken, full general and neurological examinations were done. Full metabolic profile, full cardiac investigations, carotid duplex, MRI brain stroke protocol with initial clinical evaluation and after 1 month re-evaluation using (NIHSS ) scale. Results: All patients underwent transthoracic echocardiography which revealed absence of “A” wave corresponding to atrial fibrillation in 33 patients (16.5%). Those Patients with atrial fibrillation had a median NIHSS score of 11.00 with IQR of 6.00 - 18.50 at admission and 6.00 with IQR of 2.00 - 14.50 after one month. Patients with atrial fibrillation showed significantly higher NIHSS at admission than patients in sinus rhythm, P < 0.05. Magnetic resonance imaging findings showed that MRA showed significant intracranial vessel stenosis in 117 (79.1%) patients. 51 (34.4%) patients had lacunar infarction, 65 (43.9%) patients had partial anterior circulation infarction, 25 (16.2%) patients had posterior circulation infarction and 7 (4.7%) patients had total anterior circulation infarction. 111 (75%) patients showed leucoaraiosis. Conclusion: Atrial fibrillation was found not to have significantly statistical effect on stroke severity and short term mortality.
Cite this paper
Alloush, T. , Ibrahim, M. , Ibrahim, N. , El-Shahed, G. , El-Sayed, L. , Ibrahim, M. and Azmy, H. (2014) Effect of Atrial Fibrillation on Acute Ischemic Stroke Severity. Open Journal of Medical Imaging, 4, 95-101. doi: 10.4236/ojmi.2014.42013.
Alloush, T. , Ibrahim, M. , Ibrahim, N. , El-Shahed, G. , El-Sayed, L. , Ibrahim, M. and Azmy, H. (2014) Effect of Atrial Fibrillation on Acute Ischemic Stroke Severity. Open Journal of Medical Imaging, 4, 95-101. doi: 10.4236/ojmi.2014.42013.
References
[1] Poungvarin, N. (1998) Stroke in the Developing World. The Lancet, 352, S19-S22. [2] Bertson, J.A. and Bruce, H. (2004) Depression and Psychosis in Neurologic Practice. In: Neurology in Clinical Practice, 4th Edition. [3] Longmore, M., Wilkinson, I.B., Davidson, E.H., et al. (2010) Arrythmias. In: Oxford Handbook of Medicine, 8th Edition, Oxford University Press, Oxford, 118. [4] Ballinger, S.P. (2007) Cardiovascular Medicine. In: Pocket Essentials of Clinical Medicine, 4th Edition, Saunders, 120. [5] Camm, A.J. and Bunce, N. (2009) Cardiovascular Diseases. In: Kumar and Clark’s Clinical Medicine, 7th Edition, Saunders, 811. [6] Rothwell, P. (2009) Cerebrovascular Diseases. In: Brain’s Diseases of the Nervous System, 12th Edition, Oxford University Press, Oxford, 1003.
http://dx.doi.org/10.1093/med/9780198569381.003.0767 [7] Hatano, S. (1976) Experience from a Multicentre Stroke Register: A Preliminary Report. Bulletin of the World Health Organization, 54, 541-553. [8] Samuels, O.B., Joseph, G.J., Lynn, M.J., et al. (2000) A Standardized Method for Measuring Intracranial Arterial Stenosis. American Journal of Neuroradiology, 21, 643-646. [9] Biller, J., Betsy, B. and Michael, J. (2008) Vascular Diseases of the Nervous System. In: Neurology in Clinical Practice, 5th Edition, 1165. [10] Cordonnier, C. and Leys, D. (2008) Stroke, the Bare Essentials. Practical Neurology, 8, 263-272.
http://dx.doi.org/10.1136/jnnp.2008.149401 [11] World Health Organization (2004) World Health Organization: Statistical Annex. The World Health Report 2004, WHO, Geneva. [12] Carmine, M., Federica, S., Simona, S., et al. (2005) Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke, Results From a Population-Based Study. Stroke, 36, 1115-1119.
http://dx.doi.org/10.1161/01.STR.0000166053.83476.4a [13] Sandercock, P., Bamford, J., Dennis, M., et al. (1992) Atrial Fibrillation and Stroke: Prevalence in Different Types of Stroke and Influence on Early and Long Term Prognosis (Oxfordshire Community Stroke Project). BMJ, 305, 1460.
http://dx.doi.org/10.1136/bmj.305.6867.1460 [14] Hart, R.G. and Halperin, J.L. (2001) Atrial Fibrillation and Stroke: Concepts and Controversies. Stroke, 32, 803-808.
http://dx.doi.org/10.1161/01.STR.32.3.803
[1] Poungvarin, N. (1998) Stroke in the Developing World. The Lancet, 352, S19-S22. [2] Bertson, J.A. and Bruce, H. (2004) Depression and Psychosis in Neurologic Practice. In: Neurology in Clinical Practice, 4th Edition. [3] Longmore, M., Wilkinson, I.B., Davidson, E.H., et al. (2010) Arrythmias. In: Oxford Handbook of Medicine, 8th Edition, Oxford University Press, Oxford, 118. [4] Ballinger, S.P. (2007) Cardiovascular Medicine. In: Pocket Essentials of Clinical Medicine, 4th Edition, Saunders, 120. [5] Camm, A.J. and Bunce, N. (2009) Cardiovascular Diseases. In: Kumar and Clark’s Clinical Medicine, 7th Edition, Saunders, 811. [6] Rothwell, P. (2009) Cerebrovascular Diseases. In: Brain’s Diseases of the Nervous System, 12th Edition, Oxford University Press, Oxford, 1003.
http://dx.doi.org/10.1093/med/9780198569381.003.0767 [7] Hatano, S. (1976) Experience from a Multicentre Stroke Register: A Preliminary Report. Bulletin of the World Health Organization, 54, 541-553. [8] Samuels, O.B., Joseph, G.J., Lynn, M.J., et al. (2000) A Standardized Method for Measuring Intracranial Arterial Stenosis. American Journal of Neuroradiology, 21, 643-646. [9] Biller, J., Betsy, B. and Michael, J. (2008) Vascular Diseases of the Nervous System. In: Neurology in Clinical Practice, 5th Edition, 1165. [10] Cordonnier, C. and Leys, D. (2008) Stroke, the Bare Essentials. Practical Neurology, 8, 263-272.
http://dx.doi.org/10.1136/jnnp.2008.149401 [11] World Health Organization (2004) World Health Organization: Statistical Annex. The World Health Report 2004, WHO, Geneva. [12] Carmine, M., Federica, S., Simona, S., et al. (2005) Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke, Results From a Population-Based Study. Stroke, 36, 1115-1119.
http://dx.doi.org/10.1161/01.STR.0000166053.83476.4a [13] Sandercock, P., Bamford, J., Dennis, M., et al. (1992) Atrial Fibrillation and Stroke: Prevalence in Different Types of Stroke and Influence on Early and Long Term Prognosis (Oxfordshire Community Stroke Project). BMJ, 305, 1460.
http://dx.doi.org/10.1136/bmj.305.6867.1460 [14] Hart, R.G. and Halperin, J.L. (2001) Atrial Fibrillation and Stroke: Concepts and Controversies. Stroke, 32, 803-808.
http://dx.doi.org/10.1161/01.STR.32.3.803