Association of intracranial large artery disease with long-term prognosis after ischaemic stroke.

Introduction: Intracranial large artery disease (ICLAD) is a common cause of ischaemic stroke and is associated with the risk of recurrent vascular events in the short term. We compared the incidence of various long-term vascular outcomes between ischaemic stroke patients with and without ICLAD.

Methods: This was a longitudinal observational study of acute ischaemic stroke patients who were followed up serially for recurrent stroke, myocardial infarction or vascular death up to a median of 86 months.

Recurrent vascular events partially explain association between diabetes and poor prognosis in young ischemic stroke patients.

Background And Aims: Stroke is the second leading cause of death and third leading cause of disability worldwide. There is an increasing incidence of stroke among the young. In this study, we aimed to identify factors associated with poor long-term prognosis in young stroke patients.

Long-Term Post-Stroke Functional Outcomes: A Comparison of Diabetics and Nondiabetics.

Introduction: Diabetes mellitus (DM) is known to influence outcomes in the short term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and nondiabetic ischemic stroke patients, and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes.

Intracranial Large Artery Disease is Independently Associated with Poor Functional Outcome in a Cohort of Ethnic South Asian Ischemic Stroke Patients.

Background: Intracranial large artery disease (ICLAD) in ischemic stroke patients is associated with an increased risk for recurrent stroke; however, it is not known if ICLAD influences functional status following stroke. We studied the 6-month functional outcome in south Asian ischemic stroke patients and compared those with and without ICLAD.

Materials And Methods: This is a prospective cohort study of consecutive south Asian ischemic stroke patients.

National Institutes of Health Stroke Scale: comparison of original and modified versions for Singapore culture.

Introduction: The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria.

Methods: In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items.

Impact of beliefs about medication on the relationship between trust in physician with medication adherence after stroke.

Objective: To investigate the relationship between medication adherence, trust in physician and beliefs about medication among stroke survivors. To determine whether beliefs about medication would mediate the relationship between trust in physician and medication adherence.

Methods: A sample of 200 patients with a diagnosis of ischemic stroke or transient ischemic attack (TIA) completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), and Trust in Physician Scale (TIPS).

Changes in Informed Consent Policy and Treatment Delays in Stroke Thrombolysis.

Objectives: The efficacy of thrombolytic therapy with tissue plasminogen activator (tPA) is highly time dependent. Although clinical guidelines do not recommend written informed consent as it may cause treatment delays, local policy can supersede and require it. From 2014 to 2017, three out of five public hospitals in Singapore changed from written to verbal consent at different time points.

Modifiable Factors Associated with Non-Adherence to Secondary Ischaemic Stroke Prevention Strategies.

Background: Secondary stroke-prevention strategies proven to reduce stroke recurrence include pharmaceutical agents and lifestyle modifications.

Aims: We aimed to study factors associated with adherence to medications and lifestyle modifications amongst ischaemic stroke and transient ischaemic attack (TIA) patients.

Methods: In a prospective cohort study, we surveyed 200 outpatients attending stroke clinic at a Singaporean tertiary hospital.

Emergency medical services use and its association with acute ischaemic stroke evaluation and treatment in Singapore.

Background: Emergency medical services (EMS) is a critical link in the chain of stroke survival. We aimed to assess EMS use for stroke in Singapore, identify characteristics associated with EMS use and the association of EMS use with stroke evaluation and treatment.

Methods: The Singapore Stroke Registry combines nationwide EMS and public hospital data for stroke cases in Singapore.

Wake-up Stroke and Onset-to-door Duration Delays: Potential Future Indications for Reperfusion Therapy.

Introduction: There is limited utilisation of acute stroke reperfusion treatments which have narrow therapeutic windows, with delayed hospital presentation being a major limiting factor in Singapore. Most patients who wake up with symptoms are ineligible for reperfusion treatments as duration from onset time is not known. We studied the profile of wake-up strokes, onset-to-door duration and their associated factors among ischaemic stroke patients in the context of potential new treatments.

Circulating microRNAs as biomarkers of acute stroke.

MicroRNAs have been identified as key regulators of gene expression and thus their potential in disease diagnostics, prognosis and therapy is being actively pursued. Deregulation of microRNAs in cerebral pathogenesis has been reported to a limited extent in both animal models and human. Due to the complexity of the pathology, identifying stroke specific microRNAs has been a challenge.

Associations of retinal microvascular signs and intracranial large artery disease.

Background And Purpose: Intracranial large artery disease (ICLAD) is a major cause of ischemic stroke. Retinal microvascular changes are associated with stroke, including small vessel cerebral disease and extracranial carotid disease. We examined the relationship between ICLAD and retinal microvascular changes.

Timing of arrival to a tertiary hospital after acute ischaemic stroke - A follow-up survey 5 years later.

Introduction: Intravenous tissue plasminogen activator (tPA) within 3 hours of stroke onset is a licensed proven therapy for ischaemic stroke, with recent trial data showing benefit up to 4.5 hours. We previously published in this journal data of a survey conducted in 2004 showing only 9% of ischaemic stroke patients presenting to the Singapore General Hospital (SGH) arrived within 2 hours of onset.

Metabolic syndrome is associated with intracranial large artery disease among ethnic Chinese patients with stroke.

Background: The association of metabolic syndrome (MetS) and intracranial large artery disease (ICLAD) has been described, but only in cohorts of ethnic Korean patients with stroke. We investigated the relationship of MetS and ICLAD among ethnic Chinese patients.

Methods: This is a prospective study of consecutive ethnic Chinese patients with acute ischemic stroke living in Singapore.

Ethnic South Asian ischaemic stroke patients have a higher prevalence of a family history of vascular disease compared to age, gender and diabetes-matched ethnic Chinese subjects.

Family history is a known non-modifiable risk factor of stroke. We aimed to compare the frequency of a family history of vascular disease between ethnic South Asian and Chinese stroke patients. We studied consecutive ethnic South Asian and Chinese ischaemic stroke patients matched for age, gender and presence of diabetes.

Arterial stiffness is associated with intracranial large artery disease among ethnic Chinese and South Asian ischemic stroke patients.

Objective: Intracranial large artery disease (ICLAD) is a common stroke subtype that carries a poor prognosis. We studied the association of arterial stiffness, a recognized risk factor for atherosclerosis and ICLAD among ethnic Chinese and South Asian ischemic stroke patients.

Methods: In this prospective study, we recruited consecutive ischemic stroke patients of Chinese and South Asian ethnicity.

Serum erythrocyte sedimentation rate is higher among ethnic South Asian compared to ethnic Chinese ischemic stroke patients. Is this attributable to metabolic syndrome or central obesity?

Inflammation, a vascular risk factor, is more pronounced among ethnic South Asians compared to ethnic Chinese in the general population. We compared serum erythrocyte sedimentation rate (ESR) levels between ethnic South Asian and Chinese acute ischemic stroke patients, and further investigated if metabolic syndrome or central obesity could account for any difference detected. We prospectively recruited consecutive ischemic stroke patients within seven days of onset.

Concomitant coronary artery disease among Asian ischaemic stroke patients.

Introduction: Coronary artery disease (CAD) is the leading cause of death following ischaemic stroke. We aimed to study the prevalence and associations of concomitant CAD among ischaemic stroke patients in Singapore.

Materials And Methods: We prospectively studied 2686 consecutive Asian ischaemic stroke patients.

Is routine retinal examination useful in patients with acute ischemic stroke?

Background And Purpose: Patients with ischemic stroke have a high prevalence of hypertension and diabetes, which are major risk factors for potentially blinding retinal diseases. We studied the prevalence of retinal diseases, and the need for an ophthalmology referral, among persons with acute ischemic stroke.

Methods: We conducted a prospective study of 300 consecutive patients with acute ischemic stroke.

Metabolic syndrome among ethnic South Asian patients with ischemic stroke and comparison with ethnic Chinese patients: the Singapore General Hospital experience.

Background: South Asians are the largest ethnic group in the world, yet there are no data on metabolic syndrome (MetS) among ethnic South Asian patients with ischemic stroke. Ethnic differences in the prevalence of MetS are known to exist.

Methods: We studied 126 consecutive ethnic South Asian patients and 126 age-, sex-, and diabetes-matched ethnic Chinese patients admitted with acute ischemic stroke.

South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease.

Background And Purpose: South Asians are the most prevalent ethnic group in the world. Intracranial disease is the most common vascular lesion worldwide.

Methods: We prospectively studied 200 consecutive ethnic South Asian patients with acute ischemic stroke in Singapore.

Intracranial large artery disease among OCSP subtypes in ethnic South Asian ischemic stroke patients.

The site of vascular stenosis correlates well with the Oxfordshire Community Stroke Project (OCSP) classification among Caucasians, but not among ethnic Chinese patients. We prospectively studied 205 consecutive ethnic South Asian ischemic stroke patients to investigate the prevalence of intracranial large artery disease determined by transcranial color-coded doppler and magnetic resonance angiography among OCSP subtypes. The distribution of OCSP subtypes was 7% total anterior circulation infarction (TACI), 17% partial anterior circulation infarction (PACI), 14% posterior circulation infarction (POCI) and 62% lacunar infarction (LACI).