Leonid Churilov

The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia

Are you Leonid Churilov?

Claim your profile

Publications (131)259.61 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In acute stroke management, time efficiency in the continuum of patient management is critical. We aimed to determine if implementation of system improvements at our institution translated to reduced picture-to-puncture (P2P) times over a 6-year period.
    Journal of neurointerventional surgery 06/2014; · 1.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Clinical deterioration in the acute stage of ischemic stroke powerfully predicts outcome and may serve as a marker for urgent intervention. However, accurate monitoring of acute stroke patients is hampered by the lack of validated continuous monitoring devices. We sought to assess the use of wireless accelerometry in this setting, hypothesizing that stroke patients would have a greater difference in movement between upper limbs than controls and that the magnitude of correlation between upper limb movements would be negatively associated with the National Institutes of Health Stroke Scale (NIHSS) score. Methods: In this pilot study, 20 patients with acute ischemic stroke and unilateral upper limb weakness and 10 controls were recruited from a comprehensive stroke centre. All subjects were fitted with two 3-axis accelerometers and underwent 24 h of continuous accelerometry recording of upper limb movements and repeat NIHSS assessments. The intra-class correlation coefficient (ICC), assessing the similarity (or otherwise) of spontaneous movements in each arm was calculated. The association between NIHSS (total and motor subset scores) and the magnitude of ICC was estimated by Spearman's rank correlation, receiver-operating characteristic curve analysis was performed and the optimal diagnostic threshold value of ICC was calculated. Results: The magnitude of the ICC was significantly associated with the baseline NIHSS score (p = 0.02) and non-significantly associated with the baseline NIHSS motor score (p = 0.08). At the optimal diagnostic threshold of ICC magnitude = 0.7, wireless accelerometry distinguished patients from controls with a sensitivity of 0.95, a specificity of 0.6 and a diagnostic odds ratio of 28.5. Conclusions: The wireless accelerometry system successfully detects a motor deficit in the setting of acute ischemic stroke, accurately differentiating patients from controls, and correlates well with the baseline NIHSS score. Its use is feasible in the acute stroke setting. Overall, it shows promise as a diagnostic tool to continuously monitor acute stroke patients but requires validation in a larger trial. © 2014 S. Karger AG, Basel.
    Cerebrovascular diseases (Basel, Switzerland). 06/2014; 37(5):336-341.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and PurposeIn acute ischemic stroke perfusion/diffusion-weighted image, mismatch using magnetic resonance imaging approximates the ischemic penumbra. For early time windows, mismatch salvage improves clinical outcomes, but uncertainty exists at later time epochs. We hypothesized that (a) mismatch may exist up to 48 h; (b) the proportion of mismatch salvage is time independent; and (c) when salvaged, it improves clinical outcomes. Methods Magnetic resonance imaging was performed within 48 h of ischemic stroke. Perfusion-weighted image was defined by relative Tmax two-second delay. Perfusion/diffusion-weighted image mismatch was the perfusion-weighted image not overlapped by the diffusion-weighted image when coregistered. Infarct volume and disability (modified Rankin Score) were assessed at three-months. Mismatch salvage was the region not overlapped by final infarction. Favorable outcome was defined as modified Rankin Score 0–1. ResultsSixty-six patients were studied [mean age 69·9 years (standard deviation 13·1), initial median National Institute of Health Stroke Scale 9·0 (interquartile range 6·0, 18·3)]. There was no relationship between time of stroke onset and the proportion of mismatch salvaged (P = 0·73). Age (adjusted odds ratio = 0·92, 95% confidence interval 0·86–0·98, P = 0·01), initial National Institute of Health Stroke Scale (adjusted odds ratio = 0·80, 95% confidence interval 0·70–0·92, P < 0·01), mismatch volume (adjusted odds ratio = 0·98, 95% confidence interval 0·968–0·1, P = 0·05), and percentage of mismatch salvage (adjusted odds ratio = 1·04, 95% confidence interval 0·99–1·07, P = 0·05) were independently associated with favorable outcome. Conclusion Using coregistered perfusion/diffusion-weighted image criteria, mismatch persists up to 48 h post stroke. For the whole group, the proportion of mismatch salvage remains independent of time and, although the effect is small, its salvage is independently associated with improved clinical outcomes at three-months. Larger sample sizes are needed to determine the time limit for mismatch salvage.
    International Journal of Stroke 04/2014; · 2.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine symptoms, signs, and etiology of brain attacks in children presenting to the emergency department (ED) as a first step for developing a pediatric brain attack pathway. Prospective observational study of children aged 1 month to 18 years with brain attacks (defined as apparently abrupt-onset focal brain dysfunction) and ongoing symptoms or signs on arrival to the ED. Exclusion criteria included epilepsy, hydrocephalus, head trauma, and isolated headache. Etiology was determined after review of clinical data, neuroimaging, and other investigations. A random-effects meta-analysis of similar adult studies was compared with the current study. There were 287 children (46% male) with 301 presentations over 17 months. Thirty-five percent arrived by ambulance. Median symptom duration before arrival was 6 hours (interquartile range 2-28 hours). Median time from triage to medical assessment was 22 minutes (interquartile range 6-55 minutes). Common symptoms included headache (56%), vomiting (36%), focal weakness (35%), numbness (24%), visual disturbance (23%), seizures (21%), and altered consciousness (21%). Common signs included focal weakness (31%), numbness (13%), ataxia (10%), or speech disturbance (8%). Neuroimaging included CT imaging (30%), which was abnormal in 27%, and MRI (31%), which was abnormal in 62%. The most common diagnoses included migraine (28%), seizures (15%), Bell palsy (10%), stroke (7%), and conversion disorders (6%). Relative proportions of conditions in children significantly differed from adults for stroke, migraine, seizures, and conversion disorders. Brain attack etiologies differ from adults, with stroke being the fourth most common diagnosis. These findings will inform development of ED clinical pathways for pediatric brain attacks.
    Neurology 03/2014; · 8.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stroke thrombolysis is highly time-critical, but data on long-term effects of small reductions in treatment delays have not been available. Our objective was to quantify patient lifetime benefits gained from faster treatment. Observational prospective data of consecutive stroke patients treated with intravenous thrombolysis in Australian and Finnish centers (1998-2011; n=2258) provided distributions of age, sex, stroke severity, onset-to-treatment times, and 3-month modified Rankin Scale in daily clinical practice. Treatment effects derived from a pooled analysis of thrombolysis trials were used to model the shift in 3-month modified Rankin Scale distributions with reducing treatment delays, from which we derived the expected lifetime and level of long-term disability with faster treatment. Each minute of onset-to-treatment time saved granted on average 1.8 days of extra healthy life (95% prediction interval, 0.9-2.7). Benefit was observed in all groups: each minute provided 0.6 day in old severe (age, 80 years; National Institutes of Health Stroke Scale [NIHSS] score, 20) patients, 0.9 day in old mild (age, 80 years; NIHSS score, 4) patients, 2.7 days in young mild (age, 50 years; NIHSS score, 4) patients, and 3.5 days in young severe (age, 50 years; NIHSS score, 20) patients. Women gained slightly more than men over their longer lifetimes. In the whole cohort, each 15 minute decrease in treatment delay provided an average equivalent of 1 month of additional disability-free life. Realistically achievable small reductions in stroke thrombolysis delays would result in significant and robust average health benefits over patients' lifetimes. The awareness of concrete importance of speed could promote practice change.
    Stroke 03/2014; · 6.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although intra-arterial therapy for acute ischemic stroke is associated with superior recanalization rates, improved clinical outcomes are inconsistently observed following successful recanalization. There is emerging concern that unfavorable arterial collateralization, though unproven, predetermines poor outcome. We hypothesized that poor leptomeningeal collateralization, assessed by preprocedural CTA, is associated with poor outcome in patients with acute ischemic stroke undergoing intra-arterial therapy. We retrospectively analyzed patients with acute ischemic stroke with intracranial ICA and/or MCA occlusions who received intra-arterial therapy. The collaterals were graded on CTA. Univariate and multivariate analyses were used to investigate the association between the dichotomized leptomeningeal collateral score and functional outcomes at 3-months mRS ≤2, mortality, and intracranial hemorrhages. Eighty-seven patients were included. The median age was 66 years (interquartile range, 54-76 years) and the median NIHSS score at admission was 18 (interquartile range, 14-20). The leptomeningeal collateral score 3 was found to have significant association with the good functional outcome at 3 months: OR = 3.13; 95% CI, 1.25-7.825; P = .016. This association remained significant when adjusted for the use of IV tissue plasminogen activator: alone, OR = 2.998; 95% CI, 1.154-7.786; P = .024; and for IV tissue plasminogen activator and other confounders (age, baseline NIHSS score, and Thrombolysis in Cerebral Infarction grades), OR = 2.985; 95% CI, 1.027-8.673; P = .045. We found that poor arterial collateralization, defined as a collateral score of <3, was associated with poor outcome, after adjustment for recanalization success. We recommend that future studies include collateral scores as one of the predictors of functional outcome.
    American Journal of Neuroradiology 01/2014; · 3.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Background: Many stroke research trials do not include assessment of cognitive function. A Very Early Rehabilitation Trial (AVERT) is an international multicenter study that includes the Montreal Cognitive Assessment (MoCA) as an outcome. At the Malaysian AVERT site, completion of the MoCA has been limited by low English proficiency in some participants. We aimed to develop a Bahasa Malaysia (BM) version of the MoCA and to validate it in a stroke population. Methods: The original English version of the MoCA was translated into BM and then back-translated to ensure accuracy. Feasibility testing in a group of stroke patients prompted minor changes to the BM MoCA. In the validation phase, a larger group of bilingual stroke patients completed both the original English MoCA and the finalized BM MoCA, with presentation order counter-balanced. Results: Forty stroke patients participated, with a mean age of 57.2 (SD = 10.3). Agreement between BM MoCA and English MoCA was strong (intra-class correlation coefficient = 0.81, 95% CI 0.68-0.90). Scores on BM MoCA were slightly higher than scores on English MoCA (median absolute difference = 2.0, IQR 0-3.5), and this difference was present regardless of which version was completed first. Conclusions: The existence of a validated BM version of the MoCA will be of major benefit to clinicians and researchers in Malaysia and the wider South-east Asian region, where the Malay language is used by over 200 million people.
    International Psychogeriatrics 01/2014; · 2.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with stroke are more likely to have impaired autonomic nervous function and abnormal circadian blood pressure (BP) patterns. It remains unclear whether circadian BP patterns in patients with transient ischemic attack or minor stroke (National Institutes of Health Stroke Scale ≤3) differ from those in the normal population. Participants were assessed using a 24-hour ambulatory BP monitor and a short-term measurement of heart rate variability. There were 76 patients (mean age, 67.2 years; 57.9% men; and 61.8% transient ischemic attack) and 82 controls (65.6 years; 54.9% men). A history of hypertension was more prevalent in patients (72.4%; controls 48.8%). Circadian BP patterns were distributed similarly among patients and controls, and heart rate variability was also consistent between patients and controls. In contrast to previous findings among patients with acute stroke, patients with transient ischemic attack or minor stroke had similar BP patterns and autonomic nervous system function, when compared with controls.
    Stroke 01/2014; · 6.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background. Sedentary behaviour is associated with health risks, independent of physical activity. This study aimed to investigate patterns of sedentary behaviour and physical activity among stroke survivors in rehabilitation hospitals. Methods. Stroke survivors admitted to four Swedish hospital-based rehabilitation units were recruited ≥7 days since stroke onset and their activity was measured using behavioural mapping. Sedentary behaviour was defined as lying down or sitting supported. Results. 104 patients were observed (53% men). Participants spent an average of 74% (standard deviation, SD 21%) of the observed day in sedentary activities. Continuous sedentary bouts of ≥1 hour represented 44% (SD 32%) of the observed day. A higher proportion (30%, SD 7%) of participants were physically active between 9:00 AM and 12:30 PM, compared to the rest of the observed day (23%, SD 6%, P < 0.0005). Patients had higher odds of being physically active in the hall (odds ratio, OR 1.7, P = 0.001) than in the therapy area. Conclusions. The time stroke survivors spend in stroke rehabilitation units may not be used in the most efficient way to promote maximal recovery. Interventions to promote reduced sedentary time could help improve outcome and these should be tested in clinical trials.
    Stroke research and treatment. 01/2014; 2014:591897.
  • Kristian Rotaru, Leonid Churilov, Andrew Flitman
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose ‐ The current state of theory-building in the field of operations and supply chain management (OSCM) is in a strong need of rigorous, empirically based theories that enhance understanding of the causal relationships between the structural elements and properties of the business processes. In this research note the authors propose the critical realism (CR) philosophy of science as a particularly suitable philosophical position (not to the exclusion of others) to review the mechanisms of OSCM knowledge generation and to provide philosophical grounding and methodological guidance for both OSCM theory building and testing. Design/methodology/approach ‐ To demonstrate potential benefits of CR-based structured approach to knowledge generation in OSCM research, this conceptual paper uses a case study that illustrates the adoption of one of the OSCM theories ‐ i.e. the theory of swift, even flow. Findings ‐ CR interprets the accumulated empirical information about OSCM phenomena as observable manifestations of the underlying causal mechanisms that cannot be perceived otherwise. CR can provide epistemological support to the choice of performance measures that manifest the underlying causal mechanisms of interest. Extensive accumulation of empirical data from multiple innovative sources will not dramatically add to understanding of the system under investigation, unless and until the underlying causal mechanisms that trigger the observed behaviour are identified and tested. The CR abductive mode of reasoning emphasises the role of uncertainty in complex process behaviours and can facilitate enrichment and refutation of OSCM theories. Originality/value ‐ CR has a clear potential to contribute to OSCM research by enabling better understanding of causal relationships underlying complex behaviours of different elements of business process by providing robust and relevant mechanisms of generating knowledge about business processes that explicitly link empirical and causal aspects of theory building and testing.
    Supply Chain Management 01/2014; 19(2). · 1.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Intra-arterial (IA) therapy for stroke is an increasingly utilised management approach for acute ischaemic stroke. We aimed to correlate radiological characteristics and recanalisation success with radiological and functional outcomes at 90 days in patients treated with IA therapy. This was a single centre, retrospective study investigating the correlation between pre-procedural Computed Tomography-Angiogram Source Image (CTA-SI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS), recanalisation success, and functional outcome at 90 days in patients with an acute ischaemic stroke from 2007–2012. Outcome measures were pre-procedural non-contrast computed tomography (NCCT), CTA-SI, and post-procedural NCCT ASPECTS that were obtained and analysed by three blinded reviewers, recanalisation success (Thrombolysis in Cerebral Infarction [TICI] 2b–3) and favourable clinical outcome (90 day modified Rankin scale [mRS] score ⩽ 2). Forty-four patients satisfied the inclusion criteria. The mean age was 64.2 years (standard deviation: 14.9; median: 66.5; interquartile range [IQR]: 54.5–76.5). The median National Institutes of Health Stroke Scale score was 17 (IQR: 13.5–20). Twenty-one (47.7%) patients achieved a mRS score ⩽ 2. The 90 day mortality rate was 25.0% (n = 11). Of the patients who achieved TICI 2b–3, 65.5% (19/29) achieved mRS ⩽ 2. There was a statistically significant association between recanalisation success (TICI ⩾ 2b) and favourable neurological outcome at 90 days (odds ratio [OR] 25.22, 95% confidence interval [CI]: 2.86–222.37, p < 0.005). Patients with high pre-procedural CTA-SI ASPECTS are significantly more likely to have high post-procedural NCCT score (OR 23.36, 95% CI: 3.26–166.92, p = 0.002). Recanalisation success was strongly associated with good clinical outcome, unaffected by known predictive factors, which included age and stroke severity. This association was unattenuated by CTA-SI ASPECTS.
    Journal of Clinical Neuroscience 01/2014; · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stroke survivors experience accelerated bone loss and increased fracture risk, particularly in paretic weight bearing limbs. Understanding how these changes unfold and their relationship to stroke severity and physical activity could help in the development of targeted interventions to prevent or reduce the severity of these outcomes. The primary aim of this study is to investigate the time course and magnitude of changes in volumetric bone mineral density within the first year after stroke, and to examine relationships with physical activity and motor recovery. This is a prospective, observational study of 43 nondiabetic, nonambulant adults with first ever hemispheric stroke. The primary outcome was the difference in six-month change of total volumetric bone mineral density between paretic and nonparetic distal tibiae, measured at 7% of bone length site using high-resolution peripheral quantitative computed tomography. The secondary outcomes are cortical and trabecular volumetric bone mineral density, cortical thickness, and total and cross-sectional areas of distal tibiae and radii of paretic and nonparetic limbs. Also included are total body and regional bone mineral density derived using dual-energy X-ray absorptiometry, physical activity measured using accelerometry, and motor recovery (Chedoke McMaster Stroke Assessment). Measuring the timing and magnitude of changes to volumetric bone mineral density and bone structure from immediately after stroke, and relationships between these changes with physical activity and motor recovery will provide the basis for targeted interventions to reduce fracture risk in stroke survivors.
    International Journal of Stroke 12/2013; · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Providing evidence-based clinical care reduces disability and mortality rates following stroke. We examined if compliance with evidence-based processes of care were different for patients with intracerebral haemorrhage when compared with ischemic stroke and sought to describe differences in health outcomes during hospitalization and at time of discharge for these stroke subtypes. The New South Wales acute stroke dataset was used. This included data from 50-100 consecutively admitted patients' medical records collected from 32 New South Wales hospitals between 2003 and 2010. Multivariable logistic regression analyses were conducted taking into account patient factors and clustering of patients by hospital. Ischemic stroke and intracerebral haemorrhage cases had similar demographic features (ischemic stroke n = 3467, mean age 74 years [standard deviation 13], 50% female; intracerebral haemorrhage n = 275, mean age 74 years [standard deviation 13], 48% female). Following multivariable analyses patients with intracerebral haemorrhage were less likely to be admitted to a stroke unit (adjusted odds ratio 0·65; 95% confidence interval 0·45-0·94) or receive an assessment from allied health (adjusted odds ratio 0·54; 95% confidence interval 0·33-0·89) than patients with ischemic stroke. Patients with intracerebral haemorrhage are also less likely to be independent (adjusted odds ratio 0·36; 95% confidence interval 0·3-0·5) at time of hospital discharge and had a greater odds of dying in hospital (adjusted odds ratio 2·1; 95% confidence interval 1·3-3·5). Patients that were admitted to a stroke unit had a greater odds of being independent (modified Rankin Score 0-2) at day 7-10 irrespective of stroke type or severity on admission (adjusted odds ratio 1·3; 95% confidence interval 1·01-1·66). Following intracerebral haemorrhage, patients were less likely to be admitted to an acute stroke unit and receive allied health interventions. Admission to stroke units improved the likelihood of being independent at days 7-10 and, therefore, more should be done to encourage evidence-based care for intracerebral haemorrhage.
    International Journal of Stroke 11/2013; · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The currently proven time window for thrombolysis in ischemic stroke is 4·5 h. Beyond this, the risks and benefits of thrombolysis are uncertain. To determine whether thrombolysis and reperfusion were beneficial after 4·5 h, we examined clinical and radiological outcomes in patients treated with tissue plasminogen activator or placebo within 4·5-6 h, using data from the Echoplanar Imaging Thrombolytic Evaluation Trial. In the Echoplanar Imaging Thrombolytic Evaluation Trial, ischemic stroke patients presenting three to six-hours after stroke onset were randomized to tissue plasminogen activator or placebo, without knowledge of magnetic resonance imaging results. This analysis was restricted to patients treated between 4·5 and 6 h. The effect of tissue plasminogen activator and reperfusion on infarct growth between baseline diffusion-weighted imaging and day 90 T2 imaging was assessed, along with good neurological outcome (≥8 point reduction or reaching 0-1 at 90 days on National Institutes of Health Stroke Scale) and functional outcome (modified Rankin scale). The effect of tissue plasminogen activator on reperfusion was also analyzed. Sixty-nine patients were treated 4·5-6 h after onset, and infarct growth was assessed in 63. Tissue plasminogen activator was associated with lower relative growth (94% vs. 168%, P = 0·03) and a trend to lower absolute growth (-0·17 ml versus 9·6 ml, P = 0·07). Reperfusion was increased in the tissue plasminogen activator group (58% versus 25%, P = 0·03) and was associated with increased rates of good neurological (86% versus 28% P < 0·001) and functional (modified Rankin scale 0-2 73% versus 34%, P = 0·01) outcomes. Reperfusion was strongly associated with lower relative (80% versus 189%, P < 0·001) and absolute (-2·5 ml versus 40 ml, P < 0·001) infarct growth. Thrombolysis 4·5-6 h after stroke onset reduced infarct growth and increased the rate of reperfusion, which was associated with good neurological and functional outcome.
    International Journal of Stroke 11/2013; · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Thrombolysis with tissue plasminogen activator is proven to reduce disability when given within 4·5 h of ischemic stroke onset. However, tissue plasminogen activator only succeeds in recanalizing large vessel arterial occlusion in a minority of patients. We hypothesized that anterior circulation ischemic stroke patients, selected with 'dual target' vessel occlusion and evidence of salvageable brain using computed tomography or magnetic resonance imaging 'mismatch' within 4·5 h of onset, would have improved reperfusion and early neurological improvement when treated with intra-arterial clot retrieval after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone. EXTEND-IA is an investigator-initiated, phase II, multicenter prospective, randomized, open-label, blinded-endpoint study. Ischemic stroke patients receiving standard 0·9 mg/kg intravenous tissue plasminogen activator within 4·5 h of stroke onset who have good prestroke functional status (modified Rankin Scale <2, no upper age limit) will undergo multimodal computed tomography or magnetic resonance imaging. Patients who also meet dual target imaging criteria: vessel occlusion (internal carotid or middle cerebral artery) and mismatch (perfusion lesion : ischemic core mismatch ratio >1·2, absolute mismatch >10 ml, ischemic core volume <70 ml) will be randomized to either clot retrieval with the Solitaire FR device after full dose intravenous tissue plasminogen activator, or tissue plasminogen activator alone. The coprimary outcome measure will be reperfusion at 24 h and favorable clinical response (reduction in National Institutes of Health Stroke Scale by ≥8 points or reaching 0-1) at day 3. Secondary outcomes include modified Rankin Scale at day 90, death, and symptomatic intracranial hemorrhage.
    International Journal of Stroke 11/2013; · 2.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Stroke and poststroke depression are common and have a profound and ongoing impact on an individual's quality of life. However, reliable biological correlates of poststroke depression and functional outcome have not been well established in humans. Our aim is to identify biological factors, molecular and imaging, associated with poststroke depression and recovery that may be used to guide more targeted interventions. In a longitudinal cohort study of 200 stroke survivors, the START - STroke imAging pRevention and Treatment cohort, we will examine the relationship between gene expression, regulator proteins, depression, and functional outcome. Stroke survivors will be investigated at baseline, 24 h, three-days, three-months, and 12 months poststroke for blood-based biological associates and at days 3-7, three-months, and 12 months for depression and functional outcomes. A sub-group (n = 100), the PrePARE: Prediction and Prevention to Achieve optimal Recovery Endpoints after stroke cohort, will also be investigated for functional and structural changes in putative depression-related brain networks and for additional cognition and activity participation outcomes. Stroke severity, diet, and lifestyle factors that may influence depression will be monitored. The impact of depression on stroke outcomes and participation in previous life activities will be quantified. Clinical significance lies in the identification of biological factors associated with functional outcome to guide prevention and inform personalized and targeted treatments. Evidence of associations between depression, gene expression and regulator proteins, functional and structural brain changes, lifestyle and functional outcome will provide new insights for mechanism-based models of poststroke depression.
    International Journal of Stroke 11/2013; · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Intravenous recombinant tissue plasminogen activator is associated with significant recanalisation failure in the setting of large artery occlusion. Endovascular treatment by stentriever achieves improved rates of recanalisation but its impact on clinical outcomes remains unclear. We hypothesise that successful recanalisation, unattentuated by age and stroke severity, is associated with improved clinical outcomes in patients treated with the Solitaire stentriever (ev3 Endovascular, Plymouth, MN, USA). We conducted a retrospective study of 60 consecutive acute ischaemic stroke patients treated with the Solitaire stentriever. The data included demographics, vascular risk factors, ictal onset time, National Institutes of Health Stroke Scale (NIHSS) score at presentation, angiographic findings, post-procedure imaging, and clinical follow-up. Recanalisation success was defined as a thrombolysis in cerebral infarction score (TICI)⩾2b. Good clinical outcome was defined as a modified Rankin Scale score (mRS)⩽2 at 3months. Of the 60 patients, the mean age was 64.1 (standard deviation 13.4) years and 68.3% were men. Median NIHSS score at presentation was 18 (interquartile range 14-22). Successful recanalisation (TICI⩾2b) was achieved in 44 patients (73.3%). Of these 44 patients, 25 patients (56.8%) achieved mRS⩽2 at 3months. Multiple logistic regression showed significant association between recanalisation success and improved clinical outcome (p=0.019). Of all patients, four (6.7%) developed symptomatic intracranial haemorrhage. Overall mortality was 28.3%. In conclusion, the Solitaire stentriever was associated with improved recanalisation rates. We showed that successful recanalisation is associated with good clinical outcomes after adjustments for age, sex and stroke severity.
    Journal of Clinical Neuroscience 10/2013; · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: CHADS2 and CHA2DS2-VASc scores are validated tools for assessing stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with 3-month stroke outcomes and evaluated the utility of these scores in stratifying 3-month stroke outcomes in both patients with and without AF. Methods: We analysed 6,612 acute ischaemic stroke patients from the Virtual International Stroke Trials Archive who received either placebo or ineffective active treatments not associated with significant cardiac complications. Outcomes included 3-month mortality, good functional outcomes defined as modified Rankin Scale score ≤1 and serious cardiac adverse events (SCAEs) defined as one of acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, life-threatening arrhythmia and cardiac death. The association between the pre-stroke CHADS2 and CHA2DS2-VASc scores and 3-month stroke outcomes was assessed using binary logistic regression. The utility of the two scores in estimating 3-month stroke outcomes was assessed using area under the receiver operator characteristic curves (AUC) and compared using the χ(2) test. Results: In this cohort, 26.5% had AF, 35.3% received IV tissue plasminogen activator (tPA), 17.7% died, 25.1% achieved good functional outcomes and 9.5% had ≥1 SCAE at 3 months. High-risk (≥2) pre-stroke CHADS2 and CHA2DS2-VASc scores are both associated with 3-month mortality (CHADS2: odds ratio, OR, 2.33, 95% confidence interval 1.81-3.00; CHA2DS2-VASc: OR 3.01, 2.00-4.80), good functional outcomes (CHADS2: OR 0.47, 0.39-0.57; CHA2DS2-VASc: OR 0.55, 0.42-0.71) and SCAEs (CHADS2: OR 1.76, 1.28-2.42; CHA2DS2-VASc: OR 2.69, 1.53-4.73) after adjusting for baseline differences in neurological impairment, tPA use and AF. The pre-stroke CHA2DS2-VASc score is better than the CHADS2 score in estimating 3-month stroke outcomes in both patients with and without AF (p ≤ 0.005 in all AUC comparisons). High-risk pre-stroke CHA2DS2-VASc score has high sensitivity for mortality (AF: 0.96, 0.94-0.98; no AF: 0.88, 0.86-0.91) and negative predictive value for SCAE (AF: 0.93, 0.87-0.96; no AF: 0.96, 0.95-0.97) within 3 months. Low risk pre-stroke CHA2DS2-VASc score has high specificity for good functional outcome (AF: 0.99, 0.98-0.994; no AF: 0.94, 0.93-0.95) at 3 months. Conclusions: The pre-stroke CHA2DS2-VASc score appears to be a simple tool for identifying patients at lower risk of poor outcomes and serious cardiac complications within 3 months following ischaemic stroke in patients with and without AF. © 2013 S. Karger AG, Basel.
    Cerebrovascular Diseases 10/2013; 36(4):273-280. · 2.81 Impact Factor
  • Australian Physiotherapy Conference, Melbourne, Australia; 10/2013
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury.Trial registration: NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010).
    Trials 09/2013; 14(1):291. · 2.21 Impact Factor

Publication Stats

481 Citations
259.61 Total Impact Points

Institutions

  • 2011–2014
    • The Florey Institute of Neuroscience and Mental Health
      Melbourne, Victoria, Australia
  • 2013
    • RMIT University
      • School of Mathematical and Geospatial Sciences
      Melbourne, Victoria, Australia
    • La Trobe University
      • Department of Physiotherapy
      Melbourne, Victoria, Australia
    • Xuanwu hospital
      Peping, Beijing, China
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
    • Fudan University
      • Department of Neurology
      Shanghai, Shanghai Shi, China
  • 2008–2013
    • University of Melbourne
      Melbourne, Victoria, Australia
  • 2011–2012
    • National Neuroscience Institute
      • Department of Neurology
      Singapore, Singapore
  • 2003–2008
    • Monash University (Australia)
      Melbourne, Victoria, Australia
  • 2006
    • University of Vic
      Vic, Catalonia, Spain