ANNOTATED

BIBLIOGRAPHY
ON
STROKE

SUBMITTED TO:

SUBMITTED BY:

Sr. Dr. Vijaya M Udumala

T.Rechel

Principal

M.Sc nursing,1st yr

JMJ College of Nursing

JMJ College of Ns

INTRODUCTION
REVIEW OF LITERATURE
A review of the literature is an essential part of our academic research
project. The review is a careful examination of a body of literature pointing toward the
answer to research question. Literature reviewed typically includes scholarly journals,
scholarly books, authoritative databases and primary sources.
Sometimes it includes newspapers, magazines, other books, films, and audio and
video tapes, and other secondary sources.
All good research and writing is guided by a review of the relevant literature. The
review literature will be the mechanism by which research is viewed as cumulative
process.
ANNOTATED BIBLIOGRAPHY
An annotated bibliographyis a list of citations of books, articles, and documents.
Each citation is followed by a brief (usually about 150 words) descriptive and evaluative
paragraph, the annotation. The purpose of the annotation is to inform the reader of the
relevance, accuracy, and quality of the sources cited.
First, locate and record citations to books, periodicals, and documents that may
contain useful information and ideas on your topic. Briefly examine and review the
actual items. Then choose those works that provide a variety of perspectives on your
Cite the book, article, or document using the appropriate style.topic.
Cite the book, article, or document using the appropriate style. Write a concise
annotation that summarizes the central theme and scope of the book or article. Include
one or more sentences thata)

Evaluate the authority or background of the author,

b)

Comment on the intended audience,

c)

Compare or contrast this work with another you have cited, or

d)

Explain how this work illuminates your bibliography topic.

INTERNET ARTICALS

1.Munshi.A,

kaul.S (2010) Genetic base of stroke, 185-190

Stroke or brain attack is a complex disease, comprising of a mix of clinically

different risk profiles, incidence rates, management and outcome. It is the third largest
killer in the world after heart attack and cancer. Genetic predisposition to stroke does
occur and has been documented in both animal models and human beings. However, a
precise definition of genetic factors responsible for stroke is still lacking because
research into genetic basis of stroke presents some unique challenges.
Studies involving twins, siblings and families have detected significant evidence
for heritability. In recent years there have been several parallels of research to establish
the functional variants of some candidate genes and the risk of stroke.
In case control studies, a family history of stroke has been shown to increase the
risk of stroke by about 75%. If there are genetic variants that predispose to stroke, a
positive family history of stroke should be a risk factor for stroke. However, these
ANNOTATEDmethodological concerns, family history studies generally support a
genetic component of stroke risk. A prospective cohort of 789 men living in Gothenburg,
Sweden, was followed for up to 18.5 years. Men whose mothers had died of stroke had
a threefold increased incidence in the risk of stroke compared with men without a
maternal history of stroke. Interestingly, the study did not find paternal history of fatal
stroke to be a risk factor for stroke in cohort members.
Genetic predisposition differs depending on stroke subtype and age, both twin
and family-history studies document a stronger genetic component in stroke patients
aged younger than 70 years in comparison with those who are older. Genetic factors
might affect stroke at various levels. They could contribute to conventional risk factors
such as hypertension, diabetes or homocysteine concentrations, which in turn have a
known genetic component. Interact with environmental factors or contribute directly to
an established stroke mechanism such as atherosclerosis. Further latency to stroke,
infarct size after vessel occlusion or stroke outcome, might also be affected by genetic
factors.

At present, although a genetic predisposition may be a risk factor in individual

patients, identifying the underlying genetic basis is usually impossible, and is clinically
irrelevant. Currently, no gene test is mandated as part of the routine assessment of
patients with ischemic stroke. However, in a minority of stroke patients, abnormalities in
a single gene are responsible for stroke. In this group, it is quite realistic to identify the
underlying genetic abnormality. This may have important implications for both clinical
management, and genetic testing of other family members.

There seems to be more than one way by which stroke genetics may alter our current
management of stroke. Further studies will hopefully tell us how far the genetic
information will assist to tailor clinical and therapeutic decisions to an individual
genotype. This will also enable the identification of pre-symptomatic at risk individuals.
Ultimately, the healthcare costs and the social burden associated with stroke might be
lowered with this kind of information.

2. S, Komoltri Wongwiangjunt C, Poungvarin N and Nilanont Y.(2015).Stroke awareness

and factors influencing hospital arrival time: a prospective observational study,
Mar;98(3):260-4.
Author find out data concerning stroke awareness and factors associated with
time of hospital arrival for acute stroke patients.
This is aprospective study comprising consecutive acute stroke patients admitted
in Siriraj Hospital, Bangkok, Thailand between August 2010 and December 2011.
Demographic data, stroke severity using the NIHSS, diagnosis and stroke awareness
questionnaire were collected. Of 217 acute stroke patients, mean age was 66 years.
Mean stroke severity was. Patients arrived at the Emergency Department within 4.5
hours (early hospital arrival: EHA) in 38.2% of the cases, 16.6% by ambulance. Only
34.6% of patients recognized that they were having stroke.
Only one-third of patients were aware of stroke symptoms. Only one in six
patients used emergency transportation. Public educational campaign is needed to
increase the community awareness of stroke warning symptoms and the urgent
emergency medical services.

3. Lip GY, Lane DA.(2015)MAY Stroke prevention in atrial fibrillation.pub med

Author find out that atrial fibrillation (AF) is associated with an increase in
mortality and morbidity, with a substantial increase in stroke and systemic
thromboembolism.
Strokes related to AF are associated with higher mortality, greater disability,
longer hospital stays and lower chance of being discharged home than strokes
unrelated to AF.
To provide an overview of current concepts and recent developments in stroke
prevention in AF, with suggestions for practical management.
The risk of stroke in AF is reduced by anticoagulant therapy. Thromboprophylaxis
can be obtained with vitamin K antagonists (VKA, eg, warfarin) or a non-VKA oral
anticoagulant (NOAC). Major guidelines emphasize the important role of oral
anticoagulation (OAC) for effective stroke prevention in AF. Initially, clinicians should
identify low-risk AF patients who do not require antithrombotic therapy. Subsequently,
patients with at least 1 stroke risk factor should be offered OAC. A patient's individual
risk of bleeding from antithrombotic therapy should be assessed, and modifiable risk
factors for bleeding should be addressed. The international normalized ratio should be
tightly controlled for patients receiving.
Stroke prevention is central to the management of AF, irrespective of a rate or
rhythm control strategy. Following the initial focus on identifying low-risk patients, all
others with 1 or more stroke risk factors should be offered OAC.

4. Wardlaw JM.et.al (2015)May. Association between brain imaging signs, early and late
outcomes, and response to intravenous alteplase after acute ischaemic stroke in the
third International Stroke Trial (IST-3)pub med,485-96
Author find that Second Brain scans are essential to exclude haemorrhage in
patients with suspected acute ischaemic stroke before treatment with alteplase.
However, patients with early ischaemic signs could be at increased risk of
haemorrhage after alteplase treatment, and little information is available about whether
pre-existing structural signs, which are common in older patients, affect response to
alteplase. We aimed to investigate the association between imaging signs on brain CT
and outcomes after alteplase. Analysis of a randomized controlled trial

.
IST-3 was a multicenter, randomized controlled trial of intravenous alteplase
versus control within 6 h of acute ischaemic stroke. The primary outcome was
independence at 6 months.
3035 patients were enrolled to IST-3 and underwent pre randomization brain CT.
Experts who were unaware of the random allocation assessed scans for early signs of
ischemia and pre-existing signs. In this prespecified analysis, we assessed interactions
between these imaging signs, symptomatic intracranial haemorrhage and independence
at 6 months, and alteplase, adjusting for age, National Institutes of Health Stroke Scale
(NIHSS) score, and time to randomization.
3017 patients were assessed in this analysis, of whom 1507 were allocated
alteplase and 1510 were assigned control.
A reduction in independence was predicted by tissue hypoattenuation, large
lesion, swelling, hyperattenuated artery, atrophy and leukoaraiosis. Symptomatic
intracranial haemorrhage was predicted by old infarct, tissue hypoattenuation and
hyperattenuated artery. Intracranial haemorrhage. However, no imaging findingsindividually or combined-modified the effect of alteplase on independence or
symptomatic intracranial haemorrhage
.
Some early ischaemic and pre-existing signs were associated with reduced
independence at 6 months and increased symptomatic intracranial haemorrhage.
Although no interaction was noted between brain imaging signs and effects of alteplase
on these outcomes, some combinations of signs increased some absolute risks. Preexisting signs should be considered, in addition to early ischaemic signs, during the
assessment of patients with acute ischaemic stroke.

5. Llull,L, Laredo.C, (2015)July, Uric Acid Therapy Improves Clinical Outcome in

Women With Acute Ischemic Stroke, American stroke association
Author find out In women with acute ischemic stroke treated with alteplase, the
administration of UA reduced infarct growth in selected patients and was better than
placebo to reach excellent outcome.

It is unknown whether women and men with acute ischemic stroke respond
similar to an antioxidant regimen administered in combination with thrombolysis. Here,
we investigated the independent effect of sex on the response to uric acid (UA) therapy
in patients with acute stroke treated with alteplase.

In the Efficacy Study of Combined Treatment With Uric Acid and r tPA in Acute
Ischemic Stroke trial, 206 women and 205 men were randomized to UA 1000 mg or
placebo. In this reanalysis of the trial, the primary outcome was the rate of excellent
outcome at 90 days.In women and men using regression models adjusted for
confounders associated with sex. The interaction of UA levels by treatment on infarct
growth was assessed in selected patients.
Excellent outcome occurred in 47 of 111 women treated with UA, and 28 of 95
treated with placebo, and in 36 of 100 men treated with UA and 38 of 105 treated with
placebo.
Treatment and sex interacted significantly with excellent outcome. Thus, UA
therapy doubled the effect of placebo to attain an excellent outcome in women, but not
in men . The interactions between treatment and serum UA levels or allantoin/UA ratio
on infarct growth were significant only in women.

JOURNAL

Andrew B. Mitchell, John W. Cole.(2015), Obesity Increases Risk of Ischemic Stroke in

Young Adults, journal of American stroke association
Andrew et.al be lives body mass index has been associated with ischemic stroke in
older populations, but its as association with stroke in younger populations is not known.
In light of the current obesity epidemic in the United States, the potential impact of
obesity on stroke risk in young adults deserves attention.

A population-based casecontrol study design with 1201 cases and 1154 controls was
used to investigate the relationship of obesity and young onset ischemic stroke. Stroke
cases were between the ages of 15 and 49 years. Logistic regression analysis was
used to evaluate the association between body mass index and ischemic stroke with
and without adjustment for comorbid conditions associated with stroke.
In analyses adjusted for age, sex, and ethnicity, obesity (body mass index >30 kg/m2)
was associated with an increased stroke risk although this increased risk was highly
attenuated and not statistically significant after adjustment for smoking, hypertension,
and diabetes mellitus.
These results indicate that obesity is a risk factor for young onset ischemic stroke and
suggest that this association may be partially mediated through hypertension, diabetes
mellitus, or other variables associated with these conditions.

2. Richard C. Becker, Heart Attack and Stroke Prevention in Women(2015)

Each year, more than one million Americans experience a heart attack, and nearly half
of them are fatal. Stroke is the leading cause of disability and the third leading cause of
death for women and men.13
Many people continue to believe that heart attacks represent a problem targeting solely
older men, yet heart disease is the number one killer of both women and men in the
United States. The difference is that among men, the risk for heart attack increases
steadily after 45 years of age. In women, the risk increases after 50 years of age.
However, younger women and men can also have heart attacks, and the current

epidemic of obesity and inactivity among our nations youth will likely shift the risk
toward occurrence at younger ages over the next one to two decades.
Each year, nearly 700 000 Americans experience either their first or second stroke, and
more than 20% of them are fatal. More women than men have strokes, and they are
more likely to die as a result. The problem is particularly serious in black Americans.48
Being familiar with factors that increase the risk for either a heart attack or stroke is the
first step toward prevention. If you have one or more of these factors, please contact
your healthcare provider to discuss the available means to reduce the risk.
In most instances, a heart attack or stroke is caused by a small blood clot lodged within
a blood vessel leading to either the heart or brain (see the Figure). The lack of blood
(and oxygen) causes injury, which increases steadily over time; therefore, prompt
recognition and medical treatment are of utmost importance.
Blood clots forming in the blood vessels serving the heart cause heart attacks; those
that develop in or travel to the blood vessels in the brain are responsible for strokes.
The signs and symptoms of heart attack and stroke are listed in the boxes. It is
important to remember that they can differ from one person to another and may wax
and wane with time. If you are not sure, it is better to seek medical advice than to wait.
Sudden weakness or numbness of face or limb on one side, Sudden, severe headache.
Difficulty talking or understanding speech. Dizziness, Sudden dimness/loss of vision,
often in one eye..
Risk Factors for Stroke
High blood pressure, Diabetes, High cholesterol. .Age (risk doubles for each decade
over 55 years of age).Family history of stroke.Smoking.Birth control pills.Atrial
fibrillation.Heart failure.Excess alcohol.Prior stroke or heart attack.Black race.Gender
(women are at greater risk than men).
women who have at least a 20% chance of a heart attack or stroke over the next 10
years.
There has been an overall improvement in the level of awareness among American
women over the past decade. Both a clear need and a large margin for improvement
exist, however, for national and community prevention programs to develop educational
programs directed toward those at greatest risk.

3. Jovin, M.D., Angel Chamorro, M.D. Thrombectomy within 8 Hours after Symptom
Onset in Ischemic Stroke Tudor G.
Jovin,M.D et.al aimed to assess the safety and efficacy of thrombectomy for the
treatment of stroke in a trial embedded within a population-based stroke reperfusion
registry.
During a 2-year period at four centers in Catalonia, Spain, we randomly assigned 206
patients who could be treated within 8 hours after the onset of symptoms of acute
ischemic stroke to receive either medical therapy and endovascular therapy with the
Solitaire stent retriever or medical therapy alone (control group). All patients had
confirmed proximal anterior circulation occlusion and the absence of a large infarct on
neuroimaging. In all study patients, the use of alteplase either did not achieve
revascularization or was contraindicated. The primary outcome was the severity of
global disability at 90 days, as measured on the modified Rankin scale. Although the
maximum planned sample size was 690, enrollment was halted early because of loss of
equipoise after positive results for thrombectomy were reported from other similar trials.

Thrombectomy reduced the severity of disability over the range of the modified Rankin
scale and led to higher rates of functional independence at 90 days. At 90 days, the
rates of symptomatic intracranial hemorrhage were 1.9% in both the thrombectomy
group and the control group, and rates of death were 18.4% and 15.5%, respectively .
Registry data indicated that only eight patients who met the eligibility criteria were
treated outside the trial at participating hospitals.
Among patients with anterior circulation stroke who could be treated within 8 hours after
symptom onset, stent retriever thrombectomy reduced the severity of post-stroke
disability and increased the rate of functional independence.

4. Toshio Imaizumi, MD, PhD, , Shigeru Inamura, MD.The Severity of White Matter
Lesions Possibly Influences Stroke Recurrence in Patients with Histories of Lacunar
Infarctions Journal of Stroke and Cerebrovascular Diseases

To investigate the recurrent stroke types associated with white matter lesions, we
prospectively observed recurrences in patients with histories of lacunar infarctions .

We prospectively analyzed the types of stroke recurrences in 305 patients

consecutively admitted to our hospital with LIs from April 2004 to December 2011.
WMLs were graded using Fazekas' grades. Recurrence-free rate curves were
generated by the KaplanMeier method using the log-rank test.
The follow-up period was months. During this period, 62 strokes recurred. The
incidences of strokes (all types), LIs, and deep intracerebral hemorrhages (ICHs)
presenting as recurrences in 112 patients with 1.5 %/year, respectively, values that were
significantly greater than those seen in 79 patients with . There was no significant
difference among Gr 0, 1, and 2-3 in incidences of recurrences presenting as lobar
ICHs, atherothrombotic infarctions, or cardioembolic infarctions. Multivariate analyses
demonstrated that Gr 2-3 significantly and independently elevated the rate of deep ICHs
or LIs presenting as recurrences after adjustment for risk factors.
The presence of high-grade WMLs elevated the rate of stroke recurrences presenting
as LIs and deep ICHs, but not other types.

5. Johan Herlitz, Birgitta WireklintSundstrm. (2010)Early identification and delay to

treatment in myocardial infarction and stroke: differences and similarities
Johan Herlitz , et.al believed that two major complications of atherosclerosis are acute
myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening
conditions characterised by the abrupt cessation of blood flow to respective organs,
resulting in an infarction. Depending on the extent of the infarction, loss of organ
function varies considerably.
In both conditions, it is possible to limit the extent of infarction with early intervention. In
both conditions, minutes count.
This In both conditions, symptoms vary considerably. Patients appear to suspect AMI
more frequently than stroke and, in the former, there is a gender gap (men suspect AMI
more frequently than women).
article aims to describe differences and similarities with regard to the way patients,
bystanders and health care providers act in the acute phase of the two diseases with
the emphasis on the pre-hospital phase.

With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical
Service (EMS) there is room for improvement in both conditions. The use of EMS
appears to be higher in stroke but the overall delay to hospital admission is shorter in
AMI. In both conditions, the fast track concept has been shown to influence the delay to
treatment considerably.
In terms of diagnostic evaluation by the EMS, more supported instruments are available
in AMI than in stroke. Knowledge of the importance of early treatment has been
reported to influence delays in both AMI and stroke.Both in AMI and stroke minutes
count and therefore the fast track concept has been introduced. Time to treatment still
appears to be longer in stroke than in AMI. In the future improvement in the early
detection as well as further shortening to start of treatment will be in focus in both
conditions. A collaboration between cardiologists and neurologists and also between
pre-hospital and in-hospital care might be fruitful.

BOOK REFERENCE

1.Brunner and Sudanths Text book of medical and surgical nursing

Author describes that the incidence of stroke definition of stroke types of stroke like
Ischemic stroke and Hemorrhagic stroke and its sub divisions also given in this book.
Treatment of stroke and nursing management of stroke also explained in the text book.

2.Michael brainin and Wolf dicter heiss,(2009) Text book of Stroke medicine, Cambridge
university press,89-104
Author describes the common risk factors of stroke in detail it was mainly two types they
are Manageable risk factors and Unalterable risk factors
In manageable risk factors diet and nutrition, physical inactivity, smoking, substance
abuse, heart disease, hypertension, obesity, diabetes.
In alterable risk factors age,ethnicity,heredity,gender.
3. Christoper Kennard ,(2014).Oxford text book of stroke and cerebrovascular disease.
Oxford university press
Author describes the mainly early detection of stroke. They are mainly sudden numb
ness, tingling, weakness or loss of movement in face, arm or leg, especially on
one side of the body. Sudden vision changes, Sudden trouble speaking, Sudden
confusion or trouble speaking, Sudden confusion or trouble understanding simple
statement, Sudden problems with walking or balance.
4. Lewis, (2011). Medical surgical nursing assessment and management of clinical
problems,(7th Ed ) Elseviers publishers, Newdeihi, 1110-1120
Author describes that the incidence of stroke definition of stroke types of stroke like
Ischemic stroke and Hemorrhagic stroke and its sub divisions also given in this

book. Clinical manifestation , diagnostic findings, Treatment of stroke and

nursing management of stroke also explained in the text book.

5. Shebeer. P.basheer. Yaseen khan, (2013).A concise text book of advanced nursing
practice, Emmess publication, 230-241
Author describes that the incidence of stroke definition of stroke types of stroke. causes,
pathophysiology, Clinical manifestation , diagnostic findings, Treatment of stroke
and nursing management of stroke, prevention of stroke and complications also
explained in the text book.