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Sample records for acute cerebral stroke

  1. Radiologic manifestations of focal cerebral hyperemia in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Skriver, E B; Herning, M

    1991-01-01

    In 16 acute stroke patients with focal cerebral hyperemia angiography and regional cerebral blood flow (rCBF) were studied 1 to 4 days post stroke. CT was performed twice with and without contrast enhancement 3 +/- 1 days and 16 +/- 4 days post stroke. Angiographic evidence of focal cerebral hype...

  2. Acute cerebral paragonimiasis presenting as hemorrhagic stroke in a child.

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    Chen, Zhi; Zhu, Gang; Lin, Jiangkai; Wu, Nan; Feng, Hua

    2008-08-01

    A hemorrhagic stroke in children is rarely secondary to cerebral paragonimiasis. We describe a 9-year-old boy in whom an intracerebral hemorrhage was the leading clinical indication of acute cerebral paragonimiasis. He was hospitalized because of a sudden onset of headache, right hemiparesis, and dysarthria. A computed tomography scan revealed an intracerebral hemorrhage in the left parietal lobe. Magnetic resonance angiography did not confirm any vascular abnormalities at the location of the hematoma. Four weeks later, he presented with right hemiparesis again, and fever. A diagnosis of cerebral paragonimiasis was based on repeated magnetic resonance imaging of the brain and an enzyme-linked immunosorbent assay for paragonimiasis. The patient gradually recovered with praziquantel treatment. Cerebral paragonimiasis should be considered in the differential diagnosis of hemorrhagic strokes in children in areas where paragonimiasis is epidemic.

  3. Deviation of eyes and head in acute cerebral stroke

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    Ilg UJ

    2006-06-01

    Full Text Available Abstract Background It is a well-known phenomenon that some patients with acute left or right hemisphere stroke show a deviation of the eyes (Prévost's sign and head to one side. Here we investigated whether both right- and left-sided brain lesions may cause this deviation. Moreover, we studied the relationship between this phenomenon and spatial neglect. In contrast to previous studies, we determined not only the discrete presence or absence of eye deviation with the naked eye through clinical inspection, but actually measured the extent of horizontal eye-in-head and head-on-trunk deviation. In further contrast, measurements were performed early after stroke onset (1.5 days on average. Methods Eye-in-head and head-on-trunk positions were measured at the bedside in 33 patients with acute unilateral left or right cerebral stroke consecutively admitted to our stroke unit. Results Each single patient with spatial neglect and right hemisphere lesion showed a marked deviation of the eyes and the head to the ipsilesional, right side. The average spontaneous gaze position in this group was 46° right, while it was close to the saggital body midline (0° in the groups with acute left- or right-sided stroke but no spatial neglect as well as in healthy subjects. Conclusion A marked horizontal eye and head deviation observed ~1.5 days post-stroke is not a symptom associated with acute cerebral lesions per se, nor is a general symptom of right hemisphere lesions, but rather is specific for stroke patients with spatial neglect. The evaluation of the patient's horizontal eye and head position thus could serve as a brief and easy way helping to diagnose spatial neglect, in addition to the traditional paper-and-pencil tests.

  4. Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds.

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    Shi, Zhong-Song; Duckwiler, Gary R; Jahan, Reza; Tateshima, Satoshi; Gonzalez, Nestor R; Szeder, Viktor; Saver, Jeffrey L; Kim, Doojin; Ali, Latisha K; Starkman, Sidney; Vespa, Paul M; Salamon, Noriko; Villablanca, J Pablo; Viñuela, Fernando; Feng, Lei; Loh, Yince; Liebeskind, David S

    2016-06-01

    The influence of cerebral microbleeds (CMBs) on post-thrombolytic hemorrhagic transformation (HT) in patients with acute ischemic stroke remains controversial. To investigate the association of CMBs with HT and clinical outcomes among patients with large-vessel occlusion strokes treated with mechanical thrombectomy. We analyzed patients with acute stroke treated with Merci Retriever, Penumbra system or stent-retriever devices. CMBs were identified on pretreatment T2-weighted, gradient-recall echo MRI. We analyzed the association of the presence, burden, and distribution of CMBs with HT, procedural complications, in-hospital mortality, and clinical outcome. CMBs were detected in 37 (18.0%) of 206 patients. Seventy-three foci of microbleeds were identified. Fourteen patients (6.8%) had ≥2 CMBs, only 1 patient had ≥5 CMBs. Strictly lobar CMBs were found in 12 patients, strictly deep CMBs in 12 patients, strictly infratentorial CMBs in 2 patients, and mixed CMBs in 11 patients. There were no significant differences between patients with CMBs and those without CMBs in the rates of overall HT (37.8% vs 45.6%), parenchymal hematoma (16.2% vs 19.5%), procedure-related vessel perforation (5.4% vs 7.1%), in-hospital mortality (16.2% vs 18.3%), and modified Rankin Scale score 0-3 at discharge. CMBs were not independently associated with HT or in-hospital mortality in patients treated with either thrombectomy or intravenous thrombolysis followed by thrombectomy. Patients with CMBs are not at increased risk for HT and mortality following mechanical thrombectomy for acute stroke. Excluding such patients from mechanical thrombectomy is unwarranted. The risk of HT in patients with ≥5 CMBs requires further study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Cerebral blood flow velocity changes during upright positioning in bed after acute stroke : An observational study

    NARCIS (Netherlands)

    Aries, Marcel J; Elting, Jan Willem; Stewart, Roy; De Keyser, Jacques; Kremer, Berry; Vroomen, Patrick

    2013-01-01

    Objectives: National guidelines recommend mobilisation in bed as early as possible after acute stroke. Little is known about the influence of upright positioning on real-time cerebral flow variables in patients with stroke. We aimed to assess whether cerebral blood flow velocity (CBFV) changes signi

  6. Patterns of regional cerebral blood flow in acute stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Skriver, E B

    1981-01-01

    In a consecutive group of 56 stroke patients the regional cerebral blood flow was measured within 84 hours after stroke. A 254 multidetector scintillation camera and the intracarotid Xenon-133 injection method was used to study rCBF. Typical rCBF-patterns are described and compared to the findings...

  7. [Application of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction].

    Science.gov (United States)

    Wang, Zhi-min; Wang, Peng; Chen, Jie; Luo, Dan-hong; Shen, Wang-ming

    2008-07-01

    To evaluate the efficacy of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction. 77 acute cerebral infarction patients were randomly assigned to stroke rehabilitation unit group and 73 to ordinary group. The NIH stroke scale (NIHSS), activities of daily living (ADL) Barthel index and average hospitalized time were compared in two groups before and after the treatment. The average NIHSS in two groups before treatment were 9.26 and 9.12 respectively (P > 0.05) but became 2.62 and 7.64 after treatment (P 0.05) but 87.26 and 64.20 after the treatment (P stroke rehabilitation unit being applied in the acute phase of cerebral infarction, it showed positive results in the following aspects as: improving the neurological function, capabilities of managing daily life, and also shortening the days of hospitalization.

  8. Report of moderate or severe sodium and chloride disturbance on 82 cases with acute cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    Ma shun-tian

    2000-01-01

    Abtract Objective: To decrease the fatality rate and prevalence rotc of acute cerebral stroke complicated with morderate or servere serum sodium and chioride disturbance by explonng the relation between the pathogency and prognosis Methods: Medical records were surveyed and clinical presentation, laboratory test, complicated。 Actiology pathogency and prognosis were analyzed m 82 cases with moderate or severe serum sodium and chloride disturbance among 736 cases with acute cerebral stroke collected, Results: The prevalence rate and fatality rate of acutc cerebral stroke complicated with moderate or severe serum sodium and chlorede disturbance were 11.3% (82/ 736) and 60.8% (49/52) which were different significantly form that complicated with normal or minimal sedium sodium and chloride disturbame (p (0.001) 。 The 82 cases occured at 3-13 days after hospitalization (mean 6 days) 。 The actiology and pathogency were mainly ralated with some endogenic and iatrogenic factors such as hypothalamic-pituitary system were destroyed resultly from acute cerbral stroke which led to SIADH。 Conclusion: The fatality rate of acute cerebral stroke complicatee with moderate or seyere serum sodium and chloride disturbance is mcreased significantly, Put prophylaxis first to decrease the prevalence rate and fatalty rate。 Pay attlention to comprehensive therapy of acute cerebral stoke to prevent endogenic sodium and chloride disturbance and especially place importance on iatrogenic disturbance。

  9. Thrombolytic therapy. From myocardial to cerebral infarction. The MAST-I Group. Multicentre Acute Stroke Trial.

    Science.gov (United States)

    Candelise, L; Roncaglioni, C; Aritzu, E; Ciccone, A; Maggioni, A P

    1996-02-01

    Thrombolysis is proposed for the acute treatment of cerebral infarction as it is able to recanalize occluded arteries and thus potentially restore normal perfusion of the cerebral parenchyma, but the results concerning the efficacy of this treatment are still inconclusive. However, it has been fully demonstrated that thrombolytic treatment, leads to a significant reduction in mortality, in patients with acute myocardial infarction. Data from all of the pilot studies using SK or tPA treatment in acute stroke are described in this review, which underlines the incidence of hemorrhagic transformation (hemorrhagic infart and parenchymal hematoma) and its possible correlation to clinical worsening. Pharmacological, experimental and clinical studies encourage the carrying out of large-scale clinical trials using thrombolytics in patients with acute cerebral infarction. Significant data relating to ongoing controlled clinical trials will be available in the near future; only after the analysis of these results will it be possible to confirm the efficacy of thrombolytics in acute stroke.

  10. The Longitudinal Evolution of Cerebral Blood Flow Regulation after Acute Ischaemic Stroke

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    Angela S.M. Salinet

    2014-08-01

    Full Text Available Background: Acute stroke is known to impair cerebral blood flow (CBF regulation, but the longitudinal changes of these effects have been poorly reported. The main CBF regulatory mechanisms [cerebral autoregulation (CA and neurovascular coupling (NVC] were assessed over 3 months after acute ischaemic stroke. Methods: Recordings of CBF velocity (CBFv, blood pressure (BP, and end-tidal CO2 were performed during 5 min baseline and 1 min passive movement of the elbow. Stroke patients were assessed Results: Fifteen acute stroke subjects underwent all 4 sessions and were compared to 22 control subjects. Baseline recordings revealed a significantly lower CBFv in the affected hemisphere within 72 h after stroke compared to controls (p = 0.02 and a reduction in CA index most marked at 2 weeks (p = 0.009. CBFv rise in response to passive arm movement was decreased bilaterally after stroke, particularly in the affected hemisphere (p Conclusion: The major novel finding of this study was that both CA and NVC regulatory mechanisms deteriorated initially following stroke onset, but returned to control levels during the recovery period. These findings are relevant to guide the timing of interventions to manipulate BP and potentially for the impact of intensive rehabilitation strategies that may precipitate acute physiological perturbations but require further exploration in a larger population that better reflects the heterogeneity of stroke. Further, they will also enable the potential influence of stroke subtype to be investigated.

  11. Validation of hyperintense middle cerebral artery sign in acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Gang Guo; Yonggui Yang; Weiqun Yang

    2012-01-01

    We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.

  12. Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia

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    Kepplinger, Jessica; Barlinn, Kristian; Albright, Karen C.; Schrempf, Wiebke; Boehme, Amelia K.; Pallesen, Lars-Peder; Schwanebeck, Uta; Graehlert, Xina; Storch, Alexander; Reichmann, Heinz; Alexandrov, Andrei V.; Bodechtel, Ulf

    2017-01-01

    Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 % of studied patients. We enrolled 61 patients (84 % AIS, 16 % TIA): mean age 66 ± 8 years, 44 % men, median NIHSS 1 (0–15), median ESS 5 (0–13). Analyzability was given in 56/61 (91.8 %; one-sided 95 % CI, lower-bound 86.0 %) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 % in TIA, 91 % minor stroke, 83 % major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea–hypopnea index ≥5/h (median: 20/h [0–79]); 32 % (18/ 56) mild, 30 % (17/56) moderate, and 29 % (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 %, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 %, p = 0.69) of SA. After 12 months, 27/38 (71 %) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 %) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients. PMID:23263538

  13. Decreased uric acid levels correlate with poor outcomes in acute ischemic stroke patients, but not in cerebral hemorrhage patients.

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    Wu, Hongliang; Jia, Qian; Liu, Gaifen; Liu, Liping; Pu, Yuehua; Zhao, Xingquan; Wang, Chunxue; Wang, Yilong; Wang, Yongjun

    2014-03-01

    The relationship between uric acid and stroke prognosis is ambiguous. Some studies have explored this relationship in acute stroke but have different results. In this study, we explored the relationship between uric acid levels and 1-year outcomes and vascular events of acute ischemic stroke patients and cerebral hemorrhage patients. In all, 1452 continued first, acute ischemic stroke patients and 380 continued cerebral hemorrhage patients were admitted to our hospitals. Serum uric acid concentrations were measured in 1351 ischemic stroke patients and 380 cerebral hemorrhage patients at admission. We evaluated the relationship between uric acid levels and outcomes (modified Rankin scale [mRS] > 2, all-cause death, vascular events, stroke recurrent) at 14 days, 90 days, and 1 year after stroke onset. The median uric acid concentration was 303.0 μmol/L in ischemic stroke patients and 269 μmol/L in cerebral hemorrhage patients. In univariate analysis, uric acid levels were not correlated with outcomes in cerebral hemorrhage patients. We used multiple logistic regression analysis to show that lower serum uric acid levels independently predicted poor functional outcomes (mRS >2) at 1 year after ischemic stroke onset (odds ratio [OR] = .335, 95% confidence interval [CI]: .164-.684, P = .003). Also, lower serum uric acid levels were independently correlated with vascular events in the first year in ischemic stroke patients. By multiple cox proportional hazards analysis, we obtained data which reveal that serum uric acid levels were not correlated with all-cause death (OR = .992, 95% CI: .683-1.443, P = .969) in ischemic stroke patients. Serum uric acid may be neuroprotective in acute ischemic stroke patients. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Cerebral blood volume affects blood–brain barrier integrity in an acute transient stroke model

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    Huang, Shuning; Kim, Jeong Kon; Atochin, Dmitriy N; Farrar, Christian T; Huang, Paul L; Suh, Ji Yeon; Kwon, Seon Joo; Shim, Woo Hyun; Cho, Hyungjoon; Cho, Gyunggoo; Kim, Young Ro

    2013-01-01

    Insufficient vascular reserve after an ischemic stroke may induce biochemical cascades that subsequently deteriorate the blood–brain barrier (BBB) function. However, the direct relationship between poor cerebral blood volume (CBV) restoration and BBB disruption has not been examined in acute stroke. To quantify BBB integrity at acute stages of transient stroke, in particular for cases in which extravasation of the standard contrast agent (Gd-DTPA) is not observed, we adopted the water exchange index (WEI), a novel magnetic resonance image-derived parameter to estimate the water permeability across the BBB. The apparent diffusion coefficient (ADC) and R2 relaxation rate constant were also measured for outlining the tissue abnormality, while fractional CBV and WEI were quantified for assessing vascular alterations. The significantly decreased ADC and R2 in the ischemic cortices did not correlate with the changes in CBV or WEI. In contrast, a strong negative correlation between the ipsilesional WEI and CBV was found, in which stroke mice were clustered into two groups: (1) high WEI and low CBV and (2) normal WEI and CBV. The low CBV observed for mice with a disrupted BBB, characterized by a high WEI, indicates the importance of CBV restoration for maintaining BBB stability in acute stroke. PMID:23462571

  15. Doppler Ultrasonographic Parameters for Predicting Cerebral Vascular Reserve in Patients with Acute Ischemic Stroke

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    Jung, Han Young; Lee, Hui Joong; Kim, Hye Jung; Kim, Yong Sun; Kang, Duk Sik [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2006-03-15

    We investigated Doppler ultrasonographic (US) parameters of patients with acute stroke to predict the cerebral vascular reserve (CVR) measured by SPECT. We reviewed the flow velocity and cross-sectional area of the circular vessel at the common, external, and internal carotid arteries (ICA) and the vertebral arteries (VA) in 109 acute stroke patients who underwent SPECT. Flow volume (FV) of each artery was calculated as the product of the angle-corrected time averaged flow velocity and cross-sectional area of the circular vessel. Total cerebral FV (TCBFV) was determined as the sum of the FVs of the right and left ICA and VA. We compared the Doppler US parameters between 44 cases of preserved and 65 cases of impaired CVR. In the preserved CVR group, ICA FV, anterior circulating FV (ACFV) and TCBFV were higher than in the impaired CVR group (p < 0.05, independent t-test). In the impaired CVR group, the ROC curves showed ACFV and TCBFV were suitable parameters to predict CVR (p < 0.05). Doppler US was helpful for understanding the hemodynamic state of acute stroke. FV measurement by Doppler US was useful for predicting CVR

  16. Focal cerebral hyperemia in acute stroke. Incidence, pathophysiology and clinical significance

    DEFF Research Database (Denmark)

    Olsen, T S; Larsen, B; Skriver, E B

    1981-01-01

    In a consecutive study comprising 41 patients with completed stroke of less than 72 hours duration, cerebral angiography and measurements of the regional cerebral blood flow (rCBF) were performed within 24 hours after admission. The rCBF study was done using the 133-Xenon intracarotid injection...... method and a 254 multi-detector camera. CT scan was done 24 hours after the rCBF study. Focal cerebral hyperemia was found in 16 patients. The study revealed 3 different types of hyperemia: Border-zone hyperemia, surrounding ischemic areas, was seen in patients with occluded arteries on angiography......, presumably resulting from accumulation of acid metabolites in the border-zone of acute infarcts. Postischemic hyperemia was seen in patients without occlusion, presumably due to recanalization of a prior occluded artery. Remote hyperemia was found distant from the infarcted area, presumably due to local...

  17. Cerebrolysin effects on neurological outcomes and cerebral blood flow in acute ischemic stroke

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    Amiri-Nikpour MR

    2014-12-01

    Full Text Available Mohammad Reza Amiri-Nikpour,1 Surena Nazarbaghi,1 Babak Ahmadi-Salmasi,1 Tayebeh Mokari,2 Urya Tahamtan,2 Yousef Rezaei3 1Department of Neurology, Imam Khomeini Hospital, 2School of Medicine, 3Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran Background: Cerebrolysin, a brain-derived neuropeptide, has been shown to improve the neurological outcomes of stroke, but no study has demonstrated its effect on cerebral blood flow. This study aimed to determine the cerebrolysin impact on the neurological outcomes and cerebral blood flow. Methods: In a randomized, double-blinded, placebo-controlled trial, 46 patients who had acute focal ischemic stroke were randomly assigned into two groups to receive intravenously either 30 mL of cerebrolysin diluted in normal saline daily for 10 days (n=23 or normal saline alone (n=23 adjunct to 100 mg of aspirin daily. All patients were examined using the National Institutes of Health Stroke Scale and transcranial Doppler to measure the mean flow velocity and pulsatility index (PI of their cerebral arteries at baseline as well as on days 30, 60, and 90. Results: The patients’ mean age was 60±9.7 years, and 51.2% of patients were male. The National Institutes of Health Stroke Scale was significantly lower in the cerebrolysin group compared with the placebo group on day 60 (median 10, interquartile range 9–11, P=0.008 and day 90 (median 11, interquartile range 10–13.5, P=0.001. The median of PI in the right middle cerebral artery was significantly lower in the cerebrolysin group compared with the placebo group on days 30, 60, and 90 (P<0.05. One patient in the cerebrolysin group and two patients in the placebo group died before day 30 (4.3% versus 8.7%. Conclusion: Cerebrolysin can be useful to improve the neurological outcomes and the PI of middle cerebral artery in patients with acute focal ischemic stroke. Keywords: ischemic stroke, cerebrolysin, neuroprotection, NIHSS, mean

  18. Lower Serum Caveolin-1 Is Associated with Cerebral Microbleeds in Patients with Acute Ischemic Stroke

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    Zhang, Jun; Zhu, Wusheng; Xiao, Lulu; Cao, Qinqin; Zhang, Hao; Wang, Huaiming; Ye, Zusen; Hao, Yonggang; Dai, Qiliang; Sun, Wen; Liu, Xinfeng; Ye, Ruidong

    2016-01-01

    Caveolin-1 (Cav-1) plays pivotal roles in the endothelial damage following stroke. The present study aimed to investigate whether serum Cav-1 level is associated with the presence of cerebral small vessel disease (cSVD) in patients with acute ischemic stroke. To this end, 156 patients were consecutively enrolled. Cranial magnetic resonance imaging was analyzed to determine the surrogates of cSVD, including cerebral microbleeds (CMBs), silent lacunar infarcts (SLIs), and white matter hyperintensities (WMHs). After adjusting for potential confounders, patients with low Cav-1 level had a higher risk of CMBs than patients with high Cav-1 level (OR: 4.05, 95% CI: 1.77–9.30). However, there was no relationship between Cav-1 and the presence of SLIs or WMHs. When CMBs were stratified by location and number, a similar association was found in patients with deep or infratentorial CMBs (OR: 4.04, 95% CI: 1.59–10.25) and with multiple CMBs (OR: 3.18, 95% CI: 1.16–8.72). These results suggest lower serum Cav-1 levels may be associated with CMBs, especially those that are multiple and located in deep brain or infratentorial structures, in patients with acute ischemic stroke. Cav-1 may be involved in the pathophysiology of CMBs, and may act as a potential target for treating cSVD. PMID:27119011

  19. Lower Serum Caveolin-1 Is Associated with Cerebral Microbleeds in Patients with Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Jun Zhang

    2016-01-01

    Full Text Available Caveolin-1 (Cav-1 plays pivotal roles in the endothelial damage following stroke. The present study aimed to investigate whether serum Cav-1 level is associated with the presence of cerebral small vessel disease (cSVD in patients with acute ischemic stroke. To this end, 156 patients were consecutively enrolled. Cranial magnetic resonance imaging was analyzed to determine the surrogates of cSVD, including cerebral microbleeds (CMBs, silent lacunar infarcts (SLIs, and white matter hyperintensities (WMHs. After adjusting for potential confounders, patients with low Cav-1 level had a higher risk of CMBs than patients with high Cav-1 level (OR: 4.05, 95% CI: 1.77–9.30. However, there was no relationship between Cav-1 and the presence of SLIs or WMHs. When CMBs were stratified by location and number, a similar association was found in patients with deep or infratentorial CMBs (OR: 4.04, 95% CI: 1.59–10.25 and with multiple CMBs (OR: 3.18, 95% CI: 1.16–8.72. These results suggest lower serum Cav-1 levels may be associated with CMBs, especially those that are multiple and located in deep brain or infratentorial structures, in patients with acute ischemic stroke. Cav-1 may be involved in the pathophysiology of CMBs, and may act as a potential target for treating cSVD.

  20. Aortic arch and intra-/extracranial cerebral arterial atherosclerosis in patients suffering acute ischemic strokes

    Institute of Scientific and Technical Information of China (English)

    郭毅; 姜昕; 陈实; 张少文; 赵宏文; 吴瑛

    2003-01-01

    Objective To determine the distribution of aortic arch and intra/extracranial cerebral arterial atherosclerosis in Chinese patients who had suffered acute ischemic strokes. Methods Eighty-nine patients with acute ischemic strokes were included in this study. Transesophageal echocardiography (TEE) was used to evaluate potential sources of embolisms in the aortic arch and in the heart; duplex ultrasound was used for the carotid artery; and intracranial Doppler (TCD) imaging was used for the middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), and basilar artery (BA). An atherosclerotic lesion in the aortic arch was defined as normal (0); mild plaque (1); moderate plaque (2); and protruding plaque or mobile plaque (3). A lesion in the carotid artery was considered a plaque if the maximal carotid plaque thickness was 1.2 mm. TCD results were deemed abnormal if flow velocity was either greater or lower than normal, and, in the case of the MCA, if an asymmetry index above 21% was measured. Results Of the 89 patients, 52 (58.43%) patients showed evidence of aortic arch atherosclerosis (AAA), including 11 (12.36%) patients graded mild, 18 (20.22%) patients graded moderate, and 23 (25.84%) patients graded severe. Of the 23 patients with severe AAA, AAA was determined to be an important potential embolic source in 14 patients. Forty-nine (50.56%) patients had carotid arterial plaques (CAPs). The incidence of carotid plaques was higher among patients with AAA than among patients without AAA (71.15% vs 21.62%, OR=3.291, 95% CI=1.740-6.225, P<0.001). TCD abnormalities affecting the MCA were found in 54 (60.67%) patients. Differences in incidence of TCD abnormalities between patients with AAA and without AAA (69.23% vs 48.65%) were not significant (OR=1.423, 95% CI=0.976-2.076, P=0.05). There was a higher incidence of AAA in older, male patients with a history of diabetes and smoking. Conclusions AAA is an important potential source of

  1. Cerebral lactate production and blood flow in acute stroke

    DEFF Research Database (Denmark)

    Henriksen, O; Gideon, P; Sperling, B

    1992-01-01

    that follows reperfusion. The amount of lactate present in the acute phase reflects the severity of ischemia in the affected region. The lactate level was still above normal in the subacute phase with hyperemia, suggesting lactate production through aerobic glycolysis. Thus, the lactate level in the subacute...... phase probably does not reflect the degree of anaerobic glycolysis in hypoxic neuronal tissue....

  2. Imaging Evidence for Cerebral Hyperperfusion Syndrome after Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke

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    Yi Zhang

    2016-01-01

    Full Text Available Background. Cerebral hyperperfusion syndrome (CHS, a rare complication after cerebral revascularization, is a well-described phenomenon after carotid endarterectomy or carotid artery stenting. However, the imaging evidence of CHS after intravenous tissue plasminogen activator (iv tPA for acute ischemic stroke (AIS has not been reported. Case Report. Four patients were determined to have manifestations of CHS with clinical deterioration after treatment with iv tPA, including one patient who developed seizure, one patient who had a deviation of the eyes toward lesion with worsened mental status, and two patients who developed worsened hemiparesis. In all four patients, postthrombolysis head CT examinations were negative for hemorrhage; CT angiogram showed patent cervical and intracranial arterial vasculature; CT perfusion imaging revealed hyperperfusion with increased relative cerebral blood flow and relative cerebral blood volume and decreased mean transit time along with decreased time to peak in the clinically related artery territory. Vascular dilation was also noted in three of these four cases. Conclusions. CHS should be considered in patients with clinical deterioration after iv tPA and imaging negative for hemorrhage. Cerebral angiogram and perfusion studies can be useful in diagnosing CHS thereby helping with further management.

  3. The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model.

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    Østergaard, Leif; Jespersen, Sune Nørhøj; Mouridsen, Kim; Mikkelsen, Irene Klærke; Jonsdottír, Kristjana Ýr; Tietze, Anna; Blicher, Jakob Udby; Aamand, Rasmus; Hjort, Niels; Iversen, Nina Kerting; Cai, Changsi; Hougaard, Kristina Dupont; Simonsen, Claus Z; Von Weitzel-Mudersbach, Paul; Modrau, Boris; Nagenthiraja, Kartheeban; Riisgaard Ribe, Lars; Hansen, Mikkel Bo; Bekke, Susanne Lise; Dahlman, Martin Gervais; Puig, Josep; Pedraza, Salvador; Serena, Joaquín; Cho, Tae-Hee; Siemonsen, Susanne; Thomalla, Götz; Fiehler, Jens; Nighoghossian, Norbert; Andersen, Grethe

    2013-05-01

    The pathophysiology of cerebral ischemia is traditionally understood in relation to reductions in cerebral blood flow (CBF). However, a recent reanalysis of the flow-diffusion equation shows that increased capillary transit time heterogeneity (CTTH) can reduce the oxygen extraction efficacy in brain tissue for a given CBF. Changes in capillary morphology are typical of conditions predisposing to stroke and of experimental ischemia. Changes in capillary flow patterns have been observed by direct microscopy in animal models of ischemia and by indirect methods in humans stroke, but their metabolic significance remain unclear. We modeled the effects of progressive increases in CTTH on the way in which brain tissue can secure sufficient oxygen to meet its metabolic needs. Our analysis predicts that as CTTH increases, CBF responses to functional activation and to vasodilators must be suppressed to maintain sufficient tissue oxygenation. Reductions in CBF, increases in CTTH, and combinations thereof can seemingly trigger a critical lack of oxygen in brain tissue, and the restoration of capillary perfusion patterns therefore appears to be crucial for the restoration of the tissue oxygenation after ischemic episodes. In this review, we discuss the possible implications of these findings for the prevention, diagnosis, and treatment of acute stroke.

  4. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke

    National Research Council Canada - National Science Library

    Higashida, Randall T; Furlan, Anthony J; Roberts, Heidi; Tomsick, Thomas; Connors, Buddy; Barr, John; Dillon, William; Warach, Steven; Broderick, Joseph; Tilley, Barbara; Sacks, David

    2003-01-01

    .... A number of well-designed randomized stroke trials and case series have now been reported in the literature to evaluate the safety and efficacy of thrombolytic therapy for the treatment of acute ischemic stroke...

  5. Toward fully automated processing of dynamic susceptibility contrast perfusion MRI for acute ischemic cerebral stroke.

    Science.gov (United States)

    Kim, Jinsuh; Leira, Enrique C; Callison, Richard C; Ludwig, Bryan; Moritani, Toshio; Magnotta, Vincent A; Madsen, Mark T

    2010-05-01

    We developed fully automated software for dynamic susceptibility contrast (DSC) MR perfusion-weighted imaging (PWI) to efficiently and reliably derive critical hemodynamic information for acute stroke treatment decisions. Brain MR PWI was performed in 80 consecutive patients with acute nonlacunar ischemic stroke within 24h after onset of symptom from January 2008 to August 2009. These studies were automatically processed to generate hemodynamic parameters that included cerebral blood flow and cerebral blood volume, and the mean transit time (MTT). To develop reliable software for PWI analysis, we used computationally robust algorithms including the piecewise continuous regression method to determine bolus arrival time (BAT), log-linear curve fitting, arrival time independent deconvolution method and sophisticated motion correction methods. An optimal arterial input function (AIF) search algorithm using a new artery-likelihood metric was also developed. Anatomical locations of the automatically determined AIF were reviewed and validated. The automatically computed BAT values were statistically compared with estimated BAT by a single observer. In addition, gamma-variate curve-fitting errors of AIF and inter-subject variability of AIFs were analyzed. Lastly, two observes independently assessed the quality and area of hypoperfusion mismatched with restricted diffusion area from motion corrected MTT maps and compared that with time-to-peak (TTP) maps using the standard approach. The AIF was identified within an arterial branch and enhanced areas of perfusion deficit were visualized in all evaluated cases. Total processing time was 10.9+/-2.5s (mean+/-s.d.) without motion correction and 267+/-80s (mean+/-s.d.) with motion correction on a standard personal computer. The MTT map produced with our software adequately estimated brain areas with perfusion deficit and was significantly less affected by random noise of the PWI when compared with the TTP map. Results of image

  6. Acute ischemic cerebral attack

    OpenAIRE

    Franco-Garcia Samir; Barreiro-Pinto Belis

    2010-01-01

    The decrease of the cerebral blood flow below the threshold of autoregulation led to changes of cerebral ischemia and necrosis that traduce in signs and symtoms of focal neurologic dysfunction called acute cerebrovascular symdrome (ACS) or stroke. Two big groups according to its etiology are included in this category the hemorragic that constitue a 20% and the ischemic a 80% of cases. Great interest has wom the ischemic ACS because of its high social burden, being the third cause of no violen...

  7. Correlation between cerebral microbleeds and S100B/RAGE in acute lacunar stroke patients.

    Science.gov (United States)

    Xiao, Lulu; Sun, Wen; Lan, Wenya; Xiong, Yunyun; Duan, Zuowei; Zhang, Zongjun; Fan, Wenping; Xu, Lili; Xie, Xia; Ma, Nan; Ye, Ruidong; Xu, Gelin; Liu, Xinfeng; Zhu, Wusheng

    2014-05-15

    S100B and its scavenger, soluble receptor for advanced glycation end products (sRAGE), participate in various acute and chronic brain disorders. However, their impact on hemorrhage-prone small vessel disease represented by cerebral microbleeds (CMBs) is unclear. The purpose of this study was to investigate the relationship of CMBs with plasma S100B and sRAGE. A cohort of 147 consecutive patients with first-ever acute lacunar stroke was prospectively enrolled. We collected demographic, clinical, and laboratory data, including plasma levels of S100B and sRAGE, and presence and number of CMBs using susceptibility-weighted imaging (SWI). Associations between plasma S100B, sRAGE levels and the presence, number, and location of CMBs were determined. CMBs were present in 58 patients (39.5%). Each 1SD-increase in S100B and sRAGE levels was significantly associated with presence of CMBs (adjusted odds ratio [OR], 3.06; 95% confidence interval [CI], 1.81-5.17 and adjusted OR, 0.29; 95% CI, 0.16-0.53; respectively) and number of CMBs (adjusted relative risk [RR], 4.07; 95% CI, 3.60-5.65 for S100B and RR 0.34; 95% CI, 0.25-0.46 for sRAGE). When stratified by location, plasma S100B and sRAGE levels were similarly associated with presence of deep CMBs (adjusted OR, 3.65; 95% CI, 1.99-6.69 and adjusted OR, 0.23; 95% CI, 0.12-0.46; respectively), but not with strictly lobar CMBs. Higher levels of S100B and lower levels of sRAGE are independently associated with presence and number of CMBs in patients with first-ever acute lacunar stroke, particularly in those with deep CMBs. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. The longitudinal changes of BOLD response and cerebral hemodynamics from acute to subacute stroke. A fMRI and TCD study

    Directory of Open Access Journals (Sweden)

    Hamzei Farsin

    2009-12-01

    Full Text Available Abstract Background By mapping the dynamics of brain reorganization, functional magnetic resonance imaging MRI (fMRI has allowed for significant progress in understanding cerebral plasticity phenomena after a stroke. However, cerebro-vascular diseases can affect blood oxygen level dependent (BOLD signal. Cerebral autoregulation is a primary function of cerebral hemodynamics, which allows to maintain a relatively constant blood flow despite changes in arterial blood pressure and perfusion pressure. Cerebral autoregulation is reported to become less effective in the early phases post-stroke. This study investigated whether any impairment of cerebral hemodynamics that occurs during the acute and the subacute phases of ischemic stroke is related to changes in BOLD response. We enrolled six aphasic patients affected by acute stroke. All patients underwent a Transcranial Doppler to assess cerebral autoregulation (Mx index and fMRI to evaluate the amplitude and the peak latency (time to peak-TTP of BOLD response in the acute (i.e., within four days of stroke occurrence and the subacute (i.e., between five and twelve days after stroke onset stroke phases. Results As patients advanced from the acute to subacute stroke phase, the affected hemisphere presented a BOLD TTP increase (p = 0.04 and a deterioration of cerebral autoregulation (Mx index increase, p = 0.046. A similar but not significant trend was observed also in the unaffected hemisphere. When the two hemispheres were grouped together, BOLD TTP delay was significantly related to worsening cerebral autoregulation (Mx index increase (Spearman's rho = 0.734; p = 0.01. Conclusions The hemodynamic response function subtending BOLD signal may present a delay in peak latency that arises as patients advance from the acute to the subacute stroke phase. This delay is related to the deterioration of cerebral hemodynamics. These findings suggest that remodeling the fMRI hemodynamic response function in the

  9. Very low cerebral blood volume predicts parenchymal hematoma in acute ischemic stroke

    DEFF Research Database (Denmark)

    Hermitte, Laure; Cho, Tae-Hee; Ozenne, Brice;

    2013-01-01

    BACKGROUND AND PURPOSE: Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to exp...

  10. Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Nikoubashman, Omid [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Reich, Arno; Gindullis, Mirco; Schulz, Joerg B. [Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Frohnhofen, Katharina; Pjontek, Rastislav; Brockmann, Marc-Alexander; Wiesmann, Martin [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany)

    2014-01-15

    This study aims to investigate the clinical significance of post-interventional cerebral hyperdensities (PCHD) after endovascular mechanical thrombectomy in acute ischaemic stroke. Data of 102 consecutive patients who received post-interventional CT scans within 4.5 h after mechanical thrombectomy were analysed retrospectively. Sixty-two of 102 patients (60.8 %) had PCHD on their post-interventional CT scans. The most common site of PCHD was the basal ganglia. PCHD were persisting in 13 of 62 patients (21.0 %), and transient in the remaining 49 patients (79.0 %) within 24 h. Four patients with PCHD and four patients without PCHD suffered from parenchymal haemorrhage. Neither ASA nor Clopidogrel, Tirofiban or rtPA were risk factors for PCHD. Final infarction size was congruent with or bigger than areas of PCHD in 93.3 % of cases in our series. PCHD was not a risk factor for parenchymal haemorrhage in our series. The occurrence of PCHD was strongly related to the prior presence of infarction. PCHD was also a strong predictor for final infarction size. (orig.)

  11. Optical bedside monitoring of cerebral perfusion: technological and methodological advances applied in a study on acute ischemic stroke

    Science.gov (United States)

    Steinkellner, Oliver; Gruber, Clemens; Wabnitz, Heidrun; Jelzow, Alexander; Steinbrink, Jens; Fiebach, Jochen B.; MacDonald, Rainer; Obrig, Hellmuth

    2010-11-01

    We present results of a clinical study on bedside perfusion monitoring of the human brain by optical bolus tracking. We measure the kinetics of the contrast agent indocyanine green using time-domain near-IR spectroscopy (tdNIRS) in 10 patients suffering from acute unilateral ischemic stroke. In all patients, a delay of the bolus over the affected when compared to the unaffected hemisphere is found (mean: 1.5 s, range: 0.2 s to 5.2 s). A portable time-domain near-IR reflectometer is optimized and approved for clinical studies. Data analysis based on statistical moments of time-of-flight distributions of diffusely reflected photons enables high sensitivity to intracerebral changes in bolus kinetics. Since the second centralized moment, variance, is preferentially sensitive to deep absorption changes, it provides a suitable representation of the cerebral signals relevant for perfusion monitoring in stroke. We show that variance-based bolus tracking is also less susceptible to motion artifacts, which often occur in severely affected patients. We present data that clearly manifest the applicability of the tdNIRS approach to assess cerebral perfusion in acute stroke patients at the bedside. This may be of high relevance to its introduction as a monitoring tool on stroke units.

  12. Independent Correlation of Serum Homocysteine with Cerebral Microbleeds in Patients with Acute Ischemic Stroke due to Large-Artery Atherosclerosis.

    Science.gov (United States)

    Wang, Bian-Rong; Ou, Zhou; Jiang, Teng; Zhang, Ying-Dong; Zhao, Hong-Dong; Tian, You-Yong; Shi, Jian-Quan; Zhou, Jun-Shan

    2016-11-01

    The severity of cerebral microbleeds (CMBs) affected the prognosis of patients with acute cerebrovascular disease. Considering the impact of CMBs on clinical decision, it is necessary to assess the risk factors of CMBs. We aimed to evaluate the independent risk factors of CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. 112 patients were enrolled in the study. The baseline information, the results of laboratory examination and cranial MRI were collected. The independent risk factors of CMBs in patients with acute ischemic stroke due to large-artery atherosclerosis were evaluated. CMBs were found in 56 (50%) patients. Older age and higher homocysteine (Hcy) level were associated with an elevated chance of occurrence of CMBs. Further, there was a positive correlation between CMBs grade and serum Hcy level. Serum Hcy level is strongly associated with the presence of CMBs in patients with acute ischemic stroke due to large-artery atherosclerosis. Serum Hcy level may be a potential therapeutic target for alleviating adverse clinical outcomes of CMBs. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Eye movement training results in changes in qEEG and NIH stroke scale in subjects suffering from acute middle cerebral artery ischemic stroke: a randomized control trial

    Directory of Open Access Journals (Sweden)

    Frederick Robert Carrick

    2016-01-01

    Full Text Available Context:Eye-movement training (EMT can induce altered brain activation and change the functionality of saccades with changes of the brain in general. Objective:To determine if EMT would result in changes in qEEG and NIH Stroke Scales (NIHSS in patients suffering from acute middle cerebral artery (MCA infarction. Our hypothesis is that there would be positive changes in qEEG and NIHSS after EMT in patients suffering from acute MCA ischemic stroke.Design:Double blind randomized controlled trial.Setting and Participants:34 subjects with acute MCA ischemic stroke at university affiliated hospital intensive care unit.Interventions:Subjects were randomized into a control group treated only with aspirin (125 mg/day and a treatment group treated with aspirin (125 mg/day and a subject specific EMT. Main Outcome measures: Delta-Alpha Ratio, Power Ratio Index and the Brain Symmetry Index calculated by quantitative electroencephalograms, and NIHSS. Results:There was strong statistical and substantive significant improvement in all outcome measures for the group of stroke patients undergoing EMT. Such improvement was not observed for the control group and there were no adverse effects.Conclusions:The addition of EMT to a MCA ischemic stroke treatment paradigm has demonstrated statistically significant changes in outcome measures and is a low cost, safe and effective complement to standard treatment.

  14. Low ankle-brachial index predicts early risk of recurrent stroke in patients with acute cerebral ischemia.

    Science.gov (United States)

    Tsivgoulis, Georgios; Bogiatzi, Chrysi; Heliopoulos, Ioannis; Vadikolias, Konstantinos; Boutati, Eleni; Tsakaldimi, Soultana; Al-Attas, Omar S; Charalampidis, Paris; Piperidou, Charitomeni; Maltezos, Efstratios; Papanas, Nikolaos

    2012-02-01

    Low ankle-brachial blood pressure index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease (PAD). We sought to investigate the association of low ABI with early risk of stroke recurrence in patients with acute cerebral ischemia (ACI) and without history of symptomatic PAD. Consecutive patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and no previous history of PAD were prospectively evaluated with ABI measurements. Demographic characteristics, vascular risk factors and secondary prevention therapies were documented. An ABI ≤0.90 in either leg was considered as evidence of asymptomatic PAD, and an ABI >0.90 was considered as normal. Patients with elevated ABI (>1.30) were excluded. The outcome of interest was recurrent stroke during 30-day follow-up. A total of 176 patients with acute cerebral ischemia (mean age 64±14 years, 59.1% men, 76.7% AIS) were evaluated. Asymptomatic PAD was detected in 14.8% (95%CI: 10.2-20.8%) of the studied population. The following factors were independently associated with low ABI on multivariate logistic regression models, after adjustment for potential confounders: coronary artery disease (p=0.008), diabetes mellitus (p=0.017) and increasing age (p=0.042). The cumulative 30-day recurrence rate was higher in patients with low ABI (19.2%; 95%CI: 4.1-34.3) compared to the rest (3.3%; 95%CI: 0.4-6.2%; p=0.001). Atherothrombotic stroke (ASCO grade I; pstroke recurrence on multivariate Cox regression models adjusting for confounders. Low ABI appears to be associated with a higher risk of early recurrent stroke in patients with ACI and no history of symptomatic PAD. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  15. Cerebrolysin effects on neurological outcomes and cerebral blood flow in acute ischemic stroke

    OpenAIRE

    Amiri-Nikpour MR; Nazarbaghi S; Ahmadi-Salmasi B; Mokari. T.; Tahamtan U; Rezaei Y

    2014-01-01

    Mohammad Reza Amiri-Nikpour,1 Surena Nazarbaghi,1 Babak Ahmadi-Salmasi,1 Tayebeh Mokari,2 Urya Tahamtan,2 Yousef Rezaei3 1Department of Neurology, Imam Khomeini Hospital, 2School of Medicine, 3Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran Background: Cerebrolysin, a brain-derived neuropeptide, has been shown to improve the neurological outcomes of stroke, but no study has demonstrated its effect on cerebral blood flow. This study aimed to determine the ce...

  16. Quantitative Measurement of Cerebral Perfusion with Intravoxel Incoherent Motion in Acute Ischemia Stroke: Initial Clinical Experience

    Institute of Scientific and Technical Information of China (English)

    Li-Bao Hu; Nan Hong; Wen-Zhen Zhu

    2015-01-01

    Background:Intravoxel incoherent motion (IVIM) has the potential to provide both diffusion and perfusion information without an exogenous contrast agent,its application for the brain is promising,however,feasibility studies on this are relatively scarce.The aim of this study is to assess the feasibility of IVIM perfusion in patients with acute ischemic stroke (AIS).Methods:Patients with suspected AIS were examined by magnetic resonance imaging within 24 h of symptom onset.Fifteen patients (mean age was 68.7 ± 8.0 years) who underwent arterial spin labeling (ASL) and diffusion-weighted imaging (DWI) were identified as having AIS with ischemic penumbra were enrolled,where ischemic penumbra referred to the mismatch areas of ASL and DWI.Eleven different b-values were applied in the biexponential model.Regions of interest were selected in ischemic penumbras and contralateral normal brain regions.Fast apparent diffusion coefficients (ADCs) and ASL cerebral blood flow (CBF) were measured.The paired t-test was applied to compare ASL CBF,fast ADC,and slow ADC measurements between ischemic penumbras and contralateral normal brain regions.Linear regression and Pearson's correlation were used to evaluate the correlations among quantitative results.Results:The fast ADCs and ASL CBFs of ischemic penumbras were significantly lower than those of the contralateral normal brain regions (1.93 ± 0.78 μm2/ms vs.3.97 ± 2.49 μm2/ms,P =0.007;13.5 ± 4.5 ml· 100 g-1 ·min-1 vs.29.1 ± 12.7 ml·100 g-1 ·min-1,P < 0.001,respectively).No significant difference was observed in slow ADCs between ischemic penumbras and contralateral normal brain regions (0.203 ± 0.090 μm2/ms vs.0.198 ± 0.100 μm2/ms,P =0.451).Compared with contralateral normal brain regions,both CBFs and fast ADCs decreased in ischemic penumbras while slow ADCs remained the same.A significant correlation was detected between fast ADCs and ASL CBFs (r =0.416,P < 0.05).No statistically significant correlation was

  17. The anterior cerebral artery is an appropriate arterial input function for perfusion-CT processing in patients with acute stroke

    Energy Technology Data Exchange (ETDEWEB)

    Wintermark, Max; Lau, Benison C.; Chien, Jeffrey; Arora, Sandeep [University of California, San Francisco, Department of Radiology, Neuroradiology Section, 505 Parnassus Avenue, Box 0628, San Francisco, CA (United States)

    2008-03-15

    Dynamic perfusion-CT (PCT) with deconvolution requires an arterial input function (AIF) for postprocessing. In clinical settings, the anterior cerebral artery (ACA) is often chosen for simplicity. The goals of this study were to determine how the AIF selection influences PCT results in acute stroke patients and whether the ACA is an appropriate default AIF. We retrospectively identified consecutive patients suspected of hemispheric stroke of less than 48 h duration who were evaluated on admission by PCT. PCT datasets were postprocessed using multiple AIF, and cerebral blood volume (CBV) and flow (CBF), and mean transit time (MTT) values were measured in the corresponding territories. Results from corresponding territories in the same patients were compared using paired t-tests. The volumes of infarct core and tissue at risk obtained with different AIFs were compared to the final infarct volume. Of 113 patients who met the inclusion criteria, 55 with stroke were considered for analysis. The MTT values obtained with an ''ischemic'' AIF tended to be shorter (P=0.055) and the CBF values higher (P=0.108) than those obtained using a ''nonischemic'' AIF. CBV values were not influenced by the selection of the AIF. No statistically significant difference was observed between the size of the PCT infarct core (P=0.121) and tissue at risk (P=0.178), regardless of AIF selection. In acute stroke patients, the selection of the AIF has no statistically significant impact of the PCT results; standardization of the PCT postprocessing using the ACA as the default AIF is adequate. (orig.)

  18. Using of virtual reality technology in acute cerebral stroke and their influense on post-stroke affective disorders

    Directory of Open Access Journals (Sweden)

    Maslyuk О.А.

    2014-12-01

    Full Text Available Aim. The study of virtual reality technology in the rehabilitation of patients with cerebral stroke and influence on post stroke affective disorder. Materials and methods. The study included 88 patients with ischemic stroke: 59 men (67% and 29 women (33%. The average age of the patients was 62,05 ± 11,74 years. In the study group included 46 patients, 44 patients in the control group. The groups were matched by age, time from the begin of disease, severity of disease, the severity of motor, affective and cognitive impairments. In addition, in the study group to the program of early rehabilitation to use individual training with virtual reality technology (BTS NIRVANA. The duration of the training was 21 days, 3 times a week for 40 minutes. Results. On the background of rehabilitation in the study group patients had a significant reduced of neurological deficit (p <0,05. Significantly improved neurodynamic and executive cognitive function (p <0,01. In the study group was a statistically significant decrease symptoms of depression on a scale of BDI was 31,7% vs. 20.9% in the control group, anxiety on a scale of HADS was 18,46% (p <0,05 vs. 12,23% (p <0,05 in the control group. Increase motivation and decrease symptoms of apathy in the study group of patients on a scale of AES-C was 13,78% (p <0,05 vs. 1,01 % in the control group. On the background of rehabilitation patients in the study group was no difference between the rates of pathological muscle and mental fatigue. On the background there is rehabilitation of the quality of life due to mobility and activities of daily living. Conclusion. The study showed the positive effect of virtual reality technology for the correction of post-stroke mood disorders.

  19. Serum uric acid levels and cerebral microbleeds in patients with acute ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Wi-Sun Ryu

    Full Text Available Unlike experimental studies indicating a neuroprotective property of uric acid, clinical studies have shown that elevated levels of uric acid are associated with a risk of ischemic stroke. However, the association of uric acid with cerebral hemorrhage has seldom been tested. We aimed to elucidate the association between uric acid and cerebral microbleeds (CMBs, a hemorrhage-prone cerebral microangiopathy. Seven hundred twenty-four patients with ischemic stroke who were consecutively admitted to our hospital were included in this study. We collected demographic, clinical, and laboratory data, including uric acid level, and examined the presence of CMBs using T2*-weighted gradient-echo MRI. We used logistic regression analysis to examine an independent association between uric acid and CMBs. Two-hundred twenty-six patients had CMBs (31.2%. After adjusting for possible confounders, elevated uric acid was independently associated with the presence of CMBs (the highest quartile vs. lowest quartile, adjusted odd ratio [OR], 1.98; 95% confidence interval [CI], 1.16-3.39. This association retained in patients with deep or infratentorial CMBs (with or without lobar CMBs but not among those with lobar CMBs. In addition, this association was robust among patients with hypertension (the highest quartile vs. lowest quartile, adjusted OR, 2.74; 95% CI, 1.43-5.24. In contrast, we did not find the association in patients without hypertension. We demonstrated that serum uric acid is independently associated with the presence of CMBs. In particular, the relation between uric acid and CMBs was robust in hypertensive patients.

  20. Serum Uric Acid Levels and Cerebral Microbleeds in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Ryu, Wi-Sun; Kim, Chi Kyung; Kim, Beom Joon; Lee, Seung-Hoon

    2013-01-01

    Unlike experimental studies indicating a neuroprotective property of uric acid, clinical studies have shown that elevated levels of uric acid are associated with a risk of ischemic stroke. However, the association of uric acid with cerebral hemorrhage has seldom been tested. We aimed to elucidate the association between uric acid and cerebral microbleeds (CMBs), a hemorrhage-prone cerebral microangiopathy. Seven hundred twenty-four patients with ischemic stroke who were consecutively admitted to our hospital were included in this study. We collected demographic, clinical, and laboratory data, including uric acid level, and examined the presence of CMBs using T2*-weighted gradient-echo MRI. We used logistic regression analysis to examine an independent association between uric acid and CMBs. Two-hundred twenty-six patients had CMBs (31.2%). After adjusting for possible confounders, elevated uric acid was independently associated with the presence of CMBs (the highest quartile vs. lowest quartile, adjusted odd ratio [OR], 1.98; 95% confidence interval [CI], 1.16–3.39). This association retained in patients with deep or infratentorial CMBs (with or without lobar CMBs) but not among those with lobar CMBs. In addition, this association was robust among patients with hypertension (the highest quartile vs. lowest quartile, adjusted OR, 2.74; 95% CI, 1.43–5.24). In contrast, we did not find the association in patients without hypertension. We demonstrated that serum uric acid is independently associated with the presence of CMBs. In particular, the relation between uric acid and CMBs was robust in hypertensive patients. PMID:23372838

  1. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  2. Cocktail treatment, a promising strategy to treat acute cerebral ischemic stroke?

    Directory of Open Access Journals (Sweden)

    Li-jun Liang

    2016-01-01

    Full Text Available Up to now, over 1,000 experimental treatments found in cells and rodents have been difficult to translate to human ischemic stroke. Since ischemia and reperfusion, two separate stages of ischemic stroke, have different pathophysiological mechanisms leading to brain injury, a combination of protective agents targeting ischemia and reperfusion respectively may obtain substantially better results than a single agent. Normobaric hyperoxia (NBO has been shown to exhibit neuro- and vaso-protective effects by improving tissue oxygenation when it is given during ischemia, however the effect of NBO would diminish when the duration of ischemia and reperfusion was extended. Therefore, during reperfusion drug treatment targeting inflammation, oxidative stress and free radical scavenger would be a useful adjuvant to extend the therapeutic window of tissue plasminogen activator, the only United States Food and Drug Administration (FDA approved treatment for acute ischemic stroke. In this review, we discussed the neuro- and vaso-protective effects of NBO and recent finding of combining NBO with other drugs.

  3. Computer-aided diagnosis of acute ischemic stroke based on cerebral hypoperfusion using 4D CT angiography

    Science.gov (United States)

    Charbonnier, Jean-Paul; Smit, Ewoud J.; Viergever, Max A.; Velthuis, Birgitta K.; Vos, Pieter C.

    2013-02-01

    The presence of collateral blood flow is found to be a strong predictor of patient outcome after acute ischemic stroke. Collateral blood flow is defined as an alternative way to provide oxygenated blood to ischemic cerebral tissue. Assessment of collateral blood supply is currently performed by visual inspection of a Computed Tomography Angiogram (CTA) which introduces inter-observer variability and depends on the grading scale. Furthermore, variations in the arterial contrast arrival time may lead to underestimation of collateral blood supply in a CTA which exerts a negative influence on the prediction of patient outcome. In this study, the feasibility of a Computer-aided Diagnosis system is investigated capable of objectively predicting patient outcome. We present a novel automatic method for quantitative assessment of cerebral hypoperfusion in timing-invariant (i.e. delay insensitive) CTA (TI-CTA). The proposed Vessel Density Symmetry algorithm automatically generates descriptive maps based on hemispheric asymmetry of blood vessels. Intensity and symmetry based features are extracted from these descriptive maps and subjected to a best-first-search feature selection. Linear Discriminant Analysis is performed to combine selected features into a likelihood of good patient outcome. Receiver operating characteristic (ROC) analysis is conducted to evaluate the diagnostic performance of the CAD by leave-one- patient-out cross validation. A Positive Predicting Value of 1 was obtained at a sensitivity of 25% with an area under the ROC-curve of 0.86. The results show that the CAD is feasible to objectively predict patient outcome. The presented CAD could make an important contribution to acute ischemic stroke diagnosis and treatment.

  4. Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study.

    Science.gov (United States)

    Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrissoula; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D'Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Acciarresi, Monica; D'Amore, Cataldo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario Maimone; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria Giulia; Bubba, Valentina; Silvestri, Ilenia; Lees, Kennedy R

    2015-08-01

    The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered

  5. Real-time ultrasound perfusion imaging in acute stroke: assessment of cerebral perfusion deficits related to arterial recanalization.

    Science.gov (United States)

    Bolognese, Manuel; Artemis, Dimitrios; Alonso, Angelika; Hennerici, Michael G; Meairs, Stephan; Kern, Rolf

    2013-05-01

    We investigated whether real-time ultrasound perfusion imaging (rt-UPI) is able to detect perfusion changes related to arterial recanalization in the acute phase of middle cerebral artery (MCA) stroke. Twenty-four patients with acute territorial MCA stroke were examined with rt-UPI and transcranial color-coded duplex ultrasound (TCCD). Ultrasound studies were consecutively performed within 24 h and 72-96 h after stroke onset. Real-time UPI parameters of bolus kinetics (time to peak, rt-TTP) and of refill kinetics (plateau A and slope β of the exponential replenishment curve) were calculated from regions of interest of ischemic versus normal brain tissue; these parameters were compared between early and follow-up examinations in patients who recanalized. At the early examination, there was a delay of rt-TTP in patients with MCA occlusion (rt-TTP [s]: 13.09 ± 3.21 vs. 10.16 ± 2.6; p = 0.01) and a lower value of the refill parameter β (β [1/s]: 0.62 ± 0.34 vs. 1.09 ± 0.58; p = 0.01) in ischemic compared with normal brain tissue, whereas there were no differences of the parameters A and Axβ. At follow-up, the delay of rt-TTP was reversible once recanalization of an underlying MCA obstruction was demonstrated: rt-TTP [s], 13.09 ± 3.21 at 24 h versus 10.95 ± 1.5 at 72-96 h (p = 0.03). Correspondingly, β showed a higher slope than at the first examination: β [1/s]: 0.55 ± 0.29 at 24 h versus 0.71 ± 0.27 at 72-96 h (p = 0.04). We conclude that real-time UPI can detect hemodynamic impairment in acute MCA occlusion and subsequent improvement following arterial recanalization. This offers the chance for bedside monitoring of the hemodynamic compromise (e.g. during therapeutic interventions such as systemic thrombolysis).

  6. Cerebrolysin adjuvant treatment in Broca's aphasics following first acute ischemic stroke of the left middle cerebral artery

    OpenAIRE

    Jianu, DC; Muresanu, DF; Bajenaru, O; Popescu, BO; Deme, SM; Moessler, H; Meinzingen, SZ; Petrica, L; Serpe, M; Ursoniu, S.

    2010-01-01

    Background: The aim of our study was to assess the efficacy of Cerebrolysin administration in Broca's aphasics with acute ischemic stroke. Methods: We registered 2,212 consecutive Broca's aphasics following an acute ischemic stroke admitted in four departments of neurology in Romania, between September 2005 and September 2009. Language was evaluated with the Romanian version of the Western Aphasia Battery (WAB). The following inclusion criteria were used for this study: age 20%75 years, admis...

  7. Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography.

    Science.gov (United States)

    Tao, Yiming; Dong, Wei; Li, Zhilian; Chen, Yuanhan; Liang, Huaban; Li, Ruizhao; Mo, Liyi; Xu, Lixia; Liu, Shuangxin; Shi, Wei; Zhang, Li; Liang, Xinling

    2017-05-01

    The correlation between proteinuria and contrast-induced acute kidney injury (CI-AKI) in patients with cerebrovascular disease is still unknown. To determine whether proteinuria is a risk factor for CI-AKI and death in patients with stroke undergoing cerebral angiography. Data from 2015 patients with stroke undergoing cerebral angiography between January 2009 and December 2013 were retrospectively collected. Clinical parameters were obtained from the hospital's computerized database. All variables were analyzed by univariate analysis and multivariate logistic regression analysis. CI-AKI was seen in 85 patients (4.2%). After adjustment for potential confounding risk factors, patients with proteinuria had a fivefold higher risk of CI-AKI than patients without proteinuria (OR=5.74; 95% CI 2.23 to 14.83; pProteinuria did not increase in-hospital mortality (OR=1.25; 95% CI 0.49 to 3.17; p=0.639) but did increase 1-year mortality (HR=2.30, 95% CI 1.55 to 3.41, pProteinuria is an independent risk factor for CI-AKI and 1-year mortality in patients with stroke undergoing cerebral angiography. More attention should be paid to the development of CI-AKI in patients with stroke with proteinuria. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Early Rehabilitation of Acute Stroke Patients with Hemiplegia and Effects of regional Cerebral Blood Flow (rCBF) of the Patients with Cerebral Infarction by Early Rehabiiitation

    Institute of Scientific and Technical Information of China (English)

    Luo ZuMing; Xiong Hai

    2000-01-01

    Objectives: To investigate whether early rchabilitation could improve obviously clinical prognosis of acute stroke patients. The mechanism of early rehabilitation that could improve brain function was preliminarily studied. Methods: 240 patients with acute hemiplegia were randomly divided into control group (120 cases) and rehabilitation group (120 cases). The control group received general treatment and the latter received early rehabilitation (Bobath methods) besides general treatment. At pre-rehabilitation and the end of 1,2,3,4,5,6 month at post-rehabilitation, the neurological deficit was assessed with modified Edinbcrg-Scandinavian stroke scale (MESSS); the motor function of the hemiplegic limbs were assessed with modified Fugl-meyer motor scale (FM);the ADL were assessed with modified Barthel Index (MBI), and the general secondary complications of both groups were also evaluated. Moreover, rCBF of 72 cases of acute cerebral infarction with hemiplegia (34 in control group, 38 in rehabilitation group) was earned out by SPECT imaging at pre-rehabilitation and at the end of I month at post - rehabilitation.Results and Discussion: Compared with those of control group, at the end of 1,2,3,4,5,6 month at post - rehabilitation, the scores of MESSS were more obviously decreased (p<0.05 and p<0.01); the scores of MBI and FM were more significantly increased (p<0.05 and p<0.01); and morbidity of secondary complications was more significantly decreased (p<0.05 and p<0.01). Compared with those of pre-rehabilitation in rehabilitation group, both the decrease of MESS scores and the increase of FM, MBI scores were more obvious (p<0.01) at the end of 1,2,3 month of post-rehabilitation; however, compared with that of the end of 3 month at post-rehabilitation, at the end of 4,5,6 month of post-rehabilitation in rehabilitation group. Both the decrease of MESSS scores and the increase of FM scores hadn′t statistical significance (p>0.05). but scores of MBt were

  9. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    Energy Technology Data Exchange (ETDEWEB)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  10. The expression of angiotensin-converting enzyme 2-angiotensin-(1-7)-Mas receptor axis are upregulated after acute cerebral ischemic stroke in rats.

    Science.gov (United States)

    Lu, Jie; Jiang, Teng; Wu, Liang; Gao, Li; Wang, Yao; Zhou, Feng; Zhang, Shugang; Zhang, Yingdong

    2013-10-01

    There is now unequivocal evidence that the angiotensin-converting enzyme 2(ACE2)-Ang-(1-7)-Mas axis is a key component of the renin-angiotensin system (RAS) cascade, which is closely correlated with ischemic insult occurrence. Our previous studies demonstrated that the Ang-(1-7), was an active member of the brain RAS. However, the ACE2-Ang-(1-7)-Mas axis expression after cerebral ischemic injury are currently unclear. In the present study, we investigated the time course of ACE2-Ang-(1-7) and Mas receptor expression in the acute stage of cerebral ischemic stroke. The content of Ang-(1-7) in ischemic tissues and blood serum was measured by specific EIA kits. Real-time PCR and western blot were used to determine messenger RNA (mRNA) and protein levels of the ACE2 and Mas. The cerebral ischemic lesion resulted in a significant increase of regional cerebral and circulating Ang-(1-7) at 6-48 h compared with sham operation group following focal ischemic stroke (12h: 7.276±0.320 ng/ml vs. 2.466±0.410 ng/ml, serum; 1.024±0.056 ng/mg vs. 0.499±0.032, brain) (PMas expression were markedly enhanced compared to the control in the ischemic tissues (PMas immunopositive neurons were also seen stronger expression in the ischemic cortex (19.167±2.858 vs. 7.833±2.483) (PMas axis are upregulated after acute ischemic stroke and would play a pivotal role in the regulation of acute neuron injury in ischemic cerebrovascular diseases. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  11. Neuroprotective effect of ginkgolide K against acute ischemic stroke on middle cerebral ischemia occlusion in rats.

    Science.gov (United States)

    Ma, Shuwei; Yin, Huafeng; Chen, Lvyi; Liu, Hongxia; Zhao, Ming; Zhang, Xiantao

    2012-01-01

    Ginkgolide K, a natural platelet-activating factor receptor antagonist, was isolated from the leaves of Ginkgo biloba. However, little is known about its neuroprotective effect in ischemia-reperfusion (I/R)-induced cerebral injury. Hence, the present study was carried out to investigate the effect of ginkgolide K on neuroprotection and the potential mechanisms in the rat I/R model induced by middle cerebral artery occlusion (MCAO). The rats were pretreated with ginkgolide K 2, 4 and 8 mg/kg (i.v.) once a day for 5 days before MCAO. Neurological deficit score (NDS), brain water content, 2,3,5-triphenyltetrazolium chloride (TTC) staining and pathology of brain tissue, as well as indexes of oxidative stress [superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO) and nitric oxide synthase (NOS)] were measured at 24 h after ischemia. The results indicated that pretreatment with ginkgolide K significantly diminished the volume of infarction and brain water content, and improved NDS. Moreover, ginkgolide K markedly reversed the level of MDA, NO, NOS and SOD to their normal state in serum or cerebral ischemic section. In addition, hematoxylin and eosin staining showed the neuronal injury was significantly improved after being pretreated with ginkgolide K. These findings demonstrate that ginkgolide K exhibits neuroprotective properties through its antioxidative action in MCAO rats.

  12. The distribution of cerebral microbleeds determines their association with arterial stiffness in non-cardioembolic acute stroke patients.

    Science.gov (United States)

    Song, T J; Kim, J; Kim, Y D; Nam, H S; Lee, H S; Nam, C M; Heo, J H

    2014-03-01

    Increased arterial stiffness causes vessel damage in the end-organs. Therefore small vessels in the brain may be susceptible to increased arterial stiffness. Cerebral microbleeds (CMBs) are topographically or pathophysiologically categorized as deep or infratentorial type and strictly lobar type. Whether the presence and location of CMBs are associated with brachial-ankle pulse wave velocity (baPWV) which represents a measure of arterial stiffness was investigated. Between June 2006 and January 2012, 1137 consecutive patients diagnosed with non-cardioembolic acute ischaemic stroke and who underwent baPWV measurement and brain gradient-echo imaging were enrolled. CMBs were classified as deep or infratentorial or strictly lobar according to their location. Severity of leukoaraiosis was determined using the Fazekas scoring system. CMBs were found in 30.7% of the included patients. These patients were older than those without CMBs. Mean baPWV was higher in patients with CMBs than in those without (20 ± 5 m/s vs. 19 ± 5 m/s; P = 0.001). When comparing baPWV according to the location of the CMB, it was higher in the deep or infratentorial CMB group than in the strictly lobar CMB group (22 ± 5 m/s vs. 20 ± 5 m/s; P = 0.001). In univariate and multivariate multinomial logistic regression analyses, baPWV was found to be independently associated with deep or infratentorial CMBs. Arterial stiffness was independently associated with deep or infratentorial CMBs but not lobar CMBs. These findings suggest a pathophysiological association between arterial stiffness and CMBs in the deep or infratentorial region. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

  13. Efficacy and safety of rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke with hyperdense middle cerebral artery sign: a systematic review

    Directory of Open Access Journals (Sweden)

    Xin TAN

    2016-01-01

    Full Text Available Objective To systematically review the efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke with hyperdense middle cerebral artery sign (HMCAS on CT images. Methods Search online databases such as PubMed, EMBASE/SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL and China Biology Medicine (CBM from January 1994 to December 2014 with key words: hyperdense middle cerebral artery sign/HMCAS/hyperdense artery sign/hyperdense cerebral artery sign, ischemic stroke/cerebral infarction/brain infarction/cerebral embolism, thrombolysis/thrombolytic therapy/rt-PA/recombinant tissue plasminogen activator both in Chinese and English, to collect randomized controlled trials (RCTs or non-RCTs about rt-PA treating patients with acute ischemic stroke and HMCAS. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Newcastle-Ottawa Scale (NOS was used for quality assessment, and Meta-analysis was performed using RevMan 5.2 software. Results A total of 8 studies were included after excluding duplicate ones and those which did not meet the inclusion criteria from 166 articles. There were 11 373 patients, including 2455 cases complicated with HMCAS (2316 treated by rt-PA and 139 treated by placebo and 8918 cases without HMCAS. Meta-analysis showed the occurrence of unfavorable outcome in rt-PA treatment was significantly decreased compared to placebo in HMCAS-positive patients (OR = 0.360,95%CI: 0.150-0.850; P = 0.020, while there was no statistical difference in the occurrence of symptomatic intracerebral hemorrhage (sICH between rt-PA and placebo treatment in HMCAS-positive patients (OR = 1.640, 95%CI: 0.380-7.040; P = 0.500. Meta-analysis also showed unfavorable outcome of rt-PA treatment was significantly higher in HMCAS-positive than in HMCAS

  14. [Clinical-electrophysiological characteristics of the cognitive sphere in patients in the acute period of the first cerebral ischemic stroke].

    Science.gov (United States)

    Kispaeva, T T; Kichuk, I V; Shetova, I M; Memetova, D Sh; Gudkova, V V; Ivanova, G E; Skvortsova, V I

    2011-01-01

    A neuropsychological and neurophysiological study using computed EEG was carried out in 31 stroke patients who did not have a cognitive impairment according to MMSE. Thirty age-matched patients with the same risk factors without a history of stroke were included into the control group. The examination of the control group was performed only once. The examination of stroke patients was performed on days 1, 7 and 21. It was shown that cognitive neurodynamic disturbances (memory disorders and the visual memory decrease) and bioelectrical brain activity disturbances (the decrease in a- and beta band activities and the increase of theta-band power) occurred from the first day and lasted during the acute stroke period even after the improvement of neurological status.

  15. Comparison of CT perfusion summary maps to early diffusion-weighted images in suspected acute middle cerebral artery stroke

    Energy Technology Data Exchange (ETDEWEB)

    Benson, John; Payabvash, Seyedmehdi [Hennepin County and University of Minnesota Medical Centers, Department of Radiology, Minneapolis, MN (United States); Salazar, Pascal [Vital Images, A Division of Toshiba Medical, Minnetonka, MN (United States); Jagadeesan, Bharathi; Palmer, Christopher S.; Truwit, Charles L. [Hennepin County and University of Minnesota Medical Centers, Department of Radiology, Minneapolis, MN (United States); McKinney, Alexander M., E-mail: mckinrad@umn.edu [Hennepin County and University of Minnesota Medical Centers, Department of Radiology, Minneapolis, MN (United States)

    2015-04-15

    Objectives: To assess the accuracy and reliability of one vendor's (Vital Images, Toshiba Medical, Minnetonka, MN) automated CT perfusion (CTP) summary maps in identification and volume estimation of infarcted tissue in patients with acute middle cerebral artery (MCA) distribution infarcts. Subjects and methods: From 1085 CTP examinations over 5.5 years, 43 diffusion-weighted imaging (DWI)-positive patients were included who underwent both CTP and DWI <12 h after symptom onset, with another 43 age-matched patients as controls (DWI-negative). Automated delay-corrected postprocessing software (DC-SVD) generated both infarct “core only” and “core + penumbra” CTP summary maps. Three reviewers independently tabulated Alberta Stroke Program Early CT scores (ASPECTS) of both CTP summary maps and coregistered DWI. Results: Of 86 included patients, 36 had DWI infarct volumes ≤70 ml, 7 had volumes >70 ml, and 43 were negative; the automated CTP “core only” map correctly classified each as >70 ml or ≤70 ml, while the “core + penumbra” map misclassified 4 as >70 ml. There were strong correlations between DWI volume with both summary map-based volumes: “core only” (r = 0.93), and “core + penumbra” (r = 0.77) (both p < 0.0001). Agreement between ASPECTS scores of infarct core on DWI with summary maps was 0.65–0.74 for “core only” map, and 0.61–0.65 for “core + penumbra” (both p < 0.0001). Using DWI-based ASPECTS scores as the standard, the accuracy of the CTP-based maps were 79.1–86.0% for the “core only” map, and 83.7–88.4% for “core + penumbra.” Conclusion: Automated CTP summary maps appear to be relatively accurate in both the detection of acute MCA distribution infarcts, and the discrimination of volumes using a 70 ml threshold.

  16. Prediction of clinical outcome with baseline and 24-hour perfusion CT in acute middle cerebral artery territory ischemic stroke treated with intravenous recanalization therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji-Yong; Kim, Seo Hyun; Park, Sang Hyun; Lee, Sung Soo [Yonsei University Wonju College of Medicine, Department of Neurology, Wonju (Korea); Lee, Myeong Sub [Yonsei University Wonju College of Medicine, Department of Radiology, Wonju (Korea)

    2008-05-15

    We sought to determine whether Alberta Stroke Program Early CT Scores (ASPECTS) derived from baseline noncontrast CT (NCCT) and perfusion CT (CTP) imaging maps can predict clinical outcome after recanalization therapy in acute ischemic stroke of the middle cerebral artery (MCA) territory and whether changes in the ASPECTS from baseline to 24 h after recanalization therapy can help predict clinical outcome. We retrospectively studied consecutive patients with acute ischemic stroke of the MCA territory treated with intravenous tissue plasminogen activator (t-PA) or abciximab within 6 h of symptom onset. We performed NCCT and CTP before and 24 h after intravenous t-PA or abciximab treatment and determined the ASPECTS and the changes in the ASPECTS from baseline to 24 h. A favorable outcome was defined as a modified Rankin scale score of 0 or 1 at 3 months. During the 18-month study period 44 patients were studied. In multivariate logistic regression analysis, the cerebral blood volume (CBV) ASPECTS (OR 1.80, 95% CI 1.10 to 2.93) at baseline and the increase in cerebral blood flow (CBF) ASPECTS (OR 1.68, 95% CI 1.13 to 2.50) from baseline to 24 h were associated with a favorable outcome. The cutoff values for a favorable outcome using receiver operating characteristic curves were 8 and 1, respectively. When the CBV ASPECTS at baseline was 8 or more, its positive predictive value was only 58.1%. When the CBV ASPECTS at baseline was 8 or more and the increase in CBF ASPECTS from baseline to 24 h was 1 or more, the positive predictive value was 100% and the negative predictive value was 74.2%. The CBV ASPECTS derived from baseline CTP maps was found to be predictive of a favorable outcome, but its positive predictive value was suboptimal. The change in the CBF ASPECTS from baseline to 24 h after treatment was helpful in predicting outcome. (orig.)

  17. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    2008-01-01

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (

  18. Activation of peroxisome proliferator-activated receptor β/δ attenuates acute ischemic stroke on middle cerebral ischemia occlusion in rats.

    Science.gov (United States)

    Chao, Xiaodong; Xiong, Chunlei; Dong, Weifeng; Qu, Yan; Ning, Weidong; Liu, Wei; Han, Feng; Ma, Yijie; Wang, Rencong; Fei, Zhou; Han, Hua

    2014-07-01

    Peroxisome proliferator-activated receptor (PPAR)-β/δ is a transcription factor that belongs to the nuclear hormone receptor family. There is little information about the effects of the immediate administration of specific ligands of PPAR-β/δ (GW0742) in animal models of acute ischemic stroke. Using a rat model of middle cerebral ischemia occlusion (MCAO) in vivo, we have investigated the effect of pretreatment with GW0742 before MCAO. The neuroprotective effect of GW0742 against acute ischemic stroke was evaluated by the neurologic deficit score (NDS), dry-wet weight, and 2,3,5-triphenyltetrazolium chloride staining. The levels of interleukin (IL)-1β, nuclear factor (NF)-κB, and tumor necrosis factor (TNF)-α were detected by an enzyme-linked immunosorbent assay. The expressions of inducible nitric oxide synthase (iNOS), Bax, and Bcl-2 were detected by Western blot. The apoptotic cells were counted by in situ terminal deoxyribonucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay. The pretreatment with GW0742 significantly increased the expression of Bcl-2, and significantly decreased in the volume of infarction, NDS, edema, expressions of IL-1β, NF-κB, TNFα, and Bax, contents of iNOS and the apoptotic cells in infarct cerebral hemisphere compared with rats in the vehicle group at 24 hours after MCAO. The study suggests the neuroprotective effect of the PPAR-β/δ ligand GW0742 in acute ischemic stroke by a mechanism that may involve its anti-inflammatory and antiapoptotic action. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  19. Acute antithrombotic treatment of ischemic stroke.

    Science.gov (United States)

    Alderazi, Yazan J; Grotta, James C

    2014-05-01

    Antithrombotic medication is a cornerstone of acute ischemic stroke treatment and secondary prevention. The efficacy of thrombolysis with alteplase in acute stroke has been demonstrated in several clinical trials. This safe and costeffective therapy has transformed the practice of stroke care and has led to subsequent trials of other antithrombotic medications for treatment of ischemic stroke in the acute phase. These antithrombotics include thrombolytic, antiplatelet and anticoagulant agents. While, no other medication has yet demonstrated adequate efficacy, our current and evolving understanding of infarct expansion, ischemic penumbra, collateral circulation and the blood brain barrier is allowing testing of antithrombotic medications tailored to individual patient pathophysiology in clinical trials. This understanding accompanies developments in neuroimaging and organization of stroke care that allow for wide-spread recruitment in these trials. Alteplase remains the mainstay treatment of arterial acute ischemic stroke; however, anticoagulation is the standard therapy for cerebral venous sinus thrombosis. Antithrombotic use in acute stroke, arterial and venous, has demonstrated efficacy but leaves many questions unanswered. This patient population is a fertile ground for novel research, especially as it relates to; combination antithrombotic therapy, combination of pharmacological and mechanical thrombolysis, and the transition to secondary prevention. Here we review the current antithrombotics in the acute phase of ischemic stroke highlighting the evidence-base and areas of uncertainty.

  20. Plasma biomarkers in the diagnosis of acute ischemic stroke.

    Science.gov (United States)

    Kim, Myeong Hee; Kang, So Young; Kim, Myung Chun; Lee, Woo In

    2010-01-01

    Rapid diagnosis and timely treatment improves the outcome in patients with ischemic stroke, but a rapid and sensitive blood test for ischemic stroke does not exist. This study tested whether a panel of biomarkers might be useful in the diagnosis of acute ischemic stroke. Consecutive patients with suspected stroke presenting to the emergency department of a university hospital in Korea were enrolled. Plasma specimens were assayed for brain natriuretic peptide, D-dimer, matrix metalloproteinase-9, S100β, and a proprietary composite multimarker index (MMX). There were 139 patients in this study, 89 of whom were diagnosed with acute ischemic stroke, 11 with acute cerebral hemorrhage, and 39 with other brain disorders. The MMX value was significantly higher in the patients with acute ischemic stroke in comparison to 57 healthy controls (p acute ischemic stroke vs those with acute cerebral hemorrhage (p = 0.884). The discriminatory capacity of MMX was modest, with an area under the receiver-operating-characteristic curve of 0.714 for acute stroke. Ischemic stroke was not diagnosed by any of the biochemical markers individually. Although the data suggest that MMX may be helpful to diagnose an acute stroke, it does not discriminate between acute ischemic stroke and acute hemorrhagic stroke.

  1. Imaging acute ischemic stroke.

    Science.gov (United States)

    González, R Gilberto; Schwamm, Lee H

    2016-01-01

    Acute ischemic stroke is common and often treatable, but treatment requires reliable information on the state of the brain that may be provided by modern neuroimaging. Critical information includes: the presence of hemorrhage; the site of arterial occlusion; the size of the early infarct "core"; and the size of underperfused, potentially threatened brain parenchyma, commonly referred to as the "penumbra." In this chapter we review the major determinants of outcomes in ischemic stroke patients, and the clinical value of various advanced computed tomography and magnetic resonance imaging methods that may provide key physiologic information in these patients. The focus is on major strokes due to occlusions of large arteries of the anterior circulation, the most common cause of a severe stroke syndrome. The current evidence-based approach to imaging the acute stroke patient at the Massachusetts General Hospital is presented, which is applicable for all stroke types. We conclude with new information on time and stroke evolution that imaging has revealed, and how it may open the possibilities of treating many more patients. © 2016 Elsevier B.V. All rights reserved.

  2. Purine Metabolism in Acute Cerebral Ischemia

    Directory of Open Access Journals (Sweden)

    Ye. V. Oreshnikov

    2008-01-01

    Full Text Available Objective: to study the specific features of purine metabolism in clinically significant acute cerebral ischemia. Subjects and materials. Three hundred and fifty patients with the acutest cerebral ischemic stroke were examined. The parameters of gas and electrolyte composition, acid-base balance, the levels of malonic dialdehyde, adenine, guanine, hypox-anthine, xanthine, and uric acid, and the activity of xanthine oxidase were determined in arterial and venous bloods and spinal fluid. Results. In ischemic stroke, hyperuricemia reflects the severity of cerebral metabolic disturbances, hemodynamic instability, hypercoagulation susceptiility, and the extent of neurological deficit. In ischemic stroke, hyperuri-corachia is accompanied by the higher spinal fluid levels of adenine, guanine, hypoxanthine, and xanthine and it is an indirect indicator of respiratory disorders of central genesis, systemic acidosis, hypercoagulation susceptibility, free radical oxidation activation, the intensity of a stressor response to cerebral ischemia, cerebral metabolic disturbances, the depth of reduced consciousness, and the severity of neurological deficit. Conclusion. The high venous blood activity of xanthine oxidase in ischemic stroke is associated with the better neurological parameters in all follow-up periods, the better early functional outcome, and lower mortality rates. Key words: hyperuricemia, stroke, xanthine oxidase, uric acid, cerebral ischemia.

  3. High-sensitivity cardiac troponin T levels and risk of cerebral microbleeds in acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease.

    Science.gov (United States)

    Liu, Junfeng; Wang, Deren; Xiong, Yao; Liu, Bian; Wei, Chenchen; Ma, Zhenxing; Wu, Bo; Tang, Hehan; Liu, Ming

    2016-10-15

    Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with coronary disease and small-vessel ischemic stroke through their associations with atherosclerosis. Considering the relationship between atherosclerosis and cerebral microbleeds (CMBs), the purpose of this study was to examine associations between serum hs-cTnT levels and risk of CMBs in acute ischemic stroke patients. This prospective study involved consecutively recruited acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease treated at a large tertiary care hospital in southwestern China. Clinico-demographic data were collected and analyzed by logistic regression to identify the relationship between serum hs-cTnT levels and CMB occurrence and location. In the final analysis, of 66 patients (27 males; mean age, 68.7years), 39 (59.1%) had CMBs. Hs-cTnT levels were not associated with risk of strictly lobar CMBs. However, after adjusting age, sex, current alcohol consumption, total cholesterol, hypertension, diabetes mellitus, prior antithrombotic therapy and NIHSS on admission, patients in the higher tertile were more likely to have CMBs and deep or infratentorial CMBs (PCMBs, particularly of deep or infratentorial CMBs. This finding justifies further research into how hs-cTnT levels may contribute to CMBs and potentially other subclinical small-vessel diseases. Copyright © 2016. Published by Elsevier B.V.

  4. Classification of Oxfordshire community stroke project assisted by transcranial Doppler ultrasound examination for treating acute cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    Xiaohua Xiao; Jie Situ; Tinghui Li; Shaohong Qiu

    2006-01-01

    BACKGROUND: The early correct diagnosis of acute cerebral infarction (ACI) is very important for choosing therapeutic regimen. The classification of Oxfordshire community stroke project (OCSP) provides guide for easy and rapid diagnosis and choosing therapeutic regimen in clinical practice. But current operation is not satisfied. Only depending on clinical symptoms and body signs do objective evidences lack. Transcranial Doppler ultrasound (TCD) examination may provide hemodynamical evidences for the correct classification of OCSP to some extent. OBJECTIVE: To compare the results of OCSP classification and TCD examination for treating ACI in patients, and analyze the relationship between them as well as the effect of TCD on the correct classification of OCSP. DESIGN: Controlled observation.SETTING: Department of Internal Medicine, Shenzhen Hospital of Prevention and Treatment for Occupational Disease. PARTICIPANTS: Thirty-eight inpatients with ACI including 21 males and 17 females, aged 50 to 81 years, who received treatment in the Department of Internal Medicine, Shenzhen Hospital of Prevention and Treatment for Occupational Disease within 24 hours after onset from October 2002 to October 2005 were involved. The involved inpatients all confirmed to the diagnostic criteria of ACI formulated in the 4th National Cerebrovas- cular Diseases Conference. All the cases received skull computer tomography (CT) or magnetic resonance imaging (MRI) examinations at 24 hours after onset. Those patients who had no obvious infarct focus in skull CT examination within 24 hours after onset were performed re-examination to verify ACI within 72 hours after onset. Informed consents of examination method were obtained from all the patients. METHODS: According to the classification of OCSP, the patients were assigned into 4 subtypes: lacunar infarction (LACI), total anterior circulation infarction (TACI), part anterior circulation infarction (PACI) and posterior circulation infarction

  5. Blood Pressure in Acute Ischemic Stroke

    Science.gov (United States)

    McManus, Michael

    2016-01-01

    Hypertension is present in up to 84% of patients presenting with acute stroke, and a smaller proportion of patients have blood pressures that are below typical values in the context of cerebral ischemia. Outcomes are generally worse in those who present with either low or severely elevated blood pressure. Several studies have provided valuable information about malignant trends in blood pressure during the transition from the acute to the subacute phase of stroke. It is not uncommon for practitioners in clinical practice to identify what appear to be pressure-dependent neurologic deficits. Despite physiologic and clinical data suggesting the importance of blood pressure modulation to support cerebral blood flow to ischemic tissue, randomized controlled trials have not yielded robust evidence for this in acute ischemic stroke. We highlight previous studies involving acute-stroke patients that have defined trends in blood pressure and that have evaluated the safety and efficacy of blood-pressure modulation in acute ischemic stroke. This overview reports the current status of this topic from the perspective of a stroke neurologist and provides a framework for future research. PMID:26833984

  6. Manejo da hipertensão arterial na isquemia cerebral aguda Management of arterial hypertension in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    WALTER JOSÉ FAGUNDES-PEREYRA

    1999-12-01

    Full Text Available OBJETIVO: Avaliar o nível de conhecimento dos médicos, através de sua conduta, em paciente com quadro de hipertensão arterial na fase aguda da isquemia cerebral. Também comentamos as principais condutas nesta fase, com ênfase na tensão arterial (TA. MÉTODO: Foram entrevistados 120 médicos da clínica médica e da cirurgia geral, em dez dos maiores Hospitais de Belo Horizonte, em 1997. Todos responderam a um questionário contendo um caso clínico de paciente hipertenso leve, admitido com quadro de isquemia cerebral e tensão arterial de 186x110 mmHg. Os profissionais deveriam optar por reduzir, aumentar ou manter a TA. RESULTADOS: Dos entrevistados, 38 (31,7% responderam que reduziriam os níveis tensionais, 82 (68,3% optaram pela manutenção e nenhum aumentaria (pPURPOSE: We aimed with study to assess the current clinical practice about the management of high blood pressure in patients in the acute phase of ischemic stroke. We also comment some topics of ischemic stroke treatment. METHODS: A case report of a patient admitted 8 hours after onset of ischemic stroke and with blood pressure of 186x110 mmHg was presented to 120 surgeons and clinician. They were asked to decide the best therapeutic option: to increase, decrease or maintenance blood pressure. RESULTS: Thirty-eight physicians (31,7% considered decreasing blood pressure the best therapeutics, 82 (68,3% considered maintenance and none decided to increase it (p < 0.05. There was no difference between the two specialties conduct. The physicians, with more than 10 years of graduation, had a tendency to decrease the blood pressure (p <0.05. CONCLUSION: The maintenance of blood pressure may present a sufficient blood support to compensate brain flow. A high percentage of the physicians (31,7% do not know about the current concepts of therapeutics considering hypertension in acute ischemic stroke. The development on special units to treat these patients ("stroke units" may eventually

  7. Cerebral microbleeds and suicidality in stroke.

    Science.gov (United States)

    Tang, Wai Kwong; Chen, Yang Kun; Liang, Hua Jun; Chu, Winnie C W; Mok, Vincent C T; Ungvari, Gabor S; Wong, Ka Sing

    2012-01-01

    Cerebral microbleeds (CMBs) are common in stroke survivors. The clinical significance of CMBs in the development of suicidality (SI) following stroke is unknown. This study examined the association between SI and CMBs. The aim of the study reported here was to determine the relationship between CMBs and SI in ischemic stroke survivors. A cohort of 367 patients with acute ischemic stroke admitted to the stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. SI was assessed with the geriatric mental state examination at three months following the subjects' index stroke. Depressive symptoms were assessed using the geriatric depression scale (GDS). A qualified psychiatrist administered the Chinese version of the Structured Clinical Interview for DSM-IV to diagnose depressive disorders. The presence and location of CMBs were evaluated with magnetic resonance imaging (MRI). Compared with the non-SI patients, SI patients were more likely to have CMBs in any brain region (36.6% vs. 20.2%, p = 0.017), specifically more lobar (29.3% vs. 13.5%, p = 0.008) and thalamic CMBs (19.5% vs. 7.5%, p = 0.018). Presence of CMBs (odds ratio was 2.5, p = 0.026) and lobar CMBs (odds ratio 2.6, p = 0.034) were independent predictors of SI in the multivariate analysis. The results suggest that lobar CMBs may play roles in the development of SI. The importance of CMBs in the pathogenesis of SI in stroke survivors warrants further investigation. Copyright © 2012 The Academy of Psychosomatic Medicine. All rights reserved.

  8. Volumetric Integral Phase-shift Spectroscopy for Noninvasive Detection of Hemispheric Bioimpedance Asymmetry in Acute Brain Pathology

    Science.gov (United States)

    2017-07-20

    Stroke; Stroke, Acute; Ischemic Stroke; Hemorrhage; Clot (Blood); Brain; Subarachnoid Hemorrhage; Cerebral Infarction; Cerebral Hemorrhage; Cerebral Stroke; Intracerebral Hemorrhage; Intracerebral Injury

  9. Mapping of cerebral metabolic rate of oxygen using dynamic susceptibility contrast and blood oxygen level dependent MR imaging in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Gersing, Alexandra S.; Schwaiger, Benedikt J. [Technical University Munich, Klinikum rechts der Isar, Department of Neuroradiology, Munich (Germany); University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Ankenbrank, Monika; Toth, Vivien; Bauer, Jan S.; Zimmer, Claus [Technical University Munich, Klinikum rechts der Isar, Department of Neuroradiology, Munich (Germany); Janssen, Insa [Technical University Munich, Department of Neurosurgery, Munich (Germany); Kooijman, Hendrik [Philips Healthcare, Hamburg (Germany); Wunderlich, Silke [Technical University Munich, Department of Neurology, Munich (Germany); Preibisch, Christine [Technical University Munich, Klinikum rechts der Isar, Department of Neuroradiology, Munich (Germany); Technical University Munich, Department of Neurology, Munich (Germany)

    2015-12-15

    MR-derived cerebral metabolic rate of oxygen utilization (CMRO{sub 2}) has been suggested to be analogous to PET-derived CMRO{sub 2} and therefore may be used for detection of viable tissue at risk for infarction. The purpose of this study was to evaluate MR-derived CMRO{sub 2} mapping in acute ischemic stroke in relation to established diffusion- and perfusion-weighted imaging. In 23 patients (mean age 63 ± 18.7 years, 11 women) with imaging findings for acute ischemic stroke, relative oxygen extraction fraction was calculated from quantitative transverse relaxation times (T2, T2*) and relative cerebral blood volume using a quantitative blood oxygenation level dependent (BOLD) approach in order to detect a local increase of deoxyhemoglobin. Relative CMRO{sub 2} (rCMRO{sub 2}) maps were calculated by multiplying relative oxygen extraction fraction (rOEF) by cerebral blood flow, derived from PWI. After co-registration, rCMRO{sub 2} maps were evaluated in comparison with apparent diffusion coefficient (ADC) and time-to-peak (TTP) maps. Mean rCMRO{sub 2} values in areas with diffusion-restriction or TTP/ADC mismatch were compared with rCMRO{sub 2} values in the contralateral tissue. In tissue with diffusion restriction, mean rCMRO{sub 2} values were significantly decreased compared to perfusion-impaired (17.9 [95 % confidence interval 10.3, 25.0] vs. 58.1 [95 % confidence interval 50.1, 70.3]; P < 0.001) and tissue in the contralateral hemisphere (68.2 [95 % confidence interval 61.4, 75.0]; P < 0.001). rCMRO{sub 2} in perfusion-impaired tissue showed no significant change compared to tissue in the contralateral hemisphere (58.1 [95 % confidence interval 50.1, 70.3] vs. 66.7 [95 % confidence interval 53.4, 73.4]; P = 0.34). MR-derived CMRO{sub 2} was decreased within diffusion-restricted tissue and stable within perfusion-impaired tissue, suggesting that this technique may be adequate to reveal different pathophysiological stages in acute stroke. (orig.)

  10. Intravenous Administration of Cilostazol Nanoparticles Ameliorates Acute Ischemic Stroke in a Cerebral Ischemia/Reperfusion-Induced Injury Model

    Directory of Open Access Journals (Sweden)

    Noriaki Nagai

    2015-12-01

    Full Text Available It was reported that cilostazol (CLZ suppressed disruption of the microvasculature in ischemic areas. In this study, we have designed novel injection formulations containing CLZ nanoparticles using 0.5% methylcellulose, 0.2% docusate sodium salt, and mill methods (CLZnano dispersion; particle size 81 ± 59 nm, mean ± S.D., and investigated their toxicity and usefulness in a cerebral ischemia/reperfusion-induced injury model (MCAO/reperfusion mice. The pharmacokinetics of injections of CLZnano dispersions is similar to that of CLZ solutions prepared with 2-hydroxypropyl-β-cyclodextrin, and no changes in the rate of hemolysis of rabbit red blood cells, a model of cell injury, were observed with CLZnano dispersions. In addition, the intravenous injection of 0.6 mg/kg CLZnano dispersions does not affect the blood pressure and blood flow, and the 0.6 mg/kg CLZnano dispersions ameliorate neurological deficits and ischemic stroke in MCAO/reperfusion mice. It is possible that the CLZnano dispersions will provide effective therapy for ischemic stroke patients, and that injection preparations of lipophilic drugs containing drug nanoparticles expand their therapeutic usage.

  11. Regulatory T cells are strong promoters of acute ischemic stroke in mice by inducing dysfunction of the cerebral microvasculature.

    Science.gov (United States)

    Kleinschnitz, Christoph; Kraft, Peter; Dreykluft, Angela; Hagedorn, Ina; Göbel, Kerstin; Schuhmann, Michael K; Langhauser, Friederike; Helluy, Xavier; Schwarz, Tobias; Bittner, Stefan; Mayer, Christian T; Brede, Marc; Varallyay, Csanad; Pham, Mirko; Bendszus, Martin; Jakob, Peter; Magnus, Tim; Meuth, Sven G; Iwakura, Yoichiro; Zernecke, Alma; Sparwasser, Tim; Nieswandt, Bernhard; Stoll, Guido; Wiendl, Heinz

    2013-01-24

    We have recently identified T cells as important mediators of ischemic brain damage, but the contribution of the different T-cell subsets is unclear. Forkhead box P3 (FoxP3)-positive regulatory T cells (Tregs) are generally regarded as prototypic anti-inflammatory cells that maintain immune tolerance and counteract tissue damage in a variety of immune-mediated disorders. In the present study, we examined the role of Tregs after experimental brain ischemia/reperfusion injury. Selective depletion of Tregs in the DEREG mouse model dramatically reduced infarct size and improved neurologic function 24 hours after stroke and this protective effect was preserved at later stages of infarct development. The specificity of this detrimental Treg effect was confirmed by adoptive transfer experiments in wild-type mice and in Rag1(-/-) mice lacking lymphocytes. Mechanistically, Tregs induced microvascular dysfunction in vivo by increased interaction with the ischemic brain endothelium via the LFA-1/ICAM-1 pathway and platelets and these findings were confirmed in vitro. Ablation of Tregs reduced microvascular thrombus formation and improved cerebral reperfusion on stroke, as revealed by ultra-high-field magnetic resonance imaging at 17.6 Tesla. In contrast, established immunoregulatory characteristics of Tregs had no functional relevance. We define herein a novel and unexpected role of Tregs in a primary nonimmunologic disease state.

  12. Cerebral Microbleeds Do Not Predict Hemorrhagic Transformation in Acute Ischemic Stroke Patients with Atrial Fibrillation and/or Rheumatic Heart Disease.

    Science.gov (United States)

    Liu, Junfeng; Wang, Deren; Li, Jie; Lin, Jing; Xiong, Yao; Liu, Bian; Wei, Chenchen; Wu, Bo; Ma, Zhenxing; Zhang, Shihong; Liu, Ming

    2017-01-01

    Cerebral microbleeds (CMBs) are known to be potential risk factors for intracerebral hemorrhage (ICH), but there is controversy on the relationship between CMBs and hemorrhagic transformation (HT) after ischemic stroke. Besides, the question regarding whether the relationship between CMBs and HT can be affected by antithrombotic drugs in acute stage of ischemic stroke has not yet reached a consensus. 174 acute ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) were prospectively and consecutively enrolled in the study, of which 160 patients (mean 68.09 ±12.59 years) were finally included in the final analysis (West China Hospital, Sichuan University, n=125; People's Hospital of Deyang City, n=35).We assessed the presence, location and number of CMBs by using susceptibility-weighted imaging (SWI) within 7 days after admission, and the incidence of hemorrhagic transformation was evaluated by magnetic resonance imaging(MRI) during hospitalization. The univariate and multivariate analyses were used to analyze the relationship between CMBs and HT. CMBs were detected in 90 patients (56.3%). HT was found in 62 (38.8%) patients, among which 43 were hemorrhagic infarction (HI) and 19 were parenchymal haemorrhage (PH). The presence of CMBs was not significantly different among different HT subtypes (no HT, HI and PH; 59.2%, 51.2%, versus 52.6%, P=0.64). There was no relationship between the number/location of CMBs and hemorrhagic transformation subtypes (P=0.38). In the 2 subgroups of patients treated with anticoagulants and antiplatelets after admission, the incidence of HT was not significantly different between patients with and without CMBs (anticoagulants, 13.3% versus 18.2%, P=0.71; antiplatelets, 29.2% versus 40.3%, P= 0.21). The present study suggests that CMBs do not predict the presence of hemorrhagic transformation in acute ischemic stroke patients with AF and/or RHD. The results were not affected by anticoagulant or

  13. The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sillanpaa, Niko; Hakomaki, Jari; Lahteela, Arto; Dastidar, Prasun; Soimakallio, Seppo [Tampere University Hospital, Medical Imaging Center, Tampere (Finland); Saarinen, Jukka T.; Numminen, Heikki; Elovaara, Irina [Tampere University Hospital, Department of Neurology, Tampere (Finland); Rusanen, Harri [Oulu University Hospital, Department of Neurology, Oulu (Finland)

    2012-07-15

    Recently two classification methods based on the location and the extent of thrombosis detected with CT angiography have been introduced: the Boston Acute Stroke Imaging Scale (BASIS) and the clot burden score (CBS). We studied the performance of BASIS and CBS in predicting good clinical outcome (mRS {<=}2 at 90 days) in an acute (<3 h) stroke cohort treated with intravenous thrombolytic therapy. Eighty-three consecutive patients who underwent multimodal CT were analyzed. Binary logistic regression model was used to assess how BASIS, CBS, and cerebral blood volume (CBV) ASPECTS predict favorable clinical outcome. Diagnostic sensitivities and specificities were calculated and compared. Patients with low CBS and CBV ASPECTS scores and major strokes according to BASIS had significantly higher admission NIHSS scores, larger perfusion defects, and more often poor clinical outcome. In logistic regression analysis, CBV ASPECTS, CBS and BASIS were significantly associated with the clinical outcome. The performance of BASIS improved when patients with thrombosis of the M2 segment of the middle cerebral artery were classified as having minor stroke (M1-BASIS). In the anterior circulation, the sum of CBS and CBV ASPECTS (CBSV) proved to be the most robust predictor of favorable outcome. CBV ASPECTS and CBS had high sensitivity but moderate to poor specificity while BASIS was only moderately sensitive and specific. CBS, BASIS, and CBV ASPECTS are statistically robust and sensitive but unspecific predictors of good clinical outcome. Two new derived imaging parameters, CBSV and M1-BASIS, share these properties and may have increased prognostic value. (orig.)

  14. CT findings of early acute cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon; Choi, Woo Suk; Ryu, Kyung Nam [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1992-11-15

    The CT findings of the acute cerebral infarction are well known. However the CT findings of early stroke within 24 hours of the onset have not been sufficiently reported. The purpose of this study is to evaluate early acute cerebral infarction on CT within 24 hours after ictus. The early and accurate CT diagnosis could lead to the appropriate therapy and improved outcome of the patients. Authors retrospectively analyzed 16 patients with early acute cerebral infarction. Acute cerebral infarction was confirmed by follow-up CT in 11 patients, SPECT in 4 patients, and MRI in 1 patient. The CT findings of early acute cerebral infarction include effacement of cortical sulci or cistern (n = 16, 100%), hyperattenuation of MCA (n = 3), obscuration of lentiform nucleus (n = 6), loss of insular ribbon (n = 6) and subtle low density in hemisphere (n = 5). The most frequent finding was effacement of cortical sulci in our study, and it was thought to be the most important sign of early acute cerebral infarction.

  15. Flow Augmentation in Acute Ischemic Stroke.

    Science.gov (United States)

    Yadollahikhales, Golnaz; Borhani-Haghighi, Afshin; Torabi-Nami, Mohammad; Edgell, Randall; Cruz-Flores, Salvador

    2016-01-01

    There is an urgent need for additional therapeutic options for acute ischemic stroke considering the major pitfalls of the options available. Herein, we briefly review the role of cerebral blood flow, collaterals, vasoreactivity, and reperfusion injury in acute ischemic stroke. Then, we reviewed pharmacological and interventional measures such as volume expansion and induced hypertension, intra-aortic balloon counterpulsation, partial aortic occlusion, extracranial-intracranial carotid bypass surgery, sphenopalatine ganglion stimulation, and transcranial laser therapy with regard to their effects on flow augmentation and neuroprotection. © The Author(s) 2014.

  16. Changes of resting cerebral activities in subacute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Ping Wu

    2015-01-01

    Full Text Available This study aimed to detect the difference in resting cerebral activities between ischemic stroke patients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunction and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks and 15 age-matched healthy participants. A resting-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely potential targets for the neural regeneration of subacute ischemic stroke patients.

  17. Changes of resting cerebral activities in subacute ischemic stroke patients

    Institute of Scientific and Technical Information of China (English)

    Ping Wu; Fang Zeng; Yong-xin Li; Bai-li Yu; Li-hua Qiu; Wei Qin; Ji Li; Yu-mei Zhou; Fan-rong Liang

    2015-01-01

    This study aimed to detect the difference in resting cerebral activities between ischemic stroke pa-tients and healthy participants, deifne the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efifcacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunc-tion and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks) and 15 age-matched healthy participants. A rest-ing-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental ifndings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely po-tential targets for the neural regeneration of subacute ischemic stroke patients.

  18. Neural stem cells and new neurons in the cerebral cortex of stroke-prone spontaneously hypertensive rats after stroke.

    Science.gov (United States)

    Itoh, Tatsuki; Satou, Takao; Takemori, Kumiko; Hashimoto, Shigeo; Ito, Hiroyuki

    2010-05-01

    Stroke-prone spontaneously hypertensive rats (SHRSP) are the only animal model that suffers from spontaneous cerebral stroke. In this study, we investigated the appearance of neural stem cells (NSCs) and new neurons in the penumbra and the subventricular zone (SVZ) after cerebral stroke in SHRSP. SHRSP before cerebral stroke were intraperitoneally injected with 5-bromo-2'-deoxyuridine (BrdU). SHRSP were divided into acute and chronic phase groups after cerebral stroke. Brain sections from both groups were studied with cell-specific markers such as BrdU, a cell division and proliferation marker, sex-determining region Y-box 2, a marker of NSCs, nestin, an NSC and immature astrocyte marker, doublecortin, an immature new neuron marker, and neuron-specific nuclear protein, a marker of mature neurons. NSCs and new neurons appeared in the penumbra in the early stages after cerebral stroke, and these cells differentiated into mature neurons in the chronic phase. Furthermore, soon after being affected by a cerebral stroke, there were many new neurons and immature cells, which appear to be NSCs, in the ipsilateral SVZ. Immature cells and new neurons from the ipsilateral SVZ might migrate into the penumbra after cerebral stroke, and this is the first report of their observation after a spontaneous cerebral stroke.

  19. Cerebral Blood Volume ASPECTS Is the Best Predictor of Clinical Outcome in Acute Ischemic Stroke: A Retrospective, Combined Semi-Quantitative and Quantitative Assessment.

    Directory of Open Access Journals (Sweden)

    Marina Padroni

    Full Text Available The capability of CT perfusion (CTP Alberta Stroke Program Early CT Score (ASPECTS to predict outcome and identify ischemia severity in acute ischemic stroke (AIS patients is still questioned.62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF, cerebral blood volume (CBV and mean transit time (MTT maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT, recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS at 3 months after onset were recorded.Semi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001. CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS ≤ 2 and inversely associated with final infarct volume and mRS (p values: from p<0.05 to p<0.00001. CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values: from p<0.05 to p<0.02 only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome.Our findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size.

  20. Obstruction of cerebral arteries in childhood stroke

    Energy Technology Data Exchange (ETDEWEB)

    Velkey, I.; Lombay, B. (County Teaching Hospital, Miskolc (Hungary). Child Health Center); Panczel, G. (Semmelweis Medical Univ., Budapest (Hungary). Dept. of Psychiatry)

    1992-09-01

    Middle cerebral artery obstruction in children is reviewed by our two cases. Ischemic childhood stroke was caused by moyamoya disease in the first, and by fibromuscular dysplasia in the second patient. In both cases transcranial Doppler sonography and cranial CT were performed, but the final diagnosis was made by angiography. The importance of angiography in childhood stroke is emphasized. (orig.).

  1. Sex and acute stroke presentation.

    Science.gov (United States)

    Labiche, Lise A; Chan, Wenyaw; Saldin, Kamaldeen R; Morgenstern, Lewis B

    2002-11-01

    We determine whether a sex difference exists for acute stroke emergency department presentation. The TLL Temple Foundation Stroke Project is a prospective observational study of acute stroke management that identified 1,189 validated strokes in nonurban community EDs from February 1998 to March 2000. Structured interview of the patient and the person with the patient at symptom onset identified the symptom or symptoms that prompted the patient to seek medical attention. Interview data were available for 1,124 (94%) patients. A physician blinded to sex classified the reported symptoms into 14 categories. Nontraditional stroke symptoms were reported by 28% of women and 19% of men (odds ratio 1.62; 95% confidence interval 1.2 to 2.2). Nontraditional stroke symptoms, pain (men 8%, women 12%) and change in level of consciousness (men 12%, women 17%), were more often reported by women. Traditional stroke symptoms, imbalance (men 20%, women 15%) and hemiparesis (men 24%, women 19%), were reported more frequently by men. Trends were also found for women to present with nonneurologic symptoms (men 17%, women 21%) and men to present with gait abnormalities (men 11%, women 8%). There was no sex difference in the mean number of symptoms reported by an individual patient. This study suggests that a sex difference exists in reporting of acute stroke symptoms. Women with validated strokes present more frequently with nontraditional stroke symptoms than men. Recognition of this difference might yield faster evaluation and management of female patients with acute stroke eligible for acute therapies.

  2. Cerebral embolic stroke after disappearing takotsubo cardiomyopathy.

    Science.gov (United States)

    Matsuzono, Kosuke; Ikeda, Yoshio; Deguchi, Shoko; Yamashita, Toru; Kurata, Tomoko; Deguchi, Kentaro; Abe, Koji

    2013-11-01

    Takotsubo cardiomyopathy can induce cerebral embolic stroke because of intracardiac thrombosis, but the timing of cardiogenic embolism relating to takotsubo cardiomyopathy has not been well described. We evaluated a 71-year-old woman with takotsubo cardiomyopathy, who developed cardiogenic cerebral embolism after recovery of cardiac wall motion. Nevertheless, we treated her with anticoagulation therapy. The present clinical observation suggests that attention should be paid to the timing when takotsubo cardiomyopathy resolves against risk of cardiogenic cerebral embolism.

  3. Cerebrogenic tachyarrhythmia in acute stroke

    Directory of Open Access Journals (Sweden)

    A S Praveen Kumar

    2012-01-01

    Full Text Available The electrocardiac abnormalities following acute stroke are frequent and seen in both ischemic and hemorrhagic stroke. The changes seen in electrocardiogram (ECG consist of repolarization abnormalities such as ST elevation, ST depression, negative T waves, and QT prolongation. Among tachyarrhythmias, atrial fibrillation is the most common and occurrence of focal atrial tachycardia is very rare though any cardiac arrhythmias can follow acute stroke. We report a case of focal atrial tachycardia following acute ischemic stroke in 50-year-old female without structural heart disease, and their mechanisms and clinical implications.

  4. Neuroprotection In Acute Stroke

    Directory of Open Access Journals (Sweden)

    Ali Amini Harandi

    2017-02-01

    Full Text Available Stroke is the leading cause of adult disability and remains the third most common cause of death in industrialized nations. The concept of neuroprotection mainly came from the studies of the pathology and pathophysiology of ischemic brain injury. Greater understanding of the pathophysiology of neuronal damage in ischemic stroke has generated interest in neuroprotection as a management strategy. Neuroprotective agents in stroke treatment, have generated long-term interest that have the potential to preserve brain tissue and improve overall outcome. One arm of neuroprotective agents limits acute injury to neurons in the ischemic penumbra. Many of these agents modulate neuronal receptors to reduce release of excitatory neurotransmitters, which contribute to early neuronal injury. Other neuroprotective agents prevent potentially detrimental events associated with return of blood flow. Returning blood contains leukocytes that may occlude small vessels and release toxic products. In fact they should act targeting excitotoxicity, oxidative and nitrosative stress, and inflammation. The past few decades have produced a plethora of negative neuroprotective trial results. The questions of feasibility and practicability cannot be resolved simultaneously. In the future, optimal therapy may be achieved by combining neuroprotective agents with complementary mechanisms. Relevant areas of interest include the search for safe and effective treatment strategies that combine neuroprotection reperfusion, better use of advanced brain imaging for patient selection, and wider implementation of prehospital conducted clinical trials.

  5. Thrombolysis in Acute Ischemic Stroke: The North American Experience

    Institute of Scientific and Technical Information of China (English)

    Justin Zivin

    2000-01-01

    @@It has been understood for well over a century that clots in cerebral arteries are the usual cause of strokes, but it was only in 1995 that the techniques necessary to reduce neurologic damage were identified. A lengthy and difficult effort was required to prove the value of acute stroke thrombolysis and this has become controversial topic.

  6. Hereditary cerebral small vessel disease and stroke

    DEFF Research Database (Denmark)

    Søndergaard, Christian Baastrup; Nielsen, Jørgen Erik; Hansen, Christine Krarup

    2017-01-01

    of this systematic review is to provide a guide for determining when to consider molecular genetic testing in patients presenting with small vessel disease and stroke. CADASIL, CARASIL, collagen type IV mutations (including PADMAL), retinal vasculopathy with cerebral leukodystrophy, Fabry disease, hereditary...... cerebral hemorrhage with amyloidosis, and forkhead box C1 mutations are described in terms of genetics, pathology, clinical manifestation, imaging, and diagnosis. These monogenic disorders are often characterized by early-age stroke, but also by migraine, mood disturbances, vascular dementia and often gait......Cerebral small vessel disease is considered hereditary in about 5% of patients and is characterized by lacunar infarcts and white matter hyperintensities on MRI. Several monogenic hereditary diseases causing cerebral small vessel disease and stroke have been identified. The purpose...

  7. Critical care in acute ischemic stroke.

    Science.gov (United States)

    McDermott, M; Jacobs, T; Morgenstern, L

    2017-01-01

    Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics. In this chapter, we discuss aspects of acute ischemic stroke care that are of particular relevance to a neurointensivist, covering neuropathology, neurodiagnostics and imaging, blood pressure management, glycemic control, temperature management, and the selection and timing of antithrombotics. We also focus on the care of patients who have received intravenous thrombolysis or mechanical thrombectomy. Complex clinical decision making in decompressive hemicraniectomy for hemispheric infarction and urgent management of basilar artery thrombosis are specifically addressed. © 2017 Elsevier B.V. All rights reserved.

  8. Plasma cytokines in acute stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Boysen, Gudrun; Christensen, Erik

    2011-01-01

    GOALS: The aim of this study was to test the relations between plasma cytokines and the clinical characteristics, course, and risk factors in acute stroke. PATIENTS AND METHODS: The analysis was based on 179 patients with acute stroke included within 24 hours of stroke onset. On inclusion and 3...... measured by enzyme-linked immunoassay (ELISA). FINDINGS: The levels of most cytokines were significantly different in acute stroke from the levels 3 months later; but only IL-10 was positively associated with stroke severity. C-reactive protein and white blood cell count were positively associated...... with the cytokine response. CONCLUSIONS: We found a substantial overall cytokine reaction that reflected the stroke incident. However, these results do not, at present, suggest a potential for clinical use, as they do not seem to add to the information obtained from the clinical workup of the individual patient....

  9. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature...... is directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought...

  10. [Pregnancy and acute ischemic stroke].

    Science.gov (United States)

    Bereczki, Dániel

    2016-05-15

    Pregnancy-related ischemic strokes play an important role in both maternal and fetal morbidity and mortality. Changes in hemostaseology and hemodynamics as well as risk factors related to or independent from pregnancy contribute to the increased stroke-risk during gestation and the puerperium. Potential teratogenic effects make diagnostics, acute therapy and prevention challenging. Because randomized, controlled trials are not available, a multicenter registry of patients with gestational stroke would be desirable. Until definite guidelines emerge, management of acute ischemic stroke during pregnancy remains individual, involving experts and weighing the risks and benefits.

  11. Hepatitis C and recurrent treatment-resistant acute ischemic stroke

    OpenAIRE

    Saxsena, Aneeta; Tarsia, Joseph; Dunn, Casey; Aysenne, Aimee; Shah, Basil; Moore, David F.

    2013-01-01

    Since the introduction of recombinant tissue plasminogen activator and thrombolysis, acute ischemic stroke has become a treatable disorder if the patient presents within the 4.5-hour time window. Typically, sporadic stroke is caused by atherosclerotic disease involving large or small cerebral arteries or secondary to a cardioembolic source often associated with atrial fibrillation. In the over-65-year age group, more rare causes of stroke, such as antiphospholipid syndromes, are unusual; such...

  12. Update on acute endovascular and surgical stroke treatment

    DEFF Research Database (Denmark)

    Kondziella, D; Cortsen, M; Eskesen, V

    2013-01-01

    the penumbra. Moreover, decompressive craniectomy is now a well-established treatment option for malignant middle cerebral artery infarction and cerebellar stroke. Using a case-based approach, this article reviews recent achievements in advanced treatment options for patients with acute ischemic stroke.......Emergency stroke care has become a natural part of the emerging discipline of neurocritical care and demands close cooperation between the neurologist and neurointerventionists, neurosurgeons, and anesthesiologists. Endovascular treatment (EVT), including intra-arterial thrombolysis, mechanical...

  13. Evolving Treatments for Acute Ischemic Stroke.

    Science.gov (United States)

    Zerna, Charlotte; Hegedus, Janka; Hill, Michael D

    2016-04-29

    The purpose of this article is to review advances in stroke treatment in the hyperacute period. With recent evolutions of technology in the fields of imaging, thrombectomy devices, and emergency room workflow management, as well as improvement in statistical methods and study design, there have been ground breaking changes in the treatment of acute ischemic stroke. We describe how stroke presents as a clinical syndrome and how imaging as the most important biomarker will help differentiate between stroke subtypes and treatment eligibility. The evolution of hyperacute treatment has led to the current standard of care: intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation. All patients with acute ischemic stroke are in need of hyperacute secondary prevention because the risk of recurrence is highest closest to the index event. The dominant themes of modern stroke care are the use of neurovascular imaging and speed of diagnosis and treatment. © 2016 American Heart Association, Inc.

  14. [Cerebrolysin for acute ischemic stroke].

    Science.gov (United States)

    iganshina, L E; Abakumova, T R

    2013-01-01

    The review discusses existing evidence of benefits and risks of cerebrolysin--a mixture of low-molecular-weight peptides and amino acids derived from pigs' brain tissue with proposed neuroprotective and neurotrophic properties, for acute ischemic stroke. The review presents results of systematic search and analysis of randomised clinical trials comparing cerebrolysin with placebo in patients with acute ischemic stroke. Only one trial was selected as meeting quality criteria. No difference in death and adverse events between cerebrolysin and placebo was established. The authors conclude about insufficiency of evidence to evaluate the effect of cerebrolysin on survival and dependency in people with acute ischemic stroke.

  15. [Histostructural changes of rat cerebral cortex during hemorrhagic stroke modeling].

    Science.gov (United States)

    Savos'ko, S I; Chaĭkovs'kyĭ, Iu B; Pogoriela, N Kh; Makarenko, O M

    2012-01-01

    Pathological changes during modeling of primary and secondary acute hemorrhagic stroke were studied in rats. We revealed differences in the activity of pharmacological action of medications under condition of acute stroke. The action of medications increased viability of neurons in both hemispheres of rat cerebrum at a right-side primary and secondary hemorrhagic stroke. Following secondary stroke, the amount of degenerative neurons amounted 25.5 +/- 0.8 cells/mm2, following the action ofcerebrolysin this value was 17.6 +/- 1.7 cells/ mm2 and after the action of cortexine and cerebral this value amounted 18.0 +/- 0.9 cells/mm2 and 10.7 +/- 0.4 cells/ mm2, respectively. In control animals the number of degenerative neurons did not exceed 2% and averaged 1.5 +/- 0.1 cells/mm2. Analysis of the morphological and statistical data showed that the most effective remedies under the primary and secondary hemorrhagic insult are cortexine and cerebral. Cerebral was found to be more effective.

  16. Acute Stroke Imaging Research Roadmap

    Science.gov (United States)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Köhrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Wu, Ona; Warach, Steven

    2009-01-01

    The recent “Advanced Neuroimaging for Acute Stroke Treatment” meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), industry representatives, and members of the US Food and Drug Administration (FDA) to discuss the role of advanced neuroimaging in acute stroke treatment. The goals of the meeting were to assess state-of-the-art practice in terms of acute stroke imaging research and to propose specific recommendations regarding: (1) the standardization of perfusion and penumbral imaging techniques, (2) the validation of the accuracy and clinical utility of imaging markers of the ischemic penumbra, (3) the validation of imaging biomarkers relevant to clinical outcomes, and (4) the creation of a central repository to achieve these goals. The present article summarizes these recommendations and examines practical steps to achieve them. PMID:18477656

  17. Thrombolysis for Acute Ischemic Stroke

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten; De Keyser, J.; Luijckx, G. J.

    2009-01-01

    In the last decennium, thrombolytic therapy has changed the management of acute ischemic stroke. Randomized clinical studies have demonstrated that intravenous thrombolysis with tissue plasminogen activator improves functional outcomes. Recently the time window for intravenous thrombolysis has been

  18. Risk of Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke and High Cerebral Microbleed Burden: A Meta-analysis.

    Science.gov (United States)

    Tsivgoulis, Georgios; Zand, Ramin; Katsanos, Aristeidis H; Turc, Guillaume; Nolte, Christian H; Jung, Simon; Cordonnier, Charlotte; Fiebach, Jochen B; Scheitz, Jan F; Klinger-Gratz, Pascal P; Oppenheim, Catherine; Goyal, Nitin; Safouris, Apostolos; Mattle, Heinrich P; Alexandrov, Anne W; Schellinger, Peter D; Alexandrov, Andrei V

    2016-06-01

    Cerebral microbleeds (CMBs) have been established as an independent predictor of cerebral bleeding. There are contradictory data regarding the potential association of CMB burden with the risk of symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT). To investigate the association of high CMB burden (>10 CMBs on a pre-IVT magnetic image resonance [MRI] scan) with the risk of sICH following IVT for AIS. Eligible studies were identified by searching Medline and Scopus databases. No language or other restrictions were imposed. The literature search was conducted on October 7, 2015. This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal. Eligible prospective study protocols that reported sICH rates in patients with AIS who underwent MRI for CMB screening prior to IVT. The reported rates of sICH complicating IVT in patients with AIS with pretreatment MRI were extracted independently for groups of patients with 0 CMBs (CMB absence), 1 or more CMBs (CMB presence), 1 to 10 CMBs (low to moderate CMB burden), and more than 10 CMBs (high CMB burden). An individual-patient data meta-analysis was also performed in the included studies that provided complete patient data sets. Symptomatic intracerebral hemorrhage based on the European Cooperative Acute Stroke Study-II definition (any intracranial bleed with ≥4 points worsening on the National Institutes of Health Stroke Scale score). We included 9 studies comprising 2479 patients with AIS. The risk of sICH after IVT was found to be higher in patients with evidence of CMB presence, compared with patients without CMBs (risk ratio [RR], 2.36; 95% CI, 1.21-4.61; P = .01). A higher risk for sICH after IVT was detected in patients with high CMB burden (>10 CMBs) when compared with

  19. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2013-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  20. The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Shuang; Lv, Yan; Zheng, Xin; Qiu, Jing; Chen, Hui-Sheng

    2017-07-01

    It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis. Two retrospective and nine prospective studies met inclusion criteria (total 2702 patients). The overall prevalence of CMBs on pre-IVT MRI scans was 24.0%. Pre-existing CMBs on MRI scans were not significantly associated with a higher risk of early sICH (OR 1.74; 95% CI 0.91-3.33; I (2) = 44.5%). Subgroup analyses did not substantially influence these associations. The presence of CMBs was associated with the increased risk of 3-month PFO (OR 1.58; 95% CI 1.08-2.31; I (2) = 54.2%), PH (OR 2.14; 95% CI 1.34-3.42; I (2) = 11.0%) and any ICH (OR 1.42; 95% CI 1.04-1.95; I (2) = 0.0%), respectively. This meta-analysis showed that CMBs presence was not significantly associated with the increased risk of early sICH after IVT. However, the results also demonstrated that CMBs presence increased the risks of 3-month PFO, PH and any ICH after IVT. Due to a small number of included studies and methodological limitations, the results of this meta-analysis should be interpreted cautiously. CMBs presence should not be a contraindication to IVT for AIS patients based on the existing evidence.

  1. Cognitive improvement after treatment of depressive symptoms in the acute phase of stroke Melhora cognitiva com tratamento antidepressivo na fase aguda do acidente vascular cerebral

    Directory of Open Access Journals (Sweden)

    Samuel Simis

    2006-06-01

    Full Text Available The outcome of antidepressant treatment for depressive symptoms and cognitive impairment at the acute phase of stroke is controversial. We investigated 93 patients, treating with citalopram 36 with severe depressive symptoms (HAM-D: Hamilton Depression Rating Scale >18, whilst 19 patients with mild depressive symptoms, and 38 non-depressed patients, remained untreated. At baseline (two weeks after stroke, patients with severe depressive symptoms had lower scores in total Dementia Rating Scale (DRS and in the attention and memory DRS subscales, than the non-depressed patients (pOs resultados do tratamento com antidepressivo para os sintomas depressivos e comprometimento cognitivo da fase aguda do acidente vascular cerebral não estão estabelecidos. Investigamos 93 pacientes, 36 com sintomas depressivos graves (HAM-D: Escala de Depressão de Hamilton >18 foram tratados com citalopram, enquanto 19 pacientes com sintomas depressivos leves e 38 não-deprimidos não foram tratados. Ao início do tratamento (duas semanas depois do icto, pacientes com sintomas depressivos graves tinham escores mais baixos na Escala de Avaliação de Demência (DRS total e nas subescalas de atenção e de memória da DRS do que os pacientes não-deprimidos (p<0,001. Ao fim de três meses de acompanhamento essas diferenças tinham desaparecido, mas pacientes que inicialmente tinham sintomas depressivos leves passaram a ter escores mais altos no HAM-D do que os não-deprimidos (p=0,015, e escores mais baixos nas subescalas de atenção e memória da DRS (p<0,01 do que os pacientes tratados com citalopram. O tratamento associou-se a melhora de humor, memória e atenção, e demonstra que é necessário um estudo controlado com placebo para o tratamento de sintomas depressivos leves.

  2. Nontraumatic convexal subarachnoid hemorrhage concomitant with acute ischemic stroke.

    Science.gov (United States)

    Nakajima, Makoto; Inatomi, Yuichiro; Yonehara, Toshiro; Hirano, Teruyuki; Ando, Yukio

    2014-07-01

    Nontraumatic convexal subarachnoid hemorrhage (cSAH) rarely occurs subsequent to acute ischemic stroke. The incidence, clinical background characteristics, and outcomes in acute ischemic stroke patients with cSAH were investigated. Our stroke center database was reviewed to identify patients with acute ischemic stroke/transient ischemic attack (TIA) who demonstrated acute cSAH within 14 days of admission between 2005 and 2011. Background characteristics, clinical course, and outcomes at discharge and 3 months after onset were investigated in these patients. Of 4953 acute stroke/TIA patients, cSAH was observed in 8 (.14%) patients (7 men, mean age 71 years): 7 were detected incidentally, and the other was found immediately after a convulsion. Two patients died during their hospital stay, 1 died after discharge, and 3 were dependent at 3 months. Major artery occlusion or severe stenosis was observed in 5 patients. Two patients subsequently developed subcortical hemorrhage. On gradient echo imaging, lobar cerebral microbleeds were observed in 2 patients, and chronic superficial siderosis was observed in 2 patients. In this retrospective review of cases with ischemic stroke and cSAH, over half of patients had occlusion of major arteries. Cerebral amyloid angiopathy was suggested by magnetic resonance imaging findings and subsequent events in 3 patients. The overall outcome was unfavorable although the causal relationship with cSAH was unclear. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Acute Ischemic Stroke and Acute on Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Raja Ahsan Aftab

    2016-06-01

    Full Text Available Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled. He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis, acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition. Keywords: ischemic disease; chronic kidney disease; uncontrolled hypertension. | PubMed

  4. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj

    2009-01-01

    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... of infarcts. For a number of years, tight glycemic control has been regarded as beneficial in critically illness, but recent research has been unable to support this notion. The only completed randomized study on glucose-lowering therapy in stroke has failed to demonstrate effect, and concerns relating...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  5. RAAS and stress markers in acute ischemic stroke

    DEFF Research Database (Denmark)

    Back, C.; Thiesen, K L; Olsen, Karsten Skovgaard;

    2015-01-01

    OBJECTIVES: Angiotensin II type 1 receptor blockade has neuroprotective effects in animal stroke models, but no effects in clinical stroke trials. We evaluated cerebral and peripheral changes in the renin angiotensin aldosterone system (RAAS) and stress responses in acute ischemic stroke patients....... MATERIALS AND METHODS: Blood from a jugular and cubital vein was collected within 48 h of stroke onset, after 24 and 48 h, and renin, angiotensin I, angiotensin II, aldosterone, norepinephrine, epinephrine, and cortisol were measured. Post-stroke cubital vein samples were collected after 8 (4.7-10) months......-stroke. No differences in RAAS were detected between jugular and cubital plasma levels. Jugular venous plasma levels of epinephrine and cortisol were elevated in the acute phase compared to cubital levels (P cortisol levels in the jugular vein blood may reflect a higher...

  6. [Acute tetraparesis of cerebral origin].

    Science.gov (United States)

    Feuillet, L; Milandre, L; Kaphan, E; Ali Cherif, A

    2005-09-01

    Thrombolytic treatment in the early stage of ischemic cerebral attacks requires rapid confirmation of the diagnosis and topographic localization. Unusual clinical features can lead to misdiagnosis with the risk of delaying optimal therapeutic management. We report the cases of two patients who experienced acute tetraparesis without any associated encephalic sign, consistent with the diagnosis of spinal cord injury. Cervical magnetic resonance imaging (MRI) was normal. Conversely, cerebral MRI displayed in both cases bilateral hemispheric infarction. Two ischemic lesions were revealed in the territory of both anterior cerebral arteries in the first patient, while the second patient had a bilateral infarction in the posterior arms of both internal capsules. In case of tetraparesis, emergency spinal cord MRI should be performed to rule out neurosurgical etiologies and ischemia. If negative, cerebral MRI should be performed at the same time to look for early cerebral infarction in both hemispheres and determine the indication for thrombolysis.

  7. Auditory Hallucinations in Acute Stroke

    Directory of Open Access Journals (Sweden)

    Yair Lampl

    2005-01-01

    Full Text Available Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

  8. Nutritional status in acute stroke: undernutrition versus overnutrition in different stroke subtypes.

    Science.gov (United States)

    Choi-Kwon, S; Yang, Y H; Kim, E K; Jeon, M Y; Kim, J S

    1998-09-01

    Nutritional status in the acute stage of stroke has not been properly evaluated in different stroke subtypes. The objective of this study was to investigate the nutritional status of different subtypes of stroke patients. We studied 88 female patients with first-ever strokes. Strokes were divided into cerebral infarction (CI, n=67) and intracerebral hemorrhage (ICH, n=21). We measured the nutritional status of the patients in the acute stage of stroke with the use of 8 parameters including 3 biochemical and 5 anthropometric ones. These variables were assessed in stroke patients and 120 age-matched controls, and were compared with each other. In the acute stage of stroke, undernourishment was significantly (P=0.000) more prevalent in the ICH group (62%) than in the CI group (25%) or controls (13%). On the other hand obesity was present in 10%, 24% and 17% in patients with ICH, those with CI, and controls, respectively, which was not significantly different (P=0.461). Only abdominal skinfold thickness was significantly greater in patients with CI than in those with ICH or controls. Conclusions - Our results illustrate that undernourishment is prevalent in acute stroke patients, significantly more so in patients with ICH than in those with CI. Stroke patients, especially those with ICH, should receive special nutritional intervention starting immediately after admission.

  9. Difference in the Location and Risk Factors of Cerebral Microbleeds According to Ischemic Stroke Subtypes

    OpenAIRE

    Kim, Bum Joon; Yoon, Youngshin; Sohn, Hoyon; Kang, Dong-Wha; Kim, Jong S.; Kwon, Sun U.

    2016-01-01

    Background and Purpose The location of cerebral microbleeds (CMBs) may differ according to ischemic stroke subtype, and the underlying pathomechanism may differ by their location. Here, we investigated the characteristics of CMBs according to various ischemic stroke subtypes to verify this issue. Methods Patients with acute ischemic stroke were consecutively included. The presence of CMBs was determined by gradient echo image sequence. The distribution of CMBs was classified as deep, lobar, o...

  10. Diffusion and Perfusion MRI in Acute Cerebral Ischemia

    Institute of Scientific and Technical Information of China (English)

    Tchoyoson CC Lim; Chong-Tin Tan

    2001-01-01

    Reeent advances in magnetic resonance imaging (MRI), in particular diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI), have allowed clinicians to have the ability to differentiate between irreversible cerebral infarction and the potentially reversible ischemic penumbra. This article examines the principles and practice of DWI and PWI. With continued advances in thrombolysis and other therapy for acute cerebral ischemia, neuroimaging is poised to play an increasingly important role in decisionmaking in aeute stroke.

  11. A large web-based observer reliability study of early ischaemic signs on computed tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS.

    Directory of Open Access Journals (Sweden)

    Joanna M Wardlaw

    Full Text Available BACKGROUND: Early signs of ischaemic stroke on computerised tomography (CT scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. METHODOLOGY AND PRINCIPAL FINDINGS: We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. CONCLUSIONS: Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis.

  12. A Large Web-Based Observer Reliability Study of Early Ischaemic Signs on Computed Tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS)

    Science.gov (United States)

    Wardlaw, Joanna M.; von Kummer, Rüdiger; Farrall, Andrew J.; Chappell, Francesca M.; Hill, Michael; Perry, David

    2010-01-01

    Background Early signs of ischaemic stroke on computerised tomography (CT) scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. Methodology and Principal Findings We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs) to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC) analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. Conclusions Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis. PMID:21209901

  13. Neuroprotection in acute ischemic stroke

    NARCIS (Netherlands)

    De Keyser, Jacques; Uyttenboogaart, Maarten; Koch, Marcus W; Elting, Jan Willem; Sulter, Geert; Vroomen, Patrick C; Luijckx, Gert Jan

    2005-01-01

    Neuroprotection of patients with acute ischemic stroke should start at the scene and continue in the ambulance with the assessment and treatment of the airway, breathing, circulation, body temperature, and blood glucose. The key goal in eligible patients should be fast vessel recanalization with int

  14. Multimodal MR examination in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Mezzapesa, D.M.; Petruzzellis, M.; Lucivero, V.; Prontera, M.; Tinelli, A.; Sancilio, M.; Carella, A.; Federico, F. [University of Bari, Department of Neurological and Psychiatric Sciences, Bari (Italy)

    2006-04-15

    In recent years, combined diffusion-weighted imaging (DWI) with perfusion imaging (PI) has become an important investigational tool in the acute phase of ischemic stroke, as it may differentiate reversible from irreversible brain tissue damage. We consecutively examined 20 subjects within 12 h of stroke onset using a multiparametric magnetic resonance (MR) examination consisting of DWI, mean transit time (MTT) as PI parameter, and MR angiography (MRA). T2-weighted and fluid-attenuated inversion recovery (FLAIR) on day 7 were also acquired in order to obtain final infarct volume. The following MR parameters were considered: volumetric measures of lesion growth and MTT abnormalities, quantification of regional apparent diffusion coefficient (ADC) and visual inspection of MRA findings. Our results showed: (1) an acute DWI lesion was not predictive of lesion growth and the DWI abnormality did not represent the irreversibly infarcted tissue; (2) ADC values in the ischemic penumbra could not predict tissue at risk; (3) the DWI-PI mismatch did not predict lesion growth, and the PI abnormality overestimated the amount of tissue at risk; and (4) patients with proximal middle cerebral artery occlusion had greater initial and final infarct volumes. This study did not demonstrate the prognostic value of a multimodal MR approach in early ischemic stroke; MRA alone provided predictive information about the volumetric evolution of the lesion. (orig.)

  15. Predicting hemorrhagic transformation by microvascular permeability using perfusion CT acute cerebral infarction in elderly patients

    Institute of Scientific and Technical Information of China (English)

    田超

    2014-01-01

    Objective To study the possibility of microvascular permeability(PS)value derived from perfusion CT(PCT)in predicting hemorrhagic transformation(HT)in acute cerebral infarction in elderly patients.Methods 52consecutive patients with middle cerebral artery acute ischemic stroke who received thrombolytic therapy were divided into HT group and control group,and patients in

  16. In Acute Stroke, Can CT Perfusion-Derived Cerebral Blood Volume Maps Substitute for Diffusion-Weighted Imaging in Identifying the Ischemic Core?

    Directory of Open Access Journals (Sweden)

    William A Copen

    Full Text Available In the treatment of patients with suspected acute ischemic stroke, increasing evidence suggests the importance of measuring the volume of the irreversibly injured "ischemic core." The gold standard method for doing this in the clinical setting is diffusion-weighted magnetic resonance imaging (DWI, but many authors suggest that maps of regional cerebral blood volume (CBV derived from computed tomography perfusion imaging (CTP can substitute for DWI. We sought to determine whether DWI and CTP-derived CBV maps are equivalent in measuring core volume.58 patients with suspected stroke underwent CTP and DWI within 6 hours of symptom onset. We measured low-CBV lesion volumes using three methods: "objective absolute," i.e. the volume of tissue with CBV below each of six published absolute thresholds (0.9-2.5 mL/100 g, "objective relative," whose six thresholds (51%-60% were fractions of mean contralateral CBV, and "subjective," in which two radiologists (R1, R2 outlined lesions subjectively. We assessed the sensitivity and specificity of each method, threshold, and radiologist in detecting infarction, and the degree to which each over- or underestimated the DWI core volume. Additionally, in the subset of 32 patients for whom follow-up CT or MRI was available, we measured the proportion of CBV- or DWI-defined core lesions that exceeded the follow-up infarct volume, and the maximum amount by which this occurred.DWI was positive in 72% (42/58 of patients. CBV maps' sensitivity/specificity in identifying DWI-positive patients were 100%/0% for both objective methods with all thresholds, 43%/94% for R1, and 83%/44% for R2. Mean core overestimation was 156-699 mL for objective absolute thresholds, and 127-200 mL for objective relative thresholds. For R1 and R2, respectively, mean±SD subjective overestimation were -11±26 mL and -11±23 mL, but subjective volumes differed from DWI volumes by up to 117 and 124 mL in individual patients. Inter-rater agreement

  17. STUDY OF RISK FACTORS AND CLINICAL PROFILE OF ACUTE STROKE

    Directory of Open Access Journals (Sweden)

    Tomar

    2014-05-01

    Full Text Available `INTRODUCTION: Stroke is the third leading cause of death in developed countries after cardiovascular disease and cancer. In India Community Surveys have shown a crude prevalence rate for hemiplegia 200 per 1, 00, 000 population. It accounts for nearly 1.5% of all urban admissions, 4.5 % of all medical and about 20% of neurological cases. AIMS AND OBJECTIVE: Identification of risk factors and evaluation of clinical profile of acute stroke. MATERIAL AND METHOD: INCLUSION CRITERIA: Cases of acute stoke admitted in SGMH hospital were selected for the study. EXCLUSION CRITERIA: Brain injury cases, infective, neoplastic cases producing stroke were excluded. RESULTS: Stroke was more common in male, 58 % patients were male and 42% patients were female. It was more common in 5th and 6th decade. Most common etiology was infarction. Most common risk factor was hypertension followed by smoking. In addition to limb weakness, headache and vomiting were most common presenting symptoms followed by convulsion. These symptoms were more common in hemorrhagic stroke. Right sided hemiplegia was more common than left sided. Middle cerebral artery was involved in majority of cases in atherothrombotic stroke whereas basal ganglion was most common site of bleed in hemorrhagic stroke. Coma and mortality were more in hemorrhagic stroke. CONCLUSION: The risk factors and clinical profile of acute stroke in India are similar to that of Western countries. Common risk factors are hypertension, smoking, diabetes mellitus and hyperlipidemia

  18. Prevalence of cerebral microbleeds in Thai patients with ischemic stroke

    Directory of Open Access Journals (Sweden)

    Artit Potigumjon

    2017-01-01

    Full Text Available Background: With the widespread use of magnetic resonance imaging (MRI, cerebral microbleeds (CMBs are commonly detected. Ethnicity seems to play a role in the prevalence of CMB, with higher prevalence in participants from Asian origin. The purpose of the study is to look for the prevalence of CMBs and associated factors in Thai patients with ischemic stroke. Methods: Patients with acute ischemic stroke who had MRI and magnetic resonance angiography during January–August 2014 were included in the study. T2*-weighted gradient-recalled echo was used to define CMBs. Baseline characteristics, stroke subtypes, and severity of white matter lesions were compared between patients with and without CMBs. Results: Two hundred patients were included in the study. Mean age of the patients was 61-year-old. Mean National Institutes of Health Stroke Scale was 8. The prevalence of CMBs was 20% (39/200 patients. Hypertension (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.07–8.68, P = 0.037, and moderate-to-severe white matter lesions (Fazekas 2–3, OR 7.61, 95% CI 3.06–18.95, P < 0.001 were related to the presence of CMBs. Conclusions: CMBs were found in 20% of patients with ischemic stroke, which was lower than those reported from Japanese studies but comparable to a Chinese study. CMBs were associated with hypertension and severity of the white matter lesions.

  19. Prevalence of Cerebral Microbleeds in Thai Patients with Ischemic Stroke.

    Science.gov (United States)

    Potigumjon, Artit; Watcharakorn, Arvemas; Dharmasaroja, Pornpatr A

    2017-01-01

    With the widespread use of magnetic resonance imaging (MRI), cerebral microbleeds (CMBs) are commonly detected. Ethnicity seems to play a role in the prevalence of CMB, with higher prevalence in participants from Asian origin. The purpose of the study is to look for the prevalence of CMBs and associated factors in Thai patients with ischemic stroke. Patients with acute ischemic stroke who had MRI and magnetic resonance angiography during January-August 2014 were included in the study. T2*-weighted gradient-recalled echo was used to define CMBs. Baseline characteristics, stroke subtypes, and severity of white matter lesions were compared between patients with and without CMBs. Two hundred patients were included in the study. Mean age of the patients was 61-year-old. Mean National Institutes of Health Stroke Scale was 8. The prevalence of CMBs was 20% (39/200 patients). Hypertension (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.07-8.68, P = 0.037), and moderate-to-severe white matter lesions (Fazekas 2-3, OR 7.61, 95% CI 3.06-18.95, P CMBs. CMBs were found in 20% of patients with ischemic stroke, which was lower than those reported from Japanese studies but comparable to a Chinese study. CMBs were associated with hypertension and severity of the white matter lesions.

  20. The Desmoteplase in Acute Ischemic Stroke (DIAS) clinical trial program.

    Science.gov (United States)

    von Kummer, Rüdiger; Albers, Gregory W; Mori, Etsuro

    2012-10-01

    Desmoteplase is a novel, highly fibrin-specific thrombolytic agent in phase III of clinical development. In comparison to alteplase, it has high fibrin selectivity, is associated with minimal or no neurotoxicity, and has no apparent negative effect on the blood-brain barrier. The safety and efficacy of desmoteplase is being studied in the Desmoteplase in Acute Ischemic Stroke clinical trial program. Three studies (Dose Escalation Study of Desmoteplase in Acute Ischemic Stroke, Desmoteplase in Acute Ischemic Stroke, and Desmoteplase in Acute Ischemic Stroke-2) have been completed, two large randomized, double-blind, placebo-controlled, phase III trials are ongoing at >200 sites worldwide (Desmoteplase in Acute Ischemic Stroke-3 and Desmoteplase in Acute Ischemic Stroke-4, n = 800; DIAS-3 and DIAS-4), and a randomized, double-blind, placebo-controlled, dose-escalation phase II trial is ongoing in Japan (Desmoteplase in Acute Ischemic Stroke-Japan, n = 48; DIAS-J). The objective of DIAS-3 and DIAS-4 is to evaluate the safety and efficacy of a single IV bolus injection of 90 μg/kg desmoteplase given three- to nine-hours after onset of ischemic stroke (National Institutes of Health Stroke Scale 4-24, age 18-85 years). The objective of DIAS-J is to evaluate the safety and tolerability of desmoteplase 70 and 90 μg/kg three- to nine-hours after ischemic stroke onset in Japanese patients. Patients are included with occlusion or high-grade stenosis (thrombolysis in myocardial infarction 0-1) in proximal cerebral arteries on magnetic resonance or computed tomography angiography but excluded with extended ischemic edema on computed tomography or diffusion-weighted imaging. Desmoteplase is the only thrombolytic agent in late-stage development for acute ischemic stroke that is now tested in patients with proven stroke pathology. The results of the Desmoteplase in Acute Ischemic Stroke clinical trial program will show whether patients with major artery occlusions

  1. Protective effect of grifolin against brain injury in an acute cerebral ...

    African Journals Online (AJOL)

    Protective effect of grifolin against brain injury in an acute ... Sent for review: 24 January 2017 ... levels in tissue homogenates of the cerebral ischemic rats compared with those in the negative ... Stroke is a major cause of death worldwide [1].

  2. European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke.

    Science.gov (United States)

    Ntaios, George; Dziedzic, Tomasz; Michel, Patrik; Papavasileiou, Vasileios; Petersson, Jesper; Staykov, Dimitre; Thomas, Brenda; Steiner, Thorsten

    2015-08-01

    Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. We found low-quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low-quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better-informed recommendations in the future. © 2015 World Stroke Organization.

  3. estimated glomerular filtration rate and risk of survival in acute stroke

    African Journals Online (AJOL)

    2014-03-03

    Mar 3, 2014 ... Subjects: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic ... in terms of survival and functional disability (7,8). ... magnetic resonance imaging (MRI) as either cerebral infarct or ...

  4. Pseudoradial Nerve Palsy Caused by Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Hassan Tahir MD

    2016-07-01

    Full Text Available Pseudoperipheral palsy has been used to characterize isolated monoparesis secondary to stroke. Isolated hand nerve palsy is a rare presentation for acute cerebral stroke. Our patient presented with clinical features of typical peripheral radial nerve palsy and a normal computed tomography scan of the head, which, without a detailed history and neurological examination, could have been easily misdiagnosed as a peripheral nerve lesion deferring further investigation for a stroke. We stress the importance of including cerebral infarction as a critical differential diagnosis in patients presenting with sensory-motor deficit in an isolated peripheral nerve pattern. A good history and physical exam can differentiate stroke from peripheral neuropathy as the cause of radial nerve palsy.

  5. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J;

    2001-01-01

    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome....... In addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

  6. Piracetam for acute ischaemic stroke.

    Science.gov (United States)

    Ricci, Stefano; Celani, Maria Grazia; Cantisani, Teresa Anna; Righetti, Enrico

    2012-09-12

    Piracetam has neuroprotective and antithrombotic effects that may help to reduce death and disability in people with acute stroke. This is an update of a Cochrane Review first published in 1999, and previously updated in 2006 and 2009. To assess the effects of piracetam in acute, presumed ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (last searched 15 May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1966 to May 2011), EMBASE (1980 to May 2011), and ISI Science Citation Index (1981 to May 2011). We also contacted the manufacturer of piracetam to identify further published and unpublished studies. Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within three days of stroke onset. Two review authors extracted data and assessed trial quality and this was checked by the other two review authors. We contacted study authors for missing information. We included three trials involving 1002 patients, with one trial contributing 93% of the data. Participants' ages ranged from 40 to 85 years, and both sexes were equally represented. Piracetam was associated with a statistically non-significant increase in death at one month (approximately 31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependence or proportion of patients dead or dependent. Adverse effects were not reported. There is some suggestion (but no statistically significant result) of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. There is not enough evidence to assess the effect of piracetam on dependence.

  7. Acute stroke magnetic resonance imaging: current status and future perspective.

    Science.gov (United States)

    Kloska, Stephan P; Wintermark, Max; Engelhorn, Tobias; Fiebach, Jochen B

    2010-03-01

    Cerebral stroke is one of the most frequent causes of permanent disability or death in the western world and a major burden in healthcare system. The major portion is caused by acute ischemia due to cerebral artery occlusion by a clot. The minority of strokes is related to intracerebral hemorrhage or other sources. To limit the permanent disability in ischemic stroke patients resulting from irreversible infarction of ischemic brain tissue, major efforts were made in the last decade. To extend the time window for thrombolysis, which is the only approved therapy, several imaging parameters in computed tomography and magnetic resonance imaging (MRI) have been investigated. However, the current guidelines neglect the fact that the portion of potentially salvageable ischemic tissue (penumbra) is not dependent on the time window but the individual collateral blood flow. Within the last years, the differentiation of infarct core and penumbra with MRI using diffusion-weighted images (DWI) and perfusion imaging (PI) with parameter maps was established. Current trials transform these technical advances to a redefined patient selection based on physiological parameters determined by MRI. This review article presents the current status of MRI for acute stroke imaging. A special focus is the ischemic stroke. In dependence on the pathophysiology of cerebral ischemia, the basic principle and diagnostic value of different MRI sequences are illustrated. MRI techniques for imaging of the main differential diagnoses of ischemic stroke are mentioned. Moreover, perspectives of MRI for imaging-based acute stroke treatment as well as monitoring of restorative stroke therapy from recent trials are discussed.

  8. Acute stroke magnetic resonance imaging: current status and future perspective

    Energy Technology Data Exchange (ETDEWEB)

    Kloska, Stephan P. [University of Erlangen-Nuernberg, Department of Neuroradiology, Erlangen (Germany); University of Muenster, Department of Clinical Radiology, Muenster (Germany); Wintermark, Max [University of Virginia, Department of Radiology, Neuroradiology Division, Charlottesville, VA (United States); Engelhorn, Tobias [University of Erlangen-Nuernberg, Department of Neuroradiology, Erlangen (Germany); Fiebach, Jochen B. [Charite, Universitaetsmedizin Berlin, Campus Benjamin Franklin, Center for Stroke Research Berlin (CSB), Department of Neurology, Berlin (Germany)

    2010-03-15

    Cerebral stroke is one of the most frequent causes of permanent disability or death in the western world and a major burden in healthcare system. The major portion is caused by acute ischemia due to cerebral artery occlusion by a clot. The minority of strokes is related to intracerebral hemorrhage or other sources. To limit the permanent disability in ischemic stroke patients resulting from irreversible infarction of ischemic brain tissue, major efforts were made in the last decade. To extend the time window for thrombolysis, which is the only approved therapy, several imaging parameters in computed tomography and magnetic resonance imaging (MRI) have been investigated. However, the current guidelines neglect the fact that the portion of potentially salvageable ischemic tissue (penumbra) is not dependent on the time window but the individual collateral blood flow. Within the last years, the differentiation of infarct core and penumbra with MRI using diffusion-weighted images (DWI) and perfusion imaging (PI) with parameter maps was established. Current trials transform these technical advances to a redefined patient selection based on physiological parameters determined by MRI. This review article presents the current status of MRI for acute stroke imaging. A special focus is the ischemic stroke. In dependence on the pathophysiology of cerebral ischemia, the basic principle and diagnostic value of different MRI sequences are illustrated. MRI techniques for imaging of the main differential diagnoses of ischemic stroke are mentioned. Moreover, perspectives of MRI for imaging-based acute stroke treatment as well as monitoring of restorative stroke therapy from recent trials are discussed. (orig.)

  9. Bacterial pneumonia following acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Li-Fu Chen

    2013-02-01

    Conclusion: Pneumonia after acute ischemic stroke is a severe complication. Once stroke-related pneumonia develops, neurologic assessment, CURB-65 score, and shock can be used to predict the ultimate prognosis.

  10. Acute Ischemic Stroke and Transient Ischemic Attack

    OpenAIRE

    Staykov, Dimitre; Schwab, Stefan

    2014-01-01

    This short review focuses on recent practically relevant studies in stroke treatment and prevention and discusses their implications on clinical practice and future research, including 3 shortly published randomized controlled trials investigating interventional treatment in acute ischemic stroke (The Interventional Management of Stroke phase III trial [IMS III], Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke, and ...

  11. Therapeutic hypothermia after recanalization in patients with acute ischemic stroke.

    Science.gov (United States)

    Hong, Ji Man; Lee, Jin Soo; Song, Hee-Jung; Jeong, Hye Seon; Jung, Hae-Sun; Choi, Huimahn Alex; Lee, Kiwon

    2014-01-01

    Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. We investigated the clinical and radiological effects of therapeutic hypothermia in acute ischemic stroke patients after recanalization. A prospective cohort study at 2 stroke centers was performed. We enrolled patients with acute ischemic stroke in the anterior circulation with an initial National Institutes of Health Stroke Scale≥10 who had successful recanalization (≥thrombolysis in cerebral ischemia, 2b). Patients at center A underwent a mild hypothermia (34.5°C) protocol, which included mechanical ventilation, and 48-hour hypothermia and 48-hour rewarming. Patients at center B were treated according to the guidelines without hypothermia. Cerebral edema, hemorrhagic transformation, good outcome (3-month modified Rankin Scale, ≤2), mortality, and safety profiles were compared. Potential variables at baseline and during the therapy were analyzed to evaluate for independent predictors of good outcome. The hypothermia group (n=39) had less cerebral edema (P=0.001), hemorrhagic transformation (P=0.016), and better outcome (P=0.017) compared with the normothermia group (n=36). Mortality, hemicraniectomy rate, and medical complications were not statistically different. After adjustment for potential confounders, therapeutic hypothermia (odds ratio, 3.0; 95% confidence interval, 1.0-8.9; P=0.047) and distal occlusion (odds ratio, 7.3; 95% confidence interval; 1.3-40.3; P=0.022) were the independent predictors for good outcome. Absence of cerebral edema (odds ratio, 5.4; 95% confidence interval, 1.6-18.2; P=0.006) and no medical complications (odds ratio, 9.3; 95% confidence interval, 2.2-39.9; P=0.003) were also independent predictors for good outcome during the therapy. In patients with ischemic stroke, after successful recanalization, therapeutic hypothermia may reduce risk of cerebral edema and hemorrhagic transformation, and lead to improved

  12. Visiting time of acute cerebral stroke patients and its influence factors%急性脑卒中就诊时间及其影响因素分析

    Institute of Scientific and Technical Information of China (English)

    曹海燕; 卢俏丽; 魏常娟; 薛蓉; 程焱

    2012-01-01

    Objective To study the visiting time of acute cerebral stroke patients and its influence factors. Methods Seven hundred and forty-eight cerebral stroke patients who visited Emergency Department,General Hospital of Tianjin Medical University from September 2010 to April 2011 were included in this study. Their visiting time and ways of arriving at the Emergency Department were recorded. Effect of types and severity of cerebral stroke,number of its occurrences,and occupation, education level and initial symptoms of the patients on their visiting time was analyzed. Re-rults The visiting time was <2 h and 2 ?6 h,respectively,in 22. 99% and 31. 95% of the patients after the onset of their disease. The patients uasually went to hospital by taxi, accounting for 37. 97%. The patients were diagnosed as hemorrhagic cerebral stroke with severe symptoms. The proportion of patients graduated from senior middle school,cadres and technicians with a visiting time^6 h was higher and the visiting time of those with their initial symptoms ^3 such as headach,disturbance of consciousness and epilesy was shorter(P<0. 05). Conclusion The public have a poor ability to recognize cerebral stroke and seek for first-aid. The prehospital first-aid system is imperect. The medical staff lack of standard training for the first-aid of cerebral stroke and the prehospital first-aid delay is severe.%目的 探讨急性脑卒中就诊时间及其影响因素.方法 收集2010年9月~2011年4月在天津医科大学总医院神经内科急诊室就诊的脑卒中患者748例,记录就诊时间和到达急诊室的方式,分析脑卒中类型、病情轻重、发病次数、职业、文化程度及首发症状对就诊时间是否有影响.结果 748例患者中,仅22.99%的患者在发病<2h到达医院就诊,31.95%的患者在发病2~6 h到医院就诊,到达急诊室最常见的转运方式是出租车(37.97%).脑出血、病情重、高中及以上文化程度、干部及

  13. Acute ischemic stroke in low-voltage electrical injury: A case report

    OpenAIRE

    Huan-Jui, Yeh; Chih-Yang, Liu; Huei-Yu, Lo; Po-Chih, Chen

    2010-01-01

    Background: Acute stroke is not a common complication of electrical injury, and only a few cases of acute stroke have been reported for lightning or high-voltage injuries. Case Report: We present the case of a man who suffered from a low-voltage electrical injury followed by ischemic stroke. Magnetic resonance angiography showed segmental narrowing of the right internal carotid artery and right middle cerebral artery. The patient underwent thrombolytic therapy and catheter-assisted angioplast...

  14. Brain perfusion-CT in acute stroke patients

    Energy Technology Data Exchange (ETDEWEB)

    Wintermark, M. [Dept. of Radiology, Univ. of California, San Francisco (UCSF), CA (United States)

    2005-11-15

    The role of neuro-imaging in the evaluation of acute stroke has changed dramatically in the past decade. Previously, neuro-imaging was used in this setting to provide anatomic imaging that indicated the presence or absence of acute cerebral ischemia and excluded lesions that produce symptoms or signs mimicking those of stroke, such as hemorrhage and neoplasms. More recently, the introduction of thrombolysis has changed the goals of neuro-imaging from providing solely anatomic information to providing physiologic information that could help to determine which patients might benefit from therapy. In particular, significant emphasis has been placed on the delineation of the ischemic penumbra, also called tissue at risk. Modern CT survey, consisting of three indissociable elements: noncontrast CT (NCT) of course, perfusion-CT (PCT) and CT-angiography (CTA), fulfill all the requirements for hyper-acute stroke imaging. CTA can define the occlusion site, depict arterial dissection, grade collateral blood flow, and characterize atherosclerotic disease, whereas PCT accurately delineates the infarct core and the ischemic penumbra. CT offers a number of practical advantages over other cerebral perfusion imaging methods, including its wide availability. Using PCT and CTA to define new individualized strategies for acute reperfusion will allow more acute stroke patients to benefit from thrombolytic therapy. (orig.)

  15. General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke: The AnStroke Trial (Anesthesia During Stroke).

    Science.gov (United States)

    Löwhagen Hendén, Pia; Rentzos, Alexandros; Karlsson, Jan-Erik; Rosengren, Lars; Leiram, Birgitta; Sundeman, Henrik; Dunker, Dennis; Schnabel, Kunigunde; Wikholm, Gunnar; Hellström, Mikael; Ricksten, Sven-Erik

    2017-06-01

    Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients. Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation. Difference in neurological outcome at 3 months, measured as modified Rankin Scale score, was analyzed (primary outcome) and early neurological improvement of National Institutes of Health Stroke Scale and cerebral infarction volume. Age, sex, comorbidities, admission National Institutes of Health Stroke Scale score, intraprocedural blood pressure, blood glucose, Paco2 and Pco2 modified Thrombolysis in Cerebral Ischemia score, and relevant time intervals were recorded. In the general anesthesia group 19 of 45 patients (42.2%) and in the conscious sedation group 18 of 45 patients (40.0%) achieved a modified Rankin Scale score ≤2 (P=1.00) at 3 months, with no differences in intraoperative blood pressure decline from baseline (P=0.57); blood glucose (P=0.94); PaCO2 (P=0.68); time intervals (P=0.78); degree of successful recanalization, 91.1% versus 88.9% (P=1.00); National Institutes of Health Stroke Scale score at 24 hours 8 (3-5) versus 9 (2-15; P=0.60); infarction volume, 20 (10-100) versus 20(10-54) mL (P=0.53); and hospital mortality (13.3% in both groups; P=1.00). In endovascular treatment for acute ischemic stroke, no difference was found between general anesthesia and conscious sedation in neurological outcome 3 months after stroke. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01872884. © 2017 American Heart Association, Inc.

  16. 急性脑卒中并发脑心综合征临床分析%Acute Cerebral Stroke Complicated by Brain Heart Syndrome Clinical Anal-ysis

    Institute of Scientific and Technical Information of China (English)

    吴文华; 韩国花

    2015-01-01

    目的:探讨急性脑卒中后并发脑心综合征(cerebro-cardiac syndrome,CCS)的临床特点。方法对该院神经内科住院急性脑卒中合并CCS患者的病变性质、部位、心电图、心肌酶检查、治疗与预后进行分析。结果 CCS在出血性卒中发病率(51.43%),高于缺血性卒中(19.09%),病灶位于基底节及丘脑发病率较高(68.42%),心电图表现包括各种类型心律失常、Q-T间期延长、心肌缺血等改变,实验室检查心肌酶不同程度的升高。结论急性脑卒中治疗原发病的同时应重视脑心综合征的发生,及时发现和治疗脑心综合征,可提高急性脑卒中的疗效。%Objective To study brain heart syndrome of acute cerebral apoplexy (cerebro-cardiac syndrome, CCS) clinical char-acteristics. Methods The department of neurology patients with acute brain stroke combined CCS, electrocardiogram (ecg), myocar-dial enzymes of lesion nature, part of the examination, treatment and prognosis were analyzed. Results CCS in the incidence of hemorrhagic stroke(51.43%), higher than that of ischemic stroke (19.09%), higher incidence of lesions in the basal ganglia and tha-lamus (68.42%), electrocardiogram (ecg) performance including all kinds of arrhythmia, Q-T extended, myocardial ischemia, such as change, laboratory examination elevated myocardial enzymes of different level. Conclusion Acute stroke treatment of the prima-ry disease at the same time should pay attention to the occurrence of brain heart syndrome, timely detection and treatment of brain heart syndrome, can improve the curative effect of acute brain stroke.

  17. Pediatric Stroke: The Importance of Cerebral Arteriopathy and Vascular Malformations

    OpenAIRE

    Beslow, Lauren A.; Jordan, Lori C

    2010-01-01

    Stroke is an important cause of neurologic morbidity in childhood. Population-based estimates of the annual incidence of childhood stroke range from 2 to 13 per 100,000 children. This article will review recent literature on both hemorrhagic and ischemic stroke in children with a focus on cerebral arteriopathy and vascular malformations as stroke risk factors. Additional risk factors include congenital heart disease, sickle cell disease, and hematologic abnormalities among others. Outcomes ar...

  18. [Technical standards for the interventional treatment of acute ischemic stroke].

    Science.gov (United States)

    Möhlenbruch, M A; Bendszus, M

    2015-10-01

    Acute ischemic stroke is the leading cause of acquired disability and its treatment is still a major challenge. For more than a decade, various mechanical devices have been developed for the recanalization of proximal artery occlusions in acute ischemic stroke but most of them have been approved for clinical use, only on the basis of uncontrolled case series. Intravenous thrombolysis with recombinant tissue-specific plasminogen activator administered (iv rtPA) within 4.5 h of symptom onset is so far the only approved medicinal treatment in the acute phase of cerebral infarction. With the introduction of stent retrievers, mechanical thrombectomy has demonstrated substantial rates of partial or complete arterial recanalization and improved outcomes compared with iv rtPA and best medical treatment alone in multiple randomized clinical trials in select patients with acute ischemic stroke and proximal artery occlusions. This review discusses the evolution of endovascular stroke therapy followed by a discussion of the current technical standards of mechanical thrombectomy that have to be considered during endovascular stroke therapy and the updated treatment recommendations of the ESO Karolinska stroke update.

  19. U0126 attenuates cerebral vasoconstriction and improves long-term neurologic outcome after stroke in female rats

    DEFF Research Database (Denmark)

    Ahnstedt, Hilda; Mostajeran, Maryam; Blixt, Frank W

    2015-01-01

    Sex differences are well known in cerebral ischemia and may impact the effect of stroke treatments. In male rats, the MEK1/2 inhibitor U0126 reduces ischemia-induced endothelin type B (ETB) receptor upregulation, infarct size and improves acute neurologic function after experimental stroke. Howev...

  20. Stroke intervention: catheter-based therapy for acute ischemic stroke.

    Science.gov (United States)

    White, Christopher J; Abou-Chebl, Alex; Cates, Christopher U; Levy, Elad I; McMullan, Paul W; Rocha-Singh, Krishna; Weinberger, Jesse M; Wholey, Mark H

    2011-07-05

    The majority (>80%) of the three-quarters of a million strokes that will occur in the United States this year are ischemic in nature. The treatment of acute ischemic stroke is very similar to acute myocardial infarction, which requires timely reperfusion therapy for optimal results. The majority of patients with acute ischemic stroke do not receive any form of reperfusion therapy, unlike patients with acute myocardial infarction. Improving outcomes for acute stroke will require patient education to encourage early presentation, an aggressive expansion of qualified hospitals, and willing providers and early imaging strategies to match patients with their best options for reperfusion therapy to minimize complications. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Endovascular therapy for acute stroke: Quo vadis?

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri

    2013-01-01

    Full Text Available Endovascular therapy (EVT has gained vogue in the management of patients with acute stroke. Newer stent-retriever devices have led to better recanalization rates. In many centers, EVT is slowly being used as an add on to or in some instances, even as an alternative to intravenous tissue plasminogen activator (IV tPA. The publication of the results of the SYNTHESIS expansion, Interventional Management of Stroke III and Mechanical Retrieval Recanalization of Stroke Clots Using Embolectomy trials in 2013 has questioned the enthusiastic use of EVT in acute stroke. They demonstrate that EVT (using a variety of devices is no superior to IV tPA in the management of acute stroke. In the light of these controversial findings, we review the current status of EVT in the management of acute stroke.

  2. The evaluation of cerebral oxygenation by oximetry in patients with ischaemic stroke.

    Directory of Open Access Journals (Sweden)

    Demet G

    2000-04-01

    Full Text Available AIMS: To evaluate the clinical significance of estimation of the regional cerebral oxygen saturation (rSO2 in the patients with ischaemic stroke by the cerebral oximetry during acute, sub-acute and chronic phases. SUBJECTS AND METHODS: In this prospective study, 24 patients with ischaemic stroke in the middle cerebral artery territory were included. A detailed clinical examination and appropriate laboratory investigations were carried out. The rSO2 was determined by oximetery (INVOS 3100-SD bilaterally on the first, third, seventh, and fifteenth days. The blood pressure, the peripheral capillary oxygen saturation and the arterial blood gas values were noted too. the changes were evaluated along with Glasgow coma scale (GCS using unpaired student t-test and one way ANOVA test. RESULTS: There were significant differences between the rSO2 values in acute, subacute and chronic phases on the side of the lesion (p value < 0.05. The values of oxygen saturation gradually increased throughout the chronic phase. These values showed a positive correlation with GCS, but the results were not significant statistically. The rSO2 values were also significantly higher on the non-lesional side than those on the lesion side in the acute phase (p= 0.0034, the discrepancy disappeared during the sub-acute and chronic phases. CONCLUSION: Cerebral oximetry can be used as a measure to evaluate the cerebral oxygenation during the various phases of ischaemic stroke. It has a potential to serve as a useful marker for detection of cerebral oxygenation imbalances, to judge the effectiveness of the management and for the follow-up of patients with ischaemic stroke.

  3. Color-coded cerebral computed tomographic angiography: implementation of a convolution-based algorithm and first clinical evaluation in patients with acute ischemic stroke.

    Science.gov (United States)

    Thierfelder, Kolja M; Havla, Lukas; Beyer, Sebastian E; Ertl-Wagner, Birgit; Meinel, Felix G; von Baumgarten, Louisa; Janssen, Hendrik; Ditt, Hendrik; Reiser, Maximilian F; Sommer, Wieland H

    2015-05-01

    The objective of this study was to develop a new method of displaying dynamic cerebral computed tomographic (CT) angiography (CTA) data sets in which the time delay to maximum enhancement (Tdelay) is displayed in a range of colors (color-coded CT angiography [cCTA]). This institutional review board-approved study included multiparametric CT data sets from 16 patients with different types of supra-aortic large vessel occlusions. Color-coded CT angiography was reconstructed from CT perfusion raw data sets. All voxel enhancement curves were fitted to f(t) = α · AIFmtt(t - Δt), with AIFmtt(t), indicating enhancement of AIF dilated by convolution with boxcar function (with mean transit time [mtt]); α, scaling factor; and [INCREMENT]t, transition along the time. The time delay to maximum enhancement was defined as Tdelay = Δt +0.5 · mtt. Values of Tdelay were color-coded and superimposed on temporal maximum intensity projections CTA resulting in colored angiographic composite images. For a pilot clinical evaluation, diagnostic confidence in determining the pathology, quality of the visualization of leptomeningeal collaterals, and additional diagnostic information were assessed. The reconstruction of cCTA was technically feasible in all 16 patients. Both diagnostic confidence (P < 0.01) and the quality of the visualization of collaterals (P < 0.0001) were significantly higher when using the combination of single-phase CTA and cCTA compared with single-phase CTA alone. Additional diagnostic information was obtained with cCTA regarding occlusion type (reader 1: 5 cases and reader 2: 4 cases), differentiation between arteries and veins (11/13), differentiation between antegrade and retrograde filling (12/13), as well as leptomeningeal collateralization (13/14). Color-coded CT angiography is a technically feasible technique that provides additional information on cerebral hemodynamics in ischemic stroke patients.

  4. Cerebral edema associated with acute hepatic failure.

    Directory of Open Access Journals (Sweden)

    Fujiwara,Masachika

    1985-02-01

    Full Text Available The clinicopathological findings of cerebral edema were investigated in patients with acute hepatic failure autopsied at Okayama University Hospital between 1970 and 1980 retrospectively. Nine (64% of 14 hepatic failure cases were found to have cerebral edema during a post-mortem examination of the brain. Clinical features of the patients with cerebral edema were not significantly different from those of the patients without cerebral edema. However, general convulsions were observed more frequently in patients later found to have cerebral edema. Moreover, the length of time from deep coma to death was much shorter in the brain edema cases with cerebral herniation than without herniation.

  5. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins

    2012-11-01

    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.

  6. Computed tomography in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Loevblad, Karl-Olof [HUG-Geneva University Hospital, Geneva University Medical School, Department of Neuroradiology, Department of Imaging and Medical Informatics, Geneva (Switzerland); Baird, Alison E. [SUNY Downstate Medical Center, Cerebrovascular Disease and Stroke, 450 Clarkson Avenue, Box 1213, Brooklyn, NY (United States)

    2010-03-15

    Stroke remains the third most important cause of mortality in industrialized countries; this has prompted research for improvements in both diagnostic and therapeutic strategies for patients with signs of acute cerebral ischemia. Over the last decade, there has been a parallel in progress in techniques in both diagnostic and therapeutic options. While previously only used for excluding hemorrhage, imaging now has the possibility to detect ischemia, vascular occlusion, as well as detect tissue at risk in one setting. It should also allow to monitor treatment and predict/exclude therapeutic complications. Parallel to advances in magnetic resonance imaging of stroke, computed tomography has improved immensely over the last decade due to the development of CT scanners that are faster and that allow to acquire studies such as CT perfusion or CT angiography in a reliable way. CT can detect many signs that might help us detect impending signs of massive infarction, but we still lack the experience to use these alone to prevent a patient from benefitting from possible therapy. (orig.)

  7. Perfusion Angiography in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Fabien Scalzo

    2016-01-01

    Full Text Available Visualization and quantification of blood flow are essential for the diagnosis and treatment evaluation of cerebrovascular diseases. For rapid imaging of the cerebrovasculature, digital subtraction angiography (DSA remains the gold standard as it offers high spatial resolution. This paper lays out a methodological framework, named perfusion angiography, for the quantitative analysis and visualization of blood flow parameters from DSA images. The parameters, including cerebral blood flow (CBF and cerebral blood volume (CBV, mean transit time (MTT, time-to-peak (TTP, and Tmax, are computed using a bolus tracking method based on the deconvolution of the time-density curve on a pixel-by-pixel basis. The method is tested on 66 acute ischemic stroke patients treated with thrombectomy and/or tissue plasminogen activator (tPA and also evaluated on an estimation task with known ground truth. This novel imaging tool provides unique insights into flow mechanisms that cannot be observed directly in DSA sequences and might be used to evaluate the impact of endovascular interventions more precisely.

  8. Safety of Thrombolytic Agents for Acute Cerebral Ischemic Stroke%急性脑梗死溶栓药物及安全性研究

    Institute of Scientific and Technical Information of China (English)

    鲍宇

    2013-01-01

    Acute cerebral infarction is recognized as the disease of high mortality, high morbidity and high recurrence rate. The most effective method to the acute cerebral infarction is thrombolytic therapy. But thrombolysis has side effects of bleeding,neurotoxicity, allergy etc. , which impact the security of the treatment, bring limitations to the clinical application. Here is make a summary of the safety of commonly used thrombolytic drugs, including streptokinase, urokinase, rt-PA, and hot new thrombolytic drugs, including monteplase,desmoteplase,tenecteplase,nattokinase etc. ,and a prospect of thrombolytic drugs' development.%急性脑梗死是公认的高致死率、高致残率、高复发率疾病.目前治疗急性脑梗死最有效的方法是溶栓治疗,但溶栓具有出血、神经毒性、过敏等不良反应,影响治疗安全性,给临床应用带来了局限性.该文就国内部分常用的溶栓药物(链激酶、尿激酶、重组组织型纤溶酶原激活剂)以及热点新型溶栓药物(孟替普酶、替奈普酶、去氨普酶、纳豆激酶等)的安全性进行总结,并展望溶栓药物的发展方向.

  9. Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis.

    Science.gov (United States)

    Shimoyama, Takashi; Iguchi, Yasuyuki; Kimura, Kazumi; Mitsumura, Hidetaka; Sengoku, Renpei; Kono, Yu; Morita, Masayo; Mochio, Soichiro

    2012-10-01

    Cerebral microbleeds (CMBs) are recognized as a manifestation of arteriolosclerosis in cerebral small vessels. However, little is known regarding whether stroke patients with CMBs often have systemic atherosclerosis. The aim of the present study was to elucidate this issue using the cardio-ankle vascular index (CAVI), a new index of systemic atherosclerosis, in acute ischemic stroke patients. We prospectively studied 105 patients (71 males, median age=70.0 years) with acute ischemic stroke. All of the patients were examined using T2*-weighted gradient echo magnetic resonance imaging (MRI) to look for and assess the CMBs and using fluid-attenuated inversion recovery to evaluate white matter hyperintensity (WMH). We assigned the patients into CMB and non-CMB groups and compared the clinical characteristics of these groups. The factors associated with CMBs were investigated using multivariate logistic regression analysis. T2*-weighted gradient echo MRI revealed CMBs in 47 patients (44.8%) and no CMBs in 58 patients (55.2%). The CAVI was significantly higher in the CMBs group (10.5 vs. 8.6, PCMBs. A high CAVI was independently associated with CMBs in patients with acute ischemic stroke. Our results indicated that ischemic stroke patients with CMBs may have cerebral arteriolosclerosis as well as systemic atherosclerosis.

  10. Guidelines for the treatment of acute ischaemic stroke.

    Science.gov (United States)

    Alonso de Leciñana, M; Egido, J A; Casado, I; Ribó, M; Dávalos, A; Masjuan, J; Caniego, J L; Martínez Vila, E; Díez Tejedor, E; Fuentes, B; Álvarez-Sabin, J; Arenillas, J; Calleja, S; Castellanos, M; Castillo, J; Díaz-Otero, F; López-Fernández, J C; Freijo, M; Gállego, J; García-Pastor, A; Gil-Núñez, A; Gilo, F; Irimia, P; Lago, A; Maestre, J; Martí-Fábregas, J; Martínez-Sánchez, P; Molina, C; Morales, A; Nombela, F; Purroy, F; Rodríguez-Yañez, M; Roquer, J; Rubio, F; Segura, T; Serena, J; Simal, P; Tejada, J; Vivancos, J

    2014-03-01

    Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  11. Developmental Status of Translational Medicine on Cerebral Stroke

    Directory of Open Access Journals (Sweden)

    Yun-chuan WU

    2016-12-01

    Full Text Available Translational medicine, as a new research theory and disciplinary branch, aims at the translation from bench to bedside. It can shorten the gap between basic scientific research and clinical treatment, and promote the highly efficient application of basic research results in clinical practice through bidirectional connection and feedback process between them. Cerebral stroke, as a common cerebrovascular circulatory disorder in clinic, is characterized by high morbidity, high disability rate and high mortality. After disease onset, patients are frequently complicated with severe functional disorders and sequelae, such as aphasia, paralysis, and partial or complete loss of self-care capacity, thus bringing about great burdens to the patients’ families and to the society. In China, there are more than 2 000 000 new cases with cerebral stroke annually, > 50% of whom are complicated with different-degree neurological functional decrease or deletion, and more than 1 000 000 die of cerebral stroke annually. Therefore, cerebral stroke is also an important concern in translational medicine study. In recent years, International Stroke Conference has emphasized the necessity of translational medicine research, and the bidirectional translation of bench to bedside (B2B is of great significance in guiding the development of depth and width of translational medicine on stroke. This study mainly reviewed the advances of translational medicine at home and abroad and its significance in guiding the clinical treatment of cerebral stroke.

  12. Cerebral Autoregulation in Stroke A Review of Transcranial Doppler Studies

    NARCIS (Netherlands)

    Aries, M.J.H.; Elting, Jan W.; De Keyser, Jacques; Kremer, Berry P. H.; Vroomen, Patrick C. A. J.

    2010-01-01

    Background and Purpose-Cerebral autoregulation may become impaired after stroke. To provide a review of the nature and extent of any autoregulation impairment after stroke and its course over time, a technique allowing repeated bedside measurements with good temporal resolution is required.

  13. Related Factors of Cerebral Microbleeds in Patients with Acute Ischemic Stroke%急性缺血性卒中患者脑微出血相关因素分析

    Institute of Scientific and Technical Information of China (English)

    侯晶晶; 李尧; 吴继星; 何晋涛; 唐华; 白维; 刘阳; 张娟

    2013-01-01

      目的探讨急性缺血性卒中患者合并脑微出血(cerebral microbleeds,CMB)的情况及其相关因素。  方法本研究采用单中心、前瞻性研究方法,连续收集2011年1月~2012年6月于北京市第六医院神经内科住院的急性缺血性卒中患者302例,根据有无CMB将患者分为有CMB组(83例)和无CMB组(219例),比较两组间一般临床资料、生化指标及影像学特点是否存在差异,并采用多因素逐步Logistic回归模型分析CMB发生的独立危险因素。  结果302例患者中,合并有CMB者83例(27.5%),其中年龄(t=3.67,P  结论 CMB的发生与纤维蛋白原含量、腔隙性脑梗死数目以及脑白质疏松程度相关。%Objective To investigate the prevalence and related factors of cerebral microbleeds (CMB) in patients with acute ischemic stroke. Methods Three hundred and two patients with acute ischemic stroke including all the etiological typings who were hospitalized in Department of Neurology of Beijing No.6 Hospital from January 2011 to June 2012 were successionally recruited. According to whether there were CMB, the patients were divided into two groups, CMB group (83 cases) and non-CMB group (219 cases). Then compare the difference of clinical data including general conditions, biochemical indicators and imaging features between the two groups. The independent risk factors of CMB were analyzed with the Logistic multivariable regression. Results Among a total of 302 patients, 83 (27.5%) patients had lesions of cerebral microbleeds. Compared with non-CMB group, the age (t=3.67, P Conclusion CMB had relationships with fibrinogen, number of LI and severity of LA.

  14. PET imaging of cerebral perfusion and oxygen metabolism in stroke

    Energy Technology Data Exchange (ETDEWEB)

    Pointon, O.; Yasaka, M.; Berlangieri, S.U.; Newton, M.R.; Thomas, D.L.; Chan, C.G.; Egan, G.F.; Tochon-Danguy, H.J.; O``Keefe, G.; Donnan, G.A.; McKay, W.J. [Austin Hospital, Melbourne, VIC (Australia). Centre for PET and Depts of Nuclear Medicine and Neurology

    1998-03-01

    Full text: Stroke remains a devastating clinical event with few therapeutic options. In patients with acute stroke, we studied the cerebral perfusion and metabolic patterns with {sup 15}O-CO{sub 2} or H{sub 2}O and {sup 15}O-O{sub 2} positron emission tomography and correlated these findings to the clinical background. Forty three patients underwent 45 studies 0-23 days post-stroke (mean 7 days). Fifteen patients showed luxury perfusion (Group A), 10 had matched low perfusion and metabolism (B) and 3 showed mixed pattern including an area of misery perfusion (C). Seventeen showed no relevant abnormality (D) and there were no examples of isolated misery perfusion. Twelve of the 15 in Group A had either haemorrhagic transformation on CT, re-opening on angiography, or a cardioembolic mechanism. In contrast only 5/10 in Group B, 0/3 in Group C and 2/17 in Group D had these features. Although 7/10 in group B had moderate or large size infarcts on CT the incidence of haemorrhagic transformation was low (2/10) and significant carotid stenoses were more common in those studied (5/8) compared with the other groups. Misery perfusion was not seen beyond five days. Thus, luxury perfusion seems to be related to a cardio-embolic mechanism or reperfusion. Matched low perfusion and metabolism was associated with a low rate of haemorrhagic transformation despite a high incidence of moderate to large size infarcts. Misery perfusion is an early phenomenon in the evolution of ischaemic stroke.

  15. Thrombolysis in acute ischemic stroke: where and when?

    Directory of Open Access Journals (Sweden)

    Giuseppe Micieli

    2007-12-01

    Full Text Available The therapy of acute ischemic stroke remains an open challenge for the clinicians and is closely connected to the ready acknowledgment of symptoms, to the promptness of the instrumental diagnosis and consequently to the rapidity of the pharmacological intervention. Although several studies have validated the effectiveness and the safety profileof the intravenous fibrinolytic treatment, the number of patients who benefit of such therapeutic opportunity is still too little. This data is partially due to the delay within patients arrive to the hospital and to the doubts of the physicians on the possible collateral effects, but it is also related to logistic and organizational-managerial problematic of the patient with acute stroke.These last ones mainly derive from the deficiency on the national territory of dedicated structures (Stroke Unit, from the absence of operative connections between the 118-service and the Stroke Unit, from the delay of the neurologist calling in the emergency room that does not allow an adapted diagnostic evaluation of the ischemic event. The spread of the intravenous fibrinolysis must therefore necessarily pass through the creation of participation protocols between hospitals with stroke unit and primary aid, and between department of emergency/ urgency and staff of the stroke unit also previewing the creation of professional figures like those of the urgency neurologist that could have the full right of the management and the treatment of cerebral ischemic pathology.

  16. Transient cerebral arteriopathy: a disorder recognized by serial angiograms in children with stroke.

    Science.gov (United States)

    Chabrier, S; Rodesch, G; Lasjaunias, P; Tardieu, M; Landrieu, P; Sébire, G

    1998-01-01

    Repeated clinical evaluation and cerebral arteriography during the evolution of ischemic strokes of idiopathic origin allowed us to characterize a transient cerebral arteriopathy. We retrospectively studied the clinical characteristics, course, and neuroimaging features of this disorder in nine children. Of 34 children with ischemic strokes seen consecutively between 1984 and 1995, 9 (26%) were diagnosed as having transient attack of the cerebral arterial wall, termed transient cerebral arteriopathy. All of these patients had previously been in good health. The mean age at the time of the first stroke was 6 years (range, 2 9/12 years to 13 4/12 years). All children presented with acute hemiplegia. A recurrence of the stroke took place 3 months at the latest after the initial infarct in three children (mean clinical follow-up 2 7/12 years). Cerebral imaging in all the patients showed small subcortical infarcts located in basal ganglia or internal capsule. Arteriography revealed multifocal lesions of the arterial wall (focal stenosis or segmental narrowing), mostly located in the initial parts of basal arteries of the carotid system. Longitudinal arteriographic follow-up showed initial worsening of these arterial lesions (n = 5) for a maximum duration of 7 months followed by complete regression (n = 2), improvement (n = 5), or stabilization of the lesions (n = 2). Five patients had a complete clinical recovery. Further studies are necessary to confirm a presumed inflammatory cause of this arteriopathy.

  17. Spontaneous Cervical Epidural Hematoma with Hemiparesis Mimicking Cerebral Stroke

    Directory of Open Access Journals (Sweden)

    Mehmet Tiryaki

    2014-01-01

    Full Text Available Aim. Spontaneous cervical epidural hematoma (SCEH is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INR results were 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding.

  18. The effect of comprehensive intervention on the negative emotion of the families of patients with acute cerebral stroke%综合干预减轻急性脑卒中患者家属负性情绪

    Institute of Scientific and Technical Information of China (English)

    兰洁; 廖光荣; 方向红; 张秀芳; 杨雨竹

    2013-01-01

    Objective To explore the effect of omprehensive intervention on the negative emotion of the families of patients with acute cerebral strokeMethods Ninety the families of patients with acute cerebral stroke were divided into the intervention group and the control group with 45 cases in each.The intervention group was given comprehensive intervention including supportive psychology intervention,cognitive psychology intervention,group psychology intervention and behavior intervention.The control group was given the routine health care education.The anxiety and depression self-rating scale and self-made questionnaire and scoring were used to evaluate the negative emotion of patients'families.Results Compared with the control group,the scores of the anxiety and depression self-rating scale and self-made questionnaire in the intervention group were lower (P < 0.05 or P < 0.01).Conclusions The comprehensive intervention can improve negative emotion of the patients'families.So they can cooperate with the medical workers to treat and care the patients.%目的 探讨专家门诊综合干预对急性脑卒中患者家属负性情绪的改善效果.方法 将90例急性脑卒中患者家属随机分为干预组和对照组,每组45例,干预组予以综合干预措施,包括支持心理干预、认知心理干预、集体心理干预及行为干预等,对照组则按常规健康教育,应用焦虑和抑郁自评量表和自行设计的问卷评估患者家属的负性情绪.结果 两组患者家属焦虑和抑郁自评量表和问卷评分,干预后干预组均比对照组明显低(P<0.05或P<0.01).结论 专家门诊心理干预能改善患者家属的负性情绪,使之有效配合医护人员治疗护理患者.

  19. 急性脑梗死动脉溶栓血管再通后的脑水肿研究%A clinical study on cerebral edema of intra-arterial thrombolytic recanalization in acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    马海; 任亚静; 张锡铎; 刘静; 郝锋利

    2013-01-01

    Objective To observe the cerebral edema occurrence ,evolution and prognosis of intra-arterial thrombolytic recanali-zation in patients with acute ischemic stroke .Methods From October 2010 to October 2012 ,36 patients who underwent the intra-arterial thrombolytic therapy were cerebral recanalization .They were randomly divided into two groups :1-3 h group and >3-6 h group .The alteration of brain edema was observed by cranial CT .Their mRS .NHISS and BI were scaled and recorded before and after intra-arterial thrombolytic therapy .Results After intra-arterial thrombolytic therapy ,the occurrence rate of cerebral edema was 94% ,appeared at the onset of more than 1 hours in all patients .Long-term follow-up showed ,cerebral edema location appeared obvious cerebromalacia .Cerebral edema and clinical outcome had not significant difference between 1-3 h group and 3-6 h group . Conclusion Cerebral edema and loss of cerebral tissue occurred almost inevitability in patients who received intra-artery thromboly-sis and recanalized their cerebral artery .It indicates that good local circulation and general condition may be favorable factors that can gradually reduce brain edema .%目的:观察急性缺血性脑卒中动脉溶栓血管再通后脑水肿的发生、演变及转归。方法2010年10月至2012年10月于该院就诊,通过动脉溶栓血管再通的患者共36例。将患者分为1~3 h组、>3~6 h组。头颅C T监测、随访脑水肿情况。记录溶栓前、术后1周及1年的美国国立卫生研究院卒中量表(NIHSS)、溶栓后1年改良蓝金评分(MRS)及巴塞尔指数(BI)。结果动脉溶栓血管再通后脑水肿的发生率为94%,出现在1~3 h组、>3~6 h组的所有患者中,长期随访表明,脑水肿局部出现了明显的软化灶。两组患者脑水肿及临床结局比较差异无统计学意义(P>0.05)。结论动脉溶栓血管再通后脑水肿的发生及其脑组织缺失几乎不可

  20. Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute Ischemic Stroke Survivors.

    Science.gov (United States)

    Jeon, Jae Woong; Jeong, Hye Seon; Choi, Dae Eun; Ham, Young Rok; Na, Ki Ryang; Lee, Kang Wook; Shin, Jong Wook; Kim, Jei

    2017-02-01

    It is well known that renal dysfunction and cerebral small-vessel disease (SVD), including microbleed, lacunar infarction, and white matter lesion (WML), are associated with poor prognosis after ischemic stroke. However, the prognostic relationship between renal dysfunction and SVD has not been well evaluated in acute ischemic stroke survivors. Therefore, in this study, we evaluated the prognostic relationships between estimated glomerular filtration rate (eGFR) and cerebral SVD after acute ischemic stroke. We retrospectively reviewed the clinical and radiological data of acute ischemic stroke survivors with decreased eGFR (acute ischemic stroke survivors. Both renal impairment and the presence of SVD were predictors of poor poststroke survival. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. [Nutrition for elderly acute stroke patients].

    Science.gov (United States)

    Ha, Lisa; Iversen, Per Ole; Hauge, Truls

    2008-09-11

    Elderly people have an increased risk of malnutrition due to biological and physiological changes and underlying disease. Almost 90% of the stroke patients are older than 65 years, and the consequences of acute stroke may lead to additional nutritional problems. This paper reviews nutritional therapy for stroke patients. PubMed was searched (non-systematically) for prospective cohort studies of occurrence, diagnostics and consequences of undernutrition in stroke patients. Randomized trials were examined to identify clinical effects of oral protein and energy supplements or tube feeding on nutritional status and intake, functional status, infections, length of stay, quality of life and mortality. 8-35% of stroke patients are undernourished. Body weight is one of the most important parameters for assessment of nutritional status. Dysphagia occurs in up to 80% of patients with acute stroke and increases the risk of undernutrition, which again leads to prolonged length of stay, reduced functional status and poorer survival. Early nasogastric tube feeding does not increase the risk of pneumonia and may improve survival after six months. Oral supplements lead to a significantly improved nutritional intake in undernourished stroke patients, as well as improved nutritional status and survival in undernourished elderly. Nutritional treatment can improve the clinical outcome after an acute stroke, provided that there are good procedures for follow-up and monitoring of the treatment.

  2. [Sequential enteral nutrition support for patients with severe cerebral stroke].

    Science.gov (United States)

    Chen, Jiefang; He, Xudong; Zhang, Lisan; Hu, Xingyue

    2013-11-01

    To evaluate the efficacy of sequential enteral nutrition support in patients with severe cerebral stroke. Forty-nine patients with severe cerebral stroke met the inclusion criteria were randomly divided into sequential enteral nutrition group (Group A, n=24) and conventional enteral nutrition group (Group B, n=25). Patients in Group A received short-peptide-based enteral nutrition support first, then gradually transferred to intact protein enteral nutrition. Meanwhile, patients in Group B constantly received intact protein enteral nutrition support. The nutritional indexes and the rate of complications were compared between two groups. The nutritional indexes were decreased in both groups within 4 weeks after admission, but the decreasing levels of hemoglobin and albumin in Group A were significantly lower than those in Group B (P0.05). Sequential enteral nutritional support can improve the nutritional status and decrease the incidence of complications in critical patients with cerebral stroke.

  3. The Acute STroke Registry and Analysis of Lausanne (ASTRAL): design and baseline analysis of an ischemic stroke registry including acute multimodal imaging.

    Science.gov (United States)

    Michel, Patrik; Odier, Céline; Rutgers, Matthieu; Reichhart, Marc; Maeder, Philippe; Meuli, Reto; Wintermark, Max; Maghraoui, Ali; Faouzi, Mohamed; Croquelois, Alexandre; Ntaios, George

    2010-11-01

    Stroke registries are valuable tools for obtaining information about stroke epidemiology and management. The Acute STroke Registry and Analysis of Lausanne (ASTRAL) prospectively collects epidemiological, clinical, laboratory and multimodal brain imaging data of acute ischemic stroke patients in the Centre Hospitalier Universitaire Vaudois (CHUV). Here, we provide design and methods used to create ASTRAL and present baseline data of our patients (2003 to 2008). All consecutive patients admitted to CHUV between January 1, 2003 and December 31, 2008 with acute ischemic stroke within 24 hours of symptom onset were included in ASTRAL. Patients arriving beyond 24 hours, with transient ischemic attack, intracerebral hemorrhage, subarachnoidal hemorrhage, or cerebral sinus venous thrombosis, were excluded. Recurrent ischemic strokes were registered as new events. Between 2003 and 2008, 1633 patients and 1742 events were registered in ASTRAL. There was a preponderance of males, even in the elderly. Cardioembolic stroke was the most frequent type of stroke. Most strokes were of minor severity (National Institute of Health Stroke Scale [NIHSS] score ≤ 4 in 40.8% of patients). Cardioembolic stroke and dissections presented with the most severe clinical picture. There was a significant number of patients with unknown onset stroke, including wake-up stroke (n=568, 33.1%). Median time from last-well time to hospital arrival was 142 minutes for known onset and 759 minutes for unknown-onset stroke. The rate of intravenous or intraarterial thrombolysis between 2003 and 2008 increased from 10.8% to 20.8% in patients admitted within 24 hours of last-well time. Acute brain imaging was performed in 1695 patients (97.3%) within 24 hours. In 1358 patients (78%) who underwent acute computed tomography angiography, 717 patients (52.8%) had significant abnormalities. Of the 1068 supratentorial stroke patients who underwent acute perfusion computed tomography (61.3%), focal hypoperfusion

  4. Use of 3-D magnetic resonance electrical impedance tomography in detecting human cerebral stroke: a simulation study

    Institute of Scientific and Technical Information of China (English)

    GAO Nuo; ZHU Shan-an; HE Bin

    2005-01-01

    We have developed a new three dimensional (3-D) conductivity imaging approach and have used it to detect human brain conductivity changes corresponding to acute cerebral stroke. The proposed Magnetic Resonance Electrical Impedance Tomography (MREIT) approach is based on the J-Substitution algorithm and is expanded to imaging 3-D subject conductivity distribution changes. Computer simulation studies have been conducted to evaluate the present MREIT imaging approach.Simulations of both types of cerebral stroke, hemorrhagic stroke and ischemic stroke, were performed on a four-sphere head model Simulation results showed that the correlation coefficient (CC) and relative error (RE) between target and estimated conductivity distributions were 0.9245±0.0068 and 8.9997%±0.0084%, for hemorrhagic stroke, and 0.6748±0.0197 and 8.8986%±0.0089%,for ischemic stroke, when the SNR (signal-to-noise radio) of added GWN (Gaussian White Noise) was 40. The convergence characteristic was also evaluated according to the changes of CC and RE with different iteration numbers. The CC increases and RE decreases monotonously with the increasing number of iterations. The present simulation results show the feasibility of the proposed 3-D MREIT approach in hemorrhagic and ischemic stroke detection and suggest that the method may become a useful alternative in clinical diagnosis of acute cerebral stroke in humans.

  5. Looks like a stroke, acts like a stroke, but it's more than a stroke: a case of cerebral mucormycosis.

    Science.gov (United States)

    Ermak, David; Kanekar, Sangam; Specht, Charles S; Wojnar, Margaret; Lowden, Max

    2014-09-01

    Mucormycosis is a fungus that exhibits angiocentric growth and can cause a thrombotic arteritis. Infection with this organism is uncommon and cerebral involvement is most often secondary to direct invasion through the paranasal sinuses. Here, we present a case of mucormycosis with cerebral involvement without sinus disease, which resulted in ischemic stroke with rapid progression resulting in death.

  6. Systemic inflammation as a therapeutic target in acute ischemic stroke.

    Science.gov (United States)

    Dziedzic, Tomasz

    2015-05-01

    Acute systemic inflammatory reaction superimposed on chronic low-grade inflammation accompanies acute ischemic stroke. Elevated blood levels of systemic inflammatory markers such as IL-6 or C-reactive protein are associated with an unfavorable functional outcome and increased mortality after stroke. Animal studies have demonstrated a causal relationship between systemic inflammation and ischemic brain damage. The mechanisms linking systemic inflammation with poor outcome include increased neutrophil infiltration of cerebral cortex, disruption of the blood-brain barrier, impaired tissue reperfusion, increased platelet activation and microvascular coagulation and complement-dependent brain injury. Non-selective (e.g., by statins) or selective (e.g., by inhibition of IL-6) attenuation of systemic inflammation, enhancement of systemic anti-inflammatory response (e.g., by infusion of IL-1 receptor antagonist), prevention of infections that exacerbate systemic inflammation or inhibition of neuronal pathways triggering inflammatory reaction are potential therapeutic targets in stroke patients. This review discusses the relationship between systemic inflammation, cerebral ischemia and prognosis in the context of therapeutic strategies.

  7. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial.

    Science.gov (United States)

    Baharoglu, M Irem; Cordonnier, Charlotte; Al-Shahi Salman, Rustam; de Gans, Koen; Koopman, Maria M; Brand, Anneke; Majoie, Charles B; Beenen, Ludo F; Marquering, Henk A; Vermeulen, Marinus; Nederkoorn, Paul J; de Haan, Rob J; Roos, Yvo B

    2016-06-25

    Platelet transfusion after acute spontaneous primary intracerebral haemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the haemorrhage. We aimed to investigate whether platelet transfusion with standard care, compared with standard care alone, reduced death or dependence after intracerebral haemorrhage associated with antiplatelet therapy use. We did this multicentre, open-label, masked-endpoint, randomised trial at 60 hospitals in the Netherlands, UK, and France. We enrolled adults within 6 h of supratentorial intracerebral haemorrhage symptom onset if they had used antiplatelet therapy for at least 7 days beforehand and had a Glasgow Coma Scale score of at least 8. With use of a secure web-based system that concealed allocation and used biased coin randomisation, study collaborators randomly assigned participants (1:1; stratified by hospital and type of antiplatelet therapy) to receive either standard care or standard care with platelet transfusion within 90 min of diagnostic brain imaging. Participants and local investigators giving interventions were not masked to treatment allocation, but allocation was concealed from outcome assessors and investigators analysing data. The primary outcome was shift towards death or dependence rated on the modified Rankin Scale (mRS) at 3 months, and analysed by ordinal logistic regression, adjusted for stratification variables and the Intracerebral Haemorrhage Score. The primary analysis was done in the intention-to-treat population and safety analyses were done in the intention-to-treat and as-treated populations. This trial is registered with the Netherlands Trial Register, number NTR1303, and is now closed. Between Feb 4, 2009, and Oct 8, 2015, 41 sites enrolled 190 participants. 97 participants were randomly assigned to platelet transfusion and 93 to standard care. The odds of death or dependence at 3 months were higher in the platelet transfusion group than in the

  8. Noninvasive Ventilatory Correction as an Adjunct to an Experimental Systemic Reperfusion Therapy in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Kristian Barlinn

    2010-01-01

    Full Text Available Background. Obstructive sleep apnea (OSA is a common condition in patients with acute ischemic stroke and associated with early clinical deterioration and poor functional outcome. However, noninvasive ventilatory correction is hardly considered as a complementary treatment option during the treatment phase of acute ischemic stroke. Summary of Case. A 55-year-old woman with an acute middle cerebral artery (MCA occlusion received intravenous tissue plasminogen activator (tPA and enrolled into a thrombolytic research study. During tPA infusion, she became drowsy, developed apnea episodes, desaturated and neurologically deteriorated without recanalization, re-occlusion or intracerebral hemorrhage. Urgent noninvasive ventilatory correction with biphasic positive airway pressure (BiPAP reversed neurological fluctuation. Her MCA completely recanalized 24 hours later. Conclusions. Noninvasive ventilatory correction should be considered more aggressively as a complementary treatment option in selected acute stroke patients. Early initiation of BiPAP can stabilize cerebral hemodynamics and may unmask the true potential of other therapies.

  9. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature i...

  10. Studies on the emergency care of acute stroke

    OpenAIRE

    Nolte, Christian Hans

    2012-01-01

    This work reports on factors contributing to pre- and intrahospital delay in the emergency management of acute stroke patients. Further, data on level of knowledge on stroke risk factors, stroke signs and appropriate behaviour is reported.

  11. Autonomic dysfunction in acute ischemic stroke : An underexplored therapeutic area?

    NARCIS (Netherlands)

    De Raedt, Sylvie; De Vos, Aurelie; De Keyser, Jacques

    2015-01-01

    Impaired autonomic function, characterized by a predominance of sympathetic activity, is common in patients with acute ischemic stroke. This review describes methods to measure autonomic dysfunction in stroke patients. It summarizes a potential relationship between ischemic stroke-associated

  12. Sildenafil: Can Cause Acute Ischaemic Stroke? A Case Report

    Directory of Open Access Journals (Sweden)

    Zeynep Özözen Ayas

    2015-12-01

    Full Text Available Sildenafil is an inhibitor of phosphodiesterase type-5 (PDE-5, is used for erectile dysfunction. There is not enough information about its effects on the central nervous system Headache, nasal congestion, facial flushing, nausea are the most common side effects. However, neurological complications such as third cranial nerve palsy, transient global amnesia, seizures, cerebral hemorrhage, and infarction are less commonly observed. We present a case of a 60-year-old man with acute ischaemic stroke, which we considered to be interrelated to sildenafil intake. Clinicians must be aware of the possibility of neurological side effects when the patient use sildenafil.

  13. A STUDY ON INTRACRANIAL STENOSIS IN ACUTE ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Jerrin

    2015-11-01

    Full Text Available BACKGROUND : Acute ischemic stroke is very common cause of significant morbidity and mortality throughout the world. The causes of acute ischemic stroke could be intracranial or extra cranial. Prevention of the acute episode could be decreased by surgically treating ex tra - cranial vascular disease but the prevention of intracranial cause is only medical. Various risk factors are also associated with development of ischemic stroke. However, the association between these and the pattern of vascular involvement is not clear . AIM: The aim of the study was to 1. Identify the location of the vessel involved in different cases of ischemic stroke 2. To study the various risk factors associated with the development of ischemic stroke. MATERIALS AND METHOD S: This was a prospective study conducted between the years 2010 and 2012. All adult patients with acute ischemic stroke which was confirmed by MRI and less than two weeks duration were included in the study. Parameters recorded were presence of pre - existing comorbid conditions, n eurological examination findings, Cardiovascular system examination findings, Blood pressures, blood sugar levels and pattern of vascular involvement. This was assessed using MR angiography or four vessel Doppler. Statistical analysis was done using the SP SS software. RESULTS: Two hundred patients were enrolled in the study. Pure extracranial stenosis was present in 21.5%, extracranial with intracranial stenosis in 34%, and pure intracranial stenosis in 44.5%, which was predominant and resembled other Indi an studies. 15.5% of patients had significant carotid stenosis based on Doppler study and were suitable candidates for carotid endarterectomy. Middle cerebral artery was commonly involved (55%. Hypertension (63.5%, diabetes mellitus (48%, alcoholism (20 .5% and smoking (18.5% were the common risk factors. Prevalence of these risk factors was more in those with intracranial stenosis in our study, elevated total

  14. Complete recovery following intra-arterial tenecteplase administration in a woman with acute ischemic stroke.

    Science.gov (United States)

    Meenakshi-Sundaram, S; Periakaruppan, A; Karuppiah, S N K P; Karthik, S N; Roopakumar, L; Thembavani, I

    2013-12-01

    A 23-year-old woman, who underwent a percutaneous transluminal mitral commissurotomy for a tight mitral stenosis, developed an acute ischemic stroke involving the proximal right middle cerebral artery territory. She had a dense left hemiplegia with a National Institutes of Health Stroke Scale score of 12. She was emergently treated within 1 hour with intra-arterial tenecteplase and made a dramatic recovery. Intra-arterial tenecteplase is an attractive option for treating acute ischemic stroke with proximal or major vessel occlusion.

  15. Acute cerebral vasculopathy in systemic sclerosis.

    Science.gov (United States)

    Faucher, Benoit; Granel, Brigitte; Nicoli, Francois

    2013-12-01

    Systemic sclerosis is an autoimmune disease characterized by skin and deep organ fibrosis and obliterative microvasculopathy. Cerebral involvement is currently not recognized as a manifestation of the disease, although several morphologic and functional studies suggested a frequent cerebral involvement in systemic sclerosis. We report a new case of acute cerebral vasculopathy in a patient suffering from systemic sclerosis together with five historical cases identified through a literature review. Cerebral acute vasculopathy most often revealed the disease. Affected patients suffered often from limited or diffuse cutaneous systemic sclerosis. Reversibility of arterial lesions, absence of specific histologic findings, and association with severe peripheral vascular involvement plead for a major role of vasospasm. However, the apparent efficacy of immunosuppressive treatments suggests an association with inflammatory or immune mechanisms. Awareness should be raised because of the severity of the disease, the risk of relapse, and the possible occurrence early in the course of systemic sclerosis.

  16. Current trends in the management of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Srinivasan Paramasivam

    2015-01-01

    Full Text Available Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS. Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly

  17. Current trends in the management of acute ischemic stroke.

    Science.gov (United States)

    Paramasivam, Srinivasan

    2015-01-01

    Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT) head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV) recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS). Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly improved outcome

  18. EVALUATION OF RISK FACTORS IN ACUTE STROKE

    Directory of Open Access Journals (Sweden)

    Putta

    2015-03-01

    Full Text Available Introduction: Cerebrovascular disease is the third most common cause of death in the developed world after cancer and ischemic heart disease. In India, community surveys have shown a crude prevalence rate of 200 per 100000 population for hemiplegia. Aims and objectives: Identification of risk factors for c erebrovascular disease. Materials and Methods: Inclusion Criteria: Cases of acute stroke admitted in S.V.R.R.G.G.H, Tirupati were taken for the study. Exclusion Criteria: Head injury cases, neoplasm cases producing cerebrovascular disease were excluded. Re sults: Stroke was more common in male, 54% patients were male 46% were female. It was more common in 6 th and 7 th decade. More common risk factors were hypertension followed by smoking, diabetes mellitus. More common pathology was infarction. Conclusion: Com mon risk factors for acute stroke are hypertension, smoking, diabetes mellitus, alcoholism, obesity, cardiac disease. Stroke was confirmed by CT scan of brain.

  19. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke.

    Science.gov (United States)

    Yu, Yi-Jing; Weng, Wei-Chieh; Su, Feng-Chieh; Peng, Tsung-I; Chien, Yu-Yi; Wu, Chia-Lun; Lee, Kuang-Yung; Wei, Yi-Chia; Lin, Shun-Wen; Zhu, Jun-Xiao; Huang, Wen-Yi

    2016-11-01

    The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (Ppneumonia in acute stroke stage is a significant predictor of 3-year mortality (hazard ratio=6.39, 95% confidence interval=4.03-10.11, Ppneumonia during the acute stroke stage is associated with increased risk of 3-year mortality. Interventions to prevent pneumonia in acute stroke stage might improve ischemic stroke outcome.

  20. The Relationship Between Baseline Blood Pressure and Computed Tomography Findings in Acute Stroke Data From the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)

    DEFF Research Database (Denmark)

    Sare, G.M.; Bath, P.M.W.; Gray, L.J.;

    2009-01-01

    .06-1.17) at baseline, and signs of visible infarction at day 10 (OR, 1.06; 95% CI, 1.00-1.13). A lower SBP was associated with signs of acute infarction (OR, 0.94; 95% CI, 0.89-0.99). Hemorrhagic transformation, dense middle cerebral artery sign, mass effect, and cerebral edema at day 10 were not independently...... associated with baseline BP. Conclusion-Although high baseline BP is independently associated with a poor outcome after stroke, this was not shown to be through an association with increased hemorrhagic transformation, cerebral edema, or mass effect; trial design may be suboptimal to detect this. Higher SBP...

  1. Compensatory cerebral motor control following presumed perinatal ischemic stroke

    NARCIS (Netherlands)

    van der Hoorn, Anouk; Potgieser, Adriaan R E; Brouwer, Oebele F; de Jong, Bauke M

    2014-01-01

    Case: A fifteen year-old left-handed girl presented with right-sided focal motor seizures. Neuroimaging showed a large left hemisphere lesion compatible with a middle cerebral artery stroke of presumed perinatal origin. She was not previously diagnosed with a motor deficit, although neurological exa

  2. Acute ischemic stroke. Imaging and intervention

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, R.G.; Lev, M.H. [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States). Neuroradiology Div.; Hirsch, J.A. [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States). Interventional Neuroradiology and Endovascular Neurosugery Service; Koroshetz, W.J. [Massachusetts General Hospital, Boston, MA (United States). Acute Stroke Service; Schaefer, P. (eds.) [Massachusetts General Hospital, Boston, MA (United States). Neuroradiology

    2006-07-01

    This timely book provides basic, practical and up-to-date information on how to use imaging to diagnose and treat patients with acute ischemic stroke. Written by physicians from the Massachusetts General Hospital and faculty from the Harvard Medical School, the book distills years of experience in the day-to-day management of acute stroke patients, as well as leading-edge basic and clinical research, into a practical guide. With the growing awareness that modern CT and MR imaging can meaningfully improve the outcome of the acute stroke patient, this book provides the practical information to advance the capacities of providers in delivering the most advanced care for this disease. (orig.)

  3. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation...... in patients with acute ischemic stroke and atrial fibrillation....... are at increased risk of stroke progression and recurrence. We sought to assess whether D-dimer and other markers of hemostatic activation could predict these adverse events in such patients. Method -  Blood samples were obtained from patients included in the Heparin in Acute Embolic Stroke Trial. Stroke...

  4. Ischemic postconditioning fails to protect against neonatal cerebral stroke.

    Directory of Open Access Journals (Sweden)

    Pierre-Louis Leger

    Full Text Available The lack of efficient neuroprotective strategies for neonatal stroke could be ascribed to pathogenic ischemic processes differentiating adults and neonates. We explored this hypothesis using a rat model of neonatal ischemia induced by permanent occlusion of the left distal middle cerebral artery combined with 50 min of occlusion of both common carotid arteries (CCA. Postconditioning was performed by repetitive brief release and occlusion (30 s, 1 and/or 5 min of CCA after 50 min of CCA occlusion. Alternative reperfusion was generated by controlled release of the bilateral CCA occlusion. Blood-flow velocities in the left internal carotid artery were measured using color-coded pulsed Doppler ultrasound imaging. Cortical perfusion was measured using laser Doppler. Cerebrovascular vasoreactivity was evaluated after inhalation with the hypercapnic gas or inhaled nitric oxide (NO. Whatever the type of serial mechanical interruptions of blood flow at reperfusion, postconditioning did not reduce infarct volume after 72 hours. A gradual perfusion was found during early re-flow both in the left internal carotid artery and in the cortical penumbra. The absence of acute hyperemia during early CCA re-flow, and the lack of NO-dependent vasoreactivity in P7 rat brain could in part explain the inefficiency of ischemic postconditioning after ischemia-reperfusion.

  5. Cryoglobulins in Acute Ischemic Stroke

    Science.gov (United States)

    Manukyan, L. A.; Ayvazyan, V. A.; Boyajyan, A. S.

    Cryoglobulins (Cgs) are pathogenic immune complexes, non specific markers of the inflammatory and autoimmune responses. In this study we for the first time, revealed Cgs in the blood of ischemic stroke patients and analyze their composition.

  6. The role of neuroimaging in acute stroke

    Directory of Open Access Journals (Sweden)

    Dhamija Rajinder

    2008-01-01

    Full Text Available Background: There is a need for early recognition, diagnosis, and therapy in patients with acute stroke. The most important therapies are thrombolysis or aspirin in hyperacute ischemic stroke and, for secondary prevention, antiplatelet agents, statins, ACE inhibitors (for lowering blood pressure, warfarin, and carotid endarterectomy or stenting. Imaging technology has a crucial role to play in the diagnosis and treatment of stroke. In recent years, significant advances have been made due to the availability of physiological imaging using a variety of techniques, ranging from computerized tomography (CT to magnetic resonance imaging (MRI, which enable clinicians to define brain anatomy and physiology in greater detail than ever before. Objective: In this article we discuss the imaging techniques currently available for patients with acute stroke, with an emphasis on the utility of these techniques for diagnosis and refining patient selection for early interventions. This is placed in the context of the needs of developing countries . Discussion: Although noncontrast CT (NCCT remains the most commonly used imaging modality to differentiate between ischemic and hemorrhagic stroke, to identify early CT changes, and to rule out stroke mimics, it is not sensitive enough to identify the infarct core or the mechanism of ischemic stroke. MRI, including magnetic resonance angiography (MRA, is the most useful imaging modality for the evaluation of acute stroke; it provides information about the mechanism as well as the vascular territory of the stroke. MRI also provides complete information about the status of tissue through diffusion-weighted imaging (DWI and about arterial patency by means of MRA. DWI shows acute lesions within minutes of onset of ischemia, while MRA can evaluate extracranial as well as intracranial vessels Evaluation of the proportion of penumbra vs infarcted tissue is another issue to be considered when instituting thrombolysis, and

  7. Detection of acute cerebral ischaemia with Tc-99m apcitide scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Tepmongkol, S. [Nuclear Medicine Division, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok 10330 (Thailand)

    2002-10-01

    The established indication for Tc99m apcitide scintigraphy is for detecting deep venous thrombosis. However, due to its mechanism of binding to GP IIb/IIIa receptors on activated platelets, it can be used to image acute cerebral thrombosis. I report a patient with an acute ischaemic stroke, with right leg swelling, referred for Tc99m apcitide scintigraphy to show of deep venous thrombosis. There was no abnormal uptake in the legs but there was in the left parieto-occipital region. This correlated with the clinical and CT data, indicating an acute ischaemic stroke in this area. (orig.)

  8. Reversed Robin Hood syndrome in acute ischemic stroke patients.

    Science.gov (United States)

    Alexandrov, Andrei V; Sharma, Vijay K; Lao, Annabelle Y; Tsivgoulis, Georgios; Malkoff, Marc D; Alexandrov, Anne W

    2007-11-01

    Recurrent hemodynamic and neurological changes with persisting arterial occlusions may be attributable to cerebral blood flow steal from ischemic to nonaffected brain. Transcranial Doppler monitoring with voluntary breath-holding and serial NIH Stroke Scale (NIHSS) scores were obtained in patients with acute middle cerebral artery or internal carotid artery occlusions. The steal phenomenon was detected as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in affected arteries at the time of velocity increase in normal vessels. The steal magnitude (%) was calculated as [(MFVm-MFVb)/MFVb]x100, where m=minimum and b=baseline mean flow velocities (MFV) during the 15- to 30-second period of a total 30 second of breath-holding. Six patients had steal phenomenon on transcranial Doppler (53 to 73 years, NIHSS 4 to 15 points). Steal magnitude ranged from -15.0% to -43.2%. All patients also had recurrent neurological worsening (>2 points increase in NIHSS scores) at stable blood pressure. In 3 of 5 patients receiving noninvasive ventilatory correction for snoring/sleep apnea, no further velocity or NIHSS score changes were noted. Our descriptive study suggests possibility to detect and quantify the cerebral steal phenomenon in real-time. If the steal is confirmed as the cause of neurological worsening, reversed Robin Hood syndrome may identify a target group for testing blood pressure augmentation and noninvasive ventilatory correction in stroke patients.

  9. Neck circumference, a bedside clinical feature related to mortality of acute ischemic stroke Perímetro cervical, uma medida à beira do leito relacionada com a mortalidade no acidente vascular cerebral isquêmico

    Directory of Open Access Journals (Sweden)

    Camila Andrade Mendes Medeiros

    2011-10-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate clinical/demographic factors, sleep alterations and one year mortality in acute ischemic stroke. METHODS: This was a prospective study of 89 consecutive patients (mean age 64.39 ± 8.51 years with acute ischemic stroke. High risk of obstructive sleep apnea (OSA was evaluated by the Berlin questionnaire, daytime somnolence by the Epworth Sleepiness Scale (> 10 and subjective sleep quality by the Pittsburgh Sleep Quality Index (> 5. Clinical and anthropometric data including body mass index, hip-waist ratio, neck circumference (NC were obtained. Increased NC was defined if > 43 cm in men and > 38 cm in women. Stroke severity was estimated by the Barthel Index and the modified Rankin Scale. The end-point was death after 12 months follow-up. RESULT: One-year mortality was 8.9%. Non-survivors were older (p = 0.006 and had larger NC (p = 0.02. Among all cases, large NC was related to high risk of OSA, diabetes and hypertension (Fisher's exact test. Compared to men, women showed relatively larger NC. Overall, family history of stroke (74.2 %, diabetes (33.7% and hypertension (78.6% were frequent; obesity (11.2% was uncommon. Daytime sleepiness (34.8 %, poor sleep quality (65.2% and risk of OSA (58.42% were frequently found. CONCLUSION: Poor sleep quality, excessive daytime sleepiness and high risk of OSA are frequent in this sample with acute ischemic stroke. One-year mortality was related to older age and large NC. As obesity is uncommon in acute stroke patients, a large NC should be taken as a significant clinical sign related to mortality.OBJETIVO: O objetivo do estudo é avaliar em pacientes com acidente vascular cerebral (AVC isquêmico, os fatores clínico/demográficos, alterações do sono e a mortalidade após um ano. MÉTODOS: Trata-se de estudo prospectivo envolvendo 89 pacientes consecutivos (64,39 ± 8,51 anos com AVC isquêmico agudo. Foram avaliados o risco elevado de apneia obstrutiva do

  10. Acute but not delayed amphetamine treatment improves behavioral outcome in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, Karsten; Kristiansen, Uffe;

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the effects of d-amphetamine (amph) upon recovery after embolic stroke in rats. METHODS: Ninety-three rats were embolized in the right middle cerebral artery and assigned to: (1) controls; (2) combination (acute amph and later amph-facilitate...

  11. Transient ischemic attack and acute ischemic stroke: associations with retinal microvascular signs.

    Science.gov (United States)

    Wang, Jie Jin; Baker, Michelle L; Hand, Peter J; Hankey, Graeme J; Lindley, Richard I; Rochtchina, Elena; Wong, Tien Y; Liew, Gerald; Mitchell, Paul

    2011-02-01

    Small vessel disease plays a role in cerebral events. We aimed to investigate the prevalence and patterns of retinal microvascular signs (surrogates for cerebral small vessel disease) among patients with transient ischemic attack (TIA) or acute stroke and population control subjects. Patients with TIA or acute stroke aged ≥49 years admitted to hospitals in Melbourne and Sydney, Australia, were recruited to the Multi-Centre Retina and Stroke Study (n=693, 2005 to 2007). Control subjects were Blue Mountains Eye Study participants aged ≥49 years without TIAs or stroke (n=3384, 1992 to 1994, west of Sydney). TIA, ischemic stroke, or primary intracerebral hemorrhage was classified using standardized neurological assessments, including neuroimaging. Retinal microvascular signs (retinopathy, focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar light reflex) were assessed from retinal photographs masked to clinical information. Patients with TIA or acute stroke were older than control subjects and more likely to have stroke risk factors. After adjustment for study site and known risk factors, all retinal microvascular signs were more common in patients with TIA or acute stroke than in control subjects (OR, 1.9 to 8.7; Pischemic stroke had similar prevalences of nondiabetic retinopathy (26.9% versus 29.5%; OR, 0.8; 95% CI, 0.5 to 1.6), diabetic retinopathy (55.5% versus 50.0%; OR, 1.3; 95% CI, 0.4 to 3.6), focal arteriolar narrowing (15.6% versus 18.4%; OR, 0.8; 95% CI, 0.4 to 1.5), and arteriovenous nicking (23.0% versus 17.8%; OR, 1.4; 95% CI, 0.7 to 2.7). Patients with TIA and acute stroke may share similar risk factors or pathogenic mechanisms.

  12. Reassessment of Defibrase in the treatment of Acute Cerebral lnfarction

    Institute of Scientific and Technical Information of China (English)

    Liu XQ; Guo YP; Wang WZ; Zhang CX; Yang JH; Qin Z

    2000-01-01

    Objective: to assess the safety and efficacy of defibrase in the treatment of acute cerebral iinfarction by a large sample, multicerter, randomized, double-blind, and placebo-controlled clinical trial Methods: 2244 cases with acute infarction in 41centers were randomly allocated to receive either an imitial intrdvcnons infusion of defibrase 10Bu or placebo in 250ml of normal saline within 24 hours of stroke onset Subsequent in fusions of defibrase 5Bu or placebo on the third and fifth days respectively. This treatment protocol was determined on the bases of the pretrial of 114 patientsin 8 centers The end points fincluded Climcally Neurological De ficits Scale of Stroke, Barthel Index, Mortality, adverse reaction and the level of plasma fibrinogen (FIB)Results: (1) the level of plasma FIB in defibrase group was reurarkably declied after treatment whereas the bleeding evcnts and other adverse reaction was not incteased in comparison with control group There was difference in the imtcnsity of degrading plasna FIB between defibrase from Agkistrodon halys and that frorn Agkistrodon acutns. (2) Theare were no statistically significant differences at Clinically Neurological Deficits Scale of Stroke at 2 weeks, Barthel Index sc ore and mortality at 3 months between two groups. Conclutions: This study showed that defibrase atppears safe and effective in degading plastua FIB.The dose of defibrase should regnlate propcrly according to preparations from diffcrent snake venom .This study did not show that clinical efficacy of defibrase was supetior to those present used medicines for acute cerebral infarction It is necessary to further study about the relations between its clinical efficacy and the dose,protocol of drug administration and indication.

  13. Contrast MR imaging of acute cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kogame, Saeko; Syakudo, Miyuki; Inoue, Yuichi (Osaka City Univ. (Japan). Faculty of Medicine) (and others)

    1992-04-01

    Thirty patients with acute and subacute cerebral infarction (13 and 17 deep cerebral infarction) were studied with 0.5 T MR unit before and after intravenous injection of Gd-DTPA. Thirteen patients were studied within 7 days after neurological ictus, 17 patients were studied between 7 and 14 days. Two types of abnormal enhancement, cortical arterial and parenchymal enhancement, were noted. The former was seen in 3 of 4 cases of very acute cortical infarction within 4 days after clinical ictus. The latter was detected in all 7 cases of cortical infarction after the 6th day of the ictus, and one patient with deep cerebral infarction at the 12th day of the ictus. Gd-DTPA enhanced MR imaging seems to detect gyral enhancement earlier compared with contrast CT, and depict intra-arterial sluggish flow which was not expected to see on contrast CT scans. (author).

  14. Malnutrition in Patients with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Stella D. Bouziana

    2011-01-01

    Full Text Available Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding.

  15. Malnutrition in Patients with Acute Stroke

    Science.gov (United States)

    Bouziana, Stella D.; Tziomalos, Konstantinos

    2011-01-01

    Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding. PMID:22254136

  16. Cerebral blood flow in acute mountain sickness

    DEFF Research Database (Denmark)

    Jensen, J B; Wright, Anne; Lassen, N A

    1990-01-01

    Changes in cerebral blood flow (CBF) were measured using the radioactive xenon technique and were related to the development of acute mountain sickness (AMS). In 12 subjects, ascending from 150 to 3,475 m, CBF was 24% increased at 24 h [45.1 to 55.9 initial slope index (ISI) units] and 4% increased...

  17. CT imaging in acute ischemic stroke

    NARCIS (Netherlands)

    Borst, J.

    2016-01-01

    Time is of the essence when treating acute ischemic stroke, to limit the damage caused. One form of intra-arterial treatment (IAT) used in such cases is the mechanical removal of the blood clot using stent-retrievers. It is thought that patient selection for IAT requires improvement and that CT

  18. Continuous pulse oximetry in acute hemiparetic stroke

    NARCIS (Netherlands)

    Elting, JW; Stewart, R; den Arend, A; De Keyser, J; Sulter, G.

    2000-01-01

    Background and purpose: Hypoxemia can adversely affect ischemic brain tissue in laboratory animals. The aim of this study was to assess the Value of early continuous monitoring with pulse oximetry in detecting arterial oxygen desaturations in patients with acute hemiparetic stroke, and the effects

  19. Acute ischemic stroke prognostication, comparison between ...

    African Journals Online (AJOL)

    Ossama Y. Mansour

    2014-11-20

    Nov 20, 2014 ... patients with acute ischemic stroke in comparison with the NIHSS and the GCS. ... comes; In-hospital or 30 days mortality and Modified Rankin Scale (mRS) at 3 ..... 8. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C.

  20. Acute Stroke Management in Patients Taking Dabigatran

    NARCIS (Netherlands)

    Brouns, Raf; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; De Raedt, Sylvie; Uyttenboogaart, Maarten; Luijckx, Gert-Jan; Jochmans, Kristin; De Keyser, Jacques

    Dabigatran etexilate is emerging as an alternative for vitamin K antagonists, but evidence-based guidelines for management of intracerebral hemorrhage and acute ischemic stroke in patients taking this drug are nonexistent. This review summarizes current knowledge on key pharmacological features and

  1. Radiological strategy in acute stroke in children

    Energy Technology Data Exchange (ETDEWEB)

    Paonessa, Amalia [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy)], E-mail: apaonessa7@hotmail.com; Limbucci, Nicola [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy); Tozzi, Elisabetta [Dept. of Pediatrics, University Hospital ' S. Salvatore' , L' Aquila (Italy); Splendiani, Alessandra; Gallucci, Massimo [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy)

    2010-04-15

    The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.

  2. The role of microglia and myeloid immune cells in acute cerebral ischemia

    Science.gov (United States)

    Benakis, Corinne; Garcia-Bonilla, Lidia; Iadecola, Costantino; Anrather, Josef

    2015-01-01

    The immune response to acute cerebral ischemia is a major contributor to stroke pathobiology. The inflammatory response is characterized by the participation of brain resident cells and peripheral leukocytes. Microglia in the brain and monocytes/neutrophils in the periphery have a prominent role in initiating, sustaining and resolving post-ischemic inflammation. In this review we aim to summarize recent literature concerning the origins, fate and role of microglia, monocytes and neutrophils in models of cerebral ischemia and to discuss their relevance for human stroke. PMID:25642168

  3. The role of microglia and myeloid immune cells in acute cerebral ischemia

    Directory of Open Access Journals (Sweden)

    Corinne eBenakis

    2015-01-01

    Full Text Available The immune response to acute cerebral ischemia is a major contributor to stroke pathobiology. The inflammatory response is characterized by the participation of brain resident cells and peripheral leukocytes. Microglia in the brain and monocytes/neutrophils in the periphery, have a prominent role in initiating, sustaining and resolving post-ischemic inflammation. In this review we aim to summarize recent literature concerning the origins, fate and role of microglia, monocyte and neutrophil in models of cerebral ischemia and to discuss their relevance for human stroke.

  4. 早期肠内营养支持治疗急性脑卒中的效果观察%Effect observation of early enteral nutritional support in the treatment of acute cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    赖路生; 陈伟光; 李建汉; 莫健

    2015-01-01

    Objective To explore the effect of early enteral nutritional support in the treatment of acute cerebral stroke. Methods 92 acute cerebral stroke patients with dysphagia from January 2008 to July 2014 in our hospital were select-ed and randomly divided into the observation group (52 cases) and the control group (40 cases).The observation group was given nasogastric enteral nutritional support within 72 hours after admission,the control group was fed by their families.Nutritive indexes such as arm muscle circumference (AMC),total lymphocyte count (TLC),serum albumin (Alb), prealbumin (PA),hemoglobin (Hb) in two groups was compared.The incidence rate of hypoproteinemia (serum albumin less than 35 g/L),the incidence rate of infected complication,neurologic impairment degree (NIHSS score) and activity of daily living (Barthel index) in two groups was compared. Results The level of AMC,TLC,Alb,PA and Hb after treatment in the observation group was higher than that before treatment and in the control group after treatment,with significant difference (P<0.05).The incidence rate of infection and hypoproteinemia in the observation group was lower than that in the control group,with significant difference (P<0.05).The score of NIHSS in the observation group after treatment was lower than that in the control group after treatment,with significant difference (P<0.05).The score of Barthel index in the observation group after treatment was higher than that in the control group after treatment,with significant difference (P<0.05). Conclusion Early enteral nutritional support in patients with acute cerebral stroke can effectively improve the nutritional status,enhance immunity,promote recovery of neurological function,reduce the incidence rate of infection,and improve patient’s early prognosis.%目的:探讨早期肠内营养支持治疗急性脑卒中的效果。方法选取2008年1月~2014年7月本院收治的92例急性脑卒中伴吞咽障碍患者作为研究对

  5. Promoting thrombolysis in acute ischemic stroke.

    Science.gov (United States)

    Dirks, Maaike; Niessen, Louis W; van Wijngaarden, Jeroen D H; Koudstaal, Peter J; Franke, Cees L; van Oostenbrugge, Robert J; Huijsman, Robbert; Lingsma, Hester F; Minkman, Mirella M N; Dippel, Diederik W J

    2011-05-01

    Thrombolysis with intravenous recombinant tissue plasminogen activator is an effective treatment for acute ischemic stroke, but the number of treatable patients is limited. The PRomoting ACute Thrombolysis in Ischemic StrokE (PRACTISE) trial evaluated the effectiveness of a multidimensional implementation strategy for thrombolysis with intravenous recombinant tissue plasminogen activator in acute ischemic stroke. The PRACTISE trial was a national multicenter cluster-randomized controlled trial with randomization after pairwise matching. Twelve hospitals, both urban and community, academic and nonacademic, in the Netherlands participated. All patients admitted with stroke within 24 hours from onset of symptoms were registered. The intervention included 5 implementation meetings based on the Breakthrough Series model. The primary outcome was treatment with thrombolysis. Secondary outcomes were admission within 4 hours after onset of symptoms, death or disability at 3 months, and quality of life. Overall 5515 patients were included in the study' 308 patients (12.2%) in the control centers and 393 patients (13.1%) in the intervention centers were treated with thrombolysis (adjusted OR, 1.25; 95% CI, 0.93 to 1.68). Among the 1657 patients with ischemic stroke admitted within 4 hours from onset, 391 (44.5%) of 880 in the intervention centers were treated with thrombolysis and 305 (39.3%) of 777 in the control centers; the adjusted OR for treatment with thrombolysis was 1.58 (95% CI, 1.11 to 2.27). An intensive implementation strategy increases the proportion of patients with acute stroke treated with thrombolysis in real-life settings. An apparently pivotal factor in the improvement of the treatment rate is better application of contraindications for thrombolysis.

  6. Acute ischemic stroke treatment: State of the art.

    Science.gov (United States)

    Patel, Rajan Ag; White, Christopher J

    2011-02-01

    Stroke is among the leading causes of death and serious disability in the United States. Treatment of the acute ischemic stroke patient requires a multidisciplinary approach involving first-responders, emergency department personnel, neurologists, advanced imaging experts and endovascular specialists with neurosurgical support. Contemporary stroke treatment is a rapidly advancing field. New developments in pharmacologic and endovascular stroke therapy require thoughtful trial design and expeditious trial implementation to assess clinical outcomes. This manuscript reviews the state of the art in acute stroke therapy.

  7. Electrocardiogram changes in acute cerebral infarction patients

    Institute of Scientific and Technical Information of China (English)

    Jing Fang; Weihong Yan

    2006-01-01

    BACKGROUND: Comparison of different stroke locations had been focused in past researches in electrocardiogram (ECG) changes of cerebral stroke patients. Some researches neglected the heart disease in the illness history.OBJECTIVE: To discuss ECG changes in different infarction locations and size of acute cerebral infarction and compare with healthy people.DESIGN: Contrast observation.SETrING: Shanghai Ninth People's Hospital.PARTICIPANTS: A total of 57 patients with cerebral infarction were selected from the Neurological Department of Ninth People's Hospital of Shanghai from March 2003 to September 2005. They were diagnosed according to the criteria revised in the 4th National Cerebral Disease Conference and brain images. Patients who had heart disease were excluded. There were 32 males and 25 females, who were 65-84 years old. Among them, 23 cases were involved in right hemisphere, 34 cases in left one, 23 in base ganglion, 11 in brain stem, 9in frontal lobe and 14 in other parts. According to their infarction size (plus size in every different scan), they were divided into three different groups: large-size group (n = 10) with size larger than 3.5 cm3, medium-sizegroup (n = 13) with size between 1.5-3.5 cm3, and small-size group (n = 34) with size smaller than 1.5 cm3.Another 50 healthy subjects were regarded as control group. There were 29 males and 21 females aged 40-82 years. All these cases knew and agreed of the examination.METHODS: Patients received 12-lead ECG examinations within the first 6-24 hours of onset while control group received it at the same time. The HR, PR, QTc, QRS, T wave and ST changes were compared between the two groups.MAIN OUTCOME MEASURES: The ECG changes and differences in two hemispheres, in different infarction lccations and sizes. RESULTS: All 57 patients and 50 healthy subjects were involved in the final analysis. ① ECG changes in infarction group and control group. There were no differences in HR, QRS time and cases with

  8. Cortical reorganisation of cerebral networks after childhood stroke: impact on outcome.

    Science.gov (United States)

    Kornfeld, Salome; Delgado Rodríguez, Juan Antonio; Everts, Regula; Kaelin-Lang, Alain; Wiest, Roland; Weisstanner, Christian; Mordasini, Pasquale; Steinlin, Maja; Grunt, Sebastian

    2015-06-10

    Recovery after arterial ischaemic stroke is known to largely depend on the plastic properties of the brain. The present study examines changes in the network topography of the developing brain after stroke. Effects of brain damage are best assessed by examining entire networks rather than single sites of structural lesions. Relating these changes to post-stroke neuropsychological variables and motor abilities will improve understanding of functional plasticity after stroke. Inclusion of healthy controls will provide additional insight into children's normal brain development. Resting state functional magnetic resonance imaging is a valid approach to topographically investigate the reorganisation of functional networks after a brain lesion. Transcranial magnetic stimulation provides complementary output information. This study will investigate functional reorganisation after paediatric arterial ischaemic stroke by means of resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a cross-sectional plus longitudinal study design. The general aim of this study is to better understand neuroplasticity of the developing brain after stroke in order to develop more efficacious therapy and to improve the post-stroke functional outcome. The cross-sectional part of the study will investigate the functional cerebral networks of 35 children with chronic arterial ischaemic stroke (time of the lesion >2 years). In the longitudinal part, 15 children with acute arterial ischaemic stroke (shortly after the acute phase of the stroke) will be included and investigations will be performed 3 times within the subsequent 9 months. We will also recruit 50 healthy controls, matched for age and sex. The neuroimaging and neurophysiological data will be correlated with neuropsychological and neurological variables. This study is the first to combine resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a paediatric

  9. An unusual cause of ischemic stroke - Cerebral air embolism

    Directory of Open Access Journals (Sweden)

    Vinit Suri

    2014-01-01

    Full Text Available Air embolism is a preventable, often undiagnosed but potentially treatable cause of ischemic stroke with a high morbidity and mortality. It is usually iatrogenic ocurring especially in patients in ICU setting. We describe the case and neuroimaging of a patient with ischaemic stroke due to air embolism during manipulation of central venous line. We also review the literature with respect to aetiology, incidence pathophysiology, diagnosis, and treatment options for venous and air embolism. Cerebral air embolism should be considered in patients with sudden neurological deterioration after central venous or arterial manipulations or certain neurological procedures. Prevention, as well as early diagnosis and management, may reduce morbidity and mortality.

  10. MR-visible brain water content in human acute stroke

    DEFF Research Database (Denmark)

    Gideon, P; Rosenbaum, S; Sperling, B

    1999-01-01

    Quantification of metabolite concentrations by proton magnetic resonance spectroscopy (1H-MRS) in the human brain using water as an internal standard is based on the assumption that water content does not change significantly in pathologic brain tissue. To test this, we used 1H-MRS to estimate...... brain water content during the course of cerebral infarction. Measurements were performed serially in the acute, subacute, and chronic phase of infarction. Fourteen patients with acute cerebral infarction were examined as well as 9 healthy controls. To correlate with regional cerebral blood flow (r......CBF from Day 0-3 to Day 4-7 (p = 0.050) and from Day 0-3 to Day 8-21 (p = 0.028). No correlation between rCBF and water content was found. Water content in ischemic brain tissue increased significantly between Day 4-7 after stroke. This should be considered when performing quantitative 1H-MRS using water...

  11. MR-visible brain water content in human acute stroke

    DEFF Research Database (Denmark)

    Gideon, P; Rosenbaum, S; Sperling, B;

    1999-01-01

    Quantification of metabolite concentrations by proton magnetic resonance spectroscopy (1H-MRS) in the human brain using water as an internal standard is based on the assumption that water content does not change significantly in pathologic brain tissue. To test this, we used 1H-MRS to estimate...... brain water content during the course of cerebral infarction. Measurements were performed serially in the acute, subacute, and chronic phase of infarction. Fourteen patients with acute cerebral infarction were examined as well as 9 healthy controls. To correlate with regional cerebral blood flow (r......CBF from Day 0-3 to Day 4-7 (p = 0.050) and from Day 0-3 to Day 8-21 (p = 0.028). No correlation between rCBF and water content was found. Water content in ischemic brain tissue increased significantly between Day 4-7 after stroke. This should be considered when performing quantitative 1H-MRS using water...

  12. Oral antiplatelet therapy for acute ischaemic stroke.

    Science.gov (United States)

    Sandercock, Peter A G; Counsell, Carl; Tseng, Mei-Chiun; Cecconi, Emanuela

    2014-03-26

    In people with acute ischaemic stroke, platelets become activated and can cause blood clots to form and block an artery in the brain, resulting in damage to part of the brain. Such damage gives rise to the symptoms of stroke. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and also reduce the risk of early recurrent ischaemic stroke, thereby reducing the risk of early death and improving long-term outcomes in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage. To assess the efficacy and safety of immediate oral antiplatelet therapy (that is started as soon as possible and no later than two weeks after stroke onset) in people with acute presumed ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (last searched 16 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2013), MEDLINE (June 1998 to May 2013), and EMBASE (June 1998 to May 2013). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies. Randomised trials comparing oral antiplatelet therapy (started within 14 days of the stroke) with control in people with definite or presumed ischaemic stroke. Two review authors independently applied the inclusion criteria and assessed trial quality. For the included trials, they extracted and cross-checked the data. We included eight trials involving 41,483 participants. No new trials have been added since the last update.Two trials testing aspirin 160 mg to 300 mg once daily, started within 48 hours of onset, contributed 98% of the data. The risk of bias was low. The maximum follow-up was six months. With treatment, there was a significant decrease in death or dependency at the end of follow-up (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.91 to 0.99). For every 1000 people treated with

  13. Postischemic Inflammation in Acute Stroke

    Science.gov (United States)

    Consoli, Arturo; Arnaboldi, Marco; Consoli, Domenico

    2017-01-01

    Cerebral ischemia is caused by arterial occlusion due to a thrombus or an embolus. Such occlusion induces multiple and concomitant pathophysiological processes that involve bioenergetic failure, acidosis, loss of cell homeostasis, excitotoxicity, and disruption of the blood-brain barrier. All of these mechanisms contribute to neuronal death, mainly via apoptosis or necrosis. The immune system is involved in this process in the early phases after brain injury, which contributes to potential enlargement of the infarct size and involves the penumbra area. Whereas inflammation and the immune system both exert deleterious effects, they also contribute to brain protection by stimulating a preconditioning status and to the concomitant repair of the injured parenchyma. This review describes the main phases of the inflammatory process occurring after arterial cerebral occlusion, with an emphasis on the role of single mediators. PMID:28079313

  14. Word and face recognition deficits following posterior cerebral artery stroke

    DEFF Research Database (Denmark)

    Kuhn, Christina D.; Asperud Thomsen, Johanne; Delfi, Tzvetelina

    2016-01-01

    Abstract Recent findings have challenged the existence of category specific brain areas for perceptual processing of words and faces, suggesting the existence of a common network supporting the recognition of both. We examined the performance of patients with focal lesions in posterior cortical...... areas to investigate whether deficits in recognition of words and faces systematically co-occur as would be expected if both functions rely on a common cerebral network. Seven right-handed patients with unilateral brain damage following stroke in areas supplied by the posterior cerebral artery were...... included (four with right hemisphere damage, three with left, tested at least 1 year post stroke). We examined word and face recognition using a delayed match-to-sample paradigm using four different categories of stimuli: cropped faces, full faces, words, and cars. Reading speed and word length effects...

  15. Early treatment of hypertension in acute ischemic and intracerebral hemorrhagic stroke: progress achieved, challenges, and perspectives.

    Science.gov (United States)

    Feldstein, Carlos A

    2014-03-01

    Hypertension is the leading risk factor for ischemic and intracerebral hemorrhagic subtypes of stroke. Additionally, high blood pressure (BP) in the acute cerebrovascular event is associated with poor outcome, and a high percentage of stroke survivors have inadequate control of hypertension. The present is a systematic review of prospective, randomized, and controlled trials carried out on safety and efficacy of antihypertensive treatment of both subtypes of acute stroke. Six trials involving 7512 patients were included, which revealed controversies on the speed and the goals of treatment. These controversies could be due at least in part, from the fact that some studies analyzed the results of antihypertensive treatment in ischemic and intracerebral hemorrhagic subtypes of acute stroke together, and from a different prevalence of past-stroke in the randomized groups. Further research is necessary to establish whether standard antihypertensive treatment provides greater benefit than simple observation in patients with ischemic acute stroke and Stage 2 hypertension of JNC 7, albeit they were not candidates for acute reperfusion. In that case, the target reduction in BP could be 10% to 15% within 24 hours. The recently published INTERACT 2 has provided evidence that patients with hemorrhagic stroke may receive intensive antihypertensive treatment safely with the goal of reducing systolic BP to levels no lower than 130 mm Hg. It is important to take into account that marked BP lowering in acute stroke increases the risk of poor outcome by worsening cerebral ischemia from deterioration of cerebral blood flow autoregulation. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  16. Mechanical interventions to treat acute stroke.

    Science.gov (United States)

    Fussell, David; Schumacher, H Christian; Meyers, Philip M; Higashida, Randall T

    2007-01-01

    The approach to stroke therapy has historically been limited due to the existence of relatively few treatment options and the necessity for action within 3 hours of symptom onset. As neuroimaging technology advances, fertile new ground is revealed for novel therapies. Recently, a number of exciting mechanical systems have been developed with potential efficacy even hours after cerebrovascular occlusion: endovascular clot disruption, endovascular clot extraction, and angioplasty with stenting are currently under study, with promising initial results. With more options, each with greater effectiveness in a particular clinical scenario, the physician is now better equipped than ever to treat acute ischemic stroke successfully.

  17. Racial Difference in Cerebral Microbleed Burden among Ischemic Stroke Patients.

    Science.gov (United States)

    Shahjouei, Shima; Tsivgoulis, Georgios; Singh, Mantinderpreet; McCormack, Michael; Noorbakhsh-Sabet, Nariman; Goyal, Nitin; Alexandrov, Anne W; Alexandrov, Andrei V; Zand, Ramin

    2017-08-21

    Data on the epidemiology of cerebral microbleeds (CMBs) among patients with ischemic stroke are limited. This study compared the number, associated factors, and topography of CMBs between African American and Caucasian ischemic stroke patients in the Mid-South United States. We evaluated consecutive ischemic stroke patients admitted to our tertiary stroke center, University of Tennessee Health Science Center, Memphis, Tennessee, in a two-year period. We analyzed T2*-weighted magnetic resonance images for the number, location, and topography of CMBs, as well as patients' demographic and clinical information. Among 760 ischemic stroke patients who were included (mean age was 62.1 ± 13.9 years, 51.4% men), 450 (59.2%) were African American. In comparison with Caucasians, African Americans were about five years younger (P = .000) and had a higher rate of hypertension (80.9% vs. 74.5%, P = .036). Similarly, African Americans had a higher prevalence of diabetes mellitus (P = .001). There was no significant difference between African-Americans and Caucasians in terms of CMBs presence and location. African Americans had a higher number of CMBs in comparison with Caucasians, but the difference was not significant. African Americans were more likely to have CMBs ≥5 (P = .047). Although African American stroke patients had a higher rate of large confluent white matter lesions, there was no significant racial difference regarding the rate and severity of deep white matter lesions. We did not observe any differences between African American and Caucasian patients with ischemic stroke patients regarding the presence, number, and location of CMBs. However, our results suggested that the prevalence of multiple CMBs (CMBs ≥5) might be higher among African American stroke patients. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    钱方媛

    2014-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke andpost-stroke depression(PSD)initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory(BDI,21-item)and DSM-Ⅳcriteria was used to diagnose post-stroke depression(PSD)at 2 weeks after stroke.

  19. Outcomes after acute ischemic stroke in patients with thrombocytopenia or thrombocytosis.

    Science.gov (United States)

    Furlan, Julio C; Fang, Jiming; Silver, Frank L

    2016-03-15

    Thrombocytopenia may be associated with a greater risk of cerebral hemorrhage and thrombocytosis may be associated with a greater risk of cerebral thrombosis. There is a paucity of studies focused on the potential association between blood platelet count (BPC) and outcomes after acute ischemic stroke (AIS). We hypothesized that abnormal BPC is associated with poorer outcomes after AIS. This study included data from the Ontario Stroke Registry on consecutive patients with AIS admitted between July 2003 and March 2008. Patients were divided into groups as follows: low BPC (450,000/mm(3)). Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurologic Scale: thrombocytosis on the initial admission are associated with higher mortality after AIS. Abnormal BPC does not adversely affect the degree of initial impairment, disability at discharge, or length of stay in the acute care hospital after AIS. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Evaluation of Factors Influencing Sensory Disability in Cerebral Stroke Patients

    Directory of Open Access Journals (Sweden)

    K Ghandehari

    2010-06-01

    Full Text Available Introduction: Clinical findings affecting disability in stroke patients are important as presence of these factors determines the prognosis and future course of these patients. Methods: Consecutive stroke patients admitted at Ghaem hospital, Mashhad were enrolled in this prospective study in 2008. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was evaluated in these patients. Disability score was based on the Modified Ranking Disability Score (MRDS, 72 hours post stroke. Mean of MRDS was analyzed by T test and Fisher tests and p<0.05 was considered as significant. Results: A total of 329 stroke patients were investigated. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was found in 37.4%, 13.8%, 7.9% and 7.3% of the patients, respectively. MRDS was significantly higher in patients with hemianesthesia as compared to other stroke patients, (p<0.001. MRDS of patients with hemihypoestheisa, hemineglect and homonyous hemianopsia was not significantly different than patients without these abnormalities (p=0.44, p=023 and p=0.83. Patients with triad of hemianesthesia, hemineglect and homonymous hemianopsia had significantly higher MRDS than others (p<0.001. Conclusion: Hemianesthesia is a clinical factor affecting sensory disability in cerebral stroke patients. Presence of the above triad could increase MRDS in these patients.

  1. [Acute benign cerebral angiopathy. 6 cases].

    Science.gov (United States)

    Rousseaux, P; Scherpereel, B; Bernard, M H; Guyot, J F

    1983-10-08

    The 6 cases reported here constitute, with 5 previously published cases, a special nosological entity tentatively called "acute benign cerebral angiopathy" by the authors. These 11 cases have in common certain radiological and clinical features. Arteriography shows segmental, multifocal and assymetrical stenoses involving the cerebral arteries between Willis' circle and the terminal arterioles and looking like "strings of sausages". The lesions disappear within one month and present the radiological characteristics of arteritis of medium caliber vessels. The clinical symptoms are suggestive of meningeal haemorrhage or acute cerebromeningeal oedema, with acute repetitive attacks of severe headache and agitation with obnubilation; epileptic seizures and transient neurological deficit may occur. True meningeal haemorrhage confirmed by lumbar puncture is seen in nearly one half of the cases; it seems to be due to alterations in the blood-brain barrier induced by the angiopathy. Intracerebral haematoma may develop, but the disease is usually benign and regresses spontaneously in a few days. None of the usual causes of cerebral arteritis (intra-cranial infection, collagen disease, allergic or toxic angitis) has been found. Pseudo-arteritis (notably spasm of ruptured arterial aneurysms) has been excluded. No aetiological factor common to the 11 cases reported has been elicited, although 6 of the patients had recently given birth and our 6 patients had benign virus infection before or during the clinical manifestations of the disease. In the authors' opinion, the most rewarding line of research would be the role of short acute attacks of arterial hypertension.

  2. Relationship between subtypes of MRI-confirmed acute ischemic stroke based on OCSP and TOAST classifications

    Institute of Scientific and Technical Information of China (English)

    Feng Qiu; Xiaokun Qi; Jianguo Liu; Wenluo Zhang; Qi Wang

    2008-01-01

    BACKGROUND:Two classification systems exist for subtypes of acute cerebral infarction.One was developed for the Trial of Org 10172 in Acute Stroke Treatment(TOAST),based primarily on etiology.The other is the Oxfordshire Community Stroke Project(OCSP),based on clinical features.OBJECTIVE:Tb evaluate the relationship between OCSP and TOAST classifications ifl terms of stroke location and etiology in 126 patients with acute ischemic stroke confirmed by transcranial magnetic resonance imaging(MRI).DESIGN,TIME AND SETTING:Retrospective case analysis.Transcranial MRI,diffusion weighted imaging,and magnetic resonance angiography were performed in 126 patients with acute stroke during the first 48 hours following admission to the Department of Neurology,Navy Gene ral Hospital of Chinese PLA.PARTICIPANTS:A total of 126 patients with acute stroke,comprised of 71 males and 55 females,admitted to the Navy General Hospital of Chinese PLA between December 2005 and April 2006 were included.METHODS:Of 126 patients with acute stroke,13 exhibited total anterior circulation infarcts(TACI),51 had partial anterior circulation infarcts(PACI),28 sufiered posterior circulation infarcts(POCI),and 34 had lacunar infarcts(LACI)based on OCSP classification.However,according to TOAST classification,19 cases were a result of large-artery atherosclerosis,32 by cardioembolism,36 by small-vessel occlusion,1 by stroke of other determined etiology,and 38 by stroke of undetermined etiology.MAIN OUTCOME MEASURES:The corresponding relationship of the subtypes of acute stroke based on OCSP and TOAST.RESULTS:Of patients with TACI,8(61.5%)were caused by cardioembolism.Of patients with PACI,16 (31.4%) were caused by large-artery atherosclerosis and 17(33.3%)by cardioembolism.Of patients with POCI,12(42.8%)were a result of small-vessel occlusion.Of patients with LACI,17(50.O%)were caused by hypertension and arteriolar sclerosis.CONCLUSION:(1)The OCSP system is related to anatomical and pathophysiological

  3. Plasminogen Activators and Ischemic Stroke: Conditions for Acute Delivery

    Science.gov (United States)

    del Zoppo, Gregory J

    2013-01-01

    Appropriate acute treatment with plasminogen activators (PAs) can significantly increase the probability of minimal or no disability in selected ischemic stroke patients. There is a great deal of evidence showing that intravenous recombinant tissue PAs (rt-PA) infusion accomplishes this goal, recanalization with other PAs has also been demonstrated in the development of this treatment. Recanalization of symptomatic, documented carotid or vertebrobasilar arterial territory occlusions have also been achieved by local intra-arterial PA delivery, although only a single prospective double-blinded randomized placebo-controlled study has been reported. The increase in intracerebral hemorrhage with these agents by either delivery approach underscores the need for careful patient selection, dose-appropriate safety and efficacy, proper clinical trial design, and an understanding of the evolution of cerebral tissue injury due to focal ischemia. Principles underlying the evolution of focal ischemia have been expanded by experience with acute PA intervention. Several questions remain open that concern the manner in which PAs can be applied acutely in ischemic stroke and how injury development can be limited. PMID:23539414

  4. Characteristics and dynamics of cognitive impairment in patients with primary and recurrent cerebral ischemic hemispheric stroke

    Directory of Open Access Journals (Sweden)

    A. A. Kozyolkin

    2014-08-01

    Full Text Available Acute cerebrovascular disease is a global medical and social problem of the modern angioneurology, occupying leading positions in the structure of morbidity and mortality among adult population of the world. Ischemic stroke – is one of the most common pathology. Today this disease took out the world pandemic. More than 16 million new cases of cerebral infarction recorded in the world each year and it “kills” about 7 million of people. About 111,953 cases of cerebral stroke were registered in 2013 in Ukraine. Cognitive impairment, t hat significantly disrupt daily activities and life of the patient, is one of the most significant post-stroke complications that have social, medical and biological significance. Aim. The purpose of this investigation was to study features and dynamics of cognitive impairments in patients with primary and recurrent cerebral hemispheric ischemic stroke (CHIS in the acute stage of the disease. Materials and methods. To achieve the aim, and the decision of tasks in the clinic of nervous diseases Zaporozhye State Medical University (supervisor - Doctor of Medicine, Professor Kozelkin A. based on the department of acute cerebrovascular disease were performed comparative, prospective cohort study, which included comprehensive clinical and paraclinical examinations of 41 patients (26 men and 15 women aged 45 to 85 years (mean age 66,4 ± 1,4 years with acute left-hemispheric (2 patients and right - hemispheric (39 patients CHIS . First up was a group of 28 patients (19 men and 9 women, mean age 65,6 ± 1,6 years, who suffered from primary CHIS. The second group consisted of 13 patients (7 men and 6 women, mean age 68,1 ± 2,5 years with recurrent CHIS. The groups were matched by age, sex, localization of the lesion and the initial level of neurological deficit. All patients underwent physical examination, neurological examination. Dynamic clinical neurological examination assessing the severity of stroke was conducted

  5. Current knowledge on the neuroprotective and neuroregenerative properties of citicoline in acute ischemic stroke.

    Science.gov (United States)

    Martynov, Mikhail Yu; Gusev, Eugeny I

    2015-01-01

    Ischemic stroke is one of the leading causes of long-lasting disability and death. Two main strategies have been proposed for the treatment of ischemic stroke: restoration of blood flow by thrombolysis or mechanical thrombus extraction during the first few hours of ischemic stroke, which is one of the most effective treatments and leads to a better functional and clinical outcome. The other direction of treatment, which is potentially applicable to most of the patients with ischemic stroke, is neuroprotection. Initially, neuroprotection was mainly targeted at protecting gray matter, but during the past few years there has been a transition from a neuron-oriented approach toward salvaging the whole neurovascular unit using multimodal drugs. Citicoline is a multimodal drug that exhibits neuroprotective and neuroregenerative effects in a variety of experimental and clinical disorders of the central nervous system, including acute and chronic cerebral ischemia, intracerebral hemorrhage, and global cerebral hypoxia. Citicoline has a prolonged therapeutic window and is active at various temporal and biochemical stages of the ischemic cascade. In acute ischemic stroke, citicoline provides neuroprotection by attenuating glutamate exitotoxicity, oxidative stress, apoptosis, and blood-brain barrier dysfunction. In the subacute and chronic phases of ischemic stroke, citicoline exhibits neuroregenerative effects and activates neurogenesis, synaptogenesis, and angiogenesis and enhances neurotransmitter metabolism. Acute and long-term treatment with citicoline is safe and in most clinical studies is effective and improves functional outcome.

  6. Pneumonia in acute stroke patients fed by nasogastric tube

    OpenAIRE

    Dziewas, R. (Rainer); Ritter, M.; Schilling, M; Konrad, C.; Oelenberg, S; Nabavi, D; Stogbauer, F; Ringelstein, E; Ludemann, P

    2004-01-01

    Background: Aspiration pneumonia is the most important acute complication of stroke related dysphagia. Tube feeding is usually recommended as an effective and safe way to supply nutrition in dysphagic stroke patients.

  7. Gerstmann'S syndrome in acute stroke patients.

    Science.gov (United States)

    Zukic, Sanela; Mrkonjic, Zamir; Sinanovic, Osman; Vidovic, Mirjana; Kojic, Biljana

    2012-12-01

    Gerstmann in 1924. observed in a few patients a concomitant impairment in discriminating their own fingers, writing by hand, distinguishing left from right and performing calculations. He claimed that this tetrad of symptoms constituted a syndromal entity, assigned it to a lesion of the dominant parietal lobe. Since than, Gerstmann`s syndrome (GS) was enigma for neuropsychologists. The aim of this study was to analyze frequency and clinical features of GS among acute stroke patients. We prospectively analyzed 194 acute stroke patients (average age 65±11.06 years, male 113 (58.2%), female 81 (41.8%) hospitalized at department of Neurology, University Clinical Center tuzla, during the six mounths in 2010. For clinical assessment of agraphia, alexia and acalculia we used Minessota test for differential diagnosis of aphasia's. Among these acute stroke patients, 59 (30.40%) had alexia, agraphia and acalculia or different combinations of these disorders. two patients (3.4%) had agraphia and acalculia associated with other part of tetrad of GS: fi nger agnosia and left-right disorientation. they both where men, right handed, and cranial computed tomography scan showed ischemic lesion in the left parietal and left temporoparietal lobe. Gerstmann`s syndrome is rare clinical entity, and has the high value in localization and the lesion is mainly localized to angular gyrus of the dominant hemisphere.

  8. Modern imaging of the infarct core and the ischemic penumbra in acute stroke patients: CT versus MRI.

    Science.gov (United States)

    Ledezma, Carlos J; Fiebach, Jochen B; Wintermark, Max

    2009-04-01

    Thrombolysis has become an approved therapy for acute stroke. However, many stroke patients do not benefit from such treatment, since the presently used criteria are very restrictive, notably with respect to the accepted time window. Even so, a significant rate of intracranial hemorrhage still occurs. Conventional cerebral computed tomography (CT) without contrast has been proposed as a selection tool for acute stroke patients. However, more-modern MRI and CT techniques, referred to as diffusion- and perfusion-weighted imaging and perfusion-CT, have been introduced, which afford a comprehensive noninvasive survey of acute stroke patients as soon as their emergency admission, with accurate demonstration of the site of arterial occlusion and its hemodynamic and pathophysiological repercussions for the brain parenchyma. The objective of this article is to present the advantages and drawbacks of CT and MRI in the evaluation of acute stroke patients.

  9. Multimodal use of computed tomography in early acute stroke, part 2.

    Science.gov (United States)

    Scaroni, R; Tambasco, N; Cardaioli, G; Parnetti, L; Paloni, F; Boranga, B; Pelliccioli, G P

    2006-01-01

    Computed tomography (CT) scan remains the most widely technique in the cerebrovascular emergency, as it is largely available, minimally invasive, fast, cheap and reliable. Noncontrast enhanced CT (NeCT) imaging can show early signs of infarction in ischemic stroke; however, it could not show if the ischemic tissue is irreversibly damaged. CT perfusion (CTP) imaging has been shown to predict stroke location and size and can provide information about ischemic cerebral parenchyma not definitively compromised. CT angiography (CTA) could highlight stenosis or occlusion both in intracranial and extracranial vessels. By combining NeCT, CTP, and CTA the entire cerebrovascular axis can be imaged during acute stroke. Currently, the term "multimodal CT" indicates the combined use of these three techniques in order to obtain a complete picture of the extension of ischemic damage in acute stroke patients.

  10. Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA.

    Science.gov (United States)

    Smith, Wade S; Lev, Michael H; English, Joey D; Camargo, Erica C; Chou, Maggie; Johnston, S Claiborne; Gonzalez, Gilberto; Schaefer, Pamela W; Dillon, William P; Koroshetz, Walter J; Furie, Karen L

    2009-12-01

    Acute ischemic stroke due to large vessel occlusion (LVO)-vertebral, basilar, carotid terminus, middle and anterior cerebral arteries-likely portends a worse prognosis than stroke unassociated with LVO. Because little prospective angiographic data have been reported on a cohort of unselected patients with stroke and with transient ischemic attack, the clinical impact of LVO has been difficult to quantify. The Screening Technology and Outcome Project in Stroke Study is a prospective imaging-based study of stroke outcomes performed at 2 academic medical centers. Patients with suspected acute stroke who presented within 24 hours of symptom onset and who underwent multimodality CT/CT angiography were approached for consent for collection of clinical data and 6-month assessment of outcome. Demographic and clinical variables and 6-month modified Rankin Scale scores were collected and combined with blinded interpretation of the CT angiography data. The OR of each variable, including occlusion of intracranial vascular segment in predicting good outcome and 6-month mortality, was calculated using univariate and multivariate logistic regression. Over a 33-month period, 735 patients with suspected stroke were enrolled. Of these, 578 were adjudicated as stroke and 97 as transient ischemic attack. Among patients with stroke, 267 (46%) had LVO accounting for the stroke and 13 (13%) of patients with transient ischemic attack had LVO accounting for transient ischemic attack symptoms. LVO predicted 6-month mortality (OR, 4.5; 95% CI, 2.7 to 7.3; PStroke Scale and age, independently predicted outcome. Large vessel intracranial occlusion accounted for nearly half of acute ischemic strokes in unselected patients presenting to academic medical centers. In addition to age and baseline stroke severity, occlusion of either the basilar or internal carotid terminus segment is an independent predictor of outcome at 6 months.

  11. Decreased cerebral metabolism in stroke-prone spontaneously hypertensive rats (SHRSP) with stroke and its possible improvement by Solcoseryl.

    Science.gov (United States)

    Yamasaki, Y; Yamamoto, Y; Senga, Y; Isogai, M; Shimizu, H; Yamori, Y

    1991-01-01

    Local cerebral glucose utilization (LCGU) was decreased in SHRSP with stroke compared with normotensive Wistar rats. The decrement of LCGU was less in Solcoseryl-treated SHRSP with stroke than that in saline-treated SHRSP with stroke and these brain areas where LCGU was less damaged, in Solcoseryl-treated SHRSP were consistent with the important functioning sites of emotion, motor movement and memory. The result suggests that Solcoseryl may be useful for metabolic improvement of the brain damage after stroke.

  12. The active metabolite of prasugrel, R-138727, improves cerebral blood flow and reduces cerebral infarction and neurologic deficits in a non-human primate model of acute ischaemic stroke.

    Science.gov (United States)

    Sugidachi, Atsuhiro; Mizuno, Makoto; Ohno, Kousaku; Jakubowski, Joseph A; Tomizawa, Atsuyuki

    2016-10-05

    Previously, we showed preventive effects of prasugrel, a P2Y12 antagonist, in a non-human primate model of thrombotic middle cerebral artery occlusion (MCAO); however, it remains unclear if P2Y12 inhibition after MCAO reduces cerebral injury and dysfunction. Here we investigated the effects of R-138727, the major active metabolite of prasugrel, on ex vivo platelet aggregation at 5min, 15min, 60min, and 24h after administration to non-human primates (n=3). A single intravenous dose of R-138727 (0.03-0.3mg/kg) resulted in significant and sustained dose-related effects on platelets for up to 24h. R-138727 was administered 1h after MCAO induction, and its effects on thrombosis, cerebral infarction, and neurological deficits were determined (n=8-10). R-138727 (0.3mg/kg) significantly increased total patency rate of the MCA (P=0.0211). Although there was no effect on the patency rate before R-138727 dosing (P=0.3975), it increased 1h after dosing (P=0.0114). R-138727 significantly reduced total ischaemic infarction volumes (P=0.0147), including those of basal ganglia (P=0.0028), white matter (P=0.0393), and haemorrhagic infarction (P=0.0235). Additionally, treatment with R-138727 reduced overall neurological deficits (P=0.0019), including the subcategories of consciousness (P=0.0042), sensory system (P=0.0045), motor system (P=0.0079) and musculoskeletal coordination (P=0.0082). These findings support the possible utility of P2Y12 inhibition during early-onset MCAO to limit the progression and degree of cerebral ischaemia and infarction and also associated neurological deficits.

  13. Fluid Intake Related to Brain Edema in Acute Middle Cerebral Artery Infarction.

    Science.gov (United States)

    Dharmasaroja, Pornpatr A

    2016-02-01

    Evidence of the appropriate amount of fluid intake during the first few days after acute stroke was scarce. Concerns were raised in patients with acute malignant middle cerebral infarction, who tended to have malignant brain edema later. The purpose of the study was to evaluate the effect of fluid intake on the occurrence of malignant brain edema in patients with acute middle cerebral artery infarction. Patients with acute middle cerebral artery infarction who had National Institute of Health Stroke Scale (NIHSS) score of at least 15 were included. Baseline characteristics and amount of fluid intake during the first few days were compared in patients with and without malignant brain edema. One hundred ninety-three patients were studied. Mean NIHSS score was 20. Malignant brain edema occurred in 69 patients (36%). Higher amount of fluid intake (>1650 ml or >28 ml/kg/day or >93% of daily maintenance fluid) showed a significant association with malignant brain edema (OR = 13.86, 95% CI 5.11-37.60, p value edema, 39 patients (39/65, 60%) died and only 11% (7/65 patients) had favorable outcome. High amount of fluid intake in the first few days of acute middle cerebral infarction was related to the occurrence of malignant brain edema.

  14. Trousseau’s Syndrome, a Previously Unrecognized Condition in Acute Ischemic Stroke Associated With Myocardial Injury

    Directory of Open Access Journals (Sweden)

    Charlotte Thalin MD

    2014-06-01

    Full Text Available Trousseau’s syndrome is a well-known malignancy associated hypercoagulative state leading to venous or arterial thrombosis. The pathophysiology is however poorly understood, although multiple mechanisms are believed to be involved. We report a case of Trousseau’s syndrome resulting in concomitant cerebral and myocardial microthrombosis, presenting with acute ischemic stroke and markedly elevated plasma troponin T levels suggesting myocardial injury. Without any previous medical history, the patient developed multiple cerebral infarctions and died within 11 days of admission. The patient was postmortem diagnosed with an advanced metastatic adenocarcinoma of the prostate with disseminated cerebral, pulmonary, and myocardial microthrombosis. Further analyses revealed, to the best of our knowledge for the first time in stroke patients, circulating microvesicles positive for the epithelial tumor marker CK18 and citrullinated histone H3 in thrombi, markers of the recently described cancer-associated procoagulant DNA-based neutrophil extracellular traps. We also found tissue factor, the main in vivo initiator of coagulation, both in thrombi and in metastases. Troponin elevation in acute ischemic stroke is common and has repeatedly been associated with an increased risk of mortality. The underlying pathophysiology is however not fully clarified, although a number of possible explanations have been proposed. We now suggest that unexplainable high levels of troponin in acute ischemic stroke deserve special attention in terms of possible occult malignancy.

  15. Mechanical thrombectomy with snare in patients with acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Alejandro; Mayol, Antonio [Hospital Universitario Virgen del Rocio, Interventional Neuroradiology, Department of Radiology, Seville (Spain); Martinez, Eva; Gonzalez-Marcos, Jose R.; Gil-Peralta, Alberto [Hospital Universitario Virgen del Rocio, Department of Neurology, Seville (Spain)

    2007-04-15

    We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS). This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2-4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively. Nine patients (mean age 55 years, range 17-69 years) were included. Their basal mean NIHSS score was 16 (range 12-24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50-75 min). At 3 months, the mRSS score was 0 in two patients and 3-4 in three patients (two patients died). According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS. (orig.)

  16. Relationship between serum S-100 protein level and ischemic damage degree in patients with acute cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    HE Ming-li; XU Bing-chao; HUANG Guo-sheng

    2005-01-01

    Objective: To investigate the time course of serum S-100 concentrations of patients with acute cerebral infarction,and their relation with the clinical data and the prognosis. Methods: Serum S-100 levels were serially determined in 35 patients with acute cerebral infarction within 12 h, at 24 h and day 2, 3, 4, 5,7 and 10 after acute cerebral infarction and in 20 age- and sex-matched control subjects. An S-100 content assay was performed using a two-site radioimmunoassay technique. The clinical status was assessed using NIH Stroke Scale. The functional deficit at 4 weeks after acute cerebral infarction was scored using the modified Rankin scale. A cranial computed tomography was performed initially. Results: Elevated concentrations of S100 (>0.2 μg/L) were observed in 29 of 36 patients with acute cerebral infarction,but none of the control subjects. The S-100 peak levels were at day 2 and 3 after acute cerebral infarction and were significantly high in those patients with severe neurological deficit at admission, with extensive infarction or with space-occupying effect of ischemic edema as compared with the rest of the populations. Conclusion: Serum S-100 level assay can be used as a peripheral marker of ischemic brain damage, and may be helpful for evaluation of therapeutic effects in acute ischemic stroke.

  17. Meta-analysis of defibrase in treatment of acute cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Fibrinogen-depleting agents are promising in the treatment of cerebral ischemic disease. They were studied by many trials, and the outcomes were different because of different regimens and different doses. In this study, we assessed the efficacy and safety of defibrase on acute cerebral infarction in China.Methods A search using Chinese hospital knowledge database (CHKD) and MEDLINE database for randomized controlled trials was carried out. A CHKD (1994 June 2005) search was performed with the keyword "defibrase", then a second search for the keyword "acute cerebral infarction"; a MEDLINE search (1950 June 2005) was performed with the following keywords: [(cerebral ischemia), OR (acute cerebral infarction), OR (stroke)], AND [defibrase]. Meta-analysis was performed with RevMan software 4.2.Results Included were 14 studies comparing the efficiency and safety of defibrase with other drugs in the treatment of acute cerebral infarction. Patients' records were pooled (total 646 patients; defibrase, n=328, no defibrase n=318). Neurological deficit score (NDS) before treatment showed weighted mean differences (WMD)=0.95, 95% confidence interval (CI)= (-0.60, 2.50), P=0.23; NDS after treatment showed WMD=-2.20, 95% CI= (-4.21, -0.18), P=0.03; Barthel index at 3 months showed WMD=4.45, 95% CI= (-0.13, 9.03), P=0.06; the plasma fibrinogen level before treatment showed WMD=0.02, 95% CI= (-0.16, 0.19), P=0.86; plasma fibrinogen level after treatment showed WMD=-1.51, 95% CI= (-1.88, -1.15), P<0.00 001. Conclusions With the given dose and regimen of defibrase in China, defibrase may play a role of anticoagulation. It might inhibit the progression of stroke and prevent the recurrence of stroke.

  18. Cerebral microbleeds: a new dilemma in stroke medicine

    Science.gov (United States)

    Kakar, Puneet; Charidimou, Andreas; Werring, David J

    2012-01-01

    Cerebral microbleeds (CMBs) are an increasingly common neuroimaging finding in the context of ageing, cerebrovascular disease and dementia, with potentially important clinical relevance. Perhaps the most pressing clinical question is whether CMBs are associated with a clinically important increase in the risk of intracerebral haemorrhage (ICH), the most feared complication in patients treated with thrombolytic or antithrombotic (antiplatelet and anticoagulant) drugs. This review will summarize the evidence available regarding CMBs as an indicator of future ICH risk in stroke medicine clinical practice. PMID:24175079

  19. Cerebral microbleeds: A new dilemma in stroke medicine

    Directory of Open Access Journals (Sweden)

    Puneet Kakar

    2012-11-01

    Full Text Available Cerebral microbleeds (CMBs are an increasingly common neuroimaging finding in the context of ageing, cerebrovascular disease and dementia, with potentially important clinical relevance. Perhaps the most pressing clinical question is whether CMBs are associated with a clinically important increase in the risk of intracerebral haemorrhage (ICH, the most feared complication in patients treated with thrombolytic or antithrombotic (antiplatelet and anticoagulant drugs. This review will summarize the evidence available regarding CMBs as an indicator of future ICH risk in stroke medicine clinical practice.

  20. Diabetes and poor outcomes within 6 months after acute ischemic stroke: the China National Stroke Registry.

    Science.gov (United States)

    Jia, Qian; Zhao, Xingquan; Wang, Chunxue; Wang, Yilong; Yan, Yu; Li, Hao; Zhong, Liyong; Liu, Liping; Zheng, Huaguang; Zhou, Yong; Wang, Yongjun

    2011-10-01

    Diabetes mellitus (DM) is an independent risk factor for ischemic stroke. However, controversy exists with regard to the impact of DM on prognosis after ischemic stroke in the Chinese population. We investigated the associations between DM and death, dependency, and stroke recurrence in patients after ischemic stroke onset in a nationwide, prospective registry, the China National Stroke Registry. The China National Stroke Registry consecutively recruited patients hospitalized for acute ischemic stroke in 2007 to 2008 and who were prospectively followed up for clinical and functional outcomes (death, dependency, and stroke recurrence) at 3 and 6 months after disease onset. Multivariable logistic regression was performed to analyze the association between DM and stroke outcomes after adjusting for potential confounding including age, sex, National Institutes of Health Stroke Scale score, glucose level at admission, hypertension, coronary heart disease, smoking, urinary tract infection, and other factors. DM was identified in 3483 (27.0%) of stroke patients. Compared with stroke patients without DM, patients with DM had a significantly higher incidence of death or dependency and of recurrent stroke at 3 and 6 months after stroke onset. DM was an independent risk factor for death or dependency (adjusted odds ratio=1.23; 95% confidence interval, 1.10 to 1.37) in patients with ischemic stroke at 6 months after onset. DM independently predicted poor outcomes in Chinese patients after acute ischemic stroke.

  1. [CLINICAL-HEMODYNAMIC PECULIARITIES OF THE COURSE OF HEMODYNAMIC ISCHEMIC STROKE IN ACUTE PERIOD].

    Science.gov (United States)

    Shkrobot, S; Sokhor, N; Milevska-Vovchuk, L; Yasniy, O; Shkrobot, L

    2017-02-01

    The aim of the research is to study the peculiarities of cardiac morphometric parameters, the parameters of central hemodynamics and their impact on the course of hemodynamic ischemic stroke in acute period. 116 patients were performed Echo-Doppler-cardiography in acute period of hemodynamic ischemic stroke in order to evaluate cardiac morphometric parameters. These patients were also performed transcranial duplex scanning. The results established that among significant clinical factors that influence the course of the acute period of hemodynamic ischemic stroke the most important are: the size of the focus, the level of consciousness on the 1st day, primary systolic arterial pressure, age of the patient. Hemodynamic ischemic stroke occurs on the background of changes of cardiac morphometric parameters and the disorders of the central hemodynamics. There is a close connection between the severity of hemodynamic ischemic stroke on the 7th and 14th day with the ejection fraction, the size of left atrium, the thickness of posterior wall of left ventricle, final diastolic size of left ventricle. The interrelation between the parameters of cerebral hemodynamics and cardiac morphometric parameters was established. cardiac morphometric parameters and parameters of central hemodynamics can be predictors of the course of hemodynamic ischemic stroke in acute period.

  2. Pathophysiology of brain ischemia as it relates to the therapy of acute ischemic stroke

    DEFF Research Database (Denmark)

    Lassen, N A

    1990-01-01

    Current knowledge of the pathophysiology of cerebral ischemia, summarized in the present study, predicts that neurological deficits caused by moderate ischemia (flows in the penumbral range between 23 and 10 ml/100 g/min) are reversible provided flow is restored within 3-4 h of onset. It also...... predicts that areas of dense ischemia cannot be salvaged and that reperfusion of such areas is risky, because massive edema or even hemorrhage may develop following reperfusion. On this basis, it is argued that selection of stroke cases for thrombolysis or surgical revascularization must be based not only...... on computed tomographic (CT) scanning to exclude hemorrhagic stroke, but also on cerebral blood flow (CBF) tomography to exclude lacunar infarcts, early reperfusion, and dense ischemia. The methods available for routing CBF tomography in acute stroke cases are discussed, and it is concluded that single photon...

  3. Risk assessment of deep-vein thrombosis after acute stroke: a prospective study using clinical factors.

    Science.gov (United States)

    Liu, Li-Ping; Zheng, Hua-Guang; Wang, David Z; Wang, Yi-Long; Hussain, Mohammed; Sun, Hai-Xin; Wang, An-Xin; Zhao, Xing-Quan; Dong, Ke-Hui; Wang, Chun-Xue; He, Wen; Ning, Bin; Wang, Yong-Jun

    2014-05-01

    Deep-vein thrombosis (DVT) represents a serious complication in acute stroke patients with pulmonary embolus (PE) as a potential outcome. Prediction of DVT may help with formulating a proper prevention strategy. To assess of the risk of deep venous thrombosis (DVT) in acute stroke patients, we developed and validated a clinical score in a cohort study. Incidence of Deep Venous Thrombosis after Acute Stroke in China (INVENT-China) is a multicenter prospective cohort study. The potential predictive variables for DVT at baseline were collected, and the presence of DVT was evaluated using ultrasonography on the 14 ± 3 days. Data were randomly assigned to either a training data set or a test data set. Multivariate logistic regression analysis was used to develop risk scores to predict DVT in the training data set and the area under the receiver operating characteristic curve to validate the score in the test data set. From 2006-2007, 862 hospital-based acute stroke patients were enrolled in China. The overall incidence of DVT after acute stroke within two weeks was 12.4% (95%CI 10.3-14.7%). A seven-point score derived in the training data set (age [≥65 years = 1], sex [female gender = 1]), obesity [BMI ≥ 25 kg/m(2) = 1], active cancer [yes = 2], stroke subtype [cerebral hemorraghe = 1], muscle weakness [≥2 on Lower limb NIHSS score = 1] was highly predictive of 14-day risk of DVT(c statistic = 0.70, 95% CI, 0.64-0.76, P < 0.001), in the overall study population(c statistic = 0.65, 95% CI 0.59-0.70, P < 0.001). This clinical score may help identify acute stroke patients with high risk of DVT. In addition, it also serves as a platform to develop further models of DVT prediction in stroke patients based on clinical factors. © 2014 John Wiley & Sons Ltd.

  4. Role of heparin during endovascular therapy for acute ischemic stroke.

    Science.gov (United States)

    Farook, Naureen; Haussen, Diogo; Sur, Samir; Snelling, Brian; Gersey, Zachary; Yavagal, Dileep; Peterson, Eric

    2016-06-01

    Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS). We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale). Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6±5.0 vs. 18.1±4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0-2 at 90 days. The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Thrombolytic treatment given at the and of the first week of stroke due to pulmonary embolism in a patient with middlee cerebral artery infarction

    Directory of Open Access Journals (Sweden)

    Çetin Kürşad Akpınar

    2014-08-01

    Full Text Available Thrombolytic treatment is the most effective and commonly used method into firs 4,5 hours of acute ischemic stroke and massive pulmonary embolism. It is known that thrombolytic treatment is definitely contraindicated in cases who had an ischemic stroke into last three months. In this paper, it was reported that thrombolytic treatment had given for pulmonary embolism which developed one week after stroke in a case with stroke due to middle cerebral artery occlusion. Here, we presented a case which is rarely seen and required difficulty in deciding.

  6. [Current registry studies of acute ischemic stroke].

    Science.gov (United States)

    Veltkamp, R; Jüttler, E; Pfefferkorn, T; Purrucker, J; Ringleb, P

    2012-10-01

    Study registries offer the opportunity to evaluate the effects of new therapies or to observe the consequences of new treatments in clinical practice. The SITS-MOST registry confirmed the validity of findings from randomized trials on intravenous thrombolysis concerning safety and efficacy in the clinical routine. Current study registries concerning new interventional thrombectomy techniques suggest a high recanalization rate; however, the clinical benefit can only be evaluated in randomized, controlled trials. Similarly, the experiences of the BASICS registry on basilar artery occlusion have led to the initiation of a controlled trial. The benefit of hemicraniectomy in malignant middle cerebral artery infarction has been demonstrated by the pooled analysis of three randomized trials. Numerous relevant aspects are currently documented in the DESTINY-R registry. Finally, the recently started RASUNOA registry examines diagnostic and therapeutic aspects of ischemic and hemorrhagic stroke occurring during therapy with new oral anticoagulants.

  7. Time-Dependent Computed Tomographic Perfusion Thresholds for Patients With Acute Ischemic Stroke.

    Science.gov (United States)

    d'Esterre, Christopher D; Boesen, Mari E; Ahn, Seong Hwan; Pordeli, Pooneh; Najm, Mohamed; Minhas, Priyanka; Davari, Paniz; Fainardi, Enrico; Rubiera, Marta; Khaw, Alexander V; Zini, Andrea; Frayne, Richard; Hill, Michael D; Demchuk, Andrew M; Sajobi, Tolulope T; Forkert, Nils D; Goyal, Mayank; Lee, Ting Y; Menon, Bijoy K

    2015-12-01

    Among patients with acute ischemic stroke, we determine computed tomographic perfusion (CTP) thresholds associated with follow-up infarction at different stroke onset-to-CTP and CTP-to-reperfusion times. Acute ischemic stroke patients with occlusion on computed tomographic angiography were acutely imaged with CTP. Noncontrast computed tomography and magnectic resonance diffusion-weighted imaging between 24 and 48 hours were used to delineate follow-up infarction. Reperfusion was assessed on conventional angiogram or 4-hour repeat computed tomographic angiography. Tmax, cerebral blood flow, and cerebral blood volume derived from delay-insensitive CTP postprocessing were analyzed using receiver-operator characteristic curves to derive optimal thresholds for combined patient data (pooled analysis) and individual patients (patient-level analysis) based on time from stroke onset-to-CTP and CTP-to-reperfusion. One-way ANOVA and locally weighted scatterplot smoothing regression was used to test whether the derived optimal CTP thresholds were different by time. One hundred and thirty-two patients were included. Tmax thresholds of >16.2 and >15.8 s and absolute cerebral blood flow thresholds of stroke onset-to-CTP time and the optimal CTP thresholds for all parameters based on discrete or continuous time analysis (P>0.05). A statistically significant relationship existed between CTP-to-reperfusion time and the optimal thresholds for cerebral blood flow (P<0.001; r=0.59 and 0.77 for gray and white matter, respectively) and Tmax (P<0.001; r=-0.68 and -0.60 for gray and white matter, respectively) parameters. Optimal CTP thresholds associated with follow-up infarction depend on time from imaging to reperfusion. © 2015 American Heart Association, Inc.

  8. Predictors of early arrival at the emergency department in acute ischaemic stroke.

    LENUS (Irish Health Repository)

    Curran, C

    2012-01-31

    BACKGROUND: A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window. AIMS: We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area. METHODS: A retrospective review of all case notes for 1 year was performed. RESULTS: Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model. CONCLUSION: The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.

  9. Management of Acute Hypertensive Response in Patients With Ischemic Stroke

    Science.gov (United States)

    Qureshi, Adnan I.

    2016-01-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction. PMID:27366297

  10. Management of Acute Hypertensive Response in Patients With Ischemic Stroke.

    Science.gov (United States)

    AlSibai, Ahmad; Qureshi, Adnan I

    2016-07-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction.

  11. Study on the Relationship between Plasma Homocysteine and Acute Cerebral Vascular Disease

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The levels of plasma homocysteine were determined by using high-performance liquid chromatographic method. It was found that plasma homocysteine levels were significantly higher in the patients with stroke than that in the controls. There was no correlation between plasma homocysteine levels and hypertension, smoking, concentrations of blood glucose or hypertriglyceridesemia. It was suggested that hyperhomocysteinemia may be an independent risk factor for acute cerebral vascular disease.

  12. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke.

    Science.gov (United States)

    Ruthirago, Doungporn; Julayanont, Parunyou; Tantrachoti, Pakpoom; Kim, Jongyeol; Nugent, Kenneth

    2016-01-01

    Cardiac arrhythmias and electrocardiogram (ECG) abnormalities occur frequently but are often underrecognized after strokes. Acute ischemic and hemorrhagic strokes in some particular area of brain can disrupt central autonomic control of the heart, precipitating cardiac arrhythmias, ECG abnormalities, myocardial injury and sometimes sudden death. Identification of high-risk patients after acute stroke is important to arrange appropriate cardiac monitoring and effective management of arrhythmias, and to prevent cardiac morbidity and mortality. More studies are needed to better clarify pathogenesis, localization of areas associated with arrhythmias and practical management of arrhythmias and abnormal ECGs after acute stroke.

  13. Endovascular reperfusion therapies for acute ischemic stroke: dissecting the evidence.

    Science.gov (United States)

    Tsivgoulis, Georgios; Safouris, Apostolos; Krogias, Christos; Arthur, Adam S; Alexandrov, Andrei V

    2016-05-01

    Ischemic stroke is a major cause of death and disability and intravenous thrombolysis has been the only approved acute reperfusion therapy (RT) for many years. Seven randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of endovascular therapy in patients with acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) have been recently published. These studies have changed the treatment paradigm by establishing mechanical thrombectomy (MT) as the most effective acute stroke therapy for improving functional outcome in anterior circulation ELVO with a NNT of 6. The present review will critically evaluate the results of these RCTs and of the existing meta-analyses investigating the safety and efficacy of endovascular therapy for AIS. Points of debate such as acute stroke imaging, posterior circulation stroke and general anesthesia will be addressed. We will also discuss health policies aiming to increase the availability of endovascular treatment for stroke patients.

  14. Acute stroke | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available on E.1.1Medical condition(s) being investigated Acute stroke E.1.1.1Medical condi...tion in easily understood language Acute stroke MedDRA Classification E.1.3Condition being studied is a rare

  15. Intra‐arterial treatment for acute ischemic stroke

    NARCIS (Netherlands)

    Berkhemer, O.A.

    2016-01-01

    This thesis deals with current issues in the field of acute ischemic stroke. The main objective has been to proof the effectiveness and safety of intra-arterial treatment in patients with acute ischemic stroke. MR CLEAN was the first study to proof the safety and effectiveness of intra-arterial

  16. Study of acute stroke clinical measuring scale%急性脑卒中临床计量量表研究

    Institute of Scientific and Technical Information of China (English)

    张海南; 胡治平; 蒋波; 宋兴旺

    2002-01-01

    Objective To explore the possibility of diagnosis types of acute stroke, elevating treatment quality and promoting prognosis with acute stroke clinical measuring scale . Methods To gain a measuring scale formula and simplify this formula after stepwise regression Fisher distinguish analysis to 18 clinical variable of 184 acute stroke patients and to validate its sensitivity, specificity and positive foretell value to diagnosis of acute stroke. Results We gained scale that Y=0.617× action+ 0.485× BP+ 1.241× headache+ 0.74× vomiting+ 0.955× cervical resistance-1.215× TIA-0.727× heart disease-2.78; sensitivity of this formula to diagnosis of cerebral infarction and cerebral hemorrhage was 90.5% and 70% respectively, its specificity was 70% and 90.5% respectively, positive foretell value was 71.7% and 89.7% ( Y≥ 0 means cerebral hemorrhage, Y<0 means cerebral infarction) . Simple formula is S=0.5× action+ 0.5× BP+ 1× headache+ 1× vomiting+ 1× cervical resistance-1× TIA-1× hear disease-3; its sensitivity was 89.3% and 68% , specificity was 68% and 89.3% , positive foretell value was 70.1% and 88.3% .There was no apparent difference in sensitivity; specificity and positive foretell value between two formulas. Conclusion Acute stroke clinical measuring scale can help early diagnosis, treatment and rehabilitation of cerebral stroke patients.

  17. The neuroprotective effect of magnesium sulfate in treatment of patients with acute cerebral ischemic stroke%硫酸镁对急性缺血性脑卒中的神经保护作用

    Institute of Scientific and Technical Information of China (English)

    麦辉

    2011-01-01

    Objective To explore the neuroprotective effect of magnesium sulfate in tretment of patients with cerebral ischemic stroke. Methods 40 patients with cerebral ischemic stroke were selected and randomly divided into experimental group(20 cases) and control group(20 cases). Among those two groups,the magnesium sulfate therapeutic measure was carried out in the experimental group and the control group was treated without magnesium sulfate. The difference rangeability of level of serum myelin basic protein pre and pro-therapy of both groups was compared. Results For the experimental group, the mean level of serum myelin basic protein in the first day pre-therapy was (8.3 + 2.5) μg/L, and (4.2 ± 1.7) μg/L in 10 days pro-therapy. the csrtrol group was ( 8.0 ± 3.0) μg/L for tite first day pre-therapy,and (6.0 ± 1.4) μg/L in 10 days pro-therapy. The difference rangeability of level of serum myelin basic protein pre and pro-therapy of both groups had statistical significance, compared with the controlled group,the experimental group had lower level of serum myelin basic protein ( t = 1. 231, P = 0. 041 ).Conclusion Magnesium sulfate could significantly decrease the serum level of myelin basic protein for patients with cerebral ischemic stroke,which irdicate that the magnesium sulfate should have neuroprotective effect on patients with cerebral ischemic stroke.%目的 探讨硫酸镁对急性缺血性脑卒中患者的神经保护作用。方法 采用髓鞘碱性蛋白量化分析方法,分析急性缺血性脑卒中患者硫酸镁治疗前后血清髓鞘碱性蛋白水平变化的幅度,并与对照组对比。结果 治疗组20例患者治疗前第1天血清髓鞘碱性蛋白平均水平为(8.3±2.5) μg/L,治疗后第10天为(4.2±1.7) μg/L;对照组20例患者治疗前第1天血清髓鞘碱性蛋白平均水平为(8.0±3.0)μg/L,治疗后第10天为(6.0±1.4) μg/L。两组患者治疗前后血清髓鞘碱性蛋白水平变化幅度的

  18. Difference in the Location and Risk Factors of Cerebral Microbleeds According to Ischemic Stroke Subtypes.

    Science.gov (United States)

    Kim, Bum Joon; Yoon, Youngshin; Sohn, Hoyon; Kang, Dong-Wha; Kim, Jong S; Kwon, Sun U

    2016-09-01

    The location of cerebral microbleeds (CMBs) may differ according to ischemic stroke subtype, and the underlying pathomechanism may differ by their location. Here, we investigated the characteristics of CMBs according to various ischemic stroke subtypes to verify this issue. Patients with acute ischemic stroke were consecutively included. The presence of CMBs was determined by gradient echo image sequence. The distribution of CMBs was classified as deep, lobar, or diffuse (both deep and lobar). The prevalence, risk factors, and distribution of CMBs were compared among patients with different stroke subtypes. Factors associated with the distribution of CMBs were investigated. Among the 1033 patients included in this study, ischemic stroke subtypes were classified as large artery atherosclerosis (LAA; n=432), small vessel occlusion (SVO; n=304), and cardioembolism (CE; n=297). The prevalence of CMBs was highest in patients with SVO (40.5%), followed by CE (33.0%) and LAA (24.8%; PCMBs was different according to subtype (P=0.004). CE [odds ratio (OR)=1.85 (1.02-3.34); P=0.042] and the use of antithrombotics [OR=1.80 (1.10-2.94); P=0.019] were associated with lobar CMBs, and old age [OR=1.02 (1.00-1.04); P=0.015] and hypertension [OR=1.61 (1.08-2.40); P=0.020] were associated with deep CMBs. CMBs were frequently located in the lobar area in patients with CE. Previous use of antithrombotic agents is associated with lobar CMBs. The pathogenic mechanism of CMB may differ according to ischemic stroke subtype and location.

  19. Apoptosis in rat transient focal cerebral ischemic stroke: clinical implications

    Institute of Scientific and Technical Information of China (English)

    Shoushu Jiao; Jue Wang Gal Hever; Rongzheng Kuang; Jean-Claude Louis; Ella Magal

    2000-01-01

    @@In the early phase of cerebral ischemia, factors threatening neuronal survival in the penumbra include mainly glutamate excitotoxicity, free radical damage and energy failure resulting from recurrent depolarization waves. However, at later times, other mechanisms come into play. The initial ischemic event activates a variety of genetic programs that unfold over the course of hours and days. Both positron emission tomography and magnetic resonance based techniques demonstrate that the development of irretrievable tissue damage is relatively slow, progressing over the course of several days in some cases, and a viable tissue, defined by hemodynamic and metabolic criteria,is still present many hours after stroke in human or in monkey. These findings suggest that the brain can potentially be “rescued” from infarction many hours after onset of ischemia and challenge the widespread notion of an early and short “therapeutic window” (~3-6h). This realization is of critical importance for stroke therapy because most patients reach medical attention at a time when current therapeutic strategies may no longer be effective. Therefore, it would be highly desirable to develop therapeutic interventions that can be instituted many hours after the onset of ischemia. We believe that addressing the mechanisms of delayed cell death is key to a successful therapy. The studies presented here were designed to document the potential contribution of apoptosis to ischemia induced neuronal death. We will discuss the morphological, biochemical and pharmacological evidence for apoptosis in the ischemic stroke.

  20. MANAGEMENT OF BLOOD PRESSURE AND HEART RATE IN PATIENTS WITH ACUTE STROKE.

    Science.gov (United States)

    Maida, Carlo; Tuttolomondo, Antonino; Raimondo, Domenico Di; Pinto, Antonio

    2017-07-14

    Stroke represent one of the most devastating of all neurological diseases, affecting about 15 million people per year and is an important cause of morbidity and mortality worldwide and currently the leading cause of adult disability in developed countries. Blood pressure and heart rate may undergo several modifications in patients with both ischemic and hemorrhagic stroke in fact raised blood pressure levels may lead to cerebral edema, hematoma expansion or hemorrhagic transformation and in contrast low blood pressure can lead to increased cerebral infarction or perihematomal ischemia. In addition, ECG abnormalities and cardiac arrhythmias, especially atrial fibrillation, are relatively frequent after stroke, and other well known complications such as heart failure, miocardial infarction and sudden death have been reported. The acute phase of brain infarction requires a careful management of both blood pressure levels and heart rate but despite the large amount of information, blood pressure and heart rate management are still under debate. Provide clear indications about the optimal blood pressure and heart rate management of both ischemic and hemorrhagic stroke, in view of the main available evidence. In this review, we discuss the evidence for blood pressure and heart rate management in acute stroke, the challenges and issues raised, and look to on-going and future trials that may provide some clarity in this controversial area. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  1. Dyslipidemia and Outcome in Patients with Acute Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    XU Tian; ZHANG Jin Tao; YANG Mei; ZHANG Huan; LIU Wen Qing; KONG Yan; XU Tan; ZHANG Yong Hong

    2014-01-01

    ObjectiveTo study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. MethodsData about 1 568 patients with acute ischemic stroke werecollected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale (NIHSS) >10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. ResultsThe serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 (1.259, 7.214)/2.655 (1.298, 5.43), 3.157(1.306, 7.631)/3.405(1.621, 7.154), and 0.482 (0.245, 0.946)/0.51 (0.282, 0.921), respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke (chi-square=8.235, P=0.411). ConclusionSerum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.

  2. Management of acute stroke: impact of registration studies.

    Science.gov (United States)

    Adams, Harold P

    2010-09-01

    Stroke is a life-threatening or life-changing disease that is expensive in health care costs and lost productivity. Stroke also is a leading cause of human suffering. While the risk of stroke may be reduced with advances in prevention, recent advances in acute care can limit the consequences of stroke. In particular, the success of reperfusion therapies including intra-arterial interventions and intravenous administration of thrombolytic agents means that some patients with stroke may be cured. Still, the time window for effective treatment of stroke is relatively short. As a result, modern stroke management requires the close collaboration of the public, health care providers, administrators, insurance companies, and the government. Potential strategies to extend modern stroke care to as many patients as possible include 1) educational programs to train community emergency medical service personnel and physicians, 2) development of stroke care plans at community hospitals, 3) an integrated community-comprehensive stroke center program based on consultation, and telemedicine. The goal is to have a highly integrated approach to provide emergency treatment of the stroke that provides key emergency treatment, including intravenous administration of thrombolytic medications, at a community hospital (primary stroke center) with evacuation to a comprehensive stroke center that has resources and expertise that are not available in the primary stroke center. Taiwan is an ideal location for the development of such regional stroke programs.

  3. Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo.

    Science.gov (United States)

    Lee, Seung-Han; Kim, Ji-Soo

    2015-08-01

    Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic examination can reliably differentiate acute vestibular syndrome due to stroke from more benign inner ear disease. Sometimes acute isolated audiovestibular loss may herald impending infarction in the territory of the anterior inferior cerebellar artery. Accurate identification of isolated vascular vertigo is very important because misdiagnosis of acute stroke may result in significant morbidity and mortality.

  4. Copolymer-1 promotes neurogenesis and improves functional recovery after acute ischemic stroke in rats.

    Directory of Open Access Journals (Sweden)

    Yolanda Cruz

    Full Text Available Stroke triggers a systemic inflammatory response that exacerbates the initial injury. Immunizing with peptides derived from CNS proteins can stimulate protective autoimmunity (PA. The most renowned of these peptides is copolymer-1 (Cop-1 also known as glatiramer acetate. This peptide has been approved for use in the treatment of multiple sclerosis. Cop-1-specific T cells cross the blood-brain barrier and secrete neurotrophins and anti-inflammatory cytokines that could stimulate proliferation of neural precursor cells and recruit them to the injury site; making it an ideal therapy for acute ischemic stroke. The aim of this work was to evaluate the effect of Cop-1 on neurogenesis and neurological recovery during the acute phase (7 days and the chronic phase of stroke (60 days in a rat model of transient middle cerebral artery occlusion (tMCAo. BDNF and NT-3 were quantified and infarct volumes were measured. We demonstrated that Cop-1 improves neurological deficit, enhances neurogenesis (at 7 and 60 days in the SVZ, SGZ, and cerebral cortex through an increase in NT-3 production. It also decreased infarct volume even at the chronic phase of tMCAo. The present manuscript fortifies the support for the use of Cop-1 in acute ischemic stroke.

  5. Solar term peak of onset and death in 1597 patients with acute ischemic stroke Circular statistical analysis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Previously, time data were analyzed by using constituent ratio or relative ratio; however,circular statistical analysis could exactly provide average peak phase of diseases.OBJECTIVE: To investigate the correlation of solar term peak with onset and death of acute ischemic stroke.DESIGN: Retrospective case analysis.SETTINGS: Emergency Department of Foshan Municipal Hospital of Traditional Chinese Medicine;Department of Science and Education, the Second People's Hospital of Foshan.PARTICIPANTS: A total of 1597 patients with acute ischemic stroke were selected from Emergency Room,Department of Neurology, Foshan Municipal Hospital of Traditional Chinese Medicine from 1994 to 2002.There were 875 males and 722 females, and their ages ranged from 33 to 97 years. All cases met the diagnostic criteria of acute cerebral infarction modified by the Second National Cerebrovascular Disease Academic Meeting; meanwhile, they were diagnosed with CT/MRI test. Patients and their relatives provided the confirmed consent.METHODS: Solar term of onset was retrospectively analyzed in 1 597 patients with acute ischemic stroke;among them, solar term of death in 90 cases were analyzed by using circular statistical analysis to calculate peak phase of onset and death of acute ischemic stroke and investigate the correlation of solar term with onset and death of acute ischemic stroke.MAIN OUTCOME MEASURES: Onset and death time of patients with acute ischemic stroke. RESULTS: Solar term of onset in 1 597 patients, especially solar term of death in 90 patients, was not concentrated (P > 0.05), and specific peak phase was not found out. Acute ischemic stroke low attacked from vernal equinox to summer begins, but death caused by acute ischemic stroke high attacked from grain buds to autumn begins.CONCLUSION: Patients with acute ischemic stroke do not have specific solar term peak of onset and death.

  6. Quality of health information on acute myocardial infarction and stroke in the world wide web.

    Science.gov (United States)

    Bastos, Ana; Paiva, Dagmara; Azevedo, Ana

    2014-01-01

    The quality of health information in the Internet may be low. This is a concerning issue in cardiovascular diseases which warrant patient self-management. We aimed to assess the quality of Portuguese websites as a source of health information on acute myocardial infarction and stroke. We used the search terms 'enfarte miocardio' and 'acidente vascular cerebral' (Portuguese terms for myocardial infarction and stroke) on Google(®), on April 5th and 7th 2011, respectively, using Internet Explorer(®). The first 200 URL retrieved in each search were independently visited and Portuguese websites in Portuguese language were selected. We analysed and classified 121 websites for structural characteristics, information coverage and accuracy of the web pages with items defined a priori, trustworthiness in general according to the Health on the Net Foundation and regarding treatments using the DISCERN instrument (48 websites). Websites were most frequently commercial (49.5%), not exclusively dedicated to acute myocardial infarction/ stroke (94.2%), and with information on medical facts (59.5%), using images, video or animation (60.3%). Websites' trustworthiness was low. None of the websites displayed the Health on the Net Foundation seal. Acute myocardial infarction/ stroke websites differed in information coverage but the accuracy of the information was acceptable, although often incomplete. The quality of information on acute myocardial infarction/ stroke in Portuguese websites was acceptable. Trustworthiness was low, impairing users' capability of identifying potentially more reliable content.

  7. Safety of Tirofiban in acute Ischemic Stroke: the SaTIS trial.

    Science.gov (United States)

    Siebler, Mario; Hennerici, Michael G; Schneider, Dietmar; von Reutern, Gerhard M; Seitz, Rüdiger J; Röther, Joachim; Witte, Otto W; Hamann, Gerhard; Junghans, Ulrich; Villringer, Arno; Fiebach, Jochen B

    2011-09-01

    Tirofiban is a highly selective, fast-acting nonpeptide glycoprotein IIb/IIIa platelet receptor antagonist with a short half-life time. Glycoprotein IIb/IIIa antagonists are effective for the treatment of acute coronary syndromes proven in large clinical trials. Safety and efficacy in patients with ischemic stroke are uncertain. This was addressed in the Safety of Tirofiban in acute Ischemic Stroke (SaTIS) trial. Two hundred sixty patients with acute ischemic stroke were randomized in a placebo-controlled, prospective, open-label treatment, blinded outcome reading multicenter trial. Subjects with a National Institutes of Health Stroke Scale between 4 and 18 received intravenously either tirofiban or placebo within 3 to 22 hours after symptom onset for 48 hours. The primary end point was the rate of cerebral bleeding as measured in follow-up CT scans 2 to 7 days after inclusion. The secondary end point was clinical efficacy within 1 week (National Institutes of Health Stroke Scale, modified Rankin Scale) and after 5 months (Barthel Index, modified Rankin Scale). The rate of cerebral hemorrhagic transformation (I/II) and parenchymal hemorrhage (I/II) did not differ between both groups (tirofiban 36 of 120; placebo 33 of 124: OR, 1.18; 95% CI, 0.66 to 2.06). Mortality after 5 months was significantly lower in patients treated with tirofiban (3 of 130 [2.3%] versus 11 of 126 [8.7%]; OR, 4.05; 95% CI, 1.1 to 14.9). No difference in neurological/functional outcome was found after 1 week and after 5 months. We conclude that tirofiban might be safe in acute moderate ischemic stroke even when administered within a large time window after symptom onset and might save lives in the late outcome. Clinical Trial Registration- URL: www.strokecenter.org/trials/. Trial name: SaTIS. Enrollment began before July 1, 2005.

  8. Deep cerebral microbleeds are negatively associated with HDL-C in elderly first-time ischemic stroke patients.

    Science.gov (United States)

    Igase, Michiya; Kohara, Katsuhiko; Igase, Keiji; Yamashita, Shiro; Fujisawa, Mutsuo; Katagi, Ryosuke; Miki, Tetsuro

    2013-02-15

    Cerebral microbleeds (CMBs) detected on T2*-weighted MRI gradient-echo have been associated with increased risk of cerebral infarction. We evaluated risk factors for these lesions in a cohort of first-time ischemic stroke patients. Presence of CMBs in consecutive first-time ischemic stroke patients was evaluated. The location of CMBs was classified by cerebral region as strictly lobar (lobar CMBs) and deep or infratentorial (deep CMBs). Logistic regression analysis was performed to determine the contribution of lipid profile to the presence of CMBs. One hundred and sixteen patients with a mean age of 70±10years were recruited. CMBs were present in 74 patients. The deep CMBs group had significantly lower HDL-C levels than those without CMBs. In univariable analysis, advanced periventricular hyperintensity grade (PVH>2) and decreased HDL-C were significantly associated with the deep but not the lobar CMB group. On logistic regression analysis, HDL-C (beta=-0.06, p=0.002) and PVH grade >2 (beta=3.40, p=0.005) were independent determinants of deep CMBs. Low HDL-C may be a risk factor of deep CMBs, including advanced PVH status, in elderly patients with acute ischemic stroke. Management of HDL-C levels might be a therapeutic target for the prevention of recurrence of stroke. Copyright © 2012 Elsevier B.V. All rights reserved.

  9. Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Ali, Farwa; Young, Jimmy; Rabinstein, Alejandro A; Flemming, Kelly D; Fugate, Jennifer E

    2016-05-01

    Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients. We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men. Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease. Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Abnormal EEG Complexity and Functional Connectivity of Brain in Patients with Acute Thalamic Ischemic Stroke

    Science.gov (United States)

    Liu, Shuang; Guo, Jie; Meng, Jiayuan; Wang, Zhijun; Yao, Yang; Yang, Jiajia; Qi, Hongzhi; Ming, Dong

    2016-01-01

    Ischemic thalamus stroke has become a serious cardiovascular and cerebral disease in recent years. To date the existing researches mostly concentrated on the power spectral density (PSD) in several frequency bands. In this paper, we investigated the nonlinear features of EEG and brain functional connectivity in patients with acute thalamic ischemic stroke and healthy subjects. Electroencephalography (EEG) in resting condition with eyes closed was recorded for 12 stroke patients and 11 healthy subjects as control group. Lempel-Ziv complexity (LZC), Sample Entropy (SampEn), and brain network using partial directed coherence (PDC) were calculated for feature extraction. Results showed that patients had increased mean LZC and SampEn than the controls, which implied the stroke group has higher EEG complexity. For the brain network, the stroke group displayed a trend of weaker cortical connectivity, which suggests a functional impairment of information transmission in cortical connections in stroke patients. These findings suggest that nonlinear analysis and brain network could provide essential information for better understanding the brain dysfunction in the stroke and assisting monitoring or prognostication of stroke evolution. PMID:27403202

  11. Cerebral microbleeds in patients with acute subarachnoid hemorrhage.

    Science.gov (United States)

    Jeon, Sang-Beom; Parikh, Gunjan; Choi, H Alex; Badjatia, Neeraj; Lee, Kiwon; Schmidt, J Michael; Lantigua, Hector; Connolly, E Sander; Mayer, Stephan A; Claassen, Jan

    2014-02-01

    Cerebral microbleeds (CMBs) are commonly found after stroke but have not previously been studied in patients with subarachnoid hemorrhage (SAH). To study the prevalence, radiographic patterns, predictors, and impact on outcome of CMBs in patients with SAH. We analyzed retrospectively 39 consecutive patients who underwent T2*-weighted gradient-echo imaging within 7 days after onset of spontaneous SAH. We report the frequency and location of CMBs and show their association with demographics, vascular risk factors, the Hunt-Hess grade, the modified Fisher Scale, the Acute Physiological and Chronic Health Evaluation II, magnetic resonance imaging findings including diffusion-weighted imaging lesions, and laboratory data, as well as data on rebleeding, global cerebral edema, delayed cerebral ischemia, seizures, the Telephone Interview for Cognitive Status, and the modified Rankin Scale. Eighteen patients (46%) had CMBs. Of these patients, 9 had multiple CMBs, and overall a total of 50 CMBs were identified. The most common locations of CMBs were lobar (n = 23), followed by deep (n = 15) and infratentorial (n = 12). After adjustment for age and history of hypertension, CMBs were related to the presence of diffusion-weighted imaging lesions (odds ratio, 5.24; 95% confidence interval, 1.14-24.00; P = .03). Three months after SAH, patients with CMBs had nonsignificantly higher modified Rankin Scale scores (odds ratio, 2.50; 95% confidence interval, 0.67-9.39; P = .18). This study suggests that CMBs are commonly observed and associated with diffusion-weighted imaging lesions in patients with SAH. Our findings may represent a new mechanism of tissue injury in SAH. Further studies are needed to investigate the clinical implications of CMBs.

  12. Safety and efficacy of transcranial direct current stimulation in acute experimental ischemic stroke.

    Science.gov (United States)

    Peruzzotti-Jametti, Luca; Cambiaghi, Marco; Bacigaluppi, Marco; Gallizioli, Mattia; Gaude, Edoardo; Mari, Silvia; Sandrone, Stefano; Cursi, Marco; Teneud, Luis; Comi, Giancarlo; Musco, Giovanna; Martino, Gianvito; Leocani, Letizia

    2013-11-01

    Transcranial direct current stimulation is emerging as a promising tool for the treatment of several neurological conditions, including cerebral ischemia. The therapeutic role of this noninvasive treatment is, however, limited to chronic phases of stroke. We thus ought to investigate whether different stimulation protocols could also be beneficial in the acute phase of experimental brain ischemia. The influence of both cathodal and anodal transcranial direct current stimulation in modifying brain metabolism of healthy mice was first tested by nuclear magnetic resonance spectroscopy. Then, mice undergoing transient proximal middle cerebral artery occlusion were randomized and treated acutely with anodal, cathodal, or sham transcranial direct current stimulation. Brain metabolism, functional outcomes, and ischemic lesion volume, as well as the inflammatory reaction and blood brain barrier functionality, were analyzed. Cathodal stimulation was able, if applied in the acute phase of stroke, to preserve cortical neurons from the ischemic damage, to reduce inflammation, and to promote a better clinical recovery compared with sham and anodal treatments. This finding was attributable to the significant decrease of cortical glutamate, as indicated by nuclear magnetic resonance spectroscopy. Conversely, anodal stimulation induced an increase in the postischemic lesion volume and augmented blood brain barrier derangement. Our data indicate that transcranial direct current stimulation exerts a measurable neuroprotective effect in the acute phase of stroke. However, its timing and polarity should be carefully identified on the base of the pathophysiological context to avoid potential harmful side effects.

  13. Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: Two case reports

    Science.gov (United States)

    Matsumoto, Hiroaki; Miki, Takanori; Miyaji, Yuki; Minami, Hiroaki; Masuda, Atsushi; Tominaga, Shogo; Yoshida, Yasuhisa; Yamaura, Ikuya; Matsumoto, Shigeo; Natsume, Shigeatsu; Yoshida, Kozo

    2012-01-01

    Context Acute hemiparesis is a common initial presentation of ischemic stroke. Although hemiparesis due to spontaneous spinal epidural hematoma (SSEH) is an uncommon symptom, a few cases have been reported and misdiagnosed as cerebral infarction. Design Case reports of SSEH with acute hemiparesis. Findings In these two cases, acute stroke was suspected initially and administration of intravenous alteplase therapy was considered. In one case, the presentation was neck pain and in the other case, it was Lhermitte's sign; brain magnetic resonance imaging (MRI) and magnetic resonance angiography were negative for signs of ischemic infarction, hemorrhage, or arterial dissection. Cervical MRI was performed and demonstrated SSEH. Conclusion Clinicians who perform intravenous thrombolytic treatment with alteplase need to be aware of this possible contraindication. PMID:22925753

  14. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Horsch, Alexander D. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Dankbaar, Jan Willem; Niesten, Joris M.; Seeters, Tom van; Schaaf, Irene C. van der; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Graaf, Yolanda van der [Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Kappelle, L.J. [University Medical Center, Department of Neurology, Utrecht Stroke Center, Utrecht (Netherlands); Collaboration: DUST investigators

    2015-12-15

    Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT. From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment. Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %). Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status. (orig.)

  15. Stenting in the treatment of acute ischemic stroke: literature review.

    Directory of Open Access Journals (Sweden)

    Edgar A Samaniego

    2011-12-01

    Full Text Available Recanalization of acute large artery occlusions is a strong predictor of good outcome. The development of thrombectomy devices resulted in a significant improvement in recanalization rates compared to thrombolytics alone. However, clinical trials and registries with these thrombectomy devices in acute ischemic stroke (AIS have shown recanalization rates in the range of 40-81%. The last decade has seen the development of nickel titanium self-expandable stents (SES. These stents, in contrast to balloon-mounted stents, allow better navigability and deployment in tortuous vessels and therefore are optimal for the cerebral circulation. SES were initially used for stent-assisted coil embolization of intracranial aneurysms and for treatment of intracranial stenosis. However, a few authors have recently reported feasibility of deployment of SES in AIS. The use of these devices yielded higher recanalization rates compared to traditional thrombectomy devices. Encouraged by these results, retrievable SES systems have been recently used in AIS. These devices offer the advantage of resheathing and retrieving of the stent even after full deployment. Some of these stents can also be detached in case permanent stent placement is needed. Retrievable SES are being used in Europe and currently tested in clinical trials in the United States. We review the recent literature in the use of stents for the treatment of AIS secondary to large vessel occlusion.

  16. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

    Directory of Open Access Journals (Sweden)

    Tanya West

    2013-01-01

    Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

  17. [Mesoglycan in acute focal cerebral ischemia].

    Science.gov (United States)

    Cazzato, G; Zorzon, M; Masé, G; Antonutti, L; Iona, L G

    1989-01-01

    An open, randomized, controlled study including 57 patients with acute cerebral infarct was performed. All the patients, followed and controlled by the same examiner, received, in the first ten days, 24 mg/die i.v. of dexamethasone. 28 patients were also treated with mesoglycan (150 mg/die i.m. for five days and 144 mg/die per os for a further twenty-five days). The differences between the basal and final scores in the mesoglycan group and in the controls were not statistically significant as analysed by the Mann-Whitney U test. The mesoglycan influenced only slightly the laboratory values (PT, PTT, alkaline phosphatase, GOT, GPT, cholesterol and triglycerides, fibrinogen, blood glucose, azotemia and creatinine) performed before the beginning of the treatment, as their changes after thirty days of therapy were in the normal range. The mesoglycan was very well tolerated and no side-effects were observed during the treatment.

  18. Pharmacologicalmodification of thegabaergicsystem as a potentialvariant of cerebral protection in acute cerebral ischemia

    Directory of Open Access Journals (Sweden)

    Олександр Володимирович Тихоновський

    2015-10-01

    , especially Picamilon, resulted in significantly greater improvement in metabolic parameters compared with sodium succinate may to some extent explained by the higher bioavailability of these agents cells. The impact of these drugs on the nodal points of disturbed metabolism was almost equal and different in antioxidant activity. As to normalization of lipid peroxidation reactions Picamilon was most active.Conclusions: Thus, as a result of the research the following conclusions may be done.1. Bilateral bond of the common carotid artery, accompanied by severe biochemical changes in the brain tissues, that is largely similar to clinical manifestations of acute ischemic stroke.2. Course appointment of GABA derivatives in the acute period of ischemic lesions of the tissues in varyious degrees improves metabolic status of the ischemic brain and detect different degrees of manifestation of cerebral protective action.3. The activity of various GABA derivatives in respect to the different links of pathogenesis of ischemic stroke is not the same, that leads to insufficient sustainable improvement of impaired metabolism when used alone, in the long run may be justification for finding effective combinations of cerebral protective means with different mechanism of action.4. Among the studied drugs, the most active and balanced action was presented by Picamilon drug

  19. Impact of implementing evidence-based acute stroke interventions on survival: the South London Stroke Register.

    Directory of Open Access Journals (Sweden)

    Juliet Addo

    Full Text Available BACKGROUND: Studies examining the impact of organised acute stroke care interventions on survival in subgroups of stroke patients remain limited. AIMS: This study examined the effects of a range of evidence-based interventions of acute stroke care on one year survival post-stroke and determined the size of the effect across different socio-demographic and clinical subgroups of patients. METHODS: Data on 4026 patients with a first-ever stroke recruited to the population-based South London Stroke Register between 1995 and 2010 were used. In uni-variable analyses, one year cumulative survival rates in socio-demographic groups and by care received was determined. Survival functions were compared using Log-rank tests. Multivariable Cox models were used to test for interactions between components of care and age group, sex, ethnic group, social class, stroke subtype and level of consciousness. RESULTS: 1949 (56.4% patients were admitted to a stroke unit. Patients managed on a stroke unit, those with deficits receiving specific rehabilitation therapies and those with ischaemic stroke subtype receiving aspirin in the acute phase had better one year survival compared to those who did not receive these interventions. The greatest reduction in the hazards of death among patients treated on a stroke unit were in the youngest patients aged <65 years, (HR 0.39; 95% CI: 0.25-0.62, and those with reduced levels of consciousness, GCS <9, (HR: 0.44; CI: 0.33-0.58. CONCLUSIONS: There was evidence of better one year survival in patients receiving specific acute interventions after stroke with a significantly greater effect in stroke subgroups, suggesting the possibility of re-organising stroke services to ensure that the most appropriate care is made accessible to patients likely to derive the most benefits from such interventions.

  20. Spontaneous Low Frequency Oscillations in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Phillip, Dorte; Schytz, Henrik Winther; Iversen, Helle Klingenberg

    2014-01-01

    patients admitted to the stroke unit with symptoms of ischemic stroke. 11/29 patients received thrombolytic therapy. NIRS examination was conducted 2 days (median time) from stroke onset. NIRS optodes were placed on each side of the head with a 3 cm source-detector distance. Using transfer function.......09-0.11 Hz range are affected by changes in cerebral autoregulation (CA), which is altered following stroke. We examined oxyHb LFOs at bed-side as a marker of CA in the subacute phase in stroke patients with or without recombinant tissue plasminogen activator thrombolytic therapy. Methods: We recruited 29...... analysis, inter-hemispheric phase shift and amplitude ratio of the oxyHb oscillations in the 0.09-0.11 Hz range were assessed. Results: The correlation between NIHSS scores at admission and oxyHb parameters revealed a significant positive correlation between stroke severity at admission and inter...

  1. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke.

    Science.gov (United States)

    Särkämö, Teppo; Tervaniemi, Mari; Laitinen, Sari; Forsblom, Anita; Soinila, Seppo; Mikkonen, Mikko; Autti, Taina; Silvennoinen, Heli M; Erkkilä, Jaakko; Laine, Matti; Peretz, Isabelle; Hietanen, Marja

    2008-03-01

    We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke, but little is known about the effects of an enriched sound environment on recovery from neural damage in humans. In humans, music listening activates a wide-spread bilateral network of brain regions related to attention, semantic processing, memory, motor functions, and emotional processing. Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups. The potential role of music in neurological rehabilitation, however, has not been systematically investigated. This single-blind, randomized, and controlled trial was designed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke. In the acute recovery phase, 60 patients with a left or right hemisphere middle cerebral artery (MCA) stroke were randomly assigned to a music group, a language group, or a control group. During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition, all patients received standard medical care and rehabilitation. All patients underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality of life questionnaires, one week (baseline), 3 months, and 6 months after the stroke. Fifty-four patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused mood than the control group. These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. The neural mechanisms potentially

  2. Endothelial Repair in Childhood Arterial Ischaemic Stroke with Cerebral Arteriopathy

    Directory of Open Access Journals (Sweden)

    Despina Eleftheriou

    2015-06-01

    Full Text Available Background: We have previously shown that recurrent arterial ischaemic stroke (AIS in children with cerebral arteriopathy is associated with increased circulating endothelial cells and endothelial microparticles, consistent with ongoing endothelial injury. To date, however, little is known about endothelial repair responses in childhood AIS. We examined the relationship between the number and function of circulating endothelial progenitor cells (EPC, the levels of brain-derived neurotrophic factor (BDNF and AIS recurrence. Methods: Flow cytometry was used to identify peripheral blood mononuclear cells positive for CD34/kinase insert domain-containing receptor (KDR. In a subgroup of patients (5 in each group selected at random, monocytic EPC function was assessed by colony-forming unit (EPC-CFU capacity and incorporation into endothelial cell networks in Matrigel. BDNF was measured using ELISA. Results: Thirty-five children, aged 12 years (range: 5-16.5; 9 males, with AIS and cerebral arteriopathy were studied; 10 had recurrent AIS. CD34+/KDR+ cells were significantly higher in recurrent AIS compared to non-recurrent AIS patients (p = 0.005 and controls (p = 0.0002. EPC-CFU and EPC incorporation into endothelial cell networks were significantly reduced in recurrent compared to non-recurrent AIS patients (p = 0.04 and p = 0.01, respectively. Levels of BDNF were significantly higher in recurrent compared to non-recurrent AIS patients (p = 0.0008 and controls (p = 0.0002. Conclusions: Children with recurrent AIS and cerebral arteriopathy had increased circulating CD34+/KDR+ cells and BDNF consistent with an endothelial repair response. However, EPC function was impaired. Future studies are needed to examine whether suboptimal endothelial repair contributes to childhood AIS recurrence.

  3. Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion.

    Science.gov (United States)

    Turc, Guillaume; Maïer, Benjamin; Naggara, Olivier; Seners, Pierre; Isabel, Clothilde; Tisserand, Marie; Raynouard, Igor; Edjlali, Myriam; Calvet, David; Baron, Jean-Claude; Mas, Jean-Louis; Oppenheim, Catherine

    2016-06-01

    It remains debated whether clinical scores can help identify acute ischemic stroke patients with large-artery occlusion and hence improve triage in the era of thrombectomy. We aimed to determine the accuracy of published clinical scores to predict large-artery occlusion. We assessed the performance of 13 clinical scores to predict large-artery occlusion in consecutive patients with acute ischemic stroke undergoing clinical examination and magnetic resonance or computed tomographic angiography ≤6 hours of symptom onset. When no cutoff was published, we used the cutoff maximizing the sum of sensitivity and specificity in our cohort. We also determined, for each score, the cutoff associated with a false-negative rate ≤10%. Of 1004 patients (median National Institute of Health Stroke Scale score, 7; range, 0-40), 328 (32.7%) had an occlusion of the internal carotid artery, M1 segment of the middle cerebral artery, or basilar artery. The highest accuracy (79%; 95% confidence interval, 77-82) was observed for National Institute of Health Stroke Scale score ≥11 and Rapid Arterial Occlusion Evaluation Scale score ≥5. However, these cutoffs were associated with false-negative rates >25%. Cutoffs associated with an false-negative rate ≤10% were 5, 1, and 0 for National Institute of Health Stroke Scale, Rapid Arterial Occlusion Evaluation Scale, and Cincinnati Prehospital Stroke Severity Scale, respectively. Using published cutoffs for triage would result in a loss of opportunity for ≥20% of patients with large-artery occlusion who would be inappropriately sent to a center lacking neurointerventional facilities. Conversely, using cutoffs reducing the false-negative rate to 10% would result in sending almost every patient to a comprehensive stroke center. Our findings, therefore, suggest that intracranial arterial imaging should be performed in all patients with acute ischemic stroke presenting within 6 hours of symptom onset. © 2016 American Heart Association

  4. Perfusion CT in acute stroke: prediction of vessel recanalization and clinical outcome in intravenous thrombolytic therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kloska, Stephan P.; Fischer, Tobias; Fischbach, Roman; Heindel, Walter [University of Muenster, Department of Clinical Radiology, Muenster (Germany); Dittrich, Ralf; Nabavi, Darius G.; Ringelstein, E.B. [University of Muenster, Department of Neurology, Muenster (Germany); Seidensticker, Peter [Bayer Schering Pharma AG, Global Medical Affairs, Berlin (Germany); Osada, Nani [University of Muenster, Department of Medical Informatics and Biomathematics, Muenster (Germany)

    2007-10-15

    This study evaluated perfusion computed tomography (PCT) for the prediction of vessel recanalization and clinical outcome in patients undergoing intravenous thrombolysis. Thirty-nine patients with acute ischemic stroke of the middle cerebral artery territory underwent intravenous thrombolysis within 3 h of symptom onset. They all had non-enhanced CT (NECT), PCT, and CT angiography (CTA) before treatment. The Alberta Stroke Program Early Computed Tomography (ASPECT) score was applied to NECT and PCT maps to assess the extent of ischemia. CTA was assessed for the site of vessel occlusion. The National Institute of Health Stroke Scale (NIHSS) score was used for initial clinical assessment. Three-month clinical outcome was assessed using the modified Rankin scale. Vessel recanalization was determined by follow-up ultrasound. Of the PCT maps, a cerebral blood volume (CBV) ASPECT score of >6 versus {<=}6 was the best predictor for clinical outcome (odds ratio, 31.43; 95% confidence interval, 3.41-289.58; P < 0.002), and was superior to NIHSS, NECT and CTA. No significant differences in ASPECT scores were found for the prediction of vessel recanalization. ASPECT score applied to PCT maps in acute stroke patients predicts the clinical outcome of intravenous thrombolysis and is superior to both early NECT and clinical parameters. (orig.)

  5. Reduction of cerebral injury in stroke-prone spontaneously hypertensive rats by amlodipine

    NARCIS (Netherlands)

    Blezer, ELA; Nicolay, K; Goldschmeding, R; Koomans, HA; Joles, JA

    2002-01-01

    Dihydropyridine Ca2+ channel antagonists, initiated together with high salt intake, prevent the development of hypertension and subsequent cerebral damage in stroke-prone spontaneously hypertensive rats (SHRSP). We hypothesized that the dihydropyridine Ca2+ channel antagonist amlodipine (approximate

  6. Reduction of cerebral injury in stroke-prone spontaneously hypertensive rats by amlodipine

    NARCIS (Netherlands)

    Blezer, ELA; Nicolay, K; Goldschmeding, R; Koomans, HA; Joles, JA

    2002-01-01

    Dihydropyridine Ca2+ channel antagonists, initiated together with high salt intake, prevent the development of hypertension and subsequent cerebral damage in stroke-prone spontaneously hypertensive rats (SHRSP). We hypothesized that the dihydropyridine Ca2+ channel antagonist amlodipine (approximate

  7. Selective serotonin reuptake inhibitors to improve outcome in acute ischemic stroke: possible mechanisms and clinical evidence.

    Science.gov (United States)

    Siepmann, Timo; Penzlin, Ana Isabel; Kepplinger, Jessica; Illigens, Ben Min-Woo; Weidner, Kerstin; Reichmann, Heinz; Barlinn, Kristian

    2015-10-01

    Several clinical studies have indicated that selective serotonin reuptake inhibitors (SSRIs) administered in patients after acute ischemic stroke can improve clinical recovery independently of depression. Due to small sample sizes and heterogeneous study designs interpretability was limited in these studies. The mechanisms of action whereby SSRI might improve recovery from acute ischemic stroke are not fully elucidated. We searched MEDLINE using the PubMed interface to identify evidence of SSRI mediated improvement of recovery from acute ischemic stroke and reviewed the literature on the potential underlying mechanisms of action. Among identified clinical studies, a well-designed randomized, double-blind, and placebo-controlled study (FLAME - fluoxetine for motor recovery after acute ischemic stroke) demonstrated improved recovery of motor function in stroke patients receiving fluoxetine. The positive effects of SSRIs on stroke recovery were further supported by a meta-analysis of 52 trials in a total of 4060 participants published by the Cochrane collaboration. Based on animal models, the mechanisms whereby SSRIs might ameliorate functional and structural ischemic-brain damage were suggested to include stimulation of neurogenesis with migration of newly generated cells toward ischemic-brain regions, anti-inflammatory neuroprotection, improved regulation of cerebral blood flow, and modulation of the adrenergic neurohormonal system. However, to date, it remains speculative if and to what degree these mechanisms convert into humans and randomized controlled trials in large populations of stroke patients comparing different SSRIs are still lacking. In addition to the need of comprehensive-clinical evidence, further elucidation of the beneficial mechanisms whereby SSRIs may improve structural and functional recovery from ischemic-brain damage is needed to form a basis for translation into clinical practice.

  8. Insulin Resistance Is Associated With a Poor Response to Intravenous Thrombolysis in Acute Ischemic Stroke

    Science.gov (United States)

    Calleja, Ana I.; García-Bermejo, Pablo; Cortijo, Elisa; Bustamante, Rosa; Rojo Martínez, Esther; González Sarmiento, Enrique; Fernández-Herranz, Rosa; Arenillas, Juan F.

    2011-01-01

    OBJECTIVE Insulin resistance (IR) may not only increase stroke risk, but could also contribute to aggravate stroke prognosis. Mainly through a derangement in endogenous fibrinolysis, IR could affect the response to intravenous thrombolysis, currently the only therapy proved to be efficacious for acute ischemic stroke. We hypothesized that high IR is associated with more persistent arterial occlusions and poorer long-term outcome after stroke thrombolysis. RESEARCH DESIGN AND METHODS We performed a prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis. Patients with acute hyperglycemia (≥155 mg/dL) receiving insulin were excluded. IR was determined during admission by the homeostatic model assessment index (HOMA-IR). Poor long-term outcome, as defined by a day 90 modified Rankin scale score ≥3, was considered the primary outcome variable. Transcranial Duplex-assessed resistance to MCA recanalization and symptomatic hemorrhagic transformation were considered secondary end points. RESULTS A total of 109 thrombolysed MCA ischemic stroke patients were included (43.1% women, mean age 71 years). The HOMA-IR was higher in the group of patients with poor outcome (P = 0.02). The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile). A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67–43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23–54.44]; P = 0.029). CONCLUSIONS High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis. PMID:21911778

  9. Troponin elevation in acute ischemic stroke (TRELAS)--protocol of a prospective observational trial.

    Science.gov (United States)

    Scheitz, Jan F; Mochmann, Hans-Christian; Nolte, Christian H; Haeusler, Karl G; Audebert, Heinrich J; Heuschmann, Peter U; Laufs, Ulrich; Witzenbichler, Bernhard; Schultheiss, Heinz-Peter; Endres, Matthias

    2011-08-08

    Levels of the cardiac muscle regulatory protein troponin T (cTnT) are frequently elevated in patients with acute ischemic stroke and elevated cTnT predicts poor outcome and mortality. The pathomechanism of troponin release may relate to co-morbid coronary artery disease and myocardial ischemia or, alternatively, to neurogenic cardiac damage due to autonomic activation after acute ischemic stroke. Therefore, there is uncertainty about how acute ischemic stroke patients with increased cTnT levels should be managed regarding diagnostic and therapeutic workup. The primary objective of the prospective observational trial TRELAS (TRoponin ELevation in Acute ischemic Stroke) is to investigate the frequency and underlying pathomechanism of cTnT elevation in acute ischemic stroke patients in order to give guidance for clinical practice. All consecutive patients with acute ischemic stroke admitted within 72 hours after symptom onset to the Department of Neurology at the Campus Benjamin Franklin of the University Hospital Charité will be screened for cTnT elevations (i.e. ≥ 0.05 μg/l) on admission and again on the following day. Patients with increased cTnT will undergo coronary angiography within 72 hours. Diagnostic findings of coronary angiograms will be compared with age- and gender-matched patients presenting with Non-ST-Elevation myocardial infarction to the Department of Cardiology. The primary endpoint of the study will be the occurrence of culprit lesions in the coronary angiogram indicating underlying co-morbid obstructive coronary artery disease. Secondary endpoints will be the localization of stroke in the cerebral imaging and left ventriculographic findings of wall motion abnormalities suggestive of stroke-induced global cardiac dysfunction. TRELAS will prospectively determine the frequency and possible etiology of troponin elevation in a large cohort of ischemic stroke patients. The findings are expected to contribute to clarify pathophysiologic concepts of

  10. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke.

    Science.gov (United States)

    Joundi, Raed A; Martino, Rosemary; Saposnik, Gustavo; Giannakeas, Vasily; Fang, Jiming; Kapral, Moira K

    2017-04-01

    Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

  11. Elevated admission blood pressure and stroke severity in acute ischemic stroke: the Bergen NORSTROKE Study.

    Science.gov (United States)

    Kvistad, Christopher Elnan; Logallo, Nicola; Oygarden, Halvor; Thomassen, Lars; Waje-Andreassen, Ulrike; Naess, Halvor

    2013-01-01

    Transient elevated blood pressure (BP) is frequent in patients presenting with acute ischemic stroke. The pathophysiology of this response is not clear and its effect on clinical outcome has shown contradictory results. Some studies have suggested that BP elevation may represent a protective response to enhance perfusion in ischemic brain tissue. In this study, we aimed to explore the association between elevated admission BP and stroke severity in the acute phase of ischemic stroke. If it is true that elevated BP represents a protective response in acute ischemia, we expected an inverse association between elevated BP and admission stroke severity, and a positive association between elevated BP and complete neurological recovery within 24 h and/or favorable short-term outcome. Patients with ischemic stroke with hospital admission stroke registry (Bergen NORSTROKE Registry). BP was measured immediately after admission in all patients. Elevated BP was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity upon admission. Mild stroke was defined as NIHSS score stroke as NIHSS score 8-14, and severe stroke as NIHSS score ≥15. Complete neurological recovery (CNR) was defined as no persistent ischemic stroke symptoms at 24 h after admission. Favorable short-term outcome was defined as a modified Rankin Scale score of 0 or 1 at day 7. A total of 749 patients with ischemic stroke were included, of which 621 patients (82.9%) presented with elevated BP. Elevated BP was independently associated with mild stroke (odds ratio, OR: 2.12; 95% CI: 1.39-3.24; p stroke (OR: 0.41; 95% CI: 0.25-0.68; p stroke severity on admission, where elevated BP was associated with mild stroke and lack of elevated BP was associated with severe stroke. This could be explained by a protective effect of elevated BP in the acute phase of ischemic stroke, although the absence of association between

  12. An associative Brain-Computer-Interface for acute stroke patients

    DEFF Research Database (Denmark)

    Mrachacz-Kersting, Natalie; Stevenson, Andrew James Thomas; Aliakbaryhosseinabadi, Susan

    2016-01-01

    An efficient innovative Brain-Computer-Interface system that empowers chronic stroke patients to control an artificial activation of their lower limb muscle through task specific motor intent has been tested in the past. In the current study it was applied to acute stroke patients. The system...

  13. CT angiography and CT perfusion in acute ischemic stroke

    NARCIS (Netherlands)

    Seeters, T. van

    2016-01-01

    CT angiography and CT perfusion are used in patients with acute ischemic stroke for diagnostic purposes and to select patients for treatment. In this thesis, the reproducibility of CT angiography and CT perfusion is examined, the additional value of CT angiography and CT perfusion for stroke outcome

  14. Cerebral atrophy after acute traumatic subdural orextradural hematomas in adults

    Institute of Scientific and Technical Information of China (English)

    冯海龙; 谭海斌; 黄光富; 廖晓灵

    2002-01-01

    @@ Cerebral atrophy is one of the serious sequelae ofsevere head injury. 1 Neuropathologicalinvestigation has revealed that cerebral atrophy iscaused by either diffuse axonal injury or cerebralhypoxia and ischemia. Secondary ipsilateral cerebralatrophy caused by acute subdural hematomas in infantshas been reported recently, but this unilateral cerebralatrophy after head injury in adult patients has rarelybeen reported.

  15. Remote ischemic per-conditioning: a novel therapy for acute stroke?

    Science.gov (United States)

    Hahn, Cecil D; Manlhiot, Cedric; Schmidt, Michael R; Nielsen, Torsten T; Redington, Andrew N

    2011-10-01

    Remote ischemic preconditioning is a phenomenon by which a short period of sublethal ischemia to an organ protects against subsequent ischemia in another organ. We have recently demonstrated that remote ischemic conditioning by transient hind limb ischemia delivered during ischemia and before reperfusion can provide potent cardioprotection, a phenomenon we termed per-conditioning. This study evaluated whether remote ischemic per-conditioning may provide neuroprotection in a clinically relevant rat model of acute ischemic stroke. Remote ischemic conditioning by transient limb ischemia was used in a rat transient middle cerebral artery occlusion model of acute stroke. A total of 39 P60 rats were randomly allocated to receive preconditioning, per-conditioning, or sham conditioning. Cerebral ischemia was maintained for 120 minutes followed by reperfusion. The resulting infarct size at 24 hours was quantified using computerized image analysis of 2-3-5-triphenyl tetrazolium chloride-stained brain sections. Compared with control, both pre- and per-conditioning significantly reduced brain infarct size with the more clinically relevant per-conditioning stimulus being superior to preconditioning. Remote per-conditioning by transient limb ischemia is a facile, clinically relevant stimulus that provides potent neuroprotection in a model of regional brain ischemia-reperfusion injury. Further studies are required to better understand the mechanisms and biology of this response before translation to randomized controlled trials of remote per-conditioning for acute ischemic stroke.

  16. Acute Stroke | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available n(s) being investigated Acute Stroke MedDRA Classification E.1.3Condition being s... General Information on the Trial E.1 Medical condition or disease under investigation E.1.1Medical conditio

  17. Acute stroke: postprocedural care and management of complications.

    Science.gov (United States)

    de Carvalho, Flávio Augusto; de Figueiredo, Marcelo Marinho; Silva, Gisele Sampaio

    2012-03-01

    Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

  18. Developing practice recommendations for endovascular revascularization for acute ischemic stroke

    Science.gov (United States)

    Lazzaro, Marc A.; Alexandrov, Andrei V.; Darkhabani, Ziad; Edgell, Randall C.; English, Joey; Frei, Donald; Jamieson, Dara G.; Janardhan, Vallabh; Janjua, Nazli; Janjua, Rashid M.; Katzan, Irene; Khatri, Pooja; Kirmani, Jawad F.; Liebeskind, David S.; Linfante, Italo; Nguyen, Thanh N.; Saver, Jeffrey L.; Shutter, Lori; Xavier, Andrew; Yavagal, Dileep; Zaidat, Osama O.

    2012-01-01

    Guidelines have been established for the management of acute ischemic stroke; however, specific recommendations for endovascular revascularization therapy are lacking. Burgeoning investigation of endovascular revascularization therapies for acute ischemic stroke, rapid device development, and a diverse training background of the providers performing the procedures underscore the need for practice recommendations. This review provides a concise summary of the Society of Vascular and Interventional Neurology endovascular acute ischemic stroke roundtable meeting. This document was developed to review current clinical efficacy of pharmacologic and mechanical revascularization therapy, selection criteria, periprocedure management, and endovascular time metrics and to highlight current practice patterns. It therefore provides an outline for the future development of multisociety guidelines and recommendations to improve patient selection, procedural management, and organizational strategies for revascularization therapies in acute ischemic stroke. PMID:23008406

  19. Statins in Acute Ischemic Stroke: A Systematic Review

    National Research Council Canada - National Science Library

    Hong, Keun-Sik; Lee, Ji Sung

    2015-01-01

    Statins have pleiotropic effects of potential neuroprotection. However, because of lack of large randomized clinical trials, current guidelines do not provide specific recommendations on statin initiation in acute ischemic stroke (AIS...

  20. Prognosis and outcome of acute stroke in the University College ...

    African Journals Online (AJOL)

    2011-03-02

    Mar 2, 2011 ... and ischemic heart disease), accounting for approximately ... Background: Many factors influence the outcome of acute stroke, the third ..... review. West Afr J Med 2000;19:304-7. 11. Adetuyibi A, Akisanya JB, Onadeko BO.

  1. ASSESSMENT OF EFFICACY OF SURGICAL CEREBRAL REVASCULARIZATION IN PATIENTS WITH LARGE POST-STROKE CYSTS

    Directory of Open Access Journals (Sweden)

    R. N. Lar'kov

    2015-01-01

    cysts the regression of neurological deficiency was less obvious, than in other groups (NIHSS 7.5 ± 1.7, Barthell index 76 ± 7.7. The best restoration of impaired neurological functions was seen in patients with small cysts (NIHSS 2.2 ± 0.7, Barthell index 91 ± 3.4.Conclusion: In patients with large and intermediate post-stroke cerebral cysts surgery is associated with a higher complication rate, and, first of all, of hyperperfusion syndrome. However, the risk of these complications is significantly smaller than the probability of repeated acute cerebrovascular accidents.

  2. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit : a randomized pilot study

    NARCIS (Netherlands)

    Sulter, Geert; Elting, Jan Willem; Langedijk, Marc; Maurits, Natasha M; De Keyser, Jacques

    2003-01-01

    BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the

  3. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit : a randomized pilot study

    NARCIS (Netherlands)

    Sulter, Geert; Elting, Jan Willem; Langedijk, Marc; Maurits, Natasha M; De Keyser, Jacques

    2003-01-01

    BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the

  4. Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry.

    Science.gov (United States)

    Kim, Beom Joon; Han, Moon-Ku; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Byung-Chul; Yu, Kyung-Ho; Cha, Jae Kwan; Kim, Dae-Hyun; Lee, Jun; Lee, Soo Joo; Ko, Youngchai; Park, Jong-Moo; Kang, Kyusik; Cho, Yong-Jin; Hong, Keun-Sik; Cho, Ki-Hyun; Kim, Joon-Tae; Kim, Dong-Eog; Lee, Juneyoung; Lee, Ji Sung; Jang, Myung Suk; Broderick, Joseph P; Yoon, Byung-Woo; Bae, Hee-Joon

    2014-06-01

    There are limited data on the utilization of diagnostics and the variation of treatments at the national level in acute stroke care. Clinical Research Center for Stroke--5th division stroke registry aimed to describe stroke statistics and quality of care in Korea and to implement quality indicators. Clinical Research Center for Stroke--5th division registry was established in April 2008 and covers pretreatment demographics, medical and stroke severity measures, diagnostic evaluation, hyperacute revascularization, in-hospital management, discharge disposition, quality indicators, and long-term functional outcomes. Consecutive stroke cases from 12 participating centers are registered to a web-based database. Meticulous data management and auditing policy were applied. A total of 14,792 ischemic stroke cases were enrolled from April 2008 to January 2012. The median National Institutes of Health Stroke Scale score was 4 at admission, with median delay of onset to arrival of 14 h. Rate of risk factor management before stroke exceeds more than 80% for hypertension and diabetes. Revascularization procedures were performed in 1736 subjects (12%), and 34% were endovascular (n = 598). Substantial variability was noted in the preferred modality of hyperacute revascularization (range of endovascular recanalization = 6-60%), use of computed tomography (30-93%), and perfusion imaging (2-96%). The Clinical Research Center for Stroke--5th division registry documented that the current practice of acute stroke care in South Korea largely met the standard of guidelines, but variability of practice still remains. The registry would provide an opportunity to evaluate the quality of stroke care across South Korea and compare it with that of other countries. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  5. Serum Uric Acid Levels and Outcomes After Acute Ischemic Stroke.

    Science.gov (United States)

    Wang, Zhongchao; Lin, Yanlin; Liu, Yuxiu; Chen, Ying; Wang, Bin; Li, Changgui; Yan, Shengli; Wang, Yangang; Zhao, Wenjuan

    2016-04-01

    Previous studies assessing the association between serum uric acid levels and neurological outcome after acute ischemic stroke reported conflicting results. A systematic review and meta-analysis were conducted to assess the impact of serum uric acid levels on outcome after acute ischemic stroke. Pubmed, Embase, Web of Science, and Google scholar were searched through September 26, 2014 to identify eligible published or unpublished studies on the association between serum uric acid levels and outcome after acute ischemic stroke. Hazard ratio (HR) for poor outcome or mean differences of serum uric acid levels with 95% confidence intervals (95% CIs) were pooled using meta-analysis. The primary outcome was occurrence of poor outcomes, while the secondary outcome was the mean differences of serum uric acid levels in patients with good or poor outcomes. Ten eligible studies with a total of 8131 acute ischemic stroke patients were included into the meta-analysis. Compared with low serum uric acid level, high serum uric acid level was associated better outcome after acute ischemic stroke (HR = 0.77, 95% CI 0.68-0.88, P = 0.0001). Sensitivity analysis further identified the prognostic role of serum uric acid levels on outcome after acute ischemic stroke. Patients with good outcomes had a higher serum uric acid level compared with those with poor outcome (mean difference = 30.61 μmol/L, 95% CI 20.13-41.08, P acute ischemic stroke. High uric acid level at the onset is a biomarker of better prognosis in patients with acute ischemic stroke.

  6. Segurança do transplante autólogo, intra-arterial, de células mononucleares da medula óssea na fase aguda do acidente vascular cerebral isquêmico Intra-arterial autologous bone marrow mononuclear cell transplantation for acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Maria Lúcia Furtado de Mendonça

    2006-01-01

    Full Text Available O acidente vascular cerebral (AVC é a terceira causa de óbito e a principal causa de incapacidade em indivíduos adultos. Embora a mortalidade do AVC esteja diminuindo em alguns países, a morbidade tem aumentado em razão do envelhecimento da população e do aumento da sobrevida dos pacientes¹. O tratamento com ativador do plasminogênio tissular recombinante (rt-PA é eficaz quando instituído em até 3 horas após o início dos sintomas², porém seu uso está limitado a cerca de 5% dos pacientes na fase aguda do AVC isquêmico. Além disso, nenhum agente para neuroproteção teve sua eficácia comprovada em estudos clínicos em humanos. Portanto, outras estratégias terapêuticas precisam ser desenvolvidas. Em modelos animais, o uso de células-tronco correlacionou-se com melhora funcional após o AVC³. Publicações recentes têm demonstrado a segurança do tratamento com células mononucleares da medula óssea (CMMO injetadas via intracoronária em pacientes portadores de cardiopatia isquêmica aguda ou crônica4,5. Baseado nesses dados iniciais, há crescente interesse no estudo do transplante com CMMO na fase aguda do AVC. Relatamos o primeiro caso de transplante autólogo de CMMO via intra-arterial na fase aguda do AVC isquêmico.Stroke is the third cause of death and the leading cause of disability in adult subjects. Although stroke mortality has been declining in some countries, stroke morbidity has been increasing due to the aging of population and patients improved survival.¹ Treatment with recombinant tissue plasminogen activator (rtPA is successful provided it is administered within 3 hours of symptoms onset,² but its use is limited to about 5% of the patients with acute ischemic stroke. Furthermore, no neuroprotective agent has yet been proven effective in human clinical trials. The development of other therapeutic strategies is, therefore, warranted. The use of stem cells in animal models has led to functional improvement

  7. Impaired cerebral autoregulation is associated with brain atrophy and worse functional status in chronic ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Mikio C Aoi

    Full Text Available Dynamic cerebral autoregulation (dCA is impaired following stroke. However, the relationship between dCA, brain atrophy, and functional outcomes following stroke remains unclear. In this study, we aimed to determine whether impairment of dCA is associated with atrophy in specific regions or globally, thereby affecting daily functions in stroke patients.We performed a retrospective analysis of 33 subjects with chronic infarctions in the middle cerebral artery territory, and 109 age-matched non-stroke subjects. dCA was assessed via the phase relationship between arterial blood pressure and cerebral blood flow velocity. Brain tissue volumes were quantified from MRI. Functional status was assessed by gait speed, instrumental activities of daily living (IADL, modified Rankin Scale, and NIH Stroke Score.Compared to the non-stroke group, stroke subjects showed degraded dCA bilaterally, and showed gray matter atrophy in the frontal, parietal and temporal lobes ipsilateral to infarct. In stroke subjects, better dCA was associated with less temporal lobe gray matter atrophy on the infracted side ([Formula: see text] = 0.029, faster gait speed ([Formula: see text] = 0.018 and lower IADL score ([Formula: see text]0.002. Our results indicate that better dynamic cerebral perfusion regulation is associated with less atrophy and better long-term functional status in older adults with chronic ischemic infarctions.

  8. Pharmaceutical Sponsorship Bias Influences Thrombolytic Literature in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Ryan P Radecki

    2011-05-01

    Full Text Available Background: The efficacy of thrombolytic therapy for acute ischemic stroke remains controversial in Emergency Medicine and has not been fully endorsed by either the American College of Emergency Physicians or the American Academy of emergency medicine. A growing recognition exists of the influence of pharmaceutical sponsorship on the reported findings of published clinical trials. Sponsorship bias has been suggested as a potential criticism of the literature and guidelines favoring thrombolytic therapy. Objective: The objective of this study is to review the most influential literature regarding thrombolytic therapy for acute ischemic stroke and document the presence or absence of pharmaceutical sponsorship. Methods: A publication-citation analysis was performed to identify the most frequently cited articles pertaining to thrombolytic therapy for acute ischemic stroke. Identified articles were reviewed for disclosures of pharmaceutical funding. Results: Of the 20 most-cited articles pertaining to thrombolytic therapy for acute stroke, 17 (85% disclosed pharmaceutical sponsorship. These disclosures range from general sponsorship to direct employment of authors by pharmaceutical companies. Conclusion: An overwhelming predominance of the most influential literature regarding thrombolytic therapy for acute ischemic stroke is susceptible to sponsorship bias. This potential bias may provide a basis for physician concern regarding the efficacy and safety of thrombolytic therapy. Further, large, independent, placebo-controlled studies may be required to guide therapy and professional guidelines definitively for acute ischemic stroke. [West J Emerg Med. 2011;12(4:435–441.

  9. Low dose CT perfusion in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Amanda; Symons, Sean; Jakubovic, Raphael; Zhang, Liying; Aviv, Richard I. [Sunnybrook Health Sciences Centre, Toronto, ON (Canada); So, Aaron; Lee, Ting-Yim [Robarts Research Institute, London, Ontario (Canada)

    2014-12-15

    The purpose of this investigation is to determine if CT perfusion (CTP) measurements at low doses (LD = 20 or 50 mAs) are similar to those obtained at regular doses (RD = 100 mAs), with and without the addition of adaptive statistical iterative reconstruction (ASIR). A single-center, prospective study was performed in patients with acute ischemic stroke (n = 37; 54 % male; age = 74 ± 15 years). Two CTP scans were performed on each subject: one at 100 mAs (RD) and one at either 50 or 20 mAs (LD). CTP parameters were compared between the RD and LD scans in regions of ischemia, infarction, and normal tissue. Differences were determined using a within-subjects ANOVA (p < 0.05) followed by a paired t test post hoc analysis (p < 0.01). At 50 mAs, there was no significant difference between cerebral blood flow (CBF), cerebral blood volume (CBV), or time to maximum enhancement (Tmax) values for the RD and LD scans in the ischemic, infarcted, or normal contralateral regions (p < 0.05). At 20 mAs, there were significant differences between the RD and LD scans for all parameters in the ischemic and normal tissue regions (p > 0.05). CTP-derived CBF and CBV are not different at 50 mAs compared to 100 mAs, even without the addition of ASIR. Current CTP protocols can be modified to reduce the effective dose by 50 % without altering CTP measurements. (orig.)

  10. Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis: Individual Patient Data Meta-Analysis.

    Science.gov (United States)

    Charidimou, Andreas; Turc, Guillaume; Oppenheim, Catherine; Yan, Shenqiang; Scheitz, Jan F; Erdur, Hebun; Klinger-Gratz, Pascal P; El-Koussy, Marwan; Takahashi, Wakoh; Moriya, Yusuke; Wilson, Duncan; Kidwell, Chelsea S; Saver, Jeffrey L; Sallem, Asma; Moulin, Solene; Edjlali-Goujon, Myriam; Thijs, Vincent; Fox, Zoe; Shoamanesh, Ashkan; Albers, Gregory W; Mattle, Heinrich P; Benavente, Oscar R; Jäger, H Rolf; Ambler, Gareth; Aoki, Junya; Baron, Jean-Claude; Kimura, Kazumi; Kakuda, Wataru; Takizawa, Shunya; Jung, Simon; Nolte, Christian H; Lou, Min; Cordonnier, Charlotte; Werring, David J

    2017-07-18

    We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome. We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Using multilevel mixed-effects logistic regression, we investigated associations of pre-treatment CMB presence, burden (1, 2-4, ≥5, and >10), and presumed pathogenesis (cerebral amyloid angiopathy defined as strictly lobar CMBs and noncerebral amyloid angiopathy) with symptomatic ICH, parenchymal hematoma (within [parenchymal hemorrhage, PH] and remote from the ischemic area [remote parenchymal hemorrhage, PHr]), and poor 3- to 6-month functional outcome (modified Rankin score >2). In 1973 patients from 8 centers, the crude prevalence of CMBs was 526 of 1973 (26.7%). A total of 77 of 1973 (3.9%) patients experienced symptomatic ICH, 210 of 1806 (11.6%) experienced PH, and 56 of 1720 (3.3%) experienced PHr. In adjusted analyses, patients with CMBs (compared with those without CMBs) had increased risk of PH (odds ratio: 1.50; 95% confidence interval: 1.09-2.07; P=0.013) and PHr (odds ratio: 3.04; 95% confidence interval: 1.73-5.35; PCMBs were associated with PH and PHr. Increasing CMB burden category was associated with the risk of symptomatic ICH (P=0.014), PH (P=0.013), and PHr (P10 CMBs independently predicted poor 3- to 6-month outcome (odds ratio: 1.85; 95% confidence interval: 1.10-3.12; P=0.020; and odds ratio: 3.99; 95% confidence interval: 1.55-10.22; P=0.004, respectively). Increasing CMB burden is associated with increased risk of ICH (including PHr) and poor 3- to 6-month functional outcome after intravenous thrombolysis for acute ischemic stroke. © 2017 American Heart Association, Inc.

  11. A surgical model of permanent and transient middle cerebral artery stroke in the sheep.

    Directory of Open Access Journals (Sweden)

    Adam J Wells

    Full Text Available BACKGROUND: Animal models are essential to study the pathophysiological changes associated with focal occlusive stroke and to investigate novel therapies. Currently used rodent models have yielded little clinical success, however large animal models may provide a more suitable alternative to improve clinical translation. We sought to develop a model of acute proximal middle cerebral artery (MCA ischemic stroke in sheep, including both permanent occlusion and transient occlusion with reperfusion. MATERIALS AND METHODS: 18 adult male and female Merino sheep were randomly allocated to one of three groups (n = 6/gp: 1 sham surgery; 2 permanent proximal MCA occlusion (MCAO; or 3 temporary MCAO with aneurysm clip. All animals had invasive arterial blood pressure, intracranial pressure and brain tissue oxygen monitoring. At 4 h following vessel occlusion or sham surgery animals were killed by perfusion fixation. Brains were processed for histopathological examination and infarct area determination. 6 further animals were randomized to either permanent (n = 3 or temporary MCAO (n = 3 and then had magnetic resonance imaging (MRI at 4 h after MCAO. RESULTS: Evidence of ischemic injury in an MCA distribution was seen in all stroke animals. The ischemic lesion area was significantly larger after permanent (28.8% compared with temporary MCAO (14.6%. Sham animals demonstrated no evidence of ischemic injury. There was a significant reduction in brain tissue oxygen partial pressure after permanent vessel occlusion between 30 and 210 mins after MCAO. MRI at 4 h demonstrated complete proximal MCA occlusion in the permanent MCAO animals with a diffusion deficit involving the whole right MCA territory, whereas temporary MCAO animals demonstrated MRA evidence of flow within the right MCA and smaller predominantly cortical diffusion deficits. CONCLUSIONS: Proximal MCAO can be achieved in an ovine model of stroke via a surgical approach. Permanent

  12. New Cerebral Microbleeds After Mechanical Thrombectomy for Large-Vessel Occlusion Strokes

    Science.gov (United States)

    Shi, Zhong-Song; Duckwiler, Gary R.; Jahan, Reza; Tateshima, Satoshi; Gonzalez, Nestor R.; Szeder, Viktor; Saver, Jeffrey L.; Kim, Doojin; Ali, Latisha K.; Starkman, Sidney; Vespa, Paul M.; Salamon, Noriko; Villablanca, J. Pablo; Viñuela, Fernando; Feng, Lei; Loh, Yince; Liebeskind, David S.

    2015-01-01

    Abstract The interval appearance of cerebral microbleeds (CMBs) after endovascular treatment has never been described. We investigated the frequency and predictors of new CMBs that developed shortly after mechanical thrombectomy for acute ischemic stroke, and its impact on clinical outcome. We retrospectively analyzed patients with large-vessel occlusion strokes treated with Merci Retriever, Penumbra System, or stent-retriever devices. Serial T2∗-weighted gradient-recall echo (GRE) magnetic resonance imaging (MRI) before and 48 h after endovascular thrombectomy were assessed to identify new CMBs. We examined independent factors associated with new CMBs after mechanical thrombectomy. We analyzed the association of the presence, burden, and distribution of new CMBs with clinical outcome. A total of 187 consecutive patients with serial GRE were enrolled in this study. CMBs were evident in 36 (19.3%) patients before mechanical thrombectomy. New CMBs occurred in 41 (21.9%) patients after mechanical thrombectomy. Of the 68 new CMBs, 45 appeared in the lobar location, 18 in the deep location and 5 in the infratentorial location. The presence of baseline CMBs was associated with new CMBs after mechanical thrombectomy (OR 5.38; 95% CI 2.13–13.59; P rates of hemorrhagic transformation, in-hospital mortality, and modified Rankin Scale score 4 to 6 at discharge. New CMBs are common after mechanical thrombectomy in one-fifth of patients with acute ischemic stroke. Baseline CMBs before mechanical thrombectomy predicts the development of new CMBs. New CMBs after mechanical thrombectomy do not influence clinical outcome. PMID:26632753

  13. New Cerebral Microbleeds After Mechanical Thrombectomy for Large-Vessel Occlusion Strokes.

    Science.gov (United States)

    Shi, Zhong-Song; Duckwiler, Gary R; Jahan, Reza; Tateshima, Satoshi; Gonzalez, Nestor R; Szeder, Viktor; Saver, Jeffrey L; Kim, Doojin; Ali, Latisha K; Starkman, Sidney; Vespa, Paul M; Salamon, Noriko; Villablanca, J Pablo; Viñuela, Fernando; Feng, Lei; Loh, Yince; Liebeskind, David S

    2015-11-01

    The interval appearance of cerebral microbleeds (CMBs) after endovascular treatment has never been described. We investigated the frequency and predictors of new CMBs that developed shortly after mechanical thrombectomy for acute ischemic stroke, and its impact on clinical outcome.We retrospectively analyzed patients with large-vessel occlusion strokes treated with Merci Retriever, Penumbra System, or stent-retriever devices. Serial T2*-weighted gradient-recall echo (GRE) magnetic resonance imaging (MRI) before and 48 h after endovascular thrombectomy were assessed to identify new CMBs. We examined independent factors associated with new CMBs after mechanical thrombectomy. We analyzed the association of the presence, burden, and distribution of new CMBs with clinical outcome.A total of 187 consecutive patients with serial GRE were enrolled in this study. CMBs were evident in 36 (19.3%) patients before mechanical thrombectomy. New CMBs occurred in 41 (21.9%) patients after mechanical thrombectomy. Of the 68 new CMBs, 45 appeared in the lobar location, 18 in the deep location and 5 in the infratentorial location. The presence of baseline CMBs was associated with new CMBs after mechanical thrombectomy (OR 5.38; 95% CI 2.13-13.59; P CMBs did not have increased rates of hemorrhagic transformation, in-hospital mortality, and modified Rankin Scale score 4 to 6 at discharge.New CMBs are common after mechanical thrombectomy in one-fifth of patients with acute ischemic stroke. Baseline CMBs before mechanical thrombectomy predicts the development of new CMBs. New CMBs after mechanical thrombectomy do not influence clinical outcome.

  14. Pharmacological and non-pharmacological recanalisation strategies in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Anita eFrendl

    2011-05-01

    Full Text Available According to the guidelines of the European Stroke Organization (ESO and the American Stroke Association (ASA, acute stroke patients should be managed at stroke units that include well organized pre- and in-hospital care. In ischemic stroke the restoration of blood flow has to occur within a limited time window that is accomplished by fibrinolytic therapy. Newer generation thrombolytic agents (alteplase, pro-urokinase, reteplase, tenecteplase, desmoteplase have shorter half-life and are more fibrin specific. Only alteplase has FDA approval for the treatment of acute stroke (1996. The NINDS trial proved that alteplase was effective in all subtypes of ischemic strokes within the first 3 hours. In the ECASS-III trial, intravenous alteplase therapy was found to be safe and effective (with some restrictions if applied within the first 3-4.5 hours. In middle cerebral artery (MCA occlusion additional transcranial Doppler insonication may improve the breakdown of the blood clot. According to the ESO and ASA guidelines, intra-arterial thrombolysis is an option for recanalisation within 6 hours of MCA occlusion. Further trials on the intra-arterial (IA therapy are needed, as previous studies have involved relatively small number of patients (compared to IV. trials and the optimal intra-arterial dose of alteplase has not been determined (20-30 mg is used most commonly in 2 hours. Patients undergoing combined (IV+IA thrombolysis had significantly better outcome than the placebo group or the IV therapy alone in the NINDS Trial (IMS Trials. If thrombolysis fails or it is contraindicated, mechanical devices (e.g. MERCI- FDA approved in 2004 might be used to remove the occluding clot. Stenting can also be an option in case of acute internal carotid artery occlusion in the future. An intra-aortic balloon was used to increase the collateral blood flow in the SENTIS trial (results are under evaluation. Currently, there is no approved effective neuroprotective drug.

  15. Patients' and carers' experiences of gaining access to acute stroke care: A qualitative study

    OpenAIRE

    Harrison, M; Ryan, T.; Gardiner, C.; Jones, A

    2012-01-01

    Background: Rapid access to acute stroke care is essential to improve stroke patient outcomes. Policy recommendations for the emergency management of stroke have resulted in signi ficant changes to stroke services, including the introduction of hyper-acute care. Objective: To explore patients' and carers' experiences of gaining access to acute stroke care and identify the factors that enabled or prevented stroke from being treated as a medical emergency. Methods: Qualitative semi-structured i...

  16. CT Perfusion in Acute Stroke: "Black Holes" on Time-to-Peak Image Maps Indicate Unsalvageable Brain.

    Science.gov (United States)

    Meagher, Ruairi; Shankar, Jai Jai Shiva

    2016-11-01

    CT perfusion is becoming important in acute stroke imaging to determine optimal patient-management strategies. The purpose of this study was to examine the predictive value of time-to-peak image maps and, specifically, a phenomenon coined a "black hole" for assessing infarcted brain tissue at the time of scan. Acute stroke patients were screened for the presence of black holes and their follow-up imaging (noncontrast CT or MR) was reviewed to assess for infarcted brain tissue. Of the 23 patients with signs of acute ischemia on CT perfusion, all had black holes. The black holes corresponded with areas of infarcted brain on follow-up imaging (specificity 100%). Black holes demonstrated significantly lower cerebral blood volumes (P < .001) and cerebral blood flow (P < .001) compared to immediately adjacent tissue. Black holes on time-to-peak image maps represent areas of unsalvageable brain. Copyright © 2016 by the American Society of Neuroimaging.

  17. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy resulting in stroke in an 11-year-old male

    DEFF Research Database (Denmark)

    Granild-Jensen, Jakob Bie; Jensen, Uffe Birk; Schwartz, Marianne

    2009-01-01

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the Notch3 gene on chromosome 19. The condition manifests itself clinically typically in the third to fifth decade with migraine and recurrent episodes of stroke or trans......Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the Notch3 gene on chromosome 19. The condition manifests itself clinically typically in the third to fifth decade with migraine and recurrent episodes of stroke...... or transient ischaemic attacks. We report the case of an 11-year-old male with CADASIL resulting in stroke with right hemiparesis and dysphasia. Acute magnetic resonance imaging suggested infarction in the left hemisphere; magnetic resonance angiography revealed calibre variation of the intracerebral arteries....... The patient suffered from common migraine with five to six attacks per month for 3 years 6 months before the stroke. Attacks occurred early in the morning with severe one-sided headache, photophobia, nausea, and vomiting. Antimigraine medications had no effect. The family history revealed more cases...

  18. Risk of stroke after acute myocardial infarction among Chinese

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Following an acute myocardial infarction (AMI), patients have an increased risk of stroke. Estimates of risk are mainly derived from AMI treatment trials or secondary prevention studies. The reported incidence of stroke in Caucasians in the early phase after AMI ranged from 0.5% to 2.5%.1-3 Similar assessment of risk in the Chinese population is lacking. As thrombolytic therapy becomes standard treatment for AMI, there is concern that there may be an increase in haemorrhagic stroke complicating AMI treatment, especially since haemorrhagic stroke is more common in Asian populations.

  19. 康复联动型卒中单元在地市级医院急性脑梗死治疗中的应用%Application of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    王志敏; 王鹏; 陈捷; 罗丹红; 沈王明

    2008-01-01

    Objective To evaluate the efficacy of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction.Methods 77 acute cerebral infarction patients were randomly assigned to stroke rehabilitation unit group and 73 to ordinary group.The NIH stroke scale(NIHSS),activities of daily living(ADL)Barthel index and average hospitalized time were compared in two groups before and after the treatment.Results The average NIHSS in two groups before treatment were 9.26 and 9.12 respectively(P>0.05)but became 2.62 and 7.64 after treatment(P<0.01).The average ADL Barthel index in two groups before the treatment were 52.04 and 53.16(P>0.05)but 87.26 and 64.20 after the treatment(P<0.01).The average hospitalized time in the two groups were 22.25 and 26.67 days(P<0.05).Conclusion When stroke rehabilitation unit being applied in the acute phase of cerebral infarction,it showed positive results in the following aspects as:improving the neurological function,capabilities of managing daily life,and also shortening the days of hospitalization.%目的 评价康复联动型卒中单元在地市级医院急性脑梗死治疗中的疗效.方法 急性脑梗死患者随机进入康复联动型卒中小组病房(77例)和普通病房(73例),比较治疗前后两组患者神经功能(NIHSS评分)、日常生活能力(ADL Barthel指数)及住院时间.结果 两组患者治疗前平均NIHSS评分分别为9.26与9.12(P>0.05),治疗后分别为2.62与7.64(P<0.01),治疗前平均ADLBarthel指数分别为52.04与53.16(P>0.05),治疗后分别为87.26与64.20(P<0.01),两组平均住院日分别为22.25 d及26.67 d(P<0.05).结论 康复联动型卒中单元模式应用于脑梗死急性期治疗,可改善患者的神经功能及日常生活能力,缩短住院时间,在地市级医院优于普通卒中病房.

  20. The Association of Lesion Location and Sleep Related Breathing Disorder in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Teuber, Anja; Wersching, Heike; Young, Peter; Dittrich, Ralf; Ritter, Martin; Dziewas, Rainer; Minnerup, Jens

    2017-01-01

    Background and aims Sleep related breathing disorders (SRBD) are common in patients with ischemic stroke and are associated with poor outcome. SRBD after stroke were assumed to be a direct consequence of injury of specific central nervous system structures. However, whether specific locations of ischemic infarcts cause SRBD is yet unknown. We therefore investigated the association of ischemic lesion location with SRBD. Methods Patients with acute ischemic stroke treated on our stroke unit were included in a prospective observational study. All patients underwent magnetic resonance imaging (MRI) and polygraphy in the acute phase after stroke. SRBD was defined by an apnea—hypopnea index (AHI) ≥10. MRI were evaluated using standardized maps to depict voxel-wise probability distribution of infarction for patients with and without SRBD. Groups were compared using logistic regression analysis. Results Of 142 patients included, 86 (59%) had a SRBD. Age, body mass index and prevalence of arterial hypertension were significantly higher in patients with SRBD. There was no statistically significant association between any lesion location and SRBD. Conclusion We found no association of lesion location and SRBD in stroke patients, whereas established risk factors for SRBD, known from general population, were significantly associated with SRBD. Given the high prevalence of SRBD in stroke patients, these findings suggest that cerebral ischemia facilitates the occurrence of SRBD in patients with pre-existing risk factors rather than causing it by damaging specific central nervous system structures. Our findings can be used to identify stroke patients who might benefit from polygraphy screening. PMID:28135315

  1. Role of inflammation and its mediators in acute ischemic stroke

    Science.gov (United States)

    Jin, Rong; Liu, Lin; Zhang, Shihao; Nanda, Anil; Li, Guohong

    2013-01-01

    Inflammation plays an important role in the pathogenesis of ischemic stroke and other forms of ischemic brain injury. Increasing evidence suggests that inflammatory response is a double-edged sword, as it not only exacerbates secondary brain injury in the acute stage of stroke but also beneficially contributes to brain recovery after stroke. In this article, we provide an overview on the role of inflammation and its mediators in acute ischemic stroke. We discuss various pro-inflammatory and anti-inflammatory responses in different phases after ischemic stroke and the possible reasons for their failures in clinical trials. Undoubtedly, there is still much to be done in order to translate promising pre-clinical findings into clinical practice. A better understanding of the dynamic balance between pro- and anti-inflammatory responses and identifying the discrepancies between pre-clinical studies and clinical trials may serve as a basis for designing effective therapies. PMID:24006091

  2. Wernicke's Encephalopathy Mimicking Acute Onset Stroke Diagnosed by CT Perfusion

    Directory of Open Access Journals (Sweden)

    Alok Bhan

    2014-01-01

    Full Text Available Background. Metabolic syndromes such as Wernicke’s encephalopathy may present with a sudden neurological deficit, thus mimicking acute onset stroke. Due to current emphasis on rapid admission and treatment of acute stroke patients, there is a significant risk that these stroke mimics may end up being treated with thrombolysis. Rigorous clinical and radiological skills are necessary to correctly identify such metabolic stroke mimics, in order to avoid doing any harm to these patients due to the unnecessary use of thrombolysis. Patient. A 51-year-old Caucasian male was admitted to our hospital with suspicion of an acute stroke due to sudden onset dysarthria and unilateral facial nerve paresis. Clinical examination revealed confusion and dysconjugate gaze. Computed tomography (CT including a CT perfusion (CTP scan revealed bilateral thalamic hyperperfusion. The use of both clinical and radiological findings led to correctly diagnosing Wernicke’s encephalopathy. Conclusion. The application of CTP as a standard diagnostic tool in acute stroke patients can improve the detection of stroke mimics caused by metabolic syndromes as shown in our case report.

  3. Stroke from Vasospasm due to Marijuana Use: Can Cannabis Synergistically with Other Medications Trigger Cerebral Vasospasm?

    Directory of Open Access Journals (Sweden)

    Marium Jamil

    2016-01-01

    Full Text Available We present a case of imaging proven cerebral vasospasm causing ischemic stroke in a young patient chronically on buprenorphine-naloxone for heroin remission who started smoking cannabis on a daily basis. With cannabis legalization spreading across the states in the USA, it is important for physicians not only to be aware of cannabis reported association with cerebral vasospasm in some patients but also to be on the lookout for possible interacting medications that can synergistically affect cerebral vessels causing debilitating strokes.

  4. Collateral lessons from recent acute ischemic stroke trials.

    Science.gov (United States)

    Liebeskind, David S

    2014-05-01

    Numerous acute ischemic stroke trials have recently published detailed results, providing an opportunity to consider the role of collaterals in stroke pathophysiology and their influential effect on patient outcomes. Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke (SENTIS), the largest randomized controlled trial of device therapy to date, tested the potential augmentation of collateral perfusion. SYNTHESIS Expansion, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and Interventional Management of Stroke (IMS) III chronicled the saga of endovascular therapy trialed against medical treatment for acute ischemic stroke. These recent randomized studies, however, largely neglect current device technology available for endovascular therapy as advanced by the TREVO2 and SOLITAIRE™(TM) FR With the Intention For Thrombectomy (SWIFT) studies. Such exhaustive efforts in recent trials have failed to introduce a new treatment for stroke that unequivocally improves patient outcomes. Collateral perfusion is widely recognized to vary across individuals in any population and exerts a dramatic effect on baseline variables including the time course of ischemic injury, stroke severity, imaging findings, and therapeutic opportunities. Similarly, collaterals have been recognized to influence recanalization, reperfusion, hemorrhagic transformation, and subsequent neurological outcomes after stroke. Collateral lessons may be gleaned from these trials, to expand consideration of overall study results and perhaps most importantly, alter ongoing and new trials in development. Detailed analyses of available information on collaterals from these trials demonstrate that collaterals may be more influential than the choice of treatment modality or intervention.

  5. Acute Headache at Emergency Department: Reversible Cerebral Vasoconstriction Syndrome Complicated by Subarachnoid Haemorrhage and Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    M. Yger

    2015-01-01

    Full Text Available Introduction. Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome. Case Report. A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. Conclusion. Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.

  6. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M. [University of Edinburgh, Western General Hospital, Division of Neuroimaging Sciences, Edinburgh (United Kingdom); Kummer, Ruediger von [Dresden University Stroke Centre, University Hospital, Department of Neuroradiology, Dresden (Germany); Adami, Alessandro [Sacro Cuore-Don Calabria Hospital, Stroke Center, Department of Neurology, Negrar (Italy); White, Philip M. [Stroke Research Group, Newcastle upon Tyne (United Kingdom); Adams, Matthew E. [National Hospital for Neurology and Neurosurgery, Department of Neuroradiology, London (United Kingdom); Yan, Bernard [Royal Melbourne Hospital, Neurovascular Research Group, Parkville (Australia); Demchuk, Andrew M. [Calgary Stroke Program, Department of Clinical Neurosciences, Calgary (Canada); Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J. [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom); Boyd, Elena V. [Northwick Park Hospital, Department of Radiology, Harrow (United Kingdom); Cohen, Geoff; Perry, David; Sandercock, Peter A.G. [University of Edinburgh, Western General Hospital, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Lindley, Richard [University of Sydney, Westmead Hospital Clinical School and The George Institute for Global Health, Sydney (Australia); Collaboration: The IST-3 Collaborative Group

    2014-10-07

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  7. Microbubble-Mediated Sonothrombolysis Improves Outcome After Thrombotic Microembolism-Induced Acute Ischemic Stroke.

    Science.gov (United States)

    Lu, Yongkang; Wang, Junfen; Huang, Ruizhu; Chen, Gangbin; Zhong, Lintao; Shen, Shuxin; Zhang, Chuanxi; Li, Xinzhong; Cao, Shiping; Liao, Wangjun; Liao, Yulin; Bin, Jianping

    2016-05-01

    Microthrombi originating from disintegrated clots or formed in situ may account for the poor clinical improvement of acute ischemic stroke after recanalization therapy. We attempted to determine whether microbubble-mediated sonothrombolysis could dissolve platelet-rich and erythrocyte-rich microthrombi, thereby reducing their brain injury-causing potential. Platelet- and erythrocyte-rich microthrombosis were induced by periadventitial application of 5% ferric chloride or thrombin to mesenteric microvessels in 75 Sprague-Dawley rats. Acute ischemic stroke was induced by intracarotid injection of platelet- or erythrocyte-rich microthrombi in another 50 rats. Rats were randomly divided into control (CON), ultrasound (US), ultrasound and microbubble (US+MB), recombinant tissue-type plasminogen activator (r-tPA), and US+MB+r-tPA groups. The post-treatment mesenteric microvessel recanalization rates, cerebral infarct volumes, and neurological scores were determined. The recanalization rates of platelet- and erythrocyte-rich microthrombi in mesenteric microvessels were higher (Pacute ischemic stroke. Thus, this method may serve as an attractive adjunct to recanalization therapy for acute ischemic stroke. © 2016 American Heart Association, Inc.

  8. Small-World Characteristics of Cortical Connectivity Changes in Acute Stroke.

    Science.gov (United States)

    Caliandro, Pietro; Vecchio, Fabrizio; Miraglia, Francesca; Reale, Giuseppe; Della Marca, Giacomo; La Torre, Giuseppe; Lacidogna, Giordano; Iacovelli, Chiara; Padua, Luca; Bramanti, Placido; Rossini, Paolo Maria

    2017-01-01

    Background After cerebral ischemia, disruption and subsequent reorganization of functional connections occur both locally and remote to the lesion. Recently, complexity of brain connectivity has been described using graph theory, a mathematical approach that depicts important properties of complex systems by quantifying topologies of network representations. Functional and dynamic changes of brain connectivity can be reliably analyzed via electroencephalography (EEG) recordings even when they are not yet reflected in structural changes of connections. Objective We tested whether and how ischemic stroke in the acute stage may determine changes in small-worldness of cortical networks as measured by cortical sources of EEG. Methods Graph characteristics of EEG of 30 consecutive stroke patients in acute stage (no more than 5 days after the event) were examined. Connectivity analysis was performed using eLORETA in both hemispheres. Results Network rearrangements were mainly detected in delta, theta, and alpha bands when patients were compared with healthy subjects. In delta and alpha bands similar findings were observed in both hemispheres regardless of the side of ischemic lesion: bilaterally decreased small-worldness in the delta band and bilaterally increased small-worldness in the alpha2 band. In the theta band, bilaterally decreased small-worldness was observed only in patients with stroke in the left hemisphere. Conclusions After an acute stroke, brain cortex rearranges its network connections diffusely, in a frequency-dependent modality probably in order to face the new anatomical and functional frame.

  9. Influence of dysphagia on infection incidence of patients with acute cerebral stroke%急性脑卒中吞咽障碍患者感染的影响分析

    Institute of Scientific and Technical Information of China (English)

    郑刚; 郑钱雷; 徐前炜; 黎良达; 刘勇

    2016-01-01

    目的:分析吞咽障碍对急性脑卒中患者感染的影响,从而为临床防治提供理论参考依据。方法选取2013年9月-2015年9月医院神经内科收治的急性脑卒中患者180例,根据有无吞咽障碍将患者分为观察组与对照组,各90例,对比两组患者感染率,数据采用SPSS 19.0软件进行统计分析。结果观察组患者感染44例,感染率为48.89%,对照组患者感染23例,感染率为25.56%,观察组患者感染率明显高于对照组,观察组患者各项营养指标差于对照组,NIHSS评分也低于对照组,差异均有统计学意义(P<0.05)。结论吞咽障碍增加急性脑卒中患者感染率,降低神经康复效果,临床上应采取措施进行防治。%OBJECTIVE To analyze the impact of dysphagia in stroke patients with acute infection ,so as to provide a theoretical basis for clinical prevention .METHODS Totally 180 cases of acute stroke patients admitted to hospi‐tal neurology from Sept .2013 to Sept .2015 were selected .They were divided into observation group and control group with 90 cases each according to whether had dysphagia .The infection rates of the two groups were com‐pared .SPSS 19 .0 was adopted for statistical analysis .RESULTS Totally 44 cases got infected in the observation group and the infection rate was 48 .89% .While in the control group ,23 cases appeared infection and infection rate was 25 .56% .The infection rate in the observation group was significantly higher than the control group ,the nutritional indicators of the observation group were inferior to those of the control group ,and the NIHSS score of the observation group was lower than that of the control group , with statistical significance ( P< 0 .05 ) . CONCLUSION The prevalence of dysphagia in acute stroke patients will increase the infection rate and reduce the effects of neurological rehabilitation .Relevant measures should be taken for prevention and

  10. Watershed Cerebral Infarction in a Patient with Acute Renal Failure

    Directory of Open Access Journals (Sweden)

    Ruya Ozelsancak

    2016-02-01

    Full Text Available Acute renal failure can cause neurologic manifestations such as mood swings, impaired concentration, tremor, stupor, coma, asterixis, dysarthria. Those findings can also be a sign of cerebral infarct. Here, we report a case of watershed cerebral infarction in a 70-year-old female patient with acute renal failure secondary to contrast administration and use of angiotensin converting enzyme inhibitor. Patient was evaluated with magnetic resonance imaging because of dysarthria. Magnetic resonance imaging revealed milimmetric acute ischemic lesion in the frontal and parietal deep white matter region of both cerebral hemisphere which clearly demonstrated watershed cerebral infarction affecting internal border zone. Her renal function returned to normal levels on fifth day of admission (BUN 32 mg/dl, creatinine 1.36 mg/dl and she was discharged. Dysarthria continued for 20 days.

  11. The Specific Features of Oxygen Transport in the Acute Period of Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    K. V. Lukashev

    2010-01-01

    Full Text Available Objective: to study the oxygen transport system in the acute period of ischemic stroke (IS. Subjects and methods. Central hemodynamics and the oxygen transport system were studied, intracranial pressure was measured, cerebral perfusion pressure was calculated and neurophysiological and X-ray studies were conducted in 36 patients in the first 7 days of IS. Results. In the first 5 study days, circulatory hypoxia developed due to evolving hypodynamic circulation. Later on, the situation was deteriorated by arterial hypoxemia due to acute respiratory distress syndrome and increased pulmonary shunting. Simultaneously on days 5 and 7, there were reductions in the oxygen consumption index and oxygen extraction coefficient, which was due to vasoconstriction, higher blood flow velocity, and lower oxygen extraction. Neurophysiological evidence was used to diagnose sub- and decompensation of stem structural functions. Conclusion. Vasoconstriction leads to the development of circulatory hypoxia. Thus, the early period of ischemic stroke is marked by the decreased oxygen delivery index due to the development of hypodynamic circulation. This is further attended by pulmonary complications and microcircula-tory disorders. On day 5 of the acute period, noncardiogenic pulmonary edema developed and pulmonary shunt increased, by worsening hypoxia. Impaired function of stem structures due to their damage, as evidenced by clinical, neurophysiologi-cal, radiological, and autoptic studies, is one of the causes of hemodynamic disorders, thereby impairing the oxygen transport system. Key words: acute cerebral circulatory disorder, oxygen transport system.

  12. Prevention of the collapse of pial collaterals by remote ischemic perconditioning during acute ischemic stroke.

    Science.gov (United States)

    Ma, Junqiang; Ma, Yonglie; Dong, Bin; Bandet, Mischa V; Shuaib, Ashfaq; Winship, Ian R

    2017-08-01

    Collateral circulation is a key variable determining prognosis and response to recanalization therapy during acute ischemic stroke. Remote ischemic perconditioning (RIPerC) involves inducing peripheral ischemia (typically in the limbs) during stroke and may reduce perfusion deficits and brain damage due to cerebral ischemia. In this study, we directly investigated pial collateral flow augmentation due to RIPerC during distal middle cerebral artery occlusion (MCAo) in rats. Blood flow through pial collaterals between the anterior cerebral artery (ACA) and the MCA was assessed in male Sprague Dawley rats using in vivo laser speckle contrast imaging (LSCI) and two photon laser scanning microscopy (TPLSM) during distal MCAo. LSCI and TPLSM revealed that RIPerC augmented collateral flow into distal MCA segments. Notably, while control rats exhibited an initial dilation followed by a progressive narrowing of pial arterioles 60 to 150-min post-MCAo (constricting to 80-90% of post-MCAo peak diameter), this constriction was prevented or reversed by RIPerC (such that vessel diameters increased to 105-110% of post-MCAo, pre-RIPerC diameter). RIPerC significantly reduced early ischemic damage measured 6 h after stroke onset. Thus, prevention of collateral collapse via RIPerC is neuroprotective and may facilitate other protective or recanalization therapies by improving blood flow in penumbral tissue.

  13. THE EFFECT OF ANISODAMINE ON CEREBRAL RESUSCITATION OF RATS IN ACUTE CEREBRAL ISCHEMIA FROM CARDIAC ARREST

    Institute of Scientific and Technical Information of China (English)

    彭新琦; 曹苏谊; 可君

    1995-01-01

    In order to investigate the mechanisms of acute cerebral ischemia,and to look for effective drugs on cerebral resuscitation,we made a model of acute complete global brain ischemia,reperfusion and resuscita-tion on rats according to Garavilla's method.Our results showed that the event of cerebral ischemia and reperfusion injury could result in the in-crease of total brain calcium content,and anisodamine has the same reducing brain calcium contents as dil-tiazem's,while improving neurological outcome and alleviating injury to neurons.

  14. [Application of peloidotherapy at the early stage of rehabilitation after cerebral ischemic stroke].

    Science.gov (United States)

    Gorbunov, F E; Penionzhkevich, D Iu; Kotenko, E P

    2010-01-01

    The objective of the present study was to evaluate clinical efficiency of peloidotherapy in the early reconvalescence period following cerebral ischemic stroke. A rationale for the application of peloidotherapy is presented based on the results of follow-up of 60 patients (26 men and 34 women) aged from 43 to 70 years at the early stage of recovery (within 10 weeks and more after stroke). Special attention was given to clinical dynamics of the post-stroke condition and the influence of peloidotherapy on the mechanisms underlying formation of cerebral hemodynamic effects, adaptive changes in the functional systems of hemostasis and microcirculation, and development of pathophysiological cascade of metabolic processes in the brain. All therapeutic procedures were fairly well tolerated by the patients. Neither allergic reactions nor other adverse effects of the treatment were documented which testifies to the safety of peloidotherapy at the early stage of rehabilitation after cerebral ischemic stroke.

  15. Neuronal and Glia-Related Biomarkers in Cerebrospinal Fluid of Patients with Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Clara Hjalmarsson

    2014-01-01

    Full Text Available Background Cerebral ischemia promotes morphological reactions of the neurons, astrocytes, oligodendrocytes, and microglia in experimental studies. Our aim was to examine the profile of CSF (cerebrospinal fluid biomarkers and their relation to stroke severity and degree of white matter lesions (WML. Methods A total of 20 patients (mean age 76 years were included within 5–10 days after acute ischemic stroke (AIS onset. Stroke severity was assessed using NIHSS (National Institute of Health stroke scale. The age-related white matter changes (ARWMC scale was used to evaluate the extent of WML on CT-scans. The concentrations of specific CSF biomarkers were analyzed. Results Patients with AIS had significantly higher levels of NFL (neurofilament, light, T-tau, myelin basic protein (MBP, YKL-40, and glial fibrillary acidic protein (GFAP compared with controls; T-Tau, MBP, GFAP, and YKL-40 correlated with clinical stroke severity, whereas NFL correlated with severity of WML (tested by Mann–Whitney test. Conclusions Several CSF biomarkers increase in AIS, and they correlate to clinical stroke severity. However, only NFL was found to be a marker of degree of WML.

  16. Berlin prehospital or usual delivery of acute stroke care - Study protocol.

    Science.gov (United States)

    Ebinger, Martin; Harmel, Peter; Nolte, Christian H; Grittner, Ulrike; Siegerink, Bob; Audebert, Heinrich J

    2017-08-01

    Rationale Prehospital stroke care in specialized ambulances increases thrombolysis rates, reduces alarm-to-treatment times, and improves the prehospital triage. Preliminary analyses suggest cost-effectiveness. However, scientific proof of better functional outcome compared to usual care is still lacking. Aim To prove better functional outcomes after deployment of the Stroke Emergency Mobile compared to regular ambulances. Sample size estimates A sample size of 686 patients will be required in each arm (Stroke Emergency Mobile group vs. regular care) to detect a difference regarding the primary outcome with 80% power at a two-sided significance level of 0.05. Methods and design This is a pragmatic, prospective study with blinded outcome assessment. Primary outcome will be functional status as defined by modified Rankin Scale score three months after the incident event. We will include cerebral ischemia patients within a predefined catchment area in Berlin, Germany. The study population consists of patients who might be candidates for acute recanalizing treatments, with onset-to-alarm time ≤4 h, symptoms not resolved at time of ambulance arrival, and able to walk without assistance prior to the qualifying incident. About 45% of Stroke Emergency Mobile dispatches are expected to be handled by regular ambulances, since Stroke Emergency Mobile will be already in operation creating the control group. Primary outcome Functional outcome after three months measured by the modified Rankin Scale over the entire range. Discussion The results will inform decision makers on the effectiveness of Stroke Emergency Mobile.

  17. Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction.

    Directory of Open Access Journals (Sweden)

    Siamak Abdi

    2015-03-01

    Full Text Available Serum troponin elevation, characteristic of ischemic myocardial injury, has been observed in some acute ischemic stroke (AIS patients. Its cause and significance are still controversial. The purpose of this study is to find determinants of troponin elevation and its relationship with stroke severity and location.Between January 2013 and August 2013, 114 consecutive AIS patients confirmed by diffusion-weighted magnetic resonance imaging were recruited in this study. Serum troponin T level was measured as part of routine laboratory testing on admission. Ten lead standard electrocardiogram (ECG was performed and stoke severity was assessed based on National Institutes of Health Stroke Scale (NIHSS.Troponin T was elevated in 20 (17.6% of 114 patients. Patients with elevated troponin were more likely to have higher age, higher serum creatinine and ischemic ECG changes. Troponin levels were higher in patients with more severe stroke measured by NIHSS [7.96 (6.49-9.78 vs. 13.59 (10.28-18.00]. There was no association between troponin and locations of stroke and atrial fibrillation. There were 6 (5% patients with elevated troponin in the presence of normal creatinine and ECG.Stroke severity, not its location, was associated with higher troponin levels. Abnormal troponin levels are more likely, but not exclusively, to be due to cardiac and renal causes than cerebral ones.

  18. Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection.

    Science.gov (United States)

    Leshnower, Bradley G; Thourani, Vinod H; Halkos, Michael E; Sarin, Eric L; Keeling, William B; Lamias, Mark J; Guyton, Robert A; Chen, Edward P

    2015-11-01

    Despite improved results with surgical therapy for acute type A aortic dissection (ATAAD), there remains a lack of consensus regarding the optimal method of cerebral protection and circulation management during ATAAD. The purpose of this study is to determine whether in the setting of antegrade cerebral perfusion, moderate hypothermic circulatory arrest (MHCA) provides equivalent cerebral and visceral protection as deep hypothermic circulatory arrest (DHCA) for patients undergoing emergent ATAAD repair. A review of the Emory aortic surgery database from 2004 to 2014 identified 288 patients who underwent ATAAD with right axillary artery cannulation, unilateral selective antegrade cerebral perfusion (uSACP), and hypothermic circulatory arrest (HCA). In all, 88 patients underwent HCA at 24 °C or lower (DHCA), and 206 patients underwent HCA at more than 24 °C (MHCA). Major adverse outcomes of death, stroke, temporary neurologic dysfunction, and dialysis-dependent renal failure were examined. The groups were well matched for age and major comorbidities. The DHCA patients underwent HCA at lower temperatures (DHCA 21.6 ± 3.1 °C vs MHCA 27.4 ± 1.6 °C, p 0.05). Moderate HCA with uSACP is an effective circulation management strategy that provides excellent cerebral and visceral protection during emergent ATAAD repair. In the setting of antegrade cerebral perfusion, deep hypothermia does not provide any additional benefit. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Seeters, Tom van; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: on behalf of the Dutch acute stroke study (DUST) investigators

    2016-10-15

    Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome. We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion. The determinants of poor leptomeningeal collateral flow (≤50 % collateral filling) were identified with logistic regression. We calculated the relative risk (RR) of poor leptomeningeal collateral flow in relation to poor clinical outcome (90-day modified Rankin Scale 3-6) using Poisson regression and assessed whether the determinants of leptomeningeal collateral flow affected this relation. Leptomeningeal collateral flow was poor in 142 patients (29 %). In multivariable analyses, higher admission glucose level (odds ratio (OR) 1.1 per mmol/L increase (95 % CI 1.0-1.2)), a proximal MCA occlusion (OR 1.9 (95 % CI 1.3-3.0)), and an incomplete posterior circle of Willis (OR 1.7 (95 % CI 1.1-2.6)) were independently related to poor leptomeningeal collateral flow. Poor leptomeningeal collateral flow was related to poor clinical outcome (unadjusted RR 1.7 (95 % CI 1.4-2.0)), and this relation was not affected by the determinants of leptomeningeal collateral flow. Our study shows that admission glucose level, a proximal MCA occlusion, and an incomplete ipsilateral posterior circle of Willis are determinants of leptomeningeal collateral flow that represent a combination of congenital, acquired, and acute factors. After adjustment for these determinants, leptomeningeal collateral flow remains related to clinical outcome. (orig.)

  20. Treatment of acute hydrocephalus and cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    D. Hasan (Djo)

    1990-01-01

    textabstractOnly recently has acute hydrocephalus after subarachnoid hemorrhage been recognized as a clinical important problem. The mortality rate in patients with acute hydrocephalus after subarachnoid hemorrhage is higher than in those without, which is mainly caused by cerebral ischemia. An expl

  1. Treatment of acute hydrocephalus and cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    D. Hasan (Djo)

    1990-01-01

    textabstractOnly recently has acute hydrocephalus after subarachnoid hemorrhage been recognized as a clinical important problem. The mortality rate in patients with acute hydrocephalus after subarachnoid hemorrhage is higher than in those without, which is mainly caused by cerebral ischemia. An

  2. Value of perfusion computed tomography in acute ischemic stroke: diagnosis of infarct core and penumbra.

    Science.gov (United States)

    Pan, Jiawei; Zhang, Jun; Huang, Weiyuan; Cheng, Xin; Ling, Yifeng; Dong, Qiang; Geng, Daoying

    2013-01-01

    This study aimed to perform an evaluation of 4 perfusion computed tomographic (PCT) parameters (relative cerebral blood flow, cerebral blood volume, mean transit time [MTT], and delay time [DT]) in a series of patients with acute ischemic stroke to find optimal parameters to predict infarct core and penumbra. Twenty-six patients with symptoms suggesting stroke less than 7 hours from onset were enrolled in this study. They all underwent admission and 24-hour PCT and a 24-hour diffusion-weighted imaging. Perfusion computed tomographic maps were assessed for relative reduced cerebral blood flow and cerebral blood volume and increased MTT and DT. Receiver operating characteristic curve analysis was performed to locate the optimal threshold for each parameter, using diffusion-weighted imaging as the gold standard. The PCT parameter that most accurately describes the penumbra is the relative MTT of 150% or greater (area under the curve, 0.827; 95% confidence interval, 0.826-0.827), whereas the parameter that most accurately describes the infarct core is the relative DT of + 2.0 seconds or greater (area under the curve, 0.879; 95% confidence interval, 0.878-0.879). The optimal parameters to define the infarct core and the penumbra are relative DT (≥+ 2.0 seconds) and relative MTT (≥ 150%).

  3. Role of Aquaporin-4 in Cerebral Edema and Stroke

    OpenAIRE

    Zador, Zsolt; Stiver, Shirley; Wang, Vincent; MANLEY, GEOFFREY T.

    2009-01-01

    Cerebral edema plays a central role in the pathophysiology of many diseases of the central nervous system (CNS) including ischemia, trauma, tumors, inflammation, and metabolic disturbances. The formation of cerebral edema results in an increase in tissue water content and brain swelling which, if unchecked, can lead to elevated intracranial pressure (ICP), reduced cerebral blood flow, and ultimately cerebral herniation and death. Despite the clinical significance of cerebral edema, the mechan...

  4. Observation on the curative effect of the stroke unit combined with hyperbaric oxygen in the treatment of conscious disorder associated with acute cerebral hemorrhage%卒中单元联合高压氧治疗急性脑出血意识障碍的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王轶群; 夏添; 杨世泉; 余本松; 程晋成

    2015-01-01

    Objective To observe the clinical effect of the stroke unit combined with hyperbaric oxygen (HBO) in the treatment of patients with conscious disorder associated with acute cerebral hemorrhage . Methods The patients were divided into the stroke unit group (or the SU group) and the control group.Thepatients of the 2 groups all received routine mini-traumatic trepanation and drug treatment.In addition, thecontrol group received routine medical treatment , HBO therapy and rehabilitation treatment, while the SU groupreceived comprehensive rehabilitation treatment and HBO therapy in accordance with standard operatingprocedures.Clinical therapeutic effects both before and after treatment were compared between the 2 groups,evaluated with Glasgow coma scale (GCS) scores and neurologic impairment scores, and changes in cerebralvascular function were detected as well.Results After treatment, neurological impairment of the SU group(6.57 ±2.24)was improved more significantly than that of the control group (8.93 ±3.41).GCS scores of theSU group(14.56 ±2.71) were significantly increased than those of the control group (10.25 ±2.32).Inaddition, the indexes of cerebral vascular function were greatly improved , with that of the SU group beingobviously better than that of the control group .Conclusions Stroke unit treatment combined with HBO couldsignificantly improve conscious disorder of the patients associated with acute cerebral hemorrhage , and thetherapeutic efficacy was significantly superior to that of ordinary hospitalization mode .%目的:观察卒中单元联合高压氧治疗急性脑出血伴发意识障碍患者的临床疗效。方法将500例研究对象分为卒中单元组(stroke unit,SU组,280例)和对照组(220例),均常规采用颅内血肿微创清除术及药物治疗,对照组采用常规内科及高压氧和康复治疗,卒中单元组按标准化操作程序,给予综合康复及高压氧治疗。在治疗前后通过Glasgow评

  5. The effects of citicoline on acute ischemic stroke: a review.

    Science.gov (United States)

    Overgaard, Karsten

    2014-08-01

    Early reopening of the occluded artery is, thus, important in ischemic stroke, and it has been calculated that 2 million neurons die every minute in an ischemic stroke if no effective therapy is given; therefore, "Time is Brain." In massive hemispheric infarction and edema, surgical decompression lowers the risk of death or severe disability defined as a modified Rankin Scale score greater than 4 in selected patients. The majority, around 80%-85% of all ischemic stroke victims, does not fulfill the criteria for revascularization therapy, and also for these patients, there is no effective acute therapy. Also there is no established effective acute treatment of spontaneous intracerebral bleeding. Therefore, an effective therapy applicable to all stroke victims is needed. The neuroprotective drug citicoline has been extensively studied in clinical trials with volunteers and more than 11,000 patients with various neurologic disorders, including acute ischemic stroke (AIS). The conclusion is that citicoline is safe to use and may have a beneficial effect in AIS patients and most beneficial in less severe stroke in older patients not treated with recombinant tissue plasminogen activator. No other neuroprotective agent had any beneficial effect in confirmative clinical trials or had any positive effect in the subgroup analysis. Citicoline is the only drug that in a number of different clinical stroke trials continuously had some neuroprotective benefit.

  6. Role of magnesium sulfate in neuroprotection in acute ischemic stroke

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    Harpreet Singh

    2012-01-01

    Full Text Available Aims: To study the effect of intravenous magnesium sulfate infusion on clinical outcome of patients of acute stroke. Materials and Methods: Sixty consecutive cases of acute ischemic stroke hospitalised within 24 h of an episode of stroke were taken as subjects. All subjects underwent a computed tomography head, and those found to have evidence of bleed/space-occupying lesions were excluded from the study. The subjects taken up for the study were divided into two groups of 30 subjects each. Both the groups received the standard protocol management for acute ischemic stroke. Subjects of Group 1 additionally received intravenous magnesium sulfate as initial 4 g bolus dose over 15 min followed by 16 g as slow infusion over the next 24 h. In all the subjects of the two study groups, serum magnesium levels were estimated at the time of admission (Day 0, Day 1 and Day 2 of hospitalization using an atomic absorption spectrometer. Statistical Analysis Used: Scandinavian stroke scores were calculated on Day 3, day of discharge and Day 28. Paired t-test was employed for comparison of stroke scores on Day 3, day of discharge and Day 28 within the same group and the unpaired t-test was used for the intergroup comparison, i.e. comparison of stroke scores of control group with corresponding stroke scores of magnesium group. Results: Comparison of stroke scores on Day 3 and day of discharge, on the day of discharge and Day 28 and on Day 3 and Day 28 in the magnesium group produced a t-value of 5.000 and P 0.05, which was not significant. Conclusions: The study failed to document a statistical significant stroke recovery in spite of achieving a significant rise in serum magnesium level, more than that necessary for neuroprotection, with an intravenous magnesium sulfate regime.

  7. Imaging biomarkers in acute ischemic stroke trials: a systematic review.

    Science.gov (United States)

    Harston, G W J; Rane, N; Shaya, G; Thandeswaran, S; Cellerini, M; Sheerin, F; Kennedy, J

    2015-05-01

    Imaging biomarkers are increasingly used to provide a better understanding of the pathophysiology of acute ischemic stroke. However, this approach of routinely using imaging biomarkers to inform treatment decisions has yet to be translated into successful randomized trials. The aim of this study was to systematically review the use of imaging biomarkers in randomized controlled trials in patients with acute ischemic stroke, exploring the purposes for which the imaging biomarkers were used. We performed a systematic review of imaging biomarkers used in randomized controlled trials of acute ischemic stroke, in which a therapeutic intervention was trialed within 48 hours of symptom onset. Data bases searched included MEDLINE, EMBASE, strokecenter.org, and the Virtual International Stroke Trials Archive (1995-2014). Eighty-four studies met the criteria, of which 49 used imaging to select patients; 31, for subgroup analysis; and 49, as an outcome measure. Imaging biomarkers were broadly used for 8 purposes. There was marked heterogeneity in the definitions and uses of imaging biomarkers and significant publication bias among post hoc analyses. Imaging biomarkers offer the opportunity to refine the trial cohort by minimizing participant variation, to decrease sample size, and to personalize treatment approaches for those who stand to benefit most. However, within imaging modalities, there has been little consistency between stroke trials. Greater effort to prospectively use consistent imaging biomarkers should help improve the development of novel treatment strategies in acute stroke and improve comparison between studies. © 2015 by American Journal of Neuroradiology.

  8. Maintenance of normoglycemia may improve outcome in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sruthi S Nair

    2017-01-01

    Full Text Available Introduction: Several studies have shown that high admission glucose is associated with poor outcomes after stroke, but the impact of maintenance of normoglycemia on functional outcome during hospitalization for acute ischemic stroke is less well established. Aims: The aim of this study was to examine the independent association of postadmission glycemic status in the 1st week with 3-month functional outcome in patients with acute ischemic stroke. Methods: Patients with acute ischemic stroke admitted within 48 h of symptom onset with National Institutes of Health Stroke Scale (NIHSS of ≥4 were selected from a prospectively maintained database by chart review. Demographic data, risk factors, NIHSS, and blood glucose values in the 1st week were collected. The primary outcome was Modified Rankin Scale (mRS score at 3 months (good outcome-mRS ≤2. Results: Over 3 years, 342 patients were enrolled with 220 (64.32% males. Mean age was 60.5 ± 13.4 years, and median admission score on NIHSS was 10 (interquartile range: 6–16. Blood glucose values persistently <140 mg/dl in the 1st week were associated with a good 3-month functional outcome in univariate analysis (P = 0.036. Hypoglycemic episodes occurred only in 11 (3.22% patients. Conclusions: Blood glucose values persistently below 140 mg/dl in the 1st week after acute ischemic stroke were associated with a favorable outcome in our study. Future clinical trials are needed to confirm these findings.

  9. Endovascular vs medical management of acute ischemic stroke.

    Science.gov (United States)

    Chen, Ching-Jen; Ding, Dale; Starke, Robert M; Mehndiratta, Prachi; Crowley, R Webster; Liu, Kenneth C; Southerland, Andrew M; Worrall, Bradford B

    2015-12-01

    To compare the outcomes between endovascular and medical management of acute ischemic stroke in recent randomized controlled trials (RCT). A systematic literature review was performed, and multicenter, prospective RCTs published from January 1, 2013, to May 1, 2015, directly comparing endovascular therapy to medical management for patients with acute ischemic stroke were included. Meta-analyses of modified Rankin Scale (mRS) and mortality at 90 days and symptomatic intracranial hemorrhage (sICH) for endovascular therapy and medical management were performed. Eight multicenter, prospective RCTs (Interventional Management of Stroke [IMS] III, Local Versus Systemic Thrombolysis for Acute Ischemic Stroke [SYNTHESIS] Expansion, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy [MR RESCUE], Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN], Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness [ESCAPE], Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial [EXTEND-IA], Solitaire With the Intention For Thrombectomy as Primary Endovascular Treatment [SWIFT PRIME], and Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours [REVASCAT]) comprising 2,423 patients were included. Meta-analysis of pooled data demonstrated functional independence (mRS 0-2) at 90 days in favor of endovascular therapy (odds ratio [OR] = 1.71; p = 0.005). Subgroup analysis of the 6 trials with large vessel occlusion (LVO) criteria also demonstrated functional independence at 90 days in favor of endovascular therapy (OR = 2.23; p acute ischemic stroke in the setting of LVO. © 2015 American Academy of Neurology.

  10. Symptomatic steno-occlusion in patients with acute cerebral infarction: prevalence, distribution, and functional outcome.

    Science.gov (United States)

    Kang, Jihoon; Park, Tai Hwan; Lee, Kyung Bok; Park, Jong-Moo; Ko, Youngchai; Lee, Soo Joo; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Ji Sung; Lee, Juneyoung; Lee, Byung-Chul; Yu, Kyung-Ho; Kim, Dae-Hyun; Cha, Jae-Kwan; Lee, Jun; Jang, Myung Suk; Han, Moon-Ku; Bae, Hee-Joon

    2014-01-01

    Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (Plocation (P for contrast=0.21). Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.

  11. Clinical implications of eye deviation on admission CT examination of acute ischaemic stroke patients.

    Science.gov (United States)

    Payabvash, S; Qureshi, I; Qureshi, A I

    2016-12-01

    To determine the frequency and prognostic value of eye deviation detected on the admission computed tomography (CT) of acute ischaemic stroke patients. The clinical and imaging data from the Albumin in Acute Stroke (ALIAS) Trials 1 and 2 were analysed. Two reviewers evaluated all admission CT images for the presence of eye deviation, and Alberta Stroke Program Early CT Score (ASPECTS). The admission National Institutes of Health Stroke Scale (NIHSS) scores and 3-month modified Rankin scale (mRs) scores were ascertained. Disability or death was defined as mRS score >2, at 3-month follow-up. Of 1,223 patients included in the present series, 352 (28.8%) had rightward and 331 (27.1%) had leftward eye deviation on admission CT. Patients with eye deviation on CT had higher admission NIHSS score and larger middle cerebral artery (MCA) territory infarct volume (based on ASPECTS). The presence of eye deviation on CT was associated with higher rates of haemorrhagic transformation at 24 hours (19.8% versus 13.5%, p=0.004), and higher rates of disability or death at 3-month follow-up (53.1% versus 35.7%, peye deviation relation with higher rate of disability or death is predominantly due to its association with higher admission NIHSS scores, lower ASPECTS, and to a lesser extent patients' older age. The presence of eye deviation on CT examination of acute ischaemic stroke patients is associated with larger anterior circulation stroke volumes, higher risk of 24-hour haemorrhagic transformation, and 3-month disability or death. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Perfusion differences on SPECT and PWI in patients with acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Nuutinen, Juho [Kuopio University Hospital, University of Kuopio, Department of Neurology, Kuopio (Finland); Liu, Yawu; Laakso, Mikko P. [Kuopio University Hospital, University of Kuopio, Department of Neurology, Kuopio (Finland); Kuopio University Hospital, University of Kuopio, Department of Clinical Radiology, P. O. Box 1777, Kuopio (Finland); Karonen, Jari O. [Mikkeli Central Hospital, Department of Radiology, Mikkeli (Finland); Vanninen, Esko J. [Kuopio University Hospital, University of Kuopio, Department of Clinical Physiology and Nuclear Medicine, Kuopio (Finland); Kuikka, Jyrki T. [Kuopio University Hospital, University of Kuopio, Department of Clinical Physiology and Nuclear Medicine, Kuopio (Finland); Niuvanniemi Hospital, Kuopio (Finland); Aronen, Hannu J. [University of Turku, Department of Radiology, Turku (Finland); Vanninen, Ritva L. [Kuopio University Hospital, University of Kuopio, Department of Clinical Radiology, P. O. Box 1777, Kuopio (Finland)

    2009-10-15

    The purposes of the present study were to compare the flow defect volumes on perfusion-weighted magnetic resonance imaging (PWI) and {sup 99m}Tc-labeled ethylcysteinate dimer ({sup 99m}Tc-ECD) single photon emission computed tomography (SPECT) at acute and subacute stages of ischemic stroke and to analyze the relationship between the detected flow defects on the two methods and neurological status and clinical outcomes. Perfusion defects on PWI and SPECT were measured within 48 h and on day 8 of the onset of stroke from 22 patients with their first-ever acute supratentorial ischemic stroke. The primary neurological status was evaluated prior to the imaging. Clinical outcome was assessed at 3 months after the onset of the stroke. The volumes of cerebral blood flow (CBF) defects did not differ between SPECT and PWI within the 48-h examinations. However, the volume of CBF defect was significantly larger on SPECT than on PWI on day 8 (p = 0.03). Within the 48-h examinations, the CBF defect volumes on SPECT and PWI were comparably related to the neurological status. On day 8, the CBF defect volume on SPECT showed higher correlation to the neurological status and more precisely predicted the clinical outcomes at 3 months than PWI. {sup 99m}TC-ECD-SPECT and PWI both have ability to detect cerebral hypoperfusion in patients with ischemic stroke but with some differences. The value of SPECT is more accurate in terms of the delayed outcome, such as prognosis and rehabilitation planning. (orig.)

  13. Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jeromel, Miran, E-mail: miran.jeromel@gmail.com; Milosevic, Z. V., E-mail: zoran.milosevic@guest.arnes.si; Kocijancic, I. J., E-mail: igor.kocijancic@gmail.com; Lovric, D., E-mail: dimitrijlavric@yahoo.com [University Medical Centre Ljubljana, Clinical Institute of Radiology, Department for Diagnostic and Interventional Neuroradiology (Slovenia); Svigelj, V., E-mail: viktor.svigelj@gmail.com; Zvan, B., E-mail: bojana.zvan@guest.arnes.si [University Medical Centre Ljubljana, Division Vascular and Intensive Neurology, Department of Neurology (Slovenia)

    2013-04-15

    BackgroundEndovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. The mean age of the patients was 63.1 {+-} 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5-19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS {<=}2) 30 days after stroke. Overall, significant neurological improvement ({>=}4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of {>=}4 or death occurred in three (5 %) patients. The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

  14. Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA

    Science.gov (United States)

    Wilson, Duncan; Charidimou, Andreas; Ambler, Gareth; Fox, Zoe V.; Gregoire, Simone; Rayson, Phillip; Imaizumi, Toshio; Fluri, Felix; Naka, Hiromitsu; Horstmann, Solveig; Veltkamp, Roland; Rothwell, Peter M.; Kwa, Vincent I.H.; Thijs, Vincent; Lee, Yong-Seok; Kim, Young Dae; Huang, Yining; Wong, Ka Sing; Jäger, Hans Rolf

    2016-01-01

    Objective: To determine associations between cerebral microbleed (CMB) burden with recurrent ischemic stroke (IS) and intracerebral hemorrhage (ICH) risk after IS or TIA. Methods: We identified prospective studies of patients with IS or TIA that investigated CMBs and stroke (ICH and IS) risk during ≥3 months follow-up. Authors provided aggregate summary-level data on stroke outcomes, with CMBs categorized according to burden (single, 2–4, and ≥5 CMBs) and distribution. We calculated absolute event rates and pooled risk ratios (RR) using random-effects meta-analysis. Results: We included 5,068 patients from 15 studies. There were 115/1,284 (9.6%) recurrent IS events in patients with CMBs vs 212/3,781 (5.6%) in patients without CMBs (pooled RR 1.8 for CMBs vs no CMBs; 95% confidence interval [CI] 1.4–2.5). There were 49/1,142 (4.3%) ICH events in those with CMBs vs 17/2,912 (0.58%) in those without CMBs (pooled RR 6.3 for CMBs vs no CMBs; 95% CI 3.5–11.4). Increasing CMB burden increased the risk of IS (pooled RR [95% CI] 1.8 [1.0–3.1], 2.4 [1.3–4.4], and 2.7 [1.5–4.9] for 1 CMB, 2–4 CMBs, and ≥5 CMBs, respectively) and ICH (pooled RR [95% CI] 4.6 [1.9–10.7], 5.6 [2.4–13.3], and 14.1 [6.9–29.0] for 1 CMB, 2–4 CMBs, and ≥5 CMBs, respectively). Conclusions: CMBs are associated with increased stroke risk after IS or TIA. With increasing CMB burden (compared to no CMBs), the risk of ICH increases more steeply than that of IS. However, IS absolute event rates remain higher than ICH absolute event rates in all CMB burden categories. PMID:27590288

  15. Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A meta-analysis.

    Science.gov (United States)

    Wilson, Duncan; Charidimou, Andreas; Ambler, Gareth; Fox, Zoe V; Gregoire, Simone; Rayson, Phillip; Imaizumi, Toshio; Fluri, Felix; Naka, Hiromitsu; Horstmann, Solveig; Veltkamp, Roland; Rothwell, Peter M; Kwa, Vincent I H; Thijs, Vincent; Lee, Yong-Seok; Kim, Young Dae; Huang, Yining; Wong, Ka Sing; Jäger, Hans Rolf; Werring, David J

    2016-10-04

    To determine associations between cerebral microbleed (CMB) burden with recurrent ischemic stroke (IS) and intracerebral hemorrhage (ICH) risk after IS or TIA. We identified prospective studies of patients with IS or TIA that investigated CMBs and stroke (ICH and IS) risk during ≥3 months follow-up. Authors provided aggregate summary-level data on stroke outcomes, with CMBs categorized according to burden (single, 2-4, and ≥5 CMBs) and distribution. We calculated absolute event rates and pooled risk ratios (RR) using random-effects meta-analysis. We included 5,068 patients from 15 studies. There were 115/1,284 (9.6%) recurrent IS events in patients with CMBs vs 212/3,781 (5.6%) in patients without CMBs (pooled RR 1.8 for CMBs vs no CMBs; 95% confidence interval [CI] 1.4-2.5). There were 49/1,142 (4.3%) ICH events in those with CMBs vs 17/2,912 (0.58%) in those without CMBs (pooled RR 6.3 for CMBs vs no CMBs; 95% CI 3.5-11.4). Increasing CMB burden increased the risk of IS (pooled RR [95% CI] 1.8 [1.0-3.1], 2.4 [1.3-4.4], and 2.7 [1.5-4.9] for 1 CMB, 2-4 CMBs, and ≥5 CMBs, respectively) and ICH (pooled RR [95% CI] 4.6 [1.9-10.7], 5.6 [2.4-13.3], and 14.1 [6.9-29.0] for 1 CMB, 2-4 CMBs, and ≥5 CMBs, respectively). CMBs are associated with increased stroke risk after IS or TIA. With increasing CMB burden (compared to no CMBs), the risk of ICH increases more steeply than that of IS. However, IS absolute event rates remain higher than ICH absolute event rates in all CMB burden categories. © 2016 American Academy of Neurology.

  16. Is misery perfusion still a predictor of stroke in symptomatic major cerebral artery disease?

    Science.gov (United States)

    Yamauchi, Hiroshi; Higashi, Tatsuya; Kagawa, Shinya; Nishii, Ryuichi; Kudo, Takashi; Sugimoto, Kanji; Okazawa, Hidehiko; Fukuyama, Hidenao

    2012-08-01

    Studies in the 1990s demonstrated that misery perfusion is a predictor of subsequent stroke in medically treated patients with symptomatic major cerebral artery disease. A recent randomized controlled trial demonstrated no benefit of bypass surgery for such patients. In this light, outcome in patients with misery perfusion has regained interest. The purpose of this study was to determine whether misery perfusion is still a predictor of subsequent stroke despite recent improvements in medical treatment for secondary prevention of stroke, and if so, whether the predictive value of misery perfusion has changed in recent years. We prospectively studied 165 non-disabled patients with symptomatic atherosclerotic internal carotid artery or middle cerebral artery occlusive diseases who underwent positron emission tomography from 1999 to 2008. Misery perfusion was defined as decreased cerebral blood flow, increased oxygen extraction fraction and decreased ratio of cerebral blood flow to blood volume in the hemisphere supplied by the diseased artery. All patients were followed up for 2 years until stroke recurrence or death. Bypass surgery was performed in 19 of 35 patients with and 16 of 130 patients without misery perfusion. The 2-year incidence of ipsilateral ischaemic stroke was six and four patients with and without misery perfusion, including two and one after surgery, respectively (P misery perfusion and 12 patients without (P misery perfusion in whole sample was 6.3 (95% confidence interval 1.7-22.4, P misery perfusion or bypass surgery did not differ. Between these periods, patients without misery perfusion demonstrated a decrease in stroke rate (from 16.2% to 0%), but patients with misery perfusion did not (26.3 and 25.0%). In symptomatic major cerebral artery disease, misery perfusion remains a predictor of subsequent stroke, although the recurrence rate was lower than the previous study. In patients without misery perfusion, the risk of stroke was reduced

  17. The effects of citicoline on acute ischemic stroke

    DEFF Research Database (Denmark)

    Overgaard, Karsten

    2014-01-01

    therapy. Also there is no established effective acute treatment of spontaneous intracerebral bleeding. Therefore, an effective therapy applicable to all stroke victims is needed. The neuroprotective drug citicoline has been extensively studied in clinical trials with volunteers and more than 11......,000 patients with various neurologic disorders, including acute ischemic stroke (AIS). The conclusion is that citicoline is safe to use and may have a beneficial effect in AIS patients and most beneficial in less severe stroke in older patients not treated with recombinant tissue plasminogen activator....... No other neuroprotective agent had any beneficial effect in confirmative clinical trials or had any positive effect in the subgroup analysis. Citicoline is the only drug that in a number of different clinical stroke trials continuously had some neuroprotective benefit....

  18. A Rare Cause of Stroke in Young Adults: Occlusion of the Middle Cerebral Artery by a Meningioma Postpartum

    Directory of Open Access Journals (Sweden)

    Stéphane Mathis

    2013-01-01

    Full Text Available Meningioma is the most common nonglial intracranial primary tumor. It is a slowly growing tumor and presents clinically by causing seizures along with neurological or neuropsychological deficit. However, acute presentation of meningioma is possible. We are reporting a case of cerebral infarction due to a sphenoid wing meningothelial meningioma (with progesterone receptor positivity leading to an occlusion of the middle cerebral artery (MCA in a 30-year-old right-handed woman (1 month after childbirth. After surgery, no new neurological event occurred, and she recovered most of her neurological functions. Strokes due to meningioma are a highly rare clinical occurrence but should be given serious consideration, particularly in young patients.

  19. Therapeutically Targeting Neuroinflammation and Microglia after Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Youngjeon Lee

    2014-01-01

    Full Text Available Inflammation has a pivotal role in the pathogenesis of ischemic stroke, and recent studies posit that inflammation acts as a double-edged sword, not only detrimentally augmenting secondary injury, but also potentially promoting recovery. An initial event of inflammation in ischemic stroke is the activation of microglia, leading to production of both pro- and anti-inflammatory mediators acting through multiple receptor signaling pathways. In this review, we discuss the role of microglial mediators in acute ischemic stroke and elaborate on preclinical and clinical studies focused on microglia in stroke models. Understanding how microglia can lead to both pro- and anti-inflammatory responses may be essential to implement therapeutic strategies using immunomodulatory interventions in ischemic stroke.

  20. ANALYZING EFFECT OF CONTOURED FOAM SEAT ON MULTIDIRECTIONAL REACHING ABILITY IN ACUTE STROKE SUBJECTS

    Directory of Open Access Journals (Sweden)

    Teena Padiyar

    2013-10-01

    Full Text Available Background &Objective:Cerebrovascular accident is the major disease that leads to an increase in the numberof people with motor or sensory impairment or loss of function on one side of the body (hemipelgia.Poorsitting ability is a common problem after stroke. Sitting involves not only the ability to maintainthe seatedposture, but also the ability to reach for a variety of objects located both within and beyond arm’slength.Contoured foam seat (CFS have shown improvement in sitting posture, head control and upper extremityfunction in pediatric age group suffering from cerebral palsy in previous studies. So this study wasdesigned toevaluate the effectiveness of contoured foam seat on sitting posture and multidirectional reaching ability inacute stroke subjects.Methodology:The study design of this pilot study is having ten Acute stroke subjects assample. After taking the informed consent, subjects were made to sit on a chair and multidirectionalreachingability distance was measured with and without contoured foam seat. Multidirectional reaching distance wasassessed with CFS and without CFS and obtained data was analyzed. Data was collected by measuring themaximum reaching ability distance.Result:Reaching ability in sitting position significantly improved afterapplication of CFS. Unaffected side reaching was significantly improved as compare to forward and affectedside reach after application of CFS.Discussion & Conclusion:Contoured foam seat can significantly improvepelvic alignment and provide a good postural stability thereby improve sitting posture and functional reachingability in acute stroke subjects.

  1. Analysis of the XRCC1 gene as a modifier of the cerebral response in ischemic stroke

    Directory of Open Access Journals (Sweden)

    Juo Suh-Hang H

    2006-11-01

    Full Text Available Abstract Background Although there have been studies of the genetic risk factors in the development of stroke, there have been few investigations of role of genes in the cerebral response to ischemia. The brain responds to ischemia in a series of reactions that ultimately influence the volume of a stroke that, in general, correlates with disability. We hypothesize that polymorphisms in genes encoding proteins involved in these reactions could act as modifiers of this response and impact stroke volume. One of the pathways participating in the cerebral ischemic response involves reactive oxygen species which can cause oxidative damage to nucleic acids. DNA repair mechanisms are in place to protect against such damage and imply a role for DNA repair genes in the response of the brain to ischemia and are potential candidate genes for further investigation. Methods We studied two common polymorphisms in the DNA repair gene, XRCC1, C26304T and G28152A, in 134 well characterized patients with non lacunar ischemic strokes. We also performed a case control association study with 113 control patients to assess whether these variants represent risk factors in the development of ischemic stroke. Results Independent of etiology, the "T" allele of the C26304T polymorphism is significantly associated with larger stroke volumes (T-test analysis, p Conclusion Our study suggests a major gene effect of the "T" allele of the C26304T polymorphism modulating the cerebral response to ischemia in non lacunar ischemic stroke.

  2. Acute hypoxia increases the cerebral metabolic rate

    DEFF Research Database (Denmark)

    Vestergaard, Mark Bitsch; Lindberg, Ulrich; Aachmann-Andersen, Niels Jacob

    2016-01-01

    The aim of the present study was to examine changes in cerebral metabolism by magnetic resonance imaging of healthy subjects during inhalation of 10% O2 hypoxic air. Hypoxic exposure elevates cerebral perfusion, but its effect on energy metabolism has been less investigated. Magnetic resonance......-acetylaspartate, creatine and phosphocreatine were measured in the visual cortex by magnetic resonance spectroscopy. Twenty-three young healthy males were scanned for 60 min during normoxia, followed by 40 min of breathing hypoxic air. Inhalation of hypoxic air resulted in an increase in cerebral blood flow of 15.5% (p = 0...

  3. [Prevalence and risk factor structure of cerebral stroke in people of the Khanty-Mansi autonomous okrug].

    Science.gov (United States)

    Lebedev, I A

    2011-01-01

    Based on the data of cerebral stroke register carried out in the Khanty-Mansi autonomous okrug in 2004-2007, the information on the prevalence of main risk factors has been obtained. Arterial hypertension is the most significant risk factor for all forms of acute cerebral blood flow disturbance. Comparison of prevalence of main risk factors of stroke in residents of this region and people of other regions of the Russian Federation has revealed significant differences for all factors, with the exception of alcohol abuse. The structure of risk factor prevalence in the autonomous okrug differs from that in Russia. The statistically significant differences in the prevalence of all factors for ischemic stroke and non-traumatic intracranial hemorrhages studied were found in men and women living in the okrug as well as in the settled population and in watchmen. Highly significant direct correlations (p<0.0005) between the number of risk factors and the level of early 28 day mortality were revealed.

  4. Serum vitamin B12 and folic Acid levels in acute cerebral atherothrombotic infarction.

    Science.gov (United States)

    Kocer, Abdulkadir; Ince, Nurhan; Canbulat, Cuneyt E; Sargin, Mehmet

    2004-10-01

    Hyperhomocysteinemia is an independent risk factor for atherothrombotic cerebral stroke. Vitamin B12 and folic acid are important determinants of homocysteine metabolism. We aimed to evaluate the relationship, if present, between vitamin B12 and folic acid levels and acute cerebral stroke in this study. Blood aliquots drawn within 24 hours after the stroke from hospitalized patients (n=66) with the diagnosis of acute ischemic cerebrovascular episode and also blood samples from 38 healthy controls without any vascular risk factor were analyzed. With a competitive, chemoluminescence assay, serum levels of vitamin B12 and folic acid were measured in blood samples taken within 24 hours after the stroke. The differences and correlations were tested using frequency test, student-t test and multivariate analysis. Mean serum vitamin B12 levels were significantly lower in the patients than in the control subjects, 245.40 (S.D.: 72.9) and 343.2 (S.D.: 113.0) pg/ml respectively (p=0.0001). This difference was independent from other risk factors. Likewise, mean serum folic acid levels were lower in the patients than in the control subjects, 4.62 (S.D.: 1.94) and 5.97 (S.D.: 1.19) ng/ml, respectively (p=0.003). Mean serum levels of vitamin B12 and folate at the convalescence phase were 253.05 (S.D.: 68.78) pg/ml and 4.48 (S.D.: 2.08) ng/ml, respectively; the values obtained at the acute phase were not significantly different from the values obtained at the convalescence phase. We conclude that low vitamin B12 and folic acid concentrations are associated with an increased risk of stroke, and the relationship for vitamin B12 is independent from the other known modifiable stroke risk factors. For understanding the effects of B12 and folate in stroke patients, more detailed follow-up studies with long period are needed.

  5. Acute Phase Reactants and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Mustafa Sahan

    2010-04-01

    Full Text Available Cerebrovascular diseases which called as stroke causes severe mortality and morbidity. Stoke is the third cause of death and first cause of the sequela among in its disorder group. Stroke with a 80-85% has the most frequency and the most cause of death in among the neurological disorders. Besides its lethal effects, sequela of stroke also cause physiological problems on individuals, families and social groups, it also brings some economic problems. [Archives Medical Review Journal 2010; 19(2.000: 85-140

  6. Stress hyperglycemia and acute ischemic stroke in-hospital outcome.

    Science.gov (United States)

    Tziomalos, Konstantinos; Dimitriou, Panagiotis; Bouziana, Stella D; Spanou, Marianna; Kostaki, Stavroula; Angelopoulou, Stella-Maria; Papadopoulou, Maria; Giampatzis, Vasilios; Savopoulos, Christos; Hatzitolios, Apostolos I

    2017-02-01

    Stress hyperglycemia is frequent in patients with acute ischemic stroke. However, it is unclear whether stress hyperglycemia only reflects stroke severity or if it is directly associated with adverse outcome. We aimed to evaluate the prognostic significance of stress hyperglycemia in acute ischemic stroke. We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0% males, age 79.4±6.8years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Stress hyperglycemia was defined as fasting serum glucose levels at the second day after admission ≥126mg/dl in patients without type 2 diabetes mellitus (T2DM). The outcome was assessed with adverse outcome rates at discharge (modified Rankin scale between 2 and 6) and with in-hospital mortality. In the total study population, 8.6% had stress hyperglycemia. Patients with stress hyperglycemia had more severe stroke. Independent predictors of adverse outcome at discharge were age, prior ischemic stroke and NIHSS at admission whereas treatment with statins prior to stroke was associated with favorable outcome. When the NIHSS was removed from the multivariate model, independent predictors of adverse outcome were age, heart rate at admission, prior ischemic stroke, log-triglyceride (TG) levels and stress hyperglycemia, whereas treatment with statins prior to stroke was associated with favorable outcome. Independent predictors of in-hospital mortality were atrial fibrillation (AF), diastolic blood pressure (DBP), serum log-TG levels and NIHSS at admission. When the NIHSS was removed from the multivariate model, independent predictors of in-hospital mortality were age, AF, DBP, log-TG levels and stress hyperglycemia. Stress hyperglycemia does not appear to be directly associated with the outcome of acute ischemic stroke. However, given that patients with stress hyperglycemia had higher prevalence of cardiovascular risk factors than

  7. Highly sensitive troponin T in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, J K; Ueland, T; Aukrust, P;

    2012-01-01

    in decedents than in survivors. After adjustment for stroke severity, C-reactive protein, age, NT-proBNP and prior heart and/or renal failure, hsTnT levels were not a significant predictor of long-term all-cause or cardiovascular mortality. Conclusion: Elevated levels of hsTnT are frequently present......Background: Newly developed troponin assays have superior diagnostic and prognostic performance in acute coronary syndrome (ACS), when compared to conventional troponin assays; however, highly sensitive troponin has not been evaluated in patients with acute ischemic stroke. Methods: Highly...... sensitive troponin T (hsTnT) was measured daily during the first 4 days in 193 consecutive patients with acute ischemic stroke without overt ACS or atrial fibrillation. The patients were previously tested normal with a fourth-generation TnT assay. The patients were followed for 47 months, with all...

  8. Carotid artery stenting for acute stroke; Karotisstent beim akuten Schlaganfall

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P.; Roth, C.; Grunwald, I.Q.; Ahlhelm, F.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany); Ernst, N.; Haass, A. [Universitaetsklinikum des Saarlandes, Klinik fuer Neurologie, Homburg/Saar (Germany)

    2009-04-15

    For patients with acute ischemic stroke due to total occlusion of the internal carotid artery (ICA), an effective intervention to improve neurologic symptoms and clinical outcome has not yet been established. Some authors have reported successful revascularization for patients with acute stroke symptoms secondary to ICA occlusion only in isolated series and case reports. Emergency recanalization and carotid artery stent placement can improve neurologic outcome in selected patients with acute ischemic stroke and total occlusion of the ICA. (orig.) [German] Bei Patienten mit akutem ischaemischem Schlaganfall, die sich aufgrund einer Okklusion der A. carotis interna (ACI) mit einer schwerwiegenden klinischen Symptomatik praesentieren, hat sich noch keine interventionelle Therapie etabliert. In der Literatur existieren nur einzelne Studien und Fallberichte ueber die Revaskularisierung eines akuten ACI-Verschlusses. Rekanalisierung und Stentimplantation eines akut aufgetretenen ACI-Verschlusses bei selektierten Patienten koennen zu einer deutlichen Besserung der klinischen Symptomatik fuehren. (orig.)

  9. Intensive treadmill training in the acute phase after ischemic stroke

    DEFF Research Database (Denmark)

    Strømmen, Anna Maria; Christensen, Thomas; Jensen, Kai

    2016-01-01

    The aim of the study was to (a) assess the feasibility of intensive treadmill training in patients with acute ischemic stroke, (b) test whether physical activity of the legs during training increases with time, and (c) evaluate to what extent training sessions contribute toward the overall physical...... activity of these patients. Twenty hospitalized patients with acute ischemic stroke trained on a treadmill twice daily for 30 min for 5 days and on day 30. Physical activity was measured as activity counts (AC) from accelerometers. A total of 196 of 224 initiated training sessions were completed. Training...... with increasing number of days, with the median AC being 133% higher on day 5 than on day 1. AC in the paretic leg during 60 min of training constituted median 53% of the daytime AC. Early intensive treadmill training in acute ischemic stroke patients is thus feasible and contributes considerably toward...

  10. Acute hyperglycemia worsens ischemic stroke-induced brain damage via high mobility group box-1 in rats.

    Science.gov (United States)

    Huang, Jingyang; Liu, Baoyi; Yang, Chenghui; Chen, Haili; Eunice, Dzivor; Yuan, Zhongrui

    2013-10-16

    Hyperglycemia adversely affects the outcome of ischemic stroke. Extracellular HMGB1 plays a role in aggravating brain damage in the postischemic brain. The aim of this study was to determine whether the extracellular HMGB1 is involved in the worsened ischemic damage during hyperglycemic stroke. Male Wistar rats underwent middle cerebral artery occlusion (MCAO) for 90 min with reperfusion. Acute hyperglycemia was induced by an injection of 50% dextrose. Rats received glycyrrhizin, a specific HMGB1 inhibitor, or vehicle. HMGB-1 in cerebrospinal fluid and in brain parenchyma was detected at 2 or 4 h post-reperfusion. Neurological deficits, infarct volume and cerebral edema were assessed 24 h post-MCAO the disruption of blood-brain barrier (BBB) and the expression of tight junction protein Occludin were measured at 4 h post-reperfusion. Hyperglycemia enhanced the early release of HMGB1 from ischemic brain tissue, which was accompanied by increased infarct volume, neurological deficit, cerebral edema and BBB disruption. Glycyrrhizin alleviated the aggravation of infarct volume, neurological deficit, cerebral edema and BBB disruption by decreasing the degradation of tight junction protein Occludin in the ischemic hemisphere of hyperglycemic rats. In conclusion, enhanced early extracellular release of HMGB1 might represent an important mechanism for worsened ischemic damage, particularly early BBB disruption, during hyperglycemic stroke. An HMGB1 inhibitor glycyrrhizin is a potential therapeutic option for hyperglycemic stroke.

  11. Risk factors of intracranial stenosis among older adults with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Rizaldy Pinzon

    2016-02-01

    Full Text Available Intracranial large artery atherosclerosis is an important cause of stroke worldwide. Previous studies have shown that it is found more commonly in Asians. However, studies of intracranial stenosis in Indonesian stroke patients have been very few in number. The aim of this cross-sectional study was to determine the frequency and risk factors of intracranial stenosis in acute ischemic stroke. The data were obtained from 234 consecutive patients in the transcranial doppler (TCD registry. Documentation of risk factors was performed systematically and for TCD sonography TD-DOP 9000 equipment with a 2-MHz probe was used for the examination of the intracranial circulation. The criteria of middle cerebral artery (MCA stenosis used in this study were a peak systolic velocity (PSV >140 cm/s or mean systolic velocity (MSV >80 cm/s. For stenosis of the posterior circulation the criteria were PSV > 90 cm/s or MSV >60 cm/s. The data were obtained from 234 patients, and complete examinations were performed in 182 patients (77.7%. Ischemic stroke is the most common indication for performing TCD sonography. Stenosis was present in 38% of cases, with stenosis iof the anterior circulation being the more common. The most frequent risk factors were hypertension, dyslipidemia, and diabetes. Intracranial stenosis is common in stroke patients, in whom the risk factors are hypertension and diabetes.

  12. Diffusion and Perfusion MR Imaging in Acute Stroke: Clinical Utility and Potential Limitations for Treatment Selection

    DEFF Research Database (Denmark)

    Bateman, Mathew; Slater, Lee-Anne; Leslie-Mazwi, Thabele M

    2017-01-01

    Magnetic resonance (MR) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) offer unique insight into acute ischemic stroke pathophysiology. These techniques may offer the ability to apply pathophysiology to accurately individualize acute stroke reperfusion treatment, including ...

  13. Unruptured Cerebral Aneurysm Detected after Intravenous Tissue Plasminogen Activator for Stroke

    Directory of Open Access Journals (Sweden)

    Yukihiro Yoneda

    2009-06-01

    Full Text Available Therapeutic guidelines of intravenous thrombolysis with tissue plasminogen activator (tPA for hyperacute ischemic stroke are very strict. Because of potential higher risk of bleeding complications, the presence of unruptured cerebral aneurysm is a contraindication for systemic thrombolysis with tPA. According to the standard CT criteria, a 66-year-old woman who suddenly developed aphasia and hemiparesis received intravenous tPA within 3 h after ischemic stroke. Magnetic resonance angiography during tPA infusion was performed and the presence of a small unruptured cerebral aneurysm was suspected at the anterior communicating artery. Delayed cerebral angiography confirmed an aneurysm with a size of 7 mm. The patient did not experience any adverse complications associated with the aneurysm. Clinical experiences of this kind of accidental off-label thrombolysis may contribute to modify the current rigid tPA guidelines for stroke.

  14. FTY720 ameliorates acute ischemic stroke in mice by reducing thrombo-inflammation but not by direct neuroprotection.

    Science.gov (United States)

    Kraft, Peter; Göb, Eva; Schuhmann, Michael K; Göbel, Kerstin; Deppermann, Carsten; Thielmann, Ina; Herrmann, Alexander M; Lorenz, Kristina; Brede, Marc; Stoll, Guido; Meuth, Sven G; Nieswandt, Bernhard; Pfeilschifter, Waltraud; Kleinschnitz, Christoph

    2013-11-01

    Lymphocytes are important players in the pathophysiology of acute ischemic stroke. The interaction of lymphocytes with endothelial cells and platelets, termed thrombo-inflammation, fosters microvascular dysfunction and secondary infarct growth. FTY720, a sphingosine-1-phosphate receptor modulator, blocks the egress of lymphocytes from lymphoid organs and has been shown to reduce ischemic neurodegeneration; however, the underlying mechanisms are unclear. We investigated the mode of FTY720 action in models of cerebral ischemia. Transient middle cerebral artery occlusion (tMCAO) was induced in wild-type and lymphocyte-deficient Rag1(-/-) mice treated with FTY720 (1 mg/kg) or vehicle immediately before reperfusion. Stroke outcome was assessed 24 hours later. Immune cells in the blood and brain were counted by flow cytometry. The integrity of the blood-brain barrier was analyzed using Evans Blue dye. Thrombus formation was determined by immunohistochemistry and Western blot, and was correlated with cerebral perfusion. FTY720 significantly reduced stroke size and improved functional outcome in wild-type mice on day 1 and day 3 after transient middle cerebral artery occlusion. This protective effect was lost in lymphocyte-deficient Rag1(-/-) mice and in cultured neurons subjected to hypoxia. Less lymphocytes were present in the cerebral vasculature of FTY720-treated wild-type mice, which in turn reduced thrombosis and increased cerebral perfusion. In contrast, FTY720 was unable to prevent blood-brain barrier breakdown and transendothelial immune cell trafficking after transient middle cerebral artery occlusion. Induction of lymphocytopenia and concomitant reduction of microvascular thrombosis are key modes of FTY720 action in stroke. In contrast, our findings in Rag1(-/-) mice and cultured neurons argue against direct neuroprotective effects of FTY720.

  15. Biological Signatures of Brain Damage Associated with High Serum Ferritin Levels in Patients with Acute Ischemic Stroke and Thrombolytic Treatment

    Directory of Open Access Journals (Sweden)

    Mónica Millán

    2008-01-01

    Full Text Available Background and purpose: Increased body iron stores have been related to greater oxidative stress and brain injury in clinical and experimental cerebral ischemia and reperfusion. We aimed to investigate the biological signatures of excitotoxicity, inflammation and blood brain barrier disruption potentially associated with high serum ferritin levels-related damage in acute stroke patients treated with i.v. t-PA.

  16. Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

    Directory of Open Access Journals (Sweden)

    Lee Su-Ho

    2011-01-01

    Full Text Available Abstract Background Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results Among the 500 patients (median 67 years, 62% men, the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313. Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381, knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633 and use of ambulance (OR 1.961, 95% CI 1.176-3.270 were significantly associated with early arrival. Conclusions In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.

  17. Improving delivery of acute stroke therapy: The TLL Temple Foundation Stroke Project.

    Science.gov (United States)

    Morgenstern, Lewis B; Staub, Lara; Chan, Wenyaw; Wein, Theodore H; Bartholomew, L Kay; King, Mary; Felberg, Robert A; Burgin, W Scott; Groff, Janet; Hickenbottom, Susan L; Saldin, Kamaldeen; Demchuk, Andrew M; Kalra, Anjali; Dhingra, Anupma; Grotta, James C

    2002-01-01

    Only a small minority of acute stroke patients receive approved acute stroke therapy. We performed a community and professional behavioral intervention project to increase the proportion of stroke patients treated with approved acute stroke therapy. This study used a quasi-experimental design. Intervention and comparison communities were compared at baseline and during educational intervention. The communities were based in 5 nonurban East Texas counties. The multilevel intervention worked with hospitals and community physicians while changing the stroke identification skills, outcome expectations, and social norms of community residents. The primary goal was to increase the proportion of patients treated with intravenous recombinant tissue plasminogen activator (rTPA) from 1% to 6% of all cerebrovascular events in the intervention community. We prospectively evaluated 1733 patients and validated 1189 cerebrovascular events. Intravenous rTPA treatment increased from 1.38% to 5.75% among all cerebrovascular event patients in the intervention community (P=0.01) compared with a change from 0.49% to 0.55% in the comparison community (P=1.00). Among the ischemic stroke patients, an increase from 2.21% to 8.65% was noted in the intervention community (P=0.02). The comparison group did not appreciably change (0.71% to 0.86%, P=1.00). Of eligible intravenous rTPA candidates, treatment increased in the intervention community from 14% to 52% (P=0.003) and was unchanged in the comparison community (7% to 6%, P=1.00). An aggressive, multilevel stroke educational intervention program can increase delivery of acute stroke therapy. This may have important public health implications for reducing disability on a national level.

  18. Mobilization of CD133+ progenitor cells in patients with acute cerebral infarction.

    Directory of Open Access Journals (Sweden)

    Dominik Sepp

    Full Text Available Progenitor cells (PCs contribute to the endogenous repair mechanism after ischemic events. Interleukin-8 (IL-8 as part of the acute inflammatory reaction may enhance PC mobilization. Also, statins are supposed to alter number and function of circulating PCs. We aimed to investigate PC mobilization after acute ischemic stroke as well as its association with inflammatory markers and statin therapy. Sixty-five patients with ischemic stroke were enrolled in the study. The number of CD133+ PCs was analyzed by flow cytometry. Blood samples were drawn within 24 hours after symptom onset and after 5 days. The number of CD133+ PCs increased significantly within 5 days (p<0.001. We found no correlation between CD133+ PCs and the serum levels of IL-8, IL-6, or C-reactive protein (CRP. Multivariate analysis revealed that preexisting statin therapy correlated independently with the increase of CD133+ PCs (p=0.001. This study showed a mobilization of CD133+ PCs in patients with acute cerebral infarction within 5 days after symptom onset. The early systemic inflammatory response did not seem to be a decisive factor in the mobilization of PCs. Preexisting statin therapy was associated with the increase in CD133+ PCs, suggesting a potentially beneficial effect of statin therapy in patients with stroke.

  19. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  20. Curative effect of monosialotetrahexosylganglioside combined with Xingnaojing injection on acute cerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Rui-xing SUN

    2015-07-01

    Full Text Available This paper aims to observe the curative effect of monosialotetrahexosylganglioside combined with Xingnaojing injection on acute cerebral hemorrhage. A total of 120 cases with acute cerebral hemorrhage were treated with Xingnaojing injection monotherapy (control group, N = 60 or monosialotetrahexosylganglioside combined with Xingnaojing injection (combined treatment group, N = 60. Bleeding amount and National Institutes of Health Stroke Scale (NIHSS scores of 2 groups were both significantly reduced on the 21th day after treatment (P = 0.000, for all, but bleeding amount and NIHSS scores in combined treatment group were significantly lower than those in control group (P = 0.000, for all. After 21 d treatment, total effective rate of combined treatment group was 86.67% (52/60, which was significantly higher than that of control group [66.67% (40/60; χ2 = 1.493, P = 0.024]. For patients with acute cerebral hemorrhage, monosialotetrahexosylganglioside combined with Xingnaojing injection can significantly improve the neurological function. DOI: 10.3969/j.issn.1672-6731.2015.07.014

  1. Investigation of oxidant and antioxidant levels in patients with acute stroke in the emergency service.

    Science.gov (United States)

    Atik, İsmail; Kozacı, Nalan; Beydilli, İnan; Avcı, Mustafa; Ellidağ, Hamit; Keşaplı, Mustafa

    2016-12-01

    In this study, we aimed to identify oxidative stress and the disruption in the oxidant-antioxidant balance in the acute phase of stroke and, therefore, to detect markers that will guide in the diagnosis and treatment of stroke. Eighty-six patients who were admitted to Antalya Training and Research Hospital Emergency Department between June 2013 and December 2013 and who were diagnosed as having stroke were enrolled in this study. The control group consisted of 40 healthy volunteers. Blood samples collected from all participants were screened for albumin, ischemic modified albumin (IMA), IMA/albumin ratio (IMAR), total antioxidant status, total oxidant status (TOS), and oxidative stress index (OSI). Sixty (70%) patients were diagnosed as having acute cerebral infarction (ACI) and 26 (30%) as having acute intracerebral hemorrhage (AIH). Statistically significant difference was found between AIH and control groups in terms of albumin, IMAR, TOS, OSI levels (P oxidant-antioxidant levels. There was a significant difference between patients admitted within 3 hours and healthy adults regarding the levels of IMAR, TOS, and OSI (P oxidant-antioxidant balance was impaired in favor of oxidants in ACI and AIH. In addition, impairment in oxidant-antioxidant balance was found in the early stages of ACI. Therefore, these biomarkers can be used especially in the early diagnosis of thrombolytic therapy candidates in ACI. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Unifying acute stroke treatment guidelines for a Bayesian belief network.

    Science.gov (United States)

    Love, Alexa; Arnold, Corey W; El-Saden, Suzie; Liebeskind, David S; Andrada, Lewellyn; Saver, Jeffrey; Bui, Alex A T

    2013-01-01

    With the large number of clinical practice guidelines available, there is an increasing need for a comprehensive unified model for acute ischemic stroke treatment to assist in clinical decision making. We present a unified treatment model derived through review of existing clinical practice guidelines, meta-analyses, and clinical trials. Using logic from the treatment model, a Bayesian belief network was defined and fitted to data from our institution's observational quality improvement database for acute stroke patients. The resulting network validates known relationships between variables, treatment decisions and outcomes, and enables the exploration of new correlative relationships not defined in current guidelines.

  3. Beneficial Effect of Beraprost Sodium Plus Aspirin in the Treatment of Acute Ischemic Stroke.

    Science.gov (United States)

    Chen, Siqia; Xie, Sisi; He, Wenzhen; Wei, Duncan; Li, Shunxian; Chen, Wenjie

    2017-09-12

    BACKGROUND To investigate the combination of beraprost sodium (BPS) and aspirin in the treatment of acute ischemic stroke (AIS). MATERIAL AND METHODS 308 patients with acute cerebral infarction were randomly divided into two groups: experimental group (n=154), treated with BPS (40 μg, tid) and aspirin (100 mg, qd); control group (n=154), treated with 100 mg of aspirin, qd). The antiplatelet therapy remained unchangeable until six months after hospital discharge. RESULTS Initially, no significant differences were found between the two groups. After six months, the relapse-free survival rate was similar between the treatment group (98.1%) and the control group (97.4%). One patient died from AIS in the control group. However, glomerular filtration rate was significantly higher; neurological function and functional ability of patients were better in patients treated with BPS plus aspirin (experimental group) than that in aspirin alone group. No significant difference was found in the function of the coagulation system, suggesting that BPS plus aspirin treatment did not increase the risk of bleeding. Serious adverse events did not occur in both groups. Facial flushing (one case) and mild gastrointestinal reaction (one case) were found in the treatment group without influencing treatment. CONCLUSIONS In our trial involving patients with acute cerebral infarction, BPS plus aspirin was not found to be superior to aspirin in reducing the recurrence of cerebral infarction or death. However, BPS plus aspirin treatment could improve renal function and neurological function without increasing the risk of bleeding.

  4. Recombinant human erythropoietin increases cerebral cortical width index and neurogenesis following ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Zhongmin Wen; Peiji Wang

    2012-01-01

    The cerebral cortical expansion index refers to the ratio between left and right cortex width and is recognized as an indicator for cortical hyperplasia. Cerebral ischemia was established in CB-17 mice in the present study, and the mice were subsequently treated with recombinant human erythropoietin via subcutaneous injection. Results demonstrated that cerebral cortical width index significantly increased. Immunofluorescence detection showed that the number of nuclear antigen antibody/5-bromodeoxyuridine-positive cells at the infarction edge significantly increased. Correlation analysis revealed a negative correlation between neurological scores and cortical width indices in rats following ischemic stroke. These experimental findings suggested that recombinant human erythropoietin promoted cerebral cortical hyperplasia, increased cortical neurogenesis, and enhanced functional recovery following ischemic stroke.

  5. Effects of different classes of antihypertensive agents on the outcome of acute ischemic stroke.

    Science.gov (United States)

    Tziomalos, Konstantinos; Giampatzis, Vasilios; Bouziana, Stella D; Spanou, Marianna; Papadopoulou, Maria; Kazantzidou, Pavlina; Kostaki, Stavroula; Kouparanis, Antonios; Savopoulos, Christos; Hatzitolios, Apostolos I

    2015-04-01

    It is unclear whether antihypertensive treatment before stroke affects acute ischemic stroke severity and outcome. To evaluate this association, the authors studied 482 consecutive patients (age 78.8±6.7 years) admitted with acute ischemic stroke. Stroke severity was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). The outcome was assessed with rates of adverse outcome (modified Rankin scale at discharge ≥2). Independent predictors of severe stroke (NIHSS ≥16) were female sex and atrial fibrillation. Treatment with diuretics before stroke was associated with nonsevere stroke. At discharge, patients with adverse outcome were less likely to be treated before stroke with β-blockers or with diuretics. Independent predictors of adverse outcome were older age, higher NIHSS at admission, and history of ischemic stroke. Treatment with diuretics before stroke appears to be associated with less severe neurologic deficit in patients with acute ischemic stroke. © 2015 Wiley Periodicals, Inc.

  6. Does microbleed predict haemorrhagic transformation after acute atherothrombotic or cardioembolic stroke?

    Science.gov (United States)

    Lee, S-H; Kang, B-S; Kim, N; Roh, J-K

    2008-08-01

    Cerebral microbleeds (MBs) are known to be indicative of bleeding-prone microangiopathy and may predict incident intracerebral haemorrhage. However, there is controversy concerning the causal relationship between the presence of MBs and haemorrhagic transformation (HTf) after ischaemic stroke. Of the 1034 patients with acute ischaemic stroke who were consecutively admitted to our hospital, 377 patients with stroke due to large-artery atherothrombosis or cardioembolism were selected for participation in this study. We examined the MBs using T2*-weighted gradient-echo MRI performed within 24 hours after admission, and the incidence of HTf was assessed using follow-up brain MRI during the hospitalisation period. Of the 377 patients with stroke, 234 were male (62.1%) and the mean age was 66.2 +/-11.7 years. MBs were initially found in 109 patients (28.9%), and newly incident HTf was noted during the hospitalisation period in 74 patients (19.6%). The presence of MBs was not increased in the patients with HTf (24.3% vs. 30.0% in the patients without HTf; p = 0.331). In addition, the number of MBs was not higher in the patients with HTf (0.7+/-1.5 vs. 1.8+/-8.1; p = 0.234). This lack of significance between MBs and HTf persisted after stratification by stroke mechanism. This study suggests that underlying MBs do not predict incident HTf after acute ischaemic stroke. The clinical significance of MBs should be differentially evaluated according to the type of disease (intracerebral haemorrhage vs. HTf).

  7. Intra-Arterial Immunoselected CD34+ Stem Cells for Acute Ischemic Stroke.

    Science.gov (United States)

    Banerjee, Soma; Bentley, Paul; Hamady, Mohammad; Marley, Stephen; Davis, John; Shlebak, Abdul; Nicholls, Joanna; Williamson, Deborah A; Jensen, Steen L; Gordon, Myrtle; Habib, Nagy; Chataway, Jeremy

    2014-11-01

    Treatment with CD34+ hematopoietic stem/progenitor cells has been shown to improve functional recovery in nonhuman models of ischemic stroke via promotion of angiogenesis and neurogenesis. We aimed to determine the safety and feasibility of treatment with CD34+ cells delivered intra-arterially in patients with acute ischemic stroke. This was the first study in human subjects. We performed a prospective, nonrandomized, open-label, phase I study of autologous, immunoselected CD34+ stem/progenitor cell therapy in patients presenting within 7 days of onset with severe anterior circulation ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score≥8). CD34+ cells were collected from the bone marrow of the subjects before being delivered by catheter angiography into the ipsilesional middle cerebral artery. Eighty-two patients with severe anterior circulation ischemic stroke were screened, of whom five proceeded to treatment. The common reasons for exclusion were age>80 years (n=19); medical instability (n=17), and significant carotid stenosis (n=13). The procedure was well tolerated in all patients, and no significant treatment-related adverse effects occurred. All patients showed improvements in clinical functional scores (Modified Rankin Score and NIHSS score) and reductions in lesion volume during a 6-month follow-up period. Autologous CD34+ selected stem/progenitor cell therapy delivered intra-arterially into the infarct territory can be achieved safely in patients with acute ischemic stroke. Future studies that address eligibility criteria, dosage, delivery site, and timing and that use surrogate imaging markers of outcome are desirable before larger scale clinical trials. ©AlphaMed Press.

  8. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone.

    Science.gov (United States)

    Hong, Keun-Sik; Lee, Seung-Hoon; Kim, Eung Gyu; Cho, Ki-Hyun; Chang, Dae Il; Rha, Joung-Ho; Bae, Hee-Joon; Lee, Kyung Bok; Kim, Dong Eog; Park, Jong-Moo; Kim, Hahn-Young; Cha, Jae-Kwan; Yu, Kyung-Ho; Lee, Yong-Seok; Lee, Soo Joo; Choi, Jay Chol; Cho, Yong-Jin; Kwon, Sun U; Kim, Gyeong-Moon; Sohn, Sung-Il; Park, Kwang-Yeol; Kang, Dong-Wha; Sohn, Chul-Ho; Lee, Jun; Yoon, Byung-Woo

    2016-09-01

    In patients with acute ischemic stroke caused by large artery atherosclerosis, clopidogrel plus aspirin versus aspirin alone might be more effective to prevent recurrent cerebral ischemia. However, there is no clear evidence. In this multicenter, double-blind, placebo-controlled trial, we randomized 358 patients with acute ischemic stroke of presumed large artery atherosclerosis origin within 48 hours of onset to clopidogrel (75 mg/d without loading dose) plus aspirin (300-mg loading followed by 100 mg/d) or to aspirin alone (300-mg loading followed by 100 mg/d) for 30 days. The primary outcome was new symptomatic or asymptomatic ischemic lesion on magnetic resonance imaging within 30 days. Secondary outcomes were 30-day functional disability, clinical stroke recurrence, and composite of major vascular events. Safety outcome was any bleeding. Of 358 patients enrolled, 334 (167 in each group) completed follow-up magnetic resonance imaging. The 30-day new ischemic lesion recurrence rate was comparable between the clopidogrel plus aspirin and the aspirin monotherapy groups (36.5% versus 35.9%; relative risk, 1.02; 95% confidence interval, 0.77-1.35; P=0.91). Of the recurrent ischemic lesions, 94.2% were clinically asymptomatic. There were no differences in secondary outcomes between the 2 groups. Any bleeding were more frequent in the combination group than in the aspirin monotherapy group, but the difference was not significant (16.7% versus 10.7%; P=0.11). One hemorrhagic stroke occurred in the clopidogrel plus aspirin group. Clopidogrel plus aspirin might not be superior to aspirin alone for preventing new ischemic lesion and clinical vascular events in patients with acute ischemic stroke caused by large artery atherosclerosis. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00814268. © 2016 American Heart Association, Inc.

  9. Endovascular Acute Stroke Treatment Performed by Vascular Interventional Radiologists: Is It Safe and Efficacious?

    Energy Technology Data Exchange (ETDEWEB)

    Fjetland, Lars, E-mail: lars.fjetland@lyse.net; Roy, Sumit; Kurz, Kathinka D. [Stavanger University Hospital, Department of Radiology (Norway); Larsen, Jan Petter; Kurz, Martin W. [Stavanger University Hospital, Norwegian Centre for Movement Disorders (Norway)

    2012-10-15

    Purpose: To evaluate the safety and efficacy of neurointerventional procedures in acute stroke patients performed by a team of vascular interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists and to compare the results with those of previous reports from centres with specialised interventional neuroradiologists. Material and Methods: A total of 39 patients with acute ischemic stroke due to large-vessel occlusion not responding to or not eligible for intravenous thrombolysis were treated with either intra-arterial thrombolysis or mechanical thrombectomy (Penumbra System or solitaire FR thrombectomy system, respectively) and included in our prospective study. Outcomes were measured using the modified Rankin scale after 90 days, and recanalization was assessed by thrombolysis using the myocardial infarction score. Results: Mean patient age was 68.3 {+-} 14.2 years; the average National Institutes of Health Stroke Scale score at hospital admission was 17.2 (SD = 6.2 [n = 38]). Successful recanalization was achieved in 74.4 % of patients. Median time from clinical onset to recanalization was 5 h 11 min. Procedure-related complications occurred in 5 % of patients, and 7.5 % had a symptomatic intracerebral hemorrhage. Of the patients, 22.5 % died within the first 90 postprocedural days, 5 % of these from cerebral causes. Patients who were successfully recanalized had a clinical better outcome at follow-up than those in whom treatment failed. Of the patients, 35.9 % had an mRS score {<=}2 after 90 days. Conclusion: Our results are in line with those in the published literature and show that a treatment strategy with general interventional radiologists performing neurointerventional procedures in acute stroke patients with large vessel occlusions can be achieved to the benefit of patients.

  10. Thrombolytic treatment in the oldest-old patient with acute ischemic stroke: an update on current evidence

    Directory of Open Access Journals (Sweden)

    Fabiola Maioli

    2013-09-01

    Full Text Available The incidence of ischemic stroke rises exponentially with age, with a steep increase in the age interval between 75 and 85 years. Thrombolytic therapy restores cerebral blood flow in patients with acute ischemic stroke of any etiology by using drugs that dissolve blood clots. Infusion for 1 h of alteplase at the dose of 0.9 mg/kg within 3 h of the start of the symptoms is associated to a 30% increase in the likelihood of gaining a favorable outcome with respect to placebo. There is strong evidence that selected patients with ischemic stroke may benefit from intravenous thrombolysis when treated within 3 h. The aim of the study was to evaluate available evidence for the efficacy and safety of thrombolytic therapy in patients with ischemic stroke aged 80 years and over. Compared to younger stroke patients treated with thrombolytic therapy, those aged 80 years and over have higher acute mortality due to symptomatic intracranial hemorrhage. However, functional outcome at six months is significantly better for over-80-year-olds than younger patients. There is a need for screening tools that take into account pre-stroke functional and cognitive status that are able to identify those over-80-year-old patients with ischemic stroke who can most benefit from thrombolytic treatment. Available evidence supports further recruitment of oldest-old patients into ongoing trials of thrombolysis.

  11. Stroke-Like Presentation of Cerebral Toxoplasmosis: Two HIV-Infected Cases

    OpenAIRE

    2015-01-01

    Toxoplasmosis is the most common opportunistic infection of the central nervous system in patients with acquired immunodeficiency syndrome (AIDS). Clinical presentation of cerebral toxoplasmosis in these patients includes headache, focal neurological deficits and seizures. Prompt diagnosis and appropriate therapy results in rapid clinical and radiological improvement as well as good outcome for patients. In this article, we report two cases with stroke-like presentation of cerebral toxoplasmo...

  12. Serum Levels of Substance P and Mortality in Patients with a Severe Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Leonardo Lorente

    2016-06-01

    Full Text Available Substance P (SP, a member of tachykinin family, is involved in the inflammation of the central nervous system and in the appearance of cerebral edema. Higher serum levels of SP have been found in 18 patients with cerebral ischemia compared with healthy controls. The aim of our multi-center study was to analyze the possible association between serum levels of SP and mortality in ischemic stroke patients. We included patients with malignant middle cerebral artery infarction (MMCAI and a Glasgow Coma Scale (GCS lower than 9. Non-surviving patients at 30 days (n = 31 had higher serum concentrations of SP levels at diagnosis of severe MMCAI than survivors (n = 30 (p < 0.001. We found in multiple regression an association between serum concentrations of SP higher than 362 pg/mL and mortality at 30 days (Odds Ratio = 5.33; 95% confidence interval = 1.541–18.470; p = 0.008 after controlling for age and GCS. Thus, the major novel finding of our study was the association between serum levels of SP and mortality in patients suffering from severe acute ischemic stroke.

  13. Serum Levels of Substance P and Mortality in Patients with a Severe Acute Ischemic Stroke

    Science.gov (United States)

    Lorente, Leonardo; Martín, María M.; Almeida, Teresa; Pérez-Cejas, Antonia; Ramos, Luis; Argueso, Mónica; Riaño-Ruiz, Marta; Solé-Violán, Jordi; Hernández, Mariano

    2016-01-01

    Substance P (SP), a member of tachykinin family, is involved in the inflammation of the central nervous system and in the appearance of cerebral edema. Higher serum levels of SP have been found in 18 patients with cerebral ischemia compared with healthy controls. The aim of our multi-center study was to analyze the possible association between serum levels of SP and mortality in ischemic stroke patients. We included patients with malignant middle cerebral artery infarction (MMCAI) and a Glasgow Coma Scale (GCS) lower than 9. Non-surviving patients at 30 days (n = 31) had higher serum concentrations of SP levels at diagnosis of severe MMCAI than survivors (n = 30) (p < 0.001). We found in multiple regression an association between serum concentrations of SP higher than 362 pg/mL and mortality at 30 days (Odds Ratio = 5.33; 95% confidence interval = 1.541–18.470; p = 0.008) after controlling for age and GCS. Thus, the major novel finding of our study was the association between serum levels of SP and mortality in patients suffering from severe acute ischemic stroke. PMID:27338372

  14. Multimodal CT in stroke imaging: new concepts.

    Science.gov (United States)

    Ledezma, Carlos J; Wintermark, Max

    2009-01-01

    A multimodal CT protocol provides a comprehensive noninvasive survey of acute stroke patients with accurate demonstration of the site of arterial occlusion and its hemodynamic tissue status. It combines widespread availability with the ability to provide functional characterization of cerebral ischemia, and could potentially allow more accurate selection of candidates for acute stroke reperfusion therapy. This article discusses the individual components of multimodal CT and addresses the potential role of a combined multimodal CT stroke protocol in acute stroke therapy.

  15. Stroke damage detection using classification trees on electrical bioimpedance cerebral spectroscopy measurements.

    Science.gov (United States)

    Atefi, Seyed Reza; Seoane, Fernando; Thorlin, Thorleif; Lindecrantz, Kaj

    2013-08-07

    After cancer and cardio-vascular disease, stroke is the third greatest cause of death worldwide. Given the limitations of the current imaging technologies used for stroke diagnosis, the need for portable non-invasive and less expensive diagnostic tools is crucial. Previous studies have suggested that electrical bioimpedance (EBI) measurements from the head might contain useful clinical information related to changes produced in the cerebral tissue after the onset of stroke. In this study, we recorded 720 EBI Spectroscopy (EBIS) measurements from two different head regions of 18 hemispheres of nine subjects. Three of these subjects had suffered a unilateral haemorrhagic stroke. A number of features based on structural and intrinsic frequency-dependent properties of the cerebral tissue were extracted. These features were then fed into a classification tree. The results show that a full classification of damaged and undamaged cerebral tissue was achieved after three hierarchical classification steps. Lastly, the performance of the classification tree was assessed using Leave-One-Out Cross Validation (LOO-CV). Despite the fact that the results of this study are limited to a small database, and the observations obtained must be verified further with a larger cohort of patients, these findings confirm that EBI measurements contain useful information for   assessing on the health of brain tissue after stroke and supports the hypothesis that classification features based on Cole parameters, spectral information and the geometry of EBIS measurements are useful to differentiate between healthy and stroke damaged brain tissue.

  16. The choroid plexus is a key cerebral invasion route for T cells after stroke.

    Science.gov (United States)

    Llovera, Gemma; Benakis, Corinne; Enzmann, Gaby; Cai, Ruiyao; Arzberger, Thomas; Ghasemigharagoz, Alireza; Mao, Xiang; Malik, Rainer; Lazarevic, Ivana; Liebscher, Sabine; Ertürk, Ali; Meissner, Lilja; Vivien, Denis; Haffner, Christof; Plesnila, Nikolaus; Montaner, Joan; Engelhardt, Britta; Liesz, Arthur

    2017-07-31

    Neuroinflammation contributes substantially to stroke pathophysiology. Cerebral invasion of peripheral leukocytes-particularly T cells-has been shown to be a key event promoting inflammatory tissue damage after stroke. While previous research has focused on the vascular invasion of T cells into the ischemic brain, the choroid plexus (ChP) as an alternative cerebral T-cell invasion route after stroke has not been investigated. We here report specific accumulation of T cells in the peri-infarct cortex and detection of T cells as the predominant population in the ipsilateral ChP in mice as well as in human post-stroke autopsy samples. T-cell migration from the ChP to the peri-infarct cortex was confirmed by in vivo cell tracking of photoactivated T cells. In turn, significantly less T cells invaded the ischemic brain after photothrombotic lesion of the ipsilateral ChP and in a stroke model encompassing ChP ischemia. We detected a gradient of CCR2 ligands as the potential driving force and characterized the neuroanatomical pathway for the intracerebral migration. In summary, our study demonstrates that the ChP is a key invasion route for post-stroke cerebral T-cell invasion and describes a CCR2-ligand gradient between cortex and ChP as the potential driving mechanism for this invasion route.

  17. Early time course of N-acetylaspartate, creatine and phosphocreatine, and compounds containing choline in the brain after acute stroke. A proton magnetic resonance spectroscopy study

    DEFF Research Database (Denmark)

    Gideon, P; Henriksen, O; Sperling, B

    1992-01-01

    BACKGROUND AND PURPOSE: The early time course after acute stroke of cerebral N-acetylaspartate, creatine and phosphocreatine, and compounds containing choline was studied in vivo by means of localized water-suppressed proton magnetic resonance spectroscopy. METHODS: Eight patients with acute stroke...... were studied serially in the acute phase, 1 week after, and 2-4 weeks after the onset of clinical symptoms. Ten healthy volunteers served as controls. A stimulated echo (STEAM) sequence was used for measurement of the brain metabolites in a volume of interest located within the infarcted area...

  18. Acute stroke unit improves stroke management-four years on from INASC.

    LENUS (Irish Health Repository)

    Shanahan, E

    2015-02-01

    The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.

  19. Electroacupuncture acutely improves cerebral blood flow and attenuates moderate ischemic injury via an endothelial mechanism in mice.

    Directory of Open Access Journals (Sweden)

    Ji Hyun Kim

    Full Text Available Electroacupuncture (EA is a novel therapy based on traditional acupuncture combined with modern eletrotherapy that is currently being investigated as a treatment for acute ischemic stroke. Here, we studied whether acute EA stimulation improves tissue and functional outcome following experimentally induced cerebral ischemia in mice. We hypothesized that endothelial nitric oxide synthase (eNOS-mediated perfusion augmentation was related to the beneficial effects of EA by interventions in acute ischemic injury. EA stimulation at Baihui (GV20 and Dazhui (GV14 increased cerebral perfusion in the cerebral cortex, which was suppressed in eNOS KO, but there was no mean arterial blood pressure (MABP response. The increased perfusion elicited by EA were completely abolished by a muscarinic acetylcholine receptor (mAChR blocker (atropine, but not a β-adrenergic receptor blocker (propranolol, an α-adrenergic receptor blocker (phentolamine, or a nicotinic acetylcholine receptor (nAChR blocker (mecamylamine. In addition, EA increased acetylcholine (ACh release and mAChR M3 expression in the cerebral cortex. Acute EA stimulation after occlusion significantly reduced infarct volume by 34.5% when compared to a control group of mice at 24 h after 60 min-middle cerebral artery occlusion (MCAO (moderate ischemic injury, but not 90-min MCAO (severe ischemic injury. Furthermore, the impact of EA on moderate ischemic injury was totally abolished in eNOS KO. Consistent with a smaller infarct size, acute EA stimulation led to prominent improvement of neurological function and vestibule-motor function. Our results suggest that acute EA stimulation after moderate focal cerebral ischemia, but not severe ischemia improves tissue and functional recovery and ACh/eNOS-mediated perfusion augmentation might be related to these beneficial effects of EA by interventions in acute ischemic injury.

  20. Reliability of magnetic susceptibility weighted imaging in detection of cerebral microbleeds in stroke patients

    Directory of Open Access Journals (Sweden)

    Lamiaa G. El-Serougy

    2017-03-01

    Conclusion: SWI is an important reliable technique allows accurate detection of CMBs occurring in association with hemorrhage in acute and chronic stroke and should be included in the protocols for assessment of stroke to help in choice of proper treatment and prediction of future attacks.

  1. Real-time ultrasound brain perfusion imaging with analysis of microbubble replenishment in acute MCA stroke.

    Science.gov (United States)

    Kern, Rolf; Diels, Anna; Pettenpohl, Johanna; Kablau, Micha; Brade, Joachim; Hennerici, Michael G; Meairs, Stephen

    2011-08-01

    Real-time ultrasound perfusion imaging (rt-UPI) allows visualization of microbubbles flowing through the cerebral microvasculature. We hypothesized that analysis of microbubble tissue replenishment would enable for characterization of perfusion deficits in acute middle cerebral artery (MCA) territory stroke. Twenty-three patients (mean age 70.2 ± 13.2 years, 9 weeks) were included. Sequential images of bubble replenishment were acquired by transcranial rt-UPI at low mechanical index immediately after microbubble destruction. Different parameters were calculated from regions of interest (ROIs): real-time time to peak (rt-TTP), rise rate (β), and plateau (A) of acoustic intensity, and A × β was used as an index of blood flow. Results were compared with diffusion-weighted and perfusion magnetic resonance imaging. Parameters of rt-UPI had lower values in ROIs of ischemic as compared with normal tissue (β=0.58 ± 0.40 versus 1.25 ± 0.83; P=0.001; A=1.44 ± 1.75 versus 2.63 ± 2.31; P=0.05; A × β=1.14 ± 2.25 versus 2.98 ± 2.70; P=0.01). Real-time time to peak was delayed in ischemic tissue (11.43 ± 2.67 versus 8.88 ± 1.66 seconds; Preplenishment correctly identifies ischemic brain tissue in acute MCA stroke.

  2. Iterative Reconstruction Improves Both Objective and Subjective Image Quality in Acute Stroke CTP.

    Directory of Open Access Journals (Sweden)

    Fabian Flottmann

    Full Text Available Computed tomography perfusion (CTP imaging in acute ischemic stroke (AIS suffers from measurement errors due to image noise. The purpose of this study was to investigate if iterative reconstruction (IR algorithms can be used to improve the diagnostic value of standard-dose CTP in AIS.Twenty-three patients with AIS underwent CTP with standardized protocol and dose. Raw data were reconstructed with filtered back projection (FBP and IR with intensity levels 3, 4, 5. Image quality was objectively (quantitative perfusion values, signal-to-noise ratio (SNR, contrast-to-noise ratio (CNR and subjectively (overall image quality assessed. Ischemic core and perfusion mismatch were visually rated. Discriminative power for tissue outcome prediction was determined by the area under the receiver operating characteristic curve (AUC resulting from the overlap between follow-up infarct lesions and stepwise thresholded CTP maps.With increasing levels of IR, objective image quality (SNR and CNR in white matter and gray matter, elimination of error voxels and subjective image quality improved. Using IR, mean transit time (MTT was higher in ischemic lesions, while there was no significant change of cerebral blood volume (CBV and cerebral blood flow (CBF. Visual assessments of perfusion mismatch changed in 4 patients, while the ischemic core remained constant in all cases. Discriminative power for infarct prediction as represented by AUC was not significantly changed in CBV, but increased in CBF and MTT (mean (95% CI: 0.72 (0.67-0.76 vs. 0.74 (0.70-0.78 and 0.65 (0.62-0.67 vs 0.67 (0.64-0.70.In acute stroke patients, IR improves objective and subjective image quality when applied to standard-dose CTP. This adds to the overall confidence of CTP in acute stroke triage.

  3. Dynamic CT Perfusion Imaging for the Detection of Crossed Cerebellar Diaschisis in Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Young Wook; Kim, Seo Hyun; Lee, Ji Young; Whang, Kum; Kim, Myung Soon; Kim, Young Ju; Lee, Myeong Sub; Brain Reserch Group [Wonju Christian Hospital, Yonsei University Wonju University College of Medicine, Wonju (Korea, Republic of)

    2012-01-15

    Although the detection of crossed cerebellar diaschisis (CCD) by means of different imaging modalities is well described, little is known about its diagnosis by computed tomography perfusion (CTP) imaging. We investigated the detection rate of CCD by CTP imaging and the factors related to CCD on CTP images in patients with acute ischemic stroke. CT perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) obtained from 81 consecutive patients affected by an acute ischemic stroke were retrospectively reviewed. Whole-brain perfusion maps were obtained with a multichannel CT scanner using the toggling-table technique. The criteria for CCD was a unilateral supratentorial ischemic lesion and an accompanying decrease in perfusion of the contralateral cerebellar hemisphere on the basis of CTP maps by visual inspection without a set threshold. Maps were quantitatively analyzed in CCD positive cases. The criteria for CCD were fulfilled in 25 of the 81 cases (31%). Detection rates per CTP map were as follows: MTT (31%) > TTP (21%) > CBF (9%) > CBV (6%). Supratentorial ischemic volume, degree of perfusion reduction, and infratentorial asymmetry index correlated strongly (R, 0.555-0.870) and significantly (p < 0.05) with each other in CCD-positive cases. It is possible to detect CCD on all four of the CTP-based maps. Of these maps, MTT is most sensitive in detecting CCD. Our data indicate that CTP imaging is a valid tool for the diagnosis of CCD in patients affected by an acute hemispheric stroke.

  4. Perfusion CT in acute stroke; Stellenwert der CT-Perfusion fuer die Therapie des Schlaganfalls

    Energy Technology Data Exchange (ETDEWEB)

    Eckert, Bernd [Asklepios Klinik Altona (Germany). Radiologie und Neuroradiologie; Roether, Joachim [Asklepios Klinik Altona (Germany). Neurologische Abt.; Fiehler, Jens [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention; Thomalla, Goetz [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neurologie, Kopf- und Neurozentrum

    2015-06-15

    Modern multislice CT scanners enable multimodal protocols including non-enhanced CT, CT angiography, and CT perfusion. A 64-slice CT scanner provides 4-cm coverage. To cover the whole brain, a 128 - 256-slice scanner is needed. The use of perfusion CT requires an optimized scan protocol in order to reduce exposure to radiation. As compared to non-enhanced CT and CT angiography, the use of CT perfusion increases detection rates of cerebral ischemia, especially small cortical ischemic lesions, while the detection of lacunar and infratentorial stroke lesions remains limited. Perfusion CT enables estimation of collateral flow in acute occlusion of large intra- or extracranial arteries. Currently, no established reliable thresholds are available for determining infarct core and penumbral tissue by CT perfusion. Moreover, perfusion parameters depend on the processing algorithms and the software used for calculation. However, a number of studies point towards a reduction of cerebral blood volume (CBV) below 2 ml/100 g as a critical threshold that identifies infarct core. Large CBV lesions are associated with poor outcome even in the context of recanalization. The extent of early ischemic signs on non-enhanced CT remains the main parameter from CT imaging to guide acute reperfusion treatment. Nevertheless, perfusion CT increases diagnostic and therapeutic certainty in the acute setting. Similar to stroke MRI, perfusion CT enables the identification of tissue at risk of infarction by the mismatch between infarct core and the larger area of critical hypoperfusion. Further insights into the validity of perfusion parameters are expected from ongoing trials of mechanical thrombectomy in stroke.

  5. Alteration of immunologic responses on peripheral blood in the acute phase of ischemic stroke: blood genomic profiling study.

    Science.gov (United States)

    Oh, Seung-Hun; Kim, Ok-Joon; Shin, Dong-Ah; Song, Jihwan; Yoo, Hanna; Kim, Yu-Kyung; Kim, Jin-Kyeoung

    2012-08-15

    Peripheral blood cells and inflammatory mediators have a detrimental effect on brain during cerebral ischemia. We investigated the immunologic changes on peripheral blood in the acute phase of ischemic stroke using RNA microarray. mRNA microarray and real time-polymerase chain reaction (RT-PCR) for genes of interest in microarray data were analyzed in 12 stroke patients and 12 controls. Plasma matrix metalloproteinase-9 (MMP-9) concentrations were measured in 120 stroke patients and 82 controls. In microarray analysis, a total of 11 genes of interest showed different expression in patients with ischemic stroke. The three most highly expressed genes were C19orf59 (chromosome 19 open reading frame 59), MMP9 and IL18RAP (interleukin-18 receptor accessory protein), whereas gene with the lowest expression was GNLY (granulysin). The expression patterns of three selected genes (MMP9, IL18RAP and GNLY) were validated by RT-PCR. The plasma concentration of MMP-9 was significantly elevated in the stroke patients, and showed a weakly positive correlation with infarct volume. Gene set enrichment analysis (GSEA) showed that gene sets related to immunity and defense, signal transduction, transport and cell adhesion were significant in acute ischemic stroke. In the peripheral blood, numerous genes of inflammatory mediators, including MMP9, IL18RAP and GNLY, are altered in the acute phase of ischemic stroke. This stroke-specific gene expression profiling provides valuable information about the role of peripheral inflammation to the pathophysiological mechanism of ischemic stroke. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Impact of severe extracranial ICA stenosis on MRI perfusion and diffusion parameters in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Philipp eKaesemann

    2014-12-01

    Full Text Available Purpose:The aim of this study was to investigate the impact of a coexisting internal carotid artery (ICA stenosis on lesion volumes as well as diffusion and perfusion parameters in acute ischemic stroke resulting from middle cerebral artery (MCA occlusion.Material and Methods:MRI data of 32 patients with MCA occlusion with or without additional ICA stenosis imaged within 4.5 hours of symptom onset were analyzed. Both groups consisted of 16 patients. Acute diffusion lesions were semi-automatically segmented in apparent diffusion coefficient (ADC MRI datasets. Perfusion maps of cerebral blood volume (CBV, cerebral blood flow (CBF, mean transit time (MTT and Tmax were calculated using perfusion-weighted MRI datasets. Tissue-at-risk (TAR volumes were generated by subtracting the ADC lesion from the hypoperfusion lesion defined by Tmax >6s. Median ADC and perfusion parameter values were extracted separately for the diffusion lesion and tissue-at-risk and used for statistical analysis.Results:No significant differences were found between the groups regarding the diffusion lesion and tissue-at-risk volumes. Statistical analysis of diffusion and perfusion parameters revealed CBV as the only parameter with a significant difference (p=0.009 contributing a small effect (ɛ²=0.11 to the group comparison with higher CBV values for the patient group with a coexisting ICA stenosis, while no significant effects were found for the other diffusion and perfusion parameters analyzed.Conclusion:The results of this study suggest that a coexisting ICA stenosis does not have a strong effect on tissue status or perfusion parameters in acute stroke patients except for a moderate elevation of CBV. This may reflect improved collateral circulation or ischemic preconditioning in patients with a pre-existing proximal stenosis balancing impaired perfusion from the stenosis.

  7. Off-Hours Admission and Acute Stroke Care Quality

    DEFF Research Database (Denmark)

    Kristiansen, Nina Sahlertz; Mainz, Jan; Nørgård, Bente Mertz;

    2014-01-01

    stroke care processes, including the effect of a systematic quality improvement program, and to examine 30 days case-fatality. Methods-A population-based historical cohort study, including patients admitted to Danish hospitals with a first ever acute stroke (January 1, 2003, to December 31, 2011; N=64...... characteristics (in particular, stroke severity) decreased the odds ratio to 1.03 (95% confidence interval, 0.97-1.10). Additional adjustment for hospital characteristics and compliance with performance measures had no effect on the odds ratio. Conclusion-Patients admitted off-hours received a poorer quality...... of care. However, the admission time-related differences in care were substantially reduced over time, and the differences in 30 days case-fatality appeared primarily to be explained by differences in stroke severity....

  8. STUDY OF C-REACTIVE PROTEIN IN ACUTE ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Medhini

    2014-06-01

    Full Text Available : Ischemic stroke is the 3rd leading cause of death after AMI and cancer. Stroke is also the leading cause of hospital admission causing disability. The study was based on 100 patients with ischemic stroke admitted to the JJM Medical College, Davangere. This study was done to estimate the role of C-reactive protein as a marker of acute inflammation following ischemic stroke and also to determine, its prognostic role, by assessing the functional outcome of patient using modified Barthel index scoring (ADL. Patients with CRP 6 mg/dl suffered severe disease with poor functional outcome. P value <0.05, significant, suggests CRP is a good tool for prognostic indicator

  9. [Hyponatremia in acute intracranial disorders: cerebral salt wasting].

    Science.gov (United States)

    Betjes, M G; Koopmans, R P

    2000-03-18

    Hyponatraemia is a frequent finding in the course of an acute intracranial disease, especially after a subarachnoid haemorrhage. The fall in plasma sodium concentration is usually mild and not below 124 mmol/l but may reach dangerously low levels with serious neurological complications. In the early 1950s the cause of the hyponatraemia was believed to be primarily excessive natriuresis and therefore named 'cerebral salt wasting'. After the description of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) this was favoured as the most likely explanation. Only in recent years has it become evident that many hyponatraemic patients with acute brain disease are actually hypovolaemic. This is compatible with the original diagnosis of cerebral salt wasting. The increased plasma concentrations of natriuretic peptides are likely to mediate the increased natriuresis. Cerebral salt wasting can be treated with a simple regimen of water and salt suppletion. If needed a mineralocorticoid like fludrocortisone can be given to increase renal tubular sodium reabsorption.

  10. Osteoprotegerin concentrations and prognosis in acute ischaemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper Khédri; Ueland, T; Gullestad, L;

    2010-01-01

    .1365-2796.2009.02163.x.Aim. Concentrations of osteoprotegerin (OPG) have been associated with the presence of vascular and cardiovascular diseases, but the knowledge of this marker in the setting of ischaemic stroke is limited. Methods and results. In 244 patients with acute ischaemic stroke (age: 69......Abstract. Jensen JK, Ueland T, Atar D, Gullestad L, Mickley H, Aukrust P, Januzzi JL (Odense University Hospital, Denmark; Rikshospitalet, Oslo, Norway; Massachusetts General Hospital, USA). Osteoprotegerin concentrations and prognosis in acute ischaemic stroke. J Intern Med 2009; doi: 10.1111/j...... at presentation included haemoglobin (T = -2.82; P = 0.005), creatinine (T = 4.56; P age (T = 9.66; P

  11. Changes of deceleration and acceleration capacity of heart rate in patients with acute hemispheric ischemic stroke

    Directory of Open Access Journals (Sweden)

    Xu YH

    2016-03-01

    Full Text Available Yan-Hong Xu,1 Xing-De Wang,2 Jia-Jun Yang,1 Li Zhou,2 Yong-Chao Pan1 1Department of Neurology, 2Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China Background and purpose: Autonomic dysfunction is common after stroke, which is correlated with unfavorable outcome. Phase-rectified signal averaging is a newly developed technique for assessing cardiac autonomic function, by detecting sympathetic and vagal nerve activity separately through calculating acceleration capacity (AC and deceleration capacity (DC of heart rate. In this study, we used this technique for the first time to investigate the cardiac autonomic function of patients with acute hemispheric ischemic stroke. Methods: A 24-hour Holter monitoring was performed in 63 patients with first-ever acute ischemic stroke in hemisphere and sinus rhythm, as well as in 50 controls with high risk of stroke. DC, AC, heart rate variability parameters, standard deviation of all normal-to-normal intervals (SDNN, and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals (RMSSD were calculated. The National Institutes of Health Stroke Scale (NIHSS was used to assess the severity of stroke. We analyzed the changes of DC, AC, SDNN, and RMSSD and also studied the correlations between these parameters and NIHSS scores. Results: The R–R (R wave to R wave on electrocardiogram intervals, DC, AC, and SDNN in the cerebral infarction group were lower than those in controls (P=0.003, P=0.002, P=0.006, and P=0.043, but the difference of RMSSD and the D-value and ratio between absolute value of AC (|AC| and DC were not statistically significant compared with those in controls. The DC of the infarction group was significantly correlated with |AC|, SDNN, and RMSSD (r=0.857, r=0.619, and r=0.358; P=0.000, P=0.000, and P=0.004. Correlation analysis also showed that DC, |AC|, and SDNN

  12. Carotid endarterectomy after intravenous thrombolysis for acute cerebral ischaemic attack

    DEFF Research Database (Denmark)

    Rathenborg, Lisbet Knudsen; Jensen, L P; Baekgaard, N;

    2013-01-01

    Intravenous thrombolysis (IVT) has proven effective in the treatment of acute cerebral ischaemic attack in selected cases. In the presence of a carotid artery stenosis, such patients may be candidates for carotid endarterectomy (CEA). Few studies have been made on the safety of CEA performed afte...

  13. Limb apraxia in acute ischemic stroke: a neglected clinical challenge?

    Science.gov (United States)

    Schell, Caroline; Suchan, Julia; Himmelbach, Marc; Haarmeier, Thomas; Borchers, Svenja

    2014-04-01

    Symptoms of limb apraxia and executive dysfunctions are currently not explicitly considered by the National Institutes of Health Stroke Scale and, thus, not routinely tested by clinicians in the acute care of patients with suspected stroke. Neuropsychological testing, clinical examination, MRI, and functional magnetic resonance imaging (fMRI) were performed in a right-handed patient with acute onset of left-sided sensorimotor hemiparesis due to a right hemisphere ischemic stroke. Deficits in the execution of meaningless and meaningful gestures were not detected properly on initial clinical examination but were revealed later on through neuropsychological testing. Instead, the patient's inability to respond to specific instructions in the acute care setting was mistaken to reflect severe deficits in auditory comprehension. fMRI revealed right-hemispheric localization of language in the right-handed patient. We suggest including a bedside test for limb apraxia symptoms in acute clinical care of stroke patients. The distinction between deficits in limb praxis and impairments of language can be complicated owing to the common hemispheric co-localization of the two functions.

  14. Acute Supratentorial Ischemic Stroke: When Surgery Is Mandatory

    Directory of Open Access Journals (Sweden)

    Gabriele Ronchetti

    2014-01-01

    Full Text Available Acute occlusion of middle cerebral artery (MCA leads to severe brain swelling and to a malignant, often fatal syndrome. The authors summarize the current knowledge about such a condition and review the main surgical issues involved. Decompressive hemicraniectomy keeps being a valid option in accurately selected patients.

  15. Efficacy of citicoline as an acute stroke treatment.

    Science.gov (United States)

    Clark, Wayne M

    2009-04-01

    Citicoline (cytidine-5'-diphosphocholine or CDP-choline) is a precursor essential for the synthesis of phosphatidylcholine, one of the cell membrane components that is degraded during cerebral ischemia to free fatty acids and free radicals. Animal studies suggest that citicoline may protect cell membranes by accelerating resynthesis of phospholipids and suppressing the release of free fatty acids, stabilizing cell membranes, and reducing free radical generation. Numerous experimental stroke studies with citicoline have shown improved outcome and reduced infarct size in both ischemic and hemorrhagic stroke models. Citicoline has been studied worldwide in both ischemic and hemorrhagic clinical stroke with excellent safety and possibly efficacy found in several trials. A meta-analysis of four randomized US clinical citicoline trials concluded that treatment with oral citicoline within the first 24 h after a moderate to severe stroke is safe and increases the probability of complete recovery at 3 months. Citicoline clinical efficacy trials are now continuing outside of the US in both ischemic and hemorrhagic stroke. A citicoline supplement is now available from several sources on the internet.

  16. Blood-brain barrier and cerebral blood flow: Age differences in hemorrhagic stroke

    Directory of Open Access Journals (Sweden)

    Semyachkina-Glushkovskaya Oxana

    2015-11-01

    Full Text Available Neonatal stroke is similar to the stroke that occurs in adults and produces a significant morbidity and long-term neurologic and cognitive deficits. There are important differences in the factors, clinical events and outcomes associated with the stroke in infants and adults. However, mechanisms underlying age differences in the stroke development remain largely unknown. Therefore, treatment guidelines for neonatal stroke must extrapolate from the adult data that is often not suitable for children. The new information about differences between neonatal and adult stroke is essential for identification of significant areas for future treatment and effective prevention of neonatal stroke. Here, we studied the development of stress-induced hemorrhagic stroke and possible mechanisms underlying these processes in newborn and adult rats. Using histological methods and magnetic resonance imaging, we found age differences in the type of intracranial hemorrhages. Newborn rats demonstrated small superficial bleedings in the cortex while adult rats had more severe deep bleedings in the cerebellum. Using Doppler optical coherent tomography, we found higher stress-reactivity of the sagittal sinus to deleterious effects of stress in newborn vs. adult rats suggesting that the cerebral veins are more vulnerable to negative stress factors in neonatal vs. adult brain in rats. However, adult but not newborn rats demonstrated the stroke-induced breakdown of blood brain barrier (BBB permeability. The one of possible mechanisms underlying the higher resistance to stress-related stroke injures of cerebral vessels in newborn rats compared with adult animals is the greater expression of two main tight junction proteins of BBB (occludin and claudin-5 in neonatal vs. mature brain in rats.

  17. Tissue at risk in the deep middle cerebral artery territory is critical to stroke outcome

    Energy Technology Data Exchange (ETDEWEB)

    Rosso, Charlotte; Samson, Yves [Pitie-Salpetriere Hospital, AP-HP, Urgences Cerebro-Vasculaires, Paris (France); UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris (France); Colliot, Olivier [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris (France); Valabregue, Romain [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, Centre for NeuroImaging Research (CENIR), Paris (France); Crozier, Sophie [Pitie-Salpetriere Hospital, AP-HP, Urgences Cerebro-Vasculaires, Paris (France); Dormont, Didier [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris (France); Pitie-Salpetriere Hospital, AP-HP, Department of Neuroradiology, Paris (France); Lehericy, Stephane [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, Centre for NeuroImaging Research (CENIR), Paris (France); Pitie-Salpetriere Hospital, AP-HP, Department of Neuroradiology, Paris (France)

    2011-10-15

    The clinical efficacy of thrombolysis in stroke patients is explained by the increased rate of recanalization, which limits infarct growth. However, the efficacy could also be explained by the protection of specific sites of the brain. Here, we investigate where is this outcome-related tissue at risk using voxel-based analysis. We included 68 acute stroke patients with middle cerebral artery (MCA) occlusion on the admission MRI performed within 6 h of symptoms onset (H6) and 16 controls. MCA recanalization was assessed using the magnetic resonance angiography performed at day 1 (D1). Apparent diffusion coefficient (ADC) changes were analyzed using a voxel-based method between patients vs. controls group at admission (H6) in non-recanalized vs. recanalized and in 3-month poor vs. good outcome patients at D1. Complete or partial MCA recanalization was observed in 52 of 68 patients. Good outcome at 3 months occurred in 40 patients (59%). In non-recanalized patients, ADC was decreased in the deep MCA and watershed arterial territory (the lenticular nucleus, internal capsule, and the overlying periventricular white matter). This decrease was not observed in recanalized patients at D1 or patients at H6. Fiber tracking suggested that the area is crossed by the cortico-spinal, cerebellar, and intra-hemispheric association tracts. Finally, this area almost co-localized with the area associated with poor outcome. A clinically relevant area of tissue at risk may occur in patients with MCA infarcts at the level of deep white matter fiber tracts. These findings suggest that neuroprotection research should be refocused on white matter. (orig.)

  18. The evolution of the cerebral blood volume abnormality in patients with ischemic stroke: a CT perfusion study

    Energy Technology Data Exchange (ETDEWEB)

    D' Esterre, Christopher D.; Lee, Ting Yim (Lawson Health Research Inst., London (Canada); Robarts Research Inst., London (Canada)), email: tlee@robarts.ca; Aviv, Richard I. (Sunnybrook Health Sciences Centre, Toronto (Canada))

    2012-05-15

    Background: Accurate identification of the acute infarct core abnormality is important for guiding acute stroke treatment. Abnormality volumes from diffusion-weighted MRI (DWI) and CT perfusion (CTP)-cerebral blood volume (CBV) are highly correlated. DWI lesions have been shown to be reversible at 24 h. Purpose: To examine the temporal profile of the CT perfusion (CTP)-derived CBV abnormality out to 7 days post ischemic stroke. Material and Methods: Twenty-six patients were included. Group A (n = 13) underwent a noncontrast CT (NCCT), CTP/CT angiography (CTA) within 6 h of stroke onset, CTP/CTA at 24 h, and CTP/NCCT at 5-7 days post stroke. Group B (n = 13) underwent a NCCT, CTP/CTA within 6 h of stroke onset, and NCCT at 5-7 days. Recanalization status was established in all patients. For both groups, infarct volumes were traced on 5-7 day NCCT images and superimposed onto all CTP-CBV functional maps to determine CBV. Group B (n = 13) admission images were used to define CBV infarct thresholds for gray and white matter. CBV-lesion overestimation was determined for Group A using the thresholds from Group B. Results: CBV (ml x 100g- 1; mean +- stdev) for gray/white matter, within confirmed infarcted regions (CBVI) at admission, 24 h, and 5-7 days were 1.82 +- 0.56, 1.56 +- 0.42, 1.75 +- 0.31, and 1.38 +- 0.65, 1.13 +- 0.31, 1.32 +- 0.44, respectively, when averaged over all patients (P > 0.05). Four patients had tissue time-density curves from ischemic lesions (TDCi) with an incomplete contrast medium wash-out phase (truncation) at admission and/or 24 h. Compared to admission, gray matter CBVI was higher at 5-7 days for patients with TDCi truncation (P < 0.05). There were no significant CBVI increases for the eight patients without truncation (P > 0.05). Over-estimation of acute CBV lesion was present in 3/4 (75%) and 1/9 (11%) of patients with/without TDCi truncation, respectively. Conclusion: CTP-derived CBV lesion reversal is associated with TDCi truncation

  19. Mycotic brain aneurysm and cerebral hemorrhagic stroke: a pediatric case report.

    Science.gov (United States)

    Flor-de-Lima, Filipa; Lisboa, Lurdes; Sarmento, António; Almeida, Jorge; Mota, Teresa

    2013-09-01

    Endocarditis due to Abiotrophia spp. is rare and often associated with negative blood cultures, infection relapse, and high rates of treatment failure and mortality (Lainscak et al., J Heart Valve Dis 14(1):33-36, 2005). The authors describe a case of an adolescent with cerebral hemorrhagic stroke due to mycotic brain aneurysm rupture.

  20. Magnetic resonance imaging of cerebral blood flow in animal stroke models

    Directory of Open Access Journals (Sweden)

    Qiang Shen

    2016-01-01

    Full Text Available Perfusion could provide useful information on the metabolic status and functional status of tissues and organs. This review summarizes the most commonly used perfusion measurement methods: Dynamic susceptibility contrast (DSC and arterial spin labeling (ASL and their applications in experimental stroke. Some new developments of cerebral blood flow (CBF techniques in animal models are also discussed.

  1. Magnetic Resonance Imaging of Cerebral Blood Flow in Animal Stroke Models

    OpenAIRE

    Qiang Shen; Timothy Q Duong

    2016-01-01

    Perfusion could provide useful information on the metabolic status and functional status of tissues and organs. This review summarizes the most commonly used perfusion measurement methods: Dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL) and their applications in experimental stroke. Some new developments of cerebral blood flow (CBF) techniques in animal models are also discussed.

  2. Epilepsy in Hemiplegic Cerebral Palsy Due to Perinatal Arterial Ischaemic Stroke

    Science.gov (United States)

    Wanigasinghe, Jithangi; Reid, Susan M.; Mackay, Mark T.; Reddihough, Dinah S.; Harvey, A. Simon; Freeman, Jeremy L.

    2010-01-01

    Aim: The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). Method: The study group comprised 63 participants (41 males, 22 females) from a population-based CP register whose brain imaging showed…

  3. Epilepsy in Hemiplegic Cerebral Palsy Due to Perinatal Arterial Ischaemic Stroke

    Science.gov (United States)

    Wanigasinghe, Jithangi; Reid, Susan M.; Mackay, Mark T.; Reddihough, Dinah S.; Harvey, A. Simon; Freeman, Jeremy L.

    2010-01-01

    Aim: The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). Method: The study group comprised 63 participants (41 males, 22 females) from a population-based CP register whose brain imaging showed…

  4. Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

    Directory of Open Access Journals (Sweden)

    Ayan Sen

    2014-07-01

    Full Text Available Introduction: Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements. Methods: This study was a secondary analysis of 7 stroke patients from a prospectively collected data set of patients that received 2 hours of hemodynamic monitoring in the ED. Stroke patients were included if hemorrhagic or ischemic stroke was confirmed by neuroimaging, and symptom onset was within 24 hours. They were excluded for the presence of a stroke mimic or transient ischemic attack. Monitoring was performed using the Nexfin device (Edwards Lifesciences, Irvine CA. Results: The mean age of the cohort was 71 ± 17 years, 43% were male, and the mean National Institute of Health Stroke Scale (NIHSS was 6.9 ± 5.5. Two patients had hemorrhagic stroke. We obtained 42,456 hemodynamic data points, including beat-to-beat blood pressure measurements with variability of 18 mmHg and cardiac indices ranging from 1.8 to 3.6 l/min/m2. The correlation coefficient between continuous blood pressure measurements with the Nexfin device and standard ED readings was 0.83. Conclusion: This exploratory investigation revealed that continuous, noninvasive monitoring in the ED is feasible in acute stroke. Further research is currently underway to determine how such monitoring may impact outcomes in stroke or replace the need for invasive monitoring. [West J Emerg Med. 2014;15(4:–0.

  5. Electrical Bioimpedance Spectroscopy on Acute Unilateral Stroke Patients: Initial Observations regarding Differences between Sides

    Directory of Open Access Journals (Sweden)

    Fernando Seoane

    2015-01-01

    Full Text Available Purpose. Electrical Bioimpedance Cerebral Monitoring is assessment in real time of health of brain tissue through study of passive dielectric properties of brain. During the last two decades theory and technology have been developed in parallel with animal experiments aiming to confirm feasibility of using bioimpedance-based technology for prompt detection of brain damage. Here, for the first time, we show that electrical bioimpedance measurements for left and right hemispheres are significantly different in acute cases of unilateral stroke within 24 hours from onset. Methods. Electrical BIS measurements have been taken in healthy volunteers and patients suffering from acute stroke within 24 hours of onset. BIS measurements have been obtained using SFB7 bioimpedance spectrometer manufactured by Impedimed ltd. and 4-electrode method. Measurement electrodes, current, and voltage have been placed according to 10–20 EEG system obtaining mutual BIS measurements from 4 different channels situated in pairs symmetrically from the midsagittal line. Obtained BIS data has been analyzed, assessing for symmetries and differences regarding healthy control data. Results. 7 out of 10 patients for Side-2-Side comparisons and 8 out 10 for central/lateral comparison presented values outside the range defined by healthy control group. When combined only 1 of 10 patients exhibited values within the healthy range. Conclusions. If these initial observations are confirmed with more patients, we can foresee emerging of noninvasive monitoring technology for brain damage with the potential to lead to paradigm shift in treatment of brain stroke and traumatic brain damage.

  6. Prevalence and risk factors associated with reversed Robin Hood syndrome in acute ischemic stroke.

    Science.gov (United States)

    Alexandrov, Andrei V; Nguyen, Huy Thang; Rubiera, Marta; Alexandrov, Anne W; Zhao, Limin; Heliopoulos, Ioannis; Robinson, Alice; Dewolfe, Jennifer; Tsivgoulis, Georgios

    2009-08-01

    Early deterioration can occur after acute stroke for a variety of reasons. We describe a hemodynamic steal and associated neurological deterioration, the reversed Robin Hood syndrome (RRHS). We aimed to investigate the frequency and factors associated with RRHS. Consecutive patients with acute cerebral ischemia underwent serial National Institutes of Health Stroke Scale and bilateral transcranial Doppler monitoring with breathholding. Steal magnitude (%) was calculated from transient mean flow velocity reduction in the affected arteries at the time of velocity increase in normal vessels. Excessive sleepiness and likelihood of sleep apnea were evaluated by the Epworth Sleepiness Scale and Berlin Questionnaire. Among 153 patients (age, 61+/-14 years; 48% women; 21% transient ischemic attack) admitted within 48 hours from symptom onset, 21 (14%) had steal phenomenon (median steal magnitude, 20%; interquartile range, 11%; range, 6% to 45%), and 11 (7%) had RRHS. RRHS was most frequent in patients with proximal arterial occlusions (17% versus 1%; P<0.001). The following factors were independently (P<0.05) associated with RRHS (multivariate logistic regression model): male gender, younger age, persisting arterial occlusions, and excessive sleepiness (P<0.001). A 1-point increase in the Epworth Sleepiness Scale was independently related to an increased likelihood of RRHS of 36% (95% CI, 7% to 73%). RRHS and hemodynamic steal can be found in 7% and 14%, respectively, of consecutive patients with stroke without other known causes for deterioration. Patients with persisting arterial occlusions and excessive sleepiness can be particularly vulnerable to the steal.

  7. Prediction of acute stroke progression by the National Institutes of Health Stroke Scale

    Institute of Scientific and Technical Information of China (English)

    Vinh Phuong; Tran Van Huy

    2007-01-01

    Objective To determine the occurrence of neurological changes during the first 48 hours after acute stroke as it relates to the initial stroke severity assessment. Methods The assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed serially for the first 48 hours on 68 consecutive ischemic stroke patients admitted to the Department of Geriatric Cardiology at the Khanh Hoa Hospital, Nha Trang, Vietnam. Incidence of stroke progression (a ≥ 3-point increase on the NIHSS) was recorded and analysis performed to determine its association with initial stroke severity and other demographic and physiological variables. Deficit resolution by 48 hours, defined as an NIHSS score of 0 or 1, measured the frequency of functional recovery predicted by the initial deficit.Results Overall progression was noted in 28% of events (19/68). Applying Bayes' solution to the observed frequency of worsening, the greatest likelihood of predicting future patient progression occurred with NIHSS score of =7 and >7. Patients with an initial NIHSS score of =7 experienced a 13% (6/47) worsening rate versus those of an initial score of>7 with a 62% (13/21) worsening rate (P<0.01). 42.5%(20/47) of those with an initial score of =7 were functionally normal at 48 hours, whereas only 4.7% (1/21) of those with scores of >7 retnrned to a normal examination within this period (x2, P<0.05). Conclusions This study suggests that the early clinical course of neurological deficit after acute stroke be dependent on the initial stroke severity and that a dichotomy in early outcome exist surrounding an initial NIHSS score of 7. These findings may have significant implications for the design and patient stratification in treatment protocols with respect to primary clinical outcome.

  8. Predictors of Outcome in Patients Presenting with Acute Ischemic Stroke and Mild Stroke Scale Scores.

    Science.gov (United States)

    Kenmuir, Cynthia L; Hammer, Maxim; Jovin, Tudor; Reddy, Vivek; Wechsler, Lawrence; Jadhav, Ashutosh

    2015-07-01

    Although National Institutes of Health Stroke Scale (NIHSS) is a known predictor of outcome in acute ischemic stroke, there are other factors like age, ambulatory status, and ability to swallow that may be predictors of outcome but are not assessed by the traditional NIHSS. The aim of this retrospective review was to identify predictors of outcome in mild ischemic stroke. Discharge outcomes from patients who presented to our large academic stroke center with acute ischemic stroke from 2005 to 2013 were retrospectively reviewed. Of 7189 patients reviewed, 2597 had initial NIHSS less than 5. Outcome measures were modified Rankin Scale (MRS) score 0-1 and discharge to home. In all, 65% of patients with NIHSS 0-4 were discharged directly home independent of treatment. Of those patients discharged to home, 74% were able to ambulate independently and 98% passed their dysphagia screen. Of patients not discharged directly home, 66% were unable to ambulate independently and 21% did not pass their dysphagia screen. Multivariate logistic regression analysis revealed a significant effect of dysphagia screen (P = .001), ability to ambulate independently (P = .002), age (P = .016), and NIHSS (P = .005) on discharge to home but not MRS of 0-1 (P = .564). In patients with mild stroke scale scores defined as NIHSS 0-4, several factors including age, NIHSS, ambulatory status, and ability to swallow may be independent predictors of functional outcome and discharge home. These data support the development of a modified grading system for assessing functional outcome in mild stroke that considers these factors. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Increased inter-hemispheric resting-state functional connectivity in acute lacunar stroke patients with aphasia.

    Science.gov (United States)

    Yang, Haiqing; Bai, Lin; Zhou, Yi; Kang, Shan; Liang, Panpan; Wang, Lihua; Zhu, Yifei

    2017-03-01

    Aphasia is a devastating neurological condition affecting a person's ability to communicate and reintegrate into the society. It may occur in 20% or more of patients after stroke. The recovery of language function is accompanied by brain reorganization, and identifying the inter-hemispheric interaction post-stroke will conduce to more targeted treatments. Previous studies suggested that robust homotopic resting-state functional connectivity is a key characteristic of the brain's intrinsic functional architecture, and communication between the left and right cerebral hemispheres is important for language processing. In this study, voxel-mirrored homotopic connectivity (VMHC) was used to examine the inter-hemispheric resting-state functional connectivity (RSFC) differences between 37 patients with acute lacunar stroke in the left hemisphere and 28 healthy controls. Besides, correlation analyses were carried out to investigate the relationship between VMHC values of brain regions showing abnormal inter-hemispheric RSFC and clinical variables [i.e., aphasia quotient (AQ) scores, National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination of patients]. Compared with healthy controls, patients showed significantly increased VMHC in the pars orbitalis of the inferior frontal gyrus, anterior part of the superior temporal gyrus (STG) and lingual gyrus. No brain region showed decreased VMHC in the patient group than in the healthy control group. The AQ scores were negatively correlated with VMHC values in the STG. NIHSS scores were positively correlated with VMHC values in the lingual gyrus. We hope these results could shed new insights into the pathology of aphasia in patients with acute lacunar stroke.

  10. Acute MRI Changes in Progressive Ischemic Stroke

    DEFF Research Database (Denmark)

    Kalowska, Elizabeth; Rostrup, Egill; Rosenbaum, S

    2008-01-01

    as a permanent decrease of >/=3 Scandinavian Stroke Scale (SSS) points for speech or >/=2 SSS points for consciousness or >/=2 SSS points for limb strength, when assessed at baseline compared to the day after admission and daily during the following week. Patients were followed up on day 90 and assessed using......-weighted imaging (DWI), perfusion-weighted imaging and magnetic resonance angiography were performed 3 times, immediately after clinical evaluation, on day 7 and after 3 months. Clinical neurological assessments were performed every 2 h during the first 24 h and once daily from day 2 to 7. SIP was defined...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. Results: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...

  11. Acute MRI changes in progressive ischemic stroke

    DEFF Research Database (Denmark)

    Kalowska, E.; Rostrup, E.; Rosenbaum, S.

    2008-01-01

    as a permanent decrease of >or=3 Scandinavian Stroke Scale (SSS) points for speech or >or=2 SSS points for consciousness or >or=2 SSS points for limb strength, when assessed at baseline compared to the day after admission and daily during the following week. Patients were followed up on day 90 and assessed using......-weighted imaging (DWI), perfusion-weighted imaging and magnetic resonance angiography were performed 3 times, immediately after clinical evaluation, on day 7 and after 3 months. Clinical neurological assessments were performed every 2 h during the first 24 h and once daily from day 2 to 7. SIP was defined...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...

  12. Human Motor Cortex Functional Changes in Acute Stroke: Gender Effects

    Directory of Open Access Journals (Sweden)

    Vincenzo eDi Lazzaro

    2016-01-01

    Full Text Available The acute phase of stroke is accompanied by functional changes in the activity and interplay of both hemispheres. In healthy subjects, gender is known to impact the functional brain organization.We investigated whether gender influences also acute stroke functional changes. In thirty-five ischemic stroke patients, we evaluated the excitability of the affected (AH and unaffected hemisphere (UH by measuring resting and active motor threshold and motor-evoked potential amplitude under baseline conditions and after intermittent theta burst stimulation (iTBS of AH. We also computed an index of the excitability balance between the hemispheres, laterality indexes (LI, to evidence hemispheric asymmetry. Active motor threshold differed significantly between AH and UH only in the male group (p=0.004, not in females (p>0.200, and both LIAMT and LIRMT were significantly higher in males than in females (respectively p=0.033 and p=0.042. LTP-like activity induced by iTBS in AH was more frequent in females. Gender influences the functional excitability changes that take place after human stroke and the level of LTP that can be induced by repetitive stimulation. This knowledge is of high value in the attempt of individualizing to different genders any non-invasive stimulation strategy designed to foster stroke recovery.

  13. Do nasogastric tubes worsen dysphagia in patients with acute stroke?

    Directory of Open Access Journals (Sweden)

    Ringelstein Erich B

    2008-07-01

    Full Text Available Abstract Background Early feeding via a nasogastric tube (NGT is recommended as safe way of supplying nutrition in patients with acute dysphagic stroke. However, preliminary evidence suggests that NGTs themselves may interfere with swallowing physiology. In the present study we therefore investigated the impact of NGTs on swallowing function in acute stroke patients. Methods In the first part of the study the incidence and consequences of pharyngeal misplacement of NGTs were examined in 100 stroke patients by fiberoptic endoscopic evaluation of swallowing (FEES. In the second part, the effect of correctly placed NGTs on swallowing function was evaluated by serially examining 25 individual patients with and without a NGT in place. Results A correctly placed NGT did not cause a worsening of stroke-related dysphagia. Except for two cases, in which swallowing material got stuck to the NGT and penetrated into the laryngeal vestibule after the swallow, no changes of the amount of penetration and aspiration were noted with the NGT in place as compared to the no-tube condition. Pharyngeal misplacement of the NGT was identified in 5 of 100 patients. All these patients showed worsening of dysphagia caused by the malpositioned NGT with an increase of pre-, intra-, and postdeglutitive penetration. Conclusion Based on these findings, there are no principle obstacles to start limited and supervised oral feeding in stroke patients with a NGT in place.

  14. TRPM7 in cerebral ischemia and potential target for drug development in stroke

    Institute of Scientific and Technical Information of China (English)

    Christine You-Jin BAE; Hong-shuo Sun

    2011-01-01

    Searching for effective pharmacological agents for stroke treatment has largely been unsuccessful. Despite initial excitement, antagonists for glutamate receptors, the most studied receptor channels in ischemic stroke, have shown insufficient neuroprotective effects in clinical trials. Outside the traditional glutamate-mediated excitotoxicity, recent evidence suggests few non-glutamate mechanisms,which may also cause ionic imbalance and cell death in cerebral ischemia. Transient receptor potential melastatin 7 (TRPM7) is a Ca2+permeable, non-selective cation channel that has recently gained attention as a potential cation influx pathway involved in ischemic events. Compelling new evidence from an in vivo study demonstrated that suppression of TRPM7 channels in adult rat brain in vivo using virally mediated gene silencing approach reduced delayed neuronal cell death and preserved neuronal functions in global cerebral ischemia. In this review, we will discuss the current understanding of the role of TRPM7 channels in physiology and pathophysiology as well as its therapeutic potential in stroke.

  15. Reperfusion Strategies for Acute Ischaemic Stroke From Past to Present: An Overview Towards Future Perspectives

    Directory of Open Access Journals (Sweden)

    Isabella Canavero

    2015-07-01

    Full Text Available Timely reperfusion of brain ischaemic tissue is the main therapeutic target for acute stroke. In the last few decades many recanalisation strategies have been studied by randomised controlled trials (RCTs, including intravenous (IV, intra-arterial (IA, and combined approaches. Clinical research is addressed to identify the drug associated with the better reperfusion properties and the lower rate of side-effects. To date, according to current evidence-based guidelines, IV tissue plasminogen activator (tPA is the only approved treatment for acute ischaemic stroke (AIS within 4.5 hours from onset. Other IV thrombolytics, such as tenecteplase and desmoteplase, have shown promising results in preliminary RCTs and are currently being investigated to produce further evidence. Endovascular catheter-based treatments (including IA administration of thrombolytics or mechanical thrombectomy have quite inferior feasibility, being performed only by stroke-trained interventional neuroradiologists. Until a few months ago, many trials had investigated the safety and efficacy of endovascular techniques compared with IV tPA without consistent results, limiting their application to patients with contraindications or poor response to IV tPA. More recently, the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN, Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times (ESCAPE, and Extending the Time for Thrombolysis in Emergency Neurological Deficits–Intra-arterial (EXTEND-IA trial results have demonstrated the superiority of endovascular procedures associated with standard care in AIS due to proximal arterial occlusion in the anterior cerebral circulation. These data are going to change the current decision-making process and the care pathway in AIS patients.

  16. Fractal dimension of EEG activity senses neuronal impairment in acute stroke.

    Directory of Open Access Journals (Sweden)

    Filippo Zappasodi

    Full Text Available The brain is a self-organizing system which displays self-similarities at different spatial and temporal scales. Thus, the complexity of its dynamics, associated to efficient processing and functional advantages, is expected to be captured by a measure of its scale-free (fractal properties. Under the hypothesis that the fractal dimension (FD of the electroencephalographic signal (EEG is optimally sensitive to the neuronal dysfunction secondary to a brain lesion, we tested the FD's ability in assessing two key processes in acute stroke: the clinical impairment and the recovery prognosis. Resting EEG was collected in 36 patients 4-10 days after a unilateral ischemic stroke in the middle cerebral artery territory and 19 healthy controls. National Health Institute Stroke Scale (NIHss was collected at T0 and 6 months later. Highuchi FD, its inter-hemispheric asymmetry (FDasy and spectral band powers were calculated for EEG signals. FD was smaller in patients than in controls (1.447±0.092 vs 1.525±0.105 and its reduction was paired to a worse acute clinical status. FD decrease was associated to alpha increase and beta decrease of oscillatory activity power. Larger FDasy in acute phase was paired to a worse clinical recovery at six months. FD in our patients captured the loss of complexity reflecting the global system dysfunction resulting from the structural damage. This decrease seems to reveal the intimate nature of structure-function unity, where the regional neural multi-scale self-similar activity is impaired by the anatomical lesion. This picture is coherent with neuronal activity complexity decrease paired to a reduced repertoire of functional abilities. FDasy result highlights the functional relevance of the balance between homologous brain structures' activities in stroke recovery.

  17. Fractal dimension of EEG activity senses neuronal impairment in acute stroke.

    Science.gov (United States)

    Zappasodi, Filippo; Olejarczyk, Elzbieta; Marzetti, Laura; Assenza, Giovanni; Pizzella, Vittorio; Tecchio, Franca

    2014-01-01

    The brain is a self-organizing system which displays self-similarities at different spatial and temporal scales. Thus, the complexity of its dynamics, associated to efficient processing and functional advantages, is expected to be captured by a measure of its scale-free (fractal) properties. Under the hypothesis that the fractal dimension (FD) of the electroencephalographic signal (EEG) is optimally sensitive to the neuronal dysfunction secondary to a brain lesion, we tested the FD's ability in assessing two key processes in acute stroke: the clinical impairment and the recovery prognosis. Resting EEG was collected in 36 patients 4-10 days after a unilateral ischemic stroke in the middle cerebral artery territory and 19 healthy controls. National Health Institute Stroke Scale (NIHss) was collected at T0 and 6 months later. Highuchi FD, its inter-hemispheric asymmetry (FDasy) and spectral band powers were calculated for EEG signals. FD was smaller in patients than in controls (1.447±0.092 vs 1.525±0.105) and its reduction was paired to a worse acute clinical status. FD decrease was associated to alpha increase and beta decrease of oscillatory activity power. Larger FDasy in acute phase was paired to a worse clinical recovery at six months. FD in our patients captured the loss of complexity reflecting the global system dysfunction resulting from the structural damage. This decrease seems to reveal the intimate nature of structure-function unity, where the regional neural multi-scale self-similar activity is impaired by the anatomical lesion. This picture is coherent with neuronal activity complexity decrease paired to a reduced repertoire of functional abilities. FDasy result highlights the functional relevance of the balance between homologous brain structures' activities in stroke recovery.

  18. Hyperdense basilar artery sign diagnoses acute posterior circulation stroke and predicts short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Xiaoping [Affiliated Hospital of China Medical University at Shenyang, Department of Neurology, Shengjing Hospital, Shenyang (China); Guo, Yang [Shengjing Hospital, Department of Neurology, Shenyang (China)

    2010-12-15

    It is well established that the hyperdense middle cerebral artery sign is a specific marker for early ischemia in anterior circulation. However, little is known about the hyperdense basilar artery sign (HDBA) in posterior circulation. Our aim was to determine whether the HDBA sign has utility in early diagnosis of acute posterior circulation stroke and prediction of short-term outcome. Three-blinded readers examined unenhanced computed tomography scans for the HDBA sign, and materials were classified into two groups according to this sign. Vascular risk factors, admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, short-term outcome, and radiological findings between the two groups were compared. One hundred and twenty-six cases of acute posterior circulation stroke (PCS) were included in the study. No statistically significant differences were found in risk factors of ischemic stroke, except atrial fibrillation (P = 0.025). Admission and discharge NIHSS scores for the positive HDBA group were significantly higher than scores for the negative HDBA group (P = 0.001, 0.002, respectively). The infarction territory for the positive HDBA group was mainly multi-region in nature (51.6%, P < 0.001), while the negative HDBA group showed mainly middle territory infarction. Significant independent predictors of short-term outcome included the HDBA sign (P < 0.001) and admission NIHSS scores (P < 0.001). Approximately half of the HDBA patients showed multi-region infarction and a serious neurological symptom. Based on our results, this sign might not only be helpful in early diagnosis of acute PCS but also be able to correlate with a poor short-term outcome. (orig.)

  19. Analysis of acute ischemic stroke presenting classic lacunar syndrome. A study by diffusion-weighted MRI

    Energy Technology Data Exchange (ETDEWEB)

    Terai, Satoshi; Ota, Kazuki; Tamaki, Kinya [Hakujyuji Hospital, Fukuoka (Japan)

    2002-03-01

    We retrospectively assessed the pathophysiological features of acute ischemic stroke presenting ''classic'' lacunar syndrome by using diffusion-weighted imaging (DWI). Subjects were 16 patients who were admitted to our hospital within 24 hours of stroke onset and underwent DWI examination on admission. These were divided into three categorical groups; pure motor hemiplegia (PMH) in 8, sensorimotor stroke (SMS) in 7, and dysarthria-clumsy hand syndrome (DCHS) in 1. The fresh responsible lesions were identified by DWI in the perforating territory in 7 patients with PMH and 7 with SMS. Four (one had two possible response lesions; pons and corona radiata) and five patients in the respective groups were diagnosed as lacunar infarction on admission (the largest dimension of the lesion measuring smaller than 15 mm). On the contralateral side to the neurological symptoms, DWI revealed high intensities in cortex, subcortical white matter, and anterior and posterior border zones in the remaining one patient with PMH and in the precentral arterial region in one with DCHS. They were diagnosed as atherothrombotic infarction resulting from the occlusion of the internal carotid artery and cerebral embolism due to atrial fibrillation, respectively. Three patients with PMH showed progressive deterioration after admission and follow-up DWI study in an acute stage revealed enlargement of heir ischemic lesions. The present study suggests that DWI is a useful imaging technique for diagnosis of clinical categories and observation for pathophsiological alteration in the acute ischemic stroke patients with ''classic'' lacunar syndrome. Our results also indicate a necessity to be aware that various types of fresh ischemic lesions other than a single lacune might possibly be developing in cases with this syndrome. (author)

  20. Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke.

    Science.gov (United States)

    Tsivgoulis, Georgios; Zhang, Yi; Alexandrov, Anne W; Harrigan, Mark R; Sisson, April; Zhao, Limin; Brethour, Mary; Cava, Luis; Balucani, Clotilde; Barlinn, Kristian; Patterson, Damon E; Giannopoulos, Sotirios; DeWolfe, Jennifer; Alexandrov, Andrei V

    2011-04-01

    Hypercapnia can induce intracranial blood-flow steal from ischemic brain tissues, and early initiation of noninvasive ventilator correction (NIVC) may improve cerebral hemodynamics in acute ischemic stroke. We sought to determine safety and tolerability of NIVC initiated on hospital admission without polysomnography study. Consecutive acute ischemic stroke patients were evaluated for the presence of a proximal arterial occlusion, daytime sleepiness, or history of obstructive sleep apnea, and acceptable pulse oximetry readings while awake (96%-100% on 2 to 4 L supplemental oxygen delivered by nasal cannula). NIVC was started on hospital admission as standard of care when considered necessary by treating physicians. NIVC was initiated using bilevel positive airway pressure at 10 cmH(2)O inspiratory positive airway pressure and 5 cmH(2)O expiratory positive airway pressure in combination with 40% fraction of inspired oxygen. All potential adverse events were prospectively documented. Among 356 acute ischemic stroke patients (median NIHSS score, 5; interquartile range, 2-13), 64 cases (18%) received NIVC (median NIHSS score, 12; interquartile range, 6-17). Baseline stroke severity was higher and proximal arterial occlusions were more frequent in NIVC patients compared to the rest (Pacute ischemic stroke patients with proximal arterial occlusion and excessive sleepiness or obstructive sleep apnea, NIVC can be initiated early with good tolerability and a relatively small risk of serious complications.

  1. 急性缺血性脑卒中患者血清氧化型低密度脂蛋白水平与颈动脉易损斑块的关系%Relationship Between Serum Oxidized Low-density Lipoprotein Level and Carotid Vulnerable Plaque in Patients with Acute Cerebral Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    许寅宏; 徐恩; 林清原; 邱少东

    2015-01-01

    PurposeTo investigate the relationship between the serum oxidized low-density lipoprotein (ox-LDL) level and carotid vulnerable plaque in patients with acute cerebral ischemic stroke, and to evaluate the ability of serum ox-LDL in identifying vulnerable carotid plaques.Materials and Methods 181 patients with history of acute cerebral ischemic stroke were recruited. According to the results of carotid ultrasound patients were divided into non plaque group (n=48), stable plaque group (n=38) and vulnerable plaque group (n=95). The serum total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, fasting plasma glucose and ox-LDL were measured. Carotid intima-medial thickness (CIMT), total carotid plaque area (TPA) and the characters of plaque were examined with color Doppler ultrasound.Results The serum ox-LDL and the number of patients with hypertension in plaque group were significantly higher than that in the non-plaque group (P<0.05). The serum ox-LDL and TPA in the vulnerable plaque group were significantly higher than that in the stable plaque group (P<0.05). Serum ox-LDL in patients with acute cerebral infarction was positively correlated with CIMT, serum total cholesterol and LDL-C (r1=0.154,P<0.05;r2=0.338, P<0.05;r3=0.385,P<0.05). Logistic regression analysis showed that serum ox-LDL was an independent risk factor for carotid vulnerable plaque (OR=1.038, 95%CI 1.008-1.069, P<0.01).Conclusion The serum ox-LDL is independently associated with the formation of vulnerable plaque in patients with acute cerebral infarction. This study suggests that ox-LDL can be used as a biomarker in screening for vulnerable carotid plaque in clinical practice. Carotid ultrasound combined with serology can early identify carotid artery vulnerable plaque that may lead to cerebral ischemic events.%目的:探讨急性缺血性脑卒中患者血清氧化型低密度脂蛋白(ox-LDL)水平与颈动脉易损斑块的关系,评

  2. Reperfusion Therapies for Acute Ischemic Stroke: An Update

    Science.gov (United States)

    Dorado, Laura; Millán, Mònica; Dávalos, Antoni

    2014-01-01

    Acute ischemic stroke is a major cause of morbidity and mortality in developed countries. Intravenous thrombolysis with tissue plasminogen activator (tPA) within 4.5 hours of symptoms onset significantly improves clinical outcomes in patients with acute ischemic stroke. This narrow window for treatment leads to a small proportion of eligible patients to be treated. Intravenous or intra-arterial trials, combined intravenous/intra-arterial trials, and newer devices to mechanically remove the clot from intracranial arteries have been investigated or are currently being explored to increase patient eligibility and to improve arterial recanalization and clinical outcome. New retrievable stent-based devices offer higher revascularization rates with shorter time to recanalization and are now generally preferred to first generation thrombectomy devices such as Merci Retriever or Penumbra System. These devices have been shown to be effective for opening up occluded vessels in the brain but its efficacy for improving outcomes in patients with acute stroke has not yet been demonstrated in a randomized clinical trial. We summarize the results of the major systemic thrombolytic trials and the latest trials employing different endovascular approaches to ischemic stroke. PMID:24646159

  3. Modern Imaging Modalities in the Assessment of Acute Stroke

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    Zlatareva Dora K.

    2014-08-01

    Full Text Available The AIM of this review was to present the modern concepts of diagnostic imaging in acute stroke. Neuroimaging in acute stroke aims at diagnosing the condition as early as possible and assessing the extent of parenchymal perfusion and the intracranial vessels patency. A modern approach would involve a combination of various imaging modalities as multidetector computed tomography and high field magnetic resonance imaging. A non-enhanced computed tomography (CT is used to detect hemorrhage or to identify early signs of ischemic stroke. CT angiography finds evidence of intravascular thrombi or significant stenoses, and CT perfusion displays brain tissue at risk of irreversible alterations that can be salvaged therapeutically. Magnetic resonance imaging (MRI is a more sensitive modality than CT in diagnosing acute brain ischemia. MR diffusion-weighted imaging is more sensitive than conventional MR sequences in hyperacute stage. MR angiography as a non-invasive and non-ionizing imaging method is used as an alternative modality to CT angiography. To find brain tissue at risk diffusion- and perfusion-weighted magnetic resonance imaging modalities are used. The authors present briefly the modern neuroimaging modalities used in patients with transient ischemic attack, minor stroke and venous infarction. By combining different imaging techniques in a multimodal approach we can acquire the information necessary for therapeutic planning and differentiate patients who need thrombolysis.

  4. EFFICACY OF MELDONIUM IN ACUTE PERIOD OF ISCHEMIC STROKE

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    S. V. Kotov

    2015-01-01

    Full Text Available Background: As long as systemic thrombolysis is indicated to not more than 10% of patients with ischemic stroke, the search for medical agents for basic treatment of stroke is an important problem of today’s neurology.Aim: To evaluate efficacy of meldonium in patients with acute ischemic stroke.Materials and methods: One hundred and fourteen patients were assessed in the acute period of strokes in the internal carotid artery system. The main group included 70 patients who were given meldonium (Mildronate in addition to their basic treatment regimen. The drug was administered intravenously in daily drop infusions at dose of 10 ml of 10% solution for 10 days, thereafter they were switched to oral treatment at 250 mg daily for 2 to 3 weeks. The control group consisted of 40 patients who received only basic treatment regimen. Both groups were compatible for their age, gender distribution, severity of stroke and degree of neurologic dysfunction.Results: In the patients who were given meldonium in addition to basic treatment of ischemic stroke, neurological deficiency, assessed by NIHSS, scored significantly better than in those from the control group (3.1 ± 0.1 vs. 2.6 ± 0.17, p < 0.05. Also, they had significantly less disability on modified Rankin scale (1.3 ± 0.03 vs. 1.07 ± 0.07, p < 0.01 and more improvement in mobility as per Rivermead mobility index (3.6 ± 0.17 vs. 2.9 ± 0.25, p < 0.05.Conclusion: The addition of meldonium to the set of medical treatment in ischemic stroke patients gives positive results reflecting a decreased neurological deficiency, increased levels of mobility and daily activities.

  5. Intravenous tenecteplase in acute ischemic stroke: an updated review.

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    Behrouz, Réza

    2014-06-01

    Tenecteplase in a genetically engineered variant of alteplase. Although the two have the same mechanism of action, tenecteplase has properties that makes it a seemingly more advantageous thrombolytic. Because of its rapid single-bolus administration, its use is favored over alteplase in the treatment of acute myocardial infarction. Over the past few years, several clinical studies have been conducted to assess the safety, feasibility, and efficacy of tenecteplase in ischemic stroke. In spite of the mixed results of these studies, experimentation with tenecteplase continues in from of clinical trials. In this article, the utility of tenecteplase in ischemic stroke will be discussed.

  6. Evaluation of stroke services in Anglia stroke clinical network to examine the variation in acute services and stroke outcomes

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    George Abraham

    2011-02-01

    Full Text Available Abstract Background Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors. Methods/Design We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy completed EuroQol (EQ-5D questionnaires will measure quality of life at baseline and follow-up for cost utility analyses. Discussion This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.

  7. Acute childhood arterial ischemic and hemorrhagic stroke in the emergency department.

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    Yock-Corrales, Adriana; Mackay, Mark T; Mosley, Ian; Maixner, Wirginia; Babl, Franz E

    2011-08-01

    Little is known about the presenting features of acute ischemic and hemorrhagic stroke in children presenting to the emergency department (ED). Yet, initial clinical assessment is a key step in the management pathway of stroke. We describe the presentation in the ED of children with confirmed acute ischemic and hemorrhagic stroke subtypes. We conducted a retrospective descriptive case series of consecutive patients aged 1 month to younger than 18 years and presenting to a single-center tertiary ED with radiologically confirmed acute ischemic stroke or hemorrhagic stroke during a 5-year period. Patients were identified by medical record search with International Classification of Diseases, 10th Revision codes for hemorrhagic stroke and through the hospital stroke registry for acute ischemic stroke. Signs, symptoms, and initial management were described. Fifty patients with acute ischemic stroke and 31 with hemorrhagic stroke were identified. Mean age was 8.7 years (SD 5.2), and 51% were male. Fifty-six percent were previously healthy. Median time from onset of symptoms to ED presentation was 21 hours (interquartile range 6 to 48 hours) for acute ischemic stroke and 12 hours (interquartile range 4 to 72 hours) for hemorrhagic stroke. Acute ischemic stroke presented with symptoms of focal limb weakness (64%; 95% confidence interval [CI] 49% to 77%), facial weakness (60%; 95% CI 45% to 73%), and speech disturbance (46%; 95% CI 31% to 60%). Few patients with acute ischemic stroke presented with vomiting and altered mental status. Most patients with acute ischemic stroke had a Glasgow Coma Scale (GCS) score of 14 or greater (86%; 95% CI 73% to 94%) and presented with at least 1 focal neurologic sign (88%; 95% CI 73% to 98%). Hemorrhagic stroke presented with headache (73%; 95% CI 54% to 87%), vomiting (58%; 95% CI 40% to 75%), and altered mental status (48%; 95% CI 30% to 67%). GCS score in hemorrhagic stroke was less than 14 in 38% and less than 8 in 19% (95% CI 7% to

  8. Systematic review: hereditary thrombophilia associated to pediatric strokes and cerebral palsy

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    Vinicius M. Torres

    2015-02-01

    Full Text Available OBJECTIVES: This review aimed to organize and consolidate the latest knowledge about mutations and genetic polymorphisms related to hereditary thrombophilia and their potential association with pediatric stroke and cerebral palsy (CP. SOURCES: Scientific articles published from 1993 to 2013, written in Portuguese, English, French, and Spanish, were selected and reviewed. The publications were searched in electronic databases, and also in the collections of local libraries. The terms "hereditary thrombophilia", "polymorphisms", "mutation", "pediatric strokes", and "cerebral palsy" were used for the research. SUMMARY OF THE FINDINGS: The search in databases and in the bibliographic references retrieved 75 articles for inclusion in this review. Studies that investigated hereditary thrombophilias and their associations to CP and arterial and venous pediatric stroke presented contradictory results. The meta-analysis and case-control studies that showed positive results for this association described only slightly increased relative risks and sometimes had questionable conclusions. The association of two or more hereditary thrombophilias, or the association between thrombophilia and other specific clinical risk factors, suggest a higher risk of CP and pediatric stroke than isolated hereditary thrombophilia. CONCLUSIONS: Larger, multicenter studies should be developed in order to elucidate the role of mutations leading to hereditary thrombophilia and the development of CP and pediatric stroke. The complex and multifactorial etiology of CP and stroke makes this an arduous and difficult task; however, the benefits generated by these studies are immeasurable.

  9. Effect of hyperthermia on prognosis after acute ischemic stroke.

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    Saini, Monica; Saqqur, Maher; Kamruzzaman, Anmmd; Lees, Kennedy R; Shuaib, Ashfaq

    2009-09-01

    Experimental studies have shown that hyperthermia is a determinant of poor outcome after ischemic stroke. Clinical studies evaluating the effect of temperature on poststroke outcome have, however, been limited by small sample sizes. We sought to evaluate the effect of temperature and timing of hyperthermia on outcome after ischemic stroke. Data of 5305 patients in acute stroke trials from the Virtual International Stroke Trials Archive (VISTA) data set were analyzed. Data for temperatures at baseline, eighth, 24th, 48th, and 72nd hours, and seventh day were assessed in relation to outcome (poor versus good) based on the modified Rankin Scale at 3 months. Hyperthermia was defined as temperature >37.2 degrees C and poor outcome as 90-day modified Rankin Scale >2. Hazard ratios with 95% CIs were reported for hyperthermia in relation to the outcome. Logistic regression models, in relation to hyperthermia, were fitted for a set of preselected covariates at different time points to identify predictors/determinants of hyperthermia. The average age of patients was 68.0+/-11.9 years, 2380 (44.9%) were females, and 42.3% (2233) received thrombolysis using recombinant tissue plasminogen activator. After adjustment, hyperthermia was a statistically significant predictor of poor outcome. The