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Sample records for arterial ischemic stroke

  1. Thrombophilia And Arterial Ischemic Stroke

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    A.A. Abrishamizadeh

    2017-02-01

    Full Text Available Ischemic stroke (IS is a common cause of morbidity and mortality with significant socioeconomic impact especially when it affects young patients. Compared to the older adults, the incidence, risk factors, and etiology are distinctly different in younger IS. Hypercoagulable states are relatively more commonly detected in younger IS patients. Thrombophilic states are disorders of hemostatic mechanisms that result in a predisposition to thrombosis .Thrombophilia is an established cause of venous thrombosis. Therefore, it is tempting to assume that these disorders might have a similar relationship with arterial thrombosis. Despite this fact that 1-4 % of ischemic strokes are attributed to Thrombophillia, this   alone rarely causes arterial occlusions .Even in individuals with a positive thrombophilia screen and arterial thrombosis, the former might not be the primary etiological factor. Thrombophilic   disorders can be broadly divided into inherited or acquired conditions. Inherited thrombophilic states include deficiencies of natural anticoagulants such as protein C, protein S, and antithrombin III (AT III deficiency, polymorphisms causing resistance to activated protein C(Factor V Leiden mutation, and disturbance in the clotting balance (prothrombin gene 20210G/A variant. Of all the inherited  thrombophilic disorders, Factor V Leiden mutation is perhaps the commonest cause. On the contrary, acquired thrombophilic disorders are more common and include conditions such as the antiphospholipid syndrome, associated with lupus anticoagulant and anticardiolipin antibodies. The more useful and practical approach of ordering various diagnostic tests for the uncommon thrombophilic states tests should be determined by a detailed clinical history, physical examination, imaging studies and evaluating whether an underlying hypercoagulable state appears more likely. The laboratory thrombophilia   screening should be comprehensive and avoid missing the

  2. Ischemic stroke: carotid and vertebral artery disease

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    Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  3. School-Aged Outcomes After Neonatal Arterial Ischemic Stroke

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    Theresa Czech; Pardo, Andrea C.

    2016-01-01

    Investigators from the Accident Vasculaire Cérébral de nouveau-né (AVCnn) Study Group, a multicenter registry in France, examined outcomes at 7 years of age in children previously identified with neonatal arterial ischemic stroke (NAIS).

  4. School-Aged Outcomes After Neonatal Arterial Ischemic Stroke.

    Science.gov (United States)

    Czech, Theresa; Pardo, Andrea C

    2016-02-01

    Investigators from the Accident Vasculaire Cérébral de nouveau-né (AVCnn) Study Group, a multicenter registry in France, examined outcomes at 7 years of age in children previously identified with neonatal arterial ischemic stroke (NAIS).

  5. Paradoxical centrally increased diffusivity in perinatal arterial ischemic stroke

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    Stence, Nicholas V.; Mirsky, David M.; Deoni, Sean C.L. [University of Colorado Anschutz School of Medicine, Department of Radiology, Aurora, CO (United States); Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); Armstrong-Wells, Jennifer [University of Colorado Anschutz School of Medicine, Department of Pediatrics (Neurology) and OB/GYN, Aurora, CO (United States); University of Colorado Hemophilia and Thrombosis Center, Aurora, CO (United States)

    2016-01-15

    Restricted diffusion on acute MRI is the diagnostic standard for perinatal arterial ischemic stroke. In a subset of children with perinatal arterial ischemic stroke, primarily those with large infarct volumes, we noted a core of centrally increased diffusivity with a periphery of restricted diffusion. Given the paradoxical diffusion-weighted imaging (DWI) appearance observed in some children with perinatal arterial ischemic stroke, we sought to determine its significance and hypothesized that: (1) centrally increased diffusivity is associated with larger infarcts in perinatal arterial ischemic stroke and (2) this tissue is irreversibly injured (infarcted). We reviewed all perinatal arterial ischemic stroke cases in a prospective cohort study from Aug. 1, 2000, to Jan. 1, 2012. Infarct volumes were measured by drawing regions of interest around the periphery of the area of restricted diffusion on DWI. The Mann-Whitney U test was used to compare means between groups. Of 25 eligible cases, centrally increased diffusivity was seen in 4 (16%). Cases with centrally increased diffusivity had larger average infarct volumes (mean 117,182 mm{sup 3} vs. 36,995 mm{sup 3}; P = 0.008), higher average apparent diffusion coefficient (ADC) values in the infarct core (1,679 x 10{sup -6} mm{sup 2}/s vs. 611 x 10{sup -6} mm{sup 2}/s, P < 0.0001), and higher ADC ratio (1.2 vs. 0.5, P < 0.0001). At last clinical follow-up, children with perinatal arterial ischemic stroke and centrally increased diffusivity were more often treated for ongoing seizures (75% vs. 0%; P < 0.001) than those without. Centrally increased diffusivity was associated with larger stroke volume and the involved tissue was confirmed to be infarcted on follow-up imaging. Radiologists should be aware of this unusual appearance of perinatal arterial ischemic stroke in order to avoid underestimating infarct volume or making an incorrect early diagnosis. (orig.)

  6. Ischemic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually ... are at risk for having a more serious stroke. Symptoms of stroke are Sudden numbness or weakness ...

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

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    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.

  8. Prodromal Transient Ischemic Attack or Minor Stroke and Outcome in Basilar Artery Occlusion

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    Conforto, Adriana B.; De Freitas, Gabriel R.; Schonewille, Wouter J.; Kappelle, L. Jaap; Algra, Ale

    2015-01-01

    Background The presence of prodromal transient ischemic attacks (TIAs) has been associated with a favorable outcome in anterior circulation stroke. We aimed to determine the association between prodromal TIAs or minor stroke and outcomes at 1 month, in the Basilar Artery International Cooperation St

  9. Prodromal Transient Ischemic Attack or Minor Stroke and Outcome in Basilar Artery Occlusion

    NARCIS (Netherlands)

    Conforto, A.B.; Freitas, G.R. de; Schonewille, W.J.; Kappelle, L.J.; Algra, A.; Leeuw, F.E. de

    2015-01-01

    BACKGROUND: The presence of prodromal transient ischemic attacks (TIAs) has been associated with a favorable outcome in anterior circulation stroke. We aimed to determine the association between prodromal TIAs or minor stroke and outcomes at 1 month, in the Basilar Artery International Cooperation S

  10. Pharmacoeconomic analysis of ischemic stroke therapy in patients with arterial hypertension

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    Mashin V.V.

    2010-09-01

    Full Text Available Pharmacoeconomic parameters have been examined in patients with ischemic stroke who have suffered from arterial hypertension, depending on use of antihypertensive therapy. The role of antihypertensive therapy as a factor that significantly reduces the treatment costs and improves stroke outcome has been proved. The research results show the importance of integrated analysis of clinical and economical factors in the treatment of patients with arterial hypertension

  11. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography

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    Jensen, Jesper Møller; Medina, Hector; Nørgaard, Bjarne Linde;

    2012-01-01

    BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac...... increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P...

  12. Evolution of unilateral perinatal arterial ischemic stroke on conventional and diffusion-weighted MR imaging

    NARCIS (Netherlands)

    J. Dudink (Jeroen); E. Mercuri; L. Al-Nakib; P. Govaert (Paul); S.J. Counsell (Serena); M.A. Rutherford; F.M. Cowan

    2009-01-01

    textabstractBACKGROUND AND PURPOSE: Knowledge of the sequence of signal-intensity (SI) changes on conventional and diffusion-weighted MR imaging (DWI) following perinatal arterial ischemic stroke (PAIS) is limited, adding to the difficulty in timing the onset of PAIS. We hypothesized that SI changes

  13. Acute Ischemic Stroke and Transient Ischemic Attack

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    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 ...

  14. Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies.

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    Benjamin, Laura A; Bryer, Alan; Lucas, Sebastian; Stanley, Alan; Allain, Theresa J; Joekes, Elizabeth; Emsley, Hedley; Turnbull, Ian; Downey, Colin; Toh, Cheng-Hock; Brown, Kevin; Brown, David; Ison, Catherine; Smith, Colin; Corbett, Elizabeth L; Nath, Avindra; Heyderman, Robert S; Connor, Myles D; Solomon, Tom

    2016-08-01

    HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Multiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the terminology used, a robust classification algorithm to help ascribe the various etiologies is needed. This consensus paper considers the strengths and limitations of current case definitions in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some instances new case definitions were described (e.g., HIV-associated vasculopathy). These case definitions provided a framework for an algorithm to help assign a final diagnosis, and help classify the subtypes of HIV etiology in ischemic stroke.

  15. Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

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    L. Bentsen

    2014-01-01

    Full Text Available Introduction: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments. The aim of this study was to assess the prevalence of CT angiography (CTA-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke. Method: The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA scans systematically, assessing the four segments of the extracranial vertebral arteries. First, the frequency of pathological findings including stenosis, plaques, dissection, kinked artery and coiling was assessed. Subsequently, we explored the extent of the pathological findings that were the most plausible causes of stroke, namely either a possible dissection or a kinked artery. Results: Findings in the extracranial vertebral arteries included significant stenosis (0.8%, atherosclerotic plaque types (3.8%, possible dissections (2.6%, kinked arteries (2.6% and coiling (32.0%. Eighteen patients (2.8% with pathological findings had an unknown cause of stroke, likely posterior symptoms and no clinical stroke symptoms from the anterior circuit. Of these, 3 cases were kinked arteries (0.5% and 15 cases (2.3% were possible dissections. Conclusion: We found that in approximately 3% of the study population, the most plausible cause of the cryptogenic strokes was due to a pathological finding in the posterior extracranial vertebral arteries, being either a possible

  16. Clinical and imaging features associated with intracranial internal carotid artery calcifications in patients with ischemic stroke

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    Yilmaz, Arda [Mersin University, Department of Neurology, Faculty of Medicine, Mersin (Turkey); Akpinar, Erhan [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey); Topcuoglu, Mehmet Akif; Arsava, Ethem Murat [Hacettepe University, Department of Neurology, Faculty of Medicine, Ankara (Turkey)

    2015-05-01

    Intracranial internal carotid artery calcifications (ICAC), a frequent finding on imaging studies, are predictive of future stroke risk in population-based studies. The clinical significance of this observation among ischemic stroke patients is however less clear. In this study, we analyzed ICAC burden in relation to vascular risk factor profile, stroke etiology, and extent of craniocervical vascular calcifications in a consecutive series of ischemic stroke patients. The burden of ICAC was determined both on non-contrast CT and CT-angiography source images by semiquantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype, and calcification burden in other craniocervical arteries was assessed among patients with no ICAC, mild-moderate ICAC, and severe ICAC. Of 319 patients included into the study, 28 % had no ICAC, 35 % had mild-moderate ICAC, and 37 % had severe ICAC on CT angiography. Independent factors associated with ICAC burden in multivariate analysis included age (p < 0.001), diabetes mellitus (p = 0.006), and coronary artery disease (p < 0.001). Furthermore, a stroke etiology of large artery atherosclerosis or cardioaortic embolism was significantly related to higher ICAC burden (p = 0.006). Patients with severe ICAC were more likely to harbor calcifications in other vascular beds (p < 0.001). All of these findings persisted when analyses were repeated with CT-based ICAC burden assessments. ICAC burden reflects a continuum of atherosclerotic disease involving carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with stroke of large vessel or cardioembolic origin. This information might help the clinician in prioritizing etiologic work-up in the acute period. (orig.)

  17. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?

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    Babl Franz E

    2011-10-01

    Full Text Available Abstract Background Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke. Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS Methods Children aged 1 month to Results 47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%, face (62%, leg weakness (57%, speech disturbance (46% and headache (46%. The most common signs were arm (61%, face (70% or leg weakness (57% and dysarthria (34%. 36 (78% of children had at least one positive variable on FAST and 38 (81% had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke. Conclusion The presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.

  18. Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients

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    Yu CS

    2016-03-01

    Full Text Available Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline m

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

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    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

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

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    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.

  1. Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues.

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    Rosa, Margherita; De Lucia, Silvana; Rinaldi, Victoria Elisa; Le Gal, Julie; Desmarest, Marie; Veropalumbo, Claudio; Romanello, Silvia; Titomanlio, Luigi

    2015-01-01

    Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be considered as an independent nosological entity. The relative rarity, the age-related peculiarities and the variety of manifested symptoms makes the diagnosis of paediatric stroke extremely difficult and often delayed. History and clinical examination should investigate underlying diseases or predisposing factors and should take into account the potential territoriality of neurological deficits and the spectrum of differential diagnosis of acute neurological accidents in childhood. Neuroimaging (in particular diffusion weighted magnetic resonance) is the keystone for diagnosis of paediatric stroke and other investigations might be considered according to the clinical condition. Despite substantial advances in paediatric stroke research and clinical care, many unanswered questions remain concerning both its acute treatment and its secondary prevention and rehabilitation so that treatment recommendations are mainly extrapolated from studies on adult population. We have tried to summarize the pathophysiological and clinical characteristics of arterial ischemic stroke in children and the most recent international guidelines and practical directions on how to recognise and manage it in paediatric emergency.

  2. Doppler examination and cerebral arterial stricture in patients with ischemic stroke

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    Shouchun Wang; Yingqi Xing; Fang Deng; Yuerong Cao; Jiachun Feng

    2006-01-01

    BACKGROUND: With the development of interventional therapy, it is necessary for evaluating cerebral vessels to instruct treatment and determine prognosis of patients with ischemic stroke; however, correlation of distribution of infarction focus and clinical symptoms with degrees of cerebrovasoular stricture is still unclear.OBJECTIVE: To evaluate the characteristics of cerebral arterial stricture of patients with ischemic stroke with transcranial Doppler (TCD) and color duplex flow imaging (CDFI) and compare the correlation between distribution of cerebral infarction focus and clinical types with magnetic resonance imaging (MRI).DESIGN: Contrast observation.SETTING: Department of Neurology, the First Hospital of Jilin University.PARTICIPANTS: A total of 159 patients with ischemic stroke were selected from the Department of Neurology, the First Hospital of Jilin University from January to December 2005, including 106 males and 53 females aged from 27 to 88 years. Bases on diagnostic criteria of cerebrovascular disease established by Rao et al, clinical manifestations of all patients were evaluated with CT or nuclear magnetic resonance. All patients provided the confirmed consent.METHODS: The accepted patients received TCD and CDFI examination at 1 week after onset of ischemic stroke. Among them, 112 patients received cerebrovascular imaging examination simultaneously. MRI was used to check cerebral infarction focus and cerebrovascular stricture > 50% was regarded as the accepted vessels. In addition, DWI-T2 TCD (Germany) was used to check middle cerebral artery, and degrees of middle cerebral artery were classified into mild, moderate and severe stricture based on blood velocity (140 cm/s,180 cm/s). Stroke was classified based on characteristics of infarction focus and clinical symptoms showed with MRI and correlation with degrees of cerebrovascular stricture was analyzed simultaneously.MAIN OUTCOME MEASURES: Correlation between the characteristics of ischemic

  3. Non-stenotic intracranial arteries have atherosclerotic changes in acute ischemic stroke patients: a 3T MRI study

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    Lee, Woo Jin; Choi, Hyun Seok; Jang, Jinhee; Sung, Jinkyeong; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Bum-soo [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, Seoul (Korea, Republic of); Kim, Tae-Won; Koo, Jaseong [The Catholic University of Korea, Department of Neurology, College of Medicine, Seoul (Korea, Republic of); Shin, Yong Sam [The Catholic University of Korea, Department of Neurosurgery, College of Medicine, Seoul (Korea, Republic of)

    2015-10-15

    The aim of this study is to evaluate the degree of atherosclerotic changes in intracranial arteries by assessing arterial wall thickness using T1-weighted 3D-turbo spin echo (3D-TSE) and time-of-flight MR angiography (TOF-MRA) in patients with acute ischemic stroke as compared with unaffected controls. Thirty-three patients with acute ischemic stroke and 36 control patients were analyzed. Acute ischemic stroke patients were divided according to TOAST classification. At both distal internal carotid arteries and basilar artery without stenosis, TOF-MRA was used to select non-stenotic portion of assessed arteries. 3D-TSE was used to measure the area including the lumen and wall (Area{sub Outer}) and luminal area (Area{sub Inner}). The area of the vessel wall (Area{sub VW}) of assessed intracranial arteries and the ratio index (RI) of each patient were determined. Area{sub Inner}, Area{sub Outer}, Area{sub VW}, and RI showed good inter-observer reliability and excellent intra-observer reliability. Area{sub Inner} did not significantly differ between stroke patients and controls (P = 0.619). However, Area{sub Outer}, Area{sub VW}, and RI were significantly larger in stroke patients (P < 0.001). The correlation coefficient between Area{sub Inner} and Area{sub Outer} was higher in the controls (r = 0.918) than in large vessel disease patients (r = 0.778). RI of large vessel disease patients was significantly higher than that of normal control, small vessel disease, and cardioembolic groups. In patients with acute ischemic stroke, wall thickening and positive remodeling are evident in non-stenotic intracranial arteries. This change is more definite in stroke subtype that is related to atherosclerosis than that in other subtypes which are not. (orig.)

  4. Effect of X-Ray Attenuation of Arterial Obstructions on Intravenous Thrombolysis and Outcome after Ischemic Stroke.

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    Grant Mair

    Full Text Available To assess whether the x-ray attenuation of intra-arterial obstruction measured on non-contrast CT in ischemic stroke can predict response to thrombolysis and subsequent functional outcome.The Third International Stroke Trial (IST-3 was a multicenter randomized-controlled trial of intravenous thrombolysis (rt-PA given within six hours of ischemic stroke. Ethical approval and informed consent were obtained. In a subgroup of 109 IST-3 patients (38 men, median age 82 years, a single reader, masked to all clinical and other imaging data, manually measured x-ray attenuation (Hounsfield Units, HU on non-contrast CT at the location of angiographically-proven intra-arterial obstructions, pre-randomization and at 24-48 hour follow-up. We calculated change in attenuation between scans. We assessed the impact of pre-randomization arterial obstruction attenuation on six-month functional outcome.Most arterial obstructions (64/109, 59% were hyperattenuating (mean 51.0 HU. Compared with control, treatment with rt-PA was associated with a greater, but non-significant, reduction in obstruction attenuation at follow-up (-8.0 HU versus -1.4 HU in patients allocated control, p = 0.117. In multivariable ordinal regression analysis controlled for patient age, stroke severity, location and extent of obstruction, time from stroke onset to baseline scan and rt-PA treatment allocation, the attenuation of pre-randomization arterial obstruction was not independently associated with six-month outcome (odds ratio = 0.99, 95% confidence interval = 0.94-1.03, p = 0.516.In ischemic stroke, the x-ray attenuation of the arterial obstruction may decline more rapidly from baseline to 24-48 hours following treatment with thrombolysis but we found no evidence that baseline arterial obstruction attenuation predicts six-month outcome.

  5. Cerebroprotective Effect of Moringa oleifera against Focal Ischemic Stroke Induced by Middle Cerebral Artery Occlusion

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    Woranan Kirisattayakul

    2013-01-01

    Full Text Available The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg−1 was orally given to male Wistar rats (300–350 g once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration.

  6. Cerebroprotective effect of Moringa oleifera against focal ischemic stroke induced by middle cerebral artery occlusion.

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    Kirisattayakul, Woranan; Wattanathorn, Jintanaporn; Tong-Un, Terdthai; Muchimapura, Supaporn; Wannanon, Panakaporn; Jittiwat, Jinatta

    2013-01-01

    The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg(-1) was orally given to male Wistar rats (300-350 g) once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO) and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration.

  7. Early retinal inflammatory biomarkers in the middle cerebral artery occlusion model of ischemic stroke

    Science.gov (United States)

    Ritzel, Rodney M.; Pan, Sarah J.; Verma, Rajkumar; Wizeman, John; Crapser, Joshua; Patel, Anita R.; Lieberman, Richard; Mohan, Royce

    2016-01-01

    Purpose The transient middle cerebral artery occlusion (MCAO) model of stroke is one of the most commonly used models to study focal cerebral ischemia. This procedure also results in the simultaneous occlusion of the ophthalmic artery that supplies the retina. Retinal cell death is seen days after reperfusion and leads to functional deficits; however, the mechanism responsible for this injury has not been investigated. Given that the eye may have a unique ocular immune response to an ischemic challenge, this study examined the inflammatory response to retinal ischemia in the MCAO model. Methods Young male C57B/6 mice were subjected to 90-min transient MCAO and were euthanized at several time points up to 7 days. Transcription of inflammatory cytokines was measured with quantitative real-time PCR, and immune cell activation (e.g., phagocytosis) and migration were assessed with ophthalmoscopy and flow cytometry. Results Observation of the affected eye revealed symptoms consistent with Horner’s syndrome. Light ophthalmoscopy confirmed the reduced blood flow of the retinal arteries during occlusion. CX3CR1-GFP reporter mice were then employed to evaluate the extent of the ocular microglia and monocyte activation. A significant increase in green fluorescent protein (GFP)-positive macrophages was seen throughout the ischemic area compared to the sham and contralateral control eyes. RT–PCR revealed enhanced expression of the monocyte chemotactic molecule CCL2 early after reperfusion followed by a delayed increase in the proinflammatory cytokine TNF-α. Further analysis of peripheral leukocyte recruitment by flow cytometry determined that monocytes and neutrophils were the predominant immune cells to infiltrate at 72 h. A transient reduction in retinal microglia numbers was also observed, demonstrating the ischemic sensitivity of these cells. Blood–eye barrier permeability to small and large tracer molecules was increased by 72 h. Retinal microglia exhibited enhanced

  8. Cost and Outcome in Pediatric Ischemic Stroke.

    Science.gov (United States)

    Hamilton, William; Huang, Haijuan; Seiber, Eric; Lo, Warren

    2015-10-01

    The cost of childhood stroke receives little notice. The authors examined potential drivers of cost and outcome to test whether (1) neonatal strokes cost less than childhood strokes, (2) associated diseases influence cost, (3) arterial ischemic stroke is more costly than sinovenous thrombosis, and (4) cost correlates with outcome. The authors reviewed records of 111 children who sustained arterial ischemic stroke or sinovenous thrombosis between 2005 and 2010 to identify costs for the following year. They assessed outcomes in 46 with the Recovery and Recurrence Questionnaire and the Pediatric Quality of Life Inventory. Neonatal strokes cost less than childhood stroke. Strokes associated with congenital heart disease or vasculopathy cost the most, while perinatal or idiopathic strokes cost the least. Higher costs are correlated with worse impairment and poorer quality of life. Stroke etiology significantly influences the cost of pediatric stroke. Future cost-benefit studies must consider etiology when estimating the incremental costs associated with stroke.

  9. Thrombolysis in patients with acute ischemic stroke due to arterial extracranial dissection

    NARCIS (Netherlands)

    M.D.I. Vergouwen; P.A.C.A. Beentjes; P.J. Nederkoorn

    2009-01-01

    No data of randomized controlled trials investigating the effect of thrombolysis in patients with ischemic stroke caused by an extracranial dissection are available. Previous case series suggested that thrombolysis in this group of patients is safe and improves outcome, however publication bias may

  10. Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, L; Nygård, A; Ovesen, C;

    2014-01-01

    INTRODUCTION: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments....... The aim of this study was to assess the prevalence of CT angiography (CTA)-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke...... scans systematically, assessing the four segments of the extracranial vertebral arteries. First, the frequency of pathological findings including stenosis, plaques, dissection, kinked artery and coiling was assessed. Subsequently, we explored the extent of the pathological findings that were the most...

  11. Cocaine mediated apoptosis of vascular cells as a mechanism for carotid artery dissection leading to ischemic stroke.

    Science.gov (United States)

    Dabbouseh, Noura M; Ardelt, Agnieszka

    2011-08-01

    In arterial dissection, blood may enter the arterial wall through an intimal tear, splitting the arterial wall and activating the coagulation cascade at the site of endothelial damage. Dissection of extracranial and intracranial vessels may lead to ischemic stroke through thromboembolic or hemodynamic mechanisms. Major blunt trauma or rapid acceleration-deceleration may cause dissection, but in patients with inherent arterial wall weakness, dissection can occur spontaneously or as a result of minor neck movement. Cocaine use has been associated with dissection of the aortic arch and coronary and renal arteries through cocaine-mediated hypertension. Recent preclinical studies have suggested, however, that cocaine may cause apoptosis of cells in the vascular wall. In this article, we postulate that cocaine may cause apoptosis of vascular endothelial and/or smooth muscle cells, thus weakening the vascular wall and resulting in a dissection-prone state. We review the literature and propose a biological basis for vasculopathy, vascular dissection, and ischemic stroke in the setting of cocaine use. Further research studies on vascular cells, as well as focused analysis of human pathological material, will be important in providing evidence for or against our hypotheses.

  12. Change apparent diffusion coefficient immediately after recanalization through intra-arterial revascularization therapy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Ji Eun; Yeom, Joeng A; Kim, Young Soo; Yoon, Chang Hyo; Park, Min Gyu; Park, Kyung Pil; Baik, Seung Kug [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2016-04-15

    Intra-arterial revascularization therapy (IART) for acute ischemic stroke has become increasingly popular recently. However, early change in apparent diffusion coefficient (ADC) values after full recanalization in human stroke has not received much attention. The aim of this study was to evaluate ADC changes immediately after interventional full-recanalization in patients with acute ischemic stroke. ADC values of 25 lesions from 18 acute ischemic stroke patients were recorded with both pre- and post-recanalization ADC maps. Measurement was done by placing region of interests over the representative images of the lesion. For analysis, lesions were divided into territorial infarction (TI) and watershed infarction (WI). Mean ADC values of the overall 25 lesions before IART were 415.12 × 10-6 mm{sup 2}/sec, and increased to 619.08 × 10-6 mm{sup 2}/sec after the IART. Average relative ADC (rADC) value for 22 TI increased from 0.59 to 0.92 (p < 0.000), whereas, average rADC value for 3 WI did not change significantly. There was a conspicuous increase of ADC values immediately after full-recanalization in TI lesions. On the other hand, WI lesions did not show significant change in ADC values after recanalization.

  13. Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

    Directory of Open Access Journals (Sweden)

    Davide Strambo

    2017-01-01

    Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

  14. 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.

  15. Arterial Obstruction on Computed Tomographic or Magnetic Resonance Angiography and Response to Intravenous Thrombolytics in Ischemic Stroke

    Science.gov (United States)

    Mair, Grant; von Kummer, Rüdiger; Adami, Alessandro; White, Philip M.; Adams, Matthew E.; Yan, Bernard; Demchuk, Andrew M.; Farrall, Andrew J.; Sellar, Robin J.; Sakka, Eleni; Palmer, Jeb; Perry, David; Lindley, Richard I.; Sandercock, Peter A.G.

    2017-01-01

    Background and Purpose— Computed tomographic angiography and magnetic resonance angiography are used increasingly to assess arterial patency in patients with ischemic stroke. We determined which baseline angiography features predict response to intravenous thrombolytics in ischemic stroke using randomized controlled trial data. Methods— We analyzed angiograms from the IST-3 (Third International Stroke Trial), an international, multicenter, prospective, randomized controlled trial of intravenous alteplase. Readers, masked to clinical, treatment, and outcome data, assessed prerandomization computed tomographic angiography and magnetic resonance angiography for presence, extent, location, and completeness of obstruction and collaterals. We compared angiography findings to 6-month functional outcome (Oxford Handicap Scale) and tested for interactions with alteplase, using ordinal regression in adjusted analyses. We also meta-analyzed all available angiography data from other randomized controlled trials of intravenous thrombolytics. Results— In IST-3, 300 patients had prerandomization angiography (computed tomographic angiography=271 and magnetic resonance angiography=29). On multivariable analysis, more extensive angiographic obstruction and poor collaterals independently predicted poor outcome (PHandicap Scale (P≥0.075) in IST-3. In meta-analysis (5 trials of alteplase or desmoteplase, including IST-3, n=591), there was a significantly increased benefit of thrombolytics on outcome (odds ratio>1 indicates benefit) in patients with (odds ratio, 2.07; 95% confidence interval, 1.18–3.64; P=0.011) versus without (odds ratio, 0.88; 95% confidence interval, 0.58–1.35; P=0.566) arterial obstruction (P for interaction 0.017). Conclusions— Intravenous thrombolytics provide benefit to stroke patients with computed tomographic angiography or magnetic resonance angiography evidence of arterial obstruction, but the sample was underpowered to demonstrate significant

  16. Ischemic stroke and incomplete infarction

    DEFF Research Database (Denmark)

    Garcia, Javier; Lassen, N A; Weiller, C

    1996-01-01

    The concept of selective vulnerability or selective loss o f individual neurons, with survival of glial and vascular elements as one of the consequences of a systemic ischemic-hypoxic insult (eg, transient cardiac arrest or severe hypotension), has been recognized for decades. In contrast, select......, selective neuronal death as one of the lesions that may develop in the brain after occluding an intracranial artery is an idea not readily acknowledged in the current medical literature dealing with human stroke....

  17. Ischemic Stroke of the Artery of Percheron with Normal Initial MRI: A Case Report

    Directory of Open Access Journals (Sweden)

    Guillaume Cassourret

    2010-01-01

    Full Text Available The artery of Percheron is a solitary trunk representing an uncommon anatomic variant that provides bilateral arterial supply to the paramedian thalami and the rostral midbrain. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. The clinical diagnosis is difficult because the complex anatomy causes large clinical variability. We report a case of a comatose patient with normal early head-computed tomography and magnetic resonance imaging. A bilateral paramedian thalamic infarct due to an occlusion of the artery of Percheron was revealed two days later by a new head computed tomography. To our knowledge, this is the first report in the literature of a symptomatic patient presenting an acute Percheron stroke with normal early brain magnetic resonance imaging. Our case indicates that a normal initial magnetic resonance imaging cannot formally eliminate the diagnosis of acute stroke of the artery of Percheron. We discuss the causes of noncontributive brain magnetic resonance imaging at the onset of this acute Percheron stroke and the alternative diagnosis and therapy methods.

  18. 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

  19. Ischemic strokes and migraine

    Energy Technology Data Exchange (ETDEWEB)

    Bousser, M.G.; Baron, J.C.; Chiras, J.

    1985-11-01

    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG).

  20. The Challenge of Managing Fusiform Basilar Artery Aneurysms: From Acute Ischemic Stroke to a Massive Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Sofia Bezerra

    2011-02-01

    Full Text Available We present the case of a patient with acute brain stem ischemic stroke who was found to have a fusiform basilar aneurysm with a thrombus within the dilated vessel. Three days after the ischemic stroke, the patient had a massive subarachnoid hemorrhage and died. This case illustrates the difficulties in the acute management of ischemic events in patients with basilar fusiform aneurysms, because the natural history of this disease encompasses both bleeding and thrombosis.

  1. Cerebroprotective activity of 3-benzylxanthine derivative – compound Ale-15, in conditions of bilateral common carotid arteries ligation (ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sergey V. Levich

    2013-12-01

    Full Text Available Background: Acute ischemic stroke is a leading cause of mortality, morbidity, long-term disability in industrialized countries. One of main parts of it pathogenesis is production of reactive oxygen species. The accumulation of them in neurons results in lipid peroxidation, protein oxidation, DNA damage, and finally cell death. Thereby the search of novel drugs, that have antioxidant action and can be used to complex treatment of cerebral strokes is reasonable. It is known, that xanthine derivatives exhibit a broad spectrum of biological activity, including antioxidant. So that, the goal of this research was to study in vivo neuroprotective action of water-soluble derivative of 3-benzylxanthine – morpholin-4-ium 3-benzylxanthinyl-8-methylthioacetate (Ale-15 compound in comparison with neuroprotector-antioxidant – Mexidol. Methods: Experimental part was done on white Wistar rats of both sexes of 220-260 g weight. For assessment of neuroprotective action of compound we used a model of global incomplete cerebral ischemia, that was reproduced by bilateral common carotid arteries ligation. Results: It was studied an acute toxicity of Ale-15 compound, it influence on survival of laboratory animals, on progression of neuralgic deficit, on the content of adenylic nucleotides, on criteria of energy metabolism, on the activity of antioxidant enzymes and on oxidative modification of protein. Results of study showed, that injection of Ale-15 compound to animals with ischemic stroke intragastrically during 4 days positively reduced death rate and quantity of animals with serious neurologic symptoms. The main parts of Ale-15 cerebroprotective mechanism are antioxidant and anti-ischemic actions. Conclusions: The performed study revealed significant cerebroprotective features of Ale-15 compound in conditions of experimental cerebrovascular accident. [Int J Basic Clin Pharmacol 2013; 2(6.000: 705-710

  2. Comparison of intima-media thickness of common and internal carotid arteries of patients with ischemic stroke and intracerebral hemorrhage.

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    Ali Moghtaderi

    2014-12-01

    Full Text Available Role of atherosclerosis in the pathogenesis of ischemic and hemorrhagic infarctions is still matter of debate. Intima-media thickness (IMT of the common carotid artery (CCA and internal carotid artery (ICA are markers of atherosclerosis. The aim of this study was to compare CCA IMT and ICA IMT of patients with ischemic and hemorrhagic infarction.Two equal groups of 80 patients with small and large vessel ischemic stroke and 80 patients with non-traumatic intracerebral hemorrhage (ICH who referred to our central teaching hospital of Zahedan were assessed in this descriptive study. IMT of four arteries (right and left CCA and ICA were measured, and collected data were analysis using Student's t-test.There were 137 males (57.1% and 103 (42.9% female with mean age of 62.7 ± 11.7. Mean right CCA IMT of patients with small vessel diseases (SVD, large vessel diseases (LVD, and ICH were 0.564 ± 0.130, 0.623 ± 0.150, and 0.580 ± 0.140 mm, respectively (P = 0.032. Mean left CCA IMT of patients with SVD, LVD, and ICH were 0.569 ± 0.120, 0.618 ± 0.120, and 0.573 ± 0.130 mm, respectively (P = 0.039. The above findings for right ICA were 0.572 ± 0.120, 0.569 ± 0.140, and 0.522 ± 0.130 mm, respectively (P = 0.145. Those findings for left ICA IMT were 0.525 ± 0.110, 0.554 ± 0.120, and 0.527 ± 0.120 mm, respectively (P = 0.257.Our findings showed that by using CCA IMT, differentiation between small and large vessel infarctions and hemorrhagic infarctions can be made.

  3. 椎动脉发育不良与后循环缺血性卒中%Vertebral artery hypoplasia and posterior circulation ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    孙增强; 刘明玲; 田兵; 徐蔚海

    2014-01-01

    Vertebral artery hypoplasia is a frequent variation type of vertebral arteries.At present,there is no unified theory about the relationship between vertebral artery hypoplasia and posterior circulation ischemic stroke.The available evidence suggests that vertebral artery hypoplasia may be a precipitating factor for posterior circulation ischemic stroke; particularly other vascular risk factors coexist.This article elaborates the epidemiology of vertebral artery hypoplasia,the clinical manifestation and imaging features of vertebral artery hypoplasia in patients with posterior circulation ischemic stroke,and the possible mechanism of vertebral artery hypoplasia caused posterior circulation ischemic stroke.%椎动脉发育不良是椎动脉的一种常见变异类型.关于椎动脉发育不良与后循环缺血性卒中的关系,目前尚无统一定论.现有的证据提示,椎动脉发育不良可能是后循环缺血性卒中的促发因素,尤其是在并存其他血管危险因素的情况下.文章阐述了椎动脉发育不良的流行病学、椎动脉发育不良患者后循环缺血性卒中的临床表现和影像学特点以及椎动脉发育不良引起后循环缺血性卒中的可能机制.

  4. 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...

  5. [Ischemic stroke and the ways of compensation of cerebral circulation in patients with nonspecific aorto-arteritis with lesions of the brachiocephalic arteries].

    Science.gov (United States)

    Kazanchian, P O; Varava, B N; Todua, F I; Kuntsevich, G I; Zotikov, A E; Iudin, V I; Kon, M V; Volokina, O I; Buklina, S B

    1991-01-01

    In patients suffering from nonspecific aortoarteritis associated with impairment of the common carotid arteries, cerebral blood flow is compensated for at the expense of an increase of the volumetric blood flow in the vertebral arteries. During the first three years since the onset of the first disease symptoms, the blood content in the basin of the internal carotid arteries is reduced. Brain strokes occur most frequently within that period. They mostly develop without any preceding transitory ischemic attacks. The origin of neurological symptomatology depends to a considerable measure on the condition of the anterior and posterior communicating arteries.

  6. A single-site retrospective study of pediatric arterial ischemic stroke etiology, clinical presentation, and radiologic features

    Institute of Scientific and Technical Information of China (English)

    SUN Dan; WU Xiao-man; WANG Zeng-wu; JIN Run-ming; LIU Zhi-sheng; LIU Fan; HUANG Sui

    2013-01-01

    Background Stroke occurs upon obstruction of cerebral blood circulation and is clinically characterized by sudden onset symptoms.Advanced age is the main risk factor of stroke,but cases of pediatric stroke have been rarely reported.This study aimed to determine the etiology,clinical presentation,and radiologic features of neurological deficit for pediatric arterial ischemic stroke (PALS).Methods The medical records of 42 PAlS patients (age range:9 months to 13 years) treated at Wuhan Children's Hospital between July 2007 and January 2011 were retrospectively reviewed.Infarction location was first determined by craniocerebral computed tomography and magnetic resonance (MR) imaging.The stenotic or occluded main cerebral arteries and/or branches were determined by MR angiography and digital subtraction angiography.Results The majority of the 42 PAlS cases (66.7%,n=28) were <3 years old (vs.>3 years old:33.3%,n=14; P<0.05),but the male:female ratio was similar in both groups (P>0.05).The most frequently reported signs and symptoms for both age groups were limited physical activity followed by convulsions and delirium,but convulsions were more prevalent in children <3 years-old.Children>3 years-old mainly experienced the limited physical activity symptoms,including hemiparalysis,aphasia,and ataxia.For all 42 cases,the most frequent etiologies were infections (38.1%,n=16),iron deficiency anemia (16.7%,n=7),and moyamoya syndrome (11.9%,n=5).The predominant infarcts among all cases were middle cerebral artery (63.6%,n=21)and basal ganglia (64.3%,n=27).Conclusions PAlS occurs more frequently in younger children and this group most frequently presents with convulsion as the initial symptom.The overall etiologies of PAlS may be different from those of adult stroke and the involved regions may be distinguishing features of PAlS or its different forms,but more research is required.

  7. HEMODYNAMIC INSIGNIFICANT CAROTID ARTERIES STENOSIS AND RISK OF EMBOLIC STROKE IN PATIENTS WITH ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    V. V. Semenova

    2009-01-01

    Full Text Available Aim. To assess a risk of vascular embolism in patients with ischemic heart disease (IHD and hemodynamic insignificant asymptomatic carotid stenosis.Material and methods. 100 patients with IHD were examined. Ultrasound scanning of the main cranial arteries and transcranial Dopplerography was performed in all patients as well as lipid spectrum, fibrinogen level and blood D-diameter concentration were evaluated.Results. 165 carotid atherosclerotic plaques (AP were detected in patients with IHD independently on angina severity. In IHD patients with nonhomogeneous hypoechogenic AP microembolic signals (MES were revealed in 44,78%, with nonhomogeneous hyperechogenic AP - in 25%, with homogeneous hypoechogenic AP - in 4,16% of patients. MES were not recorded in patients with homogeneous hyperechogenic AP. There were not relations between MES and parameters of lipid spectrum as well as fibrinogen and Ddiameter plasma levels.Conclusion. Thus, during transcranial dopplerographic monitoring MES were recorded in the third part (27,9% of IHD patients with hemodynamically insignificant carotid arteries stenosis. MES were predominantly observed in patients with nonhomogeneous AP especially with hypoechogenic components.

  8. Rapid identification of a major diffusion/perfusion mismatch in distal internal carotid artery or middle cerebral artery ischemic stroke

    Directory of Open Access Journals (Sweden)

    Hakimelahi Reza

    2012-11-01

    Full Text Available Abstract Background We tested the hypothesis that in patients with occlusion of the terminal internal carotid artery and/or the proximal middle cerebral artery, a diffusion abnormality of 70 ml or less is accompanied by a diffusion/perfusion mismatch of at least 100%. Methods Sixty-eight consecutive patients with terminal ICA and/or proximal MCA occlusions and who underwent diffusion/perfusion MRI within 24 hours of stroke onset were retrospectively identified. DWI and mean transit time (MTT volumes were measured. Prospectively, 48 consecutive patients were identified with the same inclusion criteria. DWI and time to peak (TTP lesion volumes were measured. A large mismatch volume was defined as an MTT or TTP abnormality at least twice the DWI lesion volume. Results In the retrospective study, 49 of 68 patients had a DWI lesion volume ≤ 70 ml (mean 20.2 ml; SEM 2.9 ml. A DWI/MTT mismatch of > 100% was observed in all 49 patients (P  100% was present in all 35 (P  Conclusions Acute stroke patients with major anterior circulation artery occlusion are exceedingly likely to have a major diffusion/perfusion mismatch if the diffusion lesion volume is 70 ml or less. This suggests that physiology-based patient assessments may be made using only vessel imaging and diffusion MRI as a simple alternative to perfusion imaging.

  9. Hemichorea after ischemic stroke

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    Sadullah Saglam

    2016-03-01

    Full Text Available The deterioration of the balance between direct and indirect ways in the basal ganglia causes chorea. The lesions of contralateral basal ganglia, thalamus or the connection of them all together are responsible for this. Chorea can be observed during the course of metabolic and vascular diseases, neurodegenerative or hereditary diseases. Hyperkinetic movement disorders after acute ischemic stroke are reported as rare; however, hemichorea is the most frequent developing disorder of hyperkinetic movement as a result of cerebrovascular disease. In this case report, we presented two case who applied us with choreiform movements in his left half of the body after acute thalamic stroke. [Cukurova Med J 2016; 41(0.100: 29-32

  10. Efficacy versus safety: the dilemma of using novel platelet inhibitors for the treatment of patients with ischemic stroke and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Iannopollo G

    2014-05-01

    Full Text Available Gianmarco Iannopollo,1 Rita Camporotondo,2 Gaetano M De Ferrari,2 Sergio Leonardi2 1Università degli Studi di Pavia, Pavia, 2Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Abstract: Coronary and cerebrovascular atherothrombosis are the leading cause of mortality and morbidity worldwide. Novel antiplatelet agents have been established for the management of patients with clinically evident coronary atherothrombosis and are increasingly used in these patients. These agents, however, have shown limited efficacy in the prevention of cerebrovascular events and potential harm in patients with history of stroke or transient ischemic attack. Herein, the efficacy and safety of two established antiplatelet agents in patients with stroke – aspirin and clopidogrel – are reviewed with a focus on the use and challenges related to novel antiplatelet agents – prasugrel, ticagrelor, and vorapaxar – in patients at risk for and with a history of stroke or transient ischemic attack. Keywords: cerebrovascular disease, coronary artery disease, aspirin, clopidogrel, novel antiplatelet agents

  11. [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.

  12. Cerebrovascular arteriopathy (arteriosclerosis) and ischemic childhood stroke.

    Science.gov (United States)

    Daniels, S R; Bates, S; Lukin, R R; Benton, C; Third, J; Glueck, C J

    1982-01-01

    The aim of this report is to describe the intracranial cerebrovascular abnormalities and clinical status of 8 children who had familial lipoprotein disorders and evidence of thromboembolic cerebrovascular disease. Six of the 8 children had low levels of plasma high density lipoprotein cholesterol, two had high triglyceride levels, and all came from kindreds characterized by familial lipoprotein abnormalities and premature cardio- and/or cerebrovascular atherosclerosis. Vascular occlusion, irregularities of the arterial lumen, beading, tortuosity, and evidence of collateralization were consistently noted. We speculate that cerebrovascular arteriosclerosis in pediatric ischemic stroke victims who have familial lipoprotein abnormalities may be related to lipoprotein-mediated endothelial damage and thrombosis formation, or to the failure to restore endothelial cells' integrity following damage. The apparent association of lipoproteins and strokes in children and their families merits further exploration, particularly when assessing cerebral angiograms in pediatric ischemic stroke victims. In children with unexplained ischemic cerebrovascular accidents, the diagnostic possibility of occlusive arteriosclerosis with thrombosis must be entertained.

  13. A Markov model to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin on prevention of recurrent ischemic stroke due to intracranial artery stenosis

    Directory of Open Access Journals (Sweden)

    Jinqiu Yang

    2014-01-01

    Full Text Available Background: Given the importance of intracranial stenosis as a cause of recurrent ischemic stroke and the lack of evidence supporting a clear choice for prevention of recurrent ischemic events, a computer simulation model for prognostic prediction could be used to improve decision making. Aims: The aim of the following study is to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin for prevention of recurrent stroke due to atherosclerotic intracranial artery stenosis. Setting and Design: The cohort consisted of 206 patients from 2006 to 2011. Materials and Methods: A two-state Markov model was used to predict the prognosis of patients with stroke or transient ischemic attack (TIA caused by angiographically verified 50-99% stenosis of a major intracranial artery to receive aspirin, clopidogrel, or dual therapy. Statistical Analysis: Two tests were used: Pearson Chi-square test or Fisher′s exact test (for percentages and Kruskal Wallis test (for rank order data. Results: In the 10-year Markov cohort analysis, 36.24% of patients who were treated with clopidogrel plus aspirin developed to recurrent stroke while the probability for patients in the aspirin group and clopidogrel group was 42.60% and 48.39% respectively. Patients with clopidogrel plus aspirin had the highest quality-adjusted life years, followed by aspirin and clopidogrel. Conclusion: To prevent recurrent stroke in patients with intracranial artery stenosis, especially in those patients with a history of TIA or coronary artery disease, medical therapy with clopidogrel plus aspirin should be considered in preference to aspirin alone.

  14. [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.

  15. Association between Single Nucleotide Polymorphism rs1044925 and the Risk of Coronary Artery Disease and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Dong-Feng Wu

    2014-02-01

    Full Text Available The present study was performed to clarify the association between the acyl-CoA:cholesterol acyltransferase-1 (ACAT-1 single nucleotide polymorphism (SNP rs1044925 and the risk of coronary artery disease (CAD and ischemic stroke (IS in the Guangxi Han population. Polymerase chain reaction and restriction fragment length polymorphism was performed to determine the genotypes of the ACAT-1 SNP rs1044925 in 1730 unrelated subjects (CAD, 587; IS, 555; and healthy controls; 588. The genotypic and allelic frequencies of rs1044925 were significantly different between the CAD patients and controls (p = 0.015 and borderline different between the IS patients and controls (p = 0.05. The AC/CC genotypes and C allele were associated with a decreased risk of CAD and IS (CAD: p = 0.014 for AC/CC vs. AA, p = 0.022 for C vs. A; IS: p = 0.014 for AC/CC vs. AA; p = 0.017 for C vs. A. The AC/CC genotypes in the healthy controls, but not in CAD or IS patients, were associated with an increased serum high-density lipoprotein cholesterol (HDL-C concentration. The present study shows that the C allele carriers of ACAT-1 rs1044925 were associated with an increased serum HDL-C level in the healthy controls and decreased risk in CAD and IS patients.

  16. Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

    Directory of Open Access Journals (Sweden)

    Hamed Asadi

    Full Text Available INTRODUCTION: Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. METHOD: We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. RESULTS: We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408. DISCUSSION: We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter

  17. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study.

    Science.gov (United States)

    Paciaroni, Maurizio; Inzitari, Domenico; Agnelli, Giancarlo; Caso, Valeria; Balucani, Clotilde; Grotta, James C; Sarraj, Amrou; Sung-Il, Sohn; Chamorro, Angel; Urra, Xabier; Leys, Didier; Henon, Hilde; Cordonnier, Charlotte; Dequatre, Nelly; Aguettaz, Pierre; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Zini, Andrea; Vallone, Stefano; Dell'Acqua, Maria Luisa; Menetti, Federico; Nencini, Patrizia; Mangiafico, Salvatore; Barlinn, Kristian; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Bovi, Paolo; Cappellari, Manuel; Linfante, Italo; Dabus, Guilherme; Marcheselli, Simona; Pezzini, Alessandro; Padovani, Alessandro; Alexandrov, Andrei V; Shahripour, Reza Bavarsad; Sessa, Maria; Giacalone, Giacomo; Silvestrelli, Giorgio; Lanari, Alessia; Ciccone, Alfonso; De Vito, Alessandro; Azzini, Cristiano; Saletti, Andrea; Fainardi, Enrico; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Silvestrini, Mauro; Ferrarese, Carlo; Beretta, Simone; Tassi, Rossana; Martini, Giuseppe; Tsivgoulis, Georgios; Vasdekis, Spyros N; Consoli, Domenico; Baldi, Antonio; D'Anna, Sebastiano; Luda, Emilio; Varbella, Ferdinando; Galletti, Giampiero; Invernizzi, Paolo; Donati, Edoardo; De Lodovici, Maria Luisa; Bono, Giorgio; Corea, Francesco; Sette, Massimo Del; Monaco, Serena; Riva, Maurizio; Tassinari, Tiziana; Scoditti, Umberto; Toni, Danilo

    2015-02-01

    The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of

  18. Imaging findings and cerebral perfusion in arterial ischemic stroke due to transient cerebral arteriopathy in children; Achados de imagem e perfusao arterial cerebral em acidente vascular cerebral isquemico devido a arteriopatia transitoria em crianca

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa Junior, Alcino Alves, E-mail: alcinojr@uol.com.br [Departamento de Diagnostico por Imagem, Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP (Brazil); Ellovitch, Saada Resende de Souza [Neuropediatria, Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP (Brazil); Pincerato, Rita de Cassia Maciel [Hospital Samaritano, Sao Paulo, SP (Brazil)

    2012-04-15

    We report the case of a 4-year-old female child who developed an arterial ischemic stroke in the left middle cerebral artery territory, due to a proximal stenosis of the supraclinoid internal carotid artery, most probably related to transient cerebral arteriopathy of childhood. Computed tomography scan, magnetic resonance imaging, perfusion magnetic resonance and magnetic resonance angiography are presented, as well as follow-up by magnetic resonance and magnetic resonance angiography exams. Changes in cerebral perfusion and diffusion-perfusion mismatch call attention. As far as we know, this is the first report of magnetic resonance perfusion findings in transient cerebral arteriopathy. (author)

  19. 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

  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. 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

  2. Sex Hormones and Ischemic Stroke

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Nordestgaard, Børge G; Jensen, Gorm B

    2016-01-01

    CONTEXT AND OBJECTIVE: Whether endogenous sex hormones are associated with ischemic stroke (IS) is unclear. We tested the hypothesis that extreme concentrations of endogenous sex hormones are associated with risk of IS in the general population. DESIGN, SETTING, AND PARTICIPANTS: Adult men (n...

  3. Common variants at 6p21.1 are associated with large artery atherosclerotic stroke

    OpenAIRE

    Holliday, Elizabeth G.; Maguire, Jane M; Evans, Tiffany-Jane; Koblar, Simon A.; Jannes, Jim; Sturm, Jonathan W; Graeme J Hankey; Baker, Ross; Golledge, Jonathan; Mark W Parsons; Malik, Rainer; McEvoy, Mark; Biros, Erik; Lewis, Martin D.; Lincz, Lisa F

    2012-01-01

    Genome-wide association studies (GWAS) have not consistently detected replicable genetic risk factors for ischemic stroke, potentially due to etiological heterogeneity of this trait. We performed GWAS of ischemic stroke and a major ischemic stroke subtype (large artery atherosclerosis, LAA) using 1,162 ischemic stroke cases (including 421 LAA cases) and 1,244 population controls from Australia. Evidence for a genetic influence on ischemic stroke risk was detected, but this influence was highe...

  4. 大动脉粥样硬化型脑梗死病情进展的预测因素%Predictors of progressive ischemic stroke caused by large artery atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    王惠; 马先军; 卞光荣; 朱孟慧; 宁倩

    2016-01-01

    Objective To investigate the predictors of progressive ischemic stroke caused by large artery atherosclerosis (LAA). Method 173 cases of hospitalized patients with acute ischemic stroke caused by LAA were selected. The patients were investigated by Scandinavian Stroke Scale to evaluate whether the ischemic stroke was progressive. Collecting the patient's medi-cal history information,laboratory and imaging examination results,to analyz the incidence and the predictors of progressive ische-mic stroke caused by LAA. Results The incidence of progressive ischemic stroke caused by LAA was 23. 1%. The related factors of progressive ischemic stroke caused by LAA included:Blood pressure on admission,H - type hypertension,Hyperhomocysteine-mia,Intracranial and extracranial artery stenosis. Systolic blood pressure on admission,H - type hypertension,Hyperhomocysteine-mia,Intracranial artery stenosis can significantly predict progressive ischemic stroke caused by LAA. Conclusion H - type hyper-tension,Intracranial artery stenosis,Systolic blood pressure on admission and Hyperhomocysteinemia are independent predictors of progressive ischemic stroke caused by LAA.%目的:探讨大动脉粥样硬化(Large Artery Atherosclerosis,LAA)型脑梗死病情进展的预测因素。方法:选取收治的急性 LAA 型脑梗死患者173例。采用斯堪地那维亚卒中量表(Scandinavian Stroke Scale,SSS)评估患者病情是否发生进展,收集患者的病史资料、实验室及影像学检查结果。对 LAA 型进展性卒中的发生率及预测因素进行分析。结果:LAA 型进展性卒中的发生率为23.1%;入院时血压、H 型高血压、高同型半胱氨酸血症( Hyperhomocysteinemia, HHcy)、颅内外动脉狭窄与 LAA 型脑梗死病情进展相关;入院时收缩压、H 型高血压、HHcy、颅内动脉狭窄对 LAA 型脑梗死病情进展有显著预测作用。结论:H 型高血压、颅内动脉

  5. 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...

  6. 儿童动脉缺血性卒中的病因%Etiologies Analysis of Pediatric Arterial Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    谢玲玲; 蒋莉

    2012-01-01

    Objective To study the characteristics of pediatric arterial ischemic stroke (AIS), and to exam the etiology and risk factor. Methods This study retrospectively reviewed the records of all patients in Children's Hospital of Chongqing Medical University from Jan. 2003 to Mar. 2011, and patients were eligible for analysis if they had been diagnosed with AIS. The characters, etiologies and risk factors were described and the relation between trivial head injury and basilar ganglia calcification were analyzed through SPSS 17. 0 software. Results Thirty-one boys and 27 girls were enrolled in the study, with age of 2 months to 13 years (average:3 years and 10 months). And Major clinical neurological manifestations were paralysis (n =52, 92. 8% ) , central facial palsy ( n = 34, 58. 6% ) , motor aphasia ( n = 16, 27. 6% ) , vomiting and headache (n = 11, 19. 0% ) , loss of consciousness ( n =8, 13. 8% ) , and convulsion (n =7, 12.1% ). In reviewed 58 cases, 40 cases had radical vascular exams, in which 33 cases showed abnormalities, and left middle cerebral artery was the most commonly involved among basal cerebral arteries( n = 19 ,47. 5% ). Major risk factors were trivial head injury (n=26, 44.8%) , moyamoya disease (n = 8, 13.8% ) and intracranial infection (n=5, 8.6% ). Eighteen cases had more than one risk factor (31.0% ), 6 cases (10.3%) had no defined risk factor or etiologies. Additionally, 22 cases (37.9% ) had respiratory infection. Conclusions The peak morbidity period is during toddler and before school period, and common neurological presentation is paralysis. Stenosis or occlusion of left middle cerebral artery is major radical image, and the main risk factors are trivial head injury, moyamoya disease and intracranial infection. Prevention of infectious disease, induction of head injury are effective to prevention of AIS, and image examination of head and intracranial vascular as soon as possible is beneficial to early diagnosis.%目的 总结儿童动脉

  7. Percutaneous transluminal angioplasty and stenting for severe stenosis of the intracranial extradural internal carotid artery causing transient ischemic attack or minor stroke.

    Science.gov (United States)

    Ko, Jun Kyeung; Choi, Chang Hwa; Cha, Seung Heon; Choi, Byung Kwan; Cho, Won Ho; Kang, Tae Ho; Sung, Sang Min; Cho, Han Jin; Lee, Tae Hong

    2015-08-01

    The purpose of this study is to assess the technical feasibility and clinical efficacy of percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic stenosis of the intracranial extradural (petrous and cavernous) internal carotid artery (ICA).Review of medical records identified 26 consecutive patients who underwent PTAS using a balloon-expandable coronary stent (n = 15, 57.7%) or a Wingspan self-expandable stent (n = 11, 42.3%) for treatment of severe stenosis (>70%) involving the intracranial extradural ICA. The inclusion criteria were transient ischemic attack with an ABCD(2) score of ≥3 (n = 12, 46.2%) or minor stroke with an NIHSS score of ≤4 (n = 14, 53.8%). Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively.PTAS was technically successful in all patients. The mean stenosis ratio decreased from 77.1% to 10.0% immediately after PTAS. The overall incidence of procedural complications was 23.1%, and the postoperative permanent morbidity/mortality rate was 7.7%. A total of 22 patients were tracked over an average period of 29.9 months. During the observation period, 20 patients (90.9%) had no further cerebrovascular events and stroke recurrence occurred in two patients (9.1%), resulting in an annual stroke risk of 3.7%. Two cases (11.1%) of significant in-stent restenosis (>50%) were found on follow-up angiography (n = 18).PTAS for severe stenosis (>70%) involving the intracranial extradural ICA showed a good technical feasibility and favorable clinical outcome in patients with transient ischemic attack or minor stroke.

  8. Higher Levels of Cystatin C Are Associated with Extracranial Carotid Artery Steno-Occlusive Disease in Patients with Noncardioembolic Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Toshitaka Umemura

    2016-01-01

    Full Text Available Background: Large artery atherosclerosis is a major cause of ischemic stroke worldwide. Differential biomarker profiles associated with extra- and intracranial atherosclerosis are a topic of considerable interest. Cystatin C (CysC, a marker of renal function, is a risk factor for cardiovascular disease. Aim: We sought to determine whether CysC levels were associated with extra- and intracranial large artery stenosis (LAS in patients with acute ischemic stroke. Methods: We retrospectively analyzed data of acute noncardioembolic ischemic stroke patients who were admitted to our stroke center within 5 days from symptom onset. Serum CysC levels were measured using latex agglutination turbidimetric immunoassay. Extra- and intracranial LAS were defined as ≥50% diameter stenosis or occlusion of the relevant internal carotid artery (ICA and/or middle cerebral artery (MCA using carotid echography and volume rendering on magnetic resonance angiography. Multivariate logistic analyses were used to assess the association between CysC levels and LAS after adjustment for potential confounders. Results: Of 205 patients (mean age 70.2 years, 76 (37.1% had LAS. The distribution of LAS was 29 extracranial ICA, 34 intracranial ICA/MCA (8 ICA only, 25 MCA only, 1 ICA+MCA and 13 tandem stenosis (both extracranial ICA and intracranial ICA/MCA. Levels of CysC were higher in patients with extracranial ICA stenosis than in those with intracranial ICA/MCA stenosis (1.23 ± 0.33 vs. 0.97 ± 0.21 mg/l, p 1.04 mg/l was significantly associated with extracranial ICA stenosis (adjusted odds ratio [OR] 5.01, 95% confidence interval [CI] 1.51-16.63, p = 0.009 after adjustment for age, sex, diabetes, chronic kidney disease, current smoking, systolic blood pressure, HDL cholesterol, high-sensitivity C-reactive protein (hs-CRP and premorbid lipid-lowering drugs use. When CysC was considered as a continuous variable, 1 SD increase in CysC was significantly associated with

  9. Genetically determined coagulation disorders in ischemic stroke

    NARCIS (Netherlands)

    M.P.J. van Goor (Marie-Louise)

    2004-01-01

    textabstractThe aim of the research described in this thesis was to investigate the role of genetically determined coagulation disorders in ischemic stroke. We therefore performed several retrospective studies and one prospective case-control study of patients with recent ischemic stroke (the COCOS

  10. [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.

  11. Common variants at 6p21.1 are associated with large artery atherosclerotic stroke

    NARCIS (Netherlands)

    Holliday, Elizabeth G.; Maguire, Jane M.; Evans, Tiffany-Jane; Koblar, Simon A.; Jannes, Jim; Sturm, Jonathan W.; Hankey, Graeme J.; Baker, Ross; Golledge, Jonathan; Parsons, Mark W.; Malik, Rainer; McEvoy, Mark; Biros, Erik; Lewis, Martin D.; Lincz, Lisa F.; Peel, Roseanne; Oldmeadow, Christopher; Smith, Wayne; Moscato, Pablo; Barlera, Simona; Bevan, Steve; Bis, Joshua C.; Boerwinkle, Eric; Boncoraglio, Giorgio B.; Brott, Thomas G.; Brown, Robert D.; Cheng, Yu-Ching; Cole, John W.; Cotlarciuc, Ioana; Devan, William J.; Fornage, Myriam; Furie, Karen L.; Gretarsdottir, Solveig; Gschwendtner, Andreas; Ikram, M. Arfan; Longstreth, W. T.; Meschia, James F.; Mitchell, Braxton D.; Mosley, Thomas H.; Nalls, Michael A.; Parati, Eugenio A.; Psaty, Bruce M.; Sharma, Pankaj; Stefansson, Kari; Thorleifsson, Gudmar; Thorsteinsdottir, Unnur; Traylor, Matthew; Verhaaren, Benjamin F. J.; Wiggins, Kerri L.; Worrall, Bradford B.; Sudlow, Cathie; Rothwell, Peter M.; Farrall, Martin; Dichgans, Martin; Rosand, Jonathan; Markus, Hugh S.; Scott, Rodney J.; Levi, Christopher; Attia, John

    2012-01-01

    Genome-wide association studies (GWAS) have not consistently detected replicable genetic risk factors for ischemic stroke, potentially due to etiological heterogeneity of this trait. We performed GWAS of ischemic stroke and a major ischemic stroke subtype (large artery atherosclerosis, LAA) using 1,

  12. Swallowing disorders after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Gabriela Camargo Remesso

    2011-10-01

    Full Text Available OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5% were men and 49.5% women; mean age 65.3 years (SD=±11.7 (p<0.001. Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p<0.001 and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p<0.001. CONCLUSION: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

  13. 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.

  14. Association Between Macrominerals Intake and Changes in Internal Carotid Artery-Intima Media Thickness in POST Ischemic Stroke Patients

    Science.gov (United States)

    Pudjonarko, Dwi; Tugasworo, Dodik; Silaen, Rumintang

    2017-02-01

    Carotid Intima Media Thickness (C-IMT) has been widely used as marker for atherosclerosis. Previous studies on minerals intake and its association with C-IMT revealed various. Most of the studies showed inconsistent results. The aim of this study is to determine wether macro minerals intake is related to internal carotid-intima media thickness (IC-IMT). This is a longitudinal study, pre test post test design conducted in Neurology clinic, Kariadi hospital, Semarang from June to December 2014. Subjects were 22 post ischemic stroke patients. Minerals intake and IC-IMT was measured using Food Frequency Questionnaire and Duplex Carotid Ultrasonography. Statistical analysis was performed using Chi-Square, Fisher Exact and Logistic Regression test. Subjects included in this study were 17 male subjects (77.3%) and 5 female subjects (22.7%). Mean of IC-IMT in female subjects was found to be higher than in male. Mean of total IC-IMT was increased after a period of six months (0.96±0.80 to 0.97±0.21 mm). There were significant association between calcium as well as sodium intakes and IC-IMT. In contrast, there were no association between magnesium as well as potassium intake and IC-IMT. Multivariate analysis suggest that sodium intake (OR=26.828) was the most influencing factor for IC-IMT, followed by calcium intake (OR=0.042). Calcium as well as potassium intake were independently associated with IC-IMT. Magnecium as well as sodium intake were not independently associated with IC-IMT changes. Sodium intake was the most influencing variable to IC-IMT changes, followed by calcium intake.

  15. 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

  16. Morbidity predictors in ischemic stroke

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    Panicker J

    2003-01-01

    Full Text Available Background: Although ischemic CVA is one of the leading causes for death and disability, parameters for predicting long-term outcome in such patients have not been clearly delineated, especially in the Indian context. Methods: A prospective hospital-based study of 105 patients of ischemic stroke, focal neurological deficits and functional score was assessed and the C-reactive protein level (CRP was measured. A follow-up was done at 5 days and at 6 months and outcome variable was the functional status at 6 months using Barthel Index of Activities of Daily Living. Accordingly, patients were grouped into 3 - Barthel Index < 41: Severely disabled, Barthel Index 41-60: Moderately disabled and Barthel Index > 60: Mildly disabled. Results: At admission, if upper limb power was less than Medical Research Council (MRC grade 4, or aphasia was present or CRP assay was positive, then at 6 months, these patients most likely belonged to the severely disabled group. If upper limb or lower limb power was greater than MRC grade 3 or there was no aphasia or conjugate gaze deviation or CRP assay was negative, these patients most likely belonged to the mildly disabled group at 6 months. Follow-up rate was 86%. Conclusion: Patients can be stratified according to the predicted prognosis. The treatment and rehabilitation can be properly planned and strictly adhered to in patients predicted to have worse prognosis.

  17. Modifiable risk factors for ischemic stroke

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    Alexandros Gianoulakis

    2010-07-01

    Full Text Available Ischemic stroke is the third leading cause of death after cardiac disease and cancer in the developed countries. In patients older than 65 years old, ischemic stroke is one of the main causes of disability. They are also responsible for approximately 4.5 million deaths each year globally.The aim of the present study was to review the literature about the modifiable risk factors related to the development of ischemic stroke.The method οf this study included bibliographic research from both reviews and researches from literature, mainly of the last 8 years. The words used in pub med data base, referred to the modifiable risk factors related to the development of ischemic stroke.Results: In the majority of research studies, responsible risk factors for ischemic stroke are classified according to their ability of modification, in modifiable and non–modifiable risk factors. Some of the modifiable risk factors have been fully documented whereas some others need further research. The main modifiable risk factor is hypertension because on the one hand it promotes atherosclerosis and, on the other hand, leads to deteriorative changes and constrictions of small brain vessels. Atrial fibrillation is the most significant risk factor for ischemic stroke, since it is responsible for more than 50% of thromboembolic cases. Also, patients with diabetes mellitus are in higher risk for developing ischemic stroke compared to healthy population, whereas the danger is increasing in insuline-depented individuals. Increase of lipids in blood and disorders of cholesterol are responsible for atherosclerosis in coronary vessels and carotid. More in detail, carotid stenosis >50% in individuals over than 65 years old consist a significant risk factor for ischemic stroke. Though, the relation of smoking to ischemic stroke is still not fully understood, however smokers are in high risk for developing ischemic stroke for the reason that smoking is significantly related to

  18. 颈动脉狭窄患者发生缺血性脑卒中的危险因素及预防%Risk Factors and Prevention for Ischemic Stroke with Carotid Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    罗旺胜; 朱静

    2013-01-01

    Objective:To analysis risk factors and effective preventive measures of ischemic stroke in patients with carotid artery stenosis in local area. Method:60 cases of ischemic stroke result in carotid artery stenosis and 60 cases of normal control group were retrospectively analyzed. Risk factors of ischemic stroke were analyzed. Result:The risk factors of carotid artery stenosis patients to ischemic stroke included age,coronary heart disease,hypertension,diabetes,hyperlipidemia,smoking,atrial fibrillation.Patients who were 60 years of age or even older with coronary heart disease and hypertension and smoking were associated with the risk of ischemic stroke increased in stratified analysis. Conclusion:For reduce the occurrence of ischemic stroke,early carotid artery ultrasonography,strengthened drug prevention,strengthened publicity and education,encouraged to stop smoking should be used for 60 years old smokers with hypertension and hyperlipemia.%目的:分析探讨本地区颈动脉狭窄患者发生缺血性脑卒中的危险因素及相关有效预防措施。方法:回顾分析本院收治的颈动脉狭窄所致的缺血性脑卒中患者60例及门诊对照组正常患者60例,对比两组患者的相关资料,分析发生缺血性脑卒中的危险因素。结果:颈动脉狭窄患者发生缺血性脑卒中危险因素包括年龄、冠心病、高血压、糖尿病、高脂血症、房颤、吸烟等。分层分析中60岁以上,同时伴有高血压、冠心病及吸烟的患者发生缺血性脑卒中几率增加。结论:对于60岁以上伴高血压高血脂的吸烟患者应早期进行颈动脉彩超检查,加强药物预防,加强宣传教育,鼓励戒烟,降低缺血性脑卒中发生。

  19. 25-Hydroxyvitamin D and symptomatic ischemic stroke

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Nordestgaard, Børge G; Schnohr, Peter;

    2013-01-01

    OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen...... City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations...... were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D...

  20. Ischemic stroke in young adults: an overview of etiological aspects

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    Fábio Iuji Yamamoto

    2012-06-01

    Full Text Available Stroke affects mainly people aged over 65 years, and atherosclerosis predominates as the main etiopathogenic factor in ischemic stroke (IS. On the other hand, cardiac embolism and arterial dissection are the most frequent causes of IS in patients aged less than 45 years. However, inappropriate control of traditional vascular risk factors in young people may be causing a significant increase of atherosclerosis-related IS in this population. Furthermore, a variety of etiologies, many of them uncommon, must be investigated. In endemic regions, neurocysticercosis and Chagas' disease deserve consideration. Undetermined cause has been still reported in as many as one third of young stroke patients.

  1. Angiogenesis-regulating microRNAs and Ischemic Stroke.

    Science.gov (United States)

    Yin, Ke-Jie; Hamblin, Milton; Chen, Y Eugene

    2015-01-01

    Stroke is a leading cause of death and disability worldwide. Ischemic stroke is the dominant subtype of stroke and results from focal cerebral ischemia due to occlusion of major cerebral arteries. Thus, the restoration or improvement of reduced regional cerebral blood supply in a timely manner is very critical for improving stroke outcomes and poststroke functional recovery. The recovery from ischemic stroke largely relies on appropriate restoration of blood flow via angiogenesis. Newly formed vessels would allow increased cerebral blood flow, thus increasing the amount of oxygen and nutrients delivered to affected brain tissue. Angiogenesis is strictly controlled by many key angiogenic factors in the central nervous system, and these molecules have been well-documented to play an important role in the development of angiogenesis in response to various pathological conditions. Promoting angiogenesis via various approaches that target angiogenic factors appears to be a useful treatment for experimental ischemic stroke. Most recently, microRNAs (miRs) have been identified as negative regulators of gene expression in a post-transcriptional manner. Accumulating studies have demonstrated that miRs are essential determinants of vascular endothelial cell biology/angiogenesis as well as contributors to stroke pathogenesis. In this review, we summarize the knowledge of stroke-associated angiogenic modulators, as well as the role and molecular mechanisms of stroke-associated miRs with a focus on angiogenesis-regulating miRs. Moreover, we further discuss their potential impact on miR-based therapeutics in stroke through targeting and enhancing post-ischemic angiogenesis.

  2. Risk factors for progressive ischemic stroke A retrospective analysis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, thc potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome.OBJECTIVE: To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke.DESIGN: A retrospective analysis.SETTING: Department of Neurology, General Hospital of Beijing Coal Mining Group.PARTICIPANTS: Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of (62±7) years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile,200 inpatients with non-progressive ischemic stroke (135 males and 65 females) were selected as the control group.METHODS: After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis.MAIN OUTCOME MEASURES

  3. Radiology of ischemic strokes in children

    Energy Technology Data Exchange (ETDEWEB)

    Raybaud, C.A.; Jiddane, M.; Livet, M.O.; Pinsard, N.

    1985-11-01

    Arterial ischemic strokes are a relatively frequent diagnostic occurrence in pediatric neuroradiology. They occur mostly in three main etiologic contexts: 1) congenital heart disease; 2) neonatal distress; 3) infections, focal or general inducing vasculitis, but many cases are considered as idiopathic. The positive diagnosis is made by CT; in neonates, however, ultrasound appears as a promising tool. The CT features are basically similar at that age and in adults, although the site of the infarct may result from pathologies more particular to children (e.g. basal ganglia infarction due to arteritis of the carotid syphon and its branches). Infarcts may be multiple and also more frequently hemorrhagic at that age, the homorrhagic phenomena affecting only the gray matter except in young infants in which the subcortical white matter may be affected also. Anatomical sequels include focal atrophy and asymmetry of the brain. Data regarding the etiology can be gathered from angiography which may show the degree of impairment of the arterial bed, its extent, the collateral blood supply and the morphological type of arterial lesion responsible for the cerebral damage. The most particular picture at that age is that of the often diffuse vasculitis, with its various expressions (segmental narrowing of the lumen, dissecting aneurysm, string-of-beads appearance). (orig.).

  4. NLRP3 deficiency ameliorates neurovascular damage in experimental ischemic stroke.

    Science.gov (United States)

    Yang, Fan; Wang, Ziying; Wei, Xinbing; Han, Huirong; Meng, Xianfang; Zhang, Yan; Shi, Weichen; Li, Fengli; Xin, Tao; Pang, Qi; Yi, Fan

    2014-04-01

    Although the innate immune response to induce postischemic inflammation is considered as an essential step in the progression of cerebral ischemia injury, the role of innate immunity mediator NLRP3 in the pathogenesis of ischemic stroke is unknown. In this study, focal ischemia was induced by middle cerebral artery occlusion in NLRP3(-/-), NOX2(-/-), or wild-type (WT) mice. By magnetic resonance imaging (MRI), Evans blue permeability, and electron microscopic analyses, we found that NLRP3 deficiency ameliorated cerebral injury in mice after ischemic stroke by reducing infarcts and blood-brain barrier (BBB) damage. We further showed that the contribution of NLRP3 to neurovascular damage was associated with an autocrine/paracrine pattern of NLRP3-mediated interleukin-1β (IL-1β) release as evidenced by increased brain microvessel endothelial cell permeability and microglia-mediated neurotoxicity. Finally, we found that NOX2 deficiency improved outcomes after ischemic stroke by mediating NLRP3 signaling. This study for the first time shows the contribution of NLRP3 to neurovascular damage and provides direct evidence that NLRP3 as an important target molecule links NOX2-mediated oxidative stress to neurovascular damage in ischemic stroke. Pharmacological targeting of NLRP3-mediated inflammatory response at multiple levels may help design a new approach to develop therapeutic strategies for prevention of deterioration of cerebral function and for the treatment of stroke.

  5. Anticoagulant Therapy In Ischemic Stroke Or TIA

    Directory of Open Access Journals (Sweden)

    Kaveh Mehrvar

    2017-02-01

    Full Text Available Stroke is the leading cause of disability and the third leading cause of death  . Anticoagulants   have been used to treat patients with acute ischemic stroke for many years. Despite their widespread use, the usefulness of emergency anticoagulation is a subject of debate. Disagreements exist about the best agent to administer, the route of administration, the use of a bolus dose to start treatment, the level of anticoagulation required, and the duration of treatment. There are 2 types of anticoagulants: Parenteral and oral. Heparin is an anticoagulant that used parenteral. Oral anticoagulants are including Warfarin and new anticoagulants such as Dabigatrn,Rivaroxaban ,Apixaban and other newer drugs. In patients with noncardioembolic  ischemic stroke or TIA antiplatelet agents are treatment of choice and preferred to anticoagulants. In cardioembolic  ischemic stroke or TIA with high risk of reembolization  anticoagulants  are considered as preferred treatment.  Warfarin, apixaban10mg/d ,Rivaroxaban20mg/d, and dabigatran 150 mg/d are all indicated for the prevention of recurrent stroke in patients with nonvalvular AF, whether paroxysmal or permanent.Also anticoagulant therapy is recommended for ischemic stroke or TIA patients in the setting of acute MI, atrial or ventricular thrombosis or dilated and restricted cardiomyopathy. Some valvular heart diseases are other indication for anticoagulant therapy in ischemic stroke or TIA patients. Ischemic  Stroke or TIA in patients with Cerebral vein thrombosis and  known hypercoagulable state specially anti phospholipid antibody syndrome are other indications for anticoagulant treatment.

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

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    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.

  7. A STUDY ON INTRACRANIAL STENOSIS IN ACUTE ISCHEMIC STROKE

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    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

  8. Atrial fibrillation in patients with ischemic stroke

    DEFF Research Database (Denmark)

    Thygesen, Sandra Kruchov; Frost, Lars; Eagle, Kim A;

    2009-01-01

    BACKGROUND: Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care...... and outcomes in a cohort of first-time ischemic stroke patients with and without atrial fibrillation. METHODS: Based on linkage of public medical databases, we did a population-based follow-up study among 3,849 stroke patients from the County of Aarhus, Denmark admitted in the period of 2003......-2007 and prospectively registered in the Danish National Indicator Project. RESULTS: Atrial fibrillation was associated with an adverse prognostic profile but not with an overall poorer quality of in-hospital care. Patients with atrial fibrillation had a longer total length of stay (median: 15 vs 9 days), and were...

  9. Global DNA methylation of ischemic stroke subtypes.

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    Carolina Soriano-Tárraga

    Full Text Available Ischemic stroke (IS, a heterogeneous multifactorial disorder, is among the leading causes of mortality and long-term disability in the western world. Epidemiological data provides evidence for a genetic component to the disease, but its epigenetic involvement is still largely unknown. Epigenetic mechanisms, such as DNA methylation, change over time and may be associated with aging processes and with modulation of the risk of various pathologies, such as cardiovascular disease and stroke. We analyzed 2 independent cohorts of IS patients. Global DNA methylation was measured by luminometric methylation assay (LUMA of DNA blood samples. Univariate and multivariate regression analyses were used to assess the methylation differences between the 3 most common IS subtypes, large-artery atherosclerosis (LAA, small-artery disease (SAD, and cardio-aortic embolism (CE. A total of 485 IS patients from 2 independent hospital cohorts (n = 281 and n = 204 were included, distributed across 3 IS subtypes: LAA (78/281, 59/204, SAD (97/281, 53/204, and CE (106/281, 89/204. In univariate analyses, no statistical differences in LUMA levels were observed between the 3 etiologies in either cohort. Multivariate analysis, adjusted by age, sex, hyperlipidemia, and smoking habit, confirmed the lack of differences in methylation levels between the analyzed IS subtypes in both cohorts. Despite differences in pathogenesis, our results showed no global methylation differences between LAA, SAD, and CE subtypes of IS. Further work is required to establish whether the epigenetic mechanism of methylation might play a role in this complex disease.

  10. Prediction factors of recurrent ischemic events in one year after minor stroke.

    Directory of Open Access Journals (Sweden)

    Changqing Zhang

    Full Text Available BACKGROUND: The risk of a subsequent stroke following a minor stroke is high. However, there are no effective rating scales to predict recurrent stroke following a minor one. Therefore, we assessed the risk factors associated with recurrent ischemic stroke or transient ischemic attack (TIA within one year of minor stroke onset in order to identify possible risk factors. METHODS: Eight hundred and sixty-three non-cardioembolic ischemic stroke patients in the Chinese IntraCranial AtheroSclerosis Study that presented with minor stroke, defined as an admission National Institutes of Health stroke scale (NIHSS score of ≤3, were consecutively enrolled in our study. Clinical information and imaging features upon admission, and any recurrent ischemic stroke or TIA within one year was recorded. Cox regression was used to identify risk factors associated with recurrent ischemic stroke or TIA within the year following stroke onset. RESULTS: A total of 50 patients (6.1% experienced recurrent ischemic stroke or TIA within one year of minor stroke onset. Multivariate Cox regression model identified lower admission NIHSS score (HR, 1.75; 95% CI, 1.32 to 2.33; P<0.0001, history of coronary heart disease (HR, 2.62; 95% CI, 1.17 to 5.86; P = 0.02, severe stenosis or occlusion of large cerebral artery (HR, 4.68; 95% CI, 1.87 to 11.7; P = 0.001, and multiple acute cerebral infarcts (HR, 2.61; 95% CI, 1.01 to 6.80; P = 0.05 as independent risk factors for recurrent ischemic stroke or TIA within one year. CONCLUSIONS: Some minor stroke patients are at higher risk for recurrent ischemic stroke or TIA. Urgent and intensified therapy may be reasonable in these patients.

  11. A more consistent intraluminal rhesus monkey model of ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Bo Zhao; Fauzia Akbary; Shengli Li; Jing Lu; Feng Ling; Xunming Ji; Guowei Shang; Jian Chen; Xiaokun Geng; Xin Ye; Guoxun Xu; Ju Wang; Jiasheng Zheng; Hongjun Li

    2014-01-01

    Endovascular surgery is advantageous in experimentally induced ischemic stroke because it causes fewer cranial traumatic lesions than invasive surgery and can closely mimic the pathophysiol-ogy in stroke patients. However, the outcomes are highly variable, which limits the accuracy of evaluations of ischemic stroke studies. In this study, eight healthy adult rhesus monkeys were randomized into two groups with four monkeys in each group:middle cerebral artery occlusion at origin segment (M1) and middle cerebral artery occlusion at M2 segment. The blood lfow in the middle cerebral artery was blocked completely for 2 hours using the endovascular microcoil placement technique (1 mm × 10 cm) (undetachable), to establish a model of cerebral ischemia. The microcoil was withdrawn and the middle cerebral artery blood lfow was restored. A revers-ible middle cerebral artery occlusion model was identiifed by hematoxylin-eosin staining, digital subtraction angiography, magnetic resonance angiography, magnetic resonance imaging, and neurological evaluation. The results showed that the middle cerebral artery occlusion model was successfully established in eight adult healthy rhesus monkeys, and ischemic lesions were apparent in the brain tissue of rhesus monkeys at 24 hours after occlusion. The rhesus monkeys had symp-toms of neurological deifcits. Compared with the M1 occlusion group, the M2 occlusion group had lower infarction volume and higher neurological scores. These experimental ifndings indicate that reversible middle cerebral artery occlusion can be produced with the endovascular microcoil technique in rhesus monkeys. The M2 occluded model had less infarction and less neurological impairment, which offers the potential for application in the ifeld of brain injury research.

  12. A more consistent intraluminal rhesus monkey model of ischemic stroke.

    Science.gov (United States)

    Zhao, Bo; Shang, Guowei; Chen, Jian; Geng, Xiaokun; Ye, Xin; Xu, Guoxun; Wang, Ju; Zheng, Jiasheng; Li, Hongjun; Akbary, Fauzia; Li, Shengli; Lu, Jing; Ling, Feng; Ji, Xunming

    2014-12-01

    Endovascular surgery is advantageous in experimentally induced ischemic stroke because it causes fewer cranial traumatic lesions than invasive surgery and can closely mimic the pathophysiology in stroke patients. However, the outcomes are highly variable, which limits the accuracy of evaluations of ischemic stroke studies. In this study, eight healthy adult rhesus monkeys were randomized into two groups with four monkeys in each group: middle cerebral artery occlusion at origin segment (M1) and middle cerebral artery occlusion at M2 segment. The blood flow in the middle cerebral artery was blocked completely for 2 hours using the endovascular microcoil placement technique (1 mm × 10 cm) (undetachable), to establish a model of cerebral ischemia. The microcoil was withdrawn and the middle cerebral artery blood flow was restored. A reversible middle cerebral artery occlusion model was identified by hematoxylin-eosin staining, digital subtraction angiography, magnetic resonance angiography, magnetic resonance imaging, and neurological evaluation. The results showed that the middle cerebral artery occlusion model was successfully established in eight adult healthy rhesus monkeys, and ischemic lesions were apparent in the brain tissue of rhesus monkeys at 24 hours after occlusion. The rhesus monkeys had symptoms of neurological deficits. Compared with the M1 occlusion group, the M2 occlusion group had lower infarction volume and higher neurological scores. These experimental findings indicate that reversible middle cerebral artery occlusion can be produced with the endovascular microcoil technique in rhesus monkeys. The M2 occluded model had less infarction and less neurological impairment, which offers the potential for application in the field of brain injury research.

  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. [Nonfasting triglycerides and risk of ischemic stroke--secondary publication

    DEFF Research Database (Denmark)

    Freiberg, J.J.; Tybjaerg-Hansen, A.; Jensen, J.S.;

    2009-01-01

    The role of triglycerides in the risk of ischemic stroke remains controversial. We tested the hypothesis that increased levels of nonfasting triglycerides are associated with ischemic stroke in the general population. Men with a nonfasting triglyceride level 5 mmol/l had a multivariable, adjusted...... hazard ratio for ischemic stroke of 2.5 (95% confidence interval: 1.3-4.8) compared with men with a nonfasting triglyceride level triglycerides is associated with risk of ischemic stroke Udgivelsesdato...

  15. Polymorphisms in apolipoprotein B and risk of ischemic stroke

    DEFF Research Database (Denmark)

    Benn, Marianne; Nordestgaard, Børge G; Jensen, Jan Skov;

    2007-01-01

    Apolipoprotein B levels associate with risk of ischemic stroke. APOB polymorphisms may influence levels of apolipoprotein B and low-density lipoprotein (LDL), but whether they associate with risk of ischemic stroke is unknown.......Apolipoprotein B levels associate with risk of ischemic stroke. APOB polymorphisms may influence levels of apolipoprotein B and low-density lipoprotein (LDL), but whether they associate with risk of ischemic stroke is unknown....

  16. 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.

  17. Asymmetric Dimethyarginine as Marker and Mediator in Ischemic Stroke

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    Karin Weissenborn

    2012-11-01

    Full Text Available Asymmetric dimethylarginine (ADMA, an endogenous nitric oxide synthase (NOS inhibitor, is known as mediator of endothelial cell dysfunction and atherosclerosis. Circulating ADMA levels are correlated with cardiovascular risk factors such as hypercholesterolemia, arterial hypertension, diabetes mellitus, hyperhomocysteinemia, age and smoking. Accordingly, clinical studies found evidence that increased ADMA levels are associated with a higher risk of cerebrovascular events. After the acute event of ischemic stroke, levels of ADMA and its analog symmetric dimethylarginine (SDMA are elevated through augmentation of protein methylation and oxidative stress. Furthermore, cleavage of ADMA through dimethylarginine dimethylaminohydrolases (DDAHs is reduced. This increase of dimethylarginines might be predictive for adverse clinical outcome. However, the definite role of ADMA after acute ischemic stroke still needs to be clarified. On the one hand, ADMA might contribute to brain injury by reduction of cerebral blood flow. On the other hand, ADMA might be involved in NOS-induced oxidative stress and excitotoxic neuronal death. In the present review, we highlight the current knowledge from clinical and experimental studies on ADMA and its role for stroke risk and ischemic brain injury in the hyperacute stage after stroke. Finally, further studies are warranted to unravel the relevance of the close association of dimethylarginines with stroke.

  18. Rehabilitation Outcomes: Ischemic versus Hemorrhagic Strokes

    Directory of Open Access Journals (Sweden)

    Robert Perna

    2015-01-01

    Full Text Available Background. Ischemic and hemorrhagic strokes have different pathophysiologies and possibly different long-term cerebral and functional implications. Hemorrhagic strokes expose the brain to irritating effects of blood and ischemic strokes reflect localized or diffuse cerebral vascular pathology. Methods. Participants were individuals who suffered either an ischemic (n=172 or hemorrhagic stroke (n=112 within the past six months and were involved in a postacute neurorehabilitation program. Participants completed three months of postacute neurorehabilitation and the Mayo Portland Adaptability Inventory-4 (MPAI-4 at admission and discharge. Admission MPAI-4 scores and level of functioning were comparable. Results. Group ANOVA comparisons show no significant group differences at admission or discharge or difference in change scores. Both groups showed considerably reduced levels of productivity/employment after discharge as compared to preinjury levels. Conclusions. Though the pathophysiology of these types of strokes is different, both ultimately result in ischemic injuries, possibly accounting for lack of findings of differences between groups. In the present study, participants in both groups experienced similar functional levels across all three MPAI-4 domains both at admission and discharge. Limitations of this study include a highly educated sample and few outcome measures.

  19. Genetics of ischemic stroke: Indian perspective

    Directory of Open Access Journals (Sweden)

    Subhash Kaul

    2012-01-01

    Full Text Available A stroke is still a major cause of long-term disability and the third largest killer in the world after heart attack and cancer. Inherited genetic variation has been shown to play a role in its pathogenesis and therefore, there is a need to identify the culprit genetic variants. They may provide novel targets for preventive therapeutics. The most intensively investigated candidate gene is PDE4D. There are several positive replication studies of PDE4D gene with stroke. The genetic contribution to ischemic stroke risk in India has not been explored adequately. Reports on few candidate genes are available but we are still lagging behind in this aspect. Most of the reports are from Andhra Pradesh, a province in south India and a few parts of north India. PDE4D has been identified as a predisposition gene for ischemic stroke in Southern as well as the Northern population of India.

  20. Thrombectomy assisted by carotid stenting in acute ischemic stroke management

    DEFF Research Database (Denmark)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel;

    2015-01-01

    -term outcome (mRS ≤ 2). Harms included complications during and following EVT. Mean age was 64.3 years (standard deviation ±12.5), 40 (85%) patients received IVT initially. Median NIHSS was 16 (inter-quartile range 14-19). Mean time from stroke onset to recanalization was 311 min (standard deviation ±78......Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky......-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long...

  1. Vertebral Artery Hypoplasia and Posterior Circulation Ischemic Stroke:from Hypothesis to Pathogenesis%椎动脉发育不良与后循环缺血性卒中:从假说到发病机制

    Institute of Scientific and Technical Information of China (English)

    俞越; 徐子奇; 罗本燕

    2014-01-01

    Vertebral artery hypoplasia is a frequent vascular variation of posterior circulation. Emerging evidence suggests that vertebral artery hypoplasia is a risk factor of posterior circulation ischemic stroke, with a morphological correlation between them. This article reviews research progress of vertebral artery hypoplasia and its role in posterior circulation ischemic stroke in order to promote optimization during clinical decision making.%椎动脉发育不良是临床常见的后循环血管变异。已有的研究结果显示,椎动脉发育不良是后循环缺血性卒中的危险因素,并与之存在区域性关联。椎动脉发育不良在后循环缺血性卒中的发生发展中起到重要作用。本文对椎动脉发育不良与后循环缺血性卒中之间的关系以及潜在的发病机制进行综述,以期为后循环缺血性卒中的科学预防和临床治疗提供参考。

  2. Ischemic Stroke during Pregnancy and Puerperium

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    Elisabetta Del Zotto

    2011-01-01

    Full Text Available Ischemic stroke during pregnancy and puerperium represents a rare occurrence but it could be a serious and stressful event for mothers, infants, and also families. Whenever it does occur, many concerns arise about the safety of the mother and the fetus in relation to common diagnostic tests and therapies leading to a more conservative approach. The physiological adaptations in the cardiovascular system and in the coagulability that accompany the pregnant state, which are more significant around delivery and in the postpartum period, likely contribute to increasing the risk of an ischemic stroke. Most of the causes of an ischemic stroke in the young may also occur in pregnant patients. Despite this, there are specific conditions related to pregnancy which may be considered when assessing this particular group of patients such as pre-eclampsia-eclampsia, choriocarcinoma, peripartum cardiomiopathy, amniotic fluid embolization, and postpartum cerebral angiopathy. This article will consider several questions related to pregnancy-associated ischemic stroke, dwelling on epidemiological and specific etiological aspects, diagnostic issue concerning the use of neuroimaging, and the related potential risks to the embryo and fetus. Therapeutic issues surrounding the use of anticoagulant and antiplatelets agents will be discussed along with the few available reports regarding the use of thrombolytic therapy during pregnancy.

  3. Obstructive sleep apnea in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aliye Tosun

    2008-01-01

    Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.

  4. The effects of estrogen in ischemic stroke.

    Science.gov (United States)

    Koellhoffer, Edward C; McCullough, Louise D

    2013-08-01

    Stroke is a leading cause of death and the most common cause of long-term disability in the USA. Women have a lower incidence of stroke compared with men throughout most of the lifespan which has been ascribed to protective effects of gonadal steroids, most notably estrogen. Due to the lower stroke incidence observed in pre-menopausal women and robust preclinical evidence of neuroprotective and anti-inflammatory properties of estrogen, researchers have focused on the potential benefits of hormones to reduce ischemic brain injury. However, as women age, they are disproportionately affected by stroke, coincident with the loss of estrogen with menopause. The risk of stroke in elderly women exceeds that of men and it is clear that in some settings estrogen can have pro-inflammatory effects. This review will focus on estrogen and inflammation and its interaction with aging.

  5. Mesenchymal stromal cell therapy in ischemic stroke

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2016-11-01

    Full Text Available Ye Zhang, Hong Deng, Chao Pan, Yang Hu, Qian Wu, Na Liu, Zhouping Tang Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China Abstract: Stroke is a clinical disease with high incidence, high disability rate, and high mortality. But effective and safe therapy for stroke remains limited. Adult mesenchymal stromal cells (MSCs perform a variety of therapeutic functions. MSC delivery improves neurological outcomes in ischemic stroke models via neurorestorative and neuroprotective effects such as angiogenic effects, promoting endogenous proliferation, and reducing apoptosis and inflammation. MSC secretome also showed powerful therapeutic effects as a cell-based therapy in animal experiments. Several clinical trials on MSC implantation via different routes have now been completed in patients with stroke. Although challenges such as immunogenicity of allo-MSCs and large-scale production strategies need to be overcome, MSCs can be considered as a promising potential therapy for ischemic stroke. Keywords: mesenchymal stromal cell, stroke, therapy, transplantation, exosomes

  6. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke : A Randomized Clinical Trial

    NARCIS (Netherlands)

    Fransen, Puck S S; Berkhemer, Olvert A; Lingsma, Hester F; Beumer, Debbie; van den Berg, Lucie A; Yoo, Albert J; Schonewille, Wouter J; Vos, Jan Albert; Nederkoorn, Paul J; Wermer, Marieke J H; van Walderveen, Marianne A A; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Brouwer, Patrick A; Emmer, Bart J; de Bruijn, Sebastiaan F; van Dijk, Lukas C; Kappelle, L Jaap; Lo, Rob H; van Dijk, Ewoud J; de Vries, Joost; de Kort, Paul L M; van den Berg, J S Peter; van Hasselt, Boudewijn A A M; Aerden, Leo A M; Dallinga, René J; Visser, Marieke C; Bot, Joseph C J; Vroomen, Patrick C; Eshghi, Omid; Schreuder, Tobien H C M L; Heijboer, Roel J J; Keizer, Koos; Tielbeek, Alexander V; den Hertog, Heleen M; Gerrits, Dick G; van den Berg-Vos, Renske M; Karas, Giorgos B; Steyerberg, Ewout W; Flach, H Zwenneke; Marquering, Henk A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Beenen, Ludo F M; van den Berg, René; Koudstaal, Peter J; van Zwam, Wim H; Roos, Yvo B W E M; van Oostenbrugge, Robert J; Majoie, Charles B L M; van der Lugt, Aad; Dippel, Diederik W J

    2016-01-01

    Importance: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. Objective: To evaluate the influe

  7. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke : A Randomized Clinical Trial

    NARCIS (Netherlands)

    Fransen, Puck S S; Berkhemer, Olvert A; Lingsma, Hester F; Beumer, Debbie; van den Berg, Lucie A; Yoo, Albert J; Schonewille, Wouter J; Vos, Jan Albert; Nederkoorn, Paul J; Wermer, Marieke J H; van Walderveen, Marianne A A; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Brouwer, Patrick A; Emmer, Bart J; de Bruijn, Sebastiaan F; van Dijk, Lukas C; Kappelle, L Jaap; Lo, Rob H; van Dijk, Ewoud J; de Vries, Joost; de Kort, Paul L M; van den Berg, J S Peter; van Hasselt, Boudewijn A A M; Aerden, Leo A M; Dallinga, René J; Visser, Marieke C; Bot, Joseph C J; Vroomen, Patrick C; Eshghi, Omid; Schreuder, Tobien H C M L; Heijboer, Roel J J; Keizer, Koos; Tielbeek, Alexander V; den Hertog, Heleen M; Gerrits, Dick G; van den Berg-Vos, Renske M; Karas, Giorgos B; Steyerberg, Ewout W; Flach, H Zwenneke; Marquering, Henk A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Beenen, Ludo F M; van den Berg, René; Koudstaal, Peter J; van Zwam, Wim H; Roos, Yvo B W E M; van Oostenbrugge, Robert J; Majoie, Charles B L M; van der Lugt, Aad; Dippel, Diederik W J

    2016-01-01

    IMPORTANCE: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE: To evaluate the influe

  8. Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

    Directory of Open Access Journals (Sweden)

    Heitor Castelo Branco Rodrigues Alves

    2016-01-01

    Full Text Available ABSTRACT Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

  9. Correlation between carotid artery vulnerable plaques and recurrent ischemic cerebral stroke%颈动脉易损斑块与缺血性脑卒中复发的相关性研究

    Institute of Scientific and Technical Information of China (English)

    刘国荣; 王大力; 张文丽; 安亚臣; 郑德松; 姚林

    2012-01-01

    目的 对颈动脉斑块进行评价,分析斑块性质、形态及其危险因素与缺血性脑卒中复发的相关性.方法 选择经头颅CT和(或)MRI确诊为缺血性脑卒中复发患者209例,应用CT血管造影联合彩色多普勒超声检查证实122例有颈动脉斑块,根据斑块性质分为易损斑块组86例,稳定斑块组36例,分析斑块性质、形态,观察发生缺血性脑血管事件相关因素,比较2组缺血性脑卒中复发的时间、分布及狭窄的关系,Cox风险比例模型分析缺血性脑卒中复发与颈动脉斑块等危险因素间的相关性.结果 209例患者中,颈动脉斑块122例,占58.4%.与稳定斑块组比较,易损斑块组年龄更高,高血压和冠心病的比例更多(P<0.05).Cox回归分析显示,易损斑块与冠心病是缺血性脑卒中复发的危险因素.结论 颈动脉斑块性质、形态和冠心病是缺血性脑卒中复发的危险因素.%Objective To assess the carotid artery plaques (CAP) and analyze the correlation of their nature, morphology and risk factors with recurrent ischemic cerebral stroke. Methods Of the 209 patients with recurrent ischemic cerebral stroke established by head CT and/or MRI in this study, 122 were diagnosed with CAP by combined CT angiography and carotid artery ultra-sonography,86 were diagnosed with vulnerable CAP and 36 were diagnosed with stable CAP according to their nature. The nature and morphology of CAP were analyzed and related factors for ischemic cerebrovascular events were observed. Relation of recurrent time of vulnerable and non-vulnerable ischemic ischemic cerebrovascular events with their distribution and stenosis was compared. Correlation between recurrent ischemic cerebrovascular events and risk factors for CAP was analyzed using the Cox risk model. Results CAP were detected in 122 patients(58. 4%). The age of patients with stable CAP was higher than that of those with vulnerable CAP. The proportion of hypertention and coronary

  10. Cortical myoclonus during IV thrombolysis for ischemic stroke

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    Carla Bentes

    2014-01-01

    Full Text Available We describe a patient with an acute middle cerebral artery ischemic stroke developing subtle involuntary movements of the paretic upper limb with cortical origin during rt-PA perfusion. Despite the multiple potential pathophysiological mechanisms for the relationship between thrombolysis and epileptic activity, seizures during this procedure are scarcely reported. Our hypothesis is that subtle and transient clinical seizures, like those described in our patient, may not be detected or are misdiagnosed as nonepileptic involuntary movements. We aimed to draw attention to the recognition challenge of this paroxysmal motor behavior, highlighting this clinical and neurophysiological identification using video recording and back-average analysis of the EEG.

  11. Phosphodiesterase 4D polymorphisms associate with the short-term outcome in ischemic stroke

    Science.gov (United States)

    Song, Yan-li; Wang, Chun-juan; Wu, Yi-ping; Lin, Jie; Wang, Peng-lian; Du, Wan-liang; Liu, Li; Lin, Jin-xi; Wang, Yi-long; Wang, Yong-jun; Liu, Gai-fen

    2017-01-01

    It has been demonstrated that phosphodiesterase 4D (PDE4D) genetic polymorphism is associated with ischemic stroke. However, the association between PDE4D gene and prognosis after ischemic stroke remains unknown. We consecutively enrolled ischemic stroke patients admitted to Beijing Tiantan Hospital from October 2009 to December 2013. Clinical, laboratory and imaging data upon admission were collected. All patients were followed up 3 months after stroke onset. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the associations of genetic polymorphisms with 3-month outcome after ischemic stroke and different subtypes, under various genetic models. A total of 1447 patients were enrolled, and 3-month follow-up data were obtained from 1388 (95.92%). Multivariate regression analysis showed that SNP87 of PDE4D gene was associated with increased risk of unfavorable outcome after total ischemic stroke (OR = 1.47, 95%CI 1.12–1.93), as well as stroke due to large-artery atherosclerosis (OR = 1.49, 95%CI 1.04–2.11) and small-artery occlusion (OR = 1.76, 95%CI 1.05–2.96) under a recessive model. No association between SNP83 genotype and poor outcome was found. Overall, this study demonstrated that the TT genotype of SNP87 in PDE4D was associated with increased risk of poor outcome after total ischemic stroke, large-artery atherosclerosis and small-artery occlusion, in a Chinese population. PMID:28225001

  12. CURRENT REPERFUSION THERAPY POSSIBILITIES IN MYOCARDIAL INFARCTION AND ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    E. V. Konstantinova

    2015-01-01

    Full Text Available Myocardial infarction and ischemic stroke remain to be of the greatest medical and social importance because of their high prevalence, disability, and mortality rates. Intractable thrombotic occlusion of the respective artery leads to the formation of an ischemic lesion focus in the tissue of the heart or brain. Emergency reperfusion serves to decrease a necrotic focus, makes its formation reversible, and reduces patient death rates. The paper considers main reperfusion therapy lines: medical (with thrombolytic drugs and mechanical (with primary interventions one and their combination in treating patients with acute myocardial and cerebral ischemia. Each reperfusion procedure is discussed in view of its advantages, disadvantages, available guidelines, and possibilities of real clinical practice. Tenecteplase is assessed in terms of its efficacy, safety, and capacities for bolus administration, which allows its use at any hospital and at the pre-hospital stage. Prehospital thrombolysis permits reperfusion therapy to bring much closer to the patient and therefore aids in reducing time to reperfusion and in salvaging as much the myocardial volume as possible. The rapidest recovery of myocardial and cerebral perfusion results in a decreased necrotic area and both improved immediate and late prognosis. The results of randomized clinical trials studying the possibilities of the medical and mechanical methods to restore blood flow are analyzed in the context of evidence-based medicine. The reason why despite the available contraindications, limited efficiency, and the risk of hemorrhagic complications, thrombolytic therapy remains the method of choice for prehospital reperfusion, an alternative to primary percutaneous coronary intervention (PCI if it cannot be carried out in patients with myocardial infarction at the stated time, and the only treatment ischemic stroke treatment that has proven its efficiency and safety in clinical trials is under

  13. Risk factors for ischemic stroke and transient ischemic attack in patients under age 50

    NARCIS (Netherlands)

    Janssen, A.W.M.; Leeuw, F.E. de; Janssen, M.C.H.

    2011-01-01

    To analyze risk factors for ischemic stroke and transient ischemic attack (TIA) in young adults under the age of 50. To make recommendations for additional research and practical consequences. From 97 patients with ischemic stroke or TIA under the age of 50, classical cardiovascular risk factors, co

  14. Genistein: A Boon for Mitigating Ischemic Stroke.

    Science.gov (United States)

    Nabavi, Seyed Fazel; Daglia, Maria; Tundis, Rosa; Loizzo, Monica Rosa; Sobarzo-Sanchez, Eduardo; Orhan, Ilkay Erdogan; Nabavi, Seyed Mohammad

    2015-01-01

    In last decades, diet and dietary components have been regarded as important strategies to prevent the development or mitigate numerous chronic diseases, including inflammation, cardiovascular pathologies, cancer, etc. One of the most common dietary components of Asian population is soy. A plethora of research shows the promising effect of soy soy-based foodstuffs and genistein, which is one of the predominant isoflavone compounds, in the prevention and mitigation of stroke. Growing evidence shows that genistein, which is a selective estrogen receptor modulator, mitigates ischemic stroke-induced damages through the modification of oxidative stress and molecular pathways. The promising pharmacological role of genistein is attributed to its ability to suppress nuclear factor (NF)-kappa B and Akt signaling pathway, direct antioxidant action, and targeting estrogen and androgen-mediated molecular pathways which help to mitigate stroke damages and prolong cell survival. In this work, we systematically review the current reports on the therapeutic role of genistein against ischemic stroke and its molecular mechanism of actions.

  15. Risk factors for young ischemic stroke and the enigma of trombophilic polymorphisms: a case report

    Directory of Open Access Journals (Sweden)

    Linda Iurato

    2011-12-01

    Full Text Available We report the case of a 48-year-old female patient with stroke family history that was admitted in our ward with suspected ischemic stroke diagnosis. The diagnostic process is described in detail, paying attention in particular to anamnestic data and to genetic polymorphisms related to higher risk for inherited thrombophilia. At the end, the diagnosis indicates red infarct in a migraine patient with cerebrovascular and cardiovascular risk factors of undetermined aetiology according to TOAST criteria. Some of the known thrombophilic polymorphisms were found in the patient: however not all the mentioned thrombophilic markers are universally recognized as predisposing factors for arterial ischemic stroke.

  16. Risk factors and prognosis of ischemic stroke in young patients in Uzbekistan

    Directory of Open Access Journals (Sweden)

    Khurshidakhon Rasulova

    2011-03-01

    Full Text Available Between 2004 and 2008, we studied reasons and risk factors of ischemic stroke in 150 young patients (aged between 17-44 years, compared with those in elderly patients (n=70. According to our data, heredity, arterial hypertension, cerebral vasculitis, thyroid diseases, chronic alcoholism, smoking and long-term use of oral contraceptives are main risk factors of ischemic stroke in the young in Uzbekistan. However, relative risk of stroke in this group of patients is less than in elder patients. In 16% cases, usage of standard diagnostic measures does not lead to identification of the disease cause.

  17. Sex Differences in Stroke Subtypes, Severity, Risk Factors, and Outcomes Among Elderly Patients with Acute Ischemic Stroke

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    Changshen eYu

    2015-09-01

    Full Text Available Background: Although the age-specific incidence and mortality of stroke is higher among men, stroke has a greater clinical effect on women. However, the sex differences in stroke among elderly patients are unknown. Therefore, we aimed to assess the sex differences in stroke among elderly stroke patients.Methods: Between 2005 and 2013, we recruited 1,484 consecutive acute ischemic stroke patients (≥75 years old from a specialized neurology hospital in Tianjin, China. Information regarding their stroke subtypes, severity, risk factors, and outcomes at 3 and 12 months after stroke were recorded.Results: Comparing with men, women had a significantly higher prevalence of severe stroke (17.20% vs. 12.54%, hypertension (76.42% vs. 66.39%, dyslipidemias (30.35% vs. 22.76%, and obesity (18.40% vs. 9.32%, P < 0.05. Comparing with women, men had a significantly higher prevalence of intracranial artery stenosis (23.11% vs. 17.45%, current smoking (29.60% vs. 13.05%, and alcohol consumption (12.15% vs. 0.47%, P < 0.05. Moreover, dependency was more common among women at 3 and 12 months after stroke, although the sex difference disappeared after adjusting for stroke subtypes, severity, and risk factors. Conclusions: Elderly women with acute ischemic stroke had more severe stroke status and worse outcomes at 3 and 12 months after stroke. Thus, elderly female post-acute ischemic stroke patients are a crucial population that should be assisted with controlling their risk factors for stroke and changing their lifestyle.

  18. Nonfasting triglycerides, cholesterol, and ischemic stroke in the general population

    DEFF Research Database (Denmark)

    Varbo, Anette; Nordestgaard, Børge G; Tybjaerg-Hansen, Anne

    2011-01-01

    Current guidelines on stroke prevention have recommendations on desirable cholesterol levels, but not on nonfasting triglycerides. We compared stepwise increasing levels of nonfasting triglycerides and cholesterol for their association with risk of ischemic stroke in the general population....

  19. Ischemic Stroke:Therapy of Risk and Benefit

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2005-01-01

    @@ Therapeutic thrombolysis is an immense opportunity in acute stroke care. For the first time, there is a treatment that has a high probability of being effective if given early enough to patients with acute ischemic stroke.

  20. The relation between oxidative stress parameters, ischemic stroke,and hemorrhagic stroke

    OpenAIRE

    İçme, Ferhat; Erel, Özcan; AVCİ, AKKAN; SATAR, SALİM; Gülen, Müge; Acehan, Selen

    2015-01-01

    Background/aim: The aims of this study were to investigate the significance of oxidative stress parameters in the pathogenesis of ischemic stroke and hemorrhagic stroke and to investigate their effects on stroke severity using the National Institutes of Health Stroke Scale (NIHSS). Materials and methods: A total of 92 patients, including 74 with ischemic stroke and 18 with hemorrhagic stroke, and 75 volunteers were enrolled in the study. Total oxidant status (TOS), total antioxidant status (...

  1. 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.

  2. Etiologic Subtypes, Risk Factors, and Outcomes of Acute Ischemic Stroke in Young Patients

    Directory of Open Access Journals (Sweden)

    İnci Şule Özer

    2015-04-01

    Full Text Available Objective: Stroke in people aged less than 45 years is less frequent than in older patients, but has major impacts on both the individual and society. The aim of this study was to determine the etiologic subtypes of acute ischemic stroke in the young. Materials and Methods: We reviewed the hospital records of 619 patients who were admitted with acute ischemic stroke between January 2011 and November 2014. Acute ischemic stroke in the young was defined as patients aged 45 years and under. Demographic data, the National Institutes of Health Stroke Scale (NIHSS scores at admission and detailed investigations aimed at determining etiologic cause were recorded. Etiologic stroke subtypes were determined using the automated Causative Classification System. Modified Rankin Scale (mRS scores were recorded in the follow-up. Results: There were 32 (5.2% young patients with acute ischemic stroke. The rates of hypertension, diabetes mellitus, atrial fibrillation, and coronary artery disease were significantly lower in young patients compared with patients aged more than 45 years (p<0.05. The mean NIHSS score at admission and hospital mortality was significantly lower in patients aged 45 years and under compared with those older than 45 years (p=0.006, p=0.043. Cardioaortic embolism was the most common etiologic stroke subtype in both groups. Other causes were significantly more frequent in the young acute ischemic stroke group compared with the older patients. The median follow-up mRS was significantly lower in patients aged 45 years and under compared with those older than 45 years (p<0.001. Conclusion: Young patients with ischemic stroke have different risk factors, stroke etiology, stroke severity and prognosis compared with patients older than 45 years with the same condition

  3. Imaging‐based patient selection for intra‐arterial stroke therapy

    NARCIS (Netherlands)

    Yoo, A.J.

    2016-01-01

    Acute ischemic strokes arising from blockages of the major brain-supplying arteries put patients at risk for extensive brain injury. Left untreated, these major strokes produce significant disability and death. Fortunately, recent advances in stroke devices have improved clinical outcomes in such pa

  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. Human Data Supporting Glyburide in Ischemic Stroke

    Science.gov (United States)

    Sheth, Kevin N.; Simard, J. Marc; Elm, Jordan; Kronenberg, Golo; Kunte, Hagen; Kimberly, W. Taylor

    2016-01-01

    The SUR1-TRPM4 channel is a critical determinant of edema and hemorrhagic transformation after focal ischemia. Blockade of this channel by the small molecule glyburide results in improved survival and neurological outcome in multiple preclinical models of ischemic stroke. A robust, compelling body of evidence suggests that an intravenous (IV) formulation of glyburide, RP-1127, can prevent swelling and improve outcome in patients with stroke. Retrospective studies of diabetic stroke patients show improved outcomes in patients who are continued on sulfonylureas after stroke onset. Early phase II study of MRI and plasma biomarkers support the conclusion that RP-1127 may decrease swelling and hemorrhagic transformation. Finally, the ongoing phase II RP-1127 development program has demonstrated continued safety as well as feasibility of enrollment and tolerability of the intervention. Continued efforts to complete the ongoing phase IIb study and definitive efficacy studies are urgently needed to bring a candidate pharmacotherapy to a population of severe stroke patients that currently have no alternative. PMID:26463916

  6. 缺血性卒中患者踝臂指数与颅内动脉狭窄数量的关系%Relationship between Ankle Brachial Index and Number of Intracerebral Artery Stenosis in Patients with Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    李轶; 孙海欣; 董可辉; 王拥军

    2011-01-01

    目的 探讨缺血性脑卒中患者踝臂指数(ABI)与颅内动脉狭窄支数的相关性.方法 测量314例行脑血管造影的缺血性卒中患者的ABI值,并收集其相关临床资料.结果 ABI异常、年龄与缺血性卒中患者颅内动脉狭窄数量有关.ABI值与患者具备的危险因素(高血压、糖尿病、冠心病及缺血性卒中史)数量之间存在负相关性,两者之间存在线性趋势(x2=36.35,P<0.001).ABI值与狭窄血管数量之间存在负相关性,两者之间存在线性趋势.结论 缺血性脑卒中患者ABI值与颅内动脉狭窄数量具有相关性.%Objective To investigate the relationship of ankle brachial index and the number of intracranial artery stenosis. Methods Ankle brachial index were measured in 314 patients with ischemic cerebrovascular disease received cerebral angiograpathy. Their data including general information and medical history were collected. Results Abnormality of ankle brachial index and age were associated with the number of intracranial artery stenosis in patients with ischemic stroke. Ankle brachial index was negative correlation with the number of risk factors( hyperten-tion/diabetes/coronary heart disease/ischemic stroke history) (r, = -0. 292,P <0. 001). Linear trend analysis showed linear trend between them(x2 =36. 35 ,P<0.001). Ankle brachial index was negative correlation with the number of intracranial artery stenosis(r, = -0. 161 ,P = 0.004). Trend analysis showed linear trend between them(x2 = 6. 53,P = 0. 01). Conclusion Ankle brachial index was associated with the number of intracerebral artery stenosis.

  7. White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction

    DEFF Research Database (Denmark)

    Andersen, Søren Due; Larsen, Torben Bjerregaard; Gorst-Rasmussen, Anders;

    2017-01-01

    -based, observational cohort study, we included 832 patients (mean age 59.6 (SD 13.9); 42.0% females) with incident ischemic stroke and no AF. We assessed the severity of white matter hyperintensities using MRI. Hazard ratios stratified by the white matter hyperintensities score and adjusted for the components......BACKGROUND: Nearly one in 5 patients with ischemic stroke will invariably experience a second stroke within 5 years. Stroke risk stratification schemes based solely on clinical variables perform only modestly in non-atrial fibrillation (AF) patients and improvement of these schemes will enhance...... their clinical utility. Cerebral white matter hyperintensities are associated with an increased risk of incident ischemic stroke in the general population, whereas their association with the risk of ischemic stroke recurrence is more ambiguous. In a non-AF stroke cohort, we investigated the association between...

  8. Multiple Vascular Accidents Including Rupture of a Sinus of Valsalva Aneurysm, a Minor Ischemic Stroke and Intracranial Arterial Anomaly in a Patient with Systemic Congenital Abnormalities: A Case Report

    Directory of Open Access Journals (Sweden)

    Masataka Nakajima

    2013-11-01

    Full Text Available A 39-year-old man with a history of rupture of a sinus of Valsalva aneurysm experienced an ischemic stroke. Although the patient presented left-sided hemiparesis for a week, no abnormal signals were indicated on diffusion-weighted imaging with repeated magnetic resonance scans. Carotid ultrasound and cerebral angiography were conducted, and they revealed hypoplasty of the left internal carotid artery with a low-lying carotid bifurcation at the level of the C6 vertebra. In addition, he was diagnosed with intellectual disabilities, evaluated by the Wechsler Adult Intelligence Scale-III, and congenital velopharyngeal insufficiency. We herein present the first report of a patient with cardio-cerebrovascular abnormalities, intellectual disabilities, and an otorhinolaryngological abnormality.

  9. 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.

  10. Multiple Silent Lacunes Are Associated with Recurrent Ischemic Stroke

    DEFF Research Database (Denmark)

    Andersen, Søren Due; Skjøth, Flemming; Yavarian, Yousef

    2016-01-01

    .16 (0.61-2.22) and 1.51 (0.86-2.66) for cardiovascular events. Conclusions: In this large cohort of patients with incident ischemic stroke and no AF, an increasing number of silent lacunes was associated with increasing incidence rates of ischemic stroke recurrence. In the adjusted Cox proportional...

  11. 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.

  12. Association of the Single Nucleotide Polymorphisms in microRNAs 130b, 200b, and 495 with Ischemic Stroke Susceptibility and Post-Stroke Mortality

    Science.gov (United States)

    Choi, Gun Ho; Ko, Ki Han; Kim, Jung Oh; Oh, Seung Hun; Park, Young Seok

    2016-01-01

    The microRNA (miRNA) is a small non-coding RNA molecule that modulates gene expression at the posttranscriptional level. Platelets have a crucial role in both hemostasis and thrombosis, a condition that can occlude a cerebral artery and cause ischemic stroke. miR-130b, miR-200b, and miR-495 are potential genetic modulators involving platelet production and activation. We hypothesized that single nucleotide polymorphisms (SNPs) in these miRNAs might potentially contribute to the susceptibility to ischemic stroke and post-stroke mortality. This study included 523 ischemic stroke patients and 400 control subjects. We investigated the association of three miRNA SNPs (miR-130bT>C, miR-200bT>C, and miR-495A>C) with ischemic stroke prevalence and post-stroke mortality. In the multivariate logistic regression, there was no statistically significant difference in the distribution of miR-130bT>C, miR-200bT>C, or miR-495A>C between the ischemic stroke and control groups. In the subgroup analysis based on ischemic stroke subtype, the miR-200b CC genotype was less frequently found in the large-artery atherosclerosis stroke subtype compared with controls (TT+CT vs CC; adjusted odds ratio for CC, 0.506; 95% confidence interval, 0.265–0.965). During a mean follow-up period of 4.80 ± 2.11 years after stroke onset, there were 106 all-cause deaths among the 523 stroke patients. Multivariate Cox regression analysis did not find a significant association between post-stroke mortality and three miRNA SNPs. Our findings suggest that the functional SNP of miR-200b might be responsible for the susceptibility to large-artery atherosclerotic stroke. PMID:27603512

  13. Detection of atrial fibrillation with concurrent holter monitoring and continuous cardiac telemetry following ischemic stroke and transient ischemic attack.

    Science.gov (United States)

    Lazzaro, Marc A; Krishnan, Kousik; Prabhakaran, Shyam

    2012-02-01

    Atrial fibrillation (AF) is a major risk factor for recurrent ischemic stroke. We aimed to compare the detection rate of AF using continuous cardiac telemetry (CCT) versus Holter monitoring in hospitalized patients with ischemic stroke or transient ischemic attack (TIA). Between June 2007 and December 2008, 133 patients were admitted to an academic institution for ischemic stroke or TIA and underwent concurrent inpatient CCT and Holter monitoring. Rates of AF detection by CCT and Holter monitoring were compared using the McNemar paired proportion test. Among the 133 patients, 8 (6.0%) were diagnosed with new-onset AF. On average, Holter monitoring was performed for 29.8 hours, and CCT was performed for 73.6 hours. The overall rate of AF detection was higher for Holter monitoring compared with CCT (6.0%; 95% confidence interval [CI], 2.9-11.6 vs 0; 95% CI, 0-3.4; P = .008). Holter detection of AF was even higher in specific subgroups (those with an embolic infarct pattern, those age >65 years, and those with coronary artery disease). Holter monitoring detected AF in 6% of hospitalized ischemic stroke and TIA patients, with higher proportions in high-risk subgroups. Compared with CCT, Holter monitoring is significantly more likely to detect arrhythmias.

  14. Myocardial infarction following recombinant tissue plasminogen activator treatment for acute ischemic stroke: a dangerous complication

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhi-gang; WANG Rui-lan; YU Kang-long

    2012-01-01

    Thrombolysis with intravenous tissue plasminogen activator (t-PA) is currently an approved therapy for patients with acute ischemic stroke.Acute myocardial infarction (AMI) immediately following t-PA treatment for stroke is a rare but serious complication.A case of acute myocardial infarction (MI) following IV t-PA infusion for acute stroke was observed.This is a 52-year-old male with a known history of hypertension and chest pain,who subsequently developed MI four hours after IV t-PA was administered for acute ischemic stroke.The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism.In addition.spontaneous recanalization of infarct-related arteries may be associated with 9reater myocardial salvage and better prognosis.

  15. [Eprosartan mesylate in controlling of blood pressure in patients with ischemic stroke].

    Science.gov (United States)

    Martynov, M Iu; Boĭko, A N; Petukhov, E B; Berezov, V P; Maskarov, A N; Gusev, E I

    2002-01-01

    In 20 patients with ischemic stroke and moderate or severe arterial hypertension the effectiveness of eprosartan mesilat (Teveten, Solway Farma, Germany) for a period of 6 months was studied. Patients received 600 mg of eprosartan mesilat daily and in 4 cases hydrochlortyaside was also added. Monotherapy with eprosartan mesilat was effective in all patients with moderate arterial hypertension and in 43.6% in patients with severe arterial hypertension. Therapy with eprosartan mesilat was associated with significant hypotensive effect (more evident in patients with high systolic blood pressure), improvement in 24-hour blood pressure profile and quality of life, and lower probability of secondary stroke. Side effects were not observed.

  16. 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.

  17. 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.

  18. PTEN degradation after ischemic stroke: a double-edged sword.

    Science.gov (United States)

    Li, W; Huang, R; Chen, Z; Yan, L-J; Simpkins, J W; Yang, S-H

    2014-08-22

    Tumor suppressor phosphatase and tensin homolog (PTEN) is highly expressed in neurons and PTEN inhibition has been reported to be neuroprotective against ischemic stroke in experimental models. On the other hand, PTEN deletion has been shown to lead to cognitive impairment. In the current study, we examined the expression and functions of PTEN in an ischemic stroke rodent model. We found rapid S-nitrosylation and degradation of PTEN after cerebral ischemia/reperfusion injury. PTEN degradation leads to activation of Akt. PTEN partial deletion or PTEN inhibition increased the expression of GABAA receptor (GABAAR) γ2 subunit and enhanced GABAA receptor current. After cerebral ischemia, increased expression of GABAAR γ2 subunit was observed in the ischemia region and the penumbra area. We also observed PTEN loss in astrocytes after cerebral ischemia. Astrocytic PTEN partial knockout increased astrocyte activation and exacerbated ischemic damage. We speculated that ischemic stroke induced neuronal PTEN degradation, hence enhanced GABAA receptor-medicated neuronal activity inhibition which could attenuate excitotoxicity and provide neuroprotection during the acute phase after stroke, while inhibiting long-term functional recovery and contributing to vascular cognitive impairment after stroke. On the other hand, ischemic stroke induced astrocytic PTEN loss and enhanced ischemic damage and astrogliosis. Taken together, our study indicates that ischemic stroke induces rapid PTEN degradation in both neurons and astrocytes which play both protective and detrimental action in a spatiotemporal- and cell-type-dependent manner. Our study provides critical insight for targeting PTEN signaling pathway for stroke treatment.

  19. Occurrence and predictors of persistent impaired glucose tolerance after acute ischemic stroke or transient ischemic attack

    NARCIS (Netherlands)

    S. Fonville (Susanne); H.M. den Hertog (Heleen); A.A.M. Zandbergen (Adrienne); P.J. Koudstaal (Peter Jan); H.F. Lingsma (Hester)

    2014-01-01

    textabstractBackground Impaired glucose tolerance is often present in patients with a transient ischemic attack (TIA) or ischemic stroke and doubles the risk of recurrent stroke. This impaired glucose tolerance can be transient, reflecting an acute stress response, or persistent, representing undiag

  20. Hemorrhagic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when ... an artery wall that breaks open. Symptoms of stroke are Sudden numbness or weakness of the face, ...

  1. Low dose aspirin after ischemic stroke associated with antiphospholipid syndrome

    NARCIS (Netherlands)

    Derksen, RHWM; de Groot, PG; Kappelle, LJ

    2003-01-01

    The authors describe course and outcome of eight patients with ischemic stroke as the first thrombotic manifestation of antiphospholipid syndrome who received low-dose aspirin as prophylactic treatment. During 8.9 years of follow-up, two patients had a recurrent stroke. Recurrent stroke rate per 100

  2. Therapy Effects of Bone Marrow Stromal Cells on Ischemic Stroke

    OpenAIRE

    Xinchun Ye; Jinxia Hu; Guiyun Cui

    2016-01-01

    Stroke is the second most common cause of death and major cause of disability worldwide. Recently, bone marrow stromal cells (BMSCs) have been shown to improve functional outcome after stroke. In this review, we will focus on the protective effects of BMSCs on ischemic brain and the relative molecular mechanisms underlying the protective effects of BMSCs on stroke.

  3. Pre-ischemic treadmill training alleviates brain damage via GLT-1-mediated signal pathway after ischemic stroke in rats.

    Science.gov (United States)

    Wang, X; Zhang, M; Yang, S-D; Li, W-B; Ren, S-Q; Zhang, J; Zhang, F

    2014-08-22

    Physical exercise could play a neuroprotective role in both human and animals. However, the involved signal pathways underlying the neuroprotective effect are still not well established. This study was to investigate the possible signal pathways involved in the neuroprotection of pre-ischemic treadmill training after ischemic stroke. Seventy-two SD rats were randomly assigned into three groups (n=24/group): sham surgery group, middle cerebral artery occlusion (MCAO) group and MCAO with exercise group. Following three weeks of treadmill training exercise, ischemic stroke was induced by occluding the middle cerebral artery (MCA) in rat for 2 h, followed by reperfusion. Twenty-four hours after MCAO/reperfusion, 12 rats in each group were evaluated for neurological deficit scores and then sacrificed to measure the infarct volume (n=6) and cerebral edema (n=6). Six rats in each group were sacrificed to measure the expression level of glutamate transporter-1 (GLT-1), protein kinase C-α (PKC-α), Akt, and phosphatidylinositol 3 kinase (PI3K) (n=6). Two hundred and eighty minutes (4.67 h) after occlusion, six rats in each group were decapitated to detect the mRNA expression level of metabotropic glutamate receptor 5 (mGluR5) and N-methyl-D-aspartate receptor subunit type 2B (NR2B) (n=6).The results demonstrated that pre-ischemic treadmill training exercise reduced brain infarct volume, cerebral edema and neurological deficits, also decreased the over expression of PKC-α and increased the expression level of GLT-1, Akt and PI3K after ischemic stroke (pdamage after ischemic stroke, which might be involved in two signal pathways: PKC-α-GLT-1-Glutamate and PI3K/Akt-GLT-1-Glutamate.

  4. Mild sensory stimulation completely protects the adult rodent cortex from ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Christopher C Lay

    Full Text Available Despite progress in reducing ischemic stroke damage, complete protection remains elusive. Here we demonstrate that, after permanent occlusion of a major cortical artery (middle cerebral artery; MCA, single whisker stimulation can induce complete protection of the adult rat cortex, but only if administered within a critical time window. Animals that receive early treatment are histologically and behaviorally equivalent to healthy controls and have normal neuronal function. Protection of the cortex clearly requires reperfusion to the ischemic area despite permanent occlusion. Using blood flow imaging and other techniques we found evidence of reversed blood flow into MCA branches from an alternate arterial source via collateral vessels (inter-arterial connections, a potential mechanism for reperfusion. These findings suggest that the cortex is capable of extensive blood flow reorganization and more importantly that mild sensory stimulation can provide complete protection from impending stroke given early intervention. Such non-invasive, non-pharmacological intervention has clear translational potential.

  5. Genetics of Atrial Fibrillation and Possible Implications for Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Robin Lemmens

    2011-01-01

    Full Text Available Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart failure and ischemic stroke. Since atrial fibrillation can result in ischemic stroke, one might assume that genetic determinants of this cardiac arrhythmia are also implicated in cerebrovascular disease. Ischemic stroke is a multifactorial, complex disease where multiple environmental and genetic factors interact. Whether genetic variants associated with a risk factor for ischemic stroke also increase the risk of a particular vascular endpoint still needs to be confirmed in many cases. Here we review the current knowledge on the genetic background of atrial fibrillation and the consequences for cerebrovascular disease.

  6. Demethylation of Circulating Estrogen Receptor Alpha Gene in Cerebral Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Hsiu-Fen Lin

    Full Text Available Estrogen is involved in neuron plasticity and can promote neuronal survival in stroke. Its actions are mostly exerted via estrogen receptor alpha (ERα. Previous animal studies have shown that ERα is upregulated by DNA demethylation following ischemic injury. This study investigated the methylation levels in the ERα promoter in the peripheral blood of ischemic stroke patients.The study included 201 ischemic stroke patients, and 217 age- and sex-comparable healthy controls. The quantitative methylation level in the 14 CpG sites of the ERα promoter was measured by pyrosequencing in each participant. Multivariate regression model was used to adjust for stroke traditional risk factors. Stroke subtypes and sex-specific analysis were also conducted.The results demonstrated that the stroke cases had a lower ERα methylation level than controls in all 14 CpG sites, and site 13 and site 14 had significant adjusted p-values of 0.035 and 0.026, respectively. Stroke subtypes analysis showed that large-artery atherosclerosis and cardio-embolic subtypes had significantly lower methylation levels than the healthy controls at CpG site 5, site 9, site 12, site 13 and site 14 with adjusted p = 0.039, 0.009, 0.025, 0.046 and 0.027 respectively. However, the methylation level for the patients with small vessel subtype was not significant. We combined the methylation data from the above five sites for further sex-specific analysis. The results showed that the significant association only existed in women (adjusted p = 0.011, but not in men (adjusted p = 0.300.Female stroke cases have lower ERα methylation levels than those in the controls, especially in large-artery and cardio-embolic stroke subtypes. The study implies that women suffering from ischemic stroke of specific subtype may undergo different protective mechanisms to reduce the brain injury.

  7. Quantitative Measurement of Physical Activity in Acute Ischemic Stroke and Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Strømmen, Anna Maria; Christensen, Thomas; Jensen, Kai

    2014-01-01

    BACKGROUND AND PURPOSE: The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers. METHODS: A total of 100 patients with acute is...... ischemic stroke. The method offers a low cost and noninvasive tool for future clinical interventional physiotherapeutic and early mobilization studies. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01560520....

  8. First-In-Man Procedural Experience with the Novel EmboTrap® Revascularization Device for the Treatment of Ischemic Stroke-A European Multicenter Series

    DEFF Research Database (Denmark)

    Kabbasch, C; Mpotsaris, A; Liebig, T;

    2016-01-01

    PURPOSE: We describe safety and efficacy aspects of mechanical thrombectomy with the novel stent-type clot retrieval device EmboTrap for revascularization of large-artery occlusions in acute ischemic stroke. MATERIALS AND METHODS: A total of 40 patients with acute ischemic stroke due to large-art...

  9. Association of reduced folate carrier-1 (RFC-1) polymorphisms with ischemic stroke and silent brain infarction.

    Science.gov (United States)

    Cho, Yunkyung; Kim, Jung O; Lee, Jeong Han; Park, Hye Mi; Jeon, Young Joo; Oh, Seung Hun; Bae, Jinkun; Park, Young Seok; Kim, Ok Joon; Kim, Nam Keun

    2015-01-01

    Stroke is the second leading cause of death in the world and in South Korea. Ischemic stroke and silent brain infarction (SBI) are complex, multifactorial diseases influenced by multiple genetic and environmental factors. Moderately elevated plasma homocysteine levels are a major risk factor for vascular diseases, including stroke and SBI. Folate and vitamin B12 are important regulators of homocysteine metabolism. Reduced folate carrier (RFC), a bidirectional anion exchanger, mediates folate delivery to a variety of cells. We selected three known RFC-1 polymorphisms (-43C>T, 80A>G, 696T>C) and investigated their relationship to cerebral infarction in the Korean population. We used the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to analyze associations between the three RFC-1 polymorphisms, disease status, and folate and homocysteine levels in 584 ischemic stroke patients, 353 SBI patients, and 505 control subjects. The frequencies of the RFC-1 -43TT, 80GG, and 696CC genotypes differed significantly between the stroke and control groups. The RFC-1 80A>G substitution was also associated with small artery occlusion and SBI. In a gene-environment analysis, the RFC-1 -43C>T, 80A>G, and 696T>C polymorphisms in the ischemic stroke group had combined effects with all environmental factors. In summary, we found that the RFC-1 -43C>T, 80A>G, and 696T>C polymorphisms may be risk factors for ischemic stroke.

  10. Correlation study on cystatin C and ischemic stroke

    Directory of Open Access Journals (Sweden)

    CHEN Rong-bo

    2013-06-01

    Full Text Available Objective To investigate the relationship between serum cystatin C (Cys C and patients with acute ischemic stroke. Methods The clinical and laboratory data of 115 patients with acute ischemic stroke and 110 controls were recorded and analyzed. Results The serum Cys C levels of patients in ischemic stroke group [(1.15 ± 0.34 mg/L] were higher than that of the control group [(0.99 ± 0.25 mg/L]. The difference between two groups was significant after correction of age and cardiovascular risk factors (t = ? 3.889, P = 0.000. It was found that age, Cys C, homocysteine (Hcy, type 2 diabetes mellitus [hemoglobin A1c (HbA1c, fructosamine (FRU], smoking, alcohol consumption, hypertension and intima-media thickness (IMT were risk factors for ischemic stroke on univariate Logistic regression analysis. The difference of serum Cys C level between the patients and controls was significant (P = 0.000, but through covariance analysis, after adjusted other risk factors, it was not significant (P = 0.875. Conclusion The serum Cys C levels of patients in ischemic stroke group is higher than the control group. It can be used as an indicator in the acute phase of ischemic stroke. The elevation of serum Cys C is a risk factor for ischemic stroke, but not an independent risk factor.

  11. 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.

  12. [Preditive clinical factors for epileptic seizures after ischemic stroke].

    Science.gov (United States)

    Fukujima, M M; Cardeal, J O; Lima, J G

    1996-06-01

    Preditive clinical factors for epileptic seizures after ischemic stroke. Clinical features of 35 patients with ischemic stroke who developed epilepsy (Group 1) were compared with those of 35 patients with ischemic stroke without epilepsy (Group 2). The age of the patients did not differ between the groups. There were more men than women and more white than other races in both groups. Diabetes melitus, hypertension, transient ischemic attack, previous stroke, migraine, Chagas disease, cerebral embolism of cardiac origin and use of oral contraceptive did not differ between the groups. Smokers and alcohol users were more frequent in Group 1 (p < 0.05). Most patients of Group 1 presented with hemiparesis; none presented cerebellar or brainstem involvement. Perhaps strokes in smokers have some different aspects, that let them more epileptogenic than in non smokers.

  13. Acute Ischemic Stroke and Long-Term Outcome After Thrombolysis

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Z; Hundborg, Heidi;

    2014-01-01

    , in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used...... to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long...

  14. Citicoline for ischemic stroke: ICTUS trial

    Directory of Open Access Journals (Sweden)

    Vladimir Anatolyevich Parfenov

    2012-01-01

    Full Text Available The paper gives data available in the literature on the use of citicoline in an experimental model of ischemic stroke (IS and in randomized multicenter placebo-controlled trials. It analyzes the results of the ICTUS trial in which 2298 patients with IS who received randomly citicoline or placebo for 24 hours after the onset of symptoms (I000 mg intravenously every I2 hours during the first 3 days, then orally as one 500-mg tablet every 12 hours during 6 weeks. The results of the trial confirmed the safety of citicoline used in IS, but failed to show its significant advantage over placebo in reducing the degree of disability (global improvement 90 days later. However, to pool the results of the ICTUS trial with those of other randomized multicenter placebo-controlled studies demonstrates a significant decrease in the degree of disability in IS patients treated with citicoline.

  15. Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Nitta, Junpei; Ishizaka, Shigetoshi; Kanaya, Kohei; Yanagawa, Takao; Hongo, Kazuhiro

    2013-10-01

    Previous studies have shown that extracranial-intracranial (EC-IC) bypass surgery has no preventive effect on subsequent ipsilateral ischemic stroke in patients with symptomatic atherosclerotic internal carotid occlusion and hemodynamic cerebral ischemia. A few studies have assessed whether an urgent EC-IC bypass surgery is an effective treatment for main trunk stenosis or occlusion in acute stage. The authors retrospectively reviewed 58 consecutive patients who underwent urgent EC-IC bypass for symptomatic internal carotid artery or the middle cerebral artery stenosis or occlusion between January 2003 and December 2011. Clinical characteristics and neuroimagings were evaluated and analyzed. Based on preoperative angiogram, responsible lesions were the internal carotid artery in 19 (32.8%) patients and the middle cerebral artery in 39 (67.2%). No hemorrhagic complication occurred. Sixty-nine percent of patients showed improvement of neurological function after surgery, and 74.1% of patients had favorable outcome. Unfavorable outcome was associated with insufficient collateral flow and new infarction after bypass surgery.

  16. Cervical artery dissection: early recognition and stroke prevention.

    Science.gov (United States)

    Cadena, Rhonda

    2016-07-01

    Cervical artery dissections involve the carotid or vertebral arteries. Although the overall incidence is low, they remain a common cause of stroke in children, young adults, and trauma patients. Symptoms such as headache, neck pain, and dizziness are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient. A missed diagnosis of cervical artery dissection can result in devastating neurological sequelae, so emergency clinicians must act quickly to recognize this event and begin treatment as soon as possible while neurological consultation is obtained. This issue reviews the evidence in applying advanced screening criteria and choosing imaging and antithrombotic treatment strategies for patients with cervical artery dissections to reduce the occurrence of ischemic stroke.

  17. 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.)

  18. 急性缺血性卒中动脉溶栓后造影剂渗出的临床分析%Clinical analysis on contrast extravasation after intra-arterial thrombolysis for acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    付睿; 贺茂林; 赵星辉; 黄栋; 席春江; 张彤; 戴威

    2013-01-01

    Objective To evaluate the risk factors and the prognosis for contrast extravasation after intraarterial(IA)thrombolysis for acute ischemic stroke.Methods A prospective and open-label trial was performed on 78 patients at the department of neurology in Beijing Shijitan Hospital from April 2008 to June 2012.Patients with acute ischemic stroke in the carotid artery system within 6 hours of symptom onset were treated with recombinant tissue plasminogen activator(rtPA) or urokinase (UK)by intra-artery thrombolysis approach.Arterial recanalization was assessed by the thrombolysis in cerebral infarction (TICI) classification.The functional outcome in 3-month was measured by mRS score.Contrast extravasation were observed by the baseline CT and postprocedure CTs.Results According to the results of digital subtraction angiography(DSA),30 patients had the internal carotid artery (ICA) occlusion and 48 patients had the middle cerebral artery(MCA) occlusion.The rote of recanalization after IA thrombolysis was 78.2% (61/78),the rate of contrast extravasation was 20.5% (16/78).Contrast extravasation were noted on immediate CT scans after intra-arterial thrombolysis in 4 patients with the ICA occlusion and 12 patients with the MCA occlusion.Patients with contrast extravasation had a partial or complete vascular recanalization.Favorable prognosis outcome,defined as a modified Rankin Score of 0-2 at 90 days,were significantly higher in patients without contrast extravasation than in patients with contrast extravasation(74.2% vs.43.8%) (P =0.020).The rate of symptomatic intracerebral hemorrhage (SICH)were significantly higher in patients with contrast extravasation than in patients without contrast extravasation(25% vs.3.2%)(P =0.017).Baseline NIHSS score >16 points (< 22 points),systolic pressure was more than 160 mm Hg during intra-arterial thrombolysis,vascular recanalization after intra-arterial thrombolysis,mechanical thrombus disruption by microcatheter and

  19. Correlation of clopidogrel resistance and carotid artery stenosis in ischemic stroke patients%缺血性脑卒中患者氯吡格雷抵抗与颈动脉狭窄的相关性分析

    Institute of Scientific and Technical Information of China (English)

    薛森新; 周伯荣; 宋成宪; 邓燕华

    2016-01-01

    目的:探讨缺血性脑卒中患者氯吡格雷抵抗与颈动脉狭窄的相关性。方法比浊法测定缺血性脑卒中患者服用氯吡格雷(75 mg/d)前及服用2周后血小板聚集率变化。根据血小板聚集率变化将病例分为氯吡格雷抵抗(clopidogrel re‐sistance ,CR)组和氯吡格雷敏感(clopidogel sensitivity ,CS)组。比较CR组和CS组相关的临床数据,并使用多变量Logistic回归分析确定CR的独立危险因素。结果228例缺血性脑卒中患者,其中CR组54例(23.68%),CS组174例(76.32%)。单因素分析结果显示:年龄(P=0.015)、血小板数量(P=0.012)、中度颈动脉狭窄(P=0.034)、性别(P=0.049)和糖尿病(P=0.032)在CR组和CS组中均存在显著差异。多因素Logistic分析结果显示,年龄(P=0.004)、血小板数量(P=0.025)、糖尿病(P=0.026)、中度颈动脉狭窄(P=0.002)是CR发生的独立危险因素。结论缺血性脑卒中患者CR与多种因素相关,其中中度颈动脉狭窄是CR的独立危险因素之一。%Objective To investigate the correlation between clopidogrel resistance (CR) and carotid artery stenosis in patients with ischemic stroke .Methods Turbidimetry was used to measure the changes of platelet aggregation rate after the included patients with ischemic stroke taking 75 mg of clopidogrel per day for two weeks .The patients were divided into either CR or clopidogrel sensitivity (CS) group according to the changes of platelet aggregation rate .The demographic and clinical da‐ta of both groups were compared .Multivariate logistic regression analysis was used to identify the independent risk factors for CR .Results A total of 228 patients with ischemic stroke were included ,among whom 54 cases (23.68% ) were in the CR group and 174(76.32% ) were in the CS group .Single factor analysis showed that there were statistical differences between the two groups in

  20. Angiographic findings of ischemic stroke in children.

    Science.gov (United States)

    Shirane, R; Sato, S; Yoshimoto, T

    1992-12-01

    A cooperative study was undertaken in the Tohoku district of Japan to investigate the relatively rare phenomenon of cerebral infarction in children. The purpose of the present paper is to describe the cerebral angiographic findings in 48 children whose ischemic lesions were confirmed by CT scan. The majority of lesions were considered to be idiopathic. The areas of cerebral infarction appearing in the CT scans were located in the territory of the middle cerebral artery including the basal ganglia. Angiographical abnormalities were observed in 40 patients (83%). The majority occurred in the supraclinoid portion of the internal carotid artery and in the cisternal portion of the middle and anterior cerebral arteries. Multiple lesions, such as in the C1, A1, and M1 or the C1, M1, and M2 segments were observed in 22 cases. These lesions generally appeared in continuation; no bilateral intracranial lesions were observed. Repeated angiography was performed in 22 cases, and in 55% of these some recovery of the lesions was seen.

  1. 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

  2. Hyperpolarized 129Xe magnetic resonance imaging of a rat model of transient Ischemic Stroke

    Science.gov (United States)

    Walvick, Ronn P.; Bastan, Birgul; Reno, Austin; Mansour, Joey; Sun, Yanping; Zhou, Xin; Mazzani, Mary; Fisher, Marc; Sotak, Christopher H.; Albert, Mitchell S.

    2009-02-01

    Ischemic stroke accounts for nearly 80% of all stroke cases. Although proton diffusion and perfusion magnetic resonance imaging (MRI) are the gold standards in ischemic stroke diagnostics, the use of hyperpolarized 129Xe MRI has a potential role to contribute to the diagnostic picture. The highly lipophilic hyperpolarized 129Xe can be non-invasively delivered via inhalation into the lungs where it is dissolved into the blood and delivered to other organs such as the brain. As such, we expect hyperpolarized 129Xe to act as a perfusion tracer which will result in a signal deficit in areas of blood deprived tissue. In this work, we present imaging results from an animal model of transient ischemic stroke characterized through 129Xe MRI. In this model, a suture is used to occlude the middle cerebral artery (MCA) in the rat brain, thus causing an ischemic event. After a period of MCA occlusion, the suture can then be removed to reperfuse the ischemic area. During the ischemic phase of the stroke, a signal void was observed in the MCA territory; which was subsequently restored by normal 129Xe MRI signal once perfusion was reinstated. Further, a higher resolution one-dimensional chemical shift image shows a sharp signal drop in the area of ischemia. Validation of ischemic damage was shown through both proton diffusion-weighted MRI (DWI) and by 2,3,5-triphenyltetrazoliumchloride (TTC) staining. The results show the potential of 129Xe to act as a perfusion tracer; information that may add to the diagnostic and prognostic utility of the clinical picture of stroke.

  3. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Kernan, Walter N; Ovbiagele, Bruce; Black, Henry R; Bravata, Dawn M; Chimowitz, Marc I; Ezekowitz, Michael D; Fang, Margaret C; Fisher, Marc; Furie, Karen L; Heck, Donald V; Johnston, S Claiborne Clay; Kasner, Scott E; Kittner, Steven J; Mitchell, Pamela H; Rich, Michael W; Richardson, DeJuran; Schwamm, Lee H; Wilson, John A

    2014-07-01

    The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

  4. Ischemic Stroke and Its Risk Factors in a Registry-Based Large Cross-Sectional Diabetic Cohort in a Country Facing a Diabetes Epidemic

    Directory of Open Access Journals (Sweden)

    Khalid Al-Rubeaan

    2016-01-01

    Full Text Available The main aim of this study is to determine the prevalence and risk factors of ischemic stroke among diabetic patients registered in the Saudi National Diabetes Registry (SNDR database. A cross-sectional sample of 62,681 diabetic patients aged ≥25 years was used to calculate ischemic stroke prevalence and its risk factors. Univariate and multivariate logistic regression analyses were used to assess the roles of different risk factors. The prevalence of ischemic stroke was 4.42% and was higher in the older age group with longer diabetes duration. Poor glycemic control and the presence of chronic diabetes complications were associated with a high risk of ischemic stroke. History of smoking and type 2 diabetes were more frequent among stroke patients. Obesity significantly decreased the risk for ischemic stroke. Regression analysis for ischemic stroke risk factors proved that age ≥45 years, male gender, hypertension, coronary artery disease (CAD, diabetes duration ≥10 years, insulin use, and hyperlipidemia were significant independent risk factors for ischemic stroke. We conclude that ischemic stroke is prevalent among diabetic individuals, particularly among those with type 2 diabetes. Good glycemic, hypertension, and hyperlipidemia control, in addition to smoking cessation, are the cornerstones to achieve a significant reduction in ischemic stroke risk.

  5. Relationship between Estradiol and Antioxidant Enzymes Activity of Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Nasrin Sheikh

    2009-01-01

    Full Text Available Some evidence suggests the neuroprotection of estrogen provided by the antioxidant activity of this compound. The main objective of this study was to determine the level of estradiol and its correlation with the activity of antioxidant enzymes, total antioxidant status and ferritin from ischemic stroke subjects. The study population consisted of 30 patients with acute ischemic stroke and 30 controls. There was no significant difference between estradiol in stroke and control group. The activity of superoxide dismutase and level of ferritin was higher in stroke compared with control group (<.05, <.001, resp.. There was no significant correlation between estradiol and glutathione peroxidase, glutathione reductase, catalase, total antioxidant status, and ferritin in stroke and control groups. We observed inverse correlation between estradiol with superoxide dismutase in males of stroke patients (=−0.54, =.029. Our results supported that endogenous estradiol of elderly men and women of stroke or control group has no antioxidant activity.

  6. Fish Consumption and Ischemic stroke in Southern Sweden

    Directory of Open Access Journals (Sweden)

    Wennberg Maria

    2011-10-01

    Full Text Available Abstract Background The relationship between fish intake and stroke incidence has been inconsistent in previous Swedish studies. Here, we report the risk of stroke and fish intake in a cohort from southern Sweden. Findings Data were obtained from an already available population based case-control study where the cases were defined as incident first-time ischemic stroke patients. Complete data on all relevant variables were obtained for 2722 controls and 2469 cases. The data were analyzed with logistic regression analysis. Stroke risk decreased with fat fish intake ([greater than or equal to] 1/week versus Conclusions The results suggest fat fish intake to decrease ischemic stroke risk and lean fish intake to increase women's stroke risk. The inconsistent relationship between fish intake and stroke risk reported in previous studies is further stressed by the results of this study.

  7. Complications of hemorrhagic and ischemic stroke : a CT perfusion evaluation

    NARCIS (Netherlands)

    Dankbaar, J.W.

    2010-01-01

    In this thesis the use of CT-perfusion (CTP) imaging in the evaluation of the most severe complications of subarachnoid hemorrhage (SAH)) and ischemic stroke was explored. These complications are delayed cerebral ischemia (DCI) after SAH and damage to the blood-brain barrier (BBB) after ischemic str

  8. Correlation of cognitive impairment with ischemic stroke-inducing cerebral artery%缺血性卒中责任动脉与认知障碍的相关性研究

    Institute of Scientific and Technical Information of China (English)

    张卫; 恽晓平

    2014-01-01

    Objective To explore the correlation of cognitive impairment with ischemic strokeinducing cerebral artery,in order to predict and find the correlations between different cognitive dysfunction and different intracranial arterial occlusion.Methods We used Montreal Cognitive Assessment (MoCA) to evaluate neuropsychological statuses in the 250 patients,who developed first time acute myocardial infarction for 2 weeks.MoCA scores and other neuropsychological cognitive assessment scores were recorded.Patients were grouped by the location of intracranial arterial occlusion.The neuropsychological cognitive assessment results were analyzed between groups.Results Middle cerebral artery occlusion was correlated with impairments of visual spatial/executive,attention,language and memory (B=-1.875 ~-1.094,P<0.05).Anterior cerebral artery and vertebral basilar artery occlusion had correlations with attention impairment (B =-3.977,B =-1.833,P<0.01).Posterior cerebral artery occlusion could cause visual spatial/executive,language and memory impairment(B=-1.714 ~-1.095,P<0.05).No correlation of cognitive impairment characteristics with anterior choroidal artery occlusion was found.Conclusions Different arterial occlusion can cause different characteristics of impairment in cognitive function,which can help to predict cognitive impairment after sub-acute stroke.It suggests that some cognitive assessments must be conducted in sub-acute stroke management.%目的 从责任动脉角度探讨缺血性卒中与认知障碍之间的关系,寻找不同责任动脉阻塞所致的特征性认知领域损害及其内在联系以期及早预测认知障碍. 方法 应用蒙特利尔认知评估量表(MoCA)北京版,对250例首次急性发病2周左右的缺血性卒中患者进行认知功能评估,记录其MoCA评分及各单项认知领域评分.按阻塞责任动脉分组,将各组的MoCA认知评估结果进行相关分析. 结果 大脑中动脉供血区梗死与视空间/执行

  9. Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

    Directory of Open Access Journals (Sweden)

    Felipe Torres Pacheco

    2015-05-01

    Full Text Available Objective The potential of computed tomography angiography (CTA was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours. Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2% based on both clinical grounds and imaging follow-up (stroke group, with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86% while artery-to-artery embolization was the most common stroke mechanism (52%. Conclusion Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism.

  10. Rotating night shift work and the risk of ischemic stroke.

    Science.gov (United States)

    Brown, Devin L; Feskanich, Diane; Sánchez, Brisa N; Rexrode, Kathryn M; Schernhammer, Eva S; Lisabeth, Lynda D

    2009-06-01

    Rotating night shift work disrupts circadian rhythms and is associated with coronary heart disease. The relation between rotating night shift work and ischemic stroke is unclear. The Nurses' Health Study, an ongoing cohort study of registered female nurses, assessed in 1988 the total number of years the nurses had worked rotating night shifts. The majority (69%) of stroke outcomes from 1988 to 2004 were confirmed by physician chart review. The authors used Cox proportional hazards models to assess the relation between years of rotating night shift work and ischemic stroke, adjusting for multiple vascular risk factors. Of 80,108 subjects available for analysis, 60% reported at least 1 year of rotating night shift work. There were 1,660 ischemic strokes. Rotating night shift work was associated with a 4% increased risk of ischemic stroke for every 5 years (hazard ratio = 1.04, 95% confidence interval: 1.01, 1.07; P(trend) = 0.01). This increase in risk was similar when limited to the 1,152 confirmed ischemic strokes (hazard ratio = 1.03, 95% confidence interval: 0.99, 1.07; P(trend) = 0.10) and may be confined to women with a history of 15 or more years of rotating shift work. Women appear to have a modestly increased risk of stroke after extended periods of rotating night shift work.

  11. Preventable Pediatric Stroke via Vaccination?

    OpenAIRE

    Press, Craig A.; Wainwright, Mark S

    2015-01-01

    Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS) group studied the risk of arterial ischemic stroke (AIS) associated with minor infection and routine childhood vaccinations.

  12. Ketogenic Diet Provides Neuroprotective Effects against Ischemic Stroke Neuronal Damages

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    Sheida Shaafi

    2014-12-01

    Full Text Available Ischemic stroke is a leading cause of death and disability in the world. Many mechanisms contribute in cell death in ischemic stroke. Ketogenic diet which has been successfully used in the drug-resistant epilepsy has been shown to be effective in many other neurologic disorders. The mechanisms underlying of its effects are not well studied, but it seems that its neuroprotective ability is mediated at least through alleviation of excitotoxicity, oxidative stress and apoptosis events. On the basis of these mechanisms, it is postulated that ketogenic diet could provide benefits to treatment of cerebral ischemic injuries.

  13. Supratentorial ischemic stroke: more than an upper motor neuron disorder.

    NARCIS (Netherlands)

    Kuijk, A. van; Pasman, J.W.; Hendricks, H.T.; Schelhaas, H.J.; Zwarts, M.J.; Geurts, A.C.H.

    2007-01-01

    The primary goal of this study was to identify secondary functional changes in the peripheral motor units of the paretic upper extremity (UE) in patients with severe ischemic stroke and to determine how these changes develop during the first weeks after stroke. An inception cohort of 27 consecutive

  14. 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

  15. Cardioembolism and Involvement of the Insular Cortex in Patients with Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Jihoon Kang

    Full Text Available To evaluate whether topographical characteristics of insular involvement in ischemic stroke are associated with cardioembolism.A consecutive series of patients hospitalized for ischemic stroke within 7 days of symptom onset were identified. Based on diffusion-weighted imaging, we included those who had ischemic lesions in the middle cerebral artery (MCA territory. Each patient was assigned to one of two groups based on the presence or absence of insular involvement. The primary outcome was the frequency of cardioembolism, which was compared based on insular involvement. Of 1,311 patients with ischemic stroke in the MCA territory, 112 had insular involvement (8.5%. The frequency of cardioembolism in patients with insular involvement (52.7% was significantly higher than that in patients without insular involvement (30.4%, P < 0.001. Although insular involvement was associated with a severe baseline National Institutes of Health Stroke Scale score (13 vs. 4, it did not independently affect the 3-month functional outcome.In cases of stroke in the MCA territory, involvement of the insular cortex may be associated with a risk of cardioembolism.

  16. miR-455 inhibits neuronal cell death by targeting TRAF3 in cerebral ischemic stroke

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    Yao ST

    2016-12-01

    Full Text Available Shengtao Yao,* Bo Tang,* Gang Li, Ruiming Fan, Fang Cao Department of Cerebrovascular Disease, The First Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China *These authors contributed equally to this work Abstract: Ischemic stroke is one of the leading causes of brain disease, with high morbidity, disability, and mortality. MicroRNAs (miRNAs have been identified as vital gene regulators in various types of human diseases. Accumulating evidence has suggested that aberrant expression of miRNAs play critical roles in the pathologies of ischemic stroke. Yet, the precise mechanism by which miRNAs control cerebral ischemic stroke remains unclear. In the present study, we explored whether miR-455 suppresses neuronal death by targeting TRAF3 in cerebral ischemic stroke. The expression levels of miR-455 and TRAF3 were detected by quantitative real-time polymerase chain reaction and Western blot. The role of miR-455 in cell death caused by oxygen–glucose deprivation (OGD was assessed using Cell Counting Kit-8 (CCK-8 assay. The influence of miR-455 on infarct volume was evaluated in mouse brain after middle cerebral artery occlusion (MCAO. Bioinformatics softwares and luciferase analysis were used to find and confirm the targets of miR-455. The results showed that the expression levels of miR-455 significantly decreased in primary neuronal cells subjected to OGD and mouse brain subjected to MCAO. In addition, forced expression of miR-455 inhibited neuronal death and weakened ischemic brain infarction in focal ischemia-stroked mice. Furthermore, TRAF3 was proved to be a direct target of miR-455, and miR-455 could negatively suppress TRAF3 expression. Biological function analysis showed that TRAF3 silencing displayed the neuroprotective effect in ischemic stroke and could enhance miR-455-induced positive impact on ischemic injury both in vitro and in vivo. Taken together, miR-455 played a vital role in protecting neuronal

  17. Application of sodium alginate microspheres in ischemic stroke modeling in miniature pigs

    Institute of Scientific and Technical Information of China (English)

    Yongchun Cui; Like Wu; Yi Tian; Yue Tang; Liujun Jia; Aili Wu; Peng Peng; Jianzhong Yang; Hong Du; Xiaojuan Wang

    2013-01-01

    The miniature pig is an optimal animal model for studying nervous system disease because of its physiologic and pathologic features. However, the rete mirabile composed of arteries and veins at the skull base limits their application as a model of ischemic stroke by middle cerebral artery occlusion. The present study investigated the possibility of establishing an ischemic stroke model in the miniature pig by blocking the skull base retia with sodium alginate microspheres. Three Bama miniature pigs were used. Using the monitor of C-arm X-ray machine, sodium alginate aortic arch, common carotid artery, ascending pharyngeal artery and the retia. Results were evaluated using carotid arteriography, MRI, behavior observation and histology. The unilateral rete mirabile was completely blocked, resulting in disturbance in blood supply to the basal ganglia, astasia of the right hind limb and salivation. MRI and hematoxylin-eosin staining showed an evident infarction focus in the basal ganglia. These findings indicate that sodium alginate microspheres are a suitable embolic material for blocking the skull base retia in miniature pigs to establish an ischemic stroke models.

  18. 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.

  19. 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.

  20. Reperfusion Therapies of Acute Ischemic Stroke: potentials and failures

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    Georgios eTsivgoulis

    2014-12-01

    Full Text Available Over the past twenty years clinical research has focused on the development of reperfusion therapies for acute ischemic stroke (AIS, which include the use of systemic intravenous thrombolytics (alteplase, desmoteplase or tenecteplase, the augmentation of systemic intravenous recanalization with ultrasound, the bridging of intravenous with intra-arterial thrombolysis, the use of multi-modal approaches to reperfusion including thrombectomy and thromboaspiration with different available retrievers. Clinical trials testing these acute reperfusion therapies provided novel insight regarding the comparative safety and efficacy, but also raised new questions and further uncertainty on the field. Intravenous alteplase (tPA remains the fastest and easiest way to initiate acute stroke reperfusion treatment, and should continue to be the first-line treatment for patients with AIS within 4.5 hours from onset. The use of tenecteplase instead of tPA and the augmentation of systemic thrombolysis with ultrasound are both novel therapeutical modalities that may emerge as significant options in AIS treatment. Endovascular treatments for AIS are rapidly evolving due to technological advances in catheter-based interventions and are currently emphasizing speed in order to result in timely restoration of perfusion of still-salvageable, infracted brain tissue, since delayed recanalization of proximal intracranial occlusions has not been associated with improved clinical outcomes. Comprehensive imaging protocols in AIS may enable better patient selection for endovascular interventions and for testing multi-modal combinatory strategies.

  1. STUDY OF C-REACTIVE PROTEIN IN ACUTE ISCHEMIC STROKE

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    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

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

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    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.

  3. Identification of ischemic regions in a rat model of stroke.

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    Anke Popp

    Full Text Available BACKGROUND: Investigations following stroke first of all require information about the spatio-temporal dimension of the ischemic core as well as of perilesional and remote affected tissue. Here we systematically evaluated regions differently impaired by focal ischemia. METHODOLOGY/PRINCIPAL FINDINGS: Wistar rats underwent a transient 30 or 120 min suture-occlusion of the middle cerebral artery (MCAO followed by various reperfusion times (2 h, 1 d, 7 d, 30 d or a permanent MCAO (1 d survival. Brains were characterized by TTC, thionine, and immunohistochemistry using MAP2, HSP72, and HSP27. TTC staining reliably identifies the infarct core at 1 d of reperfusion after 30 min MCAO and at all investigated times following 120 min and permanent MCAO. Nissl histology denotes the infarct core from 2 h up to 30 d after transient as well as permanent MCAO. Absent and attenuated MAP2 staining clearly identifies the infarct core and perilesional affected regions at all investigated times, respectively. HSP72 denotes perilesional areas in a limited post-ischemic time (1 d. HSP27 detects perilesional and remote impaired tissue from post-ischemic day 1 on. Furthermore a simultaneous expression of HSP72 and HSP27 in perilesional neurons was revealed. CONCLUSIONS/SIGNIFICANCE: TTC and Nissl staining can be applied to designate the infarct core. MAP2, HSP72, and HSP27 are excellent markers not only to identify perilesional and remote areas but also to discriminate affected neuronal and glial populations. Moreover markers vary in their confinement to different reperfusion times. The extent and consistency of infarcts increase with prolonged occlusion of the MCA. Therefore interindividual infarct dimension should be precisely assessed by the combined use of different markers as described in this study.

  4. Community Level Disadvantage and the Likelihood of First Ischemic Stroke

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    Bernadette Boden-Albala

    2012-01-01

    Full Text Available Background and Purpose. Residing in “disadvantaged” communities may increase morbidity and mortality independent of individual social resources and biological factors. This study evaluates the impact of population-level disadvantage on incident ischemic stroke likelihood in a multiethnic urban population. Methods. A population based case-control study was conducted in an ethnically diverse community of New York. First ischemic stroke cases and community controls were enrolled and a stroke risk assessment performed. Data regarding population level economic indicators for each census tract was assembled using geocoding. Census variables were also grouped together to define a broader measure of collective disadvantage. We evaluated the likelihood of stroke for population-level variables controlling for individual social (education, social isolation, and insurance and vascular risk factors. Results. We age-, sex-, and race-ethnicity-matched 687 incident ischemic stroke cases to 1153 community controls. The mean age was 69 years: 60% women; 22% white, 28% black, and 50% Hispanic. After adjustment, the index of community level disadvantage (OR 2.0, 95% CI 1.7–2.1 was associated with increased stroke likelihood overall and among all three race-ethnic groups. Conclusion. Social inequalities measured by census tract data including indices of community disadvantage confer a significant likelihood of ischemic stroke independent of conventional risk factors.

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

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    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.

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

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    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

  7. Systematic review of risk factors for progressive ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Weimin Yang; Fanyi Kong; Ming Liu; Zilong Hao

    2011-01-01

    OBJECTIVE: To determine the risk factors for progressive ischemic stroke, and to prevent onset and make a prognosis of disease, the present study systemically evaluated 19 cohort studies and 10 case-controlled studies of progressive ischemic stroke.SEARCH STRATEGY: A computer-based, online, literature search of PubMed (1966/2007), China Biological Medicine Database (CBM-disc, 1979/2007) and CNKI (www.cnki.net, 1979/2007) was performed to screen for related studies.DATA SELECTION: Cohort or case-controlled studies that focused on risk factors of progressive ischemic stroke were selected for review.Two reviewers independently extracted data and assessed study quality according to Cochrane Collaboration guidelines.Statistical analysis was performed using RevMan software.MAIN OUTCOME MEASUREMENT: Risk factors for progressive ischemic stroke.RESULTS: Using the inclusion criteria, 29/781 studies published in English and Chinese were initially reviewed, including 19 cohort studies and 10 case-control studies.Despite variations in determination of progressive ischemic stroke and the intervals between 2 evaluations, all studies described the diagnostic criteria for progressive ischemic stroke.Logistic analysis was employed in 20 of the studies.Meta-analysis of primary data in the related studies determined that the following factors that significantly correlated with progressive ischemic stroke: fever[risk ratio (RR)=2.26,95% confidence interval (Cl):1.20-4.26, P = 0.01;odds ratio (OR)=2.85,95% Cl: 1.64-4.98, P<0.01)1; diabetes (RR= 1.38, 95% Cl: 1.18-1.61,P < 0.01;OR= 2.48, 95% CI: 1.93-3.19, P < 0.01);coronary heart disease (RR= 1.22, 95% Cl: 1.08-1.38, P< 0.01); neuroimaging transformation (RR=1.55, 95%Cl: 1.34-1.80, P < 0.01; OR=2.29,95% Cl: 1.47-.58, P<0.01); and hyperglycemia (RR=2.62, 95% Cl: 1.86-3.68, P<0.01;OR=3.49,95% Cl: 1.92-6.35, P<0.01).CONCLUSION: Fever, diabetes, coronary heart disease, neuroimaging transformation, and hyperglycemia are

  8. Atrial fibrillation is a predictor of in-hospital mortality in ischemic stroke patients

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    Ong CT

    2016-06-01

    Full Text Available Cheung-Ter Ong,1,2 Yi-Sin Wong,3 Chi-Shun Wu,1 Yu-Hsiang Su1 1Department of Neurology, Chia-Yi Christian Hospital, 2Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chiayi, 3Department of Family Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan, Republic of China Background/purpose: In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigated the factors that contribute to the risk of in-hospital mortality in acute ischemic stroke patients.Materials and methods: Between January 1, 2007, and December 31, 2011, 2,556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed.Results: Of the 2,556 ischemic stroke patients, 157 received thrombolytic therapy. Eighty of the 2,556 patients (3.1% died during hospitalization. Of the 157 patients who received thrombolytic therapy, 14 (8.9% died during hospitalization. History of atrial fibrillation (AF, P<0.01 and stroke severity (P<0.01 were independent risk factors of in-hospital mortality. AF, stroke severity, cardioembolism stroke, and diabetes mellitus were independent risk factors of hemorrhagic transformation. Herniation and sepsis were the most common complications of stroke that were attributed to in-hospital mortality. Approximately 70% of in-hospital mortality was related to stroke severity (total middle cerebral artery occlusion with herniation, basilar artery occlusion, and hemorrhagic transformation. The other 30% of in-hospital mortality was related to sepsis, heart disease, and other complications.Conclusion: AF is associated with higher in-hospital mortality rate than in patients without AF. For improving outcome of stroke patients, we also need to focus to reduce serious neurological

  9. Mortality study for a decade: ischemic stroke in the elderly.

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    Javier J. García Zacarías

    2014-09-01

    Full Text Available Cerebrovascular diseases are among the top three causes of death in Cuba and the world, about 80 % of these patients belong to Ischemic Stroke. The objective of this paper is to describe the clinical and developmental profile of patients who died of Ischemic Stroke. A descriptive, prospective research, cross- sectional study was made, the sample included all deaths from ischemic stroke at the University Hospital "Camilo Cienfuegos" Sancti Spiritus, between January 1st, 2001 and December 31, 2010, and persons over 60 years of age with necropsy performed. Atherothrombotic stroke was the most frequent category, the highest mortality rates were observed in persons over 80 years of age and in females, hypertension, ischemic heart disease and transient ischemic attack were the main significant medical history; most patients were admitted in the stroke unit and died in Middle Progressive Care, cerebral edema and intracranial hypertension and hypostatic bronchopne umonia were complications and specific main causes of most frequent death. Value of cerebral edema and hypostatic bronchopneumonia as clinical complications and causes of death in patients investigated is confirmed.

  10. Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin Population Stroke Study.

    LENUS (Irish Health Repository)

    2011-04-01

    Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study.

  11. Blood-Brain Barrier Alterations Provide Evidence of Subacute Diaschisis in an Ischemic Stroke Rat Model

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    Garbuzova-Davis, Svitlana; Rodrigues, Maria C. O.; Hernandez-Ontiveros, Diana G.; Tajiri, Naoki; Frisina-Deyo, Aric; Boffeli, Sean M.; Abraham, Jerry V.; Pabon, Mibel; Wagner, Andrew; Ishikawa, Hiroto; Shinozuka, Kazutaka; Haller, Edward; Sanberg, Paul R.; Kaneko, Yuji; Borlongan, Cesario V.

    2013-01-01

    Background Comprehensive stroke studies reveal diaschisis, a loss of function due to pathological deficits in brain areas remote from initial ischemic lesion. However, blood-brain barrier (BBB) competence in subacute diaschisis is uncertain. The present study investigated subacute diaschisis in a focal ischemic stroke rat model. Specific focuses were BBB integrity and related pathogenic processes in contralateral brain areas. Methodology/Principal Findings In ipsilateral hemisphere 7 days after transient middle cerebral artery occlusion (tMCAO), significant BBB alterations characterized by large Evans Blue (EB) parenchymal extravasation, autophagosome accumulation, increased reactive astrocytes and activated microglia, demyelinization, and neuronal damage were detected in the striatum, motor and somatosensory cortices. Vascular damage identified by ultrastuctural and immunohistochemical analyses also occurred in the contralateral hemisphere. In contralateral striatum and motor cortex, major ultrastructural BBB changes included: swollen and vacuolated endothelial cells containing numerous autophagosomes, pericyte degeneration, and perivascular edema. Additionally, prominent EB extravasation, increased endothelial autophagosome formation, rampant astrogliosis, activated microglia, widespread neuronal pyknosis and decreased myelin were observed in contralateral striatum, and motor and somatosensory cortices. Conclusions/Significance These results demonstrate focal ischemic stroke-induced pathological disturbances in ipsilateral, as well as in contralateral brain areas, which were shown to be closely associated with BBB breakdown in remote brain microvessels and endothelial autophagosome accumulation. This microvascular damage in subacute phase likely revealed ischemic diaschisis and should be considered in development of treatment strategies for stroke. PMID:23675488

  12. Blood-brain barrier alterations provide evidence of subacute diaschisis in an ischemic stroke rat model.

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    Svitlana Garbuzova-Davis

    Full Text Available BACKGROUND: Comprehensive stroke studies reveal diaschisis, a loss of function due to pathological deficits in brain areas remote from initial ischemic lesion. However, blood-brain barrier (BBB competence in subacute diaschisis is uncertain. The present study investigated subacute diaschisis in a focal ischemic stroke rat model. Specific focuses were BBB integrity and related pathogenic processes in contralateral brain areas. METHODOLOGY/PRINCIPAL FINDINGS: In ipsilateral hemisphere 7 days after transient middle cerebral artery occlusion (tMCAO, significant BBB alterations characterized by large Evans Blue (EB parenchymal extravasation, autophagosome accumulation, increased reactive astrocytes and activated microglia, demyelinization, and neuronal damage were detected in the striatum, motor and somatosensory cortices. Vascular damage identified by ultrastuctural and immunohistochemical analyses also occurred in the contralateral hemisphere. In contralateral striatum and motor cortex, major ultrastructural BBB changes included: swollen and vacuolated endothelial cells containing numerous autophagosomes, pericyte degeneration, and perivascular edema. Additionally, prominent EB extravasation, increased endothelial autophagosome formation, rampant astrogliosis, activated microglia, widespread neuronal pyknosis and decreased myelin were observed in contralateral striatum, and motor and somatosensory cortices. CONCLUSIONS/SIGNIFICANCE: These results demonstrate focal ischemic stroke-induced pathological disturbances in ipsilateral, as well as in contralateral brain areas, which were shown to be closely associated with BBB breakdown in remote brain microvessels and endothelial autophagosome accumulation. This microvascular damage in subacute phase likely revealed ischemic diaschisis and should be considered in development of treatment strategies for stroke.

  13. 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

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    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

  14. Return to work after ischemic stroke: a methodological review.

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    Wozniak, Marcella A; Kittner, Steven J

    2002-01-01

    Despite the economic cost of lost employment, return to work after ischemic stroke has received little study. The percentages of patients working after stroke vary widely from 11 to 85%. Comparisons of these studies are difficult because they report return to work in different populations after diverse follow-up periods using variable definitions of stroke and work. Stroke severity as measured by activities of daily living was the most robust predictor of return to work. However, many factors known to influence vocational outcome after other illness (e.g., social and job characteristics) have not been examined. Directions for future studies of return to work are suggested.

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

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    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.

  16. Carotid Artery Stenting Successfully Prevents Progressive Stroke Due to Mobile Plaque

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    Masahiro Oomura

    2015-05-01

    Full Text Available We report a case of progressive ischemic stroke due to a mobile plaque, in which carotid artery stenting successfully prevented further infarctions. A 78-year-old man developed acute multiple infarcts in the right hemisphere, and a duplex ultrasound showed a mobile plaque involving the bifurcation of the left common carotid artery. Maximal medical therapy failed to prevent further infarcts, and the number of infarcts increased with his neurological deterioration. Our present case suggests that the deployment of a closed-cell stent is effective to prevent the progression of the ischemic stroke due to the mobile plaque.

  17. A novel effect of Noscapine on patients with massive ischemic stroke: A pseudo-randomized clinical trial.

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    Massoud Mahmoudian

    2015-03-01

    Full Text Available Massive ischemic stroke causes significant mortality and morbidity in stroke patients. The main treatments for massive ischemic stroke are recombinant tissue plasminogen activator (rtPA, craniotomy, and endovascular interventions. Due to destructive effects of bradykinin on the nervous system in ischemic stroke, it seems reasonable that using Noscapine as a Bradykinin antagonist may improve patients' outcome after ischemic stroke. The effect of Noscapine on massive ischemic stroke was shown by the previous pilot study by our group. This pseudo-randomized clinical trial study was designed to assess the result of the pilot study.Patients who had clinical symptoms or computed tomography scan indicative of massive stroke (in full middle cerebral artery territory were entered to the study. The cases received the drugs according to their turns in emergency ward (pseudo-randomized. The patient group received Noscapine, and the control group received common supportive treatments. The patients and data analyzer were blinded about the data. At the end of the study, to adjust confounding variables we used logistic regression.After 1-month follow-up, 16 patients in the control group and 11 patients in the case group expired (P = 0.193. Analyzing the data extracted from Rankin scale and Barthel index check lists, revealed no significant differences in the two groups.Despite the absence of significant statistical results in our study, the reduction rate of 16% for mortality rate in Noscapine recipients is clinically remarkable and motivates future studies with larger sample sizes.

  18. Clues to occult cancer in patients with ischemic stroke.

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    Suk Jae Kim

    Full Text Available BACKGROUND: We hypothesized that hidden malignancy could be detected in patients with cryptogenic stroke without active cancer when they showed the distinctive characteristics of cancer-related stroke. METHODS AND FINDINGS: Among 2,562 consecutive patients with acute ischemic stroke, patients with cryptogenic stroke were analyzed and categorized into two groups according to the presence of active cancer: cryptogenic stroke with active cancer (cancer-related stroke, CA-stroke group and without active cancer (CR-stroke group. Patients with active lung cancer without stroke were also recruited for comparison purposes (CA-control. Clinical factors, lesion patterns on diffusion-weighted MRI (DWI, and laboratory findings were analyzed among groups. A total of 348 patients with cryptogenic stroke were enrolled in this study. Among them, 71 (20.4% patients had active cancer at the time of stroke. The D-dimer levels were significantly higher in patients with CA-stroke than those with CR-stroke or CA-control (both p<0.001. Regarding lesion patterns, patients with CA-stroke mostly had multiple lesions in multiple vascular territories, while more than 80% of patients with CR-stroke had single/multiple lesions in a single vascular territory (P<0.001. D-dimer levels (OR 1.11 per 1 µg/mL increase; 95% CI 1.06-1.15; P<0.001 and DWI lesion patterns (OR 7.13; 95% CI 3.42-14.87; P<0.001 were independently associated with CA-stroke. Workup for hidden malignancy was performed during hospitalization in 10 patients who showed elevated D-dimer levels and multiple infarcts involving multiple vascular territories but had no known cancer, and it revealed hidden malignancies in all the patients. CONCLUSION: Patients with CA-stroke have distinctive D-dimer levels and lesion patterns. These characteristics can serve as clues to occult cancer in patients with cryptogenic stroke.

  19. Erythrocyte sedimentation rate: Can be a prognostic marker in acute ischemic stroke?

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    Selim Selçuk Çomoğlu

    2013-01-01

    Full Text Available OBJECTIVE: The aim of this study is to investigate the relationship between the erythrocyte sedimentation rate (ESR values and the severity of neurological findings on admission, short- term prognosis, risk factors and etiology of the patients with acute ischemic stroke. MATERIAL and METHODS: One hundred and fifty-eight consecutive patients who admitted to the hospital within 24 hours of stroke onset were retrospectively analyzed. National Institutes of Health Stroke Scale (NIHSS and modified Rankin Scale (mRS scores on admission and mRS scores at discharge, brain imaging findings, stroke etiology and risk factors of the patients were recorded. Patients were classified into three groups according to ESR values on admission and compared in terms of severity of clinical symptoms on admission, short-term prognosis, risk factors and etiology of stroke. RESULTS: A total 158 patients with acute ischemic stroke including 89 women and 69 men were enrolled in the study. Patients with ESR≤10 mm/h were included in group 1 (n=49, ESR levels between 11-25 mm/h were included in group 2 (n=69 and ESR≥26 mm/h were included in group 3 (n=40. No significant difference was determined between the groups in terms of NIHSS and mRS scores on admission and mRS scores at discharge and etiology of stroke. While coronary artery disease was found more frequently in group 1 and 2 than group 3 (p=0.018, valvular heart disease was more frequently in group 2 than group 1 (p=0.037. CONCLUSION: The results of our study revealed that ESR levels on admission do not reflect the severity of stroke and can not be accepted as a useful predictor of short-term prognosis in patients with acute ischemic stroke.

  20. Ischemic stroke following abuse of Marijuana in a Nigerian adult male

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    Olalekan Oyinloye

    2014-01-01

    Full Text Available Cannabis is the most widely used illicit drug among adolescents and young adults. Despite its widespread use, only a few reports exist on the association of cannabis use and stroke. A 26-year-old Nigerian male, developed right-sided ischemic stroke few hours after smoking three wraps of cannabis. He had smoked cannabis consistently for the past 4 years prior to the development of the stroke. Known stroke etiology and abuse of other illicit drugs were ruled out from history and investigations. Neuroimaging studies of the brain revealed infarcts in basal ganglia secondary to occlusion of blood flow in the left anterior and middle cerebral arteries. The mechanism of stroke in this patient was thought to be a cannabis-induced vasculopathy. Many cases of stroke in the young are increasingly being seen in hospitals in resource scarce countries. There seems to be a predilection for the basal ganglia in ischemic stroke following cannabis abuse. Therefore, cannabis abuse should be considered in young adults with basal ganglia infarcts, after excluding other known etiologies.

  1. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    Directory of Open Access Journals (Sweden)

    Ersin Kasım Ulusoy

    2015-08-01

    Full Text Available Emery-Dreifuss muscular dystrophy (EDMD is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t have regular cardiac follow-up was reported and the importance of the treatment of cardiac diseases which could play a role in ischemic stroke etiology and the implantation of pace-maker was mentioned.

  2. Intravenous tenecteplase in acute ischemic stroke: an updated review.

    Science.gov (United States)

    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.

  3. 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.

  4. Migraine and risk of perioperative ischemic stroke and hospital readmission

    DEFF Research Database (Denmark)

    Timm, Fanny P; Houle, Timothy T; Grabitz, Stephanie D

    2017-01-01

    OBJECTIVE: To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. DESIGN: Prospective hospital registry study. SETTING: Massachusetts General Hospital and two satellite campuses between...... January 2007 and August 2014. PARTICIPANTS: 124 558 surgical patients (mean age 52.6 years; 54.5% women). MAIN OUTCOME MEASURES: The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome...... was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location. RESULTS: 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0...

  5. Hemorrhagic transformation in ischemic stroke and its treatment during thrombolysis

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    Maurizio Paciaroni

    2011-08-01

    Full Text Available Haemorrhagic transformation (HT of brain infarction or hemorrhagic infarction is a complication of acute ischemic stroke, especially in cardioembolic stroke, and represents the most feared complication of thrombolysis. HT is a multifocal secondary bleeding into brain infarcts with innumerable foci of capillary and venular extravasation either remaining as discrete petechiae or emerging to form confluent purpura. HT is evidenced as a parenchymal area of increased density within an area of low attenuation in a typical vascular distribution on non-contrasted CT scans and is subdivided into two major categories on the basis of standardised definition: haemorrhagic infarct (HI and parenchymal haematoma (PH. PH has been associated to poor outcome in ischemic stroke patients. Thus, its prevention, early detection and adequate treatment represent key points in the management of acute stroke.

  6. Exercise promotes axon regeneration of newborn striatonigral and corticonigral projection neurons in rats after ischemic stroke.

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    Qiu-Wan Zhang

    Full Text Available Newborn striatal neurons induced by middle cerebral artery occlusion (MCAO can form functional projections targeting into the substantia nigra, which should be very important for the recovery of motor function. Exercise training post-stroke improves motor recovery in clinic patients and increases striatal neurogenesis in experimental animals. This study aimed to investigate the effects of exercise on axon regeneration of newborn projection neurons in adult rat brains following ischemic stroke. Rats were subjected to a transient MCAO to induce focal cerebral ischemic injury, followed by 30 minutes of exercise training daily from 5 to 28 days after MCAO. Motor function was tested using the rotarod test. We used fluorogold (FG nigral injection to trace striatonigral and corticonigral projection neurons, and green fluorescent protein (GFP-targeting retroviral vectors combined with FG double labeling (GFP(+ -FG(+ to detect newborn projection neurons. The results showed that exercise improved the recovery of motor function of rats after MCAO. Meanwhile, exercise also increased the levels of BDNF and VEGF, and reduced Nogo-A in ischemic brain. On this condition, we further found that exercise significantly increased the number of GFP(+ -FG(+ neurons in the striatum and frontal and parietal cortex ipsilateral to MCAO, suggesting an increase of newborn striatonigral and corticonigral projection neurons by exercise post-stroke. In addition, we found that exercise also increased NeuN(+ and FG(+ cells in the striatum and frontal and parietal cortex, the ischemic territory, and tyrosine hydroxylase (TH immunopositive staining cells in the substantia nigra, a region remote from the ischemic territory. Our results provide the first evidence that exercise can effectively enhance the capacity for regeneration of newborn projection neurons in ischemic injured mammalian brains while improving motor function. Our results provide a very important cellular mechanism

  7. 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...

  8. Changes in risk factor profile after ischemic stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete

    Background and aims. Adherence to preventive medication and to a healthy life style reduces stroke survivors’ risk of recurrent stroke. We investigated risk factor management in patients admitted to 3 Copenhagen hospitals with ischemic stroke (IS) Methods. 320 patients with acute IS were followed......-fatal recurrent stroke or myocardial infarction Conclusions. We suggest the organisation of secondary prevention clinics within the stroke units for life style modification and treatment to target of risk factors immediately after discharge, thus extending the success of TIA clinics to all stroke survivors...... a maximum score of 6 points. Mean baseline RFP-score was 1.6 Results. After 1 year we found a reduction in current smoking (p=0.008) and in excessive drinking (p=0.0001). There was no change in physical activity and in untreated hypertension. There was an increase in the proportion of patients on lipid...

  9. Positive effects of intermittent fasting in ischemic stroke.

    Science.gov (United States)

    Fann, David Yang-Wei; Ng, Gavin Yong Quan; Poh, Luting; Arumugam, Thiruma V

    2017-03-01

    Intermittent fasting (IF) is a dietary protocol where energy restriction is induced by alternate periods of ad libitum feeding and fasting. Prophylactic intermittent fasting has been shown to extend lifespan and attenuate the progress and severity of age-related diseases such as cardiovascular (e.g. stroke and myocardial infarction), neurodegenerative (e.g. Alzheimer's disease and Parkinson's disease) and cancerous diseases in animal models. Stroke is the second leading cause of death, and lifestyle risk factors such as obesity and physical inactivity have been associated with elevated risks of stroke in humans. Recent studies have shown that prophylactic IF may mitigate tissue damage and neurological deficit following ischemic stroke by a mechanism(s) involving suppression of excitotoxicity, oxidative stress, inflammation and cell death pathways in animal stroke models. This review summarizes data supporting the potential hormesis mechanisms of prophylactic IF in animal models, and with a focus on findings from animal studies of prophylactic IF in stroke in our laboratory.

  10. Association of Morning Blood Pressure Surge with Carotid Artery Plaque Ulceration in Ischemic Stroke Patients with Pathogenesis of Artery to Artery Embolism%动脉-动脉栓塞性缺血性卒中患者晨峰血压与颈动脉溃疡斑块的相关性研究

    Institute of Scientific and Technical Information of China (English)

    程伟; 包艳娥; 聂莉; 李婉秋; 乔向亮; 程晓玲

    2013-01-01

    目的在动脉-动脉栓塞性缺血性卒中患者中,探讨晨峰高血压与颈动脉溃疡斑块的相关性。方法连续入组120例经中国缺血性卒中亚型(Chinese Ischemic Stroke Subclassification,CISS)分型诊断为动脉-动脉栓塞性缺血性卒中患者,利用24 h动态血压监测以及颈动脉彩超分别监测晨峰血压及颈动脉溃疡斑块。利用Logistic回归模型,研究晨峰血压与颈动脉溃疡斑块的相关性。结果120例缺血性卒中患者的平均年龄为(62.6±12.8)岁,女性占36.8%。晨峰高血压组(n=48)溃疡斑块的检出率与无晨峰高血压组(n=72)相比,差异无显著性(31.3% vs 30.6%,P=0.84)。进一步将溃疡斑块按照检出部位(出现在卒中病灶同侧颈动脉或对侧颈动脉)进行分类发现,晨峰高血压组病灶同侧溃疡斑块的检出率明显高于无晨峰高血压组(27.1% vs 19.4%,P=0.008)。多因素分析的结果显示,在调整了年龄、性别之后,晨峰高血压与病灶同侧溃疡斑块的相关性具有统计学意义[优势比(odds ratio,OR):1.42;95%可信区间(confidence interval,CI):1.09~4.22)];进一步校正其他危险因素之后,两者相关性仍存在(OR 1.23;95%CI 1.02~3.46)。结论在动脉-动脉栓塞性缺血性卒中患者中,晨峰高血压与卒中病灶同侧颈动脉溃疡斑块的检出率具有相关性,提示过高的晨峰血压可能是颈动脉溃疡斑块脱落导致动脉-动脉栓塞型缺血性卒中发病的危险因素。%Objective To investigate the association of morning blood pressure surge (MBPS) with carotid artery plaque ulceration (CAPU) in ischemic stroke (IS) patients. Methods One hundred and twenty IS patients diagnosed with artery to artery embolism based on Chinese Ischemic Stroke Subclassiifcation (CISS) were enrolled in this study. MBPS was monitored by ambulatory blood pressure monitoring within 24 hours, and CAPU

  11. Exaggerated Postural Blood Pressure Rise Is Related to a Favorable Outcome in Patients With Acute Ischemic Stroke

    NARCIS (Netherlands)

    Aries, M.J.H.; Bakker, Desiree C.; Stewart, Roy E.; De Keyser, Jacques; Elting, Jan Willem J.; Thien, Theo; Vroomen, Patrick C. A. J.

    2012-01-01

    Background and Purpose-The effects of early upright positioning in the acute phase of ischemic stroke on both blood pressure and functional outcome have not been previously examined. Methods-Prospective investigation of mean arterial pressure, heart rate, and peripheral oxygen saturation in the supi

  12. Ischemic stroke susceptibility gene in a Northern Han Chinese population

    Institute of Scientific and Technical Information of China (English)

    Haiping Wang; Shujuan Shi; Wenjing Yan; Yan Song; Jingjing Zhan; Chen Zhang; Haiji Wang

    2013-01-01

    Interleukin-18 gene promoter polymorphisms are potential risk factors for ischemic cerebrovascular disease, and the-607C al ele may increase ischemic stroke risk in the Han Chinese population. In the present study, we recruited 291 patients with ischemic cerebrovascular disease from the Affi-liated Hospital of Qingdao University Medical Col ege, China, and 226 healthy controls. Both pa-tients and controls were from the Han population in northern China. Immunoresonance scattering assays detected increased serum amyloid A protein, C-reactive protein, and interleukin-18 levels in ischemic cerebrovascular disease patients compared with healthy controls. Analysis of the-607C/A (rs1946518) polymorphism in the interleukin-18 gene promoter showed ischemic cerebrovascular disease patients exhibited increased frequencies of the CC genotype and C al eles than healthy controls. Genotype and al ele frequencies of the interleukin-18-137G/C (rs187238) polymorphism and the-13T/C (rs11024595) polymorphism in the 5'-flanking region of serum amyloid A, showed no significant difference between the two groups. Multivariate logistic regression analysis on the interleukin-18 promoter A/C genetic locus, for correction of age, gender, history of smoking, hyper-tension, diabetes mel itus, hypercholesteremia, and an ischemic stroke family history, showed ischemic cerebrovascular disease risk in individuals without the A al ele (C homozygotes) was 2.2-fold greater than in A al ele carriers. Overal , our findings suggest that the-13T/C (rs11024595) polymorphism in the 5′-flanking region of serum amyloid A has no correlation with ischemic cere-brovascular disease, but the C al ele of the-607C/A (rs1946518) polymorphism in the interleukin-18 promoter is a high-risk factor for ischemic cerebrovascular disease in the Han population of northern China. In addition, the A al ele is likely a protective gene for ischemic cerebrovascular disease.

  13. 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

  14. 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.

  15. THE IMPACT OF COMORBIDITY ON COGNITIVE PARAMETERS AFTER ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Mirena Valkova

    2012-10-01

    Full Text Available Objective: The aim of our study is to examine the impact of comorbidity on cognitive parameters after the first ever ischemic stroke.Material and methods: We examined 112 patients (aged 46 to 84 (66.67± 5.96, 69 males and 43 females with first ever ischemic stroke. For cognitive assessment we used Mini Mental State Examination (MMSE, 10 word test (for short term memory and delayed recall, Isaack’s test for verbal fluency (VF, Geriatric depression scale (GDS, Hamilton depression scale (HDS, Blessed dementia information memory concentration test (revised, BDIMCT, Benton Visual Retention test (A,E; BVRT – number of corrects and number of errors and Wiskonsin Card Sorting Test (number of errors, WCST. The patients were examined on two step model. At acute stage, after collecting medical history, somatic and neurological examinations, MMSE, 10 words test and HDS were applied. At subacute stroke stage (90±5 days after first stroke symptoms, all cognitive tests were used. „STATGRAPHICS Plus 5.0 (free version” was used for statistical analysis.Results: Chronic ischemic heart disease and chronic obstructive pulmonary disease are the most important additional risk factors for cognitive decline. Thyroid pathology, renal failure and anemia are independently associated with poststroke depression.Conclusions: On the basis of these data we can conclude that vascular risk factors are independently associated with cognitive and emotional changes after stroke and their effects should be assessed and taken into account for subsequent treatment of stroke survivors.

  16. Does intravenous administration of recombinant tissue plasminogen activator for ischemic stroke can cause inferior myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Mostafa Almasi

    2016-06-01

    Full Text Available Recombinant tissue plasminogen activator (rTPA is one of the main portions of acute ischemic stroke management, but unfortunately has some complications. Myocardial infarction (MI is a hazardous complication of administration of intravenous rTPA that has been reported recently. A 78-year-old lady was admitted for elective coronary artery bypass graft surgery. On the second day of admission, she developed acute left hemiparesis and intravenous rTPA was administered within 120 minutes. Three hours later, she has had chest pain. Rescue percutaneous coronary intervention was performed on right coronary artery due to diagnosis of inferior MI, and the symptoms were resolved.

  17. 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

  18. Leptomeningeal collateralization in acute ischemic stroke: Impact on prominent cortical veins in susceptibility-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Rajeev K., E-mail: rajeev.verma@insel.ch [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland); Hsieh, Kety; Gratz, Pascal P.; Schankath, Adrian C.; Mordasini, Pasquale; Zubler, Christoph; Kellner-Weldon, Frauke [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland); Jung, Simon [Department of Neurology, Inselspital, University of Bern, Bern (Switzerland); Schroth, Gerhard; Gralla, Jan; El-Koussy, Marwan [University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern (Switzerland)

    2014-08-15

    Background: The extent of hypoperfusion is an important prognostic factor in acute ischemic stroke. Previous studies have postulated that the extent of prominent cortical veins (PCV) on susceptibility-weighted imaging (SWI) reflects the extent of hypoperfusion. Our aim was to investigate, whether there is an association between PCV and the grade of leptomeningeal arterial collateralization in acute ischemic stroke. In addition, we analyzed the correlation between SWI and perfusion-MRI findings. Methods: 33 patients with acute ischemic stroke due to a thromboembolic M1-segment occlusion underwent MRI followed by digital subtraction angiography (DSA) and were subdivided into two groups with very good to good and moderate to no leptomeningeal collaterals according to the DSA. The extent of PCV on SWI, diffusion restriction (DR) on diffusion-weighted imaging (DWI) and prolonged mean transit time (MTT) on perfusion-imaging were graded according to the Alberta Stroke Program Early CT Score (ASPECTS). The National Institutes of Health Stroke Scale (NIHSS) scores at admission and the time between symptom onset and MRI were documented. Results: 20 patients showed very good to good and 13 patients poor to no collateralization. PCV-ASPECTS was significantly higher for cases with good leptomeningeal collaterals versus those with poor leptomeningeal collaterals (mean 4.1 versus 2.69; p = 0.039). MTT-ASPECTS was significantly lower than PCV-ASPECTS in all 33 patients (mean 1.0 versus 3.5; p < 0.00). Conclusions: In our small study the grade of leptomeningeal collateralization correlates with the extent of PCV in SWI in acute ischemic stroke, due to the deoxyhemoglobin to oxyhemoglobin ratio. Consequently, extensive PCV correlate with poor leptomeningeal collateralization while less pronounced PCV correlate with good leptomeningeal collateralization. Further SWI is a very helpful tool in detecting tissue at risk but cannot replace PWI since MTT detects significantly more ill

  19. Aging aggravates ischemic stroke-induced brain damage in mice with chronic peripheral infection.

    Science.gov (United States)

    Dhungana, Hiramani; Malm, Tarja; Denes, Adam; Valonen, Piia; Wojciechowski, Sara; Magga, Johanna; Savchenko, Ekaterina; Humphreys, Neil; Grencis, Richard; Rothwell, Nancy; Koistinaho, Jari

    2013-10-01

    Ischemic stroke is confounded by conditions such as atherosclerosis, diabetes, and infection, all of which alter peripheral inflammatory processes with concomitant impact on stroke outcome. The majority of the stroke patients are elderly, but the impact of interactions between aging and inflammation on stroke remains unknown. We thus investigated the influence of age on the outcome of stroke in animals predisposed to systemic chronic infection. Th1-polarized chronic systemic infection was induced in 18-22 month and 4-month-old C57BL/6j mice by administration of Trichuris muris (gut parasite). One month after infection, mice underwent permanent middle cerebral artery occlusion and infarct size, brain gliosis, and brain and plasma cytokine profiles were analyzed. Chronic infection increased the infarct size in aged but not in young mice at 24 h. Aged, ischemic mice showed altered plasma and brain cytokine responses, while the lesion size correlated with plasma prestroke levels of RANTES. Moreover, the old, infected mice exhibited significantly increased neutrophil recruitment and upregulation of both plasma interleukin-17α and tumor necrosis factor-α levels. Neither age nor infection status alone or in combination altered the ischemia-induced brain microgliosis. Our results show that chronic peripheral infection in aged animals renders the brain more vulnerable to ischemic insults, possibly by increasing the invasion of neutrophils and altering the inflammation status in the blood and brain. Understanding the interactions between age and infections is crucial for developing a better therapeutic regimen for ischemic stroke and when modeling it as a disease of the elderly.

  20. Effect of rosuvastatin on inflammatory factors and carotid atherosclerotic plaque in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    YAN Jun

    2013-10-01

    Full Text Available Carotid atherosclerosis is closely related with ischemic stroke occurrence, development and recurrence. This study aims to make an evaluation of the effects of rosuvastatin on inflammatory factors, serum lipid and carotid atherosclerotic plaque in patients with acute ischemic stroke. In this study, 98 patients with acute ischemic stroke and carotid atherosclerosis were given oral administration of rosuvastatin calcium (10 mg once every night, and the course of treatment was 6 months. After treatment, the changes of serum high-sensitivity C-reactive protein (hs-CRP, tumor necrosis factor-alpha (TNF-α and blood lipid were measured, as well as carotid atherosclerotic intima-media thickness (IMT and the calculation of carotid atherosclerotic plaque score. According to the examination results, after 6 months' treatment with rosuvastatin, serum hs-CRP, TNF-α, total cholesterol (TC, triglyceride (TG and low-density lipoprotein cholestrol (LDL-C decreased significantly (P < 0.01, for all, while high-density lipoprotein cholestrol (HDL-C increased significantly (P < 0.01; the total number of plaque reduced, while the number of stable plaque increased (P < 0.05; carotid artery IMT and carotid artery plaque score decreased significantly (P < 0.05. There were significant differences between before and after treatment. The results of this study show that rosuvastatin plays a role in anti-inflammation and alleviates the degree of carotid atherosclerotic plaque.

  1. Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Layton, Kennith F.; Cloft, Harry J.; Kallmes, David F. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); White, J. Bradley [Mayo Clinic, Department of Neurosurgery, Rochester, MN, (United States); Manno, Edward M. [Mayo Clinic, Department of Neurology, Rochester, MN, (United States)

    2006-06-15

    Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. (orig.)

  2. Sex differences in ischemic stroke sensitivity are influenced by gonadal hormones, not by sex chromosome complement.

    Science.gov (United States)

    Manwani, Bharti; Bentivegna, Kathryn; Benashski, Sharon E; Venna, Venugopal Reddy; Xu, Yan; Arnold, Arthur P; McCullough, Louise D

    2015-02-01

    Epidemiologic studies have shown sex differences in ischemic stroke. The four core genotype (FCG) mouse model, in which the testes determining gene, Sry, has been moved from Y chromosome to an autosome, was used to dissociate the effects of sex hormones from sex chromosome in ischemic stroke outcome. Middle cerebral artery occlusion (MCAO) in gonad intact FCG mice revealed that gonadal males (XXM and XYM) had significantly higher infarct volumes as compared with gonadal females (XXF and XYF). Serum testosterone levels were equivalent in adult XXM and XYM, as was serum estrogen in XXF and XYF mice. To remove the effects of gonadal hormones, gonadectomized FCG mice were subjected to MCAO. Gonadectomy significantly increased infarct volumes in females, while no change was seen in gonadectomized males, indicating that estrogen loss increases ischemic sensitivity. Estradiol supplementation in gonadectomized FCG mice rescued this phenotype. Interestingly, FCG male mice were less sensitive to effects of hormones. This may be due to enhanced expression of the transgene Sry in brains of FCG male mice. Sex differences in ischemic stroke sensitivity appear to be shaped by organizational and activational effects of sex hormones, rather than sex chromosomal complement.

  3. Acute MRI Changes in Progressive Ischemic Stroke

    DEFF Research Database (Denmark)

    Kalowska, Elizabeth; Rostrup, Egill; Rosenbaum, S

    2008-01-01

    aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). Methods: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... 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...

  4. Acute MRI changes in progressive ischemic stroke

    DEFF Research Database (Denmark)

    Kalowska, E.; Rostrup, E.; Rosenbaum, S.

    2008-01-01

    aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). METHODS: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... 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...

  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. [Neuroprotective treatment with citicoline (ceraxon) in patients with ischemic stroke].

    Science.gov (United States)

    Martynov, M Iu; Boĭko, A N; Kamchatnov, P R; Kabanov, A A; Iasamanova, A N; Shchukin, I A; Kolesnikova, T I; Chubykin, V I; Glukhareva, A P; Gusev, E I

    2012-01-01

    The dynamics of neurological symptoms assessed with the Scandinavian stroke scale, the Barthel index and the modified Rankin scale was studied in 89 patients with moderate ischemic stroke who received citicoline (ceraxone) intravenously and orally. The results were compared to a group of 52 age-, sex- and stroke-matched patients who did not receive citicoline. To the date of discharge from the hospital (days 21-24), the full restoration (pciticoline was significantly (p<0.05) higher in patients younger than 70 years and when the drug was used in the first hours of disease.

  7. Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups

    Directory of Open Access Journals (Sweden)

    Gezmu T

    2014-05-01

    Full Text Available Tefera Gezmu,1 Dona Schneider,1 Kitaw Demissie,2 Yong Lin,2 Christine Giordano,3 Martin S Gizzi4 1Edward J. Bloustein School of Planning and Public Policy, Rutgers, the State University of New Jersey, New Brunswick, NJ, 2Rutgers School of Public Health, Department of Epidemiology, Piscataway, NJ, 3Rutgers New Jersey Medical School, Newark, NJ, 4New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, NJ, USA Abstract: Evidence implicates lipid abnormalities as important but modifiable risk factors for stroke. This study assesses whether hypercholesterolemia can be used to predict the risk for etiologic subtypes of ischemic stroke between sexes within racial/ethnic groups. Data elements related to stroke risk, diagnosis, and outcomes were abstracted from the medical records of 3,290 acute stroke admissions between 2006 and 2010 at a regional stroke center. Sex comparison within racial/ethnic groups revealed that South Asian and Hispanic men had a higher proportion of ischemic stroke than women, while the inverse was true for Whites and African Americans (P=0.0014. All women, except South Asian women, had higher mean plasma total cholesterol and higher blood circulating low-density lipoprotein levels (≥100 mg/dL than men at the time of their admissions. The incidence of large-artery atherosclerosis (LAA was more common among women than men, except among Hispanics, where men tended to have higher incidences. A regression analysis that considered patients diagnosed with either LAA or small-artery occlusion etiologic subtype as the outcomes and high-density lipoproteins and triglycerides as predictors showed inconsistent associations between lipid profiles and the incidence of these subtypes between the sexes within racial/ethnic groups. In conclusion, our investigation suggests that women stroke patients may be at increased risk for stroke etiologic subtype LAA than men. Although the higher prevalence of stroke

  8. Recombinant Human Erythropoietin in the Treatment of Acute Ischemic Stroke

    NARCIS (Netherlands)

    Ehrenreich, Hannelore; Weissenborn, Karin; Prange, Hilmar; Schneider, Dietmar; Weimar, Christian; Wartenberg, Katja; Schellinger, Peter D.; Bohn, Matthias; Becker, Harald; Wegrzyn, Martin; Jaehnig, Peter; Herrmann, Manfred; Knauth, Michael; Baehr, Mathias; Heide, Wolfgang; Wagner, Armin; Schwab, Stefan; Reichmann, Heinz; Schwendemann, Guenther; Dengler, Reinhard; Kastrup, Andreas; Bartels, Claudia

    2009-01-01

    Background and Purpose-Numerous preclinical findings and a clinical pilot study suggest that recombinant human erythropoietin (EPO) provides neuroprotection that may be beneficial for the treatment of patients with ischemic stroke. Although EPO has been considered to be a safe and well-tolerated dru

  9. Genetic overlap between diagnostic subtypes of ischemic stroke

    NARCIS (Netherlands)

    E.G. Holliday (Elizabeth); M. Traylor (Matthew); R. Malik (Rainer); S. Bevan (Steve); G.J. Falcone (Guido J.); J. Hopewell; Y.-C. Cheng (Yu-Ching); I. Cotlarciuc (Ioana); J.C. Bis (Joshua); E.A. Boerwinkle (Eric); G. Boncoraglio (Giorgio Battista); R. Clarke (Robert); J.W. Cole (John W.); M. Fornage (Myriam); K.L. Furie (Karen); M.A. Ikram (Arfan); J. Jannes (Jim); T. Kittner (Thomas); L.F. Lincz (Lisa); J.M. Maguire (Jane); J.F. Meschia (James F.); T.H. Mosley (Thomas H.); M.A. Nalls (Michael); C. Oldmeadow (Christopher); E.A. Parati (Eugenio A.); B.M. Psaty (Bruce); P.M. Rothwell (Peter); S. Seshadri (Sudha); R.J. Scott (Rodney J.); P. Sharma (Pankaj); C. Sudlow (Cathie); K.L. Wiggins (Kerri); B.B. Worrall (Bradford B.); J. Rosand (Jonathan); B.D. Mitchell (Braxton); C. Kubisch (Christian); H.S. Markus (Hugh); C. Levi (Christopher); J. Attia (John); N.R. Wray (Naomi)

    2015-01-01

    textabstractBackground and Purpose: Despite moderate heritability, the phenotypic heterogeneity of ischemic stroke has hampered gene discovery, motivating analyses of diagnostic subtypes with reduced sample sizes. We assessed evidence for a shared genetic basis among the 3 major subtypes: large arte

  10. Glibenclamide for the Treatment of Ischemic and Hemorrhagic Stroke

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    Nicholas Caffes

    2015-03-01

    Full Text Available Ischemic and hemorrhagic strokes are associated with severe functional disability and high mortality. Except for recombinant tissue plasminogen activator, therapies targeting the underlying pathophysiology of central nervous system (CNS ischemia and hemorrhage are strikingly lacking. Sur1-regulated channels play essential roles in necrotic cell death and cerebral edema following ischemic insults, and in neuroinflammation after hemorrhagic injuries. Inhibiting endothelial, neuronal, astrocytic and oligodendroglial sulfonylurea receptor 1–transient receptor potential melastatin 4 (Sur1–Trpm4 channels and, in some cases, microglial KATP (Sur1–Kir6.2 channels, with glibenclamide is protective in a variety of contexts. Robust preclinical studies have shown that glibenclamide and other sulfonylurea agents reduce infarct volumes, edema and hemorrhagic conversion, and improve outcomes in rodent models of ischemic stroke. Retrospective studies suggest that diabetic patients on sulfonylurea drugs at stroke presentation fare better if they continue on drug. Additional laboratory investigations have implicated Sur1 in the pathophysiology of hemorrhagic CNS insults. In clinically relevant models of subarachnoid hemorrhage, glibenclamide reduces adverse neuroinflammatory and behavioral outcomes. Here, we provide an overview of the preclinical studies of glibenclamide therapy for CNS ischemia and hemorrhage, discuss the available data from clinical investigations, and conclude with promising preclinical results that suggest glibenclamide may be an effective therapeutic option for ischemic and hemorrhagic stroke.

  11. Update on the Role of Cannabinoid Receptors after Ischemic Stroke

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    Luciano S. A. Capettini

    2012-01-01

    Full Text Available Cannabinoids are considered as key mediators in the pathophysiology of inflammatory diseases, including atherosclerosis. In particular, they have been shown to reduce the ischemic injury after acute cardiovascular events, such as acute myocardial infarction and ischemic stroke. These protective and anti-inflammatory properties on peripheral tissues and circulating inflammatory have been demonstrated to involve their binding with both selective cannabinoid type 1 (CB1 and type 2 (CB2 transmembrane receptors. On the other hands, the recent discoveries of novel different classes of cannabinoids and receptors have increased the complexity of this system in atherosclerosis. Although only preliminary data have been reported on the activities of novel cannabinoid receptors, several studies have already investigated the role of CB1 and CB2 receptors in ischemic stroke. While CB1 receptor activation has been shown to directly reduce atherosclerotic plaque inflammation, controversial data have been shown on neurotransmission and neuroprotection after stroke. Given its potent anti-inflammatory activities on circulating leukocytes, the CB2 activation has been proven to produce protective effects against acute poststroke inflammation. In this paper, we will update evidence on different cannabinoid-triggered avenues to reduce inflammation and neuronal injury in acute ischemic stroke.

  12. Treatment and partial recovery of ischemic stroke hemiplegy through acupuncture

    Directory of Open Access Journals (Sweden)

    David Gonçalves Nordon

    2011-06-01

    Full Text Available ABSTRACT We present the case of a patient with hemiplegy and dysphonia due to an ischemic stroke in the pons who was treated through classical systemic and scalpean acupuncture and electroacupuncture, presenting considerable improvement in speaking, walking and moving her right arm after three months of treatment.

  13. Intensive treadmill training in the acute phase after ischemic stroke

    DEFF Research Database (Denmark)

    Strømmen, Anna M; 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...

  14. Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

    DEFF Research Database (Denmark)

    Brunner-Frandsen, Nicole; Dammann Andersen, Andreas; Ashournia, Hamoun;

    2015-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study wa...

  15. High Sensitivity C-reactive Protein Levels in Acute Ischemic Stroke and Subtypes: A study from a Tertiary Care Center

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    Jaydip Ray Chaudhuri

    2013-07-01

    Full Text Available Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP(> 3 mg/L levels with ischemic stroke and its subtypes in Indian patients.Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission.Results: The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5 than controls (1.8 ± 1.5 (P < 0.001. High hsCRP had higher frequency in stroke patients 130 (61.9% compared to controls 10 (6.6%, P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3% and large artery atherosclerosis (72%. High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001, age(P = 0.01, and mortality (0.04. After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2; especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5 and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8.Conclusion: High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes.

  16. Correlation Analysis of Sleep Quality and Youth Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Shunqing Zhang

    2014-01-01

    Full Text Available Objective. To study risk factors related to ischemic stroke (IS in youth and the influence of sleep quality on youth ischemic stroke incidence. Methods. 223 patients aged 18 to 45 years who were admitted to Puyang People’s Hospital from June 2011 to February 2013 with a first-ever ischemic stroke were selected as the research cases. 158 young people with a normal physical examination were selected as the control group. The Pittsburgh Sleep Quality Index (PSQI questionnaire was used to analyse the correlation between sleep quality and youth IS incidence. The US National Institutes of Health Stroke Scale (NIHSS and modified Rankin Scale (MRS scores were used to assess cases’ state of illness and prognosis three months after IS. Results. Univariate and multivariate logistic regression analysis showed that the association of these risk factors with youth IS incidence, from highest to lowest, was hypertension, hyperlipidaemia, smoking history, high homocysteine, the quality of sleep, family history of stroke, and alcoholism. Poor sleep quality ranked fifth among all risk factors and was positively correlated with poor prognosis for youth IS patients. Conclusion. The results of this study showed that sleep quality is an important factor in the pathogenesis and prognosis of youth IS.

  17. ANNUAL FORECAST IN PATIENTS WITH ACUTE ISCHEMIC STROKE: ROLE OF PATHOLOGICAL ANKLE-BRACHIAL INDEX

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    A. N. Sumin

    2016-01-01

    Full Text Available Aim. To study the factors associated with a poor annual prognosis in patients with acute stroke and prognostic role of pathological ankle-brachial index (ABI.Material and methods. The study included 345 patients (age 63.6±7.8 years, 181 males and 164 females with ischemic stroke that were observed for 1 year. All patients were divided into 2 groups: Group 1 included patients with favorable annual outcome of stroke; Group 2 included patients that during a year had any clinical events including death. All patients underwent a standard neurological and instrumental examination including assessment of peripheral arteries status by sphygmomanometry.Results. Both groups did not differ by age and sex. The frequency of unfavorable outcomes (death, re-stroke, cardiovascular events 1 year after ischemic stroke was 29.5%. Chronic heart failure, atrial fibrillation, previous cardiovascular events, presence of peripheral atherosclerosis, overweight were identified most commonly in Group 2. Patients of Group 2 initially had a rough neurological deficit. The pathological ABI was detected in 70.7% of patients in Group 2 vs 33.8% of patients in Group 1 (p=0.000001. A strong relationship of pathological ABI with a poor outcome of stroke was found by regression analysis.Conclusions. Detection of pathological ABI in patients with ischemic stroke makes it possible to reveal peripheral atherosclerosis and to carry out the targeted preventive measures in these patients. Risk stratification can contribute to more individual and effective secondary prevention in patients with cerebrovascular disease. 

  18. 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)

  19. 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

  20. Modulation of Cardiac Autonomic Dysfunction in Ischemic Stroke following Ayurveda (Indian System of Medicine) Treatment.

    Science.gov (United States)

    Jaideep, Sriranjini Sitaram; Nagaraja, Dindagur; Pal, Pramod Kumar; Sudhakara, D; Talakad, Sathyaprabha N

    2014-01-01

    Objectives. Cardiac autonomic dysfunction in stroke has implications on morbidity and mortality. Ayurveda (Indian system of medicine) describes stroke as pakshaghata. We intended to study the effect of Ayurveda therapies on the cardiac autonomic dysfunction. Methods. Fifty patients of ischemic stroke (middle cerebral artery territory) (mean age 39.26 ± 9.88 years; male 43, female 7) were recruited within one month of ictus. All patients received standard allopathic medications as advised by neurologist. In addition, patients were randomized to receive physiotherapy (Group I) or Ayurveda treatment (Group II) for 14 days. Continuous electrocardiogram and finger arterial pressure were recorded for 15 min before and after treatments and analyzed offline to obtain heart rate and blood pressure variability and baroreflex sensitivity (BRS). Results were analysed by RMANOVA. Results. Patients in Group II showed statistically significant improvement in cardiac autonomic parameters. The standard deviation of normal to normal intervals,and total and low frequency powers were significantly enhanced (F = 8.16, P = 0.007, F = 9.73, P = 0.004, F = 13.51, and P = 0.001, resp.). The BRS too increased following the treatment period (F = 10.129, P = 0.004). Conclusions. The current study is the first to report a positive modulation of cardiac autonomic activity after adjuvant Ayurveda treatment in ischemic stroke. Further long term studies are warranted.

  1. Modulation of Cardiac Autonomic Dysfunction in Ischemic Stroke following Ayurveda (Indian System of Medicine Treatment

    Directory of Open Access Journals (Sweden)

    Sriranjini Sitaram Jaideep

    2014-01-01

    Full Text Available Objectives. Cardiac autonomic dysfunction in stroke has implications on morbidity and mortality. Ayurveda (Indian system of medicine describes stroke as pakshaghata. We intended to study the effect of Ayurveda therapies on the cardiac autonomic dysfunction. Methods. Fifty patients of ischemic stroke (middle cerebral artery territory (mean age 39.26 ± 9.88 years; male 43, female 7 were recruited within one month of ictus. All patients received standard allopathic medications as advised by neurologist. In addition, patients were randomized to receive physiotherapy (Group I or Ayurveda treatment (Group II for 14 days. Continuous electrocardiogram and finger arterial pressure were recorded for 15 min before and after treatments and analyzed offline to obtain heart rate and blood pressure variability and baroreflex sensitivity (BRS. Results were analysed by RMANOVA. Results. Patients in Group II showed statistically significant improvement in cardiac autonomic parameters. The standard deviation of normal to normal intervals,and total and low frequency powers were significantly enhanced (F=8.16, P=0.007, F=9.73, P=0.004, F=13.51, and P=0.001, resp.. The BRS too increased following the treatment period (F=10.129, P=0.004. Conclusions. The current study is the first to report a positive modulation of cardiac autonomic activity after adjuvant Ayurveda treatment in ischemic stroke. Further long term studies are warranted.

  2. 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...

  3. Sex differences in neuroinflammation and neuroprotection in ischemic stroke.

    Science.gov (United States)

    Spychala, Monica S; Honarpisheh, Pedram; McCullough, Louise D

    2017-01-02

    Stroke is not only a leading cause of mortality and morbidity worldwide it also disproportionally affects women. There are currently over 500,000 more women stroke survivors in the US than men, and elderly women bear the brunt of stroke-related disability. Stroke has dropped to the fifth leading cause of death in men, but remains the third in women. This review discusses sex differences in common stroke risk factors, the efficacy of stroke prevention therapies, acute treatment responses, and post-stroke recovery in clinical populations. Women have an increased lifetime risk of stroke compared to men, largely due to a steep increase in stroke incidence in older postmenopausal women, yet most basic science studies continue to only evaluate young male animals. Women also have an increased lifetime prevalence of many common stroke risk factors, including hypertension and atrial fibrillation, as well as abdominal obesity and metabolic syndrome. None of these age-related risk factors have been well modeled in the laboratory. Evidence from the bench has implicated genetic and epigenetic factors, differential activation of cell-death programs, cell-cell signaling pathways, and systemic immune responses as contributors to sex differences in ischemic stroke. The most recent basic scientific findings have been summarized in this review, with an emphasis on factors that differ between males and females that are pertinent to stroke outcomes. Identification and understanding of the underlying biological factors that contribute to sex differences will be critical to the development of translational targets to improve the treatment of women after stroke. © 2016 Wiley Periodicals, Inc.

  4. The use of neurovascular ultrasound versus digital subtraction angiography in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Marcos C. Lange

    2015-03-01

    Full Text Available Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS. Objective Compare the use of the neurovascular ultrasound examination (NVUE to digital subtraction angiography (DSA in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy. Method Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission. Results Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy. Conclusion The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients.

  5. Serum inflammatory cytokines combined with NIHSS to evaluate the condition of patients with acute ischemic stroke

    OpenAIRE

    Yu, Heng; LONG Chong-rong; Wang, Liang

    2013-01-01

    Objective To explore the changes of serum inflammatory cytokines and National Institute of Health Stroke Scale (NIHSS) score in acute ischemic stroke patients and their clinical significances on patients' condition assessment. Methods The serum levels of three cytokines, including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP), were measured and compared between 90 acute ischemic stroke patients (ischemic stroke group) and 50 healthy ...

  6. Cerebrolysin enhances neurogenesis in the ischemic brain and improves functional outcome after stroke.

    Science.gov (United States)

    Zhang, Chunling; Chopp, Michael; Cui, Yisheng; Wang, Lei; Zhang, Ruilan; Zhang, Li; Lu, Mei; Szalad, Alexandra; Doppler, Edith; Hitzl, Monika; Zhang, Zheng Gang

    2010-11-15

    Cerebrolysin is a peptide preparation mimicking the action of neurotrophic factors and has beneficial effects on neurodegenerative diseases and stroke. The present study investigated the effect of Cerebrolysin on neurogenesis in a rat model of embolic middle cerebral artery occlusion (MCAo). Treatment with Cerebrolysin at doses of 2.5 and 5 ml/kg significantly increased the number of bromodeoxyuridine-positive (BrdU(+)) subventricular zone (SVZ) neural progenitor cells and doublecortin (DCX) immunoreactivity (migrating neuroblasts) in the ipsilateral SVZ and striatal ischemic boundary 28 days after stroke when the treatment was initiated 24 hr after stroke. The treatment also reduced TUNEL(+) cells by ∼50% in the ischemic boundary. However, treatment with Cerebrolysin at a dose of 2.5 ml/kg initiated at 24 and 48 hr did not significantly reduce infarct volume but substantially improved neurological outcomes measured by an array of behavioral tests 21 and 28 days after stroke. Incubation of SVZ neural progenitor cells from ischemic rats with Cerebrolysin dose dependently augmented BrdU(+) cells and increased the number of Tuj1(+) cells (a marker of immature neurons). Blockage of the PI3K/Akt pathway abolished Cerebrolysin-increased BrdU(+) cells. Moreover, Cerebrolysin treatment promoted neural progenitor cell migration. Collectively, these data indicate that Cerebrolysin treatment when initiated 24 and 48 hr after stroke enhances neurogenesis in the ischemic brain and improves functional outcome and that Cerebrolysin-augmented proliferation, differentiation, and migration of adult SVZ neural progenitor cells contribute to Cerebrolysin-induced neurogenesis, which may be related to improvement of neurological outcome. The PI3K/Akt pathway mediates Cerebrolysin-induced progenitor cell proliferation.

  7. Functional disability of ischemic stroke patients

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    Theodore Kapadohos

    2010-04-01

    Full Text Available Stroke is the third leading cause of death and the first cause of disability, in the developed countries and it is frequently described by the literature as a major global health problem. It is estimated that stroke is responsible for approximately 4.5 million deaths per year and over 9 million stroke survivors, globally. Aim: The aim of the present study was to review the literature about the consequences of functional disability that stroke imposes on the survivors’ life and to shortly describe functional instruments used in evaluation of stroke patients.The method οf this study included bibliography research from both the review and the research literature, mainly in the pub med data base which referred to the functional disability of stroke patients, as well as to the scales used for the evaluation of functional state. Results: Despite the accurate diagnosis and the recent therapeutic advances, stroke can still cause long-term disability in the majority of patients which induces significant changes between the patient and his environment. The results of recent studies indicate that the loss of independence that experience stroke survivals has significant consequences on their quality of life and it is likely to lead to family-crisis and social isolation. It is also widely accepted that the economic impact of stroke is considerable, worldwide. Recovery of functional disability after stroke is influenced by many variables, of which the main are the initial severity of stroke, the level of deficit and the level of social and family support. Ιn clinical practise many measurement instruments are applied and capable of providing assessments of functional ability and other related concepts since it is well documented that evaluation of functional state is a matter of great importance for the assessment of patients’ outcome. Conclusions: As it is supported by published evidence, rehabilitation of neurological deficit in conjunction with

  8. Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Ralph R E G Geuskens

    Full Text Available CT perfusion (CTP is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow-up.This study included 35 patients with >100 mm brain coverage CTP. CTP processing was performed using Philips software (IntelliSpace 7.0. Final infarct was automatically segmented on follow-up noncontrast CT and used as reference. CTP and follow-up noncontrast CT image data were registered. This allowed classification of ischemic lesion agreement (core on CTP: rMTT≥145%, aCBV<2.0 ml/100g and infarct on follow-up noncontrast CT and misclassified ischemic core (core on CTP, not identified on follow-up noncontrast CT regions. False discovery ratio (FDR, defined as misclassified ischemic core volume divided by total CTP ischemic core volume, was calculated. Absolute and relative CTP parameters (CBV, CBF, and MTT were calculated for both misclassified CTP ischemic core and ischemic lesion agreement regions and compared using paired rank-sum tests.Median total CTP ischemic core volume was 49.7ml (IQR:29.9ml-132ml; median misclassified ischemic core volume was 30.4ml (IQR:20.9ml-77.0ml. Median FDR between patients was 62% (IQR:49%-80%. Median relative mean transit time was 243% (IQR:198%-289% and 342% (IQR:249%-432% for misclassified and ischemic lesion agreement regions, respectively. Median absolute cerebral blood volume was 1.59 (IQR:1.43-1.79 ml/100g (P<0.01 and 1.38 (IQR:1.15-1.49 ml/100g (P<0.01 for misclassified ischemic core and ischemic lesion agreement, respectively. All CTP parameter values differed significantly.For all patients a considerable region of the CTP ischemic core is misclassified. CTP parameters significantly

  9. Effect of pre-stroke use of ACE inhibitors on ischemic stroke severity

    Directory of Open Access Journals (Sweden)

    Caplan Louis

    2005-06-01

    Full Text Available Abstract Background Recent trials suggest that angiotensin-converting enzyme inhibitors (ACEI are effective in prevention of ischemic stroke, as measured by reduced stroke incidence. We aimed to compare stroke severity between stroke patients who were taking ACEI before their stroke onset and those who were not, to examine the effects of pretreatment with ACEI on ischemic stroke severity. Methods We retrospectively studied 126 consecutive patients presenting within 24 hours of ischemic stroke onset, as confirmed by diffusion-weighted magnetic resonance imaging (DWI. We calculated the NIHSS score at presentation, as the primary measure of clinical stroke severity, and categorized stroke severity as mild (NIHSS [less than or equal to] 7, moderate (NIHSS 8–13 or severe (NIHSS [greater than or equal to] 14. We analyzed demographic data, risk-factor profile, blood pressure (BP and medications on admissions, and determined stroke mechanism according to TOAST criteria. We also measured the volumes of admission diffusion- and perfusion-weighted (DWI /PWI magnetic resonance imaging lesions, as a secondary measure of ischemic tissue volume. We compared these variables among patients on ACEI and those who were not. Results Thirty- three patients (26% were on ACE-inhibitors. The overall median baseline NIHSS score was 5.5 (range 2–21 among ACEI-treated patients vs. 9 (range 1–36 in non-ACEI patients (p = 0.036. Patients on ACEI prior to their stroke had more mild and less severe strokes, and smaller DWI and PWI lesion volumes compared to non-ACEI treated patients. However, none of these differences were significant. Predictably, a higher percentage of patients on ACEI had a history of heart failure (p = 0.03. Age, time-to-imaging or neurological evaluation, risk-factor profile, concomitant therapy with lipid lowering, other antihypertensives or antithrombotic agents, or admission BP were comparable between the two groups. Conclusion Our results

  10. Questions and Answers about Treating Arterial Stenosis and Preventing Stroke

    Science.gov (United States)

    ... and Answers About Treating Arterial Stenosis and Preventing Stroke A stroke is any sudden event affecting the ... and high cholesterol. How does stenosis contribute to stroke? Atherosclerosis can activate cells involved in blood clotting. ...

  11. Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus

    DEFF Research Database (Denmark)

    Mishra, N K; Ahmed, N; Davalos, A;

    2011-01-01

    in Stroke-International Stroke Thrombolysis Register) compared to nonthrombolyzed controls (C; data from Virtual International Stroke Trials Archive). METHODS: We selected ischemic stroke patients on whom we held data on age, baseline NIH Stroke Scale score (NIHSS), and 90-day modified Rankin Scale score (m......BACKGROUND: Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. We examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy (T; data from Safe Implementation of Thrombolysis......RS). We compared the distribution of mRS between T and C by Cochran-Mantel-Haenszel (CMH) test and proportional odds logistic regression, after adjustment for age and baseline NIHSS, in patients with and without DM, PS, or the combination. We report odds ratios (OR) for improved distribution of m...

  12. Mechanism of troponin elevations in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper K.; Atar, Dan; Mickley, Hans

    2007-01-01

    the introduction of troponin in the diagnosis of acute myocardial infarction, this marker has been measured in a number of other conditions as well. One of these conditions is acute ischemic stroke, causing diagnostic dilemmas for clinicians. Because various electrocardiographic alterations have also been reported......Ischemic heart disease and cerebrovascular diseases frequently co-exist in the same patient, and similar risk factors are shared. For 60 years, experimental, observational, and clinical trial data have incessantly indicated that neurologically induced myocardial injury exists. Since...

  13. Rodent models of ischemic stroke lack translational relevance... are baboon models the answer?

    Science.gov (United States)

    Kwiecien, Timothy D; Sy, Christopher; Ding, Yuchuan

    2014-05-01

    Rodent models of ischemic stroke are associated with many issues and limitations, which greatly diminish the translational potential of these studies. Recent studies demonstrate that significant differences exist between rodent and human ischemic stroke. These differences include the physical characteristics of the stroke, as well as changes in the subsequent inflammatory and molecular pathways following the acute ischemic insult. Non-human primate (NHP) models of ischemic stroke, however, are much more similar to humans. In addition to evident anatomical similarities, the physiological responses that NHPs experience during ischemic stroke are much more applicable to the human condition and thus make it an attractive model for future research. The baboon ischemic stroke model, in particular, has been studied extensively in comparison to other NHP models. Here we discuss the major shortcomings associated with rodent ischemic stroke models and provide a comparative overview of baboon ischemic stroke models. Studies have shown that baboons, although more difficult to obtain and handle, are more representative of ischemic events in humans and may have greater translational potential that can offset these deficiencies. There remain critical issues within these baboon stroke studies that need to be addressed in future investigations. The most critical issue revolves around the size and the variability of baboon ischemic stroke. Compared to rodent models, however, issues such as these can be addressed in future studies. Importantly, baboon models avoid many drawbacks associated with rodent models including vascular variability and inconsistent inflammatory responses - issues that are inherent to the species and cannot be avoided.

  14. Smoking Cessation Intervention After Ischemic Stroke or Transient Ischemic Attack. A Randomized Controlled Pilot Trial

    DEFF Research Database (Denmark)

    Brunner Frandsen, Nicole; Sørensen, Margit; Hyldahl, Tanja Kirstine;

    2012-01-01

    BACKGROUND: Smoking cessation is widely recommended for secondary stroke prevention. However, little is known about the efficacy of smoking cessation intervention after stroke or transient ischemic attack (TIA). METHODS: Ninety-four smokers under age 76, admitted with ischemic stroke or TIA were......-report and verified by measurement of exhaled carbon monoxide (CO). Fewer patients than expected were recruited, which renders this report a pilot study. RESULTS: The 6-month self-reported smoking cessation rate was 37.8% in the minimal intervention group and 42.9% in the intensive intervention group. Smoking...... randomized to minimal smoking cessation intervention or intensive smoking cessation intervention. All patients attended a 30-min individual counseling by the study nurse. Patients randomized to intensive smoking cessation intervention also participated in a 5-session outpatient smoking cessation program...

  15. Angiogenesis, neurogenesis and neuroplasticity in ischemic stroke.

    Science.gov (United States)

    Font, M Angels; Arboix, Adriá; Krupinski, Jerzy

    2010-08-01

    Only very little is know about the neurovascular niche after cardioembolic stroke. Three processes implicated in neurorepair: angiogenesis, neurogenesis and synaptic plasticity, would be naturally produced in adult brains, but also could be stimulated through endogen neurorepair phenomena. Angiogenesis stimulation generates new vessels with the aim to increase collateral circulation. Neurogenesis is controlled by intrinsic genetic mechanisms and growth factors but also ambiental factors are important. The leading process of the migrating neural progenitor cells (NPCs) is closely associated with blood vessels, suggesting that this interaction provides directional guidance to the NPCs. These findings suggest that blood vessels play an important role as a scaffold for NPCs migration toward the damaged brain region. DNA microarray technology and blood genomic profiling in human stroke provided tools to investigate the expression of thousands of genes. Critical comparison of gene expression profiles after stroke in humans with those in animal models should lead to a better understanding of the pathophysiology of brain ischaemia. Probably the most important part of early recovery after stroke is limited capacity of penumbra/infarct neurones to recover. It became more clear in the last years, that penumbra is not just passively dying over time but it is also actively recovering. This initial plasticity in majority contributes towards later neurogenesis, angiogenesis and final recovery. Penumbra is a principal target in acute phase of stroke. Thus, the origin of newly formed vessels and the pathogenic role of neovascularization and neurogenesis are important unresolved issues in our understanding of the mechanisms after stroke. Biomaterials for promoting brain protection, repair and regeneration are new hot target. Recently developed biomaterials can enable and increase the target delivery of drugs or therapeutic proteins to the brain, allow cell or tissue transplants to

  16. 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....

  17. [Presence of immune complexes in ischemic stroke].

    Science.gov (United States)

    Gromadzka, G; Uchacz, I; Palasik, W; Ryglewicz, D; Korlak, J; Członkowska, A

    1999-01-01

    There is increasing evidence that inflammatory responses play an important role in the pathogenesis of atherosclerosis and cerebral infarct. The aim of this study was to determine the amount of immunocomplexes (i.c.) in patients with stroke in the early period of the disease. Studies were performed on 35 subjects. The concentration of immunocomplexes was determined with the precipitation method (3.5% polyethylenoglikol was used). Increased concentration of i.c. was found in patients with cerebral infarct (after 12 hours and 7 days). It suggests, that i.c. could be one of the markers for systemic inflammation and be important in the patogenesis of atherosclerosis and stroke.

  18. Association between fifteen risk factors and progressing ischemic stroke in the Han population of northeast China

    Institute of Scientific and Technical Information of China (English)

    YANG Shan-shan; TENG Da; YOU Ding-yun; SU Zhi-qiang; LI Fang; ZHAO Ji-yang

    2010-01-01

    Background The mortality and disability associated with progressing ischemic stroke are much higher than general ischemic stroke. This study was conducted to determine the risk factors for progressing ischemic stroke in the Han population of northeast China.Methods A total of 2511 patients with ischemic stroke within 24 hours admitted to Department of Neurology, First Affiliated Hospital of Harbin Medical University were studied, from November 2007 to May 2009. All of the patients were classified into the progressing or non-progressing group according to the scores of the Scandinavian Neurological Stroke Scale. Fifteen putative risk factors were evaluated. The influence of risk factors for progressing ischemic stroke was analyzed with the simple Logistic analysis, the multiple Logistic analysis, and the stepwise Logistic regression model. All the statistical analysis was performed by SAS 9.1.Results Totally 359 (14.3%) patients met the criteria for progressing ischemic stroke. The Logistic analysis showed that age, family stroke history, smoking history, hypertension on admission, a drop in blood pressure after admission to the hospital, high serum glucose on admission, and fever were related to progressing ischemic stroke in the Han population of northeast China.Conclusion People of the ischemic stroke with these factors are more likely to develop progressing ischemic stroke.

  19. Bone marrow mesenchymal stem cells transplantation promotes the release of endogenous erythropoietin after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Wen Lv

    2015-01-01

    Full Text Available This study investigated whether bone marrow mesenchymal stem cell (BMSC transplantation protected ischemic cerebral injury by stimulating endogenous erythropoietin. The model of ischemic stroke was established in rats through transient middle cerebral artery occlusion. Twenty-four hours later, 1 × 10 6 human BMSCs (hBMSCs were injected into the tail vein. Fourteen days later, we found that hBMSCs promoted the release of endogenous erythropoietin in the ischemic region of rats. Simultaneously, 3 μg/d soluble erythropoietin receptor (sEPOR was injected into the lateral ventricle, and on the next 13 consecutive days. sEPOR blocked the release of endogenous erythropoietin. The neurogenesis in the subventricular zone was less in the hBMSCs + sEPOR group than in the hBMSCs + heat-denatured sEPOR group. The adhesive-removal test result and the modified Neurological Severity Scores (mNSS were lower in the hBMSCs + sEPOR group than in the heat-denatured sEPOR group. The adhesive-removal test result and mNSS were similar between the hBMSCs + heat-denatured sEPOR group and the hBMSCs + sEPOR group. These findings confirm that BMSCs contribute to neurogenesis and improve neurological function by promoting the release of endogenous erythropoietin following ischemic stroke.

  20. Bone marrow mesenchymal stem cells transplantation promotes the release of endogenous erythropoietin after ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Wen Lv; Wen-yu Li; Xiao-yan Xu; Hong Jiang; Oh Yong Bang

    2015-01-01

    This study investigated whether bone marrow mesenchymal stem cell (BMSC) transplantation protected ischemic cerebral injury by stimulating endogenous erythropoietin. The model of isch-emic stroke was established in rats through transient middle cerebral artery occlusion. Twenty-four hours later, 1 × 106 human BMSCs (hBMSCs) were injected into the tail vein. Fourteen days later, we found that hBMSCs promoted the release of endogenous erythropoietin in the ischemic region of rats. Simultaneously, 3 μg/d soluble erythropoietin receptor (sEPOR) was injected into the lateral ventricle, and on the next 13 consecutive days. sEPOR blocked the release of endogenous erythropoietin. The neurogenesis in the subventricular zone was less in the hBMSCs + sEPOR group than in the hBMSCs + heat-denatured sEPOR group. The adhesive-removal test result and the modified Neurological Severity Scores (mNSS) were lower in the hBMSCs + sEPOR group than in the heat-denatured sEPOR group. The adhesive-removal test result and mNSS were similar between the hBMSCs + heat-denatured sEPOR group and the hBMSCs + sEPOR group. These ifndings conifrm that BMSCs contribute to neurogenesis and improve neurological function by promoting the release of endogenous erythropoietin following ischemic stroke.

  1. Intracranial transplantation of monocyte-derived multipotential cells enhances recovery after ischemic stroke in rats.

    Science.gov (United States)

    Hattori, Hidenori; Suzuki, Shigeaki; Okazaki, Yuka; Suzuki, Norihiro; Kuwana, Masataka

    2012-02-01

    Cell transplantation has emerged as a potential therapy to reduce the neurological deficits caused by ischemic stroke. We previously reported a primitive cell population, monocyte-derived multipotential cells (MOMCs), which can differentiate into mesenchymal, neuronal, and endothelial lineages. In this study, MOMCs and macrophages were prepared from rat peripheral blood and transplanted intracranially into the ischemic core of syngeneic rats that had undergone a left middle cerebral artery occlusion procedure. Neurological deficits, as evaluated by the corner test, were less severe in the MOMC-transplanted rats than in macrophage-transplanted or mock-treated rats. Histological evaluations revealed that the number of microvessels that had formed in the ischemic boundary area by 4 weeks after transplantation was significantly greater in the MOMC-transplanted rats than in the control groups. The blood vessel formation was preceded by the appearance of round CD31(+) cells, which we confirmed were derived from the transplanted MOMCs. Small numbers of bloodvessels incorporating MOMC-derived endothelial cells expressing a mature endothelial marker RECA-1 were detected at 4 weeks after transplantation. In addition, MOMCs expressed a series of angiogenic factors, including vascular endothelial growth factor, angiopoetin-1, and placenta growth factor (PlGF). These findings provide evidence that the intracranial delivery of MOMCs enhances functional recovery by promoting neovascularization in a rat model for ischemic stroke.

  2. Nitric Oxide Donors as Neuroprotective Agents after an Ischemic Stroke-Related Inflammatory Reaction

    Directory of Open Access Journals (Sweden)

    Marisol Godínez-Rubí

    2013-01-01

    Full Text Available Cerebral ischemia initiates a cascade of detrimental events including glutamate-associated excitotoxicity, intracellular calcium accumulation, formation of Reactive oxygen species (ROS, membrane lipid degradation, and DNA damage, which lead to the disruption of cellular homeostasis and structural damage of ischemic brain tissue. Cerebral ischemia also triggers acute inflammation, which exacerbates primary brain damage. Therefore, reducing oxidative stress (OS and downregulating the inflammatory response are options that merit consideration as potential therapeutic targets for ischemic stroke. Consequently, agents capable of modulating both elements will constitute promising therapeutic solutions because clinically effective neuroprotectants have not yet been discovered and no specific therapy for stroke is available to date. Because of their ability to modulate both oxidative stress and the inflammatory response, much attention has been focused on the role of nitric oxide donors (NOD as neuroprotective agents in the pathophysiology of cerebral ischemia-reperfusion injury. Given their short therapeutic window, NOD appears to be appropriate for use during neurosurgical procedures involving transient arterial occlusions, or in very early treatment of acute ischemic stroke, and also possibly as complementary treatment for neurodegenerative diseases such as Parkinson or Alzheimer, where oxidative stress is an important promoter of damage. In the present paper, we focus on the role of NOD as possible neuroprotective therapeutic agents for ischemia/reperfusion treatment.

  3. Distribution territories and causative mechanisms of ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, A.; Grive, E.; Alvarez-Sabin, J. [Unidad de Resonancia Magnetica, Hospital Vall d' Hebron, Barcelona (Spain)

    2005-03-01

    Ischemic stroke prognosis, risk of recurrence, clinical assessment, and treatment decisions are influenced by stroke subtype (anatomic distribution and causative mechanism of infarction). Stroke subtype diagnosis is better achieved in the early phase of acute ischemia with the use of multimodal MR imaging. The pattern of brain lesions as shown by brain MR imaging can be classified according to a modified Oxfordshire method, based on the anatomic distribution of the infarcts into six groups: (1) total anterior circulation infarcts, (2) partial anterior circulation infarcts, (3) posterior circulation infarcts, (4) watershed infarcts, (5) centrum ovale infarcts, and (6) lacunar infarcts. The subtype of stroke according to its causative mechanism is based on the TOAST method, which classifies stroke into five major etiologic groups: (1) large-vessel atherosclerotic disease, (2) small-vessel atherosclerotic disease, (3) cardioembolic source, (4) other determined etiologies, and (5) undetermined or multiple possible etiologies. The different MR imaging patterns of acute ischemic brain lesions visualized using diffusion-weighted imaging and the pattern of vessel involvement demonstrated with MR angiography are essential factors that can suggest the most likely causative mechanism of infarction. This information may have an impact on decisions regarding therapy and the performance of additional diagnostic tests. (orig.)

  4. Microglial Responses after Ischemic Stroke and Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    Roslyn A. Taylor

    2013-01-01

    Full Text Available Stroke is a leading cause of death worldwide. Ischemic stroke is caused by blockage of blood vessels in the brain leading to tissue death, while intracerebral hemorrhage (ICH occurs when a blood vessel ruptures, exposing the brain to blood components. Both are associated with glial toxicity and neuroinflammation. Microglia, as the resident immune cells of the central nervous system (CNS, continually sample the environment for signs of injury and infection. Under homeostatic conditions, they have a ramified morphology and phagocytose debris. After stroke, microglia become activated, obtain an amoeboid morphology, and release inflammatory cytokines (the M1 phenotype. However, microglia can also be alternatively activated, performing crucial roles in limiting inflammation and phagocytosing tissue debris (the M2 phenotype. In rodent models, microglial activation occurs very early after stroke and ICH; however, their specific roles in injury and repair remain unclear. This review summarizes the literature on microglial responses after ischemic stroke and ICH, highlighting the mediators of microglial activation and potential therapeutic targets for each condition.

  5. Lack of association between serum uric acid levels and outcome in acute ischemic stroke

    NARCIS (Netherlands)

    Miedema, Irene; Uyttenboogaart, Maarten; Koch, Marcus; Kremer, Berry; de Keyser, Jacques; Luijckx, Gert-Jan

    2012-01-01

    Background: The prognostic value of serum uric acid (UA) in acute ischemic stroke is controversial. The aim of this study is to further analyse the relation between UA and outcome after acute ischemic stroke. Methods: We analysed UA levels in blood samples collected within 6 h of stroke onset from p

  6. Intraperitoneal administration of thioredoxin decreases brain damage from ischemic stroke.

    Science.gov (United States)

    Wang, Bin; Tian, Shilai; Wang, Jiayi; Han, Feng; Zhao, Lei; Wang, Rencong; Ning, Weidong; Chen, Wei; Qu, Yan

    2015-07-30

    Recent studies demonstrate that Thioredixin (Trx) possesses a neuronal protective effect and closely relates to oxidative stress and apoptosis of cerebral ischemia injury. The present study was conducted to validate the neuroprotective effect of recombinant human Trx-1 (rhTrx-1) and its potential mechanisms against ischemia injury at middle cerebral artery occlusion (MCAO) in mice. rhTrx-1 was administrated intraperitoneally at a dose of 5, 10 and 20mg/kg 30 min before MCAO in mice, and its neuronal protective effect was evaluated by neurological deficit score, brain dry-wet weight, 2,3,5-triphenyltetrazolium chloride (TTC) staining. The protein carbonyl content and HO-1 were detected to investigate its potential anti-oxidative and anti-inflammatory property, and the anti-apoptotic ability of rhTrx-1 was assessed by casepase-3 and TUNEL staining. The results demonstrated that rhTrx-1 significantly improved neurological functions and reduced cerebral infarction and apoptotic cell death at 24h after MCAO. Moreover, rhTrx-1 resulted in a significant decrease in carbonyl contents and HO-1 against oxidative stress, which turned to be fast reduction during the first 24h and tended to be stable from 24h to 72h after MCAO. The study shows that rhTrx-1 exerts an neuroprotective effect in cerebral ischemia injury. The anti-oxidative, anti-apoptotic and anti-inflammatory properties of rhTrx-1 are more likely to succeed as a therapeutic approach to diminish oxidative stress-induced neuronal apoptotic cell death in acute ischemic stroke.

  7. Vertebrobasilar territory ischemic stroke after electrical injury: delayed sequelae.

    Science.gov (United States)

    Jain, Rajendra S; Gupta, Pankaj K; Handa, Rahul; Nagpal, Kadam; Prakash, Swayam; Agrawal, Rakesh

    2014-07-01

    Electrical injuries are of very common occurrence in India and can be rarely fatal. Usually most of the patients recover without any serious complications. Rarely, neurologic aftereffects have been observed in some survivors. These neurologic insults can occur as immediate or delayed manifestations and can affect the nervous system at various levels resulting in hemiplegia, aphasia, parkinsonism, choreoathetosis, and can also involve brainstem, spinal cord, peripheral nerves, and autonomic nervous system. The involvement of vertebrobasilar territory is a rare complication of electrical injury. We herein report a case of 55-year-old male laborer who presented with vertebrobasilar territory ischemic stroke, which occurred 2 weeks after an electrical injury. To the best of our knowledge, this is the first ante mortem case report of a posterior circulation ischemic stroke occurring as a delayed complication of electrical injury.

  8. Effects of Shuxuetong injection applied in acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Wei Zhang

    2016-01-01

    Objective: To study the effects of Shuxuetong injection in adjuvant treatment of ischemic stroke on the degree of nerve injury, lipid metabolism and blood coagulation function. Methods: Patients with ischemic stroke admitted in our hospital during the period from May 2012 to May 2015 were selected for retrospective analysis. They were divided into the control group receiving regular treatment and the Shuxuetong group receiving adjuvant treatment with Shuxuetong injection. One and the three months after treatment, serum was collected and nerve injury molecules, indexes of lipid metabolism and blood coagulation function were measured. Results: One month after treatment, the contents of neuron-specific enolase, S100 cal-cium binding protein B, total cholesterol, triglyceride, low-density lipoprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The con-tents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Three months after treatment, the contents of neuron-specific enolase, S100 calcium binding protein B, total cholesterol, triglyceride, low-density li-poprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The contents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Conclusions: Adjuvant treatment with Shuxuetong injection can reduce the injury of nerve function of patients with ischemic stroke and improve blood lipid metabolism and blood coagulation function, which is an effective drug for the treatment of ischemic stroke.

  9. Effects of Shuxuetong injection applied in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    2016-11-01

    Full Text Available Objective: To study the effects of Shuxuetong injection in adjuvant treatment of ischemic stroke on the degree of nerve injury, lipid metabolism and blood coagulation function. Methods: Patients with ischemic stroke admitted in our hospital during the period from May 2012 to May 2015 were selected for retrospective analysis. They were divided into the control group receiving regular treatment and the Shuxuetong group receiving adjuvant treatment with Shuxuetong injection. One and the three months after treatment, serum was collected and nerve injury molecules, indexes of lipid metabolism and blood coagulation function were measured. Results: One month after treatment, the contents of neuron-specific enolase, S100 calcium binding protein B, total cholesterol, triglyceride, low-density lipoprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The contents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Three months after treatment, the contents of neuron-specific enolase, S100 calcium binding protein B, total cholesterol, triglyceride, low-density lipoprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The contents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Conclusions: Adjuvant treatment with Shuxuetong injection can reduce the injury of nerve function of patients with ischemic stroke and improve blood lipid metabolism and blood coagulation function, which is an effective drug for the treatment of ischemic stroke.

  10. Hemorrhagic transformation of ischemic stroke in diabetics on sulfonylureas

    OpenAIRE

    Trostdorf, Katrin

    2014-01-01

    The paper discusses the question whether sulfonylureas may reduce the risk of hemorrhagic transformation. We analized data of 765 Patients who presented with ischemic stroke in 2005 and 2006 at the Charité Berlin. We included all patients without excluding criteria and with an Diabetes mellitus. According to medication with or without sulfonylureas we built a treatment and a controlgroup. Hemorrhagic transformations presented significantly fewer in the group with sulfonylureas. Mortality ...

  11. Do energy drinks cause epileptic seizure and ischemic stroke?

    Science.gov (United States)

    Dikici, Suber; Saritas, Ayhan; Besir, Fahri Halit; Tasci, Ahmet Hakan; Kandis, Hayati

    2013-01-01

    Energy drinks are popular among young individuals and marketed to college students, athletes, and active individuals between the ages of 21 and 35 years. We report a case that had ischemic stroke and epileptic seizure after intake of energy drink with alcohol. To the best of our knowledge, the following case is the first report of ischemic stroke after intake of energy drink. A previously healthy 37-year-old man was brought to the emergency department after a witnessed tonic-clonic seizure. According to his wife's testimony, just before loss of consciousness, the patient had been drinking 3 boxes of energy drinks (Redbull, Istanbul, Turkey, 250 mL) with vodka on an empty stomach. He did not have a history of seizures, head trauma, or family history of seizures or another disease. In cranial diffusion magnetic resonance imaging, there were hyperintense signal changes in bilateral occipital area (more pronounced in the left occipital lobe), right temporal lobe, frontal lobe, and posterior parietal lobe. All tests associated with possible etiologic causes of ischemic stroke in young patients were negative. Herein, we want to attract attention to adverse effect of energy drink usage.

  12. Ginsenoside Rd and ischemic stroke; a short review of literatures

    Directory of Open Access Journals (Sweden)

    Seyed Fazel Nabavi

    2015-10-01

    Full Text Available Panax ginseng is a well-known economic medical plant that is widely used in Chinese traditional medicine. This species contains a unique class of natural products—ginsenosides. Recent clinical and experimental studies have presented numerous lines of evidence on the promising role of ginsenosides on different diseases including neurodegenerative diseases, cardiovascular diseases, and certain types of cancer. Nowadays, most of the attention has focused on ginsenoside Rd as a neuroprotective agent to attenuate ischemic stroke damages. Some of the evidence showed that ginsenoside Rd ameliorates ischemic stroke-induced damages through the suppression of oxidative stress and inflammation. Ginsenoside Rd can prolong neural cells' survival through the upregulation of the endogenous antioxidant system, phosphoinositide-3-kinase/AKT and extracellular signal-regulated protein kinase 1/2 pathways, preservation of mitochondrial membrane potential, suppression of the nuclear factor-kappa B, transient receptor potential melastatin, acid sensing ion channels 1a, poly(ADP-ribose polymerase-1, protein tyrosine kinase activation, as well as reduction of cytochrome c-releasing and apoptosis-inducing factor. In the current work, we review the available reports on the promising role of ginsenoside Rd on ischemic stroke. We also discuss its chemistry, source, and the molecular mechanism underlying this effect.

  13. 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.

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

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    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.

  15. Therapeutic targets and limits of minocycline neuroprotection in experimental ischemic stroke

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    Kaneko Yuji

    2009-10-01

    Full Text Available Abstract Background Minocycline, a second-generation tetracycline with anti-inflammatory and anti-apoptotic properties, has been shown to promote therapeutic benefits in experimental stroke. However, equally compelling evidence demonstrates that the drug exerts variable and even detrimental effects in many neurological disease models. Assessment of the mechanism underlying minocycline neuroprotection should clarify the drug's clinical value in acute stroke setting. Results Here, we demonstrate that minocycline attenuates both in vitro (oxygen glucose deprivation and in vivo (middle cerebral artery occlusion experimentally induced ischemic deficits by direct inhibition of apoptotic-like neuronal cell death involving the anti-apoptotic Bcl-2/cytochrome c pathway. Such anti-apoptotic effect of minocycline is seen in neurons, but not apparent in astrocytes. Our data further indicate that the neuroprotection is dose-dependent, in that only low dose minocycline inhibits neuronal cell death cascades at the acute stroke phase, whereas the high dose exacerbates the ischemic injury. Conclusion The present study advises our community to proceed with caution to use the minimally invasive intravenous delivery of low dose minocycline in order to afford neuroprotection that is safe for stroke.

  16. Integrated analysis of ischemic stroke datasets revealed sex and age difference in anti-stroke targets.

    Science.gov (United States)

    Li, Wen-Xing; Dai, Shao-Xing; Wang, Qian; Guo, Yi-Cheng; Hong, Yi; Zheng, Jun-Juan; Liu, Jia-Qian; Liu, Dahai; Li, Gong-Hua; Huang, Jing-Fei

    2016-01-01

    Ischemic stroke is a common neurological disorder and the burden in the world is growing. This study aims to explore the effect of sex and age difference on ischemic stroke using integrated microarray datasets. The results showed a dramatic difference in whole gene expression profiles and influenced pathways between males and females, and also in the old and young individuals. Furthermore, compared with old males, old female patients showed more serious biological function damage. However, females showed less affected pathways than males in young subjects. Functional interaction networks showed these differential expression genes were mostly related to immune and inflammation-related functions. In addition, we found ARG1 and MMP9 were up-regulated in total and all subgroups. Importantly, IL1A, ILAB, IL6 and TNF and other anti-stroke target genes were up-regulated in males. However, these anti-stroke target genes showed low expression in females. This study found huge sex and age differences in ischemic stroke especially the opposite expression of anti-stroke target genes. Future studies are needed to uncover these pathological mechanisms, and to take appropriate pre-prevention, treatment and rehabilitation measures.

  17. Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

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    Choi, Nari; Yoon, Jee-Eun; Park, Byoung-Won; Chang, Won-Ho; Kim, Hyun-Jo; Lee, Kyung Bok

    2016-01-01

    We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding. PMID:27734002

  18. Acute development of collateral circulation and therapeutic prospects in ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Eri Iwasawa; Masahiko Ichijo; Satoru Ishibashi; Takanori Yokota

    2016-01-01

    In acute ischemic stroke, collateral circulation plays an important role in maintaining blood lfow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate with-out hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by lfuid shear stress, which occurs be-tween the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate recep-tor 1, which is a known shear-stress mechanosensing protein.

  19. Non-Gaussian diffusion imaging for enhanced contrast of brain tissue affected by ischemic stroke.

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    Farida Grinberg

    Full Text Available Recent diffusion MRI studies of stroke in humans and animals have shown that the quantitative parameters characterising the degree of non-Gaussianity of the diffusion process are much more sensitive to ischemic changes than the apparent diffusion coefficient (ADC considered so far as the "gold standard". The observed changes exceeded that of the ADC by a remarkable factor of 2 to 3. These studies were based on the novel non-Gaussian methods, such as diffusion kurtosis imaging (DKI and log-normal distribution function imaging (LNDFI. As shown in our previous work investigating the animal stroke model, a combined analysis using two methods, DKI and LNDFI provides valuable complimentary information. In the present work, we report the application of three non-Gaussian diffusion models to quantify the deviations from the Gaussian behaviour in stroke induced by transient middle cerebral artery occlusion in rat brains: the gamma-distribution function (GDF, the stretched exponential model (SEM, and the biexponential model. The main goal was to compare the sensitivity of various non-Gaussian metrics to ischemic changes and to investigate if a combined application of several models will provide added value in the assessment of stroke. We have shown that two models, GDF and SEM, exhibit a better performance than the conventional method and allow for a significantly enhanced visualization of lesions. Furthermore, we showed that valuable information regarding spatial properties of stroke lesions can be obtained. In particular, we observed a stratified cortex structure in the lesions that were well visible in the maps of the GDF and SEM metrics, but poorly distinguishable in the ADC-maps. Our results provided evidence that cortical layers tend to be differently affected by ischemic processes.

  20. Registro de enfermedad cerebrovascular isquémica Ischemic stroke registry

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    Juan I. Rojas

    2006-12-01

    patients with ischemic stroke. We analyzed all consecutive ischemic stroke in patients admitted at Hospital Italiano of Buenos Aires, between June 1, 2003 and June 1, 2005. Among 395 ischemic stroke patients, the mean age was 71.36 years (± 13.82 and 55% were male. Ischemic stroke subtypes were as follows: 40% patients had lacunar, 20% atherosclerotic stroke, 10% cardioembolic infarction, and 5% other causes of stroke. Hypertension (76%, hyperlipemia (50% and prior stroke (34% were the most frequent risk factors. Most patients with cortical symptoms had significant large-artery atherosclerosis (> 70%. Stroke informations in developing countries is difficult to obtain. This could be the reason for the very few stroke registries in South America. Hypertension was the most frequent risk factor in our registry. The pattern of stroke subtypes seems to be different from that reported in other regions of the world, with a higher frequency of small-vessel disease.

  1. Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

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    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.

  2. 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

  3. 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.

  4. The role of monocytes in ischemic stroke pathobiology: New avenues to explore

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    Ayman eElAli

    2016-02-01

    Full Text Available Ischemic stroke accounts for the majority of stroke cases and constitutes a major cause of death and disability in the industrialized world. Inflammation has been reported to constitute a major component of ischemic stroke pathobiology. In the acute phase of ischemic stroke, microglia, the resident macrophages of the brain, are activated, followed by several infiltration waves of different circulating immune cells into the brain. Among these circulating immune cells, monocytes have been shown to play a particularly important role. Following their infiltration, monocytes differentiate into potent phagocytic cells, monocyte-derived macrophages (MDMs in the ischemic brain. Initially, the presence of these cells was considered as marker of an exacerbated inflammatory response that contributes to brain damage. However, the recent reports are suggesting a more complex and multiphasic roles of these cells in ischemic stroke pathobiology. Monocytes constitute a heterogeneous group of cells, which comprises two major subsets in rodent and three major subsets in human. In both species, two equivalent subsets exist, the pro-inflammatory subset and the anti-inflammatory subset. Recent data have demonstrated that ischemic stroke differentially regulate monocyte subsets, which directly affect ischemic stroke pathobiology and may have direct implications in ischemic stroke therapies. Here we review the recent findings that addressed the role of different monocyte subsets in ischemic stroke pathobiology, and the implications on therapies.

  5. Computed tomography in acute ischemic stroke

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    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.)

  6. Current trends in the management of acute ischemic stroke

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    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

  7. 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

  8. 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

  9. Final 2 year results of the vascular imaging of acute stroke for identifying predictors of clinical outcome and recurrent ischemic eveNts (VISION study

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    Eliasziw Misha

    2011-04-01

    Full Text Available Abstract Among patients with ischemic stroke, little attention has been paid to differentiation between stroke progression and recurrence. We assessed the role of MR imaging in predicting stroke progression, recurrent stroke, and death within 2 years of symptom onset. Methods Ischemic stroke or TIA patients were prospectively enrolled. They were examined within 12 hours and had a stroke MR completed within 24 hours of symptom onset. Patients were closely followed neurologically and examined if there was any deterioration in neurological status. Relationships between baseline clinical and imaging factors and outcomes were assessed. We also examined whether baseline stroke/TIA severity (NIHSS 0-5 versus NIHSS > 5 modified these relationships. Results A total of 334 patients were enrolled. The overall rates of progression, 2-year recurrence, and 2-year death were 8.7%, 8.0%, and 6.6%, respectively. Event rates were similar among patients with mild compared to more severe strokes: 8.3% versus 9.5% (p = 0.73 for progression, and 7.3% versus 9.9% (p = 0.59 for recurrence. The effect of baseline glucose > 8 mmol/l was consistent in predicting stroke progression, recurrent stroke and death, regardless of baseline stroke severity. In multivariable analyses, DWI lesion and intracranial occlusion predicted stroke progression only in the minor stroke/TIA group; symptomatic Internal Carotid Artery (ICA stenosis predicted stroke recurrence only in the minor stroke/TIA group. Conclusions In a prospective study with early assessment and imaging we have found that stroke progression is different than stroke recurrence. Different imaging factors predict stroke progression versus stroke recurrence. Baseline hyperglycemia, a potentially modifiable factor, consistently predicted all three outcomes (stroke progression, recurrent stroke or death regardless of baseline stroke severity.

  10. Thrombolysis in acute ischemic stroke is associated with lower long-term hospital bed day use

    DEFF Research Database (Denmark)

    Terkelsen, Thorkild; Schmitz, Marie Louise; Simonsen, Claus Z;

    2016-01-01

    and the risk of readmission due to stroke-related complications. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). Thrombolysed patients were propensity-score matched with non-thrombolysed acute ischemic stroke...... using multivariable log-linear regression and Cox regression. RESULTS: We identified 1095 thrombolysed and 1095 propensity score matched eligible but non-thrombolysed acute ischemic stroke patients. The median length of the stroke admission was 9 days in the thrombolysed group and 13 days in the non...

  11. Gender differences in patients with acute ischemic stroke.

    Science.gov (United States)

    Caso, Valeria; Paciaroni, Maurizio; Agnelli, Giancarlo; Corea, Francesco; Ageno, Walter; Alberti, Andrea; Lanari, Alessia; Micheli, Sara; Bertolani, Luca; Venti, Michele; Palmerini, Francesco; Billeci, Antonia M R; Comi, Giancarlo; Previdi, Paolo; Silvestrelli, Giorgio

    2010-01-01

    Stroke has a greater effect on women than men owing to the fact that women have more stroke events and are less likely to recover. Age-specific stroke rates are higher in men; however, because of women's longer life expectancy and the much higher incidence of stroke at older ages, women have more stroke events than men overall. The aims of this prospective study in consecutive patients were to assess whether there are gender differences in stroke risk factors, treatment or outcome. Consecutive patients with ischemic stroke were included in this prospective study at four study centers. Disability was assessed using a modified Rankin Scale score (>or=3 indicating disabling stroke) in both genders at 90 days. Outcomes and risk factors in both genders were compared using the chi(2) test. Multiple logistic regression analysis was used to identify any independent predictors of outcome. A total of 1136 patients were included in this study; of these, 494 (46%) were female. Women were statistically older compared with men: 76.02 (+/- 12.93) and 72.68 (+/- 13.27) median years of age, respectively. At admission, females had higher NIH Stroke Scale scores compared with males (9.4 [+/- 6.94] vs 7.6 [+/- 6.28] for men; p = 0.0018). Furthermore, females tended to have more cardioembolic strokes (153 [30%] vs 147 [23%] for men; p = 0.004). Males had lacunar and atherosclerotic strokes more often (146 [29%] vs 249 [39%] for men; p = 0.002, and 68 [13%] vs 123 [19%] for men; p = 0.01, respectively). The mean modified Rankin Scale score at 3 months was also significantly different between genders, at 2.5 (+/- 2.05) for women and 2.1 (+/- 2.02) for men (p = 0.003). However, at multivariate analysis, female gender was not an indicator for negative outcome. It was concluded that female gender was not an independent factor for negative outcome. In addition, both genders demonstrated different stroke pathophysiologies. These findings should be taken into account when diagnostic workup and

  12. Long-term survival and regeneration of neuronal and vasculature cells inside the core region after ischemic stroke in adult mice.

    Science.gov (United States)

    Jiang, Michael Qize; Zhao, Ying-Ying; Cao, Wenyuan; Wei, Zheng Zachory; Gu, Xiaohuan; Wei, Ling; Yu, Shan Ping

    2016-08-11

    Focal cerebral ischemia results in an ischemic core surrounded by the peri-infarct region (penumbra). Most research attention has been focused on penumbra while the pattern of cell fates inside the ischemic core is poorly defined. In the present investigation, we tested the hypothesis that, inside the ischemic core, some neuronal and vascular cells could survive the initial ischemic insult while regenerative niches might exist many days after stroke in the adult brain. Adult mice were subjected to focal cerebral ischemia induced by permanent occlusion of distal branches of the middle cerebral artery (MCA) plus transient ligations of bilateral common carotid artery (CCA). The ischemic insult uniformly reduced the local cerebral blood flow (LCBF) by 90%. Massive cell death occurred due to multiple mechanisms and a significant infarction was cultivated in the ischemic cortex 24 h later. Nevertheless, normal or even higher levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) persistently remained in the core tissue, some NeuN-positive and Glut-1/College IV-positive cells with intact ultrastructural features resided in the core 7-14 days post stroke. BrdU-positive but TUNEL-negative neuronal and endothelial cells were detected in the core where extensive extracellular matrix infrastructure developed. Meanwhile, GFAP-positive astrocytes accumulated in the penumbra and Iba-1-positive microglial/macrophages invaded the core several days after stroke. The long term survival of neuronal and vascular cells inside the ischemic core was also seen after a severe ischemic stroke induced by permanent embolic occlusion of the MCA. We demonstrate that a therapeutic intervention of pharmacological hypothermia could save neurons/endothelial cells inside the core. These data suggest that the ischemic core is an actively regulated brain region with residual and newly formed viable neuronal and vascular cells acutely and chronically after at

  13. Posterior circulation ischemic stroke following Russell′s viper envenomation

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    Siddalingana Gouda

    2011-01-01

    Full Text Available Ischemic stroke following viper bite is rare. We report a case of posterior circulation ischemic infarction following viper bite in a previously healthy woman. Soon after being bitten by the snake on the left leg, she developed local redness, echymosis and one hour later became drowsy. On examination she had skew deviation of eyes and down gaze preference, generalized hypotonia. A CT scan of brain showed infarcts in cerebellar hemispheres and occipital lobes on both sides and that was confirmed on magnetic resonance imaging of brain. Her coagulation profile was deranged. Most common and serious central nervous system complication following snake bite is intracranial hemorrhage. Ischemic stroke commonly involves anterior circulation. Bilateral cerebellar and occipital infraction is not yet reported in literature. Exact cause for the development of infarction is not clear. The possible mechanisms of infarction in this scenario are discussed. Patient was treated with anti-snake venom and showed a good recovery. Early imaging and early treatment with anti-snake venom is important for a favorable outcome.

  14. Therapeutic Potential of Non-Psychotropic Cannabidiol in Ischemic Stroke.

    Science.gov (United States)

    Hayakawa, Kazuhide; Mishima, Kenichi; Fujiwara, Michihiro

    2010-07-08

    Cannabis contains the psychoactive component delta⁸-tetrahydrocannabinol (delta⁸-THC), and the non-psychoactive components cannabidiol (CBD), cannabinol, and cannabigerol. It is well-known that delta⁸-THC and other cannabinoid CB₁ receptor agonists are neuroprotective during global and focal ischemic injury. Additionally, delta⁸-THC also mediates psychological effects through the activation of the CB₁ receptor in the central nervous system. In addition to the CB₁ receptor agonists, cannabis also contains therapeutically active components which are CB₁ receptor independent. Of the CB₁ receptor-independent cannabis, the most important is CBD. In the past five years, an increasing number of publications have focused on the discovery of the anti-inflammatory, anti-oxidant, and neuroprotective effects of CBD. In particular, CBD exerts positive pharmacological effects in ischemic stroke and other chronic diseases, including Parkinson's disease, Alzheimer's disease, and rheumatoid arthritis. The cerebroprotective action of CBD is CB₁ receptor-independent, long-lasting, and has potent anti-oxidant activity. Importantly, CBD use does not lead to tolerance. In this review, we will discuss the therapeutic possibility of CBD as a cerebroprotective agent, highlighting recent pharmacological advances, novel mechanisms, and therapeutic time window of CBD in ischemic stroke.

  15. Therapeutic Potential of Non-Psychotropic Cannabidiol in Ischemic Stroke

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    Michihiro Fujiwara

    2010-07-01

    Full Text Available Cannabis contains the psychoactive component delta9-tetrahydrocannabinol (delta9-THC, and the non-psychoactive components cannabidiol (CBD, cannabinol, and cannabigerol. It is well-known that delta9-THC and other cannabinoid CB1 receptor agonists are neuroprotective during global and focal ischemic injury. Additionally, delta9-THC also mediates psychological effects through the activation of the CB1 receptor in the central nervous system. In addition to the CB1 receptor agonists, cannabis also contains therapeutically active components which are CB1 receptor independent. Of the CB1 receptor-independent cannabis, the most important is CBD. In the past five years, an increasing number of publications have focused on the discovery of the anti-inflammatory, anti-oxidant, and neuroprotective effects of CBD. In particular, CBD exerts positive pharmacological effects in ischemic stroke and other chronic diseases, including Parkinson’s disease, Alzheimer’s disease, and rheumatoid arthritis. The cerebroprotective action of CBD is CB1 receptor-independent, long-lasting, and has potent anti-oxidant activity. Importantly, CBD use does not lead to tolerance. In this review, we will discuss the therapeutic possibility of CBD as a cerebroprotective agent, highlighting recent pharmacological advances, novel mechanisms, and therapeutic time window of CBD in ischemic stroke.

  16. Prevalence and Prognostic Significance of Runs of Premature Atrial Complexes in Ischemic Stroke Patients

    DEFF Research Database (Denmark)

    Høeg Vinther, Kristina; Tveskov, Claus; Möller, Sören;

    2016-01-01

    BACKGROUND AND PURPOSE: Runs of premature atrial complexes (PACs) are common in stroke patients and perceived to be clinically insignificant, but their prognostic significance is unclear. This study investigated the association between runs of PACs in ischemic stroke patients and the risk...... of recurrent ischemic strokes/transient ischemic attacks (TIAs) or death. METHODS: The study included consecutive patients admitted with an ischemic stroke from August 2008 to April 2011. Patients with known and newly detected atrial fibrillation were excluded. Runs of PACs were defined as 3 or more PACs...... lasting less than 30 seconds during 48 hours of continuous inpatient cardiac telemetry. The patients were followed for 4 years or until death, whichever came first. They were stratified according to stroke severity. The combined primary endpoint was a recurrent ischemic stroke/TIA or death. RESULTS...

  17. Prediction of ischemic stroke in young Indians: is thrombophilia profiling a way out?

    Science.gov (United States)

    Chatterjee, Tathagata; Gupta, Neha; Choudhry, Ved Prakash; Behari, Madhuri; Saxena, Renu; Ashraf, Mohammad Z

    2013-06-01

    Stroke in the young is attributed to the prevalence of thrombophilia, however, reports explaining the cause mechanisms from Indian populations are largely not known. The information about the association of inherited thrombophilia and occurrence of stroke is still missing. Therefore, we describe here 52 cases of young ischemic stroke of which 22 cases were of recurrent stroke and 30 cases of first episode stroke along with an equal number of healthy controls. Imaging techniques (CT/MRI/Doppler studies) were used to identify the type and location of infarcts among various regions of the brain. All the patients and controls were screened for hypercoagulable state by employing Pro C global test. Those tested positive for the latter were evaluated for conventional thrombophilic factors, activity levels of protein C and protein S, antithrombin III levels, plasma homocysteine levels and presence of activated protein C resistance, lupus anticoagulant, methylenetetrahydrofolate reductase (MTHFR C677T) and prothrombin G20210A polymorphisms. Out of 52 cases there were 22 cases of recurrent stroke and 30 cases of first ischemic stroke. Infarcts were single in 39 out of 52 cases and multiple in 13 cases. Among the different regions of brain internal capsule infarcts were seen in 13 of 52 (25%) cases, and cerebellum, basal ganglion and midbrain infarcts were seen in five cases (9.6%) each and remaining infarcts were in other anatomical regions of the brain. Left middle cerebral artery territory was involved in 17 of 52 (32.7%) cases. The prevalence of individual thrombophilia among cases ranged from 28.8% (15/52) for protein S and 11.5% (6/52) for protein C deficiencies respectively. All cases of protein C were protein S deficient. Five cases of protein C deficiency patients were of 25 years and younger as compared with one case in the at least 25 years age group. Plasma homocysteine levels were elevated in three cases (5.7%) as compared with normal levels in controls

  18. Limb remote ischemic per-conditioning in combination with post-conditioning reduces brain damage and promotes neuroglobin expression in the rat brain after ischemic stroke

    Science.gov (United States)

    Ren, Changhong; Wang, Pengcheng; Wang, Brian; Li, Ning; Li, Weiguang; Zhang, Chenggang; Jin, Kunlin; Ji, Xunming

    2015-01-01

    Abstract Purpose: Limb remote ischemic per-conditioning or post-conditioning has been shown to be neuroprotective after cerebral ischemic stroke. However, the effect of combining remote per-conditioning with post-conditioning on ischemic/reperfusion injury as well as the underlying mechanisms are largely unexplored. Methods: Here, adult male Sprague Dawley rats were subjected to middle cerebral artery occlusion (MCAO). The limb ischemic stimulus was immediately applied after onset of focal ischemia (per-conditioning), followed by repeated short episodes of remote ischemia 24 hr after reperfusion (post-conditioning). The infarct volume, motor function, and the expression of neuroglobin (Ngb) were measured at different durations after reperfusion. Results: We found that a single episode of limb remote per-conditioning afforded short-term protection, but combining repeated remote post-conditioning during the 14 days after reperfusion significantly ameliorated cerebral ischemia/reperfusion injury. Interestingly, we also found that ischemic per- and post-conditioning significantly increased expression of Ngb, an oxygen-binding globin protein that has been demonstrated to be neuroprotective against stroke, at peri-infarct regions from day 1 to day 14 following ischemia/reperfusion. Conclusion: Our results suggest that the conventional per-conditioning combined with post-conditioning may be used as a novel neuroprotective strategy against ischemia-reperfusion injury, and Ngb seems to be one of the important players in limb remote ischemia-mediated neuroprotection. PMID:25868435

  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. EVALUATION OF EARLY ISCHEMIC CHANGES IN STROKE PATIENTS TREATED WITH THROMBOLYTIC THERAPY

    Directory of Open Access Journals (Sweden)

    Kolevski Goran

    2016-07-01

    Full Text Available Introduction:The aim of this study is to evaluate early brain ischemic changes on CT scan in stroke patients in correlation with the clinical outcome, as well as to evaluate if there is prognostic and predictive features that can be used. Patients and methods: We examined 20 patients with acute ischemic stroke, from which 12 were male and 8 were female, at the age from 47 to 76 years. Results: The hyperdense medial artery (HMA sign was present in 10 (50% patients. Concerning the ASPECTS score, 5 patients (25% had normal score of 10 points, while 7 patients (35% had score of 7 points. 12 patients (60% had unfavorable outcome, while 8 patients (40% had favorable outcome. Our statistical analysis shows that age of more than 65 years, presence of 2 or more risk-factors, ASPECTS score of 7 and presence of HMA sign were all statistically significant predictors of unfavorable outcome in examined patients (p<0.05 each. The presence of the hyperdense medial artery sign was the most significant single predictor for unfavorable clinical outcome (p=0.0042, p<0.05. Conclusion:The presence of HMA sign is the most significant single predictor for unfavorable clinical outcome.

  1. A COMPAR A TIVE STUDY OF SELECTIVE INDICATOR PROFILES IN PATIENTS WITH ISCHEMIC STROKE AND HEMORRHAGIC STROKE

    OpenAIRE

    Narayanaswamy; Ravi; Nagarjun

    2015-01-01

    BACKGROUND: In Urban India, stroke accounts for 1% mortality in all hospital admissions. The pathogenic role of increased plasma fibrinogen level in causing stroke has been recently reinforced. It was therefore of interest to measure plasma fibrinogen level in patients with ischemic and hemorrhagic stroke and to compare it with lipid profile....

  2. Platelet glycoprotein Ibα is an important mediator of ischemic stroke in mice

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    De Meyer Simon F

    2011-09-01

    Full Text Available Abstract Background Platelets play an important role in ischemic stroke. GPIbα is a major platelet receptor that is critical for platelet adhesion to exposed subendothelial matrix components at sites of vascular damage. Methods In this study, we used transgenic mice in which the extracellular part of GPIbα is replaced by human interleukin 4-receptor (GPIbα/IL4Rα. We observed normal brain vasculature in these mice. We compared infarct size in GPIbα/IL4Rα and wild-type (WT mice 23 hours after 1-hour transient middle cerebral artery occlusion (tMCAO. In addition, the functional outcome was evaluated using a modified Bederson score. Results We found a significantly smaller infarct size in GPIbα/IL4Rα mice compared to WT mice (38.0 ± 6.5 mm3 vs. 74.2 ± 8.6 mm3, p Conclusions Our data illustrate and further confirm the important role of platelet GPIbα in ischemic stroke, suggesting that targeted inhibition of this receptor may open new avenues in stroke treatment.

  3. Laryngeal Elevation Velocity and Aspiration in Acute Ischemic Stroke Patients

    Science.gov (United States)

    Zhang, Jing; Zhou, Yun; Wei, Na; Yang, Bo; Wang, Anxin; Zhou, Hai; Zhao, Xingquan; Wang, Yongjun; Liu, Liping; Ouyoung, Melody; Villegas, Brenda; Groher, Michael

    2016-01-01

    Objectives Aspiration after stroke has been associated with aspiration pneumonia, which contributes to increased mortality of stroke. Laryngeal elevation is a core mechanism for protection from aspiration. Few studies have explored the predictive value of laryngeal elevation velocity for aspiration after stroke. This study aimed to explore the ability of laryngeal elevation velocity to predict aspiration in patients with acute ischemic stroke. Methods This was a prospective cohort study that included consecutive acute ischemic stroke patients treated at a teaching hospital during a 10-month period. Patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis of acute ischemic stroke. Patients who were at risk of aspiration and could swallow 5 ml of diluted barium (40%, w/v) for a videofluoroscopic swallowing (VFS) study were included. The association between abnormal indices in the oral and pharyngeal phase of the VFS study and aspiration was examined using univariate analyses. These indices included the lip closure, tongue movement and control, laryngeal elevation velocity and range, the latency of pharyngeal swallowing, pharyngeal transit time (PTT), abnormal epiglottis tilt, residual barium in the pharynx, and the duration of upper esophageal sphincter (UES) opening. The laryngeal elevation velocity (%/s) was calculated as the range of laryngeal elevation (%) from the resting position to the maximum superior position or to the position where the laryngeal vestibule is fully closed divided by the corresponding duration of laryngeal elevation. The range of laryngeal elevation (%) was the percentage calculated as the distance between the resting laryngeal position and the maximum superior excursion position or position where the laryngeal vestibule is fully closed divided by the distance between the resting laryngeal position and the lowest edge of the mandible. A logistic regression analysis was used to determine the predictive value for aspiration

  4. Statin Prescription Adhered to Guidelines for Patients Hospitalized due to Acute Ischemic Stroke or Transient Ischemic Attack

    OpenAIRE

    Hong, Keun-Sik; Oh, Mi Sun; Choi, Hye-Yeon; Cho, A-Hyun; Kwon, Hyung-Min; Yu, Kyung-Ho; Bae, Hee-Joon; Lee, Juneyoung; Lee, Byung-Chul; ,

    2013-01-01

    Background and Purpose Secondary stroke prevention guidelines recommend statins for the management of dyslipidemia in ischemic stroke and transient ischemic attack (TIA). This study assessed the guideline-based statin prescription (GBSP) rate in Korea and the associated physician and patient factors. Methods A survey was conducted to assess Korean neurologists' knowledge of and attitude toward the current dyslipidemia management guidelines. The characteristics and discharge statin prescriptio...

  5. Investigation of Antiphosphatidyl-Serine Antibody and Antiphosphatidyl-Inositol Antibody in Ischemic Stroke Patients

    Directory of Open Access Journals (Sweden)

    Hirohisa Okuma

    2010-01-01

    Full Text Available Antiphospholipid syndrome is characterized by arterial or venous thrombosis and the presence of antiphospholipid antibodies (aPL. We measured β2-GPI aCL, IgGaCL, LA, antiphosphatidyl-serine antibody (PS, and antiphosphatidyl-inositol antibody (PI in each patient at one month after the onset of stroke. In addition, carotid artery echography was performed in patients positive for PI or PS. Among the 250 patients, 13.6% (34/250 were positive for either PI or PS, and 6.8% (17/250 were positive for both. Carotid artery echography performed on these 34 patients showed that the frequencies of increased intimal-medial thickness (IMT of 1.1 mm or more, plaque, and carotid artery stenosis of 50% or more were all significantly higher in patients positive for antinuclear antibody than those negative for the antibody (P<.05. PI and PS are associated with antinuclear antibody and precipitation of atherosclerosis. Ischemic stroke patients with SLE frequently showed a variety of antiphospholipid-protein antibodies.

  6. Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study

    Science.gov (United States)

    Zhu, Runxiu; Yan, Zhongrui; Zheng, Shouhuan; Wang, Jingwei; Huo, Jia; Liu, Yunlin; Li, Xin; Ji, Yong

    2016-01-01

    To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE) at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale) score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05–2.11, p<0.001). Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery. PMID:26751070

  7. Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Wei Yue

    Full Text Available To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05-2.11, p<0.001. Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery.

  8. Prevalence of electrocardiographic ST-T changes during acute ischemic stroke in patients without known ischemic heart disease

    DEFF Research Database (Denmark)

    Jensen, Jesper K; Bak, Søren; Flemming Høilund-Carlsen, Poul;

    2008-01-01

    We evaluated characteristics and prevalence of ST-segment depression and/or T-wave inversion in the resting electrocardiogram of 244 consecutive patients with acute ischemic stroke, but without ischemic heart disease. The prevalence of ST-T changes ranged from 13% to 16% and this is what to expect...

  9. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne; Høst, Nis;

    2016-01-01

    AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents...

  10. Fibrinogen γ′ in ischemic stroke: A case-control study

    NARCIS (Netherlands)

    E.Y.L. Cheung (Elim); S.U. de Willige; H.L. Vos (Hans); F.W.G. Leebeek (Frank); D.W.J. Dippel (Diederik); R.M. Bertina (Rogier); M.P.M. de Maat (Moniek)

    2008-01-01

    textabstractBACKGROUND AND PURPOSE - To determine the contribution of fibrinogen γ′ levels and FGG haplotypes to ischemic stroke. METHODS - Associations between fibrinogen γ′ levels, fibrinogen γ′/total fibrinogen ratio, and FGG haplotypes with the risk of ischemic stroke were determined in 124 case

  11. Strongly increased levels of fibrinogen elastase degradation products in patients with ischemic stroke

    NARCIS (Netherlands)

    Lau, L.M.L. de; Cheung, E.Y.L.; Kluft, C.; Leebeek, F.W.G.; Meijer, P.; Laterveer, R.; Dippel, D.W.J.; Maat, M.P.M.de

    2008-01-01

    Ischemic stroke is associated with leucocyte activation. Activated leucocytes release elastase, an enzyme that can degrade fibrinogen. Fibrinogen elastase degradation products (FgEDP) may serve as a specific marker of elastase proteolytic activity. In a case-control study of 111 ischemic stroke pati

  12. Value of Whole Brain Computed Tomography Perfusion for Predicting Outcome after TIA or Minor Ischemic Stroke

    NARCIS (Netherlands)

    Van Den Wijngaard, Ido R.; Algra, Ale; Lycklama À Nijeholt, Geert J.; Boiten, Jelis; Wermer, Marieke J H; Van Walderveen, Marianne A A

    2015-01-01

    Introduction About 15% of patients with transient ischemic attack (TIA) or minor ischemic stroke have functional impairment after 3 months. We studied the role of whole brain computed tomography perfusion (WB-CTP) in the emergency diagnosis of TIA or minor stroke in predicting disability at 3 months

  13. Clinical experience with ceraxon used in ischemic stroke

    Directory of Open Access Journals (Sweden)

    Vladimir Anatolyevich Parfenov

    2010-01-01

    Full Text Available Citicoline (Ceraxon is a neuroprotective agent used in acute ischemic stroke (IS and chronic cerebrovascular diseases. The efficiency and safety of Ceraxon intravenously in a dose of2000 mg/day for 10 days, then orally for 35 days with evaluation of its effect on cognitive functions were studied in 24 patients (13 men, 11 women; mean age 68.2+9.3 years with IS. During treatment, none of the patients died or developed recurrent stroke, myocardial infarction, or other vascular events. A gradual regression of neurological disorders and a lower degree of disability were observed in most patients (18/24. Ceraxon was found to have a positive effect on cognitive function and their improvement on day 45 after disease onset. The findings agree with the results of the multicenter studies showing the efficacy and safety of citicoline in IS.

  14. Simulation of human ischemic stroke in realistic 3D geometry

    Science.gov (United States)

    Dumont, Thierry; Duarte, Max; Descombes, Stéphane; Dronne, Marie-Aimée; Massot, Marc; Louvet, Violaine

    2013-06-01

    In silico research in medicine is thought to reduce the need for expensive clinical trials under the condition of reliable mathematical models and accurate and efficient numerical methods. In the present work, we tackle the numerical simulation of reaction-diffusion equations modeling human ischemic stroke. This problem induces peculiar difficulties like potentially large stiffness which stems from the broad spectrum of temporal scales in the nonlinear chemical source term as well as from the presence of steep spatial gradients in the reaction fronts, spatially very localized. Furthermore, simulations on realistic 3D geometries are mandatory in order to describe correctly this type of phenomenon. The main goal of this article is to obtain, for the first time, 3D simulations on realistic geometries and to show that the simulation results are consistent with those obtain in experimental studies or observed on MRI images in stroke patients. For this purpose, we introduce a new resolution strategy based mainly on time operator splitting that takes into account complex geometry coupled with a well-conceived parallelization strategy for shared memory architectures. We consider then a high order implicit time integration for the reaction and an explicit one for the diffusion term in order to build a time operator splitting scheme that exploits efficiently the special features of each problem. Thus, we aim at solving complete and realistic models including all time and space scales with conventional computing resources, that is on a reasonably powerful workstation. Consequently and as expected, 2D and also fully 3D numerical simulations of ischemic strokes for a realistic brain geometry, are conducted for the first time and shown to reproduce the dynamics observed on MRI images in stroke patients. Beyond this major step, in order to improve accuracy and computational efficiency of the simulations, we indicate how the present numerical strategy can be coupled with spatial

  15. Infarto cerebral isquémico en el postoperatorio inmediato de una transposición de grandes vasos en una niña de 5 meses y medio Ischemic stroke in the early postoperative period of a transposition of great arteries in a 5 and a half months female infant

    Directory of Open Access Journals (Sweden)

    A. Rico

    2009-07-01

    Full Text Available La Transposición de los Grandes Vasos con septum íntegro (TGV con SI es una cardiopatía congénita caracterizada por la existencia de una discordancia aislada ventrículo-arterial con concordancia aurículo-ventricular. Al no existir mezcla entre las circulaciones sistémica y pulmonar a través de una comunicación interventricular se trata de una cardiopatía cianosante severa, ya que no es posible la oxigenación a nivel sistémico. Presentamos el caso de una niña diagnosticada de TGV con SI a los 5 meses y 15 días de edad. Se intervino mediante atriseptostomía de urgencia y posterior cirugía de "recuperación" (banding de la arteria pulmonar y shunt subclavia-pulmonar previa a la corrección anatómica mediante switch arterial. Falleció a los 8 días del ingreso como consecuencia de un infarto cerebral isquémico.Transposition of the Great Arteries (TGA with intact ventricular septum is a congenital heart disease characterized by ventricle-arterial discordance and atria-ventricle concordance. Cyanosis is common in patients with TGA because there is no mixing between systemic and pulmonary circulations through a ventricular septal defect and systemic oxygenation is not possible. We report the case of a 5 months and 15 days old female infant who was diagnosed with TGA with intact septum. Balloon atrial septostomy and "retraining" of left ventricle by pulmonary artery banding and subclavian-pulmonary artery shunt were necessary to be performed before anatomical correction by arterial switch. Nevertheless, she died 8 days after admission due to an ischemic stroke.

  16. Non-convulsive status epilepticus after ischemic stroke: a hospital-based stroke cohort study.

    Science.gov (United States)

    Belcastro, Vincenzo; Vidale, Simone; Gorgone, Gaetano; Pisani, Laura Rosa; Sironi, Luigi; Arnaboldi, Marco; Pisani, Francesco

    2014-11-01

    To evaluate in the setting of a stroke unit ward the usefulness of a prolonged (>6 h) video-EEG recording (PVEEG) in identifying non-convulsive status epilepticus (NCSE) in patients with an acute ischemic stroke. Predictors of NCSE were also evaluated. Patients with an acute ischemic stroke, referred to our unit, were included in this prospective observational study. A PVEEG recording was implemented after stroke in all patients during the first week: (a) promptly in those exhibiting a clear or suspected epileptic manifestation; (b) at any time during the routine activity in the remaining patients. After the first week, a standard EEG/PVEEG recording was hooked up only in presence of an evident or suspected epileptic manifestation or as control of a previous epileptic episode. NCSE was identified in 32 of the 889 patients (3.6 %) included in the study. It occurred early (within the first week) in 20/32 (62.5 %) patients and late in the remaining 12. Diagnosis was made on the basis of a specific clinical suspect (n = 19, 59.4 %) or without any suspect (n = 13, 40.6 %). In a multivariate analysis, a significant association of NCSE was observed with NIHSS score, infarct size and large atherothrombotic etiology. NCSE is not a rare event after an acute ischemic stroke and a delayed diagnosis could worsen patient prognosis. Since NCSE can be difficult to be diagnosed only on clinical grounds, implementation of a prompt PVEEG should be kept available in a stroke unit whenever a patient develop signs, although subtle, consistent with NCSE.

  17. The Prognostic Values of Leukocyte Rho Kinase Activity in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Cheng-I. Cheng

    2014-01-01

    Full Text Available Objective. It has been reported that leukocyte ROCK activity is elevated in patients after ischemic stroke, but it is unclear whether leukocyte ROCK activity is associated with clinical outcomes following acute stroke events. The objective of this study is to investigate if leukocyte ROCK activity can predict the outcomes in patients with acute ischemic stroke. Materials and Methods. We enrolled 110 patients of acute ischemic stroke and measured the leukocyte ROCK activity and plasma level of inflammatory cytokines to correlate the clinical outcomes of these patients. Results. The leukocyte ROCK activity at 48 hours after admission in acute ischemic stroke patients was higher as compared to a risk-matched population. The leukocyte ROCK activity significantly correlated with National Institute of Health Stroke Scale (NIHSS difference between admission and 90 days after stroke event. Kaplan-Meier survival estimates showed lower stroke-free survival during follow-up period in patients with high leukocyte ROCK activity or plasma hsCRP level. Leukocyte ROCK activity independently predicted the recurrent stroke in patients with atherosclerotic stroke. Conclusions. This study shows elevated leukocyte ROCK activity in patients with ischemic stroke as compared to risk-matched subjects and is an independent predictor for recurrent stroke.

  18. 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.

  19. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease

    DEFF Research Database (Denmark)

    Jensen, J S; Feldt-Rasmussen, B; Strandgaard, S

    2000-01-01

    Albumin excretion in urine is positively correlated with the presence of ischemic heart disease and atherosclerotic risk factors. We studied prospectively whether a slight increase of urinary albumin excretion, ie, microalbuminuria, adds to the increased risk of ischemic heart disease among...... hypertensive subjects. In 1983 and 1984, blood pressure, urinary albumin/creatinine concentration ratio, plasma total and HDL cholesterol levels, body mass index, and smoking status were obtained in a population-based sample of 2085 subjects, aged 30 to 60 years, who were free from ischemic heart disease......, diabetes mellitus, and renal or urinary tract disease. Untreated arterial hypertension or borderline hypertension was present in 204 subjects, who were followed until 1993 by the National Hospital and Death Certificate Registers with respect to development of ischemic heart disease. During 1978 person...

  20. Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Aldo Bonaventura

    2016-11-01

    Full Text Available After an acute ischemic stroke (AIS, inflammatory processes are able to concomitantly induce both beneficial and detrimental effects. In this narrative review, we updated evidence on the inflammatory pathways and mediators that are investigated as promising therapeutic targets. We searched for papers on PubMed and MEDLINE up to August 2016. The terms searched alone or in combination were: ischemic stroke, inflammation, oxidative stress, ischemia reperfusion, innate immunity, adaptive immunity, autoimmunity. Inflammation in AIS is characterized by a storm of cytokines, chemokines, and Damage-Associated Molecular Patterns (DAMPs released by several cells contributing to exacerbate the tissue injury both in the acute and reparative phases. Interestingly, many biomarkers have been studied, but none of these reflected the complexity of systemic immune response. Reperfusion therapies showed a good efficacy in the recovery after an AIS. New therapies appear promising both in pre-clinical and clinical studies, but still need more detailed studies to be translated in the ordinary clinical practice. In spite of clinical progresses, no beneficial long-term interventions targeting inflammation are currently available. Our knowledge about cells, biomarkers, and inflammatory markers is growing and is hoped to better evaluate the impact of new treatments, such as monoclonal antibodies and cell-based therapies.

  1. Comparative study of DSC-PWI and 3D-ASL in ischemic stroke patients.

    Science.gov (United States)

    Zhang, Shui-xia; Yao, Yi-hao; Zhang, Shun; Zhu, Wen-jie; Tang, Xiang-yu; Qin, Yuan-yuan; Zhao, Ling-yun; Liu, Cheng-xia; Zhu, Wen-zhen

    2015-12-01

    The purpose of this study was to quantitatively analyze the relationship between three dimensional arterial spin labeling (3D-ASL) and dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) in ischemic stroke patients. Thirty patients with ischemic stroke were included in this study. All subjects underwent routine magnetic resonance imaging scanning, diffusion weighted imaging (DWI), magnetic resonance angiography (MRA), 3D-ASL and DSC-PWI on a 3.0T MR scanner. Regions of interest (ROIs) were drawn on the cerebral blood flow (CBF) maps (derived from ASL) and multi-parametric DSC perfusion maps, and then, the absolute and relative values of ASL-CBF, DSC-derived CBF, and DSC-derived mean transit time (MTT) were calculated. The relationships between ASL and DSC parameters were analyzed using Pearson's correlation analysis. Receiver operative characteristic (ROC) curves were performed to define the thresholds of relative value of ASL-CBF (rASL) that could best predict DSC-CBF reduction and MTT prolongation. Relative ASL better correlated with CBF and MTT in the anterior circulation with the Pearson correlation coefficients (R) values being 0.611 (P1.0 were 75.7%, 89.2% and 87.8% respectively. ASL-CBF map has better linear correlations with DSC-derived parameters (DSC-CBF and MTT) in anterior circulation in ischemic stroke patients. Additionally, when rASL is lower than 0.585, it could predict DSC-CBF decrease with moderate accuracy. If rASL values range from 0.585 to 0.952, we just speculate the prolonged MTT.

  2. An Inflammatory Polymorphisms Risk Scoring System for the Differentiation of Ischemic Stroke Subtypes

    Science.gov (United States)

    Muiño, Elena; Krupinski, Jurek; Carrera, Caty; Gallego-Fabrega, Cristina; Montaner, Joan; Fernández-Cadenas, Israel

    2015-01-01

    Inflammation has been associated with atherothrombotic stroke and recently with cardioembolic stroke. Different genetic risk factors have been specifically associated with the subtypes of ischemic stroke (cardioembolic, atherothrombotic, and lacunar). However, there are no studies that have generated genetic risk scores for the different subtypes of ischemic stroke using polymorphisms associated with inflammation. Methods. We have analyzed 68 polymorphisms of 30 inflammatory mediator genes in 2,685 subjects: 1,987 stroke cases and 698 controls. We generated a genetic scoring system with the most significant polymorphisms weighted by the odds ratio of every polymorphism and taken into consideration the stroke subtype. Results. Three polymorphisms, rs1205 (CRP gene), rs1800779, and rs2257073 (NOS3 gene), were associated with cardioembolic stroke (p value <0.05). The score generated was only associated with the cardioembolic stroke subtype (p value: 0.001) and was replicated in an independent cohort (p value: 0.017). The subjects with the highest score presented a cardioembolic stroke in 92.2% of the cases (p value: 0.002). Conclusion. The genetics of inflammatory markers is more closely associated with cardioembolic strokes than with atherothrombotic or lacunar strokes. The genetic risk scoring system could be useful in the prediction and differentiation of ischemic stroke; however, it might be specific to particular ischemic stroke subtypes. PMID:26355258

  3. Prognostic Significance of Uric Acid Levels in Ischemic Stroke Patients.

    Science.gov (United States)

    Zhang, Xia; Huang, Zhi-Chao; Lu, Tao-Sheng; You, Shou-Jiang; Cao, Yong-Jun; Liu, Chun-Feng

    2016-01-01

    The importance and function of serum uric acid (UA) levels in patients with cardiovascular disease or stroke are unclear. We sought to evaluate the appropriate UA levels for stroke patients and the association between endogenous UA levels and clinical outcomes in acute ischemic stroke (AIS) patients, particularly regarding the possible interaction between gender and UA levels with respect to AIS prognosis. We examined 303 patients who had an onset of ischemic stroke within 48 h. Of those, 101 patients received thrombolytic treatment. Serum UA (μmol/L) levels were measured the second morning after admission. Patient prognosis was evaluated 90 days after clinical onset by modified Rankin Scale. Patients were divided into four groups according to serum UA quartiles. A binary multivariate logistic regression model was used to assess clinical relevance in regard to functional outcome and endogenous UA levels. Analysis of subgroups by gender and normal glomerular filtration rate were also been done. Poor functional outcome was associated with older age, history of atrial fibrillation, or higher baseline National Institutes of Health Stroke Scale scores. After adjustment for potential confounders, patients with higher UA levels (>380 μmol/L) or lower UA levels (≤250 μmol/L) were 2-3 times more likely to have a poor outcome (OR 2.95, 95% CI 1.14-7.61; OR 2.78, 95% CI 1.02-7.58, respectively) compared to the baseline group (UA level 316-380 μmol/L). The same results were observed in thrombolyzed patients. Patients with high and low UA levels were 9-18 times more likely to having poor outcomes compared to the baseline group (UA level: 316-380 μmol/L; OR 18.50, 95% CI: 2.041-167.67; OR 9.66, 95% CI 1.42-65.88, respectively). In men, patients with high UA levels were 6 times more likely to have poor outcomes compared to the baseline group (UA level: 279-334 μmol/L; OR 6.10, 95% CI 1.62-22.93). However, female patients with UA level 271-337 μmol/L were seven times more

  4. Insulin-Like Growth Factor I Serum Levels Influence Ischemic Stroke Outcome

    NARCIS (Netherlands)

    De Smedt, Ann; Brouns, Raf; Uyttenboogaart, Maarten; De Raedt, Sylvie; Moens, Maarten; Wilczak, Nadine; Luijckx, Gert-Jan; De Keyser, Jacques

    2011-01-01

    Background and Purpose-Insulin-like growth factor I (IGF-I) is neuroprotective in animal models of stroke. We investigated whether serum IGF-I levels in patients with acute ischemic stroke influence stroke severity and outcome. Methods-Concentrations of IGF-I and IGF binding protein 3 were measured

  5. Evaluation of the motor cortical excitability changes after ischemic stroke

    Directory of Open Access Journals (Sweden)

    D K Prashantha

    2013-01-01

    Full Text Available Background: We evaluated progressive changes in excitability of motor cortex following ischemic stroke using Transcranial Magnetic Stimulation (TMS. Materials and Methods: Thirty-one patients (24 men, 7 women; age 37.3 ± 8.2 years were recruited and TMS was performed using Magstim 200 stimulator and a figure-of-eight coil. Resting motor threshold (RMT was recorded from affected and unaffected hemispheres and motor evoked potential (MEP was recorded from contralateral FDI muscle. Central motor conduction time (CMCT was calculated using F wave method. All measurements were done at baseline (2 nd , 4 th , and 6 th week of stroke. Results: Affected hemisphere: MEP was recordable in 3 patients at baseline (all had prolonged CMCT. At 4 weeks, MEP was recordable in one additional patient and CMCT remained prolonged. At 6 weeks, CMCT normalized in one patient. RMT was recordable (increased in 3 patients at baseline, in one additional patient at 4 weeks, and reduced marginally in these patients at 6 weeks. Unaffected hemisphere: MEP was recordable in all patients at baseline, and reduced significantly over time (2 nd week 43.52 ± 9.60, 4 th week 38.84 ± 7.83, and 6 th week 36.85 ± 7.27; P < 0.001. The CMCT was normal and remained unchanged over time. Conclusion: The increase in excitability of the unaffected motor cortex suggests plasticity in the post-stroke phase.

  6. Neuroprotective efficacy of methylene blue in ischemic stroke: an MRI study.

    Directory of Open Access Journals (Sweden)

    Qiang Shen

    Full Text Available Methylene blue (MB has unique energy-enhancing and antioxidant properties and is FDA-approved drug to treat methemoglobinemia and cyanide poisoning. This study evaluated the efficacy of MB to treat ischemic stroke in rats using longitudinal MRI and behavioral measures. Rats were subjected to 60-minute middle-cerebral-artery occlusion. In a randomized double-blinded design, vehicle or MB was administered after reperfusion. The initial lesion volumes at 30 minutes post-ischemia were not significantly different between the two groups (P = 0.92. The final infarct volumes two days after stroke increased in the vehicle group but decreased in the MB group, yielding a 30% difference in infarct volume (P = 0.03. Tracking tissue fate on a pixel-by-pixel basis showed that MB salvaged more initial core pixels compared to controls (22±3% versus 11±3%, P = 0.03, and more mismatch pixels compared to controls (83±3% versus 61±8%, P = 0.02. This study demonstrates MB treatment minimizes ischemic brain injury and improves functional outcomes.

  7. 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.

  8. Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Emilie M.M. [Erasmus MC - University Medical Center Rotterdam, Department of Radiology, P.O. Box 2040, Rotterdam (Netherlands); Department of Radiology, AMC, Amsterdam (Netherlands); Yoo, Albert J. [Texas Stroke Institute, Plano, TX (United States); Beenen, Ludo F.; Majoie, Charles B. [Department of Radiology, AMC, Amsterdam (Netherlands); Berkhemer, Olvert A. [Department of Radiology, AMC, Amsterdam (Netherlands); Department of Neurology, Erasmus MC, Rotterdam (Netherlands); Blanken, Mark D. den; Wismans, Carrie [AMC, Department of Biomedical Engineering and Physics, Amsterdam (Netherlands); Niessen, Wiro J. [Erasmus MC - University Medical Center Rotterdam, Department of Radiology, P.O. Box 2040, Rotterdam (Netherlands); Delft University of Technology, Faculty of Applied Sciences, Delft (Netherlands); Marquering, Henk A. [Department of Radiology, AMC, Amsterdam (Netherlands); AMC, Department of Biomedical Engineering and Physics, Amsterdam (Netherlands); Collaboration: on behalf of the MR CLEAN investigators

    2016-02-15

    Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland-Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs. (orig.)

  9. 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

  10. Optical Doppler tomography and spectral Doppler imaging of localized ischemic stroke in a mouse model

    Science.gov (United States)

    Yu, Lingfeng; Nguyen, Elaine; Liu, Gangjun; Rao, Bin; Choi, Bernard; Chen, Zhongping

    2010-02-01

    We present a combined optical Doppler tomography/spectral Doppler imaging modality to quantitatively evaluate the dynamic blood circulation and the artery blockage before and after a localized ischemic stroke in a mouse model. Optical Doppler Tomography (ODT) combines the Doppler principle with optical coherence tomography for noninvasive localization and measurement of particle flow velocity in highly scattering media with micrometer scale spatial resolution. Spectral Doppler imaging (SDI) provides complementary temporal flow information to the spatially distributed flow information of Doppler imaging. Fast, repeated, ODT scans across an entire vessel were performed to record flow dynamic information with high temporal resolution of cardiac cycles. Spectral Doppler analysis of continuous Doppler images demonstrates how the velocity components and longitudinally projected flow-volume-rate change over time for scatters within the imaging volume using spectral Doppler waveforms. Furthermore, vascular conditions can be quantified with various Doppler-angle-independent flow indices. Non-invasive in-vivo mice experiments were performed to evaluate microvascular blood circulation of a localized ischemic stroke mouse model.

  11. Angiogenesis in Ischemic Stroke and Angiogenic Effects of Chinese Herbal Medicine

    Directory of Open Access Journals (Sweden)

    Sai-Wang Seto

    2016-06-01

    Full Text Available Stroke is one of the major causes of death and adult disability worldwide. The underlying pathophysiology of stroke is highly complicated, consisting of impairments of multiple signalling pathways, and numerous pathological processes such as acidosis, glutamate excitotoxicity, calcium overload, cerebral inflammation and reactive oxygen species (ROS generation. The current treatment for ischemic stroke is limited to thromolytics such as recombinant tissue plasminogen activator (tPA. tPA has a very narrow therapeutic window, making it suitable to only a minority of stroke patients. Hence, there is great urgency to develop new therapies that can protect brain tissue from ischemic damage. Recent studies have shown that new vessel formation after stroke not only replenishes blood flow to the ischemic area of the brain, but also promotes neurogenesis and improves neurological functions in both animal models and patients. Therefore, drugs that can promote angiogenesis after ischemic stroke can provide therapeutic benefits in stroke management. In this regard, Chinese herbal medicine (CHM has a long history in treating stroke and the associated diseases. A number of studies have demonstrated the pro-angiogenic effects of various Chinese herbs and herbal formulations in both in vitro and in vivo settings. In this article, we present a comprehensive review of the current knowledge on angiogenesis in the context of ischemic stroke and discuss the potential use of CHM in stroke management through modulation of angiogenesis.

  12. Blood flow and vascular reactivity in collaterally perfused brain tissue. Evidence of an ischemic penumbra in patients with acute stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Larsen, B; Herning, M;

    1983-01-01

    ischemic low flow areas were a constant finding in the collaterally perfused tissue. In 6 of the patients, the collaterally perfused part of the brain had low flow values comparable to those of an "ischemic penumbra" (viable, but functionally depressed brain tissue due to inadequate perfusion......In a group of 48 patients with completed stroke, 8 patients had viable collaterally perfused brain tissue which was accessible for rCBF recordings with a two dimensional technique. All 8 had deep subcortical infarcts on CT-scan, and angiographic occlusion of the arteries normally supplying...... the infarcted territory. The brain tissue overlying the deep infarcts appeared normal on CT-scan and was supplied by collateral circulation. rCBF was measured in all within 72 hours after the stroke. The intra-carotid Xe-133 injection method and a 254 multidetector camera were used to study rCBF. Relatively...

  13. Shared genetic contribution to ischemic stroke and Alzheimer's disease

    Science.gov (United States)

    Adib‐Samii, Poneh; Harold, Denise; Dichgans, Martin; Williams, Julie; Lewis, Cathryn M.; Markus, Hugh S.; Fornage, Myriam; Holliday, Elizabeth G; Sharma, Pankaj; Bis, Joshua C; Psaty, Bruce M; Seshadri, Sudha; Nalls, Mike A; Devan, William J; Boncoraglio, Giorgio; Malik, Rainer; Mitchell, Braxton D; Kittner, Steven J; Ikram, M Arfan; Clarke, Robert; Rosand, Jonathan; Meschia, James F; Sudlow, Cathie; Rothwell, Peter M; Levi, Christopher; Bevan, Steve; Kilarski, Laura L; Walters, Matthew; Thijs, Vincent; Slowik, Agnieszka; Lindgren, Arne; de Bakker, Paul I W; Lambert, Jean‐Charles; Ibrahim‐Verbaas, Carla A; Harold, Denise; Naj, Adam C; Sims, Rebecca; Bellenguez, Céline; Jun, Gyungah; DeStefano, Anita L; Bis, Joshua C; Beecham, Gary W; Grenier‐Boley, Benjamin; Russo, Giancarlo; Thornton‐Wells, Tricia A; Jones, Nicola; Smith, Albert V; Chouraki, Vincent; Thomas, Charlene; Ikram, M Arfan; Zelenika, Diana; Vardarajan, Badri N; Kamatani, Yoichiro; Lin, Chiao‐Feng; Gerrish, Amy; Schmidt, Helena; Kunkle, Brian; Dunstan, Melanie L; Ruiz, Agustin; Bihoreau, Marie‐Thçrèse; Choi, Seung‐Hoan; Reitz, Christiane; Pasquier, Florence; Hollingworth, Paul; Ramirez, Alfredo; Hanon, Olivier; Fitzpatrick, Annette L; Buxbaum, Joseph D; Campion, Dominique; Crane, Paul K; Baldwin, Clinton; Becker, Tim; Gudnason, Vilmundur; Cruchaga, Carlos; Craig, David; Amin, Najaf; Berr, Claudine; Lopez, Oscar L; De Jager, Philip L; Deramecourt, Vincent; Johnston, Janet A; Evans, Denis; Lovestone, Simon; Letenneur, Luc; Morón, Francisco J; Rubinsztein, David C; Eiriksdottir, Gudny; Sleegers, Kristel; Goate, Alison M; Fiçvet, Nathalie; Huentelman, Matthew J; Gill, Michael; Brown, Kristelle; Kamboh, M Ilyas; Keller, Lina; Barberger‐Gateau, Pascale; McGuinness, Bernadette; Larson, Eric B; Green, Robert; Myers, Amanda J; Dufouil, Carole; Todd, Stephen; Wallon, David; Love, Seth; Rogaeva, Ekaterina; Gallacher, John; St George‐Hyslop, Peter; Clarimon, Jordi; Lleo, Alberto; Bayer, Anthony; Tsuang, Debby W; Yu, Lei; Tsolaki, Magda; Bossù, Paola; Spalletta, Gianfranco; Proitsi, Petroula; Collinge, John; Sorbi, Sandro; Sanchez‐Garcia, Florentino; Fox, Nick C; Hardy, John; Deniz Naranjo, Maria Candida; Bosco, Paolo; Clarke, Robert; Brayne, Carol; Galimberti, Daniela; Mancuso, Michelangelo; Matthews, Fiona; Moebus, Susanne; Mecocci, Patrizia; Del Zompo, Maria; Maier, Wolfgang; Hampel, Harald; Pilotto, Alberto; Bullido, Maria; Panza, Francesco; Caffarra, Paolo; Nacmias, Benedetta; Gilbert, John R; Mayhaus, Manuel; Lannfelt, Lars; Hakonarson, Hakon; Pichler, Sabrina; Carrasquillo, Minerva M; Ingelsson, Martin; Beekly, Duane; Alvarez, Victoria; Zou, Fanggeng; Valladares, Otto; Younkin, Steven G; Coto, Eliecer; Hamilton‐Nelson, Kara L; Gu, Wei; Razquin, Cristina; Pastor, Pau; Mateo, Ignacio; Owen, Michael J; Faber, Kelley M; Jonsson, Palmi V; Combarros, Onofre; O'Donovan, Michael C; Cantwell, Laura B; Soininen, Hilkka; Blacker, Deborah; Mead, Simon; Mosley, Thomas H; Bennett, David A; Harris, Tamara B; Fratiglioni, Laura; Holmes, Clive; de Bruijn, Renee F A G; Passmore, Peter; Montine, Thomas J; Bettens, Karolien; Rotter, Jerome I; Brice, Alexis; Morgan, Kevin; Foroud, Tatiana M; Kukull, Walter A; Hannequin, Didier; Powell, John F; Nalls, Michael A; Ritchie, Karen; Lunetta, Kathryn L; Kauwe, John S K; Boerwinkle, Eric; Riemenschneider, Matthias; Boada, Mercè; Hiltunen, Mikko; Martin, Eden R; Schmidt, Reinhold; Rujescu, Dan; Wang, Li‐San; Dartigues, Jean‐François; Mayeux, Richard; Tzourio, Christophe; Hofman, Albert; Nöthen, Markus M; Graff, Caroline; Psaty, Bruce M; Jones, Lesley; Haines, Jonathan L; Holmans, Peter A; Lathrop, Mark; Pericak‐Vance, Margaret A; Launer, Lenore J; Farrer, Lindsay A; van Duijn, Cornelia M; Van Broeckhoven, Christine; Moskvina, Valentina; Seshadri, Sudha; Williams, Julie; Schellenberg, Gerard D; Amouyel, Philippe

    2016-01-01

    Objective Increasing evidence suggests epidemiological and pathological links between Alzheimer's disease (AD) and ischemic stroke (IS). We investigated the evidence that shared genetic factors underpin the two diseases. Methods Using genome‐wide association study (GWAS) data from METASTROKE + (15,916 IS cases and 68,826 controls) and the International Genomics of Alzheimer's Project (IGAP; 17,008 AD cases and 37,154 controls), we evaluated known associations with AD and IS. On the subset of data for which we could obtain compatible genotype‐level data (4,610 IS cases, 1,281 AD cases, and 14,320 controls), we estimated the genome‐wide genetic correlation (rG) between AD and IS, and the three subtypes (cardioembolic, small vessel, and large vessel), using genome‐wide single‐nucleotide polymorphism (SNP) data. We then performed a meta‐analysis and pathway analysis in the combined AD and small vessel stroke data sets to identify the SNPs and molecular pathways through which disease risk may be conferred. Results We found evidence of a shared genetic contribution between AD and small vessel stroke (rG [standard error] = 0.37 [0.17]; p = 0.011). Conversely, there was no evidence to support shared genetic factors in AD and IS overall or with the other stroke subtypes. Of the known GWAS associations with IS or AD, none reached significance for association with the other trait (or stroke subtypes). A meta‐analysis of AD IGAP and METASTROKE + small vessel stroke GWAS data highlighted a region (ATP5H/KCTD2/ICT1) associated with both diseases (p = 1.8 × 10−8). A pathway analysis identified four associated pathways involving cholesterol transport and immune response. Interpretation Our findings indicate shared genetic susceptibility to AD and small vessel stroke and highlight potential causal pathways and loci. Ann Neurol 2016;79:739–747 PMID:26913989

  14. A pharmacological screening approach for discovery of neuroprotective compounds in ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Simret Beraki

    Full Text Available With the availability and ease of small molecule production and design continuing to improve, robust, high-throughput methods for screening are increasingly necessary to find pharmacologically relevant compounds amongst the masses of potential candidates. Here, we demonstrate that a primary oxygen glucose deprivation assay in primary cortical neurons followed by secondary assays (i.e. post-treatment protocol in organotypic hippocampal slice cultures and cortical neurons can be used as a robust screen to identify neuroprotective compounds with potential therapeutic efficacy. In our screen about 50% of the compounds in a library of pharmacologically active compounds displayed some degree of neuroprotective activity if tested in a pre-treatment toxicity assay but just a few of these compounds, including Carbenoxolone, remained active when tested in a post-treatment protocol. When further examined, Carbenoxolone also led to a significant reduction in infarction size and neuronal damage in the ischemic penumbra when administered six hours post middle cerebral artery occlusion in rats. Pharmacological testing of Carbenoxolone-related compounds, acting by inhibition of 11-β-hydroxysteroid dehydrogenase-1 (11β-HSD1, gave rise to similarly potent in vivo neuroprotection. This indicates that the increase of intracellular glucocorticoid levels mediated by 11β-HSD1 may be involved in the mechanism that exacerbates ischemic neuronal cell death, and inhibiting this enzyme could have potential therapeutic value for neuroprotective therapies in ischemic stroke and other neurodegenerative disorders associated with neuronal injury.

  15. Analysis of risk factors and risk assessment for ischemic stroke recurrence

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    Xiu-ying LONG

    2016-08-01

    Full Text Available Objective To screen the risk factors for recurrence of ischemic stroke and to assess the risk of recurrence. Methods Essen Stroke Risk Score (ESRS was used to evaluate the risk of recurrence in 176 patients with ischemic stroke (96 cases of first onset and 80 cases of recurrence. Univariate and multivariate stepwise Logistic regression analysis was used to screen risk factors for recurrence of ischemic stroke.  Results There were significant differences between first onset group and recurrence group on age, the proportion of > 75 years old, hypertension, diabetes, coronary heart disease, peripheral angiopathy, transient ischemic attack (TIA or ischemic stroke, drinking and ESRS score (P < 0.05, for all. First onset group included one case of ESRS 0 (1.04%, 8 cases of 1 (8.33%, 39 cases of 2 (40.63%, 44 cases of 3 (45.83%, 4 cases of 4 (4.17%. Recurrence group included 2 cases of ESRS 3 (2.50%, 20 cases of 4 (25% , 37 cases of 5 (46.25% , 18 cases of 6 (22.50% , 3 cases of 7 (3.75% . There was significant difference between 2 groups (Z = -11.376, P = 0.000. Logistic regression analysis showed ESRS > 3 score was independent risk factor for recurrence of ischemic stroke (OR = 31.324, 95%CI: 3.934-249.430; P = 0.001.  Conclusions ESRS > 3 score is the independent risk factor for recurrence of ischemic stroke. It is important to strengthen risk assessment of recurrence of ischemic stroke. To screen and control risk factors is the key to secondary prevention of ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2016.07.011

  16. What Lies behind the Ischemic Stroke: Aortic Dissection?

    Directory of Open Access Journals (Sweden)

    Turgut Deniz

    2014-01-01

    Full Text Available Introduction. Some cases with aortic dissection (AD could present with various complaints other than pain, especially neurological and cardiovascular manifestations. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache. Case Report. A 71-year-old woman was admitted to emergency department with vertigo which started within the previous one hour and progressed with deterioration of consciousness following speech disorder. On arrival, she was disoriented and uncooperative. Diffusion magnetic resonance imaging (MRI of brain was consistent with acute ischemia in the cerebral hemisphere. Fibrinolytic treatment has been planned since symptoms started within two hours. Echocardiography has shown the dilatation of ascending aorta with a suspicion of flap. Computed tomography (CT angiography has been applied and intimal flap has been detected which was consistent with aortic dissection, intramural hematoma of which was reaching from aortic arch to bilateral common carotid artery. Thereafter, treatment strategy has completely changed and surgical invention has been done. Conclusion. In patients who are admitted to the emergency department with the loss of consciousness and stroke, inadequacy of anamnesis and carotid artery involvement of aortic dissection should be kept in mind.

  17. Elevated Troponin Level with Negative Outcome Was Found in Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Buse Hasırcı

    2013-01-01

    Full Text Available Background. Troponin increment is a highly sensitive and specific marker of myocardial necrosis. The reason of high troponin levels in acute stroke is not clear. The aim of this study was to identify the relationships between cardiac troponin-I (cTnI level and stroke. Methods. This study recruited 868 patients who were admitted to Istanbul Medeniyet University due to acute ischemic stroke, and the diagnosis was confirmed by diffusion magnetic resonance imaging. The patients with the causes increasing troponin level were excluded from the study. A total of 239 patients were finally included in the study. Clinics were evaluated by the modified Rankin Scale (mRS and the National Institutes of Health Stroke Scale (NIHSS. Results. Serum level of troponin was higher in ischemic stroke patients with anterior circulation involvement in comparison to posterior involvement or hemorrhagic stroke (. Higher troponin levels related to increased stroke scale scores at discharge in ischemic stroke (. The level of cTnI was correlated with stroke scale scores at both admission and discharge in posterior stroke patients (. Conclusion. cTnI is a highly specific and sensitive marker of myocardial damage, and its elevation was associated with more severe neurological deficits in acute ischemic stroke.

  18. [NDT-Bobath method used in the rehabilitation of patients with a history of ischemic stroke].

    Science.gov (United States)

    Klimkiewicz, Paulina; Kubsik, Anna; Woldańska-Okońska, Marta

    2012-01-01

    Ischemic stroke is the third leading cause of death and disability in human. The vitally important problem after ischemic stroke is hemiparesis of the body. The most common methods used in improving the mobility of patients after ischemic stroke is a Bobath-NDT (Neuro-Developmental Treatment - Bobath), which initiated the Berta and Karel Bobath for children with cerebral palsy. It is a method designed to neurophysiological recovery of these vital functions that the patient was lost due to illness, and wants it back.

  19. Endovascular Intervention for Acute Ischemic Stroke in Light of Recent Trials

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    Kenan Alkhalili

    2014-01-01

    Full Text Available Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous evolution that imaging and endovascular treatment modalities have undergone over the past several years has raised doubts about the validity of these trials. In this paper, we review the role of endovascular treatment strategies in acute ischemic stroke and discuss the limitations and shortcomings that prevent generalization of the findings of recent trials. We also provide our experience in endovascular treatment of acute ischemic stroke.

  20. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Cevik, Ozge; Baykal, Ahmet Tarik; Sener, Azize

    2016-01-01

    Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets' tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters) was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org) and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics). These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides an insight into

  1. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients.

    Directory of Open Access Journals (Sweden)

    Ozge Cevik

    Full Text Available Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets' tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics. These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides

  2. Insulin resistance and occurrence and prognosis of ischemic stroke A non-randomized concurrent control and intra-group comparison

    Institute of Scientific and Technical Information of China (English)

    Xiaohong Zhao; Shaojun Jiang; Yue Tan

    2008-01-01

    BACKGROUND: Clinical evidence has demonstrated that insulin resistance might be an independent risk factor for ischemic stroke, which has not been recognized. At present, insulin resistance has been proven to be an independent risk factor for coronary arteriosclerotic heart disease. However, the relationship between the onset and prognosis of ischemic stroke remains unclear. OBJECTIVE: This study was designed to analyze the relationship between insulin resistance and ischemic stroke and the correlation between insulin resistance and stroke risk factor, and to investigate the relationship between insulin resistance and ischemic stroke prognosis as well as whether insulin resistance is an independent prognostic factor. DESIGN: A non-randomized concurrent control experiment. SETTING: Department of Geriatric Disease, Second Affiliated Hospital of Kunming Medical College. PARTICIPANTS: A total of 106 inpatients with ischemic stroke of the cervical internal carotid artery, who had suffered from the disease within the previous 72 hours, were admitted to the Department of Neurology, First Affiliated Hospital of Kunming Medical College from March to December in 2005 and, recruited for the present study. All 106 inpatients corresponded to the diagnostic criteria of ischemic stroke, formulated at the Fourth National Cerebrovascular Disease Conference in 1995, and were confirmed as having had an ischemic stroke by CT/MRI examinations. The patient group consisted of 54 males and 52 females. An additional 50 healthy individuals, who received health examinations simultaneously, were included as controls. Among the control subjects, there were 26 males and 24 females. Informed consent for laboratory measurements was obtained from all subjects; this study was approved by the Hospital Ethics Committee.METHODS: Following admission, all subjects were inquired of age, gender, previous history, blood pressure, body temperature, admission time, and smoking habits. Meanwhile, they were

  3. Urgent endarterectomy using pretreatment with free radical scavenger, edaravone, and early clamping of the parent arteries for cervical carotid artery stenosis with crescendo transient ischemic attacks caused by mobile thrombus and hemodynamic cerebral ischemia. Case report.

    Science.gov (United States)

    Kobayashi, Masakazu; Ogasawara, Kuniaki; Inoue, Takashi; Saito, Hideo; Komoribayashi, Nobukazu; Suga, Yasunori; Ogawa, Akira

    2007-03-01

    A 68-year-old man with left cervical internal carotid artery stenosis suffered crescendo transient ischemic attacks caused by mobile thrombus detected by carotid echography and secondary impairment of cerebral hemodynamic reserve demonstrated by positron emission tomography. Urgent carotid endarterectomy (CEA) was performed following pretreatment with edaravone and early clamping of the carotid arteries without intraluminal shunting. The postoperative course was uneventful, and postoperative magnetic resonance imaging and single-photon emission computed tomography revealed no new cerebral ischemic lesions and no findings of cerebral hyperperfusion, respectively. The risks associated with CEA are higher for patients with evolving stroke or crescendo transient ischemic attacks than that for patients with stable disease. This case demonstrates that urgent endarterectomy for cervical carotid artery stenosis with crescendo transient ischemic attacks caused by mobile thrombi and hemodynamic cerebral ischemia can be successfully performed following pretreatment with edaravone and early clamping of the carotid arteries.

  4. The Use of Major Risk Factors for Computer-Based Distinction of Diabetic Patients with Ischemic Stroke and Without Stroke

    Science.gov (United States)

    2007-11-02

    Features include age, gender, duration of diabetes , cholesterol, higher density lipoprotein (HDL), triglicerit levels, neuropathy, nephropathy ...THE USE of MAJOR RISK FACTORS for COMPUTER-BASED DISTINCTION of DIABETIC PATIENTS with ISCHEMIC STROKE and WITHOUT STROKE Sibel Oge Merey1...boun.edu.tr Abstract- This study proposes a computer-based decision support system to investigate the distinctive factors of diabetes mellitus (DM

  5. The fate of medications evaluated for ischemic stroke pharmacotherapy over the period 1995–2015

    Directory of Open Access Journals (Sweden)

    Xiaoling Chen

    2016-10-01

    Full Text Available Stroke is a brain damage caused by a loss of blood supply to a portion of the brain, which requires prompt and effective treatment. The current pharmacotherapy for ischemic stroke primarily relies on thrombolysis using recombinant tissue plasminogen activators (rt-PAs to breakdown blood clots. Neuroprotective agents that inhibit excitatory neurotransmitters are also used to treat ischemic stroke but have failed to translate into clinical benefits. This poses a major challenge in biomedical research to understand what causes the progressive brain cell death after stroke and how to develop an effective pharmacotherapy for stroke. This brief review analyzes the fate of about 430 potentially useful stroke medications over the period 1995–2015 and describes in detail those that successfully reached the market. Hopefully, the information from this analysis will shed light on how future stroke research can improve stroke drug discovery.

  6. Gait improvement after treadmill training in ischemic stroke survivors A critical review of functional MRI studies

    Institute of Scientific and Technical Information of China (English)

    Xiang Xiao; Dongfeng Huang; Bryan O'Young

    2012-01-01

    Stroke survivors often present with abnormal gait, movement training can improve the walking performance post-stroke, and functional MRI can objectively evaluate the brain functions before and after movement training. This paper analyzes the functional MRI changes in patients with ischemic stroke after treadmill training with voluntary and passive ankle dorsiflexion. Functional MRI showed that there are some changes in some regions of patients with ischemic stroke including primary sensorimotor cortex, supplementary motor area and cingulate motor area after treadmill training. These findings suggest that treadmill training likely improves ischemic stroke patients' lower limb functions and gait performance and promotes stroke recovery by changing patients' brain plasticity; meanwhile, the novel treadmill training methods can better training effects.

  7. Antiplatelet Agents for the Secondary Prevention of Ischemic Stroke or Transient Ischemic Attack: A Network Meta-Analysis.

    Science.gov (United States)

    Wang, Wen; Zhang, Lu; Liu, Weiming; Zhu, Qin; Lan, Qing; Zhao, Jizong

    2016-05-01

    Stroke can cause high morbidity and mortality, and ischemic stroke (IS) and transient ischemic attack (TIA) patients have a high stroke recurrence rate. Antiplatelet agents are the standard therapy for these patients, but it is often difficult for clinicians to select the best therapy from among the multiple treatment options. We therefore performed a network meta-analysis to estimate the efficacy of antiplatelet agents for secondary prevention of recurrent stroke. We systematically searched 3 databases (PubMed, Embase, and Cochrane) for relevant studies published through August 2015. The primary end points of this meta-analysis were overall stroke, hemorrhagic stroke, and fatal stroke. A total of 30 trials were included in our network meta-analysis and abstracted data. Among the therapies evaluated in the included trials, the estimates for overall stroke and hemorrhagic stroke for cilostazol (Cilo) were significantly better than those for aspirin (odds ratio [OR] = .64, 95% credibility interval [CrI], .45-.91; OR = .23, 95% CrI, .08-.58). The estimate for fatal stroke was highest for Cilo plus aspirin combination therapy, followed by Cilo therapy. The results of our meta-analysis indicate that Cilo significantly improves overall stroke and hemorrhagic stroke in IS or TIA patients and reduces fatal stroke, but with low statistical significance. Our results also show that Cilo was significantly more efficient than other therapies in Asian patients; therefore, future trials should focus on Cilo treatment for secondary prevention of recurrent stroke in non-Asian patients.

  8. Anosognosia in patients with acute hemispheric ischemic stroke

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    V. N. Grigoryeva

    2016-01-01

    Full Text Available Objective: to investigate the frequency of anosognosia (a deficit of self-awareness, its anatomic correlates associated with other neuropsychological and neurological disorders in acute hemispheric ischemic stroke (IS.Patients and methods 150 patients (83 men and 67 women; mean age, 63.0±9.3 years with acute hemispheric IS were examined. All the patients underwent neurological, neuroimaging, and neuropsychological (by the procedure described by A.R. Luria examinations. neuropsychological investigations. Anosognosia was diagnosed using the Dysexecutive Questionnaire (DEX and the authors' procedure involving a scale to measure impaired self-rating of motor abilities and a scale to measure impaired self-rating of cognitive abilities in everyday life.Results and discussion. In the acute period of hemispheric IS, reduced self-awareness of motor and cognitive abilities was noted in 14% of the patients and unawareness of only cognitive abilities was recorded in 15%. Patients with anosognosia and cognitive dysfunction (ACD and those with anosognosia and motor dysfunction (AMD had right-sided hemispheric IS more frequently (76% while this was not found in patients with isolated ACD. The development of anosognosia for paralysis and paresis was favored by the large sizes of an ischemic focus that involved a few lobes in the posterior regions of the brain although no lesions were found in the anosognosia-specific anatomical regions. ACD and AMD proved to be associated with unilateral spatial and tactile neglect and obvious regulatory dysfunction. 

  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. CT Perfusion ASPECTS in the Evaluation of Acute Ischemic Stroke: Thrombolytic Therapy Perspective

    Directory of Open Access Journals (Sweden)

    Niko Sillanpaa

    2011-02-01

    Full Text Available Background and Purpose: Advances in the management of acute ischemic stroke and medical imaging are creating pressure to replace the rigid one-third middle cerebral artery (MCA and non-contrast-enhanced CT (NCCT Alberta Stroke Program Early CT Score (ASPECTS thresholds used for the selection of patients eligible for intravenous thrombolytic therapy. The identification of potentially salvageable ischemic brain tissue lies at the core of this issue. In this study, the role of CT perfusion ASPECTS in the detection of reversible ischemia was analyzed. Materials and Methods: We retrospectively reviewed the clinical and imaging data of 92 consecutive patients who received intravenous thrombolytic therapy for acute (duration Results: A perfusion defect could be detected in 50% of the patients. ASPECTS correlated inversely with the clinical outcome in the following order: follow-up NCCT > cerebral blood volume (CBV > mean transit time (MTT > admission NCCT. The follow-up NCCT and the CBV displayed a statistically significant difference from the admission NCCT, while the MTT did not reach statistical significance. The threshold that best differentiated between good and bad clinical outcome on admission was CBV ASPECTS ≧7. In patients with CT perfusion ASPECTS mismatch, MTT and CBV ASPECTS essentially provided the lower and upper limits for the follow-up NCCT ASPECTS, thus defining the spectrum of possible outcomes. Furthermore, CT perfusion ASPECTS mismatch strongly correlated (r = 0.83 with the mismatch between the tissue at risk and the final infarct, i.e. the amount of salvaged tissue. This finding suggests that the CT perfusion ASPECTS mismatch adequately identifies the amount of potentially salvageable ischemic brain tissue. Conclusions: Parameters derived from the use of CT perfusion ASPECTS can detect reversible ischemia and are correlated with clinical outcome.

  11. Anton’s Syndrome due to Bilateral Ischemic Occipital Lobe Strokes

    Directory of Open Access Journals (Sweden)

    Sanela Zukić

    2014-01-01

    Full Text Available We present a case of a patient with Anton’s syndrome (i.e., visual anosognosia with confabulations, who developed bilateral occipital lobe infarct. Bilateral occipital brain damage results in blindness, and patients start to confabulate to fill in the missing sensory input. In addition, the patient occasionally becomes agitated and talks to himself, which indicates that, besides Anton’s syndrome, he might have had Charles Bonnet syndrome, characterized by both visual loss and hallucinations. Anton syndrome, is not so frequent condition and is most commonly caused by ischemic stroke. In this particular case, the patient had successive bilateral occipital ischemia as a result of massive stenoses of head and neck arteries.

  12. The angiotensin type 2 receptor agonist Compound 21 elicits cerebroprotection in endothelin-1 induced ischemic stroke

    DEFF Research Database (Denmark)

    Joseph, Jason P; Mecca, Adam P; Regenhardt, Robert W;

    2014-01-01

    hypothesize that C21 may exert beneficial effects against cerebral damage and neurological deficits produced by ischemic stroke. We determined the effects of central and peripheral administration of C21 on the cerebral damage and neurological deficits in rats elicited by endothelin-1 induced middle cerebral...... artery occlusion (MCAO), a model of cerebral ischemia. Rats infused centrally (intracerebroventricular) with C21 before endothelin-1 induced MCAO exhibited significant reductions in cerebral infarct size and the neurological deficits produced by cerebral ischemia. Similar cerebroprotection was obtained...... in rats injected systemically (intraperitoneal) with C21 either before or after endothelin-1 induced MCAO. The protective effects of C21 were reversed by central administration of an AT2R inhibitor, PD123319. While C21 did not alter cerebral blood flow at the doses used here, peripheral post...

  13. Neurofibromatosis type 1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke.

    Science.gov (United States)

    Giannantoni, Nadia Mariagrazia; Broccolini, Aldobrando; Frisullo, Giovanni; Pilato, Fabio; Profice, Paolo; Morosetti, Roberta; Di Lella, Giuseppe; Zampino, Giuseppe; Della Marca, Giacomo

    2015-01-01

    Neurofibromatosis type 1 (NF1) is a heterogeneous, common, neurocutaneous disorder presenting different complications during a life span, including cerebrovascular dysplasia. To our knowledge this is the first reported case of NF1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke. We describe a 57-year-old man with NF1 who presented an acute onset right-sided facial palsy and hemiplegia, dysarthria, and gait imbalance. Magnetic resonance imaging showed an acute left paramedian pontine infarct and a hypoplastic right vertebral artery. Brain Computed Tomography Angiography revealed the occurrence of vertebrobasilar dolichoectasia. Co-occurrence of VBD and NF1 might not be merely casual and it may significantly heighten the mortality rate in this multisystem disorder. We suggest a possible role of VBD in the genesis of our patient's clinical-radiological features and prompt the early detection of asymptomatic arteriopathy in individuals with NF1 in order to ameliorate patients' quality of life and life expectancy.

  14. Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Callahan, Alfred; Amarenco, Pierre; Goldstein, Larry B;

    2011-01-01

    To perform a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, which tested the effect of treatment with atorvastatin in reducing stroke in subjects with a recent stroke or transient ischemic attack, to explore the effects of treatment in su...

  15. Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults

    DEFF Research Database (Denmark)

    Tibæk, Maiken; Dehlendorff, Christian; Jørgensen, Henrik S

    2016-01-01

    BACKGROUND: Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence...... of hospitalizations for TIA and stroke including sex- and subtype-specific trends in young adults aged 15 to 30 years. METHODS AND RESULTS: From the Danish National Patient Register, we identified all cases of first-ever stroke and TIA (age 15-30 years) in Denmark, who were hospitalized during the study period...

  16. A critical velocity of squeezing a droplet through a circular constriction: implications on ischemic stroke

    Science.gov (United States)

    Zhang, Zhifeng; Drapaca, Corina

    2016-11-01

    Ischemic stroke accounts for about 87 percent of all stroke cases. In these cases, models of squeezing a droplet through a smaller constriction channel can help better understand the pathology and capillary restoring after a Stroke. In the present research, we analytical expressed the minimum impulse of squeezing a droplet through a circular channel as well as its critical velocity. By comparison with a previously defined critical velocity, we find the difference between these two. Applications of this research in the understanding of ischemic stroke are also discussed. Zhifeng Zhang thanks the support of Robert A. Sebrosky Graduate Fellowship in Engineering Science and Mechanics, the Pennsylvania State University.

  17. Neutrophil recruitment to the brain in mouse and human ischemic stroke.

    Science.gov (United States)

    Perez-de-Puig, Isabel; Miró-Mur, Francesc; Ferrer-Ferrer, Maura; Gelpi, Ellen; Pedragosa, Jordi; Justicia, Carles; Urra, Xabier; Chamorro, Angel; Planas, Anna M

    2015-02-01

    Neutrophils are rapidly recruited in response to local tissue infection or inflammation. Stroke triggers a strong inflammatory reaction but the relevance of neutrophils in the ischemic brain is not fully understood, particularly in the absence of reperfusion. We investigated brain neutrophil recruitment in two murine models of permanent ischemia induced by either cauterization of the distal portion of the middle cerebral artery (c-MCAo) or intraluminal MCA occlusion (il-MCAo), and three fatal cases of human ischemic stroke. Flow cytometry analyses revealed progressive neutrophil recruitment after c-MCAo, lesser neutrophil recruitment following il-MCAo, and absence of neutrophils after sham operation. Confocal microscopy identified neutrophils in the leptomeninges from 6 h after the occlusion, in the cortical basal lamina and cortical Virchow-Robin spaces from 15 h, and also in the cortical brain parenchyma at 24 h. Neutrophils showed signs of activation including histone-3 citrullination, chromatin decondensation, and extracellular projection of DNA and histones suggestive of extracellular trap formation. Perivascular neutrophils were identified within the entire cortical infarction following c-MCAo. After il-MCAo, neutrophils prevailed in the margins but not the center of the cortical infarct, and were intraluminal and less abundant in the striatum. The lack of collaterals to the striatum and a collapsed pial anastomotic network due to brain edema in large hemispheric infarctions could impair neutrophil trafficking in this model. Neutrophil extravasation at the leptomeninges was also detected in the human tissue. We concluded that neutrophils extravasate from the leptomeningeal vessels and can eventually reach the brain in experimental animal models and humans with prolonged arterial occlusion.

  18. Development and validation of intracranial thrombus segmentation on CT angiography in patients with acute ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Emilie M M Santos

    Full Text Available Thrombus characterization is increasingly considered important in predicting treatment success for patients with acute ischemic stroke. The lack of intensity contrast between thrombus and surrounding tissue in CT images makes manual delineation a difficult and time consuming task. Our aim was to develop an automated method for thrombus measurement on CT angiography and validate it against manual delineation.Automated thrombus segmentation was achieved using image intensity and a vascular shape prior derived from the segmentation of the contralateral artery. In 53 patients with acute ischemic stroke due to proximal intracranial arterial occlusion, automated length and volume measurements were performed. Accuracy was assessed by comparison with inter-observer variation of manual delineations using intraclass correlation coefficients and Bland-Altman analyses.The automated method successfully segmented the thrombus for all 53 patients. The intraclass correlation of automated and manual length and volume measurements were 0.89 and 0.84. Bland-Altman analyses yielded a bias (limits of agreement of -0.4 (-8.8, 7.7 mm and 8 (-126, 141 mm3 for length and volume, respectively. This was comparable to the best interobserver agreement, with an intraclass correlation coefficients of 0.90 and 0.85 and a bias (limits of agreement of -0.1 (-11.2, 10.9 mm and -17 (-216, 185 mm3.The method facilitates automated thrombus segmentation for accurate length and volume measurements, is relatively fast and requires minimal user input, while being insensitive to high hematocrit levels and vascular calcifications. Furthermore, it has the potential to assess thrombus characteristics of low-density thrombi.

  19. Impact of severe extracranial ICA stenosis on MRI perfusion and diffusion parameters in acute ischemic stroke

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    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.

  20. Unusual hemodynamic stroke related to an accessory middle cerebral artery: The usefulness of fusion images from three-dimensional angiography

    Directory of Open Access Journals (Sweden)

    Kei Noguchi

    2014-01-01

    Full Text Available Background: Ischemic stroke associated with an anomaly of the middle cerebral artery (MCA is a rare occurrence. The diagnosis is very difficult when there are steno-occlusive lesions associated with an accessory middle cerebral artery (AMCA. Case Description: A 77-year-old female with hypertension and hyperlipidemia experienced repeated transient ischemic attacks (TIAs of motor aphasia and dysarthria. Although angiography showed only left intracranial occlusion, the fusion images of three-dimensional digital subtraction angiography (3-D DSA showed complex steno-occlusive lesions and an AMCA related with the TIA. The cerebral blood flow (CBF to the left frontal lobe was supplied by the AMCA, via the anterior communicating artery from the right internal carotid artery. The left temporal and parietal lobes were supplied by the stenotic MCA, via the left posterior communicating artery from the left posterior cerebral artery. Single-photon emission computed tomography showed a marked decrease in CBF to both the left frontal and temporal lobes. A left superficial temporal artery (STA-to-left MCA double anastomosis was performed, in which each branch of the STA supplied branches of the AMCA and MCA. Conclusion: This is the first reported case of ischemic stroke in a patient with an AMCA. The exact diagnosis could be made only by using fusion images of 3-D DSA, which were useful for understanding the complicated CBF pattern and for the choice of recipient artery in bypass surgery.

  1. A novel indication of platonin, a therapeutic immunomodulating medicine, on neuroprotection against ischemic stroke in mice

    Science.gov (United States)

    Sheu, Joen-Rong; Chen, Zhih-Cherng; Jayakumar, Thanasekaran; Chou, Duen-Suey; Yen, Ting-Lin; Lee, Hsing-Ni; Pan, Szu-Han; Hsia, Chih-Hsuan; Yang, Chih-Hao; Hsieh, Cheng-Ying

    2017-01-01

    Thrombosis and stroke are major causes of disability and death worldwide. However, the regular antithrombotic drugs may have unsatisfactory results and side effects. Platonin, a cyanine photosensitizing dye, has been used to treat trauma, ulcers and some acute inflammation. Here, we explored the neuroprotective effects of platonin against middle cerebral artery occlusion (MCAO)-induced ischemic stroke in mice. Platonin(200 μg/kg) substantially reduced cerebral infarct volume, brain edema, neuronal cell death and neurological deficit scores, and improved the MCAO-reduced locomotor activity and rotarod performance. Platonin(5–10 μM) potently inhibited platelet aggregation and c-Jun NH2-terminal kinase (JNK) phosphorylation in collagen-activated platelets. The antiaggregation effect did not affect bleeding time but increased occlusion time in platonin(100 and 200 μg/kg)-treated mice. Platonin(2–10 μM) was potent in diminishing collagen- and Fenton reaction-induced ∙OH formation. Platonin(5–10 μM) also suppressed the expression of nitric oxide, inducible nitric oxide synthase, cyclooxygenase-2, interleukin-1β, and JNK phosphorylation in lipopolysaccharide-stimulated macrophages. MCAO-induced expression of 3-nitrotyrosine and Iba1 was apparently attenuated in platonin(200 μg/kg)-treated mice. In conclusion, platonin exhibited remarkable neuroprotective properties against MCAO-induced ischemia in a mouse model through its antiaggregation, antiinflammatory and antiradical properties. The observed therapeutic efficacy of platonin may consider being a novel medcine against ischemic stroke. PMID:28165057

  2. Epidemiological study of incidence and risk factors of Ischemic stroke subtypes according to Trial of ORG 10172 in acute stroke treatment criteria: A 3 years, hospital-based study

    Directory of Open Access Journals (Sweden)

    Pushpendra Nath Renjen

    2015-01-01

    Full Text Available Background and Purpose: The purpose of this study was to determine the incidence and risk factor of ischemic stroke subtypes by a mechanism-based classification scheme (Trial of ORG 10172 in Acute Stroke Treatment [TOAST]. Materials and Methods: This study was conducted in Indraprastha Apollo Hospital, New Delhi, between 01/01/2004 and 31/12/2006. Out of 361 admitted stroke patients, 244 (67.59% ischemic stroke patients were analyzed retrospectively for incidence and modifiable risk factors for stroke in our region. The cause of ischemic stroke was classified according to the TOAST criteria. Results: Out of 244 patients 165 (67.6% were male and 79 (32.4% were female, the mean age at the time of stroke was 57.1 years, the incidence of different risk factors were as follows: 139 (56.9%, odds ratio 2.71 hypertensive, 85 (34.8%, odds ratio 2.4 diabetics, 95 (38.9%, odds ratio 3.12 smokers, 58 (23.7%, odds ratio 5.34 dyslipidemics, 44 (18.0%, odds ratio 1.43 coronary artery disease (CAD patients, 14 (5.7%, odds ratio 1.22 patients have the transient ischemic stroke in the past, 13 (5.3%, odds ratio 1.43 were given the history of atrial fibrillation. The incidence rates of ischemic stroke subtypes were as follows: Determined causes; large artery atherosclerosis 141 (57.7%, lacunes 18 (7.7%, cardio-embolism 11 (4.5%, hypercoagulable state 8 (3.2%, un-determined causes; atherosclerosis and/or lacunes 25 (10.2%, embolism and/or two more (hypercoagulable state/CAD possible causes 7 (2.8%, negative evaluation in 34 (13.9% patients. Ischemic stroke subtype according to the TOAST criteria was a significant predictor for long-term survival. Conclusions: Our data indicate that large vessel disease is a major cause, and the hypertension, diabetes, smoking, hyperlipidemia are the most common risk factors for Ischemic stroke.

  3. Role of homocysteine in the ischemic stroke nad development of ischemic tolerance

    Directory of Open Access Journals (Sweden)

    Jan Lehotsky

    2016-11-01

    Full Text Available Homocysteine (Hcy is a toxic, sulfur-containing intermediate of methionine metabolism. Hyperhomocysteinemia (hHcy, as a consequence of impaired Hcy metabolism or defects in crucial co-factors that participate in its recycling, is assumed as an independent human stroke risk factor. Neural cells are sensitive to prolonged hHcy treatment, because Hcy cannot be metabolized either by the transsulfuration pathway or by the folate/vitamin B12 independent remethylation pathway. Its detrimental effect after ischemia-induced damage includes accumulation of reactive oxygen species (ROS and posttranslational modifications of proteins via homocysteinylation and thiolation. Ischemic preconditioning (IPC is an adaptive response of the CNS to sub-lethal ischemia, which elevates tissues tolerance to subsequent ischemia. The main focus of this review is on the recent data on homocysteine metabolism and mechanisms of its neurotoxicity. In this context, the review documents an increased oxidative stress and functional modification of enzymes involved in redox balance in experimentally induced hyperhomocysteinemia. It also gives an interpretation whether hyperhomocysteinemia alone or in combination with IPC affects the ischemia-induced neurodegenerative changes as well as intracellular signalling. Studies document that hHcy alone significantly increased Fluoro-Jade C- and TUNEL-positive cell neurodegeneration in the rat hippocampus as well as in the cortex. IPC, even if combined with hHcy, could still preserve the neuronal tissue from the lethal ischemic effects. This review also describes the changes in the mitogen-activated protein kinase (MAPK protein pathways following ischemic injury and IPC. These studies provide evidence for the interplay and tight integration between ERK and p38 MAPK signalling mechanisms in response to the hHcy and also in association of hHcy with ischemia/IPC challenge in the rat brain. Further investigations of the protective factors

  4. Proteinuria is an independent risk factor for ischemic stroke among diabetic patients.

    Science.gov (United States)

    Mondol, G; Rahman, K M; Uddin, M J; Bhattacharjee, M; Dey, S K; Israil, A; Miah, A H; Sarkar, U K; Islam, S S; Rahman, M M; Hossain, F; Bhuiya, M M; Bhowmik, R; Chowdhury, A H; Kabir, M S; Uddin, M S

    2012-07-01

    This study was done to assess the relationship between proteinuria and ischemic stroke in subjects with diabetes mellitus, and to determine whether proteinuria is an independent risk factor for stroke. This comparative study was conducted in Mymensingh Medical College Hospital from January 2009 to June 2010. It was done to establish the relationship between proteinuria (Microalbuminuria) and ischemic stroke among diabetic patients. Other risk factors were also assessed. Patients were divided in Group A - diabetic patients with ischemic stroke (n=50) and Group B diabetic patients without stroke (n=50). Mean age of the Group A & B were 60.16±8.33 and 57.19±7.73 years (p=0.068). Mean Blood sugar (2 hours after Break Fast) was 14.68±4.32mmol/L in Group A and 14.75±4.02mmol/L in Group B (p>0.05). Albumin Creatinine ratio was abnormal in 84.0% in Group A and 22.0% in Group A (p=0.001) [Odds ratio (95%CI) = 18.61 (6.78-51.09)]. Logistic regression analysis has also shown that microalbuminuria (ACR) is an independent risk factor for ischemic stroke (p=0.001), [Odds ratio (95%CI) = 19.811(5.915-66.348)]. In diabetic patients increased urinary protein is a risk factor for stroke. Estimation of urinary protein (Microalbuminuria) may be used as a predictor for ischemic stroke in patients with diabetes.

  5. Autologous Intravenous Mononuclear Stem Cell Therapy in Chronic Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Bhasin A

    2012-01-01

    Full Text Available Background: The regenerative potential of brain has led to emerging therapies that can cure clinico-motor deficits after neurological diseases. Bone marrow mononuclear cell therapy is a great hope to mankind as these cells are feasible, multipotent and aid in neurofunctional gains in Stroke patients. Aims: This study evaluates safety, feasibility and efficacy of autologous mononuclear (MNC stem cell transplantation in patients with chronic ischemic stroke (CIS using clinical scores and functional imaging (fMRI and DTI. Design: Non randomised controlled observational study Study: Twenty four (n=24 CIS patients were recruited with the inclusion criteria as: 3 months–2years of stroke onset, hand muscle power (MRC grade at least 2; Brunnstrom stage of recovery: II-IV; NIHSS of 4-15, comprehendible. Fugl Meyer, modified Barthel Index (mBI and functional imaging parameters were used for assessment at baseline, 8 weeks and at 24 weeks. Twelve patients were administered with mean 54.6 million cells intravenously followed by 8 weeks of physiotherapy. Twelve patients served as controls. All patients were followed up at 24 weeks. Outcomes: The laboratory and radiological outcome measures were within normal limits in MNC group. Only mBI showed statistically significant improvement at 24 weeks (p<0.05 whereas the mean FM, MRC, Ashworth tone scores in the MNC group were high as compared to control group. There was an increased number of cluster activation of Brodmann areas BA 4, BA 6 post stem cell infusion compared to controls indicating neural plasticity. Cell therapy is safe and feasible which may facilitate restoration of function in CIS.

  6. Stroke and Drug Delivery--In Vitro Models of the Ischemic Blood-Brain Barrier

    DEFF Research Database (Denmark)

    Tornabene, Erica; Brodin, Birger

    2016-01-01

    Stroke is a major cause of death and disability worldwide. Both cerebral hypoperfusion and focal cerebral infarcts are caused by a reduction of blood flow to the brain, leading to stroke and subsequent brain damage. At present, only few medical treatments of stroke are available, with the Food...... and Drug Administration-approved tissue plasminogen activator for treatment of acute ischemic stroke being the most prominent example. A large number of potential drug candidates for treatment of ischemic brain tissue have been developed and subsequently failed in clinical trials. A deeper understanding...... of permeation pathways across the barrier in ischemic and postischemic brain endothelium is important for development of new medical treatments. The blood-brain barrier, that is, the endothelial monolayer lining the brain capillaries, changes properties during an ischemic event. In vitro models of the blood-brain...

  7. Inflammation after Ischemic Stroke: The Role of Leukocytes and Glial Cells

    Science.gov (United States)

    Kim, Jong Youl; Park, Joohyun; Chang, Ji Young; Kim, Sa-Hyun

    2016-01-01

    The immune response after stroke is known to play a major role in ischemic brain pathobiology. The inflammatory signals released by immune mediators activated by brain injury sets off a complex series of biochemical and molecular events which have been increasingly recognized as a key contributor to neuronal cell death. The primary immune mediators involved are glial cells and infiltrating leukocytes, including neutrophils, monocytes and lymphocyte. After ischemic stroke, activation of glial cells and subsequent release of pro- and anti-inflammatory signals are important for modulating both neuronal cell damage and wound healing. Infiltrated leukocytes release inflammatory mediators into the site of the lesion, thereby exacerbating brain injury. This review describes how the roles of glial cells and circulating leukocytes are a double-edged sword for neuroinflammation by focusing on their detrimental and protective effects in ischemic stroke. Here, we will focus on underlying characterize of glial cells and leukocytes under inflammation after ischemic stroke.

  8. Development and Validation of Intracranial Thrombus Segmentation on CT Angiography in Patients with Acute Ischemic Stroke

    NARCIS (Netherlands)

    Santos, E.M.M.; Marquering, H.A.; Berkhemer, O.A.; Van Zwam, W.H.; Van der Lugt, A.; Majoie, C.B.; Niessen, W.J.

    2014-01-01

    Background and Purpose: Thrombus characterization is increasingly considered important in predicting treatment success for patients with acute ischemic stroke. The lack of intensity contrast between thrombus and surrounding tissue in CT images makes manual delineation a difficult and time consuming

  9. Development and validation of intracranial thrombus segmentation on CT angiography in patients with acute ischemic stroke

    NARCIS (Netherlands)

    Santos, E.M.; Marquering, H.A.; Berkhemer, O.A.; Zwam, W.H. van; Lugt, A. van der; Majoie, C.B.; Niessen, W.J.; Dijk, E.J. van

    2014-01-01

    BACKGROUND AND PURPOSE: Thrombus characterization is increasingly considered important in predicting treatment success for patients with acute ischemic stroke. The lack of intensity contrast between thrombus and surrounding tissue in CT images makes manual delineation a difficult and time consuming

  10. Inherited Prothrombotic Risk Factors in Migraine, Stroke, or Transient Ischemic Attack

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-05-01

    Full Text Available The prevalence and association of inherited prothrombotic risk factors in children with established diagnoses of stroke, transient ischemic attack, or migraine were studied at Zagreb University School of Medicine, Croatia.

  11. Influence of Kinesitherapy on Gait in Patients with Ischemic Stroke in the Chronic Period

    Directory of Open Access Journals (Sweden)

    Danche Vasileva

    2015-10-01

    CONCLUSION: The applied specialized kinesitherapeutic methodology continued later as exercise program at home, which significantly improved gait cadence and speed of movement in patients with ischemic stroke in the chronic period and is with a supportive prolonged exposure.

  12. Clinical significance of TOAST typing of ischemic stroke in young adults

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Ischemic stroke in young adults brings extremely hurts for their families and society, and the etiological factors and risk factors are different in the world.OBJECTIVE: To analyze and evaluate clinical significance of ischemic stroke in young adults by using TOAST typing.DESIGN: Case analysis.SETTING: Department of Neurology, the First Affiliated Hospital, Guangxi Medical University.PARTICIPANTS: A total of 64 young adults with acute ischemic stroke were selected from the Department of Neurology, the First Affiliated Hospital, Guangxi Medical University from September 2005 to June 2006.There were 44 males and 20 females and their age ranged from 15 to 45 years. All patients met with the diagnostic criteria of the Fourth National Cerebrovarscular Academic Meeting and certainly diagnosed with CT or MRI examination. In addition, all patients provided the confirmed consent.METHODS: ① TOAST typing: Based on X-ray of thoracic part, electrocardiography, blood routine, blood glucose, electrolure, lipid, blood coagulation test, anticardiolipin antibody, antinuclear antibody, anti-double chain DNA, antineutrophil cytoplasmic antibody, crook agglutination test, syphilis antibody and human immunodeficiency virus (HIV) antibody test, patients received TOAST typing, including large-artery atherosclerotic stroke (LA), small-artery occlusion lacunar (SA), cardioembolism (CE), stroke of other demonstrated etiology (SOE), and stroke of other undemonstrated etiology (SUE). ② Risk factors: Stages of hypertension, diabetes mellitus, hyperlipemia, smoking and drinking of patients were observed. Blood pressure was measured twice after onset of acute stroke, and values of total cholesterol (TC) and/or triacylglycerol (TG) were measured more than twice to finally diagnose hyperlipemia. Diagnostic criteria of diabetes mellitus: fasting≥7.0 mmol/L; 2 hours after administrating glucose ≥ 11.1 mmol/L. Risk factor of smoking defined as more than 10 smokes every day in the

  13. Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients.

    LENUS (Irish Health Repository)

    von Sarnowski, Bettina

    2013-03-06

    OBJECTIVE: Atherosclerosis is believed to be a minor cause of TIA and stroke in younger and middle-aged patients. However, data from large cohorts are limited. This study investigates the prevalence of extracranial and intracranial atherosclerosis in stroke and TIA patients aged 18-55 years in the multinational sifap1 study. METHODS: From the sifap1 cohort (n = 5,023), we analyzed a subset of patients with complete data from carotid ultrasound studies. Patients with arterial dissections, vasculitis, and mobile thrombi were excluded. Among the remaining 2,187 patients (men: n = 1,319; 18-44 years: n = 744), intracranial arteries were additionally examined with ultrasonography in 1,612 patients (73.7%). Patients were stratified by sex and age groups (younger: 18-44 years; middle-aged: 45-55 years). RESULTS: In patients with ischemic stroke, the overall prevalence of carotid artery stenoses and occlusions was 8.9% (younger: 4.9%; middle-aged: 11.0%), of which 81% were symptomatic. Nonstenotic carotid plaques were more common in men than in women (15.8% vs 7.7%; p < 0.001), and in middle-aged than in younger patients (17.0% vs 4.9%; p < 0.001). Supratentorial intracranial artery stenoses and occlusions amounted to 11.8%. Supratentorial stenoses occurred more frequently in middle-aged patients (13.0% vs 7.8%; p < 0.001), whereas occlusions were equally common (both 3.2%; not significant). CONCLUSIONS: We observed a substantial proportion of atherosclerotic carotid artery stenoses and occlusions in younger stroke patients. Intracranial stenoses and occlusions were even more prevalent than extracranial carotid artery disease. Together with nonstenotic plaques, one-fifth of patients (21.2%) had symptomatic or asymptomatic large-artery atherosclerosis, which should encourage future stroke prevention campaigns to target risk factor modification in young people.

  14. 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

  15. Correlation between Nerve Growth Factor (NGF) with Brain Derived Neurotropic Factor (BDNF) in Ischemic Stroke Patient

    OpenAIRE

    Islam, Andi Asadul

    2016-01-01

    - The neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) is a family of polypeptides that play critical role during neuronal development, appear to mediate protective role on neurorepair in ischemic stroke. Naturally in adult brain neurorepair process consist of: angiogenesis, neurogenesis, and neuronal plasticity, it can also be stimulated by endogenous neurorepair. In this study we observed correlation between NGF and BDNF ischemic stroke patient's onset...

  16. Association of IL8 and IL10 gene allelic variants with ischemic stroke risk and prognosis

    Directory of Open Access Journals (Sweden)

    Kucherenko A. M.

    2014-05-01

    Full Text Available Aim. Evaluating a role of IL8 gene –781 C/T, and IL10 gene –592C/A polymorphisms as genetic markers of ischemic stroke risk. Methods. A case group consisted of 183 patients with ischemic stroke, which were treated in the Brain Vascular Pathology unit of SI «Institute of Gerontology of NAMS of Ukraine». A control group included 88 healthy individuals older than 65 years without any history of ischemic stroke. Genotyping was performed using PCR followed by restriction fragment length polymorphism analysis. Results. Significantly (P < 0,05 higher frequency of IL8 –781T allele carriers in the case group (81,6 % comparing to the control (70,1% was revealed. –781T allele carriers have nearly 2-fold increased ischemic stroke development risk (OR = 1.886; 95 % CI: 1.041–3.417. Significantly (P < 0,05 higher frequency of IL10 gene –592C allele carriers was observed in the patients with ischemic stroke (98,2% comparing to the control (90,7 %. The ischemic stroke development risk in such individuals is 5-fold increased (OR = 5.71; 95 % CI: 1.48–22.11. It was revealed that –592C allele homozygotes with ischemic stroke have more than 2-fold higher improvement (according to the Rankin scale chances during the first fortnight of treatment (OR = 2,76; 95 % CI: 1,26–6,07. Conclusions. On the basis of the obtained significant differences, IL8 gene –781T and IL10 gene –592C variants may be considered the factors of ischemic stroke hereditary susceptibility. Besides, IL10 gene –592CC genotype is a genetic marker of the patients state positive dynamics during first two weeks of treatment.

  17. [The importance of transcranial Doppler (TDC) in the assessment of cerebrovascular hemodynamics of the acute phase of ischemic stroke].

    Science.gov (United States)

    Wojczal, Joanna; Szerej, Anna Szczepańska; Belniak, Ewa; Blaszkowska, Anna; Stelmasiak, Zbigniew

    2003-01-01

    Most recent studies on transcranial Doppler (TCD) in the acute phase of ischemic stroke are reviewed in this paper. TCD is a highly sensitive and specific method of quick, bedside assessment of cerebrovascular circulation hemodynamics in the acute phase of ischemic stroke. The following issues are discussed in the paper: a new classification of ultrasound pathological changes associated with intracranial arteries occlusion or stenosis, the frequency of spontaneous re-canalisation by TCD, a comparison of TCD results with findings obtained by means of other vascular imaging techniques (e.g. DSA, CTA and MRA), relationship between TCD baseline assessment of primary blood flow changes and thrombolysis efficacy (the so-called TIBI classification, Thrombolysis in Brain Ischemia), and prognostic significance of TCD in the acute ischemic stroke. Moreover, first clinical reports on an additive effect of TCD on thrombolytic therapy are presented. The main limitations of TCD include the lack of sufficient bone window in 5-15% of patients and the lack of sufficiently trained staff capable of performing the examination a 24 h duty, since results of the examination to a large degree depend on the examiner's skills.

  18. Effect of Leptomeningeal Anastomoses Compensation on Ischemic Stroke Recurrence in Cerebral Infarction Patients With Middle Cerebral Artery Occlusion%软脑膜侧支代偿对伴大脑中动脉粥样硬化性闭塞脑梗死患者缺血性脑卒中复发的影响

    Institute of Scientific and Technical Information of China (English)

    杨燕; 张临洪

    2015-01-01

    Objective To investigate the effect of leptomeningeal anastomoses ( LMA ) compensation on the recurrence of ischemic stroke within one year after onset in cerebral infarction patients with middle cerebral artery( MCA ) atherosclerotic occlusion. Methods We enrolled 112 cerebral infarction patients with unilateral MCA atherosclerotic occlusion who accorded with the inclusion standard and were admitted into the Department of Neurology of Central Hospital of Wuhan from January 2010 to January 2013. The MCA occlusion and LMA compensation were evaluated by MRA. According to the results of one-year follow-up and the compensation degree,the subjects were divided into LAM positive group and LMA negative group;according to the number of compensation pathway,the subjects were also divided into double-pathway compensation group,one-pathway compensation group and no-pathway compensation group. The recurrence of ischemic stroke in follow-up period was compared among all the groups. Results Among the 112 subjects,76 subjects were in LMA positive group,36 subjects were in LMA negative group. There were 10 cases of ipsilateral ischemic stroke recurrence within 1-year follow-up,with a recurrence rate of 8. 9%. Of the 10 cases of recurrence,3 cases( cerebral infarction)were in the LAM positive group,with a recurrence rate of 3. 9%(3/76),and 7 cases(3 cases of cerebral infarction and 4 cases of TIA)were in the LAM negative group,with a recurrence rate of 19. 4%(7/36). The two groups were significantly different in one-year recurrence rate of ischemic stroke (χ2 =7. 220,P=0. 007). There were 34 subjects in double-pathway compensation group,with a recurrence rate of 2. 9%(1/34);there were 42 subjects in one-pathway compensation group,among which 14 subjects were of ACA compensation and 28 were of PCA compensation, with a recurrence rate of 4. 8% ( 2/42 );there were 36 subjects in the no - pathway compensation group, with a recurrence rate of 19. 4% ( 7/36 ). The subjects with

  19. 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

  20. [The effect of cerebrolysin in dosage 50 ml on the volume of lesion in ischemic stroke].

    Science.gov (United States)

    Shamalov, N A; Stakhovskaia, L V; Burenchev, D V; Kichuk, I V; Tvorogova, T V; Botsina, A Iu; Smychkov, A S; Kerbikov, O B; Moessler, H; Novak, P; Skvortsova, V I

    2010-01-01

    The purpose of this randomized, double-blind, placebo-controlled study was to assess safety and efficacy of cerebrolysin used in dosage 50 ml in acute ischemic stroke. Forty-seven patients with ischemic stroke, aged 45-85 years, who were admitted to a clinical unit within the first 12 h after stroke onset were included in the study. A quantitative time-related MRI analysis of the dynamics of neurological deficit revealed the more rapid decrease of stroke volume to the 28th day in the group treated with cerebrolysin (45.4% versus 43.6% in the placebo-group (p cerebrolysin was found. The results of this prospective, randomized, placebo-controlled study suggest the positive effect of cerebrolysin on the dynamics of volume lesion in patients with ischemic stroke.

  1. Increased serum neuron specific enolase concentrations in patients with hyperglycemic cortical ischemic stroke

    NARCIS (Netherlands)

    Elting, JW; De Keyser, J; Sulter, G.

    1998-01-01

    A detrimental effect of hyperglycemia in ischemic brain has been demonstrated in laboratory experiments and it has been found that hyperglycemia in ischemic stroke is a predictor of poor outcome. We determined serum neuron specific enolase (NSE) concentrations in 41 consecutive patients with a cereb

  2. Behavior outcome after ischemic and hemorrhagic stroke, with similar brain damage, in rats.

    Science.gov (United States)

    Mestriner, Régis Gemerasca; Miguel, Patrícia Maidana; Bagatini, Pamela Brambilla; Saur, Lisiani; Boisserand, Lígia Simões Braga; Baptista, Pedro Porto Alegre; Xavier, Léder Leal; Netto, Carlos Alexandre

    2013-05-01

    Stroke causes disability and mortality worldwide and is divided into ischemic and hemorrhagic subtypes. Although clinical trials suggest distinct recovery profiles for ischemic and hemorrhagic events, this is not conclusive due to stroke heterogeneity. The aim of this study was to produce similar brain damage, using experimental models of ischemic (IS) and hemorrhagic (HS) stroke and evaluate the motor spontaneous recovery profile. We used 31 Wistar rats divided into the following groups: Sham (n=7), ischemic (IS) (n=12) or hemorrhagic (HS) (n=12). Brain ischemia or hemorrhage was induced by endotelin-1 (ET-1) and collagenase type IV-S (collagenase) microinjections, respectively. All groups were evaluated in the open field, cylinder and ladder walk behavioral tests at distinct time points as from baseline to 30 days post-surgery (30 PS). Histological and morphometric analyses were used to assess the volume of lost tissue and lesion length. Present results reveal that both forms of experimental stroke had a comparable long-term pattern of damage, since no differences were found in volume of tissue lost or lesion size 30 days after surgery. However, behavioral data showed that hemorrhagic rats were less impaired at skilled walking than ischemic ones at 15 and 30 days post-surgery. We suggest that experimentally comparable stroke design is useful because it reduces heterogeneity and facilitates the assessment of neurobiological differences related to stroke subtypes; and that spontaneous skilled walking recovery differs between experimental ischemic and hemorrhagic insults.

  3. 儿童动脉缺血性与出血性脑卒中的危险因素及转归%The comparison and analysis of risk factors and outcomes of arterial ischemic stroke and hemorrhagic stroke in children

    Institute of Scientific and Technical Information of China (English)

    张园园; 王怀立

    2015-01-01

    目的:总结儿童动脉缺血性卒中(AIS)和出血性卒中(HS)的临床特点、危险因素及转归。方法回顾性分析和比较2010年11月至2014年5月诊治的142例AIS和HS患儿的临床资料。结果AIS 92例(64.8%),男60例、女32例,发病年龄(4.6±3.6)岁(1个月~16岁);HS 50例(35.2%),男34例、女16例,发病年龄(2.6±3.7)岁(1个月~13岁);两组患儿的年龄差异有统计学意义(P=0.007)。AIS最常表现为局灶神经功能受损,其中肢体瘫痪73例(79.3%)、中枢性面瘫30例(32.6%)、语言障碍19例(20.7%);HS最常表现为弥散神经功能受损,其中意识障碍29例(58.0%)、恶心/呕吐22例(44.0%)、头痛14例(28.0%)。AIS常见危险因素为脑动脉病49例(53.3%)、感染47例(51.1%)、头部轻微外伤史16例(17.4%);HS常见危险因素为维生素K缺乏22例(44.0%)、脑血管畸形8例(16.0%)、血液系统疾病6例(12.0%)。AIS患儿死亡5例(6.4%),致残48例(61.5%),复发9例(11.5%);HS患儿死亡15例(34.1%),致残19例(43.2%);HS病死率高于AIS,差异有统计学意义(P<0.01)。结论儿童脑卒中HS所占比例并不低,且预后较AIS更差。%ObjectivesTo study the clinical characteristics, the risk factors and outcomes of arterial ischemic stroke (AIS) and hemorrhagic stroke (HS) in children.MethodsThe clinical data from 142 children with AIS or HS were retrospectively re-viewed and compared from Nov. 2010 to May 2014.ResultsIn these children, 92 cases (64.8%) was diagnosed of AIS, amont whom there were 60 males and 32 females and the onset age of stroke was 4.6±3.6 years (1 months to 16 years old), and 50 cases (35.2%) was diagnosed of HS, among whom there were 34 males and 16 females and the onset age of stroke was 2.6±3.7 years (1 months to 13 years old). The difference in age between two groups was statistically signiifcant (P=0.007). The most common presentation of AIS were focal neurological dysfunction including paralysis (73 cases, 79

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Comparative analysis of general characteristics of ischemic stroke of BAD and non-BAD CISS subtypes.

    Science.gov (United States)

    Mei, Bin; Liu, Guang-zhi; Yang, Yang; Liu, Yu-min; Cao, Jiang-hui; Zhang, Jun-jian

    2015-12-01

    Based on the recently proposed Chinese ischemic stroke subclassification (CISS) system, intracranial branch atheromatous disease (BAD) is divided into large artery atherosclerosis (LAA) and penetrating artery disease (PAD). In the current retrospective analysis, we compared the general characteristics of BAD-LAA with BAD-PAD, BAD-LAA with non-BAD-LAA and BAD-PAD with non-BAD-PAD. The study included a total of 80 cases, including 45 cases of BAD and 35 cases of non-BAD. Subjects were classified using CISS system: BAD-LAA, BAD-PAD, non-BAD-LAA and non-BAD-PAD. In addition to analysis of general characteristics, the correlation between the factors and the two subtypes of BAD was evaluated. The number of cases included in the analysis was: 32 cases of BAD-LAA, 13 cases of BAD-PAD, 21 cases of non-BAD-LAA, and 14 cases of non-BAD-PAD. Diabetes mellitus affected more non-BAD-LAA patients than BAD-LAA patients (P=0.035). In comparison with non-BAD-PAD, patients with BAD-PAD were younger (P=0.040), had higher initial NIHSS score (PBAD, the PAD subtype was associated with smoking (OR=0.043; P=0.011), higher low-density lipoprotein (OR=5.339; P=0.029), ischemic heart disease (OR=9.383; P=0.047) and diabetes mellitus (OR=12.59; P=0.020). It was concluded that large artery atherosclerosis was the primary mechanism of BAD. The general characteristics showed no significant differences between the CISS subtypes of LAA and PAD within BAD, as well as between the BAD and non-BAD within LAA subtype. Several differences between PAD subtypes of BAD and non-BAD were revealed.

  6. Exercise pre‑conditioning alleviates brain damage via excitatory amino acid transporter 2 and extracellular signal‑regulated kinase 1/2 following ischemic stroke in rats.

    Science.gov (United States)

    Wang, Xiao; Zhang, Min; Feng, Rui; Li, Wen-Bin; Ren, Shi-Qing; Zhang, Feng

    2015-02-01

    Previous studies have reported that physical exercise may exert a neuroprotective effect in humans as well as animals. However, the detailed mechanisms underlying the neuroprotective effect of exercise has remained to be elucidated. The aim of the present study was to explore the possible signaling pathways involved in the protective effect of pre‑ischemic treadmill training for ischemic stroke in rats. A total of 36 male Sprague‑Dawley rats were divided at random into three groups as follows (n=12 for each): Sham surgery group; middle cerebral artery occlusion (MCAO) group; and exercise with MCAO group. Following treadmill training for three weeks, the middle cerebral artery was occluded for 90 min in order to induce ischemic stroke, followed by reperfusion. Following 24 h post‑reperfusion, six rats from each group were assessed for neurological deficits and then sacrificed to calculate the infarct volume. The remaining rats (n=6 for each group) were sacrificed and the expression levels of excitatory amino acid transporter 2 (EAAT‑2) and extracellular signal‑regulated kinase 1/2 (ERK1/2) were detected using western blot analysis. The results of the present study demonstrated that rats that underwent pre‑ischemic exercise intervention had a significantly decreased brain infarct volume and neurological deficits; in addition, the pre‑ischemic exercise group showed decreased overexpression of phosphorylated ERK1/2 and increased expression of EAAT‑2 following ischemic stroke. In conclusion, treadmill training exercise prior to ischemic stroke alleviated brain damage in rats via regulation of EAAT‑2 and ERK1/2.

  7. Does computed tomography permeability predict hemorrhagic transformation after ischemic stroke?

    Institute of Scientific and Technical Information of China (English)

    Peggy Yen; Allison Cobb; Jai Jai Shiva Shankar

    2016-01-01

    AIM: To use perfusion-derived permeability-surface area product maps to predict hemorrhagic transformation following thrombolytic treatment for acute ischemic stroke.METHODS: We retrospectively analyzed our prospectively kept acute stroke database over five consecutive months for patients with symptoms of acute ischemic stroke(AIS) who had computed tomography(CT) perfusion(CTP) done at arrival. Patients included in the analyses also had to have a follow-up CT. The permeability-surface area product maps(PS) was calculated for the side of the ischemia and/or infarction and for the contralateral unaffected side at the same level. The cerebral blood flow map was used to delineate the ischemic territory. Next, a region of interest was drawn at the centre of this territory on the PS parametric map. Finally, a mirror region of interest was created on the contralateral side at the same level. The relative permeability-surface area product maps(r PS) provided an internal control and was calculated as the ratio of the PS on the side of the AIS to the PS on the contralateral side. A student t-test was performed after log conversion of r PS between patients with and without hemorrhagic transformation. Log conversion was used to convert the data into normal distribution to use t-test. For the group of patients who experienced intracranial bleed, a student t-test was performed between those with only petechial hemorrhage and those with more severe parenchymal hematoma with subarachnoid haemorrhage.RESULTS: Of 84 patients with AIS and CTP at admission, only 42 patients had a follow-up CT. The r PSderived using the normal side as the internal control was significantly higher(P = 0.003) for the 15 cases of hemorrhagic transformation(1.71 + 1.64) compared to 27 cases that did not have any(1.07 + 1.30). Patients with values above the overall mean r PS of 1.3 had an increased likelihood of subsequent hemorrhagic transformation. The sensitivity of using this score to predict

  8. Projected Numbers of Ischemic Strokes Recorded in the Austrian Stroke-Unit Registry from 2012 to 2075

    Science.gov (United States)

    Trinka, Eugen; Seyfang, Leonard; Mutzenbach, Sebastian; Stadler, Katharina; Pikija, Slaven; Killer, Monika; Broussalis, Erasmia

    2016-01-01

    Background and Purpose This study analyzed the number of patients with ischemic strokes recorded in the Austrian Stroke-Unit Registry with the aim of projecting this number from 2012 to 2075 and to highlight that the Austrian health system will face a dramatic increase in older patients within the next few decades. Methods Current demographic information was obtained from EUROSTAT, and information on age- and sex-stratified 1-year incidence rates of ischemic stroke were obtained from the Austrian Stroke-Unit Registry. Sensitivity analysis was performed by analyzing the projections based on predicted ageing, main, and growth population scenarios, and with stratification by age and gender. Results The total number of ischemic strokes recorded in the Austrian Stroke-Unit Registry was 8,690 in 2012 and is expected to increase to 15,826, 15,626, or 18,134 in 2075 according to the ageing, main, and growth scenarios, respectively. The corresponding numbers of patients are projected to increase or decrease within different age strata as follows (100%=number of registered ischemic strokes in 2012): 0–40 years, 100%/99% (males/females); 40–50 years, 83%/83%; 50–60 years, 98%/97%; 60–70 years, 126%/119%; 70–80 years, 159%/139%; 80–90 years, 307%/199%; and 90+ years, 894%/413%. Conclusions The ageing population in Austria will result in the number of patients increasing considerably from 2012 to 2075, to 182%, 180%, or 208% (relative to 100% in 2012) according to the ageing, main, and growth scenarios, respectively; the corresponding value among those aged 80+ years is 315%, 290%, or 347%. These figures demonstrated the importance of improving primary preventive measures. The results of this study should provide a basis for discussions among health-care professionals and economists to face the future large financial burden of ischemic stroke on the Austrian health system.

  9. EXPLORING PATHOGENIC MECHANISMS IN ISCHEMIC CEREBRAL DEATH: A RAY OF HOPE FOR DESIGNING NEW THERAPEUTIC STRATEGIES FOR STROKE

    Directory of Open Access Journals (Sweden)

    Deshmukh A. B.

    2011-03-01

    Full Text Available In ischemic stroke, the blood supply to the brain is disrupted by cerebrovascular disease. After coronary heart disease (CHD and cancer, stroke is the third commonest cause of death worldwide which necessitates exploring key targets that can treat the disease. Long duration or severe ischemia leads to necrotic cell death. However, if ischemia is transient or incomplete, the genes executing programmed cell death may be activated that depends upon the duration and severity of the ischemic insult which further is dependent on the exact location of the arterial occlusion and whether or not reperfusion occurs. The finely tuned balance of proapoptotic and antiapoptotic is not only a key point in regulating cell death or survival but also serves as a switch between the two forms of cell death, apoptosis and necrosis. Compelling evidences from more recent studies strongly suggest the involvement of cell death/survival signaling pathways. A greater understanding and future studies of the various signaling pathways involved in the pathophysiology of stroke such as Glutaminergic excitotoxic cascade, marked increase in intracellular calcium, PPAR (peroxisome proliferator activated receptor pathways and Hsp (Heat shock protein pathways, role for leukocytes in propagating tissue damage after ischemia and reperfusion may provide novel therapeutic strategies in clinical stroke.

  10. Compromised Blood-Brain Barrier Competence in Remote Brain Areas in Ischemic Stroke Rats at Chronic Stage

    Science.gov (United States)

    Garbuzova-Davis, Svitlana; Haller, Edward; Williams, Stephanie N.; Haim, Eithan D.; Tajiri, Naoki; Hernandez-Ontiveros, Diana G.; Frisina-Deyo, Aric; Boffeli, Sean M.; Sanberg, Paul R.; Borlongan, Cesario V.

    2014-01-01

    Stroke is a life threatening disease leading to long-term disability in stroke survivors. Cerebral functional insufficiency in chronic stroke might be due to pathological changes in brain areas remote from initial ischemic lesion, i.e. diaschisis. Previously, we showed that the damaged blood-brain barrier (BBB) was implicated in subacute diaschisis. The present study investigated BBB competence in chronic diaschisis using a transient middle cerebral artery occlusion (tMCAO) rat model. Our results demonstrated significant BBB damage mostly in the ipsilateral striatum and motor cortex in rats at 30 days after tMCAO. The BBB alterations were also determined in the contralateral hemisphere via ultrastructural and immunohistochemical analyses. Major BBB pathological changes in contralateral remote striatum and motor cortex areas included: (1) vacuolated endothelial cells containing large autophagosomes, (2) degenerated pericytes displaying mitochondria with cristae disruption, (3) degenerated astrocytes and perivascular edema, (4) Evans Blue extravasation, and (5) appearance of parenchymal astrogliosis. Importantly, discrete analyses of striatal and motor cortex areas revealed significantly higher autophagosome accumulation in capillaries of ventral striatum and astrogliosis in dorsal striatum in both cerebral hemispheres. These widespread microvascular alterations in ipsilateral and contralateral brain hemispheres suggest persistent and/or continued BBB damage in chronic ischemia. The pathological changes in remote brain areas likely indicate chronic ischemic diaschisis, which should be considered in the development of treatment strategies for stroke. PMID:24610730

  11. 尿激酶动脉溶栓与重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性卒中的疗效比较%Comparative efficacy of intra-arterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    周俊山; 徐梦怡

    2010-01-01

    Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) for acute ischemic stroke. Methods A total of 43 patients with acute ischemic stroke within 6 hours of onset were included, 31 of them underwent superselective intra-arterial thrombolysis in the intra-arterial thrombolysis group and 12 of them underwent intravenous thrombolysis with rtPA in the intravenous thrombolysis group. Vascular recanalization was observed in the intra-arterial thrombolysis group, and the modified Rankin scale (mRS) scores at day 90 were used to evaluate the outcomes in both groups. Results Eighteen patients (58.1%) had complete recanalization and 7 (22.6%) had partial recanalization in the intra-arterial thrombolysis group. The recanalization rate was 80.6%, 3 complicated symptomatic intracranial hemorrhage, and 1 died. There vere no significant differences between the good outcome rate (74.2% vs. 66.7%, x2 =0.24, P=0.622) and the incidence of symptomatic intracranial hemorrhage at 90 d (9. 68% vs. 8. 33%, x2 =0. 19, P =0. 892). Conclusions Urokinase intra arterial thrombolysis within the time window can significantly improve the recanalization rate of the occluded vessels and improve the clinical symptoms of the patents in acute phase and long term outcomes. Their short-term efficacy and long-term outcomes are almost the same with intrave nous thrombolysis with rtPA.%目的 评价尿激酶动脉溶栓与重组组织纤溶酶原激活剂(recombinant tissue plasminogen activator,rtPA)静脉溶栓治疗急性缺血性卒中的疗效和安全性.方法 发病6 h内的急性脑梗死患者43例,其中动脉溶栓组31例行超选择性动脉溶栓,静脉溶栓组12例行rtPA静脉溶栓.观察动脉溶栓组血管再通.90 d时改良Rankin量表(modified Ranlkin scale,mRS)评分评价2组转归.结果 动脉溶栓组完全再通18例(58.1%),部分再通7例(22.6%),

  12. Relationship Between HbAlc Levels and Cerebral Arterial Lesions in Patients With Ischemic Stroke With Different Glucose Metabolism%不同糖代谢状况缺血性脑卒中患者HbAlc水平与脑动脉病变程度的关系

    Institute of Scientific and Technical Information of China (English)

    詹红艳; 杨红英; 袁莉; 牛春华; 王丽英; 陈丽丽

    2015-01-01

    ObjectiveTo study the relationship between the level of glycosylated hemoglobin and cerebral arterial lesions in patients with ischemic stroke with different glucose metabolism.Methods 120 cases of ischemic stroke patients were chosen from June 2013 to June 2015 in Tangshan workers hospital, according to glucose metabolism is divided into normal group (n=20) and abnormal group (n=65), diabetes group (n=35). To analysis of HbA1c level, risk factors for cerebral artery disease, cerebral artery lesion sites and count of the three groups were compared. ResultsThere were no significant differences in gender, hypertension, smoking, TG, Hcy among the three groups (P>0.05), the differences were statistically signiifcant with alcohol, coronary heart disease, TC, HDL-C, HbAlc, LDL-C In the three groups of patients (P<0.05). In the patients with abnormal glucose metabolism and diabetes mellitus, cerebral blood vessel stenosis was dominated by moderate and severe cerebral artery stenosis, and the main was the main and the most affected (P<0.05).Conclusion Different levels of glucose metabolism affect cerebral vascular lesions and HbAlc level of cerebral artery stenosis, the location of the lesion and lesion count is affect brain artery disease are important risk factors.%目的研究不同糖代谢状况缺血性脑卒中患者的糖化血红蛋白水平与脑动脉病变程度的关系。方法选取2013年6月~2015年6月唐山市工人医院收治的缺血性脑卒中患者120例,根据糖代谢情况分为正常组(n=20)、异常组(n=65)、糖尿病组(n=35),比较三组的一般资料、分析HbAlc水平、脑动脉病变危险因素、脑动脉病变部位及支数。结果三组患者性别、高血压、吸烟、TG、Hcy等方面比较,差异无统计学意义(P>0.05),三组患者中饮酒、冠心病、HbAlc、TC、HDL-C、LDL-C比较,差异有统计学意义(P<0.05);三组患者中,正常组脑血管狭窄以轻度为主,

  13. Polymorphism of Nitric Oxide Synthase 1 Affects the Clinical Phenotypes of Ischemic Stroke in Korean Population

    Science.gov (United States)

    Yoo, Seung Don; Yun, Dong Hwan; Kim, Hee-Sang; Kim, Su Kang; Kim, Dong Hwan; Chon, Jinmann; Je, Goun; Kim, Yoon-Seong; Chung, Joo-Ho; Chung, Seung Joon; Yeo, Jin Ah

    2016-01-01

    Objective To investigate whether four single nucleotide polymorphisms (SNPs) rs2293054 [Ile734Ile], rs1047735 [His902His], rs2293044 [Val1353Val], rs2682826 (3'UTR) of nitric oxide synthase 1 (NOS1) are associated with the development and clinical phenotypes of ischemic stroke. Methods We enrolled 120 ischemic stroke patients and 314 control subjects. Ischemic stroke patients were divided into subgroups according to the scores of the National Institutes of Health Stroke Survey (NIHSS, <6 and ≥6) and Modified Barthel Index (MBI, <60 and ≥60). SNPStats, SNPAnalyzer, and HelixTree programs were used to calculate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. Multiple logistic regression models were performed to analyze genetic data. Results No SNPs of the NOS1 gene were found to be associated with ischemic stroke. However, in an analysis of clinical phenotypes, we found that rs2293054 was associated with the NIHSS scores of ischemic stroke patients in codominant (p=0.019), dominant (p=0.007), overdominant (p=0.033), and log-additive (p=0.0048) models. Also, rs2682826 revealed a significant association in the recessive model (p=0.034). In allele frequency analysis, we also found that the T alleles of rs2293054 were associated with lower NIHSS scores (p=0.007). Respectively, rs2293054 had a significant association in the MBI scores of ischemic stroke in codominant (p=0.038), dominant (p=0.031), overdominant (p=0.045), and log-additive (p=0.04) models. Conclusion These results suggest that NOS1 may be related to the clinical phenotypes of ischemic stroke in Korean population. PMID:26949676

  14. Gut dysbiosis is associated with metabolism and systemic inflammation in patients with ischemic stroke

    Science.gov (United States)

    Yamashiro, Kazuo; Tanaka, Ryota; Urabe, Takao; Ueno, Yuji; Yamashiro, Yuichiro; Nomoto, Koji; Takahashi, Takuya; Tsuji, Hirokazu; Asahara, Takashi; Hattori, Nobutaka

    2017-01-01

    The role of metabolic diseases in ischemic stroke has become a primary concern in both research and clinical practice. Increasing evidence suggests that dysbiosis is associated with metabolic diseases. The aim of this study was to investigate whether the gut microbiota, as well as concentrations of organic acids, the major products of dietary fiber fermentation by the gut microbiota, are altered in patients with ischemic stroke, and to examine the association between these changes and host metabolism and inflammation. We analyzed the composition of the fecal gut microbiota and the concentrations of fecal organic acids in 41 ischemic stroke patients and 40 control subjects via 16S and 23S rRNA-targeted quantitative reverse transcription (qRT)-PCR and high-performance liquid chromatography analyses, respectively. Multivariable linear regression analysis was subsequently performed to evaluate the relationships between ischemic stroke and bacterial counts and organic acid concentrations. Correlations between bioclinical markers and bacterial counts and organic acids concentrations were also evaluated. Although only the bacterial counts of Lactobacillus ruminis were significantly higher in stroke patients compared to controls, multivariable analysis showed that ischemic stroke was independently associated with increased bacterial counts of Atopobium cluster and Lactobacillus ruminis, and decreased numbers of Lactobacillus sakei subgroup, independent of age, hypertension, and type 2 diabetes. Changes in the prevalence of Lactobacillus ruminis were positively correlated with serum interleukin-6 levels. In addition, ischemic stroke was associated with decreased and increased concentrations of acetic acid and valeric acid, respectively. Meanwhile, changes in acetic acid concentrations were negatively correlated with the levels of glycated hemoglobin and low-density lipoprotein cholesterol, whereas changes in valeric acid concentrations were positively correlated with the

  15. Gait analysis in a pre- and post-ischemic stroke biomedical pig model.

    Science.gov (United States)

    Duberstein, Kylee Jo; Platt, Simon R; Holmes, Shannon P; Dove, C Robert; Howerth, Elizabeth W; Kent, Marc; Stice, Steven L; Hill, William D; Hess, David C; West, Franklin D

    2014-02-10

    Severity of neural injury including stroke in human patients, as well as recovery from injury, can be assessed through changes in gait patterns of affected individuals. Similar quantification of motor function deficits has been measured in rodent animal models of such injuries. However, due to differences in fundamental structure of human and rodent brains, there is a need to develop a large animal model to facilitate treatment development for neurological conditions. Porcine brain structure is similar to that of humans, and therefore the pig may make a more clinically relevant animal model. The current study was undertaken to determine key gait characteristics in normal biomedical miniature pigs and dynamic changes that occur post-neural injury in a porcine middle cerebral artery (MCA) occlusion ischemic stroke model. Yucatan miniature pigs were trained to walk through a semi-circular track and were recorded with high speed cameras to detect changes in key gait parameters. Analysis of normal pigs showed overall symmetry in hindlimb swing and stance times, forelimb stance time, along with step length, step velocity, and maximum hoof height on both fore and hindlimbs. A subset of pigs were again recorded at 7, 5 and 3 days prior to MCA occlusion and then at 1, 3, 5, 7, 14 and 30 days following surgery. MRI analysis showed that MCA occlusion resulted in significant infarction. Gait analysis indicated that stroke resulted in notable asymmetries in both temporal and spatial variables. Pigs exhibited lower maximum front hoof height on the paretic side, as well as shorter swing time and longer stance time on the paretic hindlimb. These results support that gait analysis of stroke injury is a highly sensitive detection method for changes in gait parameters in pig.

  16. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke

    DEFF Research Database (Denmark)

    Hacke, Werner; Kaste, Markku; Bluhmki, Erich

    2008-01-01

    and 4.5 hours after the onset of a stroke. METHODS: After exclusion of patients with a brain hemorrhage or major infarction, as detected on a computed tomographic scan, we randomly assigned patients with acute ischemic stroke in a 1:1 double-blind fashion to receive treatment with intravenous alteplase...

  17. When void matters: Imaging, detection, quantification, and analysis of thrombi in patients with acute ischemic stroke

    NARCIS (Netherlands)

    Santos, E.M.M.

    2016-01-01

    Stroke is the most common cause of disability and the third most common cause of death worldwide. However, despite improvements in imaging techniques and treatments, there is a large group of patients that do not recover with currently available therapies. Ischemic stroke, which accounts for 80% of

  18. Early ficolin-1 is a sensitive prognostic marker for functional outcome in ischemic stroke

    DEFF Research Database (Denmark)

    Zangari, R; Zanier, E R; Torgano, G

    2016-01-01

    BACKGROUND: Several lines of evidence support the involvement of the lectin pathway of complement (LP) in the pathogenesis of acute ischemic stroke. The aim of this multicenter observational study was to assess the prognostic value of different circulating LP initiators in acute stroke. METHODS: ...

  19. Selected acute phase CSF factors in ischemic stroke: findings and prognostic value

    Directory of Open Access Journals (Sweden)

    Intskirveli Nino

    2011-03-01

    Full Text Available Abstract Background Study aimed at investigation of pathogenic role and prognostic value of several selected cerebrospinal fluid acute phase factors that can reflect the severity of ischemic brain damage. Methods Ninety five acute ischemic stroke patients were investigated. Ischemic region visualized at the twenty fourth hour by conventional Magnetic Resonance Imaging. Stroke severity evaluated by National Institute Health Stroke Scale. One month outcome of disease was assessed by Barthel Index. Cerebrospinal fluid was taken at the sixth hour of stroke onset. CSF pro- and anti-inflammatory cytokines were studied by Enzyme Linked Immunosorbent Assay. Nitric Oxide and Lipoperoxide radical were measured by Electron Paramagnetic Resonance. CSF Nitrate levels were detected using the Griess reagent. Statistics performed by SPSS-11.0. Results At the sixth hour of stroke onset, cerebrospinal fluid cytokine levels were elevated in patients against controls. Severe stroke patients had increased interleukin-6 content compared to less severe strokes (P Conclusion According to present study the cerebrospinal fluid contents of interleukin-6 and nitrates seem to be the most reliable prognostic factors in acute phase of ischemic stroke.

  20. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Ansaar T., E-mail: ansaar.rai@gmail.com; Jhadhav, Yahodeep; Domico, Jennifer [West Virginia University Health Sciences Center, Interventional Neuroradiology (United States); Hobbs, Gerald R. [West Virginia University Health Sciences Center, Department of Community Medicine (United States)

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  1. Influenza A (H1N1)-induced ischemic stroke in a child: case report and review of the literature

    OpenAIRE

    Chiaretti, Antonio; Calzedda, Roberta; Ceccarelli, Manuela; PRIOLO, FRANCESCA; Valentini, Piero; Ferrara, Pietro; Massimi, Luca

    2014-01-01

    Ischemic stroke is an important cause of death and long term morbidity in children. Viral respiratory infections are emerging as important risk factors responsible for ischemic stroke in this age group. The direct action of virus against cerebral vessels, autoimmune reactivity, and increased production of cytokines are advocated as the main factors for causing ischemic stroke. This study can be useful for clarifying some molecular aspects of H1N1 virus infection in children. We re...

  2. Assessment and Explorations on the Mechanism of Neuroprotection of Patients in Ischemic Stroke by Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Ischemic stroke is a common clinical emergency, with thrombolysis and neuroprotection as its cardinal treatment, and nowadays the latter is more and more stressed by stroke researchers. On the basis of pathophysiology and ischemic cascade of ischemic stroke, we now try to analyze the conceivable mechanism of intervention by tradition Chinese medicine (TCM) and hopefully provide experience for experimental and clinical research in the future.

  3. Acute ischemic stroke in a child with cyanotic congenital heart disease due to non-compliance of anticoagulation

    Science.gov (United States)

    Mohammad, Misbahuddin; James, Anish F.; Qureshi, Raheel S.; Saraf, Sapan; Ahluwalia, Tina; Mukherji, Joy Dev; Kole, Tamorish

    2012-01-01

    BACKGROUND: Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric patients. In case of acute ischemic stroke in pediatric age group, management is different from that of adult ischemic stroke where thrombolysis is a good op. METHODS: We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and asymmetry. The patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation previously. He had a history of missing his daily dose of warfarin for last 3 days prior to the stroke. RESULTS: The patient recovered from acute ischemic stroke without being thrombolyzed. CONCLUSION: In pediatric patients, acute ischemic stroke usually is evolving and may not require thrombolysis. PMID:25215056

  4. Fifty-eight cases of ocular ischemic diseases caused by carotid artery stenosis

    Institute of Scientific and Technical Information of China (English)

    LUO Rong-jiang; LIU Shao-rui; LI Xiao-min; ZHUO Ye-hong; TIAN Zhen

    2010-01-01

    Background The blood supply to the eye comes from the retinal central vascular system of the ophthalmic artery and the ciliary vascular system. The ophthalmic artery stems from the ipsilateral internal carotid artery. If occlusion or stenosis occurs in the carotid artery, the blood perfusion to the ophthalmic artery becomes insufficient, leading to signs and symptoms of anterior and posterior ocular ischemia. The objective of this study was to evaluate the clinical characteristics and risk factors of ocular ischemic diseases caused by carotid artery stenosis.Methods This study was a retrospective review of 145 patients with carotid artery stenosis. Fifty-eight patients who had symptoms of ocular ischemic disease caused by carotid artery stenosis formed group A and the other 87 patients who only had carotid artery stenosis formed group B. We analyzed the causes and course of disease, and relative risk factors,by comparing the two groups.Results The degree of carotid artery stenosis in group A was higher than that in group B. And group A had a greater decrease of ophthalmic artery flow. Male, hypertension, hyperlipidemia, and smoking were significantly related to carotid artery stenosis. Amaurosis fugax was the most common ocular symptom in group A. The ocular ischemic diseases mainly included ischemic optic neuropathy, central/branch retinal artery occlusion, ophthalmoplegia externa, and ocular ischemic syndrome.Conclusions Carotid artery stenosis correlates with ocular ischemic diseases. Ophthalmologists must observe for ocular symptoms, which were the onset symptoms in some patients.

  5. Impact of coexisting coronary artery disease on the occurrence of cerebral ischemic lesions after carotid stenting.

    Directory of Open Access Journals (Sweden)

    Kuo-Lun Huang

    Full Text Available BACKGROUND: Coronary artery disease (CAD may coexist with extracranial carotid artery stenosis (ECAS, but the influence of CAD on procedure-related complications after carotid artery stenting (CAS has not been well investigated. The study aimed to determine the impact of CAD on the occurrence of peri-CAS cerebral ischemic lesions on diffusion-weighted imaging (DWI scanning. METHODS: Coronary angiography was performed within six months before CAS. DWI scanning was repetitively done within 1 week before and after CAS. Clinical outcome measures were stroke, angina, myocardial infarction and death within 30 days. RESULTS: Among 126 patients (69.5±9.0 years recruited for unilateral protected CAS, 33 (26% patients had peri-CAS DWI-positive lesions. CAD was noted in 79% (26 in 33 and 48% (45 in 93 of patients with and without peri-CAS DWI-positive lesions (OR, 4.0; 95% CI, 1.6-10.0; P = .0018, and the number of concomitant CAD on coronary angiography was positively correlated with the risk for peri-CAS DWI-positive lesions (P = .0032. In patients with no CAD (n = 55, asymptomatic CAD (n = 41 and symptomatic CAD (n = 30, the occurrence rates of peri-CAS DWI-positive lesions were 13%, 41% and 30% (P = .0048, and the peri-CAS stroke rates were 2%, 7% and 0% (P = .2120. CONCLUSIONS: The severity of morphological CAD and the presence of either symptomatic or asymptomatic CAD are associated with the occurrence of peri-CAS cerebral ischemic lesions.

  6. In-hospital medical complications associated with patient dependency after acute ischemic stroke: data from the China National Stroke Registry

    Institute of Scientific and Technical Information of China (English)

    WANG Peng-lian; ZHAO Xing-quan; DU Wan-liang; WANG An-xin; JI Rui-jun; YANG Zhong-hua; WANG Chun-xue

    2013-01-01

    Background The mortality of stroke patients is strongly affected by medical complications.However,there are limited data investigating the effect of in-hospital medical complications on the dependency of stroke patients worldwide.We prospectively and systematically investigated the effect of medical complications on dependency of patients at 3,6 and 12 months after stroke using the China National Stroke Registry (CNSR).Methods This prospective cohort study collected data of patients age >18 years with acute ischemic stroke in 132 clinical centers distributed across 32 provinces and four municipalities (including Hong Kong region) of China,from September 2007 to August 2008.Data on medical complications,dependency and other information were obtained from paper-based registry forms.Medical complications associated with stroke outcomes were assessed using multivariable Logistic regression.Results Of 11 560 patients with acute ischemic stroke,1826 (15.80%) presented with in-hospital medical complications.In-hospital medical complications were independent risk factors for dependency of patients at 3 months (adjusted odds ratio (OR) 2.367,95% confidence interval (CI) 2.021-2.771),6 months (adjusted OR 2.257,95% CI 1.922-2.650),and 12 months (adjusted OR 1.820,95% CI 1.538-2.154) after acute ischemic stroke.Conclusion The results demonstrated that the short-term and long-term dependency of acute ischemic stroke patients is significantly associated with in-hospital medical complications in China.

  7. Feasibility and Diagnostic Accuracy of Ischemic Stroke Territory Recognition Based on Two-Dimensional Projections of Three-Dimensional Diffusion MRI Data.

    Science.gov (United States)

    Wrosch, Jana Katharina; Volbers, Bastian; Gölitz, Philipp; Gilbert, Daniel Frederic; Schwab, Stefan; Dörfler, Arnd; Kornhuber, Johannes; Groemer, Teja Wolfgang

    2015-01-01

    This study was conducted to assess the feasibility and diagnostic accuracy of brain artery territory recognition based on geoprojected two-dimensional maps of diffusion MRI data in stroke patients. In this retrospective study, multiplanar diffusion MRI data of ischemic stroke patients was used to create a two-dimensional map of the entire brain. To guarantee correct representation of the stroke, a computer-aided brain artery territory diagnosis was developed and tested for its diagnostic accuracy. The test recognized the stroke-affected brain artery territory based on the position of the stroke in the map. The performance of the test was evaluated by comparing it to the reference standard of each patient's diagnosed stroke territory on record. This study was designed and conducted according to Standards for Reporting of Diagnostic Accuracy (STARD). The statistical analysis included diagnostic accuracy parameters, cross-validation, and Youden Index optimization. After cross-validation on a cohort of 91 patients, the sensitivity of this territory diagnosis was 81% with a specificity of 87%. With this, the projection of strokes onto a two-dimensional map is accurate for representing the affected stroke territory and can be used to provide a static and printable overview of the diffusion MRI data. The projected map is compatible with other two-dimensional data such as EEG and will serve as a useful visualization tool.

  8. Interleukin-16 Polymorphism Is Associated with an Increased Risk of Ischemic Stroke

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    Xiao-li Liu

    2013-01-01

    Full Text Available Clinical and experimental data have demonstrated that inflammation plays fundamental roles in the pathogenesis of ischemic stroke. Interleukin-16 (IL-16 is identified as a proinflammatory cytokine that is a key element in the ischemic cascade after cerebral ischemia. We aimed to examine the relationship between the IL-16 polymorphisms and the risk of ischemic stroke in a Chinese population. A total of 198 patients with ischemic stroke and 236 controls were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP and DNA sequencing method. We found that the rs11556218TG genotype and G allele of IL-16 were associated with significantly increased risks of ischemic stroke (TG versus TT, adjusted OR = 1.88; 95% CI, 1.15–3.07; G versus T, adjusted OR = 1.54; 95% CI, 1.05–2.27, resp.. However, there were no significant differences in the genotype and allele frequencies of IL-16 rs4778889 T/C and rs4072111 C/T polymorphisms between the two groups, even after stratification analyses by age, gender, and the presence or absence of hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia. These findings indicate that the IL-16 polymorphism may be related to the etiology of ischemic stroke in the Chinese population.

  9. Painless Legs and Moving Toes as an Initial Presentation of Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Se Mi Oh

    2009-05-01

    Full Text Available Painless legs and moving toes is an unusual syndrome, which has not previously been reported as an initial presentation of ischemic stroke. We encountered a 78-year-old woman who developed dysarthria and involuntary movement of her left toes that was clinically regarded as painless legs and moving toes. These symptoms appeared abruptly and simultaneously as the initial symptoms of stroke, and improved gradually with conservative management by intravenous hydration for a month. We suggest that, in our case, a cortical brain lesion caused by ischemic stroke might be associated with the development of painless legs and moving toes.

  10. A mathematical model of inflammation during ischemic stroke

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    Dronne Marie-Aimée

    2010-12-01

    Full Text Available In this article we propose a model to describe the inflammatory process which occurs during ischemic stroke. First, an introduction to some basic concepts about the biological phenomenon is given. Then, a detailed derivation of the model and the numerical scheme used are presented. Finally, the studies of the model robustness and sensitivity are showed and some numerical results on the time and space evolution of the process are presented and discussed. Dans cet article, nous nous attachons à modéliser le processus inflammatoire lors d’un accident vasculaire cérébral ischémique. Tout d’abord, nous expliquons brièvement les bases biologiques de ce phénomène. Puis, nous décrivons les équations et les schémas numériques retenus pour le modéliser et l’implémenter. Nous présentons ensuite des études de robustesse et de sensibilité et montrons et discutons les premiers résultats de simulation obtenus.

  11. Ischemic stroke management in West Scotland: a chart review

    Science.gov (United States)

    Verpillat, Patrice; Dorey, Julie; Guilhaume-Goulant, Chantal; Dabbous, Firas; Aballéa, Samuel

    2015-01-01

    Background Little information is available about the long-term management of ischemic stroke (IS) in West Scotland. In this study we aim to describe the management of IS at onset, admission, and during follow-up among patients who survived an IS event. Methods General practitioners (GPs) (n=20) were randomly selected to recruit IS patients and extract data about patient characteristics, hospitalizations, discharge, and ambulatory care from GP databases, hospital letters, and direct contact with patients and their relatives. Descriptive analyses were conducted. Results One hundred and one patients were included, with a mean age of 65.6±13.4. About half of the patients contacted their GPs at the time of onset (45.4%). Cardiovascular history was prevalent in 29.7% of cases, and 14% of all cases were recurrences. Of the patients, 89 (88%) were hospitalized with mean length of stay (LOS) 11.8 days. Treatment was administered on average within 12.9 hours of admission and 23.6% of the admitted patients received thrombolytic treatment. During the 1-year follow-up period, 33.6% of patients were rehospitalized and the mean LOS was 15.1±29.5 days. Further, patients on average sought nursing care (10.9%), physical therapy (45.5%), occupational therapy (27.7%), speech therapy (12.9%), and professional caregivers (12%). Conclusion The health-care resource utilization of IS patients is a major driver of economic burden. PMID:27123179

  12. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma

    DEFF Research Database (Denmark)

    De Bruin, Marie L; Dorresteijn, Lucille D A; van't Veer, Mars B;

    2009-01-01

    Cox regression techniques to study treatment-related factors and other risk factors. All statistical tests were two-sided. RESULTS: After a median follow-up of 17.5 years, 96 patients developed cerebrovascular disease (55 strokes, 31 TIAs, and 10 with both TIA and stroke; median age = 52 years). Most......, after prolonged follow-up. The cumulative incidence of ischemic stroke or TIA 30 years after Hodgkin lymphoma treatment was 7% (95% CI = 5% to 8%). Radiation to the neck and mediastinum was an independent risk factor for ischemic cerebrovascular disease (hazard ratio = 2.5, 95% CI = 1.1 to 5.6 vs......BACKGROUND: Information on clinically verified stroke and transient ischemic attack (TIA) following Hodgkin lymphoma is scarce. We quantified the long-term risk of cerebrovascular disease associated with the use of radiotherapy and chemotherapy in survivors of Hodgkin lymphoma and explored...

  13. Epistasis analysis for estrogen metabolic and signaling pathway genes on young ischemic stroke patients.

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    Yi-Chen Hsieh

    Full Text Available BACKGROUND: Endogenous estrogens play an important role in the overall cardiocirculatory system. However, there are no studies exploring the hormone metabolism and signaling pathway genes together on ischemic stroke, including sulfotransferase family 1E (SULT1E1, catechol-O-methyl-transferase (COMT, and estrogen receptor α (ESR1. METHODS: A case-control study was conducted on 305 young ischemic stroke subjects aged ischemic stroke susceptibility. Gene-gene interaction effects were analyzed using entropy-based multifactor dimensionality reduction (MDR, classification and regression tree (CART, and traditional multiple regression models. RESULTS: COMT Val158Met polymorphism showed a significant association with susceptibility of young ischemic stroke among females. There was a two-way interaction between SULT1E1 -64G/A and COMT Val158Met in both MDR and CART analysis. The logistic regression model also showed there was a significant interaction effect between SULT1E1 -64G/A and COMT Val158Met on ischemic stroke of the young (P for interaction = 0.0171. We further found that lower estradiol level could increase the risk of young ischemic stroke for those who carry either SULT1E1 or COMT risk genotypes, showing a significant interaction effect (P for interaction = 0.0174. CONCLUSIONS: Our findings support that a significant epistasis effect exists among estrogen metabolic and signaling pathway genes and gene-environment interactions on young ischemic stroke subjects.

  14. Mechanism of treating ischemic stroke by atorvastatin combined with Huoxuetongmai capsules

    Institute of Scientific and Technical Information of China (English)

    Bei-Hua Wu; Xiao-Hui Zhao

    2016-01-01

    Objective:To investigate the mechanism of treating ischemic stroke by atorvastatin combined with Huoxuetongmai capsules, for helping clinical treatment of ischemic stroke. Methods:A total of 160 cases of patients with ischemic stroke were selected, and randomly divided into observation group and control group, each group was 80 cases, control group was given conventional treatment, and observation group was given atorvastatin combined with Huoxuetongmai capsules based on the above conventional treatment, the changes of hemodynamic indexes, inflammation factors and coagulation function related indexes in patients with ischemic stroke were detected before and after treatment.Results:The comparison of hemodynamic indexes, inflammation factors and coagulation function related indexes in the two groups before treatment was not statistically significant. Compared with before treatment, hemodynamic indexes (whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity, maximum red blood cell aggregation index and hematocrit) and inflammation factors (IL-6, IL-8, CRP and TNF-α) in observation group after treatment by atorvastatin combined with Huoxuetongmai capsules significantly decreased, while coagulation function related indexes (FIB, DDI, TXB2 and PAI-1) significantly increased, and were considered to be statistically significant. Compared with control group after treatment, hemodynamic indexes, coagulation function related indexes (FIB, DDI, TXB2 and PAI-1) and inflammation factor in observation group after combined treatment significantly decreased, while PT significantly increased, there were statistically significant difference between the groups.Conclusion:The treatment of ischemic stroke by atorvastatin combined with Huoxuetongmai capsules could improve hemodynamic indexes, inflammation factors and coagulation function related indexes in patients with ischemic stroke, and provide help for clinical treatment of ischemic stroke.

  15. PLASMA C-REACTIVE PROTEIN LEVELS AS A PROGNOSTIC MARKER IN FIRST EVER ACUTE ISCHEMIC STROKE

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    Bharat

    2014-12-01

    Full Text Available BACKGROUND AND PURPOSE: Acute ischemic stroke may trigger an inflammatory response that leads to increased levels of C-reactive protein (CRP. High levels of CRP may be associated with poor outcome because they reflect either an inflammatory reaction or tissue damage. We related plasma CRP levels to first ever ischemic stroke and its role as a diagnostic aid. METHODS: Sixty patients fulfilling inclusion and exclusion criteria with first ever acute ischemic stroke were included in study. CT scan of brain was done after 24 hours of onset of symptoms to confirm the diagnosis. Plasma CRP level was determined after 12 hours and before 72 hours of onset of symptoms in all CT confirmed ischemic stroke patients. This clinical study was done from January 2008 to June 2009. CRP was randomly measured in 60 age and sex matched individuals admitted in other wards of the hospital matched in all possible criteria expect the disease under study as a control group. RESULTS: The CRP concentration in ischemic strokes was independent of infarction site, the value was more between 51-70 years of age group and almost equal in both genders. 54 of the 60 ischemic strokes studied had CRP value >6 mg/l and only 6 patients had 6 mg/l, which is insignificant. CONCLUSION: The CRP level is significantly higher in ischemic strokes and by its elevation between 12-72 hours of symptom onset is a bad prognostic indicator. The risk of poor outcome or death at 3 months increased with higher levels of CRP. Elevated CRP values is a risk factor in association with other risk factors like diabetes/hypertension

  16. Elevated Plasma YKL-40 Levels and Ischemic Stroke in the General Population

    DEFF Research Database (Denmark)

    Kjaergaard, A.D.; Bojesen, S.E.; Johansen, J.S.

    2010-01-01

    Objective: We hypothesized that elevated plasma YKL-40 levels are associated with increased risk of ischemic cardiovascular disease in the general population. In contrast to C-reactive protein (CRP) produced in the liver in response to inflammation, YKL-40 is produced by lipid-laden macrophages...... inside the vessel wall. Methods: We measured plasma YKL-40 in 8,899 21- to 93-year-old participants of the Copenhagen City Heart Study 1991-1994 examination, and followed them for up to 18 years. Endpoints were ischemic stroke, ischemic cerebrovascular disease, myocardial infarction, and ischemic heart...

  17. Oral fibrinogen-depleting agent lumbrokinase for secondary ischemic stroke prevention: results from a multicenter, randomized, parallel-group and controlled clinical trial

    Institute of Scientific and Technical Information of China (English)

    CAO Yong-jun; ZHANG Xia; WANG Wan-hua; ZHAI Wan-qing; QIAN Ju-fen; WANG Jian-sheng; CHEN Jun

    2013-01-01

    Background Elevated fibrinogen (Fg) level is a known risk factor for ischemic stroke.There are few clinical trials on oral fibrinogen-depleting therapies for secondary ischemic stroke prevention.We aimed to assess the effects of one-year therapy with oral lumbrokinase enteric-coated capsules on secondary ischemic stroke prevention.Methods This is a multicenter,randomized,parallel group and controlled study that began treatment in hospitalized patients with ischemic stroke and continued for 12 months.Patients were randomized to either the control group that received the standard stroke treatment or the fibrinogen-depleting group that received the standard stroke treatment plus enteric-coated lumbrokinase capsules.The NIH Stroke Scale scores (NIHSSs) and plasma Fg level were recorded.The carotid artery intima-media thickness (IMT) and status of plaques were examined through carotid ultrasound examination.Primary outcomes included all-cause mortality,any event of recurrent ischemic stroke/transient ischemic attack (TIA),hemorrhagic stroke,myocardial infarction and angina,and other noncerebral ischemia or hemorrhage.Kaplan-Meier survival analysis and the Long-rank test were used to compare total vascular end point incidence between the two groups.Comparison of median values between two groups was done by the Student t test,one-way analysis of variance (ANOVA),or non-parametric rank sum test.Results A total of 310 patients were enrolled,192 patients in the treatment group and 118 patients in the control group.Compared to the control group,the treatment group showed favorable outcomes in the Fg level,carotid IMT,the detection rate of vulnerable plaques,the volume of carotid plaques,NIHSS scores,and incidence of total vascular (6.78% and 2.08%,respectively) and cerebral vascular events (5.93% and 1.04%,respectively) (P <0.05).In the treatment group,the volume of carotid plaques was significantly related to the carotid IMT,the plaque diameter,width and number (P

  18. Analysis of the XRCC1 gene as a modifier of the cerebral response in ischemic stroke

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    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.

  19. Vascular Endothelial Growth Factor and Brain-Derived Neurotropic Factor Levels in Ischemic Stroke Subject

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    Andri Hidayat

    2016-08-01

    Full Text Available BACKGROUND: Vascular endothelial growth factor (VEGF and brain-derived neurotropic factor (BDNF present during early neuronal development and play important roles in the process of neurorepairing includes angiogenesis, neurogenesis and neuronal plasticity after ischemic stroke. In this study, we observed VEGF and BDNF levels of subjects with ischemic stroke in different onset time. METHODS: A cross sectional study was designed. Study subjects were 51 ischemic stroke subjects, aged 30-80 years old, recruited from Gatot Subroto Army Central Hospital, Jakarta, Indonesia. Ischemic stroke was diagnosed by neurologist, based on clinical examination and magnetic resonance imaging (MRI result. Subjects were divided into 3 groups based on onset time of stroke: 30 days (Group C. VEGF and BDNF levels from serum were measured using lumine Magpix. The data was analyzed for comparison and correlation. RESULTS: VEGF and BDNF levels of group B and C were significantly different with p=0.034 and p=0.007, respectively. Group B had the highest VEGF levels, whereas Group C had the highest BDNF level. VEGF and BDNF levels in each group were not significantly correlated. CONCLUSION: Each stage of time after ischemic stroke has different recovery activities like angiogenesis, neurogenesis and plasticity. Angiogenesis process was optimum in 7-30 days after onset. in more than 30 days onset, Low VEGF with high BDNF have important role in a long period of time after the onset of stroke in the regeneration and repair, such as maintaining neuronal survival and plasticity. KEYWORDS: ischemic stroke, VEGF, BDNF

  20. A STUDY OF MEAN PLATELET VOLUME LEVELS IN PATIENTS WITH ISCHEMIC STROKE

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    Kandan Muralidharan

    2016-09-01

    Full Text Available CONTEXT Stroke is the most common cause of death after cardiac disease and cancer. This study attempts to identify the significance of mean platelet volume as a risk factor as well as prognostic factor for ischemic stroke patients1 . This may help in early identification of high risk individuals who can be targeted for aggressive acute management and improved secondary prevention measures. AIM OF THE STUDY To assess whether mean platelet volume levels are elevated in ischemic stroke and to assess MPV as independent risk factor and to assess whether the severity and outcome of ischemic stroke correlates with elevated mean platelet volume. SETTINGS AND DESIGN Analytical Case Control Study. MATERIALS AND METHODS This study is conducted among 50 ischemic stroke patients who were admitted at Government Rajaji Hospital, Madurai from December 2014 to June 2015. After taking detailed history and physical examination and investigations, MPV was determined for Ischemic stroke patients and Modified Rankin scale (MRS at the time of admission was calculated. After 8 weeks of onset of stroke, all the patients were again followed up. Functional outcomes were determined by use of Modified Rankin Scale (MRS2,3. All patients were stratified using MRS2,3 Scale [0-2, 3-4 and 5-6] into three groups. MPV level was correlated with MRS score at the time of admission and again at 8 weeks. Patients with MRS score of 5 and 6 were declared as very poor outcome & MRS of 3 and 4 as poor outcome. Patients with MRS 0, and 1 were considered as good outcome. STATISTICAL ANALYSIS One way ANOVA, Pearson correlation and Chi square test. RESULTS There is no statistically significant difference among the case and control groups with regard to the age or sex composition or smoking or alcoholism. MPV did not vary with diabetes or hypertension. There was a linear relation with MPV and severity of ischemic stroke i.e. as the MPV increases the severity (MRS 2,3of stroke increases

  1. Stroke Recurrence in Congenital Heart Disease

    OpenAIRE

    J Gordon Millichap

    2012-01-01

    Researchers at the Hospital for Sick Children, Toronto, Canada identified 135 patients with congenital heart disease diagnosed with arterial ischemic stroke during 1992-2008 and registered in the Canadian Pediatric Stroke Registry-Toronto site.

  2. Safety and Tolerability of Desmoteplase Within 3 to 9 Hours After Symptoms Onset in Japanese Patients With Ischemic Stroke

    DEFF Research Database (Denmark)

    Mori, Etsuro; Minematsu, Kazuo; Nakagawara, Jyoji

    2015-01-01

    BACKGROUND AND PURPOSE: This study investigated the safety and tolerability of desmoteplase administered within 3 to 9 hours after stroke symptoms onset in Japanese patients with acute ischemic stroke. METHODS: Patients were randomized to treatment with either desmoteplase or placebo in a 2:1 rat...... tolerated in Japanese patients with acute ischemic stroke when administered 3 to 9 hours after stroke symptoms onset. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01104467....

  3. Multimodal nanoprobes evaluating physiological pore size of brain vasculatures in ischemic stroke models.

    Science.gov (United States)

    Zheng, Shuyan; Bai, Ying-Ying; Changyi, Yinzhi; Gao, Xihui; Zhang, Wenqing; Wang, Yuancheng; Zhou, Lu; Ju, Shenghong; Li, Cong

    2014-11-01

    Ischemic stroke accounts for 80% strokes and originates from a reduction of cerebral blood flow (CBF) after vascular occlusion. For treatment, the first action is to restore CBF by thrombolytic agent recombinant tissue-type plasminogen activator (rt-PA). Although rt-PA benefits clinical outcome, its application is limited by short therapeutic time window and risk of brain hemorrhage. Different to thrombolytic agents, neuroprotectants reduce neurological injuries by blocking ischemic cascade events such as excitotoxicity and oxidative stress. Nano-neuroprotectants demonstrate higher therapeutic effect than small molecular analogues due to their prolonged circulation lifetime and disrupted blood-brain barrier (BBB) in ischemic region. Even enhanced BBB permeability in ischemic territories is verified, the pore size of ischemic vasculatures determining how large and how efficient the therapeutics can pass is barely studied. In this work, nanoprobes (NPs) with different diameters are developed. In vivo multimodal imaging indicates that NP uptakes in ischemic region depended on their diameters and the pore size upper limit of ischemic vasculatures is determined as 10-11 nm. Additionally, penumbra defined as salvageable ischemic tissues performed a higher BBB permeability than infarct core. This work provides a guideline for developing nano-neuroprotectants by taking advantage of the locally enhanced BBB permeability in ischemic brain tissues.

  4. Research Status of Etiology and Screening of Young Ischemic Stroke%青年缺血性脑卒中病因学筛查研究现状

    Institute of Scientific and Technical Information of China (English)

    黄维; 毕齐

    2015-01-01

    Ischemic stroke in people aged between 18 and 45 is defined as young ischemic stroke. The etiology of young ischemic stroke can be divided into 5 categories according to the TOAST classification. The large artery atherosclerosis and small vessel disease are the traditional etiology subtypes,in addition,cardiogenic stroke and ischemic stroke of unknown cause account for about 1 / 2 of the etiology. Standardized diagnosis process may contribute to proper diagnosis,and can reduce the proportion of cryptogenic stroke,thus may be beneficial to the targeted therapy. To confirm the diagnosis,it is essential to distinguish the definition,diagnostic criteria of cardiogenic stroke/ cryptogenic stroke/ unexplained thromboembolic stroke( ESUS) / young ischemic stroke and their mutual relationship. The epidemiology,etiology subtypes and screening of young ischemic stroke are reviewed in the paper.%青年缺血性脑卒中指18~45岁者发生的缺血性脑卒中,其病因依据 TOAST 分型通常可分为5大类,除传统的大动脉粥样硬化型、小血管病型等病因外,心源性及病因未明约占1/2。规范化诊断流程有助于明确诊断,降低隐源性脑卒中的比例,有益于针对性治疗。要明确诊断,需明确心源性脑卒中/隐源性脑卒中/原因不明的栓塞性脑卒中(ESUS)/青年缺血性脑卒中等的定义、诊断标准及相互关系。同时,本文对青年缺血性脑卒中的流行病学、病因分型、筛查的现状进行综述。

  5. The neuroprotective compound P7C3-A20 promotes neurogenesis and improves cognitive function after ischemic stroke.

    Science.gov (United States)

    Loris, Zachary B; Pieper, Andrew A; Dalton Dietrich, W

    2017-04-01

    Ischemic stroke is a devastating condition with few therapeutic interventions available. The neuroprotective compound P7C3-A20 inhibits mature neuronal cell death while also increasing the net magnitude of postnatal neurogenesis in models of neurodegeneration and acute injury. P7C3 compounds enhance flux of nicotinamide adenine dinucleotide (NAD) in mammalian cells, a proposed therapeutic approach to treating cerebral ischemia. The effectiveness of P7C3-A20 treatment on chronic histopathological and behavioral outcomes and neurogenesis after ischemic stroke has not previously been established. Here, a transient middle cerebral artery occlusion in rats was followed by twice daily injection of P7C3-A20 or vehicle for 7days. P7C3-A20-treated rats performed significantly better than vehicle-treated controls in sensorimotor cylinder and grid-walk tasks, and in a chronic test of spatial learning and memory. These behavioral improvements with P7C3-A20 treatment were correlated with significantly decreased cortical and hippocampal atrophy, and associated with increased neurogenesis in the subventricular zone and hippocampal dentate gyrus subgranular zone. Furthermore, cerebral ischemia significantly reduced NAD in the cortex but P7C3-A20 treatment restored NAD to sham levels. Thus, P7C3-A20 treatment mitigates neurodegeneration and augments repair in the brain after focal ischemia, which translates into chronic behavioral improvement. This suggests a new therapeutic approach of using P7C3 compounds to safely augment NAD and thereby promote two independent processes critical to protecting the brain from ischemic stroke: mature neuron survival and postnatal neurogenesis throughout the post-ischemic brain.

  6. Determinants of fatigue after first-ever ischemic stroke during acute phase.

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    Shan-Shan Wang

    Full Text Available Fatigue after stroke is common and has a negative impact on rehabilitation and survival. However, its pathogenesis and contributing factors remain unclear. The purpose of this study was to identify factors influencing the occurrence of fatigue after first-ever ischemic stroke in acute phase.We examined 265 consecutive patients with first-ever ischemic stroke during acute phase (within 2 weeks in two tertiary stroke care hospitals in Henan, China. We documented patients' demographic and clinical characteristics through face-to-face interviews using structured questionnaires and reviews of medical records. Post-stroke fatigue was defined as a score of ≥4 using the Fatigue Severity Scale. Multivariate logistic regression was used to examine post-stroke fatigue in relation to socio-demographic, lifestyle, clinical characteristics and family function.About 40% first-ever ischemic stroke patients experienced post-stroke fatigue in acute phase. Post-stroke fatigue was associated with lack of exercise before stroke (adjusted odds ratio 4.01, 95% CI 1.95-8.24, family dysfunction (2.63, 1.20-5.80, depression (2.39, 1.02-5.58, the presence of pre-stroke fatigue (4.89, 2.13-11.21, use of sedative medications (4.14, 1.58-10.88, coronary heart disease (3.38, 1.46-7.79 and more severe Modified Rankin Scale (2.55, 1.65-3.95.The causes of post-stroke fatigue are multifaceted. More physical exercise, improving family function, reducing depression and appropriate use of sedative medications may be helpful in preventing post-stroke fatigue.

  7. Effect of statin use on clinical outcomes in ischemic stroke patients with atrial fibrillation

    Science.gov (United States)

    Wu, Yi-Ling; Saver, Jeffrey L.; Chen, Pei-Chun; Lee, Jiann-Der; Wang, Hui-Hsuan; Rao, Neal M.; Lee, Meng; Ovbiagele, Bruce

    2017-01-01

    Abstract It remains unclear whether statin therapy should be applied to ischemic stroke patients with atrial fibrillation. The objective of this study was to clarify whether statin therapy can influence the prognosis in recent ischemic stroke patients with atrial fibrillation. We identified ischemic stroke patients with atrial fibrillation between 2001 and 2011 from Taiwan National Health Insurance Database. Patients not treated with statins during the first 90 days after the index stroke were matched to patients treated with statins in the first 90 days in a 2:1 ratio on the basis of age, sex, hypertension, diabetes mellitus, ischemic heart disease, heart failure, estimated National Institutes of Health Stroke Scale, use of anticoagulant, and year of their entry into the cohort. The primary outcome was the first event of recurrent stroke, and the secondary outcome was in-hospital death. A total of 1546 atrial fibrillation patients with statin therapy in the first 90 days poststroke and 3092 matched atrial fibrillation nonstatin controls were enrolled for this analysis. During the median 2.4-year follow-up, the risk of recurrent stroke was not different between subjects receiving versus not receiving statin therapy (hazard ratios = 1.01, 95% confidence interval 0.88 to 1.15). However, patients with atrial fibrillation receiving statin therapy had a reduced risk for death during any hospitalization throughout the long-term follow-up period (hazard ratios = 0.74, 95% confidence interval 0.61 to 0.89). Among ischemic stroke patients with atrial fibrillation, statin therapy initiated during the acute to subacute poststroke stage did not alter the rate of stroke recurrence but was associated with a decreased rate of in-hospital death. PMID:28151869

  8. Association of inflammatory gene polymorphisms with ischemic stroke in a Chinese Han population

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    Zhao Nan

    2012-07-01

    Full Text Available Abstract Background Inflammatory mechanisms are important in stroke risk, and genetic variations in components of the inflammatory response have been implicated as risk factors for stroke. We tested the inflammatory gene polymorphisms and their association with ischemic stroke in a Chinese Han population. Methods A total of 1,124 ischemic stroke cases and 1,163 controls were genotyped with inflammatory panel strips containing 51 selected inflammatory gene polymorphisms from 35 candidate genes. We tested the genotype-stroke association with logistic regression model. Results We found two single nucleotide polymorphisms (SNPs in CCL11 were associated with ischemic stroke. After adjusting for multiple testing using false discovery rate (FDR with a 0.20 cut-off point, CCL11 rs4795895 remained statistically significant. We further stratified the study population by their hypertension status. In the hypertensive group, CCR2 rs1799864, CCR5 rs1799987 and CCL11 rs4795895 were nominally associated with increased risk of stroke. In the non-hypertensive group, CCL11 rs3744508, LTC4S rs730012, FCER1B rs569108, TGFB1 rs1800469, LTA rs909253 and CCL11 rs4795895 were associated with ischemic stroke. After correction for multiple testing, CCR2 rs1799864 and CCR5 rs1799987 remained significant in the hypertensive group, and CCL11 rs3744508, LTC4S rs730012, FCER1B rs569108, TGFB1 rs1800469, LTA rs909253 remained significant in the non-hypertensive group. Conclusions Our results indicate that inflammatory genetic variants are associated with increased risk of ischemic stroke in a Chinese Han population, particularly in non-hypertensive individuals.

  9. CT Angiography in Ischemic Stroke: Optimization and Accuracy

    NARCIS (Netherlands)

    C. de Monyé (Cécile)

    2012-01-01

    textabstractStroke is the third leading cause of death after coronary heart disease and cancer. The clinical burden of stroke now exceeds that of coronary heart disease.1 Especially in the aging population stroke is a major disease. By the year 2020 the incidence of stroke in the Netherlands is expe

  10. Free Floating Thrombus in Carotid Artery in a Patient with Recurrent Strokes.

    Science.gov (United States)

    Roy, Moni; Roy, Ashish Kumar; DeSanto, Jeffrey R; Abdelsalam, Murad

    2017-01-01

    We present a case of 72-year-old male with reported past medical history of recurrent transient ischemic attacks (TIAs) presenting with myriad of neurological symptoms. Patient was transferred from outlying hospital with complaints of right sided facial droop and dysarthria. Computed tomography angiography (CTA) showed high grade proximal left internal carotid artery (ICA) stenosis along with interesting finding of a free floating thrombus (FFT) in the left ICA. After discussion with the neurosurgical team, our case was treated conservatively with combination of antiplatelet therapy with Aspirin and anticoagulation with Warfarin without recurrence of TIAs or strokes on six-month follow-up.

  11. Association of serum calcium levels with infarct size in acute ischemic stroke: Observations from Northeast India

    Directory of Open Access Journals (Sweden)

    Meghna Borah

    2016-01-01

    Full Text Available Background: Calcium is known to be major mediator in ischemic neuronal cell death. Recent studies have shown that elevated serum calcium levels at admission in patients with stroke have been associated with less severe clinical deficits and with better outcomes. Aim: The aim of this to determine the correlation between serum calcium (total, corrected, and ionized and infarct size (IS in patients with acute ischemic stroke. Materials and Methods: Data were collected from 61 patients presenting with acute ischemic stroke from May 2015 to April 2016 at a tertiary care institute in Northeast India. Only patients aged ≥40 years and diagnosed as having acute ischemic cerebrovascular stroke with clinical examination and confirmed by a computed tomography scan were included in the study. Serum calcium levels (total, albumin corrected, and ionized were collapsed into quartiles, and these quartile versions were used for calculating correlation. Pearson's correlation coefficient was used for comparing calcium levels with IS. Results: Total calcium, albumin-corrected calcium, and ionized calcium had a statistically significant negative correlation with IS with r = −0.578, −0.5396, and −0.5335, respectively. Total and ionized calcium showed a significant negative correlation with IS across all four quartiles. Albumin-corrected calcium levels showed a significant negative correlation with IS only across the lowest and highest quartiles. Conclusion: The findings in our study suggest that serum calcium can be used as a prognostic indicator in ischemic stroke as its levels directly correlates with the IS.

  12. Acute ischemic stroke treatment, part 2: TreatmentRoles of Capillary Index Score, Revascularization and Time

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    Firas eAL-ALI

    2015-06-01

    Full Text Available Due to recent results from clinical intra-arterial treatment for acute ischemic stroke (IAT-AIS trials such as the Interventional Management of Stroke (IMS III, IAT-AIS and the merit of revascularization have been contested. Even though intra-arterial treatment (IAT has been shown to improve revascularization rates, a corresponding increase in good outcomes has only recently been noted. Even though a significant percentage of patients achieve good revascularization in a timely manner, results do not translate into good clinical outcomes (GCOs. Based on a review of the literature, the authors suspect limited good clinical outcomes following timely and successful revascularization are due to poor patient selection that led to futile and possibly even harmful revascularization. The Capillary Index Score (CIS is a simple angiography-based scale that can potentially be used to improve patient selection to prevent revascularization being performed on patients who are unlikely to benefit from treatment. The CIS characterizes presence of capillary blush related to collateral flow as a marker of residual viable tissue, with absence of blush indicating the tissue is no longer viable due to ischemia. By only selecting patients with a favorable CIS for IAT, the rate of GCOs should consistently approach 80-90%. Current methods of patient selection are primarily dependent on time from ischemia. Time from cerebral ischemia to irreversible tissue damage seems to vary from patient to patient, however, so focusing on viable tissue based on the CIS rather than relying on an artificial time window seems to be a more appropriate approach to patient selection.

  13. A Randomized trial comparing ticlopidine with aspirin fof the prevention of ischemic cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    Li Yizhao; Li Danian; Wang Lei

    2000-01-01

    OBJECTIVE To assess the effect and cafety of t iclopidine in the prevention of ischemic cerebral stroke and to compare theeffect of low-dose aspirin with t iclopidine. BACKGROUND The effect and safety of ticlopidine irn the prevention of ischemic cerebral stroke in China has not been reported. METHODS 329 patients with TIA or mild ischemic cevebral stroke wasrandonmly assigned to ticlopidine group(165 case) or aspirin group (164 case) in this study.These patrents were randomly allocated to receive either 250mg trclopidine or 50mg aspirin daily and didnd take any other platelet antiaggregating drugs. Time of eacn follow up visit was one to two months. Follow up lasted for 6 to 18 months. RESULTS The event rate for stroke or death from any cause was 8.3% in ticlopidine group arid 14.9% in aspirin group. This repesented a risk reduction of 44.3%(95% cofidence interval, 0.29-0.94) for ticiopidine group as compared with aspirin group. The event raite for ischemic cerebral stroke or myocarction of ticlopidine group(7.0%)was lower than that cf aspirin group(14.8%)(P<0.05).A riskreduction of 52.7%(95% confidence interval,0.24-0.92) for ticlopidine group compared with aspirin group. The rate of adverse effects of ticlopidine group and aspirin group were 6.9% and 11.0% during the trial ,but this was not statistically significant(P<0.05).DISCUSSION and CONCLUSION Therapeutic efficacy for the prevention oi ischemic stroke of ticlopidine was better than that of aspirin, the rate of side effects in ticlopidine group and aspirin group are not statistically significant. So ticiopidine could serve as a first-line drug for the prevention of ischemic stroke.

  14. Lysophospholipids in coronary artery and chronic ischemic heart disease

    Science.gov (United States)

    Abdel-Latif, Ahmed; Heron, Paula M.; Morris, Andrew J.; Smyth, Susan S.

    2015-01-01

    Purpose of review The bioactive lysophospholipids, lysophosphatidic acid (LPA) and sphingosine 1 phosphate (S1P) have potent effects on blood and vascular cells. This review focuses their potential contributions to the development of atherosclerosis, acute complications, such as acute myocardial infarction, and chronic ischemic cardiac damage. Recent findings Exciting recent developments have provided insight into the molecular underpinnings of LPA and S1P receptor signaling. New lines of evidence suggest roles for these pathways in the development of atherosclerosis. In experimental animal models, the production, signaling and metabolism of LPA may be influenced by environmental factors in the diet that synergize to promote the progression of atherosclerotic vascular disease. This is supported by observations of human polymorphisms in the lysophospholipid metabolizing enzyme, PPAP2B, that are associated with risk of coronary artery disease and myocardial infarction. S1P signaling protects from myocardial damage that follows acute and chronic ischemia both by direct effects on cardiomyocytes and through stem cell recruitment to ischemic tissue. Summary This review will suggest novel strategies to prevent the complications of coronary artery disease by targeting LPA production and signaling. Additionally, ways in which S1P signaling pathways may be harnessed to attenuate ischemia-induced cardiac dysfunction will be explored. PMID:26270808

  15. Free radical scavenger, edaravone, reduces the lesion size of lacunar infarction in human brain ischemic stroke

    Science.gov (United States)

    2011-01-01

    Background Although free radicals have been reported to play a role in the expansion of ischemic brain lesions, the effect of free radical scavengers is still under debate. In this study, the temporal profile of ischemic stroke lesion sizes was assessed for more than one year to evaluate the effect of edaravone which might reduce ischemic damage. Methods We sequentially enrolled acute ischemic stroke patients, who admitted between April 2003 and March 2004, into the edaravone(-) group (n = 83) and, who admitted between April 2004 and March 2005, into the edaravone(+) group (n = 93). Because, edaravone has been used as the standard treatment after April 2004 in our hospital. To assess the temporal profile of the stroke lesion size, the ratio of the area [T2-weighted magnetic resonance images (T2WI)/iffusion-weighted magnetic resonance images (DWI)] were calculated. Observations on T2WI were continued beyond one year, and observational times were classified into subacute (1-2 months after the onset), early chronic (3-6 month), late chronic (7-12 months) and old (≥13 months) stages. Neurological deficits were assessed by the National Institutes of Health Stroke Scale upon admission and at discharge and by the modified Rankin Scale at 1 year following stroke onset. Results Stroke lesion size was significantly attenuated in the edaravone(+) group compared with the edaravone(-) group in the period of early and late chronic observational stages. However, this reduction in lesion size was significant within a year and only for the small-vessel occlusion stroke patients treated with edaravone. Moreover, patients with small-vessel occlusion strokes that were treated with edaravone showed significant neurological improvement during their hospital stay, although there were no significant differences in outcome one year after the stroke. Conclusion Edaravone treatment reduced the volume of the infarct and improved neurological deficits during the subacute period, especially

  16. Vascular Risk Factors in Patients with Different Subtypes of Ischemic Stroke May Affect Their Outcome after Intravenous tPA.

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    Yi Dong

    Full Text Available Intravenous (i.v. tissue-type plasminogen activator (tPA is the only approved noninvasive therapy for acute ischemic stroke (AIS. However, after tPA treatment, the outcome of patients with different subtypes of stroke according to their vascular risk factors remains to be elucidated. We aim to explore the relationship between the outcome and different risk factors in patients with different subtype of acute strokes treated with i.v. tPA. Records of patients in this cohort were reviewed. Data collected and analysed included the demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS scores, 90-day modified Rankin Scores (mRS, and subtypes of stroke. By using the 90-day mRS, patients were dichotomized into favorable versus unfavorable outcome in each subtype of stroke. We identified the vascular risk factors that are likely associated with the poor outcome in each subtype. Among 570 AIS patients received i.v. tPA, 217 were in the large artery atherosclerosis (LAA group, 146 in the small vessel occlusion (SVO group, and 140 in the cardioaortic embolism (CE group. Lower NIHSS score on admission was related to favorable outcome in patients in all subtypes. Patients with history of dyslipidemia were likely on statin treatment before their admission and hence less likely to have elevated cholesterol level on admission. Therefore, there was a possible paradoxical effect on the outcome in patients with LAA and SVO subtypes of strokes. SVO patients with history of diabetes had higher risk of unfavorable outcome. SVO patients had favorable outcome if their time from onset to treatment was short. In conclusion, the outcome of patients treated with i.v. tPA may be related to different vascular risk factors associated with different subtypes of stroke.

  17. Vascular Risk Factors in Patients with Different Subtypes of Ischemic Stroke May Affect Their Outcome after Intravenous tPA

    Science.gov (United States)

    Ren, Jinma; Nair, Deepak S.; Parker, Sarah; Jahnel, Jan L.; Swanson-Devlin, Teresa G.; Beck, Judith M.; Mathews, Maureen; McNeil, Clayton J.; Upadhyaya, Manas; Gao, Yuan; Dong, Qiang; Wang, David Z.

    2015-01-01

    Intravenous (IV) tissue-type plasminogen activator (tPA) is the only approved noninvasive therapy for acute ischemic stroke (AIS). However, after tPA treatment, the outcome of patients with different subtypes of stroke according to their vascular risk factors remains to be elucidated. We aim to explore the relationship between the outcome and different risk factors in patients with different subtype of acute strokes treated with IV tPA. Records of patients in this cohort were reviewed. Data collected and analysed included the demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) scores, 90-day modified Rankin Scores (mRS), and subtypes of stroke. By using the 90-day mRS, patients were dichotomized into favorable versus unfavorable outcome in each subtype of stroke. We identified the vascular risk factors that are likely associated with the poor outcome in each subtype. Among 570 AIS patients received IV tPA, 217 were in the large artery atherosclerosis (LAA) group, 146 in the small vessel occlusion(SVO) group, and 140 in the cardioaortic embolism(CE) group. Lower NIHSS score on admission was related to favorable outcome in patients in all subtypes. Patients with history of dyslipidemia were likely on statin treatment before their admission and hence less likely to have elevated cholesterol level on admission. Therefore, there was a possible paradoxical effect on the outcome in patients with LAA and SVO subtypes of strokes. SVO patients with history of diabetes had higher risk of unfavorable outcome. SVO patients had favorable outcome if their time from onset to treatment was short. In conclusion, the outcome of patients treated with IV tPA may be related to different vascular risk factors associated with different subtypes of stroke. PMID:26247772

  18. Epidemiology of childhood stroke in Estonia.

    Science.gov (United States)

    Laugesaar, Rael; Kolk, Anneli; Uustalu, Ulle; Ilves, Pilvi; Tomberg, Tiiu; Talvik, Inga; Köbas, Kristel; Sander, Valentin; Talvik, Tiina

    2010-02-01

    We investigated the incidence and 30-day case-fatality of childhood stroke in Estonia, and clinical signs and risk factors of childhood stroke. A retrospective (1995-2003) and prospective study (2004-2006) of childhood stroke (arterial ischemic, hemorrhagic, and sinovenous thrombosis) and transient ischemic attack was conducted. Stroke-incidence calculation was based on the prospective study. Clinical diagnoses of stroke were confirmed by neuroradiology. The incidence rate of childhood stroke in Estonia was 2.73/100,000 person-years for children aged 30 days to 18 years: 1.61/100,000 for arterial ischemic stroke, 0.87/100,000 for hemorrhagic stroke, 0.25/100,000 for sinovenous thrombosis, and 0.37/100,000 for transient ischemic attack. No arterial ischemic stroke patients died within 30 days, but case-fatality for intracerebral hemorrhage was 46%. Focal signs occurred in 100% of arterial ischemic strokes and 64% of intracerebral hemorrhage cases. Risk factors were identified in 35/48 (73%) children with cerebrovascular attacks. Six children with arterial ischemic stroke (6/24, 25%) manifested more than one risk factor. The incidence rate of childhood stroke in Estonia is similar to that in earlier data.

  19. Diabetes and hypertension markedly increased the risk of ischemic stroke associated with high serum resistin concentration in a general Japanese population: the Hisayama Study

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    Kawamura Ryoichi

    2009-11-01

    Full Text Available Abstract Background Resistin, secreted from adipocytes, causes insulin resistance in mice. The relationship between resistin and coronary artery disease is highly controversial, and the information regarding resistin and ischemic stroke is limited. In the present study, the association between serum resistin concentration and cardiovascular disease (CVD was investigated in a general Japanese population. Methods A total of 3,201 community-dwelling individuals aged 40 years or older (1,382 men and 1,819 women were divided into quintiles of serum resistin, and the association between resistin and CVD was examined cross-sectionally. The combined effect of either diabetes or hypertension and high serum resistin was also assessed. Serum resistin was measured using ELISA. Results Compared to those without CVD, age- and sex-adjusted mean serum resistin concentrations were greater in subjects with CVD (p = 0.002 or ischemic stroke (p Conclusion Elevated serum resistin concentration appears to be an independent risk factor for ischemic stroke, especially lacunar and atherothrombotic infarction in the general Japanese population. The combination of high resistin and the presence of either diabetes or hypertension increased the risk of ischemic stroke.

  20. Effects of statins on second prevention of ischemic stroke and transient ischemic attack%他汀类降脂药能降低缺血性脑卒中患者再发卒中的风险

    Institute of Scientific and Technical Information of China (English)

    张韩英

    2010-01-01

    Objective To observe the effects of statins on second prevention of ischemic stroke and transient ischemic attack. Methods 60 cases with ischemic stroke or transient ischemic attack which were collected from March 2006 to January 2007 were divided into control group and statins-treating group randomly.The control group only received routine treating containing rehabilitation care and risk factors controlling. The statins-treating group received atorvastatin 20 mg qd except routine treating. The incidence of ischemic stroke/transient ischemic attack recurrence, death, other heart-cerebral vessel events were collected within 3 years. Results The incidence of ischernic stroke/transient ischemic attack recurrence, coronary artery events in statinstreating group was lower significantly than in the control group, and no significantly deference was found in the incidence of death and encephalorrhagia between two groups. Conclusion Statins can reduce incidence of ischemic/transient ischemic attack recurrence, coronary artery events.%目的 观察他汀类药物在缺血性脑卒中二级预防中的作用.方法 将2006年以来在本院住院治疗的脑卒中/TIA患者60例随机分为他汀干预组和对照组.对照组仅接受康复治疗及危险因素治疗,干预组在对照组治疗基础上加用阿托伐他汀20 mg 1次/d治疗,观察3年内两组患者再发脑卒中/TIA,死亡以及其他心血管事件发生率.结果 干预组再发脑卒中/TIA,冠脉事件发生率低于对照组,而死亡率,脑出血发生率两组却无明显差异.结论 他汀类药物能有效预防脑卒中/TIA患者再发心脑血管事件的发生.

  1. Localizing the focus of ischemic stroke with near infrared spectroscopy

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective To evaluate the changes in near infrared spectroscopy (NIRS) absorptive properties induced by cerebral ischemia. Methods A dual wavelength (760?nm and 850?nm) NIRS system measuring total hemoglobin concentration changes was constructed. Twenty Sprague-Dawley rats were used to set up middle cerebral artery occlusion (MCAO) model that had a stable ischemia focus on the cortex. We used NIRS to localize the ischemia focus that was confirmed with magnetic resonance imaging (MRI) and triphenyltetrazonlium chloride brain staining. The cortical ischemia area and the geometric configuration of the NIRS topograms were compared with those from MRI and the anatomical samples for the same rat. Results The reconstructed NIRS topograms showed that there was an optical density decreased area on the left cortex of the rats with MCAO model. The mean ischemia area as shown in NIRS images was 19.50?mm2 (19.50±0.35?mm2, n=20). Anatomical samples showed that the mean ischemic area located in the NIRS measurement area was 18.46?mm2  (18.46±0.38?mm2, n=20). For MRI, the mean ischemia area located in the NIRS measurement area was 20.71?mm2  (20.71±0.27?mm2, n=20). There were no significant differences among NIRS, MRI and anatomical samples (F(2,57)=2.47, P>0.05) for defining the ischemia area. The results showed that there was a significant correlation among NIRS, MRI (r=0.782, P<0.05) and anatomical sample (r=0.851, P<0.05) for the same cortical ischemia area. Meanwhile, the location and geometric configuration of the ischemia focus shown by NIRS were identified by MRI and anatomical samples, though the NIRS images had worse spatial resolution. Conclusions NIRS showed a good agreement with MRI and anatomical samples in the ischemic area and location determination of the infarction focus for the rat MCAO model. The study suggests that NIRS can non-invasively trace cortical hemodynamic changes induced by ischemia in real time.

  2. Drip-and-Ship Thrombolytic Therapy Supported by the Telestroke System for Acute Ischemic Stroke Patients Living in Medically Under-served Areas

    Science.gov (United States)

    KAGEJI, Teruyoshi; OBATA, Fumiaki; OKA, Hirofumi; KANEMATSU, Yasuhisa; TABATA, Ryo; TANI, Kenji; BANDO, Hiroyasu; NAGAHIRO, Shinji

    2016-01-01

    There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Prefectural Kaifu Hospital (TPKH), located in rural Japan, can relay CT or MRI scans and other patient data via their smart phone to off-site stroke specialists. In the course of 34 months, we used the TSS in 321 emergencies. A total of 9 of 188 (4.8%) with acute ischemic stroke, received iv rt-PA infusion therapy using a mobile TSS; in 5 among these (55.6%), we obtained partial or complete recanalization of occluded arteries. None suffered post-treatment hemorrhage and their average NIH stroke score fell from 14.6 at the time of admission to 6.8 at 24 h post-infusion. The drip-and-ship protocol contributed to the safe and effective treatment of the stroke patients living in medically under-served rural areas. PMID:27333939

  3. Rolipram stimulates angiogenesis and attenuates neuronal apoptosis through the cAMP/cAMP-responsive element binding protein pathway following ischemic stroke in rats.

    Science.gov (United States)

    Hu, Shouye; Cao, Qingwen; Xu, Peng; Ji, Wenchen; Wang, Gang; Zhang, Yuelin

    2016-03-01

    Rolipram, a phosphodiesterase-4 inhibitor, can activate the cyclic adenosine monophosphate (cAMP)/cAMP-responsive element binding protein (CREB) pathway to facilitate functional recovery following ischemic stroke. However, to date, the effects of rolipram on angiogenesis and cerebral ischemia-induced neuronal apoptosis are yet to be fully elucidated. In this study, the aim was to reveal the effect of rolipram on the angiogenesis and neuronal apoptosis following brain cerebral ischemia. Rat models of ischemic stroke were established following transient middle cerebral artery occlusion and rolipram was administered for three, seven and 14 days. The results were examined using behavioral tests, triphenyl tetrazolium chloride staining, immunostaining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) to evaluate the effects of rolipram therapy on functional outcome, angiogenesis and apoptosis. Western blot analysis was used to show the phosphorylated- (p-)CREB protein level in the ischemic hemisphere. The rolipram treatment group exhibited a marked reduction in infarct size and modified neurological severity score compared with the vehicle group, and rolipram treatment significantly promoted the microvessel density in the ischemic boundary region and increased p-CREB protein levels in the ischemic hemisphere. Furthermore, a significant reduction in the number of TUNEL-positive cells was observed in the rolipram group compared with the vehicle group. These findings suggest that rolipram has the ability to attenuate cerebral ischemic injury, stimulate angiogenesis and reduce neuronal apoptosis though the cAMP/CREB pathway.

  4. Current recommendations for endovascular interventions in the treatment of ischemic stroke.

    Science.gov (United States)

    Appelboom, Geoffrey; Strozyk, Dorothea; Meyers, Philip M; Higashida, Randall T

    2010-07-01

    Ischemic stroke remains one of the leading cause of adult death and disability in the United States. Reperfusion of the occluded vessel is the standard of care in the setting of acute ischemic stroke according to established guidelines. Since the introduction of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) in the late 1990s, significant advances have been made in methods to deliver thrombolytic agents and in devices for mechanical recanalization of occluded vessels. Furthermore, improvements in patient selection contribute to achievement of good clinical outcomes after endovascular therapy. This article summarizes findings from recent clinical trials and presents evidence-based guidelines for endovascular interventions in the treatment of ischemic stroke.

  5. Impact on the gait time cycle of ischemic stroke in the treatment with yinyang respiratory reinforcing and reducing needling technique

    Institute of Scientific and Technical Information of China (English)

    李旗

    2014-01-01

    Objective To compare the difference in the efficacy on gait time cycle of ischemic stroke between yin-yang respiratory reinforcing and reducing needling technique(yin-yang needling)and the conventional acupuncture.Methods Sixty cases of ischemic stroke between yin-yang

  6. No influence of dabigatran anticoagulation on hemorrhagic transformation in an experimental model of ischemic stroke.

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    Ferdinand Bohmann

    Full Text Available BACKGROUND: Dabigatran etexilate (DE is a new oral direct thrombin inhibitor. Clinical trials point towards a favourable risk-to-benefit profile of DE compared to warfarin. In this study, we evaluated whether hemorrhagic transformation (HT occurs after experimental stroke under DE treatment as we have shown for warfarin. METHODS: 44 male C57BL/6 mice were pretreated orally with 37.5 mg/kg DE, 75 mg/kg DE or saline and diluted thrombin time (dTT and DE plasma concentrations were monitored. Ischemic stroke was induced by transient middle cerebral artery occlusion (tMCAO for 1 h or 3 h. We assessed functional outcome and HT blood volume 24 h and 72 h after tMCAO. RESULTS: After 1 h tMCAO, HT blood volume did not differ significantly between mice pretreated with DE 37.5 mg/kg and controls (1.5±0.5 µl vs. 1.8±0.5 µl, p>0.05. After 3 h tMCAO, DE-anticoagulated mice did also not show an increase in HT, neither at the dose of 37.5 mg/kg equivalent to anticoagulant treatment in the therapeutic range (1.3±0.9 µl vs. control 2.3±0.5 µl, p>0.05 nor at 75 mg/kg, clearly representing supratherapeutic anticoagulation (1.8±0.8 µl, p>0.05. Furthermore, no significant increase in HT under continued anticoagulation with DE 75 mg/kg could be found at 72 h after tMCAO for 1 h (1.7±0.9 µl vs. control 1.6±0.4 µl, p>0.05. CONCLUSION: Our experimental data suggest that DE does not significantly increase hemorrhagic transformation after transient focal cerebral ischemia in mice. From a translational viewpoint, this indicates that a continuation of DE anticoagulation in case of an ischemic stroke might be safe, but clearly, clinical data on this question are warranted.

  7. Fullerenols and glucosamine fullerenes reduce infarct volume and cerebral inflammation after ischemic stroke in normotensive and hypertensive rats.

    Science.gov (United States)

    Fluri, Felix; Grünstein, Dan; Cam, Ertugrul; Ungethuem, Udo; Hatz, Florian; Schäfer, Juliane; Samnick, Samuel; Israel, Ina; Kleinschnitz, Christoph; Orts-Gil, Guillermo; Moch, Holger; Zeis, Thomas; Schaeren-Wiemers, Nicole; Seeberger, Peter

    2015-03-01

    Cerebral inflammation plays a crucial role in the pathophysiology of ischemic stroke and is involved in all stages of the ischemic cascade. Fullerene derivatives, such as fullerenol (OH-F) are radical scavengers acting as neuroprotective agents while glucosamine (GlcN) attenuates cerebral inflammation after stroke. We created novel glucosamine-fullerene conjugates (GlcN-F) to combine their protective effects and compared them to OH-F regarding stroke-induced cerebral inflammation and cellular damage. Fullerene derivatives or vehicle was administered intravenously in normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR) immediately after transient middle cerebral artery occlusion (tMCAO). Infarct size was determined at day 5 and neurological outcome at days 1 and 5 after tMCAO. CD68- and NeuN-staining were performed to determine immunoreactivity and neuronal survival respectively. Cytokine and toll like receptor 4 (TLR-4) expression was assessed using quantitative real-time PCR. Magnetic resonance imaging revealed a significant reduction of infarct volume in both, WKY and SHR that were treated with fullerene derivatives. Treated rats showed an amelioration of neurological symptoms as both OH-F and GlcN-F prevented neuronal loss in the perilesional area. Cerebral immunoreactivity was reduced in treated WKY and SHR. Expression of IL-1β and TLR-4 was attenuated in OH-F-treated WKY rats. In conclusion, OH-F and GlcN-F lead to a reduction of cellular damage and inflammation after stroke, rendering these compounds attractive therapeutics for stroke.

  8. Omega-3 polyunsaturated fatty acids ameliorate neuroinflammation and mitigate ischemic stroke damage through interactions with astrocytes and microglia.

    Science.gov (United States)

    Zendedel, Adib; Habib, Pardes; Dang, Jon; Lammerding, Leoni; Hoffmann, Stefanie; Beyer, Cordian; Slowik, Alexander

    2015-01-15

    Omega-3 polyunsaturated fatty acids (PUFA n3) provide neuroprotection due to their anti-inflammatory and anti-apoptotic properties as well as their regulatory function on growth factors and neuronal plasticity. These qualities enable PUFA n3 to ameliorate stroke outcome and limit neuronal damage. Young adult male rats received transient middle cerebral artery occlusion (tMCAO). PUFA n3 were intravenously administered into the jugular vein immediately after stroke and 12h later. We analyzed stroke volume and behavioral performance as well as the regulation of functionally-relevant genes in the penumbra. The extent of ischemic damage was reduced and behavioral performance improved subject to applied PUFA n3. Expression of Tau and growth-associated protein-43 genes were likewise restored. Ischemia-induced increase of cytokine mRNA levels was abated by PUFA n3. Using an in vitro approach, we demonstrate that cultured astroglial and microglia directly respond to PUFA n3 administration by preventing ischemia-induced increase of cyclooxygenase 2, hypoxia-inducible factor 1alpha, inducible nitric oxide synthase, and interleukin 1beta. Cultured cortical neurons also appeared as direct targets, since PUFA n3 shifted the Bcl-2-like protein 4 (Bax)/B-cell lymphoma 2 (Bcl 2) ratio towards an anti-apoptotic constellation. Thus, PUFA n3 reveal a high neuroprotective and anti-inflammatory potential in an acute ischemic stroke model by targeting astroglial and microglial function as well as improving neuronal survival strategies. Our findings signify the potential clinical feasibility of PUFA n3 therapeutic treatment in stroke and other acute neurological diseases.

  9. Prevalence of patent foramen ovale in ischemic stroke in Italy: the SISIFO study.

    Science.gov (United States)

    Consoli, Domenico; Paciaroni, Maurizio; Aguggia, Marco; Melis, Maurizio; Malferrari, Giovanni; Vidale, Simone; Cerrato, Paolo; Sacco, Simona; Gandolfo, Carlo; Bovi, Paolo; Serrati, Carlo; Del Sette, Massimo; Cavallini, Anna; Diomedi, Marina; Postorino, Paolo; Ricci, Stefano

    2014-06-01

    Patent foramen ovale (PFO) is a common congenital anatomical defect in the general population with a mean prevalence of 20 %. Transcranial Doppler sonography and echocardiography, both with infusion of agitated saline as an echo contrast, have been introduced for the diagnosis of PFO. Transesophageal echocardiography is considered the gold standard. Several studies have suggested an association between cryptogenetic stroke and PFO, but the role of this condition as a risk factor for stroke is still debated. The aims of this prospective multicentre study are the evaluation of PFO prevalence in the whole ischemic stroke population and the identification of a stroke recurrence profile risk in patients with PFO. All consecutive patients admitted for acute ischemic stroke and with a confirmed diagnosis at discharge are eligible cases for the study. Demographic and vascular risk factors are registered. Clinical severity is summarized by the National Institute of Health stroke scale. Echocardiographic and transcranial studies are performed in each patient to detect the presence of PFO. Prevalence of PFO will be calculated with 95 % CIs. Univariate analysis will be performed to detect the correlation of PFO with different registered factors and multivariable analysis with PFO as independent variable. The present study should contribute to better identify the role of PFO in ischemic stroke risk and recurrence-related events. Qualifying findings of the study are represented by the high number of enrolled patients, the prospective methodology of the study and the presence of secondary instrumental endpoints.

  10. Metabolic syndrome, platelet activation and the development of transient ischemic attack or thromboembolic stroke.

    Science.gov (United States)

    van Rooy, Mia-Jeanne; Pretorius, Etheresia

    2015-03-01

    Stroke is the second most common cause of mortality in the world today, where transient ischemic attack (TIA) is a period of focal ischemia, the symptoms of which resemble a thromboembolic stroke. Contrary to stroke, TIA symptoms typically last less than one hour and necrosis is absent. Stroke is often preceded by TIA, making it an important predictor of future ischemic events. The causal role of atherosclerosis in the development of TIA is well established, however, research indicates that the atherosclerotic process begins years earlier with the development of metabolic syndrome, which affects approximately 45% of the adult population worldwide. Metabolic syndrome is present if three or more of the following is present: increased waist circumference, increased triglycerides, decreased HDL, increased fasting glucose and hypertension. This syndrome causes systemic inflammation that activates the coagulation system and may cause the formation of pathological thrombi. The role of platelets in stroke has been studied and platelet activation pathways identified. ADP and thromboxane A(2) are the most common activators of platelets in normal physiology. Several pharmacological treatments have been employed to prevent the activation of platelets, the most common of which include aspirin and P2Y(12)-inhibitors. Although treatment is administered strokes and subsequent TIAs are very common in individuals that suffered an initial event. This indicates that research needs to be done in order to elucidate new therapeutic targets, but also to better treat ischemic events to not only decrease the amount of recurring events but also decrease stroke mortality worldwide.

  11. Effects of statins on the liver: clinical analysis of patients with ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li-san; LIU Zheng-xia; L(U) Wen; HU Xing-yue

    2011-01-01

    Background Statins are one of the most common agents prescribed for ischemic stroke patients, but their side effects on the liver are worrisome to both physicians and patients. This study aimed to analyze the features and related factors of the hepatic side effects of, statins in patients with ischemic troke.Methods Four hundred and eighty-one patients with ischemic stroke who had been treated with statins at our department from July 1, 2008 to June 30, 2009 were investigated retrospectively. Liver function, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), within 6 months after they began to use statins and related factors were analyzed.Results The incidence of mild ALT and AST elevation, less than three times the upper limit of normal, and the incidence of moderate elevation, ALT and AST levels 3-10 times the upper limit of normal, in ischemic stroke patients who had been treated with statins were 2.3% and 2.1%, respectively. These incidences were higher than in patients with common hyperlipidemia or coronary heart disease. The relatively high incidence was associated with older age (>65 years) and chronic liver diseases, and was not related to the type of stroke, gender, and reduction of low-density lipoprotein. The levels of ALT and AST normalized after withdrawal of statins or lowering the dosage. None of the patients developed hepatic failure.Conclusions Asymptomatic elevation of ALT and AST after administration of statins is more likely to occur in ischemic stroke patients than in others, and the elevation is related to age and chronic liver diseases. However, statins are still safe for ischemic stroke patients.

  12. Polymorphism of the methylenetetrahydrofolate reductase gene association with homocysteine and ischemic stroke in type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Sun Jia-Zhong

    2009-12-01

    Full Text Available Background : Ischemic stroke is a frequent heterogeneous multifactorial disease. A number of genetic mutations and environmental factors have been implicated. A polymorphism in the gene for methylenetetrahydrofolate reductase (MTHFR has been reported to be associated with hyperhomocysteinemia a risk for atherosclerotic vascular diseases. Aim : A cross-sectional study was performed to determine the relationship between the gene polymorphism for MTHFR and ischemic stroke in type 2 diabetes mellitus. Materials and Methods : Of the 215 unrelated patients with type 2 diabetes mellitus recruited, 119 patients had ischemic stroke, Control group included 142 healthy subjects. The genotype of the subjects for the C677T polymorphism of MTHFR was analyzed by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP followed by HinfI digestion. Plasma total homocysteine (Hcy levels were measured using high-performance liquid chromatography (HPLC with fluorescence detection. Results : The genotype distribution did not differ between the control subjects and type 2 diabetic patients (P > 0.05. Plasma homocysteine levels were markedly higher in diabetic patients with TT genotype than those with CC or CT genotype (P > 0.05. Ischemic stroke was more frequently observed in type 2 diabetic patients with the TT genotype than in those with the CT and CC genotype (odds ratio=4.04, 95% CI=1.95-8.34, P=0.0036. Logistic regression analysis revealed that the C677T mutation of MTHFR gene was independently associated with ischemic stroke in type 2 diabetes. Conclusion : MTHFR C677T gene polymorphism associated with a predisposition to hyperhomocysteinemia could constitute a useful pre