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Zhou P, Liu RL, Wang FX, Hu HF, Deng Z. Blood urea nitrogen has a nonlinear association with 3-month outcomes with acute ischemic stroke: A second analysis based on a prospective cohort study. Clin Nutr ESPEN 2024; 59:140-148. [PMID: 38220367 DOI: 10.1016/j.clnesp.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Evidence regarding the relationship between blood urea nitrogen (BUN) and 3-month outcomes in acute ischemic stroke (AIS) patients is still scarce. Therefore, the present study was preformed to explore the link between the BUN and 3-month poor outcomes in patients with AIS. METHODS A retrospective study of 1866 participants with AIS enrolled from January 2010 to December 2016 at a hospital in South Korea. Binary logistic regression, smooth curve fitting, and a set of sensitivity analyses were used to analyze the association between BUN and 3-month poor outcomes. RESULTS After adjusting covariates, the results of the binary logistic regression model suggested that the relationship between the BUN and the risk of 3-month poor outcomes for AIS patients was not statistically significant. However, there was a special nonlinear relationship between them, and the inflection point of the BUN was 13 mg/dl. On the left side of the inflection point, every unit increase in the BUN reduces the risk of 3-month poor outcomes by 14.1 % (OR = 0.859, 95%CI: 0.780-0.945, p = 0.0019). On the right side of the inflection point, the relationship is not statistically significant. CONCLUSION There is a nonlinear relationship with saturation effect between BUN level and 3-month poor outcomes in AIS patients. Maintaining the BUN at around 13 mg/dl can reduce the risk of 3-month poor outcome in AIS patients.
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Affiliation(s)
- Pan Zhou
- Department of Emergency Medicine, Shenzhen Second People's Hospital / the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Ren-Li Liu
- Department of Emergency Medicine, Shenzhen Second People's Hospital / the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Fang-Xi Wang
- Department of Emergency Medicine, Shenzhen Second People's Hospital / the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Hao-Fei Hu
- Department of Nephrology, Shenzhen Second People's Hospital / the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.
| | - Zhe Deng
- Department of Emergency Medicine, Shenzhen Second People's Hospital / the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.
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Yoo IH, Kim JM, Han SH, Ryu J, Jung KH, Park KY. Increased pulsatility index of the basilar artery is a risk factor for neurological deterioration after stroke: a case control study. Clin Hypertens 2022; 28:27. [PMID: 35965347 PMCID: PMC9377089 DOI: 10.1186/s40885-022-00210-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Higher pulsatility of the middle cerebral artery (MCA) is known to be associated with stroke progression. We investigated whether pulsatility index (PI) of the basilar artery (BA) can predict neurological deterioration (ND) after acute cerebral infarction. Methods A total of 708 consecutive patients with acute ischemic stroke who had undergone transcranial Doppler (TCD) ultrasonography were included. ND was defined as an increase in the National Institutes of Health Stroke Scale scores by two or more points after admission. The patients were categorized into quartiles according to BA PI. Multivariable logistic regression analysis was performed to examine whether BA PI is independently associated with ND. Results BA PI was well correlated with the right (n = 474, r2 = 0.573, P < 0.001) by Pearson correlation analysis although MCA PI could not be measured from right MCA (n = 234, 33.05%) and left MCA (n = 252, 35.59%) by TCD owing to insufficient temporal bone window. Multivariable logistic regression analysis including age, sex, cerebral atherosclerosis burden, National Institutes of Health Stroke Scale at admission, and the proportion of patients with current smoking status, hypertension, diabetes mellitus, atrial fibrillation revealed that the higher BA PI (odds ratio, 3.28; confidence interval, 1.07–10.17; P = 0.038) was independently associated with ND. Conclusions BA PI, which would be identified regardless of temporal window, could predict ND among acute stroke patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00210-9.
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Bhole R, Nouer SS, Tolley EA, Turk A, Siddiqui AH, Alexandrov AV, Arthur AS, Mocco J. Predictors of early neurologic deterioration (END) following stroke thrombectomy. J Neurointerv Surg 2022; 15:584-588. [PMID: 35584910 DOI: 10.1136/neurintsurg-2022-018844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Early neurologic deterioration (END) following ischemic stroke is a serious event and is associated with poor outcomes. However, the incidence and predictors of END after stroke thrombectomy for emergent large vessel occlusion are largely unknown. METHODS The baseline characteristics of patients enrolled in the COMPASS trial (NCT02466893) were analyzed. The primary outcome was worsening of ≥4 National Institutes of Health Stroke Scale (NIHSS) points 24 hours post thrombectomy (4+ END24) and the secondary outcome was deterioration of ≥2 points (2+ END24). RESULTS Among 270 patients, 27 (10%) developed 4+ END24 and 42 (16%) had 2+ END24. Those with 4+ END24 were older (76.4±12.9 vs 70.9±12.9 years; p=0.04), had a higher prevalence of hypertension (96% vs 69%; p=0.003), diabetes (41% vs 27%; p=0.13) and higher pretreatment systolic blood pressure (SBP) (170.4±32.6 vs 157.6±28.1 mmHg; p=0.03). More 4+ END24 patients had failed reperfusion: Thrombolysis in Cerebral Infarction ≤2a (26% vs 8%; p=0.003). In unadjusted analysis, older patients and those with hypertension, diabetes, elevated SBP and failed reperfusion had higher odds of 4+ END24. In adjusted analysis, age increase by 5 years led to an increase in 4+ END24 of 28%, diabetes increased odds of 2.6 and failed reperfusion increased odds of 4.5. In the multivariable analysis for the secondary outcome, age (OR 1.33; 95% CI 1.109 to 1.593), diabetes (OR 2.7; 95% CI 1.247 to 5.764) and failed reperfusion (OR 7.2; 95% CI 0.055 to 0.349) were also significant predictors of 2+ END24. CONCLUSIONS Older patients with acute ischemic stroke who have a history of diabetes or hypertension, with elevated pretreatment SBP and failed reperfusion are at a higher risk of END following stroke thrombectomy for emergent large vessel occlusion.
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Affiliation(s)
- Rohini Bhole
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Simonne S Nouer
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Elizabeth A Tolley
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aquilla Turk
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Adnan H Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | | | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
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Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment. Chin Med J (Engl) 2021; 133:1655-1661. [PMID: 32604178 PMCID: PMC7401737 DOI: 10.1097/cm9.0000000000000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Early neurologic deterioration (END) may occur in patients with anterior circulation ischemic stroke (ACIS) after receiving endovascular treatment (EVT). Hemodynamic insufficiency, re-occlusion, and post-re-canalization hyper-perfusion are likely to play a critical role in END. We hypothesized that hemodynamic changes can predict END in patients with ACIS post-successful EVT using trans-cranial Doppler (TCD). Methods We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital, Capital Medical University. TCD parameters including peak systolic velocity (PSV), bilateral mean flow velocity (MFV), and pulse index (PI) were determined via the middle cerebral arteries within 72 h post-EVT. A logistic regression model was applied to detect independent predictors for END. Results Totally, 112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with <50% residual stenosis, while 17/80 (21.3%) patients suffered END, for which vasogenic cerebral edema (11/17) was considered as a leading role and followed by symptomatic intra-cranial hemorrhage (4/17) and ischemia progression (2/17). For the 80 patients, the PSV (median: 127 cm/s vs. 116 cm/s, P = 0.039), the ratio of ipsilateral-MFV/contra-lateral-MFV (iMFV/cMFV) (median: 1.29 vs. 1.02, P = 0.036) and iMFV/mean blood pressure (MBP) (median: 0.97 vs. 0.79, P = 0.008) in END patients were higher than those of non-END. Using the receiver-operating characteristic curve to obtain cut-off values for PSV, PI, iMFV/cMFV, and iMFV/MBP for END, we found that PI ≥0.85 (odds ratio: 11.03, 95% confidence interval: 1.92–63.46, P = 0.007) and iMFV/MBP ≥0.84 (odds ratio: 9.20, 95% confidence interval: 2.07–40.84, P = 0.004) were independent predictors of END in a multivariate logistic regression model, with a sensitivity of 82.4% and 76.5% and a specificity of 42.9% and 66.7%, respectively, and had the positive predictive values of 29.0% and 38.2%, and negative predictive values of 90.0% and 91.3%, with an area under the receiver-operating characteristic curve of 0.57 and 0.71, respectively. Conclusion TCD examination of EVT patients may be used as a real-time tool to detect END predictors, such as the higher PI and iMFV/MBP, allowing for better post-thrombectomy management in ACIS patients.
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Yi X, Zhou Q, Zhang Y, Zhou J, Lin J. Variants in clopidogrel-relevant genes and early neurological deterioration in ischemic stroke patients receiving clopidogrel. BMC Neurol 2020; 20:159. [PMID: 32345264 PMCID: PMC7187527 DOI: 10.1186/s12883-020-01703-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early neurological deterioration (END) is common in acute ischemic stroke (IS). However, the underlying mechanisms for END are unclear. The aim of this study was to evaluate the associations of 16 variants in clopidogrel-relevant genes and interactions among these variants with END in acute IS patients receiving clopidogrel treatment. METHODS We consecutively enrolled 375 acute IS patients between June 2014 and January 2015. Platelet aggregation was measured on admission and after the 7-10 days of clopidogrel treatment. The 16 variants in clopidogrel-relevant genes were examined using mass spectrometry. The primary outcome was END within the 10 days of admission. Gene-gene interactions were analyzed by generalized multifactor dimensionality reduction (GMDR) methods. RESULTS Among the 375 patients, 95 (25.3%) patients developed END within the first 10 days of admission. Among the 16 variants, only CYP2C19*2 (rs4244285) AA/AG was associated with END using single-locus analytical approach. GMDR analysis revealed that there was a synergistic effect of gene-gene interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPIIIa rs2317676 on the risk for END. The high-risk interactions among the three variants were associated with the higher platelet aggregation and independent predictor for END after adjusting for the covariates (hazard ratio: 2.82; 95% confidence interval: 1.36-7.76; P = 0.003). CONCLUSIONS END is very common in patients with acute IS. The mechanisms leading to END are most likely multifactorial. Interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPIIIa rs2317676 may confer a higher risk for END. It was very important to modify clopidogrel therapy for the patients carrying the high-risk interactive genotypes. CLINICAL TRIAL REGISTRATION INFORMATION The study described here is registered at http://www.chictr.org/ (unique Identifier: ChiCTR-OCH-14004724). The date of trial registration was May 30, 2014.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, the People’s Hospital of Deyang City, Deyang, 618000 Sichuan China
| | - Qiang Zhou
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, 108 Wanson Road, Ruian City, Wenzhou, 325200 Zhejiang China
| | - Yongyin Zhang
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, 108 Wanson Road, Ruian City, Wenzhou, 325200 Zhejiang China
| | - Ju Zhou
- Department of Neurology, the People’s Hospital of Deyang City, Deyang, 618000 Sichuan China
| | - Jing Lin
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, 108 Wanson Road, Ruian City, Wenzhou, 325200 Zhejiang China
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Zhang Z, Pu Y, Mi D, Liu L. Cerebral Hemodynamic Evaluation After Cerebral Recanalization Therapy for Acute Ischemic Stroke. Front Neurol 2019; 10:719. [PMID: 31333570 PMCID: PMC6618680 DOI: 10.3389/fneur.2019.00719] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 06/18/2019] [Indexed: 12/14/2022] Open
Abstract
Cerebral recanalization therapy, either intravenous thrombolysis or mechanical thrombectomy, improves the outcomes in patients with acute ischemic stroke (AIS) by restoring the cerebral perfusion of the ischemic penumbra. Cerebral hemodynamic evaluation after recanalization therapy, can help identify patients with high risks of reperfusion-associated complications. Among the various hemodynamic modalities, magnetic resonance imaging (MRI), computed tomography perfusion, and transcranial Doppler sonography (TCD) are the most commonly used. Poststroke hypoperfusion is associated with infarct expansion, while hyperperfusion, which once was considered the hallmark of successful recanalization, is associated with hemorrhagic transformation. Either the hypo- or the hyperperfusion may result in poor clinical outcomes. Individual blood pressure target based on cerebral hemodynamic evaluation was crucial to improve the prognosis. This review summarizes literature on cerebral hemodynamic evaluation and management after recanalization therapy to guide clinical decision making.
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Affiliation(s)
- Zhe Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yi X, Lin J, Wang Y, Zhou J, Zhou Q, Wang C. Response to clopidogrel is associated with early neurological deterioration after acute ischemic stroke. Oncotarget 2018; 9:19900-19910. [PMID: 29731992 PMCID: PMC5929435 DOI: 10.18632/oncotarget.24945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/28/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose The relationship between response to clopidogrel and early neurological deterioration (END) after acute ischemic stroke (IS) is not well defined. The aim of present study was to evaluate the associations of clopidogrel resistance (CR) with END, and stratified analyze the effectiveness of clopidogrel alone and clopidogrel plus aspirin for the prevention of END. Results A total of 375 patients, 144 patients were received clopidogrel alone, 231 patients took clopidogrel plus aspirin. CR occurred in 153 patients (40.8%). 95 (25.3%) patients developed END within the first 10 days. Platelet aggregation was higher on admission, and inhibition of platelet aggregation was significantly lower in patients with END than patients without END. Diabetes mellitus, CR, and clopidogrel plus aspirin were independently associated with END. Dual antiplatelet therapy with aspirin and clopidogrel can inhibit both arachidonic acid (AA)-induced and ADP-induced platelet aggregation Methods This was a prospective, two-center study. A total of 375 IS patients taking clopidogrel alone or clopidogrel plus aspirin were enrolled. Platelet aggregation was measured before and after the 7–10 day treatment. CR was assessed by adenosine diphosphate (ADP)-induced platelet aggregation. The primary endpoint was END within the 10 days after admission. The secondary endpoint was a composite of recurrent ischemic stroke, myocardial infarction, and death during the 10 days after admission. Conclusions CR and END are fairly common after acute IS. CR is associated with higher risk of END. Clopidogrel plus aspirin combination therapy provides greater inhibition of platelet aggregation, and may afford protection against END.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Jing Lin
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China
| | - Yanfen Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Ju Zhou
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Qiang Zhou
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
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Miyamoto N, Tanaka R, Ueno Y, Watanabe M, Kurita N, Hira K, Shimada Y, Kuroki T, Yamashiro K, Urabe T, Hattori N. Analysis of the Usefulness of the WORSEN Score for Predicting the Deterioration of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:2834-2839. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/29/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022] Open
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Yi X, Lin J, Wang C, Zhou Q. CYP Genetic Variants, CYP Metabolite Levels, and Neurologic Deterioration in Acute Ischemic Stroke in Chinese Population. J Stroke Cerebrovasc Dis 2016; 26:969-978. [PMID: 27916259 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The mechanisms of neurologic deterioration (ND) are not fully understood. The aim of the present study was to evaluate the relationship between CYP genetic variants and CYP metabolite levels with ND in acute ischemic stroke patients. METHODS Eleven single nucleotide polymorphisms (SNPs) of seven CYP genes were genotyped in 396 patients with acute ischemic stroke. The CYP plasma metabolite levels (20-hydroxyeicosatetraenoic acid [HETE], total epoxyeicosatrienoic acids [EETs], and dihydroxyeicosatrienoic acids [DiHETEs]) were also assessed. The primary outcome was ND within 10 days on admission. ND was defined as an increase of two or more points in the National Institutes of Health Stroke Scale score. RESULTS Among 396 patients, 101 patients (25.5%) experienced ND. The plasma levels of 20-HETE and DiHETEs were significantly higher and the EET levels were significantly lower in patients with ND compared to patients without ND. Univariate analyses revealed that old age, diabetes mellitus (DM), higher fasting glucose, and higher hemoglobin A1c (HbA1c) were associated with ND. CYP2C8 rs17110453 CC, EPHX2 rs751141 GG, and CYP4A11 rs9333025 GG were independently associated with ND after adjusting age, DM, fasting glucose, and HbA1c (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.02-3.72; OR: 3.01, 95% CI: 1.29-7.13; OR: 2.75, 95% CI: 1.17-6.24, respectively). Also, these polymorphisms were associated with CYP metabolite levels in patients with ND. CONCLUSIONS ND is fairly common in acute ischemic stroke. Specific CYP gene SNPs are associated with CYP plasma metabolite levels, which may explain their associations with ND. Further studies are needed to validate our findings.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, The People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Jing Lin
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
| | - Chun Wang
- Department of Neurology, The People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Qiang Zhou
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China
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Duan Z, Fu C, Chen B, Xu G, Tao L, Tang T, Hou H, Fu X, Yang M, Liu Z, Zhang X. Lesion patterns of single small subcortical infarct and its association with early neurological deterioration. Neurol Sci 2015; 36:1851-7. [PMID: 26032577 DOI: 10.1007/s10072-015-2267-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/22/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Zuowei Duan
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China.
| | - Changbiao Fu
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Bin Chen
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Gang Xu
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Lihong Tao
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Tieyu Tang
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Hongling Hou
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Xuetao Fu
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Ming Yang
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China
| | - Zhensheng Liu
- Department of Radiology, Yangzhou No.1 People's Hospital, Yangzhou, 225001, People's Republic of China
| | - Xinjiang Zhang
- Department of Neurology, Yangzhou No.1 People's Hospital, 45 Taizhou Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China.
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Seners P, Turc G, Oppenheim C, Baron JC. Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry 2015; 86:87-94. [PMID: 24970907 DOI: 10.1136/jnnp-2014-308327] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Early neurological deterioration (END) following ischaemic stroke is a serious event with manageable causes in only a fraction of patients. The incidence, causes and predictors of END occurring within 24 h of acute ischaemic stroke (END24) have not been systematically reviewed. We systematically reviewed Medline and Embase from January 1990 to April 2013 for all studies on END24 following acute ischaemic stroke (<8 h from onset). We recorded the incidence and presumed causes of and factors associated with END24. Thirty-six studies were included. Depending on the definition used, the incidence of END24 markedly varied among studies. Using the most widely used change in National Institutes of Health Stroke Scale ≥4 definition, the pooled incidence was 13.8% following thrombolysis, ascribed to intracranial haemorrhage and malignant oedema each in ∼20% of these. As other mechanisms were rarely reported, in the majority no clear cause was identified. Few data on END24 occurring in non-thrombolysed patients were available. Across thrombolysed and non-thrombolysed samples, the strongest and most consistent admission predictors were hyperglycaemia, no prior aspirin use, prior transient ischaemic attacks, proximal arterial occlusion and presence of early CT changes, and the most consistent 24 h follow-up associated factors were no recanalisation/reocclusion, large infarcts and intracranial haemorrhage. Finally, END24 was strongly predictive of poor outcome. The above findings are discussed with emphasis on END without a clear mechanism. Data on incidence and predictors of the latter subtype is scarce, and future studies using systematic imaging protocols should address its underlying pathophysiology. This may in turn lead to rational preventative and therapeutic measures for this ominous event.
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Affiliation(s)
- Pierre Seners
- Sorbonne Paris Cité, INSERM UMR S894, Service de Neurologie, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Guillaume Turc
- Sorbonne Paris Cité, INSERM UMR S894, Service de Neurologie, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- Sorbonne Paris Cité, INSERM UMR S894, Service de Neuroradiologie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Jean-Claude Baron
- Sorbonne Paris Cité, INSERM UMR S894, Service de Neurologie, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
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Helleberg BH, Ellekjær H, Rohweder G, Indredavik B. Mechanisms, predictors and clinical impact of early neurological deterioration: the protocol of the Trondheim early neurological deterioration study. BMC Neurol 2014; 14:201. [PMID: 25347961 PMCID: PMC4219127 DOI: 10.1186/s12883-014-0201-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/01/2014] [Indexed: 12/19/2022] Open
Abstract
Background 10-40% of patients with acute ischemic stroke (AIS) suffer an early neurological deterioration (END), which may influence their long term prognosis. Multiple definitions of END exist, even in recently published papers. In the search for causes, various biochemical, clinical, and imaging markers have been found to be associated to END after AIS in some but not in other studies. The primary aim of this study is to assess the contribution of END to functional level at 3 months post stroke measured by modified Rankin Scale (mRS). Secondary aims are to identify factors and mechanisms associated with END and to define the prevalence, degree and timing of END in relation to stroke onset, and to compare Scandinavian Stroke Scale (SSS) and National Institute of Health Stroke Scale (NIHSS) based END-definitions. We hypothesized that END detected by changes in NIHSS and SSS (according to previously published criteria) at a threshold of 2 points indicate worsened prognosis, and that SSS is not inferior to NIHSS in predicting such a change. We further hypothesized that clinical deterioration has several causes, including impaired physiological homeostasis, vascular pathology, local effects and reactions secondary to the ischemic lesion, along with biochemical disturbances. Methods Single-centre prospective observational study. Participants: Previously at home-dwelling patients admitted to our stroke unit within 24 hours after ictus of AIS are included into the study, and followed for 3 months. They are managed according to current procedures and national guidelines. A total of 368 patients are included by the end of the enrolment period (December 31st 2013), and the material will be opened for analysis by June 30th 2014. Frequent neurological assessments, continuous monitoring, and repeated imaging and blood samples are performed in all patients in order to test the hypotheses. Discussion Strengths and weaknesses of our approach, along with reasons for the methods chosen in this study are discussed.
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Affiliation(s)
- Bernt Harald Helleberg
- Research group for Geriatrics, Stroke and Movement (GeMS), Department of Neuroscience (INM), Norwegian University of Science and Technology, N-7489, Trondheim, Norway. .,Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, University Hospital in Trondheim, N-7006, Trondheim, Norway.
| | - Hanne Ellekjær
- Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, University Hospital in Trondheim, N-7006, Trondheim, Norway.
| | - Gitta Rohweder
- Research group for Geriatrics, Stroke and Movement (GeMS), Department of Neuroscience (INM), Norwegian University of Science and Technology, N-7489, Trondheim, Norway. .,Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, University Hospital in Trondheim, N-7006, Trondheim, Norway.
| | - Bent Indredavik
- Research group for Geriatrics, Stroke and Movement (GeMS), Department of Neuroscience (INM), Norwegian University of Science and Technology, N-7489, Trondheim, Norway. .,Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, University Hospital in Trondheim, N-7006, Trondheim, Norway.
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