1
|
Xu J, Huang S. Omentin-1 May Be One Treatment Factor for Intravenous Thrombolysis of Acute Cerebral Infarction Through the Inhibition of NLRP3 Ubiquitination by AMPK Function: Preliminary Findings. Neurol India 2024; 72:309-318. [PMID: 38691475 DOI: 10.4103/ni.ni_1325_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/27/2022] [Indexed: 05/03/2024]
Abstract
BACKGROUND Acute cerebral infarction (ACI) is a common neurological disease that is associated with high morbidity, disability and mortality rates. At present, antiplatelet therapy is a necessary treatment for ACI. The present study aimed to investigate the effects of omentin-1 on the intravenous thrombolysis of ACI. OBJECTIVE The present study aimed to investigate the effects of omentin-1 on the intravenous thrombolysis of ACI. MATERIAL AND METHODS The mouse model of ACI was induced using male C57BL/6 mice through middle cerebral artery occlusion (MCAO). Meanwhile, the murine BV2 microglial cells were pretreated with 0.1 mg/ml of lipopolysaccharide (LPS), and then induced with 2 mM of adenosine triphosphate (ATP). RESULTS The omentin-1 mRNA expression in patients receiving intravenous thrombolysis for ACI was down-regulated compared with the normal group. Additionally, the serum level of omentin-1 was negatively correlated with National Institute of Health Stroke Scale (NIHSS) score or serum level of IL-1β or MMP-2 in patients receiving intravenous thrombolysis for ACI. Meanwhile, the serum mRNA expression of omentin-1 was positively correlated with Barthel index or high-sensitivity C-reactive protein (hs-CRP) in patients undergoing intravenous thrombolysis for ACI. As observed from the in vitro model, Omentin-1 reduced inflammation, promoted cell growth, alleviated ROS-induced oxidative stress, and enhanced AMPK activity through activating NLRP3 ubiquitination. Omentin-1 presented ACI in the mouse model of ACI. Regulating AMPK activity contributed to controlling the effects of Omentin-1 on the in vitro model. CONCLUSIONS Omentin-1 reduced neuroinflammation and ROS-induced oxidative stress in the mouse model of ACI, which was achieved by inhibiting NLRP3 ubiquitination through regulating AMPK activity. Therefore, omentin-1 may serve as a treatment factor for the intravenous thrombolysis of ACI in further clinical application.
Collapse
Affiliation(s)
- Junjiao Xu
- Department of Emergency, Shanghai Jiading District, Nanxiang Hospital, Shanghai, China
| | - Shiren Huang
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai, China
| |
Collapse
|
2
|
Bai YB, Zhao F, Wu ZH, Shi GN, Jiang N. Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report. World J Clin Cases 2024; 12:973-979. [PMID: 38414596 PMCID: PMC10895634 DOI: 10.12998/wjcc.v12.i5.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/13/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Venoarterial (VA) extracorporeal membrane oxygenation (ECMO), an effective short-term circulatory support method for refractory cardiogenic shock, is widely applied. However, retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%. Embolization in important organs caused by complications of left ventricular thrombosis (LVT) during VA-ECMO is also an important reason. Although the incidence of LVT during VA-ECMO is not high, the consequences of embolization are disastrous. CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d. After excluding the diagnosis of coronary heart disease, we established a diagnosis of "clinically explosive myocarditis". The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO, with heparin for anticoagulation. On day 4 of ECMO support, a left ventricular thrombus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography. Left ventricular decompression was performed and ECMO was successfully removed, but the patient eventually died of multiple cerebral embolism. CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs. Therefore, a "wait and see" strategy should be avoided.
Collapse
Affiliation(s)
- Yao-Bang Bai
- Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Feng Zhao
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Zhen-Hua Wu
- Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Guo-Ning Shi
- Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Nan Jiang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| |
Collapse
|
3
|
Li Y, Wang H, Zhao J, Xia L, Xiong K, Zhong H. Effects of butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis: a preliminary study. Int J Neurosci 2024:1-8. [PMID: 38197188 DOI: 10.1080/00207454.2023.2301424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To analyze the effects of Butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis. METHODS Clinical efficacy, cerebral vascular circulation indicators [anterior cerebral artery (ACA), middle cerebral artery (MCA), vertebral artery (VA) blood flow velocity], coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB)], neurological function indicators [Activities of Daily Living (ADL) score. RESULTS The total effective rate of treatment in the control group was 76.47%, while in the observation group, it was 96.08%, with the observation group showing a significantly higher total effective rate than the control group (p < 0.05). Before treatment, there was no significant difference in ACA, MCA, and VA blood flow velocity between the two groups (p > 0.05). However, after treatment, the ACA, MCA, and VA blood flow velocity in the observation group were significantly higher than those in the control group (p < 0.05). Before treatment, there was no significant difference in PT, APTT, TT, and FIB levels between the two groups (p > 0.05). CONCLUSION In patients with acute severe ischemic stroke undergoing intravenous thrombolysis, the addition of Butylphthalide to the treatment regimen yields favorable clinical outcomes. Compared to Alteplase alone, the addition of Butylphthalide further improves cerebral vascular circulation and coagulation function, promoting the recovery and reconstruction of neurological function in patients. Importantly, the addition of Butylphthalide does not increase the risk of adverse reactions, making it a safe and ideal option for clinical application.
Collapse
Affiliation(s)
- Yu Li
- Department of Critical Care Medicine, The People's Hospital of Rongchang District, Chongqing, China
| | - Hui Wang
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
| | - Jiansen Zhao
- Department of Critical Care Medicine, The People's Hospital of Rongchang District, Chongqing, China
| | - Lei Xia
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
| | - Kaiju Xiong
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
| | - Huaping Zhong
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
| |
Collapse
|
4
|
Qi PQ, Zeng YJ, Peng W, Kuai J. Lung imaging characteristics in a patient infected with Elizabethkingia miricola following cerebral hemorrhage surgery: A case report. World J Clin Cases 2024; 12:169-175. [PMID: 38292629 PMCID: PMC10824168 DOI: 10.12998/wjcc.v12.i1.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/12/2023] [Accepted: 12/18/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Elizabethkingia miricola is a non-fermenting gram-negative bacterium, which was first isolated from the condensate of the Russian peace space station in 2003. Most studies on this bacterium have been carried out in the laboratory, and clinical case studies are rare. To date, a total of 6 clinical cases have been reported worldwide. CASE SUMMARY We present the first case of postoperative pulmonary infection in a patient with intracerebral hemorrhage due to Elizabethkingia miricola. The imaging characteristics of pulmonary infection were identified and the formulation and selection of the clinical treatment plan for this patient are discussed. CONCLUSION Elizabethkingia miricola infection is rare. When pulmonary infection occurs, computed tomography imaging may show diffuse distribution of a ground glass density shadow in both lungs, the air containing bronchial sign in local areas, thickening of bronchial vascular bundle, and pleural effusion.
Collapse
Affiliation(s)
- Ping-Qiang Qi
- Department of Neurosurgery, The Third Affiliated Hospital of Chengdu Medical College Pidu District People’s Hospital, Chengdu 611730, Sichuan Province, China
| | - Yi-Jun Zeng
- Department of Neurosurgery, The Third Affiliated Hospital of Chengdu Medical College Pidu District People’s Hospital, Chengdu 611730, Sichuan Province, China
| | - Wei Peng
- Department of Neurosurgery, The Third Affiliated Hospital of Chengdu Medical College Pidu District People’s Hospital, Chengdu 611730, Sichuan Province, China
| | - Juan Kuai
- Department of Neurosurgery, The Third Affiliated Hospital of Chengdu Medical College Pidu District People’s Hospital, Chengdu 611730, Sichuan Province, China
| |
Collapse
|
5
|
Yao L, Zhou Z, Yu T, Wang G, Fan Z, Tang Y. The predictive value of neurally adjusted ventilatory assist indexes for the prognosis of patients with severe cerebral hemorrhage. Eur J Med Res 2024; 29:7. [PMID: 38173023 PMCID: PMC10763000 DOI: 10.1186/s40001-023-01601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study assessed the predictive value of electrical activity of the diaphragm (EAdi) and the EAdi-derived monitoring index in the prognosis of patients with severe cerebral hemorrhage. METHODS Ninety patients with severe cerebral hemorrhage were admitted to the Neurosurgery Intensive Care Unit of Yijishan Hospital from April 2019 to June 2021 and were divided into the good prognosis group (Glasgow Outcome Scale [GOS] ≥ 4) and poor prognosis group (GOS ≤ 3). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate prediction accuracy. RESULTS EAdi, neuro-ventilatory efficiency (NVE), and neuro-muscular efficiency (NME) in patients with good prognosis were significantly higher than those in patients with poor prognosis (4.707 µV vs 2.80 µV, P < 0.001; 141.85 ml/µV vs 66.01 ml/µV, P = 0.000; 2.57 cm H2O/µV vs 1.37 cm H2O/µV, P = 0.000). The area under the ROC curve for the EAdi score was 0.719, with sensitivity of 69.70% and specificity of 68.42% when EAdi was 3.6 µV. The AUC for NVE score was 0.793, with sensitivity of 75.76% and specificity of 75.44% when the NVE value was 95.32 ml/µV. The AUC for NME score was 0.792, with sensitivity of 69.70% and specificity of 78.95% when the NME value was 2.06 H2O/µV. The 6-month survival time of patients with higher EAdi, NVE, and NME was significantly longer than that of patients with lower EAdi, NVE, and NME CONCLUSION: EAdi, NVE, and NME can be used as indices for predicting the prognosis of patients with severe cerebral hemorrhage. TRIAL REGISTRATION NO ChiCTR1900022861. Registered April 28, 2019, http://www.chictr.org.cn .
Collapse
Affiliation(s)
- Lin Yao
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
- The Translational Research Institute for Neurological Disorders of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Zihao Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
- The Translational Research Institute for Neurological Disorders of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Tao Yu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
- The Translational Research Institute for Neurological Disorders of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Guiliang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
| | - Zhen Fan
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
| | - Yun Tang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China.
- The Translational Research Institute for Neurological Disorders of Wannan Medical College, Wuhu, 241001, People's Republic of China.
| |
Collapse
|
6
|
Marsool MDM, Prajjwal P, John J, Keluskar HS, Sivarajan VV, Kundiri KA, Lam JR, Chavda S, Atew HG, Marsool ADM, Hameed AAZ, Hussin OA. Association of multiple sclerosis with stroke: A comprehensive review. Health Sci Rep 2024; 7:e1837. [PMID: 38264155 PMCID: PMC10804671 DOI: 10.1002/hsr2.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/23/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
Background Multiple sclerosis (MS) is a chronic immune-mediated disorder characterized by the degradation of the myelin sheath in the central nervous system. Research indicates that individuals with MS exhibit a higher susceptibility to stroke compared to the general population. This association is rooted in shared underlying mechanisms, specifically involving neuroinflammatory processes. Methodology We performed an extensive search on PubMed, MEDLINE, Embase, Scopus, and Google Scholar using specific terms. The search terms included variations of "multiple sclerosis," "stroke," "cerebrovascular disease," "vascular risk factors," "disease-modifying therapies," and "neuroinflammation." The search was limited to articles published from January 1, 2000, up to 31 May, 2023. Results and Discussion Stroke, a global health burden characterized by significant mortality and adult disability, underscores the critical importance of understanding the link between MS and stroke. Despite a growing body of research establishing an elevated risk of stroke in MS patients, notable information gaps persist. Limited prospective multicenter studies on stroke incidence in MS patients contribute to an incomplete understanding of the precise relationship between these two conditions. Conclusion In conclusion, this review underscores the critical need for a thorough understanding of the complex relationship between MS and stroke. The identified risk factors and the influence of MS DMTs on stroke risk necessitate further investigation to inform evidence-based preventive and therapeutic strategies. Bridging the existing information gaps through prospective multicenter studies is imperative for a comprehensive understanding of this association. The development of targeted diagnostic and therapeutic approaches for acute stroke risk in MS patients is paramount to mitigate the impact of these debilitating conditions. Ultimately, this review serves as a foundation for future efforts to enhance preventative measures and therapeutic interventions, thereby improving the overall quality of life for individuals with MS susceptible to strokes.
Collapse
Affiliation(s)
| | | | - Jobby John
- Internal MedicineDr. Somervell Memorial CSI Medical College and HospitalNeyyāttinkaraIndia
| | | | | | | | - Justin R. Lam
- Internal MedicineCebu Institute of MedicineCebuPhilippines
| | - Sachi Chavda
- Internal MedicineGMERS Medical College SolaAhmedabadIndia
| | - Hundaol G. Atew
- Internal MedicineSt Paul's Millennium Medical CollegeAddis AbabaEthiopia
| | | | | | | |
Collapse
|
7
|
Gazeteci Tekin H, Öztekin Ö. Transient Ischemic Attack (TIA) presenting with isolated anomic aphasia due to ischemia in the posterior cingulate gyrus in a 11-year-old girl. Int J Neurosci 2023:1-5. [PMID: 38095174 DOI: 10.1080/00207454.2023.2295226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Anomic aphasia, characterized by difficulty in word finding, is a subtype without impairments in fluent speech, comprehension, reading, writing, and repetition. Recognizing pure anomic aphasia in this group is crucial for a comprehensive understanding of localization and brain functions. CASE REPORT We present the case of an 11-year-old girl with transient ischemic attack and anomic aphasia. Neuroimaging identified abnormalities in the cingulate gyrus and temporo-occipital regions. No focal neurological findings were observed without aphasia. In terms of etiology, an MTHFR mutation was detected, and aside from this, no hematological or systemic cause could be identified. CONCLUSION This case marks the first demonstration of posterior cingulate gyrus involvement in pure anomic aphasia.
Collapse
Affiliation(s)
- Hande Gazeteci Tekin
- Department of Pediatrics, Division of Pediatric Neurology, İzmir Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Özgür Öztekin
- Department of Radiology Division of Neuroradiology, İzmir Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
8
|
Doskas T, Dardiotis E, Vavougios GD, Ntoskas KT, Sionidou P, Vadikolias K. Stroke risk in multiple sclerosis: a critical appraisal of the literature. Int J Neurosci 2023; 133:1132-1152. [PMID: 35369835 DOI: 10.1080/00207454.2022.2056459] [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: 04/21/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Observational studies suggest that the occurrence of stroke on multiple sclerosis (MS) patients is higher compared to the general population. MS is a heterogeneous disease that involves an interplay of genetic, environmental and immune factors. The occurrence of stroke is subject to a wide range of both modifiable and non-modifiable, short- and long-term risk factors. Both MS and stroke share common risk factors. The immune mechanisms that underlie stroke are similar to neurodegenerative diseases and are attributed to neuroinflammation. The inflammation in autoimmune diseases may, therefore, predispose to an increased risk for stroke or potentiate the effect of conventional stroke risk factors. There are, however, additional determinants that contribute to a higher risk and incidence of stroke in MS. Due to the challenges that are associated with their differential diagnosis, the objective is to present an overview of the factors that may contribute to increased susceptibility or occurrence of stroke in MSpatients by performing a review of the available to date literature. As both MS and stroke can individually detrimentally affect the quality of life of afflicted patients, the identification of factors that contribute to an increased risk for stroke in MS is crucial for the prompt implementation of preventative therapeutic measures to limit the additive burden that stroke imposes.
Collapse
Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | | | | | | |
Collapse
|
9
|
Shin DS, Yeo DK, Choi EJ. Successive development of ischemic malignant strokes in a patient with multiple fusiform aneurysms: A case report. World J Clin Cases 2023; 11:7712-7717. [DOI: 10.12998/wjcc.v11.i31.7712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Intracranial fusiform aneurysms are rare, spindle-shaped, and nonsaccular arterial dilatations that may be caused by dissection.
CASE SUMMARY A 48-year-old man complained of wake-up onset of dysarthria and left-sided weakness. Diffusion-weighted magnetic resonance imaging of the brain revealed an infarction in the territories of the right middle and posterior cerebral arteries. Computed tomography angiography showed fusiform aneurysms in the right vertebral artery and bilateral petrous segments of the internal carotid arteries (ICAs). Despite conservative management, malignant ischemic stroke recurred in the contralateral ICA territory within a day of the onset of the index stroke.
CONCLUSION We report a rare case of successive malignant strokes in a patient with multiple fusiform aneurysms. Herein, we emphasize that clinicians should consider aggressive treatment for patients with ischemic stroke and multiple fusiform aneurysms.
Collapse
Affiliation(s)
- Dae-Seop Shin
- Department of Neurology, Soonchunhyang University Gumi Hospital, Gumi 39371, South Korea
| | - Dong Kyu Yeo
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi 39371, South Korea
| | - Eu Jene Choi
- Department of Neurology, Soonchunhyang University Gumi Hospital, Gumi 39371, South Korea
| |
Collapse
|
10
|
Sarıtaş AŞ, Batum M, Ataç C, Öztürk Ü, Yılmaz H, Mavioğlu H, Selçuki D, Ak AK. Prognostic factors in patients with cerebral sinus venous thrombosis presenting with hemorrhage and papilledema. Clin Neurol Neurosurg 2023; 234:108013. [PMID: 37844432 DOI: 10.1016/j.clineuro.2023.108013] [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: 09/10/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The thromboinflammatory process is considered to play a role in the pathogenesis and prognosis of cerebral sinus vein thrombosis (CSVT). The purpose of the study was to compare the thromboinflammatory parameters between individuals with CSVT and healty controls. Additionally, the study sought to compare these parameters among CSVT subgroups with and without haemorrhage, as well as with and without papilledema. Furthermore, the investigation also aimed to identify which parameters had a more significant impact on the risk of hemorrhage and the development of papilledema in CSVT. METHODS Thromboinflammatory parameters were compared retrospectively between the CSVT group of 88 patients and 80 age- and sex-matched healthy controls, and in the CSVT subgroups with (n = 35) /without hemorrhage (n = 53) and with (n = 52) /without papilledema (n = 36) after ethics committee approval. In both groups, parameters contributing to the risk of hemorrhage and papilledema development were determined by univariate and multivariate analyses. RESULTS Regarding the risk of hemorrhage in CSVT patients, the most significant factors included hematocrit of <30.2 (%), mean platelet volume of ≤8.9 fL, neutrophil count of >5600, and hsCRP of >9 mg/L. Regarding the risk of papilledema development, the most important risk factors were age of ≤49, presence of vomiting, presence of blurred vision, HDL of >47 mg/dL, and D-dimer of >178 ng/mL. CONCLUSION It was suggested that evaluating serum thromboinflammatory parameters, as well as demographic characteristics and neurological examination findings, had a critical role regarding prognosis and predictive factors in CSVT.
Collapse
Affiliation(s)
| | - Melike Batum
- Celal Bayar University Neurology Department Manisa, Turkey
| | - Ceyla Ataç
- Izmir Bozyaka Training and Research Hospital Neurology Department, Turkey
| | - Üzeyir Öztürk
- Celal Bayar University Neurology Department Manisa, Turkey
| | - Hikmet Yılmaz
- Celal Bayar University Neurology Department Manisa, Turkey
| | | | | | | |
Collapse
|
11
|
Xie W, Ma X, Xu G, Wang Y, Huang W, Liu M, Sheng S, Yuan J, Wang J. Development and validation of a nomogram for the risk prediction of malignant cerebral edema after acute large hemispheric infarction involving the anterior circulation. Front Neurol 2023; 14:1221879. [PMID: 37780698 PMCID: PMC10538642 DOI: 10.3389/fneur.2023.1221879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/18/2023] [Indexed: 10/03/2023] Open
Abstract
Background Malignant cerebral edema (MCE) is a life-threatening complication of large hemisphere infarction (LHI). Therefore, a fast, accurate, and convenient tool for predicting MCE can guide triage services and facilitate shared decision-making. In this study, we aimed to develop and validate a nomogram for the early prediction of MCE risk in acute LHI involving the anterior circulation and to understand the potential mechanism of MCE. Methods This retrospective study included 312 consecutive patients with LHI from 1 January 2019 to 28 February 2023. The patients were divided into MCE and non-MCE groups. MCE was defined as an obvious mass effect with ≥5 mm midline shift or basal cistern effacement. Least absolute shrinkage and selection operator (LASSO) and logistic regression were performed to explore the MCE-associated factors, including medical records, laboratory data, computed tomography (CT) scans, and independent clinic risk factors. The independent factors were further incorporated to construct a nomogram for MCE prediction. Results Among the 312 patients with LHI, 120 developed MCE. The following eight factors were independently associated with MCE: Glasgow Coma Scale score (p = 0.007), baseline National Institutes of Health Stroke Scale score (p = 0.006), Alberta Stroke Program Early CT Score (p < 0.001), admission monocyte count (p = 0.004), white blood cell count (p = 0.002), HbA1c level (p < 0.001), history of hypertension (p = 0.027), and history of atrial fibrillation (p = 0.114). These characteristics were further used to establish a nomogram for predicting prognosis. The nomogram achieved an AUC-ROC of 0.89 (95% CI, 0.82-0.96). Conclusion Our nomogram based on LASSO-logistic regression is accurate and useful for the early prediction of MCE after LHI. This model can serve as a precise and practical tool for clinical decision-making in patients with LHI who may require aggressive therapeutic approaches.
Collapse
Affiliation(s)
- Wei Xie
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China
| | - Xiaoming Ma
- North China University of Science and Technology, Tangshan, China
| | - Geman Xu
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China
- Department of Neurology, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China
| | - Yumei Wang
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China
| | - Wendie Huang
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China
| | - Meng Liu
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China
| | - Shiying Sheng
- Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China
| | - Jie Yuan
- Institution of Mental Health, North China University of Science and Technology, Tangshan, China
- Jitang College, North China University of Science and Technology, Tangshan, China
| | - Jing Wang
- Clinical Department, Tangshan Vocational and Technical College, Tangshan, China
- Tangshan Union Medical College Hospital, Tangshan, China
| |
Collapse
|
12
|
Li H, Khan S, Siddique R, Bai Q, Liu Y, Zhang R, Zhang Y, Yong VW, Xue M. Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy. Neurol Res 2023; 45:796-803. [PMID: 34112057 DOI: 10.1080/01616412.2021.1939486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/01/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES This article aimed to analyze the relationship between obesity and the efficacy of acute ischaemic stroke patients treated with IVT. BACKGROUND Stroke causes morbidity and mortality in large numbers of individuals annually. Intravenous thrombolysis (IVT)with recombinant tissue plasminogen activator (r-tPA) is currently the only approved by the FDA for treatment of acute ischaemic stroke. Researchers have focused on studying the mechanisms associated with ischaemic stroke. Obesity is an established vascular risk factor with increasing prevalence and a huge impact on public health worldwide. It is an independent predictor for ischaemic stroke with a 4% risk increase for each unit augmentation in body mass index (BMI). Therefore, obese patients will constitute an increasing subgroup of candidates for IVT. However, its impact on prognosis in acute ischaemic stroke patients with intravenous thrombolysis did not reach a consensus conclusion. METHODS Systematic literature search of PUBMED databases published before August 2020, was performed to identify studies addressing the role of obesity in acute ischaemic stroke patients treated with IVT. Studies included randomized clinical trials, observational studies, guideline statements, and review articles. CONCLUSIONS Obesity may be related to long-term prognosis of large group of AIS patients treated with IVT. It depends on the scale of clinical study samples, follow-up time, and evaluation criteria.
Collapse
Affiliation(s)
- Hongmin Li
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Suliman Khan
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Rabeea Siddique
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Qian Bai
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yang Liu
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Ruiyi Zhang
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yan Zhang
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - V Wee Yong
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mengzhou Xue
- The Departments of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, Henan, China
| |
Collapse
|
13
|
Abbruzzese L, Martinelli G, Salti G, Basagni B, Damora A, Scarselli C, Peppoloni G, Podgorska A, Rosso G, Bacci M, Alfano AR, MANCUSO MAURO. Persistent dysexecutive syndrome after pneumococcal meningitis complicated by recurrent ischemic strokes: A case report. World J Clin Cases 2023; 11:5344-5350. [PMID: 37621577 PMCID: PMC10445069 DOI: 10.12998/wjcc.v11.i22.5344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/09/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Meningitis is a possible complication of pneumococcal infection concerning acute otitis media and sinusitis. It might compromise cognitive function, both for the infection itself and the vascular events that sometimes follow the acute phase. CASE SUMMARY Here we describe the case of a 32-year-old female patient admitted to the emergency room due to extensive pneumococcal meningitis as a consequence of sinus outbreak. She presented with extensive laminar ischemic damage in the acute phase, resulting in severe cognitive and behavioural impairment. Four years of follow-up, through neuropsychological assessments and neuroradiological investigations, demonstrated the presence of subsequent vascular events, 3 months and 2 years after onset. CONCLUSION The case is discussed in light of scientific knowledge of the long-term outcomes of this pathology in order to potentially improve diagnosis and promote better outcomes.
Collapse
Affiliation(s)
- Laura Abbruzzese
- CRT, Tuscany Rehabilitation Clinic, Montevarchi, Arezzo 52025, Italy
| | - Giulia Martinelli
- CRT, Tuscany Rehabilitation Clinic, Montevarchi, Arezzo 52025, Italy
| | - Giulia Salti
- CRT, Tuscany Rehabilitation Clinic, Montevarchi, Arezzo 52025, Italy
| | - Benedetta Basagni
- CRT, Tuscany Rehabilitation Clinic, Montevarchi, Arezzo 52025, Italy
| | - Alessio Damora
- CRT, Tuscany Rehabilitation Clinic, Montevarchi, Arezzo 52025, Italy
| | | | - Giulia Peppoloni
- CRT, Tuscany Rehabilitation Clinic, Montevarchi, Arezzo 52025, Italy
| | - Aleksandra Podgorska
- Physical and Rehabilitative Medicine Unit, NHS ASL-Tuscany South Est, Grosseto 58100, Italy
| | - Giuliana Rosso
- Physical and Rehabilitative Medicine Unit, NHS ASL-Tuscany South Est, Grosseto 58100, Italy
| | - Marco Bacci
- Physical and Rehabilitative Medicine Unit, NHS ASL-Tuscany South Est, Grosseto 58100, Italy
| | - Alba Rosa Alfano
- Department of Internal Medicine and Medical Specialties, UOC Geriatrics, Sapienza University of Rome, Rome 00185, Italy
| | - MAURO MANCUSO
- Physical and Rehabilitative Medicine Unit, NHS ASL-Tuscany South Est, Grosseto 58100, Italy
| |
Collapse
|
14
|
Yang L, Xu X, Wang L, Zeng KB, Wang XF. Edaravone administration and its potential association with a new clinical syndrome in cerebral infarction patients: Three case reports. World J Clin Cases 2023; 11:4648-4654. [PMID: 37469729 PMCID: PMC10353518 DOI: 10.12998/wjcc.v11.i19.4648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/24/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and, in most cases, edaravone-induced side effects are mild. However, edaravone-related adverse reactions have been receiving increasing attention.
CASE SUMMARY We treated three patients with acute cerebral infarction who died following treatment with edaravone. Edaravone is a widely used treatment for patients with cerebral infarction and, in most cases, edaravone-induced side effects are mild. However, edaravone-related adverse reactions have been receiving increasing attention.
CONCLUSION Our cases highlight the importance of educating clinicians regarding the new edaravone-induced clinical syndromes of cerebral infarction as potentially fatal adverse drug reactions. Considering that no laboratory or confirmatory test exists to diagnose edaravone-induced death from cerebral infarction, clinicians’ knowledge is the key element in recognizing this phenomenon.
Collapse
Affiliation(s)
- Liu Yang
- Department of Neurology, Central Hospital Affiliated to Chongqing University, Chongqing 400010, China
| | - Xin Xu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Ke-Bin Zeng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Xue-Feng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| |
Collapse
|
15
|
Huang P. Rare cause of cerebral venous sinus thrombosis: Spontaneous intracranial hypotension syndrome: A case report. World J Clin Cases 2023; 11:4677-4683. [PMID: 37469739 PMCID: PMC10353506 DOI: 10.12998/wjcc.v11.i19.4677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Spontaneous intracranial hypotension syndrome is a relatively uncommon neurological disorder of unknown etiology with a good prognosis. Cerebral venous sinus thrombosis is a specific type of cerebrovascular disease caused by multiple etiologies of cerebral venous sinus or vein thrombosis that obstructs cerebral venous return and is associated with impaired cerebrospinal fluid absorption; this entity is rarely seen clinically. Spontaneous intracranial hypotension syndrome is one of the causes of cerebral venous sinus thrombosis, and the probability of their combined occurrence is only 1%-2%. As such, it is easily overlooked clinically, thus increasing the difficulty of diagnosis and treatment.
CASE SUMMARY A 29-year-old young woman presented with postural headache. Lumbar puncture suggested a pressure of 50 mmH2O (normal 80 mmH2O-180 mmH2O), and magnetic resonance imaging cerebral venography suggested thrombosis of the supratentorial sinus. These findings were considered indicative of cerebral venous sinus thrombosis due to spontaneous intracranial hypotension syndrome after ruling out immunological causes, tumor, infection, abnormal coagulation mechanism, and hypercoagulable state, etc. She was treated with rehydration and low-molecular heparin anticoagulation for 15 d, and follow-up magnetic resonance imaging cerebral venography suggested resolution of the thrombus. The patient had complete improvement of her headache symptoms.
CONCLUSION Spontaneous intracranial hypotension syndrome is one of the rare causes of cerebral venous sinus thrombosis, which is frequently misdiagnosed or missed and deserves consideration by clinicians during differential diagnosis. Dehydration should be avoided in such patients, and early rehydration and anticoagulation therapy are effective treatment options.
Collapse
Affiliation(s)
- Pan Huang
- Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| |
Collapse
|
16
|
Huang K, Ma T, Li Q, Zhou Y, Qin T, Zhong Z, Tang S, Zhang W, Zhong J, Lu S. Genetic Variants of CYP4F2 Associated with Ischemic Stroke Susceptibility in the Han Population from Southern China. Pharmgenomics Pers Med 2023; 16:599-607. [PMID: 37342180 PMCID: PMC10278860 DOI: 10.2147/pgpm.s413632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
Background The pathophysiological mechanism of ischemic stroke is complex. Traditional risk factors cannot fully or only partially explain the occurrence and development of IS. Genetic factors are getting more and more attention. Our study aimed to explore the association between CYP4F2 gene polymorphism and susceptibility to IS. Methods A total of 1322 volunteers were enrolled to perform an association analysis through SNPStats online software. Using FPRP (false-positive report probability) to detect whether the result is a noteworthy finding. The interaction of SNP-SNP in IS risk was assessed by multi-factor dimensionality reduction. Statistical analysis of this study was mainly completed by SPSS 22.0 software. Results Mutant allele "A" (OR = 1.24) and genotype "AA" (OR = 1.49) or "GA" (OR = 1.26) of CYP4F2-rs2108622 are risk genetic factors for IS. Rs2108622 is significantly associated with an increased risk of IS among subjects who are females, aging >60 years old, with BMI ≥24 kg/m2, and smoking or drinking volunteers. CYP4F2-rs3093106 and -rs3093105 are associated with susceptibility to IS among smoking, drinking subjects, or IS patients complicated with hypertension. Conclusion CYP4F2-rs2108622, -rs3093106, and -rs3093105 are associated with an increased risk of IS.
Collapse
Affiliation(s)
- Kang Huang
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Tianyi Ma
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Qiang Li
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Yilei Zhou
- Medical College, Jingchu University of Technology, Jingmen, Hubei, People’s Republic of China
| | - Ting Qin
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Zanrui Zhong
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Shilin Tang
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Wei Zhang
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Jianghua Zhong
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| | - Shijuan Lu
- Department of Cardiovascular Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, People’s Republic of China
| |
Collapse
|
17
|
Hattori Y, Ikeda S, Matsumoto M, Tagawa N, Hatakeyama K, Ihara M. Case Report: Postmortem brain and heart pathology unveiling the pathogenesis of coexisting acute ischemic stroke and electrocardiographic abnormality. Front Cardiovasc Med 2023; 10:1200640. [PMID: 37388637 PMCID: PMC10306394 DOI: 10.3389/fcvm.2023.1200640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Electrocardiography abnormalities have been occasionally reported at the onset of stroke. Simultaneous electrocardiographic abnormalities and stroke require a rapid differentiated diagnosis among several diseases. However, direct causal relationships remain unclear. A 92-year-old woman presented to our emergency department in a sudden-onset coma. The patient suffered from huge acute ischemic stroke with bilateral internal carotid artery occlusion assessed by brain magnetic resonance imaging, and her electrocardiography showed ST-segment elevation at II, III, aVF and V4-6, and atrial fibrillation (AF). However, the etiology of the medical condition was clinically unknown. Eventually, the patient died on day 4 of hospitalization before the diagnosis could be completed. Therefore, an autopsy was performed to investigate pathological findings after obtaining informed consent from the family. A postmortem pathological evaluation demonstrated that fibrin mural thrombi in the left atrial appendage (LAA), and the cerebral and coronary arteries possessed CD31-positive endothelial cells, and CD68-positive and CD168-positive macrophages in a similar fashion, suggesting the fibrin thrombi observed in the three sites implicated to be identical. We concluded that nearly concurrent cerebral and coronary artery embolism because of the fibrin thrombi in LAA developed by AF. Simultaneous cerebral infarction and myocardial infarction are referred to as cardiocerebral infarction (CCI), a rare disorder for which clear pathomechanisms remain unknown, although several mechanisms of CCI have been proposed. We first revealed the clear pathology of CCI using the autopsy. Additional pathological studies are warranted to establish clear pathomechanisms and preventive strategies of CCI.
Collapse
Affiliation(s)
- Yorito Hattori
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shuhei Ikeda
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Manabu Matsumoto
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Tagawa
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| |
Collapse
|
18
|
Giraldo Tapias LM, Arango Guerra P, Lopez Brokate L. Moyamoya syndrome resulting in stroke as a manifestation of paroxysmal nocturnal hemoglobinuria. Neurologia 2023; 38:303-305. [PMID: 37169471 DOI: 10.1016/j.nrleng.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/24/2022] [Indexed: 05/13/2023] Open
Affiliation(s)
| | | | - L Lopez Brokate
- CES University-Instituto Neurológico de Colombia, Medellín, Colombia
| |
Collapse
|
19
|
Sun MY, Bhaskar SMM. Bridging the Gap in Cancer-Related Stroke Management: Update on Therapeutic and Preventive Approaches. Int J Mol Sci 2023; 24:ijms24097981. [PMID: 37175686 PMCID: PMC10178058 DOI: 10.3390/ijms24097981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The underlying aetiopathophysiology of cancer-related strokes and thromboembolisms differs from that of noncancer-related strokes, which makes treating cancer-related strokes and thromboembolisms a distinct clinical challenge. This necessitates the development of novel, individualised diagnostic and treatment strategies. However, limited guidelines are available for the management of cancer-related strokes and the prevention of acute strokes or other thromboembolic events in this patient population. In this article, we present an updated overview of the therapeutic and preventive strategies for strokes in cancer settings. These strategies include acute reperfusion therapy, anticoagulant therapy, antiplatelet therapy, and lifestyle management options. We also outline comprehensive pathways and highlight gaps in the evidence-based clinical management of cancer-related strokes or thromboembolisms. Additionally, future recommendations for the management of strokes in cancer patients are provided.
Collapse
Affiliation(s)
- Ming-Yee Sun
- Global Health Neurology Lab, Sydney, NSW 2000, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South Western Sydney Clinical Campuses, Sydney, NSW 2170, Australia
| | - Sonu M M Bhaskar
- Global Health Neurology Lab, Sydney, NSW 2000, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South West Sydney Local Health District (SWSLHD), Liverpool, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| |
Collapse
|
20
|
Mechanical Thrombectomy in Acute Ischemic Stroke COVID-19 and Non-COVID-19 Patients: A Single Comprehensive Stroke Center Study. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010186. [PMID: 36676134 PMCID: PMC9866657 DOI: 10.3390/life13010186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/01/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Coronavirus disease 2019 (COVID-19) increases the risk for thromboembolic events, such as acute ischemic stroke (AIS). Mechanical thrombectomy (MT) is a therapy of choice in early diagnosed AIS; however, its success and outcomes in COVID-19 patients are contradictory. This study presented our experience with MT performed in COVID-19 patients compared to a control group. The retrospective analysis included patients with AIS who underwent MT from April 2021 to April 2022 at our institution. There were 13 COVID-19-related patients (with active or past COVID-19 infection) and 55 non-COVID-19 patients (negative COVID-19 status). We analyzed patients' baseline clinical and laboratory data, modified Thrombolysis in Cerebral Infarction (mTICI) scale, used 24 h follow-up CT findings, and modified the Rankin scale. The COVID-19 group had higher values of leukocytes, neutrophils, neutrophil/leukocyte ratios, ASL, ALT, LDH and CRP, and lower values of lymphocytes compared to the control group. The AIS mostly occurred in posterior circulation in the COVID-19 group, while anterior circulation was more affected in the control group. Treatment approach and successful reperfusion did not differ between groups. In conclusion, although differences in some clinical and laboratory parameters between COVID-19 and non-COVID-19 groups were found, the outcomes of mechanical thrombectomy were equal.
Collapse
|
21
|
Torrisi F, Stella G, Guarino FM, Bucolo M. Cell counting and velocity algorithms for hydrodynamic study of unsteady biological flows in micro-channels. BIOMICROFLUIDICS 2023; 17:014105. [PMID: 36714795 PMCID: PMC9878589 DOI: 10.1063/5.0138587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 05/20/2023]
Abstract
In this paper, the combination of two algorithms, a cell counting algorithm and a velocity algorithm based on a Digital Particle Image Velocimetry (DPIV) method, is presented to study the collective behavior of micro-particles in response to hydrodynamic stimuli. A wide experimental campaign was conducted using micro-particles of different natures and diameters (from 5 to 16 μ m ), such as living cells and silica beads. The biological fluids were injected at the inlet of a micro-channel with an external oscillating flow, and the process was monitored in an investigated area, simultaneously, through a CCD camera and a photo-detector. The proposed data analysis procedure is based on the DPIV-based algorithm to extrapolate the micro-particles velocities and a custom counting algorithm to obtain the instantaneous micro-particles number. The counting algorithm was easily integrated with the DPIV-based algorithm, to automatically run the analysis to different videos and to post-process the results in time and frequency domain. The performed experiments highlight the difference in the micro-particles hydrodynamic responses to external stimuli and the possibility to associate them with the micro-particles physical properties. Furthermore, in order to overcome the hardware and software requirements for the development of a real-time approach, it was also investigated the possibility to detect the flows by photo-detector signals as an alternative to camera acquisition. The photo-detector signals were compared with the velocity trends as a proof of concept for further simplification and speed-up of the data acquisition and analysis. The algorithm flexibility underlines the potential of the proposed methodology to be suitable for real-time detection in embedded systems.
Collapse
Affiliation(s)
- Federica Torrisi
- Department of Electrical, Electronic and Computer Engineering, University of Catania, 95125 Catania, Italy
| | - Giovanna Stella
- Department of Electrical, Electronic and Computer Engineering, University of Catania, 95125 Catania, Italy
| | - Francesca M. Guarino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy
| | - Maide Bucolo
- Department of Electrical, Electronic and Computer Engineering, University of Catania, 95125 Catania, Italy
| |
Collapse
|
22
|
Caproni S, Riva A, Barresi G, Costanti D, Costantini F, Galletti F, Di Schino C, Appolloni E, Muti M, Colosimo C. Predictors of Carotid Atherosclerosis Progression: Evidence from an Ultrasonography Laboratory. Brain Sci 2022; 12:brainsci12121600. [PMID: 36552060 PMCID: PMC9775088 DOI: 10.3390/brainsci12121600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to investigate the role of risk factors in predicting the variation in carotid atherosclerosis at ultrasonographic follow-up and, therefore, its role in the progression of large-vessel disease. METHODS This retrospective population study included all the outpatients that underwent at least two carotid ultrasonographies at our laboratory from 2001 to 2017. Demographic data, vascular risk factors, and the results at follow-up were analysed to determine if correlations exist between these risk factors and variation in carotid atherosclerosis. RESULTS Data from 600 patients (327 males and 273 females with a mean age of 67 years) were collected. The mean follow-up period was 49 months (range: 1-195). We analysed each demographic variable and risk factor to assess its correlation with a worsening of carotid atherosclerosis; previous myocardial infarction (2.594), previous carotid surgical treatment (2.368), and hypertension (1.85) were found to have the highest odds ratios, respectively. Furthermore, the sample was divided into specific subpopulations (diabetes, hypertension, and smoking), and an association was found between age and worsening stenosis. DISCUSSION AND CONCLUSIONS Our results confirm the importance of carotid ultrasonographic follow-up in the monitoring and managing of large-vessel disease. Myocardial infarction, previous stroke, and previous surgical treatment were the strongest predictors of a worsening of carotid atherosclerosis. These findings suggest a strict follow-up is needed, even in the absence of significant carotid atherosclerosis at baseline.
Collapse
Affiliation(s)
- Stefano Caproni
- Neurology and Stroke Unit, Neuroscience Department, “S. Maria” University Hospital, 05100 Terni, Italy
| | - Alice Riva
- Neurology, Medicine Department, Università Politecnica delle Marche, 06126 Ancona, Italy
| | | | - Danilo Costanti
- Neurology and Stroke Unit, Neuroscience Department, “S. Maria” University Hospital, 05100 Terni, Italy
| | - Franco Costantini
- Neurology and Stroke Unit, Neuroscience Department, “S. Maria” University Hospital, 05100 Terni, Italy
| | - Francesca Galletti
- Neurology and Stroke Unit, Neuroscience Department, “S. Maria” University Hospital, 05100 Terni, Italy
| | - Chiara Di Schino
- Neurology and Stroke Unit, Neuroscience Department, “S. Maria” University Hospital, 05100 Terni, Italy
| | | | - Marco Muti
- Health Physics, Oncology Department, “S. Maria” University Hospital, 05100 Terni, Italy
| | - Carlo Colosimo
- Neurology and Stroke Unit, Neuroscience Department, “S. Maria” University Hospital, 05100 Terni, Italy
- Correspondence:
| |
Collapse
|
23
|
Yang P, Rong X, Wang T, Gong X, Yu C, Xu B, Xing X. Effect of Cluster Nursing on Recovery Effect and Hospitalization Time of Patients with Acute Cerebral Infarction After Thrombectomy. J Multidiscip Healthc 2022; 15:2503-2510. [PMID: 36349245 PMCID: PMC9637334 DOI: 10.2147/jmdh.s378509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/23/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To explore the effects of cluster nursing on self-care ability, length of hospital stay, complications and neurological function of patients with mechanical thrombectomy of large vessel occlusion in acute cerebral infarction. METHODS A total of 83 patients with acute cerebral infarction who underwent thrombolectomy in a tertiary hospital in Anhui Province from June 2019 to March 2021 were randomly divided into observation group and control group. The observation group was treated with cluster nursing intervention mode, and the control group was treated with routine nursing mode. Barthel index scores and National Institute of Health Stroke Scale (NIHSS) scores were compared between the two groups at admission and at 1 week, 1 month and 3 months of nursing intervention. The length of stay and incidence of complications were compared between the two groups. RESULTS There was no significant difference in baseline data, Barthel index and NIHSS score between the two groups at admission (P>0.05). The Barthel index at 1 week, 1 month and 3 months after operation in the observation group was significantly higher than that in the control group (P<0.05), while the NIHSS score, incidence of complications and length of hospital stay were significantly lower than those of the control group (P<0.05). CONCLUSION Cluster nursing can improve the neurological function, improve the self-care ability, reduce the incidence of complications, shorten the hospitalization period, improve the prognosis and promote the recovery of patients with acute cerebral infarction thrombolysis.
Collapse
Affiliation(s)
- Peixiang Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China
| | - Xiangxia Rong
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China,Correspondence: Xiangxia Rong, Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China, Email
| | - Tao Wang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China
| | - Xiuqun Gong
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China
| | - Chuanqing Yu
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China
| | - Bu Xu
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China
| | - Xiaoli Xing
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, Anhui, People’s Republic of China
| |
Collapse
|
24
|
Zhang W, Xing W, Zhong G, He J. Acute cerebral infarction of posterior circulation in a patient with vertebral artery fenestration deformity: A case report. Heliyon 2022; 8:e11210. [PMID: 36325143 PMCID: PMC9618973 DOI: 10.1016/j.heliyon.2022.e11210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 09/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Cerebrovascular fenestration malformation is a rare congenital vascular variation. Cerebrovascular fenestration malformation rarely directly leads to cerebral infarction, and the mechanism of cerebral infarction is not clear. Cases of young patients with vertebral artery fenestration malformation who suffered from acute cerebral infarction of posterior circulation are rare and have not been reported widely. Patient concerns A 36-year-old male patient, who had been in good health and without a family history of stroke, was admitted to our hospital with a 6-h history of dizziness and unstable walking. Diagnosis Brain MR examination showed multiple irregular high signal lesions in the left thalamus, left occipital lobe and left cerebellum. Brain MR enhancement examination confirmed multiple cerebral infarction in left thalamus, left occipital lobe and left cerebellum. CT angiography of head and neck showed fenestration deformity of V2–V3 segment of left vertebral artery. Interventions Considering that the patient was suffering from acute cerebral infarction of posterior circulation, he was treated with antiplatelet, lipid-lowering and plaque stabilization, etc. Outcomes After receiving our treatment, the patient's symptoms were relieved. At 3 and 6 months after discharge, there was no dizziness, unstable walking, no acute cerebral infarction, which meant that the patient recovered well. Conclusion In the absence of traditional risk factors and other evidence of cryptogenic stroke, the cerebral infarction in the blood supply area of fenestration malformation should be considered to be related to fenestration malformation, but its pathogenesis is not clear. Antiplatelet therapy, lipid-lowering and plaque stabilization, etc. are effective in prevention of new infarction for such patients.
Collapse
|
25
|
Carrillo-Loza K, Baranchuk A, Serrano F, Hasseb S, Espinosa Lira F, Soriano E, Arauz A. Advanced interatrial block predicts recurrence of embolic stroke of undetermined source. Neurologia 2022; 37:647-652. [PMID: 31899017 DOI: 10.1016/j.nrl.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/19/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Advanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS). METHODS 104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram. Electrocardiogram findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable. RESULTS Median age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P < .001; OR = 10.86; 95% CI, 3.07-38.46), male sex (P = .028; OR = 4.6; 95% CI, 1.18-17.96), and age older than 50 years (P = .039; OR = 3.84; 95% CI, 1.06-13.88). In the Cox proportional hazards model, the risk variables identified were age older than 50 years (P = .002; hazard ratio, 7.04; 95% CI, 2.06-23.8) and P-wave duration (per ms) (P = .007; hazard ratio, 1.02; 95% CI, 1.01-1.04). CONCLUSIONS Advanced IAB and age older than 50 years predict ESUS recurrence.
Collapse
Affiliation(s)
- K Carrillo-Loza
- Servicio de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - A Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canadá
| | - F Serrano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - S Hasseb
- Division of Cardiology, Queen's University, Kingston, Ontario, Canadá
| | - F Espinosa Lira
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - E Soriano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - A Arauz
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.
| |
Collapse
|
26
|
Clinical characteristics and prognostic factors in intracranial hemorrhage patients with hematological diseases. Ann Hematol 2022; 101:2617-2625. [PMID: 36178488 DOI: 10.1007/s00277-022-04982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022]
Abstract
The clinical characteristics and prognosis of intracranial hemorrhage (ICH) in patients with hematological diseases remain controversial. This study aimed to describe the clinical characteristics and explore the prognostic factors in such patients. A total of 238 ICH patients with a hematological disease were recruited from the Institute of Hematology and Blood Diseases Hospital, China, from January 2015 to April 2020. The Cox proportional hazards model was used to identify the prognostic factors for 30-day mortality in ICH patients with a hematological disease. There were 123 cases of acute leukemia (AL), 20 of myelodysplasia/myeloproliferative neoplasm, 35 of aplastic anemia (AA), 29 of immune thrombocytopenia (ITP), 19 of congenital/acquired coagulation factor deficiency, and 12 of other hematological diseases. Furthermore, 121 patients presented with a multi-site hemorrhage (MSH), 58 with a single-site hemorrhage in the brain parenchyma (PCH), 23 with a subarachnoid hemorrhage, 33 with a subdural hemorrhage (SH), and three with an epidural hemorrhage. The Cox proportional hazards model indicated association of SH (vs PCH, hazard ratio [HR]: 0.230; 95% confidence interval [CI]: 0.053-0.996; P = 0.049), low white blood cells (≤ 100 × 109/L vs > 100 × 109/L, HR: 0.56; 95% CI: 0.348-0.910; P = 0.019), AA (vs AL, HR: 0.408; 95% CI: 0.203-0.821; P = 0.012), and ITP (vs AL, HR: 0.197; 95% CI: 0.061-0.640; P = 0.007) with improved 30-day mortality. However, increased age (HR: 1.012; 95% CI: 1.001-1.022; P = 0.034), MSH (vs PCH, HR: 1.891; 95% CI: 1.147-3.117; P = 0.012), and a disturbance of consciousness (HR: 1.989; 95% CI: 1.269-3.117; P = 0.003) were associated with increased risk of 30-day mortality. In conclusion, in this study, we revealed the clinical characteristics of Chinese ICH patients with a hematological disease. Moreover, we identified risk factors (age, white blood cells, AA, ITP, SH, MSH, and a disturbance of consciousness) that may influence 30-day mortality.
Collapse
|
27
|
Xu YT, Yin QQ, Guo ZR. Common carotid artery thrombosis and malignant middle cerebral artery infarction following ovarian hyperstimulation syndrome: A case report. World J Clin Cases 2022; 10:9478-9483. [PMID: 36159413 PMCID: PMC9477690 DOI: 10.12998/wjcc.v10.i26.9478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Arterial thrombosis is a serious and rare complication of ovarian hyperstimulation syndrome (OHSS). Herein, we describe a case of OHSS complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction after egg retrieval and before embryo transfer.
CASE SUMMARY A 32-year-old female with a family history of thrombosis who was undergoing in vitro fertilization due to unexplained infertility, was admitted due to abdominal distension for 3 d and coma for 2 h. She received egg retrieval 7 d ago and embryo transfer had not yet been performed. Blood biochemical analysis showed estrogen of 15781 pmol/L. Gynecological examination showed palpable masses on both sides of the adnexal areas. Ultrasound observed enlarged ovaries and abdominal ascites. Imaging examination of the head and neck revealed fresh malignant middle cerebral artery infarction in the left side of brain and internal carotid artery as well as occlusion in the left carotid artery, internal carotid artery, and middle cerebral artery. The patient was finally diagnosed with severe OHSS, complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction. Liquid replacement, anticoagulation, vascular endothelium protection, brain protection and decompressive craniectomy were carried out. Rehabilitation training was then performed for 6 mo. At present, she has poor speaking ability and decreased muscle strength on the right side.
CONCLUSION There is a risk of thrombosis during any period of OHSS. During in vitro assisted reproduction, for cases with a family history of thrombosis, hyperlipidemia and other high-risk factors, serum lipid levels should be controlled as soon as possible to improve metabolic dysfunction. When thrombosis occurs, timely and effective treatment should be performed to improve the prognosis.
Collapse
Affiliation(s)
- Yan-Ting Xu
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai 264400, Shandong Province, China
| | - Qian-Qian Yin
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai 264400, Shandong Province, China
| | - Zhao-Rong Guo
- Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai 264400, Shandong Province, China
| |
Collapse
|
28
|
Pawluk H, Kołodziejska R, Grześk G, Kozakiewicz M, Woźniak A, Pawluk M, Kosinska A, Grześk M, Wojtasik J, Kozera G. Selected Mediators of Inflammation in Patients with Acute Ischemic Stroke. Int J Mol Sci 2022; 23:ijms231810614. [PMID: 36142524 PMCID: PMC9500922 DOI: 10.3390/ijms231810614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
During a stroke, a series of biochemical and metabolic changes occur which eventually lead to the death of cells by necrosis or apoptosis. This is a multi-stage process involving oxidative stress and an inflammatory response from the first signs of occlusion of a blood vessel until the late stages of regeneration and healing of ischemic tissues. The purpose of the research was to assess the concentration of pro-inflammatory cytokines IL-6 and TNF-α in the blood serum of patients with ischemic stroke (AIS) and to investigate their role as new markers in predicting functional prognosis after thrombolytic therapy. The researches have shown that the concentrations of the measured biomarkers were higher compared to the control group. Serum levels of IL-6 and THF-α before the initiation of intravenous thrombolysis were lower in the subgroup of patients with a favourable functional result (mRS: 0−2 pts) compared to the group of patients with an unfavourable functional result (mRS: 3−6 pts). A positive correlation was found between the concentration of IL-6 and TNF-α in patients with AIS during <4.5 h and on one day after the onset of stroke, which means that the concentration of IL-6 increases with the increase in TNF-α concentration. It has also been shown that higher levels of IL-6 in the acute phase of stroke and on the first and seventh days, and TNF-α during onset, were associated with poorer early and late prognosis in patients treated with intravenous thrombolysis. A relationship was found between the level of IL-6 and TNF-α in the subacute AIS and the severity of the neurological deficit. It has been shown that the investigated biomarkers may be a prognostic factor in the treatment of thrombolytic AIS.
Collapse
Affiliation(s)
- Hanna Pawluk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
- Correspondence: (H.P.); (R.K.)
| | - Renata Kołodziejska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
- Correspondence: (H.P.); (R.K.)
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Mariusz Kozakiewicz
- Division of Biochemistry and Biogerontology, Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Dębowa 3, 85-626 Bydgoszcz, Poland
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
| | - Mateusz Pawluk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
| | - Agnieszka Kosinska
- Centre for Languages & International Education, University College London, 26 Bedford Way, London WC1H 0AP, UK
| | - Magdalena Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Jakub Wojtasik
- Statistical Analysis Centre, Nicolaus Copernicus University in Toruń, Chopin 12/18, 87-100 Toruń, Poland
| | - Grzegorz Kozera
- Medical Stimulation Centre, Medical University of Gdańsk, Dębowa 25, 80-204 Gdańsk, Poland
| |
Collapse
|
29
|
Wen H, Wang N, Hou R. Correlation analysis between D-dimer-to-fibrinogen-ratio and carotid plaque in young patients aged 18-45 with acute cerebral infarction. Clin Neurol Neurosurg 2022; 222:107427. [PMID: 36108464 DOI: 10.1016/j.clineuro.2022.107427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND D-Dimer and fibrinogen were commonly used to detect the coagulation and fibrinolytic function, but D-dimer to fibrinogen ratio (DFR) in carotid plaque in young patients aged 18-45 with acute cerebral infarction (ACI) has not been used clinically. In this work, we focused on the evaluation of the DFR value of this group of patients and analyzed its possible correlation. METHODS A total of 164 patients with ACI patients aged 18-45 were selected as research subjects after their first admission. They had undergone carotid plaque contrast-enhanced ultrasound (CEUS) and were divided into two groups with carotid plaque (n = 97) and with no carotid plaque (n = 67). According to NIHSS score and carotid plaque grade, the clinical symptoms of patients were judged. Univariate and multivariate analyses were conducted to compare the risk factors of carotid plaque in ACI patients. RESULTS The DFR value of patients in the carotid plaque group (103.41 ± 20.81) was significantly higher than that of the no carotid plaque control group (88.9 ± 26.51). We also identified DFR X103 was the only independent risk factor (β = 0.53; 95% CI, 0.914-0.984; P = 0.05). DFR X103 was increased with the severity of the disorder and with the CEUS grades. The area under the DFR curve was 0.673 (95% CI 0.584~0.762). CONCLUSION The value of the DFR is positively correlated with CEUS carotid plaque grading and NIHSS score, which can predict the severity of carotid plaque in ACI patients aged 18-45. Therefore it is worthy of clinical application.
Collapse
Affiliation(s)
- Huijun Wen
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, PR China
| | - Ning Wang
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, PR China
| | - Ruihua Hou
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, PR China.
| |
Collapse
|
30
|
Isolated Central Nervous System Vasculitides in COVID-19: A Systematic Review of Case Reports and Series. REPORTS 2022. [DOI: 10.3390/reports5030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cerebral vasculitides, both isolated or in systemic disorders, could be triggered by infections, and few cases have been associated to coronavirus disease 2019 (COVID-19). This study searched for publications in Pubmed, EMBASE, and Cochrane library databases for case reports and series of isolated central nervous system (CNS) vasculitides triggered by severe acute respiratory syndrome coronavirus-2. We included 12 studies (published from June 2020 to July 2022) and collected 39 adult patients (5/39 pathologically or radiologically proven, 34/39 suggestive for primary CNS vasculitis or PCNSV). All cases had a positive real-time polymerase chain reaction on a nasopharyngeal swab or a respiratory tract specimen. About the 85% of the included cases were males, and disease onset occurred later than 50 years old in all but three subjects. In total, 33/39 patients presented severe COVID-19 pneumonia, frequently requiring intensive care unit care. The most common neurological features were headache, obnubilation, and coma. PCNSV was suspected mainly on radiological findings, whereas the cerebrospinal fluid analysis was minimally altered. Magnetic resonance imaging showed vessel wall enhancement in 32/39 cases, generally with the concomitant presence of microbleeds, subarachnoid haemorrhages, and/or multiple ischemic lesions. Despite the severe respiratory and neurological disease course, most cases (93%) improved spontaneously or after a course of high-dose intravenous steroids with no need for immunosuppression. In conclusion, PCNSV could rarely relate to COVID-19 and independently from pulmonary disease severity. Adults with COVID-19-related PCNSV could have a favourable prognosis.
Collapse
|
31
|
Wang R, Wang Z, Jiang L, Gu G, Zheng B, Xian L, Zhang Y, Wang J. High Actin Expression in Thrombus of Acute Ischemic Stroke Can Be a Biomarker of Atherothrombotic Origin Stroke. Front Neurol 2022; 13:896428. [PMID: 35937070 PMCID: PMC9355373 DOI: 10.3389/fneur.2022.896428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background As the treatment target, the imaging information and histologic characteristics of the thrombus may differ according to the stroke subtype. This study aimed to provide the correlative study of stroke etiology with the non-contrast CT, and histological composition of retrieved clots in acute ischemic stroke (AIS). Materials and Methods A total of 94 patients with AIS who underwent the endovascular treatment with successfully retrieved clots from January 2017 to October 2020 were enrolled in the present study. Histological analysis was performed using hematoxylin and eosin (H&E) staining and immunostaining with CD3, CD20, CD105, and actin antibodies. CT obtained at the patients' admission was to measure the attenuation and volume of all thrombus. Results A total of 94 subjects were included in this study. Fifty-six patients were classified as cardioembolic (CE), and 38 were classified with large-artery atherosclerosis (LAA). The subjects with LAA tend to exhibit higher actin and CD105 levels, and lower Hounsfield Unit (HU) values than subjects with CE. After adjusting for confounders, the actin was positively correlated with CD105 but not with HU values. Logistics regression shows actin was valuable for the prediction of LAA (OR, 1.148; 95% CI, 1.075–1.227; p < 0.001), even adjusted for age, sex, and intervention type (OR, 1.129; 95% CI, 1.048–1.216; p = 0.001), CT density and CD105 (OR, 1.161; 95% CI, 1.056–1.277; p = 0.002). Actin levels have a strong accuracy in differentiating LAA from CE, especially combined with CT density and CD105, which yielded a sensitivity of 63.2%, a specificity of 89.3%, with the area under the curve (AUC) at 0.821 (95% CI, 0.731–0.912). Conclusion Our findings suggest that actin's level was a major factor differentiating atherothrombotic origin strokes from the cardioembolic stroke. Clinical Trial Registration ChiCTR2100051173.
Collapse
Affiliation(s)
- Rongyu Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhiqiang Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Neurology, Chengdu BOE Hospital, Chengdu, China
| | - Lianyan Jiang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Gangfeng Gu
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Bo Zheng
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Liulin Xian
- Acupuncture and Tuina College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yaodan Zhang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Wang
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
- *Correspondence: Jian Wang
| |
Collapse
|
32
|
Jeon JP, Han SW, Kim TY, Lim SH, Youn DH, Rhim JK, Park JJ, Ahn JH, Kim HC, Yang J. Association of Haptoglobin Phenotypes with Outcomes in Patients with Spontaneous Intracerebral Hemorrhage. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071001. [PMID: 35888091 PMCID: PMC9318044 DOI: 10.3390/life12071001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
Object. We aimed to investigate the association of Haptoglobin (Hp) phenotypes with perihematomal edema (PHE) and neurological outcomes after intracerebral hemorrhage (ICH). Methods. This prospective multicenter study enrolled patients that suffered ICH from March 2017 to February 2020. Hp phenotypes were determined using Western blotting; relative α1 intensity was calculated in patients with Hp2-1. A multivariable logistic regression analysis was then conducted to identify risk factors for increased relative PHE at 96 h and 3-month poor outcomes. Results. In total, 120 patients were ultimately enrolled: Hp1-1 (n = 15, 12.5%); Hp2-1 (n = 51, 42.5%); and Hp2-2 (n = 54, 45.0%). Hp phenotype was significantly associated with PHE (p = 0.028). With Hp1-1 as a reference value, Hp2-2 significantly increased the likelihood of increased rPHE (OR = 6.294, 95% CI: 1.283–30.881), while Hp2-1 did not (OR = 2.843, 95% CI: 0.566–14.284). Poor outcomes were found to be closely associated with hematoma volume at admission (OR = 1.057, 95% CI: 1.015–1.101) and surgical treatment (OR = 5.340, 95% CI: 1.665–17.122) but not Hp phenotypes (p = 0.190). Further, a high level of relative α1 intensity was identified to be significantly associated with decreased rPHE (OR = 0.020, 95% CI: 0.001–0.358). However, the relative α1 intensity was not associated with poor outcomes (OR = 0.057, 95% CI: 0.001–11.790). Conclusions: ICH patients with Hp2-2 exhibited a higher likelihood of increased rPHE than those with Hp1-1. Higher relative α1 intensities were identified to be closely associated with rPHE in patients with Hp2-1.
Collapse
Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24253, Korea;
| | - Sung Woo Han
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Tae Yeon Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Seung Hyuk Lim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Dong Hyuk Youn
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju 63243, Korea;
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul 05030, Korea;
| | - Jun Hyong Ahn
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon 24289, Korea;
| | - Heung Cheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon 24253, Korea;
| | - Jinseo Yang
- Department of Neurology, Konkuk University Medical Center, Seoul 05030, Korea;
- Correspondence:
| |
Collapse
|
33
|
Jin A, Wang M, Chen W, Yan H, Xiang X, Pan Y. Differential Effects of Genetically Determined Cholesterol Efflux Capacity on Coronary Artery Disease and Ischemic Stroke. Front Cardiovasc Med 2022; 9:891148. [PMID: 35859596 PMCID: PMC9289203 DOI: 10.3389/fcvm.2022.891148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Observational studies indicated that cholesterol efflux capacity (CEC) of high-density lipoprotein (HDL) is inversely associated with cardiovascular events, independently of the HDL cholesterol concentration. The aim of the study is to examine the casual relevance of CEC for coronary artery disease (CAD) and myocardial infarction (MI), and compare it with that for ischemic stroke and its subtypes using a Mendelian randomization approach. Methods We performed a 2-sample Mendelian randomization to estimate the casual relationship of CEC with the risk of CAD, MI, and ischemic stroke. A CEC-related genetic variant (rs141622900) and other five genetic variants were used as the instrumental variables. Association of genetic variants with CAD were estimated in a GWAS involving 60,801 CAD cases and 123,504 controls. They were then compared with the associations of these variants with ischemic stroke and its subtypes (large vessel, small vessel, and cardioembolic) involving 40,585 ischemic stroke cases and 406,111 controls. Results Using the SNP of rs141622900 as the instrument, a 1-SD increase in CEC was associated with 45% lower risk for CAD (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.44–0.69, p < 0.001) and 33% lower risk for MI (odds ratio [OR] 0.67, 95% CI 0.52–0.87, p = 0.002). By contrast, the causal effect of CEC was much weaker for ischemic stroke (odds ratio [OR] 0.79, 95% CI 0.64–0.97, p = 0.02; p for heterogeneity = 0.03) and, in particular, for cardioembolic stroke (p for heterogeneity = 0.006) when compared with that for CAD. Results using five genetic variants as the instrument also indicated consistently weaker effects on ischemic stroke than on CAD. Conclusion Genetic predicted higher CEC may be associated with decreased risk of CAD. However, the casual association of CEC with ischemic stroke and specific subtypes would need to be validated in further Mendelian randomization studies.
Collapse
Affiliation(s)
- Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianglong Xiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yuesong Pan
| |
Collapse
|
34
|
Giraldo Tapias L, Arango Guerra P, Lopez Brokate L. Moyamoya syndrome resulting in stroke as a manifestation of paroxysmal nocturnal hemoglobinuria. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
35
|
Neuroprotection in Stroke-Focus on the Renin-Angiotensin System: A Systematic Review. Int J Mol Sci 2022; 23:ijms23073876. [PMID: 35409237 PMCID: PMC8998496 DOI: 10.3390/ijms23073876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 01/01/2023] Open
Abstract
Stroke is the primary cause of disability in the adult population. Hypertension represents the leading risk factor being present in almost half the patients. The renin-angiotensin system is involved in the physiopathology of stroke and has an essential impact on hypertension as a risk factor. This article targeted the role of the renin-angiotensin system in stroke neuroprotection by reviewing the current literature available. The mechanism of action of the renin-angiotensin system was observed through the effects on AT1, AT2, and Mas receptors. The neuroprotective properties ascertained by angiotensin in stroke seem to be independent of the blood pressure reduction mechanism, and include neuroregeneration, angiogenesis, and increased neuronal resistance to hypoxia. The future relationship of stroke and the renin-angiotensin system is full of possibilities, as new agonist molecules emerge as potential candidates to restrict the impairment caused by stroke.
Collapse
|
36
|
Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063368. [PMID: 35329054 PMCID: PMC8948762 DOI: 10.3390/ijerph19063368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention.
Collapse
|
37
|
Arnăutu SF, Morariu VI, Arnăutu DA, Tomescu MC, Dan TF, Dragos Jianu C. Left Atrial Strain Helps Identifying the Cardioembolic Risk in Transient Ischemic Attacks Patients with Silent Paroxysmal Atrial Fibrillation. Ther Clin Risk Manag 2022; 18:213-222. [PMID: 35299625 PMCID: PMC8922319 DOI: 10.2147/tcrm.s359490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Patients with transient ischemic attacks often present asymptomatic and paroxysmal atrial fibrillation. Since atrial fibrillation initiates in the atria, we aimed to identify whether the abnormalities in left atrial structure and function could identify the cardioembolic etiology of the transient ischemic attacks in patients at sinus rhythm. Patients and Methods A total of 190 patients over 50 years old with sinus rhythm discharged after a transient ischemic attack were included in the study and divided into two groups according to the presence (group I) or absence (group II) of documented paroxysmal atrial fibrillation. The documentation of paroxysmal atrial fibrillation was based on the examination of medical registers. Cardiac ultrasound assessment was performed at a minimum of 14 days after the onset of the transient ischemic attack, to avoid assessment of atrial stunning. Results The group I patients were older, more frequent women, with a history of stroke or transient ischemic attack and a higher CHA2DS2-VASc score. They also presented larger left atrial volumes, lower left atrial emptying fraction, and significantly impaired left atrial deformation patterns. Multivariate logistic regression identified three variables that were independently associated with paroxysmal atrial fibrillation: age, left atrial reservoir strain, and left atrial emptying fraction (P < 0.0001). The cut-off levels for the variables were age > 55 years, reservoir strain < −17%, and emptying fraction < 51%. Conclusion The present study demonstrates that the LA strain is independently associated with paroxysmal atrial fibrillation in transient ischemic attack patients and might be of great help in identifying their cardioembolic etiology and preventing subsequent strokes by the initiation of anticoagulant therapy.
Collapse
Affiliation(s)
- Sergiu Florin Arnăutu
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
| | - Vlad Ioan Morariu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Diana Aurora Arnăutu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
- Correspondence: Diana Aurora Arnăutu; Mirela Cleopatra Tomescu, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, Timisoara, 300041, Romania, Tel +40 734600550; +40722979516, Fax +40 256220636, Email ;
| | - Mirela Cleopatra Tomescu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Traian Flavius Dan
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
| | - Cătălin Dragos Jianu
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
| |
Collapse
|
38
|
Red Blood Cell Morphodynamics in Patients with Polycythemia Vera and Stroke. Int J Mol Sci 2022; 23:ijms23042247. [PMID: 35216363 PMCID: PMC8880197 DOI: 10.3390/ijms23042247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Polycythemia vera (PV) is a Ph-negative myeloproliferative neoplasm (MPN) which is characterized by erythrocytosis and a high incidence of thrombotic complications, including stroke. The study aimed to evaluate red blood cell (RBC) morphodynamic properties in PV patients and their possible association with stroke. We enrolled 48 patients with PV in this cross-sectional study, 13 of which have a history of ischemic stroke. The control group consisted of 90 healthy subjects. RBC deformability and aggregation analysis were performed using a laser-assisted optical rotational red cell analyzer. The following parameters were calculated: aggregation amplitude (Amp), RBC rouleaux formation time constant (Tf), time of formation of three-dimensional aggregates (Ts), aggregation index (AI), rate of complete disaggregation (y-dis), and the maximal elongation of RBC (EImax). Statistical analysis was performed with the R programming language. There were significant differences in RBCs morphodynamics features between patients with PV and the control group. Lower EImax (0.47 (0.44; 0.51) vs. 0.51 (0.47; 0.54), p < 0.001) and γ-dis (100 (100; 140) vs. 140 (106; 188) s−1, p < 0.001) along with higher amplitude (10.1 (8.6; 12.2) vs. 7.7 (6.6; 9.2), p < 0.001) was seen in patients with PV compared with control. A statistically significant difference between PV patients with and without stroke in aggregation amplitude was found (p = 0.03). A logistic regression model for stroke was built based on RBC morphodynamics which performed reasonably well (p = 0.01). RBC alterations may be associated with overt cerebrovascular disease in PV, suggesting a possible link between erythrocyte morphodynamics and increased risk of stroke.
Collapse
|
39
|
Rubin E, Pippione AC, Boyko M, Einaudi G, Sainas S, Collino M, Cifani C, Lolli ML, Abu-Freha N, Kaplanski J, Boschi D, Azab AN. A New NF-κB Inhibitor, MEDS-23, Reduces the Severity of Adverse Post-Ischemic Stroke Outcomes in Rats. Brain Sci 2021; 12:brainsci12010035. [PMID: 35053779 PMCID: PMC8773493 DOI: 10.3390/brainsci12010035] [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] [Received: 12/09/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: Nuclear factor kappa B (NF-κB) is known to play an important role in the inflammatory process which takes place after ischemic stroke. The major objective of the present study was to examine the effects of MEDS-23, a potent inhibitor of NF-κB, on clinical outcomes and brain inflammatory markers in post-ischemic stroke rats. Main methods: Initially, a Toxicity Experiment was performed to determine the appropriate dose of MEDS-23 for use in animals, as MEDS-23 was analyzed in vivo for the first time. We used the middle cerebral artery occlusion (MCAO) model for inducing ischemic stroke in rats. The effects of MEDS-23 (at 10 mg/kg, ip) on post-stroke outcomes (brain inflammation, fever, neurological deficits, mortality, and depression- and anxiety-like behaviours) was tested in several efficacy experiments. Key findings: MEDS-23 was found to be safe and significantly reduced the severity of some adverse post-stroke outcomes such as fever and neurological deficits. Moreover, MEDS-23 significantly decreased prostaglandin E2 levels in the hypothalamus and hippocampus of post-stroke rats, but did not prominently alter the levels of interleukin-6 and tumor necrosis factor-α. Significance: These results suggest that NF-κB inhibition is a potential therapeutic strategy for the treatment of ischemic stroke.
Collapse
Affiliation(s)
- Elina Rubin
- Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 8410501, Israel; (E.R.); (J.K.)
| | - Agnese C. Pippione
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (A.C.P.); (S.S.); (M.L.L.); (D.B.)
| | - Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel;
| | - Giacomo Einaudi
- Pharmacology Unit, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (G.E.); (C.C.)
| | - Stefano Sainas
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (A.C.P.); (S.S.); (M.L.L.); (D.B.)
| | - Massimo Collino
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10125 Turin, Italy;
| | - Carlo Cifani
- Pharmacology Unit, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (G.E.); (C.C.)
| | - Marco L. Lolli
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (A.C.P.); (S.S.); (M.L.L.); (D.B.)
| | - Naim Abu-Freha
- Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel;
| | - Jacob Kaplanski
- Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 8410501, Israel; (E.R.); (J.K.)
| | - Donatella Boschi
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (A.C.P.); (S.S.); (M.L.L.); (D.B.)
| | - Abed N. Azab
- Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 8410501, Israel; (E.R.); (J.K.)
- Department of Nursing, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 8410501, Israel
- Correspondence:
| |
Collapse
|
40
|
Filippenkov IB, Stavchansky VV, Denisova AE, Valieva LV, Remizova JA, Mozgovoy IV, Zaytceva EI, Gubsky LV, Limborska SA, Dergunova LV. Genome-Wide RNA-Sequencing Reveals Massive Circular RNA Expression Changes of the Neurotransmission Genes in the Rat Brain after Ischemia-Reperfusion. Genes (Basel) 2021; 12:genes12121870. [PMID: 34946819 PMCID: PMC8701796 DOI: 10.3390/genes12121870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022] Open
Abstract
Ischemic brain stroke is one of the most serious and socially significant diseases. In addition to messenger RNAs (mRNAs), encoding protein, the study of regulatory RNAs in ischemic has exceptional importance for the development of new strategies for neuroprotection. Circular RNAs (circRNAs) have a closed structure, predominantly brain-specific expression, and remain highly promising targets of research. They can interact with microRNAs (miRNAs), diminish their activity and thereby inhibit miRNA-mediated repression of mRNA. Genome-wide RNA-Seq analysis of the subcortical structures of the rat brain containing an ischemic damage focus and penumbra area revealed 395 circRNAs changed their expression significantly at 24 h after transient middle cerebral artery occlusion model (tMCAO) conditions. Furthermore, functional annotation revealed their association with neuroactive signaling pathways. It was found that about a third of the differentially expressed circRNAs (DECs) originate from genes whose mRNA levels also changed at 24 h after tMCAO. The other DECs originate from genes encoding non-regulated mRNAs under tMCAO conditions. In addition, bioinformatic analysis predicted a circRNA–miRNA–mRNA network which was associated with the neurotransmission signaling regulation. Our results show that such circRNAs can persist as potential miRNA sponges for the protection of mRNAs of neurotransmitter genes. The results expanded our views about the neurotransmission regulation in the rat brain after ischemia–reperfusion with circRNA action.
Collapse
Affiliation(s)
- Ivan B. Filippenkov
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (V.V.S.); (L.V.V.); (J.A.R.); (I.V.M.); (S.A.L.); (L.V.D.)
- Correspondence: ; Tel.: +7-499-196-1858
| | - Vasily V. Stavchansky
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (V.V.S.); (L.V.V.); (J.A.R.); (I.V.M.); (S.A.L.); (L.V.D.)
| | - Alina E. Denisova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Ostrovitianov str. 1, 117997 Moscow, Russia; (A.E.D.); (L.V.G.)
| | - Liya V. Valieva
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (V.V.S.); (L.V.V.); (J.A.R.); (I.V.M.); (S.A.L.); (L.V.D.)
| | - Julia A. Remizova
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (V.V.S.); (L.V.V.); (J.A.R.); (I.V.M.); (S.A.L.); (L.V.D.)
| | - Ivan V. Mozgovoy
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (V.V.S.); (L.V.V.); (J.A.R.); (I.V.M.); (S.A.L.); (L.V.D.)
| | - Elizaveta I. Zaytceva
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Leninskie Gory, 119991 Moscow, Russia;
| | - Leonid V. Gubsky
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Ostrovitianov str. 1, 117997 Moscow, Russia; (A.E.D.); (L.V.G.)
- Federal Center for the Brain and Neurotechnologies, Federal Biomedical Agency, Ostrovitianov str. 1, Building 10, 117997 Moscow, Russia
| | - Svetlana A. Limborska
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (V.V.S.); (L.V.V.); (J.A.R.); (I.V.M.); (S.A.L.); (L.V.D.)
| | - Lyudmila V. Dergunova
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (V.V.S.); (L.V.V.); (J.A.R.); (I.V.M.); (S.A.L.); (L.V.D.)
| |
Collapse
|
41
|
Carrillo-Loza K, Baranchuk A, Serrano F, Hasseb S, Espinosa Lira F, Soriano E, Arauz A. Advanced interatrial block predicts recurrence of embolic stroke of undetermined source. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:647-652. [PMID: 34656503 DOI: 10.1016/j.nrleng.2019.10.008] [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: 02/21/2019] [Accepted: 10/13/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Advanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS). METHODS 104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram (ECG). ECG findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable. RESULTS Median age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P < .001; OR = 10.86; 95% CI, 3.07-38.46), male sex (P = .028; OR = 4.6; 95% CI, 1.18-17.96), and age older than 50 years (P = .039; OR = 3.84; 95% CI, 1.06-13.88). In the Cox proportional hazards model, the risk variables identified were age older than 50 years (P = .002; hazard ratio, 7.04; 95% CI, 2.06-23.8) and P-wave duration (per ms) (P = .007; hazard ratio, 1.02; 95% CI, 1.01-1.04). CONCLUSIONS Advanced IAB and age older than 50 years predict ESUS recurrence.
Collapse
Affiliation(s)
- K Carrillo-Loza
- Servicio de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - A Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - F Serrano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - S Hasseb
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - F Espinosa Lira
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - E Soriano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - A Arauz
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.
| |
Collapse
|
42
|
Demyanenko S, Dzreyan V, Sharifulina S. Histone Deacetylases and Their Isoform-Specific Inhibitors in Ischemic Stroke. Biomedicines 2021; 9:biomedicines9101445. [PMID: 34680562 PMCID: PMC8533589 DOI: 10.3390/biomedicines9101445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/01/2023] Open
Abstract
Cerebral ischemia is the second leading cause of death in the world and multimodal stroke therapy is needed. The ischemic stroke generally reduces the gene expression due to suppression of acetylation of histones H3 and H4. Histone deacetylases inhibitors have been shown to be effective in protecting the brain from ischemic damage. Histone deacetylases inhibitors induce neurogenesis and angiogenesis in damaged brain areas promoting functional recovery after cerebral ischemia. However, the role of different histone deacetylases isoforms in the survival and death of brain cells after stroke is still controversial. This review aims to analyze the data on the neuroprotective activity of nonspecific and selective histone deacetylase inhibitors in ischemic stroke.
Collapse
|
43
|
Chen X, Cao L, Feng H, Huang X. Successive development of ischemic stroke and hemorrhagic stroke in a patient with essential thrombocythemia: a case report. J Int Med Res 2021; 49:300060520987718. [PMID: 33472495 PMCID: PMC7829530 DOI: 10.1177/0300060520987718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patients with essential thrombocythemia (ET) can experience hemorrhagic or
ischemic vascular events. The prevention of these complications is challenging,
and the overall risk of vascular events caused by ET is often overlooked. A
34-year-old man was admitted for a 10-day history of weakness and numbness in
his right limbs. He had been diagnosed with ET in 2008 but had stopped receiving
treatment half a year before admission. Physical examination showed a
superficial sense of disturbance in the right limbs and decreased muscle
strength in the right upper and lower limbs (4/5). His platelet count
(459 × 109/L) was elevated. Magnetic resonance imaging showed
acute watershed infarction, and he was treated successfully. However, he was
readmitted for headache and left limb weakness 14 months later. A head computed
tomography scan revealed spontaneous subdural hemorrhage. He underwent subdural
hematoma removal and decompressive craniectomy. Surgery and pathological
investigation revealed no venous sinus thrombosis or vascular malformation. His
condition improved, and he exhibited a stable condition 1 year after discharge.
Successive development of ischemic stroke and spontaneous subdural hemorrhage is
rare in a patient with ET. This case suggests that ET is not only a risk factor
for stroke but can also cause highly heterogeneous strokes.
Collapse
Affiliation(s)
- Xuhui Chen
- Department of Neurology, 74573Peking University Shenzhen Hospital, Shenzhen, China
| | - Liming Cao
- Department of Neurology, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China.,Department of Neurology, 499778Shenzhen University First Affiliated Hospital, Shenzhen, China
| | - Hongye Feng
- Department of Neurology, 499778Shenzhen University First Affiliated Hospital, Shenzhen, China.,Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xuming Huang
- Department of Gastroenterology, Shenzhen Shiyan People's Hospital, Shenzhen, China
| |
Collapse
|
44
|
Takeshita S, Ogata T, Arima H, Tsuboi Y. Proposed definition for young-onset ischemic stroke according to its cause. Clin Neurol Neurosurg 2021; 204:106595. [PMID: 33752143 DOI: 10.1016/j.clineuro.2021.106595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Young-onset stroke has a greater social impact than does stroke in older persons, indicating the importance of its prevention. Although there have been studies comparing stroke risk factors in young versus older individuals, no definition of young-onset ischemic stroke has been established. Large extracranial and intracranial atheroma, small vessel disease and atrial fibrillation have a major role in cases of stroke in the elderly, while these disorders are much less frequent in young adults. The purpose of this study was to determine the optimal cut-off point for defining young-onset ischemic stroke according to its cause. METHODS We identified 203 patients aged 65 years or less who had been admitted to our hospital between 2010 and 2017 with ischemic stroke, and we divided them into two groups according to the causes of the stroke. We allocated patients with strokes caused by small vessel occlusion, large artery atherosclerosis, atrial fibrillation, or aortic atheroma to Group A and those with strokes of other causes to Group B which included dissection, Trousseau syndrome and cerebral sinus thrombosis. We then used receiver operating characteristics curve analysis by the above groups and by sex to determine the cut-off age for defining young-onset. RESULTS Group A comprised 131 patients (58 ± 7 years, 92 men, 39 women) and Group B 72 (45 ± 15 years, 47 men, 25 women). Receiver operating characteristics curve analysis to differentiate Group B from Group A in all participants indicated a cut-off value of 53 years of age (area under curve: 0.78 [0.71-0.85], P < 0.001), which we therefore considered should define young-onset ischemic stroke. After dividing all patients by their sex, ROC analyses identified a cut-off for age of between 53 and 54 years for men (AUC: 0.75, 95% CI: 0.65-0.85, P < 0.001). In comparison, ≤ 48 years was the cut-off for young ischemic stroke in women (AUC: 0.83, 95% CI: 0.71-0.94, P < 0.001). CONCLUSIONS The age of 53 years may be the optimal cut-off point for young-onset ischemic stroke. Of note, the cut-off point between young- and non-young-onset stroke was 48 years for women, whereas it was 53 years for men. It is therefore important to carefully examine and treat female patients with this sex difference in mind.
Collapse
Affiliation(s)
- Sho Takeshita
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| |
Collapse
|
45
|
Elzanaty AM, Patel N, Sabbagh E, Eltahawy EA. Patent foramen ovale closure in the management of cryptogenic stroke: a review of current literature and guideline statements. Curr Med Res Opin 2021; 37:377-384. [PMID: 33460329 DOI: 10.1080/03007995.2021.1876648] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The management recommendations for patent foramen ovale (PFO) closure in cryptogenic stroke are rapidly evolving. The data has expanded recently with four major trials demonstrating superiority of percutaneous device closure over medical management in preventing cryptogenic stroke recurrence. This paper aims to review the current literature for referring physicians who may encounter patients with patent foramen ovale before referring these patients to stroke specialists and/or interventional cardiologists. METHOD For this Narrative review, we conducted a broad literature search with expert selection of relevant data. Our search included a review of the currently available trials, guideline statements, position papers, cost-effectiveness of device closure data, as well as the impact of device closure on quality of life. RESULTS Most European societies are now in favor of evaluating all patients aged 60 years or younger with recent cryptogenic stroke in the setting of a PFO after careful consideration of the patient's echocardiographic and clinical risk factors. On the other hand, American societies, except for the American Academy of Neurology, have not yet passed official updated recommendations. CONCLUSION PFO closure can be considered for the prevention of recurrent cryptogenic stroke in patients aged ≤60 years after a thorough evaluation and discussion about benefits and potential risks (including but not limited to atrial fibrillation) of the procedure. Accumulating evidence supports prognostic, quality of life, and economic benefit from percutaneous PFO closure with newer generation closure devices in the right subset of patients. HIGHLIGHTS Data from 4 major trials (RESPECT, CLOSE, DEFENSE-PFO, REDUCE) demonstrates the superiority of PFO closure over medical management alone in preventing cryptogenic stroke recurrence. Trials investigated mostly patients ≤60 years old, and therefore results may not be generalizable to the entire population. Further randomized trials evaluating the safety and efficacy of PFO closure in patients older than 60 years are warranted.Atrial fibrillation is one of the most common "occult" causes of cryptogenic stroke and should be excluded by ambulatory electrocardiographic monitoring. It is important to also rule out other causes of stroke, including hypercoagulable states, atherosclerotic lesions, other cardioembolic sources, and arterial dissection.Complications of PFO procedure include new-onset AF, development of scar tissue, risk of aortic root dilation and subsequent erosions, and potential thrombi formation on the device.PFO closure with medical therapy is more cost-effective than medical therapy alone.Patients who underwent PFO closure had lower rates of depression, anxiety, and stress compared to those who did undergo closure.Development of the RoPE score has helped clinicians identify patients with cryptogenic stroke and PFO who might be a candidate for PFO closure. A score of 7, 8, and 9-10 corresponds to a causal risk of 72%, 84%, and 88%, respectively, and defines a subset of patients who may benefit from PFO closure.Current guidelines recommend determining the need for PFO closure on a case-by-case basis, depending on risk factors, in patients age 60 or less with recent cryptogenic stroke in the setting of PFO.
Collapse
Affiliation(s)
- Ahmed M Elzanaty
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Neha Patel
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ebrahim Sabbagh
- Department of Cardiology, University of Toledo, Toledo, OH, USA
| | - Ehab A Eltahawy
- Department of Cardiology, University of Toledo, Toledo, OH, USA
| |
Collapse
|
46
|
Klissurski M, Petrov I, Tasheva I, Penev L, Grozdinski L. A rare case of non-conventional risk factors for ischemic stroke: A long pathogenic sequence, neurointervention combined with IV acetylsalicylic acid and secondary prevention. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
47
|
Abstract
Patent foram ovale (PFO) is the most common anatomical cause of an interarterial shunt. It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults. Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment, six subsequent randomized clinical trials (CLOSURE I, PC Trial, RESPECT, CLOSE, REDUCE, and DEFENSE-PFO) performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure. However, the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO, but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation, as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.
Collapse
|
48
|
İNAN RA, ÖZER D, ÖZEN BARUT B. Üçüncü Basamak Sağlık Merkezinde Genç İskemik İnme Hastalarında Etiyolojik inceleme. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.735340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
49
|
Al-Hakeim HK, Abdulla AK, Almulla AF, Maes M. Hereditary haematologic disorders in Najaf province-Iraq. Transfus Clin Biol 2020; 27:213-217. [PMID: 33036881 DOI: 10.1016/j.tracli.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hereditary hematologic disorders (HHDs) originate from genetic factors that cause disruptions of blood homeostasis. The Thalassemia Unit, Najaf province, Iraq, keeps all medical records of all patients with HHD from the Najaf province. OBJECTIVES We aimed to conduct an epidemiological study to obtain a comprehensive epidemiological picture concerning sex distribution, and effects of blood groups and consanguinity. PATIENTS AND METHODS All registered HHD patients (until May 2019) in the Thalassemia Unit (1033 patients, aged 0.5-65 years old) were included in the study. RESULTS The prevalence of HHD in Najaf city is 69.60 per 100,000 population. There are significantly more male than female HHD patients (Male=53.437%, Female=46.563%, p=0.019). The top 3 prevalent HHD are transfusion-dependent thalassemia (36.012%), non-transfusion dependent thalassemia (34.656%), and sickle-β thalassemia disorder (13.746%). The highest percentage of patients were in the centre of Najaf (56.42%), followed by Kufa, Mishkhab, Haidariah, Manathera, and Abbasiya. The distribution of blood groups and Rh factors of HHD patients in the Najaf population was not significantly different from that in the normal population. The consanguinity rate observed in our patients' parents (78.67%) was significantly higher (p<0.0001) as compared with the consanguinity rate in the population (45.8%). CONCLUSIONS During the last few years, there was an increase in HHD cases in Najaf city and, therefore, there is an urgent need to increase awareness about the effects of consanguinity marriages on HHD in order to limit the incidence of HHD.
Collapse
Affiliation(s)
| | | | - Abbas F Almulla
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq.
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; School of Medicine, IMPACT Strategic Research Centre, Deakin University, Australia.
| |
Collapse
|
50
|
Three myeloproliferative neoplasms: An overview. Nursing 2020; 50:22-30. [PMID: 32618765 DOI: 10.1097/01.nurse.0000684184.44195.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A group of rare hematologic cancers, myeloproliferative neoplasms (MPNs) evolve when bone marrow dysfunction causes overproduction of one or more blood cell types. This article explores the diagnosis, treatment, and nursing care of patients diagnosed with one of three classic MPNs: essential thrombocythemia, polycythemia vera, and primary myelofibrosis.
Collapse
|