Right insular infarction and mortality after ischaemic stroke

BACKGROUND AND PURPOSE

Several studies have described an association between insular infarction and mortality. Large infarcts often include the insula and lesion size is associated with mortality. We hypothesized that there is an association between insular infarction and mortality independent of lesion volume.

METHODS

We included consecutive stroke patients between 1 September 2008 and 11 November 2012 from the 1000Plus database with an acute ischaemic lesion on diffusion-weighted imaging on day 1 and a completed 90-day follow-up. Insular infarct location was determined using the in-house software Stroke Lesion Atlas. In multiple Cox regression analysis (dependent variable: mortality), we adjusted for insular infarcts, age, lesion volume, history of atrial fibrillation, National Institutes of Health Stroke Scale and previous stroke.

RESULTS

We included 736 patients, of whom 168 had an insular infarction. Within a medium follow-up time of 107 days, cumulative survival was 90% in patients with insular infarction and 99% in patients without insular infarction (P < 0.001). Right insular infarction was independently associated with mortality (hazard ratio, 2.60; confidence interval, 1.3-5.4; P = 0.010).

CONCLUSIONS

In our study, right insular involvement was a prognostic marker for mortality after ischaemic stroke. A selection bias towards patients able to give informed consent warrants further studies.

Circulating insulin-like growth factor binding protein-3 predicts one-year outcome after ischemic stroke

BACKGROUND

Insulin-like Growth Factor-1 (IGF-1) and Insulin-like Growth Factor Binding Protein-3 (IGFBP-3) have been ascribed neuroprotective effects. We sought to determine whether levels of IGF-1 and IGFBP-3 predict functional outcome after ischemic stroke.

METHODS

IGF-1 and IGFBP-3 levels were measured in the first week after stroke in patients with first ischemic stroke who were enrolled in the Berlin Cream&Sugar Study. National Institutes of Health Stroke Scale (NIHSS) was collected at admission. Lesion volume was determined from acute MRI if available. Functional outcome according to the modified Rankin Scale (mRS) was assessed after one year. In multivariate analyses we identified parameters associated with unfavourable functional outcome (mRS>2).

RESULTS

We included 100 patients. 21 patients had an unfavourable functional outcome. IGF-1 levels were<- 2 standard deviation score (SDS) in 7 patients, and>2 SDS in 12 patients. IGFBP-3 levels were<the 5(th) percentile in 13 patients, and no patient had IGFBP-3 levels>the 95(th) percentile. Low levels of IGFBP-3 (p=0.002), NIHSS at admission (p=0.043) and age (p=0.001) were associated with unfavourable functional outcome in the univariate analyses. In multivariate analysis including IGFBP-3, IGF-1, age, thrombolysis and NIHSS only low IGFBP-3 levels (OR 7.2, 95%CI 1.8-29.0, p=0.006) were associated with unfavourable functional outcome. If lesion volume was incuded (n=71), only IGFBP-3 levels (OR 7.2, 95%CI 1.5-35.5, p=0.015) were associated with unfavourable functional outcome.

CONCLUSION

IGFBP-3 levels after ischemic stroke may independently predict functional outcome after one year.