Brain Infarction Patients Research Articles

<i>MTHFRC677T</i> Polymorphism and Hyperhomocysteinemia in Ischemic Stroke Patients

Background: Homocysteine is an intermediate sulfur amino acid of methionine metabolism. Hyperhomocysteinemia, characterized by increased level of homocysteine, is an independent and modifiable vascular risk factor which metabolic pathway involves vitamins B6, folate and vitamin B12. Objective: We compared the prevalence of MTHFRC677T polymorphism, homocysteine folate and vitamin B12 in ischemic stroke patient’s subgroups. Methods: We conducted a cross-sectional analytical study. The study included 128 consecutive ischemic stroke patients associated with hyperhomocysteinemia. The MTHFRC677T polymorphism was investigated by TaqMan probes (thermos Fisher Scientific) combined with polymerase chain reaction (PCR). We compared the prevalence of MTHFRC677T polymorphism and homocysteine level in ischemic stroke patient’s subgroups. We adjusted the variable homocysteine level to the covariates, MTHFR polymorphism, folate and vitamin B12 with ANCOVA. Results: The sex ratio (men/women) was 1.5 with an average age of 60 years. The prevalence of MTHFRC677T polymorphism was 19.5% with 18% CT and 1.5% TT. Homocysteine level was 29.89 µmol/l in wildtype patients, 26.54 µmol/l in patients with CT genotype, and 56.17 µmol/l in patients with TT genotype (t=2.04, p=0.033, CI 95% [0.017; 0.407]). The MTHFR polymorphism prevalence, homocysteine, folate and vitamin B12 level did not differ between large brain infarction and multiple small brain infarction patients respectively (chi square: Qobs=0.05, p=0.94, 95% CI; ttest: t=0.716, df=126, p=0.475, 95% CI). Conclusion: The MTHFRT677T genotype increases homocysteine level. MTHFR polymorphism and homocysteine did not influence the subtypes of brain ischemic stroke.

Association between red blood cell distribution width and mortality of COVID-19 patients

PurposeWe have previously reported an association between high red blood cell distribution width (RDW) and mortality in septic and brain infarction patients. However, no association between RDW and mortality in coronavirus disease 2019 (COVID-19) patients has been reported so far; thus, the objective of this study was to determine if that association exists.MethodsProspective and observational study carried out in 8 Intensive Care Units from 6 hospitals of Canary Islands (Spain) including COVID-19 patients. We recorded RDW at ICU admission and 30-day survival.ResultsWe found that patients who did not survive (n = 25) compared to surviving patients (n = 118) were older (p = 0.004), showed higher RDW (p = 0.001), urea (p < 0.001), APACHE-II (p < 0.001) and SOFA (p < 0.001), and lower platelet count (p = 0.007) and pH (p = 0.008). Multiple binomial logistic regression analysis showed that RDW was associated with 30-day mortality after controlling for: SOFA and age (OR = 1.659; 95% CI = 1.130–2.434; p = 0.01); APACHE-II and platelet count (OR = 2.062; 95% CI = 1.359–3.129; p = 0.001); and pH and urea (OR = 1.797; 95% CI = 1.250–2.582; p = 0.002). The area under the curve (AUC) of RDW for mortality prediction was of 71% (95% CI = 63–78%; p < 0.001). We did not find significant differences in the predictive capacity between RDW and SOFA (p = 0.66) or between RDW and APACHE-II (p = 0.12).ConclusionsOur study provides new information regarding the ability to predict mortality in patients with COVID-19. There is an association between high RDW and mortality. RDW has a good performance to predict 30-day mortality, similar to other severity scores (such as APACHE II and SOFA) but easier and faster to obtain.

Early Mortality of Brain Infarction Patients and Red Blood Cell Distribution Width.

Background: Meta-analysis has found that high baseline red blood cell distribution width (RDW) is associated with increased long-term mortality (mortality at one year or more) in ischemic stroke. The objectives of this study were to determine whether there is an association between RDW and 30-day mortality, and to explore whether RDW during the first week of ischemic stroke could be a 30-day mortality biomarker. Methods: We included patients with malignant middle cerebral artery infarction (MMCAI). RDW at days 1, 4, and 8 of MMCAI were determined. The end-point study was 30-day mortality. Results: We found that survivor (n = 37) in respect to non-survivor patients (n = 37) had lower RDW at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.02). The area under curve (95% CI) for prediction of 30-day mortality by RDW at days 1, 4, and 8 of MMCAI were 0.80 (0.69–0.89; p < 0.001), 0.79 (0.66–0.89; p < 0.001), and 0.73 (0.58–0.84; p = 0.02). Regression analysis showed an association between RDW (odds ratio = 1.695; 95% CI = 1.230–2.335; p < 0.001) and 30-day mortality. Conclusions: The association between RDW and early mortality, and the potential role of RDW during the first week of MMCAI as a prognostic biomarker of early mortality were the main novelties of our study.

The Diagnostic Ability of rs-DWI to Detect Subtle Acute Infarction Lesion in the Different Regions of the Brain and the Comparison between Different b-Values.

Objective To evaluate the diagnostic ability of rs-DWI to detect subtle acute infarction lesion in the different regions of the brain in comparison to routine DWI and the comparison between different b-values. Method 35 acute brain infarction patients were included. The subtle acute infarction lesions in ss-DWI and rs-DWI sequence were evaluated in 9 anatomical regions of the brain, and the ss-EPI DWI was also acquired with different b-values of 0, 1000, 2000, and 3000s/mm2. The McNemar test was performed for comparing the diagnostic ability of ss-DWI and rs-DWI and different b-values. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the whole brain and in each anatomical region were calculated. Result A total of 406 subtle acute infarction lesions were confirmed. The ss-DWI detected 338 subtle lesions, out of which 318 were true positive and 20 were false positive lesions. The rs-DWI detected 386 subtle lesions, out of which 385 were true positive lesions and 1 was true negative lesion. Sensitivity, specificity, positive predictive value, and negative predictive value in rs-DWI were better than ss-DWI in all anatomical regions of the brain. In the comparison of different b-values, b2000 was found better among b1000, b2000, and b3000. Conclusion The rs-DWI offers a useful alternative to routine DWI for detecting the subtle acute infarctions, especially in the regions that are susceptible to distortion as in frontal cortex. In addition, high b-value can also provide benefit by increasing diffusion weighting but further raising can deteriorate image quality as SNR is decreased.

Ratio of apoB/LDL: a potential clinical index for vascular cognitive impairment.

BackgroundVascular cognitive impairment (VCI), compared to vascular dementia (VD), has a broader definition and highlights the effect of vascular disease in dementia, and stroke seems play an important role in the development of VCI. However, not all patients with brain infarcts suffer from VCI; unique risk factors appear to cause such progression. This study aimed to find potential risk factors of vascular cognitive impairment among patients with brain infarcts.MethodsThirty-seven dementia patients and 74 brain infarction patients were included; all had infarcts in both basilar ganglia. The frequencies of risk factors, such as age, hypertension, and hyperlipidemia, were compared between the two groups.ResultsThe incident rate of hyperlipidemia in the patients with dementia was 35.14%, which was significantly lower than that in the patients with infarction (59.46%, P = 0.015). In the dementia group, there was a positive correlation between the ratio of apoprotein B (apoB)/low density lipoprotein (LDL) and the Mini Mental State Examination (MMSE) score (R = 0.411, P = 0.011).ConclusionOur study indicated that the ratio of apoB/LDL may be a potential clinical index for vascular cognitive impairment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0766-1) contains supplementary material, which is available to authorized users.

Correlation between brain damage, associated biomarkers, and medication in psychiatric inpatients: A cross-sectional study

We clarified the correlation between brain damage, associated biomarkers and medication in psychiatric patients, because patients with schizophrenia have an increased risk of stroke. The cross-sectional study was performed from January 2013 to December 2015. Study participants were 96 hospitalized patients (41 men and 55 women) in the Department of Psychiatry at Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan. Patients were classified into schizophrenia (n=70) and mood disorders (n=26) by psychiatric diagnoses with DSM-IV-TR criteria. The incidence of brain damage [symptomatic and silent brain infarctions (SBIs) and white matter hyperintensity (WMH)] was correlated more with mood disorders than with schizophrenia. It has been previously shown that the concentrations of protein-conjugated acrolein (PC-Acro) and interleukin-6 (IL-6) increased in plasma of brain infarction patients together with C-reactive protein (CRP). The concentration of PC-Acro was significantly higher in patients with mood disorders than in those with schizophrenia. The concentration of IL-6 in both groups was nearly equal to that in the control group, but that of CRP in both groups, especially in mood disorders, was higher than that in the control group. Accordingly, the relative risk value for brain infarction was higher in patients with mood disorders than with schizophrenia. Medication with atypical antipsychotics reduced PC-Acro significantly in all psychiatric patients and reduced IL-6 in mood disorder patients. Measurement of 3 biomarkers (CRP, PC-Acro and IL-6) are probably useful for judgement of severity of brain damage and effectiveness of medication in psychiatric patients.

Correlation between post-stroke pneumonia and outcome in patients with acute brain infarction

Objective: To investigate the correlation between post-stroke pneumonia and outcome in patients with acute brain infarction. Methods: Consecutive acute cerebral infarction patients who were hospitalized in Department of Neurology, Jinan Military General Hospital were prospectively recruited from August 2010 to August 2014. The baseline data including age, sex, the National Institute of Health Stroke Scale (NIHSS) scores, type of Oxfordshire Community Stroke Project (OCSP: total anterior circulation infarct, partial anterior circulation infarct, posterior circulation infarct and lacunar infarct), fasting blood glucose etc. after admission were recorded. Post-stroke pneumonia was diagnosed by treating physician according to criteria for hospital-acquired pneumonia of the Centers for Disease Control and Prevention. Recovery was assessed by modified Rankin Scale (mRS) 180 days after stroke by telephone interview (mRS≤2 reflected good prognosis, and mRS>2 reflected unfavorable prognosis). Multinominal Logistic regression analysis, Kaplan-Meier curve and log rank test were used. Results: A total of 1 249 patients were enrolled, among them 173 patients were lost during follow-up. A total of 159 patients had post-stroke pneumonia, while 1 090 patients were without post-stroke. Compared with patients without post-stoke pneumonia, patients with post-stroke pneumonia were older (67±13 vs 63±12 years, P=0.000), more severe (NIHSS, 15(14) vs 4(4), P=0.000). Compared with patients without post-stoke pneumonia, more patients with post-stroke pneumonia suffered from heart failure (12.58% vs 3.40%, P=0.000), atrial fibrillation (26.42% vs 8.81%, P=0.000), myocardial infarction (10.06% vs 5.05%, P=0.016), recurrent brain infarction (30.19% vs 22.66%, P=0.045), total anterior circulation infarct type of OCSP (46.54% vs 19.63%, P=0.000), posterior circulation infarct of OCSP (39.62% vs 25.51%, P=0.001); more patients suffered from disorder of consciousness (60.38% vs 9.27%, P=0.000), dysphagia (34.59% vs 19.89%, P=0.000), vomiting (26.42% vs 8.81%, P=0.000), aphasia (35.85% vs 16.61%, P=0.000) since onset. The morbidity of post-stroke pneumonia among patients with unfavorable outcome (29.37%(111/378)) was significantly higher than that among patients with favorable outcome (3.73%(26/698)) (P=0.000). Post-stroke pneumonia was an independent prognostic factor for long-term unfavorable outcome (OR=2.414, 95%CI: 1.336-4.361, P=0.004) and long-term mortality (OR=2.132, 95%CI: 1.229-3.699, P=0.007). According Kaplan-Meier estimation, the cumulative 180 days survival of patients with post-stroke pneumonia was lower than those without post-stroke pneumonia (62.04%(85/137) vs 93.29%(876/939)); Log-rank test: χ2=137.32, P=0.000. Conclusions: Acute brain infarction patients with post-stroke pneumonia are older, more severe; more suffering from heart failure, atrial fibrillation, myocardial infarction; more suffering from disorder of consciousness since onset. Post-stroke pneumonia is an independent prognostic factor for long-term unfavorable outcome and for long term mortality in patients with acute brain infarction.

Non Rheumatic Atrial Fibrillation as Risk of Stroke

Atrial fibrillation (AF) is one of the main risk factor for ischemic stroke. The reason for an increased stroke risk in AF has always been claimed to be the occurrence of left atrial thrombosis causing arterial embolism. In patients with Rheumatic heart disease especially mitral valve stenosis with AF, the frequency of atrial thrombosis has found to be 30 - 42% (Keren G et al. 1987), and the prevalence of left atrial thrombosis in NRAF are higher than in control 13-27% (Petersen P et al. 1988). Objectives: We investigated if there are any differences in risk factors or atherosclerotic manifestations between ischemic brain infarction patients with and without AF? Are the brain lesions characteristics in these patients similar?Patients and Methods: This is a case- control study of 26 patients with acute ischemic stroke and NRAF (case subjects) a and 26 patients with acute ischemic stroke and sinus rhythm. (control subjects). The patients admitted to the hospital; the diagnosis of cerebral infarction was confirmed by new CT of the brain. All the participants underwent the standard examination and testing as well as ECG and ECHO. Result: Patient with NRAF had higher mortality 30% than in control (SR) 7% (P<0.001). NRAF patients had positive brain CT finding 68% compared to 23% of the SR Patients (P<0.001). Conclusion: Brain infarction in non-Rheumatic AF group are more serious than other and therefor make up a (high risk) group for which acute treatment would be specially indicated and primary prophylaxis with anticoagulants might therefore be considered.

Home-based tele-supervising rehabilitation for brain infarction patients (HTRBIP): study protocol for a randomized controlled trial.

BackgroundWith high morbidity, mortality and disability rate, brain infarction brings a huge economic and health burden to the whole society in China. Although some previous studies suggested that telerehabilitation may facilitate rehabilitation for stroke survivors at home, the evidence is insufficient for clinical application; additionally, as yet no trial evaluates efficacy of telerehabilitation for brain infarction patients. Therefore, more high quality trials are needed to provide practice evidence for this novel rehabilitation strategy.Methods/DesignBased on recruitment criteria, this assessor blinded, paralleled randomized controlled trial will recruit 210 brain infarction patients. After being randomly allocated into two groups, participants will receive home-based tele-supervising rehabilitation or conventional rehabilitation. Outcome measurement will be conducted at the end of intervention and 90-day follow-up. Among which, Barthel index assessment will be considered as primary outcome measurement, secondary outcome measurements include NIHSS score, mRS score, 3-oz water swallow test and surface electromyography. Adverse events will also be recorded during the whole process of the trial for safety assessment.DiscussionThe HTRBIP trial will evaluate efficacy and safety of home-based tele-supervising rehabilitation for brain infarction patients. It is expected to provide new evidence for telerehabilitation application.Trial registrationRegistration date: 17 September 2014; Registration number: ChiCTR-TRC-14005233

Abstract TP65: Fas Ligand Induced Brain Inflammation After Ischemic Stroke And Attenuates By Human Urinary Kallidinogenase

Inflammation is an important contributing mechanism in ischemic stroke. Fas ligand plays a critical role in post-stroke inflammatory responses. However, little progress has been made in clinical therapy, especial the treatment of inflammation after ischemic stroke. From 2010-2012, acute brain infarction patients within 72 hours of onset in the territory of anterior circulation artery have been enrolled in this study. All the patients were randomized to the HUK treated group (HP) and non HUK treated group (control group, CP). Both two groups received the same foundation treatment. In HP group, the patients received an intravenous transfusion of HUK once a day, for 10 days. The NIHSS index were used to evaluate neurological deficit at both day 0, days 10 and day 90. All patients were imaged with 3.0T MRI at both day 0 and day 10. The ischemic lesion area was measured by both DWI, PWI and FLAIR. The brain edema extent were compared. The blood samples were taken by all the patients for sFAL and inflammation factors detection at day 0, day 10 and day 90. We found: 1) 206 patients were enrolled in this study, 117 patients were in HP group and 89 patients were in CP group. The NIHSS index and brain edema extent show no significant difference between the HP group and CP group at day 2) sFAL could be detected in peripheral blood, and the level of sFAL had an significant increase at day 10 compared to day 0. Both inflammation cells and inflammation factors were increased at day 10 as compared to day 0. 3) As patients which received the HUK treatment, we observed the obvious improvement of NIHSS score, brain edema as well as inflammatory mediators. sFAL induced inflammation might contribute to the brain injury after ischemic stroke, and HUK protects against ischemic brain injury by inhibiting inflammatory response.

Videofluoroscopic assessment of pharyngeal stage delay reflects pathophysiology after brain infarction

The pathophysiology of dysphagia caused by brain infarction varies with the site of the lesion in the brain. Patients with suprabulbar lesions have demonstrated delayed triggering of pharyngeal stage including delayed laryngeal elevation. Patients with severe pharyngeal stage delay have a high risk of intractable aspiration to the lower respiratory tract. Despite this, few studies have compared the pharyngeal stage delay with the lesion site. We defined a new temporal parameter of the pharyngeal stage delay to assess laryngeal elevation delay against the bolus inflow into the pharyngeal space. This study aimed to elucidate whether this parameter of pharyngeal stage delay is clinically useful to assess the pathophysiology of brain lesions after brain infarction. Case-control study. Videofluoroscopic assessment of swallowing examinations was performed from January 7, 2000 to March 29, 2011 at Kyushu University Hospital. We evaluated the pharyngeal stage delay using motion analysis on videofluoroscopic swallowing examination in patients with normal swallowing and brain infarction patients divided into pathophysiologic lesion groups. Laryngeal elevation delay time and pharyngeal delay time were analyzed. Significant differences in laryngeal elevation delay time were observed between each pathophysiologic lesion group. However, pharyngeal delay time remained similar among groups. Brain infarctions of corticobulbar tract and basal ganglion were significantly associated with laryngeal elevation delay time prolongation. Laryngeal elevation delay time with low-viscosity contrast medium is a recommended parameter to discriminate the corticobulbar tract and the basal ganglion lesion.

Study on the relationship between glial fibrillary acidic protein and non-thrombolytic hemorrhagic transformation

Objective To study the predictive effect of glial fibrillary acidic protein (GFAP) on the non ⁃ thrombolytic hemorrhagic transformation in brain infarction patients. Methods In this study there were 78 acute brain infarct patients at the mean age of (62.85 ± 11.18) years old. Fifty⁃two patients were males (66.67%) and 26 were females (33.33%). All patients were admitted to the hospital less than 72 hours after onset. No hemorrhagic findings were seen on the head magnetic resonance imaging (MRI) (including multiplanar gradient ⁃ recalled echo) in the patients. All of them were not selected for thrombolytic therapy. On 7-10 d after the first MRI at the onset, low signal for hemorrhagic transformation was seen on multiplanar gradient⁃recalled echo. The patients were divided into 2 groups based on whether patients presented hemorrhagic transformation or not, and 60 healthy volunteers [35 (58.33%) males and 25 (41.67%) females] without history of cerebrovascular diseases were selected as control group with mean age of (64.02 ± 13.97) years old. The plasma GFAP level in the hemorrhagic transformation group, the non⁃hemorrhagic transformation group and the control group was quantitatively analysed by enzyme ⁃ linked immunosorbent assay (ELISA), the differences between groups were compared, and the factors that may affect the hemorrhagic transformation were explored. Results Among 78 patients, low signals on gradient⁃echo MR image were found in 11 cases. Plasma GFAP level in brain infarct patients [(2798.46 ± 1072.66) ng/L] were significantly higher than that in the control group [(2173.37 ± 867.77) ng/L, P = 0.000]. Plasma GFAP level in hemorrhagic transformation group (3660.03 ± 629.64) ng/L were significantly higher than that in non⁃ hemorrhagic transformation group (2657.01 ± 1066.89) ng/L and control group (P = 0.000, P = 0.005, respectively). GFAP levels in plasma were correlated with hemorrhagic transformation (P = 0.005). Atrial fibrillation was correlated with hemorrhagic transformation (P = 0.017). Logistic stepwise polynomial regression analysis indicated that plasma GFAP level and atrial fibrillation were risk factors for hemorrhage transformation. Conclusion Plasma GFAP concentration higher than 2856.90 ng/L may predict the occurrence of non ⁃ thrombolysis hemorrhagic transformation in acute brain infarction patients admitted within 72 hours after onset. The plasma GFAP level may be one of the markers for the prediction of non ⁃ thrombolytic hemorrhagic transformation. DOI：10.3969/j.issn.1672-6731.2011.06.008

Glucose Level and Brain Infarction: A Prospective Case-Control Study and Prospective Study

Hyperglycaemia in the acute phase of stroke has been established as a predictor of higher mortality. But recent data regarding active treatment of hyperglycaemia showed no clinical benefit suggesting that hyperglycaemia may not have a detrimental effect in brain infarction. Additional data are needed to resolve this uncertainty and identify patients at higher risk if any. A total of 477 adult Caucasian patients with brain infarction and 395 age- and sex-matched controls admitted at the same centres for nonneurological causes were recruited consecutively from 12 neurological centres in France. Electrocardiographic, carotid ultrasonography, and transcranial Doppler studies were performed. Blood was drawn in the morning from fasting subjects for glucose measurement. Functional outcome was measured on admission, at 10 days and at 6 months after the onset of stroke using the modified Rankin scale. Among 477 brain infarction patients and 395 hospitalised controls the adjusted mean (+/-SEM) glucose level was higher in cases (6.4+/-1.0 mmol/l) than in controls (6.0+/-1.01 mmol/l, P=0.006), with a significant heterogeneity across sexes. The fully adjusted odds ratio of brain infarction per 1-standard deviation increase in log-glucose level was 1.02 (95% confidence interval, 0.77-1.37) in men and 2.21 (95% confidence interval, 1.44-3.40) in women. Among the 477 brain infarction cases elevated admission glucose levels were associated with poor outcomes and higher poststroke mortality after adjustment for conventional vascular risk factors and infarct volume. These relationships were not modified by sex. Elevated admission glucose levels were associated with brain infarction in women only and with a higher 5-year mortality. Further investigation focusing on the impact of glucose level in different target population is needed to optimise glycaemic management in acute brain infarction patients.

뇌경색 위험인자로서의 혈중 지질에 대한 임상적 연구

Objective The purpose of this case-control study was done to examine the relationship among the acute brain infarction, silent brain infarction and blood lipids. Methods We compared the components of blood lipids among acute brain infarction patients group (n

Alterations in fluid, electrolytes and other serum chemistry values and their relations with enteral tube feeding in acute brain infarction patients

This study was performed to examine whether fluid and electrolyte levels are significantly altered after enteral tube feeding in acute brain infarction patients. Results on the water and electrolyte complications associated with enteral tube feeding are inconsistent and this is partly because of uncontrolled disease-related variables. Non-experimental design (retrospective study). This study was conducted by retrospectively reviewing the medical records of 85 tube-fed patients. Mean values of major serum electrolytes (sodium, potassium and chloride) were not significantly altered by tube feeding. However, differences between fluid input and output were significantly increased after tube feeding. The incidence of dehydration reduced overall, while over-hydration increased. The enteral tube feeding of iso-osmolar formulae appeared to be tolerated by most subjects in the present study in terms of electrolyte balance. However, fluid imbalance and over-hydration incidences were significantly increased after tube feeding. Due to significant alterations in fluid balance after tube feeding, close attention to the recording of fluid balance, such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage in enteral tube-feeding patients.

Effects of Nasogastric Tube Feeding on Serum Sodium, Potassium, and Glucose Levels

To examine whether significant alterations in serum sodium, potassium, and glucose levels occurred after nasogastric tube feeding with iso-osmolar formula in acute brain infarction patients. Serum sodium, potassium, and glucose levels were analyzed by a retrospective medical record review of 85 nasogastric tube-fed patients. The mean values of serum sodium and potassium levels on the day before, and 1st, 2nd, and 3rd days of nasogastric feeding were within the normal range. Alterations in the incidence rates of high, normal, and low level of serum sodium and potassium after tube feeding were not statistically significant. The mean blood glucose levels on the day before, and 1st, 2nd, and 3rd days of tube feeding were above normal, and the increase after tube feading was not statistically significant. Enteral tube feeding using iso-osmolar formula did not significantly alter serum sodium and potassium balance. However, most participants were hyperglycemic before and after tube feeding, indicating that hyperglycemia can be induced in the acute stages of brain infarction regardless of tube feeding.

Office blood pressure variability as a predictor of brain infarction in elderly hypertensive patients.

Large 24-h blood pressure (BP) variability and an excessive drop in BP during nighttime are associated with a higher risk of cardiovascular events. Data are lacking regarding the prognostic significance of variability in BP measured during office visits. We analyzed the relationship between office BP variability and the risk of brain infarction in elderly patients receiving antihypertensive therapy. Patients who experienced their first-ever stroke at the age of 60 years or over were registered in the study. At least 2 sex- and age-matched control patients were registered for each case patient. Office BP at each clinic visit and known cardiovascular risk factors were recorded. The BP variability was defined as the variation coefficient (VC) of office BP. In this report, we analyze the data of brain infarction patients. The VC of both systolic and diastolic BPs was significantly higher in the brain infarction patients than in the control patients. Higher office BP variability was associated with a higher risk of brain infarction after adjustment for BP level and other confounding factors. Regarding diastolic BP, the association of brain infarction with the maximal value for the difference of office BPs taken at any consecutive two visits (Max-deltaBP) or the difference between the highest and lowest values of office BP (BP-range) recorded during a 1-year period prior to the event was also significant. In conclusion, a retrospective case-control study suggested that office BP variability was an independent predictor of brain infarction. Either the Max-deltaBP or the BP-range may be surrogate indices of diastolic BP variability.

A SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY STUDY OF THE THERAPY OF INTRAVASCULAR LOW INTENSITY LASER IRRADIATION ON BLOOD FOR BRAIN INFARCTION

We used single photon emission computed tomography (SPECT) in brain perfusion imaging to study the changes of regional cerebral blood flow (rCBF) and cerebral function in brain infarction patients treated with intravascular low intensity laser irradiation of blood (ILIB). Seventeen of 35 patients with brain infarction were admitted to be treated by ILIB on the base of standard drug therapy, and SPECT brain perfusion imaging was performed before and after ILIB therapy with self-comparison. The results were analyzed using the brain blood flow function change rate (BFCR%) model. The effect of ILIB during the therapy process in the other 18 patients was also observed. In the 18 patients, SPECT indicated an improvement of rCBF (both in focus and in total brain) and cerebral function after a 30 min-ILIB therapy. And the 17 patients showed an enhancement of total brain rCBF and cerebral function after ILIB therapy in comparison with that before, especially for the focus side of the brain. The enhancement for the focal area itself was extremely obvious with a higher significant difference (P 0.05). BFCR% of foci was prominently higher than that of mirror regions (P<0.0001). In conclusion, the ILIB therapy can improve rCBF and cerebral function and activate brain cells of patients with brain infarction. The results denote new evidence of ILIB therapy for those patients with cerebral ischemia.

Ultraschalldiagnostik der intra-kraniellen Hirnarterien und Monitoring-Techniken

There have been significant further developments in ultrasound diagnostics of the intracranial brain arteries in recent years. Besides the traditional transcranial Doppler sonography (TCD) the two-dimensional colour duplex technique (TCCS) has become a well-established method. This enables a safe differentiation of the basal brain arteries even without compression tests, as well as a clear definition against surrounding parenchymal structures. It is now possible to obtain safe and rapid information on the vascular status for immediate diagnosis in brain infarction patients. Since information on vascular malformations and aneurysms can be obtained only if the vascular pathology is sufficiently large, TCCS cannot replace other methods of identification as far as this aspect is concerned. The ultrasound contrast media for whom the lungs are patent greatly improve the signal-to-noise ratio of the Doppler signal. After enhancement by the ultrasound contrast media, Doppler signals may be analysed even under unfavourable conditions (for example: insufficient penetration of sound through the temporal bone). By means of haemodynamic TCD monitoring it is now possible to determine significant characteristics of brain blood supply with relatively little effort, such as changes in the median speed of flow, cerebrovascular resistance and autoregulation. The clinical application of this kind of monitoring is demonstrated by three examples. During the interventional neuroradiological experimental occlusion of the internal carotid artery the TCD data can be used to assess haemodynamic and possible clinical effects of such an occlusion. In the tilting-table test ICD can supply valuable insights into the cerebral effects of systemic dysregulations. In a subgroup of patients with orthostatic intolerance it was only TCD that showed clear pathological changes. For practical reasons it has not yet been possible to establish TCD monitoring in continuous control checking in stroke units. However, first experiences seem to point out that possibly TCD monitoring may reveal the development for critical cerebral circulatory disturbances in patients with space-occupying media infarctions and may thus supply a significant contribution to the indication for cranial decompression. By means of repeat examinations of the course, using the TCD and TTCS technique, it is possible to identify in patients with acute cerebral infarction the time of rechannelling and to estimate the space-occupying effect of an infarction by measuring the displacement of the third ventricle. Monitoring patients after thrombendarterectomy of the internal syndrome, whereas monitoring of an embolism helps to estimate the risk of a post-operative ischaemic event.

Non-rheumatic atrial fibrillation as a risk factor for stroke.

The association between non-rheumatic atrial fibrillation (AF) and stroke has been studied in 402 patients consecutively admitted to a stroke unit. Brain infarction patients with sinus rhythm (n = 196) and non-rheumatic AF (n = 92) were further compared. Some findings supported an embolic origin of the stroke: half of the deceased AF patients (n = 24) at autopsy either had left atrial thrombosis or arterial embolism compared to none of the ten with sinus rhythm. Patients with AF also had a higher mortality and more severe brain lesions, findings compatible with a sudden occlusion of blood flow. However, these differences might also be explained by an atherothrombotic occlusion with impaired autoregulation in the ischaemic region in conjunction with heart failure, which was more common in the AF patients. Other findings supporting an atherothrombotic mechanism were: the prevalence of AF was higher (19-29%) in all kinds of stroke, including haemorrhage, than in age-matched controls (3-9%). Also patients with previous AF and no present embolic source resembled the whole AF group and differed from patients with sinus rhythm. Thus embolism is a plausible cause of stroke in many AF patients, whereas an atherothrombotic origin is more likely in others. Characteristics identifying the mechanism in an individual case were not found.