Ischemic Cerebral Infarction Research Articles

Practical methods for segmentation and calculation of brain volume and intracranial volume: a guide and comparison.

Accurate segmentation and calculation of total brain volume (BV) and intracranial volume (ICV) (further-volumetry) may serve various clinical tasks and research studies in neuroscience. Manual segmentation is extremely time consuming. There is a relative lack of published broad recommendations and comparisons of tools for automated volumetry, especially for users without expertise in computer science, for settings with limited resources, and when neuroimaging quality is suboptimal due to clinical circumstances. Our objective is to decrease the barrier to entry for research and clinical groups to perform volumetric cranial imaging analysis using free and reliable software tools. Automated volumetry from computed tomography (CT)/magnetic resonance imaging (MRI) scans was accomplished using 3D Slicer (v. 4.11.0), FreeSurfer (v. 7.1.1), and volBrain (v. 1.0) in a cohort of 39 patients with ischemic middle cerebral artery territory brain infarcts in the acute stage. Visual inspection for accuracy was also performed. Statistical analysis included coefficient of determination (R2) and Bland-Altman (B-A) plots. A multifaceted comparison between 3D Slicer, FreeSurfer, and volBrain from practical user perspective was performed to compile a list of distinguishing features. BV: FreeSurfer, 3D Slicer, and volBrain provide similar estimations when high quality T1-MRI scans with 1 mm slices (3D scans) are available, whereas 3 mm and thicker slices (2D scans) introduce a dispersion in results. ICV: the most accurate volumetry is provided by 3D Slicer using CT scans. volBrain uses T1-MRIs and also provides good results which agree with 3D Slicer. Both of these methods may be more trustworthy than T1 MRI-derived FreeSurfer calculations. All three studied tools of automated intracranial and brain volumetry-3D Slicer, FreeSurfer, and volBrain-are free, reliable, require no complex programming, but still have certain limitations and significant differences. Based on our investigation findings, the readers should be able to select the right volumetry tool and neuroimaging study, and then follow provided step-by-step instructions to accomplish specific volumetry tasks.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia.

BACKGROUNDEarly thrombolytic therapy is crucial to treat acute cerebral infarction, especially since the onset of thrombolytic therapy takes 1-6 h. Therefore, early diagnosis and evaluation of cerebral infarction is important.AIMTo investigate the diagnostic value of magnetic resonance multi-delay three-dimensional arterial spin labeling (3DASL) and diffusion kurtosis imaging (DKI) in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia.METHODSEighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included. All patients in the acute stage underwent magnetic resonance-based examination, and the data were processed by the system’s own software. The apparent diffusion coefficient (ADC), average diffusion coefficient (MD), axial diffusion (AD), radial diffusion (RD), average kurtosis (MK), radial kurtosis (fairly RK), axial kurtosis (AK), and perfusion parameters post-labeling delays (PLD) in the focal area and its corresponding area were compared. The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging (T2WI) was analyzed.RESULTSThe DKI parameters of focal and control areas in the study subjects were compared. The ADC, MD, AD, and RD values in the lesion area were significantly lower than those in the control area. The MK, RK, and AK values in the lesion area were significantly higher than those in the control area. The MK/MD value in the infarct lesions was used to determine the matching situation. MK/MD < 5 mm was considered matching and MK/MD ≥ 5 mm was considered mismatching. PLD1.5s and PLD2.5s perfusion parameters in the central, peripheral, and control areas of the infarct lesions in MK/MD-matched and -unmatched patients were not significantly different. PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and -unmatched patients were significantly lower than those in peripheral and control areas. The MK and MD maps showed a lesion area of 20.08 ± 5.74 cm2 and 22.09 ± 5.58 cm2, respectively. T2WI showed a lesion area of 19.76 ± 5.02 cm2. There were no significant differences in the cerebral infarction lesion areas measured using the three methods. MK, MD, and T2WI showed a good correlation.CONCLUSIONDKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction. 3DASL can effectively determine the changes in perfusion levels in the lesion area. There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.

Acute ischemic stroke: a rare complication of hump-nosed pit viper (Hypnale spp.) bite: a case report

BackgroundHump-nosed pit viper is a medically important deadly venomous snake in Sri Lanka and is the commonest cause of venomous snakebites in the country. It frequently causes local effects and systemic manifestations such as acute kidney injury and coagulopathy that occur in less than 10% of all bites. This also includes some atypical presentations such as thrombotic microangiopathy and myocardial infarction. Currently, no antivenom is available for hump-nosed pit viper bites in Sri Lanka, and patients are managed with supportive treatment. This case illustrates an acute ischemic stroke following a hump-nosed viper bite, which is the second case in the literature.Case presentationA 71-year-old a Sinhalese male patient presented with left-sided hemiparesis with mouth deviation on day 2 of hump-nosed viper (Hypnale spp.) bite on the right foot. Non-contrast computed tomography of brain showed right ischemic stroke in internal capsule. He was given antiplatelets and statins and continued supportive treatment including limb physiotherapy and speech therapy. He recovered completely and was discharged on day 4 with clinic follow-up.ConclusionsPhysicians should be aware that ischemic cerebral infarcts may occur following hump-nosed pit viper bites.

Protein-based HDL subspecies: Rationale and association with cardiovascular disease, diabetes, stroke, and dementia

HDL-cholesterol is associated with reduced risk of cardiovascular disease, and is used in clinical practice for risk stratification. HDL is composed of many protein-defined subspecies that each comprises just a few percent of the total, some associated with lower and some with higher risk of CVD. HDL that contains apoC3 or apoE are subspecies that have opposing actions on HDL reverse cholesterol transport and opposing associations with risk of future CVD, apoC3 adverse and apoE beneficial. In addition to coronary heart disease, HDL that contains apoC3 is associated with risk of future type 2 diabetes and insulin resistance; ischemic stroke and cerebral infarction; dementia and the deposition of beta-amyloid in the brain. HDL that contains apoE and apoE itself are associated with lower risk of dementia. Other HDL subspecies that contain complement C3, alpha-2 macroglobulin, plasminogen, or haptoglobin are associated with higher future risk of coronary heart disease, whereas others such as HDL that contains apoC1 are associated with lower risk. At this time, these findings provide improved understanding of the multifaceted HDL system to better determine risk and targeting of therapy for the most prevalent chronic lifestyle diseases in our society.

The crosstalk signals of Sodium Tanshinone ⅡA Sulfonate in rats with cerebral ischemic stroke: Insights from proteomics

BackgroundStroke could cause long-term disability, even mortality around the world. Recently, Sodium tanshinone IIA sulfonate (STS), identified from Salvia miltiorrhiza Bunge and was found to have unique efficiency in clinical practice as a potential therapeutic agent for ischemic cerebral infarction. However, systematic investigation about the biological mechanism is still lacking. Herein, we utilized high-throughput proteomics approach to identify the underlying targets for the treatment of STS in stroke. MethodsWe investigated the effect of STS on stroke outcomes on rat model of the Middle Cerebral Artery Occlusion and Reperfusion (MCAO/R), assessing by Z-Longa score, infarct volume and HE staining. Pharmacoproteomic profiling of ischemic penumbra in cortical (IPC) was performed using DIA-based label-free liquid chromatography-tandem mass spectrometry (LC-MS/MS) technique. Bioinformatics analysis was processed for further investigation. The expression of core proteins was semi-quantified by DIA, and the major protein correlating with stroke was examined using parallel reaction monitoring (PRM). ResultsRats in the MCAO/R group showed neurological function deterioration, which was improved by STS. There were 423 differentially expressed proteins (DEPs) in IPC being detected and quantified in both the sham group and the MCAO/R group. Meanwhile, 285 proteins were significantly changed in the STS treated group, compared to the MCAO/R model. Protein-protein interaction (PPI) network, pathway and biological function enrichment were processed for the DEPs across each two groups, the results of which were integrated for analysis. Alb, mTOR, Dync1h1, Stxbp1, Cltc, and Sptan1 were contained as the core proteins. Altered molecules were discovered to be enriched in 18 signal pathways such as phosphatidylinositol signaling system, PI3K/AKT signal pathway and HIF-1 signal pathway. The results also showed the correlation with sleep disturbances and depression post-stroke. ConclusionsWe concluded that STS could prevent penumbra from progressively ongoing damage and improve neurological deficits in MCAO/R model rats. The intersected pathways and protein networks predicted by proteomics might provide much more detailed information for the therapeutic mechanisms of STS in the treatment of CIS.

Neuroimaging Parameters Are Not Associated With Chronic Post-stroke Fatigue in Young Stroke Patients.

IntroductionPost-stroke fatigue is frequently present in young adults, but its underlying mechanism is still unclear. The aim of the study was to investigate the association between lesion location, network efficiency and chronic post-stroke fatigue based on voxel-based lesion-symptom mapping and structural network connectivity analysis.Patients and MethodsOne hundred and thirty five young patients, aged 18–50 years, with a first-ever transient ischemic attack or cerebral infarction from the Follow-Up of Transient ischemic attack and stroke patients and Unelucidated Risk factor Evaluation (FUTURE) study, underwent 1.5T MRI and were assessed for fatigue using the self-report Checklist Individual Strength. Stroke lesions were manually segmented, and structural network efficiency was calculated using the diffusion MRI-based brain networks and graph theory for each patient. Univariate and multivariate analyses was performed to study the associations between MRI parameters and chronic post-stroke fatigue. In addition, we used voxel-based lesion-symptom mapping to analyze the relationship between the lesion location and chronic post-stroke fatigue.ResultsMean age at index event was 39.0 years (SD ± 8.2), and mean follow-up duration was 11.0 years (SD ± 8.0). 50 patients (37%) had post-stroke fatigue. Voxel-based lesion-symptom mapping showed no significant relation between stroke lesions and the presence of chronic post-stroke fatigue. Furthermore, there were no significant associations between the lesion size or network efficiency, and the presence of chronic post-stroke fatigue.DiscussionWe did not find any association between stroke characteristics (lesion location and size) and chronic post-stroke fatigue (CIS20-R), nor associations between structural brain network connectivity and post-stroke fatigue on the long term in young stroke patients.

Inhalation of Atmospheric-Pressure Gas Plasma Attenuates Brain Infarction in Rats With Experimental Ischemic Stroke

Previous studies suggest the potential efficacy of neuroprotective effects of gaseous atmospheric-pressure plasma (APP) treatment on neuronal cells. However, it remains unclear if the neuroprotective properties of the gas plasmas benefit the ischemic stroke treatment, and how to use the plasmas in the in vivo ischemic stroke models. Rats were subjected to 90 min middle cerebral artery occlusion (MCAO) to establish the ischemic stroke model and then intermittently inhaled the plasma for 2 min at 60 min MCAO. The regional cerebral blood flow (CBF) was monitored. Animal behavior scoring, magnetic resonance imaging (MRI), 2,3,5-triphenyltetrazolium chloride (TTC) staining, and hematoxylin and eosin (HE) staining were performed to evaluate the therapeutic efficacy of the gas plasma inhalation on MCAO rats. Intermittent gas plasma inhalation by rats with experimental ischemic stroke could improve neurological function, increase regional CBF, and decrease brain infarction. Further MRI tests showed that the gas plasma inhalation could limit the ischemic lesion progression, which was beneficial to improve the outcomes of the MCAO rats. Post-stroke treatment with intermittent gas plasma inhalation could reduce the ischemic lesion progression and decrease cerebral infarction volume, which might provide a new promising strategy for ischemic stroke treatment.

Effect of enteral nutrition on the intestinal microbiome and risk of death in ischemic stroke patients.

Studies have shown that the intestinal microbiome of stroke patients is significantly altered and that the degree of microbiota disturbance correlates with prognosis. Enteral nutrition (EN) can reshape the intestinal microbiome and is important for stroke patients with dysphagia. We aimed to describe the intestinal microbiome in patients with ischemic cerebral infarction receiving standard EN. First, 17 healthy controls (HCs), 54 stroke patients with oral feeding (ON), and 50 stroke patients with EN were matched to investigate the changes in the intestinal microbiota with EN in the first week after admission and dynamic changes in the EN group in the second week. Second, we investigated the relationship between the intestinal microbiome and clinical characteristics in a larger sample of participants receiving EN (n = 147). Survival analysis was performed using Cox proportional hazards regression. The composition and structure of the intestinal microbiota were analyzed by 16S rRNA sequencing. Compared with the HC and ON groups, patients with EN exhibited significantly different compositions of the intestinal microbiota in the first week, including enrichment of the opportunistic pathogen Enterococcus and depletion of bacteria such as Lachnospiraceae, and Ruminococcus, which were further depleted in the second week. An increase in Parvimonas and Comamonas abundances was associated with an increased risk of 180-day mortality. The intestinal microbiota in ischemic stroke patients receiving EN is significantly altered, and specific strains of bacteria may be associated with prognosis and clinical indicators.

Hsa-miR-518-5p/hsa-miR-3135b Regulates the REL/SOD2 Pathway in Ischemic Cerebral Infarction.

ObjectivesIschemic cerebral infarction (ICI) is a fatal neurovascular disorder. A bioinformatics approach based on single-cell and bulk RNA-seq analyses was applied to investigate the pathways and genes involved in ICI and study the expression profile of these genes.MethodsFirst, the aberrantly regulated “small-molecule ribonucleic acids” [microRNA (miRNAs)] and messenger RNAs (mRNAs) were analyzed using transcriptome data from the ischemic brain infarction dataset of the Gene Expression Omnibus (GEO) database. In mouse cerebrovascular monocytes, the single-cell regulatory network inference and clustering (SCENIC) workflow was used to identify key transcription factors (TFs). Then, the two miRNA-TF-mRNA interaction networks were constructed. Moreover, the molecular complex detection (MCODE) extracted the core sub-networks and identified the important TFs within these sub-networks. Finally, whole blood samples were collected for validation of the expression of critical molecules in ICI.ResultsWe identified four cell types and 266 regulons in mouse cerebrovascular monocytes using SCENIC analysis. Moreover, 112 differently expressed miRNAs and 3,780 differentially expressed mRNAs were identified. We discovered potential biomarkers in ICI by building a miRNA-TF-mRNA interaction network. The hsa-miR-518-5p/hsa-miR-3135b/REL/SOD2 was found to play a potential role in ICI progression. The expression of REL and superoxide dismutase 2 (SOD2) was significantly elevated in the ICI group in the clinical cohort (P < 0.05). Furthermore, a REL expression was elevated in endothelial cells and fibroblasts at the single-cell level, indicating that REL is a cell-specific regulon. Functional enrichment analyses revealed that REL is primarily engaged in neurotransmitter activity and oxidative phosphorylation.ConclusionsOur research uncovered novel biomarkers for ICI of neurovascular disease. The hsa-miR-518-5p/hsa-miR-3135b may regulate the REL/SOD2 pathway in ICI progression.

Resveratrol pretreatment protects neurons from oxygen-glucose deprivation/reoxygenation and ischemic injury through inhibiting ferroptosis.

Ferroptosis, a newly discovered iron-dependent cell death, is involved in brain ischemia-reperfusion injury. Iron scavengers or ferroptosis inhibitors could reduce infarct volume and improve neurological function in mice. Resveratrol has neuroprotective and neurorestorative effects. However, it is unclear whether resveratrol can play a neuroprotective role via inhibiting ferroptosis. Our study showed that resveratrol pretreatment had a similar effect with ferrostatin‑1, which inhibited neuronal ferroptosis-related changes, such as iron overload, damages of oxidation-reductionsystem,and destruction of mitochondrial structure, after oxygen-glucose deprivation/reoxygenation (OGD/R) and application of ferroptosis inducers. In addition, middle cerebral artery occlusion/reperfusion (MCAO/R) injury in vivo also induced ferroptosis, and resveratrol pretreatment could inhibit ferroptosis and reduce degenerative neurons, cerebral ischemic damage and infarction volume. Our results are the first to indicate that resveratrol pretreatment might inhibit ferroptosis induced by OGD/R and ferroptosis inducers in neurons, and MCAO/R in rats.

A 44-Year-Old Man With Acute Mutism: Acute Stroke, Psychiatric Disorder, or Substance Abuse?

Mutism is a common presentation of psychiatric diseases. However, patients presenting to the emergency department with mutism should be assumed to have an organic pathology irrespective of their psychiatric history. Little is known about the causality between mutism and illicit drug use. We report a case of a 44-year-old man with acute mutism who was initially diagnosed with ischemic cerebral infarction involving the dorsolateral frontal cortex causing Broca's aphasia. He was later found to have a history of amphetamine, ketamine, and new psychoactive substance use. Substance abuse could be a precipitating factor for acute stroke, especially among patients aged below 55 years. Patients should be routinely screened and counseled regarding illicit drug use. The present case report highlights the possibility that transient ischemia could be associated with acute mutism in drug abusers. Prompt acquisition of drug abuse history or basic drug screening is especially mandatory.

Teriparatide induces angiogenesis in ischemic cerebral infarction zones of rats through AC/PKA signaling and reduces ischemia-reperfusion injury

Teriparatide is a commonly used drug indicated for the treatment of osteoporosis in postmenopausal women. Teriparatide can also upregulate Ang-1 expression through the AC/PKA signaling pathway to promote angiogenesis. At present, promoting angiogenesis is a promising but unrealized strategy for the treatment of ischemic cerebral infarction. However, there are few studies on the application of teriparatide in the treatment of cerebral infarction. We used teriparatide to treat ischemic cerebral infarction in rats and obtained three major findings. First, teriparatide can promote angiogenesis, reduce cerebral infarct size, and increase cerebral perfusion by upregulating Ang-1 expression. Second, teriparatide can promote the expression of HO1, SOD2 and inhibit the production of pro-inflammatory cytokines IL-1β, IL-6 by upregulating Nrf2 expression. Third, we further found that teriparatide can mitigate blood-brain barrier disruption and brain edema by downregulating the expressions of MMP9, Ang-2 and AQP4. Our results indicate that teriparatide is neuroprotective through multiple mechanisms of action that include promoting angiogenesis, inhibiting oxidative stress and neuroinflammation, protecting blood-brain barrier, and reducing brain edema.

Acute cerebral infarction due to severe COVID-19, bacterial meningitis due to Pseudomonas stutzeri, mild loculated pericardial effusion due to MIS-C

Neurological involvement was common in children and adolescents with Coronavirus disease-2019 (COVID-19) related hospitalization and is mostly transient. A spectrum of life-threatening neurologic involvement infrequently occurred and was associated with more extreme inflammation and severe sequel. We reported a patient male, seven months old with chief complaint of fever since 1 month before admission. The patient was diagnosed by confirmed case COVID-19 with a positive RT-PCR SARS-CoV-2 swab. He had some contact with his parents that had confirmed with COVID-19 before. The patient also complained with focal seizures in the left extremity with decreased of consciousness. The seizure always repeated every day for 1 week with the same pattern. Patient also complain of nausea and vomiting every time he has been breastfed. There is no changes of the lips and oral cavity, no cutaneous rash, no red eyes, no swelling or edema on extremities. Non-contrast head CT-Scan revealed large area of acute cerebral infarction. Echocardiography revealed mild loculated pericardial effusion and cerebrospinal fluid cultured result revealed Pseudomonas stutzeri. After 3 weeks discharged from the hospital, the patient underwent a head MRI examination and the results revealed chronic ischemic cerebral infarction and communicating hydrocephalus. The patient was planned to undergo a VP shunt as a treatment for hydrocephalus. The neurological involvement can occur in children and adolescents with COVID-19. The range of severe neurologic complications including peripheral nerve disorders, focal CNS disease and diffuse CNS involvement, make it likely that multiple mechanisms underlie this wide spectrum of disease.

Organic Hallucinosis in Non-Hemorrhagic Stroke Caused by Thrombosis Process: A Case Report

Background/aim: Hallucinations are the special ability to experience phenomena that are not visible to normal individuals. Hallucinations, delusions, and confabulations are common symptoms between neurology and psychiatry. Nervous disease that manifests with hallucinatory symptoms like this is one of them due to right hemispheric stroke. The authors report cases of new-onset organic hallucinosis. and stroke in brain regions similar to the salience network (insular cortex, parietal cortex, and striatum). Case: A 43-year-old man comes to the ER Sanglah Hospital Denpasar, Bali Indonesia with complaints of slurred speech using an incomprehensible language, and repeating the same words. Talking about seeing a shadow following him but actually not there. Patients often experience sleep disorders, from the results of neurological physical examination found right eye ptosis, pupil anisokor, nerve III dextra complete lesion, supranuclear left NVII paresis, supranuclear left NXII paresis, left flaccid hemiparesis. Psychiatric status obtained unnatural appearance, looks confused, verbal and visual contact is sufficient, mood dysphoric, confused affect and there is no harmony. The thought process obtained realistic, coherent, preoccupation with pain. Perceptual disturbances in the form of visual and auditory hallucinations. Insomnia mixed type and there is hypobulia. Psychomotor calm on examination, history increases. Narcissistic personality traits and defense mechanisms of ego repression. Grade 4 view. CT scan of the head with and without contrast shows subacute ischemic cerebral infarction in the right internal capsule to the right thalamus and midbrain. Conclusion: Organic hallucinosis occur in non-hemorrhagic stroke caused by thrombosis process if an infarction is found in the right hemisphere. Keywords: organic hallucinations, ischemic cerebral infarction, non-hemorrhagic stroke, right hemisphere.

Observation of the Effect of Nursing BPR on Thrombolytic Efficacy and Prognosis of Patients with Cerebral Infarction Based on CT Images.

Cerebral infarction has become the main cause of death among Chinese residents, especially ischemic cerebral infarction. The existing CT technology is not very effective for the detection of cerebral infarction, and some angiography has problems such as blurring and shadowing. In order to understand the treatment methods and effects of patients with cerebral infarction, this article observes the effect of nursing BPR on thrombolytic efficacy and prognosis of patients with cerebral infarction based on CT images. The patients were divided into thrombolytic group and nonthrombolytic group, and a simple rating scale was used to assess the motor function of the patients' limbs, and the stroke scale was used to assess the patient's neurological function. Compare the baseline data, the time of admission, 24 hours and 7 days, the scores before and after treatment, and the ratio between the two groups. According to the monitoring, record each time point. The analysis of the occurrence of primary endpoint was events and secondary endpoint events and risk factors affecting limb motor function. The results of the study found that, based on the computer scanning observation of nursing BPR, compared with the traditional model, the patient's bleeding was significantly reduced, and the time required for nursing was also reduced by more than 50% compared with the traditional model. Compared with the traditional nursing model, the satisfaction of patients with the BPR nursing model is nearly 40% higher than that of the traditional nursing model. This shows that the observation of thrombolytic effect in patients with cerebral infarction based on computed tomography and BPR nursing can produce good therapeutic effects.

Prevalence of Noncommunicable Diseases in Japan Using a Newly Developed Administrative Claims Database Covering Young, Middle-aged, and Elderly People.

Introduction: Noncommunicable diseases (NCDs) are an ongoing public health problem globally. The present study aimed to estimate the prevalence of NCDs in Japan using a newly developed, commercially available administrative claims database covering young, middle-aged, and elderly people. Methods: We compared the age-stratified population distribution between the DeSC administrative claims database and the population estimates. We calculated the 1 year prevalence of several NCDs using the DeSC database and compared the prevalence of diabetes mellitus and hypertension between the DeSC database and the Japan National Health and Nutrition Survey. Results: The age distribution of the population included in the DeSC database was similar to that of the population estimates. The estimated prevalence rates were as follows: diabetes mellitus (12.2%), hypertension (20.9%), ischemic heart disease (5.6%), heart failure (5.3%), cerebral infarction (3.4%), stroke (3.7%), gastric cancer (0.6%), colorectal cancer (0.8%), breast cancer (1.5%), prostate cancer (0.6%), cataract (7.1%), depression (3.5%), and osteoporosis (6.3%). The estimated prevalence of diabetes and hypertension was comparable with that of the National Health and Nutrition Survey. Conclusions: The distribution of age and sex in the database was comparable with that of the population estimates. The prevalence of diabetes mellitus and hypertension was comparable with that in a previously reported national survey. Our data can be utilized as basic information for policymaking in clinical medicine and public health in Japan.

Effect of early nutritional initiation on post‐cerebral infarction discharge destination: A propensity‐matched analysis using machine learning

Malnutrition is associated with poor outcomes in cerebral infarction patients, with research indicating that early nutritional initiation may improve the short-term prognosis of patients. However, evidence supported by big data is lacking. Here, to determine the effect of nutritional initiation during the first 3 days after hospital admission on home discharge rates, propensity score matching was conducted in patients with acute cerebral infarction. This retrospective observational study, using the Diagnosis Procedure Combination anonymised database in Japan, included 41 477 ischaemic cerebral infarction patients hospitalised between 2016 and 2019. The patients were divided into two groups: those who received oral or enteral nutrition during the first 3 days of hospital admission (early nutrition group, n= 37 318) and those who did not (control group, n= 4159). One-to-one pair-matching was performed using propensity scores calculated via extreme gradient boosting to limit the confounding variables of the two groups. After propensity score matching, 3541 pairs of patients were selected. The dependence of home discharge rates on early nutrition was significant (p< 0.05), and the effectiveness of early nutrition for home discharge showed an odds ratio of 1.79 (95% confidence interval of 1.59-2.03 in Fisher's exact test). Our findings revealed that early nutritional initiation during the first 3 days of admission resulted in higher home discharge rates.

Neuronal injuries in cerebral infarction and ischemic stroke: From mechanisms to treatment (Review).

Stroke is the leading cause of disabilities and cognitive deficits, accounting for 5.2% of all mortalities worldwide. Transient or permanent occlusion of cerebral vessels leads to ischemic strokes, which constitutes the majority of strokes. Ischemic strokes induce brain infarcts, along with cerebral tissue death and focal neuronal damage. The infarct size and neurological severity after ischemic stroke episodes depends on the time period since occurrence, the severity of ischemia, systemic blood pressure, vein systems and location of infarcts, amongst others. Ischemic stroke is a complex disease, and neuronal injuries after ischemic strokes have been the focus of current studies. The present review will provide a basic pathological background of ischemic stroke and cerebral infarcts. Moreover, the major mechanisms underlying ischemic stroke and neuronal injuries are summarized. This review will also briefly summarize some representative clinical trials and up-to-date treatments that have been applied to stroke and brain infarcts.

Aortic Thrombus Embolization in A Patient with Tuberous Sclerosis

AbstractTuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder affecting many organ systems. Patients commonly develop a variety of benign tumors as well as neurological disease, including seizures, autism, and cognitive delay. We report here the case of an adolescent patient with TSC and a history of mild COVID-19 who presented with a 1-day history of altered mental status. The patient was found to have ischemic cerebral infarction of the right MCA and ACA territories. Initial angiography showed an occlusion of the right internal carotid artery without a demonstrable etiology, with follow-up echocardiography and angiography revealing a large aortic thrombus. The patient was not a candidate for thrombus removal due to her cerebral infarct and received medical anticoagulation. Thrombosis progressed to involve the left ICA, with left cerebral infarction and subsequent death. Aortic thrombus embolization as a cause of cerebrovascular accident (CVA) is a novel finding in the setting of TSC and should be considered for pediatric patients with CVA of unknown etiology. It is unclear whether this was related to the prior COVID-19 infection.