Days Of Ischemic Stroke Research Articles

The dynamics of markers of apoptosis in the acute period of ischemic stroke

To study the dynamics of markers of apoptosis (Bcl-2, p53) in serum in the acute period of ischemic stroke (IS) in comparison to the severity of the neurological condition and the volume of infarct. Fifty-one patients (mean age 60.5±2.2 years) with the first ever carotid IS were examined within the first 24 hours. The comparison group consisted of 20 patients (mean age 58.7±2.1 years) with chronic cerebral insufficiency. Clinical and neurological dynamic examinations with assessment of neurological deficit using (NIHSS), CT/MRI of the brain; ELISA immunoassay of p53 and Bcl-2 in blood serum were carried out. Significantly higher levels of p53 and of Bcl-2 were shown on the 3rd and 10th days in patients with IS compared to the control group (p<0.05). An increase in the content of p53 was positively correlated with the severity of neurological deficit (NIHSS≥10) on the first and third days of acute IS and with larger amounts of damage to the brain parenchyma according to the MRI study from the first day of IS and all subsequent days. High levels of Bcl-2 were positively correlated with the large volume of brain damage only on the 10th day of IS (p<0.045). The results confirm the active involvement of pro- and antiapoptotic processes in the formation of delayed neuronal death in the brain, which are important components of damaged brain tissue in IS.

Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome.

BackgroundHow short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.MethodsPatients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.ResultsA total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03–1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01–1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.ConclusionShort-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day.

Association between Chlamydia Pneumonia Seropositivity and Ischemic Stroke: A Case-Control Study

Background: Apart from traditional risk factors, infectious agent might contribute to ischemic stroke. The aim of this study was to evaluate the association between Chlamydia pneumonia seropositivity and ischemic stroke.&#x0D; Methods: 42 ischemic stroke patients diagnosed by history, clinical examination and confirmed by CT scan or MRI of brain selected as case. The same number (42) of age and sex matched subjects having no history or clinical evidence of ischemic stroke were selected as control. Blood samples were collected within 2 to 14 days of ischemic stroke from indoor patients. Controls were collected from both indoor and outdoor patients with neurological disorders other than ischemic stroke. Anti-C. pneumoniae antibodies IgG and IgA were detected by ELISA (enzyme-linked immunosorbent assay) in the Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU).&#x0D; Results: Among the study population, 66.7% of cases and 45.2 % of control patients were seropositive to C. Pneumoniae IgG (OR: 2.42, 95% CI: 1.00 - 5.85, p = 0.048). Whereas IgA were positive in 81% of case and 57.1% of control (OR: 3.19, 95% CI: 1.19 - 8.52, p = 0.018). Seropositivity to IgA showed more significant results than IgG.&#x0D; Conclusion: There was a significant association between Chlamydia pneumonia seropositivity both IgG and IgA with ischemic stroke.&#x0D; Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 47-54

Abstract 246: Length of Stay and Its Association With Get With the Guidelines-stroke Award Recognition

Background and Objectives: The average length of stay (ALOS) provides important information regarding care efficiency and the financing of hospitals. A shorter ALOS helps to reduce hospital costs, increase capacity optimization, and improve hospital efficiency. A longer ALOS can be associated with reduced readmission rates and mortality rates. The objective of this study was to analyze the ALOS for stroke patients based on etiology subtype and Get With The Guidelines (GWTG)-Stroke award recognition. Methods: A retrospective review of the ALOS for hemorrhagic and ischemic stroke patients was conducted for the states of Illinois, Iowa, and Michigan from 99 hospitals using GWTG-Stroke from July 2014 through December 2015. Stroke subsets, GWTG award status, and ALOS were examined. Results: The national ALOS is 5.22 days for ischemic stroke, 12.75 days for subarachnoid hemorrhage (SAH), and 8.5 days for intracerebral hemorrhage (ICH). The ALOS for ischemic stroke was 4.36 days for non-award winning hospitals and 4.52 days for award winning hospitals. The ALOS for SAH was 7.51 days for non-award winning hospitals and 10.77 days for award winning hospitals. The ALOS for ICH was 18.63 days for non-award winning hospitals and 6.80 days for award winning hospitals. Further broken down, hospitals with a higher award (gold vs silver), had longer ALOS for both SAH and ICH (11.11 vs 8.72 and 7.07 vs 5.84 respectively), while there was no significant difference in ALOS for ischemic stroke. Conclusions: This study demonstrated that GWTG-Stroke award winning hospitals have a shorter ALOS for ICH and a higher ALOS for SAH than non-award winning hospitals. Those hospitals that have attained gold award status more closely align with national ALOS. Thus, hospitals that are more adherent to guideline recommended care via a quality improvement program may be more efficient when providing care, which impacts hospitals costs.

Abstract WP299: Patients Transferred to Tertiary Care Centers with Fatal Ischemic Strokes Increase Center Specific Mortality Rates

Background: The Center for Medicare and Medicaid Services (CMS) tracks annualized 30 day mortality data for patients with ischemic stroke across hospitals. Due to the increased complexity and severity of stroke patients transferred to tertiary centers, mortality rates would be expected to be higher than at institutions which transfer these patients. Publicly available mortality data may not adequately account for this referral pattern, making tertiary care centers appear to provide inferior care. Methods: We retrospectively analyzed all recorded deaths within 30 days of ischemic stroke from 2009-2011 at our Comprehensive Stroke Center. Data was abstracted from patient charts, including the NIHSS as recorded or calculated retrospectively based on documented exam, admission time, time of first palliative care consult, time of comfort care orders and time of death. Descriptive and nonparametric statistics were used. Results: There were 42 CMS patient deaths reviewed, median age (interquartile range, IQR) was 82 (75-87), median NIHSS = 22.5 (IQR 19-27), 55% were transferred in, 24% received IV tPA, 36% died within 72 hours of admission, 36% had Palliative Care consults and 90% were placed on comfort care. Transfer patients that died did not differ from direct admit deaths by age, NIHSS or death within 72 hours; NIHSS scores averaged 21 in the transferred group vs. 23 in the direct admits, death within 72 hours was 39% for transfers vs 31% for direct admits. There was a trend toward increased use of tPA (35% transfers vs. 11% direct admits, P = 0.07). Patients that died within 72 hours of admission had significantly higher NIHSS scores (26 (IQR 24-31) vs. 20 (IQR 13-25), P = 0.0025) and were less likely to have received a Palliative Care consult (13% vs. 48%, P = 0.024); there were no differences in age or other factors. Conclusions: Over half of the deaths counted in our institutions 30 day ischemic stroke mortality rate were from transfers. Almost all of these patients were placed on comfort care. Many passed away within 72 hours of admission. Early withdrawal of care for severe ischemic strokes in elderly patients may reflect higher, rather than lower, quality of care. Including early deaths with comfort care may bias the CMS mortality measure against tertiary referral centers.

Symptomatic Carotid Occlusion Is Frequently Associated With Microembolization.

Symptomatic carotid artery disease is associated with significant morbidity and mortality. The pathophysiologic mechanisms of cerebral ischemia among patients with carotid occlusion remain underexplored. We conducted a prospective observational cohort study of patients hospitalized within 7 days of ischemic stroke or transient ischemic attack because of ≥50% carotid artery stenosis or occlusion. Transcranial Doppler emboli detection was performed in the middle cerebral artery ipsilateral to the symptomatic carotid. We describe the prevalence of microembolic signals (MES), characterize infarct topography, and report clinical outcomes at 90 days. Forty-seven patients, 19 with carotid occlusion and 28 with carotid stenosis, had complete transcranial Doppler recordings and were included in the final analysis. MES were present in 38%. There was no difference in MES between those with carotid occlusion (7/19, 37%) compared with stenosis (11/28, 39%; P=0.87). In patients with radiographic evidence of infarction (n=39), 38% had a watershed pattern of infarction, 41% had a nonwatershed pattern, and 21% had a combination. MES were present in 40% of patients with a watershed pattern of infarction. Recurrent cerebral ischemia occurred in 9 patients (19%; 6 with transient ischemic attack, 3 with ischemic stroke). There was no difference in the rate of recurrence in those with compared to those without MES. Cerebral embolization plays an important role in the pathophysiology of ischemia in both carotid occlusion and stenosis, even among patients with watershed infarcts. The role of aggressive antithrombotic and antiplatelet therapy for symptomatic carotid occlusions may warrant further investigation given our findings.

Algorithms of the correction of fluid and electrolyte disorders in patients with severe ischemic stroke

To develop a practical algorithm for the correction of sodium levels and osmolality of blood plasma during the acute period of severe ischemic stroke (IS). One hundred and fifty patients with cardioembolic or atherothrombotic stroke, aged from 30 to 80 years, hospitalized in the first 12 h after symptom emergence, were examined. Neurological deficit was assessed with the NIHSS. The monitoring of blood plasma sodium level and osmolality of blood plasma in the 1st and 5th day after stroke as well as of blood circulation volume was performed. The level of antidiuretic hormone (ADH) was measured in patients with hyperosmolar syndrome with hypernatremia. It has been shown that hyponatremia is not an independent predictor of outcome of IS, but requires a diagnostic search of the causes of this condition with subsequent correction of sodium levels. For hypernatremia therapeutic tactics varies depending on the timing of the beginning of IS. A conservative strategy for the correction of hypernatremia to plasma sodium blood levels of 150 mmol/L on the first day of IS and to 155 mg/dL since the third day can be used. If these values are exceeded, the most rapid correction of hypernatremia is necessary.

Use of computer stimulating programs in patients with post-stroke cognitive impairment

Objective: to evaluate the efficiency of using computer stimulation programs (CSPs) for acute ischemic stroke (IS) in patients with cognitive impairment (CI). Patients and methods. 81 patients aged 40 to 79 years with post-stroke CI (PSCI) were examined and randomized into two groups. A study group consisted of 45 people, including 31 and 14 patients with predementia CI and mild dementia, respectively; their median age was 61 [55; 68] years. A comparison group included 36 patients, including 21 and 15 patients with predementia CI and mild dementia; their median age was 64 [57; 70] years. In addition to standard stroke therapy, the study group received a ten-day correction cycle for CI, by using CSPs. Cognitive functions (CF) were evaluated before and after classes, by applying a short mental status questionnaire (SMSQ), a battery of frontal lobe dysfunction tests (BFLDT), a clock drawing test, and a speech activity test. Results. After 10 days of therapy (at 18–20 days of IS), the patients were observed to have statistically significant improvements of cognitive functions in all major neuropsychological scales: SMSQ, BFLDT, a clock drawing test, and a speech activity test (p>0.05). Assessing the total indicators of SMSQ subtests in both groups showed that the study group achieved statistically significant differences in memory, time and place orientation, and concentration. In the study group, the total values of BFTLD subtests were also statistically better in indicators, such as speech fluency (by 33.0%), dynamic praxis (by 23.3%), a simple choice reaction (by 30.0%), and a complicated choice reaction (by 26.7%). At the same time, not only trained functions (attention, memory), but also other cognitive indicators improved. Re-examination demonstrated that the achieved results persisted 6-8 months later. Conclusion. CSPs are a promising area of neurorehabilitation. The method is effective, easy-to-use; the patients can do lessons at hospital and at home after discharge in the presence of relatives or themselves. Further investigations will be able to evaluate the effectiveness of CSPs in patients with PSCI in the later periods of IS.

The fluctuation of free amino acids in serum during acute ischemic stroke

Abstract Currently, little data exists regarding the involvement of free amino acids (AA) in the pathogenesis of ischemic stroke (IS). Thus, our objective was to study the degree of the degree of fluctuation of free amino acids level in serum during the acute phase of IS. The study consisted of eighteen patients (female/male: 10/8; age: 73.1 ± 4.1) with acute IS that was confirmed by way of computed tomography, while twelve sex and age matched individuals were assigned as control group. During the study period, the patients did not receive any supplemental amino acids therapy that could affect the obtained results. The venous blood was obtained after &gt;3 hours fasting at two time-points; time-point 1 – at admission to the hospital; time-point 2 – on day 5 from stroke onset. The blood for control purposes was collected only once, and the blood collection at time-point 1 was done before thrombolytic treatment (nine patients). The amino acids were identified using the Amino Acids Analyser (AAA 400) by INGOS Corp., Praha, Czech Republic. Our results revealed a statistically significant increase of glutamate, cystine and methionine on day 1 of stroke, in comparison to control, whereas, proline level was decreased on day 1 of stroke – in comparison to control serum. On comparing day 5 to the initial day of IS, elevation was observed of levels of asparagine, glycine, tyrosine, arginine, threonine, valine, leucine and phenylalanine. It can be said, then, that ischemic stroke induces both essential and nonessential amino acid fluctuations. Moreover, the decrease in proline and glutamine serum level with the simultaneous increase in the concentration of branch chain amino acids, Glu and Thr suggests a violent mobilization of the body’s proteins. Thus, a decrease of Pro and a simultaneous increase of Glu serum level could be considered as a marker of acute IS.

Prognostic Value of Hypothalamic Copeptin in Acute Ischemic Stroke

Background: Some studies showed that copeptin, a hypothalamic hormone derived from the precursor of vasopressin, may be useful in the prediction of outcome of ischemic cerebral stroke. The aim of this work was to search if there is any correlation between serum copeptin, in the first day of ischemic stroke, and its clinical severity, radiological findings and also its predictive value of functional outcome in these patients. Methods: This study was conducted on 55 patients of both sexes with ischemic cerebral stroke admitted to Neurology Department, Menofyia University within 24 hours of the onset of ischemic stroke. Patients were subjected to general and neurological examination, laboratory assessment (routine and serum level of copeptin), and brain computerized tomography (CT), or magnetic resonance imaging (MRI). The anatomical site of stroke was evaluated by using the Oxford Community Stroke Project (OCSP) classification. The etiological subtypes of stroke were classified according to Trial of Organization 10172 in Acute Stroke Treatment (TOAST) classification. Stroke severity was evaluated by Scandinavian stroke scale (NIHSS) and disability by modified Rankin scale (MRS) at admission and at 30 days. Results: The results showed high statistically significant correlation between the mean value of copeptin level and severity of stroke on admission (P < 0.001), and also with the size of the infarction (P < 0.001). There was statistically significant difference (P = 0.011) of copeptin level among the studied groups regarding the site of stroke. Additionally, there was high statistically significant difference (P < 0.001) between copeptin level and the etiological subtypes of stroke. The favorable outcome of the stroke was with cutoff point of copeptin below 21.5 ng/mL. Conclusion: Serum copeptin may help in the prediction of severity of ischemic stroke, its size, site, etiological subtypes and functional outcome. J Neurol Res. 2016;6(2-3):41-45 doi: http://dx.doi.org/10.14740/jnr377w

Abstract TMP61: Outcomes After Ischemic Stroke Among “America’s Best Hospitals”

Background: The ranking of “America’s Best Hospitals” by the US News &amp; World Report is a popular hospital-profiling system, but it is not known whether the 50 top hospitals for Neurology and Neurosurgery have lower 30-day risk-standardized mortality (RSMR) and readmission rates (RSRRs) after stroke compared with other hospitals, or whether outcomes are comparable among these 50 top hospitals. Methods: The 50 top hospitals for adult Neurology and Neurosurgery were identified from the 2015-16 US News &amp; World Report rankings. CMS Hospital Compare provided RSMRs and RSRRs within 30 days of ischemic stroke for hospitals with ≥25 stroke cases/year. We fit a mixed model to assess differences in RSMRs and RSRRs between top-ranked vs other hospitals, adjusted for hospital characteristics and weighted by hospital volume. Among the 50 top-ranked hospitals, we explored whether ranking order was associated with outcomes. Results: Among 2718 hospitals, the 50 top-ranked vs other hospitals had lower mean 30-day mortality (RSMR 14.8% vs 15.3%, p&lt;.01) but higher readmission (RSRR 14.5% vs 13.4%, p&lt;.01). These patterns persisted in adjusted analyses; top hospitals had lower mortality by 0.98% (95% CI -1.36%, -0.60%) and higher readmission by 0.66% (0.41%, 0.92%). Among top hospitals, there was considerable variability in risk-standardized outcomes, ranging from 9.5-19.3% for mortality and 10.8-17.5% for readmission. RSMRs were lower than the national average for 14% of top hospitals while RSRRs were lower for only 2% and higher for 14% (figure). Hospital rank was not significantly associated with either mortality (RSMR 0.04% increase with each rank, 95% CI 0.0%, 0.08%) or readmission (RSRR -0.01%; 95% CI -0.04%, 0.02%) among the 50 top-ranked hospitals. Conclusions: Admission to a top-ranked hospital for Neurology or Neurosurgery was associated with lower 30-day risk-standardized mortality but higher readmission. There was considerable heterogeneity among the top 50 hospitals.

Worse Neurological State During Acute Ischemic Stroke is Associated with a Decrease in Serum Albumin Levels.

High serum albumin levels during ischemic stroke (IS) decrease the risk of a poor outcome. This study aimed to determine whether serum albumin levels within the first days after IS correlate with radiological and biochemical markers of brain tissue damage. Fifty-six IS patients were enrolled into the study. Neurological examinations were based on the National Institute of Health Stroke Scale. Serum albumin levels and S100BB were evaluated using commercially available ELISA kits. The albumin decrease index (ADI) was calculated as the difference between serum albumin levels measured on days 1 and 10 of IS. All parameters were estimated on the 1st, 3rd, 5th, and 10th days of IS, and the volume of ischemic focus was measured on the 10th day. Mean serum albumin levels were decreased during acute IS. There were correlations between the ADI and mean S100BB serum levels (r = 0.36, p < 0.05), the volume of ischemic focus (r = 0.39, p < 0.05), and the patients’ neurological state when measured on day 10 of IS (r = 0.59, p < 0.001). A decrease in serum albumin levels during the acute phase of IS corresponds to a worse neurological state as a result of a large ischemic focus with intense catabolic processes.

Endovascular Treatment of Thrombosis and Embolism.

Deep venous thrombosis (DVT) is a common disorder with a significant mortality rate. Successful endovascular treatment of acute DVT is most likely to be achieved in patients with recently formed thrombus, (<10-14 days) with acute iliofemoral DVT. Endovascular treatment options include: Catheter-directed thrombolysis (CDT), pharmacomechanical catheter-directed thrombolysis (PCDT), percutaneous aspiration thrombectomy (PAT), vena cava filter protection, venous balloon dilatation and venous stent implantation. Current practice shows strong clinical tendency for the use of PCDT with or without other endovascular methods and an individualized approach for each DVT patient. PMT has not received general acceptance because of the associated risk of PE and damage to venous valves caused by thrombectomy devices. PAT is most commonly used as an adjunctive endovascular technique like balloon maceration to fragment thrombus, balloon angioplasty, stent implantation and vena cava filter placement. Interventional endovascular therapies for DVT have the potential to provide PE protection and prevention of PTS. Patient centered individualized approach for endovascular DVT treatment is recommended to optimize the ideal clinical result.Acute stroke is the leading cause of death for people above the age of 60 and the fifth leading cause in people aged 15-59. Mortality during the first 30 days of ischemic stroke is 20% and 30% of survivors will remain permanently disabled. Acute stroke patients within the therapeutic window must receive IVrtPA unless there is a contraindication. In case of contraindication to IVrtPA or for patients out of the therapeutic window for thrombolytics, standart of care is the intraarterial treatment. Patients have to be transferred to a comprehensive stroke center with capacity of dedicated neurovascular imaging and interventional neuroradiology. Noncontrast head CT that is used to rule out hemorrhage is followed by imaging studies dedicated to show if there is reasonable penumbra to save. Intraarterial thrombolysis has the main advantage of extended therapy window, earlier and more efficient recanalization and less risk of hemorrhage due to lower doses of thrombolytics. Mechanical thrombectomy has several advantages over IV/IA fibrinolysis including faster recanalization and less risk of hemorrhage especially in large artery occlusions. ASA guidelines recommend choosing stent retrievers over other devices for mechanical thrombectomy. Better recanalization rates and less infarct volume after mechanical thrombectomy result in higher numbers of functionally independent patients compared with other treatments. Two landmark studies that were published recently, SWIFT PRIME and MR CLEAN, showed that IA treatment especially with the new stent retrievers lead to a significant increase in functional recovery and independence in daily life after an acute stroke.Cerebral venous and sinus thrombosis (CVST) comprises nearly 0.5-1% of all stroke cases. CVST causes different neurological deficits depending on the sinus/cortical vein involved. CVST may cause death and dependency in 13.4% of patients. CT/CT venography and MR/MR venography can be effectively used to diagnose and to follow up CVT cases. Anticoagulation with heparin is the most widely accepted therapy to prevent the expansion of the thrombus. Patients deteriorating despite heparinization and patients presenting with very severe neurological deficits must receive endovascular treatment. Endovascular methods include intrasinus infusion of thrombolytics or heparin, balloon angioplasty, mechanical thrombectomy or a combination of different techniques. There is a higher rate or recanalization with endovascular methods compared to other medical therapies.

Clinical and stabilometric restructuring of patients stability during balance therapy from the first days of ischemic stroke

To study the process of recovery of postural function during stabilometric training with biofeedback (BFB) in patients with ischemic carotid stroke. Forty-two patients underwent 10-day stabilometric training from the onset of stroke. Clinical and stabilometric parameters were assessed at 4 points: at baseline, after 5 sessions, after 10 sessions and after 3-4 months in the early recovery stage after discharge from the hospital. There was no correlation between the positive regress of neurologic symptoms and trends of stabilometry indicators. The latter were deteriorated in the very acute and acute stages (in case of positive clinical dynamics) compared to normative indicators, a trend toward normalization appeared in the early recovery period that reflects the reorganization of postural mechanisms and formation of a new model of balance control. Stabilometric training decreased neurological deficit in the patients. The remote effect of BFB-treatment was noted as well. Stabilometric training in the very acute period was safe and effective in patients with mild to moderate stroke.

Prognostic Value of Hypothalamic Copeptin in Acute Ischemic Stroke

Background: Some studies showed that copeptin, a hypothalamic hormone derived from the precursor of vasopressin, may be useful in the prediction of outcome of ischemic cerebral stroke. The aim of this work was to search if there is any correlation between serum copeptin, in the first day of ischemic stroke, and its clinical severity, radiological findings and also its predictive value of functional outcome in these patients. Methods: This study was conducted on 55 patients of both sexes with ischemic cerebral stroke admitted to Neurology Department, Menofyia University within 24 hours of the onset of ischemic stroke. Patients were subjected to general and neurological examination, laboratory assessment (routine and serum level of copeptin), and brain computerized tomography (CT), or magnetic resonance imaging (MRI). The anatomical site of stroke was evaluated by using the Oxford Community Stroke Project (OCSP) classification. The etiological subtypes of stroke were classified according to Trial of Organization 10172 in Acute Stroke Treatment (TOAST) classification. Stroke severity was evaluated by Scandinavian stroke scale (NIHSS) and disability by modified Rankin scale (MRS) at admission and at 30 days. Results: The results showed high statistically significant correlation between the mean value of copeptin level and severity of stroke on admission (P &lt; 0.001), and also with the size of the infarction (P &lt; 0.001). There was statistically significant difference (P = 0.011) of copeptin level among the studied groups regarding the site of stroke. Additionally, there was high statistically significant difference (P &lt; 0.001) between copeptin level and the etiological subtypes of stroke. The favorable outcome of the stroke was with cutoff point of copeptin below 21.5 ng/mL. Conclusion: Serum copeptin may help in the prediction of severity of ischemic stroke, its size, site, etiological subtypes and functional outcome. J Neurol Res. 2016;6(2-3):41-45 doi: http://dx.doi.org/10.14740/jnr377w

Low Concentration of BDNF in the Acute Phase of Ischemic Stroke as a Factor in Poor Prognosis in Terms of Functional Status of Patients.

BackgroundAccording to recent studies, brain-derived neurotrophic factor (BDNF) probably plays a role in development of cerebral ischemia and can be significant for the prognosis of improved mobility after stroke. The aim of this prospective study was to evaluate the blood concentration of BDNF during the 1st day of first-ever ischemic stroke and find a potential association between BDNF concentration and the neurological status in the acute period, as well as between BDNF and the functional status in the sub-acute phase of stroke.Material/MethodsThe prospective study involved 87 patients aged 39–99 years (42 women, 45 men) with first-in-life complete ischemic stroke.All study subjects underwent analysis as follows: BDNF blood concentration and neurological status according to NIHSS on the 1st day of stroke, comorbidities, etiological type of ischemic stroke by ASCOD, and functional status on the 14th and 90th day after the onset according to mRankin scale.ResultsMean concentration of BDNF in the study group was 9.96 ng/mL±5.21, median 10.39 ng/mL. Patients aged ≤65 years (25 individuals) had a significantly higher mean concentration of BDNF (11.94 ng/mL±4.46; median 12.34 ng/mL) than the older subjects (62 individuals) with a mean concentration of 9.17 ng/mL±5.32 (median 8.66 ng/mL).The mean score by mRankin scale on the 90th day was significantly higher among patients with lower concentrations of BDNF on the 1st day of stroke, which reflects their poorer functional status.The functional status on the 90th day was significantly worse (3–6 points by Rankin scale) in patients who had BDNF below the mean value in the acute phase of stroke.The independent factors for poor functional status of patients on the 90th day after stroke were a score >4 points by NIHSS (RR 1.14; 95% CI: 1.00–1.31; p=0.027) and the concentration of BDNF below the mean value (assessed on the 1st day of stroke) (RR 14.49; CI 4.60–45.45; p=0.000).ConclusionsThe neurological status and concentration of BDNF on the 1st day of ischemic stroke are independent prognostic factors in medium-term observation.Reduction in the concentration of BDNF in the acute phase of stroke is a factor for poor prognosis in terms of the functional status of patients on the 90th day after onset.

Activity of different subtypes of superoxide dismutase in acute period of ischemic stroke

86 patients in the acute period of ischemic stroke (IS) were involved in a study of the activity of general SOD, intracellular (Cu,Zn-SOD), mitochondrial (Mn-SOD2) and numbers of white blood cells with a high content of intracellular reactive oxygen species (ROS+-cells). A reduction of activity of general SOD, Cu,Zn-СОД, Mn-SOD and increase of ROS+-cells number were detected. There was a reliable negative correlation between activity of general SOD, Mn-SOD and the number of ROS+-cells on the 1st day of IS. It was established that the activity of the general SOD, Cu,Zn-СОД, Mn-SOD and number of ROS+-cells depend on the severity of the IS and the infarct size. Credible negative correlations were found at the moderate and severe IS and infarct size 10-100 cm2. A direct reliable correlation between the content of ROS+-cells and degree of the severity and size of the IS were observed.

Activity of cathepsin D in acute period of ischemic stroke

Free (FA) and total (TA) activities of cathepsin D in serum of 86 patients in the acute period of ischemic stroke (IS) were studied. It was established that in patients with IS FA and TA of cathepsin D increases. The activity of cathepsin D depends on the patient`s age and stroke severety. In 45-60 year-old patients on the 1st day of IS we revealed significantly greater TA and FA of cathepsin D compared with patients older than 60. On the 7th day FA of cathepsin D in 45-60 year-old patients was significantly lower than in patients older than 60 and correlated with the patient`s age. The lowest TA and FA of cathepsin D on the 1st day were found in the patients with mild IS, the highest – in the patients with moderate stroke. In patients with mild and moderate IS on the 7th day was observed reduced FA of cathepsin D while in the patients with severe IS - its increase.

Dynamic cerebral autoregulation is compromised in ischaemic stroke of undetermined aetiology only in the non-affected hemisphere

Background and purposeTo assess dynamic cerebral autoregulation (CA) in patients with acute ischaemic stroke of undetermined aetiology, within 72h of stroke onset. Materials and methodsIn 6 patients with ischaemic stroke of undetermined aetiology (aged 66±9 years, National Institutes of Health Stroke Scale [NIHSS] score on admission: 4.0, range: 4–11), selected based on screening of 118 consecutive ischaemic stroke patients and in 14 volunteers (aged 62±10 years), we continuously monitored RR intervals (RRI), mean arterial pressure (MAP) by means of photoplethysmography, mean cerebral blood flow velocity (CBFV) using transcranial Doppler ultrasonography, end-tidal CO2 (ETCO2) and respiration during 2-min deep breathing paced at 6min−1 (0.1Hz). To assess CA, we evaluated the impact of breathing-induced MAP oscillations on fluctuations of CBFV in the hemispheres with stroke, the non-involved hemispheres and randomly selected hemispheres of controls by applying cross-spectral analysis and calculating coherence, transfer function gain (CBFV–MAP gain) and phase shift angle between the two oscillating signals. ResultsPhase shift angle between MAP and CBFV oscillations showed values >0 and was significantly reduced in the hemispheres without stroke as compared to controls (0.39±0.95 vs. −1.59±0.33rad, p=0.015), whereas in the hemispheres with stroke, phase shift angle did not differ significantly from that observed in the control hemispheres. Clinical status of stroke patients significantly improved at discharge from the hospital (NIHSS: 2.0, range: 1–8, p=0.028). ConclusionsDuring the first days of ischaemic stroke of undetermined aetiology, dynamic cerebral autoregulation is compromised in the non-affected hemisphere, but not in the hemisphere with ischaemic lesion.

Abstract 61: Safety and Feasibility of Acute Dabigatran Therapy in Minor Ischemic Stroke Patients Without Atrial Fibrillation.

Introduction: Transient Ischemic Attack (TIA) and Minor ischemic stroke (MIS) patients are at high risk for recurrent events. Older anticoagulants are associated with a reduction in recurrent events, but also an increase in hemorrhagic transformation (HT). Dabigatran etexilate (DE), a novel oral anticoagulant that is associated with reduced risk of intracranial bleeding in atrial fibrillation (AF) patients, may be an effective therapy in this population. DE is not indicated within 14 days of ischemic stroke, due to an absence of data. We tested the feasibility and safety of initiating DE therapy within 24 h of TIA/MIS. Methods: We designed a 50 patient single arm open label treatment trial. The primary endpoint was symptomatic HT within 30 days of enrolment. All patients underwent MRI prior to treatment. TIA/MIS patients (NIHSS score ≤3) with a DWI lesion were prospectively treated with DE 150 mg BID (110 mg BID in patients ≥ 80 or if CrCl &lt;40 ml/min). Treatment began within 24 h of onset and continued for 30 days. Patients with known atrial fibrillation (AF) were excluded. Patients were re-imaged at day 7 and 30, with clinical assessment to 90 days. Results: Forty-three of 50 patients have been enrolled to date (March 2012-August 2013). The mean age was 66±12 years and median (IQR) NIHSS was 1 (2). Median baseline DWI volume was 0.89(1.9) ml. The median time from onset to initial DE dose was 18.5 (12.2) h. Therapy was completed in 41 patients and discontinued in two (withdrawal of consent (1) and dysphagia (1)). Two patients died within the 90 day study period, both after completion of DE therapy. No patients experienced systemic bleeding or symptomatic intracranial hemorrhage. One patient had asymptomatic HT (ECASS grade, HI1) on day 7, which resolved by day 30 despite continuing DE. No patients experienced recurrent clinical stroke. New asymptomatic DWI lesions developed in 7 (16%) patients by day 30. Conclusion: These preliminary data suggest DE may be used safely in acute TIA/MIS patients and larger randomized trials are warranted. The low HT rate may make DE an ideal antithrombotic for use immediately after TIA/ischemic stroke.