Early Ischemic Stroke Research Articles

Stroke : Highlights of Selected Articles

<i>Stroke</i> : Highlights of Selected Articles

Clinical, Laboratory, and Imaging Characteristics of Transient Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and Intracranial Arteries

Background/Aims: The aims of this study were to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 h of TIA onset between April 2008 and December 2013, 85 patients (63 men, mean age 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared with those in the extracranial group. Eleven patients in the extracranial group and none in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2 vs. 0%, p = 0.044) and the 90-day risk (17.1 vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Among our patients with TIA caused by large artery disease, patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

Concurrent Carotid Inflammation in Acute Coronary Syndrome as Assessed by 18F-FDG PET/CT: A Possible Mechanistic Link for Ischemic Stroke

Patients with acute coronary syndrome (ACS) are prone to ischemic stroke (IS) especially during the early phase. ACS patients are more likely to have concurrent complex carotid plaques which, when destabilized, may serve as a source of distal embolism. This study investigated whether inflammatory activity in carotid artery was increased in ACS survivors compared to chronic stable angina (CSA) patients. We prospectively enrolled 74 patients with ACS or CSA (39 ACS patients versus 35 CSA patients), and fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was performed within 1 week after diagnosis. Carotid PET signal was quantified as standardized uptake value (SUV) and target-to-background ratio (TBR, carotid SUV/jugular venous SUV). Baseline characteristics were similar between groups. TBRs and SUVs were significantly higher in the carotid arteries of ACS patients than those of CSA patients (P < .001). Systemic inflammatory biomarker correlated significantly with carotid FDG uptake (high-sensitivity C-reactive protein versus average SUV: r = .361, P = .002), and the presence of cardiovascular risk factors was also related to inflammation activity. During follow-up, 3 cerebrovascular events occurred in ACS patients (including 1 early IS in a patient with severe baseline carotid inflammation), whereas none in CSA patients (P = .057). This study provided in vivo evidence that ACS survivors might experience concurrent carotid arterial inflammation. Our findings supported the role of systemic immune activation contributing to multiarterial instability in symptomatic atherosclerosis as a possible mechanistic link between ACS and IS.

Added value of CT perfusion and CT angiography in detection of early ischemic stroke: Comparison with noncontrast CT

The purpose of this study was to determine whether PCT and CTA increase the sensitivity of NCT in early diagnosis of acute ischemic stroke. Patients and methodsSixty-four patients of acute stroke were retrospectively evaluated with respect to early CT findings. This included findings on noncontrast CT, perfusion defects and angiographic findings of vascular occlusion. Inclusion criteria comprised a clinical and radiological diagnosis of ischemic stroke based on clinical data and the presence of infarction in follow-up MRI scans done 12–24h after the onset of the neurologic deficit. ResultsCT perfusion showed evidence of cerebral hypo-perfusion in the form of prolonged MTT and decreased CBF in all stroke cases giving 100% sensitivity. The CBV was decreased in only 24 cases and was normal in 24 cases and increased in 16 cases. Analysis of the CTA revealed artery occlusion in 55 (86%) cases, while it was normal in 8 (12.5%) cases. ConclusionCT perfusion and CTA provide effective diagnostic tools in acute stroke with increased sensitivity to detect acute cerebral ischemia compared with noncontrast CT alone.

Stroke : Highlights of Selected Articles

<i>Stroke</i> : Highlights of Selected Articles

Inter-Observer Agreement on Diffusion-Weighted Magnetic Resonance Imaging Interpretation for Diagnosis of Acute Ischemic Stroke Among Emergency Physicians

SUMMARYObjectivesDiffusion-weighted magnetic resonance imaging (DW-MRI) is a highly sensitive tool for the detection of early ischemic stroke and is excellent at detecting small and early infarcts. Nevertheless, conflict may arise and judgments may differ among different interpreters. Inter-observer variability shows the systematic difference among different observers and is expressed as the kappa (Κ) coefficient. In this study, we aimed to determinate the inter-observer variability among emergency physicians in the use of DW-MRI for the diagnosis of acute ischemic stroke.MethodsCranial DW-MRI images of 50 patients were interpreted in this retrospective observational cross-sectional study. Patients who were submitted to DW-MRI imaging for a suspected acute ischemic stroke were included in the study, unless the scans were ordered by any of the reviewers or they were absent in the system. The scans were blindly and randomly interpreted by four emergency physicians. Inter-observer agreement between reviewers was evaluated using Fleiss’ Κ statistics.ResultsThe mean kappa value for high signal on diffusion-weighted images (DWI) and for reduction on apparent diffusion coefficient (ADC) were substantial (k=0.67) and moderate (k=0.60) respectively. The correlation for detection of the presence of ischemia and location was substantial (k: 0.67). There were 18 false-positive and 4 false-negative evaluations of DWI, 15 false positive and 8 false-negative evaluations of ADC.ConclusionsOur data suggest that DW-MRI is reliable in screening for ischemic stroke when interpreted by emergency physicians in the emergency department. The levels of stroke identification and variability show that emergency physicians may have an acceptable level of agreement.

Bystander Effect Fuels Human Induced Pluripotent Stem Cell-Derived Neural Stem Cells to Quickly Attenuate Early Stage Neurological Deficits After Stroke.

: Present therapies for stroke rest with tissue plasminogen activator (tPA), the sole licensed antithrombotic on the market; however, tPA's effectiveness is limited in that the drug not only must be administered less than 3-5 hours after stroke but often exacerbates blood-brain barrier (BBB) leakage and increases hemorrhagic incidence. A potentially promising therapy for stroke is transplantation of human induced pluripotent stem cell-derived neural stem cells (hiPSC-NSCs). To date, the effects of iPSCs on injuries that take place during early stage ischemic stroke have not been well studied. Consequently, we engrafted iPSC-NSCs into the ipsilesional hippocampus, a natural niche of NSCs, at 24 hours after stroke (prior to secondary BBB opening and when inflammatory signature is abundant). At 48 hours after stroke (24 hours after transplant), hiPSC-NSCs had migrated to the stroke lesion and quickly improved neurological function. Transplanted mice showed reduced expression of proinflammatory factors (tumor necrosis factor-α, interleukin 6 [IL-6], IL-1β, monocyte chemotactic protein 1, macrophage inflammatory protein 1α), microglial activation, and adhesion molecules (intercellular adhesion molecule 1, vascular cell adhesion molecule 1) and attenuated BBB damage. We are the first to report that engrafted hiPSC-NSCs rapidly improved neurological function (less than 24 hours after transplant). Rapid hiPSC-NSC therapeutic activity is mainly due to a bystander effect that elicits reduced inflammation and BBB damage. Clinically, cerebral vessel occlusion is rarely permanent because of spontaneous or thrombolytic therapy-mediated reperfusion. These results have clinical implications indicating a much extended therapeutic window for transplantation of human induced pluripotent stem cell-derived neural stem cells (hiPSC-NSCs; 24 hours after stroke as opposed to the 5-hour window with tissue plasminogen activator [tPA]). In addition, there is potential for a synergistic effect by combining hiPSC-NSC transplantation with tPA to attenuate stroke's adverse effects.

Effect of Blood Pressure Lowering in Early Ischemic Stroke: Meta-Analysis.

Elevated blood pressure is common in acute stage of ischemic stroke and the strategy to manage this situation is not well established. We therefore conducted a meta-analysis of randomized controlled trials comparing active blood pressure lowering and control groups in early ischemic stroke. Pubmed, EMBASE, and Clinicaltrials.gov from January 1966 to March 2015 were searched to identify relevant studies. We included randomized controlled trials with blood pressure lowering started versus control within 3 days of ischemic stroke onset. The primary outcome was unfavorable outcome at 3 months or at trial end point, defined as dependency or death, and the key secondary outcome was recurrent vascular events. Pooled relative risks and 95% confidence intervals were calculated using random-effects model. The systematic search identified 13 randomized controlled trials with 12 703 participants comparing early blood pressure lowering and control. Pooling the results with the random-effects model showed that blood pressure lowering in early ischemic stroke did not affect the risk of death or dependency at 3 months or at trial end point (relative risk, 1.04; 95% confidence interval, 0.96-1.13; P=0.35). Also, blood pressure lowering also had neutral effect on recurrent vascular events, as well as on disability or death, all-cause mortality, recurrent stroke, and serious adverse events. This meta-analysis suggested blood pressure lowering in early ischemic stroke had a neutral effect on the prevention of death or dependency.

Abstract T P43: Hyperdense Basilar Artery (HDBA) Sign: Its Association With Clinical Signs, Symptoms And Outcome Of Posterior Circulation Ischemic Stroke

Background and purpose: Posterior circulation ischemic stroke is a clinical syndrome associated with ischemia related to stenosis, in situ thrombosis, or embolic occlusion of the posterior circulation arteries - the vertebral arteries, basilar, posterior cerebral arteries, and their branches. In order to reach the definite diagnosis, different imaging methods can be used, such as CT (computed tomography) and MRI (magnetic resonance imaging), or by conventional angiography. Hyperdense Basilar artery (HDBA) is a radiologic sign seen on unenhanced computed tomography scan suggestive of an early ischemic stroke. In a hospital facility that lacks advancement in neuroimaging, evaluating HDBA sign on unenhanced cranial CT scan can help clinicians in the diagnosis of posterior circulation ischemic stroke. Methods: A total of 67 subjects were included in the study. Medical records and neuroimaging of patients with a final diagnosis of posterior circulation ischemic stroke were retrieved. The radiologist who read the Cranial CT Scan was blinded as to the clinical signs, symptoms, and outcome of our subjects. All neuroimaging were reviewed as to location of the posterior circulation infarction, and for presence or absence of HDBA sign. Results: There were higher proportions with cerebellar signs and quadriplegia among those with positive HDBA sign, and a higher proportion with ocular signs among those with negative HDBA sign. However, we found no significant statistical difference (P=0.185). Location of infarction (P=0.363), baseline NIHSS (p=0.307), MRS on discharge (P=0.938), and timing of neuroimaging (P=0.227) were also not statistically significant. A positive HDBA sign had low sensitivity (54%), specificity (43%) and positive predictive value (16%). However, it had a high negative predictive value which means that among those found without an HDBA sign, 83% are likely to survive. Conclusion: There is no significant association between HDBA sign and clinical findings among patients with a posterior circulation ischemic stroke. Among those found with a positive HDBA sign, there is high likelihood for the presence of infarction and for those with a negative HDBA sign, a higher likelihood for survival.

Low-molecular-weight heparin or dual antiplatelet therapy is more effective than aspirin alone in preventing early neurological deterioration and improving the 6-month outcome in ischemic stroke patients.

Background and PurposeDual antiplatelet therapy (DAT) with clopidogrel and aspirin has been shown to confer greater protection against early neurological deterioration (END) and early recurrent ischemic stroke (ERIS) than aspirin alone in patients who have experienced an acute ischemic stroke. However, few studies have compared the effects of anticoagulation therapy with low-molecular-weight heparin (LMWH), DAT, and aspirin.MethodsPatients with acute ischemic stroke (n=1,467) were randomized to therapy groups receiving aspirin (200 mg daily for 14 days, followed by 100 mg daily for 6 months), DAT (200 mg of aspirin and 75 mg of clopidogrel daily for 14 days, then 100 mg of aspirin daily for 6 months), or LMWH (4,000 antifactor Xa IU of enoxaparin in 0.4 mL subcutaneously twice daily for 14 days, followed by 100 mg of aspirin daily for 6 months). The effects of these treatment strategies on the incidence of END, ERIS, and deep-vein thrombosis (DVT) were observed for 10-14 days after treatment, and their impacts on a good outcome were evaluated at 6 months.ResultsThe DAT and LMWH were associated with a more significant reduction of END and ERIS within 14 days compared with aspirin-alone therapy. In addition, LMWH was associated with a significantly lower incidence of DVT within 14 days. At 6 months, DAT or LMWH improved the outcome among patients aged >70 years and those with symptomatic stenosis in the posterior circulation or basilar artery compared with aspirin.ConclusionsLMWH or DAT may be more effective than aspirin alone for reducing the incidence of END and ERIS within 14 days, and is associated with improved outcomes in elderly patients and those with stenosis in the posterior circulation or basilar artery at 6 months poststroke.

Population-based study of blood biomarkers in prediction of subacute recurrent stroke.

Risk of recurrent stroke is high in the first few weeks after transient ischemic attack or stroke and clinical risk prediction tools have only limited accuracy, particularly after the hyperacute phase. Previous studies of the predictive value of biomarkers have been small, been done in selected populations, and have not concentrated on the acute phase or on intensively treated populations. We aimed to determine the predictive value of a panel of blood biomarkers in intensively treated patients early after transient ischemic attack and stroke. We studied 14 blood biomarkers related to inflammation, thrombosis, atherogenesis, and cardiac or neuronal cell damage in early transient ischemic attack or ischemic stroke in a population-based study (Oxford Vascular Study). Biomarker levels were related to 90-day risk of recurrent stroke as hazard ratio (95% confidence interval) per decile increase, adjusted for age and sex. Among 1292 eligible patients, there were 53 recurrent ischemic strokes within 90 days. There were moderate correlations (r=0.40-0.61; P<0.0001) between the inflammatory biomarkers and between the cell damage and thrombotic subsets. Associations with risk of early recurrent stroke were weak, with significant associations limited to interleukin-6 (adjusted hazard ratio, 1.12; 1.01-1.24; P=0.033) and C-reactive protein (adjusted hazard ratio, 1.15; 1.02-1.30; P=0.022) after adjusting for age, sex, hypertension, smoking, and diabetes mellitus although P-selectin seemed to predict stroke after transient ischemic attack (adjusted hazard ratio, 1.28; 1.00-1.63; P=0.046). In the largest study to date, we found limited predictive use for early recurrent stroke for a panel of inflammatory, thrombotic, and cell damage biomarkers.

The diagnostic value of VILIP-1 and NR2 peptide combined detection in the early ischemic stroke

Objective To Investigate the concentration of VILIP-1 and NR2 peptide in the serum of patients with ischemic stroke,and to explore their clinic value in early diagnostic of ischemic stroke patients. Methods The levels of VILIP-1 and NR2 peptide were examined by ELISA (enzyme linked immunosorbent assay,ELISA) with suspicious TIA (defined as a neurological deficit that resolved within 24 hours) or acute ischemic stroke patients (within 72 hours of onset of symptoms) 340 cases,102 healthy controls,98 patients with vascular risk factors and 35 patients with hemorrhagic stroke.Among all the groups,VILIP-1 and NR2 peptide level were analyzed using the nonparametric Wilcoxon test.Diagnostic performance were analyzed among the groups with the two biomarkers independently and combinedly. Results Serum levels of VILIP-1 and NR2 peptide in patients with ischemic stroke (IS) were 9.80 (1.90-14.22) μg/L,14.40 (5.60-27.91) μg/L respectively，which was higher than that of the healthy control group ［VILIP-1：0.02 (0.01-0.09)，NR2：0.33 (0.02-1.15)，χ2 were 5.61 and 9.54，P<0.001］,the group with vascular risk factors ［VILIP-1：0.03 (0.02-0.16),NR2：0.27 (0.01-1.54),χ2 were 6.74 and 10.62，P<0.001］,the group of patients non-stoke ［VILIP-1：0.04 (0.03-0.19)，NR2：0.53 (0.45- 1.21)，χ2 were 3.78 and 7.63，P<0.001］.The levels of VILIP-1 and NR2 peptide was significantly increased in IS patients presenting within 3 h of symptom onset.When differentiating IS from patients with hemorrhagic stroke,NR2 had a AUC of 0.934,showing a strong distinguishing effectiveness.Differentiating IS from healthy controls,patients with vascular risk factors and non-stroke patients,the AUC of combination of VILIP-1 and NR2 was 0.974,which was higher than the AUC of either VILIP-1(0.849) or NR2(0.862) alone（P<0.05）. Conclusions VILIP-1 and NR2 peptide are very sensitive and specific biomarkers to the early diagnosis of IS.The combination of VILIP-1 and NR2 peptide has higher value of clinical applications than one of them independently.（Chin J Lab Med,2014,37:469-472） Key words: Brain ischemia; Stroke; Neurocalcin; Receptors,N-methyl-D-aspartate

Oral antiplatelet therapy for acute ischaemic stroke.

In people with acute ischaemic stroke, platelets become activated and can cause blood clots to form and block an artery in the brain, resulting in damage to part of the brain. Such damage gives rise to the symptoms of stroke. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and also reduce the risk of early recurrent ischaemic stroke, thereby reducing the risk of early death and improving long-term outcomes in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage. To assess the efficacy and safety of immediate oral antiplatelet therapy (that is started as soon as possible and no later than two weeks after stroke onset) in people with acute presumed ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (last searched 16 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2013), MEDLINE (June 1998 to May 2013), and EMBASE (June 1998 to May 2013). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies. Randomised trials comparing oral antiplatelet therapy (started within 14 days of the stroke) with control in people with definite or presumed ischaemic stroke. Two review authors independently applied the inclusion criteria and assessed trial quality. For the included trials, they extracted and cross-checked the data. We included eight trials involving 41,483 participants. No new trials have been added since the last update.Two trials testing aspirin 160 mg to 300 mg once daily, started within 48 hours of onset, contributed 98% of the data. The risk of bias was low. The maximum follow-up was six months. With treatment, there was a significant decrease in death or dependency at the end of follow-up (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.91 to 0.99). For every 1000 people treated with aspirin, 13 people would avoid death or dependency (number needed to treat 79). Antiplatelet therapy was associated with a small but definite excess of symptomatic intracranial haemorrhages, but this small hazard was significantly outnumbered by the benefit, the reduction in recurrent ischaemic stroke and pulmonary embolus. Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in people who cannot swallow) and started within 48 hours of onset of presumed ischaemic stroke, reduced the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications; long-term outcomes were improved.

Blood Pressure Management in Early Ischemic Stroke

Elevated blood pressure is common at the time of presentation among patients with ischemic stroke, occurring in two-thirds to three-quarters of cases.1,2 The early hypertension that follows ischemic stroke often reflects undiagnosed or undertreated chronic hypertension. However, in the great preponderance of patients, an early hypertensive response to brain ischemia is an important contributing factor, partially explained by neuroendocrine response to physiologic stress. This initial hypertensive response is self-limiting, most marked in the first few hours following the onset of cerebral ischemia and resolving over several days. Within the first 24 hours after stroke, blood pressure spontaneously declines by about one-quarter in most patients.3

Abstract 71: Refining the CT Angiography Collaterals Scoring System to Better Predict Outcome in Acute Ischemic Stroke

Background: Collateral circulation profile is an important determinant of outcome in patients with large artery occlusion (LAO). We sought to refine the collateral score (CS) to better identify patients with potential for good outcome after AIS. Methods: We studied 342 patients presenting to our center with AIS and LAO (MCA or ICA) from 03/05 to 04/13. We modified the CS to a 5 point scale (mCS) (fig 1). We dichotomized the score into unfavorable (0-2A) and favorable (2B-3) profiles. Logistic regression model with good and poor discharge outcome (mRS 0-2 and 4-6, respectively) was used. We performed receiver-operating characteristic (ROC) analysis to compare the mCS with the CS and with ASPECTS. Results: Table 1 shows the baseline characteristics. Patients with favorable mCS had a significantly higher odds of a good outcome (OR 9.61, 95%CI 2.78-33.2, p=0.0003). Moreover, patients with unfavorable profile mCS (0-2A) had greater odds of poor outcome at discharge (4-6), and this association was maintained when using more stringent criteria for poor outcome (mRS 5-6) (table 2). These results persisted after adjustment for CT early ischemic changes (ASPECTS) and stroke severity (NIHSS). The modified scale was more precise than the original CS in predicting patients’ clinical outcomes (table 2). Importantly, patients treated with IV tPA who had good collaterals showed better odds of good outcome (OR 7.07, 95%CI 1.39-35.9, p=0.02). Furthermore, mCS showed more specificity and sensitivity than the original CS and ASPECTS as illustrated on ROCs (AUC: 0.73 compared to CS 0.669 and ASPECTS 0.667) in fig 2. Conclusion: The modified collateral CTA score (mCS) which gives a finer gradation of the collaterals discriminates better those who have potential for good outcome compared with the CS and ASPECTS. A simple score that does not require sophisticated radiology expertise may help physicians triage patients in the acute setting by identifying patients who may achieve a good outcome.

Abstract W P17: Factors Associated With DWI Lesion Growth After Endovascular Therapy for Acute Ischemic Stroke

Background: The factors impacting infarct evolution after intra-arterial(IA) intervention for acute ischemic stroke remain uncertain. We studied the infarct evolution on MRI DWI among acute stroke patients who underwent IA therapy. Methods: We reviewed the early ischemic stroke imaging database at Cleveland Clinic Cerebrovascular Center for those undergoing IA therapy in anterior circulation from 2009 to 2012. Patients with both pre-treatment and follow-up MRI were included. Infarct volume was measured on initial and follow-up DWI by region of interest demarcation. Patients were grouped into quartiles by infarct growth from initial to follow-up. Outcome were defined as modified Rankin Score 0-2 at 30 days. Results: Among the 76 patients, the median (range) infarct growth of four quartiles were 0.5 cc (-19.1-4.2), 13.8 cc (4.8-25.8), 38.8 cc (28.0-77.6), and 166.3 cc (78.0-314.5). Baseline characteristics of age, gender, race, diabetes, and hypertension were similar among groups except more smokers (p=0.017) and fewer patients on anticoagulation or antiplatelet agents in large-growth group (p=0.049). Compared to No-growth group (Quartile 1), large-growth group (Quartile 4) had more Hyperdense M1 MCA sign ( 26.3% vs 73.7%, p=0.004), larger initial ischemic lesion measured by CT ASPECT (p=0.002) and DWI volume (p=0.012), and absence of full collaterals on CTA ( 36.8% vs 0, p=0.004). There was a trend of lower recanalization rate in large-growth group (73.7% vs 47.4%, p=0.097). With the increment of infarct growth, there is a decrement in favorable outcomes (mRS 0-2) at 30 days: 42%, 37%, 26% and 10.5% (p=0.027). Conclusion: Infarct growth after IA therapy determines outcome. Initial ischemic lesion size, collaterals, and hyperdense vessel sign are associated with infarct growth.

The Effectiveness of Functional Electrical Stimulation Based on a Normal Gait Pattern on Subjects with Early Stroke: A Randomized Controlled Trial

Objective. To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke. Methods. Forty-five subjects were randomly assigned into a four-channel FES group (n = 16), a placebo group (n = 15), or a dual-channel group (n = 14). Stimulation lasted for 30 min in each session with 1 session/day, 5 days a week for 3 weeks. All subjects were assessed at baseline, at 3 weeks of treatment, and at 3 months after the treatment had finished. The assessments included Fugl-Meyer Assessment (FMA), the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Modified Barthel Index (MBI). Results. All 3 groups demonstrated significant improvements in all outcome measurements from pre- to posttreatment and further gains at followup. The score of FMA and MBI improved significantly in the four-channel group at the end of the 3 weeks of training. And the scores of PASS, BBS, MBI, and FAC in the four-channel group were significantly higher than those of the placebo group. Conclusions. This study indicated that four-channel FES can improve motor function, balance, walking ability, and performance of activities of daily living in subjects with early ischemic stroke.

The neuroprotective effects of carnosine in early stage of focal ischemia rodent model.

ObjectiveThis study was conducted to elucidate neuroprotective effect of carnosine in early stage of stroke.MethodsEarly stage of rodent stroke model and neuroblastoma chemical hypoxia model was established by middle cerebral artery occlusion and antimycin A. Neuroprotective effect of carnosine was investigated with 100, 250, and 500 mg of carnosine treatment. And antioxidant expression was analyzed by enzyme linked immunosorbent assay (ELISA) and western blot in brain and blood.ResultsIntraperitoneal injection of 500 mg carnosine induced significant decrease of infarct volume and expansion of penumbra (p<0.05). The expression of superoxide dismutase (SOD) showed significant increase than in saline group in blood and brain (p<0.05). In the analysis of chemical hypoxia, carnosine induced increase of neuronal cell viability and decrease of reactive oxygen species (ROS) production.ConclusionCarnosine has neuroprotective property which was related to antioxidant capacity in early stage of stroke. And, the oxidative stress should be considered one of major factor in early ischemic stroke.

Early recurrent ischaemic stroke (ERIS) — /INS;under recognised cause of early neurological deterioration (END) in stroke patients undergoing thrombolysis

Early recurrent ischaemic stroke (ERIS) — /INS;under recognised cause of early neurological deterioration (END) in stroke patients undergoing thrombolysis

Predictors of early post ischemic stroke apathy and depression: a cross-sectional study

BackgroundApathy and depression are important neuropsychiatric disorders that can occur after a stroke but the etiology and risk factors are not well understood. The purpose of this study was to identify risk factors for apathy and depression following a stroke.MethodsPatients with an acute stroke who met the inclusion criteria were recruited from our hospital, and general information was recorded from patient charts. The Apathy Evaluation Scale, Clinician Version (AES-C) was used to evaluate these patients within 2 weeks after the stroke. The Montreal Cognitive Assessment (MoCA), mini-mental state examination (MMSE), Hamilton Depression Scale (HAMD), Mattis Dementia Rating Scale Initiation/Perseveration subset (MDRS I/P), Frontal Assessment Battery (FAB) and Stroop Color-Word Association Test were employed to evaluate emotion, cognitive function and executive function. The patients were divided into two groups: the apathy group and the non-apathy group. We also divided the patients into two groups based on whether or not they had post-stroke depression. The clinical characteristics and scores on the MoCA, MMSE, HAMD and MDRS I/P were compared between the apathy and non-apathy groups as well as between patients with and without depression. Logistic regression analysis was performed to identify risk factors for apathy and depression following a stroke.ResultsA total of 75 patients with acute stroke were recruited. Of these, 25 (33.3%) developed apathy and 12 (16%) developed depression. Multivariate logistic regression analysis indicated that a history of cerebrovascular disease (OR: 6.45, 95% CI: 1.48-28.05, P = 0.013), low HbA1c (OR: 0.31, 95% CI: 0.12-0.81, P = 0.017) and a low MDRS I/P score (OR: 0.84, 95% CI: 0.74, 0.96, P = 0.010) were risk factors for post-stroke apathy. Additionally, multivariate logistic regression indicated that a low MDRS I/P (OR: 0.85, 95% CI: 0.75, 0.97, P = 0.015) was associated with post-stroke depression.ConclusionsThree risk factors for post-stroke apathy were identified as a history of cerebrovascular disease, low HbA1c and lower MDRS I/P scores. A low MDRS I/P score was also identified as a risk factor for post-stroke depression. These results may be useful to clinicians in recognizing and treating apathy and depression in patients after a stroke.