Factor In Acute Ischemic Stroke Research Articles

Study of Stress Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke at a Tertiary Care Hospital

Background: The second most prevalent cause of disability and death worldwide, stroke is silently taking on the characteristics of an epidemic. Almost 85% of the all strokes are ischemic strokes. Objective: To assess the stress hyperglycemia as a prognostic factor in acute ischemic stroke at a tertiary care hospital. Design of the Study: It was a case control study. Place and Duration of Study: This study was conducted at the Department of medicine & Allied Services Hospital Lahore from March 2022 August 2022. Patients and Methods: Total 100 patients with Computerized Tomography (CT) Brain evidence of acute ischemic stroke who met the inclusion criteria were included in the study. At admission, a thorough history was taken and clinical examination was performed. The National Institutes of Health Stroke Scale (NIHSS scale) was used to measure the patient’s neurological state. Fasting Blood sugar (FBS) and Glycosylated Hemoglobin (HBA1c) were performed. Patients' functional recovery was measured by comparing their NIHSS scores on the day of admission and after 7 days in the hospital. Results of the Study: Most of the patients enrolled in our study had age of 61 to 70 years. In study sample 56% of patients were male and 44% were female. Out of 100 patients 56 had stress hyperglycemia and 44 were without stress hyperglycemia. Functional recovery was greater in patients with normoglycemia than in patients with stress hyperglycemia (based on differences in NIHSS score on day one and day seven). The mortality was observed to be 9.2% in patients who had stress hyperglycemia. The mean NIHSS scores was 3.45±1.64 in patients with stress hyperglycemia and 4.50 ± 1.05 was in participants with normoglycemia. Practical Implication: The present study was carried out to know whether stress hyperglycemia can be a prognostic marker in patients of acute ischemic stroke. Conclusion: When compared to patients with stress hyperglycemia, functional recovery was better in patients with normoglycemia. This study demonstrates that patients with normoglycemia had greater functional recovery as compared to patients with stress hyperglycemia, as measured by the difference between the NIHSS scores. As a result, patients with normoglycemia had better outcomes than those with stress hyperglycemia. Keywords: Stress hyperglycemia, Normoglycemia, Acute Ischemic Stroke, Prognostic Factor, NIHSS

Predictive value of longitudinal changes of serum matrix metalloproteinase-9 and brain-derived neurotrophic factor in acute ischemic stroke.

BackgroundMatrix metalloproteinase-9 (MMP-9) and brain-derived neurotrophic factor (BDNF) have documented roles in the inflammatory injury cascade of neurovascular units following ischemic brain injury. However, their dynamic changes and predictive values after acute ischemic stroke (AIS) have not been well elucidated.ObjectiveTo investigate the temporal profiles of serum MMP-9 and BDNF concentrations and their relationship with the prognosis in patients with AIS.MethodsMMP-9 and BDNF levels were measured in 42 AIS patients in prospectively collected blood samples, which were taken on the first day (Day 1), the second day (Day 2), and the fifth day (Day 5) after admission. Healthy subjects (n = 40) were used as controls. The AIS patients were divided into groups of good functional prognosis (n = 24) and poor prognosis (n = 18) according to their modified Rankin Scale score at 3 months. Longitudinal analysis of MMP-9 and BDNF and their association with neurological prognosis was performed using repeated measurement ANOVA.ResultsAt baseline (Day 1), the levels of serum MMP-9 and BDNF were significantly higher in the AIS group than in the normal control group (P < 0.01). Repeated measurement ANOVA showed a significant main effect and interaction of MMP-9 between good prognosis and the poor group (P < 0.05). Further simple-effect analysis showed that the MMP-9 level was significantly increased in the poor prognosis group compared with the good prognosis group at T5 (P < 0.05). There were no significant time-dependent or the interaction effect (all P > 0.05), but a main effect (P < 0.05) for BDNF. Compared with the poor prognosis group, the simple-effect results indicated that the BDNF level of the good prognosis group was lower at Day 1, while the same was reversed for expression at Day 5 (P < 0.05).ConclusionMMP-9 and BDNF are closely related to the prognosis of patients with AIS in a time-dependent manner. The dynamic changes of the two biomarkers are superior to baseline levels in predicting the prognosis of AIS patients. A sustained decrease in MMP-9 and an increase in BDNF levels in AIS patients after several days of treatment implied a favourable prognosis.

Longitudinal assessment of anxiety/depression rates and their related predictive factors in acute ischemic stroke patients: A 36-month follow-up study.

This study aimed at investigating the longitudinal changes of poststroke anxiety/depression rates, and their potential risk factors in acute ischemic stroke (AIS) patients.A total of 250 first diagnosis of AIS patients were enrolled and followed for 36 months. Anxiety/depression of patients were assessed using hospital anxiety and depression scale (HADS) at month (M) 0 (M0) and then every 3 months till M36.During 36-month follow-up, both HADS-anxiety score (from 6.9 ± 3.1 at M0 to 8.0 ± 3.5 at M36) and anxiety rate (from 41.2% at M0 to 54.0% at M36) (both P < .01) were increased with time longitudinally. Meanwhile, HADS-depression score (from 6.2 ± 3.0 at M0 to 6.9 ± 3.1 at M36) and depression rate (from 32.4% at M0 to 40.4% at M36) (both P > .05) displayed an upward trend with time longitudinally but without statistical significance. By forward multivariate logistic regression analysis, female, diabetes and higher National Institute of Health Stroke Scale (NIHSS) score independently predicted elevated anxiety risk at M0, M12, M24, and M36 (all P < .05); while longer education duration and hypertension independently predicted raised anxiety risk at M0 and M12 (all P < .05), respectively. Regarding depression, diabetes independently predicted increased depression risk at M0, M12, M24, and M36 (all P < .01); longer education duration independently predicted higher depression risk at M0 and M12 (both P < .05); female independently predicted increased depression risk at M24 and M36 (both P < .01); higher NIHSS score independently predicted raised depression risk at M24 and M36 (both P < .01).Poststroke anxiety and depression are frequent, which deteriorate with time; besides, female, diabetes, NIHSS score, hypertension and education duration independently predicted increased poststroke anxiety or depression risk in AIS patients.

Clinical characteristics and tumor markers in ischemic stroke patients with active cancer

Cancer-associated ischemic stroke (CAS) refers to a hypercoagulation disorder related to malignant tumors, especially adenocarcinoma. Carbohydrate antigen (CA) 125 is a mucinous serum marker that might reflect hypercoagulation status, but the association between CA 125 and CAS is unclear across various types of cancer. The aim of this study was to investigate the associations among tumor markers, coagulation markers, and clinical factors in acute ischemic stroke (AIS) patients with active cancer. Consecutive AIS patients with active cancer (a diagnosis or ongoing active therapy for cancer within 6months) were prospectively enrolled at four hospitals. D-dimer, C-reactive protein (CRP), carcinoembryonic antigen (CEA), CA19-9, and CA 125 levels were measured. Of 120 AIS patients with active cancer, 47 were diagnosed with CAS. CA 125 had the strongest correlations with D-dimer and CRP (ρ = 0.543, p < 0.001 and ρ = 0.452, p < 0.001, respectively). The areas under the receiver-operating characteristic curves for the diagnosis of CAS were 0.812 (95% CI 0.718-0.878) for CA 125, 0.714 (95% CI 0.602-0.801) for CEA, and 0.663 (95% CI 0.552-0.759) for CA 19-9. Multivariable analysis revealed that CA 125 levels in the highest quartile (OR 2.91, 95% CI 1.68-5.53), multiple lesions in multiple vascular territories observed on diffusion-weighted imaging, the absence of dyslipidemia, and the absence of atrial fibrillation were independently associated with CAS. Increased CA 125 levels, which indicate hypercoagulability, were useful for diagnosing CAS in AIS patients with active cancer.

Assessing the level of infectious and inflammatory factors in acute ischemic stroke in diabetic and non-diabetic patients

Introduction. Stroke is one of the principal leading causes of death globally. In 2005, stroke cause approximate 5.7 million death, 87% of deaths was in low and middle-income countries. Recently period, collecting evidence indicated that inflammation and atherosclerosis play important roles in stroke evolution. Material and method. In this prospective longitudinal observational study including 340 patients with acute ischemic stroke with / without diabetes mellitus we analyzed as main criteria infectious factors, inflammatory factors and biochemical factors. The patients were divided into 2 groups: 101 diabetic patients (study group) and 239 non-diabetic patients (control group), were we analyzed as main criteria infectious factors (cytomegalovirus IgG plasma level, cytomegalovirus IgM plasma level, Helicobacter pylori IgG plasma level), inflammatory factors (leucocyte, C-reactive protein) and biochemical (plasma level of fibrinogen). Results. Cytomegalovirus-IgG levels are lower in diabetic versus non-diabetic patients with an arithmetic mean of 1170 AU/ml (95% CI 862.4169 to 1477.8326) versus 1398 AU/ml (95% CI 1169.6839 to 1627,2042) but this difference, although it exists, is not statistically significant p = 0.123. The cytomegalovirus-IgM level is lower in diabetic versus non-diabetic patients a statistically significant difference, p 0.001. The Helicobacter IgG level is lower in diabetic patients with a mean value of 1.0763 U/ml with a 95% CI from 0.8141 to 1.3386 versus non-diabetics with an average of 1.3943 U/ml with a CI of 95% from 1.1963 to 1.5923, but this difference, although there, is not statistically significant, p = 0.07.The number of leukocytes diagnosed in diabetic patients is lower than that of people without diabetes (p = 0.0001). The level of C-reactive protein at diagnosis of diabetic patients is lower (an average value of 3.0207mg/dl with a 95% CI of 0.9726 to 5.0688) than in people who do not suffer from diabetes (arithmetic mean of 5.8218 mg/dl with a 95% CI of 0.5894 to 11.0542), but this difference is not statistically significant. The serum level of fibrinogen at the diagnosis of diabetic patients is lower, with a mean value of 399.4 mg/dl with a 95% CI of 327.7993 to 471.0749, than that of people without diabetes, with an arithmetic mean of 653.8 mg/dl, with a 95% CI of 497.8700 to 809.8647, the difference being statistically significant, p = 0.041. Conclusions. Inflammatory markers such as leukocyte levels at intake, C-reactive protein (CRP), and fibrinogen levels showed lower levels at admission in diabetic patients versus non-diabetic patients. There is no statistically significant difference between diabetic vs. non-diabetic patients regarding cytomegalovirus IgG levels, referring to cytomegalovirus IgM level is lower in diabetic versus non-diabetic patients with significant statistically difference. The Helicobacter IgG level is lower in diabetic patients versus non-diabetics patients.

A study of mean platelet volume in acute ischemic stroke

Background: A stroke is defined by the abrupt onset of neurological deficit that is attributable to a focal vascular cause. Because of the growth in the number of ageing population, the burden of stroke is likely to increase automatically in the coming future. Mean platelet volume (MPV), a marker of platelet function is a physiological variable of hemostatic importance. Changes in MPV play a more important role in hemostasis than platelet count. Very few studies has looked at the association between mean platelet volume and ischemic stroke. So, the objectives were to study mean platelet volume in acute ischemic stroke, the role of mean platelet volume as an independent risk factor in acute ischemic stroke and to study the association between MPV and outcome in patients with acute ischemic stroke.Methods: A cross sectional analytical study was conducted on 60 patients with ischemic stroke identified based on clinical features and MRI of Brain admitted in Mahadevappa Rampure Medical College, Kalaburgi. Mean platelet volume (MPV) on admission was documented and severity of stroke at the presentation and at discharge was assessed using Modified Rankins scale (MRS).Results: Among 60 patients, 40% of the study patients were aged between 60-80 years and 60% of study population were male and 40% female. The co-morbid conditions present were hypertension in 50%, diabetes mellitus in 41% .The MPV was raised (&gt;12.5fl) in 64 %of the patients. The clinical severity of stroke at presentation as determined by the Modified Rankin‘s scale (MRS) were moderate (20%), moderately severe (35%) and severe disability in 36.7% of cases. In our study MPV showed statistically significant correlation with Ischemic stroke severity. Clinical outcome as assessed by comparing MRS at admission and discharge with presentation MPV showed 25% moderately, 30% moderately severe and 23% were severely disabled. However, no statistical significance was seen.Conclusions: We conclude that MPV is raised in acute ischemic stroke and is an independent predictor of the risk of stroke. Higher MPV are associated with more severe stroke and tend to have poorer outcome. Mean platelet volume an indicator of platelet reactivity is a simple and easy test available in panel of hemogram and can serve as a valuable predictor of severity and outcome in acute ischemic stroke patients.

Study of Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke

Background: Acute ischemic stroke (AIS) is a grave threat to global healthcare system, which is accompanied by high disability and mortality. Stress hyperglycemia is common in critically ill patients and appears to be a marker of disease severity. Furthermore, both the admission as well as the mean glucose level during the hospital stay is strongly associated with patient outcomes. Objective: To determine the impact of hyperglycemia in AIS on short-term outcome and prognosis. Patients and methods: This was a cross-sectional study, which was carried out on 150 patients arrived to Emergency Department (ED) in Emergency Mansoura University Hospital with clinical presentation and radiological investigations of ischemic stroke over the period from June 2018 to May 2019. Results: There were statistically significant difference as regards both onset and course of symptoms among both groups. Normoglycemic group demonstrated significant increase as regards serum creatinine, while demonstrated significant decrease as regards SBP, DBP, Glasgow coma scale (GCS) and glucose level in comparison with hyperglycemic group. Normoglycemic group demonstrated better outcomes in terms of CT brain and CBC compared to hyperglycemic group. Hyperglycemic group demonstrated abnormal outcomes in terms of ABG. Hyperglycemic group demonstrated marked increase in overall mortality rate compared to normoglycemic one. There were significant increase in ward admission cases as regards onset GCS and significant decrease as regards stay duration more than one week in comparison with ICU admission cases. Conclusion: Stress hyperglycemia is common among acute stroke patients and was associated with less favorable outcomes especially in terms of mortality, hospital stay and functional outcome.

Abstract P077: Hypertension And Ischemic Stroke; The Effect Of A Combined Anti-hypertension Medications And Thrombolytic Therapy

Background: The aim of this study is to identify clinical risk factors in acute ischemic stroke ( AIS) pretreated with anti-hypertensive (anti-HTN) medications with a subsequent thrombolytic therapy that are associated with potential worsening or improving neurological functions. Methods: We analyzed retrospectively collected data from consecutive AIS patients with a combined anti-HTN medications and recombinant tissue plasminogen activator (rtPA) therapy for AIS. We used logistic regression model to identify demographic and clinical risk factors that are associated with improving or worsening neurologic functions in AIS patients with a combined anti-HTN and thrombolytic therapy. The overall correct classification of the logistic regression models was determined using the Hosmer-Lemeshow test, while the area under the receiver operating characteristic curve was used to test the sensitivity of the model. The variance inflation factor was used to check for multicollinearity. Results: In the adjusted analysis, patients with increasing age (Odd ratio (OR)=1.035, 95% CI, 1.022-1.049, P &lt;0.001), female AIS patients (OR = 1.630, 95% CI, 1.182-2.248, P =0.002) with a history of substance abuse (OR = 2.315, 95% CI, 1.107-4.842, P = 0.026) were associated with worsening neurologic functions. However, Caucasians (OR = 0.535, 95% CI, 0.361-0.793, P = 0.002) with dyslipidemia (OR = 0.655, 95% CI, 0.479-0.897, P = 0.008), obesity (OR = 0.642, 95% CI, 0.472-0.873, P = 0.005), high-density lipoproteins (HDL; OR = 0.988, 95% CI, 0.976-1.000, P = 0.045), and with a direct admission (OR = 0.509, 95% CI, 0.341-0.761, P = 0.001) were associated with improving neurologic function in AIS patients with a combined anti-HTN medications and rtPA therapy. Conclusion: Our findings reveal specific demographic and clinical risk factors that are associated with worsening or improving neurological functions in AIS pretreated anti-HTN medications with a subsequent thrombolytic therapy. This finding suggests the development of management strategies to manage identified clinical risk factors in AIS patients pretreated with anti-HTN medications prior to thrombolytic therapy.

Do All ASPECT Score Regions have the Same Predictive Power for Functional Outcomes?

Background and PurposeASPECTS (Alberta Stroke Program Early CT Score) is a 10-point topographic CT scan score that has been shown to be a strong prognostic factor in acute ischemic stroke. We investigated whether all ASPECTS regions have the same prognostic value. MethodsClinical characteristics, ASPECTS, and 3-month modified Rankin Scale (mRS) data were retrospectively collected in 350 patients who were diagnosed with middle cerebral artery (MCA) territory stroke. To describe the 3-month mRS data, an ordered categorical approach was applied using a proportional odds model. Furthermore, external validation was performed using additional data from 30 patients. ResultsAs expected, ASPECTS was an independently important predictor. However, when 10 regions were analyzed separately, the M1, M2, and M3 regions, related to MCA cortex, were not found to predict 3-month mRS scores in the final model. The odds ratios for ischemic change in other regions (except M1, M2, and M3) ranged from 2.6 to 3.8. Moreover, among clinical characteristics, only age was identified as a significant predictor. The sensitivity and specificity of the final model in the external validation were 91% and 88%, respectively. ConclusionsAll ASPECTS regions did not have the same predictive power for functional outcomes, defined as the 3-month mRS. The implementation of a proportional odds model allowed a proper description of the ordered categorical nature of the mRS and the identification of relevant predictors.

Intravenous thrombolytic therapy for acute ischemic stroke in Hubei, China: a survey of thrombolysis rate and barriers

BackgroundRates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists’ experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists.MethodsSurvey of 2096 AIS patients and 709 neurologists from 66 hospitals was conducted in Hubei province between 2014 and 2015. A multivariable logistic regression model was utilized to identify the factors associated with thrombolysis utilization and neurologists’ experiences with thrombolysis.ResultsOf the 2096 AIS patients, only 3.8% received thrombolysis. Of the 709 neurologists, 66.0% reported using thrombolysis for AIS patients. The main reasons for not using thrombolysis were late arrival of patients, fear of the risk of complications of thrombolysis, and light or quickly recovered stroke symptoms. The behavior and clinical characteristics of patients, including early admission to hospital (odds ratio [OR] = 5.81, 95% confidence intervals [CI] 3.31–10.20), using emergency medical services to be hospitalized (OR = 3.36, 95% CI 2.00–5.62), stroke history (OR = 0.53, 95% CI 0.28–0.99), and National Institute of Health Stroke Scale score < 4 (OR = 0.46, 95% CI 0.27–0.77) were shown to significantly affect the thrombolysis utilization in the multivariate model. In addition, hospital grade (OR = 2.84, 95% CI 1.84–4.37), education level (OR = 2.49, 95% CI 1.09–5.73), and working years (OR = 1.88, 95% CI 1.18–3.00) were strongly associated with neurologists’ experiences of thrombolysis.ConclusionsA very low proportion of AIS patients received thrombolysis in Hubei province, China. Considerable education programs and interventions were required regarding knowledge of stroke treatment for clinicians and proper behavior after stroke for AIS patients and their families.

Abstract WP326: Factors in Acute Ischemic Stroke Predicting Pre-Hospital Notification by Emergency Medical Services

Introduction: Acute ischemic stroke (AIS) treatment is time sensitive and every 15 minutes saved in treatment results in 1 additional month of disability-free life in patients treated with thrombolysis. Pre-notification by Emergency Medical Services (EMS) has shown to reduce door to CT scan time, door to needle time for thrombolysis and increase the number of patients treated with thrombolysis. Determining which factors contribute to recognition and emergent treatment of stroke in the emergency department (ED) which are not recognized in the field can help improve models of pre-hospital notification. Objective: To determine which factors predict pre-hospital notification by EMS in patients with AIS treated with emergent therapy. Methods: We retrospectively reviewed our institutional database for all patients arriving through the ED by EMS who underwent acute stroke treatment from 2007-2018. All patient's arriving by EMS were dichotomized by the presence or absence of pre-hospital notification. We assessed the impact of demographic, clinical [NIHSS, FAST scores ((Face, Arm, Speech, Time) dichotomized into 0-1 or 2-3)], and diagnostic (vascular territory) factors on the likelihood of pre-hospital notification by EMS. A multivariate logarithmic regression analysis with assessment for confounding factors was applied. Results: A total of 183 patients were identified. The presence of 2 or 3 FAST criteria increased the odds of pre-hospital notification by EMS by 3.07 (p = 0.022, 95% CI 1.17-8.05) when adjusted for age. The vascular territory involved did not independently predict the likelihood of pre-hospital notification. We did not identify any significant confounders in the multivariate analysis. Conclusions: Patients with AIS receiving emergent treatment are over three times more likely to benefit from pre-hospital notification by EMS when presenting with 2 or 3 FAST criteria. Pre-hospital notification of AIS has established itself as a means to expedited clinical and radiographic evaluation and faster and more frequent treatment on hospital arrival. Improving EMS triage of AIS patients presenting with symptoms not well represented in the FAST criteria represents a stroke systems of care performance and quality improvement opportunity.

Dehydration as a Poor Prognostic Factor in Acute Ischemic Stroke: An Observational Study in a Tertiary Care Hospital in India

Dehydration as a Poor Prognostic Factor in Acute Ischemic Stroke: An Observational Study in a Tertiary Care Hospital in India

C-Reactive Protein and T3: New Prognostic Factors in Acute Ischemic Stroke

BackgroundSeveral studies have shown that high level of plasma C-reactive protein (CRP) is associated with stroke outcomes and future vascular events, and a decrease in serum triiodothyronine (T3) was reported to be associated with stroke severity and poor prognosis. ObjectiveThe goal of this study is to evaluate CRP and T3 as independent predictors of poor functional and cognitive outcomes in patients with acute ischemic stroke at hospital discharge. MethodsThis study evaluated 120 patients who were admitted to the Clinical Hospital of Neurology and Psychiatry Brasov, between July 2016 and January 2017. The patients were evaluated for clinical stroke severity (National Institutes of Health Stroke Scale) and serum CRP and total T3 were evaluated on admission. Functional outcome and cognitive outcome were evaluated at discharge. ResultsThe severity of NIHHS scores were associated with higher CRP levels (β = .583, P = .000) and lower T3 concentration (β = −.185, P = .043). Poor cognitive prognosis was associated with CRP levels (β = .441, P = .000) but not with T3 concentrations (P = .142). Poor functional outcome was associated with higher CRP levels (β = .457, P = .000), but not with T3 concentrations (P = .100). Using CRP and T3 as prognostic factors resulted in a probability of 53.5% to predict a poor functional outcome and of 80.42% to predict a poor cognitive outcome in stroke patients at discharge. ConclusionsThe study showed that higher CRP and lower T3 levels were associated with stroke severity on admission. Functional outcome is likely secondary to stroke severity but functional outcome at discharge was associated with higher CRP levels and not with T3 concentration. Cognitive outcome was associated with higher CRP levels and not with T3 concentration.

Neuroprotective Effects of a Novel Antioxidant Mixture Twendee X in Mouse Stroke Model

Oxidative stress and inflammation are important aggravating factors in acute ischemic stroke. In the present study, the neuroprotective effects of a novel antioxidant mixture Twendee X containing multiple antioxidative ingredients, such as coenzyme Q10, ascorbic acid, and cystine, were evaluated. After the pretreatment of a vehicle or Twendee X (20 mg/kg/d) for 14 days, mice were subjected to transient middle cerebral artery occlusion for 60 minutes and further treated with vehicle or Twendee X for 1 or 5 days. Twendee X administration reduced the infarct size, and reduced oxidative stress markers such as 8-hydroxy-2'-deoxyguanosine, 4-hydroxy-2-nonenal, and Nε-(carboxymethyl) lysine (one of advanced glycation end products), as well as inflammatory markers such as ionized calcium binding adapter molecule-1, tumor necrosis factor-α, and monocyte chemotactic protein-1. In the present study, the neuroprotective effects of Twendee X were shown on transient middle cerebral artery occlusion mice via antioxidative and anti-inflammatory pathways, providing a potential of Twendee X as one preventive and therapeutic treatment.

Microalbuminuria- an emerging risk factor in acute ischemic stroke

O bjective: To study the role of biomarkers like microalbuminuria in acute ischemic stroke. Material and Methods: A total of 70 cases admitted in wards an d ICU under Department of Medicine, NIMS Medical College &amp; Hospital Jaipur and 70 controls that were the normal age/sex matched during study period of 15 months i.e. July 2014 to September 2015 were taken into study based on inclusion and exclusion criteria. Urine for microalbumin is tested at the time of admission. Stroke severity and prognosis is assessed by NIHSS score on day 0, 3, 7 &amp; 14. Tests of statistical significance were done using Chi-square Test, unpaired’t’ test and fisher test. Results: Out of 70 age and sex matched cases and controls, Microalbumiuria is seen in 51.43% of cases an d 2.86% of controls, which is statistically significant (P &lt;0.001). Mean urine albumin creatinine ratio (UACR) is 65.10 + 79.12 in cases where as it is 7.53 + 8.04 in controls which is also statiscally significant (p&lt;0.001). Hence MA is considered as a risk factor in acute ischemic stroke. Among 70 acute ischemic stroke cases studied, MA was seen in 36 in whom 11 patients fell in severe NIHSS score and 16 very severe which is statistically significant (Chi-square = 27.605 with 3 degrees of freedom; P &lt;0.001) * Mean NIHSS sco re for the patients with MA at the time of admission and discharge was 22.05 and 16.16 compared to 8.36 and 3.61 at the time of admission and discharge in patients without MA , most of our comatose patients had microalbuminuria thus predicting seriousness of stroke in patients with microalbumin uria. Conclusion: We found that MA is an independent risk factor and potential prognostic marker in acute ischemic stroke.

Phase II Trial of Intravenous Low-Dose Granulocyte Colony-Stimulating Factor in Acute Ischemic Stroke

Granulocyte colony-stimulating factor (G-CSF) has shown neuroprotective and neurogenerative activities in experimental studies, and our previous phase I clinical study suggested the safety and potential efficacy of low-dose G-CSF in acute ischemic stroke patients. The present phase II trial is aimed to evaluate the effect of G-CSF administration on neurological function and infarct volume, compared with a placebo group. Forty-nine acute ischemic stroke patients (29 males, 20 females; 71 ± 10 years) within 24 hours after onset were recruited. Eligible patients were randomized 2:2:1 to receive G-CSF 150 µg/body/day, G-CSF 300 µg/body/day, and placebo, respectively. We evaluated clinical outcome in terms of the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index at 90 days after onset, together with changes in infarct volume on magnetic resonance imaging. We found no serious adverse event, including change in leukocyte levels, which remained below 31,000/µL, at 150 and 300 µg G-CSF/body/day. Clinical outcome scores did not show any significant difference among the 3 groups. Chronological changes in infarct volume also showed no significant difference. G-CSF was well-tolerated at 150 and 300 µg/body/day in patients with acute ischemic stroke. However, administration of G-CSF at both 150 and 300 µg/body/day neither contributed to functional recovery nor reduced infarct volume at 3 months after onset, compared with the control group. The apparent lack of effectiveness may have been due to the small sample size. A trial of combination therapy with recombinant tissue plasminogen activator and G-CSF is planned.

Abstract TP440: Heart Failure is Associated With Elevated von Willebrand Factor (vWF) Antigen but not Factor VIII (FVIII) in Acute Ischemic Stroke (AIS)

Introduction: von Willebrand Factor (vWF) and factor VIII (FVIII) contribute to thrombosis and are important risk factors in acute ischemic stroke (AIS). Elevated vWF has been correlated with depressed left ventricular (LV) function, but has not been examined in a cohort of patients with AIS, particularly with regard to concurrent elevation in FVIII. Hypothesis: We hypothesized that vWF is associated with HF and that combined elevation of vWF and FVIII would strengthen this association. Methods: From our prospective stroke registry, AIS patients &gt;18 years of age admitted from 09/2011 to 01/2015 were included if both FVIII and vWF were measured during hospitalization and an echocardiogram was performed. Comparisons were done between the following groups: patients with normal (-) vs. elevated (+) vWF, patients with (-) vs. (+) FVIII, and patients with (-) vs. (+) levels of both factors. Results: Of 1,091 patients in the study period, 212 patients met inclusion criteria. In all groups, patients differed significantly according to history of DM. +vWF had higher frequency of female gender than -vWF, but did not differ according to any other demographic or baseline characteristics. +vWF patients had higher frequency of HF (p=0.007) and higher frequency of depressed LV function (p=0.028) compared to those with -vWF. vWF level correlated with HF (r=0.189, p=0.006) and reduced LV function (r=0.187, p=0.006). Similar findings were found with dual elevation, but we found no relationship between FVIII and HF. After adjustment for HTN, CAD, and DM, vWF remained an independent predictor of HF (OR 1.003, 95%CI 1.000-1.007, p=0.036). While we found no relationship between LV function and FVIII level, median vWF levels increased with decreasing LV function (p=0.027). Conclusion: The results of our study suggest an association between HF and elevated vWF in the setting of AIS, irrespective of FVIII elevation. These results suggest the potential utility of vWF as an independent biomarker for heart failure in the AIS patient population.

Demographic Characteristics and Prognostic Factors in Acute Ischemic Stroke in a Tertiary Care Hospital in Nepal (P1.073)

Demographic Characteristics and Prognostic Factors in Acute Ischemic Stroke in a Tertiary Care Hospital in Nepal (P1.073)

Initial body temperature in ischemic stroke: nonpotentiation of tissue-type plasminogen activator benefit and inverse association with severity.

Body temperature (BT) is an important physiological factor in acute ischemic stroke. However, the relationship of initial BT to stroke severity and degree of benefit from thrombolytic therapy has been delineated incompletely. We analyzed the public data set of the 2 National Institute of Neurological Disorders and Stroke Tissue-Type Plasminogen Activator (tPA) stroke trials, comparing patients with lower (<37.0°C) and higher (≥37.0°C) presenting BT. Among 595 patients (297 placebo and 298 tPA treated) with documented initial BT, 77.1% had initial BT <37.0°C and 22.9% ≥37.0°C. Patients with higher initial BT had lower baseline stroke severity in both tPA-treated patients (the National Institute of Health Stroke Scale median, 11 versus 15; P=0.05) and placebo-treated patients (median, 13 versus 16; P<0.01). Patients with higher initial BT also had lower infarction volume on computed tomography at 3 months in both tPA-treated patients (median, 9.6 versus 16.7 cm(3); P=0.08) and placebo-treated patients (median, 13.1 versus 28.1 cm(3); P=0.02), but no clinical outcome differences. Analysis of lytic treatment effect found no heterogeneity in the degree of tPA benefit in both higher and lower BT groups (≥37.0°C: odds ratio for the modified Rankin Scale 0-1 outcome, 2.55; 95% confidence interval, 1.05-6.21 and <37.0°C: odds ratio, 2.30; 95% confidence interval, 1.38-3.84; heterogeneity P=0.83). In patients with hyperacute stroke, higher presenting temperatures are associated with less severe neurological deficits and reduced final infarct volumes. Presenting temperature does not modify the benefit of tPA on 3-month favorable outcome.

Leptomeningeal collateralization in acute ischemic stroke: Impact on prominent cortical veins in susceptibility-weighted imaging

BackgroundThe extent of hypoperfusion is an important prognostic factor in acute ischemic stroke. Previous studies have postulated that the extent of prominent cortical veins (PCV) on susceptibility-weighted imaging (SWI) reflects the extent of hypoperfusion. Our aim was to investigate, whether there is an association between PCV and the grade of leptomeningeal arterial collateralization in acute ischemic stroke. In addition, we analyzed the correlation between SWI and perfusion-MRI findings. Methods33 patients with acute ischemic stroke due to a thromboembolic M1-segment occlusion underwent MRI followed by digital subtraction angiography (DSA) and were subdivided into two groups with very good to good and moderate to no leptomeningeal collaterals according to the DSA. The extent of PCV on SWI, diffusion restriction (DR) on diffusion-weighted imaging (DWI) and prolonged mean transit time (MTT) on perfusion-imaging were graded according to the Alberta Stroke Program Early CT Score (ASPECTS). The National Institutes of Health Stroke Scale (NIHSS) scores at admission and the time between symptom onset and MRI were documented. Results20 patients showed very good to good and 13 patients poor to no collateralization. PCV-ASPECTS was significantly higher for cases with good leptomeningeal collaterals versus those with poor leptomeningeal collaterals (mean 4.1 versus 2.69; p=0.039). MTT-ASPECTS was significantly lower than PCV-ASPECTS in all 33 patients (mean 1.0 versus 3.5; p<0.00). ConclusionsIn our small study the grade of leptomeningeal collateralization correlates with the extent of PCV in SWI in acute ischemic stroke, due to the deoxyhemoglobin to oxyhemoglobin ratio. Consequently, extensive PCV correlate with poor leptomeningeal collateralization while less pronounced PCV correlate with good leptomeningeal collateralization. Further SWI is a very helpful tool in detecting tissue at risk but cannot replace PWI since MTT detects significantly more ill-perfused areas than SWI, especially in good collateralized subjects.