Group Of Ischemic Stroke Patients Research Articles

Ischemic Stroke and COVID-19 Infection: an Analysis of Treatment Outcomes in Patients who Underwent Endovascular Thrombectomy

Aim. This study aimed to compare and evaluate treatment outcomes in groups of ischemic stroke patients with or without COVID-19 infection who underwent endovascular thrombectomy (EVT).
 Materials and methods. We conducted a retrospective analysis of 817 case records of IS patients aged 25 to 99 years with confirmed thrombotic occlusion of cerebral arteries and subsequent EVT who were treated in regional vascular centers in St. Petersburg from January 1, 2021
 to December 31, 2021.
 Results. Patients without COVID-19 had favorable outcome more often than patients with confirmed COVID-19 (35.0% vs. 7.3%, p 0.001); mortality rate was 30% vs. 52%, respectively (p 0.001).
 Conclusions. Intercurrent COVID-19 significantly worsened prognosis and increased risk of death in ischemic stroke patients who underwent EVT.

Correlation of Whole Blood Cell Morphology on Electrical Impedance Spectroscopic Characteristics on the Severity Level of Ischemic Stroke Patients

This paper discusses the influence of peripheral blood smear morphology methods on the electrical impedance spectroscopic characteristics of blood samples from ischemic stroke patients. In this study, there were 26 blood samples, consisting of a control group with 5 blood samples and a group of ischemic stroke patients with 21 samples with varying degrees of severity. The methods used are electrical impedance spectroscopy (EIS) and whole blood cell morphology methods. The EIS method was carried out using the BISDAQ tool and application, and results were obtained in the form of Bode Plot, Bode Phase Plot, Nyquist Plot, and measurement data values in the form of Ms. Excel. Meanwhile, the Morphological method is carried out by making a peripheral blood smear, then viewing and obtaining an image using a digital microscope, and then counting the number of cells using the Image Raster application. Based on the results of the method carried out, the correlation can be seen to conclude that whole blood cell morphology greatly influences the characteristics of EIS and determines the severity of ischemic stroke patients.

Croatian study on COVID-19-positive stroke patients during the second wave of the pandemic

To investigate stroke characteristics in patients with concomitant coronavirus disease 2019 (COVID-19) infection in Croatia during the second wave of the COVID-19 pandemic. This retrospective study investigated the characteristics of two groups of ischemic stroke patients: those who developed COVID-19 infection before stroke and those who developed the infection during the hospital stay after stroke onset. Stroke etiology was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. We analyzed data from 255 stroke patients from 12 Croatian hospitals. The two groups of ischemic stroke patients differed in stroke etiology (P=0.038). Patients with COVID-19 infection before stroke had fewer cardioembolic strokes (46% vs 29.1%), more cryptogenic strokes (32.5% vs 14.3%), and more strokes in multiple vascular territories (12.4% vs 1.8%). The percentage of large-vessel occlusions was high in both groups (49.6% and 44.4%). Median modified Rankin Scale score on discharge was 4 in both groups. Mortality was 36.4% in the group with stroke after COVID-19 and 33.3% in the group with COVID-19 after stroke. Ischemic stroke after COVID-19 differs in etiology from ischemic stroke complicated by COVID-19 infection. Both patient groups are characterized by severe disability and high mortality. Raising the awareness of prehospital stroke and optimization of clinical workflow are important if we want to improve the stroke outcomes by acute recanalization techniques.

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018).

The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

Peningkatan Kadar Lipoprotein-Associated Phospholipase A2 Meningkatkan Kejadian Stroke Iskemik Akut

Introduction: Stroke is a major health problem in the world, and associated with mortality, disability, and economic burden. Stroke is the second leading cause of death in the world after heart disease and cause of disability in adults. Several recent studies show that levels of Lp-PLA2 contribute to high serum lead to ischemic stroke, whereas some others do not get the association. Aims: studies an association between serum Lp-PLA2 with incident ischemic stroke. Method: This study is a descriptive analytic comparative with cross sectional design in the Neurology ward RS. DR. M. Djamil Padang between October 2013 to April 2014 with total of 88 subjects consisting of 44 subjects ischemic stroke patients and 44 healthy control group who participated in the study. Statistical analysis is used parametric test with unpaired t test, test for normality with the Kolmogorov-Smirnov test, and logistic regression analysis. Result: P value 0.05 was considered statistically significant. The mean age of subjects in the group of ischemic stroke patients was 57.30 ±8.86 years old. Female in patients with ischemic stroke group was 23 people (52,3%). Mean levels of Lp-PLA2 serum in patiens with ischemic stroke group was 103.49±48.00 ng/mL. A significan association between serum levels of Lp-PLA2 with incident ischemic stroke with p<0.05. Conclusion: There was a significant relation in elevation of serum Lp-PLA2 levels with incident of ischemic stroke.

Hippocampal atrophy is independent of amyloid status 3 years after ischemic stroke

AbstractBackgroundHippocampal atrophy, long thought to be an imaging signature of Alzheimer’s disease, is seen in a range of neurodegenerative disorders, and in association with vascular risk factors in people without dementia. We examined hippocampal volume (HV) in a group of ischemic stroke patients who participated in an amyloid PET imaging study 3 years after their stroke. Given the complex interactions between normal brain aging, vascular risk factors and brain histopathology, we hypothesized that there would be no association between HV and amyloid status.MethodThe Cognition And Neocortical Volume After Stroke (CANVAS) study is an observational cohort study of 135 patients with ischemic stroke examining brain volume and cognition over 3 years compared to healthy controls. Amyloid 18F‐NAV4694 PET imaging was offered at 3 years as a sub‐study. Only participants with usable MRI scans at 3 years were included. We report centiloids (CLs) not SUVRs for comparison of our results with others using different amyloid PET tracers. CL amyloid status was classified as: CL<15 NEGATIVE; CL 15‐25 UNCERTAIN; CL>25 POSITIVE. In addition, Brain Banking was offered to all CANVAS participants: participants are classified amyloid‐positive with Braak staging>3. We compared HVs between the amyloid‐positive and ‐negative groups and associations between co‐morbidities and vascular risk factors (VRFs) by comparing Charlson Co‐morbidity Indices (CCI) and number of VRF using Multiway ANOVA (anovan, MATLAB 2019b).ResultOne participant was Brain Banked; 34 (27 men) participated in the PET imaging sub‐study. There were no differences in years of education, VRF and CCI between PET and non‐PET participants, although PET participants had larger heads (Fig1). CCI was significantly associated with HV (p<0.0001) but CCI variability was explained by age (collinear). VRFs were not significantly associated with HV. PET participants were significantly older than the 61 (42 men) non‐PET participants (69.6+/‐8.6 vs 64.2+/‐13.5 years; p=0.037). Five participants were amyloid‐positive: Brain Bank participant (Braak Stage 5), 4 PET participants (Fig2). There was no association between amyloid CLs and HV, but amyloid positivity was associated with greater CCI.ConclusionIn this small study of stroke patients, hippocampal atrophy occurred independently of amyloid pathology and was more associated with age and co‐morbidity.

Effects of Preexisting Psychotropic Medication Use on a Cohort of Patients with Ischemic Stroke Outcome.

Background Several studies investigated the use of selective serotonin reuptake inhibitors (SSRI) after ischemic stroke to improve motor recovery. However, little is known about the effects of preexisting psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke functional disability. Objective We sought to determine the prevalence of PPMU and whether PPMU relates to the long-term clinical outcome in a cohort of patients presenting with acute ischemic strokes. Methods We retrospectively analyzed 323 consecutive patients who presented with an acute ischemic stroke in a single institution between January 2015 and December 2017. Baseline characteristics, functional disability as measured by the modified Rankin Scale (mRS), and major adverse cardiovascular complications (MACE) within 365 days were recorded. The comparison groups included a control group of ischemic stroke patients who were not on psychotropic medications before and after the index ischemic stroke and a second group of poststroke psychotropic medication use (PoMU), which consisted of patients started on psychotropic medication during the index admission. Results The prevalence of PPMU in the studied cohort was 21.4% (69/323). There was a greater proportion of females in the PPMU than in the comparison groups (P < 0.001), while vascular risk factors were similar in all groups, except for an increased presence of posterior circulation infarcts in the PPMU (37.4% vs. 18.8%, P < 0.001). Among the patients with available 1-year follow-up data (n = 246), we noted significantly greater improvement in stroke deficits, measured by National Institute of Health Stroke Scale (NIHSS) between PPMU and PoMU vs. control (3 (0-7) versus 1 (0-4), P = 0.041). The 1-year mRS was worse in PPMU and PoMU compared to the control group (2 (IQ 1-3) vs. 2 (IQ 0-3) vs. 1 (IQ 0-2), respectively, P = 0.013), but delta mRS reflecting the degree of mRS improvement showed no significant difference between any PMU and control patients (P = 0.76). There was no statistically significant difference in MACE. Conclusion PPMU in ischemic stroke is common; it can be beneficial in ischemic stroke in the long-term clinical outcome and is not associated with increased risks of MACE.

Abstract TP150: Effects of Pre-existing Psychotropic Medication Use on a Cohort of Patients With Ischemic Stroke Outcome

Background: Although SSRI use for ischemic stroke related motor recovery has been studied with mixed results, the effects of the pre-existing psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke outcome is unknown. Objective: We sought to determine the prevalence of PPMU, and the clinical outcome in a cohort of patients presenting with acute ischemic strokes. Methods: We retrospectively analyzed 323 consecutive patients who presented with an acute ischemic stroke that were included in an institutional stroke registry between January 2015 and December 2017. Baseline characteristics, functional outcome measured by mRS, cardiovascular complications and death within 90 days and 365 days were recorded. The control was defined as a group of ischemic stroke patients that were not on psychotropic medications pre- and/or post-ischemic stroke. Results: The prevalence of PPMU in the studied cohort was 21.4% (69/323). The prevalence of female gender in PPMU was higher compared to the control and post stroke-psychotropic medication use groups (P&lt;0.001), and the patients with PPMU had similar vascular risk factors compared to the control (NS), except for an increased presence of hyperlipidemia (68.1% vs. 57.5%, p&lt;0.05). Among the patients with an available 90-day follow-up (n=175) and 365-day follow-up (n=246), there was no statistically significant difference in outcome events of MI, stroke, death, and dementia. The mRS was higher on PPMU and poststroke-psychotropic medication use groups compared to the control group within the 365-day follow-up (P=0.013). Conclusion: The prevalence of PPMU is common in ischemic stroke, and it is not associated with worsened post-stroke complications within 1 year.

A stress-related explanation to the increased blood pressure and its course following ischemic stroke

BackgroundA hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke.MethodsIschemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3–6 h, 6–12 h and 12–24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or multiple), time window (admitted within or after 6 h of symptom onset) and presence of persistent proximal middle cerebral artery (MCA) occlusion versus normal findings on magnetic resonance angiography (MRA) at 24 h.ResultsA reduction in systolic BP and diastolic BP from baseline to 12–24 h was found across all DWI locations except for diastolic BP in cerebellar (P=0.072) lesions. Apart from diastolic BP in patients with normal MRA findings at 24 h (P=0.060), a significant fall in systolic BP and diastolic BP at 12–24 h was registered, irrespective of whether patients were admitted within 6 h or after 6 h of stroke onset or had persistent MCA occlusion versus normal MRA findings.ConclusionWe found a relatively consistent decline in BP within 24 h after admission across different stroke locations in patients admitted within or after 6 h of stroke onset and in patients with persistent MCA occlusion. Our findings suggest that a systemic factor such as psychological stress may be an important contributor to the frequently elevated BP on admission in patients with ischemic stroke.

Abstract TP154: Recovery of Slow-5 Oscillations in a Longitudinal Study of Ischemic Stroke Patients

Introduction: Functional networks in resting-state fMRI are identified by characteristics of their intrinsic low-frequency oscillations, more specifically in terms of their synchronicity. In advanced aging and clinical populations, this synchronicity among functionally linked regions is known to decrease, which may be associated with the observed cognitive and behavioral changes. Previous work from our group has revealed oscillations at the slow-5 range (0.01-0.027 Hz) are particularly susceptible to disruptions in aging and stroke. Hypothesis: In this study, we aim to characterize longitudinally slow-5 oscillations in stroke patients for hope to observe a recovery of those impaired oscillations in the later stage of the stroke. Methods: We followed a group of ischemic stroke patients (n=20) and healthy older adults (n=14) over two visits separated by a minimum period of three months. For the stroke patients, one visit occurred in their subacute window (10 days to 6 months after stroke), the other happened over their chronic window (&gt; 6 months after stroke). Using a groupICA on 10-minutes eyes-close resting-state fMRI data, we assessed the frequency distributions of component’s representative time-courses for differences between the two time-points, in particular in regards to slow-5 spectral power. Results: Slow-5 oscillations exhibited lower amplitudes in the stroke patient in their subacute stage in comparison to their healthy counterparts as was presented previously. Over time in their chronic stage, those patients show a recovery of those oscillations (p&lt;0.005), reaching near equivalence to the healthy older adult group. Conclusions: Our results indicate disrupted network dynamics in the subacute stroke population and demonstrate that return to normal level of spectral power by the chronic stage, potentially marking a recovery of the cortical system. This also verifies the implication of slow-5 oscillations in the integrity of network function in normal, but also in injured cortical systems.

Recovery of slow-5 oscillations in a longitudinal study of ischemic stroke patients.

Functional networks in resting-state fMRI are identified by characteristics of their intrinsic low-frequency oscillations, more specifically in terms of their synchronicity. With advanced aging and in clinical populations, this synchronicity among functionally linked regions is known to decrease and become disrupted, which may be associated with observed cognitive and behavioral changes. Previous work from our group has revealed that oscillations within the slow-5 frequency range (0.01–0.027 Hz) are particularly susceptible to disruptions in aging and following a stroke. In this study, we characterized longitudinally the changes in the slow-5 oscillations in stroke patients across two different time-points. We followed a group of ischemic stroke patients (n = 20) and another group of healthy older adults (n = 14) over two visits separated by a minimum of three months (average of 9 months). For the stroke patients, one visit occurred in their subacute window (10 days to 6 months after stroke onset), the other took place in their chronic window (> 6 months after stroke). Using a mid-order group ICA method on 10-minutes eyes-closed resting-state fMRI data, we assessed the frequency distributions of a component's representative time-courses for differences in regards to slow-5 spectral power. First, our stroke patients, in their subacute stage, exhibited lower amplitude slow-5 oscillations in comparison to their healthy counterparts. Second, over time in their chronic stage, those same patients showed a recovery of those oscillations, reaching near equivalence to the healthy older adult group. Our results indicate the possibility of an eventual recovery of those initially disrupted network oscillations to a near-normal level, providing potentially a biomarker for stroke recovery of the cortical system. This finding opens new avenues in infra-slow oscillation research and could serve as a useful biomarker in future treatments aimed at recovery.

Thrombolysis-related intracerebral hemorrhage and cerebral amyloid angiopathy: accumulating evidence.

Intracerebral hemorrhage (ICH) is the most feared risk of systemic thrombolysis for ST-elevated myocardial infarction, pulmonary embolism, or acute ischemic stroke. Clinical, radiological, and pathological evidence suggests that cerebral small vessel disease and, in particular, cerebral amyloid angiopathy (CAA) may contribute to or in some cases directly underpin thrombolysis-related intracerebral hemorrhage (TICH) (1). Further developments, particularly in neuroimaging, have strengthened this hypothesis, hinting at the prospect of identifying biomarkers to measure TICH risk for individual patient groups. Emerging biomarkers for CAA such as lobar cerebral microbleeds (2) may become increasingly useful for outcome endpoints in clinical trials and patient risk stratification for TICH (3). Thrombolysis-related intracerebral hemorrhage is a complex pathophysiological process. For ischemic stroke patients, a key issue is the location of TICH, i.e., hemorrhage into the area of ischemia vs. hemorrhage in a remote non-ischemic site (occurring in about 20% of patients with symptomatic TICH). Classification of TICH has traditionally focused on clinical and radiological features (4), with less emphasis on whether different mechanisms might be implicated in TICH in remote from or within the acute infarcted region (5) or whether pathological assessment has occurred. Coregistered Pittsburgh compound B positron emission tomography (PiB-PET) imaging has revealed that spontaneous hemorrhage hotspots preferentially occur at locations with increased amyloid β-protein burden (6). In patients treated with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke, cerebral amyloid β-protein (as detected with PiB-PET) retention was higher in patients with parenchymal hemorrhage compared to patients without (7). Although PiB-PET has somewhat poor spatial resolution and cannot reliably resolve parenchymal and cerebrovascular amyloid β-protein, the finding is probably one of the strongest pieces of radiological evidence implicating CAA in TICH. Matrix metalloproteinase 9, a zinc-dependent endopeptidase and a marker of hemorrhagic transformation after ischemic stroke, is released from neutrophil granules by rt-PA in humans (8). Amyloid β-protein can also release and activate MMP-9 from mouse endothelial cells (9), suggesting that convergent risk factors may lead to hemorrhage. Cerebral microbleeds identified on MRI in a lobar distribution are considered a characteristic hemorrhagic marker of a vasculopathy related to CAA (2). It has slowly emerged that multiple microbleeds might increase the risk of symptomatic ICH following thrombolysis treatment, a relationship which increases with increasing numbers of microbleeds (10, 11). In more recent studies with larger groups of ischemic stroke patients receiving intravenous thrombolysis in both European and Chinese populations, multiple cerebral microbleeds were more clearly associated with symptomatic and parenchymal hemorrhage, respectively (12, 13). Future study may provide insights into potential mechanisms, and meta-analyses may highlight the relative importance of lobar and non-lobar cerebral microbleeds in stratifying the intracerebral hemorrhagic risk from thrombolysis. In a review in 2004 (1), we identified 10 patients with pathological investigation of TICH, 7 of whom had evidence of CAA. All of these patients had been treated for acute myocardial infarction and nine of the patients had multiple hemorrhages in a lobar distribution. With an increasing emphasis on primary percutaneous intervention for ST-elevated myocardial infarction, it may not be surprising that no further TICH cases following thrombolysis for acute myocardial infarction have been reported. However, although thrombolysis rates have increased for acute ischemic stroke patients, in an updated systematic literature search, only two further autopsy TICH cases (multiple and both hemispheres) have been reported in the stroke literature, both of whom had CAA (14). The relative lack of human pathological studies compared to neuroimaging studies hampers further developments in this area. A pathological register attached to a clinical register would enhance our understanding of TICH, particularly in the older population with acute ischemic stroke. The known predictors of clinically significant TICH currently include age, clinical stroke severity, high blood pressure, hyperglycemia, early CT ischemic changes, large baseline diffusion lesion volume, leukoaraiosis, and cerebral microbleeds on MRI; the evidence for a role of CAA in TICH continues to accumulate.

Oxidative Stress and Post-Ischemic Inflammatory Response in Ischemic Stroke Complicated with Diabetes Mellitus Type 2

Oxidative stress and post-ischemic inflammatory response are the key pathogenic mechanisms of the neuronal injury caused by ischemic stroke (IS). On the other hand, Diabetes is a major risk factor for the development of stroke, increasing the susceptibility to atherosclerosis and the prevalence of atherogenic risk factors, including hypertension, obesity, and abnormal blood lipids. The aim of current study was to analyze the functional activity of oxidant-antioxidant system and post-ischemic inflammatory response in IS patients complicated and noncomplicated with diabetes mellitus type 2 (DM2). ELISA, photochemiluminescent and spectrophotometric methods were used to analyze the serum samples of IS patients complicated and noncomplicated with DM2, DM2 patients, as well as healthy subjects. The results obtained suggest that IS complicated with diabetes is characterized by higher intensity of the lipid peroxidation process as compared to IS noncomplicated with diabetes that, probably, is one of the determining factors responsible for more severe clinical course of IS patients complicated with DM2 compared to those noncomplicated with DM2. It is also shown that mechanisms of the compensatory response to oxidative stress on the level of antioxidants in IS patients complicated with diabetes differ from those detected in IS noncomplicated with diabetes. A significant increase of the levels of the five analyzed cytokines in both groups of IS patients were detected. Based on the results obtained we suggest that metabolic, molecular, and cellular level alterations are typical for long-term DM2 impair compensatory mechanisms protecting the body from oxidative stress, and that in IS complicated with DM2 the systemic inflammatory reactions and oxidative stress are more intense than in case of IS noncomplicated with DM2.

Determination of number of Extracranial and Intracranial Atherosclerotic Arterial Stenosis in Patients of Ischemic Stroke with Diabetes Mellitus under DSA Evaluation

Objective: To evaluate the solitary &amp; multiple site of extracranial and intracranial atherosclerotic arterial stenosis in patients of ischemic stroke with diabetes mellitus.&#x0D; Methodology: This retrospective observational study was conducted among the patients having ischemic stroke with diabetes mellitus who were admitted in Dhaka Medical College &amp; Hospital (DMCH) out patient department during March 2010 to February 2011. A total of 30 patients with ischemic stroke and diabetes mellitus were included in the study. CT scan of brain was done to every patient to confirm the diagnosis. Digital subtraction angiography was performed for complete evaluation.&#x0D; Result: The mean (±SD) age was 57.9±9.2 years with a range from 43 to 80 years and male female ratio was 29:1. Among 21 patients with extracranial stenosis, either single, double and triple or more lesions were found in 53.3%, 85.7% and 87.5% of patients respectively. Again among 9 patients with intracranial stenosis, it was observed that 46.7% of patients had single lesion stenosis, 14.3% of patient had double lesion stenosis and 12.5% of patients had triple or more lesion stenosis. Double (85.7%) and triple (87.5%) lesions were significantly (p&lt;0.05) higher in extracranial stenosis compared to intracranial stenosis (14.3% and 12.5% respectively). Most (78.9%) of the patients had &gt;70% stenosis in extracranial arteries and 21.1% in intracranial arteries. Patients with &gt;70% stenosis were significantly (p&lt;0.05) higher in extracranial arteries.&#x0D; Conclusion: A conclusion can be made from the above mentioned result that occurrence of multiple site of lesions and more severe stenosis occurred more in extracranial group than in intracranial group of ischemic stroke patients among diabetic population of Bangladesh.&#x0D; Bangladesh Journal of Neuroscience 2013; Vol. 29 (1) : 1-4

Abstract 2703: In-hospital Versus Out-of-hospital Stroke Treated With Iv Tpa And 3 Month Outcomes.

Background: Most hospitals set up Code Stroke alert teams in the Emergency Departments. Expanding sufficient Code Stroke coverage to in-hospital areas requires additional resources, often through Neuro-hospitalist teams. Most data on outcomes after stroke are based on out-of-hospital stroke. We evaluated the outcomes of patients with stroke that occurs in the hospital versus out-of-hospital. Methods: We included all adult patients with Code Stroke alerts, diagnosis of acute ischemic stroke, who had 90-days post Code Stroke modified Rankin Scale from the UCSD SPOTRIAS database (2004 to 2011) and excluded patients transferred from acute care facilities. The patients were grouped into 1: out-of-hospital Code Stroke alerts (EMS or ED) and 2: in-hospital (all inpatient units) and analyzed by baseline demographics, time to treatment decision, frequency of IV tPA use, 90-day modified Rankin Scale (mRS) and adjusted for multiple co-variables. Symptomatic intracranial hemorrhage (SICH) was defined as ≥4 point increase in NIHSS and ICH that was deemed the cause of the clinical change. Results: We identified 590 Code Stroke alerts; 563 in group 1 and 27 in group 2. Baseline demographics were balanced, except group 2 patients younger (64.26±16 vs 70.2±15.5 years of age, p=0.0497) and were more likely to be Hispanic (29.6 vs 14.2%, p=0.047). IV tPA was given in 13/27 (48.2%) patients in Group 2 and 266/563 (47.3%) in Group 1 (NS). Anticoagulation was the reason for exclusion in 4/14 (28.6%) of patients in Group 2 vs 18/266 (6.5%) (p=0.017). The frequency of other diagnoses and reasons for exclusion were similar between groups. The time from stroke onset to tPA treatment in group 2 was 135.1±57.9 vs 151.4±121.2 min (NS). A 90-day mRS of 0 or 1 was achieved in 9/27 (33.3%) patients in Group 2 and 221/563 (39.3%) patients in Group 1 (NS); in tPA treated patients: Group 2 3/13 (23.1%), Group 1 83/266 (31.2%) (NS). SICH occurred in the tPA treated patients: Group 2 1/13 (7.7%); Group 1 9/266 (3.4%) (NS). Conclusion: We identified a relatively small group of ischemic stroke patients with in-hospital onset. In those patients, however, rates of tPA use and outcomes were similar to out-of-hospital stroke.

Thrombolytic Therapy for Patients Who Wake-Up With Stroke

Approximately 25% of ischemic stroke patients awaken with their deficits. The last-seen-normal time is defined as the time the patient went to sleep, which places these patients outside the window for thrombolysis. The purpose of this study was to describe our center's experience with off-label, compassionate thrombolysis for wake-up stroke (WUS) patients. A retrospective review of our database identified 3 groups of ischemic stroke patients: (1) WUS treated with thrombolysis; (2) nontreated WUS; and (3) 0- to 3-hour intravenous tissue plasminogen activator-treated patients. Safety and clinical outcome measures were symptomatic intracerebral hemorrhage, excellent outcome (discharge modified Rankin score, 0-1), favorable outcome (modified Rankin score, 0-2), and mortality. Outcome measures were controlled for baseline NIHSS using logistic regression. Forty-six thrombolysed and 34 nonthrombolysed WUS patients were identified. Sixty-one percent (28/46) of the treated WUS patients underwent intravenous thrombolysis alone whereas 30% (14/46) were given only intra-arterial thrombolysis. Four patients received both intravenous and intra-arterial thrombolysis (9%). Two symptomatic intracerebral hemorrhages occurred in treated WUS (4.3%). Controlling for NIHSS imbalance, treated WUS had higher rates of excellent (14% vs 6%; P=0.06) and favorable outcome (28% vs 13%; P=0.006), but higher mortality (15% vs 0%) compared to nontreated WUS. A second comparison controlling for baseline NIHSS between treated WUS and 174 intravenous tissue plasminogen activator patients treated within 3 hours of symptoms showed no significant differences in safety and clinical outcomes. Thrombolysis may be safe in WUS patients. Our center's experience supports considering a prospective, randomized trial to assess the safety and outcome of thrombolysis for this specific patient population.

Stroke development in women and constitutional factors

Neurological, psychological, anthropological, biochemical, and neurovisualization statuses have been studied in 45 female patients after ischemic stroke and 40 women with chronic cerebrovascular pathology. Significant differences are demonstrated in the group of ischemic stroke patients toward more serious dishormonal disorders compared to the group of patients with moderate discirculator encephalopathy.

Risk Factors of Sensorineural Hearing Loss in Patients With Ischemic Stroke

We investigated risk factors of sensorineural hearing loss (SHL) in patients with early stage of ischemic stroke (IS). Our study consisted of 60 patients with IS who were treated at Department of Neurology, Medical University of Gdansk between 2006 and 2007. A multivariate stepwise linear regression was used to identify the risk factors that were related to SHL as measured by pure-tone average (0.5, 1, and 2 kHz), the high-tone average (4, 6, and 8 kHz), the pure-tone middle-tone average (0.5, 1, 2, and 4 kHz), and the overall average (0.5, 1, 2, 4, 6, and 8 kHz). The following factors were included in the analysis: age, sex, smoking habit, addiction to alcohol, presence of tinnitus and vestibular symptoms, arterial hypertension, cardiac ischemic disease, hyperlipidemia, diabetes, number of risk factors, neurologic state at the admission, localization of stroke, cause of stroke, number of ischemic focuses, the side and diameter of ischemic focuses, the result of directional hearing acuity angle test, results of certain laboratory tests, blood morphology parameters, and coagulogram. Values for p less than 0.05 were considered significant. Our analysis suggests the presence of the following risk factors of SHL in patients with IS: 1) older age (>60 yr); 2) male sex; 3) presence of tinnitus; 4) arterial hypertension; 5) lacunar type of stroke; 6) presence of multiple ischemic focuses; 7) presence of bilateral ischemic focuses; 8) changes in blood cell count; and 9) disturbances of agglutination. The highest risk of hearing loss in the group of IS patients occurred at older people, particularly men with tinnitus, lacunar stroke, multiple, bilateral ischemic focuses, and arterial hypertension. A negative statistically significant influence of decreased level of red cells, platelets, and hematocrit value on hearing loss was found. Abnormally lowered levels of activated partial thromboplastin time, activated partial thromboplastin time ratio, prothrombin index, and abnormal lowered level of international normalized ratio statistically impaired hearing.

A comparative study on oxidative stress and antioxidant status in ischemic stroke patients with and without diabetes.

The study was conducted to find out the extent of lipid peroxidation and antioxidant status in ischemic stroke patients (ISPs) with and without diabetes. Malondialdehyde (MDA) was studied as a marker of lipid peroxidation. Glutathione (GSH), uric acid and ceruloplasmin were estimated to study the antioxidant potential of ISPs. Significantly higher levels of MDA were found in both the groups of ISPs and the increase in MDA was more in ISPs without diabetes. GSH levels were decreased significantly in both the groups of ISPs and maximum decline was found in ISPs with diabetes. Uric acid levels were significantly increased in both the groups of ISPs. Ceruloplasmin levels were increased significantly in ISPs without diabetes, whereas its levels were slightly decreased in ISPs with diabetes. A negative correlation was found between MDA and the antioxidants GSH, uric acid and ceruloplasmin in ISPs with diabetes. This study suggests that there is an association between ischemic stroke and increased oxidative stress and the antioxidant potential is impaired in both the groups of ISPs with and without diabetes.

Increased levels of elastin-derived peptides in cerebrospinal fluid of patients with lacunar stroke

Objective To investigate whether elastin-derived peptides (EDP) are detectable in the cerebrospinal fluid (CSF) of healthy controls and of patients with acute brain ischemia and if so to assess possible trends in EDP levels in different groups of ischemic stroke patients (small-vessel disease vs. other ischemic strokes; first-ever vs. recurrent stroke). Patients and methods Levels of EDP were determined by ELISA in blood sera and CSF of 80 patients with acute ischemic stroke (mean age 61.5 ± 10.8; age range 47–70; 22 women) and in 15 healthy age- and sex-matched controls (mean age 57.3 ± 13.4; age range 50–65). The patients were divided into a group with first ever lacunar stroke (27); first ever non-lacunar ischemic stroke (27) and recurrent stroke (26). EDP were measured early (mean 7 days, range 1–15) after stroke onset. Results Serum EDP levels were mildly higher in recurrent strokes as compared to first ever lacunar lesion and controls. However, in the CSF the concentrations of EDP in stroke patients were strongly elevated (from 2 up to 30 times depending on subgroup) as compared with healthy subjects. The highest level of EDP in CSF and in the serum was found in recurrent strokes. Subgroup analysis revealed a trend for significantly higher EDP concentrations in CSF in lacunar and recurrent stroke as compared with non-lacunar. Conclusions This study is the first application of elastin peptide measurement to human CSF and stroke patients. The increased levels of EDP were detected in CSF of patients with lacunar and recurrent strokes.