Hours Of Stroke Research Articles

Occupational Characteristics and Working Hours of Stroke and Myocardial Infarction Patients at a Hospital in Bangkok: A Descriptive Study

OBJECTIVE The aim of this study was to investigate occupational risk factors, particularly focusing on working hours, in the patients with cerebrovascular diseases and cardiovascular diseases to help reduce the incidence of those diseases in the future. METHODS This descriptive study was conducted retrospectively. Patients age 18 to 65 with a first diagnosis of acute stroke and acute myocardial infarction in the years 2019 to 2022 were included. Demographic data were obtained from in-patient records. Occupational data, including working hours and other missing data, were obtained through telephone interviews with the patients. RESULTS After excluding individuals who were unemployed at the time of the disease incident, deceased, unwilling or unreachable to participate, a total of 146 patients were included in this study. Of those, 115 participants (78.8%) were first diagnosed with acute stroke and 31 participants (21.2%) were first diagnosed with acute myocardial infarction during the study period. The median and interquartile range of weekly working hours of all participants, participants with acute stroke, and participants with acute myocardial infarction were 56 (25), 56 (35), and 59 (27) hours per week, respectively. The range of working hours per week was from 4 to 112 hours. The majority of participants reported not engaging in dangerous work as defined by Thailand’s Ministry of Labour, reported no significant occupational hazards, stated they had minimal stress and that they had control over their own job. CONCLUSIONS The results indicate that the majority of stroke and myocardial infarction patients from this center worked ≥ 55 hours per week. Although the majority reported having no significant occupational factors, recognizing and incorporating a history of occupational factors could be beneficial in disease diagnosis, disease prevention, prevention of recurrence, and aiding the return-to-work process of the patients. KEYWORDS overwork, cerebrovascular disease, cardiovascular disease, myocardial infarction, stroke, occupational disease, long working hours

Leucine Reduced Blood-Brain Barrier Disruption and Infarct Size in Early Cerebral Ischemia-Reperfusion.

A disruption of the blood-brain barrier (BBB) is a crucial pathophysiological change that can impact the outcome of a stroke. Ribosomal protein S6 (S6) and protein kinase B (Akt) play significant roles in early cerebral ischemia-reperfusion injury. Studies have suggested that branched-chain amino acids (BCAAs) may have neuroprotective properties for spinal cord or brain injuries. Therefore, we conducted research to investigate if leucine, one of the BCAAs, could offer neuroprotection and alter BBB disruption, along with its effects on the phosphorylation of S6 and Akt during the early phase of cerebral ischemia-reperfusion, specifically within the thrombolytic therapy time window. In rats, ten min after left middle cerebral artery occlusion (MCAO), 5 µL of 20 mM L-leucine or normal saline was injected into the left lateral ventricle. After two hours of reperfusion following one hour of MCAO, we determined the transfer coefficient (Ki) of 14C-α-aminoisobutyric acid to assess the BBB disruption, infarct size, and phosphorylation of S6 and Akt. Ischemia-reperfusion increased the Ki (+143%, p < 0.001) and the intra-cerebroventricular injection of leucine lowered the Ki in the ischemic-reperfused cortex (-34%, p < 0.001). Leucine reduced the percentage of cortical infarct (-42%, p < 0.0001) out of the total cortical area. Ischemia-reperfusion alone significantly increased the phosphorylation of both S6 and Akt (p < 0.05). However, the administration of leucine had no further effect on the phosphorylation of S6 or Akt in the ischemic-reperfused cortex. This study suggests that an acute increase in leucine levels in the brain during early ischemia-reperfusion within a few hours of stroke may offer neuroprotection, possibly due to reduced BBB disruption being one of the major contributing factors. Leucine did not further increase the already elevated phosphorylation of S6 or Akt by ischemia-reperfusion under the current experimental conditions. Our data warrant further studies on the effects of leucine on neuronal survival and its mechanisms in the later stages of cerebral ischemia-reperfusion.

Randomised study of bailout intracranial angioplasty following thrombectomy for acute large vessel occlusion (ANGEL-REBOOT): protocol of a multicentre randomised controlled trial

RationaleUnsuccessful thrombectomy of acute large vessel occlusions (LVOs) has been associated with unfavourable outcomes. Multiple randomised controlled trials (RCTs) have reported a failure rate of 12%–41% for thrombectomy procedures. Various...

Temporal changes of QT dispersion in patients with acute ischemic stroke

Aim: Ischemic stroke is a significant cause of morbidity and mortality and can lead to fatal arrhythmias even in the absence of underlying cardiac pathology. The objective of this study was to investigate the impact of acute ischemic stroke on QT dispersion and its temporal changes over time. Methods: A total of 124 patients with acute ischemic stroke who did not receive any reperfusion treatment were included in the study. Corrected QT dispersion (QTcd) values were obtained from 12-lead surface electrocardiograms taken within the first 12 hours and after 48 hours of stroke onset. These values were compared with those of 93 age and sex-matched control subjects. The effects of diabetes and lesion lateralization on QT dispersion were also analyzed. Stroke patients whose lesions were clearly localized to either the right or left hemisphere were divided into two subgroups. The change in QT dispersion overtime during the follow-up period was also determined. Results: The study included 124 patients with acute ischemic stroke (54 females and 70 males) with a mean age of 67±11 years, as well as a control group of 93 subjects (49 females and 44 males) with a mean age of 69±8 years. The QTcd values of the stroke group were significantly longer than the control group in the first 12 hours of symptom onset. However, after 48 hours, the QTcd values of the stroke group decreased and the difference between the two groups was not statistically significant. The presence of diabetes mellitus caused a more significant increase in QT dispersion, and after 48 hours, the QTcd values of diabetic stroke patients were still significantly longer. The QTcd values of patients with left hemispheric lesions were significantly longer than those of patients with right hemispheric lesions, and this difference persisted after 48 hours. Conclusion: This study found that QT dispersion increases during the first few hours of ischemic stroke and decreases during the treatment period. This increase is more obvious and lasts longer in stroke patients with diabetes and left hemispheric lesions. The results suggest that QT dispersion may be a useful prognostic indicator for patients with acute ischemic stroke.

Effect of VEGF on neurological impairment and prognosis of acute cerebral infarction patients: A retrospective case-control study.

Due to the complex pathological mechanism of acute cerebral infarction, the role of vascular endothelial growth factor (VEGF) on the disease is not clear. Therefore, a retrospective case-control study was performed to explore the effect of VEGF on neurological impairment and prognosis of acute cerebral infarction patients. A total of 100 patients with acute cerebral infarction admitted to our hospital from April 2021 to April 2022 were selected. Blood samples from all patients would be routinely collected to detect the expression of serum VEGF. Pearson chi-square, Spearman correlation and univariate Logistic regression were used to analyze the clinical data to explore the relationship between VEGF expression and basic information, stroke degree, quality of life, and prognosis of patients. To determine whether VEGF can provide relevant basis for the early prevention and prognostic treatment of acute cerebral infarction. And multivariate logistic regression was used to calculate the odds ratio between each variable and VEGF expression. Pearson chi-square test and Spearman correlation coefficient showed that sex, degree of stroke, limb convulsions, loss of consciousness, hemiplegia, aphasia, mental functioning score, overall quality of life score, and short-term prognosis were significantly correlated with VEGF expression in 100 patients. Univariate logistic regression was used to describe the ORs and 95% confidence interval of subjects at the univariate level, and the degree of stroke (OR = 83.333, P < 0.001), tic of limbs (OR = 26.316, P < 0.001), loss of consciousness (OR = 23.256, P < 0.001), hemiplegia (OR = 62.500, P < 0.001), aphasia (OR = 76.923, P < 0.001), mental functioning score (OR = 7.937, P < 0.001), overall quality of life score (OR = 5.464, P < 0.001), short-term prognosis (OR = 37.037, P < 0.001) was significantly correlated with the high expression of VEGF. The level of serum VEGF was positively correlated with neurological impairment degree and prognosis in patients with acute cerebral infarction, the more severe the degree of stroke and the worse the prognosis.

Predictors of early seizures after first acute stroke

Background and objective:&#x0D; There is a lack of local data regarding the frequency and predictors of early seizures after stroke. The objective of this study was to determine the frequency of early seizures after stroke and identify the predictors which lead to them after first acute stroke.&#x0D; Methods:&#x0D; This cross-sectional observational study was conducted in the Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad from October 2021 to June 2022. A total of 310 consecutive eligible patients of acute stroke were recruited. Key inclusion criteria included any patient of &gt;20 years of age with confirmed diagnosis of stroke on imaging, non-traumatic, with no history of seizures in past. Data was analyzed by SPSS version 23.0.&#x0D; Results: &#x0D; The mean age of patients in the seizures group was 48.40 ± 20.9 years. Hypertension was the most common co-morbid present in 225 (76.5%) patients. Early seizures were found in 52 (16.8%) patients with 42 (80.76%) having seizures in first 24 hours of stroke (p value 0.001). On National Institute of Health Sciences Scale (NIHSS) score most patients 125 (40.3%) had moderate severity score i.e. score in between 7 to 25 (p value 0.05). Ischemic stroke was identified as the stroke variety with most of the early seizures i.e. 16 (30.76%) (p value 0.003).&#x0D; Conclusion: &#x0D; Early seizures were not infrequent after acute stroke (16.77%) in our study. Early seizures were associated with younger age, cortical region lesion, ischemic stroke, followed by cerebral venous thrombosis. Higher NIHSS score and greater disability was associated with increased incidence of early seizures.&#x0D;

The Correlation of Glial Fibrillary Acid Protein Level to Cognitive Function Outcome in Acute Lacunar Ischemic Stroke Patient

ABSTRACT :&#x0D; Introduction : Glial fibrillary acidic protein (GFAP) is a filamentous protein found in central nervous system astrocytes. Increased serum GFAP levels are caused by the process of astrogliosis after ischemic stroke and are associated with multisynaptic disorders so that they are at risk of causing cognitive disorders.&#x0D; Objective: To analyze the correlation between GFAP levels and cognitive function output in acute lacunar ischemic stroke patients.&#x0D; Research Methods : Analytical observational with prospective cohort approach. The subjects of this study were Acute lacunar ischemic stroke patients with mild to moderate NIHSS scores. Serum GFAP levels were taken at the onset of 48-72 hours of stroke. Cognitive function was measured using the Indonesian version of MoCA (MoCA Ina) test on the seventh and thirtieth day. Bivariate and multivariate analyzes were performed to assess the correlation between GFAP levels, cognitive functions and the confounding factors.&#x0D; Results: There was a significant correlation between GFAP levels and the MoCA Ina scores on the seventh day (r= -0.32, p=0.044), the thirtieth day (r= -0.398, p=0.011), and improvement in MoCA Ina scores (r= -0.342, p = 0.031). There was a significant correlation between GFAP levels on the executive domain on the seventh day (p= 0.01) and thirtieth day (p= 0.005), visuospatial on seventh day (p= 0.004) and thirtieth day (p= 0.016), language on the thirtieth day (p = 0.005), and memory on thirtieth day (p= 0.001). There was no significant correlation between GFAP levels and improvements in attentional, memory, language, visuospatial, and executive domains.&#x0D; Conclusion: There was a significant correlation between GFAP levels and MoCA Ina scores on the seventh, thirtieth day and the improvement of MoCA Ina scores. There was a significant correlation between GFAP levels with the executive, visuospatial, language, and memory domains.&#x0D; Keywords: cognitive, GFAP, lacunar ischemic stroke, MoCA Ina

Metabolic Profile as a Predictor of Ischaemic Stroke: The Experience of a Rural Hospital in Nigeria

BACKGROUNDThe metabolic profile which includes glycated haemoglobin, insulin resistance, pancreatic beta cell function and lipid profile is frequently deranged in acute ischaemic stroke. Stroke is a leading cause of death worldwide and an emerging cause of long-term disability and mortality in Africa. Our study aimed to determine the correlation between the metabolic profile and acute ischaemic stroke in a rural Hospital in Southern Nigeria.METHODOLOGYThis was a prospective cross-sectional study. Fifty consecutive first-ever ischaemic stroke patients presenting within 72 hours of stroke were matched for age and sex with 3 control groups (49 persons with type 2 diabetes and hypertension, 49 persons with hypertension only and 57 apparently healthy individuals). Blood samples were obtained from all participants to determine glycated haemoglobin, fasting lipid profile, fasting plasma glucose, fasting insulin and C-peptide and random plasma glucose (in stroke cases at presentation). Insulin resistance and pancreatic beta-cell function were determined using the Homeostatic Model Assessment (HOMA). Data were analysed by multivariate and univariate statistics.RESULTSOne hundred and two (49.8%) males and 103 (50.2%) females participated in the study. The overall mean age of the study participants was 61.6 ± 10.1 years. Compared with the control groups, predictors of acute ischaemic stroke were Fasting insulin (hyperinsulinaemia) [OR (95%CI) = 1.108 (1.043-1.178), p= 0.001], HOMA-β% [OR (95%CI) = 0.994 (0.990-1.001) p=0.006] and total cholesterol [OR (95%CI)= 0.009 (0.001-0.012) p=0.022].CONCLUSIONIn this study, hyperinsulinaemia, impaired beta-cell secretory function (HOMA-β) and elevated total cholesterol were found to be significant risk factors of ischaemic stroke. Hence, the need for regular screening to detect abnormal metabolic profiles and prompt treatment.

HsCRP (High-Sensitivity C - reactive protein) and its Association with Short Term Prognosis Following Ischaemic Stroke

Introduction: Stroke is a major cerebrovascular disease is one of the most common Neurological diseases. It is the second leading cause of death worldwide. Cerebrovascular disease threatening human health and life with high morbidity, disability and mortality. Major risk factors of ischaemic strokes are hypertension, diabetes, and dyslipidaemia. High sensitivity C-reactive protein (HsCRP) is an inflammatory marker which appears to be a strong predictor of risk factor and prognostic marker of Ischaemic stroke. Objective: To find the acute course of HsCRP and its association with short term prognosis following Ischaemic stroke. Methods: A Cross sectional observational study at Dept. of Neurology, Enam Medical College Hospital, Savar, Dhaka, Bangladesh From March 2020 to April 2021. Total number of subjects in this study were 101 with power 80% (persons aged 30 years &amp; above; both male and female). Both sexes and their plasma high sensitivity C-reactive protein (HsCRP) level was measured within 48 hours of admission and on the 5th day after admission. Results: The study showed that the level of HsCRP did not change significantly when measured within 48 hours of onset of Ischaemic stroke and on 5th day after stroke (p=0.335) - the prognosis and severity remained same when followed for 5 days. It, also, showed that the level of CRP ≥ 3 within 48 hours of admission is associated with increased severity and mortality of stroke (Z=14.4; p&lt;0.0001). Conclusion: HsCRP level provides rapid and reliable information regarding severity &amp; prognosis in patients with Ischaemic stroke. The level of HsCRP does not change significantly when measured within 48 hours of onset of Ischaemic stroke and on 5th day after stroke. Also, the level of CRP on 5th day was same as within 48 hours of stroke - the prognosis and severity remained same. If confirmed by larger, longitudinal studies this association may be used as a tool to assess the severity and prognosis in a patient with Ischaemic strokes.

167 Reversible VWF Inhibitor Lyses MCA Occlusion 6 Hours after Large Vessel Occlusion Stroke

INTRODUCTION: Acute ischemic stroke (AIS) is the leading cause of combined morbidity and mortality worldwide. Recombinant tissue plasminogen activator (rtPA) represents the only approved pharmacological treatment for AIS but is limited to treating those within 4.5 hours of stroke onset because of the risk of intracranial hemorrhage. Moreover, it is ineffective in treating large vessel occlusion (LVO) stroke. For this population, endovascular mechanical thrombectomy (MT) effectively recanalizes the occlusion but is limited to highly-specialized hospitals, leaving the vast majority without timely acute treatment. METHODS: Utilizing a canine embolic middle cerebral artery occlusion (eMCAO) model of LVO stroke, we assessed DTRI-031 on vessel recanalization after 6 hours of LVO stroke by digital subtraction angiography (DSA). We also measured the effect of recanalization on infarct volume (efficacy) and hemorrhage (safety) using magnetic resonance imaging (MRI). Finally, we assessed the ability of DTRI-025, an oligonucleotide that binds DTRI-031 to reverse DTRI-031 activity. RESULTS: DTRI-031 administration after 6 hours of LVO stroke resulted in &gt;TICI 2A in 62.5% and &gt;TICI 2B in 50% of canines (n = 8). Negative control group demonstrated no revascularization (n = 7). Recanalization resulted in reduced infarct volume compared to negative control (p &lt; 0.05, unpaired t-test). None of the animals that received DTRI-031 had intracranial hemorrhage on MRI. Finally, DTRI-025 completely reversed the activity of DTRI-031 within 5 minutes of administration in both whole blood impedance aggregometry (WBA) and PFA-100. CONCLUSION: DTRI-031 effectively recanalizes LVO after 6 hours of stroke onset with reduced infarct volume and no incidence of hemorrhage. DTRI-025 rapidly reverses DTRI-031. This drug/reversal agent combination represents a robust yet safe approach to treat AIS.

Abstract 45: Vwf Inhibitor Lyses Middle Cerebral Artery Occlusion After 6 Hours Of Large Vessel Occlusion Stroke

Introduction: Acute ischemic stroke (AIS) is the leading cause of combined morbidity and mortality worldwide. Recombinant tissue plasminogen activator (rtPA) is the only FDA-approved drug to treat AIS, however, it is limited to treating patients within 4.5 hours of stroke onset because of the risk of intracranial hemorrhage. This limits rtPA administration to ~6% of patients. Moreover, it poorly lyses large vessel occlusion (LVO) stroke. Endovascular mechanical thrombectomy (MT) effectively recanalizes LVO but is limited to highly specialized hospitals, leaving the majority without acute therapy. Hypothesis: We hypothesize that targeted von Willebrand Factor (VWF) inhibition by DTRI-031 will recanalize arterial thrombosis in a canine model of LVO stroke, and DTRI-031 activity will be rapidly reversed by DTRI-025, which is specifically designed to inhibit DTRI-031. Methods: Utilizing a canine embolic middle cerebral artery occlusion (eMCAO) model of LVO stroke, we assessed DTRI-031 on vessel recanalization after 6 hours of LVO stroke by digital subtraction angiography (DSA). We also measured the effect of recanalization on infarct volume (efficacy) and hemorrhage (safety) using magnetic resonance imaging (MRI). Finally, we assessed the ability of DTRI-025, an oligonucleotide that binds DTRI-031 to reverse DTRI-031 activity. Results: DTRI-031 administration after 6 hours of LVO stroke resulted in ≥TICI 2A in 62.5% and ≥TICI 2B in 50% of canines (n=8). The negative control group demonstrated no revascularization (n=7). Recanalization resulted in reduced infarct volume compared to the negative control (p&lt;0.05, unpaired t-test). None of the animals that received DTRI-031 had an intracranial hemorrhage on MRI. Finally, DTRI-025 completely reversed the activity of DTRI-031 within 5 minutes of administration in both whole blood impedance aggregometry (WBA) and PFA-100. There was no difference in heart rate, blood pressure, or temperature among the 3 groups studied. Conclusion: DTRI-031 effectively recanalizes LVO after 6 hours of stroke onset with reduced infarct volume and no incidence of hemorrhage. DTRI-025 rapidly reverses DTRI-031. This drug/reversal agent combination represents a robust yet safe approach to treat AIS.

Association of CT-Based Hypoperfusion Index With Ischemic Core Enlargement in Patients With Medium and Large Vessel Stroke.

The rate of infarct core progression in patients with acute ischemic stroke is variable and affects outcome of reperfusion therapy. We evaluated the hypoperfusion index (HI) to estimate the initial rate of core progression in patients with medium vessel occlusion (MeVO) compared to large vessel occlusion (LVO) stroke and within a larger time frame since stroke onset. Core progression was assessed in 106 patients with acute stroke and CT perfusion. Using reperfusion trial core time criteria, fast progressors had core >70 mL within 6 hours of stroke onset and slow progressors had core ≤70 mL, mismatch ≥15 mL, and mismatch to core ratio ≥1.8 within 6 to 24 hours. The relationship between HI and infarct core progression (core/time) was examined using receiver operating characteristics to determine optimal HI cutoff. The HI cutoff was then tested in the overall cohort, compared between MeVO and LVO, and evaluated in patients up to 24 hours from stroke onset to differentiate fast from slow rate of core progression. HI threshold was assessed in a second independent cohort of 110 patients with acute ischemic stroke. In 106 patients with acute stroke, 6.6% were fast progressors, 27.4% were slow progressors, and 66% were not classified as fast or slow progressor by reperfusion trial core time criteria. HI >0.5 was associated with fast progression and able to distinguish fast from slow progressors (area under the curve [AUC] 0.94; 95% confidence interval [CI] 0.80-0.99). In MeVO (n = 26) HI >0.5 had a core progression of 0.30 mL/min compared to 0.03 mL/min for HI ≤0.5 (p < 0.001). In LVO (n = 80), HI >0.5 had a core progression of 0.26 mL/min compared to 0.02 mL/min for HI ≤0.5 (p < 0.001). In patients not classified as fast or slow progressor by reperfusion trial criteria, those with HI >0.5 had progression rate of 0.21 mL/min compared to 0.03 mL/min for those with HI ≤0.5 (p < 0.001). Validation in a second cohort of patients with acute ischemic stroke (n = 110; MeVO = 42, LVO = 68) yielded similar results for HI >0.5 to distinguish fast and slow core progression with an AUC of 0.84 (95% CI 0.72-0.97). HI can differentiate fast from slow core progression in MeVO and LVO within the first 24 hours of acute ischemic stroke. Consideration of core progression rate at time of stroke evaluation may have implications in the selection of patients with MeVO and LVO stroke for reperfusion therapy that warrant further study.

Frequency of Elevated Homocysteine Level in Patients Presented with Ischemic Stroke

Background: A stroke is the rapidly developing focal or global neurological deficit due to disturbance in the blood vessels supplying to the brain. There is increasing proof that increased homocysteine concentration may act as independent risk factor for ischemic stroke. So, this study was done to find the elevated homocysteine in stroke patients. Objective: To determine the frequency of elevated homocysteine levels in patients presenting with ischemic stroke. Study Design: Cross sectional study. Settings: Department of Neurology, Mayo Hospital, Lahore, Pakistan. Duration: Six months from March to August 2011. Methodology: Patients detailed medical history, physical examination and demographics were stored electronically, moreover the blood samples were drawn under aseptic measures within 24 hours of stroke. For each patient, homocysteine level was assessed through standard procedures from the blood. Data was analyzed through SPSS version 20 and entered in Proforma. Results: Mean age of patients was 45.09 ± 5.36 years. Majority of the patients were male. 8(8.0%) patients were 20-30 years of age, 7(7.0%) patients were between 31-40 years old and 85(85%) patients were 41-50 years of age. Elevated homocysteine level was confirmed in 56 patients (56.0%). Conclusion: Homocysteine level was found to be frequently elevated in patients with ischemic stroke.

Ischemia-modified albumin and fibulin-5 as diagnostic and prognostic markers for acute cerebrovascular disease

BackgroundFibulin-5 and ischemia-modified albumin (IMA) levels increase in acute phase of cerebrovascular diseases, yet data regarding their levels in various stroke subtypes and correlation with severity and prognosis are still insufficient. This work aims to evaluate serum IMA and fibulin-5 as markers for early detection and predicting prognosis in acute cerebrovascular disease.MethodThis case-control study was done on 100 patients with first time stroke, assessed by the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) within the first 24 h after stroke event, lesion volume was calculated, serum fibulin-5 and IMA levels were measured in the first few hours of stroke, and their levels were compared with levels measured in 75 control subjects. Three months later, stroke patients were assessed by the modified Rankin Scale (MRS).ResultsFibulin-5 and IMA were significantly higher in the patient than in the control group and were positively correlated with lesion volume and NIHSS score but inversely correlated with GCS score. Fibulin-5 was statistically higher in hemorrhage group, whereas IMA was statistically higher in infarction group. MRS score was positively correlated with fibulin-5 levels at onset of stroke but not with IMA.ConclusionFibulin-5 and ischemia-modified albumin are increased during the acute stroke phase and correlated with severity of stroke, but only fibulin-5 shows significant correlation with prognosis.

High glucose-induced effects on Na+-K+-2Cl- cotransport and Na+/H+ exchange of blood-brain barrier endothelial cells: involvement of SGK1, PKCβII, and SPAK/OSR1.

Hyperglycemia exacerbates edema formation and worsens neurological outcome in ischemic stroke. Edema formation in the early hours of stroke involves transport of ions and water across an intact blood-brain barrier (BBB), and swelling of astrocytes. We showed previously that high glucose (HG) exposures of 24 hours to 7 days increase abundance and activity of BBB Na+-K+-2Cl- cotransport (NKCC) and Na+/H+ exchange 1 (NHE1). Further, bumetanide and HOE-642 inhibition of these transporters significantly reduces edema and infarct following middle cerebral artery occlusion in hyperglycemic rats, suggesting that NKCC and NHE1 are effective therapeutic targets for reducing edema in hyperglycemic stroke. The mechanisms underlying hyperglycemia effects on BBB NKCC and NHE1 are not known. In the present study we investigated whether serum-glucocorticoid regulated kinase 1 (SGK1) and protein kinase C beta II (PKCβII) are involved in HG effects on BBB NKCC and NHE1. We found transient increases in phosphorylated SGK1 and PKCβII within the first hour of HG exposure, after 5-60 min for SGK1 and 5 min for PKCβII. However, no changes were observed in cerebral microvascular endothelial cell SGK1 or PKCβII abundance or phosphorylation (activity) after 24 or 48 h HG exposures. Further, we found that HG-induced increases in NKCC and NHE1 abundance were abolished by inhibition of SGK1 but not PKCβII, whereas the increases in NKCC and NHE activity were abolished by inhibition of either kinase. Finally, we found evidence that STE20/SPS1-related proline/alanine-rich kinase and oxidative stress-responsive kinase-1 (SPAK/OSR1) participate in the HG-induced effects on BBB NKCC.

Lifetime quality of life and cost consequences of delays in endovascular treatment for acute ischaemic stroke: a cost-effectiveness analysis from a Singapore healthcare perspective

ObjectivesEndovascular therapy (EVT) significantly improves clinical outcomes in patients with acute ischaemic stroke (AIS), while the time of EVT initiation after stroke onset influences both patient clinical outcomes and healthcare...

Thrombectomy for Acute Stroke in Brazil

Endovascular thrombectomy (EVT) has become an important treatment for patients with acute ischemic stroke who can be treated within 6 hours of stroke

The predictive value of mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio in acute middle cerebral artery infarction patients

Objective: The aim of this study was to determine the predictive value of mean platelet volume (MPV), neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) in patients with acute middle cerebral artery (MCA)branch infarction. Method: This examination was performed on the files of 50 patients followed up at the Anesthesia and Reanimation ICU of Onsekiz Mart University Hospital between April 2017 and September 2019 for acute occlusion in the MCA branch, with no previous history of an ischemic stroke. These patients were assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Score (mRS). The ratios of the neutrophil and platelet countsto the lymphocyte count (NLR and PLR ratios) within the first hour of the stroke and MPV were compared to a control group. Results: The study included 50 patients with the acute ischemia of the MCA branch, of which 28 (56%) were female. The control group consisted of 50 healthy people, and 24 (48%) of these were female. The mean NIHSS score of the patients was 11.4 ± 2.6, and their mean mRS was 2.5 ± 1.5. Conclusions: In our study with patients who had acute middle cerebral artery infarction, we found that the NLR, PLR, and MPV levels within the first hour of stroke were higher in the patient group in comparison to the control group ona statistically significant level. However, multicenter studies with larger subject groups are needed for the use of hematological parameters as biomarkers in an ischemic stroke

NR2 antibodies as diagnostic and prognostic stroke biomarker

Given the high percentage of disability and mortality resulting from a stroke, search of new ways to improve early diagnosis and optimize therapeutic approaches is highly relevant. The article reviews the studies of NR2 antibodies to glutamate N-methyl-D-aspartate (NMDA) receptors as a biomarker in acute stroke. The review shows that this biomarker is suitable for determining the presence of ischemic process in the brain and the degree of destruction of brain tissue, both in the first hours of stroke and at follow-up. In addition, the analysis of NR2 antibodies can be informative to predict the worsening, the increase in the locus size, which can contribute to the timely correction of treatment and will improve the effectiveness of the therapy. The prognostic potential of NR2 antibodies can be used for personalized therapeutic approach. However, currently the lack of studies of NR2 antibodies in acute stroke requires further study of this biomarker.

Reversible diffusion-weighted imaging lesions in acute ischemic stroke: A systematic review.

To systematically review the literature for reversible diffusion-weighted imaging (DWIR) lesions and to describe its prevalence, predictors, and clinical significance. Studies were included if the first DWI MRI was performed within 24 hours of stroke onset and follow-up DWI or fluid-attenuated inversion recovery (FLAIR)/T2 was performed within 7 or 90 days, respectively, to measure DWIR. We abstracted clinical, imaging, and outcomes data. Twenty-three studies met the study criteria. The prevalence of DWIR was 26.5% in DWI-based studies and 6% in FLAIR/T2-based studies. DWIR was associated with recanalization or reperfusion of the ischemic tissue with or without the use of tissue plasminogen activator (t-PA) or endovascular therapy, earlier treatment with t-PA, shorter time to endovascular therapy after MRI, and absent or less severe perfusion deficit within the DWI lesion. DWIR was associated with early neurologic improvement in 5 of 6 studies (defined as improvement in the NIH Stroke Scale (NIHSS) score by 4 or 8 points from baseline or NIHSS score 0 to 2 at 24 hours after treatment or at discharge or median NIHSS score at 7 days) and long-term outcome in 6 of 7 studies (defined as NIHSS score ≤1, improvement in the NIHSS score ≥8 points, or modified Rankin Scale score up to ≤2 at 30 or 90 days) likely due to reperfusion. DWIR is seen in up to a quarter of patients with acute ischemic stroke, and it is associated with good clinical outcome following reperfusion. Our findings highlight the pitfalls of DWI to define ischemic core in the early hours of stroke.