Severe Ischemic Stroke Research Articles

Monocyte Chemoattractant Protein-1 as a Biomarker in Acute Ischemic Stroke: A Prospective Pilot Study

Background: Monocyte chemotactic protein-1 (MCP-1) was implicated in the progression of atherosclerosis and is associated with elevated stroke risk. However, there is limited evidence regarding the MCP-1 role as an early biomarker for predicting the severity and outcomes of acute ischemic stroke (AIS). This prospective pilot case–control study aims to offer preliminary evidence into whether MCP-1 levels are elevated in AIS, whether they vary across different stroke subtypes, and their potential utility as a biomarker for assessing stroke severity and predicting outcomes. Methods: MCP-1 levels were quantified using ELISA in patients with AIS or transients ischemic attack (TIA) and healthy participants. Stroke severity was assessed with the NIHSS score and functional outcome with the mRS scale. Results: A total of 32 patients with AIS or TIA were compared to 13 healthy controls. MCP-1 levels were found to be 77% higher in stroke patients compared to healthy controls (p < 0.001). No significant differences in MCP-1 levels were observed between patients with AIS and those with TIA, nor among different stroke subtypes. A positive correlation was observed between MCP-1 levels and NIHSS changes from admission to discharge (b = 0.376, p < 0.05) and mRS scale at 6-month follow-up (b = 0.507, p < 0.05). Conclusions: This prospective pilot study provides preliminary evidence that MCP-1 levels are significantly elevated in AIS and are associated with NIHSS change during hospitalization and unfavorable outcome at 6-month follow-up. These findings indicate the potential of MCP-1 as an early biomarker for assessing disease severity and predicting outcomes in AIS.

Evaluation of the MAPH Score in Predicting Acute Ischemic Stroke Severity and Major Vessel Occlusion in the Emergency Department

Evaluation of the MAPH Score in Predicting Acute Ischemic Stroke Severity and Major Vessel Occlusion in the Emergency Department

Net Benefit of Anticoagulation in Subclinical Device-Detected Atrial Fibrillation

The role of anticoagulation for stroke prevention in patients with device-detected atrial high-rate episodes, also known as subclinical atrial fibrillation (AF), is a subject of equipoise. To assess the net benefit of nonvitamin K antagonist oral anticoagulants (NOACs) in patients with device-detected subclinical AF. Decision analytical model run with 10 000 patients with anticoagulation and 10 000 patients without anticoagulation in a clinical scenario of deciding whether to start NOACs for stroke prevention in patients with subclinical AF. A Markov decision model was conducted on October 1, 2024, to estimate net outcomes of NOACs. The patients had stroke risk and bleeding risks similar to those of patients in randomized trials of anticoagulation in subclinical AF. Anticoagulation was modeled to decrease the risk of ischemic stroke by 32% and increase the risk of major bleeding by 62%. In probabilistic sensitivity analyses, the 95% CIs for treatment effect sizes were also considered. The main outcome measure for overall net benefit was the cumulative quality-adjusted life-years (QALYs) during the simulation. The model considered the number and severity of ischemic strokes, hemorrhagic strokes, other intracranial bleeds, and extracranial bleeds, as well as the number of deaths during a 10-year simulation. When comparing the 2 cohorts of 10 000 patients (mean age, 77 years; 3700 [37%] women), those receiving NOAC therapy had 233 fewer ischemic strokes (21.7%), 55 fewer deaths (1.1%), and 453 more major bleeding events (37.3%) over a 10-year simulation period. Per patient, these differences translated to approximately 1 additional quality-adjusted week of life (0.024 QALYs) with NOAC treatment during the 10-year simulation. When the 95% CIs of treatment effect sizes were considered in probabilistic sensitivity analysis, there was a 65.8% probability that NOAC treatment leads to more QALYs than withholding treatment. In this analytical model study, initiating NOACs in patients with device-detected subclinical AF was associated with a minimal increase in QALYs. However, the benefits were uncertain, and the effect size of the overall net benefit does not appear to be clinically meaningful.

Correlation of Serum Bilirubin with Severity of Acute Ischemic Stroke

Serum bilirubin is associated with stroke severity, existing data on this relationship remain limited and inconclusive. Objectives: To determine the correlation between serum bilirubin and the National Institute of Health stroke scale score in patients with acute ischemic stroke. Methods: This cross-sectional study was done at the Medical Emergency of Mayo Hospital Lahore from June 2022 to December 2022. A total of 205 patients suffering from acute ischemic stroke were included. Serum bilirubin was obtained within 24 hours of the onset of stroke at presentation, and stroke severity was assessed same time using NIHSS. Data analysis was done using SPSS version 26.0. Pearson correlation was determined between serum bilirubin and NIHSS score at presentation. Results: In current study population, 44.5% of patients were diabetics, 77.6% were hypertensive, and 27.8% were smokers. Mean serum bilirubin level was 0.98 ± 0.19 mg/dL, and mean NIHSS score is 19.51 ± 8.94, Pearson correlation coefficient between bilirubin and NIHSS is -0.082, p-value=0.240, statistically not significant. Conclusions: It was concluded that in our study, a weak negative correlation was observed between serum bilirubin levels and NIHSS scores in patients with acute ischemic stroke. This suggests that higher bilirubin levels may have a slight protective effect, as stroke severity (NIHSS scores) tended to decrease minimally with increasing bilirubin levels.

Предикторное значение тяжести полиорганной дисфункции у пациентов с тяжелым ишемическим инсультом: проспективное наблюдательное исследование

INTRODUCTION: Severe acute ischemic stroke (AIS) remains a pressing problem in modern medicine. The multiple organ dysfunction (MOD) in this category of patients is a common complication, and early assessment its severity is important in determining intensive care tactics. OBJECTIVES: to assess the predictive significance of the severity of MOD in patients with severe AIS. MATERIALS AND METHODS: The observational two-center prospective study included 140 patients with severe AIS. Neurological status was assessed according to the National Institutes of Health Stroke Scale (NIHSS), severity of the patient's condition and organ disorders using the New Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA) scales. The outcome of the disease was assessed upon discharge from the hospital or upon the fatal outcome. The predictive value of the SAPS II, SOFA, and NIHSS was assessed using ROC analysis and the area under the ROC curve (AUC). RESULTS: The study group included 25 patients with AIS in vertebrobasilar region and 115 with hemispheric localization. The mortality rate was 60 %. Only the SAPS II score was independent predictor for hospital outcome. The SAPS II has the greatest predictive significance (AUC = 0.719). Also, SOFA has a satisfactory predictor value for the 1st day (AUC = 0.706). SAPS II predictor significance was higher in the cardioembolic subtype in the comparison with the atherothrombotic AIS (AUC = 0.808 and AUC = 0.667, respectively). A three-dimensional regression model was obtained for the probable hospital mortality dependence on the NIHSS on the first day and the dynamics of severity by SOFA from day 1 to day 5. CONCLUSIONS: Assessment of the severity of the condition and MOD using specialized scales in patients with severe AIS has prognostic value in relation to the hospital outcomes, including in patients with various pathogenetic subtypes of AIS.

Impact of hemoglobin levels on acute ischemic stroke severity.

Stroke is one of the most common causes of disability and mortality worldwide. In Saudi Arabia, it is a crucial health issue. Ischemic stroke is the most common type of stroke in this area, and understanding its relationship with hemoglobin (Hgb) levels is vital. To date, no study has established an exact relationship between Hgb levels and stroke severity. This study assessed the association between Hgb levels and the severity of acute ischemic stroke (AIS) at presentation. We conducted a retrospective study of patients admitted and diagnosed with AIS between 2013 and 2017. The exclusion criteria included other stroke types (such as hemorrhagic or venous infarction), patients with a history of internal bleeding, and pregnant and lactating women. The patients were divided into three groups based on Hgb levels: low, average, and high. Correlations were analyzed between these groups and the National Institutes of Health Stroke Scale (NIHSS) scores, stroke outcomes at discharge (cured, improved, or mortality decreased), and stroke subtype, as determined and classified by the TOAST classification criteria. The Pearson correlation coefficient showed a weak positive correlation between Hgb levels and NIHSS scores. Neither stroke outcomes nor stroke types showed significant correlations with mean Hgb level. The results of this retrospective study on a small cohort of patients diagnosed with AIS indicate that higher Hgb levels at hospital admission are associated with greater stroke severity, as measured by the NIHSS score. However, no significant effect was observed on stroke outcome at discharge or the TOAST classification.

Association of gut microbiota and immunometabolic profiles with ischemic stroke severity

This study investigates the influence of three regulators of human homeostasis—intestinal microbiota, immune profile, and circulating metabolites—on stroke severity. We conducted a study involving 33 patients with mild/moderate stroke (MS) and 32 with severe stroke (SS), all assessed during the acute phase (first 24 h). The analysis focused on microbiota composition (45 patients), serum metabolomics and inflammatory markers (20 patients). The patients with SS exhibited more pronounced insulin resistance associated with increased levels of branched-chain amino acids and their metabolites. SS patients showed an increase in inflammatory cytokines IL-6 and TNF-α, and surprisingly an increase in IL-10 and butyrate which are anti-inflammatory. SS patients also displayed a distinct microbiota profile, with statistically significant differences in β-diversity compared to the MS group, notably a higher prevalence of Pseudomonadota (formerly Proteobacteria). In summary, our data indicate that patients with SS, compared to those with MS, are characterized by a more inflammatory and insulin-resistant state, associated with three key regulators: microbiota, metabolites, and interleukins. These findings provide new insights into the regulatory components of the gut-brain axis, which could be developed into cost-effective and widely accessible therapies for SS.

Association of carotid atherosclerosis, perivascular adipose tissue, and stiffness by ultrasound assessment in young adults with ischemic stroke

In the last decade, the incidence of stroke among young adults has risen globally. The relevance of carotid intima-media thickness (IMT) and plaque in predicting ischemic stroke (IS) in this population remains uncertain. This study investigated the relationship between ultrasound-evaluated carotid wall properties and occurrence and severity of IS in young adults. Young adults (n = 147) aged 18–50 years with IS and 294 age- and sex-matched controls were included. Ultrasound-assessed variables included carotid atherosclerosis, perivascular adipose tissue, and arterial stiffness. Ultrasound parameters included IMT, plaque presence, extra-media thickness (EMT), and flow augmentation index (FAI). Multivariate and ROC curve analyses were conducted. All ultrasound parameters were elevated in the IS group. Carotid EMT and FAI were associated with IS, while IMT and plaque were not. The multivariate model combining carotid EMT and FAI showed a superior area under the curve compared to models incorporating either parameter alone. Plaque presence and increased EMT thickness correlated with higher scores on the National Institutes of Health Stroke Scale. Carotid EMT and FAI are independent vascular risk factors for IS in young adults. The potential of EMT and plaque presence as biomarkers for assessing disease severity warrants further investigation.

Cilostazole versus clopidogrel in acute large-vessel moderate and moderate-to-severe ischemic stroke: a randomized controlled trial.

More than one-third of all ischemic strokes are induced by large vessel occlusion (LVO). All the wide-scale trials that assessed the impacts of cilostazol versus clopidogrel in stroke management have been conducted in Asia and involved patients with minor stroke or TIA. Our trial is the first-ever study to evaluate cilostazol versus clopidogrel in acute LVO with moderate to severe ischemic stroke in North Africa. We assessed the efficacy and safety of cilostazol versus clopidogrel in first-ever LVO moderate and moderate to severe ischemic stroke patients. 580 moderate and moderate-to-severe LVO ischemic stroke participants were randomly enrolled to receive loading and maintenance doses of cilostazol or clopidogrel. 580 patients were included in the intention-to-treat analysis. 29 (10.0%) participants in the cilostazol arm and 43 (14.8%) participants in the clopidogrel arm experienced a new stroke (HR 0.37; 95% CI, 0.29-0.73; P-value = 0.03). Eight participants (2.8%) in the cilostazol arm and 17 patients (5.9%) in the clopidogrel arm had drug-related hemorrhagic complications (HR 0.29; 95% CI, 0.18-0.63; P-value = 0.008). Patients who experienced acute LVO moderate and moderate-to-severe ischemic stroke and received loading and maintenance doses of cilostazol within the first 24h after stroke onset had better clinical outcomes based on recurrent stroke rates and better safety outcomes regarding hemorrhagic transformation of brain infarction and drug-induced peripheral hemorrhagic side effects compared to those who received loading and maintenance doses of clopidogrel. There were no significant differences between the two groups regarding death due to vascular events and unfavorable mRS after three months of stroke onset. Retrospectively registered on ClinicalTrials.gov, NCT06242145, 27-01-2024.

Anesthetic management of endovascular procedures in patients with ischemic stroke

Background. Stroke is one of the main causes leading not only to mortality, but also severe disability even in timely access to medical care. Timely restoration of blood flow in ischemic brain area is essential in ischemic stroke. Over the past decade, active development of endovascular revascularization for ischemic stroke has improved the outcomes in these patients. There are still certain questions regarding the factors influencing the choice of general anesthesia and sedation in patients with ischemic strokes undergoing endovascular intervention. Objective. To assess the incidence of general combined anesthesia and sedation during endovascular interventions in patients with ischemic stroke, the influence of consciousness and verbal contact on the choice of anesthetic support for endovascular procedures, as well as the outcomes of disease after different methods of anesthetic support. Material and methods. A single-center retrospective observational study included 47 patients with ischemic strokes who underwent endovascular interventions under general anesthesia or sedation over a 1-year period. Results. General anesthesia and sedation was used in 42 (91%) and 4 (9%) patients, respectively. General anesthesia was accompanied by higher incidence of adverse outcomes. Conclusion. Preferable general anesthesia in patients with ischemic stroke undergoing endovascular interventions is due to lower level of consciousness and unavailable verbal communication. Higher incidence of adverse outcomes in patients undergoing general combined anesthesia is also associated with severity of ischemic stroke.

Construction and validation of a predictive model for poor long-term prognosis in severe acute ischemic stroke after endovascular treatment based on LASSO regression.

We aimed at establishing a predictive model for poor long-term prognosis (3 months post-treatment) following endovascular treatment (EVT) for severe acute ischemic stroke (AIS) and evaluating its predictive performance. The patients with severe AIS (NIHSS score ≥ 16) who received EVT were divided into a modeling group (178 patients), an internal validation group (76 patients), and an external validation group (193 patients). Internal and external validation were performed using cross-validation. Poor long-term prognosis was defined as a modified Rankin Scale (mRS) score > 2 at 3 months after the stroke. Univariate analysis and LASSO regression were used to select risk factors, and a logistic regression model was established to create a nomogram. The model's performance and clinical applicability were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curves. Five predictive factors were identified: baseline NIHSS score (OR = 1.096, 95% CI: 1.013-1.196, p = 0.0279), symptomatic intracranial hemorrhage (OR = 6.912, 95% CI: 1.758-46.902, p = 0.0156), time from puncture to reperfusion (OR = 1.015, 95% CI: 1.003-1.028, p = 0.0158), age (OR = 1.037, 95% CI: 1.002-1.076, p = 0.0412), which were found to be risk factors for poor long-term prognosis after EVT for severe AIS. Collateral circulation was identified as a protective factor (OR = 0.629, 95% CI: 0.508-0.869, p = 0.0055). Based on these five factors, a nomogram was constructed to predict poor long-term prognosis after EVT. The ROC curve showed that the AUC for predicting poor long-term prognosis was 0.7886 (95% CI: 0.7225-0.8546) in the modeling group, 0.8337 (95% CI: 0.7425-0.9249) in the internal validation group, and 0.8357 (95% CI: 0.7793-0.8921) in the external validation group. The calibration curve and clinical decision curve demonstrated good consistency and clinical utility of the model. The predictive model for poor long-term prognosis following EVT for severe AIS has accurate predictive value and clinical application potential.

The Relationship Between Clinical Features of Ischemic Stroke and miRNA Expression in Stroke Patients: A Systematic Review.

Background/Objectives: Ischemic stroke remains a leading cause of death and disability worldwide. Despite significant progress in reperfusion therapy, the optimal ischemic stroke management strategy has not been developed. Recent studies demonstrate that microRNA may play an essential role in the pathophysiology of ischemic stroke and its possible potential to be a treatment target point. The proposed systematic review aimed to report the relationship between IS's clinical severity and miRNA expression. Secondary outcomes included infarct volume, systemic inflammatory markers, and prognosis, as well as additional features such as stroke subtype, comorbidity, and risk of subsequent stroke in correlation to miRNA expression. Methods: We have performed a systematic search of database resources according to PRISMA statement guidelines. Twenty-seven studies on a total number of 3906 patients were assessed as suitable for the present SR. Included studies analyzed the expression of 30 different miRNA fragments. Results: After investigating available data, we have identified a set of possible miRNA fragment candidates that may be used in stroke diagnostics and have the potential to be a base for the development of future treatment protocols. Conclusions: Studies included in the presented SR indicate that miRNA expression may be significantly associated with clinical severity, infarct volume, and inflammation in ischemic stroke. More prospective, properly designed protocols with consistent methods of miRNA testing and optimized clinical assessment are needed to confirm the role of miRNA expression in the course of a stroke.

. Association of Antioxidant Markers (SOD, GSH, NO, Catalase) with Ischemic Stroke Severity and Recovery Outcomes

Objective: The aim of this study was to investigate the relationship between antioxidant markers (Superoxide Dismutase [SOD], Glutathione [GSH], Catalase, and Nitric Oxide [NO]) and the severity of ischemic stroke in affected individuals. Methods: A randomized controlled, single-blind study was conducted from June 2022 to November 2024. The study included 364 patients aged 45-80 years diagnosed with ischemic stroke. Participants were randomly divided into two groups: Group A (n=193) received standard stroke rehabilitation therapy, while Group B (n=171) received additional antioxidant support. Serum levels of SOD, GSH, Catalase, and NO were measured. The severity of ischemic stroke was evaluated using the modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS), with follow-up evaluations conducted at 2-, 4-, and 6-months post-treatment. Results: Among the 364 participants, 203 (55.7%) were male, and 161 (44.3%) were female, with a mean age of 67.3 ± 12.2 years. Serum SOD levels were higher in the experimental group (16.3 ± 3.7 U/mL) compared to the control group (12.5 ± 4.1 U/mL, p = 0.014). GSH levels were also significantly higher in the experimental group (178 ± 31 μmol/L) than in the control group (145 ± 26 μmol/L, p = 0.032). NO levels were higher in the experimental group (42.1 ± 8.6 μmol/L) than in the control group (35.4 ± 7.3 μmol/L, p = 0.021). Catalase levels were 52.3 ± 11.1 U/mL in the experimental group and 49.6 ± 10.2 U/mL in the control group, with no significant difference between the groups (p = 0.213). Significant inverse correlations were found between SOD, GSH, and NO levels and stroke severity (p < 0.05), but catalase showed no such correlation (p = 0.513). Conclusion: This study identified a significant relationship between lower levels of SOD, GSH, and NO and more severe ischemic stroke outcomes. Higher levels of these antioxidants were associated with improved recovery. In contrast, catalase did not show a significant association with stroke severity or recovery, suggesting that SOD, GSH, and NO may play a more critical role in the pathophysiology of ischemic stroke.

The severity of ischemic stroke and risk of all-cause mortality in patients with atrial fibrillation on different oral anticoagulant treatments admitted to the emergency department

Although direct oral anticoagulants (DOACs) are non-inferior to Vitamin K antagonists (VKA) in preventing ischemic stroke (IS) in atrial fibrillation (AF) patients, there are limited data regarding stroke severity and prognosis of patients admitted with IS during DOAC treatment. We performed a single center retrospective study including patients with AF on oral anticoagulants admitted to the Emergency Department for IS were included. The primary endpoint was to analyse the severity of stroke evaluated through NIHSS scale according to anticoagulant therapy. The secondary endpoint was 3-month all-cause mortality. A total of 106 AF patients were included, with a mean age of 81.3 ± 7.5 years. Overall, 54.7% were women and 61.3% on DOAC. The AF patients on DOAC were older, with no other clinical differences. Median NIHSS was 12 (Interquartile Range [IQR] 5–19). At multivariable logistic regression analysis DOAC use (compared to warfarin) was associated with lower risk of moderate-severe/severe stroke (NIHSS ≥ 16) (Odds Ratio [OR] 0.355, 95% confidence interval [95% CI] 0.127–0.995). Mechanical thrombectomy was strongly associated with higher severity of stroke (OR 6.113, 95%CI 2.186–17.099). During follow-up, 42 patients died. DOAC use inversely correlated with mortality risk (OR 0.323, 95%CI 0.127–0.822) after adjusting for CHA2DS2-VASc, time to hospital admission from symptom onset and type of acute treatment. In conclusion, in our contemporary real-world population, patients on DOACs treatment admitted for IS had better outcomes in terms of stroke severity and all-cause mortality compared with patients on VKAs.Graphical

Clinical and Radiological Evaluation of Severity of Acute Ischemic Stroke with Special Reference to Neuroinflammatory Biomarkers.

Given the complexity of stroke, diverse mechanisms are known to be involved in its pathophysiology among which inflammation is one of the major culprits. Poor clinical outcomes are seen in those stroke patients with significant systemic inflammation. Therapeutic options to fight stroke are still limited and the only approved drug is tissue-plasminogen activator and/or mechanical thrombectomy. As inflammation highly influences susceptibility of stroke patients to overcome the disease, there is an increasing need to develop new diagnostic, prognostic, and therapeutic strategies for poststroke inflammation. This study was conducted over a period of 18 months. Seventy-five patients who were diagnosed with acute ischemic stroke based on patient's clinical history, neurological signs, and radioimaging were included. Patients underwent computed tomography scan/magnetic resonance imaging scan within 24 h of admission to exclude stroke mimics and primary intracerebral hemorrhage. National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke clinically. Inflammatory biomarkers such as plasma MMP-9, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and S100B were measured using the ELISA kits. We observed that plasma concentration of MMP-9, IL-6, and S100B showed statistical significant association with severity of stroke as assessed by NIHSS, with Chi-square test values of χ2 = 24.69 for IL-6 (P = 0.00), χ2 = 11.91 for S100B (P = 0.008), and χ2 = 19.5 for MMP-9 (P = 0.00). The mean values of MMP-9, IL-6, S100B levels, and hs-CRP levels were significantly elevated in severe, moderately to severe stroke groups as related with mild stroke group as evaluated by NIHSS. Neuroinflammatory markers such as MMP-9, IL-6, S100B, and hs-CRP are the promising tool as inflammatory biomarkers with other indicators of acute ischemic injury to diagnose acute ischemic stroke and facilitate a better clinical assessment of patients during the acute phase of the disease. More importantly, this study showed that these biomarkers have strong independent prediction values for stroke outcome. We propose that some of those biomarkers might turn out to be targets to be therapeutically altered overcoming the urgent need for the identification of potent drugs to modulate stroke-associated inflammation.

PROGNASTIC SIGNIFICANCE OF VEGETATIVE CIRCULATION INDICATORS IN PATIENTS WHO HAVE SUFFERED ISCHEMIC STROKE WITH AND WITHOUT A NEW CORONAVIRUS INFECTION

A potential new method for predicting the course and outcome of ischemic stroke in the acute period developed against the background of COVID-19 is proposed based on qualitative and quantitative measurement of the autonomic regulation indices of the cardiovascular system, namely the autonomic circulation index. Today, stroke is the leading cause of disability in the population and the second leading cause of death worldwide. The increase in the number of strokes against the background of COVID-19 is explained by the fact that the SARS-CoV-2 coronavirus infection, due to its pathogenic effect, triggers a chain of morphological, metabolic and functional disorders, which, ultimately, are the trigger factors of ischemic stroke. The autonomic circulation index allows one to assess the state of the autonomic tone of the cardiovascular system quantitatively and dynamically, and compare it with the clinical condition of the patient. The aim of this work was to study the state of the autonomic circulation index in patients who had ischemic stroke against the background of the new coronavirus infection SARS-CoV-2 and without it. We examined 165 patients with ischemic stroke against the background of COVID-19, included in the main group, and 85 patients with ischemic stroke without confirmed COVID-19. On days 1, 7 and 14 after admission, all the patients had their autonomic circulation indices and the severity of ischemic stroke recorded according to the NIHSS scale. In addition, in all patients, concomitant and comorbid diseases were assessed using the Charlson Comorbidity Index and the Cumulative Illness Rating Scale. The study revealed that the concomitant comorbidity indices in patients in both groups did not differ statistically significantly. This indicates that in this sample of the patients, comorbidity had no prognostic significance in relation to the severity and outcome of ischemic stroke. However, it was found that pronounced sympathicotonia, developing on day 7, is precisely a prognostically unfavorable factor in the course and outcome of ischemic stroke both in the main group and in the comparison group, which is clinically proven by the NIHSS scores. In the main group, autonomic blood circulation parameters reached values of pronounced sympathicotonia, which is explained by the pathogenic effect of the SARS-CoV-2 virus on the microcirculatory bed, which leads to functional disorders of the midline structures of the brain responsible for the autonomic regulation of the body.

CLINICAL CHARACTERISTICS OF THE COURSE OF ISCHEMIC STROKE ASSOCIATED WITH COVID-19

Purpose: Аn analysis of the clinical and laboratory parameters of ischemic stroke (IS) associated with the new coronavirus infection COVID-19 (NCVI). Materials and methods: the study provided a comparative analysis of 52 IS cases in combination with NCVI (main group) and 253 IS cases without NCVI (comparison group). All the patients were analyzed in terms of the IS severity according to the NIHSS scale; stroke subtypes according to the TOAST classification; locations of the affected vascular territories, and clinical outcomes. We also evaluated hemostasis parameters, inflammatory markers and D-dimer levels in 149 patients. Results: it was revealed that in the IS group with NCVI compared with the group without NCVI, the stroke severity according to the NIHSS scale was higher at the moment of admission (8.0 [2.0; 14.0] points versus 5.0 [2.0; 11.0] points; p = 0.049); lacunar stroke subtype was diagnosed less often (p = 0.03; OR = 0.23; 95% CI 0.05-0.97); disease progression was observed more frequently (p = 0.04; OR = 2.66; 95% CI 1.01-6.95); and the mortality rate was significantly higher (p < 0.001; OR= 9.04; 95% CI 4.12-19.82). Among the inflammatory markers, higher ferritin and IL-6 levels were recorded in the IS group in combination with NCVI compared to the IS group without NCVI (p = 0.002 and p = 0.017). Conclusions: ischemic stroke associated with a new coronavirus infection is characterized by a more frequent disease progression, more frequent large ischemia, and high mortality rate. An increased level of markers indicates the effect of systemic inflammatory response on the ischemic stroke with NCVI.

Rationale and Study Design to Assess the Efficacy and Safety of Minocycline in Patients with Moderate to Severe Acute Ischaemic Stroke (EMPHASIS)

BackgroundInflammation and blood-brain barrier disruption may contribute to the pathogenesis of ischaemic stroke. Minocycline was shown to exert anti-inflammatory effects by attenuating microglial activation and protecting blood-brain barrier in preclinical...

Capsular warning syndrome and resistance to dual antiplatelet therapy: A clinical dilemma

Background. Capsular warning syndrome (CWS) involves multiple stereotypical transient ischemic attacks (TIAs) within 24 hours, often preceding a more severe ischemic stroke. This serves as a critical warning sign, emphasizing the need for urgent medical intervention. Case report. We report a 65-year-old diabetic and hypertensive woman who experienced transient recurrent episodes of mouth deviation and slurred speech, lasting 10 seconds each, with full recovery. Initial MRI showed no abnormalities, and she was started on dual antiplatelets. Despite treatment, she developed sudden right-sided hemiplegia, with MRI showing a hyperacute non-hemorrhagic infarct in the left ganglio-capsular region. Intravenous tenecteplase was administered in accordance with the European Stroke Organization’s evidence-based recommendation, which supports its use as an effective alternative to alteplase for acute ischemic stroke within 4.5 hours of onset. Conclusion. This case highlights the importance of early identification of capsular warning syndrome (CWS). Despite dual antiplatelet therapy, CWS can progress to ischemic stroke, posing a treatment challenge. Further research is needed to establish optimal treatment protocols for CWS.

The optimal timing for initiating oral anticoagulant in ischemic stroke combined with non-valvular atrial fibrillation patients: A real-world big data analysis.

The optimal timing for initiating oral anticoagulant in ischemic stroke combined with non-valvular atrial fibrillation patients: A real-world big data analysis.