NIHSS Scale Research Articles

Влияние инсулинорезистентности на течение ишемического инсульта в остром периоде

Among the reasons that increase the risk of stroke, its severity and outcome, a special place is given to disorders of carbohydrate metabolism. However, to date, there is no consensus on the role of hyperglycemia in stroke, whether it is physiological or pathological. The purpose to study the effect of insulin resistance on the course and clinical outcome of ischemic stroke (IS) in the acute period. Material and methods. A total of 862 patients with IS (370 men, 492 women), mean age was 66,1 ± 10,8 years. The degree of neurological deficit (NIHSS scale) and clinical outcome were assessed. When admitted to hospital, the level of glycemia, insulin, and C-peptide in the fasting blood were found. Results. In 186 (21,6%) patients type 2 diabetes mellitus (DM) was diagnosed. In 27,8% of patients without DM and 76,3% of patients with DM hyperglycemia was detected. In patients without DM with hyperglycemia, compared with patients with normoglycemia, a higher representation of severe neurological deficit (by 14,7%), a lower frequency of noticeable positive dynamics (by 14,8%), and a higher mortality rate (by 11,5%) were found. In patients with DM, hyperglycemia was associated with a lower incidence of noticeable positive dynamics (by 27,7%). The development of IS is accompanied by an increase in the blood level of C-peptide more than twice. High values of the C-peptide/insulin ratio are associated with a higher frequency of severe neurological deficit in patients with DM (by 32,4%) and without DM (by 23,8%), and a decrease in the incidence of noticeable positive dynamics (by 23,5% and 20,9%, respectively). Conclusion. Development of IS is characterized by high representation of disorders of carbohydrate metabolism. The severity of glucose metabolism disorders is interrelated with the severity and clinical outcome of the disease.

Влияние инсульт-ассоциированной пневмонии на исход острого каротидного ишемического инсульта

Aim: to study the stroke-associated pneumonia (SAP) effect on the outcome of ischemic stroke (IS) in the internal carotid artery system. Patients and Methods: 87 patients with IS underwent the follow-up study, of which 75 had no inflammatory bronchopulmonary complications (group 1), and 12 had pneumonia manifestation (group 2). The study was performed on days 1, 5, and 9 after IS, and 6 months and 12 months after discharge from the hospital. Neurological deficit severity (NIHSS, Barthel index) and inflammatory markers (peripheral blood leukocyte composition, C-reactive protein (CRP), ESR) were studied. Results: it was found that the presence of SAP was associated with increased mortality during the acute IS period (4 (33.1%) patients died in group 1 and 10 (13.3%) — in group 2, p<0.05), greater severity of neurological deficits (63.3±5.3 and 71.5±4.0 points on the NIHSS scale, respectively, p<0.05) and incapacitation (Barthel index — 63.3±5.3 and 71.5±4.0 points, respectively, p<0.05) at the end of the inpatient treatment period. In group 2, signs of an inflammatory response were detected on day 5, and the values of the white blood cell shift index, ESR and CRP significantly (p<0.05) differed from the initial values. During examination at 6 months and 12 months, there were no significant differences in these indicators between the groups. An association was established between the probability of SAP occurrence and the presence of swallowing disorders (r=0.672; p<0.05), the age of patients (r=0.572; p<0.05) and the presence of diabetes mellitus (r=0.522; p<0.05). The studied laboratory inflammatory markers allow us to timely assume the occurrence of pulmonary pathology. Conclusion: timely diagnosis and prevention of SAP can reduce the risk of fatal outcome, facilitate rehabilitation measures, and improve early IS outcomes. KEYWORDS: ischemic stroke, cardioembolic stroke, atherothrombotic stroke, complications, acute period, inflammatory markers, strokeassociated pneumonia, long-term outcomes. FOR CITATION: Chipova D.T., Santikova L.V., Zhemukhov A.Ch. Impact of stroke-associated pneumonia on the outcome of acute ischemic stroke in internal carotid artery system. Russian Medical Inquiry. 2020;4(9):539–543. DOI: 10.32364/2587-6821-2020-4-9-539-543.

Possibilities of target neurotrophic therapy of ischemic stroke

The study aimed to comprehensively investigation the features of changes in the structural and functional characteristics of the brain tissue, cytokine profile, and β-adrenergic reception in the acute period of ischemic stroke (IS) to optimize treatment. Materials and methods. EHF dielectrometry was used to measure the complex dielectric conductivity (CDC) of peripheral blood erythrocytes in patients with IS. Changes in the osmotic resistance of erythrocytes (ORE) under the action of β-adrenergic blockers (β-AB) were determined by photoelectron colourimetry. Plasma levels of interleukin (IL)-6 and tumour necrosis factor (TNF)-α were assessed using an enzyme-linked immunosorbent assay. The basis of the work was the materials of a comprehensive examination of 350 patients with the first in life IS in the dynamics of treatment with human cryopreserved cord blood serum (CCBS). Results. In patients with IS, from the first hours of the development of the disease, there is a sharp increase in the levels of proinflammatory cytokines IL-6 and TNF-α in the blood serum (by 9.3 and 3.9 times, respectively). At the onset of IS, there is a significant increase in the level of β-ARM by 2.4 times as compared with the control and a decrease in CDC by 10.0 % after exposure to an adrenaline solution. The maximum levels of β-ARM (42.43 ± 3.64 CU) are observed in patients with initially severe disease. The established direct correlations between plasma levels of IL-6, TNF-α and β-ARM (r 0.73; p < 0.05 and r = +0,86; p < 0.05, respectively); IL-6, TNF-α and total clinical score on the NIHSS scale (r = +0.895; p < 0.05 and r = +0.9; p < 0.05, respectively). Conclusions. The study has demonstrated the positive immunomodulatory and membrane-protective effects of human CCBS in the acute period of IS. Stabilization of the absolute values of CDC indicated changes in the levels of cell hydration, causing the activation of not only the membrane receptor complex (MRC) of erythrocytes but also an increase in the functional characteristics of the sympathoadrenal system (SAS). The use of CCBS caused a more significant and rapid decrease in the concentrations of the central proinflammatory cytokines IL-6 and TNF-α, which indicated the regulatory effect of the drug in suppressing the local inflammatory response initiated by hypoxia.

Факторы риска геморрагической трансформации при тромболитической терапии ишемического инсульта в популяции Тюменской области

Aim: identification of risk factors of hemorrhagic transformation (HT) after intravenous thrombolytic therapy. Patients and methods: the study included 100 medical records of patients, who underwent thrombolytic therapy. Patients were divided into two groups according to the outcome: 89 patients with HT and 11 patients without HT. Clinical and demographic characteristics of patients were analyzed, including neurological status assessment using NIHSS, Rankin, Rivermead and Waterloo scales. Results: among patients with HT 54.5% were smokers, compared to 29.2% in no HT group (p < 0.05). Significant differences in Rankin, Rivermead and Waterloo scales on admission, after the intervention and at discharge were observed (p < 0.05). Conclusion: smoking is as a significant risk factor of HT, which should be taken into account in the development of thrombolytic therapy programs.

ASSESSMENT OF THE NEURONAL DAMAGE AND OXIDATIVE STRESS MARKERS LEVEL IN POST STROKE PATIENTS

Relevance. 100-110 000 acute disorders of cerebral circulation are registered in Ukraine annually, about 57% of which are ischemic stroke (IS). Study of dynamics of the neuronal damage markers level and their correlation with oxidative stress indicators may be informative for estimating the prognosis of the IS recovery period.
 Objective: to study the features of of neuronal damage markers level, the pro- and antioxidant systems status and their effect on the of neurological deficiency manifestations and the functional status of post stroke patients.
 Materials and methods. 120 patients in the early recovery period of first-ever hemispheric atherothrombotic IS were examined. The control group (CG) included 20 healthy individuals, representative by age and gender. Assessment of neurological deficiency and functional status of patients was performed with the help of the NIHSS scale, the Scandinavian Stroke Scale (SSS), the modified Rankin Scale (mRS) and the Bartel Index (BI). The level of neuron-specific enolase (NSE) in serum was determined by enzyme-linked immunosorbent assay. The determination of the level of oxidative protein modification (OPM) products in serum, glutathione reductase (GR) and glutathione peroxidase (GP) activity was performed spectrophotometrically. Statistical processing of the results was carried out using Statistica 6.0 statistical analysis package (StatSoft, Inc.) with the help of nonparametric results estimation methods.
 Results. In patients after 1 month after IS an increase of AFGn (356 nm) content by 33.9% (p<0.05) compared to CG was observed. KFGn (370 nm) level was increased by 26.0% (p<0.05), AFGo (430 nm) - by 76.2% (p<0.01), CFG (530 nm) - 125.0% (p<0.01). The general OPM products was 37.0% higher than in CG (p<0.05), while the activity of GP and GR decreased by 31.6% and 28.6%, respectively (p<0, 05), and the NSE level was increased by 150.6% (p<0.05).
 The NIHSS score correlated with the level of AFGn (356 nm) (r=0.24; p=0.032), KFGo (530 nm) (r=0.41; p=0.047) and the general OPM products level (r=0.25 ; p=0.039), whereas the GR activity significantly influenced the NIHSS score (r=-0.27; p=0.048), SSS score (r=0.23; p=0.034) and BI (r=0.31; p=0.038). Also significant correlations were found between the NSE level and the concentration of all OPM products, GP ans GR activity.
 Conclusions. The NSE level increase is characteristic for the post stroke patients, which correlates with the degree of neurological deficiency manifestations and the patients’ functional status. The NSE level increases due to the increase of OPM products concentration and the decrease of GP and GR activity, which may indicate a worsening of the neuronal damage degree, linked to the pro- and antioxidant systems imbalance. These processes adversely affect the functional status of patients, with the greatest influence of the KFGo (530 nm) concentration, the general OPM products level and the GR activity.

Features of the dynamics of inflammation and apoptosis markers in patients with different acute post-stroke period

The purpose of this was to study the dynamics of markers of inflammation and apoptosis in the serum of patients with ischemic stroke in the early post-stroke period. Materials and methods. The study involved 22 patients (mean age 60 ± 5.5 years) with different dynamics of neurological symptoms in the acute post-stroke period. Patients were examined twice: on the 1st and 10th day of observation. Quantitative assessment of the severity of neurological deficit using ESS and NIHSS scales was carried. Enzymatic activity of leukocyte elastase, functional activity of a1-proteinase inhibitor, level of autoantibodies to MBP (inflammatory markers), as well as the content of p53 and Bcl-2 proteins (markers of apoptosis) were determined in serum. The control group consisted of 35 somatically healthy people of the appropriate age and sex. Results. Identified the different features of the spectrum of the analyzed markers of inflammation and apoptosis in patients with positive and negative dynamics of neurological symptoms in the acute period of ischemic stroke assessed according to the ESS and NIHSS scales. The observed clinical and biological relationships reflect the features of the course of the early post-stroke period and can be considered as possible predictors of the development trajectory of acute brain ischemia.

Endothelial SIRT6 blunts stroke size and neurological deficit by preserving blood-brain barrier integrity: a translational study.

Aging is an established risk factor for stroke; genes regulating longevity are implicated in the pathogenesis of ischaemic stroke where to date, therapeutic options remain limited. The blood-brain barrier (BBB) is crucially involved in ischaemia/reperfusion (I/R) brain injury thus representing an attractive target for developing novel therapeutic agents. Given the role of endothelial cells in the BBB, we hypothesized that the endothelial-specific expression of the recently described longevity gene SIRT6 may exhibit protective properties in stroke. SIRT6 endothelial expression was reduced following stroke. Endothelial-specific Sirt6 knockout (eSirt6-/-) mice, as well as animals in which Sirt6 overexpression was post-ischaemically induced, underwent transient middle cerebral artery occlusion (tMCAO). eSirt6-/- animals displayed increased infarct volumes, mortality, and neurological deficit after tMCAO, as compared to control littermates. Conversely, post-ischaemic Sirt6 overexpression decreased infarct size and neurological deficit. Analysis of ischaemic brain sections revealed increased BBB damage and endothelial expression of cleaved caspase-3 in eSIRT6-/- mice as compared to controls. In primary human brain microvascular endothelial cells (HBMVECs), hypoxia/reoxygenation (H/R) reduced SIRT6 expression and SIRT6 silencing impaired the barrier function (transendothelial resistance) similar to what was observed in mice exposed to I/R. Further, SIRT6-silenced HBMVECs exposed to H/R showed reduced viability, increased cleaved caspase-3 expression and reduced activation of the survival pathway Akt. In ischaemic stroke patients, SIRT6 expression was higher in those with short-term neurological improvement as assessed by NIHSS scale and correlated with stroke outcome. Endothelial SIRT6 exerts a protective role in ischaemic stroke by blunting I/R-mediated BBB damage and thus, it may represent an interesting novel therapeutic target to be explored in future clinical investigation.

Intravenous thrombolysis by tenecteplase: Experience of the neurology department of Chu Hassan II Fez, Morocco

Intravenous infusion of alteplase was the thrombolytic agent used for thrombolysis of ischemic stroke since 2010 in our neurology department.Tenecteplase was used as a thrombolytic agent for 127 patients in 2 years.The objective of our study is to determine the prevalence of Thrombolysis patients by Tenecteplase, to evaluate the length of care, the NIHSS scale before and after thrombolysis, the modified Rankin scale at 3 months, in order to assess the autonomy and the mortality rate. It’s a retrospective study involving a group of 127 patients over 2 years old, who have undergone intravenous Thrombolysis by tenecteplase in our department. The mean age was 67 years with a slight male predominance (69%). High blood pressure was the main cardiovascular risk factor. 38% of patients had a NIHSS between 8 and 14, 47% greater than 14. The average time to admit patients (from onset of symptoms to arrival in the emergency room) was 130 minutes. The average imaging time (from admission to the imaging room) was 22 minutes. The mean time to Thrombolysis (from admission to emergency at the start of treatment with rt-PA) was 69 minutes. The average time from onset of symptoms to treatment was 200 minutes.The main etiology for our patients was the cardio-embolic origin.The mean of the Rankin scale is not yet defined (our study is in progress). This study shows that tenecteplase before thrombectomy was associated with a high incidence of reperfusion and appears to be effective in thrombolysis among patients with ischemic stroke.

The implementation of the educational tools of the angels initiative project in the stroke departments in Kyrgyzstan

The Angels Initiative is an international non-profit volunteer organization whose goal is to optimize the management of care and treatment of patients with acute stroke [3] To introduce into the practice of acute stroke departments in Kyrgyzstan the tools of the anti-stroke program of the “Angels Initiative”. 5 volunteer students and 5 doctors underwent “Train the Trainer” trainings, after which 18 doctors in stroke departments were trained in the use of the NIHSS scale. Upon returning to Bishkek, volunteers of the project ESO-EAST, Kyrgyzstan conducted 20 training sessions on the NIHSS scale, 10 trainings on the classification of ischemic stroke on the TOAST classification. We conducted the training on the correct assessment of swallowing, temperature and glucose measurements according to the FeSS protocol for the nurses of 3 stroke units .We led the massive educational campaign with Kyrgyz version of FAST (“SOKKU”) algorithm and trained more than 240 patients and their relatives. The project volunteers gave speeches on the local radio and carried out informing the population about the stroke, risk factors and possible consequences and the identification of the first symptoms of stroke. Angels Initiatives volunteer training led to improved patient care during the acute period of stroke, with emphasis on the use of diagnostic scales for tracking the dynamics of the condition, testing swallowing in patients with stroke, and serum glucose.

P3770Interatrial block: a prognostic factor for atrial fibrillation in cryptogenic stroke patients

Abstract Background Atrial fibrillation (AF) is a well-known risk factor for ischemic stroke. Interatrial block (IAB), resulting from a conduction delay in Bachmann's bundle, is an electrical abnormality that, especially in its advanced (A-IAB) form, has been associated with atrial fibrotic cardiopathy and remodeling, sharing a common pathologic substrate with AF. Therefore, IAB has been proposed as a marker of atrial electromechanical dysfunction that may predispose to the development of AF. We hypothesized that IAB could be a marker of AF in patients with cryptogenic stroke (CS). Methods We retrospectively screened a cohort of CS patients with no prior history of AF, and collected their demographic, cardiovascular risk factors and other co-morbidities, stroke severity and resultant functional disability (NIHSS and mRS scales), CHA2DS2-VASc score, baseline 12-lead ECG, transthoracic echocardiogram, and neuroimaging studies on admission. All patients underwent continuous ECG monitoring for at least 48h. Forty-eight (64%) patients underwent additional out-patient 24h Holter monitoring following hospital discharge. P-wave (PW) analysis of baseline ECG classified patients into three groups: normal p-wave duration (N, PW <120 ms), partial IAB (P-IAB, PW ≥120 ms) and advanced IAB (A-IAB, PW ≥120 ms and biphasic morphology in leads DII, DIII and aVF). AF episodes (defined as irregular supraventricular arrhythmias without detectable PWs lasting >30 s), frequent premature atrial contractions (PACs) (>1%) and atrial tachyarrhythmia episodes (runs of >3 consecutive PACs) were detected on 24h Holter readings. Ischemic brain lesions were classified as cortical, subcortical or lacunar in relation to their localization and maximal diameter. Results Out of the 80 consecutive CS patients identified, 5 were excluded due to poor quality ECG readings. A high prevalence of both P-IAB (n=30, 40%) and A-IAB (n=23, 30.7%) was found in the final analysis with 75 CS patients. No differences were found between demographics, cardiovascular risk factors and co-morbidities, NIHSS, mRS and CHA2DS2-VASc scores, left atrial size and left ventricular ejection fraction among the 3 ECG categories. Cortical ischemic brain lesions were more frequent in patients in the IAB groups than in the N ECG group. After a mean follow-up of 522 days, AF was clinically diagnosed in 13 patients (17%), with an increasing risk in accordance to the severity of the IAB (p<0.05) (Figure 1A). 24h Holter readings showed greater frequency of PACs and atrial tachyarrhythmia episodes in patients with IAB (p<0.05) (Figure 1B). Figure 1 Conclusions In CS, IAB is associated with a greater risk to develop AF and its presence identifies a subgroup of patients with probable atrial fibrotic cardiopathy that could potentially benefit from early oral anticoagulation in secondary prevention.

Behavioral changes in patients with large vessel occlusion in subacute period of stroke in Kyrgyzstan

Behavioral and cognitive changes in acute and post-stroke period are frequent and take part in patients’s rehabilitation. to distinguish behavioral, mood and cognitive changes in patients in the acute period of large artery atherosclerotic ischemic (LAAIS) and intracerebral hemorrhage (ICH) in the sample of 100 patients. We applied NIHSS scale; MoCA test, FAB test, clock drawing test, "Schulte Table" technique; Spielberger`s Test Anxiety, the Bartell index. Mean age of LAAIS patients was 50.5 ± 9.8 years, there were 54.8% of men. The pronounced cognitive impairment was found in patients with a long-term hypertension (14.6 ± 6.8 points (p = 0.2) in MOCA test). In the ICH group, severe neurologic impairment according to NIHSS 9.5 ± 2.6 points was followed the moderate CI according to MOCA test: 14.7 ± 3.8 points. High personal and moderate situational anxiety (p = 0.006) was specific more to cardioembolic strokes patients. These patients showed a high dependence on others on the Bartell index (74.4 ± 3.7), p = 0.001. Mild cognitive impairment were observed in patients with a small vessel occlusion and this group did not have a functional dependence on others. Cognitive impairment is typical for LAAIS and expressed in iimpaired constructive praxis, speech disturbances and attention span. Slow course of LAA is bringing to cognitive and behavioral changes with secondary depression. The duration of hypertension, large size of the infarction and high level of anxiety made these patients highly dependent on others.

Increased interleukin-18 level contributes to the development and severity of ischemic stroke.

Although interleukin-18 (IL-18) has been implicated in the pathophysiology of stroke, research findings concerning IL-18 level in stroke have been inconsistent. Thus, we performed a cross-sectional study in patients with first-episode ischemic stroke and then extracted relevant data from databases to validate our results. A total of 252 patients and 259 healthy subjects were recruited, and serum IL-18 level was evaluated in a cross-sectional study. Then, we extracted data and conducted a meta-analysis, including 2,928 patients and 3,739 controls to support our results. A 95% confidence interval for standardized mean difference (SMD) was calculated using a Z test. We found IL-18 was higher in stroke patients than in controls (2.39 ± 0.25 vs. 2.25 ± 0.28, F=8.60, p=0.004) and was negatively associated with the NIHSS scale (r = -0.14, p=0.028). A subsequent meta-analysis confirmed that IL-18 level was higher in stroke patients than in controls (SMD = 2.14, 95% CI = 1.54 ∼ 2.73, P< 0.001). IL-18 level increased with the severity of the stroke (p< 0.01). These findings revealed increased IL-18 level contributed to the development and severity of ischemic stroke, suggesting the potential of this biomarker to become an important reference for the early monitoring of ischemic stroke.

PECULIARITIES OF THE RELATIONSHIPS OF POSTINSULAR COGNITIVE DISORDERS WITH DISTURBANCES IN THE SYSTEM OF HEMOSTASIS, LIPID AND CARBOHYDRIC SPECTRUM OF THE BLOOD AND ARTERIAL HYPERTENSION

Objective - study of the effects of disorders in the hemostasis system, blood lipid spectrum,carbohydrate metabolism and blood pressure on the clinical manifestations of theneuropsychological state in patients with post-stroke consequences, which remainedafter the transferred ischemic stroke.Materials and methods. In accordance with the purpose of the work, the data of clinicaland laboratory examination of 109 patients who underwent hemisphere ischemic strokewere analyzed. The study included 74 (67.9%) men and 35 (32.1%) women. The averageage of patients was 58.6 ± 4.9 years. Since the onset of acute ischemic stroke, 64 (58, 7%)had passed from 2 to 3 months, and the remaining 45 (41.3%) patients had up to four months. Arterial hypertension (in 14.7%), dyslipidemia (in 68, 8%) and theircombination (in 16.5%) of cases was the presumed causes of cerebral ischemic stroke.Comprehensive clinical, neuropsychiatric and laboratory studies using the MMSE,NIHSS scales, the Barthel scale and methods for determining the lipid and carbohydratespectrum of the blood, the state of homeostasis was carried out in the early recoveryperiod in patients who had hemispheric ischemic stroke. Statistical processing of theobtained results was carried out using the STATISTICA 6.0 program. The test wascarried out according to the criterion of Shapiro-Wilks. For comparison of qualitativefeatures and independent samples, the Pearson's criterion (x2) and Fisher's exact testwere used; in dependent samples, the Mac-Nemar criterion was used.Results. The analysis of the results of clinical studies and changes in the complex ofneuropsychic tests of cognitive disorders in patients with ischemic stroke in the earlyrecovery period made it possible not only to identify the special nature of cognitiveimpairments and their manifestations, but also to establish their dependence on thequantitative detection of such adverse factors as arterial hypertension, increased bloodviscosity, dyslipidemia and hyperglycemia. All of these risk factors were included in asingle cluster that combines the main causes of the formation and further course ofcognitive disorders. Conjugacy of disorders in the system of homeostasis, in the lipidspectrum of blood, carbohydrate metabolism and arterial hypertension with the severityof cognitive disorders diagnosed in the early recovery period was noted. It has beenestablished that the presence of one or two of the listed aggravating factors is associated with mild cognitive impairment, and more than two contribute to the appearanceof moderate neuropsychiatric disorders.Conclusions. 1. The recovery period in patients with ischemic stroke is characterized bythe presence of mild cognitive impairment in 36.7% of cases and moderate in 63.3% ofcases. 2. The development of cognitive disorders in the post-stroke period is due to thecompleteness of the cluster of risk factors, the basis of which is arterial hypertension,dyslipidemia, increased activity of the blood coagulation system and hyperglycemia. 3.In the formation and further manifestation of mild cognitive disorders, no more than twopathogenetic risk factors are simultaneously involved; in moderate cases, their numberincreases from 2 to 4. 4. A high correlation was found between the severity of cognitivedisorders and disorders in the hemostasis system, lipid and carbohydrate spectra ofblood and blood pressure.

Effects of interactive health education on neurological function and Barthel index in patients with cerebral infarction

Objective To investigate the effect of interactive health education on neurological function and Barthel index in patients with cerebral infarction. Methods A total of 114 patients with cerebral infarction admitted to this hospital from January 2016 to December 2017 were selected as the research objects. The selected patients were randomly divided into interactive health education group and conventional control group, with 57 cases each. Traditional healthy education nursing was carried out in the conventional control group, while interactive healthy education was carried out in the interactive health education group. NIHSS scale was used to evaluate the neurological function recovery of the patients, Barthel index was selected to evaluate the daily living ability, and the nursing satisfaction table of the hospital was used to investigate the nursing quality satisfaction of the two groups. Results After intervention, neurological function was improved in both groups, and the number of patients with mild neurological disorders was significantly increased, especially in the interactive health education group.Comparison between the two groups at the same time after intervention showed statistically significant differences (P<0.05). After intervention, self-care disorders were improved in both groups, and the number of patients with mild self-care disorders was significantly increased, and the interactive health education group showed more significant improvement.Comparison of the two groups at the same time after intervention showed statistically significant difference (P<0.05). After intervention, the nursing satisfaction rate of the interactive health education group was 100%, which was significantly higher than that of the conventional control group (91.23%), and the difference was statistically significant(P<0.05). Conclusion Through interactive health education, patients' awareness of the knowledge of cerebral infarction is improved, the self-discipline of patients is enhanced, and the recovery of patients' neurological function and living ability is promoted, which is worth promoting in clinical use. Key words: Cerebral infarction; Interactive health education; Neural function; Self-care ability of daily living

EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE: POTENTIAL PREDICTORS, CAUSES AND RELATION TO INFARCT GROWTH

Background: Worsening of acute stroke early in its course (within 48–72 h of its onset) is a common occurrence and haspotentially serious short term and long term consequences. The incidence of early neurological deterioration (END) amonghospitalized patients varies widely in different studies between 13% and 38%. Aim of the Work: To define incidence and timing of END in relation to acute ischemic stroke (AIS) onset. To identify possible causes and predictors associated with END. To assess the relation between END and the patient functional level at three months post stroke. Patients and Methods: Three hundred patients were recruited into this hospital prospective comparative study. Clinical history,laboratory indices, structural brain imaging, Magnetic Resonance Angiography (MRA) and Carotid Duplex ultrasonography were done. Patients were examined on NIHSS and Glasgow Coma Scale (GCS) in day 1, 2, 3 and patients with END did a follow up (MRI diffusion film or CT brain) at day4 or 5 and all patients were followed up by Modified Rankin scale (MRs) at three-month post stroke. Results: Of the Three hundred patients included in the study, the incidence of END was 16.7%. The median NIHSS on admission was 9.25. END was associated with long duration of DM (P 0.012), IHD (p 0.015), AF (p 0.048), severe stroke (p 0.0044), low blood pressure on admission (p 0.0079), high uric acid (p 0.033) and MCA occlusion(p 0.0007). END was associated with significant increase in MRS at 3 month (p<0.0001) and mortality rate (44% vs 4.4). Patients with END are more prone for aspiration pneumonia (p 0.0001) and hemorrhagic transformation. Conclusion: Early neurological deterioration is a frequent complication after acute stroke, with a poor short-term prognosis. This study provides that hyperglycemia, hyperuricemia and cardiac disease (IHD and AF) may increase the risk of END.

Iatrogenic carotid-cavernous fistula secondary to endovascular rescue of a left M1 occlusion in the presence of a cavernous carotid aneurysm utilizing a stentriever

Background and importanceIatrogenic Direct carotid-cavernous fistulas (CCFs) are uncommon complications of intracranial endovascular rescue. We describe the first reported case of an intraprocedural direct carotid cavernous fistula that developed immediately after flow restoration during treatment of an acute left M1 occlusion utilizing a stentriever. Clinical presentationThis was an 86 year old right handed Caucasian woman who presented with acute onset of aphasia, right sided weakness, and right facial droop. The time of onset was unknown. NIHSS scale on arrival to the ED was 16. Stroke protocol CT Perfusion imaging demonstrated a large region of ischemic penumbra within the left MCA distribution. Occlusion of the left M1 segment with collaterals to a limited number of opercular, insular, and cortical branches was noted on CT Angiography. Successful TICI 3 endovascular rescue of the left M1 occlusion was obtained. Later attempts at embolizing the iatrogenic left CC Fistula were abandoned for patient safety. ConclusionWhile CCFs are not life threatening, the morbidity from ocular complications can be high. Each Carotid Cavernous Fistula should be reviewed as a unique case and the optimal treatment should be selected to decrease risk to the patient. Careful Endovascular navigation and device deployment of the retriever under full inspection of the roadmap may prevent or reduce the incidence of direct CCFs; however, sometimes it may become necessary to choose the potential complication to save a patient's life as was the case described in this report.

Interatrial block in prediction of all-cause mortality after first-ever ischemic stroke

BackgroundInteratrial block (IAB) is an ECG indicator of atrial fibrosis related to atrial remodeling and thrombus formation thus leading to embolic stroke and increasing mortality. We aimed to assess weather IAB predicted all-cause mortality during 10 years after ischemic stroke.MethodsThe study sample comprised 235 patients (median age 74 (interquartile range 25–75% 65–81) years, 95 female) included in the Lund Stroke Register in 2001–2002, who had sinus rhythm ECGs at stroke admission. IAB was defined as a P-wave duration ≥120 ms without = partial IAB (n = 56) or with = advanced IAB (n = 41) biphasic morphology (±) in the inferior ECG leads. All-cause mortality was assessed via linkage with the Swedish Causes of Death Register.ResultsDuring follow-up 126 patients died (54%). Advanced IAB, but not partial, was associated with all-cause mortality in univariate Cox regression analysis (hazard ratio (HR) 1.98, 95% CI 1.27–3.09, p = 0.003). After adjustment for age, gender, severity of stroke measured by NIHSS scale and smoking status in patients without additional comorbidities advanced IAB independently predicted all-cause mortality (HR 7.89, 95% CI 2.01–30.98, p = 0.003), while in patients with comorbidities it did not (HR 1.01 95% CI 0.59–1.72, p = 0.966).ConclusionAdvanced IAB predicted all-cause mortality after ischemic stroke, but mostly in patients without additional cardiovascular comorbidities.

Application of mathematical modeling methods in the evaluation of severity of ischemic stroke in patients with arterial hypertension

To study the possibility of applying methods of mathematical modeling in assessing the severity of ischemic stroke in patients with arterial hypertension. The study included 80 patients with ischemic stroke. Blood pressure was measured. Transcutaneous polarography was used to measure the oxygen tension in tissues. Measurements of gas composition of the blood and thickness of the intima-media complex were performed. The level of stable metabolites of nitric oxide in the blood was determined. Measurement of endothelin-1 in the blood was performed by enzyme immunoassay. NIHSS scale was administered to assess the neurological status. Patients were divided into 3 groups according to the degree of neurological deficit. The control group consisted of 10 people without signs of vascular pathology. An increase in the neurological deficit was accompanied by an increase in the level of endothelin-1, a decrease in the level of stable metabolites of nitric oxide, and a reduction in tissue oxygenation. Discriminative functions were developed for each group of patients using discriminant analysis based on the data obtained in the study. The most statistically significant were two signs: the level of systolic blood pressure and the content of stable metabolites of nitric oxide in the blood. Thus, the imbalance in the indices of endothelium-dependent mechanisms of vascular tone regulation reflect the severity of the condition in ischemic stroke. The method of discriminant analysis allows the creation of sufficiently reliable mathematical models that can have practical significance, and can be used as a method of clarifying the severity of the condition in the acute period of ischemic stroke.

Validation of the Catherine Bergego Scale in patients with unilateral spatial neglect after stroke

ABSTRACT.The Catherine Bergego Scale (CBS) is a scale to evaluates the impact of unilateral spatial neglect (USN) on everyday life of patients after stroke.Objective:The aim of this study was to evaluate the reliability and comprehension of the Portuguese version of the CBS for patients with USN after stroke.Methods:This was a cross-sectional study in patients with stroke and USN. The CBS was translated, culturally adapted and applied by two independent investigators. The patients were also evaluated by the Behavioural Inattention Test (BIT), NIHSS, mRS and Barthel scale to assess USN severity, neurological function, disability and autonomy consecutively. Consistency and coherence were analysed using Cronbach’s α, inter-observer reliability by Kappa, and the correlation between the CBS, BIT, NIHSS, mRS, and Barthel was determined using Pearson correlation.Results:Twenty-two patients were evaluated and the observed Cronbach’s α=0.913. For intra-observer reproducibility, the 10 items showed a reasonable and high reliability between evaluators. The CBS showed a negative correlation with the BIT. There was a low correlation between the BIT and NIHSS, mRS and Barthel index.Conclusion:The CBS is an adequate and validated scale for assessing patients with USN after stroke in a Brazilian population.

Optimization of Early Rehabilitation of Patients with Ischemic Stroke and Sleep-Disordered Breathing

Introduction: Sleep-disordered breathing (SDB) is detected in 70% of stroke patients and impedes functional rehabilitation; it also increases the length of hospital stay and the risk of stroke recurrence and fatal outcome. Objective: To study the dynamics of SDB in its correlation with neurological disorders in stroke patients and to develop the approaches to optimization of early rehabilitation. Materials and methods: Seventy eight patients with acute ischemic stroke were examined. SDB was verified by cardiorespiratory monitoring; neurological deficit was assessed with the NIHSS and mRS scales. Examination was performed upon admission (days 2–5 post stroke) and repeated 3 weeks after. The effect of SDB correction on neurological recovery was studied for positional therapy (elevated head of bed by 30°) in combination with oxygen therapy (insufflation of O2 with maintenance of saturation level not less than 95% under digital sensor control). Results: Upon admission, SDB was revealed in 88% of patients; moderate and severe disorders being predominant (the apnea/hypopnea index (AHI) ≥ 15 h–1), most frequently presenting as obstructive apnea. In patients with AHI < 15 h–1, the positive dynamics of neurological disorders (p < 0.04) was observed along with stable SDB parameters. Neurological improvement (р < 0.05) was present in patients with AHI ≥ 15 h–1, which was associated with lesser severity of SDB. A direct correlation between the severity of neurological disorders and AHI after 3 weeks from the onset was revealed: RNIHSS/AHI = 0.45 (р = 0.003) and RmRS/AHI = 0.44 (р = 0.004). Patients with AHI ≥ 15 h–1 were divided into 2 groups: group A (no interventions) and group B (with application of positional and oxygen therapy in the night sleep during 7 days). A positive effect of therapy on restoration of neurological functions, along with a decrease in AHI, was revealed. Conclusions: SDB is a frequent and persistent disorder in patients with ischemic stroke. Early detection and correction of SDB should be regarded as an important component of post-stroke rehabilitation.