Past History Of Stroke Research Articles

Abstract 3306: Effect Of General Obesity On Neurological Deterioration After Acute Stroke

Objective: The increasing prevalence of obesity in Asia has led to concern that obesity negatively affects outcomes after acute cardiovascular events and stroke. Here, we examined the relationship between body mass index (BMI), as a general indicator of obesity, and neurological deterioration after acute stroke. Patients and Methods: Consecutive acute stroke patients (n=2310: 489 hemorrhagic stroke, 1702 ischemic stroke, 119 TIA; median age 73.0; 1392 male) participated in this study. All patients were admitted within 7 days of stroke onset to a regional brain attack center in Japan between January 2005 and December 2010, and provided written informed consent. Patient attributes (age; sex; current smoking and/or drinking status; past history of stroke, hypertension, diabetes mellitus, and hypercholesterolemia; and body weight and height) were recorded upon admission; BMI was calculated using the height and weight measurements. Patients whose NIHSS score increased by 4 or more from admission to discharge or who died during hospitalization were classified into the neurological deterioration group; all other patients were classified into the non-deterioration group. Logistic regression analysis was performed using the deterioration and non-deterioration groups as dependent variables, and factors related to deterioration were examined using SPSS version 15.0. Results: The deterioration group comprised 221 patients, and had a higher proportion of patients with hypertension and/or diabetes mellitus and age over 75 years, but these patients had significantly lower BMI values than the 2089 patients in the non-deterioration group (22.4 ± 4.2 kg/m 2 vs. 23.2 ± 3.5, p=0.002). No intergroup differences were observed for history of stroke, smoking and/or drinking status, or hypercholesterolemia. Logistic regression analysis of the patient attributes listed above indicated that age and history of hypertension (odds ratio=1.77 and 1.75, 95% CI: 1.24-2.52 and 1.07-2.85, respectively) were positively correlated with neurological deterioration; in contrast, a larger BMI was negatively correlated with neurological deterioration (odds ratio by 1 kg/m 2 increase in BMI=0.948, 95% CI: 0.899-0.999, p=0.04). Conclusion: Lower BMI at admission was positively correlated with neurological deterioration after acute stroke after adjusting for other cerebrovascular risk factors.

Swan Ganz Catheter for Diagnosis of Transient Central Diabetes Insipidus after Mitral Valve Replacement

Abstract Transient Diabetes Insipidus (DI) occurring in a pati-ent undergoing open heart surgery is a rare occurrence. In this case report, we are presenting a 30 years old female patient with past history of stroke who under-went redo mitral valve replacement developed poly-uria. The diagnosis of hypovolemia was made with the help of swan ganz catheter. The patient responded to desmopressin and completely recovered seven days after surgery. It is possible that transient cerebral is-chemia given her history of Stroke resulted in the dys-function of osmotic receptors in the hypothalamus or hypothalamus - pituitary axis during Cardiopulmo-nary Bypass (CPB). Therefore, we concluded that cen-tral DI is a probable cause of polyuria after CPB. Keywords: Transient Diabetes Inspidus, Swan Ganz Catheter, Mitral valve replacement.

An indirect comparison of dabigatran, rivaroxaban and apixaban for atrial fibrillation

New oral anticoagulant drugs are emerging as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation. Two agents are direct factor Xa inhibitors (rivaroxaban and apixaban), and the third is a direct thrombin inhibitor (dabigatran). They have been separately compared to warfarin in large randomised trials. Our objective was to indirectly compare the three agents to each other for major efficacy and safety outcomes. Studies were assessed for comparability and the odds ratios of selected outcomes for each anticoagulant versus one another were estimated indirectly. The three cohorts differed significantly in terms of CHADS(2) score and the number of individuals with a past history of stroke, transient ischemic attack or systemic embolism. The estimated odds ratio of stroke or systemic embolism was 1.35 for rivaroxaban vs dabigatran 150 mg (p=0.04), 0.97 for rivaroxaban versus dabigatran 110 mg (p=0.81), 1.22 for apixaban versus dabigatran 150 mg (p=0.18), 0.88 for apixaban versus dabigatran 110 mg (p=0.34) and 0.90 for apixaban versus rivaroxaban (p=0.43). The estimated odds ratio of major bleeding was 1.10 for rivaroxaban versus dabigatran 150 mg (p=0.36), 1.28 for rivaroxaban versus dabigatran 110 mg (p=0.02), 0.74 for apixaban versus dabigatran 150 mg (p=0.004), 0.87 for apixaban versus dabigatran 110 mg (p=0.17) and 0.68 for apixaban versus rivaroxaban (p<0.001). In conclusion, the available data indicate no significant difference in efficacy between dabigatran 150 mg and apixaban for the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation. It appears however that apixaban is associated with less major bleeding than dabigatran 150 mg or rivaroxaban and that rivaroxaban is less effective than dabigatran 150 mg in preventing stroke or systemic embolism. Such an indirect comparison should be used only to generate hypotheses which need to be tested in a dedicated randomised trial comparing the three drugs directly.

Cilnidipine Lowers Plasma Leptin of Patients with Obese Hypertension Associated with Cerebrovascular Disorder

Background: Since cilnidipine suppresses not only the L-type but also N-type calcium channels found on peripheral sympathetic nerve endings which control noradrenaline release, it is thought to be a Ca antagonist with low sympathetic nerve activation when lowering blood pressure (dual blocking action). As activation of sympathetic nervous system is suggested to contribute to hypertension in obesity, dual blocking action of cilnidipine may contribute to patients with obesity-hypertension. Methods: The effects of cilnidipine on plasma leptin levels and blood pressure were studied. Twenty three patients with obesity-hypertension associated with a past history of stroke or ischemic changes confirmed by brain magnetic resonance imaging were enrolled. Cilnidipine (10 mg/day) was administered orally once a day after breakfast. The duration of the study treatment was 12 weeks. Retroperitoneal adipose tissues around the kidney of both fat and lean cadaver and neuronal and non-neuronal tissues of rat were used for immunohistochemical examination. Result: The mean circulating leptin level decreased from 11.8 ng/ml to 10.8 ng/ml that reached statistical significance. Multiple regression analysis revealed no significant effects of covariates except for baseline leptin level. An immunohistochemical study revealed that N-type calcium channel protein was expressed on the cell membrane of adipocytes. We speculate that a blockade of calcium current through the N-type channel, instead of the L-type channel may suppress leptin secretion. Conclusion: The dual blocking action of cilnidipine may help control both arterial hypertension and leptininduced atherosclerosis in patients with obese hypertension associated with cerebrovascular disorder.

Clinical characteristics of patients with asymptomatic recurrences of atrial fibrillation in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico–Atrial Fibrillation (GISSI-AF) trial

Atrial fibrillation (AF) is a common arrhythmia that frequently recurs after restoration of sinus rhythm. In a consistent percentage of cases, AF recurrences are asymptomatic, thus making its clinical management difficult in relation to both therapeutic efficacy and thromboembolic risk. The GISSI-AF trial enrolled 1,442 patients in sinus rhythm with previous AF episodes. Patients were randomized to valsartan or placebo and followed for 12 months. To improve the likelihood of detecting arrhythmic recurrences, arrhythmic follow-up was based on both programmed or symptom-related control visits and transtelephonic electrocardiographic transmissions. The present post hoc analysis was performed on 1,638 arrhythmic episodes that occurred in 623 patients. Asymptomatic AF recurrences were present in 49.5% of patients. In multivariable analysis, asymptomatic AF recurrences were significantly associated with a longer duration of qualifying arrhythmias (odds ratio [95% CI] 1.57 (1.26-1.97), P < .0001). A lower ventricular response (P < .001) and a longer duration of the arrhythmic recurrence (P < .001) characterized asymptomatic episodes. Patients with asymptomatic events were more likely to be in AF at the time of electrocardiographic control at the end of the 12-month follow-up (adjusted odds ratio [95% CI] 4.9 (2.8-8.4), P < .001). Moreover, a higher CHADS(2) (Congestive heart failure, history of Hypertension, Age≥75 years, Diabetes mellitus, and past history of Stroke or TIA doubled) score and a more frequent use of amiodarone, calcium-channel blockers, and digitalis characterized patients with asymptomatic, whereas 1C drugs were more often used in subjects with symptomatic recurrences. Asymptomatic AF recurrences were frequent in the GISSI-AF study population in patients who were more likely to develop persistent-permanent AF and were characterized by an increased thromboembolic risk.

Fractal dimension of the retinal vasculature and risk of stroke: A nested case-control study

Recent studies show associations between retinal vascular changes and small infarcts detected on brain imaging, or clinical stroke.1 Fractal dimension has been used as a global measure of the geometric pattern of the retinal vasculature2,3 potentially representing the complex branching pattern of the microvasculature, including the cerebral microvasculature. We have developed an automatic method to assess spectrum fractal dimension (SFD) of the retinal microvasculature using Fourier-transformed images.4,5 Two previous studies have reported cross-sectional associations between retinal fractal dimension and lacunar stroke.6,7 In this study, we aimed to examine the association between baseline SFD and stroke incidence using a case-control sample nested in the Blue Mountains Eye Study (BMES). ### Methods. The BMES is a population-based cohort study of an urban population aged 49 years or older (n = 3,654), representing 82.4% of eligible population in a defined area of the Blue Mountains region, Australia.1 Stroke cases were defined among participants with no past history of stroke at baseline (1992–1994) but who developed stroke during the subsequent 5 years (1997–1999), or who died from stroke or stroke-related causes by late 2005. Detailed definitions of stroke events and mortality are shown in …

Distribution of ankle—brachial index and the risk factors of peripheral artery disease in a multi-ethnic Asian population

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and is associated with increased cardiovascular morbidity and mortality. We describe the prevalence and risk factors of PAD in a multi-ethnic Asian population (Chinese, Malays and Indians) in Singapore. The Singapore Prospective Study Program recruited 4132 individuals between 2004 and 2006 in which the ankle-brachial index (ABI) was measured using the Smartdop™ 20EX bi-directional blood flow detector. PAD was defined as ≤ 0.9 and a high ABI > 1.4, with ABI 1.11-1.20 as reference. The mean age (SD) of individuals in the study was 49.9 (11.8) years, with 51.8% females. PAD was present in 4.3% of the population and a high ABI (> 1.4) was rare. Malays and Indians had a higher risk (especially in females). Compared to those with an ABI between 1.11 and 1.20, those with PAD were more likely to be of Malay and Indian ethnicity, female sex, with higher systolic blood pressure and pulse pressure, with increased prevalence of diabetes mellitus, hypertension, albuminuria and renal impairment, and with a past history of stroke. In conclusion, in this large multi-ethnic Asian population, we document the distribution and risk factor associations for PAD. PAD shows an ethnic distribution similar to that of coronary artery disease in Singapore, with differences in sex distribution. Apart from traditional vascular risk factors, pulse pressure, renal impairment and a past history of stroke are important determinants of PAD.

大腿骨頸部骨折患者の歩行自立に必要な要因―決定木分析による検討―

The purpose of this study was to develop a decision-making process to assess the conditions for predicting gait independence in patients with femoral neck fracture. A total of 108 patients were divided into 2 groups on the basis of their walking abilities at discharge for an unrelated illness; an independent (n=55) and dependent group (n=53). Details regarding age, sex, length of hospital therapy, operative procedures, classification of fracture, past history of stroke and fracture were collected from medical records. Body mass index (BMI), knee extension power, maximum walking speed, functional reach test (FRT) and the mini-mental state examination (MMSE) were measured to evaluate motor ability and cognitive status at discharge. Student's t-test and the chi-squared test were used to test for statistical differences between the 2 groups. On multivariate analysis, classification and regression trees (CART) was used to determine the predictive value of those measures that differed significantly between the 2 groups. On bivariable analysis, significant differences were found in nearly all variables, except for BMI and length of hospital therapy. As a result of this analysis, the decision tree, which consists of knee extension power, FRT, MMSE and a past history of stroke, was created. CART analyses showed that when knee extension power was >0.34 kgf/kg, the MMSE score was >13.5; with no past history of stroke, the rate of independent walking at discharge was 93.8%. In contrast, when knee extension power was ≤0.33 kgf/kg, FRT was ≤25.5 cm, the MMSE score was ≤13.5, and the rate of dependent walking at discharge was 100%. Our findings indicate that the decision tree can be helpful in predicting gait independence in patients with femoral neck fracture.

148 Hypoxemia due to right-to-left interatrial shunt with no pulmonary artery hypertension. One centre experience with transcatheter closure including 63 consecutive patients

Hypoxemia related to interatrial right-to-left shunt may have a significant impact on exercise tolerance. We report here one centre experience in transcatheter closure of interatrial RL shunt. From August 1995 to 2009, 63 consecutive patients (37 females and 26 males, mean age 54 ± 24 years), underwent transcatheter closure of interatrial RL shunt because of cyanosis and shortness of breath at exercise. Associated malformations were modified Fontan (n = 4), Ebstein anomaly (n = 1), RV hypoplasia (n = 1), pectus excavatum (n = 2), aortic aneurysm (n = 1). Ten pts had a past history of stroke. A real platypnea-orthodeoxia syndrome was noticed in only 17 pts. The vast majority of patients had cardiac catheterization under local anaesthesia with a sole fluoroscopic control. None of them had pulmonary artery hypertension. Transcatheter closure was performed with a Sideris device (n = 10), a PFO Amplatzer occluder (n = 40), an ASD Amplatzer occluder (n = 8), a Cardioseal device (n = 3), a VSD Amplatzer occluder (n = 2). Device implantation succeeded in all but two (1 Sideris and 1 Cardioseal device). The fluoroscopic time was 12 ± 8 minutes. All patients had better clinical tolerance after closure with an oxygen saturation > 92%. All underwent serial echocardiographic follow-up with bubble study. One month after implantation, no shunt was noticed in all but 6 pts (tiny RL shunt). In 5 of these remaining pts, the 6-month control did not see any residual shunting. Transcatheter closure of interatrial RL shunt responsible of cyanosis is an effective and a safe method. Many devices using a double disk system can be employed and provide excellent results. The classic platypnea-orthodeoxia syndrome is observed in < 25% of this population.

Protocol for Past BP: a randomised controlled trial of different blood pressure targets for people with a history of stroke of transient ischaemic attack (TIA) in primary care

BackgroundBlood pressure (BP) lowering in people who have had a stroke or transient ischaemic attack (TIA) leads to reduced risk of further stroke. However, it is not clear what the target BP should be, since intensification of therapy may lead to additional adverse effects. PAST BP will determine whether more intensive BP targets can be achieved in a primary care setting, and whether more intensive therapy is associated with adverse effects on quality of life.Methods/DesignThis is a randomised controlled trial (RCT) in patients with a past history of stroke or TIA. Patients will be randomised to two groups and will either have their blood pressure (BP) lowered intensively to a target of 130 mmHg systolic, (or by 10 mmHg if the baseline systolic pressure is between 125 and 140 mmHg) compared to a standard group where the BP will be reduced to a target of 140 mmHg systolic. Patients will be managed by their practice at 1-3 month intervals depending on level of BP and followed-up by the research team at six monthly intervals for 12 months.610 patients will be recruited from approximately 50 general practices. The following exclusion criteria will be applied: systolic BP <125 mmHg at baseline, 3 or more anti-hypertensive agents, orthostatic hypotension, diabetes mellitus with microalbuminuria or other condition requiring a lower treatment target or terminal illness.The primary outcome will be change in systolic BP over twelve months. Secondary outcomes include quality of life, adverse events and cardiovascular events.In-depth interviews with 30 patients and 20 health care practitioners will be undertaken to investigate patient and healthcare professionals understanding and views of BP management.DiscussionThe results of this trial will inform whether intensive blood pressure targets can be achieved in people who have had a stroke or TIA in primary care, and help determine whether or not further research is required before recommending such targets for this population.Trial RegistrationISRCTN29062286

Sex Differences in Prevalence and Risk Indicators of Geriatric Depression: The Shih-Pai Community-based Survey

Information about sex difference is important for the development of better prevention and intervention strategies for geriatric depression. We investigated sex differences in prevalence and risk indicators associated with geriatric depression among community-dwelling elderly people in Shih-Pai, Taipei, Taiwan. A cross-sectional community-based survey was conducted from June 1999 to November 2002 among non-institutionalized residents aged =65 years in Shih-Pai community. Trained interviewers collected data through home visits. Geriatric depression was defined as a score of = 5 on the Geriatric Depression Scale-Short Form. The prevalence of geriatric depression was 9.8% in 3970 participants, with a higher rate in women (12.4%) than men (7.8%). Geriatric depression was significantly associated with women [odds ratio (OR) =1.49, 95% confidence interval (CI) =1.07-2.07), separated/divorced marital status (OR =3.29, 95% CI = 1.51-7.18), living alone (OR = 2.56, 95% CI = 1.38-4.77), past history of stroke (OR = 3.63, 95% CI = 2.09-6.31), and cognitive impairment (OR =2.83, 95% CI =1.96-4.09). Living alone (OR = 3.56, 95% CI = 1.48-8.57), living with children (OR = 1.97, 95% CI = 1.02-3.78), and past history of gouty arthritis (OR =2.46, 95% CI = 1.27-4.79) were significantly associated with depression in women, but not in men. Women have a higher prevalence of geriatric depression than men. Our data support the differential exposure hypothesis and the differential vulnerability hypothesis of sex difference in geriatric depression.

Three-month exercise and weight loss program improves heart rate recovery in obese persons along with cardiopulmonary function

Heart rate recovery (HRR) after exercise is an independent risk factor for cardiovascular disease and mortality, and it is well known to be modifiable by weight loss. We investigated whether HRR was mainly improved by better cardiopulmonary function or by alteration of the metabolic profile. The weight loss program included 2h of group exercise per week and individual dietary instruction by a qualified dietician every week. Clinical assessment (including HRR) was done before and after the 3-month program. The subjects were 125 obese persons without a past history of stroke, cardiovascular events, or use of medications who participated in and completed our exercise plus weight loss program. HRR (35.61+/-12.83 to 45.34+/-13.6 beats/min, p<0.0001) was significantly faster after the program. The change in HRR was significantly correlated (p<0.05) with the changes in body weight, body mass index, percent body fat, waist circumference, hip circumference, resting heart rate, peak exercise heart rate, exercise time, maximal work load, physical working capacity divided by body weight (PWC75%HRmax/weight), subcutaneous fat area, visceral fat area, low-density lipoprotein cholesterol, and leptin. Multivariate analysis showed that the change in HRR was significantly correlated (p<0.05) with the changes in resting heart rate, peak exercise heart rate, and PWC75%HRmax/weight. Our data demonstrated that HRR can be improved in obese subjects by a 3-month exercise and weight loss program. Improvement in cardiopulmonary function by exercise seems to be the main contributor to the increment of HRR.

The CHADS2 score for stroke risk stratification in atrial fibrillation – friend or foe?

The risk of stroke in patients with non-valvular atrial fibrillation (NVAF) varies widely depending on patient age and the presence of other risk factors such as hypertension, diabetes mellitus, congestive heart failure or prior stroke or transient ischaemic attack (TIA) (1, 2). Warfarin reduces the risk of stroke by about twothirds when compared to placebo or no treatment, and by about two-fifths when compared to aspirin, but substantially increases major bleeding (2, 3). The most feared complication of warfarin is intracranial bleeding which occurs at the rate of 2–5 per 1,000 patients per year and often results in disability or death (3). Consequently, the decision to use warfarin must balance the benefits of warfarin for stroke prevention against the risk of major bleeding. The goal of stroke prediction models is to help clinicians and patients select the most appropriate antithrombotic therapy for stroke prevention. Because the absolute benefit of warfarin for stroke prevention increases with increasing baseline stroke risk whereas the absolute risk of major bleeding is more constant (3, 4), the balance between benefits and risks of warfarin in individual patients is determined primarily by their baseline untreated stroke risk. In this paper we critically examine the value of the CHADS2 (acronym for recent Congestive heart failure, history of Hypertension, Age≥75 years, Diabetes mellitus, and past history of Stroke or TIA) risk index to estimate stroke risk in patients with NVAF.

Total and LDL cholesterol as risk factors of ischemic stroke in Emirati patients

The role of total and LDL-cholesterol as independent risk factors of ischemic stroke remains uncertain. The aim of this hospital based prospective observational study is to investigate the association between total and LDL cholesterol levels and ischaemic stroke in Emirates patients admitted to hospital between June 2007 and June 2009 with atherothrombotic stroke. One hundred and seventy one Emirati patients, 89 males and 82 females with acute ischemic stroke were diagnosed and investigated for risk factors, including hypertension, diabetes mellitus, cardiac diseases, cigarettes smoking and past history of transient ischemic attack (TIA) and past history of stroke. Exclusion criteria were patients with acute or chronic atrial fibrillation and patients receiving statins. Brain CT scan, echocardiogram and carotid ultrasound were done on hospital admission. One hundred and twelve patients (65.5%) had hypercholesterolemia (total cholesterol level ≥ 5.2 mmole/L, LDL cholesterol ≥ 4.2 mmole/L). One hundred and thirty patients (76.0%) were hypertensive. Ninety patients (52.8%) were diabetic. Twenty two (12.9%) were heavy smokers. Fifty patients (29.2%) had past history of cardiac disease. Twenty eight patients (16.4%) had previous stroke Twelve patients (12%) had TIA. Out of the one hundred and twelve patients with hypercholesterolemia nine patients (5%) only had isolated hypercholesterolemia. The commonest risk factor associated with hypercholesterolemia is hypertension (78.8%). In conclusion, the results of this study do not support the association between isolated hypercholesterolemia and atherothrombotic stroke. Hypercholesterolemia is not an independent risk factor for ischaemic stroke but it can interact with other risk factors mainly hypertension to promote atherosclerosis.

Oxidant–antioxidant Status and Lipid Profile in the Hypertensive Patients.

Background: Hypertension is associated with an elevation of ROS and frequently also with an impairment of endogenous antioxidant mechanisms. Increased level of serum cholesterol, TG, VLDL has been observed in patients with hypertension. It has been shown that oxidized lipoprotein inactivates NO and aggravates hypertension. This study intends to know the association of oxidative stress and lipid profile with hypertensive patients of the Western Nepal.Methods: Our study group comprised of 32 confirmed cases of HTN. Inclusion criteria included the patients with blood pressure ≥140/90mm of Hg. Patients with secondary hypertension, past history of stroke, coronary artery disease (CAD), myocardial infarction, and peripheral vascular disease and diabetes mellitus were excluded. Serum lipid profile, plasma thiobarbituric acid reactive substances (PTBARS), plasma total antioxidant activity (TAA) and urinary thiobarbituric acid reactive substances (UTBARS) were estimated in these patients by standard procedures and the values were compared with 30 age, sex and socioeconomically matched normal healthy control subjects.Results: TBARS levels and Lipid profile were significantly raised in HTN patients, but TAA and urinary TBARS levels were comparable to normal subjects. BMI and W/H ratio in patients were comparable to control. Smoking and alcohol did not influence lipid profile, TBARS and TAA.Conclusion: Lipid profile and TBARS were significantly raised in HTN patients compare to controls. Thus, monitoring lipid level and maintaining oxidative balance in hypertensive patients would be helpful in preventing the diseases associated with hypertension. Key words: Hypertension; Lipid profile; Oxidative stress; Antioxidant; Nepal.doi: doi: 10.3126/jnhrc.v6i2.2185Journal of Nepal Health Research Council Vol. 6, No. 2, 2008 October Page : 63-68

Southern Egypt Stroke Study: Case Fatality Rates in a Hospital-Based Setting

Background: The best approach to reduce the burden of stroke remains prevention. The large majority of epi- demiological data available focus only on western countries. A better knowledge of stroke patients characteristics in Mid- dle East and African communities will help to promote tailored campaigns by health care authorities and medical socie- ties. Objectives: to determine the characteristics of hospitalized stroke patients and case fatality in Upper Egypt governorates areas (Sohag, Quena, Aswan). Methods: prospective hospital-based study carried out in the Neurology department of Sohag University hospital, in- volved 467 consecutive stroke patients. Demographic data, stroke-subtypes, risk factors, and stroke outcome, were ana- lyzed. The study population was a consecutive series of patients admitted in the main tertiary health care level hospital of the area. Results: hemorrhagic strokes reported in 37.5% of cases. Fifty six % were above 60 years and 8.6% were juvenile events. Sixty two % of stroke occurred in autumn-winter. Hemorrhagic stroke was higher in spring-summer (53%). Hypertension was the more frequent risk factor reported in 42% of patients. In the study population smoking was present in 37.7%, ischemic heart diseases in 32.8%, dyslipidaemia in 29.5%, Diabetes (DM) in 21.6%, past history of stroke in 10.5%, obe- sity in 10.1%, positive family history for stroke in 9.6%, atrial fibrillation in 6%, Rheumatic heart disease (RHD) in 5.6% of patients and alcohol abuse in 1.3%. The 1-month case fatality rate was 27.8%. Conclusion: In Upper Egypt, we reported higher prevalences of hemorrhagic events, juvenile strokes and RHD compared with other studies.

Relationship of homocysteine with other risk factors and outcome of ischemic stroke

Objective Hyperhomocysteinemia (HH) is an emerging risk factor for ischemic stroke but its role in outcome is controversial. We compare the risk factors, nature of stroke and outcome of patients with and without hyperhomocysteinemia. Patients and methods CT proven ischemic stroke patients were included. The conventional risk factors such as diabetes, hypertension, hyperlipidemia, obesity, smoking, and family history of stroke were recorded. Dietary history was noted. Fasting serum homocysteine (Hcy), B12 and folic acid were estimated after 1 month of stroke. Severity of stroke was assessed by Canadian Neurological Scale (CNS) and outcome at 3 months by Barthel Index (BI) score into good (BI ≥ 12) and poor (BI < 12). Serum Hcy, B12 and folic acid were also estimated in 200 normal healthy volunteers. Results There were 198 patients with ischemic stroke whose median age was 56 years and 36 were females. In the study group, 41.4% patients were vegetarian, 55.1% hypertensive, 24.7% diabetic, 30.8% smoker, 61.1% sedentary and 28.8% obese. 23.2% had past history of stroke and 21.7% had stroke in their first degree relative. Serum cholesterol was elevated in 11.7% and LDL in 10.8% patients. Serum Hcy was elevated in 60.6% and serum B12 low in 25.7% and folic acid in 42.1%. Hcy levels correlated with serum B12 and LDL. Patients with hyperhomocysteinemia had significantly better outcome at 3 months. Hcy levels in stroke patients did not significantly differ from controls. Conclusion Hyperhomocysteinemia is found in 60.6% stroke patients, which is related to low serum B12 level. Patients with hyperhomocysteinemia had a better 3-month outcome.

Association of acute ischemic stroke with the MTHFR C677T polymorphism but not with NOS3 gene polymorphisms in a Singapore population

The association of polymorphisms in the nitric oxide synthase 3 (NOS3) gene (T-786C, variable number tandem repeats 4A/B/C, and G894T) and in the methylenetetrahydrofolate reductase (MTHFR) gene (C677T) with acute ischemic stroke have been reported. First-time onset acute ischemic stroke patients (n = 120) and controls (n = 207) with no past history of stroke were compared. Allele specific gene amplification and restriction fragment length polymorphism (RFLP) analysis were used to determine the genotype and allelic frequencies in both groups. Plasma homocysteine (Hcy) and nitrite levels were measured. No significant association of NOS3 polymorphisms with ischemic stroke was noted. The TT genotype of the MTHFR C677T polymorphism was significantly associated with ischemic stroke (P = 0.004). Elevated plasma Hcy levels were also significantly associated with ischemic stroke (P = 0.001). The TT genotype of C677T polymorphism in the MTHFR gene contributes to genetic susceptibility of acute ischemic stroke in a Singapore population.

Vascular biomarkers of cognitive performance in a community-based elderly population: the Dublin Healthy Ageing study

population studies suggest that cardiovascular risk factors may be associated with cognitive impairment. Epidemiological studies evaluating individual markers of vascular disease as risk factors for cognitive dysfunction have yielded inconsistent results. Homocysteine has emerged as a marker consistently associated with poorer outcomes. Existing studies have largely examined individual vascular risks in isolation and have tended to ignore patient psychological status. to investigate the association between markers of vascular disease and cognition in a community-dwelling non-demented elderly population while adjusting for vascular and non-vascular confounds. cross-sectional community based assessment. 466 subjects with mean age 75.45 (s.d., 6.06) years. 208 (44.6%) were male. higher levels of homocysteine were consistently associated with poorer performance in tests assessing visual memory and verbal recall. No other vascular biomarker was found to be associated with cognitive performance. Factors such as alcohol use, tea intake, life satisfaction, hypertension and smoking were positively correlated with global cognitive performance. Negative correlations existed between cognitive performance and depression, past history of stroke, intake of fruit and use of psychotropic medication. homocysteine was the only vascular biomarker associated with poorer function in a number of domains on neuropsychological testing, independent of vascular and non-vascular confounds. Other psychosocial factors may need to be taken into account as potential confounds in future studies investigating cognition.

高コレステロール血症患者の脳卒中発症に対するＥＰＡの効果―ＪＥＬＩＳサブ解析

The JELIS (Japan EPA Lipid Intervention Study) was conducted with a PROBE design to examine the preventive effects of eicosapentaenoic acid (EPA) on coronary heart diseases (CHD) and other vascular events including stroke. In JELIS, patients with a total cholesterol of 250mg/dL or greater were recruited throughout Japan between 1996 and 1999. Patients were randomly assigned to receive 1,800mg of EPA daily with statin (EPA group; n=9,326) or statin only (control group; n=9,319) with a 5-year follow-up. One of the major findings was a significant suppression of CHD by 19% in the EPA group as compared to the control group. There were no statistically significant differences between the two groups in total stroke incidence. In patients with the past history of stroke, stroke recurrence was detected in 6.8% of patients in the EPA group as compared with 10.5% of patients in the control group, indicating a significant 20% relative reduction of stroke recurrence by EPA (p=0.047). The mean EPA concentrations on treatment in all patients were divided in tertile. Incidence of stroke was significantly lower in the highest tertile by 14% than in the lowest tertile (p=0.042). When only the patients with good compliance for test drug were selected for analysis, these patients in the EPA group showed a significantly lower incidence of stroke by 14% than those in the control group (p=0.048). The patients with the past history of stroke and good compliance for test drug showed a significantly lower incidence of stroke recurrence in the EPA group by 36% than in the control group (p=0.004). These data indicate that EPA is a promising treatment for prevention of stroke, especially for the secondary prevention of ischemic stroke in Japanese hypercholesterolemic patients.