Recurrent Cerebral Infarction Research Articles

Effects of Batroxobin with Continuous Transcranial Doppler Monitoring in Patients with Acute Cerebral Stroke: A Randomized Controlled Trial

Our objective was to determine whether continuous transcranial Doppler (TCD) monitoring could safely enhance the efficacy of batroxobin, a thrombin-like enzyme extracted from Bothrops atrox moojeni venom, in the treatment for acute cerebral stroke beyond the thrombolytic time window. Ninety patients suffering an acute cerebral stroke were recruited into the study within 12 hours after the onset of symptoms. Patients were randomized to receive batroxobin with (target group) or without 1 hour of continuous TCD monitoring (control group). Clinical evaluation of stroke was based on the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index (BI), Thrombolysis in Brain Ischemia score (TIBI), the incidence of advancing stroke, and the recurrence of cerebral infarction. The patients receiving continuous TCD monitoring showed significant improvement in NIHSS score at 57 days post treatment compared with the control. Similarly, patients receiving continuous TCD monitoring also showed significant improvement in BI at 3 months compared with the controls. Consistently, both the incidence of advancing stroke after 1 week and the incidence of stroke recurrence after 3 months were significantly lower in TCD monitored group than control group. Moreover, the safety of the employment of TCD monitoring in the treatment of these patients was confirmed as there was no significant difference of the incidence of intracranial hemorrhage at 1 week after the treatment between the target and control groups. Taken together, our study showed that batroxobin, in combination with continuous TCD monitoring at the middle cerebral artery, reduced the incidence of advancing stroke and stroke recurrence after treatment without adverse effects in terms of poststroke intracranial hemorrhage.

The Pitfall in Conservative Therapy for Working Patients with Brain Ischemia

A 59-year-old employed man was recommended to have surgical treatment for symptomatic left middle cerebral arterial stenosis. He refused surgical treatment for social reasons but was given conservative therapy for the prevention of the recurrence of cerebral infarction. Immediately after he retired, he had severe recurrent cerebral infarction with severe anemia and low blood pressure due to gastroduodenal ulcer bleeding. It was inferred from MRI findings that this recurrent cerebral infarction was related to a hemodynamic mechanism and mental stress due to the gastroduodenal ulcer. The influence of occupational mental stress has been reported to be a risk factor of gastroduodenal ulcer. The occupational situation of a patient should be an important factor in consideration of the prevention of cerebral apoplexy.

The effect of transient ischemic attack clinical pathway.

Clinical pathway (CP) of transient ischemic attack (TIA) is an interdisciplinary, comprehensive, standardized management model for medical care of TIA. It aims to standardize the procedure, reduce the cost, and improve the quality of medical care. However, its effect is still unclear. To evaluate the effect of TIA CP and provide evidence for control of medical care cost, optimize the structure of hospital cost, and make best use of medical resource. 112 patients in the CP group and 179 patients in the nonclinical pathway (NCP) group were included in this nonconcurrent cohort study. The average length of stay was 9.55 ± 3.89 days in the NCP group, and it was 7.26 ± 2.09 days in the CP group. The average length of stay was significantly shortened by 2.29 days. Hospital cost in the CP group significantly increased by 7.9% (868 yuan) compared with that in the NCP group. The proportion of medication cost significantly decreased by 5%, while the proportion of examination cost significantly increased by 8%. As for the clinical outcomes of patients with TIA, 98.21% of the patients in the CP group were discharged in a good condition, while the proportion was 97.77% in the NCP group, and no significant difference was found between the improvement rate of the two groups. Eight patients (4%) in the NCP group were admitted to the hospital because of a 30-day recurrent TIA or cerebral infarction; four of them had cerebral infarction, whereas no recurrent TIA or cerebral infarction was found in the CP group at the 30-day follow-up. Implementation of TIA CP could reduce the length of stay, the proportion of medication cost, and optimize the structure of hospital expense, thus making best use of medical resources and improve the quality of TIA medical care.

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.

Analysis of mortality in patients with stroke according to data of Republican hospital №1 (Tyva Republic)

Aim. To study the change in overall mortality in in-patients with stroke admitted to the department of neurology from 2010 to 2012. Methods. The analysis of the overall mortality in in-patients with stroke admitted to the department of neurology of Republican Hospital №1 was performed using the statistical data from 2010 to 2012. Results. In 2012 overall mortality from stroke has increased by 4.59% compared to 2011. Among the patients who died of stroke in 2012, patients with cerebral hemorrhage dominated over the patient with ischemic stroke. 14% of patients succumbed within first 24 hours, which can be explained by a severe condition of admitted patients. Arterial hypertension, alone and in combination with cerebral atherosclerosis and diabetes mellitus, was the most often concomitant condition in patients who died of stroke at the department of neurology. The reasons for death in patients with cerebral hemorrhage were cerebral edema associated with brain herniation, progression to intraventricular hemorrhage and brainstem hemorrhage. The reason for death in patients with ischemic stroke was recurrent cerebral infarction. There was 1 case of concomitant myocardial infarction in a patient with cerebral hemorrhage. Conclusion. The number of patients who has died of stroke - 200, an autopsy was performed in 81%; the highest mortality was observed in patients aged 51-60 years, the lowest - in patients aged 18 to 30 years (1.5%). Discrepancy between clinical and postmortem diagnosis was observed in 2 cases.

Cilostazol, a selective Type III phosphodiesterase inhibitor: prevention of cervical myelopathy in a rat chronic compression model

Regional blood flow is decreased in experimental models of chronic spinal cord compression, and the alteration presumably contributes to the development of myelopathy. Cilostazol (Otsuka Pharmaceuticals Co.), a selective Type III phosphodiesterase inhibitor, has been shown to be neuroprotective in cerebral hypoperfusion animal models and clinically effective in preventing the recurrence of cerebral infarction. To investigate the neuroprotective effect of cilostazol on cervical spondylotic myelopathy, the preventive effect against progressive motor dysfunction and the loss of anterior horn motor neurons were assessed using a chronic cord compression model in rats. To produce chronic cervical cord compression in male Wistar rats, thin polyurethane sheets (3 × 5 × 0.7 mm) that gradually expand over 48-72 hours by absorbing water were implanted under the C5-6 laminae. In sham operations, the sheets were momentarily placed and then immediately removed. This model has been shown to reproduce characteristic features of clinical cervical myelopathy, with progressive motor disturbances after a latency period and insidious neuronal loss preceding the onset of symptoms. In the treatment group, cilostazol (30 mg/kg/day) was orally administered to the rats once a day, starting the day after surgery and continuing through the entire observation period of 25 weeks. In the control group, vehicle solution was administered under the same protocol. Changes in motor function were monitored by measuring bilateral forepaw grip strength and the duration of forced running on a treadmill. Twenty-five weeks after surgery, cervical spinal cords were examined histopathologically. Cilostazol preserved both forepaw grip strength and forced running capability. The drug also preserved anterior horn motor neurons in the C5-6 spinal cord segment, which diminished in number in the untreated chronic compression group. The drug decreased the number of TUNEL-positive apoptotic cells. These results indicate that cilostazol is neuroprotective in the chronically compressed cervical cord and is potentially useful in the treatment of cervical spondylotic myelopathy.

Thrombo-embolic cerebral infarction secondary to giant Lambl’s excrescence

Lambl’s excrescences are common fibrinous strands found at the contact margin of cardiac valves. They are referred to as “giant” when multiple strands form a complex. Embolic stroke secondary to these valvular strands has rarely been described in the literature. We present a patient with recurrent thrombo-embolic cerebral infarction secondary to giant Lambl’s excrescence successfully treated with anticoagulation.

Recurrent Cerebral Infarction due to Rhino-Orbito-Cerebral Mucormycosis

Recurrent Cerebral Infarction due to Rhino-Orbito-Cerebral Mucormycosis

Recurrent Cerebral Infarction Caused by Mobile Aortic Arch Thrombus Refractory to Warfarin Therapy

The mobile thrombus in the aortic arch is a rare condition, which becomes rarer when associated with cerebral infarction, resulting in disabling complications. Transesophageal echocardiography is useful for detecting the source of thrombi in the heart and aortic arch. Here, we report a case of a patient who suffered from recurrent cerebral infarction four times during the previous 18 months due to mobile thrombus in the aortic arch despite anticoagulant therapy. The thrombus with rocking motion (9.6 and 8 mm) was laid in the top of the aortic arch, and surgical resection was not allowed due to the location. We began anticoagulation therapy initially with heparin followed by a combination of warfarin, aspirin, and atorvastatin with an international normalized ratio between 2 and 3. The size of the aortic thrombi was significantly decreased by 3 mm and stabilized after 18 months.

Algorithm for initiation of medication self-management training based on FIM (AIMS-F) in stroke patients

Furusato K, Nagao T, Taketani M, Nakazono H, Noguchi D, Watanabe S. Algorithm for initiation of medication self-management training based on FIM (AIMS-F) in stroke patients. Jpn J Compr Rehabil Sci 2013; 4: 14-16. Objective: Medication management is an important factor for the prevention of deterioration or recurrence of cerebral infarction. Aiming at early achievement of independence in medication, we developed a new algorithm for initiating medication self-management training based on the Functional independence Measure (FIM) scale, which we abbreviated as AIMS-F. Methods: Stroke patients who ultimately achieved independence in medication management were analyzed retrospectively. The patients were divided into two groups: a group that required self-help devices for management and a group that was able to manage with medication bags, at the initiation of training. From the scores of five items in the FIM scale (bladder control, bowel control, grooming, memory, and social interaction), the choice of the optimal initiation method (self-help devices or medication bags) was predicted. Logistic regression analysis was conducted to find the cutoff point at which training can be initiated with medication bags. Results: The receiver operating characteristic curve (ROC) that fitted the logistic model had an area under the curve (AUC) of 82%. The cutoff point of the total score of five FIM items was 32. At this cutoff, sensitivity was 85% and specificity was 64%. Conclusion: This study demonstrated the usefulness of AIMS-F to standardize the initiation of medication self-management training. By introducing the AIMS-F, the timing and the method of initiating medication self-management training are clearly indicated, which may provide a standardized approach that allows early achievement self-management.

Effect of 20 mg/day Atorvastatin: Recurrent Stroke Survey in Chinese Ischemic Stroke Patients with Prior Intracranial Hemorrhage

Background and PurposeTreatment with atorvastatin (80 mg) in stroke secondary prevention for patients with prior intracranial hemorrhage (ICH) has been associated with a higher frequency of ICH. The aim of this study was to determine whether 20 mg/day atorvastatin is linked to stroke recurrence in Chinese ischemic stroke patients with prior ICH.MethodsA single-center retrospective cohort study was conducted, involving 354 cases from 395 Chinese in-patients who had ischemic stroke with prior ICH history in Beijing Chaoyang hospital from May 1, 2005 to October 31, 2010. Survivors were followed by telephone interviews for 12-60 months. Cox regression and Kaplan-Meier plot analysis were used to evaluate the effect of 20 mg/day atorvastatin on cerebral infarction and ICH recurrence.ResultsThe overall rate of stroke recurrence was lower in the 20 mg/day atorvastatin group (χ2=6.687, p=0.022) than in the control group. The incidence of cerebral hemorrhage was increased by 20 mg/day atorvastatin for ischemic stroke cases with a history of ICH compared to those not receiving the drug, but the difference was not significant [hazard ratio (HR)=1.097, 95% confidence interval (CI)=0.800-1.243, p=0.980]. The incidence of ischemic stroke recurrence was significantly reduced in subjects receiving atorvastatin (HR=0.723, 95% CI=0.578-0.862, p=0.028), and the mean duration of all stroke recurrences was significantly prolonged, compared with those not exposed to the drug (χ2=5.351, p=0.021). The mean duration of ICH recurrence appeared to have shortened with atorvastatin, but the difference was not significant (χ2=0.680, p=0.480), and the mean duration of cerebral infarction recurrence was significantly prolonged (χ2=8.312, p=0.004).ConclusionsMedication with 20 mg/day atorvastatin may be beneficial in reducing ischemic stroke recurrence in ischemic stroke patients with a history of ICH and is not associated with an increased risk of ICH recurrence.

A Modified Technique of Direct Aortic Arch Debranching Using a Shunt for Cerebral Perfusion Protection During Hybrid Repair of an Aortic Arch Aneurysm

Introduction: We report a 74-year-old man with highly advanced arteriosclerosis and aortic arch aneurysm and who had a past medical history of cerebral infarction. Case report: Recurrence of cerebral infarction during operation if cerebral blood flow decreased during debranching of the cerebral arteries was a concern. A direct reconstruction to the arch vessels was carried out with a temporary shunt blood circuit using a 12-Fr balloon perfusion catheter to prevent cerebral ischaemia, and thoracic endovascular aneurysm repair was performed. Discussion: This method is safe and useful for elderly persons with advanced arteriosclerosis. A Modified Technique of Direct Aortic Arch Debranching Using a Shunt for Cerebral Perfusion Protection During Hybrid Repair of an Aortic Arch AneurysmEJVES ExtraVol. 25Issue 1PreviewWe report a 74-year-old man with highly advanced arteriosclerosis and aortic arch aneurysm and who had a past medical history of cerebral infarction. Full-Text PDF Open Access

Relationship of blood glucose, blood lipids, blood uric acid and fibrinogen level, and prognosis of acute lacunar cerebral infarction patients

Objective To investigate the relationship of blood glucose,blood lipids,serum uric acid,fibrinogen level and prognosis of patients with acute lacunar cerebral infarction.Methods Clirical data of 127 cases with acute lacunar cerebral infarction were retrospectively analyed.Patients with normal blood glucose,blood lipid,uric acid and fibrinogen level were enrolled into A group of 64 cases,63 cases with abnormal levels were selected as group B,an average of 2 years of follow-up,observing the two groups of neurologic,re-infarction incidence and prevalence of vascular dementia were obsenved in two groups.Results After 4 weeks of treatment,A group of neural function defect score(9.6 ±7.3) was significantly lower than group B( 14.3 ±7.4) (t =3.8696,P ＜0.05) ;95.4％ total effective rate in A group was significantly higher than B group of 82.0％ ( x2 =5.8623,P ＜ 0.05 ).After an average follow-up of 2 years,A group of recurrent cerebral infarction rate( 18.8％ ),vascular dementia rates(7.8％ ),were significantly lower than group B(28.6％),17.5％(11/63)(x2 =6.5421,5.9623,P＜0.05).Conclusion A number of abnormal serum biochemical indexes had a significant impact on short and long-term prognosis of acute lacunar cerebral infarction. Key words: Cerebral infarction; Apolipoproteins; Blood glucose; Uric acid; Fibrinogen

Abstract 2607: A GWAS From The Vitamin Intervention For Stroke Prevention (VISP) Clinical Trial Identifies Variants That Contribute To Recurrent Stroke And Combined Vascular Endpoints

We have performed a genome-wide association study (GWAS), using the Illumina Omni 1M SNP platform, in 2,100 stroke patients from the Vitamin Intervention for Stroke Prevention (VISP) trial. VISP was a controlled, double blinded clinical trial, designed to determine whether the daily intake of high dose folic acid, vitamins B6 and B12 reduce recurrent cerebral infarction. Extensive quality control (QC) measures were performed, resulting in a total of 737,081 SNPs for analysis. Principal Component Analysis (PCA), implemented in KING, was utilized to address confounders due to population substructure. We performed genome wide association (survival) analyses for recurrent stroke and combined vascular endpoints (stroke, MI, and CHD death), using stratified Cox model. Clinic sites were treated as strata and age, sex, treatment arm, and the top 10 principal components were used as covariates for these analyses. There is no inflation in our GWAS scan results, with GC lambda values of 1.008 and 0.995 for recurrent stroke and combined vascular endpoints, respectively. For recurrent stroke, we observed association with two SNPs that reached genome wide significance (≤10 -8 ). Both SNPs were located in a gene sparse region of chromosome 1p31 (P=1.73×10 -8 ; beta=-0.64; P=3.43×10 -8 ; beta=-0.62). Two additional SNPs approached genome wide significance, one located in the same 1p31 region (P=7.60×10 -7 ) and the second located in the GMPR gene (P=8.69×10 -7 ). Variants in the GMPR gene region have been associated with LDL-cholesterol measures in previous GWAS. While no SNPs reached genome wide significance for combined vascular endpoints, six SNPs approached genome wide significance (P values ranging from 9.51×10 -6 to 2.56×10 -7 ). These variants are located in genes that have implications in vascular disease. In particular, GPR37L1 has been identified as a potential target for heart failure in mouse expression studies while NSMAF may play a role in regulating TNF-induced cellular responses (e.g. inflammation). Additionally, ILDR2 is located in a region that has shown previous linkage for hypertension, suggesting potential biological implications for these variants in relation to stroke and vascular disease. Our GWAS scans represent the first large scale genetic association study of recurrent stroke and combined vascular events. Our findings have identified novel associations for genes that contribute to recurrent stroke and composite vascular endpoints.

Abstract 3012: Significant Genome Wide Association Identified Between the Glycine N-Methyltransferase Gene (GNMT) and Post-Methionine Load Test Homocysteine Levels in the Vitamin Intervention for Stroke Prevention (VISP) Cohort

The Vitamin Intervention for Stroke Prevention (VISP) trial was a multi-center, controlled, double blinded clinical trial, designed to determine whether the daily intake of high dose folic acid, vitamins B6 and B12 reduced recurrent cerebral infarction. Baseline post-methionine load homocysteine levels were predictive of recurrent stroke risk in VISP. We have conducted a genome-wide association study (GWAS), investigating 2100 VISP stroke cases required to have homocysteine levels greater than the 25th percentile at enrolment. Using imputation with 1000 genomes and principal component analysis, we were able to detect an association of p≤6.70x10-17 for SNPs within, or flanking, the glycine N-methyltransferase (GNMT) gene and post-methionine load test homocysteine level. Change in homocysteine levels pre and post-methionine load test also resulted in significant GWAS scores in the chromosome 6 region (p = 2.54x10-23, rs7760250). GNMT catalyzes the conversion of S-adenosyl-L-methionine to S-adenosyl-L-homocysteine and sarcosine via the folate one-carbon metabolism pathway. In addition to being an essential component in the conversion of methionine to homocysteine, GNMT plays a significant role in the global epigenetic state as homocysteine is an important methyl donor. This region displays significant linkage disequilibrium, warranting close analysis of the entire GNMT locus in search of both rare and common variants. Cases who carry the minor allele haplotype at associated loci had a higher level of post-methionine load homocysteine (37.69µM/L) than those who carry the major allele haplotype (27.33µM/L), inferring functional differences due to GNMT variants. Taken together these data suggest a clear and important role for GNMT in post-methionine load test homocysteine level, epigenetic state and stroke risk.

Abstract 2414: Genome-wide Association Analyses From The Vitamin Intervention For Stroke Prevention (visp) Trial Identify Genetic Loci That Influence Post-stroke Measures Of Inflammation And Thrombosis

The Vitamin Intervention for Stroke Prevention (VISP) trial was a multi-center, controlled, double blinded clinical trial, designed to determine whether the daily intake of high dose folic acid, vitamins B 6 and B 12 reduced recurrent cerebral infarction. As part of GARNET (the Genomics and Randomized Trials Network), we have performed a Genome-Wide Association Study (GWAS), using the Illumina Omni 1M SNP platform in 2,100 ischemic stroke patients from VISP. Extensive quality control (QC) measures were performed, resulting in a total of 737,081 SNPs for analysis. We have performed GWA analyses for baseline quantitative measures of creatinine, total cholesterol (TC), high density lipoprotein (HDL), triglycerides (TG), C-reactive protein (CRP), Factor 1+2 thrombin-antithrombin (TAT), tissue plasminogen activator (tPA), thrombomodulin (TM) and von Willebrand factor (vWF), using linear regression approaches implemented in PLINK. Principal component analysis (PCA), implemented in KING, was utilized to address confounders due to population substructure. Inverse normal transformation was performed for each of the quantitative traits, prior to analysis. Genome wide association analyses were performed using age, sex and the top 10 principal components as covariates. There is no inflation in our GWAS scan results (GC lambda ≤ 1.012 in all scans). We observed three associated loci that exceed genome wide significance (≤6.8×10 -8 ): in or near the CETP gene for HDL (6.5×10 -10 ), the CRP gene for CRP (7.4×10 -10 ), and at the ABO locus for vWF (8.7×10 -31 ). The most strongly associated SNPs for other traits were closest to the following genes: GABRA3 for creatinine ( rs994424 , 5.7×10 -6 ), SPATA13 for TC (rs9553189, 3.2×10 -7 ), between ARMCX2 and NXF5 genes on the X chromosome for TG (rs2213369, 1.7×10 -6 ); the ZIC4 gene for TAT (rs17565826, 4.1×10-6); LOC283089 for tPA (rs3011337, 3.6×10 -6 ); and JAZF1 for TM (rs10258132, 1.1×10 -6 ). Putative novel associations with these traits will require confirmation in larger independent samples. Our GWAS scan has successfully replicated associations for SNPs in the CETP, CRP and ABO genes for HDL, CRP and vWF respectively in an ischemic stroke population.

A case of a patient positive for anti-cardiolipin antibodies with recurrent fetal wastage and cerebral infarction who was successfully treated with Sairei-to, low dose aspirin, and heparin

We report a successful case of a pregnant female positive for anti-cardiolipin antibodies who experienced two abnormal pregnancies with postpartum cerebral hemispheric infarctions. A 38-year-old female diagnosed as being positive for anti-cardiolipin antibodies was referred to our hospital due to her strong desire to have a baby. The administration of Japanese herbal medicine, Sairei-to, as immunosuppressive therapy, and low dose aspirin, as anti-coagulation therapy, were initiated prior to the patient’s pregnancy. Five months after beginning the treatment, the patient conceived spontaneously. At 34 weeks of gestation, emergency cesarean section was performed due to increasing genital bleeding resulting from coincidental placenta previa and the patient delivered an appropriate-for-date female infant (1970 g). Treatment with Japanese herbal medicine (Sairei-to) and low-dose aspirin is considered to be an effective treatment option for patients positive for anti-phospholipid antibodies with past histories of abnormal pregnancies.

Increased Cerebral Cortex Perfusion in Stroke Patients with Cognitive Disorder Following Cilostazol Administration, Two Cases Report

Objective: In our search for a new augmentation therapy for stroke patients, we administered cilostazol, an antiplatelet agent. Subjects: The patients suffered from mild hemiparesis or cognitive disorder showing reduced cerebral perfusion in the prefrontal cortex. Methods: We evaluated the functional cerebral blood flow (CBF) before and after the administration of cilostazol using near-infrared resonance spectroscopy (NIRS) during a verbal fluency task (VFT). Results: For the patient with cognitive disorder, statistically significant improvements were observed in the number of generated words in the VFT before and after administration of 50 mg cilostazol (p 0.05, Mann-Whitney U test). Another patient without cognitive disorder, however, showed no significant VFT improvement after administration of cilostazol. Effect size data revealed large or very large effects of cilostazol on brain activation (oxy-Hb levels) at the affected side prefrontal cortex for both patients. The patient with cognitive disorder showed significant improvement in VFT performance as well as an increase in bilateral prefrontal CBF after cilostazol administration. Discussion: These findings suggest that, for patients with cerebrovascular lesions suffering from cognitive disorder, cilostazol may be promising as a drug to improve cognitive function in addition to preventing recurrent cerebral infarction.

The Brainstem Is at High Risk for Recurrent Noncardioembolic Cerebral Infarction in Association with Diabetes Mellitus: A Hospital-Based Study

The goals of the study were to investigate the importance of brainstem infarction (BSI) in recurrent noncardioembolic ischemic stroke and to examine the relevant clinical background. Data were retrospectively reviewed for 655 consecutive patients with acute noncardioembolic infarction who were admitted to our hospital from January 2004 to August 2010. The patients were divided into first-stroke (n = 592) and recurrent-stroke (n = 63) groups. Acute infarcted lesions were explored on MRI, and clinical background factors including age, sex, smoking, atrial fibrillation, coronary heart disease, hypertension, hyperlipidemia and diabetes mellitus (DM) were assessed. The frequency of BSI in the recurrent-stroke group was significantly higher than that in first-stroke patients (30.2 vs. 14.9%, p = 0.0033). No other clinical background factors differed between the two groups. Only the frequency of DM differed significantly among four subgroups formed based on stroke recurrence and BSI (p < 0.0001): DM was present in 63.2% of recurrent-stroke patients with BSI, 54.5% of first-stroke patients with BSI, 27.4% of first-stroke patients without BSI, and 20.5% of recurrent-stroke patients without BSI. We conclude that the brainstem is at high risk for recurrent cerebral infarction in patients with DM.

Stroke Incidence and Usage Rate of Thrombolysis in A Japanese Urban City: The Kurashiki Stroke Registry

To investigate stroke incidence and rate of thrombolytic therapy in an urban city of around 500,000 residents. Patients suffering acute stroke in Kurashiki City (population 474,415) between March 2009 and February 2010 (inclusive) and admitted to 1 of 10 hospitals throughout the city were prospectively enrolled. We enrolled patients with first-ever stroke (n = 763; men 415; median age 72 years) and first-ever/recurrent stroke (n = 1009; men 552; median age 73 years). Among first-ever strokes, 68% were cerebral infarctions, 23% were intracerebral hemorrhages, and 8% were subarachnoid hemorrhages. Crude incidences for first-ever stroke per 100,000 residents were 159.8 (95% confidence interval [CI] 148.4-171.1) for all strokes, 108.8 (95% CI 99.4-118.1) for cerebral infarction, and 36.5 (95% CI 31.0-41.9) for intracerebral hemorrhage. After adjustment using the world population model, age-adjusted incidences were 60.7 (95% CI 45.4-75.9) for all strokes, 38.4 (95% CI 26.3-50.5) for cerebral infarction, and 16.1 (95% CI 8.3-24.0) for intracerebral hemorrhage. Among 698 cases with first-ever and recurrent cerebral infarction, thrombolysis was administered for 31 (5%). Of 197 cerebral infarction patients admitted within 3 hours of onset, the thrombolysis rate was 16%. In this urban Japanese city, the age-adjusted incidence of first-ever stroke between March 2009 and February 2010 was 60.7 per 100,000 residents, which was relatively low compared with findings for other countries. Thrombolysis was given to approximately 5% of patients with acute ischemic stroke.